非酒精性脂肪肝诊治研究.DOCVIP

临床医学论文-非酒精性脂肪肝诊治研究 【摘要】? 目的 探讨非酒精性脂肪肝（NAFL）的临床诊断和治疗对策。方法 研究168例NAFL在人群分布的特点、临床表现及其诊断和治疗。结果 本研究中男性与女性之比为6：1且均以青壮年多见。所有病例均有不同程度的超重，肥胖者达90%以上；合并2型糖尿病者，男25.0%，女20.8%。彩色B超和（或）CT检查，有助于明确绝大多数非酒精性脂肪肝的诊断，肝穿刺活检尚很难以为患者所接受。饮食的“总量不变，结构调整”八字方针以及运动的“不拘形式”是减肥的行之有效的措施。保肝治疗非常必要，甘草酸二铵有修复非特异性的肝细胞损伤的作用，复方丹参可以改善肝脏微循环；硫普罗宁或还原性谷胱甘肽，对于脂肪肝之由于脂肪浸润引起的肝细胞损伤的修复有独到的作用。168例中有60例（35.7%）因用降脂药物1～2周出现肝功能（主要是ALT）异常的加重；合并2型糖尿病的41例（男36例，女5例）患者中有58.5%(24/41)的人用降糖药物后也出现肝功能（主要是ALT）异常的加重。结论 非酒精性脂肪肝以男性青壮年居多，多伴肥胖，可合并2型糖尿病。在诊断上，无创和有创检查的结合是以后的努力方向。控制饮食和运动以减肥是治疗NAFL的首要措施；保肝治疗非常必要，甘草酸二铵和复方丹参作为基本用药，硫普罗宁或还原性谷胱甘肽作为必选药物；慎用降糖药物，不提倡常规使用降脂药物。 【关键词】? 非酒精性脂肪肝；诊断；治疗 ????? 【Abstract】? Objective? To study the clinical diagnosis and theraputic countermeasure of the cases of nonalcoholic fatty liver (NAFL).Methods? Study the feature of distribution in population, the clinical menifestation, diagnosis and theraputic countermeasure of 168 cases of NAFL.Results?In this study, the ratio between male and female is 6:1 and most of the cases are young and middle-aged. All cases overweight with different degrees and over 90% of the cases are obesity. 25.0% of male cases and 20.8% of female cases have the complication-diabetes mellitus type II(DM2). Type B color ultrasonic examination and/or computerized tomography (CT) are helpful for the definit of diagnoses of most NAFL but needle biopsy of liver is very hard to be accepted by patients. Both the principle on diet, i.e. 抰he total number of food unchanged, the component of the food modulated?and 抦ovement with whatever forms?are effective methods to reduce body weight. The therapy of protection of liver function is very necessary: diammonium glycyrrhizinate can recover the non-specific damage of liver cells, Fufangdanshen can improve the microcirculation of liver, and tiopronin and reduced glutathione has the unique function to recover liver damage caused by fat invasion. Of 168 cases, 60 cases (35.7%) show exacerbation of liver function (mainly ALT) after using fat-reducing drug