肝炎后肝硬化患者血清瘦素测定的临床意义

目的　检测肝炎肝硬化患者血清瘦素水平 ,并探讨瘦素与肝硬化患者肝功能、胰岛素抵抗及其营养参数之间的关系。方法　 2 0 0 2 - 0 3～ 2 0 0 3- 0 1河北医科大学第二医院 32例男性肝炎肝硬化患者及 14名男性健康受试者均测定空腹血糖 (FPG)、空腹胰岛素 (FINS)和瘦素 ,同时测量肝硬化患者的营养参数 ,并对肝硬化患者进行Child -pugh分级。结果　肝硬化患者血清瘦素水平显著高于正常对照组 (P <0 . 0 5 ) ;但依据Child -pugh分级后的 3组肝硬化患者间的血清瘦素水平差异无显著性 (P >0 . 0 5 ) ;血清瘦素水平与体重指数 (BMI)、三头肌皮褶厚度 (TSF)及FINS均呈显著性正相关 (r值分别为 0 . 343、0 .340和 0 . 35 2 ,P值均 <0 . 0 5 ) ,而与肌酐身高指数 (CHI)及胰岛素敏感指数 (ISI)均呈负相关 (r值分别为 - 0 .36 0和 - 0 . 4 16 ,P值均 <0 . 0 5 )。结论　肝炎肝硬化患者血清瘦素水平的改变可能与肝功能无关 ,但参与了肝硬化的营养不良和胰岛素抵抗。     

肝硬化患者血清瘦素水平测定及其临床意义的探讨

为了解肝硬化患者血清，腹水中瘦素水平情况，探讨其可能的临床意义。选择肝硬化组，对照组各21例，分别测定受试者的血脂，肝功，血糖，胰岛素，血清纱及部分腹水瘦素水平，测量其身高，体重，计算体重拽数，体脂肪含量。瘦素，胰岛素分别采酶联免疫吸附试验，放射性免疫试验方法测定，胰岛素抵抗用HOMA模式估算。结果显示：肝硬化，对照组的血清瘦素水平差异不显著，且肝硬化组无性别差异。肝硬化患者的血清瘦素水平与体重指数（BMI），总蛋白，总胆固醇，空腹胰岛素相关，与胰岛素抵抗素（IR）无关。腹水中的瘦素水平与腹水的性质有关，渗出液高于漏出液。上述结果说明肝硬化患者血清瘦素水平表现异常，与疾病本身相关。     

老年男性血脂紊乱患者的血清瘦素水平观察

瘦素 (ＬＰ)是脂肪组织合成和分泌的一种激素蛋白 ,通过对下丘脑摄食中枢的负反馈作用 ,抑制食欲 ,减少能量摄入 ,兴奋交感神经活性 ,使产热、能耗增加 ,体重减轻。ＬＰ水平能反映体脂含量的多少 ,而血清ＬＰ水平与血脂之间的关系目前尚无定论 ,本文主要探讨老年人血脂正常及血脂紊乱者的血清ＬＰ水平观察情况。1　资料和方法1 1　一般资料　老年患者 73例 ,均为男性 ,年龄 60～ 10 1岁 ,病情控制平稳 ,无明显并发症。均伴有血脂紊乱 ,已经经调脂治疗。根据血脂控制情况分为血脂(控制 )正常组及血脂紊乱组 ,血脂正常组血脂标准为 :总胆固醇 …     

慢性乙肝及肝炎肝硬化患者血清转化生长因子β-1、瘦素的检测

目的检测慢性乙型肝炎及肝炎肝硬化患者血清中转化生长因子β-1(TGFβ-1)、瘦素(Leptin)的含量并分析其与透明质酸(HA)、层黏连蛋白(LN)和前胶原蛋白Ⅲ(PCⅢ)等肝纤维化指标的相关性。方法分别用放免法及酶联免疫法测定109例慢性乙肝及肝炎肝硬化患者血清TGFβ-1、Leptin和HA、LN、PCⅢ的浓度。结果慢性乙肝重度及肝炎肝硬化组患者血清TGFβ-1水平明显高于慢性乙肝轻、中度及正常对照组(P均<0.05);且与HA、LN、PCⅢ等指标存在明显的正相关;而慢性乙肝轻、中度组血清TGFβ-1水平与正常对照组无显著性差异(P>0.05)。慢性乙肝及肝炎肝硬化组患者血清Leptin水平高于正常对照组,但差异无显著性(P>0.05);且与TGFβ-1、HA、LN、PCⅢ等指标无相关关系。结论TGFβ-1参与慢性乙型肝炎、肝硬化的进程,可作为诊断肝纤维化有用的血清学指标;慢性乙肝及肝炎肝硬化组患者血清leptin水平升高,但并未参与肝硬化的进程。     

乙型肝炎肝硬化患者血清和腹水瘦素测定

瘦素是由肥胖基因（ob基因）编码的一种由167个氨基酸组成的分泌型蛋白质，于1994年由Zhang等应用定向克隆法从肥胖与糖耐量异常的ob／ob小鼠中首次克隆成功。近年发现，瘦素与肝纤维化和肝硬化的发展密切相关。但由于研究对象、病因及病情不同，结果尚存争议。本研究通过观察我国发病率最高的乙型肝炎肝硬化患者血清和腹水瘦素水平变化，探讨瘦素在评价肝硬化患者肝功能储备状况及腹水鉴别中的应用价值。     

维持性血液透析患者血清瘦素水平的测定

瘦素 (Ｌｅｐｔｉｎ)是Ｚｈａｎｇ等[1] 1 994年首先克隆成功并命名的 ,是一种肥胖基因的表达产物 ,由脂肪细胞合成并分泌 ,由 1 67个氨基酸组成的分泌型蛋白质 ,相对分子质量为 1 40 0 0～ 1 60 0 0 ,Ｌｅｐｔｉｎ通过与Ｌｅｐｔｉｎ受体结合影响着机体许多生理系统和代谢通路     

原发性高血压患者血清瘦素浓度的测定及意义

目的 :探讨血清瘦素与原发性高血压患者性别及体重指数间的关系。方法 :用放射免疫法检测了 2 0例健康正常人 (正常对照组 )和 48例原发性高血压患者 (高血压组 )血清瘦素浓度 ,同时测血压和体重指数 (BMI) ;根据体重指数将 2组研究对象又分为肥胖者和非肥胖者。检测血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白 (HDL C)、低密度脂蛋白 (LDL C)等指标。并将血清瘦素水平与血压、体重指数、性别、TG、TC、HDL C和LDL C进行相关分析。结果 :高血压组血清瘦素水平高于正常对照组 ,有显著性差异 (P <0 0 5 ) ;高血压组和正常对照组肥胖者血清瘦素浓度均高于非肥胖者 ,有显著性差异 (P <0 0 5～ 0 0 1) ;女性血清瘦素明显高于男性 ,有显著性差异 (P <0 0 1) ;血清瘦素与收缩压、舒张压、TG呈正相关 ,而与TC、HDL C、LDL C无明显相关性。结论 :血清瘦素与原发性高血压患者血压及肥胖程度呈正相关 ,女性高于男性     

脂肪肝患者血清瘦素水平测定及与胰岛素抵抗关系的探讨

目的了解脂肪肝患者血清瘦素水平变化,探讨其可能的临床意义。方法测定脂肪肝患者肝功、血脂、血糖及胰岛素、血清瘦素水平,测量其身高、体重,计算体重指数、体脂肪含量。瘦素、胰岛素分别采用ELISA、IRA方法测定,胰岛素抵抗用HOMA模式估算。结果脂肪肝组血清瘦素水平高于对照组,与BM I、?t、ALT、CHE相关,与IR无关。结论血清瘦素是脂肪肝患者发病的一个危险因素,与胰岛素抵抗无直接相关性。     

男性肥胖儿童血清瘦素水平测定及意义

瘦素是肥胖基因的蛋白产物,由脂肪细胞合成并释放入血,在食欲调节和能量动态平衡中有重要作用。2007年6月-2008年6月,我们采用ELISA法测定了34例男性肥胖儿童及同期32例正常儿童血清瘦素水平,并结合、BMI、睾丸体积、体内激素水平等相关指标,分析瘦素与肥胖及性发育的关系。     

冠心病患者血清瘦素及可溶性瘦素受体检测分析

目的:研究血清瘦素(Lp)及可溶性瘦素受体(sLR)水平与冠心病的关系。方法:应用放射免疫分析法(RIA)及酶联免疫吸附分析法(ELISA)检测34例冠心病患者及其36例对照者血清Lp、sLR、空腹血糖(FBG)、TC、TG、HDL、LDL、胰岛素(INS)、稳态模型(HOMA)评估胰岛素抵抗(IR)(HOMA-IR)、体质指数(BMI)、腰围、臀围、腰臀比(WHR)等临床指标,分析Lp、sLR与血脂、IR及冠心病的关系。结果:冠心病组Lp、INS及HOMA-IR水平明显高于对照组,sLR水平明显低于对照组(P<0.01)。Lp与BMI、腰围、臀围、INS、HOMA-IR、TC、TG呈正相关,与sLR呈负相关;sLR与Lp、BMI、腰围、臀围呈负相关(P<0.05或P<0.01)。结论:Lp及sLR异常与肥胖、血脂异常、IR密切相关,共同参与冠心病的发生发展。     

重型病毒性肝炎临床诊断标准探讨(附565例重型病毒性肝炎的临床主要特点分析)

目的分析重型肝炎的临床特点,重新探讨重型肝炎的临床诊断标准。方法使用SPASS软件和SDAS软件将我院近3年收治的565例重型肝炎患者的临床特点进行分析。结果①发生于急性肝炎的45例,发生于慢性的有明确的肝病史及无明确的肝病史分别为400例及120例。②9例急性重型肝炎,出现肝性脑病7例,均在7天内出现。36例亚急性及520例慢性重型肝炎患者,在12周内达到重型肝炎诊断标准分别为100. 0％及82. 2％。③急性重型肝炎发生的肝性脑病均为首先出现,无1例发生腹水。亚急性重型肝炎及慢性重型肝炎首先出现肝性脑病仅为11. 1％及1. 7％,仅发生腹水分别为5. 6％及3. 5％。④无明确肝病史的120例患者,最后诊断为慢性重型肝炎早、中及晚期分别为17例、31例及72例。结论①重型肝炎依发病基础分为急性重型肝炎(暴发性肝衰竭)、亚急性重型肝炎(亚暴发性肝衰竭)及慢性重型肝炎;②暴发性肝衰竭、亚暴发性肝衰竭的时限分别为14天内、15天至24周(半年);③亚急性重型肝炎分腹水型及脑病型;④亚急性重型肝炎及慢性重型肝炎仍应区分为早期、中期及晚期。     

Reduced glutathione concentration in erythrocytes of patients with acute and chronic viral hepatitis

SUMMARY. Reduced glutathione (GSH), the main intracellular mechanism that protects against oxidative stress, is the subject of considerable interest in viral hepatitis. In patients with chronic hepatitis C, results reported from different centres are controversial, demonstrating either a reduction or an elevation of GSH concentration. The aim of this study was to evaluate the glutathione concentration in erythrocytes (normal range 2.45 ± 0.15 mmol l^?1) in patients with acute and chronic viral hepatitis. In 52 patients with acute viral hepatitis (hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection) there was marked reduction of GSH at the beginning of the disease (0.79 ± 0.43 mmol l^?1. P < 0.001) with high alanine aminotransferase (ALT) activity (1549 ± 772.9 IU l^?1). In 37 patients with chronic HCV infection the mean value of GSH was below the normal range (1.92 ± 0.62 mmol l^?1. P < 0.001). In 60% of patients (n = 22), depletion of GSH was observed and 40% (n = 15) presented with a normal concentration of GSH. In 10 patients with chronic HBV infection the mean value of GSH was also below the normal range (1.93 ± 0.32 mmol l^?1, P < 0.001); in 80% of cases (n = 8) depletion of GSH was observed and 20% of patients (n = 2) had normal GSH concentrations. The ALT activity was not significantly different in patients with depleted and normal GSH concentrations (P > 0.05) in groups with chronic HBV and HCV infection.     

妊娠期病毒性肝炎临床特点分析

目的了解妊娠期病毒性肝炎的临床特点。方法回顾性分析2009年1月至2013年3月于广州市第八人民医院因病毒性肝炎住院的77例妊娠妇女的临床资料,分析肝炎病因、血清病毒学特点、肝损害程度与孕期的相关性。计量资料的组间比较采用Kruskal-Wallis H检验。结果病因:乙型肝炎多见,共72例(93.51%),有10.27%患者感染甲、乙或戊型肝炎病毒所致急性病毒性肝炎;肝损害程度:中度肝损害64例(83.12%),重度肝损害7例(9.09%),肝衰竭3例(3.90%);肝炎发作时孕期:妊娠早期16例(20.78%),妊娠中期49例(63.64%),妊娠晚期12例(15.58%);肝功能指标:总胆汁酸(TBA)、TBil、白蛋白(Alb)、ALT、AST、凝血酶原活动度(PTA)在HBeAg阳性和阴性患者间,以及在HBV DNA106IU/ml和HBV DNA≤106IU/ml患者间差异均无统计学意义(P0.05)。结论妊娠期病毒性肝炎主要由HBV引起,多数引起中度肝损害,重度肝损害或肝衰竭常发生于妊娠中晚期,因此育龄妇女妊娠期须注意防治慢性乙型肝炎。     

microRNA在乙型、丙型肝炎中的作用

近年来,作为基因表达的重要调节因子microRNA(miRNA),以及与这些miRNA关联或调控的各种肝脏疾病,如肝炎、肝纤维化和肝细胞癌(HCC)等方面的研究取得了新进展.许多编码miRNA的基因及其靶标被发现,它们与肝脏疾病的直接或间接的关联性也通过大量的实验研究(包括人体组织)得到确证.病毒性肝炎是由多种不同肝炎病毒引起的一组以肝脏损伤为主的传染病,根据病原学诊断,肝炎病毒至少有5种,但目前最常见的是HBV和HCV感染.本文就miRNA与病毒性肝炎的关系研究进展作一综述.     

重型病毒性肝炎血清甲状腺激素水平检测及临床意义

目的 探讨重型病毒性肝炎患者血清甲状腺激素水平与肝损害程度关系及临床意义.方法 应用放射免疫法测定54例重型病毒性肝炎、41例急性病毒性肝炎患者及30例正常人血清甲状腺激素水平.结果 重型病毒性肝炎T3、T4、TSH水平显著低于急性病毒性肝炎及正常人(P＜0.05);rT3则增高(P＜0.05).T3、T4与血浆Alb呈正相关,L、TSH与PT,rT3与ALT呈负相关.重型病毒性肝炎死亡者T3、T4、TSH显著低于存活者(P＜0.01).rT3则增高(P＜0.01).结论 重型病毒性肝炎患者甲状腺激素水平可作为反映肝功能的敏感指标,对判断疾病严重程度、预后有重大价值.     

病毒性肝炎中西医结合临床路径实施的效果分析

目的：评价临床路径应用于临床的实际效果。方法：对200例病毒性肝炎患者资料进行回顾性分析,对比应用临床路径（路径组）及未用临床路径（非路径组）治疗后患者临床效果、人均住院天数、人均住院费用等情况。结果：路径组患者人均住院天数、人均住院费用明显减少,临床总有效率明显提高,与非路径组比较,差异有显著性意义（P〈0.01）。结论：在中西医结合治疗的基础上应用临床路径治疗病毒性肝炎,能有效提高临床疗效,缩短住院天数,减少住院费用,可在临床中推广应用。     

Interleukin-12: potential clinical applications in the treatment of chronic viral hepatitis

Summary. Interleukin-12 (IL-12) is a heterodimeric cytokine that promotes cell-mediated immunity by facilitating type 1 helper T-lymphocyte responses, inducing the secretion of interferon-γ from both T and natural killer cells, enhancing the lytic activity of natural killer cells, and augmenting specific cytolytic T-lymphocyte responses. In addition, IL-12 can increase the production of some subclasses of IgG antibodies. IL-12 has been shown to have potent therapeutic effects in a number of animal models of tumours and infectious diseases, including several viral infections. These results have led to the initiation of clinical trials to evaluate the therapeutic potential of IL-12 in human cancer patients and in patients infected with the human immunodeficiency virus. The biological activities of IL-12 suggest that it may also have clinical utility in the treatment of patients suffering from chronic hepatitis B or Cvirus infections. Because of the lack of suitable animal models for evaluating the efficacy of IL-12 in the treatment of infections with these viruses, only a clinical trial in patients with chronic viral hepatitis can address the potential role of IL-12 as an effective treatment for these disorders.     

重型病毒性肝炎预防性抗菌治疗临床对照观察

目的　观察预防性应用抗菌药物对重型病毒性肝炎医院感染的影响。方法　选择 1996 - 10～ 2 0 0 1- 12泉州市第一医院入院前 1周未经抗菌治疗、入院时无感染征象、住院时间超过 72h的重型肝炎病例 ,根据临床分期及抗菌药物应用情况进行分组、对照研究。结果　 15 9例患者中 76例发生医院感染 ,未预防性应用抗菌药物组 (A组 )、静脉注射第三代头孢菌素组 (B组 )及半合成青霉素组 (C组 )医院感染率分别为 5 6 16 % (41/ 73)、34 0 % (17/ 5 0 )和 5 0 0 % (18/ 36 )。与A组比较 ,B组早、中、晚期重型肝炎医院感染发生时间均明显推迟 ,中期、晚期重型肝炎医院感染发生率明显降低 ,中期重型肝炎病死率明显降低 ,各组差异均有显著性意义。 (P <0 0 5 )。与A组比较 ,C组各期重型肝炎的医院感染发生时间、感染发生率、病死率差异无显著意义 (P >0 0 5 )。结论　预防性应用第三代头孢菌素可推迟重型肝炎医院感染发生时间 ,降低中、晚期重型肝炎医院感染发生率 ,降低中期重型肝炎病死率。     

Seroprevalence of viral hepatitis in Tanzanian adults

In a cross-sectional study in Dar es Salaam, Tanzania, we determined the seroprevalence of markers for hepatitis A, B, C and E viruses and examined associated risk markers. Among 403 healthy adults, the seroprevalence of antibodies to hepatitis A virus was 99.0% (95% confidence interval: 97.599.7). Prior exposure to hepatitis C and E viruses was rare (hepatitis C: 0.7% (0.22.1); hepatitis E: 0.2% (< 0.11.4)). The prevalence of all markers of hepatitis B was 70.7% (66.075.1). Hepatitis B surface antigen was identified in 6.0% (3.98.7) of subjects. Independent predictors of hepatitis B infection identified by logistic regression included older age, male gender, Muslim religion and type of abode. Given the high prevalence of hepatitis B and the low prevalence of hepatitis C, the majority of chronic viral hepatitis is likely to be associated with hepatitis B. Control efforts should focus primarily on hepatitis B.     

Aetiology,clinical course and outcome of sporadic acute viral hepatitis in pregnancy

Hepatitis E causes large-scale epidemics in endemic areas. The disease, during epidemics, has increased incidence and severity in pregnant women. Sporadic acute viral hepatitis (AVH) is common in endemic areas. The relationship of sporadic AVH and pregnancy has not been well studied. Over a 3-year period we prospectively studied 76 pregnant women and 337 non-pregnant women of childbearing age with sporadic acute viral hepatitis for aetiology, clinical course and outcome of disease. The aetiology in sporadic AVH was hepatitis A virus (HAV) in six (1.5%), hepatitis B virus (HBV) in 62 (15%), hepatitis C virus (HCV) in seven (1.7%), hepatitis D virus (HDV) co-infection in six (1.5%), hepatitis E virus (HEV) in 205 (49.6%), and hepatitis non-A-to-E (HNAE) in 127 (30.7%). Sixty-five (85.5%) pregnant women and 140 (41.5%) nonpregnant women had hepatitis E. The proportion of pregnant women was 31.7% in HEV group and 5.3% in non-HEV group [P < 0.001; OR=8.3 (95%C1 4.2-16.3)]. The prevalence of HEV in pregnant women in first trimester (76.9%), second trimester (88.9%), third trimester (83.8%) and puerperium (100%) did not differ significantly (P=0.09). Forty-seven (61.8%) of the 76 pregnant women developed fulminant hepatic failure (FHF), 69.2% in HEV group and 10% in non-HEV group (P < 0.001). Thirty-four (10.1%) nonpregnant women developed fulminant hepatic failure, 10% in HEV group and 9.7% in non-HEV group (P=0.86). FHF had occurred in four (40%) of 10 patients with HE in first trimester as against 41 (74.5%) of 55 patients in second trimester and beyond (P=0.015). Amongst the major complications of fulminant hepatic failure, cerebral oedema (53.2%) and disseminated intravascular coagulation (21.3%) occurred more often in pregnant women than in nonpregnant women (29.4% and 2.8%; P=0.03 and 0.016, respectively) while infections occurred more often in nonpregnant women (36.1%) than in pregnant women (10.6%; P=0.003). Fifty (61.7%) patients with FHF died [25 (53.2%) pregnant women and 25 (69.5%) nonpregnant women (P=0.06)]. Cerebral oedema and HEV aetiology were independent variables of survival in patients with FHF. Patients with cerebral oedema had worse prognosis and patients with HEV aetiology had best chances of survival. Hence HEV was the most common cause of sporadic AVH in this endemic area. High proportion of pregnant women and increased severity of disease in pregnancy were limited to patients with hepatitis E. Sporadic AVH caused by agents other than HEV did not show any special predilection to or increased severity in pregnancy. FHF in pregnant women caused by HEV was an explosive disease with short pre- encephalopathy period, rapid development of cerebral oedema and high occurrence of disseminated intravascular coagulation and may represent a severe manifestation of a Schwartzmann-like phenomenon.