慢性乙型肝炎的病理与临床

目的：提高慢性乙型肝炎临床诊断的正确性。方法：对202例慢性乙型肝炎患者的临床表现，血液生物化学指标[血清总胆红素（TBil)，白蛋白(ALB),凝血酶原活动度（PTA），ALT，白蛋白／球蛋白比值（A／G），r-球蛋白（GGT）]与病理分级分度进行对比分析。结果：临床表现如乏力，纳差，厌油，腹胀，鼻／牙龈出血及肝掌，蜘蛛痣，脾静脉增宽,胆囊炎与肝组织炎症活动密切相关；TBil,ALT,GGT上升及Alb,A/G比值，PTA下降均与肝组织炎症程度加重有关。6项指标中，轻度慢性肝炎临床与病理诊断符合率较高，为63.8%-79.0% ,其次为重度慢性肝炎，为40.0%-62.5%，符合率最低的是中度慢性肝炎，为10.0%-28.2%。结论：临床诊断时要高度重视临床症状，体征的变化，可适当放宽临床分度中有关中度异常值范围。     

血清生化指标对慢性肝炎病变程度的评价

目的:分析临床肝病常用血清生化指标与慢性肝炎病变程度的相关性.方法:检测慢性肝炎患者142例的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、白蛋白(ALB)、总胆红素(TBIL)和凝血酶原活动度(PTA),并将其结果与肝炎病变程度(病理分级和分期)对比分析.结果:ALT、AST、ALB和PTA在不同病理分级(炎症)之间均有显著性差异( F = 6.812,6.592,10.131,3.247,P<0.05或0.01); ALT、AST、ALP、GGT、ALB、TBIL和PTA在不同病理分期(纤维化)之间无显著性差异;TBIL、PTA和病理分级呈正相关,ALB和病理分级分期呈负相关.结论:常用血清生化指标ALT、AST、ALB、PTA能反映慢性肝炎的炎症程度,但不能反映慢性肝炎的纤维化程度.     

大黄素对肝纤维化大鼠肝功能的影响

目的 研究大黄素对肝纤维化大鼠肝功能的影响。方法 采用40％四氯化碳(CCl_4)给大鼠皮下注射制备肝纤维化模型并以小、中和大剂量大黄素(20、40和80mg/kg体重)治疗,通过常规方法测定大鼠血清谷丙转氨酶(ALT)、碱性磷酸酶(AKP)、总蛋白(TP)、白蛋白(ALB)和球蛋白(G)。结果 与正常组比较,大黄素组大鼠血清ALT、AKP显著降低(P<0.05～0.01);TP、ALB显著升高(P<0.05～0.01);G降低,白蛋白/球蛋白(A/G)比值升高,但无统计学差异。结论 大黄素对肝纤维化大鼠肝功能有一定的保护作用。     

慢性乙型肝炎患者肝组织病理研究

目的:探讨慢性乙型肝炎(CHB)患者临床表现和病理诊断的相关性.方法:收集30例CHB患者的临床资料,分析临床表现与病理诊断的相关性.结果:肝组织的炎症和纤维化程度的相关性显著(r=0.659,P＜0.01),白蛋白/球蛋白比值(A/G)与肝脏炎症和纤维化分级显著负相关(r=-0.368,P＜0.05;r=-0.401,P＜0.05).年龄、性别及其他化验指标如ALT、AST、TP、ALB、GLO、TBil、PLT、PT、PTA、门静脉宽度、脾脏厚度等与肝组织炎症和纤维化分级无显著相关性(P＞0.05).结论:慢性乙型肝炎肝脏炎症和纤维化的严重程度密切相关,仅根据肝功能判断轻中度的CHB患者的肝脏炎症及纤维化程度有相当的局限性.     

慢性乙型肝炎肝脏病理与可溶性白细胞介素2受体关系探讨

目的探讨慢性乙型肝炎病理与血清中可溶性白细胞介素2受体(sIL-2R)在慢性乙型肝炎发病机制中的作用和临床应用的价值.方法采用双抗体夹心酶联免疫法检测了307例病人血清sIL-2R(其中275例慢性乙型肝炎和16例脂肪肝均做了肝活检,16例慢性重型肝炎未做肝活检),用自动生化分析仪检测了血清总胆红素(TB)、白蛋白(A)、球蛋白(G)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(γ-GT)等指标在肝脏病理各级炎症及各期纤维化中的改变.结果血清sIL-2R、TB、G、ALT、ALP和γ-GT均值随着肝脏病理炎症程度加重而逐渐增高,A均值则随着肝脏病理炎症程度加重逐渐下降,各组间比较有显著性差异P＜0.05或P＜0.01.sIL-2R、G均值随着肝纤维化的进展而逐渐增高,A均值则随着肝纤维化的进展而逐渐下降,各组间比较有显著性差异P＜0.05或P＜0.01.结论慢性乙型肝炎病人血清sIL-2R、TB、A、G、ALT、ALP和γ-GT水平的变化可作为判定肝组织炎症程度的参考指标,sIL-2R、A、G可作为判定肝纤维化程度的参考指标.     

慢性乙型肝炎患者血生化指标与肝组织病理的相关性

目的评价慢性乙型肝炎患者血生化指标诊断肝组织炎症活动度与纤维化程度的临床价值。方法对205例慢性乙型肝炎患者活体肝穿刺的病理标本进行组织炎症活动度分级(G)和纤维化程度分期(S),并分别与同期检测的血清肝功能指标比较。结果血清TBIL、ALT、AST、GGT平均值随病理分级和分期的增加而逐渐升高,ALB、PTA则相反;与病理诊断比较,临床诊断的灵敏度分别为:轻度83.5%(81例),中度56.8%(46例),重度51.9%(14例)。结论血清TBIL、ALT、AST、GGT可反映慢性乙型肝炎肝组织炎症活动的程度;ALB、PTA是慢性乙型肝炎病变进展的指标。     

慢性乙型肝炎患者肝组织炎症与肝功能和乙型肝炎病毒标志物的关系

目的：探讨慢性乙型肝炎（乙肝）和活动性肝硬变肝组织病变与乙肝病毒标志物（HBVM）和肝功能的关系。方法：在Knodell的乙肝肝组织炎性活性指标（HAI）分类上采用3次密码读片。用常规的方法检测血清胆红素（SB）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、白蛋白／球蛋白（A／G）比率，肝内HBsAg,HBcAg检测用PAP法。结果：SB、ALT、AST值随HAI记分值的增高而增高，慢性肝炎，活动肝硬变患者血清A、G的含量及A／G随HAI记分值的增高而变化，结论：HAI能客观定量的反映肝组织病变的程度，为疾病的诊断，治疗和预后判断提供一种实用的病理指标，并有利于微机图像阅片和统计学分析。     

慢性乙型肝炎血清学检测与肝脏病理的对比研究

研究血清学指标预测慢性乙型肝炎 (简称慢乙肝 )肝组织病变程度的可靠性 ,探讨慢乙肝的临床诊断与病理诊断的符合度。对 10 5例慢乙肝患者的肝穿组织进行炎症活动度分级 (G)及纤维化程度分期 (S) ,并定量检测血清中的ALT、AST、A/G、GGT、PTA及HBVDNA。对慢乙肝的临床诊断与病理诊断进行对照。血清ALT、AST、A/G、GGT、PTA在各级各期慢乙肝中的差异无显著意义 (P <0 0 5 )。HBVDNA定量在各级各期慢乙肝中的差异无显著意义 (P >0 0 5 )。慢乙肝的临床诊断与病理诊断的符合率 ,慢肝轻度 96 8%、慢肝中度 5 0 0 %、慢肝重度 7 7%。血清ALT、AST、A/G、GGT、PTA可作为慢乙肝肝组织病变程度的预测指标 ,而血清HBVDNA水平不能作为慢乙肝肝组织病变程度的预测指标。临床诊断慢性肝炎中重度患者应行肝组织病理检查 ,尽可能使临床诊断与病理诊断相符。     

慢性乙型肝炎患者临床指标与肝脏纤维化程度关系及明显肝纤维化危险因素的Logistic回归分析

目的:探讨慢性乙型病毒性肝炎(chronic hepatitis B,CHB)患者肝脏纤维化分期与临床指标的关系,并分析CHB患者明显肝纤维化的危险因素.方法:选择2012-01/2015-07在昆明医科大学第二附属医院消化内科住院接受肝活检的76例C H B患者为研究对象.记录患者的性别、年龄,收集所有患者的全血细胞计数,包括白细胞、血红蛋白(hemoglobin,HB)、血小板(platelet,PLT)、红细胞分布宽度(red blood cell distribution width,RDW)、平均血小板体积(mean platelet volume,MPV)以及白蛋白(albumin,ALB)、球蛋白(globinemia,GLO)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP),γ-谷氨酰转移酶(gamma-glutamyl transpeptidase,GGT)、总胆红素(total bilirubin,TB)、凝血酶原时间(prothrombin time,PT)、血清HBV DNA.分析各个指标与CHB患者肝纤维化分期的关系及明显肝纤维化的危险因素.结果:随着肝纤维化程度加重,白细胞计数、HB、PLT、ALB逐渐降低,而RDW、GLO、AST、PT、GGT随肝纤维化程度加重逐渐升高,差异有统计学意义(P0.05).Spearman相关性分析示:ALT、AST、GGT、TB、GLO、PT、RDW、MPV、年龄与肝纤维化呈正相关;ALB、白细胞计数、HB、PLT与肝纤维化呈负相关.在Logistic回归分析中,PLT是明显肝纤维化的独立危险因素.结论:ALT不是反映肝纤维化程度的较好指标,血小板是明显肝纤维化的独立危险因素.因此,对于年纪大,血小板降低的CHB患者,即使ALT正常或轻度升高,也应行肝组织学评估.     

肝组织G_1～G_2慢性乙型肝炎患者临床资料分析

目的探讨肝组织G1～G2慢性乙型肝炎患者HBV DNA、HBeAg含量、ALT以及超声检查的变化。方法对肝组织学表现为G1～G2的126例慢性乙型肝炎患者的临床资料进行了分析。结果G1患者的纤维化分期主要在S0～S1期,G2患者则主要集中在S2～S3两期;G1患者脾脏厚度较G2小(P=0.012),但G1与G2患者的年龄、ALT、AST、HBV DNA、门静脉内径和脾静脉内径无统计学差异;随着纤维化程度的增加,血清HBeAg阴性患者的比例有增加的趋势(P0.05)。结论脾厚是早期反映肝脏炎症坏死和肝纤维化进展的敏感指标。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Hepato-pancreato-biliary fat: the good, the bad and the ugly

Obesity has become epidemic in the United States, in Europe, and in many urban areas in the developing world. The globalization of certain 'fast foods' and 'soft drinks' may, in part, be contributing to this epidemic. Diets high in saturated fatty acids and trans fats as well as drinks that have high fructose corn syrup levels may be particularly harmful. Recent research suggests that fat is a dynamic endocrine organ and that visceral fat is associated with the metabolic syndrome. Central obesity leads to organ steatosis and altered serum adipokines including reduced adiponectin and markedly elevated leptin. This abnormal adipokine milieu results in increased tissue infiltration of monocytes and macrophages which produce proinflammatory cytokines that alter organ function. Over many years, the combination of steatosis and local inflammation leads to fibrosis and eventually to cancer. Nonalcoholic fatty liver disease (NAFLD) is a precursor for nonalcoholic steatohepatitis (NASH). NAFLD and NASH (1) lead to cirrhosis and hepatocellular carcinoma, (2) increase the risk of liver resection, and (3) compromise the outcome of liver transplantation. Similarly, in the pancreas nonalcoholic fatty pancreas disease (NAFPD) may lead to nonalcoholic steatopancreatitis (NASP). NAFPD and NASP may (1) promote the development of chronic pancreatitis and pancreatic cancer, (2) exacerbate the severity of acute pancreatitis, and (3) increase the risk of pancreatic surgery. In the gallbladder nonalcoholic fatty gallbladder disease (NAFGBD, cholecystosteatosis) may lead to steatocholecystitis. Cholecystosteatosis may be an explanation for (1) the increased incidence of chronic acalculous cholecystitis and (2) the increased number of cholecystectomies.