Bhat Ganesh, Baba Chalamalasetty Sreenivasa, Pandey Amaresh, Kumari Neeraj, Choudhuri Gourdas
Ganesh Bhat, Department of Gastroenterology, Kasturba Medical College, Manipal University, Manipal 576104, India.
World J Hepatol. 2012 Jul 27;4(7):209-17. doi: 10.4254/wjh.v4.i7.209.
To study the effect of regular aerobic exercise on insulin resistance, serum aminotransferase and liver histology in nonalcoholic fatty liver disease (NAFLD) patients.
Sixty (mean age 40.0 ± 8.5 years, 75% male) NAFLD patients were included in the study. After baseline anthropometric measurement i.e., body mass index (BMI), waist circumference (WC); all patients were advised regular aerobic exercise for 30 min/d, for at least 5 d/wk and trained to achieve around 70% of his maximal heart rate. In addition, moderately energy restricted diet was advised to patients with high BMI (> 25 kg/m(2)). Monthly follow up was done by measuring BMI, WC, aspartate aminotransferase, and alanine aminotransferase (ALT). Insulin resistance was calculated using homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) model, at baseline and after 6 mo. Insulin resistance was arbitrarily considered altered when it was ≥ 2. Liver biopsy was done in a section of patients at baseline and after 6 mo.
Seventy percent (42/60) patients were overweight or obese; 95% (57/60) had central obesity (WC > 90 cm in men, > 80 cm in women). In the 45 exercise compliant patients insulin resistance decreased from 6.4 ± 6.1 to 1.3 ± 1.0, BMI from 26.7 ± 3.3 kg/m(2) to 25.0 ± 3.3 kg/m(2), WC from 95.7 ± 8.9 cm to 90.8 ± 7.3 cm and ALT from 84.8 ± 43.5 U/L to 41.3 ± 18.2 U/L (P < 0.01). In 15 exercise noncompliant patient's insulin resistance, BMI, WC and ALT did not show significant change at 6 mo follow up. Six of 8 patients in compliant group on repeat liver biopsy showed significant change in steatosis and necroinflammation. Nonalcoholic steatohepatitis scores improved form 5.3 ± 1.5 to 3.35 ± 1.5. The decline in insulin resistance correlated with decline in ALT (P = 0.01, r(s) = 0.90) and liver histology (P = 0.03, r(s) = 0.73).
Life style modification improves insulin resistance resulting in improvement in ALT and liver histology in NAFLD patients.
研究规律有氧运动对非酒精性脂肪性肝病（NAFLD）患者胰岛素抵抗、血清转氨酶及肝脏组织学的影响。
60例NAFLD患者（平均年龄40.0±8.5岁，75%为男性）纳入本研究。在进行基线人体测量即体重指数（BMI）、腰围（WC）后；建议所有患者进行规律有氧运动，每天30分钟，每周至少5天，并训练使其达到最大心率的70%左右。此外，建议BMI较高（>25kg/m²）的患者适度限制能量饮食。通过测量BMI、WC、天冬氨酸转氨酶和丙氨酸转氨酶（ALT）进行每月随访。在基线和6个月后使用胰岛素抵抗稳态模型评估（HOMA）模型计算胰岛素抵抗（HOMA-IR）。当胰岛素抵抗≥2时，任意认为其发生改变。在一部分患者的基线和6个月后进行肝脏活检。
70%（42/60）的患者超重或肥胖；95%（57/60）有中心性肥胖（男性WC>90cm，女性>80cm）。在45例依从运动的患者中，胰岛素抵抗从6.4±6.1降至1.3±1.0，BMI从26.7±3.3kg/m²降至25.0±3.3kg/m²，WC从95.7±8.9cm降至90.8±7.3cm，ALT从84.8±43.5U/L降至41.3±18.2U/L（P<0.01）。在15例不依从运动的患者中，胰岛素抵抗、BMI、WC和ALT在6个月随访时未显示出显著变化。依从组8例患者中有6例在重复肝脏活检时显示脂肪变性和坏死性炎症有显著变化。非酒精性脂肪性肝炎评分从5.3±1.5改善至3.35±1.5。胰岛素抵抗的下降与ALT的下降相关（P=0.01，rs=0.90）以及肝脏组织学变化相关（P=0.03，rs=0.73）。
生活方式的改变可改善胰岛素抵抗，从而改善NAFLD患者的ALT及肝脏组织学。
