ALT、AST、GGT、CHE在肝病中的诊断价值

目的 探讨肝脏疾病时肝脏酶的变化关系，方法 采用速率法，测定113例肝病患者空腹血清丙氨酸氨基转移酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰基转移酶（GGT）、胆碱酯酶（CHE），并与32例正常体检者作对照组比较。结果 各型肝病患者的血清ALT、急性黄疸肝炎组的血清GGT及慢性肝炎重度组血清AST活性均显著升高（p〈0．01），慢性肝炎重度、肝硬化患者CHE活性均明显降低（P〈0．01）。结论 血清ALT、AST、GGT、CHE是肝病较为敏感指标，作为肝功能检测组合。有助于肝病的鉴别诊断和判断预后。     

新生儿高胆红素血症肝功能测定的临床意义及应用

目的探讨新生儿高胆红素血症时血清TBA、ALT、AST、GGT的变化及临床意义。方法采用7170全自动生化分析仪德国DILAB试剂,对70名正常新生儿和30名轻度黄疸患儿和38名中、重度黄疸患儿的血清进行检测。结果将轻度黄疸和中、重度黄疸各测定项目分别与正常对照组进行两样本均数t检验,轻度黄疸TBA（P〈0.05）与正常对照组有显著差异,ALT、AST、GGT（P均大于0.05）无显著差异。中重度黄疸TBA（P〈0.01）、AST、GGT（P〈0.05）均有显著性差异,ALT（P〉0.05）无显著差异。结论新生儿黄疸患儿的胆汁酸与正常对照有显著差异,且随黄疸程度增加显著升高,而ALT、AST、GGT变化不明显。     

巴马小型猪脑死亡状态下血清炎症介质的改变及在肝脏损伤中的作用

目的：探讨巴马小型猪在脑死亡状态下血清炎症介质的变化及对肝脏损伤的作用。方法:巴马小型猪10只，随机分脑死亡组与对照组，每组5只。用颅内加压法建立脑死亡模型，对照组仅开颅麻醉维持，分别于3、6、12、18和24h取血清测丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）及IL-1β、IL-6和TNF-α水平。结果:（1）炎症介质变化：脑死亡组动物血清IL-1β、IL-6和TNF-α水平均自脑死亡后3h开始升高，并随时间的延长而继续升高；脑死亡后3、6、12、18和24 h脑死亡组明显高于对照组（P<0.05）。（2）肝脏酶学变化：血清ALT、AST水平自脑死亡后12 h开始升高，并随时间的延长而继续升高；脑死亡后12、18和24 h脑死亡组明显高于对照组（P<0.05）。结论：巴马小型猪脑死亡状态下血清炎症介质升高，并随时间的延长而继续升高。脑死亡状态下肝脏功能的损伤可能与这些炎症介质的水平升高有关。     

ALT、AST、GGT、CHE在肝病中的诊断价值

目的探讨肝脏疾病时肝脏酶的变化关系.方法采用速率法,测定113例肝病患者空腹血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰基转移酶(GGT)、胆碱酯酶(CHE),并与32例正常体检者作对照组比较.结果各型肝病患者的血清ALT、急性黄疸肝炎组的血清GGT及慢性肝炎重度组血清AST活性均显著升高(p＜0.01),慢性肝炎重度、肝硬化患者CHE活性均明显降低(p＜0.01).结论血清ALT、AST、GGT、CHE是肝病较为敏感指标,作为肝功能检测组合.有助于肝病的鉴别诊断和判断预后.     

慢性病毒性肝炎临床与病理的相关性研究

目的：研究慢性病毒性肝炎（CH）临床与病理的相关性及CH的临床诊断。方法：对973例CH患者血清生化指标、影像学检查、症状与体征等多种因素与肝组织病理损伤程度进行单因素及多因素判别分析，采用肝功能指数（AAPEA指数）分析血清生化指标在CH诊断中的应用。结果：CH患者凝血酶原活动度（PTA）、血清丙氨酸转氨酶（ALT）、总胆红毒（TBIL）、白蛋白（ALB）、白／球蛋白比值（A／G）、蛋白电泳γ球蛋白（γG）、天冬氨酸转氨酶（AST）、胆碱酯酶（CHE）等生化指标及B超脾脏厚度等，与肝组织病理损伤程度密切相关；AST反映肝脏炎症活动程度优于ALT。多因素判别分析总体误判率为28.1%，但对中、重度误判率较率。肝功能指数（AAPEA）指数与CH肝组织炎症活动程度、纤维化程度及病理分度的相关系数分别为0．559、0．545及0．529（P＜0．0001）。结论：PA、ALT、TBIL、ALB、A／G、γG、CHE、AST等生化指标以及B超脾脏厚度在判定CH程度方面有重要意义。AST反映肝脏炎症活动程度优于ALT。多因素判别分析对CH中、重度误判率较高。AAPEA指数与病理诊断符合率比单项指标判定为高。     

慢性乙肝病毒感染者肝脏病理与临床特征研究

目的 探讨肝活检病理组织学对慢性乙型肝炎病毒（HBV）携带者和血清ALT轻度升高慢性乙型肝炎患者（CHB）的临床意义.方法 105例慢性HBV感染患者全部进行肝组织活检,并按血清ALT水平分为3组：ALT≤0.5×正常参考值上限（ULN）为A组,0.5×ULN＜ALT≤1×ULN为B组,1×ULN＜ALT＜2×ULN为C组;对3组肝脏炎症程度及纤维化程度比较,并对不同肝组织炎症程度、纤维化程度与患者基本情况的关系进行分析.结果 105例患者中炎症程度≥G2者占40.95%,其中ALT正常的患者有30.43%≥G2;纤维化程度≥S2者占26.67%,其中ALT正常的患者中≥S2者占17.39%.血清ALT及透明质酸随肝脏炎症程度加重及纤维化分期的增加而增加（P＜O.05）.结论 密切随访血清ALT和透明质酸可协助了解肝脏病变情况,肝脏病理学依据仍然是决定是否抗病毒治疗的有力依据.     

铜过量小鼠肝损伤模型的建立及各项指标的观察研究

目的探讨昆明小鼠在不同剂量的铜负荷时所引起的肝脏抗氧化水平和相关病理的改变。方法32只昆明小鼠平均分为4组，第1组为对照组，每天灌胃生理盐水2次，第2、3、4组作为实验组，分别用不同浓度（12．8、25．6和38．4mg／mL）的硫酸铜每日灌胃2次，16周后，观察肝组织中丙二醛（MDA）含量、超氧化物歧化酶（SOD）以及谷胱甘肽过氧化物酶（GSH-Px）的活性，测定血清谷丙转氨酶（ALT）和谷草转氨酶（AST）以及血清和肝组织中铜含量，并做肝脏病理以及电镜检查。结果与正常对照组相比，实验组肝组织中MDA含量明显升高（P〈0．05），而SOD和GSH-Px活性明显下降（P〈0．05）；血清ALT、AST活性以及血清、肝脏铜含量明显升高（P〈0．05）；病理组织学检查可见高剂量铜灌胃组小鼠肝细胞变性坏死以及少量铜颗粒沉积：电镜提示肝细胞核、线粒体等细胞器异常．并可见铜颗粒。结论过量的铜可对肝脏造成损害，其机制可能与释放出的铜离子介导脂质过氧化而造成肝脏损害有关。其病变过程与Wilson’s病相似，可为进一步研究铜代谢异常等疾病提供动物模型。     

慢性乙型肝炎患者血清HBsAg水平与肝脏炎症和纤维化程度相关性研究

目的 探讨慢性乙型肝炎患者HBsAg水平与肝脏炎症和纤维化的关系.方法 301例确诊为慢性乙型肝炎的患者纳入研究,同时进行肝脏活检术检查和生物化学、铁蛋白、血清HBsAg、HBV DNA定量检测.Spearman等级相关分析血清HBsAg水平与肝脏炎症分级和纤维化分期间的关系;logistic回归分析法分析相关指标的诊断意义,受试者工作曲线法评价血清HBsAg水平预测肝脏炎症分级和纤维化分期的准确性.结果 体质量指数、年龄、性别、基因型和家族史对CHB患者肝脏炎症和纤维化无明显影响(P＜0.05).AST、ALT随着炎症、纤维化进展而升高,差异具有统计学意义(x2=71.193、96.344、47.847、63.981;P =0.000、0.000、0.000、0.000).纤维化为S4时,HBV DNA明显下降(x2=33.322,P=0.000).HBsAg水平随着炎症和纤维化程度加重而逐步下降(x2=68.173,15.719;P =0.000,0.000).HBsAg水平预测≤G3和≤S3的曲线下面积分别为0.732和0.793,特异度分别为0.778、0.891,灵敏度依次为0.685、0.633.结论 中国CHB患者HBsAg水平随着肝脏炎症分级和纤维化分期程度加重而逐渐下降.血清HBsAg水平对CHB患者肝脏炎症≤G3和纤维化≤S3的预测具有较高的特异性,且对纤维化的预测优于炎症.     

慢性乙型肝炎患者血清IL-21水平检测及意义

目的:检测慢性乙型肝炎(CHB)患者血清IL-21及HBV-DNA、ALT水平,探讨血清IL-21在CHB发生发展中的意义.方法:采用双抗体夹心ELISA法检测63例CHB患者(其中慢性轻度16例,慢性中度25例,慢性重度22例)和20例健康者血清IL-21水平,并同期检测患者HBV-DNA、肝功能等指标.结果:与正常对照组相比,各型CHB患者血清IL-21水平均升高,其中以慢性重度乙型肝炎患者升高最明显(P<0.01);IL-21在ALT异常组明显高于ALT正常组(P<0.01);慢性乙型肝炎HBV-DNA低栽量组与中高载量组之间IL-21水平差异无统计学意义(P＞0.05).结论:IL-21可能参与了CHB抗病毒应答及发病过程,可以在一定程度上反映CHB肝脏内的炎症反应.     

肾上腺素对内毒素致大鼠炎症性肝损害的保护作用

目的 探讨肾上腺素（Epi）对内毒素（脂多糖，LPS）致大鼠炎症性肝损害的保护作用及其作用机制。方法 50只SD大鼠随机分为5组（每组各10只）：对照组：静脉滴注生理盐水2．4mL·kg^-1·h^-1；LPS组：静脉注射LPS6mg·kg^-1后，静脉滴注生理盐水2．4mL·kg^-1·h^-1；低、中和高剂量Epi组：静脉注射LPS6mg·kg^-1后，分别静脉滴注Epi0．12、0．3和0．6μg·kg^-1·min^-1。在LPS注射前、注射后2和6h3个时点取血，检测血清ALT、AST、TNF-α、IL-1β和IL-10水平，并在6h时点观察肝脏的组织病理学改变。结果 LPS组注射LPS后2、6h血清AST和ALT水平较对照组显著升高。同时血清TNF-α、IL-1β和IL-10水平亦较对照组显著升高（P〈0．05）。病理检查结果示：LPS组肝窦扩张、充血，局灶性肝细胞坏死。高剂量Epi可显著降低血清AST和ALT水平，减轻肝脏病理损伤，并显著可降低TNF-α水平和升高IL-10水平（1）8LPS组，P均〈0．05），但对IL-1β水平无影响。中、低剂量Epi对LPS致炎症性肝损害无明显保护作用。结论 Epi可通过抗炎作用减轻LPS诱导的炎症性肝损害。     

慢性乙肝患者血清补体C3、C4 与肝炎分级程度以及肝纤维化程度的关系研究

目的:研究血清补体C3 及C4 水平与慢性乙肝(CHB)患者肝炎分级程度及肝纤维化程度的关系。方法:收集2014 年3 月~2016 年3 月期间,我院收治的CHB 患者185 例作为CHB 组,同期体检健康者60 例作为对照组,检测并比较两组的血清补体C3、C4 水平,并分析C3、C4 与CHB 肝炎G 分级、肝纤维化S 分级的关系。结果:CHB 组的血清C3、C4 水平显著低于对照组(t = 10.476、9.172,P<0.5);血清C3、C4 水平在不同肝炎活动度之间比较差异显著(F = 4.321、3.495,P <0.05),在不同肝纤维化分级之间比较差异显著(F =3.861、4.541,P<0.05);血清C3、C4 水平与肝炎活动度G 分级呈显著负相关性(r =-0.575、-0.542,P<0.05),与肝纤维化S 分级(逸S1)显著负相关性(r =-0.2、-0.636,P<0.05)。结论:血清补体C3、C4 水平与CHB 患者肝炎程度及肝纤维化程度密切相关,可作为CHB 患者肝病理学状态的辅助预测指标。     

HBV感染者血清AST/ALT比值及HBV血清标志物联合检测的辅助诊断价值研究

为检测HBV感染者在疾病不同阶段血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、AST/ALT比值及HBV血清标志物水平,探讨它们之间的相互关系,采用速率法、ELISA法分别检测收集的296例HBV感染者和99名健康体检者的血清ALT、AST水平及HBV血清标志物,并计算其对应的AST/ALT比值.结果显...     

儿童慢性乙肝肝组织病理与相关标志物的研究

目的 分析乙肝病毒核内共价闭合环状DNA（HBV cccDNA）、肝纤维化血清标志物、乙肝病毒基因型与肝脏纤维化和炎症活动度的相关性,以了解其在乙肝诊断中的价值,指导治疗和预后.方法 2008年4月至2011年8月于甘肃省人民医院儿科和兰州大学第一医院感染科门诊就诊和住院的乙肝及HBV携带患儿为慢性乙肝组和HBV携带组,选择同期健康查体儿童为对照组.检测慢性乙肝组、HBV携带组和对照组血清HA、LN、PCⅢ和CⅣ.依据病情严重程度,慢性乙肝组进一步分为轻度、中度和重度亚组;慢性乙肝组和HBV携带组检测血清HBV cccDNA和HBV基因型;分析HBV cccDNA、肝纤维化血清标志物、HBV基因型与肝脏纤维化和炎症活动度的相关性.结果 46例患儿进入分析,男34例,女12例,年龄1～16岁,平均年龄（11.8±3.7）岁.HBV携带组20例,慢性乙肝组26例（轻度13例、中度8例、重度5例）,对照组20例.①随乙肝临床分度加重,血清HA、LN、PCⅢ和CⅣ呈升高趋势,以重度乙肝亚组上升最为明显;②随肝组织纤维化程度与炎症活动度的增加,血清HA、LN、PCⅢ和CⅣ呈升高趋势;③血清HBV cccDNA阳性组与阴性组在肝组织炎症活动度〈G2级比例的差异无统计学意义（29/35 vs 9/11,P=0.963）;在肝组织纤维化〈S2期比例的差异无统计学意义（31/35 vs 9/11,P=0.736）;④HBV B基因型患儿肝炎症活动度和纤维化程度显著高于C基因型.结论 血清HBV cccDNA水平与肝纤维化和炎症活动度无相关性;血清HA、LN、PCⅢ和CⅣ,HBV基因型与肝纤维化和炎症活动度有较好的相关性.临床可结合病毒复制水平、丙氨酸氨基转移酶、肝纤维化血清标志物及HBV基因分型综合判断肝损害程度.     

Predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B patients and their diagnostic values in hepatic fibrosis

Objective: To investigate predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B (CHB) patients and their diagnostic values in hepatic inflammation and fibrosis. Methods: A total of 106 HBeAg-negative CHB patients with clinically and pathologically proven steatosis and 98 patients without steatosis were recruited into this study. The levels of fasting blood glucose (FBG), fasting insulin (FINS), triglyceride (TG), cholesterol (CHOL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), globulin (Glb), HBV DNA, body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR) and pathological changes of the liver in inflammation, fibrosis and fatty deposition were examined in all patients. Results: The levels of BMI, HOMA-IR, FBG, insulin, TG, and CHOL were significantly higher in patients with steatosis than those without steatosis (all P<0.05). But ALT, AST and HBV DNA levels were significantly lower in patients with steatosis (all P<0.05). Logistic regression analysis showed that only FINS was a significant predictor for hepatic steatosis (P<0.05); FINS and Glb were significant predictors for hepatic inflammation (all P<0.05); BMI and TC were significant predictors for hepatic fibrosis (all P<0.05). Conclusions: Hepatic steatosis, a common disease in HBeAg-negative CHB patients, was positively associated with BMI, FBG, FINS, TG, TC, GGT, ALP and HOMA-IR. In these patients, the prevalence of hepatic inflammation and fibrosis was also increased.     

Serum liver fibrosis markers discriminate significant liver inflammation in chronic hepatitis B patients with normal or near-normal alanine aminotransferase

Chronic liver inflammation caused by chronic hepatitis B virus (CHB) infection leads to liver cirrhosis and hepatocellular carcinoma. Recently, the role of alanine aminotransferase (ALT) as a predictor of liver inflammation has been questioned. The aim of this study was to investigate the utility of noninvasive fibrosis markers including hyaluronic acid (HA), collagen type IV (CIV), N-terminal propeptide of type III procollagen (PIIINP), and laminin (LN) in identifying significant liver inflammation in patients with CHB, especially in patients with normal or near-normal ALT. A total of 242 CHB patients who underwent liver biopsy were enrolled. The serum levels of ALT, aspartate aminotransferase, HA, CIV, PIIINP, and LN were quantified and the relationship between histological staging and serum markers was systematically analyzed. Serum CIV, PIIINP, HA, and LN levels increased significantly along with the increasing severity of liver inflammation. Multivariate analysis showed that CIV and LN were independently associated with significant inflammation. CIV, PIIINP, HA, and LN levels were found to have high diagnostic values for predicting significant inflammation in patients with CHB (area under the curve, AUC = 0.807, 0.795, 0.767, and 0.703, respectively). The combined index for the identification of significant inflammation, including CIV, PIIINP, HA, and LN levels, significantly improved diagnostic performance (AUC = 0.851). Moreover, the combined index also achieved excellent diagnostic accuracy (AUC = 0.861) in patients with CHB with normal or near-normal ALT. In conclusion, the combined index may be a strong indicator for discriminating significant liver inflammation, especially in patients with CHB with normal or near-normal ALT.     

慢性乙型肝炎患者肝细胞凋亡的研究

目的 探讨慢性乙型肝炎(CHB)患者肝细胞凋亡与肝组织诱导性一氧化氮合酶(iNOS)、肝脏病理及血清转氮酶水平之间的相关关系.方法 取37例CHB患者和10例正常对照,采用dUTP缺口末端标记技术(TUNEL)检测肝组织中的细胞凋亡情况,免疫组化法检测肝组织iNOS的表达,并常规测定患者肝组织炎症分级和纤维化分期、血清丙氨酸转氨酶(ALT)、HBV DNA水平.结果 所有CHB患者的肝组织中均见到不同程度的TUNEL染色阳性.正常对照肝组织中未见到TUNEL阳性肝细胞.在CHB肝组织中,凋亡指数(A1)与炎症分级(r=0.404,P=0.015)及肝组织iNOS水平(r=0.465,P=0.004)明显相关并有统计学意义,而与血清ALT水平、HBV DNA以及组织学纤维化分期无明显关系.结论 慢性乙型肝炎患者体内氧化应激水平可能是肝细胞凋亡的诱导因素之一,细胞凋亡参与了CHB的肝细胞损伤过程,但并不影响患者的生物化学指标.     

Frequency and distribution of DNA fragmentation as a marker of cell death in chronic liver diseases

 To study the early stages of cell death in various types of chronic liver injury, liver biopsies from a total of 26 patients, including 7 with chronic hepatitis C(CHC), 4 with chronic hepatitis B(CHB), 7 with alcoholic liver disease (ALD), 4 with autoimmune or drug hepatitis(AI/DH), and 4 with primary biliary cirrhosis(PBC), were examined by an in situ nucleotidyl transferase assay (ISNTA), which detects DNA fragmentation. Positive nuclei in hepatocytes and sinusoidal lining cells were counted in all parenchymal areas, excluding triads and areas of fibrosis, using a computer with Sigmascan software. The number of positive hepatocytes/mm² was similar in the biopsies of patients with CHC, CHB, ALD and AI/DH, but significantly lower in PBC. The number of positive sinusoidal lining cells/mm² was significantly greater in biopsies with CHC compared to CHB, ALD, AI/DH and PBC. Double staining revealed that the ISNTA-positive sinusoidal lining cells were also CD68 positive, indicating that they were Kupffer cells. The frequency of ISNTA positivity did not correlate with serum AST or ALT levels, steatosis, cell swelling or cirrhosis. ISNTA-positive hepatocytes were more frequent than acidophilic bodies in every disease category. We conclude that apoptosis may be a common pathway of cell death in different liver diseases, that the high frequency of DNA fragmentation in Kupffer cells in CHC suggests that during chronic hepatitis C infection activated Kupffer cells may be subject to regulatory control by apoptosis and that ISNTA is more sensitive than acidophilic bodies in assessing the degree of cell injury in the liver. Received: 17 February 1997 / Accepted: 18 March 1997     

High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe

The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a nonendemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf,Germany over the past 19 years (1990–2009) were evaluated. Thirty-nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 x ULN (upper limit of normal) and 128 patients had ALT >2 x ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2)was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥ 40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis.Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis.     

67例慢性丙型肝炎治疗过程及随访中血清ALT、病毒载量及肝纤维化指标的变化

目的 观察聚乙二醇干扰素α-2b联合利巴韦林治疗慢性丙型肝炎过程中肝功能、病毒复制及肝纤维化指标的改变情况.方法 检测67例慢性丙型肝炎患者在干扰素联合利巴韦林治疗开始（0周）、结束（48周）和停药12周（60周）时血清丙氨酸转氨酶（ALT）、丙肝病毒核糖核酸（HCV RNA）、透明质酸（HA）、Ⅲ型前胶原肽（PCⅢ）、Ⅳ型胶原（Ⅳ-C）和层粘连蛋白（LN）水平.结果 治疗后完全应答组（CR-S,43/67） ALT、HCV RNA及血清4项纤维化指标均显著下降（P ＜0.05或P＜0.01）,部分应答组（CR-R,13/67）和无应答组（NR,11/67） ALT、HCV RNA及血清4项纤维化指标变化不明显,反跳甚至更高.结论 聚乙二醇干扰素α-2b联合利巴韦林治疗慢性丙型肝炎约65％患者完全应答,随着肝细胞炎症的改善,病毒RNA滴度、肝纤维化指标水平明显下降,表明干扰素联合利巴韦林能抑制HCV RNA复制,调节机体免疫功能,减轻肝脏炎症反应,改善肝功能,减少肝纤维化.