人脐带间充质干细胞治疗慢性HIV感染者的回顾性研究

目的明确人脐带间充质干细胞(human umbilical cord-derived mesenchymal stem cells,UC-MSC)治疗慢性HIV感染者的长期安全性和有效性。方法回顾性分析2009年3月—2012年7月在我院接受UC-MSC治疗的57例慢性HIV感染者随访3年的资料。根据UC-MSC治疗前CD4+T淋巴细胞水平,将所有患者分为≤200个/mm3组(免疫重建失败组)和200个/mm3组(免疫重建成功组)。分析UC-MSC治疗的长期安全性和有效性。结果 2组患者接受UC-MSC治疗1、2、3年,其外周血CD4+T淋巴细胞计数及CD4/CD8比值均较基线水平显著升高。进一步分析发现,免疫重建失败组UC-MSC治疗1年和2年的有效率(以CD4+T淋巴细胞计数较基线水平升高30%为有效)显著高于免疫重建成功组。2组随访中未发现明显不良事件,安全性好。结论 UC-MSC治疗慢性HIV感染者3年安全性好,可显著持续升高外周血CD4+T淋巴细胞计数和CD4/CD8比值,UC-MSC治疗免疫重建失败患者疗效更为显著。本研究提示慢性HIV感染者免疫重建失败可能是UC-MSC治疗的适应证。     

人脐带血间充质干细胞输注治疗慢性肝衰竭患者的近期疗效观察

目的观察人脐带间充质干细胞静脉输注治疗慢性肝功能衰竭患者的近期疗效。方法 18例肝硬化合并慢性肝衰竭患者分为两组,治疗组9例在内科综合治疗基础上通过外周静脉输注脐血干细胞,每次干细胞回输量为(12～62)×109/L,每周一次,连续输注1～3次为1个疗程。对照组9例仅给予常规内科综合治疗。分别观察间充质干细胞治疗前及治疗后4周患者临床症状、血液生化、血凝等指标变化。结果经人脐带间充质干细胞治疗后4周,白蛋白和凝血酶原活动度较治疗前明显升高,差异有统计学意义(P<0.05)。症状和体征改善两组无显著差异。结论通过外周静脉输注人脐带间充质干细胞治疗慢性肝衰竭患者,在近期内可明显改善肝功能衰竭患者症状,提升白蛋白等肝脏指标。     

人脐带间充质干细胞生物学特性及向类肝细胞的分化

目的: 研究脐带间充质干细胞(umbilical cord-mesenchymal stem cells, UC-MSCs)生物学的特性及向肝细胞分化的可能性.方法:从脐带中分离间充质干细胞, 体外行传代培养, 检测脐带间充质干细胞表面免疫标志、细胞周期和生长活性等, 利用肝细胞生长因子、成纤维生长因子4和抑瘤素等细胞因子诱导脐带间充质干细胞向肝细胞分化, 用免疫细胞方法对诱导和未诱导的细胞进行免疫学检测, 糖原染色进行功能鉴定.结果: 从人脐带中可分离到贴壁生长的间充质干细胞, 细胞形态类似成纤维细胞,可在体外进行长期稳定培养; CD29、CD105和Vimentin表达阳性, 基本不表达CD34、CD31, 经加入细胞因子可成功将间充质干细胞向肝细胞诱导分化, 分化的细胞表达肝细胞表面标志物ALB、AFP、CK18和CK19, 糖原染色呈现阳性.结论:人脐带中可成功分离到间充质干细胞, 细胞可实现体外长期培养, 表达脐带间充质干细胞的表面标志, 在体外脐带间充质干细胞诱导分化为肝细胞, 有望成为细胞替代治疗的理想来源之一.     

双环醇片治疗慢性HIV感染者抗病毒治疗相关药物性肝损伤的临床疗效观察

目的观察双环醇片治疗慢性HIV感染者抗病毒治疗相关药物性肝损伤的临床效果与安全性。方法通过随机、对照、前瞻性设计,61例慢性HIV感染者抗病毒治疗后出现药物性肝损伤的患者入组研究,其中治疗组31例,在常规高效抗逆转录病毒治疗同时服用双环醇片,25 mg,3次/d;对照组30例,在常规高效抗逆转录病毒治疗同时服用硫普罗宁肠溶片,200 mg,3次/d。疗程均为4周。观察两组治疗前及治疗后2周、4周血清ALT、AST、TBil和ALP变化,并观察记录血常规、尿常规、肾功能等指标及其他不良医疗事件。结果治疗组在肝功能指标与综合疗效改善方面明显优于对照组(P0.01,P0.05),两组患者均未出现严重不良事件。结论双环醇片可有效治疗慢性HIV感染者抗病毒治疗引起的药物性肝损伤,疗效确切,安全性好。     

人脐带间充质干细胞对大鼠脑出血后脑内IL-1β的影响

目的观察人脐带间充质干细胞移植对脑出血后大鼠脑内白细胞介素-1β（IL-1β）的影响。方法胶原酶VII制作大鼠脑出血模型,实验组采用人脐带间充质干细胞移植治疗。通过ELISA和免疫组织化学方法检测脑出血损伤后3 d和7 d大鼠脑内IL-1β含量的变化。结果与对照组比较,实验组在脑出血损伤后3 d和7 d脑内IL-1β含量均减少。结论人脐带间充质干细胞能够减少大鼠脑出血后脑内IL-1β的含量,进而减轻炎症反应。     

脐带间充质干细胞经肝动脉灌注治疗失代偿期肝硬化患者

目的 观察人脐带间充质干细胞治疗失代偿期肝硬化患者的有效性.方法 失代偿期乙型肝炎肝硬化患者10例,经肝动脉灌注人脐带间充质干细胞2×107个.比较患者在移植前及移植后1、4、8、12、24周肝功能以及临床病情的变化情况.结果 随访过程中,患者乏力、尿少、水肿症状在第1～2周即明显缓解,食欲较术前明显增加,腹水消退快,...     

不同来源间充质干细胞在肝病治疗中应用的研究进展

肝脏疾病是临床的常见病、多发病,在我国无论是相对发病率还是绝对病例数,肝脏疾病患者均居世界首位,是严重危害健康和耗费社会资源的主要疾病之一.近年来,国内外有关干细胞治疗慢性肝病的研究成果令人鼓舞,显示了勃勃生机.间充质干细胞是来源于发育早期中胚层的一类多能干细胞,研究证明他不仅存在于骨髓中,也存在于其他一些组织与器官的间质中,如外周血、脐血、松质骨、脂肪组织、滑膜和脐带等.本文就骨髓间充质干细胞、脐血间充质干细胞以及脐带间充质干细胞在治疗肝脏疾病方面的研究作一综述.     

人脐带血间充质干细胞治疗脑梗死的临床疗效研究

目的观察人脐带血间充质干细胞治疗脑梗死的临床疗效。方法选取我院2010年9月—2013年2月收治的脑梗死患者100例,将其随机分为治疗组和对照组,各50例。对照组给予常规药物治疗,同时予以康复训练;治疗组在对照组治疗基础上给予人脐带血间充质干细胞治疗。按照美国国立卫生院神经功能缺损评分(NIHSS)和简式Fugl-Meyer运功功能(FMA)评分评价治疗前,治疗后1、2、3个月时两组患者的神经功能缺损情况。结果治疗前、治疗后1个月、治疗后2个月,两组患者NHISS评分和FMA评分比较,差异均无统计学意义(P0.05);治疗后3个月,治疗组NHISS评分低于对照组,FMA评分高于对照组(P0.05)。治疗组有1例患者出现低热反应,余未发现其他不良反应。结论人脐带血间充质干细胞治疗脑梗死疗效明显,可以明显改善患者的临床症状,且不良反应少。     

自身骨髓间充质干细胞及其分化的神经干/前体细胞移植治疗神经系统疾病临床观察

目的观察自体骨髓间充质干细胞及其诱导后分化的神经干/前体细胞移植治疗中枢神经系统疾病的临床疗效及安全性。方法采用自体骨髓间充质干细胞及其诱导后获得的神经干/前体细胞移植治疗中枢神经系统疾病30例,其中随访满2 a者7例,对其神经功能的恢复情况及移植术后的不良反应进行了观察分析。结果干细胞移植后1个月时患者临床症状即出现不同程度的改善,之后间断呈现好转趋势。移植术后有4例出现过短暂性发热,对症处理即可控制。随访过程中,7例均未出现继发性肿瘤等干细胞移植的严重并发症。结论自体骨髓间充质干细胞及其诱导分化的神经干/前体细胞移植治疗中枢神经系统疾病安全、有一定疗效。     

c-Met基因过表达脐带间充质干细胞株的构建*

目的 建立c-Met慢病毒载体转染人脐带间充质干细胞（hUMSC）,为治疗肝衰竭作为种子细胞。方法 培养hUMSC,经流式细胞技术检测细胞表面表型,转染c-Met慢病毒载体,在荧光显微镜下观察转染效率,确定最佳多重感染复数（MOI）。采用嘌呤霉素抗性筛选稳定表达c-Met的hUMSC细胞系,采用Western-blot法检测细胞c-met蛋白表达量。结果 P5代细胞高表达CD44、CD90和CD105抗原,不表达CD31、CD45和CD34相关造血细胞抗原,符合人脐带间充质干细胞的特性;构建成功的c-Met慢病毒载体转染人脐带间充质干细胞最佳MOI=80,经嘌呤霉素筛药,在荧光显微镜下观察发现荧光阳性率为100%,且经Western-blot法检测证实该细胞过表达c-Met蛋白。结论 成功构建过表达c-Met基因的脐带间充质干细胞,为进一步实验打下了基础。     

阿德福韦酯治疗慢性乙型肝炎85例不良反应观察

目的观察阿德福韦酯治疗慢性乙型肝炎的不良反应。方法 2007年12月至2012年2月慢性乙型肝炎患者共120例,排除失代偿性肝病、原发性或继发性泌尿系统疾病。所有病例治疗前无尿常规及肾功能异常。其中单一使用常规剂量阿德福韦酯治疗的初治病例85例（A组）,其余35例患者予以拉米夫定或恩替卡韦治疗（B组）。治疗过程中起初12周每4周复查血尿常规及肝肾功能,之后每12周复查血尿常规、肝肾功能、血磷、血清肌酸激酶及淀粉酶等。结果 A组9例（10.59%）出现尿常规异常,包括蛋白尿、镜下血尿等,其中一过性异常5例（5.88%）,持续异常4例（4.71%）。B组有1例（2.86%）一过性尿蛋白阳性。两组尿检异常率及持续尿检异常率对比差异均无统计学意义（P〉0.05）。A组5例（5.88%）尿素氮（BUN）升高,B组1例（2.86%）BUN升高,均为一过性,两组对比差异无统计学意义（P〉0.05）。无血清肌酐（SCr）升高病例,未见其他不良反应。结论常规剂量阿德福韦酯治疗慢性乙型肝炎安全性良好。少数病例出现持续性尿检异常,可考虑换药。     

Efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy in the treatment of generalized anxiety disorders

ObjectiveTo observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders.MethodsA total of 202 generalized anxiety disorders patients were randomly allocated to a control condition (Paroxetine combined with cognitive therapy) or a treatment condition (Yiqiyangxin Chinese medicine compound combined with cognitive therapy). Subsequently, scores of Hamilton Anxiety Scale (HAMA), Zung Self-rating Anxiety Scale (SAS) and blood routine, urine routine, liver function, renal function, electrocardiogram were detected before treatment, 3 months, 6 months after treatment and 6 months after medicine withdrawal, respectively.ResultsHAMA and SAS scores were significantly reduced in two groups (P<0.001) after treatment, but the differences in HAMA and SAS scores, apparent effect and effectiveness were not significant (P>0.05). HAMA and SAS scores were significantly increased in two groups (P<0.05) after medicine withdrawal, and there were significant differences in HAMA and SAS scores, recurrent disease and adverse reaction (P<0.001). The incidence of recurrent disease and adverse reaction in treatment group was low. Both two groups showed no apparent abnormality in blood routine, urine routine, liver and renal function, and electrocardiogram.ConclusionsYiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders. Furthermore, the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.     

血浆置换治疗慢性重型肝炎临床疗效观察

目的　观察人工肝支持系统血浆置换对慢性重型肝炎的疗效。方法　对 32例慢性重型肝炎患者给予血浆置换 59次。观察患者临床症状、肝肾功能、电解质、凝血酶原活动度(PTa)、血氨、血常规变化。结果　血浆置换后,患者临床症状均得到不同程度的改善。血浆总胆红素、直接胆红素、丙氨酸转氨酶、天门冬氨酸转氨酶、血氨较治疗前明显降低 (P<0 01或P<0 05 ),PTa上升 (P<0 05)。不良反应较轻。早期重症肝炎 7例全部存活(100% ),中期重症肝炎 15例中存活 10例(66 7% ),晚期重症肝炎 10例存活 3例(30% )。结论　血浆置换对早、中期慢性重症肝炎疗效较好。     

小剂量雷公藤多甙联合低分子肝素钠治疗慢性肾小球肾炎临床观察

目的探讨小剂量雷公藤多甙联合低分子肝素钠治疗慢性肾小球肾炎的临床疗效。方法将64例慢性肾小球肾炎患者分为3组。在常规治疗基础上，实验组予小剂培雷公藤多甙联合低分子肝素钠治疗；对照组l予小剂量雷公藤治疗；对照组Ⅱ子低分子肝素钠治疗。分别检测患者治疗前及治疗12周后肾功能、血清白蛋白、24h尿蛋白定量、尿中红细胞、肝功能、血常规及血粘度、血脂，并进行比较。结果3组患者治疗前后肾功能、血清白蛋白、尿蛋白及尿红细胞差异有统计学意义；实验组治疗后血清白蛋白、尿蛋白及尿红细胞水平与对照组l、Ⅱ治疗后差异有统计学意义。结论小剂量雷公藤多甙联合低分子肝索钠治疗慢性肾小球肾炎，疗效显著，药物毒副作用小。     

Human umbilical cord mesenchymal stem cells improve liver function and ascites in decompensated liver cirrhosis patients

Decompensated liver cirrhosis (LC), a life-threatening complication of chronic liver disease, is one of the major indications for liver transplantation. Recently, mesenchymal stem cell (MSC) transfusion has been shown to lead to the regression of liver fibrosis in mice and humans. This study examined the safety and efficacy of umbilical cord-derived MSC (UC-MSC) in patients with decompensated LC. A total of 45 chronic hepatitis B patients with decompensated LC, including 30 patients receiving UC-MSC transfusion, and 15 patients receiving saline as the control, were recruited; clinical parameters were detected during a 1-year follow-up period. No significant side-effects and complications were observed in either group. There was a significant reduction in the volume of ascites in patients treated with UC-MSC transfusion compared with controls (P < 0.05). UC-MSC therapy also significantly improved liver function, as indicated by the increase of serum albumin levels, decrease in total serum bilirubin levels, and decrease in the sodium model for end-stage liver disease scores. UC-MSC transfusion is clinically safe and could improve liver function and reduce ascites in patients with decompensated LC. UC-MSC transfusion, therefore, might present a novel therapeutic approach for patients with decompensated LC.     

胺碘酮对心力衰竭并心房颤动病人的疗效观察

目的：就胺碘酮对心力衰竭并心房颤动病人的疗效观察进行探讨。方法选择我院2008年11月到2013年1月所收治的心力衰竭并心房颤动患者50例,随机将所有患者分为2组,分别是治疗组、对照组,。对照组采用常规治疗方法,而治疗组在此基础上增加静脉注射胺碘酮溶液及口服胺碘酮。结果治疗组有效率为96％,对照组有效率为82％,二者存在着较为明显的差异,具有统计学意义（P〈0.05）。与治疗前相比,两组患者在治疗后血压值都出现了较为明显的变化,都达到正常水平,存在着统计学意义（P〈0.05）;但两组之间差异不存在着统计学意义（P〉0.05）。两组患者在治疗后都没有出现肾功能、肝功能损害、恶性心律失常、不可耐受性低血压等严重不良反应。结论胺碘酮对心力衰竭并心房颤动病人的疗效较佳,安全有效,无较为严重的不良反应,可以作为首选治疗药物,值得推广应用。     

肾移植术后早期肝损害的预防和治疗效果分析

目的探讨肾移植术后早期肝损害的预防措施和治疗效果。方法将504例肾移植术后患者按照随机原则分为两组,常规预防组251例,于肾移植术后在应用常规药物同张顺财时即开始采用还原型谷胱甘肽2400mg,静脉滴注;未预防组253例,除肾移植后药物外未采用任何保肝预防药物。如果预防治疗后仍出现肝损害,依照治疗方案不同将患者随机分为两组,A组34例,连续8周口服双环醇片75mg/d（每次25mg,每日3次）。B组34例,连续8周口服硫普罗宁片600mg/d（每次200mg,每日3次）。结果常规预防组的肝损害发生率明显小于未预防组（P〈0.01）;常规预防后仍出现肝损害的患者联用双环醇后,在肝功能与综合疗效改善方面明显优于硫普罗宁组（P〈0.05,P〈0.01）;未发现与研究药物明显相关的不良事件。结论还原型谷胱甘肽可预防肾移植后早期肝损害的发生,联用双环醇片可有效治疗常规预防后仍出现的肝损害。     

Multicenter clinical study on Fuzhenghuayu capsule against liver fibrosis due to chronic hepatitis B

AIM: To study the efficacy and safety of Fuzhenghuayu capsule (FZHY capsule, a capsule for strengthening body resistance to remove blood stasis) against liver fibrosis due to chronic hepatitis B. METHODS: Multicenter, randomized, double blinded and parallel control experiment was conducted in patients (aged from 18 to 65 years) with liver fibrosis due to chronic hepatitis B. Hepatic histologic changes and HBV markers were examined at wk 0 and 24 during treatment. Serologic parameters (HA, LM, P-Ⅲ-P, Ⅳ-C) were determined and B ultrasound examination of the spleen and liver was performed at wk 0,12 and 24. Liver function (liver function and serologic parameters for liver fibrosis) was observed at wk 0, 6, 12, 18 and 24. Blood and urine routine test, renal function and ECG were examined before and after treatment. RESULTS: There was no significant difference between experimental group (110 cases) and control group (106 cases) in demographic features, vital signs, course of illness, history for drug anaphylaxis and previous therapy, liver function, serologic parameters for liver fibrosis, liver histologic examination (99 cases in experimental group, 96 cases in control group), HBV markers, and renal function. According to the criteria for liver fibrosis staging, mean score of fibrotic stage(s) in experimental group after treatment (1.80) decreased significantly compared to the previous treatment (2.33, P<0.05), but there was no significant difference in mean score of fibrotic stage(s) (2.11 and 2.14 respectively). There was a significant difference in reverse rate between experimental group (52%) and control group (23.3%) in liver biopsy. With marked effect on decreasing the mean value of inflammatory activity and score of inflammation (P<0.05), Fuzhenghuayu capsule had rather good effects on inhibiting inflammatory activity and was superior to that of Heluoshugan capsule. Compared to that of pretreatment, there was a significant decrease in HA, LM, P-Ⅲ-P and Ⅳ-C content in experimental group after 12 and 24 wk of treatment. The difference in HA, LM, P-Ⅲ-P and Ⅳ-C content between 12 and 24 wk of treatment and pretreatment in experimental group was significantly greater than that in control group (P<0.01-0.05). The effect, defined as two of four parameters lowering more than 30% of the baseline, was 72.7% in experimental group and 27.4% in control group (P<0.01). Obvious improvement in serum Alb, ALT, AST and GGT was seen in two groups. Compared to that of control group, marked improvement in GGT and Alb was seen in experimental group (P<0.05). The effective rate of improvement in serum ALT was 72.7% in experimental group and 59.4% in control group. No significant difference was seen in blood and urine routine and ECG before and after treatment. There was also no significant difference in stable rate in ALT and serologic parameters for liver fibrosis between experimental group and control group after 12 wk of withdrawal. CONCLUSION: Fuzhenghuayu capsule has good therapeutic effects on alleviating liver fibrosis due to chronic hepatitis B without any adverse effect and is superior to that of Heluoshugan capsule.     

疳脂平片联合恩替卡韦治疗慢性乙型肝炎合并非酒精性脂肪性肝炎疗效观察

目的：观察疳脂平片联合恩替卡韦治疗慢性乙型肝炎（ CHB）合并非酒精性脂肪性肝炎（ NASH）的临床疗效。方法：64例CHB合并NASH患者随机分为观察组32例和对照组32例,服用恩替卡韦的同时在医生指导下进行饮食调整及有氧运动,3个月后血清丙氨酸转移酶（ALT）依然高于80U/L的即为入选病例。观察组患者加用疳脂平片,对照组患者继续单服恩替卡韦片治疗3个月。观察两组患者治疗前后症状及血脂、肝功能、肝脏超声等指标变化。结果：两组患者在服用恩替卡韦3个月后, ALT下降不理想,观察组患者在3～6个月加服疳脂平片后, ALT明显下降,并且血脂指标得到明显改善。结论：疳脂平片联合恩替卡治疗CHB合并NASH的疗效确切且未见明显不良反应,值得临床深入推广。