胆道感染菌群与胆结石术后丙氨酸氨基转移酶变化的研究

[目的]了解广西地区胆结石并感染病人胆汁中不同菌属致病菌与术后丙氨酸氨基转移酶恢复的关系,探讨术后护理方法,总结护理措施。[方法]回顾性分析2008年10月-2010年9月在我院住院并手术的100例胆结石感染病人,根据术中胆汁培养结果分为革兰阳性菌组与革兰阴性菌组。用重复测量方差分析病人术后第1天、第3天、第5天和第7天的丙氨酸氨基转移酶变化。[结果]革兰阳性菌组和革兰阴性菌组与术后丙氨酸氨基转移酶恢复无交互作用。[结论]胆道感染病人术后肝功能恢复缓慢,护士配合医生在应用敏感抗生素基础上减少和避免应用损伤肝细胞的药物对病人的早日康复有积极的作用。     

胆结石并胆道感染菌群与术后胆红素变化规律的护理研究

[目的]了解胆结石并胆道感染病人胆汁中不同菌属致病菌与术后胆红素恢复的关系。[方法]回顾性分析2008年10月—2010年9月在我院住院手术的100例胆结石并胆道感染病人,根据术中胆汁培养结果分为革兰阳性菌组与革兰阴性菌组,对病人术后第1天、第3天、第5天和第7天的总胆红素、直接胆红素、间接胆红素进行两因素重复测量的方差分析。[结果]革兰阳性菌组和革兰阴性菌组与术后胆红素恢复无交互作用。[结论]胆道感染病人术后胆红素恢复缓慢;应加强对革兰阴性菌感染病人的术后护理,减少和避免应用对肝细胞有损的药物,促进病人早日康复。     

胆结石并胆道感染茵群与术后胆红素变化规律的护理研究

[目的]了解胆结石并胆道感染病人胆汁中不同菌属致病菌与术后胆红素恢复的关系。[方法]回顾性分析2008年10月一2010年9月在我院住院手术的i00例胆结石并胆道感染病人,根据术中胆汁培养结果分为革兰阳性菌组与革兰阴性菌组,对病人术后第1天、第3天、第5天和第7天的总胆红素、直接胆红素、间接胆红素进行两因素重复测量的方差分析。[结果]革兰阳性菌组和革兰阴性茵组与术后胆红素恢复无交互作用。[结论]胆道感染病人术后胆红素恢复缓慢;应加强对革兰阴性菌感染病人的术后护理,减少和避免应用对肝细胞有损的药物,促进病人早日康复。     

胆结石并胆道感染不同菌群术后切口愈合情况的临床研究

[目的]了解广西地区胆结石并感染病人胆汁中不同菌属致病菌的术后切口愈合情况。[方法]分析2008年10月—2010年9月在我院住院并手术的100例胆结石感染病人,根据术中胆汁培养结果分为革兰阳性菌组与革兰阴性菌组,比较两组术后切口情况。[结果]两组术后切口感染、切口裂开、切口愈合等级及术后其他并发症无统计学意义;革兰阳性菌组术后更换无菌敷料次数少于革兰阴性菌组;革兰阳性菌组术后拆线时间早于革兰阴性菌组。[结论]根据胆结石并感染病人胆汁中不同菌属致病菌运用敏感抗生素,加强术后护理,以避免切口感染,促进术后切口早日愈合,减少术后其他并发症的发生。     

胆结石感染菌群与术后T型管护理的临床研究

目的了解广西地区胆结石感染患者胆汁不同致病菌与术后T管引流量、引流液颜色及拔管时间的关系,探讨术后护理方法。方法回顾性分析2008年10月～2010年9月我院住院并手术的100例胆结石感染患者,根据术中胆汁培养结果分为G+菌组和G-菌组。对两组患者术后T管引流液量、颜色、拔管时间进行分析。结果两组术后T管引流量及引流液颜色比较无统计学意义;G+菌组术后拔T管时间早于G-菌组(P<0.05)。结论胆道感染不同致病菌与术后拔T管时间有一定的关系;胆汁引流量和引流液颜色对于胆道感染菌群鉴别有待加大样本量进行更深入的研究。     

丙氨酸氨基转移酶活性临界值的研究

目的初步探讨建立宁夏血液中心实验室血液筛查丙氨酸氨基转移酶(ALT)活性的临界值。方法使用自动生化分析仪对241名符合《献血者健康检查要求-GB 18467》要求的无偿献血者的血浆ALT活性进行检测,其中男性121名,女性120名,依据美国临床实验室标准化协会(CLSI)C28-A2文件要求进行分析。结果血浆ALT活性在男性、女性2组间差异具统计学意义(P<0.01),男性高于女性;本实验室的血浆ALT活性的临界值,男性为57 U/L,女性为40 U/L。结论血站实验室应使用自己的检测系统按照性别分组建立ALT活性临界值标准,科学地判定血液的"合格"与"报废"。     

丙氨酸氨基转移酶测定的质控与参考值调查

本文连续监测（３７℃）调查无锡地区３９４名２０～５０岁健康人（男１９４人，女２００人）的ＡＬＴ参考值。用质量控制的方法，保证调查结果的可信度，采用质量控制及格实验室的数据，经统计分析，两种试剂之间无显著性差异（Ｐ〉０．２）。男性高于女性，男女之间有显著性差异（Ｐ〈０．０１）。综合调查结果，提出无锡地区健康人成ＡＬＴ正常参考值，男８～５０Ｕ／Ｌ，女７～４５Ｕ／Ｌ。     

丙氨酸氨基转移酶检测方法确认

目的对献血者的丙氨酸氨基转移酶(ALT)采用速率法进行检测,并对这种方法进行性能验证,证明其满足ISO15189的要求。方法按照CNSA-CL02:2012《医学实验室质量和能力认可准则》及《血站技术操作规程》(2012版)的要求对检测系统的精密度、正确度、灵敏度、可报告范围、生物学参考区间以及测量不确定度进行验证。结果 ALT质控血清和两个浓度献血者标本检测20次和20d的批内不精密度5.0%,批间不精密度6.7%;正确度估计通过2014年的原卫生部室间质评结果分析和校准品结果分析,相对偏倚均小于1/2CLIA′88允许总误差;可报告范围用直线回归得到回归方程Y=0.995 1 X-5.618 4,r=0.999 7(R2=0.999 4),该检测范围内结果准确;生物学参考区间为0.0~32.7U/L;测量不确定度为(74.90±3.32)U/L。结论 ALT检测方法的性能指标均符合ISO15189的预期要求,该方法可以作为实验室的血液筛查检测方法。     

昆明地区健康成人血清丙氨酸氨基转移酶及天门冬氨酸氨基转移酶参考区间调查

目的建立昆明地区健康成人血清丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）的生物参考区间。方法按照美国临床和实验室标准协会（CLSI）C28-A2文件推荐的间接抽样法,选取昆明市第一人民医院2010年5月至2011年3月的健康体检者共9 890例,用奥林巴斯AU5421全自动生化分析仪对ALT和AST进行检测,用Stata 11对检测结果进行统计分析。结果各项指标的参考区间（≤P95）如下：男性ALT≤51U/L,女性ALT≤34U/L;男性AST≤40U/L,女性AST≤35U/L。ALT和AST水平随年龄增长大体呈升高趋势,在男性组中,30～40岁组的ALT水平最高。结论昆明地区ALT和AST的参考区间明显不同于参考书或其他地区的参考区间,因此建立本实验室ALT和AST的生物参考区间非常必要。     

丙氨酸氨基转移酶测定波长设置的实验研究

目的观察波长设置对含有不同干扰物丙氨酸氨基转移酶（ALT）标本测定的影响。方法对NADH纯品溶液、试剂样本及含不同干扰物的样品进行全波长扫描。依据吸收曲线设定不同的副波长,然后对含不同干扰物的定值血清进行测定,以定值血清所给的值为参照,确定最佳波长组合。结果定值血清测量结果,单波长340nm与双波长（340/380nm,340/404nm）差异无统计学意义（P〉0.05）;血红蛋白（Hb）和胆红素（BIL）干扰的ALT标本,340/404nm测定结果与靶值差异无统计学意义（P〉0.05）,340/380nm测定结果与靶值差异有统计学意义（tHb=2.144,PHb=0.042〈0.05;tBIL=2.453,PBIL〈0.05）;血脂（TG）干扰的ALT标本340/380nm测定结果与靶值差异无统计学意义（P〉0.05）,而340/404nm测定结果与靶值差异有统计学意义（t=-3.338,P〈0.01）。结论利用单波长即可准确测得低干扰程度丙氨酸氨基转移酶（ALT）标本的活性。若采用双波长时应视标本干扰物的种类而选择不同双波长,溶血、黄疸干扰应选择340/404nm,血脂干扰应选择340/380nm。     

Stability of aspartate aminotransferase and alanine aminotransferase activities

Because there are conflicting data regarding the effect of different temperatures and durations of storage on the stability of the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), a new study has been conducted to re-examine this important issue. Blood obtained from patients with varying aminotransferase levels was centrifuged, the resultant serum was divided into aliquots, the samples were stored at room, refrigerator, and freezer temperatures, and the aminotransferases measured on days 0, 1, 2, 3, 4, and 30. In all but one circumstance, both AST and ALT activities declined markedly beginning within 24 hr of venipuncture; the temperature of storage did not significantly affect the rate or degree of loss of enzyme activity. The exception was the evidence that ALT activity in samples obtained from individuals with initially normal values showed a rise during the first 3 to 4 days, followed thereafter by a decline to below baseline values. Thus, to ensure accuracy of aminotransferase measurement, testing of samples should be conducted on the day of venipuncture.     

血清谷氨酸氨基转移酶与高尿酸血症的相关性分析

目的分析血清谷氨酸氨基转移酶(ALT)升高与高尿酸血症发生的相关性。方法以69例高尿酸血症患者为观察组,以60例健康人群为对照组;分别对两组对象的血清ALT和血清尿酸(SUA)水平进行检测,对观察组患者的血清炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)]及脂肪因子[血清游离脂肪酸(FFA)、血清脂联素(APN)]水平进行检测。统计两组对象ALT升高的发生率,对比分析不同ALT升高程度下观察组患者血清炎性因子及脂肪因子的水平。结果观察组患者ALT升高的发生率及ALT水平均高于对照组(P0.05)。针对观察组患者,在SUA水平上,ALT重度升高组、中度升高组、轻度升高组、未升高组依次升高(P0.05);在血清TNF-α、CRP、IL-6及FFA水平上,ALT重度升高组、中度升高组、轻度升高组、未升高组依次升高(P0.05),在血清APN水平上,重度升高组、中度升高组、轻度升高组、未升高组依次降低(P0.05)。结论血清ALT升高与SUA的发生密切相关,二者指标变化趋势一致,相互影响,而影响机制可能与血清炎性因子及脂肪因子的改变有关。     

Influence of viral load and alanine aminotransferase on viral genetic heterogeneity in patients with chronic hepatitis C virus infection

BACKGROUND/AIM: Hepatitis C virus (HCV) populations in vivo consist of genetically different heterogeneous mixtures defined as 'quasispecies', which vary in the hypervariable region 1 (HVR1) mostly. To further address the role of quasispecies diversity in hepatitis C infection, this study aimed to evaluate the influence of ALT, viral load and genotypes on quasispecies heterogeneity in patients with HCV infection. METHODS: Thirty-six chronic hepatitis C patients with high levels of alanine aminotransferase (ALT) were studied. None of them received any antiviral therapy. HCV RNA serum levels, genotype and genetic heterogeneity were determined by branched-chain DNA assay, restriction fragment length patterns and RT-PCR single-strand conformational polymorphism analysis of HVR1, respectively. RESULTS: Twenty-eight patients had genotype 1b (28/36; 78%), 6 patients had genotype 1a (6/36; 17%), 1 patient was 2a (1/36; 3%) and genotype could not be determined in 1 patient. The patients were categorized into two groups according to the number of bands representing the dominant strains in the circulation: group A with 2 bands having 1 strain (14/36 patients; 39%) and group B with more than 2 bands indicating more than 1 strain (22/36 patients; 61%). The serum viremia and ALT levels for these groups were 11 +/- 8.8 and 5.3 +/- 4.6 mEq/ml (p < 0.05), and 79 +/- 20, and 127 +/- 80 IU/l (p < 0.05), respectively. CONCLUSION: The results of this study suggest that hepatitis C patients having 1 dominant strain in the circulation may show a relatively weaker immune response resulting in lower ALT and higher viremia levels, whereas patients with high degrees of virus quasispecies diversity have higher ALT levels and a more active immune response causing the selection of new genome variants and depressing viral replication partly.     

Optimization of methods for aspartate aminotransferase and alanine aminotransferase.

Conditions for accurate measurement of catalytic activity of aspartate aminotransferase and alanine aminotransferase in human serum have been reinvestigated. The basic variables (kind of buffer, buffer concentration, pH, ion effects, and the influence of pyridoxal-5-phosphate) can now be considered optimized. On this basis, the kinetic parameters of both aminotransferases were determined, i.e., Michaelis and inhibitor constants for substrates and reaction products. With a mathematical approach for two-substrate enzyme reactions the substrate concentrations were calculated from the viewpoints "most economical," "most convenient," and "lowest variability." Also the conditions for the indicator reactions have been newly defined with respect to a kinetic model. All calculated data were rechecked experimentally and it can be shown that both approaches fully agree. Furthermore, we show that the mathematical approach allows more precise recommendations for optimized methods. For technical reasons, the catalytic activity of aspartate aminotransferase in human serum can only be measured as a 0.96 fraction of its theoretical maximum velocity, the catalytic activity of alanine aminotransferase as a 0.91 fraction. The assay conditions for a Reference Method are finally described and recommendations are made for optimized routine methods for determination of the catalytic activity of these transferases in human serum.     

双腔"T"型管在肝胆管结石患者术后行胆道冲洗中的效果观察

目的 探讨双腔"T"型管在肝胆管结石患者术后行胆道冲洗及注药的效果,探索更为规范、高效、安全的胆道冲洗及注药、胆汁引流方法.方法 2014年5月~2015年7月收治的100例肝胆管结石患者行开腹胆道探查取石、"T"管引流手术.按照放置"T"管类型不同,随机分为治疗组(放置双腔"T"型管)和对照组(传统"T"管),各50例.记录并比较两组患者术后胆道冲洗平均耗时、冲洗液外滴、冲洗胀痛感、冲洗后寒颤高热、胆道造影后寒颤高热、结石残留率、患者满意度评分等指标.结果 治疗组胆道冲洗平均耗时(6.32±2.70)min,对照组(17.67±3.23)min;治疗组冲洗液外滴3例,对照组40例;治疗组冲洗时胀痛感7例,对照组23例;治疗组冲洗后寒颤高热1例,对照组13例;治疗组胆道造影后寒颤高热2例,对照组11例;治疗组患者满意度评分(99.17±1.37)分,对照组(91.21±4.35)分,以上指标比较差异均有统计学意义 (P<0.05).治疗组术后结石残留患者23例,对照组31例,差异无统计学意义 (P>0.05).结论 双腔"T"型管引流手术后,患者胆汁引流畅通、胆道冲洗及注药安全,能降低胆道感染及结石残留,减轻患者痛苦,提高患者满意度,促进患者术后早日康复,值得临床推广应用.