非酒精性脂肪肝伴2型糖尿病患者左室舒张功能的影响

目的探讨非酒精性脂肪肝（NAFLD）对2型糖尿病患者左室舒张功能的影响。方法纳入596例2型糖尿病住院患者,进行腹部超声、颈动脉超声、心脏超声等检查,以E/A作为评估左室舒张功能的指标,分为NAFLD组和非NAFLD组,组内或组间差异比较用单因素方差分析或χ^2检验,并采用多因素Logistic回归分析对可能影响舒张功能的因素进行分析。结果 2型糖尿病合并NAFLD组的BMI、收缩压、丙氨酸氨基转移酶、甘油三酯、LDL胆固醇、HbA1c、HOMA-IR、颈动脉内膜中层厚度显著高于无NAFLD组（P〈0.05）,E/A值显著低于无NAFLD组（P〈0.05）;NAFLD与左室舒张功能减退的相关性经多因素Logistic回归分析进行校正后OR值为1.72（95%CI 1.26～2.75,P〈0.05）。结论在2型糖尿病患者中,NAFLD是左室舒张功能减退的重要危险因素。     

单纯性非酒精性脂肪肝与非酒精性脂肪性肝炎临床特征比较

目的 探讨单纯性非酒精性脂肪肝（NAFL）与非酒精性脂肪性肝炎（NASH）患者临床相关因素的异同点.方法 收集2006年6月～2010年6月间我院住院及门诊资料完整的非酒精性脂肪性肝病（NAFLD）患者150例,其中非酒精性脂肪性肝炎65例,非酒精性脂肪肝85例,比较两组患者年龄、体重指数（BMI）、临床表现、实验室检查和合并症等因素.结果 非酒精性脂肪性肝炎组患者BMI、血清铁蛋白、IV型胶原、空腹胰岛素、空腹血糖、胰岛素抵抗指数、代谢综合症等相关疾病的发生率较非洒精性脂肪肝组明显增多,差异有显著性（P〈0.05）,其余指标比较差异无显著性.结论 非酒精性脂肪肝组与非酒精性脂肪性肝炎组患者非特异性症状（如疲劳、乏力等）的发生率及肝功能比较尤显著性差异;非酒精性脂肪性肝炎组并发症（如2型糖尿病等）较非洒精性脂肪肝组突出;非酒精性脂肪性肝炎组BMI、血清铁蛋白、Ⅳ型胶原、空腹血糖、空腹胰岛素、胰岛素抵抗指数等血清学指标较非酒精性脂肪肝组显著升高.     

2型糖尿病合并脂肪肝患者的临床特征分析

近年来,非酒精性脂肪肝（NAFL）的发病率逐渐升高,在2型糖尿病（DM）患者中其发病率约为50%.NAFL可进展为非酒精性脂肪性肝炎（脂肪肝合并炎症、坏死或纤维化）、肝硬化、甚至可发展为终末期肝病和肝细胞癌.NAFL已成为危害人们健康的常见病.本文对初诊2型DM合并脂肪肝患者的临床特征做一分析,旨在探讨2型DM患者脂肪肝的易患因素,以利于脂肪肝的预防和治疗.     

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。     

2型糖尿病患者非酒精性脂肪肝与微血管病变关系的研究

目的探讨2型糖尿病(T2DM)患者中非酒精性脂肪肝(NAFLD)与慢性肾脏疾病(CKD)及糖尿病视网膜病变(DR)的关系。方法收集2008年5月至2009年7月上海交通大学附属第一人民医院内分泌代谢科448例T2DM患者的临床资料,按是否合并NAFLD分组,比较两组间CKD和DR的发生率及其与NAFLD的联系。结果(1)448例T2DM患者中NAFLD合并率为59.4%。(2)与无NAFLD组相比,NAFLD组尿白蛋白/肌酐比值(UACR)及CKD和DR的发病率明显升高(P0.01)。(3)Logistic回归分析显示,NAFLD是T2DM患者发生CKD和DR的独立危险因素(OR=1.9,P0.05;OR=2.8,P0.01)。结论T2DM患者中NAFLD与CKD和DR密切相关,提示通过早期诊断和干预NAFLD可预防微血管并发症。     

2型糖尿病合并非酒精性脂肪肝与骨密度的关系

目的探讨2型糖尿病(T2DM)患者合并非酒精性脂肪肝(NAFLD)与骨密度(BMD)的相关性。方法筛选T2DM患者119例,依据B超结果分为2组:T2DM组(62例),T2DM合并NAFLD组(57例)。测定正位腰椎2-4(L2-4)、左侧股骨颈、Ward's三角、大粗隆及左前臂骨密度,行肝脏彩超及血糖、血脂、空腹C肽、肝肾功能、尿微量白蛋白检测,测量身高、体重等。结果 T2DM合并NAFLD组患者体重指数、三酰甘油、总胆固醇、空腹C肽、谷氨酰转酞酶、尿酸、尿微量蛋白均高于T2DM组,差异有统计学意义(均P0.05);左股骨颈、Ward's三角和左前臂骨密度值低于T2DM组,差异有统计学意义(均P0.05)。T2DM合并NAFLD与年龄、病程、左侧股骨和左前臂骨密度呈负相关(均P0.05),与体重指数、三酰甘油、总胆固醇、空腹C肽、尿微量蛋白呈正相关。左侧股骨颈骨密度值与年龄、病程、血糖、糖化血红蛋白A1C、总胆固醇呈负相关(均P0.05),与体重指数、高密度脂蛋白、肌酐呈正相关(P0.05)。体重指数、三酰甘油、尿酸与NAFLD独立相关(P0.05)。结论 T2DM合并NAFLD患者骨密度水平低于单纯2型糖尿病患者,二者有相关性。体重指数、空腹C肽、血脂是影响T2DM合并NAFLD患者骨密度水平的因素。     

2型糖尿病非酒精性脂肪肝患者visfatin水平与相关因素分析

目的 探讨visfatin与2型糖尿病(T2DM)及其非酒精性脂肪肝(NAFLD)并发症和相关代谢指标的关系.方法 将80例T2DM患者分为合并NAFLD组50例和单纯T2DM组30例,并选30例健康人做对照.所有的受试者均采用酶联免疫测定法(ELISA)测定空腹血清visfatin浓度;并测定各组的人体指标和血代谢指标水平;并分析各指标间及与NAFLD并发症的相关性.结果 ①T2DM合并NAFLD组、单纯T2DM组及对照组间相互比较血清visfatin浓度差异无显著性(P =0.874;P=1.000).②相关分析显示,T2DM组血清visfatin浓度与WC、TG均呈正相关.③多元线性逐步回归分析显示,TG是血清visfatin独立相关因素.结论 血清visfatin浓度在合并非酒精性脂肪肝的2型糖尿病中无明显变化,但与腹型肥胖及高甘油三酯血症密切相关.     

2型糖尿病并发非酒精性脂肪肝患者的临床特征及影响因素分析

目的分析并发非酒精性脂肪肝(NAFLD)的2型糖尿病(T2DM)患者的临床特征,探讨T2DM患者发生NAFLD的影响因素。方法选取T2DM患者167例,收集患者性别、年龄、糖尿病病程、身高、体质量等一般资料,采集空腹血糖(FPG)、TG、TC、LDL-C、HDL-C、糖化血红蛋白(HbA1c)、ALT、AST、空腹胰岛素、空腹-C肽(FCP)等实验室检查指标。于空腹状态下行腹部肝脏多普勒超声检查,根据检查结果诊断是否存在NAFLD。比较有、无并发NAFLD的T2DM患者的一般资料、实验室检查指标;比较不同HbA1c、TG、TC、BMI水平分层的T2DM患者的NAFLD发生率;分析T2DM患者并发NAFLD的相关危险因素。结果根据B超检查结果,分为单纯T2DM患者86例、T2DM并发NAFLD患者81例。T2DM并发NAFLD患者的HbA1c、TG、TC、BMI、ALT、FCP均高于单纯T2DM患者,糖尿病病程小于单纯T2DM患者(P均<0.05)。HbA1c>8.9%、TG>1.7 mmol/L、BMI>23.43 kg/m²的T2DM患者并发NAFLD的发生率较高(P均<0.05)。以是否并发NAFLD为因变量,临床指标为自变量进行logistic回归分析示,FCP(OR=0.737,P=0.009)、BMI(OR=0.786,P=0.003)、HbA1c(OR=0.996,P<0.001)是导致T2DM患者并发NAFLD的独立危险因素。结论血糖控制不佳、血脂水平较高、病程短的T2DM患者更易出现NAFLD。FCP、BMI、HbA1c是导致T2DM患者发生NAFLD的独立危险因素。建议对BMI超过23.43 kg/m²、高脂血症的T2DM人群进行肝脏彩超筛查,及时预防NAFLD发生。     

非酒精性脂肪肝病临床特征探讨

目的 探讨非酒精性脂肪肝病临床特征及常见病因。方法 对我院B超诊断的非酒精性脂肪肝病102例进行临床分析。结果 非酒精性脂肪肝病患者大多临床症、征及肝功损害较少。符合非酒精性脂肪肝炎15例(14．7％)。常见病因分别为肥胖、高脂血症及Ⅱ型糖尿病。提出了合并乙型肝炎病毒表面抗原携带的非酒精性脂肪肝病筛选标准。结论 早期非酒精性脂肪肝病易被忽视，随着人偿生活水平提高，非酒精性脂肪肝病的危害将逐渐增加。     

非酒精性脂肪性肝病合并2型糖尿病患者临床特征分析

目的：探讨非酒精性脂肪性肝病（NAFLD）合并2型糖尿病（ T2DM）患者的临床特征。方法选择NAFLD/T2DM患者60例和同期T2DM患者52例,比较他们的临床资料。结果 NAFLD/T2DM与T2DM患者BMI分别为（29.60±3.70）和（24.45±4.64）（P〈0.05）,腰围分别为（96.55±16.15） cm和（90.66±8.96） cm （P〈0.05）,收缩压分别为（135.18±16.13）mmHg和（116±21.36） mmHg（P〈0.05）,舒张压分别为（86.82±11.68） mmHg和（76.74±10.05） mmHg（P〈0.05）;NAFLD/T2DM 组和T2DM组TG分别为（2.56±1.58）mmol/L和（1.89±1.38） mmol/L（P〈0.05）,TC分别为（4.08±1.52） mmol/L和（3.09±1.78） mmol/L（P〈0.05）,ALT分别为（30.05±16.23） U/L和（20.07±26.0） U/L（P〈0.05）,AST分别为（26.08±10.59）U/L和（19.71±14.11）U/L（P〈0.05）,In分别为（2.48±0.53） uIu/L和（2.18±0.60） uIu/L（P〈0.05）,HomA-IR分别为（1.37±0.55）和（1.05±0.73）（P〈0.05）。结论 NAFLD/T2DM患者存在明显的超重、中心性肥胖、血脂紊乱、胰岛素抵抗和高血压,纠正胰岛素抵抗、增加胰岛素敏感性,改善脂代谢紊乱,有助于治疗NAFLD患者。     

Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease.

BACKGROUND AND AIM: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes. AIM: To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver. METHODS: We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT-PCR in 26 frozen liver samples and the ratio CB2/beta-actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann-Whitney U-test. We considered as significant differences those with a P-value <0.05. RESULTS: Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti-CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/beta-actin ratio of 0.001+/-0.01, steatosis 6.52+/-17.3 (P=0.05 vs normal) and NASH 6.49+/-12.2 (P=0.06 vs normal and P=0.6 vs steatosis). CONCLUSION: CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.     

Interaction of Type 2 diabetes and nonalcoholic fatty liver disease

Evauation of: Kasturiratne A, Weerasinghe S, Dassanayake A et al. Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus. J. Gastroenterol. Hepatol. 28(1), 142–147 (2013).

It has been a few decades that Type 2 diabetes has been clearly linked to the development and progression of nonalcoholic fatty liver disease (NAFLD). In a recent study reported by Kastuiratne et al., the reverse scenario is also reported. In this study, a cohort of Sri Lankan adults were evaluated for NAFLD by ultrasound and for the presence of Type 2 diabetes. Those without diabetes at baseline were followed prospectively for 3 years and assessed for incident diabetes. On multivariate analysis, after adjustment for a number of factors (age, impaired fasting glucose, BMI, waist circumference, elevated ALT, family history of diabetes and presence of hypertension and hyperlipidemia), NAFLD was the only predictor of incident diabetes in those with and without impaired fasting glucose at baseline. This study adds to the growing evidence connecting NAFLD to Type 2 diabetes and highlights the importance of its recognition in an effort to target those at the highest risk of diabetes for lifestyle and pharmacologic intervention.     

Liver steatosis,but not fibrosis,is associated with insulin resistance in nonalcoholic fatty liver disease

Background To address the hypothesis that liver steatosis causes systemic insulin resistance, we sought to determine the liver histological feature that most strongly contributes to insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Methods Liver biopsy specimens were obtained from 131 patients with clinically suspected NAFLD. The stage, grade of nonalcoholic steatohepatitis (NASH), and level of steatosis were scored and analyzed in relation to the homeostasis model assessment of insulin resistance (HOMA-IR) and the metabolic clearance rate (MCR), measured using the glucose clamp method. Results In the univariate analysis, the degree of hepatic steatosis (r = 0.458, P < 0.001), stage (r = 0.360, P < 0.001), and grade (r = 0.349, P < 0.01) of NASH were significantly correlated with the HOMA-IR. Multiple regression analysis adjusting for age, sex, body mass index, and each histological score showed that steatosis was significantly and independently associated with HOMA-IR (coefficient = 1.42, P < 0.001), but not with the stage (coefficient = 0.33, P = 0.307) or grade (coefficient = 0.67, P = 0.134) of NASH. Similar independent relationships were observed between steatosis and MCR, but the relationship was weaker (coefficient = −0.98, P = 0.076). Conclusions Steatosis of the liver, but not the stage or the grade of NASH, is associated with insulin resistance in patients with NAFLD.     

非酒精性脂肪性肝病相关心血管疾病的发病机制

非酒精性脂肪性肝病也称为代谢相关脂肪性肝病,是全球最为常见的慢性肝病。研究发现非酒精性脂肪性肝病与心血管疾病的风险增加有关,并且非酒精性脂肪性肝病本身是心血管疾病的独立危险因素。鉴于非酒精性脂肪性肝病与心血管疾病的密切关联,文章综述了连接非酒精性脂肪性肝病与心血管疾病的病理生理机制,为临床非酒精性脂肪性肝病患者心血管疾病的诊治提供了思路。