脂肪肝の治療について
Treatments for Nonalcoholic Fatty Liver Disease
| Treatment | Comparison | Study type | Patient population | Results | |
|---|---|---|---|---|---|
| Weight loss and exercise14 | No lifestyle intervention | Controlled trial | Body mass index > 25 kg per m2 and steatosis | Improvement in AST and ALT levels and steatosis. Histology improved ut not to statistical significance. | |
| Orlistat (Xenical)15 | NA | Open label | Obese patients with NASH | Improvement in AST and ALT levels. Steatosis improved in six patients, and fibrosis improved in three patients. | |
| Metformin (Glucophage) and diet16 | Diet | RCT | Patients without diabetes who have NASH | Metformin group had significant improvements in AST, ALT, and fatty infiltrate levels. Improvement in liver inflammation was not statistically significant. | |
| Rosiglitazone (Avandia)17 | NA | Open label | Patients with or without diabetes who have NASH | Significant improvement in liver fat content and AST and ALT levels | |
| Pioglitazone (Actos)18 | NA | Open label | Patients without diabetes who have NASH | Significant decrease in AST, ALT, insulin, and C-peptide levels. Significant improvements in steatosis and histology | |
| Gemfibrozil (Lopid)19 | Placebo | RCT | Patients with NASH | Improvement in AST, ALT, and GGT levels | |
| Atorvastatin (Lipitor) and UDCA20 | UDCA | Open label | Patients with NASH (those with hyperlipidemia were placed in the atorvastatin group) | Patients in the atorvastatin group experienced decreased steatosis and improvement in AST, ALT, alkaline phosphatase, and GGT levels. UDCA group had improvement only in ALT and GGT levels. | |
| Pravastatin (Pravachol)21 | NA | Open label | Patients with NASH | Improvement in liver histology and liver enzyme levels | |
| UDCA22 | Placebo | RCT | Patients with NASH | No significant change in steatosis, necroinflammation, or fibrosis | |
| Vitamin E23 | NA | Open label | Obese children with elevated transaminase levels and fatty liver | Normalization of AST and ALT levels during treatment | |
| Vitamin E and lifestyle modifications24 | Vitamin E | RCT | Patients with NASH | Improvement in liver enzymes in both groups, but no additional benefit with vitamin E | |
| Vitamin E(1,000 IU daily) and vitamin C (1,000 mg daily)25 | Placebo | RCT | Patients with NASH | Posttreatment liver biopsy showed decreased fibrosis in treatment group, but no improvement in inflammatory activity or ALT level. | |
| Betaine26 | Placebo | RCT | Patients with NASH | Significant improvements in steatosis, hepatomegaly, and AST, ALT, and GGT levels | |
| Betaine27 | NA | Open label | Patients with NASH | AST and ALT levels improved. Improvement in histology |
AST = alanine transaminase; ALT = aspartate transaminase; NA = not applicable; NASH = nonalcoholic steatohepatitis; RCT = randomized controlled trial; GGT = γ-glutamyltransferase; UDCA = ursodeoxycholic acid.
