重型肝炎患者外周血干细胞因子水平及临床意义

目的: 探讨重型肝炎患者外周血干细胞因子(stem cell factor,SCF)与其肝损害程度及预后的关系.方法: 贵州省遵义医学院第一附属医院住院的肝炎患者45例及门诊体检者15例.肝炎患者分为急性肝炎组15例,慢性肝炎组16例和重型肝炎组14例;重型肝炎患者又分为好转组4例,死亡组10例.ELISA法检测各组血清SCF水平.结果: 重型肝炎患者血清SCF水平明显高于急性肝炎、慢性肝炎和健康对照组,差异具有统计学意义(2403.1±42.8 ng/L vs 2354.9±19.0ng/L,2376.7±16.4 ng/L,2358.4±16.0 ng/L,均P＜0.05).重型肝炎患者死亡组血清SCF水平明显高于好转组,差异有统计学意义(2418.1±50.7 ng/L vs 2376.3±11.7 ng/L,P＜0.05).血清SCF与肝细胞生长因子有明显正相关(r =0.38,P＜0.01).SCF与血清白蛋白、凝血酶原时间活动度呈明显负相关( P＜0.01).结论: 重型肝炎患者外周血清SCF水平随着肝损害程度加重而明显升高,提示严重肝损害时,肝再生可能需要干细胞的参与.     

乙型肝炎患者血清Ⅲ型前胶原、Ⅳ型胶原和透明质酸及层粘连蛋白的检测及其意义

检测9例急性乙型肝炎、14例慢性乙型肝炎(轻度)、12例慢性乙型肝炎(中重度)和17例乙型肝炎肝硬变患者的血清Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C—Ⅳ)、透明质酸(HA)和层粘连蛋白(LN)的水平,并与200例正常人作对照.结果表明,各型乙型肝炎患者的血清PCⅢ、C一Ⅳ和LN均显著高于正常人,HA水平在慢性肝炎患者(中重度)和肝炎肝硬变组明显高于正常人,且PCⅢ、C—Ⅳ和HA随病倩的进展而升高.因此,血清PCⅢ、C一Ⅳ、HA和LN水平有助于判定肝纤维的活动程度.     

血清AFP、CEA、IL-6和TNF水平对判断重型肝炎预后的价值

目的 :探讨血清AFP、CEA、IL 6和TNF检测在判断重型肝炎患者死亡与恢复中的作用。方法 :应用RIA法检测重型肝炎患者 4种因子的血清水平。结果 :IL 6和TNF水平在重型肝炎死亡组较恢复组显著升高 (P <0 0 5 ) ;AFP水平在重型肝炎死亡 /肝移植组较恢复组显著降低 (P <0 0 1) ;CEA水平在重型肝炎死亡 /肝移植组较恢复组显著降低 (P <0 0 1;P <0 0 5 )。IL 6和TNF水平升高、AFP和CEA水平降低 ,对重型肝炎死亡 /肝移植的诊断效率为 66 7%、 61 1%、 69 4%和 75 0 %。结论 :血清IL 6和TNF升高、AFP和CEA低水平变化预示着重型肝炎患者死亡或需肝移植 ,它们的相反变化预示着重型肝炎患者的预后良好     

高迁移率族蛋白1在乙型重型肝炎患者中的表达水平及其临床意义

目的探讨血清高迁移率族蛋白1(high mobility group-box protein 1,HMGB1)在重型肝炎患者中的表达水平及其临床意义。方法对32例乙型重型肝炎患者、22例慢乙肝初治患者、10例急性乙肝患者血清HMGB1水平进行检测分析,与16名健康人进行对照研究,分析其与患者肝功能生物化学指标的相关性。结果重型肝炎患者血清HMGB1水平高于健康人,差异具有统计学意义(P0.05),重型肝炎组与慢乙肝初治组、重型肝炎组与急性乙肝组、慢乙肝初治组与急性乙肝组、慢性乙肝组与正常人组、急性乙肝与正常人组均无统计学意义(P0.05),重型肝炎患者血清HMGB1水平与ALT水平呈正相关,差异具有统计学意义(r=0.942,P0.05)。结论重型肝炎患者血清HMGB1水平较正常人高,可能成为评价重型肝炎的一个指标,这可能具有一定的临床意义。     

慢性乙肝及肝炎肝硬化患者血清转化生长因子β-1、瘦素的检测

目的检测慢性乙型肝炎及肝炎肝硬化患者血清中转化生长因子β-1(TGFβ-1)、瘦素(Leptin)的含量并分析其与透明质酸(HA)、层黏连蛋白(LN)和前胶原蛋白Ⅲ(PCⅢ)等肝纤维化指标的相关性。方法分别用放免法及酶联免疫法测定109例慢性乙肝及肝炎肝硬化患者血清TGFβ-1、Leptin和HA、LN、PCⅢ的浓度。结果慢性乙肝重度及肝炎肝硬化组患者血清TGFβ-1水平明显高于慢性乙肝轻、中度及正常对照组(P均<0.05);且与HA、LN、PCⅢ等指标存在明显的正相关;而慢性乙肝轻、中度组血清TGFβ-1水平与正常对照组无显著性差异(P>0.05)。慢性乙肝及肝炎肝硬化组患者血清Leptin水平高于正常对照组,但差异无显著性(P>0.05);且与TGFβ-1、HA、LN、PCⅢ等指标无相关关系。结论TGFβ-1参与慢性乙型肝炎、肝硬化的进程,可作为诊断肝纤维化有用的血清学指标;慢性乙肝及肝炎肝硬化组患者血清leptin水平升高,但并未参与肝硬化的进程。     

血清和胃液PⅢNP、LN在胃癌辅助诊断中的价值

目的:探讨胃液、血清中层黏连蛋白(laminin,LN)、Ⅲ型前胶原氨端(N-terminal procollagenⅢpeptide,PⅢNP)含量的检测在胃癌辅助诊断中的价值.方法:采用放射免疫法测定50例胃癌患者、25例癌前病变患者胃液和血清中PⅢNP和LN含量,以46例浅表性胃炎患者作为对照.结果:胃癌组患者胃液中PⅢNP含量显著高于癌前病变组和对照组(40.49μg/L±39.07μg/L vs8.49μg/L±5.45μg/L,7.38μg/L±6.13μg/L,均P<0.01),LN的水平也显著高于癌前病变组和对照组(131.61ng/mL±55.71ng/mL vs90.92ng/mL±58.36ng/mL,80.65ng/mL±59.43ng/mL,P<0.05;P<0.01);胃癌组血清中PⅢNP含量明显高于癌前病变组和对照组(55.38μg/L±25.13μg/L vs41.56μg/L±18.27μg/L,39.89μg/L±13.07μg/L,均P<0.05),LN的水平亦显著高于对照组(158.62ng/mL±42.70ng/mL vs126.25ng/mL±36.18ng/mL,P<0.01).胃液PⅢNP和LN单独检测对胃癌诊断的敏感性分别为68.00%、66.00%,二者联合检测其敏感性为86.00%.进一步分析显示,伴有淋巴结或器官转移的患者胃液和血清中PⅢNP和LN水平高于不伴有转移的患者;PⅢNP和LN水平与病理分级相关,低分化腺癌患者胃液、血清中PⅢNP和LN含量高于高分化腺癌患者.结论:胃液及血清PⅢNP和LN含量的检测在胃癌的辅助诊断中有一定临床价值.     

慢性乙型肝炎和肝炎肝硬化患者血浆内皮素-1水平与血清肝纤维化指标和门静脉宽度的关系

目的探讨慢性乙型肝炎和肝炎肝硬化患者血浆内皮素-1（ET-1）水平的变化及其与肝纤维化血清指标和门静脉宽度的关系。方法采用放射免疫法测定急性乙型肝炎、慢性乙型肝炎和肝炎肝硬化患者血浆ET-1、血清透明质酸（HA）、层粘蛋白（LN）、Ⅲ型胶原肽（PⅢP）和Ⅳ型胶原（Ⅳ-C）水平。结果23例急性乙型肝炎肝纤维化血清指标中仅HA水平较正常对照组明显升高；81例慢性乙型肝炎和64例肝炎肝硬化患者。血浆ET-1、血清HA、LN、PⅢP和Ⅳ-C水平均较正常对照组明显升高。在慢性乙型肝炎中血浆ET-1、血清HA、LN、PⅢP和Ⅳ-C水平随着肝脏损害程度（轻、中、重度）的加重而逐步升高。在慢性乙型肝炎和肝炎肝硬化患者中。血浆ET-1水平与血清HA、LN、PⅢP和Ⅳ-C水平明显相关；同时ET-1还与患者门静脉宽度明显相关。结论ET-1、HA、LN、PⅢP和Ⅳ-C与慢性乙型肝炎肝脏损害相关：ET-1与慢性乙型肝炎和肝炎肝硬化患者肝纤维化程度和门静脉高压有一定的关系。     

血清肝纤维化标志物与慢性丁型肝炎肝纤维化程度关系的探讨

目的探讨ALT、HBV DNA及血清纤维化标志物透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)与慢性丁型肝炎(CHD)患者肝纤维化程度的关系。方法收集2008年3月至2013年1月在广州市第八人民医院肝病科住院并未曾接受任何抗病毒治疗的CHD患者28例,检测患者血清中ALT、HBV DNA和纤维化标志物(HA、LN、PⅢP及CⅣ)的水平,并行肝活组织检查检测肝组织纤维化分期。HBe Ag阳性与阴性组间计量资料比较采用t检验,计数资料比较采用χ2检验,不同纤维化分期间比较采用非参数检验中的Kruskal-Wallis检验;相关性分析采用Spearman等级相关分析。结果 HBe Ag阳性与HBe Ag阴性组患者间肝纤维化程度差异无统计学意义(χ2=0.129,P=0.720)。肝纤维化S1、S2及S≥3 3组间HA及LN水平差异有统计学意义(Z值分别为12.035、8.457,P值分别为0.002、0.015),其中S≥3组患者水平最高[HA:(169.4±166.3)ng/ml,LN:(149.2±85.1)ng/ml]且与S1、S2组比较差异均存在统计学意义(P值均0.05),而3组间其他实验室指标ALT、HBV DNA、PⅢP及CⅣ水平差异均无统计学意义(P值均0.05)。肝纤维化分期与HA、LN、PⅢP及CⅣ水平呈正相关(r值分别为0.512、0.472、0.451、0.454,P值分别为0.005、0.011、0.016、0.015)。结论 HA、LN水平可能作为评估CHD患者肝纤维化程度的血清学指标。     

血清透明质酸、Ⅲ型前胶原氨基端肽及层黏蛋白与老年慢性心力衰竭心肌纤维化相关性研究

目的 分析老年慢性心力衰竭(CHF)患者血清透明质酸(HA)Ⅲ型前胶原肽(PCⅢP)及层黏连蛋白(LN)与CHF及其心肌纤维化的关系.方法 采用放射免疫平衡法检测老年CHF组患者39例(心功能Ⅱ级14例,Ⅲ级21例,Ⅳ级4例,纽约心脏病学会分级法NYHA)及老年心功能Ⅰ级组(NYHA)46例血清HA,PCⅢP及LN浓度.结果 血清HA,PCⅢP及LN浓度分别为CHF组(359.75±84.59),(77.88±24.67),(86.73±23.90)μg/L;心功能Ⅰ级组(211.60±54.80),(64.82±23.99),(82.26±23.98)μg/L.与心功能Ⅰ级组比较,CHF组HA浓度显著增加(P＜0.05);两组间PCⅢP及LN浓度差异不显著(P＞0.05).结论 血清HA浓度升高可提示老年CHF及其心肌纤维化.     

丹芍化纤胶囊对肝纤维化大鼠PDGFR-β和p-ERK1/2的影响

目的:通过观察丹芍化纤胶囊对肝纤维化大鼠PDGFR-β和p-ERK1/2的影响,探索其抗肝纤维化的可能机制.方法:♂SD大鼠55只,体质量180-220g,随机分为正常组、模型组、预防组.除正常组外,其余均采用四氯化碳、高脂饮食及乙醇复合因素复制肝纤维化模型,造模同时预防组每日一次予以0.8 g/kg丹芍化纤自来水悬液灌胃,模型组、正常组予以等体积自来水灌胃,持续8 wk.造模结束后肝组织HE染色病理检查,免疫组化检测肝组织PDGFR-β、蛋白印迹检测肝组织p-ERK1/2在各组表达,生化法检测各组血清透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PⅢP)、白蛋白(ALB)、总蛋白(TP),计算白球比(A/G).结果:造模8 wk后经病理学证实模型大鼠形成典型的肝纤维化,模型成功.与正常组相比,模型组肝组织PDGFR-β、p-ERK1/2及血清HA、LN、PⅢP均有显著升高,ALB、A/G显著降低(PDGFR-β:184.6±8.5 vs 89.6±5.8,P<0.05;p-ERK1/2:360.0±14.5 vx 15.4±2.1,P<0.05;HA:517.5±91.5μg/L vs 254.4±33.1μg/L,P<0.05;LN:58.4±11.3μg/L vs 37.3±9.8μg/L,P<0.05:PⅢP:36.9±5.6μg/L vs 4.7±1.5μg/L,P<0.05;ALB:27.4±4.9 g/L vs 42.1±1.6 g/L,P<0.05;A/G:0.89±0.08 vs 1.38±0.09,P<0.05);与模型组相比,预防组肝组织PDGFR-β、p-ERK1/2及血清HA、LN、PⅢP均有显著降低,ALB、A/G显著升高(PDGFR-β:91.1±6.3 vs 184.6±8.5,P<0.05;p-ERK1/2:253.8±18.2 vs 360.0±14.5,P<0.05;HA:322.9±41.4μg/L vs 517.5±91.5μg/L,P<0.05;LN:46.0±9.4μg/L vs 58.4±11.3μg/L,P<0.05;PⅢP:14.5±2.4μg/L vs 36.9±5.6μg/L,P<0.05;ALB:37.2±2.8g/L vs 27.4±4.9g/L,P<0.05;A/G:1.18±0.13 vs 0.89±0.08,P<0.05).结论:PDGFR-β及p-ERK1/2在肝纤维化形成中起重要作用,丹芍化纤胶囊具有良好的预防肝纤维化形成的作用,其降低PDGFR-β及p-ERK1/2在肝组织的表达可能是其作用机制之一.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

Women with gout: efficacy and safety of urate-lowering with febuxostat and allopurinol

Objective

To compare the characteristics of female versus male gout patients and assess urate‐lowering efficacy and safety of febuxostat or allopurinol treatment in women with gout.

Methods

This was a retrospective analysis of 4,101 hyperuricemic (serum urate [sUA] level ≥8.0 mg/dl) gout subjects enrolled in 3 phase III comparative trials and randomized to receive placebo, febuxostat (40 mg, 80 mg, 120 mg, or 240 mg daily), or allopurinol (100 mg, 200 mg, or 300 mg daily, based on renal function). Baseline demographics and characteristics were summarized and compared between female and male subjects. Urate‐lowering efficacy, which was defined as the proportion of subjects with sUA levels <6.0 mg/dl at final visit, was assessed for all subjects and, among women, according to baseline renal function.

Results

Female gout subjects (n = 226) were older with significantly higher rates of obesity and metabolic and cardiovascular comorbidities than their male counterparts. The percentage of female subjects with sUA levels <6.0 mg/dl at final visit was 0% in the placebo group, 54.3%, 85.1%, 81.0%, and 100.0% in the febuxostat 40 mg, 80 mg, 120 mg, and 240 mg groups, respectively, and 45.9% in the allopurinol group. Similar patterns of urate‐lowering efficacy rates were observed when stratified by renal function. Among all the female subjects, febuxostat 80 mg was significantly more efficacious than allopurinol (P < 0.001). Rates of adverse events (AEs) were low. The most frequently reported AEs were upper respiratory tract infections, musculoskeletal/connective tissue disorders, and diarrhea.

Conclusion

These data suggest that febuxostat 80 mg may be more efficacious than commonly prescribed doses of allopurinol in female gout subjects with high rates of comorbidities.     

Treatment of metastatic renal cancer with ifosfamide and mesnum with and without irradiation

Ifosfamide (50-60 mg/kg of body weight, Days 1-5) and mesnum (10-12 mg/kg of body weight, Days 1-5) were given to 15 patients with measurable metastatic renal cancer. This treatment was repeated on Day 29. In addition, six of these 15 patients received irradiation to some of the metastatic areas. There was one partial remission among 11 evaluable patients after two ifosfamide courses. The partial remission was seen in a metastatic area treated with low-dose irradiation prior to the first ifosfamide course. Two cases of early death and two cases of toxic death (urotoxicity) were observed. The main hematologic complication was moderate to severe leukopenia. Previously reported high response rates to ifosfamide treatment of renal cancer could not be confirmed.     

Risk of thrombosis with lenalidomide and its prevention with aspirin

Lenalidomide, an analog of thalidomide, is an effective new treatment for multiple myeloma. Both compounds are associated with an increased risk of venous thromboembolism, particularly when used in combination with high-dose dexamethasone. As new trials with lenalidomide are being planned and performed, investigators are placing high importance on reducing the risk of thrombosis by incorporating an antithrombotic agent into the therapeutic regimen. Low-molecular-weight heparin, warfarin, and aspirin have all been suggested as candidate drugs for thromboprophylaxis, but none of these agents have been evaluated in randomized clinical trials. A body of opinion has evolved that aspirin is very effective in preventing venous thrombosis in myeloma patients treated with lenalidomide. If correct, this view has important implications, because aspirin is inexpensive and is safer and more convenient than anticoagulants. On the other hand, aspirin is less effective than anticoagulants for preventing venous thrombosis in other high-risk groups, and therefore might not be the most appropriate choice for preventing of venous thrombosis in myeloma patients. This commentary examines the strength of the evidence supporting the effectiveness of aspirin in preventing venous thrombosis in multiple myeloma patients treated with lenalidomide. It is concluded that the evidence that aspirin is efficacious in preventing venous thrombosis in myeloma patients is based on "before/after" and retrospective studies, with potential for bias and confounders. There is, therefore, a critical need to incorporate a randomized comparison of aspirin with an anticoagulant in future trials evaluating lenalidomide in multiple myeloma.     

Treatment of strongyloidiasis with mebendazole and its combination with thiabendazole

Although Strongyloides stercoralis (S. stercoralis) infection rate in Okinawa Prefecture was less than 2% by the traditional method, it has been proven to be 6.2% by the new technique--agar plate method. Thiabendazole has strong activity to eradicate the organism, but it is well known that the rate of severe side effects is extremely high. Therefore, we attempted to evaluate the new treatment for the infection by mebendazole and its combination with thiabendazole. The reason for use of the drug is based on the reports of successful treatment of S. stercoralis infection in humans with the mild and infrequent side effects produced by the drug. Thirty three patients were orally given mebendazole 100 mg twice daily for 28 days. Twenty six patients were given thiabendazole 500 mg thrice daily for 5 days and after that, mebendazole 100 mg twice daily for 9 days. This combination therapy was repeated twice. The following results were obtained: 1) Out of a total of 59 patients, the cure rate was 83.3% (20/24) in single use of mebendazole and 100.0% (22/22) in the combination therapy. 2) Constipation (9.1%) and headache (9.1%) were of relatively high incidence in the mebendazole group, but they were mild. Nausea (19.2%) and headache (15.4%) were observed in the combination therapy group and the drug was discontinued in 2 patients. 3) The incidence of the elevation of S-GOT, S-GPT was noted in 71.4% (20/28) for the mebendazole group and 52.2% (12/23) for combination therapy group. All 13 patients of the mebendazole group were negative in lymphocyte stimulation test for mebendazole.(ABSTRACT TRUNCATED AT 250 WORDS)