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目的探讨生活方式管理后非酒精性脂肪性肝炎(NASH)患者胰岛素抵抗(IR)以及病情的变化。方法84例NASH患者随机分为干预组和对照组,每组各42例。所有患者均给予服用熊去氧胆酸,疗程24周,对干预组同时实施生活方式管理。比较治疗前后两组间体重指数(BMI)、腰围(WI)、血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、γ-谷氨酰转氨酶(GGT)等水平及稳态模型胰岛素抵抗指数(HOMA-IR)。结果干预前,两组间BMI、WI、TG、TC、HDL-C、ALT、AST、GGT、HOMA-IR等指标的差异无统计学意义(P>0.05);干预24周后,干预组总有效率(78.57%)显著高于对照组(57.14%)(P<0.05),干预组干预后上述指标显著下降(P<0.01),也显著低于对照组(P<0.05);对照组干预后ALT、AST、GGT显著下降(P<0.05),但BMI、WI、TG、TC、HDL-C及HOMA-IR的差异无统计学意义(P>0.05)。结论生活方式管理能改善IR,促进NASH患者肝功能的恢复。
Objective To investigate the changes of insulin resistance (IR) and disease in patients with non-alcoholic steatohepatitis (NASH) after lifestyle management. Methods 84 patients with NASH were randomly divided into intervention group and control group, 42 cases in each group. All patients were given ursodeoxycholic acid treatment for 24 weeks, while the implementation of lifestyle intervention in the intervention group. Body mass index (BMI), waist circumference (WI), serum triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT) Aspartate aminotransferase (AST), γ-glutamyl transaminase (GGT) levels and steady-state model of insulin resistance index (HOMA-IR). Results Before intervention, there was no significant difference in BMI, WI, TG, TC, HDL-C, ALT, AST, GGT and HOMA-IR between the two groups (P> 0.05) The effective rate (78.57%) was significantly higher than that of the control group (57.14%) (P <0.05), and the above indexes were significantly decreased after intervention in the intervention group (P <0.01) The levels of ALT, AST and GGT were significantly decreased (P <0.05), but there was no significant difference between BMI, WI, TG, TC, HDL-C and HOMA-IR. Conclusion Life style management can improve IR and promote the recovery of liver function in patients with NASH.