HCV-RNA载量与慢性丙型肝炎患者肝功能的相关性

目的分析丙型肝炎病毒RNA(HCV-RNA)载量与慢性丙型肝炎患者肝功能指标的相关性。方法选取2018年6月至2019年6月镇平县中医院收治的137例慢性丙型肝炎患者为研究对象,根据HCV-RNA载量分为低载量组(17例)、中载量组(24例)、高载量组(96例)。比较3组患者血清白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平,分析HCV-RNA载量与各项肝功能指标的相关性。结果高载量组和中载量组患者血清ALT、AST水平均高于低载量组,高载量组患者血清ALT、AST水平高于中载量组,差异有统计学意义(均P<0.05)。3组血清ALB水平差异无统计学意义(P>0.05)。慢性丙型肝炎患者HCV-RNA载量与血清ALT水平呈正相关(r=0.789,P<0.001),与AST水平呈正相关(r=00.814,P<0.001),与ALB水平无相关性(r=00.253,P=0.737>0.05)。结论检测HCV-RNA载量可一定程度评估患者肝功能情况,可协助常规检测为临床早期诊断、治疗、疗效监测等提供数据参考。     

丙型肝炎患者HCV-RNA病毒载量与转氨酶及胆红素关系的研究

目的:研究丙型肝炎患者血清HCV-RNA含量与转氨酶及胆红素的关系。方法:采用PCR-荧光探针法检测365例来自门诊和病房的丙型肝炎患者血清HCV-RNA,同时采用酶免疫吸附试验法(ELISA)检测抗-HCV,全自动生化分析仪测定转氨酶(ALT和AST)及胆红素(TB和DB)。结果:365份血清标本中,抗-HCV均为阳性,360份标本HCV-RNA均高于上限值(1000 IU/ml)两种方法的符合率为98.63%,说明两种方法之间具有很好的一致性,HCV-RNA含量与ALT和AST的异常率呈正相关(ALT:r=0.971,P<0.05;AST:r=0.956,P<0.05),HCV-RNA含量和胆红素异常率不相关,HCV-RNA含量和转氨酶及胆红素浓度水平相关性不显著。结论:HCV-RNA和抗-HCV的检测是诊断HCV-RNA感染的重要指标,HCV-RNA是反映HCV复制的可靠指标,结合转氨酶和胆红素测定可以帮助临床了解HCV在体内的复制状况及肝脏的损伤情况,为临床提供诊断和治疗依据。     

丙型肝炎HCV-RNA及肝功能指标的变化特点与临床意义

目的 分析丙型肝炎病毒核糖核酸(HCV-RNA)及肝功能指标的变化特点与临床意义.方法 选取2016年3月至2019年5月本院收治的80例慢性丙型肝炎感染患者作为研究对象,采集外周静脉血标本,检测血清HCV-RNA、谷氨酰基转移酶(GGT)、天门冬氨酸氨基转移酶(AST)以及丙氨酸氨基转移酶(ALT)水平,并通过Pearson相关性分析对HCV-RNA与GGT、AST、ALT变化的关系进行分析.结果 80例患者中,HCV-RNA阳性率为67.5％(54/80).HCV-RNA低水平组、中水平组、高水平组GGT、AST、ALT水平均明显高于HCV-RNA阴性组(P<0.05);且HCV-RNA高水平组各项肝功能指标均明显高于低水平组、中水平组(P<0.05),HCV-RNA中水平组各项肝功能指标均明显高于低水平组(P<0.05).丙型肝炎患者HCV-RNA与AST、ALT表现呈高度正相关(P<0.05).结论 丙型肝炎患者具有较高的HCV-RNA阳性率,与ALT、AST等肝功能指标呈高度正相关,能准确反映肝组织损伤情况.     

难治性丙型肝炎临床病理特点及中西药抗病毒治疗效果比较

目的探讨难治性丙型肝炎(RHC)的临床病理特点及中西药治疗效果。方法难治性丙型肝炎患者70例(研究组)随机分为观察亚组37例和对照亚组33例,对照亚组采用常规方案治疗,观察亚组在对照亚组基础上加用自拟犀角地黄汤合黄连解毒汤;另选择同期治疗的普通慢性丙型肝炎患者50例作为普通组。观察难治性丙型肝炎的临床病理特点并比较治疗前后肝功能指标和病毒载量的变化。结果研究组丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、碱性磷酸酶(ALP)均显著高于普通组(P<0.05);研究组重度肝细胞脂肪变性率、小叶间胆管损伤率、淋巴滤泡样结构发生率均显著高于普通组(P<0.05)。治疗12个月,2亚组ALT、AST及HCV-RNA定量均较治疗前降低(P<0.05),且观察亚组低于对照亚组(P<0.05)。观察亚组HCV-RNA阴转率为10.81%(4/37),高于对照亚组的3.03%(1/30),差异有统计学意义(X~2=4.699,P=0.030),治疗12个月后2亚组HCV-RNA载量均明显降低(t=4.929,2.225,P<0.05),且观察亚组低于对照亚组(t=2.475,P<0.05)。结论难治性丙型肝炎临床病理特点为重度肝细胞脂肪变性、小叶间胆管损伤和淋巴滤泡样结构,血清ALT、AST及病毒载量显著升高。中西药联合治疗能够显著改善肝功能,具有一定抗病毒作用,可以作为难治性丙型肝炎治疗的方法之一。     

慢性丙型肝炎患者血清GP73水平与肝功能及HCV-RNA的相关分析

目的 探讨慢性丙型肝炎(CHC)患者血清高尔基体蛋白73(GP73)水平与肝功能及丙型肝炎病毒(HCV)-RNA载量的相关性.方法 选取该院2012年8月至2018年9月收治的CHC患者84例,按照HCV-RNA水平分为HCV-RNA阴性组(n=23)和HCV-RNA阳性组(n=61),另纳入同期84例健康体检者为对照组,与病例组1:1匹配,比较3组对象血清GP73及肝功能相关指标水平;同时将61例CHC HCV-RNA阳性患者依据血清GP73水平分为高GP73组、中GP73组、低GP73组3个亚组,比较3组患者HCV-RNA及肝功能指标水平.结果 HCV-RNA阳性组和HCV-RNA阴性组患者血清GP73及肝功能相关指标水平均高于对照组(P<0.001),且HCV-RNA阳性组血清GP73及肝功能相关指标水平高于HCV-RNA阴性组(P<0.001);HCV-RNA阳性高GP73组不同肝功能指标及HCV-RNA水平均高于中、低GP73组(P<0.001),且中GP73组不同肝功能指标及HCV-RNA水平均高于低GP73组(P<0.001);HCV-RNA阳性患者血清GP73水平与丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)及HCV-RNA水平均呈正相关(r=0.621、0.652、0.604、0.618,P<0.05).结论 血清GP73水平可为CHC患者的确定和改善预后提供重要的价值.     

不同气腹压力对腹腔镜胆囊切除术后患者胆红素和转氨酶及肩痛的影响

目的探讨不同的气腹压力下行腹腔镜胆囊切除术(LC)对患者胆红素、转氨酶及肩痛的影响。方法选取2012年4月至2014年4月在武汉大学中南医院行采用不同气腹压力性LC的患者130例为研究对象。采用随机数字法分为低压组(65例)和高压组(65例),高压组气腹压维持在14~16 mm Hg(1 mm Hg=0.133 k Pa),低压组气腹压维持在8~12 mm Hg。比较术前、术后第1日及第3日肝功能指标丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)及直接胆红素(DBIL)的变化。比较肩部疼痛等气腹并发症的发生率。结果 LC术后两组患者血清ALT、AST及TBIL较术前均明显升高(P<0.05),且高压组患者ALT、AST及TBIL高于低压组(P<0.05)。患者ALT、AST及TBIL在术后第1日明显升高(P<0.05),第3日均明显下降(P<0.05)。两组患者DBIL术后均无明显改变(P>0.05)。两组患者血清DBIL术后均无明显改变(P>0.05)。高压组患者术后肩部疼痛的发生率(26.2%)明显高于低压组(4.6%)(P<0.05)。结论低气腹压下行LC对患者术后胆红素和转氨酶影响较小,肩痛的发生率较低。     

丙型肝炎患者血清肝功能与肝纤维化的相关性

目的 探讨肝功能指标:丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)在丙型肝炎患者肝纤维化评价中的应用.方法 检测106例丙型肝炎患者和79例健康体检人群的血清肝功能指标(ALT、ALB、TBIL)和肝纤维化标志物(HA、LN、PCⅢ、Ⅳ-C),并分析它们之间的关系.结果 丙型肝炎患者的血清HA、LN、PCⅢ、Ⅳ-C、ALT、TBIL含量高于正常人,ALB低于后者,差异具有统计学意义(P＜0.01).相关分析表明:ALT与PCⅢ存在显著正相关(r=0.201,P＜0.05);ALB与HA、 PCⅢ、Ⅳ-C存在显著负相关(r=-0.391,-0.239,-0.303,均P＜0.05);TBIL与HA、LN、PCⅢ和Ⅳ-C存在显著正相关(r=0.319,0.211,0.377,0.389,均P＜0.05).结论 丙型肝炎患者的肝功能较正常人群有所下降,肝纤维化风险更高.肝功能指标ALT、ALB和TBIL在辅助诊断丙型肝炎患者肝纤维化时有一定作用,三者在肝纤维化评价中的应用价值呈TBIL > ALB >ALT顺序排列.     

2型糖尿病患者肝脏硬度与功能的相关性研究

目的 探讨2型糖尿病(T2DM)患者肝脏硬度与肝脏功能及血流动力学的相关性。方法 收集2020年4月~2020年12月在笔者医院内分泌科住院的T2DM患者共74例,根据肝功能情况分为肝功能正常组(A组)46例及肝功能异常组(B组)28例。另选同期健康对照组(C组)50例。收集各组肝功能血清学指标,同时应用声脉冲辐射力成像(ARFI)技术和彩色多普勒检测各组肝脏组织剪切波速度(SWV)、门静脉及肝固有动脉血流动力学参数,比较各组指标差异并分析相关性。结果B组患者谷氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)高于A组及C组(P＜0.05);A组与B组患者的直接胆红素(DBIL)均高于C组(P＜0.05);3组间间接胆红素(IBIL)两两比较,差异有统计学意义(P＜0.05),B组高于A组,A组高于C组。肝脏SWV比较,B组高于A组及C组(P=0.00)。相关性分析显示,肝脏SWV值与ALT、AST、GGT、TBIL、DBIL、IBIL均呈正相关(P＜0.05)。结论 T2DM患者的肝脏硬度与肝脏功能相关性较高,与血流动力学无相关性,SWV可作为评价T2DM患者肝脏损害的有益补充。     

血清PCT、BNP水平与脓毒症患者肝损伤相关指标的相关性分析

目的 分析血清降钙素原(procalcitonin, PCT)、B型利钠肽(B-type natriuetic peptide, BNP)水平与脓毒症患者肝损伤相关指标的相关性。方法 选取2019年6月～2021年6月我院收治的151例脓毒症患者作为研究对象,根据患者是否存在肝损伤分为脓毒症组(n=48)和脓毒症肝损伤组(n=103),并根据肝损伤程度将脓毒症肝损伤组患者分为轻度肝损伤组(n=26)、中度肝损伤组(n=50)和重度肝损伤组(n=27)。于患者入院时测定PCT、BNP水平及肝功能指标：谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)、白蛋白(ALB)。比较脓毒症组、脓毒症肝损伤组血清PCT、BNP水平及肝功能指标。比较轻度肝损伤组、中度肝损伤组、重度肝损伤组血清PCT、BNP水平及肝功能指标。分析血清PCT、BNP水平与AST、ALT、TBIL、DBIL、ALB的相关性。结果 脓毒症组血清PCT、BNP、AST、ALT、TBIL、DBIL水平显著低于脓毒症肝损伤组,ALB水平显著高于脓毒症肝损伤组(P<0.05)。脓毒症肝损伤...     

创伤性多发伤的预后与肝功能的关系

目的探讨创伤性多发伤的预后与肝功能的关系。方法选取我院2010年10月~2016年6月的64例创伤性多发伤患者进行分析,其中死亡46例,存活18例,对患者的α-L-岩藻糖苷酶(AFU)、白蛋白(ALB)、碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、直接胆红素(DBIL)、谷氨酰转肽酶(GGT)、球蛋白(GLB)、间接胆红素(IBIL)、总胆汁酸(TBA)、总胆红素(TBIL)、总蛋白(TP)等指标进行测定,分析创伤性多发伤的死亡、存活与肝功能的关系。结果死亡患者的AFU、ALB、TBA、GLB、TP水平与存活患者比较差异无统计学意义(P0.05);死亡患者的ALT、AST、DBIL、IBIL、TBIL、GGT水平均明显高于存活患者,差异有统计学意义(P0.05);死亡患者的ALP水平明显低于存活患者,差异有统计学意义(P0.05);对死亡患者与存活患者的ALT、AST、DBIL、IBIL、TBIL、GGT、ALP存在明显差异的指标进行多因素分析,结果显示DBIL、IBIL、TBIL与创伤性多发伤的预后有密切关系(P0.05)。结论创伤性多发伤患者的死亡或存活与ALT、AST、DBIL、IBIL、TBIL、GGT、ALP等肝功能水平有关,DBIL、IBIL、TBIL是独立危险因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.