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Objective:To explore the values of CTP score, MELD score, MELD-Na score, ALBI score and neutrophil-lymphocyte ratio (NLR) in predicting the short/long-term prognoses of patients with end-stage liver disease (ESLD) after liver transplantation (LT).Methods:From August 2015 to February 2017, basic preoperative profiles and survival status were retrospectively reviewed for 125 ESLD patients undergoing orthotopic LT.Receiver operating characteristic (ROC) curve was utilized for evaluating the capability of five scores for predicting short-term (3 months post-operation) and long-term (5 years post-operation) prognoses.Cut-off value was determined according to the Jordan index and Kaplan-Meier survival curve plotted.The difference in survival rate between upper and lower cut-off values was analyzed by Log-rank test.Results:Five-year survival rate post-LT was 69.6%(87/125), case fatality rate 30.4%(38/125) and case fatality rate within 3 months post-operation 12.8%(16/125). The AUROC values of CTP score, MELD score, MELD-Na score, ALBI score and NLR for short-term prognosis were 0.787, 0.767, 0.875, 0.801 and 0.837 and AUROC values for predicting long-term prognosis 0.744, 0.744, 0.817, 0.778 and 0.815 respectively.De Long test indicated that the capabilities of MELD-Na score for predicting short-term prognosis varied significantly from that of another four models ( P<0.05). No significant difference existed in capability of predicting long-term prognosis ( P>0.05). The cut-off values of MELD and MELD-Na scores at Month 3/60 post-LT were 20.09 vs.16.44 and 23.63 vs.17.79.The survival rates of upper and lower groups distinguished by cut-off values were 90.9% vs.50.0%, 86.5% vs.45.1% and 99.3% vs.55.6%, 93.9% vs.42.4% respectively.The differences were statistically significant ( P<0.05). Conclusions:Predictive value of MELD-Na score for short-term prognosis of LT is superior to than that of CTP, MELD score, ALBI score or NLR.However, it offers no significant superiority in predicting long-term prognoses.With a rising preoperative MELD/MELD-Na score, postoperative mortality spikes.
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Mesenchymal stem cells (MSCs) are a group of stem cells derived from mesodermal mesenchyme.They can be recovered from a variety of tissues,including bone marrow,umbilical cord tissue,umbilical cord blood,peripheral blood,and adipose tissue.Under given conditions,MSCs can differentiate into bone,fat,nerve cells,bepatocytes,and many other cells.Thus,MSCs can be used as a new treatment to substitute for organ transplantation.In recent years,the incidence of end-stage liver disease has been increasing and liver disease has become one of the major diseases affecting human health.Donor scarcity and immunological rejection limit the clinical application of liver transplantation.Numerous studies have confirmed the therapeutic effects of MSCs on hepatic fibrosis,cirrhosis,and other liver diseases,which may be related to the differentiation of MSCs into functional hepatocytes.This paper reviews the capacity,regulation,and molecular mechanism of MSC differentiation,and it discusses the therapeutic effects of different sources of stem cells for liver fibrosis.
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ObJective To explore the value of acute physiology and chronic health evaluation Ⅲ(APACHE Ⅲ ) score and the concentration of serum cholinesterase (ChE) in predicting the condition and prognosis of patients with severe acute pancreatitis (SAP) within 24 hours afar hospitalization.Methods Sixty-two SAP patients were enrolled and APACHE Ⅲ score was assessed and the concentration of serum ChE was detected within 24 hours after hospitalization.The correlation between the concentration of serum ChE,APACHE Ⅲ score and the condition and prognosis was analyzed.Results There were 44 survivalcases and 18 dead cases.The APACHE Ⅲ score of the surval patients was significantly lower than that of the dead patients [(52.16 ± 13.76) scores vs.(97.10 ± 15.85) scores] (P＜0.01).The concentration of serum ChE of survival patients was significantly higher than that of the dead patients [ (3685 ± 466) U/L vs.(2109 ± 345) U/L] (P＜ 0.01 ).The higher APACHE Ⅲ score was,the lower the serum ChE concentration was,and the higher the mortality rate was.APACHE Ⅲ score and the concontration of serum ChE both had statistical significances compared with the prognosis in the Logistic regression analysis (P =0.0043,0.0075);APACHE Ⅲ score (95％ CI 1.0306-1.1507),the concentration of serum ChE (95％ CI0.9986-1.0125 ).ROC areas under curve (AUC) of APACHE Ⅲ score,serum ChE concentration with the prognosis were 0.936 and 0.882,respectively.There was no significant difference (P=0.0820).In combined prediction of APACHE Ⅲ score and serum ChE concentration,AUC was 0.952,and its predicting accuracy was higher than either APACHE Ⅲ score or serum ChE concentration (P=0.0016,0.0027).Conclusions APACHE Ⅲ score and the concentration of serum ChE both are significantly correlated with the condition and prognosis of SAP patients.Their combined detection can significantly improve the accuracy of prognosis judgement and provide some clinical guidances for treatment.
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Objective To analyze the clinical characteristics of autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and AIH/PSC or/PBC overlap syndrome in order to further understand the autoimmune liver diseases (AILD). Methods One hundred and nine patients with AILDs confirmed pathologically were collected between Jan. 2004 and June 2006. Of 109 patients, AIH was found in 27 eases, PBC in 67 cases, PSC in 4 eases, AIH-PSC overlap syndrome in 1 case and AIH-PBC overlap syndrome in 10 cases. The clinical and laboratory data of all patients were assessed retrospectively. Results The AILD was predominantly found in middle-aged women (73.3% ,80/109), and the main clinical manifestations were jaundice, malaise, anorexia and pruritus. The age distribution of patients with AIH showed a single peak at 50 years. Elevated serum gamma globulin and IgG were found in patients with AIH, of whom 62.9% (17/27) were positive for anti-nuclear antibody (ANA) and 3 were positive for liver-kidney microsomes type 1 antibody. The main histological changes in severe AIH cases included interface hepatitis (77.7 %) and bridging necrosis. Most of the PBC patients were presented with elevated serum alkaline phosphatase, glutamyl transpeptidase and IgM. Fifty patients (74.6%) were positive for anti-mitochondrial antibody (AMA) and AMA-M2. The pathological examination showed that 28. 3% of the cases were in Ⅰ or Ⅱ stage and 71.7% in Ⅲ or Ⅳ stage in patients with PBC who received liver biopsy. The pathologic change of reduction or even disappearing of bile ducts was found in 62. 6% patients with PBC. The clinical and pathological manifestations in patients with AIH-PBC overlap syndrome had both characteristics of PBC and AIH. Three out of 10 patients with AIH-PBC overlap syndrome were positive for ANA and AMA/AMA-M2. Conclusion Since AILD is not rare in Chinese, its diagnosis should be based on the clinical presentation, biochemical, immunological and histologic changes.