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phenanthridinyl acetone alkaloids from bocconia arborea

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Journal of the Mexican Chemical SocietySociedad Química de Méxicoeditor@.mxISSN (Versión impresa): 1870-249XISSN (Versión en línea): 1665-9686MÉXICO2001Aníbal Julián / Guillermo Delgado(±)-BOCCONARBORINES A AND B, NOVEL 1,3-BIS-BENZO[C]PHENANTHRIDINYLACETONE ALKALOIDS FROM BOCCONIA ARBOREAJournal of the Mexican Chemical Society, octubre-diciembre, año/vol. 45, número 004Sociedad Química de MéxicoMexico, Méxicopp. 189-194Red de Revistas Científicas de América Latina y el Caribe, España y PortugalUniversidad Autónoma del Estado de MéxicoRevista de la Sociedad Química de México, Vol. 45, Núm. 4 (2001) 189-194Investigación(±)-Bocconarborines A and B, Novel 1,3-Bis-Benzo[c]phenanthridinyl Acetone Alkaloids from Bocconia arboreaAníbal Julián and Guillermo Delgado*Instituto de Química de la Universidad Nacional Autónoma de México. Circuito Exterior, Ciudad Universitaria.Coyoacán. México 04510, D. F. Tel: +(52)-(55)-5622-4446; E-mail: delgado@servidor.unam.mxRecibido el 15 de octubre del 2001; aceptado el 18 de diciembre del 2001Dedicated to Professor Fernando WallsAbstract.Chemical examination of the aerial parts of Bocconia arborea(Papaveraceae), a plant used in traditional medicine, led to the characterization of (±)-6-acetonyldihydrosanguinarine (1), (±)-6-acetonyldihydrochelerythrine (2), (±)-6-methoxydihydrochelerythrine (3), (±)-sanguidimerine (4), chelidimerine (5), and the novel cons-tituents (±)-bocconarborine A ((6R,6’S+ 6S,6’R)-13-(6-hydrosan-guinarinyl)-15-(6’-hydrochelerythrinyl)-acetone, 6) and (±)-boc-conarborine B ((6R,6’R+ 6S,6’S)-13-(6-hydrosanguinarinyl)-15-(6’-hydrochelerythrinyl)-acetone, 7). The structure and stereochemistry of the novel structures were determined by analyzing the preferred conformations and the spectroscopic data. Antimicrobial evaluations revealed that 3exhibited activity against S. aureus, S. faecalis and C. albicans.Keywords:Bocconia arborea,medicinal plant, Papaveraceae, alka-loids, benzophenanthridine, bocconarborines A and B, antimicrobial activity.Resumen.El análisis químico de las partes aéreas de Bocconia arborea(Papaveraceae), una planta usada en la medicina tradicional, condujo a la caracterización de (±)-6-acetonildihidrosanguinarina (1), (±)-6-acetonildihidroqueleritrina (2), (±)-6-metoxidihidroqueleritrina (3), (±)-sanguidimerina (4), quelidimerina (5), y los compuestos novedosos (±)-bocconarborina A ((6R,6’S+ 6S,6’R)-13-(6-hidrosan-guinarinil)-15-(6’-hidroqueleritrinyl)-acetona, 6) y (±)-bocconarbori-na B ((6R,6’R+ 6S,6’S)-13-(6-hidrosanguinarinil)-15-(6’-hydro-queleritrinil)-acetona, 7). La estructura y la estereoquímica de las estructuras nuevas fueron determinadas mediante el análisis de las conformaciones preferidas deducidas y los datos espectroscópicos. La evaluación antimicrobiana reveló que 3tiene actividad contra S. aureus, S. faecalis y C. albicans.Palabras clave:Bocconia arborea, planta medicinal, Papaveraceae, alcaloides, benzofenantridina, bocconarborinas A y B, actividad antimicrobiana.The genus Bocconia(Papaveraceae), which includes ca. nine species, occurs in tropical areas of Mexico, Central and South America [1,2]. Taxonomic considerations indicate a close rela-tionship with the Asiatic genus Macleaya and with the North American species Sanguinaria canadensis[3]. Bocconia species biosynthesize protopine, protoberberine and ben-zophenanthridine alkaloids [1], which display anti-microbial [4-6], cytotoxic [7], anti-tumor [8-11], anti-viral [12] and anti-inflammatory activities [13], among others. Bocconia arborea is a shrub widespread in Mexico that is known as llora sangre (weeping blood), cocoxíhuitl, ahuacachilli, mano de león (lion's hand), palo del diablo (devil's stick), palo amarillo (yel-low stick), among many other common names [14,15]. This plant has many different uses in traditional medicine in several regions: as purgative, vermifuge, antitumor and anti-inflam-matory agent [14], to heal wounds and dissolve warts [15,16], as a carminative agent, catartic, and analgesic [17].Previously, the methanolic extract of B. arborea showed anti-microbial activity against S. aureus, E. coli, P. aeruginosa and C. albicans[18], and the alkaloids dihydrochelerythrine and dihydrosanguinarine were identified as some of the active substances [19]. Now we report the isolation and identification of (±)-6-acetonyldihydrosanguinarine (1), (±)-6-acetonyldihy-drochelerythrine (2), (±)-6-methoxydihydrochelerythrine (3),(±)-sanguidimerine (4), chelidimerine (5), and the new com-pounds (±)-6and (±)-7, named trivially bocconarborines A and B, respectively, from the aerial parts of this plant. In addi-tion, the antimicrobial evaluation revealed that 3displayed activity.Results and discussionRepeated column chromatography of the ethanol extract over silica yielded compounds 1-3. Compound 1was a solid which showed physical and spectroscopic characteristics identical to that of (±)-6-acetonyldihydrosanguinarine [20], and COSY, DEPT, HMQC and HMBC experiments allowed the complete assignments of the NMR data which confirmed the structure (Table 1). The major constituent from this extract was identi-fied as (±)-6-acetonyldihydrochelerythrine (2) [21], and (±)-6-methoxydihydrochelerythrine (3) [21, 22] was isolated as the most polar and minor secondary metabolite from this residue. These structures were identified by comparison with the data published in the literature.Compound 4, isolated from the dichloromethane extract as an optically inactive substance, showed well resolved reso-nances for sixteen hydrogens in the 1H NMR spectrum (Table(±)-Bocconarborines A and B, Novel 1,3-Bis-Benzo[c]phenanthridinyl Acetone Alkaloids from Bocconia arborea191R H HR RHNational Herbarium (MEXU), Instituto de Biología de la Uni-versidad Nacional Autónoma de México.Extraction and Isolation.Dried and powdered plant material (1 kg) was extracted with dichloromethane at room tempera-ture (3 times, 24 h each) and then with ethanol (3 times, 24 h each). Elimination of the solvents at reduced pressure afforded 40 g and 120 g of residues, respectively. Part of the ethanolic extract (26 g) was adsorbed on silica gel (70-230) and chro-matographed on a silica gel (230-400) column packed with n-hexane-chloroform (20:1), and using increasing amounts of chloroform, and then mixtures of chloroform-methanol as eluting system. The chromatography was developed at reduced pressure [31]. Some fractions were further rechro-matographed to give, in order of increasing polarity: (±)-1 (100 mg), (±)-2(310 mg), and (±)-3(52 mg). The dichloro-methane residue (40 g) was adsorbed on silica gel (70-230) and applied to a column packed with silica gel (230-400) sus-pended in n-hexane. The column was developed at reduced pressure [31] with mixtures of n-hexane-EtOAc. Fractions eluted with n-hexane-EtOAc (20:1) were rechromatographed using mixtures of n-hexane-CHCl3as eluent, to give addition-al amounts of (±)-1(100 mg). Fractions eluted with n-hexane-EtOAc (9:1) were rechromatographed in an open column using n-hexane-CHCl3-MeOH (1:1:0.1) as constant eluent, and recrystallization of some fractions from MeOH-CHCl3 provided (±)-4(40 mg). 1H NMR analysis of some fractions indicated the presence of meso-5(ca.3 % with respect to (±)-4). From fractions eluted with n-hexane-EtOAc (4:1) of the main column was obtained a residue, which was further rechromatographed in an open column packed with n-hexane and eluting with mixtures of n-hexane-EtOAc. This column afforded (±)-6(40 mg) as the less polar constituent, and sub-sequent fractions afforded (±)-7(45 mg) as the more polar constituent.(±)-6 Acetonyldihydrosanguinarine (1).Colorless powdery solid, mp 190-191 °C (lit [20]: 194-195 °C), R f0.58 (n-hexa-ne-CHCl3-MeOH,1.5:1.5:0.05); [α]D= 0° (CDCl3); IR (CHCl3) νmax1711, 1470, 870 cm–1; 1H NMR (500 MHz) and 13C NMR (125 MHz), see Table 1.(±)-6 Acetonyldihydrochelerythrine (2).Colorless powdery solid, mp 199-200 °C (lit [21]: 194 °C), R f0.53 (n-hexane-CHCl3-MeOH, 1.5:1.5:0.05); [α]D= 0° (CDCl3); IR (CHCl3)νmax1712, 1604, 1492, 1463, 1417, 1359, 1275, 1083, 1041 cm–1; 1H (300 MHz, CDCl3) δ7.71 (1H, d, 8.4, H-11), 7.54 (1H, d, 9, H-10), 7.51 (1H, s, H-4), 7.48 (1H, d, 8.4, H-12), 7.10 (1H, s, H-1), 6.95 (1H, d, 8.4, H-9), 6.04 (2H, dd, 2.1, 1.2, -OC H2O-), 5.04 (1H, dd, 11.4, 3.6, H-6), 3.95 (3H, s, (C-7)-OC H3), 3.92 (3H, s, (C-8)-OC H3), 2.64 (3H, s, N-C H3), 2.58 (1H, dd, 15.0, 11.4, H-13B), 2.25 (1H, dd, 15.0, 3.6, H-13A), 2.06 (3H, s, -COC H3).(±)-6 Methoxydihydrochelerythrine (3).Yellow solid, mp 248-250 °C (lit [3]: 210 °C); R f0.43 (CHCl3-MeOH, 2.9:0.1);[α]D = 0° (CDCl3); IR (CHCl3) νmax1496, 1464, 1448, 1416, 1275, 1067, 1040, 946 cm–1; 1H NMR (300 MHz, CDCl3) δ7.78 (1H, d, 8.5, H-11), 7.70 (1H, s, H-4), 7.62 (1H, d, 9.0, H-10), 7.47 (1H, d, 8.5, H-12), 7.12 (1H, s, H-1), 7.04 (1H, d, 9.0, H-9), 6.05 (2H, s, -OC H2O-), 5.55 (1H, s, H-6), 3.96 (3H, s, (C-7)-OC H3), 3.93 (3H, s, (C-8)-OC H3), 3.46 (3H, s, (C-6)-OC H3), 2.76 (3H, s, N-C H3); EIMS m/z(rel. int.): 379 [M]+ (40), 348 (100), 333 (37), 318 (20), 290 (27), 174 (20). (±)-Sanguidimerine (4).Colorless powdery solid, mp 180 °C (lit [23b]: 174 °C), R f0.56 (n-hexane-CHCl3-MeOH, 1.5:1.5:0.05), [α]D= 0° (CHCl3), IR (CHCl3) νmax2924, 1712, 1602, 1440, 1352, 1250, 1040, 940, 857 cm–1; 1H NMR (300 MHz, CDCl3) see Table 2; EIMS m/z(rel. int.): 720 [M]+, 389 (3), 332 (26), 317 (100), 259 (5), 201 (8), 158 (7).(±)-Bocconarborine A (6).Colorless powdery solid, mp 159-163 °C, R f0.43 (n-hexane-CHCl3-MeOH, 1.5:1.5:0.05), [α]D = 0° (CHCl3), IR (CHCl3) νmax2928, 2900, 2854, 2802, 1713, 1602, 1494, 1463, 1442, 1416, 1361, 1274, 1240, 1103, 1081, 1043, 948, 861 cm–1; 1H NMR (500 MHz, CDCl3) see Table 3; 13C NMR (CDCl3, 125 MHz) δ207.02 (C O), 152.14 (C-8’), 148.08, 148.01, 147.70, 147.50, 147.11, 145.69 (C-7’), 144.28 (C-7), 139.30 (C-4b), 132.57, 130.99, 130.88, 128.39, 127.57, 127.31, 124.86, 123.79, 123.77, 123.36, 123.21, 119.86 (C-11), 119.67 (C-11’), 118.67 (C-10’), 116.41 (C-6a), 116.22 (C-10), 111.46 (C-9’), 107.28 (C-9), 104.30, 104.16, 101.59 (O C H2O), 100.91 (O C H2O), 100.75, 100.63, 60.93 (C-7’-O C H3), 55.80 (C-8’-O C H3), 54.81 (C-6’), 53.56 (C-6), 47.23 (C-13), 46.79 (C-15), 42.99 (C H3-N), 42.77 (C H3’-N); HRFABMS m/z736.2404 [M + 1]+for C44H36N2O9(calcd [M + 1]+m/z: 736.3421).(±)-Bocconarborine B (7). Colorless powdery solid, mp 181°C (dec.), R f0.41 (n-hexane-CHCl3-MeOH, 1.5:1.5:0.05), [α]D= 0° (CHCl3), IR (CHCl3) νmax2960, 2898, 2841, 1712, 1602, 1492, 1463, 1442, 1415, 1361, 1101, 1082, 1041, 948, 858 cm–1; 1H NMR (500 MHz, CDCl3) see Table 3; 13C NMR (CDCl3, 125 MHz) δ206.53 (CO), 152.07 (C-8’), 148.11, 148.07, 147.55, 147.17, 145.49, 144.37, 139.35, 131.081, 130.99, 128.34, 127.44, 127.38, 124.86, 123.83, 123.77, 123.47, 123.18, 120.00 (C-11), 119.68, (C-11’), 118.69 (C-10’), 116.45 (C-10), 116.35, 111.50 (C-9’), 107.38 (C-9), 104.21, 104.15, 101.48 (O C H2O), 100.94 (O C H2O), 100.78, 100.70, 60.68 (C-8’-O C H3), 55.77 (C-7’-O C H3), 54.39 (C-6’), 53.87 (C-6), 47.08 (C-13), 46.54 (C-15), 42.74 (C H3-N), 42.56 (C H3’-N); EIMS m/z(rel. int.): 736 [M]+(5), 405 (3), 389 (7), 348 (100), 332 (60), 317 (7), 290 (6).Biological Activities. The dichloromethane and ethanol extracts, the main fractions of the column chromatographies, as well as compounds 1-4were tested against S. aureus, S. faecalis, E. coli, P. aeruginosa, S. sonnei, K. pnemoniae, and C. albicans, following the procedures described previously [18, 19]. Bioguided fractionation allowed to identify that 3 displayed activity against Staphylococcus aureus(ATCC(±)-Bocconarborines A and B, Novel 1,3-Bis-Benzo[c]phenanthridinyl Acetone Alkaloids from Bocconia arborea193H HHHHHHHRHHHHR HHR H R H。

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北玄参根中的一个新环烯醚萜衍生物_英文_

北玄参根中的一个新环烯醚萜衍生物_英文_

A new iridoid derivative from the roots ofScrophularia buergerianaWU Xi-min 1†, ZHANG Liu-qiang 1†, CHEN Xiao-chong 1, FENG Li 1,XING Wang-xing 2*, LI Yi-ming 1*(1. School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;2. School of Medicine, Hangzhou Normal University, Hangzhou 310036, China )Abstract : Phytochemical investigation of the roots of Scrophularia buergeriana Miq. (Scrophulariaceae), resulted in the isolation of a new iridoid derivative named as buergerinin (1). Its structure was elucidated as rel-(1R , 5R , 6R )-(2-oxa-bicyclo[3.3.0]oct-7-en-6, 7-diyl)dimethoxypropane based mainly on MS and 1D and 2D NMR spectroscopic analyses.Key words : Scrophularia buergeriana ; iridoid derivative; buergerinin CLC number : R284 Document code : A Article ID : 0513-4870 (2014) 07-1019-03北玄参根中的一个新环烯醚萜衍生物吴喜民1†, 张刘强1†, 陈小冲1, 冯 丽1, 邢旺兴2*, 李医明1*(1. 上海中医药大学中药学院, 上海 201203; 2. 杭州师范大学医学院, 浙江 杭州 310036)摘要: 从北玄参块根中发现了一个新的环烯醚萜衍生物, 命名为buergerinin (1)。

常见的有机化学基团名称翻译

常见的有机化学基团名称翻译

有机化学基团名称翻译A伸乙烷合萘基；伸二氢苊基 acenaphtheneylene 亚乙烷合萘基；亚二氢苊基 acenaphthenylidene醋酰胺基；乙酰胺基 acetamido; acetamino 乙炔基 acetenyl;ethynyl乙酰乙酰基 acetoacetyl丙酮基 acetonyl亚丙酮基 acetonylidene乙酰氧基 acetoxy乙酰基 acetyl乙酰亚胺基 acetylimino酸硝基 aci-nitro吖啶基 acridinyl丙烯酰基 acrylyl; acryloyl己二酰基 adipoyl; adipyl脲[基]羰基；脲甲酰基 allophanyl; allophanoyl烯丙基 allyl甲脒基 amidino; guanyl酰胺基 amido酰胺草酰基；草酰胺酰基 amidoxalyl; oxamoyl 胺基 amino戊基 amyl; pentyl伸戊基 amylene亚戊基 amylidene亚戊基 amylidene; pentylidene苯胺基 anilino大茴香亚甲基；对甲氧苯亚甲基；对甲氧亚苄基 anisal; anisylidene甲氧苯胺基 anisidino大茴香酰基；对甲氧苯甲酰基；对甲氧苄酰基 anisoyl大茴香亚甲基；对甲氧亚苄基；对甲氧苯亚甲基 anisylidene; p-methoxybenzylidene; anisal 邻胺苯甲酰基；邻胺苄酰基 anthraniloyl; anthranoyl蒽基 anthranyl; anthryl蒽醌基 anthraquinonyl伸蒽基；次蒽基 anthrylene精胺酰基 arginyl亚胂酸基 arsinico胂基 arsino胂酸基 arsono亚胂基 arsylene细辛基；2,4,5-三甲氧苯基 asaryl;2,4,5-trimethoxyphenyl天[门]冬酰胺酰基 asparaginyl; asparagyl 天[门]冬胺酰基 aspartyl阿托酰基；颠茄酰基；2-苯丙烯酰基 atropoyl 壬二酰基 azelaxyl迭氮基；三氮基 azido; triazo偶氮亚胺基 azimino; azimido次偶氮基 azino偶氮基 azo氧偶氮基 azoxyB苯亚甲基；亚苄基 benzal苯甲酰胺基；苄酰胺基 benzamido苯亚磺酰基 benzene sulfinyl;phenylsulfinyl苯磺酰胺基 benzenesulfonamido苯磺酰基 benzenesulfonyl次苄基 benzenyl; benzylidyne二苯甲基 benzhydryl; diphenylmethyl二苯亚甲基 benzhydrylidene; diphenylmethylene联苯胺基 benzidino亚苄基；苯亚甲基 benzilidene二苯羟乙酰基 benziloyl苯并咪唑基 benzimidazolyl苯甲酰亚胺基 benzimido; benzoylimino亚胺苄基 benzimidoyl; benzimidoyle苯并呋喃基；熏草基 benzofuryl苯并哌喃基 benzopyranyl苯并【口+咢】【口+井】基 benzoxazinyl苯并【口+咢】唑基 benzoxazolyl苯甲酰氧基；苄酰氧基 benzoxy; benzoyloxy 苯甲酰基；苄酰基 benzoyl伸苯甲酰基 benzoylene苯甲酰亚胺基 benzoylimino; benzimido苯甲酰氧基 benzoyloxy; benzoxy苄基；苯甲基 benzyl亚苄基；苯亚甲基 benzylidene; benzylene; benzal次苄基；苯次甲基 benzylidyne; benzenyl 联苯基 biphenylyl【草(之上)+伯】基；龙脑基；冰片基；莰基 bornyl; camphenyl丁二烯基 butadienyl次丁烯基 butenylidyne丁氧基 butoxy丁基 butyl伸丁基 butylene亚丁基 butylidene次丁基 butylidyne丁酰基 butyrylC卡可基；二甲胂基 cacodyl莰基；【草(之上)+伯】基；龙脑基 camphanyl; bornyl樟脑二酰基；莰二酰基 camphoroyl樟脑基 camphoryl亚樟脑基 camphorylidene癸酰基{旧名：capryl} caprinoyl己酰基 caproyl辛酰基 caprylyl; capryloyl脲基 carbamido; ureido 胺甲酰基 carbamoyl; carbamyl苯胺甲酰基；苯胺羰基 carbanilino咔唑基 carbazolyl乙氧羰基；乙氧甲酰基 carbethoxy; ethoxycarbonyl苄氧甲酰基；苄氧羰基 carbobenzoxy甲氧甲酰基；甲氧羰基 carbomethoxy羰基 carbonyl羰二氧基 carbonyldioxy羧基 carboxyl羧甲基 carboxymethyl香旱芹基 carvacryl鲸蜡基；十六基 cetyl氯甲酰基 chloroformyl【草(之上)+快】基 chrysenyl亚桂皮基；苯亚烯丙基 cinnamal; cinnamylidene苯乙烯基；苏合香基 cinnamenyl; styryl 桂皮酰基 cinnamoyl桂皮基；苯烯丙基 cinnamyl柠康酰基 citraconoyl香茅基 citronellyl松柏基 coniferyl甲苯酚甲酰基 cresotyl甲苯氧基 cresoxy甲苯酚基 cresyl伸苄基 cresylene巴豆酰基 crotonoyl; crotonyl亚巴豆基 crotonylidene巴豆基 crotyl亚茴香基；对异丙亚苄基；【草(之上)+久】亚甲基 cumal; p-cuminylidene【草(之上)+久】基；异丙苯基 cumenyl; isopropylphenyl【草(之上)+久】胺基 cumidino茴香基；对异丙苄基 cuminyl亚茴香基 cuminylidene乙醛酰基 glyoxyl; glyoxylyl愈创木基；邻甲氧苯基 guaiacyl;o-methoxyphenyl胍基 guanidino胍基 guanido甲脒基 guanylH十一基 hendecyl; undecyl二十一基 heneicosyl三十一基 hentriacontyl十七酰基 heptadecanoyl十七基 heptadecyl庚酰基 heptanoyl; enanthyl庚基；正庚基 heptyl; n-heptyl六十基 hexacontyl二十六基 hexacosyl十六酰基；软脂酰基 hexadecanoyl; palmityl 十六基 hexadecyl六亚甲基 hexamethylene己二酰基 hexanedioyl己酰基 hexanoyl己烯酰基 hexenoyl亚己基 hexylidene次己基 hexylidyne马尿酰基；苯甲酰胺乙酰基 hippuroyl; hippuryl组胺酰基 histidyl升胡椒基 homopiperonyl;3,4-methylenedioxy-phenethyl升藜芦酰基；3,4-二甲氧苯乙酰基 homoveratroyl;3,4-dimethoxyphenylacetyl升藜芦基；3,4-二甲氧苯乙基 homoveratryl; 3,4-dimethoxyphenethyl大风子酰基 hydnocarpoyl大风子基 hydnocarpyl环肼基 hydrazi 肼基 hydrazino伸肼基；氢偶氮基 hydrazo亚肼基 hydrazono氢桂皮酰基 hydrocinnamoyl氢桂皮基；3-苯丙基 hydrocinnamyl羟亚胺基 hydroximino羟基 hydroxy; hydroxyl羟胺基 hydroxyamino羟甲基 hydroxymethylI四氢咪唑基；咪唑啶基 imidazolidinyl 咪唑啶基；四氢咪唑基 imidazolidyl咪唑啉基；二氢咪唑基 imidazolinyl咪唑基 imidazolyl亚胺基 imido二氢茚基 indanyl吲唑基 indazolyl茚基 indenyl吲哚啉基；二氢吲哚基 indolinyl吲哚基 indolyl吲哚基 indyl二氧碘基 iodoxy丙烯基 isoallyl异戊氧基 isoamoxy异戊基 isoamyl伸异戊基 isoamylene亚异戊基 isoamylidene异【草(之上)+伯】基；异莰基 isobornyl 异丁烯基 isobutenyl异丁氧基 isobutoxy异丁基 isobutyl伸异丁基 isobutylene亚异丁基 isobutylidene次异丁基 isobutylidyne异丁酰基 isobutyryl异氰酸基 isocyanato异氰基 isocyano异己基 isohexyl 亚异己基 isohexylidene 次异己基 isohexylidyne异二氢吲哚基；异吲哚啉基isoindolinyl 异吲哚基 isoindolyl 异白胺酰基 isoleucyl异硝基；酸硝基 isonitro; aci-nitro 异亚硝基；羟亚胺基 isonitroso; oxyamino 异戊基 isopentyl 亚异戊基 isopentylidene 次异戊基 isopentylidyne 异戊氧基 isopentyloxy异酞酰基；间苯二甲酰基isophthaloyl 亚异酞基；间苯二亚甲基 isophthalylidene 异平基 isoprenyl 异丙烯基 isopropenyl 异丙氧基 isopropoxy 异丙基 isopropyl异丙苯甲酰基 isopropylbenzoyl 异丙苄基 isopropylbenzyl 异丙亚苄基 isopropylbenzylidene 亚异丙基 isopropylidene 异喹啉基 isoquinolyl 异硫氰酸基 isothiocyano 异戊酰基 isovaleryl 异【口+咢】唑基 isoxazolyl K酮基；侧氧基 keto 乳酰基 lactoyl; lactyl 月桂酰基；十二酰基 lauroyl 月桂基；十二基 lauryl; dodecyl 白胺酰基 leucyl 沈香基 linalyl 苹果酰基；羟丁二酰基 maloyl 苯乙醇酰基；苦杏仁酰基 mandeloyl 【草(之上)+孟】基 menthyl 巯基；氢硫基 mercapto 中康酰基 mesaconoyl【草(之上)+米】基；2,4,6-三甲苯基 mesityl 中草酰基 mesoxalyl甲磺酰基 mesyl; methanesulfonyl 间胺苯磺酰基 metanilyl 甲基丙烯酰基 methacryloyl甲基烯丙基 methallyl; 2-methylallyl 亚甲基 methene; methylene次甲基 methenyl; methylidyne; methine 甲硫胺酰基 methionyl 甲氧草酰基 methoxalyl 甲氧基 methoxy甲氧苯甲酰基；大茴香酰基 methoxybenzoyl; anisoyl甲氧羰基 methoxycarbonyl 甲氧苯基 methoxyphenyl 甲基 methyl甲基丙烯酰基 methylacryloyl 甲苄基 methylbenzyl 亚甲基 methylene 次甲基 methylidyne羟甲基 methylol; hydroxymethyl 【口+末】啉基 morpholinyl 蜜蜡基；三十基 myricyl; melissyl 肉豆蔻酰基；十四酰基 myristoyl 肉豆蔻基；十四基 myristyl Nmorpholino N-【口+末】啉基萘亚甲基 naphthal; naphthylmethylene 萘二甲酰亚胺基 naphthalimido 萘次甲基 naphthenyl 萘氧基 naphthoxy 萘甲酰基 naphthoyl萘甲酰氧基 naphthoyloxy萘基 naphthyl伸萘基 naphthylene亚二氢萘基 naphthylidene萘亚甲基 naphthylmethylene萘次甲基 naphthylmethylidyne萘氧基 naphthyloxy新戊基 neopentyl苨肉基 neryl正己基 n-hexyl硝胺基 nitramino氮基 nitrilo硝基 nitro亚硝胺基 nitrosamino亚硝亚胺基 nitrosimino亚硝基 nitroso正辛基 n-octyl二十九基 nonacosyl十九基 nonadecyl伸壬基 nonamethylene壬二酰基 nonanedioyl壬酰基 nonanoyl壬基 nonyl降莰基；降【草(之上)+伯】基 norcamphanyl; norbornyl正十五基 n-pentadecyl正戊基 n-pentylO二十八基 octacosyl十八酰基；硬脂酰基 octadecanoyl; stearoyl 十八基 octadecyl伸辛基 octamethylene辛酰基 octanoyl伸辛基 octylene庚酰基 oenanthyl; oenanthoyl; heptanoyl 柳基；邻羟苄基 o-hydroxybenzyl; salicyl 油酰基 oleoyl 邻甲氧甲酰苯甲酰苯 o-methoxycarbonyl-benzophenone鸟胺酰基 ornithyl邻【草(之上)+叨】甲酰基；邻甲苯甲酰基 o-toluoyl邻【草(之上)+叨】基；邻甲苯基 o-tolyl 二甘氧基 oxadiethyl酸草酰基 oxalo草酰基 oxalyl草酰胺基；乙二酰胺基 oxamido草酰胺酰基 oxamoyl; oxamyl【口+咢】【口+井】基 oxazinyl【口+咢】唑啶基 oxazolidinyl【口+咢】唑啉基 oxazolinyl【口+咢】唑基 oxazolyl侧氧基；酮基 oxo; ketoP棕榈酰基；软脂酰基；十六酰基 palmitoyl 棕榈基；软脂基；十六基 palmityl对苯醌基 p-benzoquinonyl壬酰基 pelargonyl五十基 pentacontyl二十五基 pentacosyl十五酰基 pentadecanoyl十五基 pentadecyl五亚甲基；伸戊基 pentamethylene五唑基 pentazolyl戊烯基 pentenyl【口+叵】啶基 perimidinyl苯甲酰甲基 phenacyl苯甲酰亚甲基 phenacylidene啡啶基；5-氮菲基 phenanthridinyl菲基 phenanthryl伸菲基 phenanthrylene低苯基 phenenyl苯乙基 phenethyl乙氧苯基 phenetyl苯氧基 phenoxy 苯基 phenyl苯乙酰基 phenylacetyl苯胺甲酰胺基；苯脲基 phenylcarbamido 伸苯基 phenylene伸苯双偶氮基 phenylenebisazo 亚环己二烯基 phenylidene 苯亚胺基 phenylimino苯胺砜基；苯胺磺酰基 phenylsulfamyl 苯亚磺酰基 phenylsulfinyl 苯磺酰基 phenylsulfonyl 苯胺硫甲酰基 phenylthiocarbamyl; phenylthiocarbamoyl 亚酞基 phthalidylidene 酞酰基；邻苯二甲酰基phthaloyl 邻苯二亚甲基 phthalylidene 苦味[酸]基；2,4,6-三硝苯基 picryl 哌啶基 piperidyl向日葵基；3,4-亚甲二氧苄基 piperonyl 亚向日葵基；3,4-亚甲二氧苯亚甲基 piperonylidene三甲基乙酰基 pivalyl对甲氧苯胺基 p-methoxyanilino; anisidino 对甲氧苄基；对甲氧苯甲基 p-methoxybenzyl 对甲氧亚苄基 p-methoxybenzylidene 脯胺酰基 prolyl炔丙基；2-丙炔基 propargyl 亚丙烯基 propenylidene丙炔酰基；炔丙酰基 propiolyl; propioloyl 丙酰基 propionyl 丙氧基 propoxy 丙基 propyl 伸丙基 propylene假【草(之上)+久】基；2,4,5-三甲苯基 pseudocumyl; 2,3,5-trimethylphenyl 假吲哚基 pseudoindoyl吡唑啶基 pyazolidyl; pyrazolidinyl喹唑啉基 quinazolinyl 喹啉基；苯并吡啶基 quinolyl 苯醌基 quinonyl; benzoquinonyl 喹【口+咢】啉基 quinoxalinyl 【口+昆】啶基 quinuclidinyl 间苯二酚基 resorcyl S柳基；邻羟苄基 salicyl; o-hydroxybenzy 亚柳基；邻羟亚苄基 salicylidene 柳酰基；邻羟苯甲酰基 salicyloyl 檀香基 santalyl 二级戊基 sec-amyl 二级丁氧基 sec-butoxy 二级丁基 sec-butyl 二级亚丁基 sec-butylidene 二级戊基 sec-pentyl 半卡肼基 semicarbazido 半卡腙基 semicarbazono异戊烯酰基；二甲烯丙酰基 senecioyl 硅[烷]氧基 siloxy硬脂酰基；十八酰基 stearoyl 苯乙烯基 styryl; cinnamenyl 环庚基 suberyl琥珀酰胺酰基 succinamoyl; succinamyl 琥珀酰亚胺基；丁二酰亚胺基 succinimido 琥珀酰基；丁二酰基 succinyl磺胺基；对胺苯磺酰基 sulfa-磺酸胺基 sulfamino胺磺酰基 sulfamoyl; sulfamyl磺胺基；对胺苯磺酰胺基 sulfanilamido氢硫基；硫醇基；巯基 sulfhydryl磺酸基 sulfo磺酰胺基 sulfonamido-磺酰基；砜基 sulfonyl磺[酸基]苯基 sulfophenylT羟丙二酰基；丙醇二酰基tartronoyl; tartronyl牛[胆]磺酰基；胺乙磺酰基 tauryl对苯二亚甲基terephthalal; terephthalyidene对酞酰基；对苯二甲酰基 terephthaloyl【草(之上)+孟】烯基 terpinyl三级丁氧基 tert-butoxy三级丁基 tert-butyl三级戊基 tert-pentyl四十基 tetracontyl二十四基 tetracosyl十四酰基；肉豆蔻酰基 tetradecanoyl十四基 tetradecyl四氢糠基；四氢呋喃甲基 tetrahydrofurfuryl 四氢萘基 tetralyl伸丁基；四亚甲基 tetramethylene四甲伸苯基 tetramethylphenylene四甲对伸苯基 tetramethyl-p-phenylene四唑基 tetrazolyl; tetrazyl噻吩甲酰基 thenoyl噻吩甲基 thenyl噻吩亚甲基 thenylidene噻【口+井】基 thiazinyl四氢噻唑基 thiazolidinyl四氢噻唑基 thiazolidyl噻唑基 thiazolyl 噻吩基 thienyl硫基 thio胺硫甲酰基 thiocarbamoyl; thiocarbamyl 硫羰基 thiocarbonyl硫羰基 thiono亚磺酰基；氧硫基 thionyl亚硫酰基 thionyl苯硫基 thiophenyl硫[酮]基 thioxo苏胺酰基 threonyl【草(之上)+丢】基 thujyl瑞香[草]基；3-对莳萝基；3-对【草(之上)+散】基 thymyl; 3-p-cymyl邻【草(之上)+叨】氧基；邻甲苯氧基 toloxy; tolyloxy; cresoxy甲苯磺酰基toluenesulfonyl; tosyl; tolylsulfonyl【草(之上)+叨】胺基；甲苯胺基 toluidino; toluido; toluino【草(之上)+叨】甲酰基；甲苯甲酰基 toluyl; toluoyl甲伸苯基 tolylene【草(之上)+叨】氧基；甲苯氧基 tolyloxy 【草(之上)+叨】磺酰基；甲苯磺酰基 tolylsulfonyl; tosyl; toluenesulfonyl 三十基；蜜蜡基 triacontyl三氮烯基；胺偶氮基 triazeno三【口+井】基 triazinyl迭氮基 triazo; azido三唑啶基 triazolidinyl三唑基 triazolyl二十三基 tricosyl十三酰基 tridecanoyl十三基 tridecyl伸丙基 trimethylene三苯甲基 triphenylmethyl; trityl三苯硅基 triphenylsilyl十一酰基 undecanoyl十一基 undecyl脲基 uramino; ureido; carbamido脲基 ureido伸脲基 ureylene戊酰基；缬草酰基 valeryl异缬[草]胺酰基 valyl香草酰基 vanilloyl香草基 vanillyl亚香草基 vanillylidene亚藜芦基 veraltrylidene; veratral亚藜芦基 veratral; veratrylidene藜芦酰基 veratroyl藜芦基 veratryl乙烯基 vinyl伸乙烯基 vinylene亚乙烯基 vinylidene【口+山】基 xanthenyl联苯基 xenyl; biphenylyl茬胺基 xylidino茬甲酰基 xyloyl茬基；二甲苯基；甲苄基 xylyl苯二甲基；伸茬基xylylene; phenylenedimethylene。

国际纯粹与应用化学联合会IUPAC有机物系统命名法 (B部) 杂环命名法

国际纯粹与应用化学联合会IUPAC有机物系统命名法 (B部) 杂环命名法


哒嗪基(Pyridazinyl)
(19) 吲哚嗪(Indolizine) (20) (21) (22) 吲哚(Indole) (23) 1 氢-吲唑(1H-Indazole) (24)* 嘌呤(Purine) (25) (26) 异喹啉(Isoquinoline) (27) 喹啉(Quinoline) (28) (29) (30) 喹喔啉(Quinoxaline) 喹唑啉; 间二氮杂萘(Quinazoline) (31) 酞嗪/2,3 二氮杂萘(Phthalazine) 二氮杂萘, 萘啶(Naphthyridine) 4 氢-喹嗪(4H-quinolizine) 异吲哚(Isoindole) 3 氢-吲哚(3H-Indole)
IV 表 D碲吩(Tellurophene) IV 表 D硒吩(Selenophene) IV 表 D夹二硒(杂)蒽(Selenanthrene) IV (1) 噻吩(Thiophene) (4) 噻蒽(Thianthrene) 噻蒽基(Thianthrenyl) 表 D吩噻砷(Phenothiarsine) IV (5) 呋喃 (Furan) (6) 吡喃 (Pyran) (7) 异苯并呋喃基 (Isobenzofuranyl) (Chromenyl) 呫吨/氧杂蒽/二苯并吡喃(Xanthene) 吡喃基 (Pyranyl) 呋喃基 (Furyl) 噻吩基(Thienyl)
(phenoxathiin) (11) 2 氢-吡咯(2H-Pyrrole) 2 氢-吡咯基(2H-Pyrrolyl)
(12) 吡咯(Pyrrole)
吡咯基(Pyrrolyl)
(13) 咪唑(Imidazole) (14) 吡唑(Pyrazole) (14a) 异噻唑(Isothiazole) (14b) 异恶唑(Isoxazole)
超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究

超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究

∗基金项目:河南省医学科技攻关计划项目(编号: 2018020246)作者单位:450052郑州市郑州大学第五附属医院超声诊断科第一作者:郭萌,女,41岁,医学硕士,副主任医师㊂E-mail: guomeng.823@ ㊃非酒精性脂肪性肝病㊃超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究∗郭萌,郭琦,张峰㊀㊀ʌ摘要ɔ㊀目的㊀分析应用超声瞬时弹性成像检测的受控衰减参数(CAP)评估非酒精性脂肪性肝病(NAFLD)患者肝脂肪变程度的价值㊂方法㊀2020年5月~2022年5月我院诊治的NAFLD患者78例,均接受肝脏超声检查和超声瞬时弹性成像检查,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估CAP诊断NAFLD患者肝脂肪变程度的效能㊂结果㊀肝脏超声检查结果显示,78例NAFLD患者中包括轻度肝脂肪变41例㊁中度肝脂肪变23例和重度肝脂肪变14例;重度肝脂肪变患者血清ALT和AST水平分别为(77.2ʃ14.9)U/L和(59.1ʃ11.7)U/L,显著高于中度肝脂肪变患者ʌ分别为(40.1ʃ8.3)U/L和(35.9ʃ6.2)U/L,P<0.05ɔ或轻度肝脂肪变患者ʌ分别为(26.7ʃ5.5)U/L和(23.3ʃ4.8)U/L, P<0.05ɔ;重度肝脂肪变患者血清TG水平和CAP分别为(3.5ʃ0.7)mmol/L和(317.7ʃ27.6)dB/m,显著高于轻度肝脂肪变患者ʌ分别为(1.6ʃ0.6)mmol/L和(259.9ʃ27.5)dB/m,P<0.05ɔ或中度肝脂肪变患者ʌ分别为(2.7ʃ0.6)mmol/L和(292.1ʃ30.7)dB/m,P<0.05ɔ,而血清HDL-C水平为(0.8ʃ0.4)mmol/L,显著低于轻度肝脂肪变患者ʌ(1.3ʃ0.3)mmol/L, P<0.05ɔ或中度肝脂肪变患者ʌ(1.1ʃ0.3)mmol/L,P<0.05ɔ;以CAP>285.4dB/m为截断点,诊断NAFLD患者中度肝脂肪变,以CAP>309.1dB/m为截断点,诊断NAFLD患者重度肝脂肪变,结果发现轻度肝脂肪变39例,中度肝脂肪变22例,重度肝脂肪变17例,其AUC㊁敏感度和特异度分别为0.783(95%CI:0.669~0.896)㊁78.3%和75.6%,和0.696(95% CI:0.515~0.876)㊁78.6%和69.6%(P<0.05)㊂结论㊀应用CAP诊断NAFLD患者肝脂肪变程度可能比超声检查更准确,有很大的临床应用价值㊂㊀㊀ʌ关键词ɔ㊀非酒精性脂肪性肝病;肝脂肪;超声瞬时弹性成像;受控衰减参数;诊断㊀㊀DOI:10.3969/j.issn.1672-5069.2024.02.008㊀㊀Evaluation of hepatic steatosis by controlled attenuation parameter of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases㊀Guo Meng,Guo Qi,Zhang Feng.Department of Ultrasound,Fifth Affiliated Hospital, Zhengzhou University,Zhengzhou450052,Henan Province,China㊀㊀ʌAbstractɔ㊀Objective㊀The aim of this study was to investigate the evaluation of hepatic steatosis by controlled attenuation parameter(CAP)of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases(NAFLD).Methods㊀78 patients with NAFLD were enrolled in our hospital between May2020and May2022,and they all received liver ultrasonography and ultrasonic transient elastography for CAP.The receiver operating characteristic curve(ROC)was plotted and the area under the curve(AUC)was calculated to evaluate the efficacy of CAP in predicting the degree of hepatic steatosis in patients with NAFLD.Results㊀The liver ultrasonography showed that out of the78patients with NAFLD in our series,there were mild hepatic steatosis in41cases,moderate hepatic steatosis in23cases and severe hepatic steatosis in14cases;serum ALT and AST levels in patients with severe liver steatosis were(77.2ʃ14.9)U/L and(59.1ʃ11.7)U/L,significantly higher than[(40.1ʃ8.3)U/L and(35.9ʃ6.2)U/L,P<0.05]in patients with moderate or[(26.7ʃ5.5)U/L and(23.3ʃ4.8)U/L,P<0.05]in patients with mild liver steatosis;serum triglyceride level and the CAP in patients with severe liver steatosis were(3.5ʃ0.7)mmol/L and (317.7ʃ27.6)dB/m,both significantly higher than[(1.6ʃ0.6)mmol/L and(259.9ʃ27.5)dB/m,P<0.05]in patients with mild or[(2.7ʃ0.6)mmol/L and(292.1ʃ30.7)dB/m,P<0.05]in patients with moderate,while serum high-density lipoprotein cholesterol level was(0.8ʃ0.4)mmol/L,much lower than[(1.3ʃ0.3)mmol/L,P<0.05]in patients with mild or[(1.1ʃ0.3)mmol/L,P<0.05]in patients with moderate liver steatosis;with the CAP>280.4dB/m as the cut-off value for the diagnosisof moderate hepatic steatosis in patients with NAFLD,the AUC,sensitivity(Se)and specificity(Sp)were0.783(95%CI:0.669-0.896),78.3%and75.6%,and with the CAP>309.1dB/m as the cut-off value for the diagnosis of severe hepaticsteatosis,the AUC was0.696(95%CI:0.515-0.876),with the Se of78.6%and the Sp of69.6%(P<0.05).Conclusion㊀The application of CAP obtained by ultrasonic transient elastography might help assess more accurately the severity of liver steatosis in patients with NAFLD.㊀㊀ʌKey wordsɔ㊀Nonalcoholic fatty liver diseases;Hepatic steatosis;Ultrasonic transient elastography;Controlled attenuation parameter;Diagnosis㊀㊀非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是一种以肝脏脂肪变性为特征的疾病㊂据统计,NAFLD已影响了超过25%成年人[1]㊂NAFLD是全球慢性肝病的主要病因,与包括肥胖㊁糖尿病㊁高血压和高脂血症在内的代谢综合征密切相关,有进展为非酒精性脂肪性肝炎(NASH)㊁肝纤维化㊁肝硬化甚至肝细胞癌的风险[2]㊂由于NAFLD 在早期是一个可逆的过程,故尽早诊断并给予合理的治疗至关重要㊂肝活检是目前诊断NAFLD的 金标准 ,但该操作有一定的创伤性,无法在临床上得到广泛的开展[3]㊂超声瞬时弹性成像(FibroScan)是一种新兴的超声成像技术,由法国Echosens公司研发,具有检查时间短㊁无创㊁可重复等优点,通过无创弹性测量评估肝脏实质的硬度和脂肪变间接反映肝纤维化和肝脂肪变程度,已被广泛应用于慢性肝病的无创诊断[4]㊂基于FibroScan设计的新的参数,称为受控衰减参数(controlled attenuation parameter, CAP),可用于定量反映肝脂肪变程度[5]㊂本研究旨在使用超声瞬时弹性成像检测NAFLD患者CAP,评估肝脂肪变程度,以期为临床管理提供依据㊂1㊀资料与方法1.1一般资料㊀2020年5月~2022年5月我院收治的NAFLD患者78例,男性41例,女性37例;年龄为34~66岁,平均年龄为(49.9ʃ7.1岁)㊂符合‘非酒精性脂肪性肝病防治指南(2018年更新版)“[6]的诊断标准㊂纳入标准:(1)无饮酒史;(2)超声提示肝脂肪变㊂排除标准:(1)合并严重的心㊁脑㊁肺㊁肾功能障碍;(2)排除病毒性肝炎㊁酒精性肝病㊁药物性肝损伤㊁自身免疫性肝病等㊂全部患者签署知情同意书,本研究经我院医学伦理委员会审核通过㊂1.2肝脏超声检查㊀使用飞利浦中国投资有限公司提供的彩色多普勒超声诊断仪检查,超声探头频率为3.5MHz㊂检查时,患者取仰卧位或左侧卧位,观察肝脏形态㊁大小㊁轮廓㊁边界㊁肝区回声㊁前场回声增强㊁远场回声衰减和管道结构等,从而对肝脂肪变进行分度㊂轻度肝脂肪变:肝脏前场回声增强,远场回声轻度衰减;中度肝脂肪变:肝脏前场回声增强,远场回声衰减;重度肝脂肪变;肝脏前场回声明显增强,远场回声明显衰减,管道结构模糊㊂1.3CAP检测㊀使用无锡海斯凯尔医学技术有限公司生产的FibroTouch超声瞬时弹性成像仪检测,超声探头频率为3.5MHz㊂由经过专门培训且获得Fi-broTouch操作证书的医生按照使用手册,定人定机操作㊂在测量时,患者取仰卧位,右手抱头,最大程度地扩展肋间隙㊂选择右侧腋前线到腋中线第7㊁8㊁9肋间作为检测区域,保持探头与肋间隙皮肤表面垂直㊂当压力指示器显示为绿色,显示屏上M波形强度一致㊁分布均匀和A波形呈线性时,开始测量㊂所有患者测量次数>10次,并以有效测量结果的中位数作为最终结果㊂有效测量结果指的是所有测量结果的四分位间距/中位数<30%,同时(成功测量次数/总测量次数)成功率ȡ60%㊂1.4血清指标检测㊀使用北京普朗新技术有限公司提供的全自动生化分析仪检测血生化指标㊂1.5统计学处理㊀应用SPSS26.0统计学软件处理数据㊂计量资料均满足正态分布,以(xʃs)表示,采用单因素方差分析㊂绘制受试者工作特征曲线(re-ceiver operating characteristic curve,ROC)并计算曲线下面积(area under curve,AUC),评估CAP诊断NAFLD患者肝脂肪变程度的效能,以P<0.05为差异有统计学意义㊂2㊀结果2.1肝脏超声检查结果㊀经超声检查,在78例NAFLD患者中,发现轻度肝脂肪变41例㊁中度肝脂肪变23例和重度肝脂肪变14例㊂2.2不同肝脂肪变的NAFLD患者肝功能指标比较㊀重度肝脂肪变患者血清ALT和AST水平显著高于轻度或中度肝脂肪变患者,差异均具有统计学意义(P<0.05,表1)㊂2.3不同肝脂肪变的NAFLD患者血脂和CAP比较㊀重度肝脂肪变患者FPG㊁血清TG㊁LDL-C水平和CAP显著高于轻度肝脂肪变患者,而血清HDL-C水平显著低于轻度或中度肝脂肪变患者(P<0.05,表2)㊂表1㊀不同肝脂肪变的NAFLD患者肝功能指标(xʃs)比较肝脂肪变例数TBIL(μmol/L)ALT(U/L)AST(U/L)ALB(g/L)轻度4112.9ʃ1.626.7ʃ5.523.3ʃ4.847.5ʃ3.7中度2315.9ʃ2.040.1ʃ8.3①35.9ʃ6.2①48.0ʃ3.9重度1416.1ʃ2.177.2ʃ14.9①②59.1ʃ11.7①②48.1ʃ3.9㊀㊀与轻度肝脂肪变比,①P<0.05;与中度肝脂肪变比,②P<0.05表2㊀不同肝脂肪变的NAFLD患者血脂和CAP(xʃs)比较肝脂肪变例数TC(mmol/L)TG(mmol/L)LDL-C(mmol/L)HDL-C(mmol/L)CAP(dB/m)轻度41 5.0ʃ0.8 1.6ʃ0.6 2.9ʃ0.9 1.3ʃ0.3259.9ʃ27.5中度23 5.1ʃ0.9 2.7ʃ0.6① 3.3ʃ0.8 1.1ʃ0.3①292.1ʃ30.7①重度14 5.0ʃ0.9 3.5ʃ0.7①② 3.5ʃ0.9①0.8ʃ0.4①②317.7ʃ27.6①②㊀㊀与轻度肝脂肪变比,①P<0.05;与中度肝脂肪变比,②P<0.052.4CAP诊断NAFLD患者肝脂肪变程度的效能情况㊀以CAP>285.4dB/m为截断点,诊断NAFLD患者中度肝脂肪变,以CAP>309.1dB/m为截断点,诊断NAFLD患者重度肝脂肪变,结果发现轻度肝脂肪变39例,中度肝脂肪变22例,重度肝脂肪变17例,其AUC㊁敏感度和特异度分别为0.783(95%CI:0.669~0.896)㊁78.3%和75.6%(P<0.05,图1),和0.696(95%CI:0.515~0.876)㊁78.6%和69.6%(P<0.05,图2)㊂图1㊀CAP诊断NAFLD患者中度肝脂肪变的ROC曲线分析图2㊀CAP诊断NAFLD患者重度肝脂肪变的ROC曲线分析3㊀讨论近年来,NAFLD患病率不断升高㊂预计到2030年,我国NAFLD患者总数将超过3亿[7]㊂NAFLD 包括各种不同严重程度的肝脏疾病,而处于单纯性脂肪肝阶段的病变是可逆的,早期诊断和干预将有助于改善预后[8]㊂但NAFLD的发病机制尚不清楚,通常认为是由于脂肪在肝细胞内过度沉积和肝细胞脂肪变性所致,全身性炎症㊁胰岛素抵抗㊁肠道微生态失调等均可促进疾病的发生和发展[9]㊂作为全身代谢综合征的一种表现,NAFLD与血糖和血脂代谢紊乱密切相关[10]㊂非肥胖型NAFLD患者代谢紊乱程度较肥胖型NAFLD患者更轻,其肝脂肪变程度亦显著减轻[11]㊂本研究发现不同肝脂肪变的NAFLD 患者血生化指标存在显著性差异,NAFLD患者代谢紊乱程度随着肝脂肪变程度的加重而逐渐加重㊂缓解NAFLD的一种方法为抑制TG合成,另一种为促进TG代谢,而抑制脂质合成和促进脂肪酸氧化可改善肝脂肪变程度[11]㊂故早期无创诊断NAFLD患者肝脂肪变程度尤为重要㊂目前,常规超声检查被广泛用于肝脂肪变的一线评估,但普通超声检查缺乏定量的准确性,对低肝脂肪含量诊断的敏感性差,并且在极大程度上依赖操作者的临床经验[12]㊂超声瞬时弹性成像是一种非侵入性的检查方法,具有快速㊁无创㊁可重复性好等优点,其测量的组织体积相比活检样本至少大100倍,同时测量结果不受操作者主观影响,在慢性肝病具有较高的诊断价值[13,14]㊂因脂肪为一种衰减介质,而通过超声瞬时弹性成像检测CAP是基于超声在介质传导过程中的能量衰减原理,通过对信号能量在肝脏传播过程中的衰减速度进行测量,从而有助于定量评估肝脂肪变程度[15]㊂CAP可用于评估病毒性肝炎患者肝脂肪变程度[16-18]㊂本研究通过对比不同肝脂肪变的NAFLD患者CAP值,结果显示重度肝脂肪变患者CAP显著高于中度或轻度肝脂肪变患者,表明CAP与NAFLD患者肝脂肪变程度密切相关㊂随着NAFLD患者肝脂肪变程度的加重,其肝脏脂肪含量亦不断增加,其CAP也随之增大,提示使用Fibroscan检测CAP可用于评估NAFLD患者肝脂肪变程度㊂不同作者报道的CAP 诊断NAFLD中度和重度肝脂肪变的截断点分别为258dB/m和293dB/m等不等[19,20],而本研究应用CAP诊断NAFLD患者中度和重度肝脂肪变具体良好的诊断效能㊂一方面,通过肝脏超声检查对肝脂肪变进行分级可能受操作者经验的影响,另一方面可能是由于所纳入的病例数有限所致㊂本研究结果显示,CAP诊断NAFLD患者中度和重度肝脂肪变的AUC分别为0.783和0.696,其敏感度分别为78.3%和78.6%,特异度分别为75.6%和69.6%,表明应用CAP评估NAFLD患者肝脂肪变程度具有一定的价值,是一种较理想的检查方法㊂因此,使用Fibroscan检测CAP有助于指导临床评估NAFLD患者肝脂肪变程度,同时结合患者肝功能㊁空腹血糖和血脂指标等,有望实现早期无创诊断,具有较高的临床应用价值㊂但本研究仍存在一定的局限性,首先,未对患者进行肝活检检查,而是以肝脏超声检查结果作为诊断不同肝脂肪变分级的标准,可能会对结果造成一定的影响;其次,为单中心临床研究,所纳入的病例数较少,可能使得结果出现一定的偏倚㊂后续工作的开展还有待进行多中心㊁大样本的研究,以进一步分析CAP评估NAFLD患者肝脂肪变程度的价值㊂ʌ参考文献ɔ[1]Duell PB,Welty FK,Miller M,et al.Nonalcoholic fatty fiver dis-ease and cardiovascular risk:a scientific statement from the American Heart Association.Arterioscler Thromb Vasc Biol,2022, 42(6):168-185.[2]Truong E,Yeo YH,Cook-Wiens G,et al.Nonalcoholic fatty liverdisease prevalence and severity in Asian Americans from the national health and nutrition examination surveys2017-2018.Hepatol Com-mun,2022,6(9):2253-2261.[3]Troelstra MA,Witjes JJ,van Dijk AM,et al.Assessment ofimaging 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