转录因子Egr-1在失血性休克复苏后肝脏损伤中的作用

目的研究转录因子Egr-1在失血性休克复苏（HS/R）后肝脏损伤中的作用.方法利用Egr-1野生型（WT）和基因封闭型（KO）小鼠复制失血性休克复苏模型.取肝组织,RT-PCR法测定肝组织中TNF-α、IL-6、G-CSF、ICAM-1 mRNA的表达变化.通过检测肝组织中MPO的含量、血清ALT水平和组织学检查,评估肝脏炎症细胞浸润和损伤程度.结果失血性休克2.5 h＋复苏4 h后,Egr-1 KO小鼠肝组织中TNF-α、IL-6、G-CSF、ICAM-1 mRNA的表达水平明显低于Egr-1WT组;Egr-1 KO组失血性休克复苏后肝组织炎性浸润和损伤程度减轻,表现为血清ALT水平低,肝组织中MPO含量低,病理损伤轻.结论本实验结果表明转录因子Egr-1参与了失血性休克复苏后肝脏炎症反应基因表达的调节,在失血性休克复苏后的肝脏损伤中起一定的作用.     

肝脏少见恶性肿瘤的CT表现

目的 分析5例不同组织类型的肝脏少见恶性肿瘤的CT表现，以提高对这些恶性肿瘤的识别能力。方法 经临床和病理证实的肝脏少见恶性肿瘤5例，均行CT检查，其中肝肉瘤3例(包括血管肉瘤1例，恶性间叶瘤1例，恶性纤维组织细胞瘤1例，类癌2例)。结果 上述肝脏恶性肿瘤表现多样化，恶性间叶瘤以儿童肝内巨大单发囊性为主病灶；肝血管肉瘤表现为肝内多发境界清楚的低密度灶，可合并坏死、囊变及新鲜出血，无肝硬化基础；恶性纤维组织细胞瘤为肝右叶单发巨块低密度病灶，可伴纤维分隔，免疫组织化学标记具有诊断价值；类癌CT特征为肝内单发或多发病灶，密度不均匀，呈单房或多房，增强表现实质部分强化，伴类癌综合征时更具有诊断价值。结论 本组分析的5例肝脏恶性肿瘤临床均较少见，各种病理类型的此类肿瘤有其相似和不同的CT征象，结合临床及实验室检查，应在临床诊断中考虑到上述肿瘤的可能，以免漏诊或误诊。     

肝移植术后血管并发症的病因学分析

目的 探讨肝移植术后血管并发症的病因。方法 对1993年4月～2002年4月所完成的160例原住肝移植临床资料进行回顾性分析。结果 肝动脉并发症发生率为5％，与肝动脉并发症相关的死亡率为3．13％；门静脉并发症发生率为3．75％，与门静脉并发症相关死亡率为0；肝后下腔静脉狭窄并发症发生率为3．75％。结论 肝移植术后早期魂脉并发症主要与手术技术和肝动脉病变有关，改进吻合技术，术前评估肝动脉病变能降低早期肝动脉并发症发生率；术前有门脉高压症手术治疗史、移植术前门静脉血栓、门静脉手术史以及严重感染病史等是门静脉并发症的高危因素；手术技术是导致下腔静脉狭窄的重要原因，腔静脉整形的改良背驮式肝移植能避免该并发症的发生。     

Treatment of hepatitis B and C after liver transplantation. Part 1, hepatitis B

Abstract The outcome of OLT for HBV-related liver disease is dependent on the prevention of allograft re-infection. Over the past decade, major advances have been made in the management of HBV transplant candidates. The advent of long-term hepatitis B immune globulin (HBIG) administration as a prophylaxis against HBV recurrence, and the introduction of new antiviral agents against HBV infection, such as lamivudine (LAM), were a major breakthrough in the management of these patients. Results of OLT for HBV infection are similar to those achieved with other indications. Pre-OLT antiviral treatment such as LAM can suppress HBV replication before OLT and thus decrease the risk of re-infection of the graft. Combination prophylaxis with LAM and HBIG after transplantation highly effectively reduces the rate of HBV re-infection, even in HBV replicative cirrhotic, patients. The optimal HBIG protocol in the LAM era is yet to be defined: dosing of HBIG, routes of administration, and possibility of stopping HBIG. Several antiviral drugs have been developed for the management of HBV infection on the graft, so outcome is currently good.     

应用抑制消减杂交和cDNA表达谱芯片筛选肝星形细胞持续活化的相关基因

目的：利用抑制消减杂交（suppression subtractive hybridization,SSH）和cDNA表达谱芯片筛选早期活化的肝星状细胞与大鼠正常肝脏组织、轻度肝纤维化组织、重度肝纤维化组织中差异表达的基因.方法：从SSH构建的大鼠轻度和重度肝纤维化中两个差异cDNA文库中挑选1 000条上调显著的基因,与正常大鼠4 136条基因克隆制作成一张芯片,筛选持续期活化的肝星状细胞相关基因.结果：获得与HSC持续活化相关的上调基因633条,下调基因715条,其中血清和糖皮质激素调节蛋白激酶（SGK）在正常大鼠基因克隆和2、8周SSH上调差异基因中均呈上调信号.结论：联合应用SSH和cDNA表达谱芯片是筛选和鉴定不同样本中差异表达基因的快速、经济和有效方法;SGK可能作为多种细胞信号传导通路和细胞磷酸化级联反应的一个功能性交汇点,参与了肝星状细胞的早期活化和信号传导.     

Management of ascites in cirrhosis

Ascites is one of the earliest and most common complications of patients with cirrhosis. A typical circulatory dysfunction characterized by arterial vasodilation, high cardiac output and stimulation of vasoactive systems is commonly present in these patients and is associated with a poor prognosis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past two decades, although controlled trials in large series of patients are needed to delineate whether TIPS is a safe and useful treatment for these patients.     

Mr imaging of hepatic nodular regenerative hyperplasia

Nodular regenerative hyperplasia (NRH), a rare condition that is commonly associated with noncirrhotic portal hypertension, is not well described in the MR literature. Three patients at two institutions were identified who had both abdominal MR imaging and pathologic evidence of NRH. All examinations were performed at 1.5 T and included axial T1- and T2-weighted spin-echo (SE) images. The MR studies were reviewed by two radiologists in consensus. Two patients had multiple liver lesions that had high signal components on T1-weighted images and were predominantly isointense with liver on the T2-weighted images. One patient had no focal lesions identified. NRH, when visualized on MR images, appears as multifocal masses with shortened Tl and T2 similar to liver. NRH should be considered in the differential diagnosis of hepatocellular tumors, especially in patients with a predisposing condition.     

慢性HBV感染患者HBsAg亚型分析

对包括慢性肝炎、肝炎肝硬变和原发性肝癌在内的１００例慢性ＨＢＶ感染者作了ＨＢｓＡｇ亚型分析。结果显示，在这组病例中ａｄｒ亚型占６１％，ａｄｗ占３３％，ａｙｒ占２％，ａｄｗｒ占４％。ａｄｒ亚型有随年龄增长更占优势的趋向。ａｄｒ和ａｄｗｒ亚型感染者ＨＢｓＡｇ滴度较ａｄｗ组显著增高，且ｅ抗原阳性率亦较高。上述发现提示，具有ａｄｒ和ａｄｗｒ亚型的ＨＢＶ株可能具有较强的复制活性，不易被清除，从而导致受感染者     

乙型肝炎与肝癌关系的流行病学研究—广西HBsAg携带者及肝损害者的分布及发生肝癌的前瞻性研究

本文对20岁以上22830人按HBsAg状况和肝损害表现分队列进行随访,平均追踪6.8年,在肝癌高发区和低发区均以HBsAg携带者并有重度肝损害者(肝大+肝功能异常)的肝癌死亡率和相对危险性最高,相对危险性分别为37.3和22.5倍。以无肝大和肝功能异常的非携带者最低,肝癌的发生和肝损害的程度呈平行关系。HBsAg携带者发生肝癌死亡的相对危险性高于非携带者7倍,并发现HBsAg携带并有重度肝损害的肝癌死亡的平均年龄显著提前。认为肝癌高发区人群中HBV的持续感染和肝损害的广泛存在是导致肝癌高发和早发的重要因素。     

Hepatic falciform ligament artery: angiographic anatomy and clinical importance

Summary The hepatic falciform ligament artery (HFLA) was evaluated by angiography and also by dissections. Based on the findings, the mechanism of the post-chemoembolization skin rash was studied. A total of 340 liver cirrhosis patients who underwent hepatic artery chemoembolization for hepatocellular carcinoma were reviewed in terms of the angiographic incidence of the HFLA, variations in its origin, and the incidence of skin rash. The HFLA was demonstrated in 26 (7.6%) of the 340 patients on angiography. Two HFLAs were observed in one patient. The origin was the middle hepatic artery (A4) in 16 cases, the superior branch of the middle hepatic artery in three, the inferior branch of the middle hepatic artery in two, the inferior branch of the left hepatic artery (A3) in three, and the confluence of A3 and A4 in three cases. There were no patients who developed post-chemoembolization skin rash. Two cadavers were dissected to investigate the anastomosis between the HFLA and the subcutaneous artery. Two different anastomoses were found: (1) direct and (2) via the ensiform branch of the internal thoracic artery. These were located at the lower and upper part of the falciform ligament, respectively. The distribution of a chemotherapeutic agent through these anastomoses is the likely cause of post-chemoembolization skin rash. If prophylactic embolization of the proximal portion of the HFLA using a metallic coil is performed, the skin rash will be prevented.

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L'artère du ligament rond du foie : anatomie angiographique et implication clinique

Résumé L'artère du ligament falciforme hépatique (ALFH) fut étudiée par des angiographies et des dissections. D'après les résultats, le mécanisme d'un rash cutané après chimio-embolisation est discuté. Un total de 340 patients présentant une cirrhose hépatique ayant eu une chimio-embolisation de l'artère hépatique pour un carcinome hépato-cellulaire fut revu en fonction de l'incidence angiographie de l'ALFH, les variations d'origine de l'ALFH, et l'incidence d'un rash cutané. L'ALFH fut objectivée angiographiquement chez 26 (7,6%) des 340 patients. Deux ALFH furent objectivées chez un patient. L'origine des ALFH était située sur l'artère hépatique moyenne (A4) dans 16 cas, la branche supérieure de l'artère hépatique moyenne dans 3 cas, la branche inférieure de l'artère hépatique moyenne dans 2 cas, la branche inférieure de l'artère hépatique gauche (A3) dans 3 cas, et la confluence A3 et A4 dans 3 cas. Aucun patient ne développa un rash cutané après chimio-embolisation. Deux cadavres furent disséqués pour étudier les anastomoses entre l'ALFH et les artères sous-cutanées. Deux types d'anastomoses entre l'ALFH et des artères sous-cutanées furent individualisés directement et par l'intermédiaire de l'artère xiphoïde et de l'artère thoracique interne. Celles-ci étaient respectivement situées à la partie inférieure et à la partie supérieure du ligament falciforme. La distribution de l'agent chimiothérapique par ces anastomoses est vraisemblablement la cause des rash cutanés après chimio-embolisation. Dans le cas d'une embolisation prophylactique de la portion proximale de l'ALFH par utilisation d'un coil métallique le rash cutané pourrait être prévenu.