甲状腺功能亢进合并肝损害治疗观察

回顾性分析甲亢合并重症肝损害患者的临床表现、治疗方法及转归。结果:除1例肝功能1个月恢复正常外,其余均于2～3周恢复正常。肝功好转后均及时行131I治疗甲亢。结论:甲亢合并重症肝损害患者的治疗原则是先明确肝损害原因并保肝治疗,肝功能出现好转后行131I治疗甲亢。     

甲状腺功能亢进伴发轻度肝功能损害患者的碘治疗

对42例甲状腺功能亢进症(甲亢)伴发肝功能损害患者口服I治疗并随访6个月，观察治疗前后的肝功能变化，证实对这类患者I治疗甲亢是安全和有效的。     

人工肝结合~(131)I治疗与内科常规治疗40例甲亢合并重症肝损害疗效的比较

目的:对人工肝结合131I治疗与内科常规治疗甲状腺功能亢进(甲亢)合并重症肝损害患者的临床疗效进行比较.方法:对近6年来我院40例甲亢合并重症肝损害患者的临床表现、实验室检查、治疗方式及预后进行回顾性分析,比较采用人工肝[方式有分子吸附再循环系统(molecula radsorbent recirculating system,MARS)、血浆置换]结合131I与内科常规治疗的疗效和预后.结果:人工肝组有25例患者,20例好转,5例病情恶化,内科常规治疗组共15例患者,6例好转,9例恶化,人工肝组好转率(80%)明显高于内科常规治疗组(40%),人工肝治疗能显著改善患者肝功能、甲状腺功能指标,缩短凝血酶原时间,提高治愈率.结论:甲亢合并重症肝损害病情复杂,治疗棘手,根据病情需要行人工肝治疗,在肝功能改善后行131I能明显改善预后,提高生存率,降低病死率.     

甲状腺功能亢进患者131↑I治疗的预后规律分析

目的探讨甲状腺功能亢进症（甲亢）131↑I治疗后的不同预后规律。方法收集633例131↑I治疗后甲亢患者资料,分析治疗后无效、好转、痊愈、甲状腺功能减退（甲减）、复发患者的预后变化规律。结果痊愈323例患者中,6个月内痊愈占57．9％,7—12个月痊愈占18．0％,12个月以上痊愈占24．1％;痊愈患者中暂时性甲减13例,均为早发甲减。甲减139例患者中,早发甲减占60．4％。晚发甲减中未见发生率存在逐年上升趋势。结论甲亢131↑I治疗后6个月内未愈者选择二次131↑I治疗应慎重;早发甲减病例中仅少部分为暂时性甲减。     

131I治疗甲亢对性腺和胰岛功能的影响

本文对131I治疗甲亢前后患者睾酮(T)、雌二醇(E2)、胰岛素(INS)、C-肽(C-P)含量进行了对比分析,探讨服用131I治疗甲亢对患者性腺和胰岛内分泌的影响。1对象与方法1.1对象为本院收治的甲亢患者256例(所有病人均经吸131I率测定、FT4、FT3、TSH、TGA、TMA测定确诊为甲亢患者),其中     

甲状腺功能亢进致肝功能损害46例临床分析

目的分析甲状腺功能亢进（甲亢）所致肝损害的特点和分布。方法对46例初诊甲状腺功能亢进患者在治疗各阶段进行甲状腺功能、肝功能等检查，并进行对照、分析。结果甲亢患者较正常对照组肝功能异常有显著性差异（P〈0.01），且以Gravers病人为著。积极治疗后肝功能异常能够恢复。结论甲亢患者常伴有肝功能损害．早期检查有助于鉴别是否甲亢药物所致肝损害，积极的抗甲亢及护肝治疗可使肝功能恢复正常。     

131Ⅰ治疗甲亢性心脏病108例临床分析

目的探讨甲亢性心脏病的临床特征、发病相关因素及其治疗方案。方法对108例甲亢性心脏病患者给予131I治疗,对其临床资料进行回顾性分析。结果甲亢性心脏病以中、老年女性为主,心律失常以心房纤颤常见;甲状腺弥漫性肿大的甲亢患者伴发甲亢性心脏病的几率明显高于结节性肿大的患者;经131I抗甲亢治疗以后,随着甲亢的治愈,绝大多数甲亢性心脏病可以治愈。结论131I治疗甲亢性心脏病疗效好,治愈率高,是治疗甲亢心的理想方法。     

甲状腺功能亢进症合并肝衰竭的临诊应对

本研究收集了既往诊治的11例甲状腺功能亢进症(甲亢)合并肝衰竭患者的临床资料, 其中4例为药物性肝炎引起的肝衰竭, 1例为血吸虫性肝硬化病史合并甲亢, 6例为甲状腺毒症相关性肝损伤(hyperthyroidism-induced liver injury, HILI)引起的肝衰竭。住院期间所有患者接受基础支持治疗以及β-受体阻滞剂对症治疗, 分别有9例患者接受糖皮质激素和人工肝治疗。11例患者中2例死亡, 8例患者于治疗后1～12个月甲状腺和肝功能恢复正常, 1例肝硬化患者后期肝功能稳定。肝功能改善后7例患者接受同位素治疗, 1例行甲状腺全切手术, 1例接受药物治疗。以上结果表明药物性肝炎及HILI肝衰竭引起的肝功能异常的临床特征并不尽相同, 治疗上应在β-受体阻滞剂和糖皮质激素基础上尽早进行人工肝治疗以缓解甲状腺毒症及肝功能损害, 为后续同位素或手术治疗甲亢创造时机。     

131I治疗Graves甲亢专家共识(2010年)

甲状腺功能亢进症(hyperthyroidism,简称甲亢)以Graves甲亢最多见,我国人群患病率约1.2％[1].Graves甲亢的主要治疗方法为抗甲状腺药物和131I治疗.近年来,用131I治疗Graves甲亢的患者呈增多趋势,为了进一步规范131I治疗,由多位核医学专家经多次共同商讨,数易其稿,历时2年,就有关131I治疗Graves甲亢临床相关问题形成此共识.     

甲亢患者甲状腺相关指标及肝功能状况的临床分析

正甲亢是内分泌科较为常见的疾病,是由多种病因引起的甲状腺合成释放过多的甲状腺激素,进而产生的患者机体代谢亢进和交感神经兴奋所致的各类症状~([1])。临床研究显示,过多的甲状腺激素常会作用于肝脏,从而引起患者肝功能异常。因此,了解甲亢患者肝功能各项指标的变化情况,对于判定患者治疗效果及预后有重要的临床意义~([2])。为进一步研究甲状腺激素相关指标及肝功能指标在甲亢患者中的变化情况,我院对40例甲亢患者进行了各项指标的检测与研     

Effect of hepatic dysfunction on oral cyclosporin pharmacokinetics in marrow transplant patients

The effect of hepatic dysfunction, defined as abnormal serum bilirubin level, on oral cyclosporin (CSP) pharmacokinetics was examined in 28 marrow transplant patients who received CSP for prophylaxis of graft-v- host disease. Serum CSP concentrations were measured by radioimmunoassay. Forty-one concentration-time courses were studied, divided among patients with no (less than 1.2 mg/dL), mild (1.2 to 2.0 mg/dL), and moderate (2.0 to 5.0 mg/dL) hepatic dysfunction. CSP elimination, as determined by elimination rate constant and clearance, was delayed in patients with moderate hepatic dysfunction compared to those with no hepatic dysfunction (P less than .05). The volume of distribution, lag time for absorption, maximum serum concentration, and time at which the maximum concentration was achieved was not affected by hepatic function. These data indicate that patients with moderate hepatic dysfunction have delayed CSP or CSP metabolite elimination and may be at higher risk for developing CSP-related toxicity.     

Hepatic function in circulatory insufficiency. Mathematical modeling of 137I-labelled rose bengal transport in the body]

131I-labelled bengali pink was used to perform radiohepatography in patients with circulatory failure. Both amplitude-time parameters of blood clearance curves and hepatograms and the generalized index of parameters of the linear 3-chambered reversible model of this tracer transport in the body indicate that the decrease of hepatic absorptive and excretory function in the presence of 131I-labelled bengali pink occurs in a direct relationship to the degree of circulatory insufficiency and developed in parallel with bilirubin metabolic disturbances. In some patients, hepatic lesion in the presence of Stages IIB-III circulatory insufficiency with signs of hepatocellular failure and cholestasis was accompanied only by moderate hepatic absorptive and excretory dysfunction against 131I-labelled bengali pink and by an increase in blood total bilirubin levels no more than that in Stage IIA circulatory insufficiency.     

Elevated carboxy terminal cross linked telopeptide of type I collagen in alcoholic cirrhosis: relation to liver and kidney function and bone metabolism

BACKGROUND: The carboxy terminal cross linked telopeptide of type I collagen (ICTP) has been put forward as a marker of bone resorption. Patients with alcoholic liver disease may have osteodystrophy. AIMS: To assess circulating and regional concentrations of ICTP in relation to liver dysfunction, bone metabolism, and fibrosis. METHODS: In 15 patients with alcoholic cirrhosis and 20 controls, hepatic venous, renal venous, and femoral arterial concentrations of ICTP, and bone mass and metabolism were measured. RESULTS: Circulating ICTP was higher in patients with cirrhosis than in controls. No overall significant hepatic disposal or production was found in the patient or control groups but slightly increased production was found in a subset of patients with advanced disease. Significant renal extraction was observed in the controls, whereas only a borderline significant extraction was observed in the patients. Measurements of bone mass and metabolism indicated only a mild degree of osteodystrophy in the patients with cirrhosis. ICTP correlated significantly in the cirrhotic patients with hepatic and renal dysfunction and fibrosis, but not with measurements of bone mass or metabolism. CONCLUSIONS: ICTP is highly elevated in patients with cirrhosis, with no detectable hepatic net production or disposal. No relation between ICTP and markers of bone metabolism was identified, but there was a relation to indicators of liver dysfunction and fibrosis. As the cirrhotic patients conceivably only had mild osteopenia, the elevated ICTP in cirrhosis may therefore primarily reflect liver failure and hepatic fibrosis.     

Quantitative liver imaging using 131-I Rose Bengal as an index of liver function and prognosis.

A technique for assessing quantitatively hepatic function by direct measurement of liver parenchymal cell uptake of 131I Rose Bengal using a scintillation camera with a digital store and retrieval system is described. Ninety-four studies were performed on 84 patients with a variety of hepatic disorders over a two-year period, the diagnosis in each case being established by liver biopsy or laparotomy. The results were compared with the clinical, biochemical and histological assessment of the patients. A good correlation was found between the half-time for hepatic uptake of 131I Rose Bengal and the histological changes, as well as with clinical prognosis measured in terms of clinical improvement or deterioration to death. The rate of liver uptake was found to be a better index than the clearance of radioisotope from the blood and was superior to conventional biochemical investigations in both icteric and anicteric patients. The test was not shown to be of clinical value in discriminating between intra- and extrahepatic causes of jaundice. It is suggested that this technique may provide a safe and sensitive method for assessing the severity of liver dysfunction and also for monitoring clinical progress, especially in situations where liver biopsy may be unreliable or hazardous.     

Hepatic toxicity of low doses of mithramycin in hypercalcemia

The medical records of patients receiving mithramycin for the treatment of hypercalcemia at The Johns Hopkins Oncology Center were reviewed. Of 67 evaluable patients, 11 (16%) developed hepatic toxicity when graded using standard criteria. The pattern of laboratory abnormalities noted suggested mild hepatocellular damage that was reversible within 2 weeks. Review of these patients did not identify factors which predispose to hepatic toxicity, although failure to do so may reflect the limited number of toxic patients evaluated. Mild, reversible hepatic dysfunction appears to be a more common sequela of mithramycin administration than has previously been recognized.     

The Spectrum of Hepatic Injury in Enteric Fever

Thirty six patients with culture-proven enteric fever and 15 patients of fever with etiology other than enteric fever as a control group were studied, with special reference to hepatic dysfunction and its relation to clinical features of the disease. Hepatomegaly was observed in 55% of enteric fever patients, and was slightly more common than splenomegaly (50%). Its incidence in typhoid fever (67%) was three times higher than in paratyphoid fever (22%). Hepatic dysfunction occurred in 55% of cases. Jaundice was noted in only 8% of the cases, whereas hyperbilirubinemia (serum bilirubin greater than 1.8 mg %) was present in 17%. Although hepatic manifestations of enteric fever were mild, a small but important group had sufficient hepatic involvement to mimick the clinical picture seen in viral hepatitis, amebic liver disease, and malaria with jaundice. It may be considered of clinical significance, since enteric hepatitis responds very well to specific therapy.     

Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity

Objective

This study evaluated the effect of echocardiographic left ventricular (LV) diastolic dysfunction on acute congestive heart failure after transcatheter atrial septal defect (ASD) closure in elderly patients.

Background

Although there is concern that LV diastolic dysfunction develops acute congestive heart failure after ASD closure, limited information is available regarding the influence, especially in elderly patients with severe LV diastolic dysfunction.

Methods

Two hundred consecutive patients older than 60 years were divided into 3 groups according to echocardiographic LV diastolic dysfunction: severe (early diastolic mitral annular velocity [e’] <5.0 cm/s), mild (5.0≤ e’ <8.0 cm/s), and normal (e’ ≥ 8.0 cm/s). Changes in plasma B‐type natriuretic peptide (BNP) levels were evaluated.

Results

No patients with severe LV diastolic dysfunction developed acute congestive heart failure immediately after the procedure. BNP levels unchanged after the procedure in patients with severe LV diastolic dysfunction (126 ± 181 to 131 ± 148 pg/ml, P = 0.885), and this increase in BNP levels was not different from that between the diagnosis of ASD and the procedure. The change in BNP levels in patients with severe LV diastolic dysfunction, who were frequently treated with diuretics before the procedure, was equivalent to that in patients with mild LV diastolic dysfunction and normal LV diastolic function (5 ± 119 vs. 16 ± 101 vs. 9 ± 131 pg/ml, P = 0.724).

Conclusions

Our findings suggest that transcatheter ASD closure under volume management is safe and valuable in elderly patients with echocardiographic severe LV diastolic dysfunction.

     

移植前及预处理期间肝功能异常对异基因造血干细胞移植效果的影响

 目的 探讨异基因造血干细胞移植(allo-HSCT)患者移植前和预处理期间肝功能异常的特征及其与肝脏合并症和预后的关系。方法 回顾性分析196例allo-HSCT治疗血液系统疾病患者,采集其移植前和预处理期间肝功能数据,观察其对造血重建、移植相关肝脏并发症、生存和移植相关死亡的影响。结果 196例患者中,38例移植前存在肝功能异常,159例预处理期间发生肝功能异常,28例(17.6%)出现3度肝损害,无4度肝损害出现。移植前和预处理期间肝功能异常对造血重建时间、肝静脉阻塞病(HVOD)、肝脏急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)发生无显著影响。单因素分析显示年龄(P=0.022)、移植前疾病状态高危(P=0.003)、移植前AST(P=0.019)和TBil水平升高(P=0.015)、Ⅲ~Ⅳ度肝脏aGVHD(P=0.000)和HVOD(P=0.000)是影响总生存(OS)率的危险因素。多因素Cox回归分析显示移植前疾病状态为高危(P=0.002)、Ⅲ~Ⅳ度肝脏aGVHD(P=0.000)是影响OS率的独立危险因素,同时也是影响移植相关死亡(TRM)率的独立危险因素(P值分别为0.002和0.000),而移植前和预处理期间肝功能异常对OS率和TRM率无显著影响。结论 1~2度肝功能异常患者,在密切监测肝功能、充分保肝治疗及积极预防HVOD基础上,可考虑进行allo-HSCT。
        

T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities

Magnetic resonance has shown T2 hyperintensity along the cortico-spinal tract in the brain of cirrhotic patients. This abnormality, which is reversible after liver transplantation, appears to correspond to mild edema. Because astrocytic edema present in hepatic encephalopathy may be responsible for neuronal dysfunction, we studied whether T2 hyperintensity along the cortico-spinal tract may relate to functional abnormalities. Twenty patients with cirrhosis underwent neuropsychologic tests, neurophysiologic study of the cortico-spinal tract with transcranial magnetic stimulation, and (1)H-magnetic resonance. The study was repeated 6 months after liver transplantation (n = 15) and was compared with a control group of healthy subjects (n = 11). Cirrhotic patients exhibited increased T2 signal and several functional abnormalities along the cortico-spinal tract (increased central motor conduction time, increased motor cortical threshold, and decreased motor-evoked potential amplitude). Functional abnormalities reversed after liver transplantation and were associated with normalization of T2 cortico-spinal hyperintensity and with improvement of minimal hepatic encephalopathy. In conclusion, T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities that are reversible after liver transplantation. These findings suggest that mild cerebral edema along the cortico-spinal pathway may cause neuronal dysfunction. These results support the participation of astrocytic edema in the pathogenesis of hepatic encephalopathy.     

Sulfur amino acid metabolism in hepatobiliary disorders.

Sulfur amino acid metabolism was studied in patients with mild to severe forms of liver dysfunction and compared with that of healthy controls. Patients with mild liver dysfunction (for example, Gilbert's syndrome) had a normal sulfur amino acid metabolism. With increased inflammatory activity and cirrhosis (for example, chronic active hepatitis, alcohol-induced cirrhosis, and hepatic coma) a decreased ability to metabolize methionine (to cysteine, with cystathionine accumulation) and cysteine (to inorganic sulfate, with thiosulfate and N-acetylcysteine accumulation) was found. In contrast, transaminative metabolism of sulfur amino acids was preserved in patients with advanced forms of liver dysfunction, suggesting that transamination of sulfur amino acids is performed not only in the liver but also in extrahepatic tissues. Some implications of these findings are discussed.