Wang Rex T, Koretz Ronald L, Yee Hal F
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA.
Am J Med. 2003 Nov;115(7):554-9. doi: 10.1016/s0002-9343(03)00449-2.
To assess the evidence supporting the efficacy of weight reduction for patients with nonalcoholic fatty liver.
Potentially relevant studies were identified by a computerized search of databases and a manual search of abstracts from scientific meetings. Studies were included if they reported histology, serum aminotransferase levels, or radiological imaging of the liver in obese adult patients who had undergone weight reduction. Weight reduction regimens included diet, exercise, antiobesity medications, gastric bypass, gastroplasty, or any combination of these interventions. Studies involving jejunoileal or small bowel bypass surgery were excluded.
We identified 517 potentially relevant studies, of which 15 met the inclusion criteria: one randomized controlled trial (in abstract form), two nonrandomized controlled trials, nine case series, one retrospective review, and two case reports. Three studies included more than 50 patients, whereas nine studies had 25 or fewer patients. Twelve studies used behavioral, dietary, or pharmacologic therapy for weight reduction, and three studies used surgical interventions. Although all 15 studies demonstrated overall improvement in the measurements of liver outcome after weight reduction, more than half did not report histologic results.
Despite general acceptance that weight reduction is an effective therapy for nonalcoholic fatty liver, this systematic review found little data to support or refute this recommendation.
评估支持体重减轻对非酒精性脂肪性肝病患者疗效的证据。
通过计算机检索数据库以及手工检索科学会议摘要来确定潜在相关研究。如果研究报告了接受体重减轻的肥胖成年患者的肝脏组织学、血清转氨酶水平或肝脏影像学检查结果，则纳入该研究。体重减轻方案包括饮食、运动、抗肥胖药物、胃旁路手术、胃成形术或这些干预措施的任何组合。排除涉及空肠回肠或小肠旁路手术的研究。
我们确定了517项潜在相关研究，其中15项符合纳入标准：1项随机对照试验（摘要形式）、2项非随机对照试验、9个病例系列、1项回顾性综述和2例病例报告。3项研究纳入了50多名患者，而9项研究的患者人数为25名或更少。12项研究采用行为、饮食或药物疗法减轻体重，3项研究采用手术干预。尽管所有15项研究均表明体重减轻后肝脏结局指标总体有所改善，但超过一半的研究未报告组织学结果。
尽管人们普遍认为体重减轻是非酒精性脂肪性肝病的有效治疗方法，但本系统评价发现几乎没有数据支持或反驳这一建议。
