TJLB, transjugular liver biopsy

TJLB,经颈静脉肝活检
  • 文章类型: Journal Article
    背景:造血干细胞(HSC)输注已证明慢性肝病患者的肝功能短期改善。HSC与间充质干细胞(MSCs)的组合,具有免疫调节作用,可能会增强效果并延长肝功能改善的持续时间。本研究的目的是评估在失代偿期肝硬化中输注自体HSCs和MSCs组合的安全性。
    方法:在研究的第一阶段,进行体外评估以观察共培养MSC与HSC对其活力和细胞因子谱的影响。研究的第二阶段是评估干细胞输注组合的安全性。使用标准方案抽吸骨髓(50ml)用于MSC分离和扩增。患者接受皮下剂量(n=5)的粒细胞集落刺激因子(G-CSF)用于干细胞动员,然后使用CliniMac进行白细胞去除术以收获HSC。在荧光透视引导下通过肝动脉输注HSC和MSC,并监测任何不良反应。
    结果:体外研究显示,在类似于单一培养的共培养中94%的活HSC。HSC仅释放白细胞介素(IL)-8,而MSC在单一培养中分泌IL-8和IL-6,IL-8和IL-6在共培养中均分泌。未观察到G-CSF给药和骨髓抽吸相关并发症。通过肝动脉输注细胞是安全的,未发现术后并发症.
    结论:在失代偿期肝硬化患者中,自体HSC和MSC联合输注是一种安全的方法,结果需要在更大的研究中进行评估.
    背景:NCT04243681。
    BACKGROUND: Haematopoietic stem cell (HSC) infusion has demonstrated short-term improvement in liver functions in patients with chronic liver disease. The combination of HSC with mesenchymal stem cells (MSCs), which has an immunomodulatory effect, may augment the effects and enhance the duration of improvements on liver functions. The aim of the present study was to assess the safety of infusing the combination of autologous HSCs and MSCs in decompensated liver cirrhosis.
    METHODS: In phase I of the study, in vitro assessment was performed to observe the effect of coculturing MSCs with HSCs on their viability and cytokine profiles. Phase II of the study was to assess the safety of combination of stem cell infusions. Bone marrow (50 ml) was aspirated for MSC isolation and expansion using standard protocol. Patients received subcutaneous doses (n = 5) of granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization followed by leukapheresis for harvesting HSCs using CliniMacs. HSCs and MSCs were infused through the hepatic artery under fluoroscopic guidance and were monitored for any adverse effects.
    RESULTS: In vitro studies revealed 94% viable HSCs in coculture similar to monoculture. HSCs released only interleukin (IL)-8, whereas MSCs secreted IL-8 and IL-6 in monocultures, and both IL-8 and IL-6 were secreted in coculture. G-CSF administration- and bone marrow aspiration-related complications were not observed. Infusion of the cells through the hepatic artery was safe, and no postprocedural complications were noted.
    CONCLUSIONS: The combination of autologous HSC and MSC infusion is a safe procedure in patients with decompensated liver cirrhosis, and the outcomes needed to be assessed in larger studies.
    BACKGROUND: NCT04243681.
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  • 文章类型: Journal Article
    急性肝衰竭(ALF)是罕见的,不可预测的,各种病因导致的急性肝损伤(ALI)的潜在致命并发症。文献中报道的ALF病因具有区域差异,影响临床表现和自然病程。在旨在反映印度临床实践的共识文章的这一部分中,疾病负担,流行病学,临床表现,监测,和预测已经讨论过了。在印度,病毒性肝炎是ALF的最常见原因,抗结核药物引起的药物性肝炎是第二常见的原因。ALF的临床表现以黄疸为特征,凝血病,和脑病。区分ALF和其他肝衰竭的原因是很重要的,包括慢性急性肝衰竭,亚急性肝功能衰竭,以及某些可以模仿这种表现的热带感染。该疾病通常具有暴发性临床过程,短期死亡率很高。死亡通常归因于脑部并发症,感染,导致多器官衰竭。及时肝移植(LT)可以改变结果,因此,在可以安排LT之前,为患者提供重症监护至关重要。评估预后以选择适合LT的患者同样重要。已经提出了几个预后评分,他们的比较表明,本土开发的动态分数比西方世界描述的分数更具优势。ALF的管理将在本文件的第2部分中描述。
    Acute liver failure (ALF) is an infrequent, unpredictable, potentially fatal complication of acute liver injury (ALI) consequent to varied etiologies. Etiologies of ALF as reported in the literature have regional differences, which affects the clinical presentation and natural course. In this part of the consensus article designed to reflect the clinical practices in India, disease burden, epidemiology, clinical presentation, monitoring, and prognostication have been discussed. In India, viral hepatitis is the most frequent cause of ALF, with drug-induced hepatitis due to antituberculosis drugs being the second most frequent cause. The clinical presentation of ALF is characterized by jaundice, coagulopathy, and encephalopathy. It is important to differentiate ALF from other causes of liver failure, including acute on chronic liver failure, subacute liver failure, as well as certain tropical infections which can mimic this presentation. The disease often has a fulminant clinical course with high short-term mortality. Death is usually attributable to cerebral complications, infections, and resultant multiorgan failure. Timely liver transplantation (LT) can change the outcome, and hence, it is vital to provide intensive care to patients until LT can be arranged. It is equally important to assess prognosis to select patients who are suitable for LT. Several prognostic scores have been proposed, and their comparisons show that indigenously developed dynamic scores have an edge over scores described from the Western world. Management of ALF will be described in part 2 of this document.
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