Pretransplant increases in left ventricular volume and mass are associated with QT prolongation during pediatric liver transplantation

Structural alterations in the cirrhotic heart may contribute to electromechanical abnormalities, represented by QT prolongation. The aim of this study was to investigate the changes in QTc according to the operative stage during pediatric LT and to identify which baseline echocardiographic parameters were associated with intraoperative QTc prolongation. Data were evaluated from 39 children undergoing LT for chronic liver disease (median age 9 months). In 19 patients (48.7%), baseline QTc was prolonged ≥440 ms (462 ± 19 ms). Through the period of post‐reperfusion, QTI, QTc, and JTI progressively increased, although values partially recovered toward the end of surgery. High LVMI (≥82.51 g/m²) was associated with baseline QTc ≥ 440 ms (OR = 1.034, P = .032). In the 5 minutes post‐reperfusion stage, marked QTc prolongation (defined as QTc ≥ 500 ms; n = 24, 61.5%) was significantly associated with high EDVI (OR = 1.060, P = .027) and SVI (OR = 1.075, P = .026). In children with chronic liver disease, increased ventricular volumes and mass may increase the risk of QTc prolongation during LT, suggesting that repolarization abnormalities might be contributed by structural changes characteristic of cirrhotic cardiomyopathy.     

A new method for attenuation coefficient measurement in the liver: comparison with the spectral shift central frequency method.

OBJECTIVE: To assess the feasibility of a new method of measuring the attenuation coefficient in the liver, which offers less variability of results than the conventional method. METHODS: The attenuation coefficient was evaluated on the basis of the following equation with sound field correction: [log(M0 (z)) - tau(z)]. In our system, the attenuation coefficient was also evaluated by the spectral shift central frequency method at the same time. We used 44 cases of normal liver, 40 cases of fatty liver, and 20 cases of cirrhotic liver in the system. RESULTS: With this new method, attenuation coefficient values were 0.59+/-0.10 dB x cm(-1) x MHz(-1) in normal livers, 0.80+/-0.12 dB x cm(-1) x MHz(-1) in fatty livers, and 0.62+/-0.09 dB x cm(-1) x MHz(-1) in cirrhotic livers. In both methods we recorded a statistically significant difference between normal and fatty livers and between fatty and cirrhotic livers (P < .0001). Only in the fatty liver was any significant difference (P < .0001) found between attenuation coefficients in the new method and those in the spectral shift central frequency method (0.70+/-0.05 dB x cm(-1) x MHz(-1)). CONCLUSIONS: This new method, which was more sensitive in detecting fatty infiltration than the spectral shift central frequency method, was considered usable for evaluating the attenuation coefficient of the liver in vivo.     

Expression of HGF and TGF-β1 mRNA after partial hepatectomy in rats with liver cirrhosis

Hepatocyte growth factor (HGF) is a potent mitogen for the maturation of hepatocytes in vitro which plays a role in liver regeneration in vivo. In addition, transforming growth factor-₁ (TGF-₁) is also a potent regulator of liver regeneration. In attempting to clarify the mechanisms related to liver regeneration after partial hepatectomy, we investigated the expression of HGF and TGF-₁ in rats with liver cirrhosis (LC). A rat model of LC was prepared using carbon tetrachloride (CCl₄). The expression of HGF mRNA in both the LC and control groups showed a similar time-course with the highest expression seen at 18 h after a 70% hepatectomy. The expression of TGF-₁ mRNA peaked at 18 h after partial hepatectomy in the LC group and at 48 h in the control group. The 5-bromo-2'-deoxyuridine (BrdU) labeling index for the LC group at 24, 48, and 72 h after partial hepatectomy was 9.2%, 5.9%, and 1.8%, while for the control group it was 7.0%, 11.7%, and 6.8%, respectively. The BrdU labeling index in the LC group was thus suppressed earlier than that in the control group. We therefore postulate that regeneration of the remnant liver in the presence of LC accelerates immediately after partial hepatectomy, but the extent of regeneration is insufficient because of an early cessation due to an early expression of TGF-₁.     

Antibody and complement levels in patients with hypersplenism associated with cirrhotic portal hypertension and therapeutic principles

BACKGROUNDHypersplenism associated with cirrhotic portal hypertension is a common condition often resulting from hepatitis B-related cirrhosis. However, the levels of immunoglobulin (Ig) and complement in patients with hypersplenism associated with cirrhotic portal hypertension remain unclear. This study was undertaken to determine the levels of Ig and complement in these patients, the relationship between these levels and Child-Pugh class and their clinical significance.AIMTo investigate the antibody (Ig) and complement levels in patients with hypersplenism associated with cirrhotic portal hypertension and their clinical significance.METHODSClinical data of 119 patients with hypersplenism associated with cirrhotic portal hypertension were statistically analyzed and compared with those of 128 control patients. RESULTSIgA and IgG levels in patients with hypersplenism were significantly higher than controls (P < 0.001). There was no significant difference in IgM between the two groups (P = 0.109). C3 and C4 levels in patients with hypersplenism were significantly lower than controls (P < 0.001). As liver function decreased, IgA and IgG levels increased (P < 0.001), and C3 and C4 levels decreased (P < 0.001).CONCLUSIONPatients with hypersplenism associated with cirrhotic portal hypertension have significantly higher antibody (IgA and IgG) levels and significantly lower complement (C3 and C4) levels, which are both related to liver damage. Clinically, the administration of anti-hepatitis virus agents and protection of liver function should be strengthened.     

西沙必利对肝硬化大鼠肠道细菌过度生长和肠道细菌转位的影响

目的观察肝硬化大鼠肠道细菌过度生长和肠道细菌转位情况及西沙必利对其影响.方法以皮下注射50%CCl4;橄榄油溶液诱导大鼠肝硬化后随机分为西沙必利治疗组(A组)和对照组(B组)各10只,A组予西沙必利混悬液灌胃,每日2mg/kg,早晚各1次,共10d,B组灌以同等剂量的生理盐水,另外取5只同期正常大鼠作为正常对照组(C组).治疗结束后在无菌条件下获取肠系膜淋巴结、肝脏、脾脏、空肠及盲肠内容物作细菌培养.结果B组空肠内细菌数高于C组[分别为(2.43±1.01)×106CFU/ml和(0.87±0.18)×106CFU/ml,P＜0.01],A组明显减少[1.03±0.51CFU/ml,P＜0.01].A、B两组肝硬化大鼠肠道细菌过度生长发生率分别为20%和踟%,细菌转位发生率分别为10%和60%(P＜0.05).转位的细菌除1只大鼠是肠球菌外,其余均为大肠杆菌.结论西沙必利能够减少肝硬化大鼠小肠细菌过度生长和肠道细菌转位发生的机会,对防治肝硬化肠源性细菌感染可能有益.     

肝硬化低蛋白血症辨治浅议

探讨肝硬化低蛋白血症的发病机制和辨证论治规律,认为本病的发生与肝郁、脾虚、肾亏密切相关,病机主要为气虚、血瘀、痰阻,其证候表现有内在规律,治则为疏肝健脾、补益肝肾、活血化瘀、化痰散结、消补兼施,并阐述了几个需要重视的问题。     

MRI及其定期随访对肝硬化结节癌变的诊断价值

目的探讨MR及定期随访在肝硬化结节癌变诊断中的价值,旨在早期发现肝硬化结节癌变。方法回顾性分析经病理或手术证实48例肝硬化结节恶变患者的T1WI、T2WI、增强扫描、DWI表现及随访资料,分析肝硬化结节恶变MR表现、信号变化。结果48例患者共66个病灶,T1WI呈等、低信号,偶有高信号;T2WI多为稍高信号,亦可见等信号;三期增强扫描“快进快出”、“快进慢出”、“持续性强化”都可出现,典型“快进快出”为主;DWI呈高信号多见。部分病灶首次MR检查并未发现癌变,随访过程中T2WI信号增高,强化方式改变或进行性增大等改变,后经证实已癌变。结论磁共振常规技术及DWI能对大多数肝硬化结节癌变做出明确诊断,定期随访能早期发现结节恶变,明显提高诊断准确率。     

普萘洛尔联合5-单硝酸异山梨醇酯治疗肝硬化门脉高压的临床观察

目的：观察普萘洛尔与5-单硝酸异山梨醇酯联合用药对肝硬化门静脉血流动力学的影响及预防食道胃底曲张静脉破裂再出血的有效率。方法：60例肝硬化失代偿期患者随机分为治疗组和对照组各30例,在用药前及治疗后4周用彩色多普勒超声检测门脉系统血流动力学变化、比较食道胃底曲张静脉破裂再出血的机率。结果：经过4周治疗后,治疗组门脉血流量、脾静脉血流量明显下降,门静脉内径、脾静脉内径均下降,与用药前有显著差异。联合用药无明显副反应,差异有统计学意义（P〈0.05）。治疗组再出血率显著低于对照组,两组比较有统计学意义（P〈0.05）。结论：普萘洛尔与5-单硝酸异山梨醇酯联合用药治疗肝硬化门脉高压安全,预防食道胃底曲张静脉破裂再出血有效。     

肝硬化患者左心功能变化与终末期肝病模型评分的相关性研究

目的研究肝硬化患者左心结构和功能的变化与终末期肝病模型(MELD)评分的关系。方法选择2012年6月~2014年6
月期间89例肝硬化患者,根据MELD评分将其分为MELD≤9分、MELD10-19分和MELD≥20分3组,选择30例健康体检者为
对照组。超声心动图测量静息状态下左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左室后壁
厚度(LVPWT)、左房内径(LAD)、左室射血分数(LVEF)、心输出量(CO)、二尖瓣血流速度、E峰减速时间(DT)等指标,并评估其与
MELD评分的关系。结果与对照组比较,肝硬化组LVESD、LVEDD、IVST、LAD增大,CO增加、VE/VA比值降低、DT延长,差
异均具有统计学意义（P值<0.05或0.01）。随MELD评分的增加,LVESD、LVEDD、IVST、LAD逐渐增大,DT延长,差异均具有
统计学意义（P值<0.05或0.01）;VE/VA比值在MELD10-19分组高于MELD≤9分组,在MELD≥20分组明显下降。分别有55%
和44%患者出现左房增大和VE/VA≤1,MELD评分≥20分组中左房增大和VE/VA≤1患者的比例明显高于其他两组（P值均<
0.05）。LAD、LVEDD、DT与MELD评分呈正相关关系,r值分别为0.208、0.319和0.197,P值<0.05或0.01。结论肝硬化患者可
合并心脏受累,主要表现为左心舒张功能障碍,而且与肝病严重程度呈正相关。
     

一氧化氮在实验性肝硬化内毒素血症大鼠中的作用

目的探讨一氧化氮(NO)在实验性肝硬化内毒素血症大鼠中的作用。方法采用大鼠饮用0.03%～0.04%硫代乙酰胺(TAA)溶液10周复制肝硬化模型,随机分为:①正常+LPS组(对照组);②肝硬化组(TAA组);③肝硬化+LPS组(TAA+LPS组);④肝硬化+LPS+AG组(氨基胍组)。模型造成后,除TAA组外,其余各组向腹腔内注入大肠杆菌内毒素(LPS)3.0 mg/kg,同时TAA组向腹腔内注入等量的生理盐水,AG组于注射LPS 3 h后,腹腔注射AG(50 mg/kg)。并在注入LPS 6 h后,各组动物经腹主动脉穿刺采全血观察血浆中丙氨酸氨基转移酶(ALT)、天门冬氨基酸转移酶(AST)、一氧化氮(NO)的表达。结果对照组、TAA组、AG组、TAA+LPS组动物血浆内NO、AST、ALT水平依次升高,且各组之间差异有统计学意义(P<0.05)。结论一氧化氮参与了大鼠肝硬化时内毒素血症引起的肝损伤,但它未起到保护作用,它与内毒素对机体的损伤有关。