Effects of nystatin oral care combined with health education in preventing oral fungal infection in patients with severe hepatitis / 中国实用护理杂志

Objective:To explore the risk factors of oral fungal infection in patients with severe hepatitis, and the prevention role of nystatin oral care combined with precision health education on oral fungal infection.Methods:A total of 150 patients with severe hepatitis who were hospitalized for diagnosis and treatment in the First Affiliated Hospital of Zhengzhou University from February 2018 to February 2020 were selected as the research objects. According to the random number table method, they were divided into the observation group (given nystatin oral care combined with precision health education intervention) and the control group (given routine oral care combined with precision health education intervention), 75 cases in each group. The incidence of oral fungal infections in the two groups after the intervention were compared.Results:The fungal infection rate in the observation group at 1 week, 2 weeks and 4 weeks after intervention were 2.67% (2/75), 4.00% (3/75), 8.00% (6/75), which were significantly lower than 12.00% (9/75), 18.67% (14/75), 25.33% (19/75) in the control group ( χ2=4.81, 8.03, 8.11, all P<0.05). Four weeks after the intervention, among the 6 patients with fungal infection in the observation group, there were 5 cases of oral leukoplakia and foreign body sensation in the pharynx, and 1 patient with oral leukoplakia; among the 19 patients with fungal infection in the control group, all had oral mucosal leukoplakia. There were 17 cases of leukoplakia and pharyngeal foreign body sensation, and 2 cases of oral leukoplakia. Conclusions:Nystatin oral care combined with precision health education is of great significance in patients with severe hepatitis, and can effectively reduce the incidence of oral fungal infections.

COSSH score and associated risk stratification in predicting short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure / 中华临床感染病杂志

Objective:To evaluate the prognostic efficacy of the Chinese Group on the Study of Severe Hepatitis B (COSSH) acute-on-chronic liver failure (ACLF) II score (COSSH ACLF IIs) and associated risk stratification in predicting short-term prognosis of patients with hepatitis B virus-related ACLF (HBV-ACLF).Methods:Clinical data of 224 patients with HBV-ACLF admitted to the First Affiliated Hospital of Wannan Medical College and the First Hospital of Quanzhou, Fujian Medical University from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into survival group ( n=171) and fatal group ( n=53) according to 28-day survival status. The values of the COSSH ACLF IIs, the Chronic Liver Failure-Consortium (CLIF-C) ACLF score (CLIF-C ACLFs), the CLIF-C organ failure score (CLIF-C OFs), the Model of End-stage Liver Disease (MELD) score (MELDs), the MELD-sodium score (MELD-Nas), and the Child-Turcotte-Pugh score (CTPs) for 28-day mortality prediction were compared using the area under the receiver operating characteristic curve (AUC). The patients were divided into groups according to COSSH ACLF classification and COSSH ACLF IIs risk stratification, respectively. The differences in 28-day mortality between groups were compared by Kaplan-Meir method, and the consistency of the two ACLF classification systems was compared by Kappa consistency test. Results:The AUC, sensitivity, and specificity of the COSSH ACLF IIs in 28-day mortality prediction were 0.885, 0.981 and 0.731, respectively. For predicting 28-day mortality, the COSSH ACLF IIs achieved a higher AUC than the CLIF-C OFs, the MELDs, the MELD-Nas, and the CTPs ( P<0.01), while there was no significant difference in AUC between the COSSH ACLF IIs and the CLIF-C ACLFs ( Z=1.696, P=0.090). The cumulative 28-day mortality rates significantly increased with the ascending of COSSH ACLF grade and risk strata of the COSSH ACLF IIs (11.7%, 43.5% and 93.3%, P<0.001; 14.2%, 41.0% and 81.3%, P<0.001). The two ACLF grading systems showed a consistency in severity stratification of HBV-ACLF patients (Kappa=0.478, P<0.001). Conclusion:The COSSH ACLF IIs shows an excellent prognostic performance in predicting short-term mortality of HBV-ACLF patients. Using the new risk stratification scale can simplify the severity stratification of HBV-ACLF patients.

Analysis of clinical features and prognosis of acute severe autoimmune hepatitis / 中华肝脏病杂志

Objective: To analyze the clinical features and prognosis of acute severe autoimmune hepatitis (AIH). Methods: A retrospective analysis of the clinical data of patients with acute severe AIH admitted to our hospital from 2008 to 2019 was divided into acute AIH (A-AIH) and chronic acute AIH (AC-AIH) according to the presence or absence of liver diseases. Patients' general condition, liver biochemistry, immunology, histological features of liver, hormonal therapies prognosis and related factors were analyzed. Results: A total of 41 cases [39 females, age (54.24 ± 10.55) years] were collected. Alanine aminotransferase (ALT) and total bilirubin (TBil) were significantly increased, and the international normalized ratio (INR) was > 1.5. Acute lobular inflammation was the feature of acute and severe AIH in the histology of liver. The serum IgG level was (28.36 ± 8.35) g / L. The positive rate of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA) was 82.9%, and 17.1%, respectively. Over 70% of acute severe AIHs were AC-AIH. The duration of onset of AC-AIH was > 8 weeks, while most A-AIHs < 8 weeks, and the differences between the two groups were statistically significant (P = 0.001). The mortality rate within 30 days after hormonal treatment was 19.5%. There were statistically significant differences in TBil, Model for End-Stage Liver Disease (MELD) score and leukocyte count between the death and survival group. Conclusion: The mortality rate in acute severe AIH is high, and most of them have the basis of chronic liver disease. Serum IgG level, autoantibodies and acute lobular inflammation are important factors for diagnosis. The prognosis of hormonal therapy is related to the patients' condition and course of disease.

The therapeutic effect of Gansu tablet combined with entecavir on severe hepatitis B patients and its influence on their immune function / 公共卫生与预防医学

Objective To explore the therapeutic effect of Gansu tablets combined with entecavir on patients with severe hepatitis B and the effect on patients’ immune function. Methods A total of 108 cases of severe hepatitis B patients who were treated in our hospital from January 2018 to January 2019 were randomly divided into two groups: entecavir group and combination treatment group, 54 cases each. Entecavir group was treated with entecavir, and combination treatment group was treated with Gansu tablets and entecavir. The levels of AST, GGT, alt, FIB, APTT, Pt, GSH Px, LPO and MDA in serum were measured by enzyme-linked immunosorbent assay. T-lymphocyte subsets were measured by cell analyzer. The therapeutic effect and adverse reactions were compared between the two groups. Results The levels of AST, GGT and ALT in the combined treatment group were significantly lower than those in the entecavir group (P 0.05). Conclusion The use of Gansu tablets combined with entecavir in the treatment of severe hepatitis B patients was able to improve liver function, improve coagulation function, reduce oxidative stress injury, and improve the immune function of patients, demonstrating a potential clinical application value.

Study of endoplasmic reticulum stress role in hepatic failure induced by severe hepatitis B / 中华肝脏病杂志

Objective@#To investigate the endoplasmic reticulum stress (ERS) role in the course of liver failure induced by severe hepatitis B virus (HBV) infection and its related mechanism.@*Methods@#Liver tissue samples and clinical data [chronic hepatitis B patients (12 cases, chronic hepatitis B group), hepatic failure induced by severe hepatitis B virus (12 cases, severe hepatitis B virus liver failure group), and normal subjects (8 cases, control group)] were collected from the Beijing You'an Hospital affiliated to Capital Medical University between 2009 to 2011. Statistical analysis was performed on the clinical indicators of each group. The structure of endoplasmic reticulum in liver tissue was observed by transmission electron microscopy. Western blot and qRT-PCR were used to detect the expression of endoplasmic reticulum stress and apoptosis-related factors, including glucose-regulated protein (Grp), and C/EBP homologous protein (CHOP). Frozen sections of liver tissues were prepared for immunofluorescence test. All data were expressed as mean ± standard deviation. LSD-t test was used to compare the results between groups. A p value < 0.05 was considered as statistically significant.@*Results@#Transmission electron microscopy showed that the morphological structure of the endoplasmic reticulum was damaged in both groups (chronic hepatitis B and liver failure induced by severe hepatitis B virus), and liver failure induced by severe hepatitis B virus group was more critical. Western blot and qRT-PCR showed that Grp78, Grp94 and Caspase-4 were highly expressed in normal group and chronic hepatitis B group, and the relative protein expressions were 1.20 ± 0.13 and 0.78 ± 0.11, 0.90 ± 0.06 and 0.11 ± 0.01, 0.15 ± 0.02 and 0.22 ± 0.04, respectively. The expression of protein was weakened in liver failure induced by severe hepatitis B virus group (relative protein expression was 0.01 ± 0, 0.01 ± 0, and 0.11 ± 0.02, respectively).There was a statistically significant difference between the two groups (P < 0.05). The expression of CHOP was consistent with the results of immunofluorescence, and increased with the stressing of injury.@*Conclusion@#During the course of severe hepatitis B infection, dysregulated endoplasmic reticulum stress activated mild stress in chronic hepatitis B group, while severe stress in hepatic failure induced by severe hepatitis B virus group. Therefore, endoplasmic reticulum stress plays an important and complex role in the pathogenesis of hepatic failure induced by severe hepatitis B virus.

Pathogen infection distribution and drug resistance analysis of patients with severe liver disease / 解放军医学杂志

Objective To explore the infection distribution and drug resistance of pathogens in patients with severe liver disease,and provide reference for clinical medication.Methods Retrospective analysis of the microbiological specimens from patients with severe liver disease in Department of Infection of our hospital from August 2014 to November 2016 and the drug susceptibility testing were carried out by means of K-B disc diffusion method after bacterial culturing,and the distribution and drug resistance of pathogens were analyzed.Results Totally 17 of 73 patients with severe liver disease developed hospital infection (23.3％).104 strains of bacteria were isolated and 78 strains out of them were multidrug-resistant bacteria (75.0％).Among them,28(26.9％) strains were gram-positive coccus,mainly consisting of Staphylococcus aureus and Staphylococcus epidermidis,and 58(55.8％) were gram-negative coccus,mainly composed of Escherichia coli,Klebsiella pneumonia and Acinetobacter baumannii,and 18(17.3％) strains fungi.S.aureus and enterococci were resistant to penicillin,erythromycin and levofloxacin,the resistance rates were above 80.0％,but had low resistance rates to vancomycin,teicoplanin and tigecycline.The resistance rates of E.coli and K.pneumoniae to piperacillin,cefazolin and cefuroxime sodium were above 85.0％,but they had lower resistance rates to tigecycline and amikacin.Acinetobacter baumannii was 100％ resistant to piperacillin and tazobactam,ceftazidime,imipenem and amikacin,but had low resistance to tigecycline and minocycline.Conclusions Multi-drug resistant bacteria are the main bacterial pathogens in patients with severe liver disease and have a high resistance rate to commonly used antibiotics,empirical treatment in the population at high risk of multidrug-resistant bacteria infections requires the use of broad-spectrum or high-grade antibiotics (e.g.carbapenems or tigecycline) and drugs against specific pathogenic bacteria (glycopeptides,linezolid,and amikacin etc).Early de-escalation policies are recommended to prevent the spread of multidrug-resistant bacteria in cirrhosis.

Evaluation of therapeutic effect and safety of bilirubin absorption combined with low volume plasma exchange in treating severe hepatitis / 重庆医学

Objective To evaluate the therapeutic effect and safety of bilirubin absorption(BA) combined with low volume plasma exchange(PE) in the treatment of severe hepatitis.Methods Forty-five inpatients with severe hepatitis in this hospital from January 1,2015 to December 31,2016 were performed the prospective study.All cases were given the therapy of BA combined with low volume PE.The indicators of liver function (ALT,AST,TBIL,CHE,ALB),coagulation function (PTA,INR),blood routine (WBC,Hb,PLT),electrolytes(K+,Na+,Cl-,Ca2+) and renal function(BUN,Cr) were collected before and after treatment.The changes of clinical symptoms and signs(weak,anorexia,abdominal distension,etc.) before and after treatment were recorded in all cases.The complications during the treatment process were also observed and recorded.The t-test was used for the inter-group comparison of the measurement data and the abnormal distribution adopted the Wilcoxon rank sum test.Results After the treatment of BA and low volume PE,the clinical symptoms of the patients were improved in different levels.The levels of ALT,AST and TBIL were decreased(P＜0.01),the CHE level was increased(P＜0.01),ALB level was decreased(P＜0.01);PTA was increased(P＜0.05),INR was decreased(P＜0.01);WBC,HGB and PLT were decreased(P＜0.05).Nineteen cases(31.1％) developed adverse reactions,which were recovered to normal after general symptomatic treatment.The treatment compliance was good without influence on artificial liver therapy.Conclusion BA combined low volume PE for treating severe hepatitis can significantly improve the liver function with safety and effectiveness.

Comparative analysis on short-term efficacies of two kinds of artifical liver method in treating severe hepatitis B / 重庆医学

Objective To investigate the short-term efficacy of plasma exchange(PE),PE combined with double plasma molecule absorption system(PE+DPMAS) for treating severe hepatitis B(SHB).Methods The clinical data in 70 patients with SHB were retrospectively analyzed.The patients were divided into the PE group and PE+-DPMAS group according to different treatment modes.The clinical symptoms,liver function,coagulation function,blood routine,renal function and electrolytes changes,score decrease of model for end-stage liver disease(MELD) before and after treatment were compared between the two groups.Results After treatment,the alimentary tract symptoms were improved,the grade of hepatic encephalopathy was reduced and MELD score was decreased,but there was no statistically significant difference in the short-term effective rate between the two groups(P＞0.05).After treatment ALT,TBIL,RBC,Hb and PLT in the two groups were decreased significantly(P＜0.05);the ALB level in the PE+DPMAS group was decreased,while K+ and C1 were increased(P＜0.05);the PTA and ALB levels in the PE group were increased,while WBC was decreased in the PE group(P＜0.05).Conclusion The two kinds of treatment method PE and PE-+DP-MAS are effective in treating SHB.PE+-DPMAS can reduce the plasma usage and improve serum K+,Cl-levels;PE is superior to PE+DPMAS in the aspects of improving coagulation function and ALB level.

The value of MELD-Na score in predicting complication severity grades after orthotopic liver transplantation for severe hepatitis / 中华肝胆外科杂志

Objective To study the value of preoperative MELD-Na score (Model for End-Stage Liver Disease-Sodium) in predicting complication severity grades after liver transplantation (LT) for severe hepatitis.Methods Patients who underwent LT for severe hepatitis between August 1,2004,and September 1,2014 were retrospectively studied.The Accordion severity grading system was used to classify the complication severity grades after LT.The grades were classified as grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).The area under the curve (AUC) was calculated by plotting the receiver operating characteristic curve (ROC) to evaluate the predictive accuracy of the MELD-Na score for the severe and mortality grades after LT.The correlation between the MELD-Na score with the complication severity grade after LT was studied by the Spearman correlation and by multivariate analysis.Results The incidences of postoperative complications for the 159 patients in this study were:grade 2 in 43 patients (27.0％,MELD-Na score 27.3 ±7.4),grade 3 in 41 patients (25.8％,MELD-Na score 32.7 ± 12.4),grade 4 in 31 patients (19.5％,MELD-Na score 34.3 ± 12.1),grade 5 in 9 patients (5.7％,MELD-Na score 30.7 ± 12.3),grade 6 in 35 patients (22％,MELD-Na score 37.1 ± 10.4).There was no grade 1 patient.The AUC of the MELD-Na score for the severe and death groups were 0.631 (P ＜ 0.05;95 ％ CI,0.533 ～ 0.728) and 0.670 (P ＜ 0.05;95 ％ CI,0.574 ～ 0.766) respectively.The MELD-Na score was significantly correlated with the Accordion severity grade (rho 0.297,P ＜ 0.01) on Spearman correlation analysis.Multivariate analysis showed that a MELD-Na score ≥25 was a risk factor of postoperative severe grade complication (P ＜ 0.05,OR =4.35),a MELD-Na score ≥35 was a risk factor of postoperative mortality (P ＜0.01,HR =4.72).Conclusion The MELD-Na score was significantly correlated with the Accordion severity grade,which efficaciously predicted the complication severity grades after liver transplantation.

Value of accordion severity grading system in predicting short-term outcome after orthotopic liver transplantation for severe hepatitis / 中华器官移植杂志

Objective To explore the value of the Accordion severity grading system (ASGS) in predicting short-term outcomes after orthotopic liver transplantation for severe hepatitis by classifying post-surgery complications.Methods The clinical documents of 159 patients were retrospectively analyzed who underwent orthotopic liver transplantation for severe hepatitis between Aug.1,2004 to Sept.1,2014 at our center.Complications were categorized according to the ASGS:grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).Outcome measures included ventilator support time,the length of ICU stay,postoperative recovery time.Spearman rank correlation analysis was used to test the correlation between the different grades with these outcome measures.1-year survival trends of different grade complication groups were demonstrated by Kaplan-Meier method and compared by Log-rank test.Results In total,43 (27.0％) patients had a grade 2 complication;41 (25.8％) grade 3;31 (19.5％) grade 4;9 (5.7％) grade 5;and 35 (22.0％) grade 6.There was no grade 1 patient.There was a significant correlation between the complication grades and the ventilator support time,the length of ICU stay and postoperative inpatient time (P＜0.01).With the increase of the complication grades,the outcome measures were even worse.Severe grade complication group had a longer ventilator support time,the length of ICU stay and postoperative inpatient time than the moderate grade complication group (P＜0.01).There was a significant downward trend in 1-year survival with the increase of the complication grade (P＜0.01).Conclusion The ASGS is helpful to assess risks and predict short-term outcomes after liver transplantation for severe hepatitis.Higher Accordion grades are correlated with even worse short-term outcomes.

A randomized controlled study on the effect of entecavir in the treatment of 50 patients with chronic severe hepatitis B / 中国基层医药

Objective To investigate the effect of entecavir in the treatment of chronic severe hepatitis B and the influence on peripheral blood T cell subsets and liver function.Methods 100 patients with chronic severe hepati-tis B were selected as research subjects,who met the inclusion criteria.The patients were randomly divided into the observation group(50 cases)and control group(50 cases),then the clinical effects were assessed after treatment. Results The CD +4 ,CD +4 /CD +8 of the observation group and control group after treatment were (40.65 ±5.06)%and (35.32 ±5.18)%,(1.83 ±0.35)% and (1.30 ±0.26)%,which were significantly higher than before treat-ment,the differences were statistically significant(t =7.762 and 5.192,6.319 and 3.392,all P <0.05),the CD +8 levels were (22.13 ±4.85)% and (27.24 ±4.66)%,which were significantly lower than before treatment,the differences were significant(t =8.553,3.667,all P <0.05).The CD +4 ,CD +4 /CD +8 of the observation group were significantly higher than the control group,the differences were statistically significant(t =3.479,5.413,all P <0.05),the CD +8 was significantly lower than the control group,the difference was significant(t =3.551,P <0.05). The ALT,AST,HBV-DNA of the observation group and control group after treatment were (45 ±17)U /L and (90 ± 22)U /L,(55 ±20)U /L and (86 ±25 )U /L,(2.71 ±0.50)copy/mL and (4.62 ±0.53)copy/mL,which were significantly lower than before treatment,the differences were statistically significant(t =10.568 and 6.773,9.935 and 7.035,6.339 and 3.448,all P <0.05).The ALT,AST,HBV-DNA of the observation group were significantly lower than the control group,the differences were statistically significant(t =3.662,3.514,3.604,all P <0.05). Conclusion Entecavir can effectively suppress viral replication,enhance immune function and improve liver func-tion,and has better security in the treatment of 50 patients with chronic severe hepatitis B,which is worthy of clinical use.

The value of interleukin 35 in assessing the prognosis of severe hepatitis / 中国基层医药

Objective To explore the significance of interleukin -35 (IL -35)in serum of patients with severe hepatitis.Methods Collected 39 cases of chronic hepatitis B(CHB)patients and severe hepatitis,and col-lected 19 cases of healthy control's(HC)peripheral blood at the same time.ELISA method was used to detect IL -35 levels.Results IL -35 in CHB and severe hepatitis group [(483.5 ±280.7)ng/mL and (277.9 ±248.7)ng/mL] were higher than HC group (50.5 ±47.8)ng/mL(t =2.089,3.303,P =0.044,0.002).In severe hepatitis group, the IL -35 levels in survivors group (305.3 ±301.2)ng/mL was higher than death group (78.7 ±33.2)ng/mL (P =0.012).IL -35 was positively correlated with ALT and AST,the correlation coefficient were 0.649 and 0.599. Conclusion IL -35 is involved in the pathogenesis of hepatitis B process,the low serum IL -35 levels in severe hepatitis patients may herald a bad prognosis.

Effect of alprostadil injection on serum TNF-α,β2-MG and sIL-2 R in adjunctive treatment of severe hepatitis with liver and kidney syndrome / 中国生化药物杂志

Objective To investigate the effect of alprostadil injection on serum tumor necrosis factor ( TNF-α) ,β2-microglobulin (β2-MG) and soluble interleukin 2 receptor (sIL-2R) levels in adjunctive treatment of patients of severe hepatitis with liver and kidney syndrome.Methods A total of 60 patients of severe hepatitis with liver and kidney syndrome were collected and randomly divided into experimental group and control group with 30 cases in each group.The two groups were treated by conventional therapy, patients in the control group were treated by continuous renal replacement therapy, patients in the experimental group were treated on the basis of the control group with alprostadil injection in adjuvant therapy for 3 weeks.The serum biochemistry and liver and kidney function and clinical curative effect were detected.Results Compared with the control group, the serum TNF-α, β2-MG and sIL-2R levels of the experimental group were lower (P<0.05); alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirnbin (TBiL) levels were lower (P<0.05), albumin (Alb) level and prothrombin time activity (PTA) were higher (P<0.05), serum creatinine (Scr), urea nitrogen (BUN), CysC and 24h urine protein were lower (P<0.05), 24h urine volume was higher (P<0.05); efficacy in experimental group was better than control group (Z=-2.321,P=0.020).Conclusion Alprostadil injection in adjunctive treatment of severe hepatitis with liver and kidney syndrome patients has significant effect and high safety, could significantly reduce the serum TNF-α, β2-MG and sIL-2R levels.

Clinical efficacy of modulation of intestinal microecology and plasmapheresis for preventing and treating multiple organ failure in patients with severe hepatitis / 临床肝胆病杂志

ObjectiveTo explore the methods for prevention and treatment of endotoxemia and multiple organ failure in patients with severe hepatitis. MethodsA total of 61 patients with severe hepatitis and toxic enteroparalysis were randomly assigned to three groups. The first group was treated with plasmapheresis, the second group with plasmapheresis and colon dialysis, and the third group with plasmapheresis, colon dialysis, and oral probiotics. Analyses were performed on the clinical symptoms and physical signs, hepatic function, endotoxin level, and clinical outcome in each group. Comparison of continuous data between groups was performed by analysis of variance, and further pairwise comparison by SNK test; comparison of categorical data between two groups was performed by chi-square test. ResultsThe liver function improved in all groups after treatment. The endotoxin level was significantly lower in the third group than in the other two groups (P＜005). The symptom improvement rates in the three groups were 35.3%, 64.7%, and 81.5%, respectively; the recurrence rates were 833%, 727%, and 364%, respectively; the clinical remission rates were 5.9%, 17.6%, and 48.1%, respectively, and the third group had a significantly higher rate than the first group (χ2=8.59, P＜0.05). ConclusionA combination of plasmapheresis, colon dialysis, and oral probiotics can effectively improve the prognosis of patients with severe hepatitis and toxic enteroparalysis, and can help prevent and treat multiple organ failure in such patients.

Nursing of chronic severe hepatitis patients with hypoglycemia / 现代临床护理

Objective To summarize the experience in nursing the patients with chronic severe hepatitis complicated with hypoglycemia. Method Five chronic severe hepatitis patients with hypoglycemia were cared and by monitoring blood glucose, observing the state of disease, correcting low blood sugar and safety control, providing an appropriate nutritional support, arranging the speed of infusion in a proper order and offering related disease knowledge. Results After the treatment, the blood sugar was 3.3~4.9 mmol/L, with a median of 4.2 mmol/L. One patient died of liver and kidney failure, one gave up the treatment because of deterioration and the rest three got better. The hospital stay was 42~120 d with an average of 88.0 d. Conclusion Relevant nursing intervention for the hypoglycemia of chronic severe hepatitis can promptly correct low blood sugar , maintain normal level of blood sugar and avoid serious complications.

Comparative study of efficacy of different types of artificial liver treatments in management of hepatitis B-associated subacute severe hepatitis / 重庆医学

Objective To observe the clinical efficacy of plasma exchange(PE),PE combined with plasma bilirubin absorp-tion(PE+PBA),and PE combined with double plasma molecule absorption system(PE+DPMAS),to investigate the best treat-ment options for the patients of hepatitis B-associated subacute severe.Methods Totally 140 patients who had hepatitis B-associat-ed were randomly divided into a PE group,a PE+PBA group,and a PE+DPMAS group.The dinical symptoms and blood rontine, electrolytc and the main biochemical indexes were recorded both before and after treatment and compared among the three groups. Results The total effective rate was higher in the PE +DPMAS group than in the PE group and PE+PBA group,which were 70.8%,60.9%,67.4% respectively,but there was no significant difference(P >0.05).compared with before treatment,serum total bilirubin (TBIL),alanine aminotransferase (ALT),aspartic acid amino shift enzyme (AST),valley aminoacyl transfer peptidase (GGT),alkaline phosphatase (ALP),globulin (GLB)and other biochemical indexes decreased significantly after treatment in 3 groups (P 0.05).Serum K+ and Cl- was obviously declined after treatment in the PE group,there was significant difference(P <0.001).Serum Na+ was obviously declined after treatment between the PE + PBA and PE + DPMAS groups (P < 0.001 ),but the difference was no significant in the PE groups.Serum Ca2+ was significantly decreased in the three groups of patients after treatment(P <0.001).WBC,Hb and PLT were significantly statistical difference after treatment(P <0.05).Conclusion The three groups also can improve liver function and the treatment rate for the patients of subacute hepatitis B-associated severe hepatitis.PE+PBA and PE+DPMAS groups can effective-ly reduce two thirds of the overall usage of the plasma.PE+DPMAS groups that the quantity of Cl- ,Ca2+ ,Hb decline much least in the three groups show larger value in the clinical application.

The efficacy and safety analysis of glucocorticoid deescalation combined antiviral therapy on severe hepatitis B / 重庆医学

Objective Observe the efficacy and safety of glucocorticoid deescalation combined antiviral therapy on severe hepati‐tis B .Methods Forty‐nine patients with early severe hepatitis were selected and divided them into observation group(n=24) and control group (n=25) randomly .Control group were given the conventional synthetic therapy while observation group were given conventional synthetic therapy combined glucocorticoid deescalation therapy .Then compare the differences of TBIL ,ALT ,PTA be‐fore and after treatment ,and the improvement time of syndrome and death rate between two groups .Results The death rate in ob‐servation group and control group were 16 .7% and 32 .0% respectively(P0 .05) .After the treatment ,the TBIL ,ALT ,PT were improved in both two groups(P 0 .05) .Conclusion Glucocorticoid deescalation therapy could decrease the death rate ,shorten the syndrome lasting time in treating severe hepatitis B .It was an effective and safety meth‐od .

Clinical Observation of Plasmapheresis plus Acupoint Injection for Severe Hepatitis / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of plasmapheresis plus acupoint injection in treating severe hepatitis. MethodSixty patients with severe hepatitis were randomized into a treatment group of 31 cases and a control group of29 cases. The two groups both received plasmapheresis in addition to the comprehensive internal medicine treatment, while thetreatment group simultaneously received acupoint injection withHuang Qi(Radix Astragali) at Zusanli (ST 36). After the intervention, the symptoms, signs, liver function, blood coagulation, and blood ammonia were observed in the two groups.ResultAfter the intervention, the symptoms, signs, and biochemical indexes were significantly improved,and theindexes in the treatment group were significantly different from that in the control group (P<0.05,P<0.01), and the total effective rate of the treatment group was markedly higher than that of the control group (P<0.05).ConclusionPlasmapheresis plus acupoint injection can effectively improve the short-term condition of the patients, enhance therapeutic efficacy, with fewer adverse reactions.

Experience in Director Shen Yuanliang Treating Severe Hepatitis / 浙江中医药大学学报

Objective] To sum up director doctor Sheng Yuanliang ’s experience in treating severe hepatitis. [Method] Through analyzing the treating rules,causa morbi and mechanism of severe hepatitis,it sums up the key points of data of severe hepatitis,with 1 case for detailed explanation. [Result] The reason of the disease is mainly“damp,heat and toxin evils”,with corresponding therapies of removing heat to promote dieresis ,removing toxin and stasis. [Conclusion] The famous TCM doctor Shen Yuangliang’s applying clearing heat to promote dieresis,removing stasis and toxin to treat severe hepatitis,gets good clinical effect,having enlightenment meaning to clinical practice,with promotion value.

Clinical analysis of 42 cases of pregnancy complicated with severe hepatitis / 中国综合临床

Objective To investigate the clinical features of pregnancy complicated severe hepatitis and summarize experience in diagnosis and treatment so as to decrease maternal mortality.Methods Forty-two cases of pregnant women with severe hepatitis in the hospital were retrospectively analyzed.According to the outcome,all subjects were divided into death group(27 cased) and survival group(15 cases).Clinical data including viral markers,clinical manifestations,blood biochemistry,clinical treatment and pregnancy outcomes were recorded.Results (1) Pathogen examination showed that the major infection was hepatitis B virus (HBV),accounting for 64.29％ (27/42).(2) The first symptoms was gastrointestinal symptoms,accounting for 73.81％ (31/42).(3) The level of serum albumin,cholesterin (CH) and cholinesterase (CHE) in survival group were (29.91 ± 6.78) g/L,(2.80 ± 1.02) μmol/L and (5 399.4 ± 1 096.5) U/L respectively,significantly higher than that in death group((25.14 ± 7.36) g/L,(1.73 ± 0.77) μmol/L,(3423.6 ± 1102.7) U/L respectively).The serum creatinine(SCr) and prothrombin time (PT) levels in survival group were (83.06 ± 47.23) μ mol/L,(18.98 ± 6.72) s,lower than that in death group ((231.54 ± 58.90) μmol/L,(44.16 ± 5.38) s).The differences were statistically significant (t =2.07,3.84,5.57,8.37,13.29 ; P ＜ 0.05 or P ＜ 0.001).(4) The mortality rate of patients who chose pregnancy termination was 31.58％ (6/19),lower than the overall average mortality rate 64.29％ (27/42) and the difference was statistically significant (x2 =5.636,P =0.018).Conclusion HBV infection is the main reason for pregnant women with severe hepatitis.Gastrointestinal symptoms is the main symptom.Serum albumin,SCr,PT,serum CH and CHE can be regarded as prognostic indicators of the disease.Active comprehensive treatment and timely pregnancy termination can reduce maternal mortality.