Clinical Observation Of Probiotics On The Treatment Of Metabolic Associated Fatty Liver Disease

BackgroundMetabolic associated fatty liver disease（MAFLD）once named non-alcoholic fatty liver disease（NAFLD）.The early stage of MAFLD can lead to liver function damage,which can seriously lead to liver fibrosis,cirrhosis and even liver cancer.Its prevalence is increasing worldwide,and there is no specific drug approved for the treatment of the disease.Studies have found that gut microbiota disturbance can lead to small intestinal bacterial overgrowth and stimulate the production of inflammatory factors,while at the same time,it can alter intestinal permeability to mediate hepatic fat deposition through the hepato-enteric axis leading to MAFLD.Based on the plasticity of gut microbiota,in this study,we used the administration of lifestyle modification and conventional medicine based on the addition of Bifidobacterium triplet live bacteria to treat MAFLD,observed its clinical effects in the adjuvant treatment of MAFLD,and explored the feasibility and efficacy of probiotics in the treatment of MAFLD.ObjectiveObserving the clinical effects of probiotic adjunctive therapy for MAFLD,it is expected to provide a novel therapeutic method for MAFLD patients.MethodsIn this paper,according to the guidelines for the prevention and treatment of NAFLD（2018 update）,60 patients who were hospitalized and clinically diagnosed with NAFLD in the Department of Gastroenterology and Hepatology of our hospital from may 2020 to may2021 were recruited for the clinical study,and the 60 patients were divided into a control group versus an observation group according to the random number table.Study setting:control group（n=30）: Administration of oral hepatoprotective drugs（polyene phosphatidylcholine capsules）conventional therapy combined with placebo;Observation group（n=30）: on the basis of conventional treatment,an oral probiotic preparation（Bifidobacterium triplet living bacterial dispersion）was administered.All subjects were given basic treatment such as health preaching,moderate intensity physical exercise,and low calorie diet for 8 weeks,and all patients were examined before and 8 weeks after treatment for lipid profile,fasting plasma glucose glycosylated hemoglobin aspartate aminotransferase,and γ-Glutamyl transpeptidase,Alanine transaminase hypersensitivity C-reactive Protein,tumor necrosis factor-α,Interleukin-6;Transient elastography of the liver（Fibro Scan）were performed to evaluate the Controlled attenuation parameter and Liver stiffness measurement,and relevant adverse effects were strictly recorded.Results1.Serological indicators: 1)Metabolic indicators: there was no significant difference in glucose and lipid metabolism between the two groups before treatment（P>0.05）;After treatment in each group,except for Hb A1c（P>0.05）and HDL-C（P>0.05）,in all group were significantly lower than before treatment,The FPG level of the observation group was lower than that of the control group after treatment,and the decrease was statistically significant（P<0.05）;2)In terms of liver function: after treatment,ALT and AST in each group were lower than before treatment;observation groups after treatment of ALT,AST level lower than the control group [（34.6±9.4）U/L vs（42.2±11.1）U/L;（22.6±4.6）U/L vs（29.5±8.0）U/L;P<0.05],The γ-GGT level was no significant difference between the two group after treatment;3)Inflammatory factor levels :after treatment,the serum TNF-α,IL-6are decreased,the TNF-α,IL-6 observation group was obviously lower than the control group [（0.5±0.3）μg/L vs（0.8±0.4）μg/L;（47.3±8.3）pg/m L vs（52.7±7.0）pg/m L;P<0.05],there was no significant difference before and after Hs-CRP treatment.2.Color Doppler ultrasound of the liver: evaluation of the severity of steatosis on liver ultrasound the results showed that both groups improved after treatment compared with before treatment,and in the observation group,46.4% showed a reduction in the severity of fatty liver,50.0% had no difference,and 3.6% had progression;27.6% of the control group showed a reduction in the severity of fatty liver disease,55.2% had no change,and17.2% had progression.However,there was no significant difference between the observation group and the control group（P>0.05）3.Transient elastography of the liver: Liver stiffness measurement（LSM）and Controlled attenuation parameter（CAP）were not significantly different before treatment（P>0.05）;The values of LSM and CAP decreased after intervention in both groups compared with before treatment,The change in CAP values as the primary outcome showed a significant reduction from baseline to week 8 of treatment in the observation group[（299.9±30.0）d B/m vs（277.2±30.1）d B/m;（P<0.05）]The difference was statistically significant;The changes in LSM values measured in the two groups were not significant,But showed a more pronounced decrease in the observation group[（8.3±1.7）KPa vs（7.6±1.7）KPa;（P>0.05）]control group[（8.1±2.0）KPa vs（7.6±1.5）KPa;（P>0.05）],The changes of LSM values between the two groups were not statistically significant（P>0.05）.ConclusionProbiotics can improve glucose and lipid metabolism and adjuvant treatment of MAFLD by regulate Gut microbiota imbalance and reducing TNF-αand IL-6.