S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁/焦虑的临床效果研究

目的:研究S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁/焦虑患者的临床效果。方法:选择2011年3月~2013年3月我院收治的51例不同病因的胆汁淤积性肝病(药物性肝损害13例、慢性乙型肝硬化14例、酒精性肝硬化11例、自身免疫性肝病6例、肝癌5例、胆管癌2例)并抑郁/焦虑的患者,予S-腺苷蛋氨酸1.0 g治疗2周,应用SDS/SAS量表分别评估和比较治疗前后各组患者抑郁/焦虑程度的评分情况。结果:S-腺苷蛋氨酸治疗后,所有组别胆汁淤积性肝病肝病改善的临床总有效率94.12%,其中药物性肝损害、慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝硬化总有效率均为100.00%,肝癌的有效率为60.00%,胆管癌的有效率为50.00%,药物性肝损害患者临床疗效与其他各组有差异(P0.05);药物性肝病患者SDS和SAS评分均较治疗前显著降低(P0.05)。而慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝病、肝癌、胆管癌患者SDS和SAS评分与治疗前相比均无统计学差异(P0.05)。结论:S-腺苷蛋氨酸可改善药物性胆汁淤积性肝病并轻、中度抑郁/焦虑患者的肝功能,并有效减轻其抑郁/焦虑情绪。     

急性胰腺炎合并急性肝损害128例分析

目的:探讨急性胰腺炎(AP)合并肝损害的临床特点及发病机制.方法:对两家医院自2000年1月至2009年11月所收治的176例AP进行回顾性临床分析.结果:176例AP中有128例合并肝损害(占72.72%),重型胰腺炎肝损害程度较轻型胰腺炎肝损害重,差异有显著性,P<0.05.结论:AP合并肝损害发病率较高,其程度与急性胰腺炎病情程度成正相关,其发病机制是炎性破坏因子,多种炎性介质,胆汁淤积,内毒素等多因素结果.因此AP并发肝损时首选积极治疗原发病,同时加强保肝治疗,保护肝脏功能是非常重要的.     

基于超高效液相色谱质谱的药物性肝损害患者血清代谢组学研究

目的 应用代谢组学结合多变量统计学方法研究药物性肝损害患者血清当中的小分子代谢物质,寻找可用于药物性肝损害早期诊断的潜在生物标志物.方法 选择药物性肝损害患者26例和正常对照23例,应用非靶向的线性梯度超高效液相色谱质谱系统检测血清中的小分子代谢物质.结果 药物性肝损害组和对照组相比,血清中溶血卵磷脂C16∶0、溶血卵磷脂C18∶0、溶血卵磷脂C18∶3、溶血卵磷脂C18∶2的浓度明显降低,硬脂酰胺、油酰胺、十四酰胺、卵磷脂、甘氨鹅去氧胆酸、甘氨胆酸、胆红素、次黄嘌呤显著升高.结论 药物性肝损害患者代谢发生了显著的变化,根据代谢物质的变化有助于临床诊断,研究表明代谢组学是临床研究的一个强有力工具.     

药物性肝损害的病理学特征分析

目的:了解肝活检证实的药物性肝损害临床表现、生化学指标及病理学表现等方面的特征.分析生化学指标与肝组织病理学炎症程度分级、纤维化程度分期有无相关性.方法:筛选58例肝活检证实的药物性肝损害患者,分析其临床表现、生化学指标及病理学表现的特征.并对其生化学指标与病理学炎症程度分级(G)、纤维化程度分期(S)分别进行相关性分析.结果:患者年龄19-66岁,平均(38.05± 12.04)岁,其中女性46例,占79.31％.最常见的致肝损害药物为不明具体成分的中药(占32.76％),最常见的临床表现包括乏力(81.03％)、纳差(75.86％)、黄疸(53.45％).病理学主要表现为混合性炎细胞浸润(94.83％)、凋亡小体(84.48％)、界面炎(81.03％)、肝细胞点灶状坏死(74.14％)、肝细胞水样变性(58.62％).生化学指标(ALT、AST、ALP、GGT、TBIL、PT)与病理学炎症程度分级(G)、纤维化程度分期(S)无相关性,P＞0.05,偏回归系数无统计学意义.按照不同炎症程度的分级或分期进行分组分析,各组间生化学指标(ALT、AST、ALP、GGT、TBIL、PT)之间无区别,P＞0.05,差异无统计学意义.结论:DILI患者生化学指标与肝组织病理学分级、分期无相关性.生化学指标不能替代病理学检查,因此条件允许的情况下尽早行肝穿刺组织病理学检查是明确诊断、及时治疗的最好办法.     

肝肺综合征20例的临床分析

目的探讨肝肺综合征的诊断及治疗。方法回顾性分析2008年9月份以来我院收治的肝硬化病例基本符合诊断标准的肝肺综合征20例。结果17例患者好转（85%）,3例死亡（15%）。结论肝肺综合征是终末期肝病的一种严重并发症。本病发病率高,发病机制尚未清楚,治疗困难。     

68例重症肝炎院内感染分析

重症肝炎(简称重肝)常并发院内感染,且对其预后有重要影响。我院自2001年-2004年共收治68例重症肝炎患者,其中39例发生院内感染,现作一回顾性调查分析。旨在加强对医院内感染的防治,提高护理质量,为降低病死率提供参考依据①资料和方法:病例与调查方法,全部病例系我院2001年1月-2004年12月我院治疗的重肝患者68例,其中男性51例,女性17例。年龄19-72岁,诊断均符合上海全国病毒性肝炎会议修订标准,采用回顾性调查方法,对所调查的重肝逐项查阅,列表登记。②院内感染的诊断标准凡入院时经临床体检,血象及腹水等检查无感染存在,也不处于潜伏期,参照美国疾病控制中心(CDC)所列标准,凡在入院48小时之后发生感染者为医院感染。其结果见正文:     

细菌性阴道病的实验室诊断--附洁阴康洗液治疗BVⅡ期临床试验127例诊断结果分析

目的:了解目前BV的发病情况及诊断结果分析情况.方法:对门诊127例患者阴道分泌物进行线索细胞、胺试验、pH值测定.结果:典型病例(其中三项均阳性)45例,占35.4%,非典型病例(其中两项阳性)为34例,占26.7%.结论:典型病例有上升趋势,同时非典型病例也占相当优势,给临床治疗带来了一定困难,应引起广泛关注.     

大剂量蝮蛇抗栓酶治疗不稳定心绞痛21例临床观察

蝮蛇抗栓酶已广泛应用于血栓病的防治 ,而在心血管病方面的应用报告较少 ,我院自 1 998年 1 0月至 2 0 0 0年 3月用大剂量的精制蝮蛇抗栓酶治疗不稳定心绞痛 2 1例 ,疗效满意 ,报告如下。1　资料和方法1 .1　病例选择　本组 2 1例不稳定心绞痛患者符合 WHO诊断标准。男 1 7例 ,女 4例 ,年龄 49～ 71岁 (平均年龄 5 3 .4岁 ) ,随机设对照组 2 0例 ,男 1 8例 ,女 2例 ,年龄 5 0～ 72岁 (平均年龄 5 4 .5岁 ) ,有下列情况除外 :(1 )有出凝血异常及消化性溃疡病史 ;(2 )严重肝、肾功能损害或心功能不全。1 .2　治疗方法　对照组 :应用常规疗法…     

非肝炎病毒所致肝损害超声影像与病理关系的探讨

目的:对154例肝损害原因的超声与病理关系进行总结性分析,以提高对肝损伤的认知.方法:所有病例均行肝脏穿刺及病理检查,并结合临床相关特异性检查,明确肝损害的原因.结果:超声提示分别为肝损害、脂肪肝、肝纤维化、肝硬化,部分超声显示未见异常,病理结果提示在超声检查未见明显异常者中,部分确诊为代谢性疾病,超声提示肝损害组中,病理提示因药物、环境类生化因素所致肝损伤占有相当比例.结论:超声检查在肝损害的筛查中作用明显,而在肝损害原因中,药物性及环境类生化因素所致的肝损害占有相当比例.     

蝮蛇抗栓酶颈动脉滴注治疗脑血栓形成40例报告

1988年10月至1989年6月,我院用颈动脉加压滴注蝮蛇抗栓酶(清栓酶)治疗脑血栓形成40例.取得良效,报告如下:一般资料脑血栓形成40例中,男33例,女7例、年龄40～79岁,其中40～49岁5例;50～59岁9例;60～69岁23例;70～79岁3例.急性期15例.恢复期及后遗症期25例.有高血压史11例(占27.5%)有冠心病史9例(占20.5%),胆固醇增高12例(占30%),血流变学示血粘增高17例(占45%),5例脑部 CT 检查诊断为脑梗塞,本组病例从发病到治疗时间为3天至2年.均用清栓酶治疗.诊断标准按1978年全国第二届神经精神学术会议制定的标准.1.有脑动脉硬化或有高血压病者.2.多在安静状     

Liver enzyme abnormalities during concurrent use of herbal and conventional medicines in Korea: A retrospective study

Concurrent use of herbal medicine (HM) and conventional medicine (CM) is increasing. However, little is known about the prevalence of drug-induced liver injury (DILI) related to this concurrent use. In order to investigate changes in liver enzymes during concurrent use of HM and CM and to assess the prevalence of DILI related to their concurrent use, we screened for liver injury among inpatients at our institution who were administered both HM and CM for at least 14 days while hospitalized between 2006 and 2010. We used the Council for International Organization of Medical Science (CIOMS) laboratory criteria to define liver injury. Of the 892 patients included in the study, 34 (3.81%) had liver injury on admission and 21 (2.35%) had liver injury at discharge. Of the 48 cases that fulfilled the CIOMS laboratory criteria for liver injury, 34 had preexisting liver injury. The remaining 14 were analyzed, and five were concluded to have DILI, resulting in a prevalence of 5/892 (0.56%, with a 95% confidence interval of 0.07-1.05%). Overall, clinical symptoms of liver injury were mild. We thus contend that concurrent use of HM and CM is relatively safe.     

Safety of co-administration of herbal and conventional medicines on liver and kidney function in stroke patients: A single-center retrospective study

BackgroundAlthough herbal medicines (HMs) are widely used worldwide, information concerning their interactions with conventional medicines (CMs) is sparse. In particular, stroke affects a high proportion of elderly people with impaired hepatic and renal function. Stroke is often accompanied by various complications and is commonly treated via the co-administration of HMs and CMs in Asia.PurposeWe aimed to investigate the effects of co-administration of HMs and CMs on liver and kidney function in patients with stroke. We estimated the prevalence of drug-induced liver injury (DILI) or herb-induced liver injury (HILI) and drug-induced acute kidney injury (DIAKI) or herb-induced acute kidney injury (HIAKI) in patients co-administered HMs and CMs.Study designThis was a retrospective study that reviewed the electronic medical records of 401 patients with stroke in a single hospital.MethodsThe prevalence of DILI or HILI and types of liver injury was examined according to abnormal increases in liver tests. The probable causality between drug or herb administration and liver injury was assessed using the Roussel Uclaf Causality Assessment Method. In addition, the prevalence of DIAKI or HIAKI was estimated using the Kidney Disease Improving Global Outcomes acute kidney injury stage criteria and related medical records.ResultsOut of a total of 401 patients, only four (1.0%) developed liver injury. Two cases of DILI (0.5%) and two cases of HILI (0.5%) were reported. Moxifloxacin and ebastine were the CMs that caused hepatotoxicity. Chungpyesagan-tang and Yeoldahanso-tang were the HMs that caused liver toxicity. Even in cases showing severe liver damage, alkaline phosphatase levels remained less than five times the normal value, and liver function test values recovered within 14 days. There were no cases of DIAKI or HIAKI in this cohort.ConclusionThese results suggest that if appropriately prescribed by experts, the co-administration of CMs and HMs is safe and does not adversely affect liver and kidney function in patients with stroke. To support these results, further large-scale multicenter prospective studies and toxicological studies based on the interaction between HMs and CMs are warranted.     

S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑的临床效果研究

目的：研究s-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑患者的临床效果。方法：选择2011年3月-2013年3月我院收治的51例不同病因的胆汁淤积性肝病（药物性肝损害13例、慢性乙型肝硬化14例、酒精性肝硬化11例、自身免疫性肝病6例、肝癌5例、胆管癌2例）并抑郁／焦虑的患者,予s-腺苷蛋氨酸1．0g治疗2周,应用SDS／SAS量表分别评估和比较治疗前后各组患者抑郁／焦虑程度的评分情况。结果：S-腺苷蛋氨酸治疗后,所有组别胆汁淤积性肝病肝病改善的临床总有效率94．12％,其中药物性肝损害、慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝硬化总有效率均为100．00％,肝癌的有效率为60．00％,胆管癌的有效率为50．00％,药物性肝损害患者临床疗效与其他各组有差异（P〈0．05）;药物性肝病患者SDS和SAS评分均较治疗前显著降低（P〈0．05）。而慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝病、肝癌、胆管癌患者SDS和SAS评分与治疗前相比均无统计学差异（P〉0．05）。结论：S-腺苷蛋氨酸可改善药物性胆汁淤积性肝病并轻、中度抑郁／焦虑患者的肝功能,并有效减轻其抑郁／焦虑情绪。     

77例不明原因肝功能异常患者的临床与病理特点

目的探讨不明原因肝功能异常患者的临床与病理特点。方法75例不明原因肝功能异常患者行1秒钟肝穿刺,2例外科手术肝活检,标本均送免疫组化双标记及HE染色、Masson染色、网状纤维染色、罗丹宁铜染色、普鲁士蓝染色,进一步分析其临床及病理特点。结果77例病因不明肝功能异常患者除6例无诊断学异常及3例非特异性炎症外,其余68例（88．31％）经肝组织病理检查分别诊断为急慢性肝炎12例、自身免疫性肝病27例、代谢性肝病4例、脂肪性肝病11例、药物性肝损伤10例、先天性肝纤维化及肝小静脉闭塞病各1例。结论肝组织病理检查在不明原因肝功能异常患者诊断价值较高,但由于病理检查存在一定的局限性,如果重视临床资料收集,通过临床及病理特点相结合的方法可进一步提高临床确诊率。     

Drug-induced liver injury: A 2-year retrospective study of 1169 hospitalized patients in a single medical center

BackgroundAlthough herbal medicines (HMs) are widely used in Asian and Western countries, medicinal information concerning their hepatic toxicity or interaction with conventional medicines (CMs) is sparse.PurposeThe aim of our study was to estimate the prevalence of drug-induced liver injury (DILI) among total inpatients prescribed HMs or CMs. Furthermore, we noted all medications suspected to be associated with hepatotoxicity in the liver injury group during the period of hospitalization.Study designWe retrospectively observed medical records of 1169 inpatients in a single medical center from January 2012 to July 2014.MethodsBased on a database of the 1169 inpatients at a single medical center, we researched the occurrence rate and type of liver injury according to the criteria of the Council for International Organization of Medical Science (CIOMS). We also utilized a simplified Roussel Uclaf Causality Assessment Method (RUCAM) score for probable causality assessment between drugs and liver injury.ResultsAmong a total of 1169 inpatients, 13 cases whose baseline LFTs had been in the normal range at admission had abnormal liver parameters at the time of follow-up, and 11 of them (0.94%) were attributed to drugs: 0.43% (5 of 1169) to HMs, 0.43% (5 of 1169) to CMs, and 0.09% (1 of 1169) to combined drug classes. Two of them were found to have liver injury because of pneumonia and sepsis. As for liver injury type, 8 cases were hepatocellular, 2 were cholestatic, and 1 was of mixed pattern. The common causative HMs for hepatotoxicity were Ephedrae Herba and Scutellariae Radix, while CMs included antidepressants, antihistamines, and antibacterials.ConclusionsWe investigated approximate incidence rates and analyzed suspicious drugs associated with liver damage, which revealed a low frequency of liver injury induced by HMs. However, further study, based on a well-designed, long-term, multicenter prospective study, will be required to determine the safety of HMs.     

多烯磷脂酰胆碱胶囊联合复方益肝灵胶囊治疗抗结核药物致肝损伤患者的临床疗效

目的:研究多烯磷脂酰胆碱胶囊联合复方益肝灵胶囊治疗抗结核药物致肝损伤患者的临床疗效。方法:选取2014年4月到2015年4月我院收治的抗结核药物致肝损伤患者150例,按照随机数字表法将患者分为研究组和对照组,每组75例,两组均继续行抗结核治疗,对照组给予常规保肝药物治疗,研究组给予多烯磷脂酰胆碱胶囊联合复方益肝灵胶囊保肝治疗,比较两组临床疗效,治疗前后谷丙转氨酶(ALT)、谷草转氨酶(AST)以及r-谷氨酰转移酶(r-GT)。结果:研究组有效率为89.3%显著高于对照组的73.3%,两组比较差异具有统计学意义(P0.05);两组治疗后AST、ALT以及r-GT显著低于治疗前,且治疗后研究组AST、ALT以及r-GT均显著低于对照组,比较差异均具有统计学意义(均P0.05)。结论:多烯磷脂酰胆碱胶囊联合复方益肝灵胶囊治疗抗结核药物致肝损伤具有较好临床疗效,能增强对肝脏的保护作用。     

Hospital Admissions for Drug-Induced Liver Injury: Clinical Features, Therapy, and Outcomes

We investigated clinical features, therapy, and outcomes of patients hospitalized for drug-induced liver injury (DILI). DILI resolution was defined as liver biochemistry values back to normal or lower than CIOMS laboratory criteria; Chronicity was defined as persistent biochemical abnormality for >6?months after drugs?? withdrawal. Three-hundred cases were reviewed retrospectively; mean age 51 (13?C86) years, and 204 (68?%) were females. It included 267 (89?%) hepatocellular injury, 16 (5.3?%) cholestatic injury, and 17 (5.7?%) mixed injury cases. In hepatocellular injury group, 197 (73.8?%) patients with TBIL?<?10× ULN included 142 (72.1?%) females and 70 (26.2?%) patients with TBIL????10× ULN included 39 (55.7?%) females (P?=?0.012). Of 70 patients (TBIL????10× ULN), 20 were treated with steroid step-down therapy (79?±?26?days) and others with non-steroid therapy. The steroid therapy group showed higher DILI resolution rate (P?=?0.029) and shorter recovery time (P?=?0.012). Notably, 274/300 (91.3?%) patients resolved, 18/300 (6?%) developed chronic liver injury, 7/300 (2.3?%) died, and one patient received liver transplantation. In death group, TBIL, ALB, PT, and PTA revealed more severe abnormality than in recovery group. In 121/300 (40.3?%) patients, use of herbal medicines was the leading cause of liver injury, followed by antibiotics, cardiovascular drugs, and endocrine drugs. We concluded that step-down steroid therapy for DILI improved curative effect, shortened disease course, and was safe.     

The Incidence of Liver Injury in Uyghur Patients Treated for TB in Xinjiang Uyghur Autonomous Region,China, and Its Association with Hepatic Enzyme Polymorphisms NAT2, CYP2E1, GSTM1 and GSTT1

Background and Objective

Of three first-line anti-tuberculosis (anti-TB) drugs, isoniazid is most commonly associated with hepatotoxicity. Differences in INH-induced toxicity have been attributed to genetic variability at several loci, NAT2, CYP2E1, GSTM1and GSTT1, that code for drug-metabolizing enzymes. This study evaluated whether the polymorphisms in these enzymes were associated with an increased risk of anti-TB drug-induced hepatitis in patients and could potentially be used to identify patients at risk of liver injury.

Methods and Design

In a cross-sectional study, 2244 tuberculosis patients were assessed two months after the start of treatment. Anti-TB drug-induced liver injury (ATLI) was defined as an ALT, AST or bilirubin value more than twice the upper limit of normal. NAT2, CYP2E1, GSTM1 and GSTT1 genotypes were determined using the PCR/ligase detection reaction assays.

Results

2244 patients were evaluated, there were 89 cases of ATLI, a prevalence of 4% 9 patients (0.4%) had ALT levels more than 5 times the upper limit of normal. The prevalence of ATLI was greater among men than women, and there was a weak association with NAT2*5 genotypes, with ATLI more common among patients with the NAT2*5*CT genotype. The sensitivity of the CT genotype for identifying patients with ATLI was 42% and the positive predictive value 5.9%. CT ATLI was more common among slow acetylators (prevalence ratio 2.0 (95% CI 0.95,4.20) )compared to rapid acetylators. There was no evidence that ATLI was associated with CYP2E1 RsaIc1/c1genotype, CYP2E1 RsaIc1/c2 or c2/c2 genotypes, or GSTM1/GSTT1 null genotypes.

Conclusions

In Xinjiang Uyghur TB patients, liver injury was associated with the genetic variant NAT2*5, however the genetic markers studied are unlikely to be useful for screening patients due to the low sensitivity and low positive predictive values for identifying persons at risk of liver injury.     

Injuries to the Liver: Analysis of 20 Cases

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.