ALT、AST、GGT、AKP、CHE在两生化分析系统间的偏倚评估

[目的]通过对同一临床实验室两生化分析系统进行方法对比分析和预期偏倚评估，探讨两生化分析系统之间检测结果是否具有可比性或检测结果的偏倚是否在允许的范围内，以确保检测结果的准确稳定。[方法]按照美国临床实验室标准化委员会(NCCLS)EP9-A文件的要求，以美国强生Vitros-750生化分析仪为比较方法，日立7600生化分析仪为实验方法，用患者样品对ALT、AST等5个生化项目进行了检测，对两分析系统之间的预期偏倚进行评估。[结果]在所测定的5个项目中，胆碱脂酶在两台仪器测定结果的预期偏倚不能被接受；其余项目测定结果的预期偏倚均可以被接受。[结论]胆碱脂酶在方法学上存在差异，应固定在强生干化学分析仪上检测，其余ALT、AST等4项酶可在两生化分析系统上任一检测。当实验室内同一项目存在两套以上分析系统检测时，需对其进行对比分析和偏倚评估，对这些项目在分析系统间的偏倚有了准确的评价管理依据，对不可接受偏倚的项目采取相应的纠正措施，才能保证检测结果的准确稳定。     

自制ALT、AST、ALP、GGT质控物的实验探讨

临床生化11项的室内质控已普遍开展,并作为评价实验室的重要内容,其得益于商品质控血清的供应。而酶的室内质控尚未普遍开展,其重要原因是尚未能获得国产的质控物。我们摸索制备了ALT、AST、ALP、GGT质控物,并经六个月实验观察,结果尚称满意,此质控物作为对二级或二级以下实验室的四种酶的质量评价已足够,且此质控物制作简单易行。特作如下介绍,供讨论指正。     

血清GGT、ALT对2型糖尿病早期诊断价值的初步探讨

目的探讨血清γ-谷氨酰基转移酶（GGT）、丙氨酸氨基转移酶（ALT）对2型糖尿病早期诊断的临床应用价值。方法采用Roche Modu lar全自动生化分析仪及配套试剂检测200例2型糖尿病患者（男、女各100例）及200名正常对照者的血清葡萄糖（G lu）、GGT和ALT水平,并进行统计分析。结果 2型糖尿病患者男性及女性的G lu、GGT水平与对照组比较,差异均有统计学意义（P〈0.05）,而ALT则无差异;男性和女性2型糖尿病患者中GGT浓度超出参考区间的百分率分别是13%和16%,明显高于对照组。结论 GGT对于2型糖尿病的早期诊断有一定意义。     

血清GGT、ALT对2型糖尿病早期诊断价值的初步探讨

目的探讨血清γ-谷氨酰基转移酶(GGT)、丙氨酸氨基转移酶(ALT)对2型糖尿病早期诊断的临床应用价值。方法采用Roche Modu lar全自动生化分析仪及配套试剂检测200例2型糖尿病患者(男、女各100例)及200名正常对照者的血清葡萄糖(G lu)、GGT和ALT水平,并进行统计分析。结果 2型糖尿病患者男性及女性的G lu、GGT水平与对照组比较,差异均有统计学意义(P<0.05),而ALT则无差异;男性和女性2型糖尿病患者中GGT浓度超出参考区间的百分率分别是13%和16%,明显高于对照组。结论 GGT对于2型糖尿病的早期诊断有一定意义。     

联合检测血清ALP,GGT和AFP对肝癌的诊断价值

<正>肝癌(Hepatocellular carcinoma,HCC)是中国及亚非地区消化系统中最常见的恶性肿瘤,发病率高,预后差,已经成为全球第五大常见肿瘤。2004年中国原发性肝癌的死亡率约为21.59/10万[1]。现在大都认为肝癌的早期诊断主要依靠B超、CT及血清     

家兔玻璃体液CHE、AST活性变化与PMI的相关性研究

目的探讨死后家兔玻璃体液胆碱脂酶(CHE)、谷草转氨酶(AST)两种酶的活性与死后经过时间(postmortern interval，PMI)之间的相关关系，为更加准确地推断死亡时间寻求一种新方法的可能。方法应用全自动生化检测仪检测家兔死后0-54h玻璃体液在不同的环境温度下两种酶的失活情况。结果两种酶的活性改变在一定时间内各出现一个平台期，平台期后两酶的活性迅速下降，低温组在死亡54h后活性几乎为零，高温组在死亡48h后活性几乎为零。经统计学分析死后两种酶活性变化与PMI之间呈显著的负相关性。结论在一定的范围内依据各自的回归方程可以大致地推断PMI，依据两种酶多元回归方程可以较准确地推断PMI。     

血清AFU、ALP、GGT、CHE和Hcy联合检测对原发性肝癌的诊断价值

目的 探讨血清AFU、ALP、GGT、CHE和同型半胱氨酸(homocysteine,Hcy)对原发性肝癌的诊断价值.方法 对213例原发性肝癌、85例良性肝病和50例健康人血清中AFU、ALP、GGT、CHE和Hcy水平进行检测分析.结果 原发性肝癌患者血清AFU、ALP、GGT、CHE和Hcy水平与良性肝病组及正常对照组比较差异有统计学意义(P＜0.05);联合检测的敏感性和诊断准确性均较高.结论 联合检测AFU、ALP、GGT、CHE和Hcy对原发性肝癌的诊断有重要价值.     

病毒性肝炎患者血清PBP、PA、CHE、ALB的变化及临床意义

<正>肝脏是体内蛋白合成的主要场所,各种肝病均可引起多种血清蛋白浓度的变化,视黄醇结合蛋白(RBP)、前白蛋白(PA)、胆碱脂酶(CHE)、白蛋白(ALB)     

慢性乙型肝炎患者血清AST/ALT比值与甲状腺激素的关系探讨

目的通过检测临床确诊为慢性乙型肝炎患者血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、甲状腺激素T3、T4及促甲状腺素（TSH）含量,进一步探讨慢性乙型肝炎患者肝损情况与甲状腺分泌功能的关系。方法收集2009年1-4月79例确诊为慢性乙型肝炎患者（病例组）血清标本,分别检测其ALT、AST、甲状腺激素T3、T4及TSH含量。以同期健康体检者30例作为对照组。比较两组的差异及各指标间的相关性。结果病例组AST为（87±113）U/L、ALT为（135±241）U/L、AST/ALT为0.97±0.57、TSH为（1.63±1.29）mU/L、T3为（1.61±0.52）ng/mL、T4为（10.7±2.9）μg/dL,对照组分别为（23±5）U/L、（18±5）U/L、1.31±0.26、（2.13±0.90）mU/L、（1.19±0.16）ng/mL和（8.6±0.9）μg/dL,两组各指标比较均有统计学差异（P〈0.01）。所有指标均正常的共有6例（7.6%）,有73例（92.4%）存在不同程度的指标异常;在68例AST/ALT比值降低的慢性乙型肝炎患者（93.2%）中,伴有单纯T4升高的有11例（16.2%）,单纯T3升高的有4例（5.9%）,T3、T4同时升高的有11例（16.2%）,T3、T4同时升高且TSH降低的有2例（2.9%）,1例T4升高且TSH降低（1.5%）,1例仅TSH升高（1.5%）;在4例AST/ALT比值正常的慢性乙型肝炎患者（5.5%）中,有1例T3、T4同时升高且TSH降低,1例T3和T4同时升高,1例单纯T4升高,1例单纯TSH降低;有1例仅AST/ALT比值升高而其他项正常。结论慢性乙型肝炎患者除AST/ALT比值异常外,还同时伴有不同程度的甲状腺激素指标异常,其原因可能与慢性乙型肝炎应用干扰素治疗时甲状腺功能受损有关。     

γ-谷氨酰转肽酶、丙氨酸转氨酶及其比值在肝癌诊断中的价值

目的探讨 (研究 )血清γ 谷氨酰转肽酶 (GGT)和GGT与丙氨酸转氨酶 (ALT)比值在原发性肝癌诊断中的价值。方法分健康对照组、肝硬化组、原发性肝癌组 ,分别测定 3组外周血清中的GGT及ALT活性 ,并计算GGT与ALT的比值。结果与健康对照组比较 ,肝硬化组和原发性肝癌组的外周血GGT及ALT活性均显著增高 (P <0 0 5 ) ;原发性肝癌组与肝硬化组比较 ,GGT活性显著增高 ,但ALT活性无显著性差别 (P >0 0 5 ) ;三组GGT与ALT比值比较 ,健康对照组与肝硬化组之间无显著性差异 ,但二组均与原发性肝癌组存在显著性差异 (P <0 0 5 )。结论外周血清中GGT活性及GGT与ALT的比值有鉴别肝硬化及原发性肝癌的价值 ,有助于临床对原发性肝癌的诊断     

血清前清蛋白和胆碱酯酶在肝损伤中的临床价值

目的探讨血清前清蛋白（PA）、胆碱酯酶（CHE）在肝功能检测中的临床价值。方法对196例患者血清PA、CHE活性及其它肝功能指标进行检测,PA以免疫比浊法,CHE以速率法在日立7600—020型全自动生化分析仪上测定。结果血清PA、CHE检测结果比较差异有统计学意义（P〈0．001）,其降低程度随病情的加重而增加。结论PA、CHE水平与肝脏合成功能有关,其异常程度随肝功能检测中异常项目增多而越发明显,肝脏疾病时PA的改变比CHE更为敏感。因此,在肝功能检测中PA、CHE这两项指标只需包含PA。     

Infection by an unenveloped DNA virus associated with non-A to -G hepatitis in Japanese blood donors with or without elevated ALT levels

BACKGROUND: An unenveloped, single-stranded DNA virus named TT virus has been found in association with elevated alanine aminotransferase (ALT) levels in recipients of transfusions and has been detected frequently in patients with acute or chronic hepatitis of non-A to -G etiology in Japan. DNA of the TT virus was searched for in blood donors with or without elevated ALT levels. STUDY DESIGN AND METHODS: A total of 861 blood donors without previous transfusions and who were negative for markers of hepatitis B or C virus infection were tested. DNA of the TT virus was detected by polymerize chain reaction with hemi-nested primers. RESULTS: TT virus DNA was detected in 62 of 280 (22.1% [95% CI: 18.1-26.6]) donors with elevated ALT levels (mean +/- SD, 89.3 +/- 36.4 U/L; range, 61-301 U/L), which is significantly more frequently (p<0.02) than its detection in 91 of 581 (15.7% [95% CI: 13.2-18.4]) donors with normal ALT (< or = 45 U/L).The frequency of TT virus DNA increased with age, in donors with and without elevated ALT. CONCLUSION: The detection of TT virus DNA, at a frequency higher in donors with elevated ALT than in those without, strengthens the association of TT virus with non-A to -G hepatitis.     

回族地区慢性乙型肝炎患者HBV-DNA与ALT及血清标志物的关系

目的探讨宁夏地区283例慢性乙型肝炎(CHB)患者的丙氨酸氨基转移酶(ALT)、乙型肝炎病毒(HBV)-DNA载量与血清学标志物浓度之间的关联性。方法应用化学发光微粒子免疫分析法定量检测HBV血清学标志物和荧光定量聚合酶链反应检测HBV-DNA载量。结果乙型肝炎e抗原(HBeAg)阳性患者较阴性患者的HBV-DNA载量较高、较乙型肝炎e抗体(抗-HBe)水平较低(P<0.01);女性的HBeAg和抗-HBe水平均较男性高(P<0.01);30～50岁组CHB患者的HBV-DNA、HBeAg、抗-HBe与小于30岁组、>50岁组比较差异有统计学意义(P<0.01);CHB患者中HBV-DNA载量与HBeAg呈正相关(r=0.451,P<0.01),与抗-HBe呈正相关(r=0.434,P<0.01);ALT与HBsAg呈正相关(r=0.131,P<0.05)。结论宁夏地区283例CHB的HBV-DNA载量、ALT与血清学标志物浓度有一定相关性,与国内外的研究结果相一致。     

维持性血液透析患者血管通路血流量递减与Kt/V及尿素清除率定量分析

目的　通过测定维持性透析患者血管通路血流量、Kt/V值及尿素清除率 (URR)的定量分析 ,进一步探讨血流量对透析充分性的影响。方法　本研究选择慢性维持性血液透析患者 80例。设定血液透析开始后在线血流量 ,根据血流量不同分为 3组 ,I组血流量 30 0ml/min ,Ⅱ组血流量 2 5 0ml/min ,Ⅲ组血流量2 0 0ml/min ,计算各组Kt/V值与尿素减少率 ,观察血流量与Kt/V值及尿素减少率之间的相关关系。结果　 3组之间Kt/V、URR比较P <0 .0 0 1,差异均具有显著性 ;血流量与Kt/V、URR之间呈正相关 (r1=0 .4 4 8,P <0 .0 0 1;r2 =0 .4 13,P <0 .0 0 1;)随着血流量从 30 0ml/min降到 2 0 0ml/min ,Kt/V、URR分别从(1.33± 0 .33)、(6 8.19± 8.86 ) %降到 (0 .99± 0 .31)、(5 8.5 9± 13.19) % ,分别降低 2 5 .5 6 %、14 .0 8%。结论　进一步从定量水平明确血液透析患者的血流量与Kt/V、URR密切相关 ,透析时保证足够的血流量是透析患者综合临床状况分析的一项重要指标。     

The predictive value of white cell or CD34+ cell count in the peripheral blood for timing apheresis and maximizing yield

BACKGROUND: The collection of peripheral blood stem and progenitor cells (PBPCs) for transplantation can be time-consuming and expensive. Thus, the utility of counting CD34+ cells and white cells (WBCs) in the peripheral blood was evaluated as a predictor of CD34+ cell yield in the apheresis component. STUDY DESIGN AND METHODS: The WBC and CD34+ cell counts in the peripheral blood and the apheresis components from 216 collections were assessed. Sixty-three patients underwent mobilization with chemotherapy plus filgrastim, and 17 patients and 14 allogeneic PBPC donors did so with filgrastim alone. The relationship between the number of WBC and CD34+ cells in the peripheral blood and in the apheresis component was analyzed by using rank correlation and linear regression analysis. RESULTS: The correlation coefficient for CD34+ cells per liter of peripheral blood with CD34+ cell yield (x 10(6)/kg) was 0.87 (n = 216 collections). This correlation existed for many patient and collection variables. However, patients with acute myeloid leukemia had fewer CD34+ cells in the apheresis component at any level of peripheral blood CD34+ cell count. Components collected from patients with CD34+ cell counts below 10 x 10(6) per L in the peripheral blood contained a median of 0.75 x 10(6) CD34+ cells per kg. When the WBC count in the blood was below 5.0 x 10(9) per L, the median number of CD34+ cells in the peripheral blood was 5.6 x 10(6) per L (range, 1.0-15.5 x 10(6)/L). A very poor correlation was found between the WBC count in the blood and the CD34+ cell yield (p = 0.12, n = 158 collections). CONCLUSION: The number of CD34+ cells, but not WBCs, in the peripheral blood can be used as a predictor for timing of apheresis and estimating PBPC yield. This is a robust relationship not affected by a variety of patient and collection factors except the diagnosis of acute myeloid leukemia. Patients who undergo mobilization with chemotherapy and filgrastim also should undergo monitoring of peripheral blood CD34+ cell counts, beginning when the WBC count in the blood exceeds 1.0 to 5.0 x 10(9) per L.     

Fructose 1,6-bisphosphatase in the diagnosis of chronic hepatitis. II. Classification of chronic hepatitis based on fructose 1,6-bisphosphatase and other laboratory data

The histomorphology of typical liver cell necroses are here correlated with heterotope distributions of enzymes in liver parenchyma. A variety of findings indicate a congruence between gluconeogenetic areas of the liver and the typical pattern of 'piecemeal' necrosis. We therefore propose a diagnostic index based on fructose 1,6-bisphosphatase activity and the data from the clinical laboratory. This index makes it possible to distinguish between chronic persistent and chronic aggressive hepatitis.     

脑死亡判定中呼吸暂停试验临床实施的可行性及对血压和心率的影响

目的探讨脑死亡判定标准中呼吸暂停试验临床实施的可行性及对平均动脉压(MAP)、心率(HR)的影响。方法对22例临床可疑的脑死亡患者进行呼吸暂停试验,先经呼吸机吸入纯氧10min,再停机并经插至气管隆突水平的导管以6L/min纯氧供氧10min,观察患者有无自主呼吸,并分别测定其充氧前、充氧后、停机后的动脉血pH值、PaO2、PaCO2的变化,及停机后MAP、HR的动态变化。结果试验过程中,22例患者无一例出现自主呼吸,其中16例试验结束时PaCO2≥60mmHg。停机后所有患者pH值明显下降、PaCO2明显升高(P<0.01),充氧后PaO2明显升高(P<0.05),而停机后PaO2无明显下降趋势(P>0.05)。停机后患者MAP、HR均逐渐下降,且各组停机后与停机前比较均有显著差异(P<0.05),至停机8min时下降尤为显著,再通气后HR回升迅速,而MAP则缓慢。结论呼吸暂停试验为判定脑死亡的关键步骤之一,停机后MAP、HR尽管逐渐下降,但不发生低氧血症,若纠正停机前的过度通气,并控制停机时间在8min内,临床上是可行和安全的。     

The visually-evoked cerebral blood flow response in women with a recent history of preeclampsia and/or eclampsia

Several studies provide evidence for altered cerebral hemodynamics during (pre)eclampsia. Whether (pre)eclampsia has a persistent negative impact on cerebral hemodynamics, possibly contributing to an elevated risk of premature stroke, is unknown. The aims of this study were (i) to refine and apply a control system-based method previously introduced by Rosengarten to quantify the visually-evoked blood flow response of the posterior cerebral artery (PCA); and (ii) to test the hypothesis with this method that cerebral hemodynamics in women with a recent history of (pre)eclampsia is abnormal relative to that in parous controls. Hereto, we recorded cerebral blood flow velocity (CBFV) in the PCA by transcranial Doppler (TCD) sonography during cyclic visual stimulation in 15 former preeclamptics, 13 former eclamptics and 13 controls. The typical CBFV response was fitted with the step response of a second-order-linear model enabling quantification by parameters K (gain), zeta (damping), omega (natural frequency), T(v) (rate time) and T(d) (time delay). The method refinement introduced here consisted of response filtering before quantification and of considering the individual instead of group-averaged response patterns. Application of this refinement reduced the fitting errors (1.4 +/- 1.2 vs. 3.2 +/- 1.8, p < 0.01). Intergroup differences in model parameters were not found. Although statistically not significant, a trend was observed that critical damping (zeta>1) occurred more frequently in the combined group of former patients than in the controls (7 of 28 vs.1 of 13, p = 0.16). Critical damping (zeta>1) reflects an abnormal response, which is either compensated for by a rise in rate time ("intermediate"; zeta>1; T(v) > 20) or remains uncompensated ("sluggish"; zeta>1; T(v) < 20). Critical damping increased significantly (p = 0.039) with (pre-)eclampsia-to-test-interval in the PE+E patients with abnormal responses (zeta>1), suggesting that (pre)eclampsia might induce diminishing cerebral hemodynamic function over time. Based on a system-analytical classification approach, the data of this study provide evidence for individual CBFV responses to be abnormal in former (pre)eclamptics compared with controls. Further study is needed to reveal how the abnormal CBFV response classification reflects cerebrovascular dysfunction.     

血清TG测定在放射性药物131碘治疗复发或转移的分化型甲状腺癌中的价值

目的分析在放射性药物131碘(131I)治疗复发或转移的分化型甲状腺癌(DTC)过程中,检测血清甲状腺球蛋白(TG)的意义。方法采用放射免疫分析(RIA)检测患者治疗前后不同时期血清TG水平,并进行统计学处理。结果放射性药物131I治疗复发或转移的DTC患者1个月后血清TG明显降低(t=5.5,P<0.01),3月后降到最低水平(t=6.3,P<0.01);DTC中滤泡状癌TG下降幅度明显高于乳头状癌。结论血清TG的RIA检测,可作为放射性药物131碘治疗转移或复发DTC的有效检测指标,并指导是否做重复治疗。