慢性肝炎及肝硬化辩证分型与血清肝纤维化指标的关系

本文研究结果显示慢性肝炎及肝硬化患者血清人Ⅲ型前胶原（ｈＰＣⅢ）、透明质酸（ＨＡ）、层粘蛋白（ＬＮ）均升高，其升高程度依次为肝郁脾虚型〈肝肾阴虚型〈脾肾阳虚型〈湿热中阻型〈瘀血阻络型，以湿热中阻、瘀血阻络升高最为明显。因此认为这两型是肝纤维化的关键，其中湿热是肝纤维化的启动因子，瘀血则是肝纤维化主要的病理基础。     

慢性肝炎的辨证分型与血清肝纤维化指标的关系

我们研究了123例慢性肝炎辨证分型与血清肝纤维化指标的关系,从中医理论探讨肝纤维化的病理基础,现报告如下。 1 材料与方法 1.1 临床资料 123例患者均为1995年10月～1996年9月住院病人,其中男78例,女45例,年龄17～68岁,平均年龄为38.9岁,临床诊断慢性病毒肝性炎,乙型104例,丙型19例,其中轻度24例,     

慢性肝炎肝纤维化病理分期和评估

慢性肝炎肝纤维化是由于慢性肝炎时反复的肝细胞坏死,主要是碎屑样坏死和桥样坏死引起肝网状支架塌陷,使肝细胞不能沿原有网状支架再生修复(一期愈合),而导致肝星状细胞(HSC)增生,产生细胞外基质,即由纤维结缔组织和再生的肝细胞共同修复(二期愈合),其结果是肝脏纤维结缔组织总量增多,即肝纤维化.     

慢性肝炎及肝硬化辨证分型与血清肝纤维化指标的关系

本文研究结果显示慢性肝炎及肝硬化患者血清人Ⅲ型前胶原(hPCⅢ)、透明质酸(HA)、层粘蛋白(LN)均升高,其升高程度依次为肝郁脾虚型<肝肾阴虚型<脾肾阳虚型<湿热中阻型<瘀血阻络型,以湿热中阻、 瘀血阻络升高最为明显。因此认为这两型是肝纤维化的关键,其中湿热是肝纤维化的启动因子,瘀血则是肝纤维化主要的病理基础。     

慢性肝炎肝硬化中医证型与血清肝纤维化指标关系的探讨

以放射免疫法测定152例慢性肝炎肝硬化患者的血清肝纤维化标志物透明质酸(HA)、Ⅲ型前胶原(hPCⅢ)和Ⅳ型胶原(Ⅳ-C)三项,旨在探讨中医证型与上述指标的关系。结果显示,各中医证型组的肝纤三项指标均为对照组升高,但改变有各自的特点,其中肝郁脾虚组的平均升高幅度最小,此为基础的两两比较发现,湿热中阻组肝纤三项均显著性升高;肝肾阴虚和瘀血阻络组以 HA、hPCⅢ升高为主。提示测定上述指标对慢性肝病患者的中医分型有一定指导意义,肝纤维化在肝郁脾虚阶段便已开始,湿热中阻是肝纤维化的活跃期,而血瘀则贯穿于肝纤维化的整个过程。     

慢性病毒性肝炎血瘀证患者肝功能及肝纤维化血清学指标的临床研究

目的:探讨慢性病毒性肝炎血瘀证患者的血清肝功能及肝纤维化指标变化.方法:根据临床症状将患者分为血瘀证组和非血瘀证组,观察两组患者的血清丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、白蛋白(Alb)、球蛋白(Glb)、A/G、肝纤4项(HA、LN、ⅣC、PCⅢ)水平,并进行对照.结果:血瘀证患者的HA、LN、Ⅳ-C值的平均秩(MEAN RANK)分别为31.52、31.96、32.06,高于非血瘀证组,P＜0.05.而ALT、Alb、Glb、A/G及PCⅢ经检验P＞0.05,提示血瘀证组与非血瘀证组差异无显著性意义.结论:病毒性肝炎血瘀证患者肝组织内存在活动性肝纤维化,提示肝病的慢性化趋势.     

血流速度测定和血清肝纤维化指标与慢性肝病病理分期的关系

目的：探讨门静脉血流动力学及血清HA,LN,Ⅳ－C,PCⅢ与慢性肝病病理分期的关系,方法：对100例慢性肝病患者用多普勒超声检测门静脉流动力,用放免法检测血清肝纤维化4项指标,同时进行肝活检,对肝纤维化进行分期。结果：病理S0－S4门静脉内径宽度和截面积逐渐增大,而血流速度逐渐减慢,血清肝纤维化4项指标与病理分期呈正相关,结论：联合检测门静脉血流动力学参数和血清肝纤维化4项指标可作为肝纤维化的早期评价标准。     

肝纤维化指标与中医辨证分型的关系

我们检测分析了186例肝炎、肝硬变患者血清4项肝纤维化指标与中医证型的关系。 1 临床资料 186例患者均为1998年3月～1999年11月间,我院门诊和住院病人。男134例,女52例;年龄20～70岁,平均年龄36.2±12.1岁;慢性肝炎者152例,肝炎后肝硬变者34例,病     

慢性乙型肝炎肝纤维化辨证分型与肝纤维化病理及血清学指标的相关性研究

目的:探讨慢性乙型肝炎(CHB)肝纤维化证型分布与血清肝纤维化指标及肝纤维化病理分期的相关性.方法:对确诊的171例CHB肝纤维化患者进行辨证分型,并观察肝纤维化病理分期、肝纤维化4项与辨证分型的关系.结果:肝郁脾虚型主要见于在肝纤维化早期(S1),瘀血阻络型主要见于肝纤维化中晚期(S3～S4),两者比较,各病理期的分布有显著性差异(P＜0.01);脾肾阳虚型、瘀血阻络型HA含量显著高于肝郁脾虚型,差异有显著性意义(P＜0.05或P＜0.01);瘀血阻络型HA含量高于肝肾阴虚型和湿热中阻型,差异有显著性意义(P＜0.05);瘀血阻络组LN和Ⅳ-C含量明显高于肝郁脾虚型,差异有显著性意义(P＜0.05);各证型患者血清PCⅢ含量差异无显著性意义(P＞0.05).结论:CHB肝纤维化不同病理阶段,证型分布发生相应变化,并与肝纤维化指标具有显著相关性.     

慢性肝炎肝硬化中医证型与血清肝纤维化指标关系的探讨

以放射免疫法测定152例慢性肝炎肝硬化患的血清肝纤维化标志物透明质酸(HA)、Ⅱ型前胶原(hPCⅡ)和Ⅳ型胶原(Ⅳ-C)三项．旨在探讨中医证型与上述指标的关系。结果显示．各中医证型组的肝纤三项指标均为对照组升高．但改变有各自的特点．其中肝郁脾虚组的平均升高幅度最小．此为基础的两两比较发现．湿热中阻组肝纤三项均显性升高；肝肾阴虚和瘀血阻络组以HA、hPCⅡ升高为主。提示测定上述指标对慢性肝病患的中医分型有一定指导意义．肝纤维化在肝郁脾虚阶段便已开始．湿热中阻是肝纤维化的活跃期．而血瘀则贯穿于肝纤维化的整个过程。     

慢性乙型肝炎患者中医证型与肝组织病理、肝内Ⅳ型胶原免疫组化及血清肝纤维化指标的关系

目的:探讨慢性乙型肝炎(CHB)患者中医证型与肝组织病理、肝内Ⅳ型胶原(CⅣ)及血清Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、CⅣ同步检测的相关性及对肝纤维化的诊断意义.方法:104例CHB患者进行中医辨证分型、肝组织病理学、肝内CⅣ免疫组化及血清PCⅢ、HA、CⅣ的检测.结果:①病理学诊断属CHB轻度者74例,中度21例,重度9例;②中医辨证分型:属肝郁脾虚型56例(53.88%)、肝胆湿热型3例(2.85%)、肝肾阴虚型14例(13.46%)、脾肾阳虚型5例(4.81%)及瘀血阻络型26例(25.00%);③CHB轻度组,中医辨证以肝郁脾虚型为主,占71.62%(53/74);中度组以瘀血阻络型为主,占66.66%(14/21);重度组病例均属瘀血阻络型.④依中医证型肝内CⅣ免疫组化检测,瘀血阻络型肝内CⅣ检测值显著高于其他各型(P＜0.01);⑤血清PCⅢ、HA与CⅣ检测值瘀血阻络型均显著高于其他各型(P＜0.01);⑥肝内CⅣ检测值与血清PCⅢ、HA和CⅣ检测值比较,呈明显正相关性(r值分别为0.995,0.993,0.984;均P＜0.01).结论:CHB患者肝组织病理、肝内CⅣ免疫组化及血清PCⅢ、HA、CⅣ同步检测与中医证型间有显著相关性,对指导CHB患者肝纤维化的诊断与治疗具有重要临床意义.     

Influence of Liver Fibrosis on Hepatic Artery Doppler Resistance Index in Chronic Hepatitis of Viral Origin

Background: Hepatic arterial Doppler sonography is increasingly being used in liver diagnostics. The determinants of the elevation of hepatic artery impedance indexes in chronic liver disease, however, have still not been fully clarified. The aim of the present study was to investigate the relationship between histological alterations and liver circulation in chronic hepatitis. Methods: Hepatic artery resistance index and portal flow velocity were measured using Doppler sonography in 47 patients with chronic hepatitis of viral origin diagnosed at histopathology. The patients were divided into two groups, those with mild and those with severe alterations, in accordance with the various histological parameters of the Knodell scoring system. Results:     

安络化纤丸对慢性肝炎患者肝纤维化指标的影响

目的 :观察安络化纤丸对慢性肝炎患者肝纤维化指标的影响。方法 :将 89例慢性肝炎患者随机分为对照组 ( 4 4例 )和安络化纤丸组 (治疗组 ,45例 )。两组治疗前和疗程结束后 ,采用放免法检测血清PCⅢ、HA、LN、Ⅳ C的水平 ,采用彩色多普勒超声仪观察门静脉内径、门静脉血流速度、门静脉血流量和脾脏厚度 ,对部分患者进行肝组织学检测。结果 :治疗前两组患者血清PCⅢ、HA、LN、Ⅳ C水平及门静脉内径、门静脉血流速度、门静脉血流量和脾脏厚度差异无显著性意义 (P >0 0 5 ) ,治疗组治疗后血清PCⅢ、HA、LN、Ⅳ C水平及门静脉内径、脾脏厚度与治疗前相比有显著性减低 (P <0 0 1) ,门静脉血流速度、门静脉血流量明显改善 (P <0 0 5 ) ,与对照组相比差异均有显著性意义 (P <0 0 1～ 0 0 5 )。结论 :安络化纤丸具有阻止和逆转慢性肝炎患者肝纤维化的作用     

拉米夫定联合双甲五灵胶囊的抗肝纤维化作用

目的研究拉米夫定与双甲五灵胶囊联合治疗对慢性乙型肝炎患者血清肝纤维化指标及肝脏病理组织学的影响。方法随机选择50例慢性乙型肝炎患者作为治疗组,给予口服中药双甲五灵胶囊,3次/d,6粒/次,并同时口服拉米夫定01g/d,疗程1年;同时设对照组,给予保肝对症治疗。动态观察服药0、6、12个月患者血清中肝纤维化指标透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(ⅣC)的变化;对其中8例患者治疗前后肝穿刺活检,用Masson三色组织化学染色后观察肝组织纤维化程度的改变。结果与对照组相比,治疗组患者4项血清肝纤维化指标明显下降(P<001)。肝细胞坏死、汇管区炎细胞浸润及纤维化明显减轻。结论拉米夫定联合双甲五灵胶囊治疗慢性乙型肝炎,可使患者血清HA、LN、PCⅢ、ⅣC含量显著下降,并减轻肝组织的炎症坏死和纤维化程度。     

抗纤散在慢性乙型肝炎抗纤维化治疗中的作用研究

目的:研究抗纤散(KXS)在慢性乙型肝炎(CHB,慢乙肝)抗纤维化治疗中的作用.方法:将40例慢性乙型肝炎患者随机分为两组,治疗组及对照组各20例.对照组给予保肝、退黄、降酶药物治疗,治疗组每日给予抗纤散汤剂200ml,分两次口服,其他治疗方案同对照组.治疗两个疗程后,分别检测两组患者血清乙肝标志物及丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、总胆红素(TBil)、Ⅲ型前胶原PCⅢ、层粘连蛋白(LN)、透明质酸(HA)的含量.结果:治疗组13例HBeAg( )阴转7例,对照组11例HBeAg( )只有1例转阴,治疗组患者血清ALT、AT、TBil、PCⅢ、LN、HA含量检测提示均显著低于对照组(P＜0.05).结论:抗纤散在慢性乙型肝炎抗纤维化治疗中有确切疗效.     

肝纤维化分期和血清生化学关系的研究

目的：探讨肝纤维化程度与血清纤维化标志物的关系。方法：67例肝炎患者均作肝脏活组织检查,标本行苏木精伊红染色（HE）和免疫组化染色,用光镜确定肝组织纤维化分期。采用放 射免疫法测定血清透明质酸（HA）,Ⅲ型前胶原（PCⅢ）,层粘连蛋白（LN）、Ⅳ型胶原（ⅣC）含量。结果：随着肝组织纤维化程度增加（S1→S4）,血清HA、PCⅢ、LN、ⅣC水平呈同步升高,在纤维化分期为S4时,含量最高。血清HA、PCⅢ、LN、ⅣC含量与慢性肝炎疾病进展呈一致性,随疾病加重而升高,在肝硬化阶段处于最高水平。结论：肝组织纤维化分期与血清HA、PCⅢ、LN、ⅣC有较好的相关性,血清纤维化指标可作为反映肝纤维化程度的指标之一。     

Evaluation of the Relation Between Hepatic Fibrosis and Basic Laboratory Parameters in Patients With Chronic Hepatitis B Fibrosis and Basic Laboratory Parameters

Background:

The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today.

Objectives:

This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B.

Patients and Methods:

The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed.

Results:

There were 320 male and 136 female patients, with a mean age 36.7 ± 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score (stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P = 0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men.

Conclusions:

According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.     

Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B

Background:

Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes.

Objectives:

To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis.

Patients and Methods:

This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA.

Results:

In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001).

Conclusions:

AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.     

HBsAg阳性慢性肝病患者肝组织HBV DNA分子状态与血清HBV标志物关系的研究

采用分子杂交技术对28例慢性肝病患者进行肝组织和血清HBV对比研究,结果表明:①肝组织HBV DNA阳性率显著高于血清HBV DNA阳性率,②血清DNA-P反映乙肝病毒的早期复制;③血清HBeAg阴性、Anti-HBe阳性时肝组织内可发现游离型HBV DNA及小片段DNA,表明肝内HBV正处于活跃复制状态,从分子水平证实了Anti-HBe阳性时部分患者可有传染性,需积极有效治疗:④慢迁肝和慢活肝中发现整合型HBV DNA较少,提示慢活肝经治疗后有希望达到从肝内清除乙肝病毒的目的。另外,也提示乙肝病毒在肝内的复制状态与病理损伤无直接关系。