摘要:目的:通過建立高脂血癥脂肪肝動物模型,探討杜仲葉醇提取物(alcohol extractive of Folium Eucommiae,AEFE)對脂肪肝的防治作用。方法:高脂飲食8周加維生素D36×105IU/kg分3d腹腔注射，建立大鼠高脂血癥脂肪肝動物模型。各給藥組從造模第3周開始分別灌胃給予洛伐他汀(4mg·kg-1·d-1)、 AEFE(70、140和420mg·kg-1·d-1),共給藥6周。各組每天灌服等量生理鹽水，灌胃容積為0.5mL/100g體重。結果:AEFE用藥6周后顯示,各劑量組血清膽固醇、甘油三酯和游離脂肪酸、谷丙轉氨酶和谷草轉氨酶均較模型組明顯降低(Plt;005),肝組織丙二醛含量降低和超氧化物歧化酶活性升高,肝脂肪變性和炎癥反應減輕,尤以中劑量組作用最明顯(Plt;001)。AEFE對肝內腫瘤壞死因子α濃度無明顯影響。結論:AEFE改善高脂性大鼠肝臟脂肪變性,此作用可能與其降血脂、抗氧化損傷有關。
ObjectiveTo investigate the value of proton magnetic resonance spectroscopy (1H-MRS), gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR.MethodsThirty patients with fatty liver diagnosed by CT or ultrasound who admitted in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between August 2017 and May 2018, were enrolled and undergone gradient dual-echo, triple-echo, and 1H-MRS examination before and 3 months after treatment. The fat index (FI) and relative lipid content (RLC) were measured. Fatty liver index (FLI) was calculated from blood biochemical indicators, waist circumference, and BMI at the same time. With the reference standard of FLI, the results before and after treatment measured from MRI were analyzed.ResultsThere were significantly differences of FLI, FIdual, FItriple, and RLC before and after treatment (t=5.281, P<0.001; Z=–3.651, P<0.001; Z=–3.630, P<0.001; Z=–4.762, P<0.001), all indexes decreased after treatment. FIdual and FItriple were positively correlated with FLI before (rs=0.413, P=0.023; rs=0.396, P=0.030) and after treatment (rs=0.395, P=0.031; rs=0.519, P=0.003), the highest correlation factor was FItriple to FLI after treatment. There were no significant correlation between RLC and FLI before and after treatment (P>0.05).ConclusionsIt is feasible to quantitatively evaluate the treatment effect of fatty liver by using 1H-MRS, gradient dual-echo, and triple-echo sequences. Gradient triple-echo sequences has better accuracy, which is technically easy to implement and more suitable for clinical development.
Objective To evaluate the value of medical imaging technology in qualitative and quantitative diagnosis of liver steatosis. Methods To describe the current status and advancement s of medical imaging technology such as sonography , CT and MRI in qualitative and quantitative diagnosis of liver steatosis , and to cont rast their advantages and shortages. Results Sonography could be used as the primary screening and evaluate measures in qualitative and quantitative diagnosis of liver steatosis , and CT was more reliable in quantitative diagnosis , MRI had significant improving with its high sensitivity and specificity. Conclusion Medical imaging technology has significant clinical value in qualitative and quantitative diagnosis of liver steatosis , especially with the help of functional MR imaging techniques such as spect roscopy and chemical shif t Gradient-Echo technic.
Objective To investigate the diagnostic value of proton magnetic resonance spectroscopy （1 H-MRS） on the quantification of hepatic steatosis at 3.0 T MR united.Methods Twenty-two patients who were candidated for liver surgery (living liver transplantation donor candidates, lobectomy or segmental resection for focal liver diseases, etc.) were enrolled in this study. 1 H-MRS was conducted with point resolved selective spectroscopy （PRESS） sequence, using SAGE software packages. The values of water peak (PW), lipid peak (PL) were measured, the area under water peak (AW) and lipid peak (AL), and then the relative lipid content of liver cells (RLC1, RLC2) was calculated. All subjects underwent surgical resection of liver shortly after MR scanning, fresh frozen specimens were obtained for Sudan Ⅲ staining, and staging was conducted.Results In all 22 patients, 7 patients without fatty liver, 11 patients with mild fatty liver, 4 patients with moderate or severe fatty liver. Intercomparison between different histopathological grades showed following findings: the values of PL, AL, RLC1 and RLC2 had statistical significance (Plt;0.05). The values of PL， AL， RLC1 and RLC2 were positively correlated with the proportion of fatty degenerative cells (PFDC), Plt;0.05, and the highest correlation factor was 0.771 (RLC1 to the PFDC).Conclusion 1 H-MRS can accurately quantify liver fat content and reflect the severity of hepatic steatosis. It has the potential to replace invasive liver biopsy.
Objective To explore the relationship between different diagnostic criteria (ATPIII2002, IDF2005 and CDS2007 criteria) for metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD). Methods A total of 666 elderly males admitted to West China Hospital for routine physical examination were involved in this study in May, 2010. The diagnostic agreement rates of different criteria were compared, along with the relationship between different diagnostic criteria for MS and NALFD. Results The diagnostic agreement of CDS2007 criteria with either IDF2005 or ATPIII2002 criteria was good. However, the agreement of ATPIII2002 with IDF2005 was compromised. The prevalence of NAFLD in MS group was significantly higher than that of non-MS group (Plt;0.01). On the basis of CDS2007 criteria, there was significant correlation between NAFLD and MS (Plt;0.000). Conclusion There is a close relation between NAFLD and all three diagnostic criteria of MS. NAFLD is one of the most important risk factors of MS. The diagnostic agreement of CDS2007 criteria with the other two is good, and there is significant correlation between NAFLD and criteria CDS2007 of MS. CDS2007 is found to be of high accuracy and applicability in the diagnosis of MS in Chinese population including the elderly.
目的 了解成都地區非酒精性脂肪肝（NAFLD）及高尿酸血癥（HUA）患病情況及相關因素。 方法 對2010年9月－2011年3月健康體檢的36 000名18歲以上受檢者，進行病史采集、體格檢查、空腹血糖、血脂、肝功能、腎功能、血尿酸檢測以及上腹部彩色多普勒超聲檢查。 結果 高尿酸血癥（HUA）的總患病率為18.17%。NAFLD患者HUA患病率為39.41%，明顯高于總患病率（P＜0.01）。NAFLD患者的HUA患病率隨體質量指數（BMI）的增加呈遞增趨勢。BMI、舒張壓、甘油三酯、膽固醇、丙氨酸轉氨酶、門冬氨酸氨轉移酶、谷氨酰轉肽酶、血肌酐、胱抑素C均隨著血尿酸水平的升高而遞增；高密度脂蛋白隨著血尿酸水平的升高而遞減。 結論 NAFLD及HUA關系密切，且二者與代謝紊亂聯系緊密。
ObjectiveTo investigate the diagnostic value of spectral saturation inversion recovery, gradient-echo chemical shift MRI， and proton magnetic resonance spectroscopy in quantifying hepatic fat content. MethodsConventional T1-weighted and T2-weighted scanning (without fat saturation and with fat saturation)， gradient-echo T1W in-phase （IP） and opposedphase （OP） images and 1H-MRS were performed in 31 healthy volunteers and 22 patients who were candidates for liver surgery. Signal intensities of T1WI amp; T1WIFS (SInonfat1, SIfat1), T2WI amp; T2WI-FS (SInonfat2, SIfat2), and IP amp; OP (SIin, SIout) were measured respectively, the relative signal intensity one (RSI1), relative signal intensity two (RSI2)， and fat index (FI) were calculated. Peak values and the area under peak of 1H-MRS were measured, and the relative lipid content of liver cells (RLC ) were calculated. Twenty-two patients accepted liver resection and histological examination after MRI scanning, the proportion of fatty degenerative cells were calculated by image analysis software. Results①Hepatic steatosis group showed higher average values of RSI1, FI， and RLC to non-hepatic steatosis group (Plt;0.05), while there was no significant difference in RSI2 between two groups (Pgt;0.05). ②There was a statistical significant difference in RLC among different histopathological grades of hepatic steatosis, and RLC increased in parallel with histopathological grade (Plt;0.05).There was no significant difference in RSI2, RSI1, and FI among different histopathological grades, although the latter two had a tendency of increasing concomitant with histopathological grade (Pgt;0.05). ③The values of FI and RLC were positively correlated with the PFDC （r=0468, P=0.027； r＝0771， Plt;0.000 1）, while they were not in RSI1 and RSI2 (r=0.411, P=0.057； r=0.191, P=0.392). ConclusionsSPIR, Gradient-echo chemical shift MRI and 1H-MRS can help to differentiate patients with hepatic steatosis from normal persons, the latter also can help to classify hepatic steatosis. In quantifying hepatic fat content, 1H-MRS is superior to gradient-echo chemical shift MRI, while SPIR’s role is limited.
目的 觀察羅格列酮鈉對血糖控制未達標的2型糖尿病（T2DM）合并與不合并非酒精性脂肪肝（NAFL）患者的降糖療效和安全性。 方法 2009年1月－2011年1月60例僅用磺脲類和二甲雙胍治療血糖控制未達標的T2DM患者，按合并和不合并NAFL分為觀察組和對照組各30例，兩組均在原口服降糖藥基礎上聯合加用國產羅格列酮鈉4 mg 1次/d，治療共3個月，觀察治療前后的血糖、胰島素、糖化血紅蛋白（HbA1c）、體質量指數（BMI）、血脂、肝功、血壓水平以及藥物不良反應，并比較治療后的血糖達標率。 結果 兩組患者治療后的空腹血糖（FPG）、餐后2 h血糖（2hPG）、HbA1c、空腹胰島素、甘油三酯和極低密度脂蛋白膽固醇均較治療前下降，高密度脂蛋白膽固醇較治療前升高（P＜0.05），而丙氨酸轉氨酶、總膽固醇、低密度脂蛋白膽固醇及血壓無明顯變化（P＞0.05），但觀察組治療后的FPG和2hPG均較對照組下降更明顯（P＜0.01），且血糖達標率為73.3%，顯著高于對照組的46.7%（P＜0.05），同時觀察組餐后2 h胰島素（2hINS）水平在治療前后均明顯高于對照組而且治療后有顯著下降（P＜0.01），但對照組治療后2hINS雖然也有下降但無統計學意義（P＞0.05）。觀察組治療前后BMI無明顯變化，但對照組治療后BMI有明顯的升高（P＜0.05）。結論 國產羅格列酮鈉片對血糖控制未達標的T2DM合并和不合并NAFL患者均有進一步降低血糖、HbA1c以及改善血脂的作用，但對T2DM合并NAFL的患者的降糖療效更顯著，未見加重肝功能損壞，不良反應小，可作為此類患者聯合用藥的一種選擇。