内毒素诱导实验性暴发性肝功能衰竭模型中肝细胞再生程度分析

目的 :检测再生肝细胞表面增殖细胞核抗原 (PCNA)表达分布状态 ,对肝细胞再生程度作出动态评价。方法 :制备亚急性暴发性肝功能衰竭模型 ,以 PCNA单克隆抗体 ,采用免疫组织化学技术检测。结果 :大白鼠术后不同时期 ,AL T、TB水平呈进行性增高 ,术后 2 4h PCNA阳性细胞百分率进行性下降 ,与对照组相比分别为 2 4h(18.8± 11.2 ) % / (30 .7± 16 .8) % (P <0 .0 5 ) ,36 h (7.7± 5 .7) % / (2 8.5± 12 .3) % (P <0 .0 1) ,48h(5 .7±8.9) % / (2 5 .8± 8.9) % (P <0 .0 1) ,72 h(2 .8± 6 .4) % / (15 .6± 7.2 ) % (P <0 .0 1)。结论 :实验性亚急性暴发性肝功能衰竭模型中肝细胞的再生进行性受到抑制 ,可能与机体免疫因素参与有关。     

中药肝复健冲剂对大鼠肝纤维化形成的影响

目的 :观测中药肝复健冲剂对二乙基亚硝胺 (DEN)诱导大鼠肝纤维化形成的影响 .方法 :建立DEN诱导大鼠肝硬化模型 ,同时给予肝复健冲剂进行干预 ,应用天狼红 苦味酸特染法、免疫组化染色法及计算机图像分析技术检测中药对DEN致大鼠肝纤维化过程胶原沉淀及肝细胞增殖特性的影响 .结果 :随着模型大鼠肝纤维化程度加重 ,肝内胶原沉积量亦呈逐渐增加趋势 .中药组大鼠肝脏炎性损害及肝纤维化程度均较同期模型组大鼠轻 ,胶原沉积量及细胞增殖核抗原(PCNA)阳性着色肝细胞数明显减少 ,两组间差异有统计学意义 ,P <0 .0 5 [胶原沉积量 :4wk(1 5 .2 0± 2 .2 1 )vs (7.1 9± 0 .97) ;1 2wk(2 7.1± 4 .6 )vs (1 6 .0± 1 .7) .阳性表达PCNA肝细胞数 :1 2wk(2 1 .1± 0 .32 )vs(6 .4± 0 .2 ) ;1 6wk (31 .1± 7.1 )vs (1 0 .1± 0 .8) ].结论 :中药肝复健冲剂可通过减少肝内胶原沉积及可能恶性增殖的肝细胞 ,抑制和延缓实验性动物肝纤维化的形成 ,并一定程度上预防肝硬化向肝癌的转变     

生长激素对实验性梗阻性黄疸肝细胞PCNA表达的影响

目的:研究重组人生长激素(rhGH)对实验性梗阻性黄疸(OJ)肝细胞增殖细胞核抗原(PCNA)表达的影响,以证实rhGH促OJ肝细胞再生的作用。方法:健康雄性Wistar大鼠随机分为假手术阴性对照组(A组) ,OJ阳性对照组(B组) ,OJ +rhGH实验组(C组)。B组、C组建立OJ模型,C组应用rhGH进行干预。观察各组肝细胞形态学改变,检测白蛋白(ALB) ,谷丙转氨酶(ALT) ,肝细胞PCNA表达水平,进行对照分析。结果:与A组相比,B组ALB明显下降,ALT明显升高(P <0. 0 1 ) ;与B组相比,C组ALB明显升高,ALT明显下降(P <0.0 1 )。肝组织形态学方面,A组为正常肝脏结构;B组肝细胞局灶性坏死;C组肝组织较B组损害减轻。PCNA标记指数B组较A组显著升高;C组较B组显著升高(P <0 .0 1 )。结论:rhGH能提高实验性OJ受损肝细胞PCNA表达水平,促进肝细胞再生,减轻肝细胞损害进而保护肝脏功能     

组织芯片技术研究肝脏良恶性病变细胞增殖活性和微血管密度的差异

目的 :研究肝脏良恶性病变中细胞增殖活性和微血管密度表达强度与数量的差异性 ,进一步揭示肿瘤的生物学特征。 方法 :选取肝细胞癌 2 90例、肝硬化 12 8例与肝良性病变 (包括肝细胞腺瘤和肝细胞局灶性结节增生 ) 2 5例 ,应用组织芯片技术和免疫组化方法研究细胞核增殖抗原 (PCNA)、Ki- 6 7和微血管密度 (MVD)在肝脏良恶性病变中的表达强度与数量。结果 :PCNA、Ki- 6 7在肝细胞癌组阳性率分别为 90 .2 %和 4 3.1% ,在肝硬化组为 4 8.5 %和 3.9% ,组间差异有高度显著性(P<0 .0 1) ,而良性病变组无 1例阳性 ;MVD在肝细胞癌组为 2 2 .7± 15 .8,显著高于肝硬化组 (8.3± 7.6 ) ,差异有高度显著性(P<0 .0 1) ,而与良性病变组 (31.3± 2 2 .7)无差异 (P>0 .0 5 )。肝细胞癌病理 - 级 MVD(2 9.9± 18.6 )显著高于病理 级和 级 (2 2 .2± 18.2、2 2 .9± 19.0 ,P<0 .0 1)。结论 :细胞高增殖状态与多量的新生血管是恶性肿瘤的重要特征 ,PCNA、Ki- 6 7和MVD可作为鉴别肝脏良恶性病变的生物学检测指标     

大鼠肝移植后肝切除-肝再生功能的探讨

目的　探讨肝移植后肝细胞的再生功能。方法　从肝左静脉根部到肝脏面的肝右叶和肝中叶交叉点进行肝切除。肝切除后定时屠杀 ,标本行苏木素 伊红 (HE)、增殖细胞核抗原 (PCNA)染色检查。血液行动脉血酮体比 (AKBR)测定、血清白蛋白测定。结果　术后第 3天对照组的再生肝对残肝重量比为 (2 .19± 0 .18)倍 ,3、6、12个月实验组分别为 (1.6 6± 1.11、1.6 6± 0 .17、1.17± 0 .31)倍 ,与对照组相比差异有显著性 (P <0 .0 5 )。对照组术后 1d的PCNA染色阳性细胞总数达最高值 (4 5 9.2± 2 1.5 )个 ,7d为 (35 .7± 7.2 )个。 3、6、12个月实验组术后 7d分别为 (35 6 .2± 4 0 .8)个、(341.2± 17.6 )个、(35 9.7± 2 3.0 )个 ,与对照组相比差异有显著性 (P <0 .0 0 1)。实验组第 3、7天的血清白蛋白值比对照组降低。对照组术后 1、3d的AKBR值分别是 0 .5 6± 0 .2 6和0 .79± 0 .12 ,全部实验组的AKBR值术后显低值 ,3、6、12个月实验组术后 1d的AKBR值分别为 0 .33± 0 .12、0 .31± 0 .0 5 ,3d分别为 0 .2 9± 0 .0 9、0 .2 8± 0 .0 9、0 .2 6± 0 .15 ,与对照组相比差异均有非常显著性 (P <0 .0 1)。结论　移植肝脏肝切除后的再生功能 ,比正常肝组织缓慢。肝移植后肝脏的预备能减弱 ,再生缓慢。     

肝药酶诱导剂对暴发性肝衰竭的影响

目的：研究肝微粒体药物代谢酶（肝药酶）诱导剂苯巴比妥（PB）和利福平（RFP）对肝药酶和肝衰竭的影响。方法：观察PB和RFP对肝药酶细胞色素P450（P450）和细胞色素b5（Cyt.b5)的含量、苯胺羟化酶活性、肝切除暴发性肝衰竭死亡率和高血氨性肝昏迷存活期的影响。结果：PB和RFP能明显提高正常肝脏和部分肝切除后再生肝P450含量和苯胺羟化酶活性。在肝切除术后5h至9d内,经PB处置的小鼠暴发性肝衰竭死亡率低于空白对照组,分别为32.1%和49.2%.存活期也明显长于空白对照组,分别为（160.7±84.1)h和（128.9±92.6)h。此外,在肝切除小鼠中,PB和RFP组NH4Cl所致的高血氨性肝昏迷存活期分别为（60.8±22.5)h和（112.9±7.2)h,也明显长于空白对照组的（44.6±.28.3)h。结论：PB和RFP能显著地诱导肝药酶,延长高血氨性肝昏迷的存活期,以及有一定的降低肝切除暴发性肝衰竭死亡率作用。     

慢性乙型肝炎病人NK细胞细胞毒活性的研究

本文应用3H-TdR释放法检测22例慢性乙型肝炎病人外周血NK细胞细胞毒活性。并以24名正常人作对照。结果:慢活肝12例及慢迁肝10例的NK细胞毒活性(x±s),分别为48.1±20.9％及32.6±9.8％,和对照组23.1±19.5％比较,P值分别<0.002和<0.05。而慢活肝亦较慢迁肝组增高(P值<0.05)。上述结果提示,慢活肝和慢迁肝病人NK细胞活性均较正常人增高。而肝脏病变较重的慢活肝较病变较轻的慢迁肝增高。NK细胞活性和肝细胞损伤及损伤程度一致。NK细胞可能参与慢乙肝肝细胞的损伤机制。     

小鼠肝脏内自然杀伤细胞功能和数量与鼠龄变化的关系

目的研究不同鼠龄小鼠肝脏内自然杀伤细胞的功能和数量变化的规律。方法应用4小时51Cr释放法测定2周龄、8周龄小鼠(CL57BL/6)肝脏和脾脏内NK细胞的杀伤活性;应用流式细胞仪测定2周龄、8周龄小鼠肝脏和脾脏内NK细胞的百分率和数量,测定NK细胞表面CD69,M ac-1和Ly49C/I的表达水平;应用RT-PCR法测定肝脏单核细胞内穿孔素的表达强度。结果2周龄和8周龄小鼠肝脏内NK细胞占全部淋巴细胞的百分比大致相同(11.9%±1.7%vs 9.9%±1.6%,P>0.05),但是单位质量肝脏内所含的NK细胞数在2周龄鼠明显多于8周龄鼠[(11.6±2.5)×105/g vs(3.4±0.8)×105/g,P<0.05]。2周龄小鼠肝内NK细胞具有极强的细胞杀伤活性(71.0%±5.5%vs 23.8%±4.4%,P<0.05)。2周龄小鼠肝内NK细胞表型主要是CD69增高M ac-1、Ly49C/I减低,而8周龄鼠肝内NK细胞主要是CD69减低,M ac-1、Ly49C/I增高。2周龄小鼠肝脏单核细胞内高度表达穿孔素。结论2周龄小鼠肝内NK细胞具有极强的杀伤能力和特殊的表型。这提示幼龄期鼠肝脏具有特殊的微环境以及肝脏内NK细胞特殊的发育方式。     

PLA-O-CMC纳米粒子培养的猪肝细胞移植对急性肝衰竭大鼠肝再生作用的初步研究

目的:探讨胶原凝胶包埋聚乳酸-O-羧甲基壳聚糖(PLA-O-CMC)纳米粒子粘附培养猪肝细胞移植对急性肝衰竭(ALF)大鼠肝的再生作用。方法:D-氨基半乳糖腹腔内注射制作大鼠ALF模型;48h后分别将5mlⅠ型胶原凝胶包埋的PLA-O-CMC纳米粒子粘附培养24h猪的肝细胞、5mlⅠ型胶原凝胶固定培养24h的猪肝细胞、5ml培养24h的猪肝细胞悬液(均含5.0×107个)移植到各组ALF大鼠腹腔内,并以5mlRPMI1640腹腔内注射作为阴性对照。观察大鼠14天存活率和受体肝脏的病理变化。结果:移植后14天ALF大鼠的存活率:单纯肝细胞移植组(Ⅰ组)为56.25%,胶原肝细胞移植组(Ⅱ组)为62.5%,纳米胶原肝细胞移植组(Ⅲ组)为75%,阴性对照组(Ⅳ组)为18.75%,各移植组14天存活率高于对照组(P<0.05),各移植组间无统计学意义(P>0.05)。ALF大鼠肝脏再生于ALF后5～7天最为显著;各组肝脏病理变化以Ⅲ组恢复最好,双核细胞最多,肝再生最快。结论:应用PLA-O-CMC纳米粒子和Ⅰ型胶原联合培养猪肝细胞移植于ALF大鼠腹腔内能促进肝脏的再生。     

入肝门静脉动脉化加门腔分流术对大鼠肝脏再生的影响

【目的】 在大鼠70%肝部分切除基础上建立入肝门静脉动脉化加门腔分流术的模型,并研究大鼠肝脏再生情况&#65377;【方法】 155只Sprague-Dawley大鼠分为3组&#65377;实验组大鼠65只,利用右肾动脉行入肝门静脉动脉化,并行门腔分流及肝部分切除,肝切组大鼠65只,仅进行肝部分切除,对照组大鼠25只,仅右肾切除&#65377;分别观察实验组及肝切组术后2&#65380;7&#65380;14及28 d残肝再生比率变化,以及3组在术中0 h&#65380;术后24&#65380;48&#65380;72 h及7 d各时相点残肝肝脏S期细胞比例及增殖细胞核抗原(PCNA)阳性表达的肝细胞比例情况&#65377;【结果】 术后2&#65380;7&#65380;14 d两组肝脏再生比率相比,实验组较肝切组明显增高,差异有显著统计学意义(P < 0.01);至术后28 d,实验组及肝切组肝脏再生比率趋平,差异无统计学意义(P > 0.05)&#65377;术后各时相点实验组及肝切组残肝S期肝细胞比例及PCNA阳性表达肝细胞比例均较对照组明显升高,差异有显著统计学意义(P < 0.01)&#65377;实验组与肝切组相比,术后24 h残肝S期细胞比例及PCNA阳性细胞比例均已经开始升高,至术后48&#65380;72 h及术后7 d,实验组仍明显高于肝切组,差异有显著统计学意义(P < 0.01)&#65377;【结论】 入肝门静脉动脉化重建入肝血流对大鼠肝细胞的增生及增殖有促进作用,是预防肝部分切除术后急性肝功能衰竭的有效方法&#65377;     

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>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

<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>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     

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。     

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     

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.     

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。