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时间:2020-05-24
《非酒精性脂肪性肝病患者的循证治疗.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、·3529··医学循证·非酒精性脂肪性肝病患者的循证治疗王璐,董卫国,吕晓光,季梦遥【摘要】目的借助循证医学方法为1例非酒精性脂肪性肝炎(NASH)患者确定治疗方案。方法2012—04—23本院消化内科收治1例37岁男性中度NASH患者,在评估患者情况后针对其情况提出临床问题,通过计算机检索Cochrane图书馆、PubMed、Embase、中国知网(CNKI)(1990-2012年),收集相关高质量证据进行评价,并结合医生经验及患者愿望制定治疗方案。结果共纳入相关文献24篇,其中系统评价/Meta分析I2篇,随机对照试验(RCT)10篇,队列研究2篇。结合患者的情况对检索结果进行综合分
2、析,制定合理的治疗方案:低糖低脂饮食;中等量有氧运动200min/周;将体质量减至79以下;口服吡格列酮30ms/d。随访6个月后,患者食欲不振、肝区胀痛等症状明显缓解,肝脏超声显示轻度脂肪肝。结论改变生活方式、控制体质量、改善胰岛素抵抗、加用护肝药物,能有效提高NASH的治疗效果,并提高患者生活质量,但其远期疗效尚需进一步观察。【关键词】非酒精性脂肪性肝病;循证医学;Meta分析;随机对照试验;治疗【中图分类号】R575【文献标识码】Adoi:10.3969/j.issn.1007—9572.2013.10.077王璐,董卫国,吕晓光,等.非酒精性脂肪性肝病患者的循证治疗[J].中国全
3、科医学,2013,16(10):3529—3532.[WWW,chinagp.net]Evidence—basedTreatmentforACasewitllNon—alcoholicSteatohepatitisWANGLu,DONGWei—guo,LVXiao—guang,eta1.DepartmentofCriticalCareMedical,PeoplesHospitalofWuhanUniversity,Wuhan430060,China【Abstract】ObjectiveTomakeanindividualizedtreatmentplanforacaseofnon—alc
4、oholicsteatohepatitis(NASH)byusingmethodsofevidence—basedmedicine.MethodsA37一year—oldmanwasdiagnosedasmoderateNASHonApril23rd,2012.Afterclinicalproblemswereputforward,evidencefrom1990to2012wascollectedfromtheCochranelibrary,PubMed,EmbaseandChineseJournalFull—textDatabase(CNKI).Treatmentprotocolsw
5、eremadeaccordingtothesearchre—suits,combinedwithpatientpreferencesandphysiciansclinicalexperience.ResultsAtotalof12meta—analysisorsystematicreviews,10RCTsand2coho~studieswereincluded.Theresultswereanalyzedandatherapyplanwasformulatedasfollows:low—fatandlow—carbohydratediet,moderate—intensityactiv
6、ities200min/week,bodyweightlosstothegoalof79kg,takingpioglitazone30ms/d.Afterasix—monthfollowup,thepatientSanorexiaandhepatalgiawereimproved,andultrasoundshowedmildfattyliver.ConclusionIntegrationoflifestyleintervention,weightcontrol,drugsimprovinginsulinresistanceanddrugsofliverprotectioncanimpr
7、ovetheoutcomeandlifequalityinnon—alcoholicfattyliverpatient。butlong—termeffectneedsfurtherobservation.【Keywords】Non—alcoholicfattyliverdisease;Evidence—basedmedicine;Meta—analysis;Randomizedcontrolledtrial;Therapy非酒精性脂
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