肝癌相关抗原MRP-L28血清学特异性研究及其临床意义

目的 检测肝癌相关抗原MRP-L28的肝癌血清学特异性.方法 应用SEREX技术检测MRP-L28在肝癌、胃癌、肺癌、直肠癌、肝炎、肝硬化病人及正常人血清中的抗体阳性率.结果 相应抗体主要见于HCC患者血清,肝癌病人血清阳性反应率为48.4%;肝炎、肝硬化病人血清阳性反应率均为6.5%;肺癌、直肠癌、胃癌的病人血清阳性反应率分别是6.5%、9.7%和3.2%;正常人血清阳性反应率为3.1%.经比较,MRP-L28抗体在肝癌血清中的阳性率最高(P<0.05);其余各组之间MRP-L28抗体阳性率无统计学意义.同时,本文还比较了MRP-L28抗体阳性率与AFP阳性率及含量、病理分级、年龄和γ-谷氨酰转肽酶(GGT)的关系,结果显示无统计学意义.使用MRPL-28诊断肝癌的灵敏度、特异性和准确度分别为48.4%、94.1%和87.6%.结论 MKP-L28在HCC检测中有一定的特异性,在肝癌血清学诊断方面具有一定的临床意义,可以考虑作为新的HCC血清学诊断标记物.     

肝癌标记物的研究进展

肝细胞癌(HCC)是常见的恶性肿瘤之一,HCC有很高的致死率,特别是在肝硬化基础上发展为肝癌的病人[1].在我国,HCC主要和乙型肝炎病毒感染、肝硬化相关,确诊时大多属于中、晚期,缺乏有效治疗手段,预后差.     

血清同工铁蛋白RIA测定对AFP阴性肝占位性病变的鉴别诊断

46例病理诊断的AFP阴性肝占位性病变病人的血清铁蛋白(SF)和酸性铁蛋白(SAF)放射免疫测定结果。结果表明,在这些病人中,原发性肝癌病人约占一半;SF和SAF的放免测定对AFP阴性肝占位性病变的性质具有一定的鉴别诊断价值、有助于对AFP阴性原发性肝癌(HCC)的诊断。SF和SAF放免测定诊断HCC的敏感性分別为57.1%和76.2%,特异性分別为96.0%和100%,诊断准确性分别为78.3%和89.1%。结果提示,对AFP阴性HCC的诊断价值,SAF优于SF。     

原发性肝癌病人血清过氧化物酶同工酶的测定

报告血清过氧化物酶(POD)同工酶的检测方法,并检测了45例正常人及20例原发性肝癌病人的血清POD同工酶.结果正常人血清POD同工酶出现1～3条区带,HCC病人血清POD同工酶出现2～6条区带.提示,HCC病人血清POD同工酶区带比正常人明显增多(P<0.001),活性也明显增高(P<0.01).     

肝癌患者外周血单个核细胞端粒酶活性表达与临床相关性研究

目的探讨原发性肝癌(HCC)病人外周血单个核细胞(PBMCs)端粒酶活性与临床的相关性。方法采用聚合酶链式反应-酶联免疫吸附测定(PCR-ELISA)检测肝癌、肝硬化、慢性肝炎病人及健康体检者PBMCs端粒酶活性。结果52例肝癌病人中44例端粒酶活性明显增高,阳性率为84.62%,端粒酶活性为(0.82±0.69)。端粒酶活性在肝硬化组为(0.19±0.12),肝炎组为(0.17±0.09),健康体检组为(0.12±0.06),均显著低于HCC组(P<0.01)。外周血单个核细胞端粒酶活性的阳性率显著高于血清AFP(34/52,65.38%,P<0.01)。结论端粒酶表达在HCC的发病机制中可能起着重要作用,HCC病人外周血单个核细胞端粒酶活性的测定,是一种灵敏、微创的早期诊断肝癌方法。     

经导管动脉栓塞化疗对肝癌病人肝功能的影响

原发性肝细胞癌 (HCC)是最常见的恶性肿瘤之一 [1 ,2 ] ,未经治疗的 HCC病人 ,平均存活期仅为 2～ 4个月。手术切除仍然是治疗 HCC根本的方法 ,但是仅有少数病人能够接受此疗法 [1 ,3 ] 。在过去的近 2 0年中 ,经导管动脉栓塞化疗(TACE)已被广泛地用于不能手术的 HCC病人。由于该疗法具有较好的疗效、较少的并发症及较低的副作用 ,使其成为当前 HCC非手术疗法中最主要的方法 [1～ 4] 。 TACE后最常见的并发症是肝功能的损害 [4] 。因此 ,TACE对肝功能的影响近年来受到关注 [1～ 5] 。深入了解 TACE后引起肝功能损害的因素 ,对…     

原发性肝细胞癌介入治疗的新进展

原发性肝细胞癌(HCC)的治疗手段目前主要包括外科手术切除、介入治疗、生物基因治疗、中医中药治疗,传统以为肝切除是唯一根治的办法,但是仅有5%～10%新诊断的HCC适于行手术切除.     

经皮肝动脉化疗栓塞结合无水酒精注射在原发性肝癌治疗中的应用

原发性肝癌(Hepatocellular Carcinoma,HCC)的外科手术切除仍是首选的治疗手段,手术切除可使部分病人获根治性的治疗,目前国内HCC手术切除的5年生存率在30％～40％左右,其中小肝癌的手术切除术后5年生存率可高达60％。但由于我国HCC病人多伴有肝硬化(1),部分病人就诊时肝癌已是晚期,使手术切除的适应证受到很大限制,目前国内HCC的切除率仅在40.4％～51.1％,即使是小肝癌,也有10％的病人不能手术切除(2)。     

HBV-M表达模式和HBV-DNA定量与原发性肝癌的关系研究

目的 探讨乙型肝炎病毒血清学标志物(HBV-M)表达模式、HBV-DNA复制水平与原发性肝癌(HCC)的关系.方法 216例原发性肝癌(HCC组),353例慢性乙型肝炎(CHB组),应用酶联免疫吸附试验和聚合酶链式反应方法分别检测两组血清HBV-M和HBV-DNA水平.结果 两组HBV-M表达模式构成差异有统计学意义(P＞0.05),HCC组血清学小三阳(HBsAg、HBeAb、HBcAb阳性)表达率(62.04%)显著高于大三阳(HBsAg、HBeAg、HBcAb阳性)表达率(18.98%);CHB组小三阳表达率为61.47%,大三阳为36.83%;CHB组大三阳表达率高于HCC组(P＜0.05).HBV-DNA阳性率HCC组为56.5%,CHB组为79.0%,差异无统计学意义(P＞0.05),但在HBV-DNA阳性患者中,HCC组HBV-DNA复制水平显著低于CHB组,差异有统计学意义(P＜0.05).结论 HCC患者HBV-M表达模式以小三阳为主,其HBV-DNA复制水平较CHB患者低.     

STUDY ON SMALL HEPATOCELLULAR CARCINOMA AND ITS EXTENSION

This paper surranarizes the “study on small hepatocellular carcinoma and its extension“ in Liver Cancer lrmtitute, Zhongshan Ho6pital of Shanghai Medical University during the past 25 years. The results indicared that it was an important approach to obtain long-term HCC survivors, of the 239 patients with 5-year survival, small HCC resection accounted for 51.4%. It was an effective approach to improve the prognosis of HCC in the entire series, the 5-year survival of inpatients treated in authorst institution was 4.8% in 1958-1970, 12.2% in 1971-1983, and 46. 7% in 1984-1995t which were correlated to the increase proportion of small HCC resection in the series; it was more effective as compared to large HCC resection,the 5 year survival was 61.3 %(n=645) versus 33.6% (n=950). Extensions of small HCC study included early detection and treatment of small recurrenx HCC, of the 147 patients with re-resection, the 5-year survival was 48.9% calculated from the time of first resection. Another extension was conversion of large HCC into small HCC, using muhimodality combination treatment, 72 out of the 663 patients with surgically verified unresectable HCCs have been converted to resectable, 5 year survival being 62.1%, which was comparable to that of small HCC resection. Studies on related basic aspect of small HCC such as cell origin of recurrence, and molecular aspect of small HCC * indicated that biological characteristics, particularly the tumor invasiveness, remained the key link for further prolong survival after small HCC resection. Recently, a“patient-like“ human HCC metastatic model in nude mice has been established. Experimental interventions have also been tried. Clinical trials for prevention of recurrence after small HCC resection have shown preliminary encouraging results. However, the “cost-effectiveness“ of screening, the invasiveness of HCC, the multieentrie origin, the coexisted Chilcl C cirrhosis, etc. , remained great challenge.     

探讨脂肪肝供肝在肝脏移植中的价值

目的探讨应用不同脂肪沉着程度供肝对肝移植患者预后的影响。方法选取64例进行肝移植术患者,依据供肝浸润程度,随机分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组、无脂肪肝组共四组,每组各16例,比较四组患者肝功能(主要观察ALT、AST指标)、入住ICU的平均时间、1年移植物成活率、移植物原发无功发生率。结果轻度脂肪肝组入住ICU的平均时间、ALT和AST水平、移植物原发无功发生率与无脂肪肝组接近;中度脂肪肝组入住ICU平均时间、ALT和AST水平均较轻度组和无脂肪肝组明显增高,P0.05;重度脂肪肝组入住ICU平均时间、ALT和AST水平、移植物原发无功发生率明显较前三组为高,P0.05。结论轻、中度肝脏脂肪浸入可作为肝移植供肝,重度脂肪肝不能作为供肝的选择目标。     

Microenvironment of Liver Regeneration in Liver Cancer

The occurrence and development of liver cancer are essentially the most serious outcomes of uncontrolled liver regeneration. The progression of liver cancer is inevitably related to the abnormal microenvironment of liver regeneration. The deterioration observed in the microenvironment of liver regeneration is a necessary condition for the occurrence, development and metastasis of cancer. Therefore, the use of a technique to prevent and treat liver cancer via changes in the microenvironment of liver regeneration is a novel strategy. This strategy would be an effective way to delay, prevent or even reverse cancer occurrence, development and metastasis through an improvement in the liver regeneration microenvironment along with the integrated regulation of multiple components, targets, levels, channels and time sequences. In addition, the treatment of "tonifying Shen (Kidney) to regulate liver regeneration and repair by affecting stem cells and their microenvironment" can regulate "the dynamic imbalance between the normal liver regeneration and the abnormal liver regeneration"; this would improve the microenvironment of liver regeneration, which is also a mechanism by which liver cancer may be prevented or treated.     

Liver

<正>209293 Probing into indication of living-related Liver Transplantation for Wilson’s disease/Cheng Feng(Liver Transplant Center,1st Hosp Nanjing Med Univ,Key Lab Living Donor Liver Transplant,Minist Public Health,Nangjing 210029)…∥Chin J Surg.-2009,47(6).-437~440Objective To probe into indication of living-related liver transplantation(LRLT)for Wilson’s Disease.Methods From January 2001 to February 2007,thirty-seven living-related liver transplants were performed.A retrospective analysis was carried on outcome of those patients.The indications for LRLT were acute hepatic failure in 3 patients and chronic advanced liver disease in 32 patients including 13 patients with Wilsonian neurological manifestations.Two patients presented with severe Wilsoian neurological manifestations even though their liver functions were stable.According to the scoring system for evaluation of the neurological impairment in Wilsion disease based on neurological signs and functions(total score was 30),the pre-transplantation score of those patients with neurological manifestations was 15.9±4.3(n=15).Results Thirty-seven patients were followed up for 20-93 months.The survival rates of post-transplant patients and grafts at 1,3,and 5 year were 91.9%,83.8%,75.7%,and 86.5%,78.4%,75.7%,respectivly.Postoperative surgical complications occurred in 2 donors with bile leakage required drainage,in 2 recipients with hepatic thormbosis underwent retransplantation of cadeveric liver and in 1 recipient with hepatic stenosis required balloon dilatation.Neurological function was improved in all recipients and the score of posttransplantation at 6,12,18,24,and 30 months was 17.5±3.7(n=13);21.0±4.3(n=12);23.9±3.9(n=10);26.6±2.2(n=10)and 28.1±1.9(n=7)respectively.Conclusion Patients with acute hepatic failure or patients with severe liver disease unresponsive to chelation tratment should be treated with LRLT.Early transplantation in patients with an unsatisfactory response medical tratment may prevent irreversible neurologica     

Liver

<正>209461 Intraoperative ligation of recipient’s portasystemic shunt in liver transplantation/Chen Litian(,Organ Transplant Center,Tianjin 1st Centr Hosp Tianjin 300192)…∥Chin J Gen Surg.-2009,25(4).-489～491Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation.Methods From January 2007 to August 2008,35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan,among them 23 patients had spontaneous major portasystemic shunts,the other 12 patients did not have portasystemic shunts.16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry.The shunt of the other 7 patients were left untreated.Results The portal blood flow in the 12 patients without portasystemic shunt judged by preoperative CT scanning were(1 101±70)ml/min.The shunts in 7 patients with portal blood flow greater than 1 000 ml/min were not ligated,that of the 16 patients with portal blood flow volume lower than 1 000 ml/min were ligated.The portal blood flow volume in those 16 patients before and after ligating the shunt were(657±112)ml/min and(1 136±161)ml/min,respectively(P<0.05).Postoperatively 2 patients suffered from portal vein thrombosis,among them 1 patients suffered from intermittent disturbance of consciousness,2 patients died within 3 months,with one died of respiratory failure from pulmonary aspergillus infection,one died of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive.Conclusion The ligation of portasytemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1 000 ml/min.5 refs,2 figs.     

Liver

Alleviation of ischemia-reperfusion injury in rat liver donors by induction of exogenous hTERT gene;Effects of surgical technique on acute renal failure after orthotopic liver transplantation in patients with end-stage liver disease at high risk： a report of 90 eases;Timing for liver transplantation for chronic severe hepatitis;Analysis of bacterial variance and drug resistance after orthotopic liver transplantation;The influence of splenectomy on orthotopic liver transplantation and its management     

Liver

<正>209604 The suppressive effect of CD8+ CD28-regulatory T cells from spontaneous tolerance models on the acute rejection responses in rat liver transplantation/Chen Ning(陈宁,Dept Gastroenterol,Peking Univ Peop Hosp,Beijing 100044)…∥Chin J Organ Trans-plant. -2009,30(9). -524 ～526     

Liver

<正>209087 Clinical analysis of outcome of invasive fungal infection after kidney transplantation/Chen Guodong(陈国栋,Dept Transplant Surg,1st Hosp,Sun Yat sen Univ, Guangzhou 510080)…∥Chin J Organ Transplant. -2009, 30(10). -616～619 Objective To explore the outcome of invasive fungal infection in kidney transplantation and the influencing factors.     

Liver

Prevention and treatment of artery complication after liver transplantation by HBO , Clincal feature of cytomegabvirus pneumonia in orthtopic liver-transplantation and treatments, Risk factors of diabetes mellitus following orthotopic liver transplantation , Re-infection of hepatitis B virus after liver transplantation , Diagnosis and treatment of fungal infection after orthotopic liver transplantation , Two successful adult-to-adult living donor liver transplantation using dual grafts     

脂肪肝患者血清肝纤维化指标分析

目的探讨脂肪肝患者血清肝纤维化指标特点，寻找可能引起脂肪肝肝纤维化改变的相关因素。方法记录脂肪肝组和正常对照组临床资料与血清生化指标以及肝纤维化指标，分析各项指标的异常及脂肪肝组肝纤维化指标及其他指标的相关关系。结果脂肪肝组和正常对照组血清生化指标和肝纤维化指标之间的比较：脂肪肝患者组血清FPG、TG、Tc、ALT、HA、LN、PCⅢ、CIV、CG与对照组比较差异有统计学意义（P〈0．05）。血清肝纤维化指标HA与年龄（≥50岁）、酗酒、男性、CG增高、ALT增高、高血压病有线性回归关系；血清肝纤维化指标LN与酗酒、肥胖、糖尿病有线性回归关系；血清肝纤维化指标CIV与高脂血症，ALT增高有线性回归关系；血清肝纤维化指标PcⅢ与年龄（I〉50岁）、高脂血症、高血压病有线性回归关系。结论通过多元线性回归分析显示：男性，年龄≥50岁，酗酒，肥胖，伴发高血压病、高脂血症、糖尿病，出现CG增高，ALT增高，可能是促进脂肪肝发生肝纤维化的危险因素。     

化肝汤1号治疗酒精性肝纤维化症状及肝功能改变

目的观察活血化瘀、软坚散结药配伍治疗肝纤维化时对患者主、次症状改变及肝功能的影响。方法将确诊为酒精性肝纤维化患者90例,随机分为三组,治疗组采用自制方剂化肝汤1号(醋鳖甲、黄芩、柴胡、赤芍等),对照组1采用凯西莱治疗,对照组2采用化肝汤1号和凯西莱联合治疗,疗程3个月。观察三组患者治疗前后主、次症状改善情况,血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(γ-GT)变化。结果三组治疗后的临床疗效比较差异无统计学意义(H=2.5897,P>0.05)。三组治疗后肝功能指标均有改善,与治疗前比较,差异有统计学意义(P<0.05)。结论化肝汤1号可有效地降低肝细胞的损害程度,促进受损细胞修复,从而改善肝功能。