中重度阻塞性睡眠呼吸暂停综合征与非酒精性脂肪性肝病相关性研究

目的 :探究中重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnoea syndrome,OSAS)与非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)关系及脂肪肝指数(fatty liver index,FLI)在OSAS患者诊断中有无脂肪肝的准确性。方法:347例入组患者行多导睡眠监测(polysomnography,PSG),采集患者的血样本行实验室检测,并行腹部超声检查,根据生化指标计算患者FLI,选取FLI在预测NAFLD中的最佳截点值。结果:与非脂肪肝组相比,NAFLD组患者的夜间呼吸暂停低通气指数(apnea hypopnea index,AHI)、氧减指数(oxygen desaturation index,ODI)和睡眠期间脉搏血氧饱和度(pulse oxygen saturation,SpO_2)低于90%时间占总睡眠时间的百分比(T90)明显升高(均P0.05)。NAFLD组患者平均SpO_2和最低SpO_2较非脂肪肝组明显下降(均P0.05)。当FLI截点为52时可准确判断NAFLD,此时受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.827(95%可信区间:0.722～0.914)。结论:在中重度OSA患者中,罹患脂肪肝组夜间低氧程度重于非脂肪肝组。FLI是预测患者有无脂肪肝的良好指标。     

我国中老年人群脂肪肝指数与胰岛素抵抗的相关性研究

目的 探讨我国中老年人群脂肪肝指数(FLI)与胰岛素抵抗(IR)的相关性。方法 纳入南京市鼓楼区45岁以上社区自然人群3592例，根据胰岛素抵抗指数(HOMA-IR)分为IR组1938例和无IR组1654例；根据FLI分为FLI＜30组2221例、30≤FLI＜60组911例、FLI≥60组460例，比较不同亚组的一般资料、生化指标、血糖及胰岛素相关指标。采用Spearman非参数相关性分析评估FLI与HOMA-IR及胰岛β细胞功能相关指标的相关性；采用受试者工作特征(ROC)曲线评估FLI对IR的预判能力；采用多因素logistic回归分析评估FLI与IR的关系。结果IR组男性比例、年龄、血压、血脂、肝功能、OGTT各时间点血糖和胰岛素、FLI、胰岛β细胞功能指数(HOMA-β)、早期胰岛素分泌指数(ΔI0-30/ΔG0-30)及HOMA-IR均高于无IR组，血肌酐和Matsuda ISI 均低于无IR组(P＜0.05或P＜0.001)。不同FLI亚组血压、生化指标、血糖及胰岛素相关指标比较差异均有统计学意义(P<0.001)。Spearman非参数相关分析结果显示，FLI与HONA-IR呈正相关(P＜0.001)，与Matsuda ISI呈负相关(P<0.001)。ROC曲线分析结果显示，依据FLI判断IR的ROC曲线下面积(AUC)为0.670(95%CI 0.653～0.688)。多因素logistic回归分析结果显示，FLI为IR的危险因素之一，可使IR的发生风险增加1.021倍(P<0.001)。结论 在我国中老年人群中，FLI与IR相关，FLI可作为评估IR的简单易行的指标。     

非酒精性脂肪性肝病显著肝纤维化的无创诊断

目的:通过对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者多个肝纤维化非创伤性诊断模型的验证和分析比较,评价其诊断价值.方法:选取29例NAFLD患者,进行肝组织活检和病理学分期,并检测血清指标,用受试者操作特征(ROC)曲线等方法评估APRI指数、AST/ALT比率、BARD评分等模型的诊断价值.结果:29例病例中17例(58.9%)为男性,平均年龄(51±12)岁,平均体质量指数为(27±5)kg/m2,糖尿病患者15(51.7%);病理肝纤维化分级提示显著纤维化S3-S4:6例(20.6%).各诊断模型对肝脏显著纤维化程度都具有一定诊断价值,其中AST/ALT比率表现最佳[其曲线下面积(AUROC)为0.83],其次为BARD评分(AUROC0.77)和APRI指数(AUROC0.67).AST/ALT比率和BARD评分模型的阴性预测值均大于90%(分别为93%和95%).阳性预测值均处于中低等水平.AST/ALT比率和BARD评分模型分别可使68.9%和37.9%的患者避免肝活检.结论:肝纤维化非创伤性诊断模型能较好地区分存在显著肝纤维化的NAFLD患者,其中以AST/ALT比率、BARD评分模型较为有效,可以避免部分患者行肝穿刺检查.     

盐水负荷试验对原发性醛固酮增多症的诊断价值

目的:评价盐水负荷试验对于原发性醛固酮增多症(PHA)的诊断价值。方法:回顾性分析1994-06至2012-05我院72例PHA患者(PHA组)和44例排除PHA的原发性高血压(EH)患者(EH组)的临床资料。并应用受试者工作曲线(ROC曲线)对盐水负荷试验前后血浆醛固酮水平及试验后血浆醛固酮/肾素活性比值进行评价,分析其诊断效能,得出最佳诊断切点。结果:试验后血浆醛固酮水平ROC曲线下面积为0.759,敏感性为74.6%,特异性为63.6%。试验后血浆醛固酮/肾素活性比值ROC曲线下面积为0.899,敏感性为83.6%,特异性为88.6%,最佳诊断切点为111[ng/dl:ng/(ml·h)]。结论:盐水负荷试验后血浆醛固酮水平及血浆醛固酮/肾素活性比值,对于PHA均有诊断价值,试验后血浆醛固酮/肾素活性比值诊断效能更高。     

新型胰岛素激素水平在非酒精性脂肪性肝病患者临床诊断中的价值

目的:探讨新型胰岛素激素(betatrophin)血清、ALT、AST水平在非酒精性脂肪肝病(NAFLD)患者临床诊断中的应用价值,为临床诊断NAFLD提供实验室依据。方法:选取2015年2月~2016年8月我院收治的NAFLD患者76例,设为NAFLD组,另选取同期性别、年龄匹配的健康体检者68例,设为非NAFLD组。比较两组血清ALT、AST和betatrophin水平,应用受试者工作特征曲线(ROC)对上述血清指标诊断NAFLD的意义进行分析,以最大约登指数确定切点,并分析以各切点作为诊断标准时各项指标及联合检测的诊断效能。结果:NAFLD组血清ALT、AST和betatrophin水平均明显高于非NAFLD组,差异均具有显著性意义(P<0.05);ALT、AST和betatrophin诊断NAFLD的ROC曲线下面积(AUC)分别为0.865、0.794、0.711,灵敏度分别为90.79%、85.53%、65.79%,特异性分别为67.65%、61.76%、73.53%,约登指数分别为0.5844、0.4729、0.3932,切值分别为20.68IU/L、24.54 IU/L、1.05μg/L;以联合ALT、betatrophin诊断NAFLD的正确率、特异性、约登指数、阳性似然比最高,以联合ALT、AST、betatrophin诊断NAFLD的灵敏度最高,阴性似然比最低。结论:NAFLD患者血清ALT、AST和betatrophin水平均呈现不同程度的增加,上述3个指标均对NAFLD有诊断意义,联合检测ALT、betatrophin可提高NAFLD的诊断效能。     

黄嘌呤氧化酶和对氧磷酶1活性测定及其比值在非酒精性脂肪肝中的临床应用价值

目的分析血清黄嘌呤氧化酶(xanthine oxidase,XOD)和对氧磷酶1(paraoxonase1,PON1)活性与非酒精性脂肪性肝(non-alcoholic fatty liver disease,NAFLD)严重程度分级的关系,探讨XOD/PON1比值在NAFLD中的诊断价值。方法收集144例确诊NAFLD患者为研究对象,依据肝/脾CT比值将其分为轻(41例)、中(62例)、重(42例)三组,45例健康体检者作为正常对照组。检测血清中的XOD、PON1和总抗氧化能力(TAOC)水平。Spearman等级相关分析XOD和PON1与NAFLD严重程度的相关性。ROC曲线法评估XOD/PON1比值对于NAFLD的诊断价值。结果 NAFLD患者血清XOD和TAOC水平显著高于正常对照组(P0.01),PON1水平显著低于对照组(P0.01)。相关分析显示,XOD水平与NAFLD严重程度呈正相关(r=0.740),PON1水平与NAFLD严重程度呈负相关(r=-0.845),XOD/PON1比值与NAFLD严重程度成正相关(r=0.870)。建立XOD/PON1比值对NAFLD的ROC曲线,曲线下面积(AUC)为0.965,敏感度为94.4%,特异度为97.9%。结论血清XOD和PON1活性随NAFLD加重而分呈上升和下降趋势。XOD/PON1比值可作为无创性判断NAFLD严重程度的良好指标,有助于临床确诊NAFLD。     

外周血miR-29a和T细胞斑点试验在活动性肺结核患者中的临床意义

目的:对活动性肺结核患者外周血miR-29a的表达及其临床意义进行探讨,并对结核感染T细胞斑点试验(T-SPOT)在活动性肺结核诊断中的价值及临床意义进行探讨。方法:患者来自2015-10—2017-10呼吸与危重症医学科专科门诊收治的活动性肺结核患者151例及同一段时间收治的非结核的肺炎患者78例,采集2组患者的外周血,运用逆转录荧光定量PCR(qRT-PCR)检测各组外周血miR-29a水平,miR-29a的诊断价值的评估采用受试者工作特征曲线(ROC曲线)。同时采用T-SPOT试验进行检测,采用ROC曲线分别评估T-SPOT试验中早期分泌性靶抗原6(EAST-6抗原)和滤液培养蛋白10(CFP-10抗原)的诊断价值,并对EAST-6抗原和CFP-10抗原联合后的诊断价值进行评估。结果:活动性肺结核组的外周血miR-29a的水平显著比对照组高,差异有统计学意义(P0.01)。miR-29a的敏感度94.1%,特异度63.6%,ROC曲线下面积0.878。EAST-6抗原、CFP-10抗原及此2种抗原联合在活动性肺结核患者和非结核患者间差异有统计学意义(P0.01)。EAST-6抗原的敏感度90.2%,特异度86.4%,ROC曲线下面积0.892。CFP-10抗原的敏感度80.4%,特异度90.9%,ROC曲线下面积0.873。EAST-6抗原和CFP-10抗原联合检测的敏感度81.8%,特异度92.2%,ROC曲线下面积0.908。结论:活动性肺结核患者血浆miR-29a表达水平的检测可作为活动性肺结核诊断的潜在生物学标志。T-SPOT试验在活动性肺结核的诊断中具有较高价值,是一项值得广泛应用的结核诊断试验。     

2型糖尿病合并非酒精性脂肪肝的危险因素及其与中国人内脏脂肪指数的相关性研究北大核心CSCD

目的 通过评估2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的危险因素及与中国人内脏脂肪指数(CVAI)的相关性,探讨CVAI在T2DM合并NAFLD患者中的预测价值。方法 纳入2019年1月至2019年6月至复旦大学附属中山医院青浦分院内分泌科住院治疗的T2DM患者。根据超声检查结果分为合并NAFLD组及未合并NAFLD组,运用Spearman相关分析探讨CVAI与各项指标相关性。使用logistic回归分析及受试者工作特征(ROC)曲线研究T2DM合并NAFLD的相关危险因素及CVAI对此类患者的预测价值。结果 研究共纳入244例患者,其中女性82例,男性162例,T2DM合并NAFLD的患病率为50.82%。两组间年龄、体质指数(BMI)、腰围(WC)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿酸(UA)、CVAI、内脏脂肪指数(VAI)的差异有统计学意义(均P<0.05)。多因素logistic回归校正后,年龄[比值比(OR)1.110,95%可信区间(CI)1.070~1.152],BMI(OR1.217,95%CI 1.070~1.383),TG(OR 1.995,95%CI 1.404~2.836),UA(OR 1.005,95%CI 1.001~1.010),CVAI(OR1.034,95%CI 1.023~1.045)和VAI(OR 1.306,95%CI 1.139~1.498)升高是T2DM合并NAFLD的危险因素。CVAI诊断T2DM合并NAFLD曲线下面积为0.807,灵敏度97.0%,特异度71.7%。结论 年龄、BMI、TG、UA升高是T2DM合并NAFLD的独立危险因素。CVAI对T2DM合并NAFLD具有较好的预测价值。     

血清A1AT水平与2型糖尿病合并非酒精性脂肪肝及肝脏纤维化的关联性分析

目的 分析血清α1抗胰蛋白酶(A1AT)水平与2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)及肝脏纤维化的关联性。方法 招募2019年3月至2020年3月西藏自治区第二人民医院收治的117例T2DM合并NAFLD患者为T2DM+NAFLD组,于同期纳入性别、年龄与NAFLD+T2DM组匹配的单纯T2DM患者(单纯T2DM组)和健康体检者(对照组)各80例。采用免疫比浊法检测血清A1AT水平,采用非酒精性脂肪肝纤维化评分(NAFLDFS)评估患者肝脏纤维化情况。采用多因素logistic回归分析T2DM合并NAFLD的影响因素,采用受试者工作特征(ROC)曲线分析血清A1AT水平对T2DM合并NAFLD的诊断价值,采用Spearman秩相关分析血清A1AT水平与NAFLDFS的相关性。结果 多因素logistic回归分析结果显示,较高水平的空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA稳态模型计算胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、肝脏脂肪含量(LFC)和A1AT是T2DM患者发生NAFLD的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清A...     

环状RNA FLI1在肝细胞癌患者中的表达及其与预后的关系

目的探讨环状RNA FLI1(circ FLI1)在肝细胞癌(HCC)患者中的表达及意义。方法收集2013年1月-2018年1月于西南医科大学附属医院经手术切除的45例HCC患者的癌组织及配对癌旁组织和血清样本(HCC组)。同时收集45例健康体检者的血清标本(对照组)。人肝癌细胞株HepG2、SMMC7721、HB611均来自中国科学院生物化学与细胞生物学研究所。real-time PCR法检测circ FLI1在肝癌细胞及45例肝癌组织、血清标本中的表达。计量资料2组间比较采用t检验。采用Kaplan-Meier法分析circ FLI1表达与患者生存时间的关系,采用受试者工作特征曲线(ROC曲线)分析血清circ FLI1 E2-4及circ FLI1 E2-5作为诊断HCC生物标志物的潜能,应用单因素及多因素Cox比例风险模型分析影响HCC预后的因素。结果 circ FLI1 E2-5及circ FLI1 E2-4在3种肝癌细胞中高表达。circ FLI1 E2-4(7. 09±0. 26 vs 1. 14±0. 20,t=19. 970,P 0. 001)及circ FLI1 E2-5(7. 50±0. 25 vs 1. 29±0. 30,t=16. 640,P 0. 001)在HCC患者血清中的表达明显高于对照组;在HCC患者癌组织中的表达明显高于癌旁组织(7. 62±1. 33 vs 1. 55±0. 32,t=15. 560,P 0. 001; 7. 92±0. 35 vs 1. 42±0. 39,t=21. 170,P 0. 001)。高表达circ FLI1 E2-5的患者中位无进展生存时间[(11. 17±0. 49)个月vs (23. 35±1. 27)个月,χ2=28. 480,P 0. 001]及总生存时间[(19. 75±0. 76)个月vs(37. 44±1. 57)个月,χ2=21. 750,P 0. 001]均较低表达者明显缩短;高表达circ FLI1 E2-4的患者中位无进展生存时间[(10. 29±0. 42)个月vs(24. 65±1. 58)个月,χ2=19. 620,P 0. 001]及总生存时间[(21. 32±0. 55)个月vs(35. 69±1. 74)个月,χ2=19. 730,P 0. 001]亦较低表达者明显缩短。血清circ FLI1 E2-4作为诊断HCC血清标志物的ROC曲线下面积为0. 910[95%可信区间(95%CI):0. 621～0. 970,P 0. 001],灵敏度和特异度分别为84. 3%和90. 5%。血清circ FLI1 E2-5作为诊断HCC血清标志物的ROC曲线下面积为0. 760(95%CI:0. 650～0. 860,P 0. 001),灵敏度和特异度分别为80. 5%和87. 3%。Cox多因素回归模型分析提示,血清circ FLI1 E2-4(风险比=3. 060,95%CI:1. 630～5. 870,P=0. 001)及circ FLI1 E2-5(风险比=2. 560,95%CI:1. 250～6. 460,P=0. 008)表达是HCC患者预后的独立影响因素。结论 circ FLI1在HCC患者组织及血清中高表达,与患者的预后相关,可能是潜在的HCC患者预后标志物和治疗靶点。     

Fatty liver index vs waist circumference for predicting non-alcoholic fatty liver disease

AIM: To determine the discriminatory performance of fatty liver index(FLI) for non-alcoholic fatty liver disease(NAFLD).METHODS: The data of 5052 subjects aged over 18 years were analyzed. FLI was calculated from body mass index, waist circumference(WC), triglyceride, and gamma glutamyl transferase data. Logistic regression analysis was conducted to determine the association between FLI and NAFLD. The discriminatory performance of FLI in the diagnosis of NAFLD was evaluated by receiver operating characteristic analysis. Area under the curves(AUCs) and related confidence intervals were estimated. Optimal cutoff points of FLI in the diagnosis of NAFLD were determined based on the maximum values of Youden's index.RESULTS: The mean age of men and women in the study population were 44.8 ± 16.8 and 43.78 ± 15.43, respectively(P = 0.0216). The prevalence of NAFLD was 40.1% in men and 44.2% in women(P 0.0017). FLI was strongly associated with NAFLD, so that even a one unit increase in FLI increased the chance of developing NAFLD by 5.8%(OR = 1.058, 95%CI: 1.054-1.063, P 0.0001). Although FLI showed good performance in the diagnosis of NAFLD(AUC = 0.8656(95%CI: 0.8548-0.8764), there was no significant difference with regards to WC(AUC = 0.8533, 95%CI: 0.8419-0.8646). The performance of FLI was not significantly different between men(AUC = 0.8648, 95%CI: 0.8505-0.8791) and women(AUC = 0.8682, 95%CI: 0.8513-0.8851). The highest performance with regards to age was related to the 18-39 age group(AUC = 0.8930, 95%CI: 0.8766-0.9093). The optimal cutoff points of FLI were 46.9 in men(sensitivity = 0.8242, specificity = 0.7687, Youden's index = 0.5929) and 53.8 in women(sensitivity = 0.8233, specificity = 0.7655, Youden's index = 0.5888).CONCLUSION: Although FLI had acceptable discriminatory power in the diagnosis of NAFLD, WC was a simpler and more accessible index with a similar performance.     

Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification

AIM:To compare noninvasive methods presently used for steatosis detection and quantification in nonalcoholic fatty liver disease(NAFLD).METHODS:Cross-sectional study of subjects from the general population,a subgroup from the First Israeli National Health Survey,without excessive alcohol consumption or viral hepatitis.All subjects underwent anthropometric measurements and fasting blood tests.Evaluation of liver fat was performed using four noninvasive methods:the SteatoTest;the fatty liver index(FLI);regular abdominal ultrasound(AUS);and the hepatorenal ultrasound index(HRI).Two of the noninvasive methods have been validated vs liver biopsy and were considered as the reference methods:the HRI,the ratio between the median brightness level of the liver and right kidney cortex;and the SteatoTest,a biochemical surrogate marker of liver steatosis.The FLI is calculated by an algorithm based on triglycerides,body mass index,γ-glutamyl-transpeptidase and waist circumference,that has been validated only vs AUS.FLI < 30 rules out and FLI ≥ 60 rules in fatty liver.RESULTS:Three hundred and thirty-eight volunteers met the inclusion and exclusion criteria and had valid tests.The prevalence rate of NAFLD was 31.1% according to AUS.The FLI was very strongly correlated with SteatoTest(r = 0.91,P < 0.001) and to a lesser but significant degree with HRI(r = 0.55,P < 0.001).HRI and SteatoTest were significantly correlated(r = 0.52,P < 0.001).The κ between diagnosis of fatty liver by SteatoTest(≥ S2) and by FLI(≥ 60) was 0.74,which represented good agreement.The sensitivity of FLI vs SteatoTest was 85.5%,specificity 92.6%,positive predictive value(PPV) 74.7%,and negative predictive value(NPV) 96.1%.Most subjects(84.2%) with FLI < 60 had S0 and none had S3-S4.The κ between diagnosis of fatty liver by HRI(≥ 1.5) and by FLI(≥ 60) was 0.43,which represented only moderate agreement.The sensitivity of FLI vs HRI was 56.3%,specificity 86.5%,PPV 57.0%,and NPV 86.1%.The diagnostic accuracy of FLI for steatosis &g     

Validation of fatty liver disease scoring systems for ultrasound diagnosed non-alcoholic fatty liver disease in adolescents

Background and AimsThe incidence of non-alcoholic fatty liver disease (NAFLD) is increasing in young populations. However, there are inadequate data regarding diagnosis of NAFLD. We aimed to validate three scoring systems against a previous standard of suprailiac skinfold thickness for diagnosing NAFLD in population-based adolescents.MethodsSeventeen-year-old adolescents (n = 899), participating in the Raine Study, attended a cross-sectional follow-up. NAFLD was diagnosed using liver ultrasound. Scores for Fatty liver index (FLI), Hepatic Steatosis Index (HSI) and Zhejiang University index (ZJU index) were calculated. Diagnostic accuracy of these diagnostic tests was evaluated through discrimination and calibration.ResultsNAFLD was diagnosed 9% in males and 15% in females. The three scoring systems demonstrated better discrimination performance for NAFLD in males (AUC was FLI:0.82, HSI: 0.83 and ZJU index: 0.83) compared to females (AUC was FLI: 0.67, HSI: 0.67 and ZJU index: 0.67). Suprailiac skinfold performed better than the scoring systems (overall AUC: 0.82; male AUC:0.88; female AUC:0.73). FLI had best calibration performance.ConclusionSuprailiac skinfold thickness was a better predictor of ultrasound-diagnosed NAFLD than the three diagnostic scoring systems investigated. The higher performance characteristics of the algorithmic scoring systems in males compared with females may have implications for use in population assessments.     

Prevalence,clinical characteristics,risk factors,and indicators for lean Chinese adults with nonalcoholic fatty liver disease

BACKGROUND Nonalcoholic fatty liver disease(NAFLD) is one of the most common chronic diseases in the world. Nowadays, the percentage of non-obese or lean patients with NAFLD is increasing. NAFLD in non-obese populations, especially the lean subgroup with a normal waist circumference(WC), might lead to more problems than obese individuals, as these individuals may not visit clinics for NAFLD diagnosis or ignore the diagnosis of NAFLD. If the precise characteristics of these populations, especially the lean subgroup, are identified, the clinicians would be able to provide more appropriate advice and treatment to these populations.AIM To investigate the prevalence, clinical characteristics, risk factors, and possible indicators for NAFLD in lean Chinese adults with a normal WC.METHODS People without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included. Their fatty liver index(FLI), abdominal ultrasonography results, and controlled attenuation parameter were all assessed. Genotyping for single-nucleotide polymorphisms associated with NAFLD was performed in another small group consisting of biopsy-proven NAFLD subjects and healthy controls.RESULTS A total of 2715 subjects who underwent routine health examinations were included in the study. Among 810 lean participants with a normal WC, 142(17.5%) fulfilled the diagnostic criteria for NAFLD. Waist-height ratio,hemoglobin, platelets, and triglycerides were significant factors associated with the presence of NAFLD in these participants. The appropriate cut-off value of the FLI score in screening for NAFLD in the lean subjects with a normal WC was25.15, which had a 77.8% sensitivity and 75.9% specificity. There was no significant difference in the single-nucleotide polymorphisms in the SIRT1,APOC3, PNPLA3, AGTR1, and PPARGC1 A genes between lean subjects with and without NAFLD(P 0.05).CONCLUSION NAFLD is not uncommon in lean Chinese adults even with a normal WC.Metabolic factors, rather than genetic factors, may play important roles in the development of NAFLD in this population. A lower cut-off value of the FLI score in screening for NAFLD should be used for lean Chinese adults with a normal WC.     

Cutoff points of abdominal obesity indices in screening for non‐alcoholic fatty liver disease in Asians

Background/aims: Abdominal obesity is associated with metabolic syndrome and non‐alcoholic fatty liver disease (NAFLD). Although there have been many studies to determine the optimal cutoff points of waist circumference or visceral fat area in screening for metabolic syndrome, there have been no reports to establish adequate cutoff points of abdominal obesity indices in screening for NAFLD. Therefore, we examined the appropriate cutoff points of abdominal obesity indices associated with NAFLD in Korean men and women using receiver operating characteristic (ROC) curve analysis. Furthermore, we compared the usefulness of various abdominal obesity indices measured using computed tomography (CT), dual‐energy X‐ray absorptiometry (DXA) and anthropometric parameters for detecting NAFLD. Methods: We analysed the baseline data of an ongoing prospective, observational cohort study, including a total of 456 healthy subjects 20–88 years of age. NAFLD was diagnosed by unenhanced CT using the liver attenuation index. Results: All ROC curves of waist circumference, waist‐to‐height ratio, DXA‐measured trunk fat mass and CT‐measured visceral fat area were significantly above the diagonal line. There were no significant differences in the area under the curve values among these abdominal obesity indices in each gender. The appropriate cutoff point of waist circumference in screening for NAFLD was 89 cm for men and 84 cm for women and the optimal cutoff point of waist‐to‐height ratio was 0.52 for men and 0.53 for women with very high negative predictive values. Conclusions: The simple anthropometric parameters, such as waist circumference and waist‐to‐height ratio, are as useful as DXA and CT for predicting NAFLD in Korean adults.     

Leptin in nonalcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance (IR). Leptin plays a key role in the control of energy balance, and insulin sensitivity. In this study, we aimed to examine whether serum leptin levels correlate with insulin resistance, oxidative stress parameters and the severity of histological changes in NAFLD. Methods: Fifty-two patients (M/F: 28/24) with no alcohol intake and biopsy-proven diagnosis of NAFLD were studied. Serum leptin levels were measured by radioimmunoassay. HOMA (homeostasis model assessment) IR index was calculated. Comparisons between the patients with NAFLD and non-alcoholic steatohepatitis (NASH) were performed using the Student’s t test. Multivariate regression analysis and the area under the receiver operating characteristic (ROC) curve were used to identify the independent predictors for NASH. Results: We found no association between serum leptin, fasting insulin levels, and oxidative stress parameters. ROC curve and multiple regression analysis revealed no association between the severity of histological changes and serum leptin levels. During six months followed-up period only NASH group with elevated leptin levels had significant reductions of ALT and AST values (p = 0.03, and 0.005, respectively). Conclusion: Our findings show a preventive effect of leptin against progressive liver injury in NAFLD.     

血清学指标和脂肪肝指数诊断非酒精性脂肪性肝病价值分析*

目的 探讨应血清指标和脂肪肝指数(FLI)诊断非酒精性脂肪性肝病(NAFLD)患者的价值。方法 2016年3月～2019年3月我院肝病科诊治的NAFLD 患者86例和同期进行体检的健康人群86例,检测血清胰脂肪酶(P-LIP)、降钙素原(PCT)、C反应蛋白(CRP),计算FLI。结果 NAFLD患者血清PCT和CRP水平及FLI分别为(0.10±0.05) μg/L、(5.6±1.0)μg/L和(37.4±3.6),显著高于健康人【分别为(0.04±0.02)μg/L、(2.8±0.7)μg/L和(18.2±1.3),P<0.05】,而血清P-LIP水平为(27.1±2.4)U/L,显著低于健康人【(35.8±3.2)U/L,P<0.05】;18例非酒精性脂肪肝肝炎(NASH)相关肝硬化患者血清PCT、CRP、P-LIP和FLI分别为(0.18±0.07)μg/L、(7.4±1.2)μg/L、(22.9±1.7)U/L和39.41±4.0,与33例NASH患者【分别为(0.11±0.04)μg/L、(4.8±0.5)μg/L、(27.7±2.2)U/L和(38.0±3.7)比或与35例单纯性脂肪肝患者【分别为(0.07±0.02)μg/L、(3.0±0.3)μg/L、(34.2±2.6)U/L和(35.8±3.4)比,差异显著(P<0.05);FLI诊断NAFLD的灵敏度和特异度分别为76.7%和73.3%,而FLI联合血清CRP、PCT和P-LIP诊断的灵敏度和特异度分别为66.3%和86.1%。结论 FLI诊断NAFLD患者具有一定的临床应用价值,联合其他一些血清指标可能有助于提高诊断效率。     

长链非编码RNA EXOC7在非酒精性脂肪性肝病中的表达及临床意义

目的 观察非酒精性脂肪性肝病(NAFLD)患者血清及肝穿刺组织中长链非编码RNA(lncRNA)EXOC7的表达及临床意义。方法 选取2013年1月1日-2018年12月31日于西南医科大学附属医院住院行肝穿刺并经影像学及组织病理学诊断为NAFLD的患者120例,其中非酒精性单纯性脂肪肝(NAFL)47例,非酒精性脂肪性肝炎(NASH)73例。另选取同期体检的50例无脂肪变性和脂肪性肝炎的其他肝病患者作为对照组。采用Real-time PCR法检测lncRNA EXOC7在肝组织及血清中的表达。计量资料两组间比较采用t检验;多组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料两组间比较采用χ2检验。采用Pearson相关分析lncRNA EXOC7表达与临床各生化指标的关系。绘制受试者工作特征曲线(ROC曲线)并分析lncRNA EXOC7的临床诊断价值。结果 与对照组相比,NAFL和NASH患者的组织及血清中lncRNA EXOC7表达显著增高(P值均<0.05),且其表达水平随着肝脏脂肪变性及炎症程度的加重而提升(F=19.96,P<0.05)。相关性分析结果显示,lncRNA EXOC7表达与TG、LDL-C呈正相关(r值分别为0.785、0.847,P值均<0.001);而与HDL-C、胰岛素敏感指数呈负相关(r值分别为-0.726、-0.709,P值均<0.001)。lncRNA EXOC7诊断NAFLD的ROC曲线下面积为0.812(95%可信区间:0.599~0.915,P<0.001),敏感度为85.42%,特异度为81.17%。结论 lncRNA EXOC7在NAFLD患者中高表达,并随脂肪变性及炎症程度的加重而升高,提示lncRNA EXOC7可能是NAFLD防治的潜在新靶点。     

非酒精性脂肪性肝病患者血清SDC4变化及其临床意义探讨

目的 探讨血清多配体蛋白聚糖-4(SDC4)水平诊断非酒精性脂肪性肝病(NAFLD)患者的效能。方法 2019年6月～12月无过量饮酒史的健康体检成人,使用超声检查诊断NAFLD,采用ELISA法检测血清SDC4水平,采用多元Logistic回归分析影响脂肪肝发生的危险因素,应用受试者工作特征曲线(ROC)下面积(AUC)分析诊断效能。结果 在209例体检成人中,发现NAFLD患者102例,健康人107例;NAFLD组血清SDC4水平显著高于健康人(11.7±4.2 ng/mL对5.3±2.5 ng/mL,P < 0.05),血清SDC4水平随着NAFLD患者脂肪肝程度的加重呈显著上升趋势;Logistic回归分析发现,血清SDC4增高与NAFLD发生独立相关;以血清SDC4水平为8.45 ng/mL为诊断NAFLD的截断点,AUC为0.917,其敏感度为84.3％,特异度为87.9％。结论 血清SDC4增高可能与肥胖、代谢紊乱和NAFLD的发生密切相关,检测血清SDC4水平可能有助于无创诊断NAFLD。     

An extended fatty liver index to predict non-alcoholic fatty liver disease

BackgroundIn clinical practice, there is a strong interest in non-invasive markers of non-alcoholic fatty liver disease (NAFLD). Our hypothesis was that the fold-change in plasma triglycerides (TG) during a 2-h oral glucose tolerance test (fold-change TG_OGTT) in concert with blood glucose and lipid parameters, and the rs738409 C>G single nucleotide polymorphism (SNP) in PNPLA3 might improve the power of the widely used fatty liver index (FLI) to predict NAFLD.MethodsThe liver fat content of 330 subjects was quantified by ¹H-magnetic resonance spectroscopy. Blood parameters were measured during fasting and after a 2-h OGTT. A subgroup of 213 subjects underwent these measurements before and after 9 months of a lifestyle intervention.ResultsThe fold-change TG_OGTT was closely associated with liver fat content (r = 0.51, P < 0.0001), but had less power to predict NAFLD (AUROC = 0.75) than the FLI (AUROC = 0.79). Not only was the fold-change TG_OGTT independently associated with liver fat content and NAFLD, but so also were the 2-h blood glucose level and rs738409 C>G SNP in PNPLA3. In fact, a novel index (extended FLI) generated from these and the usual FLI parameters considerably increased its power to predict NAFLD (AUROC = 0.79–0.86). The extended FLI also increased the power to predict changes in liver fat content with a lifestyle intervention (n = 213; standardized beta coefficient: 0.23–0.29).ConclusionThis study has provided novel data confirming that the OGTT-derived fold-change TG_OGTT and 2-h glucose level, together with the rs738409 C>G SNP in PNPLA3, allow calculation of an extended FLI that considerably improves its power to predict NAFLD.