目的:了解正常妊娠妇女血清中常用肝功能指标测定结果及变化。方法:分别在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及产后（产后12周）四个时期序贯性测定120例正常妊娠妇女血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ谷氨酰转移酶（GGT）、乳酸脱氢酶（LDH）、总胆红素（TBIL）、直接胆红素（DBIL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并进行比较。结果:ALT、AST在早、中、晚孕及产后各期相对于正常对照均升高（P＜0.01）；TBIL和DBIL在早、中、晚孕均降低（P＜0.01）；TP、ALB随孕期增加逐渐下降,产后回升,到产后12周上升到正常水平（早、中、晚孕P＜0.01,产后P＞0.05）；GGT在孕期中逐渐升高,于晚孕期达最高峰（P＜0.01）,产后稍有下降；LDH在孕早中期无明显变化（P＞0.05）,孕晚期上升,到产后12周仍呈一上升趋势（P＜0.01）；PA在孕早期低于正常对照（P＜0.01）,后随孕期上升,到中孕期后上升到正常（P＞0.05）。结论:本次实验观察到在妊娠期肝功指标ALT、AST、GGT、LDH升高,可能因为孕妇肝脏负荷增加、基础代谢和能量消耗增多、甾体激素水平增高引起。胆红素代谢指标及营养性指标TBIL、DBIL、TP、ALB、PA降低,可能是妊娠期血浆稀释引起。临床诊断妊娠合并肝功能损害时应考虑上述变化。
Several unusual manifestations such as white bile draining in common bile duct (14 cases) and casual massive bleeding (2 cases ) during and following hepatobiliary and pancreatic operations is reported. These manifestations were in fact signs of hepatic insufficiency. The manners of manifestations of hepatic insufficiency and their treatment are discussed, with a stress that liver-protective treatment and nutritional support are the fundamental modalities.
【摘要】 目的 报道1例静脉滴注胺碘酮致肝肾功能不全患者。 方法 2010年10月收治1例扩张性心肌病患者，治疗过程中使用胺碘酮注射液，导致严重的肝肾功能不全。系统查阅中国期刊全文数据库及外文数据库Pubmed、Embase建库至2011年8月关于胺碘酮致肝肾功能不全的相关文献，进行静脉胺碘酮致肝肾功能不全的可能性评估，探索胺碘酮静脉滴注致肝功能不全的的作用机制。 结果 根据查阅文献结果分析，此患者静脉注射胺碘酮致肝功不全的可能性高，Naranjo概率评分分别为7分。 结论 提出临床医师和临床药师应进行胺碘酮静脉的药学监护，高度的重视胺碘酮相关的不良反应，从而及时识别和防治胺碘酮所致肝肾功能不全，减少其不良预后。【Abstract】 Objective To report a case of hepatic and renal insufficiency induced by intravenous injection with amiodarone, and to evaluate the possibility of the adverse drug reaction. Methods A patient with dilated cardiomyopathy was admitted in October, 2010. During the procedure, the use of amiodarone hydrochloride injection made the patient suffer from liver and kidney dysfunction. We retrieved the literatures about liver and kidney toxicity of amiodarone from CNKI, Pubmed, and Embase (from the establishment of the databases to November 2011). We also ssessed the possibility of the adverse drug reaction, discussed the mechanism of amiodarone-induced hepatic insufficiency. Results According to the literature, There was a great possibility of hepatic insufficiency induced by amiodarone, and the total score of the Naranjo probability score was 7. Conclusion It is important to pay more attention to the pharmaceutical care of amidarone to timely recognize and effectively prevent or treat hepatic and renal insufficiency induced by intravenous injection with amiodarone.
We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.
ObjectiveTo investigate the protective effects of diisopropylamini dichlorocacetas on impairment of hepatic function in patients with sepsis. MethodsThe 60 inpatients with liver dysfunction and sepsis treated in our hospital between June 2010 and December 2012 were randomly divided into two groups: treatment group (n=30) and control group (n=30). In the treatment group, patients were treated with intravenous diisopropylamini dichlorocacetas for 7 days, while patients in the control group were treated with Vitamin C for the same period. The venous blood sample of each patient of the two groups was collected and examined for the content of alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, alkaline phosphatase, total bilirubin, and direct bilirubin before and after treatment, and the effective rates of the two groups were determined. ResultsLiver function indicators after treatment of both the two groups were reduced. Compared with the control group, the liver function indicators were significantly decreased and the total effective rate was significantly higher in the treatment group (P<0.05). ConclusionDiisopropylamini dichlorocacetas is effective in the treatment of impairment of hepatic function in patients with sepsis.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
Objective To investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemiareperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirtyone HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16)， 1×105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P＜0.05). On the first postoperative day, the plasma CRP concentration in the UTI group was significantly lower than that in the control group(P＜0.01). The plasma cortisol level in the control group markedly increased compared with the level before operation(P=0.046). However, there was no significant difference in the UTI group between before and after operation. Conclusion Ulinastatin can effectively protect liver from ischemia/reperfusion injury in HCC patients undergoing hepatectomy performed after hepatic inflow occlusion. Also, it can relieve the surgical stress for patients.
ObjectiveThe total cavopulmonary connection (TCPC) offers a palliation for the hemodynamic derangements associated with congenital heart lesions characterized by a single functional ventricle, but it may cause acute hepatic injury because of the special physiology. The objective of this study was to characterize hepatic function and its relationship to cardiac function in children who had undergone the Fontan procedure. MethodsWe retrospectively analyzed 114 children who had undergone TCPC operation in Shanghai Children's Medical Center between January 2013 and March 2014. There were 65 males and 49 females with a median age of 3.8 years (range 2.5 to 13.2) and a median weight of 14.8 kg (range 12.0 to 33.0). The study cohort was further divided into three groups according to the Child-Pugh classification. The total scores were calculated regarding to ascite, bilirubin, albumin, and international normalized ratio (INR). The scores from 4 to 5 were classified in Child A group, from 6 to 8 classified in Child B group, from 9 to 11 classified in Child C group. Thirty-four patients met criteria for Child Class A, 53 patients for Child Class B, and 27 patients for Child Class C. The univariate analysis and multivariable logistic regression model were used to compare demographic, anatomic, and physiological variables among the three groups. ResultsWithin the study population, 80 patients of Child B group and Child C group met criteria for acute hepatic injury. Univariate risk factors for acute hepatic injury included longer total bypass time (P=0.044), longer aortic cross-clamping time (P=0.005), longer ventilation time (P=0.000), higher postoperative mean pulmonary arterial pressure (P=0.000), elevated N-terminal pro-brain natriuretic peptide (P=0.001), higher vasoactive inotropic score (P=0.000), lower mixed venous oxygen saturation (SvO2, P=0.000) and arterial oxygen saturation (P=0.001), higher incidence of arrhythmia (P=0.000), and low cardiac output syndrome (P=0.003), the need of peritoneal dialysis (P=0.000). In the multivariable logistic model, the need for peritoneal dialysis (OR=17.018, 95%CI 5.117-56.602) and the lower postoperative SvO2 (OR=0.922, 95%CI 0.871-0.976) were two independent risk factors for acute hepatic injury after the TCPC. ConclusionThe need for peritoneal dialysis and lower postoperative SvO2 may represent the compound effects of multiple risk factors including preoperative hemodynamic and a marked hepatic vascular inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate acute hepatic injury.
Objective To investigate the effect on expression regulation of calmodulin-dependent kinases casades (CaMK) Ⅱ on liver function after liver transplantation in rats. Methods Allogeneic orthotopic liver transplantation model was established by using the classic two-cuff method. The lentiviral expression systems of CaMKⅡγ protein and CaMKⅡγ shRNA were constructed. The lentiviral vector expressing CaMKⅡγ shRNA and the lentiviral vector expressing CaMKⅡγ protein were perfused into the rat after liver transplantation respectively, and the corresponding blank vector and normal saline were perfused into the control group at the same time. The serum levels of ALT and AST were measured at different time points of inferior vena cava blood in rats. Results The serum ALT and AST levels were debased in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ shRNA (P<0.05). The serum ALT and AST levels were raised in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ protein (P<0.05). There were no significant difference of serum ALT and AST levels between the blank control group and the saline group (P>0.05). Conclusion Specific blocking of CaMK Ⅱ signaling pathway can effectively reduce the serum ALT and AST levels after liver transplantation in rats, and enhanced CaMK Ⅱ signaling pathway increases the serum ALT and AST levels after liver transplantation in rats.
Objective To investigate the long-term dynamic changes of liver function and glucose-lipid metabolism in human immunodeficiency virus (HIV)-infected patients with metabolic dysfunction-associated fatty liver disease (MAFLD) after antiretroviral therapy (ART). Methods HIV-infected patients who visited Public Health Clinical Center of Chengdu between October 1st, 2012 and June 30th, 2013 were recruited and divided into two groups according to whether they had MAFLD or not. All of them were treated with the first-line regimen of tenofovir + lamivudine + efavirenz for 156 weeks, and the anthropometric indices, liver function, and levels of glucose, lipids and uric acid were measured at baseline and at each follow-up time point. In addition, the long-term dynamic characteristics of liver function and glucose and lipid metabolism parameters of the two groups were compared during the 156 weeks of ART treatment. Results A total of 61 male HIV-infected patients were enrolled. The prevalence of MAFLD in them was 31.1% (19/61) at baseline and increased by 4.9 percentage points per year after ART. Before the start of follow-up (week 0), the levels of alanine aminotransferase (ALT) [(46.23±27.09) vs. (28.00±17.43) U/L, P=0.002] and γ-glutamyl transpeptidase (GGT) [(41.46±9.89) vs. (24.02±10.72) U/L, P<0.001] were higher in the MAFLD group than those in the non-MAFLD group, while the between-group differences in the levels of aspartate aminotransferase (AST) [(33.33±15.61) vs. (28.98±12.43) U/L, P=0.248] and alkaline phosphatase [(85.30±21.27) vs. (83.41±24.47) U/L, P=0.773] were not statistically significant. During the 156-week follow-up period, the 4 items of liver function gradually increased in the MAFLD group, especially from week 120 onwards, 3 of which (ALT, AST and GGT) were significantly higher than those in the non-MAFLD group (P<0.05). In addition, the levels of fasting blood glucose, triglyceride, total cholesterol, and low-density lipoprotein were also significantly higher in the MAFLD group than those in the non-MAFLD group at some time points during the 156-week follow-up period (P<0.05). Conclusions Compared with HIV-infected patients without MAFLD, HIV-infected patients with MAFLD are more likely to develop impaired liver function and disorders of glucose and lipid metabolism during long-term tenofovir + lamivudine + efavirenz regimen ART treatment. Therefore, close clinical monitoring of liver function and glucose and lipid metabolism related parameters is required for such patients.