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目的:探讨健步走和太极拳综合练习后非酒精性脂肪肝(NAFLD)患者肝损伤、储备功能及血脂的变化,分析有氧运动对NAFLD肝功能(肝损伤及储备功能)及血脂指标的影响差异。方法:随机抽取广州市番禺区自来水公司NAFLD患者24人(男性18人,女性6人),实施为期16周健步走和太极拳综合练习的有氧运动,每周4次,每次1小时。运动强度为60%～70%HRmax(HRmax=220-年龄),运动强度开始为50%～60%HRmax,逐步递增至60%～70%HRmax。分别于实验前和有氧运动16周后采用B超诊断受试者肝脏脂肪变性程度,测定受试者体重和BMI;于实验前、有氧运动8周后、16周后测定肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、总蛋白(TP)、白蛋白(ALB)和血脂指标甘油三酯(TG)、胆固醇(TC)、载脂蛋白A-1(ApoA-1)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。结果:(1)16周有氧运动后,B超结果显示,NAFLD患者肝脏改善平均有效率为70.8%,其中轻度脂肪肝较重度脂肪肝有效率显著升高(P<0.05)。受试者体重和BMI显著降低(P<0.05或P<0.01)。(2)与实验前比较,16周有氧运动后患者血清GGT、ALT、AST、ALP显著下降,TP、ALB和ALB/GLB显著升高,有氧运动8周后GGT、ALB出现显著变化(P<0.05或P<0.01)。(3)与实验前比较,8周有氧运动后LDL-C、载脂蛋白与脂质比值均出现显著变化(P<0.05或P<0.01)。结论:16周健步走和太极拳综合练习能有效改善NAFLD患者肝损伤、储备功能及血脂代谢紊乱,而GGT和ALB与其它肝功能指标相比较先变化。LDL-C、载脂蛋白与血脂脂质比值结合,较单一指标能更好地监控有氧运动改善NAFLD脂代谢紊乱过程。
Objective: To explore the changes of liver injury, reserve function and blood lipid in patients with non-alcoholic fatty liver disease (NAFLD) after walking and shadowboxing exercises, and analyze the effect of aerobic exercise on liver function (liver injury, reserve function) and blood lipid of NAFLD difference. Methods: A total of 24 NAFLD patients (18 males and 6 females) from Panyu District Water Supply Company of Guangzhou were randomly selected and performed aerobic exercise of walking and Taijiquan comprehensive exercises for 16 weeks. They were given 4 times a week for 1 hour each time. The exercise intensity was 60% -70% HRmax (HRmax = 220-age). The exercise intensity was 50% -60% HRmax and gradually increased to 60% -70% HRmax. The degree of hepatic steatosis was measured by B-mode ultrasound before and 16 weeks after aerobic exercise respectively. The body weight and BMI of the subjects were determined. Before the experiment, after 8 weeks aerobic exercise, the liver function indicators C (ALT), aspartate aminotransferase (AST), glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin Indexes of TG, TC, ApoA-1, ApoB, HDL-C and LDL-C LDL-C). Results: (1) After 16 weeks of aerobic exercise, the results of B-ultrasound showed that the average effective rate of liver improvement was 70.8% in NAFLD patients, and the rate of severe fatty liver was significantly higher in mild fatty liver (P <0.05). Subject weight and BMI were significantly lower (P <0.05 or P <0.01). (2) Serum levels of GGT, ALT, AST and ALP were significantly decreased and TP, ALB and ALB / GLB were significantly increased after aerobic exercise in 16 weeks. There was significant change of GGT and ALB after 8 weeks of aerobic exercise P <0.05 or P <0.01). (3) Compared with the pre-experiment, LDL-C, apolipoprotein and lipid ratio showed significant changes after aerobic exercise for 8 weeks (P <0.05 or P <0.01). Conclusion: The comprehensive exercise of walking and shadowboxing for 16 weeks can effectively improve the liver injury, reserve function and dyslipidemia in patients with NAFLD, while GGT and ALB change first with other liver function indexes. The combination of LDL-C, apolipoproteins and lipid-lipids ratio can better monitor the aerobic exercise to improve the disorder of lipid metabolism in NAFLD than the single indicator.