慢性乙型肝炎病因病机探讨

慢性乙型肝炎的病因与湿热疫毒密切相关,湿热毒邪是乙肝发生的始动因素,脾运不健是乙肝发生发展的内在基础,肝络瘀阻是病变发展的重要病理环节,肝肾亏扣则病变发展的必然结果,病机特点为正虚邪恋,本虚标实,致病热缠绵,病情反复波动,治疗上必须有的效矢,才能取得满意的效果。     

干扰素治疗丙型肝炎过程中血清肝纤维化指标的变化

目的：观察干扰治疗慢性丙型肝炎过程中血清肝纤维化指标的改变。方法：应用ELISA法对44例慢性丙型肝炎病人在干扰素治疗开始时、结束时和停药后6个月检测血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原肽（PⅢP)和Ⅳ型胶原（C－Ⅳ）。结果：干扰素治疗完全应答组（CR－S）和完全应答伴反跳组（CR－R）治疗前血清HA、LN、PⅢP和C－Ⅳ水平低于无应答组（NR）、差异显著（P＜0．05）;CR－S组干扰素治疗后血清HA、LN、PⅢP和C－Ⅳ水平明显下降（P＜0．05）;CR－R组和NR组干扰素治疗后血清肝纤维化指标无明显下降,甚至升高。结论：应用干扰素治疗丙型肝炎时,随着肝内炎症的改善,血清肝纤维化指标的水平明显下降,对慢性肝炎肝纤维化的发生和发展有改善作用。     

血浆置换联合胎肝细胞悬液治疗重型肝炎

目的 :评价中间型人工肝支持系统治疗重型肝炎的疗效。方法 :对 138例重型肝炎患者进行血浆置换联合胎肝细胞悬液治疗 ,5 6例重型肝炎患者采用血浆置换治疗 ,另 48例重型肝炎患者采用胎肝细胞悬液治疗。观察血浆置换联合胎肝细胞悬液治疗患者治疗前后肝功能、氨基酸谱及心肌酶学变化。比较血浆置换联合胎肝细胞悬液治疗与单用血浆置换或胎肝细胞悬液治疗的疗效。结果 :血浆置换联合胎肝细胞悬液治疗较单用血浆置换或胎肝细胞悬液治疗能更有效提高重型肝炎患者好转存活率 ,改善肝功能 ,提高支链氨基酸 (BCAA) /芳香氨基酸 (AAA)比值 ,改善心肌酶学。结论 :血浆置换联合胎肝细胞悬液可有效治疗重型肝炎。     

HBV 基因T1862突变真核表达载体的构建及在Cos7细胞中的表达

目的研究HBV T1862变异的生物学意义。方法采用分子生物学方法,构建HBV前C/C基因EB病毒真核表达载体,利用体外定点突变技术诱导前C/C基因T1862变异,经PCR-RFLP初筛并经测序终鉴定出阳性克隆后,以脂质体介导方法将突变前后的重组质粒转染Cos7细胞, 以ELISA 检测HBeAg的表达量。结果未突变的重组质粒可稳定表达HBeAg,突变后的重组质粒未能检测到HBeAg表达。结论 HBV前C/C基因1862点突变的真核表达载体的构建,为体外研究该点突变引起HBV的一系列生物学改变奠定基础。     

人微小病毒B19感染者血清生化改变的初步分析

目的研究感染人微小病毒 Ｂ１９（ＰＶＢ１９）的病毒性肝炎患者的血清生化改变情况。方法用巢式聚合酶链式反应法 检测病毒性肝炎患者和对照者的共 ４７３份血清中的 ＰＶＢ１９ ＤＮＡ,对 ＰＶＢ１９ ＤＮＡ阳性血清进行血清生化测定并对多 项生化指标进行多元统计分析。结果共检出 １７份 ＰＶＢ１９ ＤＮＡ阳性血清。 １７份血清中多项离子、肌酐、尿酸、葡萄糖、 乳酸脱氢酶等的水平正常,而尿素氮、胆红素、蛋白、肝脏酶的水平大多偏离正常值;经多元统计分析发现临床诊断为病 毒性肝炎的ＰＶＢ １９感染者与有其他症状的ＰＶＢ１９感染者在肝细胞受损程度及肝功能不全程度上有显著性差异。结 论感染ＰＶＢ１９不会引起离子水平、肾功能、糖代谢水平等的改变,但病毒性肝炎患者感染ＰＶＢ １９后血清生化改变与 其他患者不同,是否可用血清肝脏酶和胆红素水平的异常作为ＰＶＢ１９感染的辅助诊断还需进一步研究。     

Non-alcoholic steatohepatitis

Non-alcoholic fatty liver disease (NAFLD), also referred to as metabolic associated fatty liver disease (MAFLD), is the commonest form of chronic liver disorder arising from metabolic dysregulation. It encompasses a wide spectrum of fatty liver phenotypes including isolated steatosis to non-alcoholic steatohepatitis (NASH). NASH is considered more likely to lead to grave clinical consequences such as cirrhosis and hepatocellular carcinoma, compared to simple steatosis. NASH is characterised by steatosis, inflammation, and damage to hepatocytes. Here, we present a case of a middle-aged gentleman with a background of infectious hepatitis who presented with NASH, with emphasis on terminology and histological assessment criteria of NAFLD and NASH. Reflection on and consistent effort to standardise terminology and assessment criteria will aid in addressing the scientific and clinical needs of NAFLD and NASH.     

Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.     

基于慢性乙型病毒性肝炎诊断路径的实验诊断学教学模式初探

探讨建立涵盖慢性乙型病毒性肝炎(CHB)诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程的疾病临床检验诊断路径的教学模式。根据CHB临床诊疗指南, 制订与疾病不同阶段相关的实验室检查检测策略, 建立CHB临床检验诊断路径, 以武汉大学第一临床学院2016级和2017级八年制本科生为研究对象, 通过随堂问卷比较其课堂教学效果。本研究首先建立了获得临床医生认可的CHB临床检验诊断路径, 其涵盖CHB疾病的诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程。该路径应用于2017级临床医学本科生课堂教学后, 教学质量评估指标均有较大程度的提升。此外, 随堂测验得分也有显著提高。综上, 基于CHB临床检验诊断路径的实验诊断学教学模式, 实现了实验诊断学与临床医学的融合, 提升了学生对CHB诊疗中各种实验室检查检测的整体认识, 教学质量得到了提高。     

Choleretic activity of 2-demethoxycarbonyl-2-ethoxycarbonyl-11-deoxymisoprostol on the model of CCl<Subscript>4</Subscript>-induced hepatitis

Therapeutic administration of 11-deoxymisoprostol had a hepatoprotective effect, which manifested in a decrease in the content of alanine transaminase and aspartate transaminase in blood plasma, and produced a choleretic effect in rats with CCl₄-induced toxic hepatitis. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 2, pp. 183–184, February, 2008