慢性乙肝患者HBV-DNA定量与肝脏病理及血清ALT关系的探讨

目的研究慢性乙型肝炎(CHB)患者HBV-DNA复制水平及其与肝组织病理学、血清ALT水平的相关性。方法采用荧光定量聚合酶链反应(PCR)监测300例慢性乙型肝炎患者血清HBV-DNA含量及测定相关血清ALT水平,并对患者活体肝穿刺的病理标本进行组织炎症活动度分级(G)和纤维化程度分期(S),结果利用统计软件统计分析。结果慢性乙肝患者血清HBV-DNA定量与炎症分级有明显相关性(P<0.05),但是与纤维化分期无明显相关性(P>0.05),而血清HBV-DNA定量(103～106)与血清ALT水平有较好一致性(P<0.05)。结论血清HBV-DNA定量结合血清ALT在一定条件下可较好评价肝脏炎症活动程度,但对于评价肝脏纤维化分期有一定不足。     

慢性乙肝病毒携带者血清HBeAg及HBV-DNA与肝组织病理改变的关系

目的了解慢性乙型肝炎病毒携带者肝组织病理改变特征,并分析血清HBeAg及HBV-DNA定量与肝组织病理改变的关系。方法选取临床诊断为慢性乙型肝炎病毒携带者228例,行肝穿刺病理检查、肝功能、血清HBV-DNA及乙肝血清学标志物检测。结果 228例患者中病理符合病毒携带者49例(21.5%),肝硬化7例(3.1%),慢性乙型肝炎轻度136例(59.6%),中度28例(12.3%),重度7例(3.1%),重型1例(0.4%)。炎症分级G≥2者43例(18.8%);纤维化分期S≥2者49例(21.5%)。HBeAg阴性组病理炎症分级及纤维化分期均明显重于阳性组(P值均小于0.05)。HBV-DNA低载量组纤维化分期重于高载量组,而两组间肝组织炎症分级无统计学意义。结论多数慢性乙型肝炎病毒携带者有不同程度病理变化,血清HBeAg、HBV-DNA均不能准确反映肝脏损伤情况,对此类患者制定治疗方案时应考虑肝组织病理检查结果。     

慢性乙肝患者HBV-DNA定量与肝脏病理及血清ALT关系的探讨

目的研究慢性乙型肝炎（CHB）患者HBV-DNA复制水平及其与肝组织病理学、血清ALT水平的相关性。方法采用荧光定量聚合酶链反应（PCR）监测300例慢性乙型肝炎患者血清HBV-DNA含量及测定相关血清ALT水平,并对患者活体肝穿刺的病理标本进行组织炎症活动度分级（G）和纤维化程度分期（S）,结果利用统计软件统计分析。结果慢性乙肝患者血清HBV-DNA定量与炎症分级有明显相关性（P〈0.05）,但是与纤维化分期无明显相关性（P〉0.05）,而血清HBV-DNA定量（103～106）与血清ALT水平有较好一致性（P〈0.05）。结论血清HBV-DNA定量结合血清ALT在一定条件下可较好评价肝脏炎症活动程度,但对于评价肝脏纤维化分期有一定不足。     

慢性乙型肝炎76例血生化指标与病理诊断的相关性探讨

目的 分析慢性乙型肝炎患者血生化指标诊断与肝脏组织病理诊断炎症和纤维化程度的相关性.方法 选取2007年10月至2010年12月住院治疗的76例慢性乙型肝炎患者,经活体肝穿刺取病理标本后进行肝组织炎症活动度分级(G)和纤维化程度分期(S),同时与同期血清肝功能的各项指标进行比较分析.结果 血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、谷氨酰胺氨基转移酶(GGT)与肝组织炎症活动度分级和纤维化程度分期正相关,而白蛋白(ALB)、凝血酶原活动度(PTA)与肝组织炎症活动度和纤维化程度分期负相关.与病理诊断相比,临床诊断的灵敏度分别为:轻度89.6%(43/48),中度71.4%(10/14),重度57.1%(8/14).结论 血清ALT、AST、TBIL、GGT可反映慢性乙型肝炎肝组织炎症活动的程度,ALB、PTA 可视为慢性乙型肝炎病变进展的指标.     

肝功能正常的慢性乙型肝炎病毒感染者病毒复制标志物与肝组织病理改变的关系

目的 了解肝功能正常的慢性乙型肝炎病毒感染者肝组织病理改变特征,并分析血清HBeAg及HBV DNA定量与肝组织病理改变的关系.方法 选取肝功能正常的慢性乙型肝炎病毒感染者244例,行肝穿刺病理检查、肝功能、血清HBV DNA及乙肝血清学标志物检测.结果 244例患者中病理诊断为肝硬化7例(2.9％,7/244),慢性乙型肝炎轻度143例(58.6％,143/244)、中度32例(13.1％,32/244)、重度9例(3.6％,9/244),病理无明显改变者53例(21.7％,53/244);炎症分级(G)≥2者48例(19.7％,48/244);纤维化分期(S)≥2者54例(22.1％,54/244).对HBV DNA阳性者,HBeAg阴性组肝脏病理炎症分级及纤维化分期均明显高于阳性组(P均＜0.05).HBV DNA低载量组患者肝纤维化分期高于高载量组,但两组间肝组织炎症分级差异无统计学意义.结论 多数肝功能正常的慢性乙型肝炎病毒感染者有不同程度肝组织炎症和肝纤维化,HBeAg、HBV DNA与肝组织病理改变有密切关系.     

慢性乙型肝炎患者血清e抗原及病毒载量和肝损伤的相关性研究

目的观察慢性乙型肝炎(CHB)患者不同乙型肝炎e抗原(HBeAg)状态与HBV-DNA载量及肝脏损伤的关系。方法分别采用实时荧光定量PCR法及速率法对258例慢性乙型肝炎进行血清HBV-DNA定量和丙氨酸氨基转移酶(ALT)检测。以ALT水平对肝脏损伤程度进行分型,对不同HBeAg状态、病毒载量、肝损伤程度进行分析。结果 HBeAg阴性组年龄大于HBeAg阳性组,其血清HBV-DNA载量低于HBeAg阳性组(P0.01),肝损伤程度两组比较差异无统计学意义(P0.05)。HBeAg阴性组随血清HBV-DNA载量增加,肝损伤程度明显升高(P0.05),HBeAg阳性组则无相关性。结论 HBeAg阳性是判断HBV复制的良好指标,HBeAg阳性CHB患者体内DNA载量与肝内炎症损伤无关。而HBeAg阴性CHB患者体内HBVDNA与肝脏损伤相关,应重视对HBeAg阴性患者的随访和治疗。     

ALT轻度升高的慢性乙型肝炎患者肝脏组织病理学特征分析

目的分析ALT轻度升高的慢性乙型肝炎(CHB)患者的肝组织病理学状态与临床关系,为抗病毒治疗提供依据。方法回顾性分析105例ALT轻度升高的CHB患者的肝脏组织病理学情况,根据肝组织不同炎症及纤维化分组,对比各组性别、年龄、ALT、HBV-DNA水平、HBeAg状态差异。结果 105例患者均存在不同程度的炎症活动,其中80%(84/105)为G2^G4;67.6%(71/105)存在不同程度的纤维化,其中46.6%(49/105)为S2G4;67.6%(71/105)存在不同程度的纤维化,其中46.6%(49/105)为S2^S4。不同肝组织炎症分级间性别、年龄、HBV-DNA水平、HBeAg状态比较均无统计学意义(P>0.05);不同纤维化分期间年龄比较,S1、S3、S4组与S0组差异具有统计学意义(P<0.05),性别、ALT、HBV-DNA水平、HBeAg状态在各组间比较无统计学意义(P>0.05)。结论 ALT轻度升高的CHB患者可能存在明显的肝组织病理学改变,应积极考虑行肝穿刺活检,及时确定抗病毒治疗时机。     

慢性HBV携带者与慢性乙型肝炎轻度肝组织病理比较分析

目的：研究慢性HBV携带者的肝脏病理特征。方法：分析比较24例慢性HBV携带者及29例慢性乙型肝炎（CHB）轻度患者的肝组织病理、病毒载量和ALT的变化。结果：24例慢性HBV携带者肝组织病理均有不同程度的炎症变化及纤维化，炎症G分级与纤维化S分期与CHB轻度相比，差异无显著性。结论：慢性HBV携带者均存在不同程度炎症及纤维化，且与CHB轻度患者肝组织病理变化基本一致。     

慢性乙型肝炎病毒感染患者临床与病理对照研究

目的:探讨慢性乙型肝炎患者临床特征与病理相关性。方法:对114例慢性乙型肝炎患者进行肝组织病理学检查,同时检测血清HBV-DNA水平、HBV血清标记物、血清ALT水平、血清纤维化标志物(透明质酸、层黏连蛋白、Ⅲ型前胶原及Ⅳ型胶原)。研究慢性乙型肝炎患者组织病理与年龄、血清HBV-DNA水平、血清ALT水平、纤维化血清标志物的关系。结果:114例慢性乙型肝炎患者都存在不同程度的肝脏病理改变,其中G2及以上占75.4%,S2及以上47.4%;以ALT水平进行分层分析发现ALT水平与纤维化分期及炎症程度分级无关(χ2=5.236,P>0.05;χ2=3.993,P>0.05);血清HBV-DNA水平与慢性乙型肝炎感染肝脏纤维化及炎症无关(F=2.139,P>0.05;F=1.776,P>0.05);以不同年龄组进行分层分析发现年龄与纤维化分期及炎症程度有关,随着年龄增加炎症及纤维化程度加重(χ2=30.862,P<0.01;χ2=21.167;P<0.05);随肝脏病理炎症及纤维化进展,慢性乙型肝炎患者血清HA、PCllI、ⅣC水平逐步升高,以HA、ⅣC敏感性最高。结论:年龄与慢性乙型肝炎患者肝脏病理相关,血清纤维化标志物是反映肝脏病理的良好指标。     

慢性乙型肝炎患者乙型肝炎病毒DNA与肝纤维化4项检测指标相关分析

目的探究慢性乙型肝炎(以下简称"乙肝")患者检测血清乙肝病毒(HBV)-DNA、肝纤维化4项指标的临床意义。方法对该院2013年4月至2014年12月收治的100例慢性乙型肝炎患者进行肝脏穿刺活检,同时检测血清血清HBV-DNA水平与肝纤维化4项,包括透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原肽(PCⅢ)和Ⅳ型胶原(CⅣ),比较不同肝组织炎症活动度分级和纤维化程度分期患者的血清HBV-DNA水平与肝纤维化4项水平。结果 60例乙肝病毒表明抗原(HBeAg)阳性患者的血清HBV-DNA水平在不同炎症分级及不同纤维化分期患者间差异无统计学意义(P0.05)。40例HBeAg阴性患者的血清HBV-DNA水平在不同炎症分级及不同纤维化分期患者间差异有统计学意义(P0.05)。G1分级患者的HA、LN、PCⅢ和CⅣ水平和正常值接近,从G2分级开始到G4分级,慢性乙型肝炎患者的肝纤维化4项水平逐步升高,且与G1患者比较差异有统计学意义(P0.05);各纤维化分级患者的HA、LN、PCⅢ和CⅣ水平均高于正常值,且水平逐级升高,其他级肝纤维化4项水平均高于S1患者的水平(P0.05)。结论 HBeAg阴性患者血清HBV-DNA水平在不同炎症分级和纤维化分期间差异明显,对于HBeAg阳性患者临床意义不大。肝纤维化4项水平随炎症分级和纤维化分期的水平逐级升高,且各级间差异较大,具有较高的临床诊断价值。     

异位辅助肝移植治疗急性肝功能衰竭的实验研究

目的：探讨异位辅助性部分肝移植治疗急性肝功能衰竭的可行性。方法；制作息性肝功能衰竭犬动物模型26只。分为两组：移植组20只，对照组6只。移植组切除脾脏后，于脾窝处移植同系异体60％部分肝脏，手术成功17只。观察两组实验动物的存活时间、血液生化、残肝磁共振（MRI）检查、残肝和移植肝的组织细胞形态改变。结果：对照组和移植组实验动物72h存活率分别为16．7％和82．7％。移植术后2周残肝细胞明显增生，肝功能恢复近正常，而辅助肝渐萎缩，术后5周辅助肝完全纤维化。结论：急性肝功能衰竭时，异位辅助性部分肝脏移植可为病肝提供暂时性功能支持，为残肝细胞再生、功能恢复提供机会，同时移植肝渐萎缩、纤维化。     

MR imaging of traumatic hepatic laceration: Evaluation and course of healing after surgery

Six patients with hepatic laceration underwent magnetic resonance imaging (MRI) at 0.5T. Acute hepatic laceration was slightly hypointense on T1-weighted spin-echo (SE) image, and hyperintense on T2- and proton-weighted SE images. Subacute laceration was heterogeneously intense on T1-weighted image and hyperintense on T2- and proton-weighted images. Consistent changes in signal intensity of postoperative hepatic laceration were observed. On Tl-weighted image, the signal intensity at first increased and then decreased from periphery to the center. On the T2- and proton-weighted images, the laceration was uniformly hyperintense relative to the liver prior to the appearance and growth of a hypointense ring at its periphery. The appearance of the above changes in signal intensity was also observed in postoperative recurrent hemorrhage. The postoperative biloma had none of the above changes in signal intensity. Our cases show that MRI is effective in the evaluation of hepatic laceration and in the assessment of the course of healing after operation.     

The liver as A self-organizing system. I

Summary The liver is described as a composite system consisting of a set of operative creodic microunits open to a continuous flow of matter, energy and informations. Its dynamics depend on two interactive and interrelated subsystems with actions described ashomopoiesis andhomeorhesis, making it anautoisodiasostic system. The system’s emergent (equifinal) or emergence states, operative potential, diffusion and reaction phenomena and compensation states are also formally described. For readers not familiar with the language of general system theory, of system dynamics and of categorical analysis, a glossary of some terms is provided. This paper forms part of research on pre-cancer states of the liver system, financed by theAssociazione Italiana per la Ricerca sul Cancro (AIRC), Milan and by theOspedale Maggiore — Istituto Scientifico di Ricovero e Cura — Milan.     

Does CTAP prior to hepatic resection improve patient survival rates?

The purpose of our study was to compare survival rates of colon carcinoma patients who had undergone attempted curative hepatic resection based on liver staging by computed tomographic angiography (CTA) or portography (CTAP) with previously reported survival rates of patients who underwent similar surgery without preoperative CTAP evaluations. A total of 404 CTAP studies performed at three institutions were reviewed. Of this group, 197 had colon carcinoma. Sixty-nine of the colon patients went to surgery. Actuarial adjusted yearly survival rates were calculated for the prior CTAP colon group and compared to historical controls. The control survival data were taken from reports published prior to the CTAP era. Our study demonstrated no difference in the 1-year survival data between the groups. However, the CTAP patients had greater survival in years 2–4. This greater survival may be multifactorial but in part due to better surgical selection caused by CTAP.An invited commentary on this article follows on pp. 320-324.     

Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients

Background: The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Methods: Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. Results: After chemotherapy, tumor volume decreased by 50–90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. Conclusions: These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

Liver manifestations in COVID-19 patients: A review article

The coronavirus disease 2019 (COVID-19) initially presented as a disease that affected the lungs. Then, studies revealed that it intricately affected disparate organs in the human body, with the liver being one of the most affected organs. This review aimed to assess the association between COVID-19 and liver function, shedding light on its clinical implication. However, its exact pathophysiology remains unclear, involving many factors, such as active viral replication in the liver cells, direct cytotoxic effects of the virus on the liver or adverse reactions to viral antigens. Liver symptoms are mild-to-moderate transaminase elevation. In some patients, with underlying liver disease, more serious outcomes are observed. Thus, liver function should be meticulously considered in patients with COVID-19.     

三维MRA技术在肝脏血管成像中的应用研究

目的：探讨三维增强MRA（3D CEMRA）技术在肝脏磁共振血管成像中的应用价值。方法：52例行肝脏磁共振血管成像患者及30例对照组病人，利用自动透视触发技术进行肝脏血管成像，造影剂到达降主动脉起始段时启动3D扫描，扫描时相包括肝动脉期、门静脉期及腔静脉期，分离各组图像并与蒙片剪影，再进行最大信号强度投影（MIP）及多平面图像重建（MPR），评价各期图像质量。结果：采用3DCEMRA技术所获肝动脉期及门静脉期图像质量满意；造影剂到达降主动脉起始段时间与造影剂流速、总量之间呈线性相关；造影剂总量和流速与肝血管信号强度呈正相关。结论：3DCEMRA技术可准确把握造影剂到达靶血管时间，结合最佳的造影剂总量和注射速度，明显提高肝脏磁共振血管成像质量。     

人工肝支持系统在肝衰竭中的应用经验和进展

人工肝支持系统对肝衰竭的治疗作用已经得到公认,可以使部分患者病情得到恢复,还可以使患者有效地过渡到肝脏移植,分为非生物型人工肝、生物型人工肝和混合型3种,包括血浆置换、血液滤过、血液/浆灌流、连续性血液透析滤过、血液透析、白蛋白透析、血浆胆红素吸附和生物型人工肝等。目前常应用的方法有血浆置换、连续性血液透析滤过和血浆胆红素吸附,其作用机制就是通过机械性的方法祛除肝衰竭患者体内的毒性物质及代谢产物,补充部分活性物质,纠正凝血物质缺乏,使患者内环境改善,利于肝细胞再生,病情恢复。     

酒精性脂肪肝和肝硬化患者各种血清酶的检测及其临床评价

目的 探讨酒精性脂肪肝血清特异性的鉴别指标，并用其来判断病程，指导临床诊断和治疗。方法 对76例酒精性脂肪肝、62例酒精性肝硬化以及70例非酒精性脂肪肝患者的血清酶和血脂进行测定及分析。结果 与非酒精性脂肪肝相比，酒精性脂肪肝的谷草转氨酶（AST）和γ-谷氨酰转肽酶（GGT）的异常率以及谷草转氨酶／谷丙转氨酶（AST／ALT〉1）的构成比的增高，差异均具有统计学意义；与酒精性脂肪肝相比，酒精性肝硬化的AST／ALT比值，AST和GGT的水平都有明显增高。结论 AST、AST／ALT（〉1）、GGT等指标对鉴别酒精性脂肪肝以及判断其病程，具有一定的临床意义。