吡格列酮对2型糖尿病大鼠骨骼肌脂联素受体1表达的影响

目的观察吡格列酮对2型糖尿病大鼠血清脂联素以及骨骼肌脂联素受体1(AdipoR1)表达的影响,探讨吡格列酮对2型糖尿病胰岛素抵抗的改善作用及机制。方法 40只8周龄健康雌性SD大鼠,随机分为正常对照组(n=10)、糖尿病组(n=15)及吡格列酮组(n=15)。用高糖高脂饲料加小剂量链脲佐菌素建立2型糖尿病大鼠模型,成模后吡格列酮组给予10 mg/(kg.d)吡格列酮灌胃,正常对照组和糖尿病组给予同体积生理盐水灌胃,共12周。3个月后股静脉取血,酶联免疫吸附法(ELISA)测定血清脂联素水平,留取大鼠骨骼肌,光、电镜观察骨骼肌结构,免疫组织化学染色法测定骨骼肌AdipoR1蛋白的表达。结果与正常对照组(1.73±0.32 mg/L)比较,糖尿病组血清脂联素(1.01±0.27 mg/L)水平显著降低,而吡格列酮组(1.34±0.43 mg/L)较糖尿病组显著升高,差异有统计学意义(P<0.05)。骨骼肌AdipoR1免疫组织化学染色正常对照组着色深且广泛,糖尿病组较正常对照组染色浅,吡格列酮组较糖尿病组染色深,但较正常对照组浅。光镜及电镜结果显示大鼠骨骼肌结构未见明显异常。结论 2型糖尿病大鼠血清脂联素水平及骨骼肌AdipoR1表达降低并导致糖脂代谢紊乱及胰岛素抵抗。吡格列酮可上调血清脂联素及骨骼肌AdipoR1的表达,从而调节糖脂代谢,改善胰岛素抵抗。     

吡格列酮对高脂血症大鼠主动脉脂联素受体表达的影响

目的观察高脂血症大鼠主动脉脂联素受体(adiponectin receptors1/2,AdipoR1/2)的表达改变,探讨吡格列酮对高脂血症大鼠主动脉血管脂联素受体表达的影响。方法清洁级SD大鼠26只,随机分为正常饮食组(9只)和高脂饮食组(17只);高脂饮食组12周后检测空腹血脂,明确造模是否成功,随机分为模型组(8只)和吡格列酮组(9只),后者给予吡格列酮溶液(0.6mg/ml)连续灌胃4周,之后检测血脂水平及主动脉病理,ELISA法检测血清脂联素水平,荧光RT-PCR法检测主动脉脂联素受体AdipoR1和AdipoR2mRNA的表达,Western Bolt法检测脂联受体蛋白表达。结果高脂饲料喂养12周,高脂饮食组TG、TC、LDL水平明显升高(P0.01);给药四周后,吡格列酮组TG、TC水平明显降低(P0.01),模型组主动脉脂联素受体1/2mRNA和蛋白的表达明显下降(P0.01)。与模型组比较,吡格列酮组主动脉AdipoR(1P0.05)和AdipoR2(P0.01)mRNA的表达明显升高,主动脉脂联素受体蛋白的表达明显升高(P0.05),差异有统计学意义。结论脂联素及其受体下降可能介入高脂血症血管损伤,吡格列酮具有抗动脉粥样硬化作用,该作用可能与提高血清脂联素和主动脉血管脂联素受体表达有关。     

吡格列酮对动脉粥样硬化大鼠核因子-κB表达的影响

目的探讨吡格列酮对动脉粥样硬化大鼠核因子-κB(NF-κB)表达的影响。方法将30只健康雄性Wistar大鼠随机分为3组,正常饮食组、高脂饮食组、高脂饮食加吡格列酮干预组,比较3组大鼠主动脉病理形态学改变,测定大鼠的血脂变化,采用免疫组化技术测定NF-κB在血管内皮细胞的表达。结果吡格列酮能减轻动脉粥样硬化所致的内膜和肌层增厚。吡格列酮能降低胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C),升高高密度脂蛋白胆固醇(HDL-C)。高脂饮食能刺激大鼠主动脉NF-κB的表达,吡格列酮能显著减轻这种作用。结论吡格列酮能减轻动脉粥样硬化大鼠NF-κB的表达,从而可能会有效防治动脉粥样硬化。     

PPARδ激动剂对非酒精性脂肪肝大鼠胰岛素抵抗作用的研究

目的研究PPARδ激动剂(GW501516)对高脂饮食诱导的非酒精性脂肪肝(NAFLD)大鼠胰岛素抵抗的影响及特点。方法 47只SD雄性大鼠随机分为造模组(n=37)与正常对照组(n=10),分别给予高脂饮食和普通饮食喂养12周后,造模组随机处死3只大鼠,经肝脏病理HE染色观察造模成功。余34只造模成功大鼠随机分为:模型组(n=10)、GW501516治疗组(n=12),吡格列酮治疗组(n=12)。治疗2周、4周后分别处死各组半数大鼠。测体质量、肝重、体长并计算肝指数及体质量指数(BMI);采集血清检测空腹血糖、肝功、血脂,放免法测空腹胰岛素,计算胰岛素敏感指数HOMA-IR;行肝组织油红O染色、HE染色;ELISA法测血清IGF-1;免疫组化检测SREBP-1c及GLUT-2表达情况。结果 (1)与模型组相比,GW501516治疗组肝湿重、体质量、肝指数及BMI均下降在治疗4周后更为明显(P0.05);治疗4周后,GW501516组体质量和BMI较吡格列酮治疗组低(P0.05)。(2)与模型组相比,GW501516治疗组糖代谢、脂代谢及肝功均明显改善(P0.05);治疗4周后,GW501516组糖代谢、脂代谢及肝功改善较格列酮治疗组更为明显(P0.05)。(3)与模型组相比,GW501516治疗2周及4周后肝脏脂肪变及炎症均明显减轻;治疗4周后,GW501516组肝脏组织改善程度较吡格列酮治疗组更明显。(4)与模型组相比,GW501516治疗组血清IGF-1水平升高、肝脏SREBP-1c表达下调、GLUT-2表达上调(P0.05);治疗4周后,与吡格列酮治疗组相比,GW501516组IGF-1及GLUT-2升高更明显,SREBP-1c降低更明显(P0.05)。结论 PPARδ激动剂GW501516可通过上调IGF-1及GLUT-2、下调SREBP-1c改善NAFLD大鼠的胰岛素抵抗及减轻肝脏脂质沉积,且改善作用明显优于PPARγ激动剂(吡格列酮)。     

吡格列酮对非酒精性脂肪肝模型小鼠肝脂肪变的影响

目的观察吡格列酮对非酒精性脂肪肝(NAFLD)小鼠肝组织学、胰岛素抵抗、肝功能和血脂的影响。方法C57小鼠适应性喂养1周后,对照组8只和模型组18只,对照组饲喂对照饲料,模型组喂养60%高脂饲料诱导非酒精性脂肪肝模型,共计14周。第10周模型组随机抽取10只为吡格列酮组,按10 mL/kg灌胃吡格列酮,共计4周。实验结束观察各组小鼠体质量、肝组织学、胰岛素抵抗、肝功能和血脂的变化。结果与模型组相比,吡格列酮组肝重和肝脏指数显著升高(P=0.01,P0.001),肝脏病理提示脂肪变性、肝小叶炎症明显改善(P0.001,P0.001),TG、空腹血糖、胰岛素抵抗指数(HOMA-IR)下降明显(P=0.002,P=0.001,P=0.01),高密度脂蛋白胆固醇(HDL)上升显著(P0.001)。结论吡格列酮可改善NAFLD模型动物胰岛素抵抗,减轻肝脂肪变和调节血脂作用。     

吡格列酮对大鼠非酒精性脂肪性肝炎干预的实验研究

目的　用吡格列酮对试验动物进行干预 ,探讨胰岛素抵抗与非酒精性脂肪性肝炎的关系。方法　雄性SD大鼠 5 0只随机分组。正常对照组喂饲普通饮食 ,高脂模型组喂饲高脂饮食 ,给药组分别在喂饲高脂饮食 4周后、9周后分别给予吡格列酮灌胃 ,并分别在 9周末及 14周末处死各组大鼠 ,测定血清转氨酶、血糖、血脂、胰岛素及FFA水平 ,观察肝组织学改变。结果　 9周后模型组大鼠呈现明显腹型肥胖 ,产生脂质代谢紊乱及胰岛素抵抗 ,肝脏出现肝细胞脂肪变性 ,给药组各项指标均有明显改善 ;14周后模型组大鼠血清转氨酶水平升高 ,肝脏出现炎细胞浸润 ,除肝组织炎症外 ,给药组其他指标均有不同程度的改善。结论　胰岛素抵抗在大鼠肝脏脂肪变的发生中起到关键作用 ,与脂肪肝发生炎症坏死关系甚密切 :吡格列酮可明显改善高脂饮食诱发大鼠肝脏的脂肪变性 ,对炎症变化作用不明显     

吡格列酮对老年自发性高血压大鼠心肌纤维化及胶原代谢的影响

目的探讨吡格列酮对老年自发性高血压大鼠(SHRs)心肌纤维化及胶原代谢的影响和可能机制。方法 12月龄SHRs分为吡格列酮组和SHR组,同月龄WKY鼠为对照组。观察大鼠体重及尾动脉血压、测定左室重量指数(LVI)、心肌胶原定性分析、测定心肌羟脯氨酸含量、Westen印迹法检测心肌基质金属蛋白酶(MMP)-1、MMP抑制物(TIMP)-1蛋白表达、测定心肌活性氧(ROS)和超氧化物歧化酶(SOD)水平并观察心肌过氧化物酶体增殖物激活受体(PPAR)γmRNA表达和组织定位。结果与对照组相比,SHR组血压、胶原容积积分、血管周围胶原面积和左室心肌组织羟脯氨酸浓度明显升高,吡格列酮组能改善心肌纤维化;SHR组MMP-1/TIMP-1显著降低,吡格列酮组MMP-1/TIMP-1水平显著升高,PPARγ表达增多,心肌ROS浓度显著下降(P0.05)。结论吡格列酮通过调节MMPs/TIMP平衡促进胶原降解,抑制胶原的沉积,抑制心肌纤维化,机制可能是通过激活PPARγ和抑制ROS的形成。     

吡格列酮对高脂血症大鼠主动脉内皮细胞凋亡的作用

目的观察吡格列酮对高脂血症大鼠主动脉内皮细胞凋亡的影响,并探讨其可能的作用机制。方法清洁型SD大鼠26只,随机分为健康对照组(9只)、高脂饮食组(17只),高脂饮食组喂养12周后再随机分为模型组(8只)和吡格列酮组(9只),4周后,检测各组血脂水平,通过免疫组织化学法检测主动脉Bcl-2、Bax的表达,TUNEL染色法观察主动脉内皮细胞凋亡情况,计算细胞凋亡指数。结果 (1)高脂饮食组喂养12周后,血脂明显升高;给药4周后,与模型组比较,吡格列酮组TG、TC水平明显降低(P=0.000);(2)与健康对照组相比,模型组主动脉Bax蛋白表达明显增高(P=0.003),Bcl-2蛋白表达和Bcl-2/Bax比值明显降低(P=0.000);与模型组相比,吡格列酮组主动脉Bax蛋白表达明显降低(P=0.000),Bcl-2蛋白表达(P=0.001)和Bcl-2/Bax比值明显升高(P=0.000),且吡格列酮组主动脉内皮细胞凋亡指数较模型组明显降低,差异有统计学意义(17.5633±7.0584比6.0475±2.2370,P=0.000)。结论吡格列酮可改善高脂血症大鼠血脂水平,调节凋亡蛋白表达,减少主动脉内皮细胞凋亡。     

吡格列酮对高脂血症大鼠缺血再灌注心肌细胞膜的保护作用

目的观察吡格列酮(pioglitazone,PIO)对高脂血症(hyperlipemia,HL)并发缺血再灌注大鼠干预后的心肌细胞膜组分的保护作用,并探究其可能机制。方法建立大鼠高脂模型后,再施以吡格列酮干预,4周后各组行心肌缺血再灌注。术后低温高速离心法制备心肌细胞膜,检测胆固醇(C)、磷脂(phospholipid,PL)及C/P比值、磷脂酶A2(PLA2)活性及钠钾、镁、钙ATPase活性的变化。结果 14周末,与对照组比较,高脂模型组血清中甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)含量显著升高(P0.05);8周末,高脂模型+吡格列酮组大鼠血清中TG、TC含量较高脂模型组显著降低(P0.01和P0.05)。2高脂模型组心肌细胞膜磷脂含量较对照组显著下降(P0.01),而高脂模型+吡格列酮组比高脂模型组含量升高(P0.05)。3高脂模型组C/P比值分别与对照组、高脂模型+吡格列酮组比较,差异均有显著性(P0.01)。4高脂模型组和高脂模型+吡格列酮组心肌细胞膜PLA2活性比对照组升高(P0.05)。5高脂模型组钠钾ATPase活性较对照组降低(P0.05);高脂模型组镁ATPase活性低于对照组(P0.05),而高脂模型+吡格列酮组镁ATPase活性高于高脂模型组(P0.05)。结论吡格列酮对心肌细胞膜正常的C/P比值、PLA2活性、钠钾/镁ATPase活性均有一定的保护作用。     

Fas/FasL、Bcl-2/Bax、Caspase-8在大鼠非酒精性脂肪性肝病中的作用机制

目的:探讨肝细胞凋亡及其相关因素Fas/FasL、Bcl-2/Bax蛋白及Caspase-8 mRNA的表达在大鼠非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)中的作用.方法:采用改良高脂饮食建立大鼠NAFLD模型,以正常饮食设立对照组.HE染色观察肝脏脂肪变、炎症活动和纤维化程度,采用流式细胞仪法测肝细胞凋亡百分数;免疫组织化学法检测Fas、FasL、Bcl-2及Bax在肝组织中表达情况;实时荧光定量PCR法检测肝脏Caspase-8 mRNA的表达.结果:NAFLD模型组脂肪变性明显,纤维化和炎症活动度记分均显著高于正常对照组.流式细胞仪检测显示,与对照组比较,实验组大鼠肝细胞凋亡百分数增加,随造模时间延长凋亡率增加更明显(均P<0.01);免疫组织化学染色显示随着肝脏脂肪变加重,Fas、FasL蛋白染色加深,阳性细胞数增加;Bcl-2、Bax在对照组的表达均为散在弱阳性,实验组4、8、12wk阳性细胞数渐增加,并在脂肪变明显的部位着色深且随着脂肪肝的进展,Bcl-2/Bax比率进行性下降.实时荧光定量PCR法显示Caspase-8 mRNA表达量在高脂组中显著高于对照组(均P<0.01),且随肝脏脂肪变及炎症加重呈进行性上升.结论:在NAFLD发生过程中,肝细胞凋亡促进NAFLD大鼠病情进展;Fas、FasL、Caspase-8 mRNA相关调控蛋白的活化是引起NAFLD脂肪变性、炎症及纤维化的重要因素.细胞凋亡调节蛋白Bax、Bcl-2表达上调,二者表达的相对比例发生异常,这可能是NAFLD中肝细胞发生凋亡的重要原因之一.     

整合素受体β3亚单位在非酒精性脂肪性肝病肝组织中的表达

目的观察在非酒精性脂肪性肝病(NAFLD)不同疾病状态中整合素受体β3亚单位的表达情况。方法清洁级雄性新西兰白兔30只,随机分成两组,一组饲以正常饮食(n=6),另一组饲以高脂饮食(n=24)。高脂饮食组分别在饲养1、2、3个月时随机处死8只白兔,取肝组织行HE染色和天狼星红染色,根据病理结果计算NAFLD活动度积分(NAS)。Western印迹和实时PCR检测肝组织内整合素受体β3亚单位蛋白和mRNA表达,免疫组织化学检测β3亚单位在肝脏细胞内的表达情况。结果根据病理结果,高脂饮食白兔分成3组:单纯脂肪肝组(n=10)、无纤维化的NASt组(n=6)和伴有纤维化的NASH组(n=8),NAS积分分别为2.43±0.79,5.38±1.30和5.13±1.05。与正常对照组相比,单纯脂肪肝组整合素受体β3亚单位的蛋白和mRNA表达差异无统计学意义,而NASH-组的表达明显增加,并且随着肝纤维化的加重,表达量增加更显著(均P<0.05)。此外,与正常对照组相比,单纯脂肪肝组肝组织内表达整合素受体β3亚单位的细胞无明显增多;而NASH组阳性细胞显著增多(均P<0.05),其中伴有纤维化的NASH组阳性细胞最多;这些阳性细胞主要分布于肝细胞间隙内。结论与正常对照组和单纯脂肪肝组相比,NASH组肝组织内有着更显著的整合素受体β3亚单位的表达,并且表达量随着肝纤维化的出现而进一步增加。     

Influence of TNF gene polymorphisms in Japanese patients with NASH and simple steatosis

BACKGROUND/AIMS: Tumor necrosis factor (TNF) is considered to play a role in the second hit of non-alcoholic steatohepatitis (NASH). To clarify the effects of TNF in NASH we investigated TNF gene polymorphisms that might influence TNF production were investigated. METHODS: We analyzed 102 patients with non-alcoholic fatty liver disease (NAFLD; 36 with simple steatosis and 66 with NASH) and 100 control subjects. The serum level of soluble TNF receptor (sTNFR)-2 was measured. The TNF-alpha promoter region positions -1031, -863, -857, -308, and -238 and the TNF-beta gene Nco1 polymorphism site were investigated. RESULTS: The level of sTNFR-2 was significantly higher in NASH patients than in those with simple steatosis or control subjects. In the analysis of TNF gene polymorphisms, there were no significant deviations between the group of all NAFLD patients and the control subjects. The carrier frequencies of polymorphisms at positions -1031C and -863A were significantly higher in patients with NASH than in those with simple steatosis. In the multivariate analysis, TNF-alpha promoter polymorphisms proved to be significant independent factors distinguishing NASH from simple steatosis. CONCLUSIONS: TNF polymorphisms, which influence TNF production, might be associated with the progression of NAFLD.     

Predictors reflecting the pathological severity of non-alcoholic fatty liver disease: comprehensive study of clinical and immunohistochemical findings in younger Asian patients

BACKGROUND AND AIMS: The spectrum of non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to severe steatohepatitis (NASH). The aim of our study was to identify clinical predictors distinguishing NASH from steatosis and to study the pathogenesis of NASH in a young Korean population. METHODS: Clinical and biochemical variables from 39 biopsied NAFLD patients were retrospectively analyzed. All liver biopsy specimens were immunohistochemically examined for Kupffer cells (CD68, CD14), as well as expression of tumor necrosis factor-alpha (TNF-alpha) and mitochondrial uncoupling protein 2 (UCP-2). RESULTS: There were no significant differences in serum biochemistry between the two groups (15 steatosis vs 24 NASH). There was a significant difference between the body mass index (BMI) values (kg/m(2)) of the NASH (28.4 +/- 3.4 kg/m(2)) and steatosis (25.8 +/- 2.8 kg/m(2)) patients (P < 0.025), with a BMI of 28.9 kg/m(2) representing the best threshold for distinguishing NASH from steatosis patients. BMI was significantly related to the degree of fibrosis (P < 0.01). CD68+ Kupffer cells were more common in the livers of NASH patients (P < 0.05), and TNF-alpha and UCP-2 were expressed in all NASH specimens and were related with the severity of inflammation and fibrosis (P < 0.05). CONCLUSIONS: BMI could be used to distinguish NASH from steatosis in younger Korean patients. A high BMI with a low alanine aminotransferase (ALT) value tended to suggest the presence of severe fibrosis in NASH, while the number of CD68+ Kupffer cells and the staining intensity of TNF-alpha and UCP-2 were correlated with general pathologic severity in patients with NAFLD.     

Expression of adiponectin and its receptors in livers of morbidly obese patients with non-alcoholic fatty liver disease

Background and Aim:  Obesity is one of the risk factors for non-alcoholic fatty liver disease (NAFLD) and a common disease that comprises simple steatosis and non-alcoholic steatohepatitis (NASH), and can eventually lead to liver cirrhosis. Adiponectin is an adipocyte-derived protein that has anti-obesity, antidiabetic and anti-inflammatory properties, and is considered to possess a hepatoprotective function. Its role in the development and progression of NAFLD in morbidly obese patients is unknown. In this study, we examined the expression levels of adiponectin and its receptors in liver biopsies of morbidly obese patients and then determined whether there was an association with the disease severity.
Methods:  Liver biopsies from 30 morbidly obese patients (18 NASH vs 12 steatosis) were analyzed. The needle core biopsies were subjected to routine histological examination and stained immunohistochemically for adiponectin, adiponectin receptor I (adipoRI) and receptor II (adipoRII).
Results:  The two groups were comparable with respect to body mass index, age and gender distribution. The expression of adiponectin decreased in liver biopsies with NASH as compared to those with simple steatosis (1.61 ± 0.70 vs 2.25 ± 0.75, P  = 0.028). Spearman's rank correlation coefficient analysis showed that the staining intensity of adiponectin negatively correlated with the grade of inflammation ( r  = −0.368, P  = 0.045) and stage of fibrosis ( r  = −0.380, P  = 0.038). There was no significant difference in expression of adipoRI and adipoRII between the two groups.
Conclusion:  These findings indicate that decreased liver adiponectin expression may play a role in the development and progression of NAFLD, from simple steatosis to NASH, in morbidly obese patients.     

三七总皂苷对非酒精性脂肪性肝病小鼠肝组织脂质沉积及NO/iNOS/NF-κB通路的影响

目的 研究三七总皂苷(PNS)对非酒精性脂肪性肝病(NAFLD)小鼠肝脏脂质沉积及一氧化氮(NO)-诱导型一氧化氮合酶(iNOS)-核因子κB(NF-κB)信号通路的影响.方法 随机将40只雄性BALB/c小鼠分为对照组、模型组、三七总皂苷(PNS)干预组和辛伐他汀干预组,每组10只.采用高脂饲料持续喂养法建立NAFL...     

Clinicopathological significance of oxidative cellular damage in non-alcoholic fatty liver diseases.

Oxidative stress may play an important role in the progression of simple steatosis to non-alcoholic steatohepatitis (NASH). Oxidative stress is generated through multiple sources, including oxidation of free fatty acids, cytochrome P4502E1, iron overload, and necro-inflammatory cytokines including tumor necrosis factor-alpha. Oxidative stress may trigger damage to cellular membranes and nuclear DNA, which results in lipid peroxidation and oxidative DNA damage, respectively. Here, we present our data on intrahepatic localization and clinico-pathological significance of oxidative stress-induced cellular damage in the patients with non-alcoholic fatty liver diseases (NAFLD). Our subjects were 23 patients with non-alcoholic simple fatty liver, 17 with NASH, and 7 with normal liver (control). Hepatic expression of 4-hydroxy-2'-nonenal (HNE) and 8-hydroxydeoxyguanosine (8-OHdG), as reliable markers of lipid peroxidation and oxidative DNA damage, was in situ detected by using commercially available monoclonal antibodies. While no HNE adducts were observed in control livers, they were frequently detected in NAFLD. In NASH, the localization of the HNE adducts was in the cytoplasm of sinusoidal cells and hepatocytes with a predominance in zone 3. The grade of necro-inflammation as well as the stage of fibrosis significantly correlated with the HNE labeling index. With respect to 8-OHdG, although no 8-OHdG expression was observed in normal liver and only a few in non-alcoholic simple fatty liver, 11 of 17 patients with NASH (65%) exhibited nuclear expression of 8-OHdG in hepatocytes and sinusoidal cells in areas of active inflammation. The 8-OHdG index significantly correlated with the grade of necro-inflammation, but not with the stage of fibrosis. Our observations suggest that oxidative cellular damage occurs frequently in livers with NAFLD and may be associated with some clinico-pathological features of NAFLD including liver fibrosis and possibly, hepatocarcinogenesis.     

非酒精性脂肪性肝病的临床及病理学特征

目的 探讨我国成人非酒精性脂肪性肝病(NAFLD)不同ALT水平患者的临床及病理学特征.方法 分析2005年1月-2009年3月经肝活体组织检查证实的108例NAFLD患者的人口学、生物化学及病理学资料,并比较血清ALT正常与增高患者的病理学及临床特征. 结果在108例NAFLD中,49例(45.4%)为单纯性脂肪肝(NAFL),57例(52.8%)为非酒精性脂肪性肝炎(NASH),2例(1.9%)为NASH相关肝硬化.ALT和AST水平,NASH患者分别为(156.2±137.7)U/L和(82.2士67.8)U/L,NAFL患者分别为(103.9±93.7)U/L和(52.2±33.4)U/L,t值分别为2.55和3.13,尸值均<0.01,差异有统计学意义.AST/ALT比值NASH患者为0.61±0.30,NAFL患者为0.78土0.77,NASH患者AST/ALT比值低于NAFL患者,t=2.18,p=0.03,差异有统计学意义.ALT增高组中NASH占64.9%(50/77),ALT正常组NASH占29.0%o(9/31),x~2=11.49,p=0.00.ALT增高组炎症程度显著高于ALT正常组,x~2=10.30,P=0.01,差异有统计学意义;但肝脂肪变和纤维化程度在两组之间,x~2=5.52,6.12;P=0.12,0.10,差异无统计学意义.ALT增高组血清AST、y-谷氨酰转肽酶、总胆固醇、载脂蛋白A1、载脂蛋白B和收缩压水平均比ALIT正常组显著增高(t值分别为5.91,2.00,2.30,2.10,3.14,2.43;p值分别为0.00,0.05,0.02,0.04,0.00,0.02),而AST/ALT比值、B超下脾脏肋间厚度则显著降低(t值分别为3.70和2.95;p值分别为0.00和0.01).多元回归分析显示血清ALT增高与病理学NASH相关(OR=2.78,95%CI 1.06～7.3,p=0.04),但血清ALT预测NASH的准确性欠佳,ROC曲线下面积为0.69(95%CI 0.59～0.8,P=0.00).结论 在中国成人NAFLD患者中可以见到完整的疾病谱.ALT升高患者NASH比例更高,血清ALT水平可预测NAFLD患者炎症程度,但不能预测脂肪变和纤维化程度.