肝移植受者抑郁与应对方式的相关性研究

目的 调查肝移植受者术后的抑郁状况,并探讨其抑郁状况和应对方式的相关性.方法 将100例肝移植受者按时间段分为3组,第1组为术后1-6个月,第2组为术后7-12个月,第3组为术后13-36个月.用抑郁自评量表(SDS)和医学应对问卷(MCMQ)对3组受者进行调查,以国内常模得分作为对照,与各组受者SDS得分进行比较,并将抑郁总分及各特异性症状评分与应对方式的各维度进行相关性分析.结果 肝移植受者总体抑郁得分为(41.03±7.14)分,3个时间段抑郁得分分别为(42.90±7.18)、(40.71±7.97)和(39.69±6.00)分.肝移植受者术后总体抑郁得分和各组抑郁得分与国内常模(29.78±10.07分)比较,差异均有统计学意义(P<0.05).3组抑郁得分两两比较,差异无统计学意义(P>0.05);3组肝移植术后受者抑郁发生率比较,差异无统计学意义(P>0.05);肝移植受者的抑郁水平与应对方式中的面对维度呈负相关(P<0.05)、与回避和屈服维度呈正相关(P<0.05).结论 肝移植受者抑郁水平高于一般人群,且肝移,植受者的抑郁水平与其采取的应对方式高度相关.

Abstract：

Objective To describe depression in liver transplant(LT)recipients and explore their coping styles.Methods One hundred transplant recipients were divided into three groups according to the time after LT:one to six months after the operation(group1),six months to one year(group2)and one to three years after the operation(group3).A self-rating depression scale(SDS)was used to measure their depression levels,and a Medical Coping Modes questionnaire(MCMQ)Was used to investigate their coping styles.The results were compared with those from a general population,and the relevance of depression symptoms and coping styles was analysed. Results The average SDS score of all the LT recipients was 41.03±7.14(42.90±7.18 for group 1.40.71±7.97 for group 2 and 39.69±6.00 for group 3).The average depression scores of the three groups were all significantly higher than in the normal population,but there was no statistically significant difference among the three groups.The depression scores were negatively correlated with the confrontation aspect of coping style,while positively correlated with avoidance and resignation.Conclusion LT recipients tend to be depressed,and the level of depression is strongly related with their coping styles.     

黄连素通过增强细胞缝隙连接功能增加放射诱导的细胞凋亡

Background Clinical combination of some traditional Chinese agents, including berberine, with irradiation is demonstrated to improve efficacy of tumor radiotherapy, yet the mechanisms for such effect remain largely unknown. The present study investigates the effect of berberine on apoptosis induced by X-rays irradiation and the relation between this effect and gap junction intercellular communication (GJIC). Methods The role of gap junctions in the modulation of X-rays irradiation-induced apoptosis is explored by manipulation of connexin expression, and gap junction function, using oleamide, a GJIC inhibitor, and berberine. Results In transfected HeLa cells, Cx32 expressing increases apoptosis induced by X-rays irradiation, while inhibition of gap junction by oleamide reduces the irradiation responses, indicating the dependence of X-rays irradiation-induced apoptosis on GJIC. Berberine, at the concentrations without cytotoxicity, enhances apoptosis induced by irradiation only in the presence of functional gap junctions. Conclusions These results suggest that berberine potentizes cell apoptosis induced by X-rays irradiation, probably through enhancement of gap junction activity.     

影响肝移植术后新发糖尿病逆转的相关因素

目的 探讨影响肝移植术后新发糖尿病(PTDM)逆转的相关因素.方法 回顾分析232例肝移植受者的临床资料,术后共有62例患者发生PTDM,发生率为26.7%.根据PTDM是否发生逆转,将62例患者分为暂时性PTDM组(34例)和持续性PTDM组(28例).对两组患者的性别、年龄、体重指数、糖尿病家族史、乙型肝炎病毒感染情况、术前空腹血糖水平、免疫抑制剂使用及其血药浓度、皮质激素的使用时间等相关因素进行分析.结果 两组间患者的性别、体重指数、糖尿病家族史、术前空腹血糖水平、免疫抑制方案中皮质激素的持续使用时间、术后血他克莫司浓度及使用环孢素A的患者比例等因素的差异均无统计学意义(P＞0.05).与持续性PTDM组相比,暂时性PTDM组患者移植时年龄较轻,分别为(54±8)岁和(42±6)岁(P＜0.05);发生PTDM的术后时间较晚,分别为术后(18±23)d和(35±42)d(P＜0.05);免疫抑制方案中联合运用吗替麦考酚酯(MMF)或西罗莫司(SRL)的患者比例较高,分别为0和8.9%(P＜0.05).经多因素Logistic回归分析显示,只有移植时年龄是PTDM逆转的独立预测因子(比值比为1.312,95%可信区间为1.005～1.743).结论 患者移植时年龄、发生PTDM时的术后时间及免疫抑制方案中使用MMF或SRL的患者比例等因素与肝移植术后PTDM逆转相关,但只有移植时年龄是PTDM逆转的独立预测因子.

Abstract：

Objective To study the related factors associated with the reversal of posttransplant diabetes mellitus (PTDM) following liver transplantation. Methods The clinical data of 62patients with PTDM in 232 patients receiving liver transplantation (26. 7 %) were retrospectively analyzed and the patients were divided into two groups: patients with transient PTDM (34 cases) and those with persistent PTDM (28 cases). Pre-operative and post-operative variables, including sex,age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, the immunosuppressant regime, FK506 concentration and duration of steroid usage, were analyzed retrospectively. Results The variables, including sex, age, body mass index,family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose,FK506 concentration at month 1, 3 and 6 after operation, rate of cyclosporine usage and duration of steroid usage had no significant difference between the two groups (P＞0. 05). Compared with the persistent PTDM patients, the transient PTDM patients were characterized by younger age at the time of transplantation (54 ± 8 vs. 42 ± 6 years, P＜0. 05), longer time before the development of PTDM (18 ± 23 vs. 35 ± 42 days, P＜0. 05), and higher rate of mycophenolate mofetil or sirolimus usage (0vs. 8. 9 %, P＜0. 05). Based on a multivariate analysis, age at the time of transplantation was determined as the single independent predictive factor associated with reversal of PTDM following liver transplantation (odds ratio: 1. 312, 95 % confidence interval: 1. 005 - 1. 743). Conclusion Age at the time of transplantation, duration before the development of PTDM and rate of mycophenolate mofetil or sirolimus usage are associated with reversal of PTDM following liver transplantation. Among these factors, age at the time of transplantation is only the single independent predictive factor.     

肝移植胆道重建选择胆肠吻合术的临床分析

目的 探讨肝移植胆道重建时选择胆肠吻合术的手术指征和相关并发症的防治.方法 回顾性分析2004 年10 月至2006 年10 月完成的胆道重建选用胆肠吻合术式的肝移植患者的临床资料,总结肝移植术施行胆道吻合指征和相关并发症防治经验.结果 共有24 例患者胆道重建选择了胆肠吻合术式,占同期施行肝移植总例数的5.72%(24/421).选择指征包括再移植、胆道局部解剖条件及原发疾病限制等多种因素.总的并发症发生率为25%,分别为胆道吻合口狭窄(3例)、胆道逆行感染(2 例)和胆道吻合口狭窄并胆漏(1 例).危险因素分析发现术前肝功能分级为Child原pugh C级患者更容易出现胆道并发症(P&lt;0.05).采用经PTC 的介入治疗和加强抗感染处理,4 例痊愈,1 例出现感染性休克死亡,1 例发生缺血坏死性胆道病变.结论 胆道狭窄和胆道逆行感染仍是主要的胆道并发症,正确把握胆道重建选择胆肠吻合术的适应证,规范手术方式和有选择地放置胆道引流管可以降低此类并发症的发生.     

雷帕霉素在人肝癌裸鼠肝移植瘤血管形成和肿瘤进展中的作用

目的 探讨雷帕霉素(RPM)在人肝癌裸鼠肝移植瘤血管形成和肿瘤发展中的作用.方法 建立人肝癌裸鼠肝移植瘤模型,使用RPM、环孢素A(CsA)进行干预治疗,采用实时定量PCR法检测移植瘤血管内皮细胞生长因子(VEGF)mRNA的表达,免疫组织化学方法和图像分析技术检测移植瘤VEGF蛋白、增殖细胞核抗原(PCNA)的表达和微血管密度(MVD),ELISA法检测外周血VEGF蛋白水平的变化.结果 (1)RPM、CsA和对照组移植瘤重量分别为(372±35)mg、(769±39)mg、(751±42)mg;RPM组移植瘤重量较对照组显著减少(P<0.01);CsA组和对照组比较无明显变化(P>0.05).(2)RPM组移植瘤VEGF mRNA、蛋白和PCNA的表达及外周血中VEGF蛋白水平较对照组显著下调(P<0.05),CsA组和对照组比较无明显差异(P>0.05).(3)RPM组移植瘤MVD较对照组显著减少(P<0.01);CsA组和对照组相比无明显变化(P>0.05).结论 RPM通过阻止肿瘤增殖,下调VEGF的表达,抑制肝癌血管形成和肿瘤进展.     

肝移植术后早期合并脓毒症患者的免疫功能障碍

目的 研究肝移植患者发生术后早期脓毒症时机体免疫状态的变化特点.方法 前瞻性选取2008年10月至2009年7月因慢性重型肝炎行肝移植手术患者19例,比较其与健康人群(20例)免疫状态的差异,并根据术后早期是否发生脓毒症分成脓毒症组(HSS组)和非脓毒症组(HSNS组),观察2组患者手术前后不同时期外周血T淋巴细胞亚群的动态变化.结果 与健康人群相比慢性重型肝炎患者T％、IFN-γ/IL-4均显著下降,CD4+ CD25+ Foxp3+ Treg(％)、Foxp3 mRNA 以及IL-10浓度明显上升.9例患者术后早期发生脓毒症,2组患者T％在术后第1天均较术前显著下降,HSNS组第14天恢复至术前水平,而HSS组仍维持在较低水平.HSNS组在术后第14天Treg％(t=3.265,P=0.004)和Foxp3mRNA表达(t=2.750,P=0.013)与术前相比明显降低,而HSS组术后则略呈上升趋势.HSNS组术后IFN-γ/IL-4有所上升,术后第3天最为显著(t=2.261,P =0.036),HSS组术后各时间点与术前比较无明显变化.两组患者IL-10浓度术后均明显下降,其中HSNS组一直维持在较低水平,而HSS组术后第14天再次上升至术前水平.结论 慢性重型肝炎患者免疫功能下降,术后未合并脓毒症者免疫状态于术后7～14d开始逐渐改善,发生脓毒症者仍维持术前的免疫低下状态.     

肝移植术改善良性终末期肝病病人生存质量的初步研究

目的 研究肝移植手术对良性终末期肝病病人生存质量的改变情况。方法 采用WHOQOL-BREF表对29例良性终末期肝病病人在肝移植术前、术后1～3个月、术后4～6个月以及术后6个月以上4个时间段进行生存质量的测评。结果 良性终末期肝病病人在生理领域、自身生存质量总的主观感受及对自身健康状况总的主观感受方面，肝移植术后的评分与术前相比差异有统计学意义（P〈0．05）。结论 肝移植术可以提高良性终末期肝病受者的生存质量。     

恩替卡韦对肝移植受者血清及外周血单个核细胞内HBV DNA的抑制作用

目的 研究恩替卡韦对乙型肝炎相关性终末期肝病患者肝移植术后血清及外周血单个核细胞（PBMC）内HBV DNA的抑制作用. 方法 选取从2007年8～12月的20例HBsAg阳性肝移植受者作为研究对象（围手术期组）,给予口服恩替卡韦每天0.5 mg联合肌注乙肝免疫球蛋白作为HBV再感染的预防方案,分别于术前1 d和术后1、4、12周采用实时荧光定量PCR法检测血清及PBMC内HBV DNA定量.同时回顾性分析2006年8月至2007年8月共34例行同种异体原位肝移植,术后长期使用恩替卡韦联合肌注乙肝免疫球蛋白的患者（随访组）,随访时间4.0～22.5个月,同样的方法检测血清及PBMC内HBV DNA定量.结果 20例受者血清HBV DNA在恩替卡韦治疗12周时全部转阴.术前1 d和术后1、4、12周PBMC内HBV DNA阳性率分别为85.0%（17/20）和45.0%（9/20）、45.0%（9/20）、40.0%（8/20）,术后1周与术前比较差异有统计学意义（P=0.004）,但1周以后阳性率无显著变化;围手术期PBMC内HBV DNA定量均值分别为104.07±2.07和101.69±1.96、101.51±1.72、101.30±1.63拷贝/106细胞,同样术后1周与术前比较差异有统计学意义（P=0.01）,但随术后时间的延长,下降趋缓,术后4周后定量值的下降差异无统计学意义（P〉0.05）.随访组平均随访13.6个月,均未发现HBV再感染（血清HBV DNA均阴性）,PBMC内HBV DNA阳性率为32.4%（11/34）,定量均值101.03±0.26拷贝/106细胞.结论 恩替卡韦对肝移植术后血清及PBMC内HBV DNA均具有较好的抑制效果,但PBMC内HBV DNA下降趋势在术后4周后即维持在相对稳定状态,不能完全被清除.