CONVERSION OF DEHYDROEPIANDROSTERONE SULPHATE TO OESTROGENS IN INTRAHEPATIC CHOLESTASIS AND OTHER COMPLICATIONS OF PREGNANCY

The aim of the present study was to determine whether pregnancy complications themselves influence the conversion rate of dehydroepiandrosterone sulphate (DHAS) to oestrogens during pregnancy. 100 mg DHAS was given intravenously to seven women with intrahepatic cholestasis of pregnancy, nine women with preeclampsia, nine diabetics, ten with twins and eight women with normal pregnancy between 31--40 weeks of gestation. Serum oestradiol (E2) and oestriol (E3) were measured with specific radioimmunoassays before and 1--5 h after DHAS injections. A significant oestradiol elevation following DHAS was similar in each group. By contrast there was an oestriol elevation (P less than 0.05) only in intrahepatic cholestasis of pregnancy. The results indicate that: (1) pregnancy complication itself does not effect the conversion rate of DHAS to oestradiol, (2) in patients with intrahepatic cholestasis there is a disturbed E3 metabolism which may be due to an increased placental permeability to exogenous DHAS or to a decreased metabolism of E3 by maternal liver.     

妊娠期肝内胆汁淤积症并发症与母血及脐血胆酸关系的观察

本文报道妊娠期肝内胆汁淤积症（ＩＣＰ）４４例的并发症。结果示早产。死胎。宫内窘迫（ＦＩＤ）。低体重儿及产后大出血分别为３．８０％，０．４５％，２０．４５％，２９．３２％及３１．８１％，明显高于１５６例正常孕妇对照组（Ｐ＜０．０１）。ＩＣＰ组２２例与对照组１２例并作了母血胆酸（ＭＣＡ）与脐血胆酸（ＵＣＡ）测定与并发症关系的观察。结果示ＩＣＰ组的ＣＡ与ＵＣＡ分别为２６．６２±４．６０μｍｏｌ／Ｌ与２０．２２±２。１２μｍｏｌ／Ｌ明显高于对照组（Ｐ＜０．０ｌ）。ＭＣＡ与ＵＣＡ二者水平呈正相关，并与胎儿宫内窘迫相关。ＵＣＡ≥１５μｍｏｌ／Ｌ者发生ＦＩＤ占７１．４３％。作者认为监测ＭＣＡ有助于预测胎儿安危。对其增高者，加强胎儿监护，及时剖腹产，可减少ＦＩＤ等并发症的发生。本组２例三胎三产中前２胎死于宫内，第三胎密切观察，在胎儿窒息先兆前结束妊娠行剖腹产而获得健康婴儿。     

CHOLESTASIS IN ACUTE ALCOHOLIC LIVER DISEASE

10 of a series of 108 patients with alcoholic liver disease presented with cholestasis associated with non-cirrhotic alcoholic liver disease and without evidence of extrahepatic biliary obstruction. In 7 patients liver histology and the associated conditions presenting as cholestasis were heterogeneous. However, in 3 patients who had been drinking excessively before cholestatic jaundice developed, cholestasis was a major feature of liver histology. The term acute alcoholic cholestasis is suggested for this apparently distinct syndrome of cholestatic jaundice in the absence of hepatitis.     

IMPROVEMENT OF HEPATORENAL SYNDROME BY TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Hepatorenal syndrome (HRS) is a functional renal failure occurring in advanced liver cirrhosis with ascites. It is due to renal cortical vasoconstriction resulting from complex hemodynamic disturbances related to cirrhosis and portal hypertension. There is no consistently effective therapy except for liver transplantation. We report a case of severe HRS in a patient with advanced liver cirrhosis and portal hypertension. Three sessions of hemo-dialysis were performed because of severe renal failure (serum urea S3 mg/dl, serum creatinine 6 mg/dl). Creation of an intra-hepatic portosystemic shunt reduced the portocaval gradient from 18 to 7 mm Hg. Spectacular improvement of the renal function was observed soon after the procedure, with spontaneous recovery of diuresis and a return of serum urea and creatinine to baseline values. The patient unfortunately died 2 months later from adult respiratory distress syndrome post emergency surgery for a massive bleed related to a duodenal ulcer. Throughout this episode, the renal function remained stable. The postmortem examination showed histologically normal kidneys. We conclude that the intrahepatic portosystemic shunt can improve renal function in cirrhotic patients with HRS; it could be used in patients awaiting liver transplantation to reverse preoperative renal failure.     

经颈静脉肝内门体支架分流术的并发症及其防治

目的探讨经颈静脉肝内门体支架分流术（ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｅｎｔ－ｓｈｕｎｔ，ＴＩＰＳＳ）的并发症及其防治。方法分析３１例行ＴＩＰＳＳ术患者的情况。结果手术成功率９６７％，术后近期并发症有转氨酶升高（１００％）、术后炎性反应（３２２％）、胆道出血（６４％）、术后死亡（６４％）、腹膜炎（３２％）。术后远期并发症有胆红素升高（５４８％）、白蛋白下降（２９０％）、支架狭窄或阻塞（１９３％）、低蛋白水肿（１６１％）、肝性脑病（１６１％）、合并肝癌（６４％）。结论ＴＩＰＳＳ术应严格掌握适应证并应严密注意术后并发症的防治。     

INTRAHEPATIC SEQUESTERED SEGMENT OF I.IVKR PRESENTING AS FOCAL FATTY CHANGE

Focal fatty change of the liver is a lesion that is often discovered on imaging studies und must he distinguished from space-occupying lesions. The pathogenesis is unknown. W'e report a lesion of focal fatty changes in which the portal supply and biliary drainage were anomalous so that the lesion represents sequestered liver tissue, Because insulin favors the development of steatosis, the pathogenesis of focal fatty change could he explained if the aber-rant portal snpph contained more insulin than the main portal vein, as would occur if the portal supply arose from pancreatic veins via the parabiliary venous plexus of Couinuud. Further-more, focal fatty sparing could be explained if the spared segment was supplied by veins draining from the stomach that carry blood with lower insulin levels than the main portal vein.     

245例肝硬变患者肝内血管病变的形态观察

用本文制定的血管病变评定标准,对245例肝硬变标本进行组化、免疫组化及电镜观察,结果表明,本组病例皆有肝内静脉血管的炎症、损伤、增生及阻塞病变,多伴随肝窦毛细血管化,肝窦扩张及阻塞表现,Ⅳ型胶原、FN、LN及弹力纤维也增多,从而导致肝血供不良。     

树鼩实验感染丁型肝炎病毒后肝内抗原表达状态

目的 研究树鼩实验感染人丁型肝炎病毒的可能性。方法 用免疫组化方法,检测树鼩肝组织丁型肝炎病毒抗原(HDAg),乙型肝炎病毒表面抗原HBsAg),采用原位杂交方法检测部分动物肝内HDV RNA。结果 35只动物,HDV/HBV同时感染组和重叠感染组HDAg阳性率分别为94.5％(21╱22)和84.6％(11/13);HDAg在肝内主要定位于肝细胞,在肝小叶呈灶状或片状分布,肝内持续时间在同时感染组和重叠感染组稍有不同,前者多持续3～4周,后者则可长达12周以上;部分动物肝组织细胞浆或细胞核HDV RNA阳性。结论 人HDV可感染树鼩,树鼩可成为丁型肝炎研究的动物模型。