Hepatic steatosis in participants in a program of low-dose CT screening for lung cancer

ObjectiveDetermine the frequency of moderate-to-severe hepatic steatosis (HS) in asymptomatic participants in a low-dose CT (LDCT) screening program for lung cancer, to identify risk factors, and develop recommendations.MethodsBaseline LDCT scans of the chest of 170 participants in an IRB-approved study between August 2011 and April 2016 were reviewed. Demographic variables, comorbidities, and liver function tests were documented. Hepatic and splenic attenuation values hounsfield unit (HU) were measured. Regression analyses were performed.ResultsAverage liver attenuation was 57.6 HU (standard deviation (SD) 9.3) and average liver/spleen (L/S) ratio was 1.3 (SD 0.3). Liver attenuation was <40 HU for 9 (5.3%), liver/spleen (L/S) ratio <0.8 for 6 (3.5%), and either <40 HU or L/S ratio <0.8 for 9 (5.3%). Male sex (p = 0.004), diabetes (p = 0.0005), emphysema (p = 0.03), and high BMI (p = 0.0006) were significant predictors of HS. Aspartate aminotransferase (p = 0.0018) and alanine aminotransferase (p = 0.012) were negatively correlated with liver attenuation. Reduced serum levels of alpha-1-antitrypsin may be a common factor of emphysema and HS.ConclusionLDCT can detect HS in asymptomatic participants with frequencies similar to previous reports. If liver attenuation is below 40 HU and/or L/S ratio below 0.8, further evaluation of HS to the primary care physician or liver specialist is recommended.     

非酒精性脂肪性肝病与颈动脉粥样硬化关系的临床研究

目的通过超声检测非酒精性脂肪性肝病患者颈动脉内-中膜厚度和斑块形成情况,探讨NAFLD与动脉粥样硬化的相关性。方法收集NAFLD患者70例（轻度脂肪肝及中度脂肪肝患者各25例,重度脂肪肝患者20例）和健康对照者40例。检测血清丙氨酸转氨酶（ALT）、门冬氨酸转氨酶（AST）、谷氨酰转肽酶（GGT）、直接胆红素（DBIL）、间接胆红素（IBIL）水平。采用彩色多普勒超声对脂肪肝进行诊断并测量CIMT,CIMT≥1.2mm者判定为斑块形成。结果 ALT、AST、GGT、DBIL、IBIL、CIMT在健康对照组、轻度脂肪肝组、中度脂肪肝组及重度脂肪肝组中逐渐升高,4组比较差异具有统计学意义（均P〈0.001）;在70例患者中,CIMT分别与ALT、AST、GGT、TBIL、IBIL、DBIL显著相关（P〈0.01）;spearman等级相关分析显示：斑块形成率与NAFLD患者脂肪肝程度（轻度、中度、重度）存在正相关（P〈0.01）。结论 NAFLD患者的肝功能指标与CIMT存在正相关;NAFLD患者更易发生AS和形成粥样斑块,脂肪肝的严重程度与斑块形成率呈正相关。     

罗格列酮联合α-硫辛酸对大鼠非酒精性脂肪肝的影响

目的：观察罗格列酮（RGZ）联合α-硫辛酸（LA）对大鼠非酒精性脂肪肝（NAFL）的影响,并探讨其作用机制。方法：高脂饲料诱导NAFL大鼠模型,分别以RGZ、RGZ联合LA干预。第8周测大鼠肝脏指数、肝组织甘油三酯、总胆固醇和丙二醛,观察肝脏病理学变化。结果：RGZ联合LA可显著减少NAFL大鼠肝脏脂肪沉积、降低肝脏脂质含量、丙二醛水平。结论：RGZ联合LA对NAFL大鼠肝脏脂肪沉积和氧化损伤有较好的改善作用;其作用机制与改善胰岛素抵抗和抗氧化损伤有关。     

Nonspecificity of the fat-sparing ring surrounding focal liver lesion at MR imaging

RATIONALE AND OBJECTIVES: The presence of a fat-sparing ring surrounding focal liver lesions in patients with steatosis has been described only in malignant lesions. Our purpose is to evaluate whether this fat-sparing ring peripheral to tumors is a specific marker of malignancy. MATERIALS AND METHODS: From 300 magnetic resonance examinations of focal liver lesions, 132 patients with a confirmed nature of the lesions were selected. There were 24 patients (18.2%) with lesions having a perilesional fat-sparing ring in the opposed-phase spoiled T1-weighted gradient echo images. All these livers had steatosis. RESULTS: Perilesional fat-sparing rings were observed in 19 (21.6%) malignant and 5 (11.4%) benign lesions. Size of the lesion was not related to the presence of the fat-sparing ring (P=.6), neither was type of lesion (malignant versus benign) statistically related to the presence of the perilesional fat-sparing ring in the opposed-phase gradient echo magnetic resonance images (chi-square, P=.15). Fat-sparing rings were mainly seen in metastases (51.4% of metastases), but seldom in primary malignant tumors (1.9% of hepatocellular carcinomas). Hemangiomas also presented this finding (18.5% of hemangiomas). CONCLUSIONS: We believe that the presence of this bright rim surrounding lesions on oppose-phase images in patients with steatosis mainly represent decrease portal flow, either because of compressed and atrophic hepatocyte cords with sinusoidal congestion in expanding metastatic lesions or the presence of arterioportal perfusion abnormalities in vascularized hemangiomas.     

Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years

BackgroundNo studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm.ObjectivesTo assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS.SettingUniversity hospital.MethodsA total of 191 patients with a body mass index >40 kg/m² and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS).ResultsForty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5–103.5] mg/dL to 61.0 [range, 2.0–76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from −1.0 ± 1.0 to −1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years.ConclusionsMBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.     

脂肪变性供肝对肝移植手术安全性的临床研究

目的探讨供肝脂肪变性的程度对肝移植术后早期肝功能和预后的影响。方法观察我院2009年1月至2013年2月进行肝移植患者90例,观察对象分为对照组A组(无脂肪变性供肝),不同程度脂肪变性供肝B组(脂肪变30%﹚、C组(脂肪变30%~60%)、D组(脂肪变60%),对四个小组的术后不同时间的肝功能情况、术后并发症、1年存活率进行比较。结果 D组近期肝功能恢复明显慢于其他组,术后并发症D组明显高于其他组,1年存活率各组之间差异无显著性。结论不同程度的脂肪变性供肝均可以运用于肝移植手术,中至重度的脂肪变性供肝肝功能恢复慢。     

In nonalcoholic fatty liver disease,Roux-en-Y gastric bypass improves liver histology while persistent disease is associated with lower improvements in waist circumference and glycemic control

Background

In obese individuals undergoing Roux-en-Y gastric bypass (RYGB), nonalcoholic fatty liver disease (NAFLD) is seen in 75% to 100% of cases. This improves postsurgery, but some patients continue to have persistent NAFLD.

山楂叶总黄酮对NAFLD肝细胞凋亡影响的研究

目的探讨山楂叶总黄酮（HLF）对非酒精性脂肪性肝病（NAFLD）肝细胞凋亡的影响。方法采用肝L-02细胞诱导NAFLD模型,分为正常组、低剂量组、高剂量组、模型组4组,采用不同浓度HLF进行干预,低剂量组HLF100滋g/ml,高剂量组HLF400滋g/ml。观察细胞的形态学变化,流式细胞术检测细胞凋亡率,Westernblot检测凋亡蛋白表达的变化。结果模型组细胞形态学发生改变,HLF药物干预后,高剂量组细胞形态学改变明显好于低剂量组及模型组;模型组与HLF高剂量组早期凋亡率[（14.63±1.82）%、（6.75±1.83）%]比较,差异有统计学意义（P＜0.05）;模型组与HLF高剂量组中晚期凋亡率[（11.36±2.94）%、（3.49±1.03）%]比较,差异有统计学意义（P＜0.01）;HLF高、低剂量组中晚期凋亡率[（3.49±1.03）%、（8.79±1.05）%]比较,差异有统计学意义（P＜0.05）;模型组与HLF高、低剂量组总凋亡率比较,差异有统计学意义（P＜0.05或0.01）。Bax、Cyt-C和Caspase-9促凋亡蛋白在模型组中表达明显增高,Bcl-2、MitochondriaCytochromeC抗凋亡蛋白在高剂量组及正常组中高表达;模型组与高、低剂量组凋亡蛋白Bax/Bcl-2的比值[（1.999±0.376）、（0.144±0.023）、（0.399±0.045）]比较,差异有统计学意义（P＜0.01）;模型组与高、低剂量组凋亡蛋白Cytosolic/MitochondriaCytochromeC的比值[（0.287±0.037）、（0.041±0.006）、（0.097±0.024）]比较,差异有统计学意义（P＜0.01）;模型组与高、低剂量组凋亡蛋白CleavedCaspase-9的表达[（0.060±0.005）、（0.030±0.003）、（0.030±0.003）]比较,差异有统计学意义（P＜0.01）。结论NAFLD细胞模型存在凋亡现象,HLF药物可能通过调节Bcl-2、Bax、CytochromeC、Caspase-9等相关凋亡蛋白的表达,干预肝细胞的凋亡。