血清ALT与AST测定的基质效应评价

摘要：目的：评价7种室间质量评价（EQA）材料和4种市售材料在9个检测系统上测定血清ALT和AST的基质效应。 方法：参照美国临床实验室标准化协会(CLSI)EP14-A2指南,根据ALT和AST的参考方法建立不含磷酸吡哆醛的比对方法。9个检测系统的常规方法为待评方法。用比对方法和待评方法同时测定新鲜人血清、EQA材料及市售材料的ALT和AST水平,评价非血清样品的基质效应。 结果：ALT测定中1种EQA材料对所有检测系统均表现基质效应,AST测定中2种EQA材料对所有检测系统无基质效应,其他材料视系统的不同而表现出不同的情况。 结论：基质效应影响血清ALT和AST测定的准确性和可比性,应充分重视基质效应对临床检验量值溯源的影响。     

亚甲蓝光敏消毒法对血浆中凝血因子与酶活性的影响

采用凝固法与生化分析法 ,对亚甲蓝光敏消毒法处理后人血浆中凝血因子与酶活性所受影响进行了观察。向人血浆中加入 1μmol/L亚甲蓝 ,以 2 0 0 0 0lx强度的红色光 (波长为 6 4 0～ 70 0 μm)照射 30min ,血浆中凝血因子Ⅷ促凝活性的破坏低于 2 0 %可接受水平 ,活化部分凝血酶时间 (APTT)、凝血酶原时间(PT)的延长略超过正常允许值 (在照射 2 0min时仍未超过 ) ,血浆中谷丙转氨酶、乳酸脱氢酶、碱性磷酸酶和天冬氨酸转氨酶的活性均无明显变化     

Complexity of the HVR-1 quasispecies and disease activity in patients with hepatitis C

BACKGROUND: Hepatitis C virus (HCV) easily undergoes genomic changes, especially in the hypervariable region (HVR) in the N-terminus of the E2/NS1 region. The quasispecies nature of HCV may have important biological implications in relation to viral persistence; however, the relationship between disease activity of chronic HCV infection and development of the genomic complexity have yielded conflicting results. We explored the changes in the complexity of the HVR-1 in the natural course of chronic HCV infection with and without elevation of serum alanine transaminase (ALT) levels. MATERIALS AND METHODS: Ten patients with chronic hepatitis C proven by liver biopsy, who showed persistent elevation of the serum ALT levels, and 15 patients with chronic HCV infection and persistently normal serum ALT levels (PNAL) were enrolled in this study. The number of the HCV quasispecies was determined twice for each patient at an interval of mean 2.5 years by fluorescence single-strand conformation polymorphism and sequence analysis. RESULTS: There was no significant difference in the changes in the number of quasispecies during the follow-up period between chronic hepatitis C and PNAL. There was also no significant difference in the change in the number of variable nucleotides sites between the two groups. In these patients, the number of quasispecies and the diversity of HVR-1 were correlated with platelet counts and serum hyaluronic acid levels previously shown to be associated with disease progression. CONCLUSION: Our results suggested that the disease activity is not always related to the generation of the HVR-1 quasispecies complexity.     

巨大儿青少年期血糖、血脂和转氨酶水平的调查研究

目的研究巨大儿至青少年期血糖、血脂和转氨酶的代谢变化,以了解巨大儿与成人代谢综合征的相关性。方法选取出生时体质量大于或等于4000 g的巨大儿,年龄13~18岁的青少年148例为研究对象,按1∶1选取配对的148例为对照组,测定血糖、血脂和转氨酶的含量,并比较两组间的差异。结果巨大儿组的空腹血糖及转氨酶水平明显高于对照组,差异有统计学意义(P0.05),对动脉硬化有保护作用的高密度脂蛋白胆固醇(HDL-C)的含量明显低于对照组,差异有统计学意义(P0.05)。结论出生体质量与青少年相关代谢紊乱关系密切。     

The effects of hemodialysis on blood glutamate levels in chronic renal failure: Implementation for neuroprotection

Purpose

The purpose of the present study is to investigate whether hemodialysis (HD) is effective in lowering blood glutamate levels. In addition, we examined the effect of HD on glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) levels in the blood and described the rate and pattern of blood glutamate clearance during HD.

Materials and Methods

Blood samples were taken from 45 patients with stage V chronic kidney disease immediately after initiation of HD and hourly, for a total of 5 blood samples. Samples were sent for determination of glutamate, glucose, GOT, GPT, hemoglobin, hematocrit, urea, and creatinine levels. A blood sample from 25 healthy volunteers without chronic renal failure was used as a control for the determination of baseline blood levels of glutamate, GOT, and GPT.

Results

Glutamate and GPT levels in patients on HD were higher at baseline compared with healthy controls (P < .001). In the first 3 hours after HD, there was a decrease in blood glutamate levels compared with baseline levels (P < .00001). At the fourth hour, there was an increase in blood glutamate levels compared with the third hour (P < .05).

Conclusions

Hemodialysis may be a promising method of reducing blood glutamate levels.     

Nationwide survey to compare the prevalence of transient elevation of liver transaminase during treatment of diabetic ketosis or ketoacidosis in new-onset acute and fulminant type 1 diabetes mellitus

Background aims. A mild increase in liver enzyme levels is sometimes observed in patients with diabetic ketosis or ketoacidosis. The aim of the present study was to assess the cause and prevalence of the elevation of liver transaminase levels in fulminant and acute-onset type 1 diabetic patients experiencing diabetic ketosis or ketoacidosis.

Methods. We analyzed data on the liver transaminase levels of 108 patients over 18 years of age with newly diagnosed type 1 diabetes complicated by ketosis or ketoacidosis. The data were collated from a nationwide survey on fulminant type 1 diabetes and retrospective medical records.

Results. Thirty-two (60.4%) out of the 53 patients suffering from fulminant type 1 diabetes were detected with transient elevation of liver transaminase (TELT) levels during the first month after initiation of insulin therapy; in the case of acute-onset type 1 diabetes, such an observation was noted in 16 (29.1%) out of 55 patients. Fatty liver was diagnosed in 20% of the patients, and 65% of these patients exhibited TELT. The dosage of insulin injected in these patients was significantly high.

Conclusions. High blood glucose and fatty liver may influence the elevation of liver transaminase levels during the treatment of new-onset type 1 diabetes.     

Glycylprolyl beta-naphthylamidase activity in human serum.

Glycylprolyl beta-naphthylamidase activities in sera from 40 normal subjects (18-81 years) were: 22.6 +/- 0.9 (S.E.) (11.8-38.2) I.U./1 serum at 37 degrees C. The enzyme activities did not differ significantly with age between the younger group under 40-years-old and the older group over 40-years-old. Males, especially under 40-years-old, had slight but significantly higher activities than females. The levels were decreased in patients with gastric cancer. The levels were elevated in patients with hepatobiliary diseases, and had significant correlations with the results of the serum tests in hepatic diseases such as glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, alkaline phosphatase and total bilirubin, but had no correlation with serum lactate dehydrogenase. In cellulose acetate electrophoresis, normal sera had a single peak at the beta-globulin region, but the sera in hepatitis or liver cirrhosis showed not only an increase in the normal peak at the beta-globulin region but also the appearance of the other one or two new peaks in the alpha1 and alpha2-globulin regions.     

人Ⅰ型丙氨酸氨基转移酶的可溶性表达及抗血清反应模式

目的克隆表达重组人Ⅰ型丙氨酸氨基转移酶(ALT1)蛋白及制备抗血清，探讨建立ALT1特异性检测方法思路。方法逆转录聚合酶链反应(RT-PCR)扩增人ALT1 cDNA，插入pGEX-2T，构建原核表达载体pGEX-2T—ALT1，并转人大肠杆菌进行表达。SDS-PAGE，活力测定和活性染色鉴定表达产物。表达产物免疫小鼠所得抗血清对天然ALT1，重组ALT1及重组ALT2进行Western blot分析。结果重组质粒测序和酶切结果显示ALT1基因已经成功克隆到pGEX-2T载体。SDS-PAGE和活性染色表明所表达蛋白具有天然活性。抗ALT1血清除识别重组ALT1外，还可识别天然蛋白和重组ALT2。结论重组人ALT1得到高效可溶性表达。用目前方法制备的抗血清特异性不高，如建立ALT1的免疫学检测方法需要采用特异性识别ALT1的抗体，以避免交叉反应引起的假性升高。     

HBV-DNA 和 ALT、TBA 水平与 HBV 感染模式的相关性研究

目的：探讨乙型肝炎病毒（HBV）患者血清 HBV-DNA 和丙氨酸转氨酶（ALT）、总胆汁酸（TBA）与 HBV 感染模式的关系以评价 HBV 感染性。方法对308例患者采用荧光定量 PCR 法检测血清 HBV-DNA,用 ELISA 方法检测血清乙肝标记物,用连续监测法检测血清 ALT,用循环酶法检测血清 TBA。结果大三阳（HBsAg、HBeAg、HBcAb 阳性者）、小三阳（HBsAg、HBeAb、HBcAb 阳性者）和1,5（HBsAg、HBcAb）阳性3种感染模式间 HBV-DNA 水平和血清 ALT 活性差异有统计学意义（P ＜0．05）,部分 HBeAg 阴性患者体内仍存在活跃的病毒复制;在 HBeAg 阴性患者中 HBV-DNA 拷贝数与血清 ALT 水平存在显著正相关关系（P ＜0．05）;3种感染模式间血清 TBA 水平差异无统计学意义（P ＞0．05）。结论血清 HBV-DNA 水平和 ALT 活性与不同 HBV 感染模式存在相关性,它们可在一定程度上反映 HBV 复制及传染性强弱。     

慢性乙型肝炎患者外周血T淋巴细胞亚群变化临床研究

目的监测外周血T淋巴细胞亚群中CD3＋、CD4＋及CD8＋细胞在慢性乙型肝炎患者和健康人群间的变化,研究慢性乙型肝炎患者在细胞免疫方面的动态。方法用流式细胞仪监测外周血CD3＋、CD4＋及CD8＋细胞数量变化,用全自动生化分析仪检测血清中丙氨酸氨基转移酶（ALT）。结果慢性乙型肝炎患者外周血CD3＋、CD4＋细胞数及CD4＋/CD8＋比值明显低于健康人群（P〈0.01）,而CD8＋细胞数明显高于健康人群（P〈0.01）。慢性乙型肝炎患者中血清转氨酶异常者外周血CD3＋、CD8＋细胞数明显升高（P〈0.01）;CD4＋细胞数略有升高,但无统计学意义,CD4＋/CD8＋比值明显下降（P〈0.05）。结论慢性乙型肝炎患者T淋巴细胞的改变,可导致细胞免疫功能改变,使得乙肝病毒难以清除;慢性乙型肝炎患者CD8＋细胞数与血清转氨酶浓度有平行关系。     

6523例大学新生乙型肝炎病毒和丙氨酸氨基转移酶检测结果分析

目的了解大学新生乙型肝炎(下称乙肝)病毒(HBV)感染与丙氨酸氨基转移酶(ALT)异常情况。方法使用酶联免疫吸附试验(ELISA)检测HBsAg,抗-HBs、HBsAg阳性者进一步用ELISA检测乙肝5项,同时利用全自动生化分析仪检测血清ALT。结果 HBsAg阳性率为6.4%,抗-HBs阳性率为58.7%,HBV全阴率为35%,ALT在HBsAg阴性新生中异常率为3.7%,ALT在HBsAg阳性新生中异常率13.7%。结论 HBV感染与ALT异常密切相关,ALT明显异常者为乙肝活动期,对大学学生应加强传染病相关知识宣传,继续加强乙肝疫苗接种,预防HBV传播。     

秦皇岛市区非脂肪肝男性大学生ALT异常相关因素分析

[目的]探讨非脂肪肝男性大学生谷丙转氨酶(ALT)异常的相关因素.[方法]体检男性大学生182例,除外肝炎、脂肪肝,以血清ALT>30 u/L视为肝功能异常.测身高、体重、腰围(WC)和血压,计算体重指数(BMI),ALT、甘油三酯(TG)、胆固醇(TC)、空腹血糖(FBG)、血清真胰岛素(TI)等生化指标.[结果]1...     

心理干预对控制肝内胆管癌患者术后效果分析

目的 探讨心理干预对于肝内胆管癌患者术后转归的作用。方法 选取 2006 年 7 月—2011 年 7 月在上海市交通大学医学院附属新华医院外科术后病理诊断为肝内胆管细胞癌的患者200例,按恶性程度(A组恶性程度较低)和心理干预与否分为A1、A2、B1、B2四组,每组50例。术后对A2及B2组患者进行心理干预,并通过SCL-90量表观测患者术后心理变化,同时检测患者谷丙转氨酶变化。结果 ①四组病人术后SCL-90量表各项因子分值无明显差异,术后6月心理干预组结果好于对照组。②干预组病人的谷丙转氨酶变化较对照组趋势平稳,差异有统计学意义( P< 0.05) 结论 心理干预对控制胆管癌术后的肝功能恶化有明显效果。     

肝脏病理检查对转氨酶正常及轻度异常的慢性乙型肝炎患者的临床意义

目的通过分析转氨酶正常及轻度异常的慢性乙型肝炎患者的肝脏病理检查结果,探讨肝活检对这类患者抗病毒治疗的指导意义。方法检查258例患者的血清及肝脏活检病理标本,根据丙氨酸转氨酶（alaninetransaminase,ALT）升高情况,以ALT正常（n=78）和异常（n=180）分组,再以ALT升高〈2倍正常上限为界分为ALT≥2倍正常上限组（n=83）和ALT〈2倍正常上限组（n=175）,分析肝脏病理炎症损伤程度（G）及纤维化分期（S）与检验的符合程度。结果肝功能正常患者中有17例（21.8%）炎症坏死≥G2,27例（34.6%）纤维化≥S2。有33例（42.3%）肝功能正常患者肝穿符合抗病毒指征,有98例（56.0%）ALT〈2倍正常上限患者肝穿符合抗病毒指征。以ALT=63.3U/L为界预测炎症坏死≥G2或纤维化≥S2时,曲线下面积为0.781。结论对肝功能正常及轻度异常的慢性乙型肝炎患者,应将肝活检作为判断肝病活动性和是否抗病毒治疗的主要依据。如遇患者无法行肝穿病理检查时,建议医生可考虑将ALT≥63.3U/L作为抗病毒治疗的筛选指标。     

病毒性肝炎血清鸟氨酸氨基甲酰转移酶的测定及其临床意义

本文对病毒性肝炎、其他肝病及非肝病者共232例进行了血清鸟氨酸氨基甲酰转移酶(SOCT)和血清谷-丙转氨酶(SGPT)的测定。结果表明,在急性病毒性肝炎患者中,SOCT和SGPT活性升高都很明显,二者呈正相关(rs=0.9978,P<0.001)。慢性病毒性肝炎SOCT活性升高率大于SGPT,二者之间的差异有极显著性意义(P<0.01)。显示前者对判断慢性肝炎患者的病情有重要意义。尤其乙肝抗原无症状携带者SOCT活性升高率达68.8%。提示这类携带者的肝细胞有一定程度损伤,测定SOCT对其评价有重要意义。     

乙型肝炎病毒前S1抗原与乙型肝炎病毒e抗原及肝功能指标之间的关系研究

目的通过分析乙型肝炎病毒（HBV）前S1抗原与乙型肝炎病毒e抗原（HBeAg）及肝功能指标谷丙转氨酶之间的关系,探讨HBV前S1抗原在病毒复制中的意义及与肝功能损害程度的相关性。方法对2012年5月-7月住院及门诊的HBV表面抗原阳性的慢性乙型肝炎患者血清标本310例进行检测,HBV前sI抗原采用酶联免疫吸附试验检测;HBeAg采用化学发光法检测;谷丙转氨酶采用酶学速率法检测。结果①HBeAg阳性组前S1抗原检出率高;②HBV前S1抗原与具有病毒活动性复制意义的指标HBeAg有高度的相关性;③谷丙转氨酶水平增高时前S1抗原阳性率增高。结论HBV前S1抗原检测结果可以较好地反映HBV的复制及慢性肝炎的活动情况。     

Efficiency of combined methotrexate/chloroquine therapy in adjuvant-induced arthritis

The present study evaluates the effects of methotrexate (MTX) and chloroquine (CQ), and of combined MTX + CQ treatment, on the inflammatory response and on plasma and liver phosphatase and transaminase activities, employing an adjuvant-induced arthritis model in rats. Arthritis was induced by the intradermal injection of a suspension of Mycobacterium tuberculosis in mineral oil into the plantar surface of the hind paws. Development of the inflammatory response was assessed over a 21-day period. Animal groups received either: (i) MTX, administered i.p., weekly, in 0.15, 1.5, 3, 6 or 12 mg/kg doses; (ii) CQ, given intragastrically, in daily 25 or 50 mg/kg doses; or (iii) MTX + CQ, administered in two combinations (MTX1.5 mg/kg + CQ50 mg/kg, or MTX6 mg/kg + CQ50 mg/kg). At the end of the experimental period, the animals were anesthetized and killed, blood and liver samples were collected and prepared for measurement of acid and alkaline phosphatase (AP, ALP), and aspartate (AST) and alanine aminotransferase (ALT) activities. MTX at 6 and 12 mg/kg reduced the inflammatory response while CQ had no effect. MTX6 mg/kg + CQ50 mg/kg reduced the inflammatory response similar to MTX12 mg/kg, without affecting the bone marrow. Plasma AP and liver ALP activities were very elevated in the arthritic rats. While MTX treatment partially reduced both plasma AP and liver ALP activities at all doses used in the arthritic rats, CQ treatment reduced plasma AP, but increased liver AP activity. MTX + CQ treatment decreased plasma AP and liver ALP activities in the arthritic rats to control values. Plasma and liver AST activities were unaltered in the arthritic rats, and were unaffected by treatment. However, plasma and liver ALT activities were significantly reduced in the arthritic rats. While MTX or CQ treatment did not alter plasma transaminase activity in the arthritic rats, after MTX + CQ treatment, plasma ALT activity returned to normal values. In conclusion, the present data suggest that MTX + CQ treatment provides more effective anti-inflammatory protection against adjuvant-induced arthritis than does MTX alone, reverting the alterations in enzyme activities induced by this inflammatory disease in rats.     

The overall computer/mobile devices usage time is related to newly diagnosed non-alcoholic fatty liver disease: a population-based study

Background: The computer/mobile devices usage time (CMD-UT) is closely related to a sedentary lifestyle, which is an important risk factor for non-alcoholic fatty liver disease (NAFLD). But their direct relationship remains unclear.

Aims: We aimed to examine the relationship between CMD-UT and newly diagnosed non-alcoholic fatty liver disease (NAFLD) in Chinese adults.

Methods: This cross-sectional study was conducted on 7516 adults in Tianjin, China. The CMD-UT was collected via a questionnaire included five categories. NAFLD [with normal or elevated alanine transaminase (ALT) levels] was diagnosed by at least twice liver ultrasonography examinations and serum ALT concentrations (>41?U/L in males and?>33?U/L in females).

Results: The prevalence of overall NAFLD, NAFLD with normal or elevated ALT levels was 18.2, 14.2, and 4.0%, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) of having overall NAFLD by increasing CMD-UT levels were 1.00 for?<1?h/d, 1.58 (1.22–2.05) for 1-3?h/d, 1.58 (1.18-2.11) for 3–5?h/d, 1.65 (1.21-2.27) for 5–10?h/d, and 1.99 (1.29-3.05) for ≥10h/d (P-trend for CMD-UT levels = 0.02), respectively. Similar relations were observed with the use of NAFLD with normal or elevated ALT levels.

Conclusions: The present study is the first to find that CMD-UT levels are independently associated with NAFLD.

• Key Messages

• The computer/mobile devices usage time levels are independently associated with the prevalence of non-alcoholic fatty liver disease.

     

严重烧伤后早期营养支持途径对肝功能的影响

目的考察严重烧伤早期营养支持途径对机体肝功能的影响。方法37例烧伤病人随机分为早期肠道营养组和肠外营养组，观察不同途径的营养支持两周后肝功指标的变化情况。结果严重烧伤后血清血清谷草转氨酶、碱性磷酸酶、乳酸脱氢酶均明显高于正常值，不同途径的营养支持两周，血清谷草转氨酶及血清碱性磷酶活性在伤后14d肠外营养组均明显高于肠道营养组(P＜0.05)。结论严重烧伤后病人出现不同程度的肝脏功能受损，肠外营养与肝脏功能的受损有关。     

心肌肌钙蛋白Ⅰ快速检测在急性心肌梗死诊断中的价值

比较心肌肌钙蛋白Ⅰ(CTnI)与几种常用的急性心肌梗死(AMI)诊断标记物的临床应用价值。方法对36例AMI和70 例非心肌梗死患者同时检测血清CTnI、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)和α-羟丁 酸脱氢酶(α-HBD)等6项指标,并进行2组间比较,分别对AMI和非心肌梗死组各指标间的差异作对比分析。结果CTnI诊断AMI的敏 感性(91.7％)高于CK(75.0％)、CK-MB(63.9％)、AST(66.3％)、LDH(75.0％)、α-HBD(69.4％),P<0.05～0.01;CTnI诊断AMI的特异 性(95.7％)与CK-MB(92.6％)相近(P>0.05),高于CK(84.3％)、ASr(81.4％)、LDH(72.9％)及α-HBD(80.0％),P<0.05～0.01。结论 CTnI对AMI的诊断具有较高的敏感性和特异性,作为一种心肌损伤的特异标记物,具有较好的临床应用价值。