骨关节炎滑膜细胞分泌肿瘤坏死因子的生物学特征研究

目的 探讨滑液中肿瘤坏死因子（ｔｕｍｏｒ ｎｅｃｒｏｓｉｓ ｆａｃｔｏｒ－α,ＴＭＦ－α）生物活性及滑膜细胞分泌ＴＮＦ－α能力的变化在骨关节炎（ｏｓｔｅｏａｒｔｈｒｉｔｉｓ,ＯＡ）致病机制中的作用。方法 应用ＴＮＦ－α对Ｌ９２９细胞杀伤作用的比色法,检测并比较分析ＯＡ与不同年龄、不同形式关节内创伤时滑液和血清中ＴＮＦ－α生物活 ,以及培养的ＯＡ、急性关节内创伤和正常滑膜细胞自分泌及诱生性ＴＮＦ－α     

大鼠阻塞性黄疸小肠组织中细胞间粘附分子-1和肿瘤坏死因子-α的表达及其意义

目的　探讨大鼠阻塞性黄疸小肠组织中细胞间粘附分子 1(ICAM 1)和肿瘤坏死因子 α(TNF α)的表达及意义。方法　选SD大鼠 2 4只 ,用随机排列表法均分成假手术组 (SO组 )和阻塞性黄疸组 (BDL组 ) ,每组术后再随机分设 7d和 14d两个时相点。应用免疫组化的方法观察小肠组织中ICAM 1表达的变化 ,采用双抗体夹心ELISA法测定TNF α含量 ,同时检测小肠组织中髓过氧化物酶 (MPO)活性、小肠组织和血浆中二胺氧化酶 (DAO)活性。结果　胆总管结扎后 7d、14d ,ICAM 1表达主要在小肠粘膜上皮细胞 ,且表达逐渐增强 (P<0 .0 5 ) ;小肠粘膜TNF α的含量逐渐上升 ,分别为 ( 14 .2 5± 1.0 1)ng/ g和 ( 2 3.83± 1.4 3)ng/ g(P<0 .0 1) ;小肠DAO的活性逐渐降低 ,分别为 ( 1.70± 0 .36 )U/mg和 ( 1.2 2± 0 .4 1)U/mg(P <0 .0 1) ;血浆DAO活性逐渐升高 ,分别为 ( 6 .4 4± 1.74 )U/ml和 ( 8.93± 1.2 9)U/ml(P<0 .0 1) ;MPO活性逐渐增高 ,分别为 ( 2 .85± 1.2 2 )U/mg和 ( 4 .93± 1.37)U/mg(P<0 .0 1)。结论　阻塞性黄疸时小肠组织的ICAM 1表达显著上调和小肠粘膜TNF α含量显著升高 ,参与了中性粒细胞介导的小肠粘膜损伤。     

丙泊酚中长链脂肪乳对梗阻性黄疸患者手术时肝功能影响

目的：观察丙泊酚中长链脂肪乳剂对梗阻性黄疸患者行胆管探查术时肝功能影响。方法：择期行开腹胆管探查术患者40例,ASAII～III,随机分为A、B两组。A组采用1%丙泊酚长链脂肪乳注射液行麻醉维持,B组采用1%丙泊酚中/长链脂肪乳注射液行麻醉维持。连续监测心电图、血压、血氧饱和度,于术前和术毕测定肝功能各项指标。结果：两组术毕肝功能血清ALT、AST、TBIL和DBIL均升高;但B组与A组相比,其上述4项指标上升幅度明显低于A组（P〈0.05）。结论：丙泊酚中长链脂肪乳剂对梗阻性黄疸患者行胆管探查术时肝功能影响小。     

The Protective Effect of Ellagic Acid on Lung Damage Caused by Experimental Obstructive Jaundice Model

Aim : This study aimed to investigate protective effects of ellagic acid on lungs in an experimental obstructive jaundice model.

Methods : Four groups were established, each consisting of ten randomly selected rats: Group 1: sham, Group 2: ellagic acid, Group 3: obstructive jaundice, and Group 4: obstructive jaundice + ellagic acid. Ellagic acid was administered orally at a dose of 60 mg/kg/day to group 2 and 4. The animals were sacrificed eight days later. The total oxidative status and the total antioxidant capacity in their lung tissue were determined, and malondialdehyde levels in their blood were measured. Histopathological changes in the lungs were examined.

Results : In the obstructive jaundice group treated with ellagic acid, there was a decrease in malondialdehyde levels and a reduction in the total oxidative status and the oxidative stress index, whereas the total antioxidant capacity increased (p < 0.001). The histopathological examination showed that neutrophil leukocyte infiltration and edema formation decreased and destruction of lung parenchyma disappeared following the treatment with the ellagic acid (p < 0.05). Conclusion : This study shows that ellagic acid has a protective effect against oxidative damage in lung tissue in obstructive jaundice.     

胆汁回输对梗阻性黄疸患者红细胞免疫功能的影响

目的探讨梗阻性黄疸患者行胆道外引流术后胆汁回输对红细胞免疫功能的影响。方法将行胆道外引流的梗阻性黄疸患者分为胆汁回输组(n=24)和单纯外引流组(n=27)，并随机选择同期无黄疸的胆囊切除术患者(n=25)作为对照组。观察手术前、后红细胞C3b受体花环试验(C3bRRT)、红细胞免疫复合物花环试验(ICRT)、红细胞cab受体花环促进率(RFER)和红细胞cab受体花环抑制率(RFIR)的变化。结果术前，胆汁回输组及单纯引流组患者C3bRRT和RFER均明显低于对照组．ICRT及RFIR活性均明显高于对照组；术后第14天胆汁回输组C3bRRT明显高于单纯引流组(P＜0．05)。结论梗阻性黄疸患者红细胞免疫功能被抑制，在胆道外引流术后行胆汁回输有利于红细胞免疫功能的恢复。     

阻塞性黄疸时L-精氨酸对肾功能的保护作用

目的：研究阻塞性黄疸（OJ）时，L－精氨酸（L－Arg)对肾功能的保护作用。方法：胆总管结扎大鼠30只，随机分成生理盐水对照（NS）组、L－精氨酸（L－Arg)组和L－硝基精氨酸（L－NNA）组，每组10只。胆总管结扎后第2天起分别腹腔注射1ml NS、1ml L-Arg(500mg/kg)、1ml L-NNA(10mg/kg)，连用9d；假手术（SO）组用1ml NS腹腔注射。观察各组肾功能的变化，同时测定血和肾组织内皮素（ET）、一氧化氮（NO）水平、一氧化氮合酶（NOS）活性和丙二醛（MDA）的含量。并用图像分析检测ET1 mRNA和NOS mRNA表达的部位及量的变化。结果：用L－Arg后，血和肾组织NOS活性增加，肾组织ET1 mRNA表达减少，血和肾组织ET下降，NO升高；同时伴有内生肌酐清除率（Ccr)、肾皮质平均血流（RCBF）的升高，肾组织MDA含量降低。结论：L－Arg通过增强血和肾组织NOS活性来增加体内NO水平、抑制ET1 mRNA表达、降低体内ET水平，从而提高Ccr与RCBF，减轻阻塞性黄疸时的肾功能损伤。     

Surgical Intervention for Obstructive Jaundice Due to Biliary Tumor Thrombus in Hepatocellular Carcinoma

This retrospective study in eight surgically treated patients with obstructive jaundice due to biliary tumor thrombus in a patient with hepatocellular carcinoma (HCC) was performed to evaluate the role of surgical intervention. All biliary tumor thrombi were confirmed preoperatively or intraoperatively. Only two manifested intraluminal biliary obstructions due to a primary tumor that had not been found preoperatively. The operative procedures included hepatectomy with removal of the biliary tumor thrombus (n = 3), hepatectomy combined with extrahepatic bile duct resection (n = 1), thrombectomy through a choledochotomy (n = 3), and piggyback orthotopic liver transplantation (n = 1). The 1- and 3-year survival rates were 62.5% and 37.5%, respectively. Two patients survived more than 5 years. Surgical intervention was effective in patients with obstructive jaundice due to a biliary tumor thrombus in an HCC. Thus surgery for a recurrence can prolong survival, and liver transplantation is a treatment worthy of further investigation.     

The Effect of Calcium Dobesilate on Liver Damage in Experimental Obstructive Jaundice

Purpose/Aim of the study: Inflammation and oxidative stress are two significant factors affecting the degree of liver damage in obstructive jaundice. The aim of this study was to evaluate the effect of calcium dobesilate (CaDob), an effective antioxidant and anti-inflammatory drug, on damage to liver caused by experimental obstructive jaundice. Materials and Methods: 30 rats in total were randomly placed into three groups, each group consisting of 10 rats. The sham group (Group 1) only received solely laparotomy. In the control group (Group 2), ligation was applied to the biliary tract and no treatment was implemented. In the CaDob group (Group 3), following ligation of the biliary tract, 100 mg/kg/day CaDob was implemented via an orogastric tube for a 10–day period. Liver tissue and blood samples were taken for histopathological and biochemical examination. Results: The CaDob group had significantly lower test values for serum liver functions when compared to the control group. Statistically lower levels of tissue malondialdehyde (MDA) and fluorescent oxidation products (FOP) were detected in the CaDob group, and the CaDob group had significantly higher levels of sulfydryl (SH) than the control group. Histopathological scores in the CaDob group were found out to be statistically less than the scores the control group received (p < 0.05). Conclusions: CaDob treatment repaired the histpatological changes induced by bile duct ligation. The hepatoprotective effects of CaDob can be associated with its antioxidant properties of the drug.     

谷氨酰胺对阻塞性黄疸大鼠免疫功能的影响

目的 探讨谷氨酰胺对阻塞性黄疸大鼠免疫功能的影响和机理。方法 健康雄性Wistar大鼠50只，按随机数字表随机分成空白对照组（n=10）、阻塞性黄疸组（n=20）和谷氨酰胺治疗组（n=20）。血清TNF-α和IL-10水平测定用放射免疫法，肝功能用自动生化分析仪测定，同时检测细菌移位情况。结果 阻塞性黄疸组在制模后1、2周血清TNF-α较空白对照组明显下降，血清IL-10水平、TBIL、ALT及AST较空白对照组明显升高；而在应用谷氨酰胺后1、2周血清TNF-α较空白对照组和阻塞性黄疸组有明显升高，IL-10、TBIL、ALT及AST较阻塞性黄疸组明显下降，细菌移位较阻塞性黄疸组也明显减少。结论 谷氨酰胺能够改变阻塞性黄疸大鼠血清TNFa、IL-10功能的变化，增强大鼠免疫功能，减少肠道细菌移位。     

当归对阻塞性黄疸患者淋巴细胞IL-2活性和IL-2R表达的影响

目的探讨围手术期当归对阻塞性黄疸患者细胞免疫功能的调节作用。方法用当归注射液围手术期对患者进行治疗（共14d）,观察其外周血淋巴细胞IL-2的活性及IL-2R表达的变化。结果阻塞性黄疸患者血淋巴细胞IL-2活性及IL-2R表达阳性率与正常人相比均明显下降（P〈0.01）。给予当归治疗后,发现术前其IL-2活性及IL-2R表达阳性率均明显升高（P〈0.01）,术后其IL-2活性及IL-2R表达阳性率与术前相比虽略有下降,但与用药前相比仍有明显升高（P〈0.01）。结论围手术期应用当归具有改善阻塞性黄疸患者细胞免疫功能状态的临床实用价值。     

阻塞性黄疸对肠道细菌及小肠粘膜组织的影响

为探讨阻塞性黄疸（简称阻黄）对肠道细菌及粘膜组织的影响，通过建立阻黄动物模型，观察阻黄大鼠肠道细菌移位以及小肠粘膜组织学变化。结果发现：阻黄组（ＢＤＬ）术后３周厌氧性细菌移位的阳性率（４３．７５％）显著高于假性手术组（ＳＬ）（０％），Ｐ＜０．０５；组织学检查显示ＢＤＬ组肠粘膜发生了实质性损害。提示：阻黄时肠道内胆盐缺乏导致肠道常驻菌过度繁殖，肠道粘膜屏障的损害以及机体免疫功能抑制可能是促进肠道细菌移位，导致阻黄时感染易感性增高的主要原因     

黄芪对梗阻性黄疸大鼠肝功能的保护作用

目的:探讨黄芪注射液对实验性梗阻性黄疸大鼠肝功能的保护作用及作用机理.方法:SD大鼠行胆总管结扎后分别用3 mL黄芪注射液或生理盐水腹腔注射.术后测定血浆内皮素(ET-1)、血清超氧化物歧化酶(SOD)、丙二醛(MDA)含量,同时测定谷丙转氨酶(AST)、直接胆红素(DB)和总胆汁酸(TBA)浓度,并对肝脏行光镜下病理形态学观察.结果:血浆ET-1、血清MDA浓度在梗阻10 d即升高,随胆道梗阻时间延长进一步升高,SOD在梗阻10 d即下降,同时伴有血清AST、DB和TBA的升高和肝脏病理形态学的进行性改变.黄芪治疗组ET-1及MDA显著低于对照组,而SOD显著高于对照组,并能改善肝组织病理形态.结论:大鼠梗阻性黄疸时,血浆ET-1水平升高及氧自由基损害可能是肝损伤的原因,黄芪通过降低ET-1水平、抗氧化作用对梗阻性黄疸大鼠的肝脏起保护作用.     

黄芪对梗阻性黄疸大鼠肾功能的保护作用

目的:探讨黄芪对梗阻性黄疸大鼠肾功能的保护作用及机理.方法:SD大鼠胆总管结扎后分2组,每组20只,术后分别用3 mL黄芪或生理盐水腹腔注射.假手术组20只.术后10 d、20 d(每小组n=10)心脏取血测定血浆内皮素(ET-1)、血清超氧化物歧化酶(SOD)和丙二醛(MDA)含量,同时测定血清肌酐(Cr)尿素氮(BUN)和直接胆红素(DB),对肾脏行病理形态学观察.结果:血浆ET-1、血清MDA浓度在梗阻10 d即升高且随胆道梗阻时间延长进一步升高,SOD在梗阻10 d即下降,同时伴有血清Cr、BUN、DB的升高和肾脏病理形态学的进行性改变.黄芪治疗组ET-1及MDA显著低于对照组,而SOD显著高于对照组,并能改善肾组织病理形态.结论:大鼠梗阻性黄疸时血浆ET-1升高及氧自由基损害是肾损伤的原因,黄芪通过降低ET-1水平、抗氧化作用对梗阻性黄疸大鼠肾脏起保护作用.     

褪黑素对大鼠梗阻性黄疸肾损害的保护作用

目的　探讨一氧化氮 (NO)在大鼠梗阻性黄疸肾功能损害发生中的作用 ,以及褪黑素 (melatonin ,Mel)的保护作用。方法　 6 4只雄性SD大鼠随机均分为 4组 :正常对照组 (CN组 )、假手术组 (SO组 )、胆总管结扎组(BLD组 )和褪黑素治疗组 (BDL +Mel组 )。应用胆总管结扎法建立梗阻性黄疸模型 ,分别于手术后第 4天和第 8天两个时间点检测 4组中血浆NO、TB、DB、ALT、AST、BUN、Cr水平以及肾组织中NO水平和iNOS活性 ;光镜下观察肾组织病理形态改变。结果　BDL组大鼠血浆NO、TB、DB、ALT、AST、BUN、Cr水平和肾组织NO水平及iNOS活性明显升高 (P<0 .0 1) ,褪黑素治疗可使血浆NO、ALT、AST、BUN及Cr水平和肾组织中NO水平及iNOS活性显著降低 ,与BDL组比较差异有显著性意义 (P<0 .0 1)。结论　梗阻性黄疸时 ,肾组织iNOS活性增强 ,NO大量产生参与了肾功能损害的发生、发展 ;褪黑素对大鼠梗阻性黄疸肾损害的保护作用至少部分是通过干扰NO通路实现的。     

内皮素在大鼠梗阻性黄疸肝脏损伤中的作用

目的：观察大鼠胆管梗阻后内皮素在肝组织及血液中的分泌状况及甘胆酸的变化，探讨内皮素与甘胆酸之间的关系。方法：用放射免疫法观察大鼠胆管梗阻后5、10、15、20、25天时血及肝组织中内皮素含量，组织病理切片观察肝脏的病理改变。结果与结论：内皮素含量随梗阻性黄疸后时间延长而递增,与甘胆酸升高水平呈正相关（P＜0.01），说明内皮素可能是参与梗阻性黄疸致肝脏损伤的重要因素之一。     

Systemic Toxicity and Cytokine/Acute Phase Protein Levels in Patients After Isolated Limb Perfusion With Tumor Necrosis Factor-a Complicated by High Leakage

Background: Since the introduction of high-dose tumor necrosis factor- (TNF) in the settingof isolated limb perfusion (ILP) in the clinic, prevention of leakage to the body of the patient ismonitored with great precision for fear of TNF-mediated toxicity. That we observed remarkablylittle toxicity in patients with and without leakage prompted us to determine patterns of cytokinesand acute phase proteins in patients with high leakage and in patients without any leakage.Methods: TNFa, interleukin (IL)-6, IL-8, C-reactive protein, and secretory (s)-phospholipase A2 weremeasured at several time points during and after (until 7 days) ILP in 10 patients with a leakage to thesystemic circulation varying in percentage from 12% to 65%. As a control, the same measurements, bothin peripheral blood and in perfusate, were performed in nine patients without systemic leakage.Results: In patients with systemic leakage, levels of TNFaincreased during ILP, reaching valuesto 277 ng/ml. IL-6 and IL-8 peaked 3 hours after ILP with values significantly higher compared withpatients without systemic leakage. C-reactive protein and s-phospholipase A2 peaked at day 1 inboth patient groups, s-phospholipase A2 with significant higher levels and C-reactive protein, incontrast, with lower levels in the leakage patients.Conclusions: High leakage of TNF to the systemic circulation, caused by a complicated ILP,led to 10-fold to more than 100-fold increased levels of TNF, IL-6, and IL-8 in comparison withpatients without leakage. The increase of the acute phase proteins was limited. Even when highleakage occurs, this procedure should not lead to fatal complications. The most prominent clinicaltoxicity was hypotension (grade III in four patients), which was easily corrected. No pulmonary orrenal toxicity was observed in any patient. It is our experience that, even in the rare event ofsignificant leakage during a TNF-based ILP, postoperative toxicity is usually mild and can beeasily managed by the use of fluid and, in some cases, vasopressors.     

The Effects of Dimethylsulfoxide in Experimental Obstructive Jaundice

Material and methods: Thirty rats were divided into three groups, as sham, control and DMSO groups. Laparatomy was performed on each animal in the control and DMSO groups and common bile ducts were ligated. Common bile duct was observed but was not ligated for the rats in the sham group. Saline solution injection (1.5 mg/kg/intraperitoneally (ip)) was begun on the first day of surgical procedure and repeated once a day for the next 5 days. The same procedure was performed with DMSO (1.5 mg/kg/ip) instead of saline in the DMSO group. The rats were sacrificed on the postoperative seventh day, at which time venous blood and liver tissue specimens were taken. Main outcome measurements: On the 7^th postoperative day, the bilirubin, AST, ALT, ALP and GGT levels of the control and DMSO groups were significantly higher in comparison with the sham group (p < 0.01). On the 7^th postoperative day, the erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels of the control and DMSO groups were significantly lower than those of the sham group (p < 0.01), but there was no statistical difference between the two groups (p > 0.05). Erythrocyte and liver malondialdehyde (MDA) levels in the control and DMSO groups were significantly higher compared with the sham group (p < 0.01). However, the MDA levels were significantly lower in the DMSO group compared to the control group (p < 0.01).

Conclusion: It is stated that free oxygen radicals seem to play a role in the liver tissue injury, secondary to obstructive jaundice. In our experimental study, exogenic DMSO seems to have decreased lipid peroxidation and to have improved some of the parameters of liver tissue injury due to the obstructive jaundice in rats.     

婴儿梗阻性黄疸诊断与治疗探讨

目的：探讨ECT对婴儿梗阻性黄疸诊断、及鉴别诊断的价值，对临床治疗方法进行评价。方法：应用ECT核素对22例己诊断为梗阻部位和性质。结果：8例胆道延时，核素显像为胆汁淤滞型阻塞型黄疸。其中5例因黄疸加重行经套针胆囊内置管加压冲洗治愈，3例药物治愈。14例为先天性胆道闭锁（肝外型8例、肝内型6例），有肝胆显像，但肠道不显像。其中12例（肝外型8例、肝内型4例）行Kasai手术，术后均有胆汁排出，4例术后死亡，3例因胆瘘再次行肝门空肠吻合术均死亡，手术后存活5例（35%）。另外2例未及手术者死于肝衰竭。结论：ECT核素延迟显像可鉴别梗阻性黄疸的性质和部位。年龄小于60d的胆汁淤滞性黄疸患儿先应以药物抗感染、保肝、中药、利胆素及地塞米松适量应用治疗2周，如胆红素升高则手术治疗。先天性胆道闭锁患儿应在适当药物治疗尽早手术。