门脉主干壁厚检测对日本血吸虫病肝纤维化的临床意义

对１１７例血吸虫病患者、３０例肝炎后肝硬化患者及３２例健康人分别用Ｂ超检测其门脉主干壁。结果表明，血吸虫病患者门脉主干壁普遍增厚；血吸虫病肝纤维化，急者较血吸虫病非肝纤维化、肝炎后肝硬化及健康人都有显著增厚；随着血吸虫病肝纤维化Ｉ、ＩＩ、ＩＩＩ期病情加重，其门脉主干壁厚亦递增。这改变不仅与血清透明质酸、羟脯氨酸等胶原代谢测值同步，而且与肝实质纤维变、门脉分支外径等国际ＴＤＲ血吸虫病超声指标检测结果高度正相关。     

肝刺激因子对实验性免疫性肝纤维化保护作用

目的：研究肝刺激因子（ＨＳＳ）对免疫性肝纤维化的作用。方法：ＨＳＳ从初生小牛肝提取，动物模型采用人血清白蛋白（ＨＳＡ）制备，保护组同时腹腔注射８ｍｇＨＳＳ。结果：（１）ＨＳＳ可使升高的血清转氨酶（ＡＬＴ）水平、Ｎ－乙酶－β－Ｄ－氨基葡萄糖苷酶（ＮＡＧ）活力及肝组织羟脯氨酸（ＨＹＰ）含量下降。（２）光、电镜下见，ＨＳＳ可以保护肝细胞的受损，使成纤维细胞、Ｉ型及Ⅲ型胶原增生程度明显降低。（３）ＨＳＳ使贮脂细胞数目明显减少且影响其激活，并且减少了肝内ＨＳＡ免疫复合物的沉积及大量浸润的Ｔ细胞。结论：ＨＳＳ对免疫性肝纤维化有保护作用，其机制可能是通过免疫途径。     

γ-干扰素基因修饰肝细胞治疗血吸虫病肝纤维化实验研究

目的探讨γ干扰素（ＩＦＮγ）基因修饰的肝细胞经脾移植抗血吸虫病肝纤维化作用。方法采用ＥＬＩＳＡ和免疫组化方法，动态分析日本血吸虫感染小鼠ＩＦＮγ和Ⅰ、Ⅲ型胶原水平及其相互关系，并将小鼠ＩＦＮγ重组腺病毒转染的肝细胞经脾移植到感染１６周小鼠，分析ＩＦＮγ基因治疗血吸虫病肝纤维化的作用。结果感染４周时，小鼠ＩＦＮγ水平明显升高，在感染１２周时达高峰；但在１６周以后ＩＦＮγ水平明显下降，而Ⅰ、Ⅲ型胶原的合成持续增高；ＩＦＮγ基因修饰的肝细胞经脾移植后能稳定有效地表达，显著降低Ⅰ、Ⅲ型胶原的合成、沉积，减轻肝纤维化程度。结论ＩＦＮγ可能与Ⅰ、Ⅲ型胶原的合成、沉积有关；ＩＦＮγ基因治疗能有效地发挥抗血吸虫病肝纤维化作用。     

血吸虫病性肝纤维化患者甲襞微循环变化

为了研究血吸虫病肝纤维化对外周微循环的影响,我们对82例晚期血吸虫病患者甲襞微循环及肝脏B超、胶原代谢指标进行了同步观测和分析。观察对象根据临床B超影象、血清透明质酸和血清羟脯氨酸检测结果,将117例慢性或晚期血吸虫病患者分为两组:1血吸虫病性肝纤维化组(SF组),82例,其中男性68例,女性14例;2无肝纤维化慢性血吸虫病组(NSF组)35例,其中男性28例,女性7例。3健康对照组(HP组),32例,其中男性22例,女性10例。参照Yokogawa关于肝纤维化分期的标准,又将82例SF患者分别为期(SF1组)17例、组(SF2组)42例、期(SF3组)23例。检测方法和…     

血吸虫病吡喹酮治后一年B超及血清生化的变化

为了探讨日本血吸虫病患者杀虫治疗后肝纤维化的变化，对粪检阳性日本血吸虫病患者，用吡喹酮治疗后一年，观察５５例粪检复查阴性者治疗前，后腹部Ｂ超及血清透明质酸（ＨＡ）、Ⅲ型前胶原（ＰＣⅢ）的变化，ＨＡ与ＰＣⅢ均用ＲＩＡ法。结果显示，腹部Ｂ超检查门脉Ⅱ级分支外径（Ｄ）与内径（ｄ）比值由２．１５±０．３２降至１．８９±０．２４，治疗前、后差异有显著性（Ｐ＜０．０１）；治疗后肝左叶长径、肝右叶长径（Ⅰ）、脾脏长径均有明显缩小（Ｐ＜０．０５）。与自然人群比较治后肝左叶厚度，肝右叶最大斜径、脾脏长径、脾脏指数、门脉主干内径及Ｄ／ｄ比值仍有显著差异，治后肝纤维化血清指标ＨＡ、ＰＣⅢ阳性率分别由３５．４％和７１．７％降至１４．９％和２２．５％，其差异均有非常显著意义。本研究提示经吡喹酮治疗后一年，肝纤维化程度有好转，但未达正常人水平。     

晚期血吸虫病巨脾型患者肝脏胶原与血清肝纤维化指标的相关性研究

目的：探讨晚期血吸虫病巨脾型患者肝脏胶原与血清肝纤维化指标之间的关系。方法：采用免疫组化ＬＳＡＢ法,计算机图像分析和放射免疫法测定晚期血吸虫病巨脾患者肝脏１、３、４型胶原量并计算１／３型胶夺比值,同步检测血清ＰＣ３、ＨＡ和Ｃ４量。结果：血清ＨＡ与肝脏１型胶原量,ＰＣ３和Ｃ４与１／３型胶原比值显著正相关。结论：血清ＰＣ３和Ｃ４能反映肝纤维化程度,血清肝纤维化指标与肝脏胶原病理检查对诊断肝纤维化具有互     

赤芍、栀子对实验性肝纤维化的防治作用

本研究采用ＳＤ大鼠ＣＣｌ４中毒肝纤维化模型，研究了中药赤芍、栀子对实验性肝纤维化的防治作用，通过观察反映胶原增生的形态学以及ＨＡ和ＨＹＰ含量变化，初步探讨了赤芍、栀子抗肝纤维化的可能机理、本实验结果显示赤芍对ＣＣｌ４中毒性肝纤维化时ＨＹＰ和ＨＡ增高均有显著抑制作用，提示其除能抑制胶原增生外，同时还有抑制基质增生的作用。而栀子主要表现为抑制ＨＹＰ增高，说明其作用环节可能主要在于抑制胶原增生。     

日本血吸虫病合并HBV和HCV感染血清肝纤维化指标的变化及意义

目的：探讨ＨＢＶ和ＨＣＶ对日本血吸虫病肝纤维化的影响。方法：用放免和酶标法分别测定晚血、慢血和自然人群血清的ＨＢＳＡｇ和抗ＨＣＶ，分成ＨＢＳＡｇ阳性组，抗ＨＣＶ阳性组和双阴性组，用放免法和生化法测定其血清肝纤维化指标即透明质酸（ＨＡ）、层粘蛋白（ＬＮ）、Ⅲ型前胶原（ＰＣⅢ）、谷胱甘肽Ｓ转移酶（ＧＳＴ）。结果：晚血的肝纤维化指标显著高于慢血，后者又显著高于自然人群。晚血的ＨＢｓＡｇ和抗－ＨＣＶ阳性组的ＨＡ、ＬＮ和ＰＣⅢ均显著高于阴性组，慢血的ＨＢｓＡｇ和抗－ＨＣＶ阳性组的ＰＣⅢ显著高于阴阳组，而ＨＡ和ＧＳＴ没有。结论：ＨＢＶ和ＨＣＶ可能有促进日本血吸虫病肝纤维化形成作用     

日本血吸虫病合并HBV和HCV感染血清肝纤维化指标的变化？…

目的：探讨ＨＢＶ和ＨＣＶ对日本血吸虫病肝纤维化的影响。方法；用放免和酶标法分别测定晚血，慢血和自然人群血清的ＨＢＳＡｇ和抗ＨＣＶ，分成ＨＢＳＡｇ阳性组，抗ＨＣＶ阳性线和双阴性组，用放免法和生化法测定其血清肝纤维化即透明质酸（ＨＡ）。层粘蛋白（ＬＮ）Ⅲ型前胶原（ＰＣⅢ）谷胱甘肽Ｓ转移酶（ＧＳＴ）。结果：晚血的肝纤维化和指标显著高于慢血，后者又显著高于自然人群，晚血的ＨＢｓＡｇ和抗－ＨＣＶ阳性组的ＨＡ     

RNA对血吸虫病肝纤维化兔血浆透明质酸和肝组织羟脯氨酸含量的影响

为探讨核糖核酸（ＲＮＡ）对血吸虫病肝纤维化兔血浆透明质酸（ＨＡ）和肝组织羟脯氨酸（ＨＹＰ）的影响,将５４只日本家兔随机均分为正常组、病理组、ＲＮＡ组。病理组和ＲＮＡ组每兔感染血吸虫尾蚴（１００±１）条,３０ｄ后用吡喹酮杀虫并对ＲＮＡ组用ＲＮＡ治疗,于用ＲＮＡ后第４０、７０、１００ｄ,每组随机选６只兔取血和肝供检测备用。用放射免疫方法测定血浆ＨＡ和紫外分光光度法测定肝组织ＨＹＰ含量。结果ＲＮＡ组ＨＡ于１００ｄ时（４．６６±１．３５）μｇ／ｍｌ,显著低于相同阶段的病理组（１０．１６±２．５２）μｇ／ｍｌ（Ｐ＜０．０１）;ＲＮＡ组ＨＹＰ于１００ｄ时（７．２４±１．２４）μｇ／ｍｇ肝粉,亦显著低于病理组相同阶段（１０．８５±１．７３）μｇ／ｍｇ肝粉（Ｐ＜０．０１）。表明ＲＮＡ对血吸虫病肝纤维化兔血浆ＨＡ和肝组织ＨＹＰ有下调作用。     

Mixed hepato/cholangiocarcinoma with paraneoplastic hypercalcemia

Malignant hypercalcemia without bone metastasis may result from the abnormal secretion of parathyroid hormone (PTH) or PTH-related protein (PTH-rP). We present a case of possible PTH-rP-secreting mixed hepato/cholangiocarcinoma. In July 2000, a 52-year-old woman presented with right hypochondrial pain and weight loss. Imaging procedures revealed a 10-cm lesion involving the right hepatic lobe and the hilum. Retrohepatic inferior vena caval invasion was detected by abdominal angiography. Serum calcium was elevated, while intact PTH was undetectable. The rising level of hypercalcemia rapidly became life-threatening. Medical treatment with diphosphonate and octreotide was ineffective. Chemoembolization of the right branch of the hepatic artery, preceded by right portal vein embolization, helped regain normocalcemia and improve the patient’s general condition. Extended right hepatectomy with prosthetic replacement of the vena cava and resection of the left portal vein was performed. Histopathology revealed mixed hepato/cholangiocarcinoma. Hypocalcemia appeared postoperatively but was successfully corrected. Recurrence of diffuse hepatic nodules resulted in recurrent hypercalcemia and death 3 and a half years after the surgery. This is the third case to be reported in the English-language literature. Paraneoplastic PTH-rP-induced hypercalcemia, which may be a fatal complication, can respond to arterial chemoembolization. Extensive hepatic resection may offer a good chance for survival.     

Advances in hepato–pancreato biliary surgery

The Americas Hepato–Pancreato Biliary Association (AHPBA) Annual 2011 Meeting provided a forum for discussion of multidisciplinary advances surrounding six tracks including the liver, biliary system, liver transplantation, pancreas, imaging and biomedical engineering and general hepato–pancreato biliary (HPB) surgical disease. The meeting and postgraduate courses attracted the largest ever attendance and participation in the AHPBA annual meeting, including field leaders and participants from across North, Central and South America who interchanged clinical and scientific knowledge, and discussed advances in technology, care and outcomes for treatment of HPB diseases. The AHPBA Foundation, established in 2010, announced progress toward support of meritorious research in HPB disease and enrichment of educational programs. HPB fellowship graduates were recognized, marking successful establishment of the AHPBA as an important body guiding HPB education and training in the USA and the Americas.     

CD133和CD90在肝细胞癌中的表达及其意义

存在于肿瘤组织中的少数具有干细胞性质的细胞群体被称为肿瘤干细胞(CSCs),可促进肿瘤的发生和发展,也是肿瘤耐药性、复发及转移的根源.有报道CD133和CD90可能为肿瘤干细胞表面标志物,但CD133和CD90在肝癌中的表达及其意义报道尚少.本研究采用免疫组织化学方法检测不同肝组织中CD133及CD90蛋白的表达水平,探讨其在肝癌中的表达情况及其与肝癌生物学特性及预后的关系.     

髓样分化蛋白88在炎症感染相关原发性肝癌发生中的作用

原发性肝癌是常见的恶性肿瘤之一,其中90%为肝细胞癌(HCC).近年来,人们对HBV、HCV慢性感染等所致肝脏持续炎症反应中Toll样受体(TLR)髓样分化蛋白88(MyD88)在肝癌发生中作用机制的研究取得了较大进展,增加了对肝癌发生的性别差异分子基础的认识.现就HCC这一炎症相关肿瘤的发病机制及与之相关的宿主遗传因素在HCC发生中的作用的最新研究进展作一综述.     

肝炎、肝硬变和肝癌大鼠血中10种微量元素的变化

本文系列观察了DAB诱发肝炎、肝硬变和肝癌大鼠血中10种微量元素变化及其变化规律。给予Wistar大鼠喂养DAB饲料26周。在实验第8周(肝炎期)、18周(肝硬变期)和26周(肝癌期)分别检测6只肝炎、肝硬变和肝癌大鼠血中10种微量元素。结果显示:肝炎时仅Mn低于正常组(P<0.005);肝硬变时Mn、Ba、Fe、Si、Zn和Se均显著低于正常组(P<0.05～0.001),Cu显著高于正常组(P<0.001);肝癌时Mn、Ba、Fe、Si、Zn、Se和Mo均显著低于正常组(P<0.05～0.001),Cu和Cr显著高于正常组(P<0.001)。结果表明:1.肝病越重,微量元素变化越明显;2.Se、Zn、Mn、Si、Fe、Mo和Ba可能对肝硬变和肝癌有预防作用。     

Telomerase activity, P53 mutation and Ki-ras codon 12 point mutation of the peripheral blood in patients with hepato pancreato biliary diseases

Background

With progress in molecular biology, the presence of telomerase activity, P53 mutation and Ki-ras codon 12 point mutation has been reported in malignant tumours of the liver, pancreas and biliary tree. The purpose of this paper is to clarify the clinical implications of finding these three biomarkers in the peripheral blood of affected patients.

Methods

Telomerase activity, P53 mutation, and Ki-ras codon 12 point mutation in the peripheral blood were examined among 86 patients with hepato pancreato biliary disease, both benign and malignant, and the results were compared with clinical findings.

Results

Of 20 patients with benign conditions, only one patient with intraductal papillary adenoma showing severe dysplasia exhibited a biomarker (telomerase activity) in the peripheral blood. In total, there were 66 patients with various HPB carcinomas. Of 56 cancer patients studied pre-operatively, 16 were positive for more than one biomarker, 13 were positive for telomerase activity, 4 for P53 mutation (three at exon 7 and another at exon 8), and 2 for Kiras codon 12 point mutation (both in the second letter). Twelve of the 16 biomarker-postiive patients had stage IV disease as opposed to 23 of 40 biomarker-negative patients. The resectability rate of the cancer was 38% in positive patients and 50% in negative patients. The one-year survival rate after resection was zero in positive patients and 15% in negative patients, but the difference was not significant (P=0.65). Of 32 patients with liver metastasis at the time of the molecular examination, eight were positive and 24 negative. Of 34 patients without liver metastasis, nine were positive and 25 negative. The development of subsequent liver metastases in those without them at the start was not significantly different in those with and without biomarkers (56 vs 36%: P=0.31).

Conclusions

The three novel biomarkers of the peripheral blood seemed to be of little value for screening of early malignant HPB neoplasms but may help to predict liver metastasis.     

人Midkine启动子驱动的HSV-TK自杀基因体外抗肝癌作用

目的 观察以人Midkine(MK)启动子调控单纯疱疹病毒胸苷激酶基因(HSV-TK)/丙氧鸟苷(GCV)自杀基因系统在体外对人肝癌细胞的杀伤效应.方法 以含有人MK启动子调控的HSV-TK基因的重组腺病毒分别感染体外培养的甲胎蛋白(AFP)阳性人肝癌细胞BEL-7402和AFP阴性人肝癌细胞SMMC-7721,RT-PCR法检测HSV-TK基因在上述两种细胞中的转录表达,观察GCV对人肝癌细胞的杀伤作用.结果 GCV在体外对重组腺病毒感染的BEL-7402及SMMC-7721均有明显的杀伤作用,又以前者为著.相同的病毒滴度,其杀伤作用随着GCV浓度的增高而增强.均具有旁观者效应.结论 在体外表现HSV-TK基因的AFP阳性及阴性人肝癌细胞均可被人MK启动子调控的自杀基因HSV-TK杀伤.     

The role of (99m)technetium-labelled hepato imino diacetic acid (HIDA) scan in the management of biliary pain

Objective. To assess the outcome of laparoscopic cholecystectomy on the basis of an abnormal provocative ^99mtechnetium-labelled hepato imino diacetic acid (HIDA) scan for patients with typical biliary pain and normal trans-abdominal ultrasound (TUS) scan. Patients and methods. Prospective data were collected for 1201 consecutive patients with typical biliary symptoms. Patients who were found to have a normal TUS and upper GI endoscopy subsequently underwent cholescintigraphy (HIDA scan). Patients with an abnormal HIDA scan, i.e.<40% ejection fraction with Sincalide® (cholecystokinin octapeptide) – were offered cholecystectomy. Symptoms and histology were reviewed postoperatively. Results. In all, 48/1201 (4%) patients with typical biliary symptoms had a normal ultrasound and endoscopy; 35/48 patients had an abnormal provocative HIDA scan and all underwent laparoscopic cholecystectomy. Histology in all cases revealed chronic cholecystitis and 18 patients had sludge or microlithiasis within the gallbladder. At 6-week follow-up, 31 of the 35 patients were completely asymptomatic or improved. Furthermore, 79% of patients remained symptom-free or improved at a median follow-up of 28.5 months (range 4–70). Conclusions. HIDA scan is a useful clinical tool as an adjunct to the diagnosis and management of patients who present with typical biliary pain and a normal TUS scan.