Clin Gastroenterol H:非酒精性脂肪性肝炎患者体重变化与组织学特征和血液标志物变化之间的关系

2021-04-29 MedSci原创 MedSci原创

体重变化与NASH患者生化和组织学特征的变化独立且相关。NASH治疗指南应纳入有关避免体重增加和减轻体重的建议。

指南建议非酒精性脂肪性肝炎(NASH)患者减轻体重,但体重变化对疾病活动的影响尚未明确。

近日,消化病领域权威杂志Clinical Gastroenterology and Hepatology发表了一篇研究文章,研究人员旨在评估体重变化(增加/减轻)与NASH生化和组织学特征变化之间的关联。

这是对PIVENS和FLINT试验中NASH成人基线和1.5年或2年肝活检进行的分析。多变量回归模型评估了体重变化与以下方面之间的相关性:(a)血液肝标志物、(b)NASH分辨率无纤维化恶化、(c)纤维化改善且无NASH恶化以及(d)个体组织学特征。

421名参与者的BMI为34.4kg/m2(SD:6.5),平均体重变化为+0.4kg(SD:6.5)。体重变化与肝酶和纤维化-4评分的变化独立且呈正相关(所有p<0.001)。体重每减轻一公斤可使NASH分辨率增加7%(95%CI:3-10%,p<0.001),而纤维化不会恶化,而体重减轻了5%(95%CI:1%-8%,p=0.01),在没有NASH恶化的情况下实现纤维化改善的几率增加。体重增加与疾病活动恶化有关。体重每减少一公斤,纤维化改善的几率提高了5%(95%CI:2-8%,p=0.001)。没有证据表明体重变化与预后之间的关联取决于药物治疗、试验、体重指数和基线纤维化。

由此可见,体重变化与NASH患者生化和组织学特征的变化独立且相关。NASH治疗指南应纳入有关避免体重增加和减轻体重的建议。

原始出处:

Dimitrios A. Koutoukidis.et al.Association of weight changes with changes in histological features and blood markers in non-alcoholic steatohepatitis.Clinical gastroenterology and hepatology.2021.https://www.cghjournal.org/article/S1542-3565(21)00382-7/fulltext

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712789, encodeId=17271e12789ec, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Oct 19 14:24:28 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712789, encodeId=17271e12789ec, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Oct 19 14:24:28 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
  6. 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2022, time=2022-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673662, encodeId=a57116e3662f9, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Thu Jun 24 06:24:28 CST 2021, time=2021-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1014050, encodeId=dc4a1014050e8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77455482846, createdName=木糖醇的现代生活, createdTime=Thu Sep 02 20:43:23 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712789, encodeId=17271e12789ec, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Oct 19 14:24:28 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
    2021-07-30 qjddjq
  7. 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  9. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712789, encodeId=17271e12789ec, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Oct 19 14:24:28 CST 2021, time=2021-10-19, status=1, ipAttribution=)]
    2021-09-02 木糖醇的现代生活

    学习了

    0

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非酒精性脂肪性肝炎(NASH)迎来新进展:lanifibranor达到期中研究的主要终点

随着肥胖及其相关代谢综合征全球化的流行趋势,非酒精性脂肪性肝病现已成为欧美等发达国家和我国富裕地区慢性肝病的重要病因。

JAHA:伴有非酒精性脂肪性肝炎的肥胖患者心脏形态、功能和血流动力学改变

极端肥胖患者,NASH与左心室向心性重塑和循环高压力相关。伴有心输出量增加的NASH可能是该人群发生心血管事件的另一个危险因素。

Gastroenterology:belapectin用于治疗非酒精性脂肪性肝炎、肝硬化和门脉高压患者

belapectin可降低无食管静脉曲张的NASH、肝硬化和门脉高压患者肝静脉压力梯度,降低静脉曲张风险

NEJM:皮下注射司美鲁肽对非酒精性脂肪性肝炎的疗效

这项对NASH患者的2期临床试验结果表明,使用司美鲁肽治疗可使NASH缓解的患者百分比显著高于安慰剂。但是,该试验并未显示出纤维化分期改善的患者百分比存在显著的组间差异。