黑木耳多糖提取物对肝纤维化大鼠肝功能及MPO, MDA, TGF-beta的影响

目的：探究黑木耳多糖提取物对肝纤维化大鼠血清髓过氧化物酶(MPO)、丙二醛(MDA)及转化生长因子beta(TGF-beta)的影响及 肝功能的保护作用。方法：将健康的Wistar大鼠30 只随机分为3 组：对照组、模型组、黑木耳多糖提取物组,利用胆总管结扎术制 备肝纤维化动物模型,术后分别用生理盐水0.1 mL/(kg·d)、黑木耳多糖提取物0.1 mg/(kg·d)灌胃1 次/d。21 d后腹主动脉采血,测 肝功能指标,取肝组织测MDA、MPO、TGF-beta,Masson 染色。结果：肝纤维化动物模型成功制备。黑木耳多糖提取物组总胆红素 (STB)、谷氨酸转移酶(ALT)、天门冬氨酸转移酶(AST)、MPO、MDA较模型组明显降低,TGF-茁含量降低。Masson 染色可见：模型 组肝小叶结构破坏,较对照组汇管区可见大面积胶原纤维的形成;黑木耳多糖提取物组肝细胞轻度水肿、肝索排列欠整齐,肝汇 管区及各部位胶原纤维形成量略少。结论：黑木耳多糖提取物可减轻胆总管结扎大鼠脂质过氧化损伤,MPO 含量使TGF-beta因子 释放减少,从而减少胶原纤维形成,减轻或延缓大鼠肝纤维化。     

Depression of lymphocyte reactivity to phytohemagglutinin by serum from patients with liver disease

The influence of serum from patients with a variety of liver abnormalities on the in vitro response of normal human peripheral blood lymphocytes to stimulation with phytohemagglutinin was studied. These experiments demonstrate that serum from patients with acute viral hepatitis, chronic Australia antigenemia, common bile duct obstruction, primary biliary cirrhosis, hepatic necrosis secondary to halothane, and alcoholic cirrhosis suppresses DNA synthesis by stimulated normal lymphocytes. Sera obtained from two patients 1 week after surgical correction of their common duct obstruction no longer demonstrated lymphocyte suppression. Dilution of normal serum with serum from either of three patients resulted in more rapid decrease of thymidine uptake by stimulated lymphocytes than when normal serum was diluted with culture medium. This indicates the presence of an inhibitory factor (s) in the patients' sera. No correlation was shown between the extent of thymidine uptake by stimulated lymphocytes and the bilirubin, transaminase, or alkaline phosphatase levels in the serum in which they were cultured. The addition of bile salts to stimulated lymphocyte cultures did result in suppression of the response but only at concentrations much higher than would be expected in serum of the patients studied. Cell death after 72-hr incubation was 42% in normal serum and only 50% in serum from a patient who had demonstrated prominent suppression of DNA synthesis.     

SF方案治疗肝硬化的疗效观察

目的：观察SF方案对代偿性乙型肝炎肝硬化患者的治疗作用。方法：代偿性乙肝肝硬化患者63例,分为治疗组33例,对照组30例。治疗组采用SF方案进行治疗,对照组采用常规护肝疗法,疗程为9～12个月,定期监测肝功能指标变化。结果：SF方案对肝硬化有较好的疗效,一是肝脏炎症反应减轻,肝功能恢复,血清ALT、AST、TBiL经治疗后治疗组均显著低于治疗前和同期对照组;二是阻止肝纤维化进展,肝纤维化指标明显好转;三是免疫功能得以改善,外周血CD4／CD8淋巴细胞比值回升,补体C3水平上升;四是抗病毒效果显著,HBVDNA阴转率达54．5％。结论：SF方案有显著改善患者肝功能,恢复患者免疫功能,抑制病毒增殖的作用,可扩大样本量进一步研究。     

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。     

The excretion pattern of biliverdin and bilirubin in bile of the small skate (Raja erinacea)

Summary Bile pigment composition (biliverdin, bilirubin and their conjugates) was analyzed in stored gallbladder bile and newly synthesized hepatic bile from the small skate (Raja erinacea). During a five day period of captivity, gallbladder volume remained relatively constant while bilirubin and biliverdin content increased two to three fold. Biliverdin which accounted for 50% of the pigments did not increase as a percentage of tetrapyrroles during this period. The relative proportion of bilirubin and its conjugates also remained constant, averaging 65% for bilirubin monoglucuronide, 30% for bilirubin diglucuronide and 5% for unconjugated bilirubin as measured by HPLC methods. Intravenous administration of biliverdin resulted in significant increases in the biliary excretion of both biliverdin and all bilirubin tetrapyrroles. Insignificant quantities of³H-biliverdin were detected in hepatic bile following the intravenous administration of³H-bilirubin. These studies indicate that the small skate excreted both biliverdin and bilirubin conjugates in bile and that the biliverdin was not produced by in vitro oxidation of bilirubin or its metabolites.     

Pathophysiological basis of liver disease in cystic fibrosis employing a DeltaF508 mouse model

The molecular pathogenesis of cystic fibrosis (CF) liver disease is unknown. This study investigates its earliest pathophysiological manifestations employing a mouse model carrying DeltaF508, the commonest human CF mutation. We hypothesized that, if increased bile salt spillage into the colon occurs as in the human disease, then this should lead to a hydrophobic bile salt profile and to "hyperbilirubinbilia" because of induced enterohepatic cycling of unconjugated bilirubin. Hyperbilirubinbilia may then lead to an increased bile salt-to-phospholipid ratio in bile and, following hydrolysis, precipitation of divalent metal salts of unconjugated bilirubin. We document in CF mice elevated fecal bile acid excretion and biliary secretion of more hydrophobic bile salts compared with control wild-type mice. Biliary secretion rates of bilirubin monoglucuronosides, bile salts, phospholipids, and cholesterol are increased significantly with an augmented bile salt-to-phospholipid ratio. Quantitative histopathology of CF livers displays mild early cholangiopathy in approximately 53% of mice and multifocal divalent metal salt deposition in cholangiocytes. We conclude that increased fecal bile acid loss leads to more hydrophobic bile salts in hepatic bile and to hyperbilirubinbilia, a major contributor in augmenting the bile salt-to-phospholipid ratio and endogenous beta-glucuronidase hydrolysis of bilirubin glucuronosides. The confluence of these perturbations damages intrahepatic bile ducts and facilitates entrance of unconjugated bilirubin into cholangiocytes. This study of the earliest stages of CF liver disease provides a framework for investigating the molecular pathophysiology of more advanced disease in murine models and in humans with CF.     

A correlative study on serum cholylglycine levels in hepatobiliary disease.

The serum cholylglycine (CG), alanine aminotransferase (ALT) and total bilirubin levels were studied in 210 patients with hepatobiliary disease and in 70 healthy subjects. Serum CG concentrations in all the hepatobiliary diseases were found to be significantly higher than those of their controls. Patients with abnormal increases in ALT and bilirubin levels also showed raised CG concentrations; however, some patients with normal ALT and bilirubin levels, still had markedly elevated CG values. Patients with hepatic cirrhosis had high serum CG levels, followed, in descending order, by chronic active hepatitis and chronic persistent hepatitis. In the cholecystitis and cholelithiasis cases, their CG levels were significantly higher than those of the controls but lower than the values in hepatic disease patients; however, more cholecystitis cases had abnormally high serum bilirubin levels than CG. The results also show that serum CG concentrations vary in the different hepatobiliary diseases, and that serial CG measurements are more sensitive than measuring ALT and bilirubin levels in the diagnosis of hepatic diseases. Serum CG can be used as an index for evaluating the activity of chronic hepatitis; it can also be employed as a diagnostic tool in cholecystitis and cholelithiasis.     

Enzymatic conversion of bilirubin monoglucuronide to diglucuronide by rat liver plasma membranes.

Formation of bilirubin monoglucuronide from unconjugated bilirubin requires a microsomal enzyme, UDP-glucuronate glucuronyltransferase (EC 2.4.1.17). Conversion of bilirubin monoglucuronide to bilirubin diglucuronide, the major bilirubin conjugate in bile, was studied in subcellular fractions of rat liver. The highest specific activity for bilirubin diglucuronide formation occurred in a fraction highly enriched in plasma membranes. Studies of reaction stoichiometry and utilization of UDP-D-[14C]glucuronic acid revealed that conversion of bilirubin monoglucuronide to bilirubin diglucuronide is not catalyzed by UDP-glucuronyltransferase, and results from transglucuronidation of bilirubin monoglucuronide, with formation of bilirubin diglucuronide and unconjugated bilirubin. When unconjugated bilirubin was infused intravenously into rats at rates exceeding the maximal hepatic excretory capacity, bilirubin monoglucuronide accumulated in serum and bilirubin diglucuronide was found exclusively in bile as the predominant bilirubin metabolite. These results suggest that formation of bilirubin diglucuronide occurs at the surface membrane of the liver cell. Conversion of bilirubin monoglucuronide to bilirubin diglucuronide may play a role in the transport of bilirubin glucuronides from liver to bile.     

Enteral bile acid treatment improves parenteral nutrition-related liver disease and intestinal mucosal atrophy in neonatal pigs

Total parenteral nutrition (TPN) is essential for patients with impaired gut function but leads to parenteral nutrition-associated liver disease (PNALD). TPN disrupts the normal enterohepatic circulation of bile acids, and we hypothesized that it would decrease intestinal expression of the newly described metabolic hormone fibroblast growth factor-19 (FGF19) and also glucagon-like peptides-1 and -2 (GLP-1 and GLP-2). We tested the effects of restoring bile acids by treating a neonatal piglet PNALD model with chenodeoxycholic acid (CDCA). Neonatal pigs received enteral feeding (EN), TPN, or TPN + CDCA for 14 days, and responses were assessed by serum markers, histology, and levels of key regulatory peptides. Cholestasis and steatosis were demonstrated in the TPN group relative to EN controls by elevated levels of serum total and direct bilirubin and also bile acids and liver triglyceride (TG) content. CDCA treatment improved direct bilirubin levels by almost fourfold compared with the TPN group and also normalized serum bile acids and liver TG. FGF19, GLP-1, and GLP-2 were decreased in plasma of the TPN group compared with the EN group but were all induced by CDCA treatment. Intestinal mucosal growth marked by weight and villus/crypt ratio was significantly reduced in the TPN group compared with the EN group, and CDCA treatment increased both parameters. These results suggest that decreased circulating FGF19 during TPN may contribute to PNALD. Moreover, we show that enteral CDCA not only resolves PNALD but acts as a potent intestinal trophic agent and secretagogue for GLP-2.     

Bile flow and electrolyte composition of bile associated with maximum bilirubin excretion in sheep.

Changes in the composition of bile accompanying the maximum biliary excretion (Emax) of bilirubin were investigated in sheep. Sheep fitted with chronic 'T-tubes' in the common bile duct were infused with taurocholate and bilirubin at various rates. Bile collected during both pre- and post-bilirubin steady-state periods was analyzed for the biliary concentration of electrolytes, bile salts, and bilirubin. Bilirubin Emax was 24.6 mumol/min while bile salt excretion during this period was 103 mumol/min. At Emax bilirubin entry into bile reached a concentration of 16.1 mumol/mL, increased the biliary concentration of sodium, did not change osmolarity of bile, and did not increase bile flow. The data suggest that bilirubin either interacts with mixed micelles in bile or forms molecular aggregates.     

Bile pigment formation and excretion in the rabbit

Bile and plasma levels of biliverdin and bilirubin, together with the hepatic biliverdin reductase and bilirubin UDP-glucuronosyl transferase activities, were studied in the rabbit. No biliverdin could be detected in the blood plasma. The bilirubin concentration in blood was 7.81 +/- 0.79 mumol/l. Biliverdin was the predominant pigment in bile (63%). Hepatic biliverdin reductase activity was 0.086 +/- 0.016 nmol/mg protein/hr. The synthesis of bilirubin was apparently limited by the enzyme activity. Most of the bilirubin in bile was conjugated (90%) with monoconjugates predominating (75%). Hepatic UDP-glucuronosyl transferase activity was 2.65 +/- 0.18 and 1.14 +/- 0.16 mumol/mg protein/hr with and without activation, respectively.     

Effect of Milk Whey and Its Fermentation Products by Lactic Acid Bacteria on Mitochondrial Lipid Peroxide and Hepatic Injury in Bile Duct-ligated Rats

The study was carried out to assess whether bovine milk whey and its products fermented by lactic acid bacteria could ameliorate the lipid peroxidation of hepatic mitochondria associated with cholestatic liver injury due to bile duct ligation. Rats were maintained on one of five diets for 3 weeks before being operated upon and killed 3 weeks after bile duct ligation. The diets included one deficient in vitamin E (control diet) and others supplemented with either 5% milk whey or 5% milk whey fermented with Bifidobacterium longum (B. longum), Lactobacillus acidophilus (L. acidophilus), and Streptococcus salivarius subsp. thermophillus (S. thermophillus). Bile duct-ligated rats, compared with sham-operated rats, had higher organ weights (liver and spleen), higher serum alkaline phosphatase activity, higher serum bilirubin concentration, and higher content of hepatic mitochondrial lipid hydroperoxide. The rats fed on diets containing milk whey fermented with B. longum ameliorated the elevation of organ weights, enzyme activity, bilirubin concentration, and content of mitochondrial lipid hydroperoxide. Milk whey and milk whey fermented with L. acidophilus and S. thermophillus also suppressed the elevation of mitochondrial lipid hydroperoxide, but had no ameliorating effects on organ weights, enzyme activity, and bilirubin concentration. The elevation of serum lipid hydroperoxide was ameliorated in rats fed on diets containing milk whey and milk whey fermented with B. longum and S. thermophillus. The reduction in plasma α-tocopherol due to bile duct ligation was ameliorated in those rats fed on diets containing milk whey fermented with B. longum as well as by S. themophillus. These results suggest that a milk whey fermented with lactic acid bacteria exerts a beneficial effect on free radical-mediated hepatic injury.     

Minor liver profile dysfunctions in Plasmodium vivax, P. malaria and P. ovale patients and normalization after treatment

Liver function tests were performed in 61 vivax, 54 malariae and 15 ovale malaria patients who were admitted to Bangkok Hospital for Tropical Diseases between 2001 and 2004. The objective of the study was to evaluate changes in hepatic biochemical indices before and after treatment with artemisinin derivatives. On admission and prior to treatment, hepatic dysfunction was found among the 3 groups. Serum liver function tests and physical examinations were performed weekly during the 28-day follow-up period. Initially elevated serum bilirubin and diminished albumin returned to normal within 2 weeks of treatment. Serum alkaline phosphatase and aminotransferases returned to within normal limits within 3 weeks. We conclude that patients with Plasmodium vivax, P. malariae and P. ovale infections had slightly elevated serum bilirubin, aminotransferase and alkaline phosphatase levels, and hypoalbuminemia. These minor abnormalities returned to normal within a few weeks after treatment with therapies based on artemisinin derivatives.     

Increased concentrations of plasma IL-18 in patients with hepatic dysfunction after hepatectomy

We investigated the dynamic aspects of circulatory IL-18 and other inflammatory cytokines in patients who underwent a hepatectomy. In patients with post-operative hepatic dysfunction, plasma concentrations of these cytokines increased, reflecting severe surgical trauma. IL-6, IL-10 and IFN-gamma increased in the early phase, while IL-18 increased in the later phase after 1 week. Interestingly, the increase in the plasma IL-18 concentration was correlated with that in serum bilirubin levels in hepatectomized patients. Hence, the decrease in the hepatic metabolism of IL-18 may cause the plasma accumulation of IL-18. This mechanism was confirmed using rat experiments. Intravenously administered human IL-18 was excreted into bile. Furthermore, the plasma clearance of human IL-18 was prolonged in bile duct-ligated rats. These results suggest that IL-18 is metabolized in the liver and excreted into bile, and an increase in plasma IL-18 in patients with hepatic dysfunction reflects the decreased metabolism in the liver.     

Alpha-asarone inhibits HMG-CoA reductase, lowers serum LDL-cholesterol levels and reduces biliary CSI in hypercholesterolemic rats.

Our results showed that alpha-asarone was an inhibitor of hepatic HMG-CoA reductase and that the administration of alpha-asarone at 80 mg/kg body wt. for 8 days decreased serum cholesterol by 38% (p < 0.001) in hypercholesterolemic rats. This alpha-asarone treatment affected mainly the serum LDL-cholesterol levels, leaving serum HDL-cholesterol lipoproteins unaffected, with a consequent decrease of 74% in the LDL/HDL ratio. In addition, alpha-asarone especially stimulated bile flow in hypercholesterolemic rats (60%), increasing the secretion of bile salts, phospholipids and bile cholesterol. The drug also reduced the cholesterol levels of gallbladder bile, whereas the concentration of phospholipids and bile salts increased only slightly, leading to a decrease in the cholesterol saturation index (CSI) of bile in the hypercholesterolemic rats. This CSI decrease and the increase in bile flow induced by alpha-asarone may account for the cholelitholytic effect of alpha-asarone. It seems that alpha-asarone induced clearance of cholesterol from the bloodstream and that the excess of hepatic cholesterol provided by LDL-cholesterol is diverted to bile sterol secretion via a bile choleresis process. The inhibition of HMG-CoA reductase and the increase in bile flow induced by alpha-asarone, as well as the decrease in the CSI, could then explain the hypocholesterolemic and cholelitholytic effects of alpha-asarone.     

Increased renal expression of bilirubin glucuronide transporters in a rat model of obstructive jaundice

Regulation of bilirubin glucuronide transporters during hyperbilirubinemia in hepatic and extrahepatic tissues is not completely clear. In the present study, we evaluated the regulation of the bilirubin glucuronide transporters, multidrug resistance-associated proteins (MRP)2 and 3, in rats with obstructive jaundice. Bile duct ligation (BDL) or sham operation was performed in Wistar rats. Liver and kidneys were removed 1, 3, and 5 days after BDL (n = 4, in each group). Serum and urine were collected to measure bilirubin levels just before animal killing. MRP2 And MRP3 mRNA expressions were determined by real-time RT-PCR. Protein expression of MRP2 and MRP3 was determined by Western blotting. Renal MRP2 function was evaluated by para-aminohippurate (PAH) clearance. The effect of conjugated bilirubin, unconjugated bilirubin, human bile, and sulfate-conjugated bile acid on MRP2 gene expression was also evaluated in renal and hepatocyte cell lines. Serum bilirubin and urinary bilirubin excretion increased significantly after BDL. In the liver, the mRNA expression of MRP2 decreased 59, 86, and 82%, and its protein expression decreased 25, 74, and 93% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. In contrast, the liver expression of MRP3 mRNA increased 138, 2,137, and 3,295%, and its protein expression increased 560, 634, and 612% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. On the other hand, in the kidneys, the mRNA expression of MRP2 increased 162, 73, and 21%, and its protein expression increased 387, 558, and 472% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. PAH clearance was significantly increased after BDL. The mRNA expression of MRP2 increased in renal proximal tubular epithelial cells after treatment with conjugated bilirubin, sulfate-conjugated bile acid or human bile. Upregulation of MRP2 in the kidneys and MRP3 in the liver may be a compensatory mechanism to improve bilirubin clearance during obstructive jaundice.     

Antipyrine,paracetamol, and lignocaine elimination in chronic liver disease.

The plasma half lives of antipyrine, paracetamol, and lignocaine given by mouth were measured in 23 patients with stable chronic liver diseases of varying severity. Fifteen patients received all three drugs and 19 at least two. The half life of paracetamol was abnormally prolonged in nine out of 17 patients (mean 2-9 hours, normal 2-0 hours), of antipyrine in 10 out of 19 patients (mean 30-4 hours, normal 12-0 hours), and of lignocaine in 19 out of 21 patients (mean 6-6 hours, normal 1-4 hours). Prolongation of the half lives of all three drugs was significantly correlated with an increase of the vitamin-K1-corrected prothrombin time ratio and a reduction in serum albumin concentration. There was no correlation with serum bilirubin concentration or serum alanine aminotransferase activity. This suggests that impaired drug elimination was related to depressed hepatic protein synthesis. Considerable prolongation of the half life of one drug was invariably associated with delayed elimination of the others. The half life of lignocaine, however, was always the most prolonged and was a highly sensitive indicator of hepatic dysfunction. The pharmacokinetic characteristics of a drug as well as the severity of liver disease should be taken into account when considering drug dosage in patients with chronic liver disease.     

Biliary bilirubin in rats and exposure to metals

After cannulation the bile duct of unexposed rats, changes in bilirubin concentration in the samples of bile collected were observed. During the first hour after the cannulation the bilirubin concentration decreased remaining constant until about the 3.-4. hour and then continuously increased upto the 24. hour when the experiment ended. The final concentration was about 4 fold higher than between the 1.-4. hour after the cannulation. This could explain a large variation in values reported by various authors. This fact significantly complicated the studies on effect of exposure to heavy metal salts on changes of bilirubin concentration in bile and relationship among bilirubin concentrations in the bile fractions 1, 2 and 3. In the bile of unexposed rats comparable bilirubin concentrations were found in the bile fractions 1 and 2. The preliminary experiment with HgCl2 application to rats revealed that in the fraction 3 might be a higher bilirubin concentration than in the fractions 1 and 2, the latter ones being lower than in the bile of unexposed rats. The hypothesis was suggested that the bile fraction 3 was composed from yellow pigments liberated from compounds forming the fractions 1 and 2 with additional amount of pigments originated during disturbed protoporphyrin biosynthesis of their degradation by the metals.     

Gall Stones in Patients with Disorders of the Terminal Ileum and Disturbed Bile Salt Metabolism

In a combined historical and radiological survey gall stones were found in 23 out of 72 patients with disorders of the terminal ileum (31·9%). This is four to five times the expected incidence of cholelithiasis. In these patients the incidence of gall stones was not related to age, but did, however, increase with increased duration of the ileal disorder. Glycine/taurine conjugation ratios of bile salts in the bile were abnormally high in 10 out of 11 patients with ileal disorders. Both impaired bile salt recirculation and absorption of poorly soluble bacterially degraded bile salts are possible causes of cholelithiasis in these patients.     

Clinical significance in alcoholic patients of commonly encountered laboratory test results.

An improved understanding of medical problems of alcoholic patients can be gained from commonly encountered laboratory test results. Liver function tests--such as measures of alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase--may provide evidence of altered hepatic activity of different types, such as obstruction and hepatocellular injury. Other test results may indicate impaired hepatic function, such as measurements of albumin, bilirubin, prothrombin time, and blood urea nitrogen. Alterations are also common in electrolytes, blood glucose, magnesium, phosphate, uric acid, and acid-base balance. Disturbances in hematologic function are not infrequent in alcoholic patients, including anemias from many causes, altered granulocyte responses, and thrombocytopenia.