非酒精性脂肪肝患者运动管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.20.005

摘要/Abstract

摘要：

目的检索并汇总非酒精性脂肪肝患者运动管理的相关证据，为临床提供参考。方法系统检索UpToDate、BMJ Best Practice、国际指南协作网、苏格兰学院指南网、英国国家卫生与临床优化研究所网站、Cochrane Library、美国医疗保健研究与质量局网站、加拿大安大略注册护士协会网站、美国肝病研究学会网站、PubMed、Web of Science、CINAHL、DynaMed、Embase、中国医脉通指南网、中国知网、中华医学期刊全文数据库、万方数据知识服务平台、中国生物医学文献数据库中关于非酒精性脂肪肝患者运动管理的所有证据，包括指南、证据总结、专家共识、最佳临床实践、临床决策、推荐实践、系统评价，检索时限为建库至2022年11月。由2名研究者独立对文献进行质量评价。结果共纳入系统评价、专家共识、指南18篇文献，从运动原则、运动监督、运动类型、运动选择、运动时间与频率、运动强度等6个方面汇总24条最佳证据。结论该研究汇总的非酒精性脂肪肝患者运动管理的最佳证据具有全面性和科学性，医护人员可以通过应用最佳证据指导非酒精性脂肪肝患者合理运动，提高干预科学性。

关键词: 非酒精性脂肪肝, 运动, 循证护理学, 证据总结

Abstract:

Objective To search and obtain relevant evidence of exercise management in patients with nonalcoholic fatty liver disease（NAFLD） and to provide a reference for clinical practice. Methods UpToDate，BMJ Best Practice，International Guidelines Collaboration（GIN），Scottish College Guidelines Network（SIGN），National Institute for Healthcare Excellence（NICE） website，Cochrane Library，U.S. Agency for Healthcare Research and Quality（AHRQ） website，Canadian Association of Registered Nurses of Ontario（RNAO） website，American Association for the Study of Liver Diseases（AASLD） website，PubMed，Web of Science，CINAHL，DynaMed，Embase，CNKI，Chinese Medical journal full-text database，Wanfang Data Knowledge Service Platform，Sinomed and other databases were systematically searched for all evidence on exercise management of the NAFLD. It includes guidelines，evidence summaries，expert consensuses，best practice information booklets，clinical decisions，recommended practice，and systematic reviews. The retrieval period is from the database inception to November 2022. The quality of the literature was evaluated independently by 2 researchers. Results A total of 18 pieces of literature，including systematic evaluations，expert consensuses，and clinical practice guidelines，were included. 24 pieces of best evidence were collected from 6 aspects，including exercise principle，exercise supervision，exercise type，exercise selection，exercise time and frequency，and exercise intensity. Conclusion This study summarized the best evidence for exercise management of patients with NAFLD，which is comprehensive and scientific. Medical staff can use the best evidence to guide patients with NAFLD to exercise reasonably and improve the scientific nature of the intervention.

Key words: Nonalcoholic Fatty Liver, Exercise, Evidence-Based Nursing, Summary of Evidence

张雪玲, 郑奇容, 王巧松, 方艳, 肖烨, 林燕, 王碧芬, 林蓉金. 非酒精性脂肪肝患者运动管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(20): 2464-2471.

ZHANG Xueling, ZHENG Qirong, WANG Qiaosong, FANG Yan, XIAO Ye, LIN Yan, WANG Bifen, LIN Rongjin. The best evidence summary of exercise management of patients with nonalcoholic fatty liver disease[J]. Chinese Journal of Nursing, 2023, 58(20): 2464-2471.

图/表 4

表1 纳入文献的基本特征（n=18）

Table 1 Characteristics of included studies（n=18）

表2 纳入系统评价的文献质量评价结果（n=11）

Table 2 Quality evaluation results of the literature included in a systematic evaluation（n=11）

表3 纳入指南的质量评价结果（n=4）

Table 3 Quality evaluation results of guidelines（n=4）

表4 非酒精性脂肪肝患者运动管理的最佳证据总结

Table 4 Summary of the best evidence for exercise management in patients with NAFLD

参考文献 33

[1]	Golabi P, Bush H, Younossi ZM. Treatment strategies for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Clin Liver Dis, 2017, 21(4):739-753. DOI PMID
[2]	Lu FB, Zheng KI, Rios RS, et al. Global epidemiology of lean non-alcoholic fatty liver disease:a systematic review and Meta-analysis[J]. J Gastroenterol Hepatol, 2020, 35(12):2041-2050. DOI URL
[3]	Ye Q, Zou B, Yeo YH, et al. Global prevalence,incidence,and outcomes of non-obese or lean non-alcoholic fatty liver dis-ease:a systematic review and Meta-analysis[J]. Lancet Gastroen-terol Hepatol, 2020, 5(8):739-752.
[4]	Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China,France,Germany,Italy,Japan,Spain,United Kingdom,and United States for the period 2016-2030[J]. J Hepatol, 2018, 69(4):896-904. DOI URL
[5]	Ahmed IA, Mikail MA, Mustafa MR, et al. Lifestyle interventions for non-alcoholic fatty liver disease[J]. Saudi J Biol Sci, 2019, 26(7):1519-1524. DOI PMID
[6]	Golabi P, Locklear CT, Austin P, et al. Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease:systematic review[J]. World J Gastroenterol, 2016, 22(27):6318-6327. DOI URL
[7]	Gao Y, Lu J, Liu X, et al. Effect of long-term exercise on liver lipid metabolism in Chinese patients with NAFLD:a systematic review and Meta-analysis[J]. Front Physiol, 2021, 12:748517. DOI URL
[8]	Xiong Y, Peng Q, Cao C, et al. Effect of different exercise methods on non-alcoholic fatty liver disease:a Meta-analysis and Meta-regression[J]. Int J Environ Res Public Health, 2021, 18(6):3242 DOI URL
[9]	Hong F, Liu Y, Lebaka VR, et al. Effect of exercise training on serum transaminases in patients with nonalcoholic fatty liver disease:a systematic review and Meta-analysis[J]. Front Physiol, 2022, 13:894044. DOI URL
[10]	中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018更新版)[J]. 中华肝脏病杂志, 2018, 26(3):195-203.
	National Group on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee,Chinese Medical Doctor Asso-ciation. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:a 2018 update[J]. Chin J Hepatol, 2018, 26(3):195-203.
[11]	梁丽萍, 傅荣, 李呈慧, 等. 腹膜透析患者便秘管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(23):2930-2937. DOI
	Liang LP, Fu R, Li CH, et al. Summary of the best evidence of constipation management in peritoneal dialysis patients[J]. Chin J Nurs, 2022, 57(23):2930-2937. DOI
[12]	周芬, 郝玉芳, 从雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Guideline research and evaluation tool AGREEⅡ and supplementary explanation and reflection on scores in various fields[J]. J Nurs China, 2018, 25(18):56-58.
[13]	The Joanna Briggs Institute. Critical appraisal tools[EB/OL].[2022-12-13]. https://jbi.global/critical-appraisal-tools.
[14]	中华医学会内分泌学分会. 非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版)[J]. 中华内分泌代谢杂志, 2018, 34(7):549-554.
	Chinese Society of Endocrinology,Chinese Medical Associa-tion. Consensus for diagnosis and treatment of nonalcoholic fatty liver diseases and metabolic disorders(2nd edition)[J]. Chin J Endocrinol Metabolism, 2018, 34(7):549-554.
[15]	Wang ST, Zheng J, Peng HW, et al. Physical activity intervention for non-diabetic patients with non-alcoholic fatty liver disease:a Meta-analysis of randomized controlled trials[J]. BMC Gastroenterol, 2020, 20(1):66. DOI
[16]	沙利娟, 张爱霞, 樊雪梅, 等. 产妇产后抑郁非药物干预的最佳证据总结[J]. 中华护理杂志, 2022, 57(24):2977-2984. DOI
	Sha LJ, Zhang AX, Fan XM, et al. Evidence summary of non-pharmacological interventions for maternal postpartum depression[J]. Chin J Nurs, 2022, 57(24):2977-2984. DOI
[17]	Hashida R, Kawaguchi T, Bekki M, et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease:a systematic review[J]. J Hepatol, 2017, 66(1):142-152. DOI PMID
[18]	中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会, 中华医学会肝病学分会脂肪肝与酒精性肝病学组, 等. 中国脂肪性肝病诊疗规范化的专家建议(2019年修订版)[J]. 中华肝脏病杂志, 2019, 27(10):748-753.
	Committee of Hepatology, Chinese Research Hospital Associa-tion;Fatty Liver Expert Comitee, Chinese Medical Doctor As-sociation;National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, et al. Expert recommendations on standardized diagnosis and treatment for fatty liver disease in China(2019 revised edition)[J]. Chin J Hepatol, 2019, 27(10):748-753.
[19]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[20]	Kenneally S, Sier JH, Moore JB. Efficacy of dietary and phys-ical activity intervention in non-alcoholic fatty liver disease:a systematic review[J]. BMJ Open Gastroenterol, 2017, 4(1):e000139. DOI URL
[21]	Paris T, George ES, Roberts SK, et al. The effects of diet and lifestyle interventions on insulin resistance in patients with nonalcoholic fatty liver disease:a systematic review[J]. Eur J Gastroenterol Hepatol, 2017, 29(8):867-878. DOI URL
[22]	Zhou BJ, Huang G, Wang W, et al. Intervention effects of four exercise modalities on nonalcoholic fatty liver disease:a systematic review and Bayesian network Meta-analysis[J]. Eur Rev Med Pharmacol Sci, 2021, 25(24):7687-7697.
[23]	Yu X, Wang Y, Lai J, et al. Comparative efficacy of exercise training processes in improving nonalcoholic fatty liver disease:a systematic review and Meta-analysis[J]. Ir J Med Sci, 2022, 192(1):131-142. DOI
[24]	Smart NA, King N, Mcfarlane JR, et al. Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease:a systematic review and Meta-analysis[J]. Br J Sports Med, 2018, 52(13):834-843. DOI URL
[25]	Ratziu V, Ghabril M, Romero-Gomez M, et al. Recommendations for management and treatment of nonalcoholic steatohepatitis[J]. Transplantation, 2019, 103(1):28-38. DOI PMID
[26]	Arab JP, Dirchwolf M, álvares-Da-Silva MR, et al. Latin American Association for the study of the liver(ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease[J]. Ann Hepatol, 2020, 19(6):674-690. DOI URL
[27]	Tokushige K, Ikejima K, Ono M, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 2020[J]. J Gastroenterol, 2021, 56(11):951-963. DOI PMID
[28]	Associazione Italiana per lo Studio del Fegato(AISF), Italian Diabetes Society(SID), Italian Society for Obesity(SIO). Non-alcoholic fatty liver disease in adults 2021:a clinical practice guideline of the Italian Association for the Study of the Liver(AISF),the Italian Society of Diabetology(SID) and the Italian Society of Obesity(SIO)[J]. Eat Weight Disord, 2022, 27(5):1603-1619. DOI
[29]	Kim D, Murag S, Cholankeril G, et al. Physical activity,mea-sured objectively,is associated with lower mortality in pa-tients with nonalcoholic fatty liver disease[J]. Clin Gastroen-terol Hepatol, 2021, 19(6):1240-1247.e5.
[30]	Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease:an international expert consensus statement[J]. J Hepatol, 2020, 73(1):202-209. DOI URL
[31]	National Institute for Health and Care Excellence. Non-alcoholic fatty liver disease(NAFLD):assessment and management[EB/OL]. (2016-07-06)[2023-03-01]. https://www.nice.org.uk/guid-ance/ng49.
[32]	王晶, 王晖, 丁祥武. 节食减重与有氧运动对非酒精性脂肪肝的影响研究[J]. 中国全科医学, 2017, 20(16):1951-1954. DOI
	Wang J, Wang H, Ding XW. Effect of weight loss by dieting versus aerobic exercise on nonalcoholic fatty liver disease[J]. Chin General Practice, 2017, 20(16):1951-1954.
[33]	王丽娟, 孙苗芳. 非酒精性脂肪肝病运动疗法的研究进展[J]. 中华护理杂志, 2014, 49(5):588-592.
	Wang LJ, Sun MF. Exercise therapy for nonalcoholic fatty liver disease:a review[J]. Chin J Nurs, 2014, 49(5):588-592.