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Objective To investigate the effect of entecavir in the treatment of chronic severe hepatitis B and the influence on peripheral blood T cell subsets and liver function.Methods 100 patients with chronic severe hepati-tis B were selected as research subjects,who met the inclusion criteria.The patients were randomly divided into the observation group(50 cases)and control group(50 cases),then the clinical effects were assessed after treatment. Results The CD +4 ,CD +4 /CD +8 of the observation group and control group after treatment were (40.65 ±5.06)%and (35.32 ±5.18)%,(1.83 ±0.35)% and (1.30 ±0.26)%,which were significantly higher than before treat-ment,the differences were statistically significant(t =7.762 and 5.192,6.319 and 3.392,all P <0.05),the CD +8 levels were (22.13 ±4.85)% and (27.24 ±4.66)%,which were significantly lower than before treatment,the differences were significant(t =8.553,3.667,all P <0.05).The CD +4 ,CD +4 /CD +8 of the observation group were significantly higher than the control group,the differences were statistically significant(t =3.479,5.413,all P <0.05),the CD +8 was significantly lower than the control group,the difference was significant(t =3.551,P <0.05). The ALT,AST,HBV-DNA of the observation group and control group after treatment were (45 ±17)U /L and (90 ± 22)U /L,(55 ±20)U /L and (86 ±25 )U /L,(2.71 ±0.50)copy/mL and (4.62 ±0.53)copy/mL,which were significantly lower than before treatment,the differences were statistically significant(t =10.568 and 6.773,9.935 and 7.035,6.339 and 3.448,all P <0.05).The ALT,AST,HBV-DNA of the observation group were significantly lower than the control group,the differences were statistically significant(t =3.662,3.514,3.604,all P <0.05). Conclusion Entecavir can effectively suppress viral replication,enhance immune function and improve liver func-tion,and has better security in the treatment of 50 patients with chronic severe hepatitis B,which is worthy of clinical use.
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Objective To summarize the experience in nursing the patients with chronic severe hepatitis complicated with hypoglycemia. Method Five chronic severe hepatitis patients with hypoglycemia were cared and by monitoring blood glucose, observing the state of disease, correcting low blood sugar and safety control, providing an appropriate nutritional support, arranging the speed of infusion in a proper order and offering related disease knowledge. Results After the treatment, the blood sugar was 3.3~4.9 mmol/L, with a median of 4.2 mmol/L. One patient died of liver and kidney failure, one gave up the treatment because of deterioration and the rest three got better. The hospital stay was 42~120 d with an average of 88.0 d. Conclusion Relevant nursing intervention for the hypoglycemia of chronic severe hepatitis can promptly correct low blood sugar , maintain normal level of blood sugar and avoid serious complications.
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BACKGROUND: Procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) are inflammatory markers used to diagnose severe bacterial infections. We evaluated the diagnostic role of these markers and compared their accuracy for spontaneous bacterial peritonitis (SBP) associated with chronic severe hepatitis B (CSHB). METHODS: PCT and CRP concentrations, WBC count, and other hematological parameters were measured in serum from 84 well-characterized patients with CSHB, of whom 42 had SBP. Receiver operating characteristics (ROC) curve analysis was performed to assess the diagnostic accuracy. RESULTS: PCT and CRP concentrations were significantly higher in the CSHB patients with SBP (n=42) than CSHB patients without SBP (n=42). PCT and CRP concentrations were more accurate than WBC count for the diagnosis of CSHB-associated SBP. The optimal cutoff value of PCT was 0.48 ng/mL. The PCT concentration was significantly correlated with the CRP concentration and WBC count. CONCLUSIONS: Serum PCT and CRP seems to be better markers than WBC for the diagnosis of CSHB patients with SBP.
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Female , Humans , Male , Middle Aged , Age Factors , Area Under Curve , Bacterial Infections/complications , Biomarkers/blood , C-Reactive Protein/analysis , Calcitonin/blood , Hepatitis B, Chronic/complications , Leukocyte Count , Leukocytes/cytology , Peritonitis/complications , Protein Precursors/blood , ROC Curve , Sex Factors , TemperatureABSTRACT
ObjectiveTo analyze the expression of osteopontin (OPN) and interleukin-17 (IL-17)and study the roles in the pathogenesis of chronic severe hepatitis B.MethodsTwenty patients of acute on chronic liver failure were collected from the infection disease in-patients department of the First Affiliated Hospital of Medical College,Zhejiang University from 2009 to 2010,and 40 health controls were from medical examination center during the same period.Meanwhile,Balb/C mice were used for ConA injection to induce fulminant hepatitis and the plasma,serum and liver tissue of mice were collected.OPN and IL-17concentrations were measured using ELISA kits.PBMC were separated and cultured with anti-TNF-α or TNF-α.Supernatants were collected for analysis of OPN and IL-17.Differences between groups were evaluated by using a Student's t test and the relationship between IL-17 and OPN were evaluated by Pearson correlation.ResultsIn chronic severe hepatitis B group,levels of OPN and IL-17 were markedly higher than those of healthy control,respectively.(42.4 ± 12.9 vs 10.6 ±4.8 pg/ml; 1460.1 ±523.1 vs 472.8 ±67.5 ng/ml) ( t =2.387,3.570,P ＜ 0.05).The level of OPN in blood and liver reached peak at 6 hours at 12 hours after ConA injection,respectively.The level of IL-17 in blood and liver was significantly increased after ConA injection.IL-17 were positive correlated with OPN levels (R2 =0.582,P =0.026).TNF-α can increase the level of OPN secreted by lymphocytes.ConclusionsOPN and IL-17 levels in peripheral blood of hepatitis B patients are closely related to the hepatitis B degree.TNF-α can increase the level of OPN secreted by lymphocytes.
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Objective To investigate clinical features and antifungal therapeutic effect of chronic severe hepatitis (CSH) patients with invasive fungal infection (IFI), and to improve the diagnosis and treatment.Methods Clinical manifestation, blood routine, imageology and mycetology characteristic, antifungal treatment perscription and therapeutic effect of 79 CSH patients with IFI were retrospectively analyzed. Antifungal therapeutic effect was compared between fluconazole and voriconazole. Results Thirteen (16.5%) patients received glucocorticoid or other immunodepressants for a relatively long time, 40 (50.6%) patients had invasive operation, and 61 (77.2 %) patients were administered 1-6 kinds of broad-spectrum antibiotics. Seventy-three patients had fever. Leucocytes and neutrophilic granulocyte increased in 96.2% of the patients. Lung (31.6%), intestinal tract (26.2%) and oral cavity (14%) infections were common. Fungus was found in 70.9% of the patients. Candida albicans (40.9%) and aspergillus (21.1%) were often seen. Halo signs and crescent signs on lung CT were relatively specific in 40% of the patients with fungal pneumonia. Voriconazole was more effective than fluconazole(71.4% vs. 39.0%, P<0.05). Twelve patients with lung aspergillus infection were administered voriconazole, 8 (66.7%) patients of whom was effective, and the other 4 (33.3%) patients died. Conclusion There are high risk factors in major CSH patients with IFI. The most common clinical manifestations of CSH patients with IFI are fever, leukocytosis, lung and intestinal tract infection. Candida albicans and aspergillus infection are common. Voriconazole is more effective than fluconazole, and can increase the survival rate of CSH patients with IFI.
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Objective To investigate the effect of plasma exchange (PE) in the treatment of chronic severe hepatitis. Methods 70 cases with chronic severe hepatitis were divided randomly into two groups:treatment group and control group. The treatment group combined with PE based on combined therapy of internal medicine, control group was only performed combined therapy of internal medicine. The therapeutic efficient rate was analyzed by con-trast after one month. Results The level of TBil,ALT,CHO,CHE,PTA,BUN and Cr of patients in treatment group improved more obviously than those in control group(P <0.05). The total effective rate was 62.86% in treatment group and was 31.43% in control group,and there were significant differences in two groups(P <0.05). The death rate was 11.42% in treatment group and was 31.42% in control group,there were significant differences in two groups (P < 0.05). Conclusion PE combined with therapy of internal medicine can obviously improve therapeutic efficient rate of chronic severe hepatitis,which is an safe and effective method.
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OBJECTIVE To investigate and control the risk factors about hospital infection in patients with chronic severe hepatitis B. METHODS Totally 466 hospitalized patients with chronic severe hepatitis B in our hospital from Jan 2001 to Dec 2007 were studied retrospectively. RESULTS The total incidence of hospital infection was 20.1% for inpatients with chronic severe hepatitis B,the infection located as follows:56 patients were in lower respiratory tract (59.6%);17 patients in upper respiratory tract (18.1%);7 patients with bacteremia (7.4%);3 patients in urinary tract (3.2%);7 patients in gastrointestinal tract (7.4%);and 1 patients was in cutis tissue (1.1%). CONCLUSIONS The knowledge about the on infection risk factors liver disease must be strengthened by hospital medical staff of the use of antibiotics must be strict controlled in principle,operation must be aseptic,the concept of prevention standards must be enhanced,and the primary disease must be actively treated,all these can effectively reduce infection in hospital.
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Objective To observe the efficiency and safety of Extecavir on chronic severe hepatitis B.Methods 36 patients with chronic severe hepatitis B were randomly divided into 2 groups. Control group (n=16) was given the conventional therapy. Treatment group (n=20) was treated with Entecavir, 0.5mg daily for four weeks, on the bases of routine treatment. Before and after treatment, hepatic function, prothrombin active (PTA), HBVDNA and efficiency rate of the two groups were detected.Results the results showed that the total efficiency rates of treatment group and control group were 85% and 50% respectively. There was significant difference between the two groups (P＜0.01). After treated for four weeks, the improvement of TBil and PTA effect was observed.Conclusion It can be concluded that Entecavir has good therapeutic efficiency and safety in the treatment of chronic severe hepatitis B.
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Objective To observe the effect of treating chronic severe hepatitis modified Yinchen Zhufu Decoction.Methods 46 chronic severe hepatitis patients (belonging to Ymhuang syndrome in TCM) were randomly recruited in to a treatment group (26 cases) and a control group (20 cases). Indexes as symptoms, signs, liver functions, prothrombin activity (PTA), prothrombin (ALB) and complications were used for evaluating therapeutic effects. Results After four weeks' treatment, of all 26 cases in the treatment group, 23 cases were effective (occupying 88.5%) and 3 cases were inefficacy (occupying 11.5%); while of all 20 cases in the control group, 11 cases were effective (occupying 55%) and 9 cases were inefficacy (occupying 45%). There was significant difference between the two group in therapeutic effects( P＜0.05 ). TBIL in both groups were decreased after the treatment(P＜ 0.05 ), and the decrease amplitude in the treatment group was much bigger than the control group (P＜0.05). PTA in the treatment group was increased after the treatment (P＜0.05), but this increase amplitude showed no significant difference comparing with the control group (P＞0.05). ALB showed significant difference between the two groups after treatment, with P＜0.05, but complications demonstrated no significant difference between the two groups after treatment, with P＞0.05. Conclusion Modified Yinchen Zhufu Decoction has good therapeutic effects in treating chronic severe hepatitis of yinhuang syndrome.
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Objective To study the clinical practical use of the model for end-stage liver disease(MELD) and assess its validity in predicting the prognosis of the.chronic severe hepatitis patients.Methods The clinical data of 391 patients with chronic severe hepatitis among 2003～2005 in our hospital were analyzed,and they were graded with MELD formula.These patients were divided into plasma exchange group and none plasma exchange group according to plasma exchange treatment or not.The death rate was observed within three months.The validity of the model in predicting the prognosis of the patients with severe hepatitis was determined by the concordance(c)-statistic.Results 236 patients died within three-months and the mortality was 60.6%.The mortality of patients in PE group whose MELD score were less than 30 and 30～40 was 25% and 75% respectively,but in non-PE group they were 42.0%,90.7% respectively,there were significant difference between PE group and non-PE group(P0.05).The optimal cut-off values of MELD to predict the prognosis of patients were 30 in PE group whose sensitivity and specificity were 66.7% and 86.4%,and its c-statistic was 0.823(95% CI 0.734～0.912);and in non-PE group they were 27,76.4%,79.1% and 0.832(95% CI 0.787～0.877) respectively.Conclusions The mortality of the patient with chronic severe hepatitis increases with the increase in the MELD score.The MELD can accurately predict the short-term prognosis of patients with chronic severe hepatitis.
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OBJECTIVE To analyze the characteristics of nosocomial infections,risk factors and prevention measures in patients with chronic severe hepatitis B.METHODS A retrospective review of the medical records of 354 patients with chronic severe hepatitis B admitted between Jan 2006 and Dec 2006 was performed.RESULTS The incidence of nosocomial infection in patients with chronic severe hepatitis B was 16.67% and mainly infection sites consisted of abdominal cavity(40.32%),and upper respiratory tract(22.58%).The most common infection(47.46%) was occurred during the period of hospitalization 15-30 days after and the most commonly pathogens were Gram-negative bacilli(68.75%).The infection risk factors were associated with invasive operation,hypoalbuminemia,endotoxemia,advanced age,antibiotics application and decrease in cell immune function.CONCLUSIONS It is important for the patients with chronic severe hepatitis B to strengthen management on related risk factors in order to prevent nosocomial infection effectively.
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OBJECTIVE To evaluate the clinical characteristics of chronic severe-degree hepatitis B complicated by aspergillosis and its susceptive factors and prevention and treatment.METHODS The clinical data of 3 patients with chronic severe-degree hepatitis B complicated by aspergillosis were analyzed retrospectively.RESULTS From 23 patients with chronic severe-degree hepatitis B complicated by fungus infection,there were 3 patients complicated by aspergillosis and died.The susceptive factors included poor immunity,incorrect use of antibiotis and invasive operation.CONCLUSIONS Patients with chronic severe-degree hepatitis B complicated by aspergillosis have poor progress and prognosis. The effective preventive methods are treating underlying disease actively,using antibiotis correctly,reducing or avoiding invasive operation and disinfecting air regularly.
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Objective To compare the different types of physical artificial liver support system(ALSS) applied in the treatment of patients with early stage of chronic severe hepatitis in order to evaluate the therapeutic effect and look for the most effective one.Methods One hundred and twenty patients of chronic severe hepatitis B in early stage were randomly divided into 4 groups(each n=30).The patients in group 1 were treated by 3 000 ml plasma exchange;in group 2,by 2 000 ml plasma exchange combined with plasma adsorption for 2 hours;in group 3,only by plasma adsorption for 3 hours and in group 4,by molecular adsorbent re-circulating system(MARS).The observation time lasted for 2 weeks and the therapy twice a week,the interval between two times of treatment being 2-3 days.The improvement of symptoms,the fade away and rebound of icterus,the changes of albumin and prothrombin activity(PTA),side effects(anaphylaxis,hepatic encephalopathy,edema of conjunctiva,burp,fluid and electrolyte balance failure,changes of blood routine test and ammonia level,etc) were compared before and after the treatment.Results The symptoms of 27 cases in group 1 were improved,the rate of decrease of total bilirubin(TBil) of group 1 was 51.8% and the range of icterus rebound was 14.4% to 46.7% with comparatively more side effects.The symptoms of 24 cases of group 2 were improved,the rate of decrease of TBil in group 2 was 62.2% and the range of icterus rebound was 2.8% to 28.5% with comparatively less side effects.The symptoms of 16 cases of group 3 were improved,the rate of decrease of TBil in group 3 was 38.8% and the range of icterus rebound was 2.8% to 6.8% with less side effects.The symptoms of 26 cases of group 4 were improved,the rate of decrease of TBil in group 4 was 60.1% and the range of icterus rebound was 7.8% to 27.4% with comparatively more side effects,moreover the cost was higher than that in the other groups.Conclusion The method of reduced plasma exchange combined with plasma adsorption with macroporous resin used to cure chronic severe hepatitis at early stage has the characteristic of good effects for the fade away of icterus,little rebound of icterus and side effects.It is the reasonable method of artificial liver to cure the early stage of chronic severe hepatitis.
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AIM: To observe the therapeutic effect of hepatocyte growth promoting factor (PHGF) combined with transmetil in treatment of chronic severe hepatitis (CSF). METHODS: 120 patients were divided randomly into two groups: the combined treatment group and the routine group. All the patients received ordinary therapy, and 62 patients, based on the therapy, received PHGF combined with transmetil in the combined treatment group. RESULTS: Compared with the routine treatment group, the levels of total serum bilirubin and prothrombin time were decreased significantly (P
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OBJECTIVE:To investigate the therapeutic effect of Lipo-prostaglandin E 1 (Lipo PGE 1 )on chronic severe type B hepatitis by MELD(Model for end-stage live disease)prognosis analysis.METHODS:Of a total of115cases with chronic severe type B hepatitis,57were randomly assigned to receive a common combined therapy and58to receive a common combined therapy plus Lipo PGE 1 for4weeks,the MELD score and prognosis of diseases of the2groups were assessed.RE-SULTS:The MELD score in the treatment group(20.12?8.97)was lower than that of the control group(24.76?10.41)after4weeks’treatment(P
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Objective To explore the relationship between chronic severe hepatitis and cryptosporidium infection to provide evidences for scientific prevention and treatment of chronic severe hepatitis. Methods Fecal samples of 218 patients with chronic severe hepatitis B (CSHB) and 140 children with diarrhea were collected, and were examined for cryptosporidium oocytes by using auramine-phenol staining method (AA-p) and modified acid-fast staining method (MAF), and for cryptosporidium DNA by PCR and restriction digestion analysis. The factors affecting cryptosporidium infection of patients with CSHB were preliminarily analyzed. Results The positive rates of cryptosporidium infection detected by AA-p, MAF and PCR in the patients with CSHB and children with diarrhea were 4.1%, 3.2%, 6.0% and 0.7%, 0.7%, 1.4%, respectively. The positive rate of cryptosporidium infection detected by PCR in patients with CSHB was higher than that in children with diarrhea (P
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Objective:In order to explore the AICD happening in PBMC and the situation of peripheral blood lymphocyte subsets in chronic/ chronic severe hepatitis B Methods:The peripheral blood mononuclear cells of patients with chronic /chronic severe hepatitis B were cultured with PHA P for 72 h Then the apoptosis of PBMC was assayed by flow cytometry The peripheral blood lymphocyte subsets of patients with chronic /chronic severe hepatitis B were assayed by flow cytometry and automatic blood analyzer Results:The percentage of apoptotic PBMC in chronic hepatitis B group was higher than that in chronic severe hepatitis B group(P