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Objective To analyze the pathogenic characteristics of sepsis in patients with hepatic failure, and to explore the risk factors for sepsis in patients with liver failure. Methods The data of 221 patients with hepatic failure admitted to Tianjin Second People's Hospital from January 2014 to December 2018 were retrospectively collected. The patients were divided into two groups according to whether they suffered from sepsis or not. The pathogeny results of blood culture in patients with sepsis were observed. The levels of white blood cell (WBC), neutrophil (Neut), platelet (PLT), lactic acid (Lac), C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. The risk factors for sepsis in patients with hepatic failure were analyzed by multivariate Logistic regression analysis. Results Among 221 patients, 27 cases had incomplete data and were excluded. Finally, 194 cases were enrolled in the analysis, including 52 in sepsis group and 142 in non-sepsis group. From 2014 to 2018, there were 11, 12, 11, 11 and 8 positive cases of sepsis in patients with liver failure. The positive rate of Gram-positive (G+) bacteria increased year by year (2, 3, 4, 5 and 4 cases of G+ bacteria from 2014 to 2018). There was no significant difference in demographic and medical history data, such as gender, age and history of diabetes mellitus between the two groups. Compared with non-sepsis group, Neut, Lac, CRP and PCT in sepsis group were significantly increased [Neut:0.81±0.09 vs. 0.74±0.15, Lac (mmol/L): 3.04±0.61 vs. 2.00±0.43, CRP (mg/L): 44.09±8.37 vs. 40.54±8.37, PCT (μg/L): 0.34±0.12 vs. 0.31±0.11], with significant differences (all P < 0.05). But there was no statistical difference in WBC or PLT between the two groups. The multivariate Logistic regression model incorporated the indicators with statistical significance in univariate analysis. The results showed that Lac was an independent factor of sepsis in patients with hepatic failure [odds ratio (OR) = 58.286, 95% confidence interval (95%CI) = 16.633-204.247, P =0.000]. Conclusions For patients with hepatic failure infection, the ratio of G+ bacteria increased year by year. Elevated Lac is an independent risk factor for sepsis in patients with liver failure.
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Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus(HBV)infection in immune tolerant phase.Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study.The age,gender,serum HBV DNA level,hepatic inflammatory activity and fibrosis,hepatic HBsAg and HBcAg expressions were analyzed.The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase(ALT).Data analysis was done by chi-square test. Results In 98 patients,83(84.7%)were＜30 years old and 15(15.3%)were≥30.Patients whose mother was HBsAg positive were 48.0%.High levels of serum HBV DNA were found in all patients, with 78.5% were＞1×107 copy/mL.Only 5 cases(5.1%)were G0 of the inflammatory grade;whereas,64 cases(65.3%)were G1,29(29.6%)were G2.There were 56 patients(57.1%)had no significant liver fibrosis;and 23 cases(23.5%)were S1,14(14.3%)were S2,5(5.1%)were S3;none of patients had cirrhosis.The HBsAg and HBcAg in liver tissues were positive in 79(80.6%)and 80(81.6%)cases,respectively.The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels(X2=8.112 3,P=0.043 7).Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver,some of them have already developed fibrosis.Therefore,liver pathology is recommended for these patients to help understand the patients' conditions and make correct therapeutic decisions.
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<p><b>OBJECTIVE</b>To study the prevention and treatment of HBV reinfection after liver transplantation.</p><p><b>METHODS</b>Total 19 cases of chronic fulminant hepatitis B, the end-stage of liver cirrhosis and liver carcinoma complicated with HBV cirrhosis. Were performed liver transplantation and given anti-viral drugs pre and post transplantation. Famciclovir was administered in 4 cases, lamivudine in 13 cases and lamivudine+HBIG in 2 cases. The serum HBVM and liver biopsy immunohistochemistry were performed.</p><p><b>RESULTS</b>Four cases given famciclovir developed reinfection. Serum HBsAg, HBeAg and HBV DNA were positive in 3 cases. Liver biopsy immunohistochemistry showed HBsAg and HBeAg phenotype. Classical viral hepatitis in 1 case occurred, three cases died. In the lamivudin group 7 cases showed positive for HBsAg, 2 cases positive for HBV DNA, 4 cases HBsAg or HBcAg phenotype. One case showed positive for serum anti-HBc the other negative for HBVM, and liver biopsy immunohistochemistry was negative too.</p><p><b>CONCLUSIONS</b>These date suggest that anti-virus prevention and treatment in pre and post liver transplantation with HBV infected correlative disease is necessary, feasible and effective.</p>