【作者】 徐云；

【导师】 张顺财；

【作者基本信息】 复旦大学 ， 消化内科， 2008， 硕士

【摘要】 目的:采用动态浊度法对慢性肝病患者血、腹水中内毒素水平进行再评估。方法:第一部分:入组30位健康志愿者、45位慢性乙肝患者、66位肝硬化患者以及42位原发性肝癌患者,利用鲎试剂定量动态浊度法对其外周血中内毒素水平进行测定。同时,记录下各位慢性肝病患者的血清生化指标(如总胆红素、白蛋白、凝血酶原时间及转氨酶)、合并存在的临床事件(上消化道出血、肝性脑病及肾功能不全)及肝硬化患者的病因(乙肝病毒性及非病毒性)和Child-Pugh分级。探讨各血清生化指标与血中内毒素水平之间有无相关性,并比较不同疾病、存在不同合并症以及肝硬化不同病因、严重程度的患者血中内毒素水平有无差异。第二部分:入组11例肝硬化腹水、5例肝癌腹水,利用鲎试剂定量动态浊度法对其腹水中内毒素水平进行测定。记录患者的腹水生化指标(如白蛋白、葡萄糖及乳酸脱氢酶)。探讨各腹水生化指标与腹水内毒素水平之间有无相关性,比较不同疾病腹水内毒素水平有无差异。结果:第一部分:健康对照组、慢乙肝组、肝硬化组及原发性肝癌组血中内毒素中位数分别为0.018EU/ml、0.0928EU/ml、0.2132EU/ml及0.0792EU/ml,以0.1EU/ml为界值,内毒素阳性率分别为48.9%、62.1%、47.6%。经检验,健康对照组与慢性肝病各组内毒素水平差异显著(P＜0.001),慢性肝病各组之间的内毒素水平无显著差异,无并发症组与各并发症组之间无显著差异;肝硬化各病因组之间及各Child-Pugh级别之间无显著差异。血中内毒素水平与血清总胆红素、白蛋白、凝血酶原时间及转氨酶之间无明显相关性。第二部分:肝硬化无菌性腹水组与肝癌腹水组腹水中内毒素中位数分别为0.0104EU/ml与0.0208EU/ml,以0.1EU/ml为界值,内毒素阳性率分别为9.1%与0。经检验,差异无统计学意义。腹水中内毒素水平与腹水白蛋白、葡萄糖及乳酸脱氢酶之间无明显相关性。结论:正常人外周血中不含内毒素或仅含痕量内毒素。慢性肝病患者存在不同程度的内毒素血症,其与肝病严重程度的关系尚需进一步研究,与血清生化指标之间无明显相关性。慢性肝病患者无菌性腹水中不含内毒素或仅含痕量内毒素,且与腹水生化指标之间无明显相关性。更多还原

【Abstract】 Objective:To reevaluate the blood endotoxin concentration in patients with chronic liver diseases by means of dynamic turbidimetric analysis.Methods:Part One:We enroll 30 healthy voluteers,45 patients with chronic hepatitis B(CHB),66 patients with cirrhosis and 42 patients with hepatocellular carcinoma(HCC),and determine the peripheral blood endotoxin level by means of dynamic turbidimetric analysis.At the same time,we record the patients’ serum biochemical index(such as total bilibubin,albumin,prothrombin time and aminotransferase),complication(such as upper gastrointestinal bleeding,hepatic encephalopathy and hepatic renal syndrome) as well as cause(hepatitis B or non-hepatitis-B) and Child-Pugh stage of cirrhosis.Part Two:We enroll 11 patients with cirrhosis and 5 patients with HCC.Each of them has ascitis and its endotoxin level is determined by means of dynamic turbidimetric analysis.At the same time,we record the patients’ ascitis biochemical index(such as albumin,glucose or lactate dehydrogenase).Results:Part One:Peripheral blood endotoxin level in healthy volunteers, patients with CHB,cirrhosis and HCC is separately 0.018EU/ml,0.0928EU/ml, 0.2132EU/ml and 0.0792EU/ml.Setting up 0.1EU/ml as a limit,the positive rate is separately 48.9%,62.1%and 47.6%.The difference between the control group and CLD groups is significant(P＜0.001).Endotoxin levels between CLD subgroups have no significant difference.Neither do the level between complication subgroups, aetiological subgroups and Child-Pugh stage subgroups.Peripheral blood endotoxin level doesn’t correlate with serum total bilirubin,albumin,prothrombin time or aminotransferase.Part Two:Ascitis endotoxin level in patients with cirrhosis and HCC is separately 0.0104EU/ml and 0.0208EU/ml.Setting up 0.1EU/ml as a limit, the positive rate is separately 9.1%and 0.The difference between cirrhosis group and HCC group is not significant.Ascitic endotoxin level doesn’t correlate with ascitic albumin,glucose or lactate dehydrogenase. Conclusion:Normal people have few endotoxin in their peripheral blood while patients with CLD have different degrees of endotoxemia.It remains a problem to study further that if peripheral blood endotoxin level is corelated to the severity of liver injury.Patients with CLD have few endotoxin in their ascitis.更多还原