AIM: To explore the association between serum α-Lfucosidase(Af U) and non-alcoholic fatty liver disease(NAf LD).METHODS: A total of 16473 individuals(9456 men and 7017 women) were included in the current study, who p...AIM: To explore the association between serum α-Lfucosidase(Af U) and non-alcoholic fatty liver disease(NAf LD).METHODS: A total of 16473 individuals(9456 men and 7017 women) were included in the current study, who presented for a health examination at the first Affiliated hospital of Zhejiang University School of medicine in 2014. The baseline characteristics of the cohort were compared by NAf LD status. Linear regression analysis and stepwise multiple regression analysis were applied to assess the risk factors for NAf LD. Receiver operating characteristic curve was used to determine the sensitivity and specificity of Af U in the diagnosis of NAf LD.RESULTS: The prevalence rates of NAf LD and metabolic syndrome(met S) were 38.0% and 25.4%, respectively. The NAf LD group had significantly higher Af U levels than the non-NAf LD group(28.7 ± 7.9 U/L vs 26.0 ± 7.3 U/L, P < 0.001) and the prevalence rate of NAf LD increased with progressively higher serum Af U levels. Af U was positively correlated with met S and its five components: central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and elevated blood pressure and fasting glucose. Stepwise multiple logistic regression analysis showed that Af U was associated with an increased risk of NAf LD(OR = 1.009, 95%CI: 1.003-1.014, P < 0.001). The best cut-off value of Af U for the diagnosis of NAf LD was 27.5 U/L. The area under the curve(diagnostic efficacy index) was 0.606. The sensitivity and specificity were 54.6% and 61.8%, respectively. CONCLUSION: Af U level is significantly associated with NAf LD, and elevated Af U level is an independent risk factor for NAf LD.展开更多
This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume ...This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume and was space-fitting in the recipient hepatic fossa when it was rotated 180 degrees.The operation and postoperative course progressed satisfactorily.Three weeks after living donor liver transplantation(LDLT),the graft function was disturbed by compression of bottom-placed right hepatic vein.This was treated with a vascular stent and subsequently the graft function was normalized.The present case shows that LDLT for patients with SIT using a right posterior section graft is feasible.展开更多
Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub-Saharan Africa. We aimed at evaluating...Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub-Saharan Africa. We aimed at evaluating liver fibrosis, using the Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis Index Based on 4 factors (FIB4), and Gamma-glutamyl transpeptidase to Platelet Ratio (GPR) in chronic hepatitis B patients with transient elastography as the reference so as to choose an alternative to transient elastography. Method: We carried out a cross-sectional study using the records of patients who attended the Douala General Hospital and Marie O Polyclinic Douala from 2012 to 2017. Non-invasive tests were compared with Transient Elastography. The Spearman coefficient was used to determine correlation. The sensitivity, specificity, positive predictive values and negative predictive values were used to get the optimal cut-off values. The diagnostic accuracy was estimated by calculating the area under the Receiver Operating Characteristic Curve (ROC). P Results: Of the 243 patient records studied, the median age or interquartile range (IQR) was 35 (29 - 42) years with a male predominance of 73.7%. More than 60% of the study population had normal transaminases. Significant fibrosis was found in 88 (36.2%) patients and 32 (13.7%) patients had cirrhosis. APRI had the best cut-off values and highest area under the ROC Curve, for significant fibrosis and cirrhosis with 0.55 (0.823 95% CI [0.769 - 0.869], P Conclusion: APRI, had the best diagnostic properties to detect liver fibrosis and cirrhosis in patients with Chronic Hepatitis B in Douala. The cut-off values are 0.55 and 0.65 for significant fibrosis and cirrhosis respectively.展开更多
目的比较在中央肝切除术中肝断面胶封法处理与肝断面敞开处理的临床效果,探讨肝断面胶封法处理的临床应用价值。方法回顾性分析2020年1月至2024年12月温州医科大学附属第一医院肝胆胰外科56例行中央肝切除术患者的临床资料,根据肝断面...目的比较在中央肝切除术中肝断面胶封法处理与肝断面敞开处理的临床效果,探讨肝断面胶封法处理的临床应用价值。方法回顾性分析2020年1月至2024年12月温州医科大学附属第一医院肝胆胰外科56例行中央肝切除术患者的临床资料,根据肝断面处理方式分为两组:肝断面胶封法处理组(n=15)和肝断面敞开处理组(n=41),比较两组患者的短期临床结局和相关临床指标差异。结果两组均无手术死亡病例,未发生肝衰竭等严重并发症。肝断面胶封法处理组出现胸腔积液2例,无胆漏、创面渗血、创面感染病例;肝断面敞开处理组发生胆漏1例,胸腔积液3例,创面渗血2例,无创面感染病例。两组术后并发症发生率比较,差异无统计学意义[13.33%(2/15)vs 14.63%(6/41),P=0.678]。两组手术时间、术中出血量、肝门阻断时间比较,差异均无统计学意义(P>0.05)。肝断面胶封法处理组术后第1天[(118.67±75.77)mL vs 150.00(120.00,210.00)mL,Z=-2.124,P=0.034]、第2天[(107.00±38.63)mL vs 150.00(100.00,220.00)mL,Z=-2.628,P=0.009]、第3天[(65.67±41.18)mL vs 130.00(80.00,220.00)mL,Z=-3.661,P<0.001]腹腔引流量均显著少于肝断面敞开处理组。两组术后第1、3、7天的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和肌酐(Cr)比较,差异均无统计学意义(P>0.05)。两组共40例患者于术后1个月左右再入院接受肝癌术后预防性经动脉化疗栓塞(TACE)治疗,影像学检查见肝实质强化均匀,保留肝脏血管系统显示清晰,门静脉系统、肝静脉系统均未见狭窄。结论肝断面胶封法处理操作简便、安全可靠,可有效减少中央肝切除术后早期腹腔积液。肝断面胶封法处理为中央肝切除术中肝断面处理提供了一种新的可选择方案。展开更多
目的探讨冠心病风险及其死亡率与非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)之间的相关性。方法选取美国国家健康与营养调查(the U.S.National Health and Nutrition Examination Survey,NHANES)2017—2018年调查周期...目的探讨冠心病风险及其死亡率与非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)之间的相关性。方法选取美国国家健康与营养调查(the U.S.National Health and Nutrition Examination Survey,NHANES)2017—2018年调查周期数据作横断面分析,共纳入3921例参与者,基于疾病问卷资料分为冠心病组(n=166)和对照组(n=3755)。采用逆概率处理加权(inverse probability of treatment weighting,IPTW)匹配组间基线特征,非条件logistic回归、加权logistic回归和亚组分析冠心病与NAFLD的关联性,Cox比例风险模型分析NAFLD与冠心病死亡率的独立关联性。结果IPTW匹配后,两组基线特征基本均衡(SMD<0.20,P>0.05)。冠心病患者NAFLD发生率为72.29%(120/166),高于对照组发生率54.86%(2060/3755),组间差异有统计学意义(χ^(2)=19.562,P<0.001)。非条件logistic回归结果显示,在校正所有协变量后,NAFLD与冠心病风险升高独立相关(OR=1.572,95%CI:1.088~2.272)。加权logistic回归结果显示,冠心病与NAFLD具有相关性(OR=1.302,95%CI:1.178~1.439)。亚组分析结果显示,性别、年龄、高血压史等可能影响冠心病与NAFLD之间的关联性(P交互<0.001)。Cox比例风险模型回归未发现NAFLD与冠心病死亡率存在关联(P>0.05)。结论冠心病与NAFLD存在显著关联,NAFLD管理对冠心病的预防有重要意义。展开更多
背景非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)已成为全球重大公共卫生问题.探寻生物标志物用于NAFLD的预防监测和临床评估,对于临床靶向防治具有指导意义.炎症与NAFLD间关联复杂,探索NAFLD相关炎症标志物,有助于...背景非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)已成为全球重大公共卫生问题.探寻生物标志物用于NAFLD的预防监测和临床评估,对于临床靶向防治具有指导意义.炎症与NAFLD间关联复杂,探索NAFLD相关炎症标志物,有助于阐明致病机制.目的本研究基于美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库的数据,探究炎症标志物中性粒细胞-白蛋白比值(neutrophil to albumin ratio,NAR)与NAFLD的潜在关联.方法选取NHANES数据库2017-2018参与者数据集.根据有无发生NAFLD分为NAFLD组、非NAFLD组.比较两组临床资料;采用Logistic多模型回归分析探索NAR与NAFLD相关性;进一步通过限制性立方样条(restricted cubic spline,RCS)及阈值效应分析探索潜在拐点.结果最终纳入了4526名参与者,其中NAFLD患者有1503例.NAFLD组NAR水平高于非NAFLD组,差异有统计学意义(P<0.05);两组间性别、年龄、体质指数、吸烟状况、高血压、降压药使用、糖尿病、降糖药使用、谷丙转氨酶、谷草转氨酶、血尿素氮、肌酸酐、尿酸、甘油三酯、总胆固醇等水平差异均有统计学意义(均P<0.05),这些变量进入矫正模型.在无矫正的模型1中,NAR水平与NAFLD的发生风险有关(OR=2.154);在矫正不同变量的模型2(OR=1.375)、模型3(OR=1.693)、及模型4(OR=1.817)中,两者间仍具有独立相关性(均P<0.05).RCS曲线显示,NAR与NAFLD之间存在非线性关系(P_(for overall)<0.001,P_(for nonlinear)<0.001).阈值效应分析显示,NAR影响NAFLD的拐点为1.436,当NAR低于1.436时,NAR每增加一个单位,NAFLD发生风险增加3.304倍(OR=3.304;95%CI:2.649-4.122;P<0.001).但本研究尚未发现NAR在区别非酒精性脂肪性肝炎中的潜在价值.结论NAR与NAFLD发生风险独立相关;当NAR水平低于1.436时,NAFLD发生风险随NAR水平升高而增加.展开更多
基金Supported by National Key Basic Research Development ProgramNo.2012CB524905+9 种基金National Science and Technology Support Plan ProjectNo.2012BAI06B04National Natural Science Foundation of ChinaNo.81100278No.81170378No.81230012 and No.81270487International Science and Technology Cooperation Projects of Zhejiang ProvinceNo.2013C24010Science Fund of Health Bureau of Zhejiang ProvinceNo.2012RCA026
文摘AIM: To explore the association between serum α-Lfucosidase(Af U) and non-alcoholic fatty liver disease(NAf LD).METHODS: A total of 16473 individuals(9456 men and 7017 women) were included in the current study, who presented for a health examination at the first Affiliated hospital of Zhejiang University School of medicine in 2014. The baseline characteristics of the cohort were compared by NAf LD status. Linear regression analysis and stepwise multiple regression analysis were applied to assess the risk factors for NAf LD. Receiver operating characteristic curve was used to determine the sensitivity and specificity of Af U in the diagnosis of NAf LD.RESULTS: The prevalence rates of NAf LD and metabolic syndrome(met S) were 38.0% and 25.4%, respectively. The NAf LD group had significantly higher Af U levels than the non-NAf LD group(28.7 ± 7.9 U/L vs 26.0 ± 7.3 U/L, P < 0.001) and the prevalence rate of NAf LD increased with progressively higher serum Af U levels. Af U was positively correlated with met S and its five components: central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and elevated blood pressure and fasting glucose. Stepwise multiple logistic regression analysis showed that Af U was associated with an increased risk of NAf LD(OR = 1.009, 95%CI: 1.003-1.014, P < 0.001). The best cut-off value of Af U for the diagnosis of NAf LD was 27.5 U/L. The area under the curve(diagnostic efficacy index) was 0.606. The sensitivity and specificity were 54.6% and 61.8%, respectively. CONCLUSION: Af U level is significantly associated with NAf LD, and elevated Af U level is an independent risk factor for NAf LD.
文摘This recipient with situs inversus totalis(SIT) was a 60-year-old female who had hepatitis B-related endstage liver disease.Preoperative donor evaluation showed that the right posterior section satisfied graft volume and was space-fitting in the recipient hepatic fossa when it was rotated 180 degrees.The operation and postoperative course progressed satisfactorily.Three weeks after living donor liver transplantation(LDLT),the graft function was disturbed by compression of bottom-placed right hepatic vein.This was treated with a vascular stent and subsequently the graft function was normalized.The present case shows that LDLT for patients with SIT using a right posterior section graft is feasible.
文摘Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub-Saharan Africa. We aimed at evaluating liver fibrosis, using the Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis Index Based on 4 factors (FIB4), and Gamma-glutamyl transpeptidase to Platelet Ratio (GPR) in chronic hepatitis B patients with transient elastography as the reference so as to choose an alternative to transient elastography. Method: We carried out a cross-sectional study using the records of patients who attended the Douala General Hospital and Marie O Polyclinic Douala from 2012 to 2017. Non-invasive tests were compared with Transient Elastography. The Spearman coefficient was used to determine correlation. The sensitivity, specificity, positive predictive values and negative predictive values were used to get the optimal cut-off values. The diagnostic accuracy was estimated by calculating the area under the Receiver Operating Characteristic Curve (ROC). P Results: Of the 243 patient records studied, the median age or interquartile range (IQR) was 35 (29 - 42) years with a male predominance of 73.7%. More than 60% of the study population had normal transaminases. Significant fibrosis was found in 88 (36.2%) patients and 32 (13.7%) patients had cirrhosis. APRI had the best cut-off values and highest area under the ROC Curve, for significant fibrosis and cirrhosis with 0.55 (0.823 95% CI [0.769 - 0.869], P Conclusion: APRI, had the best diagnostic properties to detect liver fibrosis and cirrhosis in patients with Chronic Hepatitis B in Douala. The cut-off values are 0.55 and 0.65 for significant fibrosis and cirrhosis respectively.
文摘目的比较在中央肝切除术中肝断面胶封法处理与肝断面敞开处理的临床效果,探讨肝断面胶封法处理的临床应用价值。方法回顾性分析2020年1月至2024年12月温州医科大学附属第一医院肝胆胰外科56例行中央肝切除术患者的临床资料,根据肝断面处理方式分为两组:肝断面胶封法处理组(n=15)和肝断面敞开处理组(n=41),比较两组患者的短期临床结局和相关临床指标差异。结果两组均无手术死亡病例,未发生肝衰竭等严重并发症。肝断面胶封法处理组出现胸腔积液2例,无胆漏、创面渗血、创面感染病例;肝断面敞开处理组发生胆漏1例,胸腔积液3例,创面渗血2例,无创面感染病例。两组术后并发症发生率比较,差异无统计学意义[13.33%(2/15)vs 14.63%(6/41),P=0.678]。两组手术时间、术中出血量、肝门阻断时间比较,差异均无统计学意义(P>0.05)。肝断面胶封法处理组术后第1天[(118.67±75.77)mL vs 150.00(120.00,210.00)mL,Z=-2.124,P=0.034]、第2天[(107.00±38.63)mL vs 150.00(100.00,220.00)mL,Z=-2.628,P=0.009]、第3天[(65.67±41.18)mL vs 130.00(80.00,220.00)mL,Z=-3.661,P<0.001]腹腔引流量均显著少于肝断面敞开处理组。两组术后第1、3、7天的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和肌酐(Cr)比较,差异均无统计学意义(P>0.05)。两组共40例患者于术后1个月左右再入院接受肝癌术后预防性经动脉化疗栓塞(TACE)治疗,影像学检查见肝实质强化均匀,保留肝脏血管系统显示清晰,门静脉系统、肝静脉系统均未见狭窄。结论肝断面胶封法处理操作简便、安全可靠,可有效减少中央肝切除术后早期腹腔积液。肝断面胶封法处理为中央肝切除术中肝断面处理提供了一种新的可选择方案。
文摘目的探讨冠心病风险及其死亡率与非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)之间的相关性。方法选取美国国家健康与营养调查(the U.S.National Health and Nutrition Examination Survey,NHANES)2017—2018年调查周期数据作横断面分析,共纳入3921例参与者,基于疾病问卷资料分为冠心病组(n=166)和对照组(n=3755)。采用逆概率处理加权(inverse probability of treatment weighting,IPTW)匹配组间基线特征,非条件logistic回归、加权logistic回归和亚组分析冠心病与NAFLD的关联性,Cox比例风险模型分析NAFLD与冠心病死亡率的独立关联性。结果IPTW匹配后,两组基线特征基本均衡(SMD<0.20,P>0.05)。冠心病患者NAFLD发生率为72.29%(120/166),高于对照组发生率54.86%(2060/3755),组间差异有统计学意义(χ^(2)=19.562,P<0.001)。非条件logistic回归结果显示,在校正所有协变量后,NAFLD与冠心病风险升高独立相关(OR=1.572,95%CI:1.088~2.272)。加权logistic回归结果显示,冠心病与NAFLD具有相关性(OR=1.302,95%CI:1.178~1.439)。亚组分析结果显示,性别、年龄、高血压史等可能影响冠心病与NAFLD之间的关联性(P交互<0.001)。Cox比例风险模型回归未发现NAFLD与冠心病死亡率存在关联(P>0.05)。结论冠心病与NAFLD存在显著关联,NAFLD管理对冠心病的预防有重要意义。
文摘背景非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)已成为全球重大公共卫生问题.探寻生物标志物用于NAFLD的预防监测和临床评估,对于临床靶向防治具有指导意义.炎症与NAFLD间关联复杂,探索NAFLD相关炎症标志物,有助于阐明致病机制.目的本研究基于美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库的数据,探究炎症标志物中性粒细胞-白蛋白比值(neutrophil to albumin ratio,NAR)与NAFLD的潜在关联.方法选取NHANES数据库2017-2018参与者数据集.根据有无发生NAFLD分为NAFLD组、非NAFLD组.比较两组临床资料;采用Logistic多模型回归分析探索NAR与NAFLD相关性;进一步通过限制性立方样条(restricted cubic spline,RCS)及阈值效应分析探索潜在拐点.结果最终纳入了4526名参与者,其中NAFLD患者有1503例.NAFLD组NAR水平高于非NAFLD组,差异有统计学意义(P<0.05);两组间性别、年龄、体质指数、吸烟状况、高血压、降压药使用、糖尿病、降糖药使用、谷丙转氨酶、谷草转氨酶、血尿素氮、肌酸酐、尿酸、甘油三酯、总胆固醇等水平差异均有统计学意义(均P<0.05),这些变量进入矫正模型.在无矫正的模型1中,NAR水平与NAFLD的发生风险有关(OR=2.154);在矫正不同变量的模型2(OR=1.375)、模型3(OR=1.693)、及模型4(OR=1.817)中,两者间仍具有独立相关性(均P<0.05).RCS曲线显示,NAR与NAFLD之间存在非线性关系(P_(for overall)<0.001,P_(for nonlinear)<0.001).阈值效应分析显示,NAR影响NAFLD的拐点为1.436,当NAR低于1.436时,NAR每增加一个单位,NAFLD发生风险增加3.304倍(OR=3.304;95%CI:2.649-4.122;P<0.001).但本研究尚未发现NAR在区别非酒精性脂肪性肝炎中的潜在价值.结论NAR与NAFLD发生风险独立相关;当NAR水平低于1.436时,NAFLD发生风险随NAR水平升高而增加.
