Ozel Coskun Banu D, Yucesoy Mehmet, Gursoy Sebnem, Baskol Mevlut, Yurci Alper, Yagbasan Ahmet, Doğan Serap, Baskol Gulden
Departments of aGastroenterology bRadiology cBiochemistry, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Eur J Gastroenterol Hepatol. 2015 Feb;27(2):142-9. doi: 10.1097/MEG.0000000000000264.
Nonalcoholic steatohepatitis (NASH) is a prevalent liver disease that is increasingly being associated with cardiovascular disease. Ursodeoxycholic acid (UDCA) may have antioxidant and anti-inflammatory activities, and may reduce liver injury in NASH. To date, no studies have assessed the efficacy of UDCA in carotid intima media thickness (CIMT), serum lipids, apolipoprotein A1 (apo A), apolipoprotein B (apo B), and apolipoprotein B/A1 (apo B/A1) ratios in patients with NASH.
In this prospective study, 30 patients with biopsy-proven NASH and 25 healthy adults as a control group were evaluated. None of the participants had diabetes, hypertension, or hyperlipidemia. Patients with NASH received UDCA 15 mg/kg/day for 6 months. BMI, waist circumference, homeostasis model assessment, lipids, apo A1, apo B, apo B/A1 ratios, and CIMT were analyzed before and after the treatment period.
At the end of the study, there were no statistically significant changes in BMI or waist circumference. Liver enzymes decreased gradually. The homeostasis model assessment decreased from 3.4 ± 1.89 to 2.06 ± 1.68 (P < 0.001). No significant changes in the mean triglyceride, total cholesterol, low-density lipoprotein, or apo B levels were observed. The mean high-density lipoprotein (42.9 ± 7.1 vs. 45.5 ± 9.8; P = 0.037) and apo A1 (127.6 ± 17.7 vs. 135.9 ± 22.2; P = 0.02) increased significantly. Apo B/A1 ratios tended to decrease, but this decrease was not statistically significant. The mean CIMT decreased significantly (0.56 ± 0.15 vs. 0.47 ± 0.12; P = 0.001).
UDCA treatment in NASH patients resulted in statistically significant reductions in the mean CIMT over a 6-month period. We believe that this benefit of UDCA may have resulted from decreased insulin resistance and increased serum high-density lipoprotein-apo A1 levels. However, larger, longer-term studies are needed to confirm this effect of UDCA in NASH.
非酒精性脂肪性肝炎（NASH）是一种常见的肝脏疾病，越来越多地与心血管疾病相关。熊去氧胆酸（UDCA）可能具有抗氧化和抗炎活性，并可能减轻NASH中的肝损伤。迄今为止，尚无研究评估UDCA对NASH患者颈动脉内膜中层厚度（CIMT）、血脂、载脂蛋白A1（apo A）、载脂蛋白B（apo B）和载脂蛋白B/A1（apo B/A1）比值的疗效。
在这项前瞻性研究中，评估了30例经活检证实为NASH的患者和25例健康成年人作为对照组。所有参与者均无糖尿病、高血压或高脂血症。NASH患者接受UDCA 15mg/kg/天治疗6个月。在治疗前后分析体重指数（BMI）、腰围、稳态模型评估、血脂、apo A1、apo B、apo B/A1比值和CIMT。
在研究结束时，BMI或腰围无统计学显著变化。肝酶逐渐下降。稳态模型评估从3.4±1.89降至2.06±1.68（P<0.001）。甘油三酯、总胆固醇、低密度脂蛋白或apo B水平未见显著变化。高密度脂蛋白均值（42.9±7.1对45.5±9.8；P=0.037）和apo A1（127.6±17.7对135.9±22.2；P=0.02）显著升高。apo B/A1比值有下降趋势，但这种下降无统计学显著性。平均CIMT显著降低（0.56±0.15对0.47±0.12；P=0.001）。
NASH患者接受UDCA治疗6个月后，平均CIMT有统计学显著降低。我们认为，UDCA的这种益处可能源于胰岛素抵抗的降低和血清高密度脂蛋白-apo A1水平的升高。然而，需要更大规模、更长期的研究来证实UDCA在NASH中的这种作用。
