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Objective To compare the value of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, CLIF Consortium Acute Decompensation (CLIF-C AD) score, and Freiburg index of post-transjugular intrahepatic portosystemic shunt (TIPS) survival (FIPS) score in predicting the survival of patients undergoing TIPS. Methods A retrospective analysis was performed for the clinical data of 447 patients with liver cirrhosis who underwent TIPS in several hospitals in southwest China, among whom there were 306 patients in the survival group and 62 in the death group. The scores of the above five models were calculated, and a survival analysis was performed based on these models. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Pearson chi-square test was used for comparison of categorical data between groups; a multivariate Cox regression analysis was used for correction analysis of known influencing factors with statistical significance which were not included in the scoring models; the Kaplan-Meier method was used to evaluate the discriminatory ability of each model in identifying risks in the surgical population, and the log-rank test was used for analysis. The area under the receiver operating characteristic curve (AUC), C-index at different time points, and calibration curve were used to evaluate the predictive ability of each scoring model. Results Compared with the death group, the survival group had significantly lower age ( Z =2.884, P < 0.05), higher albumin ( t =3.577, P < 0.05), and Na + ( Z =-3.756, P < 0.05) and significantly lower proportion of patients with alcoholic cirrhosis ( χ 2 =22.674, P < 0.05), aspartate aminotransferase ( Z =2.141, P < 0.05), prothrombin time ( Z =2.486, P < 0.05), international normalized ratio ( Z =2.429, P < 0.05), total bilirubin ( Z =3.754, P < 0.05), severity of ascites ( χ 2 =14.186, P < 0.05), and scores of the five models (all P < 0.05). Survival analysis showed that all scoring models effectively stratified the prognostic risk of the patients undergoing TIPS. Comparison of the C-index of each scoring model at different time points showed that Child-Pugh score had the strongest ability in predicting postoperative survival, followed by MELD-Na score, MELD score, and CLIF-C AD score, and FIPS score had a relatively poor predictive ability; in addition, the prediction efficiency of each score gradually decreased over time. Child-Pugh score had the largest AUC of 0.832 in predicting 1-year survival rate after surgery, and MELD-Na score had the largest AUC of 0.726 in predicting 3-year survival rate after surgery, but FIPS score had a poor ability in predicting 1- and 3-year survival rates. Conclusion All five scoring models can predict the survival of patients with liver cirrhosis after TIPS and can provide effective stratification of prognostic risk for such patients. Child-Pugh score has a better ability in predicting short-term survival, while MELD-Na score has a better ability in predicting long-term survival, but FIPS score has a relatively poor predictive ability in predicting both short-term and long-term survival.
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Objective To investigate the diagnostic value of the real-time tissue elastography (RTE)and AST/PLT ratio in-dex (APRI)for the assessment of the early stage liver fibrosis in chronic liver disease patients.Methods Totally 90 patients with chronic liver disease were enrolled in the present study.The RTE score and the area percentage of the blue color (AREA,one of the elastic characteristics),the AST and PLT were recorded.Compared the results among different stages of liver fibrosis reported by biopsy considered as the gold standard for the assessment of liver fibrosis.The accuracy of the diagnosis of liver fibrosis by RTE scores,AREA and APRI were compared.Results RTE scores,AREA and APRI increased with the stage of liver fibrosis. Taking ≥S1 as the diagnosis standard of the early stage liver fibrosis,the area under the curve of ROC for RTE scores,AREA and APRI were 0.88,0.92,0.76 (P <0.05).Conclusion RTE is a new and promising sonography-based noninvasive method for the assessment of hepatic fibrosis in patients with chronic liver disease.Combined RTE with APRI have great clinical significance in di-agnosing the early stage liver fibrosis in chronic liver disease patients.
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Objective To investigate the incidence of familial hepatitis B viral (HBV ) infection in the southeast part of Chongqing ,and provide information for its prevention and treatment .Methods 295 patients with HbsAg positive came from 110 families were selected and divided to different groups by gender and marital status .We investigated the infections of HBV in three generations of the immediate families .This research focused on the difference between mother-to-child transmission and father-to-child transmission ,the status of receiving HBV vaccine ,the morbidity and mortality of cirrhosis and hepatic carcinoma ,the cause of death ,and the impact of gender in three generations .Results Of the 110 cases ,the HBsAg positive rate for children with HBsAg positive mothers (more than 66 .7% ) was significantly higher than that with positive father (less than 1 .1% ) ,while there was no significant difference between male spouses and female spouses (22 .2% versus 20 .5% ,P>0 .05) .Only 23 .2% received HBV vac-cine and 2 .7% got immune globulin of HBV .8 .5% of the 295 persons had cirrhosis and 4 .4% of them had primary hepatocellular carcinoma (HCC);19 patients from 16 families died of liver diseases .39 cases of 110 patients got antiviral treatment regularly .Con-clusion As well as father-to-child transmission and close contact ,mother-to-child transmission contributed to familial HBV infec-tion ,and even more common .The high rate of familial HBV infection in this area was associated with low rate of vaccination and immune globulin of HBV .The leading cause of the high incidence of hepatocellular carcinoma and hepatic cirrhosis was substandard treatment .