扬州地区肝硬化食管静脉曲张初次出血80例患者诊治分析

目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。     

Difference in Survival in Early Kidney after Liver Transplantation Compared with Simultaneous Liver-Kidney Transplantation: Evaluating the Potential of the “Safety Net”

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Antimicrobial activities of novel bipyridine compounds produced by a new strain of Saccharothrix isolated from Saharan soil

The actinobacterium strain ABH26 closely related to Saccharothrix xinjiangensis, isolated from an Algerian Saharan soil sample, exhibited highly antagonist activity against Gram-positive bacteria, yeasts and filamentous fungi. Its ability to produce antimicrobial compounds was investigated using several solid culture media. The highest antimicrobial activity was obtained on Bennett medium. The antibiotics secreted by strain ABH26 on Bennett medium were extracted by methanol and purified by reverse-phase HPLC using a C18 column. The chemical structures of the compounds were determined after spectroscopic (¹H NMR, ¹³C NMR, ¹H-¹H COSY and ¹H-¹³C HMBC spectra), and spectrometric (mass spectrum) analyses. Two new cyanogriside antibiotics named cyanogriside I (1) and cyanogriside J (2), were characterized along with three known caerulomycins, caerulomycin A (3), caerulomycin F (4) and caerulomycinonitrile (5). This is the first report of cyanogrisides and caerulomycins production by a member of the Saccharothrix genus. The minimum inhibitory concentrations (MIC) of these antibiotics were determined against pathogenic microorganisms.     

以肺动脉高压为首发表现的先天性中枢性低通气综合征临床特征和基因分析

目的探讨先天性中枢性低通气综合征(CCHS)的临床和基因变异特征。方法分析1例首发表现为不明原因肺动脉高压的CCHS患儿的临床资料,并总结国内外文献中CCHS病例的临床特点、致病机制和基因变异情况。结果11月龄女婴,主要表现为浮肿、尿少、低血压、嗜睡、发绀、抽搐及颅内压增高。B型脑利钠肽、丙氨酸氨基转移酶升高,凝血酶原时间延长。颅脑磁共振示右侧额叶出血;超声心动图示中重度肺动脉高压。靶向捕获二代测序未发现可能的致病基因。采用Sanger法验证示患儿PHOX 2 B基因第3外显子存在多聚丙氨酸重复扩展变异,基因型为20/25。患儿入院后采用无创通气,睡眠时呼吸浅慢、微弱,伴血氧下降;血气分析提示二氧化碳潴留。随后改用夜间无创通气、降肺压药物治疗。复查肺动脉压力明显下降,生命体征稳定。随访至24月龄,夜间只需较低压力水平的无创通气,生长发育无异常。结论对于不明原因的肺动脉高压伴撤机困难患儿,需警惕CCHS。疑诊者应尽早针对CCHS相关基因进行靶向捕获二代测序及PHOX 2 B基因Sanger法验证。早期给予无创通气有望改善预后。     

Role of zinc supplementation in the management of chronic liver diseases: A systematic review and meta-analysis

Introduction and objectivesZinc deficiency has been associated with poor prognosis in chronic liver disease. This systematic review and meta-analysis aimed to evaluate the role of zinc supplementation in the management of chronic liver diseases.Materials and methodsWe searched MEDLINE, LILACS, EMBASE, and Cochrane CENTRAL databases from inception to August 2018. We included randomized controlled trials evaluating adult patients with chronic liver disease of any etiology receiving zinc supplementation. Studies with other designs or evaluating chronic conditions other than liver disease were excluded. Two reviewers independently screened and extracted data from eligible studies. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized studies.ResultsOf 1315 studies screened, 13 were included. Six assessed chronic hepatitis C treatment, with a relative risk of 0.83 indicating no protective effect of zinc supplementation on the improvement of sustained virological response. Three evaluated response to hepatic encephalopathy treatment, with a relative risk of 0.66 indicating a favorable effect of zinc supplementation on clinical improvement of this condition. Of four studies evaluating the management of cirrhosis, two analyzed the effect of zinc supplementation on serum albumin levels, with no statistical difference between zinc and placebo groups.ConclusionsClinical trials assessing zinc supplementation in liver diseases do not show benefits in terms of clinical improvement or disease halting. There are possible benefits of zinc supplementation on hepatic encephalopathy, however, this is based on limited evidence. This research question is still open for evaluation in larger, well-designed, clinical trials.     

他汀类药物对肝功能影响的研究

目的观察他汀类药物对肝功能的影响,探讨定期检测肝功能的必要性。方法选择2004年9月至2005年3月门诊就诊心血管病患者,了解其所用他汀类药物的种类和剂量,每月复查血脂水平和肝功能。结果所用他汀类药物有辛伐他汀、普伐他汀、洛伐他汀和阿托伐他汀,常用剂量为10～20mg/d,治疗后总胆固醇和低密度脂蛋白胆固醇显著降低,而肝酶在治疗前、后无显著变化,肝酶升高3倍以上者所占比例低。结论他汀类药物在低剂量应用时对肝脏损伤小,没有必要频繁监测肝功能。     

Influence of SNPs in cytokine-related genes on the severity of food allergy and atopic eczema in children

Although many single nucleotide polymorphism (SNP) studies have reported an association of atopy, allergic diseases and total serum immunoglobulin E (IgE) levels, almost all of these studies sought risk factors for the onset of these allergic diseases. Furthermore, many studies have analyzed a single gene and hardly any have analyzed environmental factors. In these analyses, the results could be masked and the effects of other genes and environmental factors may be decreased. Here, we described the correlation between four genes [interleukin (IL)-4 (C-590T), IL-4 receptor (A1652G), FCER1B (G6842A) and STAT6 (G2964A)] in connection with IgE production; the role of IL-10 (C-627A) as a regulatory cytokine of allergy; and the severity of food allergy (FA) and atopic eczema (AE) in 220 Japanese allergic children. In addition to these SNPs, environmental factors, i.e., patient's attitude, indoor environment, and so on, were also investigated in this study. Our study was retrospective, and the correlation was analyzed by our defined clinical scores divided into three terms: worst symptoms, recent symptoms and general amelioration at the most recent examination during the disease course. Our results indicated that IL-10 AA, the genotype with lower IL-10 production, is associated with higher IgE levels in the serum (p < 0.0001, estimate; 0.912). Marginal liver abnormalities were observed in the subject group with both FA and AE (p < 0.1191, estimate; 0.1490). Our defined clinical scores enabled evaluation of various aspects of disease severity. Based on the scores, while no single SNP selected in this study determined severity, the combination of the SNP with laboratory data and environmental factors appeared to determine severity.     

肝细胞核因子-κB异常激活与肝细胞癌变

核因子-κB（nuclear factor-κB，NF-κB）是具有和某些基因上启动子区固定核苷酸序列结合而启动该基因转录的蛋白质。NF-κB是具有多向性调节作用的核转录因子，可调控多种基因（免疫、炎症反应、病毒和原癌基因）的转录表达。激活的NF-κB参与癌症的启动、发生及发展过程，在炎症性相关的肝癌（HCC）发生发展中呈高表达，在肝细胞炎症与癌变间起桥梁作用，其中包括肝脏免疫炎症反应相关基因、肝炎病毒相关基因和原癌基因的转录表达。在肝癌组织中异常激活，可抑制细胞凋亡，促进肝细胞存活，与肝癌的发生发展密切相关。     

多巴胺或多巴胺复合去甲肾上腺素对肝移植术中患者血液动力学、氧代谢及肾功能的影响

目的评价原位肝脏移植术(OLT)中持续输注多巴胺或多巴胺复合去甲肾上腺素对血液动力学、组织氧代谢和肾功能的影响。方法拟行OLT的患者30例,ASAⅢ或Ⅳ级,随机分为2组 (n=15)。A组:术中持续输注多巴胺,初始输注速率为1-3μg·kg-1·min-1;B组:术中持续输注多巴胺复合去甲肾上腺素,初始输注速率分别为1-3μg·kg-1·min-1和0．03μg·kg-1·min-1,多巴胺输注速率不超过5μg·kg-1·min-1;术中两组均调节输注速率维持MAP 60-80 mm Hg。分别于切皮前即刻、切肝期1 h、无肝期1 h、新肝期1h和术毕测定血液动力学、组织代谢和肾功能指标。结果两组HR、 MAP均维持较平稳。无肝期两组CVP、MPAP、PAWP、CO、CI、DO2、VO2降低(P<0．05);SVR和SVRI升高(P<0．05),但均在正常范围内。术中PVR、PVRI、pH及SvO2均较平稳。乳酸浓度增高并持续到术毕。两组术中Cr和BUN均在正常范围,B组总尿量高于A组(P相似文献