超声声像图检查对肝硬化程度的诊断研究

目的探讨超声声像图检查对肝硬化程度的诊断.方法选取肝硬化患者66例,其中慢性肝炎42例,肝硬化24例,患者在肝脏活检前、后2 d及手术前2 d行超声声像图检查,从肝脏表面、边缘、实质和肝静脉4方面综合积分评价肝脏纤维化程度,并与病理分期作对照.结果不同病理分期超声声像图检查肝硬化综合积分值显著不同(F=130.25,P＜0.001),病理分期越高,积分值也越大;肝硬化的超声声像图检查综合积分值与病理分期呈显著正相关(r=0.989,P＜0.001);曲线分析方法显示肝硬化综合积分值等于10为诊断肝硬化(早期肝硬化)的最佳界限值,其诊断灵敏性为87.5%,特异性为97.5%.结论超声声像图检查可较好评价慢性肝炎、肝硬化的纤维化程度,为肝硬化的诊断、肝硬化的评价提供了可靠的半定量指标,具有重要的临床实用价值.     

Management of patients with advanced liver cirrhosis

This article provides an overview of liver cirrhosis. The pathophysiology, common investigations and the nursing management of patients with advanced liver cirrhosis are examined.     

Diet-induced thermogenesis in patients with liver cirrhosis

Summary. Diet-induced thermogenesis after ingestion of a mixed meal was investigated in eight patients with documented liver cirrhosis and in eight age- and sex-matched healthy controls. Respiratory gas exchange was measured continuously for one hour in the basal state and for three hours after ingestion of a mixed liquid meal, consisting of 17% kJ protein, 28% kJ lipids and 55% kJ carbohydrates and dispensed to correspond to 60% of the individually computed energy expenditure. Arterial substrate and hormone concentrations were determined before and at timed intervals for three hours after the meal. Urine was collected for determination of nitrogen excretion. The patients' oxygen uptake, energy expenditure and respiratory quotient were similar to those of the controls in the basal state. After the meal, pulmonary oxygen uptake and energy expenditure rose markedly in both groups during the first hour and were subsequently stable. The average increase in oxygen uptake above basal during the whole study period was 21·2 ± 1·8% and 22·3 ± 1·2% (NS) in patients and controls, respectively. The corresponding increase in energy expenditure was 24·8 ± 2·0% in the patients and 24·9 ± 1·4% in the controls (NS). The respiratory quotient was elevated throughout the postprandial period in both groups but the quotient was significantly higher in the patients (P<0·05–0·001), suggesting a greater proportion of carbohydrate oxidation. The basal arterial concentrations of insulin and glucagon were significantly higher in the patients. After the meal the insulin level increased 10- to 20–fold in both groups. Glucose concentration rose significantly in both groups to a maximum of 8·82 ± 1·00 and 8·03 ± 0·95 mmol/l in patients and controls, respectively, at 60 min after the meal. This was accompanied by a fall in the levels of glycerol and ketone bodies in both groups, indicating decreased lipolysis. It is concluded that both the basal energy expenditure and the thermogenic response to a mixed meal are similar in patients with liver cirrhosis and in healthy controls. The patients' carbohydrate oxidation rose to a greater extent after the meal, probably as a consequence of excessive increases in insulin concentration, demonstrating that insulin resistance in these patients may be compensated for by postprandial hyperinsulinaemia.