运动训练改善代谢功能障碍相关脂肪性肝病成人的肝酶、体重指数和心肺适能：一项系统综述和荟萃分析。
完整摘要 · 中文译文
背景：运动被推荐用于代谢功能障碍相关脂肪性肝病（MASLD）。近期综述已探讨了特定运动方式或选定的结局领域，但仍需要对随机试验中肝脏、代谢和心肺反应进行更新的综合评估。 方法：我们开展了一项符合PRISMA 2020规范的系统综述和荟萃分析，纳入对象为患有MASLD或既往诊断为非酒精性脂肪性肝病/非酒精性脂肪性肝炎的成人随机对照试验。检索了PubMed、Embase、CENTRAL、Scopus、Web of Science和SPORTDiscus，检索时间自建库至2026年6月。合并了干预后均数差（MDs）或标准化均数差（SMDs）及其95%置信区间（CIs）。使用RoB 2评估偏倚风险，使用GRADE评估证据确定性。 结果：共纳入25项试验。运动降低了丙氨酸氨基转移酶（ALT；MD -7.33 U/L，95% CI -10.71至-3.95）、天冬氨酸氨基转移酶（AST；MD -5.52 U/L，95% CI -10.24至-0.79）和BMI（随机效应MD -1.54 kg/m²，95% CI -2.28至-0.80），并改善了VO2peak/VO2max（MD 4.08 mL/kg/min，95% CI 1.00至7.16）。肝脏脂肪/脂肪变性、HOMA-IR和HbA1c的合并效应无统计学显著性。Egger检验显示ALT或AST无显著不对称性，而BMI显示漏斗图不对称，提示可能存在小样本效应。 结论：运动训练可改善MASLD/NAFLD成人的肝酶、BMI和心肺适能，而肝脏脂肪和血糖结局的证据 仍不太确定。PROSPERO：CRD420261416397。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD420261416397。
完整摘要 · 英文原文
BACKGROUND: Exercise is recommended for metabolic dysfunction-associated steatotic liver disease (MASLD). Recent reviews have addressed specific exercise modalities or selected outcome domains, but an updated integrated appraisal of hepatic, metabolic, and cardiorespiratory responses across randomized trials remains needed. METHOD: We conducted a PRISMA 2020-compliant systematic review and meta-analysis of randomized controlled trials in adults with MASLD or legacy diagnoses of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. PubMed, Embase, CENTRAL, Scopus, Web of Science, and SPORTDiscus were searched from inception to June 2026. Post-intervention mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed using RoB 2 and certainty using GRADE. RESULTS: Twenty-five trials were included. Exercise reduced alanine aminotransferase (ALT; MD -7.33 U/L, 95% CI -10.71 to -3.95), aspartate aminotransferase (AST; MD -5.52 U/L, 95% CI -10.24 to -0.79), and BMI (random-effects MD -1.54 kg/m², 95% CI -2.28 to -0.80), and improved VO2peak/VO2max (MD 4.08 mL/kg/min, 95% CI 1.00 to 7.16). Pooled effects for liver fat/steatosis, HOMA-IR, and HbA1c were not statistically significant. Egger testing showed no significant asymmetry for ALT or AST, whereas BMI showed funnel-plot asymmetry consistent with possible small-study effects. CONCLUSION: Exercise training improves hepatic enzymes, BMI, and cardiorespiratory fitness in adults with MASLD/NAFLD, whereas evidence for liver fat and glycemic outcomes remains less certain. PROSPERO: CRD420261416397. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261416397.