慢性乙型肝炎患者血清HA、PⅢ、CⅣ、LN含量与肝纤维化程度关系的探讨

目的探讨慢性乙型肝炎患者血清HA、PⅢ、CⅣ、LN含量与肝纤维化程度的关系。方法用放射免疫法检测56例慢性乙肝患者血清HA、PⅢ、CⅣ及LN的含量,运用临床资料和病理结果等进行的肝纤维化临床分期,用统计学方法对血清学指标和肝纤维化程度进行相关性分析。结果患者肝组织学的炎症程度分级与纤维化分期正相关(P<0.01)。血清HA、PⅢ、ⅣC、LN水平与肝脏纤维化程度呈正相关,有统计学意义(P<0.01)。结论慢性乙型肝炎患者血清HA、PⅢ、CⅣ、LN的含量在一定程度上反映肝纤维化的进展情况,对慢性乙肝患者肝纤维化的诊断和动态检测具有临床意义。     

慢性乙型肝炎患者血清HA、LN、Ⅳ C及P ⅢNP含量与肝纤维化程度的关系探讨

目的探讨慢性乙型肝炎(以下简称慢性乙肝)患者血清的肝纤维化程度与血清透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ C)及Ⅲ型前胶原氨端肽(P ⅢNP)含量的关系.方法用放射免疫法检测439例慢性乙肝患者血清HA、LN、Ⅳ C及PⅢNP的含量,同时结合临床特点、病理切片等,运用统计学方法对上述血清学指标的诊断价值进行分析.结果慢性乙肝轻、中、重度及肝硬化患者血清HA、LN、Ⅳ C及PⅢNP水平均不同程度高于正常对照组(P＜0.05或P＜0.01).肝硬化患者随着Child-Pugh分级的增加(A级到C级),血清HA、LN、ⅣC及PⅢNP含量均逐渐增加,且不同级别间有显著性差异(P＜0.01).结论上述四项肝纤维化血清学指标的检测能在一定程度上反映肝纤维化的进展情况,对慢性乙肝患者肝纤维化的诊断有重要意义.     

复方汉防己冲剂对慢性肝病的疗效

目的观察复方汉防己冲剂对急、慢性肝炎和肝硬化消炎、降酶及抗肝纤维化的疗效以及不良反应。方法应用复方汉防己冲剂对286例急、慢性肝炎和肝硬化患者进行治疗(即治疗组),每个疗程为3个月,治疗前后行肝、肾功能、血清PⅢP、HA、肝活检病理、免疫组化Ⅰ、Ⅲ胶原及超声、CT等检查。58例慢性肝病患者口服肝泰乐、肌苷片作为对照组。结果治疗组治疗后临床症状93.8%消失,ALT(96.8%)、SB(98.4%)降至正常,ALB(66.8%)升高,接近正常。与治疗前相比,血清HA及PⅢP含量明显降低,而肝纤维程度明显减轻(P<0.05～0.001);与对照组相比均有非常显著性差异(P<0.01),而肾功无明显变化(P>0.05)。结论复方汉防己冲剂对急、慢性肝炎早期肝硬化有很好消炎、降酶、抗肝纤维化及预防肝硬化发生、发展的作用。     

肝硬化患者血清内毒素和糖类抗原125水平相关性分析

目的探讨肝硬化患者血清内毒素和糖类抗原125水平的变化,观察两者的相关性与血清肝纤维化指标的关系。方法采用黨试验酶联法和化学发光法分别测定40例肝硬化患者血清内毒素、CA125和HA、PⅢP水平,并与40名正常健康人作比较。结果肝硬化患者血清内毒素、CA125和HA、PⅢP水平均非常显著地高于正常人组(P值均﹤0.01),血清内毒素水平与CA125、HA、PⅢP水平呈显著正相关(r=0.5813,0.6021,0.6233,P值均﹤0.01)。结论检测肝硬化患者血清内毒素、CA125水平的变化可以作为肝硬化严重程度Child-Pugh分级法的辅助指标,对正确评估病情和预后具有重要的临床意义。     

肝硬化患者血清红细胞生成素与HA、PⅢP水平的相关性探讨

目的 探讨肝硬化患者血清红细胞生成素与HA、PⅢP的相关性。方法 应用放免法对64例肝硬化患者进行了血清红细胞生成素和HA、PⅢP水平检测,并与35名正常健康人作比较。结果 肝硬化患者血清中红细胞生成素和HA、PⅢP水平均非常显著地高于正常人组（P〈0.01）,尤以肝硬化腹水组为甚（P〈0.001）,血清红细胞生成素水平分别与HA、PⅢP水平呈明显正相关（r=0.6218,0.6024;P〈0.01）。结论 检测肝硬化患者血清红细胞生成素HA和PⅢP水平的变化可作为病情及预后评价的重要指标。     

血清单胺氧化酶与肝纤维化四项在肝硬化早期诊断中的临床价值

目的探讨血清单胺氧化酶(MAO)的活性联合肝纤维化四项在肝硬化早期诊断中的临床价值。方法选取90例住院治疗的肝硬化患者作为观察组,选取90例同期进行健康体检的健康者作为对照组。运用速率法、放射免疫法来检测两组受试者血清中的MAO、肝纤维化四项的含量。结果观察组MAO活性、肝纤维化四项的含量高于对照组,差异均具有统计学上意义(P<0.05);MAO活性与肝纤维化四项的含量呈正相关。结论血清中的MAO活性联合肝纤维化四项含量可反映出肝纤维化的程度,且存在较好的相关性。相比MAO的敏感性更高,操作简便,利于在临床上推广应用。     

血清细胞外基质检测对肝纤维化诊断价值的研究

目的 探讨联合检测血清细胞外基质含量对肝纤维化的诊断价值.方法 采用放免法测定200 例各种临床型肝病患者血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层粘蛋白(LN)、Ⅳ型胶原(Ⅳ·C)含量,并与100 例健康人(对照组)做比较,分析各指标的变化特点及对肝纤维化的诊断价值.结果 慢性肝炎轻型以上组4项指标均显著高于对照组和急性肝炎组(P＜0.01),且4项指标随病程的进展而升高,联合检测4项指标对肝纤维化的诊断价值明显优于各单项指标.结论 联合检测4项指标可提高临床对肝纤维化诊断的准确性和可靠性,动态观察上述指标对掌握病情的演变和指导治疗有重要意义.     

血清肝纤维化标志物在肝硬化诊断中的价值

目的 研究血清肝纤维化标志物(LN、PⅢP、CⅣ)对肝硬化的诊断价值。方法 检测184例病毒性肝炎患血清肝纤维化标志物(LN、PⅢP、CⅣ)，检测结果经F检验(方差分析)及q检验确定统计学意义。结果 血清肝纤维化标志物(LN、PⅢP、CⅣ)，在肝炎肝硬化患中检测水平最高，与急性肝炎、慢性肝炎差异均具有显性(P＜o．01)。结论 血清肝纤维化标志物(LN、PⅢP、CⅣ)对肝炎肝硬化诊断具有明显的指导价值。     

血清瘦素与慢性乙型肝炎合并酒精性肝病肝纤维化的关系

目的 研究血清瘦素与慢性乙型肝炎合并酒精性肝病(CHB+ALD)肝纤维化的关系.方法 选择CHB+ALD患者17例、肝硬化(LC)15例、慢性乙型肝炎(CHB)19例,以12例男性健康受试者(NC)为对照组.采用ELISA法测定各组血清瘦素水平,同步检测血清肝纤维化指标透明质酸(HA)、层粘连蛋白(IN)、前胶原蛋白(PCⅢ)和Ⅳ型胶原(Ⅳ-C),对结果进行分析.结果 CHB+ALD组血清瘦素水平(6.79±24.12)μg/L高于对照组(4.27±7.18) μg/L(P＜0.05),单纯CHB组差异无统计学意义,CHB+ALD组患者肝纤维化四项指标高于单纯CHB组及NC组;CHB+ALD组血清瘦素水平与血清肝纤维化四项指标呈正相关(P＜0.05或P＜0.01).结论 血清瘦素是CHB+ALD患者肝纤维化形成的促进因子之一.     

肝纤维化血清标志物在肝病中的诊断价值

目的探讨肝纤维化血清标志物在肝病中的诊断价值。方法采用放射免疫分析法（RIA法）检测148例肝病患者的血清Ⅲ型前胶原、Ⅳ型胶原及层粘连蛋白的含量。结果慢活肝、肝硬化、肝癌组的血清Ⅲ型前胶原的含量均显著升高（P〈0．01）,而慢迁肝、急性肝炎组升高不明显（P〉0．05）：血清IV型胶原及层粘连蛋白含量在慢性肝炎、肝硬化及肝癌中均有不同程度的升高（P〈0．01）,尤以肝硬化组升高显著。结论Ⅲ型前胶原、Ⅳ型胶原及层粘连蛋白血清含量的联合检测可作为监测肝纤维化的发生与发展的较好指标。     

肝硬化患者血清肝功能指标与肝纤维化标志物的相关性研究

目的探讨肝血清纤维化指标与肝功能指标的相关性。方法按Child-Pugh分级标准将100例肝硬化患者分为A、B、C三级组,选择30例健康体检者作为正常对照组。测定肝纤维化4项指标和肝功能4项指标。结果结果在A、B、C三级组中,TBIL、TBA水平随着Child-Pugh积分的增高而升高(P<0.05);CHE和ALB水平随着Child-Pugh积分的增高而下降(P<0.05);血清肝纤维化标志物水平随Child-Pugh积分增加而呈上升趋势(P<0.05),肝纤维化4项指标与肝功能4项指标之间有相关性(r=0.8580～0.0053,P<0.05),与TBIL、TBA呈正相关,与CHE、ALB呈负相关。结论联合检测血清CHE、ALB、TBIL、TBA及PCⅢ、Ⅳ-C、LN、HA水平对估测肝硬化的严重程度及预后有十分重要的临床价值。     

Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis

Background  Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease.
Aim  To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements.
Methods  Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis.
Results  Of the 80 patients included, 91, 4% were women and their mean age was 56 ± 12 (s.d.) years. A significant correlation was found ( P  < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F  > 2 and 0.96 for F  = 4. Liver stiffness measurements were 9.0 ± 5.3 and 7.9 ± 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively ( P  > 0.05).
Conclusions  In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.     

扶正化瘀胶囊联合穴位注射治疗肝硬化疗效观察

目的 观察扶正化瘀胶囊联合穴位注射治疗肝硬化的疗效.方法 64例肝硬化患者随即分为两组,治疗组34例,服用扶正化瘀胶囊,5粒/次,3次/d,并联合丹参注射液穴位注射治疗.对照组30例,采用一般护肝以及对症治疗.观察治疗前后患者肝功能生化指标及肝纤维化指标变化,并与对照组对比.结果 两组治疗后肝功能生化指标与肝纤维化指标均有改善,治疗组肝功能生化指标的改善和肝纤维指标的下降均优于对照组,组间比较有统计学意义(P＜O.01或P＜0.05).结论 扶正化瘀胶囊联合穴位注射能有效控制肝硬化患者的肝纤维化进展,改善患者肝功能.     

Platelet activation in patients with chronic hepatitis C

OBJECTIVE: To elucidate the mechanisms of thrombocytopenia in chronic hepatitis C (CHC), we investigated platelet activation in patients with chronic viral liver diseases. METHODS: Platelet activation was evaluated with flow cytometry in twenty-five patients with chronic viral hepatitis and 11 patients with liver cirrhosis of viral etiology. Liver biopsies were carried out in all patients. RESULTS: The platelet counts decreased significantly in patients with CHC and in patients with liver cirrhosis compared to controls, but not in patients with chronic hepatitis B (CHB). Patients with CHC had a significantly higher percentage of platelets positive for activation-dependent monoclonal antibodies (MoAbs), and also had a higher percentage of platelet microparticles (PMP), a marker of platelet activation, than patients with CHB. There was a significant correlation between the percentage of PMP and the levels of liver fibrosis markers, such as serum hyaluronate and N-terminal propeptide of type III procollagen (P-III-P), in CHC, suggesting the relationship between platelet activation and liver fibrosis. Platelet activation was markedly enhanced in CHC patients with high histological scores of liver fibrosis. CONCLUSION: Patients with CHC have increased platelet activation, which may contribute to the occurrence of thrombocytopenia in CHC. Liver fibrosis may play a role in activation of platelets in CHC.     

Procollagen type III peptide in the assessment of liver fibrosis in children with congenital alpha-1-antitrypsin deficiency.

In 31 children with congenital alpha 1-antitrypsin deficiency the concentration of procollagen type III peptide was determined in a trial establishing liver fibrosis degree and monitoring of fibrosis progression. No correlation was found between the degree liver fibrosis determined by histological examination and the serum concentration of procollagen type III peptide. The concentration of procollagen type III peptide was higher with coexistent cholestasis and in case of inflammatory processes outside the liver (pneumonia). In progressing cirrhosis with inflammatory reaction the concentration was higher than in advanced cirrhosis and non-inflammatory liver fibrosis.     

超声检测慢性肝病患者肝中静脉的临床意义

目的 探讨B型超声检测肝中静脉内径在慢性肝病患者中的临床应用价值.方法 80例慢性肝病患者在接受肝穿刺活组织检查的同时,采用B型超声检测肝中静脉内径,用ROC曲线分析肝中静脉内径诊断肝硬化的强度.结果 肝硬化患者肝中静脉内径[(3.82±1.84)mm]小于慢性肝炎患者[(6.15±1.67)mm](P＜0.01),失代偿性肝硬化患者肝中静脉内径[(2.98±1.15)mm]小于代偿性肝硬化患者[(4.42±2.20)mm](P＜0.05);随着肝纤维化分期的增加,肝中静脉内径逐渐缩小,两者呈负相关关系(rs=-0.465),肝中静脉内径诊断肝硬化的截断点为4.7 mm,ROC曲线下面积(AUC)达到0.813(P＜0.01),其灵敏度为67.5%,特异度为90.0%,阳性预测值为88.0%,阴性预测值为73.5%,Youden指数为57.5%.结论 B型超声检测肝中静脉内径对慢性肝病有一定的辅助诊断价值.     

凯西莱（硫普罗宁）治疗肝硬化临床分析

目的探讨分析凯西莱（硫普罗宁）治疗肝硬化、改善肝脏功能的临床疗效。方法将100例不同病因确诊肝硬化患者随机分为治疗组50例,对照组50例。对照组应用常规综合治疗,治疗组在此基础上再加用凯西莱（硫普罗宁）0．2g静脉点滴,1次,d,疗程1个月。疗程结束时,比较两组患者肝功能及血清肝纤维化等指标变化。结果治疗组患者肝功能指标丙氨酸转移酶（ALT）、天门冬氨酸转移酶（AST）、总胆红素（TBil）、白蛋白（A）及血清肝纤维化指标：透明质酸（HA）、III型前胶原（PC—III）、IV型胶原（IV—C）、层粘蛋白（LN）改善与对照组比较,除ALT、LN指标差异无显著性意义（P均〉0．05）外,余指标间差异均有显著性（P〈0．05或〈0．01）。结论凯西莱（硫普罗宁）能改善肝硬化患者肝功能,同时有一定的促进肝细胞再生作用,对肝纤维化形成也有一定抑制作用,且不良反应少,疗效显著。     

Disease progression in Chinese chronic hepatitis C patients with persistently normal alanine aminotransaminase levels

BACKGROUND: Although chronic hepatitis C virus-infected patients with persistently normal alanine aminotransaminase levels usually have mild liver disease, disease progression can still occur. However, it is uncertain which group of patients is at risk of disease progression. AIM: To examine the severity of liver disease on liver biopsy in Chinese patients with persistently normal alanine aminotransaminase levels, and their disease progression over time. METHODS: Eighty-two patients with persistently normal alanine aminotransaminase levels were followed up longitudinally. The median time of follow-up was 8.1 years. Forty-seven of the 82 patients (57.3%) had a second liver biopsy. RESULTS: At the time of analysis, six of the 82 patients (7.3%) developed decompensated liver cirrhosis. Patients with an initial fibrosis stage F2 or F3 [6/23 (26.1%) vs. 0/59 (0%), P < 0.0001] or inflammatory grade A2 or A3 [5/40 (12.5%) vs. 1/42 (2.4%), P = 0.04] were more likely to develop decompensated liver cirrhosis. On multivariate analysis, initial fibrosis stage F2 or F3 was independently associated with progression to decompensated liver cirrhosis (relative risk 2.3, 95% confidence interval 0.03-2.5, P = 0.02). CONCLUSION: Chinese chronic hepatitis C virus patients with persistently normal alanine aminotransaminase levels with moderate to severe fibrosis at initial evaluation are more likely to develop decompensated liver cirrhosis.     

74例慢性肝炎患者肝纤维化血清学指标与肝穿刺病理分期相关性分析

目的分析慢性肝炎患者肝纤维化血清学指标与肝穿病理分期的相关性。方法回顾性统计分析2010年6月～2012年6月在本院确诊的慢性肝炎患者74例肝穿刺标本和血清学纤维化指标PⅢP、Ⅳ-C、HA、LN的资料。结果 74例患者血清PⅢP、Ⅳ-C、HA、LN与病理分期、分级呈良好的正相关,且与病理分期的正相关关系较分级明显。慢性乙肝患者肝组织学纤维化不同分期、不同分级间与HA、LN、PⅢP、Ⅳ-C四项血清纤维化指标关系秩和检验结果显示,随着肝纤维化程度加重,其值有逐渐升高的趋向,各项指标差异均有统计学意义（P〈0.05或P〈0.01）。结论四项肝纤维化检测指标,能较好地反映肝纤维化的发展,预测肝硬化,结合肝穿刺等其他检测,可提高诊断的准确性。