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A Patient with Acute Liver Injury after Sulfamethoxazole/Trimethoprim Treatment for Pyelonephritis 认领
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作者 Maria Green Sarah Baroud +1 位作者 Martin Sayegh Hanady Zainah 《肾脏病(英文)》 2020年第4期367-374,共8页
<strong>Background:</strong> Sulfamethoxazole/Trimethoprim is a commonly used drug in a variety of clinically indicated scenarios, but it is not without side effect. Case-reports have stated that adverse r... <strong>Background:</strong> Sulfamethoxazole/Trimethoprim is a commonly used drug in a variety of clinically indicated scenarios, but it is not without side effect. Case-reports have stated that adverse reactions secondary to Sulfamethoxazole/Trimethoprim can present very early in the course of treatment, especially in patients who have a higher predisposition. Thus, the burden is placed on the clinician to be wary of these side effects and be able to recognize them in the correct clinic scenario. Objective: To discuss the risk of developing cholestatic hepatic dysfunction secondary to treatment with sulfamethoxazole/trimethoprim. <strong>Methods:</strong> We present the history, physical findings, laboratory investigations, and clinical course of a 47-year-old African-American female who developed cholestatic hepatic dysfunction after treatment with sulfamethoxazole/trimethoprim for pyelonephritis. <strong>Results:</strong> Drug-induced liver injury is a rare complication of sulfamethoxazole/trimethoprim therapy and only 20% of cases are secondary to cholestatic hepatic dysfunction. Our patient, who had been on sulfamethoxazole/trimethoprim for 7 days for pyelonephritis, presented to our hospital with a clinical picture consistent with hepatic injury;her laboratory investigations were noteworthy for an elevated white blood cell count, platelet count, and elevated transaminases, along with alkaline phosphatase levels greater than 2 times the upper limit of normal. Promptly following the discontinuation of sulfamethoxazole/trimethoprim, our patient improved clinically and her liver enzymes down-trended during the course of her hospital stay. She returned to normal at her 4 month follow up, thus confirming the diagnosis of cholestatic hepatic dysfunction secondary to sulfamethoxazole/trimethoprim. <strong>Conclusion:</strong> Cholestatic hepatic dysfunction is a form of drug-induced liver injury and a rare complication of sulfamethoxazole/trimethoprim treatment. The majority of cases resolve following discontinuat 展开更多
关键词 Sulfamethoxazole/Trimethoprim Cholestatic Hepatic Dysfunction
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α-荼异硫氰酸酯诱导小鼠胆汁淤积性肝纤维化及其炎症通路 认领
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作者 罗怡爽 郑秀婷 +4 位作者 章浩月 徐丽萍 裘加鹏 徐港铭 刘爱明 《中国应用生理学杂志》 CAS CSCD 北大核心 2020年第2期152-157,共6页
目的:探讨α-荼异硫氰酸酯(ANIT)诱导的胆汁淤积性肝纤维化的发展及其炎症通路。方法:将15只体重为(23±2)g的129/Sv小鼠随机分为对照组(n=5)和实验组(n=10)。对照组常规饲料喂养,实验组小鼠给予0.05%ANIT饲料食饲。实验组分别在14 ... 目的:探讨α-荼异硫氰酸酯(ANIT)诱导的胆汁淤积性肝纤维化的发展及其炎症通路。方法:将15只体重为(23±2)g的129/Sv小鼠随机分为对照组(n=5)和实验组(n=10)。对照组常规饲料喂养,实验组小鼠给予0.05%ANIT饲料食饲。实验组分别在14 d和28 d各处死5只小鼠,收集胆囊、血清、肝脏等标本。按试剂盒程序检测胆汁淤积生化指标,组织病理学评估肝细胞损伤程度,Q-PCR和WB分析肝纤维化、炎症反应等水平。结果:与对照组相比,造模第2周ANIT-14 d组(A-D14)中的主要胆汁淤积指标总胆汁酸(TBA)从(3.2±0.9)μmol/L显著增加至(31.6±4.3)μmol/L,肝损伤指标谷草转氨酶(AST)和谷丙转氨酶(ALT)也显著升高(P<0.05);纤维化因子金属蛋白酶组织抑制因子1(TIMP-1)、单核细胞趋化因子(MCP-1)、Ⅰ型胶原蛋白(CollagenⅠ)表达高于对照组(P<0.05);CollagenⅠ和α-SMA纤维化蛋白表达均上调;肝脏胶原纤维大量沉积,纤维化已产生(P<0.05)。炎症因子表达高于对照组,JNK、c-Jun、STAT3等均被激活(P<0.05)。ANIT-28 d组(A-D28)中除AST、基质金属蛋白酶2(MMP-2),CollagenⅠ指标稍有降低外,其余胆汁淤积、肝损伤、肝纤维化、炎症等指标继续上调或保持稳定(P<0.05)。结论:0.05%的ANIT饲料干预14 d,小鼠即发生明显的胆汁淤积性肝纤维化;28 d后,胆汁淤积性肝纤维化趋于稳定;JNK炎症通路在肝纤维化的发生发展中起着至关重要的作用。 展开更多
关键词 α-荼异硫氰酸酯 胆汁淤积 肝纤维化 JNK通路 小鼠
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Cholestatic liver diseases: An era of emerging therapies 认领 被引量:1
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作者 Hrishikesh Samant Wuttiporn Manatsathit +4 位作者 David Dies Hosein Shokouh-Amiri Gazi Zibari Moheb Boktor Jonathan Steve Alexander 《世界临床病例杂志》 SCIE 2019年第13期1571-1581,共11页
Recently the field of cholestasis has expanded enormously reflecting an improved understanding of the molecular mechanisms underlying bile secretion and its perturbation in chronic cholestatic disease. Novel anti-chol... Recently the field of cholestasis has expanded enormously reflecting an improved understanding of the molecular mechanisms underlying bile secretion and its perturbation in chronic cholestatic disease. Novel anti-cholestatic therapeutic options have been developed for patients not favorably responding to ursodeoxycholic acid (UDCA), the current standard treatment for cholestatic liver disease. Important novel treatment targets now also include nuclear receptors involved in bile acid (BA) homoeostasis like farnesoid X receptor and G proteincoupled receptors e.g., the G-protein-coupled BA receptor “transmembrane G coupled receptor 5”. Fibroblast growth factor-19 and enterohepatic BA transporters also deserve attention as additional drug targets as does the potential treatment agent norUDCA. In this review, we discuss recent and future promising therapeutic agents and their potential molecular mechanisms in cholestatic liver disorders. 展开更多
关键词 BILE ACIDS DRUG therapy Cholestatic liver disease NUCLEAR receptor AGONISTS
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Osteoporosis in primary biliary cholangitis 认领
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作者 Christopher J Danford Hirsh D Trivedi +2 位作者 Konstantinos Papamichael Elliot B Tapper Alan Bonder 《世界胃肠病学杂志:英文版》 SCIE CAS 2018年第31期3513-3520,共8页
Primary biliary cholangitis(PBC)is an autoimmune cholestatic liver disease with multiple debilitating complications.Osteoporosis is a common complication of PBC resulting in frequent fractures and leading to significa... Primary biliary cholangitis(PBC)is an autoimmune cholestatic liver disease with multiple debilitating complications.Osteoporosis is a common complication of PBC resulting in frequent fractures and leading to significant morbidity in this population,yet evidence for effective therapy is lacking.We sought to summarize our current understanding of the pathophysiology of osteoporosis in PBC,as well as current and emerging therapies in order to guide future research directions.A complete search with a comprehensive literature review was performed with studies from PubMed,EMBASE,Web of Science,Cochrane database,and the Countway Library.Osteoporosis in PBC is driven primarily by decreased bone formation,which differs from the increased bone resorption seen in postmenopausal osteoporosis.Despite this fundamental difference,current treatment recommendations are based primarily on experience with postmenopausal osteoporosis.Trials specific to PBC-related osteoporosis are small and have not consistently demonstrated a benefit in this population.As it stands,prevention of osteoporosis in PBC relies on the mitigation of risk factors such as smoking and alcohol use,as well as encouraging a healthy diet and weight-bearing exercise.The primary medical intervention for the treatment of osteoporosis in PBC remains bisphosphonates though a benefit in terms of fracture reduction has never been shown.This review outlines what is known regarding the pathogenesis of bone disease in PBC and summarizes current and emerging therapies. 展开更多
关键词 BILIARY cirrhosis Cholestatic liver disease OSTEOPENIA Hepatic OSTEODYSTROPHY BISPHOSPHONATES HORMONE replacement therapy
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18β-Glycyrrhetinic acid protects against alpha-naphthylisothiocyanate- induced cholestasis through activation of the Sirt1/FXR signaling pathway 认领 被引量:1
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作者 Shou-yan Wu Shi-chao Cui +6 位作者 Le Wang Yi-ting Zhang Xiao-xia Yan Heng-lei Lu Guo-zhen Xing Jin Ren Li-kun Gong 《中国药理学报:英文版》 SCIE CAS CSCD 2018年第12期1865-1873,共9页
Cholestasis is a common feature of liver injury, which manifests as bile acid excretion and/or enterohepatic circulation disorders. However, very few effective therapies exist for cholestasis. Recently, 18β-Glycyrrhe... Cholestasis is a common feature of liver injury, which manifests as bile acid excretion and/or enterohepatic circulation disorders. However, very few effective therapies exist for cholestasis. Recently, 18β-Glycyrrhetinic acid (18b-GA), a major metabolic component of glycyrrhizin, which is the main ingredient of licorice, was reported to protect against alpha-naphthylisothiocyanate (ANIT)-induced cholestasis. However, its protective mechanism remains unclear. We hypothesized that 18b-GA may stimulate the signaling pathway of bile acid (BA) transportation in hepatocytes, resulting its hepatoprotective effect. According to the results, 18b-GA markedly attenuated ANIT-induced liver injury as indicated the hepatic plasma chemistry index and histopathology examination. In addition, the expression levels of nuclear factors, including Sirt1, FXR and Nrf2, and their target efflux transporters in the liver, which mainly mediate bile acid homeostasis in hepatocytes, signi?cantly increased. Furthermore, we first revealed that 18b-GA treatment significantly activated FXR, and which can be significantly reduced by EX-527 (a potent and selective Sirt1 inhibitor), indicating that 18b-GA activates FXR through Sirt1. Taken together, 18b-GA confers hepatoprotection against ANIT-induced cholestasis by activating FXR through Sirt1, which promotes gene expression of the efflux transporter, and consequently attenuates dysregulation of bile acid homeostasis in hepatocyte compartments. 展开更多
关键词 HEPATOPROTECTIVE effect cholestatic liver injury 18β-glycyrrhetinic ACID (18b-GA) FXR SIRT1 bile ACID transporters
杠板归总黄酮提取物对α-萘异硫氰酸脂诱导小鼠胆汁淤积性肝损伤保护作用研究 认领 被引量:3
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作者 陈婧 张天洪 +2 位作者 万雪梅 蒋菁蓉 高爽 《重庆医科大学学报》 CAS CSCD 北大核心 2018年第1期32-35,共4页
目的:通过构建α-萘异硫氰酸脂(α—naphtllylisothiocyanate,ANlT)诱导小鼠肝损伤模型,研究杠板归总黄酮提取物对小鼠肝脏的保护作用及其作用机制。方法:随机将60只昆明种小鼠分为6组,分别为空白对照组,病理模型组,阳性对照... 目的:通过构建α-萘异硫氰酸脂(α—naphtllylisothiocyanate,ANlT)诱导小鼠肝损伤模型,研究杠板归总黄酮提取物对小鼠肝脏的保护作用及其作用机制。方法:随机将60只昆明种小鼠分为6组,分别为空白对照组,病理模型组,阳性对照组(联苯双酯0.15g/kg),杠板归总黄酮提取物高、中、低剂量组(1.2、0.6,0.3g/kg)。除空白对照组外,采用腹腔注射ANIT的方法制造小鼠急性肝损伤模型,用杠板归总黄酮提取物连续灌胃9d,禁食20h后,眼球取血、取肝组织,测定肝组织中超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、谷胱甘肽(glutathione,GSH)的含量及血清谷丙转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate amino transferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、总胆汁酸(total bile acid,TBA)、总胆红素(total bilirubin,TBIL)水平。结果:与模型组相比,杠板归总黄酮高剂量组小鼠血清ALT水平[(243.14±27.35)U/L]、AST水平[(345.02±24.01)U/L]、LDH水平[(505.97±68.56)U/L]、TBA水平[(112.02±17.16)nmol/mL]、TBIL水平[(15.08±4.09)nmol/mL]以及肝组织中GSH含量[(63.08±4.88)umol/mg]和MDA含量[(3.55±0.32)nmol/mg]明显降低,差异具有统计学意义(P〈0.05);中剂量组小鼠肝组织中血清ALT水平[(330.56±24.74)U/L]、AST水平[(438.60±32.51)U/L]、LDH水平[(597.90±66.90)U/L]、TBA水平[(144.62±16.37)nmol]mL]、TBIL水平[(27.36±6.51)nmol/mL]以及肝组织中GSH含量[(54.52±3.80)umol/mg]和MDA含量[(5.65±0.35)nmol/mg]与模型组相比也明显降低,差异也具有统计学意义(P〈0.05)。结论:杠板归总黄酮对ANIT诱导小鼠胆汁淤积性肝损伤有一定的疗效。 展开更多
关键词 杠板归 总黄酮 保肝 胆汁淤积性 α-萘异硫氰酸脂
Drug-induced liver injury: Do we know everything? 认领
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作者 Tamara Alempijevic Simon Zec Tomica Milosavljevic 《世界肝病学杂志:英文版(电子版)》 2017年第10期491-502,共12页
Interest in drug-induced liver injury(DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating th... Interest in drug-induced liver injury(DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating the current state of the art, the latest scientific findings, controversies, and guidelines, this review will attempt to answer the question: Do we know everything? Since the first descriptions of hepatotoxicity over 70 years ago, more than 1000 drugs have been identified to date, however, much of our knowledge of diagnostic and pathophysiologic principles remains unchanged. Clinically ranging from asymptomatic transaminitis and acute or chronic hepatitis, to acute liver failure, DILI remains a leading causes of emergent liver transplant. The consumption of unregulated herbal and dietary supplements has introduced new challenges in epidemiological assessment and clinician management. As such, numerous registries have been created, including the United States Drug-Induced Liver Injury Network, to further our understanding of all aspects of DILI. The launch of Liver Tox and other online hepatotoxicity resources has increased our awareness of DILI. In 2013, the first guidelines for the diagnosis and management of DILI, were offered by the Practice Parameters Committee of the American College of Gastroenterology, and along with the identification of risk factors and predictors of injury, novel mechanisms of injury, refined causality assessment tools, and targeted treatment options have come to define the current state of the art, however, gaps in our knowledge still undoubtedly remain. 展开更多
关键词 尖锐的肝失败 导致药的肝损害 Hepatoxicity Acetaminophen 毒性 Cholestatic 损害 肝活体检视 PHARMACOEPIDEMIOLOGY 草药导致肝损害 Hys 法律
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茵陈蒿汤对胆汁淤积性肝纤维化大鼠内质网应激PERK通路的影响 认领 被引量:9
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作者 李木松 张贵贤 +1 位作者 魏媛媛 刘震霞 《中国中医药科技》 CAS 2016年第5期535-538,共4页
目的:观察茵陈蒿汤对胆汁淤积性肝纤维化大鼠PKR样内质网激酶(PERK)-真核生物翻译起始因子(e IF2α)-转录活性因子4(ATF4)的影响,探讨茵陈蒿汤抗胆汁淤积性肝纤维的作用机制。方法:将35只SD大鼠分为假手术组和造模组,采用胆总... 目的:观察茵陈蒿汤对胆汁淤积性肝纤维化大鼠PKR样内质网激酶(PERK)-真核生物翻译起始因子(e IF2α)-转录活性因子4(ATF4)的影响,探讨茵陈蒿汤抗胆汁淤积性肝纤维的作用机制。方法:将35只SD大鼠分为假手术组和造模组,采用胆总管结扎法复制胆汁淤积性肝纤维化大鼠模型,1 W后将造模组动物分为模型组和中药组,中药组予以3.5 g/kg茵陈蒿汤灌胃,4 W后处死动物。HE、Masson染色观察肝脏组织病理学变化;Western blot法检测各组大鼠肝脏PERK、e IF2α和ATF4蛋白表达的变化。结果:肝脏组织病理学变化显示模型组大鼠肝纤维化程度较假手术组明显增加(P〈0.05),中药组大鼠肝纤维化程度较模型组减轻(P〈0.05),但仍重于假手术组。Western blot结果显示,模型组肝脏PERK、e IF2α和ATF4蛋白的表达与假手术组相比显著升高(P〈0.01),中药组较模型组PERK、e IF2α和ATF4蛋白表达明显降低(P〈0.01)。结论:抑制PERK、e IF2α和ATF4的活化,从而减少肝细胞凋亡,进而抑制内质网应激在胆汁淤积性肝纤维化中的促进作用,是茵陈蒿汤抗胆汁淤积性肝纤维化的作用机制之一。 展开更多
关键词 肝硬化 胆汁性 菌陈蒿汤 @内质网激酶 大鼠
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Primary biliary cirrhosis: Pathophysiology, clinicalpresentation and therapy 认领 被引量:4
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作者 Treta Purohit Mitchell S Cappell 《世界肝病学杂志:英文版(电子版)》 2015年第7期926-941,共16页
主要胆汁的肝硬化(PBC ) 是一自体免疫,慢慢地进步, cholestatic,长期的 cholestasis 的一个三个一组描绘的肝疾病,传播 anti-mitochondrial 抗体(AMA ) ,和 nonsuppurative 的典型的肝活体检视调查结果破坏胆管炎和 interlobular... 主要胆汁的肝硬化(PBC ) 是一自体免疫,慢慢地进步, cholestatic,长期的 cholestasis 的一个三个一组描绘的肝疾病,传播 anti-mitochondrial 抗体(AMA ) ,和 nonsuppurative 的典型的肝活体检视调查结果破坏胆管炎和 interlobular 胆汁管破坏。然而,大约 10% PBC 病人缺乏 AMA。变体的、叫的 PBC 自体免疫的肝炎(AIH ) 重叠,被 PBC 的上述调查结果和提高的浆液丙氨酸 aminotransferase,提高的浆液免疫球蛋白 G,和传播反光滑的肌肉抗体的调查结果描绘,与肝活体检视示威 periportal 或 periseptal,淋巴球,一件坏死。PBC 被假设与在遗传上脆弱的个人的环境暴露有关。它典型地发生在中年的女性。突出的临床的特征包括疲劳, pruritis,黄疸,黄瘤,骨质疏松症,和 dyslipidemia。Mayo 风险分数是广泛地使用的大多数和最好的预示的系统。Ursodeoxycholic 酸是主要治疗。它由从相对有毒的胆汁酸减少集中和损害部分工作。PBC-AIH 重叠症候群与 ursodeoxycholic 酸和 corticosteroids 被治疗,特别 budesonide。Obeticholic 酸和 fibrate 是有希望的新,但是不完全地测试了,治疗。肝移植是为先进疾病的权威的治疗,与在移植以后的大约 70%10 年的幸存。pruritis 的管理包括本地皮肤照顾,皮肤学家工作分派,避免潜在的 pruritogens, cholestyramine,并且可能 opioid 对手, sertraline,或 rifaximin。骨质疏松症的管理包括生活方式修正,钙的管理和维生素 D,并且 alendronate。Statins 是相对安全的对待与 PBC 联系的 osteopenia。联系 Sjogrens 症候群被人工的眼泪治疗, cyclosporine 刺激眼泪生产的眼的乳剂;并且口水代用品,胆碱能的代理人,和谨慎小心的口头、牙齿的照顾。从先进 PBC 的肝硬化的复杂并发症包括食道的静脉曲张,腹水,自发的细菌的腹膜炎, hepatorenal 症候群,和 hepatoma 形成。 展开更多
关键词 主要胆汁的肝硬化 Ursodeoxycholic 肝硬化 肝移植 Cholestatic 肝疾病
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胆汁淤积性肝病的诊断与治疗 认领 被引量:10
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作者 连敏 马雄 《中华肝脏病杂志》 CAS CSCD 北大核心 2015年第8期564-568,共5页
胆汁淤积是指胆汁流的形成和排泌障碍,可由肝细胞或胆管上皮的胆汁形成、分泌障碍或胆汁流的阻断引起。胆汁淤积性肝病包括原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)、原发性硬化性胆管炎(primary sclerosing cholangiti... 胆汁淤积是指胆汁流的形成和排泌障碍,可由肝细胞或胆管上皮的胆汁形成、分泌障碍或胆汁流的阻断引起。胆汁淤积性肝病包括原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)、原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)、IgG4相关硬化性胆管炎(IgG4-relatedsclerosing cholangitis,IgG4。SC)、妊娠期肝内胆汁淤积(intrahepatic cholestasis of pregnancy,ICP)以及遗传性疾病如进行性家族性肝内胆汁淤积(progressive familial intrahepatic cholestasis,PFIC)等。 展开更多
关键词 肝疾病 胆汁淤积性 肝硬化 胆汁性 胆管炎 硬化性 胆汁淤积 肝内
小柴胡汤加逐瘀利胆方治疗胆汁淤积型慢性乙型病毒性肝炎随机平行对照研究 认领 被引量:4
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作者 王忠贝 《实用中医内科杂志》 2015年第3期27-29,共3页
[目的]观察小柴胡汤+逐瘀利胆方治疗胆汁淤积型慢性乙型病毒性肝炎疗效。[方法]使用随机平行对照方法,将78例住院患者按就诊顺序号法简单随机分为两组。对照组39例肝功能检查,三元基因干扰素α-1b,500万IU/次,隔日1次,肌注。治疗组39... [目的]观察小柴胡汤+逐瘀利胆方治疗胆汁淤积型慢性乙型病毒性肝炎疗效。[方法]使用随机平行对照方法,将78例住院患者按就诊顺序号法简单随机分为两组。对照组39例肝功能检查,三元基因干扰素α-1b,500万IU/次,隔日1次,肌注。治疗组39例小柴胡汤(柴胡根15g,羌活10g,香附、瓜蒌各20g,郁金、半夏姜、南星各15g,黄芪30g,桂枝10g,荆芥穗20g,甘草5g);逐瘀利胆方(白术、柴胡根各15g,黄芪30g,郁金15g,桃仁20g,茵陈30g,大黄炒8g,滑石30g,车前子30g,甘草5g);均1剂/d,水煎200m L,早晚口服。连续治疗15d为1疗程。观测临床症状、ALT、AST、γ-GT、HBV-DNA阳性比、HBe Ag阳性比、不良反应。治疗1疗程(15d),判定疗效。[结果]治疗组痊愈15例,显效7例,有效12例,无效5例,总有效率87.18%。对照组痊愈12例,显效13例,有效4例,无效9例,总有效率76.92%。治疗组疗效优于对照组(P〈0.05)。两组症状、体征积分均有改善(P〈0.05),治疗组改善优于对照组(P〈0.05)。[结论]小柴胡汤+逐瘀利胆方治疗胆汁淤积型慢性乙型病毒性肝炎效果显著,值得推广。 展开更多
关键词 慢性乙肝 小柴胡汤 逐瘀利胆方 淤胆型 三元基因干扰素α-1b ALT AST γ-GT HBV-DNA阳性比 HBeAg阳性比 中医药治疗 随机平行对照研究
前列地尔联合复方甘草酸苷治疗重度慢性乙型肝炎合并淤胆的疗效及对血清生化指标的影响 认领 被引量:8
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作者 张海燕 范晖 《中国医学前沿杂志(电子版)》 2014年第5期136-138,共3页
目的:探讨前列地尔联合复方甘草酸苷治疗重度慢性乙型肝炎合并淤胆的临床疗效。方法将92例重度慢性乙型肝炎合并淤胆患者采用数字表法随机分为两组,两组均给予复方甘草酸苷注射液,另外观察组在此基础上加用前列地尔,比较两组临床疗... 目的:探讨前列地尔联合复方甘草酸苷治疗重度慢性乙型肝炎合并淤胆的临床疗效。方法将92例重度慢性乙型肝炎合并淤胆患者采用数字表法随机分为两组,两组均给予复方甘草酸苷注射液,另外观察组在此基础上加用前列地尔,比较两组临床疗效及血清生化指标变化。结果观察组总有效率为89.13%,显著高于对照组(76.09%)(χ2=7.83,P<0.05);观察组治疗后总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)和碱性磷酸酶(AKP)指标分别为(68.78±7.82)μmol/L、(54.64±6.68)μmol/L、(64.57±8.97)IU/L、(59.62±7.34)IU/L和(60.23±8.22)IU/L,均显著低于治疗前[(265.63±11.78)μmol/L、(138.49±11.29)μmol/L、(557.62±21.23)IU/L、(157.72±10.31)IU/L 和(170.38±11.20)IU/L](t=11.23、10.42、10.63、9.88、10.68,P<0.05)和对照组[(153.68±8.62)μmol/L、(137.44±9.31)μmol/L(、152.02±12.33)IU/L(、114.82±9.21)IU/L和(106.83±9.01)IU/L](t=8.38、8.01、7.92、8.30、7.20,P<0.05)。结论前列地尔联合复方甘草酸苷治疗重度慢性乙型肝炎合并淤胆具有显著疗效。 展开更多
关键词 前列地尔 复方甘草酸苷 乙型肝炎 淤胆
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丹参冻干注射用灭菌粉末联合优思弗治疗病毒性肝炎并发淤胆病的回顾性分析 认领
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作者 景丽荣 《世界最新医学信息文摘(电子版)》 2014年第29期61-62,共2页
目的:探讨优思弗配伍丹参冻干注射用灭菌粉末对病毒性肝炎合并淤胆的临床疗效情况。方法选取我院94例病毒性肝炎合并淤胆患者行分组对照研究,按分层法将94例患者分为试验组及对照组,每组各47例。对照组患者采用基础治疗(还原性谷胱... 目的:探讨优思弗配伍丹参冻干注射用灭菌粉末对病毒性肝炎合并淤胆的临床疗效情况。方法选取我院94例病毒性肝炎合并淤胆患者行分组对照研究,按分层法将94例患者分为试验组及对照组,每组各47例。对照组患者采用基础治疗(还原性谷胱甘肽,甘草酸二铵,岩黄连及促肝细胞生长素等);试验组在此基础上,给予优思弗配伍丹参冻干注射用灭菌粉末。对比两组临床疗效情况。结果试验组显效11例,有效35例,无效1例,总有效率为97.87%;对照组显效6例,有效25例,无效16例,总有效率为65.96%;试验组总有效率显著高于对照组(P〈0.01)。结论应用优思弗配伍丹参冻干注射用灭菌粉末治疗病毒性肝炎合并淤胆临床疗效显著,值得临床推广应用。 展开更多
关键词 优思弗 丹参冻干注射用灭菌粉末 肝炎 瘀胆
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Mastabol 导致了尖锐 cholestasis : 一份案例报告 认领
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作者 Brett M Hymel David W Victor +2 位作者 Luis Alvarez Nathan J Shores Luis A Balart 《世界肝病学杂志:英文版(电子版)》 2013年第3期133-136,共4页
A 26-year-old male presented with three weeks of jaundice after the self-initiation of the injectable anabolic steroid, Mastabol [Dromastanolone Di-Propionate (17 beta-Hydroxy-2alpha-methyl-5alpha-androstan-3one prop... A 26-year-old male presented with three weeks of jaundice after the self-initiation of the injectable anabolic steroid, Mastabol [Dromastanolone Di-Propionate (17 beta-Hydroxy-2alpha-methyl-5alpha-androstan-3one propionate)]. He reported dark urine, light stools, and pruritus. He denied abdominal pain, intravenous drug use, intranasal cocaine, blood transfusions, newly placed tattoos, or sexually transmitted diseases. He used alcohol sparingly. Physical exam revealed jaundice with deep scleral icterus. The liver was palpable 2 cm below the right costal margin with no ascites. The peak bilirubin was 23.6 mg/dL, alkaline phosphatase was 441 units/L, and aspartate aminotransferase/alanine aminotransferase were 70 units/L and 117 units/L respectively. A working diagnosis of acute intrahepatic cholestasis was made. Liver biopsy revealed a centrilobular insult with neutrophilic infiltrates and Ito cell hyperplasia consistent with acute drug induced cholestasis. The patient’ s clinical symptoms resolved and his liver enzymes, bilirubin, and alkaline phosphatase normalized. Anabolic steroids with 17 alpha carbon substitutions have been associated with a bland variety of cholestatic injury with little hepatocellular injury. Cholestasis, under these circumstances, may be secondary to the binding of drugs to canalicular membrane transporters, accumulation of toxic bile acids from canalicular pump failure, or genetic defects in canalicular transport proteins. Mastabol is an injectable, 17 beta hydroxyl compound with no alpha alkyl groups at the 17 carbon position. As such, it has been reported to have little potential toxic effects on the liver. This is the first known reported case of Mastabolinduced cholestatic liver injury. It highlights the need for physicians to consider such widely available substances when faced with hepatic injury of unclear etiology. 展开更多
关键词 Cholestatic Mastabol HEPATIC ANABOLIC STEROIDS
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丁二磺酸腺苷蛋氨酸治疗淤胆型病毒性肝炎31例疗效观察 认领 被引量:4
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作者 刘娥元 《吉林医学》 CAS 2013年第15期2870-2871,共2页
目的:观察丁二磺酸腺苷蛋氨酸治疗淤胆型病毒性肝炎的疗效。方法:选择62例淤胆型病毒性肝炎患者为研究对象,对照组31例采用常规还原型谷胱甘肽、复方甘草酸苷等保肝治疗,治疗组31例在对照组基础上加用丁二磺酸腺苷蛋氨酸。结果:治疗... 目的:观察丁二磺酸腺苷蛋氨酸治疗淤胆型病毒性肝炎的疗效。方法:选择62例淤胆型病毒性肝炎患者为研究对象,对照组31例采用常规还原型谷胱甘肽、复方甘草酸苷等保肝治疗,治疗组31例在对照组基础上加用丁二磺酸腺苷蛋氨酸。结果:治疗组患者治疗总有效率明显高于对照组(P〈0.05),生化指标下降速度以及幅度明显优于对照组(P〈0.05);皮肤瘙痒疗效明显优于于对照组(P〈0.05),SAS和SDS评分明显下降(P〈0.05),两组患者在治疗期间均未出现不良反应。结论:丁二磺酸腺苷蛋氨酸可作为临床治疗淤胆型病毒性肝炎的首选药物,其退黄效果明显,疗效显著,同时能有效的改善患者的心理状况,促进患者生活和生存质量的改善,值得在临床上广泛的推广和应用。 展开更多
关键词 丁二磺酸腺苷蛋氨酸 淤胆型 病毒性肝炎
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Human Toxocariasis Presenting with Fever and Colestatic Hepatitis: An Underestimated but Current Zoonosis 认领
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作者 Vera Sicbaldi Andrea Bellodi +2 位作者 Valerio Del Bono Eleonora Arboscello Riccardo Ghio 《临床医学国际期刊(英文)》 2012年第7期595-597,共3页
Human toxocariasis is a widespread parasitic disease caused by ingestion of Toxocara canis or catis larvae or eggs. Parasitic diseases are uncommon in industrialized countries, yet this problem has not disappeared. Pa... Human toxocariasis is a widespread parasitic disease caused by ingestion of Toxocara canis or catis larvae or eggs. Parasitic diseases are uncommon in industrialized countries, yet this problem has not disappeared. Parasitic diseases can cause different syndrome (visceral larva migrans, ocular larva migrans) and the clinical features can be confusing. Severe organ involvement affecting the liver, lungs, nervous central system and eyes can lead to serious damage. We present a case of toxocariasis presenting with fever, desaturation and cholestatic hepatitis. Only the subsequent appearance of eosinophilia helped us to arrive at the correct diagnosis. Prompt diagnosis allowed specific therapy avoiding permanent complications. 展开更多
关键词 TOXOCARIASIS VISCERAL Larva Migrans Ocular Larva Migrans PARASITOSIS Cholestatic HEPATITIS EOSINOPHILIA
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赤栀黄汤治疗胆总管结石术后胆汁淤积性黄疸35例 认领 被引量:5
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作者 闵光涛 李玉民 +3 位作者 侯旭东 曹农 高育新 汤浩 《西部中医药》 2012年第8期83-84,共2页
目的:观察中药赤栀黄汤治疗胆总管结石术后黄疸的临床疗效。方法:将55例患者随机分为治疗组35例,对照组20例,对照组使用注射型还原型谷胱甘肽1.8 g,静脉滴注,1次/d;促肝细胞生长素1.0g,静脉滴注,1次/d;维生素C 2.0 g、维生素K1200 mg... 目的:观察中药赤栀黄汤治疗胆总管结石术后黄疸的临床疗效。方法:将55例患者随机分为治疗组35例,对照组20例,对照组使用注射型还原型谷胱甘肽1.8 g,静脉滴注,1次/d;促肝细胞生长素1.0g,静脉滴注,1次/d;维生素C 2.0 g、维生素K1200 mg、肌苷0.4 g,静脉滴注,1次/d。治疗组在此基础上加用中药赤栀黄汤治疗,4周为1个疗程,1个疗程后观察临床疗效及肝功能变化情况。结果:治疗组总有效率为91.43%,对照组为75.00%,2组相比差异有统计学意义(P〈0.05);治疗后肝功能改善情况治疗组优于对照组,有统计学意义(P〈0.05)。结论:赤栀黄汤剂联合西医常规治疗胆汁淤积性黄疸可明显改善临床症状。 展开更多
关键词 黄疸 胆汁淤积性 胆总管结石术 赤栀黄汤
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主要 sclerosing 胆管炎的管理 认领
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作者 Holger H Lutz Jens JW Tischendorf 《世界肝病学杂志:英文版(电子版)》 2011年第6期137-141,共5页
Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with major morbidity and mortality.Therapeutic management is difficult,due to lack of conclusive data and individual disease progression.High-d... Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with major morbidity and mortality.Therapeutic management is difficult,due to lack of conclusive data and individual disease progression.High-dose UDCA was used for years as a pharmacotherapeutic agent to prevent disease progression,based on a positive trend in pilot studies,but has recently been proven to have a negative effect in advanced disease.Immunosuppressants might be useful in patients with overlap syndromes.Dominant bile duct stenoses should be treated endoscopically,and cholangiocellular carcinoma (CCC) still remains a therapeutic challenge in PSC patients.Early diagnosis of CCC must be improved and new strategies such as neoadjuvant radiochemotherapy with subsequent liver transplantation in selected patients are further options to be considered. 展开更多
关键词 Primary SCLEROSING CHOLANGITIS Ursodeoxycholic acid NorUDCA Cholangiocellular CARCINOMA Cholestatic liver disease ENDOSCOPY DOMINANT stenoses
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在 cholangiocyte 功能的调整的性荷尔蒙的角色 认领
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作者 Romina Mancinelli Paolo Onori +6 位作者 Sharon DeMorrow Heather Francis Shannon Glaser Antonio Franchitto Guido Carpino Gianfranco Alpini Eugenio Gaudio 《世界胃肠病理生理学杂志:英文版(电子版)》 2010年第2期50-62,共13页
Over the last years,cholangiocytes,the cells that line the biliary tree,have been considered an important object of study for their biological properties which involves bile formation,proliferation,injury repair,fibr... Over the last years,cholangiocytes,the cells that line the biliary tree,have been considered an important object of study for their biological properties which involves bile formation,proliferation,injury repair,fibrosis and angiogenesis.Cholangiocyte proliferation occurs in all pathologic conditions of liver injury where it is associated with inflammation and regeneration.During these processes,biliary cells start to secrete different cytokines,growth factors,neuropeptides and hormones which represent potential mechanisms for cross talk with other liver cells.Several studies suggest that hormones,and in particular,sex hormones,play a fundamental role in the modulation of the growth of this compartment in the injured liver which functionally conditions the progression of liver disease.Understanding the mechanisms of action and the intracellular pathways of these compounds on cholangiocyte pathophysiology will provide new potential strategies for the management of chronic liver diseases.The purpose of this review is to summarize the recent findings on the role of sex hormones in cholangiocyte proliferation and biology. 展开更多
关键词 BILIARY EPITHELIUM SEX HORMONES Cholestatic DISEASES
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婴儿胆汁淤积性肝病肝组织病理学特征及其在病因诊断中的意义 认领 被引量:7
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作者 赵瑞秋 管晓琴 +1 位作者 罗子国 许红梅 《中华肝脏病杂志》 CAS CSCD 北大核心 2010年第9期694-698,共5页
目的 研究婴儿胆汁淤积性肝病肝活组织检查的病理及超微病理结构特征,并结合临床资料探讨其在诊断中的意义.方法 对2007-2008年在重庆医科大学儿童医院就诊的36例胆汁淤积型婴儿肝炎综合征患儿进行肝活组织检查并随访,分析其肝组织病理... 目的 研究婴儿胆汁淤积性肝病肝活组织检查的病理及超微病理结构特征,并结合临床资料探讨其在诊断中的意义.方法 对2007-2008年在重庆医科大学儿童医院就诊的36例胆汁淤积型婴儿肝炎综合征患儿进行肝活组织检查并随访,分析其肝组织病理及超微病理特征.结果 36例婴儿胆汁淤积性肝病肝活组织检查的光镜结果显示,肝细胞肿胀、变性、坏死,多核巨细胞形成,胆管增生,纤维组织增生,肝小叶和汇管区炎性细胞浸润为主要病理表现.肝细胞淤胆,假腺腔形成、羽毛状变性和毛细胆管胆栓形成为胆汁淤积的特征.7例影像学检查除外胆道闭锁病例的肝组织呈现典型胆道梗阻征象.电镜下常见核改变、胞质溶解、炎症细胞浸润、胶原纤维增生和溶酶体增多.形态学改变结合临床表现诊断肝糖原累积病2例,尼曼皮克病1例,分类不明脂质沉积病1例.结论 婴儿胆汁淤积性肝病肝组织普通光镜和电镜下存在共同的病理改变,两者相结合增加了遗传代谢性疾病的检出率.部分影像学诊断困难的胆道闭锁患者,其肝组织形态学可提示胆道梗阻. 展开更多
关键词 婴儿 病理学 显微镜检查 肝病 胆汁淤积性 超微结构
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