减重和运动双管齐下，可提高肝病治疗的疗效

清照

　　一项新研究显示，患有慢性肝病的人，减重和增加运动锻炼有助增进肝功能，进而提高生活质量。

　　这项将刊登在2004年3月号英国《消化道》（Gut）杂志上的研究针对31位体重过重的肝病患者进行了15个月的减重和健身训练。其中18位患者患有丙型肝炎，13人患有其它慢性肝病。

　　他们所进行的健身计划包括定期与营养专家会面，每周两个半小时的有氧运动。

　　澳大利亚布里斯班（Brisbane）亚历山卓公主医院的鲍威尔（E. Powell）博士及其同伴表示，在研究进行期间，21位患者的体重成功减轻数磅，并且保持很好。所有患者的体重平均减少了9%。

　　减重多少与衡量肝脏功能的肝酶水准有所关联。保持减重非常关键，有10名患者因为无法保持，体内肝酶水准再次升高。

　　研究者表示，减重还对加快血清胰岛素水准的恢复有利，体重重新增加的患者则不会产生这种效果。

　　“这一研究显示，致力于减重可以降低肝病恶化的风险，”研究者说。“超重患者的治疗应该成为慢性肝病患者治疗的重要部分。”

Gut. 2004 Mar;53(3):413-419.

Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life.

Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, Powell EE.

School of Medicine, University of Queensland, and Department of Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Australia. School of Medicine, University of Queensland, Brisbane, Australia. Department of Endocrinology and Diabetes, Princess Alexandra Hospital, Brisbane, Australia. Nutrition and Dietetic Services, Princess Alexandra Hospital, Brisbane, Australia. Population and Clinical Sciences Division, Queensland Institute of Medical Research, Brisbane, Australia. School of Medicine, University of Queensland, and Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia.

BACKGROUND: and aim: Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C. The aim of this study was to investigate the longer term effect of weight loss on liver biochemistry, serum insulin levels, and quality of life in overweight patients with liver disease and the effect of subsequent weight maintenance or regain. PATIENTS: Thirty one patients completed a 15 month diet and exercise intervention. RESULTS: On completion of the intervention, 21 patients (68%) had achieved and maintained weight loss with a mean reduction of 9.4 (4.0)% body weight. Improvements in serum alanine aminotransferase (ALT) levels were correlated with the amount of weight loss (r = 0.35, p = 0.04). In patients who maintained weight loss, mean ALT levels at 15 months remained significantly lower than values at enrolment (p = 0.004), while in regainers (n = 10), mean ALT levels at 15 months were no different to values at enrolment (p = 0.79). Improvements in fasting serum insulin levels were also correlated with weight loss (r = 0.46, p = 0.04), and subsequent weight maintenance sustained this improvement. Quality of life was significantly improved after weight loss. Weight maintainers sustained recommended levels of physical activity and had higher fasting insulin levels (p = 0.03) at enrolment than weight regainers. CONCLUSION: In summary, these findings demonstrate that maintenance of weight loss and exercise in overweight patients with liver disease results in a sustained improvement in liver enzymes, serum insulin levels, and quality of life. Treatment of overweight patients should form an important component of the management of those with chronic liver disease.