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Objective:To evaluate neutrophil/lymphocyte ratio(NLR) and the model for end-stage liver disease-sodium(MELD-Na)score in predicting short-term prognosis of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods:A total of 234 consecutive HBV-ACLF patients(194 males and 40 females, aged 23-85 years)admitted to Hangzhou Xixi Hospital from January 2019 to December 2021 were enrolled. According to the 12-week clinical outcomes, patients were divided into good prognosis group( n=141)and poor prognosis group( n=93). Univariate and multivariate Logistic regression were performed to identify independent risk factors for poor prognosis of HBV-ACLF patients. Receiver operating characteristics(ROC)curve was applied to evaluate the accuracy of risk factors in predicting short-term prognosis of HBV-ACLF patients. Results:The age [(48.7±11.9) vs. (52.5±9.9) years old, t=-2.59, P=0.011], proportion of males [78.0%(110/141) vs. 90.3%(84/93), χ2=5.99, P=0.014], total bilirubin[202.9(141.2, 287.6) vs. 320.0(224.4, 400.0) μmol/L, Z=-5.14, P<0.001], creatinine [71.0(59.0, 78.0) vs. 81.0(64.0, 111.0)μmol/L, Z=-3.98, P<0.001], international normalized ratio[1.66(1.52, 1.86) vs. 1.91(1.66, 2.27), Z=-5.46, P<0.001], leukocyte count[5.16(3.99, 6.95)×10 9/L vs. 6.57(4.83, 8.30)×10 9/L, Z=-4.14, P=0.001], NLR[2.77(2.02, 3.55) vs. 5.48(3.44, 8.53), Z=-8.48, P<0.001], MELD score[22.0(20.0, 24.0) vs. 26.0(24.0, 29.0), Z=-9.22, P<0.001], MELD-Na score[22.8(20.0, 25.6) vs. 29.0(25.0, 36.0), Z=-9.16, P<0.001], liver cirrhosis[77.3%(109/141) vs. 88.2%(82/93), χ2=4.41, P=0.036], hepatorenal syndrome[4/141(2.8%) vs. 12/93(12.9%), χ2=8.91, P=0.003] and the proportion of artificial liver treatment[21/141(14.9%) vs. 24/93(25.8%), χ2=4.30, P=0.038] were significantly elevated in poor prognosis group compared with survival group. Logistic regression analysis showed that NLR( OR=3.76, 95 %CI: 2.10-6.74, P<0.001)and MELD-Na score( OR=2.24, 95 %CI: 1.17-4.29, P=0.015) were independent risk factors for poor short-term prognosis of HBV-ACLF patients. The area under the ROC curve(AUC)of NLR, and MELD-Na for the short-term prognosis of HBV-ACLF patients was 0.792 and 0.822, respectively. The AUC of the combination of NLR with MELD-Na was 0.858, which was significantly higher than that of NLR( Z=-3.04, P=0.001) or MELD-Na score( Z=-2.16, P=0.031)alone. Based on the cut-off value of the combined model, patients were classified into high combined model score (≥0.04) group and low combined model score (<0.04) group, the survival rate of the high group was significantly higher than that of the low group( χ2=67.47, P<0.001). Conclusions:NLR and MELD-Na score are independent risk factors of the short-term prognosis of HBV-ACLF patients. The combination of NLR and MELD-Na score will be beneficial to predict the short-term prognosis of HBV-ACLF patients.
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Objective To investigate the expression level and potential clinical value of serum HBV RNA in HBeAg-positive chronic hepatitis B (CHB) patients at different periods. Methods A total of 61 CHB patients who attended the outpatient and inpatient services of Department of Hepatology, Hangzhou Xixi Hospital, from August 2019 to December 2020 were enrolled, and according to the antiviral therapy for HBeAg-positive CHB patients, they can be divided into group A with untreated HBeAg-positive CHB (HBeAg+ and HBV DNA+) patients, group B with treatment-experienced patients before HBeAg seroconversion (HBeAg+ and HBV DNA-), and group C with treatment-experienced patients after HBeAg seroconversion (HBeAg- and HBV DNA-). Peripheral blood HBV RNA load was measured at different periods, and its correlation with HBsAg and HBV DNA was analyzed. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups; a Pearson or Spearman correlation analysis was used to describe the correlation between two variables. Results The positive rates of HBV RNA in these three groups were 100% (22/22), 88.2% (15/17), and 22.7% (6/22), respectively. In group A, HBV RNA was positively correlated with HBsAg and HBV DNA ( r =0.612 and 0.922, both P < 0.01), while in groups B and C, there was no correlation between HBV RNA and HBsAg. Group B had significantly higher levels of HBV RNA and HBsAg than group C ( Z =-4.44 and -2.41, both P < 0.05). The HBV DNA-positive group had a significantly higher level of HBV RNA than the HBV DNA-negative group ( Z =-6.16, P < 0.01). Conclusion After HBV DNA clearance achieved by antiviral therapy with nucleos(t)ide analogues in CHB patients, serum HBV RNA can still be detected in some of these patients. Since HBV RNA only comes from cccDNA in the liver, it can better reflect viral replication activity in the liver than HBV DNA and thus has a certain clinical value in the management of CHB patients.
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A total of 291 patients with genotype-1b chronic hepatitis C (CHC) admitted in Hangzhou Xixi Hospital and Jiande Second People′s Hospital between August 2018 to June 2019. All patients received sofosbuvir/daclatasvir (SOF/DCA) therapy for 12 weeks, and were followed up for 24 weeks after treatment. Data were missed in 2 cases, among remaining 289 cases, there were 238 cases without cirrhosis (non-cirrhosis group), 48 cases with compensated cirrhosis (compensated cirrhosis group) and 5 cases with decompensated cirrhosis (decompensated cirrhosis group). The biochemical indexes, blood routine test results, aspartate aminotransferase-to-platelet ratio index (APRI) , fibrosis-4 (FIB-4) and related adverse event were collected. In non-cirrhotic group, 15 cases and 41 cases were lost follow-up after 12 weeks and 24 weeks of treatment, respectively. The sustained virologic response rate on week 12 (SVR12) and SVR24 in non-cirrhotic group were 82.2% (194/236) and 81.7% (193/236) respectively; whole SVR12 and SVR24 rates in compensated cirrhosis group (48/48) and decompensated cirrhosis group (5/5) were all 100% (χ 2=0.96, χ 2=0.44, P>0.05). The blood ALT [ 14 (6, 23) and 14 (5, 72) U/L], AST[22 (14, 24) and 23 (15, 52) U/L], hemoglobin [46 (42, 48) and 46 (34, 51) g/L], globulin [ (32.6±4.0)和(31.6±3.8) g/L], PLT[ (145.0±49.7) and (142.0±47.4) ×10 9/L], APRI [0.4 (0.2, 0.4) , 0.4 (0.3, 1.5) ] of 289 cases on week 12 and 24 after treatment were significantly improved; compared with baseline values [44(8, 175) U/L, 44(23, 154)U/L, 45 (41, 49) g/L, (33.0±4.0) g/L, (150.0±53.7) ×10 9/L, 0.7(0.3, 6.3)] (Week 12: Z=-14.21, Z=-13.97, Z=-14.72, t=2.00, t=5.22, Z=-13.52; (Week 24: Z=-13.12, Z=-13.04, Z=-4.63, t=7.18, t=7.25, Z=-9.48, all P<0.05). Compared with baseline values [ (16.1±5.4) μmol/L, (5.7±1.5) ×10 9/L, 3.4(1.2, 15.2)], the total bilirubin (15.4±5.8)μmol/L, WBC (6.2±1.8)×10 9/L, FIB-4[3.2 (1.5, 13.7) ] levels were also improved ( t=2.34, t=-5.51, Z=-3.40, all P<0.05). Univariate logistic analysis did not find factors influencing the SVR24 of Sofosbuvir/Daclatasvir therapy. The most common adverse events were fatigue (14.8%,36/248), headache (9.3%,23/248), skin rash and pruritus (4.8%, 12/248), diarrhea (5.6%, 14/248), all of which were alleviated after treatment. In conclusion, SOF/DCA is the optimized selection for na?ve patients with genotype-1b CHC with high SVR12 and SVR24 rate and good safety.
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Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.
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Objective@#Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province.@*Methods@#A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data.@*Results@#The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05).@*Conclusions@#The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.
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Objective To evaluate the clinical value of combined detection of T cell receptor rear-rangement excision circles ( TRECs) and CD31+ regulatory T ( Treg) cells for accessing the recent thymic output in patients with chronic hepatitis B. Methods Four groups involving 135 subjects were set up in this study as follows: mild chronic hepatitis B ( Mild CHB, n=35 ) , moderate chronic hepatitis B ( Moderate CHB, n=35 ) , severe chronic hepatitis B ( Severe CHB, n=35 ) and healthy control ( HCs, n=30 ) groups. CD4+CD25+Treg cells in these subjects were sorted out using magnetic cell separation. The ratio of peripheral CD31+Treg cells to Treg cells in each group was analyzed by flow cytometry. Real-time PCR was performed to detect TRECs in CD4+CD25+Treg cells. The percentages of CD3+, CD4+ and CD8+T cell sub-sets were also measured. Results The ratios of CD31+Treg/Treg cells and the numbers of TRECs in pe-ripheral blood of the Moderate CHB and Severe CHB groups were significantly lower than those of the Mild CHB and HCs groups (P<0. 05), while no statistical difference was found between the mild CHB and HC groups (P>0. 05). No significant difference in the percentages of CD3+, CD4+ or CD8+ T cell subsets was observed between the four groups (P>0. 05). CD31+ Treg/Treg cell ratio had a positive correlation with the number of TRECs (r=0. 551, P=0. 014). Conclusions Both CD31+Treg/Treg cell ratio and the number of TRECs were reduced in the peripheral blood of patients with moderate or severe CHB. CD31+Treg/Treg cell ratio and the number of TRECs were positively correlated and could be used as new indices to evaluate recent thymus output.
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OBJECTIVE:To prepare Activated carbon N-acetylcysteine microcapsule (ACNAC),and to optimize preparation technology. METHODS:ACNAC was prepared by emulsion cross-linked method using biodegradable material gelatin as capsule wall material. Using comprehensive evaluation index of drug-loading amount,entrapment rate and particle size distribution percent-age(the percentage of 80-140 μm particle)as index,drug-loading ratio,amount of gelatin,mixing speed and the amount of emul-sifier as factors,single factor test and orthogonal test were used to optimize formulation technology. The technology was validated and distribution of particle size of ACNAC was determined. RESULTS:The optimal formulation technology was as follows as drug-loading ratio 1∶1,gelatin 15%,emulsifier 2.0%,mixing speed 1 000 r/min. Average drug-loading amount of 6 batches of ACNAC was 15.9%(RSD=1.21%),average encapsulation efficiency was 78.1%(RSD=1.11%)and average particle size distri-bution percentage was 81.9%. CONCLUSIONS:ACNAC is prepared successfully,and formulation technology is reasonable and feasible.
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Objective To investigate the HAART in PMTCT different intervention time of blocking effect. Methods 49 cases who received out -patient examination and hospital delivery of HIV positive pregnant women were selected,the intervention time pregnant 14 weeks,pregnant 28 weeks.The patients were divided into three groups,group A (n =20),group B (n =19),group C (n =10).The safe delivery,the newborn 50 out of 18 months of tracking and detection,and the results were analyzed.Results Three groups of antiviral HIV infected maternal immune status (P >0.05 ),antiviral CD +4 cell number variation had no statistical significance (P >0.05 ),the blocking effect was A group of infants 0 infection.In group B,1 cases of infant infection.Group C 2 cases of infant infection.Compared between group A and group B,the difference was not statistically significant (χ2 =0.97,P >0.05),compared between group B and group C,the difference was not statistically significant (χ2 =1.40,P >0.05). Compared between group A and group C,the difference had statistical significance (χ2 =4.08,P <0.05 ). Conclusion HAART for blocking HIV mother to child transmission effect is very significant,if in 14 weeks pregnant initiation of HAART,the infant HIV infection rate is lower,recommended the early antiviral treatment and after childbirth to strengthen follow -up and management.
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Objective To establish a rapid, sensitive, and specific quantitative method to detect hepatitis C virus. Methods A primer set targeting HCV 5'UTR was designed. The isothermal amplification was performed by the Bst DNA polymerase and AMV reverse transcriptase, under the temperature of 60℃ for 60 min. The signal was monitored by SYBR Green Ⅰ. Results One hundred and twenty positive serum samples, confirmed by the real-time PCR. All were detected by the isothermal amplification, while 110 healthy subjects' samples were negative by the both methods. The lower detect limit was determined to 10 IU/ml HCV-RNA, by the assay on serial dilutions of the quality control standards obtained from clinical investigation center of MOH. Conclusion A real time reverse loop-mediated isothermal amplification method was developed to detect HCV, with the characteristic of rapidity, high sensitivity and specificity.
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Objective To investigate the infection status of nanobacteria on patients of chronic hepatopathy and hepatocellular carcinoma,and evaluate the clinical value of PCR.Methods In sera of 68 cases of chronic hepatitis B(CHB),56 chronic severe hepatitis B(CSHB),66 cirrhosis of liver(CL)and 23 hepatocellular carcinoma(HCC),nanobacteria were detected by immunohistochemistry stain(IHC),Transmission Electron Microscopy(TEM)and polymerase chain reaction(PCR),compared with 40 healthy people.Results The positive rates of PCR were 27.69%,50.00%,61.29%,52.38% and 5.00% in patients with CHB,CSHB,CL,HCC and normal control respectively(P