育阴软肝颗粒剂对肝纤维化大鼠TGF-β1表达的影响

目的：观测育阴软肝颗粒剂对大鼠肝纤维化模型的防治作用及对转化生长因子-β1（TGF-β1）表达的影响。方法：将Wistar大鼠分为6组（n=10）,注射四氯化碳、饲以高脂饲料并饮用20%乙醇6周复制肝纤维化大鼠模型,经6.2~24.8 g/kg育阴软肝颗粒剂干预（qd）6周后,测定肝纤维化大鼠血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）活性、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（C-Ⅳ）及板层素（LN）含量,观测肝组织病理学及肝组织TGF-β1表达的变化,对育阴软肝颗粒剂防治肝纤维作用及机制进行研究。结果：实验第7周,模型组大鼠肝组织出现明显的纤维化病变（P<0.01）;与模型组比较,6.2~24.8g/kg的育阴软肝颗粒剂能明显降低肝指数以及血清ALT、AST活性与HA、PCⅢ、C-Ⅳ、LN含量,缓解肝组织纤维化病理变化,抑制纤维化肝组织TGF-β1的表达（P<0.05,0.01）。结论：育阴软肝颗粒剂对多因素复制肝纤维化大鼠造模具有明显的治疗作用,而抑制TGF-β1的表达可能是其作用机制之一。     

血清铜蓝蛋白联合透明质酸检测在肝纤维化患者诊断中的应用

目的探讨血清铜蓝蛋白(CP)联合透明质酸(HA)检测在肝纤维化患者诊断中的应用前景。方法选取2015年1月至2018年12月本院收治的疑似肝纤维化患者226例为研究对象,对患者的CP、HA水平进行联合检测,根据各项指标检测水平对患者做出诊断,并与金标准诊断方法肝穿刺活检结果进行对比。对CP、HA单独检测和联合检测的诊断结果进行统计对比,并对各组检查方法的灵敏度、特异度、假阳性率、假阴性率、准确度等进行统计对比,比较不同检查方法在不同肝纤维化分级患者中的诊断正确率。结果 226例患者中金标准诊断201例(88.94%)为肝纤维化,CP单独检测检出154例(68.14%),HA单独检测检出143例(63.27%),CP+HA联合检测检出195例(86.28%)。经Kappa一致性检验分析CP+HA联合检测与金标准结果有高度一致性,CP、HA单独检测与金标准结果为中等一致性。CP+HA联合检测的灵敏度、特异度、准确度均高于CP、HA单独检测,方法间比较差异有统计学意义(χ~2=11.602、55.959、78.047,P=0.003、0.039、0.002)。在不同分级肝纤维化患者中,CP+HA联合检测在Ⅰ级、Ⅱ级纤维化检出率高于CP、HA单独检测,方法间比较差异有统计学意义(χ~2=9.432、8.324,P=0.007、0.010)。结论 CP联合HA检测在肝纤维化患者诊断中应用情况良好,有较高的诊断正确率,且对症状程度较轻的肝纤维化患者有较高的检出率,可作为肝纤维化诊断检查的主要手段加以推广应用。     

超声弹性成像评价肝纤维化程度的探讨

目的:运用实时组织弹性成像(RTE)对肝脏弹性图像进行评分,并通过与实验室指标的比较,探讨RTE评分诊断肝纤维化程度的可行性与准确性。方法:选取我院收治的慢性病毒性肝炎患者90例作为研究对象,行RTE以及肝功能、血常规和凝血五项等实验室检查,随后肝活检获得病理学证据。比较RTE评分与实验室指标诊断肝纤维化程度的准确性。结果:90例患者中,S0期21例,S1期31例,S2期31例,S3期20例,S4期7例。RTE评分与肝纤维化程度呈正相关(r=0.79,P<0.05)。同样,门冬氨酸氨基转移酶/血小板比例指数(APRI)与肝纤维化程度也呈正相关(r=0.57,P<0.05)。RTE评分只与APRI呈相关性(r=0.667,P=0.000)。RTE评分诊断明显肝纤维化的敏感度为94.31%、特异度为78.65%、准确率为85.22%、阳性预测值为76.63%、阴性预测值为94.58%,均高于APRI。结论:实时组织弹性成像技术在诊断肝纤维化方面有广泛的临床研究价值和前景。     

肝组织TGF-β1、TIMP-1及MMP-2表达与纤维化关系的实验研究

目的探讨免疫性肝纤维化肝组织TGF-β1、TIMP-1及MMP-2表达与肝纤维化间的关系.方法 24只雄性Wistar大鼠尾静脉注射白蛋白建立实验性免疫性肝纤维化模型,检测血清HA、ALT、AST、ALB,流式细胞仪定量分析肝组织TGF-β1、TIMP-1、MMP-2和α-SMA基因表达量,观察大鼠肝组织病理、肝组织Pollak三重染色和Gomori银染色、苦味酸-天狼红染色、Ⅳ型胶原免疫组化、α-SMA免疫组化、肝匀浆Hyp测定.结果随着肝纤维化程度的加重血清HA、ALT、AST、肝组织匀浆Hyp的浓度和TGF-β1、TIMP-1及α-SMA基因表达量均增加, MMP-2于肝纤维化早期明显升高,晚期明显降低.结论实验性肝纤维化过程中TGF-β1、TIMP-1促进肝纤维化的进展,MMP-2抑制其进展.     

七味育肝颗粒对肝纤维化大鼠的防治作用*

目的: 探讨七味育肝颗粒对肝纤维化大鼠的防治作用及对基质金属蛋白酶-13(MMP-13)/基质金属蛋白酶抑制因子-1(TIMP-1)失衡的影响。方法: 取大鼠随机分为空白对照组、模型对照组、秋水仙碱组(1.0×10^-4 g/kg)、七味育肝颗粒各干预组(3.7、7.4、14.8 g/kg)组(n=8),采用皮下注射四氯化碳、灌胃乙醇6周来复制肝纤维化动物模型,造模的同时给药组每天灌胃给药,观测七味育肝颗粒对大鼠肝功能、肝组织病理学及肝纤维化相关指标的影响,采用免疫组化法测定肝组织MMP-13、TIMP-1的表达水平。结果: 与空白对照组比较,模型对照组大鼠血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)以及肝组织透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)、TIMP-1显著升高,而MMP-13显著下降,缓解肝组织纤维化病理变化(P＜0.01);与模型对照组比较,3.7、7.4、14.8 g/kg七味育肝颗粒能明显降低ALT、AST以及HA、PCⅢ、C-Ⅳ,缓解肝组织纤维化病理变化,改善肝功能,提高MMP-13活性而降低TIMP-1活性,缓解MMP-13/TIMP-1的失衡状态(P＜0.05, P＜0.01),其中七味育肝颗粒对TIMP-1及MMP-13/TIMP-1的影响有一定的量效关系趋势(P＜0.01)。结论: 七味育肝颗粒具有防治肝纤维化的作用,而改善MMP-13/TIMP-1平衡状态可能是七味育肝颗粒防治肝纤维化作用的机制之一。     

肝心宁对肝纤维化大鼠肝组织病理及PDGF-BB、TGF-β、MMP-1的影响

目的：从肝纤维化的病理学和血清标志物方面,探讨肝心宁对肝纤维化大鼠肝组织病理的影响。方法：将60只SD大鼠随机分成正常对照组,肝纤维化模型组和肝心宁干预纤维化组。采用改良式复合因素法复制大鼠肝纤维化模型。正常对照组与肝纤维化模型组给予生理盐水10mL/kg灌胃,肝心宁干预纤维化组给予10g/kg治疗。6周后,取各组大鼠肝脏组织,HE染色比较各组大鼠肝脏组织的病理学变化,检测比较不同组大鼠血清中肝纤维化指示物血小板生长因子-BB（PDGF-BB）、转化生长因子-β1（TGF-β）、基质蛋白酶-1（MMP-1）的含量。结果：肝组织病理学：与肝纤维化模型组相比,干预组炎症坏程度减轻,肝纤维化程度明显改善,血清PDGF-BB、TGF-β1含量显著下降,而MMP-1含量显著升高。结论：肝心宁能有效改善肝纤维化血清学指标和病理学指标。     

肝纤维化相关细胞因子的血清学检测对慢性乙型肝炎肝纤维化进程的诊断价值

目的:检测慢性乙型肝炎患者血清中相关细胞因子的水平,为慢性乙型肝炎肝纤维化的分期提供诊断依据。方法:选择175例在我院接受治疗的慢性乙型肝炎患者作为研究对象,采用ELISA方法检测患者血清中基质金属蛋白酶抑制剂(TIMP-1,TIMP-2)、脂连素及其受体(AdipoQ)、瘦素(Leptin)、生长因子(PDGF)、骨桥蛋白(OPN)6项指标的含量,并利用ROC曲线对各指标与肝纤维化分期之间的关系进行相关性分析。结果:TIMP-1、TIMP-2、Leptin在不同纤维化组中呈差异性表达,且AUROC高于其他指标(P0.05);其余指标无统计学意义(P0.05)。结论:TIMP-1、TIMP-2、Leptin这3项指标对慢性乙型肝炎肝纤维化分期具有一定的辅助诊断价值,与其他指标相结合可获得更好的诊断效能。     

乙肝患者血清肝纤维化标志物与HBV DNA含量分析

目的 动态观察肝纤维化活动性与肝脏病变程度。方法 采用放射免疫法检测血清中透明质酸（HA）、层连蛋白（IN）、Ⅲ型前胶原（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）肝纤维化标志物;采用核扩增荧光定量检测HBVDNA。结果 随着年龄的不同血清肝纤维化标志物水平变化呈多样性,而各年龄组间的病毒含量差异无显著性（P〉0．05）。结论 肝炎患者HBV复制活跃,传染性强,但并不表明肝炎后肝病的严重程度。     

基质金属蛋白酶及其抑制剂在肝纤维化中的表达变化

目的 观察肝纤维化形成过程中基质金属蛋白酶MMP-1及其抑制剂TIMP-1的表达变化,从细胞外基质降解代谢的角度研究四氯化碳(CCl4)中毒性肝纤维化发生的机制.方法 雄性Wistar大鼠20只,分为正常组和肝纤维化模型组.肝纤维化组采用CCl4、饮酒、高脂低蛋白饮食等复合病因刺激制备肝纤维化动物模型,造模时间为8周.实验结束后测定肝脏指数、血清透明质酸(HA)、谷丙转氨酶(ALT)及尿羟脯氨酸(HYP)排出量,光镜下观察肝组织纤维化程度,并用免疫组化SABC法检测肝组织中Ⅰ、Ⅲ型胶原蛋白及MMP-1、TIMP-1的表达,同时用荧光实时定量PCR(RT-PCR)的方法检测肝组织中MMP-1、TIMP-1 mRNA的表达.结果 与正常对照组比较,肝纤维化模型组大鼠肝脏指数、血清HA及ALT显著增高,尿羟脯氨酸的排出量明显增加,病理组织学检查发现肝组织内纤维结缔组织增生明显,有假小叶形成;免疫组化的结果显示肝组织内Ⅰ、Ⅲ型胶原蛋白、MMP-1及TIMP-1的表达较正常组显著增加.结论 肝组织中MMP-1及TIMP-1的表达变化可能是导致肝纤维化的重要机制之一.     

吡非尼酮对四氯化碳诱导的小鼠肝纤维化的影响

目的：研究吡非尼酮对四氯化碳诱导的小鼠肝纤维化的影响。方法：选用8周健康雄性SPF级ICR小鼠40只,随机分为4组（n=10）：肝纤维化模型组（CCL₄组）、吡非尼酮低剂量组（PFD-L组）、吡非尼酮高剂量组（PFD-H组）及正常对照组。CCL₄肝纤维化模型采用0.4 ml/只10%的CCL₄大豆油溶液进行小鼠腹腔注射制备,低剂量、高剂量吡非尼酮干预组在造模后采用120 mg/kg、240 mg/kg吡非尼酮（PFD）灌胃,正常对照组采用与前三组等量的生理盐水腹腔注射的方法。全自动生化仪检测血清中谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）;取肝脏组织HE染色观察组织的病理学变化;荧光定量PCR法测定肝脏中α-平滑肌肌动蛋白（α-SMA）相关基因的表达,酶联反应法检测肝纤维化指标透明质酸（HA）、层粘连蛋白（LN）、Ⅳ型胶原（IV-C）。结果：与正常组相比,CCL₄组小鼠肝小叶结构明显破坏,胶原纤维沉积明显,可见假小叶形成;血清ALT、AST、ALP均显著升高（P<0.05）;血清肝纤维化指标HA、LN、IV-C均显著升高（P<0.05）;α-SMA基因的表达水平也显著升高（P<0.05）。PFD-L组和PFD-H组小鼠AST、ALT、ALP相较于CCL₄组明显降低,PFD-L组和PFD-H组小鼠血清肝纤维化指标HA、LN、IV-C相较于CCL₄组明显降低,α-SMA基因的表达也受到抑制（P<0.05）。病理学观察发现,PFD-L组小鼠的肝纤维化程度减轻,胶原纤维减少,仅见少量假小叶;PFD-H组小鼠细胞排列恢复,小叶结构轻度紊乱,未见明显假小叶,恢复效果比PFD-L组好。结论：吡非尼酮对于肝纤维化有一定的治疗作用,其可成为肝纤维化早期干预的新药物。     

Diagnostic value of non-invasive bio-markers for stage-specific diagnosis of hepatic fibrosis in patients with advanced schistosomiasis japonica

Hepatic fibrosis caused by schistosome infection can be fatal. Its management depends on the degree of fibrosis present. To assess the diagnostic value of bio-markers in patients with advanced schistosomiasis japonica at different stages of disease progression, 84 advanced schistosomiasis japonica patients and nine controls were recruited in The People's Republic of China. Fibrosis was histologically assessed in wedge liver biopsies using the Chinese criteria for fibrosis (F) Stages. Seven selected hepatic fibrosis bio-markers were assessed and compared between the groups. The method of area under receiver operating characteristic curves (AUROCs) was used as a measurement of diagnostic efficacy. Our results showed that routine laboratory test results were normal for the controls but were significantly elevated or decreased in patients with fibrosis. While serum hyaluronic acid (HA) and matrix metalloproteinase (TIMP)-1 levels were shown to be elevated in patient groups compared with controls, the levels of platelet derived growth factor (PDGF)-BB were markedly lower. To distinguish F≥2 from no fibrosis or mild fibrosis, HA gave a high AUROC of 0.938 (95% confidence interval (CI), 0.886-0.990). Combining the aspartate aminotransferase (AST) to platelet ratio index (APRI) and HA/100 showed an AUROC of 0.958 (95% CI, 0.914-1.000). APRI in combination with TIMP-1/100 provided an AUROC of 0.873 (95% CI, 0.805-0.942) for the diagnosis of fibrosis stages greater than 2. We conclude that AST and APRI levels were reliable and sensitive markers for differentiating significant hepatic fibrosis in patients with advanced schistosomiasis japonica. HA and TIMP-1 show potential as additional markers for the diagnosis of fibrosis and cirrhosis in advanced schistosomiasis patients.     

壳聚糖介导CrmA基因治疗小鼠肝纤维化的研究

目的：探讨壳聚糖介导的CrmA对小鼠肝纤维化的治疗效果,以期为肝纤维化的基因治疗提供实验基础。方法：清洁级的75只雄性小鼠随机分为正常组、模型组、壳聚糖介导的CrmA组、壳聚糖介导的空载体组、壳聚糖组,每组15只。应用30％四氯化碳橄榄油溶液3ml／kg腹腔注射制备肝纤维化小鼠模型。治疗8周后,眼眶取血,检测血清的肝功能指标,并取肝组织做HE染色,观察各组小鼠肝脏的病理形态,Real TimePCR检测肝组织IL-1β、α-SMA、TGF—β1、TIMP-1表达量。结果：与模型组小鼠相比,壳聚糖介导的CrmA组小鼠的肝纤维化程度减轻,ALT、AST显著降低（P〈0．01）,肝组织IL-1β、α-SMA、TIMP1、TGF-β1的表达明显减少（P〈0．05）,而模型组、壳聚糖介导的空载体组和壳聚糖组均无显著性差异。结论：壳聚糖介导的CrmA能有效减轻肝纤维化小鼠的肝脏损伤和纤维化程度,为基因治疗肝纤维化提供了一种潜在的新思路和方法。     

硫普罗宁治疗慢性乙型肝炎的临床疗效对照研究

目的：评价硫普罗宁治疗慢性乙型肝炎的效果及安全性。方法：慢性乙型肝炎80例,随机分为两组。治疗组40例,以硫普罗宁0.2g加入5%葡萄糖溶液250ml中静滴,1次/日,连续治疗4周,对照组40例,以甘草酸二铵150mg加入5%葡萄糖溶液250ml中静滴,1次/日,连续治疗4周;同时分别监测肝功能指标：丙氨酸氨基转移酶（ALT）,天冬氨酸转移酶（AST）、总蛋白（TP）、总胆红素（TBi）、肝纤维化指标（HA、PCⅢ）及凝血酶原活动度（PTA）等,并进行比较分析。结果：硫普罗宁治疗组较对照组在肝功能复常方面显示良好的治疗效应,可使转氨酶及HA明显下降,两组显效率分别为50%（20/40）和25%（10/40）,总有效率为85%（34/40）和47.5%（19/40）,两组比较差异有显著性（p〈0.01）。结论：短期临床研究提示硫普罗宁治疗慢性乙型肝炎,可明显改善肝脏功能,有抗纤维化作用,且副作用少,疗效显著。     

Novel Algorithm for Non-Invasive Assessment of Fibrosis in NAFLD

Introduction

Various conditions of liver disease and the downsides of liver biopsy call for a non-invasive option to assess liver fibrosis. A non-invasive score would be especially useful to identify patients with slow advancing fibrotic processes, as in Non-Alcoholic Fatty Liver Disease (NAFLD), which should undergo histological examination for fibrosis.

Patients/Methods

Classic liver serum parameters, hyaluronic acid (HA) and cell death markers of 126 patients undergoing bariatric surgery for morbid obesity were analyzed by machine learning techniques (logistic regression, k-nearest neighbors, linear support vector machines, rule-based systems, decision trees and random forest (RF)). Specificity, sensitivity and accuracy of the evaluated datasets to predict fibrosis were assessed.

Results

None of the single parameters (ALT, AST, M30, M60, HA) did differ significantly between patients with a fibrosis score 1 or 2. However, combining these parameters using RFs reached 79% accuracy in fibrosis prediction with a sensitivity of more than 60% and specificity of 77%. Moreover, RFs identified the cell death markers M30 and M65 as more important for the decision than the classic liver parameters.

Conclusion

On the basis of serum parameters the generation of a fibrosis scoring system seems feasible, even when only marginally fibrotic tissue is available. Prospective evaluation of novel markers, i.e. cell death parameters, should be performed to identify an optimal set of fibrosis predictors.     

Ultrasound versus biological markers in the evaluation of periportal fibrosis in human Schistosoma mansoni

In this paper, the authors review the literature and share their experience of the principal biological markers of fibrosis for the evaluation of periportal fibrosis (PPF) caused by mansoni schistosomiasis. These biological markers are compared to diagnostic ultrasound (US) scans as means of grading PPF. We also review procollagen type I and III, collagen type IV, laminin, hyaluronic acid (HA), immunoglobulin G, platelets, aspartate aminotransferase to platelet ratio index (APRI) and gamma-glutamyl transpeptidase as markers of the disease. Although there are several good markers for evaluating PPF and portal hypertension, such as HA, platelets or APRI, none can yet replace US. These markers may, however, be used to identify patients at greater risk of developing advanced disease in endemic areas and determine who will need further care and US studies.     

小茴香对肝纤维化大鼠脂质过氧化水平的影响

目的：研究小茴香对肝纤维化大鼠的脂质过氧化水平的影响。方法：取Wister大鼠100只,随机取12只设为正常组,其余采用四氯化碳（CCL4）复合因素法复制肝纤维化大鼠模型,复制成功后随机分为模型对照组、小茴香组和复方丹参组（n=12）;相应药物干预8周后,镜检肝组织形态学改变;全自动生化分析仪检测外周血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平与血清总蛋白（TP）、白蛋白（ALB）含量;生化法检测肝组织羟脯氨酸（HYP）与血清丙二醛（MDA）含量及超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH—PX）、过氧化氢酶（CAT）活性。结果：HE结果显示：模型组肝脏炎症与脂肪变性明显,经小茴香干预后明显改善。生化检测结果显示：与正常组比较,模型组ALT、AST水平显著升高（P〈0．05）,TP、ALB含量显著降低（P〈O．05）,HYP、MDA含量显著增加（P〈0．05）,而SOD、GSH—PX和CAT活性显著降低（P〈0．05）;与模型组比较,小茴香组ALT、AST水平显著下降（P〈0．05）,TP、ALB水平显著升高（P〈0．05）;HYP、MDA含量显著降低（P〈0．05）,SOD、GSH—PX和CAT活性显著提高（P〈0．05）。结论：小茴香的抗肝纤维化作用可能与调节大鼠脂质过氧化水平有关。     

Increased oxidative damage of RNA in liver injury caused by hepatitis B virus (HBV) infection

To evaluate the urinary levels of 8-oxo-7,8-dihydro-2′deoxyguanosine (8-oxo-dGsn) and 8-oxo-7,8-dihydroguanosine (8-oxo-Gsn) in liver injury patients with hepatitis B virus (HBV) infection and to explore the relationship between urinary 8-oxo-dGsn or 8-oxo-Gsn and degree of liver damage. We enrolled 138 liver injury patients with HBV infection and 169 age- and sex-matched healthy controls in this study. A sensitive and accurate isotope-diluted liquid chromatograph mass spectrometer/mass spectrometer (LC-MS/MS) method was used to measure the urinary levels of 8-oxo-Gsn and 8-oxo-dGsn. Simultaneously, pathological analysis of liver biopsy tissues was carried out, and immunohistochemistry was carried out for 8-oxo-Guo, 8-oxo-dGuo and MTH1 protein in some liver injury tissues. We analysed the correlation between the degrees of inflammation and fibrosis and levels of 8-oxo-Gsn and 8-oxo-dGsn. We also analysed the levels of urinary 8-oxo-Gsn and 8-oxo-dGsn with clinical data of HBeAg, HBsAg, and HBV genotype and detected the levels of plasma aspartate aminotransferase, alanine aminotransferase (AST), platelet, alkaline phosphatase, prothrombin time (PT) and HBV DNA, and calculated the aspartate amino transferase-to–platelet ratio index (APRI) score. Nonparametric correlations were used to evaluate the correlation between 8-oxo-Gsn, 8-oxo-dGsn or APRI and various laboratory biochemical indicators. Results showed that the levels of urinary 8-oxo-Gsn and 8-oxo-dGsn in patients with liver injury were significantly higher than those of healthy controls (both p?p?=?.013, p?=?.026 and p?=?.049). The receiver operating characteristic curves of 8-oxo-Gsn were 0.696 (0.632–0.759) and 0.731 (0.672–0.790) for inflammatory activity and fibrosis, respectively. Patients with higher levels of urinary 8-oxo-Gsn are more likely to have a high degree of fibrosis and urinary 8-oxo-Gsn may have a great potential in assessing liver fibrosis.