Impaired left ventricular systolic function after a half-ironman race.

OBJECTIVE: To assess the effects of prolonged strenuous exercise in the form of a half-ironman (HI) race (2 km swim, 90 km bike ride and a 21 km run) on left ventricular systolic function. METHODS AND RESULTS: The study participants consisted of nine male triathletes (mean age +/- SD 32+/-5 years) who competed in the Great White North HI race. Two-dimensional transthoracic echocardiograms were obtained two to three days before the HI (prerace), immediately after completion of the HI (postrace) and 24 h after cessation of exercise. Compared with before the race, performing an HI was associated with a decline in systolic blood pressure (prerace 127.2+/-15.0 mmHg compared with after the race 116.1+/-10.2 mmHg, P<0.05), the systolic blood pressure to end-systolic cavity area ratio (a surrogate for left ventricular contractility - prerace 14.3+/-3.0 mmHg/cm(2) compared with postrace 11.0+/-2.2 mmHg/cm(2), P<0.05) and the fractional area change (prerace 54.1+/-3.8% compared with postrace 47.4+/-5.5%, P<0.05). There was also a concomitant increase in heart rate (prerace 56.3+/-9.4 beats/min compared with postrace 74.1+/-10.7 beats/min, P<0.05), the end-systolic cavity area (prerace 9.2+/-2.2 cm(2) compared with postrace 10.8+/-1.9 cm(2), P<0.05) and the end-systolic cavity area to end-systolic myocardial area ratio (prerace 0.39+/-0.08 compared with postrace 0.51+/-0.1, P<0.05), which returned toward baseline values 24 h after cessation of the HI. CONCLUSIONS: Performing an HI appears to be associated with a transient impairment in left ventricular contractility and a subsequent decline in left ventricular systolic function that tends to return toward normal values within 24 h after cessation of exercise.     

射频导管消融术对血栓前状态的影响及阿司匹林的作用

目的探讨射频导管消融术(RFCA)对血栓前状态的影响,评价阿司匹林(Asp)的干预作用。方法选择58例行RFCA的阵发性室上性心动过速患者将其随机分成两组:Asp组(n=28):术前3天口服Asp;对照组(n=30):术前不用药。分别于术前(T0)、电生理检查(EPS)后(T1)、射频放电后即刻(T2)、术后24 h(T3)测定血浆血管性假血友病因子(VWF)、内皮素(ET)、血小板α颗粒膜糖蛋白140(GMP-140)和D-二聚体(DD),比较两组内不同时间点各项指标的变化及两组间的差异。并作RFCA的程序变量与血栓前状态的分子标志物变化的相关性分析。结果①两组患者VWF和ET在不同时间点较术前无显著差异(P>0.05);②对照组GMP-140和DD在T1时刻即有显著升高(P<0.05),T2时刻进一步升高达峰值,T3较T0有所下降,但仍明显高于术前(P(0.05);Asp组GMP-140在T1、T2、T3时刻与T0时刻比较无明显升高(P>0.05),而DD仍有显著升高(P<0.05或P<0.01),但与对照组同一时间点比较升高的幅度明显降低(P<0.05);④GMP-140和DD升高的幅度与手术持续时间呈正相关(r=0.48,r=0.41,P<0.05)。结论尽管术中应用肝素RFCA仍可导致血栓前状态。RFCA致血栓前状态与手术持续时间呈正相关。Asp可减轻RFCA引起的血栓前状态。     

急性和慢性束缚应激对大鼠内脏敏感性的影响

目的了解急性和慢性求缚应激对大鼠内脏敏感性的影响和持续时间。方法成年SD大鼠随机分为3组：对照组（没有束缚应激），急性部分束缚应激组（单次2h的束缚应激）和慢性部分束缚应激组（连续束缚应激3天，每天2h），通过腹壁回撤反应（AWR）评分评估应激前后不同时间点大鼠对结直肠扩张（CRD）的内脏敏感性。结果①在扩张压力20mmHg和40mmHg时，急慢性束缚应激组的AWR评分均显著高于应激前基础水平（Od）（P〈0．05），但在60，80mmHg压力时各组的AWR评分均无显著差异；②急性束缚组在应激后24h和应激后第7天，AWR评分显著下降（P〈0．05）；③慢性束缚组在末次应激后24h，AWR评分仍维持增高水平，但在第7天时AWR评分回到基础水平。结论急性和慢性束缚应激郜可以导致大鼠内脏敏感性增高，但其作用可能是短暂的。     

渐进式三维滚轮训练对男性前庭功能稳定性和心血管调节能力的影响

目的 探讨渐进式三维滚轮训练对男性前庭功能稳定性和心血管调节能力的影响。方法 对12名前庭功能稳定性较差的健康男性志愿者进行为期6 d、每天1次的渐进式三维滚轮训练。在训练前后利用电动转椅对被试者的前庭功能和心血管调节能力进行评价,观察在此过程中被试者前庭功能分级、Graybiel运动病评分、血压、心率和心率变异性的改变情况。结果 与训练前相比,三维滚轮训练6 d后被试者的Graybiel运动病评分显著降低（P<0.05）,前庭功能合格率从训练前的66.7%提高至91.7%。在训练开始前,被试者的收缩压和舒张压在测试后较测试前均显著升高（P<0.05）,电动转椅测试中的归一化低频功率（LFn）显著低于测试前（P<0.05）,测试后的LFn显著高于测试中（P<0.05）,测试中的归一化高频功率（HFn）显著高于测试前（P<0.05）,测试后的HFn显著低于测试中（P<0.05）;在训练结束后,被试者的血压和心率均无明显变化,测试后的LFn显著高于测试前和测试中（P<0.05）,测试后的HFn显著低于测试前和测试中（P<0.05）;在训练前后...     

The clinical significance of monitoring alkaline phosphatase level to estimate postoperative liver failure after hepatectomy

BACKGROUND/AIMS: To predict the occurrence of postoperative liver failure after hepatectomy, the clinical significance of monitoring alkaline phosphatase (ALP) has been studied, and the relationship between the change of total bilirubin and the level of ALP or gamma-glutamyl transpeptidase (gamma-GTP) after hepatectomy was evaluated. METHODOLOGY: The 163 patients, who underwent hepatectomy at our institute for the past 12 years, were divided into three groups according to the postoperative events. HF consisted of 5 patients with liver failure, HB showed the postoperative high bilirubinemia (over 5mg/dL) in 13 cases and GP were 145 cases without any postoperative problems. RESULTS: 1. The postoperative highest level of total bilirubin (T-Bil) correlated with the decreasing rate of ALP, prothrombin time (PT), total cholesterol (T-CHO) or gamma-GTP and total blood loss (p<0.01). 2. The level of ALP decreased after hepatectomy significantly and the decreasing rate was serious in HB and HF (p<0.05). 3. The recovering time to preoperative level of ALP was clearly shorter in GP than in HB and HF. 4. The level of ALP and gamma-GTP at the point where the level of T-Bil increased over 5mg/dL, was useful to distinguish between HF and HB. 5. The good correlation between postoperative level of ALP and gamma-GTP was noted. The decreasing levels of ALP and gamma-GTP were found to be critical below 80% and 55% after bisegmentectomy. Furthermore, the recovered levels of ALP and gamma-GTP were important to distinguish between HF and HB. CONCLUSIONS: Monitoring the ALP level was indicated to be useful to estimate the postoperative course of bilirubin.     

Hematologic and Biochemical Laboratory Parameters Before and After a Marathon Race

Marathon racing is a strenuous exercise that has a profound effect on many laboratory parameters. Participants in marathon races may require abstinence of exercise and the performance of laboratory assays several days after the event. The aim of this study was to evaluate the possible changes in blood cell count and biochemical parameters observed in participants in a marathon 3 days before and 3 days after and before and immediately after a cardiopulmonary exercise test. Incremental cycle ergometry up to maximal capacity was performed in 7 marathon runners, 3 days before and 3 days after the race. The % peak oxygen consumption (peak %VO₂) achieved was statistically significantly lower after than before the race (p = 0.02). No statistically significant differences were observed in cardiac frequency (p = 0.148) or blood cell count (p = 0.501). Also, the concentration of sodium, potassium, calcium, magnesium, lactate dehydrogenase (LDH), phosphocreatine kinase (CPK) and glucose, measured before and immediately after the pulmonary exercise test, did not differ significantly (p < 0.5). A significant percentage of the laboratory results were outside the standard reference rates. According to our data, exercise performance, as expressed by peak %VO₂, continued to be decreased in marathon runners 3 days after the race. The blood cell count and biochemical parameters did not differ significantly but many marathon runners were outside the standard reference rates. Unfortunately, only 7 subjects were available for this study. Further studies with larger samples and with samples obtained at multiple times during and after exercise are needed to clarify the effects of long-distance running.     

Delayed effects of prolonged exercise on serum lipoproteins

The delayed lipoprotein changes after a 3-hour running test were examined in 14 moderately trained young male subjects. Fasting blood samples were obtained one day before, immediately before, and one, two, and four days after the race. Nonfasting samples were collected immediately after, one, and three hours after exercise. Three hours after the race, the ratio of unesterified cholesterol to cholesteryl esters was significantly increased, and one and two days after the race it was significantly decreased compared to the preexercise value. The HDL2/HDL3 ratio, measured by density-gradient ultracentrifugation was one and three hours after the running significantly elevated. However, no redistribution of the HDL2/HDL3 cholesterol ratio determined by a precipitation method with polyanions was found at this time. One day postexercise HDL cholesterol rose significantly above the preexercise value, and this was associated with an elevation of the HDL3 subfraction. On the following day a significant increase of HDL2 cholesterol and the HDL2/HDL3 cholesterol ratio was found. The apolipoproteins A-I, A-II, and B, measured by radial immunodiffusion, did not change during the first hours and the first two days after the race. On the second postexercise day the Lp(a) lipoprotein rose significantly above the preexercise value. Compared with the preexercise level the LCAT activity was significantly elevated three hours after the race and significantly decreased two days later. The present study suggests that during the first few days after prolonged exercise a number of plasma lipoprotein changes take place that are similar to those observed after a period of physical training.     

加味茵陈蒿汤联合熊去氧胆酸治疗原发性胆汁性肝硬化的临床研究

目的:观察加味茵陈蒿汤联合熊去氧胆酸治疗30例原发性胆汁性肝硬化临床分期为早中期患者的临床疗效。方法:60例患者随机分为对照组和治疗组各30例。两组均给予基础治疗,对照组患者同时口服熊去氧胆酸胶囊15～20mg.kg-1.d-1;治疗组患者在对照组基础上加服加味茵陈蒿汤,1剂/d,疗程均为24周。观察治疗前后两组患者的临床疗效、肝功能(γ-GT、ALP、ALT、AST、TBil)、免疫指标(IgM、IgG及IgA)的变化。结果:治疗结束时,治疗组26例(86.7%)患者得到完全反应,与对照组19例(63.3%)比较差异有显著性意义(P<0.05);两组患者治疗后肝功能(γ-GT、ALP、ALT、AST、TBil)均较治疗前明显下降(P<0.05),治疗组治疗后肝功能下降明显优于对照组(P<0.05或P<0.01);治疗后两组患者免疫指标IgM、IgG、IgA均较前有所下降,经比较差异无统计学意义(P>0.05)。结论:加味茵陈蒿汤联合熊去氧胆酸治疗原发性胆汁性肝硬化,较单用熊去氧胆酸疗效更好,并能明显改善患者的肝功能。     

牛磺酸对急性重型颅脑创伤大鼠脑血流的影响

目的 探讨急性重型颅脑创伤(TBI)大鼠大脑皮质脑血流(CBF)变化以及牛磺酸(Tau)的治疗效果.方法 选择SD大鼠40只,随机分为假手术组(Sham组)、脑创伤组(TBI组)、Tau低剂量组(100 mg/kg)、Tau高剂量组(200 mg/kg)各10只.采用液压打击法在大鼠大脑左侧制作TBI模型,Sham组只开骨窗.Tau组伤后立即尾静脉注射相应剂量Tau,TBI组给予相同量生理盐水.采用激光多普勒血流仪检测各组TBI前及TBI后30 min、24h两侧大脑皮质CBF变化.结果 各组TBI前CBF比较均无统计学意义.左脑:模型组TBI后30 min、24 h CBF较Sham组均明显减低(P均＜0.05);TBI后30 min,与TBI组比较,Tau低剂量组CBF无明显变化,Tau高剂量组显著升高(P＜0.01);TBI后24h,Tau高、低剂量组CBF均明显高于伤后30 min(P＜0.05).右脑:与TBI组比较,Tau低剂量组CBF在TBI后30 min无明显变化,TBI后24h显著升高(P＜0.05);Tau高剂量组TBI后30 min、24 h CBF均明显升高(P均＜0.05);Tau高、低剂量组CBF在各时段均无统计学意义.左右脑:TBI组、Tau低剂量组和Tau高剂量组左脑CBF TBI后30 min明显低于右脑;TBI后24h后左右脑的CBF比较无统计学意义.结论 Tau治疗有助于改善TBI大鼠脑创伤后CBF状况,其改善程度与用药时间、剂量呈正比.     

Changes in plasma leptin and insulin action with resistive training in postmenopausal women

OBJECTIVE: To determine the effects of 16 weeks of resistive training alone (RT) and with weight loss (RT+WL) on insulin action, plasma leptin concentrations and leptin's relationship to beta-cell sensitivity to glucose, resting metabolic rate (RMR), and plasma catecholamines in older women. SUBJECTS: Fifteen obese postmenopausal women aged 50-69 y. MEASUREMENTS: Body composition (by dual-energy X-ray absorptiometry), RMR (by indirect calorimetry), insulin action (by 2 h hyperglycemic clamps; 7.9 mmol/l above basal plasma glucose levels), plasma leptin and insulin (by RIA), and plasma catecholamines (by enzymatic methods). RESULTS: RT and RT+WL resulted in significant improvements in muscular strength (P<0.01) with no changes in maximal oxygen consumption. Body weight, fat mass and percent body fat did not change with RT, but decreased with RT+WL (P<0.001). Fat-free mass and RMR increased after training when both groups were combined (P<0.05). The insulin response during the last 20 min of the 2 h hyperglycemic clamps decreased 16% after RT (P=0.05), 43% after RT+WL (P<0.05), and 29% in the entire group (P<0. 01) without any changes in glucose utilization. Plasma leptin levels did not change after RT, but decreased by 36% after RT+WL (P<0.05). Baseline leptin levels correlated with body weight (r=0.68, P<0.01), body fat mass (r=0.77, P<0.001), and RMR (kcal/d; (r=0.69, P<0.005), but not with baseline norepinephrine or epinephrine levels. Plasma leptin levels correlated with basal insulin (r=0.73, P<0.005), and approached significance with the 0-10 min and 100-120 min insulin response to hyperglycemia before training (both r=0.51, P=0.07). In the entire group, the change in insulin response from 100-120 min during the clamp correlated with the change in leptin levels (r=0.60, P<0.05), but this was not independent of changes in fat mass. CONCLUSIONS: Although changes in leptin levels were not related to changes in RMR or plasma catecholamines after RT with and without weight loss, the increase in insulin action after training and weight loss may be related to the decrease in leptin levels that were mediated by the loss of body fat in the obese, postmenopausal women. International Journal of Obesity (2000)24, 27-32     

非淤胆型婴儿巨细胞病毒性肝炎治疗68例

目的:探讨非淤胆型婴儿巨细胞病毒性肝炎的治疗方法.方法:选择2008-01/2010-07本院儿科住院的68例非淤胆型婴儿巨细胞病毒性肝炎患儿,随机分为治疗组34例和对照组34例,均予复方甘草酸苷2 mL/(kg.次),1次/d,共3 wk.治疗组加用更昔洛韦5 mg/(kg.次),2次/d,2 wk;1次/d,1 wk.结果:治疗组和对照组总有效率分别为94.1%和91.1%,治疗3 wk复查肝功能指标结果提示丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(total bilirubin,T B I L)、谷氨酰转肽酶(g a m m a g l u t a m y ltranspeptidase,GGT)和碱性磷酸酶(alkalinephosphatase,ALP)指标较治疗前均明显下降,差异有显著意义(P<0.05);直接胆红素(directbilirubin,DBIL)、总胆汁酸(total bile acid,TBA)指标较治疗前均无明显变化,差异无显著意义(P>0.05).治疗前或治疗后2组间比较上述指标差异无显著意义(P>0.05).随访1年,失访5人,余患儿肝功能均正常;尿CMV-DNA,治疗组18人(54.5%)阳性,对照组15人(50.0%)阳性,差异无显著意义(P>0.05).结论:非淤胆型婴儿巨细胞病毒性肝炎不建议常规予更昔洛韦抗病毒治疗.     

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.     

Immediate changes in biochemical markers of bone turnover and circulating interleukin-6 after parathyroidectomy for primary hyperparathyroidism

OBJECTIVE: The time course of the immediate change in bone turnover after parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) is not clear. It is uncertain whether circulating interleukin-6 (IL-6) plays a role in mediating the acute withdrawal of the effects of parathyroid hormone (PTH) on bone turnover after PTX. The aims of this study were to determine the time course of immediate changes in biochemical markers of bone turnover after PTX and whether circulating IL-6 is involved in the immediate changes of bone turnover after PTX. DESIGN AND METHODS: IL-6 and bone turnover markers were measured in eight women (aged 55+/-11 years, mean+/-s.d. ) with PHTP at baseline and at 1-2h, and 1, 2, 5, 7 and 12 days after PTX. We compared the results with those from eight individually matched women (healthy controls) and five subjects undergoing major surgery (surgical controls). RESULTS: At baseline, serum levels of IL-6 and bone turnover markers were higher in PHPT than those in healthy controls (P<0.05). Serum levels of procollagen propeptides increased by 22 and 27% at days 2 and 5, respectively, compared with baseline (P<0.05). Serum tartrate-resistant acid phosphatase decreased by 2 days after PTX, and urinary collagen crosslinks decreased significantly by 21-41% within 24h (P<0.05). Serum IL-6 levels increased immediately in both PHPT and surgical controls at postoperative follow-up (repeated measures ANOVA). CONCLUSIONS: (1) PTX decreases bone resorption immediately and (2) circulating IL-6 is not involved in the changes in bone turnover immediately after PTX.     

二甲基亚硝胺肝硬化大鼠血清元素含量变化及其意义

目的　探讨二甲基亚硝胺 (DMN)肝硬化大鼠血清元素含量变化与肝功能损伤的关系及其在肝纤维化形成与发展中的意义。方法　用 0 .5 %DMN 生理盐水 2ml/kg给大鼠腹腔注射 ,共 4周 12次 ,分别于造模第 2周与第 4周结束后获取大鼠肝组织与血清 ,作肝病理组织学、肝组织羟脯氨酸 (Hyp)含量、肝功能及血清元素含量测定。 结果　( 1)造模第 2周时大鼠的血清ALT活性和TBIL显著升高 ,为同期正常组的 1.7倍 (P <0 .0 1)和 7.2倍 (P <0 .0 5 ) ;造模第 4周时为同期正常大鼠的 3 .4倍 (P <0 .0 1)和 3 4.6倍 (P <0 .0 1) ;第 4周模型大鼠Alb含量显著低于同期正常大鼠(P <0 .0 1)。 ( 2 )造模第 2周时大鼠的肝组织Hyp含量是同期正常组的 1.8倍 (P >0 .0 5 ) ,第 4周时较同期正常组增高了 3 .8倍 (P <0 .0 1)。 ( 3 )造模第 2周时血清元素主要表现为Cu含量显著增高 (P <0 .0 5 ) ,Cu/Zn比值也显著升高 (P <0 .0 1) ;第 4周时模型大鼠的血清Fe含量显著增高 (P >0 .0 5 ) ,Zn含量显著降低 (P <0 .0 1) ;血清Se含量较第 2周时模型大鼠进一步下降 ;Cu/Zn比值显著升高 (P <0 .0 1) ;Zn/Fe比值、Se/Fe比值均显著降低 (P <0 .0 1)。 ( 4 )以第 4周正常组和模型大鼠血清元素含量与肝组织Hyp含量及肝功能各指标作相关分析 ,血清     

经皮冠状动脉腔内介入围术期应用高维持剂量氯吡格雷对炎症因子的影响

目的:探讨高维持剂量(150 mg/d)氯吡格雷是否能抑制动脉粥样硬化炎症反应。方法:经Grace评分分级的高危急性冠状动脉综合征(ACS)患者80例,经皮冠状动脉腔内介入术(PCI)后随机分为氯吡格雷75 mg/d组(n=40)与氯吡格雷150 mg/d组(n=40),30 d后均以75 mg/d维持治疗。分别检测PCI术前、30 d的高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。随访术后6个月的主要不良心脏事件(MACE)及出血事件的发生情况。结果:1.氯吡格雷150 mg/d组和75 mg/d组,术前hs-CRP、IL-6、TNF-α水平比较差异无统计学意义(P>0.05);2.2组PCI术后30 d血清hs-CRP、IL-6、TNF-α水平均较术前显著降低(P<0.01),且氯吡格雷150 mg/d组较75 mg/d组对上述炎症因子的抑制程度更明显(P<0.05);3.2组MACE发生情况差异有统计学意义(P<0.05),而出血事件发生率差异无统计学意义(P>0.05)。结论:PCI围术期应用高维持剂量氯吡格雷,可以进一步抑制高危ACS患者动脉炎症反应而不增加出血风险,有助于降低短期MACE发生率。     

甲状腺功能亢进性肝损害与甲巯咪唑继发性肝损害的临床比较研究

目的分析甲状腺功能亢进症(简称甲亢)性肝损害患者的肝功能与甲状腺功能的相关性,探讨抗甲亢药物甲巯咪唑所致肝损害患者的临床特征及其引起肝损害的相关因素。方法纳入甲亢性肝病患者54例(甲亢性肝损害组)和初诊未治的无肝损害甲亢患者33例(甲亢无肝损害组),收集两组患者用药前的一般资料和临床资料(甲状腺功能和肝功能),分析甲亢性肝损害的相关因素;将同期抗甲亢药物甲巯咪唑致肝损害患者(27例)根据肝功能指标分为肝细胞型组(7例)、胆汁淤积型组(12例)和混合型组(8例),收集其一般资料和临床资料(甲状腺功能和肝功能)并比较。结果甲亢性肝损害组患者治疗前的ALT、AST、碱性磷酸酶(ALP)、谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、游离三碘甲腺原氨酸(FT 3)、游离甲状腺激素(FT 4)和促甲状腺激素受体抗体(TRAb)水平明显高于甲亢无肝损害组(P<0.05),两组患者ALT、ALP、γ-GT水平均与FT 3、FT 4、TRAb水平呈明显正相关(P<0.05)。肝细胞型组、胆汁淤积型组和混合型组患者的年龄、用药时间、ALT、ALP比较差异均有统计学意义(P<0.05)。结论甲亢患者甲状腺功能异常的严重程度可能与其肝损害相关;抗甲亢药物甲巯咪唑引起的肝损害类型可能与患者年龄、病程及用药时间有关。     

S-腺苷蛋氨酸对梗阻性黄疸患者肝蛋白质合成及肝功能的影响

目的 探讨S-腺苷蛋氨酸（SAMe）对梗阻性黄疸患者肝蛋白质合成及肝功能的影响.方法 选取梗阻性黄疸患者60例,依据单双号分为观察组和对照组,各30例,两组患者均给予常规保肝治疗,在此基础上观察组加用SAMe 1 g静脉滴注,两组均治疗7d,比较治疗前后前清蛋白（PA）、清蛋白（ALB）、转铁蛋白（TF）、天冬氨酸氨基转移酶（AST）、谷氨酸氨基转移酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）、谷酰转肽酶（GGT）、碱性磷酸酶（ALP）变化.结果 观察组患者在治疗后PA较治疗前明显升高（P＜0.05）,治疗后浓度高于对照组（P＜0.05）,对照组治疗后TF较治疗前有所下降（P＜0.05）,治疗后浓度低于观察组（P＜0.05）,两组在治疗前后ALB均无明显变化（P＞0.05）;两组治疗后AST、ALT、TBIL、DBIL、GGT、ALP较治疗前均有所下降（P＜0.05）,观察组以上肝功能指标下降幅度明显较对照组高（P＜0.05）.结论 SAMe用于治疗梗阻性黄疸能促进患者肝蛋白质合成及改善肝功能.     

Serum interleukin-6 and hepatocyte growth factor levels in patients after hepatectomy

BACKGROUND/AIMS: To examine whether serum hepatocyte growth factor and interleukin-6 levels are early parameters of postoperative liver dysfunction after hepatectomy. METHODOLOGY: The serum levels of hepatocyte growth factor and interleukin-6 were measured in 16 hepatectomized patients on the day of surgery (before surgery, immediately after hepatectomy, after completion of surgery) and on postoperative days 1, 3, and 5. Serum liver function tests were determined for 14 days after surgery and their results were correlated with serum interleukin-6 and hepatocyte growth factor levels. RESULTS: Serum interleukin-6 and hepatocyte growth factor levels were elevated after surgery and these values were higher in patients who underwent hepatectomy greater than lobectomy in magnitude. The mean maximum value of interleukin-6 appeared on day 0 and was earlier than that of hepatocyte growth factor, which was found on day 1. Serum total bilirubin and alanine aminotransferase levels reached the maximum within 5 days after surgery. Multiple regression analysis showed that serum levels of interleukin-6 and hepatocyte growth factor on day 0 after surgery were significantly correlated with the postoperative maximum total bilirubin level (P < 0.0001). The maximum interleukin-6 level but not hepatocyte growth factor significantly correlated with the postoperative maximum bilirubin level (P < 0.02). CONCLUSIONS: Both the serum interleukin-6 and hepatocyte growth factor levels are likely early indicators of postoperative liver dysfunction in patients after hepatectomy.     

Early diagnosis of bacterial and fungal infection in chronic cholestatic hepatitis B

AIM: To investigate the early diagnostic methods of bacterial and fungal infection in patients with chronic cholestatic hepatitis B.METHODS: One hundred and one adult in-patients with chronic hepatitis B were studied and divided into 3 groups:direct bilirubin (DBil)/total bilirubin (TBil)≥0.5, without bacterial and fungal infection (group A, n=-38); DBil/TBil&lt;0.5, without bacterial and fungal infection (group B, n=23),DBil/TBil≥0.5, with bacterial or fungal infection (group C,rr=-40). The serum biochemical index and pulse rate were analyzed.RESULTS: Level of TBil, DBil, alkaline phosphatase (ALP) and DBiI/ALP in group A increased compared with that in group B. The level of ALP in group C decreased compared with that in group A, whereas the level of TBil, DBil and DBiI/ALP increased (ALP: 156+43, 199+68, respectively,P&lt;0.05, TBil: 370+227, 220+206, respectively, P&lt;0.01,DBil: 214+143, 146+136, respectively, P&lt;0.01, DBiI/ALP:1.65+1.05, 0.78+0.70, respectively, P&lt;0.001). The level of DBil and infection affected DBiI/ALP. Independent of theeffect of DBil, infection caused DBiI/ALP to rise (P&lt;0.05).The pulse rate in group A decreased compared with that in group B (63.7+6.4, 77.7+11.4, respectively, P&lt;0.001),and the pulse rate in group C increased compared withthat in group A (81.2+12.2, 63.7+6.4, respectively, P&lt;0.001).The equation (infection=0.218 pusle rate +1.064 DBiI/ALP-16.361), with total accuracy of 85.5%, was obtained from stepwise logistic regression. Pulse rate (≥80/min) andDBiI/ALP (≥1.0) were used to screen infection. The sensitivity was 62.5% and 64.7% respectively, and the specificity was 100% and 82.8% respectively.CONCLUSION: Bacterial and fungal infection deterioratejaundice and increase pulse rate, decrease serum ALP andincrease DBiI/ALP. Pulse rate, DBiI/ALP and the equation(infection=0.218 pusle rate+1.064 DBil/ALP-16.361) arehelpful to early diagnosis of bacterial and fungal infectionin patients with chronic cholestatic hepatitis B.     

冠状动脉造影术造影剂与肾功能关系的研究

目的探讨冠状动脉造影术中造影剂对肾功能的影响。方法①按患者所用造影剂的量分成50~100ml组、100~200ml组和>200ml组。②分别测定术前、术后24h、术后48h、术后10d的血尿素氮(BUN)、血肌苷(Cr)、尿微量白蛋白(MAU)、尿β2-微球蛋白(β2MG)的值并进行比较。结果造影后24h、48h尿β2MG与造影前及造影后10d比较有显著性差异(P<0.05),其余指标各时段之间比较无显著性差异(P>0.05)。造影后24h、48h造影剂>200ml组与50~100ml组及100~200ml组之间Cr、MAU及β2MG的变化有显著性差异(P<0.05)。其余各组之间比较无显著性差异(P>0.05)。结论造影剂对肾功能有一定的损害,并且随造影剂剂量的增加其损害加重。