慢性肝病患者血浆内皮素水平变化的研究

探讨内皮素(ET)在慢性肝病患者中的变化规律.采用非平衡竞争性放射免疫法测定血浆中ET水平.128例慢性肝病患者中的ET水平分别为慢性轻度肝炎(50.46±32.74)pg/ml;慢性中度肝炎(51.16±30.69)pg/ml;慢性重度肝炎(63.61±24.86)pg/ml;肝硬化代偿期(43.78±18.97)pg/ml;肝硬化失代偿期(79.29±14.02)pg/ml;肝癌(77.00±59.20)pg/ml.各型慢性肝病的El水平与正常(32.33±3.70)pg/nl比较有显著性升高(P＜0.01).各型之间有显著性差异(P＜0.01).结论 ET随着肝脏损害程度加重而升高,与肝病的慢性化程度相关,ET越高,预后越差.     

血清甘氨酰脯氨酸二肽氨基肽酶对慢性肝病诊断的价值

观察血清甘氨酰脯氨酸二肽氨基肽酶 (GPDA)在慢性肝病中的变化 ,评价临床诊断价值。采用连续监测法测定 131例各类慢性肝病患者和 10 3名正常人血清GPDA活性 ,同步检测血清丙氨酸氨基转移酶 (ALT) ,进行比较分析。慢性肝炎轻度、中度、重度患者及原发性肝癌患者血清GPDA活性均高于正常对照组 ,差异有显著性意义(P均 <0 0 0 1) ,肝癌患者升高尤为显著 ;肝硬化代偿期和失代偿期患者GPDA水平与对照组无显著差异 (P >0 0 5 ) ;而ALT在慢性肝炎和肝硬化患者组均明显高于对照组 ,差异有非常显著性意义 (P均 <0 0 0 1) ,ALT升高的例数与倍数明显高于GPDA。血清GPDA对慢性肝炎的诊断及病情估计有一定的意义 ,但敏感性不如ALT。GPDA对肝硬化的诊断价值不大 ,但GPDA异常升高有助于肝癌的诊断     

肝病患者血浆凝血因子X活性测定的临床意义

采用二步法血浆凝血因子X测定方法检测了96例肝病患者的血浆凝血因子X活性,且与60例健康成人进行了对比分析。结果发现,急性血吸虫性肝病患者血浆凝血因子X活性较正常人低,但差异无显著意义(P>0.05);慢性持续性肝炎患者的血浆凝血因子X活性与正常组比较差异有显著意义(P<0.05);代偿期的病毒性肝硬化和代偿期血吸虫病性肝硬化患者的血浆凝血因子X较正常组的因子X活性极明显降低(P<0.001);失代偿期病毒性肝硬化患者的血浆凝血因子X活性进一步下降。结果显示:随肝细胞受损害程度的加深,血浆凝皿因子X活性呈梯度下降。     

卡维地洛降低肝硬化失代偿期患者肝静脉压力及其肠道屏障功能的影响

目的研究卡维地洛在降低肝硬化失代偿期患者肝静脉压力,同时对其肠道屏障功能的影响。方法选取我院2014年1月至2016年7月期间收治的84例肝硬化失代偿期患者,按照不同治疗方式将患者分成两组(每组42例)。对照组患者予以常规护肝以及对症治疗,观察组患者在对照组的基础上加用卡维地洛治疗,观察不同治疗对两组患者肝静脉压力、肝功能、血浆内毒素、DAO活性、D-乳酸水平变化、门静脉宽度的影响。结果对照组患者在治疗前与治疗后肝静脉自由压、肝静脉楔压、肝静脉压力梯度比较均差异无统计学意义(P0.05),观察组患者治疗后肝静脉楔压、肝静脉压力梯度水平明显低于治疗前(P0.05),而肝静脉自由压治疗前后比较差异无统计学意义(P0.05);两组患者治疗前、后ALT、AST、TBil、Alb各指标比较差异无统计学意义(P0.05),但是两组患者治疗后各指标均有改善情况,且与同组治疗前比较均差异有统计学意义(P0.05);两组患者治疗前血浆内毒素水平、DAO活性、D-乳酸水平以及门静脉宽度变化情况差异无统计学意义(P0.05),治疗后两组患者血浆内毒素水平、DAO活性、D-乳酸水平、门静脉宽度均降低,但观察组患者降低程度高于对照组(P0.05)。结论卡维地洛能明显降低肝硬化失代偿期患者肝静脉压力,减少门静脉宽度,降低血浆内毒素、DAO活性与D-乳酸水平,促进肠黏膜的修复,改善肠道屏障与肝功能。     

血清生长分化因子15水平对慢性肝病患者严重程度的评估价值及其临床意义

目的 :探讨生长分化因子15(growth differentiation factor 15,GDF-15)检测对预测慢性肝脏疾病严重程度的临床应用价值。方法:通过酶联免疫吸附测定法对100例慢性肝病患者和100名健康人进行血清GDF-15水平检测。100例慢性肝病患者包括慢性肝炎患者35例、肝硬化代偿期患者32例和肝硬化失代偿期患者33例;比较不同阶段慢性肝病患者丙氨酸转氨酶(alamine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、GDF-15及国际标准化比值(international normalized ratio,INR)水平;采用Pearson相关性检验分析GDF-15水平与肝硬化判别式值(cirrhosis discriminant score,CDS)、Child-Pugh及终末期肝病模型(model for end-stage liver disease,MELD)评分关系。采用受试者工作特征曲线(receiver operator characteristic curve, ROC曲线)分析血清GDF-1水平对慢性肝病严重程度的预测价值。结果 :肝硬化失代偿期患者[(3 485±658)ng/L]血清GDF-15水平高于肝硬化代偿期[(1 864±254) ng/L]和慢性肝炎[(1 234±242) ng/L]患者;Spearman相关分析结果显示血清GDF-15与CDS、Child-Pugh及MELD评分均呈正相关(均P0.01);血清GDF-15水平在慢性肝炎、肝硬化代偿期和肝硬化失代偿期的ROC曲线下面积分别为0.719、0.806和0.839。结论:血清GDF-15水平可作为一个有效的生物标志物,用于评估肝脏纤维化和慢性肝病的严重程度。     

肝病患者血浆cAMP、cGMP和ANP变化的意义探讨

为了探讨肝病中cAMP、cGMP和ANP的变化规律及其相互间的关系，本文用放射免疫法测定肝炎，代偿期和失代偿期肝硬化病人的血浆cAMP、cGMP和ANP含量并与正常对照，发现肝炎组血浆cAMP与正常组比较无显著差异。cAMP／cGMP比值依次为肝炎组＞代偿期肝硬化＞失代偿期肝硬化。失代偿期肝硬化cAMP和ANP显著高於正常和代偿期肝硬化。提示cGMP可能是ANP的第二信使。cAMP／cGMP比值可作为肝病严重程度的判断指标。     

慢性肝病患者血浆内皮素、NO和炎症细胞因子的关系研究

探讨慢性肝病进程过程中，ET，NO和IL-1β，IL－6和TNFα所起的作用及相关关系。应用ELISA及RIA法检测128例慢性肝病患者的ET，NO和IL-1β，IL－6和TNFα水平。慢性肝炎组，肝硬化代偿期，肝硬化失代偿期及肝癌患者的ET，NO，IL-1β，IL－6和TNFα水平均比正常有显著性增高（P＜0．05）。随着肝细胞损害程度加重，ET，NO含量增加，IL-1β，IL－6和TNFα水平亦逐渐升高。ET，NO的升高引起IL-1β，IL－6和TNFα等炎症细胞因子分泌增加，可能是慢性肝病炎症加重的原因之一。检测这些指标有助于判断慢性肝病的严重程度。     

应用MELD-Na模型评估失代偿期肝硬化患者的短期预后

目的评估终末期肝病血清钠(MELD-Na)、终末期肝病模型(MELD)及Child-Pugh评分系统对失代偿期肝硬化患者短期预后的预测价值。方法对具有完整记录和随访结果的96例失代偿期肝硬化患者的资料进行分析,分别计算每例患者的Chlid-Pugh、MELD及MELD-Na分值,使用受试者工作曲线(ROC)及曲线下面积(AUC)比较3种评分系统判断失代偿期肝硬化患者生存3个月的准确性。结果 96例患者3个月内有25例患者死亡。死亡组的Child-Pugh、MELD及MELD-Na评分均高于生存组(P0.01);MELD-Na和MELD评分在判断患者3个月生存时间的ROC曲线AUC均大于Child-Pugh(P0.001,P0.01),MELD-Na和MELD评分AUC差异均无统计学意义(P0.05)。结论 MELD-Na是判断失代偿期肝硬化患者短期预后的一个较好指标,其准确性优于Child-Pugh分级,但与MELD评分相比无明显差异。     

失代偿期肝硬化患者临床特点及预后分析

[目的]探讨失代偿期肝硬化患者临床特点、死亡原因及影响预后的危险因素。[方法]选取失代偿期肝硬化病例205例作为研究对象,分析死亡组与生存组临床指标差异、死亡原因、死亡危险因素等。[结果]死亡组患者WBC高于生存组,Hb、ALB均低于生存组,差异有统计学意义(P0.05),死亡组PT、APTT延长超过生存组,死亡组AST、TB、CRP明显高于生存组,上述指标2组差异均有统计学意义(P0.05)。2组PLT、ALT、ALP、GGT比较差异无统计学意义(P0.05)。失代偿期肝硬化患者的死亡原因主要为:上消化道出血并失血性休克、慢性肝功能衰竭、合并严重感染等。Logistic回归分析的结果表明:死亡的主要危险因素包括:年龄(≥60岁)、伴有出血(≥400ml)、PT延长、伴有中-大量腹水、慢性肝衰竭、合并感染等。[结论]对于失代偿期肝硬化患者伴有上述危险因素者应积极加强临床干预,对合并感染者应积极抗感染治疗,同时注意失代偿期肝硬化患者并发症的治疗。     

肝硬化、肝癌患者临床分期与血浆中D-二聚体检测及临床意义

目的通过检测肝硬化、肝癌不同临床分期患者血浆中D-二聚体含量，探讨其鉴别诊断意义及肝病凝血功能紊乱的机制。方法采用美国贝克曼ACL-7000检测仪，采用免疫比浊法测出样本含量（不同临床分期的肝硬化35例及肝癌28例、健康对照组25例）。结果肝硬化组代偿期及失代偿期组、肝癌Ⅰ、Ⅱ期及Ⅲ期组患者血浆中D-二聚体含量明显高于健康对照组（P＜0．01）。肝硬化、肝癌各临床分期组间比较差异有非常显著性（P＜0．01）．肝硬化代偿期组与肝癌Ⅰ、Ⅱ期组、肝硬化失代偿与肝癌Ⅲ期之间的D-二聚体相互比较差异无显著性（P＞0．05）。结论血浆D-二聚体含量在肝硬化、肝癌各临床分期患者明显增高，病情及肝功能损害程度越重血浆二聚体含量越高，肝硬化与肝癌患者比较差异无显著性（P＞0．05），故对肝硬化与肝癌的鉴别诊断意义不大。     

Activities of free oxygen radical scavenger enzymes in human liver

Activities of superoxide dismutase, catalase and glutathione peroxidase were measured in liver biopsy specimens from patients with various liver diseases, including six with chronic persistent hepatitis, nine with chronic active hepatitis, nine with non-alcoholic cirrhosis, eight with alcoholic cirrhosis and eight with acute hepatitis. Measurements from ten patients without liver disease were used as controls. Levels of total superoxide dismutase activity in the chronic active hepatitis and non-alcoholic cirrhosis groups were significantly lower than those in the controls (p less than 0.01 and p less than 0.01, respectively). The level of total superoxide dismutase activity in the acute hepatitis group was significantly higher than that in the control group (p less than 0.01). The levels of Cu,Zn-superoxide dismutase activity in all the experimental groups, except for the chronic persistent hepatitis group, were significantly lower than those in the controls (p less than 0.01 in all groups). The levels of Mn-superoxide dismutase activity in the alcoholic cirrhosis and acute hepatitis groups were significantly higher than those in the controls (p less than 0.01 and p less than 0.01, respectively), although no difference in the level of this enzyme was seen among the controls, chronic persistent hepatitis, chronic active hepatitis and non-alcoholic cirrhosis groups. The levels of catalase activity in the groups with chronic active hepatitis, non-alcoholic and alcoholic cirrhosis and acute hepatitis were significantly lower than those in the controls (p less than 0.01 in all groups). Glutathione peroxidase activity showed no difference among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

血清尿酸检测在肝硬化中的意义

探讨肝硬化患者血尿酸（UA）水平的变化及其意义。对223例乙型肝炎肝硬化患者和106例正常对照者进行血UA检测。结果显示,肝硬化患者组血UA水平明显低于正常对照组（t=2.80,P〈0.01）;肝硬化失代偿组UA水平较肝硬化代偿组降低更为明显。肝硬化伴有肾功能损害时UA水平明显高于正常对照组（t=4.28,P〈0.001）。肝硬化失代偿者UA降低比率（39.6%）明显高于肝硬化代偿者降低比率（25.0%,x2=4.18,P〈0.05）。肝硬化患者血UA水平与前白蛋白（PA）水平呈正相关（r=0.2704,P〈0.01）。研究表明,肾功能正常的肝硬化患者血UA水平降低,其降低程度与病变严重程度密切相关,检测UA对判断肝硬化患者病情、转归及预后有一定的价值。     

肝病患者血清肉碱水平的临床研究

目的观察肝病患者血清肉碱水平,探讨其临床意义,为肉碱治疗肝病提供依据。方法用酶循环法检测25例急性病毒性肝炎,34例慢性病毒性肝炎,22例肾功能正常及9例肾功能异常的肝炎后肝硬化患者血清游离肉碱水平,并分别与40名正常人的检测值比较。结果血清游离肉碱:正常人为(48．3±10．2)μmol／L;急性病毒性肝炎患者为(35．2±13．2)μmol／L,明显低于正常对照组,P=0．000。慢性病毒性肝炎患者为(36．5±9．9) μmol／L,明显低于正常对照组,P=0．000。肾功能正常的肝炎后肝硬化患者为(45．0±11．0)μmol／L,比正常对照组略有下降,但差异无统计学意义,P=0．232。肾功能异常的肝炎后肝硬化患者为(83．6±50.4)μmol／L,比正常对照组升高,但差异无统计学意义,P=0．069。结论肝病患者可发生肉碱代谢异常,肝脏疾病是导致继发性肉碱缺乏的原因之一。     

血清蛋白电泳、免疫球蛋白及其轻链测定对肝病患者的临床意义

目的探讨血清中免疫球蛋白和轻链测定以及血清蛋白电泳在肝病患者中的临床应用价值。方法用免疫散射比浊法在特定蛋白分析仪上检测92例肝病患者(包括急性肝炎患者28例、慢性肝炎患者33例、肝硬化患者31例)及45例健康者血清中免疫球蛋白IgG、IgA、IgM以及κ轻链和λ轻链的水平;用琼脂糖凝胶电泳法对所有样本进行血清蛋白电泳检测。结果与对照组相比,急性肝炎组以IgM升高为主,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平比较,差异无统计学意义(P>0.05)。急性肝炎组和肝硬化组IgG、IgA水平均高于对照组,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平分别与对照组比较,差异均有统计学意义(P<0.05)。血清蛋白电泳结果显示,急性肝炎组与对照组相比,两组γ区球蛋白含量比较,差异无统计学意义(P>0.05);慢性肝炎组和肝硬化组γ区球蛋白含量与对照组比较,差异有统计学意义(P<0.05)。结论血清中免疫球蛋白及其轻链的含量与肝脏疾病密切相关,慢性肝炎肝硬化患者血清蛋白电泳呈现典型的多克隆增殖图谱。血清蛋白电泳、免疫球蛋白和轻链水平的测定可作为肝脏功能监测的辅助指标。     

血清前白蛋白在肝病中的临床意义

了解病毒性肝炎患者血清前白蛋白 (PA)的变化 ,探讨测定血清前白蛋白对病毒性肝炎患者的诊断价值。采用免疫比浊法检测 2 76例病毒性肝炎患者血清前白蛋白 ,比较不同临床类型的血清PA的水平及同一临床类型间PA与A的异常率。血清PA的水平在急性肝炎与轻度慢性肝炎之间、慢性肝炎轻度与中度、中度与重度之间、肝硬化与慢性重型肝炎之间均有显著性差异 (P <0 0 5 ) ;急性肝炎组PA与白蛋白 (A)两者相比有高度显著性差异 (P <0 0 0 1) ;PA值比A值更灵敏地反映肝功能损害。血清PA的水平持续 <10 0mg/L作为重症肝炎早期诊断指标之一。检测血清PA对病毒性肝炎临床诊断、病情判断和预后估计有一定参考价值     

肝病患者内毒素血症的临床意义

目的探讨四种肝病内毒素血症（ｅｎｄｏｔｏｘｅｍｉａ,ＥＴＭ）的发生率及其临床意义方法１９９７－０２／１９９８－０６山西医科大学第一医院传染病科住院的急、慢性肝炎、肝炎肝硬变及重症肝炎患者３２０例采用基质显色法鲨试验定量检测血浆内毒素（ｅｎｄｏｔｏｘｉｎ,ＥＴ）水平,应用放射免疫分析法测定血浆肿瘤坏死因子（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒＴＮＦ）水平,采用琼脂单向免疫扩散法测定血浆纤维连接蛋白（ｆｉｂｒｏｎｅｃｔｉｎ,Ｆｎ）含量,采用速率法在全自动生化分析仪．上测定血浆丙氨酸转氨酶（ａｌａｎｉｎｅ　ａｍｉｎｏｔｒａｎｓｆｅｒａｓｅＡＬＴ）活性．结果肝病患者血浆ＥＴ,ＡＬＨ,ＴＮＦ含量明显高于健康对照组（Ｐ＜０．０１）,而在肝炎肝硬变、重症肝炎组Ｆｎ含量均明显低于对照组重症肝炎、肝炎肝硬变、慢性肝炎、急性肝炎患者肠源性内毒素血症（Ｉｎｔｅｓｔｉｎａｌｅｎｄｏｔｏｘｅｍｉａ,ＩＥＴＭ）发生率分别为９３．３％,８４．３％,７９．０％与７５．０％．结论肝病患者长期持续存在的ＩＥＴＭ可加剧肝细胞损伤,在急性肝炎重症化与慢性化中均具有其重要作用     

Lipid-bound sialic acid (LSA) in liver diseases of different etiologies

Objective. There are evidences that the changes in glycosylation and sialylation of proteins and lipids play an important role in the pathogenesis and progression of various liver diseases. The aim of this study was to evaluate the changes in the sialylation of serum lipids measured by the level of lipid-bound sialic acid (LSA) in liver diseases of different etiologies.Materials and methods. Tested group consisted of 303 patients suffering from liver diseases: alcoholic and non-alcoholic cirrhosis, chronic non-viral hepatitis, toxic hepatitis, chronic viral C and B hepatitis, autoimmune hepatitis, primary liver cancer, liver cancer and cirrhosis (mixed group), acute hepatitis B, primary biliary cirrhosis and fatty liver. LSA was determined by the method of Katopodis and co-workers.Results. There were significant differences in the serum LSA concentrations between liver diseases of different etiologies. The level of LSA in liver tumors was higher than that in both types of cirrhosis: alcoholic and non-alcoholic. In turn, LSA level in non-alcoholic cirrhosis was lower than in toxic hepatitis and mixed group. There was no difference in LSA concentration between tumor and mixed group. Similarly to LSA, AFP level in tumor group was also higher than that in both cirrhotic groups, but there was no difference in AFP concentration between tumor and mixed group.Conclusions. The sialylation of serum lipids alters in liver diseases of different etiologies. Given the importance of glycans in biological systems we can speculate that the changes in lipids sialylation play an important role in liver pathology, especially in primary cancer, cirrhosis and toxic hepatitis.     

Serum matrix metalloproteinase-3 (stromelysin-1) concentration in patients with chronic liver disease.

BACKGROUND/AIMS: Matrix metalloproteinase (MMP)-3 plays an important role in extracellular matrix degradation, because of its broad substrate specificity and its activation of other proMMPs. Our aims in the present study were to determine whether the measurement of serum MMP-3 is clinically useful for assessing ongoing liver fibrolysis in patients with chronic liver disease. METHODS: We measured the serum MMP-3 concentrations with a sandwich enzyme immunoassay in 58 patients with chronic hepatitis, 22 patients with liver cirrhosis, 45 patients with hepatocellular carcinoma and 124 healthy individuals. The liver MMP-3 content was also measured in autopsied livers. RESULTS: Among the healthy controls, the serum levels of MMP-3 were about 2-fold higher in the males than in the females. In this study, the serum MMP-3 results of mainly the male group were analyzed because of the large number of male subjects. Compared to the control level, the mean serum MMP-3 concentration was 55% lower in chronic hepatitis, 53% lower in liver cirrhosis and 46% lower in hepatocellular carcinoma. There was no significant difference in the serum MMP-3 levels among the chronic hepatitis, liver cirrhosis and hepatocellular carcinoma groups. The serum MMP-3 levels were not related to the histological degree of necroinflammation or of liver fibrosis in the patients with chronic hepatitis. No significant difference in serum MMP-3 levels was observed among three Child's subgroups in the group of cirrhotic patients. In the group of patients with hepatocellular carcinoma, the serum MMP-3 levels were not related to the severity of liver function, the HCC tumor size, or the histological differentiation. The serum MMP-3 level was not correlated with serum markers for connective tissue turnover, i.e. procollagen type III peptide, 7S fragment of type IV collagen, hyaluronan and tissue inhibitor of metalloproteinase-1 in the patients with chronic liver disease or hepatocellular carcinoma. CONCLUSIONS: The measurement of serum MMP-3 is of little use for assessing fibrolysis in chronically diseased livers.     

乙型肝炎肝硬化失代偿期患者首发食管静脉曲张出血或腹水的临床特征

目的比较乙型肝炎肝硬化失代偿期患者首发食管静脉曲张破裂出血或首发腹水的检验学和超声影像学方面的差异。方法回顾性研究2005年-2007年50例乙型肝炎肝硬化失代偿期患者首发以食管静脉曲张破裂出血或腹水住院者的血液分析、肝肾功能、电解质及门脾静脉宽度等资料。性别分层分析这些资料的改变与出血和腹水之间的关系。结果乙型肝炎肝硬化失代偿期首发食管静脉曲张破裂出血患者的血红蛋白显著低于以腹水为首发症状的乙型肝炎肝硬化失代偿期患者（P〈0.05）,而血糖则显著高于后者（P〈0.01）。出血组女性患者红细胞总数显著低于腹水组男性患者（P〈0.05）,出血组男女患者的血钠都显著高于腹水组男性患者（P〈0.05,0.0001）,腹水组男性血钠显著低于女性（P〈0.05）。腹水组平均发病年龄大于出血组,但差异无显著性（P〉0.05）。两组之间在白蛋白水平、凝血酶原时间、白细胞总数、血小板总数、血钾、血肌酐、血尿素氮和门脾静脉宽度等方面均无显著性差异。结论乙型肝炎肝硬化失代偿期患者首发食管静脉曲张破裂出血者多见高血糖和低血红蛋白,首发腹水者男性更多见低血钠,表明乙型肝炎肝硬化失代偿期出血性损害更倾向侵袭男性患者。