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低碳水化合物饮食和生活方式干预对瘦型非酒精性脂肪性肝病患者的疗效观察

何诗华 戴璐 郑洁 吴创鸿 胡国信

引用本文:
Citation:

低碳水化合物饮食和生活方式干预对瘦型非酒精性脂肪性肝病患者的疗效观察

DOI: 10.12449/JCH240513
基金项目: 

国家自然科学基金 (81473473)

伦理学声明:本研究方案于2023年4月11日经由前海蛇口自贸区医院伦理委员会审批,批号:2023-057(申)-01。所有患者均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:何诗华负责研究设计,数据收集与分析,稿件撰写;戴璐、郑洁负责数据收集与分析;吴创鸿负责研究设计、稿件修改;胡国信负责研究设计与把控,并最终定稿。
详细信息
    通信作者:

    胡国信, huoguoxin8228@sina.com (ORCID: 0009-0003-6618-7672)

Therapeutic effect of low-carbohydrate diet and lifestyle intervention on patients with lean nonalcoholic fatty liver disease

Research funding: 

National Natural Science Foundation of China (81473473)

More Information
  • 摘要:   目的  观察低碳水化合物饮食和线上生活方式干预对痩型非酒精性脂肪性肝病(NAFLD)患者的疗效。  方法  本研究选取2019年12月—2021年3月在北京大学深圳医院感染性疾病科、深圳市前海蛇口自贸区医院感染性疾病科就诊的痩型NAFLD患者53例,予以限制热量摄入的低碳水化合物饮食[总热量摄入根据基础代谢率(BMR)和活动因子(PAL)计算得来,总能量限制在(BMR×95%×PAL-1 000)kcal~(BMR×95%×PAL-500)kcal],碳水化合物比例波动在10%~55%和生活方式指导8周,通过线上管理软件进行监督随访并观察患者疗效及安全性。比较患者干预前后的脂肪含量(CAP)及肝硬度(LSM)、人体测量学指标、血生化、尿蛋白和尿酮体等。1年后随访患者体质量和BMI。符合正态分布的计量资料两组间比较采用成组t检验;不符合正态分布的计量资料采用配对样本的Wilcoxon符号秩和检验。计数资料组间比较采用χ2检验。  结果  经8周干预后,患者CAP从(304.47±31.91)db/m下降至(242.43±26.74)db/m,LSM从(7.43±2.41)kPa下降至(6.36±1.79)kPa,体质量从(64.29±7.37)kg下降至(60.24±7.08),差异均有统计学意义(t值分别为11.25、3.72、14.07,P值均<0.001)。25例患者(47.2%)脂肪肝消失,12例LSM异常者(63.2%)恢复正常。52例患者(98.1%)体质量平均下降(4.05±2.32)kg。CAP下降等级随着体质量下降幅度的增加而增加。经干预后患者BMI、腰围、臀围、ALT、AST、GGT、尿酸、空腹血糖、TG、TC、LDL显著下降,HDL显著升高(t值分别为12.85,13.77,10.28,7.64,6.21,8.35,6.83,6.31,7.4,4.97,5.95,-2.21,P值均<0.05)。ALT、AST、GGT、尿酸、空腹血糖、TG、TC、LDL基线异常者恢复正常的比例分别为75%、100%、81.8%、57.1%、100%、66.7%、73.5%、85.3%。尿素氮、血肌酐、尿蛋白、尿酮体无明显改变(P值均>0.05)。随访1年后患者体质量及BMI无反弹(P值均>0.05)。干预及随访期间患者无胃肠道反应。  结论  低碳水化合物饮食及生活方式干预,可以改善痩型NAFLD患者肝脂肪含量及肝功能、血脂指标,且安全性良好。

     

  • 图  1  纳入和排除受试对象的流程图

    Figure  1.  NAFLD screening process

    表  1  世界卫生组织预测BMR公式

    Table  1.   Formula for predicting basal metabolic rate by WHO

    年龄 男性(kcal/d) 女性(kcal/d)
    18~30岁 15.057×体质量+692.200 14.818×体质量+486.600
    30~60岁 11.472×体质量+873.100 8.126×体质量+845.600
    下载: 导出CSV

    表  2  根据生活方式及习惯性体力活动进行PAL分级

    Table  2.   PAL classification based on lifestyle and habitual physical activity

    分类 PAL
    静态、轻体力活动生活方式 1.40~1.69
    活跃、中度体力活动生活方式 1.70~1.99
    剧烈、重体力活动生活方式 2.00~2.40
    注:PAL为日常活动评分。
    下载: 导出CSV

    表  3  干预前后患者人体测量血指标及血生化变化情况

    Table  3.   Anthropometric measurement of blood indicators and blood biochemical changes

    指标 干预前 干预后 t P
    体质量(kg) 64.29±7.37 60.24±7.08 14.07 <0.001
    BMI(kg/m2 22.56±0.98 21.16±1.07 12.85 <0.001
    WC(cm) 86.57±5.75 82.91±4.82 13.77 <0.001
    HC(cm) 94.36±5.04 91.79±4.40 10.28 <0.001
    LSM(kPa) 7.43±2.41 6.36±1.79 3.72 <0.001
    CAP(db/m) 304.47±31.91 242.43±26.74 11.25 <0.001
    ALT(U/L) 63.11±27.34 35.28±13.01 7.64 <0.001
    AST(U/L) 43.34±19.41 27.51±6.16 6.21 <0.001
    GGT(U/L) 49.53±19.69 31.79±13.11 8.35 <0.001
    UA(μmol/L) 475.40±99.17 394.70±79.13 6.83 <0.001
    FBG(mmol/L) 5.65±0.86 5.00±0.61 6.31 <0.001
    TG(mmol/L) 2.61±1.25 1.57±0.65 7.40 <0.001
    TC(mmol/L) 5.83±0.97 5.16±0.66 4.97 <0.001
    HDL(mmol/L 1.27±0.58 1.46±0.38 -2.21 0.032
    LDL(mmol/L) 3.94±1.00 3.11±0.57 5.95 <0.001
    BUN(mmol/L) 4.86±1.02 4.92±0.96 -0.30 0.766
    Cr(μmol/L) 69.34±16.34 70.11±18.12 -0.23 0.823
    下载: 导出CSV

    表  4  患者体质量下降情况

    Table  4.   The degree of weight loss

    体质量下降比例 <3% 3%~5% 5%~7% 7%~10% >10%
    例(%) 5(9.4) 18(34.0) 10(18.9) 13(24.5) 6(11.3)
    下载: 导出CSV

    表  5  体质量下降和CAP下降的关系

    Table  5.   Relationship between percent weight loss and percent CAP loss

    组别 例数 CAP下降<15%[例(%)] CAP下降15%~30%[例(%)] CAP下降>30%[例(%)]
    体质量下降<5% 23 19(35.8) 10(18.9) 0(0.0)
    体质量下降5%~10% 24 4(7.5) 11(20.8) 0(0.0)
    体质量下降>10% 6 1(1.9) 5(9.4) 3(5.7)
    下载: 导出CSV
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