S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁/焦虑的临床效果研究

目的:研究S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁/焦虑患者的临床效果。方法:选择2011年3月~2013年3月我院收治的51例不同病因的胆汁淤积性肝病(药物性肝损害13例、慢性乙型肝硬化14例、酒精性肝硬化11例、自身免疫性肝病6例、肝癌5例、胆管癌2例)并抑郁/焦虑的患者,予S-腺苷蛋氨酸1.0 g治疗2周,应用SDS/SAS量表分别评估和比较治疗前后各组患者抑郁/焦虑程度的评分情况。结果:S-腺苷蛋氨酸治疗后,所有组别胆汁淤积性肝病肝病改善的临床总有效率94.12%,其中药物性肝损害、慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝硬化总有效率均为100.00%,肝癌的有效率为60.00%,胆管癌的有效率为50.00%,药物性肝损害患者临床疗效与其他各组有差异(P0.05);药物性肝病患者SDS和SAS评分均较治疗前显著降低(P0.05)。而慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝病、肝癌、胆管癌患者SDS和SAS评分与治疗前相比均无统计学差异(P0.05)。结论:S-腺苷蛋氨酸可改善药物性胆汁淤积性肝病并轻、中度抑郁/焦虑患者的肝功能,并有效减轻其抑郁/焦虑情绪。     

S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑的临床效果研究

目的：研究s-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑患者的临床效果。方法：选择2011年3月-2013年3月我院收治的51例不同病因的胆汁淤积性肝病（药物性肝损害13例、慢性乙型肝硬化14例、酒精性肝硬化11例、自身免疫性肝病6例、肝癌5例、胆管癌2例）并抑郁／焦虑的患者,予s-腺苷蛋氨酸1．0g治疗2周,应用SDS／SAS量表分别评估和比较治疗前后各组患者抑郁／焦虑程度的评分情况。结果：S-腺苷蛋氨酸治疗后,所有组别胆汁淤积性肝病肝病改善的临床总有效率94．12％,其中药物性肝损害、慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝硬化总有效率均为100．00％,肝癌的有效率为60．00％,胆管癌的有效率为50．00％,药物性肝损害患者临床疗效与其他各组有差异（P〈0．05）;药物性肝病患者SDS和SAS评分均较治疗前显著降低（P〈0．05）。而慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝病、肝癌、胆管癌患者SDS和SAS评分与治疗前相比均无统计学差异（P〉0．05）。结论：S-腺苷蛋氨酸可改善药物性胆汁淤积性肝病并轻、中度抑郁／焦虑患者的肝功能,并有效减轻其抑郁／焦虑情绪。     

Safety of co-administration of herbal and conventional medicines on liver and kidney function in stroke patients: A single-center retrospective study

BackgroundAlthough herbal medicines (HMs) are widely used worldwide, information concerning their interactions with conventional medicines (CMs) is sparse. In particular, stroke affects a high proportion of elderly people with impaired hepatic and renal function. Stroke is often accompanied by various complications and is commonly treated via the co-administration of HMs and CMs in Asia.PurposeWe aimed to investigate the effects of co-administration of HMs and CMs on liver and kidney function in patients with stroke. We estimated the prevalence of drug-induced liver injury (DILI) or herb-induced liver injury (HILI) and drug-induced acute kidney injury (DIAKI) or herb-induced acute kidney injury (HIAKI) in patients co-administered HMs and CMs.Study designThis was a retrospective study that reviewed the electronic medical records of 401 patients with stroke in a single hospital.MethodsThe prevalence of DILI or HILI and types of liver injury was examined according to abnormal increases in liver tests. The probable causality between drug or herb administration and liver injury was assessed using the Roussel Uclaf Causality Assessment Method. In addition, the prevalence of DIAKI or HIAKI was estimated using the Kidney Disease Improving Global Outcomes acute kidney injury stage criteria and related medical records.ResultsOut of a total of 401 patients, only four (1.0%) developed liver injury. Two cases of DILI (0.5%) and two cases of HILI (0.5%) were reported. Moxifloxacin and ebastine were the CMs that caused hepatotoxicity. Chungpyesagan-tang and Yeoldahanso-tang were the HMs that caused liver toxicity. Even in cases showing severe liver damage, alkaline phosphatase levels remained less than five times the normal value, and liver function test values recovered within 14 days. There were no cases of DIAKI or HIAKI in this cohort.ConclusionThese results suggest that if appropriately prescribed by experts, the co-administration of CMs and HMs is safe and does not adversely affect liver and kidney function in patients with stroke. To support these results, further large-scale multicenter prospective studies and toxicological studies based on the interaction between HMs and CMs are warranted.     

Drug-specific T cells derived from patients with drug-induced allergic hepatitis.

Drug-induced allergic hepatitis is a tissue-specific inflammatory disease caused by hypersensitivity to a particular drug. Although the frequency of drug-induced allergic hepatitis appears to increase in proportion to the medicine, the mechanism by which tissue specificity is determined is still to be elucidated. In this study, we established CD4+ T cell clones specific for particular drugs from patients with drug-induced allergic hepatitis accompanied with mild blood eosinophilia and analyzed the possible role of liver protein as a directing factor of liver-specific inflammatory reactions. All CD4+ T cell clones obtained from two patients with this disease proliferated in response to a combination of the particular drug plus liver specific protein (LSP), which consists of over 30 proteins. Some T cell clones were responsive to an antigenic conformation consisting of the 200-kDa glycoprotein (partly purified LSP), a component of LSP, plus the causal drug. In contrast, all CD4+ T cell clones from a patient with simple drug-induced eosinophilia responded to the causal drug in the absence of LSP and partly purified LSP. These data suggested that LSP or partly purified LSP of the appropriate Ag is the target that leads to liver-specific inflammation in drug-induced allergic hepatitis. Furthermore, T cell lines derived from patients with drug-induced allergic hepatitis and simple drug-induced eosinophilia produced large amounts of IL-5 after the appropriate antigenic stimulation, whereas CD4+ T cell clones from donors with a normal amount of peripheral blood eosinophils secreted a much less IL-5. Taken together, these results indicate that overproduction of IL-5 by the allergen-sensitized T cells may result in blood eosinophilia.     

In vivo induction of sister-chromatid exchanges in liver and marrow cells by drugs requiring metabolic activation

A highly sensitive method for the detection of in vivo induction of sister-chromatid exchange (SCE) has been developed in mice subjected to partial hepatectomy. SCE induction by either acetylaminofluorene (AAF) or cyclophosphamide, drugs requiring metabolic activation, is significantly greater in both regenerating liver and bone-marrow cells of partial hepatectomized animals than in marrow cells of unhepatectomized mice. These experiments have confirmed the ability of AAF, a well known mutagen-carcinogen, to induce SCE formation, even though the cytogenic effects of this drug on non-hepatectomized mice is very small. The in vivo system described has demonstrated the influence of the liver on drug-induced damage to extra-hepatic tissues. The procedures developed should facilitate the detection of drug-induced cytogenic damage and permit the comparison of inter-tissue differences in SCE induction with tissue-specific differences in drug-activation pathways.     

187例药源性皮肤病回顾性分析

目的探讨药源性皮肤病的一般规律和特点,为临床合理用药提供参考。方法采用回顾性研究的方法,对1996年6月～2004年12月国内医药期刊报道的药源性皮肤病187例,按性别、年龄、药物及给药途径、发生时间、发生部位、康复时间等进行统计分析。结果药源性皮肤病男性略多于女性,年龄6个月至73岁,发生时间数分钟至数天,主要发生的部位是全身反应,康复时间数小时至30天。结论临床医生、药师应了解药源性皮肤病发生的规律和特点,加强监测,以减少药源性皮肤病的发生。     

两种药物性肝炎诊断评分标准的临床应用分析

目的:比较Maria药物性肝损害(1997年)诊断标准和我国常用诊断标准对药物性肝损害的效价。方法:回顾性分析我院2005年1月至2006年4月期间经肝穿病理诊断为药物性肝损害的54例病例,分别按照上述两个标准评分。评价每一标准的准确性。结果:符合Maria药物性肝损害(1997年)诊断标准的(>10分)有45例,占83%;符合我国常用诊断标准的有39例,占72%。结论:两个诊断标准符合率较高,均可做为药物性肝损害的诊断标准,但仍有部分病例不能准确诊断,需进一步完善。     

Studies on drug-induced lipidosis. VIII. Correlation between drug accumulation and acidic phospholipids.

The effect of 4,4'-bis(beta-diethylaminoethoxy)alpha,beta-diethyldiphenylethane (DH) on lipid metabolism in the liver differed considerably in different animal species, humans, monkeys, and rats, because of differences in drug-metabolizing ability. Monkeys retain considerable drug-metabolizing ability as compared with humans, but the DH-hydroxylating activity in monkeys seems to be much lower than in rats. The hydroxyl derivative was the major substance which accumulated in rat liver following the administration of DH, while DH itself and its N-dealkylated substances accumulated in monkey liver. N-Dealkylated substances were also observed in human liver, but the amount was much smaller than in monkeys. Bis(monoacylglyceryl)phosphate (BMGP), which is characteristic of this kind of drug-induced lipidosis, did not increase as much in monkey liver as in human liver, but a marked increase in phosphatidyl inositol (PI) was observed in monkey liver during administration of DH. The concentration of acidic phospholipids (BMGP + PI) in liver showed a close correlation with the accumulation of the drug (DH + its metabolites), irrespective of species differences. Among subcellular particles isolated from a monkey liver following administration of DH, the crude mitochondrial fraction, including lysosomes, was richest in BMGP.     

High-content imaging of human hepatic spheroids for researching the mechanism of duloxetine-induced hepatotoxicity

Duloxetine (DLX) has been approved for the successful treatment of psychiatric diseases, including major depressive disorder, diabetic neuropathy, fibromyalgia and generalized anxiety disorder. However, since the usage of DLX carries a manufacturer warning of hepatotoxicity given its implication in numerous cases of drug-induced liver injuries (DILI), it is not recommended for patients with chronic liver diseases. In our previous study, we developed an enhanced human-simulated hepatic spheroid (EHS) imaging model system for performing drug hepatotoxicity evaluation using the human hepatoma cell line HepaRG and the support of a pulverized liver biomatrix scaffold, which demonstrated much improved hepatic-specific functions. In the current study, we were able to use this robust model to demonstrate that the DLX-DILI is a human CYP450 specific, metabolism-dependent, oxidative stress triggered complex hepatic injury. High-content imaging analysis (HCA) of organoids exposed to DLX showed that the potential toxicophore, naphthyl ring in DLX initiated oxidative stress which ultimately led to mitochondrial dysfunction in the hepatic organoids, and vice versa. Furthermore, DLX-induced hepatic steatosis and cholestasis was also detected in the exposed EHSs. We also discovered that a novel compound S-071031B, which replaced DLX’s naphthyl ring with benzodioxole, showed dramatically lower hepatotoxicities through reducing oxidative stress. Thus, we conclusively present the human-relevant EHS model as an ideal, highly competent system for evaluating DLX induced hepatotoxicity and exploring related mechanisms in vitro. Moreover, HCA use on functional hepatic organoids has promising application prospects for guiding compound structural modifications and optimization in order to improve drug development by reducing hepatotoxicity.Subject terms: Drug safety, Translational research, Toxicology     

Gene deletion, a mechanism of induced mutation by arabinosyl nucleosides

9-β- -Arabinofuranosyl-2-fluoroadenine (F-ara-A) and 9-β- -arabinofuranosyladenine (ara-A) are purine nucleoside analogues which are incorporated into nucleic acids. This study demonstrates the mutagenic properties of F-ara-A and ara-A and provides evidence for mechanisms by which the arabinosyl nucleosides induce mutation. At the drug dosages that evoked exponential cell killing, F-ara-A and ara-A caused a significant increase in the number of 6-thioguanine-resistant mutants in Chinese hamster ovary cells. Southern analyses showed that 15 of 16 drug-induced mutants had lost all or part of the HPRT gene, whereas no loss of the gene was found in 4 spontaneous mutants. We conclude that both F-ara-A and ara-A induced mutation predominantly by causing deletion of genetic method. The remarkable frequency of gene deletion among these drug-induced mutations is discussed with respect to possible mechanisms of action of arabinosyl nucleosides in mutational studies.     

Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches

Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated.DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions.One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.     

Macrophage migration inhibitory factor in drug-induced liver injury: a role in susceptibility and stress responsiveness

Idiosyncratic drug-induced hepatitis may depend upon many factors including a balance between pro- and anti-inflammatory mediator production levels. Using a guinea pig model of liver injury induced by bioactivation of the anesthetic drug, halothane, we found that toxicity was commensurate with an increase in serum macrophage migration inhibitory factor (MIF), a pro-inflammatory signal and counter-regulator of glucocorticoids, but only in susceptible animals. The pathogenic role of MIF was further investigated using a murine model in which liver injury was induced by the reactive metabolite of another drug, acetaminophen (APAP). MIF leakage from the liver into the sera preceded peak increases in toxicity following APAP administration. MIF null (-/-) mice were significantly less susceptible to this toxicity at 8 h. At 48 h following a 300 mg/kg dose, complete lethality was observed in wild-type mice, while 46% survival was noted in MIF-/- mice. The decreased hepatic injury in MIF-/- mice correlated with a reduction in mRNA levels of interferon-gamma and a significant increase in heat shock protein expression, but was unrelated to the APAP-protein adduct formation in the liver. These findings support MIF as a critical pro-toxicant signal in drug-induced liver injury with potentially important and novel effects on heat shock protein responsiveness.     

沙眼衣原体和解脲支原体感染的女性生殖道炎症临床分析

目的：分析沙眼衣原体和解脲支原体在女性生殖道炎症发生过程中的重要致病作用和临床特征,以期达到早期诊断,早期诊治的目的。方法：对妇科门诊683例初诊为女性急性或慢性生殖道炎症患者的宫颈分泌物进行沙眼衣原体(CT)和解脲支原体(UM)培养和鉴定,及其所致生殖道炎症患者的临床特性、表现进行综合性分析。结果：683例女性生殖道炎症患者检测结果,确诊由沙眼衣原体(CT)和解脲支原体(UM)感染所致的生殖道炎症共计249例,占36．5％(249／683),沙眼衣原体感染者87例(12．7％),解脲支原体感染者205例(30．0％),沙眼衣原体及解脲支原体合并感染者43例(6．3％),淋球菌感染31例(4．5％),其中沙眼衣原体合并淋球菌感染者22例,解脲支原体合并淋球菌感染者5例。结论：在诊断女性生殖道炎症时,由沙眼衣原体和解脲支原体感染所致的生殖道炎症不容忽视,尽管由这两种病原体所致炎症在临床表现上不具有明显的特征,但特定的病原学检查能非常有效地做出早期诊断,结合特异的防治能使本病彻底治愈得以保证。     

Etiological structure and clinical epidemiological characteristics of Leptospira infection in Rostov Province based on data from therapeutic institutions from 1960 to 1983

Changes in communal conditions, in economy, as well as in ecology and fauna, which took place in Rostov Province during the last decade (1973-1983) determined shifts in the etiological structure of Leptospira infection and in its course. The study revealed an increase in morbidity caused by L. icterohaemorrhagiae (up to 61%) and L. hebdomadis (up to 22%) with a simultaneous decrease in the isolation rate of L. grippotyphosa and L. pomona (up to 2-3%). In most cases (77%) the diseases caused by leptospires of different serogroups were found to take an icteric course accompanied by the development of hepatorenal insufficiency (46%). The similarity of clinical manifestations in different etiological forms of Leptospira infection was determined by common pathogenetic and pathophysiological features characteristic of the development of the leptospiral infectious process.     

DUSP1在药物诱导的肝癌细胞衰老中的表达变化及其作用研究

目的:在肝癌的治疗中,化学疗法是重要的治疗手段,尤其在结合外科手术切除的联合治疗中,化疗被广泛的应用于临床。而体内试验证实,化疗药物诱导的细胞衰老在治疗肿瘤的过程中,普遍存在并发挥重要作用,我们着重探讨在药物诱导的人肝癌细胞衰老中,细胞内重要信号途径的变化,发现并利用对细胞衰老有重要意义的蛋白,增强化学治疗肿瘤的效果。在本课题中,我们利用化疗药物阿霉素(doxorubicin)和蛋白酶体抑制剂MG132诱导的人衰老肝癌细胞模型,对MAPK信号途径的负调控因子DUSP家族的表达变化进行检测,筛选表达水平发生显著变化的双特异性磷酸酶(DUSP)家族成员,并初步探讨其在细胞衰老中的作用。方法:利用低剂量的阿霉素和蛋白酶体抑制剂MG132诱导人肝癌细胞衰老;通过Real time RT-PCR和Western blotting检测DUSP家族基因mRNA和蛋白质水平的变化;利用siRNA干扰技术敲降DUSP1,检测药物诱导肝癌细胞衰老水平的变化。结果:经低剂量的阿霉素和蛋白酶体抑制剂短时间处理后,人肝癌细胞系Huh7和SMMC-7721细胞发生明显的细胞衰老;在诱导的衰老细胞中,DUSP1mRNA和蛋白质水平呈显著升高。在敲降DUSP1后,MG132诱导的细胞衰老得到显著的缓解。结论:DUSP1在药物诱导的人肝癌细胞衰老中具有重要的作用,为研究临床治疗中化疗药物引起肿瘤细胞衰老的具体机制带来启发。     

Biological tests of physiologically active compounds (approaches): Communication II

This review considers the methods of investigation proposed by L. A. Piruzyan in the field of preclinical trials of physiologically active compounds: (1) the search for new physiologically active compounds illustrated by analysis of the developmental mechanisms of some diseases, such as jaundice of the newborn, renal and liver insufficiency, acute drug-induced intoxication, discoid and systemic lupus erythematosus, and lupus-like syndrome; (2) experimental studies on safety of medicinal substances—the testing of substances for mutagenicity and embryotoxicity, the preparation of compounds with antimutagenic and anticarcinogenic properties, the determination of preserved blood characteristics; (3) the stabilization of medicinal preparations for use—with drug oxidation inhibitors, and substances contained in liposomes. The ligand pathology concept is presented. The necessity of an individualized approach for assessment of chemical compound safety for humans in emphasized: it should be based on the activity determination of certain enzymes in each subject. Deceased.     

转录因子Nrf2在肝脏疾病中的作用

NF-E2相关因子2(nuclear erythroid 2-related factor 2,Nrf2)是一种能调节肝脏中大量解毒和抗氧化防御基因表达的重要转录因子.氧化应激与各种形式的肝损伤有密切的关系.Nrf2由亲电体压力或氧化应激激活,并通过结合抗氧化反应元件(antioxidant response element,ARE)诱导其靶基因,从而对细胞产生保护作用.因此,Nrf2通路在肝脏疾病中的作用已被深入研究.多种动物模型研究结果表明,Nrf2通路通过靶基因表达,在对抗病毒性肝炎、药物性肝损伤、酒精性肝病、非酒精性脂肪肝及肝癌方面表现出了不同的生物功能.根据Nrf2及其信号通路在对抗肝损伤中产生保护作用的相关文献,本文综述并讨论了其作为治疗肝损伤的药物作用靶点方面可能的应用前景.     

Evidence for the involvement of multiple forms of cytochrome P-450 in the occurrence of sex-related differences of drug metabolism in the rat

Multiple forms of cytochrome P-450 in liver microsomes of untreated male and female rats could be divided into several fractions by the use of ω-amino-n-octyl Seph. 4B and DE-52 columns. Male cytochrome P-450 fractions (I-b - I-e) differed from female fractions (I-b - I-e) with respect to absorption peaks in carbon monoxide difference spectra and 7-prop-oxycoumarin O-depropylation activities. Although male and female I-a fractions showed quite similar protein bands on SDS-polyacrylamide gel electrophoresis, some protein bands in other male fractions (I-b - I-e) were absent in corresponding female fractions. Immunochemical examinations using immunoglobulin G raised to cytochrome P-450 purified from untreated male rats also showed that liver microsomes from male and female rats contain different forms of cytochrome P-450. Based on these results, we propose that sex-related differences of drug metabolizing activities in liver microsomes are caused by multiple forms of cytochrome P-450.     

Relationship between Cell Cycle Changes and Variations of the Mitochondrial Membrane Potential Induced by Etoposide

Etoposide, a clinically useful anticancer drug, is a potent inhibitor of topoisomerase II. The DNA strand breaks caused by this epipodophyllotoxin lead to apoptotic death of tumor cells. Flow cytometry was used to investigate the relationship between the effects of the drug on the cell cycle of human leukemia HL-60 cells and the variations of the mitochondrial transmembrane potential (ΔΨ_mt). Three cationic fluorescent probes, DiOC₆, JC-1, and TMRM, were used to measure drug-induced changes of ΔΨ_mt. In all three cases, we found that the arrest in the G2/M phase of the cells treated with 0.5 μM etoposide is associated with an increase in the potential of mitochondrial membranes whereas treatment with a tenfold higher drug concentration trigger massive apoptosis and a collapse of ΔΨ_mt. DNA fragmentation (TUNEL assay) and externalization of phosphatidylserine residues in the outer leaflet of the plasma membrane (annexin V binding) were measured to characterize the apoptotic cell population.