瞬时弹性成像在慢性肝病长期治疗管理中的应用

<正>肝纤维化是各种慢性肝脏疾病向肝硬化发展的重要病理过程,影响患者的治疗和预后,准确及时的评估肝纤维化是慢性肝病患者诊治过程中的重要环节。近年来瞬时弹性成像作为一种无创性肝纤维化检测手段在评估肝纤维化、肝硬化方面展示出良好的准确性和可靠性。随着该项技术在临床应用的逐步广泛,瞬时弹性成像在慢性肝病治疗效果的评估和长期随访监测中的应用亦得到了诸多研究的验证,本文就其进展作一     

瞬时弹性成像联合声触诊组织量化技术诊断慢性HBV携带者肝纤维化与病理的对照性研究

目的:探讨瞬时弹性成像联合声触诊组织量化技术对慢性HBV携带者肝纤维化的诊断及与病理结果的相关性。方法:选择120例慢性HBV携带者,分别采用瞬时弹性成像和声触诊组织量化技术对受试者进行检测,并与病理检测结果进行对比分析。结果:采用声触诊组织量化技术检测结果显示,慢性HBV携带者肝剪切波速随病理纤维化分期的增加而逐步增高;采用瞬时弹性成像技术检测结果示随着肝纤维化程度的加重,肝脏组织硬度值逐渐升高。由此推断,肝剪切波速度和肝脏组织硬度值越大,肝纤维化程度往往越重。两者联合应用,其敏感度、特异度、准确度均较单一检测技术高,表明两者联合应用对于肝纤维化具有更高的诊断价值。结论:瞬时弹性成像和声触诊组织量化技术可无创性地反映肝组织的弹性硬度,两者联合应用能够提高诊断的特异性、敏感性、准确性,为临床诊断和治疗肝纤维化提供更有价值的信息。     

瞬时弹性成像技术用于诊断肝纤维化的评价

<正>瞬时弹性成像技术(transient elastography,TE)是一门基于超声波或磁共振的瞬时弹性成像改变评估肝脏硬度(liver stiffness measurement,LSM),从而诊断肝纤维化及其程度的新技术。可以使50%~60%的患者避免肝穿刺~([1-3]),由于其无创伤性,操作简单,可重复性等特点,在肝纤维化诊断领域得到普遍认可。本文现就瞬时弹性成像技术用于诊断肝纤维化的评价作如下概述。一、慢性乙型肝炎对慢性乙型肝炎患者,评估肝纤维化的程度不仅是确定抗病毒和抗纤维化治疗的重要依据,也是对抗病毒和抗纤维化疗效评价的重要指标。Marcellin等~([4])进行的多中心前瞻性研究     

瞬时弹性成像与实时组织弹性成像评估肝纤维化的比较

目的 对比分析瞬时弹性成像和实时组织弹性成像评估慢性肝病肝纤维化的价值.方法 对92例行肝组织学检查的慢性肝病患者同时行瞬时弹性成像和实时组织弹性成像检查,以肝组织病理学检查结果为金标准,比较瞬时弹性成像和实时组织弹性成像与肝纤维化病理分期的相关系数、诊断肝纤维化的受试者工作特征曲线下面积. 结果 瞬时弹性成像与肝纤维化病理分期的相关系数(r=0.755,95％ CI0.651 ～ 0.831,P=0.000)高于实时组织弹性成像(r=0.481,95％CI0.306 ～ 0.624,P=0.000),Z=3.07,P=0.002.瞬时弹性成像和实时组织弹性成像诊断肝纤维化(S≥2)、肝硬化(S=4)的受试者工作特征曲线下面积分别为0.903和0.740、0.915和0.786,瞬时弹性成像高于实时组织弹性成像(P值分别为0.003和0.020). 结论 瞬时弹性成像诊断慢性肝病肝纤维化效能优于实时组织弹性成像,但后者与二维超声图像融合,具有广泛的应用前景.     

瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展

肝脏纤维化程度及进展与慢性肝脏疾病的诊断与治疗密切相关。早期诊断肝纤维化程度有助于避免代偿期患者向肝硬化失代偿期发展,也有助于降低肝细胞癌的发生率。目前,临床上评估肝纤维化程度的“金标准”仍为肝脏穿刺活检,但是由于其操作的有创性,以及穿刺后可能出现的多种并发症等多种因素的影响,限制了它在临床研究中的使用。瞬时弹性成像技术无创、安全、有利于动态监测肝纤维化进展、客观评价肝脏纤维化程度,使其在国内外得到了广泛的认同,在临床上具有良好的应用前景。     

磁共振弹性成像无创检查在肝纤维化诊断中的应用

肝纤维化是各种慢性肝病进展至肝硬化的共同过程,由于临床运用有创肝病理学检查存在一定的局限性,因此运用无创检查对肝纤维化进行评价,对病情发展变化进行监测十分必要。目前弹性成像技术被认为是能够较好地评价肝纤维化的有效手段。最近研制开发的磁共振弹性成像技术对肝纤维化的评估具有良好的应用前景。本文综述了该技术在肝纤维化诊断中的应用。     

肝纤维化的影像学评价方法及研究进展

肝纤维化是各种慢性肝病发展的必经阶段.肝纤维化尚属可逆的过程,早期诊断与及时有效治疗可延缓或避免发展成为不可逆的肝硬化阶段.因此,如何准确、有效、简便地评价肝纤维化的严重程度成为临床亟待解决的难题.超声、CT、核磁共振成像都是肝脏病变的常用检查手段,影像学检查可以比较准确的无创性评估肝纤维化程度,随着新技术的发展与应用,弹性技术在肝纤维化评估中得到广泛应用.本文就影像学评估肝纤维化的方法,尤其是弹性技术的应用进展进行综述.     

瞬时弹性成像技术评估慢性乙型肝炎患儿肝纤维化

正【据Hepatology International 2021年7月报道】题:瞬时弹性成像技术评估慢性乙型肝炎患儿肝纤维化(作者Xu ZQ等)瞬时弹性成像(TE)已广泛应用于成人肝纤维化的评估,但是此项检测技术在儿童中尚缺乏大样本的高质量研究,没有严格的儿童标准。而儿童慢性乙型肝炎(CHB)急需肝纤维化的无创诊断技术。该研究旨在以肝脏病理为对照比较TE诊断慢性CHB患儿肝纤维化的准确性。研究前瞻性纳入了解放军总医院第五医学中心157例0～6岁CHB患儿。     

瞬时弹性成像技术在自身免疫性肝病中的应用进展

自身免疫性肝病(AILD)是由体内免疫功能紊乱引起的一组特殊类型的慢性肝病,常隐匿进展至肝硬化阶段,给患者带来严重不良后果。及时、准确地评估肝纤维化程度对于AILD早期诊治、监测进展具有重要意义。瞬时弹性成像技术(TE)具有安全、无创、简便、快速等优点,已普遍应用于临床,并被推荐为评估乙型和丙型病毒性肝炎等患者肝纤维化的重要手段。TE存在局限性,如多种因素可导致其检测结果不可靠或操作失败。近年来,关于TE评估AILD肝纤维化的诊断价值和影响因素的研究日益增多。现综述TE在AILD中的应用进展及其影响因素。     

瞬时弹性成像技术在自身免疫性肝病中的应用进展

自身免疫性肝病(AILD)是由体内免疫功能紊乱引起的一组特殊类型的慢性肝病,常隐匿进展至肝硬化阶段,给患者带来严重不良后果。及时、准确地评估肝纤维化程度对于AILD早期诊治、监测进展具有重要意义。瞬时弹性成像技术(TE)具有安全、无创、简便、快速等优点,已普遍应用于临床,并被推荐为评估乙型和丙型病毒性肝炎等患者肝纤维化...     

青少年高血压的研究进展

随着人们生活和行为方式的改变,高血压发病明显呈年轻化趋势。在青少年时期识别高血压病高危人群有助于早期进行有效干预和治疗,降低未来高血压的发生率及其严重性。现试从青少年高血压的诊断、发病因素、特点、治疗策略等方面的研究进展作一综述。     

Morbidity in cardiovascular diseases in immigrants in Sweden

INTRODUCTION: Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease. MATERIAL AND METHODS: The study was designed as a follow-up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35-64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model. RESULTS: The age-adjusted risk of coronary heart disease was higher in most foreign-born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level. CONCLUSIONS: Foreign-born people possess an over-risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish-born persons, also when level of education and employment status are taken into account.     

C·肉毒杀鼠素(冻干剂)应用研究

目的为研究C·肉毒杀鼠索对杀灭达乌尔黄鼠(简称黄鼠)的大面积应用情况和对家畜、家禽的毒害作用,进行了C·肉毒杀鼠素的应用研究.方法大面积投毒采用ES-2药饵撒播机[1],间隔约80m进行条投.羊、鸡采用直接灌胃.结果大面积应用的灭鼠率为83.72%.对羊、鸡最高剂量分别为500万MLD、150万MLD,均未出现中毒现象.结论 C·肉毒杀鼠素是较为理想的草原大面积杀灭黄鼠的理想、首选药物.     

Sex Differences in Ethanol-induced Dopamine Release in Nucleus Accumbens and in Ethanol Consumption in Rats

In vivo microdialysis was used to examine changes in nucleus accumbens and striatal dopamine, dihydrophenylacetic acid (DO-PAC), and homovanillic acid (HVA) following acute administration of ethanol (0.0, 0.25, 0.5, 1.0, or 2.0 g/kg) in male and female Long-Evans rats. Following dialysis, rats were trained to bar-press for oral ethanol reinforcement. In nucleus accumbens, females showed significant increases in extracellular dopamine following 0.25 or 0.5 g/ kg ethanol, but did not show significant increases over baseline at the higher doses. Males showed slight increases in dopamine at the lower doses and decreased dopamine at 2.0 g/kg. In striatum, both sexes showed increased dopamine at the lower doses and decreased dopamine at 2.0 g/kg. There were slight increases in nucleus accumbens DOPAC and HVA at some doses in both sexes, but no changes in striatal metabolite levels. In addition to showing increased responsiveness to ethanol-induced mesolimbic dopamine stimulation, females consumed more ethanol than males during behavioral testing. The pattern of both greater ethanol-induced nucleus accumbens dopamine release and greater ethanol consumption in females supports the hypothesis that ethanol reward is mediated, at least in part, by the mesolimbic dopamine system.     

高龄老年高血压的临床研究进展

随着社会老龄化进程的加快,80岁以上高龄老人的绝对数量以及占总人口的比例均在增加,如何提高高龄老年高血压的防治水平备受关注。现试从高龄老年高血压的临床特点、治疗策略等方面的临床研究进展作一综述。     

Epstein-Barr virus in malignancies in renal transplant recipients in Japan

A role for Epstein-Barr virus (EBV) in the development of malignancies including lymphomas, and carcinoma of the stomach, nasopharynx, thymus and salivary gland is suggested. It is indicated that EBV evokes polyclonal-B-cell-proliferative diseases in immunocompromised hosts, such as transplant patients, which results in monoclonal malignant lymphomas. The suppression of immune functions in these patients is thought to lead to incomplete elimination of the cells expressing EBV latent infection genes. To examine the etiological role of EBV in the development of malignancies following renal transplant in Japan, 42 malignancies in 1744 cases of renal transplant were studied for the presence and type of EBV. The polymerase chain reaction revealed that 5 malignancies were positive for EBV, all type A: 2 of 2 cases of non-Hodgkin's lymphoma (NHL), 2 of 8 cases of gastric adenocarcinoma of the common type, and 1 of 2 cases of gastric plasmacytoma. In situ hybridization revealed positive signals in the nucleus of tumor cells in 2 cases of NHL and 1 of plasmacytoma. Positive signals were found in the small lymphoid cells but not in the tumor cells in 2 cases of gastric carcinoma. On the basis of these findings, a role for EBV in the development of malignancies in renal transplant patients is unlikely except for lymphoid neoplasias.Abbreviations PCB polymerase chain reaction - EBV Epstein-Barr virus - NHL non-Hodgkin's lymphoma     

中国老年性耳聋的研究与干预进展

老年性耳聋已成为影响我国老年人生活质量的最主要的慢性病之一。助听器是目前帮助听力损失的老年人克服交流障碍的主要手段。在我国,数字助听器已逐渐取代模拟助听器并且体现出了更好的效果。但是老年听力损失患者中使用助听器的比例仍然很小。人工耳蜗植入也已被应用在老年患者中。我国针对老年人的听力康复服务还有较长的路要走。     

Progress in diabetes research in China

The prevalence of diabetes, especially Type 2 diabetes mellitus (T2DM), is increasing markedly throughout the world, including in China. Because T2DM and its complications are associated with considerable socioeconomic burden and mortality, there is increasing interest in developing strategies to prevent or delay progression of the disease. In recent decades, many researchers have focused on the mechanism of onset of diabetes, as well as examining the benefits of various interventions in subjects with different glucose tolerance status to prevent or delay development of the disease. In the present article, we focus on five areas (epidemiology, early intervention, insulin sensitivity and β-cell function, adipocytokines, and traditional Chinese medicine) to review the progress of research into diabetes in China today. The prevalence of diabetes in China is one of the highest in the world. However, with lifestyle interventions and appropriate pharmacological therapies (including traditional Chinese medicine), T2DM may be prevented, well controlled, or even put into remission. Accurate estimation of insulin secretion and insulin sensitivity, as well as better characterization of the physiological function of adipocytokines, could give us a better understanding of the basic mechanisms underlying the onset of diabetes and could lead to better interventions in people with impaired glucose tolerance and T2DM.     

Typhoid fever in children in Africa

Estimates for the year 2000 suggested that there were approximately 21.5 million infections and 200,000 deaths from typhoid fever globally each year, making the disease one of the most serious infectious disease threats to public health on a global scale. However, these estimates were based on little data, especially from Africa. Global prominence and high-profile outbreaks have created the perception in Kenya that typhoid is a common cause of febrile illness. The Widal test is used widely in diagnosis. We have reviewed recent literature, taking the perspective of a healthcare provider, to collate information on the prevalence of typhoid in children particularly, and to explore the role of clinical diagnosis and diagnosis based on a crude, but common, interpretation of the Widal test. Data suggest that typhoid in children in rural Africa is uncommon, perhaps 100 times or 250 times less common than invasive disease because of Haemophilus influenzae or Streptococcus pneumoniae, respectively. Frequent use of the Widal test may result in many hundreds of over-treatment episodes for every true case treated and may perpetuate the perception that typhoid is common. Countries such as Kenya need better bacterial disease surveillance systems allied to better information for healthcare providers to promote appropriate decision-making on prevention and treatment strategies.