Satapathy Sanjaya K, Sakhuja Puja, Malhotra Veena, Sharma Barjesh C, Sarin Shiv K
Department of Gastroenterology, GB Plant Hospital, New Delhi, India.
J Gastroenterol Hepatol. 2007 May;22(5):634-8. doi: 10.1111/j.1440-1746.2006.04756.x.
Inhibition of tumor necrosis factor (TNF)-alpha is a logical approach to manage patients with non-alcoholic steatohepatitis (NASH). Pentoxifylline reduces TNF-alpha and alanine aminotransferase (ALT) levels in patients with NASH. The aim of the present paper was to study if pentoxifylline can improve histological injury in patients with NASH.
Nine patients (mean age 31.6 +/- 7.2 years) with histologically proven NASH and with persistently elevated ALT (>1.5 times) were given pentoxyfylline at a dosage of 400 mg t.i.d. for 12 months. Besides biochemical assessment, a repeat liver biopsy was performed and the degree of inflammation and fibrosis was compared.
After 12 months of therapy a significant reduction in ALT (111 +/- 53 IU/L vs 45 +/- 19 IU/L, P = 0.003) and aspartate aminotransferase (AST) (61 +/- 27 IU/L vs 33 +/- 12 IU/L, P = 0.005) levels was observed. Steatosis and lobular inflammation each reduced in 55% and six (67%) patients down-staged on Brunt's staging (P = 0.009). Four out of six patients with baseline fibrosis had reduction in their fibrosis stage.
Long-term pentoxyfylline therapy effectively achieves sustained biochemical improvement. This correlates well with histological resolution of the disease.
抑制肿瘤坏死因子（TNF）-α是治疗非酒精性脂肪性肝炎（NASH）患者的合理方法。己酮可可碱可降低NASH患者的TNF-α和丙氨酸转氨酶（ALT）水平。本文旨在研究己酮可可碱是否能改善NASH患者的组织学损伤。
9例经组织学证实为NASH且ALT持续升高（>1.5倍）的患者（平均年龄31.6±7.2岁），给予己酮可可碱400mg，每日3次，共12个月。除了生化评估外，还进行了重复肝活检，并比较了炎症和纤维化程度。
治疗12个月后，ALT（111±53IU/L对45±19IU/L，P=0.003）和天冬氨酸转氨酶（AST）（61±27IU/L对33±12IU/L，P=0.005）水平显著降低。55%的患者脂肪变性减轻，6例（67%）患者小叶炎症在Brunt分期中降低（P=0.009）。6例基线纤维化患者中有4例纤维化分期降低。
长期己酮可可碱治疗可有效实现持续的生化改善。这与疾病的组织学缓解密切相关。
