摘要:目的: 探讨血清前白蛋白(prealbumin,PAB)、胆碱脂酶(cholinesterase,ChE)、总胆汁酸(total bile acid,TBA)在肝硬化中的检测价值。 方法 :测定105例肝硬化患者和30例健康人的前白蛋白、胆碱脂酶、总胆汁酸活性及肝功能生化指标,并按ChildPugh分级进行比较。 结果 :肝硬化组前白蛋白含量、胆碱脂酶活性均较对照组显著降低;按ChildPugh分级比较,肝硬化组前白蛋白含量在Child A级与对照组、B级与A级之间、在C级与B级之间差异有显著性(Plt;001);胆碱脂酶活性在Child A级与对照组、B级与A级、C级与B级之间差异有显著性(Plt;001)。总胆汁酸在Child B级与A级,C级与B级间有显著差异性,在A级与对照组间差异无显著性。 结论 :血清前白蛋白、胆碱脂酶在肝硬化早期评估中有很重要的价值,而总胆汁酸在肝硬化预后的判定中有重要价值。 Abstract: Objective: To evaluate the role of prealbumin (PAB), cholinesterase (ChE), and total bile acid (TBA) in evaluating liver reserve function in patients with liver cirrhosis. Methods : One hundred and five serum samples from patients with liver cirrhosis were detected in PAB, ChE, TBA and other biochemical markers. All patients were classified in accordance with ChildPugh scale. Results : For PAB, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1254, 1887, 2316) (Plt;001). For ChE, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1288, 0856, 1002) (Plt;001). For TBA, the differences among ChildPugh C group, B group and A group were statistically significant (t=0526, 1081)(Plt;001), the difference among ChildPugh A group and healthy group was not statistically significant (t=5615) (Pgt;005). Conclusion : PAB and ChE reflect liver reserve function earlier in patients with liver cirrhosis. The role of TBA is important in reflecting prognosis in patients with liver cirrhosis.
目的:分析原发性胆汁性肝硬化(PBC)患者的临床表现,试验室检查及治疗情况。方法:回顾性分析48例PBC患者临床资料。结果:93.8%是中年女性患者,平均年龄53.2±8.73。主要的临床表现包括肝功能异常(ALT、GGT、AKP升高)95.8%,乏力纳差83.3%,黄疸79.2%,瘙痒66.6%,肝肿大62.5%,脾大58.3%等。常合并干燥综合征(25%),类风湿关节炎(16.7%)等自身免疫性疾病及结缔组织疾病。所以患者AMA及AMAM-2均为阳性。全部病例使用熊去氧胆酸治疗,但仅31.3%患者病情有不同程度好转。结论:加强对PBC的认识,重视对AMA 或AMA-M2的检测,尤其对长期不明原因肝功能异常的女性患者。
ObjectiveTo summarize the research progress of the pathogenesis, diagnosis and treatment of sarcopenia in liver cirrhosis. MethodThe relevant literatures on studies of the pathogenesis, diagnosis and treatment of sarcopenia in liver cirrhosis in recent years were searched and reviewed. ResultsThe sarcopenia was a major complication that could not be ignored in patients with liver cirrhosis, and was closely related to the patient’s quality of life and prognosis. Various mechanisms such as metabolic abnormalities, malnutrition, myostatin, hyperammonemia, hormonal regulation of muscle homeostasis, ubiquitin-proteasome system and autophagy, physical activity, and dysbiosis of the intestinal flora were involved in the development of sarcopenia. There were various diagnostic methods for sarcopenia, but a unified gold standard was still lacking. In addition, some progress had been made in the treatment of sarcopenia in recent years. ConclusionsAlthough current studies obtains preliminary results about relation between liver cirrhosis and sarcopenia, there still exists many problems to be solved. Further research in future will benefit diagnosis and treatment of patients with sarcopenia in liver cirrhosis.
目的 分析彩色多普勒超声对肝硬化患者门静脉血流改变的评价作用。 方法 选择2010年1月－2011年4月收治的50例肝硬化患者作为观察组，其中代偿期患者27例，失代偿期患者23例；同时设置健康对照组50名，比较两组的门静脉内径（Dpv）、门静脉平均血流速度（Vpv）、门静脉血流量（Qpv）。 结果 观察组患者的Dpv增宽，Vpv减慢，Qpv减少，与对照组比较，差异均有统计学意义（P＜0.05）；且失代偿期患者的改变更为明显，与代偿期患者间差异有统计学意义（P＜0.05）。 结论 彩色多普勒超声检查门静脉血流改变可以对肝硬化患者进行初步确诊。
目的：分析原发性胆汁性肝硬化(PBC)患者的临床特征,以提高对该病诊治的认识。方法：分析17例PBC患者的一般资料、临床表现、生化指标、免疫学指标及病理学改变。结果：PBC主要累及中年女性，易合并干燥综合征（SS）。胆管酶升高及抗线粒体M2抗体阳性有助于本病诊断。治疗首选熊去氧胆酸，糖皮质激素、免疫抑制剂适用于合并SS者。结论：早期诊断、早期治疗PBC是防止发展为终末期肝硬化的关键。
Objective To explore the condition and quality of domestic clinical therapeutic studies on integrated traditional Chinese and western medicine for posthepatitic cirrhosis in recent 30 years. Methods Jadad scale was used to score 121 literatures selected from January 1980 to January 2010 in periodicals of domestic authoritative resources databases, such as CNKI, VIP, WanFang Data, and CBM. Systematic reviews were conducted to 39 randomized controlled trials (RCTs) literatures of treating posthepatitic cirrhosis with integrated traditional Chinese medicine and western medicine scored two or more points. Results In 30 years, the main problems existing in domestic posthepatitic cirrhosis clinical research of integrated traditional Chinese and western medicine were as follows: the design of clinical RCTs was not strict enough; there was deficiency in the use of blind method; the standardized and uniformed research standard were insufficiency; the sample content was low without specific estimation methods; there was lack of analyses in compliance with cases falling off or without follow-up; and the report of adverse reaction and the quality of life research was neglected. Conclusion Posthepatitic cirrhosis therapy of integrated traditional Chinese and western medical is of “personalized” and “diversified” characteristics. Its therapeutic effects are significantly better than those of pure western medicine and worthy to be popularized in the clinic. However, the quality and level of its clinical scientific research methods still need further improvement.
Cirrhosis is an end stage of condition of various liver diseases with specific clinic and pathologic process. The incidence is high and it seriously affects the quality of life for patients. In order to obtain the best prevention and treatment for end-stage cirrhosis, we searched The Cochrane Library (Issue 3, 2004), SUMsearch (1981~2004) and MEDLINE (1981~2004), and identified 15 systematic reviews and 65 randomized controlled trials. We critically assessed the quality of studies. The results showed the principal treatment of cirrhosis was to deal with complications, such as the prevention and treatment of variceal bleeding, the treatment of ascites etc.
Objective To evaluate the efficiency and security of physical exercise with low intensity against malnutrition and sarcopenia in patients with cirrhosis. Methods Between December 2014 and October 2015, 37 patients with cirrhosis were divided into two groups according to their willings, with 19 in the exercise group and 18 in the control group. Endurance of the exercise for 3 months were recorded. Mid-arm circumference, " up and go” time, width of portal vein and Child-Pugh score were compared before and after the research between the two groups. Results Three months later, the mid-arm circumference and the " up and go” time of the exercise group [(33.99±2.15) cm, (9.17±0.35) s] were better than those before the exercise [(32.09±2.58) cm, (9.77±0.46) s] and those in the control group [(31.93±2.04) cm, (9.76±0.30) s], and the differences above were all statistically significant (P<0.05). The change of the width of portal vein was positively correlated with pre-exercise body mass index in overweight patients (r=0.93, P=0.007). Conclusions Physical exercise with low intensity is safe and effective against malnutrition and sarcopenia in patients with cirrhosis. Overweitht patiens or malnutrition at the early stage may benefit more.