(non-alcoholic fatty liver , NASH. (non-alcoholic steatohepatitis,nash) NASH, NASH NAFLD, NAFLD NASH NASH NAFLD NASH NASH ,ALT

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1 133 李学军 1 孙倩 2 ( ; ) : ; ; :R575.5 DOI: /j.issn :A : (2014) NASH [5] (non-alcoholic fatty liver diseasenafld) NAFLD (non-alcoholic steatohepatitisnash) NASH NASH NASH [2] NASH 10%~15% NASH [3] [2 4] NAFLD (body mass indexbmi) NASH NAFLD NASH NASH 20% NAFLD NASH NAFLD 1 (alanine transarninasealt) ;2 (aspartate transaminaseast) ;3 γ- ; 4 ALT NASH ALT ; NASH ( 79%) ALT [6] ( ) Fas ( 80 ALT ) NASH 58 (72.5%) NASH NASH NASH NASH NASH [7] 26 8

2 134 J Diagn Concepts Pract 2014 Vol.13 No.2 1. : NASH( % NAFLD NASH 88%) hs-crp 1Th1 Th2 α(tumor [1 17] 18 NASH necrosis factor αtnf-α) 1(interleukin-1 IL-1) IL-6 IL-18 ;2 CC (C ) CC 2 ( CCL2 )/ [18] 1 CCL19 CCL21 T (RANTES);3 ( ) [19] NASH NASH NASH -18 TNF-α/ NASH TNF-α ob/ob NASH 0.76~0.88 NAFLD [20] IL-6-3 [8] NASH IL-6 NASH NASH Fas -18 NASH [9] IL-6 IL-6 NASH IL-6 [10] 3. : NASH NASH Logistic NASH IL-6> 4.81 pg/ml [OR=33.795% 1.7~ [23-24] 680.7P 0.022] NASH [11] NASH TNF-α NAFLD Abiru [10] NASH TNF-α TNF 1(sTNFR1) NAFLD NASH TNF-αmRNA TNF-α ALT mrna 100 ng/ml NASH ( % 74.1%) [12] TNF-α NASH α 2 A1 γ- [25] ALT AST NASH TNF-α NASH [13-15] NAFLD C (C- reaction proteincrp) BMI CRP NAFLD CRP 0.5 mg/l NASH (16 ) CRP CRP 2. : % [21-22] NASH test(biopredictive) 0.78 NASH test 97 Palekar [26] NASH 6 [16] CRP 50 BMI 30 kg/m 2 AST 45 u/ L NASH AST/ALT 0.8 (hyaluronic acid

3 135 HA) 55 μg/l NASH CRN NASH 3 [27] [35] AST ALT AST/ALT Kalhan [36] ( ) NASH ( 2 ) NAFLD NASH 0.79 (95% 0.76~0.83) CT MRI NASH NAFLD NASH NAFLD [28] MRI NASH MRI MRI E ( ) MRI [29] CT MRI 3 CT 1 α- ; 2 ; [30] CT 3 ( B ) NASH CT [37] E E 800 u/d NASH E E [31] NASH E [29] NASH NASH PNPLA3 NAFLD [32-33] Younossi [34] NAFLD 12 NASH

4 136 J Diagn Concepts Pract 2014 Vol.13 No.2 [14] Satapathy SK Sakhuja P Malhotra V et al. Beneficial effects of pentoxifylline on hepatic steatosis fibrosis and necroinflammation in patients with non-alcoholic steatohepatitis[j]. [ ] J Gastroenterol Hepatol200722(5): [15] Zein CO Yerian LM Gogate P et al. Pentoxifylline improves Pearce SG Thosani NC Pan JJ. Noninvasive biomarkers for the diagnosis of steatohepatitis and advanced fibrosis in NAFLD[J]. Biomark Res20131(1):7. nonalcoholic steatohepatitis: a randomized place- bo-controlled trial[j]. Hepatology201154(5): [16] Park SH Kim BI Yun JW et al. Insulin resistance and C- [2] Ekstedt M Franzén LE Mathiesen UL et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes[j]. Hepatology200644(4): reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men[j]. J Gastroenterol Hepatol200419(6): [3] Xie L Yui J Hatori A et al. Translocator protein (18 kda) a potential molecular imaging biomarker for non-invasively distinguishing non-alcoholic fatty liver disease[j]. J Hepatol201257(5): [17] Fierbinteanu-Braticevici C Baicus C Tribus L et al. Predictive factors for nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD) [J]. J Gastrointestin Liver Dis201120(2): [4] S 觟 derberg C St 覽 l P Askling J et al. Decreased survival of subjects with elevated liver function tests during a 28- year follow-up[j]. Hepatology201051(2): [18] Koruk M Tay 觭 i S Sava 觭 MC et al. Serum levels of acute phase proteins in patients with nonalcoholic steatohepatitis[j]. Turk J Gastroenterol200314(1): [5] Pinzani M. Pathophysiology of non-alcoholic steatohepatitis and basis for treatment[j]. Dig Dis201129(2): [19] Alkhouri N Carter-Kent C Feldstein AE. Apoptosis in nonalcoholic fatty liver disease: diagnostic and therapeutic [6] Browning JD Szczepaniak LS Dobbins R et al. Prevalence of hepatic steatosis in an urban population in the implications[j]. Expert Rev Gastroenterol Hepa- tol20115(2): United States: impact of ethnicity[j]. Hepatology (6): [20] Feldstein AE Wieckowska A Lopez AR et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for [7] Sorrentino P Tarantino G Conca P et al. Silent non-alcoholic nonalcoholic steatohepatitis: a multicenter validation fatty liver disease-a clinical-histological study[j]. study[j]. Hepatology200950(4): J Hepatol200441(5): [21] Tamimi TI Elgouhari HM Alkhouri N et al. An apoptosis [8] Senn JJ Klover PJ Nowak IA et al. Suppressor of cytokine panel for nonalcoholic steatohepatitis diagnosis [J]. J Heterleukin-6-dependent signaling-3 (SOCS-3) a potential mediator of inpatol201154(6): insulin resistance in hepatocytes [J]. J Biol Chem (16): [22] Joka D Wahl K Moeller S et al. Prospective biopsycontrolled evaluation of cell death biomarkers for prediction [9] Kugelmas M Hill DB Vivian B et al. Cytokines and NASH: a pilot study of the effects of lifestyle modification and vitamin E[J]. Hepatology200338(2): of liver fibrosis and nonalcoholic steatohepatitis [J]. Hepatology201255(2): [23] Chalasani N Deeg MA Crabb DW. Systemic levels of [10] Abiru S Migita K Maeda Y et al. Serum cytokine and soluble cytokine receptor levels in patients with non-alcoholic steatohepatitis[j]. Liver Int200626(1): lipid peroxidation and its metabolic and dietary correlates in patients with nonalcoholic steatohepatitis[j]. Am J Gastroenterol200499(8): [11] García-Galiano D Sánchez-Garrido MA Espejo I et al. IL-6 and IGF-1 are independent prognostic factors of liver steatosis and non-alcoholic steatohepatitis in morbidly obese patients[j]. Obes Surg200717(4): [24] Feldstein AE Lopez R Tamimi TA et al. Mass spectrometric profiling of oxidized lipid products in human nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[j]. J Lipid Res201051(10): [12] Alaaeddine N Sidaoui J Hilal G et al. TNF-α messenger [25] Lassailly G Caiazzo R Hollebecque A et al. Validation ribonucleic acid (mrna) in patients with nonalcoholic of noninvasive biomarkers (FibroTest SteatoTest and steatohepatitis[j]. Eur Cytokine Netw201223(3): NashTest) for prediction of liver injury in patients with [13] Satapathy SK Garg S Chauhan R et al. Beneficial effects of tumor necrosis factor-alpha inhibition by pentoxifylline on clinical biochemical and metabolic parameters of patients with nonalcoholic steatohepatitis[j]. Am J Gastroenterol200499(10): morbid obesity[j]. Eur J Gastroenterol Hepatol201123(6): [26] Palekar NA Naus R Larson SP et al. Clinical model for distinguishing nonalcoholic steatohepatitis from simple steatosis in patients with nonalcoholic fatty liver disease

5 [J]. Liver Int200626(2): [27] Neuschwander-Tetri BA Clark JM Bass NM et al. Clinical laboratory and histological associations in adults with nonalcoholic fatty liver disease[j]. Hepatology201052(3): [28] Wieckowska A McCullough AJ Feldstein AE. Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future [J]. Hepatology200746(2): [29] Day CP. Clinical spectrum and therapy of non-alcoholic steatohepatitis[j]. Dig Dis201230(Suppl 1): [30] Jang Y Kim OY Ryu HJ et al. Visceral fat accumulation determines postprandial lipemic response lipid peroxidation DNA damage and endothelial dysfunction in nonobese Korean men[j]. J Lipid Res200344(12): [31] Hirooka M Kumagi T Kurose K et al. A technique for the measurement of visceral fat by ultrasonography: comparison of measurements by ultrasonography and computed tomography[j]. Intern Med200544(8): [32] Romeo S Kozlitina J Xing C et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver 137 disease[j]. Nat Genet200840(12): [33] Valenti L Al-Serri A Daly AK et al. Homozygosity for the patatin-like phospholipase-3/adiponutrin I148M polymorphism influences liver fibrosis in patients with nonalcoholic fatty liver disease [J]. Hepatology (4): [34] Younossi ZM Baranova A Ziegler K et al. A genomic and proteomic study of the spectrum of nonalcoholic fatty liver disease[j]. Hepatology (3): [35] Trak-Smayra V Dargere D Noun R et al. Serum proteomic profiling of obese patients: correlation with liver pathology and evolution after bariatric surgery [J]. Gut (6): [36] Kalhan SC Guo L Edmison J et al. Plasma metabolomic profile in nonalcoholic fatty liver disease[j]. Metabolism201160(3): [37] Milic S Stimac D. Nonalcoholic fatty liver disease/steatohepatitis: epidemiology pathogenesis clinical presentation and treatment[j]. Dig Dis201230(2): ( : ) ( 本文编辑 : 张宁 )!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :4-687

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