肝衰竭诊疗指南

肝衰竭是临床常见的严重肝病症候群，病死率极高。多年来，各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索，但迄今尚无一致意见。2005年美国肝病学会发布了对急性肝衰竭处理的建议，国内迄今尚无肝衰竭的诊治指南，为适应临床工作需要，规范我国肝衰竭的诊断和治疗，中华医学会感染病学分会和中华医学会肝病学分会组织国内有关专家，制定了我国第一部《肝衰竭诊疗指南》（以下简称《指南》）。本《指南》的制定遵守了循证医学原则，借鉴了国内外最新研究成果，力求与国际接轨。其中推荐意见所依据的证据共分为3个级别5个等级，文中以括号内斜体罗马数字及阿拉伯数字表示。     

肝功能衰竭诊疗指南

肝功能衰竭（liver failure）是临床常见的严重肝病症候群，病死率极高。多年来，各国学者对肝功能衰竭的定义、分类、诊断和治疗等问题不断进行探索，但迄今尚无一致意见。2005年美国肝病学会发布了对急性肝功能衰竭处理的建议，国内迄今尚无肝功能衰竭的诊治指南。为了适应临床工作需要，规范我国肝功能衰竭的诊断和治疗，中华医学会感染病学分会肝功能衰竭与人工肝学组和中华医学会肝病学分会重型肝病与人工肝学组组织国内有关专家，制订了我国第一部《肝功能衰竭诊疗指南》（以下简称《指南》）。     

肝衰竭诊疗指南

肝衰竭是临床常见的严重肝病症候群,病死率极高。多年来,各国学者对肝衰竭的定义、分类、诊断和治疗等问题不断进行探索,但迄今尚无一致意见。2005年美国肝病学会发布了对急性肝衰竭处理的建议[1],国内迄今尚无肝衰竭的诊断治疗指南。为适应临床工作需要,规范我国肝衰竭的诊断和治疗活动,中华医学会感染病学分会和中华医学会肝病学分会组织国内有关专家,制订了我国第一部《肝衰竭诊疗指南》(以下简称《指南》)。本指南的制定遵守了循证医学原则,借鉴了国内外最新研究成果,力求与国际接轨。其中推荐意见所依据的证据共分为3个级别5个等级(表1…     

慢加急性肝衰竭与慢性肝衰竭临床特点分析

2006年中华医学会传染病学分会和中华医学会肝病学分会制定了我国第一部《肝衰竭诊疗指南》（简称《指南》）,将肝衰竭分为急性肝衰竭（ALF）、亚急性肝衰竭（SALF）、慢加急性肝衰竭（ACLF）和慢性肝衰竭（CLF）四类。根据《指南》分型标准,本研究对32例ACLF和38例CLF的临床和实验室检查结果分析报道如下。     

肝衰竭诊疗指南解读

2006年10月出台的《肝衰竭诊疗指南》（以下简称《指南》）是我国第一部有关肝衰竭的指南。国际上迄今为止仅见美国肝病联合会（AASLD）于2005年5月出台的有关《急性肝衰竭处理》的意见书,且范围局限。因此,可以说我国的《指南》最为全面和广泛地反映了肝衰竭的临床诊疗现状。该《指南》由中华医学会感染病学分会和中华医学会肝病学分会的肝衰竭与人工肝学组组织撰写,     

非酒精性脂肪性肝病诊疗指南(2006年2月修订)

非酒精性脂肪性肝病（NAFLD）是指除外酒精和其他明确的损肝因素所致的，以弥漫性肝细胞大泡性脂肪变为主要特征的临床病理综合征．包括单纯性脂肪肝以及由其演变的脂肪性肝炎（NASH）和肝硬化，胰岛素抵抗和遗传易感性与其发病关系密切。随着肥胖和糖尿病的高发，NAFLD现已成为我国常见的慢性肝病之一，严重危害人民健康。为进一步规范NAFLD的诊断、治疗和疗效评估，中华医学会肝病学分会脂肪肝和酒精性肝病学组组织国内有关专家，在参考国内外最新研究成果的基础上，按照循证医学的原则，制定了《非酒精性脂肪性肝病诊疗指南》（以下简称《指南》）。其中推荐的意见所依据的证据共分为3个级别5个等次．文中以括号内斜体罗马数字表示。推荐意见的证据级，参见《酒精性肝病诊疗指南》表1。     

慢性乙型肝炎防治指南

慢性乙型肝炎是我国常见的慢性传染病之一，严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗，中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家，在参考国内外最新研究成果的基础上，按照循证医学的原则，制订了《慢性乙型肝炎防治指南》（以下简称《指南》）。其中推荐的意见所依据的证据共分为3个级别5个等次，中以括号内斜体罗马数字表示。     

肝衰竭诊治指南(2012年版)

肝衰竭是临床常见的严重肝病症候群,病死率极高.多年来,各国学者对肝衰竭的定义、病因、分类、分型、诊断和治疗、预后判断等问题不断进行探索.2005年,美国肝病学会(AASLD)发布了《急性肝衰竭处理》的意见书(position-paper)[1].2006年10月,中华医学会感染病学分会肝衰竭与人工肝学组和中华医学会肝病学分会重型肝病与人工肝学组制订了我国第一部《肝衰竭诊疗指南》[2],从定义、诱因、分类、诊断和治疗等方面对肝衰竭进行了系统而精要的阐述,既与国际接轨,又具中国特色,诊断分型突出了实用性,指导和规范了我国肝衰竭的临床诊疗.2009年,亚太肝脏研究协会(APASL)推出了《慢加急性肝衰竭共识》[3].     

慢性乙型肝炎防治指南

慢性乙型肝炎是我国常见的慢性传染病之一，严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗，中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家，存参考国内外最新研究成果的基础上．按照循证医学的原则，制订了《慢性乙型肝炎防治指南》（以下简称《指南》）。其中推荐意见所依据的证据共分为3个级别5个等次，文中以括号内罗马数字表示。     

慢性乙型肝炎防治指南

慢性乙型肝炎是我国常见的慢性传染病之一，严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗，中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家，在参考国内外最新研究成果的基础上，按照循证医学的原则，制订了《慢性乙型肝炎防治指南》（以下简称《指南》）。其中推荐意见所依据的证据共分为3个级别5个等次，文中以括号内斜体罗马数字表示。     

活体肝移植的进展与展望

活体肝移植（LDLT）可扩大供肝来源,有效缓解供体紧缺局面,尤其是对儿童、急性肝功能衰竭患者和无,法长期等待的肝癌患者有着十分重要的意义。为尽可能减少LDLT潜在的手术风险,尤其是供者的风险,应由肝病内外科医师共同进行严格的供受体术前评估和准备,选择恰当的手术方案。中闰应稳步开展LDLT,并积极拓展尸体和脑死亡供体肝移植,进一步发展儿童LDLT和劈离式肝移植（SIX）以提高器官利用率。在第六届上海国际胃肠病学会议期间,国内外肝病专家就LDLT的现状作了相关报道,本文就此次会议的有关内容和最新进展作一简要介绍。     

Current management of liver diseases and the role of multidisciplinary approach

Liver is an organ having extremely diversified functions, ranging from metabolic and synthetic to detoxification of harmful chemicals. The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management. Several studies have investigated liver function, dysfunction and clinic. This editorial work discusses new ideas, challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases. In one hand the discussions have carried out on the involvement of extracellular vesicles, Na⁺/H⁺ exchangers, severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections, Drug-induced liver injury, sepsis, pregnancy, and food supplements in hepatic disorders. In the other hand this study has discussed hepatocellular carcinoma algorithms and new biochemical and imaging experiments pertaining to liver diseases. Relevant articles with an impact index value "> 0" from reference citation analysis, which is an open multidisciplinary citation analysis database based on artificial intelligence technology, have served for the study’s argumentation. This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.     

Liver regeneration after liver resection: Clinical aspects and correlation with infective complications

AIM:To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.METHODS:A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010.Regeneration was evaluated by multidetector computed tomographyat a mean follow-up of 43.85 d.The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation,and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data.Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.RESULTS:Ten of the 27 patients(37%)underwent chemotherapy prior to surgery,with a statistically significant prevalence of patients with metastasis(P=0.007).Eight patients(30%)underwent embolization,3 with primary tumors,and 5 with secondary tumors.Twenty patients(74%)experienced complications,with 12(60%)experiencing Clavien-Dindo Grade 3a to 5 complications.Regeneration≥100%occurred in 10(37%)patients.The predictors were smaller future remnant liver volume(-0.002;P<0.001),and a greater spleen volume/future remnant liver volume ratio(0.499;P=0.01).Patients with a resection of≥5 Couinaud segments experienced greater early regeneration(P=0.04).Nine patients experienced surgical site infections,and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected(P=0.016).There were no significant differences between patients with primary or secondary tumors,and either onset or infections or severity of surgical complications.CONCLUSION:Regardless of the onset of infective complications,future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.     

肝脏特异性基因miR-122与肝脏疾病研究进展

作为肝脏特异性基因miRNA之一的miR-122,其与肝脏生理及病理过程有密切联系。它不仅可促进肝细胞分化,还可调控脂类代谢。对肝脏疾病,miR-122可通过慢性丙型肝炎病毒（HCV）基因5＇-UTR结合序列相互作用来促进HCV病毒复制,反之,亦可通过miR-122-cylin G1/p53-HBV调控路径抑制慢性乙型肝炎病毒（HBV）表达及复制过程。另外,miR-122可抑制肝细胞增殖过程及其恶性转化。值得注意的是,用于HCV慢性感染治疗的首个miR-122靶向药物已研究中。随着miR-122调控慢性肝炎、肝癌作用机制及影响肝功能发挥的研究逐渐被人们所认知,在慢性感染性疾病及肿瘤治疗中,其已成为一个重要且有效治疗途径。     

2005年美国肝病学会急性肝衰竭诊治和肝移植患者评价指南简介

急性肝衰竭是指发生于既往肝功能正常的患者,短期内出现肝脏功能急剧恶化,导致进行性神志改变直至昏迷和凝血功能障碍的症候群。美国每年发生近2000例。主要病因是药物性肝脏损伤、病毒性肝炎、自身免疫性肝病、休克或低灌注,另外有近20％的急性肝衰竭无病因可寻。急性肝衰竭多发生于青年,死亡率极高。在肝移植技术推广之前,生存率不足15％。肝移植后,短期生存率可达65％。肝脏移植对于终末期肝病患者具有重要意义,已经成为各种原因引起的急性或慢性肝衰竭患     

Metrically measuring liver biopsy： A chronic hepatitis B and C computer-aided morphologic description

AIM： To describe a quantitative analysis method for liver biopsy sections with a machine that we have named ＂Dioguardi Histological Metriser＂ which automatically measures the residual hepatocyte mass （including hepatocytes vacuolization）, inflammation, fibrosis and the loss of liver tissue tectonics.METHODS： We analysed digitised images of liver biopsy sections taken from 398 patients, The analysis with Dioguardi Histological Metriser was validated by comparison with semi-quantitative scoring system.RESULTS： The method provides： （1） the metrical extension in two-dimensions （the plane） of the residual hepatocellular set, including the area of vacuoles pertinent to abnormal lipid accumulation; （2） the geo- metric measure of the inflammation basin, which distinguishes intra-basin space and extra-basin dispersed parenchymal leukoo/tes; （3） the magnitude of collagen islets, （which were considered truncated fractals and classified into three degrees of magnitude）; and （4） the tectonic index that quantifies alterations （disorders） in the organization of liver tissue. Dioguardi Histological Metriser machine allows to work at a speed of 0.1 mm^2/s, scanning a whole section in 6-8 min.CONCLUSION： The results are the first standardized metrical evaluation of the geometric properties of the parenchyma, inflammation, fibrosis, and alterations in liver tissue tectonics of the biopsy sections. The present study confirms that biopsies are still valuable, not only for diagnosing chronic hepatitis, but also for quantifying changes in the organization and order of liver tissue structure.     

Isolated Tuberculosis of Transplanted Liver,A Case Report and Review of the Literature

Introduction

Recipients of liver transplantation are prone to different types of infections such as tuberculosis (TB).

Case Presentation

Herein we report a 59-year-old man with liver transplantation due to HBV cirrhosis who developed isolated hepatic TB, 18 months after OLT (orthotropic liver transplantation). He has been successfully treated with anti-TB regimen and now after 12 months he is completely symptom-free.

Conclusions

Organ transplantation and treatment of transplanted patients with immunosuppressive drugs would prone them to various unusual infections. One of these is unusual primary involvement of liver by tuberculosis which has been extremely rare in the previous reports.     

第四届国际暨全国肝衰竭与人工肝学术会议纪要

第四届国际暨全国肝衰竭与人工肝学术会议于2007年3月1012日在重庆召开。会议共收到学术论文104篇，专家报告16篇，大会发言22篇。400余名代表参加了会议。英国Roger Williams教授，美国Stephen C Stom教授，德国Igor M．Sauer教授，中国香港Alexander Chiu教授，郑树森、斯崇文、李兰娟、贾继东教授，和数十位肝衰竭与人工肝及相关学科领域的知名专家、学者莅临作专题报告。     

肝血色病1例报道并文献复习

肝血色病又称肝血色素沉着症或肝铁过度沉积症,是一种罕见的因铁代谢紊乱,肠道铁被过度吸收导致体内铁过量的疾病。现将我院收治的1例肝血色病及相关文献复习报道如下。