腺苷脱氨酶活性与肝脏疾病的关系

目的：探讨腺苷脱氨酶在肝脏疾病中的诊断价值。方法：应用全自动生化分析仪检测肝病患者血清腺苷脱氨酶（ADA）及肝功能各项指标。结果：脂肪肝患者血清ADA无明显升高；慢性乙型肝炎、急性肝炎、肝硬化及肝硬化合并肝癌患者血清ADA活性明显增高，与正常组比较有统计学意义（P〈0．01）；肝硬化患者、肝硬化合并肝癌患者血清ADA活性较慢性乙型肝炎患者明显升高，两组比较有统计学意义P〈0．01）；急性肝炎患者经治疗血清ADA明显降低，与发病早期比较有统计学意义（P〈0．05）；肝病患者血清ADA与白球蛋白比值、前白蛋白呈负相关，与总胆红素呈正相关。结论：肝病患者血清ADA增高提示肝病慢性化、逐渐进展，反映肝脏损害程度加重，肝脏储备、合成功能逐渐降低。     

动态观察总胆汁酸在常见肝脏疾病中临床意义

目的探讨急性乙型肝炎、慢性乙型肝炎、乙型肝炎肝硬化患者血清总胆汁酸（TBA）及谷丙转氨酶（ALT）、总胆红素（TBIL）的动态变化。方法对29例健康者及101例急、慢性乙型肝炎、肝硬化患者采用全自动生化分析仪检测血清TBA含量及ALT、TBIL。结果各型肝病组TBA含量显著高于健康对照组（P〈0．01），急性乙型肝炎与慢性乙型肝炎的TBA无显著差异（P〉0．05），慢性乙型肝炎与肝硬化比较TBA有较显著差异（P〈0．05）。急性乙型肝炎患者发病初期TBA、ALT、TBIL均明显增高，随着病情好转，各项均逐渐下降，但TBA较ALT、TBIL恢复晚。结论TBA变化是常见肝病患者高度敏感的指标，它的动态变化对急性乙型肝炎患者预后判定有指导意义。     

乙型病毒性肝炎患者血清sFas水平检测及其临床意义

用ELISA法检测了107例病毒性乙型肝炎（乙肝）患者血清可溶性Fas（sFas）水平。结果各期肝炎患者血清sFas水平均显著高于正常人（P〈0．01），由低到高依次为慢乙肝、肝炎肝硬化、急性乙肝、慢性重型乙肝；血清sFas与总胆红素呈显著正相关（P〈0．01），与白蛋白、凝血酶原活动度均呈负相关（P〈0．01），与HBeAg的表达和HBV-DNA的复制无相关性（P〉0．05）。     

功能磁共振成像在乙型肝炎相关慢性肝病检测中的应用

目的 探讨功能磁共振成像指标与慢性乙型肝炎、肝硬化程度动态变化的关系，并与血清肝纤维化标志物作对照分析。方法 对47例慢性肝病患者[慢性乙型肝炎6例，肝硬化41例（其中ChildA级14例，ChildB级12例；ChildC级15例）]及10名正常人（对照组）进行扩散加权成像（DWI），用不同的b值及b值差计算肝脏表观扩散系数（ADC）。灌注加权成像（PWI）测量肝脏强化参数：到达灌注峰值时间（TP）、血容量分布及肝脏强化曲线最大上升斜率（MSI）。相位对比法（PC）测门静脉血流速度、每分钟流量。所有入选者同时检测血清肝纤维化标志物：透明质酸（HA），Ⅲ型前胶原（PCⅢ）、层黏连蛋白（LN）和Ⅳ型胶原（CⅣ）。结果 （1）DWI：Child C级肝硬化组与对照组比，ADC3差异有统计学意义（P〈0．01），Child A、B级肝硬化组与对照组之间ADC3差异也有统计学意义（P值均〈0．05）。慢性乙型肝炎组和Child C级肝硬化组间ADC3差异有统计学意义（P〈0．01）。（2）PWI：Child A、B、C级肝硬化较对照组TP明显延长（P值均〈0．01）。肝脏MSI比较，对照组明显大于Child A、B、C级肝硬化组，差异有统计学意义，P值均〈0．01。（3）Child A、B、C级肝硬化组门静脉血流速度较慢性乙型肝炎组和对照组显著下降，差异有统计学意义，P值均〈0．01。（4）Child A、B、C级肝硬化组HA较慢性乙型肝炎组和对照组显著升高，差异有统计学意义，P值均〈0．01）；Child A、B．C级肝硬化组LN也明显高于慢性乙型肝炎组和对照组，P值均〈0．01；Child A，B、C级肝硬化组PCⅢ指标较对照组显著升高，P值均〈0．01。结论 功能磁共振成像指标能反映出慢性乙型肝炎、肝硬化的动态变化，对肝硬化的诊断及临床治疗有重要的参考价值。     

慢性肝病患者骨代谢变化的临床意义

为探讨慢性乙型肝炎（下称慢乙肝），乙肝肝硬化（下称肝硬化）与骨代谢的关系，分别对32例慢乙肝，32例肝硬化和31例对照组患者进行了骨钙素（BGP），甲状旁腺激素M（PTHM），血钙，血磷及尺桡骨骨密度（BMD）检测。结果显示，肝硬化组血清BGP水平较肝炎组和对照组明显降低（P＜0．05，＜0．01），血清PTHM水平较肝炎组及对照组升高（P＜0．05，＜0．05），两肝病组血钙水平较对照组明显下降（P均＜0．001），BMD较对照组降低（P＜0．001，＜0．01）；肝硬化组和肝炎组BGP均与BMD呈正相关。提示慢性病毒性肝病可出现调钙激素异常变化，且其骨质疏松随肝病加重而呈加重趋势。     

乙型肝炎患者血浆纤维蛋白原的变化及临床意义

目的：探讨乙型肝炎病毒所致各类型肝病患者血浆中纤维蛋白原（Fbg）水平与功能变化的临床意义。方法：将连续收治的乙型肝炎患者96例根据疾病类型分为4组：急性乙型肝炎组（40例）；亚急性重症乙型肝炎组（12例）；慢性乙型肝炎组（30例）；乙型肝炎病毒致肝硬化失代偿期（14例）；对照组（30名）为健康查体者。采用微电脑自动测定系统对其血浆Fbg水平与功能进行系列测定。结果：与对照组比较，除急性乙肝组Fbg功能指数差异无显著性意义外（P〉0．05），其余各组Fbg的各项指标：包括纤维蛋白单体聚合反应速率、最大吸光度、凝固性纤维蛋白原含量、反应迟滞时间、功能指数，差异均有显著性意义（P〈0．05～0．001）。结论：在乙型肝炎病毒所致的各类型肝病中进行纤维蛋白原系列检测，能反映患者肝功能受损时所涉及的凝血功能变化，对判断预后有帮助。     

前白蛋白检测在慢性乙型肝炎病理分级中的价值

目的：明确血清前白蛋白对判断慢性乙型肝炎患者肝脏炎症分级及纤维化分期的价值。方法：检测78例经肝活检证实的慢性乙型肝炎患者血清PAB水平的变化，并将其与肝活检组织的炎症分级和纤维化分期进行对照研究。结果：肝脏病理组织炎症分为G1-G4级，纤维化分为Su-S4期。炎症轻重两组间PAB差异有显著性意义（P〈0．01）。随着纤维化程度的增加，PAB逐渐下降，且S4及S0、S1、S2和S3比较差异有显著性意义（P〈0．01）。PAB与炎症分级及纤维化分期之间相关性均非常显著（P〈0．01）。结论：PAB能较好地反映慢性乙型肝炎患者肝脏的炎症活动水平，并能较敏感地反映慢性乙型肝炎患者肝脏的纤维化程度，在一定程度上可以提示早期肝硬化。     

血清丁酰胆碱酯酶、前白蛋白评价肝硬化患者肝脏储备功能的临床价值

选取经临床诊断的肝硬化患者86例，按Child—Pugh分级，将肝硬化患者分成A、B、C三级，检测血清丁酰胆碱酯酶、前白蛋白和白蛋白；设立对照30例。结果随肝硬化程度加重，血清丁酰胆碱酯酶、前白蛋白逐渐降低，其降低幅度依次为C级〉B级〉A级，组间两两比较有显著性差异（P〈0．05）；三级与对照组比较均有显著差异（P〈0．05）。认为酰胆碱酯酶、前白蛋白与肝硬化程度密切相关，二者比白蛋白更能较好地反映肝脏储备功能。     

乙肝泰胶囊治疗慢性乙型肝炎的远期疗效观察

目的：观察乙肝泰胶囊治疗慢性乙型肝炎（CHB）患者的远期疗效。方法：将120例慢性乙型肝炎患者随机分为治疗组60例、对照组60倒。治疗组服用乙肝泰胶囊，对照组服用拉米夫定片，治疗12月，于治疗前后及停药12个月后检测肝功能及乙肝病毒标志物的变化。结果：治疗结束后，两组均能明显改善患者血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、白蛋白（ALB）、球蛋白（GLB），其中治疗组升高Alb、降低Glb水平的作用优于对照组（P〈0．05）。停药12个月后，治疗组在改善ALT、Alb、Glb方面优于对照组（P〈0．05）；治疗结束后。对照组DNA阴转率优于治疗组（P〈0．05）。停药12个月后治疗组与对照组的DNA阴转率无显著性差异（P〉0．05）。对照组的反跳率明显高于治疗组（P〉0．05）。结论：乙肝泰胶囊可能降低慢性乙型肝炎患者耶VDNA含量．改善肝功能。远期疗效优于拉米夫定。     

肝脏疾病患者血清细胞因子IFN-γ、TNF-α、IL-4、IL-10的检测

目的分析细胞因子TNF-α、IFN-γ、IL-4、IL-10在肝病患者血中的浓度改变及临床意义。方法应用酶联免疫吸附测定（ELISA）试剂盒体外检测不同类型肝病患者血清细胞因子TNF-α、IFN-γ、IL-4、IL-10的浓度。结果IL-4、TNF-α、IFN-γ在急性乙型肝炎、慢性乙型肝炎、乙型肝炎肝硬化及重型肝炎组患者外周血的浓度,较正常对照组,均显著升高（P〈0．001-P〈0．05）,而IL-10的肝病组与正常组之间、肝病组之间相比,均未有显著差别（P〉0．05）;IFN-γ在乙型肝炎肝硬化组中的浓度显著高于慢性乙型肝炎组（P〈0．01）和重型肝炎组（P〈0．05）;IL-4在重型肝炎组中的浓度显著高于急性（P〈0．05）、慢性乙型肝炎组（P〈0．05）。结论细胞因子IL-4、IFN-γ、TNF-α在乙型肝炎病毒感染中起重要作用;细胞因子IL-4、TNF-α、IFN-γ分别参与乙型肝炎病毒感染中的促纤维化作用和抗纤维化作用;促炎因子 IFN-γ、TNF-α和抗炎因子IL-4共同参与重型肝炎的发病过程。     

空腹血清总胆汁酸与肝功能Child分级的相关性

作者对41例肝炎后肝硬化患者进行了Child分级并分别测定其空腹血清总胆汁酸值,同时检测了血清白蛋白、胆红素,凝血酶原时间(PT),结果发现随肝功能Child分级加重,血清总胆汁酸(TBA)浓度呈递增现象,且A、B、C三级之间的血清TBA浓度有显著性差异,血清TBA浓度与白蛋白呈负相关,与胆红素和PT呈正相关,且敏感性高于白蛋白、胆红素和PT。     

乙型肝炎患者血脂、血清前白蛋白和总胆汁酸变化的意义

目的探讨乙型肝炎患者血脂、血清前白蛋白和总胆汁酸的变化规律,了解其与病情及预后的关系。方法在230例乙型肝炎患者[其中急性肝炎43例,慢性肝炎91例(轻度25例,中度32例,重度34例),重型肝炎33例,肝炎肝硬化63例]和50例正常人,测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、血清前白蛋白(PA)、白蛋白(ALB)、总胆汁酸(TBA)水平。结果各组总胆汁酸水平较正常对照组升高,差别有显著性意义(P<0·05);慢性肝炎组、肝硬化组、重型肝炎组患者血清甘油三脂、总胆固醇、HDL-C、血清前白蛋白、白蛋白水平均较正常对照组降低,差别有显著性意义(P<0.05);各项血脂水平随着肝功能损害的加重而降低(慢性肝炎重度组和中度组显著低于轻度组,重型肝炎组显著低于慢性肝炎组和肝硬化组)。结论检测乙型肝炎患者血脂、血清前白蛋白和总胆汁酸水平,对了解肝功能状态和估计预后均有一定的意义。     

HB virus infection and delta surinfection in Sahelian Africa

78 hospitalized patients were selected when presenting with at least one of these signs: hepatomegaly, jaundice, ascites, oesophageal varices, abdominal venous pattern, splenomegaly. All had radioimmunoassays for hepatitis B surface antigen (HBsAg) and antidelta antibody (78/78). Acute or chronic hepatic disease was diagnosed in 56 patients: 7 acute viral hepatitis, 13 chronic hepatitis, 23 non alcoholic hepatic cirrhosis, and 13 hepatocellular carcinoma. Twenty-two patients with other diagnoses served as controls. Serum antidelta was present in each group: acute viral hepatitis (2/7), chronic hepatitis (2/13), non alcoholic hepatic cirrhosis (9/23), hepatocellular carcinoma (3/13), controls (2/22). Every patient with acute or chronic hepatic disease and positive serum anti-delta was positive for serum HBsAg. Amony controls, 2 patients with positive serum antidelta were negative for serum HBsAg but positive for antiHBs. Delta superinfection is present in the sahelian region; Patients with acute viral hepatitis, chronic hepatitis, non alcoholic hepatic cirrhosis, and hepatocellular carcinoma are electively infected. Patients with acute or chronic hepatitis and positive serum antidelta have hepatitis B virus evolutive infection (positive serum HBsAg).     

Infection à virus HB et surinfection delta en Afrique Sahélienne

78 hospitalized patients were selected when presenting with at least one of these signs: hepatomegaly, jaundice, ascites, oesophageal varices, abdominal venous pattern, splenomegaly. All had radioimmunoassays for hepatitis B surface antigen (HBsAg) and antidelta antibody (78/78). Acute or chronic hepatic disease was diagnosed in 56 patients: 7 acute viral hepatitis, 13 chronic hepatitis, 23 non alcoholic hepatic cirrhosis, and 13 hepatocellular carcinoma. Twenty-two patients with other diagnoses served as controls. Serum antidelta was present in each group: acute viral hepatitis (2/7), chronic hepatitis (2/13), non alcoholic hepatic cirrhosis (9/23), hepatocellular carcinoma (3/13), controls (2/22). Every patient with acute or chronic hepatic disease and positive serum anti-delta was positive for serum HBsAg. Amony controls, 2 patients with positive serum antidelta were negative for serum HBsAg but positive for antiHBs.Delta superinfection is present in the sahelian region; Patients with acute viral hepatitis, chronic hepatitis, non alcoholic hepatic cirrhosis, and hepatocellular carcinoma are electively infected. Patients with acute or chronic hepatitis and positive serum antidelta have hepatitis B virus evolutive infection (positive serum HBsAg).     

抗核抗体在乙肝患者中的表现及意义

目的观察不同病程的乙肝患者血清中ANA的表达及其与肝功能、HBVDNA的关系。方法对35例乙肝携带1患者、192例慢性乙肝患者,35例乙肝肝硬化患者检测血清中的ANA、肝功能、HBVDNA,并进行统计学分析。结果1.ANA在乙肝携带、慢性乙肝及乙肝肝硬化患者的血清中呈进行性升高趋势。2.192例患者中ANA阳性者共29例占15.10%,29例ANA阳性患者的ALT、TBil、ALB及HBVDNA较163例ANA阴性患者的均有升高,两者间差异有统计学意义（P〈0.05）。结论ANA与乙肝患者的病程相关,并与HBVDNA复制水平及肝功能损伤的程度相关。     

血清总胆汁酸测定的意义及其局限性

目的　阐明空腹血清总胆汁酸（TBA）测定的临床意义。方法　收集913例临床资料,用SPSS软件及四格表法进行统计分析。结果　（1）正常人TBA平均（4.0±3.2）μmol/L。肝病组TBA显著高于正常人和非肝病组(P＜0.01)。（2）急性肝炎患者TBA平均为（167.2±132.4）μmol/L,最高达449.5μmol/L,与其他各组相比差异有显著性(P＜0.01),表明TBA是反映急性肝细胞损伤的敏感指标。（3）TBA对肝硬化的敏感性为85.8%,优于其他肝功能试验,TBA是反映肝硬化侧支循环的有价值的指标。（4）TBA对慢性轻度肝炎的敏感性仅为30.5%,不及ALT和总胆红素（TBIL）。（5）TBA水平与病情轻重有一定关系,但与TBIL不完全平行,对病情的判断不如TBIL有价值。结论　TBA特异性高,敏感性尚可,对肝病、特别是急性肝炎和肝硬化有重要诊断价值,但对慢性轻度肝炎的敏感性差,对病情的判断不如TBIL有意义。     

236例急性戊型肝炎的临床特征及危险因素分析

目的分析急性戊型病毒性肝炎(AHE)的临床特征及促使黄疸加重及肝衰竭的危险因素。方法回顾性分析2011年至2014年连续收治的AHE患者236例,收集患者的病史、血清学、影像学等临床资料。根据血清TBil水平将患者分为4组:TBil34μmol/L,34≤TBil85μmol/L,85≤TBil170μmol/L,TBil≥170μmol/L,分析AHE黄疸加重的影响因素。在重度黄疸(TBil≥170μmol/L)的AHE患者中,根据是否存在凝血酶原时间延长(PTA≤40%),分为肝衰竭组和非肝衰竭组,分析肝衰竭的危险因素。结果老年及男性戊型肝炎患者易出现重度黄疸(P0.01);存在饮酒史以及合并感染及胆道系统结石者,黄疸水平较高(P0.05);同时,高胆红素水平还与白细胞、血小板、前白蛋白等指标密切相关。进一步的研究发现,肝衰竭组中存在肝硬化基础的患者,以及合并感染及胆道系统结石者比例显著升高(P0.05)。Logistic回归分析显示,肝硬化基础是戊型肝炎肝衰竭的危险因素。结论多重因素参与AHE的重症化过程。存在肝硬化基础,合并胆道结石及感染的AHE患者易发生肝衰竭。     

Clinical features and risk factors of acute hepatitis E with severe jaundice

AIM:To compares the clinical features of patients infected with hepatitis E virus(HEV) with or without severe jaundice.In addition,the risk factors for HEV infection with severe jaundice were investigated.METHODS:We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group.Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum.We used χ2 analysis,Fisher's exact test,and Student's t test where appropriate in this study.Significant predictors in the univariate analysis were then included in a forward,stepwise multiple logistic regression model.RESULTS:No significant differences in symptoms,alanine aminotransferase,aspartate aminotransferase,al-kaline phosphatase,or hepatitis B virus surface antigen between the two groups were observed.HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase(GGT)(median:170.31 U/L vs 237.96 U/L,P = 0.007),significantly lower ALB levels(33.84 g/L vs 36.89 g/L,P = 0.000),significantly lower acetylcholine esterase(CHE) levels(4500.93 U/L vs 5815.28 U/L,P = 0.000) and significantly higher total bile acid(TBA) levels(275.56 μmol/L vs 147.03 μmol/L,P = 0.000) than those without severe jaundice.The median of the lowest point time tended to be lower in patients with severe jaundice(81.64% vs 96.12%,P = 0.000).HEV infected patients with severe jaundice had a significantly higher viral load(median:134 vs 112,P = 0.025) than those without severe jaundice.HEV infected patients with severe jaundice showed a trend toward longer median hospital stay(38.17 d vs 18.36 d,P = 0.073).Multivariate logistic regression indicated that there were significant differences in age,sex,viral load,GGT,albumin,TBA,CHE,prothrombin index,alcohol overconsumption,and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.CONCLUSION:Acute hepatitis E patients may naturally present with severe jaundice.     

肝病患者TBA、PA、Cys C、GLDH、CHE检测分析

目的探讨血清前白蛋白（PA）、总胆汁酸（TBA）、谷氨酸脱氢酶（GLDH）、半胱氨酸蛋白酶抑制剂C（CysC）和胆碱酯酶（CHE）联合检测在肝病患者中的变化和临床意义,为其诊断和治疗提供依据。方法 253例肝病患者分为急性肝炎（84例）、慢性肝炎（93例）、肝硬化（46例）、肝癌（30例）4组;56例健康体检者作为对照组,分别检测血清TBA、PA、CHE、GLDH、CysC浓度并进行对照分析。结果肝病患者各组患者PA、CHE浓度明显降低,以肝硬化和肝癌组最为明显;CysC、GLDH、TBA显著升高,依次为肝硬化组、慢性肝炎组、急性肝炎组,与对照组相比,差异均有统计学意义（P〈0.05）。结论 PA、CHE变化反映各型肝炎早期肝细胞的损害程度。TBA、CysC、GLDH是各种肝病的敏感指标,对肝炎的早期诊断及预后判断有重要临床意义。     

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.