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@#Primary hepatic carcinoma（PHC）is the second leading cancer that caused death in the world. The morbidity of PHC is increasing year by year,which threaten people's lives and health. Chronic hepatitis B is considered to be an independent risk factor for PHC,and the incidence of PHC is higher in patients who have progressed to liver cirrhosis. We reviewed the domestic and abroad literatures about the risk factors for hepatitis B cirrhosis progressing to PHC from the year of 1992 to 2018,and concluded that HBV-DNA,HBsAg,HBeAg expression,antiviral treatment time,different antiviral drugs,degree of cirrhosis,alanine transaminase and family history were related to the development of PHC from cirrhosis.
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Objective To investigate the histological injury as well as the risk factors for the course of HBeAg-negative chronic hep-atitis B virus( HBV)-infected patients with persistently normal alanine aminotransferase ( ALT) levels ( PNAL) . Methods Ninty four patients of HBeAg-negative chronic HBV-infected with PNAL were performed liver puncturing. The ALT, HBV markers, and liver histo-logical changes were detected. The gender, age, family history, HBV-DNA and HBsAg levels were compared between different patients with liver inflammation and fibrosis. And the Logistic model was used during the analysis of independent risk factor. Results Among 94 cases, patients with inflammatory necrosis classification≥G2 accounted for 74. 5%, fibrosis grading≥S2 accounted for 27. 7%. Patients in the group of inflammatory necrosis classification≥G2 was older than the group of < G2, and the ALT level of≥G2 group was higher, as well as a higher HBV-DNA. What is more,Patients in the group of inflammatory necrosis classification ≥G2 were mainly male, and were associated with a family history of hepatitis B. Patients in the group of fibrosis stage ≥S2 was older than < S2 group, and the ALT level of fibrosis stage ≥S2 group was higher. And those patients were often associated with a family history of hepatitis B, but there was no significant difference among the HBV-DNA level and gender constitution. HBV-DNA and family history were the independent risk fac-tors of liver inflammation necrosis≥G2, and family history was the only independent risk factor of fibrosis stage≥S2. Conclusion The patients of HBeAg-negative chronic HBV-infected with PNAL, regardless of the ALT and HBV-DNA, must have a liver biopsy. The pa-tients with high level of HBV-DNA and with a family history of hepatitis B should be performed liver puncturing accordingly.
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OBJECTIVE To investigate the epidemiology of bacterial infections isolated from liver disease patients with septic shock and analyze the antimicrobial susceptibility of major pathogens to provide reference for clinical therapy. METHODS A retrospective survey was conducted in 83 liver disease patients with septic shock of our hospital from Jan 2005 to Aug 2006. Identification and susceptibility of pathogens were assayed by MicroScan Auto-4 System. RESULTS The infection was frequently identified in intra-abdominal cavity (73.5%),blood stream (24.1%) or respiratory tract (13.3%). The top 3 pathogens were Escherichia coli (36.6%),Klebsiella pneumoniae (15.9%) and Staphylococcus aureus (6.1%). Gram-negative bacilli were usually resistant to multiple antimicrobial agents,but less resistant to imipenem,levofloxacin or piperacillin-tazobactam. Extended-spectrum ?-lactamases (ESBLs) positive rates of E. coli and K. pneumoniae were 53.3% and 7.7%. Asprergillus and Candida glabrata were the predominant pathogens from fungal infections,and they were mostly resistant to fluconazole. CONCLUSIONS Pathogens of liver disease patients with septic shock are mostly multi-drug resistant. The microbiological surveillance is important for guiding clinical therapy.
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Objective To investigate the safe model to prevent and treat complications caused by various artificial liver support system(ALSS).Methods The complications in 191 patients with severe hepatitis during the ALSS(Including plasma exchange、plasma exchange associated with continuous venovenous hemofiltration、plasma exchange associated with hemodiafiltration、plasma exchange associated with plasma absorption、molecular absorbents recycling system) treatment were observed and analyzed. Results During the treatment 287 episodes occurred and the rate of complications was 50.44%(287/569).The clinical manifestation included rash,numbness/tetany,hypotension,blood clotting in the channel,chest distress, disequilibrium syndrome,errhysis on dwell catheter,effusion on dwell catheter.75.61% of these complications was caused by plasma exchange.The rate of complications was the lowest during the treatment of plasma exchange associated with hemodiafiltration.All of these complications got better after prompt sypotomatic therapies were taken.Conclusions Although the rate of complications was high during the treatment of ALSS,all of the complications got better after prompt sypotomatic therapies were taken.This therapeusis must be performed by intensive care.It is more safe than others during the treatment of plasma exchange associated with hemodiafiltration.
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OBJECTIVE To investigate the epidemiology of bacterial infections in patients with severe liver disease in intensive care unit(ICU) and analyze the antimicrobial susceptibility of major pathogens to provide reference for clinical therapy.METHODS A retrospective survey was conducted in 206 patients with severe liver disease in ICU of our hospital from Oct 2005 to Dec 2006.Identification and susceptibility of pathogens were assayed by MicroScan Auto-4 System.RESULTS Infection was identified in 70.87% of the 206 patients with severe liver disease.Most infections were caused by single pathogen.The infection was frequently identified in respiratory tract,blood stream or intra-abdominal cavity.The top 5 pathogens were Escherichia coli(12.8%),Klebsiella pneumoniae(9.9%),Staphylococcus haemolyticus(8.5%),Pseudomonas aeruginosa(7.8%) and Stenotrophomonas maltophilia(6.4%).Gram-negative bacilli were usually resistant to multiple antimicrobial agents,but less resistant to piperacillin-tazobactam or imipenem.Most of S.haemolyticus isolates were meticillin-resistant(MRSH)(25%),which were susceptible to penicillin,ampicillin and vancomycin.CONCLUSIONS Pathogens of patients with severe liver disease in ICU are mostly multi-drug resistant.The microbiological surveillance is important for guiding clinical therapy.
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OBJECTIVE To analyze clinical and etiologic characteristics of indwelling venous catheter-related infection(CRI) in artificial liver support system(ALSS)-treated patients and explore the measures of prevention and treatment.METHODS Bacterial culture and drug sensitivity test were performed in cusp of catheters after being pulled out and the peripheral blood in liver failure patients.RESULTS Sixty four strains were isolated including 56 Gram-positive strains,2 Gram-negative strains and 6 fungi ones,respectively.The most frequent organism was Staphylococcus epidermidis which had high sensitivity to vancomycin.CONCLUSIONS The most effective measure is removing catheters in time,and vancomycin is the most optimal agent for CRI.
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Objective: To evaluate the clinical efficacy of various methods of blood purification in the treatment of patients with liver failure.Methods: Two hundred and seventy-three patients suffering from liver failure were randomly divided into two groups.On the base of medical routine treatment,160 patients were additionally treated with various methods of blood purification treatment group,including plasma exchange,plasma exchange associated with continuously venovenous hemofiltration,plasma exchange associated with hemodiafiltration,plasma exchange associated with plasma absorption,molecular absorbents recycling(system) and so on.While the other 113 patients received medical routine treatment only(control group).The efficacy of treatment and prognosis in the two groups were then observed and compared.Results: In the treatment group,the total bilirubin(TB),albumin(ALB),total bile acid(TBA),alanine aminotransferase(ALT),pre-albumin(PALB),cholinesterase(CHE) and prothrombin activity(PTA) after the treatment were better compared with those before the treatment(all P