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High prevalence of occult hepatitis C infection in predialysis patients
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作者 Luís Henrique Bezerra Cavalcanti Sette Edmundo Pessoa de Almeida Lopes +3 位作者 Nathália Campello Guedes dos Anjos Lucila Maria Valente Sávio Augusto Vieira de Oliveira Norma Lucena-Silva 《世界肝病学杂志:英文版(电子版)》 2019年第1期109-118,共10页
BACKGROUND Occult hepatitis C virus (HCV) infection (OCI) may be associated with extrahepatic diseases and it is known that the patients with chronic kidney disease (CKD) who are on hemodialysis (HD) present a higher ... BACKGROUND Occult hepatitis C virus (HCV) infection (OCI) may be associated with extrahepatic diseases and it is known that the patients with chronic kidney disease (CKD) who are on hemodialysis (HD) present a higher prevalence of this type of infection than the general population, with a worse clinical outcome. However, there are no data in the literature to assess the presence of OCI in patients prior to the initiation of renal replacement therapy (RRT). Therefore, this study aimed to evaluate the occurrence and epidemiological aspects of OCI in patients with Predialysis CKD. We hypothesize that this infection could occur before RRT initiation. AIM To research the status in predialysis patients when HD patients have high prevalence of OCI. METHODS A cross-sectional study was conducted between 2015 and 2017. Adults with creatinine clearance < 60 mL/min·1.73 m^2 (predialysis patients) were recruited to the study. Pregnant and postpartum women, patients with glomerulopathies, and patients showing positivity for serological markers of hepatitis B virus (HBV), HCV or human immunodeficiency virus infection were excluded. Patients were diagnosed with OCI according to test results of anti-HCV antibody negativity and HCV RNA positivity in either ultracentrifuged serum or, if serum-negative, in peripheral blood mononuclear cells. RESULTS Among the 91 total patients included in the study, the prevalence of OCI was 16.5%. Among these 15 total OCI patients, 1 was diagnosed by 14 ultracentrifuged serum results and 14 were diagnosed by peripheral blood mononuclear cell results. Compared to the non-OCI group, the OCI patients presented higher frequency of older age (P = 0.002), patients with CKD of mixed etiology (P = 0.019), and patients with markers of previous HBV infection (i.e., combined positivity for anti-hepatitis B core protein antibody and anti-hepatitis B surface protein antibody)(P = 0.001). CONCLUSION Among predialysis patients, OCI involved the elderly, patients with CKD of mixed etiology, and patients with prev 展开更多
关键词 OCCULT HEPATITIS infection CHRONIC HEPATITIS C CHRONIC kidney disease HEMODIALYSIS HEPATITIS C virus-RNA PERIPHERAL blood MONONUCLEAR cells
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Human immunodeficiency virus and hepatotropic viruses comorbidities as the inducers of liver injury progression
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作者 Murali Ganesan Larisa Y Poluektova +1 位作者 Kusum K Kharbanda Natalia A Osna 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第4期398-410,共13页
Hepatotropic viruses induced hepatitis progresses much faster and causes more liver-related health problems in people co-infected with human immunodeficiency virus(HIV).Although treatment with antiretroviral therapy h... Hepatotropic viruses induced hepatitis progresses much faster and causes more liver-related health problems in people co-infected with human immunodeficiency virus(HIV).Although treatment with antiretroviral therapy has extended the life expectancy of people with HIV,liver disease induced by hepatitis B virus(HBV)and hepatitis C virus(HCV)causes significant numbers of non-acquired immune deficiency syndrome(AIDS)-related deaths in coinfected patients.In recent years,new insights into the mechanisms of accelerated fibrosis and liver disease progression in HIV/HCV and HIV/HBV co-infections have been reported.In this paper,we review recent studies examining the natural history and pathogenesis of liver disease in HIV-HCV/HBV co-infection in the era of direct acting antivirals(DAA)and antiretroviral therapy(ART).We also review the novel therapeutics for management of HIV/HCV and HIV/HBV coinfected individuals. 展开更多
关键词 Human IMMUNODEFICIENCY VIRUS HEPATITIS C VIRUS HEPATITIS B VIRUS FIBROSIS Stiffness Treatment
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Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review
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作者 Aakash Desai Sonia Sandhu +1 位作者 Jin-Ping Lai Dalbir Singh Sandhu 《世界肝病学杂志:英文版(电子版)》 2019年第1期1-18,共18页
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cau... Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research. 展开更多
关键词 HEPATOCELLULAR carcinoma Non-cirrhotic liver HEPATITIS B HEPATITIS C Risk factors Clinical features Diagnostic MODALITIES Management strategies Future DIRECTIONS
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细胞角蛋白7在肝硬化病理诊断中的作用
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作者 王彦坤 马俊骥 张明 《临床荟萃》 CAS 2019年第2期124-127,共4页
目的探讨细胞角蛋白7(cytokeratin 7,CK7)在慢性肝病肝硬化诊断中的作用。方法回顾性分析2014年1月至2018年5月首都医科大学附属北京佑安医院病理科行肝脏病理检查的病例。本研究纳入病例802例,男性563例,女性239例,平均年龄(51±11... 目的探讨细胞角蛋白7(cytokeratin 7,CK7)在慢性肝病肝硬化诊断中的作用。方法回顾性分析2014年1月至2018年5月首都医科大学附属北京佑安医院病理科行肝脏病理检查的病例。本研究纳入病例802例,男性563例,女性239例,平均年龄(51±11)岁。分析不同疾病并发肝硬化时肝组织病理CK7免疫组织化学染色阳性表达比率的不同。结果肝组织CK7阴性表达患者中男性比率较大,而肝组织CK7阳性表达患者中女性比率较CK7阴性患者高。肝硬化肝组织CK7免疫组织化学染色表达阴性的病例年龄较CK7阳性病例大。非病毒性肝硬化肝组织CK7免疫组织化学染色阳性率较病毒性肝硬化组高。与慢性乙型肝炎肝硬化和自身免疫性肝炎引起的肝硬化相比,原发性胆汁性胆管炎(Primary Biliary Cholangitis,PBC)肝硬化患者CK7肝组织阳性表达率明显增加。结论CK7免疫组织化学染色在区分病毒性和非病毒性肝硬化中发挥一定的指导价值。CK7对于鉴别PBC与自身免疫性肝炎和慢性乙型肝炎肝硬化具有重要作用。 展开更多
关键词 肝硬化 肝脏病理 肝炎 病毒性 胆管炎 肝炎 自身免疫性
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Serum hepatitis B virus RNA is a predictor of HBeAg seroconversion and virological response with entecavir treatment in chronic hepatitis B patients
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作者 Hao Luo Xia-Xia Zhang +5 位作者 Li-Hua Cao Ning Tan Qian Kang Hong-Li Xi Min Yu Xiao-Yuan Xu 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第6期719-728,共10页
BACKGROUND Characteristics of alterations of serum hepatitis B virus(HBV)RNA in different chronic hepatitis B(CHB)patients still cannot be fully explained.Whether HBV RNA can predict HBeAg seroconversion is still cont... BACKGROUND Characteristics of alterations of serum hepatitis B virus(HBV)RNA in different chronic hepatitis B(CHB)patients still cannot be fully explained.Whether HBV RNA can predict HBeAg seroconversion is still controversial.AIM To investigate whether HBV RNA can predict virological response or HBeAg seroconversion during entecavir(ETV)treatment when HBV DNA is undetectable.METHODS The present study evaluated 61 individuals who were diagnosed and treated with long-term ETV monotherapy at the Department of Infectious Diseases of Peking University First Hospital(China)from September 2006 to December 2007.Finally,30 treatment-naive individuals were included.Serum HBV RNA were extracted from 140μL serum samples at two time points.Then they were reverse transcribed to cDNA with the HBV-specific primer.The product was quantified by real-time quantitative PCR(RT-PCR)using TAMARA probes.Statistical analyses were performed with IBM SPSS 20.0.RESULTS Level of serum HBV RNA at baseline was 4.15±0.90 log10 copies/mL.HBV RNA levels showed no significant difference between the virological response(VR)and partial VR(PVR)groups at baseline(P=0.940).Serum HBV RNA significantly decreased among patients who achieved a VR during ETV therapy(P<0.001).The levels of HBV RNA in both HBeAg-positive patients with seroconversion group and those with no seroconversion increased after 24 wk of treatment.Overall,HBV RNA significantly but mildly correlated to HBsAg(r=0.265,P=0.041),and HBV RNA was not correlated to HBV DNA(r=0.242,P=0.062).Furthermore,serum HBV RNA was an independent indicator for predicting HBeAg seroconversion and virological response.HBeAg seroconversion was more likely in CHB patients with HBV RNA levels below 4.12 log10 copies/mL before treatment.CONLUSION The level of serum HBV RNA could predict HBeAg seroconversion and PVR during treatment.In the PVR group,the level of serum HBV RNA tends to be increasing. 展开更多
关键词 Chronic HEPATITIS B HEPATITIS B virus RNA Virological response HBeAg SEROCONVERSION ENTECAVIR
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甲基强的松龙治疗黄疸型病毒性肝炎的疗效
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作者 田立峰 王文平 臧玮 《中国继续医学教育》 2019年第1期127-129,共3页
目的研究甲基强的松龙(甲强龙)治疗黄疸型病毒性肝炎的临床疗效。方法选取我院2017年1月—2018年1月收治的30例黄疸型病毒性肝炎患者为研究对象,根据电脑抽签的方式随机分为观察组与对照组,对照组接受还原型谷胱甘肽治疗方式,观察组接... 目的研究甲基强的松龙(甲强龙)治疗黄疸型病毒性肝炎的临床疗效。方法选取我院2017年1月—2018年1月收治的30例黄疸型病毒性肝炎患者为研究对象,根据电脑抽签的方式随机分为观察组与对照组,对照组接受还原型谷胱甘肽治疗方式,观察组接受甲基强的松龙治疗方式,观察两组患者临床治疗指标及治疗前后TBIL、ALT水平差异。结果两组患者治疗总有效率差异无统计学意义(P>0.05)。TBIL及ALT水平治疗前差异无统计学意义(P>0.05),治疗后观察组显著低于对照组,改善情况显著优于对照组,差异有统计学意义(P<0.05)。结论甲基强的松龙治疗黄疸型病毒性肝炎相较于还原型谷胱甘肽治疗未见差异,但能够更加有效的减轻患者痛苦,促进总胆红素与丙氨酸转氨酶的改善。 展开更多
关键词 甲基强的松龙 还原型谷胱甘肽 黄疸型 病毒性 肝炎 治疗有效率
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肝苏片联合乙酰半胱氨酸注射液治疗慢性重型乙型肝炎临床观察
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作者 高爱华 王新丽 +4 位作者 孙艳芹 姜清河 刘霞 张梅 张凤朝 《河北中医》 2019年第1期74-78,100共6页
目的 观察肝苏片联合乙酰半胱氨酸注射液治疗慢性重型乙型肝炎(以下简称乙肝)的临床疗效。方法 将200例重型乙肝患者随机分为2组。2组均予基础治疗,对照组100例予乙酰半胱氨酸注射液治疗;治疗组100例在对照组治疗基础上联合肝苏片治疗。... 目的 观察肝苏片联合乙酰半胱氨酸注射液治疗慢性重型乙型肝炎(以下简称乙肝)的临床疗效。方法 将200例重型乙肝患者随机分为2组。2组均予基础治疗,对照组100例予乙酰半胱氨酸注射液治疗;治疗组100例在对照组治疗基础上联合肝苏片治疗。2组均治疗14 d。比较2组疗效;观察2组治疗后主要临床症状体征改善率;比较2组治疗前后肝功能指标丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)变化;比较2组治疗前后T淋巴细胞亚群CD4^+、CD8^+、CD4^+/CD8^+水平变化;比较2组治疗前后HBV-DNA变化。结果 治疗组总有效率95.0%,对照组总有效率70.0%,治疗组疗效优于对照组(P<0.05);治疗组治疗后主要临床症状体征改善率高于对照组(P<0.05)。2组治疗后ALT、AST及TBiL均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。治疗后2组CD4^+、CD4^+/CD8^+均较本组治疗前升高(P<0.05),CD8^+降低(P<0.05),且治疗组CD4^+、CD4^+/CD8^+高于对照组(P<0.05),CD8^+低于对照组(P<0.05)。治疗后治疗组HBV-DNA较本组治疗前降低(P<0.05),且低于对照组治疗后(P<0.05)。结论 肝苏片联合乙酰半胱氨酸注射液治疗慢性重型乙肝疗效显著,能改善患者肝功能指标,降低HBV-DNA水平,恢复机体正常免疫水平。 展开更多
关键词 肝炎 乙型 T淋巴细胞 中西医结合疗法
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乙肝,艾滋病病毒的发病机制和干预措施的比较 预览
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作者 陈洁 袁星 余先祥 《临床医药文献电子杂志》 2019年第12期191-191,194共2页
乙肝和艾滋病是两种人类重大的传染病,每年有很多人因其而死亡。目前对它们的研究还处于进展之中,其形态特征已经明确,但发病机制任然不清楚,临床上很多患者仅能控制症状,病毒在体内长存导致复发,药物治疗容易产生耐药,现本文就它们的... 乙肝和艾滋病是两种人类重大的传染病,每年有很多人因其而死亡。目前对它们的研究还处于进展之中,其形态特征已经明确,但发病机制任然不清楚,临床上很多患者仅能控制症状,病毒在体内长存导致复发,药物治疗容易产生耐药,现本文就它们的研究近况作一综述. 展开更多
关键词 肝炎 乙型 艾滋病 人类免疫缺陷病毒 发病机制
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Clinical factors associated with hepatitis B screening and vaccination in high-risk adults
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作者 Rotimi Ayoola Sebastian Larion +1 位作者 David M Poppers Renee Williams 《世界肝病学杂志:英文版(电子版)》 2019年第1期86-98,共13页
BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma (HCC). Hepatitis B vaccination is 95% effective in preventing infection and the devel... BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma (HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus (DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system. AIM To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection. METHODS We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records. Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination. RESULTS Among the 999 patients, 556 (55.7%) patients were screened for hepatitis B. Of those who were screened, only 242 (43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease [odds ratio (OR): 5.122; 2.766-9.483], alcoholic hepatitis (OR: 3.064; 1.020-9.206), and cirrhosis or end-stage liver disease (OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age (OR: 0.785; 0.680-0.906), insurance status (0.690; 0.558-0.854), history of DM (OR: 0.518; 0.364-0.737), and human immunodeficiency virus (OR: 0.443; 0.273-0.718); 展开更多
关键词 Health prevention VACCINATION Hepatitis B VIRUS SCREENING Diabetes mellitus Cirrhosis END-STAGE renal disease Human IMMUNODEFICIENCY VIRUS Intravenous drug users
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CMV感染性肝炎患儿外周血T淋巴细胞的水平及意义
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作者 王锡兰 田军 《中国妇幼健康研究》 2019年第1期65-68,共4页
目的分析巨细胞病毒(CMV)感染致肝炎患儿外周血CD3、CD4、CD8和CD4/CD8T淋巴细胞水平及其与CMV载量的相关性。方法选取2016年3月至2018年3月在余姚市第二人民医院就诊的65例CMV感染致肝炎患儿为病例组,根据其CMV载量水平的不同,分为低... 目的分析巨细胞病毒(CMV)感染致肝炎患儿外周血CD3、CD4、CD8和CD4/CD8T淋巴细胞水平及其与CMV载量的相关性。方法选取2016年3月至2018年3月在余姚市第二人民医院就诊的65例CMV感染致肝炎患儿为病例组,根据其CMV载量水平的不同,分为低载量组(CMV<1×104拷贝/mL)、中载量组(CMV为1×104~<5×104拷贝/mL)、高载量组(CMV为5×104~10×104拷贝/mL),另选取同期30例体检健康儿童为对照组。比较病例组与对照组外周血T淋巴细胞亚群(CD3、CD4、CD8和CD4/CD8)的含量,并比较不同CMV载量亚组患儿外周血T淋巴细胞亚群的水平,采用Pearson相关性分析CMV感染致肝炎患儿CMV载量与外周血T淋巴细胞亚群水平的关系。结果病例组患儿外周血CD3、CD4及CD4/CD8的水平较对照组均显著降低(t值分别为5.99、5.80、7.32,均P<0.01);而两组CD8水平比较并无明显差异(t=0.84,P>0.05)。低载量组外周血CD3、CD4及CD4/CD8水平较中载量组均显著升高(q值分别为10.12、4.63、6.85,均P<0.05),较高载量组亦均显著升高(q值分别为15.96、7.68、7.95,均P<0.05),中载量组外周血CD3、CD4及CD4/CD8水平较高载量组均显著升高(q值分别为11.05、7.36、7.84,均P<0.05);而三组CD8水平比较,并无明显差异(F=1.84,P>0.05)。经Pearson相关性分析显示,CMV载量与CD3、CD4及CD4/CD8均呈负相关(r值分别为-0.58、-0.53、-0.73,均P<0.01),而与CD8并无明显关系(r=0.10,P>0.05)。结论 CMV感染致肝炎患儿机体免疫功能受损,且CMV可阻滞外周血T淋巴细胞亚群中CD3与CD4细胞增殖,而对CD8淋巴细胞的影响较小,故临床中应及时测定肝炎患儿外周血T淋巴细胞亚群,尤其是CD3和CD4的表达水平。 展开更多
关键词 肝炎 巨细胞病毒 感染 T淋巴细胞 儿童
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青海省2006-2015年甲型病毒性肝炎流行特征分析
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作者 马小军 赵建海 +5 位作者 朱向路 李寿江 杨雪琴 马艳梅 马娟 关炳菊 《医学动物防制》 2019年第1期56-58,共3页
目的分析青海省甲型病毒性肝炎(简称甲肝)流行特征,为预防控制甲肝提供参考依据。方法采用描述流行病学方法对2006-2015年在全国法定传染病报告系统(National Notifiable Disease Reported System,NNDRs)中报告的青海省甲肝病例进行三... 目的分析青海省甲型病毒性肝炎(简称甲肝)流行特征,为预防控制甲肝提供参考依据。方法采用描述流行病学方法对2006-2015年在全国法定传染病报告系统(National Notifiable Disease Reported System,NNDRs)中报告的青海省甲肝病例进行三间分布分析。结果 2006-2015年青海省报告甲肝病例6 782例,无死亡病例。年发病率波动在5.79/10万~22.17/10万之间。5~9岁组人群发病率在各年龄组中排序最高,发病率(32.23/10万)明显高于全人群平均发病率(12.11/10万)。报告病例的地区聚集性明显,报告病例主要集中在西宁市、海东市和海南州,共报告6177例,占报告病例总数的91.08%。结论青海省甲肝的发病存在明显的季节性和人群差异。应加强适龄儿童甲肝疫苗接种,在流行季节应加强健康教育,减少感染机会,以控制甲肝的发生和流行。 展开更多
关键词 甲型病毒性肝炎 流行特征 分析
IL-8与自身免疫性肝病的关系 预览
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作者 雷云洁 杨晋辉 《临床肝胆病杂志》 CAS 北大核心 2019年第2期411-413,共3页
IL-8是一种具有趋化作用的炎性细胞因子,在自身免疫性肝病中的表达水平明显升高,且能够与其相应受体——趋化因子受体1、趋化因子受体2结合,进而发挥促炎性细胞趋化、促血管生成、促纤维化和诱导细胞增殖的作用,参与疾病进程。综述了IL-... IL-8是一种具有趋化作用的炎性细胞因子,在自身免疫性肝病中的表达水平明显升高,且能够与其相应受体——趋化因子受体1、趋化因子受体2结合,进而发挥促炎性细胞趋化、促血管生成、促纤维化和诱导细胞增殖的作用,参与疾病进程。综述了IL-8与自身免疫性肝病的相关研究进展。 展开更多
关键词 白细胞介素8 肝炎 自身免疫性 原发性胆汁性胆管炎 原发性硬化性胆管炎 综述
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128例药物性肝损伤患者的免疫特点及临床分析
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作者 邓茂林 杨丽君 +1 位作者 石先利 向军英 《中国医院药学杂志》 CAS 北大核心 2019年第1期63-66,共4页
目的:探讨药物性肝损伤(DILI)患者的免疫学特点、临床与预后。方法:回顾性分析2015年12月至2017年10月就诊于某院并诊断为药物性肝损伤的病例128例,收集免疫学指标抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、γ-球蛋白检测... 目的:探讨药物性肝损伤(DILI)患者的免疫学特点、临床与预后。方法:回顾性分析2015年12月至2017年10月就诊于某院并诊断为药物性肝损伤的病例128例,收集免疫学指标抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、γ-球蛋白检测结果,分析128例患者的免疫学特点,比较免疫指标阳性组和免疫指标阴性组药物性肝损伤的临床特点及预后。结果:128例临床诊断为药物性肝损伤患者中女性96例,占75%,男性32例,占25%。由中药引起者76例,占药物性肝损伤的59. 37%。其中自身免疫抗体阳性98例,占药物性肝损伤患者的76. 56%。自身免疫抗体阳性患者中女性75例,男性23例,各所测抗体阳性比率ANA为56. 25%(72/128),SMA为15. 62%(20/128),AMA为12. 5%(16/128),γ-球蛋白17. 1%(22/128)。患者自身免疫抗体阳性组与阴性组疾病严重程度无差别,但2组临床类型构成不同。免疫抗体阳性患者预后较免疫阴性患者预后差。结论:自身免疫在DILI发病中起着重要的作用,但具体作用研究尚不清楚,需要进一步的研究。 展开更多
关键词 肝炎 中毒性 生物标记物 免疫机制 临床特点 预后分析
利可君片联合更昔洛韦治疗巨细胞病毒性肝炎婴儿的效果分析 预览
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作者 王维 《实用临床医药杂志》 CAS 2019年第1期115-117,共3页
目的探讨利可君片联合更昔洛韦治疗巨细胞病毒性(CMV)肝炎婴儿的临床效果。方法选取60例CMV肝炎患儿,随机分为对照组和观察组各30例。对照组采用更昔洛韦治疗,观察组在此基础上联合利可君片治疗。比较2组肝功能、巨细胞病毒载量(HCMV-D... 目的探讨利可君片联合更昔洛韦治疗巨细胞病毒性(CMV)肝炎婴儿的临床效果。方法选取60例CMV肝炎患儿,随机分为对照组和观察组各30例。对照组采用更昔洛韦治疗,观察组在此基础上联合利可君片治疗。比较2组肝功能、巨细胞病毒载量(HCMV-DNA)以及治疗转归情况。结果观察组治疗后谷丙转氨酶及总胆红素均显著低于对照组(P<0.05);观察组治疗后HCMV-DNA载量水平显著低于对照组(P<0.05);观察组临床症状转归情况显著优于对照组(P<0.05);观察组不良反应发生率6.67%,显著低于对照组43.33%(P<0.05)。结论利可君片联合更昔洛韦治疗CMV肝炎婴儿的疗效肯定,安全性高。 展开更多
关键词 巨细胞病毒 肝炎 更昔洛韦 利可君片 病毒载量 骨髓抑制 婴儿
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人参皂苷Rg1调节NF-κB/VCAM-1减轻胆汁淤积性肝纤维化
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作者 罗飘 楚世峰 +2 位作者 彭也 张钊 陈乃宏 《药学学报》 CAS CSCD 北大核心 2019年第2期321-328,共8页
本文通过胆总管结扎(bile duct ligation, BDL)建立胆汁淤积性肝纤维化模型小鼠,研究人参皂苷Rg1对胆汁淤积诱发的肝纤维化的治疗作用,并探讨潜在的作用机制。本文中所有动物实验都获得单位伦理学委员会批准。检测血清生化指标和病理切... 本文通过胆总管结扎(bile duct ligation, BDL)建立胆汁淤积性肝纤维化模型小鼠,研究人参皂苷Rg1对胆汁淤积诱发的肝纤维化的治疗作用,并探讨潜在的作用机制。本文中所有动物实验都获得单位伦理学委员会批准。检测血清生化指标和病理切片评估小鼠肝功能、肝损伤和纤维化;免疫组织化学和qPCR等方法检测血管细胞黏附分子-1 (vascular cell adhesion molecule 1, VCAM-1)在BDL诱导的肝纤维化过程中的表达变化规律;为探讨Rg1治疗作用的相关机制,检测转录因子-κB (nuclear factor-κB, NF-κB)及炎症因子。结果显示, VCAM-1表达先上调,至第7天达到高峰,随后表达有所下降,但与假手术组相比仍有高表达。与模型组相比, 40 mg·kg-1·d-1Rg1治疗可降低血清中谷草转氨酶(AST)、谷丙转氨酶(ALT)和总胆红素(T.Bili)水平(P<0.05或P<0.01),减轻肝功能损害,减缓BDL诱导的肝纤维化进程,显著地下调VCAM-1蛋白表达(P<0.05),抑制炎症反应。此外, Rg1可明显降低细胞核内NF-κB p65蛋白水平(P<0.05)。本研究表明VCAM-1在BDL诱导的肝纤维化过程中的表达呈动态变化, Rg1通过调节NF-κB/VCAM-1信号途径抑制炎症损伤,减轻胆汁淤积性肝纤维化,为将来Rg1开发成有效的肝纤维化治疗药物提供实验基础。 展开更多
关键词 人参皂苷RG1 胆汁淤积 肝纤维化 血管细胞黏附分子-1 肝炎
儿童自身免疫性肝炎46例临床病理特点及疗效分析
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作者 曹丽丽 张敏 +9 位作者 朱世殊 董漪 徐志强 陈大为 王丽旻 王福川 甘雨 闫建国 王璞 李爱芹 《中华儿科杂志》 CAS CSCD 北大核心 2019年第1期40-45,共6页
目的总结分析儿童自身免疫性肝炎(AIH)的临床病理特点及疗效,提高对该病的认识。方法回顾性分析2012年4月至2018年4月在解放军总医院第五医学中心青少年肝病诊疗与研究中心住院的46例AIH患儿[男19例,女27例,发病年龄10.1(1.4~18.0)岁]... 目的总结分析儿童自身免疫性肝炎(AIH)的临床病理特点及疗效,提高对该病的认识。方法回顾性分析2012年4月至2018年4月在解放军总医院第五医学中心青少年肝病诊疗与研究中心住院的46例AIH患儿[男19例,女27例,发病年龄10.1(1.4~18.0)岁]的分型、临床特点、生化指标、肝脏病理、治疗效果,组间比较采用t检验、秩和检验或χ^2检验。结果46例患儿中AIH-Ⅰ型32例(70%),AIH-Ⅱ型14例(30%),差异有统计学意义(χ^2=12.565,P=0.000)。分5种起病方式:类似急性病毒性肝炎样表现17例(37%),暴发性肝衰竭2例(4%),隐匿性发作9例(20%),合并肝硬化和门脉高压5例(11%),转氨酶升高(偶然化验发现)13例(28%)。AIH-Ⅰ型患儿中合并原发性硬化性胆管炎3例、原发性胆汁性胆管炎1例、炎症性肠病2例、系统性红斑狼疮1例。46例AIH患儿丙氨酸转氨酶(ALT)升高46例,天冬氨酸转氨酶(AST)升高46例,总胆红素(TBIL)升高35例,γ-谷氨酰基转移酶(GGT)升高39例,γ球蛋白升高32例,免疫球蛋白G(IgG)升高33例。AIH-Ⅰ型患儿γ球蛋白、IgG[(32±9)%、(27±10)g/L]均明显高于AIH-Ⅱ型患儿[(23±8)%、(18±8)g/L],差异均有统计学意义(t=3.217、3.193,P=0.002、0.003)。39例患儿行肝脏病理检查,炎症分级G≥3的22例(56%);纤维化分期S≥3的26例(67%),其中肝硬化7例。AIH特征性肝组织病理:可见界面性肝炎36例(92%),淋巴细胞或浆细胞浸润23例(59%),玫瑰花结3例(8%)。40例在诊断后接受单用激素(31例)或激素联合免疫抑制剂(9例)治疗,完全缓解29例(72%),部分缓解10例(25%),无应答1例(3%)。达到完全缓解后激素减量过程中出现复发15例(52%)。8例治疗前后均行肝脏穿刺,6例治疗后肝脏炎症及纤维化程度明显改善,1例炎症减轻,纤维化改善不明显,1例炎症与纤维化均无改善。随访时间3.3(0.3~10.5)年,39例激素应答的患儿无成功停药病例。长期激素治疗的不良反应:双眼白内障6例,1例� 展开更多
关键词 肝炎 自身免疫性 儿童 诊断 病理学
What' s New in Alcoholic Hepatitis 预览
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作者 Bin Gao Vijay H. Shah 《临床肝胆病杂志》 CAS 北大核心 2019年第3期465-466,共2页
Alcoholic hepatitis (AH) was first reported in 1961 as an acute disease in alcoholics with severe clinical syndromes including jaundice, anorexia, nausea, upper abdominal pain, hepatomegaly and fever etc. 1 Today, it ... Alcoholic hepatitis (AH) was first reported in 1961 as an acute disease in alcoholics with severe clinical syndromes including jaundice, anorexia, nausea, upper abdominal pain, hepatomegaly and fever etc. 1 Today, it is generally accepted that severe AH is a form of acute - on - chronic liver failure in patients with underlying chronic alcohol - related liver disease ( ALD). The detailed diagnosis of AH was recently defined by the National Institute on Alcohol Abuse and Alcoholism ( NIAAA)- supported consortia and published in 2016. 2 The first diagnostic criterion is alcohol drinking history, which includes heavy drinking > 5 years, recent drinking > 6 months with < 60 days of abstinence before the onset of jaundice, and men with >4 drinks ( 50 -60 g)/day, and women with >3 drinks ( 40 g)/day. The typical clinical sign is jaundice with some non - specific signs and symptoms including malaise, tender hepatomegaly, decompensation (ascites, encephalopathy, bacterial infection, variceal bleeding). 展开更多
关键词 ALCOHOLIC HEPATITIS (AH) detailed DIAGNOSIS Institute on ALCOHOL
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酒精性肝炎新进展 预览
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作者 高斌 Vijay H. Shah 《临床肝胆病杂志》 CAS 北大核心 2019年第3期467-468,共2页
酒精性肝炎是酒精性肝病的重要表现形式,通常以酗酒所致的急性肝脏炎症为特征。本文就酒精性肝炎的发病机制、临床特征、诊断、现有治疗方法及未来治疗策略等进行了概括及评述,以帮助肝病医生在临床实践中更好地认识这一类疾病。
关键词 肝炎 酒精性 述评
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重视酒精性肝炎的临床研究 预览
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作者 王炳元 《临床肝胆病杂志》 CAS 北大核心 2019年第3期469-471,共3页
酒精性肝炎(AH)是肝脏的一种无菌性炎症性损伤,大多发生在慢性肝病(脂肪肝、肝硬化)的基础上,因短期内大量饮酒所致肝病的急性恶化,是酒精性肝病严重的表现形式。AH的预后取决于治疗的时机和方法,肝功能可迅速恢复,也可迅速恶化至多脏... 酒精性肝炎(AH)是肝脏的一种无菌性炎症性损伤,大多发生在慢性肝病(脂肪肝、肝硬化)的基础上,因短期内大量饮酒所致肝病的急性恶化,是酒精性肝病严重的表现形式。AH的预后取决于治疗的时机和方法,肝功能可迅速恢复,也可迅速恶化至多脏器功能衰竭。不少临床医生还缺乏对AH的早期识别和及时处理的经验,主要原因是AH缺乏典型的临床表现,又缺少特异性的辅助检查,从而影响临床诊断,贻误治疗时机。因此,重视AH的临床研究,总结出临床真实世界的大数据,制订相应的专家共识已经势在必行。 展开更多
关键词 肝炎 酒精性 诊断 述评
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Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report
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作者 Katerina G Oikonomou Dost Sarpel +2 位作者 Alexandra Abrams-Downey Adnan Mubasher Douglas T Dieterich 《世界肝病学杂志:英文版(电子版)》 2019年第2期226-233,共8页
BACKGROUND Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions oc... BACKGROUND Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities. The treatment includes systemic steroids and oral zinc supplementation. We report a case of NAE in a 66-year-old human immunodeficiency virus (HIV)/HCV co-infected woman with NAE. NAE is rarely reported in co-infected patients and the exact mechanisms of pathogenesis are still unclear. CASE SUMMARY A 66-year-old HIV/HCV co-infected female patient presented with painless, nonpruritic rash of extremities for one week and underwent extensive work-up for possible rheumatologic disorders including vasculitis and cryoglobulinemia. Punch skin biopsies of right and left thigh revealed thickened parakeratotic stratum corneum most consistent with NAE. Patient was started on prednisone and zinc supplementation with resolution of the lesions and improvement of rash. CONCLUSION Clinicians should maintain high clinical suspicion for early recognition of NAE in patients with rash and HCV. 展开更多
关键词 Necrolytic acral ERYTHEMA Human IMMUNODEFICIENCY VIRUS HEPATITIS C VIRUS Zinc DEFICIENCY Case report
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