| Objective:By detecting the liver CAP and LSM of NAFLD patients in Qinghai,and detecting the content of fecal SCFAs(acetic acid,propionic acid,butyric acid,valeric acid,caproic acid,isobutyric acid and isovaleric acid),we can understand the difference of short chain fatty acids in different degrees of fatty liver and liver hardness,observe the difference of liver CAP,LSM and fecal SCFAs content of high-risk patients with Nash before and after treatment,and preliminarily explore the relationship between intestinal metabolism of SCFAs and the pathogenesis of NAFLD.Methods:1.A total of 90 patients with NAFLD clinically diagnosed in the Affiliated Hospital of Qinghai University from December 2020 to November 2021 were selected.They were divided into three groups: NAFL,Nash and nonalcoholic fatty liver fibrosis,with 30 cases in each group.At the same time,40 healthy people in our hospital were selected as the control group;2.The subjects collected and recorded general data(such as name,sex,age,etc.)and laboratory indexes(such as biochemistry,coagulation,etc.),tested and recorded four serological indexes of liver fibrosis in healthy group and nonalcoholic fatty liver fibrosis group;3.Fibro Scan was used to detect CAP and LSM in liver,and GC-MS was used to determine the content of SCFAs in feces;4.High risk patients in NASH group(complicated with diabetes and hyperlipidemia)were selected for treatment intervention(oral silybin capsule105mg/time,3 times/day,and walking for 1 hour every morning).After 3 months,they were followed up and tested for serological indicators,liver CAP,LSM and fecal SCFAs;5.Statistical analysis.Results:1.The contents of valeric acid and caproic acid in nonalcoholic fatty liver fibrosis group were higher than those in the control group,and the contents of valeric acid and caproic acid in NAFL group were lower than those in the control group(p<0.05);The contents of valeric acid and caproic acid in nonalcoholic fatty liver fibrosis group were higher than those in NAFL group(p<0.05);The content of valeric acid in nonalcoholic fatty liver fibrosis group was higher than that in NASH group(p<0.05);The content of caproic acid in NASH group was higher than that in NAFL group(p<0.05).2.BMI,Hb A1 c,FPG,TG,TC,ALT,AST,GGT,TBA,PT,UA,CAP and LSM in high-risk patients in NASH group were lower than those before treatment(p<0.05);3.The contents of acetic acid and propionic acid in high-risk patients in NASH group were higher than those before treatment(p<0.05);The content of isobutyric acid was lower than that before treatment(p<0.05);4.The area under the curve(AUC)of valeric acid in the diagnosis of nonalcoholic fatty liver fibrosis was 0.842,and the best boundary value was 141.42μg/g,sensitivity 86.7%,specificity 70%;The AUC of caproic acid in the diagnosis of nonalcoholic fatty liver fibrosis was 0.819,and the best boundary value was 6.93 μ g/g,sensitivity 70%,specificity 85%.Conclusions:1.NAFLD patients have different degrees of liver function injury and metabolism related abnormalities,which are manifested in the significant increase of BMI,FPG,TG,DB and CAP,and the significant decrease of IB,ALB and APTT;2.The increase of intestinal valeric acid and caproic acid may promote the progress of NAFLD;3.The increase of intestinal isobutyric acid may promote the occurrence and development of NASH;4.After clinical intervention,the serum indexes BMI,Hb A1 c,FPG,TG,TC,ALT AST,GGT,TBA,PT,UA,LSM and CAP decreased,further indicating that the increase of intestinal acetic acid and propionic acid may have a certain degree of protective effect on the liver of NAFLD patients;5.The diagnostic value of intestinal valeric acid and caproic acid is inferior to PIIIP N-P,but superior to IV-C and HA.It is speculated that valeric acid is 141.42μg/g,caproic acid is 6.93μg/g.The critical value of valeric acid and caproic acid can be used as an auxiliary index for early screening of nonalcoholic fatty liver fibrosis. |
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