JCEM：短期运动可以降低NAFLD进展的风险

短期有氧运动后，HMW脂联素与肝脏多元不饱和脂质呈正相关

肝脏脂肪变性、胰岛素抵抗、炎症、低水平的多元不饱和脂质和脂联素与非酒精性脂肪肝病（NAFLD）的发生和发展有关。为了探讨短期有氧运动对这些代谢危险因素的影响，来自美国克利夫兰医学中心的John P Kirwan教授及其团队进行了一项研究，该研究发现短期锻炼可以降低NAFLD进展的风险。该研究结果在线发表在2013年4月26日的美国《临床内分泌代谢杂志》（The Journal of Clinical Endocrinology & Metabolism）上。
该研究，由连续7天每天60分钟，在跑步机上行走至最大心率的85%组成的短期有氧运动方案中，入选临床确诊NAFLD的肥胖个体（17例，BMI=34.3±1.0kg/m2）。干预前后通过1H磁共振（MR）光谱测量肝脏（14例），包括肝脏甘油三酯含量、以及脂质饱和指数（SI）和多元不饱和脂质指数（PUI）。从口服葡萄糖耐量试验（OGTT）中估算胰岛素敏感性，并且，在OGTT期间分离单核细胞评估活性氧簇（ROS）的产生。从血浆中确定循环葡萄糖、胰岛素和高分子量（HMW）脂联素。主要结果是短期有氧运动训练改善NAFLD患者肝脏脂质构成。
该研究结果表明，运动训练导致肝脏PUI增加（P＜0.05），增加胰岛素敏感性（Matsuda指数：P＜0.05）、HMW脂联素（P＜0.05）以及最大摄氧量（VO2max）(P<0.05)。运动训练后，OGTT期间ROS产生减少(P<0.05)。在运动方案后，HMW脂联素增加，并且，HMW脂联素的增加与肝脏PUI的增加呈正相关(r=0.52, P=0.05)。在整个方案期间，体重保持稳定。
该研究发现，短期运动能以肝脏脂质构成为目标，可以降低NAFLD进展风险。肝脏脂质构成的改善可能由脂联素引起。
与肝相关的拓展阅读：

• AJG：肝硬化门静脉血栓形成预测因素
• J Gastroenterol Hepatol：非酒精性脂肪性肝病是代谢综合征独立表现
• Gastroenterology：黑猩猩试验表明TLR-7口服激动剂GS-9620或可治疗慢性乙型肝炎
• NEJM：Sofosbuvir用于慢性丙肝病毒感染初治安全有效
• Int J Infect Dis：重视隐匿性肝炎与肾小球肾炎的关系
• EASL2013：益生菌可降低肝性脑病的发生
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Improved Hepatic Lipid Composition Following Short-Term Exercise in Non-Alcoholi 
Abstract
Context:Hepatic steatosis, insulin resistance, inflammation, low levels of polyunsaturated lipids, and adiponectin are implicated in the development and progression of non-alcoholic fatty liver disease (NAFLD).Objective:We examined the effects of short-term aerobic exercise on these metabolic risk factors.Design and Participants:Obese individuals (N=17, 34.3±1.0 kg/m2) with clinically confirmed NAFLD were enrolled in a short-term aerobic exercise program that consisted of 7 consecutive days of treadmill walking at ∼85% of HRmax for 60 min/d. Pre- and post-intervention measures included hepatic triglyceride content, and a lipid saturation index (SI) and polyunsaturated lipid index (PUI) of the liver, obtained by 1H magnetic resonance (MR) spectroscopy (N=14). Insulin sensitivity was estimated from an oral glucose tolerance test (OGTT), and mononuclear cells were isolated to assess reactive oxygen species (ROS) production during the OGTT. Circulating glucose, insulin, and high molecular weight (HMW) adiponectin were determined from plasma.Main Outcome:Short-term aerobic exercise training improved hepatic lipid composition in patients with NAFLD.Results:Exercise training resulted in an increase in liver PUI (P<0.05), increased insulin sensitivity (Matsuda Index: P<0.05), HMW adiponectin (P<0.05), and VO2max (P<0.05). ROS production during the OGTT was reduced following exercise training (P<0.05). HMW adiponectin was increased after the exercise program and the increase was positively correlated with the increase in liver PUI (r=0.52, P=0.05). Body weight remained stable during the program (P>0.05).Conclusion:Short-term exercise can target hepatic lipid composition, which may reduce the risk of NAFLD progression. The improvement in hepatic lipid composition may be driven by adiponectin.