肥胖是一种以过度脂肪堆积为特征的慢性疾病,正在影响全球约6.5亿人的身体健康。尽管肥胖已被广泛认定为一种需要长期管理的慢性病,其诊断和治疗策略在临床实践中仍存在显著的不足与不一致。特别是在治疗理念、干预措施以及患者的长期管理方面,尚存在诸多盲区和误区,影响了治疗效果和患者预后。本文系统评估了肥胖症的现有管理策略,包括生活方式干预、药物治疗、代谢手术等,同时探讨了新型治疗方法和未来研究方向,旨在为优化肥胖症的治疗提供科学依据和指导。Obesity is a chronic disease characterized by excessive fat accumulation and is affecting the health of approximately 650 million individuals worldwide. Although obesity has been widely recognized as a chronic disease requiring long-term management, there are still significant deficiencies and inconsistencies in diagnostic and treatment strategies in clinical practice. Especially in terms of treatment concepts, intervention measures, and long-term management of patients, there are still many blind spots and misunderstandings, all of which impact therapeutic outcomes and prognosis. This review systematically evaluates the current management strategies for obesity, including lifestyle interventions, pharmacotherapy, and metabolic surgery, while also exploring emerging therapeutic approaches and future research directions. The goal is to provide a scientific basis and guidance for optimizing the management of obesity.
目的:探究2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的脂肪、四肢骨骼肌质量指数与肝脏脂肪变性程度的相关性。方法:选取2023年9月至2024年9月于石家庄市人民医院内分泌科住院接受治疗18~75岁T2DM合并MAFLD患者共200例。根据代表肝脏脂肪变性的严重程度的受控衰减参数(CAP)水平(S0: CAP Objective: To investigate the correlation between fat, limb skeletal muscle mass index and liver steatosis in patients with type 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD). Methods: A total of 200 patients with T2DM and MAFLD aged 18~75 years who were hospitalized in the Department of Endocrinology of Shijiazhuang People’s Hospital from September 2023 to September 2024 were selected. According to the level of controlled attenuation parameter (CAP) representing the severity of hepatic steatosis (S0: CAP < 238 dB/m, S1: 238 dB/m ≤ CAP < 260 dB/m, S2: 260 dB/m ≤ CAP < 292 dB/m, S3: CAP ≥ 292 dB/m), the patients were divided into 88 cases of non-severe hepatic steatosis group and 112 cases of severe hepatic steatosis group. All patients were measured visceral fat grade (VFG), body mass index (BMI), body fat mass (FM), body fat percentage (BF%), limb skeletal muscle mass (ASM), fat mass index (FMI), limb skeletal muscle mass positive college value (ASMI), limb skeletal muscle mass weight correction value (ASM/W), instantaneous elasticity imaging parameters CAP value (dB/m) and other indicators. Results: 1) VFG, BMI, BF %, FM, FMI, ASMI, HOMA-IR, TG and ALT in severe hepatic steatosis group were higher than those in non-severe hepatic steatosis group, while ASM/W was significantly lower than that in non-severe hepatic steatosis group (P < 0.05). 2) Pearson/Spearman correlation analysis showed that CAP was positively correlated with VFG, BMI, BF %, FM, FMI, ASMI, FINS, HOMA-IR and ALT (r = 0.302, 0.547, 0.470, 0.581, 0.580, 0.183, 0.420, 0.429, 0.354, P < 0.05), and CAP was negatively correlated with A
目的:探究2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的TG/HDL-C与肝脏脂肪变相关性。方法:选取2023年9月至2024年8月于石家庄市人民医院内分泌科住院接受治疗27~75岁T2DM合并MAFLD患者共186例。根据代表肝脏脂肪变性的严重程度的受控衰减参数(CAP)水平(S0: CAP γ-GGT、TG/HDL-C、CAP均高于非重度脂肪变组,差异均有统计学意义(P γ-GGT、BMI、TG/HDL-C等均呈正相关(r值分别为0.407、0.392、0.422、0.547、0.381、0.433、0.368、0.538、0.568)。(3) 行二元Logistic多因素回归分析得出:TG/HDL-C、LDL-C、BMI、ALT是T2DM合并MAFLD患者肝脏脂肪变的独立危险因素(TG/HDL-C 95%置信区间1.726 (1.238, 2.407),P = 0.001)。(4) 将TG/HDL-C、TG、LDL-C、ALT代入ROC曲线分析,曲线下面积分别为:0.753、0.747、0.609、0.695。其中TG/HDL-C敏感度54.7%,特异度86.3%,TG、TG/HDL-C均能预测T2DM合并MAFLD患者的重度肝脏脂肪变性,但TG/HDL-C预测价值更优(P = 0.000),具有统计学意义。Objective: To investigate the correlation between TG/HDL-C and hepatic steatosis in patients with type 2 diabetes mellitus (T2DM) combined with metabolism-associated fatty liver disease (MAFLD). Methods: A total of 186 patients with T2DM combined with MAFLD aged 27-75 years who were hospitalized in the Department of Endocrinology of Shijiazhuang People’s Hospital from September 2023 to August 2024 were selected. The patients were categorized into 80 cases in the non-severe hepatic steatosis group and 106 cases in the severe hepatic steatosis group according to the level of controlled attenuation parameter (CAP), which represents the severity of hepatic steatosis (S0: CAP γ-GGT, TG/HDL-C, and CAP were higher in the severe steatosis group than those in the non-severe steatosis group, and the differences were statistically significant (P γ-GGT, BMI, and TG/HDL-C (r-values of 0.407, 0.392, 0.422, 0.547, 0.381, 0.433, 0.368, 0.538, respectively, 0.568). (3) Binary logistic multifactorial r
