肝硬化患者血浆内皮素—1及肿瘤坏死因子—α水平的变化及意义

用放免法检测６１例肝硬化患者与正常对照组的血浆内皮素－１和肿瘤坏死因子－α。结果,肝硬化组血浆ＥＴ－１及ＴＮＦ－α水平显著高于对照组,且在肝功能Ｃｈｉｌｄ－Ｐｕｇｈ分级中,呈现Ｃ〉Ｂ〉Ａ级的规律。组间分析表明肝硬化患者食管静脉曲张伴大中量腹水组（ＬＣ４）及仅有大中量腹水组（ＬＣ３）的血浆ＥＴ－１和ＴＮＦ－α均显著高于食管静脉曲张伴少量腹水或无腹水组（ＬＣ２）,ＬＣ２组高于无腹水和亦无静脉曲张组（Ｃ     

肝硬化患者血浆ET1,CGRP变化意义探讨

目的：为了解ＬＣ患者血浆ＥＴ，ＣＧＲＰ水平，探讨其临床意义，方法：采用放射免疫分析法检测健康成人及ＬＣ患者血浆ＥＴ，ＣＧＲＰ水平，结果：ＬＧ组血浆ＥＴ１明显高于对照组（Ｐ〈０．０１），ＣＧＲＰ明显低于对照组（Ｐ〈０．０１），ＬＣ组内ＥＴ１，ＣＧＲＰ水平与肝功分级，血浆蛋白及ＡＬＴ，ＡＳＴ值无明显相关性（Ｐ〉０．０５）。结论：作为血管活性物质ＥＴ与ＣＧＲＰ相互拮抗，调节门脉压力保持动态平衡。ＬＣ门脉     

肝硬化患者血清sICAM-1水平变化与肝功能关系探讨

为了解肝硬化（ＬＣ）患者血清可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）水平的变化及其与患者肝功能损伤的关系。用酶联免疫吸附法（ＥＬＩＳＡ）检测１７例正常人和３３例ＬＣ患者的血清ｓＩＣＡＭ－１。结果显示,ＬＣ患者血清ｓＩＣＡＭ－１水平显著高于对照组（ＨＣ）,且在肝功能分级中,呈现ＣｈｉｌｄＣ〉ＣｈｉｌｄＢ〉ＣｈｉｌｄＡ的规律。相关分析显示,ＬＣ患者血清ｓＩＣＡＭ－１与总胆红素（ＴＢ）及谷丙转氨酶（ＡＬＴ）均呈明显正相关。提示ＬＣ患者血清ｓＩＣＡＭ－１升高与肝细胞损伤有关,可反映ＬＣ的严重程度。     

降钙素基因相关肽在II型糖尿病合并视网膜病变中的变化

检测了Ⅱ型糖尿病合并视网膜病变和Ⅱ型糖尿病无视网膜病变两组病人的血浆中降钙素基因相关肽（ＣＧＲＰ）和内皮素（ＥＴ－１）的水平，结果显示：Ⅱ型糖尿病合并视网膜病变的病人，其血浆中ＣＧＲＰ明显下降，ＥＴ－１水平的改变虽有一定的升高但无统计学意义。结果提示：糖尿病病人血浆中ＣＧＲＰ的下降很可能是致糖尿病视网膜血管病变的因素之一。     

老年冠心病患者血ET-1、CGRP水平的变化及其意义

老年冠心病患者血ＥＴ－１、ＣＧＲＰ水平的变化及其意义潍坊医学院附属医院（２６１０３１）郭战利宋书凯位玉臻黄丽红李广宙刘志翔我们对部分老年冠心病患者的血浆内皮素－ｌ（ＥＴ－ｌ）、降钙素相关肽（ＣＧＲＰ）水平进行了检测，并与健康老年人进行对比分析，旨在探...     

系统性红斑狼疮活动期血浆降钙素基因相关肽及内皮素-1含量变化

目的：为了探讨肽－降钙素基因相关肽和内上素－１在ＳＬＥ活动期中的作用。方法；采用放射免疫分析法测定了３４例系统性红斑狼疮病人和２０例健康人血浆ＥＴ－１，ＣＧＲＰ水平。结果；有抗ｄｓ－ＤＮＡ抗体升高和补体Ｃ３，Ｃ４下降的ＳＬＥ组，ＥＴ－１水平升高，ＣＧＲＰ水平降低。『     

急性心肌梗塞溶栓治疗对内皮素和降钙素基因相关肽的影响

旨在观察急性心肌梗塞（ＡＭＩ）溶栓治疗前后血浆内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）水平的同期动态变化,探讨溶栓治疗对ＥＴ和ＣＧＲＰ的影响。对象与方法：３０例按ＷＨＯ诊断标准确诊的初发ＡＭＩ患者,根据溶栓情况分三组：（１）溶栓再通组１２例,男１...     

肺心病患者血浆内皮素一氧化氮降钙素基因相关肽的研究

目的 研究缺氧性肺动脉高压产生的机理。方法 经右心导管监测５５例慢性阻塞性肺疾病（ＣＯＰＤ）及慢性肺心病患５５例，依平均肺动脉压（ｍＰＡＰ）≥２．６７ｋＰａ，分为Ａ组（２８例）〈２．６７ｋＰａ分为Ｂ组（２７例）及２２名健康（对照组）观察血流动力学变化，并测定其俩动脉血浆内皮素（ＥＴ－１），一氧化氮（ＮＯ）和降钙素基因相关肽（ＣＧＲＰ）水平，以探讨了ＥＴ－１，ＮＯ，ＣＧＲＰ与肺动脉高压的关系。结     

老年非杓型高血压病患者内皮素和降钙素基因相关肽含量变化及 …

目的 探讨老年非杓型高血压病（ＥＨ）患者内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）含量变化及氨氯地平对其影响。方法 观察氨氯地平治疗老年非杓型ＥＨ患者疗效及其治疗前后ＥＴ和ＣＧＲＰ含量变化。结果 老年非杓型ＥＨ患者血浆ＥＴ水平明显高于老年杓型ＥＨ患者,而ＣＧＲＰ则明显降低;氨氯地平使老年非杓型ＥＨ患者白昼及夜间血压下降,治疗后老年非杓型ＥＨ患者血浆ＥＴ水平降低,而ＣＧＲＰ明显升高。结论 ＥＴ及Ｃ     

老年非杓型高血压病患者内皮素和降钙素基因相关肽含量变化及氨氯地平对其影响

目的探讨老年非杓型高血压病（ＥＨ）患者内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）含量变化及氨氯地平对其影响。方法观察氨氯地平治疗老年非杓型ＥＨ患者疗效及其治疗前后ＥＴ和ＣＧＲＰ含量变化。结果老年非杓型ＥＨ患者血浆ＥＴ水平明显高于老年杓型ＥＨ患者,而ＣＧＲＰ则明显降低;氨氯地平使老年非杓型ＥＨ患者白昼及夜间血压下降,治疗后老年非杓型ＥＨ患者血浆ＥＴ水平降低,而ＣＧＲＰ明显升高。结论ＥＴ及ＣＧＲＰ参与了老年非杓型ＥＨ的病理过程,氨氯地平是一种治疗老年非杓型ＥＨ患者有效药物,能纠正老年非杓型ＥＨ患者ＥＴ与ＣＧＲＰ之间的失衡。     

乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素分析

目的探索乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素。方法选取2014年10月—2016年6月因乙型肝炎肝硬化并发食管胃静脉曲张来我院进行治疗的患者165例,根据就诊当天是否发生破裂出血分为出血组和非出血组,分析该类患者破裂出血的危险因素。结果单因素分析结果显示:2组患者在年龄、性别和WBC计数方面的差异无统计学意义(P0.05),出血组患者HGB、PT明显高于非出血组,而PLT明显低于非出血组,差异有统计学意义(P0.05);出血组患者中肝功能Child-Pugh评分C级患者、重度食管胃静脉曲张患者及中重度腹水患者明显多于未出血组,2组患者在肝功能Child-Pugh评分、食管胃静脉曲张和腹水严重程度上的差异有统计学意义(P0.05)。多因素分析结果显示:肝功能Child-Pugh评分、PLT、腹水、门静脉内径和感染是发生破裂出血的危险因素,其中腹水严重程度是最主要的独立危险因素。结论肝功能Child-Pugh分级较低、PLT较低、腹水较严重、门静脉内径较大和出现感染是乙型肝炎肝硬化患者发生食管胃静脉曲张破裂出血的危险因素,临床上须尽早进行对症治疗,预防破裂出血的发生。     

糖尿病对肝硬化食管静脉曲张内镜治疗后再出血影响的临床研究

目的探讨合并糖尿病是否影响肝硬化食管静脉曲张患者内镜治疗后的再出血。方法2015年6月至2018年3月,因肝硬化食管静脉曲张破裂出血在安徽医科大学第一附属医院接受内镜下静脉曲张套扎术或内镜下硬化剂注射术初次治疗的207例病例纳入回顾性分析,以术后6个月作为观察结束点统计再出血情况,根据有无出血分为出血组(n=54)和未出血组(n=153),对于可能导致术后再出血的影响因素先行单因素分析,发现差异性后再行Logistic回归分析。结果单因素分析发现,性别构成、年龄、有无门静脉血栓、有无吸烟史、有无饮酒史(P=0.05)、有无高血压、血小板计数、总胆红素水平、白蛋白水平、谷丙转氨酶水平、凝血酶原时间、食管静脉曲张程度构成、手术方式构成在出血组和未出血组间差异均无统计学意义(P均≥0.05),是否合并糖尿病、血红蛋白水平、血糖水平、腹水程度构成、肝功能分级构成在出血组和未出血组间差异均有统计学意义(P均<0.05)。将合并糖尿病(是/否)、血红蛋白水平、血糖水平、腹水程度(无-轻度/中-重度)、肝功能Child-Pugh分级(A级/B-C级)以及饮酒史(有/无)纳入多因素分析,结果显示合并糖尿病是肝硬化食管静脉曲张内镜治疗后再出血的独立危险因素(P=0.008,OR=2.973,95%CI:1.322~6.689)。结论合并糖尿病的肝硬化食管静脉曲张患者内镜治疗后易发生再出血。     

Brain natriuretic peptide and severity of disease in non-alcoholic cirrhotic patients

BACKGROUND: Cirrhotic patients have a hyperdynamic systemic circulation. They have insidious cardiac problems besides well-known complications. Brain natriuretic peptide (BNP) relaxes vascular smooth muscle and has a portal hypotensive action. The relations between BNP levels and severity of disease, cardiac dysfunction and esophageal varices were studied in non-alcoholic cirrhotic patients. METHODS: Fifty-two non-alcoholic cirrhotic patients were evaluated for decompensation component of cirrhosis. The BNP concentration of echocardiographically examined patients was determined. RESULTS: The BNP levels were significantly higher in ascites, spontaneous bacterial peritonitis and hepatic encephalopathy history group (P = 0.033, P < 0.001, P = 0.014, respectively), but no significant difference were observed for presence of esophageal varices and bleeding history (P = 0.267, P = 0.429). A significant correlation was observed between BNP concentration and Child score (r = 0.427, P = 0.012), interventricular septal thickness (r = 0.497, P < 0.001) and left ventricular posterior wall thickness (r = 0.526, P < 0.001). According to Child-Pugh classification there were no significant difference between groups for echocardiographic measurements and blood pressure (P > 0.05), but plasma BNP levels were significantly higher in Child class B and C patients compared with class A patients (P < 0.05). CONCLUSION: Increased levels of BNP are more likely related to the severity of disease in non-alcoholic cirrhotic patients. The advanced cirrhosis is associated with more advanced cardiac dysfunction and BNP has prognostic value in progression of cirrhosis.     

慢性肝病患者血浆内皮素、内毒素及肿瘤坏死因子水平的研究

研究慢性肝病患者血浆内皮素、内毒素及肿瘤坏死因子的变化，发病机理及相互关系。方法采用放射免疫法检测血浆ＥＴ、ＴＮＦ－α含量，用基质显色法鲎试验定量检测血浆ＥＴＭ含量。     

Ultrasonic diagnosis and vasoactive substances examination in patients with cirrhosis

Objective:To investigate hemodynamic change of patients with cirrhosis by using Color Doppler ultrasound technique and to explore the significance of change in the content of vasoactive substances-plasma endothelin-1(ET-1)and calcitonin gene-related peptide(CGRP).Methods:A total of 178 cases with cirrhosis were regarded as study groups,and were divided into three degrees:A,B and C according to child-pugh and meanwhile 60 cases were regarded as normal control group.Portal vein and splenic vein of patients were explored by adopting Color Doppler ultrasound technique,related indexes were recorded and the blood flow as well as their ration in the two groups was calculated.Radio immunoassay was adopted to detect the content of plasma ET-1 and CGRP in both study group and contrast group.Results:Compared with the healthy cases in the contrast group,there was abnormal hemodynamics in the system of portal vein of patients with cirrhosis and the content of plasma ET-1 and CGRP was increased obviously.In the Child-Pugh liver function grades,the content of ET-1 and CGRP was increased as the degree of cirrhosis became more and more serious.There was no significant difference in the comparison between those without ascites and those in contrast group(P0.05),the content of plasma ET-1and CGRP in patients without ascites was increased remarkably.Besides,there was positive correlation between the content of plasma ET-1 and CGRP and Dpv,Dsv and Qsv.Conclusion:Dotection of abnormal hemodynamics of portal vein and splenic vein by Color Doppler ultrasound technique can be one of the means for diagnosis of hypertension.Plasma ET-1 and CGRP of patients with cirrhosis reflect the serious degree of the damage in live function and play an important role in the formation and development of portal hypertension.     

Role of serotonin in development of esophageal and gastric fundal varices

AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis. RESULTS:The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L,P < 0.0001). There was no significant correlation be-tween serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs =-0.217,P > 0.05). However,the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs =-0.601,P < 0.01). CONCLUSION:Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices,indicating the clinical value of serotonergic receptor blockers in these patients.     

Endoscopic Evaluation of Rectal Mucosal Reddening in Patients with Liver Cirrhosis

Background: Colonic mucosal lesions observed in patients with portal hypertension have been reported as portal hypertensive colopathy. We studied the rectal mucosa in patients with liver cirrhosis to evaluate the prevalence of mucosal reddening which looks like gastric red spots in the portal hypertensive gastropathy and to determine whether there is a correlation between this lesion and portal hypertension or the severity of liver disease. Methods: Seventy‐two patients with liver cirrhosis and 50 control subjects were examined. Colonoscopy was performed to evaluate the presence of mucosal reddening in the rectum. We investigated the relations between rectal mucosal reddening and esophageal varices, portal hypertensive gastropathy and the severity of liver cirrhosis. Results: Rectal mucosal reddening was observed in eight of 72 patients with liver cirrhosis but in none of the 50 control subjects; its prevalence in cirrhosis patients was significantly higher than that in the control subjects (P < 0.05). Cirrhosis patients with esophageal varices were more likely to have rectal mucosal reddening than cirrhosis patients without esophageal varices (P < 0.05). In addition, the occurrence of rectal mucosal reddening correlated with the severity of cirrhosis, based on Child–Pugh's classification (P < 0.05). Conclusion: We have shown that rectal mucosal reddening develops in patients with liver cirrhosis and is associated with the existence of esophageal varices and the severity of liver cirrhosis. These results suggest the possibility that portal hypertension and impaired liver function may play an important role in the pathogenesis of rectal mucosal reddening in patients with cirrhosis.     

乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者临床特征及影响因素分析

目的 探讨乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者的临床特征及其影响因素。方法 2015年6月～2020年6月我院收治的乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者90例和同期乙型肝炎肝硬化未出血患者90例,收集患者临床资料,分析乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者的临床特征,并采用多因素Logistic回归分析影响出血的因素。结果 单因素分析结果显示,出血组病程长、有消化道出血史、使用非甾体类药物、Child-Pugh分级差、食管静脉曲张程度严重、胃左静脉内径和门静脉内径宽、PT延长、有腹水和血清白蛋白水平低与未出血组比,存在显著性统计学差异(P<0.05);多因素Logistic回归分析结果显示,肝硬化病程长、应用非甾体类药物、Child-Pugh分级差、食管静脉曲张程度严重、胃左静脉内径增宽、门静脉内径增宽、PT延长和有腹水是乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血的独立危险因素(OR=3.145;3.171;2.190;2.672;2.363;3.142;3.083;3.062,P<0.05),而血清白蛋白增加是出血的保护因素(OR=0.288,P<0.05)。结论 乙型肝炎肝硬化并发食管胃底静脉曲张患者存在一些可能诱发曲张静脉破裂出血的危险因素,临床应予以重视,以预防曲张静脉破裂出血的发生。     

肝硬化门静脉血栓患者血浆D-二聚体水平及其临床意义

目的探讨肝硬化门静脉血栓（PVT）患者血浆D-二聚体水平及其临床意义。方法在77例肝硬化患者中,PVT形成患者31例,无血栓形成患者46例,依据螺旋cT检查诊断PVT,采用乳胶凝集法检测血浆D-二聚体水平。结果血栓组和无血栓组患者血浆D-二聚体水平分别为1．2±0．5mg/l和0．6±0．4mg／l（P〈0．01）;血栓组伴中重度食管静脉曲张患者血浆D-二聚体水平（1-3±O．5m鲫）显著高于轻度食管静脉曲张患者（0．9±0．5mg/l,P〈0．05）;血栓形成伴消化道出血和死亡患者血浆D-二聚体水平显著高于无出血和生存患者（P〈0．01）。结论肝硬化患者血浆D-二聚体水平升高可能与PVT形成有关,并严重影响预后。     

Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound

Background:Thoracic duct dilation has been demonstrated in portal hypertension and hepatic cirrhosis by lymphangiography and laparotomy and at autopsy. It is thought to be secondary to increased hepatic lymph flow and has been described in the absence of ascites or esophageal varices. The aim of the present study was to observe thoracic duct morphology by endoscopic ultrasound in various subsets of patients with portal hypertension and hepatic cirrhosis and also to validate existing radiologic/surgical data. Methods:The thoracic duct of 33 patients with cirrhosis and portal hypertension was studied by endoscopic ultrasound. Patients were divided into four groups: 1, patients with ascites and esophageal varices; 2, esophageal varices without ascites; 3, without esophageal varices or ascites; 4, extrahepatic portal hypertension due to pancreatic malignancy. The thoracic duct diameter was also measured in 14 control subjects (group 5). Results:When the thoracic duct diameter for the five groups was compared with analysis of variance, significance was p < 0.0001; by pairwise comparison, group 1 differed from the other four groups (p < 0.05). Thoracic duct dilation (5.61 mm) was seen in group 1 patients, whereas no dilation was present in groups 2 through 4. Additionally, thoracic duct diameter in 33 portal hypertensive and/or cirrhotic patients was significantly different from that in the 14 control subjects (p = 0.003). Conclusion:The thoracic duct can be reliably identified by EUS in patients with hepatic cirrhosis and portal hypertension. Dilation of the duct is seen only in patients with hepatic cirrhosis, ascites, and esophageal varices. No thoracic duct dilation is present in extrahepatic portal hypertension. Contrary to existing radiologic/surgical data, thoracic duct dilation is not seen in all patients with hepatic cirrhosis and portal hypertension signifying advanced disease. A dilated thoracic duct by endoscopic ultrasound should be considered yet another sign of portal hypertension. (Gastrointest Endosc 1998;48:588-92.)