Objective To investigate the effects of activities of Na+K+ATPase in plasma membranes of hepatocytes on the formation of calcium bilirubinate gallstone. MethodsThe research were studied in Xiao’s rabbit models.One hundred and three rabbits were randomly divided into the control group (Con,n=28),simple biliary obstruction group (BO,n=36),biliary obstruction and infection group (BOI,n=39).The activities of Na+K+ATPase,contents of intracellular calcium and bile acids in bile were measured in 3rd,7th,14th and 20th day. ResultsThe activities of Na+K+ATPase,contents of bile acids in bile decreased gradually and the contents of intracelluar calcium of hepatocytes increased continously in all phases of experimental groups compared with control group (P＜0.01).There was more significant changes in BOI group than in BO group (P＜0.05). Conclusion The progressive decrease of activities of Na+K+ATPase has a close relationship with the overloaded intracellular calcium and the continous decrease of bile acids contents in bile in formation of calcium bilirubinate gallstone.Infection can promote above mentioned changes and more stone formation.
ObjectiveTo evaluate the role of N-methyl-D-aspartate (NMDA) receptor in central nervous system (CNS) injury of obstructive jaundice. MethodThe related literatures about NMDA receptor and the CNS injury caused by hyperbilirubinemia were retrieved and reviewed. ResultsThe CNS injury of obstructive jaundice was related to overactivation of NMDA receptor, which finally resulted in degeneration and necrosis of nerve cells. The NMDA receptor antagonist MK-801 could relieve the CNS injury of obstructive jaundice. ConclusionsNMDA receptor plays an important role in the CNS injury caused by hyperbilirubinemia, and the blocker of NMDA receptor has protective effects in this process. However, there is no report of MK-801 in clinical application when hyperbilirubinemia happened.
ObjectiveTo investigate the predictive value of preoperative red blood cell distribution width to platelet count ratio (RPR) and platelet-albumin-bilirubin (PALBI) scoring for postoperative complications after radical resection of hepatic alveolar echinococcosis (HAE). MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients diagnosed with HAE and underwent radical hepatectomy in the Affiliated Hospital of Qinghai University from January 2018 to October 2022 were retrospectively collected. The risk factors affecting postoperative complications after radical hepatectomy for HAE were analyzed by univariate and multivariate unconditional logistic regression analysis, which were used to construct the nomogram. The receiver operating characteristic curve was used to evaluate the value in predicting postoperative complications by nomogram model. The discrimination of the nomogram was evaluated using Bootstrap internal 1 000 resampling and evaluated using a consistency index. The predicted postoperative complications probability by nomogram and actual postoperative complications probability were calculated by Kaplan-Meier method, and the calibration curve was drawn. The calibration ability of the nomogram model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The decision curve analysis was used to evaluate clinical benefit of the nomogram model. ResultsA total of 160 patients with HAE radical hepatectomy were included, of which 105 had no postoperative complications and 55 had postoperative complications. The multivariate unconditional logistic regression analysis showed that the operation time ≥207 min, intraoperative bleeding ≥650 mL, and albumin ＜38 g/L, RPR ≥0.054, and higher PALBI grading (3 levels) were the risk factors affecting postoperative complications after HAE radical hepatectomy (OR＞1, P<0.05). Based on the risk factors, the nomogram was constructed. The area under the receiver operating characteristic curve (95%CI) predicted by the nomogram for the postoperative complications was 0.873 (0.808, 0.937), with an optimal cutoff value of 0.499. The consistency index was 0.855 for discriminating postoperative complications after HAE radical hepatectomy. The calibration curve was tested by Hosmer-Limeshow and showed a good fit between the predicted curve by the nomogram and actual curve (χ2=3.193, P=0.367), indicating that the nomogram had a good calibration ability. The decision curve analysis showed that there was a good clinical applicability within the range of 11% to 93% of the threshold probability. ConclusionsThe preoperative RPR and PALBI scoring are risk factors affecting postoperative complications after radical hepatectomy for HAE. The nomogram constructed with risk factors including RPR and PALBI has a good predictive value for postoperative complications after radical hepatectomy for HAE.
ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
ObjectiveTo investigate the application value of albumin-bilirubin (ALBI) score in the treatment and prognosis of hepatocellular carcinoma (HCC).MethodThe literatures related to studies on the relationship between the ALBI score and the HCC were searched. The sources of ALBI score and its role in predicting the survival of patients after the liver cancer resection, liver transplantation, and non-surgical treatment such as radiofrequency ablation, radiotherapy, sorafenib treatment, and other therapies were reviewed.ResultsThe ALBI score was the independent prognostic factor after the hepatectomy. As a risk factor for the early recurrence of HCC after the radical hepatectomy, the ALBI score might help to determine the appropriate treatment based on the patient’s liver function when the recurrence occurred. As an independent predictor of mortality after the liver transplantation, the ALBI level 3 might be helpful in optimizing individual risk assessment for the liver transplantation. The ALBI score could be used as the reference tool for the clinicians to choose between the hepatectomy and non-surgical treatment in the patients with HCC.ConclusionsRole of ALBI score in evaluating liver function is no less useful than that of Child-Pugh grade. It plays an important role in evaluating prognosis and recurrence of patients with HCC, and is conducive to selection of individualized treatment for them, and formulation of treatment plan that maximizes benefit of patients.
Objective To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia. Methods All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery. Results The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up. Conclusions Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.
摘要:目的:分析高膽紅素血癥新生兒血清神經元特異性烯醇化酶(NSE)含量和新生兒行為神經能力測評(Neonatal Behavioral Neurological Assessment,NBNA)的變化,探討高膽紅素血癥新生兒血清NSE含量變化的臨床意義。方法:應用放射免疫分析法分別測定60例高膽紅素血癥新生兒和20例對照組新生兒血清NSE含量,同步測定血清總膽紅素(TSB),進行NBNA評分;高膽紅素血癥組早期干預后再次測定血清NSE含量。結果: 與對照組比較,高膽紅素血癥新生兒血清TSB、NSE含量顯著升高,而NBNA評分明顯降低,差異有顯著性意義(Plt;0.01);對照組與高膽紅素血癥新生兒輕度增高、中度增高、重度增高四組兩兩比較(均Plt;0.05),存在顯著性差異;血清NSE含量與NBNA評分呈明顯負相關(r=-0628,Plt;0.01);高膽紅素血癥新生兒經早期干預治療后,血清NSE含量均下降(Plt;0.05),差異有顯著性。結論: 高膽紅素血癥可導致新生兒腦損傷,血清NSE含量可以作為腦損傷的監測指標。Abstract: Objective: To analyze levels of neuronspecific enolase(NSE)in serum and neonatal behavioral neurological assessment (NBNA), to study whether NSE in serum can be used as a tool for the early identification of brain damage in neonatal hyperbilirubinemia. Methods: Serum NSE level of 60 full term infants with hyperbilirubinemia and 20 cases as to control group were measured by radioimmunoassay; Also total serum bilirubin (TSB) and NBNA were detected. In the hyperbilirubinemia group,serum NSE level were measured second when TSB were less than 855 μmol/L(5 mg/dL). Results: Compared with control group,the levels of serum TSB、NSE of the hyperbilirubinemia group were significantly higher, but NBNA score was significantly lower. The levels of serum NSE was significantly negative related to NBNA score. In the hyperbilirubinemia group, serum NSE level were significantly lower after treatment. Conclusion: Hyperbilirubinemia in neonates can cause brain damage. Serum NSE level could work as monitoring indexes of this damage.
ObjectiveTo investigate the trend of serum bilirubin in patients with liver cirrhosis before and after transjugular intrahepatic portosystemic shunt (TIPS).MethodsThe data of patients with cirrhotic portal hypertension who underwent TIPS between October 2016 and June 2018 were collected retrospectively, including liver function before and after surgery (1 week, 1 month, 3 months, and 6 months after surgery), preoperative and postoperative portal vein pressure, and the Child-Pugh scores, model for end-stage liver disease (MELD) scores, and albumin-bilirubin (ALBI) scores. Paired t-test was used for the statistical measurement data. The total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels at five time points were analyzed by analysis of variance of repeated measurement data with its own before and after comparison, and Wilcoxon signed ranks test was used for the ordered data.ResultsA total of 60 patients were included.The portal vein pressure was (27.86±2.53) mm Hg (1 mm Hg=0.133 kPa) before TIPS and (17.22±2.33) mm Hg after TIPS, and the difference was statistically significant (P<0.05). The common logarithm of the serum TBIL level [lg(TBIL)] before surgery and 1 week, 1 month, 3 months, and 6 months after surgery were (1.27±0.23), (1.44±0.21), (1.51±0.20), (1.56±0.22), (1.48±0.19) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum DBIL level [lg(DBIL)] at the five time periods were (0.90±0.26), (1.14±0.24), (1.18±0.25), (1.21±0.28), (1.08±0.21) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum IBIL level [lg(IBIL)] at the five time periods were (1.00±0.23), (1.13±0.22), (1.20±0.23), (1.26±0.21), (1.22±0.23) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). There were no statistically significant differences in the three liver reserve function scores (Child-Pugh, MELD, and ALBI, respectively) before and six months after operation (P>0.05). The differences in the composition of Child-Pugh and ALBI before and after surgery were not statistically significant (P>0.05).ConclusionsTIPS has a significant effect on reducing portal hypertension. Serum bilirubin levels continue to increase during a period after TIPS, but begin to decrease within 6 months.
ObjectiveTo evaluate the prognostic value of the easy albumin-bilirubin (EZ-ALBI) score for postoperative complications and long-term prognosis of hepatocellular carcinoma (HCC) patients. MethodsThe data on consecutive 1 822 HCC patients who underwent hepatectomy were obtained and retrospectively analyzed from five medical centers, including West China Hospital, Sichuan Provincial People’s Hospital, The First People’s Hospital of Neijiang City, The Second People’s Hospital of Yibin City, and People’s Hospital of Leshan City. Non-conditional logistic and Cox proportional hazards regression were used to evaluate the aspect on the postoperative complications and long-term prognosis. ResultsThe patients in EZ-ALBI grade 2 had higher incidences of severe complication (Clavein-Dindo classification>2, P=0.001), post-hepatectomy liver failure (P=0.040), length of stay>10 d (P<0.001), perioperative transfusion (P<0.001), and 90 d mortality (P<0.001). The 1-, 3- and 5-year cumulative survival rates in EZ-ALBI grade 1 group were 85.5%, 67.0%, and 58.7% while in EZ-ALBI grade 2 group were 72.7%, 51.1%, and 39.8%. Multivariate Cox proportional hazards regression manifested that patients in EZ-ALBI grade 2 had a significantly worse overall survival [HR=1.24, 95%CI (1.04, 1.48), P=0.015]. ConclusionThe EZ-ALBI score is an easy and feasible classifying method to predict postoperative complications and survival of HCC.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.