Correlation of bile acid composition between liver tissue and bile

Bile acid composition of ten paired human livers and bile specimens were compared with gas chromatography-selected ion monitoring. The bile acid composition in liver and in bile was found to be similar but not identical. This difference seems to be a reflection of bile acid synthesis in liver tissue. It is suggested that analysis of bile acid composition in liver tissue is useful to evaluate abnormality of bile acid synthesis in several pathological states.     

慢性肝炎彩色多普勒血流成像与肝功能损害程度相关性研究

目的探讨慢性肝炎门静脉血流动力学改变的超声测值与慢性肝功能损害程度的相关性。方法对60例不同程度慢性乙型肝炎患者和60例对照组进行门静脉血流动力学改变的超声测量（门静脉内径、门静脉截面积、门静脉最大流速和门静脉充血指数）,结果与肝功能损害程度相比较：结果慢性肝炎轻度组,门静脉内径较对照组增宽、截面积增大,但差异无显著性意义（P〉0.05）,中度组、重度组门静脉内径增宽、截面积增大明显,与对照组、轻度组比较,差异有显著意义（P〈0.05）．门静脉最大流速在轻度组略减低,与对照组比较差异无显著意义（P〉0.05）,中度组重度组的门静脉最大流速明显减低,与对照组比较差异有显著性意义（P〈0.01）。CI值随着病情进展逐渐增高,差异有显著性意义（P〈0．05）。结论慢性肝炎患者门静脉血流动力学参数能反映肝脏肝功能损害程度,对慢性肝炎的临床治疗评价有一定的价值。     

多种损伤因子与重症胸腹损伤急性肝功能障碍相关性研究

目的探讨肿瘤坏死因子-α（tumornecrosisfactor-α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）、磷脂酶A2（phospholipaseAz,PLA2）在重症胸腹损伤急性肝功能损害发生过程中的作用。方法胸腹创伤患者82例（观察组）,同期体检健康者46例（对照组）,检测2组谷丙转氨酶（glutamicpropylictransaminase,GPT）、谷草转氨酶（glutamicoxaolacetictransaminase,GOT）、TNF—α、IL-6和PLA2水平并进行比较。结果观察组就诊时GPT（（208．43±41．35）u／L）、GOT（（198．49±39．62）u／L）、TNF—α（（36．41±18．09）μg／L）、IL-6（（393．83±143．86）μg／L）、PLA2（（41．35±14．26）μg／L）均高于对照组（（17．25±4．48）u／L,（18．29±5．37）u／L,（1．28±0．59）μg／L,（63．93±41．49）μg／L,（7．47±5．27）μg／L）（P〈O．01）;观察组GPT、GOT分别与TNF-α、IL-6、PLA2呈显著正相关（P〈0．01）。结论TNF-α、IL-6、PLA2参与了胸腹损伤急性肝功能损害的发生、发展;对TNF—α、ID6、PLA2进行早期干预可抑制急性肝功能损害发生或减轻损害程度。     

慢性肝炎超声血流成像定量指标与肝功能损害程度的相关性研究

目的 探讨慢性肝炎门静脉及肝动脉血流动力学改变的超声测值与慢性肝功能损害程度的相关性.方法 将457例慢性肝炎患者肝功能异常分为轻度组、中度组和重度组,选取120例健康者为对照组;全部受检者均行门静脉、肝动脉超声检测和血清学、病毒标记物检测,209例患者经肝组织活检病理证实.将超声测值与血清学检测的肝损害程度分期对照分析.结果 对照组与轻度组,在门静脉内径、门静脉血流速度比较,无显著差异(P＞0.05);在肝动脉流速、阻力指数和收缩期峰值与舒张期峰值比值中存在显著差异(P＜0.05);对照组、轻度组与中度组、重度组在血流定量指标中存在显著差异(P＜0.05).结论 慢性肝炎患者门静脉流速、肝动脉流速及肝动脉阻力指数等能反映肝脏肝功能损害程度,从而对慢性肝病的临床治疗评价有一定的价值.     

胆汁中总胆汁酸盐/磷脂比例与大鼠移植肝胆道相对热缺血损伤的相关性

背景:据报道,供肝的热缺血、冷保存时间过长都可导致移植肝产生"毒性胆汁",并进而损伤胆道,然而胆道相对热缺血是否也会引起胆汁成分改变,目前尚无相关报道.目的:建立大鼠自体原位肝移植胆道相对热缺血损伤模型,观察胆道相对热缺血对大鼠移植肝分泌的胆汁中总胆汁酸盐、磷脂浓度的影响及与胆道损伤的相关性.方法:选用SD大鼠32只建立大鼠自体原位肝移植胆道相对热缺血损伤模型.按随机数字表法分为4组(n=8):Ⅰ组为假手术组,只游离肝脏,不进行肝脏冷灌注;Ⅱ、Ⅲ、Ⅳ组的胆道相对热缺血时间分别为0,30,60 min,即分别在门静脉开放后0,30和60 min时开放肝动脉.采用循环酶法测定术后胆汁中总胆盐浓度,酶比色法测定磷脂浓度.取肝门部胆管,光镜观察其组织学形态,透射电镜观察胆道上皮细胞的超微结构变化,原位末端标记法检测上皮细胞凋亡情况.分析总胆汁酸盐磷脂比例与胆道损伤的相关性.结果及结论:死亡1只,进入结果分析31只.肝移植胆道相对热缺血可以引起移植肝分泌的胆汁成分改变,表现为总胆汁酸盐/磷脂比例升高,胆汁毒性增加,这种改变与相对热缺血时间呈正相关,相对热缺血时间越长,胆汁成分改变越明显;而且与胆道损伤的病理学改变呈密切正相关,说明胆汁成分改变是相对热缺血导致胆道损伤的重要机制之一.     

急性胰腺炎胰腺外炎症CT评分及其与肝/脾CT值比的相关性研究

目的探讨急性胰腺炎(acute pancreatitis,AP)胰腺外炎症CT评分(extra-pancreatic inflammation on CT,EPIC)与肝/脾CT值比的相关性。方法 75例经临床确诊的AP患者,均进行腹部CT平扫。两名放射科医师根据EPIC评分标准进行盲法评分并分别测量肝脏、脾脏CT值及计算肝/脾CT值比。分析AP的EPIC评分与肝/脾CT值比之间的相关关系。结果75例患者中有39例患者肝/脾CT值比<1,占52%。AP的EPIC评分与肝/脾CT值比呈负相关(rs=-0.293,P=0.011)。结论肝损伤是AP常见的并发症,随着AP严重程度的增加,肝损伤发生率也逐渐增加,损伤程度也逐渐加重。     

Relationship between bile flow and Na+, K+-adenosinetriphosphatase in liver plasma membranes enriched in bile canaliculi.

The relationship between bile flow and Na+,K+-ATPase activity in liver plasma membranes enriched in bile canaliculi was studied in rats treated with ethinyl estradiol, phenobarbital, or 20-methyl cholanthrene. In comparison with controls (1.49+/-0.12 microliter/min per g liver), bile flow was significantly diminished by ethinyl estradiol, increased by phenobarbital, and unchanged by 20-methyl cholanthrene or the solvent, propanediol (0.92+/-0.31, 2.50+/-0.21, 1.62+/-0.18, and 1.64+/-0.30 microliter/min per g liver, respectively). The corresponding values for canalicular Na+,K+-ATPase activity were 80.7+/-19.2, 50.0+/-18.4, 231.7+/-42.6, 82.7+/-30.7, and 143.6+/-55.3 micronmol Pi/h per g liver. Canalicular Na+,K+-ATPase activity was significantly correlated (r=0.785, n=31) with bile flow. These findings support the hypothesis that a fraction of bile flow is related to Na+,K+-ATPase activity and canalicular Na+ transport.     

Correlation of ultrasonic attenuation with pathologic fat and fibrosis in liver disease

The attenuation coefficient in two groups (n1 = 70; n2 = 59) of pathologically graded in vitro human liver specimens was measured over a frequency range from 1.25-8.0 MHz and fitted to a power law model. The slopes of the power law curves at 5 MHz were correlated with pathological scores for fat in Group I, which consisted of normal and fatty livers (no fibrosis); they were also correlated with the pathological score for fibrosis in Group II, which consisted of normal and fibrotic livers (no intracellular fat). Significant (p less than 0.002) differences were found between the two groups. The fatty liver group exhibited approximately a 0.23 +/- 0.06 dB cm-1 MHz-1 (fat grade)-1 behavior (mean +/- s.d.), while the fibrotic liver group exhibited approximately a 0.11 +/- 0.01 dB cm-1 MHz-1 (fibrosis grade)-1 behavior. These results may explain some of the conflicting literature in this area, and suggest that attenuation may in principle be used for screening for liver disease, but not for differentiation between fatty and fibrotic conditions.     

新西兰大白兔甲状旁腺缺血后细胞凋亡与甲状腺形态的关联研究

目的探讨新西兰大白兔甲状旁腺缺血后细胞凋亡与甲状腺形态的相关性。方法选取新西兰大白兔100只按随机数字表法分为健康对照组、甲状旁腺缺血5、10、20、30 min组,每组20只。检测各组大白兔甲状旁腺细胞凋亡数、甲状腺功能、甲状腺绝对质量及相对质量、左右叶及峡部厚度、甲状腺系数、细胞核数以及滤泡面积。采用Logistic回归法分析甲状旁腺缺血后细胞凋亡与甲状腺形态的相关性。结果与健康对照组相比,甲状旁腺缺血5、10、20、30 min组大白兔甲状旁腺细胞凋亡数、甲状腺功能以及甲状腺形态差异有统计学意义(P<0.05),随着缺血时间延长,甲状旁腺细胞凋亡数、甲状腺系数和细胞核数显著增多,血小板生成素(TPO)值、左右叶及峡部厚度显著增大,促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT₃)、游离甲状腺素(FT₄)、甲状腺质量、滤泡面积显著降低,尤以缺血30 min组最为显著(P<0.05)。Logistic分析发现,甲状旁腺缺血与甲状旁腺形态变化指标包括甲状腺相对质量(P=0.012)、左叶厚度(P=0.011)、右叶厚度(P=0.013)、峡部厚度(P=0.009)、甲状腺系数(P=0.002)、甲状腺细胞核数(P=0.004)和滤泡面积(P=0.001)均存在显著相关。结论甲状旁腺缺血会造成细胞凋亡,增加各部位厚度,引发甲状腺形态异常。     

TACE治疗原发性肝癌所致急性肝损伤与化疗栓塞容积的相关性研究

经动脉化疔栓塞术（Transarterial chemoembolization，TACE）是利用肝癌（Hepatocellular carcinoma，HCC）的富血供特性，将化疗药直接注入肝动脉，使得肿瘤内具有很高的药物浓度从而降低全身的副作用。该治疗方法已成为不能行手术切除HCC患者的首选，但其远期疗效仍不如人意，究其原因，TACE所导致的肝功能损伤是一个不可忽视的原因。本文旨在探讨TACE后导致急性肝功能损伤的原因，总结出安全、有效的治疗方案。     

TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction

Background  Growing evidence suggests that poor coronary blood flow after primary percutaneous coronary intervention (PCI) is associated with unfavorable clinical out-come. We retrospectively evaluated data from our single center “real world patients” database of patients undergoing primary PCI to determine differences in clinical and angiographic patterns in patients with or without restoring thrombolysis in myocardial infarction (TIMI) flow 3. Methods and results  Between 2001 and 2006, 500 patients underwent primary PCI for STEMI. In 430 patients, post-interventional TIMI flow 3 could be established. In this group, in-hospital mortality was significant lower (6.4% Vs. 32.9%; P < 0.0001), left ventricular ejection fraction was better (51.3 Vs. 44.2%; P < 0.0001), and prehospital fibrinolytic therapy (6.3% Vs. 14.3%; P = 0.015), cardiogenic shock (10.9% Vs. 24.3%; P = 0.002) and use of intra-aortic balloon pump were all more unlikely (5.8% Vs. 11.4%; P = 0.045) compared to patients with TIMI flow ≤ 2. In patients with post-interventional TIMI flow ≤ 2 the left anterior descending coronary artery (LAD) was significantly more often seen as the target vessel (54.3% Vs. 44.6%; P = 0.039). A regressions analysis showed that predictors leading to such flow patterns are diabetes (P = 0.013), pre-hospital fibrinolytic therapy (P = 0.017), cardiogenic shock (P = 0.002) and a 3-vessel disease (P = 0.003). After 6 months, patients without restored normal TIMI flow had worse New York Heart Association functional class (NYHA), and had to undergo repeat coronary angiography more often. Conclusion  Post-interventional TIMI flow ≤ 2 is strongly associated with adverse out-come during hospitalization and after 6 months following hospitalization. The authors have no financial associations that might pose a potential conflict of interest with the paper to disclosure.     

血清总胆汁酸与传统肝功能酶学指标在肝胆疾病中的比较

目的探讨血清总胆汁酸(TBA)水平在肝硬化、肝癌和梗阻性黄疸中的临床价值。方法采用酶循环法对120例肝胆疾病患者(病例组)和80例健康体检者(健康对照组)进行TBA水平检测,同时检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)的活性,并对检测结果进行比较分析。结果肝硬化组、肝癌组、梗阻性黄疸组血清TBA水平均明显高于健康对照组,差异有统计学意义(P<0.01);并且肝硬化组和梗阻性黄疸组的TBA水平明显高于肝癌组,差异有统计学意义(P<0.01);血清TBA在肝硬化、肝癌及梗阻性黄疸中的阳性率分别为100%、80%、100%,并且明显高于传统肝功能酶学指标,差异有统计学意义(P<0.01)。结论 TBA是反映肝细胞损伤、胆道梗阻的良好指标,其灵敏度、特异性都优于常规肝功能酶学检测项目,对肝胆疾病早期诊断、病情监测具有重要的临床价值。     

Correlation between CT morphologic appearance and histologic findings in colorectal liver metastasis after preoperative chemotherapy

Abdominal Radiology - Radiological evaluation of the efficacy of preoperative chemotherapy for colorectal liver metastasis (CRLM) is the most important tool for determining treatment strategies....     

Allopurinol and nitric oxide activity in the cerebral circulation of those with diabetes: a randomized trial

OBJECTIVE—Type 2 diabetes increases risk of stroke, perhaps because of impaired cerebrovascular basal nitric oxide (NO) activity. We investigated whether this activity is improved by a 2-week course of the xanthine oxidase inhibitor allopurinol.RESEARCH DESIGN AND METHODS—We performed a randomized, double-blind, placebo-controlled crossover study. We measured the response to infusion of NG-monomethyl-L-arginine (l-NMMA) in males with type 2 diabetes before and after allopurinol or placebo. The primary end point was the change in internal carotid artery flow following l-NMMA infusion, expressed as the area under the flow-per-time curve.RESULTS—We enrolled 14 participants. Allopurinol improved responses to l-NMMA when compared with responses associated with placebo (P = 0.032; median reduction in internal carotid artery flow following l-NMMA of 3,144 ml [95% CI 375–7,143]).CONCLUSIONS—Xanthine oxidase inhibition with allopurinol appears to improve cerebral NO bioavailability, as evidenced by a greater response to infusion of l-NMMA.Type 2 diabetes conveys an increased risk of stroke (1,2), perhaps because of impaired cerebrovascular basal nitric oxide (NO) bioavailability—a hypothesis suggested by impaired response to infusion of the endothelial NO synthase inhibitor NG-monomethyl-l-arginine (l-NMMA) (3). We performed a randomized, double-blind, placebo-controlled crossover study to test whether this response is improved following a course of the xanthine oxidase inhibitor allopurinol.     

抑郁症复发患者甲状腺功能减退与认知功能障碍的相关性

目的探讨抑郁症复发患者甲状腺功能减退与认知功能障碍相关性。方法选取西安市精神卫生中心精神科就诊患者240例,根据抑郁症发作情况分为首发组和复发组,并选择同期健康体检者150例作为对照组。比较认知功能评分、甲状腺激素水平、血清叶酸(FA)水平和同型半胱氨酸(HCY)水平之间的差异性,并分析各因素与认知功能损伤之间的相关性。结果复发组与首发组、对照组相比,各评分均较低,差异有统计学意义(P0.05)。进一步研究发现,复发组血清甲状腺素(T4)、血清游离甲状腺素(FT4)水平低于对照组和首发组,促甲状腺激素(TSH)高于对照组和首发组,差异有统计学意义(P0.05)。与对照组和首发组相比,复发组HCY升高,FA水平均下降,差异有统计学意义(P0.05)。相关性分析显示,TSH、HCY与简易精神状态量表(MMSE)呈现负相关性,T4、FT4、FA与MMSE呈现正相关性。结论本研究证实了抑郁症复发的患者甲状腺功能的减退与认知功能障碍相关,并分析发现可能通过HCY水平的升高和FA的下降所导致,为抑郁症复发与认知功能障碍的相关性研究奠定了基础,为临床治疗提供分子靶标。     

下丘脑—垂体—肾上腺轴应变调控与脑缺血再灌流相关性的研究

建立了脑缺血动物模型，测试有关激素的变化，为缺血性脑血管病临床整体防治研究工作提供实验理论依据。用家兔，以３％戊巴比妥钠麻醉，分为不全脑缺血组、全脑缺血组、再灌流组和对照组。实验过程中同步监测血压、心率、呼吸，各组于结扎动脉后即刻、３０分钟、６０分钟和１２０分钟各取血１次，于１２０分钟后迅速解剖取大脑皮层颞叶、海马、下丘脑和中脑，测试脑缺血及再灌流等各组血浆、脑匀浆促肾上腺皮质激素（ＡＣＴＨ）、皮质醇与外周血嗜酸粒细胞绝对值（ＥＣ值）的变化。结果：全脑缺血组及其再灌流组血浆、脑匀浆ＡＣＴＨ、皮质醇含量显著增高，其活性变化反应敏感、活跃；不全脑缺血组ＡＣＴＨ及皮质醇变化相对不明显。脑匀浆ＡＣＴＨ、皮质醇均以下丘脑含量为最高。以上３组外周血ＥＣ值同期显著降低。实验结果表明：在急性脑血循环障碍、脑缺血、缺氧特定条件下，动物机体内环境应变调控功能同时受到干扰，ＡＣＴＨ、皮质醇和ＣＥ值三者自身活动变化敏感。充分提示神经内分泌系统在脑缺血、再灌流过程中应变调控的总体效应，且反应强度与中枢神经系统损害严重程度紧密相关。作者认为，本实验对缺血性脑血管病临床整体防治研究工作提供了实验理论依据     

Relationships between hepatitis B infection status and liver dysfunction after chemotherapy of lung cancer patients in mainland China

Purpose

A preliminary analysis on the risk factors of liver dysfunction was made after the investigation of hepatitis B prevalence and chemotherapy-related hepatic dysfunction occurrence for patients with lung cancer.

Patients and methods

Consecutively diagnosed 950 lung cancer patients treated in Huashan Hospital, Fudan University from 1999 to 2009 were enrolled in the study. We investigated hepatitis B (HB) prevalence and analyzed chemotherapy-related hepatic dysfunction occurrence and its influencing factors. Liver dysfunction was considered when alanine transaminase, aspartate aminotransferase, and serum bilirubin levels exceeded at least 1.25-fold of normal levels, and HB statuses were categorized into diagnosed HB, previous HB infection, HB immunity, and no HB infection.

Results

Among the 950 lung cancer patients, 632 accepted the HB serum marker tests: 8.4 % (53/632) were HB surface antigen positive, and 37.2 % (235/632) were HB core antibody positive. A number of 281 patients received liver function follow-up examinations after they underwent a total of 774 chemotherapy courses, and 34 liver dysfunctions were detected. A logistic regression analysis showed that younger age at diagnosis (≤60 years; P?=?0.029) and abnormal liver function before chemotherapy (P?=?0.000) were the risk factors for liver dysfunctions after chemotherapy, but HB status had no influence.

Conclusions

The screening rates for serum HB marker and HB prevalence in patients with lung cancer were high in mainland China. Lung cancer patients with abnormal liver function before chemotherapy and in younger ages had higher risks for liver dysfunctions after chemotherapies, whereas HB status before the first chemotherapy is not an independent impact factor for post-treatment liver dysfunctions.