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目的 探索非酒精性脂肪性肝炎 (NASH)的诊断标准和治疗方法。方法 比较分析NASH、酒精性肝病、单纯脂肪肝、慢性肝炎患者 ,健康人及 2型糖尿病患者的临床资料。根据NASH患者的体重指数 (BMI)、血清胰岛素浓度及谷丙转氨酶 (ALT)水平给予不同的治疗。查阅 4 0例 2型糖尿病病人资料。结果 75例NASH患者平均年龄为 36 8岁 ;男性 6 6例 (88% ) ;BMI≥ 2 5者 5 8例 (77 3% )。所有患者ALT均升高 ,均存在高胰岛素血症 ,B超示脂肪肝 6 7例 ;口服葡萄糖耐量实验异常 30例 (4 0 % ) ;高脂血症者 6 0例 (80 % ) ;2型糖尿病 5例 (7% )。NASH患者的BMI与健康组有显著差异 ,P <0 0 5。健康组与NASH组的血清游离脂肪酸 (FFA)、肿瘤坏死因子 α(TNF α)差异均显著 (P <0 0 5 )。ALT水平与患者血清胰岛素水平、游离脂肪酸、TNF α有关 (P <0 0 1)。 4 0例 2型糖尿病患者中 12例 (30 % )可诊断为NASH。 2个月的治疗后 ,NASH患者的肝功能均正常。结论 NASH是ALT升高的原因之一 ;与胰岛素抵抗综合征相关。诊断NASH的重要依据是 :转氨酶反复轻至中度升高 ;排除肝炎病毒感染等其它肝病 ;胰岛素释放异常 ;高脂血症 ;影像学提示脂肪肝 ;BMI≥ 2 5 ;血清FFA和TNF升高。节制饮食及适当运动是治疗NASH的关键 ,辅以合适的
Objective To explore the diagnostic criteria and treatment of non-alcoholic steatohepatitis (NASH). Methods The clinical data of NASH, alcoholic liver disease, simple fatty liver disease, chronic hepatitis, healthy people and type 2 diabetes mellitus were compared and analyzed. NASH patients according to the body mass index (BMI), serum insulin levels and alanine aminotransferase (ALT) levels were given different treatment. Access to 40 cases of type 2 diabetes patient information. Results The average age of 75 patients with NASH was 368 years old. There were 66 males (88%) and 58 (77.3%) patients with BMI≥25. All patients had elevated ALT, hyperinsulinemia, B ultrasound showed 67 cases of fatty liver; 30 cases of abnormal oral glucose tolerance test (40%); 60 cases of hyperlipidemia (80%); 2 5 cases of type diabetes (7%). There was a significant difference between BMI and healthy group in NASH patients, P <0 05. Serum free fatty acid (FFA) and tumor necrosis factor α (TNFα) were significantly different between healthy group and NASH group (P <0.05). The level of ALT was correlated with serum insulin level, free fatty acid and TNFα (P <0.01). Of the 40 patients with type 2 diabetes, 12 (30%) were diagnosed as NASH. After 2 months of treatment, liver function was normal in NASH patients. Conclusion NASH is one of the reasons for the elevated ALT; it is associated with insulin resistance syndrome. Diagnosis of NASH is based on the following: repeated mild to moderate aminotransferase; to exclude other liver diseases such as hepatitis virus infection; abnormal insulin release; hyperlipidemia; imaging prompted fatty liver; BMI ≥ 25; serum FFA and TNF increased . Controlling diet and proper exercise are the key to treating NASH, supplemented by appropriate