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)事实上是一个肝脏脂肪性病变的疾病谱,包括单纯性脂肪肝、非酒精性脂肪性肝炎(NASH)、肝纤维化或肝硬化、肝衰竭,甚至部分患者发生肝细胞性肝癌。NAFLD与代谢综合征(MS)密切伴随,并认为是代谢综合征的肝脏表现。胰岛素抵抗可能是二者共同的发病基础。NAFLD已经成为MS、2型糖尿病(T2DM)和心血管疾病(CVD)的重要的独立预测因子,NAFLD成为T2DM和CVD高危人群,因此早期诊断和早期干预NAFLD对预防T2DM和CVD具有重要意义。     

非酒精性脂肪性肝病与动脉粥样硬化关联性的研究进展

非酒精性脂肪性肝病(NAFLD)是与遗传易感性和胰岛素抵抗(IR)密切相关的代谢应激性肝病,目前亦认为是代谢综合征(MS)的肝脏表现,常常与肥胖、2型糖尿病、高血压病、高脂血症以及MS等合并存在。近年来,NAFLD的患病率逐年增高,并且在2型糖尿病、肥胖患者中其患病率更高。动脉粥样硬化(AS)是心血管疾病(CVD)的基础,而目前研究发现NAFLD与CVD关系密切,NAFLD患者主要死亡原因是CVD和恶性肿瘤,NAFLD与AS关系亦密切,其机制目前仍不明确,可能涉及到胰岛素抵抗、血脂代谢紊乱、氧化应激、炎症反应、脂肪激素水平变化和肝功能等方面。本文就NAFLD和AS间的相关性及可能机制进行综述。     

非酒精性脂肪肝与代谢综合征研究进展

研究认为,脂肪肝与糖尿病两者具有共同的患病基础,非酒精性脂肪肝(NAFLD)与代谢综合征(MS)的肥胖、脂代谢异常、胰岛素抵抗(IR)等组分并存,甚至认为NAFLD是MS的一个临床特点或肝脏表现.因此,美国临床内分泌医师学会将NAFLD列为MS的主要组分之一[1].     

磁共振波谱在非酒精性脂肪肝的临床应用和进展

正非酒精性脂肪性肝病(NAFLD)指除外酒精和其他明确损害肝脏的因素所导致的,以弥漫性肝细胞大泡性脂肪变为主要组织学特征的临床病理综合征,疾病谱包括单纯性脂肪肝(SNAFL)、脂肪性肝炎(NASH)、肝纤维化及肝硬化。NAFLD往往和肥胖、胰岛素抵抗、高脂血症、高尿酸血症等多种代谢紊     

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)是一种包括从单纯的肝脂肪变性到非酒精性脂肪性肝炎,以致最终发展为肝硬化的一组肝脏慢性广谱性临床病理综合征。近年来大量研究表明,NAFLD与代谢综合征(MS)的各个组分密切伴随,甚至有学者将其作为MS的组分之一,并发现胰岛素抵抗在NAFLD发病机制中起关键作用。迄今对NAFLD的发病机制还了解甚少,目前广泛接受的一个理论是“二次打击”假说。脂肪酸和甘油三酯在肝脏沉积造成的“第一次打击”之后,肝细胞对氧化应激和炎症因子作用导致的“第二次打击”的敏感性增加而引起肝损害。本文主要目的是对NAFLD的临床病理特点、与胰岛素抵抗及MS的关系以及可能的分子机制进行综述,同时也介绍了目前预防和治疗NAFLD的策略。     

非酒精性脂肪性肝病的临床特征

非酒精性脂肪性肝病(NAFLD)是一组肝脏病理学改变与酒精性肝病相似，但无过量饮酒史的临床综合征，包括单纯性脂肪肝、非酒精性脂肪性肝炎(NASH)和肝硬化等一系列改变。肥胖和糖尿病是NAFLD的主要危险因素，NAFLD特别是NASH患者通常伴有胰岛素抵抗(IR)和代谢综合征，IR可能为联系NAFLD病因和临床特征之间的桥梁。     

NFATc4在NASH领域的研究进展

非酒精性脂肪性肝病(NAFLD )在普通人群中的发病率约为20％ ～30％,是目前最常见的肝脏疾病.其疾病谱中的非酒精性脂肪性肝炎(NASH )有进展为肝硬化,甚至肝细胞癌的风险.而且,除了肝脏病变,NAFLD常与肥胖、2型糖尿病、胰岛素抵抗、脂质代谢紊乱等代谢异常相关.因此,深入了解NAFLD的发病机制,寻找潜在的治...     

老年非酒精性脂肪肝研究进展

正非酒精性脂肪肝(NAFLD)的发病率呈逐年升高的趋势,NAFLD是以肝脏脂肪异常积累为特征,进而引起肝脏脂肪变性的一种临床综合征。胰岛素抵抗和遗传易感性与其发病关系密切~([1])。NAFLD和高血压、糖尿病、脂代谢异常、胰岛素抵抗和肥胖等因素密切相关~([2])。老年患者存在肥胖、代谢异常及年龄比较高的特点,成为NAFLD高危人群。NAFLD是代谢综合征     

非酒精性脂肪性肝病与动脉粥样硬化之间关系的研究进展

非酒精性脂肪性肝病( NAFLD)常与肥胖、糖尿病、高血脂、高血压以及代谢综合征合并存在,认为是代谢综合征的肝脏表现。NAFLD的患病率约20％～30％,在2型糖尿病人群中NAFLD患病率更高。NAFLD与心血管疾病(CVD)关系密切,NAFLD患者的主要死亡原因是CVD。NAFLD和动脉粥样硬化(AS)关系密切,其机制可能涉及氧化应激、炎症反应、脂代谢紊乱、脂肪激素水平的变化和胰岛素抵抗等方面。本文就NAFLD和AS间的关系以及可能机制进行综述。     

非酒精性脂肪肝病与结直肠肿瘤相关性研究进展

正非酒精性脂肪肝病(NAFLD)是全球最常见的慢性肝病之一,全球患病率为25.2%左右[1]。其发生与肥胖、胰岛素抵抗(IR)、高血压、血脂异常等密切相关,目前被认为是代谢综合征的肝脏表现[2]。NAFLD可发展为NAFLD肝炎、肝硬化和肝细胞癌[1]。但其临床负担并不局限于肝脏,大量研究发现,NAFLD可能是罹患结直肠肿瘤的危险因素。结     

Gastro-oesophageal reflux disease and respiratory disease

Abstract An epidemiological survey showed that respiratory symptoms with gastro-oesophageal reflux (GER) were twice as high as those without GER symptoms. In 46 cases of unknown chronic cough or asthma, 67% had positive oesophageal pH monitoring. Of 34 patients with snoring and reflux symptoms, 16 (47.1%) were confirmed as positive for obstructive sleep apnoea (OSA) and GER. Anti-reflux therapy significantly improved both GER and OSA.     

Risk of cardiovascular disease in inflammatory bowel disease

Abundant scientific evidence supporting an association between inflammatory bowel disease(IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.     

先天性巨结肠类缘病的治疗探讨

目的探讨先天性巨结肠类缘病(HAD)的治疗方法。方法分析7例HAD患儿的治疗方案。术前或术中明确诊断的4例HAD患儿中,1例行根治性手术,1例行延期根治性手术,1例根治性手术后继续保守治疗,1例行肠造瘘术后等待根治术时机;3例按先天性巨结肠(HD)行根治术,术后复习病理切片才明确诊断,及时随诊,2例分别在首次术后3个月和8个月再行根治术,1例继续扩肛治疗。结果7例HAD患儿排便情况满意。结论根治手术对HAD治疗至关重要,保守治疗是HAD治疗的必要补充。     

慢性肾脏病所致心血管疾病概述

慢性肾脏病(CKD)是心血管疾病(CVD)的高危因素,CKD患者的CVD患病率很高,非常值得重视。本文将对CKD时的冠状动脉粥样硬化性心脏病、尿毒症心肌病、尿毒症心包炎、脑卒中及外周动脉病做一简介。     

Anorectal Crohn's disease

A group of 86 patients with anorectal Crohn's disease were followed up from ten to 40 years to determine the course of the disease and the number of patients who later required proctectomy. The overall cumulative probability of avoiding proctectomy was 91.6 percent at ten years and 82.5 percent at 20 years. Resection of all proximal Crohn's disease did not ameliorate the anorectal disease, except in patients who had all proximal disease removed and had no recurrence. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.     

Rheumatoid arthritis,periodontal disease and coronary artery disease

Rheumatoid arthritis (RA), periodontal disease (PD), and coronary artery disease (CAD) are common chronic inflammatory diseases. RA is associated with accelerated vascular risk resulting in an increased prevalence of CAD with attendant early mortality and excess morbidity. RA and PD have a common pathobiology. Accordingly, the aim of this study was to evaluate the association between RA, PD, and CAD and the influence of systemic inflammatory factors. A total of 100 active RA patients of which 50 had established CAD and 50 had no CAD were assessed for PD. All subjects underwent a clinical, cardiac, dental, laboratory, and radiological evaluation. Blood samples were obtained, and the level of high sensitivity C-reactive protein (hs-CRP), total white blood counts (WBC), erythrocyte sedimentation rate (ESR), fibrinogen and tumor necrosis factor (TNF) alpha, total cholesterol (TC), and high density lipoprotein (HDL) were assayed. The findings of this study demonstrated an association between RA, PD, and CAD. The RA patients with CAD had significantly more PD than RA patients without CAD. The inflammatory markers, hsCRP, ESR, WBC, fibrinogen, and TNF-α, were raised in all patients but were significantly higher in RA patients with CAD who also had PD. HDL levels were lower in RA patients with CAD when compared to RA patients without CAD. Evidence from this study shows an association between RA, PD, CAD, and systemic levels of the inflammatory mediators. The implication is that inflammation may be the central link between the chronic inflammatory, autoimmune disorders, and atherosclerosis. An erratum to this article can be found at     

Castleman's病合并糖尿病Graves病1例

1病历资料患者女,53岁。主因Castleman s病6年,糖尿病5年,烦热伴消瘦明显6个月,咳嗽伴发热2 d入院。患者自     

合并还是模拟:当Castleman病与结缔组织病共存时

目的探讨Castleman病与CTD共存时的关系,减少误诊误治。方法回顾性分析2001年1月至2017年5月北京协和医院收治的疑诊CTD最终诊断Castleman病患者的临床及实验室资料。结果①Castleman病合并或模拟CTD 11例,占同期Castleman病患者的5.7%(11/194),发病平均年龄(51±17)岁,男性6例,女性5例;②常见的临床表现依次为多发浅表淋巴结肿大(10/11)、发热(8/11)、浆膜腔积液(6/11)、关节肿痛(5/11)、脱发(2/11)、雷诺现象(1/11)、光过敏(1/11);③实验室检查表现为ESR增快(11/11)、低白蛋白血症(11/11)、hs-CRP升高(10/11)、IgG升高(7/11)、蛋白尿(5/11)、镜下血尿(5/11)、ANA阳性(5/11);④疑诊的CTD包括SLE 5例,IgG4相关性疾病2例,成人Still病2例;合并SS 2例;⑤11例均由活检病理明确诊断为多中心型Castleman病,浆细胞型10例,混合型1例。结论Castleman病可出现发热、多浆膜腔积液、关节肿痛、蛋白尿等合并或模拟CTD的表现,诊断和治疗需谨慎,必要时行淋巴结或肿物活检,减少误诊误治。     

脂肪性肝病与胃食管反流病的相关性研究

目的评估脂肪性肝病(FLD)与胃食管反流病GERD之间的关系。方法选取2 000例受试者,采用较简便的胃食管反流病问卷(GerdQ)作为初筛GERD诊断标准,对入选者均进行腹部超声波等检查,分析FLD与GERD关系。结果对2 000例患者利用GerdQ评估GERD诊断情况,有176例(8.8%)诊断为GERD,女68人(38.64%),男108人(61.36%);脂肪肝患者760例,患病率38.0%,在脂肪肝组中,男女性GERD症状的GerdQ阳性率分别为13.77%和12.24%,两者无明显差异(P>0.05)。脂肪肝人群发生GERD症状的患病率与对照组存在统计学差异(P<0.05)。结论脂肪肝与GERD显著相关,控制脂肪肝发展可以降低GERD发病率。