肝泡状棘球蚴病

肝泡状棘球蚴病 (Ａｌｖｅｏｌａｒｅｃｈｉｎｏｃｏｃｃｏｓｉｓ ,Ａ ｅ .)是一种对人体危害极大的人畜共患的寄生虫病 ,由多房棘球绦虫的幼虫寄生于肝脏并不断增殖芽生 ,似癌样浸润扩散 ,造成肝组织不可逆的进行性损害。临床上具有慢性隐袭进行性的特点 ,常伴有肺及脑等重要器官转移。由于Ａ ｅ .具有一定的地区分布性 ,易于引起误诊 ,因此复习有关文献 ,提高Ａ ｅ .的全面认识 ,对临床诊治工作必将有所裨益。1　流行病学[1- 5]泡球蚴病主要流行于北半球高纬度地带。我国主要在西北地区流行。　　多房棘球绦虫的主要终宿主是狐及狼等野生…     

抗骨桥蛋白抗体对沙鼠肝泡球蚴组织细胞因子表达的影响

目的观察抗骨桥蛋白（OPN）抗体对沙鼠肝泡状棘球蚴组织中细胞因子表达的影响,并探讨其免疫机制。方法选长爪沙鼠30只,采用开腹直视下肝脏穿刺接种泡状棘球蚴组织混悬液的方法建立模型后,随机分为实验组（抗OPN抗体干预,10只）、对照组（兔血清干预,10只）和模型组（无干预,10只）。于100d后剖杀所有沙鼠,取肝泡状棘球蚴组织,采用苏木精-伊红（HE）染色法和免疫组织化学SP法观察沙鼠肝泡状棘球蚴组织中IL-2,IL-5,IL-10及TNF-α因子的表达情况。结果感染泡状棘球蚴的沙鼠肝脏和腹腔中见大小不等的团块状囊泡。IL-2,IL-5及TNF-α在实验组、对照组与模型组间免疫组化染色阳性细胞率比较差异无统计学意义（P〉0.05）,而实验组IL-10的阳性细胞率明显低于对照组与模型组（P〈0.05）。结论 Th1细胞介导的细胞免疫与Th2细胞介导的体液免疫共同参与了宿主抗肝泡状棘球蚴免疫。抗OPN抗体可使IL-10的表达减低。     

肝泡球蚴病（泡型包虫病）

人体肝包虫病(棘球蚴病)有囊型和泡型,囊型包虫病(CE)由细粒棘球绦虫的幼虫致病,通称包虫囊肿。泡型包虫病(AE)简称泡球蚴病,由多房棘球绦虫的幼虫所致。这二型包虫病无论是生物学、流行病学、病理学、临床学、治疗和预后等方面,均有差异。目前对 AE 的认识仍然不足,误诊者屡见不鲜。为此,特作扼要介绍。     

肝泡状棘球蚴病的超声及病理表现

目的: 分析肝泡状棘球蚴病患者的临床、病理及超声图像特征.方法: 回顾性分析2002-2007年我院经手术病理证实的肝泡状棘球蚴病患者15例的超声图像特征并分型.结果: 15例肝泡状棘球蚴病单发12例,多发3例,共发现肿块20个;超声特征:多位于左肝,大小多为5 cm以上,形态多不规则,边界多清晰,内部回声多呈高回声、不均匀、无液化、无钙化,后方回声多衰减,无声晕、无内部血流多见,未见肝门及腹腔淋巴结肿大;根据声像图特征分为:实性肿块型(13个,65%)、肿块液化型(7个,35%)、肿块钙化型(8个,40%).结论: 超声检查肝泡球蚴病超声影像具有特征性,是肝泡球蚴病重要的影像学检查方法.     

抗骨桥蛋白抗体抑制肝泡型棘球蚴侵袭性生长和转移

目的外源性给予抗骨桥蛋白(osteopontin,OPN)抗体,观察其对肝泡型棘球蚴生长和转移的抑制作用。方法采用开腹直视下肝脏穿刺接种泡型棘球蚴组织混悬液的方法(0.1 ml/只,约含原头节400个),建立肝泡型棘球蚴沙鼠模型180只,随机分为3组。实验组和对照组于接种后当天经尾静脉分别注射0.15 ml抗OPN抗体(效价1∶32)和沙鼠注射用的兔血清,共注射17次,前7次每次间隔2 d,后10次每次间隔1周。模型组未作处理。上述3组沙鼠分别于感染后1、20、40、60、80和100 d随机各处死10只沙鼠,观察泡型棘球蚴的生长和转移情况,采用免疫组织化学SP法观察各组沙鼠肝泡型棘球蚴组织中OPN的表达情况。于感染后100 d乙醚轻度麻醉沙鼠后,摘眼球取血,分离血清,用ELISA测定沙鼠血清中OPN的含量。结果感染后1、20、40、60和80 d,实验组与对照组和模型组囊湿重、胸腔淋巴结转移率间的差异均无统计学意义(P>0.05)。感染后100 d,实验组囊湿重、胸腔淋巴结转移率[(7.28±0.38)g、20%]均低于对照组[(9.70±0.61)g、70%]和模型组[(9.32±0.73)g、70%](...     

肝泡状棘球蚴病治疗方法的研究进展

肝泡状棘球蚴病（hepatic alveolar echinococcosis, HAE）是由多房棘球绦虫感染所致的一种寄生虫病,其发病率远低于细粒棘球蚴病,但泡状棘球蚴如同肿瘤呈浸润性、外生性生长,常向远处器官转移,所以有“虫癌”之称。患者就诊时,往往进入晚期阶段,手术切除机会少,对病人的健康危害严重。我国该病主要分布在西部牧区,甘肃、青海、宁夏、新疆、四川西部,与放牧时接触牧羊犬有关。仅新疆每年因患包虫病而接受手术者达2000人次以上,已成为农牧民“因病致贫,因病返贫”的主要原因,严重地危害人类健康。     

骨桥蛋白在肝细粒棘球蚴外囊壁中的表达

目的 研究骨桥蛋白（osteopontin，OPN）在肝细粒棘球蚴外囊壁中的分布及表达。 方法 用免疫组化、免疫荧光双标记法观察60例患者手术切除的肝细粒棘球蚴外囊壁及巨噬细胞中OPN的表达与分布；Von Kossa染色观察囊壁中钙化分布特征。 结果 肝细粒棘球蚴外囊壁中有不同程度OPN表达，75%（45/60）集中分布于近虫体侧纤维囊壁（内层），.3%（5/60）分布于近肝组织侧纤维性囊壁（外层），两者差异有统计学意义（P＜0.01）。在内、外层交界处可见巨噬细胞带，多数巨噬细胞胞浆内有OPN表达。OPN表达阳性的囊壁均合并有不同程度的钙盐沉积，其在囊壁内、外层的分布与OPN的基本一致。 结论 OPN主要分布在肝细粒棘球蚴外囊的内层纤维囊壁。     

不同培养基及不同温度对体外培养泡球蚴原头节的影响

目的观察不同温度下不同培养基对体外培养泡球蚴原头节的影响,探讨泡球蚴原头节体外培养合适条件。方法按照培养基的不同,随机分为3组:Ⅰ组为含10%胎牛血清的RPMI-1640(4℃、25℃、37℃);Ⅱ组为含10%胎牛血清的D-MEM(4℃、25℃、37℃);Ⅲ组为含10%胎牛血清的M199(4℃、25℃、37℃)。观察各组泡球蚴原头节存活、生长情况,并记录原头节存活率及最长生存时间。结果 RPMI-1640培养基、D-MEM培养基与M199培养基中泡球蚴原头节的存活率有统计学差异(P0.05),RPMI-1640培养基与D-MEM培养基中泡球蚴原头节的存活率无统计学差异(P0.05);4℃、25℃与37℃泡球蚴原头节的存活率无统计学差异(P0.05),但RPMI-1640培养基在4℃及37℃,D-MEM培养基在25℃泡球蚴原头节存活率较高;各组在第3d和第9d泡球蚴原头节存活率有统计学差异(P0.05)。4℃各组原头节存活时间明显高于25℃组和37℃组。结论不同温度及不同培养基对体外培养泡球蚴原头节的存活的影响不同,RPMI-1640在4℃下培养,D-MEM在25℃培养,原头节成活率较高,存活时间较长,M199培养基不适合泡球蚴原头节的体外培养。     

1例脑泡状棘球蚴病的诊疗分析

包虫病是人体感染棘球绦虫的幼虫棘球蚴而引起的一种慢性肝、肺、心、肾等部位的寄生虫病，颅内少见，约占全身包虫病的1％左右。脑包虫病分为细粒棘球蚴病和泡状棘球蚴病两类，前者多为原发性，常见于儿童，又称包虫囊肿，后者多为继发性，多见于成人，犹如恶性肿瘤对组织破坏严重，     

70例肝泡球蚴病临床病理分析及其预后因素

本组７０例，地区分布以甘肃省为最多（８２．８％）、尤以漳县多见（６５．６％）。女稍多于男，年龄以青壮年为多（９２．８％）。症状以肝肿块为主（５６．４％），腹痛次之（２８．２％）。影像检查和免疫试验均有助于诊断。镜下观察肝泡球蚴囊泡壁生发膜的增殖芽由数个细胞核构成，可显示为外殖性或内殖性芽生，按泡球蚴增殖与否而分为衰退性Ⅰ级和增殖性Ⅱ级病理，３４例手术探查无１例切除，有８例和１例分别作泡球蚴坏死性假     

Radiological findings of alveolar hydatid disease of the lung caused by Echinococcus multilocularis

Alveolar hydatid disease is a highly malignant form of echinococcosis caused by the larvae of the cestode Echinococcus multilocularis. Alveolar hydatid disease always affects the liver and can metastasise to the lungs and brain. The case reports describe the radiological features of alveolar hydatid disease of the lung caused by E. multilocularis. Multiple nodules which varied in size and shape were seen on CXR, CT showed most nodules to be lobulated, well circumscribed and of varying shape. Multiple lobulated lesions located between two segments of the lung and of varying shape appear to be characteristic of pulmonary alveolar hydatid disease caused by E. multilocularis.     

Components of the mitogen-activated protein kinase cascade are activated in hepatic cells by Echinococcus multilocularis metacestode

AIM： To explore the effect of Echinococcusmultilocularis on the activation of mitogen-activated protein kinase （MAPK） signaling pathways and on livercell proliferation.METHODS： Changes in the phosphorylation of MAPKs and proliferating cell nuclear antigen （PCNA）expression were measured in the liver of patients withalveolar echinococcosis （AE）. MAPKs, MEK1/2 [MAPK/extracellular signal-regulated protein kinase （ERK）kinase] and ribosomal S6 kinase （RSK） phosphorylationwere detected in primary cultures of rat hepatocytesin contact in vitro with （1） E. multilocu/aris vesicle fluid（EmF）, （2）E. multilocularis-conditioned medium （EmCM）.RESULTS： In the liver of AE patients, ERK 1/2 andp38 MAPK were activated and PCNA expression wasincreased, especially in the vicinity of the metacestode.Upon exposure to EmF, p38, c-Jun N-terminal kinase（JNK） and ERK1/2 were also activated in hepatocytesin vitro, as well as MEK1/2 and RSK, in the absenceof any toxic effect. Upon exposure to EmCM, only JNKwas up-regulated.CONCLUSION： Previous studies have demonstratedan influence of the host on the MAPK cascade inE. multilocularis. Our data suggest that the reverse,i.e. parasite-derived signals efficiently acting onMAPK signaling pathways in host liver ceils, is actuallyoperating.     

早期皮下寄生多房棘球蚴的蛋白组学分析

目的 了解皮下寄生多房棘球蚴的蛋白质组特征。方法 每只BALB/c小鼠皮下多点注射约600只原头蚴,一月后分离皮下寄生的包囊,制备组织切片,HE染色,糖原染色,利用显微镜观察虫体形态,同时提取蛋白质并进行测序、GO基因功能分析和COG分析,最后利用Western blotting对部分蛋白质进行验证。结果 皮下寄生的多房棘球蚴呈半透明状,如绿豆大小,包囊内含有囊液。在光学显微镜下,可见包囊中含有子囊,囊中仅有少数原头蚴,且一些原头蚴头节上还带有小钩;囊壁糖原染色阳性,呈粉红色。测序共鉴定203种蛋白质,其中多种蛋白酶的表达水平很高,如磷酸烯醇丙酮酸羧激酶、柠檬酸合酶等。在功能上,所鉴定的蛋白质主要富集在翻译后修饰、蛋白质转换和伴侣分子信号通路、能量合成与转换以及碳水化合物运输与代谢方面,而参与免疫应答、脂质运输与代谢等方面的蛋白质则较少。在丰度较高的前20种蛋白质中,多数为参与糖代谢过程的蛋白质。Western blotting结果显示,VCP、Enolase、14-3-3和β-actin在包囊蛋白中均有不同程度地表达,而GST不表达或表达水平非常低,这与测序结果基本一致。结论 研究结果表明,皮下寄生的多房棘球蚴在糖代谢和脂质代谢方面可能发生了明显地改变,这为探索包囊不育的机理提供了有价值的线索。     

新疆北部多房棘球绦虫动物宿主研究初报

本文报告在新疆北部泡型包虫病流行地区的农村牧区以及山地和草原地带进行多房棘球绦虫终宿主和中间宿主调查的结果。采用槟榔碱导泻法检查 30 5只家 (牧 )犬 ,在 5 2只犬中检出棘球绦虫成虫 ,感染率为 17%。对所获 13974条虫体进行鉴定的结果 ,皆为细粒棘球绦虫。表明在新疆北部泡型包虫病流行地区 ,家犬不是多房棘球绦虫的终宿主。检查啮齿目动物 31种 5 16 3只 ,食虫目动物 4种 2 6 1只和兔形目动物 2种 196只。在西部天山地区捕获的伊犁田鼠和塔尔巴哈台山地区捕获的水鼠平中发现多房棘球蚴感染 ,表明这两种鼠类是当地多房棘球绦虫的中间宿主。属于国内新记录。     

泡球蚴组织的体外培养及在药物筛选中的应用

目的 建立泡球蚴组织的体外培养模型，对4种药物的体外抗泡球蚴疗效进行初步筛选。方法 泡球蚴组织体外培养9周后，分为7组：阿苯达唑组、汉防己甲素组、己酮可可碱组、苦豆碱组、氧氟沙星组、未用药组和二甲基亚砜组。在加药24h和18d后，分别取样固定并在电子显微镜下观察超微结构。实验期间对囊泡计数。实验结束后，将培养物接种BALB／c小鼠进行活力测试。结果 汉防己甲素和己酮可可碱在体外能抑制泡球蚴的生长（P〈0．005），氧氟沙星对泡球蚴没有作用（P〉0．005），苦豆碱能促进泡球蚴生长。接种各药物组培养物的BALB／c小鼠饲养80d后处死并解剖，发现所有小鼠的腹腔中均有泡球蚴生长。结论 汉防己甲素和己酮可可碱在体外对泡球蚴有一定的抑制作用，氧氟沙星和苦豆碱对寄生虫无治疗作用。活力测试提示所选药物只能抑制寄生虫生长而无杀灭作用。     

Expression of vascular endothelial growth factor in surgical specimens of hepatocellular carcinoma

Purpose: Vascular endothelial growth factor (VEGF) has been reported to play an important role in angiogenesis in hepatocellular carcinoma (HCC). However, there is great variation in reports on the distribution of VEGF expression, especially in non-carcinoma liver cells. Furthermore, some reports have mentioned that endothelial cells were positive for VEGF antibody but have not evaluated its significance. In this study, we focused our attention to these problems and try to solve them. We also analyzed the factors influencing VEGF expression and evaluated the prognostic potential of VEGF protein in HCC. Methods: We examined the VEGF expression in specimens surgically removed from 46 HCC patients and 3 patients with liver cancer metastatic from the colon, and in 4 specimens of liver tissue with benign disease, by immunohistochemical methods. Results/conclusions: VEGF was expressed in HCC cells and hepatocytes and on vascular endothelial cells. Our finding that about seven times more endothelial cells were positive for VEGF antibody in carcinoma areas than in non-carcinoma areas (P < 0.001) suggests that VEGF is a very important angiogenesis factor for HCC growth. VEGF expression in HCC cells and non-carcinoma liver cells and on endothelial cells did not closely correlate with the disease recurrence rate (P > 0.05), suggesting that VEGF expression may not be useful as an individual factor for estimating the prognosis of HCC. A statistical analysis of the relationships between VEGF expression and clinicopathological variables revealed the following: preoperative transcatheter arterial embolization enhanced VEGF expression in both HCC cells and non-carcinoma liver cells. The histological grade of HCC and the level of alanine aminotransferase was related to VEGF expression in non-carcinoma liver cells and on endothelial cells in HCC areas. Tumor size and the histological status of the accompanying chronic hepatitis also influenced the VEGF expression on endothelial cells. Our findings concerning not only HCC but also the surrounding liver and endothelial cells may provide useful information for further research on the role of VEGF expression in HCC patients. Received: 29 July 1999 / Accepted: 11 October 1999     

Decreased salivary vascular endothelial growth factor in elderly patients with pneumonia during the course of recovery

Background: Elderly individuals are known for their high risk of acquiring pneumonia. Poor oral hygiene and high incidence of gastro‐oesophageal reflux continue to cause persistent oropharyngeal mucosal injuries and results in overgrowth of bacterial population and alteration of bacterial flora to respiratory pathogens in the oropharyngeal cavity. Salivary secretion contributes in maintaining homeostasis of the oropharyngeal mucosal barrier. Vascular endothelial growth factor (VEGF) acts as an angiogenic and permeability‐enhancing cytokine but is normally secreted in saliva. It has been previously demonstrated that VEGF secreted in the airway functions in the restoration or repair of the injured tissue. We hypothesized that salivary VEGF is a candidate as a marker to evaluate the degree of oropharyngeal mucosal injury. Methods: We compared the volumes, protein contents, and the amount of VEGF secreted in the saliva of patients with pneumonia during the course of recovery (P; n = 7) and those without pneumonia (n = 10). Results: Volumes and protein contents within the secreted saliva were similar between the patients with P and the control subjects (0.60 ± 0.28 mL versus 0.41 ± 0.34 mL, P = 0.126, 7.12 ± 5.57 µg/mL versus 3.92 ± 3.58 µg/mL, P = 0.231, respectively). The concentrations of salivary VEGF were significantly lower in patients with P than those of the controls (0.71 ± 0.37 versus 2.66 ± 3.44 µg/µg protein, P = 0.032). Conclusion: Lower concentrations of salivary VEGF in patients with pneumonia during the course of recovery suggested the presence of persistent oropharyngeal mucosal injury even after normalization of systemic C‐reactive protein levels. The concentration of salivary VEGF is capable of being a marker for discriminating impaired oral mucosal barrier that precipitates in development of pneumonia in elderly individuals.     

Antibodies against Echinococcus multilocularis alkaline phosphatase as markers for the specific diagnosis and the serological monitoring of Alveolar echinococcosis

The immunological properties of the purified alkaline phosphatase (pAP) of Echinococcus multilocularis metacestodes have been investigated using alveolar echinococcosis (AE) patient sera in ELISA tests. A comparative study was done with EmC-Ag (crude antigen) and pAP-Ag (purified antigen). When the parasite purified enzyme pAP was used as antigen, the specificity of the ELISA was markedly increased since it reached 100% without any decrease of its sensitivity (100%). The serologic follow-up of AE patients was conducted during several months with these two antigens in three categories of patients: cured, stabilized and aggravated. There was a good correlation between clinical and serologic data when the pAP was used as antigen in ELISA tests. The anti-pAP antibodies titres did change more rapidly than anti-EmC antibodies titres when a recurrence occurred. Modifications of the anti-pAP antibodies levels were also observed during the patient's therapy: mebendazole, albendazole and Isoprinosine^®. These results suggest that pAP-Ag should be used for the diagnosis and the follow-up of AE patients.