Endothelial and bile canalicular alkaline phosphatase in human liver and serum.

The alkaline phosphatase in homogenates of human liver was separated into two components by the addition of Triton X-100 to an agarose gel electrophoretic system. One of these components migrated at a rate identical to that of the original one and similar to alpha2-macroglobulin. The other component migrated more slowly, at a rate that resembled that of beta1-transferrin. Human serum samples regularly contained an identical fast-migrating fraction, whereas an identical slowly migrating fraction only appeared in serum obtained from patients with various diseases, especially from patients with malignant tumours, even though the liver did not contain tumour metastases. Slow isoenzyme was found in a few sera that had alkaline phosphatase activity within the normal range. Histochemical examinations of liver tissue from patients whose serum contained the slowly migrating isoenzyme showed a pronounced reaction of alkaline phosphatase in the bile canaliculi, and this isoenzyme seems to arise from the canaliculi. The fast-migrating isoenzyme might arise from the endothelial cells of the liver, to which the activity is usually confined in histochemical stainings.     

The effect of biliary obstruction on some properties of alkaline phosphatase of rat liver

Alkaline phosphatase in extracts of livers of rats with occluded bile ducts is significantly more stable to heat than the enzyme extracted from normal liver. There is also some increase in the ratio of orthophosphatase to inorganic pyrophosphatase activity in the former case, but no differences were detected in electrophoretic mobility or in Michaelis constants for orthophosphate hydrolysis. Within a particular group of animals, e.g. normal or bile duct-ligated, the properties of the enzyme show little variation.     

ERCP在治疗胆管梗阻疾病中的应用价值

目的评价十二指肠镜下治疗胆管梗阻疾病的作用。方法对225例胆管梗阻性疾病行十二指肠镜治疗的资料进行回顾性分析。结果内镜下括约肌切开（EST）取石一次性取净成功者182例，2例因结石大配合碎石器取净，经内镜逆行胆管引流（ERBD）一次放置成功37例，2例ERBD失败转手术治疗，3例急性梗阻性化脓性胆管炎经内镜鼻胆管引流（ENBD），引流1周后行EST取石成功，2例胆管狭窄病人ENBD成功1例，1例因胆管横断导丝无法通过狭窄置管失败转手术胆肠吻合术，术后无严重并发症。结论十二指肠镜下治疗胆管梗阻性疾病取得了与外科治疗相似的结果。十二指肠镜治疗可在不麻醉、不开腹的情况下进行，具有创伤小、痛苦少、恢复快、住院时间短、疗效肯定、治疗后即可下地活动等优点。EST取石可作为胆管取石的首选方法。ERBD可作为恶性梗阻性黄疸病人姑息性治疗的首选方法。     

A comparison of canine normal hepatic alkaline phosphatase and variant alkaline phosphatase of serum and liver.

The isoenzyme of alkaline phosphatase from normal liver, the corticosteroid induced isoenzyme of alkaline phosphatase from serum and liver and a hepatocellular variant isoenzyme of alkaline phosphatase induced by lymphosarcoma have been partially purified and their the present modification incorporates Polybrene into buffer to eliminate this heparin interference. The proposed method shown excellent agreement with a reference procedure based on clottable protein, and excellent day-to-day precision (C.V.3.5%). The present method is easily adaptable to semi-automated measurements.     

肝病患者血清碱性磷酸酶凝集素结合率的变化

目的观察不同肝病患者血清碱性磷酸酶凝集素结合率的变化。方法采用凝集素亲和沉降法对39例健康者、41例原发性肝癌患者及98例其它肝病、消化道肿瘤患者和孕妇等血清碱性磷酸酶L型红腰豆凝集素、小扁豆凝集素、蔓陀萝凝集素结合率进行测定。结果原发性肝癌患者血清碱性磷酸酶三种凝集素结合率均明显升高，尤以L型红腰豆凝集素结合率升高显著。结论血清碱性磷酸酶凝集素结合率测定可用于原发性肝癌的实验诊断和鉴别诊断。     

Changes in rat serum lipoproteins following ligation of the bile duct.

Lipoproteins in the serum of normal and of cholestatic rats have been studied by crossed immunoelectrophoresis coupled with separations by rate and isopycnic density gradient centrifugation and by gel exclusion chromatography. Normal rat serum contained distinct lipoprotein species closely analogous to human VLDL, LDL, HDL2 and HDL3. Three days after ligation of the common bile duct, there were major changes in the lipoproteins of rat serum. The amounts of VLDL, LDL and of a minor HDL component were elevated and several novel types of lipoprotein were detected. Three of these could be identified as the characteristic lipoprotein of cholestasis, LP-X, as an enlarged and modified HDL and as a lipoprotein of density 1.055 g/ml intermediate in size between LDL and VLDL. Some unusually small VLDL particles were also detected. It is concluded that the changes in rat serum lipoproteins following ligation of the common bile duct are very similar to the changes observed in cholestatic disease in human patients.     

Automated quantification of bone and liver alkaline phosphatase isoenzymes of human serum

Coupling two Technicon AAII samplers synchronised at 50 per hour with a 2 : 1 sample to wash ratio, sera are denatured and collected automatically. The incubation is done in continuous flow by passage through a U device made of large metallic needles soaked in a water bath at 60 ± 0.1°C. This allows a very quick temperature equilibration and a very reproducible incubation time of 35 sec. Initial and residual activities of alkaline phosphatase (ALP: EC 3.1.3.1) are measured on a Rotochem II (Aminco) with the procedure recommended by the Société Franlaise de Biologie Clinique (SFBC). For a mixture of bone and liver ALP, the initial rate constant of heat denaturation K_app = (A × K_b) + (B × K₁), where A and B are the fractions of each isoenzyme in the mixture, and K_b and K₁ the rate constants for bone (b) and liver (1) experimentally determined as 1.8 min^?1 and 0.45 min^?1 respectively. An equation was derived which converts the percent residual activity to a percentage of bone and liver isoenzyme: % bone ALP = 183 ? 2.38 ×% residual activity. This automated method was applied to 2700 people of both sexes from 4 to 100 years old.     

Physiologic concentrations of bile salts inhibit rat hepatic alkaline phosphatase but not the intestinal isoenzyme

Objective: The effect of bile salts on alkaline phosphatase (EC 3.1.3.1) activity from Wistar rat liver, duodenum, jejunum, and serum was investigated.

Design and results: For concentrations higher than 1 mM conjugated bile salts (glycocholate, glycochenodeoxycholate, taurocholate, taurodeoxycholate, and taurochenodeoxycholate) inhibited hepatic ALP but, up to concentrations of 10 mM, had no effect on intestinal ALP. Also cholate, deoxycholate, and chenodeoxycholate, within the same concentration range, did not have any effect on intestinal ALP. ALP inhibition induced by conjugated bile salts was significantly higher in serum of starved rats than in serum of fed animals, what is in good agreement with the known higher proportion of hepatic ALP and lower proportion of intestinal ALP in serum of starved rats.

Conclusions: Bile salts can, thus, be used to help discriminating between tissue-nonspecific and intestinal ALP isoenzymes and identifying pathologic conditions where the relative quantities of these isoenzymes are altered in serum. Inhibition of hepatic ALP by physiologic concentrations of bile salts may bear some relation to the bile salts effects on their own enterohepatic circulation and/or biosynthesis.     

多层螺旋CT阴性法胆管造影诊断胆管梗阻

目的评价多层螺旋CT(MSCT)阴性法胆管造影(N-CTCP)对胆管梗阻的诊断价值。方法对60例怀疑有胆管梗阻的病例进行N-CTCP成像,使用曲面重建(CPR)和最小密度投影(Min-IP)技术对有无胆管梗阻、梗阻部位及梗阻病变的性质进行评价,并将其结果与手术和(或)病理结果对照。结果60例均一次屏气完成扫描,N-CTCP成像显示胆管满意,CPR加Min-IP对胆管梗阻的定位诊断与定性诊断的灵敏度分别为89.86%、88.64%,特异度分别为94.59%、81.25%,阳性预测值分别为91.18%、92.86%,阴性预测值分别为93.75%、72.22%,阳性似然比分别为16.61、4.73,阴性似然比分别为0.11和0.14。结论N-CTCP对胆管梗阻性疾病定位准确,对良性及恶性胆管梗阻判断有较高准确性。     

Echinococcal cysts in the common bile duct: An uncommon cause of obstruction

Obstruction of the biliary system due to intraductal echinococcal cysts is a rare but serious presentation of hepatic echinococcal disease. Four cases are described. There was a 50% mortality rate and morbidity was high. The clinical presentation is difficult to differentiate from other disease processes. Careful preoperative sonograms should be taken to detect echogenic cyst material in the biliary system in all patients with hepatic echinococcal cysts. If biliary pigments are seen in the cyst during surgical removal, or if the patient has a recent history of jaundice or cholangitis, intraoperative cholangiography should be done to rule out intraductal cysts, which may cause obstruction.     

Distal common bile duct obstruction: An experimental study in monkeys

Biliary obstruction was accomplished by surgically occluding the distal common bile duct in seven rhesus monkeys. Ultrasound scanning at 24-hour intervals showed that dilation of the common bile duct and gallbladder occurred before elevation of bilirubin or development of jaundice. The bile ducts expanded centrifugally from the obstructing point, with dilation of the intrahepatic ducts occurring several days after the onset of obstruction. After surgical release of the obstruction, the biliary ducts contracted centripetally, with the common bile duct requiring 30–50 days to return to normal size.     

优质护理在胆管梗阻介入支架置入术中的应用

目的:探讨优质护理在胆管梗阻介入支架置入术中的应用.方法:收集我院符合研究标准的病例80例,将其随机分为观察组和常规组各40例,观察组给予优质护理,常规组实施常规护理,比较两组患者并发症发生情况、健康教育知识掌握情况及对护理工作的满意度.结果:观察组患者并发症发生率低于常规组,健康教育知识掌握情况及对护理工作的满意度均高于常规组,两组比较有统计学意义(P＜0.05).结论:优质护理服务不仅能降低并发症发生率,而且能提高患者满意度.     

Recovery of hepatic clearance and extraction following a release of common bile duct obstruction in the rat

The rat of recovery for hepatic clerance and extraction following release of common-duct obstruction was investigated in the rat. Male Wistar rats underwent ligation of a cannulated common bile duct. Two weeks later, the cannula was opened and implanted into the duodenum, thus re-establishing enterohepatic circulation. Hepatic extraction and indocyanine green clearance were determined in three groups of six rats each, which differed by the time elapsed from the re-establishment of communication between the common bile duct and duodenum, i.e., 1, 48 and 168 h, respectively. A fourth group, in which a sham operation was performed, served as a control. Clearance was reduced from 16.9±2.5 ml/min per kg in the control group to 2.9±0.8, 5.4±2.4, and 8.5±3.3 ml/min per kg 1, 48, and 168 h, respectively, after release of common-bile-duct obstruction. Extraction rate was reduced from 37.3±5.9% to 17.5±2.7% in the 1st hour and recovered completely at 1 week. Thus, in the rat, release of a 2-week common-bile-duct obstruction is associated with complete recovery of the extraction capacity of the liver within a week, but only incomplete recovery of clearance. This decrease in clearance seems to be due to a decrease in effective hepatic blood flow, mostly probably due to the development of porto-systemic shunts.