RESUMO
Objective To investigate the clinical, biochemical, pathological, disease course, and prognostic features of drug-induced liver injury (DILI) patients with different types of bile duct injury. Methods Four patients who were diagnosed with bile duct injury-type DILI by liver biopsy in Shijiazhuang Fifth Hospital, from March 2015 to October 2010 were selected, and related data were collected, including clinical data, laboratory examinations, radiological examination, and prognosis.The semi-quantitative score was determined for liver pathological morphology, and each indicator was compared between the four patients. Results Bile duct injury-type DILI was more common in female patients, and most patients tended to have a good prognosis.Clinical symptoms, liver biochemical parameters, and prognosis varied with the site, grade, scope, regeneration, and repair of bile duct injury. Conclusion Liver biopsy is still the gold standard for making a definite diagnosis of bile duct injury-type DILI, understanding the condition of lesions, and judging the prognosis of this disease.
RESUMO
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.
RESUMO
Objective To improve the awareness of emergency biliary obstruction (BO) disease,and to further improve the diagnosis and treatment ability of BO patients.Methods Data of the etiology,clinical manifestations,imaging data,laboratory tests,and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.Results Common bile duct stones were the most common cause of BO patients (63.49％),followed by cholangiocarcinoma (19.05％);the most common clinical manifestations of BO patients were jaundice (90.48％),abdominal pain (87.30％),and fever (53.97％);the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P ＜ 0.05),but there was no significant difference between CT and MRCP (P =1.000);compared with benign group,hemoglobin and albumin in malignant group were significantly lower,while total bilirubin and direct bilirubin were higher,with statistically significant difference (P ＜ 0.05).Most patients in BO patients improved after treatment,and the mortality rate of BO patients was 3.17％ (2/63) at the end of emergency visit.Conclusions Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients.The most common clinical manifestations of patients with emergency BO are jaundice,abdominal pain,and fever.Better than abdominal ultrasound,CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients.Anemia,hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients.Most patients can temporarily get better at the end of emergency visit.
RESUMO
Objective@#To improve the awareness of emergency biliary obstruction (BO) disease, and to further improve the diagnosis and treatment ability of BO patients.@*Methods@#Data of the etiology, clinical manifestations, imaging data, laboratory tests, and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.@*Results@#Common bile duct stones were the most common cause of BO patients (63.49%), followed by cholangiocarcinoma (19.05%); the most common clinical manifestations of BO patients were jaundice (90.48%), abdominal pain (87.30%), and fever (53.97%); the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P<0.05), but there was no significant difference between CT and MRCP (P=1.000); compared with benign group, hemoglobin and albumin in malignant group were significantly lower, while total bilirubin and direct bilirubin were higher, with statistically significant difference (P<0.05). Most patients in BO patients improved after treatment, and the mortality rate of BO patients was 3.17%(2/63) at the end of emergency visit.@*Conclusions@#Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients. The most common clinical manifestations of patients with emergency BO are jaundice, abdominal pain, and fever. Better than abdominal ultrasound, CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients. Anemia, hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients. Most patients can temporarily get better at the end of emergency visit.
RESUMO
Objective To investigate the angiogenesis,apoptosis and their mechanisms in septic mice with myocardial injury.Methods Forty male C57BL/6 mice aged 8 weeks were randomly ( random number) divided into two groups:the sepsis group and the control group.The mice of sepsis group were treated with lipopolysaccharide (LPS) ( 10 mg/kg Intraperitoneal injection) while the mice of control group were treated with saline solution instead (10 mg/kg Intraperitoneal injection).Cardiac function of mice (n =40) was evaluated with ultrasound 6 hours after LPS administration.Subsequently,the tissues of heart,lung and kidney of mice (n =6) were taken and treated with Haematoxylin -Eosin staining (H&E) in order to observe the pathological changes and verify the successfulness of modeling.Immunohistochemistry staining with PECAM - 1 and α - SMA was used to identify the angiogenesis in the heart ( n =3 ),while the TUNEL apoptosis assay was applied for detecting the myocardial cell apoptosis ( n =3 ).The mRNA was extracted from heart tissue (n =6) to observe the expression of HIF-1 ot which was proved to be an angiogenesis factor.All the results were analyzed by independent sample t - test.Results Compared to the control group,mice in the sepsis group showed increased in thickness of left ventricular diastolic anterior wall ( t =- 4.60,P ＜ 0.05 ) and thickness of left ventricular systolic anterior wall (t =-3.24,P ＜0.05 ) along with decrease in left ventricular end diastolic diameter ( t =3.57,P ＜ 0.01 ) and stroke volume ( t =5.51,P ＜ 0.01 ).Immunohistochemistry staining with alpha - SAM antibody revealed increase in cardiac angiogenesis in the sepsis group (t =- 11.00,P ＜ 0.01 ).TUNEL apoptosis assay demonstrated apoptosis of the cardiomyocytes [ sepsis group versus control group:( 191.31 ±5.41 ) vs ( 52.24 ±4.32) ] and RT - PCR showed an increase in the expression of HIF - 1 alpha in the mice of the sepsis group ( t =- 8.12,P ＜0.05) Conclusions There were apparent myocardial angiogenesis,apoptosis and cardiac dysfunction in septic animal models.HIF-1α might play a role in the angiogenesis pathway.