Plasma leucine enkephalin content in patients with “Liver-blood deficiency” syndrome and clinical significance

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Ethical frontiers in liver transplantation

Liver transplantation represents a pivotal intervention in the management of end-stage liver disease,offering a lifeline to countless patients.Despite significant strides in surgical techniques and organ procurement,ethical dilemmas and de-bates continue to underscore this life-saving procedure.Navigating the ethical terrain surrounding this complex procedure is hence paramount.Dissecting the nuances of ethical principles of justice,autonomy and beneficence that underpin transplant protocols worldwide,we explore the modern challenges that plaques the world of liver transplantation.We investigate the ethical dimensions of organ transplantation,focusing on allocation,emerging technologies,and decision-making processes.PubMed,Scopus,Web of Science,Embase and Central were searched from database inception to February 29,2024 using the following key-words:“liver transplant”,“transplantation”,“liver donation”,“liver recipient”,“organ donation”and“ethics”.Information from relevant articles surrounding ethical discussions in the realm of liver transplantation,especially with regards to organ recipients and allocation,organ donation,transplant tourism,new age technologies and developments,were extracted.From the definition of death to the long term follow up of organ recipients,liver transplantation has many ethical quandaries.With new transplant techniques,societal acceptance and perceptions also play a pivotal role.Cultural,religious and regional factors including but not limited to beliefs,wealth and accessibility are extremely influential in public at-titudes towards donation,xenotransplantation,stem cell research,and adopting artificial intelligence.Understanding and addressing these perspectives whilst upholding bioethical principles is essential to ensure just distribution and fair allocation of resources.Robust regulatory oversight for ethical sourcing of organs,ensuring good patient selection and transplant techniques,and high-quality long-term surveillance to mitigate risks is essential.Efforts to promote equitable access to transplantation as well as prioritizing patients with true needs are essential to address disparities.In conclusion,liver transplantation is often the beacon of hope for individuals suffering from end-stage liver disease and improves quality of life.The ethics related to transplantation are complex and multifaceted,considering not just the donor and the recipient,but also the society as a whole.

Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

AIM: To assess a protocol for treating patients with multiple synchronous colonic cancer liver metastases, which are unresectable in one stage. METHODS: Patients enrolled in the "liver first" protocol presented with colon-only(not rectal) cancer and multiple synchronous hepatic metastases(type Ⅱ or Ⅲ). All patients showed good performance status(ECOG PS 0-1) and were treated with curative intent. Complete oncologic staging including positron emission tomography-computed tomography was performed in order to rule out extrahepatic disease. If bowel obstruction was imminent, an intraluminal colonic stent was placed endoscopically. Subsequently, all patients received standardised neo-adjuvant chemotherapy, that is, FOLFOX or XELOX regimens combined with an antiangiogenic agent(bevacizumab or cetuximab). Provided that a response to chemotherapy was observed, patients underwent either one or two hepatectomies with or without portal vein embolization followed by the indicated colectomy. Further chemotherapy was administered after each procedure. Re-staging was performed after each chemotherapeutic treatment. Disease progression at any stage resulted in discontinuation of the protocol and conversion to palliative disease management.RESULTS: Prospectively recorded data from 11 consecutive patients(8 men) were analysed for this study. Their mean age at the time of their first assessment was 65.7(SD ± 15.3) years. Six(54.6%) patients presented with type Ⅲ metastatic disease. The minimum and maximum follow-up periods were 7.3 and 39.6 mo, respectively. The mean overall survival of all patients was 16.5(95%CI: 10.0-23.2) mo. A colonic stent had to be placed in 5(45.5%) patients due to the onset of an intraluminal obstruction. Four(36.4%) patients succeeded in completing all planned surgical operations. Their mean overall survival was 27.2(95%CI: 15.1-39.3) mo and the mean disease-free survival was 7.7(95%CI: 3.0-12.5) mo. Patients, who were obliged to shift to palliative treatment due to dis-ease progression, had a mean overall survival of 10.5(95%CI: 8.6-12.4) mo. None of these patients underwent palliative colectomy. No postoperative mortality was recorded.CONCLUSION: The implementation of a structured "liver first" approach protocol for the treatment of patients with extensive, liver-limited colon cancer metastatic disease may be beneficial.

Profile of Amoebic vs. Pyogenic Liver Abscess and Comparison of Demographical, Clinical, Radiological, and Laboratory Profiles of These Patients from Three Secondary Care Centers in Senegal

Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.

基于livertox数据库的药物说明书乙型肝炎再激活风险警示标注情况调查分析

目的调查和分析996种药物HBV再激活(HBV reactivation,HBVr)在livertox数据库的记录情况与药品说明书中HBVr用药警示信息进行对比分析。方法统计livertox数据库中药物的HBVr提示信息,并与丁香园用药助手系统中收录的药品说明书HBVr用药警示信息标注进行对比。结果livertox数据库中共有47个药物和1类药物有HBVr风险信息提示并已在我国上市。其中糖皮质激素类药物和10个药物说明书并无HBVr风险信息提示,有2个药物部分说明书有提示,部分没有。结论药品生产企业及时修订药品说明,根据最新信息增加警示标语。临床医师及药师在临床使用中,需加强对病毒性感染患者的用药监护。

Assessment of Liver Fibrosis in HBsAg-Negative and Anti HBc Positive Patients

Background: Surface antigen (HBsAg) is the mean marker of hepatitis B virus infection. During the course of the infection, some patients lose the HBsAg and only the presence of anti-HBc antibody indicates previous contact with the virus. Among these patients, some have detectable viral load (occult infection) but most without viral replication. There is no guideline regarding these patients. The aim of this study was to assess hepatic fibrosis in patients with only the hepatitis B virus contact marker “total anti-HBc”. Patients and methods: it was a descriptive and analytical cross-sectional study, conducted in three private hospitals from January to August 2022. Were included HBsAg-negative and HBc-positive patients, consulting in Gastroenterology departments. Noninvasive methods (APRI, FIB-4 and FIBROSCAN) were used to evaluate liver stiffness because of their easy accessibility and low-cost. The hepatic fibrosis was considered significant when the score determined by APRI, FIB-4 and FIBROSCAN® tests was respectively greater than 1.5;2.67 and 8 kPa corresponding to fibrosis level 2 (F2). Results: A total of 63 HBsAg-negative/total HBcAg-positive patients were included. The mean age was 49.9 ± 13.4 years. The male/female sex ratio was 1.78. Of the 63 patients, 19 had significant liver fibrosis (30.1%) among which 9 patients had HCC. The FIB-4 score outperformed the APRI score in assessing liver fibrosis, with a sensitivity of 84.2%, a specificity of 100% and a negative predictive value of 93.6%. In univariate analysis, there was a significant association between the occurrence of significant liver fibrosis and age over 40 years, dyslipidaemia, obesity, alcohol consumption, smoking, herbal medicine, negative anti-HBs immunological status and detectable viral load. Conclusion: Our study revealed a high prevalence of significant to severe hepatic fibrosis in anti-HBc positive patients. In most of the cases, the fibrosis was severe. Progression to HCC has also been possible. There is no consensus on the follow-up strategy for those patients. However, screening for hepatic fibrosis using noninvasive methods should be recommended for patients aged over 40 years, alcohol or herbal medicine users, patients with metabolic syndrome or occult hepatitis B. In HBsAg-negative/anti-HBc-positive patients, liver stiffness should be evaluated and if it is greater than F2, HCC screening should be started.

Acute Fatty Liver of Pregnancy—A Case Report in Grange University Hospital, Wales

Acute fatty liver of pregnancy (AFLP) is a rare obstetric complication, and despite improvements in recognition and management over recent decades, it still carries a high risk of maternal and fetal morbidity and mortality. Patients typically present in the third trimester with non-specific symptoms, including nausea and vomiting, upper abdominal pain, malaise and anorexia. Initial diagnosis can be challenging due to the sometimes-insidious presentation, as well as the difficulty in distinguishing between AFLP and other conditions seen in pregnancy with overlapping features. We report a case study of a 32-year-old primigravida who presented with mild and non-specific symptoms, and examination findings leading to a timely diagnosis of AFLP were made. This case highlights the importance of early recognition, prompt intervention, and multidisciplinary management to achieve optimal maternal and fetal outcomes.

Quantitative Assessment of Liver Fibrosis by Elastography in Patients with Chronic Liver Disease: A Cross-Sectional Study in Lomé (Togo)

Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducted over seven month at the Autel dElie Clinic in Lom, from January to August 2022, on adult patients with chronic liver disease who underwent abdominal ultrasound coupled with two-dimensional elastography. Results: The sample size was 54 patients. The mean age of the patients was 33 12 years, with extremes of 18 and 66 years. Patients aged 30 years or less accounted for 48.1% (n = 26). All patients (n = 54) had at least one transaminase assay with a mean of 69.3 78.3 IU/l (AST) and 59.3 82.8 IU/l (ALT). There was no statistically significant association between the biological parameters and the presence of fibrosis. Viral liver disease was the main cause, accounting for 81.5% (n = 44) of cases, with no significant association with the degree of fibrosis. Ultrasound revealed a dysmorphic liver (57.4%;n = 31) and portal hypertension (18.5%, n = 10). Fibrosis stages F1, F2 and F4 accounted for (48.1%, n = 26), (24.1%, n = 13) and (13%, n = 7) of cases respectively. Liver dysmorphia was significantly associated with the presence of fibrosis (p = 0.012) and portal hypertension was significantly associated with the degree of fibrosis (p = 0.0063). Conclusion: Assessment of liver fibrosis in patients with chronic liver disease using 2D-SWE elastography is essential for patient follow-up.

Nursing Care of 10 Patients with Vasovagal Reflex Caused by Artificial Liver Support System Treatment

This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.

Biochemical Liver Functions and Molecular Identification of Fasciola hepatica from Experimentally Infected Rat Model

The current study was performed to evaluate the liver function status as well as molecular characterization of the recovered worms in rats experimentally infected with F. hepatica. Sixteen male Wister rats aged 30 days were randomly allocated into two groups (n = 8). The first group was infected orally with 15 viable encysted metacercaria of F. hepatica per animal. The other group was kept non-infected (control group). At zero time (before infection), the 2nd, 4th, 6th, 8th, 10th, 12th and 14th weeks post-infection (WPI), blood and serum samples were collected via puncture of retro-orbital plexus of veins from each rat. Serum enzyme level (AST and ALT) and total protein were measured, and the serum protein profile was carried out using agarose gel electrophoresis. During the period of the experiment, serum ALT and AST activities and serum total globulins significantly increased while serum total proteins and albumin markedly decreased in the infected group. On the 14th WPI, the data of the electropherogram showed that globulin fractions (α1-, β- and γ-globulin) levels were significantly increased while α2-globulin was markedly decreased in the infected group. The molecular analysis confirmed the amplification of the ITS1, ITS2 and NDI genes of F. hepatica recovered from the infected liver of rats with amplicon sizes of 630, 510 and 560 bp, respectively. Sequencing of the amplified ITS gene resulted in the determination of 3 strains (PP108836, PP108837, and PP108838). Also, analysis of the ITS2 gene resulted in obtaining 3 isolates under the accession numbers (PP109065, PP109066, and PP109067). In conclusion, fasciolosis in the rat model is suitable for routine experimental infections and caused a pronounced liver dysfunction with discharging of the Fasciola eggs in the faeces and the development of adult stages in the bile ducts. Furthermore, molecular techniques are a sensitive tool for the identification and characterisation of the Fasciola parasite.

Diagnosis and Management of Biliary Strictures after Deceased-Donor Liver Transplantation Based on Clinical Practice

Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.

A Retrospective Analysis of Glucagon-Like Peptide 1 Receptor Agonists in Treating Type 2 Diabetes Mellitus Complicated by Nonalcoholic Fatty Liver Disease

Background: The objective of this study was to compare and analyze the variations in clinical indices before and after treatment of type 2 mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD) that were treated with glucagon-like peptide 1 receptor agonists (GLP-1RAs). Methods: The electronic medical record system was utilized to search for a total of 16 patients with type 2 diabetes complicated by NAFLD who were hospitalized at the First Affiliated Hospital of Yangtze University from October 2022 to April 2023 and treated with GLP-1RA for the first time. The clinical indices were compared before and after 12 weeks of treatment with GLP-1RA. Results: The liver-spleen CT ratio (L/S), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in all patients treated with GLP-1RA after 12 weeks were significantly different (P 0.05). The patients were categorized into two groups based on the types of GLP-1RAs. The changes in L/S, TC, TG, and LDL-C in the long-acting group after treatment were statistically significant (P Conclusions: GLP-1RAs can improve liver function, regulate lipid metabolism, and reduce the severity of fatty liver in patients with T2DM complicated by NAFLD, which demonstrates the importance of clinical applications.

Ultrasound Biometry of the Liver at the Point “G” University Hospital Center in Bamako

Introduction: Biometrics therefore corresponds to the measurement of the morphological elements of humans. One of the most common ultrasound requests by clinicians is the assessment of liver size. The aim of our study was to study liver biometry using ultrasound in healthy adult subjects. Material and Methods: This was a prospective, descriptive and analytical study, carried out at CHU Point-G over a period of 7 months. A liver ultrasound was performed on 100 individuals without lesions, by a doctor in his final year of specialization in radiology and medical imaging. For each subject, we determined the height and anteroposterior diameter of the right liver and the left liver. Results: The mean age was 39.05 ± 16.86 years. The body mass index (BMI) 18.5 - 24.9 group was the most represented with 58%. The mean height of the right liver was 138.40 ± 14.85 mm. It was 136.81 ± 14.70 mm in men and 139.92 ± 14.99 mm in women (P = 0.306). That of the left liver was 95.55 ± 14.34 mm, in men, it was 91.79 ± 13.51 mm and 99.16 ± 14.31 mm in women (P = 0.019). We found a significant correlation between right liver height and BMI (P = 0.013). Conclusion: The mean values of liver biometry were established in our series. There was a significant correlation between right liver height and BMI. Liver ultrasound remains a reliable technique for liver biometry.

Respiratory Mechanics, Respiratory Muscle Strength, Control of Ventilation and Gas Exchange in Patients with Autoimmune Liver Disease

Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-autoimmune liver disease and control subjects. These findings were then related to control of ventilation and gas exchange. A secondary objective was to assess respiratory muscle strength and gas exchange and their relation to respiratory mechanics. Methods: Measurements included respiratory elastance and resistance using the passive relaxation method. Pulmonary function, gas exchange and control of ventilation were assessed using standard methods. Results: a) Compared to control subjects, Ers in patients with liver disease was on average 50% greater than in controls;b) mean respiratory resistance, expressed as the respiratory constants, K1 and K2 in the Rohrer relationship, Pao/V’ = K1 + K2V’, was not different from control resistance;c) mean maximal inspiratory and maximal expiratory pressures averaged 36% and 55% of their respective control values;d) inspiratory occlusion pressure in 0.1 sec (P0.1) was increased and negatively associated with FVC;and e) increases in P0.1, mean inspiratory flow (Vt/Ti) and presence of respiratory alkalosis confirmed the increase in ventilatory drive. Despite inspiratory muscle weakness in patients, P0.1/Pimax averaged 5-fold higher than in control subjects. Conclusions: Despite inspiratory muscle weakness and a V’E similar to that in normal subjects, central drive is increased in patients with chronic liver disease. The increase in ventilatory drive is related to smaller lung volumes and weakly associated with increase in respiratory elastance. Findings confirm that P0.1 is a reliable measure of central drive and is an approach that can be used in the evaluation of control of ventilation in patients with chronic liver disease.

苦参碱对油酸诱导的脂肪变性Chang Liver细胞的影响及机制

目的探讨苦参碱对油酸诱导的脂肪变性Chang Liver细胞的改善作用及可能的机制。方法将Chang Liver细胞分为空白组、模型组和苦参碱低、中、高浓度组(0.1、0.5、1.0 mmol/L)。除空白组外,其余各组细胞使用1.0 mmol/L油酸处理24 h建立脂肪变性细胞模型,苦参碱各剂量组加入相应浓度药物干预24 h。检测细胞活性,观察细胞内脂滴形态,测定细胞中的脂质含量,检测细胞中肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、碱性磷酸酶(ALP)]含量和法尼醇X受体(FXR)、细胞色素P4507A1(CYP7A1)、成纤维细胞生长因子19(FGF19)的mRNA及蛋白表达水平。结果油酸和苦参碱对Chang Liver细胞活性无明显影响。经油酸处理后的细胞内可见橘红色脂滴;与空白组比较,其相对脂质含量、肝功能指标水平均显著升高,FXR、CYP7A1、FGF19 mRNA及蛋白表达水平均显著降低(P<0.05)。经低、中、高浓度苦参碱干预后,上述指标均显著逆转(P<0.05)。结论苦参碱可通过调控FXR/CYP7A1/FGF19信号通路来改善油酸诱导的脂肪变性Chang Liver细胞的脂质含量和肝功能指标。

基于“肝脾同调”阐析慢性肝病的中医治疗

慢性肝病是临床常见疾病,“郁、虚、湿、毒、瘀”是其核心病机,在疾病的不同阶段各有侧重,其中,以“郁、虚”为核心的肝脾失调是慢性肝病发生发展的关键。“肝脾同调”是治疗慢性肝病的基本治法,在慢性肝病不同阶段,其“肝脾同调”内涵同中有异。根据肝、脾生理病理特性,治脾明辨虚实,厘清轻重,活用运脾、健脾、温脾、醒脾、补脾等法;调肝体用并重,精准辨证,活用疏肝、缓肝、散肝、柔肝等法。临床上,治脾与调肝相辅相成,治调并举,常获良效。

精准肝蒂解剖技术辅助腹腔镜肝癌切除术的效果及对炎症免疫应激、肝功能的影响

目的探讨精准肝蒂解剖技术辅助腹腔镜肝癌切除术的效果及对炎症免疫应激、肝功能的影响。方法选取达州市中心医院2019年10月至2022年6月114例原发性肝癌患者,按照随机数字表法分为常规组(n=57)与精准组(n=57)。2组均行腹腔镜肝癌切除术,常规组采用常规方法切除肝脏,精准组采用精准肝蒂解剖技术切除肝脏。比较2组手术指标、手术前后炎症-免疫指标[白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、免疫球蛋白A(IgA)、IgM、IgG]、肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)]、肿瘤因子[甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)、胸苷激酶1(TK1)]水平、并发症发生率,并随访1 a,统计2组1 a复发率、生存率。结果2组手术时间、切缘阳性率差异无统计学意义(P>0.05);精准组术中出血量、术后引流量少于常规组,术后拔管时间、住院时间短于常规组(P<0.05);2组术后1 d、3 d、7 d血清IL-6、CRP、TNF-α、ALT、AST、γ-GT、TBIL水平呈升高后降低趋势,且精准组低于常规组(P<0.05),血清IgA、IgM、IgG水平呈降低后升高趋势,且精准组高于常规组(P<0.05);2组术后3个月血清AFP、CA19-9、TK1水平低于术前,精准组低于常规组(P<0.05);精准组并发症发生率5.26%(3/57)低于常规组17.54%(10/57)(P<0.05);随访1 a,精准组失访2例,常规组失访1例,精准组1 a复发率25.45%(14/55)低于常规组44.64%(25/56),1a生存率85.45%(47/55)高于常规组62.50%(35/56)(P<0.05)。结论精准肝蒂解剖技术应用于原发性肝癌腹腔镜肝切除术中能优化手术情况,减轻炎症免疫应激与肝功能损伤,减少并发症,还可明显抑制肿瘤因子表达,降低复发率,提高生存率。

人工肝治疗的临床实践与研究进展

人工肝支持系统是治疗肝衰竭的重要方法之一,近年来非生物型人工肝在肝衰竭救治中的作用越来越受到认可,在非肝衰竭疾病中的应用也日益广泛。临床上需要综合多种因素,合理选择非生物型人工肝治疗的时机及模式,规范化、个体化、精准化治疗及不同模式的优化组合是人工肝临床应用的趋势。生物型人工肝有关种子细胞来源、生物反应器等关键技术不断完善,且部分已经进入临床试验阶段。尽管人工肝治疗的临床实践与研究已取得很大进展,但仍面临不少挑战。如何通过技术创新与优化组合进一步提高其疗效与安全性,如何通过高质量的临床试验获得更高级别循证医学证据,仍是目前亟需解决的难题。

AFP、GP73及GPC3检测在原发性肝癌诊断及预后评估中的价值

目的分析血清甲胎蛋白(AFP)、高尔基体糖蛋白73(GP73)及磷脂酰肌醇蛋白聚糖3(GPC3)检测在原发性肝癌诊断及预后评估中的价值。方法选取2021年5月至2022年5月郑州大学第一附属医院收治的原发性肝癌患者52例为研究对象,另外选取同期本院收治的肝硬化患者46例与健康体检者48名,分别设为肝硬化组与健康组。对比三组以及PHC组不同病理分期者AFP、GP73及GPC3水平;比较PHC不同预后者的一般资料及AFP、GP73及GPC3水平,采用多元Logistic回归分析影响PHC预后的危险因素,绘制ROC曲线分析血清AFP、GP73及GPC3单独检测及联合检测诊断PHC的效果。结果AFP、GP73、GPC3水平:PHC组>肝硬化组>健康组,差异具有统计学意义(P<0.05);PHC组不同病理分期者AFP、GP73、GPC3水平:Ⅳ期>Ⅲ期>Ⅱ期>Ⅰ期,差异具有统计学意义(P<0.05);预后良好组45例,预后不良组7例。两组性别、年龄、BMI指数比较,差异无统计学意义(P>0.05)。两组凝血酶原、红细胞计数、载脂蛋白A1、GGT、AFP、GP73、GPC3水平比较,差异具有统计学意义(P<0.05);经多元Logistic回归分析显示,凝血酶原、红细胞计数、载脂蛋白A1、GGT、AFP、GP73、GPC3水平上升是影响PHC患者预后不良的危险因素(P<0.05);AFP、GP73、GPC3联合检测诊断PHC的敏感度、特异度分别为0.956、0.857;AUC=0.950(95%CI:0.909~0.991),明显高于AFP、GP73、GPC3单独检测。结论血清AFP、GP73、GPC3三者联合在PHC诊断中具有较高的临床价值,可用于PHC的早期诊断,临床可通过检测上述指标血清水平来评估PHC患者的预后情况。

饲料中添加复合胆汁酸对皮质酮诱导的肉鸡脂肪肝综合征的缓解作用研究

[目的]本试验旨在探究饲料中添加胆汁酸(bile acid,BA)对皮质酮(corticosterone,CORT)诱导的肉鸡脂肪肝综合征的缓解作用。[方法]试验选取了120只1日龄雄性AA肉鸡,随机分为2组,分别饲喂基础日粮和含BA日粮。BA添加分为前期、中期、后期3个阶段,剂量依次递增。28日龄时,从基础日粮组中选取肉鸡20只,随机分为对照组(control,CON)、皮质酮处理组(CORT);从胆汁添加组中随机选取10只设为皮质酮+胆汁酸组(CORT+BA)。CON组颈部皮下注射乙醇PBS溶液(15%乙醇),CORT组和CORT+BA组注射4 mg·kg^(-1) CORT,连续注射7 d。肉鸡40日龄屠宰采样,记录器官与组织质量,采集血清和肝脏组织以测定生化指标、脂代谢相关基因和蛋白表达水平。[结果]饲料中添加BA可显著缓解由CORT处理引起的腹脂率升高及腿肌重降低(P<0.05)。生化测定结果表明,CORT处理显著降低了40日龄肉鸡血清中高密度脂蛋白(HDLC)水平、增加游离脂肪酸(NEFA)水平,而BA处理显著升高血清HDLC水平(P<0.05)。与CON组相比,CORT组肉鸡肝脏内甘油三酯(TG)水平显著升高(P<0.01),肝细胞内脂滴显著富集且出现空泡化现象,而BA处理可显著缓解肝脏内的TG沉积(P<0.01)。CORT处理显著上调肝脏中硬脂酰辅酶A去饱和酶(scd1)和乙酰辅酶A羧化酶(acc)基因表达水平(P<0.05),显著上调ACC和脂肪酸合成酶(FASN)蛋白表达水平(P<0.05),同时下调过氧化物增殖激活受体(PPARα)蛋白的表达水平(P<0.05);BA处理可显著逆转皮质酮引起的以上基因和蛋白表达变化,并显著增加肉毒碱棕榈酰基转移酶1A(cpt1a)基因表达水平,显著降低脂肪酸转位酶(CD36)蛋白表达水平(P<0.05)。[结论]日粮中添加胆汁酸可减少肝脏内甘油三酯合成,促进其分解,抑制肝细胞对脂肪酸的摄取,从而缓解皮质酮诱导的肉鸡脂肪肝综合征。