低密度脂蛋白免疫复合物对小鼠腹腔巨噬细胞胆固醇酯蓄积和一氧化氮释放的影响

目的 探讨低密度脂蛋白免疫复合物对小鼠腹腔巨噬细胞胆固醇酯的蓄积和一氧化氮释放的影响。方法 密度梯度超速离心从新鲜人血浆分离天然低密度脂蛋白，与抗低密度脂蛋白抗血清IgG组分制备低密度脂蛋白免疫复合物，低密度脂蛋白免疫复合物与小鼠腹腔巨噬细胞孵育后采用酶荧光法检测细胞胆固醇酯含量，进行细胞形态学观察和组织化学分析．并用硝酸还原酶法测定细胞释放至培养基中的一氧化氮量。结果 低密度脂蛋白免疫复合物剂量依赖性地诱导巨噬细胞内胆固醇酯的大量堆积，其效应显著强于氧化型低密度脂蛋白（P〈0．01）。经低密度脂蛋白免疫复合物处理的巨噬细胞呈典型泡沫细胞状，与猩红强染色，而天然低密度脂蛋白、抗低密度脂蛋白IgG处理的巨噬细胞内未见胆固醇酯的蓄积。此外，低密度脂蛋白免疫复合物剂量依赖性地抑制巨噬细胞一氧化氮的分泌。结论 低密度脂蛋白免疫复合物不仅通过致小鼠腹腔巨噬细胞泡沫化，也通过损伤巨噬细胞分泌一氧化氮的功能参与致动脉粥样硬化作用。     

蒙药总黄酮对淋巴细胞转化和巨噬细胞吞噬功能的影响

目的探讨蒙药总黄酮对淋巴细胞转化和巨噬细胞吞噬功能的影响。方法分别给予昆明种小鼠2210、442、44．2mg/（kg·bw）剂量的蒙药总黄酮,连续16d后,采用淋巴细胞转化实验测定小鼠淋巴细胞增殖情况及腹腔巨噬细胞吞噬功能。结果蒙药总黄酮3个剂量组均可促进淋巴细胞的转化和增强小鼠腹腔巨噬细胞吞噬功能（P均〈0．01）。结论一定剂量的蒙药总黄酮可提高小鼠的免疫功能。     

自发性细菌性腹膜炎的一些共识与进展

自发性细菌性腹膜炎(spontaneous bacterialperitonitis,SBP)是肝硬化合并腹水患者的常见与严重的并发症,发生率高达10％～30％,这与肝硬化患者免疫功能明显降低,特别是肝内网状内皮系统严重受损、巨噬细胞吞噬功能以及白细胞黏附趋化与吞噬功能降     

东方田鼠肝内巨噬细胞的分离和鉴定

目的 目的 对东方田鼠 （Microtus fortis,Mf） 肝内巨噬细胞进行分离纯化和功能鉴定。方法 方法 采用在体灌注、 胶原 酶消化及梯度密度离心相结合的方法分离Mf肝内巨噬细胞, 并采用流式和墨汁吞噬功能实验进行巨噬细胞的功能鉴 定。结果 结果 通过此方法获得Mf肝脏来源的巨噬细胞, 分离的细胞呈透亮圆形, 贴壁生长, 活细胞比例为95%。Mf来源的 巨噬细胞与抗鼠CD14流式单抗 （Clone：Sa2?8） 阳性结合率是小鼠来源巨噬细胞与该抗体结合率的50%左右。Mf肝脏来 源的巨噬细胞墨汁吞噬实验阳性。结论 结论 该方法能有效地分离纯化Mf肝内巨噬细胞, 可为进一步研究东方田鼠肝脏巨 噬细胞抗血吸虫机制奠定基础。     

肝硬化腹水合并自发性细菌性腹膜炎55例临床分析

自发性细菌性腹膜炎(spontaneoushacterialperitonitis,SBP)，是肝硬化合并腹水的患者常见与严重的并发症之一，这与肝硬化患者免疫功能明显降低，特别是肝内网状内皮系统严重受损，巨噬细胞吞噬功能以及白细胞黏附趋化与吞噬功能降低等原因有关，也是导致死亡的重要因素之一。本研究对大连市第八人民医院近2年来收治的55例肝硬化腹水合并自发性细菌性腹膜炎的临床资料进行分析，现将结果报道如下。     

母牛分支杆菌制剂对免疫功能低下小白鼠的免疫调节作用

不同剂量的母牛分支杆菌制剂应用免疫功能低下的小鼠模型，检测小鼠腹腔巨噬细胞吞噬百分率。吞噬指数及脾淋巴细胞增殖率。结果显示注射不同剂量的母牛发支杆菌制剂小鼠腹腔巨噬细胞吞噬百分率及吞噬指数明显高于未注射该制剂对照组（Ｐ〈０．０１），淋巴细胞增殖率也明显高于对照组（Ｐ〈０．０１或Ｐ〈０．０５），提示母牛分支杆菌制剂能明显激活巨噬细胞免疫功能，对脾淋巴细胞增殖有明显刺激作用，对调节及提高机体免疫应答水     

桑银降糖胶囊对糖尿病模型小鼠免疫功能的影响

目的将桑叶多糖、银杏黄酮、牛磺酸、生物铬等按一定比例组成桑银降糖胶囊，并对链脲酶素所致昆明鼠糖尿病模型进行降糖治疗，观察桑银降糖胶囊对糖尿病模型小鼠免疫功能的影响。方法小鼠腹腔巨噬细胞吞噬功能实验和体外抗体形成细胞检测（溶血分光光度法）。结果实验表明桑银胶囊能明显提高单核细胞的吞噬活性（吞噬指数和吞噬百分率）促进小鼠的细胞免疫功能。经统计学分析，实验大、小、剂量组与正常对照组相比较差异具有统计学意义（P〈0．01）。桑银降糖胶囊大剂量组和小剂量组与正常对照组相比体外抗体形成细胞均增加（P〈0．05），差异具有统计学意义。说明桑银降糖胶囊可以明显增强小鼠B淋巴细胞产生抗体的功能。结论桑银胶囊大、小剂量组能提高小鼠腹腔巨噬细胞吞噬功能及明显增强小鼠淋巴细胞产生抗体的功能，起到了促进非特异免疫防御体系的扶正固本作用，提示有提高细胞免疫及体液免疫的功能。     

复方炎平水提物对淋巴细胞转化和巨噬细胞吞噬的影响

目的探讨复方炎平水提物（YP）对淋巴细胞转化和巨噬细胞吞噬的影响。方法淋巴细胞转化试验（体外试验）测定小鼠淋巴细胞增殖情况，并测定小鼠巨噬细胞吞噬功能。结果YP100μg／ml可同时促进小鼠脾淋巴细胞及小鼠脾细胞伴刀豆蛋白A（ConA）的增殖，并具有剂量依赖性；YP10g/kg连续藩服2w，小鼠腹腔巨噬细胞的吞噬功能明显增强。结论YP可明显增强小鼠免疫功能。     

肝癌自发性破裂患者中的血管硬化现象

肝癌自发性破裂是一种危及生命的急性出血性并发症，患者血管壁的性能将与肿瘤的破裂有直接相关。我们检测了与血管病变相关的第八因子相关抗原（ｖｏｎｗｉｌｌｅｂｒａｎｄ ｆａｃｔｏｒ，ｖＷＦ）、弹性硬蛋白、弹性蛋白酶（中性粒细胞性），并发现其确有血管病变现象。 １．资料与方法：收集行手术治疗的肝癌破裂及非破裂标本各３０例。患者石蜡标本采用免疫组织化学ＡＢＣ法进行染色，第一抗体为单克隆抗体（Ｄａｋｏ公司）。新鲜标本收集后，送电镜室进行标本制作。ｖＷＦ因子着色于血管内皮细胞，弹性硬蛋白、弹性蛋白酶存在血管基质…     

纳米四君子汤对半乳糖致衰老小鼠抗氧化及免疫功能的影响

目的探讨纳米四君子汤在小鼠体内抗氧化的药理作用及对免疫功能的影响。方法采用D-半乳糖腹腔注射制备小鼠衰老模型，然后灌胃纳米四君子汤，检测小鼠脑、肝MDA含量、脑、肝SOD活性及腹腔巨噬细胞的吞噬功能、外周血IL-2含量。结果采用D-半乳糖腹腔注射7d后，检测到肝、脑组绢中的SOD活力明显下降，MDA含量明显升高（P〈0.01），同时腹腔巨噬细胞吞噬功能及外周血IL-2含量明显下降（P〈0.001），说明成功制备出衰老模型。灌胃纳米四君子汤后，检测到肝脑组织中SOD活力、腹腔巨噬细胞吞噬功能及外周血IL-2含量显著升高，MDA含量显著下降（P〈0.05）。结论纳米四君子汤具有抗氧化的作用，并有增强免疫功能的作用。     

Spontaneous tumor rupture and surgical prognosis of patients with hepatocellular carcinoma

Abstract

Background. Spontaneous rupture is an uncommon but the most fatal complication of hepatocellular carcinoma (HCC) and is recognized as a risk factor for tumor recurrence. The present study is to investigate the short- and long-term survival of the patients with HCC rupture and evaluate the influence of tumor rupture on patient's survival after hepatic resection. Patients and methods. The clinical data of 101 patients with HCC rupture from 2000 to 2010 were reviewed retrospectively. The management of tumor rupture and clinicopathological parameters affecting 30-day mortality of the patients were recorded and evaluated. Long-term survival of the 41 patients undergoing hepatic resection was compared with 446 patients with non-ruptured HCC at the same time period. Results. The 30-day mortality rate of the 101 patients with HCC rupture was 35.6% and median survival was 79 days. The independent risk factors affecting 30-day mortality were tumor size and blood transfusion quantity. Compared with 446 non-ruptured HCC patients, 41 patients with ruptured HCC undergoing hepatic resection had a similar overall and disease-free survival to 446 without rupture (Log-rank test, p = 0.704 and 0.084, respectively). Multivariate analysis revealed that age, gender, and tumor size were independently significant factors in differentiating tumor rupture from non-rupture. Conclusion. Early mortality of spontaneous rupture of HCC was dependent on preoperational liver function, tumor status, and severity of bleeding. Prolonged survival can be achieved in patients with ruptured HCC after hepatic resection as those without the complication.     

Spontaneous tumor rupture and surgical prognosis of patients with hepatocellular carcinoma

Abstract Background. Spontaneous rupture is an uncommon but the most fatal complication of hepatocellular carcinoma (HCC) and is recognized as a risk factor for tumor recurrence. The present study is to investigate the short- and long-term survival of the patients with HCC rupture and evaluate the influence of tumor rupture on patient's survival after hepatic resection. Patients and methods. The clinical data of 101 patients with HCC rupture from 2000 to 2010 were reviewed retrospectively. The management of tumor rupture and clinicopathological parameters affecting 30-day mortality of the patients were recorded and evaluated. Long-term survival of the 41 patients undergoing hepatic resection was compared with 446 patients with non-ruptured HCC at the same time period. Results. The 30-day mortality rate of the 101 patients with HCC rupture was 35.6% and median survival was 79 days. The independent risk factors affecting 30-day mortality were tumor size and blood transfusion quantity. Compared with 446 non-ruptured HCC patients, 41 patients with ruptured HCC undergoing hepatic resection had a similar overall and disease-free survival to 446 without rupture (Log-rank test, p = 0.704 and 0.084, respectively). Multivariate analysis revealed that age, gender, and tumor size were independently significant factors in differentiating tumor rupture from non-rupture. Conclusion. Early mortality of spontaneous rupture of HCC was dependent on preoperational liver function, tumor status, and severity of bleeding. Prolonged survival can be achieved in patients with ruptured HCC after hepatic resection as those without the complication.     

Are the results of surgical treatment of hepatocellular carcinoma poor if the tumor has spontaneously ruptured?

BACKGROUND: The aim of this study was to clarify whether the results of surgical treatment of ruptured hepatocellular carcinoma (HCC) are poorer than the results of surgical treatment of non-ruptured HCC. METHODS: Out of a total of 224 HCC patients, the 6 patients with ruptured HCC were compared with 15 patients with non-ruptured HCC based on TNM stage IVA and having a Cancer of the Liver Italian Program (CLIP) score of 1 or 2. RESULTS: There were no significant differences in clinical and pathological features between the two groups. The 1-year and 3-year overall survival rates were 69.3% and 21.2%, respectively, in the ruptured HCC group and 51.3% and 20.5%, respectively, in the non-ruptured HCC group. The 1-year and 3-year disease-free survival rates were 33.0% and 0%, respectively, in the ruptured HCC group and 38.9% and 15.6%, respectively, in the non-ruptured HCC group. The differences in survival rates between these two groups did not reach statistical significance. CONCLUSION: Hepatic resection as definitive treatment after recovery from the initial insult of the rupture of HCC yields results similar to those obtained by surgical treatment of non-ruptured HCC at the same tumor stage and with the same degree of liver damage.     

The clinical study on spontaneously ruptured hepatocellular carcinoma]

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.     

Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study

AIM: To investigate the risk factors and surgical outcomes for spontaneous rupture of Barcelona Clinic Liver Cancer (BCLC) stages A and B hepatocellular carcinoma (HCC).METHODS: From April 2002 to November 2006, 92 consecutive patients with spontaneous rupture of BCLC stage A or B HCC undergoing hepatic resection were included in a case group. A control arm of 184 cases (1:2 ratio) was chosen by matching the age, sex, BCLC stage and time of admission among the 2904 consecutive patients with non-ruptured HCC undergoing hepatic resection. Histological confirmation of HCC was available for all patients and ruptured HCC was confirmed by focal discontinuity of the tumor with surrounding perihepatic hematoma observed intraoperatively. Patients with microvascular thrombus in the hepatic vein branches were excluded from the study. Clinical data and survival time were collected and analysed.RESULTS: Sixteen patients were excluded from the study based on exclusion criteria, of whom 3 were in the case group and 13 in the control group. Compared with the control group, more patients in the case group had underlying diseases of hypertension (10.1% vs 3.5%, P = 0.030) and liver cirrhosis (82.0% vs 57.9%, P < 0.001). Tumors in 67 (75.3%) patients in the case group were located in segments II, III and VI, and the figure in the control group was also 67 (39.7%) (P < 0.001). On multivariate analysis, hypertension (HR = 7.38, 95%CI: 1.91-28.58, P = 0.004), liver cirrhosis (HR = 6.04, 95%CI: 2.83-12.88, P < 0.001) and tumor location in segments II, III and VI (HR = 5.03, 95%CI: 2.70-6.37, P < 0.001) were predictive for spontaneous rupture of HCC. In the case group, the median survival time and median disease-free survival time were 12 mo (range: 1-78 mo) and 4 mo (range: 0-78 mo), respectively. The 1-, 3- and 5-year overall survival rates and disease-free survival rates were 66.3%, 23.4% and 10.1%, and 57.0%, 16.8% and 4.5%, respectively. Only radical resection remained predictive for overall survival (HR = 0.32, 95%CI: 0.08-0.61, P = 0.015) and disease-free survival (HR = 0.12, 95%CI: 0.01-0.73, P = 0.002).CONCLUSION: Tumor location, hypertension and liver cirrhosis are associated with spontaneous rupture of HCC. One-stage hepatectomy should be recommended to patients with BCLC stages A and B disease.     

Spontaneous rupture of liver hemangioma: Risk factors for rupture

We report a case of spontaneous rupture of a giant cavernous hemangioma of the liver arising from the caudate lobe, with extrahepatic growth, in a 67-year-old man. At emergency laparotomy, partial resection of the caudate lobe was performed and the hemangioma was found to measure 13 ×12×8 cm. The patient had a 10-year history of severe asthma requiring steroid therapy. To investigate the risk factors for spontaneous rupture of hepatic hemangioma, we compared the characteristics of patients with ruptured and non-ruptured lesions showing extrahepatic growth reported in the Japanese literature. Lesions with a diameter ≥4 cm located on the surface of the liver or showing extrahepatic growth appear to have a high risk of spontaneous rupture if the patient receives steroid therapy for a coexisting disorder. Even in patients who have not received steroid therapy, hemangiomas≥7–8 cm in diameter located in the left lobe with extrahepatic growth may also have a high risk of rupture. The treatment of hepatic hemangioma should be decided on the basis of the size and the location, and on the requirement for steroid therapy.     

Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

AIM:To determine the risk factors for hepatocellular carcinoma(HCC) rupture,and report the management and long-term survival results of patients with spontaneous rupture of HCC.METHODS:Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006,200(4.8%) patients with ruptured HCC(case group) were studied retrospectively in term of their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment,transarterial embolization(TACE) or hepatic resection.Results of various treatments in the case group were evaluated and compared with the control group(202 patients) without ruptured HCC during the same study period.Continuous data were expressed as mean ± SD or me-dian(range) where appropriate and compared using the unpaired t test.Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate.The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.RESULTS:Compared with the control group,more patients in the case group had underlying diseases of hypertension(7.5% vs 3.0%,P =0.041) and liver cirrhosis(87.5% vs 56.4%,P 0.001),tumor size 5 cm(83.0% vs 57.4%,P 0.001),tumor protrusion from the liver surface(66.0% vs 44.6%,P 0.001),vascular thrombus(30.5% vs 8.9%,P 0.001) and extrahepatic invasion(36.5% vs 12.4%,P 0.001).On multivariate logistic regression analysis,underlying diseases of hypertension(P = 0.002) and liver cirrhosis(P 0.001),tumor size 5 cm(P 0.001),vascular thrombus(P = 0.002) and extrahepatic invasion(P 0.001) were predictive for spontaneous rupture of HCC.Among the 200 patients with spontaneous rupture of HCC,105 patients underwent hepatic resection,33 received TACE,and 62 were managed with conservative treatment.The median survival time(MST) of all patients with spontaneous rupture of HCC was 6 mo(range,1-72 mo),and the overall survival at 1,3 and 5 years were 32.5%,10% and 4%,respectively.The MST was 12 mo(range,1-72 mo) in the surgical group,4 mo(range,1-30 mo) in the TACE group and 1 mo(range,1-19 mo) in the conservative group.Ninety-eight patients in the control group underwent hepatic resection,and the MST and median diseasefree survival time were 46 mo(range,6-93 mo) and 23 mo(range,3-39 mo) respectively,which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection(P 0.001).The 1-,3-,and 5-year overall survival rates and the 1-,3-and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%,19.0% and 7.6%,27.6%,14.3% and 3.8%,respectively,compared with those of 77.1%,59.8% and 41.2%,57.1%,40.6% and 32.9% in 98 patients with-CONCLUSION:Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy,although the survival results were inferior to those of the patients without ruptured HCC.     

Spontaneous ruptured hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life‐threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non‐ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53–100%. A one‐stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12–42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two‐step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC.     

Treatment of spontaneous ruptured hepatocellular carcinoma.

BACKGROUND/AIMS: Spontaneous rupture with bleeding is a potentially life-threatening complication of hepatocellular carcinoma (HCC). We review our experience with treatments of ruptured HCC. METHODOLOGY: Between January 1988 and December 1997, 18 patients with ruptured HCC were admitted. The patients were divided into 4 groups according to the treatment type of ruptured HCC. Group 1 consisted of 10 patients treated by transarterial embolization (TAE) followed by elective hepatectomy. Group 2 consisted of 2 patients treated by only TAE. Group 3 consisted of 3 patients treated by emergency operation. Group 4 consisted of 3 patients who could not be treated by TAE or surgery. RESULTS: In Group 1, 4 of the 10 patients died; 3 from recurrent HCC and 1 from cerebral hemorrhage, and hospital mortality was absent. The 1-year survival rate was 87.5%. In Group 2, both patients recovered sufficiently well to be discharged. The 1-year survival rate was 50%. In Groups 3 and 4, hospital mortality rate was 100%. CONCLUSIONS: TAE followed by elective hepatectomy was an effective treatment in patients with ruptured HCC.     

Ruptured hepatocellular carcinoma following chemoembolization:a western experience

Introduction Hepatocellular carcinoma is the most common primary tumor of the liver and is reported as the third most common cause of cancer-related deaths.[1] The incidence is high in Asian and African countries, but there has been a dramatic increase in western countries over the past few years due to rise in hepatitis C infection.[2] Although hepatic resection and transplantation provide hope for cure, 70%-80% of patients are diagnosed at intermediate to advanced stages and are not suitabl…