弹性酶结合低热量饮食治疗非酒精性脂肪性肝病的临床观察

目的 :评价弹性酶结合低热量饮食在治疗非酒精性脂肪肝 (NAFLD)中的作用。方法选择临床诊断非酒精性脂肪肝病5 0例 ,随机分为治疗组和对照组。治疗组 30例 ,口服弹性酶肠溶片 6 0 0U /次 ,每日 3次 ;对照组 2 0例 ,口服水飞蓟素 ,77mg/次 ,每日 3次 ,两组均结合低热量饮食 ,共治疗 2 4周。治疗前 ,治疗 30d、6 0d分别测定肝功能、肾功能、血脂 ,或肝脏B超。结果 :(1)治疗 6 0d后 ,治疗组丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)、γ -谷氨酰转肽酶 (γ -GT)及碱性磷酸酶 (ALP)比治疗前降低 ,有极显著差异 (P <0 .0 1) ,而对照组治疗前后无显著差异 ,(p >0 .0 5 )。 (2 )治疗 6 0d后 ,治疗组血清胆固醇、甘油三酯比治疗前下降 ,血清高密度脂蛋白则升高 ,有极显著差异 (P <0 .0 5 ) ,但血清低密度脂蛋白无显著差异 ,(p >0 .0 5 )。对照组则上述指标均无显著差异 ,(p >0 .0 5 )。 (3)治疗 6 0d后治疗组与对照组B超脂肪肝消失和好转所占比例分别为 2 0 / 30和 3/ 2 0 (P<0 .0 1)。 (4)治疗 6 0d治疗组与对照组有效率分别为 86 .6 7%和 10 .0 0 % ,有极显著差异 ,(P <0 .0 1)。 (5 )两组均无严重不良反应发生。结论 :弹性酶可减少NAFLD肝脏脂肪沉积 ,降血脂 ,改善肝功能 ,不良反应甚微 ,可作为NAFLD的药物     

非酒精性脂肪肝病患者血清对氧磷脂酶1水平及意义

目的探讨对氧磷脂酶1（PON1）活性与非酒精性脂肪肝病的关系。方法以对氧磷为底物测定30例正常人、52单纯性脂肪肝患者、41例脂肪性肝炎患者、31例脂肪性肝硬化患者血清PON1活性。结果单纯性脂肪肝组、脂肪性肝炎组及脂肪性肝硬化组血清PON1活性分别为（153．41±13．34）、（108．72±16．17）、（98．90±13．05）U／L,均低于正常对照组（181．12±9．50）U／L,差异有统计学意义（P〈0．01）;脂肪性肝炎组、脂肪性肝硬化组PON1活性与单纯性脂肪肝组比较差异有统计学意义（P〈0．05）;脂肪性肝炎组PON1活性与脂肪性肝硬化组比较差异无统计学意义（P〉0．05）。结论PON1活性与肝脏的受损害程度密切相关,在一定程度上可反映非酒精性脂肪肝的严重程度,同时PON1还可能是非酒精性脂肪性肝病受损害的因素之一。     

四逆散加味治疗非酒精性脂肪性肝病120例

目的 观察四逆散加味治疗非酒精性脂肪性肝病的临床疗效.方法 将120例非酒精性脂肪性肝病患者按随机数字表法随机分为两组,治疗组60例采用四逆散加味合用多烯磷脂酰胆碱治疗,对照组60例单纯采用多烯磷脂酰胆碱治疗.结果 治疗组总有效率为91.67%,对照组总有效率85%,治疗组疗效明显优于对照组(P＜0.05).结论 四逆散加味治疗非酒精性脂肪性肝病具有良好的临床疗效.     

非酒精性脂肪肝患者血清肝纤维化指标与脂联素的关系

目的探讨非酒精性脂肪肝患者血清脂联素与肝纤维化的关系。方法选择99例体检者，根据体检结果分为健康对照组（52例）和非酒精性脂肪肝（NAFLD）组（47例），测定所有体检者的体质量指数（BMI）、腰臀比（WHR）及血清谷丙转氨酶（ALT）、谷草转氨酶（AST）水平，应用酶联免疫吸附法（ELISA）测定血清中脂联素、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）含量。结果与对照组比较，NAFLD组BMI、WHR、ALT、HA及PCⅢ水平明显升高，而血清脂联素水平明显低于对照组，两者均有显著统计学差异（P〈0．01）。NAFLD组中有32例（68．09％）患者血清HA超过正常值，37例（78．72％）患者血清PCⅢ超过正常值，且两者均高于对照组（P〈0．01）。血清脂联素水平与HA、PCⅢ呈明显负相关（r=-0．69、-0．73，P均〈0．01）。结论非酒精性脂肪肝有发生肝纤维化的倾向，且脂联素有一定的抗肝纤维化作用。     

代谢相关脂肪性肝病和慢性丙型病毒性肝炎的相关性研究进展

代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)是由一种胰岛素抵抗和遗传易感密切相关的代谢功能障碍所引发的脂肪性肝病,也称非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)。慢性丙型病毒性肝炎(chronic hepatitis C,CHC)是一种全球性分布的由丙型肝炎病毒(hepatitis C virus,HCV)感染引起的目前可治愈的病毒性肝炎。MAFLD如合并CHC,CHC可导致胰岛素抵抗以及增加肝细胞氧化应激加速肝细胞脂肪变性,影响MAFLD的治疗效果。     

Semaglutide might be a key for breaking the vicious cycle of metabolically associated fatty liver disease spectrum?

Metabolically associated fatty liver disease (MAFLD) is a liver manifestation of metabolic syndrome potentially related to unfavorable hepatic and extrahepatic outcomes and progression to cirrhosis. Up to date, there are no approved pharmacotherapies for the treatment of MAFLD, so management focused on lifestyle interventions to encourage weight loss, and treatment of coexisting conditions is the only available option. Unfortunately, the aforementioned is often not potent enough to offer reversal or slow down hepatic inflammation and fibrosis. Glucagon-like peptide-1 receptor agonists have a favorable effect on glycemic management and weight loss of patients with type 2 diabetes mellitus and recently published data suggest their potential in MAFLD treatment. In addition, some of the agents have proven cardiovascular and renal benefits in dedicated cardiovascular outcome trials, making them an interesting therapeutic option. In this opinion review, we discuss the role of semaglutide in MAFLD.     

Early growth and non-alcoholic fatty liver disease in adulthood—the NAFLD liver fat score and equation applied on the Helsinki Birth Cohort Study

Abstract

Introduction. Prenatal and childhood growth influence the risk of developing the metabolic syndrome and type 2 diabetes. Both conditions are associated with non-alcoholic fatty liver disease (NAFLD). Our aim was to explore the associations between early growth and adult NAFLD.

Methods. We studied 1587 individuals from the Helsinki Birth Cohort Study (HBCS) born 1934–44 for whom birth, childhood, and adult clinical data were available. NAFLD was defined using the NAFLD liver fat score and equation. The score was converted into a dichotomous variable, with outcomes defined as either a positive or negative score. The equation predicts liver fat percentage.

Results. A positive score was found in 43% of men and 22.5% of women. Several measurements of birth and childhood body size were negatively associated with both NAFLD outcomes after adjustment for adult BMI. Those from the smallest BMI tertile at age 2 who were obese in adulthood had an OR of 18.5 for a positive score compared to those from the same group who were normal weight in adulthood.

Conclusions. A larger childhood body size was negatively associated with NAFLD outcomes. Individuals who are small during early childhood and obese as adults seem to be at the highest risk of developing NAFLD.     

Sonographic measurement of the thickness of subcutaneous tissues in nonalcoholic fatty liver disease versus other chronic liver diseases

PURPOSE: To measure an average subcutaneous tissue thickness in nonalcoholic fatty liver disease (NAFLD) and other liver diseases using bedside sonography and make comparisons of thickness between groups. The study also addressed whether a cut-off subcutaneous tissue thickness exists below which NAFLD is unlikely. METHODS: Sonograph was performed on 113 consecutive patients with chronic liver disease. Diagnosis was derived from serological data combined with liver biopsy in all cases. Distance was measured between the skin and the liver surface and was labeled the subcutaneous tissue thickness. RESULTS: Of the 113 patients, 16 were diagnosed with NAFLD, 56 were diagnosed with chronic hepatitis C, 17 were diagnosed with autoimmune liver disease, and 24 had miscellaneous diagnoses (hepatitis B, hemochromatosis, granulomatous hepatitis, and cryptogenic hepatitis). The subcutaneous tissue thickness was 25.6 mm +/- 5.6 mm in NAFLD versus 19.5 mm +/- 5.2 in the non-NAFLD patients (p < 0.001). The subcutaneous tissue thickness of the HCV group was 20.2 mm +/- 4.8, and although it was not different than all other patients, it was different from the NAFLD patients (p < 0.01). Fifteen out of sixteen of the NAFLD patients had a greater than average subcutaneous tissue thickness (20 mm). CONCLUSIONS: A sonographically measured subcutaneous tissue thickness of less than 20 mm makes the diagnosis of NAFLD unlikely.     

36例成人散发急性乙型肝炎伴脂肪性肝病临床分析

目的分析成人散发急性乙型肝炎（AHB）伴脂肪性肝病（FLD）患者的生化学及病毒学特点,探讨影响其预后的可能因素。方法以236例成人AHB伴FLD患者为观察组,33例成人AHB不伴FLD患者为对照组,比较两组间在生化指标、病毒学指标及其转归方面有无差异。结果合并有FLD的AHB患者较不合并FLD的AHB患者入院时HBV DNA阴转率低,HBsAg定量、HBV DNA定量值高,阴转时间长,差异有统计学意义;患者生化指标及复常时间、HBeAg定量及阴转时间的差异无统计学意义。结论合并有FLD的AHB患者较不合并FLD的AHB患者不利于HBV的清除。     

Nonalcoholic fatty liver disease shows significant sex dimorphism

Nonalcoholic fatty liver disease (NAFLD), which has been renamed metabolic dysfunction-associated fatty liver disease, is a growing global medical problem. The incidence of NAFLD and its associated end-stage liver disease is increasing each year, and many research advancements have been achieved to date. This review focuses on the current knowledge of the sex differences in NAFLD and does not elaborate on areas without differences. Studies have revealed significant sex differences in the prevalence, influencing factors, pathophysiology, complications and therapies of NAFLD. Men have a higher incidence than women. Compared with women, men exhibit increased visceral fat deposition, are more susceptible to leptin resistance, lack estrogen receptors, and tend to synthesize fatty acids into fat storage. Male patients will experience more severe hepatic fibrosis and a higher incidence of liver cancer. However, once NAFLD occurs, women show a faster progression of liver fibrosis, higher levels of liver cell damage and inflammation and are less likely to undergo liver transplantation than men. In general, men have more risk factors and more severe pathophysiological reactions than women, whereas the development of NAFLD is faster in women, and the treatments for women are more limited than those for men. Thus, whether sex differences should be considered in the individualized prevention and treatment of NAFLD in the future is worth considering.     

非酒精性脂肪肝患者血清游离脂肪酸与胰岛素抵抗的关系

目的研究非酒精性脂肪肝(NAFLD)患者血清游离脂肪酸(FFA)水平及其与胰岛素抵抗(IR)的关系。方法测定118例NAFLD患者(NAFLD组)及103名健康体检者(正常对照组)的血清FFA并计算胰岛素抵抗指数(HOMA-IR)。结果 NAFLD组血清FFA浓度为(752.50±101.42)μmol/L,HOMA-IR为1.48±0.42,均高于正常对照组[(441.75±95.64)μmol/L,0.67±0.33](P<0.01)。NAFLD组FFA与HOMA-IR呈正相关(r=0.325,P<0.05)。结论 FFA与NAFLD密切相关,FFA致NAFLD可能通过IR起作用。     

“整合疗法”综合治疗脂肪肝的临床探讨

目的:探讨应用HD肝病治疗仪中药导入配合运动疗法、饮食疗法有机"整合"综合治疗脂肪肝的临床疗效及不良反应。方法:采用随机对照研究方法,治疗组采用HD-91-Ⅱ型肝病治疗仪物理治疗和中药穴位透入配合运动疗法、饮食疗法有机"整合"综合治疗;对照组采用降脂药物血脂康加凯西莱片口服治疗,均20d为1个疗程。结果:治疗组在症状和体征改善方面优于对照组;治疗组ALT治疗后下降优于对照组(P<0.01);治疗前后血脂比较,治疗组TC和TG均显著下降,两组治疗后血脂比较,有显著性差异;治疗组与对照组临床总有效率分别是90%和70%,治疗组明显优于对照组。治疗组在治疗过程中未发生1例不良反应。结论:采用"整合疗法"综合治疗脂肪肝,效果较满意,可以代替药物治疗,值得临床推广。     

软脉灵对非酒精性脂肪肝大鼠肝组织抗氧化能力的影响

目的观察软脉灵对非酒精性脂肪性肝病大鼠肝组织抗氧化能力的影响。方法采用高脂饲料喂养方式建立SD大鼠模型。模型A组采用高脂饲料喂养,药物A组高脂饲料喂养同时予软脉灵灌胃,两组均于8、16周处死;模型B组高脂饲料喂养16周后改基础饲料喂养,药物B组高脂饲料喂养16周后改基础饲料喂养,并予软脉灵灌胃,两组均于24、32周处死;空白对照组应用基础饲料喂养,于第16、32周处死。观察肝组织抗氧化指标。结果预防实验中,软脉灵能减小肝组织MDA升高的水平及SOD降低的程度(P<0.05~0.01);治疗实验中,软脉灵能降低肝组织MDA水平(P<0.05~0.01),提高SOD活力(P<0.01)。结论在非酒精性脂肪性肝病大鼠模型中,软脉灵有改善肝脏抗氧化能力的作用。     

106例非酒精性脂肪肝血液流变性分析

目的 探讨非酒精性脂肪肝患者血液流变性变化相关因素.方法 检测106例非酒精性脂肪肝患者（观察组）和50名健康体检者（正常组）的生化和血液流变学指标进行对比分析并采用B超进行综合诊断.结果 观察组的全血比黏度、血浆黏度、红细胞聚集指数、红细胞压积、体重指数、血糖、尿酸、血清谷丙转氨酶、谷氨酰胺转肽酶、血清总胆固醇、甘油三酯均高于正常组,具有统计学意义（P〈0.05）.结论 肥胖症、糖尿病、高脂血症都是非酒精性脂肪肝的危险因素,要做到及时防治.     

成人非酒精性脂肪肝与高尿酸血症关系的研究

目的了解成都地区非酒精性脂肪肝(NAFLD)及高尿酸血症(HUA)患病情况及相关因素。方法对2010年9月-2011年3月健康体检的36 000名18岁以上受检者,进行病史采集、体格检查、空腹血糖、血脂、肝功能、肾功能、血尿酸检测以及上腹部彩色多普勒超声检查。结果高尿酸血症(HUA)的总患病率为18.17%。NAFLD患者HUA患病率为39.41%,明显高于总患病率(P<0.01)。NAFLD患者的HUA患病率随体质量指数(BMI)的增加呈递增趋势。BMI、舒张压、甘油三酯、胆固醇、丙氨酸转氨酶、门冬氨酸氨转移酶、谷氨酰转肽酶、血肌酐、胱抑素C均随着血尿酸水平的升高而递增;高密度脂蛋白随着血尿酸水平的升高而递减。结论 NAFLD及HUA关系密切,且二者与代谢紊乱联系紧密。     

Managing Diabetes in Patients with Chronic Liver Disease

Abstract

Diabetes and chronic liver disease (CLD) are common long–term conditions in the developed and developing world. The 2 conditions often coexist, and there is evidence to suggest that diabetes can have a significant adverse effect on patients with CLD, leading to increased complications and premature mortality. While diabetes, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis (NASH) appear to have common origins related to obesity and insulin resistance, diabetes is also common among patients with alcoholic and viral CLD. In patients with NASH, improvement in metabolic indices appears to reduce the progression of CLD. It is not clear whether improving glycemic control in other forms of CLD leads to improved outcomes. Managing diabetes in patients with CLD can be challenging because many antihyperglycemic therapies are contraindicated or must be used with care. Metformin and pioglitazone may be useful in patients with NASH, but sulfonylureas and insulin must be used with caution, as hypoglycemia may be a problem. Insulin doses frequently need to be reduced in patients with CLD. Newer glycemic agents have not been widely used in patients with CLD, but bariatric surgery may lead to significant improvement in liver indices in patients with NASH. Management of patients with diabetes and CLD may be enhanced by using a multidisciplinary approach.