论辛散法治肝

根据《黄帝内经》“肝欲散 ,急食辛以散之 ,以辛补之”的理论 ,结合后世医家对这一理论的不断充实和认识 ,运用传统方法总结探讨了治肝之法——辛散法。对辛散法治肝的概念、机制、具体应用进行了系统阐释与论证 ,并借现代实验研究予以证实 :归经不同的辛味药均能在不同程度上改善肝郁大鼠异常的客观指标 ,辛味药确实具有预防、治疗肝病的作用。     

慢性重型乙肝患者血乳酸水平变化及核苷类抗病毒治疗的疗效分析

目的 探讨慢性重型乙肝患者血乳酸水平变化及核苷类抗病毒治疗的疗效.方法 回顾性分析30例慢性重症肝炎患者的临床资料,检测血乳酸并计算MELD评分.将患者按照入院顺序分两组,分别采用拉米夫定（LAM）、恩替卡韦（ETV）治疗,观察血乳酸和MELD评分的变化.结果 慢性重症肝炎患者随着MELD评分的增加,血乳酸浓度逐渐增加（P＜0.05）;治疗后,两组血乳酸值稍高于治疗前,但组间治疗后比较无统计学意义（P〉0.05）,同时在MELD评分上也无明显改善（P〉0.05）;个例初步分析以乳酸水平轻度升高为多,但无乳酸中毒.结论 MELD评分与血乳酸具有良好相关性,二者联合应用对于病情判断具有重要意义;应用核苷类抗病毒药物的严重肝病患者以血乳酸轻度升高为主,临床上应权衡利弊选择使用并注意监测.     

肝病大鼠创伤弧菌攻击后肝细胞损伤和血清细胞因子检测

目的:探讨创伤弧菌(Vibrio vulnificus,Vv)所致肝病大鼠肝细胞损伤、血清细胞因子的变化及其相关性.方法:采用四氯化碳制备慢性肝病大鼠18只,分Vv攻击和肝病大鼠对照组(n=9),Vv致死性感染多器官损伤肝病大鼠模型(5.0×107cfu/只),在观察肝细胞超微结构改变的同时检测大鼠血清中的前炎症因子(TNF-α、IL-1 β、IL-6)和抗炎症因子(IL-10)的含量变化,还与接受相同菌量攻击、盐水攻击的正常大鼠(n=9)相比较.结果:在接受Vv攻击后4 h肝病大鼠组仅存活1只,5 h后全部死亡(0/9,0%),较之正常大鼠Vv攻击组5h存活8只(8/9,88.9%)差异有显著性(P＜0.01);血清细胞因子的含量检测提示,肝病大鼠血清IL-10(32.5 pg/ml)显著低于正常大鼠Vv攻击组(71.8 pg/ml,P＜0.05),而TNF-α(54.3 pg/ml)、IL-1 β(421.1 pg/ml)和IL-6(740.9 pg/ml)则分别明显高于正常大鼠Vv攻击组(40.7、255.4和352.5 pg/ml)差异有显著性(P＜0.01,P＜0.01,P＜0.01).超微结构提示,肝病Vv攻击组肝细胞线柱体嵴减少、肿胀、空泡样改变,提示肝细胞损伤严重,而正常大鼠以同样Vv菌量攻击后未见同样改变,提示肝病大鼠Vv攻击后的死亡率、肝细胞损伤程度以及TNF-α、IL-1 β、和IL-6的含量均较非与肝病大鼠Vv攻击组明显升高,而IL-10则显著低于正常大鼠Vv攻击组.结论:本结果提示肝病大鼠Vv攻击后血清前炎症因子(TNF-α、IL-1 β、IL-6)以及抗炎症因子(IL-10)的浓度与大鼠的死亡率、肝细胞损伤程度相关.     

甲亢性肝病46例临床分析

目的:探讨甲亢性肝病患者肝损害的临床特点。方法:分析46例甲亢性肝病(A组,肝功能异常组)的临床特点,并与60例新诊断甲亢患者(B组,肝功能正常组)相对照,比较两组患者一般情况、临床表现、肝功能指标和甲状腺功能指标。结果:A组患者血清ALT、AST、TT3、TT4 水平和平均年龄明显高于B组(P<0.05)。结论:甲亢性肝病临床表现不典型,甲亢性肝病多发生于年龄较大、病情较重的患者。     

Clinical utility of ursodeoxycholic acid in preventing flutamide-induced hepatopathy in patients with prostate cancer: A preliminary study

BACKGROUND: The present study was designed to ascertain retrospectively the validity of ursodeoxycholic acid (UDCA) in the treatment of prostate cancer in terms of prophylactic effects on the occurrence of flutamide-induced hepatopathy in a large number of patients surveyed in a multi-center cooperative study. METHODS: One hundred and eighty-one patients (74.1 +/- 4.9 years) with prostate cancer treated with flutamide with (n = 70) or without (n = 111) UDCA were retrospectively evaluated and the occurrence of hepatopathy was compared between these two patient groups. RESULTS: Between patients treated with UDCA and those without it, no significant differences were noted in age, clinical stage, grade, duration of flutamide administration and serum prostate-specific antigen (PSA) levels before treatment. However, there were significant differences in the presence or absence of previous treatments and treatments used together with flutamide. The incidence of hepatopathy was 11.4% (8/70) in patients with UDCA and 32.4% (36/111) in those without it, showing a statistically significant difference (P < 0.05). The hepatopathy-free rate obtained by the Kaplan-Meier method was also significantly higher in patients with UDCA (88.4% 1 year following flutamide administration) than that in those without it (59.6%) (P < 0.005). CONCLUSION: These results suggest that UDCA has a prophylactic effect against flutamide-induced hepatopathy in patients with prostate cancer.     

Basic Study on Active Changes in Biological Function of Mouse Liver Graft in Cold Storage after Low-Dose X-Irradiation

We previously reported that low-dose X-irradiation alleviates ischemia-reperfusion injury such as mouse paw edema. In this study, we examined active changes in the biological function of mouse liver grafts in cold storage after low-dose X-irradiation. Mouse livers were sham-irradiated or were irradiated with 0.25, 0.5, 1.0, or 5.0 Gy of X-ray and stored for 4, 8, 24, or 48 h in preservation or saline solution. The results show that storage for 24 h in saline solution after 0.5 Gy irradiation significantly increased the activity of superoxide dismutase (SOD) and catalase. Following storage for 4, 8, or 48 h in preservation solution, lipid peroxide levels of the 0.5 Gy irradiated group were significantly lower than those of the sham irradiated group. Following storage for 24 h in preservation solution, the activity of SOD and catalase of the 1.0 Gy irradiated group were significantly higher than those of the sham irradiated group. Hepatocytes stored in saline solution were vacuolated. However, no vacuole formation was observed in hepatocytes stored in preservation solution. These findings suggest that low-dose irradiation significantly activates antioxidative functions of liver grafts. Moreover, the dose at which enhancement of antioxidative function occurs in livers stored in preservation solution, which contains glutathione, is significantly higher than that in saline solution.     

芳香酯酶测定底物探讨及临床应用评价

目的该科合成芳香酯酶(ArylesterhydrolaseEC3.1.1.2,ArE)底物4-已酰氧基-3-甲氧基-ω-硝基乙烯;建立手工的和自动生化仪检测方法;评价在常见肝病中的应用。方法底物合成:香草醛加冰乙酸、乙酸铵。在乙醇溶液中用硝基四烷进行硝基化,滤取结晶。用乙酸酐进行酯化,滤取结晶,重结晶。方法建立。程序:取pH8.6Tris-HCL缓冲液2.5ml,加血清30ul,再加3mmol/l底物液0.4ml,37℃10min,加5ml/dl正丁醇3ml。混匀,在520nm,读取吸光度。摩尔消光系数(20345±280)A。计算:ArEU/L=971.3×A。结果反应条件:底物溶剂以甲醇13.65%为最佳。产物光吸收峰498nm,选用520nm,吸光度达93.20%。择取pH8.6缓冲液,加0.51mmol/LCa2 和68.3mmol/LNa 可提酶活力14.00%。批间CV为3.21%~4.52%。溶血、黄疸和脂血标本对ArE结果无干扰。临床应用:90例健康人ArE(470.6±49.7)U/L,参考值:<421U/L。肝硬化、肝癌、肝炎3组ArE结果x±S,U/L分别是(266±77),(35±84)和(366±111);ROC曲线下面积分别是0.979,0.910和0.807。面积愈大诊断价值愈高,ArE愈低,肝功能愈差。尤其对肝硬化、肝癌。肝硬化组<421U/L阳性率为92.30%;肝癌ArE(Y)与脂碱脂酶CHE相关系数为0.909,Y=0.045X 190.53。结论ArE简便可靠。在肝硬化、肝癌、肝炎中阳性率性高,特异性好。有望     

Biochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction

BackgroundDifferentiation of HF-induced renal dysfunction (RD) from irreversible intrinsic kidney disease is challenging, likely related to the multifactorial pathophysiology underlying HF-induced RD. In contrast, HF-induced liver dysfunction results in characteristic laboratory abnormalities. Given that similar pathophysiologic factors are thought to underlie both conditions, and that the liver and kidneys share a common circulatory environment, patients with laboratory evidence of HF-induced liver dysfunction may also have a high incidence of potentially reversible HF-induced RD.Methods and ResultsHospitalized patients with a discharge diagnosis of HF were reviewed (n = 823). Improvement in renal function (IRF) was defined as a 20% improvement in estimated glomerular filtration rate (eGFR). An elevated international normalized ratio (INR; odds ratio [OR] 2.8; P < .001), bilirubin (BIL; OR 2.2; P < .001), aspartate aminotransferase (AST; OR 1.8; P = .004), and alanine aminotransferase (ALT; OR 2.1; P = .001) were all significantly associated with IRF. Among patients with baseline RD (eGFR ≤45 mL min^?1 1.73 m^?2), associations between liver dysfunction and IRF were particularly strong (INR: OR 5.7 [P < .001]; BIL: OR 5.1 [P < .001]; AST: OR 2.9 [P = .005]; ALT: OR 4.8 [P < .001]).ConclusionsBiochemical evidence of mild liver dysfunction is associated with reversible RD in decompensated HF patients. In the absence of methodology to directly identify HF-induced RD, signs of HF-induced dysfunction of other organs may serve as an accessible method by which HF-induced RD is recognized.