Khodadoostan Mahsa, Zamanidoost Maryam, Shavakhi Ahmad, Sanei Hosein, Shahbazi Masood, Ahmadian Mehdi
Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2017 Feb 22;6:12. doi: 10.4103/2277-9175.200787. eCollection 2017.
Nonalcoholic fatty liver disease (NAFLD), defined as excessive liver fat deposition and one of end-stage liver disease causes. Increased ferritin levels are associated with insulin resistance and a higher hepatic iron and fat content. Hyperferritinemia has been associated with severity of liver damage in NAFLD. The study aimed to evaluate the effects of phlebotomy on liver enzymes and histology in such patients.
Thirty-two eligible patients who had NAFLD and after 6 months of lifestyle modification still had NAFLD, and whose ferritin serum was above 250 mg/dl, were enrolled in this clinical trial study. After written informed consent was obtained, each patient's blood serum was taken for aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALK-P), complete blood count (CBC), total iron-binding capacity (TIBC), iron, and ferritin. Then the patients underwent liver biopsy. After that patients underwent phlebotomy, giving 350 cc blood monthly. Before every phlebotomy, hemoglobin and ferritin were checked. If they were in the goal range, phlebotomy was discontinued and the patient underwent liver biopsy. A serum sample was taken for testing at the beginning of the study. The results before and after phlebotomy were compared. The maximum duration of the study was 6 months.
Thirty-two patients (26 males and 6 females) were enrolled, and the mean average age was 33.7 ± 6.74 years. Phlebotomy improved liver enzymes and histology of liver significantly ( < 0.001) and induced reduction of ferritin.
Phlebotomy is effective for the improvement of liver enzymes and histology in patients with NAFLD and hyperferritinemia.
非酒精性脂肪性肝病（NAFLD）被定义为肝脏脂肪过度沉积，是终末期肝病的病因之一。铁蛋白水平升高与胰岛素抵抗以及肝脏铁和脂肪含量增加有关。高铁蛋白血症与NAFLD患者肝脏损伤的严重程度相关。本研究旨在评估放血疗法对这类患者肝酶和肝脏组织学的影响。
32例符合条件的NAFLD患者，在进行6个月生活方式调整后仍患有NAFLD，且血清铁蛋白高于250mg/dl，被纳入本临床试验研究。在获得书面知情同意后，采集每位患者的血清用于检测天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALK-P）、全血细胞计数（CBC）、总铁结合力（TIBC）、铁和铁蛋白。然后患者接受肝脏活检。之后患者接受放血疗法，每月放血350cc。每次放血前检查血红蛋白和铁蛋白。如果它们在目标范围内，停止放血，患者接受肝脏活检。在研究开始时采集血清样本进行检测。比较放血前后的结果。研究的最长持续时间为6个月。
32例患者（26例男性和6例女性）被纳入，平均年龄为33.7±6.74岁。放血疗法显著改善了肝酶和肝脏组织学（<0.001），并导致铁蛋白降低。
放血疗法对改善NAFLD和高铁蛋白血症患者的肝酶和肝脏组织学有效。
