腺苷蛋氨酸治疗肝炎后肝硬化高胆红素血症临床疗效观察

肝炎后肝硬化常合并肝内胆汁瘀积,发生高胆红素血症,其病程长,黄疸深,消退缓慢。思美泰（腺甘蛋氨酸）治疗肝炎后肝硬化高胆红素血症取得良好的疗效,现将结果报道如下。     

腺苷蛋氨酸在胆汁淤积性肝病治疗中的应用

肝内胆汁淤积系指胆管树内无机械性梗阻时的胆汁流速减慢，随之出现肝脏和血液内胆汁成分（胆红素和胆汁酸盐）以及毛细胆管的酶[碱性磷酸酶（ALP）和γ-谷氨酰转肽酶（γ-GT）]潴留现象。肝内胆汁淤积可见于急性和慢性肝病，也可见于肝内胆管损伤、药物性肝炎和其他肝脏疾病。其主要临床表现是黄疸和瘙痒，血清总胆红素和结合胆红素均增高，伴ALP和γ-GT增高。     

新生儿高胆红素血症γ-谷氨酰转肽酶测定的临床意义

目的探讨新生儿高胆红素血症γ-谷氨酰转肽酶(γ-GT)活性测定的临床意义。方法选取206例高胆红素血症的新生儿为高胆红素血症组,另选择60例生理性黄疸新生儿为对照组(生理性黄疸组),采用全自动生化仪分别测定两组总胆红素(TBIL)和γ-GT水平并作比较。结果新生儿高胆红素血症组γ-GT高于新生儿生理性黄疸组(P<0.05)。结论γ-GT测定在新生儿高胆红素血症诊疗中有一定的临床意义。     

穴位天灸结合凉血活血药治疗肝炎后高胆红素血症

自 1 998年 4月以来 ,笔者采用穴位天灸结合凉血活血中药治疗慢性肝炎高胆红素血症 ,疗效满意 ,现报告如下。1　资料与方法1 .1　一般资料 :慢性肝炎后高胆红素血症患者 71例 ,均为慢性乙型肝炎恢复期患者 ,慢性乙型肝炎按1 995年全国传染病会议拟定的标准诊断 ,入选患者肝功能检查血清总胆红素 ( TBil) >1 7.1 μmol/L,并排除肝外梗阻性黄疸 ,丙氨酸转氨酶 ( ALT)、天门冬氨酸转氨酶 ( AST)正常或轻度异常 ,其他临床症状轻微者。其中男 49例 ,女 2 2例 ,肝炎病史 1 .2～ 8.3年。 TBil2 5 .1～ 63.7μmol/L。上述患者按治疗先后随机分…     

不同剂量思美泰治疗重型病毒性肝炎高胆红素血症临床疗效观察

重型病毒性肝炎高胆红素血症临床上较常见,是目前肝病治疗的难题之一。加速黄疸消退、促进肝细胞恢复,是改善本病预后的关键。为探讨其临床治疗方法,我科于2003年7月-2007年7月以大剂量腺苷蛋氨酸（商品名：思美泰）治疗重型病毒性肝炎高胆红素血症患者33例,取得了较好疗效,现报告如下。     

病毒性肝炎高胆红素血症的治疗进展

血清胆红素大于 171μｍｏｌ/Ｌ称为高胆红素血症 ,临床上常见于各种原因的肝内、外胆汁淤积。高胆红素血症可以引起细胞死亡而加重肝损伤 ,高胆红素血症持续存在 ,可发生广泛肝内泥砂样结石、胆汁性肝硬化 ,乃至肝细胞液化或凝固性坏死。有效地促进黄疸消退是治疗的关键。目前病毒性肝炎高胆红素血症尤其是重型肝炎和急、慢性肝炎合并肝内胆汁淤积尚缺乏特效疗法 ,而苯巴比妥、肾上腺皮质激素的副作用较大 ,为此 ,探索出有效治疗高胆红素血症的药物方法是当务之急。现就国内近年来病毒性肝炎高胆红素血症的治疗进展作一综述。1　腺苷蛋氨酸…     

思美泰对肝内胆汁淤积症患者情志的影响

目的:研究思美泰与苦黄对于肝内胆汁淤积症患者情志的影响。方法:选择60例肝内胆汁淤积症住院患者,随机分为思美泰组和苦黄组,应用Zung编制的SAS/SDS量表对两组患者治疗前后分别进行测评,并进行比较。结果:在SAS和SDS量表中,思美泰组和苦黄组治疗后两组间比较,P0.05;各组治疗前后比较,P0.05或0.01。结论:思美泰组和苦黄组在临床上对肝内胆汁淤积的疗效差异无显著性意义(P0.05),而对于情志改变的改善,思美泰有着比较明显的优势,对于抑郁和焦虑症状的改善,思美泰组明显优于苦黄组。     

重新审视腺苷蛋氨酸在肝病治疗中的价值

S-腺苷蛋氨酸(SAMe)即思美泰,长久以来被广泛用于肝炎、肝硬化所致的肝内胆汁淤积以及妊娠期肝内胆汁淤积等治疗.近年来,研究发现其对肝细胞具有多重保护机制,包括解毒,抗氧自由基,抗炎症介质、细胞因子,增加膜流动性,保护细胞骨架,提高Na+-K+-ATP酶活性等[1],从而达到降低胆红素水平,全面保护肝细胞的作用.另外,腺苷蛋氨酸在延长酒精性肝硬化患者生存率、抑制肝纤维化进程,改善肝病患者情绪、治疗肝病患者抑郁症等方面的作用亦逐渐引起人们的重视.     

前列地尔治疗慢性乙型淤胆型肝炎的临床观察

慢性淤胆型肝炎可见于各种病毒性肝炎、药物性肝炎及其他病因引起的各种肝炎，淤胆型肝炎黄疸持续时间长，一般退黄效果不理想，且高胆红素血症可进一步引起肝细胞死亡，加重肝损伤，若高胆红素血症持续存在可导致胆汁性肝硬化。慢性乙型肝炎（CHB）出现肝内胆汁淤积说明病情较重，因此加速黄疸消退、促进肝细胞再生恢复是改善本病预后的关键。我科近几年收治的慢性乙型淤胆型肝炎在常规治疗基础上，加用前列地尔注射液静脉滴注，取得满意的疗效，现总结如下：     

思美泰与前列腺素E_1联合治疗重度慢性病毒性肝炎35例

重度慢性病毒性肝炎(重度慢性肝炎)患者有高胆红素血症、丙氨酸转氨酶(ALT)升高等严重肝功能损害,也易进展为重型肝炎,因此国内外学者采用许多疗法治疗重度慢性肝炎,其中思美泰(腺苷蛋氨酸)治疗黄疸型慢性肝炎有效,但尚未见思美泰治疗重度慢性肝炎的报道。我们采用思美泰与前列腺素E_1治疗重度慢性肝炎,取得较好疗效,报道如下。     

Histological evolution of chronic hepatitis C. Factors related to progression

We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positive to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver biopsies were carried out for each patient, with an interval ranging between 12 and 126 months (mean 50.2±30.7). In all cases the usual histological classification was applied and the histological activity index scoring system according to Knodell et al. was determined. Fifteen cases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patients (18.5%) in the second liver biopsy. Epidemiological, clinical, biochemical and histological parameters were compared between the group without histological progression and the group with impairment in liver histology. Factors related to histological worsening were: more advanced age (p=0.002), high levels of aspartate aminotransferase (p=0.04), high global histological activity index (p=0.03) and piecemeal necrosis and bridging necrosis scores (p=0.02) at first biopsy. The histological activity index can be applied to assess the natural history of chronic viral hepatitis, and is a good tool to evaluate the prognosis. Thus chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.     

病原未定型肝炎的临床研究

目的探讨病原未定型肝炎的临床特征。方法以43例慢性乙型肝炎和30例急性乙型肝炎为对照组,对62例病原未定型肝炎患者进行临床分析,比较病原未定型肝炎的流行病学、临床表现、实验室检查及肝组织学改变。结果62例病原未定型肝炎患者发病以冬末及春季多见;发病年龄以青、中年(18岁~50岁)占92.2%;临床表现有急性和慢性,多数症状轻、肝病体征少;血清转氨酶水平呈轻、中度升高;肝活检组织病理学显示炎症轻;绝大多数预后良好。结论病原未定型肝炎的致病因子仍不清楚。     

Absence of anti-LKM-1 antibody in hepatitis C viral infection in the United States of America

Summary. Several studies from Europe have observed a relationship between hepatitis C virus infection and anti-liver/kidney microsome-1 (anti-LKM-1) positive chronic hepatitis. It has been suggested that hepatitis C may induce an autoimmune phenomenon that leads to the development of a specific type (type II anti-LKM-1 positive) autoimmune chronic hepatitis. We evaluated 204 sera from patients with well-documented hepatitis C infection from two centres in the United States of America and compared them with sera from 428 French patients from three centres. We evaluated the serological prevalence of anti-smooth muscle antibodies, anti-nuclear antibodies, anti-liver cytosol antibodies, and anti-mitochondrial antibodies subtype anti-M₂ in patients with chronic hepatitis C. The two groups were matched in their ages, gender, mode of transmission of hepatitis C infection and severity of liver disease. Anti-LKM-1 was not observed in the patients from the USA at a time when it was noted in 3.7% of French patients. There were no differences, however, in the expression of other auto-antibodies, which were often in low titres. Absence of anti-LKM-1 in USA sera in comparison with French sera suggests that there may be differences in induction of anti-LKM-1 related to environmental and/or host genetic factors, and/or genomic variation in the hepatitis C virus.     

A case of transfusion-acquired hepatitis C

Summary The Blood Transfusion Service introduced screening for Hepatitis C antibody (HCV) in September 1991. This is done by second generation enzyme linked immunosorbent assay (ELISA) tests. We present a case of post-transfusion hepatitis C hepatitis in a patient with myeloma. Infection was acquired before screening was introduced. Both the patient and the infected blood donor were diagnosed using ELISA assays and the polymerase chain reaction (PCR). In this way we prevented the blood donor from spreading the virus via subsequent blood donations. There were some interesting discrepancies in the HCV assays. Blood samples, when tested by different methods, gave both positive and negative results. The results also varied according to when the blood samples to be tested were taken. The case illustrates the importance of confirming positive results and that no single laboratory test is entirely satisfactory in diagnosing HCV infection.     

Detection of HBV core promoter and precore mutations helps distinguish flares of chronic hepatitis from acute hepatitis B

Background and Aim: Acute exacerbation of chronic hepatitis B has to be distinguished from acute hepatitis, because treatment strategies differ between them. Methods: Mutations in the core promoter and precore region of hepatitis B virus (HBV) were determined in 36 patients with acute exacerbation of chronic hepatitis B, in whom alanine aminotransferase (ALT) increased above 500 IU/L, as well as the 36 patients with acute hepatitis. Results: Mutations in the core promoter (A1762T/G1764A) and precore region (G1896A) were more frequent in patients with acute exacerbation of chronic hepatitis than acute hepatitis (81% vs 19%; P < 0.0001 and 58% vs 6%; P < 0.0001, respectively). Of the 19 patients with mutations in both the core promoter and precore region, 17 (89%) had acute exacerbation of chronic hepatitis. In contrast, among the 32 patients with the wild‐type for both the core promoter and precore region, 29 (89%) developed acute hepatitis. By multivariate analysis, the double mutation in the core promoter was predictive of acute exacerbation in chronic hepatitis with the highest odds ratio at 26.4. Conclusions: In patients with hepatitis B having ALT levels >500 IU/L, mutations in the core promoter and precore region are useful in distinguishing acute exacerbation of chronic from acute HBV infection. Detection of these mutations would be useful for commencing prompt antiviral treatments on patients with acute exacerbation of chronic hepatitis for a better prognosis.