超声检查及超声引导下穿刺活检大网膜鉴别良、恶性腹水

目的评价超声检查及超声引导下穿刺活检大网膜对良、恶性腹水的鉴别价值。方法对184例不明原因腹水患者进行超声检查及超声引导下大网膜穿刺活检，并与穿刺活检病理结果进行对比分析。结果根据大网膜超声检查表现分为2型，无结节型150例；有结节型34例。病理检查良性腹水125例，以结核为主，占59．9％（110／184）；恶性59例，以转移癌为主，占28．3％（52／184）。大网膜超声无结节型以结核为主，占66．7％（100／150），有结节型以恶性为主，占70．59％（24／34），两组间差异有统计学意义（P〈0．001）。结论网膜声像图改变特别是网膜结节有助于提示腹水的良恶性。对于腹水穿刺细胞学检查未发现肿瘤细胞的患者，应行超声引导下大网膜穿刺活检网膜活检进一步明确诊断。     

卵巢癌血清、腹水中白细胞介素-6测定的临床价值

探讨ＩＬ－６在卵巢上皮癌中的临床价值。方法：通过对４０例卵巢癌患者血清，腹水中白细胞介素－６进行生物活性测定。结果１、腹水中ＩＬ－６水平明显高于血清中ＩＬ－６水平；２、腹水或血清中ＩＬ－６水平与卵巢癌分期呈正相关；３、卵巢癌术后残留与ＩＬ－６水平呈正相关；     

Fractalkine in the peritoneal fluid of women with endometriosis.

OBJECTIVE: The objective of this study was to evaluate the presence of fractalkine in the ascites and the association between fractalkine levels in the ascites and endometriosis. METHODS: Peritoneal fluids and peripheral blood samples were obtained from patients undergoing laparoscopy for infertility work-up or laparoscopic cystectomy. Three samples of peritoneum were obtained from patients undergoing hysterectomy. Western blotting, RT-PCR and immunohistochemistry were performed. RESULTS: Fractalkine protein was detected in the ascites. Positive staining was confirmed in peritoneal surface cells and perivascular cells of the peritoneum. CX3CR1 positive cells were present in the cells in the peritoneal fluid. The fractalkine concentrations in the ascites of patients with endometriosis were lower than those without endometriosis. There was no significant difference between serum fractalkine levels in patients with and without endometriosis. CONCLUSION: The decreased level of fractalkine found in the peritoneal fluid of patients with endometriosis may contribute to the pathogenesis of endometriosis.     

腹腔免疫化疗对晚期结肠癌癌性腹水患者IL-6及IL-10影响

目的：探讨腹腔内免疫化疗前后晚期结肠癌癌性腹水患者血清IL－6及IL－10水平的变化及其意义。方法：采用酶联免疫法测定治疗前、治疗后1周及治疗后4周患者外周血清中IL－6及IL－10水平，并与正常对照组比较。结果：晚期结肠癌癌性腹水患者血清IL－6和IL－10水平较正常组明显升高。腹腔内免疫化疗治疗晚期结肠癌癌性腹水患者1周后大部分患者外周血清中IL－6及IL－10水平有所下降。四周后所有患者的IL－6和IL－10均有下降。且第1周后IL－6及IL－10水平有否变化与免疫化疗是否有效有明显关系。结论：腹腔内免疫化疗是治疗晚期结肠癌癌性腹水较为有效的方法。同时，早期监测外周血清中IL－6和IL－10水平对腹腔内免疫化疗的疗效有预测功能。     

结核性腹膜炎和肝癌患者的腹水与血清趋化因子测定及其意义

目的研究结核性腹膜炎，肝癌所引起的腹水和腹水中趋化因子-调节活化正常T细胞表达和分泌因子（RANTEs）和基质细胞衍生因子（SDF-1），以及它们的受体CCR3和CXCR4的表达水平及临床意义。方法用酶联免疫吸附法（ELISA）和流式细胞仪（FCM）测定16例结核性腹膜炎，39例肝癌患者以及正常对照20例血清和／或腹水中RANTES、SDF-1和受体CCR3、CXCR4的水平。结果结核性腹膜炎血清及腹水中SDF-1以及CXCR4升高，而肝癌患者血清及腹水中RANTES以及受体CCR3水平上升。结论趋化因子在腹部结核和肿瘤时会出现不同性质T细胞免疫应答，为以后的应用奠定实验基础。     

载三氧化二砷纳米微粒对胰腺癌腹水抑制效应的实验研究

目的探讨用纳米载体包裹的三氧化二砷(As2O3)在荷胰腺癌SCID小鼠体内的分布及对腹水生成和存活时间的影响。方法用超声乳化法制备载As2O3乳酸羟基乙酸共聚物纳米微粒(As2O3-NPs),用体外释药方法研究其释放特性。于小鼠右前腋下接种SW1990细胞12d后,静脉给As2O3-NPs5.0mg/kg体重,采用高压液相色谱法(HPLC)测定血浆、正常和肿瘤组织中As2O3含量。观察不同浓度As2O3-NPs对腹水生成的抑制作用。观察10.0mg/kg体重As2O3-NPs处理的胰腺癌小鼠的存活期、体重、腹腔渗透性及腹水中凋亡细胞的变化。结果As2O3-NPs直径为(210±23)nm,含药量为29%(重量比),体外释药速度明显慢于单纯的As2O3。As2O3-NPs在体内呈浓度依赖性抑制腹水形成,减少腹膜的通透性,增加腹水内凋亡细胞量,延长荷瘤小鼠的存活时间。结论As2O3-NPs具有明显的缓释药物功能,能有效积聚在肿瘤组织,并抑制癌性腹水生成,是一种有希望的抗肿瘤药物。     

Portal hypertension and ascites

Portal pressure is the product of portal blood flow and resistance; an increase in either leads to increased portal pressure. Cirrhosis is the underlying cause in most cases, but portal hypertension can develop due to pre-, intra- and post-hepatic obstruction to the flow, secondary to variety of causes. Diagnosis can be established by a combination of non-invasive imaging or portal vasculature and clinical or serological markers for the cause underlying cirrhosis. Development of gastro-oesophageal varices and ascites is the most important clinical manifestation of portal hypertension. Non-selective beta-blockers and endoscopic band ligation are effective in primary and secondary prevention of variceal bleeding. Active variceal haemorrhage is managed using a combination of vasoactive drug (for example terlipressin) and endoscopic band ligation. If these measures fail, transjugular intrahepatic portosystemic shunt (TIPS) insertion achieves haemostasis. Diuretic therapy with spironolactone and furosemide are the mainstays of management of ascites. If ascites becomes refractory, repeat large-volume paracentesis and TIPS in selected cases help to control symptoms. Development of ascites is an important landmark in the natural history of cirrhosis and liver transplantation should be considered definitive treatment.     

慢性肝炎肝硬化腹水并发自发性细菌性腹膜炎相关危险因素分析

目的探讨慢性肝炎肝硬化患者腹水并发自发性腹膜炎的相关危险因素,为临床病情判断和预防提供依据。方法回顾性分析慢性肝炎肝硬化患者186例,根据患者是否并发SBP分为SBP组（观察组）和非SBP组（对照组）。对并发SBP的危险因素进行单因素和多因素Logistic回归分析。结果单因素分析显示观察组在Child—Pugh分级、AST、T—Bil、腹水白蛋白方面较对照组增高;对照组在男性比例较观察组高,差异有统计学意义（P〈0．05）,观察组在上消化道出血、肝性脑病和肝肾综合征的发生率（24．2％、12．6％、15．7％）较对照组高（9．9％、7．7％、8．8％）,但差异无统计学意义（P〉0．05）,其他各项指标比较差异无统计学意义。Logistic回归分析显示Child—Pugh分级、T—Bil、腹水白蛋白3个因素是其独立的危险因素（P〈0．05）。结论慢性肝炎肝硬化患者腹水并发自发性腹膜炎的危险因素是多方面的,其中Child—Pugh分级、总胆红素、腹水白蛋白是SBP发生的独立危险因素。     

差异荧光电泳分离人卵巢癌腹水蛋白的研究

目的探索并优化差异荧光电泳(DIGE)分离人卵巢癌腹水蛋白方法,获得重复性、稳定性好的DIGE图谱。方法通过改良人卵巢癌腹水标本预处理方法,对一维等电聚焦和二维固相胶条分离试验条件的探索,寻找适于人卵巢癌腹水的蛋白质样品处理及DIGE分离方法。结果用DIGE技术有效分离人卵巢癌腹水蛋白,获得分辨率较高、重复性较好的双向凝胶电泳图谱。结论 DIGE方法是分离寻找卵巢癌腹水中差异蛋白分子的有效方法。     

腹水超滤浓缩回输治疗乙肝肝硬化腹水的临床观察

目的：观察腹水超滤浓缩回输治疗乙肝肝硬化腹水的临床疗效。方法：25例乙肝肝硬化腹水病人在限钠限水、补充白蛋白、利尿等综合治疗的基础上加用腹水浓缩回输系统进行腹水超滤回输腹腔治疗,开始治疗前当日及治疗后第2日检测患者总蛋白、白蛋白、肾功能和电解质含量,并观察患者临床症状及体征的变化。结果：腹水浓缩回输技术对于难治性肝硬化腹水患者,能迅速改善压迫症状,治疗后患者体重下降,腹围减小,24 h尿量增多,腹胀得到明显缓解。患者血清总蛋白、白蛋白浓度较治疗前提高,血肌酐下降,血电解质治疗后无明显改变。结论：腹水浓缩回输腹腔治疗顽固性肝硬化腹水可迅速缓解患者压迫症状,改善肝肾功能。