环孢菌素A和吡喹酮联合应用预防小鼠血吸虫性肝纤维化的研究

目的：观察环孢菌素Ａ和吡喹酮联合应用对小鼠血吸虫性肝纤维化的影响。方法：感染第５ｗｋ末给药，吡喹酮８００ｍｇ／ｋｇ１次喂服及环孢菌素Ａ３０ｍｇ／ｋｇ皮下注射，每日１次，连续５日。结果：联合用药组血清游离羟脯氨酸水平在９、１２、１５ｗｋ分别为７．９１±０．２１、９．０３±１．６６、９．６９±１．２３μｍｏｌ／Ｌ，显著低于单独应用吡喹酮组的１０．１３±１．４５、１１．２３±１．３４和１１．８９±１．６２μｍｏｌ／Ｌ（Ｐ＜０．０１或Ｐ＜０．０５）；第９ｗｋ时肝脏虫卵肉芽肿面积（１．０８×１０５μｍ２）和其中胶原纤维的百分含量（１８．９１％±７．８２％），分别显著小于单独应用吡喹酮组（１．７２×１０５μｍ２和２９．４１％±１３．０９％）（Ｐ均＜０．０５）。结论：联合用药组的肝脏纤维化程度较单独用吡喹酮者为轻。     

急性心肌梗死PTCA诱发室壁瘤破裂致死1例

患者,男性,５２岁。因持续胸骨后疼痛伴恶心、冷汗３小时于１９９７年７月２１日急诊入院。既往有高血压病病史３０年,糖尿病病史５年。大量吸烟,不饮酒。体检：除第一心音低钝外,余无特殊发现。血压２２／１４ｋＰａ。实验室检查：天冬氨酸转氨酶８９ＩＵ／Ｌ,磷酸肌酸激酶７７２ＩＵ／Ｌ,肌钙蛋白Ｔ阳性。空腹血糖１２．３ｍｍｏｌ／Ｌ,总胆固醇６．６４ｍｍｏｌ／Ｌ,甘油三酯２．２５ｍｍｏｌ／Ｌ,低密度脂蛋白－胆固醇５．１ｍｍｏｌ／Ｌ,高密度脂蛋白－胆固醇１．１ｍｍｏｌ／Ｌ,载脂蛋白Ｂ１．２９ｇ／Ｌ,载脂蛋白Ａ１．…     

病毒性肝炎患者血清脯氨酸肽酶活性检测的临床意义

用生化法测定了２２７例病毒性肝炎血清脯氨酸肽酶（ＰＬＤ）活性，结果急性肝炎（２３２９．８±５７５．８Ｕ／Ｌ）、慢性迁延性肝炎（１４４３．０±２７２．９Ｕ／Ｌ）、慢性活动性肝炎（２０５５．５±５５０．２μ／Ｌ）、重型肝炎（１９３５．９±４３２．９／ＵＬ）及肝炎后肝硬化（２３９６．５±３７１．３Ｕ／Ｌ）均较正常值（１１５０．３±１９５．２Ｕ／Ｌ）显著升高，非肝炎（１１９７．１±２２１．１Ｕ／Ｌ）无升高。急性肝炎ＰＬＤ变化与丙氨酸转氨酶（ＡＬＴ）变化一致，二者显著正相关；慢性活动性肝炎ＰＬＤ与ＡＬＴ均升高，但二者变化不相关，ＰＬＤ异常率显著高于ＡＬＴ：肝硬化ＡＬＴ正常，但ＰＬＤ仍显著升高。结果表明ＰＬＤ可作为一项反映肝病慢性化与肝损害的指标。     

老年人流行性出血热合并肝脏损害的临床特点

动态检测３５例老年流行性出血热（ＥＨＦ）患者的血清总胆红素（ＳＢ）、丙氮酸转氨酶（ＡＬＴ）、总蛋白（Ｔ）、白蛋白（Ａ）和球蛋白（Ｇ），并与３５例青中年患者比较。结果表明：老年人重型ＥＨＦ中ＳＢ（２９．９±１１．８μｍｏｌ／Ｌ）和ＡＬＴ（１３２．９±６１．４Ｕ／Ｌ）增高，Ｔ（６０．０±８．１ｇ／Ｌ）和Ａ（２９．１±５．１ｇ／Ｌ）降低，与青中年患者比较差异有显著性（Ｐ＜０．０１或（０．０５）；恢复期末老年人ＥＨＦ的ＳＢ（２１．９±９．１μｍｏｌ／Ｌ）、ＡＬＴ（８０．２±３６．６Ｕ／Ｌ）、Ｔ（６４．２±９．１ｇ／Ｌ）和Ａ（３２．３±７．１ｇ／Ｌ）均异常（Ｐ＜０．０１或Ｐ＜０．０５），而青中年患者仅ＡＬＴ（４９．９±２０．５Ｕ／Ｌ）稍高；ＥＨＦ的肝脏损害主要与病型、病期和年龄有关。提示动态检测老年人ＥＨＦ的肝功能有助于判断病情和估计预后。     

青藤碱对豚鼠心室肌细胞膜钾离子通道的阻滞作用

利用膜片钳全细胞记录技术研究青藤碱（Ｓｉｎ）对分离的豚鼠单个心室肌细胞膜内向整流钾电流（Ｉｋ１）和延迟整流钾电流（ＩＫ）的影响，发现１μｍｏｌ／Ｌ和５μｍｏｌ／Ｌ的Ｓｉｎ使ＩＫｍａｘ（去极化终末最大ＩＫ）从３５５．９±２１．９ｐＡ分别降至３１７．６±２０．１ｐＡ和２３３．１±１８．７ｐＡ（ｎ＝７，Ｐ均＜０．０５），分别降低了１０．８％和３４．４％；外向尾电流从１５５．１±９．３ｐＡ分别降至１２９．４±６．２ｐＡ和９１．８±６．９ｐＡ（ｎ＝７，Ｐ均＜０．０５），分别降低了１６．６％和４０．８％。当维持电压－４０ｍＶ，超极化－１００ｍＶ时，１μｍｏｌ／Ｌ和５μｍｏｌ／Ｌ的Ｓｉｎ使Ｉｋ１从３．１５７±０．７９４ｎＡ分别降至２．７３５±０．７９９ｎＡ和２．４１１±０．５８１ｎＡ（ｎ＝８，Ｐ均＜０．０１），抑制率分别为１３．４％和２３．６％。５μｍｏｌ／ＬＳｉｎ于不同膜电位水平均能抑制Ｉｋ１，且使Ｉｋ１Ｉ－Ｖ曲线零电位从－８０ｍＶ降至－７０ｍＶ。结果表明Ｓｉｎ对ＩＫ和Ｉｋ１均具浓度依赖性阻滞作用，其延长心肌细胞的复极效应可能与钾通道阻滞有关。     

磺脲类降糖药对HIT细胞胰岛素分泌刺激作用的分子机制研究

通过对ＨＩＴ细胞的体外试验，探讨了甲磺丁脲及优降糖抑制ＡＴＰ敏感性钾离子通道和钾的外流、促进细胞外钙离子的内入和胰岛素释放的一系列分子生物学机制，并且对此两种药物的作用强度及特点进行了比较。二者与β细胞受体的亲和常数分别为０．４±０．１ｎｍｏｌ／Ｌ和２．５±０．５μｍｏｌ／Ｌ；抑制８６Ｒｂ＋外流的ＩＣ５０分别为０．７±＋０．５ｎｍｏｌ／Ｌ和１．９±０．８μｍｏｌ／Ｌ；促进细胞内钙离子升高的ＥＤ５０分别为０．９ｎｍｏｌ／Ｌ和２．４μｍｏｌ／Ｌ，刺激胰岛素分泌的ＥＤ５０则分别为１．０±０．４ｎｍｏｌ／Ｌ和４．３±２．２μｍｏｌ／Ｌ。ＡＴＰ－敏感性钾离子通道激动剂──二氮嗪（０．４ｍｍｏｌ／Ｌ）能在上述各个环节阻断优降糖对β细胞的作用；而钙离子通道抑制剂──尼莫地平（１μｍｏｌ／Ｌ）则能在不影响８６Ｒｂ＋外流的情况下显著减低细胞内钙离子的浓度，进而抑制ＨＩＴ细胞的胰岛素分泌。表明此类药物能在不影响腺苷酸环化酶─ｃＡＭＰ系统的情况下，通过促进胰岛β细胞膜上ＡＴＰ敏感性钾离子通道的关闭，导致电压依赖性钙离子通道的开启，进而触发了细胞外钙离子的内入和胰岛素的分泌。     

高血压病患者盐敏感性与高胰岛素血症之间的关系

目的：探讨高胰岛素血症（ＨＩＳ）与盐敏感性高血压病肾脏排钠障碍间的关系。方法：根据盐敏感性（盐负荷试验Ｓｕｌｉｖａｎ标准），将５３例高血压病患者分为２组：盐敏感型（ＳＳ）组２２例、盐不敏感型（ＳＲ）组３１例。测定患者在盐负荷试验中血糖和血胰岛素浓度变化，计算胰岛素抵抗。结果：ＳＳ组与ＳＲ组相比较，基础状态、盐负荷和服呋喃苯胺酸（速尿）后各时点血糖及血胰岛素变化明显（血糖：５．１２±１．２５、５．９７±１．５９、５．２１±１．２８ｍｍｏｌ／Ｌ比４．９６±１．１４、５．４８±１．３８、５．０７±１．２３ｍｍｏｌ／Ｌ，Ｐ＞０．０５；血胰岛素：１２．４６±４．１４、３１．６８±１２．２１、１４．３５±４．４５ｍＵ／Ｌ比１０．１５±３．６２、２２．１４±８．６４、１０．８９±３．９１ｍＵ／Ｌ，Ｐ＜０．０１），ＳＳ组中胰岛素抵抗发生率显著高于ＳＲ组（６３．６％比３２．３％，Ｐ＜０．０５）。结论：ＳＳ高血压病肾脏排钠障碍与高胰岛素血症有关。     

载脂蛋白AI和高密度脂蛋白对内皮细胞保护作用的实验观察

目的观察高密度脂蛋白（ＨＤＬ）和载脂蛋白ＡＩ（ａｐｏＡＩ）在保护血管内皮细胞拮抗低密度脂蛋白（ＬＤＬ）损伤方面的作用。方法细胞形态观察、计数细胞成活率、测定乳酸脱氢酶（ＬＤＨ）释放百分比和６－酮－前列环素Ｆ_（１α）（６－ｋｅｔｏ－ＰＧＦ_（１α））。结果预加入ＨＤＬ或ａｐｏＡＩ（１００μｇ／ｍｌ），细胞再受到较大剂量（１５００μｇ／ｍｌ）的ＬＤＬ损伤时，不发生显著形态变化，细胞成活率由２５．０％（ＬＤＬ组）提高到９１．８％（ＨＤＬ＋ＬＤＬ组）和８９．７％（ａｐｏＡＩ＋ＬＤＬ组）；细胞膜的完整性增强，ＬＤＨ释放百分比由７２．０％±５．５％（ＬＤＬ组）降至２６．８％±３．４％（ＨＤＬ＋ＬＤＬ组）和２９．４％±４．５％（ａｐｏＡＩ＋ＬＤＬ组）；促进细胞自身分泌前列环素，使６－ｋｅｔｏ－ＰＧＦ_（１α）的含量由７．８±１．４μｇ／ｍｌ（ＬＤＬ组）增至１６．５±４．３μｇ／ｍｌ（ＨＤＬ＋ＬＤＬ组）和１４．２＋１．９μｇ／ｍｌ（ａｐｏＡＩ＋ＬＤＬ组）。结论在拮抗ＬＤＬ损伤时，ａｐｏＡＩ和ＨＤＬ在维持细胞形态、保持细胞膜完整性以及增加细胞自身分泌等方面作用近似。     

40例原发性醛固酮增多症手术前后血压与血液生化改变对比分析

目的：研究原发性醛固酮增多症患者血压及血液生化改变与手术效果的关系。方法：分析４０例原发性醛固酮增多症患者，其中男１７例，女２３例，年龄１８～５６岁，平均４０．３岁。对手术后病理诊断进行分类，术前术后测定血压，血钾、钠，尿钾，血浆肾素活性、醛固酮并计算醛固酮／肾素活性比值。结果：单纯腺瘤２６例，增生９例，混合５例，术后平均收缩压自２４．０±３．３ｋＰａ（１８０±２５ｍｍＨｇ）降至１７．７±１．９ｋＰａ（１３３±１４ｍｍＨｇ），平均舒张压自１５．６±２．４ｋＰａ（１１７±１８ｍｍＨｇ）降至１１．６±１．２ｋＰａ（８７±９ｍｍＨｇ），血钾自２．８±０．５ｍｍｏｌ／Ｌ升至４．１±０．４ｍｍｏｌ／Ｌ，２４小时尿钾排泄自４９．０ｍｍｏｌ降至２９．８ｍｍｏｌ，血浆肾素活性自０．５０±０．４３ｎｇＡＩｍｌ－１／ｈ升至５．４７±２．６８ｎｇＡＩｍｌ－１／ｈ，血浆醛固酮由３８５．７±２０４．１ｐｇ／ｍｌ降至１２９．０±６１．９ｐｇ／ｍｌ，血浆醛固酮／血浆肾素活性比值由７７３．９降至４６．２。结论：原发性醛固酮增多症患者血液生化改变，对原发性醛固酮增多症诊断及术后疗效判定有重要价值。     

梗阻性黄疸内毒素血症与细胞免疫功能的关系

目的研究梗阻性黄疸免疫功能及其与内毒素血症的相关性．方法检测２８例梗阻性黄疸患者及２０例健康对照者血清内毒素，Ｔ淋巴细胞亚群及血清ＳＩＬ２Ｒ的水平．结果梗阻性黄疸患者血清内毒素和ＳＩＬ２Ｒ水平较对照组明显升高（４７０ｎｇ／Ｌ±１１３ｎｇ／Ｌ和７２５ｋＵ／Ｌ±２０１ｋＵ／Ｌｖｓ２８４ｎｇ／Ｌ±１０３ｎｇ／Ｌ和３２４ｋＵ／Ｌ±１１６ｋＵ／Ｌ，Ｐ＜００１），Ｔ淋巴细胞亚群ＣＤ３，ＣＤ４，ＣＤ４／ＣＤ８明显降低（５０４％±３３％和２９９％±３８％ｖｓ６３８％±４４％和３８３％±２８％，Ｐ＜００１；１２２±０３２ｖｓ１４３±０３７，Ｐ＜００５），同时亦发现梗阻性黄疸内毒素血症组较非内毒素血症组ＣＤ３，ＣＤ４水平明显减低，ＳＩＬ２Ｒ水平明显升高（４７４％±５１％和２７６％±５２％和８６７ｋＵ／Ｌ±２３１ｋＵ／Ｌｖｓ５２３％±５２％和３１２％±４３％和６７４ｋＵ／Ｌ±１８９ｋＵ／Ｌ，Ｐ＜００５）．相关分析显示血清内毒素水平与血清ＳＩＬ２Ｒ水平呈显著正相关（ｒ＝０８５１７，Ｐ＜００１）．结论梗阻性黄疸时内毒素血症与免疫功能状态密切相关．     

急慢性肝炎和肝硬化患者上消化道黏膜病变与幽门螺杆菌感染的临床研究

目的观察肝病患者上消化道黏膜病变及HP感染的状况,探讨其相关性。方法对577例急慢性肝炎(急性肝炎74例,慢性肝炎232例)和肝硬化(271例)患者进行胃镜检查及HP检测。结果所有患者均存在各自不同的上消化道黏膜病变:发现食管炎37例(6.41%);食管、胃底静脉曲张271例(46.97%);慢性胃炎560例(97.05%);胃溃疡46例(7.97%);门脉高压性胃病52例(9.01%);胃癌2例(0.35%);十二指肠溃疡51例(8.84%);十二指肠炎34例(5.89%)。HP检出率:急性肝炎32.43%(24/74),慢性肝炎43.97%(102/232),肝硬化38.75%(105/271)。结论在肝病患者中普遍存在上消化道黏膜病变,但HP感染率不高于文献报道的非肝病患者,说明肝病患者不是HP感染的高发人群,其上消化道黏膜病变的发生与肝病本身的致病因素有关。     

抗结核药物对慢性肝病肺结核患者肝功能的影响

目的 探讨2HRZE/4HR方案对患不同慢性肝病的肺结核患者肝功能的影响.方法 回顾性分析2004年8月～2005年8月住院期间收治的1475例初治肺结核患者在化疗过程中发生肝功能损害的临床资料.B超检查提示同时患有慢性肝病者(脂肪肝、肝硬化等)为观察组(136例);未患肝病者为对照组(1339例).结果 观察组有57例(41.9%)出现了肝损害,其中脂肪肝12例(60.0%),肝硬化7例(87.5%),慢性酒精性肝病6例(35.7%),慢性乙型肝炎9例(45.0%),慢性血吸虫病肝8例(50.0%),肝血管瘤或肝囊肿10例(26.3%),肝内胆管结石5例(25.0%).对照组出现肝损害138例(10.3%).观察组肝功能损害比对照组严重.观察组经护肝治疗肝功能的恢复也比对照组慢.结论 2HRZE/4HR方案对各类慢性肝病的肺结核患者肝功能损害较大,发生较早,恢复较慢.应尽量选用对肝脏损害小的药物,并密切监测肝功能,同时给予有效的护肝治疗.     

Colchicine reduces procollagen Ⅲ and increases pseudocholinesterase in chronic liver disease

AIM:To test whether colchicine would be an effective antif ibrotic agent for treatment of chronic liver diseases in patients who could not be treated with α-interferon.METHODS:Seventy-four patients(46 males,28 females) aged 40-66 years(mean 53±13 years) participated in the study.The patients were affected by chronic liver diseases with cirrhosis which was proven histologically(n=58);by chronic active hepatitis C(n=4),chronic active hepatitis B(n=2),and chronic persistent hepatitis C(n=6).In the four patient...     

慢性乙型肝炎拉米呋定治疗前后组织学变化的病理研究

目的 :探讨慢性乙型肝炎患者拉米呋定治疗前后肝组织学的变化。方法 :随机选择 2 0例慢性乙型肝炎患者 ,口服拉米呋定 ,10 0mg/d× 1y ,治疗前后作肝组织活检、病理检查。结果 :14例患者肝组织炎症明显减轻 ,治疗前后比较 ,呈现显著差异 (P <0 .0 5 )。 2例患者肝组织纤维化减轻 ,治疗前扣比较 ,差异不显著 (P >0 .0 5 )。结论 :拉米夫定可以有效减轻慢性乙型肝炎患者的肝组织炎症 ,但改善肝组织纤维化效果不明显。     

Lamivudine treatment for acute hepatitis B after liver transplantation

Background/Aims: Acute hepatitis caused by recurrent or de novo hepatitis B virus (HBV) infection after liver transplantation frequently induces aggressive disease leading to liver failure. To aim of this study was to determine the efficacy and safety of lamivudine treatment in post-transplant acute hepatitis B.Method: Twelve patients with acute hepatitis B were started on lamivudine 100 mg po daily within 8 weeks of the appearance of HBsAg. One patient was excluded after 1 month because of hepatocellular carcinoma recurrence. Patients were followed for an average of 68.6 weeks (range 32–108), and were clinically and biochemically evaluated on a monthly basis. They had a histological assessment at baseline, after at least 6 months, and whenever clinically indicated.Results: Basal HBV-DNA ranged between 13 and 1288 pg/ml and serum alanine aminotransferase between 97 and 1036 U/l. HBV-DNA became undetectable within 8 weeks and transaminases normalized within 24 weeks in all cases. At the last visit, eight patients (73%) remained HBV-DNA negative by liquid hybridization and had normal or close to normal alanine aminotransferase. Five patients (45%) were also HBsAg negative and HBV-DNA negative by polymerase chain reaction. HBV-DNA and transaminase breakthrough occurred in three patients (27%). Histology after 6–9 months showed chronic hepatitis in seven patients. Lamivudine was well tolerated without serious adverse reactions.Conclusions: These results indicate that lamivudine treatment induces sustained inhibition of viral replication and normalization of transaminases in the majority of post-transplant patients with acute hepatitis B. HBsAg loss may be achieved in a considerable number of cases. Although viral resistance is relatively frequent, early initiation of lamivudine appears to be effective and safe.     

Clinical features of acute hepatitis E super-infections on chronic hepatitis B

AIM To examine the clinical features and risk factors for adverse outcomes in chronic hepatitis B(CHB) superimposed with hepatitis E virus(HEV).METHODS This retrospective cohort study included 228 patients with acute HEV infection(showing clinical acute hepatitis symptomology and positivity for anti-HEV immunoglobulin M) with underlying CHB(confirmed by positivity for hepatitis B surface antigen and/or hepatitis B virus(HBV) DNA over 6 mo) who had been admitted to the Shanghai Public Health Clinical Center, which represents the regional tertiary hospital for infectious diseases in Shanghai city, China. Data for adverse outcomes were collected, and included severe liver diseases(defined as liver failure and/or acute liver decompensation) and liver-related mortality. Logistic regression modeling was performed to determine the risk factors for adverse outcomes.RESULTS The symptoms caused by superimposed acute hepatitis E(AHE) were much more severe in cirrhotic patients(n = 94) than in non-cirrhotic patients(n = 134), as evidenced by significantly higher liver complications(77.7% vs 28.4%, P 0.001) and mortality rate(21.3% vs 7.5%, P = 0.002). Most of the cirrhotic patients(n = 85, 90.4%) had no prior decompensation. Among the non-cirrhotic patients, superimposed AHE caused progressively more severe diseases that corresponded with the CHB disease stages, from immune tolerant to immune reactivation phases. Few risk factors were identified in the cirrhotic patients, but risk factors for non-cirrhotic patients were found to be intermediate HBV DNA levels(OR: 5.1, P = 0.012), alcohol consumption(OR: 6.4, P = 0.020), and underlying diabetes(OR: 7.5, P = 0.003) and kidney diseases(OR: 12.7, P = 0.005). Only 28.7% of the cirrhotic patients and 9.0% of the non-cirrhotic patients had received anti-HBV therapy previously and, in all cases, the efficacy had been suboptimal. CONCLUSION CHB-related cirrhosis and intermediate HBV DNA level were associated with severe disease in superinfected patients, and successful antiviral treatment might counter this outcome.     

慢性肝病中抗肝抗原自身抗体的检测

目的　探讨中国人不同病因所致慢性肝病患者中抗肝抗原自身抗体的存在状况及自身免疫性肝病的自身抗体特征。方法　 166例肝功能异常患者分为 6组 :自身免疫性肝炎 (AIH ) 12例、原发性胆汁性肝硬化 (PBC) 2 0例、原发性硬化性胆管炎 (PSC)13例、HBV组 66例、HCV组 2 2例、肝豆状核变性 (HDL) 3 9例。用间接免疫荧光法检测抗核抗体 (ANA)、平滑肌抗体 (SMA)、抗肝肾微粒抗体I型抗体 (anti LKM1)、抗线粒体抗体 (AMA)和抗中性粒细胞胞浆抗体 (ANCA) ,免疫印迹法检测抗肝细胞胞溶质抗原 1型抗体 (anti_LC1)、抗可溶性肝抗原 /肝胰抗原抗体 (anti_SLA/LP)、抗肝肾微粒抗体 1型 (anti_LKM1)、AMA_M2亚型等多种肝抗原自身抗体。结果　 166例中ANA、AMA、M_2、pANCA阳性率在 7组中有显著差异 (P <0 .0 1)。PBC中AMA、M 2阳性检出率均为 10 0 % ,PSC中pANCA阳性检出率为 5 3 8% ,Fisher精确检验在a =0 .0 0 2水准与其他各组比较有显著差异。AIH与PBC的ANA阳性率分别为10 0 %和 60 % ,Fisher精确检验在a =0 .0 0 2水准二者无显著差异。与其他各组比较有显著差异。在AIH组SMA阳性率为 2 5 % ,LKM 1、LC 1、SLA/LP阳性率均为 8.3 % ,统计学处理与其他组无显著差异 (P >0 0 5 ) ,可能与病例少有关。PBC中分别有 1     

81例不明原因肝损伤肝穿病理分析

目的研究肝穿活检对不明原因肝损伤的诊断价值。方法81例不明原因肝损伤接受B超引导下肝穿活检,标本常规行光镜及电镜检查。结果77例经肝穿活检明确诊断。检出自身免疫性肝病72例（72/81,88.9%）,其中自身免疫性肝炎36例,原发性胆汁性肝硬化34例,原发性硬化性胆管炎2例。发现慢性乙型肝炎、弓形虫病、脂肪性肝炎、肝淀粉样变、血吸虫性肝损伤各1例。4例经肝穿活检未能确诊。结论肝穿活检在不明原因肝损伤的诊断中有重要价值。对不明原因肝损伤患者,应重视自身免疫性肝病的诊断。     

Colchicine reduces procollagen III and increases pseudocholinesterase in chronic liver disease

AIM: To test whether colchicine would be an effective antifibrotic agent for treatment of chronic liver diseases in patients who could not be treated with α-interferon.METHODS: Seventy-four patients (46 males, 28 females) aged 40-66 years (mean 53 ± 13 years) participated in the study. The patients were affected by chronic liver diseases with cirrhosis which was proven histologically (n = 58); by chronic active hepatitis C (n = 4), chronic active hepatitis B (n = 2), and chronic persistent hepatitis C (n = 6). In the four patients lacking histology, cirrhosis was diagnosed from anamnesis, serum laboratory tests, esophageal varices and ascites. Patients were assigned to colchicine (1 mg/d) or standard treatment as control in a randomized, double-blind trial, and followed for 4.4 years with clinical and laboratory evaluation.RESULTS: Survival at the end of the study was 94.6% in the colchicine group and 78.4% in the control group (P = 0.001). Serum N-terminal peptide of type III procollagen levels fell from 34.0 to 18.3 ng/mL (P = 0.0001), and pseudocholinesterase levels rose from 4.900 to 5.610 mU/mL (P = 0.0001) in the colchicine group, while no significant change was seen in controls. Best results were obtained in patients with chronic hepatitis C and in alcoholic cirrhotics.CONCLUSION: Colchicine is an effective and safe antifibrotic drug for long-term treatment of chronic liver disease in which fibrosis progresses towards cirrhosis.     

肝复乐治疗肝炎肝硬化52例近期疗效观察

目的：探讨肝复乐片治疗肝炎肝硬化的临床疗效。方法：101例肝炎肝硬化患者，随机分为治疗组52例，对照组49例，两组均给予常规综合治疗，治疗组加用肝复乐片口服，每次6片，Tid，疗程8W，结果：治疗组乏力，纳差，腹胀，肝区不适等症状的改善较对照组快，降ALT，AST和消除AFP异常作用明显（P＜0．05），该药还有一定的利尿作用，有助于肝硬化患者的腹水消退，但两组治疗前后肝大，脾大及HBV－M的变化无显著性差异（P＞0．05），综合疗效：治疗组（92．31％）显著优于对照组（77．55％）（P＜0．05），其中，代偿性肝硬化治疗组明显优于对照组（P＜0．05），而失代偿性肝硬化治疗组亦优于对照组，但统计学检验未见显著性差异（P＞0．05），未见明显不良反应，结论：肝复乐片可作为肝炎肝硬化综合治疗中的一种较好选择。