非酒精性脂肪性肝炎是一种常见的引起血清ALT水平升高的慢性肝脏疾病，但是ALT水平升高在多大程度上能反应肝损伤并不清楚。评估维生素E治疗后，肝组织学的改善及ALT的变化。非酒精性脂肪性肝炎试验中评估维生素E联合安慰剂比格列酮，维生素E，安慰剂三组在ALT水平，体重和肝组织学变化的相关性。ALT应答被定义为下降至≤40 U/L 和较基线下降了≥30% 。治疗前和治疗后行肝活检来进行非酒精性肝病的炎症和纤维化程度。维生素E组比安慰剂对照组有更高的ALT应答率。在维生素E治疗组，ALT反应与炎症程度降低有关，而与纤维化程度无关。但是安慰剂治疗组中，ALT反应与炎症与纤维化程度均有关。体重降低与ALT应答，肝组织炎症及纤维化程度改善均有关，而维生素E均有此作用，无论有无体重的减轻。在未用维生素治疗的组中，体重增加大于2kg，与低ALT应答、肝组织炎症及纤维化程度恶化有关。非酒精性脂肪性肝病患者的ALT水平降低与组织学改善有关。我们应强调降低体重的重要性，并且尽量避免体重的增加。无论有没有体重的降低，维生素E都能降低ALT水平，改善肝组织活动。
吉林大学第一医院肝病科 杨伟民 摘译
Vitamin E and changes in serum alanine aminotransferase levels in patients with non-alcoholic steatohepatitis.
Abstract
BACKGROUND:
Non-alcoholic steatohepatitis (NASH) is a common cause of serum alanine aminotransferase (ALT) elevations and chronic liverdisease, but it is unclear how well ALT elevations reflect the liver injury.
AIM:
To assess how well changes in ALT elevations reflect improvements in liver histology in response to vitamin E therapy.
METHODS:
The vitamin E and placebo arms of the Pioglitazone vs. Vitamin E vs. Placebo in Non-alcoholic Steatohepatitis (PIVENS) trial were reassessed for associations among changes in ALT levels, body weight and liver histology. An ALT response was defined as a decrease to ≤40 U/L and by ≥30% of baseline. Liver biopsies taken before and after treatment were scored for non-alcoholic fatty liver disease activity (NAS) and fibrosis.
RESULTS:
ALT responses were more frequent among vitamin E (48%) than placebo (16%) recipients (P < 0.001). Among vitamin E recipients, ALT responses were associated with decreases in NAS (P < 0.001), but not fibrosis scores (P = 0.34), whereas among placebo recipients, ALT responses were associated with significant decreases in both (P < 0.05). Weight loss (≥2 kg) was also associated with ALT response (P < 0.001), improvements in NAS (P < 0.001) and fibrosis (P < 0.02), but vitamin E had an added effect both with and without weight loss. Weight gain (≥2 kg) was associated with lack of ALT response and worsening NAS and fibrosis scores in patients not on vitamin E.
CONCLUSIONS:
Decrease of ALT levels to normal in patients with NASH is usually associated with improved histological activity. Management should stress the value of weight loss and strongly discourage weight gain. Vitamin E can improve both ALT levels and histology with and without weight loss. Clinical Trial Number: NCT00063622.
