失代偿期肝硬化肝功能的再代偿

目前研究认为, 经过有效治疗后失代偿期肝硬化出现肝功能的再代偿。然而, 肝功能再代偿的程度、肝功能再代偿判断的标准、如何从肝功能的角度预测再代偿等多个问题仍需进一步探索。现从肝功能角度探讨失代偿期肝硬化的再代偿。     

经皮射频消融术对肝癌患者围术期肝功能的影响及相关因素分析

目的探讨射频消融术(FA)对肝癌患者肝功能的影响,进一步提高FA的治疗效果。方法回顾性分析118例肝癌患者FA围术期肝功能五项主要指标变化;分析肝功能异常率及其与肿瘤性质、肝功能分级和消融范围等的关系。结果术后3、7、14 d肝功能异常率分别为97%、66%、16%;原发性肝癌肝功能异常率明显高于转移性肝癌;肝功能分级越低、消融范围越大,肝功能异常率越高。结论 FA可引起术后短暂的肝功能损害;对于原发性大肝癌、肝功能C级和需大范围消融患者做好术前评估及术后监测是防止术后急性肝衰竭及其他严重并发症的主要措施。     

229例肝功能衰竭病因与转归分析

目的根据最新指南回顾性分析肝功能衰竭患者的病因及转归。方法收集北京佑安医院人工肝中心2008年5月—2014年7月收治的229例肝功能衰竭患者的临床资料,分析肝功能衰竭患者病因学及转归的临床特征。结果病毒性肝炎尤其是乙型肝炎病毒是全部肝功能衰竭患者的主要病因,HBV相关肝功能衰竭者占全部肝功能衰竭患者比例为53.3%。急性肝功能衰竭(ALF)前3位的病因是:HBV(3).8%),药物性(30.8%),酒精性(1 5.4%);亚急性肝功能衰竭(SALF)前3位的病因为药物性(52.6%)、HBV(1 5.8%)、自身免疫性和不明原因性均为(10.5%);慢加急性肝功能衰竭(ACLF)前2位的病因为HBV(71.1%)、酒精性(1 5.6%);慢性肝功能衰竭(CLF)前2位病因为HBV(43.0%)、酒精性(33.6%)。老年肝功能衰竭患者好转率17.3%,中青年肝功能衰竭患者好转率47.9%。结论 HBV相关肝功能衰竭在全部肝功能衰竭中占比例最多,且.以ACLF及CLF为主,ACLF、C、LF前2位病因均为HBV、酒精性。故乙型肝炎防治及成酒很重要。肝功能衰竭患者老年人较中青年预后差。     

急性胰腺炎肝功能损害37例

目的探讨急性胰腺炎(AP)的肝功能损害及不同诱因的肝功能损害程度及发生率。方法分析82例AP患者丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TB iL)、直接胆红素(DB iL)及白蛋白(ALB)的检查结果。结果37例有肝功能损害(45.12%)。轻型AP 69例,发生肝功能损害24例(66.70%);重型AP 13例,发生肝功能损害13例(100%)。胆源性AP 33例,发生肝功能损害20例(60.61%),明显高于非胆源性AP的34.69%。结论AP的肝功能损害较常见,重型AP的肝功能损害发生率100%,损害程度明显高于轻型AP;胆源性AP的肝功能损害程度及肝功能损害发生率明显高于非胆源性AP。     

成人获得性风疹患者肝功能损害的病理及临床观察

目的 探讨成人获得性风疹患者肝功能损害的临床及病理学特点,为临床诊治及判断预后提供依据.方法 36例成人获得性风疹患者,分别于入院次日及以后每隔5～10 d抽取静脉血,全自动生化分析仪定量检测患者血清总胆红素、直接胆红素、ALT、AST、血清总蛋白和血清白蛋白等肝功能指标,对其并发肝功能损害情况进行了连续动态观察,并对其中2例典型病例进行了肝活组织病理检查.无肝功能损害患者与并发肝功能损害患者住院天数比较采用秩和检验.结果 成人获得性风疹患者并发肝功能损害发生率高达77.8%,但其肝功能损害多轻微,多以ALT和(或)AST升高为主,其中以退疹后的第6～10日肝功能损害发生率最高,达72.2%,且此时肝功能损害亦最明显.肝脏活组织病理学检查发现其肝脏组织结构完整,仅有肝脏组织轻微炎症改变,并发现其病毒包涵体.并发肝功能损害患者组平均住院18.2 d,与无并发肝功能损害患者组平均住院7.8 d比较,差异有统计学意义(u=3.596,P＜0.05).结论 近年成人获得性风疹患者并发肝功能损害发生率高,但其肝功能损害多轻微,多以ALT升高为主.但一旦出现AST异常或黄疸,说明肝功能损害较重,除积极治疗外,要严密观察,防止发生急性肝衰竭.如本病患者并发肝功能损害,则明显延长了病程及住院时间.     

甲状腺功能亢进症初诊患者肝功能异常的临床分析

探讨甲状腺功能亢进症(甲亢)初诊患者肝功能异常的发生率、临床特点及相关因素。将428例甲亢患者根据肝功能是否异常分为两组,分析其临床表现、肝功能指标与血清甲状腺激素水平以及甲状腺自身抗体的水平的关系。初诊甲亢患者肝功能异常的发生率为30．1％,肝功能损害最常见的是碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)增高,其甲状腺激素水平显著高于无肝功能异常者。而TSH、甲状腺微粒体抗体(TMA)、甲状腺球蛋白抗体(TGA)则无明显差异。甲亢初诊患者合并肝功能异常较常见,肝功能损害以ALP、ALT增高为最常见,且与甲状腺激素水平关系密切。     

肝动脉化疗,栓塞损害肝功能的临床研究

肝动脉化疗，栓塞对肝功能损害的系统分析，国内外文献报道甚少。笔者对收治的５２例肝癌肝动脉化疗，栓塞后的肝功能变化进行了前瞻性研究。结果显示：（１）全部患者治后肝功能均有不同程度的损害，某些肝功能指标高达治前水平的３－４倍，为正常的５－１０倍；（２）大部分肝功能有１月内恢复至汉前水平或正常，３例肝功能持续性恶化，直至肝功能衰竭而死亡；（３）栓塞组的肝功能损害较化疗组严重。     

小儿重症感染性疾病并发肝功能损害的回顾性研究

目的回顾性分析小儿重症感染性疾病并发肝功能损害的临床特点。方法将我院在2012年6月至2015年6月收治的130例小儿重症感染性疾病患者作为研究对象,所有患儿均行肝功能检查,对本组患儿的临床表现、肝功能检测结果、治疗及转归情况等进行回顾性分析。结果130例患儿中,有111例发生肝功能损害,肝功能损害发生率为85.38%。肝功能损害患儿的男女比例差异无统计学意义(P0.05)。3岁患儿的肝功能损害发生率显著低于其他年龄段患儿(P0.05)。肝功能损害患儿中,重症呼吸道感染占比例最高,为52.25%,其次为重症消化道感染(26.13%),传染性单核细胞增多症(16.22%)。肝功能损害患儿中89.19%均为病毒感染,显著高于细菌感染(6.31%)、支原体感染(3.60%)及弓形虫感染(0.90%)(P均0.05)。结论小儿重症感染性疾病常引起肝功能损害,临床在治疗重症感染患儿时要注意避免使用会对肝脏造成损害的药物,以免加重肝功能损害而影响患儿的预后效果。     

急性胰腺炎与肝功能异常之间的“因-果”关系研究进展

急性胰腺炎(acute pancreatitis,AP)与肝功能异常之间的关系问题是一个全新的临床课题,现有的研究结果暗示:AP易累及肝脏,肝功能受损也可影响胰腺.AP与肝功能异常之间可能存在着一定的互为"因-果"的关系.本文检索和分析了近十年来有关AP与肝功能异常之间关系的文献报道,从AP与肝功能异常的概念、AP诱发的肝功能异常及其机制、肝功能异常诱发的胰腺炎及其机制、胰腺炎与肝功能损伤之间的相互关系及临床意义等方面进行了综述,期望能够为对临床预防和治疗"AP"或"肝功能异常"提供新的思考,并为探索"AP"或"肝功能异常"的病理机制提供新的研究方向.     

肝切除术后使用地塞米松对肝功能保护的有效性研究

肝脏切除术后肝功能的保护至关重要。本研究通过对100例肝脏切除术后患者的肝功能监测,论证地塞米松在肝脏切除术后肝功能的保护作用。总结如下：     

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.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.