异甘草酸镁注射液治疗抗结核药物所致急性肝损伤的临床研究

本文旨在研究用异甘草酸镁注射液治疗抗结核药物所致急性肝损伤的有效性和安全性。采用随机、双盲、阳性药平行对照设计,入选者为初治肺结核常规抗结核治疗中发生急性肝功能损伤的患者,试验组采用异甘草酸镁注射液治疗,与对照组（硫普罗宁注射液）进行比较。结果显示,异甘草酸镁注射液在降低主要疗效指标---肝功能综合疗效指标、丙氨酸氨基转移酶（ALT）等方面明显优于对照组（P＜0．01）,在降低天冬氨酸氨基转移酶（AST）、碱性磷酸酶（AKP）等方面也优于对照组（P＜0．05）,且未发生明显不良反应。本研究提示,异甘草酸镁注射液在治疗抗结核药物引发的急性肝损伤中安全、有效。     

中国人群肝癌的易感基因研究

以单核苷酸多态性（single nucleotide polymorphism,SNP）为遗传标记的遗传关联研究是近年来鉴定复杂疾病易感基因的主要策略之一.尤其是新近发展成熟的全基因组关联研究（genome-wide association study,GWAS）,已被公认是行之有效的系统搜寻重大疾病易感基因的研究方法.军事医学科学院与国内同行合作开展的HBV相关肝癌GWAS结果表明,1p36.22的UBE4B-KIF1B-PGD区域是一个全新的肝癌易感基因区域,证明了遗传易感性在肝癌发生发展中的病因学意义.肝癌易感基因的发现,不仅为深入阐明肝癌的发生机制开辟了新的研究方向,而且为肝癌的风险预测和早期预警研究提供了理论依据;同时,也为后续开发新型的治疗药物奠定了基础.     

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。     

强直性脊柱炎易感基因的研究进展

强直性脊柱炎（ankylosing spondylitis,AS）是一种常见的高度遗传的风湿类疾病。至20世纪70年代以来,越来越多的证据表明HLA-B27是AS最主要的易感基因。然而,全基因组扫描和关联分析等研究发现在HLA以外的区域仍存在AS的易感区域,大量的证据显示在HLA区内外有许多基因与AS的发病有关。文章主要综述了与AS相关的易感基因以及它们的研究现状。     

精神分裂症易感基因GULP1与中国人群大脑容量的相关性研究

精神分裂症是一种复杂的精神疾病,全世界约有1%的人患有这种疾病。以往的研究发现精神分裂症患者的脑容量比正常人小,且一些精神分裂症易感的DNA序列多态性也同时与脑的结构异常有关,这与精神分裂症的神经发育假说是吻合的。最近研究发现人的GULP1基因的两个SNP（rs2004888和rs4522565）与精神分裂症显著相关。为了研究这两个精神分裂症易感的SNP是否也符合神经发育假说,我们检测了791个正常人的这两个SNP的基因型并测量它们的脑容量,相关性分析发现这两个SNP和脑容量无关,说明GULP1的精神分裂症易感性存在更加复杂的机制。     

精神分裂症易感基因DKK4与中国人群大脑容量的相关性

精神分裂症是一种复杂的精神疾病,全世界约有1%的人患有这种疾病。以往的研究发现,精神分裂症患者的脑容量比正常人小,且一些精神分裂症易感基因的DNA序列多态性也同时与脑的结构异常有关,这与精神分裂症的神经发育假说是吻合的。最近研究发现,人的DKK4基因的SNP(rs2073665)与精神分裂症显著相关。为了研究DKK4精神分裂症易感SNP是否与脑发育相关,本文检测了961个正常人rs2073665的基因型并测量了他们的脑容量。相关性分析发现,rs2073665在加性模型下和显性模型下都与脑容量存在显著相关性,这为精神分裂症易感基因同时能影响脑容量提供了证据,同时也为精神分裂症的神经发育异常假说提供了佐证。     

分枝杆菌膜蛋白相关抗结核药物靶标的研究进展

结核病是由结核分枝杆菌引起的慢性传染病。当前结核病耐药等问题愈加严重,基于新靶点的抗结核新药研发也变得尤为重要。分枝杆菌膜蛋白是镶嵌于细胞膜磷脂双层或与脂双层结合的一类蛋白,参与细胞结构合成、物质跨膜转运、催化等重要的生物学功能,并在宿主感染中参与免疫识别、免疫逃逸、毒力因子释放等致病机制。另一方面,膜蛋白具有特定的拓扑结构和细胞定位,药物靶标可及性强,因此膜蛋白是抗结核药物作用的理想靶标。本文就分枝杆菌膜蛋白在细胞壁合成、物质跨膜转运、细菌休眠、细菌与宿主互作及分泌系统相关研究进展进行综述,旨在为抗结核药物研发提供新思路。     

中国汉族高原肺水肿易感基因的全基因组关联研究

高原肺水肿(High-altitude pulmonary edema, HAPE)是一种特发于高原低氧环境的肺水肿, 是遗传和环境因素共同作用的结果。为了寻找与中国汉族高原肺水肿相关的单核苷酸多态性(Single nucleotide polymorphism, SNP)位点及易感基因, 文章利用Affymetrix SNP Array 6.0芯片, 对2010年5月至2012年7月在青海省玉树地区执行援建任务时来自平原地区的40例HAPE患者和33例健康对照进行全基因组SNP分型, 通过PLINK软件对芯片结果进行全基因组关联分析(Genome-wide association study, GWAS), 筛选出在病例组和对照组中间有显著差异(P < 10E-7)的SNP位点57个, 通过对57个SNP位点附近74个基因进行GO与Pathway富集分析, 发现这些基因与“前列腺素代谢”、“四烯酸代谢”、“氮代谢”显著相关(adjust P < 0.05), 以上代谢过程与HAPE病理生理机制相关。结果表明, 高原肺水肿受遗传多态性影响, 与多个基因以及位点相关。     

中国人群食管鳞状细胞癌多个易感基因位点获确认

由中国医学科学院北京协和医学院肿瘤医院肿瘤研究所林东听教授领衔的食管鳞状细胞癌易感基因研究获重大突破。林东听研究组通过全基因组关联分析,鉴别出多个中国人群食管鳞状细胞癌易感基因位点,并分析了相关基因与环境的互作关系。     

一个中国Gilbert综合征家系的遗传学分析

对一个中国汉族Gilbert综合征遗传家系致病基因突变位点进行鉴定,以期了解该病的分子遗传学基础。首先提取先证者基因组DNA,PCR扩增尿苷二磷酸葡萄糖醛酸转移酶UGT1A1基因的5个外显子,以琼脂糖电泳鉴定PCR产物,纯化后直接测序鉴定。基因扫描显示,与血清胆红素水平密切相关的UGT1A1基因在第1和第5外显子存在纯合突变,而 UGT1A1基因启动子区域和内含子/外显子剪接边界位点序列未检测到突变。进一步对其他家系成员该基因的相应位点进行突变检测,结果显示他们在第1和第5外显子也存在杂合突变,其中还有两个成员在启动子区域检测到(TA)插入突变。对家系成员未抗凝新鲜血液进行生化检测证实了基因突变分析的结果。综合以上结果发现该家系三种突变并存,致病因素为第1和/或第5外显子突变,为显性遗传,两种突变位点纯合导致先证者出现严重胆红素代谢功能障碍。该家系因此成为Gilbert综合征突变位点及其致病机理研究的一个典型临床病例。     

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.     

Two genetic variants in FABP1 and susceptibility to non-alcohol fatty liver disease in a Chinese population

Liver fatty acid-binding protein (FABP1) serves as a key regulator of hepatic lipid metabolism, and polymorphisms within the FABP1 gene have been associated with several metabolic traits. To investigate the association between FABP1 polymorphisms and the risk of non-alcohol fatty liver disease (NAFLD) in a Chinese population, the genotypes and haplotypes of FABP1 (rs2241883 T/C and rs1545224G/A) were determined in 553 patients with NAFLD and 553 healthy controls. The results showed that individuals with at least one copy of the rs2241883 C allele (TC or CC genotype) had an elevated risk for developing NAFLD (odds ratio [OR]=1.32, 95% CI: 1.01-1.71), and individuals with at least one copy of the rs1545224 A allele (GA or AA genotype) also had a significantly increased risk for NAFLD (OR=1.52, 95% CI: 1.14-2.02). Cumulative effect analysis of the two SNPs revealed that individuals with two risk genotypes were at significantly higher risk of NAFLD than those without risk genotype, and a significant trend of increased risk with increasing numbers of risk genotype was observed. Stratification analysis showed that the rs2241883 C allele carriers had higher level of LDL-C and the rs1545224 A allele carriers had higher level of FPG than those without this allele. In addition, haplotype analysis revealed that the one composed of the rs1545224 A and rs2241883 C variants was significantly associated with an increased risk for NAFLD (OR=1.34; 95% CI=1.05-1.40) compared to the GT haplotype. Taken together, the present study suggests that genetic variations within FABP1 influence susceptibility to NAFLD independently or jointly.     

Incidence, clinical features and impact on anti-tuberculosis treatment of anti-tuberculosis drug induced liver injury (ATLI) in China

Background

Anti-tuberculosis drug induced liver injury (ATLI) is emerging as a significant threat to tuberculosis control in China, though limited data is available about the burden of ATLI at population level. This study aimed to estimate the incidence of ATLI, to better understand its clinical features, and to evaluate its impact on anti-tuberculosis (TB) treatment in China.

Methodology/Principal Findings

In a population-based prospective study, we monitored 4,304 TB patients receiving directly observed treatment strategy (DOTS) treatment, and found that 106 patients developed ATLI with a cumulative incidence of 2.55% (95% Confidence Interval [CI], 2.04%–3.06%). Nausea, vomiting and anorexia were the top three most frequently observed symptoms. There were 35 (33.02%) ATLI patients with no symptoms, including 8 with severe hepatotoxicity. Regarding the prognosis of ATLI, 84 cases (79.25%) recovered, 18 (16.98%) improved, 2 (1.89%) failed to respond to the treatment with continued elevation of serum alanine aminotransferase, and 2 (1.89%) died as result of ATLI. Of all the ATLI cases, 74 (69.81%) cases changed their anti-TB treatment, including 4 (3.77%) cases with medication administration change, 21 (19.81%) cases with drugs replacement, 54 (50.94%) cases with therapy interruption, and 12 (11.32%) cases who discontinued therapy. In terms of treatment outcomes, 53 (51.46%) cases had TB cured in time, 48 (46.60%) cases had therapy prolonged, and 2 (1.94%) cases died. Compared with non-ATLI patients, ATLI patients had a 9.25-fold (95%CI, 5.69–15.05) risk of unsuccessful anti-TB treatment outcomes and a 2.11-fold (95%CI,1.23–3.60) risk of prolonged intensive treatment phase.

Conclusions/Significance

ATLI could considerably impact the outcomes of anti-TB treatment. Given the incidence of ATLI and the size of TB population in China, the negative impact is substantial. Therefore, more research and efforts are warranted in order to enhance the diagnosis and the prevention of ATLI.     

4-羟基苯并恶唑-2-酮对四氯化碳致小鼠急性肝损伤保护作用

日的研究4一羟基苯并恶唑-2-酮（4-hydroxy-2-benzoxazolone,HBOA）对四氯化碳所致小鼠急性肝损伤的保护作用,并探讨其疗效机制。方法采用腹腔注射四氯化碳（carbonte trachloride,cch）制备小鼠急性肝损伤模型,HBOA灌胃给药,检测小鼠血清中的乳酸脱氢酶（LDH）活性以及肝组织中过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH-Px）含量,并用免疫组化法观察肿瘤坏死因子（TNF-a）的表达情况。结果HBOA能明显降低CCh致急性肝损伤小鼠血清LDH活性,同时升高肝组织中CAT、GSH-Px的活性并降低肝组织中TNF-a的表达。结论HBOA对CCh所致小鼠急性肝损伤有一定的保护作用。     

Protective effect of zinc on liver injury induced byd-galactosamine in rats

The protective effects of zinc on liver injury induced byd-galactosamine (GalN) were investigated in rats in vivo and in vitro. Zinc supplementation (50 mg/kg/d) for 5 d of rats treated with GalN (1.5 g/kg, ip) could reduce their mortality rate, restore liver pathomorphological changes, maintain zinc content, inhibit the lipid peroxidation, hasten the protein synthesis, and improve liver function. In vitro, zinc supplement could abate the death of GalN-intoxicated hepatocytes, decrease malonaldehyde (MDA) content, and maintain reduced glutathione (GSH). It is concluded that zinc has protective effects on GalN-induced liver damage. Its effects may be owing to inhibition of lipid peroxidation and hastening of protein syntheses.