Division of Gastroenterology and Hepatology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Hepatology. 2010 Jan;51(1):121-9. doi: 10.1002/hep.23276.
Nonalcoholic steatohepatitis (NASH) is a chronic progressive liver disease that is strongly associated with obesity. Currently, there is no approved therapy for NASH. Weight reduction is typically recommended, but efficacy data are lacking. We performed a randomized controlled trial to examine the effects of lifestyle intervention using a combination of diet, exercise, and behavior modification, with a goal of 7% to 10% weight reduction, on clinical parameters of NASH. The primary outcome measure was the change in NASH histological activity score (NAS) after 48 weeks of intervention. Thirty-one overweight or obese individuals (body mass index [BMI], 25-40 kg/m(2)) with biopsy-proven NASH were randomized in a 2:1 ratio to receive intensive lifestyle intervention (LS) or structured education (control). After 48 weeks of intervention, participants assigned to LS lost an average of 9.3% of their weight versus 0.2% in the control group (P = 0.003). A higher proportion of participants in the LS group had a reduction of NAS of at least 3 points or had posttreatment NAS of 2 or less as compared with the control group (72% versus 30%, P = 0.03). NAS improved significantly in the LS group (from 4.4 to 2.0) in comparison with the control group (from 4.9 to 3.5) (P = 0.05). Percent weight reduction correlated significantly with improvement in NAS (r = 0.497, P = 0.007). Participants who achieved the study weight loss goal (>or=7%), compared with those who lost less than 7%, had significant improvements in steatosis (-1.36 versus -0.41, P < 0.001), lobular inflammation (-0.82 versus -0.24, P = 0.03), ballooning injury (-1.27 versus -0.53, P = 0.03) and NAS (-3.45 versus -1.18, P < 0.001).
Weight reduction achieved through lifestyle intervention leads to improvements in liver histology in NASH.
非酒精性脂肪性肝炎（NASH）是一种慢性进行性肝脏疾病，与肥胖密切相关。目前，尚无针对 NASH 的批准疗法。通常建议减轻体重，但缺乏疗效数据。我们进行了一项随机对照试验，以研究饮食、运动和行为改变相结合的生活方式干预对 NASH 的临床参数的影响，目标是减轻 7%至 10%的体重。主要终点是干预 48 周后 NASH 组织学活动评分（NAS）的变化。31 名超重或肥胖（体重指数 [BMI]，25-40kg/m2）且经活检证实为 NASH 的患者按 2:1 的比例随机分为接受强化生活方式干预（LS）或结构化教育（对照组）。干预 48 周后，LS 组参与者平均减轻体重 9.3%，而对照组仅减轻 0.2%（P=0.003）。LS 组中更大部分的患者的 NAS 至少减少 3 分，或治疗后 NAS 为 2 或更低，而对照组为 30%（72%对 30%，P=0.03）。LS 组的 NAS 显著改善（从 4.4 降至 2.0），而对照组仅略有改善（从 4.9 降至 3.5）（P=0.05）。体重减轻百分比与 NAS 的改善显著相关（r=0.497，P=0.007）。与体重减轻不足 7%的患者相比，达到研究减肥目标（>或=7%）的患者，在肝脂肪变性（-1.36 对-0.41，P<0.001）、肝小叶炎症（-0.82 对-0.24，P=0.03）、气球样变损伤（-1.27 对-0.53，P=0.03）和 NAS（-3.45 对-1.18，P<0.001）方面均有显著改善。
通过生活方式干预实现的体重减轻可改善 NASH 的肝脏组织学。
