2011-9-17脂肪肝最近的研究.pptVIP

治疗前后患者肝功能变化情况 治疗前后患者血脂变化情况 治疗前后临床主要症状的变化 原则:应用至肝功能正常后，改为口服，停药后仍应观察 甘草酸制剂一般为肝功能恢复后1个月，逐渐减量停药 水飞蓟素一般为肝功能恢复后1-3个月 多烯磷脂酰胆碱一般为肝功能恢复后1-3个月 还原型谷胱甘肽至肝功能正常可停用 S腺苷氮氨酸应用15天无效可停用，有效至轻度黄疸 皮质激素短期、足量、快减(快进快出) 应用抗炎保肝药物的疗程 * * 非酒精性脂肪肝病 (NAFLD) 与心脏代谢疾病危险升高相关 非酒精性脂肪肝病 (NAFLD) 及其更严重的临床结果－非酒精性脂肪性肝炎【NASH】，与一系列构成代谢综合症的心脏代谢危险因素密切相关。这些危险因素对这类人群的预后非常重要，幻灯片中的数据是一项在400例2型糖尿病伴NAFLD患者中所进行的病例对照研究结果，与年龄和性别相匹配的对照组比较，这些患者的代谢综合征患病率增加；冠状动脉、脑动脉和外周动脉粥样硬化的患病率也增加。在调整了各种心血管和代谢参数后，NAFLD、代谢综合征、年龄、性别和吸烟都是心血管事件的独立预测因素。然而，对代谢综合征进行调整后，NAFLD与心血管危险性间就不再存在有显著的相关性。【相反，无论调整 NAFLD与否，代谢综合征与心血管的危险性之间仍然存在着显著相关性。】这显示了代谢综合症及其组成成分是这些合并NAFLD或NASH患者不良心血管结局危险增加的主要原因。 Non-alcoholic fatty liver disease is associated with elevated cardiometabolic risk Non-alcoholic fatty liver disease (NAFLD) and its more serious clinical consequence, non-alcoholic steatohepatitis, are closely associated with the cluster of cardiometabolic risk factors that make up the metabolic syndrome. These risk factors are prognostically important in this population, as shown by a case-control study in 400 type 2 diabetes patients with NAFLD. This study demonstrated a higher prevalence of metabolic syndrome and an increased prevalence of atherosclerotic disease of the coronary, cerebrovascular or peripheral arteries, compared with a population of age- and gender-matched control subjects. NAFLD, metabolic syndrome, age, gender and smoking status were independent predictors of cardiovascular events after adjustment for various cardiovascular and metabolic parameters, but further adjustment for the presence or absence of the metabolic syndrome rendered the risk associated with NAFLD non-significant. Thus, it appeared that the metabolic syndrome and its components were largely responsible for the elevated risk of adverse cardiovascular outcomes in patients with NAFLD or NASH. Targher G, Bertolini L, Padovani R et al. Increased prevalence of cardiovascular disease in Type 2 diabetic patients with non-alcoholic fatty liver disease. Diabet Med 2006;23:403-9