血清甘胆酸动态水平在肝硬化疗效观察中的意义

许多研究表明，血清甘胆酸(Cholylglycine acid简称SCGA)含量测定对肝硬化的论断比常规肝功能试验敏感，但SCGA对肝硬化治疗效果观察。治疗后疾病转归及肝脏代偿功能的判断 是否比常规肝功能试验敏感，目前尚缺乏系统对比研究。本通过对69例活动性肝硬化患治疗前后SCGA常规肝功能试验的动态验测及对比分析，探讨二在上述问题中的意义。     

病毒性肝炎患者血清透明质酸,甘胆酸和腺甘脱氨酶检测的临床意义

作者对８０例病毒性肝炎患者血清透明质酸（ＨＡ）、甘胆酸（ＣＧ）及腺苷脱氨酶（ＡＤＡ）活力进行检测，结果显示除ＣＰＨ组ＨＡ与ＡＤＡ水平与对照组差异无显著性外，各型肝炎ＨＡ，ＣＧ、ＡＤＡ均高于对照组，肝病患者同时检测此三项指标，对肝炎的诊断、确定肝细胞损害程度、修复情况有一定参考价值，透明质酸对了解肝纤维化的程度也有一定意义。     

血清甘胆酸测定对肝病诊断价值探讨

目的探讨血清甘胆酸测定对肝病的诊断价值。方法对342例各型病毒性肝炎、肝炎肝硬化、原发性肝癌及7例梗阻性黄疸患者进行空腹血清甘胆酸测定。结果在重型肝炎时血清甘胆酸明显升高,与急性黄疸型肝炎比较存在显著差异(P<0.01);在梗阻性黄疸和淤胆型肝炎时,甘胆酸升高与γ-GT呈正相关系,并与急性黄疸型肝炎比较存在显著性差异(P<0.01)。结论测定血清甘胆酸有助于肝病的诊断与鉴别诊断。     

检测血清甘胆酸对肝炎后肝硬化及肝癌患者的诊断意义

血清甘胆酸检测是评价肝功能的一项很有意义的指标。本应用放射免疫分析法(RIA)检测肝炎后肝硬化、原发性肝癌患血清甘胆酸(CG)的浓度，旨在探讨CG对慢性、良恶性肝病诊断的临床价值，现报告如下。     

血清结合胆酸检测的临床意义

我院于1986年起,对94例肝病患者、48例正常入和27例非肝病患者进行甘胆酸放射免疫测定,现将结果及临床意义分析如下: 1 方法 采用F1—2003/018、~(125)Ⅰ免疫测量仪和北京原子能研究所生产的甘胆酸放射免疫分析药盒测试。 根据北京原子能研究院生产的甘胆酸放射免疫药盒说明书介绍,CG的正常值为X±SD=113±     

肝硬化患者联合检测甲状腺激素及甘胆酸的意义

目的：探讨肝硬化患者甲状腺激素（Ｔ３，Ｔ４）及血清结合胆酸（ＣＧ）的诊断意义和相互间的关系。方法：用放免法测定８０例肝经病人血清中的Ｔ３，Ｔ４及ＣＧ并与正常对照组相比，结果：肝硬化与正常对照组比较在ＣＧ，Ｔ３，Ｔ４差别有显著性，ＣＧ在肝硬化病人明显升高，Ｔ３，Ｔ４在肝硬化病人降低；结论：联合检测甲状腺激素及甘胆酸对肝硬化病人有重要意义。     

肝脏疾病相关的肾脏损害

病例摘要 病例1 病史患者男性,32岁,因"持续性尿检异常2年余,孤立性肉眼血尿1月余",2000-02-01人院.缘于1998年体检时发现尿隐血2 ,蛋白 ,未予注意.1999-12-25,自觉咽痛不适,无畏寒、发热,检查发现"化脓性扁桃体炎",以"青霉素"对症治疗半个月后咽痛好转.期间曾发现1次尿液暗红色,呈浓茶样,但尿中无血块,亦无尿频、尿急、尿痛等尿路刺激症状,持续1天后尿色转清.查尿常规蛋白 ,隐血3 .即开始服中药煎剂(具体药物不详).虽再未发现尿色变化,但多次查尿常规均异常(蛋白2 ～3 ,RBC3 ).病程中无水肿,无皮疹,无腹痛等症状,亦无关节痛,否认高血压.因尿常规始终异常,至本院就诊查尿RBC 78～215万/ml,多形,24h尿蛋白定量0.46g,住院进一步检查治疗.     

慢性肝病中医证型与血清肝纤维化指标及甘胆酸的关系

目的：探讨慢性肝病中医证型与肝纤维化标志物透明质酸（HA）、Ⅳ型胶原（Ⅳ－C）、Ⅲ型前胶原（PCⅢ）及甘胆酸（CG)之间的关系。方法：采用放射免疫法测定120例慢性肝病瘀血阻络、湿热中阻、肝肾阴虚的肝纤维化指标及CG水平,同时与40例正常对照者比较。结果：各中医证型组的肝纤维化3项指标均较对照组升高,以瘀血阻络组的HA、PCⅢ升高最为显著;各中医证型组的CG指标均较对照组升高,以湿热中阻组升高最为显著。结论：上述指标对慢性肝病患者的中医分型有一定的指导意义。     

胆道肿瘤患者血清甘胆酸和透明质酸的变化

血清甘胆酸（ＣＧ）和透明质酸（ＨＡ）均是反应肝脏疾病的良好指标,已广泛应用于临床．ＣＧ,ＨＡ在胆道肿瘤的诊断方面,也有较好临床意义如下．１　材料和方法１．１　材料　正常对照组４０例（均为本院健康献血员）,年龄１９岁～５３岁．胆石症５５例（胆囊结石３４例,胆管结石２１例）,年龄３３岁～７６岁,胆道肿瘤组３１例（胆管癌２３例,胆囊癌８例）,年龄３８岁～７５岁．均经手术及病理证实．１．２　方法　血清检测ＨＡ,采用海军医学研究所提供的ＨＡ放免试剂盒．血清ＣＧ检测采用北京原子能研究所提供的ＣＧ放免试剂盒．…     

Combination Therapy in Liver Transplant Recipients with Hepatitis B Virus Without Hepatitis B Immune Globulin

Introduction: Conventional therapy to prevent HBV recurrence in liver transplant (LTx) recipients consists of Hepatitis B Immune Globulin (HBIg). The aim of this review is to investigate the safety and efficacy of converting HBIg and LAM therapy to ADV and LAM therapy. Methods: A retrospective review involving all liver transplant patients with HBV maintained on HBIg and LAM therapy. Results collected included: gender, age, HBV serological and DNA status (COBAS AmpliScreen PCR-based testing). Serologic testing was done every three months. Patients were followed for drug reactions, therapy compliance, and immune suppression compliance. A cost benefit analysis was done for drug comparisons using United States currency values. Results: Patient demographics included: Male (n=6), Female (n=4), mean age 44 years (range 33 to 65). The mean length of follow up since therapy conversion (from HBIg and LMV to ADV and LMV) was 21 months (range 16 to 25 months). Serological status at time of conversion revealed that DNA status remained negative in all patients, HBsAg negative in 10/10, HB eAg (+) (5/10) and HBeAb (+)(5/10). None of the patients experienced an increase in transaminases while on dual ADV and LAM therapy. All patients were maintained on immune suppression monotherapy (tacrolimus) at 7–9 ng/mL. All patients reported compliance with the dual therapy and that they experienced no drug related side effects. Mean yearly costs for ADV and LAM was 7,235.00 United States dollars (range 6,550.00 to 8,225.00); while mean monthly costs for HBIg and LAM; 9225.00 (range 7205.00 to 12005.00). Conclusion: The above results demonstrate beneficial effects of ADV and LAM in place of the current standard of HBIg and LAM therapy. Safety and short term results show nucleoside therapy is adequate at preventing HBV viral recurrence. Lastly, the economic benefit for ADV and LAM vastly outweighed the HBIg and LAM group.     

慢性乙型肝炎肝脏炎症分期与血清多肽分子的相关性分析

背景:准确诊断肝组织炎症程度对慢性乙型肝炎(CHB)的预后评估具有重要临床意义。肝活检具有较多缺陷,因此迫切需寻求非创伤性、准确可靠的血清诊断标记物。目的:应用血清多肽组学法筛选CHB患者肝脏炎症分期的多肽诊断标记物。方法:建立146例前瞻性队列,包括126例CHB患者和20名对照者。采用Scheuer病理学标准进行肝脏炎症分期;液相色谱法串联质谱法(LC-MS/MS)分离和筛选血清差异多肽峰;多反应监测(MRM)法分析血清差异多肽分子m/z 520.3离子对与炎症程度、病毒载量的关系。计算受试者工作特征曲线下面积(AUROC),评估差异多肽诊断炎症分期的敏感性和特异性。结果:LC-MS/MS法筛选出9个差异表达多肽峰。差异多肽分子m/z 520.3为二羟丙酮激酶(DAK)片段,其4个离子对(520.3/176.1、520.3/353.7、520.3/459.8和520.3/503.3)的SPAR值随着肝脏炎症程度加重而逐渐减少,但与病毒载量(HBeAg阳性和HBV-DNA)无关。多肽离子对520.3/176.1、520.3/503.3区分G2～G4期与G0～G1期的AUROC值分别为0.840、0.856;区分G3～G4期与G0～G2期的AUROC值分别为0.886、0.888。结论:血清DAK的多肽分子m/z 520.3能有效诊断CHB的肝脏炎症程度。     

乙型肝病毒感染相关性肝硬化临床早期诊断研究

目的：探讨如何对慢性乙型肝炎伴早期肝硬化者进行早期诊断,方法：选取经肝活组织病理检查确诊的80例慢性乙型肝炎伴早期肝硬化（早期（LC）者作为研究对象,采集病史及体征,芊肝功能和肝纤维化指标以及B超检查,并以同期随机抽取的80例单纯慢性乙型肝炎（CHB）患者作对照。结果：早期LC组患者的临床症状较重,某些体征（如蜘蛛痣、肝掌和肝病面容等）、血清总胆红素（TBil)、而血清丙氨酸转氨酶（ALT）与单纯慢性乙肝组比较差异不显著（P＞0．05）;并且,早期LC组的血清透明质酸（HA）、C3氨基端肽（PⅢP）和板层素（LN）水平显著高于CHB组;此外,早期LC组的B超异常声像图（如肝内光点增粗、分布欠均匀、脾肿大和门静脉增宽等）明显高于CHB组,然而,两组之间HBsAg滴度高低和HBeAg阳性率却无明显差异（P＞0．05）。结论：重视体格检查,肝功能化验和血清HA、PⅢP、LN以及B超声像图检查对慢性乙型肝炎合并早期LC的早期诊断具有较大的参考价值。     

The Seroconversion Rate of Hepatitis A Virus Vaccination among Patients with Hepatitis B Virus-Related Chronic Liver Disease in Korea

Background/Aims

The aim of this study was to evaluate the seroconversion rate of a hepatitis A virus (HAV) vaccination in patients with hepatitis B virus (HBV)-related chronic liver disease (CLD).

Methods

Analyses were conducted using clinical records from 94 patients with chronic HBV infection who were seronegative for IgG anti-HAV antibodies between September 2008 and June 2009. Two doses of an HAV vaccine were administered 24 weeks apart. A third vaccine dose was administered only for patients seronegative for anti-HAV antibodies at week 48.

Results

The seroconversion rate of anti-HAV following the two-dose vaccination was 86.17%. The seroconversion rate of anti-HAV was not significantly different according to age or status of liver disease. The rate was higher in female than in male patients. A third HAV vaccine dose was administered to 13 patients seronegative for anti-HAV after the two-dose regimen, and 84.62% of these patients showed seroconversion at week 72.

Conclusions

HAV vaccination is effective in most Korean patients with HBV-related CLD, and it might be necessary to evaluate three-dose vaccination approach for non-responders to the conventional regimen to maximize the success of an HAV vaccination program.     

HBsAg阳性慢性肝病患者肝组织HBV DNA分子状态与血清HBV标志物关系的研究

采用分子杂交技术对28例慢性肝病患者进行肝组织和血清HBV对比研究,结果表明:①肝组织HBV DNA阳性率显著高于血清HBV DNA阳性率,②血清DNA-P反映乙肝病毒的早期复制;③血清HBeAg阴性、Anti-HBe阳性时肝组织内可发现游离型HBV DNA及小片段DNA,表明肝内HBV正处于活跃复制状态,从分子水平证实了Anti-HBe阳性时部分患者可有传染性,需积极有效治疗:④慢迁肝和慢活肝中发现整合型HBV DNA较少,提示慢活肝经治疗后有希望达到从肝内清除乙肝病毒的目的。另外,也提示乙肝病毒在肝内的复制状态与病理损伤无直接关系。     

慢性乙型肝炎合并脂肪肝126例病理与临床

目的:调查慢性乙型肝炎(慢乙肝)中脂肪肝的发生率.方法:采用Menghini型快速肝穿取得肝组织,10%甲醛固定,常规制片,HE染色.结果:550例慢乙肝中有126例病理证实合并有脂肪肝,占22.91%(126/550),其中83例为B超检出,检出率为15.1%(83/550),B超与病理诊断符合率为65.87%(83/126).结论:慢性乙型肝炎易合并脂肪肝,无创伤性B超检查为脂肪肝诊断首选,肝组织活检是目前唯一的确诊方法.     

Distribution of Hepatitis B Virus Genotypes in Azerbaijani Patients With Chronic Hepatitis B Infection

Background:

Hepatitis B virus (HBV) has been classified into ten genotypes (A-J) based on genome sequence divergence, which is very important for etiological and clinical investigations. HBV genotypes have distinct geographical distributions worldwide.

Objectives:

The aim of this study was to investigate the distribution of HBV genotypes among Azerbaijani patients with chronic hepatitis B, came from the Republic of Azerbaijan country to Iran to receive medical care.

Patients and Methods:

One hundred and three patients with chronic HBV infection, referred to hospitals related to Iran University of Medical Sciences and Tehran Hepatitis Center from August 2011 to July 2014, were enrolled in this cross sectional study. About 3-milliliter of peripheral blood was taken from each patient. After viral DNA extraction, HBV genotypes were tested using the INNO-LiPA™ HBV kit (Innogenetics, Ghent, Belgium). HBV genotyping was confirmed using sequencing of hepatitis B surface antigen (HBsAg) and polymerase (pol) regions of HBV.

Results:

The mean age of patients was 35.9 ± 11.7 years (19-66). Of 103 patients, 72 (69.9%) were male. In the present study, the predominant HBV genotype was D (93.2%) followed by genotype A (5.8%) and concurrent infection with A and D genotypes (0.97%).

Conclusions:

The main and frequent HBV genotype among Azerbaijani patients with chronic hepatitis B virus infection was genotype D followed by genotype A.     

Occult Hepatitis B Virus Infection in Japanese Chronic Hemodialysis Patients

We investigated the prevalence of occult hepatitis B virus (HBV) infection in Japanese chronic hemodialysis patients. Hemodialysis patients (n = 1041) were screened for occult HBV. The presence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and hepatitis B core antibody (anti‐HBc) was determined by various chemiluminescent immunoassays. HBV‐DNA was quantified in patients positive for anti‐HBc using quantitative real‐time polymerase chain reaction. Among the 1041 patients, six (0.6%) were HBsAg‐positive and 218 (20.9%) were anti‐HBc‐positive. All HBsAg‐positive patients also tested positive for the presence of HBV DNA. Of 212 HBsAg‐negative and anti‐HBc‐positive patients, three were positive for HBV DNA. Our study showed that the prevalence of occult HBV infection in chronic hemodialysis patients from eastern Japan was 0.3%.     

酒精性肝病合并乙型肝炎病毒感染60例临床分析

目的 通过对郑州大学第一附属医院5年收治的60例酒精性肝病(ALD)合并乙型肝炎病毒(HBV)感染患者的临床资料分析,研究其临床特点和危险因素,以提高大众对酒精性肝病合并乙型肝炎病毒感染的认识及增加对戒酒等健康生活习惯的重视.方法 分析60例酒精性肝病合并乙型肝炎病毒感染患者的临床资料,并以100例单纯酒精性肝病患者、100例单纯乙型肝炎病毒感染患者为对照组,比较组间疾病严重程度,评价3组的治疗效果,分析酒精性肝病合并乙型肝炎病毒感染发病类型的危险因素.结果 (1)合并组实验室指标升高明显高于对照组(P＜0.05).(2)治疗4周后合并组治疗效果较两对照组差(P＜0.05).(3)通过Logistic回归分析表明,危险因素OR值为平均每日饮酒量＞HB-DNA定量＞饮酒年限＞吸烟＞年龄.结论 乙型肝炎病毒感染可加重酒精性肝病患者病情,降低治疗效果;每日饮酒量、饮酒年限、HBV-DNA定量、吸烟、年龄均为二者合并时的危险因素;因此对于酒精性肝病合并乙型肝炎病毒感染患者通过戒酒,培养良好生活方式是预防肝功能损伤加重、改善疾病疗效及预后的重要积极措施.