2018—2021年泰西地区慢性丙型肝炎流行特征及肝脏功能损害影响因素分析

目的分析2018—2021年泰西地区慢性丙型肝炎流行趋势及肝脏功能损害情况,为该地区丙肝患者预防肝脏功能损害提供参考依据。方法从中国疾病预防控制中心传染病报告信息管理系统下载泰西地区报告的丙肝病例数据,采用描述流行病学方法分析丙肝流行病学特点,从医院HIS系统中收集,包括患者性别、年龄、居住地、吸烟史、饮酒史、治疗药物、基因分型等临床资料,根据患者是否肝功能损伤分为肝功能损伤组和对照组,采用单因素分析和logistic回归分析泰西地区丙肝患者肝脏功能损害的因素。结果2018—2021年报告550例丙肝病例,无死亡病例;男性292例,女性258例;平均年龄53.47±5.74岁,不同年龄段男女构成间差异无统计学意义(χ^(2)=1.472,P>0.05);40~59岁所占比例明显高于20~39岁和≥60岁患者;职业构成以农民为主(占44.36%),居住地主要为农村(占52.18%)。发生肝功能损伤129例(23.45%),肝功能损伤组ALT、AST、GGT值明显高于对照组(P<0.05),ALB值明显低于对照组(P<0.05);两组在平均年龄、饮酒史、合并糖尿病、基因分型、HCV-RNA病毒载量、CD4^(+)CD25^(+)Treg间差异具有统计学意义(P<0.05);CD4^(+)CD25^(+)Treg<5%、1b型基因分型、HCV-RNA高载量是泰西地区丙肝患者肝脏功能损害的的独立危险因素(P<0.05)。结论2018—2021年泰西地区丙肝发病率较高,对于CD4^(+)CD25^(+)Treg>5%、1b型基因分型、HCV-RNA高载量的丙肝患者发生肝功能受损的风险较高,应积极进行治疗,降低肝功能损伤的发生。

登革热并发肝功能损害与血小板、白细胞的相关性分析

目的分析登革热并发肝脏功能损害的临床表现及特征与血小板及白细胞的相关性。方法对2014年9~11月收治的823例登革热患者的临床资料进行回顾性分析。通过对登革热患者丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、总胆红素（TB）及白细胞（WBC）、血小板（PLT）的检测,分析登革热并发肝脏功能受损害的情况及其与WBC、PLT的相关性。结果823例登革热患者中并发肝脏功能损害者共582例（70.7%）,其中丙氨酸氨基转移酶（ALT）升高447例（占54.3%）,门冬氨酸氨基转移酶（AST）升高554例（67.3%）,而总胆红素（TB）升高仅66例（8%）,血小板减少者602例（74.0%）,白细胞减少者596例（73.3%）。儿童及中老年登革热患者合并肝脏功能损害的发生率较青少年患者要高。ALT、AST在病程的7~14 d高于病程的7d内及14 d后,差异有统计学意义,而TB在病程的7 d内升高明显,但与病程的7~14 d及14 d后相比较无明显差别。登革热患者血清中ALT、AST、TB的改变与同期静脉血中WBC、PLT改变无显著相关性。结论登革热患者并发肝脏功能损害是登革热病程中多系统器官功能损害中一个多发和常见的局部表现之一,其与年龄及病程有关,而与WBC及PLT无关。

抗结核药物致肝损害72例报告

目的 探讨抗结核药物对肝脏的损害 ,找出一定规律及防治方法。方法 回顾分析临床用药后出现的肝功异常情况。结果 72例肝脏损害病例中 ,单种用药 8例 ,两种用药 32例 ,3种用药 32例。抗结核治疗过程中的肝脏功能损害后果严重。

60例大肠癌根治术后肝转移患者CEA、AFP观察

目的分析大肠癌患者在治疗后出现肝转移时CEA、AFP的动态变化和CEA增高的程度与肝脏功能损害和患者生存时间的关系。方法分析我院收治的根治术后进行了正规术后巩固治疗的60例大肠癌肝转移患者临床资料。观察CEA、AFP动态变化与患者肝脏功能损害及生存时间的关系。结果CEA值从正常水平到升高，提示病情有进展。CEA增高明显的患者肝脏功能损害严重，CEA增高程度与病情严重性和肝功能损害程度成正比；CEA越高，患者生存时间越短。结论CEA浓度持续不断升高，或其数值超过正常5-6倍者均提示预后不良。连续随访定量检测血清CEA含量，对肿瘤病情判断更具有意义。CEA升高幅度和阳性率取决于结肠癌分期及是否存在扩散或转移。

微波预照射对家兔肝缺血再灌注损伤时氧自由基的影响

目的 探讨微波预处理对家兔肝缺血再灌注损伤的影响及其作用机理。 方法 家兔32只, 随机分为 4组: A组,对照组(假手术组); B组, 20W微波照射 20min组; C组, 微波照射+肝门阻断组(预处理组); D组, 单纯肝门阻断组。检测肝功能及肝组织中脂质过氧化物丙二醛 (malondi aldehyde, MDA)和超氧化物歧化酶 (superoxidedismutase, SOD)的浓度变化。 结果 B、C、D组手术后 2h、4h肝功能均有损害,而D组的ALT、AST、LDH均高于C组;C组肝组织MDA浓度为 (15. 3±0. 8)nmol/mg,低于D组的(21. 2±1. 2)nmol/mg,C组的SOD浓度为 (529. 5±48. 4)U/mg,高于D组的(418. 3±9. 1)U/mg(P<0. 05)。 结论 微波预处理可能通过减少氧自由基的生成而减轻家兔肝缺血再灌注损伤所致的肝脏功能损害。

隔药灸治疗肝硬化腹腔积液临床疗效及患者生活质量改善效果分析

肝硬化是临床中较为常见的慢性进行性肝病,是由于慢性肝炎、酒精肝、脂肪肝等一种或多种病因长期或反复作用而导致的广泛性、弥漫性肝损害。肝硬化初期机体肝脏代偿功能依然保持相对较强的功能和作用,患者可没有任何症状出现,但后期肝脏代偿功能降低,肝脏功能损害较大,导致门静脉高压.

中西医结合治疗肝硬化腹水50例疗效观察

目的：观察中西医结合治疗肝硬化腹水疗效。方法：对50例确诊为肝硬化腹水患者，按其临床症状，拟中医辨证分为气滞湿阻、寒湿困脾、肝脾血瘀、脾肾阳虚、肝肾阴虚5型，采用护肝扶正治本，利尿祛邪治标。结果：显效44例，有效4例，无效2例，显效率88％，总有效率96％。结论：中西医结合治疗肝硬化腹水较单一的中医或西医治疗，使腹水消退、肝功能恢复快，疗效满意。

Effect of naked eukaryotic expression plasmid encoding rat augmenter of liver regeneration on acute hepatic injury and hepatic failure in rats

AIM: To study the protective effect of eukaryotic expression plasmid encoding augmenter of liver regeneration (ALR) on acute hepatic injury and hepatic failure in rats. METHODS: The PCR-amplified ALR gene was recombined with pcDNA3 plasmid, and used to treat rats with acute hepatic injury. The rats with acute hepatic injury induced by intraperitoneal injection of 2 mL/kg 50% carbon tetrachloride (CCl4) were randomly divided into saline control group and recombinant pcDNA3-ALR plasmid treatment groups. Recombinant pcDNA3-ALR plasmid DNA (50 or 200 μg/kg) was injected into the rats with acute hepatic injury intravenously, intraperitoneally, or intravenously and intraperitoneally in combination 4 h after CCl4 administration, respectively. The recombinant plasmid was injected once per 12 h into all treatment groups four times, and the rats were decapitated 12 h after the last injection. Hepatic histopathological alterations were observed after HE staining, the expression of proliferating cell nuclear antigen (PCNA) in liver tissue was detected by immunohistochemical staining, and the level of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was determined by biochemical method. The recombinant plasmid DNA (200 μg/kg) and saline were intraperitoneally injected into the rats with acute hepatic failure induced by intraperitoneal injection of 4 mL/kg 50% CCl4 after 4 h of CCl4 administration, respectively. Rats living over 96 h were considered as survivals.RESULTS: The sequence of ALR cDNA of recombinant pcDNA3-ALR plasmid was accordant with the reported sequence of rat ALR cDNA. After the rats with acute hepatic injury were treated with recombinant pcDNA3-ALR plasmid, the degree of liver histopathological injury markedly decreased. The pathologic liver tissues, in which hepatic degeneration and necrosis of a small amount of hepatocytes and a large amount of infiltrating inflammatory cells were observed, and they became basically normal in the most effective group after four times of injection of recombinant pcDNA3-ALR plasmid. The indexes of PCNA significantly increased in the recombinant pcDNA3-ALR plasmid treatment groups compared to model group. The level of serum AST and ALT remarkably reduced in recombinant pcDNA3-ALR plasmid treatment groups compared to model group. The results showed that the effect of 200 μg/kg recombinant pcDNA3-ALR plasmid in the rats with acute liver injury was stronger than that of 50μg/kg pcDNA3-ALR DNA.The effect of intravenous injection of recombinant pcDNA3ALR plasmid was better. After the rats with acute hepatic failure were treated with recombinant pcDNA3-ALR plasmid,the survival rate (40%) significantly increased in treatment groups compared to control group (15%, P＜0.01).CONCLUSION: The ALR gene may play an important role in relieving acute hepatic injury and hepatic failure by promoting hepatic cell proliferation and reducing level ofAST and ALT in CCl4-intoxicated rats.

Adiponectin,a key adipokine in obesity related liver diseases

Non-alcoholic fatty liver disease (NAFLD) comprising hepatic steatosis,non-alcoholic steatohepatitis (NASH),and progressive liver fibrosis is considered the most common liver disease in western countries.Fatty liver is more prevalent in overweight than normal-weight people and liver fat positively correlates with hepatic insulin resistance.Hepatic steatosis is regarded as a benign stage of NAFLD but may progress to NASH in a subgroup of patients.Besides liver biopsy no diagnostic tools to identify patients with NASH are available,and no effective treatment has been established.Visceral obesity is a main risk factor for NAFLD and inappropriate storage of triglycerides in adipocytes and higher concentrations of free fatty acids may add to increased hepatic lipid storage,insulin resistance,and progressive liver damage.Most of the adipose tissue-derived proteins are elevated in obesity and may contribute to systemic inflammation and liver damage.Adiponectin is highly abundant in human serum but its levels are reduced in obesity and are even lower in patients with hepatic steatosis or NASH.Adiponectin antagonizes excess lipid storage in the liver and protects from inflammation and fibrosis.This review aims to give a short survey on NAFLD and the hepatoprotective effects of adiponectin.

麻醉药预处理减轻肝脏缺血再灌注损伤的研究进展

缺血再灌注（ischemia reperfusion,IR）损伤是指缺血后的再灌注不仅不能使组织器官功能恢复,反而加重组织器官的功能障碍和结构损伤。其中肝脏IR损伤即是一种常见的临床病理生理过程,休克、感染、肝脏外伤、肝叶切除及肝移植所致的肝脏功能损害、衰竭都与之有关。

异丙酚对家兔CO2气腹时肝损伤的影响

腹腔镜手术因其创伤小、恢复快、疗效可靠等优点，已广泛应用于临床。该手术的麻醉方法常采用异丙酚复合麻醉。腹腔镜手术过程中需要使用CO2建立气腹，而气腹压力可造成肝脏功能损害。研究表明，异丙酚对肝脏有一定保护作用，也有研究表明，持续输注异丙酚可减少肝动脉血流，

肝硬化合并胆囊结石的相关因素研究现状

肝硬化是一种常见的慢性进行性肝脏疾病，病理特征为广泛肝细胞坏死、残存肝细胞结节样增生、结缔组织增生与纤维隔形成，继而失代偿期引发肝脏功能损害和门脉高压症等临床表现，与此可伴发不同程度的胆道系统病变，主要表现为胆结石及非特异性炎症。

丹参防治新生兔全胃肠外营养相关性胆汁淤积的实验研究

1971年Peden等首先报道1例接受全静脉营养（total parenteral nutrition，TPN）治疗的早产儿出现肝脏功能损害和肝内胆汁淤积后，TPN相关肝胆并发症越来越受到重视。成人多表现为肝的脂肪化，新生儿期则多见全胃肠外营养相关性胆汁淤积（total parenteral nutrition associated cholestasis，TPNAc）。目前TPNAc的确切病因及治疗方法尚无定论。本研究通过观察新生兔TPN模型的肝脏损害情况，探讨可能的作用机理，及丹参对TPN所致胆汁淤积的防治效果。