ω-3多不饱和脂肪酸联合膳食营养对非酒精性脂肪性肝病患者的影响

目的 观察ω-3多不饱和脂肪酸(omega-3 polyunsaturated fatty acid, ω-3 PUFA)联合膳食营养对非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)患者的影响。方法 128例NAFLD患者以抛硬币法随机分为膳食营养组(59例)和ω-3 PUFA联合膳食营养组(69例)。膳食营养组行严格膳食营养控制和有氧运动,后组在此基础上服用ω-3 PUFA,每次2g,每天3次。连续治疗24周,评价症状积分、肝功能、血脂和胰岛素抵抗指数(HOMA-IRI)、肝病理NAS评分、CT下脂肪肝程度变化。结果 118例患者完成研究,膳食营养组55例,联合组63例。和膳食营养组比,联合组在症状积分(1.01±1.78 vs 0.97±1.12, P=0.001),丙氨酸转氨酶(ALT)、γ-谷氨酰转移酶(GGT)、总三酰甘油(TG)和HOMA-IRI改善差异有统计学意义(均P＜0.05)。同时,联合组NAS评分(中位数5.4 vs 2.9, P=0.004)较膳食营养组(中位数5.2 vs 3.6, P=0.008)下降更为明显(P=0.01),但肝纤维化改变二组间差异无统计学意义。二组脂肪肝程度均减轻,但以联合组明显。结论 ω-3 PUFA联合膳食营养较单膳食营养更能改善NAFLD症状、肝功能、血脂、胰岛素抵抗程度和部分肝病理变化。
Objective To assess the effectiveness of combined Omega-3 polyunsaturated fatty acids(ω-3 PUFA) with dietary nutrition in patients with non-alcoholic fatty liver disease(NAFLD). Methods One hundred and twenty-eight patients with NAFLD were enrolled in this 24-week randomized controlled trial. Patients in group A(n=59) received strict diet control and aerobic exercise, and those in group B(n=69) received ω-3 PUFA 6g/day in addition to the same dies as in group A. The symptom scores, liver function, serum lipid levels and HOMA-insulin resistance index(HOMA-IRI) were assessed after 12 and 24 weeks of treatment. Hepatic fat infiltration and NAFLD activity score(NAS) were determined after 24 weeks of treatment by abdominal CT scan and hepatic pathology, respectively. Results One hundred and eighteen patients(55 in group A, 63 in group B) completed the study. After 24 weeks of treatment, the total symptom scores(1.01±1.78 vs 0.97±1.12, P=0.001), alanine aminotransferase(ALT), gamma-glutamyl transpeptidase(GGT), triglyceride(TG) and HOMA-IRI levels were more significantly decreased in group B than those in group A(P＜0.05). Additionally, as compared with the group A(median 5.2 vs 3.6, P=0.008), NAS in group B(median 5.4 vs 2.9,P=0.004) achieved a substantial improvement,but there was no a statistical reduction in fibrosis scores in the two groups. Group B resulted in a significant improvement of fatty liver degree as demonstrated by CT scan. Conclusion A combination of ω-3 PUFA with dietary nutrition demonstrates more marked improvement in symptom scores, liver function, serum lipid levels, HOMA-IRI and hepatic pathology