安络化纤丸对慢性肝炎患者肝纤维化指标的影响

目的 :观察安络化纤丸对慢性肝炎患者肝纤维化指标的影响。方法 :将 89例慢性肝炎患者随机分为对照组 ( 4 4例 )和安络化纤丸组 (治疗组 ,45例 )。两组治疗前和疗程结束后 ,采用放免法检测血清PCⅢ、HA、LN、Ⅳ C的水平 ,采用彩色多普勒超声仪观察门静脉内径、门静脉血流速度、门静脉血流量和脾脏厚度 ,对部分患者进行肝组织学检测。结果 :治疗前两组患者血清PCⅢ、HA、LN、Ⅳ C水平及门静脉内径、门静脉血流速度、门静脉血流量和脾脏厚度差异无显著性意义 (P >0 0 5 ) ,治疗组治疗后血清PCⅢ、HA、LN、Ⅳ C水平及门静脉内径、脾脏厚度与治疗前相比有显著性减低 (P <0 0 1) ,门静脉血流速度、门静脉血流量明显改善 (P <0 0 5 ) ,与对照组相比差异均有显著性意义 (P <0 0 1～ 0 0 5 )。结论 :安络化纤丸具有阻止和逆转慢性肝炎患者肝纤维化的作用     

安络化纤丸治疗慢性乙型肝炎肝纤维化疗效观察

目的观察安络化纤丸对慢性乙型肝炎(乙肝)患者的肝功能、血清肝纤维化指标的影响。方法将98例门诊慢性乙肝患者随机分为2组。对照组48例给予常规护肝治疗;治疗组50例,在对照组用药的基础上给予安络化纤丸6g,早晚各1次,服用6个月。对比分析治疗前后血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)水平的变化及肝功能变化。结果治疗组在降低血清肝纤维化指标方面均优于对照组;治疗组治疗后转氨酶明显降低。结论安络化纤丸能较好地促进肝功能的恢复,具有良好的抗肝纤维化作用。治疗期间未发现明显不良反应。     

软肝健脾丸治疗慢性乙型肝炎肝纤维化的临床研究

目的：观察自制中药软肝健脾丸对慢性乙型肝炎肝纤维化的临床疗效。方法：将87例慢性乙型肝炎肝纤维化患者随机分为两组：治疗组44例,服用软肝健脾丸,对照组43例,服用安络化纤丸;治疗前后检测患者血清透明质酸（HA）、层粘蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）的水平,并观察主要症状、肝功能相关指标及肝脏B超声像图情况。结果：两组临床疗效比较,治疗组的显效率和总有效率分别为52.27%和88.63%;对照组分别为25.58%和67.44%,差异均有显著性意义（P〈0.01、P〈0.05）。HA、LN、PCⅢ、Ⅳ-C的水平治疗组患者治疗前后比较,差异有显著性意义（P〈0.01）;与对照组治疗后比较,差异均有显著性意义（P〈0.01、P〈0.05）。治疗组患者治疗前后ALT、AST、TBil、Alb比较差异有显著性意义（P〈0.01）,但与对照组治疗后比较差异无显著性意义（P〉0.05）。两组间在改善主要症状、脾脏回缩、肝脏声像图改变方面比较,差异有显著性意义（P〈0.05）。结论：软肝健脾丸对慢性乙型肝炎患者有较好的抗肝纤维化作用。     

前列腺素E1治疗慢性乙型肝炎108例疗效观察

目的：探讨治疗乙型肝炎（乙肝）及抗肝纤维化的有效方法。方法：采用前列腺素E1（PGE1）静脉滴注治疗慢性乙肝患者108例（治疗组），并与行综合治疗90例（对照组）疗效比较，观察两组治疗前后，后血清Ⅲ型前胶原（PCⅢ），层粘蛋白（LN）、透明质酸（HA）、Ⅳ型胶原（Ⅳ－C）、肝功能等指标变化。结果：治疗组血清肝纤维化指标（PCⅢ、LN、HA、Ⅳ－C），丙氨酸转氨酶，天冬氨酸转氨酶，总清总胆红素均明显降低，与治疗前及对照组比较差异均有非常显著性意义（均P＜0．01），结论：PGE1具有较好的保肝和抗肝组织纤维化作用。     

血清转化生长因子β1水平在慢性乙型肝炎与乙型肝炎肝硬化患者中差异的意义

目的:观察血清转化生长因子β1(TGFβ1)水平是否与肝脏炎症、纤维化程度相关及其在慢性乙型肝炎与乙肝肝硬化患者中的差异.方法:慢性乙肝(慢性肝炎组)65例,乙肝肝硬化(肝硬化组)56例,体检健康、乙肝标志物阴性者(正常对照组)50例,均空腹采血,肝纤维化指标(HA、CⅣ、PCⅢ、LN)采用放免法测定,血清TGFβ1检测采用ELISA.结果:慢性肝炎组血清TGFβ1水平明显高于肝硬化组和正常对照组(22±13μg/L vs 10±9μg/L,11±9μg/L,P<0.01),肝硬化组血清TGFβ1水平与正常对照组相比无显著性差异(P>0.05).肝硬化组PCⅢ与血清TGFβ1水平相关(r=0.269,P=0.045),慢性肝炎和肝硬化组血清TGFβ1水平与肝功能、肝纤维化指标无明显相关性(P>0.05).结论:血清TGFβ1水平可协助诊断肝脏炎症程度与纤维化程度,但不能作为他们的判断标准.     

重组人γ-干扰素联合安络化纤丸治疗慢性乙型肝炎肝纤维化的血清学变化

目的研究重组人γ-干扰素(IFN-γ)联合安络化纤丸治疗慢性乙型肝炎(慢乙肝)肝纤维化患者肝纤维化血清学变化.方法60例慢乙肝肝纤维化患者随机分为A、B 2组,A组:30例采用IFN-γ联合安络化纤丸治疗,B组:30例采用常规药物(凯西莱 肝安注射液)治疗,疗程为9个月.用放射免疫法测定治疗前、治疗3、6、9个月及停药后3个月血清HA、LN、PCⅢ及Ⅳ-C水平.结果A组血清HA、LN、PCⅢ及Ⅳ-C的测定值随治疗时间逐渐降低,至9个月到最低点(P＜0.05),B组则无明显改变(P＞0.05).有效率A组仅为66.7%(20/30),B组为10%(3/30),2组比较有显著性差异(P＜0.05).结论A组血清肝纤维化指标随治疗进行不断下降,至治疗结束时达到最低点;与A组比较,B组的肝纤维化4项指标虽然也呈下降趋势,但下降幅度明显小于A组.说明γ-干扰素联合安络化纤丸对慢性乙型肝炎肝纤维化有良好的联合抗纤维化效果.     

拉米夫定联合双甲五灵胶囊的抗肝纤维化作用

目的研究拉米夫定与双甲五灵胶囊联合治疗对慢性乙型肝炎患者血清肝纤维化指标及肝脏病理组织学的影响。方法随机选择50例慢性乙型肝炎患者作为治疗组,给予口服中药双甲五灵胶囊,3次/d,6粒/次,并同时口服拉米夫定01g/d,疗程1年;同时设对照组,给予保肝对症治疗。动态观察服药0、6、12个月患者血清中肝纤维化指标透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(ⅣC)的变化;对其中8例患者治疗前后肝穿刺活检,用Masson三色组织化学染色后观察肝组织纤维化程度的改变。结果与对照组相比,治疗组患者4项血清肝纤维化指标明显下降(P<001)。肝细胞坏死、汇管区炎细胞浸润及纤维化明显减轻。结论拉米夫定联合双甲五灵胶囊治疗慢性乙型肝炎,可使患者血清HA、LN、PCⅢ、ⅣC含量显著下降,并减轻肝组织的炎症坏死和纤维化程度。     

替诺福韦酯联合苦参素胶囊对高病毒载量乙肝肝硬化代偿期患者的疗效观察

[目的]研究高病毒载量乙肝肝硬化代偿期患者应用替诺福韦酯联合苦参素胶囊的抗病毒疗效及对肝纤维化指标改善的情况。[方法]选取入院行常规对症治疗的高病毒载量乙肝肝硬化代偿期患者126例作为研究对象,随机分为治疗组(替诺福韦酯联合苦参素胶囊治疗)和对照组(单用替诺福韦酯治疗),每组各63例。比较2组患者治疗前后肝功能指标(ALT、AST)、肝脏硬度值(LSM)、肝纤维化血清学指标(HA、LN、PCⅢ、CⅣ)的差异及治疗48周时血清HBV-DNA阴转率、HBeAg阴转率。[结果]治疗组与对照组患者在治疗前肝功能指标、肝纤维化血清学指标及LSM比较均差异无统计学意义(P0.05);治疗48周后,治疗组的HBV-DNA阴转率(43/63,68.3%)高于对照组(32/63,50.8%),2组比较差异有统计学意义(P0.05);同期治疗组、对照组HBeAg阴转率(20.6%、15.9%)相比,差异无统计学意义(P0.05)。治疗48周后,治疗组ALT、AST、HA、LN、PCⅢ、CⅣ及LSM水平较对照组均明显下降,2组比较均差异有统计学意义(P0.05~0.01)。[结论]替诺福韦酯联合苦参素胶囊可较好地改善乙肝肝硬化患者的肝纤维化程度,提高抗病毒疗效,显著地改善患者预后。     

拉米夫定治疗慢性乙型肝炎对血清肝纤维化指标影响的临床观察

目的探讨拉米夫定治疗慢性乙型肝炎对患者血清肝纤维化指标的影响。方法对42例慢性乙型肝炎患者在拉米夫定治疗前和治疗1年后测定血清透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(ⅣC)水平,并与39例对照组进行比较。结果治疗组治疗后4项血清肝纤维化指标明显下降(P均<0.01);治疗后治疗组与对照组相比也有显著性差异(P均<0.01)。结论拉米夫定治疗慢性乙型肝炎对血清肝纤维化指标有明显降低作用。     

细胞外基质成分联合检测在肝纤维化诊断中的意义

为探讨非创伤性诊断肝纤维化的方法，对107例肝炎患者进行血清Ⅳ－C、HA及PCⅢ含量规定。结果显示，三项指标在慢性肝炎及肝硬化组均较对照组明显升高（P＜0．01），并且慢性肝炎组与肝硬化组之间Ⅳ－C、HA含量比较也有显著性差异（P<0.01）。说明Ⅳ-C及HA在鉴别慢性肝炎与肝硬化时有较大参考价值，而PCⅢ相对作用较小，若三项指标联合检测，可提高对肝纤维化诊断的灵敏性和特异性。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.