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1.
Journal of Clinical Hepatology ; (12): 653-655, 2022.
Article in Chinese | WPRIM | ID: wpr-922974

ABSTRACT

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease accompanied by cholestasis, with the histological feature of non-purulent cholangitis. This article briefly describes the advantages and limitations of the traditional pathological staging systems such as Rubin stage, Scheuer stage, and Ludwig stage and the latest Nakanuma stage. Among them, Nakanuma stage refines the histological grading and staging standards to reduce the chance of missed diagnosis due to sampling errors, thus providing more adequate diagnostic and prognostic information for the clinic. A combination of new and traditional staging systems can provide guidance to the diagnosis, treatment, and research of PBC.

2.
Journal of Clinical Hepatology ; (12): 553-557, 2022.
Article in Chinese | WPRIM | ID: wpr-922952

ABSTRACT

Objective To investigate the value of international standardized ratio-to-platelet ratio (INPR) versus aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) in the diagnosis of liver fibrosis in patients with primary cholangitis (PBC). Methods A retrospective analysis was performed for the patients who underwent liver biopsy and were diagnosed with PBC in The First Affiliated Hospital of Zhengzhou University from October 2013 to March 2021. Scheuer score was used to systematically evaluate the degree of liver fibrosis (S0-S4 stage). According to the results of liver biopsy, the degree of liver fibrosis was classified as significant liver fibrosis (≥S2), progressive liver fibrosis (≥S3), and liver cirrhosis (S4). Related data including general information, liver function, routine blood test results, and blood coagulation were collected, and related formulas were used to calculate the values of the noninvasive serological models INPR, APRI, and FIB-4. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between multiple groups. A Spearman correlation analysis was used to evaluate the correlation between noninvasive models and liver fibrosis stage. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the noninvasive serological models in the diagnosis of liver fibrosis degree, and the DeLong method was used for comparison of the area under the ROC curve (AUC). Results A total of 143 patients with PBC were enrolled in the study, among whom 4 had stage S0 liver fibrosis, 50 had stage S1 liver fibrosis, 46 had stage S2 liver fibrosis, 26 had stage S3 liver fibrosis, and 17 had stage S4 liver fibrosis. There was a significant difference in INPR value between the PBC patients with different liver fibrosis degrees ( χ 2 =27.347, P 0.05). Conclusion INPR is a simple and accurate noninvasive model for the evaluation of liver fibrosis and has a certain value in the diagnosis of liver fibrosis in PBC.

3.
CES med ; 35(2): 135-145, mayo-ago. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1364609

ABSTRACT

Resumen La trombosis séptica de la vena porta es una complicación infrecuente de la diverticulitis, la apendicitis y de otras infecciones intraabdominales. Se asocia a elevadas tasas de complicaciones, como isquemia mesentérica, absceso hepático, hipertensión portal o muerte. Se presenta el caso de un paciente de 67 años quien consultó por fiebre, dolor abdominal e ictericia, y en quien se documentó bacteriemia por Escherichia coli y Streptococcus dysgalactiae. En las imágenes se identificó trombosis de la porta hepática secundaria a enfermedad diverticular aguda, lo que configura un diagnóstico de pileflebitis séptica. El paciente recibió terapia antibiótica dirigida, sin anticoagulación, obteniéndose adecuada respuesta clínica. Se realiza una discusión sobre el diagnóstico, etiología y tratamiento de la trombosis séptica portal.


Abstract Septic thrombosis of the portal vein is a rare complication of diverticulitis, appendicitis and other intra-abdominal infections; it is associated with high rates of complications, such as mesenteric ischemia, liver abscess, portal hypertension or death. We present the case of a 67-year-old patient who consulted for fever, abdominal pain and jaundice, and in whom Escherichia coli and Streptococcus dysgalactiae bacteremia was documented; images showed hepatic portal thrombosis secondary to acute diverticular disease, which configures a diagnosis of septic pylephlebitis. The patient received targeted antibiotic therapy without anticoagulation, with adequate clinical response. The diagnosis, etiology, and treatment of portal septic thrombosis are discussed.

4.
Rev. med. Risaralda ; 27(1): 101-106, ene.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1280500

ABSTRACT

Resumen Introducción: El Síndrome de Mirizzi es una complicación infrecuente de la enfermedad litiásica biliar, con una incidencia menor al 1% en países desarrollados, puede desarrollarse en cinco variantes, siendo menos frecuente la variante tipo V. La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar. Caso Clínico: Se presenta el caso de Síndrome de Mirizzi en un hombre de 80 años, que es remitido al departamento de urgencias por sospecha de sepsis de origen abdominal, con estudio ecográfico de colelitiasis, neumobilia y dilatación de las vías biliares. Se realizó Colangiopancreatografía retrógrada endoscópica con imposibilidad técnica para la movilización y extracción de los cálculos por gran tamaño, recurriéndose a exploración a través de técnica laparoscópica, obteniéndose resultados satisfactorios. Conclusión: Para tratar el Síndrome de Mirizzi, es necesario considerar las características del paciente y la experiencia del cirujano ya que ambos factores influyen directamente en la modalidad del tratamiento, sus complicaciones y tasas de éxito. En el presente caso, la experiencia del autor principal en el manejo de procedimientos mínimamente invasivos y la consideración de reducir el riesgo de complicaciones como infecciones en un paciente frágil, fueron los factores que influyeron para la decisión de intervención laparoscópica.


Abstract Introduction: Mirizzi's syndrome is an infrequent complication of biliary lithiasic disease, with an incidence of less than 1% in developed countries, being even less frequent the type V variant. Current literature disagrees on the management of this condition, stating that laparoscopic surgery is not safe as a standard procedure. Clinical Case: We present the case of Mirizzi's Syndrome in an 80-year-old man, which is referred to the emergency department for suspicion of sepsis of abdominal origin, with ultrasound study of cholelithiasis, pneumoobilia and dilation of the bile ducts. Retrograde endoscopic cholangiopancreatography was performed with technical impossibility for the mobilization and extraction of large-size stones, resorting to exploration through laparoscopic technique, obtaining satisfactory results. Conclusion: It is necessary to emphasize that the type of Mirizzi syndrome, the patient's characteristics and the surgeon's experience directly influence the treatment modality, its complications and/or success rates. In the present case, the experience of the main author in the management of minimally invasive procedures and the consideration of reducing the risk of complications such as infections in a fragile patient, were the factors that influenced the decision for laparoscopic intervention.


Subject(s)
Humans , Male , Aged, 80 and over , Cholelithiasis , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy , Mirizzi Syndrome , Therapeutics , Bile Ducts , Calculi , Sepsis , Emergencies , Emergency Service, Hospital , Infections
5.
Arq. gastroenterol ; 58(2): 227-233, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1285313

ABSTRACT

ABSTRACT BACKGROUND: Primary sclerosing cholangitis (PSC) is a rare hepatobiliary disorder, whose etiology remains not fully elucidated. Given how rare PSC is in childhood, until the recent publication of a multicenter international collaboration, even data on its characteristics and natural history were scarce. Symptomatic cholelithiasis has not been previously reported as the presentation of PSC. OBJECTIVE: The aim of this study was the diagnosis of PSC following the initial unusual presentation with symptomatic cholelithiasis, that followed an atypical clinical course that could not be explained by cholelithiasis alone. A literature review was also conducted. METHODS: We conducted a retrospective chart review of three patients, who were diagnosed and/or followed at the Clinics Hospital, University of Campinas - Sao Paulo/ Brazil, between 2014 and 2020. Data analyzed included gender, age of presentation, past medical history, imaging findings, laboratory results, endoscopic evaluation, response to medical therapy and follow-up. RESULTS: Age at time of presentation with cholelithiasis varied from 10 to 12 years. In two of the cases reported, a more subacute onset of symptoms preceded the episode of cholelithiasis. Two patients were managed with cholecystectomy, not followed by any surgical complications, one patient was managed conservatively. Percutaneous liver biopsy was performed in all three cases, showing histological findings compatible with PSC. Associated inflammatory bowel disease (IBD) was not seen in any of the patients. The patients have been followed for a mean time of 3.4 years. CONCLUSION: PSC and cholelithiasis are both rare in the pediatric population. This study reports on symptomatic cholelithiasis as a presentation of PSC and raises the importance of suspecting an underlying hepatobiliary disorder in children with cholelithiasis without any known predisposing factors and/or that follow an atypical clinical course for cholelithiasis alone.


RESUMO CONTEXTO: A colangite esclerosante primária (CEP) é uma doença hepatobiliar rara, cuja etiologia ainda não está totalmente elucidada. Dada a raridade do CEP na infância, até a recente publicação de uma colaboração multicêntrica internacional, mesmo dados sobre suas características e história natural eram escassos. A colelitíase sintomática não foi relatada anteriormente como a apresentação inicial de CEP na infância. OBJETIVO: O objetivo deste estudo foi o diagnóstico de CEP após a apresentação inicial incomum com colelitíase sintomática, que seguiu um curso clínico atípico que não poderia ser explicado apenas pela colelitíase. Também foi realizada uma revisão da literatura. MÉTODOS: Foi realizada uma revisão retrospectiva dos prontuários de três pacientes, que foram diagnosticados e/ou acompanhados no Hospital das Clínicas da Universidade Estadual de Campinas - São Paulo / Brasil, entre 2014 e 2020. Os dados analisados incluíram sexo, idade de apresentação, história médica pregressa, achados de imagem, resultados laboratoriais, avaliação endoscópica, resposta à terapia médica e acompanhamento. RESULTADOS: A idade no momento da apresentação da colelitíase variou de 10 a 12 anos. Em dois dos casos relatados, um início mais subagudo dos sintomas precedeu o episódio de colelitíase. Dois pacientes foram tratados com colecistectomia, não seguida de qualquer complicação cirúrgica, e um paciente foi tratado de forma conservadora. Biópsia hepática percutânea foi realizada em todos os três casos, mostrando achados histológicos compatíveis com CEP. Doença inflamatória intestinal associada não foi observada em nenhum dos pacientes. Os pacientes foram acompanhados por um tempo médio de 3,4 anos. CONCLUSÃO: CEP e colelitíase são raras na população pediátrica. Este estudo relata a colelitíase sintomática como uma apresentação de CEP e levanta a importância da suspeita de doença hepatobiliar subjacente em crianças com colelitíase sem quaisquer fatores predisponentes conhecidos e/ou que seguem um curso clínico atípico.


Subject(s)
Humans , Child , Cholangitis, Sclerosing/complications , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/therapy , Inflammatory Bowel Diseases , Cholelithiasis/complications , Cholelithiasis/diagnostic imaging , Brazil , Retrospective Studies , Multicenter Studies as Topic
6.
Rev. colomb. gastroenterol ; 36(supl.1): 85-90, abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251553

ABSTRACT

Resumen La enfermedad de Crohn (EC) es considerada una entidad inmunológicamente mediada que compromete el tracto digestivo. Su compromiso suele ser transmural y puede afectar cualquier parte del tubo digestivo, desde la cavidad oral hasta el ano. Aunque se sabe que su extensión es variable, es poco habitual ver un compromiso extenso y multiorgánico. Se presenta el caso de un paciente joven, quien debutó con síntomas pulmonares asociados con la EC y años más tarde se presentaron los síntomas digestivos y de la vía biliar. El tratamiento se basó en la terapia con anticuerpos contra el factor de necrosis tumoral alfa (TNF-α), con lo cual se obtuvo una respuesta clínica satisfactoria. La relevancia clínica de este caso es la forma de presentación clínica tan florida, tanto por el compromiso gastrointestinal extenso como por las manifestaciones extradigestivas tan infrecuentes.


Abstract Crohn's disease (CD) is considered an immunologically mediated entity that involves the digestive tract. It is characterized by transmural inflammation and can affect any part of the digestive tract, from the oral cavity to the anus. Although it is recognized that its severity varies, extensive and multiple organ failure is unusual. We present the case of a young patient, who initially presented with pulmonary symptoms associated with CD. Years later, digestive and bile duct symptoms appeared. Treatment was based on anti-tumor necrosis factor-alpha antibody therapy, resulting in a satisfactory clinical response. The clinical relevance of this case is its full-blown presentation, which includes extensive gastrointestinal involvement and rare extraintestinal manifestations.


Subject(s)
Humans , Male , Adult , Crohn Disease , Bile Ducts , Gastrointestinal Tract , Mouth
7.
Journal of Clinical Hepatology ; (12): 1466-1468, 2021.
Article in Chinese | WPRIM | ID: wpr-877339

ABSTRACT

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease caused by the combined effect of genetic and environmental factors and characterized by the apoptotic necrosis of biliary epithelial cells (BEC) in the small intrahepatic bile ducts. This article describes the effect of B cells, macrophages, natural killer cells, NKT, and T cells on the immune injury of BEC during PBC, so as to provide some guidance for the targeted immune therapy for PBC.

8.
Journal of Clinical Hepatology ; (12): 888-892, 2021.
Article in Chinese | WPRIM | ID: wpr-875901

ABSTRACT

ObjectiveTo investigate the clinical features, diagnosis, treatment, and prognosis of autoimmune pancreatitis (AIP) alone versus AIP with IgG4 sclerosing cholangitis (IgG4-SC). MethodsA retrospective analysis was performed for the clinical data of 40 patients with type 1 AIP who were admitted to The First Affiliated Hospital of Zhengzhou University from June 2015 to January 2020, among whom 29 patients had AIP alone and 11 had AIP with IgG4-SC. The two groups were compared in terms of clinical manifestations, laboratory examination, imaging findings, treatment, and prognosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate recurrence rate and plot recurrence curve, and the log-rank test was used for univariate analysis. ResultsCompared with the AIP group, the AIP+IgG4-SC group had significantly higher number of affected organs [3.0(3.0-4.0) vs 3.0(1.5-3.5), Z=-2.172, P=0035] and response index before treatment [12.0(12.0-15.0) vs 12.0(9.0-13.5), Z=-2.157, P=0.032]. The AIP+IgG4-SC group had a significantly higher median serum IgG level than the AIP group [21.0(15.8-23.7) g/L vs 14.8(13.3-15.7) g/L, Z=-2.711, P=0.004]. During the median follow-up time of 15.8 (6.5-31.3) months, the AIP+IgG4-SC group had a significantly higher recurrence rate than the AIP group (χ2=8.155, P=0.004). ConclusionPatients with AIP and IgG4-SC tend to have higher serum IgG4 level, number of affected organs, and recurrence rate than those with AIP alone. Early identification, diagnosis, and treatment can reduce the recurrence rate of AIP.

9.
Journal of Clinical Hepatology ; (12): 718-720, 2021.
Article in Chinese | WPRIM | ID: wpr-873824

ABSTRACT

The etiology and pathogenesis of primary biliary cholangitis (PBC) remain unclear at present, and it is believed that the change in bile duct microenvironment and autoimmune response are the main factors for the onset of this disease. Anion exchanger 2 (AE2) is an HCO3-/Cl- exchange protein located on the membrane of epithelial cells and has been taken seriously by scholars since studies have shown that it can induce and aggravate PBC. This article summarizes the role of AE2 in bile duct microenvironment and autoimmune response from the aspects of AE2 and related regulatory mechanisms and further analyzes the pathogenesis of PBC, so as to find new therapies and diagnostic and prognostic indicators for PBC by exploring the regulatory mechanism of AE2 in PBC.

10.
Article in Chinese | WPRIM | ID: wpr-912179

ABSTRACT

Objective:To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.Methods:Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.Results:There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively. Conclusion:For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.

11.
Article in Chinese | WPRIM | ID: wpr-911739

ABSTRACT

Objective:To analyze the etiology of biliary fungal infection and risk factors of case fatality.Methods:Clinical and laboratory data of 91 biliary fungal infection patients admitted in Li Huili Hospital of Ningbo Medical Center from January 2013 to June 2019 were retrospectively reviewed, including 14 patients (16.4%) with fungal infection and 77 patients (84.6%) with fungal and bacterial mixed infection. There were 79 survivors and 12 deaths, the risk factors of fatality were analyzed by binary Logistic regression analysis.Results:The fungal strain Candida albicans was detected in 61 cases, Candida glabrata in 19 cases and Candida tropicalis in 6 cases. Drug sensitivity test showed that the fungal strains were highly sensitivity to amphotericin B and 5-fluorouracil [100.0%(91/91),97.8%(89/91)]. In 77 mixed infection cases Gram-negative bacteria was the more common (34 cases,44.2%). The average age of patients was 70.7 years old. Benign diseases were found in 66 cases (72.5%) and 61(67.0%)of them were cholelithiasis. Patients with a history of repeated biliary operation were more likely to have mixed infection of biliary fungi and bacteria (χ 2= 4.56, P=0.03). The mean albumin level in the fatal group was significantly lower than that in the survival group [(28.1±5.2)g/L vs. (33.3±5.3)g/L; t=2.77, P=0.01]. The median length of hospital stay in the survival group was significantly shorter than that in the fatal group [12.0(9.0, 18.0)d vs. 29.5 (13.0, 42.7)d; Z=-2.37, P=0.02]. Multiple logistic regression analysis showed that the history of repeated biliary operation ( OR=4.46, 95% CI: 1.06—4.97) and mixed infection of fungi with bacteria ( OR=10.20, 95% CI: 1.48—70.27) were the risk factors of case fatality. Conclusion:Candida albicans is the main fungus in biliary fugal infection which is often complicated with bacterial infection. Repeated biliary operations and mixed infection of fungi with bacteria are the risk factors of death in patients with biliary infection.

12.
Article in Chinese | WPRIM | ID: wpr-911432

ABSTRACT

Primary biliary cholangitis is a chronic autoimmune cholestatic disease with a progressive course. This disease is not rare in China, but standardized diagnosis and treatment for primary biliary cholangitis are insufficient. Based on the evidence and guidelines from China and other countries, Rheumatology Branch of Chinese Medical Association developed the recommendations of diagnosis and treatment for primary biliary cholangitis in China. The aim is to help clinicians recognize clinical characters, therapeutic selection and prognosis judgement of primary biliary cholangitis, which will contribute to make diagnosis in time, to select treatment properly and to manage follow-up scientifically.

13.
Article in Chinese | WPRIM | ID: wpr-910637

ABSTRACT

Acute severe cholangitis is a serious disease with fast development and high mortality. The therapeutic options are stills limited. Once diagnosed, the key step of treatment is to timely reduce the high pressure of bile duct caused by biliary obstruction, and to block bacteria and toxins from entering the blood, which might trigger inflammation " cascade reaction" . The policy of " relieve obstruction, remove lesions, and bile duct drainage" raised by academician Huang Zhiqiang, is still the criterion for acute cholangitis treatment. Active biliary drainage, early continuous renal replacement therapy, and simultaneous antibacterial therapy and multi-organ function support can significantly improve the disease outcome and reduce mortality.

14.
Chinese Journal of Rheumatology ; (12): 525-528, 2021.
Article in Chinese | WPRIM | ID: wpr-910202

ABSTRACT

Objective:To investigate the distribution and clinical significance of subtypes of antimitochondrial antibodies (AMA)-M2, M4, M9 in primary biliary cholangitis (PBC).Methods:A total of 1 367 patients were detected with AMA-M2, M4, M9 in Peking Union Medical College Hospital (PUMCH) from Jan 2014 to Dec 2019 and the clinical parameters were collected. The distribution patterns of AMA subtypes in different groups were analyzed and the diagnostic sensitivity and specificity of AMA subtypes in PBC were calculated. Chi-square test was used for statistical analysis.Results:In 1 367 patients, 236 of whom were positive for AMA subtypes. The positivity of AMA subtypes in female was significantly higher than in male (20.34% vs 9.41%, χ2=23.792, P<0.01). In addition, the positivity of AMA subtypes was significantly higher in 30-65 years old patients than in patients younger than 30 years old or older than 65 years old [(20.00%(193/965) vs 10.97%(17/155) vs 10.53%(26/247), χ2=17.209, P<0.01]. 110 patients with positive AMA subtypes were diagnosed with PBC. The diagnostic sensitivity and specificity of AMA-M2 were both desirable [94.64%(106/112) and 92.35%(1 159/1 255)]. Although the specificity of AMA-M4 was as high as 99.12%(1 244/1 255), its sensitivity was very low [15.18%(17/122)]. Combined detection of different AMA subtypes could not improve the diagnostic sensitivity and specificity significantly. Diseases other than PBC can be positive for AMA subtypes, predominantly for AMA-M2. Conclusion:Female and 30-65 years old patients were more frequently positive for AMA subtypes. AMA-M2 was the most valuable AMA subtype for diagnosing PBC.

15.
Chinese Journal of Rheumatology ; (12): 467-471,c7-3, 2021.
Article in Chinese | WPRIM | ID: wpr-910197

ABSTRACT

Objective:To explore the early response of hepatobiliary biochemical indexes after short-term ursodeoxycholic acid treatment in patients with primary biliary cholangitis (PBC).Methods:According to the Child-Pugh (C-P) score, the patients with newly diagnosed PBC were divided into groups A, B and C. The early biochemical response was defined as the improvement of hepatobiliary biochemical indexes while daily dose of 13-15 mg/kg ursodeoxycholic acid(UDCA) was administrated for 3-4 weeks. Rank sum test was used to compare the alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), total bile acid (TBA) and total bilirubin (TBil) before and after treatment between groups. Chi-square test was used to analyze the differences in numerical data between groups. ROC curve was also used for data an-alysis.Results:The levels of AST, ALP, GGT and TBil of groups A and B after treatment were lower than those of before treatment ( P<0.05). And there was no significant difference in group C ( P>0.05). On the contrast, TBA levels after treatment in group A, B and C were significantly higher than those of before ( P<0.05). ROC curve analysis of the baseline ALP, GGT and AST indexes that declineed less than 20% showed that their cut-off value of indexes were 211.00, 285.85 and 86.68 U/L respectively in group A. And then the cut-off value of above parameters in group B was 505.00, 353.10 and 179.15 U/L respectively. But no statistical significant difference was found in ROC curve analysis of above indexes of group C. The baseline TBil level declined synchronously with the decline of ALP, AST and GGT less than 20% were analyzed by ROC curve, but no statistical significant difference was found in group A, B and C. ROC curve analysis of the treatment showed that increased of TBA level was synchronously to the decline of ALP, AST and GGT less than 20% showed that cut-off value were 38.75 and 35.95 μmol/L respectively in group A and B. There was no statistically significant difference in ROC curve analysis of TBA in group C. As for baseline ALP, GGT and AST their level were decreased with treatment, and less than 40%, ROC curve analysis did not find statistical significant difference in above indexes. Conclusion:After 3-4 weeks of UDCA treatment, the cut off values of ALP, GGT and AST in Grade A or B of C-P are met, and the biochemical response could be reduced by 20% or more, among which the accuracy of ALP is higher. The TBA level of C-P in grade A or B PBC patients after UDCA treatment increases, and when the Cut-off value is met, it suggests that ALP, GGT and AST indexes may decrease by 20% or more. Total bilirubin does not show response to treatment.

16.
Journal of Chinese Physician ; (12): 1461-1465, 2021.
Article in Chinese | WPRIM | ID: wpr-909725

ABSTRACT

Objective:To explore the related factors influencing prognosis of patients with grade Ⅲ cholangitis with myocardial injury.Methods:91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively. They were divided into endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75) and non-ERCP group ( n=16) according to whether ERCP was performed. According to 28-day survival patients were divided into survival group ( n=56) and death group ( n=35). The level of serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N terminal pro-brain natriuretic peptide (NT-proBNP), white blood cell (WBC), platelet (PLT), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), International Standardized Ratio (INR), Glasgow Coma Score (GCS) at different time points were detected and the risk factors influencing the prognosis of patients were analyzed. Results:The cTnT ( P=0.018), NT-proBNP ( P<0.001), PLT ( P=0.016), GCS score ( P=0.07) on day 3 and cTnI ( P=0.027), cTnT ( P=0.002), CK-MB ( P=0.046), NT-proBNP ( P<0.001), PLT ( P=0.041), GCS score ( P<0.001) on day 7 in the ERCP group were significantly different with the non-ERCP group respectively. The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group ( P<0.001). The cTnT ( P=0.006) on day 1, the cTnT ( P=0.021), NT-proBNP ( P=0.02), WBC ( P=0.037), GCS score ( P<0.001) on day 3, and the cTnI ( P=0.029), cTnT ( P=0.008), CK-MB ( P<0.001), PLT ( P=0.008), NT-proBNP ( P=0.004), GCS ( P<0.001) on day 7 in survival group were significantly different from the death group. Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate. Conclusions:In patients with Grade Ⅲ cholangitis-related myocardial injury, the levels of myocardial injury markers, NT-proBNP, platelet (PLT) and Glasgow Coma Score (GCS) are related to mortality. ERCP for patients can significantly improve 28 days survival and prognosis.

17.
Journal of Chinese Physician ; (12): 1452-1456, 2021.
Article in Chinese | WPRIM | ID: wpr-909723

ABSTRACT

Objective:To evaluate the value of shock index and platelet count in early identification of grade 3 acute cholangitis.Methods:This study is a retrospective case-control study. A total of 750 patients who met the diagnostic criteria of acute cholangitis were treated in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to December 2020. They were divided into grade 1, grade 2 and grade 3 groups according to the 2018 Tokyo Guidelines. The age, gender, etiology, complications, Charlson comorbidity index (CCI), vital signs, blood routine indexes, C-reactive protein, lactic acid and consciousness of patients in each group were compared, and the effective indexes for differentiating grade 3 cholangitis were selected. Logistic regression and receiver operating characteristic curve (ROC) analysis were used to screen the indexes with high specificity and sensitivity for early identification of acute cholangitis.Results:There were significant differences in age, CCI score, incidence of acute cholecystitis, all-cause mortality, shock index, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiration, lactic acid, white blood cell count, neutrophil count, lymphocyte count, granulocyte ratio, C-reactive protein, hematocrit, platelet count, thrombocytocrit and platelet distribution width among the three groups ( P<0.05). ROC curve analysis showed that platelet count and thrombocytocrit were more effective in predicting grade 3 cholangitis ( P<0.05). Logistic regression analysis showed that shock index and platelet were significantly correlated with grade 3 cholangitis ( P<0.05). For patients without unconsciousness, the area under curve (AUC) value of shock index alone was 0.621 for differentiating grade 3 cholangitis; The sensitivity was 47.6%, and the specificity was 71.3%. The AUC value of combined shock index and platelet for differentiating grade 3 cholangitis was 0.861, with a specificity of 95.6% and sensitivity of 71%. Conclusions:Shock index combined with platelet can be used as a good indicator for early differentiation of severe acute cholangitis without conscious disorder.

18.
Journal of Chinese Physician ; (12): 1448-1451,1456, 2021.
Article in Chinese | WPRIM | ID: wpr-909722

ABSTRACT

Objective:To investigate the correlation between serum calcium level and patients with acute obstructive suppurative cholangitis (AOSC).Methods:The clinical data of 104 patients with AOSC treated in the emergency room of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2019 to February 2020 were retrospectively selected, of which 53 patients with severe sepsis were included in group A, 51 patients with simple AOSC were included in group B, and 50 patients with non infectious severe diseases hospitalized in the same period were selected as control and included in group C. The levels of serum calcium, C-reactive protein (CRP), procalcitonin (PCT) and D-dimer (D-D) were compared in the three groups. Pearson analysis was used to analyze the correlation between serum calcium and CRP, PCT and D-D.Results:The levels of serum calcium in group A were significantly lower than those in group B and group C, and the levels of inflammatory related factors CRP, PCT and D-D were significantly higher than those in group B and group C ( P<0.01), with significant difference. In AOSC group, serum calcium was negatively correlated with CRP, PCT and D-D levels ( r=-0.550, -0.479, -0.431, P<0.05). Conclusions:Patients with AOSC are prone to hypocalcemia under infection, and the level of serum calcium is negatively correlated with infection inflammatory indexes CRP, PCT and D-D, indicating that the level of calcium is related to the severity of infection. Hypocalcemia should be found in time in clinical work, and the severity of the disease should be evaluated as soon as possible.

19.
Journal of Chinese Physician ; (12): 1441-1443, 2021.
Article in Chinese | WPRIM | ID: wpr-909720

ABSTRACT

Acute biliary tract infection is a common digestive system emergency, which is prone to complications and high risk of death. Therefore, paying attention to the early identification of the severity of the disease in patients with acute biliary tract infection and taking appropriate intervention measures for complications will help to improve the survival rate of patients and shorten the length of hospital stay. Six articles in this column introduced the early severity identification and diagnosis methods of acute cholangitis and the clinical characteristics of common complications such as liver abscess and sepsis myocardial injury, and elaborated the treatment effect from the perspective of Western medicine and traditional Chinese medicine.

20.
International Journal of Surgery ; (12): 690-694, 2021.
Article in Chinese | WPRIM | ID: wpr-907506

ABSTRACT

Acute obstructive suppurative cholangitis (AOSC) is one of the common surgical acute abdomen. It often causes the increase of intrabiliary pressure due to biliary obstruction, resulting in various clinical symptoms. The onset is urgent and the disease progresses quickly. It is the primary cause of death of benign biliary diseases. Timely biliary decompression and bile drainage are the key to treat AOSC and save the lives of patients. With the continuous progress of the concept of enhanced recovery after surgery and minimally invasive technical means, minimally invasive technical means such as endoscopic retrograde cholangiopancreatography, ppercutaneous transhepatic catheterizde drainage and endoscopic ultrasound guided biliary drainage have gradually become the preferred treatment for AOSC, playing a more and more important role in the treatment of AOSC. Combined with relevant research literature and the author′s personal experience in the treatment of AOSC with these technologies, this paper introduces the application value, advantages and disadvantages of the above three minimally invasive technologies in the treatment of AOSC.

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