目的 探讨肝硬化腹水患者不同血清钠水平与病情严重程度的关系。 方法 回顾分析2008年7月－2010年6月收治47例肝硬化腹水并发低钠血症患者，根据其入院时血清钠水平分为低钠血症轻（A组）、中（B组）、重（C组）3组。比较肝硬化腹水患者不同血钠水平的腹水程度及疗效的关系、以及低钠程度与肝性脑病、肝肾综合征和死亡发生率的关系。 结果 与A组比较，B、C两组腹水量、肝性脑病、肝肾综合征及病死率明显增高，差异有统计学意义（P＜0.05）；对治疗的效果明显降低（P＜0.05）。 结论 肝硬化腹水患者的血清钠水平与其病情程度具有紧密相关性，监测血清钠的水平可作为判断病情严重程度的重要指标之一，提示在临床上需重视预防、及时发现并治疗低钠血症。
Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.
【Abstract】Objective To investigate the protective effects of epidermal growth factor (EGF) on pancreas of rats with acute pancreatitis(AP). Methods Seventytwo male SpragueDawley rats were randomly divided into 3 groups: Control group, AP group and AP-EGF group. Subcutaneously injection of EGF (0.1 μg/g) were given to animals in the AP-EGF group after the establishment of the model of AP. The other two groups of animals received the same volume of saline. At 6 h, 12 h and 24 h after induction of AP, 8 animals in each group were sacrificed respectively， 4 ml of blood sample was withdrawn from heart，2 ml for the analysis of amylase activity and 2 ml for MDA content in serum. Ascites was sucked with dry gauzes and was weighed thereafter. Changes of pancreas morphology were evaluated at every time point. The same part of pancreas was removed for measurement of MDA content, apoptotic index (AI) and histologic changes. Results Histologic injury of the animals in the APEGF group was milder than that in the AP group. Ascites weight in the AP-EGF group decreased significantly compared with that in the AP group at 12 h and 24 h 〔(4.53±1.29) g vs (6.58±1.47) g, (7.64±1.85) g vs (11.96±2.13) g，P＜0.05，P＜0.01〕. Amylase activity in the APEGF group also decreased significantly compared with that in the AP group at 12 h and 24 h 〔(142.0±8.3) U/L vs (187.9±10.4) U/L, (194.3±10.4) U/L vs (253.3±8.6) U/L, P＜0.05，P＜0.01〕. MDA content in plasm 〔(2.34±0.23) μmol/L vs (3.15±0.38) μmol/L, P＜0.05〕 and in pancreas 〔(5.21±1.46) μmol/g vs (7.68±1.63) μmol/g, P＜0.01〕 in the APEGF group decreased significantly compared with those in the AP group at 24 h. AI of pancreas in the APEGF group increased significantly compared withthatintheAPgroupafteroperation〔(16.22±3.53)%〖KG4vs (7.35±1.04)%, (11.67±2.40)% vs (4.81±0.86)%, (6.38±1.42)% vs (1.97±0.21)%, P＜0.01〕. Conclusion EGF may accelerate the restoration of pathologic injury and alleviate the hemorrhage and edema of pancreas. It may also depress MDA content in plasm and in pancreas so that to lessen oxidative damage. EGF may protect pancreas by inducing cellular apoptosis.
目的:为了探讨肝硬化放腹水后应用右旋糖酐40代替人血白蛋白治疗顽固性腹水的临床疗效及其经济性。方法:将216例肝硬化顽固性腹水患者随机分为A,B,C三组。A组:定期放腹水后应用右旋糖酐40;B组:定期放腹水后应用人血白蛋白或血浆;C组:传统治疗方法,限钠和不断增加利尿剂用量。结果:A组分别与B组,C组相比较,其腹水消退时间,ALT复常率,输血不良反应,住院费用,平均住院日,好转治愈率,死亡率,以上各项对比均有显著性差异(Plt;0.05)。血清蛋白量的对比无显著性差异(Pgt;0.05)。结论:肝硬化放腹水后应用右旋糖酐40治疗顽固性腹水,能缩短病程,减少住院日,降低医疗费用,降低死亡率。
【摘要】 目的 应用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）探讨α-L-岩藻糖苷酶（AFU）对恶性腹水和非结核良性腹水的诊断价值。 方法 2004年7月—2008年1月对213例诊断明确的良、恶性腹水（其中良性腹水117例、恶性腹水96例）AFU活性进行检测。采用ROC曲线评价AFU的诊断灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及Youden指数，评价其诊断效率。 结果 恶性腹水组AFU水平（164.96±87.72） μmol/（L•h），良性腹水组（104.02±62.07） μmol/（L•h），两者比较差异有统计学意义（Plt;0.01）。AFU诊断恶性腹水的ROC 曲线下面积为0.754±0.034，最佳分界值101.95 μmol/（L•h）。以AFU≥101.95 μmol/（L•h）来预测恶性腹水，其诊断的灵敏度为82.3%，特异度为63.2%，准确性为72.8%、阳性预测值为65.3%、阴性预测值为83.1%、阳性似然比为2.23、阴性似然比为0.28及Youden指数为0.455。 结论 腹水AFU活性检测有助于恶性腹水和非结核良性腹水的鉴别诊断，是一个比较理想的实用指标，适合于基层医院的临床应用。【Abstract】 Objective To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. Methods Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. Results The average level of AFU in the malignant group [(164.96±87.72) μmol/(L•h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L•h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L•h). When an AFU level equal to or higher than 101.95 μmol/(L•h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.
Objective To study the effect and intrinsic mechanism of acute suppurative peritonitis associated ascitic fluid (ASPAAF) on experimental liver injury of rats. Methods Thirty-two male or female Sprague-Dawley (SD) rats were randomly divided into two groups: ASPAAF group (n=16) and control group (n=16), in which 8 ml ASPAAF or normal saline (NS) were injected into the peritoneal cavity, respectively. The rats were killed at each time intervals after peritoneal cavity injection (6 h and 12 h) respectively in two groups and specimens were made to detect the levels of serum TNF-α, endotoxin and liver function (AST, ALT and STB). The level of TNF-α in liver tissues was measured. The pathological change of liver was observed by microscope. Results The levels of TNF-α, endotoxin, ALT, AST and STB in serum and the levels of TNF-α in liver tissues at different time points were markedly higher in ASPAAF group compared with those in control group (P＜0.05), and these indexes increased with increasing time in ASPAAF group (P＜0.05). In ASPAAF group, hepatic tissue appeared hydrops, even spotty necrosis and the changes at 6 h and 12 h were not obvious different. No abnormal pathological change of hepatic tissue was found in control group. Conclusion ASPAAF can induce the injury of the liver in rats, which may involved in TNF-α and endotoxin.
目的:观察持续腹腔引流治疗顽固性腹水的疗效。方法:将顽固性腹水患者74例分为两组,治疗组38例,采用腹腔置管,持续腹腔引流腹水,3000mL/天;对照组36例,以常规补充白蛋白、限钠、限水、利尿治疗为主,比较两组的疗效。观察治疗组治疗前后患者尿量、腹围和体重变化,并比较治疗组与对照组在肝、肾功能及电解质的变化及总体疗效。结果:治疗组疗效优于对照组(Plt;0.05),与治疗前比较,治疗组治疗后尿量、腹围、体重有明显改变(Plt;0.01), 肝、肾功能及电解质与对照组比较无明显变化(Pgt;0.05)。结论:持续腹腔引流治疗顽固性腹水经济适用,不良反应少,患者依从性好。
ObjectiveTo understand the application progress of interventional therapy for chylous ascites (CA). MethodsThe domestic and foreign literature related to the diagnosis, imaging examination methods, and interventional treatment of CA in recent years were retrieved and summarized. ResultsThe sources of CA are diverse, the aetiology is different, and the treatment modalities will vary greatly, with the diagnosis of the source of lymphatic leakage being the basis for the effectiveness of interventional therapy. Through interventional treatment, such as intranodal lymphography, hepatic lymphogram, balloon occlusion retrograde abdominal lymphangiography, lymphatic leakage that is difficult to identify in traditional imaging examinations (CT, MRI, etc.) can be located and embolised to improve the diagnosis and treatment of CA. As an emerging means for the treatment of CA, interventional therapy has the advantages of less trauma, quick effect, and fewer complications. ConclusionsWith the continuous improvement of the interventional treatment approach, angiography, embolization materials, and the continuous accumulation of clinical experience, the interventional of CA will have more significant therapeutic effects and a broader application prospect.