The treatment of fatty liver
The treatment of fatty liver is the most effective drug what? It should be noted, as well as food taboos?
Answer:
Fat metabolism in the liver is an important place. When the synthesis of fatty liver on the ability to increase and / or transfer into the blood’s ability to decrease, lipid material (for triglycerides) in the liver accumulation of too many more than 5% of the weight of the liver, or histology, 50% In real terms over the liver and fat, which is fatty liver [1]. Fatty liver disease is not an independent, but by a variety of diseases and causes of fatty liver caused by the change. The most common reason for obesity, alcoholism, diabetes; followed by malnutrition, drug poisoning, pregnancy, genetic, and so on.
With the material life of our people continue to improve our country the incidence of fatty liver increased year by year, have accounted for an average of 10% of the population, obesity, diabetes and Anopheles sprinkling the crowd could be as high as 50% to 60%, of which about 25% The occurrence of liver fibrosis patients, 1.5% to 8.0% of patients develop liver cirrhosis. As a result, the prevention and treatment of fatty liver to stop the progress of chronic liver disease and improve the prognosis is very important.
1. The pathogenesis of fatty liver
Not yet clear, the following factors may play a role [3].
1.1 fat metabolism: ① transport free fatty acids increased inflow; ② liver synthesis of free fatty acids or carbohydrate synthesis of triglycerides increase; ③ fatty acid oxidation in liver mitochondria b reduction; ④ very low density lipoprotein synthesis to reduce the secretion of the three - Glycerol obstacle to the transfer.
1.2 hormones: estrogen, cortisol, growth hormone, glucagon, insulin and insulin-like growth factor, and so on, may change the source of energy metabolism and induced the formation of fatty liver.
1.3 Environmental factors: diet, nutrition, food contamination and hepatitis virus infection (mainly HCV) and factors such as fatty liver and its complications steatohepatitis, cirrhosis-related.
1.4 Genetic factors: whether alcoholic or non-alcoholic, there is a certain degree of genetic risk factors. ALD is a multi-gene genetic diseases, alcohol dehydrogenase (ADH), cytochrome P450 2E1 (CYP2E1), or microsomal ethanol oxidation system (MEOS), aldehyde dehydrogenase (ALDH) are genetic polymorphism, when there is High activity of ADH isozyme, CYP2E1 activity in the high or low ALDH activity may have a rate of acetaldehyde-induced increase in the rate of oxidation decreased.
1.5 oxidative stress and lipid peroxidation: promoting oxide and antioxidants to reduce the number of oxygen stress can be caused by oxygen molecules from the reactive oxygen radicals produced or increased reactive oxygen and Polyunsaturated Fatty Acids From lipid peroxidation generated LPO.
1.6 immune response: a new antigen expression, lymphocyte phenotype changes in body fluids and antibodies and cytokines appear related to immune response.
1.7 liver screen change: sinusoidal endothelial cell layer was sieve-like structure (that is, liver sieve), the lipid metabolism of selective in order to maintain the normal structure of the liver; liver sieve structure and function can cause changes in lipid metabolism Lead to fatty liver, liver fibrosis and cirrhosis.
1.8 The role of free fatty acids: fatty liver oxidative phosphorylation and fatty acid oxidation b damaged in the formation of fatty liver disease plays a key role in the process.
1.9 hypoxia and liver microcirculation: the long-standing problem of fatty liver may be a result of serious liver disorder or lipid metabolism changes oppression sinusoidal liver cells, liver cells caused by avascular necrosis, which induced cirrhosis of liver fibrosis. Alcoholic and non-alcoholic fatty liver cirrhosis occurred in the process of chance and, with both likely to cause liver microcirculation and the different levels of hypoxia-related.
2. Fatty liver clinical performance
Fatty liver patients, some of the things in addition to weight gain no significant symptoms. Most people have a weakness, loss of appetite, abdominal distension, diarrhea and other symptoms. Some people as a result of increased volume of the liver, liver capsule was a sense of traction and liver pain area. For patients with a history of hepatitis, liver disease often feel heavier and more restrictions on activities, increase nutrition; due to the increasing body weight, increase the fatty liver, liver pain exacerbated by the district, a vicious circle. Individual bile pressure may be small because of mild jaundice. There are only a part of a long-term performance of mild to moderate increased transaminase, without any discomfort, but a medical examination found elevated transaminase, elevated blood lipids in particular, higher triglycerides. Ultrasound examination found that contribute to fatty liver. B-ultrasound in real terms in the liver usually reflected wave was at the bottom and front to strengthen weakened. CT scanning, can be seen in real terms in the liver to reduce the density (CT value low). In particular, the spleen contrast with the more precise and easily identified. Contribute to liver biopsy confirmed.
3. Fatty liver drug treatment
The treatment of fatty liver of a lot of drugs can be broadly divided into: lipid-lowering drugs, Liver fat-free Chinese medicine and drugs. But noted that the current treatment of fatty liver is still to remove the causes, treatment and adhere to the original incidence of eating a reasonable system of the main drug treatment only play a supporting role, according to the cause of fatty liver disease and a reasonable choice.
3.1 lipid-lowering drugs [5]:
3.1.1-fibrate, including fibrates, bezafibrate, fenofibrate, and so on. Have lower plasma triglycerides and inhibit the synthesis of cholesterol synthesis inhibit liver at the same time can reduce low-density lipoprotein and serum uric acid. As a result, most suitable for plasma triglyceride and diabetes was significantly higher in patients with hyperlipidemia. In recent years, the development of micronized fenofibrate so that the rate of absorption increased by 30%, and reduced the plasma of the active ingredient variability, uniform absorption, serum stability, it is considered to be the best third-generation phenoxy-acid preparation . Oral amount of 200mg, qd, 2 ~ 3-month course of treatment. This product is safe and reliable, short-term (<December) and long-term (June to 6 years) application of the total incidence of adverse reactions were 6.3% and 11.3%, mainly on the abdominal discomfort, burning fullness, decreased appetite or light Severe diarrhea, etc. [7].
3.1.2 choline, methionine choline to constitute one of the components of lecithin, to participate in the body-for-shift and the role of lipoprotein metabolism, not only fat but also to the oxidation of fatty acids in the liver also play an important role. Is an essential amino acid methionine, the body in the provision of Synthesis-choline, can affect the body’s metabolism and maintain phospholipid biofilm integrity of the structure and function. According to the study, eating rats in the absence of choline or methionine can occur fatty liver and liver fibrosis, and add methionine and choline to prevent or mitigate the lack of choline and alcohol-induced liver injury, liver pathology to make changes to reverse . The two often combined for the treatment of hyperlipidemia. In recent years, found that the lack of human choline found only in malignant malnutrition and long-term intravenous nutrition high-energy treatment. Therefore, the two drugs that apply only to a vicious long-term intravenous nutrition and high-nutrition therapy-induced fatty liver. The agents used were: choline chloride, 0.3 ~ 1.0g / times, po, tid. Choline compound, each 2ml, qd or bid, intramuscular injection. Met: every 1 ~ 2g, tid. At present, the domestic market, commonly used Dongbao Gantai also a type of drug tablets, the main ingredients are: methionine, choline re-tartaric acid, vitamin B12 and so on nine drug. Use 3 to 1, 3 times a day. Li Jun, etc. [8] Dongbao with liver fat will tayga an 149 cases of the treatment of fatty liver, liver imaging to obtain improved sound effects.
Due to chronic liver disease in patients with liver S-adenosylmethionine synthetase and alcohol-phosphatidyl-N-methyltransferase activity decreased plasma methionine clearance rate of decline, so large or long-term oral treatment of methionine, induced liver The risk of encephalopathy. In recent years, so the 2 drugs have been very few applications.
3.1.3 type of nicotinic acid for Class B vitamins. There are nicotinic acid inhibitory adipose tissue break down fat, lower plasma levels of fatty acids, which affects the liver’s synthesis of triglycerides; Niacin can also block catecholamine, adrenocorticotropic hormone, glucocorticoid, such as on fat Decomposition, and inhibit the 3 - hydroxy -3 - A Coenzyme A (HMG-CoA) reductase activity, so that the synthesis of cholesterol reduction. In addition, there are strong around the vasodilator effect. Therefore, the drug has a lower plasma triglycerides, and very low density lipoprotein cholesterol, regulate blood lipids. Reduce the role of triglyceride lowering cholesterol than the more visible role, it can be used for the treatment of fatty liver. At present, nicotinic acid commonly used class of lipid-lowering drugs: vitamin E nicotinate, 0.1 ~ 0.3g, tid; pentylenetetrazol-smoking, 1 ~ 2g, tid. Although a new generation of nicotinic acid drugs side effects than decreased, but due to its lowering effect of chlorine than fibrates precise, so it was not that these drugs [1].
3.1.4 lowering drugs other HMG-CoA reductase inhibitors, simvastatin can inhibit liver Ito cell proliferation, and to significantly improve alcoholic fatty liver in patients with liver function and blood lipid metabolism and its lipid-lowering effect and whether or not patients HCV infection unrelated to the merger. Pravastatin can significantly reduce the high-fat diet-induced hyperlipidemia and fatty liver of rabbit blood lipid levels, so that the liver fat deposition to improve [6]. The antioxidant glutathione, taurine, β carotene, vitamin E and so on will help reduce the deposition of fatty liver caused by lipid peroxidation damage, to prevent the formation of hepatic fibrosis.
For the above-mentioned lipid-lowering drug in the treatment of fatty liver, there are still objections [9]. This is because many of the lipid-lowering drugs may become more focused so that the blood lipid metabolism in the liver to carry out, but the promotion of lipid accumulation in the liver and liver damage. Therefore, no significant hyperlipidemia patients should not blindly take the long-term lipid-lowering drug.
3.2 Liver fat-free drug
3.2.1 fatty acids and phospholipids such drugs synthesis liver and the biofilm is a very important component of low-density lipoprotein, the body’s absorption of fat, and trans-shipment price of unsaturated fatty acids play an important role in storage, liver synthesis Phospholipid very active, long-term alcoholics biofilm in unsaturated fatty acids and phospholipids reduced, thus affecting the membrane structure and function, leading to abnormal lipid metabolism and liver fat deposition. Gumderman [10] with more fatty lecithin (a liver health) in the treatment of 32 cases of fatty liver associated with diabetes, medication for 6 months after the disappearance of hepatomegaly, improve liver function and liver cells to reduce fat deposition In such areas as better than the control group; and patients tolerated the drug well, can be prompted for the treatment of fatty liver. Clinical dose commonly used for: 1 ~ 2, tid, po; injection usually 5ml, qd, intravenous injection, severe cases can be used to 10 ~ 20ml.d-1.
3.2.2 S-adenosyl-L-methionine (SAMe) SAMe is present in the human body fluids and all the elements of a physical activity, mainly by the liver S-adenosylmethionine synthetase catalytic substrate ATP and methionine The synthesis. As the methyl donor physiologic and SH precursor compounds involved in a number of important biochemical reactions in vivo. It can be phospholipid membrane protein methylation and its impact on liquidity and micro stickiness, to increase the liver glutathione-S-, and taurine sulfate levels and increased homocysteine coenzyme A, and so on Synthesis. In the liver cells and therefore the maintenance of mitochondrial integrity of the structure and function plays a key role. Clinically, SAMe for the treatment of cholestatic liver disease. The main preparation is thought the United States and Thailand, the initial treatment: 500 ~ 1000mg.d-1, muscle or intravenous injection, a total of 2 weeks; maintenance therapy: 1000 ~ 2000mg.d-1, po. In the small-scale clinical studies found that as a result of long-term alcohol abuse can SAMe in the body synthase activity decreased, SAMe and its metabolites reduce the generation of liver cells to remove anti-free radical oxidation of lipid the ability to weaken, SAMe treatment of alcoholic fatty liver Patients with ALT and GGT levels were significantly decreased. But think of the United States and Thailand’s expensive, it is difficult in the near future, widely used clinically.
3.2.3 JiangMei liver drug in the past that fatty liver on liver function is very small, do not take drugs JiangMei Liver. In recent years, with the incidence of fatty liver increased continuously found that more than 30% of patients with fatty liver transaminase levels can be increased to the normal limit of 2 to 3 times that of alcoholic fatty liver of patients with AST and ALT levels in some cases as well as rise High-normal upper limit of 5 to 10 times, and AST / ALT> 2, GGT level was significantly higher than normal, and is considered to be alcohol-induced liver disease diagnosis based on one. As a result, to have abnormal liver function of patients should be given JiangMei Liver-aid treatment. Could Granule selection sarmentosum 10g, tid; film Liver 4 / times, tid. However, these drugs JiangMei all of a sudden stop after the emergence of aminotransferase rebound. As a result, in the normal liver function should be a gradual reduction to be suspended. Glycyrrhizin type of preparation can also be chosen, but because the drug has steroid-like effects, long-term use can increase blood pressure and blood sugar is not conducive to the treatment of fatty liver. As the fatty liver induced liver disease is a slow, especially alcoholic fatty liver is usually AST> ALT, therefore, are not in favor of selection of DDB JiangMei category of drugs [11].
3.2.4 Other Liver drug ursodeoxycholic acid (Ursodexycholic acid) have similar cholesterol-Biliary resin eliminate the role of reduced blood lipids and stability of the liver cell membrane and inhibit mononuclear cells produce cytokines. Laurin, and so on [12] with ursodeoxycholic acid or chlorine Bedin in the treatment of non-alcoholic fatty liver in 40 cases. The results showed that Bedin chlorine in the treatment of non-alcoholic fatty liver no clinical effect, and ursodeoxycholic acid treatment in patients after 12 months of the ALP, ALT, GGT and fatty liver changes have been significantly improved. Tiopronin (Tiopronin) for a new type of thiol drugs, to participate in the series, and other aspects of metabolism plays an important role. Can be caused by chemicals in the prevention and treatment of liver damage and speed up the excretion of alcohol in the body [13], to prevent the accumulation of triglycerides, for the treatment of fatty liver; silymarin on drugs and alcohol-induced liver poisoning Damage to a better effect; glucurolactone inhibit decomposition of liver glycogen, so that the increase in liver glycogen and fat storage reduction, to reduce serum transaminase; propylamine peacekeeping promote liver regeneration, reducing blood lipid; inosine and muscle Sodium guanosine increase pyruvate and coenzyme A oxidase activity and improve liver function and prevent fatty liver.
3.3 Chinese medicine [1,15] a number of Chinese herbal medicine has a role in blood fat, such as Polygonum multiflorum, salvia, Alisma, Chuanxiong, cassia, such as hawthorn; some of the traditional Chinese medicine, such as Xiao Chai Hu Tang, Sini Powder, Liuweidihuangwan For the treatment of fatty liver and hyperlipidemia have a certain effect. At present, the treatment of fatty liver than the commonly used Chinese medicine and Chinese medicine are tea extracts pigment, and Xuezhikang zhinbiticose. Tea green pigment extracted from natural ingredients. Better regulation of blood lipid disorders, can reduce serum cholesterol and triglycerides, there are significant anti-lipid peroxidation and free radical scavenging effect. Apply to the treatment of hyperlipidemia and fatty liver. Use 1-2, tid. Xuezhikang to Dangshan Monascus rice system for raw materials, the use of modern bio-technology and modern medical means to regulate the breeding of fine strains lipid made from traditional Chinese medicine. Can be effective prevention and treatment of atherosclerosis and coronary heart disease arising, such as cerebral vascular disease. To use: 0.6 g, 2 times / d. Zhinbiticose the main ingredients are: Hawthorn, Atractylodes, Monascus, and so on, for the use of: 1.05 g, 3 times / d. Xiao super strong [16], and so on for more than two drugs used in treatment of hypercholesterolemia, are better effect. Chinese medicine to fatty liver disease according to their machines into Liver depression and Qi stagnation, phlegm and Qizhixueyu resistance, and so on a different type, using Chinese medicine for the treatment of fatty liver should be dialectical.
4. Various types of fatty liver treatment of the main points:
4.1 Merger viral hepatitis patients with fatty liver fatty liver, liver and the use of lower fat, more fat at the same time as a result of the reduction factor by reducing the fat out of Hong Kong, combined with over-limit physical activity, long-term high-calorie high-sugar diet And the gradual formation of fatty liver. Because of viral hepatitis in patients with liver detoxification capacity of the drug decline in the use of fibrate drugs, easy to cause liver damage. As a result, should be chosen to Liver lipid drug. Abnormal liver function may JiangMei taking medication. The merger of fatty liver hepatitis, hepatitis prognosis depends largely on the process itself. As a result, the use of anti-viral treatment of viral hepatitis in favor of fatty liver of a turn for the better, and reduce the long-term due to the deposition of fatty liver caused by liver fibrosis.
4.2 over-nutrition in the treatment of fatty liver in the treatment of fatty liver, fatty liver as the basis of obesity, nutrition, diabetes and other maladies must be a reasonable diet, adequate exercise and positive treatment of diabetes and other methods to conduct a comprehensive treatment. Can not only look forward to taking some drugs, in the short term to achieve the purpose of cure fatty liver, should not blindly take lipid-lowering drugs in order to avoid increasing the burden on the liver and increase the fatty liver caused by liver damage.
4.3-alcoholic fatty liver treatment of alcoholic fatty liver is the key to the treatment of alcoholism. If the alcoholic fatty liver in the early alcohol, fatty degeneration of the liver can be fully restored. Alcoholic fatty liver in the late alcohol, has become a fatty liver and cirrhosis of the disease can be significantly reversed.
4.4 how to deal with normal blood lipid fatty liver in patients with normal blood lipids in patients with fatty liver was mainly due to the fat metabolism in the liver’s ability to diminish or to be consumed in excess of fat metabolism in the liver of their ability. As a result, the main treatment is to strengthen the liver metabolism of fat, while reducing dietary fat in the amount of income. Tiopronin treatment can be chosen, silymarin drugs, such as drug treatment. The promotion of lipid-lowering drugs fat metabolism in the liver, but may increase the burden on the liver.
Fatty liver disease eating principles
In recent years, the fatty liver of patients with more and more, according to a medical examination and investigation, the adult prevalence rate of fatty liver of 5% to 9%, obesity in children, 20% to 30% suffer from varying degrees of fatty liver. Some people suffer from fatty liver do not understand, “I never Chi Feirou, how could it get fatty liver.” In fact, the accumulation of fat in the body, in many ways, fat or oil was just one of the digestion and absorption, too much protein or carbohydrates, the body can also be turned into fat. When the storage of fat in the liver, liver weight content of more than 10%, fatty liver can be diagnosed.
The occurrence of fatty liver, there are other reasons, for example, some people are not fat, and even some weight, but can also occur fatty liver, which is caused by poor liver function; inadequate intake of protein, fat contained in the delivery of intrahepatic Lack of lipoprotein, resulting in the accumulation of fat in the liver, fatty liver, and so appear. In fatty liver caused by many reasons, our patients as a result of obesity, diabetes, hyperlipidemia, such as hepatitis caused by the majority, is due to a small number of drug poisoning, caused by poor nutrition, diet accounts for very important unreasonable. As a result, no matter what method of treatment of fatty liver, should be combined with diet therapy can be achieved effectively.
Intake of high-protein diet can provide choline, methionine, and other factors make the anti-fatty liver fat into lipoprotein, is conducive to smooth out their liver to prevent the infiltration of fat. There are high protein foods special power, stimulate metabolism, increase the appropriate quality protein will help to reduce body weight. Daily intake of 90 to 120 grams of protein, eggs, milk, meat, beans and its products can be. If abnormal liver function should be mainly dry beans and bean products, and to limit the production of ammonia in the intestines of more meat.
Adequate supply of energy in order to avoid residual heat into the fat suit when the heat control. Of normal weight, light energy can work per kg body weight 0.13 MJ (30 kcal), who were overweight 0.11 to 0.08 MJ (20 to 25 kcal). Amount of fat in the supply of essential fatty acids involved in the synthesis of phospholipids, make fat in the liver from a smooth out, enabling the prevention of fatty liver. As a result, should be given adequate fat, 50 grams a day or so. Cholesterol-free vegetable oil, useful for treating fatty liver. Should use cooking oil, fish oil can be selected, should be limited to high-cholesterol food alcohol fatty liver, such as animal offal, fat and skin, as well as roe, egg yolk, and so on.
The provision of low carbohydrate diet may stimulate a large number of synthetic fatty liver, is caused by obesity and fatty liver an important factor. As a result, as opposed to reduce fat, carbohydrate intake control, and more conducive to weight loss and treatment of fatty liver, and in particular fasting sugar, fructose, glucose and sugar content of food such as cakes. To ensure adequate vitamin poor liver function when the storage capacity of the vitamin to reduce, if not in time to add attention, it will cause a lack of vitamins in the body. In order to protect the liver cells and prevent damage to fresh multi-vitamin-rich food such as fresh yellow-green vegetables, fruits and so on.
Dietary fiber and minerals added vitamins, minerals supply in favor of metabolic waste discharge, blood lipid regulating dietary fiber, the role of blood sugar has also been confirmed for many of the Institute. Food should not be too fine, the staple food should be thick with cereals, with more vegetables, fruits and algae bacteria, such as celery, scallions, bamboo shoots, bananas, edible fungus, mushroom, seaweed, laver, and so on in order to ensure an adequate number of dietary fiber intake.
Prohibition to quit smoking as long as excessive drinking, the liver should be the first to be affected. Toxic effect of alcohol on the liver cells and reduce the liver’s ability to Sinotrans fat cells, leading to accumulation of fat in the liver, cause or aggravate fatty liver. As a result, have taken place if the fatty liver, alcohol is an effective treatment. Drinking and smoking, as if “worse”, should Jiejue.
More tea drinking tea in a variety of pharmacological effects, including the promotion of fat metabolism, cardiovascular disease prevention and control function, prevention and treatment of fatty liver is also good. Black tea, green tea, oolong tea, white tea, tea and tea are yellow lipid-lowering effect, with more green tea, green tea because of the content of the highest tea polyphenols.
To sum up, quit alcohol, tea, I eat vegetables and fruits, Chi Feirou fewer calories Liangchu control for income, to make ends meet; increase in the amount of exercise, the more jobs they do, patients will certainly be able to effectively To prevention and treatment of fatty liver.
