病毒性肝炎血清SIgA RIA的临床观察

本文用放射免疫分析法测定１２９例各型病毒性肝炎患者血清分泌型免疫球蛋白Ａ（ＳＩｇＡ）含量，结果显示，各型肝炎患者其ＳＩｇＡ含量均增高，增幅随病变严重程度而增加，顺序海依次为慢活肝，肝炎后肝硬化，急性肝炎，慢迁肝，ＨＢＶ携带者。慢活肝组ＳＩｇＡ水平显著高于慢迁肝组。     

病毒性肝炎及肝硬化患者血清锌、铜、铁测定及其意义

我们对204例病毒性肝炎及肝硬化患者(93例急肝、21例慢迁肝、51例慢活肝、6例重症肝炎、33例肝硬化)和384例正常人进行血清锌、铜、铁测定。两组的年龄、性别无明显差异。1.测定方法与结果:采用WFX-IB型原子吸收分光光度计校正曲线法。用1%硝酸稀释血清后,用同1%硝酸配制的标准液直接测定,结果见附表。从附表可见,各型病毒性肝炎及肝硬化患者的血清锌浓度均较对照组降低,以重肝组最低(P<0.01),其次为肝硬化(P<0.05)、急肝、慢     

肝硬化及各型肝炎的血浆氨基酸失衡及评价两种支链氨基酸制剂对其调正作用

本文报道了100例正常成年人及226例住院肝硬化及各型肝炎病人的血浆氨基酸分析。经统计对比,急性肝炎(64例),慢迁肝(16例)其血浆氨基酸图形变化尚不严重。慢活肝(26例)、亚重(9例)、慢重肝炎(18例)、肝硬化(99例)其血浆氨基酸图形变化剧烈。肝硬化及各型肝炎血浆氨基酸图形变化特征:     

传染病和寄生虫病

中国医学文摘·内科学1997年第18卷第5期·379·973414血清透明质酸、甘胆酸及铁蛋白在各型病毒性肝炎中的临床意义/张美丽…//上海医学一1997,20(5)一278~279 测定144例各型肝炎患者和12例非肝炎患者。结果:透明质酸(HA)值以肝硬化病人最高。依次为慢重肝、急黄肝、慢肝;甘胆酸(CG)以慢肝;铁蛋白以慢重肝为最高,依次为慢肝、急黄肝和肝硬化。认为铁蛋白为肝炎病人中测定肝细胞损害程度的较敏感的指标。表2参4(俞瑞纲)973415急性病毒性肝炎患者血清白细胞介素6动态变化及其意义/王忠民…//临床肝胆病杂志一1 997,13(2)一100一102 采用MTT…     

血清前白蛋白在肝病中的临床意义

了解病毒性肝炎患者血清前白蛋白 (PA)的变化 ,探讨测定血清前白蛋白对病毒性肝炎患者的诊断价值。采用免疫比浊法检测 2 76例病毒性肝炎患者血清前白蛋白 ,比较不同临床类型的血清PA的水平及同一临床类型间PA与A的异常率。血清PA的水平在急性肝炎与轻度慢性肝炎之间、慢性肝炎轻度与中度、中度与重度之间、肝硬化与慢性重型肝炎之间均有显著性差异 (P <0 0 5 ) ;急性肝炎组PA与白蛋白 (A)两者相比有高度显著性差异 (P <0 0 0 1) ;PA值比A值更灵敏地反映肝功能损害。血清PA的水平持续 <10 0mg/L作为重症肝炎早期诊断指标之一。检测血清PA对病毒性肝炎临床诊断、病情判断和预后估计有一定参考价值     

病毒性肝炎患者血清透明质酸水平的变化及临床意义的研究

本研究应用检测透明质酸(HA)的放射分析法,观察了各种类型病毒性肝炎患者的血清 HA 水平变化;分析了 HA 与其它肝功能指标的相关性;并对部分患者 HA 水平变化作了连续动态观察;在此基础上提出了HA 在鉴别诊断慢性肝炎和肝硬化及判断预后中的动态诊断标准。研究结果表明,急性肝炎、慢迁肝、慢活肝、重型慢活肝和肝硬化的 HA 水平均明显     

心肝宝治疗慢性乙型病毒性肝炎及肝炎后肝硬化的近期疗效观察

心肝宝治疗慢性乙型病毒性肝炎及肝炎后肝硬化的近期疗效观察太原市传染病医院（０３００１２）杨倚竹，王联生，邓惠英太原市红十字医院马言顺中国幅射防护研究院吴浩阳慢性乙型病毒性肝炎（包括慢迁肝和慢活肝）和肝炎后肝硬化（肝硬化）治疗比较困难，有的治疗报导缺少...     

病毒性肝炎患者血清视黄醇结合蛋白检测的临床意义

为了解血清视黄醇结合蛋白(RBP)在各型病毒性肝炎中的变化,探讨测定血清RBP对病毒性肝炎患者的诊断价值。分别检测161例不同类型的肝炎患者及正常对照组的血清RBP、前白蛋白(PA)、白蛋白(ALB)水平,并进行统计分析。发现除慢性肝炎轻度组外,各组肝病患者血清RBP、PA均显著低于对照组(P<0.05);且异常率均高于同组PA、ALB的异常率(P<0.05)。重型肝炎组死亡者RPB、PA均显著低于存活者,死亡者与存活者之间的RBP有极显著性差异(P<0.01)。提示血清RBP可作为判断急性肝损害的灵敏指标。能更准确地反映肝脏贮备功能,对估计重型肝炎、肝炎后肝硬化的预后有重要的参考价值。     

慢性肝病患者血清肿瘤坏死因子-α研究

病毒性肝炎肝细胞损伤的病理机制十分复杂，近年来细胞因子在肝炎肝细胞损伤及纤维化过程中的作用已受到广泛重视。我们通过对慢性肝病，肝硬化，重型肝炎患者血清TNF—a的含量检测以探讨其在发病中的作用。一、材料与方祛1．病例选择：慢性活动性肝炎患者（慢活肝）39例，慢性迁延性肝炎（慢迁肝）16例，重型肝炎10例，乙肝后肝硬化64例，原发性肝癌26例，酒精性肝硬化4例，其它肿瘤14例，均为重庆医科大学附属第二医院住院患者，其中慢性肝病，肝硬化，原发性肝癌大部分病例经病理活检证实，其它经临床和实验室检查确诊。另失代偿性肝硬…     

病毒性肝炎患者血浆可溶型α—颗粒膜蛋白含量变化及其临床意义

为了研究各型病毒性肝炎患者血浆可溶型ＧＭＰ－１４０的含量变化，采用ＥＬＩＳＡ法检测了１１９例病毒性肝炎患者血浆ＧＭＰ－１４０含量。结果，各型肝炎患者血浆ＧＭＰ－１４０含量均较正常对照组增高，其中急性肝炎、慢性肝炎（慢肝）重度、慢性重型肝炎（慢重肝）与正常对照组比较有显著性差异；慢重肝、慢肝重度又较稳性肝炎和慢肝轻、中度显著升高；预后不同的慢重肝也存在显著性差异，好转组高于恶化组。动态观察表明，急性     

Plasma amino-acid patterns in liver disease.

Plasma amino-acid concentrations were measured in 167 patients with liver disease of varying aetiology and severity, all free of encephalopathy, and the results compared with those in 57 control subjects matched for age and sex. In the four groups of patients with chronic liver disease (26 patients with chronic active hepatitis, 23 with primary biliary cirrhosis, 11 with cryptogenic cirrhosis, and 48 with alcoholic hepatitis +/- cirrhosis) plasma concentrations of methionine were significantly increased, while concentrations of the three branched chain amino-acids were significantly reduced. In the first three groups of patients plasma concentrations of aspartate, serine, and one or both of the aromatic amino-acids tyrosine and phenylalanine were also significantly increased, while in the patients with alcoholic hepatitis +/- cirrhosis plasma concentrations of glycine, alanine, and phenylalanine were significantly reduced. In the three groups of patients with minimal, potentially reversible liver disease (31 patients with alcoholic fatty liver, 10 with viral hepatitis, and 18 with biliary disease) plasma concentrations of proline and the three branched chain amino-acids were significantly reduced. Patients with alcoholic fatty liver also showed significantly reduced plasma phenylalanine values. Most changes in plasma amino-acid concentrations in patients with chronic liver disease may be explained on the basis of impaired hepatic function, portal-systemic shunting of blood, and hyperinsulinaemia and hyperglucagonaemia. The changes in patients with minimal liver disease are less easily explained.     

Clinical significance of serum hyaluronan in patients with chronic viral liver disease

In order to elucidate the clinical significance of serum hyaluronan in chronic viral hepatitis, serum hyaluronan concentrations were measured using a sandwich enzyme binding assay in 115 patients with chronic viral hepatitis. These findings were examined in relation to the results of laboratory liver tests, levels of serum markers for fibrosis and liver histological findings. Serum hyaluronan levels increased with the progress of liver disease, particularly in liver cirrhosis. There were no significant differences in serum hyaluronan levels among the cirrhotic patients according to Child's grade. Multivariate analysis showed that the significant independent predictors of serum hyaluronan were serum aspartate aminotransferase (P= 0.020), serum alanine aminotransferase (P= 0.008), serum cholinesterase (P< 0.001), particularly serum type IV collagen 7S domain (P< 0.0001), and the histological degree of liver fibrosis (P< 0.0001). These findings suggest that elevated serum hyaluronan levels are closely related to the severity of liver fibrosis. We assessed the predictive value of serum hyaluronan in differentiating cirrhosis from chronic hepatitis, constructing receiver operating curves; we found that serum hyaluronan was a better test for diagnosing cirrhosis than serum type IV collagen 7S domain and laboratory liver tests.     

Significance of β2-Microglobulin in Liver Diseases

Serum levels of beta 2-microglobulin (beta 2-M) were found to be significantly elevated in acute viral hepatitis, chronic persistent or active hepatitis and liver cirrhosis. beta 2-M values were significantly lower in chronic persistent hepatitis than in the three other groups. Serum beta 2-M was normal in 75 asymptomatic carriers of HBsAg. Steroid therapy was followed by reduction of serum beta 2-M levels in 11 cases of chronic active hepatitis. Variations of beta 2-M were independent from that of transaminases, bilirubin and gamma-globulins.     

Clinical Significance of Serum and Urinary Neopterin Levels in Patients with Various Liver Diseases

Serum and urinary neopterin levels were measured by radioimmunoassay in 120 healthy controls, 16 asymptomatic HBsAg carriers, 12 patients with acute hepatitis, 13 with chronic inactive hepatitis, 35 with chronic active hepatitis, 46 with liver cirrhosis, 18 with hepatocellular carcinoma, and 6 with alcoholic liver disease. Serum and urinary neopterin levels were significantly higher in almost all patients than in normal subjects. Neopterin levels were highest in acute hepatitis and correlated with the results of liver function tests, but did not show this correlation in chronic liver disease. In chronic liver disease, the levels of serum neopterin in non-A non-B viral patients was significantly increased, compared with those in B viral and alcoholic patients. The rate of abnormal urinary neopterin levels in chronic liver disease was higher than the rate of abnormal serum neopterin levels, but no difference was observed between the rates of abnormal serum and urinary levels in acute hepatitis and asymptomatic HBsAg carriers. These results indicate that serum and urinary neopterin levels may be useful markers for cell-mediated immunity in liver disease, and that the immune system response in chronic liver disease may be different for different pathogens.     

Identification of hepatitis B antigens in hepatic tissue in various forms of acute hepatitis

Presence of HBsAg and HBcAg have been tested by immunohistochemical technique (peroxidase-antiperoxidase complex, PAP) in liver tissue of 223 patients with acute viral hepatitis using formalin fixed and paraffin embedded pieces of tissue. Histologic picture in usual acute viral hepatitis in 203 cases, submassive hepatic necrosis in 16, massive hepatic necrosis in four. HBsAg was positive in the serum of 85 of the 223 patients. In seven cases HBsAg and/or HBcAg was detected in liver tissue. In five of them only HBcAg was present; in one case only HBsAg and in one other HBsAg and HBcAg were detected. All but one of this seven cases had HBsAg positive in the blood. Three of seven cases with antigens in liver tissue went into chronic active hepatitis, one of them died with cirrhosis. The low incidence of detection of HBsAg or HBcAg in liver tissue was explained by the clearing of virus during the acute phase. The presence of this viral marks during this phase could be correlated with a bad evolution.     

肝病患者血清肉碱水平的临床研究

目的观察肝病患者血清肉碱水平,探讨其临床意义,为肉碱治疗肝病提供依据。方法用酶循环法检测25例急性病毒性肝炎,34例慢性病毒性肝炎,22例肾功能正常及9例肾功能异常的肝炎后肝硬化患者血清游离肉碱水平,并分别与40名正常人的检测值比较。结果血清游离肉碱:正常人为(48．3±10．2)μmol／L;急性病毒性肝炎患者为(35．2±13．2)μmol／L,明显低于正常对照组,P=0．000。慢性病毒性肝炎患者为(36．5±9．9) μmol／L,明显低于正常对照组,P=0．000。肾功能正常的肝炎后肝硬化患者为(45．0±11．0)μmol／L,比正常对照组略有下降,但差异无统计学意义,P=0．232。肾功能异常的肝炎后肝硬化患者为(83．6±50.4)μmol／L,比正常对照组升高,但差异无统计学意义,P=0．069。结论肝病患者可发生肉碱代谢异常,肝脏疾病是导致继发性肉碱缺乏的原因之一。     

Quantification of individual serum bile acids in patients with liver diseases using high-performance liquid chromatography

Using high-performance liquid chromatography combined with a column of immobilized 3 alpha-hydroxysteroid dehydrogenase, 15 bile acids, i.e., cholate, chenodeoxycholate, deoxycholate, lithocholate, ursodeoxycholate, and their five taurine conjugates and five glycine conjugates, were clearly separated and quantified in 38 patients with various hepatobiliary diseases and 9 normal controls. The serum levels of bile acids, both primary and total, were elevated in patients with liver disease, but did not differentiate between parenchymal disease and cholestasis. The ratio of cholate/chenodeoxycholate was significantly increased in cholestasis as compared with parenchymal liver injury. In primary biliary cirrhosis, the ratio of total glycine/taurine conjugates was decreased, with a marked increase of taurochenodeoxycholate. The bile acid pattern was distinctly different between extrahepatic cholestasis and primary biliary cirrhosis, which mainly reflects intrahepatic cholestasis. In acute hepatitis, there was a quick normalization of major taurine and glycine conjugates in the convalescent stage. Most of the major taurine and glycine conjugated bile salts were significantly elevated in cirrhosis, and the elevation of taurochenodeoxycholate was particularly marked in the decompensated state. Furthermore, the quantitative relationship between taurocholate and taurochenodeoxycholate in cirrhosis was reversed from that in acute hepatitis. These changes in absolute and relative concentrations of bile acids in various liver diseases perhaps reflect differing pathology and metabolism, and may prove diagnostic. Measurement of individual bile salts is easily and quickly done with this method, and may lend itself clinical application.     

Clinical significance of serum procalcitonin levels in patients with acute or chronic liver disease

OBJECTIVE: To evaluate the diagnostic value of serum procalcitonin levels in patients with acute or chronic liver disease, with or without bacterial infections and to correlate the results with the clinical outcome and the laboratory findings for these patients. METHODS: One hundred and six consecutive hospitalized patients with liver disease were evaluated for procalcitonin levels on admission. Fifteen of them (14.2%) had acute alcoholic hepatitis on cirrhotic background (group A), 20 (18.9%) had alcoholic cirrhosis without hepatitis and/or bacterial infection (group B), 16 (15.1%) had decompensated cirrhosis with proved bacterial infection (group C), 42 (39.6%) had uncomplicated viral hepatitis-related cirrhosis (group D) and 13 (12.3%) had acute icteric viral hepatitis (group E). Serum procalcitonin levels were measured using an immunoluminometric assay. Statistical analysis was based on Student's t-test and the non-parametric Kruskall-Wallis test (P<0.05). RESULTS: Serum procalcitonin levels were significantly higher in cirrhotic patients with bacterial infection (9.80+/-16.80 ng/ml) than in those without bacterial infection (0.21+/-0.13 ng/ml, P=0.001), whereas they were within normal range (<0.5 ng/ml) in all patients with uncomplicated cirrhosis, irrespective of the cause of cirrhosis. Seven of 15 group A patients (46.2%) and 4/13 group E patients (30.8%), all of them cirrhotics, had procalcitonin levels higher than 0.5 ng/ml on admission, without established bacterial infection. CONCLUSION: Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.     

Serum carboxy terminal propeptide of type I procollagen to amino terminal propeptide of type III procollagen ratio is a better indicator than each single propeptide and 7S domain type IV collagen for progressive fibrogenesis in chronic viral liver diseases

Twenty chronic viral hepatitis patients, mainly with hepatitis B related with progression to liver cirrhosis were included for an assay of serum collagen markers: PICP (carboxy terminal propeptide of type I procollagen), PIIINP (amino terminal propeptide of type III procollagen), and 7S-IV (7S-domain type IV collagen). PICP is increased in 20% of chronic hepatitis patients with a mean of 190.3 ng/ml, which is not different from that of the follow-up concentration in liver cirrhosis, where 35% of cases were abnormal with a mean of 220.5 ng/ml. The serum level and percent of abnormality of PIIICP in chronic hepatitis and in liver cirrhosis are 23.5 ng/ml vs 14.8 ng/ml and 90% vs 100%, respectively (P>0.05). PICP/PIIINP is significantly higher during liver cirrhosis (15.11 vs 10.08,P<0.05). PICP during chronic hepatitis is not related to serum biochemical changes, while PICP during liver cirrhosis and PIIINP are correlated with hepatic enzymes. 7S-IV in chronic hepatitis and in liver cirrhosis is 14.0 ng/ml vs 10.9 ng/ml, respectively; both were positively correlated with hepatic enzymes. These results suggest that PICP/PIIINP is a better indicator of hepatic fibrogenesis than either PICP or PIIINP alone in viral hepatitis. A ratio of more than 12 is suggestive of liver cirrhosis.