肝硬化原发性肝癌直径<1 cm超声造影表现及其与血清AFU、AFP-L3、GPC3、TSGF、GP73水平相关性研究

摘要 目的：探讨肝硬化原发性肝癌（PHC）直径<1cm超声造影（CEUS）表现及其与血清α-L-岩藻糖苷酶（AFU）、甲胎蛋白异质体-L3（AFP-L3）、磷脂酰肌醇蛋白聚糖-3（GPC3）、肿瘤特异生长因子（TSGF）、高尔基体糖蛋白（GP73）水平相关性。方法：选取2018年1月-2022年8月于湖北省襄阳市中医院收治的肝硬化PHC直径<1 cm患者44例,根据术后病理结果分为高分化组、中分化组和低分化组。所有患者术前均完善CEUS和血清AFU、AFP-L3、GPC3、TSGF、GP73水平检查。比较三组CEUS表现、定量时间-强度曲线（TIC）分析、血清AFU、AFP-L3、GPC3、TSGF、GP73水平。采用Spearman相关性分析肝硬化PHC直径<1 cm患者的CEUS表现与血清AFU、AFP-L3、GPC3、TSGF、GP73水平的相关性。结果：44例肝硬化PHC直径<1 cm患者的CEUS表现均为肝内单发病灶,呈圆形或类圆形,病灶边界清晰,周围可见声晕。不同分化程度肝硬化PHC直径<1 cm患者在动脉期、门脉期和延迟期的CEUS表现上差异均无统计学意义（P＞0.05）。高分化组、中分化组和低分化组的达峰时间、廓清时间和峰值加速时间逐渐减少,差异有统计学意义（P＜0.05）。而高分化组、中分化组和低分化组的峰值强度增加率逐渐增加,差异有统计学意义（P＜0.05）。高分化组、中分化组和低分化组的增强时间对比差异无统计学意义（P＞0.05）。高分化组、中分化组和低分化组血清AFU、AFP-L3、GPC3、TSGF、GP73水平逐渐升高,差异有统计学意义（P＜0.05）。Spearman相关性分析显示,达峰时间、廓清时间和峰值加速时间与血清AFU、AFP-L3、GPC3、TSGF、GP73水平呈负相关（P＜0.05）;峰值强度增加率与血清AFU、AFP-L3、GPC3、TSGF、GP73水平呈正相关（P＜0.05）。结论：肝硬化PHC直径<1 cm患者的CEUS表现均为肝内单发病灶,呈圆形或类圆形,病灶边界清晰,周围可见声晕。CEUS表现和血清AFU、AFP-L3、GPC3、TSGF、GP73水平具有相关性,两者可辅助鉴别肝硬化PHC直径<1 cm的不同分化程度。     

Amino Acid Neurotransmitter Receptor Changes in Cerebral Cortex in Alcoholism: Effect of Cirrhosis of the Liver

Gamma-aminobutyric acidA/benzodiazepine receptor binding sites and the N-methyl-D-aspartate subclass of glutamate receptor sites were assessed in synaptic plasma membrane homogenates of cerebral cortex tissue obtained at autopsy from cirrhotic and noncirrhotic alcoholic patients and matched control subjects. The alcoholic patients consumed an average of greater than 80 g of ethanol/day, the control subjects less than 20 g/day. Postmortem delays up to approximately 100 h caused no significant loss of any of the binding sites; the patient and subject groups were closely matched for age. The affinities (KD) of the receptor sites did not differ between the patient and subject groups, nor between cortical regions. Using three different radioligands ([3H]muscimol, [3H]flunitrazepam, and [3H]diazepam), the gamma-aminobutyric acidA/benzodiazepine receptor complex was found to have greater density (Bmax) in superior frontal gyrus in alcoholic patients (which selectively shows morphological change in alcoholic patients), but was unchanged in motor cortex. Alcoholic patients with cirrhosis had much less pronounced changes. The density of the N-methyl-D-aspartate subclass of glutamate receptors, assessed with [3H]MK-801, did not vary across patient and subject groups.     

熊去氧胆酸联合非诺贝特对原发性胆汁性胆管炎的临床疗效及安全性

摘要 目的：分析熊去氧胆酸联合非诺贝特对原发性胆汁性胆管炎无熊去氧胆酸生化反应的临床疗效及安全性。方法：151例原发性胆汁性胆管炎无熊去氧胆酸患者按随机数表法分为73例对照组和78例研究组。对照组在常规治疗基础上给予安慰剂联合熊去氧胆酸治疗,研究组在常规基础上给予非诺贝特联合熊去氧胆酸治疗,两组均持续治疗12个月。比较两组临床疗效,肝功能,血脂指标,肝纤维化指标,免疫球蛋白G（IgG）、免疫球蛋白M（IgM）,瘙痒及乏力评分,不良反应发生情况。结果：治疗后,研究组总有效率高于对照组,比较差异有统计学意义（P<0.05）。治疗后,两组肝功能指标均降低,研究组低于对照组,比较有统计学意义（P<0.05）。治疗后,两组总胆固醇（TC）、甘油三酯（TG）均降低,研究组低于对照组,比较有统计学意义（P<0.05）,两组治疗前后低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）比较无统计学意义（P>0.05）。治疗后,两组肝纤维化指标均降低,研究组低于对照组,比较有统计学意义（P<0.05）。治疗后,两组IgG、IgM均降低,研究组低于对照组,比较有统计学意义（P<0.05）。治疗后,两组瘙痒、乏力评分均降低,研究组低于对照组,比较有统计学意义（P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论：熊去氧胆酸联合非诺贝特对原发性胆汁性胆管炎无熊去氧胆酸生化反应的疗效较好,能够改善肝功能,且未明显增加药物不良反应。     

失代偿期肝硬化患者感染的危险因素及临床特点分析

目的：分析失代偿期肝硬化患者感染的相关危险因素和临床特点。方法：回顾性分析我院2012年4月--2013年4月住院的197例肝硬化失代偿期患者,比较感染患者与非感染患者的年龄、性别、肝功能分级、白细胞水平、门静脉内径、肝硬化并发症、侵入性操作措施、应用抗菌药物、住院时间等差异。结果：197例患者中发生感染的56例,其中以呼吸道和腹部感染为主。统计发现肝功能分级、白细胞水平、侵入性操作、住院时间及抗菌药的运用等与感染因素有关（P〈0．05）。结论：引起失代偿期肝硬化感染的危险因素是多方面的,临床特点也较突出,需要我们采取防措施去避免。     

双歧杆菌四联活菌片对肝硬化白发性细菌性腹膜炎患者肠黏膜屏障和炎症因子的影响

目的探讨双歧杆菌四联活菌片对肝硬化自发性细菌性腹膜炎（SBP）患者肠黏膜屏障和炎症因子的影响。方法选择乙肝后肝硬化SBP患者68例,分为治疗组和对照组。两组患者均予以低盐饮食、护肝利尿、补充白蛋白和抗感染等基础治疗。治疗组在此基础上予以双歧杆菌四联活菌片口服,1．5g／次,3次／d,连用6周。结果治疗6周后,两组血浆内毒素、PCT和尿L／M比值比较均有明显下降（对照组比较P〈0．05,或治疗组比较P〈0．01）,且治疗组下降幅度明显优于对照组（P〈0．05）;两组血浆TNF-α、IL-6和IL-10水平均有明显下降（对照组比较P〈0．05,或治疗组比较P〈0．01）,且治疗组下降幅度明显优于对照组（P〈0．05）。治疗组临床总有效率明显高于对照组（χ2=8．17,P〈0．01）,治疗期间未发生严重的药物不良反应。结论双歧杆菌四联活菌片治疗肝硬化SBP患者具有较好的临床疗效及安全性,对患者肠黏膜屏障功能具有良好保护和改善作用,并能下降血浆TNF—α、IL-6和IL-10水平,具有辅助治疗肝硬化作用。     

CT灌注成像在兔早期肝硬化诊断中的应用价值研究

目的:探讨CT灌注成像在兔早期肝硬化诊断中的应用价值。方法:将55只新西兰大白兔随机分为2组,其中实验组45只,对照组10只。实验组给予皮下注射葡萄籽油稀释的50%CCL4,1次/4天,前4次剂量为1.0 m L/kg,第5次剂量为1.35 m L/kg,共注射20次。对照组采用同样方法只注射相同剂量的生理盐水。每注射4次后分别对实验组兔7只和正常对照组兔2只做螺旋CT灌注扫描,分析灌注参数,同时做相应的病理学观察,将二者进行比较及统计学分析。结果:注药4次末,兔血清ALT及AST明显高于注药前,注药8次末,兔血清ALT及AST最高,之后兔血清ALT及AST轻度减低,注药前后兔血清ALT及AST的变化有统计学意义(P0.05)。而血清(ALB)水平变化不明显,仅在注药16次末后,ALB水平稍减低,但差异无统计学意义。对照组肝脏灌注参数正常,实验组从注药4次开始,HAP呈上升趋势,但注药4次末及注药8次末,实验组及对照组之间差异无统计学意义(P0.1),注药12次末后二者之间差异有统计学意义(P0.05);而HPP、HBF及HBV呈下降趋势,MTT逐渐延长,与对照组的差异均有统计学意义(P0.05)。随兔血清ALT及AST的升高,HAP逐渐升高,MTT逐渐延长,而HPP、HBF及HBV逐渐减低。实验组肝小叶正常结构破坏,肝实质被纤维组织分割成大小不一、圆形或近圆形结节(假小叶),间隔较窄,炎症轻,结节边界尚整齐;汇管区内门脉小支扩张,壁增厚。对照组肝小叶结构规整,肝板排列有序,汇管区无扩大,其内个别炎细胞浸润,肝小叶内偶见点灶状坏死。结论:全肝CT灌注功能成像可为早期肝硬化的诊断提供影像学依据,将灌注征象与病理学变化结合有利于肝硬化的早期诊断和治疗。     

人类免疫缺陷病毒/丙型肝炎病毒混合感染者免疫细胞和肝生化指标的分析

目的 探讨人类免疫缺陷病毒/丙型肝炎病毒(HIV/HCV)混合感染者的免疫淋巴细胞亚群和肝脏生化指标的特征。方法 检测并分析研究组(40例混合感染HIV/HCV的血友病患者)和对照组(12例单独感染HIV的血友病患者)若干相关实验室指标。结果两组(研究与对照)结果 差异显著的指标分别为:自然杀伤(NK)细胞9.26%±5.98%对12.19%±5.80%,P<0.05;CD4/CD8细胞比值0.39±0.21对0.53±0.24,P<0.05;CD3细胞74.99%±10.33%对68.42%±8.82%,P<0.05;CD8细胞52.28%±12.59%对43.58%±10.99%,P<0.05;丙氨酸氨酶(ALT)(48.59±40.21)U/L对(26.87±27.23)U/L,P<0.01;天冬氨酸转氨酶(AST)(61.66±51.02)U/L对(34.17±30.24)U/L,P<0.001;谷氨酰转肽酶(GGT)(136.50±111.50)U/L对(43.88±36.17)U/L,P<0.001;甘胆酸(CG)(683.41±962.22)μg/L对(250.96±290.81)μg/L,P<0.001;透明质酸(HA)(180.94±196.69)ng/ml对(64.68±32.74)ng/ml,P<0.001;白/球蛋白(A/G)比值1.35±0.24对1.50±0.34,P<0.05。与单独HIV感染者比较,HIV/HCV混合感染者的NK细胞、CD4/CD8细胞比值和A/G比值显著降低,而ALT、AST、GGT、CG和HA的水平显著增加。结论 HIV/HCV混合感染可能加剧患者淋巴细胞亚群的不平衡,加重肝脏损伤和出现肝硬化趋势。     

Effects of protein deficiency on liver trace elements and antioxidant activity in carbon tetrachloride-induced liver cirrhosis

In liver cirrhosis, liver tissue becomes progressively substituted by fibrosis, ultimately leading to architectural distortion, liver circulatory changes, and liver failure. Some data support the hypothesis that protein undernutrition may play a role in the development and progression of nonalcoholic liver cirrhosis and that this progression is at least partially mediated by changes in glutathione peroxidase (GPX), superoxide dismutase (SOD), and other antioxidative systems, leading to an increase in lipid peroxidation. We analyzed the effects of protein deficiency on liver Cu, Fe, Zn, Mn, and Se in carbon tetrachloride (CCl₄)-induced liver cirrhosis, the relation of protein undernutrition and these trace elements with the activity of some hepatic antioxidative enzymatic mechanisms, and the relation of all of them with morphological and biochemical changes in 40 male adult Sprague-Dawley rats divided in four groups. Liver cirrhosis was induced by intraperitoneal injection of CCl₄ to 10 rats fed a 2% protein diet and another 10 fed a 18% protein control diet; two further groups included rats without cirrhosis fed the 2% protein and the 18% protein diets. The study period lasted 6 wk. GPX, SOD, and lipid peroxidation products as well as Zn, Cu, Mn, Se, and Fe were determined in liver samples. We found that liver GPX and Se were reduced in the cirrhotic animals, especially in the low-protein-fed ones, protein deficiency, but not cirrhosis, exerting the main effects. A close correlation was found between liver GPX and serum albumin and weight loss and an inverse one among GPX and hepatocyte ballooning, liver fibrosis, and fat, histomorphometrically determined. These results suggest a pathogenetic role of decreased GPX in the progression of liver disease, which may become enhanced by concomitant protein undernutrition. In addition to iron, the levels of which were increased in the malnourished rats, no differences were found regarding the other trace elements, SOD activity, and lipid peroxidation products.