乙型肝炎肝硬化和肝癌患者血清铁蛋白检测的意义

目的 研究肝细胞癌（HCC）患者血清铁蛋白（SF）含量的变化,探讨SF对HCC病情判断的意义。方法 选取慢性乙型肝炎患者42 例、乙型肝炎肝硬化患者40例和HCC患者50例及健康体检者45例,常规检测血清 SF 水平。结果 HCC、慢性乙型肝炎和乙型肝炎肝硬化患者血清SF水平分别（503.3±581.5） μg/L、（672.6±675.3） μg/L和（327.1±230.6） μg/L,均显著高于健康人【（193±160）μg/L,P<0.05】;慢性乙型肝炎患者血清SF与血清ALT、AST和AFP无相关（r=0.36,P=0.20;r=0.30,P=0.30;r=0.32,P=0.20）,乙型肝炎肝硬化患者SF与AST和AFP无相关（r=0.34,P=0.20;r=0.28,P=0.40）,HCC患者血清SF水平与 ALT和AFP也无相关（r=0.14,P=0.40;r=0.24,P=0.10）;不同特征（淋巴结转移、远处脏器转移等与否）肝癌患者血清SF水平无显著性差异（P>0.05）。结论 慢性乙型肝炎、乙型肝炎肝硬化和肝癌患者血清SF水平升高,但其升高的意义还很难被临床所应用。     

乙型肝炎、肝硬化与肝癌

原发性肝癌是世界范围内最常见、且恶性程度最高的肿瘤之一,是全球第6位、中国第3位最常见的癌症。据IARC估计,2000年中国肝癌发病人数30．6万,死亡30．0万例,分别占全世界的54．26％和54．64％。肝癌的发展大部分经历肝炎一肝硬化一肝癌的3步曲,在导致肝炎的众多病因中,乙肝病毒（HBV）感染、丙肝病毒（HCV）感染和酒精分别位列前三位,同时近年来脂肪肝引发的肝炎也存逐年递增,相当一部分隐匿性肝硬化由脂肪性肝炎发展而来。     

肝硬化和原发性肝癌患者血清IgE检测临床意义

本文报道18例肝硬化和17例原发性肝癌的血清IgE活力检测,肝硬化和原发性肝癌血清IgE活力平均值均显著高于正常值。HBV标志物阳性的肝硬化血清IgE活力明显高于阴性者,HBeAg阳性者更高,原发性肝癌血清IgE活力与HBV标志物无明显相关,两者均明显升高。     

不同时期类风湿关节炎患者血清炎性因子的变化及临床意义

目的探讨不同时期类风湿关节炎(RA)患者血清炎症因子的变化及临床意义。方法 90例RA患者根据RA患者病情评价(DAS28)分为活动组(46例)和缓解组(44例),同时抽取体检正常患者50例为对照组,所有受试者抽取空腹外周静脉血5 ml分离血清,采用双抗体夹心酶联免疫吸附法(ELISA)检测肿瘤坏死因子(TNF)-α、血管内皮生长因子(VEGF)、白细胞介素(IL)-1β、IL-6、IL-8、IL-10表达,同时观察常规检测指标,分析血清炎症因子表达变化及临床意义。结果 3组血清TNF-α、VEGF、IL-1β、IL-6、IL-8、IL-10水平组间比较差异有统计学意义(P<0.05),其中活动组均高于对照组(P<0.05),缓解组TNF-α、IL-6、IL-8、IL-10水平高于对照组(P<0.05)。TNF-α、VEGF、IL-1β、IL-6、IL-8、IL-10血清炎症因子分别与晨僵时间、关节肿胀指数、压痛指数、C反应蛋白(CRP)、红细胞沉降率(ESR)、DAS28存在正相关关系(P<0.05)。结论 RA病情可能与血清炎症因子介导的免疫反应密切相关,监测血清炎症因子在评估RA病情严重程度和预后及治疗效果评价中具有重要临床价值。     

乙型肝炎后肝硬化患者经恩替卡韦治疗后血清炎性因子的变化

目的观察乙型肝炎后肝硬化经恩替卡韦(ETV)治疗前、后患者血清中炎性因子的变化。方法乙型肝炎后肝硬化患者100例随机分为单纯护肝组和ETV组各50例;两组均连续治疗12个月;采用酶联免疫法和实时荧光定量法检测血清中白细胞介素(IL)-6、IL-8和肿瘤坏死因子(TNF)-α的变化。结果治疗后,两组血清中IL-6、IL-8和TNF-α均较治疗前降低,且ETV组降低程度明显优于单纯护肝组(P0.01)。结论ETV能通过下调乙型肝类后肝硬化患者血清中IL-6、IL-8和TNF-α的蛋白及mRNA的表达,抵抗乙型肝炎病毒,对防止肝细胞坏死具有重要意义。     

巨噬细胞移动抑制因子在不同分级的乙型肝炎肝硬化患者外周血中的检测及临床意义

目的 检测巨噬细胞移动抑制因子(M IF)在Child-Pugh分级的乙型肝炎肝硬化患者外周血中的含量,并探讨其临床意义.方法 选择102例乙型肝炎肝硬化患者作为实验组,并按Child-Pugh分级分成A、B、C三级,选择24例健康体检者作为对照组,采用酶联免疫吸附(ELISA)法测定两组血清中MIF的含量.结果 实验组MIF含量明显高于对照组,且随着Child-Pugh分级的递增,MIF的含量逐渐增加,差异有统计学意义(P＜0.05).结论 乙型肝炎肝硬化患者血清中MIF的含量与Child-Pugh分级的程度密切相关,MIF能够反映患者肝细胞功能及预后,具有重要的临床意义.     

高血压病与乙肝肝硬化及肝癌的关系探讨

目的研究高血压病与乙肝肝硬化及肝癌的关系。方法观察2 000例乙肝肝硬化患者在是否合并高血压病的基础上,肝癌及糖尿病的发病率。结果乙肝肝硬化组高血压、糖尿病发病率显著低于普通人群组(P<0.001);乙肝肝硬化合并高血压组的肝癌患病率高于乙肝肝硬化未合并高血压组(P<0.001);乙肝肝硬化组高血压、糖尿病发病率显著低于普通人群组(P<0.001)。结论乙肝肝硬化是否合并高血压病对于患者患肝癌及糖尿病有影响,乙肝肝硬化合并高血压病以后,患肝癌的几率会增加。     

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.     

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。     

3008例乙型肝炎肝硬化患者的并发症及死因分析

目的研究首都医科大学附属北京地坛医院乙型肝炎肝硬化住院患者的并发症、合并症及死亡的相关危险因素。方法分别回顾性分析本院2008年1月至2010年12月2568例和2011年1月至2014年9月3008例乙型肝炎肝硬化住院患者的相关资料。结果发现乙型肝炎肝硬化并发症发病率最高为原发性肝癌,不同时期比较发现发病率呈上升趋势(P=0.000),其余并发症如腹水、上消化道出血、自发性细菌性腹膜炎、肝性脑病、肝肾综合征发病率呈下降趋势(P=0.000)。2型糖尿病、高血压等合并症发病率前后比较无统计学差异(P=0.399,P=0.089)。除自发性细菌性腹膜炎外,肺部感染是肝硬化住院患者最易发的感染。对不同时期死亡的相关危险因素进行多元回归分析,肝癌、自发性细菌性腹膜炎、肝性脑病、肝肾综合征和上消化道出血均与病死显著相关(P=0.000)。结论原发性肝癌仍然是乙型肝炎肝硬化最常见并发症,也是乙型肝炎肝硬化最主要的病死原因,病死患者均伴发多种并发症。     

Prediction of chronic hepatitis B, liver cirrhosis and hepatocellular carcinoma by SELDI-based serum decision tree classification

PURPOSE: To screen potential serological biomarkers and develop decision tree classifications of chronic hepatitis B, liver cirrhosis (LC) and hepatocellular carcinoma (HCC), respectively, with high prediction score for improving diagnosis of liver diseases. METHODS: The total serum samples were randomly divided into three training sets (41 HBV and 35 health; 36 LC and 35 health; 39 HCC and 35 health) and three testing groups (34 HBV and 38 health; 18 LC and 52 health; 42 HCC and 47 health). Selected WCX2 protein chip capture followed by SELDI-TOF-MS analysis was applied to generate the serum protein profiles. Subsequently serum protein spectra were normalized and aligned by Ciphergen SELDI Software 3.1.1 with Biomarker Wizard including baseline subtraction, mass accuracy calibration, automatic peak detection. Once the intensities of selected significant peaks from the training data set were transferred to further BPS analysis, an optimized classification tree with sequence-decision was established to divide training data set into disease group and control group successfully. A double blind test was employed to determine the clinical sensitivity and clinical specificity of three models. RESULTS: After comparative analysis of SELDI based serum protein profile between the cases of disease and healthy, a HCC decision tree classification with sensitivity of 94.872% and specificity of 94.286%; a LC decision tree classification with sensitivity of 91.667% and specificity of 94.286% and a HBV decision tree classification with sensitivity of 95.122% and specificity of 94.286% were produced by BPS respectively. When three decision tree models were challenged by the double-blind test samples, clinical sensitivity and clinical specificity of these models were predicted in diagnosis of three liver diseases (HCC: 90.48 and 89.36%; cirrhosis: 100 and 86.5%; HBV: 85.29 and 84.21%). CONCLUSION: SELDI-based decision tree classifications showed great advantages over conventional serological biomarkers in the diagnosis of chronic hepatitis B, LC as well as HCC.     

乙型肝炎肝硬化并发轻微肝性脑病的调查分析

目的调查乙型肝炎肝硬化患者轻微肝性脑病(MHE)的发生情况。方法分别选择2012年6月-2012年12月在首都医科大学附属北京地坛医院门诊就诊的乙型肝炎肝硬化患者(肝硬化组)与健康对照组各105例,采用数字连接试验、Stroop色词测验、画钟测验3项神经心理学测验进行认知功能测评。计量资料2组间比较采用t检验或Wilcoxon秩和检验,计数资料2组间比较采用χ2检验。结果肝硬化组完成NCT-A、NCT-B和CWT-A、CWT-B、CWT-C的耗时明显长于健康对照组(t值分别为-2.158、-2.372、-2.063、-2.611、-4.325,P值均<0.05),而CDT-1得分要明显低于健康对照组(t=2.884,P<0.05)。乙型肝炎肝硬化患者中共筛出MHE 46例(43.81%),其中,信息加工速度异常者最高为24例(22.86%),其次为反应抑制能力异常者17例(16.19%),视觉空间能力异常者15例(14.29%),定势转移能力异常者10例(9.52%)。结论肝功能稳定的乙型肝炎肝硬化患者MHE的检出率较高,联合使用神经心理学测试可以提高MHE的检出率。     

Adjuvant hepatic chemotherapy after resection of solitary hepatocellular carcinoma associated with hepatitis B virus cirrhosis

BACKGROUND: Although resection is the major treatment for patients with hepatocellular carcinoma ( HCC), the high intrahepatic recurrence remains a cardinal cause of death. This study was undertaken to evaluate the effect of hepatic arterial infusion chemotherapy on the survival and recurrence of HCC patients with hepatitis B virus ( HBV) cirrhosis after resection. METHODS: Twenty-eight patients who had undergone placement of a hepatic arterial pump at the time of liver wedge resection for HCC from 1998 through 2004 were reviewed retrospectively. These patients aged 23-71 years had HBV cirrhosis (Child-Pugh class A or B). They were given floxuridine(FUDR) (250 mg), doxorubicin (10 mg) and mitomycin C (4 mg) alternatively every 2 or 3 days through arterial pumps for 8 cycles each year in the first two years after resection. Meanwhile, traditional Chinese herbal medicine was prescribed to the patients. When the leucocyte count was as low as 3 x 109/L or asparate aminotransferase (AST) level was significantly increased, the regimen of chemotherapy was delayed for the normalization of leucocyte count and AST level (below 80 U/L). RESULTS: Of the 28 patients, 23 received 8 or 16 cycles of the set regimen of chemotherapy. These patients are alive with no evidence of recurrence. Among them, 5,7, and 11 patients are alive beyond 5 years, 3 years, and 1 year respectively. In the remaining 5 patients, 3 who had had a HCC 10 cm or more in diameter showed tumor recurrence within 1 year, in whom, 8 cycles of chemotherapy were not completed because of their low leucocyte count (<3 × 109/L) and poor liver function. One patient who had received 8 cycles of chemotherapy demonstrated recurrence at 16 months after resection. One patient who had received 16 cycles of chemotherapy had intrahepatic recurrence at 58 months after surgery. No recurrence was observed in 17 patients who had received 16 cycles of chemotherapy. CONCLUSION: Adjuvant hepatic arterial chemotherapy may be feasible to improve the survival of patients after resection of solitary HCC associated with HBV cirrhosis.     

The prognostic significance of bridging hepatic necrosis in chronic type B hepatitis: a histopathologic study

ABSTRACT— A histopathologic follow-up study was conducted in 207 consecutive patients to examine the prognostic significance of bridging hepatic necrosis (BHN) in chronic type B hepatitis. One hundred and eight patients showed BHN and the other 99 intralobular spotty necrosis (SN) on initial biopsy. A higher proportion of patients with BHN healed (45.4% vs 26.4%) or developed cirrhosis (18.3% vs 3%) than the patients with SN. In contrast, intralobular inflammation persisted or recurred more frequently in the SN than in the BHN group (40.4% vs 5.6%). These figures were statistically significant (P<0.001). Alternatively, 87% of the patients who developed cirrhosis had had BHN as their initial histologic presentations. The estimated relative risk of cirrhotic progression for the BHN group compared to the SN group was 4:1. We conclude that BHN is a paradoxical prognostic factor, either for healing, or cirrhotic progression.     

Aflatoxin levels in chronic hepatitis B patients with cirrhosis or hepatocellular carcinoma in Balıkesir,Turkey

Aflatoxins, the secondary metabolites produced by species of naturally occurring Aspergilli, are commonly found in food such as cereals, dried fruits and juice, wine, beer and spices. They are hepatotoxic and are well known human carcinogens based on evidence from human studies. Aflatoxins are an environmental risk factor for the development of hepatocellular carcinoma (HCC). Chronic hepatitis B‐infected patients are at increased risk of cirrhosis, hepatic failure and liver cancer. This study was designed to determine the serum aflatoxin B₁ (AFB₁), aflatoxin B₂ (AFB₂), aflatoxin G₁ (AFG₁) and aflatoxin G₂ (AFG₂) concentrations using high‐pressure liquid chromatography (HPLC) in hepatitis B‐infected patients with or without cirrhosis and liver cancer, alongside healthy controls in Bal?kesir, Turkey. The mean AFB₁ and total AF levels in patients without liver cancer and cirrhosis were significantly higher than healthy controls. The mean AFB₁ and total AF levels in patients with chronic hepatitis B and HCC were significantly higher than infected patients with or without cirrhosis. These results suggest that patients with chronic hepatitis B who are exposed to AFs are at increased risk for developing HCC, which might be prevented by reducing consumption of contaminated foods.     

慢性乙型肝炎血清胰岛素样生长因子-1水平及其与血清肝纤维化指标关系的研究

探讨各型慢性乙型肝炎（CHB）患者血清胰岛素样生长因子-1（IGF-1）的变化及其与血清肝纤维化指标的关系。用放射免疫分析法检测CHB和乙肝后肝硬化患者血清IGF-1和肝纤维化指标（包括HA、LN、PⅢP和CⅣ）。CHB和乙肝后肝硬化患者血清肝纤维化指标明显高于正常对照组,CHB患者血清IGF-1水平明显高于正常对照组,乙肝后肝硬化患者血清IGF-1水平则明显降低。CHB患者血清IGF-1水平与肝纤维化血清指标呈正相关,乙肝后肝硬化患者血清IGF-1水平与肝纤维化血清指标无相关关系。CHB患者血清IGF-1水平异常与肝脏的损害相关,而且可能与CHB患者肝脏纤维组织增生相关联。     

乙肝肝硬化患者并发肝癌的危险因素研究

探讨乙型肝炎肝硬化患者短期内原发性肝癌的发生情况及其发生的危险因素。对180例乙型肝炎肝硬化患者作了4年随访,应用Kaplan—Meier法计算其原发性肝癌的发生情况,Cox风险模型分析发生原发性肝癌的独立的危险因素。共有30例并发原发性肝癌,第一年肝癌的发病率为2．2％,第二年为5．5％,第三年为5．7％,第四年为6．8％。平均每年发病率为4．8％。并发原发性肝癌的危险因素有以下几个：年龄大于50岁、有长期饮酒史（饮酒量大于75g／天）、有出血史、甲胎蛋白大于50μg／L、凝血酶原活动度小于70％、血小板计数小于60×10^9／、凝血酶原活动度小于70％为独立的危险因素。根据独立的危险因素可建立并发原发性肝癌的预测公式,其预测值为0—4．84。预测值大于2．57的患者为发生原发性肝癌的高风险人群,其4年中肝癌的累积发生率为61％。预测值小于2．57的患者为低风险人群,其4年中肝癌的累积发生率为8．1％。     

乙型肝炎肝硬化患者HBV血清学模式与病毒载量关系的研究

目的通过分析乙型肝炎肝硬化患者HBV血清学模式、HBVDNA、肝功能,探讨乙型肝炎肝硬化患者抗病毒治疗的临床意义。方法回顾性分析168例乙型肝炎肝硬化患者的病史、血清病毒学指标、肝功能,按不同的指标进行分组、比较。结果168例乙型肝炎肝硬化患者中以HBVDNA阳性者占绝大多数（91．0％）,其中HBeAg阴性者占81．0％;分组比较提示HBVDNA阳性组ALT、AST显著高于阴性组,ALT异常组HBVDNA载量明显高于ALT正常组（P〈0．01）;不同Child—Push分级之间HBVDNA载量无显著性差异。结论乙型肝炎肝硬化住院患者以HBVDNA阳性及HBeAg阴性者居多,HBVDNA呈较高水平复制者,肝脏炎症损害亦较重,故应及早予以抗病毒治疗。     

乙肝肝硬化患者联合检测血清视黄醇结合蛋白、前白蛋白和白蛋白的临床价值

目的联合检测视黄醇结合蛋白（RBP）、前白蛋白（PA）和白蛋白（ALB）在乙肝肝硬化患者中的血清水平变化,探讨三者的相关性及临床价值。方法应用免疫透射比浊法检测89例乙肝肝硬化患者和35例健康成年人的血清RBP与PA水平,溴甲酚绿法检测血清ALB水平。结果乙肝肝硬化患者的血清RBP、PA和ALB水平均显著低于正常对照组（P〈0.01）。血清RBP与PA水平呈正相关（r=0.743,P〈0.01）,血清RBP、PA亦分别与ALB水平呈正相关（r1=0.602,r2=0.529,P均〈0.01）。结论血清RBP、PA和ALB水平与肝功能损害程度相关,可以作为反映肝功能损害程度的指标,而RBP与PA比ALB能更灵敏地反映肝功能损害程度的变化。三者联合检测能更好地判断乙肝肝硬化患者的肝功能状况。