非酒精性脂肪性肝病(NAFLD)已成为全球范围内一个主要的公共卫生问题,同时也是最常见的慢性肝病,其患病率和发病率正迅速增加。尽管NAFLD在普通人群中相当普遍,但仅有少数NAFLD患者会进一步发展为非酒精性脂肪性肝炎(NASH),并可能伴随晚期肝纤维化(即3~4期纤维化)和肝脏相关的并发症。值得注意的是,2型糖尿病患者被认为是罹患NASH和晚期纤维化的高风险人群。当前,医学指南建议对2型糖尿病患者进行NAFLD筛查,并评估其纤维化的风险。本文旨在阐述2型糖尿病与NAFLD之间的紧密联系,并探讨相关的管理方法。Nonalcoholic Fatty Liver Disease (NAFLD) has emerged as a major global public health issue and the most common chronic liver disease, with rapidly increasing prevalence and incidence. While NAFLD is prevalent in the general population, only a fraction of patients with NAFLD progress to nonalcoholic steatohepatitis (NASH), potentially accompanied by advanced liver fibrosis (stages 3~4 fibrosis) and liver-related complications. Notably, individuals with type 2 diabetes mellitus (T2DM) are considered to be at a high risk of developing NASH and advanced fibrosis. Current medical guidelines recommend screening for NAFLD in individuals with T2DM and assessing their risk of fibrosis. This article aims to elaborate on the close association between T2DM and NAFLD and explore relevant management approaches.
目的分析新森林父母培训方案(new forest parenting programme,NFPP)对注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童及家庭的干预效能,探索该方案在中国实施的可行性和有效性。方法纳入2022年1月至2023年5月就诊于暨南大学附属第一医院儿童心理发育行为门诊确诊的22例ADHD儿童及其22例亲密养育人,根据亲密养育人的个人意愿分为试验组(n=11)和对照组(n=11),对试验组进行每周1次、为期8周的NFPP干预。采用中文版注意缺陷多动障碍SNAP-Ⅳ评定量表(Chinese version of Swanson Nolan and Pelham,versionⅣscale-parent form,SNAP-Ⅳ)、Weiss功能缺陷评定量表父母版(Weiss functional impairment rating scales-parent report,WFIRS-P)评估试验组和对照组在干预前后核心症状及社会功能损害的改善情况。试验组采用中文版父母养育胜任感评定量表(China parenting sense of competence scale,C-PSOC)、育儿方式和维度问卷(parenting styles and dimensions questionnaire,PSDQ)评估NFPP干预前后ADHD家庭亲密养育人的育儿效能和育儿方式的改善情况。干预结束后对试验组的11例ADHD儿童的亲密养育人进行关于ADHD疾病诊疗相关知识、养育态度及事实养育行为的半开放性访谈。使用SPSS 26.0分析数据,采用独立样本t检验、配对样本t检验、Mann-Whitney U检验和秩和检验进行统计分析。结果(1)干预后,试验组SNAP-Ⅳ量表总分[(4.01±1.05)分,(2.79±0.94)分;t=2.875,P<0.05]、对立违抗分量表评分[(1.27±0.34)分,(0.70±0.33)分;t=4.043,P<0.05]、WFIRS-P的家庭[(0.92±0.47)分,(0.56±0.26)分;t=2.246,P<0.05]和生活技能维度评分[1.1(0.9,1.3)分,0.6(0.5,0.8)分;Z=-2.013,P<0.05]均低于对照组。干预后,试验组SNAP-IV量表中注意缺陷、冲动/多动、对立违抗3个维度和SNAP-IV总分的评分均较干预前显著降低(均P<0.05)。(2)干预后,试验组C-PSOC量表中育儿效能感维度评分较干预前显著升高(P<0.05);干预后,试验组PSDQ问卷自评和他评中权威型育儿方式评分较干预前显著升高(均P<0.05),专制型育儿方式、放任型育儿方式评分较干预前均显著降低(均P<0.05)。(3)半开放性访谈结果显示:试验组ADHD儿童的亲密养育人对NFPP干预持积极态度,且均能全程参与为期8周的干预治疗,并将所学的养育技巧应用在日常生活中,持续提升养育效能;经过NFPP干预后,ADHD儿童的亲密养育人对ADHD疾病、ADHD儿童行为特征等知识了解加深;在干预内容中,时间管理、沟通技巧和行为预测等模块易于掌握且有效。结论NFPP可显著改善ADHD儿童的核心症状,提高其亲密养育人的育儿效能感并改善其育儿方式。
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