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Objective:To evaluate the prognostic efficacy of the Chinese Group on the Study of Severe Hepatitis B (COSSH) acute-on-chronic liver failure (ACLF) II score (COSSH ACLF IIs) and associated risk stratification in predicting short-term prognosis of patients with hepatitis B virus-related ACLF (HBV-ACLF).Methods:Clinical data of 224 patients with HBV-ACLF admitted to the First Affiliated Hospital of Wannan Medical College and the First Hospital of Quanzhou, Fujian Medical University from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into survival group ( n=171) and fatal group ( n=53) according to 28-day survival status. The values of the COSSH ACLF IIs, the Chronic Liver Failure-Consortium (CLIF-C) ACLF score (CLIF-C ACLFs), the CLIF-C organ failure score (CLIF-C OFs), the Model of End-stage Liver Disease (MELD) score (MELDs), the MELD-sodium score (MELD-Nas), and the Child-Turcotte-Pugh score (CTPs) for 28-day mortality prediction were compared using the area under the receiver operating characteristic curve (AUC). The patients were divided into groups according to COSSH ACLF classification and COSSH ACLF IIs risk stratification, respectively. The differences in 28-day mortality between groups were compared by Kaplan-Meir method, and the consistency of the two ACLF classification systems was compared by Kappa consistency test. Results:The AUC, sensitivity, and specificity of the COSSH ACLF IIs in 28-day mortality prediction were 0.885, 0.981 and 0.731, respectively. For predicting 28-day mortality, the COSSH ACLF IIs achieved a higher AUC than the CLIF-C OFs, the MELDs, the MELD-Nas, and the CTPs ( P<0.01), while there was no significant difference in AUC between the COSSH ACLF IIs and the CLIF-C ACLFs ( Z=1.696, P=0.090). The cumulative 28-day mortality rates significantly increased with the ascending of COSSH ACLF grade and risk strata of the COSSH ACLF IIs (11.7%, 43.5% and 93.3%, P<0.001; 14.2%, 41.0% and 81.3%, P<0.001). The two ACLF grading systems showed a consistency in severity stratification of HBV-ACLF patients (Kappa=0.478, P<0.001). Conclusion:The COSSH ACLF IIs shows an excellent prognostic performance in predicting short-term mortality of HBV-ACLF patients. Using the new risk stratification scale can simplify the severity stratification of HBV-ACLF patients.
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Objective To explore the therapeutic effect of Gansu tablets combined with entecavir on patients with severe hepatitis B and the effect on patients’ immune function. Methods A total of 108 cases of severe hepatitis B patients who were treated in our hospital from January 2018 to January 2019 were randomly divided into two groups: entecavir group and combination treatment group, 54 cases each. Entecavir group was treated with entecavir, and combination treatment group was treated with Gansu tablets and entecavir. The levels of AST, GGT, alt, FIB, APTT, Pt, GSH Px, LPO and MDA in serum were measured by enzyme-linked immunosorbent assay. T-lymphocyte subsets were measured by cell analyzer. The therapeutic effect and adverse reactions were compared between the two groups. Results The levels of AST, GGT and ALT in the combined treatment group were significantly lower than those in the entecavir group (P 0.05). Conclusion The use of Gansu tablets combined with entecavir in the treatment of severe hepatitis B patients was able to improve liver function, improve coagulation function, reduce oxidative stress injury, and improve the immune function of patients, demonstrating a potential clinical application value.
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Objective To investigate the short-term efficacy of plasma exchange(PE),PE combined with double plasma molecule absorption system(PE+DPMAS) for treating severe hepatitis B(SHB).Methods The clinical data in 70 patients with SHB were retrospectively analyzed.The patients were divided into the PE group and PE+-DPMAS group according to different treatment modes.The clinical symptoms,liver function,coagulation function,blood routine,renal function and electrolytes changes,score decrease of model for end-stage liver disease(MELD) before and after treatment were compared between the two groups.Results After treatment,the alimentary tract symptoms were improved,the grade of hepatic encephalopathy was reduced and MELD score was decreased,but there was no statistically significant difference in the short-term effective rate between the two groups(P＞0.05).After treatment ALT,TBIL,RBC,Hb and PLT in the two groups were decreased significantly(P＜0.05);the ALB level in the PE+DPMAS group was decreased,while K+ and C1 were increased(P＜0.05);the PTA and ALB levels in the PE group were increased,while WBC was decreased in the PE group(P＜0.05).Conclusion The two kinds of treatment method PE and PE-+DP-MAS are effective in treating SHB.PE+-DPMAS can reduce the plasma usage and improve serum K+,Cl-levels;PE is superior to PE+DPMAS in the aspects of improving coagulation function and ALB level.
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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 Observe the efficacy and safety of glucocorticoid deescalation combined antiviral therapy on severe hepati‐tis B .Methods Forty‐nine patients with early severe hepatitis were selected and divided them into observation group(n=24) and control group (n=25) randomly .Control group were given the conventional synthetic therapy while observation group were given conventional synthetic therapy combined glucocorticoid deescalation therapy .Then compare the differences of TBIL ,ALT ,PTA be‐fore and after treatment ,and the improvement time of syndrome and death rate between two groups .Results The death rate in ob‐servation group and control group were 16 .7% and 32 .0% respectively(P0 .05) .After the treatment ,the TBIL ,ALT ,PT were improved in both two groups(P 0 .05) .Conclusion Glucocorticoid deescalation therapy could decrease the death rate ,shorten the syndrome lasting time in treating severe hepatitis B .It was an effective and safety meth‐od .
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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 characterize serum hepatitis B virus(HBV)full-length genome quasispecies and to investigate its ralationship with severe exacerbation of chronic hepatitis B(CHB).Methods HBV full-length genome was amplified and cloned from four treatment naive CHB patients and four treatment naive CSHB patients.Fourteen to sixteen clones per sample were selected,sequenced and analyzed by bioinformatics software.The measurement data was compared by independent-samples t test and count data was analyzed by x2 test. Results Totally 120 HBV fulllength genome sequences were obtained.All the patients had either genotype B or C virus monoinfection.One hundred percent clones(60/60)from CSHB patients showed mutations including G1896A,A1762T/G1764A(one patient even carried A1762T/G1764A/C1766T mutations),T1753C/G and start codon mutations in preS2,preS1,which were more common than those from CHB patients(46/60,76.7%;x2=15.85,P<0.01).The quasispecies complexity and diversity were higher in CSHB patients than CHB patients within full-length genome,S,X,P genes and reverse transcriptase region,but lower within C gene at both nucleotide and amino acid levels.But the difference were not statistically significant in all regions.Conclusion The mutation frequency and quasispeeies heterogeneity in HBV genome are higher in CSHB patients than in CHB patients,which may play a role in the severe exacerbation of CHB and needs further investigation in large scale studies.
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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 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 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
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The paper is to report a retrospective study on delta antigen infection in 35 patients with severe hepatitis B (13 subacute and 22 chronic cases).One serum sample from each patients was collected at least 21 days (21～156 days)after the last attack of the disease,and anti-delta antigen was tested with EIA method (Abbot kit made in USA).The upper limit of O.D.value for positive resultswas calculated as 0.391.It was found that anti-delta antigen was positive in 12 cases(34.3%)out of the 35. 23.1%(3/13)of the subacute and 40.9%(9/22) of the chronic cases were positive.There were 3～5 serological parameters indicating HBV infection in each case.All the 12 positive patients were males of Han Nationality with a mean age of 34 years (a range of 19 to 51).11 were from Sichuan province and only 1 from Guizhou.3 were subacute cases without previous history of hepatitis,and aggravation of the clinical condition occurred in their course;there was a history of acute icteric hepatitis in the remaining 9 cases and 5 out of the 9 were long-term HBsAg carriers.The recent attack of the disease often showed a rapid progression to the severe stage within a month.It is suggested that delta antigen might be one of the factors leading to the aggravation of viral hepatitis.