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目的 探讨非酒精性脂肪性肝病 (NAFLD)的发病机制及奥利司他结合低热量饮食治疗对NAFLD的有效性和安全性。方法 将 10 7例病人分为 4组。A组为肥胖伴NAFLD和肝损伤组 (60例 ) ,B组为无脂肪肝肥胖组 (16例 ) ,C组为肥胖伴NAFLD组 (12例 ) ,D组为丙氨酸转氨酶 (ALT)和天冬氨酸转氨酶 (AST)均升高组 (19例 ) ,其中A组给予奥利司他 12 0mg ,每日 3次 ,结合低热卡饮食 ,共治疗 2 4周。分别检测各组相关代谢指标。结果 ①各组之间胰岛素 (INS)、瘦素、游离脂肪酸 (FFA)、铁蛋白、胰岛素抵抗指数 (IR)水平差异无显著性 ,而转化生长因子 (TGF) β1在A组与C组和C组与D组间差异有显著性 (P =0 .0 0 0 3 0 )。②TGF β1和FFA与肝 /脾比值 (LSR )呈负相关 ,AST、谷氨酰转肽酶 (GGT)与LSR呈负相关 ,白细胞与LSR呈正相关。③A组病人在治疗 2 4周后体重指数 (BMI)下降达 10 .76%±4.5 2 %。AST、ALT、GGT及总胆红素有显著改善 ,治疗后LSR亦显著增加 (P <0 .0 1)。④不良作用发生率为 96.7% ,均与排便有关。结论 奥利司他结合低热量饮食可改善肝功能和相关代谢综合征 ,可作为肥胖伴NAFLD的药物治疗选择
Objective To investigate the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and the efficacy and safety of orlistat combined with low-calorie diet on NAFLD. Methods 107 patients were divided into 4 groups. A group was obese with NAFLD and liver injury group (60 cases), B group was non-fatty liver obesity group (16 cases), C group was obese with NAFLD group (12 cases), D group was alanine aminotransferase (ALT) And aspartate aminotransferase (AST) were increased in group A (19 cases), in which group A was given Orlistat 120mg three times a day, combined with low calorie diet for a total of 24 weeks. Metabolic parameters of each group were tested. Results ① Insulin, leptin, free fatty acid (FFA), ferritin, insulin resistance index (IR) showed no significant difference among groups, but TGFβ1 was not significantly different between group A and group C There was a significant difference between group C and group D (P = 0.00003 0). ② TGFβ1 and FFA were negatively correlated with liver / spleen ratio (LSR), AST, glutamyl transpeptidase (GGT) were negatively correlated with LSR, while leukocytes were positively correlated with LSR. ③A group of patients in the treatment of 24 weeks after the body mass index (BMI) decreased by 10.76% ± 4.5 2%. AST, ALT, GGT and total bilirubin were significantly improved after treatment LSR also increased significantly (P <0.01). ④ The incidence of adverse effects was 96.7%, all related to defecation. Conclusions Orlistat, in combination with a low-calorie diet, may improve liver function and related metabolic syndrome and may be used as a drug treatment option for obesity with NAFLD