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Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis. Most studies have shown that sarcopenia is associated with overt hepatic encephalopathy (OHE), leading to an increased risk of events such as reduced quality of life, poor clinical prognosis, and even death in patients with liver cirrhosis, but there are few studies on the association between sarcopenia and minimal hepatic encephalopathy (MHE). This article reviews the research advances in sarcopenia and hepatic encephalopathy to provide a reliable basis for clinical treatment, and it is pointed out that the nutritional status of patients can be improved to prevent MHE and even reduce the onset of OHE, thereby improving patient prognosis, increasing quality of life, and reducing the risk of death.
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Objective To investigate the value of Stroop test, a neuropsychological test, in the diagnosis of minimal hepatic encephalopathy (MHE). Methods A total of 96 patients with liver cirrhosis who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, from August 2020 to March 2021 were enrolled, and the number connection test-A (NCT-A), digit symbol test (DST), animal naming test (ANT), and Stroop test were performed for all patients. Test results were recorded and related clinical data were collected. The t -test was used for comparison of normally distributed continuous data between two 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. The receiver operating characteristic (ROC) curve was used to investigate the value of Stroop test in the diagnosis of MHE, and the Pearson correlation coefficient was used to analyze the correlation of the results of Stroop test with those of NCT-A, DST, and ANT. Results For the 96 patients with liver cirrhosis, the prevalence rate of MHE was 30.21% (29/96). The Off+On time of Stroop test had a cut-off value of 212.49 s in the diagnosis of MHE, with an area under the ROC curve of 0.845, a sensitivity of 93.10%, and a specificity of 64.20%. The Pearson correlation analysis showed that the On+Off time and On time of Stroop test were moderately correlated with NCT-A( r =0.580 and 0.590, both P < 0.01), the Off time of Stroop test was strongly correlated with NCT-A( r =0.620, P < 0.01), and the On+Off time, On time, and Off time of Stroop test were strongly correlated with DST( r =-0.650, -0.650, and -0.630, all P < 0.01). Conclusion In the diagnosis of MHE, Stroop test is a highly sensitive method with easy-to-read results and a high diagnostic value and does not require professional equipment.
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Objective To investigate the association between liver pathological changes and clinical features in patients with chronic HBV infection and alanine aminotransferase (ALT) 1-2 × upper limits of normal (ULN).Methods A total of 80 patients with chronic HBV infection and ALT 1-2 × ULN who were hospitalized in The First Affiliated Hospital of Bengbu Medical College from July 2015 to December 2016 were enrolled.All patients underwent liver biopsy,and according to positive or negative HBeAg,these patients were divided into two groups,and the association of liver pathological changes with age,sex,and HBV DNA load was analyzed.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results The HBeAg-negative group had significantly higher age and serum ALT level than the HBeAg-positive group (t =12.35 and 7.18,both P ＜ 0.01).Compared with the HBeAg-positive group,the HBeAg-negative group had a significantly higher proportion of patients with liver inflammation ≥G2 (54.8％ vs76.3％,x2 =53.68,P＜0.01) or fibrosis degree ≥S2 (57.1％ vs 73.7％,x2 =46.67,P＜0.01).Immunohistochemical staining was performed for 35 patients to measure the expression of HBsAg and HBcAg in the liver,and there were no significant differences in the staining scores of HBsAg and HBcAg between the two groups (both P ＞ 0.05).Conclusion Among patients with chronic HBV infection and slightly elevated ALT,HBeAg-negative patients have significantly worse conditions of liver lesions than HBeAg-positive patients.Liver biopsy is recommended for older patients with a long course of disease,in order to provide guidance for antiviral therapy.
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Regulatory T cells are a subset of T cells, and can inhibit the body′s immune response and induce immune tolerance, which has become one of the hot topics in the field of immunological research in recent years. Regulatory T cell dysfunction and the change in the number of regulatory T cells are closely associated with the progression and treatment of autoimmune diseases, infectious diseases, tumor immune tolerance, transplant rejection, and allergic diseases. This article summarizes the surface markers and immunological mechanism of regulatory T cells, as well as the association of regulatory T cells with the pathogenesis of hepatitis B and antiviral therapy.
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Objective To observe the effect of plasma exchange (PE)therapy for removing serum interleukin-6 (IL-6),tumor necrosis factor alpha (TNFα),and interferon gamma (IFNγ)in patients with liver failure,and to assess the value of artificial liver support system in the treatment of liver failure.Methods The study included 36 patients with liver failure who were hospitalized in the First Affiliated Hospi-tal of Bengbu Medical College from February 2012 to February 2013.Blood samples were collected before PE and the next morning after mul-tiple treatments.Plasma TNFα,IL-6,and IFNγlevels were measured by ELISA.Between-group comparison of measurement data before and after treatment was made by independent-samples t test,and comparison of mean values between groups was made by analysis of vari-ance.Results All the 36 liver failure patients had significantly lower levels of TNFα(381.23 ±190.57 ng/L vs 274.12 ±212.30 ng/L,P0.05).After PE therapy,29 out of 36 liver failure patients recovered well,while the remaining 7 patients deteriorated.The recovered group had significantly greater decreases in TNFα(122.58 ±57.64 ng/L vs 42.45 ±19.86 ng/L,P<0.05),IL-6 (26.93 ±7.25 ng/L vs 6.71 ±3.55 ng/L,P<0.05),and IFNγ(284.06 ±94.31 ng/L vs 217.47 ±45.76 ng/L,P<0.05)than the deteriorated group.The response rates of patients with acute,subacute,acute -on -chronic,and chronic liver failure were 66.67%,85.71%,86.36%,and 50%,respectively.Conclusion Continuous artificial liver PE therapy can effectively remove pro-inflammatory cytokines from plasma and thus improve the clinical outcomes of patients with liver failure.
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Objective To investigate the clinical efficacy of plasma exchange (PE)in the treatment of liver failure.Methods A retro-spective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hos-pital.Thirty -three patients in PE group received PE in addition to medical comprehensive treatment,and 30 patients in control group were treated with medical comprehensive treatment.Clinical symptoms,complications,and the changes in biochemical markers of liver function were observed after 2 weeks of treatment,post -treatment outcomes were evaluated by 3 -month followed -up,and the influential factors for efficacy were analyzed.Experimental data were expressed as mean ±standard deviation,continuous data were compared by t test,and cate-gorical data were analyzed by chi -square test or Fisher′s exact test.Results Symptoms such as fatigue,poor appetite,and abdominal dis-tension were significantly relieved after PE.Post -treatment serum alanine aminotransferase (ALT)and total bilirubin (TBil)levels were significantly lower compared with pre -treatment levels (390.48 ±536.52 U /L vs 81.03 ±47.58 U /L and 479.27 ±130.01 μmol /L vs 244.64 ±151.05 μmol /L,P 0.05).Patients in PE group had a significantly higher improve-ment rate (χ2 =8.276,P <0.005)and a significantly lower mortality rate (χ2 =13.258,P <0.005)compared with the control group.The efficacy of PE was found to be correlated with pre -treatment TBil level,complications,bilirubin enzyme separation,and age ≥40 years (P <0.05).TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE (P <0.05,OR =1.01 and 8.75).Adverse reactions occurred in 8 cases during PE treatment,and disappeared after symptomatic treatment.Conclusion PE is a safe and effective treatment for liver failure,and holds promise for clinical application.TBil level and bilirubin enzyme separation are independ-ent risk factors affecting the efficacy of PE.
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Objective To explore the expression level of CD4+ CD25+ CD127low-regulatory T cells (Treg) in the peripheral blood of hepatitis B virus (HBV)-infected individuals,and its association with liver pathology.Methods Thirty-five HBV-infected individuals and 20 healthy controls were enrolled.The frequencies of peripheral blood CD4+ CD25+ CD127low/-Treg were detected by flow cytometry.HBV-related serological tests as well as ultrasound-guided liver biopsies were performed in HBV-infected individuals.The two groups were compared by t test.Spearman and Pearson correlation analyses were performed.Results The alanine aminotransferase (ALT) level of HBV-infected individuals was (34.57 ± 15.36) U/L,with 25 subjects of ALT＜40 U/L.Twenty subjects were hepatitis B e antigen (HBeAg) positive,and 15 were HBeAg negative.The frequency of the peripheral blood CD4+ CD25+ CD127low/-Treg in HBV-infected individuals was (5.59 ±1.50)％,which was significantly higher than that in healthy controls [(4.85±0.95) ％ ; t=2.191,P=0.033].The level of peripheral blood CD4+ CD25-CD127low/-Treg was positively correlated with HBV viral load (r=0.495,P=0.003).Thirty-one subjects had liver inflammatory score ≤2,with a peripheral blood CD4+ CD25+ CD127low/-Treg level of (5.80 ± 1.44) ％,which was significantly higher than that of the rest 4 subjects who had liver inflammatory score ＞2 [(4.00±0.77)％; t=2.425,P=0.021].Twenty-four subjects had liver fibrosis score ＜2,with a peripheral blood CD4+ CD25+ CD127low/-Treg level of (6.00±1.44) ％,which was significantly higher than that of the rest 11 subjects who had liver fibrosis score ≥ 2 [(4.70 ± 1.24)％; t =2.559,P＝0.015].The expression of CD4 + CD25 +CD127low/-Treg in peripheral blood was inversely correlated with liver inflammation (r=-0.539,P=0.001) and fibrosis (r =-0.488,P =0.003) in HBV-infected individuals.Conclusions CD4+ CD25+ CD127low/-Treg is associated with chronic condition and liver damage of hepatitis B.It may play an important role in occurrence,development and prognosis of the disease.