目的探讨同伴教育对农村住院2型糖尿病(T2DM)合并慢性非酒精性脂肪肝(NAFLD)患者肝功能、血糖控制及自我管理行为的影响。方法选取2015年3月至2017年3月2个自然村中T2DM合并慢性NAFLD患者,共106例。将其中1个自然村患者设为观察组(55例)...目的探讨同伴教育对农村住院2型糖尿病(T2DM)合并慢性非酒精性脂肪肝(NAFLD)患者肝功能、血糖控制及自我管理行为的影响。方法选取2015年3月至2017年3月2个自然村中T2DM合并慢性NAFLD患者,共106例。将其中1个自然村患者设为观察组(55例),另1个自然村患者设为对照组(51例)。对照组患者给予常规教育,观察组患者在常规教育基础上给予同伴教育,经6个月教育后,对比两组患者健康知识掌握情况、肝功能改善和血糖控制情况及自我管理行为情况。结果教育前,两组健康知识掌握程度比较无显著差异(P>0.05);教育后,两组健康知识掌握程度较教育前明显提升,且观察组健康知识掌握程度明显高于对照组(P<0.05)。教育前,两组血糖指标HbAlc、FBG、2hFBG水平比较无显著差异(P>0.05);教育后,观察组HbAlc、FBG、2 h FBG水平较教育前明显降低,而观察组Hb Alc、FBG、2hFBG水平明显低于对照组(P<0.05)。教育前,两组肝功能(ALB、AST、ALT、TBiL)水平比较差异无统计学意义(P>0.05);教育后,两组ALB水平较教育前明显提高,AST、ALT、TBiL水平较教育前均明显降低,观察组ALB水平明显高于对照组,AST、ALT、TBiL水平明显低于对照组(P<0.05)。教育前,两组SDSCA评分比较无显著差异(P>0.05);教育后,两组SDSCA评分较教育前明显上升,观察组SDSCA评分明显高于对照组(P<0.05)。结论同伴教育有利于提高农村住院T2DM合并慢性NAFLD患者健康知识掌握水平和自我行为管理能力水平,并促进患者血糖控制、肝功能改善,是一种值得推广应用的新兴教育方式。展开更多
There are several cofactors which affect body iron metabolism and accelerate iron overload. Alcohol and hepatic viral infections are the most typical examples for clarifying the role of cofactors in iron overload. In ...There are several cofactors which affect body iron metabolism and accelerate iron overload. Alcohol and hepatic viral infections are the most typical examples for clarifying the role of cofactors in iron overload. In these conditions, iron is deposited in hepatocytes and Kupffer cells and reactive oxygen species （ROS） produced through Fenton reaction have key role to facilitate cellular uptake of transferrin-bound iron. Furthermore, hepcidin, antimicrobial peptide produced mainly in the liver is also responsible for intestinal iron absorption and reticuloendothelial iron release. In patients with ceruloplasmin deficiency, anemia and secondary iron overload in liver and neurodegeneration are reported. Furthermore, there is accumulating evidence that fatty acid accumulation without alcohol and obesity itself modifies iron overload states. Ineffective erythropoiesis is also an important factor to accelerate iron overload, which is associated with diseases such as thalassemia and myelodysplastic syndrome. When this condition persists, the dietary iron absorption is increased due to the increment of bone marrow erythropoiesis and tissue iron overload will thereafter occurs. In porphyria cutanea tarda, iron is secondarily accumulated in the liver.展开更多
Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complication...Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications,including decompensation,bleeding and liver cancer.Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease.Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis,while cirrhosis requires a specif ic follow-up including screening for esophageal varices and hepatocellular carcinoma.Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive,costly and prone to sampling errors.Recently,blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis.However,there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available.This is due to an unsatisfactory accuracy for some of them,and to an incomplete validation for others.Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined.Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.展开更多
文摘目的探讨同伴教育对农村住院2型糖尿病(T2DM)合并慢性非酒精性脂肪肝(NAFLD)患者肝功能、血糖控制及自我管理行为的影响。方法选取2015年3月至2017年3月2个自然村中T2DM合并慢性NAFLD患者,共106例。将其中1个自然村患者设为观察组(55例),另1个自然村患者设为对照组(51例)。对照组患者给予常规教育,观察组患者在常规教育基础上给予同伴教育,经6个月教育后,对比两组患者健康知识掌握情况、肝功能改善和血糖控制情况及自我管理行为情况。结果教育前,两组健康知识掌握程度比较无显著差异(P>0.05);教育后,两组健康知识掌握程度较教育前明显提升,且观察组健康知识掌握程度明显高于对照组(P<0.05)。教育前,两组血糖指标HbAlc、FBG、2hFBG水平比较无显著差异(P>0.05);教育后,观察组HbAlc、FBG、2 h FBG水平较教育前明显降低,而观察组Hb Alc、FBG、2hFBG水平明显低于对照组(P<0.05)。教育前,两组肝功能(ALB、AST、ALT、TBiL)水平比较差异无统计学意义(P>0.05);教育后,两组ALB水平较教育前明显提高,AST、ALT、TBiL水平较教育前均明显降低,观察组ALB水平明显高于对照组,AST、ALT、TBiL水平明显低于对照组(P<0.05)。教育前,两组SDSCA评分比较无显著差异(P>0.05);教育后,两组SDSCA评分较教育前明显上升,观察组SDSCA评分明显高于对照组(P<0.05)。结论同伴教育有利于提高农村住院T2DM合并慢性NAFLD患者健康知识掌握水平和自我行为管理能力水平,并促进患者血糖控制、肝功能改善,是一种值得推广应用的新兴教育方式。
文摘There are several cofactors which affect body iron metabolism and accelerate iron overload. Alcohol and hepatic viral infections are the most typical examples for clarifying the role of cofactors in iron overload. In these conditions, iron is deposited in hepatocytes and Kupffer cells and reactive oxygen species （ROS） produced through Fenton reaction have key role to facilitate cellular uptake of transferrin-bound iron. Furthermore, hepcidin, antimicrobial peptide produced mainly in the liver is also responsible for intestinal iron absorption and reticuloendothelial iron release. In patients with ceruloplasmin deficiency, anemia and secondary iron overload in liver and neurodegeneration are reported. Furthermore, there is accumulating evidence that fatty acid accumulation without alcohol and obesity itself modifies iron overload states. Ineffective erythropoiesis is also an important factor to accelerate iron overload, which is associated with diseases such as thalassemia and myelodysplastic syndrome. When this condition persists, the dietary iron absorption is increased due to the increment of bone marrow erythropoiesis and tissue iron overload will thereafter occurs. In porphyria cutanea tarda, iron is secondarily accumulated in the liver.
基金Supported by An unrestricted grant from Roche-Italia
文摘Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications,including decompensation,bleeding and liver cancer.Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease.Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis,while cirrhosis requires a specif ic follow-up including screening for esophageal varices and hepatocellular carcinoma.Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive,costly and prone to sampling errors.Recently,blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis.However,there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available.This is due to an unsatisfactory accuracy for some of them,and to an incomplete validation for others.Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined.Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.
