多次化疗栓塞对肝癌患者肝纤维化指标的影响

目的：探讨多次肝动脉化疗栓塞术（ＴＡＣＥ）对肝癌患者肝纤维化进程的影响。方法：选择２４例经３次以上ＴＡＣＥ治疗的肝癌患者,测定他们每次ＴＡＣＥ治疗前后透明质酸（ＨＡ）、人Ⅲ型前胶原（ｈＰＣⅢ）和Ⅳ型胶原（ⅣＣ）的血清学水平,并进行比较研究。结果：ＴＡＣＥ治疗前后对比,３次肝纤维化指标均有不同程度的升高,以第３次ＴＡＣＥ术后升高最明显（Ｐ〈０．０１）,３项肝纤维化指标中,以ⅣＣ变化最显著,第１次ＴＡ     

血清肝纤维化指标诊断价值的初探

为评价血清肝纤维化指标的诊断价值，肝病患者103例采血透明质酸（HA）、层粘素（LN）、Ⅳ型胶原C末端（Ⅳ－C）、Ⅲ型前胶原（PCⅢ）和脯氨酸肽酶（PLD），同时肝穿行组织学检查；采用似然比（LR）和受试者工作特征曲线下面积（AUC^ROD）分析法，以病理诊断为金指标对上述血清指标的诊断价值进行分析。结果表明 在诊断肝纤维化时，PCⅢ、HA和PLD的AUC^ROD分别为0．939、0．829和0．815，该三项指标对肝纤维化具有较高的诊断价值，其临界值分别为PCⅢ≥170ng/ml（LR22．049），HA≥80ng/ml（LR3．458），PLD≥1800IU／L（LR5．048）；除HA外其他指标鉴别肝纤维化与肝硬化的价值有限，HA≥250ng/ml（AUC^ROC0．1917，LR14．319），提示肝硬化的形成。     

血清肝纤维化指标诊断价值的评价

一、资料与方法肝病患者103例,男89例、女13例,年龄21岁～52岁,均采用16号肝脏穿刺针行肝穿活检,肝组织固定于10%甲醛溶液,石蜡包埋,切片行H.E染色和Masson染色,病理医师集中读片,按1995年北京会议制定的“病毒性肝炎防治方案”标准,进行慢性肝炎分级和肝纤维化分期（0至4期）,再将0、1期归为无肝纤维化组;2、3期归为肝纤维化组;4期和肝硬化者为肝硬化组。上述患者近期内采血查肝功能和血清肝纤维化指标,血清透明质酸（HA）、层粘蛋白（LN）、Ⅳ型胶原（Ⅳ-C）、Ⅲ型胶原（PCⅢ）测定采用放免法,血清脯氨酸肽酶（PLD）测…     

口服氧化苦参碱对四氯化碳诱导的大鼠肝纤维化血清生化和纤维化指标的影响

目的 研究口服氧化苦参碱对四氯化碳(CCl4)诱导的大鼠肝纤维化血清生化和纤维化指标的影响。方法 140只雄性Wistar大鼠随机分为正常对照组(n=20)、CCl4模型组(n=30)、氧化苦参碱预防低剂量组(n=30)、中剂量组(n=30)和高剂量组(n=30)。氧化苦参碱低、中、高剂量组大鼠氧化苦参碱的用量分别为30、60、100mg／kg体重，每日灌胃1次，共12周。血清ALT、GGT、总胆红素、白蛋白水平用全自动生化分析仪检测。血清HA、LN、PⅢNP、Ⅳ型胶原含量分别以RIA和ELISA方法检测。肝组织学检查苏木精—伊红染色观察肝组织炎症和纤维化程度。结果 血清学检测结果表明，氧化苦参碱预防组较对照组肝功能有明显改善，血清肝纤维化指标水平明显降低；组织学检查结果表明，对照组肝脏炎症和纤维化程度明显高于氧化苦参碱预防组。结论 口服氧化苦参碱可改善CCl4诱导的大鼠肝纤维化血清生化和肝纤维化指标。     

α干扰素对慢性丙型肝炎患者血清肝纤维化指标的影响

丙型肝炎病毒(HCV)感染的最主要特征是慢性化,肝纤维化是这一慢性化过程中的一种极为重要的病变,因此,及早阻止肝纤维化的进程具有重要意义。α干扰素(IFN-α)的抗病毒疗效已得到肯定,关于其在慢性丙型肝炎中抗纤维化作用的报道尚不多见,为此,选取24例慢性丙型肝炎患者进行治疗前后的对比研究。     

血清胱抑素C和肝纤维化指标在老年肝癌患者中的应用

目的探讨血清胱抑素C(CysC)及肝纤维化指标的检测在老年肝癌患者中的临床意义。方法正常对照组30例、原发性肝癌组25例和转移性肝癌组23例,测定各组患者的血清CysC、透明质酸(HA)、Ⅲ型胶原(PcⅢ)、层黏蛋白(LN)和Ⅳ型胶原(Ⅳ-C)的浓度。结果血清CysC水平在肝癌组患者中明显高于正常对照组,而且原发性肝癌组与转移性肝癌组两组比较差异也有统计学意义(P<0.05),表明血清CysC与肝癌的发生以及是否转移有关;与正常对照组比较血清HA、PcⅢ、LN和Ⅳ-C水平在肝癌组患者中呈明显升高的趋势(P<0.05),表明肝癌患者存在不同程度的肝纤维化趋向。结论血清CysC水平及肝纤维化指标可作为肝癌患者筛查的重要实验室指标,并有助于判断肿瘤的转移与预后,可作为肝癌患者病情监控和疗效评估的重要依据。     

探讨慢性肝炎患者血清肝纤维化指标的临床价值

探讨慢性肝炎患者血清肝纤维化指标（ＨＡ、ＰＣⅢ、Ⅴ－Ｃ、ＬＮ）的临床实用价值。对２５００例慢性肝炎患者,用放射免疫法进行血清ＨＡ、ＰＣⅢ、Ⅳ－Ｃ、ＬＮ指标均有是面肝纤维化指标水平与乙肝口才的肝脏炎症活动度分级、肝发给化程度分期与病理组织学分主工均存在显著相关。血清肝纤维化指标对判断慢性肝炎的肝纤维化和肝硬化倾向具有临床实用意义。     

血清铁蛋白与肝纤维化指标相关性的实验研究

研究慢性肝病患者血清铁蛋白(SF)与血清肝纤维化指标(透明质酸HA、层粘连蛋白LN、血清Ⅲ型前胶原肽PⅢP、Ⅳ型胶原CⅣ)及病理分期的相关性.采用酶联免疫及放射免疫法,对85例慢性肝病患者检测SF及肝纤维化四项指标,并对其中50例慢性肝炎患者行肝穿活检.慢性肝病患者SF、肝纤维化四项指标与正常对照组比较差异显著,SF随慢性肝炎及肝硬化临床分型及Child-Pugh分级的逐渐加重而升高.SF随病理分期依次增高,与SO期比较P＜0.01;SF与HA、LN、PⅢP、CⅣ具有相关性(r值为0.68,0.58,0.47,0.61).提示肝铁代谢异常与肝纤维化的发生发展密切相关.对于判断肝纤维化的程度有一定的临床意义.     

血清纤维化指标的影响因素分析

目的 探讨慢性乙型肝炎恢复期患者血清纤维化4项指标[血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CIV)和层黏连蛋白(LN)]的影响因素及意义。方法用放射免疫法检测141例慢性乙型肝炎患者血清HA、PCⅢ、LN、CⅣ,并将他们分为不一致组和一致组。肝活检标本行常规病理检查,自动生物化学分析仪检测肝功能,B超检查肝门静脉主干内径、脾门部脾静脉内径及腋中线处脾脏厚度。结果血清纤维化指标与肝纤维化程度不一致患者16例(14.16％),血清纤维化指标不一致的产生与肝纤维化程度分期无关,与肝脏炎症活动度有关(X2=12.07,P<0.05)。不一致组患者血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰基转移酶、球蛋白水平明显下降,分别从89.28±64.25、66.10±42.30、86.26±70.36、32.13±5.18下降至49.31±26.75(t=2.45,P<0.05)、40.83±22.40(t=2.33,P<0.05)、48.99±29.96(t=2.08,P<0.05)、28.05±3.47(t=3.03,P<0.01)。白蛋白和白蛋白/球蛋白比值则明显升高,分别从42.34±4.81、1.35±0.28上升至46.19±3.61(t=3.06,P<0.01)、1.63±0.26(t=3.70,P<0.01)。血清碱性磷酸酶、总胆红素、总蛋白无明显改变,肝门静脉主干内径、脾门部脾静脉内径及腋中线处脾脏厚度也无明显改变。结论 在评价某些患者血清纤维指     

综合序贯疗法治疗中晚期肝癌临床研究

目的：探讨肝动脉栓塞化疗术（ＴＯＣＥ另ＧＳ）、瘤内无水酒精注射术（ＰＥＩ）和门静脉介入治疗术（ＰＶＥ）即３介入治疗,联合特异性肿瘤细胞毒Ｔ淋巴细胞（ＣＴＬｓ）的综合序贯疗法在中晚期肝癌治疗中的优越性。方法：１２７例中晚期肝癌（Ⅱ～Ⅲ期,巨块型或结节型,肝功ＣｈｉｄｌＡ或Ｂ级）患者随机分Ａ、Ｂ、Ｃ３组。其中Ａ组５２例为治疗组,予综合序贯治疗,Ｂ组（４５例）、Ｃ组（３０例）为对照组,分别予ＴＯＣＥ、Ｇ     

A Middle School Intervention to Improve Health Behaviors and Reduce Cardiac Risk Factors

Objective

This study aimed to measure the impact of a school-based multidisciplinary intervention program on risk factors for atherosclerosis in sixth-grade middle school students. We also measured health behaviors before and after the intervention using a validated questionnaire.

Methods

A prospective study was performed in which students served as historical controls. Sixth-grade students from 23 middle schools in 12 cities with varying populations were exposed to a program promoting healthful activity and nutrition habits through educational and environmental change. Along with a modified School-Based Nutrition Monitoring behavioral questionnaire, physiologic risk factors were studied, including body mass index, systolic and diastolic blood pressures, cholesterol panel, and random blood glucose, which were measured before the 10-week program and again 1 to 3 months after program completion.

Results

Of 4021 sixth graders (male, 49%) at 23 middle schools completing a before and after behavioral survey, 2118 students, aged 11.56 ± 0.47 years, consented to participate in the screening. The mean total cholesterol value decreased from 161.64 ± 28.99 mg/dL to 154.77 ± 27.26 mg/dL (P < .001). The low-density lipoprotein value decreased from 89.37 ± 25.08 mg/dL to 87.14 ± 24.25 mg/dL (P < .001). The high-density lipoprotein value decreased from 52.15 ± 13.35 md/dL to 49.95 ± 13.28 mg/dL (P < .001). The measure of triglycerides decreased from 113.34 ± 73.19 mg/dL to 101.22 ± 63.93 mg/dL (P < .001). The random glucose value decreased from 97.51 ± 16.00 to 94.94 ± 16.62 (P < .001). The mean systolic blood pressure decreased from 109.47 ± 15.26 mm Hg to 107.76 ± 10.87 mm Hg (P < .001), and the mean diastolic blood pressure decreased from 64.78 ± 8.57 mm Hg to 63.35 ± 7.81 mm Hg (P < .001). These changes in physiologic measures seemed to correlate with self-reported increases in vegetable and fruit consumption, increases in physical activity, and less screen time.

Conclusions

Project Healthy Schools, a middle school intervention to improve childhood cardiovascular risk factors, is feasible and seems to be effective. The results showed significant improvements in risk factors associated with early atherosclerosis among sixth-grade students, including total cholesterol, low-density lipoprotein cholesterol, triglycerides, and systolic and diastolic blood pressures. Further study with a larger group of students and a longer follow-up period would be valuable.     

Hepatocellular carcinoma: Consensus,controversies and future directions: A report from the Canadian Association for the Study of the Liver Hepatocellular Carcinoma Meeting

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide and its incidence has rapidly increased in North America in recent years. Although there are many published guidelines to assist the clinician, there remain gaps in knowledge and areas of controversy surrounding the diagnosis and management of HCC. In February 2014, the Canadian Association for the Study of the Liver organized a one-day single-topic consensus conference on HCC. Herein, the authors present a summary of the topics covered and the result of voting on consensus statements presented at this meeting.     

The Influence of Alcoholic Liver Disease on Serum PIVKA-II Levels in Patients without Hepatocellular Carcinoma

Background/AimsProthrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients.MethodsWe retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remaining patients who were negative for serum PIVKA-II (group 2).ResultsGroup 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and γ glutamyl transpeptidase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate analysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic usage (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels.ConclusionsOur study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution.     

3种选择性环氧合酶-2抑制剂对肝细胞癌生长的影响

背景肝细胞癌(HCC)中有环氧合酶(COX)-2表达,非甾体抗炎药阿司匹林可能通过抑制COX-2的表达而抑制HCC生长.目的比较3种选择性COX-2抑制剂美洛昔康、赛来昔布和罗非昔布对人肝癌细胞株SMMC-7721 生长的影响,观察高选择性COX-2抑制剂罗非昔布对裸鼠HCC原位移植瘤生长的影响.方法采用3H-胸腺嘧啶核苷(3H-TdR)掺入检测SMMC-7721细胞的DNA合成情况;采用免疫细胞化学染色检测增殖细胞核抗原(PCNA)的表达;采用DNA原位末端标记(TUNEL)染色检测细胞凋亡.给予HCC原位移植瘤裸鼠罗非昔布每日30 mg/kg 8周,测量肿瘤体积和重量.结果美洛昔康、赛来昔布和罗非昔布均能显著抑制SMMC-7721细胞的3H-TdR掺入,其抑制作用呈剂量依赖性,50%抑制浓度(IC50)分别为8.55×10-8mol/L、1.22×10-8mol/L和6.27×10-9 mol/L.3种选择性OX-2抑制剂(1×10-5 mol/L)作用24 h均可明显降低SMMC-772I细胞的PCNA表达,使细胞凋亡指数较对照组显著增高(14.6%±2.8%、21.6%±3.6%和27.1%±3.5%对1.0%±0.7%,P＜0.01),COX-2抑制剂的选择性越高,凋亡指数也越高(P＜0.01).罗非昔布组裸鼠的HCC原位移植瘤显著小于对照组,体积抑瘤率和重量抑瘤率分别为73.2%和78.1%.结论3种选择性COX-2抑制剂均能在体外有效抑制SMMC-7721细胞的生长,选择性越高,抑制作用越强.罗非昔布在体内能抑制HCC的生长,可能成为治疗HCC的有效药物.     

糖基化终末产物对巨噬细胞基质金属蛋白酶9活性的影响以及辛伐他汀的干预作用

目的研究糖基化牛血清白蛋白对巨噬细胞的活化与基质金属蛋白酶9活性的影响,并观察辛伐他汀的干预效应。方法体外培养小鼠腹腔巨噬细胞,与不同浓度糖基化牛血清白蛋白、辛伐他汀共同培养,采用明胶酶谱法测定基质金属蛋白酶9活性。结果糖基化牛血清白蛋白可在体外诱发小鼠腹腔巨噬细胞形态变化。不同浓度的糖基化牛血清白蛋白(0、50、100、200、400mg/L)作用48h后,细胞培养基中基质金属蛋白酶9活性明显增强,且均明显高于对照组(n=5,P<0.05),呈剂量依赖效应。400mg/L糖基化牛血清白蛋白处理小鼠腹腔巨噬细胞不同时间后,作用12h时基质金属蛋白酶9活性与对照组比差异无显著性(n=5,P>0.05),作用24、36、48h时基质金属蛋白酶9活性均明显高于对照组,呈时间依赖效应(n=5,P<0.05)。加入辛伐他汀后,基质金属蛋白酶9活性明显降低。结论糖基化牛血清白蛋白可在体外活化巨噬细胞,使基质金属蛋白酶9活性增加,提示其致动脉粥样硬化及斑块破裂作用;辛伐他汀可明显降低基质金属蛋白酶9活性,说明其治疗作用的多向性。     

中医三种治法对人肝癌细胞增殖及端粒酶活性的影响

目的:探讨中医活血软坚、益气养阴、清热解毒三种治法影响肝癌细胞增殖及端粒酶活性的特点和意义.方法:从临床治疗肝癌常用的活血软坚药中选取有代表性的丹参、川芎、鳖甲,益气养阴药中选取黄芪、枸杞子、女贞子,清热解毒药中选取半枝莲、白花蛇舌草,分别制成水煎剂,灌喂正常大鼠,采血制备药物血清.以正常鼠血清为阴性对照,将药物血清温育Bel-7402人肝癌细胞.噻唑蓝比色法测定细胞增殖,多聚酶链反应酶联免疫吸附(PCR-ELISA)法检测细胞端粒酶活性.结果:活血软坚药和益气养阴药均可抑制Bel-7402细胞的增殖,清热解毒药不能抑制Bel-7402细胞的增殖.活血软坚药、益气养阴药和清热解毒药均可抑制Bel-7402细胞端粒酶活性,且活血软坚药作用优于清热解毒药.结论:活血软坚法和益气养阴法均可抑制Bel-7402细胞的增殖,其主要机制可能是通过抑制Bel-7402细胞端粒酶活性.清热解毒法不能抑制Bel-7402细胞的增殖,但有一定的抑制细胞端粒酶活性的作用.     

Notch和NF-κB信号通路与心肌重塑相关性研究进展

心肌重塑是心血管疾病的共同病理过程,可见于高血压、动脉粥样硬化、心肌缺血、心肌病、心力衰竭等,是心血管疾病发生、发展和维持的病理基础。研究发现有多重因素参与心肌重塑的发生发展,同时这些因素相互促进,共同维持心肌重塑的发展。Notch信号通路由一组在进化上高度保守的细胞膜配体、受体及下游分子组成。细胞间受体配体作用可激活Notch信号转导过程,从而直接调节基因转录,使细胞基因表达受相邻细胞调控。Notch信号在细胞分化、胚胎发育、组织自我更新过程