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综合方法治疗非酒精性脂肪性肝炎临床疗效分析

Climical efficacy of comprehensive treatments on patients with nonalcoholic steatohepatitis

  • 摘要: 目的:探讨综合方法治疗非酒精性脂肪性肝炎(NASH)的临床疗效。方法:选择2011年1月至2018年11月在复旦大学附属中山医院内分泌科住院的经肝脏病理学确诊为NASH,并在治疗后接受肝脏病理学检查的患者。分析患者接受的综合治疗方式,判断其肝脏组织学改变情况,并观察治疗前后相关代谢参数改变情况。结果:共10例患者纳入研究,其中男性2例、女性8例,治疗期前平均(54.2±9.6)岁。10例患者中,合并糖代谢异常8例,合并高血压6例,合并血脂异常4例,合并甲状腺功能减退4例。经过1.04(0.73,1.54)年的治疗,80%(8/10)的患者获得NASH改善,其非酒精性脂肪性肝病活动度积分总分下降1 (0.5, 3.5)分,其中7例肝纤维化评分下降了1 (0.5,1.5)分。余20%(2/10)患者出现NASH的进展。患者治疗后体质指数(BMI)减小,同时糖化血红蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ谷氨酰转肽酶水平均下降(P<0.05)。NASH改善患者的体质量降幅更明显,为10.80%(8.62%,20%),血压控制在(128.14±8.8)/(83.14±7.47) mmHg(1 mmHg=0.133 kPa);NASH进展患者体质量未明显下降,且血压控制不佳。结论:综合治疗可改善NASH患者肝脏组织病理情况,该效应可能与体质量下降及血压下降有关。

     

    Abstract: Objective:To explore the hepatic histological changes in patients with nonalcoholic steatohepatitis (NASH) after comprehensive treatment.Methods:Inpatients who were diagnosed as NASH and received hepatic pathological examination again after comprehensive treatment were enrolled from January 2011 to November 2018 in Zhongshan Hospital, Fudan University. The comprehensive treatments and the changes in hepatic histological examination were analyzed.Results:A total of 10 patients (2 males and 8 females) with the age of (54.2±9.6) years old, were enrolled in the study. Among all the patients, 8 were complicated with abnormal glucose metabolism, 6 had hypertension, 4 had remission, and 4 had hypothyroidism. After 1.04 (0.73, 1.54) years of treatments, 80% (8/10) of the patients had improvement of NASH. The total score of NASH decreased by 1 (0.5, 3.5) point, and the grade of liver fibrosis decreased by 1 (0.5, 1.5) point. Only 2 patients had progression of NASH. After treatments, the body mass index (BMI) decreased significantly. Meanwhile, HbA1c, alanine aminotransfase, aspartate aminotransferase, and γglutamyl transpeptidase decreased (P<0.05). In the patients with remission of NASH, the weight loss was more significant (10.80% [8.62%,20%]), and the blood pressure was controlled at the level of (128.14±8.8)/(83.14±7.47) mmHg (1 mmHg=0.133 kPa). In patients with progression of NASH, no significant weight loss was observed and blood pressure was poorly controlled.Conclusions:Comprehensive treatments can ameliorate hepatic pathological changes in most NASH patients, which may be related to weight loss and blood pressure control.

     

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