106例非酒精性脂肪肝患者血液流变学分析

目的探讨非酒精性脂肪肝患者血液流变学的变化。方法在106例非酒精性脂肪肝患者和50例正常对照人群,检测血液流变学指标。结果非酒精性脂肪肝患者全血比黏度、血浆黏度、红细胞聚集指数、红细胞压积、体重指数、血糖、谷氨酰胺转肽酶、血清总胆固醇和甘油三酯均比正常人群升高。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。     

血瘀证患者血细胞参数与血液流变学指标的相关性分析

对９６例血瘀证患者和６０例健康人进行了血细胞参数和血液流变学指标的对比分析，结果表明：①平均红细胞体积（ＭＣＶ）、红细胞体积分配宽度（ＲＤＷ－ＣＶ）、平均血小板体积（ＭＰＲ）、血小板体积分配宽度（ＰＤＷ）４项血细胞参数和全血粘度、全血还原粘度、血浆粘度、红细胞沉降率、血沉方程Ｋ值５项血液流变学指标，血瘀证组明显高于健康对照组（Ｐ＜０．０１），其余指标两组相差不显著（Ｐ＞０．０５）②血瘀证组血细胞参数和血液流变学指标的阳性检出率分别为９１．７％和８７．５％，两组相差不显著（Ｐ＞０．０５）；③血细胞参数与血液流变学指标对血瘀证诊断的特异性基本一致，而其敏感性，前者明显好于后者。由于血细胞参数的测定用血量少，具有操作简便、经济、快速、便于动态观察等优点，与血液流变学指标相比，具有明显的临床实用价值。     

非酒精性脂肪性肝炎大鼠血液流变学的改变

[目的]探讨非酒精性脂肪性肝炎(NASH)大鼠血液流变学的改变。[方法]健康雄性Wistar大鼠16只,随机分为正常组和模型组,分别以标准饲料和高脂饲料喂养,连续12周后处死大鼠,苏木精-伊红染色观察大鼠肝脏组织病理学变化,脂酶法检测肝组织匀浆三酰甘油(TG)、胆固醇(TC)水平,黄嘌呤氧化酶法检测血及肝组织匀浆中超氧化物歧化酶(SOD)水平,硫代巴比妥酸(TBA)法检测血及肝组织丙二醛(MDA)水平,锥板法检测血液流变学指标。[结果]模型组大鼠肝组织重度脂肪变,并伴有肝细胞气球样变,肝细胞碎屑样坏死、炎症细胞浸润和汇管区渗出;肝组织匀浆TG、TC水平较正常组明显升高(P<0.01);血清及肝组织匀浆中MDA水平均较正常组明显增高(P<0.05)、SOD活力均较正常组明显下降(P<0.05);全血黏度(高、中、低切)、全血还原黏度及红细胞聚集性指数明显高于正常组(P<0.01,<0.05),血浆黏度、红细胞刚性和红细胞变形指数2组之间差异无统计学意义(P>0.05)。[结论]高脂饲料诱导的NASH大鼠存在血液流变学指标的异常改变。     

玉米须总黄酮对血瘀证动物模型血液流变学的影响

目的 研究玉米须总黄酮对血瘀证动物模型血液流变学的影响.方法 以肾上腺素与冰水刺激为致瘀因素复制大鼠血瘀证动物模型,观察玉米须总黄酮对血瘀证模型动物全血不同切变率下的黏度变化及血浆黏度变化.结果 玉米须总黄酮可降低瘀血模型动物全血黏度和血浆黏度,改善血液循环.结论 玉米须总黄酮对血瘀证大鼠不同切变率下的全血黏度升高有明显的改善作用,对血浆黏度升高有一定改善作用.     

牛蒡子萃取物对血瘀证动物模型血液流变学的影响

目的探讨牛蒡子萃取物对血瘀证动物模型血液流变学的影响。方法 Wistar大鼠60只,按体重随机分为假手术组、模型组、阳性组、牛蒡子提取物高、中、低剂量组,每组10只,除假手术组外,每组分别给予相应药物7 d,末次给药30 min后,各组动物皮下注射盐酸肾上腺素注射液,间隔6 h后同上述方法再注射一次,两次注射盐酸肾上腺素注射液之间将动物置于2℃冰水浴中游泳5 min,制备血瘀动物模型,假手术组不造模。检测大鼠血液流变学指标、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、血小板聚集率(PA)。结果与模型组比较,阳性组、高、中剂量组的全血黏度有所降低(P0.05);阳性组,高、中、低剂量组的PT、APTT升高,FIB含量有所降低(P0.05);阳性组PA有显著性降低(P0.01),高剂量与中剂量组有差异(P0.05),与低剂量组无差异。结论牛蒡子萃取物具有降低血瘀证大鼠全血黏度、改善血液流变学指标的作用;牛蒡子萃取物能够改善凝血功能,降低血小板聚集。     

臌胀血瘀证的血液流变学变化与治疗

臌胀血瘀证的血液流变学变化与治疗成才荣吴志荣朱峪英解放军３０３医院中医科广西南宁市５３００２１主题词血瘀／中医药疗法臌胀／中医药疗法血液流变学Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｂｌｏｏｄｓｔａｓｉｓ／ｚｈｏｎｇｙｉｙａｏｌｉａｏｆａａｂｄｏｍｉｎａ...     

从血液流变学的改变分析肾上腺素致血瘀证大鼠模型的建立

目的以肾上腺素（Adr）皮下注射法建立大鼠血瘀模型,对比不同的给药剂量、给药方式和给药周期对大鼠血液流变学的影响,确定最佳的血瘀证动物模型的建立方法。方法将实验大鼠随机分为6组,即空白对照组（不造模）、急瘀1d组（Adr 1．8mg／kg皮下注射加冰水浸泡1d）、急瘀2d组（Adr 1．8mg／kg注射加冰水浸泡2d）、慢瘀小剂量组（Adr0．1mg／kg注射7d）、慢瘀中剂量组（Adr3．3mg／kg注射7d）、慢瘀大剂量组（Adr0．9mg／kg注射7d）。用血液黏度仪检测全血黏度和血浆黏度;用红细胞变形／聚集仪检测红细胞变形和聚集指数;用血凝仪检测血浆纤维蛋白原含量。结果与对照组相比,慢瘀小、中剂量组可见大鼠全血黏度、纤维蛋白原含量明显升高（P〈0．05或P〈0．01）;急瘀1d组可见低切变下全血黏度升高（P〈0．05）,急瘀1d组和急瘀2d组可见血浆黏度和纤维蛋白原增加（P〈0．01）,急瘀2d组和慢瘀大剂量组可见红细胞变形指数明显降低（P〈0．05）。结论血瘀证动物模型戍功与否与所用的肾上腺素剂量、给药周期和给药方式密切相关。Adr0．3mg／kg注射7d和Adr1．8mg／kg注射加冰水浸泡2d大鼠出现血液流变学变化更加明显,可分别作为气郁血瘀证和气滞血瘀证的动物模型。     

老年血液流变学改变及与中医血瘀证的关系

生物流变学创始人Copley AL教授对于血液流变学的研究领域曾做过精辟论述。他认为血液流变学是研究血液在血管流动和变形的一门学科。它从宏观、细胞及分子不同水平研究有关的流变现象。Copley把血管和血液作为一个整体，并称之为“血管一血液器官”。因此，血液流变学改变，应考察这些方面的变化。     

非酒精性脂肪肝与胰岛素抵抗

鉴于在一般人群特别是肥胖人群和2型糖尿病人群中合并非酒精性脂肪肝（NAFL）者增加，NAFL的重要性已引起临床重视。本期胰岛素抵抗及其相关疾病专栏刊出了颜红梅、路影和姚定国等作者撰写的有关NAFL的文章，分别对无糖尿病、糖耐量减低（IGT）和2型糖尿病三种人群伴发NAFL和胰岛素抵抗的相关性等进行了临床观察比较。为此，特请本刊编委高鑫教授就NAFL与胰岛素抵抗的相关机制及其对2型糖尿病的防治意义发表评论，期望引起读、作者和临床同道的关注，进一步开展对NAFL的临床和相关机制的研究。[编者按]     

脂肪肝与非脂肪肝患者血常规的差异分析

目的探讨成人脂肪肝患者与非脂肪肝患者血常规的差异。方法选用沈阳地区2008年3月～2008年12月参加体检的18岁以上人群为研究对象,对肝脏彩色多普勒检查诊断的脂肪肝与非脂肪肝患者,采用问卷咨询、体格检查和生化检查外,重点探讨脂肪肝与血常规之间的关系,数据用SPSS16.0软件分析。结果入选人群共8842名,B超共检出脂肪肝3306例,占37.39%,其中酒精性、非酒精性脂肪肝分别占15%（1326名）和22.39%（1980名）,与非脂肪肝组（NAFL）相比,脂肪肝组（AFL）WBC（白细胞计数）、EO%（嗜酸性细胞比率）、RBC（红细胞计数）、HGB（血红蛋白浓度）、HCT（红细胞比积测定）、MCH（平均红细胞Hb含量）、MCHC（平均红细胞Hb浓度）、RDW（红细胞分布宽度）、PDW（血小板分布宽度）显著增加（P〈0.01）;LYM%（淋巴细胞比率）、MONO%（单核细胞比率）、MCV（平均细胞容积）、P-LCR（大型血小板比率）、MPV（平均血小板体积）等明显增加（P〈0.05）;PLT（血小板计数）明显减少（P〈0.05）;与非酒精性脂肪肝组（NAFL）比,酒精性脂肪肝（AFL）组RBC、HGB、HCT、MCV、MCHC等显著增加（P〈0.01）,LYM%明显减少（P〈0.05）,MCH、MONO%（单核细胞比率）明显增加（P〈0.05）。结论脂肪肝患者中白细胞总数及分类（除中性粒细胞百分比外）明显高于非脂肪肝组,红细胞系统（除MCHC外）也有类似的趋势,而血小板计数明显低于非脂肪肝组;而酒精性和非酒精性脂肪肝相比,红细胞系统显著增加,尤其MCV更加明显,而白细胞系统（除LYM%明显减少外）和血小板系统大部分无显著变化。说明简单的血常规及分类检查对脂肪肝的临床诊断和病因诊断具有重要的意义。     

Protein glutathionylation increases in the liver of patients with non-alcoholic fatty liver disease

Background and Aim:  Oxidative stress is an important pathophysiological mechanism in non-alcoholic steatohepatitis, where hepatocyte apoptosis is significantly increased correlating with disease severity. Protein glutathionylation occurs as a response to oxidative stress, where an increased concentration of oxidized glutathione modifies post-translational proteins by thiol disulfide exchange. In this study, we analyzed the protein glutathionylation in non-alcoholic fatty liver disease (NAFLD) and evaluated a potential association between glutathionylation, fibrosis, and vitamin E treatment.
Methods:  Protein glutathionylation was studied in the livers of 36 children (mean age 12.5 years, range 4–16 years) subdivided into three groups according to their NAFLD activity score (NAS) by Western blot analysis and immunohistochemistry, using a specific monoclonal antibody. In addition, we identified the hepatocyte ultrastructures involved in glutathionylation by immunogold electron microscopy.
Results:  Our findings showed that protein glutathionylation increases in the livers of patients with NAFLD and it is correlated with steatohepatitis and liver fibrosis. Its increase appears mainly in nuclei and cytosol of hepatocytes, and it is reversed by antioxidant therapy with reduced fibrosis.
Conclusion:  Protein glutathionylation significantly increases in livers with NAFLD, strongly suggesting that oxidative injury plays a crucial role in this disease. Furthermore, the marked increase of protein glutathionylation, in correlation with collagen VI immunoreactivity, suggests a link between the redox status of hepatic protein thiols and fibrosis.     

非酒精性脂肪性肝病的诊断

非酒精性脂肪性肝炎(NASH)是指病理上与酒精性肝炎相类似但无过量饮酒史的临床综合征,患者通常存在胰岛素抵抗及其相关代谢紊乱。当代谢性肝病的病理学特征不明或泛指整个脂肪性肝病的疾病谱时,通常使用非酒精性脂肪性肝病(NAFLD)这一术语。后者尚包括单纯性肝脂肪变、脂肪变伴小叶内炎症但没有肝细胞气球样变和纤维化、孤立性门静脉周围纤维化、以及无明显脂肪性肝炎的隐源性肝硬化等情况。     

2型糖尿病患者非酒精性脂肪肝患病率的回顾性分析

收集550名T2DM住院患者的临床、肝脏彩超及生化指标检查资料，统计非酒精性脂肪肝（NAFL）的患病率，并分析其危险因素。发现T2DM中NAFL的患病率为42%，且男性患病率明显高于女性（P〈0.05）。BMI、WC、FIns、TG、HOMA-IR是T2DM合并NAFL的独立危险因素。     

Efficacy of diacerein in reducing liver steatosis and fibrosis in patients with type 2 diabetes and non-alcoholic fatty liver disease: A randomized,placebo-controlled trial

The aim was to assess, in a randomized, double-blinded, placebo-controlled trial, the efficacy of diacerein, an anti-inflammatory drug, in improving liver fibrosis and steatosis in patients with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Sixty-nine diabetic patients with NAFLD were randomized to 24-month treatment with placebo (35 patients) or diacerein 100 mg/day (34 patients). Liver stiffness and steatosis were assessed by transient elastography (Fibroscan®) at baseline, and 12 and 24 months of follow-up. The primary outcome was the difference in mean liver stiffness and steatosis changes during treatment. Adjusted differences in mean changes on intention-to-treat analyses were estimated by generalized repeated-measures mixed-effects regressions. Diacerein significantly reduced liver stiffness in contrast to placebo by 1.6 kPa (95% CI: –2.6 to −0.5 kPa; p = 0.003), whereas no significant difference in mean changes in liver steatosis was observed. The reduction in liver stiffness was already evident at the 12-month examination, and accentuated at the 24-month examination. Eight patients reduced liver fibrosis stage during treatment, seven of whom were in the diacerein group (p = 0.020). In conclusion, a 2-year treatment with diacerein significantly reduced liver fibrosis in diabetic patients with NAFLD.     

Gut microbiota dysbiosis in patients with non-alcoholic fatty liver disease

BACKGROUND: Gut microbiota plays a significant role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). This study aimed to assess the contribution of gut microbiota dysbiosis to the pathogenesis of NAFLD. METHODS: Forty-seven human feces samples (25 NAFLD patients and 22 healthy subjects) were collected and 16S rDNA amplicon sequencing was conducted on Hiseq 2000 platform. Discrepancy of species composition between controls and NAFLD group was defined by Metastats analysis under P value<0.01. RESULTS: NAFLD patients harbored lower gut microbiota diversity than healthy subjects did. In comparison to the control group, the Proteobacteria (13.50%) and Fusobacteria (2.76%) phyla were more abundant in NAFLD patients. Ad-ditionally, the Lachnospiraceae (21.90%), Enterobacteriaceae (12.02%), Erysipelotrichaceae (3.83%), and Streptococcaceae (1.39%) families, as well as the Escherichia_Shigella (10.84%), Lachnospiraceae_Incertae_Sedis (7.79%), and Blautia (4.95%) genera were enriched in the NAFLD group. However, there was a lower abundance of Prevotella in the NAFLD group than that in the control group (5.83% vs 27.56%, P<0.01). The phylum Bacteroidetes (44.63%) also tended to be more abundant in healthy subjects, and the families Prevotellaceae (28.66%) and Ruminococcaceae (26.44%) followed the same trend. Compared to those without non-alcoholic steatohepa-titis (NASH), patients with NASH had higher abundance of genus Blautia (5.82% vs 2.25%; P=0.01) and the correspond-ing Lachnospiraceae family (24.33% vs 14.21%; P<0.01). Patients with significant fibrosis had a higher abundance of genus Escherichia_Shigella (12.53% vs 1.97%; P<0.01) and the corresponding Enterobacteriaceae family (13.92% vs 2.07%;P<0.01) compared to those with F0/F1 fibrosis. CONCLUSIONS: NAFLD patients and healthy subjects harbor varying gut microbiota. In contrast to the results of previous research on children, decreased levels of Prevotella might be detrimental for adults with NAFLD. The increased level of the genus Blautia, the family Lachnospiraceae, the genus Escherichia_Shigella, and the family Enterobacteriaceae may be a primary contributor to NAFLD progression.     

非酒精性脂肪性肝病的研究进展

非酒精性脂肪性肝病经历由非酒精性单纯性脂肪肝发展至非酒精性脂肪性肝炎和肝硬化或原发性肝癌的缓慢过程,并与心血管病的发生关系密切.本文针对非酒精性脂肪性肝病的流行病学、发病机制、诊断和治疗等的研究进展进行综述.     

Polymorphism of human leptin receptor gene is associated with type 2 diabetic patients complicated with non-alcoholic fatty liver disease in China

Background and Aim:  To investigate the relationship between human leptin receptor ( LEPR ) gene G3057A polymorphism and type 2 diabetes mellitus (T2DM) patients complicated with or without non-alcoholic fatty liver disease (NAFLD).
Methods:  Two hundred and sixteen cases of newly diagnosed T2DM patients (104 cases complicated with NAFLD) and 108 cases of normal glucose tolerances (NGT) were recruited. Hemi-nested polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and PCR-direct sequence analysis were conducted to detect the polymorphism of LEPR G3057A variation. Plasma leptin levels were measured by enzyme-linked immunosorbent assay kit. Plasma lipid and glucose metabolic parameters were measured routinely. Liver ultrasound was carried out for all subjects.
Results:  T2DM patients complicated with NAFLD had higher plasma insulin, leptin, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) levels than those without NAFLD and NGT subjects. The variant frequency at nucleotide 3057 G→A transversion was 76.0% in type 2 diabetic patients complicated with NAFLD, which was also significantly higher than those without NAFLD (62.1%) and NGT cases (53.2%). There was also significant difference in genotype distribution between the three groups (χ² = 14.63, P  < 0.01).
Conclusion:  The polymorphism of LEPR gene 3057 probably contributes to the onset of NAFLD by regulating lipid metabolism and affecting insulin sensitivity.     

非酒精性脂肪性肝病血清标志物研究进展

目的 非酒精性脂肪性肝病(NAFLD)是目前全球最流行的慢性肝脏疾病,其主要发生机制包括胰岛素抵抗和氧化应激等.不同血清标志物与NAFLD发病机制密切相关,但尚无明确的定论.本文主要就NAFLD发生发展过程中不同血清标志物的作用作一综述.     

Endothelial dysfunction in Turkish patients with non-alcoholic fatty liver disease

Background: The components of the metabolic syndrome are closely related with endothelial dysfunction, which is a pathophysiological issue of cardiovascular diseases. Non‐alcoholic fatty liver disease (NAFLD) is considered as one of the components of the metabolic syndrome. The aim of this study was to evaluate the endothelial‐dependent dilatation (EDD) and endothelial‐independent dilatation (EID) of the brachial artery in NAFLD. Methods: Fifteen non‐alcoholic steatohepatitis (NASH), 17 patients with simple steatosis and 16 healthy subjects formed the study group. Non‐alcoholic fatty liver disease group was composed of patients admitted to the gastroenterology outpatient clinic because of increased liver enzymes. Endothelial functions of the brachial artery were evaluated by vascular ultrasound. EDD was assessed by establishing reactive hyperaemia, and EID was determined by using sublingual nitrate. Results: No statistical difference for the basal diameter of brachial artery was found between the groups (P = 0.49). The values for EDD and EID were significantly different across all three groups (P < 0.0001 and P < 0.0001, respectively). EDD and EID were significantly lower in NASH compared with simple steatosis (P = 0.01 and P < 0.01, respectively). However, there was no statistical significance for EDD and EID in simple steatosis groups compared with controls (P = 0.58 and P = 0.98, respectively). Conclusions: Our study showed that patients with NASH had significantly worse endothelial dysfunction compared with patients with simple steatosis and healthy subjects. The treatment strategies with ameliorative effects for endothelial dysfunction might be effective for delaying the development of cardiovascular complications in NAFLD.