目的:采用病例对照研究设计,分析肝硬化腹水并发自发性细菌性腹膜炎(SBP)的危险因素,并评价模型拟合方程的诊断效能,为早期诊断SBP提供依据.方法:选取肝硬化腹水患者125例,其中并发SBP 40例,未并发SBP 85例为对照组.比较两组患者一般资料、既往史、肝硬化并发症、临床症状及体征、实验室检查结果、Child-Pugh评分情况.采用非条件Logistic回归分析肝硬化腹水并发SBP的危险因素,并计算模型拟合方程的Kappa系数、ROC曲线下面积.结果:单因素分析显示两组患者在发热、腹痛、既往SBP病史、WBC、CRP、Na+、腹水PMN％指标上具有统计学差异(P<0.05),多因素分析显示腹痛(OR=17.043,95％CI:3.157～92.005)、CRP(OR=1.029,95％CI:1.006～1.052)、腹水PMN％(OR=1.124,95％CI:1.071～1.180)是肝硬化腹水并发SBP的独立危险因素.由此建立的诊断方程具有较好的诊断效能,Kappa系数为0.819,模型的AUC为0.966,约登指数为0.843.结论:入院伴腹痛、CRP、腹水PMN％是肝硬化腹水并发SBP的独立危险因素,由此建立的诊断模型对SBP的诊断具有较高的准确率,为临床早期诊断SBP提供了参考.

面部痤疮容易反复发作,且治疗后易遗留瘢痕.针对以上情况,试图围绕面部痤疮这一课题,在对五脏分区理论认识的基础上,着重以理论知识从痤疮的病因病机、面部五脏分区理论、面部五脏分区论治 3 个层面探讨从热论治面部痤疮问题,从而更加有效地治疗疾病,达到不同病位辨证论治的目的.通过研究,得到以下主要结论:面部不同部位的痤疮对应不同脏腑的病变,通过面部痤疮位置判断病变脏腑进行治疗,进而取得良好的临床疗效.

Nonalcoholic fatty liver disease（NAFLD） is a chronic liver disease in which a large amount of fat accumulates in hepatocytes due to lipid metabolism disorders. Conventional anti-inflammatory and transaminase-lowering treatment regimens often have an unsatisfactory therapeutic effect, and restoring the normal biosynthesis and metabolism of lipids is the key to the treatment of NAFLD. Studies have shown that brown adipose tissue can improve metabolic diseases by enhancing insulin sensitivity and regulating lipid metabolism, and the treatment of NAFLD by promoting white fat browning has attracted wide attention in the medical field. This article reviews the mechanism of white fat browning in improving NAFLD and summarizes the hepatokines that can promote white fat browning, so as to provide new ideas for the clinical treatment of NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is a progressive metabolic disease characterized by hepatic steatosis, inflammation, and fibrosis that seriously endangers global public health. Epidemiological studies have shown that the incidence of non-alcoholic fatty liver disease in postmenopausal women has significantly increased. Studies have shown that estrogen deficiency is the main reason for this situation, and supplementing estrogen has become a new direction for preventing the occurrence of postmenopausal fatty liver. However, although classical estrogen replacement therapy can reduce the incidence of postmenopausal NAFLD, it has the risk of increasing stroke and cardiovascular diseases, so it is not suitable for the treatment of postmenopausal NAFLD. More and more recent studies have provided evidence that phytoestrogens are a promising method for the treatment of postmenopausal NAFLD. However, the mechanism of phytoestrogens in preventing and treating postmenopausal NAFLD is still unclear. This paper summarizes the clinical and basic research evidence of phytoestrogens and reviews the potential therapeutic effects of phytoestrogens in postmenopausal NAFLD from six angles: enhancing lipid metabolism in liver and adipose tissue, enhancing glucose metabolism, reducing oxidative stress, reducing the inflammatory response, regulating intestinal flora, and blocking liver fibrosis (Graphical Abstract).

"肝升肺降"是中医的经典理论,指的是"肝升于左,肺降于右"的生理功能,组成了人体的气机枢纽.肝肺功能的正常发挥关系到人体的气机、血行和津液代谢,病理情况下可能引起"痰湿瘀浊"在肝脏的沉积,出现非酒精性脂肪性肝炎(non-alcoholic fatty liver disease,NASH),临床上用苇茎汤加减"从肺治肝"、涤浊化瘀,取得了较好的疗效.在NASH的发病机制中炎症和肠道菌群紊乱都起着重要作用.现代研究发现脂多糖(lipopolysaccharide,LPS)等可以诱导肝脏内的巨噬细胞焦亡,放大肝脏的炎症反应,这一过程类似于"痰湿瘀浊"在肝脏的形成和积聚,中医理论认为"肝与大肠相通"而"肺与大肠相表里",故基于"从肺治肝"理论探讨中药干预细胞焦亡对NASH的治疗作用,可以为中医经典理论和中医药治疗NASH提供微观依据.

目的:观察健脾化湿方治疗非酒精性脂肪肝合并慢性腹泻患者的临床疗效.方法:90例非酒精性脂肪肝合并慢性腹泻患者按照随机数字表法分为试验组46例和对照组44例.试验组给予健脾化湿方颗粒,对照组给予双歧杆菌四联活菌片,两组疗程均为4周.治疗后,比较两组患者临床疗效,肠道菌群杆/球比,谷丙转氨酶(alanine transaminase,ALT)、三酰甘油(triglyceride,TG)、游离脂肪酸(free fatty acid,FFA)、肝脏瞬时弹性受控衰减参数(controlled attenuation parameter,CAP)、体质量指数(body mass index,BMI)、腰围等.结果:治疗后,试验组有效率为91.3％(42/46),对照组有效率为86.4％(38/44),两组有效率比较,差异有统计学意义(P＜0.05).治疗后,两组患者粪便杆/球比显著升高,每日大便次数显著降低(P＜0.05);且试验组每日大便次数显著少于对照组(P＜0.05).治疗后,两组患者ALT、TG、FFA水平均显著降低(P＜0.05),且试验组低于同期对照组(P＜0.05).治疗后,两组患者CAP、腰围、BMI均显著下降(P＜0.05),且试验组CAP、腰围显著低于同期对照组(P＜0.05).结论:健脾化湿方治疗非酒精性脂肪肝合并慢性腹泻疗效显著,可改善患者临床症状、肝脂肪变程度,调节肠道菌群杆/球比水平.

非酒精性脂肪性肝病(NAFLD)现已成为全球最常见的慢性肝病之一.近年研究发现,NAFLD疾病进展过程中可出现不同程度的中枢神经系统功能障碍,包括认知功能损伤、情绪失衡等.本文归纳了不同阶段下NAFLD相关认知功能损伤的主要危险因素,为该病的早期预防与临床治疗提供一定依据和思路.

ObjectiveTo investigate the effect of Huatan Qushi Huoxue prescription on lipopolysaccharide (LPS)-induced pyroptosis of RAW264.7 cells and its mechanism. MethodsAn in vitro cell model of LPS-induced activated RAW264.7 was established and divided into blank group, model group, high-, middle-, and low-dose Huatan Qushi Huoxue prescription groups, and control group. The corresponding drug-containing serum intervention was performed for 24 hours. A scanning electron microscope was used to observe cell morphology, and immunofluorescence assay was used to perform quantitative localization of GSDMD-N. ResultsThe cells in the blank group were round and regular in shape with smooth surface, and those in the control group were swollen, with folds on the surface and gaps in the capsule, which were consistent with the morphology of cell pyroptosis. The cells in the control group had bubbles on the surface with obvious pseudopodia and pores in cell membrane, and those in the high-dose group were not swollen and had a rough surface with pseudopodia, with no obvious pores in cell membrane. The cells in the low- and middle-dose groups were swollen and had a rough surface of cell membrane with pores and pseudopodia. Immunofluorescence assay showed that compared with the blank group, the model group had a significant increase in the positive staining intensity of GSDMD-N, and compared with the model group, the control group and the Traditional Chinese medicine group had a reduction in the positive staining intensity of GSDMD-N. ConclusionHuatan Qushi Huoxue prescription can improve the pyroptosis of macrophages and reduce the expression of GSDMD-N.

铁死亡是脂质过氧化驱动、铁依赖的细胞死亡.发生机制与铁稳态失衡、脂质过氧化及SLC7A11-GSH-GPX4抗氧化系统有关.在非酒精性脂肪性肝病(NAFLD)/非酒精性脂肪性肝炎(NASH)的发生发展中发挥关键作用.抑制铁死亡,几乎可以完全抑制NASH发生.通过对铁死亡发生机制及其在NAFLD/NASH疾病中的作用和进展进行综述,并提出铁死亡研究的策略和技术手段,以期为NAFLD/NASH机制研究提供参考.

ObjectiveTo investigate the association of gene mutations in the pre-C, C, and basic core promoter (BCP) regions of hepatitis B virus (HBV) with traditional Chinese medicine (TCM) syndrome types in patients with chronic hepatitis B (CHB). MethodsA retrospective analysis was performed for the clinical data of CHB patients who were diagnosed and treated at the outpatient service and ward of Spleen, Stomach, and Hepatobiliary Department, The First Affiliated Hospital of Henan University of Chinese Medicine, from November 2014 to June 2018. Related clinical data were collected and recorded, including general information, HBV serological markers, HBV gene mutations, and information obtained by four TCM diagnostic methods. Syndrome differentiation and typing were performed for each patient with reference to the criteria for TCM syndrome differentiation of viral hepatitis, and the association of gene mutation in the pre-C, C, and BCP regions of HBV with TCM syndrome types was analyzed. The chi-square test was used for comparison of categorical data between groups, and the Kruskal-Wallis H test was used for comparison of continuous data between multiple or two groups. ResultsA total of 235 patients with CHB were enrolled, among whom 101 had internal retention of damp-heat, 88 had stagnation of liver Qi and spleen deficiency, 17 had blood stasis obstructing the collaterals, 19 had liver-kidney Yin deficiency, and 10 had spleen-kidney Yang deficiency. There were significant differences in sex, age, and course of disease between the patients with different TCM syndrome types (χ2=17.389, H=173.280, H=86.520, all P＜0.01), and there was a significant difference in age between the CHB patients with gene mutations in the pre-C, C and BCP regions of HBV (H=30.150, P＜0.001). There was a significant difference in the distribution of TCM syndrome types between the CHB patients with gene mutations in the pre-C, C and BCP regions of HBV (χ2=58.117, P＜0.001), and internal retention of damp-heat and stagnation of liver Qi and spleen deficiency were major TCM syndrome types accounting for 80.43%. The patients with internal retention of damp-heat tended to have A1762T and G1764A mutations, and those with stagnation of liver Qi and spleen deficiency tended to have G1896A, A1762T, and G1764A mutations; G1764A mutation was often observed in the patients with blood stasis obstructing the collaterals or liver-kidney Yin deficiency, and I97L mutation was often observed in the patients with spleen-kidney Yang deficiency. ConclusionGene mutations in the pre-C, C, and BCP regions of HBV are associated with TCM syndrome types in CHB patients, and internal retention of damp-heat and stagnation of liver Qi and spleen deficiency are the most common TCM syndrome types. I97L mutation is often observed in patients with spleen-kidney Yang deficiency.