The pregnant patient with acute liver disease

Acute liver disease was diagnosed in three pregnant patients: two 30-year-old women had a 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome and acute fatty liver of pregnancy, respectively, and a 20-year-old woman had acute liver failure due to acute hepatitis B. The first two patients had a caesarean section, the third one delivered her child, which died spontaneously shortly after birth at a gestational age of 23 weeks. She was then treated by liver transplantation. All three patients left the hospital in good condition. Liver diseases in pregnancy may be pregnancy-related, e.g. the HELLP syndrome and acute fatty liver of pregnancy, but they may also be coincidental phenomena, e.g. viral hepatitis. The HELLP syndrome is often associated with pre-eclampsia, and presents with epigastric pain and thrombocytopenia with haemolysis. Acute fatty liver disease and acute liver failure due to hepatitis present with liver insufficiency characterised by anorexia, nausea, coagulopathy, hypoglycaemia and elevated serum ammonia levels. Management depends on the diagnosis and the gestational age; pregnancy complicated by acute fatty liver disease should be terminated while pregnancy complicated by the HELLP syndrome early in pregnancy may be maintained to improve the outcome of the foetus. In acute liver failure due to viral hepatitis, termination of pregnancy alone does not affect the disease.     

血清肝细胞生长因子水平变化与肝病的相关性探讨

目的：评价血清中肝细胞生长因子（HGF）水平与肝硬化、肝癌和慢性肝炎的关系,探讨血清HGF水平作为肝脏疾病临床指标的价值。方法：采用固相酶联免疫吸附法（ELISA）检测血清中HGF的水平。结果：肝硬化患者的HGF水平显著高于正常对照组（P〈0.01）,肝癌（HCC）和慢性肝炎（CH）患者的HGF水平明显高于正常对照组（P〈0.05）。结论：HGF水平检测可作为肝脏疾病临床诊断和治疗的有价值指标。     

The Fibrogenicity of Some Respirable Dusts Measured in Mice

A method of bio-assay of the fibrogenicity of respirable dust is described. Quartz, coal, and quartz-coal dust mixtures were administered to mice via the tail vein, and liver collagen was estimated chemically. Groups of mice that had received doses of 10, 15, and 20 mg. of these dusts were killed at intervals of 10, 20, and 30 weeks after injection.

There was, in general, a linear relation between liver dust and collagen content, and a higher liver collagen the greater the quartz content of injected dust. At 30 weeks after injection there was good differentiation of the collagen response of liver to dust mixtures of different quartz content. These provide standard curves with which liver collagen response to any unknown dust can be compared. The fibrogenicity of two samples of respirable gold-mine dust was less than would be expected from the quartz content. Dust extracted from a region of massive fibrosis in a coal-miner's lung was more fibrogenic than dust from a lung with simple pneumoconiosis.

     

常用人工肝支持方法的原理、临床应用和展望

我国人工肝技术临床应用尽管只有十多年的历史，但发展很快，正逐渐为成为重型肝炎肝衰竭及其它一些肝病常用和有效的治疗方法。目前有上百家单位开展相关临床治疗，数十家机构进行相关基础研究。由于我国肝病的多发性及肝脏移植尚不普及，因此人工肝发展潜力仍然很大。由于肝脏在人体代谢的中枢地位、复杂性及肝病的多发性和多样性，使得人工肝支持比其它任何人工器官方法更多，困难更大。本文综述了国内外几种主要人工肝技术的原理及临床应用情况，并就人工肝脏治疗存在的困难及发展方向进行初步讨论和展望。     

The MELD System for Liver Allocation

The recent implementation of the Model for End-stage Liver Disease (MELD)/Pediatric End-stage Liver Disease (PELD) system for the allocation of cadaveric liver organs in the US represents a dramatic change in organ allocation policy. Previous allocation algorithms used a categorical stratification system, in which candidates were ranked by the length of time waiting within these strata. This resulted in the ranking of patients by time waiting on the list, not by their need for a transplant. Moreover, these previous systems had not been validated for their accuracy in predicting the severity of liver disease and did not meet the needs of the enlarging population of appropriate candidates with end-stage liver disease. The MELD was identified as a potentially more accurate measure of liver disease, and a new plan for liver allocation incorporating the MELD score and virtually eliminating waiting time was devised. Several diagnoses for which liver transplantation is indicated were identified as not being served by the MELD system, so alternative mechanisms were developed for these cases. The new allocation system went into effect on February 27, 2002. One year after implementation, there was a statistically significant increase in the number of cadaveric transplants and a slight reduction in the number of waiting list deaths compared with the previous system in the year prior to MELD.As the system evolves and improvements are made, patients have a much more objective measure of the severity of their liver disease, which is comparable regardless of the geographic location or physician. This change to a mathematically-based system that defines the risk of death represents a change in the way patients and caregivers will think about the liver transplant list. In addition, payors now have a much more objective measure of the severity of illness and can more accurately risk-adjust their comparisons of centers and patients. The new system directs organs to sicker patients, and waiting candidates are likely to experience significant declines in their quality of life while waiting. In addition, because this new policy will result in more severely ill patients receiving transplants, the costs of care are likely to increase, although preliminary results suggest that survival rates have not changed. The change to this new, more evidence-based system is a significant paradigm shift in organ allocation policy. Patients, caregivers, and payors should also be prepared for continuous evolution of the system as more data become available.     

氧化苦参碱对肝纤维化大鼠保护机制的研究

目的探讨氧化苦参碱抗肝纤维化作用及其机制,为临床应用中药防治肝纤维化和肝硬化提供实验依据。方法40只SD大鼠随机分为对照组、CCl4诱导肝纤维化模型组和氧化苦参碱干预组,免疫组化方法检测NF—κB、IκBα及I型胶原在各组肝组织中的表达。结果在正常对照组、氧化苦参碱组和肝纤维化模型组肝组织中I型胶原表达的平均密度值分别为0．087、0．130、0．311,肝纤维化模型组与正常组比较差异均有显著性（P〈0．01）;氧化苦参碱组较肝纤维化模型组I型胶原表达明最减少（P〈0．01）;肝纤维化模型组肝组织NF—κB、IκBα表达均显著高于对照组（P〈0．01）;而氧化苦参碱组NF—κB表达较模型组显著降低（P〈0．01）,IκBα表达较模型组明显升高（P〈0．05）。结论氧化苦参碱可以减轻CCl4诱导的肝纤维化,对NF—κB信号转导通路相关分子的调控可能是其主要机制。     

超声造影在评估肝炎肝纤维化及肝硬化中的应用价值

目的利用声诺维（SonoVue）造影剂来评估超声造影在肝炎肝纤维化及肝硬化中的lI缶床价值。方法选取慢性肝炎患者40例,分为肝纤维化组30例,肝硬化组10例,均经超声引导下肝组织活检病理证实;对照组10例,来自健康的自愿者。在造影模式下,经肘静脉注射超声造影剂SonoVHe,记录造影剂到达肝动脉时间、到达门静脉时间、到达肝静脉时间及肝实质增强峰值时间。结果肝纤维化组超声造影剂到达肝静脉显影时间较对照组延长,差异无统计学意义,时间分别为（25．52±4．35）s、（21．40±4．87）S;肝硬化组超声造影剂到达肝静脉显影时间较肝纤维化组、对照组缩短,差异有统计学意义,时间分别为（16．45±2．86）s、（25．52±4．35）s、（21．40±4．87）s;肝纤维化组、肝硬化组的肝实质增强峰值时间较对照组延长,差异有统计学意义,时间分别为（43．53±8．63）S、（56．78±11．56）S、（28．45±8．32）s。超声造影剂到达肝肝动脉、门静脉显影时间在3组之间差异无统计学意义。结论超声造影技术在评估肝炎肝纤维化及肝硬化的诊断中有一定的临床价值,可以更好的指导临床治疗。     

宫颈癌化疗期间双环醇片预防肝损害研究

目的评价双环醇片在宫颈癌化疗期间减轻、延缓化疗期间肝功能损害的疗效。方法 2014年3月—2016年9月于江西省九江市第一人民医院肿瘤科收治的90例宫颈癌化疗患者随机分为两组,其中治疗组(双环醇片)45例,对照组(甘草酸二胺肠溶胶囊)45例。两组患者化疗前肝功能正常,治疗组化疗疗程期间口服双环醇片每次50 mg,一日3次预防性保肝治疗;对照组口服甘草酸二胺肠溶胶囊每次150 mg,一日3次预防性抗肝损治疗,化疗后每周复查肝功能,统计分析两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)变化差异。结果 90例患者均完成化疗周期内治疗,两组化疗期间均有一定程度肝功能损害,但对照组更为明显,需要辅助静脉保肝药物处理后,按原方案继续化疗;治疗组肝功能损害程度明显低于对照组,对照组出现Ⅲ—Ⅳ度肝损害发生率明显高于治疗组,以上差异均有统计学意义。结论双环醇片(150 mg/d)能有效预防和减轻患者化疗期间药物性肝损伤。     

The impact of bariatric surgery on nonalcoholic fatty liver disease

PURPOSE OF REVIEW: To analyze the effects of bariatric surgery on nonalcoholic fatty liver disease by reviewing the most important and recent studies. RECENT FINDINGS: The prevalence of obesity has increased dramatically over the last decades. Comorbidities related to obesity, such as nonalcoholic fatty liver disease are also increasing. Nonalcoholic fatty liver disease is a progressive disease with potential evolution to liver cirrhosis and hepatocellular carcinoma. Overweight patients who have nonalcoholic fatty liver disease should be considered for a weight loss program; however, long-term result with dietary interventions and drug therapy has been disappointing. Bariatric surgery is effective in promoting long-term weight loss in morbidly obese patients with control of comorbidities, especially those associated with the metabolic syndrome. On the basis of the early experience with extensive intestinal bypass, it was believed that rapid weight loss could cause liver damage. In contrast, recent prospective and retrospective observational studies and case series have demonstrated that bariatric surgery is well tolerated and is associated with nonalcoholic fatty liver disease regression in a significant number of patients. SUMMARY: There is good level of evidence that bariatric surgery is associated with nonalcoholic fatty liver disease regression in morbidly obese patients.     

黄磷中毒性肝损害的机理探讨

本研究表明,肝微粒体混合功能氧化酶参与了黄磷在体内的活化代谢,促进了肝毒作用。肝谷胱甘肽及其酶系参与了黄磷的解毒代谢,当其耗损或失代偿时,可为脂质过氧化或钙泵障碍提供发生条件,所得数据较充分证明:脂质过氧化是黄磷中毒性肝损害十分重要的机理,但不能认为是唯一的机理,它与钙泵障碍的相互关系,值得进一步研究。电镜及组化的研究发现,线粒体和粗面内质网是黄磷的靶细胞器,其功能和结构改变,是各种病理改变的基础。     

四氯化碳和免疫血清法大鼠肝纤维化模型进程的时效关系对比研究

目的 比较四氯化碳(CCl4)法和免疫血清(PS)法两种肝纤维化制模方法在肝纤维化形成进程中时效关系和病理学特征。方法 采用CCl4和PS10周法制作SD大鼠肝纤维化模型，分别观察在造模第6、10、14、20周时肝脏组病学特征，Masson三色染色和计算机图像分析系统进行分析。结果 CCl4法于制模第6周即可见肝脏假小叶形成，于第10周始最为典型；随着假小叶的形成和造模方法停止，肝脏病理结构变化趋于稳定；肝细胞脂肪变性尤为突出，与模型制作进程相平行。PS法于造模第10周即造模结束时方见纤维间隔形成，造模虽已停止但肝纤维化进程加速完成，肝组织分隔严重，假小叶形成较多并进展到第20周；制模自始至终，肝细胞未见明显脂肪变性。结论 CCl4和PS两种制模方法在肝纤维化形成进程中所表现出的时效关系和病理特征有所不同，结合使用两种方法研究肝纤维化更为合理；以抗肝纤维化干预因子进行干预研究时，干预因子的持续时间宜延长至肝纤维化形成之高峰期或之后，持续时间至少14周。     

葛根-红景天口服液对四氯化碳诱发急性肝损伤的保护作用

[目的 ]　观察葛根—红景天口服液对小白鼠脂质过氧化和转氨酶活性的影响以及肝脏病理学变化 ,并探讨其可能机制。　 [方法 ]　以四氯化碳 (CCl4)染毒小白鼠为肝损伤动物模型 ,按“保健食品功能学评价程序和检验方法”检测。　 [结果 ]　与四氯化碳模型组比较 ,葛根 -红景天中、高剂量组均可明显降低血清谷草转氨酶 (ALT)、血清谷丙转氨酶 (AST)活性和三酰甘油 (TG)、肝丙二醛 (MDA)含量 ;升高还原型谷胱甘肽 (GSH )含量。葛根 -红景天中、高剂量组可改善肝细胞退行性变 ,且高剂量组可明显减轻四氯化碳引起的肝细胞坏死。　 [结论 ]　葛根 -红景天口服液具有明显减轻由四氯化碳所致的肝脂质过氧化损害的作用 ,可能与其能清除自由基有关     

2006-2007年张家港市某机关干部脂肪肝患病调查

[目的]了解张家港市某机关干部脂肪肝的患病情况、发病特点及致病危险因素。[方法]对2006年8月至2007年12月来我院体检中心健康体检的458名某机关干部（包括120名离退休干部）进行调查。[结果]渊查458人．检出脂肪肝者128例,脂肪肝患病率27．95％。其中,男性患病率32．96％,女性患病率9．28％．二者差异有统计学意义（P〈0．01）。脂肪肝组和非脂肪肝组肥胖者分别为58．59％和6．97％;脂肪肝组和非脂肪肝组嗜酒者分别占38．28％和6．06％;脂肪肝组和非脂肪肝组血脂增高率分别为47．66％和9．09％;脂肪肝组和非脂肪肝组合并高血压者分别为42．19％和9．09％;脂肪肝组和非脂肪肝组合并糖尿病者分别占17．19％和2．12％。[结论]机关干部脂肪肝患病率较高,且男性多于女性,肥胖、嗜酒、高脂血症、高血压、糖尿病患者脂肪肝患病率较正常人高。     

肝炎后肝硬化病人前白蛋白合成速率的测定及临床评价

目的 研究肝炎后肝硬化病人的前白蛋白合成速率与肝功能损害的关系。方法 用首次静脉推注加恒速静脉滴注^15N-赖氨酸示踪技术测定前白蛋白的合成速率。结果 通过对12名正常人和23名肝硬化病人的测定发现：肝炎后肝硬化病人的人体前白蛋白合成速率明显降低，并与肝损害程度显著相关。结论 该方法测定血浆前白蛋白合成率，用于探讨肝炎后肝硬化时肝脏本身蛋白质代谢障碍，及从动态角度认识和评价肝功能，为肝炎后肝硬化的研究提供了一项新的测定方法。     

警惕中药致药物性肝损伤

目的分析4例服用过相同中药的急性肝损伤患者的病因,以加深对中药引起的肝损伤的认识。方法对有相同服药史的4例急性肝损伤患者的,临床资料进行回顾性分析,根据服药史、临床表现、肝功能、血清标志物、肝穿病理活检及停药后的治疗效果综合判断,并用两个国际上权威的药物性肝损伤诊断标准进行评分。结果结合实验室检查及辅助检查。该4例患者可排除甲型肝炎、乙型肝炎、丙型肝炎、丁型肝炎、戊型肝炎的可能,并进一步排除了EB病毒和巨细胞病毒感染所致的肝炎、自身免疫性肝病、酒精性肝病、胆系疾病所致肝损伤、遗传代谢性疾病等肝病。用两个药物性肝损伤的诊断标准评分为6～8分,诊断为“很有可能”药物性肝损伤。结论通常认为无毒、无副作用的中药制剂也可为引起肝损伤重要原因．应予以重视。     

铁和乙醇对大鼠肝脏组织脂质过氧化反应的影响

在饲料中添加羰基铁喂养大鼠,形成肝脏内铁含量没的铁过载动物模型,体外研究肝组织内不同的铁含量对乙醇诱导肝组织气体操作折影响,探讨乙醇和铁在诱导肝组织损伤过程中的交互作用。结果显示：饲料中添加铁中明显啬铁在肝脏内的蓄积,肝脏内铁含量随喂养时间而增加,与对照组比较差异有非常显著意义（Ｐ〈０．０１）。肝脏内不同的铁含量均可明显增加乙醇诱导的肝组织脂南过氧化反应。分别与单纯乙醇和相应原单纯铁过载组比较,铁     

南通市居民脂肪肝的患病情况及其相关因素

目的了解南通市居民脂肪肝的患病情况及脂肪肝的致病与保护因素，为脂肪肝的合理防治提供实践基础。方法按区域多阶段整群抽样选取被调查对象1495名，用肝胆B超检查脂肪肝患病情况，同时进行问卷调查，了解脂肪肝的相关因素。结果该次调查发现脂肪肝患病者249名（16．76％）。男性患病率（19．9％）明显高于女性（10．2％）。肥胖在各年龄组脂肪肝患者中的检出率均较高。饮酒是导致男性脂肪肝患病率（30．0％）高于女性患病率（19．2％）的重要因素。脂肪肝患者中喜食肉类、甜食，经常在外就餐，长期饮酒、吸烟，活动过少的比例较高，而经常吃鱼者较少，与非脂肪肝组比较，均P〈0．01。结论脂肪肝的发生与年龄、性别有关，随着年龄增长而患病率增高，患病原因与肥胖、高脂血症、糖尿病、饮食习惯不良、饮酒、活动少有关。经常吃鱼，可能对脂肪肝的预防有一定作用。     

糖尿病与脂肪肝对绝经女性胆石症患病的交互作用

目的 探讨糖尿病与脂肪肝的交互作用对绝经女性胆石症患病的影响。方法 研究采用多阶段分层整群抽样方法抽取苗族、侗族绝经女性作为研究对象，纳入符合条件的研究对象共3 938人。采用SPSS25.0软件进行Mann - Whitney U检验、χ2检验、单因素和多因素logistic回归分析；同时运用相乘模型和相加模型探讨糖尿病与脂肪肝的交互作用对绝经女性胆石症患病的影响。结果 本次3 938名绝经女性中，平均年龄为59.51岁，胆石症检出率为17.01%，糖尿病检出率为9.09%，脂肪肝检出率为19.86%，糖尿病合并脂肪肝检出率为4.06%。多因素logistic回归结果显示，糖尿病(OR = 1.715, 95%CI:1.325～2.220)和脂肪肝(OR = 1.438, 95%CI:1.162～1.780)均与绝经女性胆石症的患病风险有关。交互作用分析结果显示，糖尿病与脂肪肝对绝经女性胆石症的患病不存在相乘交互作用(OR = 1.605,95%CI:0.951～2.707)，结果无统计学意义；但糖尿病与脂肪肝对绝经女性胆石症的患病存在相加交互作用，糖尿病合并脂肪肝者的患病风险高于无糖尿病且无脂肪肝者(OR = 2.905,95%CI:2.040～4.138)，其相加交互作用评价指标RERI(95%CI)、AP(95%CI)和SI(95%CI)分别为1.216(0.115～2.316)、0.418(0.148～0.688)和2.760(1.043～7.305)，结果有统计学意义。结论 在绝经女性中，糖尿病和脂肪肝均与胆石症存在关联，二者对增加胆石症患病风险可能存在协同作用。     

脑梗死患者肝功能和凝血功能相关性分析

目的探究脑梗死患者的肝功能指标与凝血功能指标间存在的相关性。方法选取2019年1-12月天津市环湖医院收治的经检查确诊为脑梗死伴肝损害患者50例作为观察组,另选同期脑梗死不伴肝损害患者50例作为对照组,采集所有受试者的外周血标本,分别对两组的肝功能指标及凝血功能指标进行测定和比较,并对脑梗死患者肝功能和凝血功能指标进行相关性分析。结果观察组肝功能指标中TP和ALB水平均低于对照组;观察组凝血功能指标中FIB水平低于对照组,PT、APTT和TT水平高于对照组,差异均有统计学意义(P<0.05)。脑梗死患者AST和ALT与PT、APTT、FIB具有相关性,TP与APTT具有相关性,ALB与PT、APTT、FIB、TT具有相关性(均|r|>0.3,均P<0.05)。结论脑梗死患者肝功能与凝血功能之间存在相关性,可能和脑梗死患者体内肝脏的蛋白合成功能发生改变有关,需要进一步的研究进行验证。     

北京市乙肝病毒感染有关肝病死亡状况分析

目的了解北京市乙肝病毒感染有关肝病的死亡情况。方法随机抽取北京市东城区、大兴区、通州区、密云县4个区（县）1992—2002年来所有死亡者的医学死亡证明书，对乙肝病毒感染有关肝病的死亡情况进行整理、分析。结果1992—2002年北京市乙肝病毒感染有关肝病死亡中，占首位的是原发性肝癌，其次是肝硬化和慢性乙型肝炎。慢性乙型肝炎死亡的病例主要集中在30岁以上年龄段；乙肝后肝硬化和原发性肝癌死亡病例主要集中在40岁以上年龄组，尤其是60岁以上年龄段。所有乙肝病毒感染有关肝病的死亡均是男性多于女性。慢性乙型肝炎、乙肝后肝硬化和原发性肝癌的病程约分别为13．0年、5．1年和0．9年。结论北京市与乙肝病毒感染有关的肝病死亡状况仍然比较严重。