精神分裂症伴非酒精性脂肪肝患者血浆瘦素水平

目的探讨瘦素与精神分裂症患者非酒精性脂肪肝(NAFLD)的关系。方法 35例精神分裂症伴NAFLD患者(NAFLD组)测定血浆瘦素;同时测定体质量指数(BMI)、空腹血糖、血脂;以血清甘油三酯和血糖所得简易指数(TyG)评定IR、肝脏超声衰减系数评定NAFLD严重程度,并与35例不伴NAFLD的精神分裂症患者(对照组)进行对照。结果①NAFLD组患者BMI、TG、TC、TyG指数显著高于对照组(t=2.074~8.482,P=0.044~0.000),而HDL-C显著低于对照组(t=2.367,P=0.024);②NAFLD组患者瘦素显著高于对照组(t=7.112,P=0.000),协方差分析调整影响因素后差异仍有显著性(F=5.099,P=0.026);③NAFLD组患者肝脏超声衰减系数值显著高于对照组(t=9.953,P=0.000);④NAFLD组肝脏超声衰减系数值与血浆瘦素水平正相关(r=0.419,P=0.017),偏相关分析调整影响因素后、二者仍正相关(r=0.379,P=0.038)。结论精神分裂症伴NAFLD患者血浆瘦素水平增高,可能与NAFLD的发生机制有关。     

非酒精性脂肪肝患者血清FGF21水平变化与颈动脉粥样硬化斑块发生的相关性

目的:探讨非酒精性脂肪肝(NAFLD)患者血清成纤维细胞生长因子21(FGF21)水平变化及与颈动脉粥样硬化斑块发生的相关性。方法:选取2023-01-2023-09确诊的NAFLD患者131例,根据是否存在颈动脉粥样硬化斑块分为无斑块组(n=59)和斑块组(n=72),选取同期体检健康者39例为对照组。检测所有对象血清尿酸(UA)、低密度脂蛋白胆固醇(LDL-C)、小而密低密度脂蛋白胆固醇(sdLDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、总胆固醇(TC)和FGF21水平并比较组间差异。Logistic回归分析FGF21与NAFLD患者颈动脉粥样硬化斑块发生的相关性。结果:与对照组比较,无斑块组和斑块组患者UA、TC、TG、LDL-C、sdLDL-C和FGF21水平均升高,HDL-C水平降低(P<0.05或P<0.01);与无斑块组比较,斑块组LDL-C、sdLDL-C和FGF21升高(P<0.05或P<0.01)。Logistic回归分析显示,在充分调整协变量后,血清FGF21升高与NAFLD患者动脉粥样硬化斑块发生呈正相关。结论:血清F...     

非酒精性脂肪肝病患者血清降钙素原、CRP水平及意义的研究

目的 探讨非酒精性脂肪肝病(NAFLD)患者血清降钙素原(PCI)、CRP水平及意义.方法 分别测定50例NAFLD患者(20例非酒精性脂肪肝(NASH)、27例单纯性脂肪肝(SS)和3例局灶性脂肪肝)和50例健康对照组的体重指数(BMI)、肝功能指标、胰岛素、CKP及PCT水平,比较各个指标在NAFLD组和对照组之间的差异.结果 NASH患者、SS患者与正常对照组比较,血清PCT水平无显著性差异(0.06±0.01,0.04±0.01 V.s0.06±0.01=g/mL,P>0.05),血清CRP水平在NASH患者、SS患者显著高于健康对照组(7.5±1.6,5.2±2.5 V.s2.9±0.5mg/mL,P<0.01),3例局灶性脂肪肝患者CRP水平在正常范围.结论 NAFLD组患者较正常组血清PCT水平无明显升高,血清CRP可作为诊断NAFLD的一个辅助性指标.     

非酒精性脂肪肝病患者血清降钙素原、CRP水平及意义的研究

目的探讨非酒精性脂肪肝病（NAFLD）患者血清降钙素原（PCT）、CRP水平及意义。方法分别测定50例NAFLD患者（20例非酒精性脂肪肝炎（NASH）、27例单纯性脂肪肝（SS）和3例局灶性脂肪肝）和50例健康对照组的体重指数（BMI）、肝功能指标、胰岛素、CRP及PCT水平,比较各个指标在NAFLD组和对照组之间的差异。结果 NASH患者、SS患者与正常对照组比较,血清PCT水平无显著性差异（0.06&#177;0.01,0.04&#177;0.01 V.s0.06&#177;0.01 ng/mL,P〉0.05）,血清CRP水平在NASH患者、SS患者显著高于健康对照组（7.5&#177;1.6,5.2&#177;2.5V.s2.9&#177;0.5mg/mL,P〈0.01）,3例局灶性脂肪肝患者CRP水平在正常范围。结论 NAFLD组患者较正常组血清PCT水平无明显升高,血清CRP可作为诊断NAFLD的一个辅助性指标。     

住院精神分裂症患者伴发非酒精性脂肪肝情况

目的:了解住院精神分裂症患者伴发非酒精性脂肪肝情况。方法:对228例住院精神分裂症患者进行肝脏B超检查,并检测其空腹血糖、血脂、ALT、GGT、AKP等代谢指标。结果:住院精神分裂症患者伴发非酒精性脂肪肝的比例为32.5%,伴脂肪肝者体重指数、腰围、臀围明显大于不伴脂肪肝者(27.5±3.4/23.7±3.3,96.8±8.5/86.7±10.0,102.5±13.1/96.0±7.1,F=62.62～20.01,P=0.000),而除载脂蛋白A外其它血脂指标均高于不伴脂肪肝者(如:TC:4.7±1.0/4.2±1.0,TG:2.2±1.4/1.5±0.8,LDL-ch:3.3±0.9/2.8±0.8)。女性、BMI值较大、病程长、TG高、ALT较高者与患脂肪肝有关(回归系数分别为:-1.217、0.349、0.053、0.601、0.061)。结论:长期住院的慢性精神分裂症患者伴发非酒精性脂肪肝的比例高,存在一些危险因素,值得临床关注。     

非酒精性脂肪肝肥胖人群的血尿酸水平分析

目的:分析非酒精性脂肪肝非肥胖及肥胖人群的血尿酸(SUA)水平变化.方法:体检人群筛选出来的非酒精性脂肪肝非肥胖和肥胖者与正常对照组同时检测血尿酸(SUA)、体重指数(BMI)、腰臀比(WHR)及相关生化指标.结果:非酒精性脂肪肝非肥胖组和肥胖组SUA、BMI、WHR、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC...     

受体相互作用蛋白激酶调控非酒精性脂肪肝中细胞程序性坏死的研究进展

非酒精性脂肪性肝病（NAFLD）是一种常见的慢性肝病,如果得不到有效控制,则会进一步发展为非酒精性脂肪性肝炎（NASH）,进而引起肝纤维化、肝硬化,甚至癌变。程序性坏死是近年来发现的一种新型细胞程序性死亡方式,由受体相互作用蛋白激酶（RIPK）介导所致,最终可以导致细胞膜溶解破裂,引发炎症。RIPK家族作为细胞内和细胞外应激的重要传感器,诱导调控程序性坏死的发生,并参与炎症及其他免疫反应。近年来研究表明,RIPK调控的程序性坏死在非酒精性脂肪性肝病的发生发展中具有重要作用,在动物NAFLD/NASH模型中,RIPK的表达情况与肝脂肪变性程度密切相关。在一些临床研究中亦观察到,NAFLD/NASH患者比健康人RIPK表达水平上升。但程序性坏死到底是加速肝病进程的因素,还是肝病发展过程中的保护因素,仍然没有定论。有研究表明,RIPK抑制剂可能为NAFLD治疗提供方向。我们综述了程序性坏死的分子机制及与非酒精性脂肪性肝病的关系,以及RIPK在其中扮演的重要角色,并总结了其在NAFLD/NASH治疗方面的研究进展,为进一步探究其机制,探索新的治疗手段提供理论依据。     

血清YKL-40对非酒精性脂肪肝肝纤维化的预测作用

目的探讨非酒精性脂肪肝患者血清中YKL-40水平及在肝纤维化程度评价中的价值。方法2017年7月至2019年7月于我院就诊的NAFLD患者142例,根据是否发生肝纤维化分为纤维化组(n=60)与非纤维化组(n=82),另纳入40例健康体检者作为健康对照组,采用放射免疫分析法测定血清中透明质酸(HA)、III型前胶原(PC III)、IV型胶原(CIV)及层粘连蛋白(LN)水平。采用双夹心抗体ELISA法检测血清YKL-40水平。结果三组研究对象年龄、性别、BMI指数等一般性资料差异无统计学意义(P>0.05);健康对照组、S0~S4期血清YKL-40水平随着肝纤维化分期的不断增加而不断升高(P<0.05)。血清YKL-40水平与NFS、FIB-4、APRI评分均呈显著正相关关系,具有统计学意义(P<0.05)。ROC分析结果表明,当Cutoff值为158 ng/mL时,YKL-40对NAFLD患者肝纤维化诊断价值最高,其AUC、灵敏度、特异性、PPV、NPV等均高于传统肝纤维化指标,差异具有统计学意义(P<0.05)。结论血清YKL-40在非酒精性脂肪肝患者中水平明显升高,对肝纤维化具有良好的预测价值。     

非酒精性脂肪肝CT表现及与血脂水平的相关性分析

目的探讨非酒精性脂肪肝患者肝脏CT值与血脂之间的关系。方法选取非酒精性脂肪肝患者43例及对照组30例,分别测量肝脏的CT值及血脂水平,然后进行统计分析。结果对照组及非酒精性脂肪肝组血中TG,HDL,LDL,VLDL之间差异有统计学意义(P<0.05),但血中的CHOL差别没有统计学意义,肝脏CT值与TG、CHOL、LDL、VLDL负相关,而与HDL正相关,即CT值越低,则TG,CHOL,LDL,VLDL越高,脂肪肝程度越重。TG、HDL、LDL在非酒精性脂肪肝轻、中、重组间有差距。结论非酒精性脂肪肝患者肝脏CT值与血脂水平密切相关,血脂水平的变化会导致肝脏CT值的变化。     

中医防治非酒精性脂肪性肝病研究进展

非酒精性脂肪性肝病是以肝实质脂肪贮积以及细胞变性为特征,且无过量饮酒史的临床病理综合征,它与遗传易感和胰岛素抵抗有密切相关性。在中医古籍中,该病则属于“肝癖”、“肝著”、“痞满”等范畴。随着现代生活水平不断的提高,非酒精性脂肪性肝病的发病率迅速攀升,占据我国慢性肝病的主导地位之一,对人们的健康造成严重威胁。中医在诊治非酒精性脂肪性肝病的领域中,展现了独特的优势,对非酒精性脂肪性肝病进行分类和早期干预,充分体现了“不治已病治未病”及“救治于后不若摄生于先”的思想。     

Triglycerides Mediate Body Mass Index and Nonalcoholic Fatty Liver Disease: A Population-Based Study

IntroductionNonalcoholic fatty liver disease (NAFLD) is defined by the accumulation of triglycerides (TG). The body mass index (BMI) is associated with NAFLD. This large-scale cohort study was performed to evaluate and quantify the mediating effect of TG on the association between BMI and NAFLD.MethodsIn total, 15,943 participants in the Kailuan Group were recruited between 2010 and 2014. The impact of TG on the association between BMI and NAFLD was determined through a mediation analysis.ResultsBMI was an independent risk factor for incident NAFLD, with OR of 1.416 (95% CI 1.338–1.499) and 1.187 (95% CI 1.137–1.240) in the low-BMI and high-BMI groups, respectively (p < 0.001). The TG level was a risk factor for NAFLD in the high-BMI group, with an OR of 2.775 (95% CI 1.488–5.177; p = 0.001). Positive associations between BMI and the TG level remained in the 2 above mentioned groups after adjusting for confounders (β = 0.072 and 0.032; p < 0.001). The mediation analysis revealed that TG contributed to 26.050% of incident NAFLD in the high-BMI group (p = 0.01).ConclusionA high BMI was an independent risk factor for incident NAFLD, and a high TG level was a risk factor in the high-BMI group (BMI ≥24). TG contributes about 25% to incident NAFLD in people with obesity.     

The Role of Innate Immune Cells in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a very common hepatic pathology featuring steatosis and is linked to obesity and related conditions, such as the metabolic syndrome. When hepatic steatosis is accompanied by inflammation, the disorder is defined as nonalcoholic steatohepatitis (NASH), which in turn can progress toward fibrosis development that can ultimately result in cirrhosis. Cells of innate immunity, such as neutrophils or macrophages, are central regulators of NASH-related inflammation. Recent studies utilizing new experimental technologies, such as single-cell RNA sequencing, have revealed substantial heterogeneity within the macrophage populations of the liver, suggesting distinct functions of liver-resident Kupffer cells and recruited monocyte-derived macrophages with regards to regulation of liver inflammation and progression of NASH pathogenesis. Herein, we discuss recent developments concerning the function of innate immune cell subsets in NAFLD and NASH.     

慢性乙型肝炎合并非酒精性脂肪性肝病 中医辨治的研究进展

慢性乙型肝炎是我国三大肝病之一,近年来随着人们生活习惯及饮食方式等改变,非酒精性脂肪性肝病患病率明显增高,两者并存于同一个体的现象较为普遍,病情更加复杂,治疗难度增大。中医药在促进肝脏脂肪代谢、提高抗病毒疗效、抗纤维化进展等方面展现了独特的优势。本文通过收集相关文献从中医学理、法、方药、非药物治疗等几个方面作为切入点,浅述慢性乙型肝炎合并非酒精性脂肪性肝病患者中医辨治的研究进展。     

Nonalcoholic Fatty Liver Disease Is Associated with the Presence and Morphology of Subclinical Coronary Atherosclerosis

Purpose

In this study, we aimed to evaluate whether nonalcoholic fatty liver disease (NAFLD) was associated with the presence and morphology of coronary atherosclerotic plaques shown by multidetector computed tomography (MDCT) in asymptomatic subjects without a history of cardiovascular disease.

Materials and Methods

We retrospectively enrolled 772 consecutive South Korean individuals who had undergone both dualsource 64-slice MDCT coronary angiography and hepatic ultrasonography during general routine health evaluations. The MDCT studies were assessed for the presence, morphology (calcified, mixed, and non-calcified), and severity of coronary plaques.

Results

Coronary atherosclerotic plaques were detected in 316 subjects (40.9%) by MDCT, and NAFLD was found in 346 subjects (44.8%) by hepatic ultrasonography. Subjects with NAFLD had higher prevalences of all types of atherosclerotic plaque and non-calcified, mixed, and calcified plaques than the subjects without NAFLD. However, the prevalence of significant stenosis did not differ between groups. After adjusting for age, smoking status, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome, NAFLD remained a significant predictor for all types of coronary atherosclerotic plaque [odds ratio (OR): 1.48; 95% confidence interval (CI): 1.05-2.08; p=0.025] in binary logistic analysis, as well as for calcified plaques (OR: 1.70; 95% CI: 1.07-2.70; p=0.025) in multinomial regression analysis.

Conclusion

Our study demonstrated that NAFLD was significantly associated with the presence and the calcified morphology of coronary atherosclerotic plaques detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of NAFLD in coronary atherosclerosis.     

肠道菌群与非酒精性脂肪肝关系的研究进展

近年来非酒精性脂肪性肝病的发病率不断增加,虽然属于慢性肝病,但是患者有发展为肝硬化的风险,为临床治疗带来了很多难题。本文综述非酒精性脂肪性肝病的发病机制,分析肠道菌群与非酒精性脂肪性肝病的因果关系,寻求潜在有效的新型治疗方案。     

Nonalcoholic fatty liver disease versus metabolic-associated fatty liver disease: Prevalence,outcomes and implications of a change in name

Nonalcoholic fatty liver disease (NAFLD) affects about a third of the world’s adult population and is a major public health concern. NAFLD is defined by the presence of hepatic steatosis and the absence of other causes of liver disease. As NAFLD is closely associated with the presence of the metabolic syndrome, several experts have called for a change in nomenclature from NAFLD to metabolic-associated fatty liver disease (MAFLD) to better reflect the underlying pathophysiology of NAFLD as a metabolically driven disease and shift to a “positive” diagnostic criteria rather than one of exclusion. Recent studies have suggested that the global prevalence of MAFLD is higher than that of NAFLD, and patients with MAFLD have more metabolic comorbidities compared to those with NAFLD. Emerging data also suggest that all-cause and cardiovascular mortality may be higher in MAFLD compared with NAFLD. In this synopsis, we discuss differences in clinical features, prevalence and clinical outcomes between NAFLD and MAFLD. In addition, we highlight the advantages and disadvantages of a name change from NAFLD to MAFLD from the perspective of the scientific community, care providers and patients.     

血清APN及CG水平对非酒精性脂肪肝肝纤维化患者的诊断价值

目的：研究脂联素（APN）与甘胆酸（CG）的水平对非酒精性脂肪肝肝纤维化（NAFLD）诊断。方法：采用ELISA检测NAFLD患者和正常对照组的血清APN水平及放免法检测CG水平,并以NEFLD和正常对照组作比较。结果：NAFLD组APN水平显著低于正常对照组（P〈0.05）,CG水平显著高于正常对照组（P〈0.05）,APN水平与CG水平呈显著负相关（P〈0.05）。结论：NAFLD患者血清APN水平降低,APN的表达在NAFLD患者肝纤维化进程中可能起重要作用。