瞬时弹性扫描仪在肝纤维化诊断中的应用价值

瞬时弹性扫描仪(Fibroscan,FS)是一种新型的、无创性的通过测定肝脏硬度值来评估慢性肝脏疾病患者肝纤维化程度的仪器.他具有操作简单、快速、重复性好等优点.目前,FS不仅用于慢性丙型肝炎患者肝纤维化的测定,也可用于其他原因引起的肝脏疾病的肝纤维化测定.FS对测定早期肝硬化及合并肝硬化并发症患者的肝脏硬度值有较大的价值.由于FS能被患者普遍接受及可以重复测定,因此可用于监测肝脏纤维化的进展或逆转,指导临床治疗.但FS在临床应用中也存在一些影响因素和一定局限性.本文就FS在肝纤维化诊断方面的应用价值作一综述.     

瞬时弹性成像与非酒精性脂肪性肝病病理纤维化分期的相关性

目的:评价瞬时弹性成像(Fibroscan,FS)在非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)肝纤维化诊断中的作用.方法:选取2008-04/2011-02在北京佑安医院住院,且经病理检查诊断为NAFLD的患者83例,临床检测肝功能、空腹血糖、血脂、尿酸,同时应用FS进行肝脏硬度检测.以病理检查结果为金标准,分析肝脏硬度、生化学指标及病理肝纤维化程度的相关性,采用受试者工作特征(ROC)曲线分析FS诊断NAFLD肝纤维化的准确性.结果:不同程度肝纤维化分期的肝脏硬度值,S0期:4.28kPa±1.32kPa,S1期:7.40kPa±2.13kPa,S2期:11.52kPa±3.86kPa,S3期:19.99kPa±5.42kPa.肝脏硬度与肝纤维化程度呈正相关,Spearman相关系数为0.768,P<0.001.Pearson相关分析显示,FS肝脏硬度检测值与ALT、AST呈正相关,与HDL、ApoA呈负相关(P<0.05).FS诊断S0-S1、S2、S3期的ROC曲线下面积分别为0.889(0.813,0.965)、0.838(0.729,0.948)、0.938(0.000,1.000),诊断界值分别为8.95kPa、10.60kPa、15.66kPa.结论:FS对NAFLD肝纤维化有较高的诊断价值,可作为NAFLD患者诊断和动态随访的依据.     

肝脏瞬时弹性超声评价自身免疫性肝炎肝纤维化的价值

目的 验证肝脏瞬时弹性超声在评估自身免疫性肝炎(AIH)患者肝纤维化程度中的价值.方法 用瞬时弹性超声对30例AIH患者进行肝脏瞬时弹性测定,并将测定值与按照Scheuer系统进行纤维化分级的患者肝活组织检查结果作纤维化程度的比较,用Spearman等级相关系数方法进行统计学分析.结果 30例AIH患者中S0期4例,S1期6例,S2期5例,S3期11例,S4期4例.除l例患者因肥胖导致瞬时弹性超声检测失败以外,其余均顺利受检.29例患者测定的瞬时弹性超声硬度值与其肝纤维化分期有显著相关性(r= 0.801,P＜0.01).将S0、S1、S2期合并与S3、S4期合并后对两组间瞬时弹性超声硬度值作比较,t= -3.937,P=0.001,差异有统计学意义.结论 肝脏瞬时弹性超声评估AIH患者肝纤维化程度的可靠性较好,并且由于其无创性而在此类患者的长期随访与疗效评估中有着较好的应用前景.     

FibroScan评估酒精性肝病肝纤维化程度的诊断价值

目的探讨瞬时弹性成像技术(FibroScan)在评估酒精性肝病肝纤维化程度中的应用价值。方法对60例酒精性肝病患者采用FibroScan测量肝脏硬度,获得FibroScan弹性值(FS值),同时对患者进行肝活组织检查.以病理结果为金标准,分析FS值与酒精性肝纤维化分期的相关性。用受试者工作特征(receiver operatmg charateristic,R()C)曲线评估FibroScan对酒精性肝病的诊断价值。结果酒精性肝病患者肝纤维化分期S0~S4的FS值分别为S0:(5.31±1.06)kPa、S1:(7.91±2.81)kPa、S2:(9.81±3.39)kPa、S3:(14.66±4.31)kPa、S4:(19.81±6.02)kPa。组间差异有统计学意义(P0.(5)。进一步分析显示FS值与肝纤维化分期呈正相关性(r=0.706,P0.05)。肝纤维化程度≥S1、≥S2、≥S3和S4的ROC曲线下面积分别为0.833、0.871、0.906和0.919。结论 Fibroscan作为一种无创技术,能够较准确地定量评估酒精性肝病肝纤维化程度。     

瞬时弹性记录仪在慢性乙型肝炎病毒感染者抗病毒治疗中的价值

瞬时弹性记录仪(FibroScan)检测是利用超声技术发明的一种无创检测肝组织纤维化程度的新方法,其检测结果为弹性值(FS值),具有快速、无创、易重复等优势.对于诊断肝纤维化和早期肝硬化,传统的无创诊断方法存在一定局限性,结合瞬时弹性记录仪检测可提高诊断的准确性[1-2].本研究旨在探讨瞬时弹性记录仪检测在慢性HBV感染者抗病毒治疗中的应用价值.     

肝脏瞬时弹性值评估慢性乙型肝炎肝纤维化程度及肝脏储备功能的临床研究

目的探讨慢性乙型肝炎(CHB)患者FibroScan与肝组织纤维化面积之间的相关性,以评价FS值对肝纤维化程度测定的意义,分析乙型肝炎后肝硬化患者的FS值变化与肝脏储备功能评价系统CTP分级的关系。方法前瞻性研究正常对照组30例、肝病组113例(CHB患者62例及其所致肝硬化患者51例)FS值,对研究对象行腹部B超检查后,应用肝脏瞬时弹性超声进行FS值测定,收集肝硬化患者入院24 h内的临床资料,计算CTP分值,根据评分分为A、B、C 3级,同时采用计算机辅助数字图像分析法检测肝组织标本的纤维化程度,分析肝病组FS值与肝纤维化面积之间的相关性以及肝硬化患者FS值变化与CTP分级的关系。结果 (1)CHB患者组的FS值与正常对照组比较,肝硬化患者的FS值与CHB组比较,差异均有统计学意义(P<0.05);(2)在肝硬化组中FS值随着CTP分级升高而升高,ChildA、B、C 3组之间FS值差异均有统计学意义(P<0.05);肝病组的FS值与肝纤维化面积有显著的线性正相关性,且相关系数较高(r=0.804,P<0.01)。结论 FS弹性值与肝纤维化面积有很好的相关性,肝硬化患者的FS值随着CTP分级的上升而增加,FS值可以评估CHB肝纤维化程度,在一定程度上可以评估肝硬化患者的肝脏储备功能。     

肝脏瞬时弹性超声评估AIH患者肝纤维化程度的可行性

目的评价肝脏瞬时弹性超声评估自身免疫性肝炎(AIH)患者肝纤维化程度的可行性。方法统计分析我院2011年1月至2014年9月收治的60例AIH患者的临床资料。结果 60例患者中,8例患者为S0期,12例患者为S1期,10例患者为S2期,22例患者为S3期,8例患者为S4期。轻中度肝纤维化组(S0-S2,30例)和重度肝纤维化组(S3-S4,30例)患者的性别、年龄、体质量、身高之间的差异均不显著(P0.05);轻中度肝纤维化组患者的瞬时弹性超声硬度值显著低于重度肝纤维化组(P0.05);瞬时弹性超声硬度值随着肝组织病理学检查纤维化分期的增强而提升,二者呈显著的正相关关系(P0.05)。结论肝脏瞬时弹性超声评估AIH患者肝纤维化程度有效可行,值得在临床推广。     

瞬时弹性扫描诊断肝纤维化准确性研究

目的验证瞬时弹性扫描（FibroScan）诊断肝纤维化的准确性。方法选取141例慢性肝病患者,每例均进行肝脏活体组织检查,并应用瞬时弹性扫描仪测量肝脏硬度,以病理检查结果为金标准,验证FibroScan诊断肝纤维化的准确性。结果肝脏硬度与肝纤维化程度密切相关,Kendall相关系数为0．74（P=0．001）。FibroScan诊断肝纤维化F1～F4、F2～F4、F3～F4、F4期的受试者工作特征曲线下面积分别为0．97、O．96、0．99、0．97。结论FibroScan诊断肝纤维化有较好的准确性。     

瞬时弹性成像在诊断HBeAg阴性慢性乙型肝炎肝纤维化中的价值

目的探讨肝脏瞬时弹性成像(FibroScan,FS)在HBeAg阴性慢性乙型肝炎(CHB)患者肝纤维化中的应用价值。方法选择2011年6月-2013年5月在湖北省中医院诊治的HBeAg阴性CHB患者104例,运用FS进行肝脏硬度(Stiffness值)测量,所有患者均行肝穿刺活组织检查。以肝活组织检查病理结果为标准,Stiffness值与之对比;同时绘制FS工作特征曲线,计算受试者工作特征曲线下面积(AUC)。组间比较采用Kruskal-Wallis H检验,两组比较采用Mann-Whitney U检验。双变量相关性分析采用Pearson相关和Spearman等级相关法。结果随肝纤维化程度的提高,Stiffness值逐渐增高,差异有统计学意义(P0.01或P0.05)。Stiffness值与肝纤维化分期呈正相关(r=0.810,P0.01)。FS检测肝硬化AUC为0.956,其中以13.1 kPa作为肝硬化的诊断界值,敏感度为92.7%,特异度为80%。结论 FS在HBeAg阴性CHB患者肝纤维化程度的评估中具有较好的应用价值,尤其诊断肝硬化的准确性较高,直接、间接标志物和FS的联合应用有助于肝纤维化患者的鉴别诊断及疗效评估。     

FibroScan对慢性乙型肝炎肝纤维化患者的应用价值及ALT、AST对其诊断的影响

目的探讨瞬时弹性探测仪(FS)在慢性乙型肝炎肝纤维化患者中应用价值及ALT、AST对其诊断纤维化的影响。方法应用FS对90名慢性乙型肝炎肝纤维化患者进行肝穿前肝脏弹性测量值(LSM)的测定,同时进行血清ALT、AST的检测。以肝脏活检病理结果为金标准,对肝纤维化进行分期。结果 LSM在肝纤维化病理S1～4之间逐渐增高,组间差异有统计学意义(P<0.01);相邻两分期间LSM组间差异均有统计学意义(P<0.01)。肝脏LSM与病理分期呈正相关(r=0774,P<0.01)。S1～4各期的LSM与相应分期的ALT呈正相关,相关系数分别为0.672(P=0.000)、0.790(P=0.000)、0.845(P=0.001)和0.797(P=0.003),S1～4各期LSM与相应分期的AST呈正相关,相关系数分别为0.593(P=0.000)、0.762(P=0.001)、0.743(P=0.009)和0.872(P=0.000)。结论 FS在慢性乙型肝炎肝纤维化程度评估中有较好的应用价值,但是血清ALT和AST水平对其有一定影响。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.