在梗阻性黄疸大白鼠中SIL-2的变化

目的:探讨梗阻性黄疸大白鼠可溶性白细胞介素2受体(SIL-2)的变化.方法:采用胆总管结扎法(BDL)制造大白鼠梗阻性黄疸模型;对照组(Sham)接受同样方法但不结扎胆总管;内引流组在梗阻性三周后行胆肠内引流(ID),动态观察血清SIL-2的变化.结果:ID后SIL-2明显升高,ID1周后SIL-2水平降低.结论:梗阻性黄疸时,机体免疫功能受抑制,内引流可改善机体免疫功能.     

Isoenzymes of γ-glutamyl transpeptidase in liver diseases

Summary A new method for the separation of isoenzymes of-glutamyl-transpeptidase is described, using electrophoresis on acetate cellulose gel and a developing solution composed by-glutamyl-naphthylamide, and a colored diazonium compound.The method permits the separation of up to four different isoenzymes, which we called-GT₁,-GT₂,-GT₃,-GT₄, the first two showing an electrophoretic migration similar to that of ₁- and ₂-globulins and the other two to that of-globulins.The present technique has proved its usefulness in detecting isoenzymes in serum with values of total-glutamyl-transpeptidase higher than 80 U/L.The application of this method in 52 patients with different types of biliary obstruction and hepatocellular damage has shown that it provides new possibilities in differential diagnosis.     

Retrospective analysis of T-lymphocyte subsets and cytokines in malignant obstructive jaundice before and after external and internal biliary drainage

ObjectiveTo study changes in T lymphocyte subsets, cytokines, and liver enzymes in patients with malignant obstructive jaundice (MOJ) before and after external biliary drainage (percutaneous transhepatic cholangiography drainage, PTCD) and internal biliary drainage (percutaneous transhepatic insertion of biliary stents, PTIBS).MethodsMOJ patients undergoing PTCD (n = 44) and PTIBS (n = 38) at our hospital were enrolled in the study from January 2017 until December 2019. Peripheral blood total bilirubin (TBIL), direct bilirubin (DBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α were measured before and 1 week after biliary drainage.ResultsThere was no significant difference in any parameter between the two groups before biliary drainage. TBIL, DBIL, AST and ALT following PTCD were significantly lower than before PTCD. By contrast, CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, IL-2, IL-6 and TNF-α showed no significant difference before and 1 week after PTCD. TBIL, DBIL, AST, ALT, IL-6 and TNF-α were significantly lower following PTIBS than before PTIBS. CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio and IL-2 were significantly higher following PTIBS than before PTIBS.ConclusionBoth PTCD and PTIBS were effective for treatment of MOJ, but PTIBS was more beneficial for recovery of immune function.     

The molecular basis of jaundice: An old symptom revisited

Increased serum bilirubin level is a widely used diagnostic marker for hepatic illnesses. Nevertheless, mild elevation of unconjugated serum bilirubin (such as in Gilbert syndrome) has been recently demonstrated to correlate with low risk of chronic inflammatory and/or oxidative stress‐mediated diseases. In accord, a low serum bilirubin level has emerged as an important predisposing factor or a biomarker of these pathologic conditions including cardiovascular, tumour, and possibly neurodegenerative diseases. Bilirubin possesses multiple biological actions with interaction in a complex network of enzymatic and signalling pathways. The fact that the liver is the main organ controlling the bioavailability of bilirubin emphasizes the central role of this organ in human health.     

The role of phototherapy in the crash-cart approach to extreme neonatal jaundice

Extreme neonatal jaundice occurs infrequently but carries a high risk of permanent sequelae (kernicterus) when it does. Rapid therapeutic intervention has the potential to reduce this risk in some infants. Several case reports of infants with acute intermediate to advanced bilirubin encephalopathy shows that reversal may be possible. Phototherapy can be instituted at the flip of a switch, whereas other therapeutic measures necessarily involve delays. Therefore, high-intensity phototherapy must be regarded as an emergency measure in infants presenting with extreme jaundice and even more so in the presence of neurological symptoms. The principal and well-described effect of phototherapy involves conversion of bilirubin IXα (z, z) to more polar isomers, which are excreted in bile and urine. When care is taken to maximize the spectral power of phototherapy lights, and whenever possible with measures added to reduce the enterohepatic circulation of bilirubin, very rapid reductions in total serum bilirubin levels are possible. A hypothesis has been advanced that conversion of bilirubin to more polar photoisomers, which can reach relative concentrations of 20%-25% of total serum bilirubin within 1-2 hours, might have a direct neuroprotective effect. This theory posits that because polar molecules generally require a transporter to cross the blood-brain barrier, bilirubin photoisomers should be less prone to enter the brain. Although this theory has some support in in vitro toxicity studies, the evidence is controversial. Until further experimental support can be gained, photoconversion of bilirubin does not constitute a viable argument against instituting further measures against bilirubin neurotoxicity, such as intravenous immune globulin (when indicated) and exchange transfusion. Conversely, neither is the state of evidence an argument against immediate and effective phototherapy in the medical emergency of extreme neonatal jaundice.     

脐血总胆汁酸水平对新生儿黄疸发生及转归的影响

目的:了解新生儿脐血总胆汁酸的浓度与新生儿黄疸的发生、发展及转归之间的关系。方法:采集正常新生儿脐血,用循环酶法测定脐血血清中总胆汁酸的浓度,用经皮胆红素测定(TCB)仪动态观察正常新生儿黄疸的发生及转归。结果:新生儿脐血总胆汁酸的浓度越高,新生儿黄疸的发生率越高、程度越重、消退越慢。结论:可将脐血总胆汁酸水平作为及时预防及提前治疗新生儿黄疸的可靠指标之一。     

Comparison of conventional phototherapy and phototherapy along with Kangaroo mother care on cutaneous bilirubin of neonates with physiological jaundice

Background: One of the adjuvant and desirable therapies is skin contact between mother and baby or Kangaroo mother care (KMC) that is a cheap, accessible, relaxing, noninvasive and easy method. This study aimed to compare the effect of conventional phototherapy method and phototherapy along with KMC on cutaneous bilirubin in neonates with physiological jaundice.

Materials and methods: In this randomized clinical trial, all infants with physiological jaundice who referred for phototherapy to Mofid Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran were selected by convenience sampling based on inclusion criteria and were randomly assigned into two groups of conventional phototherapy (n?=?35) and phototherapy along with KMC (n?=?35).

Results: The results showed that there was a significant difference in the average volume of skin bilirubin before treatment with cutaneous bilirubin every 24?h after treatment (p?p?=?.236). Mean duration of hospitalization of infants in the intervention group was significantly lower than the control group (2.09 versus 3.03 d, p?Conclusion: Although KMC along with phototherapy has a favorable effect on the reduction of cutaneous bilirubin in neonates with physiological jaundice, there are not significant differences in routine care. This may need to do KMC for a longer time (more than 1?h) which must be surveyed in the future studies. KMC was effective in reduction of the duration of hospitalization in jaundiced infants.     

全血置换治疗新生儿重症黄疸疗效分析

目的:观察深静脉全血置换治疗新生儿重症黄疸的临床疗效和安全性。方法:42例重症黄疸,其中18例采用深静脉全血置换为治疗组,24例采用保守治疗为对照组,观察两组患儿一日后总胆红素水平,总住院天数,胆红素脑病发生率以及临床不良反应情况。结果:治疗组胆红素下降快,住院时间短,临床不良反应少,降低了发生胆红素脑病的风险。结论:新生儿重症黄疸采用全血置换疗法疗效好、副作用少。     

新生儿母乳性黄疸的临床研究

目的　了解母乳性黄疸 (BMJ)患儿胆红素均值及峰值水平 ,探讨BMJ患儿胆红素增高对肝脏及心肌酶的影响 ,寻求最佳干预方案。方法　以 160例确诊为BMJ患儿为研究对象 ,观察黄疸出现及消退时间 ,并行经皮胆红素、血清胆红素测定及心肌酶谱、肝功能等检查 ,并将胆红素 >2 91μmol/L 80例患儿随机分成 4组治疗 ,并评价其疗效。结果　 1.BMJ胆红素高峰期在生后 2～ 4周 ,血清胆红素峰值和均值分别为 3 16μmol/L和 2 3 1μmol/L。黄疸消退时间为 6～ 12周 ;2 .经皮测胆红素与血清总胆红素呈正相关　r =0 .92 ;3 .BMJ患儿心肌酶、肝功能、总蛋白、清蛋白、球蛋白、碱性磷酸酶均在正常范围 ;4.继续母乳组、停止母乳组、光疗暂停母乳组、光疗继续母乳组患儿黄疸消退时间以光疗暂停母乳组与光疗继续母乳组患儿黄疸消退时间快 ,但两组间无显著性差异 (P >0 .0 5)。结论　 1.经皮测胆仪不仅可作为筛查、随访工具 ,且其结果可代替血清总胆红素作为指导治疗的依据 ;2 .BMJ患儿胆红素对肝功能、心肌酶无影响 ;3 .各组中以光疗不停母乳组黄疸消退时间最快 ,疗效最显著 ,故光疗时不必停母乳