失代偿期肝硬化合并多原发癌1例报告

晁文婷; 黄睿

doi:10.12449/JCH240923

失代偿期肝硬化合并多原发癌1例报告

DOI: 10.12449/JCH240923

晁文婷¹,
黄睿^{1, 2, , ,}

1.
北京大学人民医院肝病科，北京 100044
2.
北京大学肝病研究所，北京 100044

基金项目:

北京大学人民医院研究与发展基金 (RDJ2022-21)

伦理学声明：本例报告已获得患者及家属知情同意。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：晁文婷、黄睿起草或修改文章关键内容，研究数据的获取分析解释过程；黄睿对文章的知识性内容作批评性审阅，获取研究经费，提供行政、技术或材料支持，指导撰写文章并最终定稿。

详细信息

通信作者:
黄睿， strangehead@163.com （ORCID： 0000-0001-5561-8746）

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出版历程
- 收稿日期: 2023-12-25
- 录用日期: 2024-01-23
- 出版日期: 2024-09-25

Diagnosis and treatment of decompensated cirrhosis with multiple primary cancers： A case report

Wenting CHAO¹,
Rui HUANG^{1, 2
, ,
,}

1.
Department of Hepatology，Peking University People’s Hospital，Beijing 100044，China
2.
Peking University Hepatology Institute，Beijing 100044，China

Research funding:

Peking University People’s Hospital Scientific Research Development Funds (RDJ2022-21)

More Information

Corresponding author: HUANG Rui， strangehead@163.com （ORCID： 0000-0001-5561-8746）

摘要

摘要: 多原发癌是指在同一个体中存在一种以上的具有不同组织学和部位的癌症，临床较为罕见。本文报告1例肝硬化失代偿期合并多原发癌的病例，主要讨论了肝硬化失代偿期患者合并多原发癌的诊治经过及临床启示。
- 肝硬化 /
- 多原发癌 /
- 腹水 /
- 门体分流术，经颈静脉肝内
Abstract: Multiple primary cancers （MPC） refer to the presence of more than one type of cancer with different histological features and sites in the same individual， and it is relatively rare in clinical practice. This article reports a case of decompensated cirrhosis with MPC and discusses the diagnosis， treatment， and clinical implications of this patient with decompensated cirrhosis and MPC.
- Liver Cirrhosis /
- Multiple Primary Cancers /
- Ascites /
- Portosystemic Shunt， Transjugular Intrahepatic

HTML全文

p21活化激酶4 (PAK4)是一种致癌蛋白，已成为抗癌药物开发的一个有前景的靶点。PAK4在氧化应激条件下的作用，目前还不清楚。来自韩国全北国立大学医学院生物化学和分子生物学系的Mao等研究了PAK4信号通路在肝缺血再灌注损伤(I/R损伤)中的作用。

肝细胞和髓系特异性Pak4敲除小鼠及其同窝对照小鼠受到部分肝I/R损伤。通过基因工程(基因敲除、野生型显性负激酶过表达)或药物抑制剂操纵PAK4的催化活性，并通过核事实红系2相关因子2 (Nrf2)活性检测PAK4在肝I/R损伤中的潜在功能。小鼠和人肝I/R损伤时，肝脏中PAK4的表达显著上调。在肝细胞中缺失PAK4，而在髓系细胞中缺失PAK4，可以改善肝损伤，肝细胞坏死和炎症反应的减少证明了这一点。野生型PAK4的强迫表达加重了病理改变。PAK4直接磷酸化Nrf2的T369位点，并导致其核输出和蛋白酶体降解，其中有一种损伤了肝细胞的抗氧化反应。肝脏中Nrf2沉默可消除PAK4缺乏的保护作用。一种新开发的PAK4抑制剂对小鼠肝脏I/R损伤具有保护作用。

PAK4可磷酸化Nrf2并抑制其转录活性。基因或药理抑制PAK4可减轻肝脏1/R损伤。因此，PAK4抑制可能是一种有希望干预I/R损伤的方法。

摘译自MAO Y, HAN CY, HAO L, et al. PAK4 inhibition protects against liver ischemia/reperfusion injury: Role of Nrf2 phosphorylation[J]. Hepatology, 2022. DOI: 10.1002/hep.32384. [Online ahead of print]

(吉林大学第一医院感染病中心肝病科杨鑫李婉玉报道)

注： a，肝硬化，门静脉高压，腹盆腔大量积液；b，结肠脾区肠壁增厚，结肠癌。

图 1 腹部增强CT

Figure 1. Abdominal enhanced CT

下载: 全尺寸图片幻灯片

注：宫腔可见轻中度强化，局部侵犯子宫肌层，子宫内膜癌。

图 2 盆腔增强MRI

Figure 2. Pelvic enhanced MRI

下载: 全尺寸图片幻灯片

注：门-腔静脉分流通畅。

图 3 TIPS术后

Figure 3. Post-TIPS

下载: 全尺寸图片幻灯片

注： a，结肠癌术后改变；b，子宫内膜癌术后改变。

图 4 腹部盆腔增强CT

Figure 4. Abdominal and pelvic enhanced CT

下载: 全尺寸图片幻灯片

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