中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 10
Oct.  2016

Serum levels of adiponectin and ferritin and their clinical significance in patients with nonalcoholic fatty liver in Qinghai,China

DOI: 10.3969/j.issn.1001-5256.2016.10.028
  • Published Date: 2016-10-20
  • Objective To investigate the changes in the levels of serum adiponectin( APN) and serum ferritin( SF) in patients with nonalcoholic fatty liver( NAFL) and normal populations in Qinghai,China,as well as the significance of APN and SF in the pathogenesis of NAFL. Methods A total of 39 patients diagnosed with NAFL in The Affiliated Hospital of Qinghai University from February to October,2015 were enrolled as NAFL group,and 34 healthy individuals who underwent physical examination were enrolled as control group. The anthropometric parameters and routine clinical biochemical parameters were measured and enzyme-linked immunosorbent assay and chemiluminescence immunoassay were used to measure the levels of serum APN and SF. The independent-samples t test was used for comparison between two groups,and the Pearson correlation analysis was also performed. Results Compared with the control group,the NAFL group had a significantly higher level of SF( 291. 97 ± 38. 82 ng / ml vs 93. 21 ± 8. 74 ng / ml,t = 31. 085,P < 0. 001) and a significantly lower serum level of APN( 11. 91 ± 2. 88 mg / L vs 16. 18 ± 2. 80 mg / L,t = 6. 383,P < 0. 001). The correlation analysis showed that in the NAFL group,serum APN level was negatively correlated with TG level( r =-0. 466,P < 0. 01). Conclusion The patients with NAFL in Qinghai have a reduced serum APN level and an increased SF level,and in these patients,serum APN level is negatively correlated with TG level. Serum APN monitoring may be used as a reference index to evaluate the treatment outcome of hypertriglyceridemia.

     

  • 门静脉高压是失代偿期肝硬化患者的主要临床表现之一,其导致的食管胃静脉曲张破裂出血、肝性脑病、顽固性腹水等并发症是患者死亡的重要原因[1]。大量研究表明肝静脉压力梯度(hepatic venous pressure gradient, HVPG)可反映门静脉高压的严重程度。2021年Baveno Ⅶ国际共识[2]推荐,对于病毒性肝炎相关肝硬化和酒精性肝硬化患者,HVPG值为诊断门静脉高压的金标准。Baveno Ⅶ国际共识[2]和美国肝病学会2016版指导意见[3]均明确指出和强调了HVPG对门静脉高压危险分层的作用和预后预测价值,HVPG≥20 mmHg提示肝硬化静脉曲张出血患者的止血治疗失败率和死亡风险升高[4]。然而,HVPG测定是一项有创性操作,且对操作者技术水平和医疗设备有一定要求,并在测定过程中可能引起一过性的心律失常和迷走神经反应等不良反应,这些不足在很大程度上限制了HVPG的临床应用和推广。

    近年来,非侵入性测量肝组织弹性的方法得到了发展。许多研究[5-7]已证实肝炎患者和肝硬化代偿期患者的肝脏硬度(liver stiffnes, LS)与HVPG相关,但对于肝硬化失代偿期患者仍欠缺研究,LS对肝硬化食管胃静脉曲张破裂出血二级预防的患者预测能力尚不明确。此外,以往的大多数研究使用瞬时弹性成像(transient elastography, TE)来评估LS,少有研究探讨声脉冲辐射力成像技术(acoustic radiation force impulse, ARFI)检测的LS值的预测作用。因此,通过ARFI测量门静脉高压患者LS和脾脏硬度(spleen stiffness, SS),验证LS、SS与HVPG的相关性,在临床上具有重要意义。

    选取2013年4月—2021年6月在南京鼓楼医院消化内科同时接受HVPG测定及ARFI测量LS、SS的病毒性或酒精性失代偿期肝硬化患者。

    (1) 确诊病毒性肝炎相关肝硬化或酒精性肝硬化失代偿期;既往食管胃底静脉曲张破裂出血病史。(2)年龄18~75岁。(3)在本院行经颈静脉HVPG测定,并于术前3 d内行ARFI测定LS、SS。术前3 d检验血常规、凝血功能、肝功能、肾功能,腹部彩超评估肝右叶斜径、脾肋间直径、门静脉血流速度(portal vein flow rate, PVF)、脾静脉直径(splenic vein diameter, SVD),术前或术后1周内的内镜评估食管胃底静脉曲张程度。

    (1) 合并肝癌或肝外肿瘤;(2)严重的心、肺、肝、肾功能不全,或严重出血性疾病或局部、全身感染、甲状腺功能低下、雷诺综合征、周围血管疾病等;(3)脾脏切除患者;(4)严重门静脉血栓患者;(5)计划怀孕或已怀孕或哺乳的妇女。

    根据既往研究[1],HVPG≥20 mmHg提示早期再出血及高治疗失败率,故在本研究中,根据术中测定的HVPG值,将纳入患者分为严重门静脉高压组(SPH组,HVPG≥20 mmHg)和非严重门静脉高压组(非SPH组,HVPG<20 mmHg)。收集纳入患者的临床资料,包括性别、年龄、既往史、HVPG值、LS、SS、血常规、凝血功能、肝功能、肾功能,腹部彩超评估肝右叶斜径、脾肋间直径、SVD、PVF、内镜下静脉曲张程度等指标。

    应用SPSS 22.0软件进行统计分析。符合正态分布的计量资料以x ±s表示,2组间比较采用t检验;不符合正态分布的计量资料以M(P25~P75)表示,2组间比较采用Mann-Whitney U秩和检验。计数资料2组间比较采用χ2检验。相关性分析采用Pearson检验。用Pearson r系数评估不同无创检测指标与HVPG的相关性强度。若r<0.3,提示弱强度相关;若0.3≤r≤0.5,提示中等强度相关;若r>0.5,说明高强度相关。采用Logistic回归分析不同无创检测指标与SPH发生风险之间的关系。绘制不同无创指标预测HVPG≥20 mmHg发生的受试者工作特征曲线(ROC曲线)并计算曲线下面积(AUC)、敏感度、特异度、最大约登指数及对应的临界值,以评估各指标对SPH的预测价值。P<0.05为差异有统计学意义。

    共纳入符合条件的受试者88例,其中SPH组24例,非SPH组64例。两组患者的年龄、性别、白细胞计数、血红蛋白、血小板计数、凝血酶原时间、谷丙转氨酶、谷草转氨酶、白蛋白、血钠、血肌酐、Child-Pugh肝功能分级等比较,差异均无统计学意义(P值均>0.05)(表 1)。

    表  1  受试者基线资料
    Table  1.  Baseline of the patients included
    指标 所有患者(n=88) 非SPH组(n=64) SPH组(n=24) 统计值 P
    男/女(例) 65/23 48/16 17/7 χ2=0.157 0.79
    年龄(岁) 53.93±11.39 54.35±12.08 53.54±9.68 t=0.132 0.90
    病因(病毒性/酒精性,例) 76/12 56/8 20/4 χ2=0.257 0.73
    肝右叶斜径(cm) 12.20±1.48 12.56±1.28 12.57±1.66 t=-1.245 0.22
    内镜下静脉曲张程度(轻/中/重,例) 4/19/65 3/14/47 1/5/18 χ2=0.025 0.99
    白细胞计数(×109/L) 2.25(1.70~3.30) 1.90(1.55~3.30) 2.50(2.05~3.20) Z=-1.918 0.06
    血红蛋白(g/L) 86.64±26.66 82.35±25.97 86.64±26.66 t=0.124 0.90
    血小板计数(×109/L) 59.49±33.65 60.10±28.95 57.35±30.83 t=0.367 0.72
    凝血酶原时间(s) 14.89±2.74 14.35±1.64 15.90±3.10 t=-1.772 0.08
    国际标准化比值 1.31±0.20 1.25±0.15 1.39±0.26 t=-1.525 0.07
    谷丙转氨酶(U/L) 22.75(16.40~29.40) 24.75(15.90~29.00) 18.75(15.85~29.40) Z=-0.932 0.35
    谷草转氨酶(U/L) 26.75(21.25~35.55) 26.80(22.35~36.25) 23.15(20.10~31.50) Z=-1.466 0.14
    总胆红素(μmol/L) 16.90(11.00~22.35) 15.85(10.10~20.10) 18.70(13.10~31.70) Z=-1.743 0.08
    白蛋白(g/L) 35.43±4.77 36.43±4.45 33.96±5.31 t=1.155 0.25
    血肌酐(μmol/L) 67.14±19.23 64.15±14.74 64.29±21.46 t=0.787 0.43
    血钠(mmol/L) 141.20±2.60 141.16±3.13 141.23±2.84 t=-0.137 0.89
    腹水(有/无,例) 30/58 25/39 5/19 χ2=2.581 0.13
    Child-Pugh评分 6.85±1.32 6.40±1.05 7.25±1.29 t=-1.982 0.05
    Child-Pugh分级(A/B/C,例) 37/48/3 31/32/1 6/16/2 χ2=5.517 0.06
    下载: 导出CSV 
    | 显示表格

    相关分析结果显示HVPG与LS呈中等强度正相关(r=0.458,P<0.001);而SS(r=0.117,P=0.300)、PVF(r=0.010,P=0.940)、SVD(r=-0.090,P=0.420)与HVPG不相关。

    结果显示,两组间LS比较差异有统计学意义(P<0.05),而SS、PVF、SVD两组间比较,差异均无统计学意义(P值均>0.05)(表 2)。

    表  2  SPH组和非SPH组不同无创测定指标的比较
    Table  2.  The comparison of different noninvasive indexes between SPH group and non-SPH group
    指标 所有患者(n=88) 非SPH组(n=64) SPH组(n=24) t P
    LS(m/s) 2.00±0.43 1.88±0.34 2.33±0.50 -3.970 <0.01
    SS(m/s) 3.48±0.53 3.46±0.56 3.54±0.46 -0.612 0.54
    PVF(m/s) 27.56±9.53 27.65±9.59 27.33±9.58 0.139 0.89
    SVD(cm) 1.19±0.30 1.18±0.30 1.22±0.30 -0.430 0.67
    下载: 导出CSV 
    | 显示表格

    将LS、SS、PVF、SVD根据中位数水平转化为二分类变量,采用Logistic回归分析不同LS、SS、PVF、SVD、肝功能(Child-Pugh分级)水平下SPH的发生风险。结果显示,以低LS组为参考,在调整各危险因素后,高LS组SPH发生风险为低LS组的3.941倍(95%CI:1.245~12.476,P=0.020)(表 3)。

    表  3  SPH发生风险的Logistic回归分析
    Table  3.  Logistic regression analysis of SPH risk
    无创指标 OR 95%CI P
    LS 3.941 1.245~12.476 0.020
    SS 0.840 0.281~2.507 0.754
    PVF 0.542 0.192~1.527 0.246
    SVD 1.452 0.497~4.241 0.496
    Child-Pugh分级
    B级 0.184 0.011~3.192 0.245
    C级 0.402 0.027~5.948 0.507
    注:LS≤1.925 m/s赋值为0,LS>1.925 m/s赋值为1;SS≤3.50 m/s赋值为0,SS>3.50 m/s赋值为1;PVF≤25.85 m/s赋值为0,PVF>25.85 m/s赋值为1;SVD≤1.12 cm赋值为0,SVD>1.12 cm赋值为1;Child-Pugh分级以Child-Pugh A级为参考。
    下载: 导出CSV 
    | 显示表格

    绘制不同无创指标预测SPH的ROC曲线(图 1)。其中LS预测SPH发生的AUC为0.751,最佳临界值为2.295 m/s,敏感度为54.17%,特异度为90.63%。

    图  1  不同无创指标预测SPH发生风险的ROC曲线
    Figure  1.  ROC curve of different non-invasive index to predict the risk of SPH

    由于失代偿期肝硬化患者存在显著的高死亡风险,因此精确评估、风险分层、个体化干预显得尤为重要[8]。对于失代偿期肝硬化患者,基于HVPG的风险分层进行个体化干预治疗在Baveno Ⅶ共识[2]中被推荐,即HVPG≥20 mmHg可考虑早期经颈静脉肝内门体分流术,而对于低危患者首选非选择性β受体阻滞剂联合内镜治疗进行二级预防。然而,HVPG检查属于有创操作,有一定技术难度,且患者接纳程度相对较低。因此,对无创指标的预测诊断模型的探索非常必要。近年来国内外学者在门静脉高压的预测诊断模型研究方面进行了诸多探索,其中比较有代表性的包括门静脉影像学模型、血流动力学评分模型等,但多数仍处于研究阶段且缺乏外部验证,不能广泛应用于临床[9]

    近几年来,随着超声技术的发展,LS和SS主要测量方式包括TE、实时弹性成像、ARFI。许多研究表明,LS和SS可能是评估肝硬化失代偿期风险的潜在的无创指标[2, 10]。既往研究[11]表明原发性硬化性胆管炎患者随着时间推演肝纤维化的程度增加,LS逐渐增加,且LS与发生并发症的风险呈正相关。既往一项国外Meta分析[12]发现:TE测得的LS在诊断临床显著门静脉高压方面具有出色的诊断性能,AUC为0.93;TE测得的LS诊断食管静脉曲张的AUC为0.84。Baveno Ⅶ共识[2]提出,应用TE检测LS可能有助于对门静脉高压患者的门静脉压力进行评估。与此同时,既往有大样本临床研究[13-14]得出结论:结合LS、血小板计数和脾脏直径的评分(即LSPS评分,TE测得LS×脾肋间直径/外周血血小板计数)在门静脉高压的诊断中也具有较高的预测价值;国内研究[15]表明肝脾硬度联合血清学检测对重度食管胃底静脉曲张具有较好的预判价值。

    目前TE已被广泛用于LS和SS的评估,但TE在技术上存在局限性,其在大量腹水、肥胖、肋间隙狭窄的患者中应用受限。欧洲超声医学与生物学联合会(EFUSUMB)指南[16]提出,TE不能用于肝周腹水患者。而失代偿期肝硬化患者多发生腹水,因此,尽管TE在代偿性肝硬化患者中表现良好,但在失代偿期肝硬化患者中存在不确定性。

    ARFI是一种新兴的、以超声为基础的无创评估组织弹性的方法。其检测原理为利用调制的聚焦超声波束向指定区域发射短程、低频的声脉冲波,使受检组织产生微小形变,通过追踪感兴趣区域内产生的横向剪切波的传播速度,从而将组织弹性转化为一个简单的速度值。组织的硬度越大,相应剪切波的速度值也越大[17]。ARFI目前是一种具有良好应用前景的无创、快速、简单、客观、易重复的检测肝脏纤维化程度的手段。可在测量组织弹性的同时进行常规B超检査,无需更换仪器,较TE更为方便。同时,ARFI受到腹水及肝脏脂质沉积等影响较小。既往研究[18]表明,通过ARFI测得的LS在诊断显著纤维化或肝硬化方面具有与TE相似的准确性,并且不需要单独的设备,亦不易受肝周腹水的影响。在失代偿期肝硬化患者中与TE相比具有一定的优势,几乎可以在每一例患者中清晰地显示解剖结构和进行成功的测量[17]

    既往本课题组小样本研究[19]表明,在不区分病因的情况下,提示ARFI测得的LS与HVPG呈中等强度相关(r=0.449,P<0.05)。Baveno Ⅶ共识[2]中提出HVPG是反映病毒性肝炎相关失代偿期肝硬化或失代偿期酒精性肝硬化合并门静脉高压患者门静脉压力的金标准。因此本研究纳入人群为乙型肝炎肝硬化失代偿期或酒精性肝硬化失代偿期合并门静脉高压患者。本研究评估了LS对病毒性肝炎相关肝硬化失代偿期和酒精性肝硬化失代偿期合并门静脉高压患者的诊断价值,并将其与门静脉压力值金标准HVPG进行比较。根据Pearson相关分析、Logistic回归分析及ROC曲线结果分析后认为,在临床较为常用的评估门静脉压力的无创指标中,LS对评估肝硬化型门静脉高压患者的门静脉压力具有较好的预测价值。但本研究也存在一定的不足之处,如本研究为回顾性研究,样本量较小且为单中心研究,LS临床诊断价值未来仍需多中心、大样本量的前瞻性研究进一步证实。

  • [1]WANG FS,FAN JG,ZHANG Z,et al.The global burden of liver disease:the major impact of China[J].Hepatology,2014,60(6):2099-2108.
    [2]FAN JG,YAN SY.Metabolic syndrome and fatty liver[J].J Clin Hepatol,2016,32(3):407-410.(in Chinese)范建高,颜士岩.代谢综合征与脂肪肝[J].临床肝胆病杂志,2016,32(3):407-410.
    [3]JI XL,GE YD,AN MM,et al.Relationship between nonalcoholic fatty liver disease and metabolic syndrome[J].Chin J Clin Pharmacol Ther,2014,19(6):666-670.(in Chinese)季学磊,葛艺东,安民民,等.非酒精性脂肪肝与代谢综合征的临床相关性分析[J].中国临床药理学与治疗学,2014,19(6):666-670.
    [4]The Chinese National Work-shop on Fatty Liver and Alcoholic Liver Disease for the Chinese Liver Disease Association.Guidelines for management of nonalcoholic fatty liver disease:an updated and revised edition[J].J Clin Hepatol,2010,26(2):120-124.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].临床肝胆病杂志,2010,26(2):120-124.
    [5]LI J,CHENG WJ,MA YH.Research progress of adiponectin in cardiovascular disease[J].China Med Herald,2016,13(9):76-79.(in Chinese)李晶,程文俊,马宇虹.脂联素在心血管疾病中的研究进展[J].中国医药导报,2016,13(9):76-79.
    [6]LI YL,YANG M,FU BY,et al.The changes and significance of serum cholesterol in poctients with nonalcoholic fatty liver disease[J].Shanxi Med J,2011,40(7):705-706.(in Chinese)李异玲,杨淼,傅宝玉,等.非酒精性脂肪肝病患者血清内脂素的变化及意义[J].山西医药杂志,2011,40(7):705-706.
    [7]LUO N,WANG X,ZHANG W,et al.AdR1-TG/TALLYHO mice have improved lipid accumulation and insulin sensitivity[J].Biochem Biophys Res Commun,2013,433(4):567-572.
    [8]CHRISTIANSEN T,PAULSEN SK,BRUUN JM,et al.Diet-induced weight loss and exercise alone and in combination enhance the expression of adiponectin receptors in adipose tissue and skeletal muscle,but only diet-induced weight loss enhanced circulating adiponectin[J].J Clin Endocrinol Metab,2010,95(2):911-919.
    [9]HOLLAND WL,ADAMS AC,BROZINICK JT,et al.An FGF21-adiponectin-ceramide axis controls energy expenditure and insulin action in mice[J].Cell Metabolism,2013,17(5):790-797.
    [10]ANTAL M,REGOLY MA.New approach in the interpretation of adipose tissue[J].Orv Hetil,2010,151(31):1252-1260.
    [11]YANG Z,WANG X,WEN J,et al.Prevalence of non-alcoholic fatty liver disease and its relation to hypoadiponectinaemia in the middle-aged and elderly Chinese population[J].Arch Med Sci,2011,7(4):665-672.
    [12]LI Z,XUE J,CHEN P,et al.Prevalence of nonalcoholic fatty liver disease in mainland of China:a meta-analysis of published studies[J].Gastroenterol Hepatol,2014,29(1):42-51.
    [13]NELSON JE,WILSON L,BRUNT EM,et al.Relationship between the pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver disease[J].Hepatology,2011,53(2):448-457.
    [14]UTZSCHNEIDER KM,ARGAJOLI A,BERTOLDO A,et al.Serum ferritin is associated with non-alcoholic fatty liver disease and decreased B-cell function in non-diabetic men and women[J].J Diabetes Complications,2014,28(2):177-184.
  • Relative Articles

    [1]Zhang WenJia, Zhao LiJuan, Wu JiZhou. Value of MELD、AARC、COSSH ccoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2020, 36(4): 813-817. doi: 10.3969/j.issn.1001-5256.2020.04.021
    [2]Tian XiaoLi, Wu SongLin, Wang Bo, Wu Gang. Value of the COSSH-ACLFs model in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2020, 36(6): 1258-1262. doi: 10.3969/j.issn.1001-5256.2020.06.014
    [3]Lan XiaoQin, Ji YaLi, Chen JinJun, Zhou FuYuan, Wen WeiQun. Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage: A stratified analysis based on Model for End-Stage Liver Disease score[J]. Journal of Clinical Hepatology, 2020, 36(9): 2005-2009. doi: 10.3969/j.issn.1001-5256.2020.09.019
    [4]Wang Yu, Hu JinHua. Clinical features of patients with liver failure and fungal infections and influencing factors for prognosis[J]. Journal of Clinical Hepatology, 2019, 35(2): 419-423. doi: 10.3969/j.issn.1001-5256.2019.02.041
    [5]Liu Juan, Bai FeiYun, Zhang Jing. Research advances in diagnostic criteria for acute-on-chronic liver failure and models for prognostic evaluation[J]. Journal of Clinical Hepatology, 2019, 35(6): 1384-1387. doi: 10.3969/j.issn.1001-5256.2019.06.046
    [6]Zhang BaoZhong, Zhou PengZhi. Influencing factors for short-term prognosis of liver failure in pregnancy[J]. Journal of Clinical Hepatology, 2019, 35(2): 414-418. doi: 10.3969/j.issn.1001-5256.2019.02.040
    [7]Liu YeYing, Wang Ting, Dou AiHua, Zheng SuJun, Xu Bin, Liu Mei. Current status and perspectives of prognostic markers for liver failure[J]. Journal of Clinical Hepatology, 2019, 35(5): 1135-1139. doi: 10.3969/j.issn.1001-5256.2019.05.046
    [8]Zhang Hui, Jia Lei, Yao ShiWei, Cui PeiLin, Xu YouQing. Value of MELD combined with serum sodium concentration in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure in China: A meta-analysis[J]. Journal of Clinical Hepatology, 2018, 34(9): 1950-1955. doi: 10.3969/j.issn.1001-5256.2018.09.024
    [9]Zhang Li, Chen Wen, Sheng YunJian, Deng CunLiang. Value of Model for End-Stage Liver Disease score combined with neutrophil-lymphocyte ratio in predicting the short-term prognosis of patients with HBV-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2018, 34(3): 553-557. doi: 10.3969/j.issn.1001-5256.2018.03.021
    [10]Zhang DongJing, Zhou Bin, Hou JinLin. Research progress in prognostic models of acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2018, 34(6): 1351-1356. doi: 10.3969/j.issn.1001-5256.2018.06.047
    [11]Han PuQing, Sun Yan. Prognostic models for liver failure and their role in pregnant women with liver failure[J]. Journal of Clinical Hepatology, 2018, 34(3): 635-640. doi: 10.3969/j.issn.1001-5256.2018.03.044
    [12]Wang XiaoFang, Zhu LiYing, Lu BaoLing, Zhong LiHua, Cheng Yu, Fan Jian, Yao Hong, Yu Lei. Application of different scoring systems in evaluating prognosis after transarterial chemoembolization for primary liver cancer[J]. Journal of Clinical Hepatology, 2017, 33(10): 2016-2020. doi: 10.3969/j.issn.1001-5256.2017.10.036
    [13]Gao MengDan, Zhao Yan. Research advances in immune factors for the prognosis of patients with acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2017, 33(12): 2462-2466. doi: 10.3969/j.issn.1001-5256.2017.12.047
    [14]Zhu Bing, Liu WanShu, You ShaoLi. Research advances in liver failure of unknown etiology[J]. Journal of Clinical Hepatology, 2015, 31(9): 1509-1512. doi: 10.3969/j.issn.1001-5256.2015.09.038
    [15]Liu Huan, Song LiWen, Cao WuKui, Li Fei. The predictive values of four scoring systems in short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2015, 31(9): 1418-1421. doi: 10.3969/j.issn.1001-5256.2015.09.013
    [16]Tang ShanHong, Zeng WeiZheng, Jiang MingDe, Fan QuanShui. Research progress in prediction of clinical outcome in patients with liver failure[J]. Journal of Clinical Hepatology, 2015, 31(1): 135-138. doi: 10.3969/j.issn.1001-5256.2015.01.031
    [17]Wang Xian, Wang ShaoYang, Huang DeDong, Chen Jian, Chen DeLiang. Analysis of short-term prognostic factors in patients with HBV-related acute-on-chronic liver failure treated with artificial liver support system[J]. Journal of Clinical Hepatology, 2014, 30(4): 367-369. doi: 10.3969/j.issn.1001-5256.2014.04.020
    [18]Li XinYan, Huang ShuLin, Fang Liang, Lei RuiXiang, Ke WeiMin. A simple scoring system for evaluating severity of HBV-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2014, 30(10): 996-999. doi: 10.3969/j.issn.1001-5256.2014.10.006
    [19]Zhang YuLing, Han Tao, Zhang Min, Zhang Qian. Research progress in prognostic markers of acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2014, 30(10): 1078-1081. doi: 10.3969/j.issn.1001-5256.2014.10.026
  • Cited by

    Periodical cited type(2)

    1. 柯舸,张弛,陈明锴. 门静脉高压非侵入性诊断方法的研究进展. 医学研究杂志. 2024(04): 189-192 .
    2. 陈凯,张方方,葛尚. MSCT测量门静脉系统相关指标在肝硬化门静脉高压症诊断中的应用. 肝脏. 2024(11): 1330-1333 .

    Other cited types(2)

  • 加载中
    Created with Highcharts 5.0.7Chart context menuAccess Class DistributionFULLTEXT: 3.6 %FULLTEXT: 3.6 %META: 92.0 %META: 92.0 %PDF: 4.4 %PDF: 4.4 %FULLTEXTMETAPDF
    Created with Highcharts 5.0.7Chart context menuAccess Area Distribution其他: 7.1 %其他: 7.1 %其他: 0.2 %其他: 0.2 %Austin: 0.2 %Austin: 0.2 %India: 0.2 %India: 0.2 %上海: 2.4 %上海: 2.4 %东莞: 0.5 %东莞: 0.5 %加州: 0.2 %加州: 0.2 %北京: 4.4 %北京: 4.4 %南京: 1.0 %南京: 1.0 %南宁: 0.2 %南宁: 0.2 %台州: 0.2 %台州: 0.2 %合肥: 0.2 %合肥: 0.2 %吉林: 1.0 %吉林: 1.0 %哥德堡: 0.2 %哥德堡: 0.2 %嘉兴: 0.2 %嘉兴: 0.2 %平顶山: 0.2 %平顶山: 0.2 %广州: 1.0 %广州: 1.0 %张家口: 3.9 %张家口: 3.9 %徐州: 0.2 %徐州: 0.2 %扬州: 0.2 %扬州: 0.2 %昆明: 0.7 %昆明: 0.7 %杭州: 1.0 %杭州: 1.0 %沈阳: 0.2 %沈阳: 0.2 %沧州: 0.2 %沧州: 0.2 %法兰克福: 0.2 %法兰克福: 0.2 %洛阳: 0.2 %洛阳: 0.2 %深圳: 1.0 %深圳: 1.0 %温州: 0.2 %温州: 0.2 %湖州: 0.2 %湖州: 0.2 %芒廷维尤: 36.7 %芒廷维尤: 36.7 %莫斯科: 2.2 %莫斯科: 2.2 %西宁: 27.5 %西宁: 27.5 %西安: 0.2 %西安: 0.2 %赣州: 0.5 %赣州: 0.5 %郑州: 0.2 %郑州: 0.2 %重庆: 0.2 %重庆: 0.2 %镇江: 0.5 %镇江: 0.5 %长春: 2.2 %长春: 2.2 %长沙: 1.0 %长沙: 1.0 %青岛: 0.2 %青岛: 0.2 %默特尔比奇: 0.2 %默特尔比奇: 0.2 %其他其他AustinIndia上海东莞加州北京南京南宁台州合肥吉林哥德堡嘉兴平顶山广州张家口徐州扬州昆明杭州沈阳沧州法兰克福洛阳深圳温州湖州芒廷维尤莫斯科西宁西安赣州郑州重庆镇江长春长沙青岛默特尔比奇

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2375) PDF downloads(395) Cited by(4)
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return