Jia G Y, Han T, Gao L, Wang L, Wang S C, Yang L, Zhang J, Guan Y Y, Yan N N, Yu H Y, Xiao H J, Di F S
Department of Endocrinology and Metabolism, the Third Central Clinical College of Tianjin Medical University, Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cells(TKL), Tianjin 300170, China.
Department of Hepatology, Third Central Hospital of Tianjin; Institute of Hepatobiliary Disease, Tianjin 300170, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Jan 20;26(1):34-41. doi: 10.3760/cma.j.issn.1007-3418.2018.01.009.
To investigate the effect of dietary control combined with different exercise modes on plasma vaspin, irisin, and metabolic parameters in patients with non-alcoholic fatty liver disease (NAFLD) through a randomized open parallel-controlled study. The patients aged 30-65 years who visited Tianjin Third Central Hospital from January 2013 to December 2014 and were diagnosed with NAFLD by liver ultrasound and fat content determination were screening, and 474 patients were enrolled in this randomized controlled trial and divided into aerobic exercise group, resistance exercise group, and control group. All patients received dietary intervention. The three groups were compared in terms of biochemical parameters, fat content, NFS score, energy metabolic parameters, body composition index, and levels of vaspin and irisin at baseline and after 6 months of intervention. SPSS 19.0 was used for statistical analysis. The -test, the Mann-Whitney test, the chi-square test, and an analysis of variance were used for comparison between groups. The multiple imputation method was used for missing data, and the results were included in the intention-to-treat analysis. There were no significant differences in age, sex, anthropometrical parameters, and biochemical parameters between the three groups at baseline. Compared with dietary control alone, aerobic exercise and resistance exercise helped to achieve significant reductions in waist circumference, diastolic pressure, percentage of body fat, volatile fatty acid, fasting blood glucose, homeostasis model assessment of insulin resistance, triglyceride, low-density lipoprotein cholesterol, free fatty acid, uric acid, alanine aminotransferase, and liver fat content after 6 months of intervention ( < 0.05). The aerobic exercise group had a significant increase in non-protein respiratory quotient and significant reductions in body mass index and aspartate aminotransferase after intervention, as well as a significant increase in resting energy expenditure and significant reductions in abdominal fat ratio and total cholesterol after 6 months of resistance exercise ( < 0.05). The aerobic exercise group and the resistance exercise group had a significant reduction in vaspin and a significant increase in irisin after intervention ( < 0.05), and the resistance exercise group had significantly greater changes in these two adipokines than the aerobic exercise group ( < 0.05). Exercise therapy is an effective method for the treatment of metabolism-associated diseases, and a combination of resistance and aerobic exercises is more reasonable and effective in clinical practice. As a relatively safe exercise mode, resistance exercise can also effectively improve the metabolic state of NAFLD patients.
通过一项随机开放平行对照研究，探讨饮食控制联合不同运动方式对非酒精性脂肪性肝病（NAFLD）患者血浆内脂素、鸢尾素及代谢参数的影响。对2013年1月至2014年12月就诊于天津第三中心医院、经肝脏超声及脂肪含量测定确诊为NAFLD的30 - 65岁患者进行筛选，474例患者纳入本随机对照试验，分为有氧运动组、抗阻运动组和对照组。所有患者均接受饮食干预。比较三组患者干预前及干预6个月后的生化参数、脂肪含量、NFS评分、能量代谢参数、身体成分指数以及内脂素和鸢尾素水平。采用SPSS 19.0进行统计分析。组间比较采用t检验、Mann - Whitney U检验、卡方检验和方差分析。采用多重插补法处理缺失数据，结果纳入意向性分析。三组患者基线时年龄、性别、人体测量参数和生化参数无显著差异。与单纯饮食控制相比，有氧运动和抗阻运动在干预6个月后有助于显著降低腰围、舒张压、体脂百分比、挥发性脂肪酸、空腹血糖、胰岛素抵抗稳态模型评估、甘油三酯、低密度脂蛋白胆固醇、游离脂肪酸、尿酸、丙氨酸氨基转移酶和肝脏脂肪含量（P < 0.05）。有氧运动组干预后非蛋白呼吸商显著升高，体重指数和天冬氨酸氨基转移酶显著降低，抗阻运动6个月后静息能量消耗显著增加，腹部脂肪比例和总胆固醇显著降低（P < 0.05）。有氧运动组和抗阻运动组干预后内脂素显著降低，鸢尾素显著升高（P < 0.05），且抗阻运动组这两种脂肪因子的变化显著大于有氧运动组（P < 0.05）。运动疗法是治疗代谢相关疾病的有效方法，抗阻运动与有氧运动相结合在临床实践中更合理有效。作为一种相对安全的运动方式，抗阻运动也能有效改善NAFLD患者的代谢状态。
