胆汁形成与胆汁郁积的研究进展

近年来,随着方法学的不断改进,对胆汁形成与胆汁郁积机制的研究,从过去的定位描述到目前的细胞及亚细胞机制的研究,取得了显著的进展。胆汁生成的结构基础一、肝细胞膜由一定比例的胆固醇和卵磷脂组成,它们二者的比例决定了膜的流动性。在功能上,肝细胞膜分为三个区:肝窦膜、侧膜及毛胆管膜,其中肝窦膜与毛胆管膜上有一些不规则的微绒毛,扩大了它们的表面积。这三个区肝细胞膜通过囊泡的穿梭作用而相互流动,有所增减。尽管如此,在各个区膜上的载体分布与酶的分布与活性都是不平衡的,这在胆汁形成中起着重要的作用。     

胆汁郁积性瘙痒症的治疗

胆汁郁积性瘙痒症的治疗南京解放军第八一医院容健材，魏玮黄疸患者的瘙痒是由于胆汁郁积（潴留）所致。胆汁郁积分为肝外胆汁郁积（肝外胆道阻塞）和肝内胆汁郁积（急性肝内阻塞性黄疸）；当胆流阻塞时，胆汁返流入血液致胆红素升高引起黄疸，称作阻塞性黄疸。血清胆红素...     

良性复发性肝内胆汁瘀积症1例

病例报告女，２７岁，因黄疸伴皮肤瘙痒间歇性发作３ａ于１９９３１０入院．患者１９９１０３无任何诱因突发全身黄疸，伴皮肤瘙痒，乏力，尿黄，黄疸持续３ｍｏ后自行缓解痊愈．１９９３０５又出现尿黄、乏力、全身黄疸，伴皮肤瘙痒，并进行性加重．无发热，食欲正...     

茵陈丹芩汤治疗妊娠肝内胆汁郁积症12例

妊娠肝内胆汁郁积症是在妊娠期间以黄疸和皮肤搔痒为主要临床特征的一种高危妊娠,可致早产、胎儿宫内窘迫、围产儿死亡和产后出血等,近年来,笔者应用自拟茵陈丹芩汤治疗此类患者共12例,获得满意疗效。现报告如下。 临床资料     

与胆汁郁积有关瘙痒的发病机理与治疗

许多类型的胆汁郁积包括良性或恶性肝外胆管梗阻和肝内胆汁郁积均可导致瘙痒。瘙痒通常经一般处理即可解决,但也可严重至影响病人的日常活动,引起躯体与精神上很大的痛苦。 因几乎所有原发性胆汁性肝硬化(PBC)病人最终均有瘙痒且是大多数病人的标志性症状,故传统上将PBC作为研究模型。原发性硬化性胆管炎(PSC)与PBC均为慢性胆汁郁积     

胆汁郁积性肝病并发骨质疏松症的临床研究

骨质疏松症是胆汁郁积性肝病常见的晚期并发症之一,随着对该病认识的不断深入,有关病因、发病机理、临床特点及防治有所更新,本文介绍上述方面的新观点。     

胆汁郁积性肝病并发骨质疏松症的临床研究

骨质疏松症是胆汁郁积性肝病常见的晚期并发症之一，随着对该病认识的不断深入，有关病因、发病机理、临床特点及防治有所更新，本介绍上述方面的新观点。     

思美泰治疗肝内胆汁淤积临床观察

目的 比较思美泰治疗肝内胆汁淤积的临床疗效并探讨其与剂量的关系.方法 回顾性分析150例肝内胆汁淤积患者的临床资料,比较思美泰治疗妊娠肝内淤积症、慢性乙型肝炎高胆红素血症、淤胆型肝炎3种不同类型肝病TBIL、ALT和γ-GT的变化,分析思美泰对慢性乙型肝炎高胆红素血症不同程度黄疸的影响及不同思美泰剂量治疗慢性乙型肝炎高胆红素血症后TBIL的水平变化.结果 妊娠肝内淤积症组血清TBIL、ALT和γ-GT水平的下降幅度明显,与慢性乙型肝炎高胆红素血症组下降幅度比较,其差异显著(P<0.05);黄疸分级在(TBIL 171～260 μmol/L,Ⅱ级)和(TBIL 260 μmol/L以上,Ⅲ级)黄疸患者其TBIL下降水平较(TBIL 80～170 μmol/L,Ⅰ级)差异显著(P<0.05);2.0 g/d思美泰组治疗慢性乙型肝炎高胆红素血症的黄疸下降较1.0 g/d组明显(P<0.05).结论 思美泰是治疗胆汁淤积肝病高胆红素血症的有效药物,早期足量使用疗效佳.     

慢性淤胆型肝炎高压氧治疗前后肝组织学变化的观察

观察慢性淤胆型肝炎（ＣＣＨ）高压氧（ＨＢＯ）治疗前后肝组织学结构变化,用纯氧单仓治疗（２．５ＭＰａ,２ｈ／ｄ,１０ｄ／ｃｙｃ,６ｃｙｃ）１０例ＣＣＨ,治疗前后肝穿,病理检查,９例肝细胞和毛细胆管淤胆减轻明显,７例肝细胞变性坏死,汇管区炎症减轻明显（Ｐ〈０．０５）;３例肝间质纤维化轻度减轻（Ｐ〉０．０５）;３例肝脏炎症及纤维化程度改善不明显,ＨＢＯ治疗ＣＣＨ有较好的退黄和减轻肝脏组织结构损伤的作用。     

慢性淤胆型肝炎患者高压氧治疗前后肝血流临床症状肝功能肝组织结构的变化

目的:观察慢性淤胆型肝炎(CCH)高压氧(HBO)治疗前后患者的肝血流、临床症状、肝功能、肝组织学结构变化。方法:用纯氧单仓治疗(2.5 MPa,2 h/d,10 d/cyc,6 cyc)30例CCH。治疗前后肝血流图仪和多普勒B超测定肝血流图收缩波和门静脉右支血流量;肝穿刺活检病理观察。取算术均数行t检验。结果:治疗后肝血流图收缩波和肝门静脉右支血流量明显升高;患者临床症状和肝功能明显改善;治疗前后二次肝穿活检的10例的患者中,9例毛细胆管淤胆和肝细胞淤胆减轻;7例患者肝细胞变性坏死、汇管区炎症减轻(P<0.05)。3例肝间质纤维化程度减轻(P>0.05)。结论:HBO治疗CCH,可增加肝动脉及门静脉右支血流量,改善患者临床症状和肝脏功能,有效地减轻肝细胞、毛细胆管淤胆和肝组织学结构的损伤。     

Intrahepatic cholangiocarcinoma with micrometastasis in the portal tract of the liver

Intrahepatic metastasis of intrahepatic cholangiocarcinoma (ICC) has not been evaluated in detail. We report a case of mass-forming type ICC with micrometastasis to the distant portal tract in a 40-year-old woman. In 2006, she was given a diagnosis of mass-forming type ICC, 4 cm in diameter, and right hepatectomy with lymph node dissection was performed. Macroscopic findings showed an irregular white mass-forming type lesion with two small daughter lesions and portal vein invasion in the S5 subsegment. Microscopically, other cancer cells within vessels had proliferated in the peripheral portal tract of the S8 subsegment, and these cancer cells in the portal tract had invaded the vessel wall. The endothelial cells of the vessels around the cancer cells were positive for CD34, but negative for D2-40 and CK19 on immunohistochemical analysis. Therefore, intrahepatic metastasis of cancer cells through the portal vein was diagnosed. Intrahepatic metastasis of cancer cells through the portal vein was demonstrated in a patient with mass-forming ICC.     

Partial Internal Biliary Diversion: A Solution for Intractable Pruritus in Progressive Familial Intrahepatic Cholestasis Type 1

Biliary diversion offers a potential option for intractable pruritus in children with chronic cholestatic disorders. Progressive familial intrahepatic cholestasis (PFIC) is an inherited disorder of impaired bile acid transport and excretion, which presents with jaundice and pruritus in the first few months of life and progresses to cirrhosis by infancy or adolescence. We report a child with PFIC type 1 who underwent internal biliary diversion for intractable pruritus and was relieved of his symptoms.     

老年慢性肺源性心脏病诊治分析

目的 探讨老年慢性肺心病的病因及防治措施.方法 对我院2004年7月-2011年1月收治的65例老年慢性肺心病的临床资料进行回顾性分析.结果 本组65例老年慢性肺心病患者治愈56例,死亡9例.结论 老年慢性肺心病是一种多发病、常见病,积极治疗原发病,给予合理的营养支持治疗,是减少患病率和病死率的关键.     

Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy

AIM： To evaluate the predictive value of clinical symptoms and biochemical parameters for prematurity in intrahepatic cholestasis of pregnancy （ICP）. METHODS： Sixty symptomatic patients with ICP were included in this retrospective analysis. Preterm delivery was defined as delivery before 37 wk gestation. Predictors of preterm delivery were disclosed by binary multivariate logistic regression analysis. RESULTS： Mean time of delivery was 38.1 ± 1.7 wk. No stillbirths occurred. Premature delivery was observed in eight （13.3%） patients. Total fasting serum bile acids were higher （47.8 ±15.2 vs 41.0 ± 10.0 μmol/L, P 〈 0.05）, and pruritus tended to start earlier （29.0 ± 3.9 vs 31.6 ± 3.3 wk, P = 0.057） in patients with premature delivery when compared to those with term delivery. Binary multivariate logistic regression analysis revealed that early onset of pruritus （OR 1.70, 95% CI 1.23-2.95, P = 0.038） and serum bile acid （OR 2.13, 95% CI 1.13-3.25, P = 0.013） were independent predictors of preterm delivery. CONCLUSION： Early onset of pruritus and high levels of serum bile acids predict preterm delivery in ICP, and define a subgroup of patients at risk for poor neonatal outcome.     

Determination of serum cholestatic factor level by ELISA in drug-induced allergic hepatitis

We have shown that intrahepatic cholestasis often observed in drug-induced allergic hepatitis may be induced by a kind of lymphokine, the cholestatic factor (CF). In this study, we measured the CF level in the serum of patients with jaundice by ELISA using anti-CF monoclonal antibody. As a result, CF was detected in the serum of most of the patients at the peak of jaundice, but it was not detected when the patients were recovering from jaundice. When the changes in the serum CF level were followed during the clinical course of a patient, it reached its maximum level before that of the serum total bilirubin level and quickly decreased thereafter. These results also suggest that intrahepatic cholestasis in drug-induced allergic hepatitis may be induced by CF.     

桥脑出血16例临床分析

桥脑出血是脑出血中较少见的一种 ,病情凶险 ,病死率高。随着ＣＴ的出现 ,一些出血量较少的桥脑出血能及时诊断 ,若治疗合理 ,其预后较前有明显的改善。本文报道我院 7年来收治的 16例经ＣＴ证实的桥脑出血 ,对影响其预后的一些因素作一分析。临床资料一般资料　男 10例 ,女 6例。年龄 34～ 97岁 ,平均 6 1岁。有高血压病史者 7例。 4 8ｈ内入院的14例 ,发病 5ｄ、7ｄ入院的各 1例。主要临床表现　深昏迷 7例 ,中、浅昏迷各 1例 ,嗜睡 2例 ;眼球固定 8例 ,凝视 3例 ;双侧瞳孔不等 8例 ,等大 8例 ;四肢瘫 9例 ,交叉瘫 5例 ,偏瘫 2例。头痛 6…