抗肝纤维化贵在“早”字

肝纤维化是慢性肝炎发展成肝硬化过程中的病理阶段,其发病机制相当复杂,治疗很不容易。已故现代肝脏病学奠基人、美国的汉斯·鲍勃留给我们一句名言:“谁能预防或减轻肝纤维化,谁就能医治大多数慢性肝病”。判断慢性肝病是否伴有肝纤维化的“金标准”,是肝穿刺加上肝脏病理检查     

非酒精性脂肪性肝病分子生物学发病机制研究进展

非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）是以无过量饮酒史（酒精摄人量〈20g／d）以及肝细胞脂肪变性、气球样变、弥散性肝小叶轻度炎症和（或）肝中央静脉、肝窦周围胶原沉积等为临床病理特点的慢性肝脏疾病,它包括单纯性脂肪肝（nonalcoholic fatty liver，NAFL）、脂肪性肝炎（nonalcohlic steatohepatitis，NASH）、脂肪性肝硬化（fatty liver cirrhosis，FLC）三种类型。NAFLD已成为导致转氨酶异常的首要病因，并且有部分患者进展到终末期肝病，部分患者甚至与肝脏肿瘤有关。     

乙型肝炎相关慢加急性肝衰竭抗病毒治疗的研究进展

1995年Ohnishi等［1］首次提出慢加急性肝衰竭（ACLF）,即慢性肝病和急性肝脏损伤同时发生。世界上不同组织对ACLF的定义存在差异。2009年亚太肝病学会对 ACLF 定义［2］：在既往诊断或者未诊断的隐匿性慢性肝病的基础上,急性发病后4周内出现明显的黄疸和凝血功能障碍,伴有腹腔积液和（或）肝性脑病,其诊断标准是：黄疸［血清胆红素大于或等于5 mg／dL （85μmol ／L ）］且凝血功能障碍［国际标准化比值（INR）≥1．5］,或者凝血酶原活动度小于40％。     

酒精性肝病的中医治疗

酒精性肝病诊断依据：具有长期酗酒史（至少5年）。临床表现：可见恶心、呕吐、腹泻、腹胀等，肝病进展时，可伴有黄疸、腹水、肝性脑病、上消化道出血等。但是部分肝脏损害患者可能不伴有肝病的症状和体征。辅助检查：影像学及生化检查异常（须排除其他致病原因）。肝组织活检异常。     

专家信息

正戴炜教授,主任医师,医学硕士,现任深圳市第三人民医院肝四区科主任专业专长:1.肝病;2.传染病咨询电话:0755-61238950咨询邮箱:szdaiwei@126.com人物简介:享受深圳市政府特殊津贴。兼任中华医学会肝病学分会委员,全国疑难及重症肝病攻关协作组全国委员;首批全国肝病科普咨询专家;广东省医学会肝病学分会副主任委员,广东省医师协会肝病专科医师工作委员会副主任委员;广东省医学会感染病学分会委员;深圳医学会肝病专业委员会主任委员;《中国肝脏病杂志》、《实用肝脏病杂志》、《临床肝胆病杂     

妊娠期肝病

凡妊娠期出现黄疸或肝功能损害者，均可称为妊娠期肝病。妊娠期肝病分为：（1）妊娠期合并肝病，常见的有病毒性肝炎、药物性肝炎、胆囊炎、胆石症等；（2）妊娠期特有的肝病：包括妊娠期肝内胆汁淤积和妊娠期急性脂肪肝及妊娠并发症引起的肝损害。     

妊娠期特发性肝病的研究进展

妊娠期特发性肝病是妊娠期一组原因不明的肝脏疾病或妊娠期一种原发性或自发性的肝脏疾病 [1]。它主要包括病毒性肝炎和妊娠肝内胆汁淤积症 ( ICP) ,比较少见的有妊高征并发溶血 -肝酶增高 -血小板减少 ( HELLP)综合征 ,妊娠剧吐引起的肝损害和妊娠期药物性肝损害 ,罕见的如妊娠急性脂肪肝 ( AFLP)等[2 ] 。近年来 ,对妊娠特有肝病的内涵及发病机制有了飞跃性的认识 ,临床表现也有一些新特点 ,现对此综述如下。1　胆汁瘀积性肝病　　瘙痒和黄疸是胆汁瘀积性肝病的主要表现特征 ,包括妊娠剧吐症、妊娠期肝内胆汁瘀积、药物性肝损害以及…     

1例外伤性肝破裂导致急性肝衰竭死亡的法医学鉴定分析

急性肝衰竭（acute hepatic failure．AHF）可在急性或慢性肝病、肝肿瘤、外伤、肝脏手术后、中毒症、其他系统器官衰竭等疾病的过程中发生。急性肝衰竭治疗困难，死亡率高。     

郑瑞丹:非酒精性脂肪肝与糖尿病

正人物档案郑瑞丹:福建省漳州正兴医院肝病内科主任,厦门大学医学院、南昌大学、福建中医大学硕士生导师。中华医学会肝病学分会脂肪性肝病诊疗协作组委员,福建省肝病学会副主任委员、福建省感染病学会副主任委员、福建省中西医结合肝病分会常务委员,《实用肝脏病杂志》、《肝博士》、《中国肝脏病杂志》、《临床肝胆病杂志》、     

急性肝功能衰竭的诊治规范

1定义 急性肝功能衰竭（acute liver failure,ALF）,又称暴发性肝衰竭（fulminant hepatic failure）,是指原来无肝病者急骤起病,肝炎病情迅速恶化,导致肝脏合成、解毒、排泄和生物转化功能发生严重损害,在发病2周内出现Ⅱ度及以上肝性脑病的严重临床综合征。     

痘苗病毒天坛株的减毒与其作为疫苗载体研究进展

1痘苗病毒天坛株的历史天花是人类历史上最可怕的传染病之一。天花由天花病毒（variola virus）引起,人是该病毒的惟一宿主。人感染天花病毒后的死亡率达到30%~40%[1]。世界上公认的对天花最早的准确记录来自中国,晋代药学家葛洪于公元430年左右,在《肘后备急方》中对天花有清楚的描述[1]。     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

WHO西太区与世界中医药学会联合会中医名词术语国际标准比较研究:津液辨证(英文)

Intraditional Chinese medicine (TCM),the so-called津液refers to all the fluid and liquid flowingand maintaining inside the human body.In Chineselanguage,津液is a phrase composed of twoChinese characters which describes two differentkinds of fluid or liquid in the human body .According to the theory of TCM,津refers to thepart of fluid that is thin in texture and flowss moothly inside the body while液refers to thepart of fluid that is thick in texture and mainlymaintains in the joints of the body to nourish andlubr...     

Current concept in first metatarsophalangeal joint replacement

First metatarsophalangeal joint (MTPJ) degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes it hardly respond well to conservative treatment.4 Traditional surgical techniques,such as cheilectomy,Keller resection and arthrodesis are effective procedures but remain controversial due to none of them can achieve excellent results in all patients especially the end-stage conditions.5-7 Thus,great amount of efforts have been dedicated in MTPJ replacement despite many negative reports.This technique has aroused many controversies over the past decades due to its prematurity.Nevertheless,it has been improved in many aspects such as prosthesis material,design as well as surgical indications.This review would not only update the advancements and recognitions in recent years,but also presented the major disputed areas.     

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus

The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.     

Efficacy of Different Iron Controlling Fortificants in Wheat Flour in Iron Deficiency

Objective To observe the different impacts of electrolytic iron, FeSO4, and NaFeEDTA on body iron store of anemic school students. Methods Four hundreds anemic students at the age of 11-18 years were divided into four groups. Of which, three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour （control）. The fortification level of electrolytic iron, FeSO4, and NaFeEDTA was 60 mg Fe/kg, 30 mg Fe/kg, and 20 mg Fe/kg, respectively. Blood samples were collected at 0, 2, 4, and 6 months and hemoglobin （Hb）, serum ferritin （SF）, and transferrin receptor （TfR） were measured. Results The hemoglobin levels in three intervention groups increased, the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups. SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups. These parameters did not show any significant changes in the control group. Conclusion NaFeEDTA and FeSO4 tortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4, while electrolytic iron is less effective in improving iron store in anemic students.     

Effects of the aqueous extract of Schizandra chinensis fruit on ethanol withdrawal-induced anxiety in rats

Background We previously demonstrated that the aqueous extract of the Schizandra chinensis fruit （AESC） ameliorated Cd-induced depletion of monoamine neurotransmitters in the brain through antioxidant activity.In the present study,we investigated the effect of AESC on anxiety-like behavior and the levels of norepinephrine and 3-methoxy-4-hydroxyphenylglycol （a metabolite of norepinephrine） in different brain regions during ethanol withdrawal in rats.Methods Male Sprague-Dawley rats were treated with 3 g/kg of ethanol （20％,w/v） or saline by daily intraperitoneal injection for 28 days followed by three days of withdrawal.During withdrawal,rats were given AESC （100 mg.kg 1.d-1 or 300 mg.kg 1·d1,P.O.） once a day for three days.Thirty minutes after the final dose of AESC,the anxiogenic response was evaluated using an elevated plus maze,and the plasma corticosterone levels were examined by radioimmunoassay.Meanwhile,the concentrations of norepinephrine and 3-methoxy-4-hydroxy-phenylglycol in the hypothalamic paraventricular nucleus and hippocampus were also measured by high performance liquid chromatography.Results Rats undergoing ethanol withdrawal exhibited substantial anxiety-like behavior,which was characterized by both the decrease in time spent in the open arms of the elevated plus maze and the increased level of corticosterone secretion,which were greatly attenuated by doses of AESC in a dose-dependent manner.The high performance liquid chromatography analysis revealed that ethanol withdrawal significantly increased norepinephrine and 3-methoxy-4-hydroxy-phenylglycol levels in the hypothalamic paraventricular nucleus,while not significantly altering them in the hippocampus.Similar to the results from the elevated plus maze test,the AESC significantly inhibited the elevation of norepinephrine and its metabolite in the hypothalamic paraventricular nucleus in a dose-dependent manner.Conclusions These results suggest that AESC attenuates anxiety-like behavior induced by ethanol withdrawal through modulation of the hypothalamic norepinephrine system in the brain.     

TGF-β1 Precursor and CD8 Are Potential Prognostic and Predictive Markers in Operated Breast Cancer简

The transforming growth factor β1（TGF-β1） and CD8-positive T cells are two important immune factors that function at opposite directions. The purpose of this study was to verify the relationship between the two factors and their associations with long-term effects of adjuvant chemotherapy or endocrine therapy in breast cancer. Expression of TGF-β1 precursor and CD8 was immunohistochemically detected on surgically-obtained tumor samples of 130（stageⅠ–Ⅲ） invasive breast carcinomas from Chinese subjects, who were followed up for a mean time of 112 months. Interstitial CD8-positive cells and TGF-β1 precursor-positive cells adjacent to tumor nests were counted. Infiltration of CD8-positive lymphocytes into tumor nests and TGF-β1 precursor expression in tumor cells were observed and survival analysis was performed. Our results showed that density of interstitial CD8-positive lymphocytes was an independent adverse prognostic factor for distant disease-free survival（DDFS）（HR=8.416, 95% CI=1.636–43.292, P=0.011） in hormone receptor-positive patients who were on adjuvant endocrine therapy. For breast cancer patients who did not receive adjuvant chemotherapy, those without infiltration of CD8-positive cells into tumor nests had a shorter overall survival（OS） than their counterparts with CD8-positive cell infiltration into tumor nests（Log-Rank, P=0.003）. But OS of patients without infiltration of CD8-positive cells into tumor nests was significantly prolonged by adjuvant chemotherapy（Log-Rank, P=0.013） and paralleled that of patients with CD8-positive cell infiltration. Although OS was shorter in the tumor cell TGF-β1 precursor（t-TGF-β1-pre）-positive patients than in the negative patients in patients without recieiving chemotherapy（P=0.053）, OS of t-TGF-β1-pre-positive patients was significantly prolonged by adjuvant chemotherapy（P=0.035） and was longer than that of t-TGF-β1-pre-negative patients. Analysis showed that t-TGF-β1-pre was an independent positive prognostic factor for DDFS（HR=0.392 95% CI=0.157–0.978, P=0.045） in patients who received adjuvant chemotherapy. This study suggested that density of interstitial CD8-positive lymphocytes was of prognostic value in hormone receptor-positive patients who received adjuvant endocrine therapy. Our study verified that adverse immunologic signatures consisting of absence of CD8-positive cells in tumor nests or expression of TGF-β1 precursor in tumor cells in breast cancer were associated with worse prognosis and significantly improved long-term survival with adjuvant chemotherapy, respectively.