氧氟沙星治疗肺结核合并肝损14例疗效分析

氧氟沙星治疗肺结核合并肝损１４例疗效分析蔡雄茂抗痨药物对肝脏的影响，对结核病合并肝脏疾病患者的治疗造成很大的困难。原有ＨＢＶ感染者，肝组织已有潜在性损伤。有肝炎活动者，肝细胞肿胀变性。在化疗过程中肝细胞再度受到药物损害，双重损害可导致严重肝坏死，［１...     

经埋植式给药装置肝动脉门静脉输注自体LAK细胞及化疗药物治疗中晚期肝癌

目的探讨肝动脉门静脉输注自体ＬＡＫ细胞在肝癌肝脏灌注化疗中的临床价值。方法病理证实的原发性肝癌患者９２例，１４例肝动脉门静脉输注自体ＬＡＫ细胞及化疗药物，７８例肝动脉门静脉输注化疗药物作为对照。结果自体ＬＡＫ细胞加化疗组ＣＲ６例，ＰＲ６例，有效率８５．７％；对照组ＣＲ１７例，ＰＲ２８例，有效率５７．７％；两组间疗效有显著性差异（Ｐ＜０．０５）。结论肝动脉门静脉输注自体ＬＡＫ细胞可以提高肝癌肝脏灌注化疗的效果，经埋植式给药装置肝动脉门静脉输注自体ＬＡＫ细胞及化疗药物治疗中晚期肝癌的研究具有实际临床意义。     

药物性肝损害的临床类型及诊断策略

药物性肝损害是指药物在治疗过程中，肝脏由于药物的毒性损害或对药物的过敏反应所致的疾病，也称为药物性肝炎。在美国，药物性肝炎约占住院肝病患者的2％～5％，占成人肝病患者的10％。25％的暴发性肝衰竭是由药物引起的。药物性肝损害占整个药物不良反应的10％～15％。我国药物性肝炎所占的比例约占急性肝炎住院患者的10％。     

肝动脉栓塞化疗加腹腔化疗治疗中晚期原发性肝癌

对９８例原发性肝癌随机分为２组，治疗组５０例，给予肝动脉栓塞化疗加腹腔化疗。对照组４８例人仅给予ＴＡＥ治疗，２组有效率分别为５２．０％和２９．１７％，Ｐ〈０．０１５。ＴＡＥ可引起肝癌的坏死和缩小，为中晚期肝癌的首选疗法。腹腔化疗药物经腹腔吸收入门静脉，可作为门静脉化疗的一种改良方法，为腹腔，门静脉和肝脏提供恒客和持久的高药物浓度，杀死残存肿瘤细胞，显著提高疗效。     

射频毁损治疗肝脏肿瘤现状和展望

肝脏肿瘤包括肝原发性肿瘤和肝转移瘤,其治疗目前仍首选手术切除,但确诊时85％～95％的患者已失去手术切除时机。对难以手术治疗的患者已有多种介入治疗方法,如肝动脉栓塞化疗(TAE)、经皮无水酒精注射、微波、激光、冷冻、高功率超声聚焦等。射频毁损(RFA)是近年国内外刚用于肝脏肿瘤治疗的新技术,具有安全性高、并发症少、患者易     

化疗药物引起的肝脏损害

化疗药物的肝损害是比较常见的 ,在临床上 ,有的化疗药物引起的肝损害是可以预测的 ,往往会引起临床医师的注意 ,但实际上 ,更应该引起重视的是不少化疗药物引起的肝损害是不可预知的 ,后者引起的临床后果往往更为严重。而且 ,随着大剂量化疗合并自体骨髓移植方案的临床应用 ,以及肝脏动脉灌注化疗药物的应用 ,使药物引起的肝脏损害更为常见 ,因此 ,临床医师应该充分认识化疗药物引起肝损害的重要性。一、化疗药物引起的肝损害的机制(一 )肝细胞坏死　药物在肝细胞内代谢后 ,中间的毒性产物可造成肝细胞坏死 ,而且 ,这些中间产物还可以与蛋…     

水飞蓟宾防治抗结核药物肝损害的临床观察

结核病治疗周期长，在初治肺结核化疗中，多选用异烟肼、利福平、吡嗪酰胺为主的联合化疗方案，这3种抗结核药物可对肝脏造成不同程度的损害，尤其是HBsAg( )患者，药物性肝损害发生率更高，直接影响抗结核治疗的效果。我院在2001-2002年间应用水飞蓟宾防治抗结核药物所致肝功能损害，临床观察效果良好，现报告如下。     

肝动脉化疗栓塞及瘤体内注射化疗药物、乙酸治疗原发性肝癌

目的研究肝动脉化疗栓塞及CT或B超引导下瘤体内注射化疗药物、乙酸治疗原发性肝癌的临床价值。方法选择33例中晚期肝癌分为两组，18例单纯应用肝动脉化疗栓塞（TACE）治疗，15例采用综合治疗（TACE＋瘤体内注射化疗药物及乙酸）。结果综合治疗组肿瘤缩小率、AFP下降率分别为86．6％、83．3％，而单纯TACE组分别为55．6％及40％，两组比较有显著性差异（P〈0．01）。1、2、3、4年生存率综合治疗组分别为96．7％、86．6％、51．3％、33．3％，而单纯治疗组分别为66．7％、444％、167％、0％，两组比较亦有显著性差异（P〈0．01）。结论TACE＋瘤内注射化疗药物及乙酸综合治疗是提高中晚期厚发性肝癌生存率的有效方法。     

碘油化疗药物栓塞治疗肝细胞癌24例报告

目的分析碘油化疗药物栓塞治疗失去手术时机肝细胞癌的疗效。方法采用seldinger插管方法，将导管插入肝动脉或更接近肿瘤的供血动脉，先灌注化疗药物，再用碘油与化疗药物混悬液在X线监控下栓塞肿瘤血管，直至肿瘤区碘油沉积充分后再用明胶海绵栓塞。结果6个月生存率91．6％，12个月生存率41．6％，24个月生存率4．2％，平均生存13．6月。结论碘油化疗药物栓塞治疗中晚期肝细胞癌患者能适当延长病人的生存期。     

吡喹酮对肝功能影响的临床观察

本文观察了吡喹酮对各期日本血吸虫病患者肝脏的副作用。作者通过1978～1981三年中所收治的664例血吸虫病患者的分析,认为吡喹酮引起的肝脏损害既少且轻。应用吡喹酮前肝功能正常,而用药后出现异常者占总例数的2.29％。在治疗前肝功能已有异常或合并肝脏夹杂症者中,81.4％能良好地耐受吡喹酮治疗;4.3％治后肝功能损害加重,但经辅肝药物治疗后迅速康复。上述资料提示吡喹酮远较其它传统的抗血吸虫病药物为优,可用于肝脏有损害的血吸虫病患者。     

Ultrasound liver elastography beyond liver fibrosis assessment

Several guidelines have indicated that liver stiffness(LS) assessed by means of shear wave elastography(SWE) can safely replace liver biopsy in several clinical scenarios, particularly in patients with chronic viral hepatitis. However, an increase of LS may be due to some other clinical conditions not related to fibrosis,such as liver inflammation, acute hepatitis, obstructive cholestasis, liver congestion, infiltrative liver diseases. This review analyzes the role that SWE can play in cases of liver congestion due to right-sided heart failure, congenital heart diseases or valvular diseases. In patients with heart failure LS seems directly influenced by central venous pressure and can be used as a prognostic marker to predict cardiac events. The potential role of LS in evaluating liver disease beyond the stage of liver fibrosis has been investigated also in the hepatic sinusoidal obstruction syndrome(SOS) and in the Budd-Chiari syndrome. In the hepatic SOS, an increase of LS is observed some days before the clinical manifestations;therefore, it could allow an early diagnosis to timely start an effective treatment.Moreover, it has been reported that patients that were successfully treated showed a LS decrease, that reached pre-transplantation value within two to four weeks. It has been reported that, in patients with Budd-Chiari syndrome, LS values can be used to monitor short and long-term outcome after angioplasty.     

Recurrent nonviral liver disease following liver transplantation

Recurrent disease after liver transplantation is well recognized and remains a potential cause of premature graft loss. The rates of recurrence are difficult to establish because of the lack of consistency in diagnostic criteria and approaches to diagnosis. Owing to the fact that recurrent parenchymal disease may occur in the presence of normal liver tests, those centers that use protocol biopsies will report greater rates of recurrence. It is important to recognize that rates of recurrence vary according to indication and show little correlation with rates of graft loss from recurrent disease. Recurrance rates are greatest for primary sclerosing cholangitis and autoimmune hepatitis, and low reccurrance rates are reported for alcoholic liver disease and recurrent primary biliary cirrhosis. The impact of recurrent nonalcoholic fatty liver disease is not yet clear. Patients and clinicians need to be aware of the possibility of recurrent disease in the differential diagnosis of abnormal liver tests, and management stategies may require alteration to reduce the impact of disease recurrence on outcome. Finally, an understanding of which diseases do recur after transplantation and identification of the risk factors may lead to a better understanding of the pathogenetic mechanisms of these conditions.     

中国肝癌肝移植的现状与展望

肝癌行肝移植治疗的指征、效果和相关问题一直存在争论,国际上已经有数个通用的肝癌肝移植标准,如Milan标准、Pittsburgh标准、UCSF标准等等,中国的移植学家们也在纷纷探讨适合中国的肝癌肝移植标准.本文收集并分析近年来国内外的文献,结合本移植中心460例肝移植的病例,对肝癌的分期标准、晚期肝癌行肝移植的指征进行了探讨,笔者认为影响我国肝癌肝移植的主要因素有:供肝的来源、术后乙肝及肿瘤的复发及相关社会因素等.     

Chronic liver diseases as liver tumor precursors

Liver cancer is a major global health problem and hepatocellular carcinoma (HCC) accounts for 75% of all liver carcinoma. HCC occurs more often in men than in women and mostly in people 50 to 60 years old. The disease is more common in parts of sub-Saharan Africa and Asia than in North and South America and Europe. Nevertheless its incidence increased over the past 4 decades in some Western countries. Worldwide, liver carcinoma is the 5th most common cancer and 3rd most common cause of cancer mortality (behind only lung and colorectal cancer) with approximately 680,000 annual deaths. Unlike most of the other malignancies, HCC almost entirely develops in the context of inflammation and organ injury and is related to cirrhosis in about 85% of the cases. Among underlying etiologies of liver cirrhosis, most frequent are viral infection and toxic substances, mostly alcohol. The main HCC risk factor in Eastern Asia and Africa is hepatitis B virus infection. Hepatitis C virus infection is the main risk factor in Western countries. Hereditary hemochromatosis is not a very frequent cause of liver cirrhosis, but these patients are at higher risk for HCC compared with other etiologies of cirrhosis. Aflatoxins, cancer-causing substances made by a type of plant mold, can play a role in some countries in Asia and Africa, and can have a synergistic effect with hepatitis B infection.     

Fatty liver in liver transplantation and surgery

Steatosis of the liver is common in Western countries, affecting about 25% of donors for liver transplantation and 20% of patients undergoing liver resection. Transplantation of livers with severe steatosis (> 60%) is associated with a high risk of primary nonfunction, and these livers should not be used for organ donation. In contrast, transplantation with livers containing mild steatosis (< 30%) yields results similar to those of transplantation performed with nonfatty livers. The outcome of livers with moderate steatosis (30 to 60%) are varying, and the use of these organs depends on the existence of additional risk factors. Similarly, liver resection in patients with steatosis is associated with a risk of postoperative mortality when compared with patients with nonfatty livers (14% versus 2%). Although hepatic steatosis is an important risk factor for surgery, little is known about the mechanisms of injury. In animal experiments, steatosis is associated with decreased ATP production and a disturbance of sinusoidal flow. Further contributing factors may include Kupffer cell dysfunction and leukocyte adhesion. Fatty hepatocytes have reduced tolerance against ischemic injury with a predominant necrotic form of cell death. In addition, the ability of hepatocytes to regenerate after major tissue loss is impaired in the steatotic liver. Very few protective strategies are known. Ischemic preconditioning and intermittent clamping protect the human liver against prolonged periods of ischemia. These techniques appear to be particularly protective in the steatotic liver. New insights into the mechanisms of liver failure in steatotic organs are needed to decrease the risk of surgery and increase the pool of organ donors.     

非酒精性脂肪性肝病与肝移植

随着生活水平的提高,非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)在人群中的发病率越来越高.非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)是NAFLD的最严重类型,在发达国家已成为临床上最常见的慢性肝病类型.     

药物性肝损伤合并肝脓肿

1病例捅要患者王某,男,39岁,汉族,已婚,河北省唐山市人,职业为建筑工程承包商。于2010年6月无明显诱因自觉乏力、纳差、食量减半、恶心、厌油、呕吐（非喷射样,呕吐物为胃内容物）,无发热、腹痛、腹泻、尿黄等。于当地医院查ALTl81U／L、AST109U／L、GGT386U／L,HBsAg阴性,抗HAV阴性,抗HCV阴性。腹部B超提示肝脏实质密度增高。