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Objective:To analyze the clinical characteristics and risk factors of chronic hepatitis C (CHC) complicated by fatty liver.Methods:The clinical data of 258 patients with chronic hepatitis C who received treatment in The First People's Hospital of Huzhou from March 2017 to March 2021 were included in this study. They were divided into simple CHC group and CHC complicated by fatty liver group according to whether they had fatty liver. General data, liver function, coagulation function and blood lipid indexes were compared between the two groups.Results:Among 258 patients with CHC infection, 81 cases had fatty liver, accounting for 31.40%; 177 cases did not have fatty liver, accounting for 69.14%. There were no significant differences in age, sex, and history of smoking and alcohol use between the two groups (both P > 0.05). Body mass index (BMI) differed significantly between the two groups ( χ2 = 29.81, P < 0.001). BMI in the CHC complicated by fatty liver group was slightly higher than that in the simple CHC group. There were no significant differences in history of hypertension and coronary heart disease between the two groups (both P > 0.05). There were significant differences in the presence of hypertriglyceridemia and the increase of low-density lipoprotein between the two groups ( χ2 = 8.53, 6.99, P = 0.004, 0.008). There were no significant differences in the presence of hypercholesterolemia and the reduction of high-density lipoprotein (both P > 0.05). There were no significant differences in liver function indexes such as alanine aminotransferase and aspartate aminotransferase between the two groups (both P > 0.05). The level of γ-glutamyltransferase (γ-GGT) was significantly different between the two groups ( t =-8.71, P < 0.001). There was no significant difference in activated partial thromboplastin time between the two groups ( P > 0.05). There were significant differences in prothrombin time (PT) and international normalized ratio (INR) between the two groups [PT: (10.10 ± 0.67) seconds vs. (11.99 ± 1.33) seconds; INR: 0.91 ± 0.07 vs. 0.98 ± 0.11; t = 9.74, 4.46, both P < 0.001]. There were no significant differences in fasting blood glucose and blood uric acid levels between the two groups (both P > 0.05). Fasting insulin (FINS) differed significantly between CHC complicated by fatty liver and simple CHC groups [(16.82 ± 1.15) mlU/L vs. (12.52 ± 1.06) mlU/L, t = -24.33, P < 0.001]. The general data and clinical data were compared between the two groups. BMI, hypertriglyceridemia, high- and low-density lipoprotein, γ-GGT, PT, INR and FINS differed significantly between the two groups. Multivariate logistic regression results showed that BMI ≥ 24 kg/m 2, hypertriglyceridemia, γ-GGT, PT, INR and FINS were independent risk factors for CHC complicated by fatty liver ( P = 0.017, 0.003, 0.021, 0.034, 0.004, 0.001). After 6 months of treatment, CHC RNA negative conversion rate in the simple CHC group was significantly higher than that in the CHC complicated by fatty liver group ( χ2 = 7.32, P = 0.010). Conclusion:The related risk factors of CHC complicated by fatty liver include BMI, hypertriglyceridemia, elevated low-density lipoprotein, γ-GGT, PT, INR and FINS, among which, BMI, hypertriglyceridemia, γ-GGT, PT, INR and FINS are independent risk factors. In addition, CHC complicated by fatty liver may affect the efficacy of antiviral therapy.
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Objective:To analyze the difference of immune damage between patients with severe fever with thrombocytopenia syndrome (SFTS) and patients with tsutsugamushi disease.Methods:A prospective case-control study was conducted. Thirty-one patients with SFTS and 16 patients with tsutsugamushi disease admitted to the First Affiliated Hospital of Anhui Medical University from October 2014 to June 2017 were enrolled, and another 10 healthy people were enrolled as control. The counts of CD4 + and CD8 + T lymphocytes, and the proportion of CD3 + T lymphocytes, natural kill cells (NK cells), B lymphocytes and plasma cells were detected by flow cytometry. Thirty-four inflammatory mediators were determined by a multiplex Luminex? system synchronously. The differences of lymphocytes and cytokines between the two groups were compared. Results:The proportion of CD3 + T lymphocytes, the counts of CD4 + and CD8 + T lymphocytes in SFTS patients were significantly lower than those in patients with tsutsugamushi disease ( t values were 4.860, 9.411 and 5.030, respectively, all P < 0.01), and the proportion of NK cells and B lymphocytes were significantly higher than those in patients with tsutsugamushi disease ( t values were 2.344 and 5.896, respectively, both P < 0.05). The proportion of plasma cells in peripheral blood of SFTS patients was (7.7±1.2)%, the highest proportion of plasma cells in severe SFTS patients was up to 30%, and all patients showed λ monoclonal cell group in plasma cells. No plasma cells were detected in tsutsugamushi disease patients. The abnormal expressions of interleukin-1 receptor antibody (IL-1RA), interleukin (IL-6, IL-15, IL-10, IL-8), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), granulocyte colony-stimulating factor (G-CSF), eosinophil chemotactic factor (Eotaxin), IFN-γ-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein (MIP-1α, MIP-1β), platelet-derived growth factor (PDGF-AA, PDGF-AB/BB), activated regulatory normal T cells and secretion factors (RANTES) were found in patients with SFTS and tsutsugamushi disease. The levels of IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, Eotaxin, IL-8, IP-10, MCP-1 and MIP-1α in SFTS patients were significantly higher than those in patients with tsutsugamushi disease ( Z values were 2.312, 2.447, 3.660, 5.444, 1.965, 2.402, 2.402, 2.997, 3.525, 2.481, 3.817, and 2.211, respectively, all P < 0.05), while PDGF-AA, PDGF-AB/BB and RANTES were significantly lower than those in patients with tsutsugamushi disease ( Z values were 3.728, 2.514, 2.649, respectively, all P < 0.05). Correlation analysis showed that RANTES, PDGF-AA and PDGF-AB/BB levels were significantly positively correlated with the level of platelet in patients with SFTS and tsutsugamushi disease (SFTS: r values were 0.223, 0.365, 0.330; tsutsugamushi disease: r values were 0.263, 0.632, 0.407, respectively, all P < 0.05). In SFTS patients, compared with the survival group ( n = 21), the CD3 + and CD4 + T lymphocytes in the death group ( n = 10) significantly decreased, while the plasma cells significantly increased ( t values were 3.980, 3.314 and 26.692, respectively, all P < 0.01); IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, Eotaxin, IL-8, IP-10, MCP-1, MIP-1α and MIP-1β significantly increased, while PDGF-AA, PDGF-AB/BB and RANTES significantly decreased ( Z values were 3.930, 4.014, 2.832, 3.592, 2.958, 3.508, 2.578, 3.254, 4.270, 3.465, 2.663, 3.085, 3.107, 3.639, 3.043 and 3.825, respectively, all P < 0.05). Conclusions:The immune function was impaired more seriously in SFTS patients than that in tsutsugamushi disease patients. Excessive humoral immunity and apoptosis of T lymphocytes are closely related to the death in SFTS patients. The detection of CD4 cells, plasma cells and proinflammatory and anti-inflammatory cytokines (e.g. IL-6, IL-10) had great clinical significance for the differentiation and illness evaluation in disease with SFTS or tsutsugamushi disease.
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Objective To investigate the profile and antibiotic resistance of bacteria in patients with ascites infection in intensive care unit (ICU) patients in order to provide a reference for rational clinical use of antibiotics. Methods A retrospective analysis was conducted. The bacteria isolated from ascetic fluid patients admitted from January 1st, 2004 to October 31st, 2015 to ICU of the First Affiliated Hospital of Anhui Medical University were identified, and their susceptibility to antibiotics was analyzed. Patients, who were admitted from January 1st, 2004 to December 31st, 2009 were assigned to group A, and patients admitted afterwards were assigned to group B. Results A total of 637 specimens of ascetic fluid were examined, with 185 positive culture (29.0%) during the 12 years, and 203 strains of bacteria were found. Among them 126 strains (62.1%) of gram-negative bacteria (G-), 54 (26.6%) of gram-positive bacteria (G+) and 23 (11.3%) strains of fungi were found. Compared the result of group B with that of group A, the proportion of G- bacteria was increased [71.2% (99/139) vs. 44.2% (27/64)], and that of G+ decreased [17.3% (24/139) vs. 46.9% (30/64)] in group B. The difference was statistically significant (χ2 = 20.34, P = 0.001). The main pathogenic bacteria were G-, and Enterobacteriaceae was the most common pathogenic bacteria in intra-abdominal infection of ICU patients. The isolation rate of Escherichia coli and Klebsiella pneumoniae(35.7%, 10.3%) ranked in the first and third in G- bacteria, respectively. The resistant rate of Escherichia coli against penicillin and third generation cephalosporin were > 95.0% and > 73.3%, and it showed a sensitive rate of 70% to β-lactam/inhibitor, amikacin and minocycline, and a higher sensitivity to carbapenems and tigecycline (11.1%, 0). Forty-eight strains of non-fermentation bacteria were found with a rate of 23.7%. The positive rates of Acinetobacter baumannii in groups A and B were 7.8% (5/64) and 23.7% (33/139), respectively, and they ranked first among non-fermentation bacteria. Twenty strains (62.5%) multidrug-resistant Acinetobacter baumannii were found. Acinetobacter baumannii showed a resistance rate of 84.6% to cefoperazone/sulbactam, 35.3% to minocycline, and 53.3% to tigecycline. Candida albicans was the most commonly isolated fungus in intra-abdominal infections (87.5%). No strains resistant to common antifungal drugs were isolated. Conclusions G- bacteria was the main pathogen in intra-abdominal infection in patients with ascites. Non-fermenters showed an increasing trend of producing infection, and the proportion of multidrug-resistant Acinetobacter baumannii infection increased year by year, and more attention should be taken by attending doctors.