87例慢性乙型肝炎肝穿刺活检临床病理分析

目的探讨肝穿刺活检对慢性乙型肝炎病毒感染者肝组织病理情况及乙肝合并肝占位病因诊断意义。方法对87例慢性乙肝表面抗原（HBsAg）或乙肝病毒（HBV-DNA）阳性及乙肝合并肝占位患者,采用细针快速穿刺活体肝组织及肿瘤病理检查,分析肝组织损伤程度与临床诊断对照,肿瘤的分类。结果87例慢性乙型肝炎患者中,无症状携带者15例,临床与病理诊断符合率为73.3%。慢性乙型肝炎轻度38例,临床与病理诊断符合率为76.3%。慢性乙型肝炎中度12例,临床与病理诊断符合率为50.0%。慢性乙型肝炎重度9例,临床与病理诊断符合率为77.8%。慢性乙型肝炎伴肝硬化13例,临床与病理诊断符合率为76.7%。慢性乙型肝炎并肝脏肿瘤者,肝脏都有不同程度改变。结论慢性乙型肝炎肝穿刺活检显示,临床与病理诊断存在差异,对临床表现不典型而病理改变显著者,需要进行治疗观察、随访。另外能早期发现肝肿瘤及肝肿瘤定性诊断,为临床诊断和治疗提供重要依据。     

护理干预对慢性肾功能衰竭患者肝活检术后并发症的影响

<正>我国为乙型肝炎的高发区,许多慢性肾衰终末期准备接受肾移植的患者合并有乙型肝炎病毒感染~([1]),然而肾移植术后必须应用的大量免疫抑制药物,对已有肝炎病毒感染的患者会导致肝功能恶化甚至衰竭,成为肾移植术后重要死亡原因之一。经皮肝脏穿刺组织活检术(简称肝穿术)是明确肝脏疾病诊断,或了解肝病演变过程、观察治疗效果以及判断预后,被国内外公认为判断肝脏损害病因和程度的"金标准"~([2])。     

超声诊断慢性乙型肝炎纤维化的临床价值

目的:探讨弹性超声诊断慢性乙型肝炎纤维化的临床应用价值。方法:选择46例慢性乙型肝炎纤维化患者,利用超声弹性成像技术全面检查肝脏区,根据图像判断肝组织的软硬程度,从而分析肝纤维化的程度,并进行组织活检验证其准确程度。结果:肝纤维化弹性超声诊断结果与病理活检结果一致性较高。结论:弹性超声能够获取组织内部的弹性分布的定量信息,对肝脏纤维化程度的分析有重要应用价值。     

慢性乙型肝炎B超诊断与肝活检病理结果的关系

目的:探讨B超在慢性乙型肝炎(慢乙肝)诊断中的作用。方法:对45例慢性乙型肝炎患者B超检查与肝活检病理检查进行对比分析。结果:B超肝回声异常与肝组织纤维化程度显著相关(P<0.01),与肝炎症活动度无统计学意义。慢乙肝B超诊断与病理诊断比较差异有显著性(P<0.05)。结论:目前B超检查对慢乙肝诊断的准确率不高,不能判定肝组织内炎症活动度,对肝纤维化方面有一定参考价值。     

慢性乙型肝炎患者血清肿瘤坏死因子-α与肝脏病理分度的关系

目的:探讨慢性乙型肝炎患者血清肿瘤坏死因子-α(TNF-α)水平与肝脏病理炎症程度的关系和临床应用的价值.方法:选择慢性乙型肝炎患者90例和体检正常的健康者30例,均采用酶联免疫吸附法(ELISA)检测血清TNF-α水平,并对其中60例患者行肝组织活检.结果:TNF-α均值随着肝脏病理炎症程度分级和肝纤维化分期的加重而逐渐增高,各组间比较有显著性差异(P＜0.01).结论:慢性乙型肝炎患者血清TNF-α与肝脏病理分度有密切的关系,其水平变化可作为判定肝组织分度的参考指标.     

慢性乙型肝炎穿刺活检与临床诊断结果的对比观察

目的探讨肝穿刺活检在慢性乙型肝炎病理诊断与临庆诊断结果之间的关系。方法对186例慢性乙型肝炎患者进行肝穿刺活检，并行病理炎症分级和纤维分期，比对临床诊断结果，探讨病理分级、分期与临床诊断结果之间的关系。结果在186例慢性乙型肝炎诊断中，临床与病理诊断符合率为65．05％，常常是临床诊断轻，病理诊断重。结论肝活体组织检查在肝炎临床中占有重要位置，对选择和应用抗病毒药物并对其疗效进行评估，发现早期、不甚活动的肝硬化，对患者的预后作出判断，肝穿刺活检有重要的、不可替代的作用。     

用重组人α干扰素治疗慢性非甲非乙型肝炎

非甲非乙型肝炎是肝疾病和肝硬化常见的重要病因,也是输血后肝炎的主要病因,它占散发性肝炎病例的20～40％。非甲非乙型肝炎有发展成慢性肝疾病的明显倾向。在高达60～70％的输血后非甲非乙型肝炎病例中,病人的血清转氨酶浓度持续升高一年以上。尽管许多慢性非甲非乙型肝炎病例无症状和症状轻微,但约15～25％的病人可出现明显的肝损害,隐匿地发     

慢性乙型肝炎肝病变与体液免疫应答关系的初步探讨

<正> 乙型肝炎病毒(HBV)感染导致部分患者发展为乙型病毒性肝炎,且肝病变的程度与乙型肝炎病毒标志物(HBVM)有关。目前,较统一的观点认为,HBV本身并不引起肝组织损害,造成肝组织损害的原因是HBV感染后导致肝脏的一系列炎症反应,而导致炎症反应的主要原因之一是机体对HBV的免疫反应,少数患者发展为慢性乙型肝炎,主要是机体的免疫机制异常所致。为了探讨慢性乙型肝炎肝病变与体液免疫应答的关系,本文对483例肝组织活检诊断为慢性肝炎患者的血清HBVM进行了     

慢性肝脏疾病的无创检测时代

我国是个慢性肝病高发区,乙型肝炎病毒感染者占全球1/3,曾有"十亿人口,一亿乙肝"之说;脂肪性肝病患病率已达到发达国家水平;药物性肝损害逐年增加……慢性肝病若不能早期发现、不经过合理治疗,可由肝纤维化发展为肝硬化,甚至肝癌。所以正确评估慢性肝病病情非常重要。     

肝组织FasL表达与病程演变关系的研究

目的 通过研究凋亡相关分子FasL在肝组织的表达情况,探讨慢性乙型肝炎的发病机制.方法 以免疫组化方法检测68例慢性乙型肝炎的活检组织单核细胞、肝细胞以及肝窦细胞FasL表达情况.结果 FasL在浸润的单核细胞以及病变肝细胞的胞浆内高表达,其表达程度和肝组织炎症坏死程度正相关.结论 通过FasL-Fas机制介导乙肝病毒感染的肝细胞凋亡是慢性乙型肝炎发病及炎症活动的重要机制之一,FasL阳性肝细胞可能发挥细胞毒效应,发生自杀效应.     

Liver

<正>209293 Probing into indication of living-related Liver Transplantation for Wilson’s disease/Cheng Feng(Liver Transplant Center,1st Hosp Nanjing Med Univ,Key Lab Living Donor Liver Transplant,Minist Public Health,Nangjing 210029)…∥Chin J Surg.-2009,47(6).-437~440Objective To probe into indication of living-related liver transplantation(LRLT)for Wilson’s Disease.Methods From January 2001 to February 2007,thirty-seven living-related liver transplants were performed.A retrospective analysis was carried on outcome of those patients.The indications for LRLT were acute hepatic failure in 3 patients and chronic advanced liver disease in 32 patients including 13 patients with Wilsonian neurological manifestations.Two patients presented with severe Wilsoian neurological manifestations even though their liver functions were stable.According to the scoring system for evaluation of the neurological impairment in Wilsion disease based on neurological signs and functions(total score was 30),the pre-transplantation score of those patients with neurological manifestations was 15.9±4.3(n=15).Results Thirty-seven patients were followed up for 20-93 months.The survival rates of post-transplant patients and grafts at 1,3,and 5 year were 91.9%,83.8%,75.7%,and 86.5%,78.4%,75.7%,respectivly.Postoperative surgical complications occurred in 2 donors with bile leakage required drainage,in 2 recipients with hepatic thormbosis underwent retransplantation of cadeveric liver and in 1 recipient with hepatic stenosis required balloon dilatation.Neurological function was improved in all recipients and the score of posttransplantation at 6,12,18,24,and 30 months was 17.5±3.7(n=13);21.0±4.3(n=12);23.9±3.9(n=10);26.6±2.2(n=10)and 28.1±1.9(n=7)respectively.Conclusion Patients with acute hepatic failure or patients with severe liver disease unresponsive to chelation tratment should be treated with LRLT.Early transplantation in patients with an unsatisfactory response medical tratment may prevent irreversible neurologica     

Liver

<正>209461 Intraoperative ligation of recipient’s portasystemic shunt in liver transplantation/Chen Litian(,Organ Transplant Center,Tianjin 1st Centr Hosp Tianjin 300192)…∥Chin J Gen Surg.-2009,25(4).-489～491Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation.Methods From January 2007 to August 2008,35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan,among them 23 patients had spontaneous major portasystemic shunts,the other 12 patients did not have portasystemic shunts.16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry.The shunt of the other 7 patients were left untreated.Results The portal blood flow in the 12 patients without portasystemic shunt judged by preoperative CT scanning were(1 101±70)ml/min.The shunts in 7 patients with portal blood flow greater than 1 000 ml/min were not ligated,that of the 16 patients with portal blood flow volume lower than 1 000 ml/min were ligated.The portal blood flow volume in those 16 patients before and after ligating the shunt were(657±112)ml/min and(1 136±161)ml/min,respectively(P<0.05).Postoperatively 2 patients suffered from portal vein thrombosis,among them 1 patients suffered from intermittent disturbance of consciousness,2 patients died within 3 months,with one died of respiratory failure from pulmonary aspergillus infection,one died of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive.Conclusion The ligation of portasytemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1 000 ml/min.5 refs,2 figs.     

Liver

Alleviation of ischemia-reperfusion injury in rat liver donors by induction of exogenous hTERT gene;Effects of surgical technique on acute renal failure after orthotopic liver transplantation in patients with end-stage liver disease at high risk： a report of 90 eases;Timing for liver transplantation for chronic severe hepatitis;Analysis of bacterial variance and drug resistance after orthotopic liver transplantation;The influence of splenectomy on orthotopic liver transplantation and its management     

Liver

<正>209604 The suppressive effect of CD8+ CD28-regulatory T cells from spontaneous tolerance models on the acute rejection responses in rat liver transplantation/Chen Ning(陈宁,Dept Gastroenterol,Peking Univ Peop Hosp,Beijing 100044)…∥Chin J Organ Trans-plant. -2009,30(9). -524 ～526     

Liver

<正>209087 Clinical analysis of outcome of invasive fungal infection after kidney transplantation/Chen Guodong(陈国栋,Dept Transplant Surg,1st Hosp,Sun Yat sen Univ, Guangzhou 510080)…∥Chin J Organ Transplant. -2009, 30(10). -616～619 Objective To explore the outcome of invasive fungal infection in kidney transplantation and the influencing factors.     

Liver

Prevention and treatment of artery complication after liver transplantation by HBO , Clincal feature of cytomegabvirus pneumonia in orthtopic liver-transplantation and treatments, Risk factors of diabetes mellitus following orthotopic liver transplantation , Re-infection of hepatitis B virus after liver transplantation , Diagnosis and treatment of fungal infection after orthotopic liver transplantation , Two successful adult-to-adult living donor liver transplantation using dual grafts     

探讨脂肪肝供肝在肝脏移植中的价值

目的探讨应用不同脂肪沉着程度供肝对肝移植患者预后的影响。方法选取64例进行肝移植术患者,依据供肝浸润程度,随机分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组、无脂肪肝组共四组,每组各16例,比较四组患者肝功能(主要观察ALT、AST指标)、入住ICU的平均时间、1年移植物成活率、移植物原发无功发生率。结果轻度脂肪肝组入住ICU的平均时间、ALT和AST水平、移植物原发无功发生率与无脂肪肝组接近;中度脂肪肝组入住ICU平均时间、ALT和AST水平均较轻度组和无脂肪肝组明显增高,P0.05;重度脂肪肝组入住ICU平均时间、ALT和AST水平、移植物原发无功发生率明显较前三组为高,P0.05。结论轻、中度肝脏脂肪浸入可作为肝移植供肝,重度脂肪肝不能作为供肝的选择目标。     

Microenvironment of Liver Regeneration in Liver Cancer

The occurrence and development of liver cancer are essentially the most serious outcomes of uncontrolled liver regeneration. The progression of liver cancer is inevitably related to the abnormal microenvironment of liver regeneration. The deterioration observed in the microenvironment of liver regeneration is a necessary condition for the occurrence, development and metastasis of cancer. Therefore, the use of a technique to prevent and treat liver cancer via changes in the microenvironment of liver regeneration is a novel strategy. This strategy would be an effective way to delay, prevent or even reverse cancer occurrence, development and metastasis through an improvement in the liver regeneration microenvironment along with the integrated regulation of multiple components, targets, levels, channels and time sequences. In addition, the treatment of "tonifying Shen (Kidney) to regulate liver regeneration and repair by affecting stem cells and their microenvironment" can regulate "the dynamic imbalance between the normal liver regeneration and the abnormal liver regeneration"; this would improve the microenvironment of liver regeneration, which is also a mechanism by which liver cancer may be prevented or treated.