肝病患者血清TGFα含量与肝功能的关系研究

探讨肝病患者血清TGFα的变化规律及其与肝功能损害的关系。用放射免疫法测定 172例各型肝病患者血清TGFα含量 ,测定各项肝功能指标 :ALT、AST、γ -GT、AKP、TB、A/G、AFP等。 (1)急性肝炎、慢性肝炎、肝硬化代偿期、肝硬化失代偿期、肝癌患者血清TGFα含量 (x±s)分别为 :(14 19± 7 30 )pg/ml、(11 2 8± 6 84) pg/ml、(8 14± 5 5 5 ) pg/ml、(16 0 2± 9 81) pg/ml、(19 89± 9 0 9)pg/ml,明显高于对照组 (6 86± 0 ,89) pg/ml((P <0 0 5 )。 (2 )TGFα和肝功能指标ALT、AST、γ -GT、AFP的相关有显著性意义 (P <0 0 0 5 ) ;而和AKP、TB、A/G的相关无显著性 (P >0 5 0 )。TGFα与肝病的慢性化及肝功能损害严重程度相关 ,检测血清TGFα对慢性肝病的预后估计尤其是肝硬化恶变有一定的作用。     

肝炎后肝硬化患者血浆内皮素的测定及其临床意义

为了解血浆内皮素(ET)水平在肝硬化及其发展中的变化，初步探讨其意义，应用放射免疫均相竞争法测定70例肝炎后肝硬化患血浆ET水平。结果示，(1)血浆ET水平在肝硬化肝功能Chile-Pugh评分分级A患(57．7±4.21．Spg/ml)、B级患(40．7±33．1pg／m1)和C级患(25．2±18．4pg／m1)均明显低于正常人(78．4±21．9pg/ml)(P＜0．01)。B级和c级患均低于A级患(P＜0.01)，C级患低于B级患(P＜0．01)。肝硬化患肝功能Child-Pugh评分分数与血浆ET水平呈负相关(r=-0.465，P＜0．05)。(2)有腹水的肝硬化患血浆ET水平明显低于无腹水的患(33．74±23．9pg/ml vs 52.6±20．3pg／ml，P＜0．01)。(3)肝硬化患血浆ET水平与血清白蛋白水平呈正相关（r=0．446，P<0．05)．与血清胆红素，尿素氧、血浆凝血酶原时间无明显相关。提示血浆ET的减少可能在肝炎后肝硬化体循环血管扩张的维持中起一定作用，是水钠潴留、腹水形成的因素之一。血浆ET水平与肝硬化的严重程度和循环高动力状态有密切关系。     

硝苯地平治疗高血压后血浆内皮素和降钙素基因相关肽的变化

目的硝苯地平降压治疗对血浆内皮素(ET)和降钙素基因相关肽(CGRP)水平的影响.方法31例原发性高血压(EH)患者口服硝苯地平控释片40mg/d×14,用放射免疫法直接测定治疗前后的血浆ET和CGRP水平.结果EH患者血浆ET水平明显高于对照组(85.6±21.0对42.1±20.3pg/ml,P＜0.001);CGRP水平明显低于对照组(23.0±8.1对55.4±17.8pg/ml,P＜0.001).舒张压与ET水平呈正相关(r=0.5302,P＜0.001),ET与CGRP呈弱的负相关(r=0.3707,P＜0.005).治疗后,血压和ET水平明显下降(P均＜0.001),CGRP水平呈显著增高(P＜0.001).结论硝苯地平是一种有效的降压药,它通过调节EH时多种血管活性多肽之间的平衡关系,对器官具有重要保护作用.     

不同临床类型慢性肝病患者血浆内皮素水平研究

目的探讨内皮素(endothelin,ET)与不同临床类型慢性肝病的关系。方法用放射免疫分析法测定62例慢性肝病组(包括慢性肝炎、肝硬化代偿期、肝硬化失代偿期组)患者血浆ET浓度,并进行横向比较。结果慢性肝病组ET水平较正常降低,差异有统计学意义(P<0.01),而慢性肝炎、肝硬化代偿期、肝硬化失代偿期ET水平比较差异无统计学意义(P>0.05)。结论(1)慢性肝病患者血浆ET水平显著降低;(2)血浆ET水平在慢性肝炎、肝硬化代偿期、肝硬化失代偿期患者之间差异无统计学意义。     

胰岛素样生长因子Ⅰ和各型肝病关系的研究

探讨胰岛素样生长因子１（ＩＧＦ－１）在各型肝病患者中的变化规律。用放射免疫法测定２３１例肝病患者及 ６３例正常人的血清 ＩＧＦ－１含量。急性肝炎（６４０．２９± ７３．６０）ｎｇ／ｍｌ，慢性轻度肝炎（５３９．６５± ９６．５５）ｎｇ／ｍｌ，慢性中度肝炎（５１２．６５±６９．５７）ｎｇ／ｍｌ，慢性重度及重症肝炎（３２４．７１±１６３．２７）ｎｇ／ｍｌ，失代偿期肝硬化（１６１．３５±８５．２９）ｎｇ／ｍｌ，原发性肝癌（１６．９１± ９６．５２）ｎｇ／ｍｌ，正常对照（３０２．２６± ８３．２９）ｎｇ／ｍｌ。除慢性重度重症肝炎外；其余各型肝病的ＩＧＦ－１含量与正常比较有显著性差异（Ｐ＜０．０１）。肝硬化及肝癌患者的ＩＧＦ—１水平明显低于正常（Ｐ＜０．０１）。ＩＧＦ－１是在肝脏病变的发展过程中判断肝细胞功能不良的重要指标。检测ＩＧＦ－１对肝病患者尤其是判别肝硬化是否停止进展的预后估计有一定作用。     

传染病和寄生虫病

20012979肝病息者血清TGF以含t与肝功能的关系研究/叶晓光…/八庙床肝胆病杂志一2001,17(2)一83~84 采用放免法测定转移生长因子(TGFa).结果:23例急性黄疽肝炎、69例慢性肝炎、16例肝硬化代偿期、35例肝硬化失代偿期、29例原发性肝癌TGFa分别为14.19士7.30、11.28士6.84、8.14士5.55、16·02士9·81和19·89士9·09(pg/ml),明显高于32例正常对照组(6·86士059)pg/ml,p<0.05~0.01;TGFa和ALT、AST洲一GT、AFP的相关显著性意义(P<。.005)。提示TGF。与肝病慢性化及肝功能损害严重度相关。表2参6(陈振依)20012980非甲一非庚型肝炎病…     

肝病患者血清TGF-α和TGF-β1的检测及临床意义

探讨肝病血清TGF-α与TGF-β1的关系及在肝病患者中的临床意义.TGF-α采用放射免疫法,TGF-β1采用双抗体夹心ELISA法,对153例肝病血清进行检测分析.各型肝炎、肝硬化TGF-α明显高于对照组且随病情加重而升高(P＜0.01).各型慢性肝炎、肝硬化TGF-β1也明显升高,且与TGF-α存在正相关(r=0.512,P＜0.05).肝癌组血清TGF-α及TGF-β1均显著高于各型肝病(P＜0.01).TGF-α可反映肝损伤程度.TGF-α与TGF-β1在肝炎及肝癌中各自所能发挥的作用存在不同.血清TGF-α及TGF-β1的检测对于肝炎判断病情及预后、原发性肝癌的诊断均有重要意义.     

出血性脑卒中患者血浆内皮素和血清超氧化物歧化酶研究

应用放射免疫分析法(RIA)测定55例出血性脑血管疾病患者血浆内皮素(ET)和血清超氧化物歧化酶(SOD)水平,结果表明:脑出血和蛛网膜下腔出血(SAH)患者的血浆ET和血清SOD均明显高于对照组,ET分别为68.32±12.12pg/ml、59.45±10.24pg/ml及45.69±9.12pg/ml,SOD分别为526.18±202.12ng/ml、498.18±168.85ng/ml及374.12±161.21ng/ml(P<0.01或P<0.05).相关回归分析显示两者具有相关性,提示ET和SOD与出血性脑卒中的病理改变有密切关系.     

肝肺综合征患者降钙素基因相关肽及内皮素含量检测

目的　肝肺综合征 (HPS)的发生与血循环或肺内扩张 /收缩血管物质失衡密切相关。检测HPS患者血浆中降钙素基因相关肽 (CGRP)和内皮素 (ET)含量 ,以探讨它们在HPS发病中的作用。方法　选择经肺灌注扫描及血气分析诊断的HPS患者 16例 ,无HPS的肝硬化患者 30例 ,用放射免疫分析法测定其血浆CGRP、ET含量 ,同时以 15名健康献血员作为对照。结果　HPS组血浆CGRP[(6 5± 15 )pg/ml]、ET[(78± 2 1) pg/ml]显著高于肝硬化组 [(5 1± 15 ) pg/ml,(6 0± 14 ) pg/ml,P <0 .0 1],也显著高于对照组 [(32± 12 ) pg/ml,(36± 11)pg/ml,P <0 .0 1];肝硬化组与正常对照组比较差异也有显著性(P <0 .0 1)。线性相关分析显示 ,HPS组患者血浆CGRP及ET含量与动脉血氧分压呈显著负相关 ,与肺内分流率大小无关。结论　HPS患者血浆CGRP、ET含量增高 ,其增高可能与HPS肺内血管扩张和动脉血氧分压下降有关。     

充血性心衰患者血浆内皮素含量变化以及苯那普利对其影响

目的:探讨充血性心衰患者血浆内皮素(ET)的浓度和苯那普利对ET的影响。方法:用放免法测定79例心衰患者血浆ET含量并用苯那普利10mg/d,连服2周观察疗效。结果:心衰患者的血浆ET浓度较对照组明显升高,NYHA心功能Ⅳ级者的ET水平(94.7±20.0)pg/ml较NYHA心功能Ⅱ级(69.5±19.0)pg/ml和NYHA心功能Ⅲ级者(79.2±14.3)pg/ml明显升高(P均<0.01)。左室射血分数(EF)减低者的血浆ET浓度明显升高,经相关分析后,血浆ET浓度与EF呈显著的负相关(r=-0.35,P=0.02)。其中29例患者经苯那普利治疗后,血浆ET浓度由治疗前的(113.7±36.6)pg/ml下降至(81.1±43.1)pg/ml(P<0.001)。结论:ET参与了心衰的发病和病理过程,苯那普利可明显降低心衰患者的血浆ET浓度。     

肝移植在中国的发展现状

作为治疗各种终末期肝病唯一有效的方法,肝移植近年在国内发展迅速。叙述了肝移植在国内的最新发展成果,包括肝癌肝移植受者选择标准——杭州标准的确立;挽救性肝移植及降期治疗在肝癌肝移植中的最新应用;肝移植联合人工肝技术治疗急性重症肝衰竭的进展;活体肝移植技术创新和心脏死亡器官捐献移植在中国的突破性发展。面临器官短缺,应建立符合中国国情的科学规范的器官捐献体系,在造福于广大人民的同时也将进一步提升我国器官移植学界在国际上的声誉。     

肝再生增强因子在肝脏中的作用

肝再生增强因子（ALR）除了促进肝再生，保护肝损伤之外，可能在肝脏的器官形成和发育中也发挥着重要作用。介绍了ALR在肝脏中的生物学功能和机制研究的最新进展，并归纳总结了ALR在肝脏疾病的诊断和治疗中的应用。指出ALR可能通过线粒体途径调控肝细胞的凋亡，从而参与肝脏的修复和再生。未来ALR可能作为肝衰竭患者肝再生及预后评估的候选分子，并有望成为临床治疗严重肝病和肝衰竭的有效药物。     

药物性肝损伤的研究现状及存在问题

药物性肝损伤是由于药物和（或）其代谢产物引起的肝细胞毒性损伤,或药物及其代谢产物引起的过敏反应所致的疾病。因其发生范围广,预测性差,且无特异性治疗方案,日益成为威胁人类健康的“隐形杀手”。本文针对药物性肝损伤的研究现状和存在问题进行探讨,以期加强临床医生在用药时的关注。     

某传染病医院11年问药物性肝损伤住院病例状况分析

目的探讨药物性肝损伤（drug-indUeedliverinjury,DILl）在非感染性肝病患者中的分布情况。方法回顾性研究某院2002年1月一2012年12月3848例DILI住院患者的资料,分析年度分布情况、患者性别、年龄及预后。结果DILl患者年住院数由88例（2002年）升至835例（2012年）,在非感染性肝病中的构成比由13．19％升至21．52％。10～49岁的患者随着年龄的增加,发生DILI的人数呈上升趋势;50～89岁的患者随着年龄的增加,发生DILI的人数呈下降趋势。〈10、10～19、20～29、30．39、40～49、50～59、60。69、70～79和≥80岁各年龄组DILl患者构成比分别为1．65％、5．11％、12．10％、19．08％、25．45％、20．62％、10．42％、4．58％和0．98％。各年龄组女性构成比分别为30．16％、44．90％、49．46％、55．10％、58．37％、64．28％、58．85％、52．00％和27．78％。药物性肝硬化患者构成比为7．7％,药物性肝衰竭为4．1％,药物性肝炎为88．2％。3848例中总无效死亡率为7．61％,2010年开始DILl无效死亡率呈下降趋势,2012年为2．87％。结论DILl正逐渐成为肝病中的常见病,30。59岁为DILl高发年龄．30～79岁的nTlll患者以奇件为丰。     

复方牛胎肝提取物治疗非酒精性脂肪性肝病的多中心临床研究

目的观察复方牛胎肝提取物片治疗非酒精性脂肪性肝病（NAFLD）的近期效果及其安全性。方法多中心、开放、非随机临床试验,在综合治疗的基础上,应用复方牛胎肝提取物片（3片/次,2次/日,口服,共3个月）治疗240例NAFLD,其中男195例,女45例,平均年龄为（42.2±11.3）岁,基础疾病为超重和/或中心性肥胖。结果有240例被纳入本研究,临床症状改善率85.9%（164/191）,其中以肝区不适感改善效果最为显著;ALT复常率62.5%（115/184）,从治疗前的（79.59±43.63）U/L下降至（43.99±14.83）U/L,P〈0.01,同时AST、GGT和TG、TC和LDL-C也明显下降,P〈0.01;而HDL-C以及空腹血糖、HOMA-IR无明显改变,P〉0.05。35.4%（85/240）的患者B超脂肪肝程度下降1个或1个以上等级;74例患者肝/脾CT值从治疗前的0.78±0.18升高到治疗后的0.93±0.16,P〈0.001。未进行饮食控制和增加运动的患者BMI、腰/臀围以及ALT、AST、GGT、TG、TC较治疗前均明显下降,P〈0.001,但饮食控制和增加运动的患者下降更快,P〈0.001。全组病例不良反应发生率为4.58%（11/240）,主要表现为消化道症状。结论复方牛胎肝提取物片对NAFLD有一定治疗效果,且不良反应轻微。     

Role of Kupffer cells in the outgrowth of colorectal cancer liver metastases

Colorectal cancer is one of the commonest malignancies in the "developed" world. The liver constitutes the main host organ for its distant metastases which, when present, augur a bad prognosis for the disease. Kupffer cells (KCs) are macrophages that constantly reside within the liver and form an effective first line defence against multiple harmful agents which reach the hepatic sinusoids via the portal circulation. KCs remove chemical compounds and dead or damaged cells, eliminate bacteria and protect against invading tumour cells. They may play a crucial tumouricidal role, exerting cytotoxic and cytostatic functions through the release of multiple cytokines and chemokines. Subsequently, colorectal metastasising cells are destroyed either by KC-performed phagocytosis or via the stimulation of other immune cells which migrate into the sinusoids and act accordingly. On the contrary, KC products, including cytokines, growth factors and matrix-degrading enzymes may promote liver metastasis, supporting tumour cell extravasation, motility and invasion. Current research aims to exploit the antineoplastic properties of KCs in new therapeutic approaches of colorectal cancer liver metastasis. Numerous agents, such as the granulocyte macrophage-colony stimulating factor, interferon gamma, muramyl peptide analogues and various antibody based treatments, have been tested in experimental models with promising results. Future trials may investigate their use in everyday clinical practice and compare their therapeutic value with current treatment of the disease.     

Laparoscopic resection of hepatic colorectal metastases

BackgroundLiver resection for secondary malignancy has become the standard of care in appropriately staged patients, offering 5-year survival rates of >40%. Reports of laparoscopic liver resection have been published with increasing frequency over the last few years. In these small series approximately one-third of all operations have been for malignancy, but survival figures cannot be assessed yet.MethodsA retrospective review of all laparoscopic liver resections performed by four surgeons in Brisbane between 1997 and 2004 was done. Follow-up was by regular patient review and telephone confirmation.ResultsOf 84 laparoscopic liver resections, 33 (39%) were for malignancy; 28 of these were for metastases (22 colorectal). Thirteen patients had left lateral sectionectomy with minimal morbidity; nine right hepatectomies were attempted and six cases of segmental or subsegmental resection were performed. Survival rates in 12 patients followed for 2 years with colorectal secondaries were 75% with 67% disease-free.DiscussionLaparoscopic liver resection is feasible in highly selected cases of malignant disease. Patients need to be appropriately staged and surgeons need a broad experience of open liver surgery and advanced laparoscopic procedures.     

Reappraisal of surgical treatment of small hepatocellular carcinomas in cirrhosis: Clinicopathological study of resection or transplantation

Thirty-two patients with hepatocellular carcinoma (HCC) occurring in individuals with cirrhosis had a potentially curative surgical procedure. Twenty-two had segmental hepatic resections (HR), and 10 underwent orthotopic liver transplantation (OLTx). The diagnosis of hepatic malignancy was established in each case preoperatively, and each case was studied intraoperatively by means of sonography. Postoperatively each surgical specimen was examined pathologically with attention to the possibility of intrahepatic tumor spread. Twenty-three of the 32 patients had single small HCC lesion (<5 cm diameter) identified preoperatively. Sixteen of these underwent HR and seven underwent OLTx. Multiple additional neoplastic lesions were found in 19% of the 16 HR cases and in 14% of those undergoing OLTx when the resection specimens were examined pathologically. Vascular invasion was present in 43% of the OLTx patients and in 25% of the HR patients. Subtotal hepatic resection for small HCC occurring in cirrhosis has produced few long-term survivals. Both pre- and intraoperative sonography have been shown to underestimate the extent and distribution of these tumors. Based upon this experience that (1) vascular spread occurs often in HCC and (2) a high risk of postoperative hepatic failure can be expected after HR in cirrhotic individuals, OLTx is the most rational surgical procedure for such cases as it has the potential to cure.