缺糖基转铁蛋白与天门冬氨酸氨基转移酶线粒体同工酶在酒精性肝病中的临床应用

目的探讨缺糖基转铁蛋白(CDT)与天门冬氨酸氨基转移酶线粒体同工酶(m-AST)在酒精性肝病中的应用价值。方法选取60例酒精性肝病患者作为酒精组,60例非酒精性肝病患者作为非酒精组;并选择同期60例体检健康者作为对照组。采集所有受检者治疗前或体检当天的空腹静脉血,以及酒精组患者治疗4周后的空腹静脉血,分别检测CDT、m-AST水平。比较三组患者血清缺糖基转铁蛋白百分比(%CDT)与m-AST水平;分析酒精性肝病患者CDT与m-AST联合检测的敏感性和特异性;比较不同类型酒精性肝病患者治疗前后血清%CDT与m-AST水平。结果酒精组患者的%CDT与m-AST水平均明显高于非酒精组、对照组,非酒精组患者的%CDT与m-AST水平均明显高于对照组,差异具有统计学意义(P<0.05)。CDT检测的受试者工作特征曲线(ROC)曲线下面积为0.808,敏感性为81.67%,特异性为83.33%;m-AST检测的ROC曲线下面积为0.764,敏感性为91.67%,特异性为63.33%;CDT与m-AST联合检测的ROC曲线下面积为0.875,敏感性为93.33%,特异性为76.67%。治疗后,酒精性脂肪肝、酒精性肝炎、酒精性肝硬化患者血清%CDT与m-AST水平均较治疗前明显降低,差异具有统计学意义(P<0.05)。结论CDT及m-AST联合检测可提高诊断酒精性肝病的敏感性,且对疾病的治疗具有一定的临床价值。     

肝脏疾病患者血清中线粒体型天门冬氨酸氨基转移酶检测的临床意义

目的探讨线粒体型天门冬氨酸氨基转移酶（m—AST）以及m—AST与天门冬氨酸氨基转移酶（AST）比值在各类肝脏疾病中的变化规律及临床意义。方法用免疫抑制法测定各类肝脏疾病患者血清中m—AST和AST,计算出mAST／AST比值,观察其在入院时与治疗后的变化。结果患者入院时,mAST／AST比值从高到低依次为重型肝炎0．435±0．061、急性肝炎0．375±0．057、药物性肝炎0．321±0．035、慢性肝炎0．317±0．031、肝炎肝硬化0．276±0．031,均显著高于正常对照组（P〈0．05）;治疗后,急性肝炎组和药物性肝炎组mAST／AST比值明显下降,其他组无明显变化。结论动态监测血清mAST／AST比值的变化有利于急性肝炎、重型肝炎的预后判断和急性肝炎与慢性肝炎的鉴别诊断,对急性和药物性肝炎的评估和诊断治疗有指导价值。     

线粒体型天门冬氨酸氨基转移酶同工酶在各类肝损害病程中的应用

目的：探讨不同肝病患者血清线粒体天门冬氨酸氨基转移酶同工酶（m-AST）的变化及其临床意义。方法：用全自动生化分析仪测定216例不同肝病患者血清m-AST活性。结果：肝病患者m-AST变化与ALT、AST变化呈正相关,因病情不同而有不同程度的升高。急性肝炎、慢性肝炎、肝硬变、原发性肝癌人院时m-AST分别为（65．0±33．8）、（51．1±44．6）、（47．3±18．9）、（31．5±34．3）U／L;第二周分别为（9．9±6．7）、（37．3±33．9）、（49．1±19．4）U／L、（29．3±30．1）U／L。急性肝炎组m-AST明显升高,其次是慢性肝炎和肝硬化,肝癌组m-AST轻度升高。不同肝病患者经住院治疗2周后（第三周）随着肝功能的恢复,急性肝炎m-AST明显下降,与入院时相比有显著性差异,P〈0．05,慢性活动性肝炎虽有下降,但与入院时相比无明显差异,P〉0．05。肝硬化,m-AST变化不明显。肝癌治疗前后m-AST基本无变化。结论：检测并动态观察肝脏疾病患者的m-AST活性,对于了解肝脏疾病的病理生理变化,鉴别急、慢性肝炎,评价疗效、判断肝病预后,有着重要的临床意义。     

酒精性肝炎患者血清中天门冬氨酸氨基转移酶线粒体同工酶检测的诊断意义

肝脏使人体重要的生命器官之一,也是生物转化的重要器官,当肝脏受到大量的酒精刺激和侵袭时,会引起酒精性肝病[1].近年来,随着人们生活水平的提高,应酬增多,对饮酒的需求增大,由此,酒精性肝病的发病率(ALD)也逐年增加.诊断肝病的酶类有几十种,由于酶类化学反不同,分布部位不同.当肝脏发生病变时,细胞膜的通透性增加,各种酶释放入血,导致酶的活性增高.过去诊断ALD常用的生化指标如r-谷氨酰基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)等缺乏特异性.近来国内外对天门冬氨酸氨基转移酶线粒体同工酶(m-AST)的研究较多.本研究用免疫抑制法对ALD患者血清中m-AST进行了检测,并与GGT、AST、ALT、TBA等指标进行了比较,评价其对ALD的诊断价值.     

非酒精性脂肪性肝病患者血清ALT、AST与肝纤维化的关系

目的 观察血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的水平变化,分析非酒精性脂肪性肝病(NAFLD)患者发生肝纤维化的可能性。方法 86例NAFLD患者,根据影像学检查结果分为无肝纤维化组(59例)、肝纤维化组(27例)。比较两组患者血清ALT、AST及肝纤维化指标[透明质酸酶(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)]水平,采用二元Logistic回归模型分析NAFLD患者肝纤维化的影响因素,采用Pearson相关分析NAFLD患者血清ALT、AST与肝纤维化的相关性。结果 肝纤维化组患者血清FBG、ALT、AST、HA、LN、PCⅢ水平分别为(6.41±1.02)mmol/L、(93.64±10.21)U/L、(61.59±5.23)U/L、(94.64±10.25)ng/ml、(110.79±11.82)ng/ml、(119.24±12.72)ng/ml,均明显高于无肝纤维化组的(5.69±0.97)mmol/L、(71.99±10.39)U/L、(50.68±5.51)U/L、(81.04±6.01)ng/ml、(85.62±8.61)ng/ml、(...     

免疫抑制法检测肌酸激酶同工酶活性存在的问题

目的 研究免疫抑制法检测血清肌酸激酶同工酶(CK-MB)活性存在问题以及对测定结果的影响.方法 对86例非心肌梗死患者检测结果进行分析,CK为速率法,CK-MB为免疫抑制法.结果 非心肌梗死的临床血清标本中CK-MB检测值超过5%,甚至大于CK检测值.结论 可能是血清中存在巨CK、CK.BB、AK等影响试剂单克隆抗体与肌酸激酶中的M亚基结合,存在未被抑制的CK-M,M亚基同时与B亚基参加酶反应,而且因计算时结果乘以2,更加扩大误差,是该方法学缺点造成的错误结果.     

血清肌酸激酶及其同工酶、乳酸脱氢酶和天门冬氨酸氨基转移酶的测定在精神疾病中临床价值

肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LD)、天门冬氨酸氨基转移酶(AST)属于胞浆酶,广泛存在于人体的心肌、肝脏、骨骼、肌肉、肺等组织细胞中,当上述器官和组织受到损害时,细胞破坏,使细胞膜的完整性丧失,酶即释放到血液中.心肌酶检测临床上一般用于监测心肌功能状态,是心肌梗死(AMI)早期诊断和病情监测的指标[1].我们在临床检测中发现很多精神分裂症患者血清肌酸激酶CK、CK-MB、LD及AST显著增加,体现了这些酶在临床上的重要性.     

血清肌酸激酶及其同工酶、乳酸脱氢酶和天门冬氨酸氨基转移酶的测定在精神疾病中临床价值

肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LD)、天门冬氨酸氨基转移酶(AST)属于胞浆酶,广泛存在于人体的心肌、肝脏、骨骼、肌肉、肺等组织细胞中,当上述器官和组织受到损害时,细胞破坏,使细胞膜的完整性丧失,酶即释放到血液中。心肌酶检测临床上一般用于监测心     

血清总胆汁酸在慢性肝病诊断中的应用

胆汁酸是胆汁中存在的一类胆烷酸的总称,是人胆汁中的主要成分,是胆固醇经肝组织代谢的最终产物。肝脏是合成胆汁酸的唯一场所,胆道是胆汁酸排泄最主要的途径。测定血清总胆汁酸主要用于肝脏疾病的诊断,是最敏感的肝功能试验之一,血清总胆汁酸（TBA）的测定是目前研究的热点之一。本文用Olympus AU2700全自动生化分析仪及其配套试剂,监测各型肝炎病人的TBA和丙氨酸氨基转移酶（ALT）以及天门冬酸氨基转移酶（AST）,比较分析TBA在慢性肝炎中的诊断作用。     

免疫抑制法检测血清肌酸激酶同工酶活性高于肌酸激酶总活性的原因探讨

目的探讨肌酸激酶同工酶（CK-MB）活性高于肌酸激酶（CK）总活性的原因。方法免疫抑制法检测血清标本心肌型肌酸激酶同工酶（CK-MB）、肌酸激酶（CK）活性,计算二者比值。随机选取用免疫抑制法测定出现CK-MB活性高于总活性的30例患者血清、30例心肌梗死患者血清、30例健康体检者血清。对这三组标本同时用免疫抑制法测CK-MB、酶法测总CK;用电泳法分离各个组分,由扫描仪对各条酶谱进行扫描。结果 CK-MB活性高于总活性的患者血清中在CK-MM、CK-MB中间多出一条区带,为巨CK;或在CK-MM后面靠阴极端出现一条CK-MT区带。结论对于CK-MB活性高于CK总活性的患者血清,建议用其他方法进行复查,避免假阳性对实验结果的影响。     

丙氨酸氨基转移酶在血液筛查中的应用探讨

目的探讨ALT检测在血液安全筛查中的意义。方法采用前瞻性研究方法筛选出ALT单项首次检测阳性的无偿献血者,追踪分析其重复献血的血液检测结果。结果 2010～2011年955例单项ALT阳性的献血者中,再次参加献血者476例,其中,HBsAg、Anti-HCV、Anti-HIV、梅毒抗体及ALT5项均阴性者347例;不存在ALT合并其他4项传染病阳性的献血者中,ALT单项阳性者129例;重复献血1次者256例,其中ALT阳性者42例;重复2次及以上次献血者220例,其中ALT阳性者87例;油腻饮食、烟酒、疲劳、睡眠不足等非病理性因素是引起ALT升高主要原因。结论尚未发现ALT为血液检测带来任何帮助;在献血者的招募工作中,建议对2次以上ALT均不及格的献血者,需要加强健康征询干预,或者采取献血前进行ALT初筛的策略。     

血清GPDA在肝病诊治过程中的临床应用

目的：为探讨血清甘氨酰脯氨酸二酞氨基酞酶（GPDA）对肝病诊治的意义；方法：对123例住院肝病患者治疗前后血清中GPDA和谷丙转氨酶（ALT）的活力进行测定比较，结果：显示GPDA活性在各类肝病中均呈不同程度升高，与健康对照组比较有显著差异，在治疗中一个月后进行测定，GPDA活性下降不明显，而ALT活性则显著下降，结论：本研究提示GPDA在肝病患者治疗过程中更能真实反映肝脏受损情况。     

Rapid detection of benzoylecgonine in vitreous humor by enzyme immunoassay

The usual specimens submitted by a medical examiner for toxicological analysis include blood, urine, bile, vitreous humor, stomach contents, and solid-organ tissue. The detection of drugs in these specimens typically involves a combination of techniques including colorimetry, immunoassay, and gas chromatography. Although many laboratories rely principally on urine for the detection of drugs of abuse by immunoassay, these assays may be applied to other specimen types. An evaluation of Microgenics Corporation's cloned enzyme donor immunoassay (CEDIA) was conducted in order to evaluate its use in the detection of cocaine/cocaine metabolites in vitreous humor specimens. During a 14-month period, 392 vitreous humor specimens were analyzed by the CEDIA DAU Cocaine assay. Instrument parameters were set according to published manufacturer's guidelines. All presumptive positive immunoassay results prompted confirmatory testing and quantitation by gas chromatography-mass spectrometry (GC-MS) of other specimens including blood. Vitreous humor specimens were not tested by GC-MS. Using a approximately 100-ng/mL cutoff, the CEDIA assay produced 23 presumptive positive results, 22 of which were confirmed by GC-MS. The only specimen which could not be confirmed, elicited an immunoassay screen value near the cutoff limit. Routine analysis of blood, urine, bile, and/or bladder wash specimens by gas chromatography-nitrogen phosphorus detection revealed the presence of cocaine/cocaine metabolites in only 7 (31.8%) of the 22 confirmed cases. The concentration ranges of cocaine and benzoylecgonine in the blood specimens were none detected to 337 ng/mL and 17 to 8598 ng/mL, respectively. Cocaethylene was not detected in these cases. Analysis of vitreous humor specimens by CEDIA improved the detection rate of cocaine/cocaine metabolites by 0.7% in the cases submitted to our laboratory during the 14-month period.     

Sensitivity of the SRBC PFC assay versus ELISA for detection of immunosuppression by TCDD and TCDD-like congeners

The splenic antibody plaque forming cell (PFC) assay is a widely used assay in immunotoxicity testing. A recent revision of the Federal Insecticide, Fungicide and Rodenticide (FIFRA) Immunotoxicity test guidelines by the EPA recommended that either the PFC assay or the sheep red blood cell (SRBC) specific serum IgM enzyme-linked immunosorbent assay (ELISA) be used to assess the primary humoral response to SRBCs. The PFC assay quantifies the number of plasma cells in the spleen producing SRBC-specific antibody, while the ELISA measures SRBC-specific IgM antibody in the serum. Because these two assays measure different endpoints, there is a need for comparison of their sensitivity and reliability. The purpose of this project was to determine if these two assays are equally sensitive to suppression of the SRBC response in B6C3F1 female mice. Female B6C3F1 mice were given a single oral exposure to different doses of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) or four TCDD-like congeners. One week later, two sets of mice were immunized with SRBC. The first set was evaluated for the PFC response and the second for the ELISA response, on day 4 or 5 post-immunization, respectively. The four TCDD-like congeners tested were: 1,2,3,7,8-pentachlorodibenzo-p-dioxin (PeCDD), 1,2,3,4,7-pentachlorodibenzofuran (4PeCDF), 3,3',4,4',5-pentachlorobiphenyl (PCB126) and 2,3',4,4',5-pentachlrorbiphenyl (PCB118). The results were used to generate dose-response curves for the determination of the ED(50) for TCDD and each TCDD-like congener. For all chemicals tested, measuring the level of SRBC-specific IgM antibody by ELISA was more sensitive than the PFC assay to detect immunosuppression, as indicated by lower ED(50) values. These results indicate that the SRBC-specific IgM ELISA is a more sensitive assay for detecting the T-cell mediated immunotoxicity of dioxin-like chemicals in this rodent model.     

异甘草酸镁联合门冬氨酸钾镁治疗慢性乙型肝炎的临床观察

目的观察异甘草酸镁注射液治疗慢性乙型肝炎的临床疗效。方法340例慢性乙型肝炎患者完全随机分为3组,异甘草酸镁组130例,甘利欣组126例,门冬氨酸钾镁组84例,异甘草酸镁组静脉滴注异甘草酸镁注射液150mg／d＋门冬氨酸钾镁注射液20ml／d;甘利欣组静脉滴注甘利欣注射液50mg/d＋门冬氨酸钾镁注射液20ml／d;门冬氨酸钾镁组静脉滴注门冬氨酸钾镁注射液20ml／d。观察3组患者的症状、体征以及肝功能的变化,并测定治疗前后的TBIL、AST、ALT。结果治疗30d后异甘草酸镁组TBIL、AST、ALT分别为（28±15）umol／L,（38±35）U／L,（39±38）U／L,甘利欣加门冬氨酸钾镁组分别为（56±29）umol/L,（95±74）U／L,（117±81）U／L,门冬氨酸钾镁组（67±52）umol／L,（122±92）U／L,（269±106）U／L。结论异甘草酸镁联合门冬氨酸钾镁注射液较甘利欣联合门冬氨酸钾镁用药降酶作用显著,转氨酶反跳现象极少见。     

Comparison of two methods for proteolytic enzyme detection in snake venom

An acrylamide gel system containing fibrinogen was used to detect proteolytic enzymes in snake venoms. Proteolytic activity was observed as a clear area on a blue background after electrophoresis and overnight incubation in Tris buffer, prior to staining with Coomassie blue. Venoms from eastern and western diamondback and west coast Mexican rattlesnakes, Crotalus adamanteus, C. atrox and C. basiliscus basiliscus, respectively, and southern copperhead, Agkistrodon contortrix contortrix, were analyzed at the level of 1 mg of venom. The effect of the serine proteinase inhibitor diisopropylfluorophosphate (DFP) and the metalloproteinase inhibitors tetraethylenepentamine (TEP) or EDTA on fibrinogen and normal gel profiles were evaluated. Normal gels (without fibrinogen) were Coomassie stained to visualize migration of 250 micrograms of venom proteins on the gels. Several proteolytic enzymes detected in C. atrox and C. b. basiliscus venoms were inhibited by TEP, whereas DFP had no effect on activity. The fibrinogen gels detected no protease activity in C. adamanteus venom, although it is known from other studies that there are several proteolytic enzymes in this venom. Several proteases were detected in A. c. contortrix venom, one of which was inhibited by TEP. By comparison, proteolytic activity in 5-10 micrograms of all venoms was readily detected using the mammalian plasma kallikrein specific chromogenic substrate, S2302 (H-D-Pro-Phe-Arg-p-nitroanilide). The fibrinogen gel method does not appear to have the specificity nor the sensitivity of the recently developed chromogenic substrates for detection of proteolytic enzymes in snake venom.     

MDSCs在脓毒症免疫抑制中的机制研究进展

髓源性抑制细胞（MDSCs）是一群异质性、具有免疫抑制功能的未成熟髓样细胞。常在肿瘤免疫逃避机制的研究中被提及,除此之外,MDSCs还参与慢性炎症、感染、自身免疫性疾病、创伤等疾病的免疫调节。最近研究发现,MDSCs在脓毒症的发病机制中也起着关键作用。脓毒症是由于宿主对感染的免疫反应失调而导致危及生命的器官功能衰竭。有研究表明,与脓毒症幸存者相比,非幸存者的淋巴细胞显著减少。在脓毒症发病早期,MDSCs被招募到炎症部位,起到抑制炎症的作用;然而,如果MDSCs数量增多及其组织浸润持续存在,可导致显著的病理生理学改变（如淋巴细胞减少、宿主免疫抑制和免疫瘫痪）,从而导致患者病情快速进展甚至愈后恶化。由此可见,MDSCs为脓毒症患者淋巴细胞减少提供了新的见解,现已成为脓毒症研究的一个新兴课题,并可能为脓毒症患者提供新的治疗靶点。本文综述了MDSCs的生物学特征及其在脓毒症免疫抑制中的作用机制,以期为脓毒症的基础研究和临床治疗提供新的靶点和思路。