Metabolic dysfunction-associated fatty liver disease and low muscle strength: A comment

The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes,gender,basal metabolic index,and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases.As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD,as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.

Nonalcoholic fatty liver disease is associated with coronary artery disease in Koreans

AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.The patients were classified into four groups by coronary artery stenosis:A,insignificant;B,one-vessel disease;C,two-vessel disease;and D,three-vessel disease.Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade:0,no evidence;1,mild;2,moderate;and 3,severe.We measured not only known CAD risk factors,but also serum insulin,HOMA-index,adiponectin,interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein levels.RESULTS:Of the 134 patients who met the inclusion criteria,82(61.2%)had ultrasonographically diagnosed NAFLD.Among the 46 patients with CAD,37(80.4%)had evidence of a fatty liver.The two groups(A vs B-D)were significantly different in terms of age,total cholesterol,triglycerides,low-density lipoprotein levels and fatty liver.Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner(P=0.025).In binary logistic regression,NAFLD was a significant independent predictor of CAD(P=0.03,OR=1.685;95%CI:1.051-2.702).Among the candidate mediators,the serum adiponectin level showed a trend toward lowering based on CAD progression(P=0.071).CONCLUSION:NAFLD is an independent risk factor for CAD in a grade-dependent manner.Moreover,adiponectin might be related to the pathogenesis of NAFLD.

Peripheral Artery Disease and Risk of Fibrosis Deterioration in Nonalcoholic Fatty Liver Disease:A Prospective Investigation

Objective Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease(NAFLD).Peripheral artery disease(PAD)and liver fibrosis share many common metabolic dysfunctions.We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients.Methods The study recruited 1,610 NAFLD patients aged≥40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015.Fibrosis deterioration was defined as the NAFLD fibrosis score(NFS)status increased to a higher category at the follow-up visit.PAD was defined as an ankle-brachial index of<0.90 or>1.40.Results During an average of 4.3 years’follow-up,618 patients progressed to a higher NFS category.PAD was associated with 92%increased risk of fibrosis deterioration[multivariable-adjusted odds ratio(OR):1.92,95%confidence interval(CI):1.24,2.98].When stratified by baseline NFS status,the OR for progression from low to intermediate or high NFS was 1.74(95%CI:1.02,3.00),and progression from intermediate to high NFS was 2.24(95%CI:1.05,4.80).There was a significant interaction between PAD and insulin resistance(IR)on fibrosis deterioration(P for interaction=0.03).As compared with non-PAD and non-IR,the coexistence of PAD and IR was associated with a 3.85-fold(95%CI:2.06,7.18)increased risk of fibrosis deterioration.Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients,especially in those with IR.The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.

Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan

Background:The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease(K-NAFLD)score was recently developed with the intent to operationally define nonalcoholic fatty liver disease(NAFLD).However,there remained an external validation that confirmed its diagnostic performance,especially in patients with alcohol consumption or hepatitis virus infection.Methods:Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®.Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score,fatty liver index(FLI),and hepatic steatosis index(HSI).Results:K-NAFLD-moderate[adjusted odds ratio(aOR)=2.53,95%confidence interval(CI):1.13-5.65]and K-NAFLD-high(aOR=4.14,95%CI:1.69-10.13)groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics,and FLI-moderate and FLI-high groups revealed aORs of 2.05(95%CI:1.22-3.43)and 1.51(95%CI:0.78-2.90),respectively.In addition,the HSI was less predictive for Fibroscan®-defined fatty liver.Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection,and the adjusted area under curve values were comparable between K-NAFLD and FLI.Conclusions:Externally validation of the K-NAFLD and FLI showed that these scores may be a useful,noninvasive,and non-imaging modality for the identification of fatty liver.In addition,these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.

PTEN in liver diseases and cancer

The phosphoinositide 3-kinase (PI3K)/phosphatase and tensin homolog (PTEN)/Akt axis is a key signal transduction node that regulates crucial cellular functions, including insulin and other growth factors signaling, lipid and glucose metabolism, as well as cell survival and apoptosis. In this pathway, PTEN acts as a phosphoinositide phosphatase, which terminates PI3Kpropagated signaling by dephosphorylating PtdIns(3,4)P2 and PtdIns(3,4,5)P3. However, the role of PTEN does not appear to be restricted only to PI3K signaling antagonism, and new functions have been recently discovered for this protein. In addition to the well-established role of PTEN as a tumor suppressor, increasing evidence now suggests that a dysregulated PTEN expression and/or activity is also linked to the development of several hepatic pathologies. Dysregulated PTEN expression/activity is observed with obesity, insulin resistance, diabetes, hepatitis B virus/hepatitis C virus infections, and abusive alcohol consumption, whereas mutations/deletions have also been associated with the occurrence of hepatocellular carcinoma. Thus, it appears that alterations of PTEN expression and activity in hepatocytes are common and recurrent molecular events associated with liver disorders of various etiologies. These recent f indings suggest that PTEN might represent a potential common therapeutic target for a number of liver pathologies.

Helicobacter pylori infection is not associated with nonalcoholic fatty liver disease

AIM: To determine whether Helicobacter pylori (H. pylori) infection confers a higher risk of Nonalcoholic fatty liver disease (NAFLD).METHODS: Healthy people who underwent health screening were analyzed retrospectively. Inclusion criteria were age ≥ 20 years, history of H. pylori infection, and recorded insulin level. Participants were classified as H. pylori positive or negative according to 13C urea breath tests. NAFLD was defined using the hepatic steatosis index (HSI) and NAFLD liver fat score (NAFLD-LFS). Those with an HSI > 36 or NAFLD-LFS > -0.640 were considered to have NAFLD. Multivariable logistic regression was performed to identify risk factors for NAFLD.RESULTS: Three thousand six hundred and sixty-three people were analyzed and 1636 (44.7%) were H. pylori positive. H. pylori infection was associated with older age, male gender, hypertension, higher body mass index, and a dyslipidemic profile. HSI differed significantly between H. pylori positive and negative subjects (median 33.2, interquartile range (IQR) 30.0-36.2 for H. pylori-positive vs median 32.6, IQR 29.8-36.0 for negative participants, P = 0.005), but NAFLD-LSF did not [median -1.7, IQR -2.4 - -0.7 vs median -1.8, IQR -2.4-(-0.7), respectively, P = 0.122]. The percentage of people with NAFLD did not differ between infected and uninfected groups: HIS, 26.9% vs 27.1%, P = 0.173; NAFLD-LFS, 23.5% vs 23.1%, P = 0.778. H. pylori infection was not a risk factor, but C-reactive protein concentration and smoking were significant risk factors for NAFLD.CONCLUSION: H. pylori infection is not a risk factor for NAFLD as indicated by HSI or NAFLD-LFS. Prospective, large-scale studies involving liver biopsies should be considered.

Liver transplantation and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD) is an important health problem worldwide. NAFLD encompasses a histological spectrum ranging from bland liver steatosis to severe steatohepatitis(nonalcoholic steatohepatitis, NASH) with the potential of progressing to cirrhosis and its associated morbidity and mortality. NAFLD is thought to be the hepatic manifestation of insulin resistance(or the metabolic syndrome); its prevalence is increasing worldwide in parallel with the obesity epidemic. In many developed countries, NAFLD is the most common cause of liver disease and NASH related cirrhosis is currently the third most common indication for liver transplantation. NASH related cirrhosis is anticipated to become the leading indication for liver transplantation within the next one or two decades. In this review, we discuss how liver transplantation is affected by NAFLD, specifically the following:(1) the increasing need for liver transplantation due to NASH;(2) the impact of the increasing prevalence of NAFLD in the general population on the quality of deceased and live donor livers available for transplantation;(3) the long term graft and patient outcomes after liver transplantation forNASH,and finally;and(4)the de novo occurrence of NAFLD/NASH after liver transplantation and its impact on graft and patient outcomes.

Silymarin in non alcoholic fatty liver disease

AIM: This study was undertaken to evaluate the hepatic effects of silybum marianum on non alcoholic fatty liver disease (NAFLD). METHODS: In 72 patients affected by NAFLD, main metabolic, hepatic and anti-inflammatory parameters were assayed after 3 mo of a restricted diet and before silymarin treatment (twice a day orally). The brightness of liver echography texture (hepatorenal ratio brightness) was also defined at same time. These evaluations were repeated after 6 mo of treatment. RESULTS: Serum levels of some metabolic and anti-inflammatory data nonsignificantly lowered after 6 mo of silymarin. On the contrary, Steato test, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase were significantly (P < 0.001) reduced. Instead, the AST/ALT ratio unchanged. Finally, the hepatorenal brightness ratio, as an index of hepatic steatosis, significantly (P < 0.05) dropped. CONCLUSION: The obtained results indicate that silymarin appears to be effective to reduce the biochemical, inflammatory and ultrasonic indices of hepatic steatosis. Some parameters indicative of early stage of atherosclerosis were also lowered.

Assessment of correlation between serum titers of hepatitis c virus and severity of liver disease

AIM:The significance of hepatitis C virus (HCV) serum titers has been examined in several clinical situations. There is much evidence that patients with a lower viral load have better response rates to anti-viral therapy compared to those with higher levels.Moreover,a direct association has been observed between serum titers of HCV and transmission rates of the virus.The aim of the present study was to determine if there was any correlation between HCV viral load and the severity of liver disease. METHODS:Fifty patients with HCV infection were included in the study.These comprised of 34 subjects with a history of alcohol use and 16 non-alcoholics.Quantitative serum HCV RNA assay was carried out using the branched DNA (bDNA) technique.Linear regression analysis was performed between serum viral titers and liver tests.In addition,for the purpose of comparison,the subjects were divided into two groups:those with low viral liters (≤50 genome mEq/mL) and high titers (>50 mEq/mL). RESULTS:All subjects were men,with a mean±SD age of 47±7.8 years.The mean HCV RNA level in the blood was 76.3×10~5±109.1 genome equivalents/mL.There was no correlation between HCV RNA levels and age of the patients (r=0.181),and the history or amount (g/d) of alcohol consumption (r=0.07).Furthermore,no correlation was observed between serum HCV RNA levels and the severity of liver disease as judged by the values of serum albumin (r=0.175),bilirubin (r=0.217),ALT (r=0.06) and AST (r=0.004) levels.Similarly,no significant difference was observed between patients with low viral titers and high liters with respect to any of the parameters. CONCLUSION:Our results indicate that the severity of liver disease is independent of serum levels of hepatitis C virus.These findings are important since they have a direct impact on the current debate regarding the role of direct cytopathic effect of hepatitis C virus versus immune-mediated injury in the pathogenesis of HCV-related liver damage.

Validation of genetic variants associated with metabolic dysfunctionassociated fatty liver disease in an ethnic Chinese population

BACKGROUND Genetic factors play an important role in the pathogenesis and development of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To study the association of single nucleotide polymorphisms(SNPs),previously identified in Western populations,with the risk of MAFLD in a Singapore Chinese population and their interactions with environmental and medical risk factors.METHODS A retrospective case-control study was conducted with 72 MAFLD cases and 72 controls with no hepatic steatosis on computed tomography,magnetic resonance imaging,or controlled attenuation parameter score.Subjects were recruited from two tertiary hospitals.Genetic alleles such as NCAN,GCKR,LYPLAL1,PNPLA3,PPP1R3B,FDFT1,COL13A1,EFCAB4B,PZP,and TM6SF2 were genotyped using the TaqMan®Predesigned SNP Genotyping Assay.RESULTS Weight and body mass index(BMI)were 1.2-times higher in patients(70.6 kg,95%confidence interval[CI]:57.1-84.1 vs 60.8 kg,95%CI:48.5-73.1,P<0.001 and 26.9 kg,95%CI:23-40.8 vs 23.3 kg 95%CI:19-27.6,P<0.001 respectively).The prevalence of diabetes mellitus in patients was 40.3%and 20.8%in controls(P=0.011).Patients had higher mean triglycerides than controls(P<0.001).PNPLA3 GG was more likely to be associated with MAFLD(43.4%CC vs 69.7%GG,P=0.017,and 44.8%CG vs 69.7%GG,P=0.022).In multivariable analysis,hypertriglyceridemia(odds ratio[OR]:2.0495%CI:1.3-3.1,P=0.001),BMI(OR:1.295%CI:1.1-1.4,P<0.001)and PNPLA3 GG(OR:3.495%CI:1.3-9.2,P=0.014)were associated with MAFLD(area under the receiver operating characteristic curve of 0.823).CONCLUSION Among the Chinese population of Singapore,PNPLA3 homozygous GG allele is a strong predictor of MAFLD,whereas LYPLAL1,GCKR,FDFT1,COL13A1,PZP,and TM6SF2 are not significantly associated.Hypertriglyceridemia,high BMI,and PNPLA3 GG are independent predictors of MAFLD.

Increased serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with biopsy-proven nonalcoholic fatty liver disease

AIM: To analyze the relationship between the serum lectin-like oxidized low-density lipoprotein receptor-1(LOX-1) levels and clinical and histopathological features of biopsy-confirmed nonalcoholic fatty liver disease(NAFLD) patients.METHODS: Fifty-three consecutive,biopsy-proven NAFLD patients(31 males and 22 females,mean age 42.5 ± 9.6 years) and 26 age- and gender-matched,healthy controls(14 males and 12 females,mean age 39 ± 10.7 years) were included.The patientswith NAFLD were consecutive patients who had been admitted to the hepatology outpatient clinic within the last year and had been diagnosed with NAFLD as the result of liver biopsy.The healthy controls were individuals who attended the outpatient clinic for routine health control and had no known chronic illnesses.The histological evaluation was conducted according t o t he N AF LD ac t ivi ty scoring syst em recommended by The National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network.The serum LOX-1 levels were measured using an ELISA kit(Life Science Inc.USCN.Wuhan,Catalog No.E1859Hu) in both patients and healthy controls.A receiver operating characteristic(ROC) curve analysis was used to identify the optimal cutoff value of LOX-1 and thereby distinguish between patients with nonalcoholic steatohepatitis(NASH) and healthy controls.A P-value < 0.05 was considered statistically significant.RESULTS: NAFLD and healthy control groups were similar in terms of age and sex.NAFLD patients consisted of 8 patients with simple steatosis(15%),27 with borderline NASH(51%) and 18 with definitive NASH(34%).Metabolic syndrome was found in 62.2% of the patients with NAFLD.The mean serum LOX-1 level in biopsy-proven NAFLD patients was 8.49 ± 6.43 ng/m L compared to 4.08 ± 4.32 ng/m L in healthy controls(P = 0.001).The LOX-1 levels were significantly different between controls,simple steatosis and NASH(borderline+definite) cases(4.08 ± 4.32 ng/m L,6.1 ± 6.16 ng/m L,8.92 ± 6.45 ng/m L,respectively,P = 0.004).When the cut-off value for the serum LOX-1 level was set at 5.35 ng/m L,and a ROC curve analysis was performed to distinguish between steatohepatitis patients and controls; the sensitivity and specificity of the serum LOX-1 level were 69.8% and 69.2%,respectively.CONCLUSION: The serum LOX-1 levels were significantly higher in NAFLD patients than in healthy controls.Additionally,the serum LOX-1 levels could differentiate between steatohepatitis patients and healthy controls.

CTCA定量参数对冠心病患者短期病死预测价值

目的探讨CT冠状动脉造影(CTCA)定量参数对冠心病患者短期病死预测价值。方法选取2021年3月—2023年3月收治的冠心病200例,比较不同冠状动脉病变程度冠心病患者CTCA定量参数(动脉阻力指数、总斑块负荷和斑块最小密度CT值),分析CTCA定量参数与冠心病患者冠状动脉病变程度相关性,探讨术后1年冠心病患者病死情况,分析CTCA定量参数与冠心病患者短期病死风险关联性,评价CTCA定量参数对冠心病患者短期病死预测价值。结果不同冠状动脉病变程度冠心病患者动脉阻力指数、总斑块负荷逐渐升高,斑块最小密度CT值逐渐降低(P<0.05)。冠心病患者动脉阻力指数、总斑块负荷与疾病类型、病变支数及狭窄程度呈正相关,斑块最小密度CT值与疾病类型、病变支数及狭窄程度呈负相关(P<0.05)。冠心病200例中39例(19.50%)术后1年病死。动脉阻力指数、总斑块负荷和斑块最小密度CT值与冠心病患者短期病死有关(P<0.01)。对冠心病患者短期病死预测的受试者工作特征曲线下面积动脉阻力指数、总斑块负荷和斑块最小密度CT值三者联合明显高于单独预测(P<0.05)。结论CTCA定量参数与冠心病患者冠状动脉病变程度密切相关,且联合各参数预测冠心病患者短期病死价值较高。

甘油三酯-葡萄糖指数与非肥胖型非酒精性脂肪性肝病的相关性

目的探究甘油三酯-葡萄糖指数(TyG)与非肥胖型非酒精性脂肪性肝病(NAFLD)的相关性及诊断预测价值。方法收集2020年5月~2023年12月于我院健康体检体质量指数(BMI)<25 kg/m^(2)的非肥胖者,根据上腹部彩超结果分为健康对照组与NAFLD组。采用限制性立方样条(RCS)探索TyG与非肥胖型NAFLD之间非线性关系,采用LASSO回归进行变量筛选,多因素Logistic回归探究TyG与非肥胖型NAFLD风险之间相关性。受试者工作特征(ROC)曲线评估TyG对非肥胖型NAFLD的诊断预测价值,并进行敏感性分析。结果最终纳入3723例非肥胖型体检者,其中NAFLD患者432例,患病率为11.6%。与健康对照组相比,非肥胖型NAFLD患者中收缩压、舒张压、总胆固醇、甘油三酯、LDL-C、血尿酸、空腹血糖与TyG指数升高,HDLC降低,差异均具有统计学意义(P<0.05)。多因素Logistic回归结果显示,在充分校正混杂因素后,TyG每增加1个单位,非肥胖型NAFLD风险增加约2.22倍(OR=3.22,95%CI:2.53-4.12,P<0.001)。与最低四分位Q1组相比,TyG指数Q2、Q3、Q4组的NAFLD患病风险将分别增加1.52倍(OR=2.52,95%CI:1.20-5.95)、3.56倍(OR=4.56,95%CI:2.28-10.46)与8.66倍(OR=9.66,95%CI:4.83-22.18)。RCS曲线显示TyG指数与非肥胖型NAFLD风险显著相关,两者间呈近似线性关系(非线性检验P=0.019)。ROC曲线下面积为0.819,敏感性为78.0%,特异性为71.2%,具有较好的预测诊断价值。结论TyG指数与非肥胖型NAFLD发生风险显著相关,可作为健康体检人群中脂肪肝早期筛查指标。

内脏脂肪指数对瘦型人群中非酒精性脂肪性肝病的预测价值:一项横断面研究

目的探究内脏脂肪指数(visceral adiposity index,VAI)与瘦型人群中非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的相关性及其预测价值。方法随机纳入2020年6月-2021年5月西安交通大学第二附属医院2576名健康体检者,身体质量指数(BMI)正常(即<24 kg/m^(2)),分为瘦型NAFLD组(n=213)与健康对照组(n=2363),根据VAI四分位数由低到高分为Q 1~Q 4组,比较组间生化指标差异与NAFLD患病情况。采用限制性立方样条分析VAI与瘦型NAFLD之间关系,Logistic回归与受试者工作特征(ROC)曲线探究VAI对瘦型NAFLD的预测价值。结果共纳入2576名体检者,瘦型NAFLD患病率为8.3%(213例)。Q 1~Q 4组平均年龄、男性占比、BMI与腰围(waist circumference,WC)显著增加,且呈明显剂量反应关系(均P<0.001)。与Q 1组相比,Q 2~Q 4组收缩压、舒张压、白细胞计数、血红蛋白浓度、谷丙转氨酶、谷草转氨酶、γ氨基转肽酶、碱性磷酸酶、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、血尿酸与空腹血糖水平均明显增加,直接胆红素与高密度脂蛋白胆固醇水平则逐渐降低,组间差异均具有统计学意义(P<0.001)。Q 1~Q 4组NAFLD的患病率分别为0.6%、3.3%、7.0%、22.2%,呈显著递增(P<0.001)。限制性立方样条图显示随着VAI增加,瘦型人群中NAFLD的患病风险显著增加(P<0.001),两者之间存在非线性关系(P for nonlinear<0.001)。Logistic回归结果显示,在调整各混杂因素后,Q 2、Q 3、Q 4组瘦型NAFLD的患病风险仍分别为Q 1组的2.926倍(95%CI:0.971~8.811)、3.435倍(95%CI:1.154~10.230)与5.920倍(95%CI:1.873~18.719)。ROC曲线显示,VAI对于瘦型NAFLD具有较好的预测价值,曲线下面积为0.815,临界值为1.532,诊断敏感性为77.9%,特异性为72.8%,均优于BMI与WC。结论瘦型体检人群中VAI升高与NAFLD发病风险显著相关,具有良好预测价值,可用于瘦型NAFLD早期筛查与诊断。

甘油三酯——葡萄糖指数对恩替卡韦抗病毒短期疗效的影响及预测价值

目的探讨甘油三酯—葡萄糖(TyG)指数对慢性乙型病毒性肝炎(CHB)合并代谢相关脂肪性肝病(MAFLD)患者恩替卡韦抗病毒短期疗效的影响及预测价值。方法收集2022年1—12月就诊于兰州大学第一医院感染科门诊并确诊为CHB合并MAFLD的277例患者为研究对象,根据TyG指数三分位数,分为T1组(TyG指数≤9.07,n=92)、T2组(9.079.52,n=92)。3组患者均使用恩替卡韦治疗48周,比较3组患者治疗第12、24、48周时的乙型肝炎病毒脱氧核糖核酸(HBV-DNA)和乙型肝炎e抗原(HBeAg)转阴率以及评估抗病毒疗效。在抗病毒治疗24周时,应用多因素Logistic回归分析不同校正条件下,不同TyG指数与CHB合并MAFLD抗病毒疗效的关联程度;通过受试者操作特征曲线判断TyG指数对抗病毒疗效的预测价值。结果体重指数、脂肪衰减指数、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇的水平随着TyG指数三分位数的增加而增加,高密度脂蛋白胆固醇、HBV-DNA、总有效率随着TyG指数三分位数的增加而降低。在抗病毒治疗12、24、48周,3组患者HBVDNA转阴率均差异有统计学意义,抗病毒治疗48周,3组患者HBeAg转阴率差异有统计学意义,HBV-DNA和HBeAg转阴率随着TyG指数三分位数的增加而降低。多因素Logistic回归分析显示,TyG指数是CHB合并MAFLD抗病毒疗效的独立危险因素,TyG指数增加与抗病毒无效的风险增加相关。TyG指数对抗病毒疗效的受试者操作特征曲线下面积为0.827,截断值为9.07,敏感性为80.6%,特异性为77.1%。结论TyG指数与CHB合并MAFLD患者的抗病毒疗效独立相关,抗病毒无效的风险随着TyG指数三分位数的增加而增加,具有较好地预测抗病毒疗效的能力。

生化检验指标对肝病患者的诊断价值评价

目的探讨生化检验指标对肝病患者的诊断价值。方法选取100例肝病患者设为研究组,另选取100例健康体检的健康志愿者设为对照组。采集两组受检者清晨空腹状态下外周静脉血液,离心处理后取血清检测生化检验指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、总胆汁酸(TBA)、总胆红素(TBIL)]。对比研究组与对照组的生化检验指标;对比病毒性肝炎与肝硬化患者的生化检验指标。以肝硬化患者作为阳性病例,以病毒性肝炎患者作为阴性病例,对比生化检验指标单一检测与联合检测对不同类型肝病的鉴别诊断效能。结果研究组血清AST(46.97±8.05)U/L、ALT(47.15±9.28)U/L、ALP(128.14±15.24)U/L、TBA(12.87±3.12)μmol/L、TBIL(20.90±4.19)μmol/L均高于的(24.53±4.68)U/L、(26.10±4.91)U/L、(84.37±10.46)U/L、(5.46±1.70)μmol/L、(12.81±3.37)μmol/L(P<0.05)。肝硬化患者血清AST(50.62±4.73)U/L、ALT(51.89±5.64)U/L、ALP(141.48±8.35)U/L、TBA(14.68±2.29)μmol/L、TBIL(24.07±3.82)μmol/L均高于病毒性肝炎患者的(45.33±4.29)U/L、(45.02±5.13)U/L、(122.15±7.67)U/L、(12.06±1.85)μmol/L、(19.48±3.04)μmol/L(P<0.05)。生化检验指标联合检测的灵敏度、特异度、准确率、阳性预测值、阴性预测值均比AST、ALT、ALP、TBA、TBIL单一检测更高(P<0.05);生化检验指标AST、ALT、ALP、TBA、TBIL单一检测的灵敏度、特异度、准确率、阳性预测值、阴性预测值对比,差异均无统计学意义(P>0.05)。结论肝病患者的生化检验指标水平均出现异常升高,其可准确检出肝病,并对不同类型的肝病进行准确的鉴别诊断,具有良好的诊断价值。

肝脂肪变性指数与2型糖尿病合并冠心病的关联性研究

目的探讨肝脂肪变性指数(HSI)与2型糖尿病(T2DM)合并冠心病(CHD)的关系。方法选取2017年1月至2022年12月在武汉市第三医院心血管内科住院行冠状动脉造影(CAG)的248例T2DM患者作为研究对象,收集所有研究对象性别、年龄、身高、体质量、体质量指数(BMI)及生化检查指标,根据公式计算得到HSI,根据CAG结果将所有研究对象分为CHD组(82例)和非CHD组(166例),采用二元Logistic回归分析T2DM患者发生CHD的危险因素,采用受试者工作特征(ROC)曲线评估HSI对T2DM患者发生CHD的预测价值。结果CHD组和非CHD组BMI、总胆固醇、低密度脂蛋白胆固醇、血浆清蛋白(ALB)、球蛋白(AGB)、尿酸、糖化血红蛋白、HSI比较,差异均有统计学意义(P<0.05)。二元Logistic回归分析结果显示,ALB<40.90 g/L,AGB>25.65 g/L和HSI>39.94是T2DM患者发生CHD的独立危险因素(P<0.05)。ROC曲线分析结果显示,HSI预测T2DM患者发生CHD的曲线下面积为0.556,约登指数为0.117,灵敏度为38.8%,特异度为72.9%。结论高水平HSI是T2DM患者发生CHD的危险因素,HSI对T2DM患者发生CHD有一定的预测价值。

血清神经元特异性烯醇化酶等指标预测肝硬化合并显性肝性脑病患者预后的价值

目的 探讨血清神经元特异性烯醇化酶(NSE)、预后营养指数(PNI)评分、肝性脑病(HE)分级、Integrated终末期肝病模型(iMELD)评分模型预测肝硬化合并显性HE患者近期(90 d)预后的价值。方法 回顾性分析470例肝硬化合并显性HE患者的临床资料,根据患者入院后90 d生存状态将患者分为存活组359例和死亡组111例。结合患者年龄、入院后24 h内血常规、凝血功能、肝肾功能电解质、血清NSE水平、HE分级,计算PNI评分、iMELD评分。采用受试者工作特征(ROC)曲线、多因素Logistic回归分析及Kaplan-Meier生存曲线评估影响肝硬化合并显性HE患者近期预后的因素。结果 死亡组血清NSE、HE分级、iMELD评分高于存活组,PNI评分低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,肝硬化合并显性HE患者近期预后的独立影响因素为血清NSE、PNI评分、HE分级、iMELD评分。血清NSE、PNI评分、HE分级、iMELD评分预测肝硬化合并显性HE患者近期预后的曲线下面积(AUC)分别为0.727、0.717、0.721、0.728;血清NSE、PNI评分、iMELD评分的cut-off值分别为12.23 ng/mL、34.05 ng/mL、39.26分;四者联合预测模型的预测效能最佳,AUC达到0.919,cut-off值为0.23。Kaplan-Meier生存分析提示,血清NSE、PNI评分、HE分级和iMELD评分联合预测模型cut-off值<0.23的患者90 d生存率高于血清NSE、PNI评分、HE分级和iMELD评分联合预测模型cut-off值≥0.23的患者(Log-Rank=265.567,P<0.001)。结论 血清NSE、PNI评分、HE分级、iMELD评分对预测肝硬化合并显性HE患者的近期预后具有良好的价值,联合应用预测价值更高。

肝动脉灌注化疗栓塞治疗原发性肝癌的临床疗效及对患者血清指标与生命质量的影响

目的分析肝动脉灌注化疗栓塞治疗原发性肝癌临床疗效及对患者血清指标与生命质量的影响。方法选取2020年1月至2022年10月于上饶市人民医院治疗的70例原发性肝癌患者作为研究对象,按照随机数字表法分为研究组与对照组,各35例。对照组采用经导管肝动脉栓塞治疗,研究组采用肝动脉灌注化疗栓塞治疗。比价两组临床疗效、血清学指标[血管内皮生长因子(vascular endothelial growth fac�tor,VEGF)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)]、生命质量及并发症发生情况。结果研究组治疗总有效率为91.43%,高于对照组的68.57%,差异有统计学意义(P<0.05)。治疗后,研究组血清VEGF、TNF-α及bFGF水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组生理功能、生理职能、情感职能、躯体疼痛、精神健康、社会功能、精力及总体健康评分均高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率为14.29%,低于对照组的37.14%,差异有统计学意义(P<0.05)。结论肝动脉灌注化疗栓塞治疗原发性肝癌,可促进患者血清指标水平恢复,改善其生命质量,增强临床疗效,降低并发症发生率,值得临床推广应用。

甘油三酯葡萄糖指数和胰岛素抵抗代谢评分与携带载脂蛋白Eε4等位基因人群冠心病严重程度的相关性

目的分析冠状动脉粥样硬化性心脏病(CAD)患者胰岛素抵抗代谢评分(METS-IR)和甘油三酯葡萄糖指数(TyG)与携带载脂蛋白E(ApoE)ε4等位基因的CAD人群冠状动脉狭窄程度的相关性。方法回顾性分析2021年1月至2022年12月于徐州医科大学附属医院经冠状动脉造影确诊为冠心病,且ApoE基因检测结果为ApoE4(ε3ε4,ε4ε4)的308例冠心病患者的临床资料,计算TyG与METS-IR。采用2019年改良Gensini评分(GS)评价CAD狭窄程度,并将患者分为低GS组(106例)、中间GS组(100例)与高GS组(102例)。采用SPSS 27.0统计软件进行数据分析。根据数据类型分别采用单因素方差分析、Kruskal-Wallis H检验或χ^(2)检验进行比较。采用logistic回归分析评估ApoE4冠心病患者冠状动脉狭窄程度的影响因素。采用Spearman相关性分析评估METS-IR和TyG与Gensini评分的相关性。绘制受试者工作特征(ROC)曲线,采用Delong检验比较METS-IR和TyG对冠状动脉狭窄程度的预测价值。结果高GS组METS-IR明显高于非高GS组;高GS组TyG明显高于低GS组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,METS-IR和TyG与Gensini评分呈正相关(r=0.210,0.658;P<0.001)。logistic回归分析显示,METS-IR是携带ApoEε4等位基因冠心病患者狭窄程度的独立预测因子(OR=1.147,95%CI 1.077~1.221;P<0.001)。ROC曲线显示,METS-IR与TyG预测携带ApoEε4等位基因的冠心病人群冠状动脉狭窄程度曲线下面积分别为0.824和0.608,METS-IR预测效能明显更高。结论METS-IR相比于TyG对携带ApoEε4等位基因的CAD患者冠状动脉狭窄程度有更高预测价值。