ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
【摘要】 目的 分析腺苷蛋氨酸治疗慢性乙型肝炎高胆红素血症的临床疗效。 方法 回顾性分析2010年1-12月28例接受腺苷蛋氨酸（2 000 mg静脉滴注，1次/d）治疗慢性乙型肝炎高胆红素血症患者的临床资料，并对腺苷蛋氨酸治疗慢性重症乙型肝炎高胆红素血症后症状、体征及实验室检测指标的改变情况进行总结，利用多因素logistic回归分析方法探索与疗效相关的预测因素。根据相关症状、体征和实验室结果的不同，将疗效分为显效、有效和无效3类。 结果 28例患者使用腺苷蛋氨酸治疗4周后，显效20例（71.4%），有效4例（14.3%），无效4例（14.3%）。多因素logistic回归分析提示病程短、并发症少是影响腺苷蛋氨酸疗效的独立预测因素。 结论 腺苷蛋氨酸是治疗慢性乙型肝炎高胆红素血症有效，发病时间短及并发症少的患者退黄效果更好。【Abstract】 Objective To investigate the curative efficacy of ademetionine in the treatment of hyperbilirubinemia for chronic hepatitis B patients. Methods The clinical data of 28 chronic hepatitis B patients with intrahepatic cholestasis receiving intravenous ademetionine treatment (2 000 mg per day) were retrospectively analyzed. Patients’ symptoms, body signs and laboratory examination results were summarized, and predictors for efficacy were investigated using multiple regression analysis. In this study, the curative efficacy was classified into remarkable efficacy, efficacy and inefficacy, according to the clinical data. Results After one-month treatment with ademetionine, the percentage for remarkable efficacy, efficacy and inefficacy was 71.4%, 14.3%, and 14.3% respectively. Multivariate logistic regression analysis showed that short disease duration and fewer complications were independent predictors for remarkable efficacy of ademetionine treatment. Conclusion Ademetionine is an effective agent for the treatment of hyperbilirubinemia in chronic hepatitis B patients, and the result is especially good for patients with short duration and fewer complications.
目的:通过对高胆红素血症新生儿换血前后血生化、甲状腺功能变化的检测,探讨其原因。方法:分别对17例高胆红素血症新生儿换血前后血常规、电解质、血糖及甲状腺功能等指标进行检测。结果:本组血清总胆红素和间接胆红素换血前、后有明显下降。换血后血电解质血钾降低,血钠、血钙升高,血糖暂时性升高,但在24 h内自行恢复至正常。可有贫血,白细胞及血小板明显下降,甲状腺功能变化没有显著性意义(Pgt;0.05),无明显并发症发生。结论:换血后可出现低钾、高钙、高钠、高血糖、低白细胞和血小板血症的发生,应预防感染、出血和电解质紊乱的发生。
目的:观察神经保护剂及早期干预联合应用对重症新生儿高胆红素血症神经行为预后的影响。方法:将2007年1月至2008年6月收治重症新生儿高胆红素血症患儿67例随机分为常规治疗组和综合治疗组2组。 常规治疗组按照新生儿黄疸干预推荐方案,给与对症治疗;药物治疗;蓝光治疗;周围血管法同步换血等常规治疗。综合治疗组在常规治疗基础上,同时给与新生儿抚触1天2次和神经保护剂神经节苷脂20mg/d×10天,并在经抢救治疗进入恢复期后,按照《0～3 岁早期干预大纲》采用医院和家庭相结合的方式从视,听,触,运动等各方面给予早期干预至6月龄。两组患儿均在6月龄采用北京－Gesell婴幼儿发育诊断量表进行智能测试,比较各组发育商(DQ)。同时对两组后遗症发生机率比较。结果:患儿6月龄时,综合治疗组与常规治疗组在大运动,语言,个人 社交及适应性4个能区均有显著差异(Plt;0.01),精细动作能区有明显差异(Plt;0.05),差别有统计学意义。综合治疗组与常规治疗组后遗症发生率比较(Plt;0.05),差异有统计学意义。结论:急性期神经保护剂及早期干预联合应用可促进重症新生儿高胆红素血症患儿的智能发育,减少神经行为后遗症的发生。
摘要:目的:分析高胆红素血症新生儿血清神经元特异性烯醇化酶(NSE)含量和新生儿行为神经能力测评(Neonatal Behavioral Neurological Assessment,NBNA)的变化,探讨高胆红素血症新生儿血清NSE含量变化的临床意义。方法:应用放射免疫分析法分别测定60例高胆红素血症新生儿和20例对照组新生儿血清NSE含量,同步测定血清总胆红素(TSB),进行NBNA评分;高胆红素血症组早期干预后再次测定血清NSE含量。结果: 与对照组比较,高胆红素血症新生儿血清TSB、NSE含量显著升高,而NBNA评分明显降低,差异有显著性意义(Plt;0.01);对照组与高胆红素血症新生儿轻度增高、中度增高、重度增高四组两两比较(均Plt;0.05),存在显著性差异;血清NSE含量与NBNA评分呈明显负相关(r=-0628,Plt;0.01);高胆红素血症新生儿经早期干预治疗后,血清NSE含量均下降(Plt;0.05),差异有显著性。结论: 高胆红素血症可导致新生儿脑损伤,血清NSE含量可以作为脑损伤的监测指标。Abstract: Objective: To analyze levels of neuronspecific enolase(NSE)in serum and neonatal behavioral neurological assessment (NBNA), to study whether NSE in serum can be used as a tool for the early identification of brain damage in neonatal hyperbilirubinemia. Methods: Serum NSE level of 60 full term infants with hyperbilirubinemia and 20 cases as to control group were measured by radioimmunoassay; Also total serum bilirubin (TSB) and NBNA were detected. In the hyperbilirubinemia group,serum NSE level were measured second when TSB were less than 855 μmol/L(5 mg/dL). Results: Compared with control group,the levels of serum TSB、NSE of the hyperbilirubinemia group were significantly higher, but NBNA score was significantly lower. The levels of serum NSE was significantly negative related to NBNA score. In the hyperbilirubinemia group, serum NSE level were significantly lower after treatment. Conclusion: Hyperbilirubinemia in neonates can cause brain damage. Serum NSE level could work as monitoring indexes of this damage.
ObjectiveTo evaluate the role of N-methyl-D-aspartate (NMDA) receptor in central nervous system (CNS) injury of obstructive jaundice. MethodThe related literatures about NMDA receptor and the CNS injury caused by hyperbilirubinemia were retrieved and reviewed. ResultsThe CNS injury of obstructive jaundice was related to overactivation of NMDA receptor, which finally resulted in degeneration and necrosis of nerve cells. The NMDA receptor antagonist MK-801 could relieve the CNS injury of obstructive jaundice. ConclusionsNMDA receptor plays an important role in the CNS injury caused by hyperbilirubinemia, and the blocker of NMDA receptor has protective effects in this process. However, there is no report of MK-801 in clinical application when hyperbilirubinemia happened.
Objective To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia. Methods All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery. Results The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up. Conclusions Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.