Non-invasive tests of non-alcoholic fatty liver disease

For the detection of steatosis, quantitative ultrasound imaging techniques have achieved great progress in past years. Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis. Some blood biomarkers correlate with non-alcoholic steatohepatitis, but the accuracy is modest. Regarding liver fibrosis, liver stiffness measurement by transient elastography (TE) has high accuracy and is widely used across the world. Magnetic resonance elasto...     

肝脏疾病患者凝血系列指标分析

目的 对肝脏疾病患者的PT、APTT、TT、FIB、D-D五项检测指标进行分析,探讨肝脏疾病患者的凝血系列指标变化.方法 对104例慢性肝炎、95例重症肝炎、102例肝硬化、97例原发性肝癌和110例正常对照组的凝血五项指标进行分析研究.结果 重症肝炎、肝硬化、原发性肝癌与正常对照组比较PT、APTT、TT、D-D四项检测结果均显著增高(P＜0.01),而纤维蛋白原显著减低(P＜0.01);慢性肝炎组与正常对照组相比PT、APTT、TT、D-D四项检测结果均明显增高(P＜ 0.05),而纤维蛋白原明显减低(P＜0.05).结论 动态观察凝血系列指标,能较全面地反映肝脏疾病各病程凝血因子的损害程度,对进一步防治出血、防止DIC、判断预后和降低病死率都具有重要的理论价值和实践意义.     

Diagnostic efficacy of tests for the detection of iron overload in chronic liver disease.

The value of tests for the detection of body iron overload was investigated in 8 aptients with clinically manifest primary hemochromatosis, 12 patients with cirrhosis and iron overload and 20 patients with liver disease and low or normal iron stores. Iron overload was defined as the presence of stainable iron in more than 50% of hepatocytes in a liver biopsy specimen. The percentages of patients with a true-positive (abnormal) or true-negative (normal) result were: serum iron concentration 65%, transferin saturation 85%, serum ferritin concentration 78%, serum ferritin:serum glutamic oxaloacetic transaminase (SGOT) index 78%, percent iron absorption 58%, percent iron absorption in relation to serum ferritin concetration 80% and percent iron absorption in relation to serum ferritin:SGOT index 93%. The calculated predictive value of a normal test result for the exclusion of iron overload in patients with liver disease, a group with an assumed prevalence of iron overload of 10%, was 98% to 99% for transferrin saturation and serum ferritin concentration used alone and 100% for these measures used together; the predictive value of an abnormal result for the diagnosis of iron overload was less than 50% for all of the above measures used alone or in combination. Hence, in patients with an increased serum ferritin concentration or transferrin saturation, or both, determination of the hepatocellular iron content of a specimen from a percutaneous liver biopsy is required for the diagnosis of iron overload.     

Turner's syndrome with coeliac disease, thin bones and abnormal liver function tests

A patient is described with 45 XO Turner''s syndrome and thin bones. It transpired that the patient had osteomalacia due to gluten sensitive enteropathy rather than the osteroporosis usually expected with Turner''s syndrome. In addition, she had unexplained liver dysfunction. Causes for thin bones other than the osteoporosis associated with ovarian agenesis should be considered in patients with Turner''s syndrome.     

Prevalence of hepatitis C antibodies in patients with clotting disorders in Victoria. Relationship with other blood borne viruses and liver disease.

OBJECTIVE: To elucidate the seroepidemiology of hepatitis C in patients with clotting disorders in comparison with other blood borne infections; to examine the effects of hepatitis C on liver function; and to assess the effectiveness of current screening and inactivation procedures used in preventing the transmission of blood borne viruses by clotting factor preparations. DESIGN: A retrospective analysis of the prevalence of antibodies to hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) by means of commercially available enzyme immunoassays (for antibodies to HCV and HIV) or radioimmunoassays (for HBV antibodies and surface antigen). An analysis was made of serum transaminase levels where such information was available and this was correlated with HCV status. PATIENTS AND SETTING: Panels of sera were collected from adults and children with clotting disorders attending two Melbourne haemophilia treatment centres in 1973 (n = 33), 1980 (n = 33), 1984-1985 (n = 111) and 1987-1990 (n = 217) and tested for antibodies to HCV, HBV and HIV. RESULTS: The prevalence of antibodies to HCV in the four panels tested was 45%, 74%, 75% and 76%, and the prevalence of markers of infection with HBV was 66%, 74%, 62% and 65% respectively. No antibodies to HIV were found in sera in Panels I and II but the prevalence in Panels III and IV was 23% and 36% respectively. In subjects in whom liver function test results were available, there was a significant association between the presence of antibodies to HCV and raised transaminase levels. Since heat inactivation of clotting factors was commenced in Australia in 1984, no new cases of transmission of HIV by clotting factors has been detected, but transmission of HCV in 19 subjects and HBV in one subject could not be excluded. CONCLUSIONS: Hepatitis C infection in haemophiliacs has been a very frequent event, and the presence of antibodies to HCV is associated with an increased incidence of raised transaminase levels. Screening and heat inactivation of clotting factors has prevented further HIV transmission, but exposure to HBV and HCV has not been eliminated.     

Evaluation of abnormal liver function tests

Interpretation of abnormalities in liver function tests is a common problem faced by clinicians. This has become more common with the introduction of automated routine laboratory testing. Not all persons with one or more abnormalities in these tests actually have liver disease. The various biochemical tests, their pathophysiology, and an approach to the interpretation of abnormal liver function tests are discussed in this review.     

从证候表现探讨干燥综合征与中医肝的关系

肝与津液的关系尤为密切.肝藏血,津血同源,血足则津沛;肝主疏泄,调畅三焦气机,有助于脾胃的升清降浊;肝气调达则是津血输布的目的保证.肝主疏泄、藏血功能失调则口干、眼干、疲乏诸症蜂起.干燥综合征的病理基础为肝失疏泄及肝血不足.从肝论治,使肝气条达,气津得宣,津必上承;养血柔肝,以期肝疏气调,气血平和;加以怡情养性,调肝解郁,疏畅气机,燥证自除.     

结核病与心脏瓣膜病的相关性研究

目的 通过病例对照分析肺结核病与心脏瓣膜病之间是否有关联,早期评估结核病对心脏瓣膜病的影响,及时治疗,从而降低心脏瓣膜病发病率。方法 回顾性分析鄂州市第三医院2015年1月—2018年2月住院治疗的患者临床资料,通过分层抽样方法从结核科抽取住院患者425例作为观察组,从心血管科抽取370例作为对照组,均接受心脏多普勒三维彩超检查,统计患者心脏瓣膜病发生情况,依据各年龄组调查分析结果,同时分析初治和复治肺结核病与心脏瓣膜疾病之间的关联,以及通过比较入院查痰涂片阳性与阴性的患者与心脏瓣膜病的关联。结果 结核科心脏瓣膜病发生率48.24%（205/425）低于心血管科患者心脏瓣膜病发生率54.05%（200/370）,差异无统计学意义（P≥0.05）。结核科11~60岁心脏瓣膜病累积发生频率Σf 46.35%较心血管科Σf 22.50%高。从结核科取中青年组（18~55岁）166例患者进行随机分组比较,显示有心脏瓣膜病者68例,无心脏瓣膜病者98例,复治肺结核患者心脏瓣膜病发生率为55.88%（38/68）,与初治肺结核病的30.61%（30/98）比较差异有统计学意义（P<0.01）,提示结核病是心脏瓣膜病发生的危险因素之一（OR=2.87, 95%CI 1.52~5.41）;肺结核患者中痰涂片阳性者心脏瓣膜病发病率为45.10%(23/51),与痰涂片阴性的39.13%(45/115)比较差异有统计学意义（P<0.01）,提示结核菌活动对于心脏瓣膜病形成存在一定的关联（OR=1.28,95%CI 1.10~1.49）。结论 心脏瓣膜病老年多发,而结核病是心脏瓣膜病发生的危险因素之一。     

慢性阻塞性肺病与骨质疏松症的相关性研究

目的：通过测定慢性阻塞性肺病（COPD）患者密度,肺功能和骨代谢的变化,探讨COPD与骨质疏松症的相关性。方法：用双能X线吸收测定仪（DEXA）测定88例男性COPD患者腰椎,股骨近端骨密度（BMD）,同时用肺功能仪测定肺功能,用酶联免疫法（ELISA）测定血骨钙素（BGP）,I型前胶原C端肽（PICP）,抗酒石酸盐酸性磷酸酶（TRAP）,尿胶原吡啶并酚（PyD),脱氧胶原吡啶并酚（D－PyD),并与对照组比较。结果：COPD组的BMD值与对照组相比显著降低（P＜0．01）,TRAP,PyD,D-PyD显著升高（P＜0．01）,COPD患者骨密度与用力肺活量（FVC％）,一秒钟用力呼气量（FEV1％）及一秒率（FEV1／FVC％）均呈显著正相关（P＜0．05）,吸入激素患者与未吸入激素患者相比,BMD值无显著变化,但BGP降低（P＜0．05）,TRAP升高（P＜0．05）,结论：COPD组骨密度低于对照组,COPD患者对骨代谢的影响表现为骨吸收增高,导致骨重量丢失,引起骨质疏松。COPD患者吸入激素治疗组较不吸入激素组骨吸收指标升高,骨生成指标下降。     

急性脑血管病与代谢紊乱的关系

目的　探讨急性脑血管病与代谢紊乱的关系。方法　对 2 72名上海地区正常人及 92 3例急性脑血管病 (5 0 3例脑梗死、4 2 0例脑出血 )患者住院的基线资料进行分析。结果　① 5 0 3例脑梗死、4 2 0例脑出血患者的年龄、体重指数 (BMI)、血压、血糖、低密度脂蛋白 (LDL)值均高于对照组 (P <0 .0 5 )。②脑梗死、脑出血患者中 ,伴高血压者分别为 95 .0 %、97.1% ;伴高血糖者分别为 4 4 .0 %、39.7% ;伴高三酰甘油 (TG) /低高密度脂蛋白 (HDL)分别为 34.8%、38.1% ;③脑梗死、脑出血患者中 ,合并代谢综合征者分别占 14 .7%、16 .7% ;合并 2种代谢紊乱者分别占 4 6 .9%、4 3.1% ;合并 1种代谢紊乱者分别占 36 .0 %、38.8% ;无代谢紊乱者仅分别占2 .4 %、1.4 %。④脑梗死、脑出血患者中 ,除代谢紊乱者血压均显著高于对照组及无代谢紊乱者外 ,合并 2种以上代谢紊乱患者中BMI、血糖、TG均高于对照组及无代谢紊乱者 (P <0 .0 5 )。结论　急性脑血管病患者多伴有多种代谢紊乱 ,因而 ,有效控制代谢紊乱与预防脑血管病的发生、发展及其预后有关