呼吸衰竭患者血清雌二醇和睾丸酮测定及临床意义

呼吸衰竭患者血清雌二醇和睾丸酮测定及临床意义陈茂森，李桂莲，聂立功，何冰为探讨性激素与呼吸衰竭发生发展的关系，并为呼吸衰竭辅助内分泌治疗寻找依据。对２０例正常人和２０例呼吸衰竭患者采用放射免疫方法测定了血清雌二醇和睾丸酮浓度，并测定了８例呼吸衰竭患者...     

50例肝硬化患者血清同型半胱氨酸水平观察

2004年12月～2005年6月,我们测定了50例肝炎后肝硬化患者血清同型半胱氨酸（Hcy）的浓度,现对其临床意义进行探讨。     

老年男性的血清雌二醇水平与卒中风险

为了确定血清雌二醇和睾酮水平是否可以预测卒中风险，美国弗吉尼亚大学医学院生物统计学和流行病学系的Abbott等进行了一项基于人群的研究。研究样本为1991至1993年参加火鲁奴奴-亚洲衰老研究的2197例71-93岁男性。所有受试者均无卒中、冠心病和癌症。对血栓栓塞事件和出血事件进行随访，直到1998年底。     

肝炎后肝硬化患者血清白蛋白下降规律的研究

目的:探讨肝炎后肝硬化患者血清白蛋下降的规律,为低血清白蛋白的鉴别诊断提供依据。方法:将215例肝炎后肝硬化患者的临床资料输入统计软件包。结果:发现肝病病程长短及肝功能异常的频率是影响患者血清白蛋白水平的两个重要因素。门脉内径及脾脏大小与血清白蛋白水平无显著相关性,但血清白蛋白25g/L～29g/L组患者中,二者与血清白蛋白均具有显著意义的负相关。此外,我们还分析了肝炎后肝硬化患者血清白蛋白下降的速度及单纯肝炎后肝硬化患者最低血清白蛋白阀值水平。结论:慢性肝病患者病程长短及肝功能异常的频率是评价肝硬化发展及预后的重要参考因素。     

肝硬化与睾酮、雌二醇相互作用关系研究现状

肝脏是睾酮、雌二醇等性激素在体内转化、降解的重要器官,但性激素并不是简单、被动地在肝内被代谢降解,其本身或代谢产物均参与肝脏疾病的发生、发展过程.肝硬化发生时可导致性激素睾酮、雌二醇代谢紊乱;相反地,性激素对肝硬化甚至肝癌的发生也有一定的影响.深入了解这一相互作用关系对于预防肝硬化的发生、探索肝硬化的治疗新途径具有重要意义.本文探讨了生理状态、病理状态下睾酮、雌二醇的表达变化,并探讨了睾酮、雌二醇对肝硬化发病的影响及其与肝硬化预后关系.     

男性慢性心力衰竭患者血清睾酮、雌二醇水平与心功能的相关性

慢性心力衰竭（心衰）是临床极为常见的危重症，常是所有不同病因器质性心脏病的主要并发症；其流行病学和预后存在性别差异，女性的生存率明显高于男性，提示性激素与慢性心衰可能存在一定的关系。已有大量研究报道了雌激素对女性的心血管系统的保护作用，男性体内性激素水平和心血管疾病之间的关系越来越受到人们的关注。目前有一些小样本研究提示，男性心衰患有相对低的雄激素水平。研究男性慢性心衰患性激素水平与心功能的关系，对于深人了解心衰的病理生理、拓宽治疗心衰的思路有一定的意义。     

肝炎后肝硬化血清一氧化氮的变化及其意义

国外研究表明,血清一氧化氮（ＮＯ）有助于临床判断肝炎后肝硬化（ＬＣ）病情变化。我们观察了不同病期ＬＣ患者血清ＮＯ、肝功能及门静脉内径的变化,探讨它们之间的相互关系和ＮＯ在肝炎后肝硬化中的临床意义。对象与方法　（１）肝硬化组：ＬＣ患者６４例,男性３５例,女性２９例,年龄３８岁～８５岁,平均年龄４７．８３±１６．７２岁。活动期３１例、静止期３３例。诊断符合全国第五次传染病学术修订方案。（２）对照组：随机选择年龄匹配健康体检者３６例。所有对象无亚硝酸盐类饮食及药物治疗史。（３）方法：空腹采静脉血２ｍｌ…     

肝炎后肝硬化患者外周血IL-10、IL-12的水平及其意义

目的　探讨IL -10、IL -12在肝炎后肝硬化中的作用及意义。方法　 3 4例肝炎后肝硬化患者根据Child -Pugh分级法分为A、B、C级三组 ,应用ELISA法检测外周血IL -10、IL -12水平 ,10例健康体检者作对照。结果　 3 4例肝炎肝后硬化患者有2 0例HBVDNA(+ ) ,HBVDNA(+ )组患者IL -10水平明显高于HBVDNA(-)组 (4 3 2 9± 18 66pg/mL、2 1 42± 9 47pg/mL ,P <0 0 1) ,而IL -12水平则低于HBVDNA(-)组 (92 45 + 2 9 73pg/mL、2 0 7 3 4± 83 61pg/mL ,P <0 0 1) ;肝硬化患者A级者IL -10水平稍高于对照组 (4 5 2 6± 9 43pg/mL、3 7 42± 5 61pg/mL ,P <0 0 5 )但显著高于B级和C级 (2 0 89± 7 46pg/mL、9 13± 0 2 4pg/mL ,P <0 0 1) ,且C级又明显低于B级 (P <0 0 1) ;肝硬化A、B、C级患者IL -12水平均低于对照组 (12 4 2 7± 5 0 14pg/mL、10 6 42± 49 0 6pg/mL、70 3 6± 2 0 62pg/mL ,2 15 64± 78 3 7pg/mL ,P <0 0 1) ,而以C级患者最低 (P <0 0 1)。结论　IL -10、IL -12可能在肝炎后肝硬化的发生发展中有一定作用     

肝炎后肝硬化患者血糖异常临床分析

对病毒性肝炎和肝炎后肝硬化病人的空腹血糖、餐后2h血糖进行检测,并与病毒性肝炎患者进行对比.结果肝炎后肝硬化病人可以出现糖代谢紊乱(69.4%),明显多于病毒性肝炎患者,空腹低血糖,空腹高血糖及餐后2h血糖升高均可能出现.结论对肝炎后肝硬化患者进行血糖监测有重要意义.     

肝炎后肝硬化患者血糖异常临床分析

对病毒性肝炎和肝炎后肝硬化病人的空腹血糖、餐后2h血糖进行检测，并与病毒性肝炎患者进行对比。结果：肝炎后肝硬化病人可以出现糖代谢紊乱（69．4％），明显多于病毒性肝炎患者，空腹低血糖，空腹高血糖及餐后2h血糖升高均可能出现。结论：对肝炎后肝硬化患者进行血糖监测有重要意义。     

Thyroid Hormones and Thyroxine-binding Globulin in Relation to Liver Function and Serum Testosterone in Men with Alcoholic Cirrhosis

Abstract. In 73 euthyroid male patients with histologically verified alcoholic cirrhosis, thyroid hormones, thyroxine-binding globulin (TBG) and testosterone concentrations (total, non-protein- and non-SHBG-bound) were studied in relation to each other and to the degree of liver dysfunction. Serum concentrations of triiodothyronine (T₃) decreased significantly (p<0.05) and thyroid-stimulating hormone (TSH) increased with progressing liver dysfunction. Serum concentrations of tetraiodothyronine (T₄), TBG and T₄/TBG ratio did not correlate significantly with liver function. Serum T₃ concentrations correlated significantly (Kendall Tau-β=–0.33, p=0.001) with total serum testosterone concentrations, while there was a negative correlation (Kendall Tau-β=–0.20, p=0.025) between testosterone and TSH values. No correlation was found between testosterone concentrations and serum levels of TBG. It is proposed that the association between T₃ and TSH on one hand and testosterone concentrations on the other reflects a covariation of these variables with liver function. The TBG level was normal in most patients and was not correlated to testosterone concentrations.     

Elevated Inflammation Markers are Negatively Associated With Plasma Free Testosterone Level in Male Patients With Acute Coronary Syndrome

Objectives To evaluate the levels of total testosterone （TT）, free testosterone （FT）, matrix metalloproteinase-9（MMP-9）,and tissue inhibitor of metalloproteinase-1（TIMP-1）, soluble intercellular adhesion molecule-1 （sICAM-1）, C-reactive protein （CRP）and association between them in male patients with different type of coronary heart diseases, and to assess the role they played in the pathogenesis of male acute coronary syndrome（ACS）.Methods 90 patients with coronary heart disease （CHD） including acute myocardial infarction （AMI）, unstable angina pectoris（UAP） , stable angina pectoris（SAP）and 30 healthy volunteers as controls were recruited. Serum concentrations of MMP-9, TIMP-1,sICAM-1 were measured with ELISA kits. CRP levels were measured with immunoturbidimetric assay, and white blood cell count （WBC） were also assessed before any treatment was administrated . Results ① The serum levels of free testosterone were significantly lower in patients with ACS （14.41±3.97 pg/mL in AMI group, 17.22±4.05 pg/mL in UAP group, and 26.49±8.72 pg/mL in control group）. MMP-9 levels （257.38±37.14 μg/L in AMI, 147.91±32.47 μg/L in UAP, and 57.26±31.75 μg/L in controls） and the ratios of MMP-9/TIMP-1 （4.23±0.51 in AMI, 2.32±0.38 in UAP, and 1.02±0.32 in controls）, meanwhile, were notably higher in ACS patients than those in control group（P〈 0.01）. ② Significant negative correlation between the serum levels of testosterone and MMP-9（-0.328 for TT, P〈0.05; -0.542 for FT,P 〈 0.01）, and MMP-9/TIMP-1（-0.309 for TT, P〈0.05; -0.519 for FT, P〈0.01） were observed in ACS groups. ③ The serum levels of sICAM-1, CRP and WBC in the patients with ACS were significantly higher than those in the control group （P〈 0.01）. Conclusions The elevation of serum concentrations of inflammatory markers including MMP-9, sICAM-1, CRP and WBC are associated with initiation and progression of ACS, while there are significant negative correlation between th     

Efficacy of Switching from Kanamycin Sulfate to Rifaximin in Patients with Hepatic Cirrhosis

Objective This study evaluated the efficacy associated with switching to rifaximin in patients with hepatic cirrhosis receiving kanamycin sulfate for the treatment of hepatic encephalopathy and hyperammonemia. Methods We included 37 patients who switched from kanamycin sulfate to rifaximin at our institution from January 2017 to December 2018. The onset of hepatic encephalopathy and changes in blood ammonia values during a six-month period were retrospectively evaluated. Results There were 4 (11%) patients with hepatic encephalopathy at the time of switching from kanamycin sulfate to rifaximin. The cumulative incidence of hepatic encephalopathy was 3% and 16% at 3 and 6 months later, respectively. The blood ammonia levels at the time of switching to rifaximin and at 3 and 6 months later were 94 (range, 20-243) μg/dL, 95 (range, 33-176) μg/dL, and 81 (range, 32-209) μg/dL, respectively, and no significant changes were observed. However, in the 11 patients receiving an oral dose of <1,500 mg/day of kanamycin sulfate, the blood ammonia levels at the time of switching and at 3 and 6 months later were 136 (range, 35-243) μg/dL, 95 (range, 33-150) μg/dL, and 63 (range, 43-124) μg/dL, respectively. Furthermore, the blood ammonia levels significantly decreased at the time of the switching to rifaximin and at three and six months later (p=0.043 and p=0.011, respectively). Conclusion Switching to rifaximin in hepatic cirrhosis patients receiving kanamycin sulfate to treat hepatic encephalopathy and hyperammonemia showed effects that were equivalent to or greater than the original therapy, thereby demonstrating the clinical efficacy.     

原发性高血压患者血清生长激素,睾酮和雌二醇变化研究

目的 :探讨原发性高血压患者血清生长激素 (GH)、睾酮 (T)和雌二醇 (E)水平的变化及其临床意义方法 :采用放射免疫法测定了 86例 EH患者和 30例非高血压患者的血清 GH,T,E水平。结果 :EH组血清 GH和 E水平显著低于对照组 (P<0 .5 5 ) ,T与对照组无明显差异 (P>0 .5 5 )。 EH组中 GH与 E水平呈显著正相关 ,但两者与 T无相关性。男性组血清 T显著高于女性组。 , , 期血清 GH和 T依次显著递减。伴心脑血管并发症组血清 GH与 T水平显著低于无并发症组 ,但 E无明显差异。结论 :EH组血清 GH和 E水平显著低于对照组。 , , 期血清 GH与 T依次显著递减。伴心脑血管并发症组血清 GH与 T水平显著低于无并发症组     

肝硬化门脉高压患者胰岛细胞早期分泌相的变化

选择肝硬化门脉高压患者（Ｃｈｉｌｄ－Ｐｕｇｈ 分级Ｂ级）２０ 例及健康对照者２０ 例，快速静脉注射左旋精氨酸（Ｌ－Ａｒｇ）２０ｍ ｌ，于注射前及注射后２、４、６ 分钟分别测血清胰岛素（Ｉｎｓ）、Ｃ肽（Ｃ－ｐ）和胰升糖素（Ｇｃ）水平。对照组另行葡萄糖（Ｇｌｕ）兴奋试验，方法同上。结果显示，对照组经葡萄糖和Ｌ－Ａｒｇ 刺激后２ 分钟Ｉｎｓ、Ｃ－ｐ 分泌达峰值，前者峰值虽高于后者，但无明显差异（Ｐ＞ ０．０５）。肝硬化门脉高压组空腹时Ｉｎｓ和Ｇｃ高于对照组（Ｐ均＜ ０．０５），Ｌ－Ａｒｇ 兴奋后２ 分钟两组Ｉｎｓ、Ｃ－ｐ 和Ｇｃ达峰值，门脉高压组Ｉｎｓ和Ｇｃ峰值虽高于对照组，但峰值较空腹值升高倍数却低于对照组（Ｐ均＜ ０．０５）。提示肝硬化门脉高压患者存在胰岛素抵抗、胰升糖素血症及胰岛早期储备能力下降     

血清游离色氨酸浓度改变与亚临床肝性脑病

人血清中色氮酸以游离和结合两种形式存在。该文观察结果提示:游离色氨酸浓度增高与亚临床肝性脑病呈正相关(R>0.6)。     

Profile of Hepatic Encephalopathy in Children with Cirrhosis and Response to Lactulose

Background/Aim:

Hepatic encephalopathy (HE) is associated with a poor prognosis. There is paucity of data on the treatment of HE with lactulose in children with cirrhosis.

Patients and Methods:

Retrospective analysis of consecutive cirrhotic patients (<18 years) with HE was done. HE was defined according to West-Haven criteria. Response was defined as complete if patients recovered completely from HE, partial response was defined as improvement of encephalopathy by one or more grades from admission but not complete recovery, and defined as non response if patient did not show any improvement or deteriorated further even after 10 days of lactulose therapy.

Results:

A total of 300 patients were admitted with cirrhosis and HE (278 adults and 22 children). Of 22 patients, 16 (73%) patients had complete response to lactulose and six (27%) patients did not [three (13.5%) patients worsened (non response) and three (13.5%) did not recover fully even after 10 days of treatment (partial response)]. Comparing baseline characteristics of patients who had complete response (n=16) versus partial (n=3) and non response (n=3), there was significant difference in mean arterial pressure (78.1±10.7 vs 62.6±5.0 mmHg, P=0.003), serum sodium (131.3±3.2 vs 126.5±5.2, P=0.01) and serum creatinine (0.78±0.3 vs 1.1±0.3 mg/dl, P=0.02). We did not find any difference in baseline characteristics of these patients regarding CTP score (9.6±1.2 vs 10.6±1.2), MELD score (17.6±2.9 vs 17.1±3.4), severity of HE (2.5±0.6 vs 2.6±0.5) and etiology of precipitating factors (P=0.78).

Conclusions:

Lactulose therapy causes complete recovery from hepatic encephalopathy in 73% of pediatrics patients with cirrhosis.     

放射核素定量检查评价肝硬化患者的肝脏贮备功能

目的：本文对３６例肝硬化患者采用９９ｍＴＣＥＨＩＤＡ（二乙基丁酰苯胺基亚氨二醋酸）进行肝脏动态显像检查，并作定量分析，以便对肝硬化患者的贮备功能作出正确估价。方法：每位患者在检查前禁食４小时以上，检查时仰卧于ｒ相同探头下，静注８８ｍＴＣＥＨＩＤＡＦ４０ＭＢｇ，前位连续功态采集每一帧／６０秒，连续采集３０分钟，６０分钟再作静态采集一帧，经计算机处理手作定量分析。结果：结果表明肝硬化者血液中清除指数（Ｈ５／Ｈ２ｍｉｎ）、心肝比值（Ｈ５／Ｌ５ｍｉｎ）均较对照组明显增大，而３０分钟排泄率则较对照组为低（ＥＸ３０ｍｉｎ）、两组核素显像定量值相比均有显著差异（Ｐ＜０．０１），且与肝硬心病情程度相关，按ｃｈｉｌｄＰｎｇｈ分期，Ａ、Ｂ、Ｃ级之间Ｈ５／Ｈ２ｍｉｎ、Ｈ５／Ｌ５ｍｉｎ、Ｅ×３０ｍｉｎ核素定量结果互相对比均有显著差异（Ｐ＜０．０５～０．０１）。上述三项参数与肝功能实验检测指标间有一定相关性。结论：本组资料提示该方法较敏感反映肝硬化不同时期的贮备功能，对肝硬化的早期诊断等有一定的临床价值。     

肝硬化患者血浆及胃粘膜内血管活性肠肽和生长抑素含量的变化及意义

本文采用放射免疫测定法研究了肝硬化（ＨＣ）患者血浆及胃粘膜内血管活性肠肽（ＶＩＰ）和生长抑素（ＳＳ）含量变化及其意义。结果表明：肝硬化患者血浆和胃粘膜内的ＶＩＰ含量（１７４·９９±８８·１１ｐｇ／ｍｌ，１０９．４７±３０．７０ｐｇ／ｍｇ）和ＳＳ含量（５０．８８±１５．８ｐｇ／ｍｌ，３９８．２１±１２５．７３ｐｇ／ｍｇ）均显著高于正常对照组（ＶＩＰ：１０７．４６±９．８ｐｇ／ｍｌ，５８．７４±６．７１ｐｇ／ｍｇ和ＳＳ：２６．８３±５．９２ｐｇ／ｍｌ，２１２．６２±４７．６４ｐｇ／ｍｇ）（Ｐ＜０．０１）。ＨＣ伴溃疡病患者血浆及粘膜中ＳＳ含量显著高于无溃疡的ＨＣ患者（Ｐ＜０．０５）；血浆及胃粘膜中ＶＩＰ的含量与胃、十二指肠粘膜充血程度呈正相关（Ｐ＜０．０５）；重度食管静脉曲张患者ＶＩＰ含量显著高于无食管静脉曲张者（Ｐ＜０．０５）；血浆及胃粘膜内ＶＩＰ和ＳＳ含量与血浆白蛋白呈负相关（Ｐ＜０．０１）和凝血酶原时间延长呈正相关（Ｐ＜０．０１）与腹水的有无及程度关系不密切。提示：在ＨＣ时存在着严重的胃肠激素代谢紊乱，并且它在ＨＣ的病理生理机制和ＨＣ时胃肠功能改变和病理变化中起着重要作用。     

Predictors of Minimal Hepatic Encephalopathy in Patients with Cirrhosis

Background/Aim:

Minimal hepatic encephalopathy (MHE) impairs patient’s daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated.

Patients and Methods:

A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE.

Results:

Eighty-two (41%) patients were diagnosed to have MHE – 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal psychometry had P300ERP < 358 ms, and 15 (14.5%) patients with normal psychometry results had P300ERP > 358 ms. One hundred and three patients had CFF value < 39 Hz with specificity of 86.6% and sensitivity of 72.9% for MHE. Model for end-stage liver disease (MELD) (17.9 ± 5.7 vs. 13.4 ± 4.2, P = 0.005), Child-Turcotte-Pugh (CTP) score (8.4 ± 2.5 vs. 7.7 ± 2.2, P = 0.02), ammonia (104.8 ± 37.9 vs. 72.5 ± 45.2 µmol/L, P = 0.001) and CFF (37.0 ± 2.8 vs. 41.0 ± 3.4 Hz, P = 0.001) were significantly higher in MHE as compared to non-MHE patients. Ninety-one (45.5%) patients had MELD > 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 µmol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE.

Conclusion:

Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF < 39 Hz and venous ammonia > 84.5 µmol/L were predictive of MHE.