120例药物性肝损伤临床分析

目的：对3年多来呼和浩特市第二医院收治的药物性肝损伤（DILI）患者作回顾性分析,以提高临床医师对此病的认识,尽早做出正确诊断和治疗。方法对2011年1月至2014年1月期间在我院就诊的120例药物性肝病的患者进行回顾性分析,并根据1997年 Maria药物性肝损伤评分标准进行评价,总结临床特征。结果120例患者中, Maria评分≥14分者39例,10～13分60例,6～9分21例。涉及药物发生率由高至低,主要为抗结核药46．67％（56/120）,中草药20．83％（25/120）,其他抗生素15．83％（19/120）,其他药物16．67％（20/120）。临床分型：肝细胞损伤型50．830％（61/120）,胆汁淤积型15．0％（18/120）,混合型34．17％（41/120）。结论抗结核药及中草药引起的肝损伤最为常见,少数可引起急性肝衰竭而死亡,应引起临床医生高度重视。     

132例药物性肝损伤临床分析

目的分析近年来药物性肝损伤的病因、临床特点、诊断及预后,以提高临床医生对本病的认识。方法根据Maria的"临床诊断量表(CDS)"对2003年4月至2009年4月间因药物性肝损伤而住入我院的病例进行评分,对≥10分的132例患者的病因进行回顾性分析和临床分型。结果引起肝损伤的药物有15类50余种,中草药、抗结核药、抗肿瘤药物和抗菌药物共占72.7%。潜伏期在5天～356天之间,在4周内、8周内和12周内发生肝损伤的比例分别为61.4%、84.9%和91.7%。肝细胞损伤型占78.8%,淤胆型占13.6%,混合型占7.6%。27例无临床症状和体征仅有实验室检测异常(20.5%),而有临床症状105例(79.5%),主要表现为乏力(64.4%)、纳差(53.0%)、尿黄(41.7%)。104例肝细胞损伤型患者中,在停药2月内肝功能均恢复正常,在停药30天内均有ALT降低50%,预后好。结论中草药、抗结核药、抗肿瘤药物和抗菌药物是引起药物性肝损伤的主要病因,绝大多数发生在12周内,用药时间越长,发生肝损伤的几率越高。药物性肝损伤主要临床类型为肝细胞损伤型,其临床特点与各类急、慢性肝胆疾病相似,无特异性,预后好。     

急性重症药物性肝损伤患者发病状况的回顾性研究

目的回顾性研究急性重症药物性肝损伤患者的发病状况,以期对临床用药起到指导作用。方法回顾性研究2003年5月-2013年5月广西梧州中医医院收治的急性重症药物性肝损伤的患者82例,对急性重症药物性肝损伤患者的住院诊治情况和可能导致急性重症肝损伤的药物和致死药物进行分析。结果患者的治疗方式包括行人工肝治疗和单纯药物治疗,比例分别为34.15%和65.85%。在患者治疗的过程中死亡31例(37.80%),病情恶化30例(36.59%),病情好转13例(15.85%),治愈8例(9.76%);引起肝损伤的前3类药物分别是中草药、抗结核药物和抗菌药物,致病率分别为28.05%、24.39%和14.63%,在住院期间死亡的31例患者中,也是使用中草药(35.48%)和抗结核药物(19.35%)的患者比例居多。结论急性重症药物性肝损伤致死率较高,其中,中草药和抗结核药物是导致肝损伤以及致死的主要病因,对这两种药物的临床监测需要引起重视。     

430例药物性肝损伤临床特点分析

目的分析药物性肝损伤的临床特点,提高临床医师在应用肝毒性药物时对该病的重视,为其预防及治疗提供理论基础。方法采用回顾性研究方法,收集2015年1月至2016年12月在海南医学院第二附属医院住院诊断为药物性肝损伤的430例患者的相关资料信息,分析其基线资料、肝损伤药物种类、临床分型及治疗转归。结果 430例药物性肝损伤患者中,引起肝损伤的药物前三名依次为抗肿瘤药(40.23%)、抗结核药(33.72%)、中成药及中草药(9.30%);三种临床分型的发生率分别为:肝细胞损伤型249例(57.24%),胆汁淤积型114例(27.36%),混合型67例(15.4%),其中胆汁淤积型的预后相对要差(P=0.000)。结论引起药物性肝损伤的药物种类多,最常见的是抗肿瘤药物,其次为抗结核药物,临床分型主要以肝细胞损伤型为主,但胆汁淤积型的患者预后相对较差,因此临床医师在使用肝损伤药物时要注意监测患者肝功能指标的变化,及时干预,避免产生严重不良后果。     

药物性肝损伤临床分析

目的分析因服用中草药和抗结核药物引起肝损害的临床表现。方法对药物性肝损伤患者42例的临床资料进行了回顾性分析。结果男性12例,女性30例,平均年龄50.1±16.9岁。42例中为中草药制剂所致者占28.5%,抗结核药物引起者占23.5%。所有患者在停药后肝功能恢复较快,预后良好。结论中草药和抗结核药物为目前主要的引起药物性肝损伤的药物,应引起临床医师的重视。     

药物性肝损伤107例临床特征

目的探讨药物性肝损伤(DILI)的临床特点,评价RUCAM表及Maria诊断标准临床应用价值。方法回顾性分析2007年至2011年在大连医科大学附属第一医院因DILI住院患者107例的致病药物、临床表现及治疗转归。运用Spearman相关分析和配对χ2检验,评价RUCAM表及Maria诊断标准的一致性及与临床判断的符合率。结果引起肝损伤的药物多见于中药、抗肿瘤药物、抗甲状腺药物、抗生素和抗结核药物。肝损伤临床类型为肝细胞型81例,胆汁淤积型11例,混合型12例。RUCAM表及Maria评分系统结果完全符合有34例(31.7%),相差1级48例(44.8%),相差2级19例(17.7%),表示两者有一定的正相关(r=0.233,P=0.015)。结论 DILI患者中以中药、抗肿瘤药及抗甲状腺药常见;临床类型以肝细胞型多见;RUCAM表的DILI因果关系评价更接近一般临床判断。     

老年药物性肝损伤74例临床分析

目的:通过对74例老年药物性肝损伤住院患者的回顾性分析来提高对本病的认识。方法:回顾性地从病因、临床特点、诊疗情况等方面来分析74例在我院住院年龄≥60岁的药物性肝损伤(DILI)患者,找出该类患者的临床特点和引起肝损伤的重要药物。结果:引起药物性肝损伤的重要药物为心血管药物占45.95%(34/74)、中药(中成药或保健品)占27.03%(20/74)、抗生素占10.81%(8/74)、抗结核药占9.46%(7/74);主要临床表现有纳差、乏力、黄疸、恶心、呕吐等;临床分型中胆汁淤积型占50%(37例)、肝细胞损伤型占31.08%(23例)、混合型占18.92%(14例);肝功能受损以ALT、AST、ALP和TBil增高为主;经停药和护肝治疗大多数患者(93.2%)肝功能好转或恢复正常。结论:老年DILI临床症状缺乏特异性,基础疾病多,多种药物联合应用,其中以心血管药物为主,其次为中药、抗生素、抗结核药等。及时停用肝损伤药物是治疗的关键,大多数患者经积极治疗预后良好。     

药物性肝损伤患者的回顾性分析122例

目的:分析药物性肝损伤的药物类型、临床分型、肝损伤严重程度及预后,提高临床医师对该病的认识,为临床预防提供参考.方法:采用回顾性研究方法,对2012-03/2014-12间于新疆医科大学第一附属医院住院治疗的RUCAM评分≥3分的122例药物性肝损伤病例进行数据统计,采用秩和检验进行统计学分析.结果:最常见的导致药物性肝损伤的药物为抗结核药(29.51%),其次为化疗及免疫抑制药(24.59%)、中药(19.67%);三种临床分型间的肝损伤严重程度比较,差异无统计学意义(P0.05);三种临床分型间的预后比较,差异无统计学意义(P0.05).结论:抗结核药已成为目前新疆药物性肝损伤的主要病因,需加强抗结核治疗过程中的肝功监测,防治药物性肝损伤的发生.     

急性药物性肝损伤179例临床分析

目的探讨急性药物性肝损伤临床表现特点、分型、病因、治疗及分析预后，以指导临床诊断和治疗。方法采用急性药物性肝损伤诊断及分类国际共识标准，回顾性调查近5年来中山大学附属第一医院179例急性药物性肝损伤住院患者的临床资料。结果本研究中有48％的患者无明显临床症状体征，其余亦缺乏特异性；有肝细胞型137例（76．11％），胆汁淤积型24例（14．33％），混合型18例（10．56％）。符合重症肝损伤者6例；引起肝功能损伤的药物种类很多，本组最常见的为化疗药、抗结核药、中草药；85．55％患者预后较好，主要肝功能指标于30d内恢复至正常上限两倍以内。6例发展为重型肝损伤，预后较差。结论急性药物性肝损伤症状缺乏特异性，不能单纯根据症状确定诊断；本组患者急性药物性肝损伤的类型以肝细胞型为主；临床上可以引起急性药物性肝损伤的药物种类很多，但以化疗药、抗结核药、中草药发生率最高，临床应用此类药物时，应注意监测肝功能在本组患者中急性药物性肝损伤一般预后较好，但亦可发生严重肝损害，应及时采取措施处理。     

急性药物性肝病72例临床分析

目的探讨急性药物性肝病的常见诱发药物、临床表现、分型及预后,以提高对该病的诊断水平。方法对符合诊断标准的72例急性药物性肝病的临床资料进行回顾性分析。结果诱发急性药物性肝病的药物中,抗结核药18例(25%),中草药16例(22·2%),抗生素10例(13·9%),抗肿瘤化疗药物4例(5·6%),抗甲亢药4例(5·6%),其他20例(27·8%)。临床表现为急性肝细胞型47例(65·2%),急性胆汁淤积型16例(22·2%),混合型9例(12·5%)。其中治愈52例(72·2%),好转13例(18·1%),无变化5例(6·9%),恶化2例(2·8%)。结论急性药物性肝病常见的诱发药的前五位为抗结核药、中草药、抗生素、化疗药和抗甲亢药等,应该引起临床医生的足够重视。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.