彩色多普勒超声对椎动脉型颈椎病结构血液动力学分析

目的：应用彩色多普勒超声分析临床诊断为椎动脉型颈椎病患者的解剖学和血液动力学的改变。方法：选择临床诊断的椎动脉型颈椎病患者127例及正常对照组40例,彩色多普勒超声分别观察其二维结构及各项血流动力学指标并进行比较。结果：①病变组内径偏细（小于对照组）78例（其中单侧椎动脉内径偏细57例,双侧椎动脉偏细21例）,走形异常49例（其中走形弯曲44例,椎体外走形5例）;而对照组未见此改变。②病变组中,内径偏细病例血流速度明显低于对照组相应侧而阻力指数高于相应侧（P＜0.05）;走形异常患者与对照组血流动力学参数未见明显改变（P>0.05）,而行转颈试验后血流速度低于对照组、阻力指数高于对照组（P＜0.05）。结论：椎动脉型颈椎病是由于椎动脉内径偏细、走形异常等解剖原因引起的,最终导致椎动脉血供不足、阻力增高等血流动力学改变,彩色多普勒超声是诊断椎动脉型颈椎病的有效检查手段。     

精索静脉血流速度与内径比值在精索静脉曲张诊断中的意义

目的探讨精索静脉血流速度与内径比值（V／D）对精索静脉曲张的诊断价值。方法对63例临床确诊为精索静脉曲张的患者（VC组）及50例健康受检者（对照组）应用彩色多普勒超声检查观察左侧精索静脉的发病情况，并记录相关数据，进行统计学分析。结果VC组精索静脉内径较对照组明显增宽，V／D比值较对照组明显减小，均存在明显的统计学差异（P〈0．05）；血流速度在两组之间不存在统计学差异（P〉0．05）。结论精索静脉血流速度与内径比值作为评价精索静脉曲张患者精索静脉血流动力学参数的一项重要指标，对精索静脉曲张的诊断有重要意义。     

经阴道三维和彩色多普勒超声在多囊卵巢综合征诊断中的价值

目的：探讨经阴道三维和彩色多普勒超声在多囊卵巢综合征（PCOS）诊断中的价值。材料与方法：选择在我中心诊治的55例PCOS患者和45例有正常排卵周期的健康妇女,利用经阴道三维和彩色多普勒超声对卵巢三维容积、卵泡计数、彩色血流显像特征以及血流动力学参数等进行观察检测,并对两组参数作对比分析。结果：PCOS组的卵巢容积、卵巢间质容积、卵泡容积、卵泡计数等显著大于对照组;卵巢间质动脉的阻力指数（R I）显著低于对照组,收缩期峰值血流速度（PSV）、舒张末期血流速度（PDV）显著高于对照组。结论：利用经阴道三维和彩色多普勒超声对卵巢三维容积和卵巢间质内动脉血流动力学指标的检测分析能明显提高PCOS的诊断水平,是诊断PCOS的重要客观定量指标之一。     

经阴道三维和彩色多普勒超声在多囊卵巢综合征诊断中的价值

目的：探讨经阴道三维和彩色多普勒超声在多囊卵巢综合征（PCOS）诊断中的价值。材料与方法：选择在我中心诊治的55例PCOS患者和45例有正常排卵周期的健康妇女,利用经阴道三维和彩色多普勒超声对卵巢三维容积、卵泡计数、彩色血流显像特征以及血流动力学参数等进行观察检测,并对两组参数作对比分析。结果：PCOS组的卵巢容积、卵巢间质容积、卵泡容积、卵泡计数等显著大于对照组;卵巢间质动脉的阻力指数（砌）显著低于对照组,收缩期峰值血流速度（PSV）、舒张末期血流速度（PDV）显著高于对照组。结论：利用经阴道三维和彩色多普勒超声对卵巢三维容积和卵巢间质内动脉血流动力学指标的检测分析能明显提高PCOS的诊断水平,是诊断PCOS的重要客观定量指标之一。     

彩色多普勒超声对胡桃夹综合征的诊断价值

[目的]探讨彩色多普勒超声在诊断胡桃夹综合征（nutcrackersyndrome,NCS）中的临床应用价值。[方法]应用彩色多普勒超声多体位检测NCS患者组（49例）和健康对照组（50例）,分别测量其左肾静脉近肾端扩张处内径a和经过腹主动脉和肠系膜上动脉夹角处的内径b及肾内段静脉内径C,并测量其相对应的血流峰值速度Va和Vb,通过简化柏努利方程计算左肾静脉与下腔静脉之间的压力差（Ap）。[结果]彩色多普勒超声可清晰显示NCS的解剖情况和血流动力学的变化,表现出受压狭窄处特征性的频谱形态改变,NCS组与对照组的a／b、C均有统计学差异（P〈0．05）,而Ap有显著性差异（P〈0．01）。[结论]彩色多普勒超声可作为诊断NCS的首选方法,a／b内径比、C与△P的联合应用可明确诊断NCS。     

心脏彩色多普勒超声对慢性心力衰竭患者的诊断价值分析

目的：分析心脏彩色多普勒超声对慢性心力衰竭患者的诊断价值。方法：选取2020年1月—2023年1月苏州市第九人民医院收治的冠心病患者64例为研究对象,根据冠状动脉造影（coronary angiography,CAG）检查结果分为慢性心衰组（冠心病引起的慢性心力衰竭患者40例）、对照组（单一冠心病患者24例）,并将慢性心衰组根据心功能等级不同分为三个亚组（Ⅱ级组、Ⅲ级组、Ⅳ级组）,所有患者均进行心电图、心脏彩色多普勒超声检查,观察超声检查结果,分析心电图与心脏彩色多普勒超声检查诊断慢性心力衰竭价值。结果：慢性心衰组左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、左房内径（LA）、二尖瓣舒张早期与舒张晚期血流峰值速度比值（E/A）均显著大于对照组,左心室射血分数（LVEF）显著低于对照组（P <0.01）。慢性心衰组中Ⅱ级组、Ⅲ级组、Ⅳ级组心脏彩色多普勒超声检查结果显示,Ⅳ级组LVESD、LVEDD、LA、E/A高于Ⅲ级组、Ⅱ级组,LVEF低于Ⅲ级组、Ⅱ级组,差异有统计学意义（P<0.05）。心脏彩色多普勒超声检查诊断慢性心力衰竭特异度、灵敏度、准确率均高...     

彩色多普勒观测下腔静脉血流动力学变化评估右心功能的研究

本文应用彩色多普勒二维超声心动图对５０例正常人和３０例右心衰病人的下腔静脉血流动力学进行了观测，其主要变化特点是：（１）右心衰病人下腔静脉内径吸气时明显增宽（Ｐ＜０．０１）；（２）右心衰病人多普勒频谱显示为低小负向双峰或单峰波形，收缩期＜舒张期；（３）右心衰病人下腔静脉血流速度减慢（Ｐ＜０．０１）。据此，证实彩色多普勒观测下腔静脉血流变化对于早期诊断右心衰竭，评估右心功能，监测病情和指导治疗的重要价值。     

经颅多普勒超声在老年人椎动脉型颈椎病的诊断及治疗中的价值

目的 探讨经颅多普勒超声（TCD）对老年人椎动脉型颈椎病的诊断及疗效评定价值。方法 按临床诊断标准收集椎动脉型颈椎病患者36例,平均年龄53.6岁,对照组为年龄相近的健康人28例。采用MT－1000型彩色经颅多普勒超声仪于治疗前后对基底动脉（BA）、椎动脉（VA）、大脑后动脉（PCA）、大脑前动脉（ACA）和大脑中动脉（MCA）的血流峰速度（Vp）、血流平均速度（Vm）及血流频谱图像进行检测分析。结果 疾病组椎基底动脉（VBA）流速明显低于对照组（P＜0.05）。疾病组TCD异常率为80.6％（29例／36例）,以VBA流速降低为主要特点。治疗后椎基底动脉系统血流速度明显改善（P＜0.05）。结论 TCD可作为老年人椎动脉型颈椎病患者诊断及疗效评定的参考依据。     

彩色多普勒超声诊断自发性脾肾静脉分流的临床研究

目的 探讨彩色多普勒超声对门脉高压症自发性脾.肾静脉分流的诊断方法及其临床意义.方法 运用彩色多普勒超声测量40例肝硬化门脉高压症合并自发性脾.肾静脉分流患者的门静脉系统、腹主动脉和左、右肾静脉内径及有关血流速度,并与40例正常人进行对照.结果 自发性脾肾静脉分流组左肾静脉明显增宽,血流速度增快,与对照组比较差异均有统计学意义(P＜0.001),腹主动脉、右.肾动脉内径与对照组差异无统计学意义(P＞0.05),脾门与左肾之间有丰富的血管交通支.结论 彩色多普勒超声对自发性脾肾静脉分流有一定的诊断价值,对患者预后的判断及临床治疗有指导意义.     

肝硬化患者腹腔镜胆囊切除术前彩色多普勒超声应用价值

目的探讨彩色多普勒超声在肝硬化患者腹腔镜胆囊切除术（Laparascopic cholecystectomy，LC）术前的应用价值。方法肝硬化胆石症纽35例．依据肝功能Child-Pugh分级标准分为3个亚组，正常对照组20例。运用彩色多普勒超声检测门脉系血管，测量门静脉最大内径、门静脉平均血流速度等血流动力学参数。结果门静脉平均血流速度随肝功能分级而逐渐降低，组间和组内均存在显著性差异（P〈0．01，P〈0．05）；门静脉内径组间存在差异（P〈0．05），组内无显著性差异；除脐静脉重开外，其余门脉系血管内径增粗在Child-Pugh分级B、C二级存在较大重叠。结论彩色多普勒有助于全面评估门静脉压力和门脉侧支开放及代偿情况，为筛选LC手术病人提供重要依据。     

高原藏族酒精性肝病的临床病理和电镜观察

探讨酒精性肝病（ＡＬＤ）的超微结构特点及其与肝功能损害程度的关系。方法对２０例高原藏族ＡＬＤ患者行肝穿活检组织病理学观察。结果性脂肪肝（ＡＦＬ）、酒精性肝炎（ＡＨ）、酒精性肝硬化（ＡＬＣ）常相继发生或同时存在,主要表现为肝细胞大泡性脂变,窦周纤维化,肝细胞滑面内质网增生,小叶内灶状坏死伴中性粒细胞浸润。     

酒精性肝病患者同型半胱氨酸与叶酸水平观察

目的探讨酒精性肝病(ALD)患者血浆同型半胱氨酸(Hcy)与叶酸浓度变化及二者与ALD的关系。方法选择轻型酒精性肝病60例,酒精性脂肪肝64例,酒精性肝炎42例,酒精性肝硬化40例,健康人群55例,并测定血浆中Hcy和叶酸含量。结果各酒精性肝病组Hcy和叶酸水平均高于对照组(P<0.05);各酒精性肝病组治疗后Hcy和叶酸水平均低于治疗前(P<0.05);酒精性肝硬化组治疗后Hcy和叶酸水平高于对照组(P<0.05);对照组,轻型酒精性肝病组,酒精性脂肪肝组和酒精性肝炎组Hcy和叶酸存在相关性(r=0.513,P<0.001;r=0.513,P<0.001;r=0.513,P<0.001;r=0.513,P<0.001),但酒精性肝硬化组二者间无相关性(r=0.201,P>0.05)。结论酒精性肝病Hcy和叶酸水平变化可反映肝功能损害程度,对ALD的治疗与预后判断有一定临床意义。     

Red blood cell status in alcoholic and non-alcoholic liver disease.

Macrocytosis is most commonly associated with vitamin B(12) and folic acid deficiency, followed by alcoholism, liver disease, and other pathologic conditions. We studied the red cell and vitamin status in 423 consecutive patients with various liver diseases, including 31 with acute viral hepatitis (AVH), 105 with chronic hepatitis (CH), and 134 with alcoholic liver disease (ALD), who consisted of 84 with non-cirrhotic alcoholic liver disease (NCALD) and 50 with alcoholic liver cirrhosis (ALC), 60 with non-alcoholic liver cirrhosis (NALC), and 93 with hepatocellular carcinoma (HCC). The mean corpuscular volume (MCV) and red cell distribution width (RDW) were significantly higher in patients with ALD and NALC, and among them macrocytosis occurred more frequently in patients with ALC. Macrocytic anemia was mostly found in cirrhotic patients, in which the Child-Pugh score was closely related to the development of macrocytic anemia. In ALD, the MCV was significantly correlated with the estimated alcohol consumption and inversely correlated with the serum folic acid level, which, however, was often maintained within the normal range in patients with macrocytic ALC. After abstinence from alcohol, the MCV and RDW were reduced significantly and were associated with an increasing serum folic acid level. This suggests that macrocytic anemia was a common feature of alcoholic and non-alcoholic liver cirrhosis and that alcohol abuse and folic acid deficiency play a secondary role in macrocytosis.     

酒精性肝病发病机制

酒精性肝病（alcoholic liver disease, ALD）是因长期过量饮酒引起的肝脏疾病,其中包括轻症ALD、酒精性脂肪肝、酒精性肝炎、酒精性肝纤维化和酒精性肝硬化,我们就氧化应激、内质网应激、硝化应激及调脂因子在酒精性肝病发病机制中的作用等进行阐述。     

1-14C]Ethanol breath test in alcoholic liver disease

The activity of ethanol metabolising enzymes was assessed in 51 patients with alcoholic and non-alcoholic liver disease using tracer doses of [1-14C]ethanol and measuring 14CO2 excretion in the breath. Alcoholic patients with only fatty infiltration of the liver showed significantly increased activity compared with controls. Comparing alcoholic patients with cirrhosis and a serum albumin greater than 28 g/l, activity in those with a recent history of continued heavy drinking was significantly greater than in patients who had abstained from alcohol. In addition, both groups of alcoholic cirrhosis showed significantly more activity than patients with non-alcoholic cirrhosis. The activities of patients with acute alcoholic or viral hepatitis were normal when their prothrombin times were less than 7 sec prolonged, but were reduced when prolongation exceeded 7 sec. These results demonstrate that in chronic alcoholic liver disease, even with cirrhosis, alcohol can still increase the activity of ethanol oxidising enzymes provided hepatic function remains adequate. However, this response is lost in acute liver damage and in chronic alcoholic disease with severe hepatic dysfunction.     

Oxidative stress and antioxidant status in patients with alcoholic liver disease

BACKROUND: Alcoholic liver diseases (ALD) are very common in lower socio-economical strata due to heavy drinking habits and multiple nutritional deficiencies. Ethanol causes liver damage by many mechanisms. The generation of lipid peroxidation by free radicals has been proposed as a mechanism for ethanol induced hepatotoxicity. These free radicals are destroyed by anti-oxidants. Many anti-oxidants are present in the diet, e.g., vitamin E, vitamin C etc. However, poor nutrition or malabsorption leads to deficiency of these vitamins. This may impair the anti-oxidative defense leading to ethanol induced oxidative stress and then to liver damage. METHODS: Oxidative stress and antioxidant defense were assessed in patients with alcoholic liver disease. Serum malondialdehyde (MDA) concentrations were measured as an index of lipid peroxidation, i.e., oxidative stress; and serum vitamins E and C concentrations were measured as an index of antioxidant status. RESULTS: Serum MDA concentrations were increased with the increase in severity of the disease. Concentrations of serum vitamins E and C were decreased in patients with alcoholic liver disease as compared to controls. CONCLUSIONS: Our observations may be due to increased demands of the same or increased utilization.     

缺糖基转铁蛋白在酒精性肝病中的诊断价值

目的研究酒精性肝病（ALD）患者血清中缺糖基转铁蛋白百分含量（%CDT）,并与肿瘤坏死因子-α（TNF-α）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）、红细胞平均体积（MCV）、平均血红蛋白浓度（MCHC）、红细胞平均血红蛋白含量（MCH）进行比较,评价其对ALD的诊断价值。方法选择ALD患者43例,分为酒精性脂肪肝组、酒精性肝炎组、酒精性肝纤维化组、酒精性肝硬化组共4组。非酒精性肝病患者（NALD组）39例,对照组40例,运用免疫散射比浊法测定%CDT;ELISA法测定TNF-α;速率法测定ALT、AST、GGT;全自动血细胞分析仪测定MCV、MCHC、MCH。结果 4组的%CDT、TNF-α、GGT、MCV、MCHC、MCH明显高于对照组（P〈0.05）;4组的%CDT、TNF-α、GGT、MCV、MCHC、MCH明显高于NAFLD组,ALT、AST明显低于NAFLD组,差异有统计学意义（P〈0.05）。NAFLD组TNF-α、GGT、ALT、AST、MCV明显高于对照组,差异有统计学意义（P〈0.05）。%CDT诊断ALD的敏感度为86.0%,特异度为90.0%。TNF-α诊断ALD的敏感度为76.7%,特异度为80%。%CDT、TNF-α和GGT联合检测在ALD组诊断敏感度提高为95.3%,特异度为97.5%。结论 %CDT在诊断ALD中具有重要的作用,其价值优于TNF-α、ALT、AST、GGT、MCV、MCHC、MCH。联合检测%CDT、TNF-α和GGT,对ALD的诊断及临床治疗具有重要的意义。     

还原性谷胱甘肽治疗酒精性肝病临床观察

目的:观察还原性谷胱甘肽治疗酒精性肝病的疗效。方法:60例酒精性肝病患者随机分A组(治疗组)和B组(对照组),分别用还原性谷胱甘肽和门冬氨酸钾镁治疗,均口服维生素E及益肝灵。疗程均为15d。结果:治疗组总有效率93.3%,与对照组相比差异有显著性(P<0.005);治疗组显效所需时间平均为(8.7±5.4)d,明显少于对照组(P<0.01);治疗组ALT、AST、r-GT下降幅度均明显高于对照组(P<0.01)。结论:还原性谷胱甘肽治疗酒精性肝病疗效较好,优于门冬氨酸钾镁。     

Pathogenesis, diagnosis, and treatment of alcoholic liver disease

Alcohol-related liver disease is a major cause of morbidity and mortality in the United States. Alcoholic liver disease encompasses a clinicohistological spectrum, including fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Fatty liver is a benign and reversible condition, but progression to alcoholic hepatitis and cirrhosis is life-threatening. Alcoholic hepatitis is diagnosed predominantly on clinical history, physical examination, and laboratory testing, although liver biopsy is often necessary to secure the diagnosis. The major focus of management is abstinence from alcohol, supportive care, treatment of complications of infection and portal hypertension, and maintenance of positive nitrogen balance through nutritional support. Corticosteroid therapy is controversial but should be considered in patients with a discriminant function greater than 32 and/or presence of spontaneous hepatic encephalopathy in the absence of infection, gastrointestinal bleeding, and renal failure. The only curative therapy for advanced alcoholic cirrhosis is liver transplantation. Several recent advances in understanding the pathogenesis of alcoholic liver disease may lead to novel future treatment approaches, including inhibition of tumor necrosis factor a, antioxidant therapy, stimulation of liver regeneration, and stimulation of collagen degradation.     

Evaluation of blood oxidative stress-related parameters in alcoholic liver disease and non-alcoholic fatty liver disease

Oxidative stress is implicated in the pathogenesis of liver disease. We investigated oxidative stress-related parameters and correlated with clinical findings in 35 non-alcoholic fatty liver disease (NAFLD) patients, 38 alcoholic liver disease (ALD) patients and 38 normal subjects. NAFLD patients showed significantly higher body mass index, cholesterol, LDL-cholesterol, VLDL-cholesterol levels and transaminase activities compared to the other two groups. Haematological parameters were significantly altered in ALD patients and were reported only in male subjects. Glutathione content, catalase activity, glutathione reductase activity and glutathione peroxidase activity in NAFLD patients were reduced by 10.7 %, 18.5 %, 8.1 % and 16.8 %, respectively, and in ALD patients by 21.8 %, 29.6 %, 24.3 % and 45.3 %, respectively, compared to the normal group. However, thiobarbituric acid reactive substance content, superoxide dismutase activity and glutathione s-transferase activity were increased by 35.2 %, 31.6 % and 5.4 %, respectively, in NAFLD patients, and in ALD patients by 75.2 %, 72.7 % and 32.4 %, respectively, compared to the normal group. Oxidative stress is associated with collagen production and leads to fibrosis. Type IV collagen level in NAFLD patients (190.6 +/- 83 ng/mL) was significantly higher than in the normal group (124.5 +/- 14.5 ng/mL) and lower than in ALD patients (373.4 +/- 170 ng/mL). While type IV collagen level of >124 ng/mL was a predictor of NAFLD patients from normal subjects, elevated ALT (>40 IU/L) activity could discriminate either of the liver disease patients from normal subjects.