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Serial Study of Liver Function Variables of Normal Pregnancy

目的:了解正常妊娠婦女血清中常用肝功能指標測定結果及變化。方法:分別在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及產后（產后12周）四個時期序貫性測定120例正常妊娠婦女血清谷丙轉氨酶（ALT）、谷草轉氨酶（AST）、γ谷氨酰轉移酶（GGT）、乳酸脫氫酶（LDH）、總膽紅素（TBIL）、直接膽紅素（DBIL）、總蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并進行比較。結果:ALT、AST在早、中、晚孕及產后各期相對于正常對照均升高（P＜0.01）；TBIL和DBIL在早、中、晚孕均降低（P＜0.01）；TP、ALB隨孕期增加逐漸下降,產后回升,到產后12周上升到正常水平（早、中、晚孕P＜0.01,產后P＞0.05）；GGT在孕期中逐漸升高,于晚孕期達最高峰（P＜0.01）,產后稍有下降；LDH在孕早中期無明顯變化（P＞0.05）,孕晚期上升,到產后12周仍呈一上升趨勢（P＜0.01）；PA在孕早期低于正常對照（P＜0.01）,后隨孕期上升,到中孕期后上升到正常（P＞0.05）。結論:本次實驗觀察到在妊娠期肝功指標ALT、AST、GGT、LDH升高,可能因為孕婦肝臟負荷增加、基礎代謝和能量消耗增多、甾體激素水平增高引起。膽紅素代謝指標及營養性指標TBIL、DBIL、TP、ALB、PA降低,可能是妊娠期血漿稀釋引起。臨床診斷妊娠合并肝功能損害時應考慮上述變化。

RELATIONSHIP BETWEEN BILE DUCT DRAINAGE AND THE PROGNOSIS OF HILAR CHOLANGIOCARCINOMA

Objective To discuss the relationship between the efficiency of bile duct drainage and the postoperative liver functional recovery and the prognosis of hilar cholangiocarcinoma. Methods We studied retrospectively 58 cases of hilar cholangiocarcinoma which entered our department between June 1987 and October 1998. The postoperative liver functional recovery and mortality and morbidity between unilateral (n＝27) and bilateral (n＝31) bile duct drainage groups were compared. Results The liver function in bilateral drainage group was nearly normal within 6 weeks after operation. The ALb level of unilateral drainaged patients recovered gradually to normal after operation, and the TBIL and ALT decrease nearly to the normal range within 6 weeks after operation. The AKP decreased within 2 postoperative weeks, then steadily increased. The differences of perioperative complication rate and mortality of the two groups showed no significance. Conclusion The data showed that the liver function can recover to some extent by unilateral bile duct drainage, and unilateral drainage operations are the choice for hilar cholangiocarcinoma that can not be excised now.

Arterial Ketone Body Ratio as Indicator in Liver Function

Objective To estimate the relationship between arterial blood ketone body ratio (AKBR) and liver function and to appraise the feasibility of adding AKBR into liver function estimate. MethodsFrom 1994 to 1998, 44 patients with unresectable liver cancer recieved the combined radiochemoembolization with mixed emulsion of phosphorus32 glass microspheres (32PGMS), chemoagent and glycerine or lipiodol, via intraoperative hepatic artery instillation, hepatic artery ligation and operational arterial embolization (HAL+OAE) or transcatheter hepatic artery embolization (TAE). Preoperative and postoperative function and energy change level of the liver were tested by liver function test and AKBR. CT, SPECT, AFP were used to judge the therapy effect; multivariate statistical analysis methods were used to evaluate the correlation between AKBR and liver function. Spearmen rank correlation analysis was used to evaluate whether there was any relationship between AKBR and liver function test, and to evaluate that there was any relationship between AKBR and survival time. ResultsA negative correlation showed between the level of AKBR and liver function. The correlation coefficient of the three level of AKBR before operation and survival time was 0.4409. Conclusion AKBR can well reflect the degree of liver function.

Liver dysfunction during pregnancy in 35 452 pregnancy women and its association with premature birth: a prospective cohort study

ObjectivesTo explore the association between liver dysfunction and premature birth (PTB).MethodsA prospective cohort of HBV-infected or uninfected pregnant women of Han nationality attending antenatal care at Nantong Maternal and Child Health Hospital was recruited from January 1st, 2012 to June 30th, 2016. Liver function tests (LFTs) were monitored through pregnancy. Robust Poisson regression was used to estimate adjusted risk ratios (RRs) on HBV infection and LFT abnormalities.ResultsAmong 35 452 pregnant women (1 073 HBV carriers and 34 379 non-HBV women), 4 266 (12.03%) had at least one instance of abnormal LFT results. One fold upper limit of normal aspartate aminotransferase (AST), two folds upper limit of normal total bilirubin, and four folds upper limit of normal total bile acid rather than HBsAg positivity, were identified as independent risk factors for PTB by Robust Possion regression analysis.ConclusionsAbnormal LFTs among pregnant women is an independent risk factor of PTB. We suggest monitoring the LFTs results of high-risk population throughout pregnancy.

UNUSUAL MANIFESTATIONS AND THEIR TREATMENT OF HEPATIC INSUFFICIENCY

Several unusual manifestations such as white bile draining in common bile duct (14 cases) and casual massive bleeding (2 cases ) during and following hepatobiliary and pancreatic operations is reported. These manifestations were in fact signs of hepatic insufficiency. The manners of manifestations of hepatic insufficiency and their treatment are discussed, with a stress that liver-protective treatment and nutritional support are the fundamental modalities.

Clinical application of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus

ObjectiveTo investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.MethodsThe clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were grouped according to different surgical procedures, 21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group, and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group. The operation time, intraoperative bleeding volume, postoperative hospital stays, liver function recovery, and postoperative complications were compared between the two groups.ResultsThere was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time (P>0.05), but the postoperative hospital stays in the observation group shortened (P=0.025). The changes on the ALT, TB, and AST in the observation group was obvious than those of the control group (P<0.05). There was no statistically significant incidence between the two groups in the total incidence of complications (P=0.128).ConclusionsCompared with Pringle method of total hepatic vascular exclusion, descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers, and it is convenient to implement hemihepatic blood flow occlusion. It has less damage to healthy side of the liver and quicker liver function recovery, and it can reduce postoperative complications and shorten postoperative hospital stay.

Long-term dynamic characteristics of liver function in human immunodeficiency virus-infected patients with metabolic dysfunction-associated fatty liver disease

Objective To investigate the long-term dynamic changes of liver function and glucose-lipid metabolism in human immunodeficiency virus (HIV)-infected patients with metabolic dysfunction-associated fatty liver disease (MAFLD) after antiretroviral therapy (ART). Methods HIV-infected patients who visited Public Health Clinical Center of Chengdu between October 1st, 2012 and June 30th, 2013 were recruited and divided into two groups according to whether they had MAFLD or not. All of them were treated with the first-line regimen of tenofovir + lamivudine + efavirenz for 156 weeks, and the anthropometric indices, liver function, and levels of glucose, lipids and uric acid were measured at baseline and at each follow-up time point. In addition, the long-term dynamic characteristics of liver function and glucose and lipid metabolism parameters of the two groups were compared during the 156 weeks of ART treatment. Results A total of 61 male HIV-infected patients were enrolled. The prevalence of MAFLD in them was 31.1% (19/61) at baseline and increased by 4.9 percentage points per year after ART. Before the start of follow-up (week 0), the levels of alanine aminotransferase (ALT) [(46.23±27.09) vs. (28.00±17.43) U/L, P=0.002] and γ-glutamyl transpeptidase (GGT) [(41.46±9.89) vs. (24.02±10.72) U/L, P<0.001] were higher in the MAFLD group than those in the non-MAFLD group, while the between-group differences in the levels of aspartate aminotransferase (AST) [(33.33±15.61) vs. (28.98±12.43) U/L, P=0.248] and alkaline phosphatase [(85.30±21.27) vs. (83.41±24.47) U/L, P=0.773] were not statistically significant. During the 156-week follow-up period, the 4 items of liver function gradually increased in the MAFLD group, especially from week 120 onwards, 3 of which (ALT, AST and GGT) were significantly higher than those in the non-MAFLD group (P<0.05). In addition, the levels of fasting blood glucose, triglyceride, total cholesterol, and low-density lipoprotein were also significantly higher in the MAFLD group than those in the non-MAFLD group at some time points during the 156-week follow-up period (P<0.05). Conclusions Compared with HIV-infected patients without MAFLD, HIV-infected patients with MAFLD are more likely to develop impaired liver function and disorders of glucose and lipid metabolism during long-term tenofovir + lamivudine + efavirenz regimen ART treatment. Therefore, close clinical monitoring of liver function and glucose and lipid metabolism related parameters is required for such patients.

自身免疫性肝炎合并免疫球蛋白 A 腎病一例

Evaluation of Correlation between Hepatic Pathohistology of Biopsies and Clinical Indices in 359 Patients with Chronic Hepatitis B

【摘要】 目的 分析慢性乙肝患者血清生化、血常規、血清病毒載量及乙型肝炎標志物與肝組織炎癥分級、纖維化分期的相關性,以找到有較好相關性的臨床指標；通過肝活檢證實臨床診斷與病理診斷的符合情況,探討肝活檢的重要性及價值。方法 對2007年6月—2009年8月在傳染科行肝穿刺活檢的359例慢性乙型肝炎患者的血清丙氨酸氨基轉移酶(ALT)、門冬氨酸氨基轉移酶(AST)、總膽紅素(TB)、白蛋白(ALB)、球蛋白(GLB)等指標,白細胞(WBC)、血小板(PLT)等指標,凝血酶原時間(PT),血清HBV DNA定量及乙肝標志物的不同狀態與肝穿病理分級、分期的相關性進行分析；統計慢性乙肝患者臨床診斷與病理診斷的符合情況。結果 肝組織炎癥分級及纖維化分期之間有一定相關性(Plt;0.05)；血清ALT、AST、ALB、GLB、PT有助于判斷肝組織炎癥程度(Plt;0.05)；ALB、GLB、WBC、PLT、PT對肝組織纖維化程度的評估有意義(Plt;0.05)；HBV DNA復制水平與肝組織炎癥及纖維化無關(Pgt;0.05),但存在負相關的趨勢；纖維化程度高的患者HBeAg陰性組較HBeAg陽性組更多(Plt;0.05)。慢性乙型肝炎患者臨床與病理診斷總符合率為56.3％。結論 動態監測慢性乙肝患者肝功能、血常規、凝血常規在一定程度上有助于判斷疾病的程度,但要確診肝組織炎癥分級及纖維化分期,肝組織病理活檢是必需的。

A report of successful radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma with hyperbilirubinemia

Objective To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia. Methods All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery. Results The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up. Conclusions Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.