冠心病患者血清P-选择素、纤维蛋白原检测的临床意义

目的：研究冠心病（CHD）患者血清P-选择素、纤维蛋原（Fib）的变化规律及临床意义。方法：选取30例急性心肌梗死（AMI）、30例不稳定型心绞痛（UA）、30例稳定型心绞痛（SA）患者及30例同期健康体检人群作为空白对照组,测定血清P-选择素、Fib含量,同时分析二者在不同CHD患者中的表达变化。结果：SA组血清P-选择素水平与对照组差异无显著性（P〉0．05）,而Fib水平与对照组差异有非常显著性（P〈0．01）．UA及AMI组与对照组的血清P-选择素、Fib含量差异有非常显著性（Jp〈0．01）,而AMI组与UA组的P-选择素、Fib含量差异亦有显著性（P〈0．05,P〈0．01）,AMI组明显高于UA组。结论：P-选择素、Fib水平与CHD的病变程度有相关性,检测CIAD患者P-选择素、Fib水平,有利于发现高危人群,预防冠心病,对指导CHD临床诊断与抗凝治疗均有重要意义。     

感染性心内膜炎患者血浆可溶性E-选择素和P-选择素的检测及其临床意义

目的　探讨血浆可溶性E -选择素和P -选择素在感染性心内膜炎 (IE)患者血栓形成过程中 ,对炎症诱导的凝血因子前体 (酶原 )变化和内皮细胞活性改变的作用。方法　 6 3例感染性心内膜炎患者纳入研究 ,并在开始抗生素治疗 3d内 ,完成经食道超声心动图 (TEE)检查 ,其中 15例住院期间发生栓塞事件。另将同期门诊健康体检者 35例设为对照组 ,于入院 /门诊体检时空腹抽外周静脉血测IE患者中发生血栓事件者和未发生血栓事件者及正常对照组的血浆sE -SLT和sP -SLT水平。结果　IE栓塞 (+)组赘生物检出率较高 ,但与IE栓塞 (- )组比较 ,两者之间差异不显著 (86 .7%vs 6 2 .5 % ,P >0 .0 5 ) ,但前者赘生物的最大径较后者大 ,并有显著差异 [(13± 5 )mmvs (9± 4 )mm ,P <0 .0 5 ]。IE栓塞 (+)组血浆sP -SLT水平明显增高 ,与IE栓塞 (- )组和对照组比较均差异显著 [(6 0 .31± 6 .6 3) μg/Lvs (30 .72± 5 .33) μg/L ,P <0 .0 0 1,和(6 0 .31± 6 .6 3) μg/Lvs (2 7.39± 5 .5 8) μg/L ,P <0 .0 0 1]。同样 ,IE栓塞 (+)组血浆sE -SLT水平也明显增高 ,与IE栓塞 (- )组和对照组比较都差异显著 [(76 .0 6± 9.37) μg/Lvs (4 0 .6 5± 6 .6 9) μg/L ,P <0 .0 0 1和(76 .0 6± 9.37) μg/Lvs (37.2 3± 5 .76 ) μg/     

创伤时患者血清P-选择素的变化及临床意义

目的:探讨创伤时患者血清中P-选择素的变化及意义.方法:采用酶联免疫法(ELISA)测定92例创伤患者血清中P-选择素水平.结果:正常对照组血清中P-选择素即有表达,创伤患者血清中P-选择素含量明显高于对照组,并且与创伤的严重程度明显相关.结论:创伤可导致血清中P-选择素大量表达,这与创伤时存在明显的微循环紊乱和内皮功能障碍有关.     

溃疡性结肠炎患者P-选择素检测和血小板计数的临床意义

目的:探讨溃疡性结肠炎(ulcerative colitis,UC)和血小板计数及血小板活化状态的关系.方法:对54例活动期溃疡性结肠炎、26例缓解期溃疡性结肠炎和正常对照组30例采用血细胞记数仪测定血小板数量.流式细胞术检测P-选择素(CD62p).结果:①血小板计数:活动期UC患者血小板计数[(212.2±97.6)×109/L]明显高于缓解期[(168.7±67.8)×109/L]和对照组[(166.8±81.4)×109/L](P<0.01);缓解期患者与对照组相比无明显差异(P>0.05).②P-选择素水平:与对照组(3.9±1.2%)和缓解期(8.6±2.1%)患者组比较,活动期溃疡性结肠炎患者P-选择素(13.3±3.4)%显著升高(P<0.01),缓解期患者P.选择素仍高于正常对照组(P<0.05).③在活动期UC患者中,对于不同的病情程度,血小板计数与P-选择素水平有显著性差异.结论:活动期溃疡性结肠炎体内存在血小板活化;p-选择素和血小板计数的变化对评价病情活动性与严重程度均有良好的价值.     

冠心病患者血清P-选择素、白细胞介素-6检测的临床意义

目的本研究通过检测冠心病患者P-选择素、白细胞介素-6的变化规律,初步探讨其在冠心病(CHD)发病机制中的意义、病情监测、冠状动脉病变程度的关系及评价斑块不稳定性作用。方法选择冠心病病人70例,采用酶联免疫吸附法(ELISA)测定P-选择素、IL-6,比较各组之间的差异,通过相关分析,了解P-选择素、IL-6与其他心血管病危险因素的关系。结果 P-选择素在ACS组比SAP组显著升高(P<0.01),AMI组显著高于UAP组(P<0.05);IL-6水平在AMI组、UAP组显著高于SAP组(P<0.01)。结论检测Ps和IL-6的水平可能有助于冠心病的诊断和分类,Ps、IL-6作为两种炎症因子交互作用并共同促使CHD发生。     

原发性肝癌患者血浆P-选择素、凝血酶调节蛋白测定的临床意义

目的：检测原发性肝癌患血浆可溶性P－选择素（sP-selectin sP-sel)、凝血酶调节蛋白（TM）水平，并探讨其临床意义。方法：采用酶联免疫吸附夹心法（ELISA），检测30例原发性肝癌患术前和术后血浆sP-sel和TM水平，结果：术前患血浆sP-sel和TM含量明显高于对照组（P＜0．01），术前较术后高（P＜0．05）。结论：血浆 sP-sel和TM含量测定对原发性肝癌的辅助诊断有一定的参考价值。     

P-选择素检测在慢性肾脏病中的价值研究

慢性肾小球肾炎是以蛋白尿、血尿、高血压、水肿伴缓慢进展的肾功能减退为临床特点的一组肾小球疾病,在我国其为引起终末期肾衰竭的主要原因。早期发现,早期干预,防止或延缓肾功能进行性恶化、改善或缓解临床症状有着重要的意义。P—选择素又称P—选择素,又称GMP—140（granule membrane protein-140）,是一种存在于血小板α-颗粒及内皮细胞Weibel—Palade体上的黏附分子,当血小板被激活后,而表达于血浆,因而可作为反映血小板功能状态的重要指标。     

慢性乙型肝炎患者血浆可溶性E-选择素的水平及临床意义

目的研究慢性乙型肝炎(慢性乙肝)患者血浆可溶性E-选择素(sE-selectin)与肝功能指标的相关性.方法利用酶联免疫吸附法对45例慢性乙肝患者和10例正常人进行了血浆sE-selectin的测定,同时对其肝功能相关指标进行了检测.结果慢性乙肝组的sE-selectin显著高于正常对照组(P＜0.01),且与ALT、TB呈显著正相关,与PTA、ALB呈显著负相关.结论检测慢性乙肝患者血浆sE-selectin的含量,在一定程度上反应了肝脏的炎症程度,有一定的临床应用价值.     

冠心病患者D-二聚体、P-选择素测定及临床意义

目的 探讨冠心病(CHD)患者血中D-二聚体、P-选择素的变化以及临床意义.方法 分别测定24例稳定性心绞痛患者(SA)、38例不稳定性心绞痛患者(UA)、25例正常对照组体内的D-二聚体、P-选择素含量,并分析有无冠状动脉事件发生者之间的关系,以及与冠状动脉事件检出的敏感度.结果 UA组D-二聚体、P-选择素含量与SA组、对照组相比较差异有统计学意义(P＜0.01),而SA组与对照组相比均无统计学意义(均P＞0.05).有冠状动脉事件发生者与无冠状动脉事件发生者相比也有统计学意义(P＜0.01),D-二聚体、P-选择素对冠状动脉事件的检出均较为敏感.结论 D-二聚体、P-选择素可作为冠状动脉血栓形成的指标之一,并在一定程度上反映了冠状动脉事件发生的危险性.     

乙型病毒性肝炎肝硬化患者发生原发性肝癌的危险因素分析

目的 研究分析乙型病毒性肝炎肝硬化患者发生原发性肝癌（primary hepatic carcinoma,PHC）的危险因素。方法 回顾性分析南昌大学第二附属医院收治的乙型病毒性肝炎肝硬化合并PHC及单纯乙型病毒性肝炎肝硬化病例。151例乙型病毒性肝炎肝硬化合并PHC患者为观察组,136例单纯乙型病毒性肝炎肝硬化患者为对照组,采用χ2检验、t检验和Logistic回归模型分析PHC的危险因素。结果 两组患者的临床资料经单因素分析显示,性别、乙型肝炎e抗体（hepatitis B virus e antibodies,Anti-HBe）、肝功能分级（Child-Pugh）、甲胎蛋白（alpha-fetoprotein,AFP）、血糖、血型共6项指标差异有统计学意义（P<0.05）。多因素非条件Logistic回归分析结果显示,AFP（OR=5.046、2.716和9.373,P<0.01）、Anti-HBe阳性（OR=2.305、1.075和4.945,P<0.01）为PHC的危险因素。结论 男性发生PHC的可能性大于女性,Anti-HBe阳性为PHC的独立危险因素,Child-Pugh A期发生PHC的可能性高于Child-Pugh B和C期。     

慢性重症肝炎和肝硬化并发自发性细菌性腹膜炎189例临床分析

1临床资料2000-01/2003-12慢性重症肝炎和肝硬化并发自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)患者189(男109,女80)例,年龄15～73岁,以中老年患病率为高.     

Expression of HBxAg in human chronic hepatitis,cirrhosis and primary hepatic carcinoma and its significance

The specimens of this study were obtained from 110 cases of chronic hepatitis,108cirrhosis and 110 primary hepatic carcinoma(PHC).Formalin-fixed and paraffin-embedded seetions were stained by ABC method forHBxAg,and by PAP method for HRsAg and HBcAgOf the 110 cases of chronic hepatitis,72(65.5％)were positive HBxAg in the liver cells,66(60％)were postitive in HBsAg and 35(31.8％)in HBcAg.Among the 108 eases of drrhosis,84(77.8％)revealed to be HBxAg positive in the liver cells,73(67.6％)were demonstrated to beHBsAg-positive and 18(16.7％)were shown to be HBcAg-positive.Among the 110 eases of pri-mary hepatic carcinoma,64(58.2％)showed HBxAg-positive reaction in cancerous tissues.Therates of positive HRsAg and HBcAg in tumor tissues were 15.5％ and 10.9％,respectively.Six-ty-three(78.8％)of 80 cases of the non-cancerous hepatic tissues displayed HBxAg positivenessand the rates of positive HRsAg and HBcAg in the non-tumor tissues were 47(58.8％)and 21(2.6.3％),respectively.The above-mentioned results sugared that the detection rote of HBxAg inchronic hepatitis,cirrhosis and PHC was higher than that of HBsAg and HBcAg.This studydemonstrates a dose relationship between chronic hepatitis,cirrhosis,PHC and chronic persistentinfection of hepatitis B virus(HBV).Persistent chronic HBV infection plays an important role inthe pathogenesis of chronic hepatitis, cirrhosis and PHC.It is possible that the detection ofHBxAg with anti-HBx could be an additional new diagnostic marker for HBV infection.Howev-er,the role of HBxAg in the pathogenesis of chronic liver diseases needs to be furtherinvestigated.     

肝炎肝硬化患者肝功能的检测价值

目的 探讨肝炎肝硬化患者肝功能检测的临床价值.方法 选取我院2018年12月至2019年12月收治的肝炎肝硬化患者60例,其中肝功能Child分级:A级26例、B级20例、C级14例.另选择同期来我院进行健康体检60例作为健康对照组,比较肝炎肝硬化组及对照组的总胆汁酸(TAB)、清蛋白(ALB)、血清胆碱酯酶(CHE)...     

乙型肝炎与肝硬化和肝细胞癌的关系

近年来,应用免疫组织化学技术观察肝组织内乙型肝炎表面抗原(HBsAg)的研究屡有报导。大多数作者认为乙型肝炎在肝硬化、肝癌的发病中起重要作用;但有的流行病学研究则认为在某些地区,肝炎不是肝癌的病因。我省是肝癌高发区之一,关于这方面尚未见有报道。本文应用免疫酶法标记定位观察肝硬化、肝癌病人肝组织中HBsAg,以探讨本地区肝炎与肝硬化和肝细胞癌的关系。     

Detection of carboxyhemoglobin in patients with hepatic encephalopathy due to hepatitis B virus-related cirrhosis

Background  The heme oxygenase/carbon monoxide (HO/CO) system plays an important role in the development of hepatic fibrosis. The level of the HO/CO can be directly obtained by determining the carboxyhemoglobin (COHb) level. The aims of this study were to reveal the significance of COHb in patients with hepatitis B virus-related cirrhosis (HBC) complicated by hepatic encephalopathy (HE), and to further investigate the influence of the HO/CO pathway on the end-stage cirrhosis, hoping to find a reliable indicator to evaluate the course of HBC.

Methods  According to the diagnostic criteria, 63 HBC inpatients with HE were enrolled in group H. Patients regaining awareness with current therapies were categorized into group P-H. Comparisons were made with a control group (group N) consisting of 20 health volunteers. The levels of COHb, partial pressure of oxygen (PaO₂) and oxygen saturation (SaO₂) were determined by arterial blood gas analysis method. The incidences of hepatorenal syndrome (HRS), upper gastrointestinal bleeding, esophagogastric varices and spontaneous bacterial peritonitis (SBP) in group H were recorded. COHb levels in different groups were compared, and the correlations of COHb levels with HE grades (I, II, III, and IV), PaO₂, SaO₂ and hypoxemia were analyzed.

Results  The COHb level in group P-H ((1.672±0.761)%) was significantly higher than that in group N ((0.983±0.231)%) (P <0.01), and the level in group H ((2.102±1.021)%) was significantly higher than groups P-H and N (P <0.01). A positive correlation was observed between the COHb concentration and the grade of HE (r_s=0.357, P=0.004). There were no significant differences of COHb levels between HE patients with and without complications such as esophagogastric varices ((2.302±1.072)% vs. (1.802±1.041)%, P >0.05) or the occurrence of SBP ((2.960±0.561)% vs. (2.030±1.021)%, P >0.05). Compared with HE patients with HRS, the level of COHb was significantly higher in HE patients without HRS ((2.502±1.073)% vs. (1.981±1.020)%, P=0.029). The COHb level had a negative correlation with PaO₂ (r=−0.335, P=0.007) while no statistically significant relationship was found with SaO₂ (r=−0.071, P >0.05). However, when the above two parameters met the diagnostic criteria of hypoxemia, the COHb concentration increased ((2.621±0.880)% vs. (1.910±0.931)%, P=0.011).

Conclusions  COHb is a potential candidate to estimate the severity and therapeutic effect of HE. The levels of COHb may be tissue-specific in cirrhotic patients with different complications.

     

Autonomic neuropathy in patients with hepatic cirrhosis

Background: Autonomic neuropathy has been reported in patients with alcoholic liver disease but information on its occurrence in patients with non-alcoholic liver disease is contradictory. Aim: To assess autonomic functions in patients with alcoholic and non-alcoholic liver disease. Study design: Autonomic function using five standard tests was examined in 20 cirrhotics (10 alcoholics and 10 non-alcoholics) and 20 age and sex matched controls. The extent of autonomic dysfunction was determined in the patients and a comparison between the characteristics of patients with and without autonomic neuropathy was made. Results: Sixteen (80%) of the cirrhotic subjects were found to have evidence of autonomic neuropathy. Of these, three (15%) patients had early parasympathetic damage, five (25%) had definite parasympathetic damage, and eight (40%) had combined (that is, both parasympathetic and sympathetic) damage. Nine (90%) of the alcoholics and seven (70%) of the non-alcoholics had autonomic dysfunction. Only one patient belonging to the alcoholic group had clinical evidence of peripheral neuropathy. Moreover, there was no significant association between subjective symptoms of autonomic neuropathy and objective evidence of autonomic damage as assessed by autonomic function tests. Autonomic dysfunction was significantly more frequent in advanced liver disease compared with early liver damage. Nine (75%) out of 12 cirrhotic subjects belonging to Child class B and six (85.7%) of the seven patients belonging to Child class C had autonomic neuropathy. Conclusion: This study shows that autonomic neuropathy is common in cirrhotic subjects, that it is found with comparable frequency in alcoholics and non-alcoholics, and that it increases in severity with increase in extent of liver damage, suggesting that liver damage contributes to the neurological deficit.     

智力测验调查肝病患者轻微型肝性脑病的发病学

目的 对肝硬化和慢性肝炎患者的轻微型肝性脑病发病状况进行调查。方法 对400例肝硬化患者和416例慢性肝炎患者进行数字连接试验（NCT）和数字符号试验（SDT）。结果 肝硬化患者中NCT异常率为38.0％,SDT异常率为41.8％,二项均异常为29.3％,至少有一项异常（即MHE发病率）为51.0％。MHE发病率和性别、年龄、吸烟、饮酒无关,但和肝功能Child-pugh分级相关。A级肝硬化患者MHE发病率为39.8％,B级发病率为54.4％,C级发病率为72.4％。三级之间有显著性差异（P〈0.01）。慢性肝炎患者的MHE发病率为7.2％,显著低于肝硬化组（P〈0.01）。结论 肝硬化MHE发病率为51.0％,显著高于慢性肝炎的7.2％。MHE发病率与肝功能Child-push分级相关,与性别、年龄、病因、吸烟无关。     

和络舒肝片联合恩替卡韦治疗对乙肝肝硬化患者肝纤维化的影响

目的观察和络舒肝片联合恩替卡韦治疗乙肝肝硬化患者肝纤维化的疗效。方法将180例乙肝肝硬化患者随机分为对照组与联合组,每组90例,对照组给予恩替卡韦治疗,联合组给予和络舒肝片+恩替卡韦治疗,疗程6个月,比较两组临床疗效,血清炎症因子、肝功能以及肝纤维化的变化情况。结果治疗后,联合组总好转率较对照组明显提高(P<0.05);两组血清IL-6、TNF-α水平明显降低(P<0.01),IL-10、IL-13水平明显升高(P<0.01),与对照组比较,联合组改善幅度更大(P<0.01);两组ALT、AST、TBil水平明显降低(P<0.01),联合组比对照组改善幅度更明显(P<0.01);两组HA、LN、Ⅳ-C以及PC-Ⅲ水平同样明显降低(P<0.01),联合组比对照组改善幅度更大(P<0.01);两组治疗过程中无明显不良反应发生。结论对乙肝肝硬化患者应用和络舒肝片联合恩替卡韦治疗,能够明显提升临床治愈率,调节患者血清炎症因子水平,改善肝功能,抑制肝纤维化进程,无明显不良反应,安全性较好。