湖南省酒精性肝病流行病学分析

近几年我国酒精性肝病(ALD)发病率迅速上升,饮酒者中已达6.1%[1].但是并非所有饮酒者均发病,个体对酒精的敏感性存在很大差异[2],同时也受其他很多因素的影响.此研究依据人群流行病学调查结果对ALD的发生与酒精摄入的量、饮酒的行为习惯、酒的种类及饮酒者是否肥胖等的关系进行了对比分析.     

酒精性肝病的诊断与治疗

一、诊断1. 长期大量饮酒史：长期大量饮酒是诊断酒精性肝病（ALD）的必备条件。英国皇家学院建议的男性每周饮酒21单位（210g），女性14单位以上为超量。意大利的前瞻性研究6534例对象中，发生ALD 危险性是每日超过30g酒精，并有时间依赖性升高。日本以每日饮用50g酒精称为习惯饮酒者，每日80g称为大量饮酒者。国内一般也采用这个标准。2. 饮酒方式：单纯饮酒不进食和（或）同时饮用多种不同的酒易发生ALD。在饮酒之前进食一定数量的食物，可延迟胃的排空，减缓小肠对酒的吸收，降低血中酒精浓度。饮用低浓度的酒（啤酒）比高浓度的酒…     

消化系统疾病

20050367 酒精性肝病的危险因素分析/鲁晓岚…//胃肠病学和肝病学杂志。-2004,13(2).-172～174 1270名饮酒者中共检出单纯酒精性肝病(ALD)患者83例,其中酒精性脂肪肝72例,酒精性肝炎6例,酒精性肝硬化4例。结果:①每日饮酒精≥40g,持续饮用5年以上,ALD患病率明显增加,最高的OR值(10.7)出现     

酒精性肝病的危险因素分析

酒精性肝病(ALD)在我国的危害现在虽不如西方国家突出，但近几年发病率迅速上升，饮酒者中已达6．1％。但是并非所有饮酒者均发病，个体对酒精的敏感性存在很大差异，同时也受很多其他因素影响。对ALD的发生与酒精摄入的量、饮酒的行为习惯、种类及肥胖等关系的研究尚少。本研究依据人群流行病学调查结果对此进行了分析。     

辽宁省部分城市酒精性肝病流行现状调查

目的探讨辽宁省居民酒精性肝病的流行现状及特点。方法采用分层随机抽样法,对调查人群进行问卷调查,再按调查人群的35%抽样进行相关体格检查及生化检查。结果共调查18020人,抽样调查6598人,其中有长期饮酒者1708人(26.98%);有长期饮酒者(38.33%对5.64%)及周平均饮酒量(223.27±258.88g/w对114.12±199.85g/w,P=0.042)均为男性多于女性;男性饮酒人群的平均年龄大于女性(41.14±9.56岁对36.48±10.21岁,P=0.002),多集中于30～49岁年龄段;男性饮酒的起始年龄早于女性(23.26±5.38岁对25.38±5.20岁);共检出ALD450例(6.8%)。结论辽宁省7岁以上居民中超过1/4的人群有饮酒习惯,而ALD的患病率为6.1%,其中AFL或轻微肝损伤、AH及ALC的患病率为4.29%、2.18%及0.35%。ALD的发生与年龄、性别及饮酒的行为方式密切相关。     

西安地区军队老年人健康相关因素分析

目的探讨西安地区65岁以上军队老年人健康相关因素及各因素随年龄变化趋势。方法从2005年6月30日~2006年6月30日对1987年建立的西安市22所军队离退休干部队列人群中的健康相关因素进行了再次调查,完成调查的干部694例,对其18年前后健康相关因素的变化趋势进行了对比分析。结果694例老年人中,吸烟率67.58%,饮酒率63.83%,自答锻炼率88.47%,按中国成人体重指数(BMI)标准,超重者(BMI≥24kg/cm2)287例,肥胖者(BMI≥28kg/cm2)80例;体检指标18年后与18年前比较显示,TG上升、舒张压下降、锻炼者和饮酒者比例均升高(P<0.05),各种疾病患病率随年龄的增加均有上升趋势(P<0.05)。结论该人群吸烟率、饮酒率和超重率高于国内水平,提示在该人群中应加强相关健康教育;同时也要密切关注多种疾病患病率随年龄发生的动态变化。     

酒精性肝病的危险因素

酒精滥用与肝脏损伤、数种癌症、交通事故、婚姻破裂以及家庭和社会暴力等密切相关,长期过量饮酒者脂肪性肝病患病率高达75%,然而仅20%～25%的重度嗜酒者发生脂肪性肝炎,10%～20%发生肝硬化,提示酒精中毒与遗传和环境因素相互作用共同导致酒精性肝病(ALD)的发生和发展~([1-2]).除了饮酒量、持续时间和饮酒方式外,ALD的危险因素主要有乙醇代谢酶的基因多态性、女性、营养不良、肥胖症以及合并嗜肝病毒感染等.     

2009年美国肝病学会酒精性肝病诊疗指南介绍

2009年美国肝病学会酒精性肝病(ALD)诊疗指南,已在2010年1期Hepatology发表~([1]),现介绍如下. 一、ALD的患病率和自然病史 全世界的饮酒方式存在地理差异,几乎2/3的美国成年人饮酒.少量或适量饮酒是否有益健康,尚缺乏相关证据.而过量饮酒者可发展为洒精耐受,酒精依赖和酒精戒断,另外,酒精滥用和酗酒义可带来消极的社会和健康后果(如失业,家庭破裂、器官受损、意外伤害或死亡).     

谨防“酒精性肝病”

近年来酒精性肝病的患病率呈上升趋势。在此,有必要提醒人们:长期过量饮酒可导致酒精性肝病的发生。酒精性肝硬化的发生与饮酒方式、性别、遗传、个体差异、营养状况、吸烟及是否合并肝炎病毒感染等因素有关。1g酒精相当于25～40ml啤酒、8～10ml黄酒、5～12ml葡萄酒、3～7ml保健酒、2～3ml白酒。长期过量饮酒(折合乙醇量男性≥40g/d、女性≥20g/d,连续5年以上)是酒精性肝病发病的前提条件,乙醇及其代谢产物乙醛的直接肝毒性是导致嗜酒     

酒精性肝病的病理诊断标准分级、分期与分类

病理组织学检查在酒精性肝病（ALD）的诊断、分类及预后判定上占有重要地位，是衡量ALD炎症活动度、纤维化程度的金标准，也是进行分类的重要依据。但在诊断ALD前首先需确定患者是否嗜酒者，了解患者的饮酒史，包括饮酒年限、日饮酒量及戒酒史，以保证ALD诊断的准确性。关于嗜酒者的标准我们参考国内外标准，将日饮酒精量超过40g（合50度白酒100ml），连续饮酒5年以上者定为嗜酒者，以此标准检出的136例嗜酒者，经肝穿无一不具ALD改变，包括轻症ALD 41例。说明日饮酒精≥40g已为不安全剂量。ALD组织学诊断标准包括4个方面：(1)肝细…     

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.