Taketani Hiroyoshi, Sumida Yoshio, Tanaka Saiyu, Imajo Kento, Yoneda Masato, Hyogo Hideyuki, Ono Masafumi, Fujii Hideki, Eguchi Yuichiro, Kanemasa Kazuyuki, Chayama Kazuaki, Itoh Yoshito, Yoshikawa Toshikazu, Saibara Toshiji, Fujimoto Kazuma, Nakajima Atsushi
Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
J Gastroenterol. 2014 Jul;49(7):1163-74. doi: 10.1007/s00535-013-0871-5. Epub 2013 Aug 22.
It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated.
This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks.
Of the 123 patients, 76 (62%) were female and 87 (71%) were obese, with 34 (28%) having AIS scores ≥ 6 and 31 (25%) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33%) had NAFL and 83 (67%) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores.
Nearly 30% of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.
有研究表明，非酒精性脂肪性肝病（NAFLD），包括非酒精性脂肪肝（NAFL）和非酒精性脂肪性肝炎（NASH），可能与失眠和胃食管反流病（GERD）有关。本研究调查了经活检证实为NAFLD的患者中GERD与失眠之间的关系。
本研究纳入了123例经活检证实为NAFLD的患者。采用雅典失眠量表（AIS）评估失眠情况，该量表是一种基于ICD - 10标准设计的自我评估心理测量工具，用于量化睡眠困难程度；AIS评分≥6分被认为失眠阳性。使用胃食管反流病症状频率量表（FSSG）评估GERD症状；FSSG评分≥8分被认为阳性。在调整潜在混杂因素后，采用逻辑回归模型评估失眠与GERD的关联。13例GERD患者接受质子泵抑制剂雷贝拉唑（RPZ；10毫克/天）治疗，为期12周。
123例患者中，76例（62%）为女性，87例（71%）肥胖，34例（28%）AIS评分≥6分，31例（25%）FSSG评分≥8分。肝活检显示，40例患者（33%）为NAFL，83例（67%）为NASH。两组的FSSG和AIS评分相似。失眠患者的稳态模型评估胰岛素抵抗（HOMA - IR）、FSSG评分和γ - 谷氨酰转移酶（GGT）浓度显著高于非失眠患者。逻辑回归分析表明，FSSG评分和GGT浓度与失眠独立相关。RPZ治疗导致AIS和FSSG评分均显著降低。
近30%经活检证实为NAFLD的患者存在失眠，这与GGT和GERD有关，且可通过RPZ治疗得到缓解。
