ABSTRACT
Objective To evaluate the therapeutic value of alpha-fetoprotein (AFP) and cholinesterase (ChE) in patients with hepatitis B virus related acute onset chronic liver failure (HBV-ACLF). Methods A case-control observation was conducted. Sixty-seven patients with HBV-ACLF admitted to Tianjin Second People's Hospital from January 2009 to October 2015 were enrolled. According to the diagnostic criteria of ACLF, the patients were divided into early, middle, and late groups, and alternatively, according to the outcome, they were divided into survival group and death group. Serum samples were collected after 0, 2, 4, 8 weeks to determine the value of AFP and ChE and analyze the value of AFP and ChE in reflecting the changes during HBV-ACLF progression. The differences in AFP and ChE between the survival group and the death group were compared. The prognostic values of AFP and ChE for HBV-ACLF patients were evaluated. Results Among 67 patients, there were 24, 24, and 19 patients in the early, middle and late stage, respectively, and there were 0, 9, 18 deaths at 8 week. With the advance of HBV-ACLF, the levels of both AFP and ChE were decreased in the early, middle, and late stage, with the AFP value of 40.205 (14.663, 90.550), 23.445 (8.233, 64.213), 8.990 (6.120, 14.340) μg/L (F = 36.149, P = 0.000) and the ChE value of (4.217±1.408), (3.619±1.200), (2.503±1.248) kU/L, respectively (F = 19.575, P = 0.000). In the death group, the levels of serum AFP at 0, 2, 4, 8 weeks were significantly lower than those in survival group [μg/L: 21.540 (7.670, 50.470) vs. 60.680 (16.383, 146.100), 10.560 (6.170, 20.100) vs. 60.090 (27.662, 100.700), 8.750 (3.045, 10.105) vs. 51.875 (16.778, 88.833), 3.900 (2.120, 7.660) vs. 20.400 (12.950, 50.430), P < 0.05 or P < 0.01]. The levels of serum ChE at 2, 4, 8 weeks in the death group were significantly lower than those in the survival group (kU/L: 3.206±1.480 vs. 4.008±1.227, 2.893±1.478 vs. 4.140±1.236, 2.948±1.355 vs. 4.329±1.390, P < 0.05 or P < 0.01). The levels of AFP in 67 patients were 30.100 (10.100, 90.100) μg/L, and ChE was (3.685±1.382) kU/L at 2 weeks, and they showed no correlation between AFP and ChE according to the linear correlation analysis (r = 0.082, P = 0.508), suggesting that AFP and ChE could be used as two independent prognostic factors for HBV-ACLF patients. It was showed by receiver operating characteristic curve (ROC) analysis that the area under the curve of AFP (AUC) was 0.847 (P = 0.000), while the AUC of ChE was 0.681 (P = 0.012). The highest values of Youden index and the maximum effectiveness of testing were obtained when AFP and ChE reached 20.520 μg/L and 2.924 kU/L, respectively, with the sensitivity and the specificity of AFP being 85.0% and 77.8%, respectively, and of ChE being 77.5% and 59.3%, respectively. When using the value of AFP ≥ 20.520 μg/L combined with the value of ChE ≥ 2.924 kU/L, the sensitivity for predicting HBV-ACLF outcome was 65.9%, and its specificity was 91.0%. Conclusion Both AFP and ChE were helpful in providing accurate information for the progression and prognosis of HBV-ACLF patients due to the facts that their values were less interfered by the clinical treatment and that they have higher specificity.
ABSTRACT
OBJECTIVE:To observe the efficacy and safety of Compound sabal berry tablet combined with tamsulosin in the treatment of benign prostatic hyperplasia complicated with urinary obstruction. METHODS:86 patients with benign prostatic hyper-plasia complicated with urinary obstruction were randomly divided into control group(43 cases)and observation group(43 cases). Control group orally received 0.2 mg Tamsulosin hydrochloride orally disintegrating sustained-release tablet,once every evening. Observation group additionally received 500 mg Compound sabal berry tablet before a meal,3 times a day. 4-week was regarded as 1 treatment course,and it lasted 3 courses. During the treatment,all patients in the two groups ate light food,avoiding spicy and bland food. The clinical efficacy,TCM symptom scores,interleukin-8 (IL-8),interleukin-10 (IL-10),tumor necrosis factor α(TNF-α),maximum flow rate(Qmax),post-void residual(PVR),the International Prostate Symptom Score(IPSS)scores before and after treatment and the incidence of adverse reactions in the 2 groups were observed. RESULTS:The total effective rate in ob-servation group was significantly higher than control group,the difference was statistically significant(P0.05). After treatment,TCM symptom scores,IPSS scores,IL-8,IL-10,TNF-α and PVR in 2 groups were signifi-cantly lower than before,and observation group was lower than control group,Qmax was significantly higher than before,and obser-vation group was higher than control group,the differences were statistically significant (P<0.05). And there were no severe ad-verse reactions during treatment. CONCLUSIONS:The efficacy of Compound sabal berry tablet combined with tamsulosin is superi-or to tamsulosin alone in the treatment of benign prostatic hyperplasia complicated with urinary obstruction,it can reduce the in-flammatory reactions and residual urine,with good safety.