慢性心力衰竭患者血尿酸和血清胆红素异常的临床意义

目的 探讨慢性心力衰竭（CHF）患者血尿酸（UA）和血清胆红素异常的变化及其临床意义。方法选择72例CHF患者为研究组,按心功能分级分为2组：心功能Ⅲ-Ⅳ级组41例;心功能Ⅱ级组31例。另外选取30例心功能正常者作为对照组。所有病例入院当天或第2天测定其血尿酸和血清胆红素水平,其中心功能Ⅲ-Ⅳ级患者治疗1周后复查血尿酸和血清胆红素。结果与心功能正常对照组及心功能Ⅱ级患者比较,心功能Ⅲ-Ⅳ级患者血尿酸及血清胆红素水平明显升高（P〈0．01）;治疗一周,心衰有效纠正后,复查血尿酸和血清胆红素水平明显下降（P〈0．01）。心功能Ⅱ级患者血尿酸和血清胆红素水平与对照组比较差异无统计学意义。结论对慢性心衰患者观测血尿酸和血清胆红素水平有助于判断心衰严重程度及其治疗效果。     

2型糖尿病患者血清尿酸胆红素测定的临床意义

目的探讨尿酸、胆红素浓度与2型糖尿病的关系。方法采用全自动生化分析仪,检测并比较65例2型糖尿病患者（其中血管病变患者32例）和57例健康者（对照组）血清总胆红素、直接及间接胆红素浓度和UA水平。结果T2DM患者血清总胆红素（TBIL）、直接及间接胆红素含量明显低于对照组（P〈0．05）,血清UA含量显著高于对照组（P〈0．05）。血管病变的患者中血清TBIL〈10μmol／L的例数高于对照组（Х^2=13．2,P〈0．01）,尿酸≥430μmol／L的例数高于对照组（Х^2=32．6,P〈0．01）。结论检测T2DM患者血清TBIL和UA水平对预测评估病情及预后T2DM有一定临床价值。     

血清总胆红素、血脂、血尿酸与冠心病发生发展的相关性研究分析

目的研究体内血清总胆红素、血脂、血尿酸的水平变化与冠心病发生发展的相关性。方法选择2009年3月～2011年11月笔者所在医院心内科收治的冠心病确诊患者124例(CHD组),同期行冠状造影正常者78例(对照组),空腹检测两组患者TBIL,血脂及SUA水平。CHD组根据造影结果,再分为单支病变组(40例)、双支病变组(40例)和多支病变组(44例)。采用Spearman等级相关分析TBIL、血脂及SUA水平与CHD病变程度的相关性。结果 CHD组TBIL水平明显低于对照组,差异有统计学意义(P<0.05)。CHD组高密度脂蛋白胆固醇明显低于对照组,差异有统计学意义(P<0.05);总胆固醇、低密度脂蛋白胆固醇、血清甘油三脂水平明显高于对照组,差异有统计学意义(P<0.01)。CHD组SUA水平明显高于对照组,差异有统计学意义(P<0.01)。血清TBIL、HDL-C水平与冠状动脉病变支数呈负相关性,随其支数增加浓度显著降低,差异有统计学意义(P<0.01);血清TC、TG、LDL-C、SUA水平与冠状动脉病变支数呈正相关性,随其支数增加浓度显著升高,差异有统计学意义(P<0.01)。结论 TBIL浓度降低、血脂异常、SUA浓度升高与CHD的发生及其病变程度关系密切,TBIL、血脂及SUA的检测对测评CHD的严重程度有一定的临床价值。     

胆红素和内毒素联合作用对NRK52E细胞缝隙连接功能的影响

目的: 观察胆红素(BR)和内毒素(LPS)联合作用对肾小管上皮细胞(NRK52E)生长及细胞间缝隙连接(GJ)的影响。方法: 体外培养NRK52E细胞,不同浓度的BR和LPS联合干预,用MTT测量细胞生长;观察它们对生长融合细胞(有GJ形成)和生长未融合细胞(无GJ形成)集落形成的影响;采用细胞荧光免疫示踪法分析细胞间GJ的功能。结果: BR 从17.1 μmol/L增加至 513 μmol/L,可浓度依赖性地增加细胞生长;当BR浓度继续增加时,细胞生长逐渐降低。LPS(10-1 000 μg/L)能浓度依赖性地降低NRK52E细胞生长。 BR和LPS 联合作用下,513 μmol/L BR增加100 μg/L LPS作用下的细胞生长(P<0.05),而684 μmol/L BR降低100 μg/L LPS的细胞生长(P<0.05);513 μmol/L BR能增加100 μg/L LPS作用下GJ传递数目(P<0.05),684 μmol/L BR降低100 μg/L LPS作用下的GJ传递数目。 结论: BR和LPS联合作用时,513 μmol/L BR降低LPS的细胞毒性,684 μmol/L BR增加LPS的细胞毒性,其改变可能是通过细胞间缝隙连接发挥作用的。     

Non-operative management of right side thoracoabdominal penetrating injuries—The value of testing chest tube effluent for bile

Introduction

While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients’ chest tube effluent.

Patients and methods

We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury.

Results

Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3 ± 4.1 mg/dL) and was always higher than both serum bilirubin (p < 0.05) and chest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (p < 0.05). One RST injury patient died of line sepsis.

Conclusion

Non-operative management of RST penetrating trauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.     

胆红素与核因子kB

胆红素不只是体内的代谢产物,它还具有抗氧化、抗脂质过氧化、抗炎、抑制细胞凋亡等作用。核因子kB（NF—kB）作为一种普遍存在的转录因子,参与多种信号转导途径,可高效诱导多种细胞因子,同时对参与炎性反应放大与延续的多种酶的基因表达也具有重要的调控作用。本文就胆红素与NF-kB关系进行综述。     

Association of bilirubin and protein thiols in relation to copper and ceruloplasmin in hyperbilirubinemic patients

Objective： Bilirubin is a double edged sword in biological system, acting as a toxic molecule and cytoprotectant. Unconjugated bilirubin is proved to show antioxidant activity in vitro and in vivo. In the current work we tried to know the relationship between both conjugated and uneonjugated bilirubin with copper and protein thiols in patients with hyperbilirubihernia. Methods： Study was conducted on 56 hyperbilirubinemie eases and 56 healthy controls. Serum copper, ceruloplasmin, protein thiols, total bilirubin, conjugated and unconjugated bilirubin, uneonjugated bilirubin/albumin ratio, total protein, albumin, AST, ALT and ALP were estimated. Results： There was significant increase in serum copper, total biliruhin, conjugated and uneonjugated bilirubin, uneonjugated bilirubin/albumin ratio, AST, ALT, and ALP, and decrease in serum ceruloplasmin, protein thiols, total protein, and albumin in hyperbilirubinemie cases when compared to healthy controls. Conjugated bilirubin correlated positively with liver enzymes AST and ALP, and negatively with protein thiols, total protein and albumin. Uneonjugated bilirubin correlated positively with ALT. Protein thiols correlated negatively with copper and positively with eeruloplasmin, and also correlated negatively with liver enzymes like AST, ALT and ALP, and positively with total protein and albumin. Conclusion： Combination of elevated levels of trace elements like copper and availability of reducing agent like bilirubin may prove deleterious by generating free radicals.     

不稳定型心绞痛患者血清胆红素及尿酸水平的分析

目的 探讨冠心病不稳定型心绞痛与胆红素及尿酸的关系.方法 将入选202例冠心病不稳定型心绞痛患者,采集空腹静脉血测定总胆红素、直接胆红素、间接胆红素及尿酸,比较其心绞痛发作时、3个月、6个月及1年内未再发作时胆红素及尿酸的变化情况.结果 心绞痛发作时胆红素降低,尿酸偏高.结论 胆红素和尿酸水平可间接反映不稳定型心绞痛机体氧化、抗氧化情况,胆红素对评估病情有一定帮助.     

Rotavirus Causes Hepatic Transaminase Elevation

Rotavirus is one of the leading causes of acute gastroenteritis among children. While clinical complaints are generally intestinal including vomiting and diarrhea, there is evidence to suggest that disease outside the gastrointestinal tract occurs. This study examines the frequency of hepatic transaminase elevation in children with rotavirus gastroenteritis. Patients identified with rotavirus gastroenteritis by stool antigen testing between November 2005 and March 2006 had available serum analyzed for alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, total bilirubin, direct bilirubin, and creatinine phoshosphokinase (CPK). Chart review was conducted to identify patients with possible liver injury unrelated to rotavirus. Among the 92 patients identified with rotavirus during the study period, 75 had serum specimens available for testing. Fifteen patients (20%) had elevated ALT and AST, including one patient with an increase in AST, ALT, alkaline phosphatase, and total and direct bilirubin. The mean ALT elevation was 56 IU/L (range, 44 to 114 IU/L), and the mean AST elevation was 80 IU/L (range, 57 to 126 IU/L). Fifty-three patients (71%) had an increase in AST alone, and three patients (4%) had an increase in AST and alkaline phosphatase. The mean AST values in these groups were 61 IU/L (range, 42 to 110 IU/L) and 79 IU/L (range, 59 to 96 IU/L), respectively. In conclusion, rotavirus commonly causes elevation of liver transaminases.     

腺苷蛋氨酸对新生鼠肝脏葡萄糖醛酸基转移酶活性的影响

目的：研究腺苷蛋氨酸对新生鼠肝脏胆红素-尿苷二磷酸葡萄糖醛酸基转移酶（Bilirubin uridine glucuronosyl transferase,B-UGT）活性的影响。方法：试验组腹腔注射腺苷蛋氨酸,阳性对照组腹腔注射苯巴比妥/尼可刹米,阴性对照组腹腔注射等量氯化钠溶液,每日1次,疗程7天,测定3组肝脏B-UGT活性。结果：阳性对照组肝脏B-UGT活性显著高于同期阴性对照组,试验组肝脏B-UGT活性显著高于同期阴性对照组和阳性对照组。结论：腺苷蛋氨酸能够诱导提高新生鼠肝脏B-UGT活性,从而促进胆红素代谢。