Objective To systematically review the effectiveness and safety of hyperthermia (HT) plus intraperitoneal hyperthermic perfusion chemotherapy (IHPC) versus IHPC alone for malignant ascites. Methods Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials (RCTs) on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites (OR=3.40, 95%CI 2.58 to 4.48, Plt;0.000 01), better improvement in quality of life (OR=2.77, 95%CI 1.90 to 4.05, Plt;0.000 01), with significant differences. The two groups were alike in 1-year survival with no significant difference (OR=1.80, 95%CI 0.61 to 5.31, P=0.28). As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation. Conclusion The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.
目的:水泡口炎病毒(Vesicular Stomatitis Virus,VSV)基质蛋白(Matrix protein, M 蛋白)具有诱导肿瘤细胞凋亡的作用,本研究探讨水泡口炎病毒基质蛋白对癌性腹水形成的抑制和治疗作用。方法:采用旋转蒸发仪法制备纳米脂质体,检测其体外转染效率;采用脂质体转染技术将已构建的水泡口炎病毒基质蛋白(VSVM)重组真核表达质粒pcDNA31M 转入MethA肿瘤细胞,转染后6小时将细胞接种于小鼠腹腔,观察小鼠腹水的形成情况;腹水治疗组,则先将MethA肿瘤细胞接种于小鼠腹腔,将小鼠随机分成4组,于接种后第二天分别用脂质体包裹的pcDNA31M、pcDNA31空载体、单纯脂质体及生理盐水治疗,观察腹水的形成情况。结果:自制的DOTAP:DOPE脂质体与Sigma公司购买的Lipofectamine 2000的转染效率相似,pcDNA31M明显抑制MethA腹水的形成,对已经形成的腹水也有明显的治疗作用,与对照组比较有统计学意义(Plt;005),同时明显延长了小鼠的存活期。结论: VSVM蛋白真核表达质粒pcDNA31M对小鼠腹水的形成有抑制作用,能延长小鼠的存活期,对于恶性腹水的治疗具有一定的意义,值得进一步研究。
目的 探讨布-加综合征的个体化治疗。 方法 我们对首都医科大学附属复兴医院及宣武医院、二炮总医院及其他医院2004年2月至2009年5月期间会诊收治的20例布-加综合征患者的临床资料进行回顾性分析。结果 20例患者中术后24 h死亡1例（5.0%），死于DIC； 19例顺利出院。19例患者术后均获随访，随访时间（34.7±3.3）个月，其中恢复良好者占73.7%（14/19）； 1例（5.3%）行肠-腔-颈转流术者，术后间断出现肝性脑病，短期住院治疗后可以改善； 术后18个月1例（5.3%）行肠-腔转流术者因全身脏器衰竭死亡。结论 个体化手术治疗方案可明显提高布-加综合征患者的生存率。
目的 探讨肝硬化腹水患者不同血清钠水平与病情严重程度的关系。 方法 回顾分析2008年7月－2010年6月收治47例肝硬化腹水并发低钠血症患者，根据其入院时血清钠水平分为低钠血症轻（A组）、中（B组）、重（C组）3组。比较肝硬化腹水患者不同血钠水平的腹水程度及疗效的关系、以及低钠程度与肝性脑病、肝肾综合征和死亡发生率的关系。 结果 与A组比较，B、C两组腹水量、肝性脑病、肝肾综合征及病死率明显增高，差异有统计学意义（P＜0.05）；对治疗的效果明显降低（P＜0.05）。 结论 肝硬化腹水患者的血清钠水平与其病情程度具有紧密相关性，监测血清钠的水平可作为判断病情严重程度的重要指标之一，提示在临床上需重视预防、及时发现并治疗低钠血症。
【摘要】 目的 应用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）探讨α-L-岩藻糖苷酶（AFU）对恶性腹水和非结核良性腹水的诊断价值。 方法 2004年7月—2008年1月对213例诊断明确的良、恶性腹水（其中良性腹水117例、恶性腹水96例）AFU活性进行检测。采用ROC曲线评价AFU的诊断灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及Youden指数，评价其诊断效率。 结果 恶性腹水组AFU水平（164.96±87.72） μmol/（L•h），良性腹水组（104.02±62.07） μmol/（L•h），两者比较差异有统计学意义（Plt;0.01）。AFU诊断恶性腹水的ROC 曲线下面积为0.754±0.034，最佳分界值101.95 μmol/（L•h）。以AFU≥101.95 μmol/（L•h）来预测恶性腹水，其诊断的灵敏度为82.3%，特异度为63.2%，准确性为72.8%、阳性预测值为65.3%、阴性预测值为83.1%、阳性似然比为2.23、阴性似然比为0.28及Youden指数为0.455。 结论 腹水AFU活性检测有助于恶性腹水和非结核良性腹水的鉴别诊断，是一个比较理想的实用指标，适合于基层医院的临床应用。【Abstract】 Objective To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. Methods Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. Results The average level of AFU in the malignant group [(164.96±87.72) μmol/(L•h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L•h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L•h). When an AFU level equal to or higher than 101.95 μmol/(L•h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.
目的:为了探讨肝硬化放腹水后应用右旋糖酐40代替人血白蛋白治疗顽固性腹水的临床疗效及其经济性。方法:将216例肝硬化顽固性腹水患者随机分为A,B,C三组。A组:定期放腹水后应用右旋糖酐40;B组:定期放腹水后应用人血白蛋白或血浆;C组:传统治疗方法,限钠和不断增加利尿剂用量。结果:A组分别与B组,C组相比较,其腹水消退时间,ALT复常率,输血不良反应,住院费用,平均住院日,好转治愈率,死亡率,以上各项对比均有显著性差异(Plt;0.05)。血清蛋白量的对比无显著性差异(Pgt;0.05)。结论:肝硬化放腹水后应用右旋糖酐40治疗顽固性腹水,能缩短病程,减少住院日,降低医疗费用,降低死亡率。
目的:观察持续腹腔引流治疗顽固性腹水的疗效。方法:将顽固性腹水患者74例分为两组,治疗组38例,采用腹腔置管,持续腹腔引流腹水,3000mL/天;对照组36例,以常规补充白蛋白、限钠、限水、利尿治疗为主,比较两组的疗效。观察治疗组治疗前后患者尿量、腹围和体重变化,并比较治疗组与对照组在肝、肾功能及电解质的变化及总体疗效。结果:治疗组疗效优于对照组(Plt;0.05),与治疗前比较,治疗组治疗后尿量、腹围、体重有明显改变(Plt;0.01), 肝、肾功能及电解质与对照组比较无明显变化(Pgt;0.05)。结论:持续腹腔引流治疗顽固性腹水经济适用,不良反应少,患者依从性好。
Objective To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.
Objective To study the effect and intrinsic mechanism of acute suppurative peritonitis associated ascitic fluid (ASPAAF) on experimental liver injury of rats. Methods Thirty-two male or female Sprague-Dawley (SD) rats were randomly divided into two groups: ASPAAF group (n=16) and control group (n=16), in which 8 ml ASPAAF or normal saline (NS) were injected into the peritoneal cavity, respectively. The rats were killed at each time intervals after peritoneal cavity injection (6 h and 12 h) respectively in two groups and specimens were made to detect the levels of serum TNF-α, endotoxin and liver function (AST, ALT and STB). The level of TNF-α in liver tissues was measured. The pathological change of liver was observed by microscope. Results The levels of TNF-α, endotoxin, ALT, AST and STB in serum and the levels of TNF-α in liver tissues at different time points were markedly higher in ASPAAF group compared with those in control group (P＜0.05), and these indexes increased with increasing time in ASPAAF group (P＜0.05). In ASPAAF group, hepatic tissue appeared hydrops, even spotty necrosis and the changes at 6 h and 12 h were not obvious different. No abnormal pathological change of hepatic tissue was found in control group. Conclusion ASPAAF can induce the injury of the liver in rats, which may involved in TNF-α and endotoxin.