TNFa、IL6与肝储备功能关系的探讨

目的 :探讨外周血中TNFa、IL6与肝功能之间的关系 ,了解TNFa、IL6预测肝储备功能的方法可行性。方法 :采用放射免疫分析法测量 84例肝脏外科疾病的病人 (梗阻性黄疸 5 9例 ;肝硬化门脉高压 10例 ;肝癌 15例 )。外周血中TNFa和IL6的浓度。同时病人行常规肝功检测。结果 :肝病组外周血清中TNFa、IL6的浓度比对照显著升高 ,肝病组为TNFa13 .35± 5 .14(fmol l) ;IL6为 2 40 .6 2± 70 .17(pg l)对照组TNF为 6 .2 1± 2 .0 3(fmol l) ,IL为 93.75± 40 .5 7(pg l)肝病组与对照组比较 ,TNFa和IL6的P值均 <0 .0 1;肝功能越差TNFa越高 ,且在肝功A级、B级、C级三级间两两比较亦有差异P <0 .0 5。结论 :外周血中TNFa和IL6可作为肝功能损害的一种标记物     

Signal transduction pathway of the muscarinic receptors mediating gallbladder contraction

In gallbladder smooth muscle, carbachol interacts with M₃ receptors to mediate contraction. To examine components of the intracellular second messenger system that is coupled to these receptors we have tested whether carbachol stimulates the formation of inositol phosphates (IP) to cause contraction. Guinea pig gallbladder muscle strips were prelabeled with [³H]inositol and were incubated with 0.1 mmol/l carbachol, a concentration causing maximal contraction. [³H]inositol monophosphates, [³H]inositol bisphosphates and [³H]inositol trisphosphates and contraction were measured at various times (0–90 s). To examine whether a pertussis toxin-sensitive guanine nucleotide binding protein is coupled to the muscarinic receptors, guinea pigs were pretreated with pertussis toxin (180 g/kg i.v./24 h). The effectiveness of pertussis toxin treatment was determined by measuring [³²P]ADP-ribosylation of a –40/41 kDa protein from gallbladder homogenates. Carbachol caused a significant time-dependent increase in the formation of [³H]inositol monophosphates, [³H]inositol bisphosphates and [³H]inositol trisphosphates. The time course of [³H]inositol trisphosphate turnover caused by carbachol was biphasic, and was detectable at 15 s and maximal at 60 s; at 75 s and 90 s formation of [³H]inositol trisphosphates decreased, whereas the time course of carbachol-induced contraction of the gallbladder smooth muscle strips reached a plateau after 90 s. The effects of carbachol on [³H]inositol trisphosphates and on contraction were abolished by atropine. Pretreatment with pertussis toxin resulted in ADP-ribosylation of a 40/41 kDa protein from gallbladder cell membranes but did not affect the concentration-response or time course of carbachol-induced contraction. These results indicate that carbachol-induced contraction of gallbladder smooth muscle cells is accompanied by the activation of inositol phosphate turnover and does not involve a pertussis toxin-sensitive G-protein.This article is based in part on the doctoral thesis of Burkhard Mackensen at the Faculty of Medicine, University of Hamburg, Germany. Some of the results were presented at the meeting of the American Gastroenterological Association (AGA) in San Francisco 1992 (von Schrenck et al. 1992) Correspondence to: T. von Schrenck at the above address     

慢性病毒性肝炎胆囊声像异常与肝组织炎症坏死程度的关系

目的：探讨慢性病毒性肝炎胆囊声像异常与肝组织炎症程度的关系。方法：分析了１１２例慢性肝炎患胆囊壁厚度,光滑度,胆囊大小异常,合并胆囊结石及息肉的发生率,并与肝组织病理炎症坏死程度分级进行比较及相关分析。结果：胆囊声像异常总发生率为５７．１４％,胆囊壁厚在轻、中、重度慢性肝炎相互间比较差异均有显性,与肝脏炎症坏死程度呈显性正相关（ｒ＝０．６７,Ｐ〈０．０００１）。胆囊壁不光滑及胆囊大小异常发生     

胆囊癌P~（53）、C－mycmRNA异常表达与TNM分期相关研究

应用地高辛标记的Ｐ￣(５３)、ｃ－ｍｙｃｃＤＮＡ探针对２１例胆囊癌石腊切片上的ｍＲＮＡ进行原泣杂交。结果表明ｃ－ｍｙｃ和Ｐ￣(５３)ｍＲＮＡ的表达均位于细胞核内。ｃ－ｍｙｃ和Ｐ￣(５３)ｍＲＮＡ在胆囊癌的表达率分别为６６．６％和５７．１％,在癌周正常组织中没有ｃ－ｍｙｃ、Ｐ￣(５３)ｍＲＮＡ的表达。ｃ－ｍｙｃ、Ｐ￣(５３)ｍＲＮＡ表达的强度和胆囊癌的原发肿瘤大小,有无淋巴结转移及远处转移有关。分期越晚,表达率越高。有淋巴结转移者高于无转移者。Ｐ￣(５３)ｍＲＮＡ表达的阳性率和胆囊癌的分化程度无关;而ｃ－ｍｙｃｍＲＮＡ的表达和分化程度有关,分化越差,表达率越高。     

Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis

The sonographic and computed tomographic (CT) findings were reviewed in 17 patients with acute acalculous cholecystitis (AAC) over a 6-year period from 1984 to 1989. Of the six patients in whom both ultrasound and CT were performed, CT revealed marked gallbladder (GB) wall abnormalities, including perforation, and pericholecystic fluid collections in five patients not demonstrated by sonography. Of the total group, five patients had GB wall thicknesses of 3 mm (normal) at pathologic examination, which demonstrated a spectrum of disease ranging from acute hemorrhagic/necrotizing, to gangrenous acalculous cholecystitis with perforation. Sonography was falsely negative or significantly underestimated the severity of AAC in seven of the 13 patients examined by sonography. CT because of its superior ability to assess pericholecystic inflammation may provide additional diagnostic information even after a thorough sonographic study in cases of AAC.     

胆囊癌的临床治疗分析

目的　探讨胆囊癌的临床治疗方法及其预后。方法　回顾性分析 161例胆囊癌的临床资料 ,其中单纯胆囊切除 48例 ,根治性胆囊癌切除 41例 ,胆囊癌扩大切除 2 0例 ,胆囊加胰十二指肠切除 3例 ,单纯探查术 7例 ,介入及放化疗 42例。随访 6个月至 5年。结果　行探查术患者 1年内全部死亡 ,单纯胆囊切除和根治性胆囊癌切除患者的 5年生存率分别为 69%、5 9% ,放疗和介入治疗患者的 5年生存率为 0。结论　胆囊癌早期发现 ,并行根治性切除 ,可显著提高 5年生存率     

46例胆囊癌临床分析

目的：探讨胆囊癌早期诊断、治疗及预后。方法：分析46例胆囊癌病历资料，结合术后病例随访。术前诊断主要为B超及CT检查。结果：术前诊断胆囊癌28例(60．9%)，术中诊断39例(84．8％)，术中漏诊7例(15．2％)。Ⅰ期2例．Ⅱ期7例，行胆囊切除。Ⅲ期8例，Ⅳ期6例，Ⅴ期5例，行根治性胆囊癌切除。中位生存期分别为68．0个月，42．9个月．18．5个月．8．1个月，6．4个月。Ⅳ期2例，Ⅴ期12例，行胆道引流术，中位生存期4．2个月。Ⅴ期5例，手术活检．中位生存期2．8个月。结论：胆囊癌术前诊断率低(60．9％)，早期诊断困难，术中仍有一定的漏诊率。Ⅰ～Ⅱ期胆囊癌行单纯胆囊切除术，预后良好。Ⅲ～Ⅴ期胆囊癌根治切除术中，Ⅲ期预后理想，胆囊癌根治切除术应为Ⅲ期胆囊癌的常规术式．Ⅳ～Ⅴ期预后差。     

癌基因c-fos和c-jun产物在胆囊癌中的表达

目的：探讨癌基因c-fos、c-jun产物在胆囊癌中的表达及其意义。方法：采用免疫组织化学SABC法观察c-fos、c-jun蛋白在10例正常胆囊组织、16例慢性胆囊炎和胆囊良性肿瘤28例恶性肿瘤中的表达。结果：c-fos、c-jun蛋白在胆囊癌中的阳性表达率均显著高于胆囊良性肿瘤、慢性胆囊炎和正常胆囊组织（P＜0．01），但c-fos、c-jun蛋白的表达强度与胆囊癌的TNM分期、组织学类型及癌组织分化程度无关（P＞0．05）。结论：癌基因c-fos、c-jun在胆囊癌的发生中可能起协同作用。     

Geographic Clustering Patterns in Mortality from Biliary Tract Cancer in Japan

We calculated the standardized mortality ratios (SMRs) of biliary tract cancer (BTC) in Japan from 1981 to 1990 and statistically analyzed the results according to 333 Secondary Areas of Medical Care, as well as sex and subsite [gallbladder cancer (GBC) and extrahepatic bile duct cancer (BDC)], in order to examine geographic clustering patterns of BTC. In GBC in both sexes, the Secondary Areas of Medical Care with high SMRs were clustered in the eastern part of Japan. In BDC in both sexes, the Areas with high SMRs were clustered between the northern and eastern parts of Japan. In comparison with GBC, this clustering favored the northern part of Japan. In males, the clustering pattern in mortality from BTC was mainly due to the occurrence of BDC. In females, the clustering pattern in mortality from BTC reflected that of GBC. The clustering of BTC, especially GBC, seems to be related to the distribution of plains, basins, and rivers.     

p16基因产物表达与胆囊癌生物学行为和预后的关系

目的与方法:为了解p16基因与胆囊癌发生、生物学行为和预后的关系,采用免疫组化ABC法对36例胆囊癌和20例胆囊腺瘤中的p16蛋白进行了检测.结果:胆囊癌中p16蛋白的阳性率低于胆囊腺瘤(P<0.05);不同组织类型和分化程度不同的胆囊癌之间p16蛋白的阳性率无明显差别(P>0.05);p16蛋白的表达与胆囊癌有无浸润和淋巴结转移及病人的生存期密切相关(P<0.05).结论:p16基因失活与胆囊癌的发生有关,p16蛋白表达缺失与胆囊癌进展和预后不良有关.