Objective:To establish donor liver quality related risk factors for the loss of function of transplanted liver.Methods:The data of donors and recipients of liver transplantation at the Organ Donation and Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University from Nov 2011 to Dec 2018 were analyzed retrospectively. Propensity score matching (PSM) was performed to evaluate and screen the data of donors and recipients, in order to balance the covariates.Results:Of the organ donation, there were 70 males and 20 females , aging (40.6±16.3) years. Of the liver transplantation recipients, there were 70 males and 20 females , aging (41.8±20.3) years. Liver dysfunction after transplantation was significantly correlated with the following variables: the donor's CPR time( t=0.429, P=0.000), 15-minute retention rate of indocyanine green ( χ2=67.151, P=0.000), liver function grading ( χ2=54.154, P=0.000), bullae fatty liver grading ( χ2=8.120, P=0.017), vesicular fatty liver grading ( χ2=16.000, P=0.001), ICU stay time ( χ2=14.900, P=0.001)and serum creatinine level ( χ2=44.685, P=0.000). The donor scoring system was established in our studying. For the 90 organ donation cases, the donated liver quality were classified into four levels,which were of good correspondence to the prognosis of the recipients. Conclusion:This donor scoring system and grading standards established by analyzing the high-risk factors of liver dysfunction after transplantation helps evaluate the quality of donor liver in China.

目的:分析降钙素原(PCT)对评估肾移植术后感染的预测价值和临床意义.方法:回顾性分析2017年6月—2020年6月96例肾移植术后患者的临床资料,根据临床病原体培养结果以及临床症状将其分为感染组46例和非感染组50例.对比分析两组PCT在术前和术后第1～7天的差异,应用工作特征曲线(ROC)分析PCT对肾移植术后第2～5天发生感染的预测效能.结果:感染组与非感染组术前PCT对比,差异无统计学意义(P>0.05).但肾移植术后第1～7天,感染组的PCT整体趋势和峰值明显高于非感染组,其中术后第2～5天的对比,差异有统计学意义(P<0.05).ROC曲线分析显示,肾移植术后第2～5天的ROC曲线下面积(AUC)分别为0.745、0.773、0.792、0.794,差异均有统计学意义(P<0.05).结论:降钙素原(PCT)对肾移植术后出现感染有预测价值,它能指导临床及时有效的使用抗菌药物,一定程度上能预防严重感染的发生.

目的:探讨肿瘤坏死因子-α (TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-1β (IL-1 β)、白细胞介素-2(IL-2)、白细胞介素-8(IL-8)对肾移植患者术后发生感染的预测价值.方法:回顾性选取2017年12月-2020年12月在本院行同种异体肾移植手术的82例患者,根据感染诊断标准和培养结果将其分为感染组(n=42)和非感染组(n=40).比较感染组与非感染组白细胞计数(WBC)、中性粒细胞计数(NEU)、TNF-α、IL-6、IL-10、IL-1 β、IL-2、IL-8的水平差异,应用多因素logistic回归分析肾移植患者术后发生感染的独立影响因素,应用受试者工作特征(ROC)曲线分析细胞因子对感染的预测价值.结果:感染组TNF-α、IL-2均高于非感染组(P＜0.05).多因素logistic回归分析结果显示,IL-2为影响肾移植术后感染的独立危险因素(P＜0.05).ROC曲线分析结果显示,IL-2对肾移植术后感染预测价值的约登指数为0.682,曲线下面积为0.811.结论:IL-2为肾移植术后感染的独立危险因素,对肾移植术后发生感染有一定的预测价值.

Background: Circular RNAs (CircRNAs) and their associations with human disease have been widely studied. However, the roles of circRNAs in gallstone disease (GD) remain uncertain.Methods: We recruited 1134 gallstone first formation patients, 2068 gallstone free controls, 158 gallstone second formation patients and 644 recovered patients. The expression level 12 candidate circRNAs from patients’ serum samples was determined by quantitative polymerase chain reaction. We then explored the potential of using candidate circRNAs as independent genetic risk factors and novel diagnostic biomarkers for gallstone first and second formation.Findings: Among 12 candidate circRNAs, circHIPK3 and hsa_circ_0014243 were significantly increased in GD patients (All P>0.05). After controlling common risk factors, circHIPK3 (phase 1: OR 1.33; 95% CI 1.10 ~ 1.60) (phase 2: OR 1.47; 95% CI 0.97 ~ 2.23) and hsa_circ_0014243 (phase 1: OR 1.29; 95% CI 1.06 ~ 1.57) (phase 2: OR 1.46; 95% CI 0.98 ~ 2.17) were identified as independent risk factors for GD. GD patients with increased expression of circHIPK3 and high triglyceride showed the highest OR. In phase 1, the area under the receiver operating characteristic curve (AUC) for circHIPK3 and hsa_circ_0014243 were 0.81 and 0.73, respectively. Similarly, the AUC in phase 2 were 0.79 and 0.66, respectively.Interpretation: circHIPK3 and hsa_circ_0014243 may be independent genetic risk factors and novel diagnostic biomarkers for gallstone first and second formation.Funding Information: The Committee of National Natural Science Foundation.Declaration of Interests: No potential conflict of interest relevant to this article was reported. Ethics Approval Statement: All protocols in this study were approved by the ethics committee of Dong Guan Nan Cheng Hospital and The First Affiliated Hospital, Sun Yat-sen University. Informed consent was provided to all participants, and the study protocol conformed to the ethical guidelines of the Declaration of Helsinki (1975).

目的 探讨单克隆抗体与多克隆抗体对肾移植患者降钙素原的影响.方法 回顾性选取2017年6月至2020年6月中山大学附属第一医院收治的101例肾移植患者作为研究对象,按照免疫抑制治疗方案分为单克隆抗体组(50例)与多克隆抗体组(51例),单克隆抗体组给予巴利昔单抗干预,多克隆组给予抗人胸腺细胞免疫球蛋白干预.比较两组肾移植术后患者的降钙素原、肌酐、尿素氮等生物学指标水平.结果 两组术后1～4 d的降钙素原比较,差异无统计学意义(P＞0.05);术后5～6 d,多克隆组的降钙素原水平高于单克隆组,差异有统计学意义(P＜0.05);术后5～7 d,两组的降钙素原水平均低于术后1d,差异有统计学意义(P＜0.05).两组术后1～7 d的肌酐、尿素氮比较,差异无统计学意义(P＞0.05);术后6～7 d,两组的肌酐水平均低于术后1d,差异有统计学意义(P＜0.05);术后7d,两组的尿素氮水平低于术后1d,差异有统计学意义(P＜0.05).结论 免疫抑制剂会导致降钙素原升高,且多克隆抗体较单克隆抗体引起降钙素原水平波动的更大.

Background: Administration of terlipressin can reverse hypotension in potential organ donors with norepinephrine-resistance. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive brain-dead patients who were potential organ donors. Methods: A retrospective study was conducted by using the ICU database of one hospital. 18 patients in a total of 294 brain-dead cases were enrolled and administered terlipressin intravenously. All physiological parameters of recruited patients were obtained at baseline, 24 and 72 h after administration, and immediately before organ procurement. Results: Terlipressin induced significant increases in mean arterial pressure (MAP) from 69.56 ± 10.68 mm Hg (baseline) to 101.82 ± 19.27 mm Hg (immediately before organ procurement) and systolic blood pressure (SBP) from 89.78 ± 8.53 mm Hg (baseline) to 133.42 ± 26.11 mm Hg (immediately before organ procurement) in all patients. The increases in MAP were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm (baseline) to 83.89 ± 11.70 bpm (immediately before organ procurement), which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min (baseline) to 0.09 ± 0.02 μg/kg/min (immediately before organ procurement). There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin. Renal function, assessed by serum creatinine (SCr), urine output (UOP), creatinine clearance rate (CCr), and estimated glomerular filtration rate (eGFR), improved significantly. Conclusion: Our analysis of brain-dead patients with hypotension indicates that administration of terlipressin can significantly increases MAP, SBP, UOP, CCr, and eGFR, while decreases HR and Scr. Terlipressin appears to help maintain hemodynamic stability, reduce vasoactive support, and improve renal function.

Background:The pandemic of coronavirus disease 2019 (COVID-19) resulted in grave morbidity and mortality worldwide. There is currently no effective drug to cure COVID-19. Based on analyses of available data, we deduced that excessive prostaglandin E2(PGE2) produced by cyclooxygenase-2 was a key pathological event of COVID-19.Methods:A prospective clinical study was conducted in one hospital for COVID-19 treatment with Celebrex to suppress the excessive PGE2production. A total of 44 COVID-19 cases were enrolled, 37 cases in the experimental group received Celebrex as adjuvant (full dose: 0.2 g,bid; half dose: 0.2 g,qd) for 7–14 days, and the dosage and duration was adjusted for individuals, while seven cases in the control group received the standard therapy. The clinical outcomes were evaluated by measuring the urine PGE2levels, lab tests, CT scans, vital signs, and other clinical data. The urine PGE2levels were measured by mass spectrometry. The study was registered and can be accessed athttp://www.chictr.org.cn/showproj.aspx?proj=50474.Results:The concentrations of PGE2in urine samples of COVID-19 patients were significantly higher than those of PGE2in urine samples of healthy individuals (mean value: 170 ng/ml vs 18.8 ng/ml,p< 0.01) and positively correlated with the progression of COVID-19. Among those 37 experimental cases, there were 10 cases with age over 60 years (27%, 10/37) and 13 cases (35%, 13/37) with preexisting conditions including cancer, atherosclerosis, and diabetes. Twenty-five cases had full dose, 11 cases with half dose of Celebrex, and one case with ibuprofen. The remission rates in midterm were 100%, 82%, and 57% of the full dose, half dose, and control group, respectively, and the discharged rate was 100% at the endpoint with Celebrex treatment. Celebrex significantly reduced the PGE2levels and promoted recovery of ordinary and severe COVID-19. Furthermore, more complications, severity, and death rate were widely observed and reported in the COVID-19 group of elders and with comorbidities; however, this phenomenon did not appear in this particular Celebrex adjunctive treatment study.Conclusion:This clinical study indicates that Celebrex adjuvant treatment promotes the recovery of all types of COVID-19 and further reduces the mortality rate of elderly and those with comorbidities.

AbstractBackgroundThe world is under serious threat with the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19). However, there is no effective drug for the treatment of COVID-19. Based on analyses of available data, we deduced that the excessive prostaglandins E2(PGE2) accumulation mediated by cyclooxygenase-2 (COX-2) was the key pathological basis of COVID-19.MethodsThe urine PGE2levels were measured by mass spectrometry. An experimental study about Celebrex to treat COVID-19 was conducted based on routine treatment. A total of 44 confirmed COVID-19 patients were enrolled (Experimental group n=37, Control group n=7). Patients in experimental group were given Celebrex once or twice a day (0.2 g/time) for 7–14 days. The dosage or duration was modified for individuals. Clinical outcomes of Celebrex adjuvant therapy were evaluated by vital signs, laboratory tests, and computed tomography upon the discontinuance of Celebrex.ResultsWe found that the concentrations of PGE2in urine samples of COVID-19 patients were significantly higher than that of healthy individuals (mean value is 170 ng/mlvs18.8 ng/ml,p<0.01) and positively correlated with the progression of COVID-19. Among the experimental group (ordinary n=29, severe n=7, critical n=1), 25 cases were treated with full dose and 11 cases with half dose of Celebrex, and 1 case with Ibuprofen. The remission rate were 100%, 82% and 57% in full dose, half dose and control group respectively. Celebrex significantly reduced the PGE2levels and promoted recovery of ordinary or severe COVID-19.ConclusionOur study suggests that Celebrex adjuvant treatment may be helpful for the therapy of COVID-19.

Introduction: Toll-like receptor (TLR) 7 is an important mediator in inflammation. However, its role in hyperoxia-induced acute lung injury (HALI) remains to be elucidated. Methods: C57BL/6 wild-type and C57BL/6 background TLR 7 deficiency mice were exposed to hyperoxia to stimulate HALI in airtight cages. Animals were sacrificed at 72 h post hyperoxia or room air exposure. Lung injury indicators were measured. Moreover, soluble epoxide hydrolase (sEH) activity was detected by a 14, 15-EET/DHET ELISA kit. Activation of activator protein (AP)-1 and nuclear factor kappa-B (NF-kappa B) was detected with enzyme linked immunosorbent assay kits. Results: Our data revealed that pulmonary histological assay and wet to dry weight ratio, myeloperoxidase and malondialdehyde activity were reduced in TLR 7 deficiency mice compared with wild-type mice. Moreover, hyperoxia-caused elevation of sEH activity was reduced in TLR 7 deficiency mice. Transcription factors AP-1 activation was significantly inhibited in TLR 7 deficiency mice compared with wild-type mice. Similarly, the activation of NF-kappa B was reduced in TLR 7 deficiency mice. Tumor necrosis factor-a and interleukin-1 beta, potent proinflammatory cytokines, were reduced in TLR 7 deficiency mice. Conclusion: TLR 7 deficiency is associated with inhibition of inflammation in HALI in mice.

BACKGROUND:Tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recent promising markers for identification of cardiac surgery-associated acute kidney injury (CSA-AKI). The aim of this study was systematically and quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for the diagnosis of CSA-AKI.METHODS:Three databases including PubMed, ISI web of knowledge, and Embase were systematically searched from inception to March 2018. Two investigators conducted the processes of literature search study selection, data extraction, and quality evaluation independently. Meta-DiSc and STATA were used for all statistical analyses.RESULTS:A total of 8 studies comprising 552 patients were included in this meta-analysis. Pooled sensitivity and specificity with corresponding 95% confidence intervals (CIs) were 0.79 (95% CI, 0.71-0.86, I 2 = 74.2%) and 0.76 (95% CI, 0.72-0.80, I 2 = 80.8%), respectively. Pooled positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 3.49 (95% CI, 2.44-5.00, I 2 = 61.5%), 0.31(95% CI, 0.19-0.51, I 2 = 51.8%), and 14.89 (95% CI, 7.31-30.32, I 2 = 27.9%), respectively. The area under curve estimated by summary receiver operating characteristic was 0.868 (standard error [SE] 0.032) with a Q* value of 0.799 (SE 0.032). Sensitivity analysis demonstrated that one study notably affected the stability of pooled results. One of the subgroups investigated-AKI threshold-could account for partial heterogeneity.CONCLUSION:Urinary TIMP-2 and IGFBP7 is a helpful biomarker for early diagnosis of CSA-AKI. And, the potential of this biomarker with a broader spectrum of clinical settings may be the focus of future studies.

Astragalin, a bioactive component of medicinal plants such as Rosa agrestis, has anti-inflammatory and antioxidant features. Induction of heme oxygenase (HO)-1 is an effective strategy to reduce excessive generated oxidants during the pathogenesis of acute lung injury (ALI). The aim of the present study is to investigate that whether the anti-inflammatory and antioxidant features of astragalin is HO-1 dependent in lipopolysaccharide (LPS)-induced ALI. Sprague–Dawley rats were used in animal study. Intratracheal LPS was performed to induce experimental ALI model. Astragalin was administrated 1 h after LPS challenge. Human lung epithelial cells were used in cell study. Samples from rats were harvested at 24 h post LPS challenge. Astragalin treatment inhibited LPS-induced inflammatory cells infiltration in the lung and pulmonary edema. Astragalin treatment markedly enhanced the activity of HO-1 compared with vehicle-treated group at 24 h post LPS challenge. Levels of lipid hydroperoxide, a marker for oxidative stress, were decreased in astragalin-treated animals compared with vehicle-treated group. However, the protective effect of astragalin on LPS-induced ALI was abolished in an inhibitor of HO-1-treated animals. Moreover, the astragalin-induced the upregulation of HO-1 in human lung epithelial cells was inhibited when nuclear factor erythroid-2-related factor 2 (Nrf2) was silenced by small interfering RNA. Astragalin reduces LPS-induced ALI via activation of Nrf2/HO-1 pathway.

Objectives . Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association between DP and mortality among ventilated patients with ARDS. Methods . PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase were systematically searched from inception to June 2018. Two investigators conducted the literature search study selection, data extraction, and quality evaluation independently. RevMan 5.3 software was used for all statistical analyses. Results . A total of seven studies comprising 8010 patients were included in this meta-analysis. Higher DP showed a significant association with higher mortality (pooled risk ratio, 1.10; 95% [CI], 1.05–1.16; I 2 =58%). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. One of the subgroups investigated, ARDS severity, could account for the heterogeneity. An exploratory post hoc subgroup analysis and higher DP significantly increased mortality in the mild to severe ARDS subgroup (RR 1.28; 95% [CI], 1.14–1.43;  I 2 =0), but not in the moderate to severe ARDS subgroup (RR 1.18; 95% [CI], 0.95–1.46;   I 2 =52%). Conclusion . Higher DP was significantly associated with an increased risk of death among ventilated patients with ARDS. But it did not seem to predict prognosis to moderate to severe ARDS. Future prospective randomized clinical trials are needed to verify the results of this meta-analysis and address the unresolved questions about optimum cutoff values for DP. Trial Registration . This trial is registered with PROSPERO ( CRD42018102146 ), on 11 August 2018.

Case Report Regulating rigorous judgement on brain death is the premise of organ donation for brain injury patients. During the process of judging brain death, there is abnormal movement, which should be identified. This article has reported a case of brain death patient, in which the patient was confirmed to be brain death according to Chinese brain death judgment instruction and by means of clinical judgement and three confirmation tests. But owing to the abnormal movement, there was misunderstanding between relatives and medical staff. Abnormal movement and brain death judgement are not conflict. The explanation on this should be done well, so that organ donation can be successfully implemented.

Background: To investigate the occurrence and risk factors of acute kidney injury (AKI) in organ donors. Methods: Clinical data of 153 donor patients who donated organs in our hospital from January 2016 to July 2018 were collected. Patients were divided into AKI group and non-AKI group according to AKI diagnostic criteria. Clinical indicators of patients in the two groups were compared, and the related risk factors were analyzed by unifactorial and multivariate logistic regression. Results: The incidence of donor patients complicated with AKI was 48.37%. Unifactorial analysis suggested that the SOFA score, positive rate of blood culture, hypothermia incidence and vasoactive drug dose in donor AKI group were larger than those in non-AKI group. Multivariate Logistic regression analysis showed that the dose of booster drugs (P=0.02, OR=3.53) and the positive rate of blood culture (P=0.01, OR=6.64) were independent risk factors for donor patients complicated with AKI. Conclusion: The incidence of acute kidney injury in organ donors is high, with the dose of booster drugs and the positive rate of blood culture as independent risk factors for evaluation basis to assess the incidence rate of donor patients complicated with AKI.

Purpose:To investigate the clinical significance of serum procalcitonin (PCT) concentrations and related indicators of infection in the early diagnosis and prognosis of severe surgical patients with infection. Methods: This study included 77 critically ill patients taken from the Surgery Department to the Intensive Care unit between June 2015 and July 2017. Patients were divided into control, sepsis and septic shock groups, and their serum concentrations of PCT and related indicators of infection were compared. Results: PCT levels increased significantly from the control to the sepsis group and from the sepsis to the septic shock group (P<0.01 each). There were no significant differences in white blood cell (WBC) count, neutrophil percentage and body temperature among the groups (P>0.05). Receiver operating curve (ROC) analysis showed that the areas under the curve (AUC) for PCT, WBC count, neutrophil percentage and body temperature were 0.949, 0.657, 0.640 and 0.656, respectively. PCT, with 0.52 µg/L as the cut-off concentration, had the highest performance in the diagnosis of severe surgical sepsis, with a sensitivity of 96.1%, a specificity of 92.3% and a Youden index of 0.884. Conclusion: PCT concentration is diagnostic of infection in severe surgical patients, has high specificity in the early diagnosis of sepsis, and can reflect the severity of infection.

Patients with myasthenia gravis (MG) often benefit from thymectomy, but the optimal timing of extubation following thymectomy in these patients remains unknown. This study of MG patients compared the effect of early and late extubation following thymectomy on clinical outcome. We performed a study of data from 96 patients with MG who received thymectomy procedures, followed by early (< 6 h) or late (> 6 h) extubation, at our institution between October 2011 and November 2017. Patient clinical and demographic characteristics, preoperative data, and postoperative clinical outcomes were analyzed. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. The patients in the early extubation group (n = 53) and late extubation group (n = 43) had similar preoperative clinical and demographic characteristics. However, the early extubation group had a significantly longer duration of MG (24 months vs. 12 months, P < 0.013) and a lower incidence of reintubation (11.3% vs. 37.2%, P = 0.003). Postoperative pulmonary infection was significantly more common in the late extubation group (39.5% vs. 11.3%, P = 0.001; adjusted odds ratio = 6.94, 95% CI 1.24–38.97). Also, patients in the late extubation group had a longer duration of ICU stay (6.4 ± 4.0 h vs. 4.3 ± 1.8 h; P = 0.003) and had a longer adjusted duration of ICU stay by 0.93 days (95% CI 0.02–1.85). Our analysis of patients with MG who received thymectomy procedures indicated that early extubation was associated with improved clinical outcomes, in particular with reduced risk of postoperative pulmonary infection and reduced ICU stay.

Objective Study on the mechanism of sliencing microRNA (miRNA,miR)-16 on chemoresistance in SMMC-7721.Methods The lentiviral vectors were used to construct stable cell lines.To determine whether constructed successfully,the expression of miR-16 was detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) and inhibitor of kappaB kinase beta (IKBKB),the target gene of miR-16,was detected by Western blotting.The sensitivity and resistance mechanism of the stable cell lines to paclitaxel were detected by Western blotting and thiazole blue (MTT).Results The expression of miR-16 in 7721-miR16 group was significantly higher than SMMC-7721 and 7721-mock groups (4.63 ± 1.32 vs.1.00 ± 0.30 vs.0.93 ± 0.37,P =0.000).The expression of IKBKB in 7721-shmiR16 was 25.73 times than the controls (P =0.000).The expression of multidrug resistance protein 1 (MDR1) in 7721-shmiR16 was increased and the half maximal inhibitory concentration (IC50) to paclitaxel was 4.903 μmol/L,10.64 times than the control group (0.461 μmol/L) (P =0.000).The results of western showed that silencing miR-16 induced resistance mainly through activating nuclear factor-kappaB (NF-κB) pathway.Conclusion Silencing miR-16 in SMMC-7721 significantly increases IKBKB expression leadind paclitaxel resistance.

Hepatocellular carcinoma (HCC) is a common malignant tumor usually resistant to chemotherapy. MicroRNAs play important roles in modulation of carcinogenesis and chemoresistance, which miR-16 has been reported to mediate chemoresistance in many types of cancers. However, the role of miR-16 in HCC remains unknown. The aim of this study was to investigate whether miR-16 is participated in chemoresistance in HCC and shed light on the underlying molecular mechanisms. The findings of the current study discover that miR-16 is down-regulated in HCC tissue and cell lines. The results demonstrate that the inhibition of miR-16 renders resistance to paclitaxel in vitro and in vivo by targeting IKBKB via NF-κB signaling pathway, suggesting that miR-16 may be a meaningful therapeutic potential to overcome drug resistance in HCC.

Myeloid derived suppressor cell (MDSC) is a kind of myogenic stem cells that are induced by tumor-derived cytokines.MDSCs not only have their own immunosuppressive effects,but also can mediate the immunosuppressive effects of T lymphocytes through different mechanisms.Recent studies have shown that MDSCs involved in tumor immune escape,immune tolerance as well as other pathological processes,and played an important role in promoting the generation and development of tumors.The advances of the generation,immunosuppressive effects of MDSCs and their relation with digestive system tumors were summarized in this paper,which would provide evidences for the clinical use of MDSCs in treating digestive system tumors.

目的 评估熊去氧胆酸(UDCA)降低肝移植受者术后胆道并发症(BC)的临床疗效.方法 选取2011年7月至2013年12月于中山大学附属第一医院行肝移植术的215例受者作为本次研究的评估对象.采用随机对照研究方法.入组病例按2:1随机分为用药组和空白组,用药组受者于肝移植术后第1天起每天服用UDCA 250 mg,2次/d;空白组不服用UDCA或其他安慰剂,治疗时间为6个月,停药后继续随访6个月.研究观察终点为复合观察终点,包括非外科因素引起的缺血性胆道病变(ITBL)、术后1个月后由非外科及排斥反应引起的总胆红素(TBIL)>51.3μmol/L、移植物失功、受者死亡.比较两组受者术前一般情况、手术相关情况、术后各项生化指标、术后转归情况、复合观察终点累积发生率、受者生存比例及移植物累积存活率.采用两独立样本t检验或基于秩次的两独立样本Wilcoxon检验比较年龄、Child-Pugh评分和冷缺血时间等定量资料.用卡方检验或Fisher确切概率法比较开腹手术史、激素诱导等定性资料.采用Kaplan-Meier法绘制生存曲线,利用log-rank检验比较两组复合观察终点累计发生率.P<0.05为差异有统计学意义.结果 60例受者纳入研究:空白组20例,用药组40例.两组受者术前基线情况可比.手术相关情况(冷缺血时间、手术时间、无肝期、热缺血时间、术中出血量、红细胞输注量、ICU住院时间及激素诱导情况)差异均无统计学意义(t=1.12,U=298,U=331,U=359,U=344,U=398,U=329,χ2=0.01,P均>0.05).空白组受者肝移植术后第1、2、3周血清γ-谷氨酰转肽酶,第2、3、4周血清碱性磷酸酶及第2、3、6个月血清总胆汁酸水平均高于用药组,差异均有统计学意义(U=206、160、148、222、211、219、144、140和94,P均<0.05).空白组受者术后第1、6、12个月复合观察终点累计发生率分别为15%、15%、28%,用药组分别为3%、18%、18%,两组差异均无统计学意义(χ2=0.66,P>0.05).空白组受者术后第1、6、12个月生存比例分别为90%、90%、84%,用药组均为97.5%.两组差异均无统计学意义(χ2=3.28,P>0.05).空白组受者术后第1、6、12个月移植物累积存活率分别为90.0%、84.4%、77.9%,用药组均为97.5%,两组差异均有统计学意义(χ2=5.13,P<0.05).结论 UDCA对移植肝具有保护作用,可有效减轻由缺血再灌注及疏水性胆汁酸造成的移植肝损伤,促进移植肝酶学指标恢复正常. 用药组移植物存活率优于空白组,但在复合观察终点比较中未能显示出降低胆道并发症的临床效果.