运动对非酒精性脂肪性肝病患者肝功能及胰岛素抵抗标志物的影响：一项随机对照试验的系统评价和荟萃分析

Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

作者信息

Hejazi Keyvan, Hackett Daniel

机构信息

Department of Physical Education and Sport Sciences, Hakim Sabzevari University, Sabzevar 9617976487, Iran.

Discipline of Exercise & Sport Science, Health and Performance Faculty Research Group, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.

出版信息

J Clin Med. 2023 Apr 20;12(8):3011. doi: 10.3390/jcm12083011.

BACKGROUND

Structured exercise as part of lifestyle modification plays an important role in the improvement of non-alcoholic fatty liver disease (NAFLD); however, its effectiveness has been shown to vary. This systematic review with meta-analysis investigated the effects of exercise on liver function and insulin resistance markers in patients with NAFLD.

METHODS

Six electronic databases were searched using terms related to exercise and NAFLD up to March 2022. Data were analyzed using a random-effects model to estimate the standardized mean difference (SMD) and 95% confidence interval.

RESULTS

The systematic search identified 2583 articles, of which a total of 26 studies met the inclusion criteria and were eligible. Exercise training had a moderate effect on reducing ALT (SMD: -0.59, = 0.01) and small effects on reducing AST (SMD: -0.40, = 0.01) and insulin (SMD: -0.43, = 0.02). Significant reductions in ALT were found following aerobic training (SMD: -0.63, < 0.01) and resistance training (SMD: -0.45, < 0.001). Moreover, reductions in AST were found following resistance training (SMD: -0.54, = 0.001), but not after aerobic training and combined training. However, reductions in insulin were found following aerobic training (SMD: -0.55, = 0.03). Exercise interventions for <12 weeks compared to ≥12 weeks were more effective in reducing FBG and HOMA-IR, while interventions for ≥12 weeks compared to <12 weeks were more effective in reducing ALT and AST levels.

CONCLUSIONS

Our findings support the effectiveness of exercise in improving liver function markers but not in blood glucose control in NAFLD patients. Additional studies are needed to determine the exercise prescription to maximize health in these patients.

背景

结构化运动作为生活方式改变的一部分，在改善非酒精性脂肪性肝病（NAFLD）方面发挥着重要作用；然而，其有效性已被证明存在差异。这项系统评价和荟萃分析研究了运动对NAFLD患者肝功能和胰岛素抵抗标志物的影响。

方法

截至2022年3月，使用与运动和NAFLD相关的术语检索了六个电子数据库。使用随机效应模型分析数据，以估计标准化平均差（SMD）和95%置信区间。

结果

系统检索共识别出2583篇文章，其中共有26项研究符合纳入标准并合格。运动训练对降低谷丙转氨酶（ALT）有中度效果（SMD：-0.59，P = 0.01），对降低谷草转氨酶（AST）（SMD：-0.40，P = 0.01）和胰岛素（SMD：-0.43，P = 0.02）有较小效果。有氧运动训练（SMD：-0.63，P < 0.01）和抗阻训练（SMD：-0.45，P < 0.001）后ALT显著降低。此外，抗阻训练后AST降低（SMD：-0.54，P = 0.001），但有氧运动训练和联合训练后未降低。然而，有氧运动训练后胰岛素降低（SMD：-0.55，P = 0.03）。与≥12周相比，<12周的运动干预在降低空腹血糖（FBG）和稳态模型评估的胰岛素抵抗（HOMA-IR）方面更有效，而与<12周相比，≥12周的干预在降低ALT和AST水平方面更有效。