肝功能评估模型的演变及研究进展

肝硬化作为一种慢性进行性肝病,已严重威胁人类健康。近半个世纪以来,临床医生为准确地评价肝硬化患者的肝脏储备功能,建立了Child-Turcotte-Pugh（CTP）评分、终末期肝病模型（MELD）评分等评估模型,并不断创立其他相关评价指标。本文就肝功能评估模型的演变、研究现状等进行综述。     

乙型肝炎相关慢加急性肝衰竭的预后模型

乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)病死较高,早期准确评估其临床转归、采取有效的干预措施有助于延长患者生存时间。目前应用于HBV-ACLF预后的模型包括终末期肝病模型及其衍生评分,序贯器官衰竭评分及其衍生评分,亚太肝病学会慢加急性肝衰竭研究联盟评分,中国重型乙型肝炎研究组评分以及人工神经网络模型等,但对于HB...     

人工肝治疗慢性重型肝炎的MELD预后分析

目的 应用终末期肝病评分模型(MELD)评价人工肝治疗重型肝炎的临床疗效,观察它对重型肝炎预后的预测作用.方法 164例重型肝炎患者在内科综合治疗基础上联合人工肝治疗,分析治疗前后临床、生化指标及MELD分值,观察所有患者3个月内的临床转归.结果 (1)人工肝治疗明显改善临床症状.(2)人工肝治疗后可明显降低血清总胆红素(TBJIJ)和肌酐(Cr)数值,凝血酶原时问(PT)的国际标准化比率(INR)显著降低(P＜0.01).(3)除MELD评分≥40分组的预期病死率(100%)相同外,对评分＜40分者应用人工肝治疗可降低MELD平均分值和预期病死率(P＜0.01).结论 人工肝是治疗重型肝炎有效、安全的方法,对MELD＜40分者具有明显的改善预后作用.MELD评分对重型肝炎预后具有预测作用,临床值得推广应用.     

熊去氧胆酸的作用机制及在慢性肝病中的应用

熊去氧胆酸(UDCA)为亲水性胆汁酸,具有利胆、细胞保护、免疫调节等作用,是目前唯一被FDA批准用于胆汁淤积性肝病治疗的药物,临床上广泛用于治疗各种肝病.笔者就UDCA的作用机制及临床应用作一浅述.     

肾上腺糖皮质激素在肝病治疗中的应用现况

自1952年 Ducci 报道肾上腺糖皮质激素(以下简称皮质激素)对重型肝炎治疗有效以来,临床上一度较广泛地将其用于肝病治疗。以后,在与病毒相关的慢性活动性肝炎(CAH)治疗中各家学者持有不同的观点,因而皮质激素的应用受到限制。随着经验的积累,皮质激素在肝病应用的适应征渐趋明朗,本文仅就皮质激素在肝病临床应用的现况作一扼要介绍。     

终末期肝病模型在临床中的研究进展

目前原发性肝癌的治疗仍以手术切除为首选。手术后有可能出现肝功能不全甚至肝功能衰竭导致患者死亡。因此,术前正确评估肝脏的储备功能,对选择合理的治疗方法,把握合适的肝切除范围,减少术后肝衰竭的发生率具有重要意义。鉴于CTP分级存在诸多不足,美国学者建立了新的评价体系——终末期肝病模型(MELD)评分系统。本研究就MELD在临床中研究进展做一综述。     

60例肝病患者胆碱酯酶及前白蛋白测定结果分析

目的：探讨胆碱酯酶及前白蛋白测定对肝病患者的临床价值。方法：选取2013年6月至2014年6月我院收治的肝病患者和健康志愿者120例,随机分成两组,每组60例,对两组的胆碱酯酶及前白蛋白指标进行检测,观察两组测定效果。结果：观察组胆碱酯酶指标及前白蛋白指标明显高于对照组,P〈0．05,有统计学意义。结论：胆碱酯酶及前蛋白检测在肝病患者临床诊断中的应用价值是比较大的,安全有效,值得临床推广。     

脂肪性肝病

<正>脂肪性肝病是指脂肪(主要是TG)在肝脏过度沉积的临床病理综合征。随着生活水平的改善和生活方式的改变,脂肪性肝病的发病率不断升高,据报道其发病率高达10%,而且发病年龄日趋提前。目前我国脂肪性肝病已成为危害人类健康的仅次于病毒性肝炎的第二大肝病。临床上脂肪性肝病则有非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)和酒精     

生物电阻抗技术在肝病病人人体成分测量中的应用

该文介绍了生物电阻抗技术在肝病中应用的现状,重点介绍了多频节段电阻抗技术的应用.多频节段电阻抗技术可以克服因水肿、腹水而造成的体重对人体组成结果的影响,还可能判定腹水量.相比单频电阻抗技术,其在肝病病人中可能存在较好的应用前景,有助于客观地评价肝病病人的营养状况及能量代谢,但仍需临床进一步研究.     

胎儿肝细胞移植治疗各种肝病

近年来,国内外学者对各种肝病的治疗方法进行了广泛而深入地研究,取得了可喜的成就。本文就胎儿肝细胞(以下简称FLC)移植治疗各种肝病的现状及展望作简要综述。 FLC移植治疗各种肝病的理论基础由于FLC中肝细胞和造血细胞约各占半数,且胎儿肝脏来源较广,因而可以应用FLC对肝脏功能起代偿性支持作用。根据近年临床应用和实验研究,FLC治疗各种肝病的机理可总结为:     

广西某纺织企业女工生殖道感染状况及影响因素分析

目的 了解广西纺织企业女工生殖道感染(RTIs)现状,分析影响女工RTIs的危害因素,为制定健康保护和劳动防护策略提供依据.方法 采用横断面调查,通过整群抽样法选取广西某纺织企业女工进行问卷调查,采用x2检验和非条件二分类多因素Logistic回归分析影响女工RTIs的危害因素.结果 在592名纺织女工中,有156人(...     

HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality

Background  

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer, but little is known about the burden of disease caused by the virus. We summarised burden of disease data presently available for Europe, compared the data to current expert estimates, and identified areas in which better data are needed.     

Diagnoses of, and deaths from, severe liver disease due to hepatitis C in England between 2000 and 2005 estimated using multiple data sources

Matching individuals reported to a sentinel surveillance scheme for hepatitis C between 2000 and 2005 to individuals with a hospital episode for hepatitis C-related liver disease in the same hospitals, we estimated that the number of cases of hepatitis C-related end-stage liver disease in these English hospitals was 42% (597/419) higher than Hospital Episode Statistics (HES) would indicate. Further, matching records of hepatitis C-related deaths in HES to death certificates, we estimated that, between 2000 and 2005, the true number of deaths from hepatitis C-related end-stage liver disease was between 185% (353/124) and 257% (378/106) higher than the number recorded in routine mortality statistics. We provide estimates of under-recording that can be used to modify existing models of disease burden due to hepatitis C and provide a simple approach to improve the monitoring of trends in severe hepatitis C-related morbidity over time.     

终末期肝病患者肝移植前后的能量代谢特点

目的探讨乙肝病毒感染终末期肝病患者肝移植前后能量代谢及碳水化合物、蛋白质、脂肪氧化供能的特点。方法采用间接测热法应用CCM/D营养代谢测试系统测定10例终末期肝病患者肝移植术前1周及术后4～6月内的静息能量消耗(REE)、晨起空腹呼吸商(RQ)及三大营养物质的氧化率,并比较肝移植前后的差别。结果10例终末期肝病患者术前REE为(5983.5±2238.4)kJ/24h,夜间禁食晨起空腹时RQ为0.84±0.05,碳水化合物、蛋白质、脂肪氧化率依次为(38.20±20.05)%、(24.40±22.53)%、(37.30±24.94)%。肝移植术后,REE为(5084.3±1266.6)kJ/24h,与术前比较差异无显著性(P=0.105),晨起空腹RQ(0.93±0.11)、碳水化合物氧化率[(66.60±35.48)%]和蛋白质氧化率[(66.60±35.48)%]均较术前升高,但差异无显著性(P>0.05);脂肪氧化率显著降低至(2.20±47.70)%(P=0.049)。结论终末期肝病患者处于低代谢状态,对糖类利用存在障碍,只能通过加强脂肪动员供能。随着新肝植入及肝功能恢复,患者体内对糖类利用增加,脂肪...     

Trends in the incidence of treated end-stage kidney disease among Indigenous Australians and access to treatment

OBJECTIVE: To determine temporal trends of incidence of treated end-stage kidney disease in Indigenous Australians and the extent to which these patients had to move from their home community to access renal replacement therapy. METHODS: Data for 1993-2001, regarding place of residence before starting renal replacement therapy, were analysed to give accurate incidence for 1,194 Indigenous treated end-stage kidney disease patients. We calculated indirectly standardised incidence ratios of treated end-stage kidney disease by State and Territory. We surveyed treating renal units about which Indigenous patients relocated to access therapy from 1999 to 2001. RESULTS: The incidence of treated end-stage kidney disease among Indigenous Australians is high and rising; however, the rate of increase is lower than has been previously reported. The Northern Territory (NT) and Queensland have the most new Indigenous treated end-stage kidney disease cases. The highest standardised incidence ratio was in the NT (17.0), followed by Western Australia (WA) (11.9). From 1999 to 2001, half of the 476 Indigenous patients starting therapy had to relocate to access treatment. CONCLUSIONS: The incidence of end-stage kidney disease among Indigenous Australians continues to rise. However, significant gaps in knowledge remain about the burden of early chronic kidney disease and whether many Indigenous patients with end-stage kidney disease still choose not to receive renal replacement therapy. The need to relocate to access treatment has a strong negative impact on individuals, families and entire communities.     

Liver transplantation

Liver transplantation has evolved from an experimental procedure to an acceptable therapy for end-stage liver disease. The major challenges now faced are donor organ shortage, long-term complications related to immunosuppressive therapy, and the prevention and treatment of disease recurrence.     

Protective effect of whey proteins against nonalcoholic fatty liver in rats

Background  

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and can vary from hepatic steatosis to end-stage liver disease. It is the most common liver disease and its prevalence is increasing worldwide. In the present study, the effect of whey proteins on some parameters of NAFLD was investigated.     

The pervading influence of alcoholic liver disease in hepatology

Rising levels of alcohol consumption in the UK are leading to substantial increases in morbidity and mortality from liver disease. Drinking is starting at an earlier age with binging an increasing common pattern, and women are overtaking men in the consumption. Manifestations of liver damage range from fatty liver to end-stage cirrhosis, but it is the increasing number of cases presenting with an acute alcoholic hepatitis (AAH) that are the cause for greatest concern. Development of well-validated prognostic scoring systems (Maddrey Modified Discriminant Function, Glasgow Alcohol Score) makes it possible to select those patients with AAH who are most likely to respond to corticosteroids. The results of early pilot studies of a number of anti-TNF agents are encouraging and with infliximab, reduction in portal pressure has been demonstrated to be consequent on controlling inflammatory processes in the liver. For those deteriorating to the stage of liver failure, artificial liver support with MARS is of value in correcting major pathophysiological disturbances and as a bridge to liver transplantation, the results of which both for end-stage alcoholic cirrhosis and for AAH--of which there is limited experience, are excellent. Even as the stringent regulatory measures needed to control rising alcohol consumption are introduced by government, the burden of liver disease in the UK will remain high for years to come.     

Orthotopic liver transplantation in children

Between 1-1-1982 and 1-1-1988 52 children with an end-stage liver disease were evaluated to determine whether orthotopic liver transplantation (OLT) would be appropriate. 24 children were accepted as candidates in the long term. Twelve were not accepted as potential recipients. The parents of 3 decided not to accept OLT as treatment for their children. Two children died before a suitable donor liver was available, so that OLT was carried out in 11 children. Two of these children needed a second transplant. In 3 children only a part of a donor liver was transplanted. Shortage of donor livers of small size is partly alleviated by using a part of a larger liver. The underlying diseases of the transplanted children were cryptogenic cirrhosis (1x), biliary atresia with a hepatoportoenterostomy (8x) and cirrhosis following neonatal hepatitis (2x). Ten children with OLT are clinically and physically well. Postoperatively a primary graft dysfunction occurred in one child. He was retransplanted. The median waiting time for a donor liver was 5 months. The timing for OLT has to take this in account. In treating children with end-stage liver disease (partial) OLT should be considered.