病毒性肝炎患者血清视黄醇结合蛋白检测的临床意义

为了解血清视黄醇结合蛋白(RBP)在各型病毒性肝炎中的变化,探讨测定血清RBP对病毒性肝炎患者的诊断价值。分别检测161例不同类型的肝炎患者及正常对照组的血清RBP、前白蛋白(PA)、白蛋白(ALB)水平,并进行统计分析。发现除慢性肝炎轻度组外,各组肝病患者血清RBP、PA均显著低于对照组(P<0.05);且异常率均高于同组PA、ALB的异常率(P<0.05)。重型肝炎组死亡者RPB、PA均显著低于存活者,死亡者与存活者之间的RBP有极显著性差异(P<0.01)。提示血清RBP可作为判断急性肝损害的灵敏指标。能更准确地反映肝脏贮备功能,对估计重型肝炎、肝炎后肝硬化的预后有重要的参考价值。     

异甘草酸镁注射液联合序贯血液净化疗法对急性肝衰竭患者Alb、PTA水平的影响

目的探究甘草酸镁注射液联合序贯血液净化疗法对急性肝衰竭患者清蛋白(Alb)及凝血酶原活动度(PTA)水平的影响。方法选取2015年5月至2017年11月我院62例急性肝衰竭患者,依据随机数表法将患者分为观察组与对照组,各31例。对照组予以异甘草酸镁注射液治疗,观察组于异甘草酸镁注射液治疗基础上予以序贯血液净化疗法治疗。对比两组治疗效果、不良反应发生情况及治疗前、疗程结束后谷草转氨酶(AST)、总胆红素(TBil)、谷丙转氨酶(ALT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、Alb及PTA水平的变化。结果观察组总有效率为83.87%,显著高于对照组的61.29%(P 0.05)。两组疗程结束后AST、ALT、TBil水平均较治疗前有所降低(P 0.05),且观察组更为显著(P 0.05);两组疗程结束后PTA、Alb水平均较治疗前有所升高(P 0.05),且观察组升高更为显著(P 0.05);两组疗程结束后IL-6、TNF-α水平均较治疗前有所降低(P 0.05),且观察组降低更为显著(P 0.05)。观察组不良反应率为22.58%,与对照组的12.90%相比,差异无统计学意义(P 0.05)。结论异甘草酸镁注射液联合序贯血液净化疗法治疗急性肝衰竭患者,可显著改善患者肝功能及凝血功能,明显降低血清IL-6、TNF-α水平,效果更为显著,且安全性较高,值得临床推广应用。     

索拉非尼联合TACE治疗进展期原发性肝癌的临床研究

目的探究分析索拉非尼(Sorafenib)联合肝动脉栓塞化疗(TACE)治疗进展期原发性肝癌的临床疗效及并发症。方法选取2011年1月至2014年6月期间我院收治的进展期原发性肝癌患者86例作为临床研究对象,按照患者入院顺序将其分为联合治疗试验组和单纯治疗对照组,每组各43例,对照组采用单纯TACE治疗,试验组在其基础上术后加用索拉非尼治疗,比较两组患者治疗前与满疗程治疗后半年甲胎蛋白(AFP)、白蛋白(Alb)、总胆红素(TBil)、ALT及AST等肝功能指标变化情况,对比两组患者半年随访期内并发症发生情况,同时记录和观察两组患者术后2年生存率及死亡率情况。结果两组患者接受治疗前,组间AFP、AST、TBil、ALT及Alb水平均差异无统计学意义(t=1.32、1.35、1.73、2.01、1.77,P均0.05),行不同治疗后,两组患者AFP指标水平均明显降低,TBil、ALT、AST及Alb水平明显升高,且试验组患者AFP、AST、TBil、ALT及Alb水平均明显低于对照组(P均0.05)。半年随访期内,试验组患者出现皮肤反应、胃肠反应、、肝区疼痛、骨髓移植、高胆红素血症以及其他并发症的几率均明显低于对照组(P均0.05),组间差异具有显著统计学意义。试验组患者术后1年、2年生存率及中位生存期均明显高于对照组患者(P均0.05),其术后1年死亡率和2年死亡率也较对照组明显偏低(P均0.05),组间差异具有统计学意义。结论 TACE治疗进展期原发性肝癌具有一定的临床疗效,在此基础上联合使用索拉非尼可有效抑制肝癌的进展,同时明显改善患者肝功能和术后生活质量,安全窗广。     

血清视黄醇结合蛋白 前白蛋白 总胆汁酸 胆碱酯酶检测在肝脏疾病中的临床意义

目的：探讨视黄醇结合蛋白（RBP）、前白蛋白（PA）、总胆汁酸（TBA）、胆碱酯酶（CHE）在不同类型肝脏疾病中的临床价值。方法应用全自动生化分析仪分别检测110例不同类型肝脏疾病患者RBP、PA、TBA、CHE、丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）水平,观察不同肝病组各项指标的变化,并与68名健康体检者（健康对照组）进行对比分析。结果重症肝炎组、肝硬化组及肝癌组中RBP、PA浓度显著低于健康对照组（ P＜0.01）;五组肝病患者TBA水平显著高于健康对照组（ P＜0.01）;重症肝炎组、肝硬化组及肝癌组中的CHE活力显著低于健康对照组（ P＜0.01）;急性病毒性肝炎组、重症肝炎组ALT、AST活力显著高于健康对照组（ P＜0.01）。结论检测血清RBP、PA、TBA、CHE对肝脏疾病的诊断、治疗和判断预后有一定的临床意义,在反映肝脏实质性病变程度方面优于ALT、AST。 ALT、AST检测同时联合RBP、PA、TBA、CHE检测能更好地反映肝脏功能。     

血清甘氨酰脯氨酸二肽氨基肽酶对慢性肝病诊断的价值

观察血清甘氨酰脯氨酸二肽氨基肽酶 (GPDA)在慢性肝病中的变化 ,评价临床诊断价值。采用连续监测法测定 131例各类慢性肝病患者和 10 3名正常人血清GPDA活性 ,同步检测血清丙氨酸氨基转移酶 (ALT) ,进行比较分析。慢性肝炎轻度、中度、重度患者及原发性肝癌患者血清GPDA活性均高于正常对照组 ,差异有显著性意义(P均 <0 0 0 1) ,肝癌患者升高尤为显著 ;肝硬化代偿期和失代偿期患者GPDA水平与对照组无显著差异 (P >0 0 5 ) ;而ALT在慢性肝炎和肝硬化患者组均明显高于对照组 ,差异有非常显著性意义 (P均 <0 0 0 1) ,ALT升高的例数与倍数明显高于GPDA。血清GPDA对慢性肝炎的诊断及病情估计有一定的意义 ,但敏感性不如ALT。GPDA对肝硬化的诊断价值不大 ,但GPDA异常升高有助于肝癌的诊断     

葛根素联合复方甘草酸单铵S治疗酒精性肝炎的疗效探讨

目的探讨葛根素联合复方甘草酸单铵S治疗酒精性肝炎的临床疗效。方法选取2011年2月-2014年2月解放军97医院收治的92例酒精性肝炎患者,随机分为联合组和对照组各46例。对照组在常规治疗方案的基础上,加用复方甘草酸单铵S治疗;联合组在对照组治疗方案的基础上,加用葛根素联合治疗。两组患者治疗20 d,对比其治疗前后的TBil、ALT、AST、GGT、白蛋白(Alb)水平、Glasgow酒精性肝炎(GAHS)评分及腹部超声,同时对比两组患者的临床疗效和不良反应。计量资料组间比较采用t检验,计数资料组间比较采用卡方检验。结果治疗后两组患者的GAHS评分、TBil、ALT、AST和GGT均显著低于治疗前,差异均有统计学意义(P值均0.05);联合组治疗后的TBil水平为(20.96±6.85)μmol/L,ALT水平为(33.72±14.18)U/L,AST水平为(38.69±6.38)U/L,均显著低于对照组,差异均有统计学意义(P值均0.05);联合组治疗后的显效率为63.04%,总有效率为93.48%,腹部超声的改善率44.44%,均显著高于对照组,差异均有统计学意义(P值均0.05);两组患者不良反应的对比,差异无统计学意义(P0.05)。结论葛根素联合复方甘草酸单铵S可提高酒精性肝炎的临床疗效,保护患者的肝功能,且安全性较好,值得推广应用。     

N-乙酰半胱氨酸对TACE肝癌患者凝血酶原、胆红素和谷丙转氨酶的影响

目的观察N-乙酰半胱氨酸(NAC)对肝动脉化疗栓塞术(TACE)肝癌患者脱γ-羧基凝血酶原(DCP)、总胆红素(TBil)和谷丙转氨酶(ALT)的影响。方法纳入2016年1月至2018年1月于我院收治的60例TACE肝癌患者为研究对象,按照抽签随机方法分为两组,各30例,其中对照组予以常规护肝治疗,观察组在此基础上予以NAC治疗。对比两组治疗前后DCP及氧化应激指标丙二醛(MDA)、超氧化物歧化酶(SOD)水平,并分析治疗前后TBil、ALT及谷草转氨酶(AST)、清蛋白(ALB)水平。结果观察组治疗后DCP、MDA水平显著低于治疗前及对照组治疗后(P0.05),SOD水平显著高于治疗前及对照组治疗后(P0.05)。观察组治疗后TBil、ALT、AST水平较术前均无统计学意义(P0.05),但均显著低于对照组治疗后(P0.05);观察组治疗后ALB水平较治疗前及对照组治疗后均无统计学意义(P0.05)。结论 NAC能减轻TACE肝癌患者脂质过氧化反应,改善肝功能。     

抗病毒治疗对失代偿肝硬化患者生存时间及肝癌发生的影响

目的探究抗病毒治疗对失代偿肝硬化患者生存时间及肝癌发生的影响。方法随机选取我院在2012年10月至2015年10月期间收治的300例失代偿肝硬化患者为研究对象,分为观察组(n=160例)和对照组(n=140例),其中对照组患者采用常规治疗,观察组患者采用核苷类药物进行抗病毒治疗,对比分析两组患者治疗后的肝功能变化、生存时间及肝癌发生率。结果治疗后,两组患者的肝功能指标均有所改善,观察组患者的肝功能指标Alb、ALT、TBil及PTA显著优于对照组(P0.05);观察组患者的平均生存时间(49.22±30.15)月明显优于对照组(27.86±15.74)月,两组差异有统计学意义(P0.05);治疗后观察组患者的肝癌发生率(21.88%)显著低于对照组(44.29%),两组对比差异具有统计学意义(P0.05)。结论核苷(酸)类似物抗病毒治疗能够显著改善失代偿肝硬化患者的肝功能指标,有效延长生存时间,降低肝癌发生率,具有积极的临床意义。     

二术解毒汤治疗乙型肝炎肝硬化高甲胎蛋白血症临床疗效

目的:探讨二术解毒汤治疗乙型肝炎肝硬化伴高甲胎蛋白血症的临床疗效。方法:将符合入组标准的72例乙型肝炎肝硬化伴高甲胎蛋白血症的患者随机分为治疗组和对照组,治疗组患者予以二术解毒汤颗粒剂治疗,对照组患者只予二术解毒汤安慰剂治疗。治疗48周后,观察两组患者治疗前后甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、血清丙氨酸氨基转移酶(ALT)、天门氡氨酸氨基转移酶(AST)、总胆红素(TBil)、血清谷氨酰转肽酶(GGT)、血清白蛋白(Alb)的变化。结果:治疗组患者显效10例,有效16例,无效6例,有效率81.3%;对照组患者显效3例,有效9例,无效18例,有效率40.0%,两组有效率比较治疗组明显高于对照组(P0.05);与对照组相比,治疗组患者AFP、AFP-L3水平明显降低,差异具有统计学意义(P0.05);ALT、AST、GGT、TBil水平明显降低,Alb水平升高,患者肝功能显著改善,差异具有统计学意义(P0.05)。结论:二术解毒汤对乙型肝炎肝硬化伴高甲胎蛋白血症的患者具有良好的临床疗效,值得进一步推广。     

养容胶囊保肝及抗肝纤维化的临床作用

[目的]观察养容胶囊保肝及抗肝纤维化的临床作用.[方法]将133例慢性乙型肝炎及肝硬化患者随机分为2组,治疗组(67例)口服养容胶囊,对照组(66例)口服护肝片,疗程均为6个月.观察2组用药后临床疗效结果,肝功能[谷丙转氨酶(ALT)、血清总胆红素(TBil)、血清白蛋白(Alb)]、血清肝纤维化指标[透明质酸酶(HA)、层黏蛋白(LN)、Ⅳ型胶原(Ⅳ-C]等方面的变化.[结果]治疗组治疗后ALT、TBil、Alb及HA、LN、Ⅳ-C较治疗前明显改善(P＜0.05),临床疗效、临床症状改善与对照组比较,差异有统计学意义(P＜0.05).[结论]养容胶囊对慢性乙型肝炎及肝硬化可能具有一定的保肝及抗纤维化作用.     

活体肝移植的进展与展望

活体肝移植（LDLT）可扩大供肝来源,有效缓解供体紧缺局面,尤其是对儿童、急性肝功能衰竭患者和无,法长期等待的肝癌患者有着十分重要的意义。为尽可能减少LDLT潜在的手术风险,尤其是供者的风险,应由肝病内外科医师共同进行严格的供受体术前评估和准备,选择恰当的手术方案。中闰应稳步开展LDLT,并积极拓展尸体和脑死亡供体肝移植,进一步发展儿童LDLT和劈离式肝移植（SIX）以提高器官利用率。在第六届上海国际胃肠病学会议期间,国内外肝病专家就LDLT的现状作了相关报道,本文就此次会议的有关内容和最新进展作一简要介绍。     

Liver regeneration after liver resection: Clinical aspects and correlation with infective complications

AIM:To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.METHODS:A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010.Regeneration was evaluated by multidetector computed tomographyat a mean follow-up of 43.85 d.The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation,and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data.Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.RESULTS:Ten of the 27 patients(37%)underwent chemotherapy prior to surgery,with a statistically significant prevalence of patients with metastasis(P=0.007).Eight patients(30%)underwent embolization,3 with primary tumors,and 5 with secondary tumors.Twenty patients(74%)experienced complications,with 12(60%)experiencing Clavien-Dindo Grade 3a to 5 complications.Regeneration≥100%occurred in 10(37%)patients.The predictors were smaller future remnant liver volume(-0.002;P<0.001),and a greater spleen volume/future remnant liver volume ratio(0.499;P=0.01).Patients with a resection of≥5 Couinaud segments experienced greater early regeneration(P=0.04).Nine patients experienced surgical site infections,and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected(P=0.016).There were no significant differences between patients with primary or secondary tumors,and either onset or infections or severity of surgical complications.CONCLUSION:Regardless of the onset of infective complications,future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.     

Current management of liver diseases and the role of multidisciplinary approach

Liver is an organ having extremely diversified functions, ranging from metabolic and synthetic to detoxification of harmful chemicals. The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management. Several studies have investigated liver function, dysfunction and clinic. This editorial work discusses new ideas, challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases. In one hand the discussions have carried out on the involvement of extracellular vesicles, Na⁺/H⁺ exchangers, severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections, Drug-induced liver injury, sepsis, pregnancy, and food supplements in hepatic disorders. In the other hand this study has discussed hepatocellular carcinoma algorithms and new biochemical and imaging experiments pertaining to liver diseases. Relevant articles with an impact index value "> 0" from reference citation analysis, which is an open multidisciplinary citation analysis database based on artificial intelligence technology, have served for the study’s argumentation. This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.     

人工肝在肝移植围手术期的应用

目的 探讨人工肝支持系统在肝移植围手术期的应用效果。方法采用非生物人工肝治疗9例等待供肝患者，3例肝移植术后患者(包括1例等待供肝成功过渡到肝移植患者)。9例等待供肝患者中4例成功过渡到肝移植。结果 人工肝支持后患者肝性脑病有所好转，血清胆红素明显下降。4例成功过渡到肝移植的启者中2例痊愈出院，已存活12和14个月。结论 术前使用人工肝支持系统能改善患者一般情况；原位肝移植加人工肝支持系统是治疗慢性肝衰竭的有效方法。     

慢性乙型肝炎患者肝组织病理研究

目的:探讨慢性乙型肝炎(CHB)患者临床表现和病理诊断的相关性.方法:收集30例CHB患者的临床资料,分析临床表现与病理诊断的相关性.结果:肝组织的炎症和纤维化程度的相关性显著(r=0.659,P＜0.01),白蛋白/球蛋白比值(A/G)与肝脏炎症和纤维化分级显著负相关(r=-0.368,P＜0.05;r=-0.401,P＜0.05).年龄、性别及其他化验指标如ALT、AST、TP、ALB、GLO、TBil、PLT、PT、PTA、门静脉宽度、脾脏厚度等与肝组织炎症和纤维化分级无显著相关性(P＞0.05).结论:慢性乙型肝炎肝脏炎症和纤维化的严重程度密切相关,仅根据肝功能判断轻中度的CHB患者的肝脏炎症及纤维化程度有相当的局限性.     

Right hepatic lobe living donation: A 12 years single Italian center experience

Mini invasive techniques are taking over conventional open liver resections in the setting of left lateral segmentectomy for living liver donation,and hydride procedure are being implemented for the living related right hepatectomy.Our center routinely performs laparoscopic left lateral segmentectomy for pediatric recipient and has been the first in the Europe performing an entirely robotic right hepatectomy.Great emphasis is posed on living donor safety which is the first priority during the entire operation,then the most majority of our procedures are still conventional open right hepatectomy(RHLD),defined as removal of a portion of liver corresponding to Couinaud segments 5-8,in order to obtain a graft for adult to adult living related liver transplant.During this 10 years period some changes,herein highlighted,have occurred to our surgical techniques.This study reports the largest Italian experience with RHLD,focused on surgical technique evolution over a 10 years period.Donor safety must be the first priority in right-lobe living-related donation:the categorization of complications of living donors,specially,after this"highly sensitive"procedure,reflects the need for prompt and detailed reports.     

Metrically measuring liver biopsy： A chronic hepatitis B and C computer-aided morphologic description

AIM： To describe a quantitative analysis method for liver biopsy sections with a machine that we have named ＂Dioguardi Histological Metriser＂ which automatically measures the residual hepatocyte mass （including hepatocytes vacuolization）, inflammation, fibrosis and the loss of liver tissue tectonics.METHODS： We analysed digitised images of liver biopsy sections taken from 398 patients, The analysis with Dioguardi Histological Metriser was validated by comparison with semi-quantitative scoring system.RESULTS： The method provides： （1） the metrical extension in two-dimensions （the plane） of the residual hepatocellular set, including the area of vacuoles pertinent to abnormal lipid accumulation; （2） the geo- metric measure of the inflammation basin, which distinguishes intra-basin space and extra-basin dispersed parenchymal leukoo/tes; （3） the magnitude of collagen islets, （which were considered truncated fractals and classified into three degrees of magnitude）; and （4） the tectonic index that quantifies alterations （disorders） in the organization of liver tissue. Dioguardi Histological Metriser machine allows to work at a speed of 0.1 mm^2/s, scanning a whole section in 6-8 min.CONCLUSION： The results are the first standardized metrical evaluation of the geometric properties of the parenchyma, inflammation, fibrosis, and alterations in liver tissue tectonics of the biopsy sections. The present study confirms that biopsies are still valuable, not only for diagnosing chronic hepatitis, but also for quantifying changes in the organization and order of liver tissue structure.     

Introducing an Optimal Liver Allocation System for Liver Cirrhosis Patients

Background

Liver transplantation (LT) is the only treatment option for patients with advanced liver disease. Currently, liver donation to these patients, considering priorities, is based on the Model for End-Stage Liver Disease (MELD). MELD score is a tool for predicting the risk of mortality in patients with advanced liver disease. However, few studies have so far been conducted in Iran on the efficacy of MELD score of these patients.

Objectives

This study reviews the present status of the MELD score and introduces a new model for optimal prediction of the risk of mortality in Iranian patients with advanced liver disease.

Patients and Methods

Data required were collected from 305 patients with advanced liver disease who enrolled in a waiting list (WL) in Imam Khomeini Hospital from May 2008 to May 2009. All of the patients were followed up for at least 3 years until they died or underwent LT. Cox regression analysis was applied to select the factors affecting their mortality. Survival curves were plotted. Wilcoxson test and receiver operating characteristics curves for survival predictive model were used to compare the scores. All calculations were performed with the SPSS (version 13.0) and R softwares.

Results

During the study, 71 (23.3%) patients died due to liver cirrhosis and 43 (14.1%) underwent LT. Viral Hepatitis (43.7%) is the most common cause of end-stage liver disease among Iranian patients. A new model (NMELD) was proposed with the use of the natural logarithms of two blood serum variables (total bilirubin and albumin) and the patients'' age (year) by applying the Cox model:NMELD = 10 × (0.736 × ln (bilirubin) – 1.312 × ln (albumin) + 0.025 × age + 1.776)

Conclusions

The results of the Wilcoxon test showed that there is a significant difference between the usual MELD and our proposed NMELD scores (P < 0.001). Receiver operating characteristics curve for survival predictive model indicated that the NMELD score is more efficient compared with the MELD score in predicting the risk of mortality. Since serum creatinine was not significant in NMELD score, further studies to clarify this issue are suggested.     

肝窦内皮细胞在肝损伤中的功能研究进展

肝窦内皮细胞（liver sinusoidal endothelial cells, LSECs）位于肝血窦表面，是肝脏与血液接触的第一道防线，也是肝脏中含量最多的非实质细胞。在生理情况下，LSECs通过参与物质运输、代谢废物清除而诱导肝脏免疫耐受，从而维持肝脏稳态；在病理情况下，LSECs通过抗原递呈促进肝脏炎症反应。LSECs在维持肝再生和肝纤维化平衡中发挥了重要的调节作用。本文对LSECs功能、LSECs在肝损伤中的变化、调节LSECs功能相关的信号通路以及LSECs与肝内其他细胞的相互作用等四方面研究进展进行综述，从而进一步明确LSECs的功能及在肝损伤中的作用。     

Isolated Tuberculosis of Transplanted Liver,A Case Report and Review of the Literature

Introduction

Recipients of liver transplantation are prone to different types of infections such as tuberculosis (TB).

Case Presentation

Herein we report a 59-year-old man with liver transplantation due to HBV cirrhosis who developed isolated hepatic TB, 18 months after OLT (orthotropic liver transplantation). He has been successfully treated with anti-TB regimen and now after 12 months he is completely symptom-free.

Conclusions

Organ transplantation and treatment of transplanted patients with immunosuppressive drugs would prone them to various unusual infections. One of these is unusual primary involvement of liver by tuberculosis which has been extremely rare in the previous reports.