复方嗜乳酸菌片联合门冬氨酸鸟氨酸治疗肝性脑病的疗效观察

目的 探讨复方嗜乳酸菌片联合门冬氨酸鸟氨酸治疗肝性脑病（HE）的临床价值及安全性.方法 选取HE患者92例,对照组45例在常规治疗上予门冬氨酸鸟氨酸注射液静脉滴注,观察组47例在对照组的基础上口服复方嗜乳酸菌片.检测治疗前后ALT、AST、TBil、血氨水平,比较两组临床疗效、苏醒时间、住院时间及不良反应.结果 两组治疗后ALT、AST、TBil、血氨均较治疗前下降（P〈0.05）,且观察组变化更为显著（P〈0.05）.观察组有效率高于对照组,苏醒及住院时间短于对照组（P〈0.05）.两组不良反应比较,差异无统计学意义（P〉0.05）.结论 复方嗜乳酸菌片联合门冬氨酸鸟氨酸可明显降低血氨水平,改善肝功能,迅速缓解临床症状,是HE的一种理想治疗方案.     

血清总胆汁酸在肝脏疾病诊断中的应用

目的探讨常见肝病中血清总胆汁酸（TBA）及4种肝酶的差异。方法 152例肝病患者为肝病组,128名健康志愿者为对照组。比较2组患者血清TBA、AST、ALT、γ‐谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）水平及其异常率。比较肝病组血清TBA与AST、ALT、GGT、ALP异常率。结果肝病组患者血清TBA、AST、ALT、GGT、ALP水平、异常率均明显高于对照组（P〈0.01）。肝病组患者血清TBA异常率明显高于4种肝酶异常率（P〈0.05）。结论在急慢性肝炎、肝硬化、肝癌疾病中,TBA异常率高于4种肝酶指标,且对潜在性肝细胞损害有早期诊断价值。     

门冬氨酸鸟氨酸治疗肝性脑病的临床研究

目的应用门冬氨酸鸟氨酸对肝性脑病的临床疗效及安全性进行观察。方法 2000年4月2009年11月,将60例肝硬化肝性脑病患者分为对照组和治疗组,对照组给予常规精氨酸治疗,治疗组在对照组基础上加门冬氨酸鸟氨酸10g/d,静脉滴注,连续7d。观察治疗前后神志变化、血清氨基转移酶（ALTAST）、血清白蛋白（ALB）等指标变化。结果治疗组经门冬氨酸鸟氨酸治疗后神志改变、ALT、AST明显优于治疗前（P〈0.05）。结论门冬氨酸鸟氨酸治疗肝性脑病疗效确切,且对肝功能有改善作用,副反应小。     

乙型肝炎患者血清HBeAg与肝功能指标相关性研究

目的研究和分析乙型肝炎（乙肝）患者血清中HBeAg与肝功能指标丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、总胆红素（TBIL）间的关系,为临床乙肝的诊断、治疗和预后提供参考依据。方法采用酶联免疫吸附法检测桂阳县中医院269例HBsAg阳性患者和40例健康体检者的HBeAg;采用全自动生化分析仪检测血清中ALT、AST、γ-GGT、TBIL水平,并应用t检验对结果进行统计分析。结果 HBeAg阳性组患者ALT、AST、γ-GGT、TBIL水平均高于健康对照组（P〈0.05）和HBeAg阴性组（P〈0.05）;HBeAg阴性组患者ALT、γ-GGT、TBIL水平高于健康对照组（P〈0.05）,而AST水平差异则无统计学意义（P〉0.05）。结论肝功能指标ALT、AST、γ-GGT、TBIL与HBeAg有着密切的联系,在乙肝的诊断及肝功能评估中应予以综合考虑,这样才能准确反映HBV感染及肝功能损伤程度,从而为临床诊断、治疗及预后提供有价值的依据。     

非乙醇性脂肪性肝炎病人IL-6和hsCRP测定及意义

目的探讨非乙醇性脂肪性肝炎（NASH）病人血清白细胞介素-6（IL-6）和高敏C反应蛋白（hsCRP）水平及其临床意义。方法检测27例NASH病人（NASH组）、33例非乙醇性单纯性脂肪肝病人（NAFL组）及30例健康对照者（对照组）血清IL-6、hsCRP、丙氨酸氨基转移酶（ALT）、谷氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、总胆固醇（TC）、三酰甘油（TG）和空腹血糖（FPG）水平,并测定收缩压及体质量指数（BMI）。结果与对照组相比,NASH组血清hsCRP、IL-6、ALT、AST、GGT、TC、TG、FPG、BMI和收缩压水平均明显升高,差异有显著性（F=3.58～35.70,q=5.30～10.50,P〈0.05、0.01）;NAFL组血清hsCRP、ALT、AST、GGT、TC、BMI亦明显升高,差异有显著意义（q=4.24～6.69,P〈0.01）。与NAFL组相比,NASH组血清IL-6、ALT、AST、GGT、TG、收缩压水平均明显升高,差异有显著意义（q=2.54～10.46,P〈0.05、0.01）。结论血清IL-6及hsCRP在NASH的诊断及鉴别诊断中有一定的临床意义。     

妊娠期肝功能损害孕妇生化指标与血小板4项参数的关系

目的　探讨妊娠期肝功能损害孕妇生化指标与血小板 4项参数的关系。方法　分析对比门诊随访正常孕妇 (2 8例 )、单纯ALT升高组患者 (3 0例 )及黄疸伴ALT升高组患者 (2 7例 )的血生化和血小板 4项参数。结果　单纯ALT升高组ALT、AST、DB、TBA、GGT均高于正常孕妇组 (P <0 .0 1)、TB、MPV均高于正常孕妇组 (P <0 .0 5 )、PCT、PLT低于正常孕妇组 (P <0 .0 5 ) ,而两组间ALP、PDW无显著性差异 (P >0 .0 5 ) ;黄疸伴ALT升高组ALT、AST、TB、DB、TBA、ALP均高于单纯ALT升高组 (P <0 .0 1)、MPV高于单纯ALT升高组 (P <0 .0 5 )、PCT、PLT低于单纯ALT升高组 (P <0 .0 5 ) ,而两组间GGT、PDW无显著性差异 (P >0 .0 5 )。所有 5 7例肝损害孕妇生化指标和PLT4项参数进行相关分析 ,其中MPV与ALT、AST、GGT均存在正相关 (P <0 .0 5 ) ;PLT与TB、DB存在负相关 (P <0 .0 1) ;PCT与TB、DB存在负相关 (P <0 .0 5 ) ;其余生化指标和PLT4项参数不存在相关性 (P >0 .0 5 )。结论　GGT、ALP可能不是判断妊娠期肝功能损害的敏感指标 ;黄疸引起妊娠肝损害孕妇PLT计数减少     

异甘草酸镁治疗酒精性肝病的疗效观察

目的：观察异甘草酸镁注射液在酒精性肝病治疗中的作用。方法：异甘草酸镁注射液150 mg治疗慢性乙型肝炎40例,对照组复方甘草酸苷注射液100 ml治疗36例,治疗结束后进行疗效评估。结果：两组肝功能指标ALT、AST及GGT均有明显下降,与治疗前相比有统计学差异（P〈0.05）。治疗后治疗组ALT、AST及GGT下降明显,较对照组有统计学差异（P〈0.05）。治疗组显效率71.8%;对照组显效率47.2%,差异有统计学意义（P〈0.05）。结论：异甘草酸镁可明显改善酒精性肝病患者症状,减轻肝功能损害,促进肝功能恢复。     

肝硬化患者血清Lp-PLA2、Cys-C水平的变化及其意义

目的探讨肝硬化患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、胱抑素C(Cys-C)的水平变化及其意义。方法选取我院2016年3月至2017年5月我院确诊的120例慢性乙肝肝硬化患者(病例组)、选取120例体检结果正常的对象作为对照组;对比两组的血清Lp-PLA2、Cys-C、肝功能指标;分析不同肝功能患者血清Lp-PLA2、Cys-C水平差异。结果病例组的血清ALT、AST、γ-GGT水平显著高于对照组(P0.05);病例组的血清ALB水平显著低于对照组(P0.05);病例组的血清Cys-C水平显著高于对照组(P0.05);病例组的血清Lp-PLA2水平显著低于对照组(P0.05);不同肝功能分级的肝硬化患者血清Cys-C水平显著升高,组间两两比较差异具有统计学意义(P0.05);不同肝功能分级的肝硬化患者血清Lp-PLA2水平差异无统计学意义(P0.05);肝硬化患者血清Cys-C水平与血清ALT、AST、-γGGT水平呈正相关系(P0.05),与ALB水平呈负相关系(P0.05);肝硬化患者血清Lp-PLA2水平与血清ALT、AST、γ-GGT、ALB水平无相关性(P0.05)。结论肝硬化患者血清Lp-PLA2水平降低、Cys-C水平升高,Cys-C水平变化与肝硬化肝功能受损具有一定的关系。     

肝功能损伤患者血清视黄醇结合蛋白的检测

目的探讨视黄醇结合蛋白（RBP）在不同临床类型肝损伤患者血清中的水平及临床意义。方法分别检测100例不同临床类型的肝损伤患者和健康对照者血清中的RBP、总蛋白（TP）、清蛋白（ALB）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（γ-GT）水平,进行相关统计学分析。结果与对照组比较,慢性肝病和脂肪肝患者RBP、TP、ALB明显升高（P〈0.05）;肝癌和肝硬化患者RBP、TP、ALB与对照组比较明显降低（P〈0.05）;与对照组比较,各组中ALT、AST、γ-GT均升高（P〈0.05）;相关分析发现,各组中RBP与TP、ALB呈正相关,与ALT、AST、GGT呈负相关,P均小于0.001。结论 RBP可以作为反映肝功能损伤程度的指标之一,对重型肝炎的预后判断有一定的临床意义。     

乙型肝炎后肝硬化自身抗体检测及其对肝功能影响的研究

目的探讨乙型肝炎后肝硬化患者血清中自身抗体存在的情况及其对肝功能的影响。方法利用间接免疫荧光法及免疫印迹法分别检测89例乙型肝炎后肝硬化（HBC）患者及64例慢性肝炎患者（CHB）血清中自身抗体阳性率,将两组阳性率进行统计比较。将89例HBC患者按照自身抗体存在情况分成自身抗体阳性组和自身抗体阴性组,利用全自动生化分析仪分别检测两组患者的肝功指标,并与90例正常对照者（正常对照组）进行比较。结果乙型肝炎后肝硬化组自身抗体检出情况与慢性乙型肝炎组相比,AMA、AMA-M2升高最为明显（P〈0．01）,ANA检出率也显著增高（P〈0．05）,其他指标差异无统计学意义（P〉0．05）。肝功能指标中,自身抗体阳性组与阴性组比较,ALP升高最为明显（P〈0．01）,AST、TBA值显著升高（P〈0．05）,其他指标差异无统计学意义（P〉0．05）。自身抗体阳性组与正常对照组比较,ALT、AST、TBil、DBil、GGT、ALP、TBA值均显著升高（P〈0．01）。自身抗体阴性组与正常对照组比较,ALT、AST、TBil、GGT、TBA及DBil显著升高（P〈0．01或P〈0．05）,ALP值差异无统计学意义（P〉0．05）。结论乙型肝炎后肝硬化患者合并自身免疫性肝病对肝脏损害更大,在肝病患者中检测自身抗体将有助于判断肝病患者病情的严重程度和预后。     

Ratio of serum ornithine carbamoyltransferase to alanine aminotransferase as a potent indicator for hepatocellular carcinoma

OBJECTIVES: To evaluate the clinical advantage of the ratio of serum ornithine carbamoyltransferase (OCT) to alanine aminotransferase (ALT) in the diagnosis of hepatocellular carcinoma (HCC). DESIGN AND METHODS: Serum levels of hepatic enzyme markers and their combinations were evaluated and compared with those of two other markers for HCC. RESULTS: OCT/ALT was significantly higher in case of HCC than chronic hepatitis or liver cirrhosis. Its sensitivity (64.3%) was higher than those of alpha-fetoprotein and PIVKA-II (21.4% and 42.9%, respectively). Fluctuations of OCT/ALT before and after treatment were similar to those of alpha-fetoprotein. CONCLUSIONS: OCT/ALT is a potent indicator for the diagnosis and the prognosis of HCC.     

Hyperammonemia caused by impaired mitochondrial ornithine transport in a patient with partial quantitative deficiency of ornithine carbamoyltransferase

Late-onset hyperammonemia was observed in a male patient with partial quantitative deficiency of ornithine carbamoyltransferase (OCT). His liver contained 10% of the normal level of OCT, but with normal kinetics. This reduced enzyme activity alone, however, could not explain the hyperammonemia. Therefore, the effects of impaired ornithine transport into mitochondria, which seemed to be a possible precipitating factor, were examined by numerical simulation of the urea cycle. The results were as follows: (a) On the assumption that the ornithine concentrations in the cytosol and mitochondrial matrix were always equal, the ammonia handling efficiency would be unchanged by decrease in the OCT concentration to 10% of normal; (b) Under conditions of impaired mitochondrial ornithine transport that had no effects on ureagenesis with a normal amount of enzyme, 10% of the normal concentration of enzyme would impair ammonia handling efficiency. Thus, impaired mitochondrial ornithine transport seemed to cause hyperammonemia in the state of partial quantitative deficiency of OCT in this case.     

Effects of high hepatic acetaldehyde level following simultaneous administration of ethanol and cyanamide on liver function in rats

Extremely high concentrations of hepatic acetaldehyde were induced in rats by the intragastric administration of ethanol and cyanamide, an aldehyde dehydrogenase inhibitor; and these high levels were maintained for 4 weeks. Liver function tests, including mitochondrial ornithine carbamoyltransferase (OCT) and GOT activities, were within normal limits, and no increase in either hepatic triglyceride or collagen contents was observed. These results suggest that hepatotoxic effects of ethanol are not derived from the high acetaldehyde levels in the liver.     

乙型肝炎病毒相关慢性肝炎、肝硬化和慢加急性肝衰竭患者血浆氨基酸谱变化及特点

目的分析乙型肝炎病毒（HBV）相关慢性肝炎、肝硬化、慢加急性肝衰竭患者血浆氨基酸谱的变化及特点,为肝病严重程度判断和临床针对性干预提供依据。方法选择35例HBV相关慢性肝病包括慢性乙型肝炎、乙型肝炎肝硬化、慢加急性肝衰竭患者和10例健康对照者,应用质谱方法检测其血浆氨基酸、肝功能和血氨,分析以上不同类型肝病氨基酸谱变化及其特点,同时观察尿素循环中重要氨基酸代谢产物瓜氨酸和鸟氨酸水平与血氨的变化。结果与正常对照比较,慢性乙型肝炎患者尚无明显氨基酸代谢失衡;肝硬化和慢加急性肝衰竭患者血浆芳香族氨基酸水平升高,支链氨基酸/芳香族氨基酸比值明显降低。慢性乙型肝炎、肝硬化和肝衰竭患者血浆鸟氨酸、瓜氨酸、血氨均较正常对照组升高。结论慢性乙型肝炎患者血浆氨基酸谱尚无明显变化,一旦发展到肝硬化和慢加急性肝衰竭则变化明显,尤其支链氨基酸/芳香氨基酸比值,鸟氨酸、瓜氨酸与血氨变化显著。基于血氨升高和氨基酸失衡在肝性脑病发病中的重要作用,本研究结果再次提示,血浆氨基酸谱、鸟氨酸、瓜氨酸与血氨检测可以用于肝病严重程度判断、肝性脑病的预测,并指导临床治疗。     

Peroxisome localized human hepatic alanine-glyoxylate aminotransferase and its application to clinical diagnosis

The subcellular localization of alanine-glyoxylate aminotransferase (EC 2.6.1.44 L-Alanine: glyoxylate aminotransferase) of adult human liver was examined by sucrose density gradient centrifugation. The enzyme sedimented at the same density as catalase, indicating that it was localized in the peroxisomes. Alanine-glyoxylate aminotransferase activity in the liver of patients with cirrhosis was about 65% of that of normal liver or 71% of that from patients with chronic hepatitis, but its activity in the serum of patients with cirrhosis was higher than that from patients with chronic hepatitis. Patterns of activity of alanine-glyoxylate aminotransferase in liver and serum differed from those of aspartate-2-oxoglutarate aminotransferase and ornithine carbamoyltransferase that have a different intracellular location. Serum immunoreactive alanine-glyoxylate aminotransferase (Im-AGT) was measured by enzyme-linked immunoadsorbent assay (ELISA). The Im-AGT levels (mean +/- SEM) in acute (80 +/- 13 micrograms/L) and chronic (72 +/- 4 micrograms/L) hepatitis were higher than those of normal controls (44 +/- 1 micrograms/L). However, the difference between acute and chronic hepatitis was not statistically significant. The level in liver cirrhosis (54 +/- 3 micrograms/L) was lower than those of the hepatitides but higher than that of normal controls. The apparent half-life of serum Im-AGT of patients who underwent liver lobectomy by a microwave tissue coagulation method was approximately 3-4 days.     

不同浓度右美托咪定对脓毒症大鼠炎性因子、OCT和STAT3的影响及肝损伤保护机制

目的分析不同浓度的右美托咪定对脓毒症大鼠鸟氨酸氨基甲酰转移酶(OCT)、炎性因子和信号转导与转录因子3(STAT3)的影响及肝损伤保护机制。方法取50只雄性SD大鼠,随机分为假手术组(仅打开腹腔翻动盲肠)、模型组(经盲肠结扎穿孔术建立脓毒症大鼠模型)、低浓度组(脓毒症+右美托咪定2.50μg·kg-1·h-1)、中浓度组(脓毒症+右美托咪定5.00μg·kg-1·h-1)、高浓度组(脓毒症+右美托咪定10.00μg·kg-1·h-1),每组各10只。于造模后12 h,通过酶联免疫吸附试验法测定大鼠肝脏组织中炎性因子白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和OCT的水平;用免疫印迹法测定肝脏组织中STAT3蛋白表达水平;经苏木精-伊红染色观察各组大鼠肝脏组织病理形态学改变。结果相比假手术组,模型组、低浓度组、中浓度组和高浓度组大鼠肝组织均出现不同程度的病理学损伤。模型组、低浓度组、中浓度组和高浓度组大鼠肝脏组织中OCT、IL-6、IL-10及STAT3的水平均显著高于假手术组(P<0.05);相比模型组,低浓度组、中浓度组和高浓度组OCT、IL-6、IL-10及STAT3的水平均显著降低(P<0.05);在低浓度组、中浓度组和高浓度组中高浓度组OCT、IL-6、IL-10及STAT3的水平最低,其次为中浓度组、低浓度组(P<0.05)。结论右美托咪定具有保护脓毒症大鼠肝损伤的作用,并具有剂量依赖性的特点,其作用机制可能与STAT3蛋白表达下调而参与右美托咪定保护脓毒症大鼠肝损伤的过程密切相关。     

晚期肝硬化和尿毒症患者血浆TPO水平及其对巨核系造血的影响

血小板生成素（TPO）是调节巨核细胞系增殖，分化及血小板生成的重要细胞因子。肝脏和肾脏是合成和分泌TPO的重要器官，当肝功能和肾功能受损时，可能会影响TPO的合成，本研究采用夹心酶联免疫吸附法检测15例晚期肝硬化患，20例尿毒症血液透析患和40名正常人对照血浆的TO水平。分析血浆TPO水平与外周血血小板计数间的相关性。结果显示：晚期肝硬化患血浆TPO水平与正常人对照血浆TPO水平在统计学上无明显差异；尿毒症血液透析患血浆TPO水平明显低于正常对照，各患组骨髓巨核细胞计数和外周血血小板计数均与血浆TPO水平无相关性。结论：晚期肝硬化患可维持正常的TPO生成，且肝硬化患血小板减少与血浆TPO水平无关。但肾功能衰竭TPO生成明显减少。     

Some kinetic properties of liver ornithine carbamoyl transferase (oct) in a patient with oct deficiency

Some kinetic properties of liver OCT from a patient with OCT deficiency were studied. Contrary to controls, in which two pH optima were observed (pH 7.7 and pH 8.5), only the pH optimum of 8.5 could be demonstrated in our patient. From K_M studies at pH 7.7 and pH 8.5, the most striking abnormalities in comparison with human controls were (a) a strongly increased K_M (ornithine) at pH 7.7, but less pronounced at pH 8.5, (b) a higher V_max at pH 8.5 compared with the V_max at pH 7.7 and (c) the absence of substrate inhibition at pH 8.5 of ornithine was elevated up to a concentration above approximately 1.5 mM.     

Serum level of ornithine carbamoyltransferase is influenced by the state of Kupffer cells

BACKGROUND: The ratio of ornithine carbamoyltransferase (OCT) to alanine aminotransferase (ALT) or glutamate dehydrogenase (GDH) in serum has been suggested as an indicator for the diagnosis of hepatocellular carcinoma and alcoholic liver disease, respectively. However, the mechanisms responsible for the increase in these ratios are still unclear. METHODS: Wistar rats were pretreated with lipopolysaccharide (LPS) or gadolinium chloride (GD) before being administered with thioacetamide (TAA, 200 mg/kg, ip). Serum OCT and ALT levels were compared with control values. Half-lives of the enzymes in circulation were evaluated after the intravenous injection of the purified enzymes into rats with or without the pretreatment. RESULTS: The serum level of OCT at 24 h after the administration of TAA was significantly lower in the LPS-treated group, and not influenced by pretreatment with GD. The half-life of OCT was prolonged from 1.06+/-0.14 to 2.07+/-0.29 h (p<0.05) by the pretreatment with GD, but not influenced by the administration of LPS. No change was observed in the clearance of GDH or ALT among the pretreatments. CONCLUSIONS: Leakage into and clearance from the circulation of OCT are influenced by whether Kupffer cells are activated or not. OCT alone or in combination with other markers may be a useful indicator for Kupffer cell activation as well as mitochondrial damage in hepatic cells.     

肝硬化患者血清微量元素的检测及其临床意义

目的 探讨肝硬化患者血清微量元素水平与病情的相关性。方法 采用日立7170A全自动生化分析仪检测肝硬化90例及40例正常对照者血清中镁、铁、铜、锌的水平。结果 肝硬化患者血清镁、锌水平均显著低于正常对照组（P〈0．01），血清中镁、锌水平以Child—Pugh C级组最低。肝硬化患者血清铜、铁水平均显著高于正常对照（P〈0．01），以Child-PughC级组最高。结论 检测肝硬化患者血清中的微量元素，对了解病情及指导临床治疗具有一定的意义。