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Expanding etiology of progressive familial intrahepatic cholestasis 预览
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作者 Sarah AF Henkel Judy H Squires +3 位作者 Mary Ayers Armando Ganoza Patrick Mckiernan James E Squires 《世界肝病学杂志:英文版(电子版)》 2019年第5期450-463,共14页
BACKGROUND Progressive familial intrahepatic cholestasis(PFIC)refers to a disparate group of autosomal recessive disorders that are linked by the inability to appropriately form and excrete bile from hepatocytes,resul... BACKGROUND Progressive familial intrahepatic cholestasis(PFIC)refers to a disparate group of autosomal recessive disorders that are linked by the inability to appropriately form and excrete bile from hepatocytes,resulting in a hepatocellular form of cholestasis.While the diagnosis of such disorders had historically been based on pattern recognition of unremitting cholestasis without other identified molecular or anatomic cause,recent scientific advancements have uncovered multiple specific responsible proteins.The variety of identified defects has resulted in an ever-broadening phenotypic spectrum,ranging from traditional benign recurrent jaundice to progressive cholestasis and end-stage liver disease.AIM To review current data on defects in bile acid homeostasis,explore the expanding knowledge base of genetic based diseases in this field,and report disease characteristics and management.METHODS We conducted a systemic review according to PRISMA guidelines.We performed a Medline/PubMed search in February-March 2019 for relevant articles relating to the understanding,diagnosis,and management of bile acid homeostasis with a focus on the family of diseases collectively known as PFIC.English only articles were accessed in full.The manual search included references of retrieved articles.We extracted data on disease characteristics,associations with other diseases,and treatment.Data was summarized and presented in text,figure,and table format.RESULTS Genetic-based liver disease resulting in the inability to properly form and secrete bile constitute an important cause of morbidity and mortality in children and increasingly in adults.A growing number of PFIC have been described based on an expanded understanding of biliary transport mechanism defects and the development of a common phenotype.CONCLUSION We present a summary of current advances made in a number of areas relevant to both the classically described FIC1(ATP8B1),BSEP(ABCB11),and MDR3(ABCB4)transporter deficiencies,as well as more recently described gene mutati 展开更多
关键词 CHOLESTASIS Progressive FAMILIAL INTRAHEPATIC CHOLESTASIS BENIGN recurrent INTRAHEPATIC CHOLESTASIS INTRAHEPATIC CHOLESTASIS of pregnancy Drug induced CHOLESTASIS BILE acids BILE transport
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加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床研究 预览
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作者 罗志平 石珍珍 +3 位作者 黄启玉 金卉 江芳 李甜甜 《河北中医》 2019年第6期891-895,共5页
目的 观察加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床疗效。方法 将88例肝胆湿热型妊娠期肝内胆汁淤积症患者按照随机数字表法分为2组。对照组44例予熊去氧胆酸胶囊治疗;治疗组44例在对照组治疗基础上加用加... 目的 观察加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症的临床疗效。方法 将88例肝胆湿热型妊娠期肝内胆汁淤积症患者按照随机数字表法分为2组。对照组44例予熊去氧胆酸胶囊治疗;治疗组44例在对照组治疗基础上加用加味茵陈蒿方治疗。2组均治疗2周后统计临床疗效,并观察2组治疗前后中医症状积分、总胆汁酸(TBA)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBiL)、甘胆酸(CG)和血清白细胞介素4(IL-4)、干扰素γ(IFN-γ)水平,以及妊娠结局。结果 治疗组总有效率93.18%,对照组总有效率72.23%,治疗组临床疗效优于对照组(P<0.05)。治疗后2组各中医症状积分及血清TBA、AST、ALT、DBiL、CG、IFN-γ水平均降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后2组血清IL-4水平均上升(P<0.05),且治疗组高于对照组(P<0.05)。治疗组早产、新生儿窒息、胎儿窘迫、产后出血发生率与对照组比较差异无统计学意义(P>0.05);治疗组新生儿体质量高于对照组(P<0.05),羊水污染率低于对照组(P<0.05)。结论 加味茵陈蒿方联合熊去氧胆酸治疗肝胆湿热型妊娠期肝内胆汁淤积症疗效确切,并能改善肝功能。 展开更多
关键词 妊娠并发症 胆汁淤积 肝内 肝胆湿热 中西医结合疗法
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STAT3在妊娠期肝内胆汁淤积症孕妇胎盘中的表达及意义 预览
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作者 叶云飞 蒙文霞 +3 位作者 陈滢 周一萍 李文怡 陈柏秀 《重庆医学》 CAS 2019年第11期1866-1869,共4页
目的探讨信号转导和转录活化因子3(STAT3)在妊娠期肝内胆汁淤积症(ICP)孕妇胎盘中的表达及意义。方法选择2016年1月至2017年12月于柳州市人民医院产科门诊产检并住院分娩、资料完整的重度ICP孕妇25例为试验组,选择同期健康顺产孕妇30例... 目的探讨信号转导和转录活化因子3(STAT3)在妊娠期肝内胆汁淤积症(ICP)孕妇胎盘中的表达及意义。方法选择2016年1月至2017年12月于柳州市人民医院产科门诊产检并住院分娩、资料完整的重度ICP孕妇25例为试验组,选择同期健康顺产孕妇30例为对照组。采用免疫组织化学链霉素抗生物素蛋白-过氧化物酶链接法(SP法)测定STAT3、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)在孕妇胎盘组织中的定位与表达水平。蛋白印迹法检测STAT3蛋白的表达水平。结果(1)试验组孕妇胎盘滋养层细胞中STAT3、IL-6和TNF-α阳性细胞率及平均光密度值明显高于对照组(P<0.05)。(2)试验组孕妇胎盘滋养层细胞中STAT3表达阳性细胞率与IL-6、TNF-α水平呈正相关(r=0.687,P<0.05)。(3)试验组STAT3蛋白的表达量明显高于对照组,差异有统计学意义(P<0.05)。结论STAT3可能参与了ICP的发病且与IL-6、TNF-α在ICP发生发展中具有共同促进作用。 展开更多
关键词 胆汁淤积 肝内 胎盘 信号转导和转录活化因子3 白细胞介素-6 肿瘤坏死因子-α
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肝圆韧带途径在肝门胆管良性狭窄中的应用
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作者 孙增鹏 彭创 +1 位作者 易为民 吴金术 《中华普通外科杂志》 CSCD 北大核心 2019年第5期381-383,共3页
目的探讨肝圆韧带途径在肝门部胆管良性狭窄疾病中的应用价值。方法回顾性分析2016年3月至2018年3月湖南省人民医院收治的62例肝门部胆管良性狭窄患者的临床资料。结果62例肝门部胆管狭窄的病因依次为肝胆管结石(37例),医源性近段胆管损... 目的探讨肝圆韧带途径在肝门部胆管良性狭窄疾病中的应用价值。方法回顾性分析2016年3月至2018年3月湖南省人民医院收治的62例肝门部胆管良性狭窄患者的临床资料。结果62例肝门部胆管狭窄的病因依次为肝胆管结石(37例),医源性近段胆管损伤(12例),胆肠吻合口再次狭窄(7例),胆管囊状扩张症(4例),桥祥结石(2例)。本组患者均经肝圆韧带途径成功进入肝内胆管,行肝门胆管整形,胆管盆式内引流术,平均历时230.3 min,平均失血量196.8 ml。按照Clavien-Dindo评分系统,Ⅰ级并发症32例,Ⅱ级并发症3例,无Ⅲ级以上并发症。出院后经过门诊、电话随访1-24个月,3例患者发生返流性胆管炎,尚未发现胆肠吻合口再次狭窄的病例。结论肝圆韧带途径是一条解除肝门部胆管良性狭窄、进入肝内胆管的有效途径。 展开更多
关键词 缩窄 病理性 胆管 肝内
益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及机制研究 预览
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作者 王菊平 马姝丽 +1 位作者 李小芹 周方 《重庆医学》 CAS 2019年第14期2356-2359,共4页
目的分析益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及其机制。方法60只幼年雄性SD大鼠分为正常组、模型组与干预组,每组各20只。干预组大鼠每天1次行益生菌4.2×10^8个活菌数/kg灌胃,正常组与模型组给予同等量温生理盐水... 目的分析益生菌对急性肝内胆汁淤积模型大鼠肝损伤的保护作用及其机制。方法60只幼年雄性SD大鼠分为正常组、模型组与干预组,每组各20只。干预组大鼠每天1次行益生菌4.2×10^8个活菌数/kg灌胃,正常组与模型组给予同等量温生理盐水灌胃。模型组与干预组第5天开始建立急性肝内胆汁淤积模型,造模后48、72h分别处死大鼠,取血行总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、二胺氧化酶(DAO)、D-乳酸(D-LA)检测,取肝组织测定核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)表达。结果造模后48、72h模型组及干预组血清TBIL、DBIL、ALT、DAO、D-LA水平和肝组织NF-κB、TNF-α表达均显著高于正常组,且干预组低于模型组,差异均有统计学意义(P<0.05)。结论益生菌能有效保护急性肝内胆汁淤积模型大鼠肝损伤,其机制可能与益生菌下调血清DAO、D-LA及肝组织NF-κB、TNF-α表达有关。 展开更多
关键词 胆汁淤积 肝内 鼠李糖乳杆菌 化学性与药物性肝损伤 药理作用分子作用机制
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Analysis of intrahepatic sarcomatoid cholangiocarcinoma:Experience from 11 cases within 17 years 预览
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作者 Dong Kyun Kim Bo Ra Kim +1 位作者 Jin Sook Jeong Yang Hyun Baek 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期608-621,共14页
BACKGROUND Intrahepatic sarcomatoid chonalgiocarcinoma(s-CCC)is an extremely rare disease,accounting for less than 1%of hepatobiliary system malignancies,and its pathophysiology is not well known.On the hypothesis tha... BACKGROUND Intrahepatic sarcomatoid chonalgiocarcinoma(s-CCC)is an extremely rare disease,accounting for less than 1%of hepatobiliary system malignancies,and its pathophysiology is not well known.On the hypothesis that its clinical,serologic,or radiologic diagnosis are not fully understood and its prognosis is poor,we investigated the distinguishing features of s-CCC compared with those of intrahepatic bile duct adenocarcinoma[cholangiocellular carcinoma(CCC)]in patients from a single center.AIM To analyze the clinical,serologic,imaging,and histopathologic characteristics of intrahepatic s-CCC patients diagnosed in a single center.METHODS The clinical,serologic,imaging,and histopathologic features of 227 patients diagnosed with intrahepatic cholangiocarcinoma(IHCC)in a single medical center during the last 17 years were analyzed.The characteristics of 11 patients with s-CCC were compared with those of 216 patients with CCC.RESULTS The number of patients with s-CCC who presented fever and abdominal pain and past history of chronic viral hepatitis or liver cirrhosis(LC)was higher than that of patients with CCC.In imaging studies,patients with s-CCC showed relatively aggressive features.However,no clear distinction was observed between s-CCC and CCC based on other clinical,serologic or radiologic examination results.An accurate diagnosis could be made only via a histopathologic examination through immunohistochemical staining.The clinical course of s-CCC was generally aggressive,and patients had a relatively poor prognosis.CONCLUSION In patients with s-CCC,early diagnosis through biopsy and aggressive treatment,including surgical resection,are important. 展开更多
关键词 INTRAHEPATIC SARCOMATOID CHOLANGIOCARCINOMA IMMUNOHISTOCHEMICAL STAINING Survival Prognosis Surgical RESECTION
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Effect of compound Yindan decoction on alpha-naphthylisothiocyanate-Induced acute intrahepatic cholestasis in rats
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作者 Sun Fengxia Li Xiaoling +3 位作者 Xu Chunjun Sui Jingli Li Pan Wu Jingjing 《中医杂志:英文版》 SCIE CAS CSCD 2019年第3期315-323,共9页
OBJECTIVE:To investigate the therapeutic mechanism of compound Yindan decoction (CYD) in a rat model of acute intrahepatic cholestatic (AIC).METHODS:A total of 108 adult male rats were randomly divided into control (n... OBJECTIVE:To investigate the therapeutic mechanism of compound Yindan decoction (CYD) in a rat model of acute intrahepatic cholestatic (AIC).METHODS:A total of 108 adult male rats were randomly divided into control (n =18) and AIC groups (n =90).AIC was induced in rats using alpha-naphthylisothiocyanate (ANIT)(75 mg/kg,10 mL/kg in corn oil,p.o.).Then,90 AIC rats were randomly divided into five groups:a control group (n =18),a CYD high dose group (n =18),a CYD middle dose group (n =18),a CYD low dose group (n =18),and a ursodeoxycholicacid (UDCA) group (n =18).According to sampling time,each group was subdivided into three subgroups:24 h (n =6),48 h (n =6),and 72 h groups (n =6).The CYD-high,-middle and-low groups were orally administered 24.48,12.24,and 6.12 g.kg-1.d-1 modified CYD,respectively,while the model group was given 20 mL/kg of body weight of distilled water once a day.The UDCA group was given 67.5 mg.kg-1.d-1 UDCA once a day.Radioimmunity assay was used to detect the activity of alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),gamma-glutamyl transpeptidase (GGT) and the levels of total bilirubin (TBil) and indirectbiliruin (DBil) in rats.Reverse transcription quantitative polymerase chain reaction (qRT-PCR),Western blot analysis,and immunohistochemistry were used to detect multidrug resistance-associated protein 2 (MRP2) expression.In vitro,HepG2 hepatocellular carcinoma cells were treated with CYD medicated serum at a concentration of 15 mol/L.MRP2 and retinoid X receptor alpha (RXRα) expression was analyzed by qRT-PCR and Western blotting.RESULTS:Serum levels of ALT,AST,GGT,ALP,TBil,and DBil were significantly reduced in the CYD and positive drug groups compared with the control group (P < 0.05 and P < 0.01,respectively).Pathological changes in rat liver tissues at 72 h in the CYD-high and-medium dose groups and positive drug group were not significant compared with the control group.CYD and UDCA treatment ameliorated ANIT-induced biliary epithelial cell pro 展开更多
关键词 Cholestasis intrahepatic MULTIDRUG resistance-associated proteins RETINOID X receptor alpha COMPOUND Yindan DECOCTION
Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma 预览
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作者 Shi-Hua Luo Jian-Guo Chu +1 位作者 He Huang Ke-Chun Yao 《世界临床病例杂志》 2019年第13期1599-1610,共12页
BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hyper... BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement,and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ^2 = 12.227, P = 0.018;χ^2 = 12.457, P = 0.014;χ^2 = 26.490, P = 0.013;χ^2 = 21.956, P = 0.009, and χ^2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Grou 展开更多
关键词 HEPATOCELLULAR carcinoma PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT Transarterial CHEMOEMBOLIZATION RADIOFREQUENCY ablation
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Temporal trends of cirrhosis associated conditions 预览
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作者 Tomoki Sempokuya Guangxiang Zhang Kazuma Nakagawa 《世界肝病学杂志:英文版(电子版)》 2019年第1期74-85,共12页
AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Projec... AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant. RESULTS From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357%(P < 0.0001) in comparison to HC not related to viral hepatitis by 33 %(P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3%(P = 0.95). CONCLUSION The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased. 展开更多
关键词 CIRRHOSIS Hepatic ENCEPHALOPATHY Spontaneous bacterial PERITONITIS Esophageal VARICES Transjugular INTRAHEPATIC portosystemic SHUNT
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腹腔镜、胆管镜、扩张导管、T管支架捆绑引流治疗胆结石、乳头部梗阻52例 预览
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作者 陈安平 曾乾桃 +5 位作者 周华波 高原 索运生 刘安 刘进衡 张胜龙 《中华普外科手术学杂志(电子版)》 2019年第2期193-195,共3页
目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架捆绑引流(LCDTS)治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析1999年11月至2017年9月期间,符合入选标准的52例患者的临床资料。... 目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架捆绑引流(LCDTS)治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析1999年11月至2017年9月期间,符合入选标准的52例患者的临床资料。结果腹腔镜下行胆囊切除术和胆总管探查取石术52例。逐级导管扩张乳头并留置T形管+塑料胆管支架75.1%(39/52),逐级导管联合球囊导管扩张乳头并留置T形管+塑料胆管支架11.5%(6/52),因逐级导管扩张乳头不成功而中转为腹腔镜术中内镜乳头切开术并留置T形管+塑料胆管支架9.6%(5/52),因塑料胆管支架放置失败而中转为T管引流术3.8%(2/52)。术后残石1例(1.9%),胆汁漏1例(1.9%),经T管瘘道拔支架失败2例(3.8%)。无肠穿孔、胆管穿孔、大出血、急性胰腺炎等并发症,无死亡患者。术后总并发症发生率为7.7%(4/52)。结论从本研究初步研究发现,只要病例选择合适,LCDTS治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄是可行、有效和安全的。 展开更多
关键词 胆结石 胆汁淤积 肝内 腹腔镜 扩张术
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肝内胆管癌分子水平研究进展
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作者 李雪鹏 刘苏来 蒋波 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第2期219-226,共8页
肝内胆管癌(ICC)是位于2级胆管以上胆管上皮的恶性肿瘤,术后易复发、化疗效果不明确,远期生存率不高。ICC目前缺乏特异性早期诊断标志物,确诊时往往已是中晚期或者晚期。随着对ICC分子水平的深入研究,发现了一些关键调节子如抑癌基因p53... 肝内胆管癌(ICC)是位于2级胆管以上胆管上皮的恶性肿瘤,术后易复发、化疗效果不明确,远期生存率不高。ICC目前缺乏特异性早期诊断标志物,确诊时往往已是中晚期或者晚期。随着对ICC分子水平的深入研究,发现了一些关键调节子如抑癌基因p53、p16,原癌基因Ras以及miRNA和组蛋白的修饰等,这些调节因子可能成为治疗靶点。笔者就DNA-RNA-蛋白质中心法则为线索对ICC分子水平研究进展进行综述。 展开更多
关键词 胆管肿瘤 胆管 肝内 分子靶向治疗 综述文献
Interventions to improve sarcopenia in cirrhosis:A systematic review 预览
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作者 Maliha Naseer Erica P Turse +3 位作者 Ali Syed Francis E Dailey Mallak Zatreh Veysel Tahan 《世界临床病例杂志》 2019年第2期156-170,共15页
BACKGROUND Sarcopenia,i.e.,muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis.Hence,it is ... BACKGROUND Sarcopenia,i.e.,muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis.Hence,it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation,exercise,combined life style intervention,testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS)to improve muscle mass in cirrhosis.METHODS We search PubMed,EMBASE and Cochrane between June-August 2018,without a limiting period and the types of articles(RCTs,clinical trial,comparative study)in adult patients with sarcopenia and cirrhosis.The primary outcome of interest was improvement in muscle mass,strength and physical function interventions mentioned above.In the screening process,154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria.The studies were diverse in terms of the design,setting,interventions,and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies.Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass,strength and physical function following aerobic exercise.60%of the included studies on the nutritional intervention,100%of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low,the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise,nutritional interventions,hormonal and TIPS interventions.High quality randomized controlled trials needed to further strengthen these findings. 展开更多
关键词 SARCOPENIA CIRRHOSIS Treatment Intervention Nutrition Therapy Exercise TESTOSTERONE Trans JUGULAR INTRAHEPATIC portosystemic SHUNT
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糖皮质激素治疗感染性胆管炎引起肝内胆汁淤积1例报告 预览
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作者 赵优优 张端 +2 位作者 殷鑫 温晓玉 高普均 《临床肝胆病杂志》 CAS 北大核心 2019年第2期386-387,共2页
1 病例资料患者男性,46岁,因“间断发热、上腹痛半月,加重伴尿黄10 d”于2018年1月11日入本院。患者半月前劳累受凉后出现发热,体温最高39℃,伴寒战,无盗汗、关节肿痛等,于当地医院给予消炎等对持治疗(具体不详),症状未见明显好转,并出... 1 病例资料患者男性,46岁,因“间断发热、上腹痛半月,加重伴尿黄10 d”于2018年1月11日入本院。患者半月前劳累受凉后出现发热,体温最高39℃,伴寒战,无盗汗、关节肿痛等,于当地医院给予消炎等对持治疗(具体不详),症状未见明显好转,并出现中上腹部胀痛,无放射痛,伴恶心、呕吐、尿黄,皮肤瘙痒,白陶土样便。给予保肝、褪黄、降酶等对症治疗(具体不详),腹痛好转,但胆红素呈进行性升高,遂行胆囊造瘘术,并因右肾结石、积水,血清肌酐明显升高行右侧肾盂造瘘术,病情无明显好转,遂就诊于本院。既往:8年前因发热、皮肤黄染,不伴腹痛,于当地医院诊断为胰腺炎,给予对症治疗(具体不详)后,症状好转,未明确胰腺炎病因,自行口服“优思弗、奥美拉唑、水林佳,各1片/d”,否认肝炎病史、酗酒史。查体:皮肤、巩膜重度黄染,右上腹留置胆囊造瘘引流管1枚,右侧肾盂造瘘引流管1枚。当地医院2018年1月4日检查结果示降钙素原(PCT)4.01μg/L;血常规:WBC 3.88×10 9/L,中性粒细胞3.45×10 9/L,中性粒细胞百分比88.8%,PLT 98×10 9/L。本院2018年1月11日肝功能检查结果示:AST 127.7 U/L,ALT 242.3 U/L,GGT 368.2 U/L,ALP 267.3 U/L,总蛋白56.0 g/L,Alb 28.9 g/L,TBil 389.0μmol/L,DBil 311.7μmol/L,IBil 77.3μmol/L,总胆汁酸165.2μmol/L;尿常规:尿胆红素(+++)。血常规、CRP、PCT、凝血常规、抗核抗体、抗线粒体抗体、风湿三项、免疫五项、IgG4未见明显异常。自身免疫性肝炎相关抗体阴性,甲、乙、丙、戊型肝炎标志物阴性。胆汁培养:3 d无菌生长。腹部CT(2018年1月12日,图1)示:(1)肝左叶外侧段可疑低密度影;(2)胆囊造瘘中,胆囊炎,胆囊泥沙样结石。肺CT(2018年1月12日)示:(1)双肺散在少许炎症;(2)右肺上叶磨玻璃影。经内镜逆行胰胆管造影(2018年1月16日)示:十二指肠降段见乳头肿大明显,开口明显狭窄,肝内外胆管显影纤细,无明确占位� 展开更多
关键词 胆管炎 胆汁淤积 肝内 糖皮质激素类 病例报告
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Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus 预览
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作者 Yue Zhang Yi-Fan Wu +6 位作者 Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He Tao Wang Fu-Quan Liu 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第4期310-321,共12页
BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepa... BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications. AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+125I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications. METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125I implantation (TIPS-125I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively (P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-125I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group (P < 0.05). TIPS-125I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC. CONCLUSION TACE/TAE+125I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality. 展开更多
关键词 IODINE-125 Transjugular INTRAHEPATIC portosystemic SHUNT MAIN PORTAL vein tumor THROMBUS Metastasis PORTAL hypertension
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Serum ferritin in neonatal cholestasis:A specific and active molecule or a non-specific bystander marker? 预览
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作者 Behairy El-Sayed Behairy Hatem Abd-Alsattar Konswa +3 位作者 Hanaa Talaat Ahmed Dina Shehata El-Azab Nermin Mohamed Adawy Ahmad Mohamed Sira 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第2期173-180,共8页
Background:Serum ferritin(SF)and consequently hepatic iron have long been considered important in liver fibrosis progression.They have been studied in different liver diseases with no previous reports in neonatal chol... Background:Serum ferritin(SF)and consequently hepatic iron have long been considered important in liver fibrosis progression.They have been studied in different liver diseases with no previous reports in neonatal cholestasis(NC).This study aimed to measure SF in different etiologies of NC and investigate its relation to hepatic iron and fibrosis.Methods:SF was measured in 75 infants,including 50 with NC and 25 with sepsis.SF was compared between these two groups.Biochemical parameters,hepatic iron grades,and liver fibrosis and other histopathological characteristics and correlated with SF were assessed in NC group.Finally,a comparison between intrahepatic cholestasis and obstructive etiology was performed.Results:SF was elevated in NC(1598±2405 ng/mL)with no significant difference from those with sepsis(P=0.445).NC and sepsis constituted augmenting factors leading to more elevation of SF(2589±3511 ng/mL).SF was significantly correlated with hepatic iron grades(r=0.536,P<0.0001)and a cut-off value of 803.5 ng/mL can predict higher grades(≥grade 3)of iron deposition with sensitivity of 100%,specificity of 70%and accuracy of 85%.Moreover,SF was significantly higher(P<0.0001)in those with intrahepatic cholestasis(2602±3154 ng/mL)and their prevalent pathological findings of giant cell transformation(P=0.009)and hepatocyte swelling(P=0.023)than those with obstructive etiology(672±566 ng/mL)and their prevalent pathological findings of ductular proliferation(P=0.003)and bile plugs(P=0.002).SF was unrelated to the grade of liver fibrosis(P=0.058).Conclusions:SF is non-specifically elevated in NC,with positive correlation to hepatic iron grades.SF≥803.5 ng/mL can predict higher grades(≥grade 3)of hepatic iron.However,an active role of increased SF and hepatic iron in disease progression remains questionable. 展开更多
关键词 Biliary ATRESIA Liver fibrosis Hepatic IRON grade INTRAHEPATIC CHOLESTASIS IRON
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Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma 预览
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作者 Ju-Shan Wu Ji-Liang Feng +3 位作者 Rui-Dong Zhu San-Guang Liu Da-Wei Zhao Ning Li 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第5期404-415,共12页
BACKGROUND Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens (SS) can provide more information, currently, pre-treatment needle core biopsy (NCB) is increa... BACKGROUND Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens (SS) can provide more information, currently, pre-treatment needle core biopsy (NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical (IHC) staining between NCB and SS from patients with hepatic tumours were less concerned. AIM To introduce a more accurate method for interpreting the IHC staining results in order to improve the diagnostic value of hepatic malignancy in NCB samples. METHOD A total of 208 patients who underwent both preoperative NCB and surgical resection for hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma RESULTS Morphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology (k = 0.504) and histological grade (k = 0.488) between NCB and SS of the tumours. A 4-tier (+++,++,+, and -) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS (k = 0.717;k = 0.768;k = 0.633). Furthermore, with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS (k = 0.931;k = 0.907;k = 0.803), increasing the accuracy of NCB diagnosis C (k = 0.987;area under the curve = 0.997, 95%CI: 0.990-1.000;P < 0.001). CONCLUSION These findings imply that reasonable interpretation of IHC results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach. 展开更多
关键词 HISTOPATHOLOGICAL Needle core biopsy SURGICAL SPECIMENS SOLITARY hepatocellular carcinoma INTRAHEPATIC CHOLANGIOCARCINOMA
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Parallel transjugular intrahepatic portosystemic shunt with Viatorr? stents for primary TIPS insufficiency: Case series and review of literature 预览
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作者 Driss Raissi Qian Yu +1 位作者 Michael Nisiewicz Steven Krohmer 《世界肝病学杂志:英文版(电子版)》 2019年第2期217-225,共9页
BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical s... BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr■) is largely lacking despite Viatorr■ being the current gold standard for modern TIPS placement. CASE SUMMARY All three patients had portal hypertension and already had a primary Viatorr■ TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr? stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr? TIPS. CONCLUSION Viatorr?PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data. 展开更多
关键词 Transjugular INTRAHEPATIC portosystemic SHUNT PARALLEL stent Portal hypertension VARICES Viatorr? Tandem Double BARREL Case report
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Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy 预览
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作者 Shi-Hua Luo Jian-Guo Chu +2 位作者 He Huang Guo-Rui Zhao Ke-Chun Yao 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第9期1088-1099,共12页
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is currently used for the treatment of complications of portal hypertension.The incidence of hepatic encephalopathy(HE)remains a problem in TIPS placement.... BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is currently used for the treatment of complications of portal hypertension.The incidence of hepatic encephalopathy(HE)remains a problem in TIPS placement.It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein.We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt;therefore,targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed.Patients were divided into group A(targeting left branch of portal vein,n=937)and group B(targeting right branch of portal vein,n=307).TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up,recurrent bleeding and ascites did not differ significantly between groups A and B(P=0.278,P=0.561,respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94%vs 36.80%,χ2=4.839,P=0.028),3 mo(12.48%vs 34.20%,χ2=5.054,P=0.025),6 mo(10.03%vs 32.24%,χ2=6.560,P=0.010),9 mo(9.17%vs 31.27%,χ2=5.357,P=0.021),and 12 mo(8.21%vs 28.01,χ2=3.848,P=0.051).There were no significant differences between groups A and B at 3 years(6.61%vs 7.16%,χ2=1.204,P=0.272)and 5 years(5.01%vs 6.18%,χ2=0.072,P=0.562).The total survival rate did not differ between groups A and B(χ2=0.226,P=0.634,log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-relat 展开更多
关键词 PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT PORTAL VEIN branch Hepatic ENCEPHALOPATHY
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Current approaches to the management of patients with cirrhotic ascites 预览
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作者 Dmitry Victorovich Garbuzenko Nikolay Olegovich Arefyev 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第28期3738-3752,共15页
This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the C... This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords:“liver cirrhosis,”“portal hypertension,”“ascites,”“pathogenesis,”“diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients. 展开更多
关键词 Liver CIRRHOSIS ASCITES DIURETICS Large volume PARACENTESIS Peritoneovenous SHUNTING Transjugular INTRAHEPATIC portosystemic SHUNTING
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复方茵丹汤对急性肝内胆汁淤积大鼠肝组织法尼醇受体及多耐药相关蛋白3表达的影响 预览 被引量:1
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作者 隋京利 孙凤霞 +1 位作者 李晓玲 张秋香 《临床肝胆病杂志》 CAS 北大核心 2018年第9期1960-1966,共7页
目的研究复方茵丹汤对α-萘异硫氰酸酯(ANIT)诱导的大鼠急性肝内胆汁淤积的作用机制。方法将108只雄性SD大鼠随机分为正常对照组,模型组,中药复方茵丹汤高、中、低剂量组和阳性药对照组,每组18只,依据取材时间不同又将各组随机分为24... 目的研究复方茵丹汤对α-萘异硫氰酸酯(ANIT)诱导的大鼠急性肝内胆汁淤积的作用机制。方法将108只雄性SD大鼠随机分为正常对照组,模型组,中药复方茵丹汤高、中、低剂量组和阳性药对照组,每组18只,依据取材时间不同又将各组随机分为24、48、72 h 3个亚组,每组6只。模型组、中药组、阳性药对照组大鼠一次性给予2%ANIT按100 mg·kg^-1·d^-1灌胃造模,正常对照组予等容积色拉油灌胃。造模2 h后,中药高、中、低剂量组分别给予生药含量为24.48 g·kg^-1·d^-1、12.24 g·kg^-1·d^-1和6.12 g·kg^-1·d^-1的复方茵丹汤中药煎剂l ml/100 g体质量灌胃,模型组和正常对照组给予等容积生理盐水灌胃,阳性药对照组给予67.5 mg·kg^-1·d^-1熊去氧胆酸(UDCA)水溶液l ml/100 g体质量灌胃,均1次/d。造模后分别于24、48、72 h处死相应时相大鼠,采用RT-q-PCR、Western Blot和免疫组化技术检测法尼醇受体(FXR)及多耐药相关蛋白3(MRP3)在大鼠肝组织的表达水平。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。结果 RT-q-PCR结果显示,与同时相正常组比较,模型组FXR mRNA表达均明显降低(P值均〈0.05);与同时相模型组比较,中药各剂量组及UDCA组FXR mRNA表达明显升高(P值均〈0.05);中药高剂量组各时相FXR mRNA表达明显高于中、低剂量组(P值均〈0.05)。与同时相正常组比较,模型组MRP3 mRNA表达均显著升高(P值均〈0.05);与同时相模型组比较,除低剂量组24 h外,中药各剂量组及UDCA组MRP3 mRNA表达均明显升高(P值均〈0.05);中药高剂量组48 h、72 h的MRP3 mRNA表达均明显高于中、低剂量组(P值均〈0.05)。免疫组化结果显示,与同时相正常组比较,模型组FXR蛋白表达均显著降低(P值均〈0.05);与模型组比较,24 h中药各剂量组及各时相UDCA组FXR蛋白表达均显著升高(P值均〈0.05);中药高剂量组F 展开更多
关键词 胆汁淤积 肝内 法尼醇 多耐药相关蛋白3 大鼠 Sprague-Dawley
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