酒精性肝病面临的挑战和今后研究方向

酒精性肝病(ALD)作为非感染性肝病的代表将取代病毒性肝炎成为未来肝脏疾病的主要病因之一。中国、亚太、欧洲以及美国肝病年会分别在2010年、2012年、2012年以及2010年更新的ALD诊疗指南中就ALD的诊断标准、临床分型以及治疗做了全面的阐述,但并未涉及具体的发病机制和治疗新靶点的探索。总结述评了ALD的发病机制、治疗新靶点以及近期的研究热点。白细胞介素22、CXC趋化因子拮抗剂以及益生菌等都有可能成为新的有效治疗靶点。而中西方人种酒精代谢特点和ALD疾病谱的差异、ALD的风险因素以及研究ALD适宜的动物模型的探索将可能成为本领域未来研究的热点和方向。     

酒精性肝病与乙型肝炎,丙型肝炎

在酒精性肝病(ALD)的发病机制中,饮酒量和饮酒史的长短无疑是发生肝脏损伤的必要因素。然而嗜酒者中真正发生ALD者仅占10％～20％,酒精性肝炎、肝硬化等严重肝病的发生率则更低,说明ALD的发生必然有其他因素介导。现知饮酒方式、性别、遗传素质、营养不良、环境污染,伴存病毒性肝炎、血色病、α_1-AT缺乏症等其他疾病,均与ALD的发生有关,其中乙型肝炎、丙型肝炎与ALD的相关性研究日益增多。1 乙型肝炎、丙型肝炎与ALD发生、发展的关系 大量临床流行病学调查研究表明,ALD患者血清HBsAg和/或抗HCV(第一代、第二代抗体试剂盒)阳性率显著高于无ALD的嗜酒者,后者又高于一般人群,提示嗜酒者HBV、HCV的感染机率增     

酒精性肝病研究现状

长期过度饮酒,可能导致酒精性肝病(ALD),其组织学特点为脂肪肝、酒精性肝炎或酒精性肝硬化。尽管对ALD进行了大量的研究,但是,为什么长期嗜酒者仅有15～20％发生酒精性肝炎,它的形成机制是什么以及如何进行适当的治疗等问题仍继续使临床工作者感到困惑。本文就近年来有关ALD发病机制及治疗等研究资料作简要综述。     

2012年EASL临床实践指南:酒精性肝病的诊治简介

欧洲肝病学会(EASL)近公布了酒精性肝病(ALD)的临床实践指南.该指南设定9项框架项目,其中,酒精滥用和酒精依赖的管理、ALD的发病机理、酒精性肝炎和酒精性肝硬化作为专列项目,这有别于美国肝病学会(AASLD)的ALD诊疗指南[1-2].     

酒精性肝病的中西医病因病机研究进展

尽管临床指南对酒精性肝病（alcoholicliverdisease,ALD）的诊断提供了依据,但ALD的疾病严重程度却经常与饮酒量不成正相关。为了更有效地预防ALD的发生,并且提供更加有效的治疗方法,明确其病因病机显得十分必要。根据目前对ALD的病因和病机的研究,本文分别从ALD的危险因素、分子作用机制及中医对ALD病机的认识三方面进行综述。     

酒精性肝病的中西医研究现状

酒精性肝病(ALD)是由长期大量饮酒导致的中毒性肝损害,属中医酒疸、酒臌、酒胀等病范畴,包括酒精性脂肪肝、酒精性肝炎(AH)及酒精性肝纤维化及肝硬化.ALD常见的病因主要有饮酒量、酒精饮料种类、饮酒方式、性别、营养状况、肝炎病毒感染、肥胖、遗传因素和种族等,重度饮酒者中80％有一定程度的脂肪肝,10％～35％可发展成AH,10 ％～20％将发展为肝硬化[1],ALD高发于欧美等西方发达国家,美国人群中44％的肝硬化死亡原因与酒精有关(病死率4.2 /10万),在35～44岁的肝硬化人群中占60.2％.近年来我国由酒精所致肝损害的发病率亦呈逐年上升趋势,酒精已成为继病毒性肝炎后导致肝损害的第2大病因[2].本文就ALD的病因及中西医诊治予以综述.     

中美欧三大指南对酒精性肝病诊断的共识与差异

2010年Hepatology发表了美国肝病学会酒精性肝病(alcoholic liver disease,ALD)诊疗指南(简称美国指南)[1],并在中华肝脏病杂志给予介绍;同年中国肝病学会脂肪肝和酒精性肝病学组也发表了中国的ALD诊疗指南(简称中国指南)[2];2012年欧洲肝病学会在J Hepatol上发表了欧洲ALD诊疗指南(简称欧洲指南)[3],欧州指南在本期由曾民德教授给与详细介绍和述评.     

酒精性肝病与氧化应激

酒精性肝病(ALD)是威胁人类健康的重大疾病之一,其发病机制错综复杂。氧化应激性肝损害在其中占有至关重要的地位,如何系统的认识机体的氧化与抗氧化系统在ALD发生发展过程中所扮演的角色,对ALD的防治工作具有一定的指导意义。     

2010亚太肝病学会酒精性肝病纪要

<正>第20届亚太肝病学会年会于2010年3月25～28日在我国北京召开,以下就酒精性肝病(ALD)方面的报道作一简要概述。一、临床研究ALD是由于长期大量饮酒所致的肝脏疾病。ALD分为酒精性脂肪肝、酒精性肝炎(AH)和酒精性肝硬     

酒精性肝病的临床无创诊断研究现状

<正>酒精性肝病(ALD)是全球最主要的肝病负担之一[1]。据WHO公布数据,超过40%的肝病相关死亡与饮酒有关。过去20年,发达地区ALD肝移植数量持续增加。尽管疾病负担重,但大多数ALD患者常在失代偿期才被诊断发现。而且,一大部分初诊为肝硬化的ALD患者曾在初级诊疗机构或急诊部就诊,却没有获得干预处理。已知戒酒或减少饮酒可以显著降低发展成严重肝病的危险,因此ALD筛查也许可以纳入日常临床实践。ALD有一系列肝损伤表现,从单纯肝脂肪变性     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.