中老年人血清铁与非酒精性脂肪肝的相关性研究

目的:研究血清铁与非酒精性脂肪肝(NAFLD)患病风险的相关性。方法:在上海40岁以上社区居民中进行问卷调查,并进行体格检查、高分辨率超声检查以及血清铁、血脂、胰岛素、空腹及口服葡萄糖耐量试验(OGTT)2 h血糖(2hPG)、肝功能、肾功能等生化检测,对其中数据完整的2120名居民进行分析。分别采用线性回归分析血清铁离子浓度与NAFLD危险因素的相关性,多元Logistic回归模型分析血清铁与NAFLD患病风险之间的关系。结果:NAFLD的患病率为27.4%。从血清铁离子浓度第1四分位组到第4四分位组,NAFLD患病率呈增高趋势,分别为20.8%、29.2%、28.4%、31.2%(组间趋势P=0.0005)。多元Logistic回归分析显示,与血清铁离子浓度第1四分位组(≤14.3 μmol/L)相比,第2四分位组(14.4~17.8 μmol/L)、第3四分位组(17.9~21.9 μmol/L)及第4四分位组(>21.9 μmol/L)NAFLD的患病风险比值比(OR)分别是1.57[95%可信区间(CI):1.19~2.08]、1.51(95%CI:1.14~2.00)、1.72(95%CI:1.30~2.28)(趋势P=0.0005),在校正年龄、性别、吸烟、饮酒、体质量指数(BMI)、收缩压(SBP)、脂代谢指标、空腹血糖对数值(lg FPG)等相关混杂因素后,3组NAFLD患病风险OR分别是1.31(95%CI 0.91~1.89)、1.44(95%CI 0.99~2.09)、1.48(95%CI 1.01~2.19)(趋势P=0.0274)。结论:上海社区40岁以上人群中,高浓度血清铁离子与NAFLD的患病风险显著相关。     

非酒精性脂肪性肝病与代谢综合征的相关性研究

目的分析非酒精性脂肪性肝病（NAFLD）与代谢综合征（MS）的关系。方法10357例在我院体检的普通人群入选本研究,检测人体学参数、生化指标及肝脏彩超,分析该人群NAFLD和MS的患病率,探讨MS组分与NAFLD的关系。结果10357例体检者中NAFLD的患病率为31．1％,MS患病率为23．6％,NAFLD合并MS患病率为15．5％。经年龄标化后NAFLD和MS患病率男性仍明显高于女性。将全部受试者按BM1分组后,各组间NAFLD、MS及NAFLD合并MS患病率差异均有统计学意义（P〈0．01）。选择同期体检无NAFLD的个体（非NAFLD组）,经性别、年龄、BMI与NAFLD组相匹配后,NAFLD组MS患病率明显高于非NAFLD组（59．8％VS5．2％,P〈0．01）。多因素Logistic回归分析表明：NAFI。D危险因素的前五位为TG、BMI、FPG、LDL-C和吸烟。结论即使排除BMI因素的影响,NAFLD患者MS的患病率仍然明显增高。NAFLD危险因素由高到低依次为TG、BMI、FPG、LDL-C、吸烟、TC、性别、血压、SUA及ALT。HDL-C为NAFLD保护性因素。     

NAFLD与肝细胞癌的相关性研究进展*

非酒精性脂肪性肝病（NAFLD）已成为世界范围内最常见的慢性肝脏疾病,被认为是代谢综合征在肝脏的表现,其疾病谱从轻微肝细胞脂肪变性到非酒精性脂肪性肝炎（NASH）,进一步可发展为肝硬化或肝细胞癌（HCC）。随着肥胖及胰岛素抵抗问题的日益严重,NAFLD、NASH及其相关肝硬化、肝癌患者也日益增多。近年来研究表明,NASH可不经肝硬化阶段直接发展为HCC,具体机制尚不明确。     

血清胆红素水平与非酒精性脂肪性肝病的关系研究

目的探讨血清胆红素水平与非酒精性脂肪性肝病(NAFLD)的关系。方法以2013年1月-2013年6月在新疆医科大学第五附属医院进行健康体检者为研究对象,从中筛查出NAFLD患者462例,按年龄、性别配对的方法选取健康对照者462例,测量两组身高、体质量、血压、总胆红素、直接胆红素、间接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、空腹血糖、尿酸等指标,t检验比较两组上述指标差异,多因素Logistic回归分析NAFLD患病影响因素。结果与对照组相比,NAFLD组体质量指数、收缩压、舒张压、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、空腹血糖和尿酸水平明显升高(P0.01),总胆红素、直接胆红素、间接胆红素水平明显降低(P0.01);随着体质量指数(OR=1.363,P0.01)、舒张压(OR=1.040,P0.01)、丙氨酸转氨酶(OR=1.038,P0.01)、三酰甘油(OR=1.399,P0.01)、空腹血糖(OR=1.865,P0.01)和尿酸(OR=1.006,P0.01)水平上升,NAFLD发生的风险增加;随着总胆红素水平升高,NAFLD的发生风险降低(OR=0.897,P0.01)。结论血清胆红素与NAFLD的发生密切相关,血清胆红素水平下降将导致NAFLD发生的风险增加。     

Crosstalk between angiogenesis, cytokeratin-18, and insulin resistance in the progression of non-alcoholic steatohepatitis

AIM: To elucidate the possible crosstalk between angiogenesis, cytokeratin-18 (CK-18), and insulin resistance (IR) especially in patients with non-alcoholic steatohepatitis (NASH). METHODS: Twenty-eight patients with NASH and 11 with simple fatty liver disease (FL) were enrolled in this study and underwent clinicopathological examination. The measures of angiogenesis, CK-18, and IR employed were CD34-immunopositive vessels, CK-18- immunopositive cells, and homeostasis model assessment of IR (HOMA-IR), respectively. The correlations of these factors with NASH were elucidated. RESULTS: Significant development of hepatic neovascularization was observed only in NASH, whereas almost no neovascularization could be observed in FL and healthy liver. The degree of angiogenesis was almost parallel to liver fibrosis development, and both parameters were positively correlated. Similarly, CK-18 expression and HOMA-R were significantly increased in NASH as compared with FL and healthy liver. Furthermore, CK-18 and HOMA-IR were also positively correlated with the degree of neovascularization. CONCLUSION: These results indicate that the crosstalk between angiogenesis, CK-18, and IR may play an important role in the onset and progression of NASH.     

解偶联蛋白2与非酒精性脂肪性肝病关系研究进展

目前,非酒精性脂肪肝病(NAFLD)的发病率逐年攀升,已成为危害人类健康的三大肝病之一。解偶联蛋白-2(UCP-2)是新发现的一种位于线粒体内膜上的载体蛋白,具有刺激产热,减少ATP生成,抑制反应性氧簇的产生,负性调节胰岛素分泌以及抗凋亡作用。在脂肪肝中,UCP-2表达增加。现就UCP-2在NAFLD中的作用进行综述。     

Correlation between income and non-alcoholic fatty liver disease in a Chinese population

ObjectiveThe aim of the study was to analyze the correlation between income and non-alcoholic fatty liver disease (NAFLD) in a Chinese population.Methodsubjects were divided into three groups according to liver fat content (LFC). (1) normal: LFC < 9.15%, 197 cases; (2) low LFC: LFC 9.15–20%, 532 cases; and (3) high LFC: LFC > 20%, 201 cases. Participants’ clinical and social background were collected, including a routine fasting test to assess the relevant indices. Intergroup differences were compared on 1-way ANOVA, to analyze the relation between income and each index on Pearson correlation, and independent factors for LFC were identified on binary logistic regression.Results(1) In retired persons, prevalence of NAFLD was greater in females (81.2%) than males (75%), but fell with age: the highest prevalence was between 40 and 49 years of age (87.5%), and the lowest above 70 years (68%). (2) Income correlated positively with triglyceride and serum uric acid levels and LFC (P < 0.05) and negatively with alanine aminotransferase (P = 0.01). (3) As income increased from level I to V, prevalence of NAFLD increased progressively (P < 0.05). In the study, LFC was taken as the dependent variable, and the traditional NAFLD risk factors and income level (I–V) were taken as independent variables. Income emerged as an independent risk factor for NAFLD. Risk in group V was 1.964-fold higher than in group I.ConclusionPrevalence of NAFLD was closely related to socio-economic level. Demographic risk factors include female gender, age 40–49 years, and monthly income > 5,000 RMB. Thus, if income is increased without improving educational level and health awareness, NAFLD prevalence will rise.     

老年人非酒精性脂肪肝病与代谢综合征的相关研究

目的调查老年体检人员非酒精性脂肪肝病（NAFLD）和代谢综合征（MS）及其相关疾病的情况。方法从参与本院体检的405名60岁及以上的老年人中选取313例（男224例,女89例）,平均76．08±7．53岁,检测身高、体重、腰围、体质指数（BMI）、空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白及多普勒超声,并对结果分析。结果老年男、女性MS患病率分别为14．3％和20．2％,男、女NAFLD患病率为40．2％、36．0％。在MS各种组合中,男、女性均以肥胖、高血压、高血脂组合比例最高,占40％以上,NAFLD患病率在肥胖、高血压、高血脂、血糖异常组合中高达100％。NAFLD病人中的脑梗死、糖尿病、高血压比例较高,NAFLD病人的空腹血糖、甘油三酯、BMI、腰围也、显著高于非NAFLD,但血清胆固醇差异无统计学意义。NAFLD和MS相关（r=0．374,P〉0．01）。结论60岁及以上老年人的NAFLD和MS患病率均较高,NAFLD作为MS的一个组成部分应及早干预治疗。     

非酒精性脂肪性肝病与酒精性肝病的异同

脂肪性肝病是一种常见病,根据有无大量饮酒史可分为酒精性脂肪性肝病(alcoholic fatty liver,AFL)与非酒精性脂肪肝(NAFLD),前者是酒精性肝病(ALD)的一个类型。ALD是世界范围内发病率和病死率最高的疾病之一,其发生肝硬化和肝癌的机会要远超过NAFLD[1]。在临床工作中,两种疾病因无特异的临床表现,鉴别主要依赖于饮酒史,但一些患者的饮酒量介于两者诊断（指南）标准之间,此外回忆和估计的饮酒史并不可靠,而作为两种不同原因诱导的疾病,还可能存在重叠的情况。现就近年来流行病学、自然转归、发病机制、诊断和治疗等方面的研究结果对两者进行比较鉴别。     

非酒精性脂肪性肝病非侵人性诊断的研究及细胞角蛋白18的意义

此文主要介绍非酒精性脂肪性肝病(NAFLD)在临床、实验室研究中的非侵入性诊断方法,详细介绍细胞角蛋白18在非酒精性脂肪性肝炎与单纯性非酒精性脂肪肝鉴别诊断中的研究,以及运用细胞角蛋白18作为生物标志物在对NAFLD非侵入性诊断研究中所面临的挑战.     

肥胖人群血清尿酸水平与非酒精性脂肪性肝病严重程度的相关性分析

目的探究肥胖患者高尿酸血症发生的危险因素以及血清尿酸水平与非酒精性脂肪性肝病（NAFLD）严重程度的相关性。 方法回顾性分析2018年7月至2020年9月在南京鼓楼医院减重代谢中心拟行减重代谢手术的247例肥胖患者,收集患者术前临床资料及血清学数据及肝脏NAS评分。 结果221例患者进入肥胖患者高尿酸血症的危险因素分析,低尿酸组57（25.8%）人,高尿酸组164（74.2%）人,二组在性别、体质量指数（BMI）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γ-GT）、总胆红素（TBil）、甘油三酯（TG）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）、胰岛素（INS）、C肽（C-peptide）水平存在差异。141例患者拥有完善的病理学结果,其中40例可排除非酒精性脂肪性肝炎（NASH）,68例NASH可能,33例可诊断为NASH,三组高尿酸血症发生率分为别78.7%、76.5%、47.5%;多因素logistic回归分析提示三组在小叶内炎症、气球样变、ALT、UA水平存在差异（P<0.05）;而进一步研究发现血清尿酸水平与肝脏脂肪变性程度正相关（Spearman分析相关系数r=0.38,P<0.05）,而与气球样变及小叶内炎症无明显相关性（血清尿酸与气球样变：Spearman分析相关系数r=0.14,P=0.096;血清尿酸与炎症反应：Spearman分析相关系数r=0.058,P=0.493）。 结论随着肥胖患者BMI的增高,发生高尿酸血症以及非酒精性脂肪性肝炎的可能性增高;血清尿酸的增高也会促进肥胖患者非酒精性脂肪性肝病的发展,且血清尿酸水平与肝脏脂肪变性严重程度具有相关性。     

非酒精性脂肪性肝病与动脉粥样硬化

非酒精性脂肪性肝病(NAFLD)和代谢综合征(MS)的关系逐渐得到了人们的重视,NAFLD与动脉粥样硬化(AS)和心血管疾病(CVD)的关系近几年也成为了研究热点.NAFLD和AS到底关系如何,其与MS又存在怎样的关联,需要我们不断的进行深入探索.这对临床上进行早期干预、预防、延缓甚至阻止AS的发生,评估NAFLD患者...     

Correlation between Fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIMTo explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODSThis study was conducted on NAFLD/NASH patients (n = 73) who underwent Fibroscan examinations at Saint George Hospital University Medical Center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase (AST)/alanine transaminase (ALT) ratio, AST platelet ratio index (APRI) score and Fibrosis-4 score.RESULTSA significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSIONThis study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.     

Chemerin,retinol binding protein-4, cytokeratin-18 and transgelin-2 presence in sera of patients with non-alcoholic liver fatty disease

Background. Chemerin and retinol binding protein-4 (RBP-4) are adipokines which may play a role in the progression of NAFLD. It has been also suggested that cytokeratin-18 (CK-18) could be a marker of hepatocyte caspase-directed death while transgelin-2 production could reflect stage of liver fibrosis. The aim of this study was to evaluate the level of the above adipokines in sera of patients with NAFLD and determine the relation between the level of transgelin-2 and fibrosis-4 index (FIB-4).Material and methods. Ninety-five subjects included initially to the study were divided into four groups: (I) prediabetics, obese with NAFLD and metabolic syndrome (Ms), (II) lean with NAFLD and without MS, (III) obese without NAFLD and MS, and (IV) healthy individuals. We determined the levels of chemerin, RBP-4, transgelin-2 and CK-18 fragments in sera of patients with NAFLD. Moreover, we examined if the levels of CK-18 fragments and transgelin-2 correlates with FIB4 value. Results. Chemerin and RBP-4 were highly expressed in sera of all NAFLD, especially in obese individuals. Chemerin level was also linked to MS. High level of serum CK-18 fragments and transgelin-2 did not correlate with obesity and MS, but seemed to correlate with progression of NAFLD to liver fibrosis.Conclusions. In conclusion, the production of the two adipokines, chemerin and RBP-4, is strongly associated with obesity in patients with NAFLD. Serum concentrations of CK-18 fragments and transgelin-2 correlate with the severity of NAFLD, but not with obesity.     

Involvement of Porphyromonas gingivalis in the progression of non-alcoholic fatty liver disease

Journal of Gastroenterology - The risk factors in the progression of nonalcoholic fatty liver disease (NAFLD) have not been fully clarified. Porphyromonas gingivalis (P.g) has been considered to be...     

非酒精性脂肪肝并发原发性高血压患者与血压变异性的关系

目的 探讨非酒精性脂肪肝(Non-alcoholic Fatty Liver Disease,NAFLD)并发原发性高血压对血压变异性的影响.方法 纳入在2019年9月～2020年7月就诊于宣城市人民医院心血管内科的原发性高血压患者206例,进行动态血压、动态心电图及腹部超声检查.以动态血压测量参数中24 h收缩压变异...     

非酒精性脂肪性肝病的无创诊断进展

现代社会由于肥胖的高度流行,与其相关的非酒精性脂肪性肝病（NAFLD）的患病率不断升高。从疾病的发展而言,非酒精性脂肪性肝病疾病谱包括单纯性肝脂肪变、非酒精性脂肪性肝炎（NASH）及脂肪性肝硬化。目前认为单纯性肝脂肪变为良性病变,而非酒精性脂肪性肝炎则易进展成为肝硬化及肝癌。