Histological characteristics and prognosis in patients with fatty liver

Objective The clinical-pathological spectrum of fatty liver ranges from simple steatosis to end-stage fibrotic liver disease. However, no histological characteristics have been identified that can predict progression from pure steatosis to fibrotic liver disease in non-alcoholic fatty liver disease. The objective of this study was to investigate whether histological characteristics in patients with fatty liver without inflammation could predict mortality or development of cirrhosis. Material and methods A total of 417 patients had a liver biopsy performed, which showed fatty liver without inflammation. The population consisted of 170 non-alcoholic and 247 alcoholic fatty liver patients. The study cohort was linked through their unique personal identification number to The National Registry of Patients and the nationwide Registry of Causes of Death. Results Median follow-up time was 19.9 years in the non-alcoholic group and 12.8 years in the alcoholic group. Overall mortality in the non-alcoholic group was not related to morphological findings in the index liver biopsy. Mortality was significantly (p<0.05) higher in alcoholic patients with severe steatosis. One non-alcoholic patient (0.6%) developed cirrhosis versus 54 alcoholic patients (22%) during the follow-up period. Conclusions In patients with non-alcoholic fatty liver without inflammation, patients at risk for premature death cannot be identified by histological characteristics in the index liver biopsy. Patients with alcoholic fatty liver have a high risk for development of cirrhosis and increased mortality with the severity of steatosis in the index liver biopsy.     

肝移植术后新发非酒精性脂肪肝的危险因素

目的探究肝移植术后新发非酒精性脂肪肝(non-alcoholic fatty liver disease NAFLD)的危险因素。方法收集2015年5月至2019年5月于解放军总医院第五医学中心136例行肝移植患者的临床资料。比较移植术后新发NAFLD患者与无NAFLD患者的临床资料。应用logistic回归分析移植术后新发NAFLD的危险因素。结果肝移植术后1年时新发NAFLD的发病率为11.03%(15/136)。新发NAFLD患者与无NAFLD患者比较,术前BMI(27.85比23.17,P=0.003)、酒精性肝硬化(66.7%比23.1%,P=0.001)、术前高血压病史(33.3%比5.4%,P=0.016),肝移植术后1年时的ALT水平(24.0 U/L比21.5 U/L,P=0.012)差异有统计学意义。Logistic回归分析结果显示,术前酒精性肝硬化(OR=4.79,95%CI:1.35~16.98)、术前高BMI(OR=1.23,95%CI:1.05~1.46)是术后新发NAFLD的危险因素。结论肝移植术前酒精性肝硬化和高BMI是术后新发NAFLD的危险因素。     

非酒精性脂肪性肝病肝纤维化的诊断和治疗进展

非酒精性脂肪性肝病(NAFLD)正成为全球最常见的慢性肝病。从其疾病谱来看,非酒精性脂肪性肝炎(NASH)是疾病进展形式,可进展为肝纤维化,从而导致NAFLD相关肝硬化和肝癌。NASH肝纤维化与疾病预后密切相关,临床亟需有效措施诊断及干预疾病进展。重点介绍了目前非酒精性脂肪性肝纤维化的诊断和治疗进展。     

Incidence,survival and cause-specific mortality in alcoholic liver disease: a population-based cohort study

Objective: We studied the incidence of severe ALD requiring hospitalization in Finland, and survival and causes of death among the ALD patients.

Methods: A cohort of 11,873 persons (8796 men and 3077 women) with diagnosis of ALD during the years 1996–2012 was identified from Finnish national Inpatient Register. The annual incidence of alcoholic hepatitis (AH) and alcoholic liver cirrhosis was calculated. The cohort was combined with the data from national Cause of Death Register of Statistics Finland.

Results: The incidence of alcoholic liver cirrhosis increased from 8.8/100,000 in year 2001 to 14.6/100,000 in year 2012 among men and from 2.4 to 4.2/100,000 among women. The incidence of AH increased from 3.7 to 6.5/100,000 among men and from 1.3 to 2.7/100,000 among women. The relative 5-year survival ratios of patients with alcoholic liver cirrhosis and AH were 29 and 50% among men and 38 and 52% among women, respectively. Out of 8440 deaths, 65% were due to alcoholic-related causes. The risk of death among ALD patients was increased in malignancies (SMR 6.82; 95% CI: 6.35–7.29), cardiovascular diseases (6.13; 5.74–6.52), respiratory diseases (7.86; 6.70–9.10), dementia (3.31; 2.41–4.44) and accidents and violence (11.12; 10.13–12.15).

Conclusions: The incidence of AH and alcoholic liver cirrhosis is increasing. The survival is poor. Most deaths are alcohol-related and other common causes of excess deaths are cancers especially in the upper aerodigestive tract and cardiovascular, digestive and respiratory diseases as well as violence and accidents.     

FibroScan分别与GPR、APRI、NFS、FIB-4联合应用对慢性乙型肝炎合并非酒精性脂肪性肝病进展期肝纤维化的诊断价值比较

目的评价FibroScan、GPR、APRI、NFS、FIB-4单独应用及FibroScan分别与GPR、APRI、NFS、FIB-4联合应用对慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者进展期肝纤维化的诊断价值。方法选取2014年11月-2018年8月在四川省人民医院行肝穿刺病理检查并确诊为CHB合并NAFLD的患者92例。根据肝穿刺病理SAF分级诊断标准,分为轻中度肝纤维化(F1+F2)组(n=69)和进展期肝纤维化(F3)组(n=23)。同时应用FibroScan测得肝脏硬度值,根据临床指标分别计算GPR、APRI、NFS、FIB-4。计量资料两组间比较采用Mann-Whitney U检验;相关性分析采用Spearman秩相关;多因素二元logistic回归构建联合预测因子(向前逐步回归法),绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),并采用Delong方法进行比较,评价各种无创诊断方法单独及联合应用对CHB合并NAFLD进展期肝纤维化的诊断价值。结果轻中度肝纤维化组的FibroScan、GPR、APRI、NFS及FIB-4水平明显低于进展期肝纤维化组(Z值分别为-4.910、-3.425、-3.837、-3.873、-3.990,P值均<0.05)。相关性分析结果显示,FibroScan、GPR、APRI、NFS、FIB-4与肝纤维化病理分期均呈正相关(r值分别为0.518、0.361、0.405、0.407、0.418,P值均<0.001)。FibroScan、GPR、APRI、NFS及FIB-4单独应用对诊断进展期肝纤维化均有一定价值(AUC分别为0.844、0.740、0.770、0.771、0.779,P值均<0.001),但FibroScan诊断价值并不优于GPR、APRI、NFS、FIB-4(P值均>0.05)。将FibroScan分别与GPR、APRI、NFS、FIB-4联合,诊断进展期肝纤维化的AUC均较单独应用时明显提高(Z值分别为1.977、2.076、2.361、2.206,P值均<0.05);将FibroScan与GPR+APRI+NFS+FIB-4同时联合诊断进展期肝纤维化的AUC及95%可信区间为0.896(0.813~0.950)。结论FibroScan、GPR、APRI、NFS及FIB-4诊断进展期肝纤维化均有一定的临床价值,FibroScan分别与GPR、APRI、NFS、FIB-4联合诊断进展期肝纤维化的效能优于单项血清学模型,其中FibroScan联合NFS或FIB-4的临床价值可能最佳。     

Non-invasive fibrosis scoring systems can predict future metabolic complications and overall mortality in non-alcoholic fatty liver disease (NAFLD)

Background and aim: Progression to fibrosis in non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of liver-related events, overall mortality and possibly metabolic comorbidities. Our aim was to determine if non-invasive fibrosis scoring systems can predict the future risk of diabetes mellitus, cardiovascular disease (CVD), chronic kidney disease (CKD), liver-related events and overall mortality.

Methods: Patients with biopsy-proven NAFLD 1978 to 2006 were identified from a computerised register in Malmö, Sweden. Medical records were scrutinised in detail to collect data from inclusion to endpoint (death or end of 2016). Non-invasive fibrosis scoring systems (FIB-4-index, NAFLD fibrosis score (NFS), APRI and BARD score) were calculated and the scores classified into three risk categories (low, intermediate and high risk for advanced fibrosis). Chronic kidney disease was evaluated using the CKD-EPI equation.

Results: One hundred and forty-four patients with biopsy-proven NAFLD were included, with a mean age of 53.2 years and a mean follow-up time of 18.8 years. At inclusion, 18% had advanced fibrosis. NFS was the only score that could predict the future risk of all included outcomes with fairly good accuracy (Area-under-ROC curve). Multivariate-adjusted hazard ratios revealed that both the intermediate and high-risk category of FIB-4-index and NFS could significantly predict metabolic outcomes. All four scoring systems significantly predicted overall mortality in the high-risk category.

Conclusions: Non-invasive fibrosis scoring systems, especially NFS and FIB-4-index, can be used to identify patients at risk of future liver-related events, overall mortality, metabolic comorbidities and CKD.     

脂肪肝与非脂肪肝患者血常规的差异分析

目的探讨成人脂肪肝患者与非脂肪肝患者血常规的差异。方法选用沈阳地区2008年3月～2008年12月参加体检的18岁以上人群为研究对象,对肝脏彩色多普勒检查诊断的脂肪肝与非脂肪肝患者,采用问卷咨询、体格检查和生化检查外,重点探讨脂肪肝与血常规之间的关系,数据用SPSS16.0软件分析。结果入选人群共8842名,B超共检出脂肪肝3306例,占37.39%,其中酒精性、非酒精性脂肪肝分别占15%（1326名）和22.39%（1980名）,与非脂肪肝组（NAFL）相比,脂肪肝组（AFL）WBC（白细胞计数）、EO%（嗜酸性细胞比率）、RBC（红细胞计数）、HGB（血红蛋白浓度）、HCT（红细胞比积测定）、MCH（平均红细胞Hb含量）、MCHC（平均红细胞Hb浓度）、RDW（红细胞分布宽度）、PDW（血小板分布宽度）显著增加（P〈0.01）;LYM%（淋巴细胞比率）、MONO%（单核细胞比率）、MCV（平均细胞容积）、P-LCR（大型血小板比率）、MPV（平均血小板体积）等明显增加（P〈0.05）;PLT（血小板计数）明显减少（P〈0.05）;与非酒精性脂肪肝组（NAFL）比,酒精性脂肪肝（AFL）组RBC、HGB、HCT、MCV、MCHC等显著增加（P〈0.01）,LYM%明显减少（P〈0.05）,MCH、MONO%（单核细胞比率）明显增加（P〈0.05）。结论脂肪肝患者中白细胞总数及分类（除中性粒细胞百分比外）明显高于非脂肪肝组,红细胞系统（除MCHC外）也有类似的趋势,而血小板计数明显低于非脂肪肝组;而酒精性和非酒精性脂肪肝相比,红细胞系统显著增加,尤其MCV更加明显,而白细胞系统（除LYM%明显减少外）和血小板系统大部分无显著变化。说明简单的血常规及分类检查对脂肪肝的临床诊断和病因诊断具有重要的意义。     

Characteristics of intestinal bacteria with fatty liver diseases and cirrhosis

Non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) are significant health burdens worldwide with a substantial rise in prevalence. Both can progress to liver cirrhosis. Recent studies have shown that the gut microbiome was associated with NAFLD/AFLD development and progression. The present review focuses on the characteristics of bacteria in NAFLD, AFLD and liver cirrhosis. The similarities and differences of intestinal bacteria are discussed.This study reviews the existing literatures on the microbiota, fatty liver disease, and liver cirrhosis based on Pubmed database.The study showed NAFLD was characterized by increased amounts of Lachnospiraceae from the phylum Firmicutes and Roseburia from the Lachnospiraceae family, and the proportion of Enterobacteria and Proteobacteria was increased after alcohol intake. Reduced Bacteroidetes was observed in cirrhosis. Microbiota can improve or aggravate the above liver diseases through several mechanisms, like increasing liver lipid metabolism, increasing alcohol production, increasing intestinal permeability, bacterial translocation, intestinal bacterial overgrowth, enteric dysbiosis, and impairing bile secretion.Different hepatic diseases owned different intestinal bacterial characters. Microbiota can improve or aggravate three kinds of liver diseases through several mechanisms. However, the depletion of these bacteria is needed to verify their role in liver disease.     

非酒精性脂肪性肝病患者肺功能变化临床分析

目的分析探讨非酒精性脂肪性肝病(NAFLD)患者肺功能的变化及意义。方法选取2016年9月-2017年5月于陆军军医大学大坪医院体检中心进行体检的非酒精性脂肪性肝病(NAFLD)患者为NAFLD组(n=275),非NAFLD患者为对照组(n=276),对2组人群的肺功能资料进行分析,包括用力肺活量(FVC)、1秒钟用力呼气容积(FEV1)及FEV1/FVC比值,同时对ALT升高的NAFLD组和ALT正常的NAFLD组的肺功能指标进行比较。计量资料方差齐者2组间比较采用两独立样本t检验,方差不齐则采用非参数Wilcoxon秩和检验。计数资料2组间比较采用χ2检验。结果 NAFLD组FVC、FEV1分别为(3.60±0.87)L、(2.97±0.79)L,均低于对照组的(3.87±0.80)L、(3.17±0.81)L,差异均有统计学意义(t值分别为-3.78、-2.87,P值均<0.01)。NAFLD组FEV1/FVC比值为(82.06±13.88)%,略低于对照组(82.88±13.0)%,但差异无统计学意义(P>0.05)。ALT升高的NAFLD组FVC、FEV1、FEV1/FVC分别为(3.53±0.82)L、(2.72±0.80)L、(81.21±13.00)%,均低于ALT正常的NAFLD组的(3.69±0.92)L、(3.06±0.79)L、(82.69±12.92)%,但差异均无统计学意义(P值均>0.05)。结论 NAFLD患者可能发生肺功能损害,与其代谢紊乱、肝脏炎症等因素有一定关系。     

脂肪细胞脂肪酸结合蛋白在非酒精性脂肪性肝病患者肝脏中的表达及意义

[目的]研究脂肪细胞特异性蛋白脂肪细胞脂肪酸结合蛋白(adipocyte fatty acid-binding protein,aP2)在非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者肝脏中的表达及意义。[方法]收集2011-01—2012-12期间收治的16例NAFLD患者(NAFLD组)及15例有轻度肝功能异常但肝穿病理检查正常者(对照组)的肝穿标本;对2组标本行苏木精-伊红染色和Masson染色了解其脂肪肝活动度评分,免疫荧光双标染色检测肝组织中aP2蛋白的表达定位,以及RT-PCR检测aP2基因的表达;对2组以上测定结果进行分析比较。[结果]病理组织学结果显示NAFLD组患者的脂肪变程度达到1~3级,肝小叶内炎症1~3级,肝细胞气球样变达0~1级,肝纤维化评分0~2。NAFLD组活动度评分5.3±1.25,对照组为0。在激光共聚焦显微镜下,可见NAFLD组绿色荧光标记的aP2表达于肝细胞胞浆内,并且与红色荧光标记的白蛋白位置重叠;对照组肝脏中无aP2表达。RTPCR显示NAFLD组肝脏组织aP2mRNA的表达较对照组升高了约3.3倍。[结论]在NAFLD时,肝细胞可以表达脂肪细胞特征性蛋白,即发生了成脂性改变,此改变与肝脏的炎症反应相关,可能参与了疾病的进展。     

Abstinence in patients with alcoholic liver cirrhosis: A follow-up study

Aim:  To investigate the proportion of patients with alcoholic cirrhosis who abstained from alcohol after contact with a hepatology unit, the predictors for abstinence, and the role of clinical and psychosocial factors in short-term mortality in these patients.
Methods:  Eighty-seven consecutive patients with alcoholic cirrhosis from a transplant center were included. Data on cirrhosis severity and complications, as well as on abstinence and psychosocial factors were collected. Patients were followed up for 19 (12–25) months. Data on abstinence during follow up, alcohol abuse treatment, psychiatric contact, severity of cirrhosis, mortality, and liver transplantation were analyzed.
Results:  Prior to inclusion, 53/87 (61%) patients had abstained from alcohol for 24 months (interquartile range: 18–33). Twenty percent had a history of other substance abuse, 47% had undergone alcohol abuse treatment, and 21% had a previous psychiatric diagnosis. Forty-eight percent lived with a partner, 23% worked/studied, and 53% were pensioners. During follow up, 26% died, 20% received a liver transplant, 55% abstained from alcohol, 47% received alcohol abuse treatment, and 33% had psychiatric contact. In a multivariate analysis, abstinence during follow up was found to be related to abstinence upon inclusion in the study, to the model for end-stage liver disease (MELD) score at follow up, and to no abuse treatment in a detoxification unit, whereas mortality was related to index MELD and alcohol abuse treatment during follow up. Neither abstinence nor mortality was related to psychosocial factors.
Conclusion:  More than half of patients with alcoholic cirrhosis were found to abstain from alcohol during follow up, which was related to prior documentation of abstinence and cirrhosis severity. Cirrhosis severity (expressed as the MELD) and alcohol abuse treatment during follow up were related to short-term mortality.     

Placebo-controlled,randomised clinical trial: high-dose resveratrol treatment for non-alcoholic fatty liver disease

Objective “The obesity epidemic” has led to an increase in obesity-related conditions including non-alcoholic fatty liver disease (NAFLD), for which effective treatments are in demand. The polyphenol resveratrol prevents the development of experimental NAFLD through modulation of cellular pathways involved in calorie restriction. We aimed to test the hypothesis that resveratrol alleviates NAFLD in a randomised, clinical trial. Materials and methods A total of 28 overweight patients with transaminasemia and histological NAFLD were randomised 1:1 to placebo or resveratrol 1.5 g daily for 6 months. Twenty-six participants completed the trial and underwent repeated clinical investigation, blood work, MR spectroscopy; and 19 participants agreed to a repeat liver biopsy. Results Resveratrol treatment was generally not superior to placebo in improving plasma markers of liver injury (primary outcome: alanine transaminase, p?=?0.51). Resveratrol-treated patients showed a 3.8% decrease in liver lipid content (p?=?0.03), with no difference between the two treatment arms (p?=?0.38) and no improvement of histological features. Resveratrol treatment was not associated with improvements in insulin sensitivity or markers of the metabolic syndrome, except for a transient decrease in systolic BP. Microarray analysis and qRT-PCR revealed no major changes in expression profile. Also, we report a serious adverse event in a patient who developed fever and bicytopenia. Conclusions In this placebo-controlled, high-dose and long-term study, resveratrol treatment had no consistent therapeutic effect in alleviating clinical or histological NAFLD, though there may be a small ameliorating effect on liver function tests and liver fat accumulation.     

非诺贝特治疗酒精性与药物性脂肪肝的实验研究

目的 研究非诺贝特对酒精性脂肪肝以及药物性脂肪肝的作用,并探讨两种脂肪肝的发病机制。方法 建立酒精性脂肪肝和药物性脂肪肝大鼠模型并分为治疗组(80 mg/kg)和对照组。4周后处死,分别测定肝功能,血清甘油三酯(TG)、胆固醇(TC)、高密度脂酯(HDL),血清及肝组织丙二醛(MDA)、肝脂酯(HL),脂蛋白脂酶(LPL)及肝脏病理变化。 结果 酒精性脂肪肝非诺贝特组与对照组比较,血清TG治疗组为(1.07±0.06)mmol/L,对照组为(1.56±0.29)mmol/L,血清MDA分别为(1.10±0.22)nmol/L和(1.26±0.21)nmol/L,肝组织内MDA分别为(5.92±1.24)nmol/g和(7.42±1.22)nmol/g,血清内HL分别为(0.053±0.006)μEq·ml-1·h-1和(0.037±0.006)μEq·ml-1·h-1,LPL水平明显升高分别为(0.018±0.004)μEq·ml-1·h-1和(0.014±0.004)μEq·ml-1·h-1;肝组织HL分别为(0.075±0.010)μEq·ml-1·h-1和(0.065±0.007)μEq·ml-1·h-1,LPL分别为(0.022±0.014)μEq·ml-1·h-1和(0.008±0.002)μEq·ml-1·h-1,TC的水平无明显变化,肝内脂质含量分别为(26.01±1.69)mg/g和(71.45±2.66)mg/g,同时肝脏病理明显改善。药物性脂肪肝非诺贝特组与对照组比较肝脏病理改变差异无显著意义。 结论 非诺贝特治疗酒精性脂肪肝可以明显减少肝内脂质的含量,改     

Protein glutathionylation increases in the liver of patients with non-alcoholic fatty liver disease

Background and Aim:  Oxidative stress is an important pathophysiological mechanism in non-alcoholic steatohepatitis, where hepatocyte apoptosis is significantly increased correlating with disease severity. Protein glutathionylation occurs as a response to oxidative stress, where an increased concentration of oxidized glutathione modifies post-translational proteins by thiol disulfide exchange. In this study, we analyzed the protein glutathionylation in non-alcoholic fatty liver disease (NAFLD) and evaluated a potential association between glutathionylation, fibrosis, and vitamin E treatment.
Methods:  Protein glutathionylation was studied in the livers of 36 children (mean age 12.5 years, range 4–16 years) subdivided into three groups according to their NAFLD activity score (NAS) by Western blot analysis and immunohistochemistry, using a specific monoclonal antibody. In addition, we identified the hepatocyte ultrastructures involved in glutathionylation by immunogold electron microscopy.
Results:  Our findings showed that protein glutathionylation increases in the livers of patients with NAFLD and it is correlated with steatohepatitis and liver fibrosis. Its increase appears mainly in nuclei and cytosol of hepatocytes, and it is reversed by antioxidant therapy with reduced fibrosis.
Conclusion:  Protein glutathionylation significantly increases in livers with NAFLD, strongly suggesting that oxidative injury plays a crucial role in this disease. Furthermore, the marked increase of protein glutathionylation, in correlation with collagen VI immunoreactivity, suggests a link between the redox status of hepatic protein thiols and fibrosis.     

Trends in hepatocellular carcinoma due to non-alcoholic fatty liver disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is associated with hepatocellular carcinoma (HCC), the most frequent malignant liver tumor. The increasing prevalence of obesity and diabetes is influencing the epidemiology of HCC with the most dramatic increases in NAFLD-related HCC seen in Western countries. Although cirrhosis is the major risk factor for HCC in NAFLD, there is increasing recognition that NAFLD-HCC occurs in the absence of cirrhosis.

Areas covered: The epidemiology of NAFLD related HCC and its impact on changing the incidence of HCC globally. We overview risk factors for NAFLD-HCC in the presence and absence of cirrhosis and examine trends in liver transplantation (LT) related to NAFLD-HCC.

Expert commentary: The incidence of NAFLD-related cirrhosis will continue to rise globally in parallel with risk factors of obesity and diabetes. Consequently, NAFLD-related HCC will become an increasingly important cause of liver-related morbidity and mortality and a common indication for LT worldwide. Further identification of risk factors for NAFLD-HCC and effective treatments for NAFLD are required to reduce this future burden of disease.     

Characterization of patients with both alcoholic and nonalcoholic fatty liver disease in a large United States cohort

BACKGROUND Nonalcoholic fatty liver disease(NAFLD) is the hepatic manifestation of the metabolic syndrome(Met S) and is characterized by steatosis in the absence of significant alcohol consumption. However, Met S and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.AIM To assess the clinical characteristics of patients with both alcoholic and NAFLD(BAFLD) in a large cohort in the United States.METHODS Adults from the National Health and Nutrition Examination Survey between2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase(ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either Met S or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score(FIB4 index).RESULTS The prevalence of NAFLD was at 25.9%(95%CI; 25.1-26.8) and that of BAFLD was 0.84%(0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase,triglycerides, and lower platelets; P 0.01 for all. More importantly, after adjusting for Met S components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR(95%CI) based on FIB4 index 2.67 was 3.2(1.4, 7.0), P = 0.004].CONCLUSION A significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.     

水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝患者初步临床研究

目的 探讨水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝患者的疗效。方法 选取本院2014年10月~2015年10月诊治的酒精性脂肪肝患者164例,采用随机数字表法分为两组,对照组患者82例采用多烯磷脂酰胆碱治疗,观察组患者82例采用水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗,比较两组患者治疗前后血脂指标、肝功能指标、影像学检查指标的变化。结果 在治疗3个月末,观察组患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰转肽酶分别为（3.8±0.6） mmol/L、（1.3±0.2）mmol/L、（2.3±0.2） mmol/L、（47.3±7.2）U/L、（41.7±8.0） U/L、（46.5±7.3） U/L,显著低于对照组的（4.4±0.5）mmol/L、（1.5±0.2） mmol/L、（2.8±0.3） mmol/L、（58.1±12.4） U/L、（55.6±9.9） U/L和（67.8±10.1） U/L（P<0.01）;观察组高密度脂蛋白胆固醇为（1.3±0.2） mmol/L,显著高于对照组的（1.1±0.2） mmol/L（P<0.01）;观察组影像学检查提示重度、中度、轻度、正常肝脏表现者分别为1例（1.2%）、11例（13.4%）、33例（40.2%）、37例（45.1%）,显著好于对照组的6例（7.3%）、19例（23.2%）、45例（54.9%）、12例（14.6%,P<0.01）。结论 水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝可明显改善酒精性脂肪肝患者血脂指标和肝功能指标。     

Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales

BACKGROUNDSeeking potentially novel blood markers of liver fibrosis and steatosis is constantly of crucial importance. Despite a growing number of studies in this field of hepatology, a certain role of hematological indices in the course of liver disorders has not been fully elucidated, yet.AIMTo evaluate a diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR) in the course of alcoholic liver cirrhosis (ALC) and nonalcoholic fatty liver disease (NAFLD).METHODSOne hundred forty-two patients with ALC, 92 with NAFLD and 68 persons in control group were enrolled in the study. Hematological indices (NLR, PLR and MPR), indirect and direct markers of liver fibrosis (aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index, fibrosis-4, gamma-glutamyl transpeptidase to platelet ratio, procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin) were measured in each person. Model for end-stage liver disease (MELD) score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD.RESULTSMPR and NLR values in ALC patients were significantly higher in comparison to control group; PLR level was significantly lower. MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis. MPR, NLR and PLR correlated with MELD score. NLR level in NAFLD patients was significantly higher in comparison to controls. MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score. AUC values and proposed cut-offs for NLR, PLR and MPR in ALC patients were: 0.821 (> 2.227), 0.675 (< 70.445) and 0.929 (> 0.048), respectively. AUC values and proposed cut-offs for NLR, PLR and MPR in NAFLD group were: 0.725 (> 2.034), 0.528 (> 97.101) and 0.547 (> 0.038), respectively.CONCLUSIONHematological markers are inseparably connected with serological indices of liver fibrosis in ALC and NAFLD patients. MPR and NLR turned out to be the most powerful parameters in ALC patients.