Outcome of Phlebotomy on Improvement of Liver Enzymes and Steatosis in Non-Alcoholic Fatty Liver Disease: A Randomized, Controlled Trial

Background and Objective: Iron overload in the liver can potentially induce non-alcoholic fatty liver disease (NAFLD). In this study, we sought to evaluate the phlebotomy in NAFLD, and compare it with modifiedlife style. Materials and Methods: This randomized, single-blind, clinical trial was carried out to evaluate the efficacy of phlebotomy on liver enzymes and steatosis in NAFLD patients. Forty patients diagnosed with NAFLD were enrolled in the study. Patients were randomized into two groups, including twenty patients in the first group who were under daily consumption of ۸۰۰ IU vitamin E with modified lifestyle, and the second group who administrated ۴۰۰ ml phlebotomy at the baseline and fifth month of study alongside the modified lifestyle. Transient elastography (TE) was used to evaluate liver transaminases, hemoglobin, ferritin levels, and liver stiffness prior to and following the intervention. Chi-square and paired t-tests were used to analyze the data, using SPSS v۱۸. Results: In each group, there were ۱۴ men and ۶ women. There was no statistically significant difference in demographic features. After the intervention, the mean liver stiffness of the control group increased from ۱۰.۳۸±۲.۶۵ kPa before the treatment to ۱۱.۴۰±۶.۵۸ kPa, which was not significantly different (P=۰.۴۶۳). The liver stiffness was ۱۱.۲۹±۴.۷۱ kPa in the intervention group before the treatment, which was reduced to ۸.۱۰±۲.۳۶ kPa after the treatment; however, the difference between pre and post-treatment values was statistically significant (P=۰.۰۰۹). Before and after the treatment, there were no significant differences in the levels of liver enzymes between the two groups. Conclusion: Phlebotomy is a useful treatment for NAFLD patients, and decreased liver stiffness as cirrhosis complication.

Keywords:

Phlebotomy , Nonalcoholic fatty liver disease , Nonalcoholic steatohepatitis , Transient elastography , Fibroscan