急慢性肝炎、肝硬化及肝癌患者血脂检测的临床意义

目的 探讨急慢性肝炎、肝硬化及肝癌患者血脂(TC、TG、HDL.C、LDL-C、APO-A1、APO-B)的变化及其临床意义.方法 对我院近3年上述肝病患者的血脂结果进行回顾分析.结果 与对照组比较,急性肝炎、肝硬化、肝癌,血脂下降显著(P＜0.05或P＜0.01).结论 血脂水平在一定程度上能反映肝脏的功能,对于了解临床疗效、预后判断具有一定参考价值.     

病毒性肝炎患者CK,CK—MB及CK—MB／CK总活力百分比的研究

对107例病毒性肝炎(以下简称肝炎)患者血清CK、CK-MB水平及CK-MB/CK总活力百分比进行了检测,并与正常人对照,发现肝炎患者血清CK总活力平均水平比正常人明显下降(P<0.001);CK-MB均值与正常人无显著差异.对临床不同型别肝炎及不同程度黄疸分组作进一步研究发现,各组CK总活力水平无显著差异(P>0.05),但CK-MB/CK总活力百分比有显著差异(P<0.01),它们是:慢重肝>肝硬化失代偿>慢活肝>急性肝炎>慢迁肝;高黄疸>低黄疸>无黄疸;这一比值随肝损害程度加重而呈进行性上升,可能反映了肝炎并发心脏的损害。     

急性白血病患者血清甲状腺激素的研究

本文对43例急性白血病患者初发、完全缓解(CR)、复发时的血清甲状腺激素进行了检测。结果:初发、复发的患者血清TT_3明显低于正常对照组(P值分别<0.01、0.001),而TT_4、FT_4I及TSH无显著性改变;复发组rT_3高于正常值。在CR期,所有指标接近正常(P>0.05)。这种不伴TSH升高的低T_3可能即为病态甲状腺综合征中的低T_3综合征。低T_3综合征与疾病分期有关,并与Karnofsky健康状况相关。我们认为该综合征是疾病时的一种保护机制,建议低T_3综合征可作为急性白血病分期的参考。     

Serum Interleukin 6 Levels in Patients with Chronic Hepatitis B

Studies were undertaken to evaluate the role of interleukin 6 (IL-6) in the pathogenesis of chronic hepatitis B. Using recently developed sensitive and specific enzyme-linked immunosorbent assay, we determined serum levels of IL-6 in patients with chronic active hepatitis B (B-CAH), chronic persistent hepatitis B (B-CPH), and primary biliary cirrhosis (PBC). Serum IL-6 activity tended to increase in patients with B-CAH (38.4 +/- 68.0 pg/ml) (+/- SD), compared with controls (9.7 +/- 6.8 pg/ml), although the difference was not significant because of the wide scatter in values. IL-6 levels in B-CPH and PBC were similar to those of controls. There was a significant correlation between the levels of IL-6 and aminotransferase in B-CAH. In addition, IL-6 activity was significantly enhanced during acute exacerbation of the illness, accompanied by clearance of HBeAg. Patients who received IFN-alpha and IL-2 therapy showed depressed IL-6 activity during treatment, and a rebound beyond pretreatment values after cessation of therapy. These findings suggest that IL-6 plays a role in the development of chronic hepatitis B, and it may contribute, at least in part, to the elimination of HB virus.     

Fulminant Adenoviral-Induced Hepatitis in Immunosuppressed Patients

Human adenovirus (HAdV) can often lead to fulminant hepatitis in immunocompromised patients, mostly after reactivation of HAdV. Different risk factors, e.g., transplantation and chemotherapy, increase the risk of developing a HAdV hepatitis. We retrospectively analyzed three patients who showed the characteristics of a HAdV hepatitis observed in disseminated disease. In addition to PCR, diagnosis could be proven by pathology, CT scan, and markedly elevated transaminases. All patients had a hemato-oncologic underlying disease. Two had received a stem-cell transplant, and one was under chemotherapy including rituximab. Despite therapy with cidofovir, all patients died. As the incidence of HAdV hepatitis is low, diagnosis may be easily overlooked. No treatment approaches have yet been established. HAdV hepatitis should be considered as a differential diagnosis, especially when risk factors are present. To avoid dissemination, treatment should be initiated as soon as possible.     

Cardiopulmonary Bypass and Serum Thyroid Hormone Profile in Pediatric Patients with Congenital Heart Disease

Objective: To study the effect of cardiopulmonary bypass (CPB) on serum thyroid hormone profile in children undergoing open‐heart surgery. Design: Prospective cross‐sectional study. Setting: Multispecialty tertiary level referral center. Patients: One hundred consecutive patients (age 15.9 ± 14.6 months, weight 6.7 ± 2.5 kg) undergoing open‐heart surgery under CPB. Interventions: None. Outcome Measures: Levels and trends of serum total thyroxine (TT4), free thyroxine (FT4), total tri‐iodothyronine (TT3), free tri‐iodothyronine (FT3) and thyroid stimulating hormone (TSH), survival, inotropic score, duration of mechanical ventilation, postoperative complications. Results: TT4 levels were 9.08 ± 3.6, 6.4 ± 2.5, 6.24 ± 2.1, 6.43 ± 2.4, 7.20 ± 3.0 µg/dL at baseline and at 1, 24, 48 and 72 hours; FT4 levels were 1.82 ± 0.5, 1.49 ± 0.3, 1.29 ± 0.3, 1.32 ± 0.4, and 1.43 ± 0.5 ng/dL; TT3 levels were 1.81 ± 0.4, 1.31 ± 0.3, 0.99 ± 0.2, 1.0 ± 0.37, and 1.17 ± 0.48 ng/ml; FT3 levels were 4.09 ± 1.0, 3.02 ± 0.8, 2.21 ± 0.6, 2.22 ± 0.7, and 2.66 ± 1.05 pg/ml; TSH levels were 5.40 ± 3.8, 2.0 ± 3.1, 1.24 ± 1.1, 2.90 ± 3.3, and 4.03 ± 3.4 mIU/L. There was significant fall (29.1% for FT4, 32.1% for TT4, 77% for TSH, 46% for FT3 and 45% for TT3, p < 0.0001). When area under curve (AUC) TT4 was compared between survivors (n = 87) and nonsurvivors (n = 12), significantly larger AUC was seen in survivors (492.81 ± 158.6) than nonsurvivors (360.75 ± 179.6 p = 0.0125). In survivors >72 hours, AUC TT4 was larger in patients with uneventful postoperative course versus those with postoperative complications (516.48 ± 18.6 vs. 394.78 ± 29.9, p = 0.001). AUC TT4 showed significant inverse correlation with inotropic score and borderline inverse correlation with duration of mechanical ventilation. Conclusion: Children undergoing surgery under CPB showed significant fall in thyroid hormones. Because TT4 level is modifiable, prophylactic administration of TT4 for improving outcomes needs to be studied further.     

Serum Leptin Levels in Patients with Liver Cirrhosis and Chronic Viral Hepatitis

Background: The aim of the present study was to investigate serum leptin levels in relation to anthropometric features in patients with liver cirrhosis (LC) and chronic viral hepatitis (CVH), and to determine the effect of the severity and aetiology of the LC on serum leptin levels. Methods: Forty-nine patients with LC, 32 patients with CVH and 69 control subjects were age, body mass index (BMI) and sex-matched and included in the study. Plasma glucose, serum leptin and insulin levels were determined. Insulin resistance was assessed using homoeostasis model assessment (HOMA). Body composition was estimated by skinfold thickness. Results: Female patients with Child-A LC had higher levels of leptin, and female and male patients with Child-A LC had higher absolute leptin (leptin/BFM) levels compared to patients with Child-C LC and control subjects. Serum leptin levels of the patients with alcohol LC were higher than the control subjects, but the absolute leptin levels were comparable. When alcoholic and post-viral hepatitis cirrhotic patients were compared with each other on an aetiologic basis, there was no significant difference between them in leptin and absolute leptin levels. There were significant correlations between leptin and BMI, body fat percentage (BFP), BFM (body fat mass) in all three groups in both sexes. Conclusions: These data suggest that the physiologic correlations among serum leptin level, sex, BMI and BFM were well preserved in patients with chronic liver disease. Patients with alcohol LC had higher leptin levels. In early stages of liver disease, leptin levels and absolute leptin levels are higher than in normal subjects. However, in advanced stages of the disease the significant decline in leptin levels and similar levels of leptin expressed in relation to BFM compared to control subjects predominantly represent the expression of fat mass.     

Acute and Acute Severe (Fulminant) Autoimmune Hepatitis

Autoimmune hepatitis frequently has an abrupt onset of symptoms, and it can present with acute liver failure. The abrupt presentation can indicate spontaneous exacerbation of a pre-existent chronic disease, newly created disease, a superimposed infectious or toxic injury, or new disease after viral infection, drug therapy, or liver transplantation. Deficiencies in the classical phenotype may include a low serum immunoglobulin G level and low or absent titers of the conventional autoantibodies. The original revised diagnostic scoring system of the International Autoimmune Hepatitis Group can guide the diagnostic evaluation, but low scores do not preclude the diagnosis. Liver tissue examination is valuable to exclude viral-related or drug-induced liver injury and support the diagnosis by demonstrating centrilobular necrosis (usually with interface hepatitis), lymphoplasmacytic infiltration, hepatocyte rosettes, and fibrosis. Conventional therapy with prednisone and azathioprine induces clinical and laboratory improvement in 68–75 % of patients with acute presentations, and high dose prednisone or prednisolone (preferred drug) is effective in 20–100 % of patients with acute severe (fulminant) presentations. Failure to improve or worsening of any clinical or laboratory feature within 2 weeks of treatment or worsening of a mathematical model of end-stage liver disease within 7 days justifies liver transplantation in acute liver failure. Liver transplantation for acute severe (fulminant) autoimmune hepatitis is as successful as liver transplantation for autoimmune hepatitis with a chronic presentation and other types of acute liver failure (patient survival >1 year, 80–94 %). Liver transplantation should not be delayed or superseded by protracted corticosteroid therapy or the empiric institution of nonstandard medications.     

Low Serum Creatine Phosphokinase Values in Patients with Acute Viral Hepatitis

Low values of serum creatine phospbokinase (CPK) were found in a group of 27 patients suffering from acute viral hepatitis. The values were significantly lower than CPK values in a group of 25 patients with extra hepatic obstructive jaundice (23.3 ± 32.1 versus 163 ± 43 U/L, p < 0.001). CPK values in the hepatitis group when recovered (6 months after hospitalization) were much higher than the mean CPK levels in the same group during the acute illness (178 ± 28 versus 23.3 ± 32.1 U/L, p < 0.001) and were the same as a control group of 26 healthy volunteers (179 ± 28 versus 179 ± 20.9 U/L). Similar results were found when the groups were divided into separate male and female groups. Serum CPK values, thus, were found to be a useful diagnostic tool to distinguish between patients with intrahepatic jaundice due to acute viral hepatitis and patients with extra hepatic obstructive jaundice.     

AST/ALT Ratio Predicts Cirrhosis in Patients With Chronic Hepatitis C Virus Infection

Objective: A liver biopsy is necessary to grade and stage chronic hepatitis C virus (HCV) infection. In a previous study of patients with nonalcoholic liver disease, an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio > 1 suggested cirrhosis. We sought to examine the value of the AST/ALT ratio in distinguishing cirrhotic patients with chronic HCV infection from noncirrhotic patients and to correlate the ratio with the grade and stage of hepatitis and other biochemical indices.
Methods: We retrospectively studied 139 patients with chronic HCV infection. Routine biochemical indices were determined, and the histological grade of necroinflammatory activity and the stage of fibrosis of the liver biopsy specimens were scored.
Results: The mean AST/ALT ratio in the cirrhotic patients (  n = 47  ) was higher than in the noncirrhotic patients (  n = 92  ) (  1.06 ± 0.06 vs 0.60 ± 0.09  ;   p < 0.001  ). A ratio ≥1 had 100% specificity and positive predictive value in distinguishing cirrhotic from noncirrhotic patients, with a 53.2% sensitivity and 80.7% negative predictive value. The ratio correlated positively with the stage of fibrosis but not with the grade of activity or other biochemical indices. Of the cirrhotic patients, 17% had no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio ≥1.
Conclusion: The AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection.     

Effects of Triiodothyronine Administration in Patients with Chronic Renal Failure

Clinically euthyroid patients with severe, chronic, non-thyroidal illnesses usually have decreased serum total and absolute free T₃ concentrations. Since T₃ is the metabolically more active of the two thyroid hormones, it has been suggested that these patients may be hypothyroid and thus may benefit from T₃ therapy. To test this hypothesis, five patients with chronic renal failure requiring maintenance haemodialysis were treated with 5 μg T₃ eight hourly, increasing at three weekly intervals to 10 μg eight hourly, 20 μg eight hourly and finally 30 μg eight hourly. The mean ± SD serum T₃ level did not change over the 12 week period (1–42± 0–17 vs. 141 ± 0–26 nmoll ^-1)whilst the mean serum T₄ and TSH levels fell from 87 0± 15 2 to 47 5± 18 8 nmol l^-1 and 19 ± 0–9 to 1 3± 1 6 mU 1^-1respectively. Only the change in T₄ levels was significant (P < 0005). A significant decrease in mean serum T₄ levels was apparent even after the treatment period with 5 μg T₃ eight hourly (87 0±15-2 vs. 51 2±15 7; P <0005). The mean fasting serum triglyceride level fell from 1 16 ± 0 74 to 0 94 ± 0 74 mmoll^-1(P <005) and the mean fasting serum cholesterol level fell from 6 06± 1 13 to 4 69± 1 10 mmoll^-1 (P < 005). There were no subjective improvements in any of the patients. From the marked changes in serum T₄ levels during the administration of T₃, it is concluded that, prior to treatment, the patients were biochemically euthyroid and not hypothyroid and thus did not require T₃ therapy.     

COPD患者甲状腺激素和皮质醇的测定及临床意义

目的观察COPD患者血清甲状腺激素、皮质醇的变化。方法选择46例COPD患者作为观察组,于急性加重期及恢复期分别采血测定血清总三碘甲状腺原氨酸（TL）、总甲状腺素（TT4）、促甲状腺素（TSH）;血清皮质醇（F）、促肾上腺皮质激素（ACTH）。并选择36例健康人作为对照组。（1）将AECOPD分别与健康对照组及恢复期比较,（2）急性加重期合并呼衰组与无呼衰组比较,并将数据进行统计学分析。结果AECOPD与健康人激素水平相比,急性加重期与稳定期相比均显示ACTH升高,F、TT3下降,经t检验,均有显著差异（t〉2.32、P〈0.05）,而TT4、TSH虽有下降,但无显著性差异（P〉0.05）。合并呼衰组与无呼衰组相比F、TT3、TT4均下降,且有统计学意义（t〉2.32、P〈0.05）。结论COPD患者皮质醇降低,亦存在低甲状腺激素综合症,尤其是低T1综合症,血清甲状腺激素、皮质醇水平有助于判断病情的严重程度,亦有助于疗效观察及估计预后。     

Acute Pancreatitis Associated with Interferon and Ribavirin Therapy in Patients with Chronic Hepatitis C

Acute pancreatitis is a rare complication of interferon (IFN) and ribavirin (RBV) therapy. The aim of this study was to determine the incidence, clinical presentation, and outcome of acute pancreatitis in patients with chronic hepatitis C virus (HCV) infection treated with IFN and RBV combination therapy. We conducted a retrospective review of 1706 HCV-infected patients treated with IFN alpha-2b and RBV. The diagnosis of drug-induced acute pancreatitis was made based on the presence of epigastric pain, elevated amylase and lipase levels, and the absence of other identifiable causes of pancreatitis. Acute pancreatitis was diagnosed in 7 of 1706 HCV-infected patients (0.4%; 95% CI, 0.2 to 0.8%) who were treated with IFN alpha-2b and RBV. The mean age of the patients (four males and three females) was 51.4 +/- 4.7 years and the median duration of therapy prior to development of pancreatitis was 12.0 weeks (range, 4.0-21.0 weeks). All patients presented with epigastric pain associated with nausea, vomiting, and/or fever. The median amylase and lipase values at the time of diagnosis of pancreatitis were 330.0 U/L (range, 182.0-1813.0 U/L) and 500.0 U/L (range, 171.0-2778.0 U/L), respectively. IFN and RBV were discontinued in all patients at the time of diagnosis and six of the seven patients were hospitalized; one patient refused hospital admission. Pancreatitis resolved in all seven patients and none of these individuals had recurrent pancreatitis during a median follow-up of 18.0 months (range, 3.0-27.0 months). In conclusion, IFN and RBV combination therapy is a potential cause of drug-induced pancreatitis in patients with chronic HCV. In these individuals, pancreatitis is often severe enough to warrant hospital admission, although symptoms resolve promptly after discontinuation of antiviral therapy.     

Serum Iron Markers in Patients With Chronic Hepatitis C Infection

Background

Patients with chronic hepatitis C (CHC) often have elevated serum iron markers, which may worsen liver injury.

Objectives

The aim of this study was to investigate the possible correlations between iron metabolism serum markers, HCV viral load, and liver disease severity in treatment-naive patients with chronic hepatitis C infection.

Patients and Methods

Eighty five patients with untreated hepatitis C chronic infection were investigated.

Results

Twenty one patients (24.7%) had elevated serum iron levels, and 29 subjects (34.1%) had severe liver fibrosis. Significantly elevated levels of serum iron (P < 0.05) and ferritin (P < 0.001), associated with lower levels of TIBC (P < 0.05) were detected in patients with severe fibrosis compared to no/mild fibrosis. Severe necroinflammatory activity was also significantly correlated with serum iron (P < 0.001), TIBC (P < 0.05), and ferritin levels (P < 0.001). Using multiple linear regression analysis, serum levels of ferritin and transferrin were the independent variables selected as being good predictors for advanced fibrosis and severe necroinflammatory activity. No significant correlations were detected between HCV viral load and iron markers.

Conclusions

This study revealed that serum iron markers (especially ferritin and transferrin) might be used as surrogate markers for both liver fibrosis and necroinflammatory activity.Patients with chronic hepatitis C (CHC) often have elevated serum iron markers, which may worsen liver injury.     

Serum Uric Acid to Creatinine Ratio in Patients with Chronic Obstructive Pulmonary Disease

Serum uric acid (UA), the final product of purine degradation, has been shown to be increased in the hypoxic state. We assessed whether the presence of higher values of serum UA and serum UA to creatinine ratio is associated with clinical or functional characteristics in patients with chronic obstructive pulmonary disease (COPD). Fifty-nine consecutive stable patients with COPD, without comorbid conditions, were included. Clinical and functional characteristics were compared between patients with levels below and above the median values of serum UA and serum UA to creatinine ratio. Patients with serum UA levels above the median value differed significantly from the group with levels below this value only in FVC (p = 0.04), and serum UA did not correlate significantly with the parameters analyzed. Patients with the serum UA to creatinine ratio above the median value had lower FVC (63 ± 18 vs. 73 ± 15 percentage of predicted, p = 0.028), lower FEV₁ (43 ± 19 vs. 55 ± 18 percentage of predicted, p = 0.019), and a higher level of dyspnea (MRC scale, 1.5 ± 1.1 vs. 0.8 ± 1.0, p = 0.011). The serum UA to creatinine ratio correlated with FVC (r = −0.27), with FEV₁ (r = −0.31), and with dyspnea (r = 0.29). In view of these results, we consider that the serum UA to creatinine ratio warrants evaluation as an additional parameter for predicting outcome in COPD.     

Serum Level of Adiponectin Correlated with Gender and Genotype in Patients with Chronic Hepatitis C

Adiponectin is well recognized as plasma physiologically active polypeptide hormone exclusively derived from human and animal mature adipocytes, with vigorous property in antidiabetic, antiobesity, antiatherogenic, and anti-inflammatory processes. In this study, we investigated the correlation between serum adiponectin level and clinical and pathological parameters in patients with chronic hepatitis C (CHC). The study included 127 patients with CHC and 42 healthy volunteers as controls whose laboratory parameters and serum adiponectin and tumor necrosis factor-α (TNF-α) were assessed using enzyme-linked immunosorbent assay (ELISA). We demonstrated that a lower serum adiponectin level was associated with male gender, higher γ-glutamyltransferase (γ-GGT), higher albumin, higher TNF-α, and steatosis grade. The higher level of serum adiponectin in patients with genotype 2a was demonstrated when compared with that in the patients with genotype 1b. Furthermore, of great interest, results suggested that the significant differences regarding viral genotype seemed to occur only in male patients with CHC but not in female patients. In conclusion, serum adiponectin was associated with gender, genotype, liver steatosis, and TNF-α in a Chinese population with CHC.     

Serum Cryoglobulin and Chronic Hepatitis C Virus Disease among Japanese Patients

Objectives: Hepatitis C virus (HCV)-associated mixed cryoglobulins appear to be detected often in hepatitis C-related chronic liver disease. The association of the two phenomenon among Japanese patients is the subject of the present study.
Methods: Serum levels of total hemolytic complement (CH50) and anti-C3d-binding immune complex, as well as the prevalence of cryoglobulins, were studied in 213 patients with chronic liver disease thepatitis C, 155; hepatitis B, 58). Cryoprecipitates were tested for anti-HCV Ah and HCV RNA.
Results: CH50 activity was significantly lower in patients with hepatitis C than in those with hepatitis B except in responders to interferon who showed a sustained loss of HCV RNA. Cryoglobulins were detected in 24 (37%) of 65 patients with hepatitis C; they generally consisted of polyclonal immunoglobulins but one case. Cryoglobulins were more frequently observed in cirrhotic patients and in those with a longer duration of disease. Cryoglobulinemia-related clinical signs such as vasculitis occurred in only three cases. Patients with cryoglobulins had lower CH50 activity and higher immune complex values than those without cryoglobulins. Anti-HCV Ab and HCV RNA were detected in all cryoprecipitates tested.
Conclusions: These findings suggest that HCV is a major cause of cryoglobulins and advanced liver damage. However, serum cryoglobulins with polyclonal immunoglohulins appear to be less frequent among Japanese patients than among those studied in Western countries.     

散发性重型戊型病毒性肝炎11例的临床,病原学,病理特征

本组病例有６３．６％的患者病产喜食水生贝类及生冷食物，经常在餐馆就餐，有可能经食物源传播；２７．１％病例发病前１－２月在镜外生活，可能有输入性传播；５４．５％是在慢性ＨＢＶ感染基础上重叠感染ＨＥＶ，与印度报道相一致，提示这是ＨＢＶ高发区ＨＥＶ感染的一个特点。本组ＦＨ－Ｅ的临床特点的黄疸深、退黄时间长、肝功能损害明显，并发症以肝性脑病及继发感染为多见。病理组织学特征是汇管区有明显炎性细胞浸润及毛细胆