Sumida Yoshio, Naito Yuji, Tanaka Saiyu, Sakai Kyoko, Inada Yutaka, Taketani Hiroyoshi, Kanemasa Kazuyuki, Yasui Kohichiroh, Itoh Yoshito, Okanoue Takeshi, Yoshikawa Toshikazu
Hepatogastroenterology. 2013 Sep;60(126):1445-50. doi: 10.5754/hge11421.
BACKGROUND/AIMS: Vitamin E is one of the most promising treatments for non-alcoholic steatohepatitis (NASH). However, the long-term efficacy of this treatment remains unknown.
We retrospectively examined 17 patients with biopsy-proven NASH who received vitamin E at a dose of 300 mg/day for >=2 yr, and underwent second liver biopsies after treatment. Variables were compared between patients with (group R) and without (group NR) fibrosis regression.
The median interval between basal and second liver biopsies was 2.4 yr (range, 2.0-5.8 yr). Overall, transaminase activities, insulin resistance index, and hepatic fibrosis markers were significantly improved. Although histological steatosis, inflammation, and fibrosis did not change after treatment, liver fibrosis improved in seven patients (41.2%), progressed in five (29.4%), and remained unchanged in five (29.4%). At baseline, subjects in group R (n = 7) were more likely to have diabetes, insulin resistance, and severe fibrosis compared to those in group NR (n = 10). Lower NAFLD activity score and larger decrease of ALT and insulin resistance after treatment were observed in group R compared with group NR.
Two years or longer treatment can be expected to ameliorate NASH fibrosis, especially in those whose serum transaminase activities and insulin resistance can be improved.
背景/目的：维生素E是治疗非酒精性脂肪性肝炎（NASH）最有前景的疗法之一。然而，这种治疗的长期疗效尚不清楚。
我们回顾性研究了17例经活检证实为NASH且接受每日300毫克维生素E治疗≥2年的患者，并在治疗后进行了第二次肝脏活检。对有（R组）和无（NR组）纤维化消退的患者的各项变量进行了比较。
初次肝脏活检与第二次肝脏活检之间的中位间隔时间为2.4年（范围为2.0 - 5.8年）。总体而言，转氨酶活性、胰岛素抵抗指数和肝纤维化标志物均有显著改善。虽然治疗后组织学上的脂肪变性、炎症和纤维化没有变化，但7例患者（41.2%）的肝纤维化有所改善，5例（29.4%）病情进展，5例（29.4%）保持不变。基线时，与NR组（n = 10）相比，R组（n = 7）的患者更易患糖尿病、胰岛素抵抗且纤维化更严重。与NR组相比，R组治疗后NAFLD活动评分更低，ALT和胰岛素抵抗下降幅度更大。
预计两年或更长时间的治疗可改善NASH纤维化，尤其是那些血清转氨酶活性和胰岛素抵抗能够改善的患者。
