非酒精性脂肪性肝病与动脉粥样硬化之间关系的研究进展

非酒精性脂肪性肝病( NAFLD)常与肥胖、糖尿病、高血脂、高血压以及代谢综合征合并存在,认为是代谢综合征的肝脏表现。NAFLD的患病率约20％～30％,在2型糖尿病人群中NAFLD患病率更高。NAFLD与心血管疾病(CVD)关系密切,NAFLD患者的主要死亡原因是CVD。NAFLD和动脉粥样硬化(AS)关系密切,其机制可能涉及氧化应激、炎症反应、脂代谢紊乱、脂肪激素水平的变化和胰岛素抵抗等方面。本文就NAFLD和AS间的关系以及可能机制进行综述。     

非酒精性脂肪性肝病客观化指标与中医辨证分型关系探讨

目的:探讨非酒精性脂肪性肝病(NAFLD)客观化指标与中医辨证分型的关系。方法:筛选NAFLD患者176例及健康对照组60例,观察记录两组人员中医证侯、肝功能、血脂、B超、CT肝脾比值结果,根据临床证候对`NAFLD患者进行中医辨证分为肝郁脾虚型、湿热内蕴型、痰瘀互结型、肝肾不足型4组,与对照组及各组间相互比较,分析辨证分型与客观化指标之间的关系。结果:NAFLD患者中医辨证分型以肝郁脾虚居多(29.54%)。各临床分型与对照组相比其客观化指标均有不同程度的异常。各组间比较ALT升高多集中在湿热内蕴型和痰瘀互结型,TG升高多为痰瘀互结型,LDL、TC升高多为肝肾不足型,CT肝脾比值降低以湿热内蕴型和痰瘀互结型为甚,B超呈重度改变多发于湿热内蕴型。结论:NAFLD患者客观化指标与中医辨证分型具有一定的内在关系。     

非酒精性脂肪性肝病证治

本文简述了中医对非酒精性脂肪性肝病的辨证、治疗要点和临床应用,介绍了食疗、体疗、心疗并重的治疗方法,对临床治疗具有指导意义。     

酒精性肝病与非酒精性脂肪性肝病临床分型诊断探讨

目前 ,国内外对酒精性肝病分型诊断及诊断标准缺乏共识性意见。本研究旨在提出一种较为实用的酒精性肝病的临床分型诊断方案及其筛选标准 ,并以此用于非酒精性脂肪性肝病的分型诊断 ,同时对比分析两者分型诊断结果。材料与方法一、纳入标准(一 )既往无肝炎、血吸虫及其他重要器官疾病史 ,酒精组患者无长期服药史。肝炎病毒血清标志物阴性。(二 )B超检查均有肝区回声不同增强 ,肝后回声不同程度衰减 ,肝内血管纹理欠清晰或显示不清 ,肝脏不同程度增大或饮酒组患者肝脏缩小。(三 )既往无长期饮酒或每周饮酒精量 <40g为非酒精组 ,长期饮用白酒…     

非酒精性脂肪性肝炎患者血清同型半胱氨酸水平及氧化应激状态与颈动脉内膜中层厚度的关系

目的评估非酒精性脂肪性肝炎(NASH)病人血清中同型半胱氨酸(Hcy)水平及氧化应激状态与颈动脉内膜中层厚度(c-IMT)的关系。方法选取55例NASH患者及32例健康对照者,检测血中脂类、肝脏生化标志物、Hcy、还原型谷胱甘肽(GSH)及c-IMT等指标。结果 NASH患者脂类和肝脏生物标志物水平异常,c-IMT厚度及血清Hcy水平显著高于对照组(P0.01),而GSH显著低于对照组(P0.01)。此外,血清Hcy水平与腰围(WC)、体质指数(BMI)、游离胆固醇、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及多种转氨酶呈正相关(P0.05或P0.01);而与GSH呈负相关(P0.05)。结论 NASH是一个独立的心血管疾病风险因子,与Hcy水平升高、氧化应激和c-IMT相关联。c-IMT可以作为一个因血脂异常和氧化应激诱发的早期动脉粥样硬化的判断指标,而Hcy水平的升高则可能是肝损伤的一种表征。     

新诊断2型糖尿病并非酒精性脂肪性肝病患者颈动脉内膜中层厚度与血浆内脂素及游离脂肪酸水平的关系

检测49例新诊断T2DM并非酒精性脂肪肝病患者（NAFLD组）,2型糖尿病无大血管病变组54例（T2DM组）,健康对照组35名的颈动脉内膜中层厚度与血浆内脂素（Visfatin）、游离脂肪酸（FFA）和相关临床指标。结果：T2DM患者血浆Visfatin、FFA水平高于正常对照组（P〈0．05）,T2DM＋NAFLD组血浆Visfatin、FFA水平较正常对照组升高（P〈0．01）;而T2DM＋NAFLD组、T2DM组、正常对照组中Visfatin水平依次升高,组间统计存在显著性差异（P〈0．001）。多元线性逐步回归分析显示腰臀比和空腹血糖是影响血浆Visfatin及FFA水平的独立相关因素。结论：血浆内脂素、游离脂肪酸水平变化与糖脂代谢关系密切,它在T：DM并NAFLD患者的大血管病变发病机制中起着一定作用。     

非酒精性脂肪性肝病的危险因素及其与血管病变的相关性

目的分析新诊断的轻、中度非酒精性脂肪性肝病(NAFLD)的危险因素,探讨其与血管病变相关性。方法选择体检发现的单纯轻、中度NAFLD患者202例为脂肪肝组,同期健康体检者91例为对照组。采用彩色多普勒超声检查,检测颈动脉内膜中膜厚度(IMT)及内皮舒张功能[包括内皮依赖性舒张功能(FMD)和内皮非依赖性舒张功能(NMD)]。并分析两组临床生化指标。结果 (1)与对照组相比,脂肪肝组体质指数、腰臀比、收缩压、舒张压、低密度脂蛋白胆固醇、总胆固、甘油三酯、谷丙转氨酶、谷草转氨酶、尿酸、高敏C反应蛋白、胰岛素抵抗指数均增高,高密度脂蛋白胆固醇降低,差异有统计学意义(P0.01)。(2)Logistic回归分析发现,NAFLD的独立危险因素有胰岛素抵抗指数、高敏C反应蛋白、谷丙转氨酶,OR值分别为2.725、1.623、1.054(P0.05)。(3)完成彩超检查的脂肪肝组45例(其中轻度23例,中度22例),对照组40例。与对照组比较,脂肪肝组颈动脉IMT增高[0.92(0.80,1.02)比0.87(0.74,0.99)],FMD、NMD均降低[4.7%(2.2%,6.8%)比5.2%(2.4%,7.7%);18.5%(12.2%,25.3%)比20.5%(12.2%,28.7%)],但两组差异无统计学意义。与对照组比较,轻度脂肪肝组及中度脂肪肝组IMT、FMD、NMD差异亦无统计学意义。单因素相关分析表明IMT、FMD、NMD与是否NAFLD无显著相关性。结论胰岛素抵抗指数、高敏C反应蛋白、谷丙转氨酶增高是NAFLD的独立危险因素。新诊断的轻、中度NAFLD患者血管病变与健康者无显著差异,NAFLD与动脉硬化确切相关性有待进一步研究。     

高血压与颈动脉内膜中层厚度的关系

目的　研究高血压病程与颈动脉粥样硬化的关系。方法　用高频超声检测3 0 5例高血压病患者和1 1 2例健康人的颈动脉内膜中层厚度(IMT)。结果　(1 )高血压病组IMT明显高于正常对照组(P <0 . 0 5 ) ;高血压病不同病程各组之间比较有显著性差异(P <0 . 0 5 ) ;高血压病有无合并冠心病组间比较有显著性差异(P <0 . 0 5 )。(2 )颈动脉IMT增厚与冠心病密切相关。结论　超声检测高血压病患者的颈动脉情况,可以判断动脉粥样硬化程度,监测高血压病的进展、预后,在高血压动脉粥样硬化防治监测上有重要意义。     

Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness,insulin resistance and nonalcoholic fatty liver disease in children and adolescents

Background and aimsThe triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD).Methods and resultsThe study population, including 548 children (aged 6–16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08–3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03–15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30–3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62–4.56); P < 0.01].ConclusionTG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.     

非酒精性脂肪性肝病与肝细胞癌发生

肝细胞癌的发病率在全球逐年升高。绝大多数肝细胞癌与肝炎病毒感染有关,然而非酒精性脂肪性肝病也是引起肝细胞癌的重要原因之一。近年来,随着饮食习惯及生活方式的改变,非酒精性脂肪性肝病发病率持续升高,其与肝细胞癌发生的关系也得到了更多的关注。本文主要从非酒精性脂肪性肝病相关肝细胞癌的发病进程、危险因素及发病机制等方面做一介绍。     

血清细胞角蛋白18诊断非酒精性脂肪性肝病的价值探讨

目的研究血清细胞角蛋白18(CK18)水平诊断非酒精性脂肪性肝病的价值。方法选择93例非酒精性脂肪性肝病(NAFLD)患者和44名年龄与性别相匹配的健康人,检测血清CK18水平,同时测定ALT、AST、GGT、FBG、FINS、TC、TG、HDL、LDL水平,以及血压、身高、体重、腰围(WC)、臀围(HC),并计算腰臀比(WHR)和体重指数(BMI);应用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)。对其中30例NAFLD患者进行肝组织病理学检查。结果 NAFLD患者血清CK18水平显著高于正常对照组(P<0.001);血清ALT升高的NAFLD患者血清CK18水平(16.38±8.1ng/ml)高于ALT正常组(5.655±4.72 ng/ml),差异有统计学意义(P<0.001);经病理学检查证实的非酒精性脂肪性肝炎患者血清CK18水平(20.93±8.07ng/ml)明显高于非酒精性单纯性脂肪肝患者(7.61±5.51ng/ml),差异有统计学意义(P<0.001);NAFLD患者血清CK18水平与肝脂肪变(r=0.527,P=0.003)、炎症(r=0.662,P<0.001)和纤维化(r=0.715,P<0.001)具有显著的相关性。结论血清CK18水平能反映NAFLD患者肝脏炎症和纤维化程度,因而具有一定的诊断意义。     

非酒精性脂肪性肝病脂毒性多臂表型研究进展

正2001年Unger把过量的游离脂肪酸(FFA)由脂肪组织(AT)异位集聚于非AT(NAT)引起细胞损伤现象称为脂肪毒,胰岛素抵抗(IR)和脂凋亡是其两个特征性表型。近来,研究认为脂毒性是NAFLD的多重打击的主轴,其多臂表型介导了NAFLD进展及代谢综合征(MS)发生~([1-5])。此假设日益受到重视,成为当前研究的热点。1 NAFLD是脂毒性肝病1.1脂滴(LD)是脂肪肝(FL)形成的根~([6-8])FL不仅是肝细胞     

青少年非酒精性脂肪肝相关危险因素分析

目的 调查青少年非酒精性脂肪性肝病（NAFLD）发生的危险因素。方法 2015年6月~2016年6月在我院体检的青少年1222例, 行超声检查诊断,常规行血生化指标检测。采用Logistic回归分析影响青少年发生NAFLD的危险因素。结果 在1222名调查者中,发现NAFLD 142例;NAFLD组肥胖、2型糖尿病、高胆固醇、高甘油三酯血症、HOMA-IR均高于1080例非NAFLD人群（P<0.05）;Logistic回归分析显示BMI（RR：1.750,CI：2.215~2.317,P<0.001）、腰臀比（WHR,RR：1.135,CI：2.750~4.215,P<0.001、2型糖尿病（RR：1.317,CI：1.875~2.013,P<0.001）、TG（RR：1.415,CI：1.217~4.375,P<0.001）、HOMA-IR（RR：1.750,1.887~152.402,P<0.001）为发生NAFLD的独立危险因素;以BMI=25.48为诊断NAFLD的截断点,其敏感度为92.97%,特异度为80.28%,以WHR=0.835为诊断NAFLD的截断点,其敏感度为85.6%,特异度为83.8%。结论 出现肥胖、2型糖尿病、高血脂和胰岛素抵抗的青少年往往已经存在NAFLD,应注意防治。     

Fibroscan联合人体测量学指标诊断非酒精性脂肪性肝病效能分析

目的探讨瞬时弹性成像技术（Fibroscan）联合人体测量学指标在非酒精性脂肪性肝病（NAFLD）诊断中的应用价值。方法选择经超声检查诊断的NAFLD患者132例和健康人120例,常规行受控衰减参数（CAP）检测及测量腰围（WC）和臀围（HC）,计算体质指数（BMI）和身高腰围比（WHtR）。结果男性NAFLD患者CAP、BMI、WC和WHtR分别为（272.83±35.22）dM/m、（27.14±2.53） kg/m2、（92.29±6.27） cm和（0.55±0.03）,女性分别为（255.47±30.16） dM/m、（25.31±2.37） kg/m2、（82.52±6.37） cm、（0.53±0.05）,均显著高于健康人（P<0.05）;CAP、BMI、WC和WHtR诊断的灵敏度分别为85.61%、74.24%、71.97%和79.55%,联合后可将诊断的灵敏度提高到91.7%,但并不能提高诊断的特异度。结论使用Fibroscan检测CAP有助于在体检人群中筛选NAFLD患者,结合人体测量学指标可在大规模人群体检过程中得到初步应用。     

Carotid lesions in outpatients with nonalcoholic fatty liver disease

AIM： To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease （NAFLD） at abdominal ultrasound （US）. METHODS： One hundred and fifty-four consecutive outpatients （age range 24-90 years, both sexes） referred by general practitioners for abdominal US, and drinking less than 20 g alcohol/day, underwent carotid US for an assessment of carotid intima-media thickness （c-IMT） and carotid plaque prevalence. Hepatic steatosis, visceral fat thickness and subcutaneous fat thickness were also assessed at ultrasonography. RESULTS： Higher c-IMT values were found in the presence of NAFLD （90 patients）, even after adjustment for indices of general and abdominal obesity and for the principal cardiovascular risk factors （0.84 ± 0.10 mm vs 0.71 ± 0.10 mm, P 〈 0.001）. The prevalence of carotid plaques was 57.8% in the patients with NAFLD vs 37.5% in the patients without this condition （P = 0.02）. The adjusted relative risk of having carotid plaques for patients with NAFLD was 1.85 （95% CI： 1.33-2.57, P 〈 0.001）.CONCLUSION： An incidental finding of hepatic steatosis may suggest the presence of silent carotid atherosclerotic lesions.     

非酒精性脂肪性肝病的饮食治疗

随着高脂肪高热量膳食的盛行、生活节奏的加快和多坐少动生活方式的流行,肥胖、糖尿病及其相关非酒精性脂肪性肝病（Nonalcoholic fatty liver diseases,NAFLD）已成为愈来愈重要的慢性非传染性流行病。在重度肥胖症患者中,NAFLD的发病率高达90%,其中20%～30%为非酒精性脂肪性肝炎（NASH）,高达8%患者已发展至肝硬化阶段。     

The correlation of irregularities in carotid arterial intima-media thickness with coronary artery disease

Noninvasive ultrasonographic assessment of carotid artery intima-media thickness (IMT) can improve risk stratification for coronary artery disease (CAD) in certain patients. Several measurements have been used to evaluate carotid atherosclerosis by ultrasonography. Although it has been reported that angiographic arterial irregularities correlate with pathologic changes of atherosclerosis and the occurrence of cardiovascular events, only a few studies have assessed carotid arterial wall irregularity by ultrasonography. The purpose of this study was to evaluate the irregularity of IMT quantitatively, and its association with the presence or absence of CAD. The correlation of maximum and mean IMT values, and IMT irregularity with the presence or absence of CAD, was investigated in 90 patients who had undergone coronary angiography. IMT was measured by manual tracking of the far wall of the common carotid arteries, carotid bulbs, and internal carotid arteries. The IMT irregularity was defined as the root mean square (RMS) difference between each IMT and averaged IMT. Multiple logistic regression analysis, after adjustment for coronary risk factors, indicated that the RMS difference was a more accurate predictor of CAD than were the mean or maximum IMT values. These results indicate that the evaluation of IMT irregularity by ultrasonography is a useful predictor for the presence of coronary atherosclerosis. Received: March 13, 2002 / Accepted: June 15, 2002 Acknowledgment We are grateful to Hitachi Medical Corporation, Tokyo, Japan, for the computer software used for ultrasonographic measurement of intima-media thickness. Correspondence to T. Ishimitsu     

脂肪细胞因子和非酒精性脂肪性肝病

本文对脂肪细胞分泌的脂联素、瘦素、抵抗素、内脏脂肪素和炎症因子等在胰岛素抵抗导致非酒精性脂肪性肝病(NAFLD)代谢通路中的多重角色作了系统的综述;阐述了脂源性因子在脂肪组织和肝脏之间的对话机制中介导的代谢综合征和脂肪性肝病之间的关联。