肝部分切除治疗肝内胆管结石患者术后并发症及影响因素分析

目的:分析肝部分切除术治疗肝内胆管结石患者术后并发症及影响因素。方法:选取我院收治的肝内胆管结石患者117例,均采取肝部分切除术治疗,对其临床资料进行回顾性分析,研究术后并发症的发生情况,并对影响因素进行分析。结果:本组117例患者,并发症发生率35.04%,其中肝功能衰竭1例,胆道出血2例,消化道出血6例,腹腔感染6例,胆瘘6例,胸腔积液8例,切口感染12例。并发症组患者术前白蛋白、手术时间、既往胆道手术史水平与非并发症组比较,差异均有统计学意义(P0.05)。肝部分切除术后的并发症多因素Logistic回归分析结果显示,手术时间、既往胆道手术史均是术后并发症独立风险因素。结论:肝部分切除术治疗肝内胆管结石患者术后并发症发生率较高,以切口感染和胸腔积液为最,患者的既往手术史以及手术时间均是影响并发症发生的重要危险因素,做好针对性预防可预防并发症的发生。     

Bone marrow transplantation results in donor-derived hepatocytes in an animal model of inherited cholestatic liver disease

Cell transplantation is a potential therapy for acquired or inherited liver diseases. Donor-derived hepatocytes (DDH) have been found in humans and mice after bone marrow transplantation (BMT) but with highly variable frequencies in different disease models. To test the effect of liver repopulation after BMT in inherited cholestatic liver diseases, spgp (sister of P-glycoprotein, or bile salt export pump, abcb11) knockout mice, a model for human progressive intrahepatic cholestasis type 2 with defects in excreting bile salts across the hepatocyte canalicular membrane, were transplanted with bone marrow cells from enhanced green fluorescent protein (EGFP) transgenic donor mice after lethal irradiation. One to 6 months later, scattered EGFP-positive DDHs with positive spgp staining were observed in the liver. These hepatocytes had been incorporated into hepatic plates and stained positively with hepatocyte-specific marker albumin. RT-PCR for the spgp gene revealed positive expression in the liver of sgsp knockout mice that had received the transplant. Bile acid analysis of bile samples showed that these mice also had higher levels of total biliary bile acid and taurocholic acid concentration than knockout mice without transplantation, indicating that BMT partially improved biliary bile acid secretion. Our results indicate that bone marrow cells could serve as a potential source for restoration of hepatic functions in chronic metabolic liver disease.     

Stable expression and functional characterization of a Na+-taurocholate cotransporting green fluorescent protein in human hepatoblastoma HepG2 cells

Sodium-dependent uptake of bile acids from blood is aliver-specific function which is mediated by theNa⁺-taurocholate cotransporting polypeptide(Ntcp). We report the stable expression of aNa⁺-taurocholate cotransporting green fluorescentfusion protein in the human hepatoblastoma cell lineHepG2, normally lacking Ntcp expression. Ntcp-EGFPassociated green fluorescence colocalized with Ntcpimmunofluorescence in the plasma membrane. Intransfected HepG2 cells, the fusion protein mediatedthe sodium-dependent uptake of the bile acidtaurocholate (K_m: 24.6 mol/l) and of the anionicsteroids estrone-3-sulfate and dehydroepiandrosteronesulfate. We conclude that the Ntcp-EGFP fusion proteinfollows the sorting route of Ntcp, is functionallyidentical to Ntcp and could be used to monitor proteintrafficking in living HepG2 cells.     

The hydroalcoholic extract of watercress attenuates protein oxidation,oxidative stress,and liver damage after bile duct ligation in rats

Cholestatic liver disease is recognized by extreme collagen formation and deposition, which is mediated by free radicals. The aim of the current study was to investigate the probable hepatoprotective effects of hydroalcoholic extract of watercress (WC) against oxidative stress and liver injury in bile duct ligation (BDL)- induced cholestatic rats. A total of 32 male Wistar rats were divided into four groups; sham control (SC), BDL, SC + hydroalcoholic extract of WC and BDL + hydroalcoholic extract of WC. WC-treated rats received daily WC 500 mg/kg/day for 10 days. Biochemical tests, hepatic oxidative stress markers, and antioxidant enzymes activity were estimated. Further, liver hydroxyproline content was assayed and histological analysis was made. The BDL model markedly elevated the protein carbonyl (PCO) and hydroxyproline contents and decreased the glutathione peroxidase (GPx) activity. Hydroalcoholic extract of WC significantly decreased the surge in liver PCO and hydroxyproline levels and increased the reduced GPx enzyme activity contents in the hepatic tissue. As determined by hematoxylin and eosin staining, BDL considerably induced hepatocyte necrosis. Moreover, these changes were significantly attenuated by the hydroalcoholic extract of WC treatment. Our data indicate that the hydroalcoholic extract of WC extract attenuated liver damage in BDL rats by decreasing the hydroxyproline content and histopathological indexes. Also, it reduced oxidative stress by preventing the hepatic protein oxidation and enhancing the activity of the GPx enzyme via antioxidative effect and free-radical scavenging. Our findings suggest that hydroalcoholic extract of WC could be a beneficial new curative agent for cholestatic liver damage.     

益生菌对急性肝内胆汁淤积大鼠肝组织NF-κB和MCP-1的影响

目的通过研究益生菌制剂对异硫氰酸萘酯（ANIT））所致的急性肝内胆汁淤积大鼠肝组织NF-κB和MCP-1表达的影响,进一步探讨益生菌防治急性肝内胆汁淤积肝损伤的作用机制。方法72只幼年雄性Sprague-Dawley（SD）大鼠分为正常对照组（8只）、中毒组（32只）和干预组（32只）。中毒组及干预组幼鼠,按100mg／kg一次性灌服ANIT诱导急性肝内胆汁淤积病变,干预组于ANIT灌胃前3d开始灌服培菲康[4．2×10^8个活菌／（kg·d）]。观察各组在灌服ANIT后24h、48h、72h和96h血浆总胆红素（TB）、丙氨酸转氨酶（ALT）的浓度,同时用RT-PCR测定肝组织中MCP-1mRNA的表达,用免疫组化方法测定肝组织中NF-κB、MCP-1蛋白的表达,并在光学显微镜下观察肝脏的形态学改变。结果干预组大鼠血清ALT、TB在灌服ANIT后24h、48h、72h和96h各时间点升高的峰值较中毒组明显减低,且其肝组织MCP-1mRNA和蛋白表达水平以及NF-κB蛋白表达水平较中毒组低。结论益生菌能够改善急性肝内胆汁淤积肝脏功能,降低NF-κB、MCP-1的基因表达,对急性肝内胆汁淤积性肝损伤起到一定的防治作用。     

Targeted genomic profiling revealed a unique clinical phenotype in intrahepatic cholangiocarcinoma with fibroblast growth factor receptor rearrangement

Genomic aberrations (GAs) in fibroblast growth factor receptors (FGFRs) are involved in the pathogenesis of intrahepatic cholangiocarcinoma (ICC), and clinical trials have shown efficacy of FGFR inhibitors in treating ICC patients with FGFR GAs such as FGFR2 rearrangement. To clarify the FGFRs GA profile and corresponding clinicopathological features in Chinese patients with ICC, a total of 257 cases were identified. Fourteen cases (5.45%) were positive for FGFR2 rearrangement. Further analysis on the 110 FGFR2 rearrangement negative cases showed that 13 patients present additional FGFRs GAs, including FGFR3 rearrangement (2.73%), and FGFRs mutations. When compared with patients without FGFRs GAs, those with FGFR2 or FGFR3 rearrangement presented more under the age of 58 years, female sex, HBsAb positivity, CD10 expression, and PD-L1 expression. The clinical characteristics between patients with FGFRs mutation and those without FGFRs GAs were similar, with the exception that cases with FGFRs mutation have more hepatolithiasis. We concluded that FGFR rearrangement is associated with unique clinical phenotypes in ICC.     

Melatonin protects against taurolithocholic‐induced oxidative stress in rat liver

Cholestasis, encountered in a variety of clinical disorders, is characterized by intracellular accumulation of toxic bile acids in the liver. Furthermore, oxidative stress plays an important role in the pathogenesis of bile acids. Taurolithocholic acid (TLC) was revealed in previous studies as the most pro‐oxidative bile acid. Melatonin, a well‐known antioxidant, is a safe and widely used therapeutic agent. Herein, we investigated the hepatoprotective role of melatonin on lipid and protein oxidation induced by TLC alone and in combination with FeCl₃ and ascorbic acid in rat liver homogenates and hepatic membranes. The lipid peroxidation products, malondialdehyde and 4‐hydroxyalkenals (MDA + 4‐HDA), and carbonyl levels were quantified as indices of oxidative damage to hepatic lipids and proteins, respectively. In the current study, the rise in MDA + 4‐HDA levels induced by TLC was inhibited by melatonin in a concentration‐dependent manner in both liver homogenates and in hepatic membranes. Melatonin also had protective effects against structural damage to proteins induced by TLC in membranes. These results suggest that the indoleamine melatonin may potentially act as a protective agent in the therapy of those diseases that involve bile acid toxicity. J. Cell. Biochem. 110: 1219–1225, 2010. Published 2010 Wiley‐Liss, Inc.