重型肝炎与肠源性内毒素血症

肠源性内毒素血症(IETM)与重型肝炎之间的关系日益受到重视。动物研究证实在各种实验性肝脏疾病均伴有IETM的发生,临床观察也显示在重型肝炎的患者出现严重IETM的发生率高达(93·3-100)%[1]。随着研究的深入,IETM在重型肝炎患者发生发展中所发挥的作用及临床治疗方面都出现了一     

重型病毒性肝炎并发低血糖临床分析

目的 探讨重型病毒性肝炎患者血糖低于正常值的临床特点及防治对策。方法 回顾性分析2002年6月至2004年4月住院重型病毒性肝炎患者空腹血糖,对其在治疗过程中的变化做动态分析。结果 92例重型病毒性肝炎患者,空腹血糖低于正常67例(72．8％),其中死亡56例(68．7％),与其他并发症并存的发生率较高。动态分析空腹血糖降低患者治疗过程中血糖变化有三种形式,空腹血糖持续多次减低患者死亡率亦较高。空腹血糖减低患者中,仅部分呈典型低血糖症表现,死亡率最高。结论 重型病毒性肝炎常并发空腹血糖减低者的死亡率高。在积极综合治疗后,持续多次空腹血糖减低患者死亡率较高。呈低血糖症患者死亡率最高。血糖减低的治疗需要采取综合措施,个体化原则。     

Galactosamine hepatitis, endotoxemia, and lactulose

Studies by Liehr et al. suggest that endotoxins are important in the pathogenesis of galactosamine hepatitis (Gal-N hepatitis) in rats. Lactulose (9.1 gm per kg per day) prevents hepatic lesions induced by Gal-N; an antiendotoxin effect of lactulose is postulated. However, commercial preparations of lactulose are contaminated with galactose, which shows a competitive action to Gal-N. To analyze the effect of galactose, male Wistar rats were pretreated with lactulose (Duphalac, 9.1 gm per kg per day) and given Gal-N (375 mg per kg i.p.). After 24 hr, serum was analyzed for glutamic pyruvate transaminase, glutamate dehydrogenase, and sorbitol dehydrogenase activities. Pretreatment with Duphalac, even 1 hr before Gal-N, abolished toxicity. Duphalac contains 10 gm galactose per 100 ml. Galactose was given in a similar concentration and similar inhibition occurred. Pretreatment with purified lactulose (9.1 gm per kg for 5 days) diminished the effects of Gal-N but did not normalize enzyme concentrations. Because small doses of galactose (80 and 300 mg per kg) showed similar inhibitory effects, we conclude that the protective effect of commercial lactulose preparations is mainly due to galactose contamination and not to an antiendotoxin effect.     

微生态调节剂治疗重型肝炎内毒素血症的研究进展

肠源性内毒素血症是慢性重型肝炎发生和发展的重要机制之一。各种微生态制剂可调整肠道失调菌群,从而降低血清内毒素水平,减少并发症和降低病死率,对慢性重型肝炎有明显的治疗作用。     

谷氨酰胺颗粒对重度慢性乙型病毒性肝炎患者肠道通透性、内毒素血症与肝功能的影响

目的: 研究谷氨酰胺颗粒对重度慢性乙型病毒性肝炎患者肠黏膜通透性异常、内毒素血症及肝功能的影响,并探讨其病理生理机制.方法: 60例重度慢性乙型病毒性肝炎患者随机分为对照组和实验组.每组各30例.对照组采用常规护肝,抗病毒治疗,而实验组在对照组治疗方案的基础上加用谷氨酰胺颗粒10 g,tid,疗程为2 wk.于治疗前后采用自动生化分析仪分别测定2组患者的肝功能,包含ALT、AST、TBIL、PT、ALB,胆碱酯酶(CHE) 等;同时于治疗前后采用鲎实验法测定血清内毒素(ET),高效液相色谱蒸发光散射器(HPLCELSD)法测定尿乳果糖和甘露醇排泄率的比值(L/M).并加以比较.结果: 2 wk治疗后,2组患者的肝功能、ET、L /M水平均较治疗前有不同程度的好转( P＜0.05或0.01).与对照组治疗前后ALT、TBIL、CHE、ET、L/M的差值比较,治疗组治疗前后各指标的差值更为显著(281.86±149.34 U vs 199.65±127.09 U,168.65±102.04μmol/L vs 94.13±172.67 μmol/L,-1301.04±662.78 U vs -892.23±861.41 U,0.0198±0.0128 vs 0.0089±0.0228,均P＜0.05).结论: 谷氨酰胺颗粒能够起到保护肠上皮细胞,纠正重度慢性乙型肝炎患者肠黏膜通透性异常,改善肠源性内毒素,加速肝功能恢复的作用.     

乙型肝炎病毒变异与重症肝炎关系探讨

乙型肝炎病毒(HBV)是一种高度变异的病毒,由于病毒变异后往往引起抗原性和致病性改变,所以认为HBV感染在临床上出现的不同疾病谱与病毒变异有关。乙型病毒性肝炎病情轻重由宿主和病毒两方面决定,随着HBV变异研究的不断深入,变异所引起的生物学意义也不断被人们所认识,它既可使肝病加重,又可使病毒逃避机体免疫而持续感染[1 ] 。本文就重型肝炎(重肝)相关的HBV变异,并对HBV变异引起重肝的机制作如下综述。一、前C区终止密码子突变HBV前C区1896G→A突变,产生一终止密码子TAG ,使HBeAg不能转录合成。在日本、以色列和南欧一些地区…     

谷胺酰胺颗粒对慢性重症乙型肝炎患者肝功能和内毒素水平的影响

目的观察慢性重症乙型肝炎患者应用小剂量谷胺酰胺颗粒后肝功能和内毒素水平的临床变化,评价小剂量谷胺酰胺颗粒应用于慢性重症乙型肝炎患者的可行性。方法 40例诊断慢性重症乙型肝炎明确的患者随机分为对照组和治疗组。对照组给予常规护肝、抗病毒和支持治疗;治疗组在对照组治疗的基础上加用小剂量谷胺酰胺颗粒5 g,tid,疗程均为14 d。观察两组慢性重症乙型肝炎患者治疗前后肝功能和内毒素水平的变化,并进行组间和组内对比分析。结果两组患者治疗前后对比,肝功能和内毒素水平均有所改善(P0.01),但加用小剂量谷胺酰胺颗粒5 g,tid后,治疗组与对照组相比,肝功能和内毒素水平均无明显变化(P0.05)。结论在慢性重症乙型肝炎患者治疗中加用小剂量谷胺酰胺颗粒未能起到进一步改善肝功能及内毒素血症的临床作用。     

Prevalence of hypoglycemia among severe malaria children in a rural African population

ObjectiveTo determine the prevalence of hypoglycemia in severe malaria children in a rural African community.MethodsThirty two children who fulfilled the inclusion criteria were recruited for the study from two hospitals with intensive care facilities. Blood sugar levels of the patients were monitored serially at admission and then every 4 hours (after admission) for 24 hours using a glucometer; taking values <2.2 mmol/L as hypoglycemia. The children received intensive care according to WHO guidelines for severe malaria.ResultsFifteen out of 32 children recruited (representing 46.9%) had hypoglycemia with about 60% under 5 years of age. The mean age of the children was (4.49±2.89) years. The pre-correction and average post correction blood glucose levels were (2.04±0.13) mmol/L and (3.18±0.23) mmol/L, respectively.ConclusionsThe result has demonstrated that about 1 in 2 children with severe malaria may suffer from hypoglycemia in an African rural environment hence there is a need for at least three-point glucose estimation (at recruitment, 4 hours following correction and the end of the 24 hours).     

谷氨酰胺颗粒干预重度慢性乙型病毒性肝炎内毒素血症的临床疗效观察

目的 观察谷氨酰胺颗粒干预重度慢性乙型病毒性肝炎内毒素血症的临床疗效.方法 将60例重度慢性乙型病毒性肝炎内毒素血症患者随机分成对照组和治疗组,每组30例.对照组采用常规护肝、抗病毒治疗,而治疗组在对照组治疗方案的基础上加用谷氨酰胺颗粒10 g,3次/d,疗程为2周.观察治疗前后两组患者的血清内毒素、肝功能的变化以及治疗后的总有效率.结果 治疗组总有效率(83.3%)优于对照组(50.0%),差异有统计学意义(P<0.01).两组肝功能、血清内毒素较治疗前均有不同程度好转,治疗组与对照组比较差异有统计学意义(P<0.05或P<0.01).结论 谷氨酰胺颗粒治疗重度慢性乙型病毒性肝炎内毒素血症是一种有效的辅助治疗方法.     

Relationships among endotoxemia, arterial pressure, and renal function in dogs

This study evaluated the effects of increasing plasma endotoxin (Difco 055:B5) concentration by intravenous and intrarenal infusion on renal hemodynamics and renal function. Plasma endotoxin was increased to 130-150 ng/ml (infusion rate of 32 micrograms/min) in two groups of dogs and changes in plasma endotoxin concentration were correlated with arterial pressure (AP), glomerular filtration rate (GFR), renal blood flow (RBF), and urinary sodium excretion (UNaV) for 4 hr. In group 1, intrarenal endotoxin infusion decreased AP, GFR, RBF, and UNaV equally between infused and contralateral noninfused kidneys. In dogs with unilateral renal denervation (group 2), intravenous endotoxin maximally decreased AP, GFR, RBF, and UNaV in both kidneys by 90 min. Despite continued endotoxin infusion, RBF and GFR then spontaneously increased after 90 min, and by 240 min these values were significantly greater in the innervated kidneys compared with denervated kidneys (P less than 0.05). In both groups of dogs, the spontaneous increase in GFR and RBF was associated with a spontaneous increase in arterial pressure. These data suggest that renal dysfunction during moderate endotoxemia may be mediated by systemic hemodynamic changes rather than by direct intrarenal toxicity and that renal innervation may protect against endotoxin-induced reductions in RBF and GFR.     

重肝合剂保留灌肠阻抑重型肝炎内毒素血症的临床研究

目的:观察重肝合剂保留灌肠(滴灌法)对重型肝炎内毒素血症的阻抑效果.方法:将100例重型肝炎(亚急性、慢性重型乙型肝炎)按分层均衡、随机分组设计:治疗组50例(早期、中期重型肝炎各25例),对照组50例(早期、中期重型肝炎各25例).治疗组采用重肝合剂保留灌肠+常规治疗,对照组采用乳果糖溶液保留灌肠+常规治疗.结果:治疗组与对照组比较:临床疗效优于对照组(P＜0.05);治疗3周后血浆内毒素(ET)水平显著低于对照组(治疗3周组间比较P＜0.05,治疗4周组间比较P＜0.05);治疗3周后血浆肿瘤坏死因子(TNF-α)水平显著低于对照组(治疗3周组间比较P＜0.05,治疗4周组间比较P＜0.05).结论:采用重肝合剂保留灌肠+常规治疗,是重型肝炎内毒素血症的较优治疗方法.重肝合剂保留灌肠对重型肝炎内毒素血症有较好的阻抑效果.