Guiding opinions:
survey fee
1. Serum enzymology examination
(1)ALT and AST: generally slightly increased, reaching 2-3 times the normal upper limit. AST of alcoholic fatty liver was significantly increased, and AST/alt >；. It has diagnostic significance. Changes of ALT/AST > in nonalcoholic fatty liver; 1。 ALT> 130U, suggesting that there is obvious fat infiltration in hepatic lobules, and the continuous increase of alt suggests that there is fat granuloma.
(2)γ-GT and ALP: The increase of γ-GT is more common in alcoholic fatty liver, and ALP can also increase, reaching twice the normal upper limit; The γ-GT of patients with nonalcoholic fatty liver can be increased.
(3)GST: It can reflect stress liver injury and is more sensitive than ALT.
(4) Glutamate dehydrogenase (GDH) and ornithine carbamoyl transferase (DCT). GDH is a mitochondrial enzyme, which is mainly active in the third region of hepatic acinus, while DCT is a urea synthase, which participates in the methyl transfer reaction. Both of these enzymes are elevated in fatty liver. Especially alcoholic fatty liver, its gdh/oct >；; 0.6。
(5) Cholinesterase and lecithin cholesterol acyltransferase (LCAT): The serum cholinesterase and LCAH of 80% fatty liver increased, but the increase of alcoholic fatty liver was not obvious under low nutrition. CHE has certain significance in differentiating obese fatty liver.
2. Changes of plasma protein
(1)β globulin, α 1, α2 and β lipoprotein all increased.
(2) Albumin is normal.
(3) In obese fatty liver, LDL-C increased, HDL-C decreased significantly, and ApoB, ApoE, ApoC and ⅲ increased.
3. The plasma lipid TG, FA, cholesterol and phospholipid are often increased, among which the cholesterol is significantly increased, often >:13mmol/L. 。
4. The excretion of BSP and ICG decreased in pigment excretion test. In obesity and alcoholic fatty liver, because fat storage is mostly in hepatic acinus III area, pigment therapy is also in this area. Liver fat storage affects the function of pigment secretion by hepatocytes. The degree of decreased excretion is related to the degree of fat infiltration in the liver.
5. Bilirubin can increase blood bilirubin when severe fatty liver occurs, and bilirubin in mild to moderate fatty liver is normal.
6. The prothrombin time (PT) of nonalcoholic fatty liver is normal, and some of them can be prolonged.
7. The blood insulin level showed a high response delay type, and the peak value of glucose tolerance curve increased and the decline was delayed.
8. Blood urea nitrogen and uric acid occasionally increase.
accessory examination
1.Ultrasonic images of diffuse fatty liver examined by B-ultrasound mainly showed echo attenuation. Fatty liver can be divided into three types according to attenuation degree: (1) mild fatty liver: near-field echo is enhanced, far-field echo attenuation is not obvious, and tubular structures in liver are still visible.
(2) Moderate fatty liver: the echo in the front field is enhanced, the echo in the back field is attenuated, and the tubular structure is blurred.
(3) Severe fatty liver: the near-field echo is obviously enhanced, the far-field echo is obviously attenuated, and the tubular structure is unclear and unrecognizable. The sensitivity of ultrasound to severe fatty liver is 95%.
2. CT images of fatty liver are different from those of real-time ultrasound (US). The accuracy of CT diagnosis is better than that of B-ultrasound, which mainly shows that the density of liver is generally or locally decreased, even lower than that of spleen and blood vessels in liver. In contrast, the echo of portal vein is enhanced and the density is reduced in accordance with the severity of obesity. Dynamic CT changes can reflect the increase or decrease of liver fat infiltration. On CT, diffuse fatty liver shows that the density of liver is generally lower than that of spleen and blood vessels in liver; For severe fatty liver, the CT value of liver can be reduced to about 10Hu (the density of normal liver is 6 ~ 12hu higher than that of spleen). After enhanced CT scanning, the hepatic vascular shadow of fatty liver was clearly displayed with normal shape and direction. Sometimes the blood vessels can be thinned and narrowed, but there is no migration and wrapping phenomenon, which is helpful to distinguish the non-affected areas of liver cancer and fatty liver (normal "liver island").
3.MRI is generally considered to be less valuable than US and CT. Magnetic resonance imaging (MRI) of fatty liver showed fat infiltration in the whole liver, one lobe or focal region, and the spin echo (SE) sequence and inversion recovery (IR) pulse sequence T 1 weighted signal were normal. T2-weighted images of short IR sequences and SE can be slightly higher, but only proton images of fat are displayed. The fat infiltration area is high signal, and the blood vessels in the liver are normal. In recent years, some people use nuclear magnetic resonance to measure the fat content of liver tissue.
4. Liver biopsy is an important method to diagnose fatty liver, especially for localized fatty liver. Ultrasound-guided liver biopsy is far more accurate and safer than blind liver biopsy in the past. The significance of biopsy is to determine whether there is fat infiltration and fibrosis in the liver.
(1) Focal fatty liver or diffuse fatty liver with normal hepatic island is difficult to distinguish from malignant tumor, and liver biopsy under the guidance of B-ultrasound is needed.
(2) Find out the causes of some rare fatty liver diseases, such as cholesteryl ester storage disease, glycogen storage disease and Wilson's disease.
(3) Liver biopsy is the only diagnostic method for asymptomatic and suspicious nonalcoholic steatohepatitis.
(4) Alcoholism, alcoholic liver disease or alcoholic liver disease and alcoholic hepatitis with unknown clinical or biochemical causes need liver biopsy to exclude active infection before considering corticosteroid therapy.
(5) After losing 65438 00% of the original weight, the liver function enzymology of obese fatty liver patients is still abnormal, so liver biopsy is needed to find other reasons.
(6) those who suspect that severe hepatitis is caused by fatty liver and need a definite diagnosis by liver biopsy to understand its etiology.
(7) To evaluate the reliability of some serological indexes such as B-ultrasound, CT and imaging examination in the diagnosis of fatty liver and fibrosis, it is necessary to objectively evaluate the exact curative effect of a certain treatment scheme on fatty liver fibrosis with the changes of liver biopsy as the gold standard.
(8) Anyone who suspects non-simple hepatic steatosis or fatty liver or liver function damage caused by various reasons should be identified by liver biopsy.
Relationship between fatty liver and liver cirrhosis
Fatty liver and cirrhosis are common diseases in liver diseases. If you don't pay attention to cirrhosis every day, it may develop into cirrhosis, and the consequences are unimaginable.
Fatty liver refers to the pathological changes of excessive fat accumulation in liver cells caused by various reasons. Fatty liver disease is seriously threatening the health of people in China, becoming the second largest liver disease after viral hepatitis, and has been recognized as the common cause of occult cirrhosis. Fatty liver is a common clinical phenomenon, not an independent disease.
Cirrhosis is a common chronic progressive liver disease in clinic, and it is a diffuse liver damage caused by long-term or repeated action of one or more causes. Pathohistologically, there are extensive hepatocyte necrosis, nodular regeneration of residual hepatocytes, proliferation of connective tissue and formation of fibrous septa, which lead to the destruction of hepatic lobule structure, the formation of false lobules, and the gradual deformation and hardening of the liver, which leads to cirrhosis.