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1 ( ) *. :. :... / / / / : (P=/) (P=/). (P=/) AST (P=/) ALT (P=/) (P =/) (P</)...(R=/) :. : // : // : *

2 / NAFLD.( )...().() ).(.( ). 5. Tumor Necrosis Factorα (TNFα) (NAFLD) (NASH)..() NASH.().() NASH.()..( ) ( ) ( ) 1 NonAlcoholic Fatty Liver Disease 2 Simple Steatosis 3 Non Alcoholic Steatohepatitis 4 Obese 5 Morbid Obesity

3 / / / (Utrecht, the Netherlands.... /.. ( Convex Siemens G40 / Mhz... ( ) () ( ).() ().... A... (Seca 770; Seca / GmbH & Co, Hamburg, Germany) (Lameris, 7 Antinuclear antibody, Antismooth muscle antibody, Antiliver kidney microsomal antibody

4 / NAFLD (.. (+).. :. : : : :. : : : :. : : :. : (.. /.().().( ) 8 Mesenteric leaves

5 / / P.. / ( ) /±/..( ) (Inc, Chicago, IL SPSS) SPSS.. T U ( ρ * ٠/٠٠١ ٣٨/۴±١٠/٣ ۴٢/٣ ± ١٠/۵٠ ٣۵/۶١±٩/٢ () <٠/٠٠١ <٠/٠٠١ ٠/١٣١ ٠/٩۶٧ ٠/۴٠١ ٠/۴٠۶ ٠/٧١٧ ١۶٧/٣±١٠/٢ ٨۴/٠۵±١۴/٧ ٢٩/٩±۴/۴ ٩۶/٠٣±١٧/٢ ٩٩±١٨/٣ ١/٢۵±٠/٧٨ ١٣/۴۴±٣/٠٨ ١۵٧/٠٢±۴/۶ ٧۵/۶±١٢/٢ ٣٠/٧±۴/٩ ٩۵/٩±١٢/٧ ١٠٠/٨±٢٢/۴ ١/١٨±٠/٨۴ ١٣/٣١±٣/١ ١٧۴/٨±۵/۶ ٩٠/٠٩±١٣/٣ ٢٩/٣±۴ ٩۶/٠٩±١٩/٩ ٩٧/٧±١۴/٧ ١/٣١±٠/٧۴ ١٣/۵٣±٣/١٧ (cm) (kg) (kg/m2) (cm) (mg/dl) (mm) / P* (/ P=/) (/ P=/) (/ P=/). AST) (ALT.( ) ( /) : /) ( /).( / ) ( P</) (/

6 / NAFLD ( ρ / / / </ / / / / / / / / / / /±/ /± /±/ ±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /± /±/ /±/ /±/ ±/ /±/ /± /±/ /±/ /±/ /±/ /±/ /± /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ /±/ ±/ /±/ /±/ /±/ /±/ /± /±/ /±/ /± /±/ /±/ () () () () ( ) () ( )HDL ( )LDL ( )AST ( )ALT ( )Alk P ( ) Alkaline phosphatase:alk P, non significant: alanine aminotransferase,:alt, aspartate aminotransferase:ast, Low density lipoprotein:ldl,high density lipoprotein:hdl.( ).(R=/) ( *ρ / / / / / / / / / / / / / *P. P</) (/ (/ P</) (/ P</) (/ p=/) P=/) P</) (/ (/ LDLHDL ALT AST

7 / /.( ).() α.( ) α.().(). ) (.().().().()..( ).().() ( )..().( ). 9 Portal 10 Nonportal

8 / NAFLD..().. ().() ( ) ()..() ().. References: 1.Mills SJ, Harrison SA. Comparison of the natural history of alcoholic and nonalcoholic fatty liver disease. Curr Gastroenterol Rep 2005; 7: Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002; 123: Caballeria L, Auladell MA, Toran P, et al. Risk factors associated with nonalcoholic fatty liver disease in subjects from primary care units. A casecontrol study. BMC Gastroenterol 2008; 8: Marchesini G, Marzocchi R. Metabolic syndrome and NASH. Clin Liver Dis 2007;

9 / / 11 : Utzschneider KM, Kahn SE. Review: The role of insulin resistance in nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2006; 91: Hamaguchi M, Kojima T, Takeda N, et al. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med 2005; 143: Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: Stranges S, Dorn JM, Muti P, et al. Body fat distribution, relative weight, and liver enzyme levels: a populationbased study. Hepatology 2004; 39: Eguchi Y, Eguchi T,Mizuta T,et al. Viseral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gasrtoentrol 2006; 41: Alberti KG, Zimmet P, Shaw J. The metabolic syndromea new worldwide definition. Lancet 2005; 366: RebuffeScrive M, Andersson B, Olbe L, et al. Metabolism of adipose tissue in intraabdominal depots of nonobese men and women. Metabolism 1989; 38: Bjorntorp P. Portal adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis 1990; 10: Bjorntorp P. Metabolic implications of body fat distribution. Diabetes Care 1991; 14: Koda M, Kawakami M, Murawaki Y, et al. The impact of visceral fat in nonalcoholic fatty liver disease: crosssectional and longitudinal studies. J Gastroenterol 2007; 42: Ahima RS, Flier JS. Adipose tissue as an endocrine organ. Trends Endocrinol Metab 2000; 11: Charatcharoenwitthaya P, Lindor KD. Role of radiologic modalities in the management of nonalcoholic steatohepatitis. Clin Liver Dis 2007; 11: Derchi LE, Solbiati L, Rizzatto G, et al. Normal anatomy and pathologic changes of the small bowel mesentery: US appearance. Radiology 1987; 164: Ong JP, Younossi ZM. Epidemiology and natural history of NAFLD and NASH. Clin Liver Dis 2007; 11: Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000; 132: ZelberSagi S, NitzanKaluski D, Halpern Z, et al. Prevalence of primary nonalcoholic fatty liver disease in a populationbased study and its association with biochemical and anthropometric measures. Liver Int 2006; 26: Angulo P, Keach JC, Batts KP, et al. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999; 30: Rinella ME, Alonso E, Rao S, et al. Body mass index as a predictor of hepatic steatosis in living liver donors. Liver Transpl 2001; 7: Fried SK, Kral JG. Sex differences in regional distribution of fat cell size and lipoprotein lipase activity in morbidly obese patients. Int J Obes 1987; 11: Larter CZ, Farrell GC. Insulin resistance, adiponectin, cytokines in NASH: Which is the best target to treat?. J Hepatol 2006; 44: Hotamisligil GS, Peraldi P, Budavari A, et al. IRS1mediated inhibition of insulin receptor tyrosine kinase activity in TNFalpha and obesityinduced insulin resistance. Science 1996; 271: Barzilai N, She L, Liu BQ, et al. Surgical removal of visceral fat reverses hepatic insulin resistance. Diabetes 1999; 48: Thorne A, Lonnqvist F, Apelman J, et al. A pilot study of longterm effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding. Int J Obes Relat Metab Disord 2002; 26: van der Poorten D, Milner KL, Hui J, et al. Visceral fat: a key mediator of steatohepatitis in metabolic liver disease. Hepatology 2008; 48: Song HR, Yun KE, Park HS, et al. Relation between alanine aminotransferase concentrations and visceral fat accumulation among nondiabetic overweight Korean women. Am J Clin Nutr 2008; 88: Roskams T, Yang SQ, Koteish, et al. Oxidative stress and oval cell accumulation in mice and humans with alcoholic and nonalcoholic fatty liver disease. Am J Pathol 2003; 163: Banfi C, Mussoni L, Rise P, et al. Very low density lipoproteinmediated signal transduction and plasminogen activator inhibitor type 1 in cultured HepG2 cells. Circ Res 1999; 85: Samuel VT, Liu ZX, Qu X, et al. Mechanism of hepatic insulin resistance in

10 / NAFLD nonalcoholic fatty liver disease. J Biol Chem 2004; 279: Furukawa S, Fujita T, Shimabukuro M, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 2004; 114: Yajima Y, Ohta K, Narui T, et al. Ultrasonographical diagnosis of fatty liver: significance of the liverkidney contrast. Tohoku J Exp Med 1983; 139: Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123: