乙肝肝硬化患者联合检测血清视黄醇结合蛋白、前白蛋白和白蛋白的临床价值

目的联合检测视黄醇结合蛋白（RBP）、前白蛋白（PA）和白蛋白（ALB）在乙肝肝硬化患者中的血清水平变化,探讨三者的相关性及临床价值。方法应用免疫透射比浊法检测89例乙肝肝硬化患者和35例健康成年人的血清RBP与PA水平,溴甲酚绿法检测血清ALB水平。结果乙肝肝硬化患者的血清RBP、PA和ALB水平均显著低于正常对照组（P〈0.01）。血清RBP与PA水平呈正相关（r=0.743,P〈0.01）,血清RBP、PA亦分别与ALB水平呈正相关（r1=0.602,r2=0.529,P均〈0.01）。结论血清RBP、PA和ALB水平与肝功能损害程度相关,可以作为反映肝功能损害程度的指标,而RBP与PA比ALB能更灵敏地反映肝功能损害程度的变化。三者联合检测能更好地判断乙肝肝硬化患者的肝功能状况。     

肝硬化患者中血清总胆汁酸测定的临床意义

背景：胆汁酸在肝内合成和分泌，因此可以作为反映肝细胞损害的指标之一。目的：探讨肝硬化患者血清总胆汁酸（TBA）测定的临床意义。方法：收集42例肝硬化患者的肝功能资料，比较TBA与其他常规肝功能指标的敏感性差异。结果：肝硬化组的TBA显著高于健康对照组（P＜0．01），其水平为健康对照组的6．9倍，异常率为74％，显著高于丙氨酸转氨酶（ALT）、γ－谷氨酰转移酶（γ－GT）和碱性磷酸酶（ALP）（P＜0．01）。肝硬化失代偿期患者的TBA水平显著高于代偿期患者（P＜0．01）。结论：TBA是反映肝硬化患者肝细胞损害的敏感指标之一。     

血清总胆汁酸和4项肝纤维化指标与肝硬化Child-Pugh分级的关系

背景：血清总胆汁酸（TBA）以及肝纤维化指标Ⅲ型前胶原（PCU1）、Ⅳ型胶原（C-Ⅳ）、层黏蛋白（LN）和透明质酸（HA）水平可判断肝硬化程度，但国内外研究关于肝纤维化指标与Child-Pugh分级关系的结果并不完全一致。目的：研究肝硬化患者血清TBA含量以及PCⅢ、C-Ⅳ、LN、HA水平与肝硬化Child-Pugh分级的关系。方法：按Child．Pugh分级标准将42例肝硬化患者分为A、B、C三级，酶法测定血清TBA含量，放射免疫测定法检测空腹血清PCⅢ、C．IV、LN、HA水平。结果：血清TBA含量随Child．Pugh分级增高而升高，不同分级间有显著差异（P〈0．01）。肝功能C级患者血清PCU1水平显著高于A级患者（P〈0．05），各级肝功能患者间血清C-Ⅳ水平均无显著差异，肝功能C级患者血清LN水平显著高于A级和B级患者（P〈0．01，P〈0．05），肝功能B级和C级患者血清HA水平均显著高于A级患者（P〈0．01）。结论：血清TBA含量能灵敏地反映肝硬化患者肝功能损害程度，对指导肝硬化患者肝功能分级具有很好的参考价值；联合检测肝硬化患者血清PCU1、LN、HA对指导肝功能的分级也有一定意义。     

肝硬化患者脂质代谢紊乱及其临床意义

目的：了解肝硬化（LC）患者的血脂质变化及其临床意义。方法：选择89例LC患者及20例对照者清晨空腹采静脉血检测TC、TG、HDL－C、LDL－C、apoA、apoB,Lpa及肝功能，比较各组血脂水平的差异性并将血脂质与肝功能进行相关性检验。结果：LC患者各项血脂质除TG外普遍低于对照组，其中LDL－C、apoA,Lp a具显著性意义（P＜0．05－0．0001），部分脂质LC各亚组间亦存在显著性差异，其下降程度与肝损害程度平行。血脂质与肝功能相关性检验显著TC、LD-C,apoA,Lpa与TBiL呈负相关（P＜0．05）－0．0001），TG，apoB与ALT呈正相关（P＜0．05），TG，apoB与AST呈正相关（P＜0．05－0．001）,apoA,Lpa与AST呈负相关（P＜0．01），TC，HDL－C，HDL－C，apoA,apoB,Lpa与Alb呈正相关（P＜0．01－0．001）。结论：LC患者存在多项血脂质不同程度下降且与TBiL,ALT,AST,Alb等常规肝功能试验有很好的相关性，因此可将血脂质的水平作为评价肝功能的一项参考指标。     

血清IGF—1、IGFBP—1，GH水平与糖尿病慢性并发症关系的研究

目的：揭示胰岛素样生长因子－1,胰岛素样生长因子结合蛋白－1,生长激素对糖尿病慢性并发症的发生,发展的影响。方法：测定20例健康对照者和62例2例糖尿病,10例1例糖尿病患者的胰岛素样生长因子－1（IGF－1）,胰岛素样生长因子结合蛋白－1（IGFBP－1）,生长激素（GH）及血浆胰岛素（INS）,C肽（C－P）,糖化血红蛋白（HbAlc)指标,结果：（1）IGF－1水平,1型糖尿病患者显著低于对照组（P＜0．05）,2型糖尿病患者显著低于对照组（P＜0．05）,（2）IGFBP－1水平,1型糖尿病患者显著高于对照组（P＜0．05）,2型糖尿病肥胖型伴高胰岛素血症者显著低于对照组（P＜0．05）;（3）GH水平,1型糖尿病患者显著高于对照组（P＜0．05）,2型糖尿病与对照组无显著差异（P＞0．05）,（4）合并糖尿病肾病及视网膜病变患者IGF－1水平均较对照组增高（P＜0．05）,（5）IGF－1水平与HbAlc间呈负相关（P＜0．01 2型r=-0.62 1型r=-0.73)。结 论：IGF－1,IGFBP－1,GH水平的检测对糖尿病慢性并发症,特别是微血管病变的发生,发展有重要的临床意义。     

血清胰岛素样生长因子及其结合蛋白诊断儿童生长激素缺乏症的价值

为了解血清胰岛素样生长因子1（IGF－1），胰岛素样生长因子结合蛋白－3（IGFBP－3）浓度与生长激素缺乏症（GHD）患儿生长激素（GH）激发试验中血清生长激素峰值的关系，以确定血清IGF－1，IGFBP－3浓度诊断GHD的价值，为其代替GH激发试验提供依据，选择GHD患儿62例（男39例，女23例）为GHD组，60例健康儿童（男38例，女22例）为对照组。分别用放射免疫分析（RIA）法，免疫放射分析（IRMA）法检测GHD组血清IGF－1，IGFBP－3浓度，同时被GH激发试验，测定血清GH峰值，并比较其与IGF－1，IGFBP－3的关系，测定对照组血清IGF－1，IGFBP－3。结果显示，GHD组血清IGF－1，IGFBP－3均显著低于对照组（t分别为3.116,11.579,p均＜0．01）；GHD组血清IGF－1，IGFBP－3浓度与GH激发试验中的GH峰值呈显著正相关（r分别为。331，0。347，P均＜0．01）；GHD组血清IGF－1，IGFBP－3降低的阳笥率分别为97．58％，98．38％，与激发试验的阳性率（100％），比较无统计学意义（x^2分别为.3074,2.033,P均＞0．05）。表明血清中IGF－1，IGFBP－3浓度检测对诊断GHD有重要价值，认为检测血清中IGF－1，IGFBP－3浓度可以替代GH激发试验。     

血清RBP4水平和慢性乙型肝炎疾病程度的相关性

目的：探讨血清RBP4水平与慢性乙型肝炎患者肝损害严重程度的相关性。方法检测120例慢性乙型肝炎、60例肝硬化和20例健康对照者的血清RBP4水平,同时检测肝脏炎症、纤维化及糖、脂肪代谢的血清学指标。结果血清RBP4水平与ALT、AST、PT、HA、PLT相关（P＜0．05）,与BMI、TG、CHO、FBG 等代谢综合征组分及 HBV DNA不相关（P＞0．05）。CHB组与乙型肝炎肝硬化组及对照组三组的血清 RBP4水平组间比较有差异（F＝80．19, P＝0．000）,肝硬化组低于慢性乙型肝炎组及对照组（P＝0．000）。血清RBP4水平诊断乙型肝炎肝硬化的ROC曲线下面积0．719（P＝0．023）,根据最佳截断值24．075,灵敏度0．667,特异度0．727。结论血清RBP4水平和慢性乙型肝炎疾病严重程度负相关,RBP4可作为一个评价慢性乙型肝炎肝损害程度的血清学指标。     

老年糖尿病白内障人工晶体植入生长因子变化与术后并发症及疗效的关系

目的：探讨老年糖尿病白内障囊外摘除（ECCE），后房型人工晶体（IOL）植入术前后血清胰岛素样生长因子－I（IGF－I），表皮生长因子（EGF）含量动态变化与术后并发症及疗效的关系。方法：用放射免疫法（RIA）对39例老年糖尿病患者，39例老年性白内障患者ECCE，IOL植入前后血清IGF－I，EGF含量进行动态观察，并与20例正常老年组进行对照，结果：术前糖尿病白内障患者中单纯糖尿 性视网膜病变（BDR），增殖性糖尿病性视网膜病变（PDR）组血清中IGF－I，EGF含量比老年性白内障组，正常对照组显著升高（P＜0．05），血清IGF－I，EGF含量随视网膜病变程度而增高（P＜0．01）；血清IGF－I，EGF含量与术后最终视力呈负相关（r=-0.94,r=-0.90,均P＜0．01）。结论：PDR患者在ECCE及IOL植入前后血清IGF－I，EGF含量变化与术后并发症及疗效有关。     

外周血可溶性E-选择素与慢性乙型肝炎的关系

为研究慢性乙型肝炎（慢乙肝）患者血清可溶性E－选择素（sE-selectin)与肝功能，肝纤维化指标及血清病毒载量的关系，采用双抗体夹心ELISA法检测了54例慢乙肝患者的血清sE-selectin水平，用荧光定量聚合酶链反应（PCR）检测其血清HBVDNA定量，用放射免疫法测定其透明质酸（HA），Ⅲ型前胶原（PCⅢ），同时检测肝功能等。结果显示，慢乙肝患者外周血sE-selectin水平明显高于正常对照组（P＜0．001）sE-selectin水平与丙氨酸转氨酶（ALT），天门冬氨酸转氨酶（AST），总胆红素（TBIL）呈正相关（P均＜0．01），与白蛋白（ALT）呈负相关（P＜0．01）；与血清HA，PCⅢ水平均呈正相关（P均＜0．01）；与血清HBV DNA定量无相关性（P＞0．05）。认为sE-selectin水平可反映慢乙肝患者的炎症活动度和肝纤维化程度，不能反映其病毒血症水平。     

宫内发育迟缓与胰岛素样生长因子及其结合蛋白关系的研究

为探讨宫内发育迟缓（IUGR）的发生机制,检测了86例新生儿脐血胰岛素样生长因子－1（IGF－1）、胰岛素样生长因子结合蛋白－3（IGFBP－3）水平,并分析上述指标变化与胎儿期生长的关系。将86例新生儿分为两组,IUGR（即小于胎龄儿）组22例,适于胎龄儿（AGA）组64例,采用竞争性放射免疫分析法（RIA）测定两组脐血IGF－1水平,非竞争性免疫放射分析法（IRMA）测定IGFBP－3水平。结果显示,与AGA组相比,IUGR组脐血IGF－1和IGFBP－3水平显著降低（P＜0．001）;IGF－1水平随胎龄及出生体重增加而增加（P＜0．01）;IGFBP－3水平与胎龄及出生体重呈相关（P＜0．01）;IGF－1与IGFBP－3呈正相关（P＜0．01）。认为IUGR与IGF－1及其结合蛋白密切相关,不论何种原因引起的IUGR,其脐血IGF－1、IGFBP－3水平均低,IGF－1水平下降与IGFBP－3下降相伴随;脐血IGF－1、IGFBP－3水平与胎龄及出生体重呈正相关,随着胎龄的增加和出生体重的增长,IGF－1、IGFBP－3水平不断升高。     

Fatty liver suppressed the angiogenesis in liver metastatic lesions

BACKGROUND/AIMS: We have demonstrated that colorectal cancer with fatty liver had few liver metastases clinically as well as experimentally. In this study, to clarify why colorectal cancer with fatty liver had few liver metastases, we focused on the angiogenesis of carcinomas. METHODOLOGY: The rat colon cancer cells (RCN-9) were injected into 40 rats (the fatty liver group = FL group includes 20 rats, the non-fatty liver group = NFL group includes 20 rats). In each group, the PyNPase (pyrimidine nucleoside phosphorylase) activity in the metastatic lesion of the liver was examined using the high-performance liquid chromatographic method. In addition, the microvessel density in the metastatic lesion of the liver was assessed by Von Willebrand factor-related antigen immunostaining. RESULTS: 1) The PyNPase activity in the FL group was 33.34 +/- 6.27 (microgram FU/mg protein/hr), which was significantly lower than that of the NFL group (49.30 +/- 14.82) (P = 0.0021). 2) Microvessel density in the FL group was 1.845 +/- 0.357 (%), while that in the NFL group was 2.777 +/- 1.371 (%). The microvessel density of the FL group was significantly lower than that of the NFL group (P = 0.0365). 3) The regression coefficient between PyNPase activity and microvessel density was 0.480, which indicated a significant correlation (P = 0.0098). CONCLUSIONS: We think that, in colorectal carcinomas with fatty liver, the decreased activity of PyNPase and the decreased neovascularization in the metastatic lesion are closely related to fewer liver metastasis compared with colorectal cancer patients without fatty liver.     

Heart diseases affecting the liver and liver diseases affecting the heart

BACKGROUND: The association of cardiac and liver disorders has not been extensively outlined in the literature. METHODS: A survey of the MEDLINE database was performed to assess the current status of research regarding the association between cardiac and liver disorders. RESULTS: Combined cardiac and hepatic disorders occur in 3 different settings: heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology. The spectrum of heart diseases affecting the liver includes mild alterations of liver function tests in heart failure, cardiogenic ischemic hepatitis, congestive liver fibrosis, and cardiac cirrhosis. The liver diseases affecting the heart include complications of cirrhosis such as hepatopulmonary syndrome, portopulmonary hypertension, pericardial effusion, and cirrhotic cardiomyopathy as well as noncirrhotic cardiac disorders such as high-output failure caused by intrahepatic arteriovenous fistulae. Cardiac and hepatic disorders with joint etiology include infectious, metabolic, immune, vasculitic, and toxic disorders. We propose a practical approach to a diagnostic workup of combined cardiac and hepatic disorders based on recognizing the sequence of appearance of the cardiac and liver disease, presence of features of a multisystem disease, and presence of pathognomonic features. The evaluation of combined cardiac and hepatic disorders takes into consideration the expected benefit of treatment and the risks related to invasive procedures. Accordingly, investigations can be limited to ancillary tests for patients with congested liver and mild alterations of liver function tests, in cardiogenic ischemic hepatitis, patients with cardiac cirrhosis who are proposed for conservative treatment, and multisystem disease involving the heart and the liver. Conversely, comprehensive investigations are recommended when invasive therapeutic interventions are considered for the treatment of hepatopulmonary syndrome, portopulmonary hypertension, or arteriovenous fistulae. CONCLUSION: Classification of a patient to any of the 3 categories-heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology-permits the physician to narrow the span of the possible diagnoses and allows for a more simple workup.     

Multiple necrotic nodules of the liver simulating liver metastasis

A 70‐year‐old man was referred to our hospital due to anemia and elevated serum tumor marker levels. He had advanced colon cancer, and hepatic lesions were found incidentally. On ultrasonography (US) and computed tomography (CT), the hepatic lesions had a maximum diameter of 20 mm and were located in Couinaud's segments V, VI, VII, and VIII, which suggested liver metastasis. On early‐ and late‐phase CT during hepatic arteriography (CTHA), all of the lesions had rim enhancement. On early‐phase CT during arterioportography (CTAP), all of the lesions were seen as nodules with an irregular perfusion defect, and on late‐phase CTAP, all the lesions gradually became iso‐dense, and their shape and size changed. Based on the CTAP findings, these lesions were thought to be fibrotic tumors. Partial resection of the liver (including the lesions in Couinaud's segments V and VIII) was done. Histological examination revealed that the lesions were necrotic nodules. Thus, CT angiography (CTHA and CTAP) was useful for identifying necrotic nodules, because their appearance on this modality is different from that of liver metastases.