应用生态制剂对肝硬化患者血浆内毒素水平和自发性细菌性腹膜炎发生的影响

对肝硬化腹水患才应用双歧杆菌制剂预防原发性腹膜炎效果进行探索。68例患者随机分为培菲康组和对照组。入院时两组患者的年龄、诊断、并发症、肝肾功能和凝血酶原活动度比较无显著差异。68例患者共发性原发性腹膜炎8例,其中治疗组34例中,发生1例,发生率为2.9％,对照组34例发生7例,发生率为20.6％。8例腹膜炎患者中5例腹水分离出细菌,以革兰阴性菌为主,其中大肠杆菌2例,培菲康口服后血浆内毒素水平显著降低,结果表明,双歧杆菌制剂预防肝炎肝硬化腹水患者的自发性腹膜炎有一定效果。     

Chronic liver and renal diseases differently affect structure of human serum albumin

Human serum albumin (HSA) binding with endogenous metabolites and drugs is substantially decreased in chronic renal and liver diseases. To test the hypothesis that the decreased binding ability is caused by conformational changes of the protein, we analyzed infrared and Raman spectra of HSA isolated from healthy donors and patients with chronic uremia and liver cirrhosis. Uremia did not affect the secondary structure of HSA but modified the environment of its Asp/Glu residues. Liver cirrhosis increased the amount of extended and beta-structures, modified the environment of Asp/Glu and Tyr side chains, and changed the configuration of disulfide bridges in albumin molecules. The conformational changes of "cirrhotic" albumin were not caused by reversibly bound ligands and resembled a partial unfolding of the protein induced by adsorption on the charcoal surface. The dramatic structural alterations of HSA in liver cirrhosis may be caused by its oxidative modification and might underlie the decreased binding ability and changed body distribution of albumin.     

肝硬化门静脉高压患者并发上消化道出血的危险因素及RLR、TBA、PT的预测效能研究

摘要 目的：分析肝硬化门静脉高压（CPH）患者并发上消化道出血（UGIB）的危险因素并探讨红细胞分布宽度与淋巴细胞比值（RLR）、总胆汁酸（TBA）、凝血酶原时间（PT）的预测效能。方法：选取2019年5月～2022年4月我院收治的150例CPH患者,根据是否并发UGIB分为UGIB组57例和非UGIB组93例。采用多因素Logistic回归分析CPH患者并发UGIB的危险因素,受试者工作特征（ROC）曲线分析RLR、TBA、PT对CPH患者并发UGIB的预测效能。结果：两组患者饮酒史比例、Child-Pugh分级、门静脉内径、食管静脉曲张程度、Hb、白蛋白、RDW、LC比较差异统计学意义（P＜0.05）。UGIB组RLR、TBA高于非UGIB组,PT长于非UGIB组（P＜0.05）。多因素Logistic回归分析显示,饮酒史、Child-Pugh C级、门静脉内径增加、重度食管静脉曲张、RLR上升、TBA上升、PT上升为CPH患者并发UGIB的独立危险因素,Hb上升为独立保护因素（P＜0.05）。ROC曲线分析显示,RLR、TBA、PT单独与联合预测CPH患者并发UGIB的曲线下面积（AUC）分别为0.804、0.779、0.786、0.920,灵敏度分别为63.16％、70.18％、59.65％、77.19％,特异度分别为94.62％、80.65％、88.17％、96.77％。RLR、TBA、PT联合预测CPH患者并发UGIB的AUC大于RLR、TBA、PT单独预测（P＜0.05）。结论：饮酒、Child-Pugh C级、门静脉内径增加、重度食管静脉曲张、RLR上升、TBA上升、PT上升是CPH患者并发UGIB的危险因素,Hb上升为保护因素,RLR、TBA、PT联合预测CPH患者并发UGIB的效能较高。     

MRI-based modeling of spleno-mesenteric confluence flow

Characterization of hepatic blood flow magnitude and distribution can lead to a better understanding of the pathophysiology of liver disease. However, the underlying patterns and dynamics of hepatic flow, such as the helical flow structure that often develops following the spleno-mesenteric confluence (SMC) of the hepatic portal vein, have not yet been comprehensively studied. In this study, we used magnetic resonance image (MRI)-based computational models to study the effects of the helical flow structure and SMC geometry on portal blood flow distribution. Additionally, we examined these flow dynamics with four-dimensional (4D) flow MRI in a group of 12 cirrhotic patients and healthy subjects. A validation model was also created to compare computational data to particle image velocimetry (PIV) data. We found significant correlations between flow structure development, vessel geometry, and blood flow distribution in both virtually modified models and in healthy and cirrhotic subjects. However, the direction of these correlations varied among vessel configuration types. Nonetheless, validation model results displayed good qualitative agreement with computational model data.     

Oxidative Stress and S100B Protein in Cirrhotic Children

Cirrhosis represents the terminal stage of a number of chronic liver diseases. Consequences include accumulation of toxic metabolic wastes, reduced synthesis of key proteins, increased portal venous pressure, and portosystemic shunting. We conducted a case-control study to assess the serum levels of S100B protein and parameters of oxidative stress, superoxide dismutase (SOD), catalase (CAT) and oxidative stress measured by the thiobarbituric acid method (TBARS), in a group of 14 pediatric patients with cirrhosis. No differences were found between groups in S100B protein levels. SOD activity and TBARS levels were higher; and CAT activity was lower in the cirrhotic group. A negative correlation between S100B and TBARS in the case group was found (r = −0.815, p = 0.001). Conclusions: This study didn’t indicate a possible role of S100B serum levels as marker of brain damage in cirrhotic children but suggest a possible relation between astrocyte function and oxidative damage in cirrhotic children.     

肝硬化CT诊断的研究进展

能谱CT碘基图是一种定量检测方法,它克服了传统CT平扫易受噪音等因素干扰的问题,通过水-碘、钙-碘等基物质在灌注时期的不同表现,分析不同扫描时期组织碘含量的比值,可用于诊断。近年来,能谱CT在肝硬化的诊断方面有了很大的进展。但能谱CT碘基图诊断早期肝硬化仍有许多问题需要解决,今后有必要开展临床、动物学研究,积累经验,规范CT技术参数设置,深入分析碘值与肝硬化的不同肝功能分级之间的关系及影响因素,系统评估能谱CT碘值在肝硬化诊断的应用价值。     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。     

外周血红细胞分布宽度与肝硬化和肝癌的相关性分析

目的:分析红细胞分布宽度(Red blood cell distribution width,RDW)与肝硬化和肝癌的相关性。方法:回顾性分析2017年5月到2018年4月就诊于无锡市人民医院的169例肝硬化患者、195例肝癌患者和177例健康受试者RDW、血清丙氨酸氨基转移酶(Alanine aminotransferase, ALT)和总胆红素(Total bilirubin, TBil)水平,分析肝癌患者RDW与ALT和TBil水平的相关性。结果:肝癌组RDW、ALT和TBil水平均高于健康对照组(P0.05)。肝硬化组ALT和TBil水平均高于健康对照组(P0.05),RDW与健康对照组比较无显著差异(P0.05)。肝癌患者RDW水平与ALT(R2=0.8971,P0.001)、TBil(R2=0.8971,P0.001)水平均呈显著正相关。结论:肝癌患者的RDW水平增加,利于肝癌诊断。     

Plasma amino acids in four models of experimental liver injury in rats

Summary We studied the plasma amino acid profiles in four models of hepatic injury in rats. In partially hepatectomized rats (65% of liver was removed) we observed significant increase of aromatic amino acids (AAA; i.e. tyrosine and phenylalanine), taurine, aspartate, threonine, serine, asparagine, methionine, ornithine and histidine. Branched-chain amino acids (BCAA; i.e. valine, leucine and isoleucine) concentrations were unchanged. In ischemic and carbon tetrachloride acute liver damage we observed extreme elevation of most of amino acids (BCAA included) and very low concentration of arginine. In carbon tetrachloride induced liver cirrhosis we observed increased levels of AAA, aspartate, asparagine, methionine, ornithine and histidine and decrease of BCAA, threonine and cystine. BCAA/AAA ratio decreased significantly in partially hepatectomized and cirrhotic rats and was unchanged in ischemic and acute carbon tetrachloride liver damage. We conclude that a high increase of most of amino acids is characteristic of fulminant hepatic necrosis; decreased BCAA/AAA ratio is characteristic of liver cirrhosis; and decrease of BCAA/AAA ratio may not be used as an indicator of the severity of hepatic parenchymal damage.Abbreviations BCAA branched-chain amino acids (i.e. valine, leucine and isoleucine) - AAA aromatic amino acids (i.e. tyrosine and phenylalanine)     

Region-Selective Decreases in Densities of [3H]Tryptamine Binding Sites in Autopsied Brain Tissue from Cirrhotic Patients with Hepatic Encephalopathy

Abstract: The distribution of [³H]tryptamine binding sites, in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy (HE) and an equal number of age-matched control subjects free from hepatic, neurological, or psychiatric disorder, was investigated. Scatchard analysis demonstrated a heterogeneous distribution for this binding site, with the highest density being observed in hippocampus ≫ frontal cortex = caudate nucleus > temporal cortex = cerebellum. When comparing [³H]-tryptamine binding site densities in control brain tissue with that in brain tissue from patients with HE, significant decreases in densities were observed in the frontal cortex (by 56%, p < 0.001), hippocampus (by 43%, p < 0.001), and caudate nucleus (by 41%, p < 0.01) of the HE group. Binding site affinities were within normal limits. The findings of decreased densities of [³H]tryptamine binding sites taken in conjunction with previous reports of increased CSF and brain tryptamine concentrations in HE suggest a pathogenic role for this neuroactive amine in HE resulting from chronic liver failure.