肝硬化患者浆纤维蛋白原的水平及纤维蛋白单体聚合功能的研究

目的 :研究肝硬化患者血浆纤维蛋白原 (Fbg)水平及去肽A后纤维蛋白单体 (desA Afibrinmonomer)的聚合功能。方法 :以蕲蛇酶水解Fbg ,用计算机自动检测系统测定患者血浆中纤维蛋白单体聚合反应速率 (FMPS)、最大吸光度 (Amax)、凝固性纤维蛋白原含量 (FC)、反应延滞时间 (DT)、功能指标 (FI =FMPS/Amax)。结果 :失代偿性肝硬化患者 30例 ,其FMPS为 0 32 6± 0 0 6,Amax为 0 178± 0 0 2 8,FC为 1 70 0± 0 40 0g/L ,DT为 6± 2 0s ,FI为 1 831。除DT外其它数据均较对照组为低。结论 :失代偿性肝硬化患者因纤维蛋白原浓度下降致使纤维蛋白单体聚合功能降低 ,从而出现低凝状态 ,这可能是构成出血倾向的原因之一。     

冠心病患者血浆纤维蛋白原水平变化

目的　观察冠心病患者血浆纤维蛋白原水平变化特点。方法　选择 10 2例有典型心绞痛或不典型胸痛患者行冠状动脉造影、同时测定其血浆纤维蛋白原 ( fg)水平 ,观察冠状动脉造影阳性与阴性患者血浆 fg的关系 ,同时观察不同的冠状动脉狭窄支数与 fg水平变化的关系。结果　 1)、5 3例心绞痛患者的 fg水平明显高于 37例冠状动脉造影正常组 ( 3.86± 0 .70 g/L,3.37± 0 .62 g/L ,P<0 .0 1) ;12例急性心肌梗死之 fg明显高于心绞痛 B组与正常组 A组 ( 5 .83± 1.85 g/L ;3.37± 0 .62 g/L ;P<0 .0 1) ;2 )、在不同的狭窄支数亚组中 ,Fg水平与病变支数无显著差异性。结论　冠心病患者血浆 fg水平明显升高 ,说明 fg在动脉粥样硬化及血栓形成中起重要作用     

血浆纤维蛋白原水平升高与卒中

近年来,血浆纤维蛋白原(FG)水平升高同动脉粥样硬化及血栓形成的联系有很多研究。其中血浆FG水平升高作为冠心病(CHD)的一个危险因素的研究报道最多,而作为卒中的危险因素也有不少直接和间接的研究,本文就此综述如下。一、前瞻性研究表明血浆FG水平升高是卒中的一个危险因素。在FG水平升高与卒中联系的前瞻性研究中,最受重视的是哥德堡的研究资料,Wilhelmsen等人对年龄54岁的792例的随机样本进行了前瞻性研究。13.5年的随访结果,在792人中,92人患心     

急性乙型肝炎纤维蛋白原水平及其功能的研究

目的了解急性乙型肝炎血浆中纤维蛋白原的浓度与其纤维蛋白单体的聚合功能.方法以蕲蛇毒水解纤维蛋白原,用计算机自动检测系统测定.结果40例急性乙型肝炎纤维蛋白单体聚合反应速率(FMPS)为0.380±0.100,最大吸光度(Amax)为0.199±0.032,凝固性纤维蛋白原浓度(FC)为1.99±0.46g/L,功能指数(FI)(FMPS/Amax)1910.反应延滞时间(DT)0±1s,均低于正常,除FI外P值均＜0.05.结论急性乙型肝炎因肝功能受损常影响凝血功能.本研究发现病人呈低凝状态,可能导致出血倾向.     

肝硬化、肝癌患者血小板参数纤维蛋白原及凝血酶原时间改变的临床意义

目的探讨肝硬化、肝癌患者血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)、纤维蛋白原(Fib)及凝血酶原时间(PT)改变的临床意义。方法对69例肝硬化、肝癌患者的PLT、MPV、PCT、PDW、Fib及PT进行检测。结果肝硬化组(或肝癌合并肝硬化组)PLT、MPV、PCT均显著降低(P<0.01),PDW显著升高(P<0.05),Fib显著降低(P<0.05~0.01),PT显著延长(P<0.01);随Child分级,其异常程度逐级加重,有显著差异(P<0.05~0.01)。肝癌组Fib显著升高(P<0.01);肝癌并发肝硬化患者Fib显著下降(P<0.01)。说明血小板四项参数对评估出血倾向及肝硬化严重程度有重要的辅助指导意义。结论血浆Fib下降程度及PT延长时间与肝硬化严重程度正相关,可作为预后指标。肝癌患者Fib下降提示预后欠佳。     

脂肪肝患者血浆纤维蛋白原与纤维蛋白单体聚合功能的测定及临床意义

目的测定脂肪肝患者血浆中纤维蛋白原的浓度与纤维蛋白单体聚合功能,以了解其凝血功能.方法以蕲蛇酶水解纤维蛋白原,用计算机测定其相关数值.结果 20名脂肪肝患者,其纤维蛋白聚合反应速率为0.393±0.07g/min;最大吸光度为0.201±0.045OD;纤维蛋白原浓度为1.943±0.44(g/L);反应延滞时间为22±3.5sec.结论脂肪肝患者除纤维蛋白原水平降低外,其功能反应也减弱,但尚无出血之虞.     

乙型肝炎肝硬化患者血清D-二聚体、纤维蛋白原及抗凝血酶-Ⅲ的测定意义

目的探讨乙型肝炎肝硬化患者血浆D-二聚体（D-D）、纤维蛋白原（FIB）及抗凝血酶-Ⅲ（AT-Ⅲ）的变化及其临床意义。方法选择78例肝硬化患者和65例正常对照人群,测定其血浆D-D、FIB和AT-Ⅲ水平。结果肝硬化患者血浆FIB和AT-Ⅲ含量显著低于（P〈0.05）,而血浆D-D水平显著高于正常人群;随着肝功能的变差,三种物质的变化更加明显。结论通过对D-D、AT-Ⅲ和FIB联合检测,有助于对肝硬化患者病情严重程度的评估。     

肝炎后肝硬化患者唾液酸水平的测定及在肝癌诊断中的意义

探讨唾液酸在各种肝病患者血清中变化的情况,研究其在肝炎肝硬化患者中诊断肝癌的价值。收集患者血清包括肝癌4 2例,肝硬化6 6例,慢性肝炎2 4例,重型肝炎12例及健康人对照血清5 3例,应用化学比色方法测定血清中的唾液酸水平,同时以竞争性放射免疫方法测定甲胎蛋白的含量。4 2例肝癌患者中,唾液酸阳性15例,阳性检出率为35 7% ,而4 3例肝硬化患者和4 5例正常人血清对照无一例显示阳性。以唾液酸和甲胎蛋白对4 1例肝癌患者进行联合检测,肝癌阳性检出率达80 . 4 9% (33/ 4 1) ,显著高于单独应用甲胎球蛋白(6 8 .2 9% )和唾液酸(36 . 5 9% ) ,二者一致性为4 3. 9% (18/ 4 1) ,相关性检验P =0 . 0 76 ,无显著相关。上述结果显示,唾液酸具有肿瘤特异性高和不受肝脏炎症干扰的特点,与甲胎蛋白具有很好的互补性,配合AFP可以明显的提高肝癌的阳性检出率,适合应用于肝炎后肝硬化人群肝癌的诊断。     

冠心病患者血小板膜结合纤维蛋白原的免疫荧光定量研究

为探讨冠心病患者血小板聚集性增强的结构基础和病理机制，我们应用流式细胞术对４１例冠心病患者血小板膜结合纤维蛋白原和膜糖蛋白Ⅱｂ／Ⅲａ进行了免疫荧光定量测定。４１例冠心病患者中，急性心肌梗塞１４例，不稳定性心绞痛１２例，稳定性心绞痛１５例。结果表明，血小板膜结合纤维蛋白原在稳定性心绞痛、不稳定性心绞痛及急性心肌梗塞之间呈递增趋势，差异均有显著性，且急性心肌梗塞和不稳定性心绞痛患者该指标均高于正常组（Ｐ＜０．０５），稳定性心绞痛患者与正常组间差异无显著性（Ｐ＞０．０５）；各观察组间血小板膜糖蛋白Ⅱｂ／Ⅲａ量差异均无显著性，且与血小板膜结合纤维蛋白原量之间无直线相关性。提示：血小板膜结合纤维蛋白原量的增加是急性心肌梗塞和不稳定性心绞痛患者血小板聚集性增高的病理基础，是血小板在急性不稳定性心肌缺血机制中的早期主要变化之一，具有加重冠状动脉病变的作用；血小板膜结合纤维蛋白原的增加并非膜糖蛋白Ⅱｂ／Ⅲａ数量变所致。     

冠心病患者血小板膜结合纤维蛋白原的免疫荧光定量研究

为探讨冠心病患者血小板聚集性增强的结构基础和病理机制，我们应用流式细胞术对４１例冠心病患者血小板膜结合纤维蛋白原（Ｆｇ）和膜糖蛋白（ＧＰ）Ⅱｂ和ＧＰⅢａ进行了免疫荧光定量测定。４１例冠心病患者中，急性心肌梗塞（ＡＭＩ）１４例，不稳定性心绞痛（ＵＡ）１２例，稳定性心绞痛（ＳＡ）１５例。结果表明，血小板膜结合Ｆｇ在ＳＡ、ＵＡ及ＡＭＩ之间呈递增趋势，差异均有显著性，且ＡＭＩ和ＵＡ患者该指标均高于正常组（Ｐ＜０．０５），ＳＡ患者与正常组间差异无显著性（Ｐ＞０．０５）；各观察组间血小板膜ＧＰⅡｂ和ＧＰⅢａ量差异均无显著性，且与血小板膜结合Ｆｇ量之间无直线相关性。提示：血小板膜结合Ｆｇ量的增加是ＡＭＩ和ＵＡ患者血小板聚集性增高的病理基础，是血小板在急性不稳定性心肌缺血机制中的早期主要变化之一，具有加重冠状动脉病变的作用；血小板膜结合Ｆｇ的增加并非膜ＧＰⅡｂ－ＧＰⅢａ数量改变所致。     

Plasma betatrophin levels in patients with liver cirrhosis

AIM: To investigate the plasma levels of betatrophin in patients with cirrhosis.METHODS: Forty patients diagnosed at the clinic with liver cirrhosis according to biological, ultrasonographic,or histological criteria were included.The severity of cirrhosis was classified according to Pugh's modification of Child's classification and MELD score. Insulin resistance(IR) was assessed by the Homeostasis Model Assessment. A total of 20 patients showed a MELD score higher than 14. The control group consisted in 15 sex-and aged-matched subjects.Fasting blood samples were obtained for subsequent analysis. Serum insulin was determined by Liaison automated immune chemiluminiscence assay(DiaSorin S.p.A.) using a sandwich assay. The sensitivity of the assay was 0.2 μU/mL. The intra and interassay variation coefficients were 4% and 10%,respectively. The normal values were between 2 and17 μU/mL. Human active betatrophin was analyzed by specific quantitative sandwich ELISA(Aviscera Bioscience). The sensitivity of the assay was 0.4 ng/mL, and the intra and interassay reproducibility were 6% and 10%, respectively.RESULTS: Plasma betatrophin levels were significantly increased in patients with cirrhosis compared with those in healthy subjects(P = 0.0001). Betatrophin levels were also associated with disease severity, being higher in Child-Pugh C patients compared to Child-Pugh B(P 0.0005) and in patients who displayed a MELD score higher than 14 points compared to patients with lower punctuation(P = 0.01). In addition, we found a positive correlation between plasma betatrophin levels and the severity of cirrhosis according to Child-Pugh classification(r = 0.53; P 0.01) or MELD score(r = 0.45; P 0.01). In the overall cohort, a moderate correlation between serum betatrophin and plasmatic bilirrubin(r= 0.39; P 0.01) has been observed, as well as an inverse correlation between betatrophin and albumin(r =-0.41; P 0.01) or prothrombin time(r =-0.44;P 0.01). Moreover, insulin resistance was observed in82.5% of the cirrhotic patients. In this group of patients,betatrophin levels were significantly higher than those in the group of patients without IR(P 0.05).CONCLUSION: Plasma betatrophin is increased in patients with cirrhosis. This increase is related to the severity of cirrhosis, as well as with the emergence of insulin resistance.     

Plasma amino acid levels in patients with colorectal cancers and liver cirrhosis with hepatocellular carcinoma

BACKGROUND/AIMS: A variety of cancer-bearing patients have been shown to have disturbances in carbohydrate, lipid and protein metabolism. The complex of metabolic derangements of protein in cancer patients may be reflected by alteration in the plasma free amino acid profile. In this study, we try to investigate the plasma free amino acid profile in patients with colorectal cancer and liver cirrhosis with hepatocellular carcinoma, which are the most common cancers in Taiwan. METHODOLOGY: Fasting venous blood samples were drawn from sixteen control volunteers and 42 cancer-bearing patients including 14 early stage colorectal cancer patients (Duke A and B), 18 late stage ones (Duke C and D) and 10 liver cirrhotic patients with hepatocellular carcinoma. Seventeen amino acid levels were measured using a Beckman amino acid analyzer. RESULTS: About one third of early or late colorectal cancer patients had body weight loss more than 10% in half a year and were defined as malnourished. For individual amino acids, in early colorectal cancer patients, the plasma level of most essential amino acids and non-essential amino acids decreased (significantly in Tyr, Ala, Met, Phe and Thr). In late stage colorectal cancer patients and patients with liver cirrhosis with hepatocellular carcinoma, plasma levels of most essential amino acids and non-essential amino acids decreased more obviously. For group amino acids, the plasma levels of essential amino acids, non-essential amino acids, gluconeogenic amino acids and branched-chain amino acids were also lower in the cancer patients than those in control volunteers. The difference was also noticeably significant in patients with late stage colorectal cancer and liver cirrhosis with hepatocellular carcinoma. The plasma free amino acid patterns in colorectal cancer patients are quite different from those in patients with non-gastrointestinal cancer and weight loss. The plasma level of essential amino acids and branched-chain amino acids was not kept within normal range in colorectal cancer patients. Elevation of plasma aromatic amino acids and methionine levels usually observed in liver cirrhotic patients without hepatocellular carcinoma was not apparent in our cirrhotic patients with hepatocellular carcinoma. CONCLUSIONS: The plasma free amino acid patterns in our colorectal cancer patients and cirrhotic patients with hepatocellular carcinoma were rather characteristic. The results will offer useful tools for improving diagnosis and therapy.     

不同Child-Pugh分级肝硬化患者血胆碱酯酶和肝纤维化标志物的变化

目的探讨肝硬化患者血胆碱酯酶(CHE)和肝纤维化标志物的变化规律。方法 94例肝硬化患者根据Child-Pugh分级分为Child-Pugh A组(n=35例)、Child-Pugh B组(n=32例)和Child-Pugh C组(n=27例),同期选择30例健康体检者作为对照组。常规检测血清CHE和透明质酸(HA)、IV型胶原(IV-C)、层粘蛋白(LN)和Ⅲ型前胶原(PCⅢ)水平。结果 94例肝硬化患者血清CHE水平(4.37±2.77 ku/L)明显低于30例健康人(8.26±2.98 ku/L,P0.05),血清HA、IV-C、LN、PCⅢ[分别为(824.04±442.21)μg/L、(155.08±45.09)μg/L、(133.17±47.87)μg/L和(230.65±92.12)μg/L]明显高于健康人[分别为(98.35±72.15)μg/L、(58.91±20.36)μg/L、(74.32±22.67)μg/L和(78.11±59.54)μg/L,P0.05];随着Child-Pugh分级的逐渐递增,血清HA、IV-C、LN、PCⅢ水平呈进行性升高(P0.05),而血清CHE水平呈进行性降低(P0.05);血清CHE水平与血清HA、IV-C、LN、PCⅢ呈负相关(r1=-0.482,r2=-0.364,r3=-0.718,r4=-0.780,P0.01)。结论肝硬化患者CHE水平降低,肝纤维化标志物升高,对评估肝硬化严重程度和判断预后具有较高的临床价值。     

MELD-Na评分对肝硬化患者血脂和预后的影响

目的 探讨肝硬化患者血脂水平与终末期肝病模型（MELD-Na）评分的相关性。方法 回顾性分析2011年1月至2012年12月我院收治的肝硬化患者120例,根据患者入院时MELD-Na评分将患者分为MELD-Na高分组(≥18分)和MELD-Na低分组（<18分）,比较两组患者血脂水平和临床预后。结果 35例高分组和85例低分组患者血清总胆固醇分别为[（3.90±1.13） mmol/L 和（5.49±1.47） mmol/L,P<0.001];甘油三脂分别为[（0.9±0.3） mmol/L 和（1.3±0.4） mmol/L,P<0.001];高密度脂蛋白分别为[（1.0±0.2） mmol/L 和（1.3±0.3） mmol/L,P<0.001];低密度脂蛋白分别为[（1.8±0.5） mmol/L 和（2.6±0.5） mmol/L,P<0.001];载脂蛋白A1分别为[（120.5±17.4） mmol/L 和（135.8±16.5） mg/dl,P<0.001];载脂蛋白B分别为[（69.1±14.7） mmol/L 和（94.7±14.7） mg/dl,P<0.001];高分组患者3年内肝性脑病、肝肾综合征、消化道出血和死亡发生率分别为37.1%、25.7%、48.6%和34.3%,显著高于低分组的1.2%、2.4%、4.7%和1.2%。结论 MELD-Na评分明显与肝硬化患者血脂水平相关。     

肝硬化患者胃生长素、瘦素水平的研究

检测肝硬化患者胃生长素(ghrelin)、瘦素的水平,探讨其与营养状态、肝硬化并发症的关系。测定45例肝硬化患者ghrelin、瘦素水平。病例组ghrelin水平显著性高于正常(P<0.05)。病例组瘦素水平显著性高于正常(P<0.01),并随Ch ild-Pugh分级而递增,其中B、C级与对照组相比,差异显著(P<0.05)。肝硬化患者ghrelin升高;瘦素参与了肝硬化时的营养不良。     

Plasma and platelet serotonin levels in patients with liver cirrhosis

AIM： To analyze the relationship between plasma and platelet serotonin levels and the degree of liver insufficiency. METHODS： The prospective study included 30 patients with liver cirrhosis and 30 healthy controls. The degree of liver failure was assessed according to the Child-Pugh classification. Platelet and platelet poor plasma serotonin levels were determined. RESULTS： The mean plasma serotonin level was higher in liver cirrhosis patients than in healthy subjects （215.0 ±26.1 vs 63.1 ± 18.1 nmol/L; P 〈 0.0001）. The mean platelet serotonin content was not significantly different in patients with liver cirrhosis compared with healthy individuals （4.8 ± 0.6; 4.2± 0.3 nmol/platelet; P 〉 0.05）. Plasma serotonin levels were significantly higher in ChildPugh grade A/B than in grade C patients （246.8 ± 35.0 vs 132.3 ± 30.7 nmol/L; P 〈 0.05）. However, platelet serotonin content was not significantly different between Child-Pugh grade C and grade A/B （4.6 ± 0.7 vs 5.2 ± 0.8 nmol/platelet; P 〉 0.05）. CONCLUSION： Plasma serotonin levels are significantly higher in patients with cirrhosis than in the controls and represent the degree of liver insufficiency. In addition, platelet poor plasma serotonin estimation is a better marker for liver insufficiency than platelet serotonin content.     

Normal serum gastrin levels in patients with liver cirrhosis.

In 28 patients with cirrhosis of the liver, histologically confirmed by liver biopsy, serum gastrin concentrations were determined radioimmunologically afer an overnight fast. Mean value and standard deviation in the patients with cirrhosis (30.1 +/- 19.3 pg/ml) was not found to be significantly different from the mean value established in 275 normal subjects (39.7 +/- 21.3 pg/ml).