乙型肝炎肝窦病变的免疫组织化学及电镜观察

目的　研究乙型肝炎（ ＨＢ） 肝窦病变的免疫组化表达及超微结构变化的病理意义．方法　ＨＢ 肝活检标本３００ 例， 用ＦＮ，ＬＮ，ＣｏⅣ，αＳＭＡ 及ＶＥＧＦ 单克隆抗体作免疫组化（ＳＰ 法） 染色；另对６５ 例按照电镜技术制样，作超微结构观察．结果　ＨＢ 肝窦有狭窄、阻塞、扩张及肝窦毛细血管化４ 种病变． ＡＨＢ 以肝窦狭窄及阻塞较重者占多数（９５ ％ ） ，而ＣＨＢ 则以肝窦扩张及毛细血管化最明显，两者差异显著（ Ｐ＜ ０－０１） ．肝窦狭窄时肝细胞水肿、微绒毛断裂、线粒体畸型、窦内皮细胞增生或损伤，窗孔减少，基膜物质增多，以αＳＭＡ，ＶＥＧＦ 强表达较前者显著（ Ｐ ＜ ０－０１） ． ＦＮ ，ＬＮ，ＣｏⅣ及αＳＭＡ 表达随肝窦扩张程度升降，与ＶＥＧＦ 表达明显不同（ Ｐ＜ ０－０１） ． 肝窦内皮细胞可出芽形成管腔，基膜物质增多而ＶＥＧＦ 则下降．结论　肝窦病变免疫组化及超微结构变化与ＨＢ 演变有关．     

老年痴呆患者血清及脑脊液载脂蛋白E含量的变化

目的评价Ａｌｚｈｅｉｍｅｒ病（ＡＤ）及多梗塞性痴呆（ＭＩＤ）患者血清及脑脊液（ＣＳＦ）中载脂蛋白Ｅ（ａｐｏＥ）含量变化的临床意义。方法用圆周免疫扩散法测定ＡＤ１４例、ＭＩＤ１８例及对照组１８例的血清ａｐｏＥ含量，同时测定部分患者ＣＳＦ中ａｐｏＥ含量，作对比分析。结果ＣＳＦ中ａｐｏＥ含量，ＡＤ组为０．３４±０．１０ｇ／Ｌ，明显低于对照组的０．５２±０．１６ｇ／Ｌ（Ｐ＜０．０５），ＡＤ组与ＭＩＤ组（０．４３±０．０８ｇ／Ｌ）、ＭＩＤ组与对照组间差异无显著性（Ｐ＞０．０５）；血清中ａｐｏＥ在３组间差异无显著性（Ｐ＞０．０５）。结论ＣＳＦ中ａｐｏＥ含量降低对ＡＤ的诊断及鉴别诊断可能有重要意义。     

特发性肺纤维化患者支气管肺泡灌洗液谷胱甘肽和透明质酸的检测

应用生化法和放射免疫分析法分别检测了不吸烟的１０例特发性肺纤维化（ＩＰＦ）患者和６例正常对照者支气管肺泡灌洗液（ＢＡＬＦ）和血中谷胱甘肽（ＧＳＨ）及透明质酸（ＨＡ）水平，以判断氧自由基代谢异常与肺纤维化的关系。结果：①ＩＰＦ患者ＢＡＬＦ中ＧＳＨ水平明显低于正常对照组（Ｐ＜０．０５）；②ＩＰＦ患者ＢＡＬＦ中ＨＡ水平明显高于正常对照组（Ｐ＜０．０５），且与嗜中性粒细胞计数呈显著正相关（ｒ＝０．６３４，Ｐ＜０．０５）；③血中ＧＳＨ和ＨＡ含量在病变组和对照组无明显差别。说明肺组织局部ＧＳＨ降低对肺纤维化形成有一定作用，ＢＡＬＦ中ＨＡ测定对判定肺泡炎程度有一定意义。     

高血压病患者动脉血管平滑肌细胞NO含量及作用

目的: 探讨在基础状态下高血压病患者（ＥＨ）动脉血管平滑肌细胞（ＶＳＭＣ）的一氧化氮合酶（ＮＯＳ）和一氧化氮（ＮＯ）的变化特点及其对ＶＳＭＣ增殖的影响。方法: 采用血压正常者（ＮＴ）及ＥＨ 患者的肠系膜动脉进行分离培养,对比观察ＮＴ组和ＥＨ 组的动脉ＶＳＭＣ的ＮＯＳ活性、ＮＯ含量、细胞计数和细胞周期的变化,研究ＥＨ 患者动脉ＶＳＭＣ的ＮＯＳ－ＮＯ系统的变化与细胞增殖的关系。结果:①在基础状态下,ＥＨ组动脉ＶＳＭＣ的ＮＯＳ活性和ＮＯ含量较ＮＴ组明显降低（Ｐ＜ ０．０５）。②ＥＨ组动脉ＶＳＭＣ的细胞数量明显高于ＮＴ组（Ｐ＜ ０．０５）。③ＥＨ组Ｓ期百分率和细胞增殖指数（ＰＩ）明显高于ＮＴ组（Ｐ＜ ０．０５）,ＥＨ组Ｇ０／Ｇ１ 期百分率较ＮＴ组明显降低（Ｐ＜ ０．０５）。④ＮＴ组和ＥＨ组的ＮＯＳ活性和ＮＯ含量与ＰＩ均呈负相关。结论:ＥＨ患者动脉ＶＳＭＣ存在着ＮＯＳ－ＮＯ系统功能低下;ＮＯ具有抑制ＶＳＭＣ增殖的作用     

急性颅脑损伤后脑脊液中心钠素和精氨酸加压素含量变化及其临床意义

对３４例急性脑外伤患者脑脊液（ＣＳＦ）中心钠素（ＡＮＦ）和精氨酸加压素（ＡＶＰ）的含量进行放射免疫测定。结果表明脑外伤后４８小时和６～１０天ＣＳＦ中ＡＮＦ含量较对照组均明显降低（Ｐ＜０．００１）；ＡＶＰ含量较对照组明显升高（Ｐ＜０．００１）。伤后２～３周ＣＳＦ中ＡＮＦ水平升高，与对照组相比无明显差异（Ｐ＜０．０５）；ＡＶＰ水平降低，但仍明显高于对照组（Ｐ＜０．０１）。Ｇｌｏｓｇｏｗｃｏｍａｓｃａｌｅ（ＧＣＳ）≤８分者ＣＳＦ中ＡＶＰ含量高于ＧＣＳ＞８分者（Ｐ＜０．０５）；ＣＳＦ压力≥１．９６ｋＰａ者ＡＶＰ含量高于ＣＳＦ压力＜１．９６ｋＰａ者（Ｐ＜０．０５）。ＡＮＦ的含量变化与ＧＣＳ计分和ＣＳＦ压力无关，提示ＡＮＦ和ＡＶＰ可能参与颅脑损伤的病理生理变化，ＡＮＦ的分泌减少与ＡＶＰ的释放增加可能是导致脑外伤后继发脑水肿的重要因素。     

四氯化碳肝纤维化大鼠储脂细胞表皮生长因子受体的变化

目的：研究四氯化碳（ＣＣｌ_４）所致实验性肝纤维化大鼠肝脏储脂细胞（ＦＳＣ）表皮生长因子受体（ＥＧＦ－Ｒ）的变化,探讨ＥＧＦ－Ｒ在ＦＳＣ激活中的作用。方法：~（１２５）Ｉ标记ＥＧＦ,放射配体结合分析测定正常和ＣＣｌ４肝纤维化大鼠肝脏原代ＦＳＣ的ＥＧＦ－Ｒ　结果：ＣＣｌ４肝纤维化大鼠肝脏ＦＳＣ数量（６．７１× １０~±５．３２ × １０~７）较正常大鼠（２．６３×１０~７±１．０４×１０~７）显著增多（Ｐ＜０．０５）;正常与 ＣＣｌ_４肝纤维化大鼠ＦＳＣ的ＥＧＦ－Ｒ最大结合位点数（ＲＴ）、解离常数（ｋＤ）分别为：２．２２ ×１０~３ｓｉｔｅｓ／ｃｅｌｌ,４．０９ × １０~(－１０）Ｍ和９．２７× １０~３ｓｉｔｅｓ／ｃｅｌｌ,３．２６× １０~(－１０）Ｍ。肝纤维化时ＥＧＦ－Ｒ明显增高（Ｐ＜０．０５）。结论：ＣＣｌ_４引起肝纤维化时ＦＳＣ增殖,同时ＥＧＦ－Ｒ的表达增加。     

老年人不同体质对心脏结构、血流、功能及血压的影响

目的观察体重对老年人心血管系统的影响。方法６２３例老年人根据体质指数（ＢＭＩ）分为肥胖、超重、正常及消瘦４组，检测血压、空腹血糖（ＢＳ）、胆固醇（ＴＣ）、甘油三酯（ＴＧ）及超声心动图。结果肥胖及超重组较正常体重及消瘦组收缩压（ＳＢＰ）及舒张压（ＤＢＰ）均增高（均为Ｐ＜０．０５），主动脉径（ＡｏＤ）、左房径（ＬＡＤ）、左室舒张及收缩末径（ＥＤＤ及ＥＳＤ）及心肌质量（ＬＶＭ）增加（均为Ｐ＜０．０５）。ＳＢＰ、ＤＢＰ均与体重、ＢＭＩ、ＴＣ、ＬＶＭ及心房收缩期与舒张早期充盈峰值流速（ＡＰＦＶ与ＥＰＦＶ）之比值（Ａ／Ｅ）呈明显正相关（Ｐ＜０．０５、０．０１或０．００１），ＤＢＰ与年龄呈明显负相关（Ｐ＜０．００１）。多元逐步回归分析证实ＬＶＭ、ＡＰＦＶ及ＬＡＤ均与ＢＭＩ呈正相关（均为Ｐ＜０．０１），ＥＰＦＶ与ＢＭＩ呈负相关（Ｐ＜０．０５）；射血分数（ＥＦ）、年龄、ＢＳ与ＳＢＰ呈正相关（Ｐ＜０．０５、０．００１及０．０１），与ＤＢＰ呈负相关（Ｐ＜０．０５或０．００１）。结论体重是影响心脏结构、血流、功能及血压的重要因素；ＥＦ、年龄、ＢＳ是分别影响ＳＢＰ及ＤＢＰ的独立因素。     

老年男性冠心病患者血清硫酸脱氢表雄酮含量变化的临床意义

目的观察老年男性冠心病患者血清硫酸脱氢表雄酮（ＤＨＥＡ－Ｓ）含量变化，探讨其与睾酮（Ｔ）、胰岛素（ＩＮＳ）、血糖（Ｇｌｕ）、甘油三酯（ＴＧ）、总胆固醇（ＴＣ）、载脂蛋白Ｂ（ａｐｏＢ）及年龄的相关性。方法用放免法测定６９例老年男性冠心病患者血清ＤＨＥＡ－Ｓ含量，并与３５例年龄匹配的男性健康人对照。结果冠心病组ＤＨＥＡ－Ｓ含量（２．９６±１．８０μｍｏｌ／Ｌ）显著低于对照组（４．０６±１．７６μｍｏｌ／Ｌ，Ｐ＜０．０１），病情重组（２．４４±１．３６μｍｏｌ／Ｌ）又明显低于病情轻组（３．３２±２．１２μｍｏｌ／Ｌ，Ｐ＜０．０５）；冠心病组ＤＨＥＡ－Ｓ含量与年龄呈负相关（ｒ＝－０．３０５４，Ｐ＜０．０１），对照组两者也呈负相关（ｒ＝－０．３６１５，Ｐ＜０．０５）；冠心病患者ＤＨＥＡ－Ｓ降低与空腹血清ＩＮＳ、ＴＧ及ａｐｏＢ增高均呈负相关（分别为ｒ＝－０．３２９７、－０．２５１９及－０．２４１３，Ｐ＜０．０１或０．０５）。结论老年男性冠心病患者血清ＤＨＥＡ－Ｓ含量降低，并与冠心病某些危险因素如老年、高胰岛素血症、高甘油三酯血症、血清ａｐｏＢ高值相关，但其确切的发病机理有待深入研究。     

转化生长因子α与增殖细胞核抗原在血HBsAg阳性人肝组织中的表达及其意义

目的：探讨慢性肝病的病变机制。方法：应用免疫组化检测人肝组织ＴＧＦ－α与ＰＣＮＡ的表达，同时测血清ＡＦＰ。结果：ＴＧＦ－α的表达在ＣＡＨ－Ｂ，ＬＣ．ＨＣＣ肝组织两两比较差异无显著性（Ｐ＞０．０６），ＰＣＮＡ的表达在ＣＡＨ－Ｂ与ＨＣＣ组差异无显著性（Ｐ＞０．０５）．但分别与ＬＣ组相比差异有显著性（Ｐ＜０．０５）；血清ＡＦＰ值＞２０μｇ／Ｌ例数在ＣＡＨ－Ｂ与ＨＣＣ组间差异无显著性（Ｐ＞０．０５），分别与ＬＣ组比较差异有显著性（Ｐ＜０．０５），正常肝组织上述各指标皆阴性。结论：ＴＧＦ－α能诱导肝细胞增殖分化，但可被某些因子抑制，致肝组织呈现不同的病理变化。有ＰＣＮＡ表达者其相应血清中ＡＦＰ明显升高。     

肝硬化患者血浆亮啡肽,神经肽Y含量的变化及临床意义

目的　探讨肝硬化患者血浆亮啡肽（ＬＥＮＫ）、神经肽Ｙ（ＮＰＹ）含量的变化规律及其临床意义。方法用放射免疫法检测４９例肝硬化患者血浆ＬＥＮＫ、 ＮＰＹ含量，并以１８例慢性肝炎、１４例急性肝炎和１０名健康者作对照。结果　肝硬化患者血浆ＬＥＮＫ含量显著高于正常人和急、慢性肝炎（Ｐ＜０．０５），有腹水、肝性脑病者分别显著高于无腹水和无肝性脑病者（Ｐ＜０．０５）；而血浆ＮＰＹ水平肝硬化患者明显下降（Ｐ＜０．０５），有腹水或肝性脑病者下降更明显（Ｐ＜０．０５）。结论肝硬化患者血浆ＬＥＮＫ、ＮＰＹ等内源性神经肽水平明显变化，且以有腹水、肝性脑病等严重并发症者更为明显，提示这些神经肽可能参与了肝硬化患者的高动力状态循环异常，并与腹水及肝性脑病形成有关。     

肝硬化患者血浆及胃粘膜内血管活性肠肽和生长抑素含量的变化及意义

采用放射免疫测定法研究了肝硬化（ＨＣ）患者血浆及胃粘膜内血管活性肠肽（ＶＩＰ）和生长抑素（ＳＳ）含量变化及其意义。结果表明：肝硬化患者血浆和胃粘膜内的ＶＩＰ含量和ＳＳ含量均显著高于正常对照组（Ｐ＜０．０１）；ＨＣ伴溃疡病患者血浆及胃粘膜中ＳＳ含量显著高于无溃疡的ＨＣ患者（Ｐ＜０．０５）；血浆及胃粘膜中ＶＩＰ的含量随着胃、十二指肠粘膜充血程度的加剧而升高；并且血浆及胃粘膜内ＶＩＰ和ＳＳ含量与肝功能密切相关。提示：在ＨＣ时存在着严重的胃肠激素代谢率乱，并且它在ＨＣ的病理生理机制和ＨＣ时胃肠功能改变和病理变化中起着重要作用。     

原发性干燥综合征与脂代谢紊乱关系初探

目的 了解原发性干燥综合征(pSS)患者血脂水平情况,探讨脂代谢紊乱与pSS的相关因素及可能的机制.方法 选取114例pSS患者和20名健康者对照,回顾性分析血脂水平变化及与临床和实验室指标之间的关系.结果 pSS患者平均血清高密度脂蛋白胆固醇(HDL-c)与载脂蛋白A1(apoA1)水平低于正常(P<0.05).pSS中39.5%存在血脂异常,血脂异常组较健康对照组平均病程较长,腮腺肿大发生率高,红细胞沉降率(ESR)增快、唾液流率降低明显(P<0.05).Logistic回归分析发现腮腺肿大与pSS患者出现血脂异常相关.经单独或联合调脂治疗,pSS症状可得到改善,而随着疾病活动性减轻,血清脂质也恢复正常.结论 pSS患者存在血脂水平异常,且脂类代谢的紊乱与pSS的病情密切相关.控制血脂升高、改善有害脂质可能对pSS的治疗起到积极的作用.     

Dopamine uptake by platelets in hepatic encephalopathy; evidence for a possible depletion of brain dopamine.

A decrease in H3-dopamine uptake was demonstrated in the blood platelets of 22 hepatic encephalopathy (HE) patients when compared to that of patients with liver cirrhosis, but without HE, and controls. There was a direct correlation between the stage of HE and the decrease in H3-dopamine uptake. As blood platelets have characteristics similar to neurons which contain amines, they have been proposed as a model for the study of amine metabolism in neurological, as well as liver diseases. A defective dopamine uptake by the HE platelets suggests that a similar biochemical derangement is, also, present in the nerve cells of the dopaminergic system. This could account for the clinical evidence of extrapiramidal dysfunction and the arousal effect of levodopa in HE. Platelets from 10 cirrhosis, but HE-free, patients had a dopamine uptake which was intermediate between the HE patients and controls. When octopamine was added at the same concentrations as in serum of HE patients, the blood platelets from five controls showed a decrease in dopamine uptake proportional to the concentration of octopamine added. Octopamine may impair dopamine uptake by platelets from HE patients.     

Plasma and CSF Benzodiazepine Receptor Ligand Concentrations in Cirrhotic Patients with Hepatic Encephalopathy: Relationship to Severity of Encephalopathy and to Pharmaceutical Benzodiazepine Intake

Increased plasma and CSF concentrations of substances which bind to brain benzodiazepine receptors have previously been reported in cirrhotic patients with hepatic encephalopathy (HE). However, their relationship to previous intake of pharmaceutical benzodiazepines has not been clearly established. In the present study, plasma levels of benzodiazepine receptor ligands (BZRLs) were measured using a sensitive radioreceptor assay in 12 control subjects with no evidence of hepatic, neurological or psychiatric illness, 11 cirrhotic patients without HE, 24 cirrhotic patients with moderate (grade I-II) HE and in 45 cirrhotic patients with severe (grade II-IV) HE. In addition, CSF concentrations of BZRLs were measured in 8 cirrhotic patients with HE and an equal number of age-matched controls. Recent intake (within 10 days) of pharmaceutical benzodiazepines was assessed by detailed review of medical files, and interviews with the patient, at least one family member as well as the pharmacist. Significantly increased plasma concentrations of BZRLs were observed in cirrhotic patients with severe encephalopathy (p<0.02) compared to controls and to cirrhotic patients without (or with mild) neurological impairment. Increased plasma BZRLs could be accounted for by prior exposure to benzodiazepine medication in all cases. CSF concentrations of BZRLs in cirrhotic patients were not significantly different from control values. These findings do not support a role for endogenous benzodiazepines in the pathogenesis of HE in chronic liver disease but suggest that pharmaceutic benzodiazepines administered to cirrhotic patients as sedatives or as part of endoscopic work-up could have contributed to the neurological impairment in some patients.     

Sexual differentiation of growth hormone feedback effects on hypothalamic growth hormone-releasing hormone and somatostatin

To investigate possible sex differences in the feedback regulation of growth hormone (GH) secretion, concentrations of immunoreactive GH-releasing hormone (GRF) and somatostatin (SS) were measured in the median eminence (ME) and the hypothalamus of male and female rats bearing the MtTW15 tumor, which secretes high amounts of GH and prolactin (PRL). Four weeks after tumor implantation in male rats, the GRF concentration in the whole hypothalamus, including the ME, was decreased by 37% (0.29 +/- 0.02 vs. 0.46 +/- 0.02 ng/mg protein in intact male controls; p less than 0.001) and the concentration of SS was increased by 40% (11.5 +/- 0.7 vs. 8.1 +/- 0.3 ng/mg protein in male controls; p less than 0.01). In female rats, the presence of tumor for 4 weeks caused a smaller (18%) reduction in GRF concentrations (0.27 +/- 0.02 vs. 0.33 +/- 0.03 ng/mg protein in intact female controls; p less than 0.05) and no significant change in SS concentrations (10.2 +/- 0.08 vs. 9.7 +/- 0.8 ng/mg protein in female controls). Tumor-related changes in GRF and SS concentrations were also more pronounced in male rats than in females, when determined separately in the microdissected ME and in the remaining hypothalamus. These differences occurred despite similar increases in serum GH, PRL and insulin-like growth factor I concentrations in male and female tumor-bearing rats. To assess which hormone (GH or PRL) was responsible for these changes, intact male rats were treated for 10 days with 2 daily s.c. injections of rat GH (rGH; 100 and 250 micrograms/day), rat PRL (100 and 250 micrograms/day) or vehicle.(ABSTRACT TRUNCATED AT 250 WORDS)     

脑脊液磷酸化tau蛋白的检测对阿尔茨海默病的诊断价值

目的通过对阿尔茨海默病(AD)患者脑脊液磷酸化tau蛋白检测的研究,探讨其对AD的诊断价值。方法采用ELISA法检测11例AD患者(AD组)、13例血管性痴呆患者(血管性痴呆组)及29例非神经系统疾病患者(正常对照组)的脑脊液磷酸化tau蛋白。结果与血管性痴呆组和正常对照组比较,AD组患者脑脊液中磷酸化tau蛋白含量明显增高(P<0.05)。血管性痴呆组患者脑脊液中磷酸化tau蛋白水平与正常对照组比较无明显差异(P>0.05)。结论检测脑脊液磷酸化tau蛋白含量可作为AD诊断的辅助指标。     

脑血管疾病病人脑脊液中NO和GSH-Px及锌离子的水平研究

目的探讨一氧化氮（NO）、谷胱甘肽过氧化物酶（GSH-Px）和锌离子在不同脑血管疾病病人脑脊液中的变化和意义.方法分别检测不同程度及不同渗透压脑出血、蛛网膜下腔出血病人脑脊液（CSF）中NO、GSH-Px和锌离子的水平,并分析其临床意义.结果在各种脑血管疾病病人中的重症组NO均明显高于轻症组（P〈0.05）,而轻症组又明显高于对照组（P〈0.05）;GSH-Px、锌离子明显低于轻症组,而轻症组又明显低于对照组.CSF中NO和GSH-Px呈负相关（r=-0.57,P〈0.05）,锌离子与GSH-Px呈正相关（r=0.68,P〈0.05）.CSF渗透压高组的NO含量显著高于渗透压低组（P〈0.05）,而CSF渗透压高组的GSH-Px含量显著低于渗透压低组.结论检测CSF中 NO、GSH-Px及锌离子含量可推断脑出血及蛛网膜下腔出血病人被自由基损伤的程度和清除自由基的水平.     

氟美松对激素抵抗型哮喘患者外周血单个核细胞的影响

为探讨激素抵抗（ＳＲ）型哮喘的发病机制，应用植物血凝素（ＰＨＡ）对淋巴细胞的增殖试验，观察不同浓度的氟美松对淋巴细胞增殖的抑制作用，并采用放射免疫法（ＲＩＡ）测定血浆皮质醇浓度。结果显示：氟美松对ＳＲ型哮喘患者淋巴细胞增殖的抑制作用明显低于激素敏感（ＳＳ）型哮喘患者（Ｐ＜０．０５）；ＳＲ型、ＳＳ型哮喘患者的血浆皮质醇浓度明显低于正常对照组（Ｐ＜０．０１），ＳＲ型又明显低于ＳＳ型（Ｐ＜０．０５）。提示：（１）ＳＲ型哮喘患者的淋巴细胞对糖皮质激素的抑制作用弱，反应性降低；（２）ＳＲ型哮喘患者的血浆皮质醇浓度明显降低与长期大量应用糖皮质激素有关。     

肝硬化患者尿Crosslaps检测在骨代谢异常诊断中的价值

为探讨尿骨胶原胶联 (Crosslaps)、尿钙离子 /肌酐 (Ca2 /Cr)与肝硬化骨代谢异常的关系。分别测定 6 1例乙肝后肝硬化患者尿Crosslaps水平、尿Ca2 /Cr及骨密度测量 ,并与 30例健康者对照。结果表明 ,肝硬化组尿Crosslaps水平较对照组明显升高 (P <0 0 1) ,其中骨质疏松 (OP)组与非骨质疏松 (NOP)组比较有明显差异 (P <0 0 5 ) ,且OP组尿Crosslaps水平与尺桡密度呈负相关 (r=- 0 4 33,P <0 0 1)。尽管OP组尿Ca2 /Cr较NOP组升高 (P <0 0 1) ,但与尺桡密度无相关性 (r =- 0 2 37,P >0 0 5 )。提示尿Ca2 /Cr不能作为肝硬化骨吸收指标 ,而尿Crosslaps变化对肝性骨病的诊断有一定意义