79例ALT正常慢性乙型肝炎合并脂肪肝患者的肝脏病理特点及其影响因素

目的了解ALT正常的慢性乙型肝炎合并脂肪肝患者的肝脏病理特征及相关影响因素。方法分析79例血清ALT正常且HBsAg阳性合并脂肪肝患者的肝组织病理情况,分析其损害程度与年龄、HBeAg状态、HBVDNA载量及脂肪肝程度的相关性。结果 79例患者中无或轻度组织学改变（G0～G1或S0～S1）者35例（44.3%）,有显著组织学改变（≥G2或≥S2）者44例（55.7%）。年龄≥40岁、HBeAg阴性、低病毒载量患者的组织学改变较重,P〈0.05或P〈0.01,而轻度与中重度脂肪肝患者的肝脏病理改变无统计学差异。结论 ALT正常的慢性乙型肝炎合并脂肪肝患者可能存在较大比例的肝组织损害,其肝组织损害程度与年龄、HBeAg状态及HBVDNA载量有关,而与脂肪肝程度无显著相关性。     

胰十二指肠切除术后新发非酒精性脂肪性肝病的相关因素分析

目的探讨胰十二指肠切除术(PD)后患者新发非酒精性脂肪性肝病(NAFLD)的相关因素。方法回顾性收集2018年6月至2020年12月南京大学医学院附属鼓楼医院肝胆胰中心连续收治的130例接受PD的患者资料。男性74例, 女性56例, 年龄[M(IQR)]为62(16)岁(范围:22～84岁)。其中29例患者术后发生NAFLD, 设为NAFLD组;101例患者未发生NAFLD, 设为非NAFLD组。观察指标:(1)两组患者术前一般情况、术中与术后相关指标;(2)PD术后新发NAFLD的相关因素。分类资料的比较采用χ2检验或Fisher确切概率法, 定量资料的比较采用独立样本t检验或Mann-WhitneyU检验, 多因素分析采用逐步向前法的Logistic回归模型。结果 130例患者均成功完成PD, 术后6个月内NAFLD的发生率为22.3%(29/130)。单因素分析结果显示, 体重指数、糖尿病、术前甘油三酯水平、胰腺癌是发生NAFLD的相关因素(t=-2.655、χ2=4.563、U=-2.192、χ2=7.044, P值均<0.05)。多因素分析结果显示, 性别、体重指数、是...     

Improvement of nonalcoholic fatty liver disease in morbidly obese patients after sleeve gastrectomy: association of ultrasonographic findings with lipid profile and liver enzymes

Background: After bariatric surgery an improvement or even complete resolution of nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients is achieved, but little is known about the effect of laparoscopic sleeve gastrectomy (LSG).

Patients and methods: A prospective observational study of patients undergoing LSG was performed. An abdominal ultrasonography and blood sample extraction (investigating liver enzymes and lipid profile) were performed preoperatively and 12 months after surgery.

Results: Fifty patients were included in the study. Preoperatively, 84% of the patients presented liver steatosis. A significant reduction of steatosis could be observed 12 months after surgery (p?p?=?.008) and ALT (p?=?.007) and an inverse correlation with HDL-cholesterol (p?=?.019). The reduction of liver steatosis showed an inverse correlation with the increase of HDL-cholesterol between pre- and postoperative determinations (p?=?.008).

Conclusions: Liver steatosis, as measured by ultrasonography, improves after sleeve gastrectomy, achieving a complete resolution in 90% of the cases. Preoperative steatosis correlates directly with AST and ALT levels and inversely with HDL-cholesterol. The postoperative increase of HDL-cholesterol shows an inverse correlation with liver steatosis improvement, suggesting that it could be a good marker for monitoring the postoperative liver status.     

HBeAg阳性慢性乙型肝炎合并非酒精性脂肪肝患者的临床与病理学特征

目的探讨HBeAg阳性慢性乙型肝炎患者合并非酒精性脂肪肝病（NAFLD）的临床与病理学特征。 方法选取2013年6月至2017年12月首都医科大学附属北京佑安医院病理确诊的慢性HBV感染（CHI）患者（108例）、NAFLD患者（120例）及HBeAg阳性慢性乙型肝炎合并NAFLD患者（132例）共360例。入组病例均行肝组织活检术,标本分别行HBsAg和HBcAg检测和HE染色。光学显微镜下观察肝组织脂肪变性和纤维化程度。比较各组患者血清学指标以及病理学特征。 结果较CHI患者,NAFLD患者和HBeAg（+）CHB合并NAFLD患者ALT水平显著升高,差异具有统计学意义（P均< 0.05）。较CHI和NAFLD患者,HBeAg（+）CHB合并NAFLD患者的AST与尿酸水平均显著升高,差异具有统计学意义（P均< 0.05）。较NAFLD患者,HBeAg（+）CHB合并NAFLD患者的甘油三酯（TG）水平显著降低,肝纤维化程度显著升高。CHI患者、NAFLD患者和HBeAg（+）CHB合并NAFLD患者三组患者的肌酐水平逐渐升高,差异具有统计学意义（P < 0.05）。各组患者两两比较高尿酸血症所占比例差异均有统计学意义（P均< 0.05）。与CHI患者和NAFLD患者相比,HBeAg（+）CHB合并NAFLD患者中男性高尿酸血症患者比例显著升高,差异具有统计学意义（P均< 0.05）。 结论炎症和纤维化发生率在HBeAg（+）CHB合并NAFLD患者中升高,提示NAFLD的存在可能与CHB病情进展有协同作用。     

非酒精性脂肪性肝病患者血清肝纤维化指标与肝内脂肪含量的相关性研究

目的探讨非酒精性脂肪性肝病(NAFLD)患者肝纤维化指标与T1WI同/反相位测定肝内脂肪含量的关系。 方法选取2017年6～8月非酒精性脂肪性肝病者120例,根据肝纤维化评分(NFS)将患者分为NFS<－1.455亚组(n＝35, A组),－1.455≤NFS≤0.676亚组(n＝41, B组)及NFS>0.676亚组(n＝44, C组)。选择同期体检的年龄、性别、地域相匹配的健康人群50例为对照组,使用SPSS 19.0软件包对数据进行统计分析,肝纤维化指标和肝脏脂肪相对含量用( ±s)表示,两两比较采用t检验,多组间比较采用方差分析及Spearman相关分析。P<0.05表示差异有统计学意义。 结果C组随着血清肝纤维化指标CK18、YKL40、APRI、GPRI的升高,肝内脂肪含量减低,呈负相关关系(r＝－0.850、－0.584、－0.784、－0.684, P< 0.05),A组及B组未发现相关关系(P>0.05)。 结论非酒精性脂肪性肝炎有肝纤维化趋势,肝内脂肪含量与肝纤维化的进展密切相关。     

Predicting risk of erectile dysfunction in patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is one of the risk factors for erectile dysfunction (ED). We aimed to predict the risk of ED in patients with NAFLD. The study included 146 male patients complaining impotence admitted to the urology outpatient clinic aged 24–80 years without a history of alcohol use who underwent abdominal ultrasonography between February 2018 and January 2019. 106 patients with NAFLD and 40 men without NAFLD were included in the study. Clinical and laboratory parameters, ED status according to International Index of Erectile Function-5 were compared between patients with and without NAFLD. The mean age of patients was 51.47 ± 10.34 years. NAFLD was detected in 72.6% of the patients. No statistically significant difference was found regarding mean age, BMI, IIEF-5 scores, DM status, serum glucose levels (p > .05). Fasting insulin levels, hypertension (HT), insulin resistance (IR) and ED status of the patients with NAFLD were significantly higher than patients without NAFLD (p < .05). NAFLD was found to be a significantly independent associated with ED. We also found that patients with NAFLD have risk of ED 2.92 times higher than without NAFLD (OR: 2.92). For the patients presenting with erectile dysfunction, hepatic steatosis should also be considered.     

非酒精性脂肪性肝病患者肝癌筛查的必要性及可行性

原发性肝癌的发病率和死亡率与日俱增,严重影响公众健康。其中慢性肝病,尤其是肝硬化,是导致肝癌的主要病因和危险因素。随着对病毒性肝炎的有效防治,以及肥胖、糖尿病等代谢综合征的发病率迅速增长,非酒精性脂肪性肝病已成为最常见的慢性肝病原因,因此对非酒精性脂肪性肝病患者进行肝癌筛查刻不容缓。现综述概括总结了非酒精性脂肪性肝病及...     

Increased microalbuminuria prevalence among patients with nonalcoholic fatty liver disease

Aim: To determine the prevalence of microalbuminuria, that is an indirect predictor of coronary artery disease, among non-obese and non-diabetic patients with fatty liver disease. Material and method: This retrospective study was carried out on non-obese (body mass index (BMI)?Results: The subjects were grouped according to the ultrasound findings as follows: 182 (37.9%) cases without any fat accumulation in liver were regarded as control group; and among remaining cases, 124 (25.8%) had mild, 93 (19.4%) had moderate, and 80 (16.7%) had severe fatty liver disease. There was not any statistically significant difference between groups in regards to the age, gender, liver function tests, renal function tests or glomerular filtration rate. However urinary protein/creatinine ratio was statistically significantly higher in severe nonalcoholic fatty liver disease (NAFLD) group than the other three groups. In moderate and severe NAFLD groups, microalbuminuria was statistically significantly more common compared with the control and mild NAFLD groups. Regarding the results of multiple logistic regression analysis, presence of fatty liver disease increased the risk of microalbuminuria for 1.87 times independently from increased BMI and increased HOMA-IR values. Conclusion: We have determined that microalbuminuria is more prevalent among NAFLD cases compared with control cases and microalbuminuria prevalence was increasing with the advanced stages of NAFLD although two main etiologic factors of microalbuminuria, type 2 diabetes, and obesity were excluded.     

Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Background

Controlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored.

Nonalcoholic fatty liver disease and diabetes

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic progression. The key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and efflux. Strong epidemiological, biochemical, and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance; thus the association between diabetes and NAFLD is widely recognized in the literature. Since NAFLD is the hepatic manifestation of a metabolic disease, it is also associated with a higher cardio-vascular risk. Conventional B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis, although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these patients. Treatment of NAFLD patients depends on the disease severity, ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic steatohepatitis. Abstinence from alcohol, a Mediterranean diet, and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events, as per all diabetic patients. In addition, weight loss induced by bariatric surgery seems to also be effective in improving liver features, together with the benefits for diabetes control or resolution, dyslipidemia, and hypertension. Finally, liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western countries. This review offers a comprehensive multidisciplinary approach to NAFLD, highlighting its connection with diabetes.     

Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery

The risk factors for nonalcoholic fatty liver disease in patients undergoing bariatric surgery are under study. We wanted to determine the correlation between nonalcoholic fatty liver disease and patient factors such as obesity and liver function tests. A retrospective analysis was performed on 177 nonalcoholic morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass with liver biopsy, to identify risk factors for nonalcoholic fatty liver disease. The histologic grade of liver disease was compared with preoperative body mass index, age, and liver function tests. Simple steatosis and steatohepatitis were present in 90% and 42% of patients, respectively. Elevated transaminaselevels were an independent risk for liver disease. Body mass index and liver disease were not correlated with univariate analysis. Regression analysis performed on age, body mass index, and liver disease demonstrated that the risk for liver disease increased with body mass index in the younger (<35 years old) age group and decreased with body mass index in the older (<45 years old) age group. There was a high incidence of steatosis and steatohepatitis in these nonalcoholic bariatric patients, and elevated transaminase level was indicative of disease. Body mass index was a positive risk factor for liver disease in younger patients but a negative risk factor in the older patients. Presented at the Forty-Fifth Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (poster presentation).     

剪切波弹性成像技术评估非酒精性脂肪性肝病研究进展

近年来,非酒精性脂肪性肝病(NAFLD)的患病率在我国日益升高,已成为仅次于乙型病毒性肝炎的第2大慢性肝病。弹性成像技术已广泛用于诊断乳腺、甲状腺、前列腺等部位病变,在诊断肝纤维化等方面也得到应用。本文针对三种不同剪切波弹性成像技术评估NAFLD进展程度的研究现状进行综述。     

非酒精性脂肪肝患者血清视黄醇结合蛋白4的变化及意义

目的研究非酒精性脂肪肝患者血清视黄醇结合蛋白4（RBP4）的变化及其与胰岛素抵抗（IR）的关系。方法采用ELISA法测定26例健康对照者及34例非酒精性脂肪肝患者血清RBP4水平。结果非酒精性脂肪肝患者血清RBP4水平[（25．6±11．2）mg／L]较健康对照者[（18．5±9．7）mg／L]明显升高,差异有统计学意义（P〈0．01）。相关分析显示RBP4与腰围、腰臀比、体重指数、总胆固醇、三酰甘油、空腹血糖、空腹血清胰岛素、稳态模型评估法胰岛素抵抗指数（HOMA-IR）有显著相关性（r=0．457、0．361、0．387、0．259、0．366、0．342、0．338、0．379,P〈0．01）。结论非酒精性脂肪肝患者血清RBP4水平升高,且与HOMA—IR呈正相关,提示RBP4在IR的发展中可能起一定的作用。     

Carotenoids and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a growing health problem around the world, especially in developed countries. NAFLD includes all cases of fatty liver disease from simple steatosis to cirrhosis, without excessive alcohol intake, use of steatogenic medication or hereditary disorders. Pathogenesis is associated with dietary high fat intake, decreased free fatty acid (FFA) oxidation, increased hepatic lipogenesis and lipolysis from the adipose tissue. These metabolic alterations contribute to the hepatic fat accumulation. Consequently, stimulated oxidative stress and inflammation play a major role in hepatocellular damage. Therefore, antioxidant and anti-inflammatory agents may have a role in the prevention of this disease. Carotenoids are potent antioxidant and anti-inflammatory micronutrients, which have been investigated in the prevention and treatment of NAFLD. The main sources of the carotenoids are fruits and vegetables. In this article we review the potential role and possible molecular mechanism of carotenoids in NAFLD.     

幽门螺杆菌感染与非酒精性脂肪肝的相关性

目的探讨幽门螺杆菌（Hp）现症感染与非酒精性脂肪肝（NAFLD）的相关性。 方法采用横断面调查研究方法,分析2014年4月至2014年7月于山西省人民医院体检中心进行健康体检者中体检数据完整、行¹³C-尿素呼气试验检测Hp及腹部超声检查的受试者3 447例。依据腹部超声检查结果分为非脂肪肝组2 093例,NAFLD组1 354例。应用非条件Logistic回归分析NAFLD患病率与Hp感染及代谢综合征相关组分间的关系。 结果体质量指数（BMI）、甘油三酯（TG）和血尿酸（UA）水平在男性及女性体检者中均为NAFLD患病的危险因素,男性体检者中舒张压、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）为NAFLD危险因素;女性体检者中,高密度脂蛋白胆固醇（HDL-C）为NAFLD保护因素。NAFLD患病率与总胆固醇（TC）水平及Hp感染关联无显著性。 结论NAFLD患病率可能与BMI、TG、UA、LDL-C、FPG和HDL-C水平存在相关性,而与TC水平及Hp感染的相关性不显著。     

The effect of a low-carbohydrate diet on the nonalcoholic fatty liver in morbidly obese patients before bariatric surgery

Background Bariatric surgery may be complicated by enlargement of the liver, especially of the left lobe, caused by nonalcoholic fatty liver disease often present with morbid obesity. Methods The effect of a very low carbohydrate diet for 4 weeks before surgery on liver density and volume was assessed in 14 candidates for bariatric surgery. Computed tomography (CT) scans were performed before and at termination of the diet period. Results The CT scans clearly showed a significant increase in mean liver density (p = 0.06) and a decrease in mean liver volume (p = 0.01). The increased mean density of the left lobe was markedly greater than that of the right lobe. Conclusions The findings show that 4 weeks of a very low carbohydrate diet reduces liver fat content and liver size, particularly of the left lobe. This approach may render bariatric surgery or any foregut operations less difficult in morbidly obese patients and may be a useful treatment for nonalcoholic fatty liver disease.