研究发现特定的肝病与心血管顺应性相关

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Study Finds Certain Liver Disease Related to Cardiovascular Fitness

Hepatology
Research News Alert
Wiley-Blackwell
March 24, 2008

Study Finds Certain Liver Disease Related to Cardiovascular Fitness Lifestyle Interventions May Help Slow Disease Progression

Patients with nonalcoholic fatty liver disease (NAFLD) have suboptimal levels of cardiovascular fitness, muscle strength, body composition and physical fitness, according to a new study. The findings appear in the April issue of Hepatology, a journal of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (www.interscience.wiley.com).

About one-in-four U.S. adults suffers from NAFLD, which describes a range of liver disease characterized by excessive fat in the liver. NAFLD is the most common cause of abnormal liver enzymes, and the leading reason for referrals to hepatology clinics. It is considered by many to be a manifestation of the metabolic syndrome which is less prevalent among physically fit people, but little is known about the relationship between fitness and NAFLD severity.

To address this question, researchers led by Joanne Krasnoff of the University of California San Francisco recruited 37 adult patients with a spectrum of NAFLD severity as measured by liver biopsy. Across the spectrum of NAFLD severity, patients had suboptimal cardiorespiratory fitness, muscle strength, body composition and physical activity participation. More than 97 percent had a body fat percentage that put them at increased risk for morbidity and mortality and less than 20 percent currently met recommended guidelines for physical activity.

The study did demonstrate lower cardiorespiratory fitness in subjects with increasing NAFLD severity. “This provocative finding raised the question of a cause-or-effect phenomenon—does cardiorespiratory fitness attenuate NAFLD or does increasing NAFLD severity result in a decline in cardiorespiratory fitness?” the authors ask.

“Despite our study limitations,” the authors conclude, “we believe the objective demonstration of low cardiorespiratory fitness and muscle strength with a high incidence of obesity illustrates the potential clinical relevance of these measures both before and after interventions.” Moreover, the finding that specific measures of NAFLD severity may be associated with cardiorespiratory fitness and past physical activity raises the possibility of a defined therapeutic role for prevention and exercise intervention.

Future studies should include a randomized controlled trial of exercise training that can reveal its direct effects on NAFLD histopathology, they suggest. “In the meantime, it would appear rational and prudent for healthcare providers to recommend exercise training to improve health-related fitness as an integral role in the care of patients with NAFLD,” they conclude. This work was conducted as an ancillary study of the NAFLD Clinical Research Network, a national research consortium funded by the National Institutes of Health.
肝脏病学
敏锐的研究消息
Wiley-Blackwell
2008年3月24日

研究发现特定的肝病与心血管顺应性相关，干涉生活方式可以帮助减慢疾病进程

根据一项新的研究显示，非酒精性脂肪肝(NAFLD)患者的心血管顺应性，肌力，机体组成和体能都低于最适水平。这一发现刊登在美国肝病研究协会(AASLD)的杂志《肝脏病学》四月刊。文章在Wiley Interscience网站上也有在线提供(www.interscience.wiley.com)。

大约四分之一的美国成年人患有NAFLD，通常描述的是范围是以肝脏脂肪过量为特征的肝脏疾病。NAFLD是肝脏酶学异常的最普遍原因，是和肝脏病学临床相关最主要的原因。许多人认为这是代谢综合征的一个表现，在能保持身体适度的人群中流行性差一些，但是很少有人了解适应性和NAFLD严重度的关系。

为了阐明这一问题，旧金山加利福尼亚大学的Joanne Krasnoff带领研究人员招募了37名成人NAFLD患者，由肝脏活组织检查来判断NAFLD谱系严重度。不同的NAFLD谱系严重度，患者心肺的顺应性，肌肉力量，机体组分和参与体力活动都在最适度以下。97％以上的身体脂肪百分比都使他们的发病率和死亡率增加。20％以下的能达到目前指南推荐的体力活动。

研究表明，受试者的低心肺顺应性伴随着增高的NAFLD严重度。作者提出疑问：“这一刺激的发现提出了一个因果现象的问题，心肺顺应性能够减弱NAFLD吗？或者增加的NAFLD严重度会导致心肺顺应性的下降？”

作者总结到“尽管我们研究的限制性，我们还是相信客观的说明肥胖高发发病率伴随低心肺顺应性和肌力表明了干预措施之前和之后的潜在临床关联。”此外，研究发现NAFLD严重度特殊的测定可以和心肺顺应性和过度体力活动相关，增加了确定预防和运动干预在治疗学上的作用的可能性。

他们建议，未来的研究应该包括运动练习的随机对照试验，以展示它对NAFLD组织病理学的直接作用。他们总结，“在这一过程中，可能会出现合理的谨慎的医疗保健，推荐通过运动练习来改进健康相关的适合度。运动练习在NAFLD患者的关注中起到整体的作用。”这项工作作为NAFLD临床研究网中一个辅助研究来进行的，由国立卫生研究院提供基金的全国性的研究。