一氧化氮与IL-8在肝硬变高动力循环中的作用

目的探讨一氧化氮（ＮＯ）与白介素８（ＩＬ８）对肝硬变门脉系统血流量的影响．方法应用ＥＬＩＳＡ法测定肝硬变患者（ｎ＝３２）血ＩＬ８含量；应用荧光法检测血清ＮＯ水平；应用多普勒超声检测门静脉系统血流量参数．结果肝硬变患者血清ＩＬ８与ＮＯ同步升高，其脾静脉血流量（ＳＶＦ）与肠系膜上静脉血流量（ＳＭＶＦ）之和显著大于正常对照组的门静脉血流量（ＰＶＦ）．结论肝硬变患者血ＩＬ８增加可能为ＮＯ增多的诱发因素；肝硬变患者存在内脏高动力循环状态，ＮＯ增加可能为其成因     

螺内酯对肝硬变门脉血流动力学的实验和临床研究

目的探索螺内酯对门脉高压实验犬和肝硬变患者门脉血流动力学的作用．方法用直接门脉插管测压和９９ｍＴｃＭＩＢＩ心肝放射性摄取比值（Ｈ／Ｌ）测定慢性胆总管结扎肝硬变犬（ｎ＝１６）门静脉压力和门体分流，口服螺内酯２０ｍｇ／（ｋｇ·ｄ）．肝硬变患者１４例测定Ｈ／Ｌ，门静脉内径和流速后口服螺内酯８０ｍｇ／ｄ，４ｗｋ为１疗程．结果完成试验的犬１３只治疗前后门脉压力（ｋＰａ）从２５９±０５１下降为２４２±０４７（Ｐ＜００５），Ｈ／Ｌ从０３３±００６降至０３０±００８（Ｐ＜００５）．１４例肝硬变患者治疗前后Ｈ／Ｌ值从１２０±０２６降为１０２±０３４（Ｐ＜００５），门脉内径（ｍｍ）从１３９±２３缩小为１２３±２０（Ｐ＜００５）．门静脉流速明显增加．结论螺内酯口服可降低门脉压力和门体分流．     

99mTC_MIBI直肠门脉显影评估普鲁纳洛治疗门脉高压症的疗效

目的采用９９ｍＴＣ＿ＭＩＢＩ直肠门脉显影法测定心肝核素显影比（Ｈ／Ｌ比值）评估普鲁纳洛治疗门脉高压的疗效．方法肝硬变门脉高压患者在普鲁纳洛治疗前后均进行９９ｍＴＣ＿ＭＩＢＩ直肠门脉显影测定，并与对照组结果进行比较分析．结果肝硬变门脉高压者Ｈ／Ｌ显著高于对照组（０．１４±００５，ｎ＝１０，Ｐ＜００１）；肝硬变门脉高压组于普鲁纳洛治疗后Ｈ／Ｌ组较治疗前降低，差异显著（ｎ＝１４，０．５６±０．２２，０．７７±０．２６，Ｐ＝０．０２５）；Ｈ／Ｌ比值＜０．６者曲张静脉破裂出血无复发．结论普鲁纳洛预防肝硬变门脉高压者的曲张静脉破裂出血安全、有效；９９ｍ＿ＴＣ＿Ｍ１Ｂ１直肠门脉显影可作为普鲁纳洛治疗疗效观察的可靠的无创伤性的指标．     

丹参与肝硬变犬门脉压力及胃粘膜血流的影响

通过胆总管结扎法，制造犬肝硬变门高压模型，并直接测定丹参注射液对肝硬变犬门脉压力及胃粘膜轿流（ＧＭＢＦ）的影响。结果表明，静注丹参注射液后，肝硬变犬的门脉压力（Ｐｐｖ）嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著下降（Ｐ〈０．０１），平均动坟（ＭＡＰ）、心率（ＨＲ）无显著变化（Ｐ〉０．０５）。给药后１０ｍｉｎ，肝硬变及正常犬的ＧＭＢＦ显著增加（Ｐ〈０．０５），用药后３０ｍｉｎ达最高值（     

硝苯吡啶对肝硬化门脉高压病人肝脏血流动力学的影响

硝苯吡啶对肝硬化门脉高压病人肝脏血流动力学的影响许君望，段仲璧，刘宪玲钙通道阻滞剂可降低肝硬化门脉阻力，从而降低门脉压力，但其对肝脏血流动力学的影响尚不清楚。我们采用核多功能仪首次通过法观察了硝苯吡啶（ＮＦＰ）对肝硬化门脉高压病人肝动脉、门静脉血流的...     

汉丹肝乐对门脉高压血流动力学影响的临床研究

目的研究汉丹肝乐对肝硬变门脉血流动力学影响．方法肝炎后肝硬变18例，酒精性肝硬变4例，胆汁性肝硬变1例，共23例．其中男性19例，女性4例，平均年龄56．7岁按肝功能Child－Pugh分级，A级4例，B级17例，C级2例．患者符合下列条件：肝脏、脾脏肿大、质地硬，伴食管胃底静脉曲张（经内镜证实），B超检查门脉内径≥1．4cm．患者无或有少量腹水，无上消化道出血和肝性脑病．用汉丹肝乐口服，每次300mp，3次／d，疗程4wk．应用彩色超声诊断仪监测用药前后门静脉系统血流动力学改变．结果口服汉丹肝乐（4wk）后可显著降低肝硬变患者（ChildPughA，B级）门脉血流速度（Vpv）、脾静脉血流速度（Vsv）、门静脉血流量（Qpv）、脾静脉血流量（Qsv）、门静脉阻力指数（RIvp）、峰值指数（PIvp）及脾静脉阻力指数（TIsv）、峰值指数（PIsv）（P＜0．05～0．01），并对患者乏力、厌食、腹胀及肝功能（ALT）具有部分改善作用，未见副作用．结论汉丹肝乐为安全、有效的降低门静脉压力药物，值得对其做进一步研究     

肝硬变门脉高压症患者肝细胞核形态与肝功能及预后的关系

应用计算机图像分析仪对３０例肝硬变门静脉高压患者（观察组）的肝细胞进行了形态学测定，并与５例正常人（对照组）进行比较。结果显示，观察组肝细胞肝核明显增加，对照组与观察组（不同肝功能分级）患者的肝细胞核体积及形态因子（ＦＦ）有非常显著性差异（Ｐ〈０．０１），与Ｂ级患者比较有显著性差异（Ｐ〈０．０５）；不同肝功能分级患者肝细胞核的各种光密度指标均无明显差异（Ｐ〉０．０５）。说明肝硬变门脉高压症患者的肝     

肝动脉灌注阿霉素毫微粒在荷肝瘤鼠体内的药物分布及药效研究

目的研究阿霉素毫微粒（ＮＡＤＭ）经肝动脉灌注后在荷肝肿瘤鼠体内的药物分布与药效．方法ＳＤ纯系大鼠９０只，建立Ｗ２５６移植性肝癌模型并随机分为６组，每组１５只动物，其中２组供药物分布研究，４组供药效研究．药物分布组经肝动脉以２ｍｇ／ｋｇ药物剂量分别注入ＮＡＤＭ与游离阿霉素（ＦＡＤＭ），每组于给药后１，５，１５ｈ各处死５只大鼠，分别提取血浆、肝、心、脾、肺、肾、肝肿瘤样品，采用反相高效液相色谱荧光检测法测定药物浓度；药效组经肝动脉分别灌注生理盐水（ＮＳ），ＦＡＤＭ、阿霉素加空白毫微粒（ＡＤＭ＋ＮＰ）和ＮＡＤＭ．结果给药后１，５，１５ｈ时ＮＡＤＭ组大鼠肝、脾、肝肿瘤中阿霉素浓度均显著高于ＦＡＤＭ组（Ｐ＜００１），而血浆、心、肺中阿霉素浓度则显著降低（Ｐ＜００１）．与ＦＡＤＭ及ＡＤＭ＋ＮＰ组相比，经ＮＡＤＭ治疗的大鼠生存期显著延长（Ｐ＜００１），对肿瘤生长的抑制更为明显（Ｐ＜００１），肿瘤坏死更广泛，更彻底．结论ＮＡＤＭ经肝动脉给药后改变了阿霉素的体内分布特征，对肝肿瘤表现出明显的靶向性，并显著提高阿霉素的疗效     

~（99m）Tc－Phy肝血流断层对肝病诊断的价值

１１９例肝血流断层显像（ＨＢＦ－ＥＣＴ）结果表明,肝血流动力学变化可分为正常（Ｎ）、迟缓（Ｄ）、脾高（Ｓ）、门脉高压（ＰＨ）、冷占位（ＣＣ）、动脉性冷和热占位（ＡＣ、ＡＷ）等七型。肝动脉指数（ＨＡＩ）、摄取指数（ＨＵＩ）、脾肝比（Ｓ／Ｌ）之总体均数差和组间均数差皆有显著意义。慢肝组为Ｄ或Ｎ型。门脉高压７８．９％为ＰＨ型,其阳性及阴性预测率为９１．８％及１００％,ＨＡＩ和Ｓ／Ｌ亦显著高于前者,肝硬变之ＨＵＩ明显减低而非肝硬变门脉高压者仍在正常范围。巨脾患者为Ｓ型,ＨＵＩ及ＨＡＩ正常。ＣＣ型诊断良性肿物准确性为８０％,ＡＣ型诊恶性肿瘤准确性为８３．６％。ＡＷ型对肝局限结节性增生具有病因特异性。     

丹参治疗肝硬变门脉高压症40例

目的肝硬变门脉高压症可导致许多并发症威胁患者的生命。如何降低门脉压力引起了医学界的重视．我院采用静滴丹参降低门脉压力获得了良好的效果方法丹参400mg＋10％葡萄糖500mL，静滴1次／d,共30d.如有腹水，应用少量利尿剂、补充清蛋白．应用彩色多普勒超声仪分别于用药后2wk，4wk检测门静脉内径（Dpv）、门静脉血流速度（Vpv）、脾静脉内径（Vsv），脾静脉血流速度（Vsv），并计算出门静脉血流量（Qpv）、脾静脉血流量（Qsv）．结果用药2wk后，Dpv与Dsv显著降低，与用药前比较P＜0．05，其他症状好转，如腹胀、乏力等．4wk后Dpv，Dsv继续下降，Wpv与Qsv亦有明显降低，统计学分析P＜0．01．但ChildPughC级3例，经4wk治疗后无效，其血流动力学无显著变化．结论静滴丹参能有效地降低门脉压力，改善临床症状，对心脏及血压无明显副作用．     

Prevention of liver metastasis by intraperitoneal 5-FU chemotherapy in nude mice inoculated with human colon cancer cells

AIM: To prevent hepatic metastasis by regional adjuvant chemotherapy after radical surgery for colon cancer. METHODS: A nude mouse model of human colon cancer (HCC) was used to evaluate the prevention of metastasis of HCC cells following the application of early postoperative intraperitoneal (IP) high-dose 5-fluorouracil chemotherapy. RESULTS: The incidence of liver metastasis was decreased by 40%, and the mean number of metastatic liver nodules was reduced by 50.89%. Compared with controls, 5-FU 40 mg in NS 40 mL/kg IP for 2 consecutive days prolonged mean survival by 48.21%. CONCLUSION: IP is a promising and effective novel regional adjuvant chemotherapy for the prevention of liver metastasis of HCC cells after radical surgery for colon cancer.     

Source of blood supply and embolization treatment in cavernous hemangioma and sclerosis of the liver

AIM: To investigate the source of the blood supply in carvenous hemangioma of liver (CHL), and provide a feasible treatment for CHL via thehepatic artery.METHODS: (1) Portovenography, hepatic arteriography and portal vein staining were performed in 5 patients to determine the origin of the blood supply. Two casts of hepatic blood vessels from resected specimens were observed. (2) Clinical data from 75 patients (30 males, 45 females, aged 25-57 years, mean of 37.4) were obtained. Of these, 56 were of solitary type (44 on the right lobe, 12 on the left, with 4 having intraparenchyma), and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty-two patients were treated with sclerosis, 50 by embolization via hepatic artery, and 3 were excised.RESULTS: In the 5 cases where portography was used, the contrast medium did not enter the tumor, and the tumor appeared as low density area, with the intrahepatic branches of the portal vein pushed aside. In the 5 cases with where portal vein staining was used, the normal liver parenchyma stained a deep blue; however, the tumor was not stained. The tumor area appeared as a round vacant cavity in the 2 specimen casts. For the 72 patients treated with sclerosis or embolization via hepatic artery or through interventional method, the tumors diminished by 10%-30% in diameter, and no tumors grew larger.CONCLUSION: The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and embolization decreased in size or got fibrotic.     

肝癌切除后定期直接肝动脉门静脉造影新方法的临床意义

目的探讨肝癌切除后定期直接肝动脉门静脉造影新方法的临床意义．方法肝癌切除患者２０例，术中插管至肝固有动脉及门静脉主干，并将ＩＤＤＳ埋植于腹壁皮下，术后定期直接经ＩＤＤＳ推注７６％泛影葡胺并拍摄点片，观察肝动脉门静脉显影情况．结果全组患者均能满意显示肝动脉、门静脉及其分支；造影发现ＣＴ漏诊的肝内复发病灶１例，发现肝动脉炎３例及肝动脉肝管瘘１例，发现门静脉主干癌栓１例．结论经ＩＤＤＳ定期直接肝动脉门静脉造影，有助于复发癌的监测及指导术后治疗     

肺结核病患者强化治疗期间肝功能的改变

目的 探讨肺结核病患者在抗结核强化治疗期的肝功能改变。方法 对１３１例肺结核患者强化期肝功能改变进行分析。将１３１例分为三组，即ＨＢＶ－Ｍ阳性组５４例，ＨＢsAb阳性３０例，ＨＢＶ－Ｍ阳性组４７例。结果 ５４例ＨＢＶ－Ｍ阳性组肝功能异常２４例（４４.4%)，明显高于ＨＢＶ－Ｍ阴性组（１４.9%)和ＨＢsAb阳性组（２０％）；肺结核病患者肝功能的异常多发生在治疗后第１个月内。结论 在抗结核药物强化期ＨＢＶ－Ｍ阳性肺结核病患者易发生肝脏损害。     

肝癌动脉化疗栓塞效果的病理评价

目的研究肝细胞癌经动脉化疗栓塞治疗后癌肿的变化，探索提高疗效的方法．方法对动脉化疗栓塞治疗后行手术的３９例肝癌和１１例对照标本进行坏死程度与包膜、治疗次数、病理类型、分化、血管损伤及淋巴细胞浸润诸因素的相关性分析．结果完全坏死者６例，３０％～９５％坏死者１４例，仅５％坏死及无坏死者１９例，１１例ＤＳＡ无坏死．癌肿坏死程度与肿瘤分化、治疗次数、淋巴细胞浸润无关，而与病理类型、包膜、血管损伤有关．结论肝癌动脉化疗栓塞对于有包膜的中晚期肝细胞癌有明显效果．     

Comparative study on the effects of hepatic arterial embolization with Bletilla striata or Gelfoam in treatment of primary hepatic carcinoma

AIM: To study the safety and efficacy of hepatic arterial embolization (HAE) with Bletilla striata powders containing traditional Chinese herbs in the treatment of primary hepatic carcinoma (PHC). METHODS: From May 1990 to September 1993, 106 patients with PHC were treated by HAE with different types of Bletilla striata powders (n = 56) or Gelfoam powders (n = 50) under clearly specified conditions. We analyzed the effects and complications associated with these two types of treatment. RESULTS: The Bletilla striata powders produced extensive and permanent proximal embolization of the hepatic artery, and stimulated the formation of collateral circulation. Treatment could be stopped for as long as 6-12 mo, and there was obvious evidence of tumor necrosis and shrinkage. The patient survival rates at 1, 2, and 3 years were 81.9%, 44.9%, and 33.6%, respectively, and the mean survival time without a serious complication was 19.8 mo. Patients in the Bletilla striata group displayed better clinical effects from their treatment when compared with patients in the Gelfoam group. CONCLUSION: Bletilla striata powders are superior to Gelfoam powders when used for angioembolus in patients with hepatic carcinoma.     

"力克菲蒺、利福喷汀、阿米卡星、左氧氟沙星"方案对肝损害肺结核疗效及安全性观察

目的观察“力克肺疾、利福喷汀、阿米卡星、左氧氟沙星”方案对肝功损害肺结核的疗效及安全性。方法对肝功损害肺结核100例采用随机配对分组法分为治疗组(50例)和对照组(50例)。化疗方案:治疗组用力克肺疾(D)、利福喷汀(L)、阿米卡星(K)、左氧氟沙星(V);对照组用异烟肼(H)、利福平(R)、阿米卡星(K)、吡嗪酰胺(Z),疗程均为9个月。结果共有96例患者完成化疗疗程,治疗组49例和对照组47例,治疗9个月后治疗组涂阳阴转率为95.0%,培阳阴转率96.4%;对照组涂阳阴转率为94.4%,培阳阴转率95.7%。疗程结束时治疗组和对照组X线病灶有效率分别为98.0%和97.9%;空洞闭合率分别为61.5%和57.1%;2组在疗效上无显著性差异(P＞0.05);2年复查,治疗组和对照组痰菌复阳率分别为3.7%和4.5%无显著性差异(P＞0.05)。2组肝功能损害治疗组为32.0%,对照组为58.0%,在肝损害上有显著性差异(P＜0.01)。结论“DLKV”方案对肝功能损害肺结核疗效确切且较安全。     

Effects of AT1 receptor antagonist, Iosartan, on rat hepatic fibrosis induced by CCl4

AIM To investigate effect of Iosartan, an AT1 receptor antagonist, on hepatic fibrosis induced by CCI4; and to determine whether or not AT1 receptors are expressed on hepatic stellate cells. M~THODS AND RESULTS Fifty male SpragueDawley rats, weighing (180 ± 20) g, were randomized into five groups (control group, model group, and three Iosartan treated groups ), in which all rats were given the subcutaneous injection of 40% CCl4 (every 3 days for 6 weeks) except for rats of control group. Rats of Iosartantreated groups were treated with Iosartan (20 mg/ kg, 10 mg/kg, 5 mg/kg, daily gavage). After 6 weeks liver tissue and serum samples of all rats were examined. Serum hyaluronic acid (HA), procollagen type Ⅲ (PC Ⅲ ) were detected by radioimmunoassays. van Giesion collagen staining was used to evaluate the extracellular matrix of rats with liver fibrosis. The expression of AT1 receptors, transforming growth factor-beta (TGFβ), and alpha-smooth muscle actin (α-SMA) in liver tissue were determined by immunohistochemical techniques. Compared with model group, serum ALT and AST of Iosartantreated groups were significantly reduced (t = 4.20, P < 0.01 and t = 4.57, P < 0.01 ). Serum HA and PC Ⅲ also had significant differences (t = 3.53, P<0.01 and t=2.20, P<0.05). The degree of fibrosis was improved by Iosartan and correlated with the expressions of AT1 receptors, TGF-β, and α-SMA in liver tissue. CONCLUSION AT1 receptor antagonist, Iosartan, could limit the progression of the hepatic fibrosis induced by CCl4. The mechanism may be related to the decrease in the expression of AT1 receptors and TGF-β, ameliorating the injury of hepatocytes; activation of local renin-angiotensin system might relate to hepatic fibrosis; and during progression of fibrosis, activated hepatic stellate cells might express AT1 receptors.     

368例肺结核患者抗结核药物所致肝功能损害的临床分析

目的探讨临床应用的一线抗结核药物引起肝损害状况。方法对比分析乙肝病毒感染单纯HBsAg(+)、HBsAg(+)和HBeAg(+)、HBsAg(+)和HBeAb(+)以及丙肝病毒携带者和肝炎病毒阴性患者之间经过抗结核治疗后肝功能损害情况。结果368例病例中,肝功能损害总的发生率为16.4%(59/358),乙肝HBeAg(+)、乙肝HBeAb(+)及丙肝病毒感染组发生肝功能损害的比率明显高于乙肝病毒阴性组和单纯HBsAg(+)组,乙肝病毒阴性组和单纯HBsAg(+)组发生肝功能损害的情况统计学上无差异。同时还发现,大于60岁年龄组发生肝功能损害的几率要明显高于小于60岁的年龄组。结论合并肝炎病毒感染、老年、是抗结核药物引起肝功能损害的主要危险因素,临床应用抗结核药物时,针对此类病人需密切关注其肝功能损害情况。