磁共振胰胆管成像联合血清CA125、CA19-9、CEA对良恶性梗阻性黄疸的诊断价值

摘要 目的：研究磁共振胰胆管成像（MRCP）联合血清糖类抗原125（CA125）、糖类抗原19-9（CA19-9）、癌胚抗原（CEA）对良恶性梗阻性黄疸的诊断价值。方法：将医院从2018年1月～2020年2月期间收治的90例良恶性梗阻性黄疸患者纳入研究。将其按照良恶性的差异分为良性梗阻性黄疸51例以及恶性梗阻性黄疸39例。分别对所有患者进行MRCP检测,并分析良恶性梗阻性黄疸MRCP影像学表现特征的差异。此外,采集所有患者清晨空腹静脉血,检测血清CA125、CA19-9、CEA水平并进行对比。通过受试者工作特征（ROC）曲线分析明确MRCP联合血清CA125、CA19-9、CEA对良恶性梗阻性黄疸的诊断价值。结果：恶性梗阻性黄疸部位为十二指肠乳头区人数占比明显高于良性梗阻性黄疸,而胰头上区、胰头区人数占比均明显低于良性梗阻性黄疸;且恶性梗阻性黄疸梗阻重度扩张人数占比明显高于良性梗阻性黄疸,而梗阻轻度扩张人数占比明显低于良性梗阻性黄疸,差异均有统计学意义（均P＜0.05）。恶性梗阻性黄疸患者血清CA125、CEA水平均明显高于良性梗阻性黄疸患者（均P＜0.05）;而两组血清CA19-9水平对比不明显（P＞0.05）。MRCP联合血清CA125、CA19-9、CEA诊断良恶性梗阻性黄疸的曲线下面积、灵敏度、特异度、约登指数均明显高于MRCP和血清CA125、CA19-9、CEA单独诊断。结论：MRCP联合血清CA125、CA19-9、CEA对良恶性梗阻性黄疸的诊断价值较高,值得临床推广应用。     

酪酸梭菌活菌散联合光疗治疗新生儿母乳性黄疸临床观察

目的探讨酪酸梭菌活菌散（商品名：宝乐安）联合光疗治疗母乳性黄疸的临床疗效。方法将母乳性黄疸患儿116例随机分为观察组和对照组,观察组59例在光疗、补液等常规治疗的同时给予口服酪酸梭菌活菌散;对照组57例应用光疗、补液等常规治疗。治疗中观察患儿黄疸消退时间并定期检测血清胆红素含量,比较胆红素日均下降速度及治愈时间。结果观察组治愈时间短于对照组（P〈0．05）,观察组日均胆红素下降值高于对照组（P〈0．01）,差异具有非常显著性。结论酪酸梭菌活菌散联合光疗治疗母乳性黄疸能够缩短光疗时间和快速降低血清胆红素,值得临床推广应用。     

Mode of Action of Antirheumatic Drugs

The concentrations of free and protein-bound L-tryptophan were measured in sera from normal subjects, patients with rheumatoid arthritis, pregnant women, and patients with jaundice. In the patients with rheumatoid arthritis receiving treatment with one or more antirheumatic drugs the percentage of the amino-acid bound to the circulating proteins was significantly depressed and in one patient returned to normal when therapy was stopped. Pregnancy and jaundice were also associated with raised free tryptophan and decreased bound tryptophan concentrations and bilirubin displaced the amino-acid from its binding sites on human serum proteins in vitro. It is suggested the behaviour of tryptophan mimics that of certain peptides which protect susceptible tissues against chronic inflammatory insults.     

History of the research on differentiating Hepatitis A and B]

The numerous researches devoted to 'jaundice' during the Second World War have brought to light the existence of an infectious type of hepatic jaundice or 'homologous serum jaundice' following parenteral injection of vaccines containing human serum and blood transfusions, which were carried out on a large scale at the time. This type of serum jaundice was then gradually differentiated from 'catarrhal', contagious or epidemic jaundice by clinical trials along with large series of animal studies. Finally, the epidemiological, clinical and biological data obtained made it possible to establish, between 1944 and 1954, the viral etiology of these two types of jaundice: the A virus, present in the patients' blood and stools, was considered to be the agent responsible for epidemic hepatitis; the B virus, present primarily in the blood, was held to be responsible for serum hepatitis.     

Analysis of 3-sulfated and nonsulfated bile acids by one-step solvolysis and high performance liquid chromatography

A facile solvolysis procedure of 3-sulfated bile acid was devised using trifluoroacetic acid, tetrahydrofuran, and methanol. The sulfate esters were completely solvolyzed within only 2 hr by the present method. The clinical utility of the solvolysis procedure and high performance liquid chromatography using immobilized 3 alpha-hydroxysteroid dehydrogenase was demonstrated in the analysis of bile acids in serum of patients with obstructive jaundice. The quantities of 3-sulfated bile acids were calculated from the difference in the amount of bile acids before and after solvolysis. A significantly large proportion of 3-sulfated glycochenodeoxycholic acid, i.e., 21.9 to 31.3% of total glycochenodeoxycholic acid, was found in the serum of patients with obstructive jaundice. Thus, the present method permits simultaneous quantitation of 3-sulfated as well as nonsulfated bile acids in biological samples.     

茵栀黄汤对新生儿黄疸血清总胆汁酸浓度变化的影响

目的:探究茵栀黄汤对新生儿黄疸血清总胆汁酸浓度变化的影响。方法:选取我院2014年1月到2014年11月收治的新生儿黄疸患者72例,根据应用药物不同而分成实验组与对照组。对照组给予蓝光治疗,实验组在对照组基础上予以茵栀黄汤。比较两组患者的黄疸消退时间、因黄疸再住院率、肝功能酶检测、血清总胆汁酸、血清总胆红素及间接胆红素水平。结果:与对照组相比,实验组患者黄疸消退时间明显缩短,再住院率明显降低,P0.05;两组肝功能均有所恢复,与对照组相比,实验组患者的肝功能酶水平恢复更明显,P0.05;两组患者的TBA、TBIL、DBIL水平均下降,与对照组相比,实验组下降更明显,P0.05。结论:茵栀黄汤能有效缓解新生儿黄疸症状,降低肝功能酶及TBA、TBIL、DBIL水平。     

血必净注射液对梗阻性黄疸大鼠血清内毒素及肿瘤坏死因子-alpha水平的影响

目的：探究血必净注射液对梗阻性黄疸大鼠血清内毒素(ETX)及肿瘤坏死因子-alpha(TNF-alpha)水平的影响。方法：选取雄性SD 大 鼠60 只,随机分为假手术(A)组、梗阻性黄疸(B)组、血必净干预(C)组,每组20 只。A组不结扎胆总管,B、C两组结扎胆总管。术后 七天,C 组每日皮下注射血必净4 mL/Kg,A 组、B 组用等量生理盐水替代,持续用药一周。实验两周后,检测和比较各组大鼠血清 ETX、TNF-alpha、总胆红素(TBIL)及直接胆红素(DBIL)水平。结果：术后两周,A组血清TBIL、DBIL 水平显著低于B、C两组;B组血 清TBIL、DBIL 水平显著高于C 组,差异均有统计学意义(P<0.05)。B组血清ETX和TNF-alpha水平显著高于A、C 组,差异均有统计 学意义(P<0.05)。结论：血必净注射液可能通过降低血清ETX和TNF-alpha含量改善梗阻性黄疸。     

两种不同手术方式治疗恶性梗阻性黄疸患者的临床疗效比较研究

目的:探讨经皮肝穿刺胆管引流术(PTCD)与经内镜逆行胰胆管造影术(ERCP)治疗恶性梗阻性黄疸的治疗效果,并进行比较分析。方法:选取2016年1月~2018年5月期间我院收治的127例恶性梗阻性黄疸患者。根据治疗术式的不同将患者分为ERCP组(n=63,采用ERCP联合金属支架置入术进行治疗)和PTCD组(n=64,采用PTCD进行治疗),比较两组患者术后5d黄疸缓解率,比较两组患者术前、术后2周肝功能指标[血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)、直接胆红素(DBIL)],比较两组患者术后舒适度量表评分情况及并发症发生情况。结果:两组患者术后黄疸总缓解率比较差异无统计学意义(P0.05);PTCD组低位梗阻患者黄疸缓解率低于ERCP组,而高位梗阻患者黄疸缓解率高于ERCP组(P0.05)。两组患者术前、术后2周TBIL、ALT、DBIL比较差异无统计学意义(P0.05);两组患者术后2周TBIL、ALT、DBIL水平较术前比较均下降(P0.05)。ERCP组患者术后舒适度量表评分总分低于PTCD组,差异有统计学意义(P0.05)。PTCD组术后并发症总发生率14.06%(9/64),低于ERCP组的41.27%(26/63)(P0.05)。结论:ERCP与PTCD治疗恶性梗阻性黄疸均可改善患者肝脏功能、疗效满意,但ERCP对低位梗阻患者治疗效果优于PTCD,且术后舒适度优于PTCD,但术后并发症较多,临床应根据患者情况选择具体术式。     

茵栀黄颗粒联合蓝光治疗新生儿病理性黄疸的疗效及对患儿心肌酶谱的影响

目的:探讨茵栀黄颗粒联合蓝光治疗新生儿病理性黄疸的疗效及对患儿心肌酶谱的影响。方法:选取2015年2月至2016年12月于我院就诊的80例新生儿病理性黄疸患儿,随机分为观察组和对照组,每组各40例。根据两组患儿的临床症状有针对性地给予常规治疗,对照组在此基础上加用蓝光照射治疗,观察组加用蓝光照射联合茵栀黄颗粒进行治疗,两组均持续治疗一个星期。比较两组的临床疗效、治疗前后血清心肌酶、胆红素水平的变化以及不良反应的发生情况。结果:治疗前,两组患儿的血清总胆红素(TBIL)、直接胆红素(DBIL)水平比较差异不明显(P0.05);治疗后,两组TBIL、DBIL水平均较同组治疗前显著降低(P0.05),且观察组显著低于对照组,差异有统计学意义(P0.05)。治疗前,两组患儿血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)水平比较差异不显著(P0.05);治疗后,两组血清LDH、CK、CK-MB水平均较同组治疗前显著降低(P0.05),且观察组显著低于对照组,差异有统计学意义(P0.05)。治疗后,两组不良反应的发生情况比较差异无统计学意义(P0.05)。结论:茵栀黄颗粒联合蓝光照射治疗新生儿黄疸较单用蓝光照射治疗可显著提高临床疗效,显著改善患儿血清胆红素及心肌酶谱水平,且安全性较高。     

地衣芽孢杆菌治疗新生儿母乳性黄疸的疗效观察

目的了解地衣芽孢杆菌活菌胶囊(整肠生)治疗母乳性黄疸的疗效。方法选取2012年1月至2015年4月我院门诊治疗的新生儿母乳性黄疸69例,随机分为两组,对照组给予口服茵栀黄颗粒,观察组给予茵栀黄颗粒及整肠生治疗,观察治疗效果及两组血清胆红素值及黄疸消退时间、大便次数。结果 (1)治疗后观察组总有效率97.14%,对照组治疗总有效率82.35%,差异具有统计学意义(P0.05)。(2)治疗第5天观察组血清总胆红素值明显低于对照组,黄疸消退时间短于对照组,平均大便次数多于对照组,差异具有统计学意义(P0.01)。(3)两组患儿均无过敏及脱水等不良反应。结论整肠生治疗母乳性黄疸可缩短黄疸持续时间,显著降低血清总胆红素水平,提高治疗有效率。     

Pruritus and Jaundice

The records of 147 patients who had pruritus and jaundice (11% of a series of 1262 patients with jaundice) were reviewed in an effort to delineate more clearly the etiology of jaundice associated with pruritus.Fifty-two had obstructive jaundice caused by neoplasm, 51 had obstructive jaundice not caused by neoplasm, 42 had pruritus associated with hepatogenous jaundice, and two had jaundice and pruritus associated with a lymphoma.Pruritus occurred in 17% of all patients with non-neoplastic obstructive jaundice and in 45% of patients with neoplastic obstructive jaundice. Hepatogenous jaundice was the cause of pruritus in almost one-third of the patients in this series-occurring in 20% of patients with infectious hepatitis and in 7% of patients with cirrhosis.This large series confirms the clinical impression that pruritus occurs most often in association with extrahepatic biliary obstruction, and as well re-emphasizes the common association of pruritus with hepatogenous jaundice.     

S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况影响的临床研究

目的：探讨S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况的影响。方法：选择2010年8月至2012年7月我院肝胆病区收治的90例梗阻性黄疸患者为研究对象,随机分为S-腺苷蛋氨酸治疗组（48例）和对照组（42例）,比较和分析静脉滴注S-腺苷蛋氨酸对梗阻性黄疸患者术后第5d、10d肝功能及营养指标的影响。结果：术后5d、10d,两组患者血总胆红素、直接胆红素、谷丙转氨酶、1．谷氨酰转肽酶、碱性磷酸酶水平较术前1d显著降低,且组内比较差异有统计学意义（P〈0．05）,治疗组以上指标的下降程度较对照组更明显,差异有统计学意义（P〈0．05）。术后第10d,两组患者的血白蛋白、前白蛋白、转铁蛋白水平较术后第5d显著改善（P〈0．05）;术后第5、10d,两组组间血白蛋白、前白蛋白、转铁蛋白水平比较差异有统计学意义（P〈0．05）。结论：梗阻性黄疸患者术后应用腺苷蛋氨酸能促进黄疸消退,加快胆红素的排泄和肝功能的恢复,有利于患者营养状况的改善。     

恶性梗阻性黄疸手术治疗研究进展

恶性梗阻性黄疸作为肝胆外科较为常见的疾病,对患者机体的损害较大,而且不利于预后。恶性梗阻性黄疸起病隐匿,患者得到确诊时肿瘤已发展为中晚期,错过了治疗的最佳时机。目前临床主要采用外科手术(根治性及姑息性)、内镜、ERCP、PTCD等治疗方法,随着微创技术达芬奇机器人的发展,对恶性梗阻性黄疸的治疗,特别是高龄患者有了更好的方法,扩大了手术的适应范围。根据患者病情及适应症,可以选择更适合的治疗方法,提出了更为合理的个人规范模式,使患者获益更多。本文对临床治疗恶性梗阻性黄疸的手术治疗的主要方法进行综述,旨在为恶性梗阻性黄疸的临床研究提供参考。     

Exploration of serum biomarkers for predicting the response to Inchinkoto (ICKT), a Japanese traditional herbal medicine

Introduction

In patients with obstructive jaundice, biliary drainage sometimes fails to result in improvement. A pharmaceutical-grade choleretic herbal medicine, Inchinkoto (ICKT), has been proposed to exert auxiliary effects on biliary drainage; however, its effects are variable among patients.

Objectives

The aim of this study is to explore serum biomarkers that are associated with pharmaceutical efficacy of ICKT.

Methods

Obstructive jaundice patients who underwent external biliary decompression were enrolled (n?=?37). ICKT was given orally 3 times a day at daily dose of 7.5 g. Serum and bile samples were collected before, 3 h after, and 24 h after ICKT administration. The concentrations of total bilirubin, direct bilirubin, and total bile acid in bile specimens were measured. Metabolites in serum samples were comprehensively profiled using LC–MS/MS and GC–MS/MS. Pharmacokinetic analysis of major ICKT components was also performed.

Results

ICKT administration significantly decreased serum ALT and increased bile volume after 24 h. The serum concentrations of ICKT components were not well correlated with the efficacy of ICKT. However, the ratio of 2-hydroxyisobutyric acid to arachidonic acid and the ratio of glutaric acid to niacinamide, exhibited good performance as biomarkers for the efficacy of ICKT on bile flow and ALT, respectively. Additionally, comprehensive correlation analysis revealed that serum glucuronic acid was highly correlated with serum total bilirubin, suggesting that this metabolite may be deeply involved in the pathogenesis of jaundice.

Conclusions

The present study indicates that ICKT is efficacious and provides candidates for predicting ICKT efficacy. Further validation studies are warranted.

     

Jaundice after repeated exposure to halothane: a further analysis of reports to the Committee on Safety of Medicines.

Aanalysis of data derived from 170 reports of jaundice developing after anaesthesia with halothane received after January 1974 confirmed the relations between multiple exposure to halothane and jaundice and between the number of exposures and the rapidity with which jaundice develops after exposure. When these reports were combined with 130 received earlier complete anaesthetic histories were available for 251 patients, 205 (82%) of whom had been exposed to halothane more than once; of these patients, 154 (75%) had been exposed more than once within 28 days. Altogether 139 (46%) of the 300 patients died.     

Cholesterol and its esters as serum biomarkers in malignant obstructive jaundice: a single step 1H NMR metabolomic approach

The paucity of biomarkers for malignant obstructive jaundice results in formidable morbidity and mortality rates. Therefore, alternative diagnostic measures are required for improved clinical interpretation and better peri-operative management of patients. In the present study, ¹H NMR-based metabolomic approach has been applied to investigate serum and bile based metabolic biomarkers in benign and malignant causes of obstructive jaundice (OBJ). Serum and bile specimens from benign OBJ patients (n = 28), malignant OBJ patients (n = 36) and serum of healthy controls (n = 57) were analysed by ¹H NMR spectroscopy. Quantitation of eight serum metabolites (isobutyrate, lactate, alanine, acetone, glutamine, creatine, threonine and 1-methylhistidine) was carried out. A newer and rapid single step NMR based semi-quantitative ratio analysis of serum total cholesterol (tCho), cholesterol (Chol) and cholesterol ester (CE) were performed in deuterated dimethyl sulfoxide-d₆. In bile, total bile acids, cholesterol, phosphatidylcholine, glycerophosphatidylcholine and urea were quantified. The effect of benign and malignant OBJ on small metabolites and lipids were statistically analysed by Mann–Whitney U test and multivariate discriminant function analysis. It was found that malignancy could be differentiated from benign cases of OBJ with a correct classification of 85.7 % when eight serum metabolites in combination with ratios of serum cholesterol were analysed. Significant alterations in serum tCho, Chol, CE and serum metabolites may have potential for early and differential non-invasive diagnosis of malignant and benign OBJ cases. It will further augment the novel insights of local and systemic effects in OBJ patients.     

Staphylococcal bacteraemia,fusidic acid,and jaundice.

Fusidic acid was used to treat 131 out of 250 patients with staphylococcal bacteraemia over 10 years. Other antimicrobial agents were given to the 119 remaining patients. Thirty-seven patients were already jaundiced before antibiotic treatment was started. Jaundice developed during treatment in 38 out of 112 patients given fusidic acid (34%) and in two out of 101 patients given other antimicrobials. The incidence of jaundice was higher in patients given fusidic acid intravenously (48%) rather than by mouth (13%). Jaundice appeared within 48 hours after the administration of fusidic acid in 93% of these cases. When the drug was stopped serum bilirubin concentrations fell to normal values within four days in those patients in whom they had been previously normal and who survived the bacteraemic episode. Fusidic acid was associated with increasing jaundice in 13 of 19 patients (68%) already jaundiced before it was given. In six out of 32 patients who developed jaundice while receiving intravenous fusidic acid serum alkaline phosphatase activity was raised suggestive of cholestatic jaundice. The mechanism in the remaining patients was unknown. Fusidic acid, particularly the intravenous preparation, in invaluable in treating severe staphylococcal infection but should be used with caution in patients with abnormal liver function. Patients receiving intravenous fusidic acid should be given the oral form of the drug as soon as their clinical condition permits.     

Determination of 3 beta-hydroxy-5-cholenoic acid in serum of hepatobiliary diseases--its glucuronidated and sulfated conjugates

3 beta-Hydroxy-5-cholenoic acid in the serum of control subjects and 62 patients with various hepatobiliary diseases was quantitated by mass fragmentography after separation into nonglucuronidated-nonsulfated, glucuronidated, and sulfated fractions. Deuterium-labeled deoxycholic acid and its glucuronide and sulfate were used as internal standards. Mean concentrations of total 3 beta-hydroxy-5-cholenoic acid in serum (mumole/liter) were as follows: Control subjects (14), 0.184; obstructive jaundice (15), 6.783; liver cirrhosis, compensated (12), 0.433, and decompensated (12), 1.636; chronic hepatitis (12), 0.241; and acute hepatitis (11), 2.364. Most of the 3 beta-hydroxy-5-cholenoic acid was glucuronidated or sulfated. Only in patients with obstructive jaundice did glucuronidation (60 +/- 14%) exceed sulfation (31 +/- 14%), sulfation exceeding glucuronidation in the others. The UDP-glucuronyltransferase might have different substrate specificities for 3 beta-hydroxy-5-cholenoic acid and other common bile acids, especially in the cholestatic state.     

Effets de la novobiocine sur le fonctionnement du foie: I. Etude clinique

A case of novobiocin-induced jaundice is described in which the main feature was elevated unconjugated bilirubin in the serum. No evidence of hemolysis or hepato-cellular failure was demonstrated.The effect of novobiocin on serum bilirubin was studied by administering 2 g. of the drug daily in four divided oral doses for two days. An increase in serum unconjugated bilirubin was nearly always observed in the normal subjects and in patients with cirrhosis of the liver. This rise was particularly significant in three patients with hemolytic anemia and in two patients with Gilbert''s disease. After an oral dose of 500 mg. the BSP clearance was decreased after one hour and it was close to normal after three hours. Since hemolysis is not responsible for this elevation of serum unconjugated bilirubin, the novobiocin-induced hyperbilirubinemia appears to be due to a direct effect of the drug upon the liver.