肝外阻塞性黄疸的微创治疗进展

肝外阻塞性黄疸是各种原因引起的胆道狭窄,近年来在治疗方式特别是微创治疗方面进展迅速。选用恰当的微创治疗方式可以明显提高治疗效果,减少创伤程度,延长患者的生存期和提高患者生活质量。此文对肝外阻塞性黄疸的各种微创治疗方法作一总结和探讨。     

肝外阻塞性黄疸的微创治疗进展

肝外阻塞性黄疸是各种原因引起的胆道狭窄,近年来在治疗方式特别是微创治疗方面进展迅速.选用恰当的微创治疗方式可以明显提高治疗效果,减少创伤程度,延长患者的生存期和提高患者生活质量.此文对肝外阻塞性黄疸的各种微创治疗方法作-总结和探讨.     

中药复方辅助治疗肝外阻塞性黄疸的研究概况

肝外阻塞性黄疸(obstructivejaundice,OJ)主要通过手术治疗,有较高的围手术期并发症率及手术病死率,如能用中药复方辅助治疗,能够较好的降低手术带来的并发症发生率和病死率.本文从肝外OJ发病原因及相关并发症着手,阐述中药复方辅助治疗肝外OJ的现状与进展,多方面总结中药复方辅助治疗肝外OJ的重要作用,为更进一步的实验及临床研究与应用提供理论依据.     

肝外梗阻性黄疸与肝外胆道扩张的关系及其临床意义

本文对我院近11年中各种原因引起的肝外梗阻性黄疸的病人进行了分析,报告了肝外梗阻性黄疸与肝外胆道扩张的相互关系和特点,对黄疸的鉴别诊断与治疗有一定的临床意义。     

CT，MRI对肝外恶性梗阻性黄疸的诊断价值

目的：探讨CT,MRI对肝外恶性梗阻性黄疸的定位诊断价值。方法：对80例肝外恶性黄疸病人行CT及MRI检查,并进行回顾性分析,结果：MRI对肝外恶性梗阻性黄疸具有相近定位诊断价值,对于显示肝外胆管呈软藤状或枯树状扩张较特异征象,MRCP最有意义,在定性上,CT,MRI在各段肝外恶性梗阻性黄疸诊断上各有优势,对于肝门段和胰腺上段,梗阻胆管部位显示,CT,MRI大致相近,在胰头段,对于显示梗阻胆管部位胆壁增厚,胰头增大,钩突形态,增强薄层CT显示较好,而对于无胰头和钩突增大情况下,肿瘤侵及胰头和钩突,MRI显示较好,对于胰头癌患者,MRCP还可显示较特异的扩张胰胆管呈分离状态;对于壶腹区小肿瘤所致梗阻性黄,在屏气口服造影剂情况下,CT薄层扫描有意义辅以低张十二指肠造影。结论：判断肝外恶性梗阻性黄疸部位,性质,侵及范围,切除可能性评估,有无转移,CT,MRI检查相互结合,必要时辅以它检查,起着决定性诊断作用。     

胆道外引流对梗阻性黄疸大鼠肝部分切除术后肝再生的影响

[目的]探讨不同程度胆道外引流对梗阻性黄疸大鼠肝部分切除术后肝再生的影响。[方法]建立梗阻性黄疸-再通SD大鼠动物模型(梗阻10d),根据引流后不同时相的胆红素水平,选取对照组及引流0、3、10d为4组,即正常大鼠肝切除组(A组)、胆道外引流0d肝切除组(B组)、胆道外引流3d肝切除组(C组)、胆道外引流10d肝切除组(D组)。观察术后15d大鼠死亡率、肝功能恢复、术后7d残肝重量/大鼠体重比值,免疫组织化学技术检测术后残肝组织PCNA峰值标记指数、RT-PCR技术检测术后残肝HGF mRNA的表达。[结果]D组在肝切除术后死亡率、肝功能恢复、PCNA标记指数、HGF mRNA表达及肝质量/大鼠体重比值等方面均优于C组及D组,差异均有统计学意义(P<0.05),但仍弱于A组,差异有统计学意义(P<0.05)。[结论]胆道梗阻导致的高胆红素血症明显抑制肝切除术后的肝再生,在胆道外引流后的短时间内,肝功能虽明显改善,但是肝再生仍处于抑制状态,较长时间胆道外引流、肝功能得到充分恢复才能较为安全地行扩大肝叶切除术。     

自身免疫性肝炎患者血清补体C3和C4的临床检测意义

目的评价补体C3、C4在自身免疫性肝炎(autoimmune hepatitis,AIH)的临床检测意义。方法选取2011年5月-2013年12月于奉节县人民医院就诊的AIH患者90例,其中活动期45例,缓解期45例。采用间接免疫荧光法检测患者抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)的表达,全自动生物化学分析仪检测患者的肝功能生化指标,散射比浊法检测患者外周血中的补体C3、C4、Ig G、Ig A、Ig M的表达水平,肝脏穿刺病理组织检测判断其炎性活动水平。然后分析AIH患者C3、C4水平与炎症活动程度的关系。结果 C3、C4在AIH活动期表达水平[(0.89±0.05)g/L、(0.16±0.03)g/L]显著低于缓解期表达水平[(1.12±0.06)g/L、(0.23±0.04)g/L,P0.01];C3表达水平与AST(r=-0.248,P=0.000)、TBIL(r=-0.372,P=0.003)、DBIL(r=-0.471,P=0.012)呈负相关;C4表达水平与AIH活动期患者肝脏病理组织穿刺的HAI病理评分呈负相关(r=-0.635,P=0.000)。结论 AIH活动期患者补体C3、C4表达水平下降,可通过对其检测辅助评估肝脏炎性活动程度。     

乙型肝炎患者血清免疫球蛋白和补体C3/C4检测的意义

目的探讨检测慢性乙型肝炎、乙型肝炎肝硬化和乙型肝炎肝衰竭患者血清免疫球蛋白(Ig G、Ig M、Ig A)和补体C3、C4水平的意义。方法在32例慢性乙型肝炎、33例乙型肝炎肝硬化和35例乙型肝炎肝衰竭患者,采用速率散射免疫比浊法检测血清免疫球蛋白(Ig G、Ig M、Ig A)和补体C3、C4。结果乙型肝炎肝衰竭患者血清Ig A水平为(4.06±1.20)mg/L,显著高于慢性乙型肝炎[(3.18±1.23)mg/L,P0.05]和乙型肝炎肝硬化患者[(3.21±1.53)mg/L,P0.05];C3水平为(0.33±0.02)g/L,显著低于慢性乙型肝炎[(0.54±0.25)g/L,P0.05]和肝硬化患者[(0.60±0.05)g/L,P0.05];三组其他指标无显著性相差(P0.05)。结论血清Ig G、Ig M、Ig A和补体C3、C4水平检测对肝脏疾病的诊断有一定的临床意义。     

ERCP,B超,CT诊断肝外梗阻性黄疸的价值

肝细胞性黄疸根据B超和实验室检查容易鉴别,而肝外梗阻性黄疸在临床上病因诊断比较困难。尤其胰头癌、十二指肠乳头癌和胆管肿瘤起病隐袭,病人就诊时黄疸较深,往往已届中晚期,病因诊断明确晚,给治疗带来困难。本文对肝外梗阻性黄疸进行B超、CT、ERCP同期检查,探讨其对病因诊断的可比性。     

重症肝炎血清和肝组织补体的检测及其意义探讨

重症肝炎(下称重肝)病死率极高,发病机理迄今尚未完全阐明。许多疾病的发生与补体系统的活化有关,本文分别用火箭免疫电泳法和免疫组化(PAP)法对重肝及其他各型肝炎患者的血清补体活化片段C_(3d)、C_(4d)和肝组织补体C_3、IgG进行检测,探讨补体系统活化在重肝发病机理中的作用,并对其临床意义进行讨论。现报道如下。     

血清补体C3和C4对慢性乙型肝炎患者肝组织病理状态的判断价值

目的:探讨血清补体C3 和C4判别慢性乙型肝炎患者肝组织病理学分级和分期的价值.方法:456 例经肝组织病理学检查的慢性乙型肝炎患者入选本研究.血清补体C3 和C4采用Beckman-Coulter Immage 800 免疫化学系统及其配套试剂测定.血清补体C3 和C4判别病理学分级和分期的评价采用Bayes 逐步判...     

Etiology and long-term outcome of extrahepatic portal vein obstruction in children

AIM:To study the management and outcome of children with extrahepatic portal vein obstruction(EHPVO) in a whole country population.METHODS:A nationwide multicenter retrospective case series of children with EHPVO was conducted.Data on demographics,radiographic studies,laboratory workup,endoscopic and surgical procedures,growth and development,were extracted from the patients’ charts.Characteristics of clinical presentation,etiology of EHPVO,management and outcome were analyzed.RESULTS:Thirty patients,13 males and 17 females,19(63.3%) Israeli and 11(36.7%) Palestinians,were included in the analysis.Age at presentation was 4.8± 4.6 years,and mean follow-up was 4.9±4.3 years.Associated anomalies were found in 4 patients.The incidence of EHPVO in Israeli children aged 0-14 years was 0.72/million.Risk factors for EHPVO were detected in 13(43.3%)patients,including 9 patients(30%) with perinatal risk factors,and 4 patients(13.3%) with prothrombotic states:two had low levels of protein S and C,one had lupus anticoagulant,and one was homozygous for methyltetrahydrofolate reductase mutations.In 56.6% of patients,no predisposing factors were found.The most common presenting symptoms were an incidental finding of splenomegaly(43.3%),and upper gastrointestinal bleeding(40%).No differences were found between Israeli and Palestinian children with regard to age at presentation,etiology and clinical symptoms.Bleeding occurred in 18 patients(60%),at a median age of 3 years.Sclerotherapy or esophageal banding was performed in 20 patients.No sclerotherapy complications were reported.Portosystemic shunts were performed in 11 patients(36.6%),at a median age of 11(range 3-17)years:splenorenal in 9,mesocaval in 1,and a meso-Rex shunt in 1 patient.One patient underwent splenectomy due to severe pancytopenia.Patients were followed up for a median of 3(range 0.5-15)years.One patient died aged 3 years due to mucopolysaccharidase deficiency type Ⅲ.None of the patients died due to gastrointestinal bleeding.CONCLUSION:EHPVO is a rare di     

替比夫定治疗HBeAg阳性慢性乙型肝炎和肝硬化患者血清免疫球蛋白和补体水平的变化

目的观察HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后血清免疫球蛋白IgG、IgA、IgM和补体C₃、C₄的变化,探讨替比夫定治疗对于患者体液免疫功能的影响。方法选择35例HBeAg阳性慢性乙型肝炎和22例乙型肝炎肝硬化患者,给予替比夫定抗病毒治疗,于治疗前和治疗后3个月、6个月,采用免疫透视比浊法检测血清免疫球蛋白IgG、IgA、IgM和补体C₃、C₄。结果在治疗前,慢性乙型肝炎患者血清IgG水平为（16.21±2.54） mg/L,显著低于肝硬化患者的[（19.42±2.95） mg/L,P<0.05];在治疗6个月时,肝硬化患者血清IgA水平为（1.41±0.18） mg/L,显著高于慢性乙型肝炎患者的[（1.26±0.17） mg/L,P<0.05];在其他各时间点比较,两组患者血清免疫球蛋白和补体水平无显著性相差（P>0.05）。结论HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后机体体液免疫功能有一定程度的恢复。     

冠心病患者血清补体C3、C4及HDL－C水平分析

目的分析冠心病(CHD)患者血清补体C3、C4与HDL－C的水平。 方法依据病情将2016年5月至2017年10月西安市第五医院收治的137例CHD患者分为急性冠脉综合征组(ACS组,80例)和稳定性冠心病组(SCHD组,57例),选取同时期健康体检的60例健康人员纳为对照组。对比3组患者补体C3、C4、HDL－C水平,分析补体C3、C4水平与HDL－C水平的相关性。 结果ACS组和SCHD组患者补体C3水平均高于对照组(P<0.05);ACS组患者补体C3水平高于SCHD组(P<0.05);ACS组患者补体C4水平高于对照组(P<0.05),SCHD组患者补体C4水平低于对照组(P<0.05);对照组HDL－C水平高于ACS组和SCHD组患者(P<0.05)。ACS组和SCHD组患者血清补体C3、C4水平与HDL－C水平无关(P>0.05),对照组血清补体C3水平与HDL－C水平呈负相关(P<0.05)。 结论CHD患者血清补体C3、C4水平升高,HDL－C水平降低,炎症反应影响血清补体与HDL－C水平的相关性。     

Serum complement C4a and its relation to liver fibrosis in children with chronic hepatitis C

AIM:To evaluate serum complement C4a and its relation to liver fibrosis in children with chronic hepatitis C virus(HCV)infection.METHODS:The study included 30 children with chronic HCV infection before receiving antiviral therapy.Chronic HCV infection was defined by positive anti-HCV,a positive polymerase chain reaction for HCV-RNA for more than 6 mo with absence of any associated liver disease.A second group of 30 age-and sex-matched healthy children served as controls.Serum C4a levels were measured by enzyme-linked immunosorbent assay.Liver fibrosis stage and inflammatory grade were assessed using Ishak scoring system.Serum C4a levels were compared according to different clinical,laboratory and histopathological parameters.Statistical significance for quantitative data was tested by MannWhitney U non-parametric tests.For qualitative data,significance between groups was tested by 2test.Correlation was tested by Spearman’s test.Results were considered significant if P value≤0.05.RESULTS:The age of the patients ranged from 3.5to 18 years and that of controls ranged from 4 to 17years.C4a mean levels were merely lower in patients(153.67±18.69 mg/L)than that in the controls(157.25±11.40 mg/L)with no statistical significance(P=0.378).It did not differ significantly in patients with elevated vs those with normal transaminases(152.25±16.62 vs 155.36±21.33;P=0.868)or with different HCV viremia(P=0.561).Furthermore,there was no statistical significant difference in serum levels between those with no/mild fibrosis and those with moderate fibrosis(154.65±20.59 vs 152.97±17.72;P=0.786)or minimal and mild activity(155.1±21.93 vs 152.99±17.43;P=0.809).Though statistically not significant,C4a was highest in fibrosis score 0(F0),decreasing in F1 and F2 to be the lowest in F3.When comparing significant fibrosis(Ishak score≥3)vs other stages,C4a was significantly lower in F3 compared to other fibrosis scores(143.55±2.33 mg/L vs 155.26±19.64 mg/L;P=0.047)and at a cutoff value of less than 144.01 mg/L,C4a could discriminate F3 with 76.9%sensitivity and75%specificity from other stages of fibrosis.CONCLUSION:Serum complement C4a did not correlate with any of transaminases,HCV viremia or with the histopathological scores.Although C4a decreased with higher stages of fibrosis,this change was not significant enough to predict individual stages of fibrosis.Yet,it could predict significant fibrosis with acceptable clinical performance.     

Relationship between secretory IgA, IgA-containing (C3-fixing) circulating immune complexes, and complement components (C3, C4) in patients with obstructive jaundice

Serum secretory IgA, IgA-containing circulating immune complexes (IgA-CIC), complement components, and major immunoglobulins were measured in patients with biliary tract stones and/or tumors of the biliary tract or pancreas. The levels of secretory IgA and total IgA were increased in patients with and without obstructive jaundice. The levels of both C3 and C4 were significantly higher in patients with or without obstructive jaundice than in healthy controls. In patients with obstructive jaundice the increased levels of secretory IgA, total IgA, and IgA-CIC were correlated with the increase of C3 but not with that of C4.     

Changes in Maternal Serum Levels of C3 and C4 Complement Components in Different Delivery Methods and Postpartum Hemorrhage

Background: Activation of the complement system may play a role in the pathophysiology of human labor. Yet no unanimous conclusion has been drawn. Objective: To compare the differences in maternal complement components C3 and C4 serum levels in cesarean section and the vaginal delivery at term and in the postpartum hemorrhage. Methods: One hundred and sixty six women delivered at term were enrolled in this study. Maternal blood samples were obtained from 47 cases of elective cesarean section and 119 cases of the vaginal delivery. Serum complement levels were measured subsequently by immuno-scatter turbidimetry. Results: The maternal complement levels declined significantly during delivery by both the cesarean section and the vaginal delivery (p＜0.01) in comparison with the baseline. A much larger drop of C3 serum level was found in the postpartum hemorrhage and in the vaginal delivery, and the incidence of the postpartum hemorrhage has a positive correlation with the complement decline rate. Conclusion: The complement system may be involved in the delivery process and represents a predictive value in postpartum hemorrhage.     

Serum complements C3 and C4 in chronic HCV infection and their correlation with response to pegylated interferon and ribavirin treatment

Background and study aimsTo search for an immunological parameter that may correlate with the response to interferon (IFN) treatment is very crucial. The objective of this study was to correlate the levels of C3 and C4 complement components with the response to IFN treatment in patients with chronic hepatitis C virus (HCV) infection.Patients and methodsThis study was conducted on 100 patients and control subjects classified into three groups. Group (I) consisted of 50 patients with chronic hepatitis C who were receiving IFN treatment and showed various responses; group (II) included 25 patients with chronic hepatitis C naive to IFN treatment; and group (III) included 25 healthy subjects matched for age and sex who served as controls. Measurement of the level of complement C3 and C4 was done by a quantitative turbidimetric test. Measurement of complement levels in group (I) was done at the end of treatment at the 48th week.ResultsSerum levels of C3 and C4 were found to be significantly reduced in all patients with chronic HCV infection in both groups (I and II) compared to the healthy control group (III) (p < 0.05). Moreover, chronic HCV patients treated with IFN and ribavirin had significantly lower levels of C3 and C4 compared with patients naive to IFN and ribavirin treatment. At the end of treatment, both C3 and C4 had significantly increased in responders to IFN when compared to non-responders (p = 0.025 and 0.05, respectively). There was a significant negative correlation between C3 and C4 levels and the concentration of serum alanine aminotransferase (ALT) measured simultaneously.ConclusionHigher C3 and C4 serum concentrations were found to be positively correlated to the end-of-treatment response in patients with chronic HCV infection treated with IFN and ribavirin.     

Prognostic significance of complement alleles Bf and C4 in early rheumatoid arthritis

Summary The prognostic significance of class III major histocompatibility complex complement components, factor B (Bf), C4A and C4B, were studied in a 3-year prospective study of 73 patients with early RA. Patients with C4B null allele had higher disease activity with more radiological progression than patients with C4A null allele or patients without null alleles. C4B null allele also associated with increased susceptibility to side effects from antirheumatic treatment. The Bf phenotypes did not associate with the severity of RA. C4B null allele may have prognostic significance in determining a special subgroup of RA patients with a more complicated course of the disease.     

高脂血症患者血清补体C3、C4、备解素和白细胞补体调节蛋白CD35、CD55、CD59的表达

目的:探讨高脂血症患者血清补体和外周血白细胞补体调节蛋白的表达及其在动脉粥样硬化中的意义。方法:选高脂血症患者46例(高脂血症组),年龄、性别、体重指数匹配的正常人20例作为正常对照组,用免疫散射比浊法测血清补体C3、C4、备解素(Pf);用流式细胞术测定外周血中性粒细胞、淋巴细胞和单核细胞CD35、CD55、CD59的表达,观察上述指标在高脂血症组中的变化,分析影响因素。结果:高脂血症组血清C3、C4、Pf水平较正常对照组明显升高(P<0.01);补体C3、C4水平与血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)明显正相关(P<0.01),Pf与TC、LDLC正相关(P<0.01)。CD35阳性淋巴细胞、单核细胞、粒细胞百分率较正常对照组升高(P<0.05),CD35阳性淋巴细胞、粒细胞百分率与TG呈正相关(P<0.05～0.01);CD55阳性淋巴细胞平均荧光强度较正常对照组下降(P<0.05);CD59阳性淋巴细胞、单核细胞百分率较正常对照组下降(P<0.05)。结论:高脂血症患者血清补体C3、C4、Pf升高,白细胞补体调节蛋白表达改变,补体及补体调节蛋白的改变与血脂水平相关,表明脂代谢紊乱可影响补体及补体调节蛋白的表达,提示补体及补体调节蛋白可能参与动脉粥样硬化的病理生理过程。