肝衰竭的临床诊断、预后评估和治疗进展

肝衰竭病情进展迅速,预后差,是重型肝炎患者死亡的主要原因之一。叙述了肝衰竭的临床诊断、预后评估及治疗方法,指出尽管国内外对肝衰竭诊断存在不同观点但也渐趋一致。目前,终末期肝病模型评分是较常用的评判肝衰竭严重程度和预后的方法。经过长期探索和努力,发现内科综合治疗联合人工肝治疗能显著提高肝衰竭患者的存活率,认为干细胞移植是未来临床治疗肝衰竭的新方法,展示出良好的应用前景。     

精准医学与肝衰竭治疗策略

肝衰竭是最严重的临床疾病类型之一,其临床救治成功率较低。精准医学概念的提出为肝衰竭治疗研究提供了更多启示。从准确认识精准医学的科学内涵,利用先进技术提高肝衰竭的精准诊断水平;寻找肝衰竭治疗新靶点,阻断肝细胞坏死;以及采用基因技术实现肝衰竭的精准用药与个体化生物治疗等方面进行了阐述,认为肝衰竭的精准诊断和治疗有利于提高其救治水平。     

防微杜渐,关注肝衰竭前期诊疗

肝衰竭病情重、进展快、病死率甚高,在肝衰竭发生前期进行早期预警,早期干预,对改善患者预后至关重要。目前关于肝衰竭前期的诊断标准尚不统一,关于肝衰竭前期的研究主要集中在乙型肝炎相关肝衰竭人群中进行,现就目前肝衰竭前期早期诊断、预警及治疗展开讨论。     

肝功能衰竭的诊断和治疗现状

肝功能衰竭(简称肝衰竭)是临床常见的严重肝病症侯群,其预后不良,病死率甚高(可达50%～90%),严重威胁人类健康,也是临床医师最具挑战的疾病之一。多年来,各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索,但迄今尚无一致意见,而临床对肝衰竭的认识、早期正确的诊断和治疗对于救治肝衰竭患者尤为重要。本文拟就肝衰竭的诊断和治疗进展作一综述。肝功能衰竭的定义和病因[1]定义肝衰竭是由多种病因引起的严重肝损伤,表现肝脏合成、代谢、排泄和解毒等功能严重障碍和失代偿,出现以黄疸、凝血功能障碍、肝性脑病和腹水等为主要表现的…     

肝衰竭诊疗指南

肝衰竭是临床常见的严重肝病症候群,病死率极高。多年来,各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索,但迄今尚无一致意见。2005年美国肝病学会发布了对急性肝衰竭处理的建议[1],国内迄今尚无肝衰竭的诊断治疗指南。为适应临床工作需要,规范我国肝衰竭的诊断和治疗活动,中华医学会感染病学分会和中华医学会肝病学分会组织国内有关专家,制订了我国第一部《肝衰竭诊疗指南》(以下简称《指南》)。本指南的制定遵守了循证医学原则,借鉴了国内外最新研究成果,力求与国际接轨。其中推荐意见所依据的证据共分为3个级别5个等级(表1…     

肝衰竭合并侵袭性真菌病的诊断策略

肝衰竭患者发生侵袭性真菌病(IFD)的危险性增加,致死率增加,早期诊断、及时治疗是改善预后的关键。笔者梳理了肝衰竭合并IFD的流行情况及危险因素、肝衰竭患者的早期识别、肝衰竭合并IFD的诊断、中医对肝衰竭合并真菌感染的认识等内容。肝衰竭患者凝血机制差,获取病理确诊较为困难,详细分析患者的危险因素、早期识别临床特征、及时进行血液/体液微生物学检测是早期诊断的重要策略。     

聚焦肝衰 共谋发展——第二届京津冀肝衰竭国际论坛、肝衰竭临床诊疗与前沿进展学习班会议报道

正2017年9月15日—9月16日,第二届京津冀肝衰竭国际论坛、肝衰竭临床诊疗及前沿进展学习班在北京隆重开班。本次大会的主题为"传承发展、合作创新"。会议围绕以下几个专题进行了报告和交流:(1)肝衰竭患者的分级管理探索;(2)肝衰竭基础研究进展;(3)肝衰竭的临床治疗;(4)肝衰竭相关并发症的诊断和治疗;(5)肝移植面临的挑战。     

肝衰竭诊治指南(2012年版)

肝衰竭是临床常见的严重肝病症候群,病死率极高.多年来,各国学者对肝衰竭的定义、病因、分类、分型、诊断和治疗、预后判断等问题不断进行探索.2005年,美国肝病学会(AASLD)发布了《急性肝衰竭处理》的意见书(position-paper)[1].2006年10月,中华医学会感染病学分会肝衰竭与人工肝学组和中华医学会肝病学分会重型肝病与人工肝学组制订了我国第一部《肝衰竭诊疗指南》[2],从定义、诱因、分类、诊断和治疗等方面对肝衰竭进行了系统而精要的阐述,既与国际接轨,又具中国特色,诊断分型突出了实用性,指导和规范了我国肝衰竭的临床诊疗.2009年,亚太肝脏研究协会(APASL)推出了《慢加急性肝衰竭共识》[3].     

肝衰竭诊疗指南

肝衰竭是临床常见的严重肝病症候群，病死率极高。多年来，各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索，但迄今尚无一致意见。2005年美国肝病学会发布了对急性肝衰竭处理的建议，国内迄今尚无肝衰竭的诊断治疗指南。为适应临床工作需要，规范我国肝衰竭的诊断和治疗活动，中华医学会感染病学分会和中华医学会肝病学分会组织国内有关专家，制订了我国第一部《肝衰竭诊疗指南》（以下简称《指南》）。本指南的制定遵守了循证医学原则，借鉴了国内外最新研究成果，力求与国际接轨。其中推荐意见所依据的证据共分为3个级别5个等级（表1），文中以括号内斜体罗马数字表示。     

肝衰竭并发侵袭性真菌病的诊治及预防

肝衰竭的并发症临床上表现复杂多样,极易并发局部或全身的侵袭性真菌病(IFD),继发其他脏器的损伤,从而导致肝损伤的进一步加重,使其形成"恶性循环"的病理进程,最终导致多脏器功能衰竭,病死率极高,成为临床处理中的"棘手问题"。介绍了肝衰竭并发IFD的原因、症状、诊断、治疗、预后、预防等方面的研究进展,探讨了近年来关于肝衰竭并发IFD的一些共识和争议,阐述其研究的意义及前景,旨在提高肝衰竭并发IFD的临床诊断和治疗水平。     

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)