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ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292 — 40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023 — 0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.
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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.
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ObjectiveTo investigate the nutritional risk incidence and clinical outcome in.hospitalized patients with liver diseases.MethodsThe data of 390 cases of liver disease inpatients were studied.The nutritional status of the enrolled patients was assessed with Nutritional Risk Screening 2002.ResultsThe total incidence of nutritional risk in the liver disease patients was 47.95％.The incidence was 81.82％ in severe hepatitis patients,significantly higher that that in acute hepatitis patients (43.33％,P =0.013) and chronic hepatitis patients (28.30％,P =0.000).The incidence of nutritional risk was 75.79％ in hepatic cirrhosis patients,also significantly higher than that in acute hepatitis patients (P =0.000) and chronic hepatitis patients (P =0.000).ConclusionSevere hepatitis and hepatic cirrhosis patients may have higher nutritional risk than acute and chronic hepatitis patients.
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Objective To detect the levels of tumor necrosis factor (TNF)-a,interleukin (IL)-1β,IL-2,1L-6,IL-8,1L-10,IL-12 and interferon (IFN)-α in the serum and cerebrospinal fluid of the patients with epidemic encephalitis B,and to investigate the roles in pathogenesis of epidemic encephalitis B.Methods Approximately of 2 mL serum and 2 mL cerebrospinal fluid from 24 patients with epidemic encephalitis B during acute phase were collected,and 2 mL serum from 20 healthy controls were collected.The levels of eytokines in serum and cerebrospinal fluid were detected by enzyme linked immunosorbent assay (ELISA).Means of multi-sample were compared by analysis of variance and means of two-sample were compared by t test.Results The levels of TNF-α,IL-1β,IL-6,IL-8,IL-10 and IFN-α in eerebrospinal fluid were (24.5±6.6),(7.8±2.4),(16.0±5.7),(17.6±4.8),(130.2±33.6) and (45.2±10.8) ng/L,respectively,and in serum were (25.3±11.2),(7.1±3.2),(14.5±6.2),(16.0±6.5),(82.0±27.8) and (42.5±16.2) ng/L,respectively.The levels of TNF-α,IL-1β,IL-6,IL-8,IL-10 and IFN-α in serum and cerebrospinal fluid from patients with epidemic encephalitis B were all higher than those in serum of healthy controls [(12.7±7.9),(2.6±1.0),(6.2±2.2),(9.6±3.3),(71.4±12.8) and (30.0±14.0) ng/L;F value was 14.10,29.46,23.38,14.78,32.59,7.52;all P＜0.01];while the levels of IL-2 and IL-12 were not increased significantly.The levels of IL-1β,IL-6,IL-8,IL-10,IL-12 and IFN-α in cerebrospinal fluid were higher than those in serum,while the levels of TNF-± and IL-2 in cerebrospinal fluid were lower than those in serum.The levels of IL-6 and IL-8 in cerebrospinal fluid from patients with severe type of epidemic encephalitis B were (18.8±5.4) ng/L and (20.7±2.7) ng/L,and were higher than those with common type [(12.1±3.0) and (13.3±3.3) ng/L;t=3.50,t=5.96;P＜0.05],while the levels of IL-2 in serum and in cerebrospinal fluid from patients with severe type were lower than those with common type. Conclusions Oversecretions of TNF-α,IL-1β,IL-6,IL-8,IL-10 and IFN-a are involved in the inflammatory damage of epidemic encephalitis B,while under-secretions of IL 2 and ILl2 may be involved in cellular immune responses.