复方氨基酸注射液对肝癌患者术后恢复功能的影响

目的探讨绿甘安对肝癌合并肝硬化患者术后常见并发症及肝功能的影响。方法在75例肝癌合并肝硬化并行肝癌切除术患者中,40例在肠外营养中以绿甘安为氮源,35例以复方氨基酸注射液(15AA)为氮源。结果与术前比,绿甘安治疗组患者术后第7天AST和TBIL已接近术前水平,ALB明显升高(P0.05);绿甘安治疗组患者肝性脑病发生率较对照组显著降低(P0.05)。结论绿甘安可以有效地减少肝癌合并肝硬化患者术后肝性脑病的发生,有利于术后肝功能恢复及促进机体早日恢复正氮平衡。     

肝癌与肝硬化患者血清叶酸水平对比

目的 比较肝硬化、肝癌患者血清中叶酸水平的差异及其与血红蛋白、甲胎蛋白之间的相关性,探讨叶酸的表达与肝癌的关系.方法 选取30例肝癌患者为肝癌组和35例肝硬化患者为肝硬化组,比较两组血清叶酸水平、血红蛋白浓度、甲胎蛋白水平,分析叶酸表达水平在肝硬化及肝癌中的差异.结果 肝癌组血清叶酸水平显著低于肝硬化组(P<0.05)...     

肝硬化、肝癌患者临床分期与血浆中D-二聚体检测及临床意义

目的通过检测肝硬化、肝癌不同临床分期患者血浆中D-二聚体含量，探讨其鉴别诊断意义及肝病凝血功能紊乱的机制。方法采用美国贝克曼ACL-7000检测仪，采用免疫比浊法测出样本含量（不同临床分期的肝硬化35例及肝癌28例、健康对照组25例）。结果肝硬化组代偿期及失代偿期组、肝癌Ⅰ、Ⅱ期及Ⅲ期组患者血浆中D-二聚体含量明显高于健康对照组（P＜0．01）。肝硬化、肝癌各临床分期组间比较差异有非常显著性（P＜0．01）．肝硬化代偿期组与肝癌Ⅰ、Ⅱ期组、肝硬化失代偿与肝癌Ⅲ期之间的D-二聚体相互比较差异无显著性（P＞0．05）。结论血浆D-二聚体含量在肝硬化、肝癌各临床分期患者明显增高，病情及肝功能损害程度越重血浆二聚体含量越高，肝硬化与肝癌患者比较差异无显著性（P＞0．05），故对肝硬化与肝癌的鉴别诊断意义不大。     

乙型肝炎、肝硬化与肝癌

原发性肝癌是世界范围内最常见、且恶性程度最高的肿瘤之一,是全球第6位、中国第3位最常见的癌症。据IARC估计,2000年中国肝癌发病人数30．6万,死亡30．0万例,分别占全世界的54．26％和54．64％。肝癌的发展大部分经历肝炎一肝硬化一肝癌的3步曲,在导致肝炎的众多病因中,乙肝病毒（HBV）感染、丙肝病毒（HCV）感染和酒精分别位列前三位,同时近年来脂肪肝引发的肝炎也存逐年递增,相当一部分隐匿性肝硬化由脂肪性肝炎发展而来。     

肝炎后肝硬化患者腹水氨基酸变化的初步研究

本文对２６例出现腹水的肝炎后肝硬化患者进行了腹水氨基酸谱测定。发现无论感染性腹水或非感染性腹水的氨基酸与其血浆氨基酸无显著性差异（Ｐ＞０．０５），但感染性腹水中蛋氨酸值较非感染性腹水显著增高（Ｐ＜０．０１），而ＢＣＡＡ／ＡＡＡ比值则显著降低（Ｐ＜０．０１）。认为腹水蛋氨酸值及ＢＣＡＡ／ＡＡＡ比值对肝硬化预后的预测有一定意义。     

乙型肝炎病毒相关性肝硬化肝癌与非肝硬化肝癌临床特点对比分析

[目的]探讨乙型肝炎病毒相关性肝硬化与乙型肝炎病毒相关性非肝硬化原发性肝癌患者临床特点的异同。[方法]收集乙型肝炎病毒相关性原发性肝癌患者394例的临床资料,分为肝硬化组307例(78%)和非肝硬化组87例(22%),回顾性对比分析2组患者的临床特点。[结果]非肝硬化组患者肝癌家族史阳性率显著高于肝硬化组(χ²=7.328,P=0.007);肝硬化组患者抗病毒治疗率显著高于非肝硬化组(χ ²=5.514,P=0.019);非肝硬化组患者肝功能良好及选择手术治疗的患者显著多于肝硬化组(χ²=23.04、P=0.000及χ²=54.39、P=0.000)。[结论]在乙型肝炎病毒相关性原发性肝癌患者中,肝硬化肝癌为主。相比伴有肝硬化的肝癌患者,非肝硬化的肝癌患者多有肝癌家族史、肝功能好、手术切除机会多。     

肝炎,肝硬化与肝癌的关系

肝炎、肝硬化与肝癌的关系李伟道重庆市肿瘤研究所重庆市４０００３０肝细胞癌（下称肝癌）是我国常见的恶性肿瘤之一，占恶性肿瘤死亡率第二位。近十余年来我国肝癌的诊断与治疗水平在原来基础上有很大提高，并已取得了举世瞩目的成就（１）但其治疗效果仍不理想。肝癌未...     

Elevation of serum and ascites cancer antigen 125 levels in patients with liver cirrhosis

BACKGROUND AND AIM: Serum cancer antigen (CA) 125 elevation has been reported in patients with liver disease, but it is poorly characterized. The present study aimed to evaluate the range of serum and ascitic CA 125 levels in patients with liver cirrhosis and to explore possible factors associated with CA 125 elevation. METHODS: A total of 70 patients were studied. Group I consisted of 30 patients with liver cirrhosis with or without ascites. Group II consisted of 30 patients with digestive malignant tumors with or without ascites. Group III consisted of 10 patients with benign ascites. The CA 125 levels were measured in the serum of all patients and also simultaneously in the ascitic fluid of 15 patients. RESULTS: Serum CA125 levels in 80% of (24/30) patients from group I were elevated, particularly in those with ascites, irrespective of the etiology of cirrhosis. Serum CA 125 levels were correlated with Child-Pugh scores (r = 0.38), but not significantly (P = 0.06). All patients from group II with ascites and from group III had elevated serum CA 125 levels, but there was no difference in the serum CA 125 levels between patients with ascites from group I (275 +/- 175 U/mL), group II (368 +/- 190 U/mL) or group III (396 +/- 287 U/mL), nor was there a significant difference in ascitic CA 125 levels (P > 0.05). The levels of serum CA 125 (198 +/- 108 U/mL) were lower than, but correlated with that of ascites (460 +/- 234 U/mL, r = 0.58, P = 0.026). The elevation of serum CA 125 accompanied by abnormalities of other tumor markers was more common in malignant ascites than in benign ascites (90% compared with 6%, P < 0.05). CONCLUSION: The elevation of serum CA 125 is common in patients with liver cirrhosis. It is related to the presence of ascites, and possibly to the insufficiency of liver function, but not the etiology of cirrhosis and ascites. Serum CA 125 probably comes from ascites. It usually predicts benign disease if the elevation of serum or ascites CA 125 is not accompanied by the abnormalities of other tumor markers.     

Overweight and obesity increase the risk for liver cancer in patients with liver cirrhosis and long-term oral supplementation with branched-chain amino acid granules inhibits liver carcinogenesis in heavier patients with liver cirrhosis.

We conducted a multicenter, randomized, controlled trial to investigate the effect of long-term oral supplementation with branched-chain amino acids (BCAA) on the event-free survival in 622 patients with decompensated cirrhosis. In the present study, the development of liver cancer was analyzed as an endpoint in particular. Subjects received either treatment with BCAA at 12g/day or dietary therapy containing the matched daily energy and protein intake. A Cox regression analysis was carried out to estimate the hazard ratios for different background factors stratified by treatment group. Liver cancer was noted in 89 patients. The risk for liver cancer was significantly higher for males, patients with concurrent diabetes mellitus, patients with an alpha-fetoprotein (AFP) level of 20ng/mL or higher, patients with higher body mass index (BMI), and patients with lower serum albumin levels. When the BCAA group and the diet group were compared for factors that interacted with the treatment arms, the risk for liver cancer was significantly reduced in the BCAA group with a BMI of 25 or higher and with an AFP level of 20ng/mL or higher. Oral supplemental treatment with BCAA may reduce the risk of liver cancer in cirrhotic patients with these specific factors.     

腹腔镜肝切除术在肝癌合并肝硬化患者的应用

目的：探讨腹腔镜下肝切除（LH）与开腹肝切除（OH）在治疗肝癌合并肝硬化患者近期疗效之间的差别。方法选取2010年9月至2012年6月武汉大学人民医院住院的肝癌合并肝硬化患者78例,分为2组,其中LH组32例,OH组46例,分析比较2组术中、术后恢复以及术后复发之间的差别。计量资料采用成组t检验和配对t检验,计数资料采用χ2检验。结果2组比较,术中失血量,LH组显著低于OH组（t＝0．057,P＝0．040）;手术时间,LH组高于OH组（t＝3．101,P＝0．003）;术后并发症方面,电解质紊乱、胆漏、腹水,LH组显著低于OH组（t＝3．001,3．241,4．255,P均＜0．05）;术后第1天肝功能水平（AST、ALT）,LH组显著低于OH组（t＝3．427、3．201,P＝0．001、0．002）;术后开始经口摄食的时间,LH组显著短于OH组（t＝3．012,P＝0．001）;住院时间LH组显著低于OH组（t＝2．157,P＝0．003）;肿瘤复发方面,LH组显著少于OH组（t＝2．751,P＝0．006）。结论对于肝癌合并肝硬化患者,LH较OH,无论在手术切口、术中失血量、术后腹水发生率、术后并发症、住院时间以及术后肿瘤的复发的发生方面都具有显著优势。     

酒精性肝硬化患者的临床特征

目的 探讨单独酒精或酒精合并病毒感染所致肝硬化临床表现的异同.方法 收集2004-2008年在中国医科大学附属第一医院住院的明确诊断为肝硬化的329例病例资料,其中单独酒精所致肝硬化(alcoholic liver cirrhosis,ALC)104例(28.18%)、单独乙型肝炎所致肝硬化(chronic HBV-r...     

The effect of supplementation with branched-chain amino acids in patients with liver cirrhosis

Aim: We investigated the effect of supplementation with branched-chain amino acids (BCAA) in patients with liver cirrhosis on the change of energy metabolism as well as glucose tolerance. Methods: Thirty liver cirrhosis patients underwent nutrient supervision by a dietician for one week. They were then prescribed oral supplementation with three packs of a BCAA nutrient (Livact 4.15 g/pack; Ajinomoto Pharma, Tokyo, Japan), taken three times a day: after breakfast, dinner and before sleep. The change in energy metabolism and glucose tolerance was examined using an indirect calorimeter and 75 g oral glucose tolerance test (75 g OGTT). Results: Non-protein respiratory quotient (npRQ) as well as branched-chain amino acid/tyrosine ratio (BTR) showed significant improvement, especially in patients with a creatinine height index (CHI) greater than 80. There was also a significant correlation between npRQ after one week of BCAA supplementation and the CHI. The patients with CHI greater than 80 and those with borderline pattern assessed by 75 g OGTT showed significant improvement in impaired glucose tolerance. Conclusion: Liver cirrhosis patients with CHI greater than 80 are the first candidates for BCAA supplementation. These patients showed improvement not only in energy metabolism and BTR, but also glucose tolerance.     

Difference and clinical value of metabolites in plasma and feces of patients with alcohol-related liver cirrhosis

BACKGROUND Alterations in plasma and intestinal metabolites contribute to the pathogenesis and progression of alcohol-related liver cirrhosis(ALC).AIM To explore the common and different metabolites in the plasma and feces of patients with ALC and evaluate their clinical implications.METHODS According to the inclusion and exclusion criteria, 27 patients with ALC and 24 healthy controls(HCs) were selected, and plasma and feces samples were collected. Liver function, blood routine, and other indic...     

肝硬化患者支链氨基酸的应用进展

氨基酸主要在肝脏代谢,肝硬化患者的蛋白质、糖类、脂肪代谢紊乱,体内氨基酸代谢失衡,继而引起全身多脏器、多系统的功能不全,出现肝性脑病、食管静脉曲张破裂出血、腹水等并发症,导致较高的病死率。总结了肝硬化患者氨基酸代谢特点及支链氨基酸在肝硬化治疗中的应用,指出支链氨基酸制剂在调整肝病患者的血清氨基酸谱,升高支链氨基酸与芳香族氨基酸的比值,预防肝硬化并发症,提高肝硬化患者生活质量方面具有重要作用。     

Anti-hypoalbuminemic effect of branched-chain amino acid granules in patients with liver cirrhosis is independent of dietary energy and protein intake

Aim: A multicenter prospective intervention study was conducted in 204 patients with uncompensated liver cirrhosis to explore the influence of dietary intake and patient clinical characteristics on improvement of hypoalbuminemia at weeks 12 and 24 of treatment with branched-chain amino acid (BCAA) granules. Methods: The primary endpoint set in this study was improvement of hypoalbuminemia in patients with liver cirrhosis. The dietary energy and protein intake per day were estimated based on the results of a survey on diet during a 3-day period preceding the start of the study. Results: As for the primary endpoint, the mean serum albumin level increased significantly at weeks 12 and 24 of BCAA treatment, compared with the baseline level. The mean Child-Pugh score decreased significantly at weeks 12 and 24 of treatment as compared to the mean baseline score. There was a significant increase in the serum albumin level following treatment with BCAA granules regardless of energy intake and of protein intake. The incidence of ascites and edema significantly decreased in the overall patient population both at weeks 12 and 24 of treatment, compared with the baseline incidence. A subgroup analysis conducted in patients stratified according to changes in the serum albumin level at week 12 of treatment as against baseline showed that the incidence of ascites/edema was significantly reduced not only in the increased albumin group but in the unchanged albumin group. Conclusion: The present data suggest that the anti-hypoalbuminemic effect of BCAA treatment in patients with liver cirrhosis is independent of dietary intake.     

Clinical significance of therapy using branched‐chain amino acid granules in patients with liver cirrhosis and hepatocellular carcinoma

The liver is the major organ for the metabolism of protein, fat and carbohydrate. A nutritional approach is required in the treatment of cirrhosis, which is frequently complicated with protein–energy malnutrition. Several advanced treatment approaches for hepatocellular carcinoma (HCC) have been established in the past decade. HCC is often complicated by cirrhosis, so treatment of the underlying liver diseases is also necessary to improve the prognosis. Branched‐chain amino acid (BCAA) granules were developed originally for the treatment of hypoalbuminemia associated with decompensated cirrhosis. However, subsequent studies found various other pharmacological actions of this agent. We review the clinical significance of therapy using BCAA granules in patients receiving different treatment approaches for cirrhosis and HCC based on the published work as well as our own data.