目的:探讨达格列净对2型糖尿病小鼠心、肾的保护作用.方法:选取24只6周龄的雄性2型糖尿病模型(C57BLKS/J-leprdb/leprdb,db/db)小鼠,随机等分成达格列净投药组和对照组,另选取同周龄雄性非糖尿病的(C57BLKS/J-leprdb/+,db/m)小鼠12只作为正常组.检测小鼠血糖后,从第7周开始对投药组小鼠进行为期10周的达格列净用药,其余小鼠给予同等计量生理盐水,期间定期监测血糖、血压、尿糖以及各项代谢相关指标.投药结束后分离心脏及肾脏组织,组织切片进行染色观察.结果:与对照组相比,投药组达格列净用药后第1周血糖值显著降低(P＜0.01),用药9周后糖耐量测试结果显示血糖值几乎接近正常小鼠组水平,但各组间血压值无明显差异,心肌间质纤维化、炎性细胞浸润、氧化应激水平明显下降,同时肾小球硬化、炎性细胞浸润和氧化应激程度明显得到改善.结论:达格列净用药不仅能显著降低2型糖尿病模型小鼠血糖,还能有效抑制糖尿病引起的心血管及肾损害.

目的 基于瞬时弹性成像技术(transient elastography,TE)的超声引导无创肝纤维化检测系统(Fibro Touch)与天门冬氨酸氨基转移酶/血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)建立评分系统,探讨其在病毒性肝炎肝纤维化程度评估中的应用价值.方法选取2016-01/2017-01月作者医院收治的慢性乙型病毒性肝炎患者133例作为研究对象.所有患者均接受常规肝脏穿刺病理学检查,并接受TE检查测量患者肝脏硬度(liver stiffness measurement,LSM),同时抽取患者外周静脉血进行实验室检测获取APRI结果.以病理血检查结果作为金标准制作LSM、APRI受试者工作特征曲线(receiver operator characteristic curve,ROC),分析LSM、APRI及二者联合对显著肝纤维化、严重肝纤维化、肝硬化的评估价值.结果随着肝纤维化病情的加剧,患者LSM与肝纤维化病理分期的相关性明显高于APRI(P<0.05);所有患者中TE诊断显著肝纤维化、严重肝纤维化、肝硬化的曲线下面积(area under the curve,AUC)明显高于APRI对应的ROC AUC,并且以TE检查的特异性与敏感性最高(P<0.05);基于LSM与APRI建立的评分系统可显著提升肝纤维化诊断的特异性与敏感性.结论TE对肝纤维化不同病理分期的敏感性与特异性均明显高于APRI,而基于TE与APRI建立的评分系统则可进一步提升肝纤维化诊断的敏感性与特异性.

目的 探讨生物信息红外肝病治疗仪(biological information infrared liver therapy apparatus,BILT)联合结肠透析治疗肝硬化肝性脑病的临床疗效及对预后的影响.方法 选取2016-01/2018-06月作者医院收治的92例肝硬化肝性脑病患者作为研究对象.所有患者均存在不同程度的肝昏迷,随机将其分为观察组与对照组,对照组46例肝性脑病患者入院后及时予以护肝治疗,并进行静脉输注支链氨基酸、结肠透析等综合治疗,观察组46例患者则在对照组治疗方案基础上应用BILT治疗.比较两组患者临床症状改善情况以及治疗效果、预后结局等.结果 观察组患者治疗后首次意识、认知力、记忆力、计算力、定向力、扑翼样震颤改善时间明显低于对照组(P均＜0.05);两组治疗前血氨水平比较无统计学差异(P＞0.05),治疗后7d时观察组患者血氨水平明显低于对照组(P＜0.01);治疗前两组脂多糖(lipopolysaccharides,LPS)、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)指标比较均无统计学差异(P＞0.05),治疗后观察组LPS、TNF-α、ALT、TBIL水平明显低于对照组(P均＜0.01).两组患者治疗过程中均未发生严重药物不良反应或并发症,并且观察组肝性脑病治疗总有效率明显高于对照组(P＜0.05).结论 采用结肠透析联合BILT疗法,可有效提升肝性脑病肝昏迷患者的治疗效果,积极、快速改善患者血氨水平及临床症状,显著改善患者临床预后结局.

Objective:To apply transient elastography technique to evaluate the degree of liver fibrosis after patients with chronic hepatitis B virus received antiviral treatment of Entecavir.Methods: 60 patients with chronic hepatitis B were divided into HBeAg positive group(32 cases) and HBeAg negative group(28 cases) according to examination results. And the changes of elasticity value and pathology of liver fibrosis pre and post treatment of Entecavir were observed by adopting FibroScan transient elastography. At the same time, the recovery situation of glutamic-pyruvic transaminase (ALT) and the change of HBV DNA were observed.Results: The differences of the semi quantitative score of liver fibrosis between pre and post treatment in HBeAg positive group and HBeAg negative group were statistically significant (t=5.524,t=5.389,P<0.05), respectively. The differences of value of liver elasticity of HBeAg positive group and HBeAg negative group between pre and post treatment were significant (t=5.235, t=5.171,P<0.05). There was a positive correlativity existed in the value of liver elasticity and the semi quantitative score of liver fibrosis (r=0.824,P<0.05). The recovery rate of ALT in patients with HBeAg positive was 87.5％(28/32), and it was 82.1％ in patients with HBeAg negative (23/28). And the difference of recovery rate of ALT between the two groups was no significant (x2=0.272,P>0.05).Conclusion: TE technique can dynamically observe and evaluate the effect of antiviral therapy, and can achieve noninvasively, fast and repeatedly detect liver fibrosis of patient with chronic hepatitis B. Therefore, it has application value in clinical practice.

Objective To investigate the value of magnetic resonance imaging (MRI) elastography combined with serological markers in diagnosis of hepatitis B liver fibrosis. Methods Sixty-six patients with hepatitis B liver fibrosis treated in Heilongjiang Provincial Hospital from January 2017 to December 2017 were selected as research objects. All patients were determined by liver bispsy, and underwent hyaluronic acid (HA) test, procollagen Ⅲ (PCⅢ) test, IV collagen (IV-C) test, laminin (LN) test and MRI elastography to compare diagnosis accuracy of these methods. Results The diagnostic accuracy of serological markers, such as HA, PCⅢ, IV-C and LN, was 80.3%, and diagnostic accuracy of MRI elastography was 81.8%, and it was 93.9% of combination method. There was no significant difference in diagnostic accuracy between single serological markers test and single MRI elastography (P>0.05), but the diagnostic accuracy of MRI combined with serological markers was significantly higher than single tests (P<0.05). Severity of liver fibrosis was positively correlated with MRI elasticity value (P<0.05); MRI result was negatively correlated with serological markers, such as HA, PCⅢ, IV-C and LN (P<0.05). Conclusions Serological markers combined with MRI elastograohy is superior to single tests in the diagnosis of liver fibrosis, which is worthy of further promotion in clinical. Key words: Hepatitis B liver fibrosis; Serological markers; Magnetic resonance imaging

目的:应用超声应变率成像技术(strain rate imaging,SRr)测定糖耐量异常患者腹主动脉前、后壁的位移(TT)、应变(ST)及应变率(SR)等参数,观察糖耐量异常患者腹主动脉弹性的变化情况,为早期预防、诊疗糖耐量异常患者腹主动脉疾病提供依据.方法:选择自2011年7月至2013年12月我院门诊及住院的糖耐量异常患者20例,所选患者符合糖耐量异常诊断标准,另选30例体检正常者做为对照组.应用SRI技术获取同步的位移(TT)曲线,应变(ST)曲线和应变率(SR)曲线,获得每处的最大位移(TT)、最大应变峰值(ST)、收缩期、舒张早期和舒张晚期的应变率峰值(SRs、SRe、SRa).结果:腹主动脉前后壁组织多普勒指标比较,对照组前、后壁组织多普勒各指标差异均具有统计学意义(P＜0.05),糖耐量异常组的前、后壁组织多普勒指标SRs、SRe、SRa指标均具有统计学差异(P＜0.05),前壁以SRs指标改变最为明显.糖耐量异常组前壁及后壁ST值分别与对照组比较,均有所下降.差异均有统计学意义(P＜0.05);糖耐量异常组指标(SRs、SRe、SRa)绝对值比对照组减低,差异均有统计学意义(P＜0.05)(见表4、5),应变率指标以SRs改变更明显.结论:超声应变率成像可作为评价糖耐量异常患者腹主动脉弹性的方法,为临床提供有价值的治疗和预后信息.

目的:应用血流向量图(VFM)对扩张性心肌病(DCM)患者收缩期左室心腔血液流场变化情况进行检测,初步探讨FM技术在评价DCM患者左心室收缩功能方面的临床价值.方法:选择临床诊断为DCM患者30例作为病例组,另选30例体检健康者作为对照组.在血流向量图条件下测量两组取样线上收缩期负向总流量(Systole Q-,SQ-)在涡流条件下测量涡流的最大流量(Qmax)、半值面积(S)、涡流半径(r)以及涡流强度(Qmax/S),并比较两组差异.应用Simpson双平面法获取左心室射血分数(EF),并与SQ-、Qmax/S进行相关性分析.结果:两组比较病例组基底段、中间段、心尖段收缩期负向总流量SQ-、两组组内比较基底段、中间段、心尖段收缩期负向总流量SQ-均呈逐渐递减变化趋势(P均＜0.01).收缩期涡流最大流量Qmax及涡流强度Qmax/S测值均低于对照组(P＜0.01);收缩期涡流半值面积S、涡流半径r均大于对照组(P＜0.01);Qmax/S与EF呈正相关,(r=0.78,P＜0.01);结论:VFM技术可以定量分析DCM患者左室心腔内血流流场的变化情况,有望为临床提供一种较为准确检测DCM患者左心功能的新方法.

Objective To discuss diagnosis value of ultrasonography on focal liver lesions.Methods Patients with focal liver lesions found by conventional scanning were conducted with CEUS,benign and malignant lesions detection and malignant patients time-enhanced characteristic curve characteristics were observed compared with conventional scanning image.Results Lesions qualitative detection was statistically significantly different in observation group compared with control group(P <0.05).Observation lesions time-intensity curve had a highly statistically significant(P <0.01) with contrast enhanced check.The sonogram of HCC patients was "fast forward quick out",inhomogeneous enhancement was found in metastases perfusion,and performance of cholangiocarcinoma was inconsistent;Hemangioma was showed"fast forward slow out’,a spoke-like eccentric hyperechoic was found in early of FNH,and it didn’t go away in portal and delayed phases and no enhanced echo was found in liver cysts and liver abscess.Conclusion Ultrasound contrast-enhanced MRI has significant advantages relative to conventional ultrasound,and is able to achieve the initial differential diagnosis of benign and malignant placeholder and further investigate and diagnose it with routine ultrasound examination.

Objective To evaluate the value of contrast-enhanced ultrasonography (CEUS) in diagnosis of liver cystic-solid lesions.Methods The features of conventional gray scales and contrast-enhanced ultrasonography(CEUS) for the 35 patients with cystic-solid lesions of the liver(39 lesions:benign 25, malignant 14) proved by pathology or biopsy were analyzed. Results CEUS:The malignant lesions assumed 100%(14/14) hyper-enhancement in the arterial phase, hypo-enhancement in the portal phases and withdrawal was more obvious in the late phases. The sensitivity, specificity, and accuracy of the conventional gray scales for the malignant cystic-solid lesions were 71.4%(10/14), 96.0%(24/25),and 87.1%(34/39), respectively,while the CEUS were 100%(14/14), 92.0%(23/25), and 94.8%(37/39), respectively. Conclusion CEUS is more effective in qualitative diagnosis of the liver cystic-solid lesions, providing the utility and the basis for the clinical treatment.