肝脏超声造影的优点及局限性探讨（附60例临床分析）

目的通过对比观察常规超声检查与超声造影对肝脏局灶性病变的诊断结果，探讨肝脏超声造影的优点及局限性。方法采用国外临床超声诊断模式，由一名医师对60例肝脏局灶性病变患者分别采用常规超声及超声造影进行检查，探测过程全部动态存档并标记。对两组资料进行无规则编排后，由另一名资深医师进行诊断。结果普通超声检查法诊断符合率为83.3％，超声造影法诊断符合率为90．0％，二者差别无统计学意义。结论超声造影技术对部分肝脏局灶性病变的显示有较特异性的表现，但本研究显示，对于最后诊断超声造影与常规超声检查的差别无统计学意义。     

非酒精性脂肪肝与代谢综合征的关系探讨

目的 :探讨非酒精性脂肪肝与代谢综合征的关系。方法 :采用病例对照研究 ,女性脂肪肝组 4 0例 ,无脂肪肝组 4 0例作为对照 ;男性脂肪肝组 6 0例 ,无脂肪肝组 6 0例作为对照。检测四组的血脂、血尿酸、空腹血糖、空腹血胰岛素 ,采用稳态模式胰岛素抵抗指数 (HOMA -IR)评价胰岛素抵抗。结果 :男女脂肪肝组与对照组比较 ,甘油三酯 (TG)、空腹血糖 (FPG)、空腹血胰岛素 (FINS)、HOMA -IR均有极显著升高 (P <0 .0 0 1) ;男性脂肪肝组与对照组比较 ,胆固醇 (TC)极显著升高 (P <0 .0 0 1) ,尿酸 (UA)显著升高 (P <0 .0 5 ) ;女性脂肪肝组与对照组比较 ,胆固醇 (TC)显著升高 (P <0 .0 5 ) ,尿酸 (UA)无显著差异 (P >0 .0 5 )。结论 :非酒精性脂肪肝存在明显胰岛素抵抗 ,非酒精性脂肪肝可作为代谢综合征 (MS)的特征之一 ,高尿酸血症可作为男性MS的特征之一。     

血清胆碱脂酶及前白蛋白测定在判断肝脏合成功能中的应用

目的　观察血清CHE及PA水平在各组肝病中的表现 ,探寻能更好地反映肝脏合成蛋白功能的指标。方法　测定313例共 7组肝脏疾病及 36例正常对照组的血清CHE及PA水平 ,进行统计学处理 ;同时常规测定血清TP及A水平。结果　血清CHE活性测定 ,急性肝炎、慢性活动性肝炎、重症肝炎、肝硬化、原发性肝癌活性下降 ,与对照组比较P <0 .0 0 1;脂肪肝活性升高 ,P <0 .0 0 5 ;慢性迁延性肝炎活性变化不大 ,P >0 .0 5。血清PA测定 ,慢性迁延性肝炎、脂肪肝变化不大 ,P >0 .5 0 ;其它各组肝病均出现浓度下降 ,P <0 .0 0 1。血清TP浓度在各组肝病中变化不大。血清A浓度在慢性活动性肝炎、肝硬化、重症肝炎、原发性肝癌降低 ,急性肝炎偶见降低。结论　血清CHE活性及PA浓度测定较之血清TP及A浓度测定 ,更能及时地反映肝脏细胞合成蛋白能力。     

肝移植受者术后社会功能情况的调查分析

目的 :调查肝移植受者术后的社会功能情况 ,探讨如何促进受者尽快适应社会和家庭生活 ,提高生活质量。方法 :采用社会功能缺陷筛选量表 ,通过询问知情者对已出院的 2 5例肝移植受者进行打分。结果 :在 2 5例接受手术并出院的肝移植受者中有 16例存在社会功能缺陷。结论 :多数受者出院后存在不同程度的社会功能缺陷 ,在健康教育中应增加心理支持及培养受者社会适应能力的内容 ,充分调动家庭及社会资源 ,提高受者的社会功能     

B超肝脏图像纹理特征提取方法的实验研究

目的为脂肪肝的诊断提供量化依据.方法采用纹理分析法,从灰度直方图中提取特征参数,对脂肪肝和正常肝脏B超图像进行识别.结果从直方图分析中提取的均值、斜态均能反映两类图像所特有的纹理特征.结论将该算法用软件编程实现,用在普通B型超声仪上,对图像感兴趣区域进行处理,可为医师诊断提供量化的诊断依据.     

CT评价肝细胞癌血管生成和凋亡抑制蛋白表达的价值

目的:探讨增强CT评价肝细胞癌(HCC)组织中血管生成以及凋亡抑制蛋白bcl-2和bcl-xl表达的价值。材料与方法:对38例共40个经病理证实且行动静脉双期CT增强扫描的HCC病灶进行分析,用免疫组化SP法检测癌组织中微血管密度(MVD)以及bcl-2和bcl-xl的表达情况,将CT增强表现特征与免疫组化的结果进行对照分析。结果:所有病灶的平均MVD为39.3±8.40,bcl-2和bcl-xl的阳性表达率分别为27.5%(11?/40)和50%(20/40)。bcl-2和bcl-xl之间具有一定的相关性(P<0.01),在bcl-xl表达的阴性组和阳性组,MVD分别是34.70±8.13和41.34±6.95,存在明显差异(P<0.05)。CT显示的病灶大小与bcl-xl的表达具有一定的关系(P<0.05);另外CT显示的病灶边缘欠清组、瘤内出现液化坏死组以及侵袭转移组的MVD分别大于病灶边缘清晰组、瘤内无液化坏死组及无侵袭转移组(P<0.05)。结论:FⅧRA、bcl-2和 bcl-xl等蛋白在HCC组织中呈现不同程度的表达,CT在一定程度上评价HCC的血管生成价值要大于评价凋亡抑制蛋白的表达。     

Clinical application of a new method that segments the region of interest into multiple layers for RF amplitude histogram analysis in the cirrhotic liver

Purpose We used texture analysis in conjunction with an alternative method of analyzing the amplitude histogram using a radiofrequency (RF) signal to differentiate ultrasonograms of normal and cirrhotic livers. This method segments the region of interest (ROI) into multiple layers (sub-ROIs). In each sub-ROI of a homogeneous medium, the histogram of enveloped-amplitude of RF backscattered echoes resembles a Rayleigh distribution. Theoretically, the values of the signal-to-noise ratio (SNR), skewness, and kurtosis for Rayleigh statistics are constant and independent of the mean scattering intensity, which is contributed by such undesirable effects as tissue attenuation, beam diffraction, and incident waveforms. These values, which averaged overall sub-ROI, should provide an unbiased estimator.Methods We studied 36 normal livers and 28 cirrhotic livers, all confirmed by clinical findings including laboratory and pathology data; the SNR, skewness, and kurtosis values of the disease groups were compared. At the same time, these values were estimated using the conventional method, which did not segment the ROI into multiple sub-ROIs. The unpaired t-test was used to determine statistical significance.Results With the new method, all values obtained from cirrhotic livers differed significantly from those obtained from normal livers, and the standard deviation of these values was smaller than those obtained using the conventional method.Conclusions These results suggest that the new method can be used to diagnose the cirrhotic liver objectively.This article is translated from the Japanese version, which was published in J Med Ultrasonics 2001;28:J25–33     

血浆置换联合持续性血液滤过透析对慢性重型乙型病毒性肝炎临床症状及生化指标的影响——附87例报告

目的:探讨血浆置换联合持续性血液滤过透析治疗对慢性重型乙型病毒性肝炎(慢重肝)临床症状及生化指标的影响.方法:记录87例慢重肝患者(A组)在应用血浆置换及持续性血液滤过透析联合内科综合治疗前后临床症状和生化指标的改善情况,并与94例行血浆置换联合内科综合治疗的慢重肝患者(B组)进行对比.结果:治疗后,A组临床症状改善100%(87/87),低钾血症复常率为80%(33/41)、低钠血症复常率为93%(27/29),肝性脑病清醒率55%(12/22);B组则相应为48%(45/94)、7%(3/42)、7%(2/30)和20%(5/25),2组上述各项指标比较差异均有统计学意义(均为P＜0.05).A组近期有效率、近期生存率分别为80%、48%,B组为47%、31%,2组比较差异均有统计学意义(均为P＜0.05).不良反应以血浆过敏反应为主,均未发生低血压、肺水肿等严重不良反应.结论:血浆置换及持续性血液滤过透析联合内科综合治疗可有效纠正慢重肝患者的电解质紊乱,保持内环境平衡,且能提高其近期生存率和肝性脑病清醒率,为慢重肝的治疗提供了新的选择.     

Heat-shock protein 70 favours human liver recovery from ischaemia-reperfusion

BACKGROUND: Pringle's manoeuvre controls excessive bleeding, but results in ischaemia-reperfusion injury during liver surgery. Activation of the heat-shock protein system of cell defense has been demonstrated after ischaemia-reperfusion injury in animal tissues. The aim of the present study was to determine whether the ischaemia-reperfusion accompanying hepatic surgery induces heat-shock protein 70 (HSP70) in human liver and whether the induction of HSP70 is related to the recovery of liver function. METHODS: Heat-shock protein 70 and gamma-actin mRNAs were assayed in the liver biopsies of 10 subjects undergoing partial hepatectomy for localized lesions. Measurements were performed before the Pringle's manoeuvre and at the end of the surgery. Transaminases and fibrinogen were measured before and at 12, 24 and 36 h following hepatectomy. RESULTS: After an average 40 +/- 8-min period of warm ischaemia, a significant increase of HSP70 mRNA (187 +/- 67%, 2P < 0.05) was observed. The acute increase of HSP70 mRNA correlates with the decrease of transaminases (AST: rs -0.964, ALT: rs -0.891, P < 0.002) and the increase of fibrinogen (rs -0.7, P < 0.02) observed between 12 and 24 h following surgery. CONCLUSIONS: Heat-shock protein 70 is induced by ischaemia-reperfusion injury in human liver. Its induction seems to have beneficial effects, including a prompt reduction of transaminases and a rapid recovery of fibrinogen synthesis.     

Analysis of focal spared areas in fatty liver using color Doppler imaging and contrast-enhanced microvessel display sonography.

OBJECTIVE: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow. METHODS: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis. RESULTS: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels. CONCLUSIONS: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.