二甲双胍治疗新诊断2型糖尿病合并非酒精性脂肪肝的疗效

目的探讨二甲双胍治疗新诊断2型糖尿病合并非酒精性脂肪肝的临床疗效。方法 90例新诊断2型糖尿病合并非酒精性脂肪肝患者,随机分为对照组和观察组,各45例。对照组采用西格列汀治疗,观察组在对照组基础上采用二甲双胍治疗,比较两组患者的糖代谢指标变化、肝功能及血脂指标变化。结果治疗前,两组患者空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水平比较,差异均无统计学意义(P>0.05);治疗后,观察组患者FBG、2 h PG、HbA1c、HOMA-IR、FINS水平明显低于对照组,差异均具有统计学意义(P<0.05)。治疗前,两组患者总胆固醇(TC)、甘油三酯(TG)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(AKP)、谷氨酰转肽酶(GGT)、体质量指数(BMI)水平比较,差异均无统计学意义(P>0.05);治疗后,观察组患者TC、TG、AST、ALT、AKP、GGT、BMI水平分别为(1.52±0.28)mmol/L、(4.21±0.54)mmol/L、(38.93±13.86)U/L、(39.64±17.29)U/L、(54.89±10.33)U/L、(70.16±18.52)U/L、(23.16±1.21)kg/m^2,均明显低于对照组的(2.13±0.37)mmol/L、(4.95±0.60)mmol/L、(54.67±13.71)U/L、(55.72±18.36)U/L、(69.68±13.82)U/L、(91.32±20.45)U/L、(24.75±1.43)kg/m^2,差异均具有统计学意义(P<0.05)。结论二甲双胍治疗新诊断2型糖尿病合并非酒精性脂肪肝的疗效显著,能有效增强控制血糖、血脂效果,保护肝功能,抑制肝脂肪化,具有积极的临床意义。

Nonalcoholic fatty liver disease: An overview of current insights in pathogenesis, diagnosis and treatment

Estimates of people suffering from overweight (one billion) and obesity (300 million) are increasing. The accumulation of triglycerides in the liver, in the absence of excess alcohol intake, has been described in the early sixties. It was not until 1980, however, that Ludwig et al named this condition nonalcoholic steatohepatitis (NASH). Subsequently, nonalcoholic fatty liver disease (NAFLD) has been used as a general name for conditions ranging from simple steatosis through steatohepatitis to end-stage liver disease (cirrhosis). Many studies have demonstrated the significant correlation with obesity and insulin resistance. Other studies have revealed a signifi- cant correlation between hepatic steatosis, cardiovascu- lar disease and increased intima-media thickness. WHO estimated that at least two million patients will develop cirrhosis due to hepatic steatosis in the years to come. Longitudinal cohort studies have demonstrated that those patients with cirrhosis have a similar risk to devel- op hepatocellular carcinoma as those with other causes of cirrhosis. Taken all together, NAFLD has become the third most important indication for liver transplantation. There- fore, training programmes in internal medicine, gastroen- terology and hepatology should stress the importance of diagnosing this entity and treat properly those at risk for developing complications of portal hypertension and con- comittant cardiovascular disease. This review will focus on the clinical characteristics, pathophysiology, imaging tech- niques and the readily available therapeutic options.

基于深度学习的肝脏病理图像中肝脂肪变性分级研究

目的:设计基于深层神经网络模型用来分析肝脏全景病理切片图像(Whole slide images,WSI)的肝脂肪变性分级方法,以实现对非酒精性脂肪性肝病(Non-alcoholic fatty liver disease,NAFLD)病程的辅助诊断。方法:结合临床诊断,以非酒精性脂肪肝活动度积分(NAFLD activity score,NAS)为评价标准,将肝脂肪变性程度分为无、轻度、中度和重度等四级病程,本研究采用多示例学习的策略构建并训练深度神经网络模型,将训练获得的人工智能模型用来实现计算机自动化诊断肝脏病理切片中肝脂肪变性程度分级。结果:通过使用本研究中的人工智能方法可以在3分钟内对一张WSI进行完整的分析,得到该病患肝脏病理切片中肝脂肪变性分级,训练获得的人工智能模型的AUC为0.97,肝脂肪变性分级的平均准确率为78.18%,macro-F1 score、macro-Precision和macro-Recall分别为79.49、82.03和77.10,其结果展示获得的人工智能模型已满足可辅助临床诊断的水平。结论:本研究基于深度学习技术开发的人工智能方法初步实现快速自动化诊断肝脂肪变性分级,展现了其潜在的临床使用价值。