非酒精性脂肪性肝炎75例临床诊治观察

Nonalcoholic steatohepatitis:Clinical management of 75 cases

目的 探索非酒精性脂肪性肝炎 (NASH)的诊断标准和治疗方法。方法 比较分析NASH、酒精性肝病、单纯脂肪肝、慢性肝炎患者 ,健康人及 2型糖尿病患者的临床资料。根据NASH患者的体重指数 (BMI)、血清胰岛素浓度及谷丙转氨酶 (ALT)水平给予不同的治疗。查阅 4 0例 2型糖尿病病人资料。结果 75例NASH患者平均年龄为 36 8岁 ;男性 6 6例 (88% ) ;BMI≥ 2 5者 5 8例 (77 3% )。所有患者ALT均升高 ,均存在高胰岛素血症 ,B超示脂肪肝 6 7例 ;口服葡萄糖耐量实验异常 30例 (4 0 % ) ;高脂血症者 6 0例 (80 % ) ;2型糖尿病 5例 (7% )。NASH患者的BMI与健康组有显著差异 ,P <0 0 5。健康组与NASH组的血清游离脂肪酸 (FFA)、肿瘤坏死因子 α(TNF α)差异均显著 (P <0 0 5 )。ALT水平与患者血清胰岛素水平、游离脂肪酸、TNF α有关 (P <0 0 1)。 4 0例 2型糖尿病患者中 12例 (30 % )可诊断为NASH。 2个月的治疗后 ,NASH患者的肝功能均正常。结论 NASH是ALT升高的原因之一 ;与胰岛素抵抗综合征相关。诊断NASH的重要依据是 :转氨酶反复轻至中度升高 ;排除肝炎病毒感染等其它肝病 ;胰岛素释放异常 ;高脂血症 ;影像学提示脂肪肝 ;BMI≥ 2 5 ;血清FFA和TNF升高。节制饮食及适当运动是治疗NASH的关键 。

Objective To establish the diagnosis criterion and management protocol for nonalcoholic steatohepatitis(NASH).Methods The data of 75 patients with NASH including 10 chronic hepatitis,10 simple fatty,15 alcoholic liver disease,10 healthy conerol and 40 tpye 2 diabetic patient without viral hepatitis were investigated.Results Among 75 NASH patients,the mean age was 36.8 years,and male were 66(88%);their body mass index(BMI)≥25 were 58 (77.3%).Serum ALT and insulin concentration were elevated in all patients with NASH;60 cases were with hypertriceridemia (80%),30 with normal oral glucose tolerate test (OGTT) (40%),fatty liver was detected in 67 patients (90%)by ultrasonography.The BMI were different between NASH and healthy controls,P<0.05.Concentration of serum free fatty acid (FFA ) and tumor necrosis factor(TNF-α)among NASH and healthy controls were different,P<0.05.There were correlation between serum ALT and the serum insulin concentration,FFA and TNF-αin NASH group,P<0.01.There were 12 patients with NASH in 40 type 2 diabetes (30%).After two month,all patients with NASH recovered to normal levels of ALT by different management.Conclusions NASH is related to insulin resistence syndrome.Diagnosis of NASH is based on high level of transaminoferase;precluding viral hepatitis and alcoholism;abnormal serum insulin concentration;hyperlipidemia,BMI≥25;fatty liver by imaging techniques.FFA and TNF-α play key roles in NASH development.The key to treat NASH is diet control,doing exercise and proper medical treatment.