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Objective To explore the recovery time of hepatic function in infants with jaundice type of human cytomega-lovirus (HCMV) hepatitis and its influencing factors. Methods The clinical data of 73 infants with jaundice type of HCMV hepa-titis admitted to hospital from February 2005 to October 2012 were retrospectively analyzed. The effects on hepatic function of nine factors including age, sex, liver size, total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspar-tate aminotransferase (AST), total bile acid (TBA) and the loads of HCMV DNA were assessed by Kaplan Meier method, and further analyzed by Cox proportional hazards regression model. Results The results of Cox proportional hazards regression showed that age≤3 month (RR=0.27, 95%CI:0.10-0.70), DBil≤90μmol/L (RR=0.16, 95%CI:0.08-0.32), male (RR=0.49, 95%CI:0.26-0.94) and enlarged liver size<3 cm (RR=0.50, 95%CI:0.27-0.93) were independent factors that shorten the time for TBil back to be normal. Furthermore, AST≤120 U/L (RR=0.16, 95%CI:0.08-0.33) and enlarged liver size<3 cm (RR=0.28, 95%CI:0.15-0.49) were independent factors that shorten the time for AST back to be normal. The time for TBil back to be normal was (2.23 ± 1.54) months, which was significantly shorter than that [(3.63 ± 1.93) months] of AST (t=10.37, P<0.001). Conclusions Jaundice type HCMV hepatitis had good outcome and varied in disease course. The recovery of hepatic function was significantly adversely affected by the degree of cholestasis and hepatomegaly as well as AST level, and early treatment was conducive to the recovery.
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ObjectiveTo investigate the effect of N-acetylcysteine on lung injury induced by cardiopulmonary bypass(CPB) in dogs.MethodsThirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into 2 groups (n =18 each):CPB group (group C) and N-acetylcysteine group(group N).Lung injury was produced by CPB.In group N N-acetylcysteine 150 mg/kg was injected iv immediately before CPB,followed by infusion at 20 mg· kg-1 · h-1 until 60 min after termination of CPB.Blood samples were taken from femoral artery before CPB (T0,baseline),30 and 60 min after termination of CPB (T1,T2 ).Oxygenation index ( OI =PaO2 ÷ FiO2 ) and respiratory index (RI =PA-(a) DO2 ÷ PaO2 ) were calculated.Six animals were sacrificed at each time point.Lung specimens were obtained for microscopic examination,and determination of transforming growth factor-β1 (TGF-β1) mRNA expression,MDA content and SOD activity.ResultsCPB significantly increased RI,MDA content and TGF-β1 mRNA expression and decreased OI and SOD activity at T1 and T2 as compared with the baseline values at T0 in group C.N-acetylcysteine administered before and during CPB significantly attenuated CPB-induced above changes in OI,RI,MDA content,SOD activity and TGF-β1 mRNA expression.Microscopic examination showed that N-acetylcysteine significantly ameriorated CPB-induced lung damage.ConclusionsN-acetylcysteine administered before and during CPB can attenuate CPB-induced lung injury by inhibiting lipid peroxidation response and down-regulating TGF-β1 expression.
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Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.
ABSTRACT
Objective To evaluate the protective effect on the pulmonary micmvascolar permeability and thereby to ameliorate the lungs injury attributed to cardiopuimonary bypass(CPB).Method Twenty-four adult hybrid health dogs were randomly divided into three groups(8 in each group):group C(normal saline given after CPB),group N1(NAC given intravenously just before CPB)and group N2(NAC given just after CPB).The changes of respiratory index(RI)and malondialdehyde(MDA)content in lung tissue were observed.Samples were taken three times,before CPB(T0),30 min after CPB surned off(T1)and 60 min after CPB sumed off(T2).The leucocyte count and slbumin content in bronchoalveolar lavage fluid(BAlF),the pulmonary micmvascular permeability index(PMPI),and the histological changes of lung under light microscope and electromicroscope in 3 groups were examined.Results No significant differences were found in the levels of Ri and MDA content of lung tissue between groups before CPB.However,they gradually reduced after CPB(P<0.05)in the three groups,but they still were significantly lower in group N1 and group N2 compared with those in group C at,T1 and T2(P<0.05)and those in group N1 were significantly lowere than those in group N2 at T1 and T2(P<0.05).MDA gradually increased after CPB in three groups(P<0.05),but it was still significantly lower in group N1 and group N2 than that in group C at T1 and T2(P<0.05).The leucocyte count and albumin content in BALF were significantly lower in group N1 and group N2 in comparison with those in group C(P<0.05)and they were significantly lower in group N1 compared with those in group N2(P<0.05).The PMPI were significantly lower in group N1 and sroup N2 compared with those in group C(P<0.05)and they were significantly lower in group N1 compared with those in group N2(P<0.05).By using electromicroscope,the apparent inflammatory change of lung with endothelium cellular swelling,inter-endothelial cells spaces widened,and the indistinctness,deformation or decurtation of microfilarnent were observed.And the dissolution of laminated body,swollen mitochondria and plasmolysis were found in alveolar epithelial cell Ⅱ in group C.However,these changes were markedly alleviated in group N2 and group N1.Conclusions The results clearly demonstrate that NAC could protectie effect on the CPB injured lung and reduce the pulmonary microvascalar permeability,and the protetive effect is better in group N1 than that in group N2.