Objective To investigate the incidence and risk factors of non-alcoholic fatty liver disease (NAFLD) in patients with myocardial infarction. Methods A total of 634 patients with myocardial infarction from Beijing Anzhen Hospital were asked to take liver and gallbladder ultrasonography during hospitalization, and then divided into the NAFLD and non-NAFLD groups. The incidence and risk factors of the two groups were then analyzed. Results The incidence of NAFLD was 52.2% (331/634). Both body mass index (BMI) and serum alanine aminotransferase of the NAFLD group were higher than those of non-NAFLD group, with significant difference (Plt;0.05). The incidence of NAFLD was positively increased following the severity of coronary diseases (χ2=7.275, P=0.03). The result of multivariable logistic regression analysis showed BMI, multi-vessel lesions of coronary disease, and left main coronary artery lesion were the independent risk factors of NAFLD. Conclusion The myocardial infarction patients who are particularly complicated by overweight, multi-vessel lesions and left main coronary artery lesion have a higher incidence of NAFLD.
目的:评价电脑肝病治疗仪治疗病毒性肝炎的疗效及不良反应。方法:将116例病毒性肝炎患者随机分为治疗组及对照组,治疗组60例,对照组56例。两组均以抗炎、保肝、降酶、退黄、对症为治则。治疗组加用电脑肝病仪治疗，每日一次。结果:治疗组在消化道症状改善方面有效率950%,黄疸消退方面有效率902%。谷丙转氨酶恢复方面有效率85%。而对照组分别为8214%、6786%和7143%。结论:电脑肝病治疗仪治疗肝病能迅速改善消化道症状,有效降低黄疸、转氨酶,未见明显不良反应。
【Abstract】Objective To introduce the birth and development of model of endstage liver disease (MELD) and evaluate its effect on liver transplantation(LT) as a new scoring system. Methods Literatures of MELD applied in LT were analyzed retrospectively. Results MELD scoring system was used for predicting the prognosis of patients with endstage liver disease and the death risk of candidates on waiting LT extensively and the order of organ sharing was determined by its predicable results. Conclusion MELD has been had a successful initial implementation for predicting the shortterm survival probability and mortality in patients with endstage liver disease, and meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time, which has been proven to be a powerful tool for auditing the liver allocation system.
【Abstract】Objective To compare radiologists’ performance on combined unenhanced and feridexs-enhanced MR imaging （MRI） with their performance on helical CT enhanced, unenhanced MRI, and feridexs-enhanced MR alone imaging for the characteristics of local hepatic lesions. Methods MR images and CT scans obtained in 26 patients with 57 local hepatic lesions were analyzed with reviewer operator characteristic (ROC) curve analysis. The imaging of patient were divided into 4 groups including combined unenhanced and feridexs-enhanced MRI group, helical CT enhanced group, unenhanced MRI group, and feridexsenhanced MR alone group. Results The combined approach resulted in larger area under the ROC curve (Az=0.926 0) and accuracy (86.8%),P＜0.05，as compared with the others methods. There were no significant differences among the other three methods. Conclusion Feridexs-enhanced MRI was more accurate than enhanced helical CT scan in characterization of local hepatic lesion. The combined analysis of unenhanced and feridexs-enhanced images was more accurate in the characterization of focal hepatic lesions than was review of feridexs-enhanced images alone.
肝脏移植作为终末期肝病的治疗，自上个世纪80年代在欧美国家获得公认以来，已在世界各国得到迅速开展。我国自90年代后期以来，在全国掀起了第二个肝移植的热潮，迄今已完成1 000余例肝移植，在围手术期处理、手术技术、介入放射、移植免疫、抗感染治疗等各个方面均获得丰富的经验，我国肝移植的效果及长期生存率亦逐步赶上国际先进水平。总的来讲，适合进行肝移植的病种可分为良性及恶性肝病，鉴于恶性肝病行肝移植后复发率高，长期生存率低，因而其作为肝移植的指征长期以来存在争议，而良性终末期肝病则是肝移植的主要指征。我院自1999年2月以来连续施行肝移植114例，其中良性肝病为69例，占60.5%。本文仅针对良性肝病肝移植的一些特点谈谈我们的经验和体会。
ObjectiveTo explore the relationship between liver transplantation procedure with or without preservation of retrohepatic vena cava and postoperative reinfection of hepatitis B virus.MethodsHepatitis B virus makers of 15 retrohepatic vena cava samples from hepatitis B virus active replicating recipients was detected using immunohistochemistry stain LSAB and HBV DNA hybridization in situ. Hepatitis B virus reinfection rate and survival rate after transplantation in classic group (20 cases) and piggyback group (7 cases) was analyzed retrospectively. ResultsHepatitis B virus makers including HBsAg and HBcAg and HBV DNA of all 15 retrohepatic vena cava samples, 10 from classic group and 5 from piggyback group, was negative. In classic group, 20 recipients were followedup 6-30 months, mean 18 months, only one case of hepatitis B recurrence was confirmed 22 months after operation; In piggyback group,7 recipients were followedup 5-12 months, mean 8 months, none of hepatitis B virus reinfection was encountered. Recurrence rate in classic group and piggyback group was 5.0%(1/20) and 0(0/7), respectively.ConclusionThis preliminary study indicated that the retrohepatic vena cava of hepatitis B virus active replicating recipients don’t have the residence and replication of hepatitis B virus particle. Orthotopic liver transplantation procedure with preservation of retrohepatic vena cava appears not to increase the hepatitis B virus reinfection rate in hepatitis B virus active replicating recipients after transplantation.
Liver fibrosis in chronic liver disease refers to the body’s repair response to sustained repeated necrosis or inflammation of liver cells, which results in fibrosis accompanied by relative or absolute lack of fiber degradation and deposition of extracellular matrix in the liver. Early and timely diagnosis and treatment of hepatic fibrosis are of great importance to patients with liver disease. A rational and complete diagnostic model of liver fibrosis should involve clinical pathology and histology, imaging, and serum biochemical markers. Liver biopsy has been regarded as the "gold standard" for the diagnosis of liver fibrosis and as a reference standard for other non-invasive diagnostic tests of liver fibrosis. Since it is invasive, liver biopsy is difficult to implement in clinical practice and a second liver biopsy is even more difficult. As for the non-invasive diagnosis of liver fibrosis, clinical symptoms and signs are not specific. The sensitivity and specificity of individual serum biochemical markers are still very weak, and imaging studies also lack specificity. The mathematical model “FibroTest” of serum biochemical markers has better diagnostic accuracy, but the calculation is complicated, making it difficult to achieve widespread use. There is insufficient evidence to suggest that the "gold standard" of liver biopsy can be replaced. Therefore, further research is needed to investigate how best to balance the benefits and harms of different tests, to identify the best combination, to simplify any calculation steps, to reduce costs, to avoid liver biopsy, and to find new, more specific and sensitive markers.
【摘要】 目的 了解乙型肝炎病毒（HBV）X基因在HBV相关肝病肝移植受体术后外周单个核细胞（PBMC）和骨髓CD34+细胞内的整合情况及其对乙肝疫苗接种的影响。 方法 采集1999年6月-2005年11月25例HBV相关肝病肝移植受体的外周静脉血及其中23例的骨髓血，以密度梯度离心结合单克隆免疫磁珠分离法获取外周血单个核细胞及骨髓CD34+细胞后，提取细胞DNA。因HBV X基因的整合频率最高，设计HBV X基因的特异引物，进行HBV-Alu-PCR，终产物进行电泳并回收、连接载体、筛选扩增后测序，检测有无X基因整合。 结果 经PCR后电泳及测序分析，25例HBV相关肝病肝移植受体术后的PBMC内未检测出HBV X基因的整合，其中采集到骨髓标本的23例CD34+细胞中亦未检测到HBV X基因的整合。 结论 肝移植术后受体体内HBV微生态的剧烈改变，使HBV整合的基本条件丧失，在此情况下，外周免疫细胞及骨髓造血干/祖细胞不是发生HBV整合的适宜场所，乙肝疫苗接种效果与HBV X基因整合关系不明确。【Abstract】 Objective To investigate whether hepatitis B virus HBV X gene integrates in peripheral blood mononuclear cell (PBMC) and bone marrow CD34+ cells from HBV related liver disease recipients after liver transplantation. Methods Between June 1999 and November 2005, PBMC were obtained from 25 HBV related liver disease recipients after liver transplantation and bone marrow CD34+ cells obtained from 23 cases among them. The cellular DNA was extracted by DNA isolation and purification kit following the manufacture’s instructions. Specific primers to HBV X gene and to human Alu repeats were used to amplify the virus integration through a 3-round hemi-nest PCR. The PCR final product was judged by 1.2% agarose electrophoresis, ligated to T vector, proliferated in E. coil 5α and sequenced. Results According to agarose electrophoresis and sequencing analysis, there were no HBV X gene integration in PBMC and bone marrow CD34+ cells from HBV related liver transplant recipients after surgery. Conclusions Because of the radical change of HBV microecological environment in HBV related liver transplant recipients after operation, the fundamental condition of HBV integration has been lost, which led PBMC and bone marrow CD34+ cells not suit to HBV X gene integrate to human genome. And the impact of HBV X gene integration on HBV vaccination is still undefined.
【摘要】 目的 研究2型糖尿病（type 2 diabetes mellitus，T2DM）合并非酒精性脂肪性肝病（non-alcoholic fatty liver disease， NAFLD）患者血浆脂肪细胞特异性脂肪酸结合蛋白（adipocyte-specific fatty acid-binding protein，A-FABP）的水平及其相关因素。 方法 2009年10月—2010年10月选取T2DM合并NAFLD组（A组）60例，未合并NAFLD组56例（B组）为研究对象。测定体质量指数（body mass index，BMI），检测血脂、糖化血红蛋白（hemoglobin A1c，HbA1c）等生化指标。放射免疫法测定空腹胰岛素（fasting insulin，FINS），空腹C肽水平（fasting C-peptide，FCP），计算胰岛素抵抗指数（homeostasis model of assessment-insulin resistance，HOMA-IR）、胰岛素敏感指数（insulin sensitivity index，ISI），测定A-FABP、C反应蛋白（C-reaction protein，CRP）及肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）。 结果 与B组患者相比，A组患者其血浆A-FABP水平、BMI、腰围、腰臀比、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、CRP、TNF-α、FCP、FINS、总胆固醇、甘油三酯、Ln（HOMA-IR）升高，Ln（ISI）降低，差异有统计学意义（Plt;0.05）；两组HbA1c差异无统计学意义（Pgt;0.05）。A-FABP水平变化与TNF-α、HOMA-IR、CRP呈正相关，与ISI呈负相关。 结论 T2DM伴NAFLD中，A-FABP升高与胰岛素抵抗是并存的，且存在明显相关关系，二者在疾病的发生发展中均可能具有重要的作用。【Abstract】 Objective To analyze the serum level of adipocyte-specific fatty acid-binding protein (A-FABP) in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD), and its related factors. Methods From October 2009 to October 2010, 112 patients with T2DM were categorized into two groups: the group with NAFLD (group A) with 60 patients, and the group without NAFLD (group B) with 56 patients. Body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) were detected. Radioimmunoassay was carried out to measure fasting insulin (FINS) and fasting C-peptide (FCP), and homeostasis model of assessment-insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) were calculated. At the same time, A-FABP, C-reaction protein (CRP) and tumor necrosis factor-α (TNF-α) were also detected. Results Compared with patients in group B, plasma levels of A-FABP, BMI, waistline, waist to hip ratio, ALT, AST, TG, TC, HDL-C, LDL-C, CRP, FCP, FINS, and HOMA-IR for patients in group A were all higher, while ISI was lower; and the differences in the above-mentioned parameters were statistically significant (Plt;0.05). The levels of HbA1c in the two groups were not significantly different (Pgt;0.05). The change of A-FABP level was positively correlated with TNF-α, HOMA-IR and CRP, while it wasnegatively correlated with ISI. Conclusions In patients with T2DM with NAFLD, there is an obvious correlation between the coexisting A-FABP rise and insulin resistance. Both of them played critical roles in the onset and developing of the disease.