物理型和中间型人工肝对肝衰竭支持效果的比较研究

目的 :比较物理型 (血液灌流吸附 )及中间型 (血浆置换 )人工肝支持方法对肝衰竭患者肝功能的支持效果、安全性。方法 :4 1例重型肝炎肝衰竭患者分别进行血液灌流吸附 (2 4例 5 2例次 )和血浆置换 (17例 3 6例次 )治疗 ,观察治疗前后患者临床症状体征变化 ,比较治疗前后肝肾功能、血常规、PT变化。结果 :血液灌流吸附和血浆置换治疗后 ,患者的临床症状均有不同程度改善。两种方法治疗后转氨酶、总胆红素、直接胆红素下降均有显著性意义 (P <0 0 5或P <0 0 1) ,血浆置换治疗后凝血酶原时间、总蛋白下降 ,凝血酶原活动度升高均有显著性意义 (P <0 0 5或P <0 0 1) ,比较两种治疗方法的上述指标变化程度均无显著性意义 (P >0 1或P >0 2 5 )。两种治疗方法的不良反应均较轻。结论 :物理型、中间型人工肝对重型肝炎肝衰竭患者的肝功能均有肯定的支持效果 ,中间型人工肝的支持效果与物理型人工肝无显著差异。     

纳洛酮联合醒脑静治疗肝性脑病疗效观察

目的观察纳洛酮联合醒脑静治疗昏睡期肝性脑病的临床疗效。方法 80例肝性脑病患者随机分为治疗组和对照组,对照组在常规抗肝性脑病的基础上单用纳洛酮或醒脑静;治疗组在常规抗肝性脑病基础上加用纳洛酮联合醒脑静治疗,治疗前后检查血氨指标、神志清醒时间,评价临床分期。结果 治疗组治疗后血氨含量下降程度(76±umol/L),清醒时间(5.65±2.45h),临床分期评价(有效率78%)明显优于对照组,差异有统计学意义。结论 纳洛酮联合醒脑静治疗昏睡期肝性脑病较单独使用有明显的优势。     

人工肝血浆置换术治疗重型肝炎的临床护理

目的：探讨人工肝血浆置换术治疗重型肝炎的临床护理措施及效果。方法选取行人工肝血浆置换术治疗重型肝炎患者78例，将其随机分为对照组和观察组，每组39例。对照组采取保守治疗，治疗组在对照组的基础上给予人工肝血浆置换术治疗，并给予精心、全面的护理。结果观察组总有效率82.1％，明显优于对照组总有效率59.0％，组间差异有统计学意义（P＜0.05）。治疗组出现3例酸中毒，血浆过敏反应及血压下降各1例，经对症处理后均缓解或消失。结论对于重型肝炎患者，在支持治疗的基础上配合人工肝血浆置换术治疗安全、有效，同时经精心护理和密切观察，能够有效减少并发症的发生。     

食醋保留灌肠疗法治疗肝性脑病的临床效果观察

目的 探讨肝性脑病患者食醋保留灌肠疗法的效果.方法 随机将50例肝性脑病患者分为两组,一组为观察组,在常规治疗基础上加用食醋60ml 和0.9%生理盐水140ml配制成的灌肠液行点滴保留灌肠法灌肠,每天一次,连续7天为一疗程.另一组为对照组:给予基础常规治疗后行0.9%生理盐水200ml灌肠.观察两组治疗效果及护理.结果 灌肠后血氨水平及肠道pH值均较前明显下降(P<0.01),神志清醒好转.两组比较差异有显著性(P<0.05).结论 用30%食醋保留灌肠能促进肝性脑病的好转,提高肝性脑病患者的治疗效果,疗效可靠,值得推广.     

人工肝少量血浆置换+胆红素吸附在重型肝炎肝衰竭中的应用

目的 观察重型肝炎肝衰竭患者采取人工少量血浆置换+胆红素吸附治疗的临床效果,并分析患者预后的影响因素.方法 选取住院治疗的重型肝炎肝衰竭患者100例作为研究对象,采取人工少量血浆置换+胆红素吸附治疗,观察治疗前后各项肝肾功能生理指标变化及预后的影响因素.结果 100例重型肝炎肝衰竭患者中68例有效存活,存活率为68％;治疗后无效死亡的有32例,死亡率为32％.结论 年龄≥50岁、胆酶分离、肝性脑病、肝肾综合征、电解质紊乱、消化道出血以及肝脏萎缩等均是影响患者预后的因素,这为以后血浆置换联合胆红素吸附治疗肝衰竭患者的选择提供了一定的依据,且人工少量血浆置换+胆红素吸附治疗重型肝炎肝衰竭效果显著.     

非生物型人工肝对高原地区慢性重型肝炎支持效果对比分析

目的：观察非生物型人工肝支持系统血浆置换治疗高原地区慢性重型肝炎支持疗效。方法：分析2006年9月—2007年8月我科行人工肝血浆置换治疗的16例慢性重型肝炎（来自我省不同海拔高度地区2000m～3680m）,共治疗38人次,平均每例患者（1～4）次。观察治疗前后肝功谷丙转氨酶（ALT）、血清总胆红素（TBIL）、血清白蛋白（ALB）、凝血酶原时间及活动度（PT、PTA）,血氨（NH3）等生化指标及临床症状。结果：每次治疗后患者的谷丙转氨酶、血清总胆红素、血氨均明显下降,凝血酶原时间缩短,血清白蛋白及凝血酶原活动度显著提高,患者的临床症状有不同程度改善。结论：非生物型人工肝支持系统能有效改善高原地区慢性重型肝炎患者的临床症状及生化指标,防止因高原低氧环境导致的肝细胞坏死进一步加重,为肝细胞的再生修复及肝移植赢得了时间,是高原地区治疗重型肝炎的一种有效方法。     

人工肝治疗药物性肝衰竭疗效观察

目的探讨人工肝支持系统（AISS）治疗药物性肝衰竭临床疗效。方法24例药物性肝功能衰竭患者在综合护肝治疗基础上给予ALSS（包括血浆置换、血液灌流）治疗，观察患者临床症状，肝功能、血氨、凝血酶原活动度的变化。结果ALSS治疗后，患者临床症状均得到不同程度的改善；血浆总胆红素、直接胆红素、丙氨酸转氨酶、天门冬氨酸转氨酶、血氨较治疗前明显降低（P〈0．01或P〈0．05），PTa上升（P〈0．05）；有效率（治愈或好转）为79．2％。不良反应较轻。结论ALSS治疗药物性肝衰竭安全、有效。     

人工肝支持系统在重型肝炎中的应用研究

 目的 探讨人工肝支持系统对重型肝炎的疗效。方法 应用宁波产HP-200型血液净化仪对36例重型病毒性肝炎进行69例次治疗。结果 人工肝治疗组重型肝炎治愈率为64％,明显高于对照组(37％),治疗组症状明显改善,治疗后患者TSB、ALT、AST、TBA、G明显下降,CHE显著上升。人工肝的并发症在处理后均能好转。结论人工肝是治疗重型肝炎有效、安全的手段,能显著提高患者存活率。     

恩替卡韦联合复方鳖甲软肝片治疗乙肝肝硬化的临床疗效

目的 探讨恩替卡韦联合复方鳖甲软肝片治疗乙肝肝硬化的临床疗效.方法 以参与治疗的76例乙肝肝硬化患者为例,按照双盲法将76例患者分为两组.两组患者均接受常规保肝治疗,另外对照组38例患者加用恩替卡韦治疗,观察组38例患者在对照组基础上联合使用复方鳖甲软肝片治疗.治疗结束后,观察两组患者临床治疗总有效率,并就记录两组患者肝功能各项指标改善情况.结果 治疗结束后,两组患者临床治疗总有效率比较,观察组显著高于对照组,差异有统计学意义(P<0.05).两组患者治疗后肝功能各项指标均有显著改善,且观察组显著优于对照组,差异有统计学意义(P<0.05).结论 恩替卡韦联合复方鳖甲软肝片治疗乙肝肝硬化的疗效较好,在常规保肝治疗的基础上能显著改善患者临床症状,提高肝功能水平,值得推广.     

肝苏颗粒治疗酒精性脂肪肝的临床疗效观察

目的：探讨肝苏颗粒治疗酒精性脂肪肝的临床疗效。方法将96例诊断明确的酒精性脂肪肝患者随机分为观察组与对照组各48例,观察组采用肝苏颗粒治疗,对照组采用甘利欣治疗,比较两组患者的临床疗效。结果治疗3个月后,观察组患者的肝脏生化检查结果明显好于对照组;观察组患者总有效率为84.4%,明显高于对照组71.1%（P〈0.05）。结论肝苏颗粒治疗酒精性脂肪肝的临床疗效好,值得临床推广应用。     

亚砷酸-碘油乳剂介入治疗原发性肝癌疗效分析

目的探讨亚砷酸-碘油乳剂介入治疗原发性肝癌的近期疗效与对肝功能的影响。方法选择52例肝动脉化疗栓塞患者随机分为治疗组27例和对照组25例,治疗组选用亚砷酸-碘油乳剂作为化疗栓塞方案,对照组选用丝裂霉素、表阿霉素、顺铂、碘油作为化疗栓塞方案,分别观察两组介入治疗后临床症状及肝功能6项指标。结果与对照组相比,治疗组临床症状改善更显著,对肝功能的损害亦较轻。结论亚砷酸-碘油乳剂是介入治疗原发性肝癌的一种安全有效的化疗栓塞剂。     

1H-MR spectroscopy, magnetization transfer, and diffusion-weighted imaging in alcoholic and nonalcoholic patients with cirrhosis with hepatic encephalopathy

PURPOSE: Mild swelling of astrocytes is proposed as a key event in the pathogenesis of hepatic encephalopathy. Proton MR spectroscopy ((1)H-MR spectroscopy), diffusion-weighted imaging (DWI), and magnetization transfer imaging were performed in patients with alcoholic and nonalcoholic liver cirrhosis and correlated with different clinical stages of hepatic encephalopathy to assess alterations in cerebral water metabolism in different subgroups of patients with cirrhosis. MATERIAL AND METHODS: Forty-five patients (26 alcoholics, 19 nonalcoholics [due to hepatitis C (n = 9), hemochromatosis (n = 2), primary chronic cholangitis (n = 2), hepatitis B (n = 1), Wilson disease (n = 1), cryptogenic cirrhosis (n = 4)]) and 18 controls underwent (1)H-MR spectroscopy, magnetization transfer imaging, and DWI of the basal ganglia and normally appearing occipital white matter (NAWM). N-acetylaspartate (NAA), choline (Cho), myo-inositol (mIns), and glutamine/glutamate (Glx) relative to creatine (Cr), the apparent diffusion coefficients (ADC), and the magnetization transfer ratios (MTR) were correlated to the neuropsychologic status, which was assessed by computerized psychometry and mental state grading, according to the West Haven criteria. RESULTS: Compared with controls, nonalcoholic subjects exhibited a gradual increase of Glx/Cr in the basal ganglia and NAWM; a decrease in mIns/Cr; a significant decrease of MTR in the thalamus, the putamen, the pallidum, and NAWM; and an increase in the ADC of the NAWM with increasing hepatic encephalopathy severity. In alcoholics, mIns/Cr of the basal ganglia and the NAWM, Cho/Cr of the basal ganglia, and MTR of all assessed regions were decreased. Glx/Cr of the basal ganglia and of the NAWM was increased, compared with that of controls; but no correlation to the clinical hepatic encephalopathy grading was found. ADC did not change significantly between the groups. CONCLUSIONS: Apart from a typical pattern of (1)H-MR spectroscopy alterations in hepatic encephalopathy, a gradual decrease in MTR and an increase of ADC was found correlating to clinical grading of hepatic encephalopathy in nonalcoholic patients with cirrhosis. In alcoholic patients with hepatic encephalopathy, there was no such correlation. Abnormalities detected by MR imaging may hint at different pathways of brain damage in alcohol-induced liver disease.     

MR imaging of CNS involvement in children affected by chronic liver disease

BACKGROUND AND PURPOSE: MR imaging sheds new light on CNS involvement in the course of acquired chronic liver disease; however, the exact pathogenetic mechanisms of hepatic encephalopathy and associated MR abnormalities remain unclear. Our purpose was to relate MR signal intensity abnormalities of the CNS to clinical, biochemical, and pathologic features of childhood-onset chronic liver disease. METHODS: Twenty-one patients (12 male and nine female patients) were included in the study; two had Crigler-Najjar disease type 2, 17 had chronic liver disease of different causes, and two had idiopathic copper toxicosis. Twelve patients had histologically proved liver cirrhosis, with a median disease duration of 175 months at the time of MR study. None had clinical symptoms of hepatic encephalopathy. MR imaging was performed using spin-echo T1- and T2-weighted sequences. RESULTS: Eleven patients had abnormal MR imaging findings of the brain revealed by T1-weighted MR sequences; two of the 11 had idiopathic copper toxicosis. The affected sites were the hypothalamus and globus pallidus, presenting symmetrical and bilateral high signal intensities, or the pituitary gland, which appeared homogeneously hyperintense, or both findings. Eight of the 12 patients with cirrhosis had abnormal MR signals of the brain. In these, the median cirrhosis duration was shorter (169 months) than in the remaining four patients with normal MR signals (177 months). A significant correlation was found between abnormal MR signals of the brain and cirrhosis (P = .008) and factor V activity (P = .008). CONCLUSION: MR imaging confirms the presence of abnormal brain signals in the globus pallidus, hypothalamus, and pituitary gland in patients with childhood-onset liver disease in the absence of clinical symptoms of encephalopathy. Signal intensity abnormalities are likely caused by an as yet unidentified metabolic process partially correlated with the severity of liver disease.     

血浆置换联合连续性静脉-静脉血液透析滤过治疗妊娠期急性脂肪肝伴急性肝肾功能衰竭

目的探讨血浆置换(PE)联合连续性静脉-静脉血液透析滤过(CVVHDF)治疗妊娠期急性脂肪肝(AFLP)伴急性肝肾功能衰竭的疗效。方法回顾性分析第四军医大学西京医院2012年1月至2015年1月收治的11例AFLP伴急性肝肾功能衰竭患者的临床资料。本组患者均接受PE联合CVVHDF治疗,观察治疗前后患者的症状、体征、肝肾功能、血氨、凝血系列、血常规等生化指标的变化。结果经对症支持以及PE联合CVVHDF治疗,11例患者存活9例,死亡2例。存活患者治疗前后总胆红素、直接胆红素、血氨均明显下降,凝血酶原时间缩短,纤维蛋白原含量升高,尿素氮、血肌酐等肾功能指标明显下降(P<0.05),肝性脑病缓解、病情好转、转普通病房康复。随访1年,7例患者接受随访,其中1例进展为慢性肾脏病,无患者进展至慢性肝衰竭。结论 PE联合CVVHDF治疗妊娠期急性脂肪肝伴急性肝肾功能衰竭,可取得良好临床效果。     

肝硬化合并肠功能紊乱的临床治疗观察

目的探讨肝硬化合并肠功能紊乱的有效治疗方法。方法将50例肝硬化合并肠功能紊乱患者,随机分成治疗组(26例)与对照组(24例),治疗组在对照组治疗方案的基础上给予口服贝飞达、双迪28d,同时给予心理干预治疗。观察两组治疗前后临床症状及主要的肝功能指标。结果对照组肠道功能改善总有效率70%,治疗组总有效率92%,治疗组疗效优于对照组(P<0.05)。两组患者治疗后主要肝功能指标均明显改善,治疗组治疗后ALT、T-BiL值低于对照组(P<0.05)。结论肝硬化合并肠功能紊乱的患者给予微生态制剂、肠动力药及心理干预治疗可有效改善患者临床症状,并降低肝功能指标。     

综合治疗新生儿缺氧缺血性脑病疗效评价

目的：探讨高压氧及脑活素等综合治疗措施对缺氧缺血性脑病（HIE）的疗效。方法：将我科HIE患儿随机分为两组，对照组给予常规治疗，治疗组除常规治疗外，在病情平稳后，给予脑活素、胞二磷胆碱、纳络酮、高压氧等序贯治疗。通过临床表现、NBNA评分、后遗症发生率进行综合评价疗效。结果：治疗组近期疗效明显，NBNA评分升高，后遗症的发生率明显减低。结论：脑活素、高压氧等序贯治疗对HIE有明确疗效。     

磁共振灌注成像在鼠肝纤维化、肝硬化病理分级中的价值

目的:分析大鼠肝纤维化、肝硬化磁共振灌注成像(MR-PWI)参数特征,评价PWI对肝纤维化、肝硬化病理分级的价值.方法:清洁级SD大鼠100只,体重约150～200 g,雄性.将大鼠随机分为2组,对照组(n=16),实验组(n=84);实验组腹腔定点注射硫代乙酰胺(TAA),对照组同期腹腔注射相同剂量生理盐水.建模成功后实验组和对照组分批次进行肝脏常规磁共振扫描及PWI扫描.依据病理结果将肝脏损伤分为5组:肝纤维化0期(对照组)、肝纤维化Ⅰ期(S1),肝纤维化Ⅱ期(S2),肝纤维化Ⅲ期(S3),肝硬化结节期(S4),然后分析灌注参数与病理分级的相关性.结果:共69只大鼠(实验组57只,对照组12只)成功获取PWI图像并进行灌注参数测量,成功率69％(69/100).各期门静脉诸灌注参数之间差异有统计学意义(P＜0.05),各期肝实质诸灌注参数之间差异有统计学意义(P＜0.001).门静脉TTP及WOR与肝纤维化分级之间存在相关性(r=0.420、-0.464,P＜0.001).肝实质TTP及WIR与肝纤维化分级之间存在相关性(r=0.424、-0.488,P＜0.001).结论:MR-PWI参数与大鼠肝纤维化、肝硬化的分级有一定相关性.MR-PWI对评价肝纤维化分期具有一定的临床价值.     

神经节苷脂对糖尿病脑病患者认知功能的影响研究

目的观察神经节苷脂对糖尿病脑病患者认知功能的影响。方法将我院2008年3月～2010年11月收治的52例糖尿病脑病患者随机分为两组,对照组25例采用常规疗法,观察组27例加用神经节苷脂,以简易精神状态检查量表(MMSE)评分、血清神经元特异性烯醇化酶(NSE)及S-100B蛋白为观察指标比较分析两组患者的认知功能。结果治疗前两组患者的MMSE评分、血清NSE及S-100B情况比较,差异均无统计学意义(P>0.05);治疗后两组患者的MMSE评分、血清NSE及S-100B情况均得到改善,以观察组改善更为明显,组间差异具有统计学意义(P<0.05)。结论神经节苷脂能够有效改善糖尿病脑病患者的认知功能,可能与其神经细胞保护作用有关。     

Discrimination of alcoholic from virus-induced cirrhosis on MR imaging

OBJECTIVE: The purpose of this study was to determine whether MR features help to differentiate virus-induced cirrhosis from alcoholic cirrhosis. MATERIALS AND METHODS: The MR examinations of 53 patients with cirrhosis (38 men and 15 women; age range, 28-73 years) caused by hepatitis B (n = 16), hepatitis C (n = 18), or alcohol abuse (n = 19) were retrospectively reviewed independently by two radiologists. The following MR features were assessed by each radiologist independently: volume indexes of the spleen and of each liver segment (based on 3-axis measurements), the nodularity of the surface, and the presence of regenerative nodules, ascites, iron or fat deposition, varices or collateral veins, the right posterior hepatic notch, and an expanded gallbladder fossa. RESULTS: The mean values of the volume index of the caudate lobe were significantly greater (p < 0.0001) in the group with alcoholic cirrhosis than those in the group with viral cirrhosis. The frequency of visualization of the right posterior hepatic notch in the patients with alcoholic cirrhosis was significantly greater (p < 0.05) than that in the patients with viral cirrhosis. The size of regenerative nodules of the liver in the patients with cirrhosis caused by hepatitis B was significantly greater (p < 0.02) than that in the patients with alcoholic cirrhosis. CONCLUSION: Enlargement of the caudate lobe and the presence of the right posterior hepatic notch on MR imaging are more frequent findings of alcoholic cirrhosis than of virus-induced cirrhosis.