人工肝治疗对肝衰竭患者肝脏储备功能的影响

肝衰竭患者病情危重,病死率高,人工肝治疗是积极有效的治疗手段.以吲哚氰绿(ICG)排泄试验为代表的肝脏储备功能检测是评价肝脏功能的重要方法之一.脉冲式色素浓度分析仪分析法(PDDG)进行ICG排泄试验,具有微创、简便、实时、快速和兼容等优点,但目前尚多用于肝脏手术术前肝脏储备功能的评价和肝硬化患者肝脏储备功能的评估.本研究通过ICG排泄试验为指标来预测肝衰竭患者预后,评价人工肝治疗对改善肝衰竭患者肝脏储备功能的临床意义.     

吲哚菁绿清除试验在结直肠癌肝转移患者化疗性肝损伤评估中的作用

手术是目前结直肠癌肝转移患者获得生存延长的最佳治疗手段,临床实践中多数结直肠癌肝转移患者需要术前化疗,而化疗性肝损伤的严重程度及其对围术期安全性的影响亟须精确评估。吲哚菁绿（ICG）清除试验是肝储备功能定量检测的手段之一。对于肝硬化造成永久性的肝损伤,ICG试验可以精准地反映其肝储备功能的异常。但ICG试验能否反映化疗性肝损伤对肝储备功能的影响尚存在争议。本综述将从ICG试验反映肝储备功能的原理、应用及ICG指标异常与化疗性肝损伤有无和严重程度的相关性,以及与肝切除安全性的关系和ICG指标的影响因素等多个角度进行文献归纳总结,探讨ICG试验在化疗性肝损伤的评估中的作用。     

慢性肝病肝脏储备功能与肝纤维化的关系

目的:研究慢性乙型肝炎及乙肝肝硬化患者的肝脏储备功能及肝纤维化,进一步探讨肝脏储备功能与肝纤维化之间的关系.方法:60例慢性乙肝病毒感染患者,分为慢性乙型肝炎及乙肝肝硬化代偿期两组,利用脉冲式色素浓度图像分析仪(DDG)行吲哚氰绿(ICG)排泄试验,监测ICG血浆清除率(K)和15min滞留率(R15);同时利用Fib...     

肝脏储备功能评价

肝脏是重要的器官,许多疾病的治疗都需要充分的评价肝脏的功能作为前提,反映肝功能的试验种类很多,已达700余种,归类分析可分为[1]:①反映肝细胞损伤的功能试验。②肝脏排泌的功能试验。③肝脏储备功能的试验。④反映肝脏间质变化的试验。目前,肝脏储备功能的研究近年呈现长足的进展,正日益得到临床医学家的关注。肝储备功能评价方法较多,目前较成熟的方法主要有:血清前蛋白(prealbumin,PA)检测、吲哚靛青绿(ICG)排泄试验、利多卡因试验、胰高血糖素负荷试验(glucagons loading test GLT)、肝储备功能的影像学检测。本文对上述方法分别…     

吲哚菁绿清除试验对乙型肝炎肝硬化患者肝脏储备功能的评估价值

目的通过吲哚菁绿(ICG)清除试验评估乙型肝炎肝硬化患者肝脏储备功能,探讨ICG清除试验与Child-TurcottePugh(CTP)分级和MELD评分评价肝功能之间的关系。方法收集福建医科大学附属第一医院2012年1月-2015年1月住院的乙型肝炎肝硬化患者127例,进行ICG清除试验,计算患者的ICG血浆清除率值(K值)、有效肝血流量(EHBF)、ICG 15 min滞留率(ICG R15),以及CTP分级和MELD评分。组间比较采用方差分析,进一步两两比较采用LSD-t检验;相关性比较采用Spearman等级相关性分析;采用受试者工作特征曲线下面积(AUC)比较肝脏储备功能。结果乙型肝炎肝硬化患者CTP分级:A级患者63例,B级患者45例,C级患者19例。随着CTP分级升高,ICG R15逐渐增高,而EHBF和K值则逐渐降低,差异均有统计学意义(F值分别为146.96、91.26、40.94,P值均分别为0.001、0.003、0.005)。在评价肝功能方面ICG R15与MELD评分及CTP分级呈正相关(r值分别为0.525、0.838,P值均0.01),与EHBF及K值呈负相关(r值分别为-0.703、-0.901,P值均0.01)。ICG R15AUC为0.85,MELD评分AUC为0.65。结论 ICG消除试验能够准确动态反应肝脏储备功能,ICG R15评估肝脏储备功能优于CTP分级及MELD评分。     

术前ICG排泄试验评估预测肝癌患者肝储备功能的临床研究

目的探讨术前吲哚菁绿(ICG)排泄试验对检测肝癌患者肝储备功能、预测术后肝功能不全的价值,以指导治疗疾病。方法纳入2012年6月至2015年6月我院收治的原发性肝癌手术患者74例,术前行ICG排泄试验,记录ICGR15及ICGK值,检测常规肝功能血液生化指标,明确Child-pugh分级,术后检测肝功能恢复情况。结果 174例患者包括Child A级61例,Child B级13例,按肝功能分级分组,经统计学分析,Child A级患者ICGR15更低、ICGK值更高,差异有统计学意义(P0.05);2术前ICGR15与术前白蛋白、前白蛋白呈负相关,与总胆红素呈负相关,上述相关性均差异有统计学意义(P0.05);3与术后未发生肝功能不全患者相比,术后肝功能不全患者ICGR15值更高、ICGK值更低,组间差异有统计学意义(P0.05),按ICGR1510%、10%≤ICGR1520%、ICGR15≥20%分组,肝功能不全发生率分别为15.79%、45.83%、66.67%,组间差异有统计学意义(P0.05)。结论术前ICG排泄试验能够有效评估肝癌患者肝储备功能,有助于预测术后肝功能不全,值得关注。     

吲哚菁绿试验对HBV相关肝脏疾病的肝脏储备功能及预后评估价值

目的通过吲哚菁绿清除试验评估HBV相关肝病患者肝脏储备功能,比较吲哚菁绿试验15分钟滞留率(indocyanine green retention rate at 15 minutes,ICG R15)与Child-Turcotte-Pugh score(CTP)分级和终末期肝病模型评分(the model for end-stage liver disease,MELD)对乙型肝炎肝硬化患者预后的评估能力。方法选取56例慢性乙型肝炎(chronic hepatitis B,CHB)和144例乙型肝炎肝硬化患者进行ICG R15检测,采用t检验比较CHB与乙型肝炎肝硬化两者ICG R15的差别,用Spearman相关性分析乙型肝炎肝硬化患者ICG R15与MELD评分及CTP分级的关系;通过受试者工作特征(ROC)曲线法分析ICG R15与MELD评分对肝硬化预后的评估能力。结果56例CHB患者ICG R15为1.40~9.50,平均值为4.43±2.19;144例乙型肝炎肝硬化患者ICG R15为2.40~60.00,平均值为22.80±16.00,显著高于CHB组,差异有统计学意义(P0.01)。CTP分级:A级患者70例,MELD评分4.99±2.76;B级患者54例,MELD评分6.24±4.69;C级患者20例,MELD评分11.71±3.77。在评价肝功能方面ICG R15与MELD评分及CTP分级呈正相关(r=0.414、r=0.67,P0.01)。ICG R15评估乙型肝炎肝硬化患者预后的曲线下面积(AUC)为0.903,最佳截点为9.55%,敏感度为71.5%,特异度为100%。MELD评分AUC为0.634,最佳截点为7.00,敏感度为36.8%,特异度89.3%。结论吲哚菁绿试验能动态反映肝脏储备功能,与MELD评分结合能更好地反映肝脏功能及评估患者预后。     

靛氰氯排泄试验在肝癌治疗中的应用价值

92例中晚期肝细胞癌行肝动脉化学栓塞(TACE)治疗前作靛氰氯(ICG)排泄试验。结果表明，92例肝癌患者ICGR15平均为15．84±12．73%，ICGR15<10%有36例，ICGR15 10～20％有31例，ICGR15>20％有25例；在76例肝功能Child A级患者中40例(52．63%)ICGR15>10%，在TACE治疗后肝功能指标(SB、ALT、AST、PT)损害或损害加重发生率以ICGR15<10％组为最低，10～20％组次之，>20%组最高(P<0．01)，其损害程度也与之相似。92例中9例(9．78%)发生TACE相关性肝功能衰竭，在ICGR15>20％组中占8例，其中9例ICGR15>30％者中占5例(55.56％)，本文结果表明，ICG排泄试验比常规肝功能Child分级更能反映肝硬变代偿期肝癌患者肝脏储备功能，在肝癌治疗中具有指导制定个体化治疗方案的临床价值。     

132例慢乙肝患者HBsAg定量水平与肝储备、肝硬度的相关性分析

目的 探讨慢性乙型肝病（慢乙肝）患者的血清HBsAg定量水平与肝脏储备功能、肝硬度的关系.方法 132例慢乙肝患者,包括慢性乙型肝炎（CHB组）39例、肝硬化Child-pugh A级（LCA组）54例、肝硬化Child-pughB级（LCB组）39例,分别行血清HBsAg定量、肝脏储备功能ICG R15及肝脏瞬时弹性FibroScan（FS）检测.结果 血清HBsAg定量在CHB组、LCA组、LCB组的中位数分别为3 110.00、488.19、382.72 IU/mL,三组相比,P均＜0.01.ICG R15及FS在CHB组、LCA组、LCB组的中位数分别为36.10％及41.00kPa、15.20％及21.10 kPa、9.30％及14.30 kPa,三组相比,P均＜0.01.LCB组血清HBsAg定量水平与ICG R15、FS呈负相关（r分别为-0.444、-0.440,P均＜0.01）.结论 HBsAg定量检测在一定程度上可以反映慢乙肝患者肝脏储备功能及肝脏纤维化程度.     

吲哚菁绿清除试验的临床应用

目前临床上常用的肝功能评价方法多为以血生化检测为代表的静态检测,大多侧重于检测肝脏的损伤程度及功能障碍情况,而对肝脏储备功能,即肝脏的有效功能状态的反映存在明显的局限性。吲哚菁绿(ICG)清除试验是临床中常用肝脏储备功能检测方法,且具有微创、简便、快速、可床边实时监测并短时间重复的特点。ICG清除试验在肝脏外科领域的应用价值已得到广泛认可,近年来,在肝脏内科、肝脏介入、重症患者、药物安全性评估等领域的应用研究逐步深入。现结合近几年的文献,就ICG清除试验的临床应用现状、相关进展及应用前景进行了综述。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.