总胆汁酸变化在脾切除治疗肝硬化脾功能亢进中的临床意义

目的探讨血清总胆汁酸(TBA)在脾切除治疗肝硬化脾亢中的应用。方法选取肝豆状核变性(HLD)患者肝硬化33例,乙肝(HBV)肝硬化22例,进行术前、术后总胆汁酸检测,并与总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)测定结果进行比较。结果 TBA术前大多数上升、术后有明显下降过程(P0.01)后上升;ALT、AST、TBIL、DBIL术后均有不同程度明显上升,与术前比差异有统计学意义(P0.05);TBA与ALT、AST、TBIL、DBIL呈"背离"现象。结论 TBA在脾切除治疗肝硬化脾亢中呈现上升、下降、上升的现象。动态观察并结合其他指标有助于肝损伤判断。     

FXR和BSEP在阻塞性黄疸大鼠肝细胞中的表达及其意义

目的：研究胆盐输出泵（BSEP）在阻塞性黄疸肝细胞表达过程中的变化及其与阻塞性黄疸高胆汁酸血症的关系,探讨法尼酯衍生物X受体（FXR）的活性及内毒素（ET）对BSEP表达的影响。方法：36只健康SD大鼠随机分为假手术组（Sham）、胆总管结扎组（CBDL）和胆总管结扎再通组（BR）,建立大鼠阻塞性黄疸模型,检测各时相点血清总胆红素（TBIL）、总胆汁酸（TBA）和ET水平;用免疫组织化学法观察各组大鼠肝组织FXP和BSEP蛋白的表达,用平均积分光密度(IOD)法检测FXR和BSEP蛋白的表达水平;线性相关分析FXR、TBA、ET和BSEP之间的定量关系。结果：Sham组大鼠术后各时间点血清TBIL、TBA及ET水平无明显变化（P>0.05）;CBDL组大鼠胆总管结扎术后,TBIL、TBA及ET水平显著增高（P<0.01）;BR组大鼠胆道再通术后TBIL、TBA及ET水平逐步下降,术后7 d组TBIL、TBA接近Sham组水平（P>0.05）,ET仍高于Sham组水平（P<0.05）。肝组织中FXR蛋白表达水平在Sham、CBDL和BR组中呈逐渐缓慢增高趋势,但各组间比较差异无统计学意义（P>0.05）。肝组织中BSEP蛋白表达水平在Sham和CBDL组中呈下降趋势,BR组先下降后上升,但与Sham组比较差异无统计学意义（P>0.05）。FXR蛋白表达与血清TBA水平呈正相关关系（r=0.303,P<0.05）,FXR与BSEP蛋白表达呈负相关关系（r=－0.359,P<0.05）,BSEP蛋白表达与血清ET水平呈高度负相关关系（r=－0.412,P<0.01）。结论：阻塞性黄疸时FXR在BSEP表达调控中并非起主要作用,而是ET致炎症介质的释放下调了BSEP表达。     

大黄素对胆汁淤积大鼠肝细胞转运体基因表达的影响

目的：探讨大黄素对α-萘异硫氰酸酯（ANIT）致急性肝内胆汁淤积的保护作用及其机制.方法：采用ANIT灌胃制备大鼠急性肝内胆汁淤积病理模型.将32只大鼠随机分为正常对照组、正常＋大黄素组、模型组、模型＋大黄素组,观察各组大鼠肝功能各项生化指标和肝组织病理学改变,并采用实时荧光定量RT-PCR检测肝细胞膜上转运体基因胆盐输出泵（BSEP）、多药耐药相关蛋白2（MRP2）、钠-牛磺胆酸共转运蛋白（NTCP）、多药耐药蛋白2（MDR2）、多药耐药相关蛋白3（MRP3）和核受体法尼酯衍生物X受体（FXR）mRNA水平的变化.结果：模型组与正常对照组相比较,TB,DB,ALT,AST,ALP和TBA浓度明显增高（P〈0.01）,光镜下可见肝细胞变性和坏死、中性粒细胞浸润,在mRNA水平NTCP,FXR表达降低（P〈0.01）,MDR2,MRP3表达增高（P〈0.01或P〈0.05）,而BSEP,MRP2表达差异无显著性.经大黄素治疗后TB,DB,ALT,AST,ALP和TBA均降低（P〈0.01或P〈0.05）,组织病理学改变轻微,NTCP,MDR2,MRP3表达高于模型组（P〈0.05）,但BSEP,MRP2,FXR的表达与模型组相比较差异无显著性.正常＋大黄素组与正常对照组相比较上述各项指标差异均无显著性.结论：大黄素对胆汁淤积型肝炎有保护作用,调节肝脏中与胆汁酸代谢相关的NTCP,MDR2,MRP3的表达以减少胆汁酸在肝脏中的蓄积可能是其退黄、恢复肝脏功能的作用机制之一.     

肝硬化患者肝功能与凝血功能变化的相关性研究

目的:研究分析肝硬化患者肝功能与凝血功能变化。方法:将40例肝硬化患者(硬化患者为观察组)与100例健康者(健康者为对照组)进行血清总蛋白(TP)、血清白蛋白(ALB)、血清总胆红素(TBIL)、血清直接胆红素(DBIL)、总胆汁酸(TBA)血清丙氨酸氨基转移酶(ALT)、血清天门冬氨酸氨基转移酶(AST)、和凝血酶原时间(PT)活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)进行检测,将对比结果进行统计学分析。结果:肝功能七项检查中TBIL DBIL TBA ALT AST观察组明显高于对照组,差异显著,P0.05,有统计学意义;TP ALB观察组明显低于对照组,差异显著,P0.05,有统计学意义;凝血四项中PT APTT TT观察组明显高于对照组,差异显著,P0.05,有统计学意义。结论:肝硬化肝功能损害与凝血功能变化有一定的相关性。     

195例肝硬化患者临床生化结果分析

目的分析桂西地区肝硬化病人肝功能结果的临床特点。方法检测195例肝硬化病人和206例无肝脏疾病的健康人血清直接胆红素(DBIL)、总胆红素(TBIL)、总蛋白(TP)、白蛋白(ALB)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)和胆碱酯酶(CHE),计算球蛋白(GLO)、白蛋白/球蛋白(A/G)及AST/ALT比值。结果肝硬化组DBIL、TBIL、TBA、ALT、AST、AST/ALT、ALP、γ-GT和GLO显著高于对照组(P<0.05),TP、ALB、CHE和A/G比值显著低于对照组(P<0.05)。结论肝功能结果是肝硬化病情严重程度、判断病情发展及预后的重要参考指标。     

基于FXR通路探讨鸡血藤对ANIT诱导的肝内胆汁淤积模型大鼠的作用及机制

目的观察鸡血藤对α-萘异硫氰酸盐[ANIT)诱导的肝内胆汁淤积SD大鼠的治疗作用并从调控法尼醇X受体(FXR)相关通路方面进行机制研究。方法将40只雄性SD大鼠随机分为空白对照组(对照组)、ANIT造模组(模型组)、熊去氧胆酸60mg/kg组、鸡血藤150mg/kg组(鸡血藤低剂量组)、鸡血藤300mg/kg组(鸡血藤高剂量组)5组,每组8只。空白对照组和模型组大鼠灌胃生理盐水其余各组灌胃相应药物连续灌胃7d并在第5天除对照组外灌胃ANIT诱导肝内胆汁淤积模型。给药7d后麻醉大鼠取血清检测谷丙转氨酶(ALT),谷草转氨酶(AST),总胆红素(TBIL),总胆汁酸(TBA)的水平。并通过RT-PCR检测比较各组大鼠肝组织内FXR、小异源二聚体伴侣受体(SHP)、葡萄糖醛酸转移酶2B4(UGT2B4)、胆盐输出泵(BSEP)mRNA的表达水平。结果与对照组比较,模型组血清中ALT、AST、TBIL、TBA水平明显升高;与模型组比较,鸡血藤高、低剂量组血清中ALT、AST、TBIL、TBA水平均有不同程度降低。与对照组比较模型组大鼠肝小叶结构被破坏;与模型组比较,鸡血藤高、低剂量组则有不同程度改善。与对照组比较,模型组肝组织中FXR、SHP、UGT2B4、BSEP的mRNA表达均有明显降低;与模型组比较鸡血藤高、低剂量组mRNA表达则有不同程度升高。结论鸡血藤可改善ANIT诱导的肝内胆汁淤积SD大鼠的生存状况、肝功能和肝组织结构的病理状态其治疗作用可能与上调FXR及其相关下游的SHP、UGT2B4、BSEP的表达从而抑制肝内胆汁酸的合成和重吸收,促进胆汁酸的解毒和转运有关。     

新生儿窒息血清总胆汁酸变化观察

目的分析新生儿窒息后血清总胆汁酸（TBA）变化及其临床意义。方法检测92例窒息新生儿和19例无窒息史正常新生儿的血清TBA、总胆红素（TBIL）、直接胆红素（DBIL）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）和γ-谷氨酰转移酶（γ-GT）。结果窒息组血清TBA及其他肝功能指标（TBIL、DBIL、ALT、AST、ALP、γ-GT）,与正常对照组比较均无显著性差异（P均〉0.05）。轻度窒息组与重度窒息组比较,轻度窒息组和重度窒息组分别与对照组比较,差异也均无显著性（P均〉0.05）。结论血清TBA与新生儿窒息及其窒息程度无明显关系。     

血清总胆汁酸的表达与婴幼儿肝炎综合征

目的 探讨血清总胆汁酸(TBA)在婴幼儿肝炎综合征中的表达.方法 采用全自动生化分析仪测定63例肝炎综合征患儿与对照组30例非肝胆疾病患儿TBA的表达水平,后进行比较.结果 对照组的TBA表达明显低于患儿组的TBA,两组比较差异有统计学意义P＜0.01),而与谷丙转氨酶(GPT)总胆红素(TBIL)有一定相关性(P＜0.01),且TBA的阳性率高于谷丙转氨酶(GPT)的阳性率(P＜0.05).结论 血清TBA的表达在反映肝功能损伤方面是一个灵敏的指标,对婴幼儿肝炎综合征患儿的早期诊断治疗和预后有重要临床意义.     

Investigation of evaluative value on liver function in patients with primary biliary cirrhosis by Biochemical enzyme detection

目的分析雷州地区原发性胆汁性肝硬化患者肝功能结果的临床特点.方法 采用Olympuslx10生化分析仪检测390例原发性胆汁性肝硬化病人和412例无肝脏疾病的健康者血清丙氨酸氨基转移酶(ALT),r-谷氨酰转肽酶(r-GT)、碱性磷酸酶(ALP)、总胆红素(TBIL)、直按胆红素(DBIL)、总蛋白(TP)、总胆汁酸(TBA)球蛋白(GLB)、白蛋白(ALB)/球蛋白(A/G)及AST/ALT比值.结果 原发性胆汁性肝硬化组ALT、AST、AST/ALT、ALP、TPDBIL、TBIL、TBA、TBA、r-GT和GLB显著高于对照值(P<0.05)、ALB、AIG比值显著低于对照组(P<0.05).结论 肝功能检测结果是原发性胆汁性肝硬化病情严重程度,判断病情发展及预后的重要参考指标.     

生化酶谱检测对原发性胆汁性肝硬化患者病情评估价值的探讨

目的分析雷州地区原发性胆汁性肝硬化患者肝功能结果的临床特点。方法采用Olympuslx10生化分析仪检测390例原发性胆汁性肝硬化病人和412例无肝脏疾病的健康者血清丙氨酸氨基转移酶(ALT),r-谷氨酰转肽酶(r-GT)、碱性磷酸酶(ALP)、总胆红素(TBIL)、直按胆红素(DBIL)、总蛋白(TP)、总胆汁酸(TBA)球蛋白(GLB)、白蛋白(ALB)/球蛋白(A/G)及AST/ALT比值。结果原发性胆汁性肝硬化组ALT、AST、AST/ALT、ALP、TPDBIL、TBIL、TBA、TBA、r-GT和GLB显著高于对照值(P<0.05)、ALB、AIG比值显著低于对照组(P<0.05)。结论肝功能检测结果是原发性胆汁性肝硬化病情严重程度,判断病情发展及预后的重要参考指标。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.