Influencing factors for the prognosis of biopsy proven patients with chronic drug-induced liver injury: An analysis of 255 cases / 临床肝胆病杂志

Objective To investigate the influencing factors for the prognosis of adult patients with chronic drug-induced liver injury (DILI). Methods A total of 255 patients who were diagnosed with chronic DILI by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled, and according to the liver function after 2 years, they were divided into non-recovery group and recovery group. The two groups were analyzed in terms of the clinical data including age, sex, body mass index, types of drugs used, type of DILI injury, severity of DILI injury, underlying diseases, laboratory markers, liver histology, and 2-year 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 chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for the prognosis of chronic DILI. Results After 2 years of follow-up, 195 patients (76.5%) achieved the recovery of liver function, while 60 patients (23.5%) did not achieve such recovery. There were significant differences between the two groups in the type of DILI injury ( P =0.028), the proportion of patients with diabetes ( P =0.048), and the degree of liver fibrosis ( P 2×upper limit of normal (ULN) ( OR =3.080, 95% CI : 1.331-7.127, P =0.009) were independent risk factors for the prognosis of chronic DILI. Conclusion When patients meet the diagnostic criteria for chronic DILI, the independent risk factors PLT 2×ULN may be used to screen out the patients who are more likely to have poor prognosis.

Research advances in clinical treatment of adult autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis (AIH) is an immune-mediated inflammatory injury of hepatocytes, which can develop into liver cirrhosis and end-stage liver disease. Timely immunosuppressive therapy can help patients achieve biochemical remission and even histological remission and thus improve prognosis. However, adverse drug reactions during treatment and recurrence after withdrawal are commonly seen, and therefore, standard therapy, dose reduction at the right time, and timely drug withdrawal are important for improving patients’ prognosis. This article summarizes the advances in guidelines for the diagnosis and treatment of AIH and related studies in China and globally, so as to provide a reference for clinicians in the treatment of AIH.

Recent research advances in chronicity of drug-induced liver injury / 临床肝胆病杂志

Although drug-induced liver injury (DILI) is often an acute process, about 20% of the patients may progress to chronic DILI. Chronic DILI has a long course of disease and there is still no effective treatment. With the development and clinical application of new drugs and the wide application of herbal and dietary supplements, the incidence rate of DILI chronicity gradually increases. This article overviews the latest research advances in DILI chronicity from the aspects of the epidemiology, risk factors, clinical manifestations, diagnosis, and treatment of DILI, so as to gain a comprehensive understanding of chronic DILI.

Association between cytochrome P450 gene polymorphism and drug-induced liver injury / 临床肝胆病杂志

As the prevalence rate of drug-induced liver injury increases year by year, the pathogenesis of drug-induced liver injury has become the focus of attention. As a large family, CYP450 enzymes participate in almost all oxidative metabolic reactions of drugs in the human liver. Recent studies have shown that CYP450 enzyme gene polymorphisms lead to the differences in pharmacodynamics between individuals, and therefore, exploring the role of CYP450 enzyme gene polymorphisms in drug-induced liver injury may promote the understanding of the pathogenesis of drug-induced liver injury. This article reviews the CYP450 enzyme polymorphisms that have been found to be associated with drug-induced liver injury.

Clinical diagnosis of alcoholic hepatitis / 临床肝胆病杂志

Based on the significant differences in definition, clinical features, and prognosis between alcoholic hepatitis (AH) and severe AH, it is recommended to classify AH into mild and severe AH. As for the disease spectrum of hospitalized patients with alcoholic liver disease, most patients have liver cirrhosis, and about 15% have mild or severe AH. Alcoholic liver failure belongs to the category of severe AH. Severe AH is a clinical diagnosis, while alcoholic steatohepatitis is a pathological diagnosis. The clinical diagnostic criteria for severe AH tend to be consistent in European and the United States of America, but the Chinese guideline released in 2018 is not consistent with the guidelines from western countries.

Clinical diagnosis of alcoholic hepatitis / 临床肝胆病杂志

Based on the significant differences in definition, clinical features, and prognosis between alcoholic hepatitis (AH) and severe AH, it is recommended to classify AH into mild and severe AH. As for the disease spectrum of hospitalized patients with alcoholic liver disease, most patients have liver cirrhosis, and about 15% have mild or severe AH. Alcoholic liver failure belongs to the category of severe AH. Severe AH is a clinical diagnosis, while alcoholic steatohepatitis is a pathological diagnosis. The clinical diagnostic criteria for severe AH tend to be consistent in European and the United States of America, but the Chinese guideline released in 2018 is not consistent with the guidelines from western countries.

Treatment of severe viral hepatitis with artificial liver support system / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To investigate the method and therapeutic efficacy of artificial liver support system (ALSS) in treatment of severe viral hepatitis.</p><p><b>METHODS</b>A total of 83 patients including 66 with severe viral hepatitis were treated with ALSS using Baxter-550 artificial kidney and Biologic-DT system.</p><p><b>RESULTS</b>The levels of mean bilirubin, ALT, AST, BUN, Cr and endotoxin was significantly decreased after the treatment. Of the 66 patients?with severe viral hepatitis, 31(47.0%) had improvement in symptoms and 35 (53.0%) died or left hospital. In the control group,50(27.6%) out of the 181 had improvement in symptoms and 131(72.4%) died or left hospital.</p><p><b>CONCLUSIONS</b>ALSS could exert certain therapeutic effects on severe viral hepatitis.</p>

Features of onset of chronic severe hepatitis in 520 cases / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To discuss features of onset of chronic severe viral hepatitis (CSH).</p><p><b>METHODS</b>The patterns of onset of 520 cases of CSH were analyzed by SPASS and STATA software.</p><p><b>RESULTS</b>1. Within less than 10 days, less than 2 weeks, 2 to 4 weeks, 4 weeks to 6 months, 10.4%, 18.1%, 17.1% and 64.8% of 520 cases deteriorated into severe hepatitis respectively. 2. There were no definite predisposing factors in more than 40% cases. There were 1 to 3 or more predisposing factors in more than 30% cases. The incidence of concurrent infection was the highest (P<0.01). 3. The pathogenic basis in more than 50% cases was cirrhosis. 4. Hepatic encephalopathy did not occur in more than 50% of the cases. Ascites occurred in more than 75% of cases. Hepatic encephalopathy first occurred in less than 5% cases and ascites in more than 10% of cases. 5. The latest time for occurrence of hepatic encephalopathy was later than the time of deteriorating into severe hepatitis.</p><p><b>CONCLUSIONS</b>1. Gradual deterioration into CSH was found in all the 520 cases. 2. The predisposing factors, pathogenic bases, incidence and occurring time of hepatic encephalopathy, firstly occurring complication and so on in CSH are not the same as those in acute and subacute severe hepatitis. Therefore, CSH should be independently named and the study of CSH should be strengthened.</p>

Single factor study of prognosis from 520 cases with chronic severe hepatitis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To further understand chronic severe hepatitis (CSH) and to improve the level of diagnosis and treatment and to explore the methods to reduce the fatality rate of CSH through analysing the factors related to prognosis of CSH.</p><p><b>METHODS</b>The factors related to prognosis from 520 cases with CSH were analyzed by SPASS and STATA software.</p><p><b>RESULTS</b>1. The fatality rate in cases with age > or = 40 years was higher than that in cases with age <40 years (P<0.001), there was no significant difference (P>0.05) in sex and pathogenic basis of CSH; 2. The fatality rate rose in cases with WBC > or = 10.0 x 10(9) per liter or platelet <100 x 10(9) per liter; 3. The fatality rate increased gradually with the ratio of aspartic aminotransferase to alanine aminotransferase (AST/ALT) and serum total bilirubin (TBil), appearance of deviation of TBil and ALT, decrease in prothrombin activity (PTA), total cholesterol (TC), cholinesterase and albumin (Alb) (P<0.001). 4. The fatality rate increased with appearance of complications such as ascites, electrolyte disturbance, spontaneous peritonitis and so on (P<0.001).</p><p><b>CONCLUSIONS</b>The important factors related to prognosis were age, > or = 40 years, WBC 10.0 x 10(9) per liter or platelet <100 x 10(9) per liter; the ratio of AST/ALT, TBil, Tc, cholinesterase, Alb and complication, to monitor dynamically laboratory indexes such as TBil, PTA, Tc, cholinesterase and so on and to prevent and cure various complications are important measures to reduce the fatality rate of CSH.</p>

Relationship Between Complications and Prognosis of Chronic Severe Hepatitis / 中国医师杂志

Objective To explore the relationship between complications and prognosis of chronic severe hepatitis(CSH).Methods The clinical data of 520 patients with CSH treated in our hospital were retrospectively analyzed.Results The most common complications of CSH were ascites,electrolyte disturbance and spontaneous peritonitis,and their total occurring rate was over 50%.Among all the complications,cerebral edema and cerebral hernia had the worst prognosis,failure in treatment and mortality were 100%.Secondary were followed by hepato-renal syndrome,upper digestive tract hemorrhage and hepatic encephalopathy that resulting to effectless rate and mortality of 90% .The effectiveless rate and mortality rose along with increase in number of complications .Meanwhile,the severity of hepatic encephalopathy was closely related to mortality in the patients.Conclusions Effective treatment of complications of CSH and reduction of occurring rate of the complications are very important for decreasing mortality of patients with CSH.

STUDY ON CLINICAL SIGNIFICANCE OF PREMONITORY MODE OF DETERIORATION OF SEVERE ACUTE RESPIRATORY SYNDROME(SARS) / 解放军医学杂志

Objective To analyze the clinical features of severe acute respiratory syndrome(SARS) in order to look for premonitory signs of deterioration of patients suffering from SARS. Methods Three hundred and thirty patients with SARS referred to the Chinese Disease Center(CDC) in Beijing were studied retrospectively by SPASS and SDAS software. The data reviewed included clinical manifestations, laboratory findings, and X-ray pictures. Results The prognosis of mild SARS was good with a cure ratio of 100%. Chest radiography revealed opacity or small subtle opacity in lung periphery in 53.1%, there were no signs of acute lung injury in 67.2%, and the opacity disappeared rapidly. In patients with severe SARS, the disease course was longer(41.3?5.6day), the duration of high fever was longer (8.66?3.22day), with the highest temperature reaching 39.04?0.71℃. The duration of respiratory insufficiency was also longer(8.80?4.56day), and 71.8% of them manifested acute lung injury, involving a large area of the lung, with central lesions in 21.8% or mixed in 50%. The opacity was denser, and it took a longer period to resolve. The levels of LDH, HBDH, ESR and CK-MB were high, with HBDH/LDH ratio ranged from 0.8 to 1.0. The mortality was high(14.54%). Logistic regression analysis showed that the premonitory mode of deterioration of the disease was P y=1=? s /(1+? s)(S=-10.598+0.102A+0.592B+0.077C+0.494D), with sensitivity of 86.67%, and specificity 80%, and it was correlated with age, duration of respiratory insufficiency, ESR, and duration of high temperature. Conclusions The premonitory mode of deterioration of SARS is a new, simple, low-cost, biomathematically and pathophysiogically based index. It allows the prediction of deterioration and severity of SARS.

FEATURES OF CLINICAL STAGES AND TYPES OF SEVERE ACUTE RESPIRATORY SYNDROME AND THEIR CLINICAL SIGNIFICANCE / 解放军医学杂志

Objective To study features and significance of clinical stages and types of severe acute respiratory syndrome (SARS). Methods The clinical features of 330 patients with SARS were analyzed by SPSS 11.0 and SDAS software packages, and the standard for classification of clinical stages and types of SARS were studied. Results The disease course of SARS could be divided into four stages, namely, incubation stage, initial stage, climax stage and convalescence stage. The period of incubation stage was 1~12 (5.70?2.45) days. The initial stage was the pathoformic phase during 1 st~10 th (3.98?2.48) days after the onset. The fever was the first symptom and there were usually no catarrhal symptoms. Meanwhile, no abnormality was found in the chest X-ray examination. The climax stage included 3 sequential phases of pulmonary inflammatory exudation, pulmonary tissue consolidation and ARDS or multi-organ failure. In the phase of pulmonary inflammatory exudation, there were serious cough, mild shortness of breath and hypoxemia. Furthermore, chest X-ray examination showed that there was exaggeration of lung markings, haziness or patchy opacity. In the phase of pulmonary tissue consolidation, type I respiratory failure was usually seen in the patients. Shortness of breath and hypoxemia became more serious. Chest X-ray examination showed that the area of consolidation continued to enlarge to include the entire lung. The convalescence stage usually appeared 3 weeks after the onset and lasted for 5～56 (24.37?8.81) days. This stage could further be divided into phase I (complete recovery) and phase II (possible existence of pulmonary fibrosis). SARS could be clinically classified into mild type (ordinary type), severe type and extremely severe type (fulminant type) with a mortality of zero, 5.76% and 61.54%, respectively. There were very great differences in clinical features in three types of SARS. Conclusions SARS could be divided into the incubation stage, initial stage, climax stage and convalescence stage. The climax stage included 3 phases, i.e. pulmonary inflammatory exudation, pulmonary tissue consolidation, and ARDS or MOF. The convalescence stage could be divided into phase I (complete recovery) and phase II (possible existence of pulmonary fibrosis). SARS could be classified as mild type, severe type and extremely severe type.

Damage to non-pulmonary organs like heart and kidney in SARS patients:An analysis of 330 cases / 第二军医大学学报

Objective:To analyze the features and clinical significance of damages to non pulmonary organs like the heart,kidney and peripheral blood in SARS patients.Methods:SPSS 11.0 and SDAS software packages were used to retrospectively analyze the damages to the heart,kidney and peripheral blood in 330 clinically confirmed SARS cases.Results:(1)The heart damage occurred within 1 week after SARS onset in mild cases; the rates of LDH,HBDH,CK and CK MB returning to normal were 74.2%,80.6%,100% and 100%,respectively.In severe cases,the heart damage usually occurred 1 week after SARS onset; the rates of LDH,HBDH,CK and CK MB returning to normal were 32.2%,29.5%,55.2% and 44.4%,respectively.Ten patients whose CK MB didnot return to normal died.(2) The changes of RBC count appeared after an average of 1 week (1 10 d) in 54.2% of the patients.It returned to normal in all the mild SARS cases after an average of 12.5(4 21) d but didnot in 18.4% of the severe cases ( P

A study on prognostic factors of severe SARS: a clinical analysis of 165 cases / 解放军医学杂志

Objective To analyze the single factor affecting prognosis of SARS, and to establish a model of regression analysis for multiple factors affecting the prognosis of the disease. Methods SPSS 11.0 and SDAS software packages were used to retrospectively analyze the clinical features of SARS in 165 clinically confirmed severe cases. Meanwhile, single-factor and logistic multivariate regression analyses were conducted for SARS prognosis to establish a regression model for SARS prognosis analysis. Results (1) In patients with SARS, the age was significantly correlated to prognosis (r=0.506, P0, then P y=1 was over 0.5, it denoted death of the patient. In condition of S

Recent research advances in chronicity of drug-induced liver injury / 临床肝胆病杂志

Although drug-induced liver injury (DILI) is often an acute process, about 20% of the patients may progress to chronic DILI. Chronic DILI has a long course of disease and there is still no effective treatment. With the development and clinical application of new drugs and the wide application of herbal and dietary supplements, the incidence rate of DILI chronicity gradually increases. This article overviews the latest research advances in DILI chronicity from the aspects of the epidemiology, risk factors, clinical manifestations, diagnosis, and treatment of DILI, so as to gain a comprehensive understanding of chronic DILI.