芹菜素对2型糖尿病合并非酒精性脂肪肝小鼠脂代谢紊乱的作用及机制研究

目的研究芹菜素对2型糖尿病合并非酒精性脂肪肝小鼠脂代谢紊乱的作用及机制。方法 8周龄雄性db/db小鼠随机分组分为模型组、芹菜素组(50 mg·kg~(-1)·d~(-1)),以雄性C57BL/6J小鼠为正常对照组。各干预8周后,检测小鼠体质量、空腹血糖(FBG)、总胆固醇(CHO)、三酰甘油(TG)、游离脂肪酸(FFA)、天门冬氨酸氨基转移酶(AST)、成纤维细胞生长因子-19(FGF-19)、空腹胰岛素水平(Fins)和胰岛素抵抗指数(HOMA-IR);肝组织HE染色观察肝细胞脂质蓄积; RT-PCR检测肝脏SREBP1c、FAS、Sirt1、PGC1α、CPT1基因表达; Western blot检测PPARα蛋白表达。结果与模型组比较,芹菜素组小鼠体质量、FBG、CHO、TG、FFA显著降低(P0.05,P0.01),FGF-19显著升高(P0.01); HE染色肝细胞脂肪变性程度减轻,胞内脂滴数量减少,细胞排列整齐;肝脏SREBP1c、FAS mRNA表达降低(P0.05,P0.01),Sirt1、PGC1α、CPT1αmRNA表达显著升高(P0.05); PPARα蛋白表达显著升高(P0.01)。结论芹菜素可以改善糖尿病合并非酒精性脂肪肝小鼠肝脏脂肪代谢紊乱,可能是通过下调肝脏SREBP1c、FAS mRNA表达,上调肝脏Sirt1、PGC1α、CPT1α、PPARα表达实现的。     

血清内脂素、白介素6与非酒精性脂肪性肝病关系的研究

目的探讨内脂素、白介素6与非酒精性脂肪性肝病（NAFLD）和胰岛素抵抗（IR）的关系。方法测定60例NAFLD患者及50例健康对照者的空腹血糖（FPG）、空腹胰岛素（FIns）、内脂素（visfatin）、白介素6（IL-6）浓度,计算胰岛素抵抗指数（HOMA-IR）。结果 NAFLD组患者血清内脂素、白介素6水平均高于对照组（P〈0.05）;两者与胰岛素抵抗指数呈明显正相关（P〈0.05）,且血清内脂素水平与白介素6水平呈正相关（P〈0.05）。结论血清内脂素、白介素6通过与IR相关参与NAFLD的发生和发展。     

De Novo Non-Alcoholic Fatty Liver Disease Following Orthotopic Liver Transplantation

Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized clinico-pathologic entity typically associated with obesity, type II diabetes and hyperlipidemia. It has been noted to recur after orthotopic liver transplantation (OLT). We report four patients who developed de novo NAFLD within 3 months of OLT without the typical predisposing factors of diabetes mellitus or obesity. Three of the four patients underwent OLT for hepatitis C-related cirrhosis, and the other for alcoholic cirrhosis. Examination of the liver explants revealed no evidence of steatosis. No surreptitious alcohol use or a drug-induced process could be identified in these patients. Treatment of recurrent hepatitis C infection in one patient with interferon and ribavirin led to sustained suppression of the viral RNA to undetectable levels, but no improvement in histology or liver enzymes. All four patients had histologic evidence of preservation injury on the initial post-OLT biopsies, but the significance of this finding in relationship to the development of NAFLD is unknown. NAFLD can develop without any of the known predisposing conditions after transplantation, and this raises further questions about the pathogenesis of this condition .     

非酒精性脂肪肝病病人肝细胞中趋化因子CCL4的表达水平研究

目的：探讨趋化因子CCL4在非酒精脂肪性肝病(NAFLD)病人肝细胞中的表达水平,评价CCL4的表达水平是否与NAFLD的病情进展是否相关。方法方便收集该院2013年1月—2015年11月间肝脏手术后分离培养的原代肝细胞39例,包括正常肝原代细胞13例、非酒精性脂肪肝病人肝细胞14例以及肝纤维化病人肝细胞12例,分别提取其细胞中总RNA样品并进行逆转录后,通过Real-time PCR方法分析CCL4 mRNA的表达水平。结果 CCL4的表达水平在非酒精性脂肪肝(Steatosis)病人肝细胞中的表达水平为对照组的3.64倍;而在肝纤维化(Fibrosis)病人肝细胞中的表达水平则是对照组的33.69倍,是非酒精性脂肪肝组的9.25倍,差异均具有统计学意义(P<0.05)。结论 CCL4的表达水平与非酒精性脂肪性肝病的发生及进展呈正相关,可考虑用作NAFLD诊断及治疗的新靶点来进行进一步的开发研究。     

线粒体-细胞色素C途径在兔非酒精性脂肪肝肝细胞凋亡中的作用

目的探讨线粒体-细胞色素C途径在兔非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)肝细胞凋亡中的作用。方法雄性日本大耳兔40只,随机分为正常对照组(8周)和NAFLD模型组(4、6、8周组),每组各10只。模型组按1.2 m L/kg皮下注射花生油,2次/周,建立日本大耳兔NAFLD模型。按各组时间点处死兔子,测定兔血清中生化指标水平;HE染色观察肝组织病理形态改变,流式细胞仪检测肝细胞凋亡率;提取肝脏线粒体,分光光度法检测线粒体通透转换孔(mitochondrial permeability transition pore,MPTP)的状态变化;免疫组织化学法检查Bcl-2、Bax、细胞色素C和caspase-3在肝组织中的表达情况;Western blot检测细胞色素C以及caspase-3含量变化。结果与正常对照组相比,模型组肝脏脂质代谢指标和相关炎症因子表达水平升高,模型组肝细胞凋亡率与对照组比较显著增加(P0.01)。造模4周时出现肝功能损伤,脂质代谢紊乱,随着NAFLD病程的发展,Bcl-2、Bax、细胞色素C和caspase-3表达量逐渐增加,线粒体通透转换孔开放率随高脂饮食饲养时间延长明显增加(P0.01)。结论线粒体-细胞色素C途径在NAFLD引起的肝细胞凋亡中起到了一定的调控作用。     

荷叶碱对非酒精性脂肪肝模型小鼠肝组织中SREBP信号通路的影响

[目的]研究中药荷叶有效成分对非酒精性脂肪肝(NAFLD)模型小鼠的治疗作用及相关机制。[方法]通过蛋氨酸和胱氨酸联合缺乏饲料建立NAFLD模型小鼠,同时灌胃不同剂量荷叶碱,通过考察造模给药后各组小鼠体质量及血清生化指标,同时对肝组织分别进行苏木精-伊红(HE)染色和油红O染色,研究荷叶碱对NAFLD模型小鼠的治疗作用。此外提取造模给药后各组小鼠肝组织总核糖核酸(RNA),荧光定量核酸扩增检测(qPCR)法检测各组小鼠肝组织中胆固醇调节元件结合蛋白(SREBP)通路相关基因表达,初步探究荷叶碱缓解NAFLD的作用机制。[结果]荷叶碱能显著降低NAFLD模型小鼠体质量、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆固醇(TC)及三酰甘油(TG)水平,同时荷叶碱可缓解NAFLD模型小鼠肝组织中脂肪变性,减少肝组织中脂质含量;此外,荷叶碱可下调NAFLD模型小鼠肝组织中SREBP通路相关基因SREBP-1、乙酰CoA羧化酶(ACC)、ATP-柠檬酸裂解酶(ACLY)及脂肪酸合酶(FASN)表达。[结论]荷叶碱对NAFLD具有明显的疗效,其作用机制可能与抑制肝细胞SREBP通路激活相关。     

Liver steatosis assessment: Correlations among pathology,radiology, clinical data and automated image analysis software

Quantitating hepatic steatosis is important in many liver diseases and liver transplantation. Since steatosis estimation by pathologists has inherent intra- and inter-observer variability, we compared and contrasted computerized techniques with magnetic resonance imaging measurements, pathologist visual scoring, and clinical parameters. Computerized methods applied to whole slide images included a commercial positive pixel count algorithm and a custom algorithm programmed at our institution. For all liver samples (n = 59), including pediatric, adult, frozen section, and permanent specimens, statistically significant correlations were observed between pathology, radiology, and each image analysis modality (r = 0.75–0.97, p < 0.0001), with the strongest correlations in the pediatric cohort. Statistically significant relationships were observed between each method and with body mass index (r = 0.37–0.56, p from <0.0001 to <0.05) and with albumin (r = 0.55–0.64, p < 0.05) but not with alanine aminotransferase or aspartate aminotransferase. Although pathologist assessments correlated (r = 0.64–0.86, 0.92–0.97, and 0.78–0.91 for microvesicular, macrovesicular, and overall steatosis, respectively), the absolute values of hepatic steatosis visual assessment were susceptible to intra- and inter-observer variability, particularly for microvesicular steatosis. Image analysis, pathologist assessments, radiology measurements, and several clinical parameters all showed correlations in this study, providing evidence for the utility of each method in different clinical and research settings.     

The conundrum of cryptogenic cirrhosis: Adverse outcomes without treatment options

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Effect of chronic alcohol consumption on the development and progression of non-alcoholic fatty liver disease (NAFLD)

A number of epidemiologic studies show a protective effect of light to moderate daily alcohol consumption on the development of non-alcoholic fatty liver disease (NAFLD). Although these small amounts of ethanol may prevent fatty liver, they may also be a risk factor for other diseases such as breast and colon cancer. Those individuals who have underlying hepatic steatosis or non-alcoholic steatohepatitis (NASH) should not use ethanol chronically since the data available at present do not support a beneficial effect of alcohol in this situation. Especially overweight and obese individuals may be more susceptible towards alcohol even at moderate doses. Animal experiments show a negative effect of ethanol on liver histology in either dietary or genetic NASH models. In addition, patients with NASH reveal a significant increased risk for hepatocellular cancer (HCC) even with social alcohol consumption. Thus, subjects with underlying NASH should abstain from alcohol at any amounts.