2型糖尿病患者血尿酸水平与非酒精性脂肪肝的相关性研究

回顾性分析1 007例住院2型糖尿病患者,分为伴和不伴非酒精性脂肪肝(NAFLD)2组,收集患者临床及生化资料.结果表明,血尿酸与血糖呈负相关,与体重指数及肾功能呈正相关(P＜0.01),伴NAFLD组年龄较低、2型糖尿病病程均短,血清尿酸升高,尿酸清除率降低;随血尿酸水平升高,发生NAFLD的风险增大.     

健康体检人群血尿酸与非酒精性脂肪肝的相关性研究

目的 观察非酒精性脂肪性肝病(NAFLD)在不同血尿酸水平人群中的分布,以探讨血尿酸与NAFLD的相关性.方法 以本院体检中心5 230名健康体检者为研究对象,测量其身高、体重、血压,空腹取血行肝肾功能、血脂、血糖、肝炎相关指标检查,同时行心电图、腹部超声、胸部X线等检查.NAFLD诊断依据2006年中华肝脏病学会和酒精性肝病学组所规定的NAFLD诊断标准.结果 除高血糖人群外,随血尿酸水平增高,男性和女性超重或肥胖、高血压、血脂异常以及代谢综合征(MS)检出率均逐步升高(P＜0.05或P＜0.01).除男性MS人群外,无论有无超重或肥胖、高血糖、高血压、血脂紊乱,NAFLD检出率均随血尿酸增高明显升高,尤其当血尿酸＞333 μmol/L(男)或＞233 μmol/L(女)时(P＜0.05或P＜0.01),但女性高血糖和血脂紊乱人群,最低尿酸水平组人群NAFLD的检出率亦较高(P＜0.05).对无任何MS相关组分的人群研究发现,在相同血尿酸水平下,男性NAFLD检出率明显高于女性(P＜0.01),女性NAFLD检出率在血尿酸＞233 μmol/L时迅速升高(P＜0.01);无论男女NAFLD检出率均随血尿酸增高而增高(P＜0.05);logistic回归分析显示,性别、体重指数、血糖、甘油三酯、低密度脂蛋白胆固醇、尿酸分级是NAFLD的高危因素,OR值分别为2.500、1.344、1.292、1.279、1.244和1.256.结论 高尿酸血症是NAFLD的高危因素,与NAFLD的发病密切相关.

Abstract：

Objective To evaluate the relationship between hyperuricemia and nonalcoholic fatty liver disease(NAFLD) by observing the prevalence of NAFLD among healthy individuals with different levels of serum uric acid.Methods The data of 5 230 persons from medical centers for health examination were analyzed,such as height,weight,blood pressure,blood lipids,blood sugar, hepatitis-related markers, and abdominal color Doppler ultrasound examination were conducted in the fasting state.The diagnosis of NAFLD was made according to the diagnostic criteria adopted by China Institute of Liver Disease and Alcoholic Liver Disease Group.Results The incidences of overweight or obesity, hypertension,hyperlipidemia, and metabolic syndrome were raised with serum uric acid greater than 333 μmol/L in male and＞233 μmol/L in female subjects(P＜0.05 or P＜0.01). Excluding the metabolic syndrome in male subjects, the incidence of NAFLD was increased with serum uric acid,＞333 μmol/L in males or ＞233 μmol/L in females(P＜0.05 or P＜0.01). In further studies with subjects without any metabolic syndrome, the detection rate of NAFLD was higher in males than in females at the same serum uric acid level(P＜0.01). Logistic regression analysis showed that sex, body mass index, blood glucose, and triglyceride, low-density lipoprotein cholesterol, uric acid grading were risk factors of NAFLD(OR 1.344, 2.500, 1.292, 1.279, 1.244, 1.256 respectively).Conclusion A high serum uric acid level is associated with an increased risk of NAFLD.     

钙离子与非酒精性脂肪肝

非酒精性脂肪肝的概念1980年被Schaffner首次提出,因其可发展至肝硬化,甚至肝癌,故引起越来越多的关注及研究。目前其发病机制不明确。钙离子在机体中起着重要的作用,已经证实钙离子浓度升高与很多疾病有关。钙离子可能参与此病的发生及发展。本文就钙离子与非酒精性脂肪肝发病     

血尿酸与非酒精性脂肪肝相关性meta分析

[目的]全面系统地分析总结目前已发表的血尿酸(serum uric acid, SUA)与非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)相关性研究,以评估高SUA水平人群患NAFLD的风险。[方法]全面回顾了PubMed、Cochrane图书馆、中国知网、万方等数据库截至到2020年6月关于SUA水平与NAFLD患病相关性文章,提取数据信息行meta分析。[结果]共纳入33篇文章。[结论]在高SUA水平人群中患NAFLD的风险较低SUA水平人群显著增高,且女性和BMI25人群可能更易受SUA水平的影响;定量分析提示SUA水平每升高1 mg/dl(1 mg/dl=59.5μmol/L),NAFLD患病风险提高26%,但由于剪补法前后结果存在一定差异,因此需谨慎应用此结论。     

非酒精性脂肪肝与生长激素相关性研究

目的 探讨非酒精性脂肪肝（NAFLD）与生长激素（GH）的关系。方法入选NAFLD组38例,非NAFLD组42例．测定GH、腰围（Wc）、空腹血糖（FPG）、空腹胰岛素（Fins）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、高敏c反应蛋白（hs—CRP）,谷氨酸氨基转移酶（AIJrr）、γ-谷氨酰转肽酶（GGT）水平,计算体质量指数（BMI）、胰岛素抵抗指数（HOMA—IR）。结果NAFLD组GH、HDL—C水平显著低于非NAFLD组（P〈0．05）;NAFLD组BMI、WC、FPG、Fins、HOMA—IR、TG、hsCRP、AIJT、GGT水平显著高于非NAFLD组（P〈0．05）。GH、HDL—C与NAFLD呈负相关,WC、BMI、FPG、Fins、HOMA—IR、TG、hsCRP、ALT、GGT与NAFLD呈正相关。结论GH与NAFLD密切相关,低水平CH可能是NAFLD危险因素,与肥胖、胰岛素抵抗、血脂紊乱等共同参与了NAFLD的发生与发展。     

姜黄素对非酒精性脂肪肝细胞模型铁负荷的影响

目的 探讨姜黄素与铁负荷在治疗非酒精性脂肪肝病(NAFLD)方面的作用。方法 1 mmol/L游离脂肪酸构建NAFLD大鼠肝细胞模型,油红O染色鉴定造模成功与否;利用不同浓度的姜黄素处理细胞,酶联免疫吸附试验(ELISA)检测铁蛋白的含量,筛选姜黄素的最佳作用浓度;将细胞分成5组：正常组、模型组、姜黄素组、Fe²⁺组、姜黄素+Fe²⁺组;CCK-8检测细胞存活率,磷酸甘油氧化酶法检测三酰甘油(TG)的含量,qPCR检测铁调素(Hepcidin)和膜铁转运蛋白(Fpn)-1 mRNA的表达量,Western印迹检测Hepcidin和Fpn-1的蛋白表达水平。结果 姜黄素的最佳作用浓度为25μmol/L;与正常组相比,模型组的细胞存活率、Hepcidin mRNA和蛋白表达水平显著降低(P<0.05),TG含量、Fpn-1 mRNA和蛋白表达水平显著升高(P<0.05);与模型组相比,姜黄素组细胞存活率、Hepcidin蛋白表达水平显著升高(P<0.05),TG含量、Fpn-1 mRNA和蛋白表达水平显著降低(P<0.05...     

非酒精性脂肪肝研究进展

非酒精性脂肪肝 (Nonalcoholicfattyliverdisease ,NAFLD)是一种越来越引起人们注意的临床疾病 ,它最终可发展为肝硬化 ,其病理学改变类似酒精性肝病 ,但发生于无嗜酒的患者。过去对这一疾病有多种名称 ,如非酒精性肝炎、糖尿病肝炎等 ,现在统一用非酒精性脂肪肝这一名称 ,包括一系列肝损伤 ,如单纯脂肪变性、脂肪性肝炎、进展性肝纤维化、肝硬化等。NAFLD在人群中发病率较高并有潜在危险性。本文就NAFLD近来的研究进展 ,综述如下。1　危险因素肥胖症、2型糖尿病、高脂血症被认为是NAFLD的重要危险因素。据报道约 30 %～ 10 0 %的…     

脂肪因子与非酒精性脂肪肝

非酒精性脂肪性肝病的发病机制目前尚不十分清楚,脂代谢异常(尤其是TG)与胰岛素抵抗(IR)可能是其病因的关键环节,瘦素、脂联素、抵抗素、肿瘤坏死因子等多种脂肪因子在非酒精性脂肪肝的形成、炎性改变及纤维化的过程中发挥了重要作用.     

脂肪组织瘦素基因与非酒精性脂肪肝的研究

目的探讨非酒精性脂肪肝(NAFLD)患者脂肪组织瘦素mRNA基因表达水平和胰岛素抵抗与血浆瘦素等的相关性。方法行熳性胆囊炎、胃溃疡、腹股沟疝等择期手术的NAFLD患者21例、对照组患者24例,于术中取少许腹部皮下和网膜脂肪组织送检。应用SYBR Green I实时定量逆转录聚台酶链反应法检测瘦素mRNA的表达水平,用稳态模型法计算胰岛素抵抗指数,用酶联免疫吸附法测定血浆瘦素和胰岛素水平。结果NAFLD和对照组瘦素基因表达值分别为1．32±0．12、0．99±0．05,1．10±0．09、0．87±0．13；瘦素基因表达和胰岛素抵抗指数与血浆瘦素浓度直接关联(r值分别为0．72、0．69,P值均＜0．05)。结论脂肪组织瘦素基因高表达是高瘦素血症的主要原因,肥胖和非肥胖的NAFLD患者存在瘦素抵抗和胰岛素抵抗,提示瘦素抵抗与胰岛素抵抗一样和NAFLD发病密切相关。     

血清胆红素水平与非酒精性脂肪性肝病的关系研究

目的探讨血清胆红素水平与非酒精性脂肪性肝病(NAFLD)的关系。方法以2013年1月-2013年6月在新疆医科大学第五附属医院进行健康体检者为研究对象,从中筛查出NAFLD患者462例,按年龄、性别配对的方法选取健康对照者462例,测量两组身高、体质量、血压、总胆红素、直接胆红素、间接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、空腹血糖、尿酸等指标,t检验比较两组上述指标差异,多因素Logistic回归分析NAFLD患病影响因素。结果与对照组相比,NAFLD组体质量指数、收缩压、舒张压、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、空腹血糖和尿酸水平明显升高(P0.01),总胆红素、直接胆红素、间接胆红素水平明显降低(P0.01);随着体质量指数(OR=1.363,P0.01)、舒张压(OR=1.040,P0.01)、丙氨酸转氨酶(OR=1.038,P0.01)、三酰甘油(OR=1.399,P0.01)、空腹血糖(OR=1.865,P0.01)和尿酸(OR=1.006,P0.01)水平上升,NAFLD发生的风险增加;随着总胆红素水平升高,NAFLD的发生风险降低(OR=0.897,P0.01)。结论血清胆红素与NAFLD的发生密切相关,血清胆红素水平下降将导致NAFLD发生的风险增加。     

非酒精性脂肪性肝病与代谢综合征的相关性研究

目的分析非酒精性脂肪性肝病（NAFLD）与代谢综合征（MS）的关系。方法10357例在我院体检的普通人群入选本研究,检测人体学参数、生化指标及肝脏彩超,分析该人群NAFLD和MS的患病率,探讨MS组分与NAFLD的关系。结果10357例体检者中NAFLD的患病率为31．1％,MS患病率为23．6％,NAFLD合并MS患病率为15．5％。经年龄标化后NAFLD和MS患病率男性仍明显高于女性。将全部受试者按BM1分组后,各组间NAFLD、MS及NAFLD合并MS患病率差异均有统计学意义（P〈0．01）。选择同期体检无NAFLD的个体（非NAFLD组）,经性别、年龄、BMI与NAFLD组相匹配后,NAFLD组MS患病率明显高于非NAFLD组（59．8％VS5．2％,P〈0．01）。多因素Logistic回归分析表明：NAFI。D危险因素的前五位为TG、BMI、FPG、LDL-C和吸烟。结论即使排除BMI因素的影响,NAFLD患者MS的患病率仍然明显增高。NAFLD危险因素由高到低依次为TG、BMI、FPG、LDL-C、吸烟、TC、性别、血压、SUA及ALT。HDL-C为NAFLD保护性因素。     

老年人非酒精性脂肪肝病与代谢综合征的相关研究

目的调查老年体检人员非酒精性脂肪肝病（NAFLD）和代谢综合征（MS）及其相关疾病的情况。方法从参与本院体检的405名60岁及以上的老年人中选取313例（男224例,女89例）,平均76．08±7．53岁,检测身高、体重、腰围、体质指数（BMI）、空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白及多普勒超声,并对结果分析。结果老年男、女性MS患病率分别为14．3％和20．2％,男、女NAFLD患病率为40．2％、36．0％。在MS各种组合中,男、女性均以肥胖、高血压、高血脂组合比例最高,占40％以上,NAFLD患病率在肥胖、高血压、高血脂、血糖异常组合中高达100％。NAFLD病人中的脑梗死、糖尿病、高血压比例较高,NAFLD病人的空腹血糖、甘油三酯、BMI、腰围也、显著高于非NAFLD,但血清胆固醇差异无统计学意义。NAFLD和MS相关（r=0．374,P〉0．01）。结论60岁及以上老年人的NAFLD和MS患病率均较高,NAFLD作为MS的一个组成部分应及早干预治疗。     

Correlation between Fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIMTo explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODSThis study was conducted on NAFLD/NASH patients (n = 73) who underwent Fibroscan examinations at Saint George Hospital University Medical Center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase (AST)/alanine transaminase (ALT) ratio, AST platelet ratio index (APRI) score and Fibrosis-4 score.RESULTSA significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSIONThis study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.     

中老年人血尿酸水平与非酒精性脂肪性肝病的相关性研究

目的:研究中老年人群血尿酸水平与非酒精性脂肪性肝病(NAFLD)的相关性。方法 :采取整群抽样方法,对上海市嘉定社区2 519名40岁以上常住居民进行问卷调查、体格检查,同时采血进行血尿酸、血糖、血脂、肝功能、肾功能检测,以及上腹部彩色多普勒超声检查。NAFLD的诊断依据高分辨率超声扫描结果。按照血尿酸水平四分位数将研究人群分为Q1、Q2、Q3、Q4四组,并对其各项代谢指标进行分析。结果:NAFLD组的血尿酸水平显著高于非NAFLD组[(319.6±92.3)比(272.8±88.8)μmol/L,P<0.05)。结论:上海城镇中老年人群NAFLD患病风险随着血尿酸水平升高而增加。     

血清铁、铁蛋白和脂肪肝关系的研究

目的　研究血清铁、血清铁蛋白与酒精性、非酒精性脂肪肝的关系。方法　采用 1秒钟快速肝穿刺 ,对 97例脂肪肝患者取肝组织标本 ,行HE和铁染色 ,分别用原子吸收光谱法和放射免疫法检测患者的血清铁和血清铁蛋白。结果　中重度酒精性脂肪肝 (AFL)血清铁、血清铁蛋白测定值 [(2 0 .9± 9.3) μmol/L ,(2 17.6± 71.8)ng/ml;(2 9.1± 6 .5 ) μmol/L ,(2 84 .7± 77.9)ng/ml]与对照组 [(10 .5± 5 .7) μmol/L ,(14 3.3± 71.9)ng/ml]比较明显升高 (P <0 .0 1)。重度非酒精性脂肪肝 (NAFL)的血清铁和血清铁蛋白 [(2 1.5± 11.1) μmol/L ,(199.3±72 .1)ng/ml]和对照组 [(10 .5± 5 .7) μmol/L ,(14 3.3± 71.9)ng/ml]比较亦显著升高 (P <0 .0 1) ,而且AFL多出现肝细胞灶性坏死 (6 7% )和肝铁过载(87% )。结论　重度NAFL及中重度AFL多出现血清铁和铁蛋白增高 ,AFL多合并肝铁过载 ,血清铁、铁蛋白可以作为肝铁过载的重要指标。     

Glycosyltransferases and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD) is the most common form of chronic liver disease and its incidence is increasing worldwide. However, the underlying mechanisms leading to the development of NAFLD are still not fully understood. Glycosyltransferases(GTs) are a diverse class of enzymes involved in catalyzing the transfer of one or multiple sugar residues to a wide range of acceptor molecules. GTs mediate a wide range of functions from structure and storage to signaling, and play a key role in many fundamental biological processes. Therefore, it is anticipated that GTs have a role in the pathogenesis of NAFLD. In this article, we present an overview of the basic information on NAFLD, particularly GTs and glycosylation modification of certain molecules and their association with NAFLD pathogenesis. In addition, the effects and mechanisms of some GTs in the development of NAFLD are summarized.     

Association between serum α-L-fucosidase and non-alcoholic fatty liver disease: Cross-sectional study

AIM: To explore the association between serum α-Lfucosidase(Af U) and non-alcoholic fatty liver disease(NAf LD).METHODS: A total of 16473 individuals(9456 men and 7017 women) were included in the current study, who presented for a health examination at the first Affiliated hospital of Zhejiang University School of medicine in 2014. The baseline characteristics of the cohort were compared by NAf LD status. Linear regression analysis and stepwise multiple regression analysis were applied to assess the risk factors for NAf LD. Receiver operating characteristic curve was used to determine the sensitivity and specificity of Af U in the diagnosis of NAf LD.RESULTS: The prevalence rates of NAf LD and metabolic syndrome(met S) were 38.0% and 25.4%, respectively. The NAf LD group had significantly higher Af U levels than the non-NAf LD group(28.7 ± 7.9 U/L vs 26.0 ± 7.3 U/L, P 0.001) and the prevalence rate of NAf LD increased with progressively higher serum Af U levels. Af U was positively correlated with met S and its five components: central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and elevated blood pressure and fasting glucose. Stepwise multiple logistic regression analysis showed that Af U was associated with an increased risk of NAf LD(OR = 1.009, 95%CI: 1.003-1.014, P 0.001). The best cut-off value of Af U for the diagnosis of NAf LD was 27.5 U/L. The area under the curve(diagnostic efficacy index) was 0.606. The sensitivity and specificity were 54.6% and 61.8%, respectively. CONCLUSION: Af U level is significantly associated with NAf LD, and elevated Af U level is an independent risk factor for NAf LD.     

肥胖人群血清尿酸水平与非酒精性脂肪性肝病严重程度的相关性分析

目的探究肥胖患者高尿酸血症发生的危险因素以及血清尿酸水平与非酒精性脂肪性肝病（NAFLD）严重程度的相关性。 方法回顾性分析2018年7月至2020年9月在南京鼓楼医院减重代谢中心拟行减重代谢手术的247例肥胖患者,收集患者术前临床资料及血清学数据及肝脏NAS评分。 结果221例患者进入肥胖患者高尿酸血症的危险因素分析,低尿酸组57（25.8%）人,高尿酸组164（74.2%）人,二组在性别、体质量指数（BMI）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γ-GT）、总胆红素（TBil）、甘油三酯（TG）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）、胰岛素（INS）、C肽（C-peptide）水平存在差异。141例患者拥有完善的病理学结果,其中40例可排除非酒精性脂肪性肝炎（NASH）,68例NASH可能,33例可诊断为NASH,三组高尿酸血症发生率分为别78.7%、76.5%、47.5%;多因素logistic回归分析提示三组在小叶内炎症、气球样变、ALT、UA水平存在差异（P<0.05）;而进一步研究发现血清尿酸水平与肝脏脂肪变性程度正相关（Spearman分析相关系数r=0.38,P<0.05）,而与气球样变及小叶内炎症无明显相关性（血清尿酸与气球样变：Spearman分析相关系数r=0.14,P=0.096;血清尿酸与炎症反应：Spearman分析相关系数r=0.058,P=0.493）。 结论随着肥胖患者BMI的增高,发生高尿酸血症以及非酒精性脂肪性肝炎的可能性增高;血清尿酸的增高也会促进肥胖患者非酒精性脂肪性肝病的发展,且血清尿酸水平与肝脏脂肪变性严重程度具有相关性。