AIM To compare the clinical classification of drug-induced liver injury (DILI) by different methods and analyze their relationship with the pathological features of the liver.METHODS In this study,133 patients who were clinically diagnosed with DILI and underwent liver pathological examination were enrolled.We adopted the criteria established and updated by the Council for International Organizations of Medical Sciences (CIOMS classification standard) and the guidelines developed by the European Association for the Study of the Liver in 2009 (EASL diagnostic criteria) for DILI clinical classification.The classification results were compared with liver pathological damage types to analyze the relationship between different classification standards and liver pathology.RESULTS The results of classification using "R value" were consistent to those using "R'value".The differences among the results of classification using the CIOMS classification standard,EASL diagnostic criteria,and liver pathology were statistically significant (P ＜ 0.01).The percentage of cases with hepatocellular type and the overall percentage of cases with cholestatic type and mixed type diagnosed by the three methods were as follows:(CIOMS:79.70％ vs 20.30％;EASL:54.89％ vs 45.11％;liver pathology:37.59％ vs 62.41％).Based on liver pathology,the diagnostic accordance rates of "R value","R'value",and EASL diagnostic criteria were 41.35％,41.35％,and 51.13％,respectively.During the one-year follow-up period,24 (18.05％) cases developed chronic DILI,including 15 (62.50％) cases with cholestasis in liver pathology.CONCLUSION The biochemical method based on the CIOMS classification standard and the EASL diagnostic criteria cannot objectively reflect the pathological manifestations in the liver.

Objective To analyze the relationships of serum ferritin ( SF) level, degree of Liver inflammation and types in patients with liver disease.Methods Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin ( ALB) ( by automatic biochemical analyzer ) and SF ( by immune turbidimetry ) , serum iron ( SI ) ( by complex legal) were detected and analyzed in 203 hospital patients of acute or chronic liver injury , whose SF were higher than nor-mal.The correlations between SF , SI and indicators of liver inflammation were analyzed as wel as the changes of SF and SI in patients with different liver cancer types and pathological degrees .Results Positively correlation was detected between the SF, SI and the ALT, AST (all P<0.01).SF was negatively correlated with ALB (P<0.01).The degree of elevated SF was the order of HEV infection , drug-induced hepatitis, HBV infection and HCV infection (χ2 =13.551, P<0.01) in different etiology , and meanwhile , ALT and AST followed the same order .The SI levels showed no statistical significance in different etiology(P>0.05).The levels of serum ferritin in acute hepatitis and liver failure patients were significantly higher than those in chronic hepatitis , liver cirrhosis and hepatocellular carcinoma .SI level was the lowest in hepatocellular carcinoma, and the difference in the remaining four groups performed no statistical significance (P>0.05).Conclusions SF is positively correlated with indicators of liver inflammation ( ALT, AST) .In patients with hepatitis C and liver fail-ure, SF can evaluate liver function more objectively and accurately than ALT and AST in clinical .

目的:分析自身免疫性肝炎(AIH)患者临床表现、生化、免疫学及病理学特点.方法:回顾性分析39例确诊为AIH患者的临床、实验室检查及肝脏病理,并与同期住院的40例急性乙型肝炎(急乙肝)患者进行比较.结果:AIH多见于女性(97.4％),45～59岁占76.9％.急乙肝则以45岁以下(85％)男性(72.5％)多见.15例(38.5％)AIH患者同时合并其他自身免疫性疾病,10例(25.6％)的一级亲属同时患有自身免疫性疾病.15例(38.5％)AIH患者γ-谷氨酰转肽酶(γ-GT)大于正常值上限10倍,与急乙肝比较差异有统计学意义[(216.4±158.5)U/L vs(83.4±30.5)U/L,P＜0.05].其中8例(20.5％)在ALT下降时γ-GT反而继续升高.AIH组抗核抗体(ANA)阳性率最高,有4例(10.3％)自身抗体全部阴性.肝组织病理变化以界面性炎症(65.6％)为主.结论:对疑似AIH的患者应关注一级亲属自身免疫性疾病发病情况,血清γ-GT高水平及随ALT下降反而继续升高有助于AIH的诊断.

<正>病例1,男,49岁。2002年6月查体发现HBV感染,肝功能正常,未治疗。2002年11月自觉乏力明显,化

患者,男性,37岁,已婚已育,有乙型肝炎(乙肝)家族史,母亲死于乙肝肝硬化.1997年发现乙肝病毒(HBV)阳性,间断复查肝功能正常,未治疗.2006年2月出现肝功能异常,口服甘草酸类药物,丙氨酸氨基转移酶(ALT)波动在50～100 IU/L,HBV DNA 104～108拷贝/ml.

目的:探讨聚乙二醇化干扰素α-2a(PEG-IFN α-2a,派罗欣)联合利巴韦林(RBV)治疗慢性丙型肝炎疗效。方法:30例慢性丙型肝炎患者根据体重不同每周皮下注射1次PEG-IFN α-2a 180μg或135μg,同时联合利巴韦林800~1000 mg/d,分别于治疗前及治疗后4、12、24、48周时检测ALT(谷丙转氨酶)及HCV RNA(丙型肝炎病毒核糖核酸)定量。结果:30例患者根据基因分型均按预计完成疗程(28例治疗48周,2例治疗24周),HCV RNA阴转率在治疗4周时达90%,在12、24和48周时均达100%。ALT复常率在治疗结束时,24周达95%,48周达94.4%。结论:PEG-IFN α-2a联合利巴韦林在慢性丙型肝炎治疗中显示了良好的病毒学及生化学应答反应,且提高了患者治疗依从性,能取得比较好的治疗效果。

目前,慢性乙型肝炎(CHB)仍是我国最常见的传染病之一,而其治疗的关键是抗病毒治疗.为提高抗病毒疗效,目前提出了不同的联合治疗方案,其中拉米夫定(LAM)联合干扰素序贯治疗是提议较多的一种治疗方案.为此,我们观察了37例CHB患者LAM联合干扰素序贯抗病毒治疗的疗效,结果如下.

Objective: To retrospect clinical efficacy of entecavir in the treatment of chronical hepatitis B.Methods: 56 patients with chronical hepatitis B were recruited as subjects.Half of the subjects were assigned into the investigational group in which entecavir was taken in a dose of 0.5 mg per day and the left given 100 mg of lamivudine daily into control group.Normalization of ALT,negative rate of HBV DNA in the serum and the seroconversion of e-antigen in the two groups were detected at 4,8,12 and 24 wk respectively.Results: Normalization rate of ALT,negative rate of HBV DNA and serum conversion rate of e-antigen in the treatment group and the control group were 25% and 21%(P> 0.05),50% and 25%(P> 0.05),0% and 5%(P>0.05) respectively at 4 wk;36% and 29%(P> 0.05),71% and 32%(P<0.05),19% and 21%(P> 0.05) at 8 wk;54% and 39%(P> 0.05),75% and 71%(P> 0.05),31% and 32%(P> 0.05) at 12 wk;75% and 61%(P>0.05),89% and 75%(P>0.05),44% and 42%(P>0.05) at 24 wk.Conclusion: Entecavir can suppress the replication of hepatitis B virus more effectively in an earlier stage,compared with lamivudine.There is no significant difference in normalization of ALT and serum conversion rate of e-antigen between the two groups along with the decline in the level of HBV DNA.

Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus(HBV)infection in immune tolerant phase.Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study.The age,gender,serum HBV DNA level,hepatic inflammatory activity and fibrosis,hepatic HBsAg and HBcAg expressions were analyzed.The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase(ALT).Data analysis was done by chi-square test. Results In 98 patients,83(84.7%)were＜30 years old and 15(15.3%)were≥30.Patients whose mother was HBsAg positive were 48.0%.High levels of serum HBV DNA were found in all patients, with 78.5% were＞1×107 copy/mL.Only 5 cases(5.1%)were G0 of the inflammatory grade;whereas,64 cases(65.3%)were G1,29(29.6%)were G2.There were 56 patients(57.1%)had no significant liver fibrosis;and 23 cases(23.5%)were S1,14(14.3%)were S2,5(5.1%)were S3;none of patients had cirrhosis.The HBsAg and HBcAg in liver tissues were positive in 79(80.6%)and 80(81.6%)cases,respectively.The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels(X2=8.112 3,P=0.043 7).Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver,some of them have already developed fibrosis.Therefore,liver pathology is recommended for these patients to help understand the patients' conditions and make correct therapeutic decisions.

<正>HBV所激发的免疫应答和免疫病理反应是乙型肝炎发病机制的关键。其中细胞毒性T淋巴细胞(CTL)是细胞免疫反应的主要执行者,而针对HBcAg的CTL应答决定病毒是否被清除。当HBV基因发生变异,可改变氨基酸分子的表达,尤其当CTL识别的重要表位发生变异会改变机体对病毒的免疫反应。本研究通过对HBV DNA C基因区进行核苷酸序列分析,并同时检测患者外周血

根据乙型肝炎病毒(HBV)全基因组序列差异≥8%或S基因序列≥4%,可将HBV分为A～H 8个基因型.不同基因型的产生反映了HBV变异进化的特点.目前有很多研究显示,HBV基因型与病情轻重有较密切的关系.本研究用S基因序列测定法对天津地区223例HBV DNA阳性的乙型肝炎患者进行基因分型,并分析其与临床的相关性.

目的:了解严重急性呼吸道综合征(SARS)患者外周血细胞及生化指标的变化特点.方法:观察54例SARS患者发病初及整个发病过程中外周血细胞及血清谷氨酸转氨酶、乳酸脱氢酶、肌酸激酶变化情况.结果:54例患者中重症型31例,普通型23例.入院时19例(35.19%)白细胞降低,29例(53.70%)淋巴细胞减少,8例血小板减少;全病程中49例(90.74%)白细胞升高,43例(79.63%)淋巴细胞减少,17例(31.48%)血小板减少,9例(16.67%)血小板升高.重症型和普通型患者淋巴细胞减少发生率差别有显著性(P<0.05).有29例(59.8%)血清谷氨酸转氨酶升高,39例(72.22%)乳酸脱氢酶升高,43例(79.63%)肌酸激酶升高,其中重症型和普通型乳酸脱氢酶异常发生率差别有显著性(P<0.01).结论:SARS病毒可能通过各种机理影响外周血细胞及生化学指标,观察上述指标变化有助于了解病情.尤其动态观察淋巴细胞及LDH变化对判断疾病的严重程度及预后有重要意义.

[目的]观察严重急性呼吸综合征(SARS)的临床特征及中西医结合治疗疗效.[方法]在西医对症治疗、抗菌、抗病毒、吸氧和辅助治疗基础上,根据患者全部症状、体征、舌苔、脉象所出现的频率进行辨证,在早期和中期以白虎加苍术汤加味或三仁汤加味,恢复期以清暑益气汤加味治疗.[结果]41例患者中39例(95.10%)痊愈出院,1例(2.44%)恢复期,1例(2.44%)死亡.其中服用中药患者发热、憋气、胸闷等症状改善均明显好于单纯西药治疗者,同时胸片表明服用中药可促进炎症吸收,中药并可防止激素减量后的反跳.[结论]中西医结合治疗SARS疗效较好,值得进一步深入研究.

OBJECTIVES:To study the relationship between the mutation of Leu60Val in HBV core region and the cellular immunity in patients with chronic hepatitis B (CHB).METHODS:HBV DNA C gene mutation was confirmed by polymerase chain reaction (PCR) and sequencing the products directly. The cytokines (IFN-gamma, TNF-alpha and IL-2) levels in serum were measured by enzyme linked immunosorbent assay (ELISA). The distribution of T-lymphocyte subpopulations in peripheral blood was detected by flow cytometry (FCM).RESULTS:The mutation of Leu60Val was found in 19 out of the 91 CHB patients. With the CHB severity, the mutation rate was getting higher, especially in the severe hepatitis group. The IFN-gamma and TNF-alpha levels were much higher in mutant strain group than those in wild strain group (t=2.584, 4.766, P<0.01), so was the ratio of CD4+/CD8+ (t=2.275, P<0.05).CONCLUSION:The mutant strain of 60Val may increase affinity to HLA-I molecule, or up-regulate the expression of HLA-I molecule, resulting in the activation of CTL to release the cytokines and cause immune response in liver.

Objective:To study the relationship between serum retinol_binding protein(R BP)and prealbumin(PA)in patients with viral hepatitis and its clinical significa nce.Methods:Nephelometric assay was used to detect serum RBP and PA in 113 patie nts with viral hepatitis.Twenty healthy persons were control.Results:Levels of s erum RBP and PA were correlative with the degree of liver damage.The level of se rum RBP and PA declined with thedecrease of liver function.There was a positive correlation between serum RBP an d PA,and the correlation coefficient was 0.83.Conclusion:The level of serum RBP and PA is a marker to reflect the degree of liver damage.The half life of RBP is significantly shorter than that of PA RBP is more sensitivity than PA and can be used to predict liver damage.