二甲双胍治疗非酒精性脂肪肝

非酒精性脂肪肝是一种与肝脏的胰岛素抵抗有关的潜在性、进行性肝脏疾病,目前没有确切的治疗方法。对体重过高的患者只有节食有效。二甲双胍(Metformin)可改善肝脏胰岛素     

非酒精性脂肪肝炎的临床研究进展

胖人可有脂肪肝。多年以前就发现脂肪肝中有炎症、纤维化现象。曾用过多种病名:脂肪肝肝炎、非酒精性脂肪坏死、糖尿病肝炎、非酒精性脂肪肝病、非嗜酒者酒精样肝炎等。1980年由Ludwig等创用非酒精性脂肪肝炎(NASH)这一病名,其定义为:非嗜酒者发生的慢性肝炎。组织学改变与酒精性肝病相似:脂肪变,肝细胞损害,炎症细胞浸润,不同程度的纤维化。没有肝炎病毒感染[1,2 ] 。由于肥胖已成为一个世界性的公共卫生问题,对肥胖发生非酒精性脂肪肝病(NAFLD)和NASH的认识已提到肝病学的议事日程中。国内已颁布了非酒精性脂肪肝的诊断标准。因NAS…     

凯西莱治疗非酒精性脂肪肝146例疗效观察

目的　评价凯西莱对非酒精性脂肪肝的疗效。方法　凯西莱 0 .2静滴 ,每日 1次 ,共 6周 ,后改为口服0 .2 ,每日 3次 ,共 6周 ;并以强力宁治疗作为对照。结果　治疗组 14 6例中 ,有效率为 95 .2 % ( 13 9/14 6) ,对照组为 88.0 %( 4 4/5 0 ) ,两组经统计学秩和检验 (P <0 .0 5 ) ,有显者性差异。结论　凯西莱治疗非酒精性脂肪肝具有良好效果 ,值得临床应用。     

非酒精性脂肪肝的药物治疗进展

非酒精性脂肪肝作为肝硬化和终末期肝病的病因之一，在临床上日益受到重视。它是一种以肝细胞脂肪变性和脂肪储积为病理特征，病变主体在肝小叶，无过量饮酒史的一种临床综合征。在病理上分为三种类型;单纯性脂肪肝；脂肪性肝炎；脂肪性肝硬化。本病发生的危险因素分别是;年龄45岁以上、体重指数≥26、2型糖尿病及AST／ALT比值〈1。虽然非酒精性脂肪肝的发病机制尚未完全明了，但肝脏脂质代谢障碍、胰岛素抵抗、细胞因子作用、肝细胞色素P4502E1（cYP2E1）和CYP4A表达增加、氧应激和脂质过氧化、免疫反应、遗传因素等多种相关因素均参与了发病。近来有提出以氧应激和脂质过氧化为中心的“二次打击”学说，即一次打击诱发脂肪变性，在应激产生的细胞因子、原有致病因素持续存在、肝星状细胞活化等作用下发生“二次打击”，导致肝脏发生炎症、坏死、纤维化、细胞凋亡等。非酒精性脂肪肝至今尚无完全有效的药物治疗，基础治疗主要是控制饮食和减轻体重。Eriksson等报告3例超重50％～60％的非酒精性脂肪肝炎患者，     

甘枣宁颗粒治疗非酒精性脂肪肝临床疗效及安全性分析

目的 探讨甘枣宁颗粒治疗非酒精性脂肪肝患者的临床疗效及安全性。方法 2015年10月~2016年10月收治的300例非酒精性脂肪肝患者,采取随机数字表法将其分成两组,每组150例。两组患者均接受脂肪肝中医预防保健服务包指导干预,给药组在此基础上给予甘枣宁颗粒治疗,比较两组治疗前后中医证候积分、生化指标、临床疗效及不良反应发生情况。结果 在3个月治疗末,给药组总有效率为93.3%,显著高于对照组为61.3%（P<0.01）;给药组中医证候积分（9.3±2.1）显著低于对照组【（12.8±3.6）,P<0.01】;给药组血清ALT、AST、TC、TG水平分别为（38.1±12.4） U/L、（36.4±9.6） U/L、（2.1±0.4） mmol/L、（5.2±1.4） mmol/L,均显著低于对照组[分别为（54.2±9.3） U/L、（50.±11.2） U/L、（2.7±0.4） mmol/L、（6.5±1.2） mmol/L,P<0.01]。结论 甘枣宁颗粒联合脂肪肝中医预防保健服务包治疗非酒精性脂肪肝患者有较好的临床疗效。     

易善复治疗酒精性脂肪肝的临床研究

目的观察易善复治疗酒精性脂肪肝的临床疗效。方法52例酒精性脂肪肝患者被随机分为治疗组和对照组。对照组应用甘利欣注射液150mg／日，治疗组用易善复注射液465mg／日，疗程均为4周。结果患者接受易善复治疗4周后临床症状明显改善，与对照组比，差异显著（P〈0．01）；治疗组肝功能与对照组比较，改善更明显，差异有显著性（P〈0．01或0．05）。结论易善复能改善酒精性脂肪肝患者的临床症状、肝功能，疗效优于甘利欣。     

针药结合治疗非酒精性脂肪肝的临床研究

目的：探讨针药结合治疗非酒精性脂肪肝的疗效和作用机制。方法：随机选择40例非酒精性脂肪肝患者作为针药结合治疗组，同时设立对照组30例，给予口服胆维他25mg/次，3次／d，维生素C10mg／次，3次／d。疗程均为2个月，观察患者症状、体重指数、腰臀比和肝功能、血脂指标的变化。结果：治疗组总有效率90．0％，对照组总有效率76．7％，两组相比差异有显著性意义（P〈0．05）。治疗后两组症状、体重指数、腰臀比和肝功能、血脂指标比较有显著性差异（P〈0．05）。结论：针药结合治疗非酒精性脂肪肝具有较好的疗效，有一定的临床应用价值。     

非酒精性脂肪肝的治疗

非酒精性脂肪肝 (ＮＡＦＬ)是一种可以发展至终末期肝病的临床疾病 ,但相当一部分病人病情相对较轻且较稳定。ＮＡＦＬ治疗目的是阻止疾病进一步发展。ＮＡＦＬ的发病机制尚不十分清楚 ,因此治疗仍需靠经验。治疗的关键在于治疗肥胖、糖尿病、高脂血症及停用已知可引发ＮＡＦＬ的肝毒性药物。一、相关疾病的治疗(一 )代谢及遗传状况　大量临床及流行病学资料显示 ,肥胖及 2型 (非胰岛素依赖型 )糖尿病是ＮＡＦＬ最主要的伴发疾病 ,也是发展为ＮＡＦＬ的危险因素 ,对其预防及适当处理显然可以改善或阻止疾病的发生。虽然减肥有其利弊 ,但减肥…     

依折麦布治疗非酒精性脂肪肝患者的疗效观察

目的 观察依折麦布治疗非酒精性脂肪肝患者的临床疗效。方法 选取2020年4月至2021年10月在九江市第三人医院诊治的56例非酒精性脂肪肝患者,随机分为试验组和对照组,试验组在对照组用药基础上加用依折麦布辅助强化调脂,连续治疗48周。比较两组患者治疗前后临床疗效、血清生化指标和肝脏硬度值的差异。结果 治疗48周后,试验组临床总有效率为92.85%(26/28),优于对照组的67.85%(19/28),差异有统计学意义(χ²=5.543,P=0.019)。治疗后试验组血清ALT、AST、γ-GT、TC、TG、LDL-C指标均低于对照组(P<0.05),试验组肝脏硬度值为(6.21±0.99)kPa,低于对照组的(6.79±1.05)kPa,差异有统计学意义(t=-2.109,P=0.040)。结论 依折麦布通过调控胆固醇代谢,可改善肝酶指标和肝脏纤维化程度,提高非酒精性脂肪肝患者的临床疗效。     

非酒精性脂肪肝病

第十二届世界消化病学会议于 2 0 0 2年 2月在泰国曼谷召开 ,这是继 1998年第十一届世界消化病学术会议(奥地利维也纳 )之后的又一次“奥林匹克式”的国际盛会 ,百余个国家的万余名医师出席了这次大会。会议内容广泛 ,涉及到多方面的新进展。《临床消化病杂志》曾相继及时报道了 1994年第十届及 1998年第十一届世界消化病学术大会的部分专题内容 ,受到广大读者欢迎。本期我们又组织华中科技大学同济医学院协和医院消化科医师整理了第十二届世界消化病学会大会上所涉及的近 4年来国际上在消化疾病某些领域中的最新进展 ,供同道们参考。     

Sampling variability of liver biopsy in nonalcoholic fatty liver disease

BACKGROUND & AIMS: In nonalcoholic fatty liver disease (NAFLD), the distinction between steatosis and steatohepatitis (NASH) and the assessment of the severity of the disease rely on liver histology alone. The aim of this study was to assess the sampling error of liver biopsy and its impact on the diagnosis and staging of NASH. METHODS: Fifty-one patients with NAFLD underwent percutaneous liver biopsy with 2 samples collected. The agreement between paired biopsy specimens was assessed by the percentage of discordant results and by the kappa reliability test. RESULTS: No features displayed high agreement; substantial agreement was only seen for steatosis grade; moderate agreement for hepatocyte ballooning and perisinusoidal fibrosis; fair agreement for Mallory bodies; acidophilic bodies and lobular inflammation displayed only slight agreement. Overall, the discordance rate for the presence of hepatocyte ballooning was 18%, and ballooning would have been missed in 24% of patients had only 1 biopsy been performed. The negative predictive value of a single biopsy for the diagnosis of NASH was at best 0.74. Discordance of 1 stage or more was 41%. Six of 17 patients with bridging fibrosis (35%) on 1 sample had only mild or no fibrosis on the other and therefore could have been under staged with only 1 biopsy. Intraobserver variability was systematically lower than sampling variability and therefore could not account for most of the sampling error. CONCLUSIONS: Histologic lesions of NASH are unevenly distributed throughout the liver parenchyma; therefore, sampling error of liver biopsy can result in substantial misdiagnosis and staging inaccuracies.     

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。     

弹性酶治疗高脂血症伴非酒精性脂肪肝的临床疗效及评估

观察弹性酶 (Elastase)治疗高脂血症伴非酒精性脂肪性肝病的临床疗效。高脂血症伴非酒精性脂肪性肝病治疗组 30例 ,口服弹性酶肠溶片 (30 0IU/片 ) ,2片 /次 ,3次 /日 ,6 0天为一疗程 ,安慰剂组 2 0例。通过测定肝功、血脂、肾功及B超随访。治疗组肝功能、血脂明显改善 ,优于对照组 (P <0 0 5 ) ,治疗组总有效率为 90 % ,明显优于对照组 10 % (P <0 0 5 )。弹性酶具有改善肝功能、降低血脂 ,防治高脂血症伴非酒精性脂肪性肝病的作用     

2型糖尿病肾病伴非酒精性脂肪肝患者的临床特征

目的:观察伴有非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的2型糖尿病肾病(T2DN)患者临床及肾脏病理特点。方法:收集355例肾活检诊断为T2DN患者的一般情况、血生化、尿检、肾脏病理等资料,并行彩色B超检查,以明确NAFLD病变患者,分析同时伴有NAFLD的T2DN患者临床以及肾脏病理特点。结果:62例T2DN患者同时伴有NAFLD(17.46%),与无脂肪肝患者相比有以下特点:(1)年龄相对较轻[(49.08±9.04)vs(53.85±9.61)岁,P0.01],糖尿病(DM)病程显著短于后者[(61±57.68)vs(277±72.40)月,P0.01];(2)BMI增高明显[(28.75±3.24)vs(24.9±3.48)kg/m2,P0.01],胰岛素抵抗指数更突出[(7.15±4.28)vs(5.17±4.39),P0.05),三酰甘油水平也显著升高[(3.52±4.03)vs(2.11±1.46)mmol/L,P0.01],而高密度脂蛋白水平明显低于后者(P0.01),胆固醇水平则无差异(P0.05);(3)血肌酐水平[(194.59±91.94)vs(191.83±181.22)μmol/L,P0.01],24h尿蛋白定量均低于后者[(2.21±3.44)vs(3.63±2.80)g/24h,P0.01],小分子蛋白尿比例较后者低[(7.67±13.39)vs(11.54±11.72)%,P0.05);(4)DM背景视网膜病变(17.20%vs64.90%)以及末梢神经病变(31.10%vs55.10%)均比后者少见(P0.01);(5)肾小球球性硬化比例、系膜增生程度、K-W结节比例及肾小管间质病变程度均低于后者(P0.01)。结论:伴有NAFLD的T2DN患者相对年青,DM病程相对短,存在明显的代谢紊乱、超重和胰岛素抵抗,其中三酰甘油升高、高密度脂蛋白降低与NAFLD密切相关;而肾脏等靶器官损害则相对较轻。因此,代谢异常在伴有NAFLD的T2DN患者更为突出,提示控制代谢异常对此类患者的意义更为重大。     

Treating nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is a chronic illness with multiple consequences. The spectrum of disease ranges from simple steatosis, with benign prognosis, to a potentially progressive form, nonalcoholic steatohepatitis, which may lead to liver fibrosis and cirrhosis, leading to an increase in morbidity and mortality. Furthermore, hepatocellular carcinoma incidence in NAFLD is comparable with that observed in hepatitis C-infected patients once cirrhosis is established. Current therapy is limited to lifestyle changes and control of associated metabolic disorders; however, new treatments are on the way from basic research to bedside. A review of the current literature on treatment of nonalcoholic fatty liver disease is presented in this article.     

Clinical predictive score for detecting nonalcoholic fatty liver disease with significant fibrosis in patients with metabolic syndrome

Patients with metabolic syndrome are at a higher risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis than the general population. Still, accessibility of screening method for NAFLD with significant fibrosis, such as transient elastography (FibroScan) are limited in some settings. This study aimed to develop a simple clinical predictive score for detecting NAFLD with significant fibrosis in patients with metabolic syndrome.A cross-sectional study was designed to obtain the data from medical records of all relevant patients who underwent transient elastography between January 2011 and December 2020 at Siriraj Hospital, Thailand. A liver stiffness cutoff value of 7.0 kilopascal was used to define the presence of significant liver fibrosis. To examine potential predictors, medical history and clinical data commonly assessed in routine practice were selected by following expert opinions and univariable statistical analysis. Backward and forward stepwise logistic regression was performed to acquire a final prediction model. To simplify the model, a weighted score was assigned for each categorized predictor. In addition, eligible cutoff values of the score and their predictive performances were determined.A total of 745 medical records were reviewed. The prevalence of NAFLD with significant fibrosis in patients with metabolic syndrome was 12.6%. Most clinical characteristics of patients with NAFLD with significant fibrosis and those non-NAFLD and NAFLD with no/mild fibrosis were quite disparate. The most practical model comprised globulin, aspartate transaminase, platelet count, and type 2 diabetes. It provided a good predictive performance with an area under the receiver operating characteristic curve of 0.828 (95% confidence interval [CI]: 0.782, 0.874). At the proper cutoff value, sensitivity and specificity were 76.6% (95% CI: 66.7%, 84.7%) and 72.4% (95% CI: 68.7%, 75.8%), respectively. The likelihood ratio of testing positive for NAFLD with significant fibrosis was 2.8 (95% CI: 2.34, 3.27) among patients with scores above the cutoff value.The first score for detecting of NAFLD with significant fibrosis in patients with metabolic syndrome was developed. This practical score, providing a good predictive performance, should be useful to help clinicians prioritize needs for further investigations among high-risk patients, especially in resource-limited settings.     

Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease.

BACKGROUND AND AIM: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes. AIM: To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver. METHODS: We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT-PCR in 26 frozen liver samples and the ratio CB2/beta-actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann-Whitney U-test. We considered as significant differences those with a P-value <0.05. RESULTS: Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti-CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/beta-actin ratio of 0.001+/-0.01, steatosis 6.52+/-17.3 (P=0.05 vs normal) and NASH 6.49+/-12.2 (P=0.06 vs normal and P=0.6 vs steatosis). CONCLUSION: CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.