糖尿病性肝病23例临床研究

目的研究糖尿病性肝病（DLD）的发病机制、临床、病理特点及诊断治疗。方法选取糖尿病性肝病组患者23例,采用胰岛素强化治疗方法,观察该组患者治疗前后的临床表现及测定各项生化指标、B超及肝穿病理活检,并与非糖尿病肝病外科手术组患者肝组织病理10例作比较。结果糖尿病肝病组治疗2疗程以上,肝功能均恢复正常。肝穿组织病理检查胞浆中糖原颗粒减少,糖原空洞消失。非糖尿病肝病外科手术组肝组织病理均未见核内糖原空洞,胞浆糖原较糖尿病肝病组少。结论小剂量胰岛素静脉滴注治疗糖尿病肝病,不但能较快控制血糖,还能使肝功能好转,肝肿大减轻甚至恢复正常。     

进展期非酒精性脂肪性肝病的识别和临床管理路径

非酒精性脂肪性肝病(NAFLD)全球流行率达30%～40%,特别是患有2型糖尿病、肥胖和心血管疾病的患者,发生NAFLD的风险尤其高,已成为最常见的慢性肝病。NAFLD患者可进展为肝硬化、肝癌。NAFLD患者的绝对数量巨大,疾病负担重,然而在基层医疗和糖尿病管理机构中,NAFLD患者进展性肝病风险的识别仍然非常不理想。本文总结一种对NAFLD患者进行危险分层的方法,这将有助于医务工作者对NAFLD患者的管理。     

第二届湖北省中医肝病学术会议纪要

第二届湖北省中医肝病学术会议暨湖北省中医中药学会肝病专业委员会年会于2011年9月16—18日在湖北孝感市召开。本次大会由湖北省中医中药学会肝病专业委员会主办,由孝感市中医院承办。大会以肝衰竭为主题,共收到学术论文47篇,内容涉及病毒性肝炎、肝纤维化、肝硬化、肝衰竭、脂肪性肝病、酒精性肝病、自身免疫性肝病、遗传代谢性肝病、血吸虫性肝病、肝性脑病、肝肾综合征、肝性胃肠功能不良,以及中医治疗肝病的思路与方法等。来自湖北省各地的120余名同道参加了本次盛会。     

预防糖尿病从防治脂肪肝开始

脂肪肝是糖尿病新的“后备军”。这里所说的脂肪肝主要是指非酒精性脂肪性肝病，患者没有或者仅有少量饮酒史，并除去了病毒性肝炎、自身免疫性肝病等其他原因。     

非病毒性肝病领域十年研究进展

非病毒性肝病领域主要包括自身免疫性肝病、非酒精性脂肪性肝病、药物性肝损伤、遗传代谢性肝病等。现将重点结合近十年来自身免疫性肝病和非酒精性脂肪性肝病领域的相关临床及基础研究,对取得的进展和存在的难点问题进行综述。     

从阳虚论治肝源性糖尿病的理论探讨

肝源性糖尿病在治疗中存在着矛盾,就是降糖药大多对肝脏有损害,在肝病患者中使用多有顾虑,而肝病治疗又需要给以较多的糖分,这对糖尿病不利,治疗两难,我们通过运用温阳法治疗肝源性糖尿病172例,取得了较好的疗效,既能保肝又能调糖,在一定范围内解决了这一矛盾,与参芪降糖颗粒做对照观察,结果显示总有效率分别为92.47%和75.94%,两组比较,治疗组明显优于对照组(P＜0.05).为了进一步探讨其作用机理以便推广应用,我们对温阳法治疗肝源性糖尿病的理论基础进行了研究.研究中发现阳虚气化失常是肝源性糖尿病普遍存在的一个重要病机,从阳虚论治该病具有重要的意义.     

肝源性糖尿病40例临床特点及治疗分析

肝源性糖尿病是指在肝病基础上继发的糖代谢紊乱。目前临床上并不少见，及时诊断和正确治疗，对控制慢性肝病及肝源性糖尿病的发展，改善预后具有重要意义。我们就2001年3月～2003年12月收治的40例肝炎肝硬化并发糖尿病患者临床特点及治疗结果报告如下。     

拉米夫定治疗乙型肝炎肝硬化伴肝源性糖尿病的疗效观察

乙型肝炎肝硬化为晚期肝病,乙型肝炎病毒(HBV)持续活跃复制使肝病活动,造成肝组织炎症、坏死及纤维化加重,进一步损害肝功能,部分患者伴有肝源性糖尿病,常规护肝和降血糖治疗效果较差.我们应用拉米夫定治疗乙型肝炎肝硬化伴肝源性糖尿病取得了一定的疗效.     

胆汁淤积性肝病管理指南（2021）

2015年中华医学会肝病学分会和中华医学会消化病学分会制定了我国第一个胆汁淤积性肝病的专家共识。近年来胆汁淤积性肝病的临床研究提供了新的研究数据和资料。为此,中华医学会肝病学分会自身免疫性肝病学组组织专家组对近年来的文献证据进行了评估,制定了本指南。本指南共有胆汁淤积性肝病临床诊治推荐意见22条。本指南的目的是为临床胆汁淤积性肝病诊治提供参考和指导。     

中医药治疗肝源性糖尿病的临床研究概况

“肝源性糖尿病”这一医学术语是由Naunyn等于1906年首先提出。肝源性糖尿病是指在肝病基础上继发的糖尿病。本病可在各种类型的肝病基础上发生,但以在慢性活动性肝炎或肝硬化基础上发生多见,以中老年男性患者居多。多数学者认为,80％以上的慢性肝病患者具有糖耐量异常,并发糖尿病者高达30％,而正常人群糖尿病发病率为0．6％。     

血浆置换联合血液灌流治疗重度药物性肝病12例临床分析

目的探讨血浆置换和血液灌流在重度药物性肝损害治疗中的作用。方法对我院2003年~2004年收治的12例重度药物性肝功能损害患者的治疗情况进行回顾性分析。结果12例患者(包括4例急性肝功能衰竭)患者经过内科综合治疗联合血浆置换和血液灌流治疗,均痊愈出院。结论血浆置换联合血液灌流是治疗重度药物性肝损害有效的重要手段。     

Liver disease secondary to congenital heart disease in children

ABSTRACT

Introduction: Hepatic fibrosis and hepatocellular carcinoma (HCC) can develop in children with congenital heart disease. Although hepatic fibrosis and HCC are prone to develop after the Fontan operation, they can also develop in patients suffering from congenital heart disease who have not undergone Fontan operation.

Area covered: The history of cardiac hepatopathy including Fontan-associated liver disease is described. Patient characteristics, liver histology, imaging examinations and blood tests are reviewed to elucidate the mechanism of cardiac hepatopathy. In addition, a flowchart for the follow-up management of cardiac hepatopathy in children with congenital heart disease is proposed.

Expert opinion: Congestion and low cardiac output are the main causes of cardiac hepatopathy. Advanced hepatic fibrosis is presumed to be associated with HCC. HCC can develop in both adolescents and young adults. Regardless of whether the Fontan operation is performed, children with a functional single ventricle and chronic heart failure should be regularly examined for cardiac hepatopathy. There is no single reliable laboratory parameter to accurately detect cardiac hepatopathy; hepatic fibrosis indices and elastography have shown inconsistent results for detection of this disease. Further studies using liver specimen-confirmed patients and standardization of evaluation protocols are required to clarify the pathogenesis of cardiac hepatopathy.     

血吸虫病肝病影像学表现及研究进展

血吸虫病在我国广泛流行,至2015年我国仍有3万余晚期肝纤维化的血吸虫病人。本文从血吸虫病肝病的病理变化、临床表现、影像学表现及影像诊断价值等4个方面展开论述,重点综述了血吸虫病肝病的典型影像学表现及影像新技术对肝纤维化程度的评估。     

酒精性肝病与胰岛素抵抗的关系

目的：探讨酒精性肝病与胰岛素抵抗的关系。方法：观察43例酒精性肝病和12例正常人对照组空腹血糖、血胰岛素和胰岛素敏感指数。结果：酒精性肝病患者随病情加重胰岛素敏感系数逐渐增加,且均高于对照组（P＜0．05）。酒精性肝硬化患者血胰岛素高于对照组和其他酒精性肝病患者（P＜0．01）。结论：胰岛素抵抗现象随酒精性肝损伤的加重明显增加。     

Glycogenic hepatopathy

Background

Glycogenic hepatopathy (GH) is a disorder associated with uncontrolled diabetes mellitus, most commonly type 1, expressed as right upper quadrant abdominal pain, hepatomegaly and increased liver enzymes. The diagnosis may be difficult, because laboratory and imaging tests are not pathognomonic. Although GH may be suggested based on clinical presentation and imaging studies, the gold standard for diagnosis is a liver biopsy, showing a significant accumulation of glycogen within the hepatocytes. GH may be diagnosed also after elevated liver enzymes in routine blood tests. GH usually regresses after tight glycemic control. Progression to end-stage liver disease has never been reported. This review aims to increase the awareness to this disease, to suggest a pathway for investigation that may reduce the use of unnecessary tests, especially invasive ones.

自身免疫性肝病临床与病理研究

目的分析自身免疫性肝病临床、病理特点,探讨早期诊断、治疗方法。方法１９９６—１９９８年收治６２例自身免疫性肝病,比较原发性胆汁性肝硬化（ＰＢＣ）、自身免疫性肝炎（ＡＩＨ）的临床症状、体征、生物化学指标及病理特征。结果自身免疫性肝病中ＰＢＣ占５９．６８％, ＡＩＨ ４０．３２％。自身免疫性肝病中８３．８％是中老年女性,男女之比１∶１０,而ＡＩＨ　１∶５,发病年龄平均３５岁。ＰＢＣ中血循环自身免疫抗体阳性率８５．２９％,ＡＩＨ　７８．９５％。在阳性病例中 ＡＭＡ, ＡＭＡ－Ｍ２阳性率 １００％, ＡＮＡ阳性率 ８０％,血清免疫球蛋白异常, ＰＢＣ　ＩｇＭ增高占８０％, ＡＩＨＩｇＧ增高占８２．２５％, Ｐ值＜０．０５和Ｐ值＜ ０．０２５。 ＰＢＣ肝脏活组织病理显示,胆管炎和胆管增生、炎症、损伤或三者共存的特征。ＡＩＨ显示门静脉区炎症、淋巴细胞、单核细胞、浆细胞浸润、坏死、纤维化。结论ＰＢＣ和ＡＩＨ是自身免疫性肝病临床上两个常见类型,其中ＡＩＨ以Ⅰ型为主;而血中ＡＭＡ－Ｍ２是ＰＢＣ特征抗体,强的松龙治疗效果ＡＩＨ优于ＰＢＣ。     

重组人生长激素治疗慢性肝病低蛋白血症的临床观察

目的　探讨重组人生长激素对慢性肝病低蛋白血症的治疗效果。方法　 5 6例慢性肝病患者随机分为治疗组 2 8例和对照组 2 8例 ,在相同的护肝治疗基础上 ,治疗组应用重组人生长激素 4U ,皮下注射 ,每日一次 ,连续应用 14天。对照组应用 2 0 %人血白蛋白 5 0ml ,静脉滴注 ,每日一次 ,连续应用 14天。观察治疗前 ,治疗结束当天 ,治疗结束后 14天的临床症状及肝功能的改善情况。结果　治疗组的白蛋白治疗前为 2 7.12± 4.0 6g/L ,治疗结束当天为 3 1.45± 4.76g/L ,治疗结束后 14天为 3 1.6± 4.62g/L ;对照组的白蛋白治疗前为 2 6.88± 4.68g/L ,治疗结束当天为 3 3 .3 5± 5 .84g/L ,治疗结束后 14天为 2 8.42± 3 .84g/L。结论　重组人生长激素可有效地改善慢性肝病患者的低蛋白血症。     

Hepatic venous outflow obstruction： Three similar syndromes

Our goal is to provide a detailed review of venoocclusive disease （VOD）, Budd-Chiari syndrome （BCS）, and congestive hepatopathy （CH）, all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed, enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS, and CH are almost identical： sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions. However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction. Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.     

慢性肝病患者血培养分离菌分布特征及耐药谱研究

目的:分析慢性肝病患者血培养分离菌的分布特点及耐药情况。方法:培养6913瓶慢性肝病患者全血标本,鉴定细菌,测定药敏。结果:阳性标本763份,阳性率为11.0%。共检出34个属、71个种,383株菌;需氧菌373株(97.4%),厌氧菌3株(0.7%),真菌7株(1.9%);排在前几位的细菌是:大肠埃希菌(122株),凝固酶阴性葡萄球菌(51株),肺炎克雷伯菌(41株)。大肠埃希菌和肺炎克雷伯菌产ESBLs率分别为18.0%(22/122)和12.2%(5/41);耐苯唑西林凝固酶阴性葡萄球菌产生率为51.0%(26/51)。结论:肝病患者的血培养分离菌以肠杆菌科细菌为主。     

Serum and liver iron concentration in dogs with experimentally induced hepatopathy

BACKGROUND AND AIM: Iron (Fe) status is altered in human and experimental animal hepatopathies. In dogs limited data are available. The aim of this study was to investigate serum iron (SI), total iron binding capacity (TIBC), percentage transferrin saturation (SAT) and Fe status in the liver of dogs with experimentally induced hepatopathy. METHODS: Fourteen 1-year-old dogs were divided into two equal groups. In order for hepatopathy to be induced, 0.25 mL/kg body weight of carbon tetrachloride (CCl4) solution was administered once daily, orally, for a 10-week period in group B dogs, while group A dogs were used as controls. SI, TIBC and SAT values were measured 3 times before the beginning (baseline value) and 10 times at weekly intervals during the experiment. Liver samples, obtained before the administration of CCl4 and at the end of the experimental period (10 weeks), were subjected to Fe determination, as well as to histopathological and histochemical analysis. RESULTS: At the end of the experiment SI, TIBC and liver iron concentration, as well as liver total iron score were significantly increased in group B dogs. Distribution of granular hemosiderin iron in hepatocytes, Kupffer cells, and portal triads was noticed. Positive correlations were found between SI and liver Fe concentration, as well as histochemically determined Fe. Moreover, positive correlations were evident between liver fibrosis and serum, as well as liver Fe values. CONCLUSIONS: Experimentally induced chronic hepatopathy in dogs causes Fe status disturbances. Increased serum and liver iron concentration produces liver histopathological deterioration and it may be worth attention during laboratory evaluation in canine hepatopathy.