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Spontaneous bacterial peritonitis (SBP) is the most common type of infection in end-stage liver disease, and the diagnosis and treatment of SBP are facing great difficulties and challenges. In recent years, great achievements have been made in molecular diagnostic techniques, but they have not been widely used in clinical practice. Based on the current status of the diagnosis of SBP, this article reviews the advances in molecular microbiological methods in the diagnosis of SBP. Bacterial qualitative analysis alone cannot clarify the association between bacterial DNA and clinical manifestations, and the combination of bacterial quantitative analysis and bacterial type can more accurately describe the biological characteristics of SBP, which may help with the diagnosis of SBP and its special types and the application of antimicrobial agents.
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Background/Aims@#To investigate postpartum hepatic flares and associated factors in highly viremic pregnant patients in the immune tolerance phase who adopted telbivudine (LdT) treatment in the last trimester to reduce vertical transmission of hepatitis B virus. @*Methods@#Hepatitis B e antigen (HBeAg)-positive, highly viremic pregnant women were recruited for this prospective study. Treatment with LdT was started from 28 weeks of gestation. Virological and biochemical markers were examined before LdT treatment, antepartum and postpartum. Serial blood samples at the same time were collected to detect cytokines and cortisol (COR). @*Results@#Fifty-six of 153 patients (36.6%) had postpartum hepatic flares, defined as a 2-fold increase in alanine aminotransferase 6 weeks after delivery. Age and the antepartum alanine aminotransferase and postpartum HBeAg levels were independent influencing factors of postpartum hepatic flares. Cytokines showed no regularity during or after pregnancy. Compared with the patients with no postpartum flares, the patients with flares had lower baseline interferon γ and COR levels (p=0.022 and p=0.028) and higher postpartum interferon γ levels (p=0.026). @*Conclusions@#A high proportion of highly viremic and immune-tolerant pregnant patients treated with LdT in the last trimester had postpartum hepatic flares, which implied that these patients entered the immune clearance phase after delivery. Thus, this may create an appropriate opportunity for re-antiviral therapy.
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ObjectiveTo systematically review the clinical effect of glucocorticoids used alone or in combination with pentoxifylline in patients with severe alcoholic liver disease. MethodsPubMed, Embase, Chinese Scientific Journal Full-Text Database, CBM, China Scientific Journal Database, and Chinese Medical Association Digital Journal Database were searched for related articles published up to November 2018, and related journals and collected papers from conferences were searched manually. The clinical effect of glucocorticoids versus placebo, glucocorticoids versus pentoxifylline, and glucocorticoids combined with glucocorticoids versus glucocorticoids alone was analyzed. The effect of glucocorticoids and pentoxifylline used alone or in combination on 28-day survival rate and hepatorenal syndrome in patients with severe alcoholic liver disease was assessed. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate outcome indicators. RevMan 5.3 software was used for data analysis. ResultsA total of 22 studies were included, with 1956 patients in total. The glucocorticoid group had a significantly lower 28-day mortality rate than the control group (25.12% vs 30.67%, OR=0.71, 95%CI: 0.55-0.93, P=0.01). Subgroup analysis showed that there was a significant difference in 28-day mortality rate between the glucocorticoid group and the pentoxifylline group (OR=0.68, 95%CI: 0.48-0.97, P=0.03), while there was no significant difference between the glucocorticoid+pentoxifylline group and the glucocorticoid group (OR=0.92, 95%CI: 0.66-1.29, P=0.64). Compared with the glucocorticoid group, the glucocorticoid+pentoxifylline group had a significantly lower incidence rate of hepatorenal syndrome (3.94% vs 803%, OR=0.45, 95%CI: 0.24-0.83, P=0.01). Funnel plots showed no publication bias. ConclusionGlucocorticoids combined with pentoxifylline can reduce the incidence rate of hepatorenal syndrome in patients with severe alcoholic liver disease.
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Objective@#To evaluate the incidence, and the characteristics of organ failure in relationship to prognosis in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients using chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score for judgments of clinical treatment and prognosis.@*Methods@#Clinical data of 316 patients who were diagnosed as HBV-ACLF during hospitalization from February 2015 to February 2016 were retrospectively analyzed. Intrahepatic and extrahepatic organ failures were assessed according to CLIF-SOFA score, and the relationship between clinical characteristics and prognosis was analyzed. Continuity variables were analyzed by analysis of variance, or Kruskal-Wallis H test. Comparison of the categorical data were done using χ 2 or Fisher's exact test, and the predictive efficacy of various prognostic scores was compared using the area under the receiver operating characteristic curve (AUROC) and Z-test.@*Results@#Of 316 cases (87.3% men) of HBV-ACLF, the mean age was (45 ± 11) years old. 78.8% of patients with underlying liver disease had hepatitis B virus induced cirrhosis. Mortality rates in patients without liver transplantation at 28 days, 90 days and 180 days were 20.5% (63/307), 36.7% (110/300) and 39.2% (116/296), respectively. According to the CLIF-SOFA score, 89.9% (284 patients) had organ failure at baseline, of which 97.5% had liver failure (Total bilirubin ≥ 12 mg/dl) and only 2.5% had coagulation, kidney, circulation or respiratory failure without liver failure. Besides liver failure, the incidence of extrahepatic organ failure was coagulation (23.1%), kidney (5.7%), brain (3.8%), circulation (1.3%) and respiratory failure (0.3%). With increasing number of organ failure, the mortality rate of two and three or more organ failures were 69.6% and 69.2%, respectively, which was significantly higher than that of single organ failure and non-organ failure patients (27% and 6.9%, respectively; P < 0.001). Liver failure with coagulation failure (International normalized ratio≥2.5 or platelet count≤20×109/L) had worst prognosis with a mortality rate of up to 75% at 90 days.@*Conclusion@#According to the CLIF-SOFA score, the main organ failure in patients with HBV-ACLF in China is liver failure. The mortality rate in patients with two or more organ failures is as high as 70% within 3 months. Therefore, timely manner liver transplantation should be considered.
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With the increasing prevalence rate of nonalcoholic fatty liver disease (NAFLD), this disease has been taken more seriously, more and more studies have been carried out in this field, and some important progress has been made. This article introduces the important research findings in the epidemiology, risk factors, pathogenesis, noninvasive diagnosis, and treatment of NAFLD, as well as related liver cirrhosis and hepatocellular carcinoma in China within the past five years, in order to know the current status of related research. This article points out that there still exists a certain gap between related clinical and basic research in China and the rest of the world, especially in the public's perception and the medical workers′ emphasis on NAFLD. In the future, the research on epidemiology, pathogenesis, patient management, and drug therapies should be enhanced.
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OBJECTIVE: To investigate the compatible stability of cefotiam hydroloride for injection with fructose injection.METHODS: The content changes of the mixture within 8h at 25℃ were determined by UV spectrophotometry,and its external appearance was observed,and the pH value as well as particle size of the mixture were measured.RESULTS: The mixture was clear within 6h,showing no visible changes in appearance,pH value and contents of cefotiam,with particles in line with the standard stated in China Pharmacopeia(2005 edition).CONCLUSION: The mixture of ceforiam hydrochloride for injection and fructose injection is stable within 6h.
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Objective To investigate the features and the probable affecting factors of the proliferation and differentiation of the hepatic progenitor cells (HPC) and the liver regeneration in the patients with severe hepatitis(SH). Methods Liver tissues taken from 59 cases with severe hepatitis were tested for the proliferating cell nuclear antigen (PCNA) by immunohistochemistry (IHC). Meanwhile, PCNA were also detected in liver tissues of 58 cases with common hepatitis as controls. Results The percentage of cases with positive PCNA in hepatocytes in severe hepatitis (30.5%) was significantly lower than that in common hepatitis (50.0%) (P