Central hemodynamics and portal-hepatic blood flow in patients with acute and chronic virus hepatitis

AIM: To characterize central hemodynamics and portal-hepatic blood flow in patients with acute and chronic viral hepatitis. MATERIAL AND METHODS: Ultrasound investigation, tetrapolar rheography, hepatic scintigraphy were made in 149 patients with acute and chronic viral hepatitis B, C and B + C. RESULTS: The above patients had disturbances in central hemodynamics manifesting with developing myocardiodystrophy and hyperkinetic hemodynamics syndrome; decreased intensity and increased amplitude of respiratory fluctuations of volumic hepatic blood flow; impairment of peripheral blood flow. CONCLUSION: The above changes were most prominent in patients with chronic hepatitis B + C.     

Doppler sonography measurement of portal blood flow velocity after glucagon injection in patients with chronic HCV infection

Doppler sonography measurement of portal flow velocity (PFV) after glucagon injection was performed in 45 patients with chronic hepatitis C virus (HCV) infection. Patients were divided into three groups: group 1 = no or mild liver fibrosis; group 2 = moderate to severe liver fibrosis, and group 3 = liver cirrhosis. All patients were examined using a Doppler ultrasound (US) multipurpose equipment and a convex 3.5-MHz probe, 10 min before (baseline), as well as 5 and 10 min after, IV administration of 1 mg of glucagon chloride. No significant differences were found in mean baseline PFV among group 1 (19.4 +/- 2.4 cm/s), group 2 (20.1 +/- 3.6 cm/s) and group 3 (17.5 +/- 3.7 cm/s). Five minutes after glucagon injection, all three groups showed significantly increased values of mean PFV (25.6 +/- 4.8, 23.7 +/- 4.0 and 19.5 +/- 5.0 cm/s, respectively; p < 0.05 vs. baseline). The mean increase of PFV above baseline was significantly higher in group 1 (7.9 +/- 3.7 cm/s) than in group 2 (4.5 +/- 3.9 cm/s) (p < 0.05) or in group 3 (2.7 +/- 2.3 cm/s) (p < 0.05). A significant inverse correlation was found between individual values of fibrosis score and of individual increase of PFV. In patients with chronic HCV infection, Doppler sonography measurement of PFV after glucagon injection could be useful in assessing the severity of liver histological damage.     

肝癌合并门静脉癌栓患者肝内缸流变化

目的 研究原发性肝癌合并门静脉癌栓时门静脉和肝动脉的超声表现和血流动力变化。方法 应用超声分别研究肝癌合并门静脉癌栓组（癌栓组）和对照组门静脉、肝动脉的二维和多普勒超声改变及血流动力学各项指标。结果 癌栓组较对照组门静脉内径明显增高，流速降低（P〈0.05），肝动脉显示率和流速明显提高（P〈0.05）。结论应用彩超检查获得肝癌合并门静脉癌栓肝内血流的重要指标，对诊断、指导治疗和判断预后有重要意义。     

弹性成像技术联合血清学模型评估乙型肝炎患者肝纤维化分期

目的 采用实时组织弹性成像(RTE)及剪切波弹性成像(SWE)联合血清学模型评估乙型肝炎(CHB)患者肝纤维化分期.方法 针对112例谷丙转氨酶(GPT)≤2倍正常值上限(ULN)CHB患者行RTE、SWE及血清学检查,记录其剪切波速度(Vs)、肝纤维化指数(LF指数、F指数)、GPT、谷草转氨酶(GOT)、γ-谷氨酰...     

Effect of verapamil on portal blood flow in patients with liver cirrhosis.

The effect of acute (80 mg orally) and prolonged (240 mg orally daily for 2 weeks) verapamil administration on portal blood flow was studied in 12 patients with histologically proved alcoholic liver cirrhosis. Portal hemodynamics were examined by the ultrasonic duplex Doppler system. Thirty minutes after acute verapamil administration, the following parameters remained unchanged: (1) cross-sectional area of the portal vein, from 1.52 +/- 0.41 to 1.51 +/- 0.43 cm2; (2) portal blood velocity, from 13.2 +/- 1.6 to 13.4 +/- 1.6 cm/s; (3) estimated volume of portal blood flow, from 931 +/- 96 to 954 +/- 103 mL/min; and (4) congestion index of the portal vein, from 15.1 +/- 8.3 to 15.6 +/- 8.8 cm, respectively (P = > 0.05). In addition, no significant changes in portal blood hemodynamics were noted after prolonged verapamil administration (P > 0.05). These results demonstrated that verapamil did not alter portal blood flow in patients with alcoholic liver cirrhosis.     

慢性丙型肝炎患者合并糖尿病对肝癌发生率影响的Meta分析

目的 丙型肝炎病毒(HCV)感染可导致肝纤维化、肝硬化,甚至肝癌(HCC)。而慢性丙型肝炎（CHC）患者中合并糖尿病（DM）对HCC发生率的影响目前尚不明确,本文综合评价CHC患者合并DM对HCC发生率的影响。方法 本研究通过中国知网、万方数据库、维普数据库、Pubmed、Embase等文献检索平台对CHC患者合并DM对HCC发生率影响的相关研究进行检索。然后进行文献筛选、质量评价,纳入符合标准的队列研究文献,进行数据提取及统计分析,选择随机效应模型,合并效应量为相对危险度(RR),并进行敏感性分析、异质性检验及发表偏倚的检测。结果 最终共有9篇队列研究的文献入选,共纳入11 855例CHC患者,DM组共1 058例,非DM组共10 797例。DM组和非DM组HCC的发生率差别有统计学意义（RR=2.674, 95%CI=1.800~3.974, P=0.000）,异质性较大（P=0.000,I2=86.2%）;按研究对象是否合并肝硬化进行亚组分析,当研究对象全部为肝硬化患者时,合并效应量差异无统计学意义（95%CI=0.689～1.580, P=0.842）,同时异质性显著下降（I2=40.8%, P=0.194）;当研究对象全部为未合并肝硬化患者时,合并效应量差异有统计学意义（95%CI=2.341～6.101, P=0.000）,异质性也显著下降（I2=42.2%, P=0.188）。敏感性分析结果表明综合分析纳入文献所得数据后得到的结果相对较稳定,发表偏倚检测结果也在允许范围内（Harbord法95%CI=-1.582823～10.18881,P=0.130;95%CI=-409.0079～382.1317,P=0.939）。结论 在CHC合并肝硬化患者中,合并DM对HCC发生率无影响;而在单纯CHC患者中,合并DM可增加HCC的发生率。DM可能是通过影响CHC患者发生肝硬化的过程影响HCC发生率的。     

拉米夫定联合水飞蓟宾治疗对E抗原阳性的慢性乙型肝炎患者相关血液指标的影响

目的：应用拉米夫定联合水飞蓟宾治疗 E 抗原阳性的慢性乙型肝炎,通过治疗前后的相关血液指标变化判断疗效,为个体化治疗提供依据。方法选取 E 抗原阳性慢性乙型肝炎患者226例,按肝功能损伤程度分为轻度组55例、中度组94例和重度组77例,均给予口服拉米夫定100 mg,每日1次及服用水飞蓟宾70 mg,每日3次,疗程6个月。分别对治疗前后的相关血液指标进行分析。结果治疗6个月后,轻度组及中度组患者血清 ALT 复常率、E 抗原阴转率及 HBV-DNA 阴转率有不同程度的改善,而重度组上述指标则均显著提高（P ＜0．05）。结论拉米夫定联合水飞蓟宾治疗更能有效抑制 HBV-DNA 的复制,明显促进血清 ALT 复常率及提高 E 抗原阴转率,尤其是肝功能损伤程度重者;在一定程度上提高治疗慢性乙型肝炎的疗效。     

Subpopulation blood lymphocyte composition in blood of patients with chronic hepatitis C during therapy with interferon

The number of lymphocytes expressing CD3, CD4, CD8, CD16, CD25, and CD19 antigens was studied in patients with chronic hepatitis C before and after 12-week therapy with interferon-alpha (IFN-alpha). The percentage of cells expressing CD4+, CD16+, and CD25+ antigens decreased significantly in untreated patients, while the percentage of CD8+ and CD19+ lymphocytes was increased (p < 0.05) vs. the control. After 3-month therapy with IFN-alpha the counts of CD4+ and CD25+ increased significantly in patients with chronic hepatitis C (p < 0.05 and p < 0.01, respectively) in comparison with the initial values. The treatment led to a significant (p < 0.05) decrease in the number of CD8+ cells in the blood. The number of cells expressing CD19+ decreased, but remained high in comparison with the control. These results indicate that cellular immune response is inadequate in patients with chronic hepatitis C. Time course of subpopulation composition of T lymphocytes during effective treatment with IFN-alpha indicates an important role of T-cellular component of immunity in the antiviral defense mechanisms in chronic HCV infection.     

活血柔肝法改善慢性肝炎肝纤维化的效果

目的:观察灵丹顺肝汤治疗慢性肝炎肝纤维化的临床疗效。方法:选择2001-01/2003-12解放军第四军医大学西京医院门诊及住院、符合《病毒性肝炎的诊断标准》的患者65例。①按治疗先后顺序分为灵丹顺肝汤治疗组(治疗组)34例、常规治疗组(对照组)31例。对照组给予常规治疗:云芝胞内糖肽,2粒/次,3次/d;或50g/L葡萄糖注射液250mL加甘利欣150mg静脉点滴,1次/d;维生素C、肌苷片与饮食调理。②治疗组在常规治疗基础上,加服灵丹顺肝汤(灵芝、丹参、苦参等),50mL/次、3次/d。疗程共3个月。②观察治疗前后肝纤维化4项(透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白),肝功能(丙氨酸氨基转移酶、天门冬氨酸转氨酶、总胆红素);B超检测门静脉主干内径、脾脏厚度;临床症状变化。③参照《中药新药临床研究指导原则·黄疸》标准进行疗效判定,分为显效,有效,无效。结果:①治疗组患者治疗前后血清透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白水平明显降低,门静脉主干内径、脾脏厚度亦见缩小,治疗组显效率提高、临床症状明显缓解,与对照组比较差异均有显著性(P<0.05)。②两组患者治疗前后肝功能均明显改善,但治疗组总胆红素降低与对照组比较差异有显著性[(13.30±6.01),(19.13±9.61)μmol/L,P<0.05)。③治疗组显效17例,有效13例,无效4例,总有效率88.3%;对照组显效11例,有效14例,无效6例,总有效率80.6%。④治疗组用药后无明显不良反应。结论:灵丹顺肝汤具有抗肝纤维化作用,整体调节中医脏腑(肝脾)功能,明显缓解全身乏力、腹胀、纳差症状,临床疗效肯定。     

多普勒超声检测慢性乙型肝炎及肝硬化患者门静脉和脾静脉血流的临床意义

目的评价各型慢性乙型肝炎及肝硬化患者门静脉、脾静脉的血流动力学改变。方法将111例慢性乙型肝炎患者分成轻度组、中度组、重度组及肝硬化组。选取22例健康人为对照组。超声检测门、脾静脉内径及平均流速,计算二者血流量及血流量比值,并行组间比较。结果轻度组与对照组比较,门静脉平均流速（Vpv）、门静脉内径（Dpv）、脾静脉内径（Dsv）无统计学差异（P〉0．05）。中度组的Vpv较对照组、轻度组减慢（P〈0．05）。重度组和肝硬化组的Vpv较轻、中度组及对照组减慢（P〈0．05）。重度组Dpv、Dsv较对照组增大（P〈0．05）。肝硬化组的Dpv、Dsv较其他组增大（P〈0．01）。肝硬化组脾静脉血流量（Qsv）和脾、门静脉流量比值（Qsv／Qpv）较其他组增高（P〈0．01）。结论慢性乙型肝炎及肝硬化患者Vpv、Dpv、Dsv能反应肝脏功能损害程度,Qsv、Qsv／Qpv是反映门静脉压力的较好指标,为慢性乙型肝炎及肝硬化的临床诊断及治疗评价提供了一定帮助。     

活血柔肝法改善慢性肝炎肝纤维化的效果

目的：观察灵丹顺肝汤治疗慢性肝炎肝纤维化的临床疗效。 方法：选择2001-01／2003-12解放军第四军医大学西京医院门诊及住院、符合《病毒性肝炎的诊断标准》的患者65例。①按治疗先后顺序分为灵丹顺肝汤治疗组（治疗组）34例、常规治疗组（对照组）31例。对照组给予常规治疗：云芝胞内糖肽．2粒／次,3次／d；或50g／L葡萄糖注射液250mL加甘利欣150mg静脉点滴。1次／d；维生素C、肌苷片与饮食调理。②治疗组在常规治疗基础上,加服灵丹顺肝汤（灵芝、丹参、苦参等）。50mL／次、3次／d。疗程共3个月。（爹观察治疗前后肝纤维化4项（透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白）。肝功能（丙氨酸氨基转移酶，天门冬氨酸转氨酶、总胆红素）；B超检测门静脉主干内径、脾脏厚度：临床症状变化。⑧参照《中药新药临床研究指导原则&;#183;黄疸》标准进行疗效判定，分为显效。有效。无效。 结果：①治疗组患者治疗前后血清透明质酸酶、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白水平明显降低。门静脉主干内径、脾脏厚度亦见缩小．治疗组显效率提高、临床症状明显缓解，与对照组比较差异均有显著性（P〈0．05）。②两组患者治疗前后肝功能均明显改善，但治疗组总胆红素降低与对照组比较差异有显著性[（13．30&;#177;6．01）。（19．13&;#177;9．61）μmol／L,P〈0．05）。③治疗组显效17例。有效13例。无效4例。总有效率88．3％：对照组显效11例，有效14例．无效6例．总有效率80．6％。④治疗组用药后无明显不良反应。 结论：灵丹顺肝汤具有抗肝纤维化作用，整体调节中医脏腑（肝脾）功能,明显缓解全身乏力、腹胀、纳差症状．临床疗效肯定。     

Impaired nutritive skeletal muscle blood flow in patients with chronic renal failure

1. The possibility that abnormalities of skeletal muscle may limit the exercise tolerance of patients with chronic renal failure was investigated in patients undergoing regular haemodialysis. 2. Blood flow to the calf, a vascular bed consisting predominantly of skeletal muscle, was measured in six patients before and after exercise and compared with values obtained from 12 control subjects. 3. The patients were limited on exertion and had an abnormal response of calf blood flow to bicycle exercise. Resting calf blood flow was similar in patients and control subjects, but the mean increase in calf blood flow in response to submaximal exercise was 0.55 (SEM 0.12) ml min-1 100 ml-1 in the patients and 1.43 (SEM 0.17) ml min-1 100 ml-1 in the control subjects. The increase after symptom-limited maximal exercise was 1.50 (SEM 0.80) ml min-1 100 ml-1 in the patients and 4.20 (SEM 0.40) ml min-1 100 ml-1 in the control subjects. 4. Skeletal muscle biopsies from eight haemodialysis patients were studied by histochemistry and electron microscopy. 5. Oxidative enzyme activity was increased and there were large subsarcolemmal aggregates of structurally normal mitochondria. Necrotic capillaries were observed as empty basement membrane tubes containing fragments of degenerating endothelium. 6. The changes were compatible with a response to a chronic reduction in skeletal muscle blood flow.     

苦参素联合拉米夫定对慢性乙型肝炎血清HBsAg影响的Meta分析

目的:评价苦参素联合拉米夫定对慢性乙型肝炎血清HBsAg的影响。方法:按照系统评价的原则制定检索策略,收集符合纳入标准的研究并采集相关信息进行Meta分析。结果:14篇研究符合纳入标准。疗程为3个月时相对危险度(RR)为2.03,95%可信区间(CI)为(0.85,4.84)。6个月时RR为1.89,95%CI为(1.00,3.56),联合组与对照组差异均无统计学意义。疗程为12个月时RR为2.16,95%CI为(1.30,3.59),两组差异有统计学意义。结论:随着疗程的延长,拉米夫定联合苦参素治疗慢性乙型肝炎血清HBsAg转阴率的疗效有优于单用拉米夫定的趋势。     

拉米夫定联合愈肝颗粒治疗慢性乙型肝炎近期疗效研究

目的:研究拉米夫定(3-TC)联合中药愈肝颗粒对慢性乙型肝炎(CHB)的治疗作用。方法:64例CHB患者随机分为治疗组、对照组,治疗组采用3-TC和愈肝颗粒联合治疗,对照组单用3-TC,疗程6个月,治疗前、后分别检测血清肝功能、乙肝标志物、HBV-DNA,并记录治疗期间发生的不良事件。结果:治疗6个月后治疗组HBeAg转阴率和HbeAg/抗HBe血清转换明显高于对照组,治疗组HBV-DNA转阴率与对照组差异无显著性意义(P>0.05),治疗组血清ALT下降值显著高于对照组(P<0.01)。结论:采用3-TC与愈肝颗粒联合治疗CHB有良好的疗效。     

Use of ednit in the treatment of portal hypertension in patients with chronic hepatitis and liver cirrhosis]

AIM: To study ednit (ACE inhibitor) effectiveness in the treatment of portal hypertension in patients with chronic hepatitis (CH) and hepatic cirrhosis (HC). MATERIAL AND METHODS: The examination of 87 patients with active CH and 54 patients with HC at the preascytic stage included two-dimentional ultrasonic scanning of the abdominal organs with doppler fluometry of the vessels in the territory of the portal vein, tetrapolar rheohepatography, ultrasound investigation, angiography of the abdominal vessels. The patients received combined therapy with ednit in a dose 5 mg twice a day for at least 5 weeks. RESULTS: Patients with active CH and HC having portal hypertension treated with adjuvant ednit in the above dose achieved marked clinicobiochemical remission quicker, portal-hepatic circulation improved. CONCLUSION: The addition of ednit to therapy of active CH and HC with portal hypertension is effective as it lowers total peripheral vascular resistance which eventually results in a fall of pressure in the territory of the portal vein and improvement of hepatic circulation. The highest effect is reached in administration of 5 mg twice for 24 hours.     

血浆置换联合高通量血液透析滤过治疗重症肝炎肝脏衰竭临床研究

目的 :探讨非生物型人工肝支持疗法血浆置换 (PE)与高通量血液透析滤过 (HDF)相结合对国内重症肝炎肝脏衰竭的临床疗效、安全性及可行性。方法 :对 2 6例不同病因重症肝炎肝衰竭患者应用上述人工肝方法进行治疗 5 8次 ,通过比较治疗前后患者临床症状、肝功能、凝血酶原活动度 (PTA)、血氨等指标判断临床疗效 ,观察治疗相关的不良反应及患者耐受情况判断安全性及可行性。结果 :患者意识、黄疸、乏力、腹胀、纳差等症状均明显缓解 ,血清总胆红素治疗后较治疗前平均降低 (190 .8± 93.6 )μmol/L ,PTA上升 (19.7± 8.9) % ,治疗后存活率达 80 .8% ,不良反应主要以血浆过敏居多 ,未发生大出血、休克等严重并发症及应用血制品引起的重叠感染 ,患者耐受良好。结论 :PE联合 HDF可显著改善重症肝炎肝脏功能衰竭患者临床症状及生化指标 ,提高近期存活率 ,且安全可行 ,值得在国内推广使用。     

The effect of spinal cord stimulation upon peripheral blood flow in patients with chronic neurological disease

Summary

The impact of spinal cord stimulation (SCS) upon patients with chronic neurological disease appears to be primarily upon autonomic functions. There is clinical evidence of increased blood flow in the lower limbs. In the present study, cutaneous blood flow was measured by means of xenon clearance in the legs and feet of patients receiving SCS for chronic neurological disease. In 8 patients pre-SCS cutaneous blood flow was compared with that during SCS. In 7 out of the 8 patients there was an increase in total cutaneous blood flow during stimulation. The mean pre-SCS value was 2.43 ± 1.57 ml per 100 g of tissue and this rose to 3.23 ± 1.81 ml per 100 g of tissue per minute during stimulation. The possible mechanisms for the increased cutaneous blood flow are discussed.

Résumé

L'effet de la stimulation de la moelle épinière chez les patients souffrant de maladie neurologique chronique semble porter principalement sur les fonctions autonomes. Il existe des preuves médicales de l'accroissement du débit sanguin dans les membres inférieurs. Au cours de cette étude, le débit sanguin cutané a été mesuré au moyen d'épuration au xénon dans les jambes et les pieds des patients traités par SME (stimulation de la moelle épinière) pour maladie neurologique chronique. Chez 8 patients le débit sanguin pré-SME a été comparé avec le débit sanguin enregistré pendant le traitement SME. Chez 7 patients sur les 8 examinés, on a pu observer une augmentation du débit sanguin cutané total pendant la stimulation. La moyenne pré-SME était de 2,43 ± 1,57 ml par 100 g de tissu, atteignant 3,23 ± 1,81 ml par 100 g de tissu par minute pendant la stimulation. L'article analyse les mécanismes éventuels provocant l'augmentation du débit sanguin cutané.

Zusammenfassung

Bei Patienten mit chronischen neurologischen Leiden scheint die Wirkung von Rückenmarkstimulierung SCS sich in erster Linie auf automatische Funktion zu erstrecken. Wir haben klinischen Beweis, dass eine gesteigerte Blutzirkulation der unteren Gliedmassen erfolgt. Bei der vorliegenden Arbeit wurde der kutane Blutfluss mit Xenon clearance gemessen, und zwar in den Beinen und Füssen von Patienten, welche SCS für chronische neurologische Erkrankungen erhielten. Bei 8 Patienten wurde der kutane Fluss vor SCS mit dem Fluss während SCS verglichen. Bei 7 von 8 Patienten erfolgte eine Verstärkung der totalen kutanen Blutzirkulation während der Stimulierung. Der durchschnittliche Wert war vor SCS 2,43 ± 1,57 ml per 100 g Gewebe, und dies steigerte sich auf 3,23 ± 1,81 ml per 100 g Gewebe pro Minute während der Stimulierung. Die möglichen Mechanismen für den erhöhten kutanen Blutfluss werden diskutiert.

Résumen

El estimulo de la médula espinal (EME) practicado a los pacientes afectos de enfermedades neurológicas crónicas, parece ejercer su principal efecto sobre la funciones autónomas. Existe prueba clinica del aumento del flujo sanguineo en las extremidades inferiores. En este estudio, se determinó el flujo sanguíneo cutáneo, mediante la depuración del xenón, en las piernas y pies de pacientes sometidos a EME por motivo de enfermedades neurológicas crónicas. En 8 casos, se comparó el flujo sanguineo cutáneo antes y durante el EME. En 7 de los 8 pacientes, hubo un aumento del flujo total durante el estimulo. El valor medio antes del EME fue de 2,43 ± 1,57 ml por 100 g de tejido, y ésto ascendió a 3,23 ± 1,81 ml por 100 g de tejido por minuto durante el estímulo. Se comentan los posibles mecanismos responsables del aumento del flujo sanguíneo cutáneo.     

The effect of spinal cord stimulation upon peripheral blood flow in patients with chronic neurological disease

The impact of spinal cord stimulation (SCS) upon patients with chronic neurological disease appears to be primarily upon autonomic functions. There is clinical evidence of increased blood flow in the lower limbs. In the present study, cutaneous blood flow was measured by means of xenon clearance in the legs and feet of patients receiving SCS for chronic neurological disease. In 8 patients pre-SCS cutaneous blood flow was compared with that during SCS. In 7 out of the 8 patients there was an increase in total cutaneous blood flow during stimulation. The mean pre-SCS value was 2.43 +/- 1.57 ml per 100 g of tissue and this rose to 3.23 +/- 1.81 ml per 100 g of tissue per minute during stimulation. The possible mechanisms for the increased cutaneous blood flow are discussed.     

Correlation of MRI liver volume and doppler sonographic portal hemodynamics with histologic findings in patients with chronic hepatitis C

PURPOSE: The purpose of this study was to correlate portal hemodynamics on sonography and liver volume on MRI with histologic findings in asymptomatic patients with chronic hepatitis C. METHODS: Portal blood flow in the left and right portal branches in 20 healthy volunteers and in 26 patients was measured using Doppler sonography during both fasting and postprandial states. Total liver and right-and left-lobe volumes were determined using MRI. The ratio between portal blood flow and liver volume determined the "portal flow index" of the right and left lobes. RESULTS: We observed a statistically significant difference (p < 0.01) between the volunteers and patients in the mean left-lobe volume (352 +/- 81 cm(3) versus 544 +/- 159 cm(3)) and in the mean left portal flow index (1.1 +/- 0.2 ml/minute/cm(3) versus 0.69 +/- 0.2 ml/minute/cm(3)) as measured before the subjects ate. After a meal, the portal blood-flow volume in the right lobe was similar in the 2 groups but in the left lobe was significantly lower in the patients (p = 0.0009). The left postprandial portal flow index was inversely correlated with the grade of liver fibrosis (r = 0.533). CONCLUSIONS: The left-lobe volume (positive predictive value, 83%; negative predictive value, 72%) and left postprandial portal flow index (positive predictive value, 86%; negative predictive value, 88%) are sensitive indicators of chronic hepatitis. The left postprandial portal flow index may be a useful test for differentiating patients with minimal or no fibrosis from patients with mild to severe fibrosis.     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎联合应答的预测因素分析

目的 从血清肿瘤坏死因子α(TNF-α)水平及其-238、-308位点基因多态性和HBV基因型、亚型等因素探讨阿德福韦酯(ADV,商品名:名正)治疗HBeAg阳性慢性乙型肝炎(CHB)联合应答的预测因素.方法 对203例HBeAg阳性CHB患者采用ADV 10 mg/d治疗48周,并应用PCR-RFLP检测TNF-α-238及-308位点基因多态性,ELISA测定基线血清TNF-α水平,HBV基因分型荧光定量PCR法检测HBV基因型或HBV S基因直接测序法检测HBV基因型、亚型,Logistic回归分析影响ADV应答的因素.结果 203例患者24周和48周HBV DNA转阴率、ALT复常率、HBeAg转阴率及转换率、应答率分别为31.5%、59.1%、15.8%、8.9%、13.3%和58.6%、78.3%、29.6%、16.7%、25.6%.获得24周应答的患者较无应答者的基线ALT、TNF-α水平高,而基线HBV DNA载量低(P<0.05);获得48周应答的患者较无应答者的24周HBeAg转阴率及转换率、基线TNF-α水平高,而基线HBV DNA载量低(P<0.05).结论 HBeAg阳性CHB患者ADV治疗24周应答的预测因素是基线ALT、TNF-α、HBV DNA;48周应答的预测因素是24周HBeAg转阴率及转换率、基线HBV DNA及TNF-α.