慢性肝病患者血清VitD3水平与骨代谢的关系

检测了部分慢性乙型肝炎(下简称慢乙肝)及肝硬化患者的血清1,25(OH)2D3、骨钙素(BGP)、甲状旁腺素(PTH)、钙、磷及尺桡平均密度(BMD),并与对照组比较.结果两组患者血清1,25(OH)2D3、BGP及BMD值均明显下降,肝硬化组下降尤为显著.肝硬化组血清PTH显著升高.两组患者血钙明显降低,而血磷三组间无差异.1,25(OH)2D3水平与BGP、BMD呈显著正相关;PTH与血钙、BMD无相关性.提示慢性肝病患者存在以骨形成减少为主的骨代谢紊乱,其中血清1,25(OH)2D3减少为关键因素,PTH虽升高,但与肝病患者骨密度变化无相关.     

维生素D受体基因Apa I 多态性与终末期肝病患者骨代谢的相关性研究

目的 探讨维生素D受体(VDR)基因Apa I位点多态性与终末期肝病患者骨代谢的关系.方法 选择72例终末期肝病患者,并以50例原发性骨质疏松和骨量减少患者作为对照组.采用聚合酶链反应和限制性片段长度多态性技术(PCR-RFLP)检测VDR基因ApaI位点多态性,双能x线吸收仪(DXA)检测腰椎(L1～4)及股骨颈骨密度(BMD),并检测骨代谢相关指标,包括甲状旁腺激素(PTH)、骨钙素(BGP)、血钙(Ca)、血磷(P)、尿钙(uCa)、尿肌酐(uCr).结果 ①Apa I多态性等位基因频率分布符合Hardy-Weinberg定律,终末期肝病组基因型分布为从(12.5%)、A且(34.7%)、aa(52.8%);对照组基因型分布为从(10.0%)、Aa(36.0%)、aa(54.0%).基因型分布频率两组间差异无统计学意义(P＞0.05).②终末期肝病组中,Apa I基因型与L1～4及股骨颈BMD相关(P＜0.01),从基因型L1～4及股骨颈的BMD显著高于aa型(P＜0.05).对照组中,ApaI基因型与L1～4及股骨颈BMD均无明显相关性.③终末期肝病组中,Apa I基因型与BGP水平相关,AA基因型的BGP水平高于阻型(P＜0.05);Apa I基因型与PIH、血Ca、血P及uCa/Cr水平差异无统计学意义.结论 终末期肝病患者VDR基因Apa I位点多态性与BMD及BGP水平均相关,Apa I位点多态性与终末期肝病患者骨代谢存在相关性.     

慢性肝病患者血清VitD3水平与骨代谢的关系

检测了部分慢性乙型肝炎（下简称慢乙肝）及肝硬化患者的血清1，25（OH）2D3，骨钙素（BGP），甲状旁腺素（PTH），钙，磷及尺桡平均密度（BMD），并与对照组比较，结果两组患者血清1，25（OH）2D3，BGP及BMD值均明显下降，肝硬化组下降尤为显著，肝硬化组血清PTH显著升高，两组患者血钙明显降低，而血磷三组间无差异，1，5（OH）2D3水平与BGP，BMD呈显著正相关；PTH与血钙，BMD无相关性。提示慢性肝病患者存在以骨形成减少为主的骨代谢紊乱，其中血清1，25（OH）2D3减少为关键因素，PTH虽升高，但与肝病患者骨密度变化无相关。     

慢性肾功衰患者骨密度与钙调节激素和胱抑素C的变化和关系

目的探讨慢性肾功能衰竭患者的骨密度(bone mineral density,BMD)与钙调节激素和胱抑素C的变化和关系。方法用双能X线吸收测量法(DEXA)检测75例慢性肾功衰患者(简称为CRF组)和50例正常对照组的骨密度(BMD),并测定各自的生化指标:血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、胱抑素C(Cys C)和钙调节激素指标:甲状旁腺素(PTH)、降钙素(CT)、骨钙素(BGP),做统计分析。结果 CRF组BMD较对照组显著降低(P<0.01);P、ALP、PTH、BGP和CT显著升高(P<0.01),Ca降低(P<0.01)。BMD与Cys C、PTH和BGP呈负相关,r分别是-0.39、-0.43、-0.32,与血Ca、P、CT和ALP无相关性。Cys C与PTH和BGP呈正相关(r分别是0.38、0.25)。结论 CRF患者BMD显著下降,可能与肾脏损伤程度和钙调节激素紊乱有关。     

钙剂、活性维生素D3对十堰地区低骨量人群的干预

目的应用钙剂、活性维生素D3对低骨量人群进行干预治疗,观察其对BMD、BGP、DPD及预防骨质疏松的作用。方法选取骨量减少患者100例,随机分成对照组和治疗组,每组50例,对照组服用乐力(2g/d),治疗组服用乐力(2g/d)和阿法迪三(0.5μg/d),连续治疗12个月。在治疗前、治疗后6月和12月检测BMD、BGP、DPD。结果两组经治疗后BMD、BGP均较治疗前增加(P<0.05),DPD下降(P<0.05),以治疗组差异更为明显,组间比较有统计学意义(P<0.05)。结论骨量减少应早期干预治疗,钙剂与活性维生素D联合应用可以更有效地预防及延缓骨质疏松的发生。     

钙剂、活性维生素D3对十堰地区低骨量人群的干预

目的 应用钙剂、活性维生素D3对低骨量人群进行干预治疗,观察其对BMD、BGP、DPD及预防骨质疏松的作用.方法 选取骨量减少患者100例,随机分成对照组和治疗组,每组50例,对照组服用乐力(2g/d),治疗组服用乐力(2g/d)和阿法迪三(0.5μg/d),连续治疗12个月.在治疗前、治疗后6月和12月检测BMD、BGP、DPD.结果 两组经治疗后BMD、BGP均较治疗前增加(P<0.05),DPD下降(P<0.05),以治疗组差异更为明显,组间比较有统计学意义(P<0.05).结论 骨量减少应早期干预治疗,钙剂与活性维生素D联合应用可以更有效地预防及延缓骨质疏松的发生.     

糖尿病肾病患者骨密度及骨代谢标志物的临床研究

目的探讨2型糖尿病(T2DM)不同阶段糖尿病肾病(DN)患者的骨密度(BMD)及骨代谢标志物的变化。方法检测T2DM正常白蛋白尿患者(51例)与DN患者(微量白蛋白尿组40例,临床白蛋白尿组28例,肾功不全组20例)的BMD及骨代谢指标。结果 25羟维生素D3(25-OH-D3)在正常白蛋白尿组最高,在DN各组间随着肾功能的恶化逐渐降低(P0.05)。DN各组血清骨钙素(BGP)及血清总I型胶原氨基端延长肽(T-PINP)均低于正常白蛋白尿组(P0.05)。DN各组I型胶原羧基端肽β特殊序列(βCTX)均高于正常白蛋白尿组(P0.05)。肾功不全组血清甲状旁腺激素(PTH)明显高于其他3组(P0.05),其他各组间差异无显著性(P0.05)。大量白蛋白尿组及肾功不全组各部位BMD值均低于正常白蛋白尿组(P0.05)。多元相关分析表明腰椎BMD及股骨颈BMD与年龄、血Cr、BUN、尿MA/Cr、βCTX、PTH成负相关,与血Ca、25-OHD3、BGP、T-PINP成正相关,女性患者腰椎BMD及股骨颈BMD与绝经年限成负相关。结论随着T2DM患者肾功能逐渐下降,其骨量减少的程度逐渐加重,T-PINP、BGP、βCTX、25-OH-D3等骨代谢指标较BMD更敏感地反映DN早期骨代谢的变化。DN患者的BMD与年龄、绝经年限、尿MA/Cr、25-OH-D3等因素相关。     

绝经后女性骨密度与骨代谢生化指标的相关性分析

目的分析绝经后女性骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性。方法选取西南医科大学附属医院2017年1月至2018年12月收治的绝经后女性患者151例。根据骨密度T值将患者分为骨质疏松组(83例)、骨量低下组(47例)和骨量正常组(21例),比较三组患者骨代谢生化指标的差异,并对各项指标与BMD进行相关性分析。结果骨质疏松组甲状旁腺素(PTH)、Ⅰ型前胶原氨基末端前肽(P1NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)显著高于骨量低下组和骨量正常组(P0. 05),骨量低下组显著高于骨量正常组(P0. 05)。骨质疏松组体质量指数(bone mass index,BMI)、25(OH) D_3显著低于骨量低下组和骨量正常组(P0. 05),骨量低下组显著低于骨量正常组(P0. 05)。血钙、血磷、骨钙素(BGP)、血清的骨特异性碱性磷酸酶(BALP)在三组之间比较,差异无明显统计学意义(P0. 05)。Spearman相关分析显示,PTH、P1NP、β-CTX与骨密度呈负相关(r=-0. 538,-0. 520,-0. 462,P 0. 05),25(OH) D_3与骨密度呈正相关(r=0. 517,P0. 05),血钙、血磷、BALP、BGP与骨密度无相关性(P0. 05)。结论血清25(OH) D_3、PTH、P1NP、β-CTX与骨密度存在显著相关性,骨代谢生化指标监测有助于绝经后女性骨质疏松的早期诊断。     

绝经前女性系统性红斑狼疮患者骨密度和骨代谢指标测定

目的 探讨绝经前女性系统性红斑狼疮(SLE)患者骨密度(BMD)和骨代谢指标的变化.方法 采用双能x线骨密度吸收仪(DEXA)测定178例绝经前女性SLE患者以及60例正常对照组的腰椎、股骨颈的骨密度以及T值,血钙、磷浓度,血清碱性磷酸酶(AKP)、血清骨钙素(BGP)、尿I型胶原交联氨基末端肽(NTX)水平,并将SLE组患者分为SLE初诊组与治疗组,分别对其数据进行统计分析.结果 SLE初诊组的腰椎BMD,股骨颈BMD及T值,血清AKP、尿NTX较正常对照组均无明显差异,而腰椎骨密度T值、血清BGP较正常对照组低(P＜O.05);SLE治疗组的腰椎BMD、T值和股骨颈1值,血清BGP低于正常对照组,但股骨颈BMD、血清AKP、尿NTX较正常对照组差异未达统计学意义;SLE治疗组的腰椎、股骨颈BMD与T值均显著低于SLE初诊组.SLE组的骨质疏松及骨量减少率分别为6.74%、16.85%.结论 绝经前SLE患者较同年龄正常女性易发生骨质疏松,血清BGP和腰椎骨密度可能较早反映骨质疏松的发生.     

维生素D受体基因ApaⅠ多态性与终末期肝病患者骨代谢的相关性研究

目的探讨维生素D受体（VDR）基因Apal位点多态性与终末期肝病患者骨代谢的关系。方法选择72例终末期肝病患者,并以50例原发性骨质疏松和骨量减少患者作为对照组。采用聚合酶链反应和限制性片段长度多态性技术（PCR-RFLP）检测VDR基因ApaⅠ位点多态性,双能X线吸收仪（DXA）检测腰椎（L1～4）及股骨颈骨密度（BMD）,并检测骨代谢相关指标,包括甲状旁腺激素（PTH）、骨钙素（BGP）、血钙（Ca）、血磷（P）、尿钙（uCa）、尿肌酐（uCr）。结果①Apa Ⅰ多态性等位基因频率分布符合Hardy—Weinberg定律,终末期肝病组基因型分布为AA（12．5％）、Aa（34．7％）、aa（52．8％）;对照组基因型分布为AA（10．0％）、Aa（36．0％）、aa（54．0％）。基因型分布频率两组间差异无统计学意义（P〉0．05）。②终末期肝病组中,ApaⅠ基因型与L1～4及股骨颈BMD相关（P〈0．01）,AA基因型L1-4及股骨颈的BMD显著高于aa型（P〈0．05）。对照组中,ApaⅠ基因型与L1-4及股骨颈BMD均无明显相关性。③终末期肝病组中,ApaⅠ基因型与BGP水平相关,AA基因型的BGP水平高于aa型（P〈0．05）;ApaⅠ基因型与PTH、血Ca、血P及uCa／Cr水平差异无统计学意义。结论终末期肝病患者VDR基因ApaⅠ位点多态性与BMD及BGP水平均相关,ApaⅠ位点多态性与终末期肝病患者骨代谢存在相关性。     

Acute liver failure and liver assist devices

Survival of patients presenting with acute liver failure (ALF) has improved over the past decades due to earlier disease recognition, advances in supportive measures, intensive care, and liver transplantation. Liver assist devices may have a role in future care of patients with ALF, bridging them to recovery or to transplantation. A multidisciplinary team approach to the care of patients with ALF is critical for achieving good patient outcomes.     

不规则肝切除术和规则肝切除术在肝癌手术切除中的比较

【摘要】 目的〓探究不规则肝切除术和规则肝切除术在巨大肝癌手术切除中的临床应用及比较。方法〓本研究回顾性分析2006年6月至2014年6月罗定市人民医院收治的原发性肝癌肝切除手术患者,对已实施的不规则性肝切除术与规则性肝切除术两组病例进行比较。包括两组手术的围手术期各个指标及术中、术后各个指标进行比较。结果〓规则肝切除组中的手术时间、术中出血、输血浆、输红细胞量、住院时间及并发症发生率均明显地高于不规则肝切除组的情况,差异有统计学意义(P<0.05),而肿瘤能完整切除的最大直径显著小于不规则肝切除(P<0.05);二者在死亡率的比较上无明显差异,无统计学意义(P>0.05)。结论〓与规则肝切除相较,不规则肝切除在腹部手术史引起严重腹腔内组织粘连、肝功能分级较差、肿瘤数目较多及小肝癌中均体现了明显的优势。而对于肿瘤体积较大的肝癌患者,规则肝切除则更为有效。     

Cryoablation and liver resection for noncolorectal liver metastases

BACKGROUND: Liver resection for noncolorectal liver metastases has merit for selected primary tumor types. The role of cryosurgical tumor ablation within this cohort of patients has not been evaluated. This is a single institutional review of treatment outcomes using cryosurgical ablation and conventional resection techniques for noncolorectal liver metastases. METHODS: The medical records of 42 patients undergoing 48 hepatic tumor ablative procedures from February 1991 through May 2001 at a single institution were retrospectively reviewed. Overall survival and local hepatic tumor recurrence-free survival were analyzed for different surgical procedures and primary tumor types. RESULTS: Overall survival rates at 1, 3, and 5 years are 82%, 55%, and 39%, respectively (median survival, 45 months). Local hepatic tumor recurrence-free survival rates for resection only (n = 25) and cryosurgery with or without resection (n = 23), at 3 years are 24% and 19%, respectively. The survival rates at 5 years are 40% and 37%, for resection only and cryosurgery with or without resection, respectively. CONCLUSION: Cryosurgical hepatic tumor ablation for metastatic noncolorectal primary tumors results in survival and local hepatic tumor recurrence rates similar to resection alone. The combination of cryosurgery and resection extends the cohort of patients with surgically treatable disease.     

Chronic liver disease prevention strategies and liver transplantation

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80% of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.     

Nonalcoholic fatty liver disease and liver transplantation.

Nonalcoholic fatty liver disease affects a substantial proportion of the general population worldwide. This high prevalence of nonalcoholic fatty liver disease has important consequences in the donor selection process for liver transplantation, and in the posttransplant period given the high recurrence rate of disease. This paper reviews the prevalence of nonalcoholic fatty liver disease, its progressive potential, and the implications of this liver condition in both the pre- and post-liver transplantation setting.     

Relevance of two-stage total hepatectomy and liver transplantation in acute liver failure and severe liver trauma

Emergency liver transplantation frequently is the only life-saving procedure in cases of acute liver failure. It remains unclear whether emergency hepatectomy with portocaval shunt followed by liver transplantation as a two-stage procedure should be performed in cases in which a donor organ is not yet available. It has been stated that “toxic liver syndrome” could be treated by means of this strategy. From 1990 to 1995 we performed emergency hepatectomies in eight cases of acute liver failure or traumatic liver rupture with exsanguinating bleeding. In six cases we were able to perform a subsequent liver transplantation. Five of the six patients who underwent an emergency hepatectomy died. Emergency hepatectomy led to a significant increase in epinephrine dosage until the transplantation was performed. Only after transplantation did the need for epinephrine therapy decrease. The need for oxygen support did not change during the entire observation period. Plasmatic coagulation was stabilized by substitution, showing significantly higher values at 24 h after transplantation than at 48 h before transplantation. Fibrinogen increased significantly after transplantation in this group of patients. The experiences gathered at our clinic, however, do not show advantages that would allow a recommendation of emergency hepatectomy and subsequent liver transplantation as a two-stage procedure except for situations of severe and uncontrollable hepatic bleeding. Considering the progressive destabilization of our patients, fast procurement of donor organs seems to be of imminent importance for the outcome. Received: 4 October 1999 Revised: 18 July 2000 Accepted: 23 November 2000     

腹腔镜肝脏手术治疗肝脏占位性病变

目的 :探讨腹腔镜肝脏手术的可行性、适应证及方法。方法 :分析 1998年 6月至 2 0 0 2年 8月腹腔镜下肝脏手术 2 3例的临床资料。结果 :2 3例手术均在腹腔镜下完成 ,其中肝左外叶切除术 2例 ,肝癌局部切除术 7例 ,肝局限性结节状增生局部切除术 3例 ,肝血管瘤摘除术 1例 ,肝癌射频治疗 2例 ,肝囊肿开窗引流术 +胆囊切除术 7例 ,肝脓肿引流术 1例。平均手术时间 16 5min ,平均出血 12 0ml,术后 4 8h内胃肠功能恢复 ,术后平均住院 7.6d ,痊愈出院 ,无严重并发症发生。结论 :腹腔镜下肝脏手术 ,包括肝切除术是一种安全、有效、微创的手术 ,但应严格掌握适应证     

机器人肝切除术与腹腔镜肝切除术的疗效比较

目的 配对比较机器人与传统腹腔镜肝切除的术中及术后结果,评价机器人肝切除术的安全性和优势。方法 对我院2010年3月至2017年8月实施的88例微创肝切除术病人的资料进行回顾性分析,按手术方式的不同分为机器人组(n=44)和腹腔镜组(n=44)。采用倾向匹配分析方法,按照1:1的比例,根据病人的性别、年龄、有无肝炎和肝硬化、体质量指数、美国麻醉师协会分级、肝脏切除范围在机器人组病人中进行配对。结果 两组病人的术中出血量、术中输血率、术后住院时间、术后并发症发生率和R0切除率无统计学差异。机器人组手术时间较腹腔镜组长[（183.36±64.40） min比（156.25±71.53） min, P=0.013]。但与腹腔镜组相比,机器人组中转开腹率较低（4.5%比22.7%,P=0.013）。结论 虽然机器人肝切除手术时间较长,但中转开腹率较低,与传统腹腔镜肝切除术具有相似的安全性。     

Neurological complications of liver cirrhosis and orthotopic liver transplant

Neurological complications are common in cirrhotic patients with end-stage liver failure. They comprise a wide array of etiologies, which may originate before, during, or after liver transplantation. The objective of this study was to describe the nature of the main neurological complications in patients with end-stage liver failure. Several toxins including ammonia, manganese, benzodiazepine-like substances, gamma-aminobutyric acid-like substances, and impaired dopaminergic neurotransmission are at the top of the list of candidates for hepatic encephalopathy, subclinical encephalopathy, and extrapyramidal signs before liver transplantation. Central pontine myelinolysis, cerebrovascular autoregulation impairment, and paradoxical cerebral embolism are probably responsible for the neurological complications during liver transplantation. Neurological complications represented by alterations of mental status, seizures, and focal motor deficits have been described after liver transplantation. These complications have been attributed to several pathogenetic factors, such as a poorly functioning graft, an intracranial hemorrhage, a cerebral infarction, an infection, or the toxicity of immunosuppressants.