血浆灌流联合小剂量血浆置换治疗慢性乙型重型肝炎30例

目的探讨血浆灌流联合小剂量血浆置换治疗慢性乙型重型肝炎的临床疗效。方法对30例慢性乙型重型肝炎患者在内科综合治疗基础上进行62例次血浆灌流联合小剂量血浆置换治疗,观察治疗前后临床症状及生化指标的变化。结果治疗结束时患者临床症状明显改善,ALT从531.0±130.5U/L下降至221.4±128.0U/L,AST从432.4±79.1U/L下降至160.7±98.8U/L,TBIL从253.5±70.2μmol/L下降至138.6±80.4μmol/L,PTA从36.5±7.3%上升至57.3±8.5%,治疗后患者好转率达73.3%。结论血浆灌流联合小剂量血浆置换治疗慢性乙型重型肝炎能显著改善患者的临床症状和生化指标。     

重型肝炎患者血清肝纤维化指标及甲胎蛋白水平的动态变化及其与预后的关系

目的:初步探讨重型肝炎患者血清肝纤维化指标及甲胎蛋白(AFP)水平的动态变化及其与预后的关系.方法:在比较89例病毒性肝炎患者血清肝纤维化指标及AFP水平的基础上,着重研究其中39例重型肝炎患者血清肝纤维化指标及AFP水平在不同时期的动态变化规律.结果:重型肝炎患者血清透明质酸(HA)、Ⅲ型胶原氨基末端肽(PⅢP)和AFP水平高于慢性肝炎患者及正常人(3273.19±2060.83 vs127.63±110.63.35.50±18.59;2.13±1.20 vs1.18±0.43,0.80±0.18:130.98±244.51 vs20.40±12.68,7.50±1.23,均P<0.05),重型肝炎患者血清LN水平仅高于正常人(148.95±54.47 vs 120.70±18.35,P<0.05):HA、PⅢP和LN在生存组总体呈现下降趋势,死亡组呈现上升趋势,AFP水平在生存组呈现先升后降趋势,在死亡组急剧下降;血清HA、PⅢP、LN和AFP水平在亚急性组低于慢性组:重型肝炎患者HA与PTA、ALB、TBIL有较好的相关性(r=-0.372,-0.395,0.344,均p<0.05).结论:动态监测血清HA、PⅢP、LN和AFP水平对重型肝炎患者的预后判断有一定意义.结果:重型肝炎患者血清透明质酸(HA)、Ⅲ型胶原氨基末端肽(PⅢP)和AFP水平高于慢性肝炎患者及正常人(3273.19±2060.83 vs127.63±110.63.35.50±18.59;2.13±1.20 vs1.18±0.43,0.80±0.18:130.98±244.51 vs20.40±12.68,7.50±1.23,均P<0.05),重型肝炎患者血清LN水平仅高于正常人(148.95±54.47 vs 120.70±18.35,P<0.05):HA、PⅢP和LN在生存组总体呈现下降趋势,死亡组呈现上升趋势,AFP水平在生存组呈现先升后降趋势,在死亡组急剧下降;血清HA、PⅢP、LN和AFP水平在亚急性组低于慢性组:重型肝炎患者HA与PTA、ALB、TBIL有较好的相关性(r=-0.372,-0.395,0.344,均p<0.05).结论:动态监测血清HA、PⅢP、LN和AFP水平对重型肝炎患者的预后判断有一定意义.结果:重型肝炎患者血清透明质酸(HA)、Ⅲ型胶原氨基末端肽(PⅢP)和AFP水平高于慢性肝炎患者及正常人(3273.19±2060.83 vs127.63±110.63.35.50±18.59;2.13±1.20 vs1.18±0.43,0.80±0.18:130.98±244.51 vs20.40±12.68,7.50±1.23,均P<0.05),重型肝炎患者血清LN水平仅高于正常人(148.95±54.47 vs 120.70±18.35,P<0.05):HA、PⅢP和LN在生存组总体呈现下降趋势,死亡组呈现上升趋势,AFP水平在生存组呈现先升后降趋势,在死亡组急剧下降;血清HA、PⅢP、LN和AFP水平在亚急性组低于慢性组:重型肝炎患者HA与PTA、ALB、TBIL有较好的相关性(r=-0.372,-0.395,0.344,均p<0.05).结论:动态监测血清HA、PⅢP、LN和AFP水平对重型肝炎患者的预后判断有一定意义.     

前列地尔注射液联合血浆置换治疗重型肝炎33例

目的:评价前列地尔注射液联合血浆置换治疗重型肝炎的疗效.方法:将62例重型肝炎患者随机分为试验组和对照组.试验组33例(亚急性重型肝炎2例,慢性重型肝炎31例)在内科综合治疗基础上加用血浆置换及前列地尔注射液;对照组29例(亚急性重型肝炎1例,慢性重型肝炎28例)仅用内科综合治疗加用血浆置换.结果:试验组和对照组治疗后,各指标均有明显改善,与本组治疗前比较,差异均有显著性(P<0.01):试验组治疗后TBIL和PTA改善更为明显,与对照组比较差异均有显著性(155.8±138.2 umol/L vs 296.4±100.5 umol/L,62.6%±10.4%vs 42.9%±11.4%;P<0.01);试验组存活率(治愈及好转)显著优于对照组(72.8%vs 48.3%.P<0.01).结论:前列地尔注射液联合血浆置换是治疗重型肝炎的有效方法.     

妊娠期慢性乙型肝炎55例

目的:分析妊娠期慢性乙型肝炎发病特点和临床特征. 方法:回顾性分析55例妊娠期慢性乙型肝炎患者的临床资料,并与妊娠期乙型肝炎携带者(无症状妊娠组)及正常妊娠女性进行临床比较. 结果:妊娠期慢性乙型肝炎发病集中于妊娠的中、晚期.与无症状妊娠组比较,慢乙型肝炎妊娠组患者肝功能损害表现为ALT、AST、TBIL及DBIL明显升高(210.2 U/L±144.7 U/Lvs 22.7 U/L±11.6 U/L:197.3 U/L±113.8 U/Lvs 19.1 U/L±14.9 U/L;64.9 μmol/L±37.8μmol/Lvs6.8 μmol/L±5.8 μmol/L;44.2 μmo1/L±23.8μmo1/L vs 4.8 μmol/L±2.2 μmol/L,均P<0.05),白蛋白、PTA降低(31.3 G/L±7.3 G/Lvs 35.8 G/L±4.7 G/L;66.4%±8.6% vs 82.1%±8.7%,均P<0.05).患者的病毒学特征表现为HBeAg阳性和HBV DNA高滴度. 结论:妊娠期慢性乙型肝炎的发生多集中于妊娠的中、晚期;临床类型以中、重度为主;HBeAg阳性和HBV DNA高滴度可作为妊娠期慢性乙型肝炎发生的预测指标.     

人工肝治疗37例重型肝炎的临床观察

目的 观察人工肝治疗重型肝炎的临床疗效及其安全性.方法 对37例重型肝炎患者应用血浆置换或/和血液(浆)灌流共进行50次治疗,观察患者在人工肝治疗前后症状、体征、血清胆红素、白蛋白、凝血酶原活动度(PTA)变化和不良反应及术后生存率.结果 人工肝支持治疗后症状、体征改善显效率为80.00%.治疗前后总胆红素水平显著下降(P＜0.01),PTA上升(P＜0.01),白蛋白、血红蛋白无显著变化(P＞0.05).术中及术后总并发症发生率为14.29%,主要为皮肤瘙痒、荨麻疹、畏寒、发热、血压下降.术后好转出院26例(70.27%),自动出院7例(18.92%),死亡4例(10.81%).结论 人工肝治疗重型肝炎安全、有效.     

缬沙坦对肝硬化患者门静脉压力及肝纤维化指标的影响

目的:观察缬沙坦对肝硬化患者血流动力学指标及CGRP、HA、CG、PAI-1的影响.方法:肝硬化患者随机分为对照组和治疗组各18例,对照组给予常规治疗,治疗组在此基础上加用缬沙坦80 mg/d po,疗程1 mo.治疗前后应用彩色多普勒超声仪检测门、脾静脉的内径与流速,同时采用放免法检测血CGRP、HA、CG的水平,酶联免疫法测定血PAI-1的水平.结果:缬沙坦可使门、脾静脉的内径减小,流速增快.缬沙坦亦可降低患者CGRP、HA、CG、PAI-1的水平(73.15±14.59 ng/L vs 75.79±15.06 ng/L,422.34±183.94 μg/L vs 498.39±197.53 μg/L,12.50±8.92 mg/L vs 24.23±13.05 mg/L,28.09±10.80 μg/L vs 32.56±11.18 μg/L,均P<0.05).结论:缬沙坦能够在一定程度上降低门静脉压力,同时具有一定的抗肝纤维化作用.     

银杏叶提取物EGb761对慢性乙型肝炎患者肝纤维化的影响

目的:探讨银杏叶提取物(EGb761)对慢性乙型肝炎患者肝组织纤维化的影响.方法:将60例慢性乙型肝炎患者分为EGb761治疗组(n=32)及对照组(n=28),治疗前后分别检测肝功能、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、透明质酸(HA)、层黏蛋白(LN)、血小板活化因子(PAF)、内皮素(ET-1)和转化生长因子-β_1(TGF-β_1)水平.两组中分别有26例和21例患者于治疗前后进行肝活检术,肝组织行HE、胶原纤维、网织纤维染色观察组织学变化.结果:治疗后两组的肝功能水平均较治疗前显著好转,但两组比较无差异.EGb761组治疗后ALT (621.8±271.7 nkat/L vs 1258.6±308.4 nkat/L,P<0.05),TBIL(17.1±9.5μmol/L vs 39.3±21.2μmol/L,P<0.01),PT(13.2±2.1 s vs 15.2±3.4 s,P<0.05),PCⅢ(168±48μg/L vs 307±93μg/L,P<0.95),CⅣ(102±35μg/L vs 191±35μg/L,P<0.01),HA(94±39μg/L vs 178±57μg/L,P<0.05),LN(101±31μg/L vs 193±21μg/L,P<0.05),PAF(7.62±6.54μg/L vs 13.23±9.79μg/L,P<0.05),ET-1(47.61±15.34μg/L vs 68.13±21.71μg/L,P<0.01)及TGF-β_1(17.61±5.06μg/L vs 58.43±11.04μg/L,P<0.05)水平与治疗前相比均显著下降,而ALB水平显著升高(38.2±5.9g/L vs 34.9±4.4g/L,P<0.05).与对照组相比,EGb761组治疗后血清TGF-β_1(17.61±5.06μg/L vs 61.17±11.45μg/L,P<0.05),PAF(7.62±6.54μg/L vs 11.65±8.96μg/L,P<0.05),ET-1(47.61±15.34μg/L vs 61.17±16.45μg/L,P<0.01),PCⅢ(168±48μg/L vs 298±86 ug/L,P<0.05),CⅣ(102±35μg/L vs 178±61 ug/L,P<0.05),HA(94±39μg/L vs 179±82μg/L,P<0.05)及LN(101±31μg/L vs 190±39 ug/L,P<0.01)指标改善更为明显.治疗组肝活检证实,治疗后肝脏细胞损伤减轻,纤维化程度减轻,而对照组治疗前后均无明显变化.结论:银杏叶提取物EGb761对慢性乙肝有明显的抗肝纤维化作用.     

一氧化氮、白介素、肿瘤坏死因子与肝硬化患者预后的关系

目的:探讨血清一氧化氮(NO)、IL-6、IL-10、肿瘤坏死因子(TNF)水平与肝硬化患者预后之间的关系.方法:采用硝酸还原酶法、ELISA法、双抗体夹心酶联免疫分析法分别测定30例健康对照者和56例肝硬化患者治疗前后的血清NO,IL-6,IL-10及TNF水平.结果:肝硬化患者的NO,IL-6,TNF水平显著升高,IL-10水平明显降低.治疗后肝功能减退组的NO (129.21±27.32μmol/L vs 92.18±25.68μmol/L,P<0.05)、IL-6(198.5±23.2 mg/L vs 147.0±19.1 mg/L,P<0.05)、TNF(179.2±23.5 pg/dL vs 121.4±17.5 pg/ dL,P<0.05)水平较治疗前有显著升高,IL-10水平则明显下降(33.4±7.2 mg/L vs 51.6±18.5 mg/L,P<0.05),而治疗后肝功能恢复组NO(58.63±12.25μmol/L vs 94.36±23.45μmol/L,P<0.05)、IL-6(90.3±12.7 mg/ L vs 148.5±15.8 mg/L,P<0.05)、TNF(78.2±14.3 pg/dL vs 124.9±20.1 pg/dL,P<0.05)水平较治疗前降低(P<0.05),IL-10水平则明显升高(89.3±18.9 mg/L vs 48.8±9.5 mg/L,P<0.05).结论:NO,IL-6,IL-10,TNF与肝硬化患者预后有关.     

视黄醇脂对慢性酒精性肝病患者肝脏纤维化的抑制作用

目的:证明维生素A(Vit A)对慢性酒精性肝病 (ALD)患者的肝脏纤维化形成有抑制作用,为肝纤维化的治疗提供一条简便有效的新途径．方法:选择58例ALD患者,采用临床观察的方法,通过外源性的给予Vit A,以酶联免疫吸附法检查ALD患者血清Ⅲ型前胶原肽(PⅢP)及血清透明质酸(HA)的变化．结果:Vit A可以降低ALD患者血清Ⅲ型前胶原肽及血清透明质酸水平．Vit A治疗后 18 mo,血清Ⅲ型前胶原肽(16．9±6．8 μg/L vs 28．2±9．7 μg/L)及透明质酸(132．3±71 μg/L vs 210．0±87 μg／L)水平均较治疗前显著降低 (均P<0．01),且较对照组也有显著降低(PⅢP: 16．9±6．8μg/L vs 23．6±9．6μg/L,P<0．01:HA: 132．3±71 μg/L vs 192．0±97 μg／L,P<0．05)．结论:Vit A可以抑制ALD患者肝脏纤维化的形成,其机制可能是Vit A参与肝星状细胞 (HSC)的代谢,从而抑制胶原的释放．     

重型肝炎患者血清胰岛素样生长因子-1含量及其临床意义

目的:研究重型肝炎患者血清胰岛素样生长因子(IGF-1)含量的动态变化及其对评估重型肝炎预后的意义.方法:采用ELISA定量检测47例重型肝炎患者及18例健康体检者血清IGF-1含量,同时检测有关肝功能指标.结果:死亡组治疗前IGF-1含量显著低于正常对照[(186.37±71.46)ng/ml vs (247.06±48.81)ng/ml,P＜0.01],其死亡前含量显著低于入院时含量[(131.70±43.79)ng/ml vs (186.37±71.46)ng/ml,P＜0.01].存活组治疗前IGF-1含量和正常对照组差异无显著性意义[(209.44±71.96)ng/ml vs (247.06±48.81)ng/ml,P＞0.05],其治疗后含量显著高于死亡组死亡前含量[(198.55±56.68)ng/ml vs (131.70±43.79)ng/ml,P＜0.01].IGF-1含量和部分肝功能指标(PTA、CHO、CHE)相关(P＜0.05).结论:IGF-1可以反映肝细胞增生情况,动态检测能较好预测重型肝炎发展趋势,对评估重型肝炎预后有一定价值.     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

Inhibition of intimal thickening of the carotid artery of rabbits and of outgrowth of explants of aorta by probucol.

The effect of administration of probucol in preventing intimal thickening of rabbit carotid artery after balloon catheter injury and the mechanism of action of the drug were studied. Groups of 6 male New Zealand-White rabbits were given normal diet (Group I), high cholesterol diet (Group II) or high cholesterol diet plus probucol (Group III) for 4 weeks. Balloon catheter injury was made in week 2 and animals were killed in week 4. No significant differences in the total cholesterol levels in Groups II and III were found in week 4. The medians of areas of the intimal layer in cross-sections of the carotid arteries of Groups I, II and III were 0.237, 0.475 and 0.309 mm2, respectively. Thus high-cholesterol diet increased the thickness of the intimal layer and probucol reduced its effect. There were no significant differences in the areas of the medial layers in these 3 groups. For the examination of the mechanism of the effect of probucol, rabbits were given chow containing 0.5% cholesterol with and without 0.5% probucol (7 rabbits each) and then the numbers of explants from their aortas showing outgrowth were compared. The plasma total cholesterol levels of these two groups were the same. The probucol concentrations in the plasma and aorta of the former group were 18.6 +/- 13.2 micrograms/ml and 7.3 +/- 5.4 micrograms/g wet tissue, respectively. The number of explants showing outgrowth on day 14 was suppressed by 34% in the probucol-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)