柴葛调脂汤治疗48例非酒精性脂肪肝肝纤维化临床疗效观察

选取我院门诊2010年10月~2012年10月收治的98例非酒精性脂肪性肝病患者。随机分为治疗组48例和对照组50例。治疗组采用柴葛调脂汤治疗,对照组采用安络化纤丸治疗。两组治疗过程中不使用其它治疗肝炎药物。随访6个月,检查患者的肝纤维化指标及肝脏硬度值。结果两组肝纤维化四项指标及肝脏硬度值均有不同程度的改善,且治疗组明显优于对照组。柴葛调脂汤有明显的改善非酒精性脂肪肝患者的肝纤维化四项指标及肝脏硬度值的作用,对非酒精性脂肪肝有较好的临床疗效。     

化痰祛脂汤治疗非酒精性脂肪肝临床研究

目的探讨中药化痰祛脂汤对非酒精性脂肪肝的治疗作用与机制。方法化痰祛脂汤治疗非酒精性脂肪肝患者40例,另设对照组40例,治疗前后观察患者体重、影像学变化,检测肝功能与血脂（TG、TC、HDL、LDL）。结果两组总有效率分别为95．0％、52．5％,治疗组肝功能明显改善,血脂含量下降,肥胖者体重得到有效控制与减轻,声像图也显示肝脏质地的改善,与对照组比较均有显著差异（P〈0．05）。结论化痰祛脂汤对脂肪肝具有良好的治疗效果,能够改善肝功能、控制体重,降低血脂。     

对非酒精性脂肪肝患者饮食和运动的护理干预

目的:探究对非酒精性脂肪肝患者开展饮食和运动的护理干预产生的临床效果。方法:选取2016年4月至2019年4月到本院就诊的42例非酒精性脂肪肝患者作为研究对象,按照患者的就诊时间将其分为对照组和观察组两组,每组各21例,对照组患者采用基础常规护理,观察组采用饮食和运动护理干预,对两组患者护理前与出院后12个月复诊时的总胆固醇指标、甘油三脂指标和体质量指数分别进行比较。对两组患者的临床治愈率进行对比。结果:护理前两组患者的总胆固醇指标、甘油三脂指标和体质量指数没有明显差异,组间差距不具有统计学意义(P>0.05);护理后观察组患者的总胆固醇指标、甘油三脂指标和体质量指数均远低于对照组,差异有统计学意义(P<0.05);而观察组患者的临床治愈率要远高于对照组,差异有统计学意义(P<0.05)。结论:对非酒精性脂肪肝患者在治疗过程中施予饮食和运动的护理干预不但能够降低总胆固醇指标,血脂指标和体两组指数,大大的提高了临床治愈率。     

肝脂乐颗粒治疗非酒精性脂肪肝90例临床观察

目的:观察肝脂乐颗粒治疗非酒精性脂肪肝的疗效.方法:非酒精性脂肪肝患者136例,随机分为治疗组90例,对照组46例.治疗组予肝脂乐颗粒治疗,对照组服用东宝肝泰片治疗,2组疗程均为60d.结果:治疗组临床显效率为73.3%,有效率为90.0%,对照组分别为54.3%、69.5%,2组比较有显著性差异,P＜0.05或0.01;治疗组在改善临床症状方面优于对照组,P＜0.05;治疗组对肝功能、血脂水平的改善作用优于对照组,P＜0.05,有显著性差异.结论:肝脂乐颗粒是治疗非酒精性脂肪肝较理想的药物.     

非酒精性脂肪肝患者血清肝纤维化指标与脂联素的关系

目的探讨非酒精性脂肪肝患者血清脂联素与肝纤维化的关系。方法选择99例体检者，根据体检结果分为健康对照组（52例）和非酒精性脂肪肝（NAFLD）组（47例），测定所有体检者的体质量指数（BMI）、腰臀比（WHR）及血清谷丙转氨酶（ALT）、谷草转氨酶（AST）水平，应用酶联免疫吸附法（ELISA）测定血清中脂联素、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）含量。结果与对照组比较，NAFLD组BMI、WHR、ALT、HA及PCⅢ水平明显升高，而血清脂联素水平明显低于对照组，两者均有显著统计学差异（P〈0．01）。NAFLD组中有32例（68．09％）患者血清HA超过正常值，37例（78．72％）患者血清PCⅢ超过正常值，且两者均高于对照组（P〈0．01）。血清脂联素水平与HA、PCⅢ呈明显负相关（r=-0．69、-0．73，P均〈0．01）。结论非酒精性脂肪肝有发生肝纤维化的倾向，且脂联素有一定的抗肝纤维化作用。     

净肝祛脂汤治疗非酒精性脂肪肝的临床研究

目的观察净肝祛脂汤治疗非酒精性脂肪肝患者的临床疗效。方法将80例非酒精性脂肪肝患者随机分为两组，治疗组予自拟中药方剂净肝祛脂汤口服，对照组予东宝肝泰口服，疗程均为3个月。观察两组肝功能、血脂指标及肝脏B超的变化。结果两组治疗后肝功能指标丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（γ-GGT）及血脂指标总胆固醇（TC）、三酰甘油（TG）均较治疗前明显下降，高密度脂蛋白胆固醇（HDL—C）明显升高，差异有统计学意义（P均〈0．01）；与对照组比较，治疗组治疗后肝功能中各项血清酶指标及血脂指标TC、TG下降显著，HDL—C上升明显，差异有统计学意义（P均〈0．05）。肝脏B超显示，治疗组治疗后脂肪肝清除率明显高于对照组（40．0％比20．0％，P〈0．05）；且治疗组痊愈率及总有效率也明显高于对照组（痊愈率：25．0％比10．0%，总有效率85．0％比60．0％，P均〈0．05）。结论净肝祛脂汤治疗非酒精性脂肪肝疗效显著，安全性良好。     

自拟脂肝饮治疗非酒精性脂肪肝52例临床观察

目的：探讨自拟脂肝饮治疗非酒精性脂肪肝（NAFLD）的临床疗效。方法：选取NAFLD患者104例,随机分为对照组和治疗组。对照组采用水飞蓟宾胶囊治疗,治疗组在对照组的基础上加用自拟脂肝饮,3个月为1个疗程,连续治疗2个疗程后比较2组患者血脂、肝功能情况。结果：治疗组肝功明显改善,血脂下降,与对照组比较均有显著差异。结论：自拟脂肝饮治疗NAFLD疗效确切,值得临床推广。     

温肾升阳汤治疗非酒精性脂肪肝35例

笔者从脾肾论治,采用自拟中药温肾升阳汤治疗非酒精性脂肪肝35例,与同期采用脂必妥治疗的35例对照,取得了较满意的疗效.现总结如下:     

丹皮酚对高脂饮食诱导大鼠非酒精性脂肪肝的保护作用

目的:研究丹皮酚(Paeonal,Pae)对高脂诱导的大鼠非酒精性脂肪肝(non-alcoholicfattyliverdisease,NAFLD)的保护作用。方法:用高脂乳剂灌胃获得大鼠NAFLD模型,继用Pae和水飞蓟宾(Silymarin)给NAFLD模型大鼠灌胃并与正常组、模型组平行对照,测定各组大鼠的肝脏相关生化指标并观察各组大鼠肝脏的病理变化。结果:Pae对高脂诱导的大鼠NAFLD的生化指标谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)均有影响,其中对ALT、TG,LDL-C的影响有统计学意义(P0.05);肝脏病理切片HE染色也显示Pae药物组的大鼠肝脏损害明显好于模型组。结论:Pae对高脂诱导的大鼠NAFLD模型有一定的保护作用。     

非酒精性脂肪肝肝纤维化评分与脂肪肝及胰岛素抵抗的相关性研究

目的分析非酒精性脂肪肝肝纤维化评分（NAFLDFS）与非酒精性脂肪肝（NAFLD）及胰岛素抵抗（瓜）的相关性。方法以来自江苏徐州地区的2622例健康体检人群为研究对象,检测受试者的血清谷丙转氨酶（“r）,谷草转氨酶（AsT）,血小板计数（PLT）,血清白蛋白（ALB）,空腹血糖（FBG）,餐后2h血糖（PBG）,空腹胰岛素（Fins）等相关生化指标,计算出NAFLDFS及胰岛素抵抗指数（HOMA2-IR）,将研究对象按非酒精性脂肪肝纤维化评分的低诊断阈值（～1．455）及高诊断阈值（0．676）分成三组,A1组：NAFLDFS〈-1．455;A2组：0．676≥NAFLDFS≥-1．455和A3组NAFLDFS〉0．676。Pearson分析肝纤维化评分与各指标相关性;运用二元Logistic回归计算NAFLDFS与NAFLD、IR的风险性。结果随着NAFLDFS值增高,年龄（Age）、体重（Weight）、体重指数（BMI）、腰围（wc）、臀围（Hip）、糖化血红蛋白（HbAlc）、颈围（NC）、FBG、PBG、Fins、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL-C）水平逐渐增高,且三组问的差异有统计学意义;而ALT、AST、PLT、ALB、高密度脂蛋白（HDL．c）随着NAFLDFS值的增高而减小。Pearson分析显示Age、NC、WC、Hip、Weight、BMI、HbAlc、FBG、PBG、PLT与NAFLDFS正相关。随着NAFLDFS值的增加,NAFLD与取的患病风险（OR）也增加。NAFLD的患病风险由1．22（OR=1．22）增加到1．79（OR=1．79）：IR的患病风险由1．13（OR=1．13）增加到1．91（OR=1．91）;进一步校正性别及年龄后,NAFLD的患病风险由1．15（OR=1．15）增加到1．53（OR=1．53）;IR的患病风险由1．15（OR=1．15）增加到2．02（OR=2．02）。结论NAFLDFS与NAFLDF及瓜密切相关,在临床上可将其作为简易评价NAFLD及IR的指标。     

血清铁含量检测在酒精性脂肪性肝病和非酒精性脂肪性肝病中的临床意义

目的：探讨铁代谢相关血清学指标在酒精性脂肪性肝病(ALD)和非酒精性脂肪性肝病(NAFLD)中的意义及在肝损伤过程中的作用。方法脂肪性肝病患者406例,其中 ALD 组198例,NAFLD 组208例,另选健康对照组96例,检测血清铁(SF)、铁蛋白(Ferr)及转铁蛋白(TRF)。结果 NAFLD 组、ALD 组 SF、Ferr 水平均高于健康对照组(P <0.05);且 NAFLD 组 SF、Ferr 水平高于 ALD 组。NAFLD 组、ALD 组 TRF 水平均低于健康对照组(P <0.05);且 NAFLD 组 Ferr 水平低于 ALD 组。NAFLD、ALD 组肝硬化亚组血清 SF、Ferr 明显高于肝炎亚组(P <0.05),TRF 明显低于肝炎亚组,差异均有统计学意义(P <0.05)。结论 SF、Ferr 和 TRF 有助于了解脂肪性肝病患者肝损伤程度,特别是对 NAFLD 的预后有重要意义。     

我国成人血清ALP与非酒精性脂肪肝和代谢综合征的相关性

目的 探讨中国成人的血清碱性磷酸酶（ALP）与非酒精性脂肪肝（NAFLD）和代谢综合征（MS）的相关性。 方法 回顾性调查2009年1~ 12月我院健康体检人员,排除急性肝损伤、HBV感染、HCV感染、肾脏病、充血性心力衰竭、骨骼疾病患者及饮酒、吸烟、怀孕的调查对象,共计2 638例（男性2 010例,女性628例,年龄19~92岁）。用B型超声诊断脂肪肝。用美国国家胆固醇教育计划成人治疗方案第三次报告(NCEP-ATPⅢ) 的中国人修订标准诊断MS。 结果 男、女性NAFLD患病率分别为28.0%和21.8%（P<0.01）,MS为40.1%和32.6%（P<0.01）。控制年龄和肝酶,多变量logistic分析显示性别与NAFLD与MS皆显著相关。按年龄分层显示,女性ALP水平从45岁~64岁随年龄增加显著升高,男性ALP水平从19岁～92岁随年龄增加轻微下降,变化不明显。单变量logistic回归分析显示,女性ALP与NAFLD和MS皆有显著相关性（P<0.001）;男性ALP与NAFLD和MS皆无显著相关性（P>0.05）;ROC曲线显示：女性血清ALP筛检NAFLD的cut off值是57.1 U/L,MS是57.0 U/L。 结论 ALP可作为筛检女性NAFLD和MS的一个新的共同标志物,女性绝经可能是女性血清ALP与NAFLD和MS显著相关的核心原因,其确切机制尚待研究。     

Effect of atorvastatin and diet on non-alcoholic fatty liver disease activity score in hyperlipidemic chickens

Non-alcoholic steatohepatitis (NASH) is part of the spectrum of non-alcoholic fatty liver disease (NAFLD), which includes from simple steatosis and steatohepatitis, to the most severe cirrhosis and carcinoma, which develops in the absence of excessive alcohol intake. NAFLD is the most common liver disorder in affluent societies. There is no proven treatment for NAFLD/NASH. One of the most frequent adverse effects of statins is an increase in hepatic aminotransferases. Studies that evaluate if the benefits of statins overcome the risks in NASH are lacking. The present study was conceived to explore the effect of both atorvastatin and diet on regression of steatohepatitis, using a chicken experimental model induced by a hyperlipidemic diet (HD). Plasma lipid levels, liver enzymes and hepatic histopathology, as well as image analysis were performed to determine changes in liver lipid deposits and inflammatory infiltration. Features of steatosis, cell-ballooning, and inflammation were scored to obtain the NAFLD activity score (NAS). A severe level of steatosis was found in animals fed on HD. Atorvastatin treated groups showed smaller size of lipid deposits and a lower level of inflammation than non-treated groups. Atorvastatin therapy induced a significant reduction of hepatocellular damage, even though in the animals which continuously received a hyperlipidemic diet. The combination of atorvastatin therapy and a standard diet produced the lowest decrease of NAS. Our results show that atorvastatin therapy not only decreased plasmatic levels of cholesterol and triglycerides, but also induced a reduction of liver steatosis, inflammation and hepatocellular damage, without increasing plasmatic amynotransferase levels.     

Prostacyclin in liver disease: a potential therapeutic option

Complex molecular and cellular mechanisms are involved in the initiation and progression of hepatic fibrosis. Recent studies have shown that hepatic stellate cells, endothelin, cytokines and prostacyclin play crucial roles in this pathology. Prostacyclin exerts vasorelaxant, antioxidant and antifibrotic properties that prevent the development of fibrosis and cirrhosis in liver diseases. In this editorial, the authors discuss some of the molecular and cellular mechanisms involved in the initiation and progression of liver fibrosis and the role played by prostacyclin in counteracting it. At the moment, however, only limited information is available from clinical studies demonstrating the effectiveness of prostacyclin in liver diseases and this makes it difficult to draw any conclusions; further efforts are necessary to verify whether prostacyclin, alone or in combination with other drugs, may be a valid therapeutic option in liver diseases.     

美他多辛联合多烯磷脂酰胆碱治疗酒精性肝病的疗效观察

目的观察美他多辛联合多烯磷脂酰胆碱治疗酒精性肝病的疗效。方法70例酒精性肝病住院患者随机分为治疗组和对照组各35例,两组一般治疗相同,对照组用多烯磷脂酰胆碱针,治疗组在对照组基础上加用美他多辛片。所有患者均于治疗前、后检查血清生化指标中的丙氨酸氨基转移酶（ALT）、清天冬氨酸氨基转移酶（Asr）、总胆红素（TBil）、谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、结合胆红素（DBil）,并记录临床症状和体征变化,进行肝脏彩超检查,评价临床疗效。结果4周后,治疗组患者的疗效明显高于对照组。2组治疗后肝功能各项指标均较治疗前显著降低,治疗组治疗后肝功能各项指标均明显低于对照组治疗后。治疗组轻、中、重度脂肪肝的改善情况明显优于对照组。结论美他多辛和多烯磷脂酰胆碱联用疗效优于单用多烯磷脂酰胆碱。     

Vitamin B6 efficacy in the treatment of nonalcoholic fatty liver disease: an open-label,single-arm,single-center trial

Vitamin B6 is an important cofactor in fat metabolism and its deficiency has been correlated with nonalcoholic fatty liver disease. However, no study has investigated the efficacy of vitamin B6 supplementation in these patients. The aim of this open-label, single-arm, single-center study was to examine the therapeutic effect of vitamin B6 in patients with nonalcoholic fatty liver disease. Twenty-two patients with nonalcoholic fatty liver disease received vitamin B6 (90 mg/day) orally for 12 weeks. Clinical parameters were evaluated, and liver fat and fibrosis were quantified before and after treatment using magnetic resonance imaging-based proton density fat fraction and magnetic resonance elastography. Serum alanine aminotransferase levels, the primary endpoint, did not change significantly after vitamin B6 treatment (93.6 ± 46.9 to 93.9 ± 46.6, p = 0.976). On the other hand, magnetic resonance imaging-based proton density fat fraction, a parameter of hepatic lipid accumulation, was significantly reduced (18.7 ± 6.1 to 16.4 ± 6.4, p<0.001) despite no significant changes in body mass index, even in those not taking vitamin E (n = 17, 18.8 ± 6.9 to 16.7 ± 7.3, p = 0.0012). Vitamin B6 administration significantly ameliorated hepatic fat accumulation. As an inexpensive agent with few side effects, vitamin B6 could be a novel therapeutic agent for the treatment of nonalcoholic fatty liver disease.     

A nutritional intervention that promotes increased vegetable intake in Japanese with non-alcoholic fatty liver disease: a six-month trial

The aim of this study was to investigate whether a nutritional intervention motivating increased vegetable consumption would be an effective treatment and diet therapy for patients with non-alcoholic fatty liver disease. We examined 15 patients with this disease (5 men and 10 women). During the 6-month intervention period, all participants received a small amount of vegetables twice a month as a nutritional education tool aimed at increasing vegetable consumption. They also received nutritional counseling and underwent ultrasound and blood biochemical examinations at baseline and 3 and 6 months after initiation of the intervention. Moreover, they were requested to submit dietary records for any 2 days. Green, white, and total vegetable intakes were significantly higher at 3 and 6 months than at baseline in 8 patients. These patients had significantly lower alanine amino­transferase and triglyceride concentrations than those whose vegetable intake did not increase. Additionally, green vegetable intake significantly negatively correlated with weight at 3 and 6 months (r = −0.617, p = 0.032 and r = −0.848, p = 0.008, respectively). These results suggest that our nutritional approach effectively increased vegetable consumption in at least some patients with non-alcoholic fatty liver disease, consequently improving their condition.     

脂肪肝与肥胖、血脂、血糖关系的研究

目的　探讨知识分子脂肪肝与肥胖、血脂、血糖的关系。方法　测定 14 6 8名知识分子的身高、体重、B超、血脂、血糖 ,对脂肪肝组与非脂肪肝组的结果进行比较。结果　知识分子脂肪肝患病率男性(2 6 33% )高于女性 (13 85 % ) ,差异有显著意义 (P <0 0 1) ;4 0～岁、5 0～ 6 0岁年龄组患病率 (分别为34 6 1%、30 86 % )高于 <4 0岁年龄组 (15 5 3% ) ,差异有显著意义 (均P <0 0 1) ;脂肪肝组合并高甘油三脂 ,高血糖 ,肥胖的患病率高于非脂肪肝组 ,差异有显著意义 (P <0 0 1) ,而脂肪肝合并高胆固醇的患病率与非脂肪肝组差异无显著意义 (P >0 0 5 )。结论　脂肪肝的患病率较高 ,脂肪肝人群代谢紊乱的发生率高于非脂肪肝组人群     

老年患者疼痛评估的应用进展

前言：疼痛已被护理人员作为除体温、脉搏、呼吸和血压以外的“第五个生命体征”来评估与处理[1],北美将疼痛的控制作为一项基本医疗服务。从伦理及人道主义的角度而言,“缓解疼痛是基本人权(pain relief is a basic human right)”。随着全球人口老龄化程度的日趋加重,关注老年人的身心健康,控制治疗疼痛,提高生活质量又显得十分重要。慢性疼痛在老年人中很普遍,严重影响了老年人的生活质量[2],认知功能异常可能使老年人疼痛的评估变得复杂[3]而如何对老年人进行正确疼痛评估尤显重要,现将其综述如下。