目的:評價電腦肝病治療儀治療病毒性肝炎的療效及不良反應。方法:將116例病毒性肝炎患者隨機分為治療組及對照組,治療組60例,對照組56例。兩組均以抗炎、保肝、降酶、退黃、對癥為治則。治療組加用電腦肝病儀治療，每日一次。結果:治療組在消化道癥狀改善方面有效率950%,黃疸消退方面有效率902%。谷丙轉氨酶恢復方面有效率85%。而對照組分別為8214%、6786%和7143%。結論:電腦肝病治療儀治療肝病能迅速改善消化道癥狀,有效降低黃疸、轉氨酶,未見明顯不良反應。
肝臟移植作為終末期肝病的治療，自上個世紀80年代在歐美國家獲得公認以來，已在世界各國得到迅速開展。我國自90年代后期以來，在全國掀起了第二個肝移植的熱潮，迄今已完成1 000余例肝移植，在圍手術期處理、手術技術、介入放射、移植免疫、抗感染治療等各個方面均獲得豐富的經驗，我國肝移植的效果及長期生存率亦逐步趕上國際先進水平。總的來講，適合進行肝移植的病種可分為良性及惡性肝病，鑒于惡性肝病行肝移植后復發率高，長期生存率低，因而其作為肝移植的指征長期以來存在爭議，而良性終末期肝病則是肝移植的主要指征。我院自1999年2月以來連續施行肝移植114例，其中良性肝病為69例，占60.5%。本文僅針對良性肝病肝移植的一些特點談談我們的經驗和體會。
目的:探討激素及免疫抑制劑導致乙肝病毒再激活所致的肝損害的危害性及治療效果，指導臨床治療。方法：總結本院近2年收治的7例慢性乙肝病毒感染者在使用激素及免疫抑制劑致肝炎再激活并加重患者的臨床資料進行分析。結果：慢性乙肝病毒感染者因各種原因使用激素及免疫抑制劑所導致的慢性乙肝的復發加重，病情發展迅速，病死率高。結論：抗乙肝病毒治療是預防肝病復發并惡化的關鍵，在激素或免疫抑制劑治療前和治療中都應使乙肝病毒降至盡可能低的水平。
【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.
Objective To investigate the changes of indocyanine green retention rate at 15 minutes (ICGR15) of autologous peripheral blood CD34+ hematopoietic stem cells transplantation in end-stage liver disease (end-stage liver, disease, ESLD) patients with different Child-Pugh grades during before and after transplantation of 3, 6, 12, 36, and 60 months. Methods The CD34+ hematopoietic stem cells transplantation were performed in 60 cases of advanced liver cirrhosis with different Child-Pugh grades who were ineffectively treated with strictly conservative treatment and complied with the criterion of liver transplantation. The ICGR15 were performed before transplantation and in 3, 6, 12, 36 and 60 months after transplantation. And the results of each time point in each Child-Pugh classification group were compared, and the rate of change of ICGR15 value were compared between each Child-Pugh classification group. Results The ICGR15 values of the Child-Pugh grading groups all decreased with time. In Child A group, there were respectively significant differences between the 6 months, 12 months, 36 months, and 60 months groups after transplantation and preoperative and 3 months groups after transplantation (P<0.05), but there was no significant difference between preoperative and 3 months group after transplantation (P>0.05), and there was significant difference between the 12 months and the 60 months group after transplantation (P<0.05). As same as Child A group, there were also significant differences between that time groups in the Child B group (P<0.05), but there were also significant differences between the 3 months group after transplantation and preoperative (P<0.05), and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation in the Child B group (P<0.05). Also in the Child C group, there were significant differences between that time groups (P<0.05), but there was no significant difference between preoperative and 3 months group after transplantation (P>0.05), and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation (P<0.05). There was no significant difference in the rate of ICGR15 between Child-Pugh classification groups. Conclusion Autologous peripheral blood CD34+ hematopoietic stem cells transplantation can effectively improve the liver function reserve capacity of ESLD patients and improve the safety of operation for a long time.
ObjectiveTo explore the relationship between liver transplantation procedure with or without preservation of retrohepatic vena cava and postoperative reinfection of hepatitis B virus.MethodsHepatitis B virus makers of 15 retrohepatic vena cava samples from hepatitis B virus active replicating recipients was detected using immunohistochemistry stain LSAB and HBV DNA hybridization in situ. Hepatitis B virus reinfection rate and survival rate after transplantation in classic group (20 cases) and piggyback group (7 cases) was analyzed retrospectively. ResultsHepatitis B virus makers including HBsAg and HBcAg and HBV DNA of all 15 retrohepatic vena cava samples, 10 from classic group and 5 from piggyback group, was negative. In classic group, 20 recipients were followedup 6-30 months, mean 18 months, only one case of hepatitis B recurrence was confirmed 22 months after operation; In piggyback group,7 recipients were followedup 5-12 months, mean 8 months, none of hepatitis B virus reinfection was encountered. Recurrence rate in classic group and piggyback group was 5.0%(1/20) and 0(0/7), respectively.ConclusionThis preliminary study indicated that the retrohepatic vena cava of hepatitis B virus active replicating recipients don’t have the residence and replication of hepatitis B virus particle. Orthotopic liver transplantation procedure with preservation of retrohepatic vena cava appears not to increase the hepatitis B virus reinfection rate in hepatitis B virus active replicating recipients after transplantation.
Objective To summarize the current progress in diagnosis and treatment of polycystic liver disease, and provide ideas for further research direction and clinical practice of polycystic liver disease. Method The domestic and foreign literature about polycystic liver disease was reviewed, screened, and summarized. Results The diagnosis, evaluation, and classification of polycystic liver disease were mainly performed clinically by abdominal ultrasound and CT. Surgical treatment was the main treatment, including aspiration sclerotherapy, fenestration, segmental hepatectomy, and liver transplantation. Conclusions The classification and evaluation scheme of polycystic liver disease needs to be improved, and its medical treatment still needs further research. Estrogen receptor and gonadotropin-releasing hormone receptor are promising therapeutic targets.
ObjectiveTo summarize the latest research progress on the copper death mechanism in metabolic associated fatty liver disease (MAFLD) and to provide references for the treatment of MAFLD. MethodsWe reviewed recent domestic and international research on copper and copper death in MAFLD, and summarized the role of copper death mechanisms in the pathogenesis of MAFLD and related treatments. ResultsCopper death is primarily caused by abnormal intracellular copper accumulation binding to acylated proteins in the tricarboxylic acid cycle, leading to protein oligomerization, downregulation of iron-sulfur cluster protein expression, triggering a toxic stress response, and ultimately cell death. The occurrence and progression of MAFLD are closely associated with genes associated with the copper death pathway. Imbalanced copper metabolism can lead to insulin resistance, causing abnormalities in blood glucose and lipid metabolism, promoting fat accumulation in the liver, and ultimately contributing to the development of MAFLD. Targeting genes involved in the copper death pathway can delay the progression of MAFLD. ConclusionsThe occurrence and progression of MAFLD are closely linked to the copper death signaling pathway, with copper metabolism imbalance as a core component. This pathway not only directly leads to hepatocyte death but also triggers insulin resistance and abnormal lipid metabolism, jointly driving the progression of MAFLD. Therefore, targeted regulation of the copper death pathway is a therapeutic strategy to slow the progression of MAFLD.
【Abstract】Objective To introduce the birth and development of model of endstage liver disease (MELD) and evaluate its effect on liver transplantation(LT) as a new scoring system. Methods Literatures of MELD applied in LT were analyzed retrospectively. Results MELD scoring system was used for predicting the prognosis of patients with endstage liver disease and the death risk of candidates on waiting LT extensively and the order of organ sharing was determined by its predicable results. Conclusion MELD has been had a successful initial implementation for predicting the shortterm survival probability and mortality in patients with endstage liver disease, and meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time, which has been proven to be a powerful tool for auditing the liver allocation system.
摘要:目的:分析慢性乙肝病毒攜帶者肝組織病理與年齡、病程、血清學及肝臟免疫組化指標的相關性,以確定孰是對病理進程影響最主要的指標。方法:對134例臨床診斷的慢性乙肝病毒攜帶者進行乙肝血清學標志物、肝功能、肝活組織病理及免疫組化的檢查。結果:①病理表現為不典型增生者HBeAg陰性組少于HBeAg陽性組,而表現為慢性肝炎者前者多于后者,差異均有顯著性;HBVDNAlt;105亞組分析兩組病理表現無統計學差異;兩種病理表現類型在年齡18~40歲組及gt;40歲組明顯多于lt;18歲,差異均有顯著性;兩種病理類型在免疫組化雙陽性組均多于單陽性組及全陰