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find Author "马雪梅" 5 results
  • 肝动脉化疗栓塞术后发生胆汁瘤1例报道

      患者,女,42岁,因肝血管瘤行肝动脉化疗栓塞(TACE)后8个月,皮肤、巩膜黄染及肝内多发囊性占位4个月入院。患者入院前12个月MRI发现肝多发血管瘤(图1),最大3.5 cm×7 cm,无不适。入院前8个月行血管瘤TACE,术中予碘油16 ml栓塞,术后感乏力、纳差、肝区隐痛,化验“ALT 292 U/L、Bil正常”,予以甘利欣、凯西莱等治疗,ALT有所下降,但始终不正常。入院前4个月出现皮肤及巩膜黄染、尿黄,化验“ALT 153.2 U/L, TBil 95 μmol/L, DBil 79.9 μmol/L”, B超: “肝血管瘤栓塞术后,肝内囊性占位”,应用胆维他、优思弗、思美泰等治疗,黄疸进行性加重,肝内囊性占位进行性增大入我院。化验肝功能: Alb 31 g/L, TBil 172.8 μmol/L, DBil 139.8 μmol/L,ALT 58 U/L, AST 97 U/L, ALP 321 U/L, GGT 238 U/L。B超: ①肝内多发囊性占位; ②肝大、脾大; ③血管瘤。CT(图2): ①肝血管瘤栓塞术后改变; ②肝内多发囊性低密度影; ③脾大。诊断: ①肝内多发性囊性占位,胆汁瘤可能; ②肝血管瘤。遂行肝移植术,术后恢复良好。已切除病肝见囊肿内容物为混浊的有“渣”胆汁,分房状,不与胆管相通。病理提示: 病肝组织部分区域见内衬扁平细胞的由扩张血管构成的瘤样组织,少数管腔内含血栓成分; 部分区域间肝内和小胆管内多发性结石,并见较多胆汁湖形成,其周边部较易见泡沫细胞及巨嗜细胞,其余背景肝组织内部分肝细胞及毛细胆管侧胆汁淤积,毛细胆栓形成,较多胆管及细胆管增生,纤维组织增生并包绕肝小叶,部分区域见假小叶形成,内见胆管结石及部分残留胆管壁。诊断: ①肝海绵状血管瘤; ②肝内及小胆管内多发性胆管结石,继发性胆汁性肝硬变; ③胆汁瘤。 图1 MR示介入前多发血管瘤;图2 示介入后9个月肝内多发胆汁瘤(白箭为胆汁瘤,黑箭为血管瘤)。2A: 血管瘤和胆汁瘤; 2B: 胆汁瘤   讨论 TACE是医源性胆汁瘤的常见原因,其形成机理是由于TAE和(或)PEI的理化作用导致肿瘤或相应区域肝内胆管坏死。胆管周围毛细血管丛受损,可导致胆管坏死,胆汁经坏死的胆管漏向肝实质内,积聚成囊者为囊状胆汁瘤,沿坏死的胆管壁积聚者为柱状胆汁瘤。若囊肿与胆管的瘘口封闭则囊肿内壁内皮化,并产生分泌功能,分泌液体积蓄,导致囊肿越来越大; 较大的囊肿可压迫毗邻的胆管,使之梗塞,形成“软藤状”的胆管扩张。如果囊肿与胆管潜在相通,则在达到一定压力时,囊肿内液体进入胆管内,故囊肿不会明显增大。另一方面,这类与胆管相通的囊肿,因不断有胆汁在囊肿压力较低时自胆管进入囊肿,故引流亦未必能有效缩小囊肿。本例患者为肝血管瘤栓塞治疗后形成胆汁瘤,其CT平扫表现为椭圆形或分叶状的低密度病灶,其密度接近于胆囊内的密度,囊壁菲薄而不易发现,增强后扫描囊内不强化,囊壁不强化或轻度强化。故肝血管瘤行栓塞治疗方法值得进一步商榷。因此凡是反复进行TAE、PEI治疗的患者一般情况稳定,突然并发梗阻性黄疸,CT提示肝内囊性占位,应考虑有胆汁瘤形成的可能。

    Release date:2016-09-08 11:47 Export PDF Favorites Scan
  • Regulative Effects of Th9 Cell Relative Factors in Pulmonary Fibrosis in Rats

    ObjectiveTo observe the effects of Th9 cell relative factors, including PU.1, interferon regulatory factor 4 (IRF4) and interleukin 4 (IL-4), in rats with pulmonary fibrosis. MethodsNinety SD rats were randomly divided into 3 groups, ie. a normal group, a pulmonary fibrosis group, and a dexamethasone treatment group, with 30 rats in each group. Ten rats in each group were sacrificed respectively on 7th, 14th, 28th days. Model rats were induced by injecting bleomycin into trachea. Real-time PCR was applied to detect mRNA expression of PU.1 and IRF4 in bronchoalveolar lavage fluid. IL-4 in the peripheral blood was measured by ELISA. ResultsIn the normal group, the lung tissue was normal without inflammatory reaction and fibrosis at any time points. In the pulmonary fibrosis group, at the early stage the lung tissue showed alveolar inflammation with a large number of macrophages and other inflammatory cells infiltratation in the pulmonary interstitial and alveolar cavity; on 14th day, part of the alveolar structure disappeared, inflammatory cells infiltrated slightly, while the alveolar septum was mildly widened and fibroblasts proliferated; on 28th day, alveolar structure was destructed, partial alveolar walls were collapsed, alveolar septuml was significantly widened, extracellular matrix was hyperplastic, a wide range of fibrosis occured. In the dexamethasone treatment group, the alveolar structure exsisted completely, and the inflammatory cell infiltration, widened alveolar septum and fibrosis were significantly lighter than those in the pulmonary fibrosis group. PU.1 mRNA was significantly lower in the pulmonary fibrosis group compared with the normal group. Compared with the pulmonary fibrosis group, PU.1 mRNA were lower on 14th day and 28th day in the dexamethasone treatment group (P < 0.05). PU.1 mRNA increased from 7th day, reached peak on 14th day, and declined on 28th day. IRF4 mRNA was significantly lower in the pulmonary fibrosis group compared with the normal group. Compared with the pulmonary fibrosis group, IRF4 mRNA was lower on 28th day in the dexamethasone treatment group (P < 0.05). There was a positive correlation between the content of IRF4 mRNA and IL-4 on 14th day in the pulmonary fibrosis group (r=0.044, P < 0.05). ConclusionPU.1 and IRF4 play a role in inflammation leading to pulmonary interstitial fibrosis, and IL-4 may regulate Th9 cells through activating IRF4.

    Release date:2016-10-10 10:33 Export PDF Favorites Scan
  • The role and significance of interleukin-37 and related factors in the model of acute lung injury of rats

    Objective To study the expression of interleukin (IL)-37 and related factors in lung tissue of rats with acute lung injury, and explore the role and significance of IL-37 in acute lung injury so as to understand the pathogenesis of acute lung injury. Methods Forty-five clean-grade Wistar rats were randomly divided into a healthy control group, a bleomycin group and a dexamethasone treatment group, with 15 rats in each group. The rats in the bleomycin group and the dexamethasone group were treated with bleomycin at a dose of 4 mg/kg by intratracheal administration. The healthy control group was given the same volume of saline as control. The dexamethasone treatment group was injected with dexamethasone 3 mg/kg intraperitoneally twice a day on the basis of acute lung injury. The healthy control group and the bleomycin group were injected intraperitoneally with normal saline as control. The rats in each group were sacrificed at 7, 14 and 28 days after modeling. The histopathological changes of lung tissue were evaluated by HE staining. The levels of IL-37 in lung homogenate and tumor necrosis factor (TNF)-α in serum were measured. The expression of IL-18 mRNA in lung tissue was detected by RT-PCR. Results Pathological morphology showed that the lung tissue of the healthy control group was complete, no inflammatory and fibrotic changes at all time points. The lung tissues of the bleomycin group and the dexamethasone group manifested with acute alveolitis firstly and thus developed fibrosis changes lately, and the changes in the dexamethasone group were more slightly than those in the bleomycin group. The contents of IL-37 and TNF-α and the expression of IL-18 mRNA in the bleomycin group and the dexamethasone group reached to the highest point on the 7th day, and then decreased, but were significantly higher than those of the healthy control group on the 28th day (all P<0.05). Conclusions IL-37 plays an important role in the pathogenesis of acute lung injury in rats. This effect may be related to the regulation of IL-18 and TNF-α transduction.

    Release date:2017-11-23 02:56 Export PDF Favorites Scan
  • 内源性硫化氢在肺栓塞患者中的表达及临床意义

    目的 探讨硫化氢( H2S) 在肺栓塞发病过程中的作用及与D-二聚体的关系。方法 在肺栓塞患者治疗前后应用ELISA 法检测外周血D-二聚体, 敏感硫电极方法检测血浆H2 S 水平。结果 肺栓塞患者抗凝治疗前血浆中H2S 水平高于正常对照组和抗凝治疗后( P lt;0. 05) 。抗凝治疗前血清中D-聚体含量明显增高, 与抗凝治疗前H2S 的变化呈正相关( r =0. 022) 。结论 内源性H2 S参与了肺栓塞的发生和发展, 与D-二聚体呈正相关。

    Release date:2016-09-13 04:07 Export PDF Favorites Scan
  • Therapeutic Effect on Radioative Lung Injury by Different Doses of Tanshinone ⅡA Microemulsion

    ObjectiveTo investigate the therapeutic effects of different doses of tanshinone ⅡA microemulsion on radioactive lung injury. MethodsSeventy-two Wistar rats were randomly divided into a healthy control group,a model group,a liposome microemulsion treatment group,a tanshinone ⅡA microemulsion high-dose group,a tanshinone ⅡA microemulsion middle-dose group,and a tanshinone ⅡA microemulsion low-dose group.Radiation-induced lung injury model was established by irradiation of radiotherapy instrument.In addition to the control group,other groups received 6MV X radiation with one dosage of 22Gy.Four rats in each group were sacrificed on 7th,14th,and 28th day,respectively.Lung tissues were sampled to analyze the pathological changes by HE staining and the Smad7 mRNA expression by RT-PCR.The level of glutathione(GSH)in peripheral blood was determined by ultraviolet spectrophotometric method. ResultsIn the model group and four treatment groups,lung tissue biopsy showed the pathological changes gradually from pulmonary alveolitis to fibrosis.The level of Smad7 mRNA in lung tissue and GSH in peripheral blood were higher in the high-dose group,the middle-dose group and the low-dose group than those in the model group at all time points(P<0.05),and were highest in the high-dose group.There was no significant differences in the level of Smad7 mRNA in lung tissue and GSH in peripheral blood between the liposome microemulsion treatment group and the middle-dose group. ConclusionTanshinone ⅡA microemulsion has treatment effect on lung injury in a dose dependent manner.

    Release date:2016-10-12 10:17 Export PDF Favorites Scan
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