Objective To study the relation between the pathogenesis of gallstone and blood lipid and protein.Methods Then indexes of blood lipid and protein in 204 cases of gallstone patients were measured and analysed by statistical software SPSS. Results There was a significant difference between the gallstone group and control in the value of proalbumin, total cholesterol, high density lipoprotein and carrier protein B (Ｐ＜0.01), the value of total protein, triglyceride, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and carrier protein A1 were higher than those in the control (Ｐ＜0.05). Conclusion The indexes mentioned above may play an important role in the gallstone formation.
目的 探讨体外转流胆汁在治疗恶性梗阻性黄疸中的作用。方法 随机选择28例恶性梗阻性黄疸患者行胆汁外转流术，并与同期25例行胆汁内引流术的恶性梗阻性黄疸患者进行比较。结果 外转流组术后恢复时间、黄疸消退时间及肝功能恢复时间均较内引流组短； 术后生存时间较内引流组长； 术后并发症较内引流组少； 经统计学处理差异有显著性意义(Ｐ＜0.05)。结论 体外转流胆汁术，具有胆汁内引流及外引流术的优点，同时具备手术操作简单，术后恢复快，住院时间短，并发症少，术后可经T管注药化疗等优点，是一种简单而有效的减黄方法。
【Abstract】Objective To evaluate effect of artificial liver support system (ALSS) in liver failure and liver transplantation.Methods Forty-four patients with liver failure (including 12 undergoing liver transplantation) were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine aminotransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels(P＜0.05); the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased(P＜0.05); there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60.0%(18/30). Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.
Objective To explore the effect of cytotoxic T lymphocyte-associated antigen 4 (CTLA4-Ig) fusion protein on the function of orthotopic liver allograft. Methods Orthotopic liver allograft models of rhesus monkeys were established in this study. The survival time, liver function and morphologic changes of graft were observed, respectively. The levels of IL-2 and IL-10 were detected by ELISA. Apoptosis was monitored by TUNEL.Results The average survival of control group was 6.57 d, while the average survival of CTLA4-Ig group was 14.92 d, which was statistically prolonged (Plt;0.05). Serum ALT level was highly increased, and Alb level decreased obviously in control group. While the levels of ALT and Alb kept in normal in CTLA4-Ig group. After day 3-7, the expressions of IL-2 were highly expressed in control group, while the expressions of IL-10 in CTLA4-Ig group were higher than those of control group. The severity of rejection reaction after day 3 was weaker in CTLA4-Ig group than that of control group by histological assessment. The apoptosis index after day 3 in the liver cells was highly increased in control group as compared with the CTLA4-Ig group. Conclusions CTLA4-Ig fusion protein therapy can induce immunotolerance and prolong the survival of recipients. The increasing of cytokines IL-2 or the decreasing of cytokines IL-10 may be one of the laboratory indexes in monitoring immunotolerance of transplantation.
Objective To explore the relationship between acute rejection and expression levels of perforin mRNA in peripheral blood and bile after rat liver transplantation so as to look for a kind of noninvasive method to diagnose acute rejection. Methods Rat orthotopic liver transplantation model with biliary extra-drainage was established. They were divided into 4 groups: blank control group (n=20)， isograft group (n=30)， allograft plus cyclosporine A (CsA) group (n=30) and allograft group (n=30). Semi-quantatative RT-PCR was used to measure the expressions of perforin mRNA in bile and peripheral blood and the pathological changes of the graft were observed on postoperative days of 1, 3, 5, 7 and 10. Results Blank control group and isograft group showed no expression of perforin mRNA in peripheral blood. The expression of perforin mRNA of peripheral blood in allograft group could be detected on day 3 after transplantation and it gradually elevated on day 5 and remained in high level during 7-11 days. In allograft plus CsA group perforin mRNA of peripheral blood continuously expressed in a low level, and the level at the same time points was significantly different compared with allograft group (P＜0.05). The expression of perforin mRNA in peripheral blood was analogous with the severity degree of histologic damage. The expression of perforin mRNA can not be found in bile. Conclusion The expression of perforin mRNA in the peripheral blood offers a sensitive and noninvasive means of monitoring acute rejection.
目的探索乙型肝炎DNA阳性的终末期肝病患者肝移植前快速转阴及肝移植术后复发的防治。方法4例乙型肝炎两对半小三阳、HBVDNA(-)的患者术前开始联合口服拉米夫定(lamivudine) 及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今； 2例乙型肝炎两对半大三阳、HBVDNA(+)的患者, 术前除口服拉米夫定及泛昔洛韦外, 同时肌注乙肝免疫球蛋白共14 d,肝移植术中无肝期快速静脉滴注15 000 u静脉用乙肝免疫球蛋白，术后3个月内联合口服拉米夫定及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今。结果1例患者术后第19天死于肺部霉菌感染,1例患者第49天死于肝动脉及门静脉栓塞; 4例患者长期存活, 生存时间最长的患者已接近3年,术后全部患者均未发现有乙型肝炎复发。结论拉米夫定、乙肝免疫球蛋白及泛昔洛韦联合使用可使乙型肝炎DNA阳性的终末期肝病患者在肝移植前快速转阴，并能预防乙肝复发。