恩替卡韦联合中药治疗慢性乙型肝炎肝纤维化40例

慢性乙型肝炎反复发作,肝纤维逐渐增生,或重型肝炎大量肝细胞破坏后,短期内大量肝纤维增生,是肝硬化形成的原因［1］。慢性乙型肝炎导致肝纤维化是由于患者感染乙型肝炎病毒,导致肝脏发生慢性炎症改变,机体对这种慢性炎性损伤进行主动性反复修复,使肝窦内肝星状细胞活化,过多的胶原在肝内不断沉积,从而肝内纤维组织异常增生。肝纤维化是一个可逆的过程,早期诊断,早期进行干预,可延缓、阻断甚至逆转肝纤维化的进程。笔者自2011年9月-2013年9月采用恩替卡韦联合中成治疗慢性乙型肝炎肝纤维化,取得了较好的疗效。现报告如下。     

美能联合氧化苦参碱抗肝纤维化疗效观察

慢性乙型肝炎易导致肝纤维化，随着肝纤维化程度的加重可导致肝硬化。肝纤维化是指肝脏内弥漫性纤维和结缔组织沉积，是对炎症和坏死组织的修复反应，所以治疗肝纤维化是防止或延缓肝硬化发生的重要措施。     

美能联合川芎嗪抗肝纤维化疗效观察

慢性乙型肝炎易导致肝纤维化，随着肝纤维化程度的加重可导致肝硬化，肝纤维化是指肝脏内弥漫性纤维和结缔组织沉积，是对炎症和坏死组织的修复反应，所以治疗肝纤维化是防止或延缓肝硬化发生的重要措施。     

扶正化瘀胶囊联合恩替卡韦分散片治疗乙型肝炎肝硬化32例疗效观察

<正>在我国HBV感染是导致肝硬化的主要原因,在无有效治疗的情况下,乙型肝炎肝硬化失代偿期患者的5年生存在率仅为14%~-35%。因此阻止慢性乙型肝炎向肝硬化发展至关重要,肝纤维化是指肝脏纤维结缔组织的过度沉积,是纤维增生和纤维分解不平衡的结果。纤维增生是机体对于损伤的一种修复反应,各种病因所致反复或持续的慢性肝实质炎症、坏死均可导致肝脏持续不断的纤维增生而形成肝纤维化~([1])。本研究比较恩替卡韦分散片单用与联合扶正化瘀胶囊两种方法对     

生长因子家庭与肝纤维化

肝纤维化是指肝脏细胞外基质（ECM）特别是胶原的过度沉积，是继发于肝脏炎症或损伤后组织修复的代偿反应，是慢性肝病共有的病理改变，进一步发展则形成肝硬化。此时肝脏原有结构被破坏，大量胶原纤维异常沉积，形成纤维隔。     

抗病毒治疗在慢性乙型肝炎治疗中的重要性

慢性乙型肝炎患者肝脏炎症的持续发展, 肝硬化和肝癌的发生与乙型肝炎病毒的持续性复制密切相关. 患者体内的乙型肝炎病毒载量与肝脏疾病的严重程度成正相关. 所以在慢性乙型肝炎的治疗中, 抑制病毒复制, 降低病毒载量, 是阻断患者病情发展, 提高患者生存质量的关键. 本文总结了近年来国内外学者在慢性乙型肝炎抗病毒治疗中取得的共识和进展, 对抗病毒治疗中的几个热点问题进行探讨, 并分析目前在我国慢性乙型肝炎抗病毒治疗中存在的一些问题.     

前白蛋白检测在慢性乙型肝炎病理分级中的价值

目的：明确血清前白蛋白对判断慢性乙型肝炎患者肝脏炎症分级及纤维化分期的价值。方法：检测78例经肝活检证实的慢性乙型肝炎患者血清PAB水平的变化，并将其与肝活检组织的炎症分级和纤维化分期进行对照研究。结果：肝脏病理组织炎症分为G1-G4级，纤维化分为Su-S4期。炎症轻重两组间PAB差异有显著性意义（P〈0．01）。随着纤维化程度的增加，PAB逐渐下降，且S4及S0、S1、S2和S3比较差异有显著性意义（P〈0．01）。PAB与炎症分级及纤维化分期之间相关性均非常显著（P〈0．01）。结论：PAB能较好地反映慢性乙型肝炎患者肝脏的炎症活动水平，并能较敏感地反映慢性乙型肝炎患者肝脏的纤维化程度，在一定程度上可以提示早期肝硬化。     

乙型肝炎后肝硬化失代偿患者肝脏炎症活动度的研究

乙型肝炎后肝硬化失代偿行肝移植术患者的肝脏组织病理学特点鲜有报道。目的：评估乙型肝炎后肝硬化失代偿行肝移植术患者的肝脏组织炎症活动度情况,并分析其与血清HBVDNA、临床生化指标的相关性。方法：收集乙型肝炎后肝硬化失代偿行肝移植术的连续病例72例,取肝组织行HE、网状纤维和Masson染色,观察肝脏组织炎症活动度。以Spearman秩相关分析血清HBVDNA和临床生化指标与肝脏组织炎症活动度的相关性。结果：81．9％（59／72）的乙型肝炎后肝硬化失代偿患者肝脏组织有严重的活动性炎症（G3、c4级）;43．1％（31／72）患者经抗病毒治疗后血清HBVDNA阴性,其中77．4％（24／31）的患者肝脏组织炎症活动度≥G3级。MELD评分、总胆红素和凝血酶原时间与肝脏组织炎症活动度呈正相关,而ALT、HBeAg和HBVDNA水平不能反映乙型肝炎后肝硬化失代偿患者肝脏组织炎症活动度。结论：持续存在的活动性炎症是乙型肝炎后肝硬化失代偿患者的主要病理学特征以及接受肝移植的主要原因,HBVDNA载量并不能反映患者的肝脏组织炎症活动度。     

乙型肝炎合并肺结核的治疗问题

在临床工作中，经常遇到乙型肝炎病人合并肺结核病，由于乙型肝炎大多数为慢性病程，且易发展成为肝硬化，临床治疗较为困难，再加上合并肺结核病的病人必须给予早期、联用、适量、规律、全程的抗痨治疗，因为抗痨药物大多数都对肝脏产生毒性损害，这就使乙型肝炎合并肺结核的治疗更加复杂化，抗结核药物的应用无疑是对乙型肝炎病人雪上加霜，如何寻找更加安全有效、方便易行的治疗方案显得尤为重要。现就这一问题与同道共同探讨。     

肝纤维化治疗现状与对策

肝纤维化是肝脏对各种原因所致慢性肝损伤的过度修复反应 ,是肝硬化形成的基础 ,如何有效治疗肝纤维化仍是肝病领域一个巨大挑战 ,本文扼要介绍其近年研究进展。1　去除病因如戒酒、慢性病毒性肝炎的抗病毒治疗、去除铁或铜超载、解除机械性胆道阻塞等 ,是目前最有效的措施 ,可阻止多数肝纤维化进展 ,早期实施可逆转肝纤维化。文献报道应用α 干扰素治疗慢性丙型肝炎 ,显效者的肝纤维化改善率达 70 %。用拉米夫定 (ｌａｍｉｖｕｄｉｎｅ)治疗慢性乙型肝炎也可显著减轻肝纤维化程度。2　抑制肝脏炎症肝脏炎症与肝纤维化程度呈正相关 ,抑制肝…     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

Effects of pinealectomy and melatonin administration on certain indices of ovarian hyperplasia and/or hypertrophy in rats with both ovaries intact or after unilateral ovariectomy

Abstract: In earlier studies from other laboratories it was shown that melatonin decreased ovarian weight in rats and inhibited compensatory hypertrophy of the remaining ovary after unilateral ovariectomy. This study was designed to examine the influence of melatonin on certain indices of ovarian hyperplasia and/or hypertrophy in adult female rats with both ovaries preserved and with either an intact pineal gland or with the pineal gland removed (pinealectomy, PX) or, finally, in sham-PX animals. Similar studies were conducted on rats after unilateral ovariectomy, referring the examined parameters to the remaining intact ovary. The studies included mitotic activity of granulosa layer cells and corpus luteum cells, ovarian weight, ovarian cross-sectional area, cross-sectional area of the granulosa layer of all the Graafian follicles and the cross-sectional areas of the corpora lutea, visible on the ovarian cross-section. On the basis of results, we conclude that: 1) the effect of PX on the processes of ovarian hyperplasia and hypertrophy may vary; analogously, exogenous melatonin administration may influence ovarian hyperplasia and hypertrophy in different ways; 2) PX and exogenous melatonin may, under certain conditions, exert similar biological effects, even synergistic effects; 3) melatonin inhibits ovarian growth processes, while the effects of PX are variable; 4) the results indicate that in experiments performed on rats, with the use of two control groups, i.e., intact and sham-PX, melatonin effects on these two groups may differ.