放射性肝纤维化过程的定量研究

经＾６０Ｃｏγ线照射大鼠肝区，通过光镜、电镜和图像分析仪、宣研究了照后１年肝脏的病理改变。结果表明，３０Ｇｙ组在照射后１年内逐渐发生了放射性肝纤维化病变。在肝纤维化发生过程中，肝细胞内糖原颗凿含量进行性减少，间质中胶原纤维含量进行性增加，网状纤维于照射１－３个月呈进行性增加。     

Increased plasma cathepsin D concentration in hepatic carcinoma and cirrhosis but not in breast cancer

Using a sandwich enzyme-linked immunoassay, plasma total cathepsin D concentration was assayed in 40 breast cancer patients and 84 patients with various liver diseases and compared to that of 52 normal subjects. There were no significant variations found in breast cancer patients related to tumor size, node invasiveness or metastases. In normal women, cathepsin D levels were slightly but not significantly increased in the luteal phase and in pregnancy. By contrast, plasma cathepsin D concentration was significantly increased in 70-75% of patients with liver disease (cirrhosis, hepatocarcinoma, hepatitis), but not in those with liver steatosis. Cathepsin D was independent of most of the plasma hepatic function tests and was correlated with alpha-fetoprotein in cirrhosis and with alpha-fucosidase in primary hepatocellular carcinoma. We conclude that plasma cathepsin D is not a useful marker in breast cancer. However, since the cellular level of this protease is associated with risk of metastasis in breast cancer, clinical follow-up will be required to test whether high cathepsin D plasma concentration has any prognostic value in liver cirrhosis and primary hepatocarcinoma.     

大鼠肝细胞Ⅰ，Ⅲ型前胶原基因表达及PDGF的影响

目的观察大鼠肝细胞Ⅰ，Ⅲ型前胶原基因的表达及ＰＤＧＦ对其表达的影响．方法应用原位杂交技术检测分离培养的ＳＤ大鼠肝细胞（ｎ＝３０）内Ⅰ，Ⅲ型前胶原基因的表达．同时观察１０μｇ／Ｌ（ｎ＝３０）和３０μｇ／Ｌ（ｎ＝３０）ＰＤＧＦ促进前胶原基因表达的作用．测定基因表达颗粒总面积占细胞总面积的百分比，并作比较分析．结果无论正常肝细胞或是在两种浓度的ＰＤＧＦ存在时，肝细胞内均可见到Ⅰ，Ⅲ型前胶原基因的表达．正常肝细胞Ⅰ，Ⅲ型前胶原基因表达面积的百分比（％）为７７±１９和７５±２１；加１０μｇ／ＬＰＤＧＦ后为１１５±１９和１１２±１０，而加３０μｇ／Ｌ后为１５２±３４及１８１±２８，且在后者中表达明显增强（Ｐ＜００５及Ｐ＜００１）．结论ＰＤＧＦ在转录水平上促进肝细胞胶原的合成．     

Bone disease in primary biliary cirrhosis: Lack of association with distal renal tubular acidosis

Background and Aims: Primary biliary cirrhosis (PBC) might be complicated by osteoporosis, whose etiology remains unknown but seems to be multifactorial. Prevalence rates of 30% to 60% for distal renal tubular acidosis (DRTA) have been reported in PBC patients, generally as incomplete DRTA. Although it is undisputed that a reduced bone mineral density (BMD) is the expected outcome among patients who have been suffering from longstanding chronic metabolic acidosis, it is unclear if incomplete DRTA is also associated with metabolic bone disease in PBC patients. The present study was undertaken to compare the BMD of PBC patients with and without DRTA.
Methods: The BMD of 23 PBC patients (11 with DRTA and 12 without), all with normal clearance of creatinine, was assessed by dual energy radiograph absorptiometry. The diagnosis of DRTA was made if the urine pH was above 5.4 in all samples after the oral acid overload, showing tubular inability to acidify urine in the presence of test-induced systemic metabolic acidosis.
Results: Densitometric signs of osteoporosis were found in 82% of DRTA cases and in 83% of patients without DRTA (difference not significant). There were no significant differences in BMD measurement, T and Z scores of patients with and without DRTA.
Conclusions: The present study could not support a correlation between the presence of DRTA and the bone loss observed in PBC patients.     

Management of ascites in cirrhosis

Ascites is one of the earliest and most common complications of patients with cirrhosis. A typical circulatory dysfunction characterized by arterial vasodilation, high cardiac output and stimulation of vasoactive systems is commonly present in these patients and is associated with a poor prognosis. The treatment of ascites has been based on the combination of a low-sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past two decades, although controlled trials in large series of patients are needed to delineate whether TIPS is a safe and useful treatment for these patients.     

肝硬化患者胰岛素释放试验的临床意义

本文报道46例肝硬化患者口服葡萄糖胰岛素释放试验的结果,并与18名正常人和18名原发性糖尿病患者比较。肝硬化患者糖耐量减低者28例(60.9％),其中29例(43.5％)呈糖尿病型耐量曲线。胰岛素释放高峰值在服糖后2h;释放过多和分泌延迟者32例(69.6％),降低者4例(8.7％)。20例肝源性糖尿病患者的胰岛素释放指数明显高于原发性糖尿患者。笔者认为血浆胰岛素和胰岛素释放指数测定对鉴别这两种类型的糖尿病有很大价值。     

垂体后叶素和硝酸甘油联合治疗食管静脉曲张破裂大出血

３０例肝硬化食管静脉曲张破裂大出血患者，用垂体后叶素０．２～０．４Ｕ／ｍｉｎ连续静脉滴注和硝酸甘油含服联合治疗。结果表明，近期止血有效申达８０％，死亡率１０％；无一例出现严重心绞痛和心电图异常。     

Zinc and magnesium in liver cirrhosis

Abstract. The Authors determined zinc (Zn) and magnesium (Mg) in the plasma, urine, erythrocytes (RBCs), mono- and polymorphonuclear cells (MNCs and PMNs) of patients with overt alcoholic and nonalcoholic liver cirrhosis. In order to obtain a clearer clinical picture, biochemical and nutritional parameters (retinol, tocopherol, six different carotenoids, creatinine-height index and tricipital skinfold), as well as markers of portal hypertension (spleno-portal size and platelet count) were also evaluated.
The plasma levels of Zn and Mg were found to be reduced, as were the urine levels of Mg. Urine Zn, on the other hand, was higher than normal. Plasma Zn correlated inversely, and urine Zn directly, with the severity of the disease, rather than with alcohol consumption or treatment with diuretics. Protein metabolism impairment would appear to affect the plasma transport of Zn rather than its overall availability in the organism; the opposite was found in the case of Mg, the availability of which appeared to be reduced. Determination of the two elements in RBCs, MNCs and PMNs suggested that a true nutritional deficit cannot be demonstrated. MNCs, rather than RBCs or PMNs seem better to reflect tissue status of trace elements.