原位肝移植术后弥漫性脑病的临床研究

目的观察肝移植术后弥漫性脑病的发生及临床表现,探讨其易发因素及防治方法。方法回顾性分析自2003年10月至2005年9月完成的467例肝移植患者的临床资料,对肝移植术后并发弥漫性脑病的病例进行统汁分析并结合文献进行讨论。结果术后共有72例患者发生弥漫性脑病,发生率为15．41%；平均发生时间在术后(8．4±4．3)d。高龄、术前高胆红素坦率血症、高渗透压、低血小板、肺部严重感染与弥漫性脑病密切相关。68例患者痊愈,3例死于感染．1例死于移植物抗宿主病。结论弥漫性脑病是肝移植术后常见并具有潜在危险性的并发症,产生的原因是多因素的,钙调神经蛋白抑制剂的神经毒性只是一个促进因素。针对病因的综合治疗和免疫抑制剂的及时调整有利于改善预后。     

原位肝移植术后肝脓肿的诊断和治疗

目的 探讨原位肝移植术(OLT)后肝脓肿的病因、诊断、治疗和预防措施。方法自1993年1月至2003年6月，本中心共行OLT274例，术后并发肝脓肿6例(2．2％)。患者主要临床表现有发热、寒战、腹痛、身目黄染、肝功能损害、低蛋白血症、贫血、白细胞及中性粒细胞比例增高等。诊断主要根据临床表现及超声或CT检查。治疗方法主要包括脓肿抽吸引流、清除胆泥．抗炎和支持治疗。结果6例中2例治愈，3例放弃再次肝移植术，2例死于严重全身感染，治愈率为33．3％。结论OLT后肝脓肿病因较复杂，可能与肝动脉血栓或狭窄、甲基强的松龙冲击治疗、胆管炎症和介入治疗等有关。OLT后肝脓肿的预后较差．应加强预防措施防止其发生。     

成人良性终末期肝病肝移植术后中远期生存分析

目的 了解成人良性终末期肝病肝移植术后中远期的生存情况和影响中远期生存率的因素.方法 回顾性地分析2003年10月至2006年5月203例良性终末期肝病肝移植术后生存期大于1年的165例受体的长期随访结果 ,包括各种并发症的发生率及相关死亡率.结果 肝移植术后1、2、3年的生存率分别为88.7%、85.5%、81.2%;乙肝相关性疾病受体2、3年生存率分别为88.4%和84.5%,非乙肝相关性疾病2、3年的生存率83.4%和77.0%,两组差异无统计学意义(P=0.144).存活大于1年的165例中,1年后死亡21例,平均死亡时间22.7±6.6月(12～48个月).1年后导致受体死亡的主要并发症及其病死率为:感染并发症4.8%(8/165)、胆道并发症3.6%(6/165)、乙肝病毒再感染1.8%(3/165)、慢性排斥反应1.2%(2/165)、肾功能损害0.6%(1/165)和肝动脉并发症0.6%(1/165)等.结论 良性终末期肝病肝移植术后中远期生存情况良好.影响患者术后中远期存活的主要原因是感染并发症、胆道并发症和HBV再感染.     

肝移植术改善患者生存质量的初步研究

目的：研究肝移植手术前后患者生存质量的改变情况。方法：将患者分为肝癌组和非肝癌组．采用WHOQOL-BREF表对65例患者在肝移植术前、术后1-3个月、术后4-6个月及术后6个月以上4个时间段进行生存质量的测评。结果：非肝癌组在生理领域、自身生存质量总的主观感受及对自身健康状况总的主观感受方面．肝移植术后的评分与术前相比差异有显著性意义（P〈0．05）。肝癌组在对自身健康状况总的主观感受方面上，术后评分与术前相比差异有显著性意义（P〈0．05）。结论：肝移植术可以提高患者的生存质量。     

肝移植受者抑郁与应对方式的相关性研究

目的 调查肝移植受者术后的抑郁状况,并探讨其抑郁状况和应对方式的相关性.方法 将100例肝移植受者按时间段分为3组,第1组为术后1-6个月,第2组为术后7-12个月,第3组为术后13-36个月.用抑郁自评量表(SDS)和医学应对问卷(MCMQ)对3组受者进行调查,以国内常模得分作为对照,与各组受者SDS得分进行比较,并将抑郁总分及各特异性症状评分与应对方式的各维度进行相关性分析.结果 肝移植受者总体抑郁得分为(41.03±7.14)分,3个时间段抑郁得分分别为(42.90±7.18)、(40.71±7.97)和(39.69±6.00)分.肝移植受者术后总体抑郁得分和各组抑郁得分与国内常模(29.78±10.07分)比较,差异均有统计学意义(P<0.05).3组抑郁得分两两比较,差异无统计学意义(P>0.05);3组肝移植术后受者抑郁发生率比较,差异无统计学意义(P>0.05);肝移植受者的抑郁水平与应对方式中的面对维度呈负相关(P<0.05)、与回避和屈服维度呈正相关(P<0.05).结论 肝移植受者抑郁水平高于一般人群,且肝移,植受者的抑郁水平与其采取的应对方式高度相关.

Abstract：

Objective To describe depression in liver transplant(LT)recipients and explore their coping styles.Methods One hundred transplant recipients were divided into three groups according to the time after LT:one to six months after the operation(group1),six months to one year(group2)and one to three years after the operation(group3).A self-rating depression scale(SDS)was used to measure their depression levels,and a Medical Coping Modes questionnaire(MCMQ)Was used to investigate their coping styles.The results were compared with those from a general population,and the relevance of depression symptoms and coping styles was analysed. Results The average SDS score of all the LT recipients was 41.03±7.14(42.90±7.18 for group 1.40.71±7.97 for group 2 and 39.69±6.00 for group 3).The average depression scores of the three groups were all significantly higher than in the normal population,but there was no statistically significant difference among the three groups.The depression scores were negatively correlated with the confrontation aspect of coping style,while positively correlated with avoidance and resignation.Conclusion LT recipients tend to be depressed,and the level of depression is strongly related with their coping styles.     

黄连素通过增强细胞缝隙连接功能增加放射诱导的细胞凋亡

Background Clinical combination of some traditional Chinese agents, including berberine, with irradiation is demonstrated to improve efficacy of tumor radiotherapy, yet the mechanisms for such effect remain largely unknown. The present study investigates the effect of berberine on apoptosis induced by X-rays irradiation and the relation between this effect and gap junction intercellular communication (GJIC). Methods The role of gap junctions in the modulation of X-rays irradiation-induced apoptosis is explored by manipulation of connexin expression, and gap junction function, using oleamide, a GJIC inhibitor, and berberine. Results In transfected HeLa cells, Cx32 expressing increases apoptosis induced by X-rays irradiation, while inhibition of gap junction by oleamide reduces the irradiation responses, indicating the dependence of X-rays irradiation-induced apoptosis on GJIC. Berberine, at the concentrations without cytotoxicity, enhances apoptosis induced by irradiation only in the presence of functional gap junctions. Conclusions These results suggest that berberine potentizes cell apoptosis induced by X-rays irradiation, probably through enhancement of gap junction activity.     

影响肝移植术后新发糖尿病逆转的相关因素

目的 探讨影响肝移植术后新发糖尿病(PTDM)逆转的相关因素.方法 回顾分析232例肝移植受者的临床资料,术后共有62例患者发生PTDM,发生率为26.7%.根据PTDM是否发生逆转,将62例患者分为暂时性PTDM组(34例)和持续性PTDM组(28例).对两组患者的性别、年龄、体重指数、糖尿病家族史、乙型肝炎病毒感染情况、术前空腹血糖水平、免疫抑制剂使用及其血药浓度、皮质激素的使用时间等相关因素进行分析.结果 两组间患者的性别、体重指数、糖尿病家族史、术前空腹血糖水平、免疫抑制方案中皮质激素的持续使用时间、术后血他克莫司浓度及使用环孢素A的患者比例等因素的差异均无统计学意义(P＞0.05).与持续性PTDM组相比,暂时性PTDM组患者移植时年龄较轻,分别为(54±8)岁和(42±6)岁(P＜0.05);发生PTDM的术后时间较晚,分别为术后(18±23)d和(35±42)d(P＜0.05);免疫抑制方案中联合运用吗替麦考酚酯(MMF)或西罗莫司(SRL)的患者比例较高,分别为0和8.9%(P＜0.05).经多因素Logistic回归分析显示,只有移植时年龄是PTDM逆转的独立预测因子(比值比为1.312,95%可信区间为1.005～1.743).结论 患者移植时年龄、发生PTDM时的术后时间及免疫抑制方案中使用MMF或SRL的患者比例等因素与肝移植术后PTDM逆转相关,但只有移植时年龄是PTDM逆转的独立预测因子.

Abstract：

Objective To study the related factors associated with the reversal of posttransplant diabetes mellitus (PTDM) following liver transplantation. Methods The clinical data of 62patients with PTDM in 232 patients receiving liver transplantation (26. 7 %) were retrospectively analyzed and the patients were divided into two groups: patients with transient PTDM (34 cases) and those with persistent PTDM (28 cases). Pre-operative and post-operative variables, including sex,age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, the immunosuppressant regime, FK506 concentration and duration of steroid usage, were analyzed retrospectively. Results The variables, including sex, age, body mass index,family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose,FK506 concentration at month 1, 3 and 6 after operation, rate of cyclosporine usage and duration of steroid usage had no significant difference between the two groups (P＞0. 05). Compared with the persistent PTDM patients, the transient PTDM patients were characterized by younger age at the time of transplantation (54 ± 8 vs. 42 ± 6 years, P＜0. 05), longer time before the development of PTDM (18 ± 23 vs. 35 ± 42 days, P＜0. 05), and higher rate of mycophenolate mofetil or sirolimus usage (0vs. 8. 9 %, P＜0. 05). Based on a multivariate analysis, age at the time of transplantation was determined as the single independent predictive factor associated with reversal of PTDM following liver transplantation (odds ratio: 1. 312, 95 % confidence interval: 1. 005 - 1. 743). Conclusion Age at the time of transplantation, duration before the development of PTDM and rate of mycophenolate mofetil or sirolimus usage are associated with reversal of PTDM following liver transplantation. Among these factors, age at the time of transplantation is only the single independent predictive factor.     

肝肾联合供体快速切取失误及其防范

目的 探讨快速肝肾联合供体切取过程中的失误并总结经验。方法 回顾性分析中山大学附属第三医院肝移植中心2008年1月至2009年6月共232例肝肾联合快速切取过程中的失误和肝动脉变异以及损伤情况。快速切取技术采用原位腹主动脉-肠系膜上静脉灌注加下腔静脉引流,肝肾整块切取后分离肝肾。结果 肝脏包膜不同程度撕裂伤25例（10.8%）,肝脏左叶刀割伤1例。1 例重度脂肪肝植入后原发性无功能。肾脏损伤2例,1例为右肾实质切割伤,1例肾窦处肾静脉撕裂伤,无法修整均废弃。肝肾分离时高位离断第一肝门1例。肝动脉变异46例（19.8%）,76%（35/46）的变异动脉起自胃左动脉和肠系膜上动脉。变异肝动脉损伤3例（6.5%）,2例起自胃左动脉的副肝左动脉,1例起自肠系膜上动脉的副肝右动脉。结论 肝肾联合快速切取技术能同时保护肝肾供体的质量,其方法简单、安全。充分的灌注、娴熟的切取技巧以及防止变异肝动脉的损伤是保证供体质量的关键。