非酒精性脂肪性肝病临床特点分析

目的 探讨非酒精性脂肪性肝病(NAFLD)与代谢综合征关系及相关危险因素.方法 回顾性分析在我院健康体检764例在职教师的体检资料,并对其相关资料进行统计分析.结果 NAFLD发病率高达27.23%,NAFLD组高血压、2型糖尿病、血脂异常、肥胖、代谢综合征(MS)发病率明显高于对照组;三酰甘油、总胆固醇、低密度脂蛋白胆固醇、空腹血糖、收缩压、舒张压、体质量指数均高于对照组,高密度脂蛋白胆固醇低于对照组(P<0.05).结论 NAFLD发生率高,与代谢综合征(MS)关系密切.高血压、2型糖尿病、血脂异常、肥胖是NAFLD发生的危险因素.     

男性代谢综合征及其组分与非酒精性脂肪肝病关系研究

目的 探讨男性代谢综合征(MS)及其组分与非酒精性脂肪肝病(NAFLD)的关系.方法 用横断面研究的方法对1902例研究对象进行分析,根据NAFLD的诊断标准分为NAFLD组(778例)和对照组(1 124例).测定2组人群血压、BMI、TC、TG、LDL-C、HDL-C、空腹血糖和餐后2h血糖(2 h PG)、尿酸等指标并进行比较.结果 本组男性资料NAFLD的患病率为40.9％ (778/1902);男性人群NAFLD组的BMI、高血压患病率、TG、空腹血糖及2hPG、LDL-C、尿酸水平均高于对照组[(25.6±2.1)kg/m2比(23.7± 5.6) kg/m2,33.8％ (263/778)比21.3％ (239/1124),(2.2±1.4) mmol/L比(1.4±0.8)mmol/L,(8.2±2.5) mmol/L比(7.2±1.7) mmol/L,(2.8±0.7)mmol/L比(2.7±0.7) mmol/L,(425±85) μmol./L比(336±100).μmol/L,P＜0.01],HDL-C水平低于对照组[(1.27±0.28) mmol/L比(1.44±0.34) mmol/L,P＜0.01];Logistic回归分析显示TG、HDL-C、2 h PG、尿酸、BMI、高血压[OR值(95％ CI)分别为1.6559(1.253～2.026)、0.303(0.1526 ～0.603)、1.205(1.100 ～1.320)、1.003(1.001 ～ 1.005)、1.160(1.069～1.259)、1.69(1.084～2.634),均P＜0.05]是男性NAFLD的独立危险因素;与对照组相比,NAFLD组患者伴有2个以上MS组分者增多,差异有统计学意义(P＜0.05),男性MS在NAFLD组患病率明显高于对照组[41.7％(324/778)比13.7％(154/1124),P＜0.05];男性MS患者发生NAFLD病的相对危险性是无MS患者的4.48倍(95％ CI,3.0786 ～6.5281).结论 男性人群NAFLD与多元代谢紊乱存在密切关系;MS组分TG、HDL-C、2 h PG、BMI、高血压是男性NAFLD病的独立危险因素.男性MS发生NAFLD的相对风险明显升高.     

非酒精性脂肪肝相关危险因素分析

目的分析非酒精性脂肪肝（NAFLD）患者临床指标,探讨其相关危险因素。方法 180例体检患者按有无NAFLD分为正常对照组（86例）和NAFLD组（94例）,对两组各临床指标进行统计分析。结果与对照组比较,NAFLD组体质量指数（BMI）、腰围、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转肽酶（GGT）、血脂总胆固醇（TC）、甘油三酯（TG）、非高密度脂蛋白胆固醇（non-HDL-C）、空腹血糖（FBG）、尿酸、收缩压（SBP）、舒张压（DBP）均显著升高,而高密度脂蛋白胆固醇（HDL-C）显著降低（P〈0.05）。Logistic回归分析显示BMI、腰围、TG可较好地预测NAFLD,是NAFLD的独立危险因素（P〈0.05）。结论 NAFLD患者具有中心性肥胖、高血糖、高血压、脂代谢紊乱（高TC、高TG、低HDL-C）、高尿酸的特征,且肝酶升高。BMI、腰围、TG是发生NAFLD的独立危险因素。     

二甲双胍治疗新诊断2型糖尿病合并非酒精性脂肪肝疗效观察

目的 观察二甲双胍对新诊断2型糖尿病合并非酒精性脂肪肝的临未疗效.方法 本院内分泌科住院新诊断2型糖尿病合并非酒精性脂肪患者72例,随机分为两组,A组(二甲双胍联合来得时治疗3月)38例和B组(单此来得时治疗3月)34例,测定FPG,PPG,体质指数(BMI),TC,TG,LT,AST,GGT,AKP,HbA1C.结果...     

非酒精性脂肪肝患者肝损害程度与代谢综合征各组分的关系

目的 探讨非酒精性脂肪肝（NAFLD）患者不同肝损害程度与代谢综合征（MS）各组分之间的关系.方法 1151例NAFLD患者以及年龄、性别相匹配的4113例健康对照人群均来自我院体检中心.所有研究对象均进行身高、体重、血压、血脂、血糖、肝炎系列等指标的检测,空腹行腹部彩超检查.分析并比较检测的各项结果.结果 1151例超声诊断NAFLD患者中轻度767例,中度345例,重度39例,MS检出例数分别为218、144和20例,检出率分别为28.4%、41.7%和51.3%,显著高于健康对照组（7.8%）,且随超声诊断脂肪肝的严重程度逐渐递增（P＜0.01）;ALT正常者905例,升高者246例,其中血脂紊乱、超重或肥胖和MS的检出率分别为54.6%、66.6%、31.9%和71.5%、82.5%、37.8%,均显著高于健康对照组（24.3%、32.4%和7.7%）,且随ALT升高而逐渐递增（P＜0.05）.但NAFLD组高血压、高血糖检出率与健康对照组相比差异无统计学意义（P＞0.05）.结论 NFALD患者肝损害程度与代谢综合征各组分关系密切,尤其与肥胖、血脂紊乱密切相关,因此,应重视NAFLD患者的调脂减肥治疗.     

Ezetimibe improves high fat and cholesterol diet-induced non-alcoholic fatty liver disease in mice

Ezetimibe is a novel cholesterol and plant sterol absorption inhibitor that reduces plasma low-density lipoprotein-cholesterol by selectively binding to the intestinal cholesterol transporter, Niemann-Pick C1-Like 1. Mice deficient in Niemann-Pick C1-Like 1 are protected from high fat/cholesterol diet-induced fatty liver as well as hypercholesterolemia. The object of the present study was to determine whether ezetimibe treatment could reduce hepatic steatosis in diet-induced obese mice. C57BL/6J mice were fed a high fat/cholesterol containing semi-purified diet (45% Kcal fat and 0.12% cholesterol) for 7 months after weaning. These mice were not only obese, but also developed hepatomegaly and hepatic steatosis, with varying degrees of liver fibrosis and steatohepatitis. About 87% of the mice on the high fat/cholesterol diet for 7 months had elevated plasma alanine aminotransferase activity, a biomarker for non-alcoholic fatty liver disease. Chronic administration of ezetimibe for 4 weeks significantly reduced hepatomegaly by decreasing hepatic triglyceride, cholesteryl ester and free cholesterol in diet-induced obese mice fed high fat/cholesterol diet for 7 months. Chronic ezetimibe treatment also significantly decreased plasma alanine aminotransferase activity. These results suggest that ezetimibe may be a novel treatment for high fat/cholesterol-induced non-alcoholic fatty liver disease.     

尿酸在非酒精性脂肪性肝病形成的作用

非酒精性脂肪性肝病（nonalcoholic fatty liver disease, NAFLD）作为世界上最常见的慢性肝病之一,一直是研究的热点。NAFLD与肥胖及相关代谢紊乱密切相关。高尿酸血症或高血清尿酸水平是发生在肥胖者身上常见的代谢异常。流行病学研究证实了血清尿酸水平与非酒精性脂肪肝显著相关,而黄嘌呤氧化酶（xanthine oxidase, XO）是控制尿酸合成的关键酶。本文着重对尿酸及控制其合成的限速酶XO在NAFLD形成中的作用进行综述;阐述了尿酸与代谢综合症（metabolic syndrome, MS）相关疾病之间的关系,如胰岛素抵抗、糖尿病和高血脂;最后介绍了XO抑制剂在各种疾病治疗中的应用。     

二甲双胍联合降脂、生活方式干预对非酒精性脂肪性肝病的治疗作用

目的观察二甲双胍联合降脂、生活方式干预治疗对非酒精性脂肪性肝病患者治疗效果。方法对2007年8月至2009年10月在广东省揭阳市红十字会慈云医院门诊确诊100例NAFLD患者。随机分治疗组和对照组各50例,治疗组给予二甲双胍、降脂、运动、饮食控制。对照组应用运动、生活方式干预,治疗观察6个月。比较两组治疗前后肝酶学、肝脏超声、体质量指数、血脂、血糖、胰岛素以及HOMA胰岛素抵抗指标变化。结果治疗组有效率为90%,对照组有效率为56%,两组差异有统计学意义（P〈0.05）。肝酶学、肝脏超声、体质量指数、血脂、血糖、胰岛素以及HOMA胰岛素抵抗指标改善情况治疗组优于对照组（P〈0.05）。结论对NAFLD患者在进行饮食、运动治疗同时予以二甲双胍、降脂药治疗,改善NAFLD症状及肝酶学及胰岛素抵抗疗效优于单纯的节食减重治疗。     

二肽基肽酶抑制剂联合二甲双胍对2型糖尿病合并代谢综合征患者血糖控制及HOMA-IR的影响

目的分析二肽基肽酶抑制剂联合二甲双胍对2型糖尿病合并代谢综合征患者血糖控制及胰岛素抵抗指数(HOMA-IR)的影响。方法选取某院2017年2月~2019年5月2型糖尿病合并代谢综合征患者76例,依照随机数字表法分组,各38例,对照组接受二甲双胍治疗,观察组接受二肽基肽酶抑制剂联合二甲双胍治疗,比较两组治疗前后血糖水平(空腹血糖、餐后2 h血糖)、血清炎性因子水平[白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、HOMA-IR。结果与对照组对比,观察组治疗后空腹血糖、餐后2 h血糖较低(P<0.05);治疗后,观察组血清IL-1、TNF-α、hs-CRP较对照组低(P<0.05);治疗后,与对照组对比,观察组HOMA-IR较低(P<0.05)。结论二肽基肽酶抑制剂联合二甲双胍治疗2型糖尿病合并代谢综合征,能有效降低患者血糖水平,减少胰岛素抵抗,降低炎性因子水平。     

Magnetic resonance imaging and transient elastography in the management of Nonalcoholic Fatty Liver Disease (NAFLD)

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and cirrhosis worldwide and the second most common cause of liver transplantation in major medical centers. Because liver steatosis and fibrosis severity are related to disease morbidity and mortality, the extent of disease, and disease progression, they need to be assessed and monitored. In addition, innovation with new drug developments requires disease staging and monitoring in both phase 2 and 3 clinical trials. Currently, disease assessment in both clinical practice and research is mostly performed by liver biopsy, an invasive, procedure with risks. Noninvasive, highly accurate tests are needed that could be used in clinical trials as surrogate endpoints and in clinical practice for monitoring patients.

Area Covered: We discuss noninvasive tests, transient elastography (TE) with controlled attenuation parameter (CAP), magnetic resonance imaging (MRI), and MR elastography (MRE), summarize the available evidence of their usefulness for assessing steatosis and fibrosis. Therefore they could be used as clinical trials outcomes and in disease monitoring in clinical practice.

Expert Commentary: TE with CAP, MRI and MRE are highly accurate noninvasive diagnostic tools for quantifying hepatic steatosis and fibrosis. Therefore they could be used as clinical trials outcomes and in disease monitoring in clinical practice.     

二甲双胍联合荷丹片对非酒精性脂肪性肝病生化指标的影响

目的探讨二甲双胍联合荷丹片治疗非酒精性脂肪性肝病（NAFLD）的疗效。方法将100例NAFLD患者随机分为实验组和对照组,每组50例。实验组采取二甲双胍联合荷丹片的治疗方法,对照组采取荷丹片单独治疗。结果治疗后,两组病情均有一定程度的好转。与对照组相比,实验组AST、ALT、TG、TC等指标明显改善,总有效率为94%（P〈0.05）。两组不良反应比较,差异无统计学意义。结论二甲双胍联合荷丹片治疗NAFLD较单用荷丹治疗效更佳,值得临床推广。     

非酒精性脂肪性肝病药物治疗进展及认识

非酒精性脂肪性肝病(NAFLD)是西方国家慢性肝病的首要病因。当代人们不良生活习惯增多,NAFLD的全球发病率逐年增高,我国也有相应增高。临床治疗NAFLD的药物包括降脂药、减肥药、胰岛素增敏剂和抗氧化剂等。本文综述NAFLD的药物治疗进展及认识。     

非酒精性脂肪肝患者血清脂联素水平及其与氧化应激的相关性研究

目的:探讨非酒精性脂肪性肝病患者血清脂联素水平变化及其与肝功能、氧化应激的关系。方法:选取非酒精性脂肪性肝病89例,其中非酒精性脂肪性肝病合并代谢综合征47例,健康体检者30例作为正常对照组。行腹部B超检查,测量身高、体重、腰围、臀围、血压,计算体重指数、腰臀比,检测空腹血糖(FBG)、ALT、GGT、甘油三酯、高密度脂蛋白胆固醇、脂联素、丙二醛(MDA)、还原型谷胱甘肽(GSH)和氧化型谷胱甘肽(GSSG)等指标。并分析血清脂联素与各临床指标的关系。结果:非酒精性脂肪肝患者血清脂联素水平明显低于正常对照组,氧化应激程度明显高于正常对照组;合并代谢综合征或肝功能异常的非酒精性脂肪肝患者氧化应激程度升高更显著,而脂联素水平下降更明显;血清脂联素水平与GSH、GSH/GSSG呈明显正相关,与ALT、AST、GGT、MDA、GSSG呈明显负相关;多重线性回归分析提示GSH/GSSG、GSSG、MDA、GSH、ALT是影响血清脂联素水平的独立相关因素。结论:脂联素可能是一种间接反映氧化应激程度的监测指标,脂联素、MDA及GSH/GSSG联合检测有助于非酒精性脂肪肝病情发展的判断。     

当飞利肝宁胶囊联合二甲双胍治疗非酒精性脂肪性肝病的临床效果观察

目的：观察当飞利肝宁胶囊联合二甲双胍治疗非酒精性脂肪性肝病（ NAFLD）的临床疗效。方法选取2010年2月-2012年12月医院收治的 NAFLD 患者120例,接受当飞利肝宁胶囊联合二甲双胍治疗,观察患者治疗前后血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、三酰甘油（TG）、总胆固醇（CHO）、超敏 C 反应蛋白（hs-CRP）变化情况,超声图像变化及药物不良反应。结果治疗后临床症状较治疗前明显改善者109例,有效率90.83%;治疗后超声影像表现较治疗前明显好转;ALT、AST、TG、CHO、hs-CRP 较治疗前显著改善,差异有统计学意义（P ＜0.05）。所有患者治疗期间均未出现不良反应。结论当飞利肝宁联合二甲双胍治疗 NAFLD 患者,血脂、肝功能、肝纤维化、超声等指标均有明显改善,疗效显著。     

Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: a randomised study

ABSTRACT

Background: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS). There is no established treatment for NAFLD.

Aim: To evaluate a multifactorial intervention in the treatment of NAFLD.

Methods: A prospective, open-label, randomised study in non-diabetic patients (n = 186) with MetS (follow-up: 54 weeks). All patients had both biochemical and ultrasonographic evidence of NAFLD at baseline. Other causes of liver disease were excluded. Patients received lifestyle advice and treatment for hypertension (mainly inhibitors of the renin–angiotensin system), impaired fasting glucose (metformin), obesity (orlistat) and dyslipidaemia [randomly allocated to atorvastatin 20?mg/day (n = 63) or micronised fenofibrate 200?mg/day (n = 62) or both drugs (n = 61)]. Liver ultrasonography was assessed at baseline and at the end of the study.

Results: At the end of treatment, 67% of patients on atorvastatin, 42% on fenofibrate and 70% on combination treatment no longer had biochemical plus ultrasonographic evidence of NAFLD (?p < 0.05 vs. baseline for all comparisons). The percentage of patients who no longer had evidence of NAFLD was significantly higher (?p < 0.009) in the atorvastatin and combination groups compared with the fenofibrate group. This effect was independently related to drug treatment, as well as to reductions in high-sensitivity C-reactive protein, waist circumference, body weight, triglycerides, low-density lipoprotein-cholesterol, total cholesterol, systolic blood pressure and glucose. Four patients discontinued treatment because of adverse effects.

Conclusions: Multifactorial intervention in MetS patients with both biochemical and ultrasonographic evidence of NAFLD offsets surrogate markers of NAFLD (i.e. elevated aminotransferase plus echogenic liver).     

FibroScan受控衰减参数及瞬时弹性测定值在慢性肝病中的应用价值

目的:探讨FibroScan受控衰减参数(CAP)及瞬时弹性测定值在慢性肝病不同阶段中的应用价值。方法:收集2014年12月—2016年12月就诊于山西大医院消化科的慢性肝病患者131例,按照病因分为慢性乙型肝炎(CHB)组(n=50),慢性丙型肝炎(CHC)组(n=20),原发性胆汁性肝硬化(PBC)组(n=15),肝硬化组(n=31)及肝癌组(n=15)。比较各组间CAP值及瞬时弹性测定值(E)。结果:各组CAP值比较,差异有统计学意义(P<0.05),其中CHB组、PBC组、肝硬化组、肝癌组均低于CHC组,肝硬化组低于CHB组,差异均有统计学意义(P<0.05)。各组E值比较,CHB组、CHC组、PBC组均低于肝硬化组及肝癌组,肝硬化组低于肝癌组,CHC组低于PBC组,差异均有统计学意义(P<0.05)。结论:FibroScan受控衰减参数及瞬时弹性测定值联合应用有助于区分肝病的不同阶段,有助于在不同阶段尽早进行干预性治疗。     

Health-related quality of life in patients with non-alcoholic fatty liver disease

BACKGROUND: The relative impact of non-alcoholic fatty liver disease (NAFLD) on health-related quality of life (HRQL) compared to other chronic liver diseases has not been fully explored. AIM: To compare the domain scores of the 29-item Chronic Liver Disease Questionnaire (CLDQ) for patients with NAFLD to those with chronic hepatitis B and chronic hepatitis C. METHODS: A HRQL questionnaire, CLDQ, was routinely administered to patients attending a liver clinic. Additional clinical and laboratory data were obtained on patients with NAFLD, chronic hepatitis B, and chronic hepatitis C from our quality of life database. Scores for each of the six CLDQ domains were compared using one-way anova and multiple regression. RESULTS: Complete data were available for 237 patients. NAFLD patients scored lowest on multiple CLDQ domains. Based on the bivariate data, NAFLD patients have the poorest HRQL, followed by chronic hepatitis C and chronic hepatitis B patients. Multivariate analysis showed that some specific domain score correlations remained significant for NAFLD diagnosis, cirrhosis, gender, and body mass index. CONCLUSION: NAFLD patients had significantly lower quality of life scores compared with patients with hepatitis B or hepatitis C on multiple CLDQ domains, suggesting that HRQL was severely impaired in patients with NAFLD.     

Saxagliptin and metformin XR combination therapy provides glycemic control over 24 hours in patients with T2DM inadequately controlled with metformin

Abstract

Objective:

To assess 24-hour glycemic control with saxagliptin compared with placebo as add-on treatment to metformin in patients with type 2 diabetes mellitus (T2DM) and inadequate glycemic control.     

水林佳治疗非酒精性脂肪肝的疗效观察

目的:探讨水林佳治疗非酒精性脂肪肝的疗效。方法:随机选择非酒精性脂肪肝患者90例,试验组46例,服用水林佳105mg,3次/日;对照组44例,口服硫普罗宁100 mg,3次/日,观察期为3个月。治疗前后检测肝转氨酶、血胆固醇、甘油三酯、肝纤维谱及超声影像变化。同时观察两组患者用药期间的不良反应。结果:治疗结束时,试验组ALT、AST、TC、TG及HA、LN、PC-Ⅲ均明显下降,肝脏影像学也有明显改善。对照组虽ALT、AST有所下降,但HA、LN、PC-Ⅲ和肝脏影像学无明显改善。观察期间两组均未出现明显不良反应。结论:水林佳具有保肝、降血脂、改善肝纤维化的作用,对非酒精性脂肪肝有治疗作用。     

水林佳治疗非酒精性脂肪性肝病疗效观察

目的观察水林佳（水飞蓟宾-磷脂复合物）治疗非酒精性脂肪性肝病的临床疗效。方法将56例患者随机分为2组,治疗组予水林佳口服,对照组予硫普罗宁口服,均3个月为1个疗程,疗程结束后,观察临床症状、ALT、AST、TC、TG和超声影像的变化。同时观察2组患者用药期间的不良反应。结果治疗组和对照组总有效率分别为89.3%及71.4%,治疗组明显高于对照组,2组比较差异有显著性（P〈0.05）。治疗组在改善患者临床症状、肝功能、血脂及超声影像方面疗效确切,无明显不良反应。结论水林佳治疗非酒精性脂肪性肝病有较好临床疗效。