菊叶三七致肝小静脉闭塞病35例临床分析

目的 分析菊叶三七(土三七)导致肝小静脉闭塞病(HVOD)的临床特点、诊治方法和预后。方法 回顾性分析35例因服用土三七所致肝小静脉阻塞病的临床资料。结果 HVOD临床表现为腹水(91%)、腹胀(86%)、纳差(71%)、乏力(71%)、肝肿大(66%)等。彩超可见肝大、腹水、肝内“豹纹状”、“斑片状”低回声区等,增强CT可见特征性“地图状”不均匀强化影。出院后随访1周至3年,失访3例,死亡13例,治愈/好转19例;死亡组病人白细胞计数、凝血酶原时间、血肌酐、尿素氮水平较治愈/好转组病人相对较高(P＜0.05)。结论 HVOD病程相对较短,诊治困难,预后较差。     

土三七致肝小静脉闭塞症患者的临床特点分析北大核心CSCD

目的分析土三七所致肝小静脉闭塞症(HVOD)患者的临床特点。方法分析我院收治的因外伤等原因服用土三七导致的HVOD患者的生化指标、凝血功能和血流速度等资料。结果在59例HVOD患者中,男40例,女19例,平均年龄为(62.71±11.00)岁。土三七的用药方法为煎水或泡茶服者22例、泡酒服者26例和研磨成粉吞服者11例,用药时间为1 d^3年,发病时间为用药后1周~3年,发病距就诊时间为10 d^4个月。凝血酶原延长者28例,纤维蛋白原降低者23例,血小板计数降低者46例,谷丙转氨酶升高者40例,总胆红素升高者52例。32例患者有完整的腹部B超血流速度数据,门静脉和脾静脉血流速度均降低。25例患者抗凝治疗有效;32例患者经15 d抗凝治疗无效,最终需进行经颈静脉肝内门体静脉分流术(TIPS)治疗;1例患者抗凝治疗无效,需进行肝移植;1例患者因特殊原因未予以抗凝治疗。结论 HVOD突出临床表现为门静脉高压症,主要表现为肝功能受损,门静脉和脾静脉血流速度降低,多数患者经抗凝治疗和TIPS手术治疗后能获益。     

抗结核治疗中保肝药的预防性应用分析

目的:了解在抗结核治疗过程中保肝药对药物性肝损害的预防作用。方法:对比分析4 927例初始抗结核治疗加用保肝药与未用保肝药患者治疗6个月内转氨酶变化情况,分析保肝药对肝损害的预防性作用。结果:2 771例未使用保肝药者中有2 193例(79.14%)在治疗6个月内出现转氨酶异常,而2 156例使用保肝药者中有984例(45.64%)在治疗6个月内出现转氨酶异常,差异有统计学意义(P<0.01)结论:初始治疗即加用保肝药可以有效减少患者肝损害的发生。     

中药土三七致肝小静脉闭塞病六例临床分析及文献研究

目的探讨土三七致肝小静脉闭塞病(HVOD)的发病机制、临床表现、诊疗方法及体会。方法回顾性分析我院土三七致HVOD共6例患者的临床特点及诊治经过。结果 6例土三七致HVOD患者均以腹水腹胀为主要临床表现,同时伴有乏力、恶心、食欲减退、双下肢浮肿、轻度黄疸。结论土三七致HVOD的突出临床表现为大量腹水。增强CT及介入造影检查对本病的诊断及鉴别诊断有重要价值。目前治疗尚无特效方法,抗凝治疗存在争议。加强患者对中药的鉴别能力,规范合理用药,才能减少疾病发生。     

土三七致肝小静脉闭塞症81例文献分析

目的探讨土三七致肝小静脉闭塞症（HVOD）的临床特点和危险因素,为临床合理用药提供参考。方法以＂土三七＂、＂菊三七＂、＂肝小静脉闭塞症＂、＂肝静脉闭塞病＂等为检索词,检索中国期刊全文数据库和万方数据知识服务平台,收集土三七致HVOD的文献进行统计分析。结果共收集到土三七致HVOD患者81例,其中男性50例（61.7%）,女性31例（38.3%）;年龄17~81（51±1）岁,≥45岁者73例（90.1%）。81例患者中,原发疾病为骨伤科疾病者60例,伴有慢性肝病者11例。所有患者均为自行服药。发病时间为用药后1周至2年。每日服用剂量越大者,发病时间越早;每日服用剂量小但服用时间长者,发病时间相对较晚。慢性起病者36例,亚急性起病者45例。临床表现以消化系统症状和水钠潴留为主。实验室检查以凝血功能和肝功能指标异常为主。46例肝活检显示肝小叶的静脉内皮损害及管腔狭窄。停药并给予对症治疗后,14例治愈;32例好转;15例死亡;20例放弃治疗,转归不详。结论土三七引起的HVOD与服药剂量相关,病死率较高。土三七所致HVOD重在预防,应加强宣传教育,引导患者正确使用中草药。     

土三七致肝小静脉闭塞病的血小板及凝血功能临床表现分析

目的 分析土三七所致的肝小静脉闭塞病(hepatic venular occlusive disease,HVOD)的血小板及凝血功能的临床表现。方法 搜集35例外伤后服用土三七致HVOD的血小板及凝血功能临床资料,结合文献报道进行分析。结果 35例患者中,32例血小板小于正常值,占91.4%,检测值为(81.94±17.92)×10⁹·L^-1;凝血酶原时间延长33例,占94.2%,检测值为(18.73±3.28)s,国际标准化比值检测值为1.76±0.35,部分活化凝血酶原时间检测值为(42.35±6.57)s。结论 临床上土三七致HVOD血小板数量减少、凝血功能受抑制,应用活血化瘀、抗凝为主的方案治疗土三七致HVOD有待进一步研究。     

还原型谷胱甘肽防治HBsAg(+)患者药物性肝损害的临床观察

目的评价还原型谷胱甘肽对HBsAg( )患者抗结核药所致肝损害的预防和治疗效果.方法112例住院HBsAg( )初治浸润型肺结核随机分为两组,均以2HRZE(S)/4HR方案抗结核治疗,治疗组于强化期加用还原型谷胱甘肽.对照组出现肝损害时加用还原型谷胱甘肽.结果治疗组62例,发生可逆性中度转氨酶增高10例(16.1%),经停肝损药物后转氨酶降至正常.对照组50例,发生可逆性中度转氨酶增高19例(38.0%),两组有显著性差异(P＜0.05).对照组中19例加用还原型谷胱甘肽治疗后,11例转氨酶降至正常,8例无效,经停肝损药物后转氨酶降至正常.肝损发生前后应用还原型谷胱甘肽的无效率无显著性差异(P＞0.05).结论肺结核合并HBsAg( )患者抗结核治疗中预防性应用还原型谷胱甘肽治疗可减少药物性肝损害的发生,但与出现肝损应用还原型谷胱甘肽治疗对比无效率无显著性差异.     

降脂利肝颗粒对大鼠高脂血症及脂肪肝的防治作用

目的:观察降脂利肝颗粒对动物的实验性脂肪肝的预防和治疗作用.方法:高脂饮食后腹腔注射硫代乙酰胺引起严重肝功能损害,并形成脂肪肝的动物模型,给予高、中、低三组剂量的降脂利肝颗粒及阳性对照药物.结果:造模动物口服降脂利肝颗粒后,动物的血清AST(谷草转氨酶),ALT(谷丙转氨酶)及其他肝功能指标明显下降.结论:降脂利肝颗粒对动物的实验性脂肪肝有明显的预防和治疗作用.     

10例肝小静脉闭塞病(HVOD)的临床病理分析

目的通过分析HVOD的临床及病理组织学表现,提高对该病的认识,探讨对该病的诊断方法。方法回顾性分析本科室2007年~2010年诊断的10例HVOD的临床情况及肝穿刺病理组织学表现。结果 10例HVOD患者中7例明确服用中药土三七史,3例原因不明,临床以出现腹水,黄疸,肝功能异常为主要表现。病理表现为:肝窦扩张,淤血,红细胞渗出,肝小静脉内皮肿胀,管壁硬化,不完全闭塞,肝细胞肿胀,无菌性坏死,网状纤维支架残留。结论患者有土三七服用史,结合CT、B超、实验室检查可临床诊断HVOD,但确诊需要病理活检。组织学主要表现为:肝小静脉的硬化闭塞,伴有不同程度的肝细胞无菌性坏死,网状纤维支架残留,肝窦扩张,红细胞渗出。     

阻断与不阻断入肝血流肝癌切除术的研究

目的 对阻断与不阻断入肝血流肝癌切除术进行初步研究.方法 采用阻断入肝血流和不阻断入肝血流两种方法行肝切除术.80例患者包含两组:A组为肝切除时阻断入肝血流(37例),B组肝切除时不阻断入肝血流(43例).比较两组患者手术时间、术中失血量,术后谷丙转氨酶、谷草转氨酶恢复情况.结果 A组手术时间、术中出血量均明显高于B组[(169.46±31.44)min vs.(150.23±20.38)min(P<0.05);(530.27±195.54)ml vs.(443.72±147.97)ml(P<0.05)];术后两周肝功能恢复正常或接近术前水平,两组分别为62.2%(23/37)、90.1%(39/43)(P<0.05).结论 ①不阻断入肝血流比阻断入肝血流的肝切除术时间短,失血少.②不阻断入肝血流比阻断入肝血流的肝切除更有利于肝功能的恢复.     

Effect of FOXP3 polymorphism on the clinical outcomes after allogeneic hematopoietic stem cell transplantation in pediatric acute leukemia patients

Forkhead BOX P3 (FOXP3) polymorphisms have recently been investigated as candidate risk factors in several tumors and autoimmune diseases. This study aims to evaluate the potential influence of FOXP3 rs3761548 polymorphism in the donor on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 171 patients were enrolled for this study and genotyped using direct sequencing. Patients with rs3761548 CC genotype had higher incidence of hepatic veno-occlusive disease (HVOD) and cytomegalovirus (CMV) infection than that of the individuals with AA or AC genotype (P = 0.011, P = 0.023). Treatment-related mortality (TRM) rate of patients with AA or AC genotype was lower than that of the patients with CC genotype (P = 0.044) resulting in a difference in overall survival (OS). However, there was no difference in graft-versus-host disease (GVHD) relapse or blood stream infection (BSI), depending on the genotype at rs3761548 locus. In multivariate analysis, CC genotype showed as a risk factor in the development of HVOD and CMV infection, with low OS. In conclusion, this is the first report on FOXP3 rs3761548 SNP in allo-HSCT and we suggest that this SNP be considered a candidate marker for predicting the development of HVOD and CMV infection after allo-HSCT.     

Busulphan-loaded long-circulating nanospheres, a very attractive challenge for both galenists and pharmacologists

Hepatic veino-occlusive disease (HVOD) is the most severe and frequent busulphan high risk injury. The development of busulphan-loaded'stealth'nanospheres which avoid liver accumulation should minimize busulphan toxicity. To reach this important goal, this study has attempted to develop poly(ethylene glycol) (PEG)-coated nanospheres using polyester-PEG diblock copolymers and studied the busulphan physico-chemical characteristics related to its encapsulation. Nanospheres were prepared by nanoprecipitation and by emulsion-solvent evaporation techniques. They were characterized by microscopy and dynamic light-scattering. Busulphan interactions with adjuvants were studied using gas chromatography and mass spectrometry, high performance thin-layer chromatography and dynamic scanning calorimetry. These investigations explain both the low busulphan loadings obtained ( approximately 1% w/w) and its rapid release from nanoparticles. These experiments constituted an essential step for the development of busulphan-loaded long-circulating nanospheres.     

Busulphan-loaded long-circulating nanospheres,a very attractive challenge for both galenists and pharmacologists

Hepatic veino-occlusive disease (HVOD) is the most severe and frequent busulphan high risk injury. The development of busulphan-loaded'stealth'nanospheres which avoid liver accumulation should minimize busulphan toxicity. To reach this important goal, this study has attempted to develop poly(ethylene glycol) (PEG)-coated nanospheres using polyester-PEG diblock copolymers and studied the busulphan physico-chemical characteristics related to its encapsulation. Nanospheres were prepared by nanoprecipitation and by emulsion-solvent evaporation techniques. They were characterized by microscopy and dynamic light-scattering. Busulphan interactions with adjuvants were studied using gas chromatography and mass spectrometry, high performance thin-layer chromatography and dynamic scanning calorimetry. These investigations explain both the low busulphan loadings obtained (～?1% w/w) and its rapid release from nanoparticles. These experiments constituted an essential step for the development of busulphan-loaded long-circulating nanospheres.     

Intravenous busulfan: in the conditioning treatment of pediatric patients prior to hematopoietic stem cell transplantation

An intravenous formulation of busulfan, a cytotoxic bifunctional alkylating agent, has been developed to replace oral busulfan as a conditioning treatment prior to hematopoietic stem cell transplantation (HSCT) in pediatric patients. Doses of intravenous busulfan based on actual bodyweight, but not age, reduce inter- and intraindividual variability in exposure. In a study of intravenous busulfan as a conditioning treatment prior to allogeneic or autologous HSCT, the majority of pediatric patients, who received one of five bodyweight-based doses, achieved busulfan area under the plasma concentration-time curve (AUC) values within the targeted therapeutic range. Although mean busulfan clearance values were highly variable between bodyweight strata, exposure was not affected, with no significant differences between bodyweight groups in mean AUC values. The achievement of therapeutic AUC values with intravenous busulfan resulted in a high rate of sustained engraftment, low transplant-related mortality, and promising survival outcomes post-transplant. Intravenous busulfan was considered to be well tolerated, in the particular context of HSCT, and no failure of HSCT due to organ toxicity was reported. Nonhematologic adverse events commonly associated with busulfan conditioning regimens were frequent, but generally of mild to moderate severity. The intravenous busulfan regimen was frequently associated with elevated liver enzymes, but hepatic veno-occlusive disease (HVOD) was infrequent, of mild to moderate severity, and resolved within 10 days of diagnosis. Unlike oral busulfan, intravenous busulfan does not appear to be associated with severe HVOD or death due to organ toxicity.     

溪桫化学成分研究

目的:研究楝科溪桫属植物溪桫[Chisocheton cumingianus subsp.balansae(C.Candolle)Mabber-ley]的小枝及茎皮化学成分。方法:利用正相、反相硅胶柱色谱、Sephadex LH-20凝胶柱色谱、制备HPLC等方法分离化合物,运用MS和NMR等波谱方法解析鉴定化合物结构。结果:从其乙醇提取物之三氯甲烷萃取部位中分离鉴定出10个化合物,分别为4个三萜类化合物:odoratone(1),grandifoliolenone(2),24-表-匹西狄醇A(24-epi-piscidinol A,3),chisiamol F(4);3个倍半萜类化合物:1β,6α-二羟基-4(15)-桉叶烯(1β,6α-dihydroxy-4(15)-eudesmene,5),1β,8α-二羟基-4(15)-桉叶烯(1β,8α-dihydroxy-4(15)-eudesmene,6),环氧泽泻烯(alismoxide,7);3个蒽醌类化合物:大黄酚(8),大黄素(9),大黄素甲醚(10)。结论:10个化合物均首次从该植物中分离得到。     

酸枣仁皂苷D的分离及结构鉴定

目的研究酸枣仁Ziziphus jujuba Mill var. Spinosa (Bunge) Hu ex. H.F.的化学成分。方法用多种色谱方法分离化学成分、鉴定结构。结果从正丁醇部分分离得到5个化合物，其结构分别为：酸枣仁皂苷D(1, jujuboside D)，酸枣仁皂苷A(2, jujuboside A)，5,7,4′-三羟基黄酮醇-3-O-β-D-鼠李糖(1→6)-β-D-葡糖苷(3), 5,4′-二羟基-7-甲氧基黄酮-6-C-6-对香豆酰基-β-D-葡萄糖(1→2)-β-D-葡糖苷(4, 6-coumaroylspinosin)及苯丙氨酸(5)。结论化合物1为新化合物，化合物4作为阻转异构体存在为首次报道，化合物3和5为首次从酸枣仁获得。     

茵陈化学成分的分离与鉴定

目的:分离、鉴定茵陈提取物中的化学成分。方法:采用硅胶柱、ODS开放柱和制备液相等色谱方法分离茵陈提取物,并通过NMR和MS等谱学技术确定分离出的化合物结构。结果:从茵陈提取物中分离得到8个化合物,分别鉴定为7-羟基香豆素(1)、5,7-二甲氧基香豆素(2)、7-羟基-8-甲氧基香豆素(3)、7,8-二羟基香豆素(4)、槲皮素(5)、山柰酚(6)、异鼠李素-3-O-β-D-半乳糖苷(7)、咖啡酸(8)。化合物1～4、7为首次从蒿属植物中分离得到。结论:本试验结果可为茵陈的进一步开发利用提供依据。