急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义

目的 探讨急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义,为临床诊断及鉴别诊断药物性肝损害提供依据.方法 回顾性分析北京佑安医院2006-2008年收治的药物性肝损害患者51例的临床资料,将其分为急性药物性肝损害及慢性药物性肝损害两组,并对两组患者肝功能及自身抗体的检测结果进行分析对比.对数据用SPSS10.0软件进行Mann-Whitney秩和检验.结果 急性及慢性药物性肝损害两组患者ALT水平分别为(412.1±387.5)U/L和(376.0±319.7)U/L,AST为(352.5±457.9)U/L和(198.8±142.7)U/L,总胆红素为(109.7±104.8)μmol/L和(102.4±135.7)μmol/L,直接胆红素为(66.4±73.3)μmoL/L和(61.2±72.1)μmol/L,碱性磷酸酶为(133.4±50.1)U/L和(147.4±97.3)U/L,γ-谷氨酰转肽酶为(139.9±134.1)U/L和(180.6±227.9)U/L,白蛋白为(41.3±4.9)g/L和(39.8±5.3)g/L,球蛋白为(25.1±5.3)g/L和(28.6±5.1)g/L,经秩和检验分析,两组患者除球蛋白的水平差异有统计学意义外(P<0.05),其余指标的差异均无统计学意义(P>0.05).两组患者中部分可检出自身抗体,急性药物性肝损害组抗核抗体(ANA)、平滑肌抗体滴度均≤1:320;慢性药物性肝损害患者中可检出高滴度ANA、抗线粒体抗体,其中ANA滴度≥1:320的患者15例,7例患者ANA为1:1000.结论 肝功能指标无助于鉴别急性或慢性药物性肝损害;药物性肝损害患者可检测出多种自身抗体,慢性药物性肝损害患者可出现高滴度自身抗体,应注意与自身免疫性肝炎鉴别诊断.     

早期肝功能损害对急性胰腺炎病因判定的临床价值

目的:观察急性胰腺炎(acute pancreatitis,AP)患者发病48h内肝功能改变,探讨早期肝功能损害对AP病因判定的临床意义.方法:对153例AP患者临床资料回顾性分析,按病因分为胆源性、非胆源性及不明原因3组.胆源性组(n=80);非胆源性组(n=44);不明原因组(n=29).早期肝功能检测指标:胆源性组(n=61);非胆源性组(n=33).比较胆源性组和非胆源性组早期肝功能指标血清丙氨酸氨基转氨酶(amino transaminase,ALT)、门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、直接胆红(direct bilirubin,DBIL)、谷氨酰转移酶(glutamyl transferase,GGT)、碱性磷酸酶(alkaline phosphatase,AKP),观察其早期肝功能损害的临床类型,并计算胆源性组早期肝功能损害的敏感性和特异性.结果:胆源性组患者早期肝功能损害较非胆源性组严重,ALT(214.16U/L±146.92U/Lvs30.82U/L±25.59U/L),AST(212.72U/L±210.50U/Lvs28.24U/L±22.16U/L),GGT(438.34U/L±286.69U/Lvs60.48U/L±68.32U/L),AKP(202.81U/L±147.77U/Lvs72.06U/L±36.70U/L),TBIL(56.52μmol/L±46.01μmol/Lvs18.25μmol/L±9.56μmol/L),DBIL(36.81μmol/L±32.50μmol/Lvs5.17μmol/L±4.65μmol/L,均P<0.001);早期肝功能损害临床类型以ALT、AST、GGT、AKP、TBIL及DBIL混合损害为主,占88.6%;其敏感性为95.1%,特异性为90.9%.结论:早期肝功能损害可预测AP病因为胆石(源)性.早期肝功能检测应作为急诊的常规实验室检查项目,更适合于基层医院.     

复方牛胎肝提取物治疗非酒精性脂肪肝临床观察

目的：探讨复方牛胎肝提取物治疗非酒精性脂肪肝患者的临床疗效。方法在综合治疗的基础上给予牛胎肝提取物治疗43例非酒精性脂肪肝患者12周,观察治疗前后患者临床症状、肝功能指标和 B 超检查结果的变化。结果在牛胎肝提取物治疗12周后,患者 BMI 由（26.6±3.1（降为（24.1±2.5）;血清 ALT、AST 和 GGT 由（81.2±36.8） U/L、（60.4±28.9） U/L 和（82.1±53.6） U/L 降为（40.3±15.2） U/L、（33.6±14.6） U/L 和（44.9±22.8） U/L;中重度脂肪肝患者由33例（76.7%）降为为21例（48.8%）,较治疗前均显著下降（P＜0.05）。结论牛胎肝提取物可显著改善非酒精性脂肪肝患者临床症状和肝功能指标。     

阿苯达唑致广州管圆线虫病患者肝损害的临床分析

目的 分析口服阿苯达唑治疗广州管圆线虫病致急性肝损害作用. 方法 对41例广州管圆线虫病患者接受阿苯达唑治疗后出现的急性肝损害(肝功能变化)、基础疾病及转归进行分析. 结果 1)用阿苯达唑治疗广州管圆线虫病疗程结束后,26例患者丙氨酸氨基转移酶(ALT)升高,范围为42.00～252.00 U/L,平均(97.66±56.66)U/L;9例患者天门冬氨酸氨基转移酶(AST)增高,范围为41.00～131.00 U/L,平均(60.66±29.34)U/L;13例患者γ-谷氨酰转移酶(GGT)升高,范围为56.90～213.00 U/L,平均(99.52±46.65) U/L;碱性磷酸酶(ALP)、蛋白质及胆红素水平未见显著变化;2)阿苯达唑治疗过程中,同时加用保肝药物(甘利欣、肝泰乐)组68.42%(13/19)氨基转移酶升高,未使用保肝药物组59.09%(13/22)氨基转移酶升高,差异无统计学意义(P＞0.05);3)肝功异常者停用阿苯达唑后开始出现好转,出院2个月后血清氨基转移酶大多恢复至正常水平. 结论 口服阿苯达唑可导致急性肝损害,其剂量须根据患者具体情况进行调整,临床应用时注意监测肝功能,并合理使用保肝药物.     

匹伐他汀对冠心病合并非酒精性脂肪肝患者肝功能的影响

目的:观察匹伐他汀对肝功能正常冠心病(CHD)合并非酒精性脂肪肝(NAFLD)患者肝功能的影响。方法:选择我院CHD合并NAFLD且肝功能正常的患者205例为CHD+NAFLD组,根据NAFLD严重程度患者被分为轻度组87例、中度组64例、重度组54例,另选择同期在我院就诊的单纯CHD患者70例(CHD组)作为对照。四组均在常规治疗的基础上给予匹伐他汀治疗,治疗15d。观察四组治疗前后血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(γ-GT)水平和严重肝功能损害发生率。结果:治疗后CHD组、CHD+NAFLD轻、中、重度组血清ALT、AST、γ-GT水平均显著升高(P均=0.001),且四组治疗后ALT[(45.89±11.36)U/L比(46.92±12.67)U/L比(46.35±11.95)U/L比(47.32±14.06)U/L]、AST[(46.32±12.13)U/L比(48.54±13.49)U/L比(47.63±12.57)U/L比(48.66±13.54)U/L]、γ-GT[(58.49±14.86)U/L比(57.62±11.38)U/L比(57.92±10.51)U/L比(58.52±13.8)U/L]水平及严重肝功能损害发生率(2.90%比3.57%比1.61%比3.92%)相比较差异均无统计学意义(P均>0.05)。结论:与单纯CHD患者比较,匹伐他汀用于肝功能正常CHD联合NAFLD患者未增加肝功能损害,具有良好的临床安全性。     

静脉用胺碘酮引起急性肝损害患者原因及其临床特点分析

目的 探讨并分析静脉应用胺碘酮引起急性肝损害患者的临床特点及其可能的原因。方法 2010年2月~2016年2月期间我院心内科及部分其它科室在静脉注射胺碘酮后出现急性肝功能损伤患者23例,分析患者的基础疾病、用药方法、合并用药情况、发现肝损害的时间、肝功能恢复时间以及转归等特点。结果 在静脉注射胺碘酮后,2例（8.7%）患者在8 h内即表现出肝功能损害,8例（34.8%）患者在9~48 h之间出现,5例（21.7%）患者在49~72 h间出现,7例（30.4%）在73~96 h间出现,1例（4.3%）患者在96 h后出现;谷草转氨酶峰值达17468 U/L,平均值为（3648±3889） U/L,谷丙转氨酶峰值达13437 U/L,平均为（3142±1846） U/L,15例（65.2%）患者出现黄疸;出现肝损害后立即停用胺碘酮并给予积极治疗,19例患者肝功能在2~91 d恢复正常,平均时间为（33.76±19.38） d;1例患者因心源性休克死亡,2例患者因急性肝肾功能不全死亡,1例患者因肝性脑病死亡。结论 胺碘酮致使肝功能损害的具体机制尚未明确,无法完全排除其它药物对肝功能的影响,但胺碘酮是引起肝功能损害的重要因素。     

中国高致病性禽流感A/H5N1病毒感染患者的临床与预后

目的 研究我国卫生部公布的28例高致病性禽流感A/H5 N1病毒感染(简称人禽流感)病例的临床特点,评估其临床与预后的相关性.方法 回顾总结我国2005年11月至2008年5月临床及实验室确诊的28例人禽流感病例的临床资料,应用EPIDATA 3.02建立数据库,并应用SPSS13.0软件进行统计分析,计量资料采用独立样本非参数检验,计数资料应用x<'2>(fisher)检验.结果 我国28例人禽流感病例中,男13例,女15例,治愈10例,死亡18例.发病中位年龄为29岁(6～62岁),发热为本病最突出的临床表现(100%).治愈患者首次血常规检测白细胞为(4.0±1.9)×109/L,淋巴细胞为(1.09±0.49)×109/L,,血小板为(116±39)x 109/L;死亡患者分别为(5.1±2.9)x 109/L、(0.98±0.44)x109/L 及(101±40)x109/L,两组比较差异均无统计学意义(P>0.05).治愈与死亡患者天冬氨酸转氨酶分别为(173±246)U/L和(272±263)U/L,乳酸脱氢酶(LDH)分别为(1016±568)U/L和(1512±1052)U/L,肌酸激酶分别为(1099±1590)U/L和(2534±4281)U/L,肌酸激酶同T酶分别为(28±30)U/L和(125±197)U/L.死亡患者发病初期LDH水平大于正常值上限8倍以上者6例.疾病极期均出现舣侧肺部病变.22例发展为急性呼吸窘迫综合征,其中治愈患者中5例,死亡患者中17例;急性肾损伤9例,均死亡.奥司他书抗病毒治疗的10例中,6例康复,4例死亡,康复和死亡患者开始使用奥司他韦的时间分别为(6.5±3.0)d和(11.8±3.3)d.28例患者均不同程度接受丁抗牛素和糖皮质激素治疗,开始碰用糖皮质激素的时间和疗程治愈患者与死亡患卉无差异.结论 (1)发病初期LDH升高大于正常上限8倍以上者预后不良;(2)合并急性呼吸窘迫综合征及急性肾损伤者预后差;(3)发病早期应用有效抗病毒治疗可改善预后.     

37例急性乙型肝炎患者临床和病毒学变化特征分析

目的探讨急性乙型肝炎患者的临床和病毒学变化特征。方法对37例急性乙型肝炎患者进行血清和肝组织HBV标志物监测,并随访临床转归。结果 37例急性乙型肝炎患者入院时ALT水平为1143.64±698.32U/L,TBIL为83.99±80.44μmol/L;肝功能恢复正常时间为44.41±15.43天;血清HBsAg转阴时间为55.9±44.3天,HBV DNA转阴时间为39.4±25.2天;发病后6个月时患者HBsAg转阴率为91.9%,3例（8.1%）患者发展为慢性乙型肝炎,均已使用核苷类药物抗病毒治疗;在发病后45天内完成肝穿刺检查。结果显示,肝组织HBsAg转阴时间为22.6±10.0天,阴转率为51.4%;肝组织HBcAg转阴时间为29.8±16.5天,阴转率为73.0%。结论绝大多数急性乙型肝炎患者均可清除血液及肝细胞内的病毒,使病情得到较快的恢复,而发病初期病毒载量可能对患者预后具有重要的影响。     

102例系统性红斑狼疮肝损害患者特点及危险因素分析

目的:了解系统性红斑狼疮肝脏受累的特点,为临床诊断、鉴别诊断提供依据。方法:回顾性分析系统性红斑狼疮患者566例,比较狼疮性肝损害与无肝损害患者的一般情况、实验室检查结果及预后,并对狼疮性肝损害发生的危险因素进行分析。结果:566例系统性红斑狼疮患者中,狼疮性肝损害患者102例(18.02%)。狼疮性肝损害患者与无肝损害患者相比IgG较高[(18.65±8.64)g/L比(15.80±7.14)g/L,P<0.05],系统性红斑狼疮疾病活动指数(SLEDAI)较高(13.3±8.4比11.3±6.5,P<0.05),病程较短[(3.0±4.6)年比(4.2±6.0)年,P     

58例小儿甲型肝炎临床诊治分析

总结小儿甲型肝炎的临床特征和临床转归。方法对我院2011年5月至2011年8月收治的58例甲型肝炎患儿的临床资料进行回顾性分析。观察治疗前后患者临床症状、肝功能指标和B超检查结果的变化。结果58例小儿经促肝细胞生长素联合门冬氨酸钾镁注射液治疗10 d后,30例患儿血清丙氨酸氨基转移酶由治疗前的（909.38±938.76） U/L降为治疗后的（93.55±72.83） U/L;门冬氨酸氨基转移酶由治疗前的（637.09±687.93） U/L 降为治疗后的（46.29±23.10） U/L;治疗3 w后28例患者胆红素由治疗前的（55.81±38.83）μmol/L降为治疗后的（21.94±22.78）μmol/L。3 m后全部患者血清抗-HAV IgM均呈阴性。全部患者治愈出院。结论小儿甲型肝炎预后良好,重在预防。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.