恩替卡韦联合扶正化瘀胶囊治疗肝郁血瘀型慢性乙型肝炎疗效观察

目的 观察恩替卡韦联合扶正化瘀胶囊治疗肝郁血瘀型慢性乙型肝炎的临床疗效。方法 将60例肝郁血瘀型慢性乙型肝炎患者随机分为对照组和观察组,每组30例;在常规保肝及支持治疗的基础上,对照组仅予恩替卡韦治疗,观察组在对照组治疗基础上联合扶正化瘀胶囊治疗;比较治疗前和治疗后4、12、24、48周末两组患者血清乙型肝炎病毒（hepatitis B virus,HBV）DNA水平、乙型肝炎病毒e抗原（hepatitis B e antigen,HBeAg）定量和肝功能［丙氨酸氨基转移酶（alanine aminotransferase, ALT)、总胆红素（totol bilirubin,TBIL）］、肝脏瞬时弹性变化情况。结果 治疗4周末,观察组患者血清HBV-DNA转阴率显著高于对照组（P<0.05）;治疗48周后,观察组HBeAg转阴率显著高于对照组（P<0.05）。治疗4周末,两组患者血清ALT、TBIL水平均较治疗前显著降低（P<0.05）;治疗12周末,两组患者ALT、TBIL水平均较治疗4周末显著降低（P<0.05）;治疗24周末与治疗48周末,两组ALT、TBIL水平比较,差异均无统计学意义（P>0.05）。观察组治疗4周末血清ALT、TBIL水平,治疗12、24周末TBIL水平较对照组降低更为明显（P<0.05）。治疗48周末,两组患者肝脏瞬时弹性均显著降低（P<0.05）,观察组肝脏瞬时弹性指标降低程度显著大于对照组（P<0.05）。结论 恩替卡韦联合扶正化瘀胶囊治疗有助于提高肝郁血瘀型慢性乙型肝炎患者HBeAg转阴率、HBV-DNA快速应答率,并对肝功能改善和抗肝纤维化均有较好作用。     

原发性肝癌患者体质类型与复发关系的Cox回归分析

目的探讨原发性肝癌患者复发的危险因素及与中医体质的关系,为预测和预防肝癌的复发提供依据。方法总结2009年1—12月上海长海医院中医科、介入科收治的109例原发性肝癌术后患者的临床特征,并分析其中医体质分布规律。用单因素及多因素Cox回归分析原发性肝癌术后复发的相关影响因素。结果 Cox回归分析结果显示,截至2010年4月1日,原发性肝癌术后出现复发患者的年龄、临床分期、肝功能分级、既往饮酒史与未出现复发患者相比较,差异具有统计学意义(P0.05)。年龄、临床分期、乙型病毒性肝炎病史、阳虚质、血瘀质进行入Cox回归模型。结论年龄、临床分期、乙型病毒性肝炎病史、既往饮酒史是原发性肝癌术后复发的危险因素,阳虚质、血瘀质得分越高的患者,术后出现复发的时间越短。     

逍遥煎剂联合穴位贴敷治疗腹泻型肠易激综合征肝郁脾虚证临床观察

目的 观察逍遥煎剂联合穴位贴敷治疗腹泻型肠易激综合征（diarrhea predominant irritable bowel syndrome IBS-D)肝郁脾虚证的临床疗效。方法 将130例IBS-D肝郁脾虚证患者随机分为2组,每组65例。对照组患者接受酪酸梭菌二联活菌、匹维溴铵治疗;观察组患者在对照组疗法基础上,口服逍遥煎剂以及接受穴位贴敷治疗。两组均以4周为1个疗程。比较治疗前后以及停药4周后两组患者Bristol大便性状评分、中医症状评分、肠易激综合征生活质量(irritable bowel syndrome-quality of life, IBS-QOL)评分、肠易激综合征严重程度评分系统（irritable bowel syndrome-severity scoring system,IBS-SSS）评分。结果 与治疗前比较,治疗4周后和停药4周后,两组患者Bristol评分,IBS-SSS评分及腹痛、腹泻、便溏评分,症状总评分均显著降低（P＜0.05）,IBS-QOL的焦虑不安、日常生活、躯体意识、健康担忧、食物回避、社会功能、性生活、人际关系评分均显著升高（P＜0.05）。与对照组比较,观察组治疗4周后和停药4周后IBS-SSS评分,腹痛、便溏评分和症状总评分明显降低（P＜0.05）,IBS-QOL的焦虑不安、日常生活、躯体意识、健康担忧、食物回避、社会功能、人际关系评分均显著升高（P＜0.05）。结论 逍遥煎剂口服联合穴位贴敷可减轻IBS-D的严重程度,改善患者生活质量,具有较好的近期疗效和远期疗效。     

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

84例不同中医证型慢性乙型肝炎患者肝穿刺活检回顾性研究

目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)病理分级与中医证型的关系。方法对84例经彩超引导下行肝穿刺活检的CHB患者的中医证型、肝脏病理分级、临床分级、肝功能指标进行回顾性研究。结果 84例CHB患者中,湿热蕴结证21例,肝郁气滞证34例,肝肾阴虚证7例,瘀血阻络证13例,脾肾阳虚证9例。肝脏炎症活动度与纤维化分期呈明显正相关(r=0.662,P=0.000);临床分级与病理分级呈显著正相关(r=0.556,P=0.000);不同证型CHB患者的病理分级比较,差异无统计学意义(P0.05);不同证型CHB患者血清谷丙转氨酶、谷草转氨酶、直接胆红素水平比较,差异均无统计学意义(P0.05),不同证型患者血清总胆红素水平比较,差异具有统计学意义(P0.05)。结论肝郁气滞证和湿热蕴结证是CHB患者的主要证型,病理分级和肝功能检查尚不能用于CHB的辨证分型。     

枳黄方对酒精性肝损伤大鼠肝、胃脂质过氧化水平和血清ALT活性的影响

目的：探讨枳黄方（ZHF）防治酒精性肝损伤的机制.方法：通过ZHF保护性试验和ZHF治疗性试验,记录大鼠醉酒时间,采用分光光度法和血清生化法检测肝组织和胃黏膜超氧化物歧化酶（SOD）活力和脂质过氧化产物丙二醛（MDA）水平,以及血清丙氨酸转氨酶（ALT）的活性.结果：在ZHF保护性试验中,ZHF能缩短大鼠醉酒时间（P〈0.05）,显著降低肝脏和胃黏膜MDA含量（P〈0.05或P〈0.01）,显著提高肝脏和胃黏膜中SOD活力（P〈0.01）,使酒精性肝损伤大鼠血清中ALT活性显著降低（P〈0.01）.在ZHF治疗性试验中,ZHF对大鼠醉酒时间无影响,但使大鼠肝脏MDA含量和血清ALT含量显著下降（P〈0.01）,显著提高肝脏SOD活力（P〈0.01）.结论：ZHF能对抗酒精性肝损伤大鼠肝脏脂质过氧化,保护肝功能.ZHF保护性用药可防治酒精性肝损伤.     

高原兔部分脏器的组织结构观察

对高原兔肺、肾、肝、卵巢进行了组织学观察。结果表明 ,肺实质由气体导管部和呼吸部组成 ,导管部中主要见到的是细支气管和终末细支气管 ,偶见小支气管 ,肺泡隔内毛细血管丰富 ,呈扩张状态 ,管腔内红细胞数量较多。肾内皮质肾单位和髓旁肾单位在数量上无明显差别 ,均较少 ,而位于皮质中层的肾单位较多 ,髓放线发达。肝间质组织少 ,肝小叶分界不清。卵巢中闭锁卵泡多 ,并有大量间质腺。     

亚慢性镉中毒致鸡肝细胞凋亡及硒拮抗效果的研究

以90 只100 日龄依沙褐公鸡为试验动物,在日粮中添加一定浓度的镉及硒镉,复制了鸡的亚慢性镉中毒及硒拮抗模型,通过显微结构和超微结构观察,探讨镉对动物肝的毒性作用机理及硒对其毒性作用的拮抗效应。结果显示,亚慢性镉中毒可引起鸡肝组织细胞凋亡,加硒后可有效减少肝细胞凋亡数量及损伤程度。     

The temporal fate of drugs in decomposing porcine tissue

Drug levels in decomposed individuals are difficult to interpret. Concentrations of 16 drugs were monitored in tissues (blood, brain, liver, kidney, muscle, and soil) from decomposing pigs for 1 week. Pigs were divided into groups (n = 5) with each group receiving four drugs. Drug cocktails were prepared from pharmaceutical formulations. Intracardiac pentobarbital sacrifice was 4 h after dosing, with tissue collection at 4, 24, 48, 96, and 168 h postdosing. Samples were frozen until assay. Detection and quantitation of drugs were through solid phase extraction followed by gas chromatograph/mass spectrometer analysis. Brain and kidneys were not available after 48 h; liver and muscle persisted for 1 week. Concentration of drugs increased during decomposition. During 1 week of decomposition, muscle showed average levels increasing but concentrations in liver were increased many fold, compared to muscle. Attempting to interpret drug levels in decomposed bodies may lead to incorrect conclusions about cause and manner of death.     

利用不同温度下人肝细胞DNA降解参数推断早期PMI

目的对不同温度下人体肝细胞DNA降解状态进行多参数定量分析,得出温度相关的多元回归方程。方法选取13例已知PMI的人体离体肝脏,在死后13～34h内,分别在10℃、20℃及30℃条件下,每隔1h取材,进行细胞学涂片,Feulgen-Vans染色,选用图像分析系统检测几何参数（ID）及灰度参数（AOD）指标,对不同温度的检测指标进行多元回归分析,得出相应的回归方程。结果温度相关的肝细胞DNA降解推断死亡时间的回归方程：Y=25.789-0.656XT-41.958XAOD＋3.262XID（XT=10,20,30）。结论温度及反映DNA含量的各个参数与PMI存在较强的相关性,可以将温度作为参数引入方程用于推断PMI。