乳果糖口服溶液联合谷氨酸钾注射液治疗肝性脑病的疗效观察

目的探讨乳果糖口服溶液联合谷氨酸钾注射液治疗肝性脑病的临床疗效。方法选取2014年4月—2017年4月在天门市第一人民医院治疗的肝性脑病患者114例为研究对象,将所有患者随机分为对照组和治疗组,每组各57例。对照组静脉滴注谷氨酸钾注射液,60 mL加入到生理盐水500 mL中,1次/d。治疗组在对照组的基础上口服乳果糖口服溶液,30 mL/次,3次/d。两组患者均连续治疗7 d。观察两组的临床疗效,比较两组的生化学指标和Child-Pugh评分。结果治疗后,对照组和治疗组的总有效率分别为75.44%、92.98%,两组比较差异具有统计学意义(P0.05)。治疗后,两组血氨、总胆红素(TBil)、丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转氨酶(AST)水平均显著下降,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组这些生化学指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组Child-Pugh评分均显著下降,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组Child-Pugh评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论乳果糖口服溶液联合谷氨酸钾注射液治疗肝性脑病具有较好的临床疗效,能改善精神状况,降低血氨水平,改善肝脏功能,安全性较好,具有一定的临床推广应用价值。     

冠心病患者血清胆红素、尿酸、超敏C反应蛋白水平变化及临床意义

目的研究冠心病患者血清胆红素（Bil）、尿酸（UA）及超敏C反应蛋白（hs-CRP）水平变化及临床意义。方法对96例冠心病患者[稳定型心绞痛（SAP）组46例、不稳定型心绞痛（UAP）组30例、急性心肌梗死（AMI）组20例]血清总胆红素（TBil）、直接胆红素（DBil）、UA、hs-CRP水平进行检测,并与正常对照组的30例健康受试者进行比较分析。结果冠心病患者组血清TBil[（9.96±1.05）μmol/L]、DBil[（2.69±0.32）μmol/L]水平显著低于正常对照组,UA[（376.52±40.21）μmol/L]、hs-CRP[（11.35±1.26）mg/L]水平显著高于正常对照组,差异均有统计学意义（均P〈0.05）;SAP、UAP组血清TBil[（11.21±1.12）、（9.86±1.04）μmol/L]、DBil[（3.59±0.36）、（2.98±0.32）μmol/L]水平均显著高于AMI组,UA[（292.05±29.12）、（427.41±41.98）μmol/L]、hs-CRP[（6.31±0.64）、（10.67±1.14）mg/L]水平均显著低于AMI组,差异均有统计学意义（均P〈0.05）;SAP组血清UA、hs-CRP水平显著低于UAP组,差异均有统计学意义（均P〈0.05）;TBil、DBil与UA、hs-CRP均呈显著负相关（r=-0.61、-0.59、-0.63、-0.60,均P〈0.05）。结论检测冠心病患者血清TBil、DBil、UA、hs-CRP水平对患者疾病预测及治疗具有重要的临床意义。     

Action mechanism of Yi Guan Jian Decoction on CCl4 induced cirrhosis in rats

Aim of study

To investigate action mechanism of Yi Guan Jian Decoction on cirrhosis induced by CCl₄ in rats.

Material and methods

CCl₄ (3 mL/kg) for the first time and then olive oil CCl₄ solution 50% (2 mL/kg) was administered hypodermically to rats twice each week for 12 weeks. At the end of 8th week, rats were randomly divided into CCl₄ control group (n = 10), Yi Guan Jian Decoction group (n = 9) and Xiao Chai Hu Decoction group (n = 9). Yi Guan Jian Decoction and Xiao Chai Hu Decoction were oral administrated per day respectively for 4 weeks, concomitantly continued CCl₄ administration. At 12th weekend, the rats were sacrificed for sampling and detection of liver function, histological changes of liver tissue, liver tissue hydroxyproline content and expression of α-SMA, CD68, MMP-13, TIMP-1, TIMP-2, Caspase-12, HGFα, MMP-2, MMP-9 and hepatocyte apoptotic index.

Results and conclusions

(1) Compared with that of normal rats, expression of α-SMA, CD68 and TIMP-1 in liver tissue of 8 week model group rats increases significantly (P < 0.01), moreover further increased in the 12 week of model group. However, MMP-13, HGFα, TIMP-2 content decreases gradually and the statistical difference is seen between each time point (P < 0.01). Activity of MMP-2, MMP-9, content of Caspase-12 and hepatocyte apoptotic index increased gradually at 4th, 8th, 12th week. (2) Compared to that of the same time point model group, activity of MMP-9 and contents of MMP-13, TIMP-2 and HGFα in Yi Guan Jian Decoction group improves significantly (P < 0.01), and activity of MMP-2 and contents of α-SMA, TIMP-1, Caspase-12 and hepatocyte apoptotic index decreases significantly (P < 0.01). This work suggests that Yi Guan Jian Decoction exerts significant therapeutic effect on CCl₄-induced cirrhosis in rats, through mechanism of inhibiting hepatocytes apoptosis and hepatic stellate cells activation, and regulating the function of Kupffer cell.

Ethnopharmacological relevance

This study investigates the mechanism of Yi Guan Jian against cirrhosis from aspect of heptocytes apoptosis and hepatic stellate cells activation. It suggest that although of unknown bioactive ingredients, mechanism of traditional Chinese medicine recipe against cirrhosis can be disclosed and of profound significance.     

扶正消瘤方治疗肝动脉化疗栓塞术加经皮肝肿瘤射频消融术后肝癌临床研究

目的:观察扶正消瘤方治疗Ⅰ期乙肝相关肝癌肝动脉化疗栓塞术(TACE)加经皮肝肿瘤射频消融术(RFA)术后患者的疗效。方法:选取病例312例,患者按照随机数字表法分为对照组和观察组各156例。对照组患者给予扶正消瘤方模拟剂口服,观察组患者给予扶正消瘤方口服,连续服药并随访12个月。比较两组患者肝功能指标、免疫学指标、血清肿瘤标志物、血清炎症相关因子、HBV再激活率、1年复发率情况。结果:经干预12个月,观察组患者的肝功能指标改善更明显,GGT、TBil、ALT、AST等水平显著低于对照组(P<0.05); 免疫学指标T淋巴细胞CD₄⁺、CD₄⁺/ CD₈⁺、NK细胞水平明显高于对照组(P<0.05),CD₈⁺水平、血清中CA₂₄₂、CA₇₂₄、AFP等肿瘤标志物含量、sB7-H3、IL-1β、TNF-α、PCT等炎症相关因子水平与对照组相比明显降低(P<0.05); 对照组中有7例血清HBV-DNA转为阳性(P<0.05); 观察组患者1年复发率7.69%,显著低于对照组患者的14.74%(P<0.05)。结论:扶正消瘤方更利于促进Ⅰ期乙肝相关肝癌TACE加RFA术后(正虚瘀结证)患者肝功能的恢复,提高机体免疫功能,降低血清肿瘤标志物水平,降低术后炎症反应程度,防止乙肝病毒再激活,降低复发风险。     

总胆红素、高敏C反应蛋白检测在冠状动脉疾病中的价值

目的:探讨总胆红素、高敏C反应蛋白(hsCRP)在冠状动脉疾病(CHD)中的价值.方法:检测经冠状动脉造影证实的51例CHD患者的血清总胆红素、hsCRP及其它脂类指标,分析治疗前后hsCRP的变化,并与30例健康检查者作对照分析.结果:CHD患者的TBil浓度(11.85±6.72)μmol/L,hsCRP(4.75±2.59)mg/L,与健康对照组TBil浓度(14.51±7.25)μmo/L,hsCRP(1.35±0.76)mg/L有显著性差异(P＜0.05、P＜0.01),且治疗前、后hsCRP的浓度变化差异显著(P＜0.01).结论:TBil、hsCRP与CHD发生有关,在CHD的诊断及治疗中具有一定的价值.     

Effects of Chinese herbal cataplasm Xiaozhang Tie on cirrhotic ascites

Background

Conventional methods of treating cirrhotic ascites are inadequate. We sought to identify a novel, effective approach to relieve the suffering of patients with cirrhotic ascites.

Aim of the study

To investigate the efficacy of Xiaozhang Tie, a traditional Chinese herbal cataplasm composed of dahuang (Rheum palmatum L.), laifuzi (Raphanus sativus L.), concocted gansui (Euphorbia kansui T.N. Liou ex T.P. Wang), chenxiang [Aquilaria sinensis (Lour.) Gilg], dingxiang (Eugenia caryophyllata Thunb.), bingpian (Borneolum syntheticum) and shexiang (artificial Moschus), as an adjuvant in treating cirrhotic ascites.

Materials and methods

A multicenter, randomized, placebo-controlled trial was conducted. One hundred patients with cirrhotic ascites were divided into two groups of equal size. The test group took an umbilical compress with Xiaozhang Tie for 30 days while the control group was administered an umbilical compress with placebo, in addition to primary therapy. Efficacy was evaluated according to the criteria including ascites volume, urine 24-h volume, abdominal circumference, body weight, abdominal distention, appetite, flatus and defecation.

Results

Ninety-two patients completed the study, 7 were withdrawn and 1 was excluded. The effective rate of grades I and II was 63.3% for the test group (n = 49) and 38.0% for the control one (n = 50). Both groups showed decreased body weight and abdominal circumference, increased urine volume and improved symptoms after treatment. However, the differences between pre-treatment and post-treatment in body weight, abdominal circumference and urine volume were 8.7 ± 5.8 kg, 12.4 ± 8.3 cm and 683 ± 644 ml respectively in the test group, noticeably higher than those in the control group, which were 5.3 ± 4.6 kg, 8.0 ± 6.5 cm and 372 ± 697 ml, respectively. The ranking orders of the symptoms of the test group were significantly lower than those of the control group after treatment. No severe adverse reactions were seen.

Conclusion

Xiaozhang Tie as an adjuvant to primary therapy of cirrhotic ascites is safe and shows a remarkable efficacy on relieving abdominal distention.     

血清总胆红素对血清总蛋白测定结果的影响

目的 研究血清总胆红素对血清总蛋白测定结果的影响。方法 采用双缩脲法，分别测定加入一定浓度的胆红素的血清总蛋白值和加入不同浓度的胆红素的血清总蛋白值。结果 血清中加入胆红素后使血清总蛋白测定结果高于未加胆红素的血清。结论 血清总胆红素对血清总蛋白测定结果有影响。使血清总蛋白测定结果偏高。     

茵胆平肝胶囊联合多烯磷脂酰胆碱治疗酒精性肝病的临床研究

目的探索茵胆平肝胶囊联合多烯磷脂酰胆碱治疗酒精性肝病的临床疗效。方法选取2014年2月—2017年4月渭南市中心医院收治的234例酒精性肝病患者,随机分为对照组和治疗组,每组各117例。对照组静脉滴注多烯磷脂酰胆碱注射液,30 m L加入5%葡萄糖注射液250 m L,1次/d。治疗组在对照组治疗基础上口服茵胆平肝胶囊,2粒/次,2次/d。两组均连续治疗30 d。观察两组患者的临床疗效,比较两组治疗前后天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、碱性磷酸酶(ALP)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为80.34%、94.87%,两组比较差异有统计学意义(P0.05)。治疗后,两组AST、ALT、TBil、ALP水平均显著降低,同组治疗前后差异有统计学意义(P0.05);治疗后,治疗组AST、ALT、TBil、ALP水平显著低于对照组,两组比较差异有统计学意义(P0.05)。对照组和治疗组的不良反应发生率分别为28.2%、9.4%,两组比较差异有统计学意义(P0.05)。结论茵胆平肝胶囊联合多烯磷脂酰胆碱治疗酒精性肝病具有显著疗效,能明显改善患者肝功能,不良反应较少,具有一定的临床推广应用价值。     

UPLC-MS-based serum metabonomics for identifying acute liver injury biomarkers in Chinese miniature pigs

Metabonomics has emerged as an important technology for exploring the underlying mechanisms of diseases and screening for biomarkers. In this investigation, to comprehensively assess metabolite changes in d-galactosamine (GalN)-induced liver injury in Chinese miniature pigs and to increase our understanding of physiological changes in normal and pathological states, we used ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) to analyze metabolites and identify biomarkers in serum. Blood samples were collected both from 18 h after GalN treatment group and control group pigs. We performed multivariate analyses on the metabolite profiles to identify potential biomarkers of acute liver injury, which were then confirmed by tandem MS. Based on “variable of importance in the project” (VIP) values and S-plots, four groups of biomarkers were identified – namely conjugated bile acids, lysophosphatidylcholines (LPCs), phosphatidylcholines (PCs) and fatty acid amides (FAAs) – that were present at significantly different levels in the control and GalN-induced groups. LPCs, PCs, and FAAs showed marked decreases in the GalN-treated group, whereas conjugated bile acids in the treated group showed considerable increases. Taken together, our results suggested that obvious metabolic disturbances occur during acute liver injury, which provided novel insights into the molecular mechanism(s) of d-galactosamine (GalN)-induced liver injury, and will facilitate future research and management of liver injury.     

Changes in the balance between Treg and Th17 cells in patients with chronic hepatitis B

The purpose of this study was to explore the role of Treg cells, Th17 cells and cytokines associated with Treg/Th17 differentiation in the occurrence, development and outcome of chronic hepatitis B (CHB). To do so, we detected populations of Treg and Th17 cells and their associated cytokines in the peripheral blood of CHB patients. The populations of Treg cells (CD4⁺CD25^highCD127^low T cells) and Th17 cells (CD3⁺CD8^-IL-17⁺ T cells) were analyzed in 46 patients with low to moderate chronic hepatitis B (CHB-LM), 24 patients with severe chronic hepatitis B (CHB-S) and 20 healthy controls (HC) using flow cytometry. The levels of cytokines associated with Treg/Th17 differentiation, including IL-10, TGF-β1, IL-17 and IL-23, were measured by enzyme-linked immunosorbent assay (ELISA). Our study showed that the imbalance of Treg and Th17 cells might play an important role in the occurrence, development and outcome of CHB.