病毒性肝炎患者血清sICAM-1、IL-6及TNF-α水平检测分析

应用酶联免疫吸附法检测了４３名对照组和１２９例各类病毒性肝炎患者血清ｓＩＣＡＭ－１、ＩＬ－６及ＴＮＦ－α水平含量。结果表明：急、慢性肝炎和肝硬化患者血清ｓＩＣＡＭ－１水平明显高于对照组（Ｐ〈０．０１）,慢性重型肝炎组明显高于中度和轻度肝炎组（Ｐ〈０．０１）,各类肝炎患者血清ｓＩＣＡＭ－１水平与ＡＬＴ、ＴＢｉｌ均呈明显正相关;各类肝炎及肝硬化患者血清ＩＬ－６和ＴＮＦ－α水平也较对照组显著升高（Ｐ〈０     

病毒性肝炎患者白细胞介素－6的检测及其临床意义

应用夹心ＥＬＩＳＡ检测了５６例乙型病毒性肝炎患者外周血单个核细胞（ＰＢＭＣｓ）白细胞介素－６（ＩＬ－６）的诱生水平。乙型慢性活动性肝炎（ＣＡＨ）、乙型肝炎后肝硬化（ＨＣ）和乙型重型肝炎（ＳＨ）ＰＢＭＣｓ经脂多糖诱导后，ＩＬ－６的诱生水平分别为１２．８４±３．２６ｎｇ／ｍｌ、１１．７９±３．０１ｎｇ／ｍｌ和３８．４２±８．３７ｎｇ／ｍｌ，明显高于正常对照组（Ｐ＜０．０５～０．０１）。ＣＡＨ和ＳＨ患者的ＩＬ－６水平与肝细胞变性坏死，蛋白质合成障碍和患者的预后也有一定的关系。上述结果提示，机体内ＩＬ－６的调节紊乱可能与病毒性肝炎的发病机理有关。     

肝硬化和肝癌患者血浆P物质和抗利尿激素含量变化

用放射免疫分析法对肝硬化和肝癌患者血浆Ｐ物质和抗利尿激素进行了测定，结果表明，肝硬化和肝癌组血浆Ｐ物和抗利尿激素（ＡＤＨ）含量显著高于正常人对照组（Ｐ〈０．００１），肝癌组血浆Ｐ物质和ＡＤＨ呈一致性升高，且明显的高于肝硬化组（Ｐ〈０．００１）。腹水组血浆Ｐ物质和ＡＤＨ含量显著高于无腹水组（Ｐ〈０．０１）。血浆Ｐ物质和ＡＤＨ含量在ＣｈｉｌｄＡ、Ｂ、Ｃ组均呈显著正相关（ｒ值分别为０．６５，０．６８和０     

病毒性肝炎患者IL—1,IL—6和INFa活性的检测

检测了甲，乙型病毒性肝炎患者外周血单个核细胞ＩＬ－１、ＩＬ－６和ＴＮＦａ的诱生活性及其血清中活性。结果表明，乙型慢性活动性肝炎、乙型肝炎后肝硬化和乙型生型肝炎ＰＢＭＣｓ经脂多糖诱导后，ＩＬ－１活性分别为３５３１．１±８８２．７Ｕ／ｍｌ，２７６９．７±７３０．４±Ｕ／ｍｌ和５３２９．３±１０８９．３Ｕ／ｍｌ，高于正常对照组（Ｐ＜０．０５）或＜０．０１）；ＩＬ－６诱生活性分别为３８．９０±１４．７５Ｕ     

乙型病毒性肝炎,肝癌一家系7例分析

乙型病毒性肝炎、肝癌一家系７例分析青岛市儿童医院（２６６０１１）杨瑞兰，马少春乙型病毒性肝炎是世界范围内广泛流行的病毒性传染病．我国为乙型肝炎流行的高发区，人群中感染率为６０％，乙型肝炎病毒表面抗原（ＨＢ－ｓＡｇ）携带者为１０－１５％［１］．正象其他...     

慢性乙型病毒性肝炎患者血清中IL－6、IL－8和sIL－2R水平检测

慢性乙型病毒性肝炎患者血清中ＩＬ－６、ＩＬ－８和ｓＩＬ－２Ｒ水平检测杨琨，刘崟，孙忱，刘雪松，金伯泉第四军医大学免疫学教研室西安７１００３２细胞因子在慢性乙型病毒性肝炎中的作用已受到广泛关注。为此，作者对慢性乙型病毒性肝炎患者血清ＩＬ－６、ＩＬ－８和...     

重组基因工程干扰素α－2b治疗25例慢性丙型肝炎的疗效观察

重组基因工程干扰素α－２ｂ治疗２５例慢性丙型肝炎的疗效观察吴玮，李彦恒丙型肝炎的慢性化趋势与乙型病毒性肝炎相似，或者可能更甚；其中许多患者发展为肝硬化乃至肝癌。因此丙型病毒性肝炎的抗病毒治疗可能具有更重要的意义。近几年我们应用重组基因工程干扰素α－２...     

肝硬化患者血浆C型利钠多肽测定的临床意义

目的：为探讨C－型利钠多肽在肝硬化发病机理中的作用。方法：用放免法测定了30例正常人,40例血吸虫性肝硬化患者,25例肝炎后肝硬化患者血浆中C－型利钠多肽的含量。结果：血吸虫性肝硬化组血浆中CNP含量明显高于正常人组,肝炎后肝硬化组血浆CNP含量较正常人组明显升高并明显高于血吸虫性肝硬化组。结论：CNP可能参与了肝硬化的病理生理过程,血浆中的含量检测可作为诊断肝硬化的一项参考指标。     

肝硬化患者血清透明质酸含量与sIL－2R水平的观察

本文用放射免疫测定法及双抗体夹心法测定了２５例健康人，３０例肝硬化患者血清透明质酸（ＨＡ）的含量及可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平。结果表明：（１）肝硬化组血清ＨＡ含量及ｓＩＬ－２Ｒ水平均高于对照组（Ｐ值均＜０．０１）；（２）肝硬化组血清ＨＡ与ｓＩＬ－２Ｒ水平间呈正相关关系（ｒ＝０．５１９２，Ｐ＜０．０１）。提示：肝硬化组患者血清ｓＩＬ－２Ｒ水平增高与肝损害程度有关，可能是由于肝细胞受损而对ＳＩＬ－２Ｒ清除能力降低所致。     

乙型病毒性肝炎相关晚期肝病的抗病毒治疗效果观察

目的 分析抗病毒疗法治疗乙型病毒性肝炎相关晚期肝病的临床效果。方法 选取我院2016年1月~9月收治的乙型病毒性肝炎相关晚期肝病患者80例为研究对象,随机分为对照组和观察组,各40例。对照组患者行常规治疗,观察组患者行抗病毒治疗,比较两组治疗效果。结果 原发性肝癌患者中,对照组治疗有效率为60.00%,观察组治疗有效率为88.89%;肝硬化患者中,对照组治疗有效率为64.29%,观察组治疗有效率为92.31%;重型肝炎患者中,对照组治疗有效率为68.75%,观察组治疗有效率为94.44%,组间数据比较,差异均有统计学意义（P＜0.05）。结论 针对乙型病毒性肝炎相关晚期肝病患者进行治疗时,采用抗病毒治疗疗法可以达到理想的治疗效果,有利于患者康复。     

胰岛再生源蛋白与肝脏疾病和肝再生

胰岛再生源蛋白 (Reg) 是相对分子质量为16kD的分泌型蛋白,属于C类凝集素超家族成员。Reg蛋白是1个多功能分子,主要参与调控胰腺、胃、肠和肝脏中细胞的生长和增殖,在消化性疾病及癌症的发展和预后中发挥重要作用。我们主要综述了Reg对肝脏疾病和肝再生调控的研究进展,包含其在消化性疾病中介导的信号通路,为开展Reg在相关疾病诊疗及促进肝再生中的应用研究提供重要理论基础。     

内毒素血症与肝脏疾病相关临床与实验研究进展

内毒素是革兰阴性细菌细胞壁中的脂多糖(LPS)组分.只有当细菌死亡溶解或用人工方法破坏菌细胞后才释放出来.血中细菌或病灶内细菌释放出大量内毒素至血液,或输入大量内毒素污染的液体而引起的一种病理生理表现称作内毒素血症.内毒素血症可以导致多种肝脏疾病的产生,其发生机制比较复杂,其中Toll样受体-4(TLR4)、CD14受体及Kupffer细胞在内毒素性肝损害的发生发展中起着重要作用.近年来,对于内毒素血症和肝脏疾病的临床和实验研究有了较大进展.     

人肝细胞离线混合生物人工肝支持系统的构建与实验研究

目的 构建人肝细胞离线混合生物人工肝支持系统,探讨其治疗肝衰竭患者离体血浆的可行性,为开展离线生物人工肝治疗肝衰竭患者奠定基础.方法 采用转染人肝再生增强因子（hALR）基因的Hep G2细胞为生物材料,将细胞培养于费森尤斯血浆滤过器（Psu-2S）中,构建生物反应器.利用慢性乙型病毒性肝炎基础上发生的慢加急性肝衰竭患者血浆置换后离体血浆作为治疗对象,先行2h血浆胆红素吸附治疗,然后应用构建的生物人工肝系统对其进行实验性治疗.结果 生物反应器建立过程顺利,无菌技术达到要求,细胞培养液离心检测未见细胞漏出,生物反应器外腔液中细胞活力平均达95.6%,细胞增殖旺盛.肝衰竭患者血浆在胆红素吸附治疗前后分别为（176.19±54.14）μmol/L,（50.10±16.85）μmol/L,差异有统计学意义（t=8.32,P=0.0002）,白蛋白、尿素氮、血糖等指标在胆红素吸附前后差异无统计学意义.血浆在生物人工肝治疗前后,胆红素分别为（50.10±16.85）μmoL/L,（30.27±15.02）μmol/L,差异有统计学意义（t=13.19,P=0.000）;同时尿素氮（UERA）明显升高（t=15.4,P=0.000）;血糖（GLU）明显降低（t=5.67,P=0.0013）;白蛋白治疗前后分别为（6.13±2.04）g/L及（7.19±2.42）g/L,差异无统计学意义（t=1.73,P=0.134）.结论 自行构建的混合生物人工肝支持系统细胞繁殖活性良好,对慢加急性肝衰竭患者血浆胆红素有较好的吸附及代谢作用并具有一定的蛋白合成功能.     

Regulation of hepatic blood flow in patients with liver cirrhosis and after liver transplantation

We studied liver blood flow at rest and its regulatory changes after exercise and food intake in ten patients with advanced liver cirrhosis and in 14 patients more than 10 months after orthotopic liver transplantation. The results were compared with those obtained in ten healthy volunteers. Sorbitol steady state infusion was employed to measure functional liver blood flow (FLBF). Thirty minutes of half-maximal muscular work, performed on a supine position ergometer and consumption of a standard meal were used as stimuli to study regulatory changes in hepatic perfusion. Results: FLBF at rest was reduced in end stage cirrhosis (mean 1257±105 ml/min in cirrhosis vs. 1707±76 ml/min in controls; P<0.01). After liver transplantation FLBF at rest was normalized (mean 1922±169 ml/min) in patients with stable graft function. Muscular exercise led to a reduction in FLBF, which in the transplanted patients was the same range as in normal controls (−26.7±3.7%; −24.7±0.7, respectively), but was reduced in cirrhosis (−19.1±2.1%; P<0.05). After ingestion of a standard meal FLBF increased substantially in normal controls (+40.2±2.3%), while in patients with cirrhosis this increase was rather small (+10.1±1.9%; P<0.001). After transplantation the food-induced increase in FLBF(+20.5±3.6%) was larger than in cirrhosis (P<0.05) but remained smaller than in the controls (P<0.01). We conclude that in cirrhosis FLBF is reduced and adaptive changes after exercise or food intake are impaired. After transplantation FLBF is normalized, but blood flow regulation, especially after food intake remains abnormal.     

Comparison of blood parameters in degenerative liver disease and liver neoplasia in dogs

The evaluation of blood parameters is the first step in the diagnosis of liver disease. In many cases the blood parameters indicate only cell destruction or disturbances of liver cell synthesis. It is impossible for one to make a diagnosis by blood parameters only. In our investigation we compared the liver parameters ALT, ALP, GLDH, albumin, bile acid and total bilirubin in dogs with severe degenerative liver disease and in dogs with malignant liver tumours. The aim of our investigation was to find differences between the blood parameters in both liver diseases. We found no significant difference in parameters between degenerative liver disease and liver neoplasia. However, in our investigation, compared with other reports, the mean levels of ALT, ALP, albumin and bilirubin were more often altered in liver neoplasia than in degenerative liver disease. Thus, we conclude that disturbances of liver cell integrity and function occur more often in liver tumours than in severe degenerative liver disease.     

Unusually rapid development of a HBsAG-positive liver cirrhosis after liver transplantation

Summary We report the case of a 44-year-old man who was transplanted in 1986 for hepatocellular carcinoma in a HBsAG-positive liver cirrhosis. The patient had no severe complications postoperatively. He received passive immunization for the prevention of hepatitis B reinfection during the first 6 months after liver grafting. Twelve months after the transplantation the new liver was reinfected with hepatitis B virus. Without any clinical or laboratory signs of severe hepatitis, the patient developed a histologically proven complete liver cirrhosis within 8 months after reinfection of the graft. The reasons for this might have been, first, a deleterious course of the infection under immunosuppressive therapy, and, second, the additional influence of a postoperatively acquired CMV infection or the combined toxic influence of cyclosporin A and its metabolites on the acute inflammation in the liver.Abbreviations ALT Alanine aminotransferase (EC No 2.6.1.2) - AST Aspartate aminotransferase (EC No 2.6.1.1) - CMV Cytomegalo virus - EBV Ebstein-Barr virus - ELISA Enzyme linked immunosorbentassay - HBV Hepatitis B virus - HLA Human leukocyte antigen - HSV Herpes simplex virus     

Acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is an increasingly recognized distinct disease entity encompassing an acute deterioration of liver function in patients with chronic liver disease. Although there are no widely accepted diagnostic criteria for ACLF, the Asia.Pacific Association for the Study of the Liver (APASL) and the American Association for the Study of Liver Disease and the European Association for the Study of the Liver (AASLD/EASL) consensus definitions are commonly used. It is obvious that the APASL and the AASLD/EASL definitions are based on fundamentally different features. Two different definitions in two different parts of the world hamper the comparability of studies. Recently, the EASL-Chronic Liver Failure Consortium proposed new diagnostic criteria for ACLF based on analyses of patients with organ failure. There are areas of uncertainty in defining ACLF, such as heterogeneity of ACLF, ambiguity in qualifying underlying liver disease, argument for infection or sepsis as a precipitating event, etc. Although the exact pathogenesis of ACLF remains to be elucidated, alteration of host response to injury, infection, and unregulated inflammation play important roles. The predisposition, infection/inflammation, response, organ failure (PIRO) concept used for sepsis might be useful in describing the pathophysiology and clinical categories for ACLF. Treatment strategies are limited to organ support but better understanding of the pathophysiology is likely to lead to discovery of novel biomarkers and therapeutic strategies in the future.     

肝窦状内皮细胞(LSECs)与肝脏免疫耐受

肝脏是机体重要的免疫器官,其解剖部位和功能特性决定了肝脏具有独特的免疫机制。一方面需要强大的免疫应答能力抗感染,另一方面需要强有力的调节机制避免不必要的免疫激活,而后者主要通过免疫耐受来实现。在肝脏的免疫防御系统中,肝窦状内皮细胞通过抗原特异性的免疫耐受诱导以及T淋巴细胞的凋亡诱导与清除,从而在肝脏的局部免疫以及全身免疫调控、器官移植耐受以及病毒感染的慢性化等生理病理过程中发挥着关键作用。     

肝移植的解剖学基础及临床应用--背驮式肝移植1例

目的 :探讨肝脏移植的切取及移植手术方法。方法 :采用背驮式的病肝切取要求 ,首先分离第 1肝门 ,将肝蒂解剖至分叉以上 ,然后近肝游离肝周韧带 ,保留肝后下腔静脉 (IVC)和第 2肝门的 3支肝静脉 ,第 3肝门的肝短静脉应细心结扎 (或缝扎 )离断。供肝的切取 :各管道系统保留足够长度 ,避免第 1肝门分离 ,热缺血时间在 10min以内。背驮式植肝技术 :供肝上IVC与肝左中静脉供干支的端端吻合。供肝门静脉与受体门静脉端端吻合。术后采用FK5 0 6、酶酚酸脂 (MMF)抗排斥治疗。结果 :供肝切取 10例均成功 ,热缺血时间在 10min之内。 1例肝豆状核变性 (Wilson)患者 ,行背驮式肝移植成功 ,随访 7个月 ,肝功能及血铜蓝蛋白正常。结论 :掌握肝脏系统的解剖基础 ,有利于供肝的切取及病肝的切除 ,肝脏移植是唯一能挽救终末期肝病病人生命的方法 ,新型免疫抑制剂可预防移植肝排斥反应。     

索拉菲尼对肝硬化大鼠部分肝切除术后肝脏再生的影响

目的: 在大鼠肝硬化模型的基础上行肝脏部分切除(PH),研究索拉菲尼(sorafenib)对大鼠肝脏再生的影响。方法: 使用二乙基亚硝胺(DEN)诱导Wistar大鼠肝硬化,成功建立30只肝硬化大鼠PH模型后,随机分2组,每组15只。术后第1 d开始,分别给予实验组索拉菲尼(30 mg·kg^-1·d^-1)、对照组生理盐水灌胃10 d后处死。留取PH后及实验结束后的血液及肝脏标本,检测2组肝脏再生率(LRR),增殖细胞核抗原(PCNA),生化指标: 丙氨酸转移酶(ALT)和血清白蛋白(ALB)、血清总胆红素(TBIL)和血清直接胆红素(DBIL)的变化,血管生成相关因子:血管内皮生长因子(VEGF)、血管内皮生长因子受体2(VEGFR-2)、血小板源性生长因子受体β(PDGFR-β),以及肝脏微血管密度(MVD)的变化。结果: (1)LRR在实验组及对照组分别为45.43%±3.36%和44.21%±2.77%,无显著差异(P>0.05);(2)免疫组织化学(IHC)没有检测到PCNA;(3)2组的生化指标无显著差异(P>0.05);(4)实验组VEGFR-2和PDGFR-β的表达受到抑制,MVD降低,并且实验组与对照组差异有统计学意义(P<0.01)。结论: 索拉菲尼虽然对肝硬化血管再生相关因子有抑制作用,但是对肝细胞再生和肝功能没有明显影响。