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Objective To establish a new model of indocyanine green (ICG) clearance test combined with total bilirubin actual resident rate (TBARR) for predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with artificial liver support system (ALSS) therapy. Methods A retrospective analysis was performed for the clinical data of 136 patients with HBV-ACLF who underwent ALSS therapy in Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, from June 2017 to July 2021, and according to the prognosis at 3-month follow-up, they were divided into survival group with 92 patients and death group with 44 patients. Related indicators were measured at the time of the confirmed diagnosis of ACLF, including biochemical parameters, coagulation, indocyanine green retention rate at 15 minutes (ICGR 15 ), and effective hepatic blood flow (EHBF), and related indices were calculated, including Model for End-Stage Liver Disease (MELD) score, MELD difference (ΔMELD), Child-Turcotte-Pugh (CTP) score, total bilirubin clearance rate (TBCR), total bilirubin rebound rate (TBRR), and TBARR. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used to establish a combined predictive model for the prognosis of HBV-ACLF after ALSS therapy. The area under the ROC curve (AUC) was used to compare the accuracy of various models in judging the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the Z test was used for comparison of AUC. Results There were significant differences between the death group and the survival group in MELD score, ΔMELD, CTP score, ICGR 15 , EHBF, TBRR, TBARR, neutrophil count, percentage of neutrophils, lymphocyte count, platelet count, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, albumin, prothrombin time, international normalized ratio, prothrombin time activity, prealbumin, fibrinogen, serum sodium, age, and the incidence rate of hepatic encephalopathy (all P 80%. Conclusion The combined predictive model established by ICGR 15 and TBARR has a good value for in predicting the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the combined predictive model has a better accuracy than the single model in judging prognosis.
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Objective:To investigate the clinical efficacy of plasma exchange combined with dual plasma molecular adsorption system (PE+ DPMAS) in treating patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods:A total of 114 HBV-ACLF patients admitted to The Affiliated Hospital of Southwest Medical University in Luzhou City and treated with PE+ DPMAS from June 2014 to January 2018 were included. According to different basis of liver diseases, there were type A, type B and type C. The laboratory data and model for end-stage liver disease (MELD) of patients before PE+ DPMAS and 48 h after treatment, and the prognosis of patients at 90 d were retrospectively analyzed. Independent sample t test, paired sample t test, nonparametric test, variance analysis and chi-square test were used for statistical analysis. Results:The clinical stages among patients with type A (22 cases), type B (39 cases) and type C (53 cases) were mainly early (seven, 17, 22 cases) and mid-stages (eight, 14, 20 cases). Before PE+ DPMAS, alanine aminotransferase (ALT), prealbumin (pAlb), albumin (Alb), creatinine (Cr), total bilirubin (TBil), prothrombin time (PT), international normalized ratio (INR), prothrombin activity (PTA), and MELD were all not statistically different among the patients in the three groups (all P>0.05). After PE+ DPMAS treatment, ALT, TBil, PT, INR, MELD, pAlb, Alb, and PTA in patients with type A were statistically different compared with those before treatment ( Z=5.104, t=5.555, 4.974, 4.481, 7.984, -5.396, -2.784 and -6.752, respectively, all P<0.05). ALT, TBil, PT, INR and MELD in patients with type B were significantly decreased, while pAlb and PTA were significantly increased after treatment ( Z=-5.428, t=4.867, 4.405, 4.179, 6.186, -6.290 and -4.533, respectively, all P<0.01). ALT, pAlb and TBil in patients with type C after PE+ DPMAS treatment were significantly different from those before treatment ( Z=-5.723, t=-2.525 and 2.462, respectively, all P<0.05). There was no statistically significant difference in Cr of the three groups before and after treatment (all P>0.05). The patients with type A had the shortest hospital stay ((17.95±5.92) d), while the patients with type C had the longest stay ((25.77±7.02) d). The hospital stay of patients with type B was (21.79±6.72) d. The difference was statistically significant ( F=11.317, P<0.01). After 90 d follow-up, four patients (18.18%) with type A died, nine patients (23.08%) with type B died, and 25 patients (47.17%)with type C died. The difference was statistically significant ( χ2=8.615, P=0.013). Conclusion:HBV-ACLF patients with type A and type B have better prognosis after PE+ DPMAS treatment compared to patients with type C who are in the decompensated stage of liver cirrhosis.
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Problems and insufficiency in Infectious Disease teaching were analyzed and several improvement measures were proposed to emend the teaching outline,to strengthen the construction of teaching material,to improve teaching staff quality and to improve class and experiment teaching quality.
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Objective To investigate the role of transforming growth factor-?_1 (TGF-?_1)and hepatocyte growth factor(HGF)in the pathogenesis of early renal impairment in patients with chronic hepatitis B(CHB).Methods The serum levels of TGF-?_1 and HGF of 44 patients with CHB and 20 healthy people were measured by specific-ELISA,and the urine levels of ?_1-microglobulin (?_1-MG)and microalbumin (mALB)were tested by RIA.Results The serum levels of TGF-?_1 and HGF in the patients with CHB were significantly higher than those in the control (P