New indicators in evaluation of hemolysis,elevated liver enzymes,and low platelet syndrome:A case-control study

BACKGROUND Indices such as the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),mean platelet volume(MPV),platelet distribution width(PDW),and red cell distribution width(RDW)are considered new markers of the systemic inflammatory response(SIR),and have been widely implemented for the diagnosis of patients with inflammatory diseases.These new indicators have also been widely investigated in preeclampsia(PE)but less analyzed in hemolysis,elevated liver enzymes,and low platelet(HELLP)syndrome.AIM To compare SIR markers among HELLP patients,PE only patients,and healthy gravidae.METHODS This retrospective case-control study enrolled 630 cases,including 210 patients with HELLP syndrome(HELLP group),210 patients with only PE(PE group)and 210 healthy gravidae(control group).The three groups were matched by age,parity,status of assisted reproduction,and multiple pregnancies.Birthweight,gestational age at complete blood count collection,gestational age at delivery,mode of delivery,etc.were recorded.The main indices as NLR,PLR,MPV,PDW,and RDW among the groups were compared,as well as some secondary outcomes including neutrophil,platelets,and hemoglobin.RESULTS The NLR(6.4 vs 4.3 vs 3.5),MPV(11.9 vs 11.2 vs 10.7),PDW(16.4 vs 13.3 vs 14.2),leukocyte(12.4×10^(9)/L vs 9.7×10^(9)/L vs 8.7×10^(9)/L)and neutrophil count(9.9×10^(9)/L vs 7.3×10^(9)/L vs 6.1×10^(9)/L)were highest in the HELLP group,lower in the PE group,and lowest in the control group.Both the overall comparisons between the three groups(all bP<0.01)and pairwise comparisons between every two groups elicited statistically significant differences(all dP<0.01,except control vs PE:cP<0.05 in PDW).The average lymphocyte counts were 1.4(1.1,2.0)×10^(9)/L in the HELLP group,1.6(1.3,2.0)×10^(9)/L in the PE group and 1.7(1.4,2.0)×10^(9)/L in the control group.The overall comparison of lymphocyte count within the three groups had statistically significant differences(P=0.000).The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE(P=0.019)and control groups(P=0.000),but the difference between the PE and control groups was not statistically significant(P=0.432).The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences(both P=0.000),from low to high being those in the HELLP group(43.4×10^(9)/L,64.0),control group(180.5×10^(9)/L,103.6)and PE group(181.5×10^(9)/L,112.8).Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups(both P>0.05),while the differences in the two indices between the HELLP group and the two other groups were still statistically significant(all P=0.000).RDW values were highest in the HELLP group(14.5%[13.6,15.3]),lower in the control group(14.1%[13.5,14.8])and lowest in the PE group(13.9%[13.4,14.9]).The difference between the PE and control group did not show statistical significance(P=1.000),while RDW values in the HELLP group were higher than those in the other two groups(cP<0.05 vs control,dP<0.01 vs PE).CONCLUSION SIR markers such as NLR,RDW,MPV,and PDW were increased and PLR was decreased in HELLP.These SIR markers may become new indicators in the evaluation of HELLP syndrome.

Perihepatic adhesions: An unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome

We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.

Dietary supplementation with a high dose of daidzein enhances the antioxidant capacity in swine muscle but experts pro-oxidant function in liver and fat tissues

Background： Although isoflavones are natural dietary antioxidants, they may have toxicological effects. This study aimed to evaluate the redox system in tissues of finishing pigs by supplementation with high dose of daidzein（640 mg/kg）.Results： The supplementation of high dose of daidzein for 64 d increased the activity of superoxide dismutase and total antioxidant capacity in longissimus muscle but down-regulated the expression of reactive oxygen species（ROS）-producing enzyme NADPH oxidase-2 and cyclooxygenase-2. In contrast, high-level supplementation with daidzein exerted pro-oxidant changes in back fat, abdominal fat, liver, and plasma, as reflected by increased contents of malondialdehyde, a lipid peroxidation product, in these tissues. Furthermore, daidzein supplementation resulted in higher expression of ROS-producing enzymes, including NADPH oxidase-1 and cyclooxygenase-1in liver, 5-lipoxygenase（5-LOX） in backfat and NADPH oxidase-2 both in abdominal fat and backfat. The supplementation of daidzein did not affect meat quality parameters in longissimus muscle, including marbling score,eye muscle areas, intramuscular fat, shear force, drip loss, p H and meat color.Conclusions： This experiment suggests that dietary supplementation of finishing pigs with daidzein at a high dose level improves redox status in muscle but exerts pro-oxidant effect in liver and fat tissues.

Advances in understanding and treating liver diseases during pregnancy:A review

Liver disease in pregnancy is rare but pregnancyrelated liver diseases may cause threat to fetal and maternal survival.It includes pre-eclampsia;eclampsia;haemolysis,elevated liver enzymes,and low platelets syndrome;acute fatty liver of pregnancy;hyperemesis gravidarum;and intrahepatic cholestasis of pregnancy.Recent basic researches have shown the various etiologies involved in this disease entity.With these advances,rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival.The other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic intervention.Therefore,correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better prognosis.Therefore,here we review and summarized recent advances in understanding the etiologies,clinical courses and management of liver disease in pregnancy.This information will contribute to physicians for diagnosis of disease and optimum management of patients.

Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia

AIM To study liver stiffness(LS) during pregnancy and its association with complications during pregnancy.METHODS In this observational, diagnostic study, 537 pregnant women were prospectively enrolled at the Department of Obstetrics and Gynecology, University hospital Heidelberg and Salem Medical Center. LS was measured using the Fibroscan device(Echosens, Paris) in all women and in 41 cases 24 h after delivery. Clinical and morphological data were recorded and abdominal ultrasound and standard laboratory tests were performed. No complications were observed in 475 women(controls) while preeclampsia and intrahepatic cholestasis of pregnancy(ICP) developed in 22 and 40 women, respectively.RESULTS In controls, LS increased significantly from initially 4.5 ± 1.2 kPa in the second trimester to 6.0 ± 2.3 kPa(P < 0.001) in the third trimester. In the third trimester, 41% of women had a LS higher than 6 kPa. Elevated LS in controls was significantly correlated with alkaline phosphatase, leukocytes, gestational age and an increase in body weight and body mass index(BMI). In women with pregnancy complications, LS was significantly higher as compared to controls(P < 0.0001). Moreover, in multivariate analysis, LS was an independent predictor for preeclampsia with an odds ratio of 2.05(1.27-3.31) and a cut-off value of 7.6 kPa. In contrast, ICP could not be predicted by LS. Finally, LS rapidly decreased in all women within 24 h after delivery from 7.2 ± 3.3 kPa down to 4.9 ± 2.2 kPa(P < 0.001).CONCLUSION During pregnancy, LS significantly and reversibly increases in the final trimester of pregnant women without complications. In women with preeclampsia, LS is significantly elevated and an independent noninvasive predictor.

Cryptogenic liver cirrhosis diagnosed in pregnancy and khat consumption

We report a case of cryptogenic liver cirrhosis likely due to khat consumption diagnosed in the setting of chronic hypertension and giving the appearance of atypical superimposed preeclampsia.

Liver diseases in pregnancy: Diseases unique to pregnancy

Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver.Liver disease can cause significant morbidity and mortality in both pregnant women and their infants.This review summarizes liver diseases that are unique to pregnancy.We discuss clinical conditions that are seen only in pregnant women and involve the liver;from Hyperemesis Gravidarum that happens in 1out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy(0.5%-1.5%prevalence),to the more frequent condition of preeclampsia(10%prevalence)and its severe form;hemolysis,elevated liver enzymes,and a low platelet count syndrome(12%of pregnancies with preeclampsia),to the rare entity of Acute Fatty Liver of Pregnancy(incidence of 1 per 7270 to 13000deliveries).Although pathogeneses behind the development of these aliments are not fully understood,theories have been proposed.Some propose the special physiological changes that accompany pregnancy as a precipitant.Others suggest a constellation of factors including both the mother and her fetus that come together to trigger those unique conditions.Reaching a timely and accurate diagnosis of such conditions can be challenging.The timing of the condition in relation toward which trimester it starts at is a key.Accurate diagnosis can be made using specific clinical findings and blood tests.Some entities have well-defined criteria that help not only in making the diagnosis,but also in classifying the disease according to its severity.Management of these conditions range from simple medical remedies to measures such as immediate termination of the pregnancy.In specific conditions,it is prudent to have expert obstetric and medical specialists teaming up to help improve the outcomes.

Association of autoimmune hepatitis and systemic lupus erythematodes:A case series and review of the literature

Liver test abnormalities have been described in up to 60% of patients with systemic lupus erythematodes(SLE) at some point during the course of their disease.Prior treatment with potentially hepatotoxic drugs or viral hepatitis is commonly considered to be the main cause of liver disease in SLE patients.However,in rare cases elevated liver enzymes may be due to concurrent autoimmune hepatitis(AIH).To distinguish whether the patient has primary liver disease with associated autoimmune clinical and laboratory features resembling SLE- such as AIH- or the elevation of liver enzymes is a manifestation of SLE remains a difficult challenge for the treating physician.Here,we present six female patients with complex autoimmune disorders and hepatitis.Patient charts were reviewed in order to investigate the complex relationship between SLE and AIH.All patients had coexisting autoimmune disease in their medical history.At the time of diagnosis of AIH,patients presented with arthralgia,abdominal complaints,cutaneous involvement and fatigue as common symptoms.All patients fulfilled the current diagnostic criteria of both,AIH and SLE.Remission of acute hepatitis was achieved in all cases after the initiation of immunosuppressive therapy.In addition to this case study a literature review was conducted.

养殖大黄鱼在自然海区降温不同阶段抗氧化水平及血清酶活性的变化

为了解越冬期间水温下降对大黄鱼抗氧化水平和血清酶活性的影响,作者研究了养殖大黄鱼(Pseudosciaena crocea)冬季海区自然降温不同阶段(20、16、12、10、8℃)肝脏和肌肉中抗氧化水平及血清酶活性的变化。结果显示:自然降温过程中,肝脏中3种抗氧化酶变化趋势不同,其中SOD活性呈升高趋势,8℃时SOD活性最强;POD活性呈先升高后降低的变化趋势,16℃时活性最高;CAT活性呈下降趋势;而肌肉中这3种抗氧化酶活性均呈下降趋势。肝脏中GSH和MDA含量在16℃时最高;肌肉中的3种抗氧化酶活性、GSH和MDA含量以及总抗氧化能力(T-AOC)均明显低于肝脏中,反映了肝脏对清除自由基具有重要作用,在抗氧化调节方面起到主要作用。血清酶ALT、AST、ALP、LDH及CK-MB随水温自然下降酶活性均呈现降低趋势,即20℃时酶活性最强;CK和LIP随着水温降低,呈先上升再下降的趋势;ADA和GGT随水温降低活性呈上升趋势。血清酶的不同变化,说明水温对大黄鱼血清酶活性有一定的影响。

核糖对大强度耐力训练大鼠血清酶活性和血清尿素、血糖、肌肝糖原含量的影响

目的:探讨核糖对大强度耐力训练大鼠血清生化指标影响的机理,为核糖作为运动补剂提供试验依据。方法:选取24只大鼠,随机分为安静组、训练组和核糖加药组,训练组与训练加药组参照洪平等[1]的训练模型进行3周的训练,最后一次训练进行一次性力竭运动,力竭后取血并进行样本处理。内容:利用ACE全自动生化分析仪,通过测定与运动训练相关的血清酶,血清尿素(BU)、血糖(Glu)浓度和肌肝糖原含量,研究了核糖对重要脏器的保护作用以及对糖、蛋白质代谢、大鼠跑台至力竭时间的影响。结论:核糖可保护重要器官免受运动的损伤;可促进运动中糖异生作用,有利于维持运动过程中血糖水平的稳定;可明显延缓大鼠运动疲劳的发生,使大鼠运动能力明显提高。

HELLP综合征15例临床分析

目的:通过对HELLP综合征患者的临床经过及死因进行分析,以探讨更好的诊治方法。方法:对我院6年中诊断为HELLP综合征的15例患者的临床经过、实验室检查、并发症和母儿结局进行回顾性分析。结果:15例患者平均发病孕周35.31±3周,完全性HELLP综合征12例(其中2例为产后发展为HELLP),部分性HELLP综合征3例。全部有肝酶升高(45～580U/L)和血小板减少(6～74×109/L)。孕产妇并发症:腹水、肾功能衰竭、胎盘早剥、DIC、脑部病变、子痫、产后出血,1例继发血栓性血小板减少性紫癜。15例患者均接受血浆及常规激素治疗,其中2例另接受血浆置换,1例并发急性呼吸窘迫综合征(ARDS)。母亲死亡2例(13.33%)(脑疝、ARDS各1例),围生儿死亡4例(26.67%,新生儿死亡、死产各1例,死胎2例)。结论:重视重度子痫前期的管理和治疗,早期发现HELLP综合征、大剂量激素应用,24～48小时后终止妊娠,动态观察产后72小时的实验室指标和临床变化,避免过度输液,可望改善母儿预后。

鸡肝脏和肌肉组织中常山酮残留的ELISA检测

将常山酮进行人工改造,制备了半抗原常山酮琥珀酸衍生物（Hal-suc）.采用N-羟基琥珀酰亚胺活性酯法将半抗原与牛血清白蛋白（BSA）、卵清白蛋白（OVA）偶联,制备免疫原和包被原.动物免疫6次后采血制备抗血清,以间接ELISA法测定血清效价,测得抗血清的最佳工作浓度为1∶102 400.建立了常山酮在鸡肝脏和肌肉组织中检测的ELISA法,该方法在50、100、500 ng/g 的添加浓度水平下,在鸡肝脏和肌肉组织中测得的平均回收率范围分别为74.2%～96.8%和74.3%～90.0%,检测限分别为28和19 ng/g.

不同负荷运动训练对大鼠肝脏及骨骼肌线粒体呼吸链功能的影响

目的探讨不同负荷运动训练对大鼠肝脏及骨骼肌线粒体呼吸链功能的影响。方法将50只雄性Wistar大鼠随机分为5组(n=10):安静对照(C)组、低负荷运动训练(LT)组、中等负荷运动训练(MT)组、高负荷运动训练(HT)组和极高负荷运动训练(ST)组。各训练组按不同强度训练方案进行8周跑台运动训练,每周训练6 d,1次/d。训练结束后,取大鼠肝脏和股四头肌样本,用差速离心法提取线粒体并测定线粒体呼吸链复合体酶Ⅰ-Ⅳ(CⅠ-Ⅳ)的活性。结果①肝脏线粒体CⅠ-Ⅳ活性:与C组相比,LT组和HT组CⅠ活性均显著升高(P<0.01),ST组则显著下降(P<0.05);LT组和ST组CⅡ活性均显著下降(P<0.01);MT组CⅢ活性显著升高(P<0.05),HT组则显著下降(P<0.05);MT组和HT组CⅣ活性均显著下降(P<0.05)。②骨骼肌线粒体CⅠ-Ⅳ活性:与C组相比,ST组CⅠ活性显著升高(P<0.01),LT组和MT组则显著下降(P<0.05或P<0.01);ST组CⅡ活性显著升高(P<0.01),MT组则显著下降(P<0.05);ST组CⅢ活性显著升高(P<0.01),LT组则显著下降(P<0.01);ST组CⅣ活性显著升高(P<0.05),LT组和MT组则显著下降(P<0.01)。结论不同负荷的运动训练对线粒体能量代谢的影响具有组织差异性,低、中等、高及极高负荷运动训练对改善肝脏线粒体能量代谢的效果不佳,而极高负荷运动训练在提高骨骼肌线粒体能量代谢方面效果较好。

连续血液净化救治HELLP综合征合并多脏器功能障碍综合征回顾性分析

目的探讨连续血液净化(continuous blood purification,CBP)对HELLP综合征(hemolysis,elevated liver enzymes,and low platele syndrome)合并多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)的救治效果。方法回顾性分析蚌埠医学院第一附属医院重症医学科收治的HELLP综合征合并MODS患者15例,在及时终止妊娠,内科常规综合治疗的基础上,加用CBP治疗。记录患者APACHEⅡ评分、心率、呼吸、平均动脉压(MAP)、氧合指数、乳酸脱氢酶(LDH)、转氨酶、血清总胆红素(TBIL)、血小板计数等各项理化指标,比较入科时、住院期间峰值和出科时上述指标的变化;同时分析患者平均ICU住院时间、机械通气时间和CBP次数。结果 15例患者中,治愈12例,CBP平均次数(4.2±1.6)次、机械通气时间(4.9±2.1,n=9)d、ICU住院时间(7.3±2.3)d;患者入科时各脏器功能指标较差,住院期间又进一步加重直至达到最高峰,经过连续CBP治疗,患者神志转清、呼吸平稳、正常饮食,逐步消除了头痛头晕、视物模糊、黄疸恶心、出血及少尿等临床症状;各种理化指标比入科时和峰值均有较大程度的好转,差异均有统计学意义(P<0.05),TBIL、血尿素氮(BUN)、血肌酐(Cr)等下降明显,LDH、凝血酶原时间(PT)、肝酶、血小板计数恢复较快,贫血得到纠正,平均动脉压恢复正常;APACHEII评分在出科时(12.1±9.8)与入科时(21.9±8.7)和住院期间峰值(32.5±6.4)比较,差异均有统计学意义(P<0.05)。结论包括CBP的联合治疗能够改善患者的临床症状,逆转迅速恶化的各项理化指标,提高治愈率,是救治HELLP综合征合并MODS患者的有效手段。

运动性疲劳与肝脏、骨骼肌细胞的关系研究进展

长期以来,运动性疲劳的发生发展机制一直是运动生理学研究的重点。从肝脏及肌细胞方面对运动性疲劳进行研究,对疲劳的概念及其分类,肝脏、肌细胞与疲劳的产生机制的关系以及判定标准等进行了论述。

溶血、肝酶升高及血小板减少综合征早期诊治及围产母儿结局分析

目的探讨妊娠高血压疾病并发溶血、肝酶升高及血小板减少(HELLP)综合征的早期诊断及处理对围产母儿结局的影响。方法收集并分析2007年1月—2009年4月在广西壮族自治区妇幼保健院住院发生HELLP综合征的12例孕产妇资料。结果 HELLP占重度子痫前期和子痫的8.33%(12/144),占同期住院分娩的0.15%(12/7793)。11例在产前发生,发生急性肾功能衰竭、胎盘早剥各2例,弥散性血管内凝血1例,术后并发脑出血1例,新生儿窒息8例,无1例孕产妇及围产儿死亡。结论认识HELLP综合征的临床特点,动态监测溶血、血小板、肝酶及凝血相关实验室指标有助于早期诊断和减少误诊。适时终止妊娠是控制HELLP综合征病情恶化,并改善母儿预后的关键。

阿苯哒唑及其代谢物对猪蛔虫肌肉线粒体酶复合体活性作用的研究

目的 初步了解阿苯哒唑 (albendazole,ABZ)及其主要代谢物亚砜 (albendazole- sulfoxide,ABZSX)和砜(albendazole- sulfone,ABZSN)对猪蛔虫的作用机制。方法 应用紫外分光光度计扫描系统对猪蛔虫肌肉线粒体中四种酶复合体 (com plex - NADH细胞色素 C脱氢酶 ;complex —琥珀酸 Co Q脱氢酶 ;complex — Co Q细胞色素还原酶 ;complexIV—细胞色素 C氧化酶 )活性进行测定 ,以鼠肝线粒体作对照 ,再经 ABZ及其代谢物 ABZSX,ABZSN作用后观察其活性改变。结果 ABZ及其代谢物 ABZSX对猪蛔虫肌肉线粒体中琥珀酸脱氢酶 (complex )的活性有明显的抑制作用 ,而对鼠肝线粒体中四种酶复合体均无明显抑制作用。结论 ABZ及其代谢物主要抑制了蛔虫肌肉线粒体中琥珀酸脱氢酶的活性 ,使其不能完成呼吸链的氧化磷酸化过程 ,从而达到杀虫效果。

1例脑栓塞患者合并肌酶升高及肝损伤的原因分析

目的:对1例脑栓塞患者治疗过程中出现肌酶升高及肝损伤的原因进行讨论,提高临床药师运用专业知识对临床发生不良反应的判断和分析能力。方法:查阅文献,对该病例中发生肌酶升高和肝损伤不良反应的药物相关因素进行分析。结果:阿托伐他汀钙片可能是肌酶升高和肝损伤原因。结论:临床药师需要利用专业知识对药物不良反应进行分析和监护,提高患者用药安全性。

HELLP综合征37例临床分析

目的探讨HELLP(hemolysis,elevated liver enzymes,and low platelets,HELLP)综合征的诊断及治疗。方法对我院自2007-07～2010-12分娩的37例HELLP综合征患者进行回顾性分析。结果 HELLP综合征患者占同期分娩数的0.09%;治愈36例,转院1例,分娩时孕周(37±3.57)周;新生儿存活34例,死亡1例,胎死宫内2例。HELLP综合征患者的早产、剖宫产、胎盘早剥、DIC以及围生儿死亡发生率均显著高于同期分娩患者,其差异均有统计学意义;而对于完全性、部分性HELLP及并发轻度子痫前期、重度子痫前期患者分别进行相关的实验室数据分析,差异均无统计学意义。结论 HELLP综合征严重危胁母儿安全,要早诊断、治疗,适时终止妊娠,可有效改善母儿预后。

甲状腺功能减退性肌病的临床特点

目的了解甲状腺减退性肌病的临床特征,提高临床诊疗工作中对甲状腺功能减退性肌病的认识,减少误诊误治。方法回顾性分析我院近10年收治的11例甲状腺功能减退性肌病患者的临床特征、实验室检查及辅助检查,并复习相关文献了解其可能的病理生理机制。结果甲状腺功能减退性肌病临床表现复杂,实验室检查常合并血常规、肌酶及血脂异常,肌电图改变无明显特异性,甲状腺激素替代治疗有效。结论在神经内科诊疗工作中,对以肌无力、肌肉疼痛等肌病症状为主诉的患者,应完善TSH检查,减少甲状腺功能减退性肌病的误诊误治。