Quantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C.

BACKGROUND/AIM: Quantitative tests of liver function may be superior to conventional tests to assess the prognosis of patients with liver diseases. There are insufficient data from quantitative testing of liver function (QTLF) for patients with chronic hepatitis B and C, particularly with regard to fibrosis. Therefore, we applied a broad panel of QTLF to these patients. METHODS: Three hundred and sixty-seven consecutive patients with chronic hepatitis B or C underwent liver biopsy and QTLF, which included tests for hepatic metabolism (aminopyrine breath test, galactose elimination capacity) and for hepatic perfusion (sorbitol clearance, indocyanine green clearance). QTLF values were correlated with liver histology (grading and staging for inflammation and fibrosis) and Child-Pugh classification for liver cirrhosis. RESULTS: In patients with no and moderate fibrosis, metabolic liver function was significantly decreased, whereas hepatic perfusion remained normal. Severe fibrosis and cirrhosis showed a significant decline in all QTLFs. Hepatic inflammation only reduced metabolic liver function, irrespective of the inflammatory grade. Viral etiology and HCV genotypes did not change QTLF. CONCLUSIONS: In summary, viral damage compromises hepatic metabolism before perfusion. Therefore, tests of metabolic liver function (aminopyrine breath test, galactose elimination capacity) should be useful to search for drugs that restore liver function in viral hepatitis irrespective of the fibrosis stage.     

Quantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C

Abstract: Background/Aim: Quantitative tests of liver function may be superior to conventional tests to assess the prognosis of patients with liver diseases. There are insufficient data from quantitative testing of liver function (QTLF) for patients with chronic hepatitis B and C, particularly with regard to fibrosis. Therefore, we applied a broad panel of QTLF to these patients. Methods: Three hundred and sixty‐seven consecutive patients with chronic hepatitis B or C underwent liver biopsy and QTLF, which included tests for hepatic metabolism (aminopyrine breath test, galactose elimination capacity) and for hepatic perfusion (sorbitol clearance, indocyanine green clearance). QTLF values were correlated with liver histology (grading and staging for inflammation and fibrosis) and Child–Pugh classification for liver cirrhosis. Results: In patients with no and moderate fibrosis, metabolic liver function was significantly decreased, whereas hepatic perfusion remained normal. Severe fibrosis and cirrhosis showed a significant decline in all QTLFs. Hepatic inflammation only reduced metabolic liver function, irrespective of the inflammatory grade. Viral etiology and HCV genotypes did not change QTLF. Conclusions: In summary, viral damage compromises hepatic metabolism before perfusion. Therefore, tests of metabolic liver function (aminopyrine breath test, galactose elimination capacity) should be useful to search for drugs that restore liver function in viral hepatitis irrespective of the fibrosis stage.     

Hepatocellular carcinomas do not compromise quantitative tests of liver function

BACKGROUND/AIMS: Hepatocellular carcinoma, which usually develops in cirrhotic livers, is one of the most frequent cancers worldwide. If and how far hepatoma growth influences liver function is unclear. Therefore, we compared a broad panel of quantitative tests of liver function in cirrhotic patients with and without hepatocellular carcinoma. METHODOLOGY: Patients with (n=40) and without (n=40) hepatocellular carcinoma were matched according to Child-Pugh grade and subjected to testing of aminopyrine demethylation capacity, galactose elimination capacity, sorbitol clearance and indocyanine green clearance. RESULTS: Compared to healthy controls, patients with cirrhosis Child-Pugh grade B and grade C revealed reduced metabolic (aminopyrine demethylation capacity, galactose elimination capacity) and perfusion-dependent QTLF (sorbitol clearance, indocyanine green clearance). Comparing values of quantitative tests of liver function in matched patients with and without hepatocellular carcinoma, no differences in liver function parameters were observed. CONCLUSIONS: Quantitative tests of liver function correlated inversely with the Child-Pugh grade. Since these parameters are not affected by the occurrence of hepatocellular carcinoma, the emergence of hepatic neoplasia in cirrhotics does not appear to be determined by the degree of hepatic functional deterioration.     

Can quantitative tests of liver function discriminate between different etiologies of liver cirrhosis?

Studies comparing quantitative testing of liver function (QTLF) in large numbers of patients with defined etiology of cirrhosis are lacking. In all 316 patients with proven cirrhosis underwent QTLF, including aminopyrine breath test (ABT), galactose elimination capacity (GEC), sorbitol (SCI), and indocyanine green clearance (ICG). Values were correlated with the Child-Pugh classification (CP) and the etiology of liver cirrhosis. Fifty-five percent of the patients had alcoholic cirrhosis (ALC), 31% cirrhosis due to viral hepatitis (VIC), and 14% primary biliary cirrhosis (PBC). In all three groups there was a decrease of QTLF levels from CP grade A to C, which differed from normal values. QTLF was most compromised in patients with ALC and VIC compared to patients with PBC. In conclusion, QTLF in ALC and VIC patients was more reduced than in patients with PBC. This may be due to saturation of enzymes in ALC and ongoing inflammation in VIC.     

Inducibility of microsomal liver function may differentiate cirrhotic patients with maintained compared with severely compromised liver reserve

BACKGROUND AND AIM: Quantitative tests of liver function (QTLF) can be modulated by enzyme-inducing agents. The objective of the study was to examine changes in QTLF after treatment with Phenobarbital, a potent cytochrome P450-inducing agent. METHODS: Forty-six consecutive patients with liver cirrhosis Child-Pugh score B and C (34 alcoholic, 12 hepatitis C) and a compromised aminopyrine breath test (ABT) were included. Thirty-six patients (group I) received phenobarbitone (150 mg) for 7 days. Ten patients (group II) received a placebo. The QTLF, which included ABT (microsomal liver function), galactose elimination capacity (GEC, cytosolic liver function), sorbitol clearance (SCl, liver plasma flow) and indocyanine green clearance (ICG, liver perfusion) was carried out before and after pharmacological induction. RESULTS: Group I showed a basal ABT of 0.18 +/- 0.11% dose.kg/mmol CO2 (normal >0.6%), which increased significantly after induction (172%, P < 0.05), whereas in group II the ABT values did not change. In group IB, a subgroup of group I which exceeded the basal threshold value of 0.30% after stimulation (n = 22), the ABT values increased significantly to 0.44 +/- 0.17% (244%, P < 0.01). The GEC, SCl and ICG remained unchanged before and after induction. CONCLUSIONS: After pharmacological induction, microsomal liver function increased significantly in a subgroup of patients with liver cirrhosis, whereas the GEC, SCl and ICG remained unchanged. Inducibility of the microsomal liver function could be used as a novel parameter of functional hepatic reserve and prognosis in cirrhosis.     

Noninvasive quantitative testing of liver function using ultrasonography in patients with cirrhosis

BACKGROUND/AIMS: Chronic liver disease is characterized by progressive hepatic fibrosis and changes in hepatic hemodynamics. Although there are sufficient hemodynamic ultrasonography data about patients with liver cirrhosis, reports of combinations of these data are insufficient. This study aimed to address the possibility of noninvasive diagnosis for the degree of hepatic fibrosis by evaluating the ultrasonography score, HCI (Hepatic Circulation Index), A/P (The peak velocity of hepatic artery/The peak velocity of portal vein), and CAT (hepatic vein circulation time) in patients with cirrhosis. METHODOLOGY: 53 cirrhosis patients underwent ultrasonographically-guided liver biopsy to confirm the diagnosis of cirrhosis. Values were correlated with the ultrasonography score, blood fibrosis makers, metabolic liver function tests and Child-Pugh classification. RESULTS: 53 patients participated in this study. The fibrosis stage of a total of 53 patients was > or = S2; 22.6% of the patients (n= 12) had cirrhosis of Child-Pugh grade A, 41.5% of grade B (n=22) and 35.9% of grade C (n=19). Liver function showed a steady decrease from Child-Pugh grade A to grade B and to grade C. In contrast, ultrasonography score was significantly increased in Child-Pugh grade A, B and C patients compared to healthy controls. Differences between the three Child grades were significant. CONCLUSIONS: Ultrasonography score and A/P correlated with Child-Pugh grades and HCI, CAT correlated inversely with Child-Pugh grades so they may be useful tools to predict prognosis or complications in cirrhosis.     

Improvement of quantitative testing of liver function in patients with chronic hepatitis C after installment of antiviral therapy

AIM: To investigate if and to what extent antiviral therapy influenced a broad panel of quantitative testing of liver function (QTLF). METHODS: Fifty patients with chronic hepatitis C were either treated with interferon (n=8), interferon/ribavirin (n=19) or peg-interferon/ribavirin (n=23). Quantitative testing of liver function, including aminopyrine breath test (ABT), galactose elimination capacity (GEC), sorbitol clearance (SCI) and indocyanine green clearance (ICG) was performed before and 3 mo after initiation of antiviral therapy. RESULTS: After 3 mo of antiviral treatment, 36 patients showed normal transaminases and were negative for HCV-RNA, 14 patients did not respond to therapy. ABT and GEC as parameters of microsomal and cytosolic liver function were reduced in all patients before therapy initiation and returned to normal values in the 36 therapy responders after 3 mo. Parameters of liver perfusion (SCI and ICG) were not affected by antiviral therapy. In the 14 non-responders, no changes in QTLF values were observed during the treatment period. CONCLUSION: ICG and SCI remained unaffected in patients with chronic hepatitis C, while ABT and GEC were significantly compromised. ABT and GEC normalized in responders to antiviral therapy. Early determination of ABT and GEC may differentiate responders from non-responders to antiviral treatment in hepatitis C.     

Quantitative testing of liver function compared to prognostic scores in patients with primary biliary cirrhosis

AIM: Primary biliary cirrhosis (PBC) is a slowly progressive liver disease which can lead to cirrhosis. We investigated if quantitative tests of liver function (QTLF) and serum levels of a surrogate marker of hepatic fibrogenesis (PIIINP) provide information in addition to established prognostic scores. METHODS: In 34 PBC patients PIIINP, PBC-relevant parameters, histological staging and QTLF at entry and at 2 years were determined and compared with the Christensen (CPS I, CPS II) and Mayo prognosis score. QTLF included aminopyrine breath test, galactose elimination capacity, sorbitol and indocyanine green clearance. RESULTS: Bilirubin, serum IgM and PIIINP were elevated at both time points, whereas albumin and prothrombin time remained normal. Clinical findings (ascites, cirrhosis, central cholestasis) and histological staging worsened after 2 years, as did the CPS II. However, QTLF, PIIINP, CPS I and the Mayo score revealed no significant changes. CONCLUSIONS: Only CPS II changed after 2 years, whereas CPS I and the Mayo score remained unaltered. QTLF and PIIINP did not provide any further information on progression of PBC, suggesting that QTLF cannot predict prognosis of PBC patients in a two-year interval and that CPS II is superior to CPS I and the Mayo score in short-term studies for PBC.     

Parameters of Microsomal and Cytosolic Liver Function But Not of Liver Perfusion Predict Portal Vein Velocity in Noncirrhotic Patients with Chronic Hepatitis C

Our aim was to compare color-coded Doppler sonography (CCDS) and quantitative testing of liver function (QTLF) in patients with chronic hepatitis C. In all, 74 patients with chronic hepatitis C and mild fibrosis underwent QTLF, which included aminopyrine breath test (ABT), galactose elimination capacity (GEC), sorbitol clearance (SC), and indocyanine green clearance (ICG). Hepatic artery velocity and resistance index (HA-V, HA-RI) as well as portal vein velocity (PV-V) were measured by CCDS. ABT, GEC, and PV-V were significantly reduced, whereas SCl, ICG, HA-V, and HA-RI showed normal levels. There was a significant correlation between reduction in PV-V only with GEC and ABT. QTLF did not correlate with HA-V and HA-RI. In conclusion, in hepatitis C patients with liver fibrosis, ABT and GEC are decreased significantly, which was paralleled by a reduction of PV-V. Unexpectedly SCl and ICG, the classical hepatic perfusion parameters, do not correlate with the parameters measured by CCDS.     

恩替卡韦治疗乙型肝炎失代偿期肝硬化的近期疗效观察

目的：观察恩替卡韦治疗乙型肝炎肝硬化失代偿期患者24周时的疗效。方法：乙型肝炎肝硬化失代偿期患者36例,采用恩替卡韦0.5mg/d,与32例对照组单纯支持对症治疗比较,观察24周时两组患者肝功能、Child-Pugh分级以及血清HBV DNA自基线下降的水平。结果：治疗24周时治疗组患者肝功能、Child-Pugh分级以及血清HBV DNA自基线下降的水平与对照组比较差异有显著性意义。结论：恩替卡韦能改善乙型肝炎肝硬化失代偿期患者肝功能,并能取得良好的抗病毒效果,提高生存率。     

肝炎肝硬化患者骨髓TPO、GM—CSF表达与外周血细胞的关系

目的探讨骨髓内环境造血因子血小板生成素（TPO）、粒细胞-巨噬细胞集落刺激因子（GM-CSF）在肝炎肝硬化患者骨髓液中的表达及其与外周血细胞的关系。方法选取31例肝炎肝硬化患者和15例健康对照组,晨起空腹采血、检测血常规、肝脏功能、肝炎病毒标志物,并行骨髓穿刺术,取骨髓液、离心分离,用双抗体夹心ELISA法检测骨髓液中TPO、GM-CSF浓度。结果肝炎肝硬化患者骨髓液TPO浓度与外周血血小板计数呈负相关（r=-0.496,P〈0.05）。骨髓液TPO的浓度在肝炎肝硬化组和对照组分别为（90.756±30.92）pg/ml、（118.414±49.232）pg/ml,二者之间有差异,但差异无统计学意义。肝脏功能按照Child-Pugh分为A、B、C级,分别与对照组比较,发现随肝脏损害加重,TPO浓度呈下降趋势,但差异无统计学意义。GM-CSF的浓度在肝硬化组和对照组之间差异无统计学意义。结论肝炎肝硬化患者骨髓内环境TPO浓度降低可能是外周血血小板计数减少的原因之一。肝脏功能状态及GM-CSF与外周血细胞计数变化的关系还有待进一步研究。     

A proposal of the modified liver damage classification for hepatocellular carcinoma.

OBJECTIVE: The purpose of this study was to evaluate the validity of the two common classifications for assessing liver function; the Child-Pugh classification and the liver damage classification. We also examined the feasibility of the modified liver damage classification. METHODS: A total of 2306 HCC patients diagnosed between 1990 and 2002 were categorized according to the three classifications. The modified liver damage classification is calculated by summation of the scores for five variables (serum bilirubin level, serum albumin level, prothrombin activity, ICG retention rate at 15min, ascites) of the liver damage classification and classified patients into grades A-C in the similar manner as the Child-Pugh classification. The differences in distribution and survival rate of the patients in each group were compared. RESULTS: With respect to the patient distribution, 1787 (77.5%) and 469 (20.3%) patients were categorized into Child-Pugh grades A and B, respectively, whereas 1187 (51.5%) and 962 (41.7%) patients were categorized into liver damage grades A and B, respectively. As a result of this disproportionate distribution, survival rates of Child-Pugh grades A and B were lower than those of the liver damage grades A and B. Furthermore, some discrepancies were found in the distribution of patients between the liver damage classification and the modified liver damage classification. One hundred and forty-one patients of the 1187 liver damage grade A patients were categorized into grade B by the modified liver damage classification and 71 patients of the 962 liver damage grade B patients were categorized into grade C by the modified liver damage classification. The survival rates of these subgroups were similar to those of the liver damage grades B and C, respectively. CONCLUSION: The modified liver damage classification appears to be the best available tool for assessing residual liver function, for estimating the survival of Japanese HCC patients and for making decisions concerning the treatment of these patients.     

Decreased serum total T3 level in hepatitis B and C related cirrhosis by severity of liver damage

Objective. Thyroid hormones profile in patients with hepatic cirrhosis due to chronic HBV and HCV infections was evaluated in order to find any relationship between thyroid hormones and severity of liver damage. Material and methods. Patients with the diagnosis of hepatic cirrhosis due to hepatitis B or C were screened for thyroid function status. Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Considering each thyroid function test, patients were divided into two groups with lower than normal and normal range of thyroid hormones, separately for each (for TSH, normal and upper than nor- mal). The correlation between thyroid function tests and severity of liver disease was taken into account. Results. Number of patients with a T3 level lower than normal range (70-110 ng/dL) significantly increased along with Child-Pugh scores A, B and C. A negative correlation was found between Child-Pugh scores and total serum T3 level (r = -0.453, P < 0.001). Also a reverse correlation was observed between MELD score and T3 levels (r = -0.305, P = 0.14). Conclusion. In conclusion serum T3 concentration is a good index of hepatic function, decreasing by the severity of liver damage.     

Serum hyaluronic acid concentrations in children with cirrhosis.

BACKGROUND: Liver disease is associated with increased levels of hyaluronic acid (HA). AIM: To evaluate serum HA concentrations in children with cirrhosis and its relation with liver function tests and Child-Pugh score. METHODS: Twenty-two children with biopsy-proven liver cirrhosis were studied. All were assessed for the presence of ascites or encephalopathy and liver function tests were performed. Patients were categorized according to Child-Pugh criteria. Serum HA was measured using microELISA (normal 0-100 ng/mL). Twenty-two children with chronic hepatitis B and no cirrhosis were studied as controls. RESULTS: Serum HA level in the cirrhotic children was 85.2 (72.8) ng/mL; levels were high (166.0 [46.3] ng/mL; range 115-246) in 8 (36.4%) patients. Three of 11 (27.2%) Child-Pugh class A patients, 3 of 8 (37.5%) class B patients, and 2 of 3 (66.7%) class C patients had elevated serum HA values (p=ns). Serum HA levels correlated with direct bilirubin level. The control group had lower levels (4.8 [2.3] ng/mL; p< 0.05), which were in the normal range. CONCLUSION: Serum HA level may be useful as a diagnostic tool in children with cirrhosis.     

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。     

乙型肝炎肝硬化患者外周血IL-35和IL-17的表达及意义

目的观察慢性HBV感染者外周血IL-35和IL-17的表达和临床指标的相关性。方法采集30例慢性乙型肝炎（CHB）患者、79例乙型肝炎肝硬化（LC）患者、14例慢性乙型重型肝炎（CSHB）患者、20例健康对照者的外周血,ELISA法测定外周血IL-35、IL-6、IL-17的浓度,分离制备外周血单个核细胞（PBMC）,实时定量PCR检测PBMC中EBI3、FOXP3、IL-17 mRNA的表达,Western印迹观察PBMC中EBI3、FOXP3、IL-17蛋白表达情况。所有病例及健康对照均进行肝功能检测。结果 LC、CHB和CSHB患者中EBI3、IL-17、FOXP3 mRNA表达水平均显著高于健康对照组,差异有统计学意义（P〈0.01或0.05）;LC组Child-Pugh不同分级患者之间EBI3、IL-17、FOXP3 mRNA表达水平差异明显,EBI3、FOXP3 mRNA随着肝硬化Child-Pugh分级的加重而表达下调;IL-17 mRNA随着肝硬化Child-Pugh分级的加重而上调;蛋白表达和血清浓度的变化趋势与mRNA一致。血清IL-17浓度水平与Alb呈负相关,IL-17浓度水平与TBil、ALT和Child-Pugh分级呈正相关,差异有统计学意义（P〈0.01）,IL-35浓度水平与Alb、Child-Pugh分级负相关,与ALT、TBil无相关性。结论 IL-35和IL-17可能是影响乙型肝炎肝硬化发病的重要因素之一。     

乙肝肝硬化血清透明质酸与HBV DNA的相关性

目的:探讨乙肝肝硬化患者血清透明质酸与HBV DNA水平的相关性.方法:收集乙肝肝硬化患者144例,其中女性42例,男性102例,平均年龄(54.42±11.53)岁,Child pugh A级42例,Child pugh B级40例,Child pugh C级62例,采用放射免疫法检测血清透明质酸,荧光定量PCR检测血清HBV DNA水平,对血清透明质酸、血清HBV DNA水平进行统计并分析两者之间的关系.结果:随着乙肝肝硬化Child分级的加重,患者的血清透明质酸水平也增高,不同分级之间的差异有统计学意义(174.10μg/L±127.98μg/Lvs421.35μg/L±176.96μg/Lvs903.58μg/L±212.02μg/L,P<0.01).不同Childpugh分级患者的血清HBV DNA水平差异无统计学意义(P>0.05).不同Child pugh分级患者的血清HBV DNA和透明质酸水平无显著相关性(P>0.05).结论:随着患者的Child pugh分级升高,HA水平显著增高,说明HA是反映肝硬化程度的敏感指标;乙肝肝硬化患者HBV DNA与肝硬化程度无显著相关,血清透明质酸与HBV DNA水平之间也无显著相关性,因此抗病毒和抗纤维化治疗对乙肝肝硬化患者同等重要.     

CT全灌注成像在肝癌TACE介入术前肝储备功能评估中的价值

目的探讨CT全灌注成像在肝癌TACE介入术前肝储备功能评估中的价值。方法选取2016年1月至2018年12月原发性肝癌患者68例,均于TACE术前3 d进行CT全灌注成像,比较患者正常肝组织与肿瘤组织的HAP、PVP、TLP、HAPI及不同Child-Pugh分级患者的HAP、PVP、TLP、HAPI,分析灌注参数与Child-Pugh分级的相关性。结果正常肝组织的HAP与HAPI分别为(30.10±8.69)ml/(min·100 mL)、(22.01±5.03)%显著低于肿瘤组织(81.47±19.86)ml(min·100 mL)、(69.85±15.41)%,PVP与TLP分别为(0.52±18.27)、(148.10±31.11)ml(min·100 mL)显著高于肿瘤组织(40.01±9.88)、(123.10±26.49)ml(min·100 mL)(P<0.05)。Child-Pugh A级患者的HAPI显著低于B级患者,PVP与TLP显著高于B级患者(P<0.05)。Spearman相关性分析显示,HAP与Child-Pugh分级之间无明显相关性(r=0.119,P=0.367);HAPI与Child-Pugh分级呈明显正相关(r=0.442,P=0.002),PVP、TLP均与Child-Pugh分级呈显著负相关(r=-0.550、-0.489,P<0.01)。结论CT灌注成像可定量反映不同Child-Pugh分级患者的血流动力学改变,评估患者肝储备功能,可为TACE术前评估、手术效果预测提供参考。     

内镜下乳头切开术与外科手术治疗胆总管结石合并肝硬化的回顾性分析

目的探讨内镜下乳头切开术（EST）与外科手术治疗胆总管结石合并肝硬化病例疗效及并发症情况的比较。方法1985年8月至2008年5月间,胆总管结石合并肝硬化患者中139例行EST术,98例行外科手术作为对照组。结果EST组和外科手术组取石成功率分别为95％和100％。术后并发症发生率EST组为16．5％,外科手术组为62．2％;术后死亡率EST组为5．O％,外科手术组为24．5％,两组差异均有统计学意义。并发症发生率与肝功能Child—Pugh分级关系：A级,两组比较差异无统计学意义,而B级与C级,两组比较差异有统计学意义。死亡率与肝功能Child-Pugh分级关系：A级与B级,两组比较差异无统计学意义,而C级,两组比较差异有统计学差异。结论与外科手术相比,EST治疗胆总管结石合并肝硬化可显著减少术后并发症发生率和死亡率,取石成功率高达95％。     

碱性成纤维细胞生长因子与慢性乙型肝炎及肝纤维化临床检测指标的关系

目的观察碱性成纤维细胞生长因子(b-FGF)在不同肝纤维化分期(S)肝组织中表达的差异性及其与临床检测常用的肝功能指标、肝纤维化指标、HBV DNA复制水平以及肝硬化Child-Pugh分级之间的关系。方法选取122例HBV引起的慢性肝炎及肝硬化患者,空腹静脉血检测:(1)肝功能指标:ALT、TBil、Alb;(2)肝纤维化指标:透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、Ⅳ型胶原(CⅣ);(3)HBV DNA复制水平;(4)对临床诊断肝硬化患者计算其Child-Pugh评分。行肝脏穿刺活检术后,经病理作纤维化分期(S1～S4)。免疫组织化学法测定肝组织中b-FGF在不同病理分期的表达及定位特点,半定量分析法计算b-FGF值,观察b-FGF与肝功能指标、肝纤维化指标、HBV DNA水平以及肝硬化Child-Pugh分级之间的关系。结果 (1)肝纤维化S1～S4期肝组织中b-FGF的表达部位及水平不同;(2)肝纤维化S1～S4期肝细胞中b-FGF的表达与肝纤维化分期(S1～S4)呈显著正相关(r=0.542,P<0.01);(3)不同肝纤维化分期中b-FGF的表达差异与患者ALT、TBil及Alb进行比较,其差异无统计学意义(P>0.05),不同肝纤维化分期患者,进行HBV DNA检测,其差异无统计学意义(P>0.05);(4)不同肝纤维化分期中,b-FGF与血清纤维化指标HA、PCⅢ、LN、CⅣ之间呈正相关;(5)b-FGF的表达与临床Child-Pugh分级无明显相关性。结论 b-FGF的表达与肝脏纤维化程度、肝纤维化指标有正相关关系,与患者ALT、TBil、Alb、Child-Pugh评分、及HBV DNA水平无关。