扶正化瘀胶囊治疗日本血吸虫病肝纤维化的临床疗效观察

目的:探讨扶正化瘀胶囊治疗日本血吸虫病肝纤维化的疗效。方法:临床观察日本血吸虫病肝纤维化患者48例,随机分为试验组(基础护肝治疗联合扶正化瘀胶囊)和对照组(基础护肝治疗),每组24例,患者均在护肝及抗纤维化治疗前1个月给予吡喹酮驱虫治疗,治疗前后观察患者临床症状和体征的改善,肝功能、血清肝纤维化指标的复常以及影像学指标的改变。结果:治疗24周后,两组患者临床症状和体征与治疗前比较均有明显改善,尤其肝区不适症状的缓解,试验组优于对照组(P<0.05);两组患者治疗后血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBil)水平均有显著改善(P<0.05);试验组血清透明质酸(HA)﹑Ⅲ型前胶原(PCⅢ)水平在治疗12周、24周较治疗前均显著下降(P<0.05),下降幅度均显著优于对照组(P<0.05);治疗24周患者血清层粘连蛋白(LN)﹑Ⅳ型胶原(Ⅳ-C)含量与治疗前比较两组均有显著改善(P<0.05),且试验组改善优于对照组(P<0.05);治疗24周患者肝门静脉主干内径、脾脏厚度的改变,试验组明显优于治疗前(P<0.05),且与对照组比较差异具有显著性意义(P<0.05)。结论:扶正化瘀胶囊治疗日本血吸虫病肝纤维化可明显改善患者临床症状和体征,促进肝脏功能恢复,有效地减轻肝脏纤维化。     

丹红软肝胶囊对肝纤维化患者血小板生长因子的影响

目的:研究丹红软肝胶囊对肝纤维化患者血小板生长因子(PDGF)的影响.方法:以108例慢性乙型肝炎肝纤维化患者为观察对象,随机分为两组,治疗组56例采用丹红软肝胶囊治疗,对照组52例服用复方鳖甲软肝片,均治疗6个月,观察治疗前后患者血清肝功能、肝纤维化指标及PDGF含量的变化.结果:治疗6个月时,治疗组患者肝纤维化血清指标透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)和Ⅲ型前胶原( PCⅢ)水平较治疗前均显著降低(P＜0.05);肝功能丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)与治疗前比较均显著改善(P＜0.05);PDGF含量较治疗前明显降低(P＜0.05).上述指标与对照组比较差异无显著性意义(P＞0.05).结论:丹红软肝胶囊可能通过抑制PDGF的分泌来抑制肝纤维化的发生发展.     

双甲五灵胶囊与肝纤维化血清TIMP-1的变化及临床疗效观察

目的观察自行研制的中药双甲五灵胶囊治疗慢性肝炎患者前后血清基质金属蛋白酶组织抑制剂1(TIMP1)的变化及意义,并观察双甲五灵胶囊治疗的临床疗效。方法将226例慢性肝炎患者随机分为双甲五灵胶囊治疗组和对照组,观察两组治疗半年前后临床症状、体征、肝功能、血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)以及TIMP1的变化,并进行统计学处理。结果双甲五灵胶囊治疗组与对照组比较,治疗组患者临床症状、体征、肝功能及血清肝纤维化指标明显好转(P<0.01)。结论双甲五灵胶囊可使患者血清中TIMP1水平明显降低,用于防治肝纤维化有效。双甲五灵胶囊对防治慢性肝炎肝纤维化有一定效果。     

强肝胶囊对慢性肝病肝纤维化指标的影响

目的 :了解强肝胶囊对慢性肝病患者血清肝纤维化指标 [透明质酸 (HA)、 型胶原 (C )、 型前胶原 (PC )、层粘连蛋白 (L N) ]的影响。方法 :12 1例慢性肝炎患者随机分为两组 :治疗组 (6 9例 )给予强肝胶囊 ,每日3次 ,每次 5粒 ,连服 3个月 ;对照组 (5 2例 )采用常规护肝降酶等治疗。治疗前、后分别检测两组血清 HA、C 、PC 、L N水平。结果 :治疗组血清 HA、C 、PC 、L N明显下降 ,与对照组比较差异有显著性意义 (P <0 .0 1)。结论 :强肝胶囊有较好的抗肝纤维化作用 ,是治疗肝纤维化的有效药物。     

扶正化瘀胶囊治疗血吸虫性肝纤维化效果观察

目的 探讨扶正化瘀胶囊治疗血吸虫性肝纤维化的疗效及其不良反应.方法 将日本血吸虫性肝纤维化患者64例,随机分为对照组(基础护肝治疗组)31例和实验组(基础护肝联合扶正化瘀胶囊治疗组)33例,观察两组在治疗前后肝功能、血清肝纤维化指标的变化,临床症状及其不良反应等.结果 治疗6个月,实验组患者治疗后血清丙氨酸氨基转移酶、门冬氨酸氨基转移酶、白蛋白、总胆红素等水平改善幅度较对照组更为显著,两组差异均有统计学意义(P＜0.05);对照组HA、PCⅢ、Ⅳ-C及LN治疗后较治疗前有所下降,但差异均无统计学意义(p＞0.05),实验组HA、PCⅢ、Ⅳ-C及LN治疗后均较治疗前有所下降,差异有统计学意义(p＜0.05).对照组与实验组患者症状明显好转率分别为61.3％、87.9％,实验组优于对照组,两者差异有统计学意义(p＜0.05);对照组与实验组不良反应发生率分别为3.2％、3.0％,发生率均较低,两者差异无统计学意义(p＞0.05).结论 扶正化瘀胶囊治疗血吸虫性肝纤维化具有高效、安全的特点,值得高度重视及推广应用.     

益生菌联合甘草酸二铵肠溶胶囊治疗CHB肝纤维化的效果及对肝生化、炎症反应、肝纤维化指标的影响

目的:探讨益生菌、甘草酸二铵肠溶胶囊联合方案治疗慢性乙型肝炎(CHB)肝纤维化的多方面效果,为临床治疗方案的制定提供有效参考。方法:选取2017年4月至2020年1月我院收治的124例CHB肝纤维化患者,随机数字表法分为对照组、观察组,各62例。在常规治疗基础上,对照组患者给予甘草酸二铵肠溶胶囊治疗,观察组患者给予益生菌(双歧杆菌四联活菌片)联合甘草酸二铵肠溶胶囊治疗。比较两组患者临床疗效,治疗前、治疗1个疗程后、治疗2个疗程后肝生化指标[总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清白蛋白(Alb)]、炎症反应指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)]、肝纤维化指标[透明质酸(HA)、Ⅲ型前胶原(PC-Ⅲ)、层黏蛋白(LN)、Ⅳ型胶原(Ⅳ-C)、肝硬度测定值(LSM)]、肠黏膜屏障功能指标[D-乳酸、内毒素、二胺氧化酶(DAO)]水平以及不良反应。结果:(1)疗效及安全性：观察组显效率为46.67%(28/60),高于对照组27.87%(17/61)(P<0.05),但两组患者不良反应发...     

熊去氧胆酸联合五酯胶囊、醋酸泼尼松治疗对代偿期原发性胆汁性肝硬化患者肝功能、肝纤维化与免疫功能的影响

目的 分析熊去氧胆酸(UDCA)联合五酯胶囊、醋酸泼尼松治疗对代偿期原发性胆汁性肝硬化(PBC)患者肝功能、肝纤维化和免疫功能的影响。方法 纳入106例代偿期PBC患者作为研究对象,将其随机分为观察组、对照组,每组53例。对照组行UDCA单药治疗,观察组在对照组治疗基础上行五酯胶囊+醋酸泼尼松治疗,两组均持续治疗6个月。比较两组治疗后临床疗效,治疗前后肝功能、肝纤维化指标水平和免疫功能,以及治疗期间不良反应发生情况。结果 治疗6个月后,观察组治疗总有效率高于对照组(94.34%比73.58%,P<0.05);观察组血清天冬氨酸氨基转移酶、γ-谷氨酰转移酶、丙氨酸氨基转移酶、总胆红素、碱性磷酸酶、透明质酸酶、层黏连蛋白、Ⅳ型胶原、Ⅲ型前胶原、免疫球蛋白(Ig)A、IgM、IgG水平均低于对照组(均P<0.05)。治疗期间,观察组与对照组不良反应的发生率差异无统计学意义(9.43%比5.66%,P>0.05)。结论 UDCA联合五酯胶囊、醋酸泼尼松治疗代偿期PBC效果显著,能减轻患者肝纤维化,改善肝功能,调节免疫反应,且不良反应较少。     

当飞利肝宁胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化36例

目的:观察当飞利肝宁胶囊联合恩替卡韦治疗慢性乙型肝炎肝纤维化的临床疗效。方法:68例该病患者分治疗组36例,口服当飞利肝宁胶囊联合恩替卡韦和肝泰乐治疗;对照组32例,口服肝泰乐、恩替卡韦。追踪观察两组患者治疗前后ALT、HBV DNA、血清Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)等指标变化情况。结果:治疗组患者治疗后血清肝纤维化各项指标和ALT较治疗前均有明显改善(P0.05),与对照组比较差异有显著性意义(P0.05)。结论:当飞利肝宁胶囊联合恩替卡韦对慢性乙型肝炎肝纤维化患者的抗纤维化方面有协同作用。     

苦参素针剂治疗肝纤维化的临床研究

目的　检测苦参素的抗肝纤维化作用。方法　早、中期肝纤维化患者 5 0例 ,肝功能Child分级A、B级 ,随机分为治疗组和对照组。治疗组予苦参素针剂 (KusensuSolution ,KS) ,40 0mg× 90d ,肌肉注射 ,对照组给予一般护肝及对症治疗。检测项目 :肝纤维化指标 :层粘蛋白体 (Laminin ,LN)、透明质酸 (Hyaluronicacid ,HA)、Ⅲ型胶原和Ⅳ型胶原 ;肝功能相关指标 :凝血酶原时间 (PT)、血清白蛋白、胆汁酸 (Totalbileacid ,TBA)。结果　治疗 6个月后 ,治疗组LN、HA、Ⅲ型胶原水平及TBA含量下降 ,与治疗前及对照组比较有显著差异。结论　苦参素可使早、中期肝纤维化患者肝纤维化指标水平下降 ,苦参素做为抗肝纤维化药 ,值得在临床推广使用。     

慢性肝炎血清肝纤维化指标与中医虚、实证及与肝脏病理分级分期的关系

目的:探讨慢性肝炎血清肝纤维化指标与中医虚、实证及肝脏病理的关系.方法:将75例慢性肝炎患者(其中偏实证组30例,偏虚证组45例)用放射免疫法测定血清肝纤维化指标:透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(Ⅳ-C),以同期健康体检正常者15例作对照.并对其中20例患者行肝组织活检.结果:①慢性肝炎患者血清肝纤维化指标(HA、LN、PCⅢ、Ⅳ-C)偏实证组较偏虚证组明显升高,两组差异有统计学意义.②慢性肝炎患者肝脏病理分级分期与血清肝纤维化指标存在相关性.结论:①血清肝纤维化指标可作为慢性肝炎中医虚、实证微观辨证指标之一.②湿热中阻和瘀血阻络是肝纤维化的活跃期,抗肝纤维化治疗的重点是清除湿热邪毒,活血化瘀、祛瘀通络.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.