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To explore the relationship between the liver fibrosis criteria and TCM Syndrome type in patients suffering from non-alcoholic fatty liver. Methods: Seventy-nine patients with non-alcoholic fatty liver diagnosed by B ultrasonography were classified by TCM Syndrome Differentiation and their liver fibrosis criteria was determined and compared with those of the healthy subjects as control. Results: Levels of procollagen Ⅲ (PCⅢ), hyaluronic acid (HA), collagen Ⅳ(CⅣ) and laminin (LN) in the fatty liver group were significantly higher than those in the control group (P<0.05, P<0.01). In respect to the TCM Syndrome-types, PCⅢ, CⅣ and LN in patients of Phlegm-stasis combined type were significantly higher than those in patients of Spleen deficiency-Phlegm dampness Syndrome-type and Damp-Heat Syndrome-type (P<0.05, P<0.01), while HA in different groups was insignificantly different (P>0.05). Conclusion: There was trend of liver fibrosis in fatty liver patients. It was indicated that the Phlegm-stasis combined Syndrome-type possibly was the main TCM pathologic factor of the increasing of fibrosis criteria for non-alcoholic fatty liver.
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To explore the relationship between the liver fibrosis criteria and TCM Syndrome type in patients suffering from non-alcoholic fatty liver. Methods: Seventy-nine patients with non-alcoholic fatty liver diagnosed by B ultrasonography were classified by TCM Syndrome Differentiation and their liver fibrosis criteria was determined and compared with those of the healthy subjects as control. Results: Levels of procollagen Ⅲ (PCⅢ), hyaluronic acid (HA), collagen Ⅳ(CⅣ) and laminin (LN) in the fatty liver group were significantly higher than those in the control group (P<0.05, P<0.01). In respect to the TCM Syndrome-types, PCⅢ, CⅣ and LN in patients of Phlegm-stasis combined type were significantly higher than those in patients of Spleen deficiency-Phlegm dampness Syndrome-type and Damp-Heat Syndrome-type (P<0.05, P<0.01), while HA in different groups was insignificantly different (P>0.05). Conclusion: There was trend of liver fibrosis in fatty liver patients. It was indicated that the Phlegm-stasis combined Syndrome-type possibly was the main TCM pathologic factor of the increasing of fibrosis criteria for non-alcoholic fatty liver.
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加强脂肪肝的中医药治疗研究
脂肪性肝病(fatty liver disease,FLD)简称脂肪肝,是一种病变主体在肝小叶,以肝细胞弥漫性大泡性脂肪变为主的临床病理综合征.目前认为FLD由遗传-环境-代谢应激相关因素所致,通常分酒精性和非酒精性脂肪性肝病(NAFLD)两大类.
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妊娠急性脂肪肝并急性肝衰竭的救治
妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)是一种发生于妊娠晚期,围生期死亡率很高的妊娠合并症.其主要特点是肝细胞脂肪变性,临床上以黄疽、凝血功能障碍和肝功能急剧衰竭为主要特征,同时伴有脑、肾等多种脏器功能不全~([1]).确切病因及发病机制不明,产后容易发生致命性大出血.
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急性妊娠脂肪肝三例
我院自1998年至2003年收治了3例急性妊娠脂肪肝(acute fatty liver of pregnance,AFLP)患者并全部存活,现报告如下.
关键词: 急性妊娠脂肪肝 Fatty Liver 现报告如下 患者 -
妊娠期急性脂肪肝20例临床分析
妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)是发生于妊娠晚期的一种严重并发症,主要病变为肝脏脂肪,短期内可发生多脏器损害,母婴病死率很高,孕产妇的死亡率在80%以上[1].因此,除积极地进行护肝等治疗外,早诊断、早治疗、及时终止妊娠是抢救母婴生命的有效手段.
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13C-美沙西丁呼气试验与非酒精性脂肪肝病理改变的相关性研究
目的:13C-美沙西丁(methacetine)呼气试验评价非酒精性脂肪肝肝细胞损害程度的方法及意义.方法:自行设计大鼠13C-美沙西丁呼气试验检测程序与方法;采用高脂饲料喂养方法建立脂肪肝模型;Wistar♂大鼠40只,重量200±20 g,随机分为高脂饲料喂养组(试验组)及普通饲料喂养组(正常对照组).于实验的2,4,6,8 wk分别对二组大鼠进行肝穿,观察其病理改变,根据Brunt积分系统评分;同时应用红外线能谱分析仪(IRIS)进行13C-美沙西丁呼气试验检测,观察呼气峰值(DOB)、达峰时间(T)和60 min累积呼气量(CU 60 min)各参数的动态变化,并结合动物的生理学特征分析;观察呼气试验中各参数的动态变化与病理变化的相关性.结果:试验组,对照组实验前的DOB分别为34.9±3.9‰和35.4±3.8‰,试验组2,4,6,8 wk的DOB分别为32.2±3.0%0,21.0±2.5%0,16.1±2.8%o和11.6±2.2%o,对照组2,4,6,8 wk的DOB分别为34.7±3.8‰,35.3±3.7%0,35.1±4.3%0和35.0±3.5‰;试验组各时间段之间的差别有显著性意义(P=0.00,P<0.01);与同期正常对照组大鼠相比,差别有统计学意义.而正常对照组各时间段之间差别无统计学意义(P>0.05).呼气试验结果(DOB)与同期的病理积分负相关(r=0.89,P=0.00,P<0.01).结论:13C-美沙西丁呼气试验有可能作为非酒精性脂肪肝病变程度无创性评价方法.
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中药肝脂复煎剂对酒精和高脂饲养诱导的大鼠脂肪肝的影响
目的:观察中药肝脂复煎剂对酒精和高脂饲养诱导的大鼠脂肪肝的防治作用.方法:采用高浓度酒精灌胃合高脂饲料饲养制备大鼠脂肪肝模型,同时给予不同剂量肝脂复煎剂治疗,以二甲双胍为对照.通过检测血清肝酶谱、肝组织匀浆甘油三脂含量和肝脏组织学变化,观察不同剂量肝脂复煎剂对脂肪肝的防治作用.结果:模型组大鼠肝脏出现明显的脂肪变性,肝酶活性(ALP、GGT)、血脂和肝组织甘油三脂含量升高(ALP:8 156±2 696 vs 4 478±2 229;GGT:52±14 vs24±21;TG:615±106 vs454±113,P<0.05;肝TG:53±10 vs27±8,P<0.01).肝脂复剂量组肝细胞脂肪变显著减轻,肝酶活性(ALP、GGT)、血脂和肝组织甘油三脂含量较模型组显著下降(ALP:5 666±2 187 vs8 156±2 696;GGT:24±14 vs52±14;TG:442±148 vs615±106;肝TG:35±4,36±6,38±6 vs 53±10,P<0.05-P<0.01),二甲双胍组肝组织甘油三脂含量较模型组下降(32±1 vs53±10,P<0.01),其余指标无显著差异.结论:肝脂复煎剂对脂肪肝具有良好的防治作用.
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大鼠急性酒精性脂肪肝造模方法的改进
目的:为酒精性脂肪肝的研究提供有价值的模型.方法:采用高浓度酒每日灌胃,同时改进饲料配方,增加食物中脂肪含量、增加铁剂的方法.结果:造模2 wk后可见肝脏轻微脂肪沉积,3 wk后呈中度脂肪肝,4 wk后为重度脂肪肝病变;与对照组相比,肝指数明显增大(模型组4.9±1.1;对照组4.0±0.6,P<0.05),具有统计学意义.结论:本造模方法与人类酒精性脂肪肝病变类似,方法简单易行、实验周期短,结论明确,一般实验室均可进行.
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INTRODUCTION Although liver transplantation for irreversible liver diseases is increasingly prevalent worldwide, patient die while waiting for donors because of organ shortages. One important problem commonly encountered is that fatty livers often affect the outcome of liver transplantation. It is reported that the incidence of abnormal fatty livers in autopsies after accidental death ranged from 15% to 24%.Since fatty livers may result in a primary nonfunction (PNF) liver graft, which contributes to an increased risk of mortality[1], they are usually out of consideration in liver transplantation.However, some fatty livers can be successfully transplanted. Therefore, how to choose fatty livers as donor organs correctly is the crux of success in liver transplantation.
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人工授精后双胎妊娠者发生急性脂肪肝并发多脏器功能障碍的抢救护理1例
妊娠急性脂肪肝(acute fatty liver of pregnancy, AFLP)是发生于妊娠晚期的特发性肝功能损伤,临床罕见,起病急、进展快、预后较差、母婴病死率高,并发多脏器功能障碍(metadata object description schema,MODS)的患者病死率更高[1]。国内外研究表明,双胎妊娠患者发病率较单胎妊娠患者高,而人工受精双胎妊娠患者在临床上亦较为常见。重症AFLP因急性肝衰竭导致MODS,涉及心脏、脑、肾脏、肺及凝血功能等,同时合并MODS的患者病死率高达60%以上[2]。本科室于2013年1月收治人工授精双胎孕妇发生妊娠急性脂肪肝1例,病情危重,短期内出现急性肝衰竭、产后大出血、急性肾损伤、急性心肌损伤、急性肺出血等多种严重并发症。经过积极治疗及护理,患者入住重症监护室(ICU)17天后转入普通病房,现将护理体会报告如下。
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妊娠急性脂肪肝多脏器衰竭并发耐甲氧西林金黄色葡萄球菌感染护理1例
妊娠急性脂肪肝(acute fatty liver of pregnancy, AFLP)是发生于妊娠晚期特有的致命性少见疾病,初产妇、妊娠期高血压疾病、双胎妊娠、单胎男胎为AFLP高危因素[1]。AFLP因急性肝衰竭导致多器官功能衰竭,同时合并多脏器功能衰竭的母婴病死率可高达85%以上[2],其可能与妊娠后期母体激素、环境、免疫异常,蛋白、脂质代谢障碍及胎儿等多方面因素相关[3]。研究[4]认为,胎儿线粒体长链3-羟酰基-辅酶A脱氢酶缺陷可致母亲发生AFLP。肝组织活检病理是AFLP确诊的惟一方法[5]。因此该疾病一经确诊或高度怀疑,均应紧急终止妊娠[6]。2013年2月本院收治1例AFLP并发多器官功能衰竭及耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)感染的患者,经过积极的治疗和护理,患者康复出院。现将护理体会报告如下。
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非酒精性脂肪性肝病合并糖尿病的治疗
非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是与胰岛素抵抗(IR)和遗传易感性密切相关的代谢应激性肝脏损害[1],病理学改变以肝细胞脂肪变性为主,其疾病谱包括非酒精性单纯性脂肪肝(nonalcoholic fatty liver,NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)、NASH相关性肝硬化及肝细胞癌。IR是NAFLD的核心病理生理基础,表现为机体胰岛素反应性葡萄糖转运能力降低,继而胰腺为满足细胞摄取和利用葡萄糖的需要超量分泌胰岛素代偿维持糖代谢稳态[2]。随着IR进展,不仅促使胰岛β细胞超负荷分泌胰岛素使得分泌功能受损,引起2型糖尿病(T2DM)发生,还可加重肝脏炎症和纤维化,后者又进一步损伤肝脏加剧IR,形成恶性循环[3]。NAFLD与T2DM共患,肝脏脂肪变更易向终末期肝病进展[4],肝癌发生风险倍增[5],同时患者的糖脂紊乱更难被纠正[6],显著增加T2DM相关心血管并发症的死亡率[1,7]。因此,如何选择合理的治疗策略,采取个体化的综合治疗控制血糖并延缓肝病恶化,降低心血管发病风险,对于改善NAFLD合并T2DM患者的预后具有重要意义。
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重视非酒精性脂肪性肝病合并2型糖尿病的防治
非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是与遗传易感和胰岛素抵抗(IR)密切相关的获得性代谢应激性肝损伤,疾病谱包括非酒精性脂肪肝(nonalcoholic fatty liver, NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis, NASH)及其相关肝硬化和肝细胞癌(hepatocellular carcinoma,HCC)[1-2]。随着肥胖和2型糖尿病(T2DM)的流行,NAFLD已成为我国第一大慢性肝脏疾病,普通成人患病率高达15%以上,并且愈来愈多的NAFLD发生在慢性病毒性肝炎和酒精滥用患者[3-4]。作为代谢综合征的重要组分,NAFLD患者主要死亡原因为心血管疾病(CVD)和恶性肿瘤[1-2],NASH特别是合并进展性肝纤维化患者肝病死亡显著增高,高达13.3%的T2DM患者死于肝硬化和HCC[5-6]。为此,NAFLD与T2DM互为因果,IR是其共同的发病机制。当前亟需加强NAFLD合并T2DM防治的临床研究,重视NAFLD和T2DM的筛查、预防、治疗和监测。
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非酒精性脂肪性肝病诊疗指南
非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是一种与胰岛素抵抗(insulin resistance,IR)和遗传易感密切相关的代谢应激性肝脏损伤,其病理学改变与酒精性肝病(alcoholic liver disease,ALD)相似,但患者无过量饮酒史,疾病谱包括非酒精性单纯性脂肪肝(nonalcoholic simple fatty liver,NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)及其相关肝硬化和肝细胞癌[1-2].
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非活动性HBsAg携带者并妊娠期急性脂肪肝一例报道
妊娠急性脂肪肝(acute fatty liver of pregnancy,AFLP)多发生于妊娠28~40周,临床上并不少见,近年报道该病例有增多趋势[1];AFLP起病急、病势凶险,病死率及早期诊断与治疗措施密切相关;随着乙肝疫苗的广泛接种,我国HBsAg阳性率显著降低,但仍高达7.18%[1],育龄期孕妇HBsAg阳性率达8.16%[2],高于普通人群的HBsAg阳性率,非活动性HBsAg携带者并AFLP临床上较为少见,本文报道1例如下.
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妊娠期急性脂肪肝的诊断处理再认识
妊娠期急性脂肪肝(acute fatty liver of pregnancy, AFLP)是妊娠特发致死性的严重并发症.由于此病的确切病因尚不清楚,至今还无有效的治疗方法,及早诊断和及时终止妊娠是良好预后的关键.本文就1名AFLP病例组织相关科室的临床讨论,分析了AFLP诊断及处理.
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妊娠期急性脂肪肝的诊断与治疗
妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)又称急性黄色肝萎缩,早在1940年由Sheehan报道,是一种临床上少见的产科危急重症,起病急,病情凶险,严重危及母儿生命安全.本病导致的孕产妇和围产儿死亡率已经从以前的75%和85%下降至1.8% ~18.0%和7%~23% [1-3].
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妊娠急性脂肪肝的诊治(附3例临床报告)
妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP),是妊娠特发致死性的严重并发症.AFLP起病急而凶险,死亡率高达85%.随着对该病认识的不断提高,目前该病的发病率降为1/7 000~1/6 000,孕产妇死亡率降至18%以下,围生儿死亡率降至15%~23%[1~3].早期诊断、积极有效治疗与及时合理的产科处理,可明显改善该病的预后.现结合我院收治的3例AFLP患者的临床资料,探讨其诊断和治疗.
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妊娠期急性脂肪肝研究进展
妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)是发生于妊娠晚期的一种严重的并发症,是造成妊娠期急性肝功能衰竭的原因之一.发病率1/1万~1/1.5万[1].