Development of the gene therapy against the organ dysfunction in the patients under LVAS support.

1. 为了预测术后患者的高胆红素血症，我们评估了术前因素（肝细胞损伤、肝窦内皮功能障碍、肝功能和炎症反应）。手术为二尖瓣置换术。术前测定血清谷草转氨酶（AST）、丙氨酸转氨酶（ALT）、透明质酸（HA）、总胆红素（TB）、胆碱酯酶（ChE）、白细胞介素-6 （IL-6）、白细胞介素-8 （IL-8）、CRP水平。我们评估这些指标与术后7天结核高峰水平的相关性。术前TB、ChE、I-IA、IL-6水平与术后TB峰值水平有较好的相关性。这些结果提示肝功能、肝窦内皮功能障碍和炎症反应可能是预测患者术后肝功能衰竭的重要因素。为了阐明高胆红素血症在左心室辅助装置（LVAS）设置下的机制，我们评估了LVAS植入前后肝细胞功能、肝窦内皮微循环和炎症反应的变化。我们测量了血清总胆红素（TB）、转氨酶（ALT、AST）、白细胞介素（IL-6、IL-8）和血凝素水平；LVAS植入前后肝窦循环指标。I-LA和IL-8水平与TB水平有良好的相关性。而AST、ALT和11-6与TB的变化无关。这些结果提示肝窦内皮功能障碍和炎症反应可能在lvas植入后患者肝功能衰竭中起重要作用。在目前的情况下，我们有越来越多的机会来管理肝炎后和/或充血性肝功能障碍的患者。为了防止术后肝功能衰竭，我们描述了这些患者的围手术期管理。我们没有有效的方法来估计功能储备，但我们的数据表明，术前状态的血清胆碱酯酶水平可能具有预后意义。少

1. To forecast the hyper bilirubinemia in the patients after operation, we evaluated the preoperative factors (hepatocyte damage, hepatic sinusoid-endothelial dysfunction, liver function and inflammatory response). Operations performed were mitral valve replacement. We measured the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), hyaluronic acid (HA), total bilirubin (TB), choline estelase (ChE), interleukm-6 (IL-6), interleukin-8 (IL-8) and CRP before operation. We evaluated the correlation between these indexes and the peak level of TB in seven post-operative days. The levels of preoperative TB, ChE, I-IA and IL-6 had a good correlation with the peak level of postoperative TB.These results suggested that liver function, hepatic sinusoid-endothelial dysfunction and inflammatory reaction may play a significant role in forecast of postoperative hepatic failure in patients.2. To clarify the mechanism of hyper-bilirubinemia in the setting of left ventricular assis … More t device (LVAS), we evaluated the change of hepatocellular function, hepatic sinusoid-endothelial microcirculation and inflammatory response before and after LVAS implantation. We measured serum levels of total bilirubin (TB), transaminases (ALT,AST), interleukin (IL-6, IL-8), and HA ; a indicater for hepatic sinusoidal circulation, before and after LVAS implantation. The level of I-LA and IL-8, had a good correlation with the level of TB.However, the AST, ALT or 11-6 did not relate to the alternation of TB.These results suggested that hepatic sinusoid-endothelial dysfunction and inflammatory reaction may play a significant role in hepatic failure in patients following implantation of LVAS.3. Under the current situations we have increasing opportunities to manage the patients with posthepatitis and/or congestive liver dysfunction. In order to prevent postoperative hepatic failure we described perioperative management for those patients. We have no effective methods to estimate the functional reserve, but our data suggested that serum cholineesterase level at the preoperative states might demonstrate prognostic significance. Less