酒精性肝病的流行病学调查

目的:了解本地区就诊患者的酒精性肝病(alcohol liver disease,ALD)流行病学情况.方法:对123例ALD患者的年龄、饮酒量、饮酒年限、性别、受教育程度、经济状况等资料进行调查分析.结果:40岁以上中老年患者与青年患者分别占79.72%和20.28%(P<0.01);日均酒精摄入量和饮酒年限年龄与ALD的肝脏损伤程度呈正相关(P均<0.01).男女患者分别占93.97%与6.03%;受教育程度低的患者与受教育程度高的患者的比例分别为60.16%和39.84%(P<0.05);低收入患者与富裕家庭患者的分别占56.91%和43.09%(P>0.05).结论:酒精已经成为本地区肝病的常见病因,饮酒年龄、年限、经济状况、职业、受教育程度和ALD的发生有关.     

酒精性肝病85例临床诊治分析

目的探讨酒精性肝病（Alcoholic liver disease,ALD）发病情况、临床特征。方法回顾性分析85例酒精性肝病患者,包括饮酒年限、饮酒量、生活方式是否合并其他疾病如乙肝、丙肝、2型糖尿病、血脂异常等,并进行综合分析。结果饮酒量大于150g／d,且持续5年以上者,患酒精性肝病的几率明显增加,在合并有病毒性肝炎、糖尿病、血脂异常的情况下,发展为肝硬化的可能性更大。结果ALD患者的致病因子明确,日均酒精摄入量和饮酒年限与酒精性肝病的肝脏损伤程度呈明显正相关,治疗后饮酒者预后差,死亡的主要原因是肝硬化的晚期并发症。结论相同饮酒量及饮酒年限的患者因其疾病进程、环境和遗传因素的不同,导致个体间对酒精毒性的反应也不同。ALD病情和预后与长期大量饮酒有关。有饮酒嗜好的患者应劝其戒酒,并定期监测肝功能指标,及早进行治疗,以改善预后。     

酒精性肝病78例临床分析

目的通过对酒精性肝病(ALD)患者饮酒量及饮酒时间的临床调查,明确ALD患者的发病特点及规律。方法通过门诊及住院患者的饮酒量、饮酒时间、性别、相应并发症、治疗用药等不同情况进行临床分析、总结。结果 ALD患者的致病因子明确,日均酒精摄入量和饮酒年限与酒精性肝病肝脏损伤程度呈明显正相关关系。结论相同饮酒量及饮酒年限的患者因其疾病进程、环境和遗传因素的不同,导致不同患者对酒精毒性的反应也不尽相同。     

酒精性肝病64例临床分析

目的:探讨酒精性肝病(Alcoholicliverdisease,ALD)发病情况、临床特征等。方法:回顾分析酒精性肝病的易感因素。结果:酒精性肝病患者以少数民族多见,尤以哈族及蒙古族为主,占44.35%和30.64%;发病年龄以35～47岁多见,饮酒年限以12～27年居多,体重异常占44.54%;临床症状以乏力、纳差、黄疸、腹胀为主;血清学改变以天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转肽酶、胆红素升高为主。结论:酒精性肝病对肝脏损害程度与饮酒量、饮酒种类等有关,长期大量饮酒可造成多器官损害。     

血清缺糖基转铁蛋白在酒精性肝病诊断中的价值

目的 对酒精性肝病（ALD）患者血清中缺糖基转铁蛋白（CDT）含量展开分析，探讨血清缺糖基转铁蛋白在酒精性肝病诊断中的价值。方法 本次研究随机选取2010年5月—2013年5月期间接收诊治的50例酒精性肝病患者作为观察组，同期入院的50例健康不饮酒体检人员和50例非酒精性肝病（NALD）的其他肝病患者为作对照组，所有受检者接收缺糖基转铁蛋白（CDT）、γ-谷氨酰转肽酶（γ-GGT）、红细胞平均体积（MCV）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）等肝功能实验室指标检测，分析在不同肝病类型中血清缺糖基转铁蛋白的变化情况。结果 观察组CDT、γ-GGT以及ALT含量显著高于健康不饮酒组（P〈0．05）。对照组中，健康不饮酒组与非酒精性肝病组相比，γ-GGT、ALT、AST含量比较，差异均有统计学意义（均P〈0．05）。观察组CDT、γ-GGT、MCV、ALT、AST阳性率显著高于健康不饮酒组（均P〈0．05）。对照组中，健康不饮酒组与非酒精性肝病组相比，γ-GGT、MCV、ALT、AST阳性率比较，差异均有统计学意义（均P〈0．05）。结论 血清缺糖基转铁蛋白在酒精性肝病诊断中，具有较高特异性、灵敏性，是值得临床推广的检测指标。     

酒精性肝病诊治体会

目的总结酒精性肝病的临床特点和诊治体会。方法回顾性分析2002年5月至2008年5月间我院收治的78例酒精性肝病患者的临床资料。结果78例患者中酒精性脂肪肝8例（10．3％）,酒精性肝炎44例（56．4％）,酒精性肝硬化26例（33．3％）。酒精性脂肪肝患者症状轻微,肝功能轻度异常;酒精性肝炎患者肝脏和全身炎症反应症状明显,酒精性肝硬化患者临床表现与其他原因肝硬化相似,但肝肿大更常见,蜘蛛痣、肝掌、乳房增大更明显。酒精性肝炎及酒精性肝硬化1．谷氨酰转移酶增高显著,2／3患者AST／ALT〉2,大多有黄疸,以酒精性肝炎患者较重。入院后经戒酒及综合治疗,1例酒精性肝硬化患者死于上消化道大出血,其余恢复良好。结论酒精性肝病患者以酒精性肝炎、酒精性肝硬化（失代偿期）为主,间有少量有症状的酒精性脂肪肝患者。酒精性肝病的损害程度与饮酒量、饮酒时间和方式均有密切关系,其临床特征与疾病分型有一定相关性。酒精性肝病患者经戒酒、营养支持及保肝治疗,大多效果良好。戒酒是保证治疗成功最重要的因素。     

酒精性骨质疏松症和酒精性肝病的相关性研究

目的　探讨酒精性骨质疏松和酒精性肝病的关系及其发病机制。方法　回顾性研究2016年3月至2020年12月内蒙古科技大学包头医学院第二附属医院及第一附属医院收治的122例饮酒超过5年，折合乙醇量男性≥40 g/d，女性≥20 g/d的患者为研究对象，男82例，女40例，年龄（40.0±14.6）岁。所有患者测量骨密度，检测肝功能、骨钙素、25-羟基维生素D［25（OH）D3］、肿瘤坏死因子α（TNF-α）及肝脏彩超检查。根据骨密度检查结果、肝功能检测结果及腹部彩超分为3组，酒精性骨质疏松症组35例、酒精性肝病组45例、酒精性肝病合并骨质疏松症组42例。选择同期性别及年龄相匹配的体检健康者45例纳入健康对照组。采用SPSS 24.0进行数据分析，计量资料行t检验。结果　酒精性骨质疏松组、酒精性肝病组、酒精性肝病伴骨质疏松组的骨钙素分别为（24.73±3.66）μg/L、（27.34±2.94）μg/L、（17.44±3.09）μg/L，25（OH）D3分别为（22.47±2.82）μg/L、（25.63±3.84）μg/L、（16.87±4.33）μg/L，均不同程度地低于健康对照组［分别为（32.65±3.27）μg/L、（30.21±4.22）μg/L］，酒精性肝病伴骨质疏松组骨钙素、25（OH）D3均低于酒精性骨质疏松组和酒精性肝病组，差异均有统计学意义（均P<0.05），酒精性骨质疏松组骨钙素、25（OH）D3低于酒精性肝病组，但是差异均无统计学意义（均P>0.05）。酒精性骨质疏松组、酒精性肝病组、酒精性肝病伴骨质疏松组TNF-α分别为（10.33±3.41）pg/ml、（13.23±4.02）pg/ml、（16.94±3.92）pg/ml，均不同程度地高于健康对照组［（5.54±2.39）pg/ml］，酒精性肝病伴骨质疏松组高于酒精性骨质疏松组和酒精性肝病组，酒精性骨质疏松组低于酒精性肝病组，差异均统计学意义（均P<0.05）。结论　我们考虑酒精性肝病、酒精性骨质疏松在发病过程中呈相辅相成作用。骨钙素、25（OH）D3、TNF-α可能为其共同的发病机理，其既是发病的始动因素，又是其导致的结果。     

祛湿化瘀方治疗非酒精性脂肪性肝病的临床疗效

目的：探讨祛湿化瘀方治疗非酒精性脂肪性肝病的临床疗效。方法选取2010年6月—2014年6月交口县桃红坡中心卫生院收治的非酒精性脂肪性肝病患者86例,随机分为观察组与对照组,各43例。对照组患者予以多烯磷脂酰胆碱胶囊治疗,观察组患者予以祛湿化瘀方治疗。观察两组患者临床疗效、治疗前后肝功能、血脂情况及不良反应发生情况。结果观察组患者总有效率高于对照组,差异有统计学意义（ P<0.05）;治疗前两组患者丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）、总胆固醇（ TC）、三酰甘油（ TG）水平比较,差异无统计学意义（P>0.05）,治疗后观察组患者 ALT、AST、TC、TG 水平低于对照组（P <0.05）,两组患者治疗后 ALT、AST、TC、TG水平低于治疗前（P<0.05）;两组患者不良反应发生率比较,差异无统计学意义（P>0.05）。结论祛湿化瘀方治疗非酒精性脂肪性肝病的临床疗效显著,可改善患者肝功能及血脂,且不良反应少,安全性高。     

内科疾病处方用药解析（33）

3．15酒精性肝病 酒精性肝病（ALD）是因长期、大量饮酒（含乙醇饮料）所致的肝损害。主要表现为3种形式：酒精性脂肪肝、酒精性肝炎和酒精性肝硬化,这三种形式可单独或混合存在。酒精性肝病的诊断标准：（1）有长期饮酒史,一般超过5年,折合酒精量≥40g／d,女性略低;或2周内有暴饮史。（2）禁酒后血清ALT和AST明显下降,4周内基本恢复正常,即在2倍正常上限值（ULN）以下。     

71例酒精性肝病的临床诊疗分析

目的：探讨酒精性肝病的临床特点及诊疗方法。方法对5年来收治的71例酒精性肝病患者临床资料进行回顾性分析。结果本组71例患者,61例经积极治疗,病情痊愈或好转出院,治疗好转率85.92%。死亡10例,死亡率14.08%。结论酒精性肝病的发病及病情严重程度与患者的生活方式、饮酒程度关系重大,其临床表现无特异性,治疗上主要应劝诫嗜酒者积极戒酒,定期监测肝功,并进行相应的治疗,以控制病情发展,改善患者预后。     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.