1、011.1 02011.2 051.3 10022.1 15132.2 162.3 172.4 192.5 25033.1 32313.2 34044.1 48474.2 494.3 521582.593.614.6401CHAPTER行01021.1.1 30020003002000300200020222302031.1 1.1.2 031.1.3 041.1.4 1.1.5 脸色发黄影响肝脏健康代谢变差脱发第二天没精神怕猝死黑眼圈头、脸出油月经失调体检肝指标偏高血管问题影响肾脏健康将军肚不担心熬夜影响其他情绪暴躁9.87%9.78%7.59%8.15%11.45%8.58%6.65%8.
2、49%0.30%4.93%6.61%4.29%7.59%4.59%1.07%13.92%9.82%10.09%9.76%8.93%8.96%9.04%8.11%6.95%5.56%3.13%2.27%1.65%0.82%0.92%0.04%0.08%男性女性不同性别人群关注的健康问题侧重点不同图11-不同性别关注的健康问题相比之下,男性更担心肾脏健康、精气神、将军肚、肝指标等方面问题,女性则更关注脸色发黄、脱发、代谢变差等现象。051.2 1.2.1 30020003002000061.2.2 071.2.2.1 1.2.2.2 081.2.3.1 1.2.3 091.2.3.2 101.2.
3、3.3 1.3 NAFLD1.4 1 2023,43(4):248-252.2 Modeling NAFLD disease burden in China,France,Germany,Italy,Japan,Spain,United Kingdom,and United States for the period 20162030J.Journal of Hepatology 2018 vol.69 j 896904.3 The Global Burden of Liver Disease:The Major Impact of ChinaJ.Hepatology.2014 Decem-b
4、er;60(6):20992108.doi:10.1002/hep.27406.1302CHAPTER14152.1 2.1.1 2.1.2 162.2 2.2.1 172.2.2 2.3.1 2.3 182.3.2 B192.3.3 2.3.4 2.4 202.4.1 21222.4.2 232.4.3 2.4.4 242.4.5 2.4.6 252.5 262.5.1 272.5.2 282.5.3 2.5.4 2.6 1 2 Utoh R,Komori J,Kuge H,et al.Adult hepatocytes direct liver organogenesis through
5、non-parenchymal cell recruit-ment in the kidney.J Hepatol,2018,68(4):744-753.3 4 5 KONOPKAR J,BENZER S.Clock mutants of drosophila melano-gasterJ.Proc Natl Acad SciUS A,1971,68(9):2112-2116.6 JAMES A A,EWER J,REDDY P,et al.Embryonic expressionof the period clock gene in the central nervous system of
6、 drosophilamelanogasterJ.EMBO J,1986,5(9):2313-2320.7 Grimaldi B,Bellet MM,Katada S,Astarita G,Hirayama J,Amin RH,Granneman JG,Piomelli D,Leff T,Sassone-Corsi P.PER2 controls lipid metabolism by direct regulation of PPAR.Cell Metab 2010;12:509-520.8 Paschos GK,Ibrahim S,Song WL,Kunieda T,Grant G,Rey
7、es TM,Bradfield CA,Vaughan CH,Eiden M,Masoodi M,Griffin JL,Wang F,Lawson JA,Fitzgerald GA.Obesity in mice with adipocyte-specific deletion of clock component Arntl.Nat Med 2012;18:1768-1777.9 Bugge A,Feng D,Everett LJ,Briggs ER,Mullican SE,Wang F,Jager J,Lazar MA.Rev-erb and Rev-erb coordinately pro
8、tect the circadian clock and normal metabolic function.Genes Dev 2012;26:657-667.10Hernndez-Garca J,Navas-Carrillo D,Orenes-Piero E.Alterations of circadian rhythms and their impact on obesity,metabolic syndrome and cardiovascular diseases.Crit Rev Food Sci Nutr 2020;60:1038-1047.11 VllanuevaJE,Live
9、lo C,Truijllo AS,Chandran S,Woodworth B,Andrade L,Le HD,ManorU,Panda S,Melkani GC.Time-restrict-ed feeding restores muscle function in Drosophila models of obesity and circadian-rhythm disruption.Nat Commun 2019;10:2700.12Schbler S,Amatobi KM,HornM,Rieger D,Helfrich-Frster C,Mueller MJ,Wegener C,Fek
10、ete A.Loss of function in the Drosophila clock gene period results in altered intermediary lipid metabolism and increased susceptibility to starvation.Cell Mol Life Sci 2020.13 Baron KG,Reid KJ,Kim T,Van Horn L,Attarian H,WolfeL,Siddique J,Santostasi G,Zee PC.Circadian timing and alignment in health
11、y adults:associations with BMI,body fat caloric intake and physical activity.Int J Obes(Lond)2017;41:203-209.14 Touitou Y,Reinberg A,Touitou D.Association between light at night,melatonin secretion,sleep deprivation,and the internal clock:Health impacts and mechanisms of circadian disruption.Life Sc
12、i 2017;173:94-106.15 KETTNER N M,VOICU H,FINEGOLD M J,et al.Circadian homeostasis of liver metabolism suppresses hepatocarcino-genesis J.Cancer Cell,2016,30(6):909-924.16ZHOU Y,TAN F,LI C,et al.White peony(fermented camellia sinensis)polyphenols help prevent alcoholic liver injury via antioxidationJ
13、.Antioxidants,2019;8(11):524.17Shen T,Liu Y,Shang J,et al.Incidence and etiology of drug-induced liver injury in mainland ChinaJ.Gastroenterolo-gy,2019,156(8):2230-2241.e2211.18Bjornsson E S,Bergmann O M,Bjornsson H K,et al.Incidence,presentation,and outcomes in patients with drug-induced liver inju
14、ry in the general population of IcelandJ.Gastroenterology,2013,144(7):1419-1425,1425.el411-1413;quiz el419-1420.19DiPaola F,Molleston J P,Gu J,et al.Antimicrobials andantiepileptics are the leading causes of idiosyncratic drug-induc-edliver injury in American childreJ.J Pediatr Gastroenterol Nutr,20
15、19,69(2):152-159.20Fontana R J,Liou I,Reuben A,et al.AASLD practiceguidance on drug,herbal,and dietary supplement-induced liverinju-ryJ.Hepatology(Baltimore,Md),2023,77(3):1036-1065.21Corsini A,BortoliniM.Drug-induced liver injury:therole of drug metabo-lism and transportJ.Joumalof ClinicalPharma-co
16、logy,2013,53(5):463-474.22Russmann S,Kullak-Ublick GA,Grattagliano I.Curent concepts of mecha-nisms in drug-induced hepatotoxicityJ.Curr Med Chem,2009,16(23):3041-3053.23HELEN A.VIJAYAMMAL P L Vitamin C supplemen tation onhepatic oxidative stress induced by cigarette smokeJ.J ApplToxicol 1997,17(5):
17、289-295.24HOLT PG,KEAST D.Enviromentally-induced changes in immunologicalfunction:Acuteand chronic effects of in-halation of tobaccosmoke and other atmospheric contaminants in man and experimentalanimals J.BacteriologicalRe-views,1977,41(1):205-216.25Hamabe A,Uto H,Imamura Y,et al.Impact of cigarett
18、esmokingon onset of nonalcoholic fatty liver disease over a 10-yearperiod.J Gastroenterol,2011,46:769-778.26 Chiang PH,Chang TY,Chen JD.Synergistic effect of fatty liverand smoking on metabolic syndrome.World J Gastroen-terol,2009,15:5334-5339.27 Kim,D.,Konyn,P.,Cholankeril,G.,&Ahmed,A.(2021).Physic
19、al activity is associated with nonalcoholic fatty liver disease and significant fibrosis measured by fibroscan.Clinical Gastroenterology and Hepatology,2021.28ZHENG KI,FAN JG,SHI JP,et al.From NAFLD to MAFLD:a“redefining”momentfor fattyliver disease J.Chin Med J(Engl),2020,133(19):2271-2273.DOl:10.1
20、097/CM9.0000000000000981.29NAN Y,ANJ,BAO J,et al.The Chinese Society of Hep-atologyposition statement on the redefinition of fatty liver diseaseJ.J Hepatol,2021,75(2):454-461.DOI:10.1016/j.jhep.2021.05.003.30TARGHER G.Concordance between MAFLD and NAFLD diagnostic criteria in real-worlddataJ.Liver I
21、nt,2020,40(11):2879-2880.DOI:10.1111/liv.14623.31323103CHAPTER323.1 123.1.1 3334-5673.1.2 8343.2.1 3.2 93510113.2.1.2 123.2.1.1 364131415163.2.1.3 17-223723-2526-33薓3834-3536-373.2.2.1 3.2.2.2 3.2.2 394344-483.2.3.1 3.2.3 38393.2.2.3 49-513.2.3.2 4052-5354553.2.3.3 47573.2.4.1 3.2.4.2 3.2.4 413.2.5
22、58593.2.4.3 61623.2.5.1 3.2.5.2 42636465663.2.5.3 3.2.6 673.2.6.1 68-693.2.6.2 7273743.2.6.3 3.3/Hepatic stellate cellHSCVery low density lipoproteinVLDLEicosapentaenoic AcidEPA Docosahexaenoic acidDHAPolyunsaturated fatty acidPUFAAlcoholic liver diseaseALDGlutathione peroxidaseGSH-PxSuperoxide dism
23、utaseSODReactive oxygen speciesROSMalondialdehydeMDASilymarinSILMonoamine OxidaseMAOB nuclear factor kappa-BNF-BTriglycerideTGTotal cholesterolTCHAlanine aminotransferaseALTAspartate aminotransferaseASTMeta-analysisMetaNonalcohol fatty liver diseaseNAFLDRandomized controlled trialRCTNonalcoholic ste
24、atohepatitisNASHGlutathioner-glutamyl cysteingl+glycineGSH-glutamyl transpeptidaseGGTTotal bilirubinTBilInositolINSAlcoholdehydrogenaseADHAcetaldehyde dehydrogenaseALDH Tumour necrosis factor-TNF-CHypersensitive C-reactive proteinhs-CRPP450 Cytochrome P450 Family 2 Subfamily E Member 1CYP2E1-Transfo
25、rming growth factor-,TGF-PPAR-LDL 123 Yuan S,Larsson SC.Inverse Association Between Serum 25-Hydroxyvitamin D and Nonalcoholic FattyLiver DiseaseJ.-Clin Gastroenterol Hepatol,2023,21:398-405.e4.4 Zhang JJ,Yu HC,Li Y,et al.Association between serum 25-hydroxy vitamin D concentrations andmortality amo
26、ng individuals with metabolic dysfunction-associated fatty liver disease:a prospective cohortstudyJ.Am J Clin Nutr,2022,116:1409-1417.5 Fan X,Wang J,Song M,et al.Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality ina Large Cohort:Re-sults From the UK BiobankJ.J ClinEndocrinol Metab,
27、2020,105:dgaa432.6 Luo L,Ye J,Shao C,et al.Vitamin D Status Presents Different Relationships with Severity inMetabolic-Associated Fatty Liver Disease Patients with or without Hepatitis B InfectionJ.Nutrients,2022,14:2114.7,.CPPAR-J.,2021,38(22):2791-2795.8,.J.,2024,24(05):479-491.-DOI:10.16429/j.100
28、9-7848.2024.05.040.9,.J.,2018,32(6):3.DOI:CNKI:SUN:WS-DL.0.2018-06-009.10.J.2024.241:116-11811(2019)J.,2019,35(11):2426-2430.12,.J.,2019,24(5):7.-DOI:10.12092/j.issn.1009-2501.2019.05.015.13,.MetaJ.,2019,35(5):4.-DOI:10.3969/j.issn.1001-5256.2019.05.024.14,et al.J.,2022,22(8):980-983.15 Wah Kheong C
29、et al.A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis.Clin Gastroenterol Hepatol.2017 Dec15(12)1940-1949.e8.doi10.1016/j.cgh.2017.04.016.Epub 2017 Apr 15.16 Solhi H,Ghahremani R,Kazemifar AM,Hoseini Yazdi Z.Silymarin in treatment of non-alcoholic steatohepatitis:A r
30、andomized clinical trial.Caspian J Intern Med.2014 Winter;5(1):9-12.PMID:24490006;PMCID:PMC3894463.17 Salmi HA,Sarna S.Effect of silymarin on chemical,functional,and morphological alterations of the liver.A double-blind controlled study.Scand J Gastroenterol.1982;17(4):51721.18 Ferenci P,Dragosics B
31、,Dittrich H,Frank H,Benda L,Lochs H,Meryn S,Base W,Schneider B.Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver.J Hepatol.1989;9(1):10513.19 Feher J,Deak G,Muzes G,Lang I,Niederland V,Nekam K,Karteszi M.Liver-protective action of silymarin therapy in chronic
32、 alcoholic liver diseases.Orv Hetil.1989;130(51):27237.20 Lucena MI,Andrade RJ,de la Cruz JP,Rodriguez-Mendizabal M,Blanco E,Sanchez de la Cuesta F.Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis.Results of a randomized,double-blind,placebo-controlled clinical stu
33、dy.Int J Clin Pharmacol Ther.2002;40(1):28.21Muzes G,Deak G,Lang I,Nekam K,Niederland V,Feher J.Effect of silimarin(Legalon)therapy on the antioxidant defense mechanism and lipid peroxidation in alcoholic liver disease(double blind protocol).Orv Hetil.1990;131(16):8636.22Velussi M,Cernigoi AM,De Mon
34、te A,Dapas F,Caffau C,Zilli M.Long-term(12 months)treatment with an anti-oxidant drug(silymarin)is effective on hyperinsulinemia,exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients.J Hepatol.23 Butorova LI,Tsibizova TA,Kalinin AV.Potential for the use of Legalon in non-a
35、lcoholic fatty liver disease.Exp Clin Gastroenterol.2010;3:8591.24 Gillessen A,Herrmann WA,Kemper M,Morath H,Mann K.Effect of silymarin on liver health and quality of life.Results of a non-interventional study.MMW Fortschr Med.2014;156(Suppl 4):1206.25 Sorrentino G,Crispino P,Coppola D,De Stefano G.
36、Efficacy of lifestyle changes in subjects with non-alcoholic liver steatosis and metabolic syndrome may be improved with an antioxidant nutraceutical:a controlled clinical study.Drugs R D.2015;15(1):215.26Shooka Mohammadi et al.Effects of silymarin supplementation on liver and kidney functions:A sys
37、tematic review and dose-response meta-analysis.2024 May;38(5):2572-2593.doi:10.1002/ptr.8173.Epub 2024 Mar 12.27Shudi Li,Fei Duan,Suling Li,Baoping Lu.Administration of silymarin in NAFLD/NASH:A systematic review and meta-analysis.PMID:38579127 DOI:10.1016/j.aohep.2023.101174.-4704CHAPTER484.1 4.1.1
38、 4.1.2 4.1.3 4.1.4 4.1.5 4.1.6 49344.2.1 4.2 12505224.2.2 4.2.3 114.2.4 51124.2.5 4.2.6 4.2.7 524.3 53121112254411312001201220246141314201625meta516RCT11171550.58202398“”40.0%65.0%27.042.0%18.5554.4 357CHAPTER581.1 1.2 1.1.3 592.2.1 2.2 602.3 613.3.1 3.2 MDA*062ALT987643*0806040*0806040*0633.3 644.1 4.654.2 66