肝移植门静脉动脉化的临床应用(附2例报道)

据报道[1]肝移植受者术前门静脉血栓(portal vein thrombosis,PVT)的发生率为2%～19%,在肝移植术中常导致门静脉无法常规重建,以往PVT被认为是肝移植的禁忌证。门静脉动脉化(portal vein arterialization,PVA)是通过建立动脉血     

肝细胞生长因子抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的实验研究

目的:研究肝细胞生长因子（HGF）抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的作用。方法: 采用磷酸钙/DNA-TPC方法构建携带HGF基因的重组腺病毒(Ad.HGF)。经18只小型猪的左胸冠状动脉回旋支放置Ameroid环建立慢性心肌缺血猪动物模型,并随机分为3组即盐水组、AdHGF组和缺陷型空病毒Ad5(AdNull)组,每组6只(n=6)。于缺血心肌处,分别注射4×109 pfu 200 μl AdHGF、4×109 pfu 200 μl AdNull及200 μl盐水。4周后做超声心动图检查各组的心脏功能,并行病理学心肌纤维化、心肌凋亡检测。结果: 心脏彩超检测显示,AdHGF组室壁增厚,运动增加,左室舒张末容积（LVEDV）、左室射血分数（LVEF）及短轴缩短率（FS）等明显改善(P<0.05)。AdHGF组心肌组织切片缺血坏死区纤维组织增生明显低于AdNull组(P<0.05)。AdHGF组心肌中Ⅲ型胶原蛋白的量明显低于AdNull组(P<0.05)。AdHGF组心肌细胞的凋亡率(%)明显低于对照组(P<0.05)。结论: HGF具有抑制慢性缺血性心脏病心肌纤维化及心肌细胞凋亡的作用,从而可抑制心室重构和改善心功能。     

肝移植5年后生存影响因素分析

目的评估我院肝移植患者长期生存情况,分析肝移植5年后生存质量的影响因素。方法回顾性分析2000年3月至2007年8月完成46例生存超过5年的肝移植病例,分析死亡原因、各种并发症情况。结果生存超过5年的46例患者中,死亡4例,其中胆道并发症2例,重症乙型肝炎1例,心肌梗塞1例,各种并发症:高脂血症8例,高血压7例,糖尿病3例,胆道并发症6例,乙肝复发3例,肾功能损害2例,心肌梗塞1例。结论胆道并发症、乙肝复发及免疫抑制剂副作用是影响肝移植5年后生存质量的主要因素,加强多学科长期临床随访指导,低剂量免疫抑制剂联合应用是提高肝移植5年后生存质量的重要因素。     

呈肾病综合征的乙型肝炎病毒相关性肾炎临床病理特点

目的:探讨呈肾病综合征(NS)的乙型肝炎病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)的临床病理特点。方法:回顾性分析呈NS且肾穿组织内小动脉≥5条的HBV-GN患者152例的临床病理资料,光镜下观察其肾内小动脉病变,比较伴与不伴肾内小动脉病变患者的临床病理资料。结果:平均年龄26.3岁,男∶女为3.6∶1;伴高血压者36例(23.7%)、贫血52例(34.2%)、肾衰竭者33例(21.7%)、肝功能异常者20例(13.2%)。乙肝大三阳者87例(57.2%);血清和肾组织内HBV-DNA载量呈正相关(P<0.01)。病理表现以膜性肾性(MN)、系膜增生性肾炎(MsPGN)、膜增生性肾炎(MPGN)为主;未成年组与成年组MN、MPGN所占比例不同(P<0.05)。伴有肾内小动脉病变者84例(55.2%),与无肾内小动脉病变者相比,其高血压发生率较高(P<0.05),24h尿蛋白定量显著较高(P<0.01),贫血、肾间质纤维化的发生率显著较高(P<0.01)。结论:呈NS的HBV-GN患者绝大多数为HBV携带者且伴有病毒复制,病理以MN、MsPGN及MPGN为主,半数以上伴有肾内小动脉病变,伴有肾内小血管病变者高血压、贫血及肾小管间质纤维化发生率较高,蛋白尿更严重,为预后不良的病理学指标。     

经后路椎弓根截骨内固定治疗老年严重脊柱后凸畸形

目的探讨后路经椎弓根截骨治疗老年严重脊柱后凸畸形的临床疗效。方法对18例老年严重脊柱后凸畸形患者采用后路经椎弓根截骨矫形内固定治疗,分别于术后2周、3个月、12个月通过X线片、VAS评分、Cobb角、神经功能恢复情况评估临床疗效。结果 18例均获随访,时间14～37个月。VAS评分:术前8.4分±1.3分,术后2周、3个月、12个月分别为1.1分±0.3分、1.1分±0.2分、1.2分±0.3分,与术前比较差异均有统计学意义(P<0.05)。Cobb角:术前为78.3°±5.9°,术后2周、3个月、12个月分别为42.7°±8.4°、42.9°±5.7°、44.2°±6.9°,与术前比较差异均有统计学意义(P<0.05)。有2例发生硬脊膜撕裂,1例直接缝合,1例行脑膜片修补,未发生脑脊液漏。无内固定松动、断裂及截骨面假关节形成。结论后路经椎弓根截骨矫形内固定可以有效矫正老年性脊柱后凸畸形,临床疗效良好。     

蝶窦内脑膨出并自发性脑脊液鼻漏1例及文献复习

目的探讨蝶窦内脑膨出并自发性脑脊液鼻漏的发病机制和手术治疗经验。方法收集我科收治的l例蝶窦内脑膨出并自发性脑脊液鼻漏患者资料,结合文献复习进行临床分析。结果患者因左侧鼻腔反复流出清亮液体就诊;头颅MRI示左侧蝶窦侧壁骨质缺损,蝶窦内含脑组织信号影及脑脊液信号影;入院后行左侧翼点入路硬脑膜修补术;术后患者症状消失。术后随访6个月,未见复发。结论对于蝶窦内脑膨出发病机制目前并不明确,与侧颅咽管形成、蝶窦过度气化、颅内压增高等多个因素有关;术前准确诊断瘘口位置非常重要,同时应选择个体化的手术方式,术后长期随访。     

Sodium thiosulfate attenuates high phosphorous induced vascular calcification in rats with 5/6 nephrectomy

Objective To observe the expression of Klotho and Na+/Pi cotransporter in high phosphorous-induced rats with 5/6 nephrectomy and its relationship with vascular calcification, as well as to investigate the effect of early intervention by sodium thiosulfate (STS) on the progression of vascular calcification. Methods Either 5/6 nephrectomy (n=21) or sham operation (n=14) was conducted on 35 Sprague Dawley rats, who were then fed with high phosphorus (HP) diet or normal phosphorus (NP) diet for 16 weeks respectively. The rats were divided into 5 groups as follows: (1) remnant kidney rats receiving HP diet (NHP, n=7), (2) remnant kidney rats receiving NP diet (NNP, n=7), (3) sham operation rats receiving NP diet (SNP, n=7), (4) sham operation rats receiving HP diet (SHP, n=7), (5) remnant kidney rats receiving HP diet with STS (THP, n=7). The treatment group was given STS intraperitoneally three times a week for 16 weeks. At the end of the 16th week, rats tail artery blood pressures were tested, serum creatinine (Scr), calcium (Ca2+), phosphorus (P3+), FGF23, iPTH and urine protein were examined. Throacic aorta and kidney were then removed. Vascular calcification was confirmed by Von kossa staining. Klotho and Pit-1 expression in aortas were determined by immunohistochemistry. Renal lesion was determined by PASM-Masson staining. Renal Klotho and NaPi-2a mRNA were determined by real time RT-PCR. Results After 16 weeks, Scr, P3+, FGF23, iPTH, uric protein and blood pressure were significantly higher in NHP than those in SNP rats (all P＜0.05). PASM-Masson staining revealed typical renal pathology of chronic renal failure in NHP group. With the treatment of STS, THP rats showed significant decrease in Scr, P3+, FGF23, iPTH, uric protein and blood pressure by comparison with NHP group (all P＜0.05). Significant vascular calcification was found in NHP group while NNP and SHP group occasionally had vascular calcification; THP group had marked alleviation of vascular calcification. The aorta and renal expression of Klotho decreased remarkably while expression of Pit-1 and NaPi-2a increased significantly in NHP compared with SNP group (all P＜0.05). Accordingly, the aorta and renal expression of Klotho increased and Pit-1 and NaPi-2a decreased significantly in THP compared with NHP group (P＜0.05). Conclusions The early intervention of sodium thiosulfate might regulate Klotho and Na+/Pi cotransporter expression in both aorth and kidney, decreasing serum phosphate, delaying progression of vascular calcification and improving renal function.     

1例恶性梗阻性黄疸患者围术期营养支持的案例分析

目的 探讨临床药师在恶性梗阻性黄疸患者围术期营养支持中发挥的作用,为营养支持在围术期患者中的临床应用提供参考。方法 临床药师应用营养风险筛查工具对1例恶性梗阻性黄疸患者进行术前营养风险筛查,并制订营养支持计划。根据病情变化,对围术期营养支持方案进行调整,将30%长链脂肪乳剂250 ml调整为20%中/长链脂肪乳剂250 ml,同时加用经口肠内营养补充剂,并对患者实施药学监护。结果 患者于围术期内由肠外营养支持过渡至肠内营养支持,手术创伤恢复较好,无并发症发生,黄疸情况较前改善。结论 临床药师应协助医师制订和调整营养支持方案,加强药学监护,改善患者营养状态。     

遗传性高铁血红蛋白血症分子诊断方法的研究

目的 探讨遗传性高铁血红蛋白血症的分子诊断方法。方法 采用RT-PCR和PCR产物直接测序法,对3例遗传性高铁血红蛋白血症患者细胞色素b5还原酶(b5R)cDNA编码区序列进行分析。通过基因组DNA的PCR-限制性酶切或PCR-序列测定,验证cDNA策略所检出的突变。结果 患者A的b5R cDNA在第527位碱基呈T/C杂合状态,第608位碱基呈G/A杂合状态;患者B的b5R cDNA在第170位碱基和第179位碱基均呈G/A杂合状态;患者C的b5R cDNA在第608位碱基呈G/A杂合状态,第791位碱基呈C/T杂合状态。基因组DNA策略与cDNA策略所得结果一致。结论 建立了遗传性高铁血红蛋白血症的分子诊断方法,并在3例患者中发现了3个以复合杂合子形式存在的、新的b5R基因突变。