应用人工肝支持系统治疗重型肝炎15例的疗效观察

目的 探讨人工肝支持系统(ALSS)治疗重型肝炎的疗效及安全性。方法 对15例重型肝炎患者在综合治疗的基础上进行血浆置换(PE)，血液灌流(HP)治疗，对治疗前后的肝功能、白蛋白、凝血酶原时间、肾功能、电解质、血常规、并发症以及症状进行分析。结果 ALSS治疗后患者症状明显缓解，胆红素、转氨酶明显下降，凝血酶原时间有所缩短，血常规、肾功能、电解质等无明显变化，有效率达93％，并发症少。结论 人工肝支持系统治疗重型肝炎安全有效，可降低病死率。     

人工肝支持系统治疗重型肝炎疗效观察

近年我们应用人工肝支持系统（ALSS）血浆置换（PE）交替、联合血浆灌流（PA）治疗重型肝炎,取得满意疗效,明显降低了病死率。     

应用血浆置换术治疗慢性重型肝炎的疗效分析

目的探讨血浆置换(PE)术治疗慢性重型肝炎的疗效。方法应用PE对41例慢性重型肝炎患者进行68例次治疗,观察治疗前后肝、肾功能、电解质、血常规、凝血酶原时间、总胆汁酸的变化情况及不良反应,并与一般保肝综合治疗组疗效进行比较。结果41例患者经PE治疗后ALT、TBIL、TBA水平较治疗前明显下降,ALB水平较治疗前升高(P<0.05);PE组治愈好转率为58.5%,显著高于对照组的33.3%(P<0.05)。结论PE联合一般保肝综合治疗慢性重型肝炎可显著改善血生化指标,提高患者存活率。     

人工肝支持系统治疗对重型肝炎患者血清TNF-α、IL-2、IL-10和IL-15水平的影响

目的 探讨重型肝炎患者人工肝支持系统(ALSS)治疗前后外周血中肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-10(IL-10)、白细胞介素-15(IL-15)水平的变化。方法 应用血浆置换技术治疗重型肝炎患者59例，采用ELISA法于每次治疗前后检测TNF-α、IL-2、IL-10、IL-15水平，并观察其动态变化。结果 重型肝炎患者血清TNF-α水平明显高于对照组，IL-2水平明显低于对照组，ALSS治疗后TNF-α水平明显下降，而IL-2、IL-l0则呈上升趋势，治疗前后IL-15水平无明显变化。结论 ALSS治疗能降低重型肝炎患者TNF-α含量，并升高IN-2和IL-10水平，从而抑制炎性介质的产生，减轻免疫反应对肝细胞的损伤，提高重型肝炎的存活率。     

血浆置换治疗重型肝炎时并发症的预防处理

血浆置换(PE)是人工肝支持系统(ALSS)中治疗重型肝炎的一种重要技术手段。本科自2002年12月-2004年5月采用血浆置换对36例重型肝炎患者进行治疗58次，取得了满意效果。现将治疗中的并发症及其处理作一总结分析。     

血浆置换联合血液透析滤过治疗重型肝炎肝肾综合征

目的观察血浆置换(plasma exchange,PE)联合血液透析滤过(hemodiafiltration,HDF)治疗重型肝炎肝肾综合征(hepatorenal syndrome,HRS)的临床疗效。方法临床纳入重型肝炎HRS患者70例,根据临床治疗方案不同分为观察组和对照组。对照组给予PE治疗,观察组给予PE联合HDF治疗。观察两组患者治疗前后肝肾功能及电解质的变化、近期疗效及治疗前后细胞因子的变化。结果观察组近期治疗有效率(82.86%)高于对照组(51.43%),差异有统计学意义(P0.05);治疗前,两组患者血尿素氮(BUN)、血清肌酐(Scr)、血清总胆红素(TBIL)、NH3、白蛋白(ALB)、胆碱酯酶(CHE)、Na+、K+等水平相比,差异均无统计学意义(P0.05);治疗后,研究组BUN、Scr、TBIL、NH3、ALB、CHE、Na+、K+等水平均明显优于对照组,差异有统计学意义(P0.05);治疗前,两组患者IL-8、IL-10、TNF-α等水平相比,差异均无统计学意义(P0.05);治疗后,观察组IL-8、IL-10、TNF-α等水平均明显低于对照组,差异有统计学意义(P0.05)。结论 PE联合HDF治疗重型肝炎HRS,与单独PE治疗相比,具有较高的近期治疗有效率。此外,还能够改善肝肾功能及电解质平衡,减少促炎因子,提高抗炎因子,值得临床推广。     

低分子肝素在人工肝血浆置换治疗重型肝炎中的应用观察

观察低分子肝素在人工肝(ALSS)血浆置换(PE)治疗重型肝炎中的临床效果。将30例重型肝炎患者随机分为两组,应用低分子肝素抗凝组(LMWH组)15例,应用普通肝素抗凝组(SH组)15例,两组行ALSS-PE治疗前后均记录出血、凝血情况及有关凝血功能指标变化。30例患者行60例次PE治疗后,LMWH组在出血倾向、血浆分离器及管路凝血发生率方面均优于SH组(P<0．05),且其检测有关凝血功能指标的改善方面均明显优于SH组(P<0．05)。低分子肝素在重型肝炎PE治疗中的有效性和安全性均优于普通肝素。     

人工肝血浆置换治疗重型肝炎72例疗效观察

重型肝炎是由各种原因引起的以肝细胞大量坏死、肝功能衰竭为特征的危重疾病,病情进展迅速,病死率高达50%～70%。人工肝支持系统(ALSS)是近年来治疗重型肝炎的新手段,通过血浆置换(PE)、血浆灌流(PP)等方法清除高胆红素、血氨等毒素,从而改善机体内环境,使残余的细胞获得再生[1]。我院自2008年以来对72例重型肝炎患者在常规内科综合治疗的基础上采用PE治疗,取得一定疗效,总结如下。资料与方法     

人工肝支持系统治疗重型肝炎临床研究

研究人工肝支持系统治疗重型病毒性肝炎的方法及疗效.利用HP 200血液净化治疗仪、YT50P.P血浆分离器进行人工肝支持系统(ALSS)治疗各期重型肝炎患者58例,并对治疗的疗效和并发症进行分析.治疗后TBil、ALT、AST、PT、NH3较治疗前有明显下降(P＜0.01).58例重型肝炎患者中治愈好转26例(44.8%),死亡或自动出院32例(55.2%).应用ALSS治疗重型肝炎患者具有一定疗效,且早中期患者的疗效较晚期的为佳.     

血浆置换系统治疗重型肝炎的短期疗效观察

目的 观察血浆置换人工肝对重型肝炎肝功能指标的影响和疾病转归,评价其短期疗效.方法 选择2008年3月～2009年4月武汉大学人民医院住院患者,48例重型肝炎患者除内科综合治疗外,进行人工肝血浆置换(plasma exchange,PE)治疗,对照组48例仅给予内科综合治疗,比较两组的生化指标变化及短期生存率.结果 PE治疗组每次治疗后,患者临床症状有不同程度的改善,各主要生化指标与对照组比较显著改善(P＜0.01或0.05),但治愈好转出院率两组比较无显著差异.结论 PE对于早、中期重型肝炎患者,可提高疗效,对于晚期重型肝炎病死率无明显改变.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.