心理智能测验检测肝动脉化疗栓塞对肝癌合并肝硬化患者亚临床肝性脑？…

用心理智能测验研究原发性肝癌合并肝硬化患者并发亚临床肝性脑病（ＳＨＥ）的情况,了解肝动脉化疗栓塞（ＴＡＣＥ）治疗对ＳＨＥ的影响,并探讨心理智能测验能否作为判断ＴＡＣＥ治疗后ＳＨＥ变化的指标。方法：用数字连接试验（ＮＣＴ）、数字符号试验（ＳＹｙ）与数字广度试验（ＤＳｐ）３种心理智能测验对８１例原发性肝癌合并肝硬化并接受ＴＡＣＥ治疗的患者及５０例对照进行检测,其中４８例患者在ＴＡＣＥ治疗后２周进行复查     

心理智能测验检测原发性肝癌并肝硬化患者并发亚临床肝性脑病的研究

目的 用心理智能测验的方法研究原发性肝癌合并肝硬化患者并发亚临床肝性脑病（ＳＨＥ）的情况。方法 用数字连接试验（ＮＣＴ）、数字符号试验（ＤＳＹ）中心理智能测验对８１例原发性肝癌并肝硬化２及５０例对照进行检测。结果 现代化且的各检测值存在明显差异,８１例患者中检出ＮＣＴ、ＤＳＹ和ＤＳＰ异常例数分别为６１（１９．８％）、１２（１４．８％）和１０（１２．３％）,共检出亚临床肝性病脑病２０例（２４．７％）     

抗病毒联合经导管肝动脉化疗栓塞治疗乙型肝炎后肝硬化合并肝细胞癌患者的临床观察

目的探讨抗病毒联合经导管肝动脉化疗栓塞(TACE)治疗在乙型肝炎后肝硬化合并肝细胞癌(HCC)患者中的临床疗效。方法回顾性分析抗病毒联合TACE治疗78例乙型肝炎后肝硬化合并HCC患者的临床疗效,并与同期单独行TACE患者81例对比,观察比较两组患者1、2年生存率、肝功能Child-Pugh积分及HBV DNA定量的变化。两组基线临床资料(如性别、年龄、肿瘤的大小、实验室检查及Child-Pugh评分)比较差异无统计学意义(P均>0.05)。结果治疗1、2年后,治疗组HBV DNA阴转率均显著高于对照组(P均<0.0001),肝功能Child-Pugh积分治疗组明显低于对照组(P均<0.001),差异均有统计学意义。治疗组和对照组1、2年生存率分别为83.33%、66.67%和59.2%、36.67%(P均<0.001),差异均有统计学意义。结论应用核苷酸类似物联合TACE治疗乙型肝炎后肝硬化合并HCC的患者,可抑制HBV复制,保护患者肝功能,提高患者生存率。     

肝硬化患者亚临床肝性脑病的诱发电位检测

目的 了解不同严重程度肝硬化患者亚临床肝性脑病的发生率及其临床意义。方法 对３０例无临床肝性脑病的肝炎后肝硬化患者同时进行脑干听觉、视觉和短潜伏期体感诱发电位（ＢＡＥＰ、ＶＥＰ、ＳＳＥＰ）检测。结果 三种脑诱发电位检测以ＢＡＥＰ异常率（４６．７％）高于ＶＥＰ和ＳＳＥＰ（均为３６．７％）;随着肝病程度加重,ＢＡＥＰ和ＳＳＥＰ异常率逐渐增高,分别为Ｃｈｉｌｄ－Ｐｕｇｈ Ａ级４１．７％和８．３％,Ｂ级４     

肝硬化患者的神经心理测验及轻微肝性脑病调查

轻微肝性脑病(minimal hepatic encephalopathy,MHE)是指在没有临床证据证实肝性脑病的肝硬化患者中可观测到的认知功能、电生理学参数、大脑神经化学/神经传递稳态、大脑血流、新陈代谢和体液稳态的轻微改变[1].近来的调查显示,半数以上肝病医生未进行MHE的检查[2].     

心理测验、视觉诱发电位检测亚临床肝性脑病的价值

探讨心理测验、视觉诱发电位检测在亚临床肝性脑病 (SHE)诊断中的意义。对 4 5例肝硬化患者及 30例正常人进行数字连接试验 (NCT) ,视觉诱发电位 (VEP)检测。研究其在亚临床肝性脑病诊断中的应用价值。肝硬化组NCT异常占 5 6 % (2 5 / 4 5 ) ,VEP异常占 4 9% (2 2 / 4 5 ) ,NCT和 (或 )VEP异常占 71% (32 / 4 5 ) ,两者均异常 33% (15 /4 5 ) ;对照组NCT异常占 30 % (9/ 30 ) ,VEP异常占 2 7% (8/ 30 )。两组比较差异有显著性意义 (P <0 0 5 )。NCT和VEP可用于诊断SHE ,联合检测可提高SHE检出率 ,对预防肝性脑病的发生有重要意义     

肝细胞癌切除术前应用肝动脉化疗栓塞术疗效的Meta分析

目的旨在评价肝动脉化疗栓塞术(TACE)在肝细胞癌(HCC)切除术前应用的疗效。方法计算机检索PubMed、Embase、Cochrane library、CNKI、VIP、万方数据库,截止日期到2013年3月12日。收集公开发表的关于HCC切除术前TACE治疗与单纯手术治疗比较的随机对照试验,对纳入的文献进行资料提取和质量评价,采用ReMan5.2软件进行统计分析。结果共纳入4个随机对照试验,共342例患者。Meta分析结果显示:术前TACE组与单用手术切除治疗HCC组相比,术后1、3、5年无瘤生存率的相对危险度(RR)[95%可信区间(CI)]分别为1.07(0.92~1.25)(P=0.38)、1.05(0.79~1.41)(P=0.72)、0.95(0.64~1.42)(P=0.81);1、3、5年总生存率的RR(95%CI)分别为1.01(0.92~1.10)(P=0.85)、1.14(0.97~1.34)(P=0.11)、0.95(0.75~1.21)(P=0.68);术后并发症发生率及病死率合并分析其相对危险度的RR(95%CI)分别为0.89(0.45~1.75)(P=0.73)、0.77(0.25~2.37)(P=0.65)。2组的术后1、3、5年无瘤生存率、总生存率及术后并发症发生率及病死率比较差异无统计学意义。结论HCC术前应用TACE不能提高术后无瘤生存率及总生存率。但是本研究中纳入的文献数及病例数均较少,尚需更多高质量的大样本临床随机对照试验进一步验证。     

探讨心理测验和脑诱发电位检测亚临床型肝性脑病的价值

目的评价心理测验和脑诱发电位检查诊断亚临床型肝性脑病（ＳＨＥ）的价值。方法对３６例肝炎肝硬化患者进行心理测验和三种脑诱发电位（ＥＰ）检查,并追踪１年观察临床肝性脑病（ＨＥ）出现情况。结果心理测验异常１６例（４４％）,其中言语智商异常１２例（３３％）,操作智商异常１４例（３８％）,三种ＥＰ总异常为１８例（５０％）,其中听觉诱发电位（ＢＡＥＰ）异常１２例（３３％）、视觉诱发电位（ＶＥＰ）异常３例（８％）、体感觉诱发电位（ＳＥＰ）异常６例（１６％）,心理测验和／或诱发电位异常２８例（７７％）,两者均异常者为１１例（３１％）,追踪观察１年的３４例患者中,２６例心理测验和／或脑诱发电位异常者出现临床肝性脑病１９例（７３％）,无心理测验和／或脑诱发电位检查异常８例中,出现临床肝性脑病２例（２５％）（Ｐ＜００５）。结论同时进行心理测验和脑诱发电位检查可提高ＳＨＥ检出率,检测ＳＨＥ对预测肝性脑病的发生有临床价值。     

Gastroduodenal Lesions after Transcatheter Arterial Chemo-embolization in Patients with Hepatocellular Carcinoma

We investigated the incidence and endoscopic features of gastroduodenal lesions which appeared after transcatheter arterial chemo-embolization (TACE), performed 29 times in 25 patients with inoperative hepatocellular carcinoma. The new development or exacerbation of the gastroduodenal lesions after TACE was evident in 13 of the 29 (45%). The side of the lesions ranged from the gastric body to the second portion of the duodenum, and the lesions that developed were multiple ulcers in four, and multiple erosions with white coat in nine. The development of these gastroduodenal lesions may be due to mucosal ischemia caused by embolic materials, the toxic effect of antineoplastic drugs infused, or to stress. In light of these events, upper gastrointestinal endoscopy should be added to the usual examinations done for patients undergoing TACE.     

Effects of Transcatheter Hepatic Arterial Embolization on Coagulation and Fibrinolysis in Patients with Hepatocellular Carcinoma

The changes in coagulation and fibrinolysis were studied in cases of hepatocellular carcinoma with (n = 20) and without (n = 8) transcatheter hepatic arterial embolization (TAE). The plasma levels of thrombin-antithrombin III complex (TAT) and alpha 2 plasmin inhibitor complex (PIC) were significantly elevated after TAE, concurrently with a decrease in antithrombin III and antiplasmin (alpha 2-plasmin inhibitor) levels. The elevation of TAT was most significant (2.4-fold of the pre-TAE level) on day 3, whereas that of PIC was relatively less (1.3-fold on day 3). Tissue plasminogen activator in blood was also significantly increased on day 1, but it was decreased thereafter, although plasminogen activator inhibitor (PAI) remained high for at least 7 days after TAE. In contrast, such hematological changes were not observed in patients without TAE. Thus, both coagulation and fibrinolysis were activated after TAE, but its effect on fibrinolysis was less prominent, due probably to the increased synthesis of PAI.     

探讨心理测验和脑诱发电位检测亚临床型肝脑的价值

为评价心理测验和脑诱发电位检查诊断亚临床型肝性脑病（ＳＨＥ）的价值。对３６例肝炎肝硬化患者进行心理测验和三种脑诱发电位（ＥＰ）检查,并追路过１年观察临床肝性脑病（ＨＥ）出现情况。结果心理测验异常１６例（４２％）,ＥＰ８总异常为１８例（５０％）。心理测验和／或诱发电位异常２８例（７７％）,两者均异常者为１１例（３１％）。追踪观察１年的３４例患者中,２６例心理测验和／或脑诱发电位异常者出现临床肝性脑病     

肝癌患者动脉化疗栓塞治疗后上消化道粘膜损害

本文对17例肝癌患者行20次肝动脉化疗栓塞(TACE)后上消化道粘膜损害的发生率和内镜下特征进行初步探讨。TACE后有12例次出现新的上消化道粘膜损害或原病损加剧占60％,损害部位自食道至十二指肠降部,粘膜呈弥漫性或局灶性。粘膜损害呈不规则充血、水肿、糜烂和粘膜下出血灶。分析其损害原因可能与栓塞物质造成粘膜缺血、抗癌药物毒性作用和应激反应有关,鉴此,在行TACE术前建议应常规做胃镜检查。     

Transcatheter Arterial Chemoembolization Therapy for Patients With Unresectable Hepatocellular Carcinoma

Background:

Although transcatheter arterial chemoembolization (TACE) has been widely used as a palliative treatment for unresectable hepatocellular carcinoma (HCC), its actual efficacy and prognostic usefulness have not been clarified in past studies.

Objectives:

The aim of the study is to investigate the efficacy, complications, and prognostic factors of the TACE in unresectable HCC patients.

Patients and Methods:

Thirty-two patients with unresectable HCC were treated with TACE. The procedure was performed with a combination of Lipiodol, doxorubicin, and cytomycin followed by gelatin-sponge particles embolization. CT-scan imaging and liver function tests (AST, ALT, ALP, BIL, and PT) were performed before and after the TACE. All patients were followed-up for 6-months.

Results:

Of all patients, 1 and 11 patients respectively, exhibited a complete response (CR) and a partial response (PR) (response rate, CR+PR, 44%). Data have shown that tumor size, number of lesions and number of involved segments are significantly reduced after the TACE performance (P < 0.05). No significant clinical adverse effect was observed in patients after the intervention. Also, liver function tests including AST, ALT, ALP, BIL, and PT did not significantly differ before and after the intervention (P > 0.05). The 6-month cumulative survival rates of the 32 patients were 78.1 %, respectively. Univariate analysis showed that survival correlated significantly with the following factors: tumor size; ≥ 8 cm versus < 8 cm (P < 0.010), serum ALP level; < 300 versus ≥ 300 (P < 0.043), and number of liver involved segments; < 2 versus ≥ 2 (P < 0.020).

Conclusions:

We showed that in treatment of patients with unresectable hepatocellular carcinoma, TACE significantly improved the disease and the overall survival rate. Also, we introduce the tumor size, serum ALP level, and number of liver involved segments as prognostic factors of the procedure. Finally, TACE can be recommended as the initial treatment for unresectable HCC patients.     

Prognostic Index of Cirrhotic Patients with Hepatic Encephalopathy with and Without Hepatocellular Carcinoma

This study was carried out in Japanese patients to clarify the state of liver cirrhosis complicated by hepatic encephalopathy with and without hepatocellular carcinoma and its prognosis. The subjects were 100 patients with liver cirrhosis complicated by hepatic encephalopathy. Clinical data were investigated, and prognostic factors were extracted using Cox's proportional hazard model. The cumulative survival rate after the first episode of hepatic encephalopathy was 59.1% after 1 year, 48.3% after 2 years, and 22.2% after 5 years. The prognostic index (PI) was calculated using the following formula consisting of these six factors. PI = 0.806 x Child-Pugh classification + 1.149 x presence or absence of HCC + 0.024 x BUN + 0.036 x LDH + 0.093 x WBC + 0.381 x PIVKA-II. The PI value was suggested to be useful for the prognosis of liver cirrhosis after the first episode of hepatic encephalopathy.     

Left Brachial Approach for Transcatheter Arterial Embolization with Hepatocellular Carcinoma Therapy in Patients

We evaluated the efficacy of thelipiodol-transcatheter arterial embolization (L-TAE)technique for hepatocellular carcinoma (HCC) performedusing a left brachial approach. A total of 64 procedureswere performed using the brachial route in 53patients with HCC between 1989 and 1996 using a 4-Frenchcatheter and these patients were retrospectivelystudied. The technical success rate was 95.3%. Theoverall complication rate was 31.3%: fever of over38.0°C lasting longer than three days (18.8%),transient neurologic complications (4.7%), andpancreatitis (1.6%). Complications such as lumbago, backpain, and dissection of the celiac artery or itsbranches, which frequently complicated femoralapproaches, were avoided. These data indicate that L-TAEusing the left brachial approach may be a safe andeffective alternative to the transfemoral approach inpatients with HCC.     

Predictors of Minimal Hepatic Encephalopathy in Patients with Cirrhosis

Background/Aim:

Minimal hepatic encephalopathy (MHE) impairs patient’s daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated.

Patients and Methods:

A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by psychometry, P300 auditory event-related potential (P300ERP) and critical flicker frequency (CFF). MHE was diagnosed by abnormal psychometry (>2 S.D.) and P300ERP (>2.5 S.D.). Univariate and multivariate logistic regression analyses were performed to determine the predictors of MHE.

Results:

Eighty-two (41%) patients were diagnosed to have MHE – 26/74 (35%) in Child A, 26/72 (36%) in Child B and 30/54 (56%) in Child C. Ninety-seven (48.5%) patients had abnormal psychometric tests, and 96 (48%) had prolonged P300ERP (>358 ms). Sixteen (16.5%) patients with abnormal psychometry had P300ERP < 358 ms, and 15 (14.5%) patients with normal psychometry results had P300ERP > 358 ms. One hundred and three patients had CFF value < 39 Hz with specificity of 86.6% and sensitivity of 72.9% for MHE. Model for end-stage liver disease (MELD) (17.9 ± 5.7 vs. 13.4 ± 4.2, P = 0.005), Child-Turcotte-Pugh (CTP) score (8.4 ± 2.5 vs. 7.7 ± 2.2, P = 0.02), ammonia (104.8 ± 37.9 vs. 72.5 ± 45.2 µmol/L, P = 0.001) and CFF (37.0 ± 2.8 vs. 41.0 ± 3.4 Hz, P = 0.001) were significantly higher in MHE as compared to non-MHE patients. Ninety-one (45.5%) patients had MELD > 15.5, 115 (57.5%) had CTP score > 7.5, while 93 (46.5%) had venous ammonia > 84.5 µmol/L. On univariate analysis, MELD (8.52 [95% CI, 4.46-16.26; P = 0.001]), CFF (17.34 [95% CI, 8.16-36.85; P = 0.001]) and venous ammonia (7.80 [95% CI, 4.11-14.81; P = 0.003]) were associated with MHE; while CTP score (1.51 [95% CI, 0.85-2.69; P = 0.30]) was not significant. On multivariate analysis, MELD, CFF and venous ammonia were predictive of MHE.

Conclusion:

Prevalence of MHE in this study was 41%; and MELD > 15.5, CFF < 39 Hz and venous ammonia > 84.5 µmol/L were predictive of MHE.     

Efficacy of Lactulose in Cirrhotic Patients with Subclinical Hepatic Encephalopathy

To investigate the role of lactulose in the treatment of cirrhotic patients with subclinical hepatic encephalopathy (SHE), 40 cirrhotic patients, 33 males and 7 females, were included in the study. The diagnosis of SHE was made by quantitative psychometric tests including the number connection test (NCT), figure connection test (FCT) parts A and B, and two performance subtests of Wechsler adult intelligence scale, ie, picture completion (PC) and block design (BD) tests. SHE was diagnosed in 26 (65%) of 40 patients. Of these 26 patients, 14 patients were randomized to treatment group (lactulose 30–60 ml/day for three months, SHE-L) and 12 patients to no treatment group (no lactulose, SHE-NL). Psychometric tests were repeated in all patients in both groups and in six patients with no SHE (group NSHE, N = 14) after three months. The mean scores and number of the abnormal psychometric tests at entry were significantly higher in patients in groups SHE-L and SHE-NL than in patients in group NSHE; however, there was no significant difference between SHE-L and SHE-NL. The mean number of the abnormal psychometric tests decreased in patients in group SHE-L after three months of treatment with lactulose (2.9 ± 0.9 vs 0.8 ± 1.2; P = 0.004); however, there was no change in patients in group SHE-NL after three months (3.7 ± 1.5 vs 3.5 ± 1.3; P = NS). While SHE improved in 8 of 10 patients in group SHE-L, none of the patients in group SHE-NL improved after three months of follow-up (P < 0.001). Two patients in group SHE-NL also developed overt encephalopathy during the study period. We conclude that lactulose treatment in cirrhotic patients with SHE is effective.