摘要：探讨 高蛋白饮食干预成人非酒精性脂肪肝的效果及受控衰减指数的评估效能。方法 纳入2024年3月至2025年6月右江民族医学院附属医院感染性疾病科、内分泌科门诊NAFLD患者120例。按照随机数字表法分为2组，观察组（实施高蛋白饮食）和对照组（实施限能量平衡膳食），每组 60 例。结果 两组患者干预后两组患者的体质量指数（BMI）、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）、体脂率（BFR）、内脏脂肪指数（VAI）、CAP 值、血尿酸（UA）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆固醇（TC）、甘油三酯（TG）及低密度脂蛋白胆固醇（LDL-C）水平均较本组干预前显著降低，高密度脂蛋白胆固醇（HDL-C）较本组干预前显著升高（P＜0.001）。组间比较显示，干预后观察组BMI、WC、WHR、WHtR、BFR、VAI、CAP、UA、TC、TG、LDL、AST、ALT水平均显著降低，HDL显著升高（P＜0.001），组间差值及干预后组间比较，观察组上述指标改善幅度及最终指标水平均显著优于对照组（P＜0.001）。CAP与人体成分分析指标（BMI、WC、WHR、WHtR、VAI）呈正相关（P＜0.05）。观察组总体有效占比为93.3%，对照组总体有效占比为42%。CAP、BMI是脂肪肝治疗后是否消退的独立影响因素。CAP、ALT、WHtR三个指标联合检测AUC升高至0.947(95%CI 0.892～1.00)，灵敏度92.9%，特异性93.6%，约登指数0.878，显著高于各指标单独检测。结论 高蛋白饮食可以显著改善成人NAFLD患者的CAP、BMI、WC、WHR、BFR、WHtR、肝功能、血脂，对改善和减缓NAFLD的进展具有重要的临床意义，CAP 值可客观评估脂肪肝干预效果，值得临床推广。

摘要：探讨 高蛋白饮食干预成人非酒精性脂肪肝的效果及受控衰减指数的评估效能。方法 选取2024年3月—2025年6月右江民族医学院附属医院感染性疾病科、内分泌科门诊及住院的NAFLD患者120例。按照随机数字表法分为2组，观察组（采用高蛋白饮食）和对照组（采用限能量平衡膳食），每组各 60 例。结果 两组患者干预后BMI、WC、WHR、WHtR、BFR、VAI、CAP、UA、ALT、AST、TC、TG、LDL水平均较本组干预前显著降低，HDL较本组干预前显著升高（P＜0.001）。组间比较显示，干预后观察组BMI、WC、WHR、WHtR、BFR、VAI、CAP、Scr、UA、TC、TG、LDL、AST、ALT水平均显著降低，HDL显著升高（P＜0.001），组间差值及干预后组间比较，观察组上述指标改善幅度及最终指标水平均显著优于对照组（P＜0.001）。CAP与人体成分分析指标（BMI、WC、WHR、WHtR、VAI）呈正相关（P＜0.05）。观察组总体有效占比为93.3%，对照组总体有效占比为42%。CAP、BMI是脂肪肝治疗后是否消退的独立影响因素。CAP、ALT、WHtR三个指标联合检测AUC升高至0.947(95%CI 0.892～1.00)，灵敏度92.9%，特异性93.6%，约登指数0.878，显著高于各指标单独检测。结论 高蛋白饮食可以显著改善成人NAFLD患者的CAP、BMI、WC、WHR、BFR、WHtR、肝功能、血脂，对改善和减缓NAFLD的进展具有重要的临床意义，CAP 值可客观评估脂肪肝干预效果，值得临床推广。

摘要：探讨 高蛋白饮食干预成人非酒精性脂肪肝的效果及受控衰减指数的评估效能。方法 选取2024年3月—2025年6月右江民族医学院附属医院感染性疾病科、内分泌科门诊及住院的NAFLD患者120例。按照随机数字表法分为2组，观察组（采用高蛋白饮食）和对照组（采用限能量平衡膳食），每组各 60 例。结果 两组患者干预后BMI、WC、WHR、WHtR、BFR、VAI、CAP、UA、ALT、AST、TC、TG、LDL水平均较本组干预前显著降低，HDL较本组干预前显著升高（P＜0.001）。组间比较显示，干预后观察组BMI、WC、WHR、WHtR、BFR、VAI、CAP、Scr、UA、TC、TG、LDL、AST、ALT水平均显著降低，HDL显著升高（P＜0.001），组间差值及干预后组间比较，观察组上述指标改善幅度及最终指标水平均显著优于对照组（P＜0.001）。CAP与人体成分分析指标（BMI、WC、WHR、WHtR、VAI）呈正相关（P＜0.05）。观察组总体有效占比为93.3%，对照组总体有效占比为42%。CAP、BMI是脂肪肝治疗后是否消退的独立影响因素。CAP、ALT、WHtR三个指标联合检测AUC升高至0.947(95%CI 0.892～1.00)，灵敏度92.9%，特异性93.6%，约登指数0.878，显著高于各指标单独检测。结论 高蛋白饮食可以显著改善成人NAFLD患者的CAP、BMI、WC、WHR、BFR、WHtR、肝功能、血脂，对改善和减缓NAFLD的进展具有重要的临床意义，CAP 值可客观评估脂肪肝干预效果，值得临床推广。

摘要：探讨 高蛋白饮食干预成人非酒精性脂肪肝的效果及受控衰减指数的评估效能。方法 选取2024年3月—2025年6月右江民族医学院附属医院感染性疾病科、内分泌科门诊及住院的NAFLD患者120例。按照随机数字表法分为2组，观察组（采用高蛋白饮食）和对照组（采用限能量平衡膳食），每组各 60 例。结果 两组患者干预后BMI、WC、WHR、WHtR、BFR、VAI、CAP、UA、ALT、AST、TC、TG、LDL水平均较本组干预前显著降低，HDL较本组干预前显著升高（P＜0.001）。组间比较显示，干预后观察组BMI、WC、WHR、WHtR、BFR、VAI、CAP、Scr、UA、TC、TG、LDL、AST、ALT水平均显著降低，HDL显著升高（P＜0.001），组间差值及干预后组间比较，观察组上述指标改善幅度及最终指标水平均显著优于对照组（P＜0.001）。CAP与人体成分分析指标（BMI、WC、WHR、WHtR、VAI）呈正相关（P＜0.05）。观察组总体有效占比为93.3%，对照组总体有效占比为42%。CAP、BMI是脂肪肝治疗后是否消退的独立影响因素。CAP、ALT、WHtR三个指标联合检测AUC升高至0.947(95%CI 0.892～1.00)，灵敏度92.9%，特异性93.6%，约登指数0.878，显著高于各指标单独检测。结论 高蛋白饮食可以显著改善成人NAFLD患者的CAP、BMI、WC、WHR、BFR、WHtR、肝功能、血脂，对改善和减缓NAFLD的进展具有重要的临床意义，CAP 值可客观评估脂肪肝干预效果，值得临床推广。

       目的   研究非酒精性脂肪肝老年人体质辨识及中医治未病服务对其治疗效果。方法   选择2023年1月—2024年1月贵州中医药大学第一附属医院就诊的非酒精性脂肪性肝病老年患者70例作为研究对象，根据患者就诊顺序分配为两组。对照组35例，接受常规干预；观察组35例，其在对照组基础上予中医“治未病”理念下体质辨识干预模式。比较两组干预效果，以及干预前后血脂水平、肝功能、生存质量的变化。结果   观察组的治疗总有效率91.43%，高于对照组的68.57%，差异有统计学意义（P＜0.05）。治疗前，两组各项血脂水平、肝功能、慢性肝病问卷（CLDQ）评分比较，差异无统计学意义（P＞0.05）；治疗后，两组各项血脂水平优于治疗前，各项肝功能低于治疗前，CLDQ评分高于治疗前，差异有统计学意义（P＜0.05）；治疗后，观察组的各项血脂水平优于对照组，各项肝功能低于对照组，CLDQ评分高于对照组，差异有统计学意义（P＜0.05）。结论   对非酒精性脂肪性肝病老年患者而言，中医“治未病”理念下体质辨识干预服务能够提高其治疗效果，调节血脂水平的异常，改善肝功能及生存质量，值得应用。

       Objective  To study the physical identification of nonalcoholic fatty liver in the elderly and the therapeutic effect of traditional Chinese medicine on preventing disease before arising．Methods  A total of 70 elderly patients with nonalcoholic fatty liver disease treated in the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from January 2023 to January 2024 were selected as the study objects．Patients were assigned to two groups，control group（35 cases）received  routine intervention，observation group（35 cases）received physical identification intervention based on preventing disease before arising of traditional Chinese medicine additionally．The effect of intervention and the changes of blood lipid levels，liver function and quality of life before and after intervention were compared between the two groups．Results  The total effective rate of the observation group was 91.43%，higher than that of the control group（68.57%），the difference was statistically significant（P＜0.05）．Before treatment，there were no significant differences in blood lipid levels，liver function and CLDQ scores between the two groups（P＞0.05）．After treatment，the levels of blood lipids were better than those before treatment，liver function was lower than that before treatment，CLDQ score was higher than that before treatment，the difference was statistically significant（P＜0.05）．After treatment，the blood lipid levels of the observation group was better than that of the control group，the liver function was lower than that of the control group，and the CLDQ score was higher than that of the control group，with statistical significance（P＜0.05）．Conclusions  For elderly patients with nonalcoholic fatty liver disease，the intervention service of body constitution identification under the concept of preventing disease before arising of traditional Chinese medicine can improve the therapeutic effect，regulate the abnormal blood lipid levels，improve liver function and quality of life，which is worthy of application．

目的 研究高尿酸（UA）和肥胖的交互作用对非酒精性脂肪肝病（NAFLD）患病率的影响。方法 采用病例对照的研究法,选取2021年1月至2021年12月兰州市某医院健康体检中心进行常规健康体检的504人为研究对象,按照诊断标准分为NAFLD组187人和非NAFLD 组317人。采用Logistic 回归模型、相乘、相加交互模型探讨非酒精性脂肪肝病患病风险的影响因素及因素间的交互作用。结果 多因素条件Logistic回归分析可知,肥胖（OR=4.87,95%CI：3.01~7.89）,糖尿病患者（OR=3.40,95%CI：1.51~7.68）,幽门螺杆菌（Hp）携带者（OR=1.62,95%CI：1.03~2.57）,高尿酸血症的NAFLD患病风险增加,分别是正常者、非糖尿病患者、非Hp携带者,非高尿酸血症的4.87倍,3.40倍,1.62倍,2.28倍,在调整混杂因素后交互作用结果显示,高尿酸血症和肥胖对NAFLD患病率有相乘交互作用（OR=0.30,95%CI：0.10~0.88,P=0.029）、但无相加交互作用（相对超额危险度比=3.15、归因比=0.24、协同指数=1.34）。结论 BMI、糖尿病、Hp是NAFLD患病的独立危险因素,其中高尿酸血症和超重与肥胖对NAFLD患病有相乘交互作用,无相加交互作用。

Objective To explore the influence of the interaction of high uric acid（UA）and obesity on the prevalence of non-alcoholic fatty liver disease（NAFLD）．Methods Using a case-control study method,504 people who underwent routine health checkups at the health checkup centre of a hospital in Lanzhou City from January 2021 to December 2021 were enrolled in the study,and 187 people were included in the NAFLD group and 317 people in the non-NAFLD group according to the diagnostic criteria．Logistic regression models,multiplicative and additive interaction models were used to investigate the factors affecting the risk factors of NAFLD and the interaction between the factors．Results Multifactorial conditional logistic regression analysis showed that the risk of NAFLD was increased in obese（OR=4.87,95% CI：3.01-7.89）,diabetic patients（OR=3.40,95% CI：1.51-7.68）,Helicobacter pylori（Hp）carriers（OR=1.62,95% CI：1.03-2.57）;the increased risk of NAFLD prevalence in hyperuricaemia patients was 4.87,3.40,1.62,and 2.28 times higher than that of normal,non-diabetic,non-Hp carriers,and non-hyperuricemic individuals,respectively．And the adjusted interaction showed a multiplicative interaction of hyperuricaemia and obesity on the prevalence of NAFLD after controlling for the confounders（OR=0.30,95% CI：0.10-0.88,P=0.029）,but no additive interaction （relative excess risk due to interaction=3.15,attributable proportion due to interaction=0.24,and synergy index=1.34） interactions．Conclusions BMI,diabetes mellitus,and Hp were independent risk factors for the prevalence of NAFLD,with hyperuricaemia and overweight and obesity having multiplicative interaction and no additive interaction．

目的 了解广州市某净水公司职工脂肪肝检出情况,并分析影响因素。方法 选取2023年广州市某净水公司参加职业健康检查的职工为研究对象,收集研究对象的一般情况、个人史、职业史、身体质量指数（BMI）、血压、血生化指标、肝脏彩超等资料。对该人群脂肪肝的患病情况进行描述性分析,对脂肪肝的影响因素进行单因素及多因素Logistic回归分析。结果 共收集研究对象1 217人,检出脂肪肝543例,检出率为44.62%。单因素分析结果表明,脂肪肝的发生与性别、年龄、体质量指数、高血压相关（P<0.05）。接触硫化氢、氨的职工脂肪肝检出率高于非接触者（P<0.05）,且职工工龄越长,脂肪肝检出率越高（P<0.05）。患脂肪肝职工的肝功能、脂代谢、血糖及尿酸水平高于非脂肪肝者（P<0.05）。多因素Logistic回归分析提示,年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸是脂肪肝的影响因素（P<0.05）。结论 广州市某净水公司职工的脂肪肝检出率较高,脂肪肝的发生主要与年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸等因素相关。

Objective To investigate the prevalence of fatty liver disease and influencing factors among employees of a water purification company in Guangzhou．Methods Employees of a water purification company in Guangzhou who participated in occupational health examinations in 2023 were selected as the study subjects．The subjects' general conditions,personal history,occupational history,BMI,blood pressure,blood biochemical indicators,and liver ultrasound images were collected．Descriptive analysis was used to analyze the prevalence of fatty liver disease in this population．The influencing factors of fatty liver were analyzed by single factor and multiple factor Logistic regression．Results A total of 1 217 subjects were included in this study,and 543 were diagnosed as fatty liver disease,with a detection rate of 44.62%．The results of single factor analysis showed that the occurrence of fatty liver was closely related to gender,age,BMI and hypertension（P<0.05）．The analysis of occupational hazard factors showed that,the detection rate of fatty liver disease was higher in people exposed to hydrogen sulfide and ammonia compared to non-exposed individuals（P<0.05）．The longer the working years,the higher the detection rate of fatty liver（P<0.05）．The levels of liver function,lipid metabolism,blood glucose and uric acid in workers with fatty liver were higher than those in workers without fatty liver（P<0.05）．Multivariate Logistic regression analysis showed that age,BMI,abnormal liver function,abnormal lipid metabolism,high blood glucose levels and hyperuricemia were independent influencing factors for fatty liver disease（P<0.05）．Conclusions The detection rate of fatty liver disease among employees of a water purification company in Guangzhou is high,and the occurrence of fatty liver disease is mainly related to factors such as age,BMI,abnormal liver function,abnormal lipid metabolism,high sugar levels and hyperuricemia．

目的 探讨非酒精性脂肪肝患者昼夜节律特点并分析昼夜节律与非酒精性脂肪肝的相关性。方法 选取2017年12月—2018年12月我院门诊部及住院部非酒精性脂肪肝患者60例作为观察组,对照组抽取门诊体检正常人群60例。通过使用本院自制个人一般资料调查表、睡眠节律清晨型与夜晚型量表(MEQ)以及智能手环检测两组纳入对象的昼夜节律(饮食方式、饮食时间、活动节律、体重指数、睡眠节律等)。对比分析两组患者昼夜节律特点并分析其与非酒精性脂肪肝的相关性。结果 非酒精性脂肪肝患者在BMI、睡眠绝对夜晚型、睡眠中度夜晚型、日均运动量小于30 min、睡眠时间紊乱、睡眠时长以及深度睡眠时间等方面与对照组患者比较差异有统计学意义(P＜0.05);以非酒精性脂肪肝为应变量,以昼夜节律为自变量进行回归分析发现性别、年龄、工作性质、BMI、睡眠节律、身体锻炼、睡眠时长、深度睡眠时长与非酒精性脂肪肝呈现正相关且差异有统计学意义(OR＞1,P＜0.01)。结论 非酒精性脂肪肝患者昼夜节律一般存在失眠熬夜、睡眠时间不规律、少运动、身形丰满等特点,引发非酒精性脂肪肝相关因素包括BMI、睡眠节律、运动节律、职业性质、年龄、性别、睡眠质量等,临床上可尝试对非酒精性脂肪肝患者进行昼夜节律干预治疗,改善预后。

Objective To explore the characteristics of circadian rhythm in patients with nonalcoholic fatty liver disease(NAFLD) and to analyze the correlation between circadian rhythm and NAFLD. Methods From December 2017 to December 2018,60 patients with NAFLD in outpatient department and inpatient department of our hospital were selected as observation group,while 60 normal people were selected as control group.The circadian rhythm (dietary pattern,dietary time,activity rhythm,body mass index,sleep rhythm) of the subjects in the two groups were measured by self-made personal data questionnaire,MEQ and smart bracelet.The circadian rhythm characteristics of two groups were compared and the correlation between circadian rhythm and NAFLD was analyzed. Results There were significant differences in BMI,absolute night sleep,moderate night sleep,daily average exercise less than 30 minutes,sleep disturbance,sleep duration and deep sleep time between the patients with NAFLD and the control group (P<0.05). NAFLD was used as dependent variable and circadian rhythm as independent variable. Logistic regression analysis showed that gender,age,nature of work,BMI,sleep rhythm,physical exercise,sleep duration and deep sleep time were positively correlated with fatty liver (OR>1,P<0.01). Conclusion The circadian rhythm of NAFLD patients generally has the characteristics of insomnia,staying up late,irregular sleep time,less exercise and plump figure.The related factors causing NAFLD include BMI,sleep rhythm,motor rhythm,occupational nature,age,gender and sleep quality.In clinic,circadian rhythm intervention therapy may improve the prognosis of patients with NAFLD.

目的 探讨苯作业非酒精性脂肪肝工人丙氨酸氨基转移酶(ALT)水平与颈动脉粥样硬化的关系。方法 190名的苯作业非酒精性脂肪肝工人分为ALT异常组(ALT≥40 U/L)及ALT正常组(ALT＜40 U/L)。ALT异常组再根据ALT水平分为依据ALT水平分为G1组(60例,40 U/L≤ALT＜60 U/L),G2组(40例,60 U/L≤ALT＜80 U/L),G3组(35例, ALT＞80 U/L)。观察各组颈部动脉有否内膜增厚或斑块形成。结果 与ALT异常组颈动脉内膜增厚检出率和颈动脉斑块检出率明高于ALT正常组(P<0.05)。颈动脉内膜增厚检出率和颈动脉斑块检出率与ALT正常组相比较,G1组差异无统计学意义(P＞0.05), G2组有统计学意义(P<0.05),G3组有差异(P<0.01)。颈动脉内膜增厚检出率在G1组、G2组和G3组中逐渐增加,并有统计学意义(P<0.05)。G3组颈动脉斑块检出率与G1组比较,有差异(P<0.01)。结论 苯作业非酒精性脂肪肝工人中,血清ALT水平升高与颈动脉粥样硬化密切相关。ALT≥60 U/L的苯作业非酒精性脂肪肝人群更容易患颈动脉粥样硬化,应进行必要的预防和治疗。

Objective To explore the relationship between serum alanine aminotransferase levels(ALT) and carotid atherosclerosis in benzene exposed workers with nonalcoholic fatty liver disease. Methods 190 Benzene exposed workers with nonalcoholic fatty liver disease were enrolled divided into abnormal ALT group(n=135) and normal ALT group(n=55), the abnormal ALT group was further divided into three groups according to the levels of serum alanine minotransferase (ALT): group1(G1,60 subjects, 40 U/L≤ALT＜60 U/L),group2(G2,40 subjects, 60 U/L≤ALT＜80 U/L),and group3(G3,35 subjects, ALT＞80 U/L),observed if carotid has only thick endomembrane or with plaques. Results The rate of thick endomembrane of carotid and the detection rate of plaque in the abnormal ALT group are higher than those in the normal ALT control group (P<0.05). Compared with the normal ALT control group, no significant different was found in the rate of thick endomembrane of carotid and the detection rate of plaque in G1,but G2 was significantly different(P<0.05),G3 was extremely significantly different(P<0.01). The rate of thick endomembrane of carotid in G1,G2 and G3 increased, among the three groups. There were statistically significant differences in the rate of thick endomembrane of carotid(P<0.05). benzene exposed workers with nonalcoholic fatty liver disease in G3 showed extremely statistical differences on the detection rate of plaque compared to those in G1(P <0.01). Conclusion The increased level of ALT in benzene exposed workers with nonalcoholic fatty liver disease is closely related to carotid atherosclerosis. The benzene exposed workers with nonalcoholic fatty liver disease whose ALT≥60 U/L are apt to carotid atherosclerosis, should accept the necessary precaution and treatment.