急性脑梗死患者血清胰岛素样生长因子1和胰岛素样生长因子结合蛋白3水平的变化

为探讨急性脑梗死患者血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平的动态变化及其临床意义 ,采用酶联免疫吸附试验双抗体夹心法检测 6 0例急性脑梗死患者 (发病后第 3天及第 14天 )和 30例正常人血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平 ,并根据影像学结果所显示的梗死灶的直径将所有患者分为大梗死组、中梗死组和小梗死组 ,分析梗死灶大小对血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平的影响。结果发现脑梗死组发病后第 3天和第 14天血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平均显著低于正常对照组 (P <0 .0 0 1) ,脑梗死组发病后第 3天血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平显著低于第 14天 (P <0 .0 0 5 ) ;不同大小梗死灶组之间 (发病后第 3天和 14天 )血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平差异显著 (P <0 .0 0 1)。以上提示胰岛素样生长因子 1可能对脑缺血区的神经元具有保护作用 ,而且血清胰岛素样生长因子 1和胰岛素样生长因子结合蛋白 3水平受梗死灶大小的影响     

Serum Concentrations of Insulin-Like Growth Factor-I (IGF-I) as a Marker of Liver Fibrosis in Patients With Chronic Hepatitis C

Liver biopsy was until recently the only way of evaluating liver fibrosis. Noninvasive tests for hepatic fibrosis, without potential risks, are desired by clinicians as well as patients. Insulin-like growth factor-I (IGF-I) synthesis is disturbed in liver fibrosis and reflects the severity of the clinical stage. We assessed serum IGF-I levels in patients with chronic hepatitis C (CHC) to correlate with liver fibrosis and antiviral therapy. Forty patients with CHC and persistently abnormal alanine aminotransferase values were enrolled and treated with peginterferon α-2a 180 μg per week plus ribavirin for 24 (n=20) or 48 (n=20) weeks. All patients underwent liver biopsy before treatment (METAVIR fibrosis stage F0, n=13; F1–F2, n=14; F3, n=7; F4, n=6). Serum IGF-I was measured at baseline, at the end of treatment period, and 24 weeks after finishing treatment. Mean IGF-I values were significantly lower in patients with advanced fibrosis (F4, 65.9±17.9 ng/mL) than in the others (F0, 145.2±47.1; F1–F2, 150.3±89.6; and F3, 121.4±35.2 ng/mL; P < .05). Serum IGF-I levels increased during combined therapy, being this increment markedly higher in patients with sustained virologic response. In conclusion, IGF-I synthesis is disturbed in CHC and reflects the severity of the liver fibrosis. Combined therapy improves serum IGF-I levels. IGF-I could represent a good, noninvasive marker of liver fibrosis.     

High Prevalence of Helicobacter pylori in Liver Cirrhosis (Relationship with Clinical and Endoscopic Features and the Risk of Peptic Ulcer)

In 153 consecutive patients with cirrhosis weassessed: (1) the prevalence of IgG to Helicobacterpylori and compared it with that found in 1010 blooddonors resident in the same area; and (2) therelationships of IgG to Helicobacter pylori with clinical andendoscopic features and with the risk of peptic ulcer.The IgG to Helicobacter pylori prevalence of cirrhoticswas significantly higher than in blood donors (76.5% vs 41.8%; P < 0.0005) and was notassociated with sex, cirrhosis etiology, Child class,gammaglobulins and hypertensive gastropathy. In bothgroups, the prevalence of IgG to Helicobacter pylori was significantly higher in subjects over 40. Amongpatients with cirrhosis a significantly higherprevalence of Helicobacter pylori was found in patientswith previous hospital admission (P = 0.02) and/or upper gastrointestinal endoscopy (P = 0.01) andpatients with peptic ulcer (P = 0.0004). Multivariateanalysis identified increasing age and male sex as riskfactors for a positive Helicobacter pylori serology and no independent risk factors for pepticulcer. The high prevalence of Helicobacterpylori-positive serology found in the present series isrelated to age and sex and might also be explained byprevious hospital admissions and/or uppergastrointestinal endoscopy. Our results do not confirmthe role of Helicobacter pylori as risk factor forpeptic ulcer in patients with liver cirrhosis.     

Prognostic Value of Insulin-Like Growth Factor-Binding Protein 7 in Patients with Heart Failure and Preserved Ejection Fraction

Background

The prognostic merit of insulin-like growth factor-binding protein 7 (IGFBP7) is unknown in heart failure and preserved ejection fraction (HFpEF).

Enhanced Urinary Excretion of cGMP in Liver Cirrhosis (Relationship to Hemodynamic Changes, Neurohormonal Activation, and Urinary Sodium Excretion)

Cyclic guanosine monophosphate (cGMP) has beenproposed to mediate peripheral arterial vasodilation inliver cirrhosis. Nitric oxide and natriuretic peptidesare the main signals for cGMP generation. Variation in urinary cGMP excretion parallels changes inplasma cGMP levels. Our aim was to determine urinaryexcretion of cGMP (UcGMPV) and to investigate itsrelationship to systemic hemodynamics, neurohumoral activity and renal sodium excretion incirrhosis. Urinary excretion of cGMP was measured in 19healthy subjects and 20 patients with alcoholiccirrhosis. Systemic hemodynamic parameters, blood volume(BV), plasma atrial natriuretic factor (ANF), and theendothelium-dependent vasodilator substance P (SP) weredetermined in all patients and in five healthy subjects.Urinary cGMPV was higher in the group of patients (736 pg/min; 50 -3229 pg/min) than incontrols (126 pg/min; 0-1657 pg/min) (P < 0.01). Inaddition, UcGMPV inversely correlated with the systemicvascular resistance and directly with cardiac output, blood volume, SP, ANF, and Pugh's score. By Coxregression analysis, only systemic vascular resistanceremained inversely associated with UcGMPV. Inconclusion, urinary cGMP excretion is increased incirrhosis. It is suggested that increased cGMP generationmay be related to the hyperkinetic circulation in humancirrhosis.     

Analysis of Biochemical and Virological Efficacy of Human Lymphoblastoid Interferon (IFN) in Patients with Compensated Type C Liver Cirrhosis

A controlled trial was conducted to compare the efficacy of interferon (IFN) between two groups of patients with type C liver. Thirty-five patients were randomly assigned to group A (17 patients) or group B (18 patients). The former received 3 megaunits (MU) of human lymphoblastoid IFN six days per week for two weeks, followed by three days per week for 50 weeks; the latter group received 6 MU six days per week for two weeks followed by three days per week for 24 weeks. The percentages of biological sustained responders (B-SR) and virological sustained responders (V-SR) were 29.4 and 23.5%, respectively, in group B, and 17.6% for both in group A. The therapeutic effects were not different between two groups. HCV genotype 2 accounted for significantly higher percentage of B-SR and V-SR (both 57.1%, respectively). These findings indicate that IFN is effective in type C cirrhosis with genotype 2.     

肝硬化患者血清1,25(OH)_2D_3变化对骨代谢的影响

分别采用竞争性放射受体法及放免法测定32例肝硬化患者血清1,25(OH)2D3、PTH水平,并与32例慢性乙型活动性肝炎、31例健康者对照。发现:肝硬化组血清1 ,25(OH)2D3较肝炎组和对照组明显下降(P<0.01,P<0.001),并与血钙、尺桡骨密度呈正相关(P<0.01,P<0.05);肝硬化组血清 PTH较肝炎组和对照组明显升高(P<0.05,P<0.05),但与血钙、尺桡骨密度无相关性。提示:肝硬化患者血清 1,25(OH)2D3降低与肝性骨病的发生关系密切,检测其水平,有利于该病的早期发现。     

Evaluation of Hepatic Function in Liver Cirrhosis (Clinical Utility of Galactose Elimination Capacity, Hepatic Clearance of D-Sorbitol, and Laboratory Investigations)

Assessment of hepatic function is based on bothliver blood tests and functional tests, the extensiveapplication of which is still controversial. The aim ofthis study was to evaluate the clinical utility of a few selected tests as discriminatory andprognostic indexes: serum albumin, pseudocholinesterase,prothrombin time, as well as galactose eliminationcapacity and hepatic sorbitol clearance. Two separate studies were performed: Study I to investigatehow well these tests assessed severity, and Study II toevaluate their prognostic value. A total of 128consecutive cirrhotic patients classified according to the Child-Pugh score were included in StudyI; Study II was carried out on 47 of these 128 during atwo-year follow-up period. Pairwise correlations betweenall tests and Child-Pugh score yielded higher significant values for liver blood tests thanfor the functional ones. In Study I functional testssuch as galactose elimination capacity and hepaticsorbitol clearance did not appear to be better than conventional biochemical tests indiscriminating clinical severity of cirrhotic patients,as defined by Child-Pugh classification. Results ofStudy II confirmed that in severe liver cirrhosisChildPugh score remains the best method for medium- andlong-term prognosis and for planning livertransplantation. Functional tests should be reserved fordefining the residual functioning liver mass or forstudies about functional liver plasma flow.     

Disturbed Synthesis of Insulinlike Growth Factor I and Its Binding Proteins May Influence Renal Function Changes in Liver Cirrhosis

Insulinlike growth factor-1 (IGF-1) is an anabolic hormone synthesized by the liver upon stimulation by growth hormone (GH). IGF-1 exerts important effects on renal hemodynamics and renal sodium handling. The bioactivity of this hormone is influenced by its binding proteins (BP) of which IGF-BP3 favors retention in the capillary lumen while IGF-BP1 facilitates the transport to the target tissues. IGF-BP1 modulates the actions of IGF-1 on target cells including renal tubules. Although a number of reports have dealt with disturbances of the IGF-1/IGF-BP system in cirrhosis, no studies have yet addressed the relationship between alterations in this system and renal function changes in cirrhosis. In the present study we have included 20 patients with cirrhosis and 10 healthy subjects (control group). As compared with the controls, patients showed lower circulating levels of IGF-1 and IGF-BP3, higher IGF-BP1 levels, and a tendency to higher insulinemia and GH values. The index IGF-1 × IGF-BP1/IGF-BP3 (IGF-1–IGF-BP index, reflecting the accessibility of circulating IGF-1 to target cells) was higher in patients with ascites. IGF-1 directly correlated with renal blood flow (P < 0.05), with IGF-BP3 (P < 0.001) and inversely with the Pugh's score (P < 0.02). A negative correlation was found between IGF-1–IGF-BP index and fractional sodium excretion (P < 0.01) and between IGF-BP1 and urinary sodium excretion (P < 0.02). Our findings support the hypothesis that the disturbance of the IGF-1/IGF-BP axis may be related to the degree of renal vasodilation and renal sodium retention in cirrhotic patients.     

1-Year Survey of Patients with Advanced Liver Cirrhosis: Prognostic Value of Clinical and Laboratory Indexes Identified by the Cox Regression Model

Ferro D, Saliola M, Quintarelli C, Alessandri C, Basili S, Cordova C, Bonavita MS, Violi F. 1-Year survey of patients with advanced liver cirrhosis. Prognostic value of clinical and laboratory indexes identified by the Cox regression model. Scand J Gastroenterol 1992;27:852-856.

The relation between coagulation indexes and survival rate was studied and analyzed in 46 patients with advanced liver cirrhosis (grade B and C Child-Pugh Classification), during a follow-up of 1 year. Twenty-four patients (52%) died of liver failure or fatal haemorrhage within 12 months of follow-up. Prothrombin activity, fibrinogen, fibrin(ogcn) degradation products, prekallikrein and factor VII. serum bilirubin. and the degree of liver insufficiency, scored by Child-Pugh classification, proved to be significantly correlated with survival by univariate analysis. A multivariate survival analysis (Cox regression model) disclosed two variables, prekallikrein and factor VII, that predicted survival. The rate ratios of death increased to 2.8 and 7.6 with values of prekallikrein <26% and factor VII <39%, respectively. This study shows that some simple laboratory tests exploring the clotting system may identify patients with poor prognosis in severe liver failure.     

Impact of Insulin Resistance on Insulin-Like Growth Factor-1/Insulin Like Growth Factor-Binding Protein-3 Axis and on Early Weight Gain in Small for Gestational Age Infants

Objective: To assess insulin-like growth factor-1 (IGF-1)/IGF-binding protein-3 (IGFBP-3) axis and insulin resistance (IR) and the relationship of these parameters with growth in appropriate for gestational age (AGA) and small for gestational age (SGA) infants at birth and in early infancy.Methods: Postnatal blood samples for measurement of glucose, insulin, IGF-1, and IGFBP-3 were taken from 60 infants (30 AGA and 30 SGA) at birth and at one, three, and six months of age. Both SGA and AGA infants were divided into two groups: growing well and not growing well. Blood glucose, insulin, IGF-1, and IGFBP-3 values were assessed in all infants.Results: Homeostasis model assessment-IR (HOMA-IR) values in well-growing SGA infants in the third and sixth months were found to be higher than in not well-growing SGA infants (3.9±0.8 vs. 1.0±0.3 at 3 months and 3.3±0.9 vs. 2.4±0.9 at 6 months, p<0.05). IGF-1 levels in well-growing SGA infants at 3 and 6 months were found to be higher than those in not well-growing SGA infants (83.80±44.50 vs. 73.50±17.60 ng/mL at 3 months and 95.12±50.74 vs. 87.67±22.91 ng/mL at 6 months, p<0.05). The IGF-1 values were significantly lower in well-growing SGA infants than in well-growing AGA infants (83.80±44.50 vs. 103.31±30.81 ng/mL at 3 months and 95.12±50.74 vs. 110.87±26.44 ng/mL at 6 months, p<0.05).Conclusions: This study demonstrates the effects of accelerated early infant growth on IGF-1/IGFBP-3 axis in SGA-born infants.Conflict of interest:None declared.     

Prognostic Value of Abdominal CT Scanning and Hepatic Histopathology in Patients with Acute Liver Failure

Acute liver failure has extremely high mortality without liver transplantation. We attempted to determine the value of abdominal CT scanning and liver biopsy in its management. A retrospective analysis of patients with acute liver failure was performed; demographic, clinical, radiologic and histopathologic features were noted. Over a period of 13 years, 177 patients were evaluated. The mean age was 39 years and 63% were females. The patients were divided into three groups. Fourteen percent survived with medical management (group I), 37% died (group II), and 49% had liver transplantation (group III). Most patients showed diffuse low density of the liver on CT scanning and the proportions were similar in the three groups. Moderate to large ascites was not present in group I but occurred in 31% of patients in group II and in 15% in group III. Mean hepatic volumes were similar in the three groups; however, 97% of the patients with a liver volume of less than 1000 ml either died or required liver transplantation. Liver biopsies among patients with spontaneous recovery (group I) were distinguished by the presence of regenerative changes and a hepatic parenchymal necrosis of less than 50%. These results suggest that in patients with acute liver failure a liver volume of less than 1000 ml and/or hepatic parenchymal necrosis of greater than 50% is indicative of a poor prognosis. This information may assist decision making in such patients, in particular, regarding the need for liver transplantation.     

研究探析免疫球蛋白及补体的检测对乙肝肝硬化合并糖尿病患者的检测价值

目的分析免疫球蛋白及补体的检测在乙肝肝硬化合并糖尿病患者中的检测价值。方法选取该院在2018年4月—2020年4月期间收治的乙肝肝硬化患者、糖尿病以及乙肝肝硬化合并糖尿病患者各33例作为研究对象,分别列为A、B、C 3组,采集3组患者的静脉血检测其免疫球蛋白及补体水平,比较3组患者的检测结果差异。结果在补体C3水平方面,C组患者和A组患者比较,组间数据差异无统计学意义(P>0.05),但是C组患者和B组患者比较,B组患者明显较C组患者高,差异有统计学意义(P<0.05);在补体C4水平方面,C组患者和A组患者比较,A组患者显著较C组患者高,差异有统计学意义(P<0.05),但是C组患者和B组患者比较,组间数据差异无统计学意义(P>0.05)。在IgA水平方面,C组患者和B组患者比较,组间数据差异无统计学意义(P>0.05),但是C组患者和A组患者比较,A组患者明显较C组患者低,差异有统计学意义(P<0.05);在IgG水平方面,C组患者和A组患者比较,A组患者显著较C组患者高,差异有统计学意义(P<0.05),但是C组患者和B组患者比较,B组患者显著较C组患者低,差异有统计学意义(P<0.05);在IgM水平方面,C组患者和A组以及B组患者比较,A、B两组患者显著较C组患者低,差异有统计学意义(P<0.05)。结论对于乙肝肝硬化合并糖尿病患者,积极对其开展免疫球蛋白及补体检测有利于为临床治疗带来相应的科学指导依据,检测价值显著。     

Association of Plasma Retinol Binding Protein-4 (RBP4) and Sonographic Grading of Fatty Liver in Obese Iranian Children

Background

The prevalence of obesity and its related comorbidities, such as fatty liver, in children is increasing worldwide mostly due to changes in diet and life-style. Many serological markers have been suggested for screening of fatty liver but investigations for finding more reliable factors are still in progress.

Objectives

This study aimed to investigate the correlation between the level of retinol binding protein-4 (RBP4) in the serum and sonographic grading of fatty-liver severity in obese Iranian children.

Patients and Methods

This case-control, double-blind study involved 51 obese children aged between five and 17 years as the case group. In addition, 35 healthy lean children with no liver problems were selected as the control group. Plasma RBP4 (using an ELISA), serum triglycerides (TG), low-density-lipoproteins (LDL), high-density-lipoproteins (HDL), total-cholesterol (Chol), and body mass index (BMI) were measured. Grading the severity of the fatty liver condition was done by an expert radiologist in the case group.

Results

RBP4 levels in obese children (19 482.9 ± 3 302.2 pg/ml) were higher than those found in the lean control group (14 295.68 ± 2 381.3 pg/ml) (P < 0.05). In the obese patients, RBP4 levels showed a significant correlation with the grade of fatty liver and BMI (P < 0.05).

Conclusions

It was found that the level of RBP4 had a strong correlation with the severity of fatty liver. Therefore, RBP4 may be considered as a useful, noninvasive predictive biomarker of intrahepatic lipid content in obese children prior to using radiological investigations. In particular, abdominal sonography, for the evaluation of intrahepatic lipid content in obese patients, as the sensitivity of a sonography is decreased due to the increased thickness of the abdominal wall as a result of fat deposits.     

Stem Cell Factor (SCF) and Interleukin 3 (IL-3) in the Sera of Patients with Colorectal Cancer

For a long time markers that can detect a malignant cell transformation as early as possible have been sought. Substances which have been discovered are known as tumor markers. Stem cell factor (SCF) and interleukin 3 (IL-3) are members of a group of glycoprotein growth factors called hematopoietic cytokines (HCs). These factors take part in the regulation of developmental processes of hematopoietic progenitor cells and it was proved that HCs can be produced by different cancer cells, including colorectal cancer. The aim of this study was to investigate a potential role for SCF and IL-3 as tumor markers for colorectal cancer. We compared the serum levels of SCF and IL-3 in colorectal cancer patients with those in healthy subjects (control group) and commonly accepted tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). We defined the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and receiver-operating characteristics (ROC) curve of tested substances. SCF and IL-3 were determined using enzyme-linked immunosorbent assay (ELISA). CEA and CA 19-9 were measured by microparticle enzyme immunoassay. The serum levels of HCs and tumor markers were investigated in 75 patients with colorectal cancer and in 40 healthy subjects. There were significant differences in the level of circulating SCF and IL-3 in the colorectal cancer patients compared to the control group. Moreover, the diagnostic sensitivity of SCF was higher than the sensitivity of CEA and CA 19-9. The SCF area under the ROC curve was larger than the IL-3 area but smaller than the CEA and CA 19-9 areas. The diagnostic specificities of cytokines were lower than those of tumor markers, but the combined use of cytokines and tumor markers increased the diagnostic values. The highest values of diagnostic parameters were observed for the combined use of SCF and CA 19-9. These results suggest a potential role for SCF and IL-3 as tumor markers for colorectal cancer, especially in combination with CEA or CA 19-9.     

乙肝后肝硬化患者血清1,25(OH)2D3检测及其临床意义

采用竞争性放射受体法测定３２例乙肝后肝硬化患者血清１Ｍ２５（ＯＨ）２Ｄ３水平,并与３２例性乙型肝炎、３１例健康者对照。发现：肝硬化组血清１,２５（ＯＨ）２Ｄ３水平较肝炎组和对照组明显下降（Ｐ〈０．０１,Ｐ〈０．００１）,且与血清骨钙素、尺桡密度呈正相关（Ｐ〈０．０１,Ｐ〈０．０５）。提示：测定乙肝后肝硬化患者血清１,２５（ＯＨ）２Ｄ３水平有利于肝性骨病的早期发现。