ABSTRACT
To explore the prognostic factors for patients with drug-induced liver failure (DILF) and construct a logistic regression model (LRM). Methods: A retrospective analysis of clinical data was performed in 183 hospitalized patients, who were diagnosed with DILF in Xiangya Hospital, the Second Xiangya Hospital and the Third Xiangya Hospital, Central South University from January 2009 to January 2018. The patients were divided into an improved group (n=67) and an ineffective group (n=116) according to their prognosis. Univariate analysis was performed to screen for possible prognostic factors such as age, Tbil, SCr, PT and complications. According to the results of univariate analysis, the multivariate analysis was performed to determine the independent prognostic factors and construct a LRM. The LRM was compared with the model for end-stage liver disease (MELD), the predictive value of LRM and MELD was evaluated by receiver operating characteristic curve (ROC), the parameters such as area under the ROC (AUC) and total accuracy were compared between the 2 models and verified by another independent sample. Results: According to univariate analysis, there was significant differences in age, clinical type, hepatic encephalopathy, hepatorenal syndrome, WBC count, the ratio of aspartic acid transaminase (AST) to glutamine transaminase (ALT) (AST/ALT), Tbil, SCr, PT and alpha-fetoprotein (AFP) between the 2 groups (all P<0.05). Multivariate analysis revealed that: AFP, PT, AST/ALT, hepatic encephalopathy and hepatorenal syndrome were independent prognostic factors for DILF, which could be applied to constructing a LRM. The AUC of LRM and MELD was 0.917 (95% CI 0.876 to 0.959) and 0.709 (95% CI 0.633 to 0.786) respectively, the total accuracy rate of prediction for the LRM and the MELD was 86.7% and 68.3% respectively, there was significant difference in AUC and total accuracy rate between the LRM and the MELD (P<0.05). LRM was superior to MELD. Conclusion: AFP, PT, AST/ALT, hepatic encephalopathy and hepatorenal syndrome were independent prognostic factors for DILF; the LRM can well predict the prognosis in the DILF patients, which is superior to the MELD.
Subject(s)
Humans , China , Liver Failure , Diagnosis , Logistic Models , Predictive Value of Tests , Prognosis , ROC Curve , Retrospective Studies , Severity of Illness IndexABSTRACT
Objective To evaluate the efficacy and safety of trascatheter arterial chemoembolization (TACE) with raltitrexed and oxaliplatin (RO) regimen as well as lipiodol emulsion in treating BCLC B/C hepatocellular carcinomas.Methods A total of 183 patients with BCLC B/C hepatocellular carcinoma were treated with TACE by using RO regimen and lipiodol emulsion.The therapeutic regimen included raltitrexed 3 mg/m2 for hepatic artery perfusion,oxaliplatin 130 mg/m2 mixed with lipiodol 5-30 ml emulsion for embolization.The toxicities were assessed according to WHO anti-cancer drug toxicity grading standards.Liver damage was determined by Child-Pugh classification.All the patients were followed up and the survival time was calculated.Results In 183 patients,the hematologic toxicity was characterized by bone marrow suppression.The incidences of neutropenia,anemia and thrombocytopenia were 21.9％,8.3％ and 2.7％,respectively.The degree Ⅰ,Ⅱ,Ⅲ and Ⅳ of neutrophil count decrease were seen in 15.85％,5.46％,0.55％ and 0％ of patients,respectively.Nausea and vomiting of degree Ⅰ-Ⅱ was observed in 71.58％ of patients.Liver function damage was presented as elevated transaminase and elevated bilirubin level.Preoperative Child-Pugh grade A was seen in 96 patients and grade B in 87 patients.Child-Pugh grade was elevated from preoperative grade A to postoperative grade B in 48 patients,from preoperative grade A to postoperative grade C in 6 patients,and from preoperative grade B to postoperative grade C in 12 patients.In this series,no symptoms or signs of cardiac,urinary or nervous system toxicity were observed.The survival time of 183 patients was 5-35 months,with the median survival time being 20 months.Conclusion For the treatment of BCLC B/C hepatocellular carcinomas,TACE using RO regimen and lipiodol emulsion is safe and effective,and it can reliably improve the quality of life of patients.
ABSTRACT
Objective: To determine the relationship among perceived stigma, mental health and unsafe sexual behaviors of people living with HIV/AIDS. Methods: Cross-sectional research was used to interview people living with HIV/AIDS (PLWHA) from April 2012 to March 2013 in Changsha, China. The questionnaires included General Questionnaire, Sexual Behavior Questionnaire, Patient Health Questionnaire Depression Scale (PHQ-9), General Anxiety Disorder Scale (GAD-7) and Psychometric Assessment of the HIV Stigma Scale. hTe results were statistically analyzed with SPSS18.0. Results: hTe total score of perceived stigma and its 4 dimensions were positively correlated with anxiety and depression. The total score of perceived stigma and its dimensions were associated with disclosure, but no signiifcantly correlated with other sexual behaviors. Hierarchical regression showed perceived stigma had an effect on anxiety. Conclusion: hTe stigma perceived by PLWHA is above the average level. Perceived stigma has an effect on mental health, especially anxiety, but no effect on unsafe sexual behaviors.
ABSTRACT
Objective To investigate the clinical significance of high mobility group box-1 protein (HMGB1) in chronic,severe hepatitis B patients and liver cirrhosis.Methods The contents of HMGB1 was measured by enzyme-linked immunoassay (ELISA) in the patients (include 40 patients with chronic hepatitis B and 18 severe hepatitis B patients and 18 liver cirrhosis patients) and 20 health controls.The levels of relative biochemical indicators,prothrombin time activity percentage (PTA) and the hepatic fibrosis were determined by biochemical methods.Results The contents of HMGB1 was significantly increased in severe hepatitis patients in comparison with that in chronic hepatitis B patients(P ＜0.01).The contents of HMGB1 in the chronic hepatitis were significantly increased in health controls(P ＜0.01).The contents of HMGB1 had significant difference among the liver cirrhosis patients,the severe hepatitis patients and the chronic hepatitis(P ＜0.01).There was positive correlation among the contents of HMGB1 and total bilirubin (TBIL),the proportionality of aspartate aminotransferase and alanine aminotransferase (AST/ALT),hyaluronic acid (HA) and procollagen Ⅲ N-terminal peptide (P Ⅲ NP) (r = 0.865,0.646,0.783,0.662,P ＜ 0.01).There was negative correlation among the contents of HMGB1 and prothrombin time activity percentage (PTA) and albumin (ALB) (r =-0.915,-0.852,P ＜0.01).Conclusion The contents of serum HMGB1 were closely associated with disease severity in chronic hepatitis B patients.HMGB1 was an index to auxiliary diagnosis hepatic fibrosis.
ABSTRACT
Objective To study the relationship between serum HBV DNA level and apoptosis of peripheral blood mononuclear cells (PBMC) , and the relationship between serum HBV DNA level and the activity of caspase-8 in the patients with chronic hepatitis B (CHB). Method 30 CHB patients were selected as experimental group, and it was divided into three subgroups according to the serum HBV DNA level, subgroup A (high serum HBVDNA), subgroup B (medium serum HBVDNA), and subgroup C (low serum HBVDNA). 10 healthy adults were random selected as control group. PBMC were isolated from two groups by separating medium of lymphocytic cell and culturing it with phytohemagglutinin (PHA) in vitro for 72 hours. The PBMC was stained with PI and the apoptosis was assayed with flow cytometry. At the same time, the aetivity of caspase-8 of PBMC was assayed by color matching. Results The apoptosis rate of PBMC of experimental group ( 26. 88 ± 7.37 ) % were higher than that of the control group ( 14. 95 ±2. 53)% ( P <0. 01 ). In the experimental group, the apoptosis rate of PBMC of subgroups A, B and C showed decreasing order (34. 75 ± 4. 59)%, (25.63 ± 3.55 )%, ( 18. 91 ± 3. 81 )%. The activity of caspase-8 of experimental group 2. 99 ±0. 82 were higher than that of the control group 1.43 ±0. 91 ( P <0. 01 ). The activity of caspase-8 of subgroup A, B and C showed the same decreasing order: 3. 87 ±0. 35,2. 95 ± 0. 36, 1.95 ± 0. 29. There was a positive correlation between the apoptosis level of PBMC and the activity of caspase-8 in experimen tal group ( r = 0. 610, P < 0. 01 ). Conclusion AICD of PBMC was found in patients with CHB. The activity of caspase-8 increased in that process, and it may participate in the transduction of apoptosis signal. Serum HBV DNA level was related with the apoptosis rate of PBMC and the activity of caspase-8, and it may be one of the reasons of apoptosis in PBMC.
ABSTRACT
BACKGROUND:Umbilical cord blood transplantation can ameliorate hepatic and immunologic function,repair hepatic injury,and promote hepatic regeneration,however,the differentiation mechanism and biological characteristics remain poorly understood,and the long-term efficiency need to be explored.OBJECTIVE:To investigate the long-term therapeutic efficacy of infusing umbilical cord blood and blood plasma in treating chronic severe hepatitis B patients.METHODS:Totally 50 chronic severe hepatitis B patients received treatment at the Second Xiangya Hospital,Central South University from January 2003 to January 2004 were randomly divided into the treatment and control groups,with 25 cases in each group.All patient were accepted an ordinary synthetic treatment,and the differences between age,pathogenetic condition,medication had no significance.The umbilical cord blood was obtained from healthy full-term spontaneous delivery parturient,centrifugated,remained karyotes and cord plasma,and used within 24 hours.Patients in the treatment group were received umbilical cord blood infusion,200 mL once,1 2 times per week,totally,each patients infused 4-8 times(mean 5 times);those in the control group were infused with adult fresh blood plasma.The changes of hemogram and hepatic function were measured.RESULTS AND CONCLUSION:All the patients were followed-up for 1 year.The hemogram and hepatic function indexes were similar in the 2 groups before treatment(P ＞ 0.05).The hemogram index had no obviously difference at 1 year after treatment (P ＞ 0.05),but the alanine aminotransferase and total bilirubin levels were decreased in the treatment compared with the control group(P ＜ 0.05),but the albumin was significantly increased(P ＜ 0.05).Compared with before treatment,the platelet level had no significant changes at 1 year after treatment,but the alanine aminotransferase and total bilirubin levels were deeply decreased(P＜ 0.05),albumin was significantly increased(P ＜ 0.05);the platelet and albumin levels were dramatically decreased in the control group(P ＜ 0.05).It suggested that umbilical cord blood infusion can improve the hepatic function and hemogram;therefore,it can be served as supplementary therapeutic measure for severe hepatitis.