The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThe beneficial effects of carnitine supplementation on nonalcoholic fatty liver disease are unclear. We conducted a systematic review and meta-analysis to evaluate the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance in patients with nonalcoholic fatty liver disease.MethodsA comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were performed. Only randomized placebo-controlled human studies that examined the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance up to September 2019 were included. Fixed effects or random-effects models were applied to compute the pooled effect size. Heterogeneity assessments were performed using Cochran’s Q test and I-squared statistics. The quality of the studies was assessed using the Jaded scale.ResultsA total of 5 articles were selected, including 334 individuals (167 in control and 167 in intervention groups). The results demonstrated that carnitine supplementation significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: −0.91; 95 % CI: −1.11, −0.72; p < 0.001, I² = 0.0 %) and the levels of aspartate aminotransferase (AST) (WMD: −16.62; 95 % CI: −28.11, −5.14; IU/l; p = 0.005, I² = 93.5 %), alanine aminotransferase (ALT) (WMD: -33.39; 95 % CI: −45.13, −21.66; IU/l; p < 0.001, I² = 93.4 %), and triglycerides (TG) (WMD: −22.13; 95 % CI: −38.91, −5.34; mg/dl; p = 0.01; I² = 0.0 %). However, the results of the pooled effect size did not show any significant effect of carnitine supplementation on body mass index (BMI) (WMD: 0.07; 95 % CI: −0.15, 0.29; p = 0.55; I² = 0.0 %), body weight (WMD: −0.28; 95 % CI: −2.23, 1.68; p = 0.78; I² = 45.7 %), the levels of gamma-glutamyl transferase (γGT) (WMD: −11.31; 95 % CI: −24.35, 1.73; IU/l; p = 0.09, I² = 61.1 %), cholesterol (WMD: −13.58; 95 % CI: −46.77, 19.60; mg/dl; p = 0.42; I² = 94.9 %), high-density lipoprotein-cholesterol (HDL-C) (WMD: 1.36; 95 % CI: −0.96, 3.68; mg/dl; p = 0.25; I² = 64.7 %), and low density lipoprotein-cholesterol (LDL-C) (WMD: −14.85; 95 % CI: −45.43, 15.73; mg/dl; p = 0.34; I² = 96.4 %).ConclusionsThis analysis shows that carnitine supplementation for patients with nonalcoholic fatty liver disease demonstrates a reduction in AST, ALT, TG levels and HOMA-IR. However, no significant effect of carnitine supplementation was observed on BMI, body weight, the levels of γGT, TC, HDL-cholesterol and LDL-cholesterol.     

从肝脾论治成年女性特应性皮炎

目的:特应性皮炎的发病及治疗存在很大的异质性,在治疗方面特别强调个体化治疗,本文主要总结成年女性特应性皮炎的治疗思路和方法。方法:基于肝脾两脏的生理、病理及成年女性特应性皮炎的临床表现,深入分析其病因病机及治疗方法。结果:女性成年特应性皮炎患者常肝脾同病,肝郁脾虚湿蕴和肝郁脾虚血弱是成年女性特应性皮炎的常见证型,临床可采用疏肝健脾祛湿法和疏肝健脾养血法进行治疗。典型病例中采用肝脾同调法不但可以改善患者的皮疹,也可有效缓解瘙痒和不良情绪。结论:肝脾同调法是治疗成年女性特应性皮炎的有效方法。     

伞骨草利尿抗炎活性及急性毒性研究＊

目的 研究伞骨草水提物的利尿和抗炎作用，以及利尿后对电解质平衡、糖代谢及肾脏功能的影响，并对伞骨草水提物安全性进行初步评价。方法 采用小鼠代谢笼法，检测盐水负荷小鼠在给药6 h后的排尿量，并分析小鼠尿液中离子浓度、血清中糖原、尿素氮和肌酐的变化；采用二甲苯致小鼠耳廓肿胀法，计算耳廓肿胀度及肿胀抑制率，角叉菜胶致大鼠足趾肿胀法，计算足趾肿胀率，小鼠急性毒性试验初步评价伞骨草水提物的安全性。结果 与对照组比较，伞骨草水提物能明显增加小鼠的排尿量，尿液中K⁺、Cl^-的浓度明显增加，高剂量组Na⁺、Ca²⁺浓度明显增加；伞骨草对小鼠血清中的糖原、尿素氮和肌酐均无明显影响；伞骨草中、高剂量对二甲苯所致小鼠耳廓肿胀和角叉菜胶所致大鼠足趾肿胀具有明显的抑制作用；伞骨草水提物24 h内小鼠单次灌胃给药急性毒性试验的LD₅₀为：12.33 g·kg^-1（相当于生药82.15 g·kg^-1），动物在4 h内出现毒性反应，主要表现为主要表现为腹泻、俯卧、竖毛、运动失调、死亡，腹泻至给药第2天恢复。结论 伞骨草水提物具有明显的利尿和抗炎作用，并且对机体的血糖水平和肾脏功能无明显影响。     

Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children

Anaemia is a persistent problem among young Burkinabe children, yet population‐specific information on its determinants is scant. We used baseline data from an evaluation of Helen Keller International's Enhanced Homestead Food Production Program (n=1210 children) to quantify household‐, mother‐, and child‐level factors associated with anaemia in Burkinabe children aged 6‐12 months. We used structural equation modelling to assess a theoretical model, which tested four categories of factors: (a) household food security and dietary diversity, (b) household sanitation and hygiene (latrine and poultry access and bednet ownership), (c) maternal factors (anaemia, stress, cleanliness, and health, hygiene and feeding knowledge and practices), and (d) child nutrition and health (iron deficiency (ID), retinol binding protein (RBP), malaria, and inflammation). The model also included household socio‐economic status, size, and polygamy; maternal age and education; and child age and sex. Results showed that ID, malaria, and inflammation were the primary direct determinants of anaemia, contributing 15%, 10%, and 10%, respectively. Maternal knowledge directly explained improved child feeding practices and household bednet ownership. Household dietary diversity directly explained 18% of child feeding practices. Additionally, RBP, child age and sex, and maternal anaemia directly predicted child haemoglobin. Our findings suggest that program effectiveness could be increased by addressing the multiple, context‐specific contributors of child anaemia. For young Burkinabe children, anaemia control programs that include interventions to reduce ID, malaria, and inflammation should be tested. Other potential intervention entry points suggested by our model include improving maternal knowledge of optimal health, hygiene, and nutrition practices and household dietary diversity.     

基于“317护”健教平台的慢性肝病患者健康教育效果评价

目的探讨"317护"健教平台在住院的慢性肝病患者健康教育应用中的临床效果。方法选择2018年1～6月我院170例15～65周岁的住院患者为研究对象,采用随机数字表法等分为观察组和对照组,对照组由责任护士进行常规面对面的健康教育指导,观察组采用"317护"微信平台开展健康教育,比较两组患者对入院须知、疾病知识、治疗方法、检查须知、药物知识、饮食指导、出院指导等知识的掌握程度,两组患者对所获健康知识方式的满意度。结果观察组患者对入院须知、疾病知识、药物知识、饮食指导等的知晓率达93.95%,知识掌握程度明显高于对照组的81.18%,差异有统计学意义(P0.05),观察组患者对健康教育的满意度高于对照组,差异有统计学意义(P0.05)。结论结合"317护"健教平台的管理模式,能提高患者对健康教育知识的知晓率,促进患者对疾病的自我管理,提高其对护理工作的满意度。     

Clinical Significance of the Initial and Best Responses after Chemoembolization in the Treatment of Intermediate-Stage Hepatocellular Carcinoma with Preserved Liver Function

PurposeTo evaluate the clinical implications of initial and best responses during repeated transarterial chemoembolization procedures for hepatocellular carcinoma (HCC).Materials and MethodsThis study included 726 patients who received a diagnosis of intermediate-stage HCC with Child-Pugh class A liver function between 2007 and 2016, and who were treated with transarterial chemoembolization as the first-line treatment. Evaluation of treatment response was based on the modified response evaluation criteria in solid tumors. Overall survival (OS) was compared between response categories after implementation of landmark analysis.ResultsOf the 726 patients, an objective response (complete response [CR] or partial response [PR]) was observed as the initial response in 78.1% of patients. Regarding the best response during the transarterial chemoembolization series, 87.2% of patients were overall responders. The median OS of initial responders (n = 483) was not significantly different from that of subsequent responders at the 1-year landmark (stable disease [SD] after first transarterial chemoembolization but CR or PR after repeated transarterial chemoembolization; n = 61; 46.2 vs 40.1 months, respectively; P = .145). Likewise, the median OS of initial CR patients (n = 326) was not significantly different from that of the subsequent CR group (n = 126) at the 1-year landmark (PR or SD after first transarterial chemoembolization but CR after repeated transarterial chemoembolization; 53.4 vs 46.3 months, respectively; P = .455). Multivariate Cox analyses showed that the objective responses, the initial responses (hazard ratio [HR], 0.638; P = .001), and the best responses (HR, 0.304; P < .001) had the significant prognostic significance for OS.ConclusionsBoth the initial and best responses during repeated transarterial chemoembolization were significantly associated with OS in patients with intermediate-stage HCC and preserved liver function.     

疏肝化瘀益气法对肝纤维化大鼠HIF-1α、VEGF表达的影响

目的研究疏肝化瘀益气法干预肝纤维化大鼠模型过程中,对大鼠肝脏组织HIF-1α、VEGF表达的影响。方法采用无菌猪血清诱导大鼠肝纤维化模型。随机分为3组。空白组、模型组给予生理盐水灌胃;软肝散干预组自造模开始即给予软肝散生药水煎剂灌胃。采用HE染色和Masson染色观察肝组织纤维化程度,RT-PCR、Western bolt检测肝组织中HIF-1α、VEGF蛋白的表达情况。结果与模型组相比,软肝散干预组肝组织中HIF-1α、VEGF表达显著下调(P<0.05或P<0.01)。且随着干预给药时间的延长,其表达量逐渐降低。结论以疏肝化瘀益气法为指导的软肝散可以改善肝纤维化的病理改变,通过下调HIF-1α、VEGF表达,抑制HIF-1α、VEGF的过表达,调控HIF-1α/VEGF信号通路抑制肝组织纤维化进程,从而发挥抗纤维化的作用。     

Clinical implications,diagnosis,and management of diabetes in patients with chronic liver diseases

Diabetes mellitus(DM) negatively affects the development and progression of chronic liver diseases(CLD) of various etiologies. Concurrent DM and CLD are also associated with worse clinical outcomes with respect to mortality, the occurrence of hepatic decompensation, and the development of hepatocellular carcinoma(HCC). Unfortunately, early diagnosis and optimal treatment of DM can be challenging, due to the lack of established clinical guidelines as well as the medical complexity of this patient population. We conducted an exploratory review of relevant literature to provide an up-to-date review for internists and hepatologists caring for this patient population. We reviewed the epidemiological and pathophysiological associations between DM and CLD, the impact of insulin resistance on the progression and manifestations of CLD, the pathogenesis of hepatogenic diabetes, as well as the practical challenges in diagnosis and monitoring of DM in this patient population. We also reviewed the latest clinical evidence on various pharmacological antihyperglycemic therapies with an emphasis on liver disease-related clinical outcomes. Finally, we proposed an algorithm for managing DM in patients with CLD and discussed the clinical and research questions that remain to be addressed.     

健脾疏肝降脂方干预非酒精性脂肪肝病肥胖小鼠肝功能、游离脂肪酸机制探讨

目的:观察健脾疏肝降脂方治疗非酒精性脂肪肝(NAFLD)肥胖小鼠ALT、AST、FFA及光镜下病理组织学改变,并与壳脂胶囊治疗组比较,观察其疗效。方法:将72只小鼠随机分为模型组、健脾疏肝降脂方高、中、低剂量组、壳脂胶囊对照组和空白组。采用饲养高脂饲料及皮下注射5%CCl₄复制NAFLD肥胖小鼠模型,分别以相应药物灌胃6周,检测血清中ALT、AST及FFA的含量,光镜下观察肝组织的脂肪变程度。结果:①各个用药组相比模型组,血清ALT、AST均降低有统计学意义(P<0.01),且中药各浓度组较壳脂胶囊组血清ALT、AST降低,差异有统计学意义(P<0.05); 中药高、中剂量组相比模型组FFA降低,比较有统计学意义(P<0.05); 但与壳脂胶囊组相比,中药各剂量组改善FFA,差异无明显统计学意义(P>0.05)。②光镜可见:各用药组光镜下病理组织改变均较模型组明显,以中、高剂量组较低剂量组小鼠肝细胞脂肪变程度减轻较明显。结论:健脾疏肝降脂方能有效降低NAFLD肥胖小鼠的肝功能、其与浓度无关; 可以降低FFA及改善光镜下肝脏的脂肪变,其有效程度与浓度有一定的关系。     

陆芷青教授治疗肝炎后肝硬化经验探析

陆芷青教授治疗肝炎后肝硬化辨证病机明确,治法独特,疗效显著。认为本病多因湿热疫毒伤及脏腑气血而成,早期气滞血瘀,瘀阻肝络,而成肝积;晚期正虚邪留,虚实错杂,血水不利,形成臌胀。陆芷青认为早期应着眼于化瘀消癥兼顾肝脾,晚期逐水祛邪兼以扶正,并辅以验案加以佐证。