<正>乙型肝炎病毒(HBV)慢性感染是一个全球性的健康问题,仅中国就有约3000万慢性乙肝患者。笔者于2004年3～5月,应用水林佳(由天津天士力制药股份有限公司生产)治疗肝功能异常的慢性乙型肝炎患者34例,现将结果报告如下。

目的探讨人工肝治疗老年慢性重型肝炎的临床疗效。方法回顾性分析本院住院老年慢性重型肝炎患者共104例,根据是否采用人工肝治疗分成治疗组及对照组,观察血浆置换治疗前后肝功能、凝血功能、肾功能指标,评价两组的存活率、住院时间及存活时间。结果经血浆置换治疗后肝功能、凝血功能较治疗前明显好转(P<0.05)。治疗组近期存活率(41.67%)高于对照组(17.24%)。早期接受人工肝治疗者远期存活率(66.67%)高于对照组(27.78%),中期(22.2%)和晚期(0)治疗者远期存活率与对照组(5.56%)之间差异无显著性(P>0.05)。治疗组远期存活者住院天数明显少于对照组,治疗组死亡者生存天数长于对照组(P<0.05)。结论人工肝治疗可提高老年重型肝炎患者的近期存活率,延长患者生命,缩短病程。

AIM: To explore the roles of nuclear factor-kappa B and its downstream factors such as tumor necrosis factor-α (TNF-α) and Bcl-2 in acute hepatic injury and their machanisms METHODS: A total of 90 male Wistar rats were randomly and averagely divided into normal group, TAA (thioacetamide) model group and PDTC (pyrrolidine dithiocarbamate) pretreated group. The rats in each group were killed 6, 24 and 48 h after induction of the model, 10 rats for each time point. Chromogenic substrate limulus amebocyte lysate method was used to examine the level of plasma endotoxin, and radioimmunoassay was performed to detect the level of plasma TNF-α Liver tissues were collected for pathological examination by immunohistochemistry, and the apoptotic index of hepatic cells was also measured. RESULTS: As compared with those in the normal group, the levels of plasma endotoxin (EU/mL) and TNF-α(μg/L) were significantly increased (endotoxin: 0.64±0.08 vs 0.23±0.02, P＜0.01; 0.96±0.14 vs 0.25±0.02, P＜0.01; 1.15±0.17 vs 0.25±0.03, P＜0.01; TNF-α: 5.97±1.07 vs 1.44±0.52, P＜0.01; 12.52±2.09 vs 1.57±0.62, P＜0.01; 10.76±1.95 vs 1.49±0.57, P＜0.01), and the activities of NF-KB and Bcl-2 in liver tissues were enhanced (NF-κB: 87.11%±8.23% vs 4.64%±1.82%, 78.55%±6.82% vs 4.58%±1.91%, 74.27%±6.26% vs 4.73%±1.89%, all P＜0.01; Bcl-2: 51.11%±4.23% vs 6.74%±3.93%, 71.59%±6.82% vs 6.68%±3.88%, 82.19%±8.54% vs 6.81%±4.14%, all P＜0.01) in the TAA group. With prolonging of TAA treatment, the apoptotic index of hepatic cells were increasing, and the pathological changes becoming notable. After the activity of NF-κB was inhibited by PDTC, the pathologcal injury was alleviated. CONCLUSION: TNF-α is activated in TAA-induced acute liver injury, and NF-κB aggravates hepatic injury by regulating its downstream gene expression.

目的:探讨替比夫定治疗慢性乙型肝炎(CHB)的疗效。方法:将60例CHB患者应用替比夫定抗病毒治疗,观察治疗效果。结果:替比夫定可使HBV-DNA载量下降,丙氨酸转移酶(ALT)降低;5例患者于应用后2周出现血清ALT升高;3例应用后2周出现血清总胆红素(TBIL)升高,其中1例TBIL升高大于17μmol/L(相对于用药前),加用双环醇等保肝药物治疗后逐渐好转,8周后ALT、TBIL复常。结论:替比夫定可明显抑制乙型肝炎病毒复制,部分患者有肝功能波动,需及时调整综合治疗。

Objective To observe the clinical effect of telbivudine therapy on severe hepatitis B.Methods Twelve patients with severe hepatitis B was given telbivudine,10 patients of them combined with artificial liver.Results In patients with telbivudine HBV-DNA negative sero-conversion rat decreased,PTA increased.There was obviously decreasing in TBIL about 7 patients after 2 weeks,after 6 weeks treatment(telbivudine combined with artificial liver and basing treatment) there was above 205 μmol/L in TBIL about 4 patients,liver transplantation was given to one of them.After 2 weeks treatment there was obviously decreasing in ALT about 9 patients.Conclusion Telbivudine can effectively inhibit HBV replication,liver injury would be happen in some of patients with telbivudine,we must be observed in them,so that we can square the treatment.

Reviews the research on the classification of hemodialysis membrane material,common membrane and its biocompatibility,clearance and absorption of solute,and summarizes the material and its influence on hemodialysis.

To study the efficacy of nucleosides plus artificial liver support system(ALSS) on treating chronic severe hepatitis.58 patients with chronic severe hepatitis B were divided into three groups: combined treating group with nucleosides plus ALSS,ALSS treating group and nucleosides treating group.The therapeutic efficacy was observed.In combined treating group,mortality was 25%,and liver function indexes,such as bilirubin,albumin,prothrombin time activity(PTA),and HBV DNA level,improved.Treating with nucleosides plus ALSS could accelerate the amelioration of liver function,shorten course of disease,decrease mortality and HBV DNA level.

Objectives To study the morbidity of infection and the outcome of patients with liver failure. Methods 234 patients with liver failure were enrolled in this retrospective study. Result The infection incidence in liver failure patients was 89.3%. Gram negative bacteria accounted for 92.59% in all positive culture specimens. Lower infection incidence (72.60%) was observed in patients with good outcome. High incidence of multiple site infection occurred manly in died or liver transplantation patients. Conclusions The infection incidence is higher in recent years. Gram negative bacteria is the main microorganisms responsible for infection.

慢性乙型肝炎病毒感染者主要依据病史、症状、体征、血清生化检查及肝脏超声等辅助检查确立临床诊断.虽具有方便易行,创伤小,患者容易接受,可重复性检查等优点,但慢性HBV感染者的诊断"金标准"却为肝组织病理检查.

<正>重型肝炎肝细胞大量坏死,肝功能衰竭,合成及代谢能力下降,从而影响血清甲状腺素水平。血浆置换是目前治疗重型肝炎的有效措施之一,它不仅能清除体内的有毒代谢产物,而且能够部分补充人体所需的蛋白、凝血因子等物质。笔者检测了重型肝炎患者血清甲状腺素水平变化,并观察了血浆置换对甲状腺素水平的影响,报告如下。

干扰素是目前国际公认的治疗慢性乙型及丙型肝炎的药物,但在抗病毒治疗过程中常造成白细胞和血小板减少,部分患者常因此而延续或中断治疗,从而不能完成疗程,使疗效大大降低.重组人粒细胞巨噬细胞集落刺激因子(GM CSF)刺激骨髓造血虽然效果较好,但因其价格昂贵,应用受到限制[1].我们应用地榆升白片预防和治疗慢性乙型及丙型病毒性肝炎干扰素抗病毒治疗过程中,所致的白细胞减少症,现报告如下.

Objective:To evaluate the efficacy of silibinin capsules for patients with chronic hep- atitis B (CHB). Methods: Sixty-eight patients with chronic hepatitis (abnormal ALT level) were equally randomized to receive either silibinin capsules (360mg) plus inosine (1200mg) daily or inosine monotherapy (1200mg) daily for 12 weeks. The primary endpoints were to monitor the improvement of abnormal ALT and AST in weeks 4,8 and 12 after the administration of the study drugs. Results:79.4 percent of patients treated with silibinin plus inosine experienced an ALT and AST normalization, compared to 32.3 percent of patients treated with inosine alone (P0.05). No serious adverse events were reported in the bicombination group in the course of the therapy. Conclusion: Addition of silibinin capsules to inosine regimen achieves a significant normalizatoin of the ALT and AST levels in patients with CHB.

非生物人工肝治疗重型肝炎是一种创伤性治疗方法,它与内科治疗相结合,可以达到两种目的:1.实现临床情况好转[1-4];2.为肝移植治疗争取时间[5].由于重型肝炎患者病情重,发病机制复杂,在应用非生物人工肝治疗过程中出现的并发症状也由于病情而不同.现对我院68例患者共191人次血液净化过程中出现的并发症状进行分析.

目的:初步探讨硒元素在各种慢性肝病中的分布规律,评价应用西维尔补硒治疗的临床效果.方法:对我院于2003年1～10月住院的76名患各种慢性肝病的住院患者进行了血清硒元素检测,并对其中14名肝硬化患者进行了口服补充硒元素治疗.结果:慢性肝炎、重型肝炎、肝硬化病人低血清硒比率分别为:56.2%、57.1%、93.2%,如果给予肝硬化病人补硒治疗,治疗前后血清硒水平呈正相关关系.结论:各种慢性肝病患者中存在着低血硒的情况,其中肝硬化患者中血清硒水平明显低下.对肝硬化患者予以临床补硒采取口服西维尔方法是有效而且安全的.

目的加速慢性乙型肝炎(CHB)患者黄疸的消退.方法采用熊胆胶囊治疗CHB 33例,并用同期住院患者20例做对照,观察两组患者黄疸消退情况.结果加用熊胆胶囊治疗可促使黄疸迅速消退、肝功能改善.结论熊胆胶囊有保肝利胆功效,用于治疗高黄疸的肝炎患者,可使其病程缩短.

目的:了解重型肝炎患者血清镁水平的情况.方法:采用天津市传染病医院1998年4月～2002年11月入院130份重型肝炎病人血清,利用美国DADE公司提供的标准试剂盒标定,采用比色法检测血清中镁的浓度.结果:绝大多数(>80%)重型肝炎病人存在着低血镁的情况.结论:镁的浓度低下可能与肝细胞的坏死及再生有关.重型肝炎病人应该酌情给予临床补镁治疗.