非酒精性脂肪性肝病合并胆石症的危险因素分析

目的 探讨非酒精性脂肪性肝病(Non-Alcoholic Fatty Liver Disease, NAFLD)合并胆石症(Gallstone disease, GD)的危险因素分析。方法 选取兰州大学第一医院2018年01月至2022年01月符合脂肪肝诊断的908例住院患者,根据纳排标准共纳入595例NAFLD患者,分为胆石症组(255例)和非胆石症组(340例),收集患者临床资料,分析NAFLD合并GD的危险因素。结果 多因素Logistic回归分析结果表明,与非GD组相比,GD组在性别、年龄、住院天数、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、白蛋白(albumin, ALB)、总胆汁酸(total bile acid, TBA)、甘油三酯(triglyceride, TG)和高同型半胱氨酸血症等方面统计学差异较显著(P<0.05)。结论 性别、年龄、住院天数、ALT、ALB、TBA、TG和高同型半胱氨酸血症是NAFLD合并GD的独立危险因素。     

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。     

非酒精性脂肪性肝病与代谢综合征相关性的临床研究

目的分析非酒精性脂肪性肝病与代谢综合征的关系。方法按住院顺序选择有随访资料病例共185例,将其分为四组（单纯脂肪肝组、单纯肥胖组、脂肪肝＋肥胖组、正常对照组）,在基线水平对四组出现代谢综合征情况进行横向比较。其次,在随访后再次对四组出现代谢综合征情况进行组内、组间比较。结果随访结束时,单纯脂肪肝组代谢综合征发病率明显高于正常对照组（P〈0.05）。结论非酒精性脂肪性肝病促进代谢综合征的发生,且不依赖于肥胖。     

解读非酒精性脂肪性肝病诊治指南

随着肥胖与糖尿病患者的日趋增多,脂肪性肝病(FLD)目前已成为全球性的重要肝病。临床上FLD分为酒精性肝病(ALD)与非酒精性脂肪性肝病(NAFLD);研究表明,NAFLD与肥胖、代谢综合征、2型糖尿病和心血管疾病密切相关。2006年和2010年中华医学会相继制定了中国NAFLD诊疗指南,较全面和广泛地反映了目前NAFLD的临床诊疗现状,与国际上颁布的一些诊治指南相比存在差异。本文就NAFLD诊治指南及相关问题进行解读。     

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...     

非酒精性脂肪性肝病与代谢综合征

非酒精性脂肪性肝病(NAFLD)包括单纯性脂肪肝以及由其演变的脂肪性肝炎和肝硬化.代谢综合征(MS)是心血管病的多种代谢危险因素在个体内集中的状态,NAFLD常与MS相伴,其发病与MS的各组分密切相关.很多研究表明,肥胖、胰岛素抵抗、血脂紊乱、糖代谢异常、高血压是NAFLD发病的危险因素,而在NAFLD人群中MS的患病率明显增高.因此NAFLD与MS关系密切,具有共同的发病基础,二者的预后、治疗原则相似.     

代谢相关脂肪性肝病/非酒精性脂肪性肝病的过去、现在和未来

回顾非酒精性脂肪性肝病(NAFLD)的历史,其本身的定义、检查手段和治疗方式都发生过重大变化.NAFLD更名为代谢相关脂肪性肝病(MAFLD)则是人类认识这类疾病的新起点,为其临床诊疗和学术研究带来了新的机遇和挑战.本文拟从过去和近年来MAFLD/NAFLD相关研究积累的经验和进展出发,探讨未来该类疾病诊疗的进展和发展...     

非酒精性脂肪性肝病营养治疗

非酒精性脂肪性肝病（nonalcoholic fatty liver disease,NAFLD）是一种无过量饮酒史、以肝实质细胞脂肪变性和脂肪贮积为特征的临床综合征,疾病谱随病程进展而表现不一,主要包括单纯性脂肪肝、非酒精性脂肪性肝炎（nonalcoholic steatohepatitis,NASH）、脂肪性肝纤维化和肝硬化。美国成人NAFLD发病率接近20％。日本为21.8％,韩国为24．6％,我国成人NAFLD发病率为12.6％～25％。美国12～18岁青少年NASH发病率为3．0％,     

非酒精性脂肪性肝病与代谢综合征指标变化的相关性分析

目的探讨中老年人群中非酒精性脂肪性肝病(NAFLD)与代谢综合征相关指标变化的关系。方法收集2010—2011年暨南大学附属第一医院40岁以上体检人群腹部B超检查的数据,用多因素Logistic回归分析体重指数(BMI)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)、丙氨酸转氨酶(ALT)、血尿酸(UA)的变化值与NAFLD变化的关系。结果 2年内男性组和女性组NAFLD检出率都在增加,男性新增NAFLD总检出率为13.7%,明显高于女性新增NAFLD检出率7.5%(P<0.05);男性和女性的NAFLD消减率都是5.5%,且峰值都在60岁年龄组;BMI变化值与新增NAFLD密切正相关,BMI变化值的OR=1.474(95%CI 1.184～1.811),而TG和FBG的变化值与新增NAFLD无相关性;TG和BMI的变化值与NAFLD的消减呈负相关,TG变化值的OR=0.653(95%CI 0.508～0.838),BMI变化值的OR=0.628(95%CI 0.460～0.857),而FBG变化值未发现与NAFLD消减有相关性。结论 BMI变化值与NAFLD发生有密切相关性,TG和BMI的变化值与NAFLD的消减呈负相关,是影响NAFLD变化的重要因素之一。     

非酒精性脂肪性肝病与肝移植

非酒精性脂肪性肝病（NAFLD）患病率日益增高,目前已成为西方国家肝移植的第二大适应证。虽然目前我国肝移植的主要适应证仍是乙型病毒性肝炎以及酒精性肝炎相关终末期肝病,但随着人们生活水平的提高以及代谢综合征的流行,与之相关的NAFLD患者也逐渐增加。同时,随着乙型肝炎疫苗接种的普及以及核苷类似物等药物的应用,可以预见,在...     

成人非酒精性脂肪肝与代谢综合征相关性分析

目的分析成人非酒精性脂肪肝病（NAFLD）和代谢综合征（MS）的关系。方法对2007年6月～10月广元市北街社区3180例20岁以上居民进行体格检查及肝脏B超检查,并检测空腹血糖（FBG）、血脂和丙氨酸氨基转氨酶（ALT）。结果（1）NAFLD患病率为13．5％,MS患病率为16．5％,丽病共患率为9．5％。（2）MS、中心性肥胖、血压升高、FBG升高、高甘油三酯（TG）、高密度脂蛋白（HLD—C）降低,各组NAFLD患病风险是对照组的12．7～24．1倍。（3）以NAFLD取代诊断MS的5个组分中的任何一个后,与原诊断定义相比有较高的一致性。结论该社区中1／8以上人群患有NAFLD或MS,且NAFLD与MS密切相关,NAFLD可能是MS的重要组成成分。     

Short-term orlistat therapy improves fatty infiltration indices and liver fibrosis scores in patients with non-alcoholic fatty liver disease and metabolic syndrome

Background and study aimsPatients with non-alcoholic fatty liver disease (NAFLD) exhibit features of metabolic syndrome, including a high body mass index, central obesity, high blood pressure, and abnormal lipid profile values. Orlistat, an intestinal lipase enzyme inhibitor, improves insulin resistance. We aimed to investigate the effects of short-term therapy with orlistat on the components of metabolic syndrome associated with NAFLD and explore its effect on liver fibrosis scores.Patients and methodsAn open-label placebo-controlled clinical study using orlistat for 12 weeks was carried out on 50 patients with NAFLD. They were divided into a placebo group (Group I) and an orlistat treatment group (120 mg per day, Group II). The diagnosis of NAFLD was made by ultrasonography and laboratory investigations. Anthropometric and blood pressure measurements and hepatic liver enzymes, fasting lipids, and blood glucose levels were determined before and after treatment. Lipid indices including cholesterol (Chol-I), triglyceride (TG-I), triglyceride-glucose (TYG-I), and the scores for lipid fibrosis using the NAFLD fibrosis score (NFS) and Fibrosis-4 score (Fib-4) were also determined.ResultsOrlistat significantly improved the anthropometric and metabolic indices (TG-I, TYG-I) and liver enzymes. Orlistat demonstrated a favorable impact on the NAS and Fib-4 scores for liver fibrosis.ConclusionOrlistat improves the components of metabolic syndrome, leading to the improvement of insulin resistance and thereby improves fatty infiltration of the liver. To a lesser extent, orlistat improved the liver fibrosis scores.     

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。     

Liver transplantation and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is an important health problem worldwide. NAFLD encompasses a histological spectrum ranging from bland liver steatosis to severe steatohepatitis (nonalcoholic steatohepatitis, NASH) with the potential of progressing to cirrhosis and its associated morbidity and mortality. NAFLD is thought to be the hepatic manifestation of insulin resistance (or the metabolic syndrome); its prevalence is increasing worldwide in parallel with the obesity epidemic. In many developed countries, NAFLD is the most common cause of liver disease and NASH related cirrhosis is currently the third most common indication for liver transplantation. NASH related cirrhosis is anticipated to become the leading indication for liver transplantation within the next one or two decades. In this review, we discuss how liver transplantation is affected by NAFLD, specifically the following: (1) the increasing need for liver transplantation due to NASH; (2) the impact of the increasing prevalence of NAFLD in the general population on the quality of deceased and live donor livers available for transplantation; (3) the long term graft and patient outcomes after liver transplantation for NASH, and finally; and (4) the de novo occurrence of NAFLD/NASH after liver transplantation and its impact on graft and patient outcomes.     

Pathogenesis and management issues for non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has, although it is a very common disorder, only relatively recently gained broader interest among physicians and scientists.Fatty liver has been documented in up to 10 to 15percent of normal individuals and 70 to 80 percent of obese individuals. Although the pathophysiology of NAFLD is still subject to intensive research, several players and mechanisms have been suggested based on the substantial evidence. Excessive hepatocyte triglyceride accumulation resulting from insulin resistance is the first step in the proposed 'two hit' model of the pathogenesis of NAFLD. Oxidative stress resulting from mitochondrial fatty acids oxidation, NF-κB-dependent inflammatory cytokine expression and adipocytokines are all considered to be the potential factors causing second hits which lead to hepatocyte injury, inflammation and fibrosis. Although it was initially believed that NAFLD is a completely benign disorder, histologic follow-up studies have showed that fibrosis progression occurs in about a third of patients. A small number of patients with NAFLD eventually ends up with end-stage liver disease and even hepatocellular carcinoma. Although liver biopsy is currently the only way to confirm the NAFLD diagnosis and distinguish between fatty liver alone and NASH, no guidelines or firm recommendations can still be made as for when and in whom it is necessary. Increased physical activity, gradual weight reduction and in selected cases bariatric surgery remain the mainstay of NAFLD therapy. Studies with pharmacologic agents are showing promising results, but available data are still insufficient to make specific recommendations; their use therefore remains highly individual.     

非酒精性脂肪性肝病与代谢综合征的流行现状及相关性研究

目的了解普通人群中非酒精性脂肪性肝病（NAFLD）及代谢综合征（MS）的患病率,探讨MS与NAFLD发生的关系。方法选择我院体检的普通人群共2374例,B超检查诊断脂肪肝,检测腰围、体重指数（BMI）、血压、丙氨酸氨基转氨酶、尿酸、血脂、空腹血糖（FBG）等指标,分析NAFLD和MS的患病率及MS相关组分与NAFLD的关系。结果共502人诊断为NAFLD,NAFLD患病率21．15％,男性高于女性。NAFLD组代谢综合征患病率50．4％,较对照组明显升高（P=0．001）。Logistic回归分析结果显示,NAFLD危险因素前三位分别是甘油三脂、FBG、BMI。结论普通人群中NAFLD的患病率呈上升趋势,NAFLD患者代谢综合征的患病率明显升高。     

非酒精性脂肪肝患者肝功能酶学指标与血脂检测结果相关分析

目的探讨非酒精性脂肪肝患者肝功能酶学指标与血脂的变化。方法在1383例体检者中,选择经超声诊断的非酒精性脂肪肝患者256例作为非酒精性脂肪肝组,235例无指标异常的健康人群作为对照组,把两组人员肝功能酶学指标和血脂指标结果进行统计学对比分析。结果非酒精性脂肪肝组ALT、AST、GGT明显高于对照组,差异均有显著统计学意义(P均=0.006);甘油三脂(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)亦明显高于对照组,差异有统计学意义(P=0.027、0.028、0.029),高密度脂蛋白胆固醇(HDL-C)明显低于对照组,差异有统计学意义(P=0.036)。结论非酒精性脂肪肝患者不仅存在明显的肝功能异常,而且血脂代谢也异常紊乱。     

A pilot trial of fenofibrate for the treatment of non-alcoholic fatty liver disease

BACKGROUND: Dyslipidaemia and insulin resistance are two important risk factors for non-alcoholic fatty liver disease. Both factors can improve with fenofibrate. AIMS: To evaluate the effect of fenofibrate on the clinical, analytical and histological evolution of patients with non-alcoholic fatty liver disease. SUBJECTS AND METHODS: Sixteen consecutive patients with biopsy-confirmed non-alcoholic fatty liver disease were treated with 200mg/day of fenofibrate for 48 weeks. A clinical and biochemical follow-up was done every 3 months. A new liver biopsy was performed in all patients at the end of therapy. RESULTS: All patients completed 48 weeks of therapy with fenofibrate, without adverse events. At the end of the study, a significant decrease in triglyceride, glucose, alkaline phosphatase and gamma-glutamyl transpeptidase and an increase of apolipoprotein A1 levels were found. Insulin levels and insulin resistance showed a trend to decrease. Moreover, a reduction in the proportion of patients with abnormal aminotransferase levels (>45IU/L) was observed (alanine aminotransferase: 93.7% vs. 62.5%, p=0.02; aspartate aminotransferase: 50% vs. 18.7%, p=0.02). The body mass index did not show any significant change, but the proportion of patients with metabolic syndrome decreased significantly (43.7% vs. 18.7%, p=0.04). A control biopsy after treatment revealed a decrease in the grade of hepatocellular ballooning degeneration (p=0.03), but the grade of steatosis, lobular inflammation, fibrosis or non-alcoholic fatty liver disease activity score did not change significantly. CONCLUSIONS: In patients with non-alcoholic fatty liver disease, treatment with fenofibrate is safe and improves metabolic syndrome, glucose and liver tests. However, its effects on liver histology are minimal.