老年肝病患者医院感染临床分析

目的　探讨老年肝病患者医院感染状况及对转归的影响。方法　回顾性分析、比较老年组和非老年组 ,老年各类肝病组医院感染的发生率和病死率。结果　老年组医院感染发生率和病死率分别为 33.93%和2 5 .2 6 % ,明显高于非老年组的 1 4 .6 6 %和 5 .95 % (P <0 .0 1 ) ;老年急慢性肝炎、重型肝炎、肝硬化各组间医院感染率和病死率的差异显著 (P <0 .0 1 ) ,以重型肝炎组感染率和病死率较高 ;感染部位以呼吸系统最多见 ;病原菌以革兰阴性菌及真菌为主。结论　真菌已成为老年肝病患者医院感染的重要病原菌。老年肝病患者 ,尤其是重型肝炎患者 ,易发生各种医院感染 ,并严重影响其预后     

糖尿病性肝病的病理研究

应用光镜、电镜及特殊染色方法对２１例糖尿病性肝病的肝穿、手术切除和尸检肝组织进行病理研究。结果：光镜主要变化为核内糖原空洞、脂肪变性、脂肪性肉芽肿及间质纤维组织增生；电镜变化为肝细胞核内染色质呈絮状并中心空虚，胞质有脂肪滴、糖原颗粒增多。线粒体减少、模糊。粗面内质网减少、脱粒。滑央内质网和溶酶体增多、间隙胶元纤维增生。３例进行治疗前后对比，治疗后病变减轻或消失，提示糖悄病性肝病的病理变化是可逆的。     

小儿药物性肝病30例临床分析

1临床资料药物性肝病是常见的肝病之一,临床上易被误诊,尤其是小儿药物性肝病更易误诊。我院自2000年至2007年共收住小儿药物性肝病30例,其中男14例,女16例,年龄1岁～12岁,平均年龄6岁。本组病例均符合以下条件:大多用药在1周～4周出现肝损害表现,少数于服药在1个月以上才出现肝病症状;有肝内胆汁郁滞或实质性肝损害的临床征象;有关病毒性肝炎的血清学标志阴性(也可能原为无症状HBsAg携带者,在此基础上发生的药物性肝病);少数患者偶然再次给药发生肝损害。排除了自身免疫性肝病、遗传性肝病和阻塞性黄疸等其他肝病。2临床表现和实验室检查所有患儿均有不同程度的乏力、纳差、上腹部不舒、恶心、呕吐、尿色黄或颜色变深等类似病毒性肝炎的症状。其中肝细胞损伤型24例,异烟肼、利福平引起者10例,鱼胆误服引起者1例,环丙沙星引起者2例,头孢噻钠引起者2例,环磷酰胺、氮芥引起者各2例,对乙酰胺基酚类3例,中药中的贯众、苍耳子等2例。以上病例均在服药1周～1个月间发病。有黄疸症状的18例,谷丙转氨酶160U/L～800U/L,谷草转氨酶80U/L～350U/L。有黄疸者总胆红素40U/L～300U/L,2例为HBsAg携带者。胆...     

Diagnosis of monogenic liver diseases in childhood by next‐generation sequencing

Next‐generation sequencing (NGS) has opened up novel diagnostic opportunities for children with unidentified, but suspected inherited diseases. We describe our single‐center experience with NGS diagnostics in standard clinical scenarios in pediatric hepatology. We investigated 135 children with suspected inherited hepatopathies, where initially no causative pathogenic variant had been identified, with an amplicon‐based NGS panel of 21 genes associated with acute and chronic hepatopathies. In 23 of these patients, we detected pathogenic or likely pathogenic variants in 10 different genes. We present 6 novel variants. A total of 14 of these patients presented with the characteristic phenotype of the related hepatopathy. Nine patients showed only few or atypical clinical symptoms or presented with additional signs. In another 13 out of 135 cases, we detected variants of unknown significance (VUS) in 9 different genes. Only 2 of these patients showed characteristic phenotypes conclusive with the detected variants, whereas 11 patients showed unspecific or atypical phenotypes. Our multi‐gene panel is a fast and comprehensive tool to diagnose inherited pediatric hepatopathies. We also illustrate the challenge of dealing with genetic variants and highlight arising clinical questions, especially in patients with atypical phenotypes.     

Assessing hepatic impairment in Fontan‐associated liver disease using the HepQuant SHUNT test

Background & Aims: Fontan surgery for single ventricle congenital heart disease leads to Fontan‐associated liver disease (FALD). Typical laboratory tests, imaging, and histopathology cannot predict clinical severity in FALD. HepQuant SHUNT is a proprietary serum test of hepatic function and physiology that has not yet been evaluated in FALD.
Methods: Fourteen adult FALD patients at a single urban tertiary care center who underwent a Fontan procedure in childhood received HepQuant SHUNT testing between September 2015 and April 2018. The HepQuant SHUNT disease severity index (DSI) assesses global liver function and physiology from systemic and portal hepatic filtration rates (HFRs, clearances adjusted for body mass) of orally and intra‐ venously administered cholates labeled with deuterium or 13C. The SHUNT param‐ eter of the test measures portal systemic shunting from the ratio of Systemic HFR to Portal HFR. Chart review included laboratory tests, imaging, and clinical findings. Data from FALD patients were compared with data from healthy controls.
Results: The average DSI and SHUNT values for the FALD patients were 17.5% and 36.1%, respectively, compared to 9.2% and 24.1%, respectively, for controls. Twelve (85.7%) FALD patients had a DSI >15 (upper limit of normal). Seven (50.0%) FALD patients had SHUNT values >30% (upper limit of normal), while three FALD patients (21.4%) had SHUNT values >49%. One FALD patient with preoperative SHUNT of 69%, who underwent a combined heart‐liver transplant, had confirmed cirrhotic mor‐ phology within the liver explant.
Conclusions: This pilot study demonstrated that most FALD patients had hepatic im‐ pairment detected by abnormal DSI, with a smaller number having markedly elevated SHUNT values >49% suggesting intrinsic liver disease. The HepQuant SHUNT test may be useful in detecting and quantifying liver disease severity in FALD patients.     

云南省勐海县疟疾现况的基线调查分析

了解勐海县目前疟疾发病现况、防治现状、居民对疟疾知识知晓情况等,为制订疟疾防治计划及全球基金疟疾项目实施后的效果评价提供基线数据。方法:用分层随机抽样,对抽取的乡(镇)卫生院医生、村医、社医、个体医及其登记的发热病人血检记录、病人发病时间、治疗处方、疫情报告名单等资料进行摘录;对居民、中、小学生、进行逐户逐人对2002年内是否发过疟疾,求医方式、以及对疟疾症状体征、治疗、传播途径、预防等方面知识知晓情况进行问卷调查。结果:用CMR方法,推算出勐海县2002年疟疾的发病人数为2820例,是当年疫情报告数181例的15.6倍。疫情报告符合率仅为6..42%,漏报率达93.58%。3个乡镇抽查村点的部分居民、中小学生对疟疾防治知识、抗疟药物均有不同程度的了解,而不同流行区居民、中小学生的知晓情率不尽相同。结论:目前勐海县多数疟疾病例漏报疫情,根据本调查结果推算2002年疟疾漏报数多达2639例,因此,要加强疫情管理,加大疟疾防治力度。     

苏丹瓦乌地区蚊媒密度监测及其影响因素分析

为明确任务区蚊媒种类、密度及其与环境因素的关系,笔者采用人诱法和容器指数法对苏丹瓦乌地区蚊媒的成虫和幼虫开展了密度监测。结果表明,在瓦乌维和任务区,主要蚊种为淡色库蚊、冈比亚按蚊和阿拉伯按蚊,由旱季进入雨季,蚊虫组成由单一的淡色库蚊变化为3种蚊虫共存的状态。其中阿拉伯按蚊偏好于干燥环境,而冈比亚按蚊则选择湿润环境。同时研究发现,按蚊幼虫选择弱酸性、低盐度、较清澈的积水孳生,水藻和植物有利于其孳生繁衍。库蚊则选择酸性、较浑浊的积水进行孳生。按蚊幼虫的孳生特点和成虫的活动生态特点,为开展任务区疟疾防治工作提供了基础资料和技术支持。     

清肝活血方治疗酒精性肝病的临床研究

为观察清肝活血方治疗酒精性肝病的疗效,65例患者随机分为3组进行治疗。清肝活血方组（35例）服用自拟清肝活血方,小柴胡冲剂组（15例）服用小柴胡汤,支持疗法组（15例）服用肝泰乐和维生素C,分别观察症状,体征,肝功能,血脂,肝纤维化标志物,细胞因子的改善,变化情况。结果：清肝活血方组症状和体征均有改善,各观测指标治疗前后亦有不同程度改善,总有效率优于其他两组（P＜0．05）,提示清肝活血方对酒精性肝病有明显治疗作用。     

酒精性肝病与胰岛素抵抗的关系

目的：探讨酒精性肝病与胰岛素抵抗的关系。方法：观察43例酒精性肝病和12例正常人对照组空腹血糖、血胰岛素和胰岛素敏感指数。结果：酒精性肝病患者随病情加重胰岛素敏感系数逐渐增加,且均高于对照组（P＜0．05）。酒精性肝硬化患者血胰岛素高于对照组和其他酒精性肝病患者（P＜0．01）。结论：胰岛素抵抗现象随酒精性肝损伤的加重明显增加。     

肝病红外治疗仪联合针灸对肝郁脾虚型肝硬化患者的临床疗效观察

目的:观察肝病红外治疗仪联合针灸对肝郁脾虚型肝硬化代偿期患者的临床疗效。方法:选取2014年12月至2016年12月在上海市公共卫生临床中心的中医科住院患者及门诊治疗的肝郁脾虚型肝硬化患者患者87例,随机分为肝病红外治疗仪组40例和肝病红外治疗仪联合针灸组47例。肝病红外观察组在常规治疗基础上采用肝病红外治疗仪进行治疗30 min/d;肝病红外治疗仪联合针灸组在常规治疗基础上予肝病红外治疗仪联合针灸治疗。30个工作日为1个疗程。观察并比较2组Fibro Scan、中医临床症状评分。结果:治疗后2组中医临床症状评分:胁痛、腹部胀满评分及Fibro Scan均较治疗前有所改善(均P0.05),组间比较,肝病红外治疗仪联合针灸组对失眠、腹部胀满、恶心厌食、腹泻、乏力倦怠的疗效优于肝病红外治疗仪组(P0.05)。在中医临床症状疗效比较中,肝病红外治疗仪联合针灸组总有效率为41.2%,肝病红外观察组总有效率为23.22%,总有效率有统计学意义。在临床疗效分级构成比方面,肝病红外治疗仪联合针灸组明显优于肝病红外观察组(P0.05)。在患者临床指标比较中,2组患者治疗后Fibro Scan指标均有明显改善(P0.05)。结论:肝病红外治疗仪联合针灸治疗能有效改善肝郁脾虚型肝硬化代偿期患者的中医临床症状及Fibro Scan指标。