Serum chemistry templates of disease in liver, pancreas, and gallbladder.

On routine hospital admission, 23,714 patients received a 28-test serum metabolic profile. The 33 most common diseases (4,132 patients) of liver, pancreas, and gallbladder (LPG) had unique chemical templates averaging 15 significant serum deviations. Each LPG disease differed from all others by elevations of both leucine-aminopeptidase (LAP) and alkaline phosphatase (AP) levels. LAP level was low or normal and serum glutamic oxaloacetic transaminase (SGOT) and AP levels were elevated in 43 non-LPG diseases. Patients with acute and chronic pancreatitis had elevated amylase levels. The four nonmalignant diseases of the gallbladder were associated with normal levels of amylase and lactic dehydrogenase (LDH); except for silent cholelithiasis, each showed elevated total bilirubin (BIL) levels. Patients with solitary or scattered lesions of the liver had normal bilirubin levels (2,115 patients), and those with diffuse interstitial or parencymal disease had elevated BIL levels. Cancer patients had elevated LDH and alpha1 globulin (A1G) levels, but low albumin levels. The importance of comprehensive liver profiles in the treatment of psychoses is emphasized by significant liver damage in a number of these patients. A1G was normal and LDH was elevated in patients having mononucleosis, hepatitis, lupus erythematosus, alcoholism, and alcoholic cirrhosis.     

Primary cytomegalovirus infection and liver involvement in early infancy.

Virus isolation and determination of serum transaminase activity in 237 patients under one year of age were undertaken to clarify the etiologic significance of primary infection with cytomegalovirus (CMV) in infancy. The rates of virus recovery from infants with liver involvement were 37% (29/78) and 42% (28/66), as determined by serum glutamic oxaloacetic (S-GOT) and serum glutamic pyruvic (S-GPT) transaminase values. In contrast, CMV was recovered from 14% (18/127) and 13% (18/141) of infants with normal S-GOT and S-GPT values. The differences in the rates of virus recovery between both groups were more pronounced in infants under three months of age, that is, 5 to 7 times higher rates in infants with liver involvement. Correlation between complement-fixing antibody and liver involvement, however, was not significant, probably because of the influence by maternal antibody. Majority of infants infected with CMV are postulated to involve liver during immediate months after onset of virus excretion.     

Iron status and liver function in healthy adults: a multiracial pilot study

We tested 157 apparently healthy, urban adults (78 black, 40 nonblack, 39 race not designated), and found that 7.7% of the entire group had high plasma ferritin levels (6.4%) or transferrin saturation levels (1.3%). Overall, men had significantly higher mean plasma ferritin, serum glutamic pyruvic transaminase, and total serum bilirubin values than women. In this study 17.6% of black men had high plasma ferritin levels and another 11.8% had high transferrin saturation levels. Their mean serum iron and transferrin saturation levels were significantly higher than those of nonblack men. Black men had significantly higher mean serum iron, transferrin saturation, plasma ferritin, serum glutamic pyruvic transaminase, and total serum bilirubin levels than black women. The same tests were not significantly different when black and nonblack women were compared. Likely causes of the laboratory abnormalities are occult inflammation and occult liver disease, but a primary disorder of iron metabolism is also possible.     

Albumin synthesis in cirrhotic subjects with ascites studied with carbonate-14C

The synthesis of serum albumin was measured in 19 patients with cirrhosis of the liver and ascites. Carbonate-(14)C was used to label the guanido carbon of arginine in albumin.18 of the patients had the diagnosis of cirrhosis confirmed by biopsy and/or by the presence of esophageal varices. Seven patients with albumin synthesis rates of 42-105 mg/kg per day demonstrated the lowest serum cholesterol esters and highest serum glutamic oxalacetic transaminase (SGOT) levels, while the seven patients whose albumin synthesis rates ranged from 203-378 mg/kg per day, had significantly higher cholesterol ester levels and significantly lower values for SGOT. The serum albumin levels were equally depressed in all patients.In patients with cirrhosis and ascites albumin production was found to be normal or elevated in seven of the 19 subjects, and only markedly depressed in seven patients, in spite of the fact that the serum albumin level was depressed in all patients.     

Hemoglobinemia in heroin overdose patients.

Four heroin-overdosed patients presented with coma, elevated serum enzymes (creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT), and increased levels of plasma free hemoglobin. In two patients marked myoglobinuria was also detected. The plasma free hemoglobin returned to normal levels by the 3rd hospital day. Since coma may eventuate in compression of muscles, we suggest that the disruption of erythrocytes occurs as they traverse these ischemic areas.     

Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children

BACKGROUND: Blunt abdominal trauma in children can result in injury to the liver. In hemodynamically stable patients, initial evaluation of liver transaminase levels may be useful in determining the need for computed tomography (CT). METHODS: We reviewed the medical records of 44 hemodynamically stable children who had abdominal CT and who also had liver enzyme determinations as the initial workup. RESULTS: Liver enzymes were found to be elevated in all but one patient with CT confirmed hepatic injury. The sensitivity and specificity of elevated liver enzyme levels were 92.9% and 100%, respectively, for predicting liver injury. CONCLUSION: When hemodynamically stable pediatric patients with blunt abdominal trauma have AST levels >400 and/or ALT levels >250 IU/L, abdominal CT is indicated. Children in this study with serum transaminase levels below these values were at decreased risk of liver injury.     

Drug-induced liver injury following a repeated course of ketamine treatment for chronic pain in CRPS type 1 patients: a report of 3 cases

Studies on the efficacy of ketamine in the treatment of chronic pain indicate that prolonged or repetitive infusions are required to ensure prolonged pain relief. Few studies address ketamine-induced toxicity. Here we present data on the occurrence of ketamine-induced liver injury during repeated administrations of S(+)-ketamine for treatment of chronic pain in patients with complex regional pain syndrome type 1 as part of a larger study exploring possible time frames for ketamine re-administration. Six patients were scheduled to receive 2 continuous intravenous 100-hour S(+)-ketamine infusions (infusion rate 10-20 mg/h) separated by 16 days. Three of these patients developed hepatotoxicity. Patient A, a 65-year-old woman, developed an itching rash and fever during her second exposure. Blood tests revealed elevated liver enzymes (alanine transaminase, alkaline phosphatase, aspartate transaminase, and γ-glutamyl transferase, all ?3 times the upper limit of normal) and modestly increased eosinophilic leukocytes. Patient E, a 48-year-old woman, developed elevated liver enzymes of similar pattern as Patient A during her second ketamine administration and a weakly positive response to antinuclear antibodies. In a third patient, Patient F, a 46-year-old man, elevated liver enzymes (alanine transaminase and γ-glutamyl transferase) were detected on the first day of his second exposure. In all patients, the ketamine infusion was promptly terminated and the liver enzymes slowly returned to reference values within 2 months. Our data suggest an increased risk for development of ketamine-induced liver injury when the infusion is prolonged and/or repeated within a short time frame. Regular measurements of liver function are therefore required during such treatments.     

Aminotransferase changes in burned patients

The time course of serum transaminases (alanine aminotransferase and aspartate aminotransferase) has been followed in 30 selected consecutive patients presenting burn sizes ranging from 10% to 95% of the total body surface (mean 43.13) and a survival index from 0.99 to 0.00 (mean 0.59). The results show that in all the patients both transaminases change in parallel, increasing in 18 patients (60%). In nearly all patients both enzymes increase during the second week after injury and aspartate aminotransferase increases later than alanine aminotransferase. The higher transaminase levels are noted in moderately ill patients. No clear correlation between the overall increase of transaminases and the extent of burned surface area has been found. We conclude that functional liver alterations mostly contribute to the increase of serum transaminases in burns.     

Serum CA 125 levels and lymph node metastasis in patients with endometrial cancer

The aim of this study was to evaluate the correlation of preoperative serum CA 125 levels and lymph node metastasis in patients with endometrial cancer. Preoperative levels of serum CA 125 were determined in 64 patients with endometrial cancer treated with total abdominal hysterectomy with a lymph node dissection as initial therapy. Lymph node status, determined by histopathology, was correlated with both normal and elevated CA 125 levels, determined preoperatively. A serum CA 125 level of >30 IU/ml was considered elevated. There were five patients (7.8%) with pelvic or paraaortic lymph node metastases and 59 patients (92.2%) without nodal metastases. In all five patients with lymph node metastases, serum CA 125 was within normal limits. Preoperative serum CA 125 levels were above normal in eight lymph node-negative patients. In the remaining group of 51 node-negative patients, serum CA 125 levels were within normal limits. Among the five lymph node-positive patients, four had endometrioid and one had serous papillary cancer. One patient had histologic grade 2 tumor and four patients had histologic grade 3. Preoperative serum CA 125 levels do not offer any information for predicting lymph node metastasis in patients with endometrial cancer.     

Safety and efficacy of combined gemfibrozil-lovastatin therapy for primary dyslipoproteinemias

In 25 patients with primary dyslipoproteinemias and severe premature atherosclerosis, during an average combined Lopid-Mevacor treatment span of 12.5 months per patient, our specific aim was to assess safety and efficacy of open-label therapy with diet, gemfibrozil (Lopid), and lovastatin (Mevacor). Because targeted lipid values were not reached on diet alone (low-density lipoprotein cholesterol [LDLC] less than 120 mg/dl, high-density lipoprotein cholesterol [HDLC] greater than 35 mg/dl or total cholesterol [TC]/HDLC less than 4.5), the patients received Lopid, 1.2 gm/day as their initial lipid-lowering drug. Because targeted lipid levels were not reached with Lopid treatment alone after 3 or more months, Mevacor was added, with 17 subjects receiving 20 mg/day, five receiving 40 mg, two receiving 60 mg, and one receiving 80 mg. Outpatient visits were repeated during combined therapy every 6 to 8 weeks, with an average of 6.4 visits per subject, 162 measurements of fasting lipids and liver function tests, and 127 measurements of creatine phosphokinase (CPK). By selection, all patients had normal liver function (gamma-glutamyltransferase, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT) levels) and normal CPK levels at baseline. No gamma-glutamyltransferase levels were high during combined therapy. Of the 162 liver function test measurements, five (3.1%) SGOT levels and three (1.9%) SGPT levels were high. Of 127 CPK measurements, three (2.4%) were high; one subject had a high CPK measurement, and one subject had two high measurements for CPK. No symptomatic myositis or myalgias developed in the subjects; none had palpable skeletal muscle tenderness.(ABSTRACT TRUNCATED AT 250 WORDS)     

阻塞性睡眠呼吸暂停低通气综合征患者肝功能损害研究

目的 探讨中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、胆固醇(TC)、甘油三酯(TG)、血管内皮生长因子(VEGF)及部分患者经鼻持续正压通气(nCPAP)治疗后的变化及意义.方法 研究经多导睡眠监测仪(PSG)确诊的59例OSAHS患者及28例健康对照血清ALT、AST、TC、TG、VEGF水平及13例经nCPAP治疗后的患者血清VEGF水平,并监测患者呼吸紊乱指数(AHI)、血氧饱和度《90%的时间(SIT90)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)等睡眠指标.结果 OSAHS患者根据AHI分为中、重两组.健康对照组与OSAHS中度、重度组比较血清ALT、AST、TC、TG、VEGF水平,差异均有统计学意义(P均《0.01).OSAHS患者其血清ALT、AST水平与MSaO2呈负相关,与VEGF呈正相关(相关系数分别为-0.137,-0.245,0.101,0.115,P均《0.01).13例重度OSAHS患者nCPAP治疗3个月后血清ALT(37±7)U/L、AST(24±5)U/L、TC(1.51±0.14)mmo/L、VEGF水平(520±90)ng/L,治疗前ALT(65±18)U/L、AST(52±4)U/L、TC(1.82±0.12)mmol/L、VEGF(704±93)ng/L,治疗前后差异有统计学意义(P《0.01).结论 OSAHS患者夜间反复低氧血症可能影响肝脏功能从而引起ALT、AST,TC、TG血清水平升高,经nCPAP治疗后,血清ALT、AST、TC水平下降亦证实反复低氧参与肝脏功能损害.     

儿童噬血细胞性淋巴组织细胞增生综合征13例实验室诊断分析

目的分析儿童噬血细胞性淋巴组织增生综合征(HLH)实验室诊断指标的改变及其原因,帮助临床快速准确的诊断。方法回顾性分析2011年1月至2013年3月该院收治的13例HLH患者的实验室诊断资料。结果 HLH首发症状常为发热,肝、脾及淋巴结肿大,继而全血细胞减少,肝功能及凝血功能不同程度异常,骨髓组织细胞增多,可见噬血组织细胞。外周血细胞二系减少者占23.1%,三系减少者占69.2%,三酰甘油(TG)升高者占69.2%,血清铁蛋白(SF)升高者占100.0%,乳酸脱氢酶(LDH)升高者占100.0%,丙氨酸氨基转移酶(ALT)升高者占69.2%,纤维蛋白原(FIB)下降者占76.9%。结论对不明原因持续高热,肝、脾及淋巴结肿大,外周血细胞二系或三系降低患儿均应进行HLH的一系列相关检查如肝功能、血脂、血凝、细胞免疫学及骨髓细胞形态学等初步诊断和判断预后,有条件者应进一步进行分子生物学检测以确诊。     

肝脏酶谱检测在诊断肝病中的应用及其临床意义

目的探讨肝病患者血清中肝脏酶谱酶活性单位变化的临床特点及其对诊断该病的临床意义。方法选择2007年1月至2010年12月收治的200例肝病患者为观察组,另外选取同期84例健康体检者为对照组,观察比较两组样本血清中天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、1-谷氨酰氨基转移酶（y—GT）和5’-核苷酸酶（5’-NT）的水平表达及其与肝病之间的关系。结果观察组各种肝病患者血清中的这5种酶均高于对照组,其中急性肝炎、肝硬化、原发性肝癌以及部分其他肝病患者的这5种酶活性单位均显著高于对照组（P〈0．05）,慢性肝炎和酒精性肝炎略高于对照组。结论肝病患者血清中肝脏酶谱的表达水平与其肝病类型有一定的相关性,可以根据血清中肝脏酶谱水平的变化来判断患者是否有肝功能损害。     

MR imaging enhancement with superparamagnetic iron oxidein chronic liver disease: influence of liver dysfunction andparenchymal pathology

Purpose: To analyze the influence of liver dysfunction and parenchymal pathology on the accumulation of superparamagnetic iron oxide (SPIO). Methods: We evaluated MR images of 13 patients having small hepatic neoplasms before and after administration of SPIO (10 μmol/kg). Biopsy and laboratory data confirmed the presence of severe cirrhosis in two patients, mild cirrhosis in four, chronic hepatitis in five, and normal livers in two. Degrees of liver dysfunction or liver parenchymal pathology were correlated with reductions in signal intensity of the liver and spleen after administration of SPIO. Signal intensity reduction was evaluated using a 1.5 Tesla MR unit. Results: Response to SPIO of the liver and spleen did not correlate with liver parenchymal pathology, although reductions in signal intensity of the liver were somewhat small in severely cirrhotic livers. There were slight correlations between signal intensity alterations of the liver and laboratory data such as the indocyanine green retention rate (correlation coefficient 0.47), albumin (0.36), total bilirubin (0.36), and serum glutamic oxaloacetic transaminase (GOT) (0.46). Signal intensity reduction of spleen did not correlate with liver function tests except for serum GOT. In patients with cirrhosis, heterogeneous structures were detected in the nontumorous portions of the liver. However, these did not prevent the diagnosis of small hepatomas. Conclusion: The uptake of SPIO showed some correlation with liver function but not with chronic liver parenchymal pathology. SPIO provided sufficient contrast between tumor and surrounding liver parenchyma among patients with chronic liver disease. Received: 22 August 1994/Accepted after revision: 27 January 1995     

Changes in serum enzyme activity after transcatheter arterial embolization for hepatic neoplasm

We assayed serum levels of certain enzymes and tumor markers in patients after transcatheter arterial embolization (TAE) to evaluate the effectiveness of this treatment. Twenty patients had hepatocellular carcinoma and two patients had metastases to the liver from colon cancer. Assays were first done immediately after TAE and were continued for the next 12 days. Glutamic oxaloacetic transminase (GOT; EC 2.6.1.1, -aspartate:2-oxoglutarate aminotransferase), glutamic pyruvic transaminase (GPT; EC 2.6.1.2, -alanine:2-oxoglutarate aminotransferase), and lactate dehydrogenase (EC 1.1.1.27; (S)-lactate:NAD⁺ oxidoreductase) peaked 24 to 48 h after TAE and returned to the base lines in 7 to 10 days. Mitochondrial GOT (mGOT) and glutamate dehydrogenase (GLDH; EC 1.4.1.2, -glutamate:NAD⁺ oxidoreductase) also peaked at the same time after TAE. -Fetoprotein peaked 2 h after TAE and decreased to half of the baseline on day 7. Carcinoembryonic antigen peaked at 24 h and fell at 48 h only in the patients with colon cancer. The total amount of cytosolic GOT, GPT, mGOT, and GLDH released was correlated to the volume of the necrotic mass estimated by computed tomography scans. The correlation coefficients for mGOT and GLDH were r = 0.919 and r = 0.939 (both p < 0.001), respectively. Assays of mGOT and GLDH may be useful to estimate the volume of the necrotic mass of a hepatoma or metastatic carcinoma in the liver.     

Guidelines for serological testing in the diagnosis of acute hepatitis A and B

This study was performed to determine whether elevation of serum transaminases can be used to eliminate unnecessary serological tests to diagnose acute hepatitis A (HAV) and acute hepatitis B (HBV). Serum samples of 1226 patients were tested for HBsAg, anti-HBc (IgM), and anti-HAV (IgM). Acute hepatitis was diagnosed in 113 (9.2%) patients; 75 were serologically positive for HAV, 36 for HBV, and 2 patients for both HAV and HBV. Serum transaminase levels were elevated in 104 of 107 (97.2%) of seropositive patients in whom the results of biochemical tests were available. A review of the medical records of seropositive patients with normal transaminases revealed that each of the three HAV patients had a remote history of hepatitis. None of the seropositive patients with a recent history of acute viral hepatitis had normal transaminase levels. During this period, serological tests were ordered in 266 of 1054 (25.2%) seronegative patients with normal serum transaminases. We conclude that serum transaminase levels can be reliably used to screen sera for acute HAV and HBV infection.     

Imaging diagnosis of hepatic metastases of pancreatic carcinomas: significance of transient wedge-shaped contrast enhancement mimicking arterioportal shunt

We aimed to evaluate the imaging findings of hepatic metastases from pancreatic cancers, especially wedge-shaped enhancement and its etiology. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients. Liver metastases were multiple in 84 patients (97%) and solitary in only three (3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinomas on dynamic CT and/or dynamic MR imaging. In 37 patients, more than one metastatic lesion showed wedge-shaped contrast enhancement on dynamic CT, dynamic MRI and CTHA, and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancements, which were initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement and increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.     

Causes and evaluation of mildly elevated liver transaminase levels

Mild elevations in levels of the liver enzymes alanine transaminase and aspartate transaminase are commonly discovered in asymptomatic patients in primary care. Evidence to guide the diagnostic workup is limited. If the history and physical examination do not suggest a cause, a stepwise evaluation should be initiated based on the prevalence of diseases that cause mild elevations in transaminase levels. The most common cause is nonalcoholic fatty liver disease, which can affect up to 30 percent of the population. Other common causes include alcoholic liver disease, medication-associated liver injury, viral hepatitis (hepatitis B and C), and hemochromatosis. Less common causes include α(1)-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease. Extrahepatic conditions (e.g., thyroid disorders, celiac disease, hemolysis, muscle disorders) can also cause elevated liver transaminase levels. Initial testing should include a fasting lipid profile; measurement of glucose, serum iron, and ferritin; total iron-binding capacity; and hepatitis B surface antigen and hepatitis C virus antibody testing. If test results are normal, a trial of lifestyle modification with observation or further testing for less common causes is appropriate. Additional testing may include ultrasonography; measurement of α(1)-antitrypsin and ceruloplasmin; serum protein electrophoresis; and antinuclear antibody, smooth muscle antibody, and liver/kidney microsomal antibody type 1 testing. Referral for further evaluation and possible liver biopsy is recommended if transaminase levels remain elevated for six months or more.     

Evaluation of the hepatotoxic potential of minocycline.

Minocycline (25 to 100 micrograms/g) dose dependently increased serum glutamic oxalacetic transaminase, urea, and bilirubin levels, and the hepatic triglyceride content in mice. In animals pretreated with phenobarbital to enhance minocycline metabolism, the effects on liver triglycerides were attenuated, while the changes in serum glutamic oxalacetic transaminase, urea, and bilirubin were enhanced. It is concluded that part of the toxic effects of minocycline may be produced by a metabolite of minocycline.     

新生儿缺氧缺血性脑病合并多器官损害临床分析

【目的】了解缺氧缺血性脑病 (HIE)新生儿心、肝、肾功能及钙、镁、血糖水平的变化状况。【方法】应用日立 7170A全自动生化分析仪对HIE患儿及无窒息新生儿于出生后 3d内所采血样的心肌酶谱、肝功能、尿素氮、钙、镁、血糖进行检测 ,同时检查尿常规。【结果】HIE组患儿心肌酶、肝酶、血总胆红素水平均明显高于对照组 (P <0 .0 5 ) ;HIE组血钙、镁低于对照组 (P <0 .0 1) ;HIE组肾损害发生率、高血糖发生率均高于对照组 (P <0 .0 5 )。【结论】HIE同时可并发多器官功能损害 ,在治疗脑损伤的同时 ,应对其它各器官功能密切监测并加以保护。