非酒精性脂肪肝发病机制研究进展

非酒精性脂肪肝 (nonalcoholicfattyliverdisease ,NAFLD)是指某一范围的肝脏损害 ,包括从简单的脂肪储积到脂肪性肝炎、肝脏纤维化和肝硬化 ,其主要危险因素有肥胖、Ⅱ型糖尿病和高脂血症等。脂肪储积是一病变较轻的临床过程 ,而脂肪性肝炎则是公认的肝脏纤维化和肝硬化病因。NAFLD的病理以大泡性脂肪变性为主要特点。在美国 ,NAFLD是肝功能异常最常见的原因 ,其发病率明显高于丙肝病毒感染率[1] 。最近 ,对NAFLD发病机制的研究较多 ,但尚未发现明确的发病机制。现就NAFLD发病机制的研究进展作一综述。1胰岛素抵抗 (insulinresis…     

非酒精性脂肪肝动物模型研究进展

<正>非酒精性脂肪肝 (Non-alcoholic Fatty Liver Disease, NAFLD)是一种无过量饮酒史,但病理学改变类似酒精性脂肪性肝病,以肝细胞脂肪变性和脂质贮积为特征的临床病理综合征[1]。近年来随着人民生活水平的提高,高热量的饮食习惯和不良的生活方式使得肥胖、高脂血症、糖尿病及由此引起的     

非酒精性脂肪肝治疗进展

近年来随着生活水平的改善和生活方式的改变，非酒精性脂肪肝的发病率不断升高，其病因和发病机制尚未完全明了，针对脂肪肝的治疗尚缺乏有效的药物。本文就近年来对非酒精性脂肪肝的治疗进展作一综述。     

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。     

非酒精性脂肪肝及其瘦素的相关性

<正>瘦素是在肥胖基因(Ob基因)编码下,主要由脂肪组织分泌的一种肽激素,主要调节机体的食物摄取和能量消耗,与肥胖关系密切。而非酒精性脂肪肝(NAFLD)是一种无过量饮酒史(或酒精摄入量     

非酒精性脂肪肝相关因素分析

本文对105例非酒精性脂肪肝（NAFLD）患者的病历资料进行回顾性分析,并对其相关危险因素进行讨论如下.[第一段]     

非酒精性脂肪肝浅识

提到脂肪肝,一般想到的是酒精依赖和酒精中毒,当前临床资料显示,肥胖与脂肪肝的关系比过量饮酒显得更为重要,非酒精性脂肪肝已成为我国发达地区和富裕阶层第一大慢性肝病.     

非酒精性脂肪肝病运动疗法的研究进展

非酒精性脂肪性肝病(Nonalcoholic Fatty Liver Disease,NAFLD)是一种与胰岛素抵抗(insulin resistance,IR)和遗传易感密切相关的代谢应激性肝脏损伤,其病理学改变与酒精性肝病(ALD)相似,但患者无过量饮酒史,疾病谱包括非酒精性单纯性脂肪肝(nonalcoholic simple fatty liver,NAFL)、非酒精性脂肪性肝炎(NASH)及其相关肝硬化和肝细胞癌[1-2]。欧美等国家成人患病率约为20%~33%,且随着年龄增长而上升[3]。近20年亚洲国家NAFLD增长迅速且呈低龄化发病趋势,中国上海、广州和香港等地区成人NAFLD患病率约为15%[2,4-5]。运动疗法能有效降     

非酒精性脂肪肝的发生与发展

近年来,随着人们生活水平提高,饮食结构改变,非酒精性脂肪肝(nonalcoholic fatty liver,NAFL)的发病率逐年呈上升趋势。流行病学研究显示,NAFL与肥胖、糖耐量受损(IGT)和糖尿病、血脂异常、高胰岛素血症、高血压病等因素密切相关,在2型糖尿病患者中发病率达50%,在糖尿病合并肥胖人群中发病率达100%。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[1]。NAFL已成为危害人们健康的常见病。笔者复习近年文献,对NAFL的发生与发展综述如下。1 NAFL与胰岛素抵抗NAFL是指脂…     

酒精性与非酒精性脂肪肝患者生化指标的观察

目的探讨酒精性脂肪肝与非酒精性脂肪肝特异性的鉴别指标,以指导临床诊断。方法对126例酒精性脂肪肝患者及182例非酒精性脂肪肝患者的血清酶、血脂、尿酸、血糖、血细胞比容等指标进行测定及分析。结果酒精性脂肪肝组丙氨酸转氨酶(AST)、门冬氨酸转氨酶/丙氨酸转氨酶(AST/ALT≥2)、谷氨酰转肽酶(GGT)、尿酸(UA)异常的百分数分别为76.1%、36.5%、44.4%、62.7%,非酒精性脂肪肝组分别为30.2%、17.0%、19.2%、29.6%,两组相比差异有统计学意义。结论AST、AST/ALT≥2、GGT、UA等指标可能是鉴别酒精性脂肪肝与非酒精性脂肪肝有效的临床辅助诊断指标。     

冠心病危险生物学标志物的探索

目的对冠状动脉粥样硬化性心脏病(简称冠心病)的危险因素进行再评估,寻找更全面的冠心病预警指标。方法收集2018年8月至2019年12月四川大学华西医院经冠脉造影确诊为冠心病,且确认入院前未服用过他汀类等降脂药的298例患者作为冠心病组,收集无冠心病的健康人群290例作为对照组,分析两组患者病史和实验室指标的差异。结果冠心病组三酰甘油(TG)、非高密度脂蛋白胆固醇(Non-HDL-C)、残余胆固醇(RC)、单核细胞显著高于对照组,差异有统计学意义(P<0.05);冠心病组总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(apoA)和同型半胱氨酸(Hcy)显著低于对照组,差异有统计学意义(P<0.05),多因素logistic回归分析提示TG、RC和Non-HDL-C升高是冠心病的独立危险因素,而apoA是冠心病的保护因素。结论临床在关注传统血脂四项的基础上,也应注意监测RC、Non-HDL-C、apoA水平。     

Relationship between non-alcoholic fatty liver disease and coronary heart disease

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease and considered a liver manifestation of metabolic syndrome. It is in close relationship with insulin resistance, obesity, diabetes mellitus, all of which increase risk of cardiovascular disease (CVD). Besides, many studies point out that NAFLD independently contributes to the development of atherosclerosis and CHD. On the other hand, CVDs are the leading cause of death in NAFLD patients. Many pathophysiological changes and molecular mechanisms play an important role in NAFLD for CVD formation. Atherosclerosis is common in NAFLD, which also mainly contributes to the CVD formation and CHD. Many studies linking atherosclerotic CHD and NAFLD are present in the literature. Subclinical CHD, mainly detected by coronary computed tomography views, have been detected more common in NAFLD patients. Presence of NAFLD has been found to be more common in patients with severe CHD and in stable CHD, NAFLD has been found to be associated with more diffuse disease. In acute coronary syndromes, especially in acute myocardial infarction, patients with NAFLD have been found to have poor prognosis when compared with NAFLD free patients. In this review, our aim is to evaluate the relationship between NAFLD and CHD in detail and go over the pathophysiological mechanisms underlying this relationship.     

Nighttime sleep duration and risk of nonalcoholic fatty liver disease: the Dongfeng-Tongji prospective study

Background: To examine the association between self-reported nighttime sleep duration and nonalcoholic fatty liver disease (NAFLD) risk by comparing the incidence rates of NAFLD among healthy subjects with different sleep duration during the 5 years follow-up.

Methods: 8965 eligible NAFLD-free subjects with a mean age of 61.6 years (males, 43.4%) from Dongfeng-Tongji cohort study at baseline were enrolled in the study. Logistic regression analysis was used to estimate the association between sleep duration and incident NAFLD with potential confounders adjusted. Sleep duration was categorized into five groups:?<6?h, 6–7?h, 7–8?h, 8–9?h,?≥9?h.

Result: During the 5-years of follow-up, a total of 2,197 participants were newly diagnosed as NAFLD. Compared with those reported 7–8?h per day of nighttime sleep, the multivariable-adjusted odds ratio (95% confidence intervals) were 1.21 (1.07–1.38) for those who sleep 8–9?h/day, and 1.31 (1.13–1.52) for those who sleep over 9?h/day. However, no significant association was found with short nightly sleep duration (<7?h/day).

Conclusion: Long nighttime sleep duration was associated with a modestly increased risk of NAFLD in a middle-aged and elderly Chinese population.

• Key messages

• Long nighttime sleep duration was associated with a modestly increased risk of NAFLD in a middle-aged and elderly Chinese population.

• The effect of long nighttime sleep on the risk of incident NAFLD was attenuated greatly by body mass index (BMI) in men.

     

Barriers to coronary heart disease risk modification in women without prior history of coronary heart disease

PURPOSE: To explore the extent to which women perceive barriers to coronary heart disease (CHD) risk modification and to determine if access to a nurse practitioner (NP) decreases perceived barriers to CHD risk modification. DATA SOURCES: Surveys completed by 120 women between the ages of 35 and 60 years, with no known history of CHD. The barriers scale was used to examine women's perceived barriers to CHD risk modification. CONCLUSIONS: Women with access to an NP had less perceived barriers to CHD risk modification. IMPLICATIONS FOR PRACTICE: NPs are ideally suited to decrease the mortality and morbidity associated with CHD through education strategies and attention to individual barriers women face when attempting to incorporate CHD risk factor modification into their lifestyles.     

饮食和运动干预对非酒精性脂肪肝病患者疾病转归的影响

目的探讨饮食和运动干预对非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)患者疾病转归的的影响。方法对52例NAFLD患者实施饮食和运动干预,干预前后观察患者NAFLD归转情况。结果干预后患者体重指数(body mass index,BMI)、甘油三酯(triglycerides,TG)、胆固醇(total cholesterol,TC)均低于干预前,差异具有统计学意义(均P0.05)。结论饮食和运动干预能有效改善NAFLD患者肝功能指标,促进疾病转归。