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。     

内生性乙醇与非酒精性脂肪性肝病研究进展*

非酒精性脂肪性肝病和酒精性肝病具有相似的病理学特征,使得内生性乙醇在非酒精性脂肪性肝病的进展中可能扮演的重要角色成为肝病学家们关注的新方向。内生性乙醇与肝脏、肠道和肠道细菌以及非酒精性脂肪性肝病的关系密切,给我们提供了解释非酒精性脂肪性肝病病因的新视角。     

内生性乙醇与非酒精性脂肪性肝病研究进展

非酒精性脂肪性肝病和酒精性肝病具有相似的病理学特征,使得内生性乙醇在非酒精性脂肪性肝病的进展中可能扮演的重要角色成为肝病学家们关注的新方向。内生性乙醇与肝脏、肠道和肠道细菌以及非酒精性脂肪性肝病的关系密切,给我们提供了解释非酒精性脂肪性肝病病因的新视角。     

非酒精性脂肪性肝病与肝癌关系研究进展

随着生活水平提高,生活习惯与饮食结构的改变,非酒精性脂肪性肝病的发病率在不断增加。非酒精性脂肪性肝病包括一系列的疾病谱:单纯性脂肪肝、脂肪性肝炎、脂肪性肝纤维化及脂肪性肝硬化。肝细胞癌是脂肪性肝硬化的严重后果。因此,非酒精性脂肪性肝病与肝细胞癌之间存在着重要关系。本文就非酒精性脂肪性肝病与肝细胞癌关系的研究进展总结如下。     

中医药治疗非酒精性脂肪性肝病的重要靶位——肠道微生态

肠道微生态在非酒精性脂肪性肝病发病机制中具有重要意义。系统阐释非酒精性脂肪性肝病与肠道菌群、肠道菌代谢物和肠屏障功能关系,结合中医药调节肠道微生态与治疗非酒精性脂肪性肝病关系的研究概况,提出调节肠道微生态、维持肠道稳态是中医药治疗非酒精性脂肪性肝病的重要策略。     

儿童非酒精性脂肪性肝病研究进展

随着生活水平的提高、饮食结构及生活方式的改变，全球肥胖儿童快速增加，由于肥胖是儿童非酒精性脂肪性肝病发病的最常见危险因素，因此，儿童非酒精性脂肪性肝病的发病率将会明显升高，成为儿童最常见的肝病。1983年Moran首次报道了儿童非酒精性脂肪性肝病，此后，人们对儿童非酒精性脂肪性肝病进行了一些研究，本文通过复习相关文献旨在提高人们对儿童非酒精性脂肪性肝病的认识。     

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近10年来,随着对非酒精性脂肪性肝病流行病学和自然史认识的持续加深、诊断技术的飞速进步以及治疗手段的不断更新,针对非酒精性脂肪性肝病的诊疗取得了巨大进展。2012年,美国肝病学会、胃肠病学院和胃肠病学会对非酒精性脂肪性肝病诊疗相关问题进行总结,明确了大量临床工作中的具体问题。文章对指南中重点结论进行归纳,并与现有非酒精性脂肪性肝病的指南进行比较,以促进非酒精性脂肪性肝病诊疗的规范化。     

老年非酒精性脂肪性肝病患者甲状腺激素水平及其与肝纤维化的关系

目的探讨老年非酒精性脂肪性肝病患者甲状腺素水平及其与肝纤维化的关系。方法选取57例2010年5月至2011年11月该院治疗的老年非酒精性脂肪性肝病患者和43例正常老年人为对象进行研究,比较各组患者的甲状腺激素水平和肝纤维化的指标情况。结果两组患者甲状腺激素水平和肝纤维化指标比较有显著性差异(P<0.05)。结论对老年非酒精性脂肪性肝病患者的甲状腺激素水平和肝纤维化程度进行检测,能够评估患者的预后,建议在非酒精性脂肪性肝病老年患者中广泛使用。     

非酒精性脂肪性肝病的运动处方制定

非酒精性脂肪性肝病(NAFLD)是世界范围内最常见的慢性肝病病因，且发病率逐渐上升，是多种心血管疾病、 糖尿病和慢性肾病的危险因素，因此，非酒精性脂肪性肝病的防治非常重要。虽然运动疗法作为一种治疗手段已被 证实对非酒精性脂肪性肝病的相关危险因素有改善作用，但不同的运动疗法对非酒精性脂肪性肝病的作用还需更 多证据。进一步的研究和实践应基于运动处方的制定，探索不同运动处方治疗非酒精性脂肪性肝病的安全性和疗 效。     

非酒精性脂肪性肝病与冠心病的关系及相关研究进展

非酒精性脂肪性肝病发病率不断升高且有低龄化趋势。非酒精性脂肪性肝病除可导致终末期肝病和肝癌外,还与冠心病关系密切。非酒精性脂肪性肝病患者冠心病相关残疾和死亡显著增加,并且非酒精性脂肪性肝病和不明原因的肝酶持续异常可独立预测动脉硬化和冠心病的发生。非酒精性脂肪性肝病伴随的氧化应激,脂联素减少而瘦素、抵抗素增多,以及饱餐后血脂的代谢异常,可能对血管内皮细胞产生损害,从而参与动脉硬化的发生和发展。非酒精性脂肪性肝病的基础治疗为通过改变生活方式以控制体重和腰围,伴有冠心病的病例可试用胰岛素增敏剂、抗氧化药、降脂药、保肝药,而胰高血糖素样肽1受体激动剂以及大麻受体1拮抗剂等新药仍在研究中。     

非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析

目的探讨非酒精性脂肪性肝病(NAFLD)与高脂血症性急性胰腺炎(HLAP)严重程度的相关性。方法回顾性选取2018年2月20日—2020年1月20日武汉大学人民医院胰腺外科收治的895例急性胰腺炎患者,从中筛选出101例HLAP患者。根据患者是否合并NAFLD,将患者分为非脂肪肝组(41例)和脂肪肝组(60例)。收集患者的临床资料,包括一般资料(性别、年龄、BMI、糖尿病、高血压)、生化指标(淀粉酶、脂肪酶、ALT、AST、Alb、TBil、血尿素、血肌酐、血糖、血钠、血钙、胆固醇、TG、乳酸脱氢酶、超敏C反应蛋白)水平、WBC水平、AP严重度、CT扫描下的局部并发症、系统性炎症反应综合征、菌血症、器官衰竭情况及患者住院和HLAP复发情况(住院时间、ICU入住率、HLAP的1年内复发率及HLAP的1年内发病次数)。符合正态分布的计量资料两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ^2检验或Fisher检验。结果脂肪肝组患者入院时血糖、WBC水平高于与非脂肪肝组,血钠水平低于非脂肪肝组,差异有统计学意义(Z=-2.241、t=2.187、t=-2.533,P值均<0.05)。脂肪肝组患者与非脂肪肝组相比中重症AP比例更高,差异有统计学意义(75.0%vs 53.7%,χ^2=4.968,P<0.05),且脂肪肝组患者的局部并发症、系统性炎症反应综合征、菌血症和呼吸衰竭的发生率较高,差异均有统计学意义(χ^2值分别为6.059、4.611、4.056、4.568,P值均<0.05)。两组患者住院时间差异无统计学意义(P>0.05),而脂肪组患者的ICU入住率较高(7.3%vs 23.3%,χ^2=4.463,P<0.05)。此外,两组患者HLAP的1年内复发率及HLAP的1年内发病次数差异均无统计学意义(P值均>0.05)。结论NAFLD与HLAP严重程度具有明显的相关性。NAFLD可能在HLAP的早期病情评估、疾病进展及预测预后中具有重要的作用。     

The Inflamed Liver and Atherosclerosis: A Link Between Histologic Severity of Nonalcoholic Fatty Liver Disease and Increased Cardiovascular Risk

Background  

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the Western world. It encompasses a spectrum of disease ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). Growing evidence links NAFLD to cardiovascular (CV) disease; however, the association between the histologic severity of NAFLD and CV risk remains poorly understood.     

A narrative review on effects of vitamin D on main risk factors and severity of Non-Alcoholic Fatty Liver Disease

The global prevalence of Non-alcoholic fatty liver disease (NAFLD) is increasing rapidly. Many studies have been conducted on the treatment of NAFLD; nevertheless, there is still no approved drug treatment for this disease. Although the pathogenesis of NAFLD is not fully understood, but inflammation, insulin resistance, oxidative stress, obesity and dyslipidemia are among the main causes. Epidemiological studies have shown that hypovitaminosis D is associated with these factors causing NAFLD. In addition, rate of Vitamin D deficiency has been shown to be directly related to the severity of NAFLD. Accordingly, it is believed that vitamin D may help to treatment of NAFLD by improving the above-mentioned risk factors. The purpose of this review is to survey the recent advances in the field of Vitamin D efficacy on risk factors and the severity of NAFLD based on existing evidence, especially the clinical efficiency of vitamin D supplementation in patients with NAFLD.     

Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is common and may progress to end-stage liver disease. Liver-related morbidity and mortality occur almost exclusively in patients whose disease progresses to advanced fibrosis and cirrhosis. Presence and severity of liver fibrosis seem the most important indicators of long-term prognosis. Clinical and biochemical variables may help select NAFLD patients in whom liver biopsy may provide the most prognostic information. Some serum markers of liver fibrosis and imaging techniques aimed at measuring liver stiffness are under investigation as tools to determine severity of liver fibrosis in patients who have NAFLD, but none of them yet can replace liver biopsy.     

Bariatric surgery in patients with non-alcoholic fatty liver disease-from pathophysiology to clinical effects

Non-alcoholic fatty liver disease(NAFLD) is increasingly recognized as a significant liver disease,and it covers the disease spectrum from simple steatosis with a risk of development of non-alcoholic steatohepatitis(NASH) to fibrosis,subsequent cirrhosis,end-stage liver failure,and liver cancer with a potential need for liver transplantation.NAFLD and NASH are closely related to obesity,metabolic syndrome,and type 2 diabetes(T2 D).The role of gut hormones,especially glucagon-like peptide 1(GLP-1),is important in NAFLD.Bariatric surgery has the potential for inducing great weight loss and may improve the symptoms of metabolic syndrome and T2 D.Recent data demonstrated significant effects of bariatric surgery on GLP-1 and other gut hormones and important lipid metabolic and inflammatory abnormalities in the pathophysiology of NAFLD.Therefore,bariatric surgery may reverse the pathological liver changes in NAFLD and NASH patients.In the present review,we describe NAFLD and NASH pathophysiology and the primary effects of bariatric surgery on metabolic pathways.We performed a systematic review of the beneficial and harmful effects and focused on changes in liver disease severity in NAFLD and NASH patients.The specific focus was liver histopathology as assessed by the invasive liver biopsy.Additionally,we reviewed several non-invasive methods used for the assessment of liver disease severity following bariatric surgery.     

Disease severity predicts higher healthcare costs among hospitalized nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients in Spain

The rising prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) presents many public health challenges, including a substantial impact on healthcare resource utilization and costs. There are important regional differences in the burden of NAFLD/NASH, and Spain-specific data are lacking. This retrospective, observational study examined the impact of liver disease severity, comorbidities, and demographics on healthcare resource utilization and costs in Spain.NAFLD/NASH patients in the Spanish National Health System''s Hospital Discharge Records Database (1/1/2006 to 4/30/2017) were categorized into disease severity cohorts as NAFLD/NASH overall, NAFLD/NASH non-progressors, compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplant (LT), or hepatocellular carcinoma (HCC). Patients were followed from index date until the earliest of 6 months, disease progression, end of coverage, death, or end of study. Within each cohort, pre- and post-index healthcare resource utilization and costs per patient per month (PPPM) were calculated.A total of 8,205 patients (mean age 58.4; 54% male) were identified; 5,984 (72.9%) were non-progressors, 139 (1.7%) progressed to CC, 2,028 (24.7%) to DCC, 115 (1.4%) to LT, and 61 (0.7%) to HCC. Pre-index comorbidity burden was high across disease cohorts, and the frequency of comorbidities increased with disease severity. From pre- to post-index, average length of stay (LOS) increased significantly (23%–41%) as did all-cause PPPM costs (44%–46%), with significantly longer LOS and costs in patients with increasing disease severity.Progression of NAFLD/NASH was associated with significantly higher costs and longer LOS. A coordinated approach is needed to manage resources and costs in Spain.     

Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreatitis

BACKGROUND: Coagulopathy and its association with disease severity in hyperlipidemia(HL)- and non-hyperlipidemia(NHL)-induced acute pancreatitis(AP) are not clear. The present study was to evaluate the relationship between coagulation homeostasis and AP.METHODS: This study included 106 AP patients admitted to our hospital between October 2011 and January 2013. Stratified by disease severity,the patients were divided into two groups: a mild AP(MAP) group(n=69); and a moderately severe AP(MSAP) group(n=37). Based on disease etiology,there were 31 HL-induced AP(HLP) cases and 75 NHL-induced AP(NHLP) cases. The HLP and NHLP groups were compared for parameters of coagulation homeostasis,lipid metabolism,and disease severity. Correlations between disease severity and levels of D-dimer and protein C were investigated,and the prognostic potential of D-dimer was evaluated.RESULTS: Compared with MAP patients,MSAP patients showed higher levels of D-dimer and lower levels of protein C. HLP patients had higher protein C levels than NHLP patients. Both D-dimer and protein C levels were significantly associated with the disease severity,not the disease etiology. D-dimer levels correlated positively with low density lipoprotein cholesterol levels and performed well as a sensitive and specific predictor of disease severity in AP patients,especially in HLP patients.CONCLUSIONS: The coagulation homeostasis is different between HLP and NHLP patients,and HL may be a contributingfactor for thrombosis and fibrinolysis in HLP. D-dimer may be a robust marker of disease severity in HLP.     

Racial differences in prevalence and severity of non-alcoholic fatty liver disease

The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease(NAFLD). We reviewed the published literature that reported prevalence, severity, and genetic associations of NAFLD in different ethnic groups. The metabolic syndrome(MetS) has been associated with NAFLD, but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar. An elevated triglyceride(TG) level seems to have the strongest association with NAFLD. The latter is more prevalent in Hispanic patients; Blacks have lower TG levels and a lower NAFLD prevalence, compared to Caucasians or Hispanics. The severity of liver fibrosis is lower in some, but not all biopsy-based studies of Black patients. No study has evaluated the severity of liver disease controlling for the individual components of MetS, especially TG. Important racial differences in the prevalence of selected genetic polymorphisms, particularly PNPLA-3 and MBOAT7 have been documented, together with their effects on the prevalence of liver steatosis and fibrosis. Data on overall and liver mortality have found no significant differences according to race/ethnicity, with the possible exception of one paper reporting lower cirrhosis mortality in Black patients. We conclude that NAFLD is more prevalent in Hispanics and less in Blacks. This is supported by differences in key genetic polymorphisms associated with hepatic fat storage. However, there is presently insufficient evidence to firmly conclude that race, per se, plays a role in the development of liver fibrosis and its complications. Further studies, appropriately controlled for diet, exercise, and individual MetS parameters are needed.     

Nonmedicinal interventions in nonalcoholic fatty liver disease

Unhealthy diet and lack of physical exercise are responsible for fat accumulation in the liver, which may lead to liver disease. Histologically, the severity of the disease has two stages: nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is defined by the presence of steatosis with no evidence of cellular injury such as hepatocyte ballooning. NASH is a distinct entity from NAFLD, and is characterized by the presence of inflammation with hepatocytes damage, with or without fibrosis. While several therapeutic strategies have been proposed to improve this condition, the present review aims to discuss nonmedicinal interventions used to reduce liver involvement or to prevent the disease altogether. The authors investigated dietary patterns and vitamin deficiencies associated with NAFLD, and their role in enhancing disease severity. Additionally, they reviewed the role of exercise and the use of interventions, such as as intragastric balloon and bariatric surgery, for improving disease progression. The authors propose monitoring disease progression or repair by following changes in cytoadipokine levels.     

Non-invasive diagnosis and follow-up of non-alcoholic fatty liver disease

NAFLD is a frequent disease that affects 25% of the worldwide population. There is no specific diagnostic test for NAFLD, and the diagnosis mainly relies on the elimination of the other causes of chronic liver diseases with liver biopsy kept for unsure diagnoses. Non-invasive tests are now available to assess NAFLD severity and therefore to help physicians decide on the patient management and follow-up. These non-invasive tests can also be used to define pathways that organize referrals from primary care and diabetology clinics to the liver specialist, with the ambition to improve the screening of asymptomatic patients with NAFLD and advanced liver disease. NAFLD being the liver expression of the metabolic syndrome, physicians need also take care to screen for diabetes and to evaluate the cardiovascular risk in those patients. These recommendations from the French Association for the Study of the Liver (AFEF) aim at providing guidance on the following questions: how to diagnose NAFLD; how non-invasive tests should be used to assess NAFLD severity; how to follow patients with NAFLD; when to perform liver biopsy in NAFLD; and how to decide referral to the liver specialist for a patient with NAFLD.