苦参碱抗纤维化临床研究

目的探讨苦参碱在慢性病毒性肝炎抗肝纤维化中的作用.方法选择140例慢性乙型肝炎(CHB)病人,分苦参碱组及对照组.分别于治疗前后检测肝功能、病毒指标及肝纤维化血清学指标(HA、PCⅢ、Ⅳ-C、LN).结果治疗组治疗后肝纤维化指标均明显下降,HA、PCⅢ、Ⅳ-C、LN分别为112.43士39.18ng/ml、113.33士38.77ng/ml、60.13士19.72ng/ml、95.54士39.08ng/ml,与治疗前及对照组治疗后比较,差异显著(均P＜0.01).结论苦参碱有明显的抗肝纤维化作用.     

慢性乙肝患者HBV DNA载量及肝纤维化相关性分析

目的:探讨慢性乙型肝炎患者血清乙型肝炎病毒(HBV)DNA载量与肝纤维化标志物透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原和层黏连蛋白水平的相关关系。方法:采用实时荧光定量PCR检测血清HBV DNA载量,采取酶促速率法检测血清ALT水平,采用化学发光检测透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原和层黏连蛋白的水平。结果:1 358例慢性乙型肝炎患者血清HBV DNA载量为(4.51±1.28)copies/ml,而血清ALT、透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原和层黏连蛋白的水平分别为32U/L,136ng/ml,11.27ng/ml,61ng/ml,64ng/ml,统计学分析显示血清HBV DNA载量与透明质酸水平正相关(r=0.915),但与Ⅲ型前胶原肽、Ⅳ型胶原和层黏连蛋白的水平以及ALT水平没有相关性。结论:慢性乙型肝炎患者病毒复制水平与肝细胞损伤程度程度无相关性,但与透明质酸呈正相关,因此慢性乙肝患者即使肝功能正常,也要定期检查血清HBV DNA载量和透明质酸水平。     

慢性乙型肝炎患者血清瘦素水平与肝纤维化程度相关

目的研究血清瘦素与慢性乙型肝炎肝脏炎症和肝纤维化程度之间的关系.方法20例慢性乙型肝炎患者在聚乙二醇α-2a干扰素治疗前及治疗48周、随访24周后进行肝穿刺病理学检查,另20例患者进行1次肝穿刺.采用ELISA方法检测40例慢性乙型肝炎患者血清瘦素水平,20名健康人作为对照组,对血清瘦素与肝组织炎症分级、纤维化分期间的关系进行分析.结果慢性乙型肝炎患者血清瘦素水平(12.89±7.47)ng/ml明显高于健康对照组(2.57±1.29)ng/ml,差异有统计学意义(P＜0.05).S0(5例)、S1(14例)、S2(16例)、S3(14例)、S4(11例)期肝纤维化血清瘦素水平分别为(2.62±0.89)ng/ml、(5.26±1.60)ng/ml、(13.15±4.52)ng/ml、(17.08±3.78)ng/ml、(21.56±5.89)ng/ml,随纤维化程度加重,血清瘦素水平增加;血清瘦素水平与肝组织纤维化分期成正相关(r=0.845,P＜0.01).20例患者在聚乙二醇α-2a干扰素治疗前、后肝组织纤维化计分分别为10.91±6.32和7.43±4.15,差异有统计学意义(P＜0.05);治疗前、后血清瘦素水平分别为18.35±4.93和13.57±5.39,差异有统计学意义(P=0.006).G0(4例)、G1(12例)、G2(22例)、G3(16例)、G4(6例)级炎症血清瘦素水平分别为(2.66±1.03)ng/ml、(9.04±4.92)ng/ml、(13.22±7.38)ng/ml、(16.19±7.71)ng/ml、(17.41±4.25)ng/ml,G0与G1级、G1与G2级患者血清瘦素水平差异无统计学意义(P=0.006),G2、G3、G4级患者血清瘦素水平差异无统计学意义(P＞0.05),G3～G4级患者血清瘦素水平与G1级相比,差异有统计学意义(P＜0.05).结论血清瘦素与慢性乙型肝炎肝组织纤维化分期密切相关.     

乙型肝炎后肝硬化患者血清瘦素水平测定及其临床意义

背景:瘦素水平与肝脏疾病关系密切,但因研究对象及其病因、病情不同,各研究所得结论并不一致。目的:测定乙型肝炎后肝硬化患者的血清瘦素水平,探讨其与患者肝功能、性别、体重指数(BMI)和血清肝纤维化标志物水平的可能关系。方法:69例乙型肝炎后肝硬化患者根据Child-Pugh分级分为3组,以酶联免疫吸附测定检测血清瘦素、层黏连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)和Ⅳ型胶原(CⅣ)水平;同时测量身高、体重,计算BMI。25名健康人作为对照组。结果:乙型肝炎后肝硬化患者的血清瘦素水平(18.64ng/ml±26.56ng/ml)显著高于健康对照组(12.04ng/ml±11.17ng/ml,P=0.043),但各Child-Pugh分级患者间差异无统计学意义。女性患者的血清瘦素水平显著高于男性(P=0.01)。血清瘦素水平还与BMI呈正相关(r=0.35,P=0.003),在超重者中,相关性尤为明显(r=0.537,P=0.002)。结论:乙型肝炎后肝硬化患者的血清瘦素水平明显升高且存在性别差异,该指标能反映患者体内的脂质代谢情况,但与病情无关。     

非酒精性脂肪性肝病患者瘦素与肝纤维化的关系

目的:研究非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)患者血清瘦素水平与肝纤维化指标的相关性,来探讨瘦素在NAFLD发展进程中的作用.方法:应用放射免疫法(RIA)测定33例NAFLD患者及30例对照组的瘦素、透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C),并测定空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、空腹胰岛素(FINS)、体质量指数检测(BMI)等临床指标.结果:NAFLD患者的瘦素、BMI、空腹胰岛素及胰岛素抵抗指数(HOMA IR)分别为11.07 μg/L±3.40 μg/L、27.33±2.98、14.19 mU/L±2.65 mU/L、3.48±0.65,显著高于对照组(P＜0.05);血清PCⅢ、Ⅳ-C、LN、HA在轻度NAFLD患者分别为68.17 μg/L±19.31 μg/L、39.06 μg/L±13.84 μg/L、62.51 μg/L±21.37 μg/L、44.52 μg/L±14.73 μg/L,与对照组比较无显著性差异(P＞0.05),在中、重度NAFLD患者分别为164.62 μg/L±18.47 μg/L、83.32 μg/L±24.73μg/L、152.22 μg/L±20.74 μg/L、212.51 μg/L±19.62 μg/L,明显高于对照组(P＜0.05),以HA最为显著(P＜0.01);轻度NAFLD患者,其血清瘦素与肝纤维化指标无相关关系(P＞0.05);中、重度NAFLD患者血清瘦素水平与肝纤维化指标有相关关系(P＜0.05).结论:瘦素与NAFLD患者肝纤维化进程密切相关.     

慢性乙型肝炎血清胰岛素样生长因子-1水平及其与血清肝纤维化指标关系的研究

探讨各型慢性乙型肝炎（CHB）患者血清胰岛素样生长因子-1（IGF-1）的变化及其与血清肝纤维化指标的关系。用放射免疫分析法检测CHB和乙肝后肝硬化患者血清IGF-1和肝纤维化指标（包括HA、LN、PⅢP和CⅣ）。CHB和乙肝后肝硬化患者血清肝纤维化指标明显高于正常对照组,CHB患者血清IGF-1水平明显高于正常对照组,乙肝后肝硬化患者血清IGF-1水平则明显降低。CHB患者血清IGF-1水平与肝纤维化血清指标呈正相关,乙肝后肝硬化患者血清IGF-1水平与肝纤维化血清指标无相关关系。CHB患者血清IGF-1水平异常与肝脏的损害相关,而且可能与CHB患者肝脏纤维组织增生相关联。     

血清TIMP-2水平对肝纤维化诊断价值的研究

目的评价HBV感染者血清TIMP-2水平对肝纤维化诊断的临床应用价值。方法采用ELISA法测定498例HBV感染者和100例正常对照者血清TIMP-2,采用放射免疫分析法检测HA、PCⅢ、CⅣ和LN,和采用全自动酶法测定丙氨酸氨基转移酶（ALT）。结果与健康正常人比,HBV感染者五项指标均有不同程度的升高,除慢性HBV携带者PCⅢ、CⅣ、LN、ALT和慢性肝炎轻度患者CⅣ水平与对照组比无统计学差异外,其余各组均与对照组比有显著性差异（P〈0.05）;从急性肝炎至肝硬化患者血清TIMP-2水平依次进行性升高,其中慢性HBV携带者与急性肝炎患者血清TIMP-2水平分别为78.56±26.23ng/ml和92.65±21.93ng/ml,两者相比差异显著（P〈0.01）。血清TIMP-2与HA、PCⅢ、CⅣ和LN呈显著正相关（P〈0.05）,与ALT也呈正相关（P〈0.05）。结论本文检测的肝纤维化指标均可不同程度地反映肝脏的纤维化程度,其中以血清TIMP-2较为可靠和有效。     

肝病Ⅰ号方对肝硬化血清Ⅳ型胶原的影响

对69例慢性肝病患者用中药“肝病Ⅰ号方”治疗,用酶免疫测定技术检测血清Ⅳ型胶原水平以分析其疗效。结果3个月后血清Ⅳ型胶原值由184±84ng/ml降至139±41ng/ml。肝标本的肝纤维化等级与血清Ⅳ型胶原水平显著相关。推测肝病Ⅰ号方治疗肝硬化是有前途的。     

血清肝纤维化指标水平与肝组织纤维图象分析的关系

目的 探讨血清肝纤维化指标透明质酸（ＨＡ）,Ⅲ型前胶原（ＰＣⅢ）、Ⅲ型胶原（ＣⅣ）水平与肝组织纤维化程度的关系及对慢性病毒性肝炎肝纤维化的临床意义,方法 用放射免疫法测定１５１例慢性病毒性肝炎患者血清ＨＡ、ＰＣⅢ、ＣⅣ水平,所有患者均做肝活组织检查,对肝组织标本行Ｍａｓｓｏｎ法网状纤维染色,在计算机图象分析系统下对肝组织网状纤维染色标本进行纤维组织定量测定。结果 血清ＨＡ、ＰＣⅢ、ＣⅣ水平与肝组织     

Wnt诱导分泌蛋白-1介导肝纤维化发生的实验及临床观察

目的探讨Wnt诱导分泌蛋白-1（WISP-1）在大鼠肝纤维化模型表达水平变化及其与慢性肝病患者病程进展的相关性。方法四氯化碳CCl4皮下注射制作大鼠肝纤维化动物模型,取正常组、造模8周组、造模12周组大鼠肝组织,利用免疫组化观察大鼠肝组织WISP-1表达水平的变化,光镜下半定量分析;收集健康体检者血清20例,慢性HBV携带者患者血清20例,乙型肝炎肝硬化患者血清60例,利用ELISA测定血清WISP-1水平变化,利用放射免疫检测血清透明质酸（HA）、层粘蛋白（LN）、前Ⅲ型胶原（PⅢP）、Ⅳ型胶原（CⅣ）水平,分析WISP-1水平与血清肝纤维化指标的相关性。结果造模8、12周组WISP-1表达水平分别为11.0±2.4、23.8±4.8,与正常组2.3±2.1比较差异具有统计学意义（P〈0.05）;慢性HBV携带者、乙型肝炎肝硬化患者血清WISP-1水平分别为（65.5±18.8）、（71.2±18.2）ng/ml,与健康对照组（57.3±15.2）ng/ml比较差异具有统计学意义（P〈0.05）,相关分析表明WISP-1与HA、LN、PⅢP、CⅣ相关系数分别为0.41、0.53、0.50、0.64（P〈0.05）。结论 WISP-1参与实验性肝纤维化的发生,血清WISP-1水平与慢性肝病病程进展相关,WISP-1在肝纤维化、肝硬化的作用及机制值得进一步研究     

Relationship between glycated haemoglobin levels and mean glucose levels over time

Aims/hypothesis HbA_1c, expressed as the percentage of adult haemoglobin that is glycated, is the most widely used measure of chronic glycaemia. Achieving near-normal HbA_1c levels has been shown to reduce long-term complications and the HbA_1c assay is recommended to determine whether treatment is adequate and to guide adjustments. However, daily adjustments of therapy are guided by capillary glucose levels (mmol/l). We determined the relationship between an accurate measure of mean glucose levels over time and the HbA_1c level, and whether HbA_1c can be expressed in the same units as self-monitoring results. Methods Twenty-two participants with diabetes and three non-diabetic participants were included in this longitudinal observational study. Mean glucose levels were measured by continuous glucose monitoring (CGM), which measures interstitial glucose levels every 5 min, for 12 weeks. Capillary measurements were obtained four times per day to confirm the accuracy of CGM. HbA_1c was measured at baseline and every 4 weeks. Results The HbA_1c results at weeks 8 and 12 correlated strongly (r = 0.90) with the CGM results during the preceding 8 and 12 weeks. A curvilinear (exponential) relationship and a linear regression captured the relationship with similarly high correlations, which allowed transformation of HbA_1c values to a calculated mean glucose level. Conclusions and interpretation HbA_1c correlates closely with a complete measure of average glycaemia over the preceding 8–12 weeks. The translation of HbA_1c to an average glucose level for reporting and management purposes is feasible.     

Irisin levels are associated with urotensin II levels in diabetic patients

Aims/Introduction

Irisin is a newly identified myokine that can promote energy expenditure. Previous studies showed that circulating urotensin II (UII) levels were increased in diabetes, and UII could inhibit the glucose transport in skeletal muscle in diabetic mice and aggravated insulin resistance. We presumed that irisin levels are associated with UII in diabetic patients.

Materials and Methods

A total of 71 patients with type 2 diabetes and 40 healthy subjects were recruited. Blood and urinary irisin concentrations were measured by using enzyme-linked immunosorbent assay, and UII concentrations were measured by bioelectrical impedance analysis. Every participant''s body composition was analyzed by bioelectrical impedance.

Results

The serum irisin levels were significantly lower in diabetic patients than that of controls, whereas serum UII levels were significantly higher in diabetic patients than that in that of controls. Serum irisin levels were negatively associated with circulating UII, hemoglobin A1c and the natural logarithm transformation of urinary albumin excretion, whereas serum irisin was positively associated with estimated glomerular filtration rate, and low-density lipoprotein cholesterol and urinary irisin were positively associated with urinary UII. Furthermore, circulating irisin is positively associated with muscle mass, whereas circulating UII is negatively associated with muscle mass in diabetic patients. Hemoglobin A1c and circulating UII are independent determinants of circulating irisin by multiple regression analysis.

Conclusions

The present results provide the clinical evidence of an association between irisin and UII in diabetic patients. Hemoglobin A1c and circulating UII are independent determinants of circulating irisin. Our results hint that UII and high glucose might inhibit the release of irisin from skeletal muscle in diabetic patients.