2型糖尿病患者血清肝酶谱与甲状腺激素和中国人内脏脂肪指数的关系

目的探讨2型糖尿病患者血清肝酶谱与甲状腺激素和中国人内脏脂肪指数(Chinese visceral adipose index,CVAI)的关系,分析影响肝酶的因素。方法选取700例于本院内分泌科住院的2型糖尿病患者,根据肝酶是否升高分为肝酶升高组和肝酶正常组,再将丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰胺转肽酶(GGT)分别进行三等分分组。比较2组间及ALT、AST、GGT三等分分组间甲状腺激素和CVAI的差异,分析ALT、AST、GGT与甲状腺激素和CVAI的相关性。结果肝酶升高组较肝酶正常组T4、CVAI升高(P<0.05)。随着ALT、AST的升高,FT3、T3、T4逐渐升高(P<0.05);随着ALT、GGT的升高,CVAI也逐渐升高(P<0.05)。相关性分析显示,ALT、AST与FT3、T3、T4呈正相关;ALT、GGT与CVAI呈正相关;CVAI与FT3、T3呈正相关;HbA1C与FT3、T3和T4呈负相关。回归分析显示,FT3、CVAI和HbA1C是ALT的影响因素,T4是AST的影响因素,T3和HbA1C是GGT的影响因素。结论2型糖尿病患者中甲状腺激素和CVAI与肝酶水平均有一定相关性。     

肝移植术后急性排斥反应患者血清GB mRNA的表达变化及意义

目的观察肝移植后发生急性排斥反应者外周血血清颗粒酶B（GB）mRNA表达变化，并探讨其意义。方法56例肝移植受者，其中46例未出现排斥反应（A组），10例出现急性排斥反应（B组）。采用SYBR荧光实时定量PCR法检测两组患者移植后30d内外周血清的GB mRNA。同时检测血清ALT、AST水平。结果B组患者出现排斥反应后外周血清GB mRNA与排斥前和A组患者相比均显著升高（P均〈0．01）。B组患者外周血清GB mRNA上升时间早于血肝功能酶ALT、AST升高2d。结论肝移植后出现急性排斥反应者外周血清的GB mRNA表达升高。GB mRNA可作为预测和诊断移植肝急性排斥反应的指标。     

肝移植临床化学指标实验诊断价值

目的:探讨临床化学指标对指导肝移植实验诊断价值.方法:分析98例肝移植受者病历,按出院诊断标准分为治愈组、治愈合并并发症组、死亡组3组.分析3组受者12项临床化学指标变化规律和特征.结果:ALT,AST, ALD,GLDH是预测缺血-再灌注损伤的良好指标.TB,DB,TBA是预测移植肝脏存活,恢复其胆汁分泌、排泄功能的指标.PA,CHE是反映移植肝脏存活、恢复其合成蛋白质功能的指标.急性排斥反应ALT,GGT, ALP, TB,DB有诊断价值.抗排异药物毒性反应ALT,AST, GGT, TB,DB有特异性.胆道狭窄/梗阻TB,DB有诊断价值.胆道感染时ALT, GGT有诊断特点.肺部感染时ALT,TB,DB有诊断意义.切口感染时ALT,GGT, GLDH有诊断价值.肝脏无功能临床化学指标3个特点:PA,CHE逐渐降低;TB,DB居高不降,甚至逐渐升高;ALD,GLDH进行性升高.结论:临床化学指标的变化规律和特点对判断肝脏存活、肝功能恢复,诊断、鉴别不同并发症以及指导临床治疗有诊断价值.     

卡氏肺孢子虫感染大鼠血清中酶学变化及意义

目的探讨卡氏肺孢子虫(PC)感染大鼠血清中酶学变化的意义。方法应用地塞米松诱导建立卡氏肺孢子虫肺炎(PCP)大鼠模型(PCP组),于造模前(0周)及造模后3、6、9、12周断尾取血,检测血清中丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)水平;于12周后采集肺泡灌洗液(BALF)检测ALT、AST、ALP、LDH水平。结果PCP组血清ALP、AST水平从造模第3周以后显著高于正常对照组(P<0.05),ALT及LDH水平无明显规律性变化。结论ALP、AST可作为PCP感染的辅助诊断指标。     

FOXP3免疫调节基因表达与异基因造血干细胞移植后急性移植物抗宿主病的关系

目的探讨异基因造血干细胞移植(allo-HSCT)患者移植前后外周血FOXP3免疫调节基因表达与急性移植物抗宿主病(aGVHD)的关系。方法选择21例行allo-HSCT患者,根据移植后aGVHD发生情况分为aGVHD阳性组11例、aGVHD阴性组10例。应用实时定量PCR技术检测allo-HSCT移植前、移植中及移植后外周血单个核细胞FOXP3 mRNA的表达。结果 aGVHD阳性组FOXP3 mRNA表达量较aGVHD阴性组明显降低(P<0.01),且aGVHD发生时FOXP3 mRNA表达与aGVHD发生前1～2周明显下降(P<0.05)。结论 allo-HSCT后监测患者外周血FOXP3 mRNA表达的变化可预测aGVHD发生的可能性。     

NAFLD患者血清学检测的临床价值及相关性分析

目的探讨血清检测对诊断非酒精性脂肪性肝病(NAFLD)的临床价值。方法选取2016年2月-2017年12月由我院体检并诊断为非酒精性脂肪性肝病的患者和同期体检结果为健康状态的受检者各60例,常规检测所有人员的肝/脾CT比值、血脂四项(TC、TG、LDL-C、HDL-C)、肝功三项(ALT、AST、GGT)等指标,对观测指标进行组间对比分析及相关性分析。结果 NAFLD患者的血清TC、TG、LDL-C、ALT、AST、GGT水平均明显高于健康人群(P 0. 05),但NAFLD患者血清HDL-C水平与健康人群差异无统计学意义(P 0. 05)。Spearman分析显示,NAFLD患者血清TC、TG、LDL-C、ALT、AST、GGT与肝/脾CT比值均呈负相关(P 0. 05); ROC曲线显示血清TG、ALT、GGT对诊断NAFLD具有较高准确性(AUC 0. 9),而TC、LDL-C、AST则对诊断NAFLD具有一定准确性(0. 7 AUC 0. 9)。结论肝酶和血脂的血清学指标对NAFLD患者的临床初筛与诊断具有重要意义。     

28例亳州市新型冠状病毒肺炎患者肝损伤的特征分析

目的探讨不同人群2019冠状病毒病(COVID-2019)患者肝损伤情况,进一步了解COVID-2019的致病特点。方法纳入2020年2月1日-2月12日亳州市COVID-2019定点收治医院确诊为COVID-2019伴有肝损伤的28例患者。按照性别和年龄分为男性组(n=15)和女性组(n=13)、青年组(n=10)和中老年组(n=17),检测入院时患者ALT、AST、GGT、ALP和乳酸脱氢酶(LDH)的水平。计量资料两组间比较采用Wilcoxon秩和检验,计数资料两组间比较采用Fisher确切检验。结果 28例患者出现不同程度的肝损伤,ALT、AST、GGT、ALP和LDH水平在男性组和女性组、青年组和中老年组间差异均无统计学意义(P值均0. 05)。男性组与女性组的ALT、AST、GGT和LDH指标异常率差异均无统计学意义(P值均 0. 05);青年组和中老年组的ALT、AST、GGT指标异常率差异均无统计学意义(P值均 0. 05),但LDH指标异常率差异有统计学意义(P 0. 05)。结论 COVID-2019患者随着病情的发展会出现不同程度的肝损伤,在轻型及普通型患者中肝损伤与性别及年龄无明显相关性。因此,对COVID-2019患者应注意监测肝功能的变化,慎重选择治疗方法以防肝损伤。     

创伤后肝功能变化及其临床意义

目的:探讨创伤后早期肝功能损害各指标的变化及其临床意义.方法:分析2006-05/2006-08我院创伤骨科入院患者719例中肝功能损害105例伤后24 h及48 h内肝功能指标血清丙氨酸氨基转移酶(ALT)、天门氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、乳酸脱氢酶(LDH)、总胆红素(TBIL)、结合胆红素(DBIL)、白蛋白(ALB)、凝血酶原时间(PT).结果:创伤后肝损害的发生率为14.6%,肝功能指标ALT,AST, ALP,GGT, LDH,ALB,TBIL和PT异常发生率分别为91.4%,64.8%,42.9%,61.9%,27.6%,20.9%,30.5%,5.7%;创伤后ALT,AST和GGT升高1-3倍者分别为78例(81.3%),49例(72.1%)和42例(64.6%).严重创伤患者出现ALB降低、TBIL升高及PT延长(P＜0.001),创伤后肝功能指标ALT、AST、ALP及GGT48 h与24h相比明显升高(P＜0.01).结论:创伤后早期即可出现肝功能损害,肝功能指标一般呈轻中度升高,当创伤伤情严重及并发症多时,可出现ALB降低、黄疸及PT延长,创伤后黄疸为肝细胞性黄疸,可能与胆汁淤积无关.     

老年科老年急性感染性疾病致肝功能损害临床分析

目的分析老年人急性感染性疾病致肝损的临床特点. 方法 164例合并肝损的急性感染性疾病患者,老年组89例,对照组75例.治疗后第3周末,比较2组病死率、异常肝功能指标及治愈率. 结果①治疗前老年组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(SB)值高于对照组(P＜0.05或P＜0.01);②老年组病死率高于对照组(P＜0.05);③治疗后第3周末,2组ALT、AST、GGT、ALP、SB值均较治疗前显著降低(P＜0.05或P＜0.01);老年组ALT、AST、GGT、ALP治愈率低于对照组(P＜0.05). 结论老年急性感染性疾病致肝损程度较严重,完全恢复较慢,应加强对原发病的积极治疗及护肝措施.     

体外循环心脏不停搏心内手术对肝功能的影响

目的研究体外循环心脏不停搏及停跳手术对肝功能影响的差异。方法检测体外循环心脏不停搏心内直视手术患者及体外循环心脏停搏心内直视手术患者各50例手术前,转机30min,术后2h,1d,3d和7d的丙氨酸氨基转移酶(alanineaminotransferase,ALT)、天冬氨酸氨基转移酶(aspartateaminotransferase,AST)、AST/ALT、碱性磷酸酶(alkalinephosphatase,ALP)、γ谷氨酰转移酶(gammaglutamyltransferase,GGT)变化。结果体外循环心脏手术后患者的ALT、AST、AST/ALT、ALP、GGT均升高,不停搏手术患者的恢复较快。结论体外循环心脏手术对肝功能有影响,不停搏手术的影响较小。     

重型和危重型新型冠状病毒肺炎患者肝功能损害回顾性分析

目的 探讨不同性别和年龄组肝重型和危重型冠状病毒疾病-19(COVID-19)病毒感染患者肝功能相关指标、治疗药物和疾病转归情况,为临床诊治该类肝损害提供经验。方法 2020年1月22日～2月22日我院收治的重型和危重型COVID-19感染患者27例,回顾性分析其临床特征、不同性别和年龄组入院首次肝功能相关指标、治疗药物和疾病转归情况。结果 在27例重型和危重型COVID-19感染患者中,男性22例(81.5%),女性5例(18.5%);年龄为29～91岁,中位年龄为56.0(44.0～68.0)岁。其中<60岁中青年组16例(59.3%),>60岁老年组11例(40.7%);26例(96.3%)患者出现血清ALT、AST、GGT、ALP、TBIL、PTA、DBIL和LDH水平异常;男性组与女性组血清ALT、AST、GGT、ALP、TBIL、PTA、DBIL和LDH水平比较,差异无统计学意义(P＞0.05);中青年组与老年组血清ALT、AST、GGT、ALP、TBIL、DBIL和LDH水平比较,差异无统计学意义(P＞0.05),但老年组PTA水平显著低于中青年组,差异有统计学意义(P＜0.05);22例(81.5%)接受了联合抗病毒药物,18例(66.7%)接受了联合抗炎、调节免疫类中成药物,14例(51.9%)接受了联合护肝药物;自发病起1个月时间内,本组生存率为96.3%。结论 重型和危重型COVID-19感染患者病程早期容易出现肝损害,不同性别和年龄患者肝损伤差异不大。在中西药应用过程中出现肝损害,其与药物应用有关还是病毒感染本身的作用,还有待进一步探讨。     

Significant variation of traditional markers of liver injury after a half-marathon run

Background

While the promotion of health-related fitness is thereby widespread, less focus is currently being given on the biological influence that physical activity might exert on results of laboratory testing. As such, this study was undertaken to assess the kinetics of liver injury markers following physical exercise.

Design and methods

Total and direct bilirubin as well as the activity of biochemical markers of liver injury including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT) and creatine kinase (CK), were measured before and after a half-marathon.

Results

Significant increases occurred for GGT, AST, LDH, CK, total and direct bilirubin immediately after the run. AST, LDH, CK, total and direct bilirubin were still increased 24 h thereafter, whereas GGT decreased after 6 h. None of the athletes exceed the upper reference limit for ALT, ALP and GGT, whereas significant variations were instead observed for LDH, AST, CK, total and direct bilirubin.

Conclusions

Taken together, the results of our prospective investigation clearly attest that an acute bulk of aerobic physical exercise, such as a half-marathon, might produce significant changes in the activity of traditional biomarkers of liver injury, which should be carefully considered when investigating physically active individuals undergoing laboratory testing.     

正肝方对黄曲霉毒素B1诱发的肝癌前病变大鼠肝功能的影响

目的：观察正肝方对黄曲霉毒素（AFB1）诱发的肝癌前病变大鼠肝功能的影响。方法：Wistar大鼠100只随机分为4组：模型对照组30只，正肝方小剂量预防组30只、正肝方大剂量预防组30只、正常大鼠对照组10只。除正常对照组外，先后用AFB1和2-乙酰氨基芴（2-AAF）处理各组大鼠造模。正肝方大、小剂量预防组在造模期间，将不同浓度正肝方水剂（0．6g／ml，0．3g／ml）分别灌喂大鼠；模型对照组用无菌蒸馏水灌喂大鼠。8周后处死大鼠、采血，肝组织取材。采用酶动力学法测定大鼠血清ALT、AST、ALP、GGT活性，亚硝酸钠氧化法测定血清TBil，溴甲酚绿比色法测定Alb。结果：AFB，可导致大鼠血清ALT、AST、GGT、TBil水平显著升高，Alb水平下降。正肝方能有效降低AFB，导致的大鼠血清高ALT、AST、ALP、GGT、TBi1水平。结论：AFB1可导致大鼠严重肝损伤，具有很强的肝毒性。正肝方具有抗AFB。导致的肝损伤，保护肝功能的作用。     

Characterization of liver enzymes on living related liver transplantation patients with acute rejection

BACKGROUND/AIMS: To determine the biochemical data that reliably predict allograft injury from acute rejection (AR) in patients with living related liver transplantation (LRLT), liver function test and histopathological characteristics of AR were compared and analyzed retrospectively. METHODOLOGY: From Aug. 1994 to Nov. 2000, 101 cases received orthotopic liver transplantation (OLT), which included 53 patients with LRLT in our series. Completed liver functions including aspartate transferase (AST), alanine transferase (ALT), bilirubin total/direct (Bil.T/D), alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) were collected with peak level when AR was diagnosed by liver biopsy. The best data of the same patients when disease free, were compared and analyzed with non-parametric Wilcoxon signed ranks test and Mann-Whitney test. All of the ARs were reversed with steroid pulse therapy, and two cases converted to FK506. No steroid-resistant rejection or chronic rejection was found in our series. RESULTS: In the patients with LRLT, 17 episodes in 13 patients with AR were found. The incidence of histological analysis proved AR was 12.9% (13/101) in OLT and 24.5% (13/53) in LRLT respectively. Among the liver function tests, AST (p<0.0001), ALT (p<0.0001), Bil.T (p=0.001), Bil.D (p=0.001), GGT (p<0.0001), and INR (p=0.034) were the significant predictors respectively in the patients with AR episode. Once liver enzymes had elevated, the AST/ALT ratio <1.0 showed a more significant difference in AR than in those of the no rejection group (p<0.0001). ALP showed significant difference in our series. The severity of histological change was not correlated to the degree of liver enzymes elevation. CONCLUSIONS: Complete liver function tests especially AST, ALT, Bil.T/D, GGT and the ratio of AST/ALT are very sensitive tests in a group of patients receiving LRLT with AR. The severity of AR is based on the histopathologic change but is not related to the degree of liver enzymes elevation itself. Meanwhile, the outcome of acute rejection in living related liver transplantation is quite good.     

高胆红素血症新生儿血清miR-122水平与肝功能各项指标及葡萄糖-6-磷酸脱氢酶缺乏的相关性研究

目的:探讨高胆红素血症(NHB)新生儿血清miR-122表达与肝功能各项指标和葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏的相关性。方法:将2020年3月至5月于我院新生儿科足月分娩的新生儿217例,根据临床症状和血清总胆红素(TBil)检测结果分为NHB组(n=144)和非NHB组(n=73),比较两组新生儿肝功能各项指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、TBil、白蛋白(Alb)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)]以及红细胞G-6-PD酶活性。采用实时荧光定量PCR法检测患儿血清miR-122相对表达量,并分析其与各指标之间的关系。结果:与非NHB组相比,NHB组新生儿血清ALT、AST、GGT、Alb、TBil、CRP水平(Z=-11.858~-2.126,均P<0.05)以及血清miR-122相对表达量(t=4.721,P<0.05)显著升高。根据血清TBil水平,将NHB患儿分为轻度、中度、重度3个亚组;与轻度亚组和中度亚组相比,重度亚组NHB新生儿血清ALT、AST、GGT、TBil、CRP、PCT水平以及血清miR-122相对表达量均升高(H=6.045~63.896,均P<0.05)。NHB患儿血清miR-122相对表达量与ALT、AST、GGT、TBil、PCT水平呈正相关性(r=0.173~0.550,均P<0.05)。22例新生儿G-6-PD缺乏,其血清miR-122相对表达量显著高于G-6-PD正常新生儿(Z=36.831,P<0.05)。结论:在NHB新生儿中,血清miR-122相对表达量普遍升高,这与AST、ALT、AST、GGT、TBil、PCT水平升高、G-6-PD酶缺乏有关,因此加强血清miR-122水平检测有助于更准确地评估NHB患儿肝损伤情况。     

Effects of HRT on liver enzyme levels in women with type 2 diabetes: a randomized placebo-controlled trial

BACKGROUND: Increasingly strong links are being recognized between diabetes, insulin resistance and liver fat accumulation [e.g. nonalcoholic fatty liver disease (NAFLD)]. Recent data indicating that hormone replacement therapy (HRT) may lessen diabetes risk is intriguing but explanatory mechanisms are unclear. OBJECTIVE: Post hoc investigation of the possibility that HRT may favourably influence liver enzyme levels commonly elevated in patients with diabetes. We examined liver function test data from a 6-month trial of a low-dose continuous combined HRT (1 mg 17beta oestradiol and 0.5 mg norethisterone acetate). DESIGN: Double-blind, randomized placebo-controlled. PATIENTS: Fifty women with type 2 diabetes. MEASUREMENTS: Liver enzyme levels (AST, ALT, gamma-glutamylytransferase [GGT], and alkaline phosphatase [ALP]). RESULTS: Forty-five women completed the study with 19/22 in the active group demonstrating compliance as measured by sex hormone changes. Relative to placebo recipients (n = 23), women randomized and compliant to HRT demonstrated significant reductions in ALT [-14 (-23 to -6) U/l, P = 0.002], AST [-9.2 (-14 to -5) U/l, P < 0.001] and ALP [-60.8 (-80 to -42) U/l, P < 0.001]. Circulating concentrations in GGT were also significantly reduced (P = 0.035). All changes were significant using an intention-to-treat analysis. CONCLUSION: HRT containing low-dose oestradiol and norethisterone reduces serum concentrations of liver function enzymes, potentially due to a lowering of liver fat accumulation. Better understanding of mechanisms by which this HRT improves liver function tests could help the design of new therapies to treat individuals with NAFLD.     

Relationships among viral diagnostic markers and markers of liver function in acute hepatitis E

Background  Diagnosis of acute hepatitis E has been based in many clinics predominantly on detection of anti-HEV (hepatitis E virus) antibody. Now, new assays have been developed to detect other HEV markers. Our aim was to investigate the relationships among HEV diagnostic markers and liver function markers in acute hepatitis E. Methods  Seventy serum samples were collected from non-A, non-B, non-C acute hepatitis patients and tested for HEV markers (HEV antigen and RNA and anti-HEV IgM) and markers of liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total iron binding capacity (TBA), γ-glutamyl transferase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL)]. Partial open reading frame (ORF) 2 sequences from HEV RNA-positive samples were cloned and analyzed. Results  The concordances between HEV antigen and HEV RNA and between HEV antigen and anti-HEV IgM were 77.1% and 72.9%, respectively, with significant correlations, while that between HEV RNA and anti-HEV IgM was 61.4% with no significant correlation. Eleven of 25 samples negative for anti-HEV IgM were positive for HEV antigen. The ALT, AST, ALP, TBA, GGT, TBIL, and DBIL levels did not differ significantly between the anti-HEV IgM-positive and -negative groups. However, the ALT, AST, ALP, TBA, and GGT levels were significantly higher in the HEV antigen-positive group than in the HEV antigennegative group. All of the HEV isolates cloned belonged to genotype 4. Conclusions  HEV antigen was highly correlated with HEV RNA and elevated ALT, AST, ALP, TBA, and GGT levels. Testing for HEV antigen in combination with anti-HEV IgM is useful for the diagnosis of HEV infection.