病毒性肝炎180例甲襞微循环观察

本文对180例肝炎患者采用微循环电脑测量系统,进行了甲襞微循环观察,并以田氏综合定量评分法进行分析。结果①表明各型肝炎多数存在不同程度的甲襞微循环障碍。积分值在急性肝炎、慢迁肝、慢活肝、肝硬化四组之间有非常显著性差异(P均<0.001)。②有管袢形态的改变,又有血流态及袢周状态的改变,尤其是管袢数减少,流速异常,红细胞聚集和乳头改变明显,并按急性肝炎、慢迁肝、慢活肝、肝炎后肝硬化的顺序出现微循环异常规律性递增。③各型肝炎的黄疸程度与甲襞微循环异常呈正相关。     

45例肝炎肝硬化合并胃黏膜病变临床分析

目的探讨肝炎肝硬化患者胃黏膜病变的发病机制及与幽门螺杆菌之间的关系。方法回顾性分析45例肝炎肝硬化患者的胃黏膜病变,所有患者均做胃镜检查及病理活检检查。结果本组肝炎肝硬化患者合并胃黏膜病变者占肝炎肝硬化患者总数的93.3%,以失代偿肝炎肝硬化为主;胃黏膜病变幽门螺杆菌（HP）感染率为80.0%。结论肝炎肝硬化时患者胃血流缓慢,胃微循环发生障碍,胃黏膜产生缺血性改变。胃黏膜病变HP感染率较高,说明胃黏膜病变与HP之间存在着密切的关系。     

肝炎后肝硬变球结膜微循环改变58例

目的观察肝炎后肝硬变患者球结膜微循环的改变．方法肝炎后肝硬变患者58例，用裂隙灯显微镜放大35倍，在室温18℃～25℃条件下，观察患者球结膜微循环血流情况、血管形态、微动脉与微静脉的关系变化，撮其要可列四项病症即：①血流障碍；②血管宽窄不一；③毛细血管瘤；④动脉变窄再按其病变的轻重分级标记，便可了解病变的程度结果球结膜微循环可以反应全身病变的情况，正常球结膜微循环自然流畅，呈快速流动，一般如柳树的树枝，由粗到细自然分枝，愈向末梢愈细.肝炎后肝硬变是一种影响全身的慢性病，本组肝炎后肝硬变患者病程长，由于贫血、缺氧、凝血机制障碍、激素代谢紊乱、血液流变学异常，引起血流动力学的改变，球结膜微循环的血液流速变慢，毛细血管粗细不均，毛细血管瘤形成。在观察中可以看出，球结膜微循环的变化与食管静约曲张的程度有一定的可比性，肝功能的障碍可以引起球结膜做盾环的异常，临床上给与保肝、抗肝纤维化、抗门静脉高压等药物治疗，随着肝功能的好转，球结膜微循环有所改善结论肝炎后肝硬变球结膜的变化，可结合内镜下食管静脉曲张程度、形态、肝功能障碍以及血液流变学的改变，作为判断病情变化及预后的指标     

神农软肝丸治疗肝炎肝硬化的临床研究

目的:观察神农软肝丸治疗肝炎肝硬化的临床疗效及安全性。方法:选择肝炎肝硬化患者150例,随机分为两组,治疗组口服神农软肝丸,对照组采用一般常规疗法,疗程6个月。观察治疗后的症状体征、肝功能、血清病毒学指标、血清肝纤维化指标、门脉血流动力学指标和临床综合疗效。结果:治疗组和对照组总有效率分别达93.33%及82.67%,两组比较差异有显著性意义,治疗组明显高于对照组(P<0.05)。治疗组在减轻或消除症状体征、降低肝功能和血清肝纤维化指标、改善门脉血流动力学指标等方面明显优于对照组。未发生与研究药物相关的严重不良反应。结论:神农软肝丸治疗肝炎肝硬化疗效显著,安全性良好。     

彩色多普勒超声血流成像在门脉高压症中的应用

门脉高压可由多种疾病引起 ,彩色多普勒超声血流成像对病因诊断及血流动力学改变的研究均有助益。近年来出现的二次谐波技术和高性能的声学造影剂为鉴别肝内占位性病变及研究肝病时的血液动力学变化提供了更为有用的手段。现就彩色多普勒超声血流成像在门脉高压症诊断中的应用作一概要介绍。一、门脉高压的病因门脉高压形成大致可分为肝窦前性、肝窦性和肝窦后性阻塞 3种类型。肝窦前性门脉高压以血吸虫性肝硬化、门静脉栓塞为代表 ;肝窦性以肝炎后性、酒精性肝硬化为代表 ;肝窦后性以肝静脉栓塞或上腔静脉阻塞综合征 (Ｂｕｄｄ Ｃｈｉａｒ…     

卡托普利对早期肝炎肝硬化患者血流动力学及肝纤维化指标的影响

我们应用卡托普利治疗早期肝炎肝硬化26例取得较好疗效,观察其对血流动力学及肝纤维化指标影响.报告如下.     

门脉高压症

门脉高压症是肝硬化的重要并发症 ,可导致静脉曲张破裂出血、腹水和门脉高压性脑病等肝硬化其他并发症。肝内血流阻力增加和门静脉血流增加是门脉高压症的根本原因。内脏、体循环血管扩张和高动力循环是肝硬化门脉高压症的典型血流动力学异常。门脉高压是形成食道胃底静脉曲张的主要原因 ,高动力循环会促使曲张静脉破裂出血。血管扩张和神经激素系统的激活所致肝窦内高压和钠水潴留是腹水产生的原因。肝肾综合征是血管极度扩张的结果。有效血容量的显著下降激活缩血管系统 ,肾血管强烈收缩导致肾功能衰竭。自发性细菌性腹膜炎是一种具有致死性的腹水感染 ,不能找到局部感染源。门体分流性脑病是门体侧支循环的血液分流和肝功能不全所致的神经毒素在脑内聚集的结果。一、病理生理肝硬化是所有慢性肝脏疾病的终末阶段。门脉高压症是肝硬化的主要改变 ,可致其他并发症发生 :静脉曲张破裂出血、腹水和门体分流性脑病。(一 )肝内血流阻力增加　门脉压力增加是门脉血流阻力增加的结果。肝硬化时由于纤维组织增生和再生小结形成造成肝内结构紊乱 ,使门脉血流阻力增加。除了血流结构阻力外 ,血流阻力的改变还与肝内血管状况有关。导致血流阻力增加的是扩血管物质NO缺乏。应用NO可以降低肝...     

门静脉高压症血流动力学改变的发病机理

门静脉高压症（PHT）与肝内循环、体循环和门体侧支循环的血流动力学改变有关。肝内阻力增加和高动力循环侧支血管的扩张在门静脉高压的发病机理中起到了重要作用。不同严重程度的肝硬化均存在能广泛影响人体的血流动力学紊乱。门静脉高压和高动力循环是肝硬化患者发病和死亡的主要原因。而血管结构重塑和血管新生是治疗门静脉高压症的重要目标。     

病毒性肝炎重叠感染——附135例临床分析

本文采用美国Abbott公司、上海科华公司生产的抗—HCV药盒,病毒所抗—HDV HDAg药盒,以及本所生产的乙型肝炎药盒;测定了本所住院的不同肝病病人血清标本135例,其中肝硬化58例,肝癌34例,重症肝炎13例,慢活肝18例,慢迁肝12例。结果发现HCV感染,肝硬化50％,肝癌为41.1％,重症肝炎为15.3％,慢活肝为11.1％,肝硬化、肝癌明显大于其它组,P<0.01;HDV感染:肝硬化17.2％,肝癌11.7％,重症肝炎30.7％,慢活肝22.2％,重症肝炎、慢活肝组高于其它各组。     

消化系统疾病

792967 129例病理证实的五种肝病血清蛋白电泳的改变计叔钧等临床肝胆病杂志2(2):98～99,1986 五种肝病包括急性肝炎24例,慢迁肝22例,慢活肝57例,门脉性肝硬化14例,原发性肝癌12例,以醋酸纤维薄膜法电泳测定血清蛋白。结果:白蛋白降低以肝癌及肝硬化最多,急性肝炎最少,其顺序为肝癌>肝硬化>慢迁肝>慢活肝>急性肝炎,急性肝炎与慢活肝比有非常显著差异(P<0.01),肝癌与急性肝炎、慢活肝相比P<0.02及<0.025。     

活血养血中药为主逆转肝纤维化的组织学观察——附20例治疗前后肝穿活检结果分析

以养血活血中药为主,结合辨证论治治疗乙型肝炎20例,通过二次肝穿活检对其肝纤维化或肝硬化的组织学逆转进行了观察。其中,11例Ⅱ度肝纤维化患者治疗后有10例纤维组织减少至Ⅰ度,有效率为90.9％,碎屑样坏死和桥状坏死也明显减轻;9例肝炎后肝硬变患者中,8例假小叶消失,有效率为88.9％,但碎屑样坏死及桥形坏死的改变不明显。而且患者肝功能也得到同步改善。提示应用中药逆转肝纤维化具有广阔的前景。     

Clinical and pathological study of asymptomatic HBsAg carriers in Chile

A clinical, biochemical, and pathological study was performed in 38 chronic HBsAg carriers. The study group is a part of 393 carriers found among 117 705 voluntary blood donors at the National Blood Bank, Hospital del Salvador, Santiago, Chile. None of the 38 carriers had a past history of illicit drug abuse, hepatitis, or work involving a high risk of hepatitis B virus infection. Ten individuals had a normal liver biopsy, 17 reactive non-specific hepatitis, one fatty changes, four chr onic persistent hepatitis, one aggressive hepatitis, two post-necrotic cirrhosis, and three alcoholic cirrhosis. There was not a close correlation between liver function test and liver histology. The most significant laboratory finding was the postivity of alpha fetoprotein in two cases. During the follow-up the two alpha fetoprotein patients presented a hepatocarcinoma 12 and 14 months after admission to the study.     

乙型肝炎肝纤维化麻鸭球结膜微循环及血液流变学特点

目的:观察鸭乙型肝炎肝纤维化动物模型的球结膜微循环及血液流变学特点。方法:用鸭乙型肝炎病毒(DHBV)阳性血清反复攻击建立鸭乙型肝炎肝纤维化动物模型,并检测球结膜微循环、血液流变学指标,肝纤维化指标、肝脏病理组织学变化。结果:用DHBV反复攻击造模后,其病理组织学改变具有肝脏细胞炎症,肝纤维组织增生,血清肝纤维化指标升高(P<0.01),球结膜微循环明显障碍(P<0.01),血液流变学改变(P<0.01)。结论:乙型肝炎肝纤维化麻鸭具有明显的微循环障碍及血液流变学改变。     

慢性乙型肝炎及肝硬化患者肝脏微循环改变

为探讨慢性乙型肝炎（慢乙肝）及肝硬化患者的肝脏微循环状态。对141例慢乙肝、12例肝硬化患者和2例正常人的肝组织进行HE染色,光镜观察,并对其中53例慢乙肝和2例肝硬化患者的肝组织进行了电镜观察。结果显示,正常人的肝窦腔通畅,无狭窄和闭塞,无红细胞聚集现象。慢乙肝患者86.52%有肝窦腔狭窄,60.28%肝窦腔内见红细胞聚集,34.04%肝窦腔内有血栓形成;电镜观察见94.34%的患者肝窦内皮细胞窗孔减小减少,33.96%有基底膜形成,24.53%狄氏腔内出现胶原纤维。肝硬化患者肝组织结构紊乱,肝腺泡消失,假小叶形成。提示慢乙肝患者存在肝脏微循环障碍,肝硬化时肝脏微循环结构丧失。     

乙型肝炎肝硬化与酒精性肝硬化患者血小板相关参数变化的比较

探讨酒精性肝硬化及乙型肝炎肝硬化患者血小板计数（PLT）、血小板平均体积（MPV）变化的不同及其意义,采用库尔特血细胞全自动分析仪STKS型及其配套试剂,检测40例正常人与58例乙型肝炎肝硬化、44例酒精性肝硬化患者的外周血PLT、MPV,并比较出血组与无出血组的PLT、MPV的变化,发现乙型肝炎肝硬化患者MPV低于正常组,而酒精性肝硬化患者MPV高于正常组,出血组PLT、MPV比无出血组明显减少（P＜0.01和P＜0.05）.血小板参数PLT、MPV可作为肝硬化患者衡量出血倾向的指标之一,而乙型肝炎肝硬化与酒精性肝硬化患者MPV变化不一致,能反映血小板减少原因,对肝硬化血细胞减少患者是否选择脾切除术有一定意义.     

1052例肝炎肝内血管病变的形态观察

通过对１０５２例肝炎肝组织的ＨＥ，组织化学及免疫组织化学染色观察，发现其肝内血管有炎症，破坏，增生及阻塞四种病变，并制定了评级标准，结果表明；（１）急，慢性肝炎皆有血管炎症，破坏及阻塞病变，其随肝病变加重而上升（Ｐ〈０．００１）；（２）血管增生可导致弹力纤维及ＦＮ增多而引起肝硬化；（３）ＡＳＨ，ＳＳＨ及ＣＳＨ肝内血管明显破坏及阻塞而导致肝梗塞，预后不良，这些发现为肝炎病理机制的研究提供了形态学依据     

Estrogen receptors, progesterone receptors and heat-shock 27-kD protein in liver biopsy specimens from patients with hepatitis B virus infection.

It has been proposed that in the human liver, the estrogen receptor gene may become inappropriately expressed as a consequence of HBV integration, contributing to cell transformation. This study was undertaken to examine estrogen receptor status in patients with hepatitis B virus infection and to analyze the expression of progesterone receptor and of a heat-shock 27,000-D protein (hsp27), both of which are estrogen regulated in estrogen target tissues. Receptor proteins were detected in liver biopsy specimens by immunocytochemistry using antireceptor monoclonal antibodies; a monoclonal antibody was also used to detect hsp27. Estrogen receptor and progesterone receptor were mainly seen in the nuclei of hepatocytes. The presence of hepatitis B virus infection did not always result in elevated estrogen receptor expression, but in general the expression of this receptor protein was higher in hepatitis B virus-positive patients than in patients with the same pathological findings (hepatitis, cirrhosis, hepatocarcinoma) but without hepatitis B virus. This was more clearly seen in the patients with hepatitis. Although estrogen receptor expression was moderate to high in many samples, the expression of the two biochemical markers of estrogen action at postreceptor levels (progesterone receptor and hsp27) was low or absent in most of the liver tissues examined, suggesting that in the liver the interaction of estrogen-estrogen receptor-DNA has characteristics inherent to this tissue.     

Alterations of ATP Levels and of Energy Parameters in the Blood of Alcoholic and Nonalcoholic Patients with Liver Damage

Blood adenine nucleotides were determined in patients with alcoholic and non-alcoholic liver diseases. They included patients with alcoholic hepatitis (AH), alcoholic liver cirrhosis (ALC), non-alcoholic liver cirrhosis (NALC), and amoebic liver abscess (ALA) (28 patients). A decrease of 28% to 39% in blood ATP levels was observed among the patients with AH and the cirrhotic groups, respectively (p less than 0.05), whereas no significant changes in blood ATP levels were detected in the ALA group. Although total blood adenine nucleotides were significantly diminished in AH, ALC, and NALC groups, the AH patients retained their energy relationships within normal range. On the other hand, the cirrhotic groups, independently of their etiology, failed to maintain an adequate ATP/ADP ratio, energy charge, and phosphorylation potential in the blood, suggesting a decreased energy availability in their blood cells. Nevertheless, the mechanism involved in these effects remains to be elucidated, a failure of the damaged liver to supply purines to extra-hepatic tissues might be a major event altering the blood energy parameters.     

Prevalence and significance of the C virus antibody in chronic hepatopathy not related to B virus in alcoholics]

The presence of antibody to the hepatitis C virus was determined in 254 alcoholic patients with non-B chronic hepatitis and a titre of antinuclear antibodies of 1/40 or lower. Alcoholic hepatitis was present in 12 patients, steatohepatitis in 20, active chronic hepatitis in 22, cirrhosis in 181, and hepatocarcinoma in 19. Twenty patients had previously received blood transfusion alone or during surgery, 49 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 4 patients were drug addicts, 41 had received blood transfusion after the diagnosis was made, and 128 presented with alcoholism alone. Anti-hepatitis C antibody was found in 20 out of 2,000 blood donors (1%) in our hospital. Anti-hepatitis C antibody was found in 87 patients (34.2%) in our series, a figure unaltered by past medical history. Patients with anti-HC antibody had higher levels of AST, ALT, total proteins, gamma-globulin, and IgG. The incidence of active chronic hepatitis was higher among patients with anti-HC antibody, whereas the incidence of steatohepatitis was higher among patients without anti-HC. Regarding findings on liver biopsy, the incidence of anti-HC was significantly higher (p less than 0.001) among patients with active chronic hepatitis (72.7%) than in any other group; no significant differences were found between patients with cirrhosis (33.3%), hepatocarcinoma (31.5%), steatohepatitis (15%), or alcoholic hepatitis (16.7%). Among HBsAg-negative patients, the incidence of anti-HC was similar between those with (39.7%) and without other serum markers of HB (32.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

持续丙氨酸氨基转移酶正常乙型肝炎肝硬化的临床分析

目的探讨持续ALT正常乙型肝炎肝硬化患者的肝组织病理特征及其相关因素,为临床诊断及治疗提供参考。方法选取2005年1月-2012年12月住院的乙型肝炎肝硬化患者68例,对所有患者进行肝组织病理学检查,分析肝组织病理改变程度与患者年龄、HBV DNA载量、ALT水平的相关性。结果 30岁的肝组织病变以轻度为主,≥30岁且40岁者以中度病变为主,≥40岁者以重度病变为主(P0.05);当HBV DNA载量5×105拷贝/ml时,以重度改变为主(P0.05);ALT水平为0~20 U/L时肝组织以轻度病理改变为主,20~30 U/L以中度病理改变为主,30~40 U/L以重度病理改变为主(P0.05)。结论对ALT持续正常的肝硬化患者,应结合其年龄、HBV DNA载量及ALT水平综合评估,40岁以上、HBV DNA载量5×105拷贝/ml、ALT水平在30~40 U/L的患者,应行肝组织活检以明确疾病有无进展,即使不做肝组织活检,也应予以合理的抗病毒治疗。