急性病毒性黄疸型肝炎249例胆囊B超图象分析

目的观察急性病毒性黄疸型肝炎患者胆囊变化。方法洱源县人民医院传染科及实验室确诊的急性黄疸型肝炎249例,其中男性152例、女性97例,年龄2~63岁,既往无胆囊炎、胆石症病史,B超检查,胆囊壁0·3~0·4cm为轻度异常,0·5~0·6cm为中度异常,0·7cm以上到胆囊实体样变(属胆囊内胆汁淤积浓缩)为重度异常。结果胆囊壁毛糙增厚>0·5cm175例,呈双环影25例,胆囊实体样变49例。结论急性病毒性黄疸型肝炎胆囊异常时,应注意与胆囊本身病变鉴别,动态观察胆囊变化有助于病情判断。     

儿童急性黄疸型肝炎红细胞免疫功能的改变

病毒性肝炎的发病机理与免疫有关,所以我们对22例急性黄疸型肝炎患儿红细胞免疫功能进行了检测,并与正常儿童比较,同时观察盐酸川芎嗪对患儿红细胞免疫功能的影响。 1 临床资料 1.1 诊断标准 根据1990年全国病毒性肝炎防治方案(试行)诊断标准。 1.2 一般资料 急黄肝组,共22例,其中男12例,女10例,年龄3～13岁,平均9.1岁。22例患儿入院时ALT均在200U/L以上,TBil 41.21±17.27μmol/L,甲型肝炎20例,甲、乙型混合感染2例,所有病例丙、戊肝均为阴性。对照组:随机选择30名健康儿童,其中男16例,女14例,年龄1～13岁,平均8.2岁。     

胆囊壁改变与不同临床类型肝病的关系

为了探讨胆囊壁改变与不同临床类型肝病的关系 ,我们对 1996～ 2 0 0 0年收治的 2 64例不同类型肝病患者的 B超所示胆囊壁改变结果进行分析 ,并与非肝病患者进行对照。现报告如下。资料与方法 :本组男 198例 ,女 66例 ;年龄 16～ 69岁 ;病程半个月～ 5年。其中急性黄疸型肝炎 2 7例 ,肝硬化 77例 ,肝硬化伴腹水 90例 ,病毒迁延型肝炎 70例。选择同期的 2 12例非肝病患者作为对照 ,男 172例 ,女 40例 ;年龄 17～ 72岁。均应用AL OKA-62 0型超声诊断仪检测 ,探头频率 3 .5、5 MHz。常规扫查肝胆区 ,了解肝胆系统情况 ,并测量胆囊壁厚度。…     

病毒性肝炎333例治疗过程中胆囊声像图变化

我们对住院急慢性肝炎333例的胆囊声像图进行了跟踪观察,结果发现急性肝炎组胆囊壁由水肿增厚至消炎变薄,治疗前后对比有非常显著性差异(p<0.001),而慢性肝炎组则由于胆囊的炎症水肿时间较长,囊壁的恢复时间和速度较急性肝炎缓慢,虽然慢性肝炎临床治愈,但部分患者囊壁短期内也不能完全随之复原,要继续消炎利胆,一般2个月后才能逐渐恢复正常,因此,胆囊的超声检查是判断各型肝炎的病情、治疗效果和预后的一项可利用指标。     

肝硬化患者胆囊壁异常的临床意义

肝硬化引起胆囊壁的变化十分常见但少有报道。本文对肝硬化患者的胆系Ｂ超检查结果进行了分析,旨在探讨肝硬化患者并发胆囊壁异常的临床意义。1　资料和方法1.1　168例肝硬化患者系1996年6月～1999年6月我院收治的住院病人,男122例(72.6%),女46例(37.4%),年龄29～81岁。肝硬化诊断符合全国肝炎会议制订的诊断标准[1]。原发病因:肝炎后肝硬化120例(714%),酒精性肝硬化33例(196%),病因不明性肝硬化15例(89%)。肝功能按ＣｈｉｌｄＰｕｇｈ分级:Ａ级35例(20.8%),Ｂ级82例(48.8%),Ｃ级51例(30.4%)。所有病例均排除胆石症、胆道感染和胰、心、肾疾…     

急性病毒性肝炎胆囊壁增厚的超声研究

1990的2月至1992年5月既往无胆囊炎史、同时不伴其它疾病的急性病毒性肝炎患者98例,胆囊B超发现有胆囊壁增厚者67例(68.4％)。其中急性期患者42例,重、中度增厚者39例(92.8％);恢复期25例中,重、中度增厚者5例(20.0％),二者差异显著(P<0.01)。所有病例均未见结石。同时做肝功能,发现急性期患者ALT值的高低与胆囊增厚程度间无明显相关性(P>0.05)。说明急性病毒性肝炎时胆囊B超声像图的改变与肝炎的病期有明显相关性。推测其改变是由于肝炎病毒对胆囊的直接损伤、肝炎时胆汁酸成分改变对胆囊的损伤及免疫因素的作用等,使胆囊运动功能异常,胆囊壁水肿、增厚,从而出现B超声像图的改变。此改变可作为急性病毒性肝炎患者病程分期的一个辅助指标。对其处理,不必常规应用抗生素。     

B超下肝硬化患者胆囊壁异常的临床意义

为了探讨肝炎后肝硬化背景下胆囊壁改变的性质,我们作了以下临床观察。 1 资料与方法 1.1 病史资料 肝炎后肝硬化失代偿期患者30例,其中男26例,女4例,年龄38～56岁。慢性乙型肝炎30例,其中男24例,女6例,年龄30～49岁。所有患者诊断均符合全国肝炎会议标准。来我院体检的健康人30例,其中男18例,女12例,年龄28～52岁。     

TTV在急性黄疸型肝炎中的感染状态研究

在已认识的甲、乙、丙、丁、戊及庚型肝炎病毒之外，临床上仍有相当一部分（１０％－２０％）肝炎病例不能用已知的病毒性肝炎血清学标志检测出病因。本文就ＴＴＶ在各型急性黄疸型肝炎患者中的感染状况进行初步探讨。１ 材料和方法１．１ 对象 在本所门诊及住院患者中，根据１９９５年北京病毒性肝炎防治方案规定急性黄疸型肝炎诊断标准，经检测ＡＬＴ高于正常，血清胆红素大于１７μｍｏｌ／Ｌ，并排除药物、中毒、酒精、自身免疫等原因引起的黄疸；符合上述标准８０例患者，男性４９例，女性３１例，年龄在９岁－５４岁。血清标本包括首…     

沙棘冲剂治疗小儿急性黄疸型肝炎120例

我院于1992年4月～1994年8月,用沙棘冲剂治疗小儿急性黄疸型肝炎120例,今报告如下: 临床资料 本文病例均按1990年上海全国病毒性肝炎学术会议诊断标准确诊。多数为抗HAV-IgM阳性(112/120)。沙棘冲剂组120例,其中男82例,女38例,平均年龄6.4岁。对照组40例,其中男21例,女19例,平均年龄7.3岁。     

423例急性散发性黄疸型肝炎临床和流行病学分析

1 材料和方法 1.1 观察对象 1995年3月～1996年2月收治的423例急性黄疸型肝炎病人,男263例,女160例,年龄为1～86岁。入院时详细询问肝炎史、输血及注射史、肝炎患者和流行区接触史,排除酒精或其他药物中毒性肝炎后列入观察对象。入院后每半月取血查肝功能。除26例患者因治疗效果不明显或其他原因未愈自动要求出院外,其他均在SGPT降至正常,黄疸消失和自觉症状好转后出院。     

Differentiating Acute Hepatitis B from the First Episode of Symptomatic Exacerbation of Chronic Hepatitis B

In countries with intermediate or high endemicity for chronic hepatitis B virus (HBV) infection, exacerbations of chronic hepatitis B (CHB) are common. We studied the clinical, biochemical, and virologic characteristics of patients first presenting clinically with features of acute icteric hepatitis B, to identify features that might differentiate between acute viral hepatitis B (AVHB) from first episode of exacerbation of chronic hepatitis (ECHB). We retrospectively analyzed 79 patients (mean age 35.4 ± 14 years; M:F = 60:19) who first presented clinically as AVHB, within 4 weeks of onset of symptoms. Patients who on follow-up cleared HBsAg and/or did not develop any clinical, radiologic, or histologic evidence of chronic liver disease (CLD) were categorized as AVHB (group 1). Patients who had persistence of HBsAg and developed clinical, biochemical, radiologic, or histologic evidence of chronic liver disease were categorized as ECHB (group 2). Forty-nine patients were in group 1 and 30 in group 2. The 2 groups were comparable with respect to prodrome, onset of jaundice, serum bilirubin, ALT, prothrombin time prolongation, serum albumin, and A/G ratio. Among group 1 patients, 78% had IgM anti-HBc positive in titers > 1:1000; in group 2, there were negative or positive in titers < 1:1000 in 70% patients (P < .001). Forty-seven of 49 (95.9%) patients in group 1 had HBV-DNA levels < 0.5 pg/mL, whereas 26 of 30 (86.73%) patients in group 2 had levels > 0.5 pg/mL (P ≤ .001). Quantitative HBV DNA and IgM anti-HBc titers at initial presentation can differentiate patients with a true episode of acute hepatitis B from patients with first episode of symptomatic exacerbation of chronic hepatitis B. Clinical and biochemical features do not help in differentiating the two.     

Collagen Disease Debuting as Acute Hepatitis

Three cases of acute hepatitis in debuting collagen disease were observed. One patient suffered from typical polyarteritis nodosa and succumbed after 6 months. The other two patients developed a disease resembling systemic lupus erythematosus with persisting multiorgan symptoms. Liver biopsies performed in the initial phase revealed the typical picture of acute ‘viral’ hepatitis. Two of the cases were anicteric. In one of two patients positive tests for Australia antigen were found. The observed acute hepatitis in debuting collagen diseases is discussed in relation to previously described types of liver affection in collagen disease.     

急性病毒性肝炎患者胆囊排空功能研究

目的研究急性病毒性肝炎（ＡＶＨ）患者胆囊（ＧＢ）排空功能及其与病情程度和转归的关系．方法用实时超声研究了３２例ＡＶＨ患者及２６例健康对照者ＧＢ排空功能．结果空腹ＧＢ容量（ＦＧＶ）ＡＶＨ患者（１０２２±２３１）明显小于对照组（１９７９±１５１）（Ｐ＜０００１），随病程延长，ＦＧＶ渐增多．ＦＧＶ减少与病情程度呈显著负相关（Ｐ＜００５）．餐后ＧＢ排出量（ＧＥＦ）ＡＶＨ组显著少于对照组（Ｐ＜０００１），其减少与病情程度呈明显负相关（Ｐ＜００１），与血清胆红质、ＡＬＴ水平呈显著负相关（Ｐ＜００５～００１）．６０ｍｉｎ最大ＧＥＦ及ＧＢ排空速度明显减少、减慢（Ｐ＜０００１）．恢复期ＦＧＶ及餐后ＧＥＦ均恢复正常．结论ＡＶＨ患者存在ＦＧＶ和餐后ＧＥＦ异常．其机制与肝细胞损害，泌胆功能障碍及神经—激素调控失调有关．     

Torsion of the gallbladder in a 3-year-old infant

A 3-year-old girl was admitted to hospital with complaints of severe upper abdominal pain and vomiting. On admission, a board-like rigidity in the right hypochondrium was noted, along with a high white blood cell count and a high C-reactive protein value. Abdominal ultrasonography (US) revealed a left-sided enlarged gallbladder with a thickened wall, without gallstones. Contrast-enhanced computed tomography (CT) demonstrated an enlarged gallbladder without enhancement effects and a cystic duct located on the right side of the gallbladder. The patient underwent an emergency operation following a diagnosis of torsion of the gallbladder. The gallbladder appeared gangrenous, and 180° clockwise torsion was found at the neck of the gallbladder. The gallbladder was straightened and then removed without difficulty because there was only slight inflammation around Calot’s triangle and the gallbladder was not fixed to the liver. Histopathological examination revealed an acute bleeding infarction of the gallbladder. The patient was discharged on the ninth day after surgery, without any complications. The present case suggested that abdominal US and contrast-enhanced CT examinations are helpful in making a correct diagnosis of torsion of the gallbladder even in an infant; in the event of this diagnosis, prompt cholecystectomy is necessary.     

A Superinfection of Salmonella typhi and Hepatitis E Virus Causes Biphasic Acute Hepatitis

A 47-year-old Japanese man was referred to our hospital because of a sustained high fever with diarrhea 12 days after a flight from India. Liver enzymes were elevated with rose spots, hepatosplenomegaly, relative bradycardia, and acute cholecystitis. A liver biopsy depicted the dense infiltration of lymphocytes and Kupffer cells in sinusoids and the granulomatous formation in the parenchyma. The liver damage was initially resolved with the administration of ceftriaxone for 16 days but flared up 1 week later. Laboratory tests yielded positive reactions for Salmonella typhi and hepatitis E virus RNA. The pathophysiological presentations of concurrent typhoid and type E hepatitis are discussed.     

Individualized nomogram improves diagnos-tic accuracy of stage I-II gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening

BACKGROUND: Early diagnosis of gallbladder cancer (GBC) can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage I-II GBC in chronic cholecystitis patients with gallblad-der wall thickening.
METHODS: The nomogram was developed using logistic re-gression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage I-II GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimina-tion, calibration and a prospective cohort treated at another center between January 2012 and December 2014 (n=928).
RESULTS: Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calciifcation, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves iftted well. The area under the receiver-operating characteristic curves of the no-mogram was higher than that of multidetector row computed tomography in diagnosis of stage I-II GBC (P<0.001).
CONCLUSION: The proposed nomogram improves individu-alized diagnosis of stage I-II GBC in chronic cholecystitis pa-tients with gallbladder wall thickening, especially for those the imaging features alone do not allow to conifrm the diagnosis.     

Localized wall thickening of the gallbladder mimicking a neoplasm

Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer.     

The Acute Onset of Autoimmune Hepatitis During Pregnancy in the Absence of Hypergammaglobulinemia and Autoantibodies

The onset of autoimmune hepatitis (AIH) during pregnancy is rare and often poses a diagnostic challenge. A 29-year-old Japanese woman experienced epigastric pain and nausea during the third trimester of her third pregnancy. Three days after the symptom onset, an emergency Caesarean section was performed because of suspected acute fatty liver of pregnancy; however, the patient''s liver dysfunction worsened afterward. Despite normal serum IgG concentration and absence of autoantibodies, biopsy-proven severe hepatitis with centrilobular zonal necrosis and good biochemical response to corticosteroids led to a diagnosis of AIH. Therefore, AIH should be included in the differential diagnosis of liver dysfunction during pregnancy.     

Prediction of Hepatic Encephalopathy Development in Patients With Severe Acute Hepatitis

To identify factors predicting the development of hepatic encephalopathy, 164 patients with severe acute hepatitis (SAH), defined as acute hepatitis having a prolonged prothrombin time (PT) of < 40% activity but without hepatic encephalopathy, were prospectively observed at 57 major liver centers in Japan. From the data of 65 patients enrolled from 1997 to 1998, a prediction equation was developed by multiple logistic regression analysis and prospectively evaluated using the data of 99 patients since 1999. Of the 164 patients with SAH, 51 (31%) developed hepatic encephalopathy. From the etiologic viewpoint, the percentages of patients developing encephalopathy were highest in non–A-E hepatitis (41.9%). A predictive model, logit(p) = 0.084 × age (year)+ 0.129 × serum total bilirubin (TB, in mg/dL)–0.158× prothrombin time (%)–2.434, was developed. In conclusion, old age, prolonged PT, elevation of TB, and non–A-E hepatitis are potential risk factors for developing encephalopathy in SAH.     

单一TTV DNA阳性急性肝炎临床特点及随访结果分析

目的通过分析单一TTVDNA阳性急性肝炎的临床特点 ,探讨TTV的致病性。方法临床表现为急性肝炎 ,排除甲 -庚型肝炎病毒感染。血清学检测单一TTVDNA阳性 ( 30例 )为TTV组 ,随机抽样急性乙肝 4 1例为HBV组。两组进行临床症状、体征和实验检测结果比较分析和统计学处理。结果TTV组与HBV组两组平均年龄分别为 4 2 .8岁及 30岁 ;男女比值分别为 1∶1和 4 .1∶1。两组起病及临床症状基本相同 ;黄疸型分别为83.3%及 90 .2 % ;TTV组与HBV组黄疸前期平均分别为 4 .7d及 4 .8d ;TBIL分别为 2 2 2 .1± 10 4 .1μmol/L及 191.0± 5 7.4 μmol/L ;ALT两组分别为 795 .5± 2 4 1.8u/L及 14 5 0 .1± 377.4u/L ;AST两组分别为 4 13.2±12 3.6u/L及 788.9± 183.8u/L。治疗 1月近期效果相同 ,两组均无重型肝炎及死亡病例。TTV组随访 11例 ,随访时间 1～ 5年肝功全部正常 ,10例TTVDNA持续阴性 ,恢复期慢性携带者 9.1% ( 1/ 11)。结论TTV和HBV感染一样可引起急性肝炎的临床表现 ,但年龄偏大 ,女性比例较多 (P <0 .0 5 ) ;TTV感染引起的急性肝炎的临床表现和实验检测异常与急性肝炎相似 ,但以ALT和AST为代表的肝脏炎症指标明显轻于HBV组 (P <0 .0 5 ) ;TTVDNA阳性及转归与转氨酶升降有较好的一致性 ,提示TTV可能是一种嗜肝的