系统免疫炎症指数和骨骼肌质量指数与肝硬化合并肝癌患者术后预后的关系

目的:探讨系统免疫炎症指数（SII）和骨骼肌质量指数（SMI）与肝硬化合并肝癌患者术后预后的关系。方法:选取2015年1月至2017年12月我院收治的128例肝癌合并肝硬化患者。比较不同水平SII和SMI组患者临床病理特征和预后，分析影响肝硬化合并肝癌患者术后预后的危险因素。结果:术前SII高水平组的BCLC分期、脉管癌栓占比、低分化占比高于低水平组，差异均有统计学意义（P＜0.05）。术前SMI高水平组的年龄、美国麻醉医师协会分级、BCLC分期、肿瘤个数、脉管癌栓占比均低于或少于低水平组，差异有统计学意义（P＜0.05）。术前SII低水平组1年、2年、3年累积总生存率分别为90.8%、75.5%、47.3%，术前SII高水平组1年、2年、3年累积总生存率分别为70.7%、58.2%、39.1%，差异有统计学意义（P=0.045）。术前SMI低水平组1年、2年、3年累积总生存率分别为73.3%、55.3%、34.8%，术前SMI高水平组1年、2年、3年累积总生存率分别为90.4%、77.8%、49.7%，差异有统计学意义（P=0.010）。Cox多因素分析结果显示，BCLC B-C期、多发肿瘤、低分化、脉管癌栓、术前高水平SII是患者术后预后的独立危险因素（P＜0.05），根治性切除和术前高水平SMI是其独立保护因素（P＜0.05）。结论:术前SII和SMI水平与肝硬化合并肝癌患者预后密切相关，高水平SII是其独立危险因素，而高水平SMI是其独立保护因素。     

中西医结合治疗新型冠状病毒肺炎100例疗效及肝损伤情况分析

目的回顾性分析100例上海地区新型冠状病毒肺炎(简称"新冠肺炎")患者中西医结合治疗后的临床疗效及肝损伤情况。方法收集2020年1月22日至2020年2月10日上海市公共卫生临床中心收治的100例新冠肺炎患者的出入院临床资料及治疗方案信息,观察舌象、脉象、中医证候及肝损伤情况、临床结局与转归,比较临床症状、炎症及免疫相关指标的变化情况。结果①本研究中新冠肺炎患者的中医证型主要以热毒闭肺型、湿毒郁肺型、肺脾气虚型三型为主;实证明显偏多,虚证主要为肺脾气虚,气阴两虚偏少。②入院时无任何症状者有43例(占43.0%);服用中药汤剂以后,52例有症状患者的发热、咳嗽、咳痰、纳差、腹泻等主要症状均有不同程度改善。③中药汤剂治疗前与治疗1周后比较,患者的血清白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)等炎症指标及CD4~+等免疫指标差异有统计学意义,均得到明显改善(P0.05)。④中药汤剂治疗前,共有16例患者已存在轻度肝损伤;将服中药治疗前及治疗1周后的肝功能指标进行比较,发现治疗后其中有2例患者的肝功能恢复正常,其余14例仍存在肝损伤、但均为轻度,且治疗前后肝功能各项指标差异无统计学意义(P0.05);其余84例患者在中药汤剂治疗前及治疗1周后肝功能各项指标均在正常范围内。⑤本研究中,共有81例(81.0%)患者病愈出院,19例(19.0%)患者仍在治疗中,病死率为0%。出院患者的平均住院时间为(16.0±5.8)d。5例重型患者中有3例病愈出院,剩余2例病情转轻,未向危重型发展,危重症转化率为0%。⑥81例出院患者中,仅有5例(6.2%)患者胸部CT提示肺炎感染病灶完全吸收,剩余76例(93.8%)患者胸部CT仍提示存在不同程度的异常病变。结论中西医结合治疗,特别是辨证应用中药汤剂治疗可明显减轻新冠肺炎患者的发热、咳嗽、纳差、腹泻等主要临床症状,改善体内炎症反应及免疫失调,降低病死率及危重症转化率,且不会造成药物性肝损伤。     

新疆维吾尔族、汉族抗结核药物性肝损伤患者IL-10分泌水平的研究

目的 探讨汉族、维吾尔族抗结核药物诱导的肝损伤（ATDLI）患者IL-10分泌量，比较两民族之间存在的差异。方法 选取新疆维吾尔自治区胸科医院、石河子大学医学院第一附属医院确诊的ATDLI患者。采用双抗体夹心ELISA测定患者IL-10的分泌量。比较两个民族以及两个民族不同性别、不同肝损伤程度的患者血清IL-10的表达量。结果 共收集ATDLI汉族组患者100例，维吾尔族组患者135例。维吾尔族组ATDLI患者IL-10分泌量[（56.30±17.24）pg/mL]高于汉族组[（45.81±11.04）pg/mL]，差异有统计学意义（P<0.0001）。汉族轻度、中度及重度肝损伤组患者血清IL-10水平分别为（44.73±9.10）、（47.39±10.58）、（49.52±13.21）pg/mL；维吾尔族轻度、中度及重度肝损伤组患者血清IL-10水平分别为（52.30±15.24）、（56.84±13.71）、（58.62±14.38）pg/mL。组间比较显示，IL-10的分泌量汉族、维吾尔族中重度肝损伤组患者均高于轻度肝损伤组患者（均P<0.05）。结论 ATDLI患者IL-10分泌量随肝损伤程度的加重而升高。ATDLI患者IL-10分泌量维吾尔族高于汉族。     

Magnesium intake and primary liver cancer incidence and mortality in the Prostate,Lung, Colorectal and Ovarian Cancer Screening Trial

Epidemiological studies on magnesium intake and primary liver cancer (PLC) are scarce, and no prospective studies have examined the associations of magnesium intake with PLC incidence and mortality. We sought to clarify whether higher magnesium intake from diet and supplements was associated with lower risks of PLC incidence and mortality in the US population. Magnesium intake from diet and supplements was evaluated through a food frequency questionnaire in a cohort of 104,025 participants. Cox regression was employed to calculate hazard ratios for PLC incidence and competing risk regression was employed to calculate subdistribution hazard ratios for PLC mortality. Restricted cubic spline regression was employed to test nonlinearity. We documented 116 PLC cases during 1,193,513.5 person-years of follow-up and 100 PLC deaths during 1,198,021.3 person-years of follow-up. Total (diet + supplements) magnesium intake was found to be inversely associated with risks of PLC incidence (hazard ratio_{tertile 3 vs. 1}: 0.44; 95% confidence interval: 0.24, 0.80; p_trend = 0.0065) and mortality (subdistribution hazard ratio_{tertile 3 vs. 1}: 0.37; 95% confidence interval: 0.19, 0.71; p_trend = 0.0008). Similar results were obtained for dietary magnesium intake. Nonlinear inverse dose–response associations with PLC incidence and mortality were observed for both total and dietary magnesium intakes (all p_nonlinearity < 0.05). In summary, in the US population, a high magnesium intake is associated with decreased risks of PLC incidence and mortality in a nonlinear dose–response manner. These findings support that increasing the consumption of foods rich in magnesium may be beneficial in reducing PLC incidence and mortality.     

Cabozantinib as a second-line treatment option in hepatocellular carcinoma

ABSTRACT

Introduction

Hepatocellular carcinoma (HCC) is one of the most frequent tumors affecting the gastrointestinal tract and a universal cause of morbidity and mortality. Cabozantinib is a strong multi-inhibitor of receptor tyrosine kinases approved for renal cell carcinoma that could be useful also for the treatment of HCC.     

Germline variant burden in multidrug resistance transporters is a therapy-specific predictor of survival in breast cancer patients

Multidrug resistance due to facilitated drug efflux mediated by ATP-binding cassette (ABC) transporters is a main cause for failure of cancer therapy. Genetic polymorphisms in ABC genes affect the disposition of chemotherapeutics and constitute important biomarkers for therapeutic response and toxicity. Here we correlated germline variability in ABC transporters with disease-specific survival (DSS) in 960 breast cancer (BRCA), 314 clear cell renal cell carcinoma and 325 hepatocellular carcinoma patients. We find that variant burden in ABCC1 is a strong predictor of DSS in BRCA patients, whereas candidate polymorphisms are not associated with DSS. This association is highly drug-specific for subgroups treated with the MRP1 substrates cyclophosphamide (log-rank p = 0.0011) and doxorubicin (log-rank p = 0.0088) independent of age and tumor stage, whereas no association was found in individuals treated with tamoxifen (log-rank p = 0.13). Structural mapping of significant variants revealed multiple variants at residues involved in protein stability, cofactor stabilization or substrate binding. Our results demonstrate that BRCA patients with high variant burden in ABCC1 are less prone to respond appropriately to pharmacological therapy with MRP1 substrates, thus incentivizing the consideration of genomic germline data for precision cancer medicine.     

原发性肝淀粉样变1例报告并文献回顾

目的:报道1例原发性肝淀粉样变病例，提高该病的认识水平，减少误诊误治。方法:分析我院2015年03月诊治并经病理学确诊的肝淀粉样变1例，并结合国内外文献，对本病的临床表现、诊断、治疗及预后进行讨论分析。结果:患者临床表现为右上腹隐痛、腹胀、肝大；既往:1年前因脾破裂于我院肝胆外科行脾切除术；术后病理:（脾）内有较多出血，有血肿形成，周围脾白髓萎缩，红髓间质有玻璃样变性，符合陈旧性脾破裂伴血肿形成。肝功提示:碱性磷酸酶明显升高，白蛋白减低，球蛋白升高，肝脏CT示肝脏体积明显增大，肝脏实质强化不均匀，胆囊结石。肝穿刺组织病理活检:肝细胞索变性坏死，有炎细胞浸润，肝索内肝细胞间有粉染无结构物质，免疫组化染色结果:CD34(-)、刚果红染色(+)。结论:对肝淀粉样变缺乏诊治经验是该病误诊的原因之一，以腹痛、肝大为主要临床表现极易误诊为脂肪肝，肝硬化及原发性肝癌。当临床上遇到肝脏肿大明显伴碱性磷酸酶明显升高且与其他肝功生化指标变化不平行时，尤其合并多器官受累表现者，须警惕肝淀粉样变的可能，确诊的惟一方法是肝穿刺行组织病理检查，但应注意出血等并发症。     

谭新华从肝肾论治男科疾病临证经验

谭新华教授采用温肾补肝、益肾疏肝、填精消癥、养肾柔肝、补肾泻肝之法治疗男性不育症、勃起功能障碍、前列腺增生症、精索静脉曲张、慢性前列腺炎等男科疾病临床疗效显著。本文结合典型案例对谭教授从肝肾论治男科疾病经验进行总结。