艾滋病患者心电图改变与转氨酶的关系研究

目的:了解艾滋病患者心电图改变与转氨酶的关系。方法:将416例艾滋病患者按生化检查转氨酶定量测定结果分为转氨酶正常组、丙氨酸氨基转移酶升高组、天门冬氨酸氨基转移酶升高组、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶同时升高组,对各组患者的心电图做出诊断,分析艾滋病患者心电图改变与转氨酶的关系。结果:①4组艾滋病患者心电图异常率之间差异无统计学意义(P0.05)。②艾滋病患者心电图快速心律失常:转氨酶正常组54例,占26.47%;丙氨酸氨基转移酶升高组6例,占19.35%;天门冬氨酸氨基转移酶升高组21例,占46.67%;丙氨酸氨基转移酶和天门冬氨酸氨基转移酶同时升高组32例,占23.53%。③天门冬氨酸氨基转移酶升高组心电图快速心律失常发生率分别高于转氨酶正常组、丙氨酸氨基转移酶升高组、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶同时升高组(P0.05)。结论:艾滋病患者天门冬氨酸氨基转移酶升高时,心电图快速心律失常发生率高,提示心肌有炎性改变。     

基于方证辨证之茵陈四逆汤治疗慢性乙型肝炎阴黄患者临床观察*

目的 评价茵陈四逆汤治疗慢性乙型肝炎（CHB）阴黄患者的临床疗效。方法 采用随机数字表法将60例CHB患者分为两组,给予30例对照组患者降酶、退黄、抗病毒治疗,观察组在对照组治疗的基础上加用茵陈四逆汤治疗。结果 在治疗8 w末,观察组临床总有效率为96.7%,显著高于对照组的86.7%（P<0.05）;观察组血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBIL）水平分别为【（24.0±9.3） U/L、（21.4±8.3） U/L和（26.9±7.8） μmol/L】,显著低于对照组【分别为（39.5±8.8） U/L、（33.3±8.5） U/L和（60.6±5.0）μmol/L,P<0.05】。结论 在综合治疗的基础上加用茵陈四逆汤治疗CHB阴黄证患者具有显著的临床疗效。     

超声引导下经皮微波消融治疗原发性肝癌患者疗效分析*

目的 探讨超声引导下经皮微波消融联合胸腺素-α1治疗原发性肝癌（PLC）患者的疗效。方法 2011年3月~2013年3月我院收治的PLC患者104例,随机分为观察组52例和对照组52例。对照组采用超声引导下经皮微波消融术治疗,观察组于术后皮下注射胸腺素-α1 4周。比较治疗前和治疗后外周血T淋巴细胞亚群、肝功能、甲胎蛋白（AFP）水平变化和两组肿瘤复发或转移及3年生存情况。结果 在治疗4周时,观察组外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺比值分别为71.49±6.57%、43.12±2.89%、15.89±3.24,显著高于对照组的43.21±3.74%、24.56±2.36%、5.42±2.13 （P<0.05）;观察组血清白蛋白（ALB）为39.84±2.56 g/L,显著高于对照组的34.12±1.87 g/L,丙氨酸氨基转移酶 （ALT）、天门冬氨酸氨基转移酶（AST）、AFP水平分别为34.87±3.08 U/L、43.39±2.08 U/L、85.42±10.42 μg/L,显著低于对照组的61.39±3.64 U/L、56.74±3.46 U/L、164.29±14.35 μg/L;随访3年,观察组肿瘤复发率和转移率分别为30.8%和15.4%,显著低于对照组的50.0%和32.7%（P<0.05）,观察组生存率为23.1%（12/52）,显著高于对照组的5.8%（3/52,P<0.05）。结论 超声引导下经皮微波消融后继续接受α-1胸腺素治疗PLC患者效果显著,可降低肿瘤复发或转移,延长生存时间,值得研究。     

细菌感染诱发乙型肝炎肝硬化患者发生肝性脑病60例回顾性研究

目的 总结乙型肝炎肝硬化患者发生肝性脑病（HE）与细菌感染的相关性。方法 回顾性分析60例由细菌感染诱发的肝性脑病和60例乙型肝炎肝硬化的临床资料,应用SPSS 20.0统计软件包进行统计学分析。结果 60例HE患者血清白蛋白为（24.3±6.1） g/L,显著低于肝硬化患者的（26.8±3.9） g/L;肝硬化患者血清丙氨酸氨基转移酶、总胆红素、肌酐、INR和白细胞计数分别为（112.6±18.5） U/L、（79.7±23.0） μmol/L、（71.5±16.1） μmol、（1.9±0.4）和（6.8±2.5）×10⁹/L,明显低于HE组的（201.3±59.4） U/L、（112.6±33.4） μmol/L、（98.6±26.4） μmol、（2.1±0.60和（10.9±2.7）×10⁹/L,差异具有统计学意义（P<0.05）;腹膜炎和呼吸系统感染患者发生3期和4期HE的比率显著高于泌尿系统或其他部位感染者 （x²=13.34,P<0.001）。结论 合并细菌感染的乙型肝炎肝硬化患者更容易诱发肝性脑病,应注意预防。     

双抗原夹心ELISA法检测登革病毒感染患者血清中的EDⅢ抗体

目的 建立一种检测登革病毒(dengue virus, DENV)特异性抗体的双抗原夹心ELISA方法?方法 利用毕赤酵母系统表达4个血清型登革病毒包膜蛋白Ⅲ区(envelope protein domain Ⅲ, EDⅢ),并采用改良过碘酸钠法对EDⅢ蛋白标记辣根过氧化物酶(Horseradish peroxidase, HRP),建立一种可同时检测4个血清型登革病毒EDⅢ蛋白特异性抗体的双抗原夹心ELISA法?并对2014年广州珠江医院门诊和住院确诊的登革热患者血清标本进行检测,并与澳洲Panbio MAC ELISA检测的敏感性进行比较?结果 本研究成功建立了一种检测4个血清型登革病毒EDⅢ蛋白特异性抗体的双抗原夹心ELISA法,该方法能同时检测到4个血清型登革病毒EDⅢ蛋白免疫的小鼠血清和Ⅰ型登革病毒EDⅢ蛋白免疫的兔血清,而与烟曲霉AF-MP蛋白免疫的小鼠血清和兔血清均无交叉反应?对184份健康人血清标本检测全为阴性,而对168份确诊为登革病毒感染患者血清标本检测结果表明,两种诊断方法检测结果差异无统计学意义,P<0.001(57.1% vs 57.7%),联合NS1抗原检测方法,其敏感性提高到97.6%?结论 双抗原夹心ELISA法检测登革病毒EDⅢ特异性抗体具有高度的特异性,但如果能同时联合抗原检测可明显提高登革热的早期诊断率?     

2015-2016年深圳市登革Ⅲ、Ⅳ型分离病毒株E/NS1基因序列特征

目的 了解2015-2016年深圳市分离的登革Ⅲ、Ⅳ型病毒E/NS1基因序列特征及登革Ⅲ、Ⅳ型病毒流行规律,探究其可能的传播来源。方法 收集2015-2016年深圳市登革热患者病例资料及急性期血清,用C6/36细胞培养分离登革病毒,用FQ-PCR对其进行血清分型,分离成功的病毒株用反转录-聚合酶链反应(PCR)方法扩增E基因和NS1基因,进行序列分析,绘制系统进化树,氨基酸比对分析4个不同血清型NS1蛋白。结果 从5份Ⅲ型的登革病毒标本中成功分离4份病毒株,3份Ⅳ型登革病毒标本中成功分离2份登革病毒;BLAST分析保守E基因结果表明,与DENV-3分离株同源性最高(99%)的毒株主要是印度尼西亚2010和2015年分离株、菲律宾2015年分离株。与DENV-4分离株同源性最高(99%)的毒株主要是菲律宾2013年分离株、印度尼西亚2010分离株、意大利2009年分离株。NS1基因序列分析显示所选4株不同血清型的病毒株氨基酸相似性为77.69%,4个不同血清型的登革热NS1抗原存在5-7个氨基酸保守区域。结论 2015-2016年深圳市输入的登革Ⅲ、Ⅳ型病毒可能来自印度尼西亚和菲律宾,应加强出入境人员的监测工作,避免输入引起本地感染的风险。     

血糖及肝功能的检测意义与疾控分析

目的研究血糖及肝功能的检测意义与疾控分析。方法选取2015年1月—2016年1月在该中心接受治疗的疑似脂肪肝患者56例,56例患者归为实验组,并选取已经康复的脂肪肝患者54例,将其归为对照组。通过检测两组的血糖、肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)以及-谷氨酰转移酶(GCT),来对两组患者进行对比分析,分析血糖及肝功能的检测意义。结果根据检测结果发现,实验组的血糖、肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)以及-谷氨酰转移酶(GCT)显著高于对照组患者的血糖及肝功能指标,两组存在着显著性差异,P0.05,具有统计学意义。结论通过检测脂肪肝患者的血糖以及肝功能指标能够对患者进行早期检测,在实际应用中具有重要的意义,因此,值得在实际应用中推广和使用。     

水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝患者初步临床研究

目的 探讨水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝患者的疗效。方法 选取本院2014年10月~2015年10月诊治的酒精性脂肪肝患者164例,采用随机数字表法分为两组,对照组患者82例采用多烯磷脂酰胆碱治疗,观察组患者82例采用水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗,比较两组患者治疗前后血脂指标、肝功能指标、影像学检查指标的变化。结果 在治疗3个月末,观察组患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰转肽酶分别为（3.8±0.6） mmol/L、（1.3±0.2）mmol/L、（2.3±0.2） mmol/L、（47.3±7.2）U/L、（41.7±8.0） U/L、（46.5±7.3） U/L,显著低于对照组的（4.4±0.5）mmol/L、（1.5±0.2） mmol/L、（2.8±0.3） mmol/L、（58.1±12.4） U/L、（55.6±9.9） U/L和（67.8±10.1） U/L（P<0.01）;观察组高密度脂蛋白胆固醇为（1.3±0.2） mmol/L,显著高于对照组的（1.1±0.2） mmol/L（P<0.01）;观察组影像学检查提示重度、中度、轻度、正常肝脏表现者分别为1例（1.2%）、11例（13.4%）、33例（40.2%）、37例（45.1%）,显著好于对照组的6例（7.3%）、19例（23.2%）、45例（54.9%）、12例（14.6%,P<0.01）。结论 水飞蓟宾葡甲胺联合多烯磷脂酰胆碱治疗酒精性脂肪肝可明显改善酒精性脂肪肝患者血脂指标和肝功能指标。     

两种恩替卡韦制剂治疗慢加急性乙型肝炎肝衰竭患者疗效对比研究

目的 对比研究两种恩替卡韦制剂治疗慢加急性乙型肝炎肝衰竭患者的疗效差异。方法 2011年7月~2016年4月我院诊治的慢加急性乙型肝炎肝衰竭患者105例,其中54例接受恩替卡韦分散片（润众）抗病毒治疗的患者为观察组,51例服用恩替卡韦片（博路定）抗病毒治疗的患者为对照组,对比分析两组患者治疗前和治疗12周后血清HBV DNA、肝功能变化的差异,以及12周病死率。结果 两组患者治疗后HBV DNA载量均显著下降,其中,观察组第12周HBV DNA载量<500 copies/ml的比例为72.22%（39/54）,对照组为72.55%（37/51）,组间差异无统计学意义（x²=0.03,P=0.86）;与治疗前比,观察组患者治疗12周后血清总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平下降至（66.59±10.78）μmol/L、（68.32±11.57）U/L和（46.77±18.82）U/L,血清白蛋白上升至（37.18±4.29） g/L,PT缩短至（15.34±1.28）s,对照组上述指标变为（65.32±9.18）μmol/L、（67.07±9.62）U/L、（44.17±14.18） U/L、（37.51±4.30） g/L和（15.68±1.27）s,组间差异无统计学意义（P>0.05）;在第12周末,两组患者病死率分别为31.48%（17/54）和31.37%（16/51）,差异无统计学意义（x²=0.04,P=0.84）。治疗期间两组患者均未发生严重不良反应。结论 恩替卡韦分散片与恩替卡韦在治疗慢加急性肝衰竭患者的疗效无显著性差异。     

慢性乙型肝炎肝衰竭患者血清甲胎蛋白和胸腺素β4水平变化

目的 探讨血清甲胎蛋白（AFP）和胸腺素β4水平在预测慢性乙型肝炎肝衰竭患者转归中的应用价值。方法 2015年1月~2016年7月我院收治的慢性乙型肝炎肝衰竭患者75例,采用ELISA法检测血清AFP和胸腺素β4水平。结果 治疗3个月,在75例慢性乙型肝炎肝衰竭患者中,43例患者（57.3%）死亡,32例患者（42.7%）生存;入院时,生存组血清AFP和胸腺素β4水平分别为（194.2±13.5） μg/L和（914.1±29.5） μg/L,均显著高于死亡组的【（98.4±9.5） μg/L和（504.2±15.4） μg/L,P﹤0.05】;以血清AFP大于或等于71.3 μg/L为截断点,其预测患者在3个月内生存的敏感度为81.5%,特异度为74.9%;以血清胸腺素β4大于472.7μg/L为截断点,其预测患者在3个月内生存的敏感度为76.2%,特异度为69.5%。结论 慢性乙型肝炎肝衰竭患者血清AFP和胸腺素β4水平对患者转归有一定的预测作用,两者水平越高,预后越好。     

Clinicopathological analysis of non‐alcoholic steatohepatitis

OBJECTIVE : Based on liver biopsy samples collected during the past 10 years, the present study aimed to investigate the incidence of fatty liver, the relationship between fatty liver and other underlying liver diseases, and the clinical and pathological characteristics, and the risk factors of fatty liver. METHODS : From a total of 658 liver biopsy specimens collected from 1988 to 1997, there were 71 cases of fatty liver and 68 cases of non‐alcoholic fatty liver. Matched by sex and age, 155 specimens of non‐fatty liver were used as controls. All patients from which the biopsies were taken were tested for liver function, blood lipid profile, blood glucose and hepatitis virus markers. The liver biopsy samples were all investigated by the same pathologist. RESULTS : The prevalence of fatty liver among all the liver biopsies was 10.8%. The alanine aminotransferase, aspartate aminotransferase, total bilirubin and con‐jugated bilirubin levels in the fatty liver group were significantly lower than those in the non‐fatty liver group, whereas the triglyceride levels were higher. Pathologically, steatosis in patients with fatty liver was mainly located around the hepatic lobules, and macrovesicular steatosis was common. Of the 68 cases of non‐alcoholic fatty liver, hepatic cell necrosis was found in 35 cases (51.5%), inflammatory cell infiltration in 46 cases (67.6%) and fibrosis to various degrees in 19 cases (27.9%). CONCLUSION : Non‐alcoholic fatty liver is closely related to hyperlipidemia. In asymptomatic subjects with abnormal liver function, a liver biopsy is the only way to establish the type and severity of liver lesions.     

High prevalence of elevated liver enzymes in blood donors: associations with male gender and central adiposity

OBJECTIVE: Nonalcoholic fatty liver disease is an increasingly recognized condition, but its exact prevalence is unknown. In this prospective, multicenter study, we evaluated the prevalence of elevated alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl-transpeptidase levels as indirect markers of nonalcoholic fatty liver disease in volunteer blood donors as well as their associations with epidemiological and anthropometrical characteristics. METHODS: Alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transpeptidase levels were determined in blood donors from four transfusion centers during the morning sessions of a 3-month period. Cases with positive hepatitis B surface antigen, anti-hepatitis C virus, anti-HIV or elevated liver enzymes and alcohol abuse were excluded. RESULTS: Abnormal liver enzymes were found in 17.6% of 3063 participants (alanine aminotransferase: 14.5%, aspartate aminotransferase: 4.6%, gamma-glutamyl-transpeptidase: 4.7%). Individuals with abnormal compared with those with normal liver enzymes or alanine aminotransferase values were more frequently men and had higher weight, body mass index, waist, hip and neck circumference (P<0.001 for all comparisons). The prevalence of abnormal liver enzymes was also associated with the transfusion center ranging between 8.8 and 22.1% (P<0.001) and alcohol consumption (P=0.001). In multivariate analysis, presence of elevated enzymes was independently associated with male sex, higher weight or body mass index, higher waist circumference and transfusion center. CONCLUSIONS: More than 15% of Greek blood donors exhibit elevated liver enzymes, most likely as a result of unrecognized nonalcoholic fatty liver disease. The prevalence of nonalcoholic fatty liver disease is mainly associated with male sex, obesity and waist circumference, but it may range significantly among different population groups.     

2型糖尿病患者发生脂肪肝的独立危险因素分析

目的 分析2型糖尿病患者发生脂肪肝的独立危险因素。方法 2型糖尿病伴脂肪肝患者163例,2型糖尿病非脂肪肝患者63例怍为对照组。对两组的相关变量进行logistic回归分析,并比较两组临床和肝功能等指标。结果 2型糖尿病脂肪肝组,肥胖和高脂血症患者的比例明显高于对照组。体重指数优势比(OR)为4.392与2型糖尿病脂肪肝呈正相关,胰岛素敏感性指数OR为0.000、规则使用胰岛素治疗OR为0.058与2型糖尿病脂肪肝呈负相关。2型糖尿病脂肪肝组天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、AST/ALT<1和γ-谷氨酰转移酶(GGT)的异常率分别为16.0％、25.2％、52.8％和31.9％,对照组分别为3.2％、6.4％、36.5％和11.1％,x~2值分别为6.833、10.075、4.807和10.181,P值均<0.05。结论 肥胖和胰岛素抵抗的2型糖尿病患者是脂肪肝的独立危险因素。2型糖尿病脂肪肝患者易发生血脂紊乱和肝功能损害。     

Comments on validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease

To evaluate and predict liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), several non-invasive scoring systems were built and widely used in the progress of diagnosis and treatment, which showed great diagnostic efficiency, such as aspartate aminotransferase to platelet ratio index, fibrosis-4 index, body mass index, aspartate aminotransferase to alanine aminotransferase ratio, diabetes score and NAFLD fibrosis score. Since the new concept of metabolic associated fatty liver disease (MAFLD) was proposed, the clinical application value of the non-invasive scoring systems mentioned above has not been assessed in MAFLD. The evaluation of the diagnostic performance of these non-invasive scoring systems will provide references for clinicians in the diagnosis of MAFLD.     

血清胆红素水平与非酒精性脂肪性肝病的关系研究

目的探讨血清胆红素水平与非酒精性脂肪性肝病(NAFLD)的关系。方法以2013年1月-2013年6月在新疆医科大学第五附属医院进行健康体检者为研究对象,从中筛查出NAFLD患者462例,按年龄、性别配对的方法选取健康对照者462例,测量两组身高、体质量、血压、总胆红素、直接胆红素、间接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、空腹血糖、尿酸等指标,t检验比较两组上述指标差异,多因素Logistic回归分析NAFLD患病影响因素。结果与对照组相比,NAFLD组体质量指数、收缩压、舒张压、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、总胆固醇、空腹血糖和尿酸水平明显升高(P0.01),总胆红素、直接胆红素、间接胆红素水平明显降低(P0.01);随着体质量指数(OR=1.363,P0.01)、舒张压(OR=1.040,P0.01)、丙氨酸转氨酶(OR=1.038,P0.01)、三酰甘油(OR=1.399,P0.01)、空腹血糖(OR=1.865,P0.01)和尿酸(OR=1.006,P0.01)水平上升,NAFLD发生的风险增加;随着总胆红素水平升高,NAFLD的发生风险降低(OR=0.897,P0.01)。结论血清胆红素与NAFLD的发生密切相关,血清胆红素水平下降将导致NAFLD发生的风险增加。     

健脾活血方治疗脂肪肝的临床疗效观察

目的观察健脾活血方治疗脂肪肝的临床疗效。方法运用健脾活血方治疗脂肪肝患者52例(治疗组),并与对照组(东宝肝泰片治疗)24例作对照,通过治疗前后临床症状和体征的观察,血丙氨酸转氨酶、门冬氨酸转氨酶、甘油三酯、胆固醇检测和B超检查,分析健脾活血方的临床疗效。结果健脾活血方能显著改善患者的脂肪肝B超影像,减轻和缓解临床症状,改善和恢复肝功能,降低腰臀比值和血甘油三酯、胆固醇含量,其总有效率为73.08%,显著优于对照组50.00%(P＜0.05)。结论健脾活血方是治疗脂肪肝的有效方剂。     

Alanine Aminotransferase Elevation in Obese Infants and Children: A Marker of Early Onset Non Alcoholic Fatty Liver Disease

Background:

Elevated aminotransferases serve as surrogate markers of non-alcoholic fatty liver disease, a feature commonly associated with the metabolic syndrome. Studies on the prevalence of fatty liver disease in obese children comprise small patient samples or focus on those patients with liver enzyme elevation.

Objectives:

We have prospectively analyzed liver enzymes in all overweight and obese children coming to our tertiary care centre.

Patients and Methods:

In a prospective study 224 healthy, overweight or obese children aged 1 - 12 years were examined. Body Mass Index-Standard Deviation Score, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transpeptidase were measured.

Results:

Elevated alanine aminotransferase was observed in 29% of children. 26 % of obese and 30 % of overweight children had liver enzyme elevations. Obese children had significantly higher alanine aminotransferase levels than overweight children (0.9 vs. 0.7 times the Upper Limit of Normal; P = 0.04).

Conclusions:

Elevation of liver enzymes appears in 29 % obese children in a tertiary care centre. Absolute alanine aminotransferase levels are significantly higher in obese than in overweight children. Even obese children with normal liver enzymes show signs of fatty liver disease as demonstrated by liver enzymes at the upper limit of normal.     

益肠内营养联合益生菌对非酒精性肝病肝纤维化的治疗效果及临床应用价值

目的探讨肠内营养联合益生菌对非酒精性肝病肝纤维化的治疗效果及临床应用价值。方法回顾性选取2018年1月至2020年1月西南医科大学附属医院收治的非酒精性肝病肝纤维化患者80例,分为对照组和干预组各40例,其中对照组给予常规治疗,干预组在常规治疗的基础上予以肠内营养联合肠道益生菌治疗,观察并记录治疗前、治疗后4周两组患者的肝功能天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血清总胆红素(TBiL)及直接胆红素(DBiL),营养指标血清总蛋白(TP)、白蛋白(ALB)及转铁蛋白(TF),凝血功能凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),炎症指标C反应蛋白(CRP)、白介素-6(IL-6)、白介素-10(IL-10)和肿瘤坏死因子-α(TNF-α),氧化应激指标超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)以及肝纤维化指标透明质酸(HA)、Ⅲ型前胶原(PC-Ⅲ)、层黏蛋白(LN)、Ⅳ型胶原(Ⅳ-C)。结果与治疗前比较,治疗4周后两组各肝功能指标及肝纤维化指标均降低,干预组治疗4周后TBil、DBiL、ALT、AST水平低于对照组,HA、PC-Ⅲ、LN、Ⅳ-C水平低于对照组(P<0.05)。与治疗前比较,治疗4周后两组各营养状态均改善,干预组TP、ALB和TF水平高于对照组(P<0.05)。与治疗前比较,治疗4周后两组各凝血功能均改善,干预组PT和APTT低于对照组(P<0.05)。治疗4周后,两组SOD、GSH-Px水平高于治疗前,MDA水平低于治疗前,且干预组均优于对照组(P<0.05)。与治疗前比较,治疗4周后两组各炎症反应均减轻,干预组血清CRP、IL-6和TNF-α低于对照组,IL-10高于对照组(P<0.05)。结论肠内营养联合肠道益生菌治疗非酒精性肝病肝纤维化临床疗效显著,可有效抑制肝纤维化,改善患者肝功能、营养状态及凝血功能,同时可对机体氧化应激及炎症反应发挥良好的调节作用,且安全性良好。     

Clinical characteristics of drug-induced liver injury and primary biliary cirrhosis

AIMTo summarize and compare the clinical characteristics of drug-induced liver injury (DILI) and primary biliary cirrhosis (PBC).METHODSA total of 124 patients with DILI and 116 patients with PBC treated at Shengjing Hospital Affiliated to China Medical University from 2005 to 2013 were included. Demographic data (sex and age), biochemical indexes (total protein, albumin, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, and gamma glutamyltransferase), immunological indexes [immunoglobulin (Ig) A, IgG, IgM, antinuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-mitochondrial antibodies] and pathological findings were compared in PBC patients, untyped DILI patients and patients with different types of DILI (hepatocellular type, cholestatic type and mixed type).RESULTSThere were significant differences in age and gender distribution between DILI patients and PBC patients. Biochemical indexes (except ALB), immunological indexes, positive rates of autoantibodies (except SMA), and number of cases of patients with different ANA titers (except the group at a titer of 1:10000) significantly differed between DILI patients and PBC patients. Biochemical indexes, immunological indexes, and positive rate of autoantibodies were not quite similar in different types of DILI. PBC was histologically characterized mainly by edematous degeneration of hepatocytes (n = 30), inflammatory cell infiltration around bile ducts (n = 29), and atypical hyperplasia of small bile ducts (n = 28). DILI manifested mainly as fatty degeneration of hepatocytes (n = 15) and spotty necrosis or loss of hepatocytes (n = 14).CONCLUSIONAlthough DILI and PBC share some similar laboratory tests (biochemical and immunological indexes) and pathological findings, they also show some distinct characteristics, which are helpful to the differential diagnosis of the two diseases.     

Effects of Ischemia–Reperfusion on Hepatic Glutathione and Plasmatic Markers of Graft Function During In Situ Split-Liver Transplantation in Adult Recipients

In situ split-liver transplantation is a new surgical technique where the bipartition of a single liver allows procurement of a right graft (segments I, IV, V–VIII) for an adult recipient (75% of the total liver volume), and a left graft (segments II and III) for a child recipient. The present study was designed to assess the effects of ischemia–reperfusion on right grafts obtained by in situ split-liver transplantation. To this aim, hepatic glutathione and conventional plasmatic markers of allograft function (alanine and aspartate aminotransferase, total bilirubin, prothrombin time, lactate dehydrogenase, -glutamyltranspeptidase, and alkaline phosphatase) were evaluated in four adult recipients. At the time of reperfusion, a marked glutathione decrease was found in the segment VI in three cases, whereas the amount of glutathione in segment IV was related to the duration of cold ischemia in all cases. Upon reperfusion, a marked increase in plasmatic alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase was found. A recovery in prothrombin time was observed from the first day in three cases. An increasing trend in total bilirubin, -glutamyltranspeptidase, and alkaline phosphatase was noted from the second day after transplant. This preliminary study suggests a possible relationship between the duration of cold ischemia, amount of glutathione in segment IV of the right graft, and the trend in plasmatic markers of allograft damage during in situ split-liver transplantation in adult recipients.