乙肝表面抗原携带状态结核患者抗结核治疗对肝损害的影响分析

目的研究抗结核治疗中乙肝表面抗原携带状态与肝损害的关系。方法选择武汉市结核病医院乙肝表面抗原阳性的活动性结核,并接受了3个月以上的抗结核药物治疗的病例156例作为病例组,以接受了3个月以上的标准抗结核治疗的非乙肝表面抗原携带者141例为对照组。进行回顾性病例对照研究。结果乙肝病毒携带组出现中-重度肝损害的病人的比例较对照组显著高。在肝损害恢复后,即使是乙肝病毒携带者,再次使用一线抗结核药也是安全有效的。结论对于HB-sAg阳性,HBeAg阴性的非活动性乙肝携带者可以进行常规的抗结核治疗,在每个月进行肝功能检测的情况下,可以采用推荐的包括异烟肼,利福平,乙胺丁醇和/或吡嗪酰胺的抗结核治疗方案。     

HBV携带结核患者抗结核治疗中肝功能变化的临床分析

目的研究乙肝病毒携带结核患者抗结核治疗对肝功能的影响。方法选择我院住院的活动性肺结核患者338例,其中乙肝病毒携带肺结核患者36例,无乙肝病毒携带肺结核患者302例,对抗结核治疗中肝功能变化进行回顾性分析。结果HBV携带结核患者有30.6%出现肝损害,而对照组只有15.9%。HBV阳性组在治疗前ALT分层统计,A组(男≤30U/L,女19≤U/L)与B组(男31～40U/L,女20～40U/L),抗结核治疗后发生肝损害分别为24.1%、57.1%。A、B两组有显著性差异。结论乙肝病毒携带结核患者抗结核治疗易出现肝损害,肝功能ALT正常值上限(ULN)采用男30U/L,女19U/L较目前男女均为40U/L更为安全可靠。     

2HRS(E)Z/4HR方案对肺结核合并乙肝阳性患者肝功能的影响

目的　观察分析了 6 81例 2 HRS(E) Z/ 4 HR方案对 HBV- M阳性患者头 3个月强化治疗期对肝功能的影响。方法　对12 8例慢性乙肝病毒阳性携带者 HBs Ag(+) ( 组 )以及 87例活动性肝炎患者 ( 组 )与 4 6 6例 HBV- M阴性 ( 组 )肺结核患者在接受 2 HRS(E) Z/ 4 HR方案抗结核治疗时的肝功能异常。结果　肝损害发生率分别为 : 组 2 7例 (2 1.0 9% ) , 组 4 4例 (5 0 .4 8% ) , 组 6 9例 (14 .8% )。 组与 组、 组之间经统计学处理均有显著差异 (p<0 .0 1)。而 组与 组之间无明显差异 (p>0 .0 5 )。结论　乙肝病毒阳性健康携带者合并肺结核患者 ,可予有效抗结核治疗 ,但活动性肺结核患者在接受 2 HRS(E) Z/ 4 HR方案抗结核治疗时 ,肝损率较高且程度严重 ,应高度重视     

368例肺结核患者抗结核药物所致肝功能损害的临床分析

目的探讨临床应用的一线抗结核药物引起肝损害状况。方法对比分析乙肝病毒感染单纯HBsAg(+)、HBsAg(+)和HBeAg(+)、HBsAg(+)和HBeAb(+)以及丙肝病毒携带者和肝炎病毒阴性患者之间经过抗结核治疗后肝功能损害情况。结果368例病例中,肝功能损害总的发生率为16.4%(59/358),乙肝HBeAg(+)、乙肝HBeAb(+)及丙肝病毒感染组发生肝功能损害的比率明显高于乙肝病毒阴性组和单纯HBsAg(+)组,乙肝病毒阴性组和单纯HBsAg(+)组发生肝功能损害的情况统计学上无差异。同时还发现,大于60岁年龄组发生肝功能损害的几率要明显高于小于60岁的年龄组。结论合并肝炎病毒感染、老年、是抗结核药物引起肝功能损害的主要危险因素,临床应用抗结核药物时,针对此类病人需密切关注其肝功能损害情况。     

抗结核药物对肝功能影响及其对策

几十年来抗结核化疗对结核病疫情控制起了很大作用 ,但我国是乙型肝炎的高发区 ,乙肝病毒标志物阳性携带者相当普遍 ,携带率 10 %。同时 ,多数抗结核药物对肝脏有不同程度的损害 ,尤其是结核伴有乙肝病毒标志物 (HBVM)阳性的患者。在接受抗结核治疗中药物对肝功能的影响文献报道不一 ,因此 ,探讨抗结核治疗中出现肝损时的影响因素 ,现将我院收治的 174 5例肺结核患者中出现肝损的 161例 ,其中 HBVM阳性的 175例、阴性的 14 90例、以及未检 HBVM80例出现肝损者的情况作一探讨。1　资料与方法1994年～ 1999年 12月在我院收治的 174 5例肺…     

368例肺结核患者抗结核药物所致肝功能损害的临床分析

目的 探讨临床应用的一线抗结核药物引起肝损害状况.方法 对比分析乙肝病毒感染单纯HBsAg（＋）、HBsAg（＋）和HBeAg（＋）、HBsAg（＋）和HBeAb（＋）以及丙肝病毒携带者和肝炎病毒阴性患者之间经过抗结核治疗后肝功能损害情况.结果 368例病例中,肝功能损害总的发生率为16.4%（59/358）,乙肝HBeAg（＋）、乙肝HBeAb（＋）及丙肝病毒感染组发生肝功能损害的比率明显高于乙肝病毒阴性组和单纯HBsAg（＋）组,乙肝病毒阴性组和单纯HBsAg（＋）组发生肝功能损害的情况统计学上无差异.同时还发现,大于60岁年龄组发生肝功能损害的几率要明显高于小于60岁的年龄组.结论 合并肝炎病毒感染、老年、是抗结核药物引起肝功能损害的主要危险因素,临床应用抗结核药物时,针对此类病人需密切关注其肝功能损害情况.     

抗结核药物性肝损伤临床危险因素分析

目的分析肺结核化疗中发生抗结核药物性肝损伤(ATLI)的临床危险因素。方法收集2013年1月到2014年7月期间在我院住院治疗的肺结核合并抗结核药物性肝损伤病例100例为观察组,随机抽取同一时间段在我院住院治疗的肺结核无合并抗结核药物性肝损伤病例100例为对照组,采用回顾性病例对照研究的方法,用Logistic多因素回归分析法对所有的病例肺结核病的初/复治、肺结核病变范围、痰涂片找结核菌情况,合并肺外结核、乙肝表面抗原携带者、嗜酒史、原有除乙肝外的其它肝病史、糖尿病、呼吸衰竭、心功能不全、低蛋白血症、贫血共12个因素进行统计学处理,分析影响抗结核药物性肝损伤的危险因素。结果 Logistic多因素回归分析显示抗结核药物性肝损伤的危险因素包括乙肝表面抗原携带者(OR=3.113、P=0.005)、嗜酒史(OR=3.427、P=0.008)、原有除乙肝外的其它肝病史(OR=2.359、P=0.032)、呼吸衰竭(OR=1.622、P=0.045)、心功能不全(OR=1.700、P=0.015)、低蛋白血症(OR=1.860、P=0.012)和贫血(OR=1.718、P=0.014)等7项。结论乙肝表面抗原携带者、嗜酒史、原有除乙肝外的其它肝病史、呼吸衰竭、心功能不全、低蛋白血症和贫血是抗结核药物性肝损伤的危险因素。     

中医中药治疗无症状乙型肝炎表面抗原携带者疗效观察

为探索中医中药对清除乙型肝炎病毒(HBV)复制的作用,我院门诊部于1986年至1987年应用中医中药治疗无症状乙肝表面抗原携带者(ASC)25例,用干扰素合剂治疗25例为对照,现报告如下。资料和方法一、一般资料:治疗组男性14例,女性11例;年龄自5～47岁,平均年龄26.5岁,HBsAg 携带时间在1年内者8例,1年以上17例,最短6个月,最长10余年;干扰素组的年龄、性别及携带 HBsAg 时间与治疗组相似,有可比性。二、病例选择:(1)血清 HBsAg 阳性持续在6个月以上;(2)肝功能试验正     

SARS与乙肝病毒的关系探讨

探讨SARS(重症急性呼吸综合征)并发肝功能损害及其与乙肝病毒的关系。观察SARS患者108例，其中同时有乙肝病毒携带者38例(A组)，无任何肝病基础的有46例(B组)，SARS患者有脂肪肝基础病的有24例(C组)，比较各组SARS患者肝损害的程度以及乙肝病毒变异的关系。有乙肝病毒(HBV)携带的SARS患者肝损害的程度显著高于无HBV感染者，同时并发重症肝炎的机率明显增高，在乙肝病毒携带者感染SARS病毒后极易诱发病毒野生株增多。有脂肪肝基础的SARS患者和无脂肪肝患者肝损害无显著差异。有乙肝病毒感染或病毒携带者的SARS患者需密切观察肝功能积极防治急性肝细胞坏死。     

蛋白质营养不良对抗结核药物肝损害的影响

目的 探讨合并蛋白质营养不良的肺结核病患者使用抗结核药物后对肝功能的影响.方法 选取2012年9月至2015年3月我院收治的250例肺结核合并蛋白质营养不良的患者作为观察组和同期住院治疗的250例肺结核非合并蛋白质营养不良的患者作为对照组,整理患者相关临床资料.两组患者均采用常规抗结核药物治疗,观察并比较两组患者治疗第1个月和第2个月后患者肝损害的情况以及采用单因素分析观察组患者中年龄、性别、肝炎病毒和病灶范围与抗结核药物治疗后肝损伤的相关关系.结果 观察组患者治疗第1个月后肝损害的发生率明显高于对照组,差异有统计学意义(x2 =4.691,P＜0.05),而治疗第2个月后肝损害的发生情况差异无统计学意义(x2=1.109,P＞0.05);两组患者治疗第2个月后肝损害的发生率均明显低于治疗第1个月后,差异有统计学意义(x2=23.859、5.554,P值均＜0.05);观察组患者中性别、乙肝表面抗原(HBsAg)、结核病灶的范围以及患者的年龄与患者抗结核药物治疗后是否发生药物肝损害不存在特定的相关关系(x2=2.084、0.703、1.473、0.119,P值均＞0.05).结论 肺结核病患者合并蛋白质营养不良能明显升高抗结核药物治疗后肝损害的发生率,因此需对患者的肝功能进行密切监测,及早进行临床干预,并注意改善患者的营养状况,减少肝损害的发生.     

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.     

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.     

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.     

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.