血小板在慢性肝病中的研究现状

肝纤维化、肝硬化等慢性肝病的机制较为复杂,是肝内各种细胞、细胞因子、基质相互作用的结果。传统观点认为血小板的主要功能是参与止血和凝血。最近研究认为血小板不仅含有止血所需要的分子蛋白质,且富含器官发育、组织再生和修复的生长因子,而且与肝纤维化、肝硬化等慢性肝病的发生发展及肝组织再生过程关系密切,在肝内稳态和病理中发挥关键作用。对血小板在慢性肝病中的作用进行阐述,认为血小板与肝纤维化、肝再生的信号通路等方面的关系已获得诸多研究结果,未来血小板可能成为治疗慢性肝病的新的重要靶点。     

转化生长因子-β信号通路与肝纤维化分子治疗研究进展

肝星状细胞（HSC）是肝纤维化发生的关键细胞，转化生长因子-β（TGF-β）在肝纤维化发生、发展过程中具有活化HSC、促进细胞外基质（ECM）合成和沉积等作用。TGF-β-Smad信号通路是TGF-β发挥生物学效应的主要通路，其分子组成和分子调节复杂，与其他信号通路存在广泛交互影响。深入研究TGF-β-Smad信号通路可进一步阐述肝纤维化的发病机制，为肝纤维化的防治提供新的有效途径。     

转化生长因子-β/Smad和磷脂酰肌醇3激酶/蛋白激酶B的信号串扰与肝纤维化

肝纤维化是慢性肝病发展过程中肝组织内细胞外基质(ECM)过度增生与异常沉积所致肝脏结构和肝功能异常改变的一种病理过程,其发生发展是一个连续的阶段性过程并涉及到多种细胞和细胞因子的功能改变.在肝纤维化形成中,转化生长因子-β(TGF-β)是公认的关键细胞因子,对细胞的增殖、凋亡、衰老、分化、迁移发挥着复杂多变的多向性功能[q.TGF-β与多种信号通路之间相互串扰,发挥协同或拮抗作用,是其功能多向性的分子信号基础.磷脂酰肌醇3激酶(PI3K)/蛋白激酶B(AKT)信号通路和TGF-β/Smad信号通路之间的相互串扰可能是慢性肝病肝纤维化进展中信号网络失衡的一个关键节点,也可能是临床治疗策略的切入点,故本文仅就肝纤维化形成过程中TGF-β/Smad信号通路、PI3K/AKT信号通路以及关于两条信号通路相互串扰的新近研究进展做一综述.     

Smad7对TGF-β/SMAD的调节及其在肝纤维化中的作用

肝纤维化是多种慢性肝病向肝硬化发展的中间环节,转化生长因子β(TGF-β)是肝纤维化形成中最重要的细胞因子,其信号传入依赖于受体后信使分子-SMAD蛋白来完成。Smad7是TGF-β/SMAD信号传导中重要的负性调节因子,具有抗纤维化的作用。深入研究Smad7有助于对肝纤维化发病机制的理解,为探索新的基因治疗途径提供理论依据。本文就Smad7在TGF-β信号通路中及在肝纤维化中的作用进行综述,并就其在抗纤维化中的前景予以展望。1 TGFβ特性及功能TGF-β属生长因子家族,哺乳动物存在3种亚型(TGF-β1~3),在细胞的生长、分化、迁移、凋亡及…     

松弛素抑制肝星状细胞胶原合成的体外研究

肝纤维化是各种慢性肝病向肝硬化发展的必经中间环节,尽早阻止甚至逆转肝纤维化对于改善各种慢性肝病的预后、延缓肝硬化的发生具有重要意义.目前认为,肝星状细胞(HSC)的激活是肝纤维化发生的中心环节,转化生长因子-β1(TGF-β1)是HSC激活的最强因子,而SKi相关新颖N蛋白(Ski-related novel protein N,SnoN)是TGF-β1/Smad信号通路中最重要的负性调控因子[1-3].临床研究发现,松弛素有松弛盆腔韧带和扩张子宫颈而利于妊娠和分娩的作用,另外尚有抗肝纤维化作用[4-6].本实验通过观察松弛素对体外分离的大鼠HSC内TGF-β1和SnoN蛋白表达的影响,以及PC Ⅲ、HA含量的变化,了解松弛素抗肝纤维化的作用及可能机制.     

肝纤维化与TGF-β和以其为靶位点的治疗策略

肝纤维化是细胞外基质(ECM)在肝脏中过量堆积的结果,是几乎各种慢性肝病的共同病理基础.转化生长因子β(TGF-β)是一类能够调节细胞生长和分化的多肽,在肝纤维化的发生、发展过程中起着重要作用,是最重要的促肝纤维化细胞因子之一.在细胞及分子水平上,肝纤维化主要以肝星状细胞(HSC)的活化和TGF-β的异常活性为特征.TGF-β-Smads信号转导通路与肝纤维化的发病机制具有密切关系,为肝纤维化的防治与治疗提供了新的有效途径.我们综述了肝纤维化与TGF-β-Smads信号转导通路的关系和以TGF-β为靶位点进行肝纤维化的治疗策略.     

肝纤维化相关信号转导通路研究进展

肝纤维化是肝脏对各种慢性肝损伤进行自我修复的一种病理过程,最终进展为肝硬化、肝衰竭,甚至肝癌。如何早期干预和治疗肝纤维化显得尤为重要。总结了TGFβ/Smad信号通路、Notch信号通路、Wnt信号通路、Hedgehog信号通路及整合素信号通路在肝纤维化发生机制中的最新研究进展,指出各信号通路在肝纤维化的发生发展中发挥极其重要的作用,有望为肝纤维化的治疗提供新的方向。     

核因子E2相关因子2与细胞自噬对肝纤维化的影响

肝纤维化是慢性肝病发展到肝硬化的必经阶段,在全世界范围保持着较高的发病率。肝纤维化的发生机制复杂,其发生发展受到许多细胞因子及信号通路的影响,人们对肝纤维化的认识也越来越深入。简述了核因子E2相关因子2(Nrf2)介导的抗氧化应激系统在对抗各种类型肝纤维化中的作用和细胞自噬对肝纤维化的影响,以及Nrf2和自噬的相互影响在肝纤维化中可能的作用机制。认为将Nrf2和细胞自噬联合研究是未来肝纤维化发生机制的研究方向,为肝纤维化的治疗提供了新思路。     

肝纤维化发病机制中关于肝窦血管重塑的研究进展

肝硬化及门脉高压是各种慢性肝病发展的最终阶段,肝纤维化是各种慢性肝损伤组织修复过程中代偿性的病理变化,是肝硬化发生的必经阶段。肝窦是肝脏特殊的微血管系统,肝窦血管重塑在肝纤维化形成之前已经发生,并进一步形成病理性血管,肝窦血管重塑是肝纤维化及门脉高压的重要发病机制之一。本文将重点介绍此过程中涉及的多种重要细胞、分子及肝窦血管重塑的方式。肝窦血管重塑的方式主要有两种:发芽方式和分裂方式。目前认为应深入研究肝窦血管重塑过程中关键的细胞和分子信号通路,找到更多有效的治疗靶点,有望研发出特异性抑制肝窦血管重塑、逆转早期肝纤维化的临床药物。     

慢性肝病与缺氧

肝脏代谢需要充足的氧气供应,因此肝脏对缺氧损害极为敏感.慢性肝损伤均伴有缺氧;缺氧反过来又加重肝损伤,抑制肝细胞再生,促进肝纤维化、肝硬化乃至肝癌的发生;他们互为因果,互相促进,是各种慢性肝病发展的重要机制.作为体内最重要的缺氧信号传递因子,缺氧诱导因子-1?(hypoxia inducible factor-1?,HIF-1?)参与肝脏许多缺氧适应性调节活动.随着对慢性肝病与缺氧相互关系的不断认识,肝纤维化时针对HIF-1?及其下游靶位的治疗已取得一些进展;一些药物通过改善肝脏微循环,部分纠正肝脏缺氧,对慢性肝病具有积极的治疗作用.但慢性肝病与缺氧之间涉及到复杂的信号通路,其确切调控机制仍需要大量研究工作去进一步阐明.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。