[Effect of aerobic exercise and resistance exercise in improving non-alcoholic fatty liver disease: a randomized controlled trial].

Objective: To investigate the effect of dietary control combined with different exercise modes on plasma vaspin, irisin, and metabolic parameters in patients with non-alcoholic fatty liver disease (NAFLD) through a randomized open parallel-controlled study. Methods: The patients aged 30-65 years who visited Tianjin Third Central Hospital from January 2013 to December 2014 and were diagnosed with NAFLD by liver ultrasound and fat content determination were screening, and 474 patients were enrolled in this randomized controlled trial and divided into aerobic exercise group, resistance exercise group, and control group. All patients received dietary intervention. The three groups were compared in terms of biochemical parameters, fat content, NFS score, energy metabolic parameters, body composition index, and levels of vaspin and irisin at baseline and after 6 months of intervention. SPSS 19.0 was used for statistical analysis. The t-test, the Mann-Whitney U test, the chi-square test, and an analysis of variance were used for comparison between groups. The multiple imputation method was used for missing data, and the results were included in the intention-to-treat analysis. Results: There were no significant differences in age, sex, anthropometrical parameters, and biochemical parameters between the three groups at baseline. Compared with dietary control alone, aerobic exercise and resistance exercise helped to achieve significant reductions in waist circumference, diastolic pressure, percentage of body fat, volatile fatty acid, fasting blood glucose, homeostasis model assessment of insulin resistance, triglyceride, low-density lipoprotein cholesterol, free fatty acid, uric acid, alanine aminotransferase, and liver fat content after 6 months of intervention (P < 0.05). The aerobic exercise group had a significant increase in non-protein respiratory quotient and significant reductions in body mass index and aspartate aminotransferase after intervention, as well as a significant increase in resting energy expenditure and significant reductions in abdominal fat ratio and total cholesterol after 6 months of resistance exercise (P < 0.05). The aerobic exercise group and the resistance exercise group had a significant reduction in vaspin and a significant increase in irisin after intervention (P < 0.05), and the resistance exercise group had significantly greater changes in these two adipokines than the aerobic exercise group (P < 0.05). Conclusion: Exercise therapy is an effective method for the treatment of metabolism-associated diseases, and a combination of resistance and aerobic exercises is more reasonable and effective in clinical practice. As a relatively safe exercise mode, resistance exercise can also effectively improve the metabolic state of NAFLD patients.目的： 通过随机开放平行对照研究，探讨饮食控制联合不同运动方式干预对非酒精性脂肪肝（NAFLD）患者血浆内脏脂肪组织来源的丝氨酸蛋白酶抑制剂（Vaspin）、鸢尾素（Irisin）及代谢指标的影响。 方法： 筛选2013年1月- 2014年12月就诊并经腹部超声肝脏脂肪含量测定诊断为NAFLD的30～65岁患者，474例纳入随机对照试验，分为有氧运动组、抗阻运动组和对照组，全部受试者均接受饮食干预。比较三组基线及干预6个月后的生物化学指标、肝脏脂肪含量、NAFLD纤维化评分（NFS评分）、能量代谢参数、体成分指标、Vaspin及Irisin的水平。采用SPSS19.0软件进行数据分析，采用t检验、Mann-Whitney U检验、χ(2)检验、方差分析进行组间比较，缺失数据采用多重填补法填补，并纳入意向性治疗分析。 结果： 三组间年龄、性别、人体学参数及生物化学指标等基线水平比较，差异无统计学意义，具有可比性。与单纯饮食控制组（对照组）相比，有氧运动和抗阻运动干预6个月后腰围、舒张压、体脂百分数、内脏脂肪面积、空腹血糖、胰岛素抵抗指数、甘油三酯、低密度脂蛋白胆固醇、游离脂肪酸、尿酸、丙氨酸氨基转移酶、肝脏脂肪含量均降低，差异有统计学意义（P值均< 0.05）。有氧运动组干预后可见非蛋白呼吸商升高（t = 1.462，P = 0.007），及天冬氨酸氨基转移酶下降（t = 2.278，P = 0.024）。抗阻运动组6个月后静息能量代谢水平升高，腹部脂肪比率、总胆固醇下降，P值均< 0.05，差异均有统计学意义。与对照组比较，有氧运动组及抗阻运动组干预后均可见到Vaspin降低及Irisin水平升高，且两种脂肪因子的变化在抗阻运动组更为显著，差异均有统计学意义（P值均<0.05）。 结论： 运动治疗是治疗代谢相关疾病的有效手段，联合抗阻运动和有氧运动在临床实践中更加合理有效，抗阻运动作为一种相对安全的运动形式同样可以有效地用于改善NAFLD患者的代谢状态。.