肝硬化并自发性细菌性腹膜炎的观察和护理

目的探讨肝硬化并自发性细菌性腹膜炎有效的观察方法和护理措施。方法对152例肝硬化并自发性细菌性腹膜炎的观察方法和护理措施进行回顾性分析。结果152例患者通过治疗及护理配合,治愈好转129例,死亡和自动出院23例。结论加强病情观察及实施有效的护理措施对促进患者康复、减少并发症,降低死亡率有重要的意义。     

乳果糖对肝癌TACE后肠黏膜损伤的保护作用研究

目的了解乳果糖对肝癌TACE后患者肠黏膜损伤的保护作用。方法将54例患者随机分为2组,治疗组按常规治疗加服乳果糖,对照组按常规治疗,服药后观察全身和肠道情况并检测二胺氧化酶(DAO)的内毒素水平。结果治疗组血二胺氧化酶水平与术前相比差异无显著性(P>0.05),未应用乳果糖组血内毒素水平比术前降低(P<0.05);治疗组血内毒素水平与术前相比差异无显著性(P>0.05),而未应用乳果糖组血内毒素水平比术前升高(P<0.05)。结论乳果糖增强了肠道黏膜的屏障作用,在避免肝癌TACE后的肠道细菌易位,内毒素血症起到积极作用。     

Switch of cadherin expression from E- to N-type during the activation of rat hepatic stellate cells

The activation of hepatic stellate cell (HSC) is a common pathway leading to hepatic fibrosis. However, the molecular mechanisms underlying HSC activation remain obscure. To elucidate the nature of the HSC activation, we investigated the expression of E-cadherin and its switch to N-cadherin during rat HSC activation, in vivo and in vitro. Immunohistochemical and immunocytochemical staining were performed to identify the expressions of E-cadherin, N-cadherin, and β-catenin in rat HSCs, in vivo and in vitro. Serial changes in the expressions of these adhesion molecules during the spontaneous activation of cultured rat HSCs were also demonstrated by RT-PCR and by immunoblotting. E-cadherin and β-catenin were expressed on opposing cell membranes of GFAP-positive rat HSCs and adjacent hepatocytes in vivo, and between desmin-positive rat HSCs in vitro. With the progression of rat HSC activation in tissue and in culture, E-cadherin disappeared gradually, whereas N-cadherin appeared at the cell periphery. The results of RT-PCR and immunoblotting were concordant with immunocytochemistry findings. In conclusion, resting rat HSCs express E-cadherin and β-catenin both in vivo and in vitro, and E-cadherin switches to N-cadherin during HSC activation. These results suggest that HSC activation represents transdifferentiation from an epithelial to a mesenchymal phenotype.     

The rs738409 (I148M) variant of the PNPLA3 gene and cirrhosis: a meta-analysis

The human patatin-like phospholipase domain-containing-3 (PNPLA3) gene rs738409 C>G polymorphism is associated with several types of liver disease. The aim of this meta-analysis was to assess the risk of cirrhosis on the basis of rs738409 allele frequency and genotype. Medline, the Cochrane Library, EMBASE, and Google Scholar were searched for prospective and retrospective studies assessing the effect of the rs738409 polymorphism on liver cirrhosis. Seven studies, involving 2,023 patients with cirrhosis, were included. The G allele was associated with a significantly increased risk of cirrhosis versus the C allele [pooled odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.64–2.12, Z = 9.55, P < 0.001]. Both the GC and GG genotypes were associated with a significantly increased risk of cirrhosis versus the CC genotype (GC vs. CC: pooled OR = 1.73, 95% CI = 1.51–1.98, Z = 7.86, P < 0.001; GG vs. CC: pooled OR = 3.41, 95% CI = 2.77–4.18, Z = 11.65, P < 0.001). There was no evidence of publication bias. Our findings suggest that patients at risk for liver cirrhosis may benefit from PNPLA3 genotyping and thus more intensive monitoring if the rs738409 C>G polymorphism is identified.     

Polyunsaturated fatty acid metabolites as novel lipidomic biomarkers for noninvasive diagnosis of nonalcoholic steatohepatitis

Lipotoxicity is a key mechanism thought to be responsible for the progression of nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). Noninvasive diagnosis of NASH is a major unmet clinical need, and we hypothesized that PUFA metabolites, in particular arachidonic acid (AA)-derived eicosanoids, in plasma would differentiate patients with NAFL from those with NASH. Therefore, we aimed to assess the differences in the plasma eicosanoid lipidomic profile between patients with biopsy-proven NAFL versus NASH versus normal controls without nonalcoholic fatty liver disease (NAFLD; based on MRI fat fraction <5%). We carried out a cross-sectional analysis of a prospective nested case-control study including 10 patients with biopsy-proven NAFL, 9 patients with biopsy-proven NASH, and 10 non-NAFLD MRI-phenotyped normal controls. We quantitatively compared plasma eicosanoid and other PUFA metabolite levels between NAFL versus NASH versus normal controls. Utilizing a uniquely well-characterized cohort, we demonstrated that plasma eicosanoid and other PUFA metabolite profiling can differentiate between NAFL and NASH. The top candidate as a single biomarker for differentiating NAFL from NASH was 11,12-dihydroxy-eicosatrienoic acid (11,12-diHETrE) with an area under the receiver operating characteristic curve (AUROC) of 1. In addition, we also found a panel including 13,14-dihydro-15-keto prostaglandin D₂ (dhk PGD2) and 20-carboxy arachidonic acid (20-COOH AA) that demonstrated an AUROC of 1. This proof-of-concept study provides early evidence that 11,12-diHETrE, dhk PGD2, and 20-COOH AA are the leading eicosanoid candidate biomarkers for the noninvasive diagnosis of NASH.     

微生态制剂对预防肝硬化自发性腹膜炎再发的疗效观察及护理体会

目的探讨常规保肝基础上联合微生态制剂对肝硬化自发性腹膜炎再发的疗效及护理措施。方法选取选取2011年10月至2013年6月来我院治疗的肝硬化自发性腹膜炎患者48例,随机分为微生态治疗组及对照组,微生态治疗组行常规保肝治疗并加用微生态制剂,对照组仅行常规保肝治疗,比较1年内两组患者自发性腹膜炎的再发情况及再发时各症状缓解时间的变化,并总结护理措施。结果微生态治疗组再发率明显低于与对照组再发率,差异有统计学意义(P0.05);微生态治疗组的各项症状的缓解时间也明显少于对照组,差异有统计学意义(P0.05)。结论在常规保肝基础上加服微生态制剂可以有效地预防肝硬化患者自发性腹膜炎再发,并能显著缩短再发时各症状的缓解时间。同时,护理人员的正确护理是保证治疗顺利进行,并改善患者预后的关键。     

Influence of olive and rosemary leaves extracts on chemically induced liver cirrhosis in male rats

The current study was undertaken to evaluate the protective activity of olive and rosemary leaves extracts on experimental liver cirrhosis induced by thioacetamide (TAA) in Wistar male rats. Highly significant decline in the values of body weight gain and highly statistically increase of liver/body weight ratio were noted in rats treated with TAA. Furthermore, the levels of serum alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, alkaline phosphatase and total bilirubin were statistically increased. Additionally, light microscopic examination of liver sections from rats treated with TAA showed a marked increase in the extracellular matrix collagen content and bridging fibrosis was prominent. There were bundles of collagen surrounding the lobules that resulted in large fibrous septa and distorted tissue architecture. Interestingly, the findings of this experimental study indicated that the extracts of olive and rosemary leaves and their combination possess hepatoprotective properties against TAA-induced hepatic cirrhosis by inhibiting the physiological and histopathological alterations. Moreover, these results suggest that the hepatoprotective effects of these extracts may be attributed to their antioxidant activities.     

Development of M2BPGi: a novel fibrosis serum glyco-biomarker for chronic hepatitis/cirrhosis diagnostics

Many proteins in the living body are glycoproteins, which present glycans linked on their surface. Glycan structures reflect the degree of cell differentiation or canceration and are cell specific. These characteristics are advantageous in the development of various disease biomarkers. Glycoprotein-based biomarkers (glyco-biomarkers) are developed by utilizing the specific changes in the glycan structure on a glycoprotein secreted from the diseased cells of interest. Therefore, quantification of the altered glycan structures is the key to developing a new glyco-biomarker. Glycoscience is a relatively new area of molecular science, and recent advancement of glycotechnologies is remarkable. In the author’s institute, new glycoscience technologies have been designed to be efficiently utilized for the development of new diagnostic agents. This paper introduces a strategy for glyco-biomarker development, which was successfully applied in the development of Wisteria floribunda agglutinin-positive Mac-2 binding protein M2BPGi, a liver fibrosis marker now commercially available for clinical use.     

血S100B蛋白和尿乳酸/肌酐比值对门静脉高压症术后肝性脑病发生的早期预测价值

目的评价血S100B蛋白和尿乳酸/肌酐对乙肝肝硬化门脉高压症术后肝性脑病发生的早期预测价值。方法回顾性分析65例乙肝肝硬化门脉高压症患者的临床资料,动态检测术后24、48和72h的血S100B蛋白和尿乳酸/肌酐比值水平,根据是否发生术后肝性脑病将受试者分为肝性脑病组与非肝性脑病组,并对肝性脑病组患者进行临床分度。结果乙肝肝硬化门脉高压症患者术后发生肝性脑病组72h内血S100B蛋白含量和24 h内尿乳酸/肌酐比值水平明显高于非肝性脑病组(P<0.001);72h内血S100B蛋白含量和24 h内尿乳酸/肌酐比值之间及与肝性脑病的临床分度呈正相关(P<0.001);当血S100B水平在28ng/L,尿乳酸/肌酐比值在0.47时,单独检测72h血S100B蛋白的敏感度、特异度分别为91.2%、93.6%;尿乳酸/肌酐比值预测肝性脑病的敏感度和特异性度以术后24h最高,分别为89.3%和91.7%;如检测72h血S100B蛋白的同时监测术后24h尿乳酸/肌酐比值可显著提高肝性脑病诊断的准确性,联合应用两项指标进行检测,诊断的敏感度和特异度分别为95.7%和98.6%,较两种方法单独应用敏感度和特异度均提高。结论对门静脉高压症患者术后以临床表现为基础,同时监测72h内血S100B蛋白和24h尿乳酸/肌酐比值,对提高术后肝性脑病的早期诊断和临床分度具有一定应用价值。