肝衰竭与肾上腺皮质功能不全

肝衰竭是多种因素引起的严重肝脏损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍,出现以凝血机制障碍、黄疸、肝性脑病,腹水等为主要表现的一组临床症候群[1].肾上腺皮质功能不全是一种较为罕见的疾病,血清中皮质醇水平是其确诊的主要评价指标.内源性的糖皮质激素(皮质醇)由肾上腺皮质束状带分泌,属于类固醇类激素.近年来肾上腺皮质功能不全与肝衰竭的关系越来越受到关注,现就肝衰竭合并肾上腺皮质功能不全的最新研究进展作一综述.     

肝功能衰竭的诊断和治疗现状

肝功能衰竭(简称肝衰竭)是临床常见的严重肝病症侯群,其预后不良,病死率甚高(可达50%～90%),严重威胁人类健康,也是临床医师最具挑战的疾病之一。多年来,各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索,但迄今尚无一致意见,而临床对肝衰竭的认识、早期正确的诊断和治疗对于救治肝衰竭患者尤为重要。本文拟就肝衰竭的诊断和治疗进展作一综述。肝功能衰竭的定义和病因[1]定义肝衰竭是由多种病因引起的严重肝损伤,表现肝脏合成、代谢、排泄和解毒等功能严重障碍和失代偿,出现以黄疸、凝血功能障碍、肝性脑病和腹水等为主要表现的…     

糖皮质激素应用于肝衰竭治疗机制及其临床时机的把握

肝衰竭是多种因素所引起的严重肝脏损伤,导致合成、解毒、代谢和生物转化功能严重障碍或失代偿,出现以黄疸、凝血功能障碍、肝性脑病、腹水等为主要表现的一组临床症候群[1]。由于肝衰竭发病急、进展快、病死率高,大大增加了临床治疗的难度。目前,对于肝衰竭的治疗仍没有显著的突破,主要仍以内科综合治疗、人工肝治疗和肝移植为主。人工肝是借助体外机械、化学或生物性装置,可暂时或部分替代肝脏功能。肝移植因供体相对缺乏、费用较高和各种手术禁忌证等因素,仍有一定的局限性。糖皮质激素作为肾上腺皮质束状带分泌的一类甾体激素,自20世纪80年代以来,已开始应用于各种原因导致的肝炎和肝衰竭的治疗。     

肝衰竭患者临床预后判断研究进展

肝衰竭是指多种原因导致肝细胞合成、解毒、排泄和生物转化等功能严重障碍,出现以凝血功能障碍、黄疸、肝性脑病、腹水等为主要表现的一组临床症候群,由于肝衰竭疾病凶险,因此预后判断对于其诊治具有重要意义。近年来对于肝衰竭预后判定报道屡见不鲜,回顾了有关血清学及综合模型的研究及应用,为临床肝衰竭患者合理治疗提供参考。     

中西药联合双重血浆分子净化系统救治肝衰竭并发肝性脑病1例报告并文献复习

正肝衰竭是多种因素引起的肝脏功能严重损害,致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血功能障碍、黄疸、肝性脑病、腹水等为主要表现的一组临床症候群~([1])。肝炎病毒感染为其首位病因,其次为药物、肝毒性物质(如酒精)等,也是其重要病因。《肝衰竭诊治指南》(2012年版)将其分为急性肝衰竭、亚急性肝衰竭、慢加急性肝衰竭和慢     

急性肝功能衰竭的预后评估模型及进展

肝衰竭是由多种因素引起的严重肝脏损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群。在我国．引起急性肝衰竭的主要病因是乙型肝炎病毒．其次是肝毒性药物。     

乙型肝炎相关肝衰竭抗病毒治疗研究进展

肝衰竭是由多种因素引起的严重肝脏损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍、黄疸、肝性脑病和腹水等为主要表现的一组临床症候群[1].肝衰竭是临床常见的严重肝病症候群,以病情重、进展快、治疗难、费用高、病死率高为特征,是严重危害我国国民身体健康的疾病之一.近年来,随着对肝衰竭的研究不断深入,在诊断、预后判断和治疗方面已经取得了长足的进步,在很大程度上降低了肝衰竭患者的病死率.     

全程门冬氨酸鸟氨酸治疗延缓乙型肝炎病毒相关慢加急性肝衰竭的进展

肝衰竭是多种因素引起的严重肝脏损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群[1].在我国引起肝衰竭的主要病因是HBV感染.目前,对肝衰竭的内科治疗尚缺乏特效药物和手段,多采取综合治疗措施,积极防治各种并发症.我们采用门冬氨酸鸟氨酸治疗H BV感染相关慢加急性肝衰竭来分析血氨在肝衰竭中的作用.     

肝衰竭内科治疗的思路

肝衰竭是由多种因素引起的严重肝脏损害,导致合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血功能障碍、黄疸、肝性脑病、腹水等为主要表现的一组临床症候群[1].我国肝衰竭的首要病因为肝炎病毒（主要是乙型肝炎病毒）,其次是药物及肝毒性物质（如乙醇、化学制剂等）.在西方国家,药物是引起急性、亚急性肝衰竭的主要因素[2];酒精性肝损害常导致慢性或慢加急性肝衰竭.肝衰竭在儿童中多可见于遗传代谢性疾病.肝衰竭的治疗手段主要包括内科综合治疗、人工肝支持系统辅助治疗及肝移植术治疗等,其中内科综合治疗是基础,但内科综合治疗仍未取得实质性的突破,缺乏特效药物及方法,病死率仍然较高[34].因此,肝衰竭内科治疗过程中,正确的思路非常重要.     

缓慢持续型慢加急性肝衰竭与慢性肝衰竭的甄别*

正肝衰竭是多种因素引起的严重肝脏合成和代谢功能紊乱,以黄疸、凝血功能障碍为主要表现的一组临床症候群。临床常见肝衰竭类型包括慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)和慢性肝衰竭。缓慢持续型ACLF与慢性肝衰竭的临床表现类似,部分缓慢持续型ACLF患者可发展为慢性肝衰竭,两者容易发生混淆。现从疾病概念、慢性肝病基础、病理学特征、起病过程、肝功能损伤的主要指标,即总胆红素和凝血功能指标、对人工肝治疗反应和疾病预后转归等方面进行如下甄别。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.