套式PCR技术检测肝癌和肝硬化患者TTV DNA

目的 了解肝癌和肝硬化患者中TTV DNA感染状况。方法 采用套式PCR技术检测TTV DNA及血清稀释法检测血清TTV DNA的滴度。结果 山东肝癌25例标本中8例TTVDNA阳性,阳性率为32．0％;广州肝癌16例中6例TTV DNA阳性,阳性率为37．5％;广西肝癌65例中28例TTV DNA阳性,阳性率为43．1％。16例肝硬化标本中6例TTV DNA阳性,阳性率为37．5％。结论 研究证实中国肝癌和肝硬化患者中存在35．7％的TTV DNA感染,这种TTV DNA感染是否对肝癌和肝硬化有促进作用,尚待进一步研究证实。     

前瞻性追踪受血患者输血后TT病毒感染的发生率及临床表现

背景 近来发现一种新的经输血途径传播的人DNA病毒,即TT病毒(TTV)。作者试图探明受血者感染TTV的发生率及感染TTV的临床后果。研究设计和方法 应用巢式PCR方法对连续采集的血清标本进行了TTV DNA检测,作为输血后肝炎的前瞻性研究。结果:150例成人心脏病手术患者中,59例患者的输血后血样为TTV DNA阳性,其中有13例患者的输血前血清标本为TT DNA阳性。因而在137例中有46例(33.6％)以前未感染的患者在输血后发展为TTV病毒血症。在这46例输血TTV感染者中,3例伴随着HCV感染,5例伴随有HGV感染,另外的38例为单纯TTV感染。TTV感染者平均血清ALT活性为311U/1,而38例单纯TTV感染者中有34例的血清ALT活性持续在正常范围之内。在8例以后发展为非A-G的肝炎患者中,3例为TTV阳性(1/8:46/137,P=0.8)。对12例患者进行一年时间以上的随访,12例均表现为持续地TTV病毒血症。结论:在本组心脏病手术患者中,输血传播的TTV感染率大约为30％,大多数感染者为持续感染。TTV感染率高但似乎不引发肝炎。     

献血者TT病毒DNA及其IgG抗体的检测

目的　观察献血者输血传播病毒 (TTV)的感染情况。方法　应用 Nested- PCR对 388例献血者、16 8例非肝炎住院患者进行 TTV DNA检测 ,同时用 EL ISA法检测抗 TTV Ig G。结果　 TTV基因检出率分别为献血组 15 .46 % ,对照组 2 4.40 % ;5 5 6例受检血清中 TTV DNA总的阳性检出率为 18.17% ,抗 TTV Ig G检出率分别为献血组 13.14% ,对照组 2 7.98% ;献血组与对照组相比 TTV DNA及抗 TTV Ig G均存在显著性差异 (P<0 .0 5 )。结论　献血者存在TTV感染 ,TTV存在健康携带状态。     

血液透析患者单个核细胞中TTV-DNA的研究

目的 :探讨血液透析患者血清和外周血单个核细胞 (PBMC)中输血传播病毒 (TTV)检测状况及意义。方法 :采用聚合酶链反应 (PCR)对 6 6例血液透析患者血清及PBMC进行TTV DNA检测 ,同时采用酶免疫分析 (EIA)检测血清中HBsAg和抗 HCV。结果 :血液透析患者TTV、HCV、HBV检出率分别为 18.2 %、2 4 .2 %、7.6 %。血清TTV DNA阳性与阴性患者 ,抗 HCV阳性率分别为 9.1%与 2 7.3% ,HBsAg阳性率分别为 0 %与 9.1% ,经统计学分析均无显著差异。PBMC中TTV DNA检出率 2 2 .7% ,PBMC中TTV DNA检出率在血清TTV DNA阳性者显著高于血清TTV DNA阴性者 (5 8.3%vs 14 .8% ,P<0 .0 5 )。结论 :血液透析患者TTV感染不依赖于HCV或HBV而存在。PBMC中TTV DNA主要在血清TTV DNA阳性患者中检出 ,PBMC可能是TTV的一个贮存场所。     

GP73和AFP检测在肝细胞肝癌诊断中的作用

目的通过检测肝细胞肝癌、慢性肝炎、肝硬化患者及健康体检者血清中甲胎蛋白(AFP)和高尔基体蛋白73(GP73)水平,对比分析AFP和GP73的阳性检出率,探讨GP73和AFP用于诊断肝细胞肝癌的临床意义。方法收集肝细胞肝癌、慢性肝炎、肝硬化患者及健康体检者血清样本,分别采用酶联免疫吸附法和化学发光法检测AFP和GP73水平。结果在肝细胞肝癌患者血清中,GP73阳性检出率为96.00%,AFP阳性检出率为84.00%,在肝细胞肝癌患者血清中,GP73水平为(702.64±54.35)ng/mL,AFP水平为(6 772.4±1 942.3)ng/mL,均明显高于肝硬化组、肝炎组及健康对照组,差异有统计学意义(P0.01);但是GP73和AFP联合检测在灵敏度和特异度方面与单独检测比较差异无统计学意义(P0.05)。结论 GP73和AFP在肝细胞肝癌患者中的阳性检出率和水平显著高于慢性肝炎组和肝硬化组,对于肝细胞肝癌患者早期诊断有一定参考价值。     

盐城地区孕产妇血清及乳汁中TTV感染状况

目的　了解盐城地区孕产妇血清及乳汁中 TT病毒 ( TTV)感染状况 ,探讨 TTV的传播途径。方法　采用PCR-微孔板杂交法对 1 0 5例孕产妇血清及乳汁标本进行 TTV DNA检测。结果　 1 0 5例孕产妇血清及乳汁 TTV DNA阳性率分别为 1 2 .4%和 1 0 .5 % ,1 3例孕产妇血清 TTV DNA阳性患者中乳汁同时阳性 1 0例 ,血清与乳汁感染率的差异无显著性 ( P>0 .0 5 )。结论　孕产妇存在 TTV感染 ,并可能经乳汁感染婴儿     

血清PCT、CRP、IL-6水平联合检测对肝硬化腹水感染患者的诊断效能

目的 探讨血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平联合检测对肝硬化腹水感染患者的诊断效能。方法 选取2015年6月～2019年6月我院收治的肝硬化腹水感染患者(阳性)93例为观察组,另选取同期收治的单纯肝硬化患者(阴性)90例为对照组。均行血清PCT、CRP、IL-6水平检测,比较两组血清PCT、CRP、IL-6水平、血清PCT、CRP、IL-6单独与联合诊断肝硬化腹水感染准确率。结果 观察组血清PCT、CRP、IL-6水平均高于对照组,差异均有统计学意义(P0.05);血清PCT、CRP、IL-6水平联合诊断肝硬化腹水感染准确率为90.71%(166/183),分别高于血清PCT、CRP、IL-6水平单独诊断80.87%(148/183)、77.05%(141/183)、79.23%(145/183),差异均有统计学意义(P0.05)。结论 肝硬化腹水感染患者血清PCT、CRP、IL-6水平可显著升高,联合检测可提高肝硬化腹水感染诊断准确率,为临床治疗提供数据参考。     

我国部分地区人群中TT病毒感染的分子流行病学

目的　了解我国不同地区和人群中 TTV DNA的感染情况。方法　采用巢式 PCR方法检测血清标本 TTVDNA。结果　在 2 1 4例各型病毒性肝炎患者中 ,检出 TTV DNA阳性 5 7例 ,阳性率为 2 6.64%。在甲～戊型肝炎、非甲～戊型肝炎、有偿献血者和正常人群中 ,TTV DNA流行率分别为 2 5 .97% ( 4 0 /1 5 4)、2 8.3 3 % ( 1 7/60 )、3 9.2 9% ( 2 2 /5 6)和 1 7.86%( 1 0 /5 6) ,四组差异亦无显著性 ( P>0 .0 5 ) ;我国北京、沈阳、南京、合肥和深圳的非甲～戊型肝炎患者中 TTV DNA流行率为 2 9.5 7% ( 68/2 3 0 ) ,与上述甲～戊型肝炎组比较差异亦无显著性 ( P>0 .0 5 )。结论　我国不同地区人群中存在 TTV DNA感染 ,各型病毒性肝炎患者和正常人群中 TTV DNA流行率较高。     

免疫组化法检测非甲-非庚型肝炎患者肝组织中输血传播病毒

目的　检测非甲-非庚型肝炎患者肝组织输血传播病毒(TTV)感染状况,TTV感染与肝组织炎症程度 及与血液学指标的相关性。方法　应用免疫组织化学法检测52例非甲-非庚型肝炎患者肝组织中TTV,并经原位 杂交证实;对TTV阳性和阴性组的血液学生化指标,诸如血清丙氨酸转氨酶(ALT)、血清天冬氨酸转氨酶(AST)、血 清总胆红素(TBIL)、白蛋白(ALB)、γ 球蛋白(γ G)、凝血酶原活动度(PTA)及组织学活动指数(HAI)进行了比较。 结果　非甲-非庚型肝炎患者肝组织中TTV抗原(TTVAg)阳性15例,检出率为28.8%;阳性物质主要定位于肝细 胞浆内,呈棕黄色细小颗粒,偶见肝细胞核内有表达;TTV阳性表达细胞呈单个、散在或片簇状分布;TTVAg阳性的 组织切片经苏木素-伊红(HE)染色后,可观察到病毒性肝炎的一些病理变化,如肝细胞胞浆疏松化、气球样变、嗜酸 样变、灶性坏死、凋亡、小叶内及汇管区炎细胞浸润;从15例TTVAg阳性病例中任选10例进行TTV DNA原位杂交 检测,结果8例阳性,二者符合率80.0%;同时对5例免疫组化TTVAg阴性肝组织进行TTV DNA原位杂交检测,结 果5例均为阴性,二者符合率100%;TTVAg阳性组ALT、AST、TBIL、γ G均值均高于TTVAg阴性组,ALB、PTA 均值均低于TTVAg阴性组,但两组比较差异无统计学意义(P>0.0     

献血者中TT病毒检测及其致病性探讨

目的　探讨TT病毒 (TTV)在输血过程中的传播及其致病性。方法　常规酚 氯仿法抽提血清病毒DNA ,设计位于TTVORF1保守区的两对引物 ,套式PCR扩增病毒DNA。ELISA检测血清HBsAg、抗 HAV、抗 HCV和抗 HIV。结果　健康献血者血清中TTV DNA检出率为 4 3 1 % (96 / 2 2 3)。受血者输血TTV DNA阳性血后 2周 ,血清TTV DNA转阳率为 6 3 6 % (1 4 / 2 2 )。 8周血清TTC DNA阳性率仍为 4 6 4 % (1 0 / 2 2 ) ,其中两对献血者和受血者之间血清TTV DNA同源性达 1 0 0 %。上述 2 2名受血者输血 2周后血清ALT、TB和DB正常 ,血清HBsAg、抗 HAV、抗 HCV和抗 HIV均阴性。随访其中 5例至 8周 ,无肝炎症状及体征 ,血清肝功能正常。结论　TTV可通过血液传播 ,但无明显致病性     

异位辅助肝移植治疗急性肝功能衰竭的实验研究

目的：探讨异位辅助性部分肝移植治疗急性肝功能衰竭的可行性。方法；制作息性肝功能衰竭犬动物模型26只。分为两组：移植组20只，对照组6只。移植组切除脾脏后，于脾窝处移植同系异体60％部分肝脏，手术成功17只。观察两组实验动物的存活时间、血液生化、残肝磁共振（MRI）检查、残肝和移植肝的组织细胞形态改变。结果：对照组和移植组实验动物72h存活率分别为16．7％和82．7％。移植术后2周残肝细胞明显增生，肝功能恢复近正常，而辅助肝渐萎缩，术后5周辅助肝完全纤维化。结论：急性肝功能衰竭时，异位辅助性部分肝脏移植可为病肝提供暂时性功能支持，为残肝细胞再生、功能恢复提供机会，同时移植肝渐萎缩、纤维化。     

The liver as A self-organizing system. I

Summary The liver is described as a composite system consisting of a set of operative creodic microunits open to a continuous flow of matter, energy and informations. Its dynamics depend on two interactive and interrelated subsystems with actions described ashomopoiesis andhomeorhesis, making it anautoisodiasostic system. The system’s emergent (equifinal) or emergence states, operative potential, diffusion and reaction phenomena and compensation states are also formally described. For readers not familiar with the language of general system theory, of system dynamics and of categorical analysis, a glossary of some terms is provided. This paper forms part of research on pre-cancer states of the liver system, financed by theAssociazione Italiana per la Ricerca sul Cancro (AIRC), Milan and by theOspedale Maggiore — Istituto Scientifico di Ricovero e Cura — Milan.     

MR imaging of traumatic hepatic laceration: Evaluation and course of healing after surgery

Six patients with hepatic laceration underwent magnetic resonance imaging (MRI) at 0.5T. Acute hepatic laceration was slightly hypointense on T1-weighted spin-echo (SE) image, and hyperintense on T2- and proton-weighted SE images. Subacute laceration was heterogeneously intense on T1-weighted image and hyperintense on T2- and proton-weighted images. Consistent changes in signal intensity of postoperative hepatic laceration were observed. On Tl-weighted image, the signal intensity at first increased and then decreased from periphery to the center. On the T2- and proton-weighted images, the laceration was uniformly hyperintense relative to the liver prior to the appearance and growth of a hypointense ring at its periphery. The appearance of the above changes in signal intensity was also observed in postoperative recurrent hemorrhage. The postoperative biloma had none of the above changes in signal intensity. Our cases show that MRI is effective in the evaluation of hepatic laceration and in the assessment of the course of healing after operation.     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

Does CTAP prior to hepatic resection improve patient survival rates?

The purpose of our study was to compare survival rates of colon carcinoma patients who had undergone attempted curative hepatic resection based on liver staging by computed tomographic angiography (CTA) or portography (CTAP) with previously reported survival rates of patients who underwent similar surgery without preoperative CTAP evaluations. A total of 404 CTAP studies performed at three institutions were reviewed. Of this group, 197 had colon carcinoma. Sixty-nine of the colon patients went to surgery. Actuarial adjusted yearly survival rates were calculated for the prior CTAP colon group and compared to historical controls. The control survival data were taken from reports published prior to the CTAP era. Our study demonstrated no difference in the 1-year survival data between the groups. However, the CTAP patients had greater survival in years 2–4. This greater survival may be multifactorial but in part due to better surgical selection caused by CTAP.An invited commentary on this article follows on pp. 320-324.     

Liver manifestations in COVID-19 patients: A review article

The coronavirus disease 2019 (COVID-19) initially presented as a disease that affected the lungs. Then, studies revealed that it intricately affected disparate organs in the human body, with the liver being one of the most affected organs. This review aimed to assess the association between COVID-19 and liver function, shedding light on its clinical implication. However, its exact pathophysiology remains unclear, involving many factors, such as active viral replication in the liver cells, direct cytotoxic effects of the virus on the liver or adverse reactions to viral antigens. Liver symptoms are mild-to-moderate transaminase elevation. In some patients, with underlying liver disease, more serious outcomes are observed. Thus, liver function should be meticulously considered in patients with COVID-19.     

Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients

Background: The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Methods: Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. Results: After chemotherapy, tumor volume decreased by 50–90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. Conclusions: These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.     

三维MRA技术在肝脏血管成像中的应用研究

目的：探讨三维增强MRA（3D CEMRA）技术在肝脏磁共振血管成像中的应用价值。方法：52例行肝脏磁共振血管成像患者及30例对照组病人，利用自动透视触发技术进行肝脏血管成像，造影剂到达降主动脉起始段时启动3D扫描，扫描时相包括肝动脉期、门静脉期及腔静脉期，分离各组图像并与蒙片剪影，再进行最大信号强度投影（MIP）及多平面图像重建（MPR），评价各期图像质量。结果：采用3DCEMRA技术所获肝动脉期及门静脉期图像质量满意；造影剂到达降主动脉起始段时间与造影剂流速、总量之间呈线性相关；造影剂总量和流速与肝血管信号强度呈正相关。结论：3DCEMRA技术可准确把握造影剂到达靶血管时间，结合最佳的造影剂总量和注射速度，明显提高肝脏磁共振血管成像质量。     

人工肝支持系统在肝衰竭中的应用经验和进展

人工肝支持系统对肝衰竭的治疗作用已经得到公认,可以使部分患者病情得到恢复,还可以使患者有效地过渡到肝脏移植,分为非生物型人工肝、生物型人工肝和混合型3种,包括血浆置换、血液滤过、血液/浆灌流、连续性血液透析滤过、血液透析、白蛋白透析、血浆胆红素吸附和生物型人工肝等。目前常应用的方法有血浆置换、连续性血液透析滤过和血浆胆红素吸附,其作用机制就是通过机械性的方法祛除肝衰竭患者体内的毒性物质及代谢产物,补充部分活性物质,纠正凝血物质缺乏,使患者内环境改善,利于肝细胞再生,病情恢复。     

酒精性脂肪肝和肝硬化患者各种血清酶的检测及其临床评价

目的 探讨酒精性脂肪肝血清特异性的鉴别指标，并用其来判断病程，指导临床诊断和治疗。方法 对76例酒精性脂肪肝、62例酒精性肝硬化以及70例非酒精性脂肪肝患者的血清酶和血脂进行测定及分析。结果 与非酒精性脂肪肝相比，酒精性脂肪肝的谷草转氨酶（AST）和γ-谷氨酰转肽酶（GGT）的异常率以及谷草转氨酶／谷丙转氨酶（AST／ALT〉1）的构成比的增高，差异均具有统计学意义；与酒精性脂肪肝相比，酒精性肝硬化的AST／ALT比值，AST和GGT的水平都有明显增高。结论 AST、AST／ALT（〉1）、GGT等指标对鉴别酒精性脂肪肝以及判断其病程，具有一定的临床意义。