病毒性肝炎性激素水平的探讨

用放射免疫法检测105例各型病毒性肝炎男性患者的血清酮(T)、雌二醇(E_2)、雌三醇(E_3),T 值和E_2值在肝炎各组与正常、存活组与死亡组,伴“女性化”体征组与无“女性化”体征组均无明显性差异(P>0.05)。提示与慢性肝病雄性激素水平降低、雌性激素水平升高的传统理论相违,性激素水平高低与预后无明显关系。

Resting energy expenditure and glucose, protein and fat oxidation in severe chronic virus hepatitis B patients

AIM: To study and determine the resting energy ex- penditure (REE) and oxidation rates of glucose, fat and protein in severe chronic hepatitis B patients. METHODS: A total of 100 patients with liver diseases were categorized into three groups: 16 in the acute hepatitis group, 56 in the severe chronic hepatitis group, and 28 in the cirrhosis group. The REE and the oxidation rates of glucose, fat and protein were as- sessed by indirect heat measurement using the CCM-D nutritive metabolic investigation system. RESULTS: The REE of the severe chronic hepatitis group (20.7 ± 6.1 kcal/d per kg) was significantly lower than that of the acute hepatitis group (P = 0.014). The respiratory quotient (RQ) of the severe chronic hepatitis group (0.84 ± 0.06) was significantly lower than that of the acute hepatitis and cirrhosis groups (P = 0.001). The glucose oxidation rate of the severe hepatitis group (39.2%) was significantly lower than that of the acute hepatitis group and the cirrhosis group (P < 0.05), while the fat oxidation rate (39.8%) in the severe hepatitis group was markedly higher than that of the other two groups (P < 0.05). With improve- ment of liver function, the glucose oxidation rate in- creased from 41.7% to 60.1%, while the fat oxidation rate decreased from 26.3% to 7.6%. CONCLUSION: The glucose oxidation rate is signifi-cantly decreased, and a high proportion of energy is provided by fat in severe chronic hepatitis. These re- sults warrant a large clinical trail to assess the optimal nutritive support therapy for patients with severe liver disease.

Angiotensin-receptor blockers as therapy for mild-to-moderate hypertension-associated non-alcoholic steatohepatitis

AIM： TO evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis （NASH） score （NAS） using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo. METHODS： All patients met the NCEP-ATP Ⅲ criteria for metabolic syndrome. Histology confirmed steatohepatitis, defined as a NAS greater than five up to 3 wk prior inclusion, using the current criteria. Patients with viral hepatitis, chronic alcohol intake, drug abuse or other significant immune or metabolic hepatic pathology were excluded. Subjects were randomly assigned either to the valsartan （V） group （standard dose 80 mg o.d., n = 26）, or to the telmisartan （T） group （standard dose 20 mg o.d., n = 28）. Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion （visit 1） and end of treatment （EOT） were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides （TG） and total cholesterol （TC） were evaluated at inclusion and every 4 mo until EOT （visit 6）. RESULTS： At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION： Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.

Association of hepatitis C virus infection and diabetes

Epidemiologic studies have suggested a relation between hepatitis C virus (HCV) infection and diabetes mellitus. HCV infection is emerging as a metabolic disease, and diabetes mellitus as a risk factor for HCV infection. However, some data on the prevalence of antibodies to HCV in patients with diabetes are conflicting. These seroprevalence data should be interpreted with caution. Some potential bias may occur in those clinic-based studies that target a specif ic disease group. In this letter we explain some reasons for these conflicting studies.

HPV16-E6蛋白和Survivin在宫颈鳞癌及其癌前病变中的表达及意义

目的探讨HPV16-E6蛋白和Survivin在宫颈鳞癌和宫颈上皮内瘤变组织中的表达以及在宫颈癌发生、发展中的作用。方法取宫颈鳞癌30例、宫颈上皮内瘤变90例(其中CINⅠ、CINⅡ、CINⅢ分别30例),采用免疫组化EnVision二步法检测标本中HPV16-E6和Survivin的表达,另取正常宫颈者10例为对照组。结果 HPV16-E6和Survivin在宫颈鳞癌及宫颈上皮内瘤变中的表达随宫颈病变进展而呈递增趋势,且二者呈正相关;HPV16-E6和Survivin在宫颈鳞癌中的表达与患者年龄,临床分期、病理分级、淋巴结转移无关。结论 HPV16-E6和Sur-vivin与宫颈癌的发生、发展密切相关。

血清LDH、 CK、 AST及CSF LDH水平检测在成人颅内感染患者中的临床意义

目的 探讨血清乳酸脱氢酶（LDH）、肌酸激酶（CK）、天冬氨酸转氨酶（AST）及脑脊液乳酸脱氢酶（CSF LDH）检测在成人颅内感染患者急性期的变化及其临床意义.方法 收集病毒性脑炎（病脑组）47例,结核性脑膜炎（结脑组）30例和化脓性脑膜炎（化脑组）19例及体检正常者（对照组）39例的血清标本,并收集颅内感染组的腰穿脑脊液.采用贝克曼全自动生化分析仪,以酶速率法测定所有标本的血清AST、LDH、CK以及患者CSF的LDH.结果 （1）颅内感染组血清心肌酶LDH、CK、AST水平均显著高于非感染组（P＜0.01）.（2）根据有无瘫痪、抽搐、失语、昏迷等症状将脑膜炎患者分为障碍组和无障碍组,障碍组血清LDH、AST水平均明显高于无障碍组（P＜0.05）.（3）病脑组血清AST、LDH、CK水平,化脑组血清AST、LDH水平及结脑组血清LDH水平均明显高于对照组（P＜0.01）,结脑组和化脑组CSF LDH活性升高程度较病脑组高（P＜0.01）.（4）直线相关分析颅内感染患者血清LDH与脑脊液LDH无相关（P＞0.05）.结论 （1）成人颅内感染急性期存在明显的血清LDH、CK、AST及CSF LDH的改变,以LDH改变最为明显,在合并有脑功能障碍时LDH、AST改变更明显;（2）检测血清LDH、CK、AST和CSF LDH水平有助于颅内感染早期的鉴别诊断,以及判断病情的严重程度.