肝硬化并发自发性细菌性腹膜炎临床分析

目的探讨肝硬化并发自发性腹膜炎的临床特点。方法回顾性分析53例失代偿期肝硬化的临床资料。结果多数患者缺乏腹膜炎的症状、体征,腹水细菌培养阳性率15．1％。结论肝硬化并发SBP的诊断不能依赖腹水中的细胞计数而PMN计数是诊断SBP的重要指标。     

肝硬化腹水并发自发性细菌性腹膜炎86例临床分析

目的 分析肝硬化并发自发性细菌性腹膜炎（SBP）的临床特点。方法对86例肝硬化并发SBP患者的临床资料进行回顾性分析。结果86例患者中,发热65例（75．6％）,腹胀71例（82．6％）,腹痛55例（64．0％）,腹水多形核白细胞（PMN）〉／0．50者75例（87．2％）,腹水培养阳性31例（36．0％）。结论肝硬化并发SBP临床表现不典型,腹水常规可早期诊断,腹水PMN比值是诊断SBP的可靠参数。大肠杆菌为主要病原菌,对第三代头孢菌素和第三代喹诺酮类药敏感。     

肝硬化腹水合并自发性细菌性腹膜炎的临床分析

目的:探讨肝硬化并发自发性细菌性腹膜炎(SBP)的细菌谱及临床特点.方法:回顾性分析96例肝硬化并发SBP患者的临床资料.结果:其中64例(66.7%)腹水多形核白细胞(PMN)比值≥0.50,13(13.5%)例腹水细菌培养阳性.其中大肠杆菌和其他革兰阴性杆菌为主要致病菌;药物敏感试验时第三代头孢菌素和第三代氟喹诺酮类药物敏感.结论:肝硬化合并SBP 临床表现大多数不典型,PMN计数是诊断SBP的重要指标,头孢噻肟或其他三代头孢菌素类抗生素被认为是肝硬化并发SBP患者的首选抗生素,有效率达87.5%.     

肝硬化腹水合并自发性腹膜炎的临床分析

目的 探讨肝硬化并发自发性腹膜炎的细菌谱及临床特点。方法 回顾性分析96例肝硬化并发自发性细菌性腹膜炎的临床资料。结果 其中64例(66.7%)腹水多形核白细胞(PMN)比值≥0.50,13例腹水细菌培养阳性(13.5%), 其中大肠杆菌和其他革兰氏阴性杆菌为主要致病菌;药物敏感试验对第三代头孢菌素和第三代氟喹诺酮类药物敏感。结论:肝硬化合并SBP临床表现大多数不典型,PMN计数是诊断SBP的重要指标，头孢噻肟或其他三代头孢菌素类抗生素被认为是SBP肝硬化患者的首选抗生素，有效率87.5%。     

肝硬化合并自发性腹膜炎临床分析

肝硬化患者伴肝功能障碍,机体免疫防御功能下降,易发生各种感染,自发性细菌性腹膜炎(SBP)是最常见的并发症之一,也是导致其死亡的重要因素.     

肝硬化腹水并发自发性细菌性腹膜炎的临床观察及护理

目的:探讨肝硬化腹水并发自发性细菌性腹膜炎的临床观察及护理方法。方法:回顾性总结2007年4月～2009年4月收治的45例肝硬化腹水并发自发性细菌性腹膜炎患者的临床观察与护理体会。结果:肝硬化腹水并发自发性细菌性腹膜炎患者应做好发热、腹部体征、并发症、药物应用、饮食、心理等6个方面的观察与护理。结论:肝硬化腹水并发自发性细菌性腹膜炎患者病情复杂,预后差,应密切观察病情变化,及时发现并发自发性细菌性腹膜炎先兆;及时有效地治疗;抓住护理要点,及时采取针对性的护理措施,可减轻患者的痛苦,提高治愈率,降低病死率。     

肝硬化合并自发性细菌性腹膜炎临床耐药分析

目的:了解肝硬化合并自发性细菌性腹膜炎(SBP)患者的病原菌及其耐药情况.方法:回顾性分析肝硬化合并SBP细菌培养阳性者82例的临床资料.结果:肝硬化患者合并SBP的病原菌中革兰阴性菌占67%,革兰阳性菌占29%,白色假丝酵母菌占4%;第三代头孢菌素与喹诺酮类药物的耐药率明显增加,而临床上使用较少的氨基糖苷类抗菌药物对大肠埃希菌的耐药率较低;美罗培南、亚胺培南、替考拉宁和万古霉素的耐药率低.结论:尽可能对肝硬化合并腹水患者进行腹腔穿刺检查,根据药敏试验结果合理选择抗菌药物.     

肝硬化腹水合并自发性细菌性腹膜炎75例观察及护理

目的:探讨肝硬化腹水合并自发性细菌性腹膜炎的临床观察及护理方法。方法:对75例肝硬化腹水合并自发性细菌性腹膜炎患者进行精心观察与护理。结果:本组治愈45例,好转23例,无效7例。结论:密切观察病情变化、注意用药后反应、做好腹腔穿刺护理、制定合理的饮食计划及预防并发症是患者病情恢复的关键。     

肝硬化腹水并发自发性细菌性腹膜炎的临床特征及危险因素分析

目的探讨肝硬化腹水并发自发性细菌性腹膜炎(SBP)的临床特征及危险因素。方法回顾性分析85例肝硬化腹水并发SBP患者的临床资料,总结其临床表现、实验室检查特征及治疗转归情况,并对所有临床病理因素进行Logistic回归分析。结果本组患者主要临床表现为发热、腹胀和腹痛;血常规及腹水中的白细胞计数(WBC)均显著升高,中性粒细胞(PMN)比值0.5者达83.53%;53例患者腹水细菌培养阳性(62.35%),4例真菌培养阳性(4.71%)。至2014年8月,35例(41.18%)SBP治愈或好转,50例(58.82%)无效或恶化。Logistic多元回归分析表明,腹水蛋白及消化道出血是肝硬化腹水并发SBP的独立影响因素。结论肝硬化腹水并发SBP主要临床表现为发热、腹胀和腹痛,血常规及腹水中的WBC均显著升高,治疗转归较差,腹水蛋白及消化道出血是其发病的独立危险因素。     

肝硬化并发自发性细菌性腹膜炎96例临床分析

自发性细菌性腹膜炎（SBP）是肝硬化腹水患者最常见的严重并发症之一。本文总结了2001年1月-2008年12月在本院住院的肝硬化并发自发性细菌性腹膜炎患者的临床和实验室检查资料,报道如下。     

Human monocyte CD163 expression inversely correlates with soluble CD163 plasma levels

BACKGROUND: CD163 is a monocyte/macrophage-restricted receptor involved in the clearance of hemoglobin-haptoglobin complexes and regulation of inflammatory processes. CD163 is shed from the cell surface and exists as a soluble form in plasma (sCD163). Monocyte CD163 and sCD163 are potential diagnostic tools in variety of disease states. METHODS: We determined the relation between plasma sCD163 levels by enzyme-linked immunosorbent assay, membrane expressions of CD163, CD64, and CD14 on blood monocytes by flow cytometry, and monocyte counts in 129 random blood samples. RESULTS: A strong inverse correlation was found between membrane CD163 expression and sCD163 levels (r = -0.65, P < 0.001). Monocyte CD163 expression and SCD163 levels did not correlate with the monocyte absolute count. CONCLUSIONS: The inverse relation between monocyte surface CD163 expression and sCD163 levels in human blood suggests that plasma sCD163 is derived from circulating monocytes, in addition to an unknown component from tissue macrophages. The lack of correlation with the absolute monocyte number suggests that such a balance is driven by the functional state of monocytes, rather than simply by numerical changes in circulating cells. We propose that further clinical evaluations of CD163 as a diagnostic parameter should include simultaneous measurements of soluble and cell-bound forms of this antigen.     

病毒性肝炎患者血清中可溶性CD30检测的临床意义

目的检测病毒性肝炎患者血清中可溶性CD30（sCD30）的水平及其与血清丙氨酸氨基转移酶（ALT）的相关性及临床意义。方法采用酶联免疫吸附试验（ELISA）检测85例病毒性肝炎患者（包括43例乙型肝炎、19例丙型肝炎、23例戊型肝炎）血清中sCD30的水平,同时采用日立7600生化仪检测血清中ALT的水平。另取30例ALT正常的乙型肝炎病毒（HBV）携带者作为乙型肝炎对照,30名健康体检者作为正常对照。结果各型病毒性肝炎患者血清中sCD30和ALT水平均明显高于正常对照,ALT水平升高的乙型肝炎患者较ALT正常的HBV携带者血清中sCD30水平明显升高。各型病毒性肝炎患者血清中sCD30水平均与ALT呈正相关。结论病毒性肝炎存在Th2型细胞的活化,血清sCD30水平可以作为肝炎活动性的检测指标。     

Biological variation of soluble CD163

A soluble plasma form of CD163 (sCD163) was recently identified. The protein has anti-inflammatory effects in vitro and is elevated in patients with myelo-monocytic leukaemia and infection. For rational use and evaluation of this potential new quantity it is important to have knowledge of its biological variability and to use a methodology that has a sufficiently analytical quality. The day-to-day and diurnal biological variabilities of sCD163 were studied in 12 healthy people using a sandwich ELISA. The within-run-, between run- and total analytical coefficients of variation were estimated to 3.6%, 4.8% and 6.0%, respectively. The day-to-day within-subject biological variation was estimated to 9.0%, and the between-subject biological variation to 35.9%. A diurnal variation in sCD163 concentrations with 14% lower values in the night (supine position) was observed. The ratio between total analytical variation and within-subject biological variation was 0.67. The index of individuality, calculated as the ratio between within-subject biological variation and between-subject biological variation, was low and similar to complement factors and immunoglobulins. A low index of individuality is important in a monitoring situation where small changes from the set point of the individual can be detected in serial measurements. For this purpose, the critical difference for a series of results in the same patient (significant at p < 0.05) was calculated to 30% for samples taken on different days and measured in separate runs.     

Biological variation of soluble CD163

Serum methylmalonic acid (S-MMA) as a sensitive indicator of cobalamin deficiency was introduced more than 10 years ago. The use of this method for identifying patients with cobalamin deficiency reflects much higher prevalence figures than was previously thought. In this review, all major studies on the subject are analysed. The least common denominator that could explain the probably overrated prevalence figures is the deteriorated renal function accepted for inclusion in virtually all the studies. A strong association between S-MMA and S-creatinine, even within the normal range for creatinine, has become increasingly apparent. At present, it is impossible to estimate how much of elevated S-MMA comes from impaired renal function and how much comes from impaired cobalamin metabolism. Thus, the use of S-MMA as the sole indicator of cobalamin deficiency cannot be recommended.     

The diagnostic value of soluble CD163 in patients presenting with chest pain

BackgroundCD163 is a scavenger receptor for the uptake of haptoglobin–hemoglobin (Hpt–Hb) complexes. The Hpt–Hb complexes are being formed in the plaque in response to intraplaque hemorrhage, a hallmark of atherosclerotic plaque instability. We therefore investigated whether soluble CD163 (sCD163) was elevated in patients with an acute coronary syndrome.MethodsAll subjects presenting with chest pain suggestive of myocardial ischemia referred to either the emergency department or the coronary care unit were included in a prospective follow-up study. Plasma was collected and frozen at ? 80 °C until assayed. sCD163 was measured using a commercially available Elisa assay.ResultsOf 526 included chest pain patients, the final diagnosis was non-cardiac chest pain in 244 (46%) patients, non-STEMI in 67 (13%), and STEMI in 215 (41%). The non-STEMI patients were older, used more medication, had undergone more often coronary interventions, but did not differ with respect to risk factors, except for a higher incidence in dyslipidemia. Unexpectedly, sCD163 did not differentiate between patients with non-STEMI or STEMI and the non-cardiac chest pain patients (2.09 ± 0.76 versus 2.24 ± 0.86).ConclusionAlthough ACS is characterized by intraplaque hemorrhage, the amount of intraplaque Hb release seems not to be substantial enough to result in a measurable difference in sCD163.     

肝硬化患者血小板功能变化的临床意义

目的：研究血小板功能变化与肝硬化的关系。并探讨其临床意义。方法：采用血细胞分析仪检测了91例肝炎后肝硬化患者血小板计数（PLT），血小板平均体积（MPV），血小板压积（PCT）及血小板分布宽度（PDW），并与肝功能分级（Child-Pugh积分法）比较。结果：肝硬化组PLT、MPV、PCT较对照组无显著降低（P＜0．01）或P＜0．05），而PDW显著升高（P＜0．01）；肝硬化合并上消化道出血组PLT、MPV、PCT较无上消化道出血组均显著降低（P＜0．01）；肝功能A级组PLT、B级组PLT和MPV及C级组PLT、MPV、PCT较对照组均显著降低（P＜0．01或P＜0．05），C级组PDW较对照组显著升高（P＜0．01），B级组PLT、MPV较A级组显著降低（P＜0．01或P＜0．05），C级组LT、MPV、PCT较B级组均显著降低（P＜0．01或P＜0．05）。结论：血小板四项参数可间接反映血小板功能，对评估肝硬化患者肝脏功能损害的严重程度，判断有无出血倾向，指导临床治疗及其预后都具有重要的指导意义。     

肝硬化腹水病人肿瘤抗原CA125升高的临床意义

目的 :探讨肿瘤抗原 12 5 (CA12 5 )与肝硬化腹水的关系 ,评价CA12 5是否可以作为腹水发生的预测指标。方法 :170例患者分为腹水阳性和阴性组 ,分别测定血清CA12 5。结果 :47例腹水阳性病人中有 46例升高 ,占 97 8% ,平均值为 ( 3 2 1± 2 83 )u ml,而腹水阴性组 12 3例 ,只有 9例升高 ,占 7 3 % ,平均值为 ( 13± 15 )u ml,两组比较P <0 0 0 1,9例升高患者平均 1～ 3月内出现腹水。结论 :CA12 5在肝硬化腹水病人中多数呈阳性 ,且与腹水量呈正相关 ,CA12 5升高患者近期内出现腹水 ,说明CA12 5可作为肝硬化出现腹水的预测指标。     

肝硬化腹水病人肿瘤抗原CAl25升高的临床意义

目的 :探讨肿瘤抗原 12 5 (CA12 5 )与肝硬化腹水的关系 ,评价CA12 5是否可以作为腹水发生的预测指标。方法 :170例患者分为腹水阳性和阴性组 ,分别测定血清CA12 5。结果 :47例腹水阳性病人中有 46例升高 ,占 97 8% ,平均值为 ( 3 2 1± 2 83 )u ml,而腹水阴性组 12 3例 ,只有 9例升高 ,占 7 3 % ,平均值为 ( 13± 15 )u ml,两组比较P <0 0 0 1,9例升高患者平均 1～ 3月内出现腹水。结论 :CA12 5在肝硬化腹水病人中多数呈阳性 ,且与腹水量呈正相关 ,CA12 5升高患者近期内出现腹水 ,说明CA12 5可作为肝硬化出现腹水的预测指标。     

Effects of lifestyle intervention on soluble CD163, a macrophage activation marker,in patients with non-alcoholic fatty liver disease

Objective: Liver macrophages play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Soluble CD163 (sCD163), a macrophage-specific biomarker, reflects disease activity in the range of liver diseases. The impact of lifestyle intervention on sCD163 in adult NAFLD patients has not been investigated.

Material and methods: We assessed 126 NAFLD patients participating in a lifestyle intervention study for sCD163 concentrations at baseline, after the three-month intervention period, and at long-term follow-up after 12 and 24?months.

Results: The median sCD163 concentration at baseline was 2.59?mg/L (IQR?=?1.78–3.63?mg/L). There was a significant decrease in sCD163 from baseline to three months follow-up (?0.64?mg/L, p?<?.001) with no difference between the four study groups (p?=?.6). At 12 and 24?months follow-up, the sCD163 concentrations had returned to baseline level (p?=?.3 and p?=?.1). Baseline sCD163 correlated with liver biomarkers and metabolic variables. There was a significantly greater decrease in sCD163 in patients who had a decrease in alanine aminotransferase (ALT) compared with patients with unchanged or increased ALT (?0.76?mg/L vs. ?0.41?mg/L, p?=?.02), and in patients with a decrease in HOMA-IR compared with individuals with no decrease (?0.86?mg/L vs. ?0.55?mg/L, p?=?.03).

Conclusion: sCD163 is associated with markers of liver necro-inflammation and glucose homoeostasis in NAFLD. Participation in a lifestyle intervention programme resulted in a significant reduction in sCD163. Our data support the utility of sCD163 as a biomarker for monitoring the efficacy of therapeutic interventions in NAFLD.     

可溶性肿瘤坏死因子相关凋亡诱导配体在原发性胆汁性肝硬化患者血清中的表达及意义

目的观察人可溶性肿瘤坏死因子相关凋亡诱导配体（sTRAIL）在原发性胆汁性肝硬化（PBC）患者外周血中水平的表达,并探讨sTRAIL在PBC发病机制中的作用。方法用酶联免疫吸附测定（ELISA）法检测PBC患者26例（PBC组）,慢性肝炎肝硬化患者27例（慢性肝炎肝硬化组）以及健康体检者25例（正常对照组）的sTRAIL并同时测定IgG、IgA、IgM,观察各指标在PBC中的改变。结果PBC组和慢性肝炎肝硬化组sTRAIL浓度均显著高于正常对照组（158．73±42．45）pmol／L,（108．13±41.60）pmol／L vs（73．83±8．60）pmol／L（P〈0．01）。PBC组sTRAIL也较慢性肝炎肝硬化组明显升高（P〈0．01）。结论sTRAIL在PBC患者及慢性肝炎肝硬化患者血清中均升高,但二者升高程度比较差异有统计学意义,检测sTRAIL对PBC患者的,临床诊断中具有辅助作用并有助于PBC发病机制的研究。