鄱阳湖区血吸虫病疫区居民肝脾超声图像特征及转归评估

目的观察鄱阳湖区血吸虫病疫区居民肝、脾超声图像特征及其转归,探讨超声显像(B超)在评估血吸虫病病情及其变化中的应用价值。方法1995年和2007年先后在江西省鄱阳湖区同一血吸虫病重疫区村对常住居民同时采用病原学方法和B超进行检查。结果1995年与2007年居民粪检阳性率分别为16.29%和8.54%,差异有统计学意义(P0.01);居民肝、脾肿大率分别为8.82%和20.33%、8.54%和21.34%,差异均无统计学意义(P均0.05);门静脉内径异常率分别为32.47%和6.50%,肝实质异常率分别为34.85%和51.83%,差异均有统计学意义(P均0.01)。居民肝实质I级的发展具有双向性,2007年检查结果表明,1995年肝实质Ⅰ级者中有29.90%恢复正常,34.02%发展为Ⅱ级以上。B超各项指标的改变与居民职业、血吸虫感染与否有关。结论B超可用于诊断疫区居民血吸虫病病情和病理损伤,但其反映早期病变的敏感指标或评估病情状况的综合指标还有待进一步研究。     

洞庭湖区流动渔民血吸虫病流行病学评估

目的评估洞庭湖区水上流动渔民血吸虫病流行病学现状,为制定防治对策提供科学依据。方法在东洞庭湖区随机抽查275例水上流动渔民,进行基本资料调查及粪检,同时在所调查人群中随机抽取129例进行B超检查,所得结果与2001年所调查的同一目标人群资料进行比较,以评估当前流动渔民血吸虫病流行现状。结果本次调查水上流动渔民血吸虫感染率为40.4%,标化后为53.8%,几何均数感染度为17.4±4.4,两者均低于2001年调查结果。B超显示肝脾受损仍然严重,其中肝脏声像呈网状结构的占58.1%(75/129),肝实质纤维化分级达到Ⅱ级以上的为58.9%(76/129),脾肿大率为50.4%(65/129),均高于2001年调查结果(P均0.01);但肝肿大率38.0%(49/129)及门静脉内径增大率10.1%(13/129)低于2001年调查结果(P均0.05)。同时B超结果显示肝实质受损男性仍然高于女性(P0.01)。结论水上流动渔民血吸虫感染率、感染度与2001年相比虽然有所下降,但感染率及感染度仍然较高,且肝脾损伤仍然严重。渔民仍然是重要的血吸虫病传染源,要进一步加强防控措施。     

慢性HBV携带者病毒抗原表达类型与抗病毒治疗效果相关性研究

目的观察肝脏病理改变和肝细胞内病毒抗原的表达类型与抗病毒治疗疗效的关系。方法选择79例慢性HBV携带者,通过肝组织病理检测,观察肝脏病理改变程度、肝细胞内病毒抗原的表达类型和抗病毒治疗后血清HBeAg、HBVDNA转阴之间的关系。结果HBsAg表达类型与疗效无显著相关性,HBcAg浆型表达的疗效明显优于核型表达,肝组织病理病变大于4分,血清HBV标志物阴转率高。结论肝组织HBcAg浆型表达和肝组织病理改变与慢性HBV携带者抗病毒治疗疗效均呈正相关。     

腹腔镜检查对疑难肝病的诊断

对临床及医学影像检查未能确诊的肝脏疾患62例做腹腔镜检查,均做出确定诊断。1 临床资料1.1 对象 男40例,女22例,年龄25—69岁,平均年龄38.8岁,不明原因肝脾肿大36例,肝肿大16例,脾肿大5例,肝区不适5例,均做肝功能、上消化道造影、B超检查、CT检查19例、核磁共振检查2例,均未能确诊。     

日本血吸虫配对个体间遗传学差异与其对终宿主致病性的关系

目的 目的 探讨日本血吸虫配对个体间遗传学差异与其对终宿主致病性的相关性。方法 方法 利用7个微卫星位点标 记对16组随机配对的日本血吸虫雌雄成虫进行基因分型, 计算成虫间的遗传相似性和杂合度差值, 评价其与血吸虫对 终宿主致病性的关系。结果 结果 日本血吸虫配对个体间遗传相似性与平均每对成虫肝脏沉积虫卵数 （r = 0.501 6, P < 0.05）、 平均每对成虫肠组织沉积虫卵数 （r = 0.796 5, P< 0.01） 及肝脏沉积虫卵孵化率显著相关 （r = 0.508 3, P < 0.05）, 与 平均每对成虫所引起的肝脾肿大 （r肝肿大= 0.109 5, P肝肿大 > 0.05; r脾肿大= 0.265 3, P脾肿大 > 0.05） 及肝脏肉芽肿平均直径 （r = -0.272 7, P > 0.05） 均无相关性; 配对个体间的杂合度与终宿主各病理指标间均无相关性 （P均> 0.05）。结论 结论 日本 血吸虫配对个体间的遗传差异性与其对终宿主的致病性相关, 并且遗传差异越大、 致病性越弱; 配对个体间的杂合度与 其对终宿主的致病性无关。     

安徽省枞阳县凤仪村居民血吸虫病状况调查

目的了解凤仪村居民血吸虫感染及血吸虫病对居民肝、脾损害情况。方法对5～65岁居民进行查病，确定感染情况，同时对受检者用B超进行肝、脾检查。结果人群血吸虫感染率4．81％，各年龄组均有患者，男、女人群肝、脾肿大率差异无统计学意义（P〉0．05），肝纤维化异常率男性高于女性（P〈0．01），随着年龄的增长肝纤维化异常率增高，有病史人群与无病史人群、粪检阳性人群与粪检阴性人群肝、脾肿大率差异有统计学意义（P〈0．01）。结论凤仪村人群血吸虫病病情仍较严重，肝、脾损害明显，同时提示超声检测能评价人群血吸虫病病情。     

B超诊断血吸虫肝纤维化虫卵钙化一例

患者×××、男性、43岁,生活在血吸虫病流行区,曾行血吸虫杀虫治疗4次,现仍感上腹饱胀,食欲不振,全身乏力。临床诊断为血吸虫肝纤维化、肝脾肿大。1991年3月15日B超所见,肝脏大小正常,右叶最大斜径11cm,厚径9.8cm,左叶全长5.7cm,厚径6.2cm,剑下触及,肝实质密集增粗光点,网状光带,分布不均,纹理不清,肝包膜线呈波浪状,门静脉显示不清。肝右后叶下段见直径为2.6cm增强光团,边界尚清,无包膜,其后无声影。提示为血吸虫肝纤维化,肝内实质性占位病变,定期复查。同年6月3日B超复查,肝内光团未见增大,肝脏声象图同前,诊断为血吸虫肝纤维化,肝内实质性占位病     

补中益气丸对早期糖尿病大鼠肝氧化损害及肝糖原作用的机制

目的:研究补中益气丸对STZ糖尿病大鼠肝脏NO3-、ONOO-、MDA、糖原及肝损害的影响及机制.方法:通过2次腹腔注射链脲佐菌素(STZ)制作大鼠糖尿病模型,第1次腹腔注射STZ55mg/kg,第8天行第2次腹腔注射同等剂量STZ.每周大鼠尾尖采血测空腹血糖值,造模成功的SD大鼠随机分为糖尿病组,常规喂养4wk;补中益气丸组给予补中益气丸水溶液,每只大鼠用量为8g/kg,每天1次,连续28d.采用分光光度法测定鼠肝脏ONOO-、MDA、糖原,通过HE染色病理检查和积分系统估计肝损害程度.结果:糖尿病大鼠出现明显的糖尿病症状,肝病理检测发现肝细胞变小,肝窦变窄,肝细胞核变小浅染,肝小叶结构不清,肝索结构紊乱存在充血和少量炎性细胞浸润,尤其在肝1区肝组织MDA、ONOO-水平显著升高,肝糖原显著降低.补中益气丸组大鼠肝细胞、肝细胞核、肝窦、肝索、肝小叶异常及充血和炎症明显改善,糖尿病症状亦明显改善;肝组织MDA、ONOO-水平显著降低,肝糖原显著升高.相关分析发现,肝糖原与MDA、ONOO-、肝细胞索结构紊乱、充血、炎症呈显著负相关,与肝细胞大小、肝细胞核大小、肝血窦大小呈显著正相关;肝组织MDA、ONOO-水平与肝细胞大小、肝细胞核大小、肝血窦大小呈显著负相关,与肝细胞索结构紊乱、充血、炎症呈显著正相关.结论:补中益气丸可能通过改善STZ糖尿病大鼠肝脏氧化应激,改善胰岛素信号通路、激活磷酸酶脱磷酸化活性,进而升高糖原合成酶活性和肝糖原含量,改善肝氧化代谢和肝的氧化损伤.     

乌鸡白凤丸与马洛替酯联合治疗肝炎后肝硬化低白蛋白血症40例

为探讨治疗肝炎后肝硬化低白蛋白血症的方法 ,笔者采用乌鸡白凤丸与马洛替酯联合治疗 ,收到满意疗效 ,报告如下。1　对象与方法1 .1　观察对象 :1 2 0例均为肝炎后肝硬化肝功能失代偿期患者 ,均经乙肝病毒标志物、肝功能、B超 (脾肿大 ,肝实质弥漫性改变 )和胃镜 (食管静脉曲张     

基质金属蛋白酶及其抑制因子与肝纤维化

基质金属蛋白酶是肝内细胞外基质降解酶的重要酶类。肝内MMP家族包括MMP-1、MMP-2、MMP-3及其抑制因子TIMP-1、TIMP-2、TIMP-3。MMP主要由肝脏间质细胞合成和分泌,TIMP可由肝脏实质及间质细胞合成和分泌。肝纤维化早期时,肝组织间质胶原酶活性较高,纤维化晚期活性下降;而肝纤维化时肝组织中TIMP-1表达增强,慢性肝炎患者血清TIMP-1水平显著增高,并与肝纤维化程度呈显著正相关,提示MMP及TIMP家族对于肝纤维的发生、发展及预后都有重要意义。     

晚期血吸虫病肝纤维化与肝炎后肝硬化B超观察的比较

用EUB—200A型线阵手提式超声诊断仪,探头频率为3.5MH_z,检查晚期血吸虫病肝纤维化41例(S组)与肝炎后肝硬化30例(H组)。B超图象结果表明,S组肝实质呈光带型网络状分布,似“鱼鳞状”、“龟背样”或“地图样”改变;H组(包括有腹水者)仅见肝实质光点增粗、回声增强及分布不均,无一例呈光带型网络状分布。故认为B超用于两者鉴别诊断有重要价值。肝、脾各径线测值平均值及门、脾静脉主干内径测值平均值结果,S组均大于H组,经统计学处理,差异有非常显著意义(P<0.01)。     

Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis.

OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.     

Hepatic haemangiomas: possible association with female sex hormones

BACKGROUND AND AIMS: The association of hepatic haemangiomas with female sex hormones is not entirely clear. We prospectively evaluated the impact of female sex hormones on the natural history of liver haemangiomas. METHODS: We followed 94 women with 181 haemangiomas diagnosed by ultrasound for a period of1-17 years (mean 7.3 (5.5) years). The location, number, size, and ultrasonographic pattern of the lesions were evaluated. Patients were also evaluated by questionnaire for gynaecological and reproductive history. We compared the change in number and size of haemangiomas in patients who received or did not receive exogenous hormonal treatment. RESULTS: Age at first period was inversely associated with the size of haemangiomas (r = 0.181, p = 0.015) while age at menopause was positively correlated with the number of haemangiomas detected at first ultrasound (r = 0.542, p<0.0001). During follow up, no change in the ultrasonographic pattern or number of haemangiomas was observed. An increase in the size of the lesions was demonstrated in 5/22 (22.7%) hormone therapy exposed patients compared with 7/72 (9.7%) controls. Three variables (ultrasonographic pattern, number of haemangiomas, and hormone therapy) predicted whether or not a given haemangioma would increase in size. A hypoechoic pattern increased the risk of progression while a hyperechoic pattern decreases that risk (p = 0.003). The number of haemangiomas was inversely associated with the likelihood of progression (p = 0.006) and hormone therapy increased the risk of haemangioma enlargement (p = 0.05). CONCLUSIONS: Hepatic haemangiomas seem to be influenced by both endogenous and exogenous female sex hormones although significant enlargement occurs only in a minority of patients. Consequently, routine liver ultrasound follow up in women with hepatic haemangiomas receiving hormone therapy appears appropriate.     

Cellular growth in several organs of normal and dwarfed Snell mice

The DNA, RNA and protein content of different organs was studied in Snell dwarf mice and compared with unaffected controls at different ages. The following organs were included: liver, kidneys, heart, submandibular salivary glands, spleen and thymus. In normal mice the rapid post-natal growth of all these organs is due to cell division and in the liver, kidneys, heart and submandibular salivary glands to cell enlargement as well. In dwarf mice weight of most organs studied is comparable with that of 1-2 weeks old normals. The data suggest no differences in cell size between dwarfs and normals in the liver, submandibular salivary glands, spleen and thymus, irrespective of age. In contrast, cell size of the heart and kidneys remains below the normal range and the RNA content is lowered as well. RNA is also low in the submandibular salivary glands and the liver, despite their normal protein content.     

Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders

Background: Splanchnic haemodynamic parameters for the differential diagnosis of splenomegalies of different origins are still suboptimal and the role of spleen enlargement in cirrhosis remains controversial. In an attempt to elucidate these questions, we assessed splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. Methods: Study groups comprised: (i) patients with chronic liver disease (89 with cirrhosis, 35 with chronic hepatitis), (ii) patients with splenomegaly without relevant portal hypertension (14 with haematological splenomegaly and 25 liver transplant recipients without complications), (iii) 15 patients with arterial hypertension, (iv) 22 healthy controls. In all subjects, spleen size, portal flow parameters and splenic artery resistance index were measured using duplex-Doppler ultrasound. Results: Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis ( P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. Conclusions: Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.     

超声检查对慢性病毒性肝炎肝纤维化诊断价值的评估

目的 探索超声二维图像和多普勒血流显像对慢性病毒性肝炎患者中纤维化程度和早期肝硬化的诊断价值。方法 324例慢性病毒性肝炎患者根据肝穿刺活检组织学结果分为无肝纤维化(SO)到肝硬化(S4)五期。活检组织按炎症分级为G1～G4四级。比较各组间超声指标的差异。结果 在超声定性指标中，肝表面回声，肝实质光点形态和分布异常等指标都与肝纤维化分期和炎症分级有相关性。但这些定性指标对具体患者的诊断判断变异很大。在不同纤维化程度分组间，脾长径，脾门静脉内径在各组间差异有统计学意义。根据脾长径界限值12．1cm，诊断早期肝硬化的敏感度为60．0％，特异性为75．3％；脾静脉内径以8mm作为界限值，诊断早期肝硬化的敏感度为60．0％，特异性为78．1％；门静脉主干内径12mm，诊断早期肝硬化的敏感度76．7％，特异性44．6％。门静脉最大流速界限值为30．5cm／s时，诊断早期肝硬化的敏感度为78．6％，特异性为66．9％。结论 超声检查是诊断早期肝硬化的有效工具，是临床实用的方法，并适用于随访复查。     

Influence of the spleen on portal haemodynamics: a non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders

BACKGROUND: Splanchnic haemodynamic parameters for the differential diagnosis of splenomegalies of different origins are still suboptimal and the role of spleen enlargement in cirrhosis remains controversial. In an attempt to elucidate these questions, we assessed splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. METHODS: Study groups comprised: (i) patients with chronic liver disease (89 with cirrhosis, 35 with chronic hepatitis), (ii) patients with splenomegaly without relevant portal hypertension (14 with haematological splenomegaly and 25 liver transplant recipients without complications), (iii) 15 patients with arterial hypertension, (iv) 22 healthy controls. In all subjects, spleen size, portal flow parameters and splenic artery resistance index were measured using duplex-Doppler ultrasound. RESULTS: Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis (P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. CONCLUSIONS: Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.     

超声诊断在日本血吸虫病中实用价值的研究——Ⅱ不同血吸虫病流行区村民的超声检查结果

对日本血吸虫病流行区村民(684例)、已达消灭标准地区村民(1133例)和非流行区村民(1342例)进行腹部超声检查.结果显示3个不同地区超声检查正常率分别为14.76%、61.42%和90.31%;积分异常率为18.19%、7.03%和1.45%.异常率随年龄增大而增加.对这3个不同地区超声检查结果的相互比较,显示以门脉Ⅱ级分支外/内径比值、肝实质异常及脾肿大变化的差异最大.表明超声检查可作为血吸虫病流行病学调查的一种较好方法.     

Rheumatoid‐like nodules in the spleen: New extraintestinal manifestation of Crohn’s disease?

A 26‐year‐old, HLA‐B27 positive man with steroid dependent Crohn’s disease presented with abdominal lymphadenopathy and multiple abscess‐like masses in the spleen and liver 2 years after the initial diagnosis. A biopsy of one of the liver lesions showed epitheloid cell granuloma, no microorganisms were detected despite intensive investigations. The liver lesions and the lymphadenopathy repeatedly disappeared completely in response to prednisolone pulse therapy while the lesions in the spleen remained practically unchanged. One year later, on immunosuppressive therapy with azathioprine and low‐dose prednisolone, the patient’s condition exacerbated with development of fever, disseminated arthritides and enlargement of the splenic lesions. Following ineffective antimicrobial treatment, a splenectomy was carried out. Histology showed that the splenic parenchyma was filled with abacterial, rheumatoid granulomas. After a renewed flare‐up of severe extraintestinal symptoms, the patient is now asymptomatic on immunosuppressive therapy with azathioprine and prednisolone. Abdominal lymphadenopathy is no longer present and the liver lesions are regressing. The intermittent course and the positive response to immunosuppressive therapy point to a further extraintestinal manifestation of Crohn’s disease.     

Spontaneous rupture of the spleen and liver in amyloidosis--a case report and review of the literature

A 52 year-old woman with systemic amyloidosis complicated with multiple myeloma died suddenly of intraperitoneal hemorrhage due to spontaneous rupture of the spleen and liver. Autopsy revealed multiple myeloma involving the bone marrow and diffuse amyloidosis involving the liver, spleen, kidneys, heart, bone marrow, lymph nodes, lungs, gastrointestinal tract, thyroid, skin and adrenal glands. The splenic red pulp and the hepatic parenchyma were replaced by masses of amyloid. Amyloid deposits were also numerous in the walls of blood vessels and linearly in the intracapsular regions of both the liver and spleen. This is the eighth case of spontaneous rupture of the spleen and the second case of spontaneous rupture of the liver in association with systemic amyloidosis.