肝纤维化的治疗现状

<正>肝纤维化是肝硬化的早期阶段,是慢性肝病向肝硬化发展的必经途径,是各种慢性肝病的病理学共同基础。其主要病理特点是胶原蛋白、蛋白多糖及粘连糖蛋白等多种细胞外基质在肝内过度沉积。肝纤维化在进入肝硬化之前,尚有逆转至正常的可能,因此人们对肝纤维化的治疗十分重视。有云谁能阻止或减慢肝纤维化的发生,将会治愈大多数慢性肝病患者。本文简要综述近年来对肝纤维化治疗的一些新认识和新进展。     

走出肝纤维化认识和治疗的误区

肝纤维化是临床常见的一个病理过程,可发生于多种慢性肝病过程中,是大多数慢性肝病的共同病理学基础,是各种慢性肝炎,包括肝硬化、肝癌等疾病发生过程的一个重要阶段。但有人认为肝纤维化与肝硬化概念相同,经常将肝硬化却与肝纤维化混为一谈,使我们在认识和治疗肝纤维化形成了一种误区。     

肝纤维化研究进展

肝纤维化是指各种病因引起的纤维结缔组织在肝内异常增生和沉积,是多数慢性肝病发展的共同病理过程。肝纤维化若不及时阻止、逆转,则可进一步发展为肝硬化、肝癌。近年来,随着细胞分子生物学及基因工程技术的发展和应用,对肝纤维化病理机制的研究有了很大的突破,肝纤维化的诊断和治疗也取得相应的发展。笔者就这些进展作一概述。     

复方丹参注射液联合凯西莱治疗肝炎肝纤维化和早期肝硬化疗效分析

肝纤维化是肝硬化前驱的必经阶段 ,是一切慢性肝病的共同病理学基础。由于肝硬化分子生物学研究的进展 ,我们已能从基因水平来认识 ,似乎可以认为肝纤维化是一种继发性基因调控失调肝病[1] ,许多酒精性肝病患者虽已戒酒 ,但肝纤维化和肝硬化继续发展[2 ] ,迄今已有资料证明 ,祛除原来引起肝细胞损伤的致病因素 ,肝纤维化仍可自行延续。因此 ,阻断及逆转肝纤维化是治疗肝硬化乃至减少肝癌发生的关键。我们对 2 4例早期肝硬化患者 ,采用复方丹参注射液联合凯西莱治疗 ,进行临床观察分析 ,取得良好疗效。1　资料与方法1 1　一般资料2 4例为我科…     

肝星状细胞的活化对肝纤维化形成的影响

肝纤维化(HF)是肝硬化及肝癌的前期病变,是危害人民生命健康的常见疾病.本文从诱发肝纤维化的主要因素肝星状细胞(HSC)的活化,阐述了HSC的一般性质与功能、HSC活化的机制、肝纤维化的发病原因、活化的HSC在HF中的作用、肝纤维化可逆转的分子生物学基础与临床证据,说明HF逆转的可能性,为预防肝硬化和肝癌的发生,寻找有效的预防与治疗方法.     

肝纤维化的治疗

肝纤维化是多种慢性肝病向肝硬化发展的共同病理过程,是慢性肝病发展到肝硬化的必经病理阶段,改善肝纤维化的程度具有重要的临床意义,特别是逆转进展中的肝纤维化,防治肝纤维化是攻克肝硬化的突破口。目前,肝纤维化、肝硬化的治疗局限在尽可能的去除潜在的损伤刺激,在终末期患者,进行肝移植也是一个成功的治疗方法,但可供移植器官不足、医疗费用高昂,因此,有效的抗纤维化治疗成为紧迫的问题,本文将抗纤维化的治疗介绍如下。     

肝星状细胞的活化对肝纤维化形成的影响

肝纤维化(HF)是肝硬化及肝癌的前期病变,是危害人民生命健康的常见疾病.本文从诱发肝纤维化的主要因素肝星状细胞(HSC)的活化,阐述了HSC的一般性质与功能、HSC活化的机制、肝纤维化的发病原因、活化的HSC在HF中的作用、肝纤维化可逆转的分子生物学基础与临床证据,说明HF逆转的可能性,为预防肝硬化和肝癌的发生,寻找有效的预防与治疗方法.     

浅谈肝纤维化的危害及治疗

肝纤维化是慢性肝病发展为肝硬化的中间环节。近年来对于肝病的研究揭示，多种慢性肝病共同的病理学基础是肝纤维化，其发生机制是机体对炎症的修复反应，如同疤痕形成于创伤一样。慢性肝病患者若不经过及时的诊断、合理的治疗，病情反复发作，其中10％-15％的人5年-10年后发展成为肝硬化。以至于发生门脉高压、腹水、肝性脑病甚至肝癌等严重并发症。如果能阻滞或逆转肝纤维化进展，将会提高患者的生存质量，在很大程度上改善肝病的预后。     

肝纤维化诊断方法的研究现状

肝纤维化是一种慢性过程,是肝硬化的必经阶段.肝纤维化的程度与慢性肝病的治疗和预后密切相关.目前诊断肝纤维化的方法包括病理学、影像学和血清学诊断3种.病理学诊断是金标准,但存在肝穿刺的盲目性、肝脏病变的不均一性而导致取样误差;影像学诊断在肝纤维化晚期才能出现异常图象;血清学诊断是应用最广泛的诊断方法.本文对肝纤维化诊断方法的现状予以综述.     

肝纤维化临床诊断指标的研究应用现状

肝纤维化是肝硬化的前题,它会使肝脏结构发生改变,肝细胞的血液供应等受到影响,使肝脏功能逐渐丧失,并最终发展为肝硬化。目前临床上肝纤维化的诊断主要从以下几方面:肝活检病理学检查、影像学诊断和血清学标志物检测,现就这些诊断方法做一总结。     

化肝汤1号治疗酒精性肝纤维化症状及肝功能改变

目的观察活血化瘀、软坚散结药配伍治疗肝纤维化时对患者主、次症状改变及肝功能的影响。方法将确诊为酒精性肝纤维化患者90例,随机分为三组,治疗组采用自制方剂化肝汤1号(醋鳖甲、黄芩、柴胡、赤芍等),对照组1采用凯西莱治疗,对照组2采用化肝汤1号和凯西莱联合治疗,疗程3个月。观察三组患者治疗前后主、次症状改善情况,血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(γ-GT)变化。结果三组治疗后的临床疗效比较差异无统计学意义(H=2.5897,P>0.05)。三组治疗后肝功能指标均有改善,与治疗前比较,差异有统计学意义(P<0.05)。结论化肝汤1号可有效地降低肝细胞的损害程度,促进受损细胞修复,从而改善肝功能。     

逍遥散对肝纤维化模型大鼠肝功能、肝纤维化指标的影响

目的:观察逍遥散对肝纤维化模型大鼠的肝功能、肝纤维化指标的影响。方法:选取清洁级成年Wistar大鼠80只,采用随机数字表法分为空白组(等量生理盐水)、模型组(等量生理盐水)、阳性对照组(秋水仙碱)、逍遥散低剂量组(1 g·mL~(-1)的逍遥散溶液,按照8 g·kg~(-1)灌胃)、逍遥散高剂量组(1 g·mL~(-1)的逍遥散溶液,按照16 g·kg~(-1)灌胃),均连续给药8周。结果:干预8周后,逍遥散高剂量组大鼠血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)水平均低于阳性对照组和逍遥散低剂量组(P<0.05),白蛋白(albumin,ALB)高于阳性对照组和逍遥散低剂量组(P<0.05)。逍遥散高剂量组的血清透明质酸(hyaluronic acid,HA)、层黏蛋白(laminin,LN)、Ⅲ型前胶原(precollagen typeⅢ,PCⅢ)、Ⅳ型胶原(collagen typeⅣ,Ⅳ-C)水平低于阳性对照组和逍遥散低剂量组(P<0.05)。逍遥散高剂量组的转化生长因子β1(transforming growth factor-β1,TGF-β1)、血小板衍生生长因子(platelet-derived growth factor,PDGF)蛋白表达水平低于阳性对照组和逍遥散低剂量组(P<0.05)。结论:逍遥散能显著改善肝纤维化模型大鼠肝功能(降低ALT、AST水平)和血清肝纤维化指标(降低HA、LN、PCⅢ及Ⅳ-C水平),降低肝组织中TGF-β1及PDGF蛋白表达水平。     

背驮式原位肝移植尸体供肝切取及修整

1995年9月至1996年8月,施行了2例背驮式原位肝移植,尸体用肝原位冷灌注的方法与肾一起切取。移植物开始用WMO-1号液灌注,然后用UW液灌注。第2例是9岁的患儿,接受了减体积的原位肝移植,切除供体肝左叶,右叶用于移植,术后移植肝肝功能恢复正常。其中1例存活近2年。     

肝移植及常规肝切除术后胸腔积液对比分析

目的 对比分析肝移植及常规肝切除术后胸腔积液的原因,总结其诊断及治疗经验.方法 回顾性总结符合入选条件的56例肝移植病例及同期83例常规肝切除病例,通过B超及X线检查对比分析两种术式术后胸腔积液情况,对影响呼吸功能的患者实施胸腔穿刺置放深静脉插管抽液,分析胸腔积液的原因.结果 56例肝移植患者中B超检查提示有39例术后...     

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.