Clinical performance of ultrasound attenuation imaging in assessing the degree of hepatic steatosis in metabolic dysfunction-associated fatty liver disease / 中华超声影像学杂志

Objective:To explore the diagnostic performance of ultrasound attenuation imaging (ATI) in grading the degree of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD).Methods:The liver gray-scale ultrasound and ATI examinations were performed on 212 subjects who were treated in Zhongshan Hospital Affiliated to Fudan University from August 2020 to March 2021. The attenuation coefficient(AC) values among different degrees of hepatic steatosis were analyzed and the diagnostic performance of ATI was evaluated. Relationships between AC values and clinical characteristics were assessed by Pearson′s correlation analysis.Results:The AC values for normal liver, mild, moderate and severe fatty liver were (0.56±0.05)dB·cm -1·MHz -1, (0.68±0.09)dB·cm -1·MHz -1, (0.82±0.09)dB·cm -1·MHz -1, (0.94±0.09)dB·cm -1·MHz -1, respectively. There were significant differences in AC values among different hepatic steatosis divisions( P<0.008). There was highly significant correlation between AC values and the degree of hepatic steatosis( r=0.860, P<0.01), moderate correlation between AC values and BMI( r=0.425, P<0.01), weak correlation between AC values and HDL-C( r=-0.237, P=0.029), no correlations between AC values and age, TC, TG, LDL-C ( r=0.083, 0.055, 0.133, -0.039, all P>0.05) .The areas under the receiver operating characteristics curve of ATI for mild fatty liver and above, moderate fatty liver and above, severe fatty liver and above were 0.958, 0.962, 0.918; the sensitivity were 90.1%, 95.8%, 94.9%, the specificity were 96.1%, 87.1%, 73.9%, and the cut-off values were 0.666 dB·cm -1·MHz -1, 0.719 dB·cm -1·MHz -1, 0.803 dB·cm -1·MHz -1, respectively. Conclusions:ATI is a reliable and convenient method for evaluating the degree of hepatic steatosis in MAFLD.

Sodium-glucose cotransport 2 inhibitors ameliorate the "metabolic stress" / 中华内分泌代谢杂志

Energy intake excess in modern society contributes to the abrupt increase of type 2 diabetes. The sodium-glucose cotransport 2 (SGLT-2) inhibitors, a new class of hypoglycemic agents inhibit reabsorption of glucose and excrete excessive energy by the kidney and therefore ameliorate the metabolic stress. The relief of metabolic stress further improves blood glucose, lipid levels, so as blood pressure, insulin resistance and pancreatic β cell function, which would be associated with the protection of cardiovascular diseases and amelioration of renal function.

Analysis of the Regularity of Drug Use in Coronary Heart Disease Unstable Angina Prescriptions by TCM Inheritance Auxiliary Platform / 中国药房

OBJECTIVE:To provide reference for TCM in the treatment of coronary heart disease (CHD) unstable angina and new drug research and development.METHODS:TCM inheritance auxiliary platform software was adopted to build prescription database of TCM in the treatment of CHD unstable angina.The software function of clinical collection,platform management,information management,knowledge retrieval,statistics,data analysis were adopted to analyze prescription database in respects of four properties,five tastes,channel tropism distribution,frequency statistics,rules of prescriptions and potential new prescriptions,etc.RESULTS:Through analyzing 178 prescriptions of CHD unstable angina,152 ingredients were involved.Top 3 in the list of distribution frequency of four properties were warm (617),cold (474) and mild (288).Top 3 in the list of distribution frequency of five tastes were bitter (750),sweet (732) and pungent (497).Top 3 in the list of distribution frequency of channel tropism were liver (860),heart (573) and spleen (549).A total of 40 ingredients were used more than 10 times,and top 5 were Ligusticum chuanxiong,Salvia miltiorrhiza,Astragalus membranaceus,Angelica sinensis and Carthamus tinctorious.According to the frequency of the drug combination,top 5 in descending order were L.chuanxiong-S.miltiorrhiza,L.chuanxiong-A.sinensis,L.chuanxiong-A.membranaceus,C.tinctorious-L.chuanxiong and S.miltiorrhiza-A.membranaceus.A total of 8 new prescriptions were obtained after evolution.CONCLUSIONS:Main prescriptions for CHD unstable angina included in CNKI are mild drug property,sweetness and bitterness in taste.Main selected ingredients can promote blood circulation,remove blood stasis and relieve pain,relieve restlessness and tranquilize the mind.It embodies the CHD unstable angina treatment principles of "treat both the incidental and fundamental aspects,tonification and purgation in combination".

Association of iron overload with non-alcoholic fatty liver disease in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective To analyze the association of fat content,enzymes,and fibrosis in liver with iron overload in patients with type 2 diabetes,and to explore the relationship between iron overload and severity of nonalcoholic fatty liver disease (NAFLD) in these patients.Methods Five hundred and thirty hospitalized patients with type 2 diabetes and 18 patients with abnormal glucose metabolism undergoing liver biopsy were recruited.History data,results of laboratory tests,liver ultrasound,hepatic 1 H-MRS were collected and serum ferritin level was determined.Results The serum ferritin level was significantly higher in patients with NAFLD than that without NAFLD [(328.7±252.2 vs 239.9 ± 171.8) μg/L,P＜0.01].Serum ferritin was an independent risk factor for NAFLD (P＜0.05).Multiple linear regression analysis showed that serum ferritin was positively correlated with liver fat content after adjustment for sex,age,and duration of diabetes.The serum ferritin level in NAFLD with elevated liver enzymes was significantly higher than that in simple steatosis [(429.9 ± 287.4 vs 293.4 ± 233.3) μg/L,P＜0.01].Serum ferritin was an independent risk factor for elevated liver enzymes in patients with NAFLD (P ＜0.05).Serum ferritin level in patients with advanced fibrosis was significantly lower than that in patients without advanced fibrosis [(246.8 ± 191.2 vs 382.5 ± 253.7) μg/L,P＜0.01].In 18 patients with NAFLD proven by biopsy,serum ferritin level was slightly higher in NASH group than that in simple steatosis group,but there was no statistically significant difference.Serum ferritin levels were comparable between patients with and without advanced fibrosis.Conclusion The iron overload in type 2 diabetic patients seems to be an independent risk factor for the development of NAFLD and elevated liver enzymes.Iron load in patients with advanced fibrosis is significantly decreased.

The relationship between liver fat content and liver disease outcome in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective To investigate the effects of diabetic duration on liver fat content (LFC) in patients with type 2 diabetes,and to explore its relationship with the outcome of liver disease.Methods A total of 435hospitalized patients with type 2 diabetes were recruited.The history data,results of laboratory tests,and hepatic 1 H-MRS were collected,and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) was calculated.Results The prevalence of NAFLD in newly-diagnosed type 2 diabetes mellitus (NT2DM) group was higher than that in predousb-diagnosed type 2 diabetes mellitus (PT2DM) group (92.7％ vs 82.2％,P＜0.05),with higher LFC [(27.97 ± 16.88 vs 19.44± 15.54) ％,P＜0.01].The LFC was reduced with prolonged duration of diabetes.Partial correlation analysis showed that LFC was negatively correlated with duration of diabetes (rs =-0.233,P＜0.01) after adjustment for gender,age,body mass index (BMI),oral anti-diabetic drugs,lipid-lowering drugs,and insulin treatment.Multiple linear regression analysis showed that LFC was positively correlated with BMI,albumin,and alanine aminotransferase while negatively correlated with duration of diabetes.The proportion of patients without advanced fibrosis (NFS＜-1.455) was significantly higher in NT2DM group than that in PT2DM group (26.3％ vs 15.5％,P＜0.05),and the proportion of PT2DM in patients with advanced fibrosis (NFS＞0.676) was significantly higher than that of NT2DM (79.2％ vs 20.8％,P＜0.05).NFS was positively correlated with the duration of diabetes (rs =0.236,P＜0.01).The liver fat content in patients with advanced liver fibrosis decreased significantly,and the LFC was negatively correlated with NFS (rs =-0.164,P＜0.01).Conclusions The duration of diabetes is an independent influencing factor of LFC.With the extension of the duration of diabetes,the decreased LFC in type 2diabetic patients with NAFLD is related to the development of advanced fibrosis.The decrease in LFC in type 2diabetic patient is associated with poor outcome of NAFLD.

The status of liver fibrosis evaluated by non-alcoholic fatty liver disease fibrosis score in hospitalized patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To evaluate the severity of non-alcoholic fatty liver disease(NAFLD) and progressive liver fibrosis(stage＞2)in hospitalized patients with type 2 diabetes mellitus(T2DM) by using NAFLD fibrosis score (NFS).The risk factors associated with progressive fibrosis were also analyzed.Methods A total of 721 hospitalized patients with T2DM and uhrasound verified NAFLD were involved.The history information and laboratory examinations were collected,NFS was calculated.The low cutoff score (-1.455) of NFS was used to exclude,and high cutoff score (0.676) to further accurately diagnose progressive fibrosis.Results (1) A total of 721 subjects (male/female 371/350) were diagnosed as NAFLD by ultrasound.In those subjects,173 patients were with progressive fibrosis (24.0％),111 patients without progressive fibrosis (15.4％),and 437 patients (60.6％) with NFS ranged from-1.455 to 0.676.(2) Aging,raised body mass index,aspartate amino transferase/alanine aminotransferase (AST/ALT) ratio,lowered albumin,and platelet were risk factors for progressive fibrosis of NAFLD.In addition,NFS was positively correlated with duration of diabetes,waist circumference,SBP,glycated albumin (GA),and GA/HbA1c(all P＜0.01),and negatively with red blood cell count,hemoglobin,white blood cell count (WBC),total cholesterol (TC),triglyceride,apolipoprotein-B,ALT,γ-glutamyltranspeptidase (all P＜0.01),AST,low-density lipoprotein cholesterol (all P＜0.05).(3) Logistic stepwise regression analysis showed diabetes duration,waist circunference,and GA were positively correlated with progressive liver fibrosis(OR =1.182,1.076,1.074,all P＜0.01),and negatively with WBC and TC (OR =0.613,0.703,all P＜0.01).Conclusions The detection rate of progressive fibrosis in patients with NAFLD and T2DM was approximately 24.0％ by applying NFS.Only 15.4％ of those subjects could be excluded from progressive fibrosis.It suggests that we should be alert to the risk of liver fibrosis in patients with type 2 diabetes.

New non-invasive means of determining hepatic fat content / 中华内分泌代谢杂志

Accurate determination of hepatic fat content is essential for investigating the quantitative association between hepatic steatosis and multiple metabolic disorders,and is of great significance in determining the beginning and goal for clinical intervention.More attention has been focused on establishing a non-invasive,simple and accurate method for determining hepatic fat content.Recently,a computer-aided ultrasound quantitative method may provide a new way for single and accurate estimation of hepatic fat content.

Progress in noninvasive diagnosis of nonalcoholic fatty liver disease / 中华内分泌代谢杂志

An early diagnosis of nonalcoholic fatty liver disease ( NAFLD) is meaningful to the prevention and cure of diabetes and cardiovascular disease ( CVD). The sensitivity and specificity of qualitative methods vary greatly, and these methods do not quantify liver fat content. Pathological diagnosis is a quantitative method, but it is invasive and inappropriate for clinical application. The establishment of H Magnetic Resonance Spectrum (1H MRS) opened up a brand-new era for noninvasive liver fat quantification. This review systemically introduces the new progress in noninvasive diagnosis of NAFLD.