冠状动脉狭窄<50%的夜间胸痛与阻塞性睡眠呼吸暂停低通气综合征的关系

目的　探讨冠状动脉狭窄<50%的夜间胸痛与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的关系。     

Probiotics as a Novel Treatment for Non-Alcoholic Fatty Liver Disease; A Systematic Review on the Current Evidences

Context

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, with 5-10% of liver having extra fat. Increase in its prevalence in all age groups is linked with obesity and Type II diabetes. The treatment of NAFLD remains controversial. A growing body of evidence suggests a relation between overgrowth of gut microbiota with NAFLD and non-alcoholic steatohepatitis (NASH). The objective of this review is to provide an overview on experimental and clinical studies assessing all positive and negative effects of probiotics.

Evidence Acquisition

We made a critical appraisal on various types of documents published from 1999 to March 2012 in journals, electronic books, seminars, and symposium contexts including Medline, PubMed, and Cochrane Central Register of Controlled Trials databases. We used the key words: “non-alcoholic fatty liver disease, probiotics, non-alcoholic steatohepatitis, liver disease, and fatty liver”.

Results

Probiotics, as biological factors, control the gut microbiota and result in its progression. It is in this sense that they are suggestive of a new and a natural way of promoting liver function. Correspondingly, limited evidence suggests that probiotics could be considered as a new way of treatment for NAFLD.

Conclusions

Various experimental studies and clinical trials revealed promising effects of probiotics in improving NAFLD; however given the limited experience in this field, generalization of probiotics as treatment of NAFLD needs substantiation through more trials with a larger sample sizes and with longer-term follow up.     

老年男性阻塞性睡眠呼吸暂停与心血管疾病危险因素的相关性

目的观察老年男性阻塞性睡眠呼吸暂停综合征与心血管疾病危险因素的相关性。方法采用多导睡眠仪对老年男性582例进行监测并明确有无阻塞性睡眠呼吸暂停,同时测定受试者体质指数、颈围、腰围、臀围、血压、血脂、空腹血糖和高敏C反应蛋白水平。根据多导睡眠仪监测得出的呼吸暂停低通气指数,将研究对象分为阻塞性睡眠呼吸暂停综合征组和对照组,阻塞性睡眠呼吸暂停综合征组又根据呼吸暂停低通气指数的高低分为重度、中度及轻度阻塞性睡眠呼吸暂停综合征组,观察阻塞性睡眠呼吸暂停综合征对上述冠心病危险因素的影响。结果阻塞性睡眠呼吸暂停综合征组体重指数、颈围、臀围、腰围、收缩压、空腹血糖、高敏C反应蛋白、甘油三酯较对照组明显升高(P<0.05);高密度脂蛋白胆固醇、最低脉搏容积血氧饱和度、平均脉搏容积血氧饱和度较对照组明显降低(P<0.05);阻塞性睡眠呼吸暂停综合征组合并代谢综合征人数较对照组明显增多;重度阻塞性睡眠呼吸暂停综合征组体重指数、颈围、腰围、臀围较轻、中度组明显增高(均P<0.001);重度组高密度脂蛋白胆固醇、最低脉搏容积血氧饱和度、平均脉搏容积血氧饱和度较中度组明显降低(P<0.05);Spearm an’s相关分析显示,阻塞性...     

非酒精性脂肪肝与外周动脉硬化的关系

目的 探讨非酒精性脂肪肝与外周动脉硬化的关系.方法 选取进行健康体检的300名体检者进入研究,其中非酒精性脂肪肝体检者138例,无非酒精性脂肪肝体检者162例,两组年龄、性别构成差异无显著性.测定相关的人体测量学指标、臂踝脉博波速度、踝臂指数和经超声测定脂肪肝.结果 非酒精性脂肪肝组体重、体质指数、腰围、臂踝脉博波速度、收缩压、舒张压、脉压、丙氨酸氨基转移酶及天冬氨酸氨基转移酶水平均高于无非酒精性脂肪肝组(P＜0.05),且非酒精性脂肪肝组肥胖、高血压及外周动脉硬化检出率明显高于无非酒精性脂肪肝组(P＜0.01).多因素Logistic回归分析显示,体质指数、臂踝脉博波速度、丙氨酸氨基转移酶为非酒精性脂肪肝的易患危险因素.结论 臂踝脉博波速度与非酒精性脂肪肝密切相关,非酒精性脂肪肝与外周动脉硬化之间有着密切的关系.     

阻塞性睡眠呼吸暂停低通气综合征与脑梗死的关系

目的　探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与脑梗死的关系。方法　选取160例急性期脑梗死患者,根据多导睡眠仪（PSG）监测结果,将患者分为单纯脑梗死组（n＝72）和脑梗死并OSAHS组（n＝88）,比较两组间相关实验室指标及脑梗死进展百分比。根据不同的睡眠呼吸暂停低通气指数（AHI）,将脑梗死并OSAHS组分为3个亚组：脑梗死并轻度OSAHS组28例、脑梗死并中度OSAHS组29例、脑梗死并重度OSAHS组31例,比较3个亚组间发病第7天时NIHSS评分。结果　脑梗死并OSAHS组的相关实验室指标、脑梗死进展百分比均高于单纯脑梗死组,差异有统计学意义（P<0.01）。脑梗死并重度OSAHS组NIHSS评分高于脑梗死并中度OSAHS组,脑梗死并中度OSAHS组NIHSS评分高于脑梗死并轻度OSAHS组,差异均有统计学意义（P<0.01）。结论     

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

Background

The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea.

Objective

To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample.

Methods

Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system.

Results

A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia.

Conclusion

Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.     

Association Between LYPLAL1 rs12137855 Polymorphism With Ultrasound-Defined Non-Alcoholic Fatty Liver Disease in a Chinese Han Population

Background:

Recent genome-wide association studies (GWAS) identified that gene Lysophospholipase-like 1 (LYPLAL1) rs12137855 associated with non-alcoholic fatty liver disease (NAFLD). No research has been performed regarding the association between LYPLAL1 and NAFLD in China.

Objectives:

The aim of the present study was to investigate the association between the gene LYPLAL1 rs12137855 and NAFLD, and the effect on serum lipid profiles in a Chinese Han population.

Patients and Methods:

LYPLAL1 rs12137855 gene was genotyped in 184 patients with NAFLD and 114 healthy controls using sequencing and polymerase chain reaction analysis (PCR). We tested serum lipid profiles using biochemical methods.

Results:

No significant differences in genotype and allele frequencies of LYPLAL1 rs12137855 was found between the NAFLD group and the controls group (P > 0.05). Subjects with the variant LYPLAL1 rs12137855 CC genotype had a higher mean weight, body mass index (BMI) and low density lipoprotein (LDL).

Conclusions:

Our results showed for the first time that LYPLAL1 gene is not associated with a risk of NAFLD development in the Chinese Han population. The variant carriers of overall subjects significantly increased weight, BMI and LDL.     

Hyperinflation is Associated with Lower Sleep Efficiency in COPD with Co-existent Obstructive Sleep Apnea

ABSTRACT

Prior research has shown that individuals with obstructive lung disease are at risk for sleep fragmentation and poor sleep quality. We postulated that patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (known as overlap syndrome) who have more severe lung disease, as measured by lung hyperinflation (inspiratory capacity/total lung capacity), would have greater sleep disturbances independent of traditional measures of sleep apnea. We performed a retrospective chart review of consecutive patients evaluated and treated in an academic pulmonary clinic for overlap syndrome. Pulmonary function tests and polysomnogram data were collected. Thirty patients with overlap syndrome were included in the analysis. We found significant univariable associations between sleep efficiency and apnea/hypopnea index (β = ?0.285, p = 0.01) and between sleep efficiency and lung hyperinflation (β = 0.654, p = 0.03). Using multivariable linear regression, the relationship between sleep efficiency and lung hyperinflation remained significant (β = 1.13, p = 0.02) after adjusting for age, sex, body mass index, apnea/hypopnea index, FEV₁% predicted, oxygen saturation nadir, medications, and cardiac disease. We conclude that increased severity of hyperinflation is associated with worse sleep efficiency, independent of apnea and nocturnal hypoxemia. The mechanisms underlying this observation are uncertain. We speculate that therapies aimed at reducing lung hyperinflation may improve sleep quality in patients with overlap syndrome.     

阻塞性睡眠呼吸暂停对非酒精性脂肪性肝病的影响

阻塞性睡眠呼吸暂停(OSA)引起机体长期处于慢性间歇性缺氧可导致多系统、多器官病变,严重者可发生心源性猝死。除合并呼吸、心脑血管、内分泌代谢等疾病外,OSA与消化系统疾病中的非酒精性脂肪性肝病(NAFLD)也有密切关联。简述了OSA和NAFLD的现状,叙述了OSA对NAFLD的影响,归纳了OSA影响NAFLD的机制,提出通过探索OSA影响NAFLD的可能机制,从OSA角度为NAFLD寻找新的潜在防治靶点,对延缓、甚至阻断NAFLD进展具有重要意义。     

The Effect of Berberis Vulgaris Extract on Transaminase Activities in Non-Alcoholic Fatty Liver Disease

Background:

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder in western countries and an important cause of liver cirrhosis, as well as liver failure. Up to now, 20‒40% of the individuals suffer from this disorder and its prevalence is estimated around 5‒30% in Asia. The NAFLD is one of the most prevalent causes for increases in liver enzymes and has a close relationship with obesity, dyslipidemia, hypertension, and type II diabetes. However, no definite treatment has been identified for it yet.

Objectives:

The present study aimed to investigate the effect of berberis vulgaris extract in inducing changes in liver enzymes levels.

Patients and Methods:

The present clinical trial was conducted on 80 patients, including 32 males (40%) and 48 females (60%), who were randomly assigned into two groups of case and control. All the patients had ultrasound evidence of lipid accumulation in the liver and increases in liver enzymes. The case group received two capsules (750 mg) containing berberis vulgaris extract every day for 3 months, while the control group was treated with placebo. The weight, liver transaminases levels and lipid profiles of the two groups were assessed before, during, and after the study.

Results:

In the case group, the mean serum levels of alanine transaminase (ALT) and aspartate transaminase (AST) decreased from 49 to 27.48 and 48.22 to 29.8 u/L, respectively, which was statistically significant compared to the control group (P < 0.001, P < 0.001). In the control group, the mean of ALT and AST decreased from 50.4 to 46.8 and 45.7 to 44.9 u/L, respectively. The difference was not statistically significant. In addition, a significant decrease was observed in weight, triglycerides, and cholesterol, while no significant change was found in fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL).

Conclusions:

Considering the significant decrease in the liver enzymes, triglycerides and cholesterol after using berberis vulgaris extract, further studies with larger sample sizes will identify the accurate dose as well as duration of consumption for this extract, to recommend in the treatment of patients with NAFLD.     

自身免疫性肝损伤与非酒精性脂肪性肝病

自身免疫性肝病(AILD)和非酒精性脂肪性肝病(NAFLD)是两大类造成肝功能进行性损害的慢性炎症性肝脏疾病,两者均缺乏特征性临床表现和生化指标。近年来,随着生活方式的改变,肥胖和NAFLD在全球呈流行趋势,AILD中的自身免疫性肝炎(AIH)和原发性胆汁性肝硬化(PBC)可呈现与NAFLD"共存"的现象,使诊断更为困难。已确诊的NAFLD患者如出现不明原因的肝功能恶化,应考虑并发AILD的可能。本文对"NAFLD-AILD共存"的临床病理特点作一概述,并初步探讨其可能机制。     

脂肪性肝病：愈来愈严重的全球性公共卫生问题

脂肪性肝病分为酒精性肝病和非酒精性脂肪性肝病,其发病率呈逐年上升趋势,目前认为是终末期肝病的主要病因之一,正成为世界范围内威胁人类健康的重大问题。深入探讨其发病机制,揭示疾病特点,将有助于提高脂肪性肝病的诊治水平,从而改善人类健康、减少社会经济负担。     

Effects of Metformin,Pioglitazone, and Silymarin Treatment on Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Pilot Study

Background

Nonalcoholic fatty liver disease (NAFLD) is one of the most common reasons of enzyme increase in liver. In About 10 percent of patients with NAFLD, the disease progresses toward Non Alcoholic Steatohepatitis (NASH) and about one third of them may progress toward cirrhosis, liver dysfunction, and even hepatocellular carcinoma.

Objectives

According to high prevalence of NAFLD and the fact that there is no consensus on treatment of this disease, the aim of this study was to assess the effects of metformin, pioglitazone, and silymarin on treatment of NAFLD.

Patients and Methods

Sixty six patients with NAFLD who were presented in the Endocrinology and Metabolism clinic of Boo’ali Hospital, Qazvin, Iran, were assigned randomly into three groups (n = 22). First group was treated by pioglitazone 15 mg/d, second group by metformin 500 mg/d, and third group by silymarin 140 mg/d. All patients underwent clinical and biochemical evaluations including weight, fasting blood sugar (FBS), lipid profiles, body mass index (BMI), aspartate aminotransferase (AST ), alanine aminotransferase (ALT), and serum insulin levels in pre- and post-intervention after eight-week follow up.

Results

Before the treatment there was no significant difference between three groups with respect to average age, BMI and gender, FBS, lipid profile, AST, ALT, serum insulin level, and Homeostasis Model Assessment (HOMA) index for insulin resistance. After the intervention, a significant reduction was observed in average amount of FBS, lipid profile, ALT, AST, serum insulin level and HOMA index in three groups (P < 0.01). The most reduction in average FBS, TG, serum insulin level, and HOMA index was observed in pioglitazone group, the most reduction in average amount of cholesterol was seen in metformin group, and the most decrease in average amount of AST and ALT occurred in silymarin group.

Conclusions

These results suggest that all drugs are beneficial in improving biochemical indices in patients with NAFLD. Changes in AST and ALT in silymarin group were demonstrated more than that in other groups and the average difference between changes was significant between silymarin and metformin groups.     

脂肪肝指数与非酒精性脂肪性肝病和冠状动脉粥样硬化性心脏病的相关性研究

背景：研究显示非酒精性脂肪性肝病（NAFLD）与心血管疾病关系密切,脂肪肝指数（FLI）在欧洲人群中可用于脂肪肝的预测。目的：探讨FLI在中国人群中与NAFLD和严重心血管疾病冠状动脉粥样硬化性心脏病（CAD）的相关性。方法：713例因高度疑似CAD而行冠状动脉造影的上海市本地居民纳入研究,并根据造影结果分为CAD组和非CAD组。其中574例根据腹部B超检查结果分为NAFLD组和非NAFLD组。以NAFLD或CAD为因变量,以包括FU在内的其他变量为自变量进行多因素Loostic回归分析。结果：NAFLD组FLI显著高于非NAFLD组（P〈0．01）;不同FLI级别组间（〈30、30～60和≥60）NAFLD患病率差异有统计学意义（P〈0．01）;经校正性别、年龄因素,FLI为NAFLD的危险因素之一（OR=1．038,95％CI：1．029～1．047,P=0．000）,其他危险因素包括高血压史、糖尿病史和高血脂史。CAD与非CAD组间FLI以及不同FLI级别组间CAD患病率差异均无统计学意义;经校正年龄因素,AST和总胆固醇（TC）为CAD的危险因素,高密度脂蛋白（HDL）为CAD的保护因素,FLI与CAD之间无相关性（男性OR=0．996,95％CI：0．988-1．004,P=0．359;女性OR=0．995,95％CI：0．976～1．014,P=0．574）。结论：在中国人群中,FLI与NAFLD具有相关性,可用于NAFLD的筛选和预测;FLI与CAD无明显相关性,是否可用于CAD的预测有待进一步研究。     

Circulating Levels of Pro-inflammatory Cytokines in Patients with Nonalcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis

Background: Pro-inflammatory cytokines are associated with systemic inflammatory responses. Objective: To investigate the levels of pro-inflammatory cytokines (IL-1b, IL-6, and TNF-a) in patients with non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) compared to healthy individuals. Methods: This case-control study was conducted on 30 patients with NAFL, 30 patients with NASH, and 30 healthy volunteers. The plasma level of IL-1b, IL-6, and TNF-a were determined by ELISA, and biochemical parameters were measured using colorimetric methods. Results: IL-1b and IL-6 levels were significantly higher in patients with NASH compared with NAFL and control group. However, TNF-a levels had no significant variations in NAFL and NASH patients compared to the control group (p=0.903 and p=0.960, respectively). Conclusion: Results showed that the levels of ALT activity and pro-inflammatory cytokines were higher in patients with NASH compared to control and NAFL subjects; Therefore, steatosis and inflammation develop as a result of excessive pro-inflammatory factors in NASH.     

Mortality in Obstructive Sleep Apnea: Association with Impaired Wakefulness

Sleep fragmentation from obstructive sleep apnea (OSA) is correlated with a shortened sleep latency on the Maintenance of Wakefulness Test (MWT) and the Multiple Sleep Latency Test. Whether impairment of wakefulness is associated with increased mortality in OSA patients is unknown. We evaluated survival over an average timespan of 7.5 years from the date of diagnosis in a consecutive series of 322 OSA patients who had undergone nocturnal polysomnograpy and the MWT. Evaluable survival data were obtained in 142 patients. Twenty two had died. Deaths were predominantly due to cardiovascular disease. A comparison of the demographic and sleep study data between the alive and dead groups was significant for differences in MWT sleep latency and in age at time of diagnosis. The MWT mean sleep latency, when adjusted for age, was significantly shortened in the dead patients (28 ± 11 min vs. 21 ± 10 min, p < 0.005). Also, there was a significant decrease in survival in the patients whose MWT mean sleep latency was less than 20 min. These findings demonstrate an association between impairment of wakefulness and long-term mortality in OSA patients. This association was not evident for the other measures used to assess OSA severity.Supported by NIH grants NS30019, MH47680 to Dr. Mitler and Clinical Research Center grant AA08235 to the Scripps Research Institute.     

非酒精性脂肪性肝病的非药物治疗进展

非酒精性脂肪性肝病(NAFLD)为国内外最常见的肝病之一,其发病率逐渐上升,但药物治疗的疗效并不确切,近年NAFLD的非药物治疗逐渐受到重视。生活方式改变和减肥手术均可对NAFLD产生积极影响,红外肝病治疗仪亦能起一定作用。尽管NAFLD的治疗手段逐渐多样化,但目前尚缺乏更多的随机对照试验来证实其有效性。     

肠道微生态失衡致非酒精性脂肪性肝病发病机制的研究进展

非酒精性脂肪性肝病（NAFLD）已成为一种常见的慢性肝病。近年肠道微生态失衡致NAFLD发病的机制研究已成为一个新的热点。国内外文献已报道相关发病机制可能包括干扰代谢、促进胰岛素抵抗、产生毒性代谢产物、增加肠壁通透性、激活肠道免疫、加重肝脏脂质氧化和氧化应激、激活肝脏免疫炎症损伤和肝纤维化等。而NAFLD发展到一定阶段后又可反过来影响肠道微生态,形成恶性循环。本文就肠道微生态失衡致NAFLD发病机制的研究进展作一综述。