肝纤维化和肝硬化逆转的血清学评价

肝纤维化/肝硬化是慢性肝脏疾病的共同病理过程。大量研究已经证实,在经过有效的治疗后,肝纤维化或肝硬化可以得到一定程度的逆转。如何应用简便的血清学指标判断肝纤维化/肝硬化逆转是目前的研究热点,总结了可能用于判断肝纤维化/肝硬化逆转的血清学指标的研究和应用现状。     

慢性HBV感染者获得病毒学应答后肝纤维化/肝硬化逆转因素的分析

慢性HBV感染可导致不同程度的肝纤维化,而肝纤维化是肝硬化发生的重要病理基础,控制甚至逆转肝纤维化对于降低肝硬化、肝细胞癌等终末期疾病的发病率尤为重要。慢性HBV感染者经长期抗HBV治疗获得病毒学应答后肝脏炎症消退,肝纤维化甚至肝硬化可得到不同程度的逆转,甚至完全恢复至正常结构,具体机制及相关影响因素目前尚不十分明确。归纳并分析了近年来关于慢性HBV感染者获得病毒学应答后肝纤维化/肝硬化逆转的相关研究,总结了可能与慢性HBV感染者抗病毒治疗后肝纤维化/肝硬化逆转的相关影响因素,包括年龄、性别、宿主因素、病毒因素、治疗因素、代谢相关因素等,但仍有其他的相关影响因素有待进一步研究。     

肝纤维化研究进展

肝纤维化是各种损伤因子累及肝脏后的一种病理状态。几乎任何能造成肝脏损害的因素均可致肝脏发生纤维化,如慢性乙型肝炎、慢性丙型肝炎、脂肪性肝炎(包括酒精性或非酒精性)、自身免疫性肝病、血吸虫肝病、药物性肝病和一些先天代谢性疾病等均可引起肝纤维化。在此病理进程中,正常功能的肝细胞数量减少,肝小叶结构改变,血液循环紊乱,致肝脏功能逐渐丧失,最终发展为肝硬化。随着医学科学的     

脂肪性肝纤维化研究进展

脂肪肝系多种病因引起肝脏脂质代谢紊乱,动态平衡失调,以致肝实质——肝细胞内脂质蓄积过多,肝细胞脂肪变性的一种病理综合征。肝纤维化则以肝脏间质即细胞外基质过度增生沉积、肝脏结构改变为病理特征,是各种慢性肝病的共同病理特点,是慢性肝炎向肝硬化发展的必经之路。脂肪肝与肝纤维化既可同时发生,也可前后相继发病。肝纤维化是脂肪肝的病理预后之一,临床上部分脂肪肝患者可演变为慢性脂肪性肝炎或脂肪性肝硬化,肝纤维化在单纯脂肪肝向脂肪性肝硬化的病理发展中起关键作用。预防或逆转脂肪性肝纤维化在脂肪肝尤其是重度脂肪肝患者的治疗中有重要     

肝纤维化逆转的病理评估

肝纤维化是慢性肝脏疾病的共同病理结局,准确评估肝纤维化程度对明确疾病诊断、治疗决策、监测疗效及判断预后均有重要参考价值。目前已有多项临床研究证实,经过有效治疗肝纤维化/早期肝硬化是可以逆转的,如何正确评价肝纤维化逆转成为临床研究热点。肝活组织检查一直以来都是肝纤维化评价的金标准,因此其对纤维化逆转评价至关重要。从半定量、定量、定性评价3个方面回顾了现有肝纤维化病理分期标准在肝纤维化逆转中的临床应用进展,以提出更好的病理评价体系评估肝纤维化逆转。     

2012年肝纤维化领域的研究进展

肝纤维化是各类损伤因子累及肝脏后的一种病理修复状态,肝纤维化甚至肝硬化能否改善乃至逆转是目前肝纤维化研究领域的关键.以往的动物模型已证实肝纤维化的逆转,但临床领域缺乏详尽充分的数据为此提供依据.令人鼓舞的是,近期越来越多的研究支持人体中肝纤维化甚至肝硬化的转归.2012年12月份Lancet发表的一篇随机双盲对照研究显示,富马酸替诺福韦酯治疗慢性乙型肝炎(CHB)患者,能够实现肝纤维化和肝硬化的逆转[1].该研究旨在评估对于CHB患者采用富马酸替诺福韦酯治疗在5年内对肝纤维化和肝硬化的疗效,在完成为期48周的随机双盲比较富马酸替诺福韦酯和阿德福韦酯后,研究者将符合条件的受试者(HBeAg阳性或阴性)纳入了为期7年的富马酸替诺福韦酯的开放研究,在第240周时再次进行肝脏活组织病理学检查,主要评估肝脏组织学改善程度(Knodell坏死炎症评分≥2且纤维化程度未加重)以及肝纤维化的逆转情况(Ishak评分降低≥1单位).治疗基线时28％的患者存在肝硬化(Ishak评分5分或6分),而74％肝硬化患者治疗后评分降低≥1单位,肝硬化消失;入组时未患肝硬化的252名患者中仅有3名在5年内进展为肝硬化;87％随机治疗的患者组织学改善,且51％的患者在第240周时肝纤维化出现逆转.     

肝纤维化无创诊断新进展

肝纤维化是各种慢性肝损伤共同的病理改变。大量研究认为，肝纤维化是慢性肝脏疾病进程中可变的中间状态，加以有效的治疗措施干预，疾病进程可逆转；反之，则最终进展至肝硬化。     

肝纤维化逆转机制的研究进展及治疗概况

肝纤维化是肝脏对慢性损伤的一种修复反应,多是持续性肝脏损伤或纤维化刺激因子刺激产生的共有病理改变,是一项严重的全球性健康难题.近年来临床研究发现,由病毒性肝炎造成肝纤维化或肝硬化的患者,在成功接受病毒性肝炎治疗后,其肝纤维化甚至肝硬化发生了逆转现象.因此研究和了解肝纤维化逆转的机制有利于发现新的针对肝纤维化的治疗靶向.本文就近年来有关肝纤维化逆转机制的研究以及治疗概况作一综述,以期为肝纤维化的研究提供帮助     

肝纤维化与抗肝纤维化

肝纤维化是组织学检查作出的一种形态学诊断,是诸多慢性肝病向肝硬化发展的必经阶段.其病理学特征为汇管区大量纤维组织增生,但并无假小叶和再生结节形成.随着肝脏病变的发展,肝细胞坏死、肝实质弥漫性结节再生、纤维组织包绕、分隔,终致肝脏结构变形,发展为不可逆转的肝硬化.能否将病变终止在肝纤维化阶段或逆转至正常,是近年颇受肝脏病     

外泌体在肝纤维化中的研究进展

<正>肝纤维化是各种慢性肝病的共同病理过程,是各种慢性肝病发展为肝硬化的必经之路。肝纤维化是可逆的,而晚期肝硬化难以逆转,因此探讨肝纤维的发病机制、阻断肝纤维化的进程、寻找治疗肝纤维化的靶点具有重要意义。外泌体作为细胞之间传递的小信息球,可参与细胞通讯、细胞迁移、血管新生和肿瘤细胞生长等过程。外泌体中miRNA或蛋白质等遗传分子与肝脏病理息息相关,在肝纤维化诊断中可作为潜在的分子标志物。对外泌体的研究,将有利于探索肝纤维化的发生、发展机制,     

Identification of novel anti-tuberculosis agent: An in silico investigation

BackgroundMulti-drug resistance tuberculosis is chronic and highly affected to mankind. Millions of people are affected by tuberculosis and lost their lives every year. Mycobacterium tuberculosis is resistant to the most commonly used anti-TB drugs, hence new drugs need to be developed in a short time. In this direction, many chemical compounds including benzimidazole derivatives have been identified as potent anti-tb agents.MethodVarious benzimidazole derivatives were subjected to in-silico computational screening to identify the potent anti-tubercular analogues. The ADME pharmacokinetics evaluation was performed to identify the drug-like molecules. Molecular docking investigation of selected compounds was performed against Mycobacterium Tuberculosis Enoyl Reductase (Inha) with PDB ID: 2B37, 1QG6, 4TZK, and 4TZK. The common pharmacophore hypothesis was generated using the molecular docking post-processing module.ResultThe result of ADME pharmacokinetics of some compounds is very close to the drug-like properties and can be developed as good inhibitors. Molecular docking study suggests that the proposed benzimidazole and 4H-pyran derivative have better binding affinity than standard and triclosan derivatives. Results from the pharmacophore hypothesis development study also support and suggest our prediction regarding the minimum pharmacophore features required in ligands to behave as a Mycobacterium Tuberculosis inhibitor.ConclusionCoumarin, phenylurea clubbed benzimidazole moiety and pyrano[2,3-c]pyrazole derivatives have shown greater selectivity and potency towards Mycobacterium Tuberculosis. By employing a combination of ADME, docking, and pharmacophore study calculations, novel potent hits to inhibit enoyl-acp reductase were identified with the points for consideration for designing of enoyl-acp reductase inhibitor.     

Social relations in older adults: Secular trends and longitudinal changes over a 16-year follow-up

Drawing on population studies in Finland, we investigated secular trends and longitudinal changes in social relations. The cohort comparison data comprised on 974 persons aged 65-69 years from three cohorts born between 1919 and 1939 and interviewed in 1988, 1996 and 2004. Longitudinal analyses were conducted for 635 persons aged 65-74 years over a 16-year follow-up at three measurement points. Social relations were studied on the basis of frequency seeing one's offspring, perceptions of the sufficiency of these contacts, and by asking whom the participants considered as their closest person and how often and in how many tasks they helped someone. The cohort comparisons showed that the frequency of seeing one's offspring had decreased in the most recent cohort and that the number of contacts was considered more inadequate. Longitudinal analyses showed that although the proportion of children as the closest persons increased, meetings with them became fewer. Helping others was more common in the last cohort, but in the longitudinal analyses it decreased with age. Finnish people at retirement help others more than before, but they do not meet their offspring as often as they would like. Measures are needed for action to promote intergenerational exchange in older adults on both individual and societal level.     

Extended distribution of prolonged and fractionated right atrial electrograms predicts development of chronic atrial fibrillation in patients with idiopathic paroxysmal atrial fibrillation

INTRODUCTION: This study evaluates whether electrophysiologic abnormalities in patients with idiopathic paroxysmal atrial fibrillation (PAF) predict the transition to chronic atrial fibrillation (CAF). METHODS AND RESULTS: Ninety-six patients with idiopathic PAF underwent electrophysiologic study and were followed up. During electrophysiologic study, endocardial mapping was performed at 12 sites in the right atrium (four aspects of the high, middle, and low right atrium). During follow-up of 60 to 130 months, conversion from PAF to CAF was observed in 17 patients (CAF group). The remaining 79 patients remained in sinus rhythm (PAF group). Although a high frequency of abnormal atrial electrograms was observed in the high right atrium in both groups, the frequency of those recorded from the middle right atrium was significantly higher in the CAF group than in the PAF group (70.6% vs 13.9%, P < 0.0005). Kaplan-Meier analysis showed that >50% of the patients with abnormal atrial electrograms in the middle right atrium developed CAF after 10 years, whereas only 7% of patients without those developed CAF (P < 0.0001). CONCLUSION: Our data suggest that extended distribution of abnormal atrial electrograms from the high to middle right atrium is predictive of the development of CAF in patients with idiopathic PAF.     

Association of obesity with postacute sequelae of COVID-19

Obesity is a major risk factor for the development of severe coronavirus disease 2019 (COVID-19) infection and mortality. However, it is not known whether patients with obesity are at a greater risk of developing postacute sequelae of COVID-19 (PASC). In a median follow-up time of 8 months and counting from 30 days following a positive viral test of 2839 patients who did not require intensive care unit admission and survived the acute phase of COVID-19, 1230 (43%) patients required medical diagnostic tests, 1255 (44%) patients underwent hospital admission, and 29 (1%) patients died. Compared with patients with a normal body mass index (BMI), the risk of hospital admission was 28% and 30% higher in patients with moderate and severe obesity, respectively. The need for diagnostic tests to assess different medical problems, compared with patients with normal BMI, was 25% and 39% higher in patients with moderate and severe obesity, respectively. The findings of this study suggest that moderate and severe obesity (BMI ≥ 35 kg/m²) are associated with a greater risk of PASC.     

3100例溃疡性结肠炎住院病例回顾分析

目的 回顾性调查住院溃疡性结肠炎（UC）患者,探讨近年住院病例UC的特点.方法全国选取11个地区23家医院,调查1990-2003年期间住院符合UC诊断的3100例患者的诊断、治疗、逐年住院情况和同期内镜检出率,并粗略估计患病率.结果 近14年UC住院例数和内镜检出例数均有逐年增加的趋势.UC粗略患病率为11.62/105.住院UC患者以轻度（35.4%）和中度（42.9%）为主.临床类型以慢性复发型（46%）和初发型（34.6%）为主,暴发型仅占2.4%.主要症状有腹泻（75.8%）、腹痛（67.3%）、血便（63.3%）等.肠外表现（14.0%）和并发症（9.6%）少见.辅助确诊手段主要为结肠镜（95.0%）及病理（62.3%）.UC治疗上以氨基水杨酸类（66.8%）和类固醇激素（42.8%）为主.仅2.1%患者应用免疫抑制剂.单纯内科治疗总有效率达93.6%,手术率3%,死亡19例（0.6%）.结论 UC近年有逐渐增加的趋势,以轻中度为主,疾病类型以慢性复发型和初发型为主,暴发型少见.肠外表现及并发症较少.国内轻中度患者治疗以柳氮磺胺吡啶及类固醇激素为主,手术率、死亡率及癌变率均较国外低.     

Cholecystectomy is associated with dysglycaemia: Cross-sectional and prospective analyses

Cholecystectomy has been reported to be associated with increased risk of diabetes in cross-sectional studies. In the current study, we performed both cross-sectional and prospective analyses to examine the association between cholecystectomy and dysglycaemia in Chinese community-dwelling adults. A total of 1612 participants (n = 1564 without cholecystectomy and n = 48 with cholecystectomy) were evaluated for glycaemic status (according to the World Health Organization (WHO) 1999 criteria) and then followed up over ~3.2 years. Percent changes (Δ) in fasting blood glucose and HbA1c from baseline at the follow-up visit were calculated to define glycaemic control as stable (−10% ≤ Δ < 10%), improved (Δ < −10%), or worsened (Δ ≥ 10%). The baseline cross-sectional analyses indicated that cholecystectomy was associated with an increased risk of both prediabetes and diabetes, while the prospective analysis indicated that cholecystectomy was also associated with a greater risk of deterioration in glycaemic control (ΔFPG ≥10% and ΔHbA1c ≥10%) (P < 0.05 for each, both before and after adjusting for potential confounding covariates). These observations suggest that individuals in the Chinese community-dwelling population who have undergone cholecystectomy are at increased risk of dysglycaemia. Further studies are warranted to both delineate the underlying mechanisms and to clarify whether more intense surveillance for future development of diabetes is needed in this group.