Vajro Pietro, Mandato Claudia, Franzese Adriana, Ciccimarra Edmondo, Lucariello Stefania, Savoia Marcella, Capuano Grazia, Migliaro Fiorella
Department of Pediatrics, University of Naples Federico II, Italy.
J Pediatr Gastroenterol Nutr. 2004 Jan;38(1):48-55. doi: 10.1097/00005176-200401000-00012.
A beneficial role of antioxidants in hepatopathic obese individuals has hitherto been inferred only from uncontrolled pilot studies. The authors compared the effect of vitamin E and weight loss on transaminase values and on ultrasonographic bright liver in a controlled group of children with obesity-related liver dysfunction.
Twenty-eight children with obesity-related hypertransaminasemia and bright liver were randomly allocated to two single-blind groups: group 1 (n = 14) treated with a low-calorie diet associated with oral placebo for 5 months, and group 2 (n = 14) treated with a low-calorie diet associated with oral vitamin E (400 mg/d x 2 months, 100 mg/d x 3 months). Transaminase values and ultrasonographic liver brightness along with weight loss and vitamin E levels were monitored.
Variations in transaminase levels and percentage of patients with normalized transaminase values were comparable in the two groups. The disappearance of bright liver was observed only in patients who lost weight and was twice as common in patients from group 1. Two subgroups of patients with complete normalization of transaminase values emerged as a consequence of controlled adherence to diet alone (n = 6; significant decrease of percent overweight: P = 0.0019 ) and to vitamin E alone (n = 7; unmodified percent overweight and significant increase of vitamin E/cholesterol ratio: P < 0.0001). Changes in treatment-induced alanine aminotransferase levels in these two subgroups were comparable at month 2, whereas values at month 5 were significantly lower in the subgroup adherent to diet alone (P = 0.04). In the subgroup adherent to vitamin E alone, after 2 months washout, transaminase remained stable in 5 patients and increased in 2; bright liver persisted in all.
Oral vitamin E warrants consideration in obesity-related liver dysfunction for children unable to adhere to low-calorie diets.
迄今为止，抗氧化剂对肝病肥胖个体的有益作用仅从非对照的初步研究中推断得出。作者在一组患有肥胖相关肝功能障碍的儿童中进行对照研究，比较了维生素E和体重减轻对转氨酶值及肝脏超声“亮肝”表现的影响。
28名患有肥胖相关高转氨酶血症和“亮肝”的儿童被随机分为两个单盲组：第1组（n = 14）采用低热量饮食加口服安慰剂治疗5个月，第2组（n = 14）采用低热量饮食加口服维生素E（前2个月400 mg/d，后3个月100 mg/d）治疗。监测转氨酶值、肝脏超声亮度、体重减轻情况及维生素E水平。
两组转氨酶水平变化及转氨酶值恢复正常的患者百分比相当。仅在体重减轻的患者中观察到“亮肝”消失，且在第1组患者中更为常见，是第2组的两倍。由于单纯严格控制饮食（n = 6；超重百分比显著下降：P = 0.0019）和单纯使用维生素E（n = 7；超重百分比未改变，但维生素E/胆固醇比值显著升高：P < 0.0001），出现了两个转氨酶值完全恢复正常的亚组。这两个亚组在治疗诱导的丙氨酸转氨酶水平变化在第2个月时相当，而在第5个月时，单纯严格控制饮食的亚组值显著更低（P = 0.04）。在单纯使用维生素E的亚组中，停药2个月后，5例患者转氨酶保持稳定，2例升高；所有患者“亮肝”持续存在。
对于无法坚持低热量饮食的儿童肥胖相关肝功能障碍，口服维生素E值得考虑。
