拉米夫定治疗失代偿期乙型肝炎肝硬化的临床研究

目的：研究拉米夫定对失代偿期乙型肝炎肝硬化的,临床疗效和安全性。方法：28例乙型肝炎肝硬化患者给予拉米夫定100mg／d口服,连用24个月,设立对照组。在治疗开始前、治疗开始后6个月、12个月和24个月分别记录ChadPugh得分,并进行肝功能、肝纤维化标志物、HBV血清标志物以及血清HBVDNA定量检测。结果：28例肝硬化患者拉米夫定治疗后,血浆白蛋白显著升高,血清丙氨酸转氨酶和胆红素明显降低,血清Ⅲ型前胶原、Ⅳ型胶厚、层粘连蛋白和透明质酸水平较治疗前显著降低。血清HBVDNA阴转率明显高于对照组（P〈0．005）,HBVDNA水平较治疗前显著降低。治疗组Child—Pugh计分平均降低2．5,54．2％患者提高了分级（12例从B到A,1例从C到B）,而对照组仅有10．5％的患者QlildPugh分级得到了改善,治疗组显著高于对照组（P〈0．01）。不良反应的发生率为32．1％（9／28）。结论：拉米夫定能使HBV复制指标阳性的活动性肝硬化患者的病毒复制受到抑制,肝功能改善,肝纤维化程度降低,病情缓解。应用拉米夫定治疗肝硬化患者安全可靠。     

脐血干细胞治疗失代偿期肝硬化的疗效及对门静脉血流动力学的影响

目的:观察脐血干细胞治疗失代偿期肝硬化的疗效及对门静脉血流动力学的影响。方法:选取30例失代偿期肝硬化患者,用负收集法分离提取脐带血干细胞,经股动脉穿刺插管,从肝固有动脉缓慢注入。同时选择20例失代偿期肝硬化患者,分别于治疗前,治疗后1周、1个月、3个月、6个月观察肝功能、凝血指标、AFP、CT肝脏容积、门静脉血流动力学等指标。结果:干细胞治疗组与对照组同期比较:白蛋白治疗后4、12、24周明显改善,PT治疗后12、24周降低;AFP治疗后4、12、24周升高;两组患者治疗前后门静脉血流动力学参数变化差异无统计学意义;肝脏体积治疗组与对照组同期比较,肝脏体积有增大趋势但差异无统计学意义;治疗组1例第10周确诊为原发性肝细胞癌,与对照组比较差异无统计学意义。结论:脐血干细胞治疗失代偿期肝硬化可以改善肝脏的合成功能,促进肝组织再生,有新生血管重建情况发生,未发现门静脉血流动力参数的改变。     

胆碱酯酶在乙肝肝硬化患者肝脏储备功能的评估应用

目的:研究胆碱酯酶(CHE)在评估乙肝肝硬化患者肝脏储备功能中的应用价值。方法:收集501例肝硬化患者病例,并根据肝脏功能进行Child分级。应用全动自动生化分析仪,以酶速率比色法检测胆碱酯酶(CHE),溴甲酚绿法检测白蛋白(ALB),凝固法检测凝血酶原时间(PTs)。应用方差分析,研究胆碱酯酶(CHE)在不同CHILD分级组别中的肝功能评价意义。应用相关分析方法,比较胆碱酯酶(CHE)与其他肝脏合成指标白蛋白(ALB)、凝血酶原时间(PTs)的相关性。结果:肝硬化患者在严格Child-Pugh分级标准划分而成的ABC三级中,各级胆碱酯酶(CHE)活性逐级明显下降,分别为5469.04±1777.31 U/L(Child A),2935.08±1206.95 U/L(Child B),1810.40±724.72 U/L(Child C),且结果差异有显著意义(F=261.114,P=0.000)。在肝硬化患者中,胆碱酯酶(CHE)与白蛋白(ALB)总体正相关、与凝血酶原时间(PTs)总体负相关。其中Child A级患者中,CHE与ALB成正相关,与PTs负相关。Child B级患者中,CHE与PTs负相关,但与ALB无显著相关性。Child C级患者中,CHE与ALB正相关,但与PTs无显著相关性。结论:胆碱酯酶(CHE)与肝硬化患者肝细胞损害的严重程度相关,可反映肝脏的储备功能,与白蛋白(ALB)、凝血酶原时间(PTs)有同样重要的价值。     

脐血干细胞静脉输注治疗失代偿期肝硬化1例并文献复习

目的:探讨脐血干细胞静脉输注对失代偿期肝硬化的临床治疗效果.方法:患者为慢性重症肝炎、肝硬化失代偿期,采用脐血干细胞静脉输注治疗共2次,治疗后半年观察血清转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、r-谷氨酰转肽酶(GGT)、白蛋白(ALB)、总胆红素(TBIL)、结合胆红素(DBIL)、非结合胆红素(IBIL)、凝血酶原时间(PT)水平变化,同时观察临床症状、体征改善情况.结果:各项实验室指标逐渐正常,腹水消退,临床症状明显改善.结论:脐血干细胞静脉输注治疗失代偿期肝硬化安全、简便、有效.     

脐带间充质干细胞治疗儿童重型免疫性血小板减少症的探索性研究

目的探讨脐带间充质干细胞（UC-MSC）输注治疗儿童重型免疫性血小板减少症（s ITP）的疗效及安全性。方法采用UC-MSC治疗儿童s ITP 3例。发病年龄为3个月至4岁,初治时血小板计数为（1-7）×10^9/L,3例均为s ITP,均出现严重出血,激素及免疫抑制剂无效或依赖。后给予2-3次（1次/周）静脉输注非血缘UC-MSC,输注细胞量为（1-2）×10^6/kg。输注后密切监测血象及肝肾功能等各项指标,观察疗效及不良反应。结果随访时间15-45个月,3例在输注细胞后渐显效：第1例在输注细胞后20 d血小板达到65×10^9/L,随访4个月,血小板均维持在1×10^11/L以上;第2例在输注细胞后41 d血小板达105×10^9/L,之后血小板一直维持正常;第3例在输注第2次细胞后血小板渐上升至2×10^11/L以上。输注过程中1例出现面色发红,1例出现血压升高,随访至今无明显不良反应。结论 UC-MSC对儿童重型ITP有一定的疗效,能提高儿童的生活质量;有必要扩大病例数,进一步研究UC-MSC治疗儿童ITP的疗效及机制。     

发酵乳对肝硬化失代偿期患者肠黏膜屏障功能的影响

目的 观察发酵乳在改善肝硬化失代偿期患者肠黏膜屏障功能、肝功能及提高患者生活质量方面的作用。方法 选择我院78例确诊为肝硬化失代偿期的患者,随机分成对照组和发酵乳组,其中对照组42例,发酵乳组36例。对照组患者给予常规综合治疗,发酵乳组在常规综合治疗的基础上给予口服发酵乳治疗,在治疗前及治疗4周后分别检测并比较两组患者肠黏膜屏障功能、血清白蛋白、血浆氨水平及慢性肝病问卷评分（CLDQ）的变化。结果 治疗前两组患者肠屏障功能、血清白蛋白、氨水平及CLDQ评分差异无统计学意义（均P>0.05）。治疗4周后,发酵乳组患者血清内毒素、血清二胺氧化酶、D-乳酸及血浆氨水平较治疗前显著降低,较对照组治疗后亦降低（均P<0.05）。发酵乳组患者血清白蛋白水平及部分CLDQ评分较治疗前显著升高,较对照组治疗后亦升高（均P<0.05）。结论 在常规综合治疗的基础上加用发酵乳可调节肝硬化失代偿期患者肠道菌群,改善肠黏膜屏障功能,从而保护肝脏功能,提高患者生活质量。     

自体干细胞移植治疗胆汁性肝硬化的临床疗效及对患者肝脏弹力硬度、血清TGF-β1、SIL-2R水平的影响

目的:探讨自体干细胞移植治疗胆汁性肝硬化的临床疗效及对患者肝脏弹力硬度、血清转化生长因子-β1(TGF-β1)、可溶性白细胞2受体(SIL-2R)水平的影响。方法:选取2015年1月至2017年8月于我院就诊90例的胆汁性肝硬化患者作为本研究对象,采用随机数表法将其分为观察组和对照组,每组45例。对照组给予熊去氧胆酸胶囊、多烯磷酯酰胆碱胶囊、复方甘草酸苷片等常规治疗,连续治疗24周;观察组在和对照组相同方法治疗4周后,进行自体干细胞移植治疗。比较两组的临床疗效、治疗前和治疗后24周的肝功能、肝脏弹力硬度值、血清TGF-β1、SIL-2R水平的变化及不良反应的发生情况。结果:治疗后,观察组临床疗效总有效率为86.67%(39/45),明显高于对照组[66.67%(30/45)](P0.05)。两组治疗后血清碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)较治疗前均显著降低(P0.05),且观察组血清ALP、GGT、ALT、AST、TBil水平均明显低于对照组(P0.05)。两组治疗后肝脏弹力硬度值较治疗前均明显降低(P0.05),且观察组肝脏弹力硬度值明显低于对照组[(6.20±1.05) kPa vs.(7.33±1.27) kPa](P0.05)。两组治疗后血清TGF-β1、SIL-2R水平较治疗前均明显降低(P0.05),且观察组血清TGF-β1、SIL-2R水平均明显低于对照组[(7.40±1.21)ng/mL vs.(9.23±1.49)ng/mL,(130.45±11.03)ng/L vs.(162.93±15.62)ng/L](P0.05)。两组不良反应总发生率分别为11.11%(5/45)、15.56%(7/45),组间比较差异无统计学意义(P0.05)。结论:自体干细胞移植治疗胆汁性肝硬化患者的临床效果显著,可有效改善患者肝功能、肝脏弹力硬度值,降低血清TGF-β1、SIL-2R的表达,且安全性高。     

双歧杆菌三联活菌肠溶胶囊对慢性乙型肝炎后肝硬化患者肝功能及血清细胞因子水平的影响

目的探讨双歧杆菌三联活菌肠溶胶囊对慢性乙型肝炎后肝硬化患者肝功能及血清细胞因子水平的影响。方法选取慢性乙型肝炎后肝硬化患者86例,随机分为观察组和对照组。两组患者均予以低盐饮食、保肝和营养支持等常规治疗。观察组患者加用双歧杆菌三联活菌肠溶胶囊0.42 g/次,每天3次,连用8周。对照组患者除不使用双歧杆菌三联活菌肠溶胶囊其他治疗措施同对照组。观察并比较两组患者治疗前和治疗8周后肝功能和血清细胞因子白介素(IL)-1β和肿瘤坏死因子(TNF)-α水平的变化。结果治疗8周后,两组患者丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)和总胆红素(TB)水平较前均有不同程度下降(P<0.05或P<0.01),且观察组下降程度比对照组更明显(P<0.05);同时两组患者血清IL-1β和TNF-α水平较前均有不同程度下降(P<0.05或P<0.01),且观察组下降程度比对照组更明显(P<0.05)。结论双歧杆菌三联活菌肠溶胶囊辅助治疗慢性乙型肝炎后肝硬化患者能明显降低患者肝功能指标,加速肝功能的恢复,并能下调血清细胞因子的水平,抑制肝内炎症反应,加快患者病情的恢复。     

同型半胱氨酸及甲状腺功能在他汀致冠心病患者肝功能异常中的研究

目的:研究同型半胱氨酸及甲状腺功能与他汀致冠心病患者肝功能异常的相关性。方法:服用阿托伐他汀钙(20mg,1次/日)后1-3个月肝功能正常组(ALT和AST均正常者)300例;肝功能轻度异常组(ALT或/和AST升高3倍以下者)300例;肝功能重度异常组(ALT或/和AST升高3倍以上者)300例。在转氨酶重度升高组中选取停用他汀药观察组和加用CoQ10(20mg,3次/日)治疗组各100例,对比两组转氨酶下降情况。结果:PCI术后服用他汀类药物治疗1-3个月后出现肝功能异常的冠心病患者,同型半胱氨酸水平升高,甲状腺功能降低;肝功能的异常与年龄及饮酒有相关性。转氨酶重度升高患者中,加用CoQ10治疗组较仅停药组转氨酶显著下降。结论:阿托伐他汀钙引起的冠心病患者同型半胱氨酸水平升高及甲状腺功能下降与肝功能损伤有明显相关性。CoQ10可显著降低转氨酶水平。     

脐血干细胞移植治疗失代偿期肝硬化的临床疗效

目的:探讨人脐血干细胞(umbilical cord blood stem cell,UCBSC)外周静脉移植治疗失代偿期肝硬化的临床疗效及可行性.方法:20例失代偿期肝硬化患者采用人UCBSC外周静脉移植治疗,治疗后定期观察患者血清转氨酶(ALT、AST)、总胆红素(TBIL)、白蛋白(ALB)、凝血酶原时间(PT)和纤维蛋白原(FIB)水平变化,并观察患者临床症状及体征的改善情况及不良反应.结果:UCBSC移植治疗后2周,各项肝功能指标较治疗前无显著性差异(P＞0.05);治疗后4周,除ALT和AST有所改善外(P＜0.05),其余指标无明显改善;治疗后8周各项肝功能指标均有改善(P＜0.05),12周有显著性改善(P＜0.01).治疗后4周大多数患者的临床症状有明显改善,腹水减少和双下肢浮肿减轻15例(75.0%)、乏力好转16例(80%)、食欲改善13例(65%).UCBSC移植后12周患者总体生存率为90%,其中2例患者分别在UCBSC静脉移植后4周和8周因为肝性昏迷和自发性细菌性腹膜炎而死亡.所有患者均未发现与细胞移植相关的副作用.结论:UCBSC外周静脉移植是治疗失代偿期肝硬化一种安全有效的方法,短期内可以改善失代偿期肝硬化患者肝功能及临床症状,是一种值得推荐的治疗方法.     

Effects of zinc supplementation on serum zinc and leptin levels,BMI, and body composition in hemodialysis patients

ProjectThe aim of this study was to determine the effects of zinc supplementation on serum zinc and leptin levels as well as on anthropometric status and some biochemical parameters in hemodialysis (HD) patients.ProcedureIn this randomized, double-blind, and placebo-controlled trial, sixty HD patients were randomly divided into groups to receive a daily supplement of 100 mg elemental Zn (supplemented group) or placebo (control group) for 60 days. Anthropometric measurements were taken using standard calibrated instruments. Serum zinc and leptin levels were determined by atomic absorption and ELISA method respectively before and after intervention.ResultsZinc supplementation resulted in significant increase in the mean serum zinc level in the experimental group while changes observed in the placebo group were not significant. The mean serum leptin in women part of the experimental group was decreased significantly after supplementation. After adjusting for age, BMI, body fat (%), serum zinc and dietary Zn intake, a negative and significant association was observed between serum zinc and leptin levels in all subjects (β = −0.33, P = 0.03) as a result of Zn supplementation.ConclusionsMore studies are needed to clarify the mechanisms by which serum leptin level is influenced as a result of zinc supplementation in HD patients.     

Determination of pyridinium crosslinks in serum An optimization of sample preparation

Urinary pyridinoline (UPD) and deoxypyridinoline (UDPD) are selective markers in kinetic studies of mature collagen degradation in connective tissue, especially in bone. In patients with renal dysfunction, the determination of UPD and UDPD is not entirely reliable, while in anuretic patients it is impossible. As renal dysfunction is considered a risk factor for bone diseases, it is essential to determine both markers directly in the serum (SPD and SDPD). Due to the high serum concentrations of proteins, which during acid hydrolysis are converted to amino acid hydrochlorides, the system butanol-water is sometimes separated into two phases during sample preparation. Should this fact not be taken into account, the usual sample processing on a cellulose sorbent could yield substantially lower false results. This calls for some preventive measures: to ensure the homogeneity of the system containing n-butanol it is recommended to add an appropriate third component, e.g. methanol.     

Iodine Deficiency Among Hypothyroid Patients Living in Jeddah

The objective was to determine the prevalence of iodine deficiency among hypothyroid patients and the effect of dietary goitrogens on indices of iodine and thyroid status. This is a case-control study of 106 subjects who were recruited from King Abdulaziz University Hospital, Jeddah. Blood and urine were collected for serum thyroid hormones, thyroid autoantibodies, thyroglobulin (Tg) and urinary iodine concentration (UIC). Dietary iodine and goitrogenic food intake were assessed by questionnaire. Using World Health Organization (WHO) cutoff values for UIC, both controls and cases were iodine deficient (85% and 83%, respectively). Furthermore, dietary iodine was deficient in 23% of controls and 36% of cases. In cases, there was a positive association between UIC levels and serum thyroid stimulating hormone (r = 0.405, p < 0.01) and a negative association with serum fT₄ (r = −0.358, p < 0.01). Serum Tg antibody titers were also positively associated with dietary iodine (r = 0.328, p < 0.05). Patients with elevated serum autoantibodies had lower UIC and dietary iodine than those with normal serum autoantibodies. UIC was associated with dietary goitrogens including turnip (r = 0.280, p < 0.05) and pine (r = 0.289, p < 0.05) among cases. Iodine deficiency is common and the consumption of dietary goitrogens is high among euthyroid and hypothyroid subjects living in Jeddah.     

Effect of Therapy on Serum Zinc and Copper in Primary Complex of Children

Tuberculosis is a global problem especially in children, more so because of the difficulty in the diagnosis of the disease. There are about 0.5 million deaths every year by this disease, worldwide. There are some reports that, during the disease, there are changes in serum concentrations of zinc and copper, which reach towards normal levels during treatment. Such data for children are scarce, especially in reference to India. Our study indicates that there is an insignificant to significant rise in serum zinc levels in various age groups of children after antitubercular therapy (mean 61.89 ± 3.21 to 65.24 ± 3.60 μg/dl) and significant fall in serum copper levels in different age groups of children (mean 129.96 ± 3.18 to 124.91 ± 3.48 μg/dl). The Cu/Zn ratio also changed significantly from 2.11 ± 0.12 to 1.92 ± 0.12. Because evaluation of available diagnostic criteria for primary complex in children has been found to have high sensitivity, and although this criterion is presently not recommended for diagnosis of primary complex of children, further research can prove its utility in diagnosis and treatment of this disease.     

血清胆碱酯酶与血脂的关系

通过对749例40～60岁工人SChE和血脂水平的分析,结果显示SChE与TC、TG、LDL-C和VLDL-C呈正相关,与HDL-C呈负相关,相关系数分别为0.21,0.23,0.12,0.11和-0.08。高脂血症患者的SChE活性(2271.8±650.7u/L)高于血脂正常者(1968.6±607.0u/L),但冠心病患者的SChE活性(2242.8±499.4u/L)与高脂血症组无差异。在各型高脂血症中,只有高甘油三酯血症(2241.5±623.9u/L)和混合性高脂血症患者(2561.5±704.8u/L)的SChE活性增高,而高胆固醇血症患者的SChE活性(2034.8±640.0u/L)与血脂正常者无差异(p>0.1)。提示SChE与血脂之间存在一定的联系,本文对此关系进行了讨论。     

血清胸腺因子的固相合成及抗血清的制备

通过Bpoc·Ser(tBu)·Asp·OtBu的β-羧基上树脂和依次用Fmoc·Gly·Gly·OHFmoc·Gln·ONP,Fmoc.Ser(tBu).OH,Fmoc.Lys(Boc)·OH,Fmos·Ala·OH及pGlu·OH伸长,接着氨解和酸解的策略,我们用固相方法合成了血清胸腺因子(FTS,Thymulin),pGlu·Ala·Lys·Ser·Gln·Gly·Gly·Ser·Asn;制备了具有最大生物活性的该因子和Zn~(2+)的复合物,FTS-Zn;用该复合物与牛血清白蛋白(BSA)结合所形成的免疫原免疫家兔,获得了抗FTS-Zn~(++)的抗血清,通过酶联免疫吸附分析法(ELISA)测得其滴度高达1:12800。     

血清胸腺因子(STF)的合成

本文报道了用液相法合成血清胸腺因子(STF)的结果。由于羧端L-天门冬酰胺羧基采用了对硝基苄基保护,每步均可方便地得到纯度和收率较高的中间肽结晶,最后经催化氢解温和地去除全部保护基获得有生物活性的STF纯品。     

Therapeutic effects of Typha elephantina leave’s extract against paracetamol induced renal injury in rabbits

Present study focuses on ameliorative potential of Typha elephantina leave’s aqueous (TE.AQ) extract against Paracetamol (PCM) induced toxicity in rabbits. We fed the male rabbits with 300 mg PCM in alone and in combination with TE.AQ at different doses i.e. (100, 200 and 300 mg/kg body weight) or silymarin (100 mg/kg) daily for 21 days. PCM in alone significantly (P < 0.5) increased serum urea, uric acid, creatinine, total protein, albumin, globulin and blood urea nitrogen. Serum sodium, potassium and magnesium level were high. The glutathione, radical scavenging activity and Thiobarbituric acid reactive substances were significantly reduced. Treatment with TE.AQ at dose rate 300 mg/kg body weight and Silymarin significantly ameliorated all the parameters when compared with PCM administered group. The 100 and 200 mg of TE.AQ showed no significant effects. The histopathological examination confirmed the therapeutic potential of TE.AQ. These results established the presence of natural antioxidants in Typha elephantina leaves.     

原发性肝癌:CT血液供应、P53抗体和血管内皮生长因子

目的:分析原发性肝癌(primary hepatic carcinoma,简称肝癌)血液供应(blood supply,简称血供)CT类型与患者血清P53抗体、血管内皮生长因子(vascular endothelial growth factor,VEGF)的关系,以及血清P53抗体与VEGF的相关性.方法:用酶联免疫吸附法定量检测首诊肝癌患者血清P53抗体和VEGF,与CT诊断的血供类型结果进行对比,分析不同血供类型的肝癌是否存在血清P53抗体差异(单因素分析),并分析不同血供类型的肝癌血清VEGF是否存在差异(单因素分析),然后分析血清P53抗体和VEGF之间的相关性.结果:四种不同血供类型的肝癌之间血清P53抗体滴度有差异(P<0.05).值得注意的是,富血供型与混合型之间、动-静脉漏型(AVS)与混合型之间血清P53抗体有显著差异(P<0.05),富血供型与AVS型之间血清P53抗体没有显著差异(P>0.05).不同血供类型的肝癌中,富血供型和混合型血清P53抗体与VEGF呈正相关(P<0.05),而AVS型和乏血供型中,血清P53抗体与VEGF不呈直线相关(P>0.05).结论:血清P53抗体和血清VEGF滴度在血供不同肝癌中滴度有差异,在富血供型和混合型中血清P53抗体与VEGF滴度呈正相关.     

Biological Rhythms of Biochemical Serum Parameters in a Brazilian Population: a Three‐Year Study

A marked decrease in analytical and post‐analytical variability has been achieved in clinical laboratories by the use of automated analytical systems. Current studies are now focused on the origin of pre‐analytical variability, such as that due to intra‐individual differences and biological rhythms. The objective of this work was to evaluate the occurrence of biological rhythms in several biochemical serum parameters in a Brazilian population. A retrospective study (1996 to 1998) was carried out to collect the test results within the reference intervals of adults, from 21 to 50 yr of age (average age of 36 yr) attending the outpatient clinics of the Teaching Hospital at the University of Campinas, São Paulo, Brazil. The reference sample was 52.9% male and 47.1% female and encompassed 15,036 calcium, 7,478 phosphorus, 53,641 urea, 58,315 creatinine and 6,433 uric acid determinations (140,903 in total). Significant annual rhythms were detected in serum calcium (p≤0.001), with maximum and minimum values in fall and spring, and in serum creatinine (p≤0.002), with maximum and minimum values in summer and winter. The other parameters did not present significant annual rhythmicity. The seasonal rhythms present in the serum concentrations of calcium and creatinine observed in this large population study, although of small amplitude, should be considered a component of the pre‐analytical variation of these clinical laboratory tests.