目的 探讨儿童不明原因肝功能异常的临床特点、病因及预后,为临床及时对因治疗提供帮助。方法 回顾性分析本院2016年1月—2017年12月期间205例以不明原因肝功能异常住院患者的临床资料,并对其临床特点、病因及预后进行分析。结果 在205例不明原因肝功能异常患者中,其中166例(80.97%)得到明确诊断,涉及多种疾病。其中分别为非嗜肝病毒所致感染性肝损104例(50.73%),遗传代谢疾病38例(18.54%),药物性肝损11例(5.37%),全身性疾病如川崎病6例(2.93%)、血液肿瘤疾病4例(1.95%)、营养不良3例(1.46%)等,原因未明 39例(19.02%)。结论 引起肝功能异常病因多且复杂。婴幼儿肝功能异常以非嗜肝病毒所致感染性肝损为主,感染主要为巨细胞病毒及EB病毒;遗传代谢性疾病、药物性肝损、全身性疾病也是造成肝功能异常的重要原因。

Objective To investigate the clinical features, etiology and prognosis of children patients with unexplained liver dysfunction. Methods The clinical data of 205 inpatients with unexplained liver dysfunction from January 2016 to December 2017 were analyzed retrospectively. The clinical characteristics, etiology and prognosis were analyzed. Results Of 205 patients with unexplained abnormal liver function, 166 patients with liver dysfunction (80.97%) were clearly diagnosed and involved in a variety of diseases. Among them, 104 cases were infected liver damage caused by non-hepatophilic virus, 38 cases were related to genetic metabolic diseases, 11 cases were drug-induced liver damage, 6 cases were Kawasaki disease, 4 cases were hematologic tumor diseases, 3 cases were malnutrition. The cause of abnormal liver function was not clear in 39 cases. Conclusion There are many and complicated causes of abnormal liver function, and part of the causes are unknown. Infantile liver dysfunction was mainly caused by non-hepatophilic virus, the first was cytomegalovirus, the second was Epstein-Barr virus; genetic metabolic disease, drug-induced liver damage, systemic disease are also an important cause of liver dysfunction.

目的 通过生物信息分析途径,从分子水平揭示非酒精性脂肪性肝病（NAFLD）的发病发展机制,为NAFLD研究提供新的思路。方法 从公共数据库GEO中下载NAFLD相关的基因芯片数据GSE48452,利用Transcriptome Analysis Console软件筛选差异表达基因,FunRich软件和STRING在线分析工具对差异基因进行下一步的生物信息学分析。结果 正常组与NAFLD组差异基因52个,正常组与非酒精性脂肪性肝炎（NASH）基因64个,共同差异基因15个。这些差异表达基因参与脂质转运、胆汁酸合成、脂质和脂蛋白代谢、生物氧化等过程。通过通路分析及蛋白质相互作用分析进一步筛选出与NAFLD发病发展密切相关的18个差异表达基因。结论 通过生物信息学分析筛选出MSN、CDC45、ANXA5、PIK3CG和DTL基因可能为研究乃至阻断NAFLD发展进程的重要靶点,需进一步验证。

Objective To explore the molecular mechanism of nonalcoholic fatty liver disease （NAFLD） with bioinformatics analysis. Methods The microarray data of NAFLD were downloaded from the Gene Expression Omnibus （GEO） database and analyzed using Transcriptome Analysis Console （TAC） for screening differentially expressed genes. The further analysis of differentially expressed genes was conducted by FunRich software and the online tool STRING. Results For the comparison of control group vs. NAFLD group,52 genes have differentially expressed,while control groups vs. nonalcoholic steatohepatitis （NASH） group,64 genes have differentially expressed. 15 differentially expressed genes were found in both comparisons. These genes were involved in the biological pathway of lipid transport,bile acid biosynthesis,metabolism of lipids and lipoproteins and biological oxidations. With biological pathway analysis and protein-protein interaction analysis,18 differentially expressed genes were found closely associated with the progression of NAFLD. Conclusion MSN、CDC45、ANXA5、PIK3CG and DTL may be the important target for study the progression of NAFLD,which needs a further study to confirm.

目的 分析于剖宫产产妇围手术期实施针对性护理对其切口感染率及不良情绪的影响。方法 选取2015年6月—2016年4月于我院择期行剖宫产术的102例产妇,通过随机数表法分为观察组与对照组,各51例。给予对照组常规护理,在此基础上观察组给予针对性护理干预。对比两组术后恢复情况、护理前后疼痛评分(VAS)、抑郁评分(SDS)及焦虑评分(SAS)变化情况,并统计两组并发症发生率、护理满意度。结果 观察组肛门排气时间、切口愈合时间、24 h睡眠时间、住院时间、下床活动时间均少于对照组,差异有统计学意义(P＜0.05);护理前两组SAS评分、SDS评分、VAS评分间无明显差异(P＞0.05),经护理干预,观察组SAS评分、SDS评分、VAS评分低于对照组,差异有统计学意义(P＜0.05);两组切口感染率、并发症发生率(1.96%、7.84%)低于对照组(15.69%、31.37%),差异有统计学意义(P＜0.05);两组护理满意度对比,观察组(98.04%)高于对照组(82.35%),差异有统计学意义(P＜0.05)。结论 给予剖宫产围术期产妇针对性护理疗效确切,可缓解不良情绪,减轻疼痛感,促使机体功能及早康复,减少切口感染与并发症发生。

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 观察并分析小儿肝门静脉海绵样变性者核因子-κB(NF-κB)活性在手术前后的变化。方法 以2005年2月—2013年7月我院收治的43例小儿肝门静脉海绵变性者为研究对象,以40例正常儿童为对照组,检测对照组以及观察组儿童在手术前后血清单个核细胞(PBMC)中的NF-κB p65/Lamin B1的相对含量和NF-κB活性。结果 观察组术前、术后PBMC中NF-κB p65的相对含量分别为(1269.3±349.8)ng/mg、(884.5±154.8)ng/mg,均高于正常对照组(106.1±12.7)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05);观察组术前、术后PBMC中NF-κB的活性分别为(2194.5±471.3)ng/mg、(1376.9±203.7)ng/mg,均高于正常对照组(221.1±33.6)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05)。结论 经手术治疗后,小儿肝门静脉海绵样变性者PBMC中NF-κB p65的相对含量、NF-κB的活性均显著降低,表明手术在一定程度上有效缓解了肝门静脉高压的病症。

目的 探讨腹腔镜治疗肝右叶癌的疗效。方法 2011年6月—2014年9月我院对78例肝右叶癌行手术治疗,其中18例行全腹腔镜肝癌切除术,60例行开腹肝癌切除术。比较两组患者的手术时间、术中出血量、术后住院时间、术后并发症发生率、术后一年生存率。结果 腹腔镜组手术时间为(348.8±98.8)min,长于开放手术组,差异具有统计学意义(P<0.05);腹腔镜组术中出血量、术后住院时间、术后并发症发生率均少于开放手术组,相比差异具有统计学意义(P<0.05);两组患者术后1年复发率及生存率比较未见统计学意义(P>0.05)。结论 腹腔镜治疗肝右叶癌手术难度大,但相比开腹手术,腹腔镜肝右叶癌切除术具有术中出血量少、术后住院时间短、术后并发症发生率低的优点。

Objective To evaluate the clinical efficacy of laparoscopic treatment of carcinoma of the right lobe of the liver. Methods from June 2011 to September 2014 in our hospital 78 cases of liver cancer of right lobe underwent surgical treatment, including 18 cases of pure laparoscopic liver resection, 60 cases underwent open resection of hepatocellular carcinoma. Comparing the two groups of patients with operation time,intraoperative bleeding volume,postoperative hospitalization time, postoperative complication rat and one year survival rate. Results The operative time of laparoscopic group was 348.8±98.8 min, longer than the open surgery group, the difference has statistical significance (P<0.05); The intraoperative bleeding volume,postoperative hospitalization time,postoperative complication rate in the laparoscopic group was less than that of the open surgery group, the difference has statistical significance (P<0.05); Two groups of patients with postoperative 1 year survival rate and recurrence rate were not statistically significant (P>0.05). Conclusion Laparoscopic treatment of the liver cancer of the right lobe is difficult, but compared to open surgery, laparoscopic resection of the liver cancer of the right lobe has advantages of less bleeding, shorter postoperative hospitalization, lower postoperative complication rate.

目的 探讨拉米夫定治疗对乙肝活动的肺结核病人抗结核治疗中的临床价值。方法 通过回顾性分析159例初治肺结核乙肝表面抗原(HBsAg)阳性、HBV-DNA定量阳性病人,所有病例在抗结核前查肝功能均正常,分为两组,治疗组:在抗结核及护肝治疗过程中,加用拉米夫定抗乙肝病毒治疗;对照组:没用任何抗乙肝病毒药物;分别在抗结核治疗前、治疗2周、4周及8周复查肝功能,对比两组间肝损发生率,及肝损发生时间及严重程度。抗结核治疗4周后复查HBV-DNA定量,对比两组间HBV-DNA定量下降例数。结果 治疗组的肝损发生率仅20.5%,对照组病人抗结核治疗后肝损的发生率为53.1%,两者间差异有统计学意义。治疗组肝损出现时间多为大于4周,而且多数是轻度肝损。治疗组出现肝损中断抗结核治疗的病例数低于对照组。抗乙肝病毒治疗后复查HBV-DNA定量降低例数高于对照组。结论 拉米夫定抗乙肝病毒治疗,能抑制乙肝病毒复制,降低乙肝合并肺结核病人的肝损发生率并减轻肝损严重程度,提高病人对抗结核药物的耐受性。

目的 探讨生理情况下高龄肝脏与低龄肝脏的区别,寻找可以区分高龄肝脏与低龄肝脏的指标。方法 取6周龄SD大鼠和9月龄以上退役SD大鼠各5只,采用超声弹性成像检测肝脏硬度、全自动生化检测仪检测血清学指标、H&E染色观察肝脏形态结构、Sirius Red染色及Masson染色检测胶原纤维的沉积、免疫组化SP法检测TGF-β1、p16^INK4a、SMP-30蛋白的表达。结果 高龄组和低龄组之间血清学指标、胶原纤维沉积及TGF-β蛋白、p16^INK4a蛋白的表达无差异;超声弹性成像检测低龄组Vs值为(1.21±0.09)m/s,高龄组为(1.32±0.05)m/s(P=0.033);SMP-30蛋白低龄组IOD值为138244.988±51286.257,高龄组为116240.170±35017.936(P=0.007)。结论 高龄大鼠与低龄大鼠肝脏的硬度及SMP-30蛋白的表达存在差异,随着年龄的增加肝脏硬度增大,SMP-30蛋白表达下降。肝脏硬度与SMP-30蛋白可作为区分高龄肝脏与低龄肝脏的指标。

Objective To investigate the differences between elderly and younger liver. Methods In accordance with the age of the SD rats into two groups: younger group (Group Y, 6 weeks, n=5) and elderly group (Group O, 40 weeks or more, n=5). Data were compared by using ultrasound elasticity imaging to detect liver stiffness, automatic biochemical detector to gauge serum indexes, H&E staining to observe the liver morphological structure, Sirius Red staining and Masson staining to assay the collagen fibers deposition, Immunohistochemistry to identify the expression of TGF-β₁, p16^INK4a and SMP-30 protein. Results Serum indexes, collagen deposition, TGF-β₁ and p16^INK4a protein expression were no statistically significant difference between two groups. The Vs value was (1.21±0.09) m/s in Group Y and (1.32±0.05) m/s in Group O (P=0.033). and the IOD value of SMP-30 protein between Group Y and Group O were 138244.988±51286.257 and 116240.170±35017.936 (P=0.007). Conclusion The degree of liver stiffnessnd and SMP-30 protein in elderly and younger liver are different.Increased the degree of liver stiffness and decreased the expression of SMP-30 protein in the elderly SD rats. Liver stiffness and SMP-30 protein could be used as indicators to distinguish between elderly and younger liver.

目的 探讨儿童登革热(DF)合并肝功能损害的临床特征。方法 对2014年8—12月我院感染科收治住院的78例儿童DF的临床资料进行回顾性分析。结果 并发肝功能损害36例(46.15%),其中血清丙氨酸转氨酶(ALT)升高24例(30.77%),血清天冬氨酸转氨酶(AST)升高33例(42.31%);27例(75%)ALT/AST病程2周内恢复正常,9例于1月复查恢复正常。仅有1例总胆红素(TBIL)升高80.8 μmol/L,直接胆红素升高为主,1周后恢复正常。肝功能损害组较无肝功能损害组在外周血白细胞水平、血小板水平差异有统计学意义(P<0.05)。结论 儿童DF并肝功能损害较普遍,以轻度损害为主。与年龄、性别、皮疹、外周血白细胞、血小板有相关性。

Objective To approach the clinical characteristics of children dengue fever combined liver function damage. Methods Clinical data of 78 cases of children dengue fever in our hospital were retrospectively analyzed from August to December in 2014. Results 36 cases (46.15%) complicated with liver function damage. Among them 24 cases (30.77%) of serum alanine aminotransferase (ALT) increased, 33 cases (42.31%) of serum aspartate aminotransferase (AST) increased; 27 cases (75%)ALT/AST returned to normal within 2 weeks, 9 cases were recovered to normal in 1 month. Only 1 cases of total bilirubin (TBIL) increased to 80.8 mol/L, recovered after 1 week. Liver injury group and non liver injury group of peripheral blood leukocytes, platelets level comparison was statistically significant (P<0.05). Conclusion Children dengue fever combined liver function damage was common, mainly mild. There was correlation with age, gender, skin rash, peripheral blood leukocytes and platelets.