乙肝肝硬化患者抑郁焦虑与Child-Pugh肝功能分级的关系

目的:探讨乙肝肝硬化患者抑郁焦虑与Child-Pugh肝功能分级的关系。方法:将83例乙肝肝硬化患者作为肝硬化组,选取同期年龄性别匹配的体检健康者50例作为对照组,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)评测两组患者抑郁、焦虑状况,并分析抑郁、焦虑评分分值与Child-Pugh肝功能分级的相关性。结果:乙肝肝硬化组SDS评分、SAS评分分值明显高于对照组,差异有统计学意义(t=15.602,13.018;P0.001);乙肝肝硬化组抑郁、焦虑发生率分别为38.55%、28.92%,明显高于对照组的18.0%、12.0%,差异有统计学意义(χ2=6.182,5.111;P0.05)。Child-Pugh A级患者SDS评分、SAS评分分值明显低于Child-Pugh B级患者和Child-Pugh C级患者,且Child-Pugh B级和Child-Pugh C级患者比较差异有统计学意义(F=7.261,5.310;P0.01);Child-Pugh A级抑郁、焦虑发生率分别为18.75%、12.50%低于Child-Pugh C级的52.63%、42.11%(χ2=7.511,4.441;P0.05),但Child-Pugh A级和B级、Child-Pugh B级和C级组间比较差异无统计学意义(χ2=0.796,0.473,3.125,3.420;P0.05)。结论:乙肝肝硬化患者Child-Pugh肝功能分级与抑郁、焦虑评分分值存在正相关关系。     

乙型肝炎肝硬化患者乙型肝炎病毒DNA水平与肝纤维化程度的关系

目的 探讨乙型肝炎肝硬化患者乙型肝炎病毒(HBV)DNA水平与肝纤维化程度的关系及其临床意义.方法 回顾性分析2004年至2006年本科室收治的263例乙型肝炎肝硬化住院患者的临床资料.所有患者均进行肝功能Child-Pugh分级,检测HBV DNA、HBV血清标志物、透明质酸(HA)、人Ⅲ型前胶原(Hpc-Ⅲ)、Ⅳ型胶原(Ⅳ-C)、层粘蛋白(LN);行腹部超声检测脾大小、门静脉内径、脾静脉内径;胃镜检查食管静脉曲张程度,并记录常见并发症.根据HBV DNA水平分为4组:G1组,HBV DNA＜103拷贝/ml;G2组,HBV DNA 103～＜105拷贝/ml;G3组,HBV DNA 105～＜107拷贝/ml;G4组,HBV DNA≥107拷贝/ml.比较各组间Child-Pugh分级、肝纤维化血清指标和门脉高压指标的差异以及各组肝硬化常见并发症的发生情况.结果 263例患者中217例(82.5%)HBV DNA阳性.不同HBV DNA水平患者之间的Child-Pugh评分分级、HA、Hpc-Ⅲ、Ⅳ-C、LN比较,差异无统计学意义(均P＞0.05).4组患者之间脾大小、门静脉内径、脾静脉内径及食管静脉曲张程度比较,差异无统计学意义(均P＞0.05).4组患者并发症如消化道出血、继发感染、腹水、肝性脑病、肝癌等发生率差异也无统计学意义(均P＞0.05).结论 绝大部分乙型肝炎肝硬化患者HBV DNA阳性,但血清HBV DNA水平高低与肝硬化严重程度及并发症的发生率无明显关联.     

肝动脉化疗栓塞术联合脾栓塞术治疗肝癌脾亢的临床应用价值

目的 探讨肝动脉化疗栓塞术联合脾部分栓塞术治疗原发性肝癌伴脾功能亢进的临床应用价值.方法 确诊为原发性肝癌伴脾功能亢进患者60例,2013年10月至2014年6月就诊于解放军总医院第一附属医院介入科.60例患者被随机分配到A、B两组.A组为对照组,30例患者接受肝动脉化疗栓塞术;B组为实验组,30例患者接受肝动脉化疗栓塞术及脾部分栓塞术.治疗前后检测血常规、血凝四项、肝功能、T细胞亚群,免疫球蛋白及CT扫描.观察两组患者并发症的情况.结果 实验组患者术后外周血象、肝功能、凝血功能及免疫功能较术前有所改善,差异有统计学意义(P＜0.05);两组患者术后并发症间比较无显著地差异性(P＜0.05),并未发生严重并发症.结论 肝动脉化疗栓塞术联合脾部分栓塞术是一种安全且有效的治疗方法,它能有效改善患者血细胞减少状况,改善肝功能,提高免疫力,且术后患者发生严重并发症的概率较低.     

MSCT评估肝癌伴肝硬化患者肝脏储备功能中的价值分析

目的 探讨MSCT评估肝癌伴肝硬化患者肝储备功能的价值.方法 选取2014年2月至2016年3月在我院治疗的肝癌伴肝硬化患者44例,评价患者治疗前的CT形态学分级和Child-pugh分级,并分析肝脏MSCT灌注参数与二者之间的关系.结果 重度肝硬化患者血流量(blood flow,BF)、血容量(blood volume,BV)、门静脉灌注量(pogal venous liver perfusion,PVP)、对比剂达到时间(contrast agent arrival time,IRF T0)参数显著低于轻度和中度肝硬化患者,平均通过时间(mean transit time,MTT)、肝动脉分数(hepatic arterial fraction,HAF)和A/V参数显著高于轻度和中度肝硬化患者;中度肝硬化患者BF、BV、PVP和IRF TO参数显著低于轻度肝硬化患者,MTT、HAF和A/V参数显著高于轻度肝硬化患者;肝功能Child-pugh C级患者BF、BV和PVP参数显著低于A级和B级患者,HAF和A/V参数显著高于A级和B级患者,C级和B级患者MTT和IRF TO比较差异无统计学意义(P＞0.05);肝硬化形态学分级与BF、BV、IRF TO和PVP呈负相关(r=-0.832、-0.804、-0.703和-0.856,P＜0.05),与MTr、HAF和A/V呈正相关(r=0.602、0.811和0.820,P＜0.05),与肝动脉灌注量(hepatic artery perfusion,HAP)无相关性(P＞0.05);肝功能Child-pugh分级与BF、BV、IRF TO和PVP呈负相关(r=-0.874、-0.835、-0.502和-0.831,P＜0.05),与MTr、HAF和A/V呈正相关(r=0.615、0.754和0.816,P＜0.05),与HAP无相关性(P＞0.05).结论 MSCT可用于肝癌患者肝硬化程度和肝储备功能评估,为肝硬化分级诊断提供重要手段.     

部分脾栓塞术对肝硬化脾功能亢进的介入治疗

目的:探讨和评价部分脾栓塞术(PSE)治疗肝硬化脾功能亢进的临床应用价值.方法:采用Seldinger技术对28例乙肝后肝硬化伴脾功能亢进患者用高压消毒明胶海绵颗粒共进行31次PSE.结果:28例手术中27例获得成功,栓塞范围为30%～60%,25位患者术后1周以内、1～2周及2周以上WBC和PLT均有不同程度的上升(P＜0.01),临床有效率为 92.6%.手术前后肝功能变化不大.全部病例均未发生严重并发症.结论:部分脾栓塞术对治疗肝硬化脾亢有明显疗效,可替代脾切除术.对肝功能的改善,近期疗效不明显.     

布-加综合征肝功能Child-Pugh分级合理性的探讨

目的探讨布-加综合征(Budd-Chiari syndrome,B-CS)患者肝功能Child-Pugh分级临床应用的合理性。方法对比研究68例B-CS患者(以下称B-CS组),42例肝炎后肝硬化引起的门静脉高压症(portal hypertension,PHT)患者(以下称PHT组)手术前后肝功能变化情况,以及术后随访情况。结果B-CS组病变类型包括Ⅰa型8例,Ⅰb型9例,Ⅱ型26例,Ⅲa型16例,Ⅲb型9例,其中重症B-CS患者12例。术前肝功能A级26例,B级34例,C级8例。根治性病变隔膜切除术11例,分流术35例,转流术22例。PHT组术前肝功能A级14例,B级28例,均施行断流加分流手术。两组患者均顺利完成手术,无手术死亡,并发症发生率之间差异无显著性(P>0.05);两组手术前后肝功能差异无显著性(P>0.05)。随访:B-CS组52例,PHT组38例,时间6个月～3年,平均(1.8±0.46)年,再出血率分别为1.92%(1/52)、2.63%(1/38),肝性脑病发生率分别为1.92%(1/52)、10.5%(4/38),B-CS组有效率为92.3%(48/52)。结论肝功能Child-Pu...     

肝硬化与小肠细菌过度生长相关性的临床研究

目的：探讨肝硬化患者小肠细菌过度生长(SIBO)情况,以及SIBO与肝功能状况、肝硬化原因的相关性。方法将61例肝硬化患者按肝功能Child-Pugh分级分为A级、B级、C级三组,通过葡萄糖氢呼吸试验(GHBX)分别检测肝硬化患者及20例健康对照SIBO情况,将肝硬化组与健康对照组进行组间比较分析,同时比较肝硬化各组与SIBO的关系。结果20例健康志愿者检出1例(5%)伴SIBO。61例肝硬化患者共检出38例(62.3%)患者伴SIBO,其中肝功能A级14例,4例伴SIBO,肝功能B级20例,11例伴SIBO,肝功能C级27例,23例伴SIBO。37例肝硬化伴SIBO中,17例C反应蛋白(CRP)升高,占45.95%。24例肝硬化不伴SIBO中,5例CRP升高,占20.83%。乙肝肝硬化40例,23例伴SIBO(57.5%),酒精性肝硬化12例,5例伴SIBO(41.7%)。结论肝硬化患者存在SIBO,其与肝功能分级呈正相关,与CRP升高有明显关系,与肝硬化原因无明显关系。     

肝硬化患者血清中AST、ALT比值与HA相关性的临床研究

目的 探讨不同Child-Pugh分级肝硬化患者血清中AST、ALT比值与肝纤维化标志物HA的相关性.方法 对96例不同Child-Pugh分级肝硬化患者采用重氮法检测血清AST、ALT比值,放射免疫法测定肝纤维化标志物HA水平.结果 肝硬化患者血清AST、ALT比值,HA水平均明显高于健康对照组(P<0.001) .不同 Child-Pugh分级肝硬化患者AST、ALT比值均有所不同,AST、ALT比值随着 Child-Pugh分级的逐渐升高明显递增,血清肝纤维化标志物HA水平也显著增加,二者呈明显正相关.结论 肝硬化患者AST、ALT比值与肝纤维化标志物HA水平呈正相关(r=0.435,P<0.001),维护一定水平的肝功能,降低AST、ALT比值有利于减缓肝纤维化进程及改善预后.     

2.126 普萘洛尔在肝硬化患者胃肠推进运动中的作用

目的肝硬化是常见病、多发病,其并发症包括上消化道出血、腹水、肝肾综合征、肝性脑病及肝癌等,其死亡率较高.而这些并发症的启始环节是肝源性胃肠运动障碍.因此有效地改善胃肠功能,防止肝源性胃肠运动衰竭具有重要意义.肝硬化患者的交感神经兴奋,迷走神经抑制,这导致胃肠运动功能减弱.本研究观察非选择性β-肾上腺素受体阻滞剂普萘洛尔(心得安)对肝硬化患者胃肠推进运动的影响.方法 1.病例在我院住院的肝硬化患者27例.Child-Pugh积分均为B级. 其中观察组15例(男11例,女4例),对照组12例(男9例,女3例),两组间的年龄等无差异.2 .治疗方法观察组服用普萘络尔10mg/次,3次/日,共10天;对照组服用谷维纱10mg/次, 3次/日,共10天.两组均给予相同的保肝治疗.3.胃肠运动功能检测各组病例治疗前后分别采用不透X线标志物检测GITT(以胃肠道排出%表示),治疗前测24h GITT,治疗后测24h 及48h GITT.试餐快餐面200g+香肠75g.钡条为北京航天医学研究所提供.结果见表表普萘络尔对肝硬化患者GITT的影响     

肝移植患者围术期血浆S-100β和神经元特异性烯醇化酶的变化

目的:观察不同病种、不同Child-Turcotte-Pugh(CTP)评分和终末期肝病模型(MELD)评分的肝移植患者血浆S-100β和神经元特异性烯醇化酶(NSE)的变化。方法:选择行肝移植手术的30例患者,于麻醉后(T1)、术毕时(T2)及新肝24h(T3),经左侧颈内静脉逆行置管至颈静脉球部,取血样检测S-100β和NSE浓度;并根据患者的病种、CTP和MELD评分进行分组,比较各组间S-100β和NSE浓度的变化。结果:T2时重肝组S-100β和NSE浓度均高于肝硬化组,CTP分级C级患者T2时的S-100β浓度高于A级患者;CTP分级C级患者T1时的NSE浓度高于A级患者;3个时点≥18分组的S-100β浓度均高于11分组,T1和T2时≥18分组的NSE浓度高于11分组。结论:病情越重,肝功能越差的患者,其S-100β和NSE浓度越高,表明脑损伤的程度越重。     

肝切除术后肝功能失代偿的相关风险指标分析

目的 探讨肝切除术后肝功能失代偿的风险指标。方法 回顾性分析2015年1月~2018年3月我院225例实施肝部分切除术患者的围手术期临床资料,包括人口统计学指标（性别,年龄,手术指征,相关病史）,术中情况（肝门阻断时间,肝切除范围,失血量,输血量）,术后病理诊断及血清生化指标[总胆红素（TB）,前白蛋白（PA）,白蛋白（ALB）,谷丙转氨酶（ALT）,谷草转氨酶（AST）,胆碱酯酶（ChE）,γ-谷氨酰转移酶（γ-GT）],术后住院时间等。筛选出与术后肝功能失代偿相关的风险指标。结果 225例患者中,24例（10.71%）出现术后肝功能失代偿。肝功能失代偿患者平均年龄高于肝功能代偿患者[（62.32±7.71）岁 vs （55.12±11.00）岁],差异有统计学意义（P＜0.05）。术后第3天,肝功能失代偿患者PA和ChE分别为（65.55±48.23）mg/L和（3400.00±1610.72）IU/L,低于肝功能代偿患者的（111.00±54.93）mg/L和（5146.57±2115.63）IU/L,差异具有统计学意义（P＜0.05）,其余指标差异无统计学意义（P＞0.05）。相关性分析结果显示,PA及ChE均与手术方式相关（P＜0.05）。ROC曲线提示,年龄≥62岁,术后PA≤100 mg/L及ChE≤4348 IU/L的患者,术后发生肝功能失代偿的风险显著提高。结论 肝切除术前肝功能Child-Pugh分级A级的患者,术后仍有可能发生肝功能失代偿。结合患者年龄、PA、ChE等指标,可以有效评估部分肝切除患者围手术期肝脏储备功能,预测术后肝功能失代偿的发生。     

Reassessment of monoethylglycinexylidide as preoperative liver function test in a rat model of liver cirrhosis and man

It is known that lidocaine is rapidly metabolized by the hepatic cytochrome P-450 system to form monoethylglycinexylidide (MEGX), its primary metabolite. We analyzed serum MEGX levels experimentally and clinically by fluorescent polatization immunoassay to reassess preoperative liver microsome functions. Experimental study: Liver cirrhosis was produced in rats by intra-abdominal injection of thioacetamide. MEGX, indocyanine green test (ICG), and liver biochemical variables were measured periodically. Then, survival rates were assessed after the rats received a 70% hepatectomy. Clinical study: MEGX levels were measured in various human patients with chronic hepatitis or liver cirrhosis who underwent hepatectomy. Serum MEGX levels significantly dropped and ICG levels significantly rose with macroscopic and histologic progression of liver cirrhosis in rats. The MEGX levels correlated closely with albumin levels and ICG. Preoperative MEGX and ICG levels of the mortal group of rats differed significantly from those of the survival group with 70% hepatectomy. Furthermore, 100% of the rats with MEGX levels above 40 ng/ml and ICG levels below 1.0%. In the clinical study, MEGX levels were significantly lower in patients with chronic hepatitis or liver cirrhosis than in healthy volunteers and correlated significantly with liver function tests such as albumin, Fischer's ratio, prothrombin time, hepaplastin and ICG. A significant difference was found in MEGX levels between patients receiving lobectomy and those receiving subsegmentectomy or partial hepatectomy. All patients tolerated their operations. Our data indicate that the MEGX test combined with ICG test and Child-Pugh classification is a better predictor of residual liver reserve capacity, and the analysis of hepatic MEGX formation might prove useful for rapid and reliable assessment liver function and choice of surgical treatment. Received: 22 May 2000 / Accepted: 3 November 2000     

409例肝硬化和重型肝炎病例的MELD评分结果的构成分析

目的应用两种评分方法对409例肝硬化及重型肝炎患者进行评估比较，分析血清肌酐、血清胆红素及凝血酶原时间国际标准化比值（INR）对MELD评分结果的影响程度。方法统计409例肝硬化及重型肝炎患者的相关资料，应用Child和MELD评分法分别计算后应用Chiss软件进行统计学分析。结果随着A、B、C、D各个级别的病情的加重，MELD评分明显升高。各个级别的血清胆红素、INR之间存在明显差异；各个级别的血清肌酐之间无明显差异。结论血清胆红素及凝血酶原时间国际标准化比值（INR）的变化及不同能够明显影响到评分结果，而血清肌酐的结果对评分结果的影响不显著。MELD应与多因素分析及临床经验有机结合，才是符合临床实际的判断严重肝病预后的较科学手段。     

前入路绕肝提拉法肝后隧道的解剖学研究

目的:探讨前入路绕肝提拉法手术的临床解剖学依据.方法:解剖分离21具成人尸体的肝后下腔静脉标本,采集20例因肝硬化行背驮式肝移植患者的肝后下腔静脉的临床影像资料,按不同的绕肝提拉法可能的路径和不同宽度肝后隧道(10 mm,6 mm)统计可能遇到的肝静脉.结果:前入路绕肝提拉法的标准路径平均可遇到肝短静脉的中位数是1(0～3),标准路径右上方的路径(肝后下腔静脉右缘、距肝下缘1 cm)和标准路径之间、不同宽度肝后隧道之间差异有统计学意义(P＜0.05),肝硬化组与无肝硬化对照组之间无明显差异(P＞0.05).结论:前入路绕肝提拉法肝切除手术是可行的.     

The refit model for end-stage liver disease-Na is not a better predictor of mortality than the refit model for end-stage liver disease in patients with cirrhosis and ascites

Background/Aims

The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD) and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. We aimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality in Korean patients with cirrhosis and ascites.

Methods

We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the Konkuk University Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were compared using the predictive value of the 3-month mortality, as assessed by the Child-Pugh score.

Results

In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most common etiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were 0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patients with persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among the Child-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients with persistent ascites (P=0.039).

Conclusions

Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients with cirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite the known relationship between hyponatremia and mortality in cirrhotic patients with ascites.     

The role of splenectomy in patients with hepatocellular carcinoma and secondary hypersplenism

Hypersplenism, secondary to portal hypertension, is common in hepatocellular carcinoma (HCC) with liver cirrhosis. Hepatic resection in the patient with hypersplenic thrombocytopenia (HSTC) may cause a perioperative bleeding episode and sometimes, liver failure. In order to investigate the effect of concomitant splenectomy in HCC patients with HSTC, clinical parameters are retrospectively reviewed for 18 HCC patients who underwent hepatic resection with or without splenectomy. Among 581 HCC patients who underwent hepatic resection during the past 17 years, 18 patients with HSTC were investigated. Twelve of them underwent hepatic resection for HCC and had a concomitant splenectomy and the remaining 6 patients underwent hepatic resection for HCC only. The clinical outcomes and postoperative changes in platelet count, serum albumin level, serum total bilirubin levels, prothrombin time and clinical staging (Child-Pugh Classification) were reviewed. The resected spleen mean weight was 350.7 +/- 102.9 g. Postoperative platelet counts were significantly increased with albumin levels and clinical staging scores also improved after the splenectomy. Among the 12 patients who had a splenectomy, 6 patients had postoperative complications and one died of recurrent variceal bleeding. According to this data, it is not harmful to perform a concomitant splenectomy and hepatectomy for the HCC patient with severe HSTC, it can even be beneficial in improving both the platelet count and clinical staging.     

肝移植治疗脾功能亢进相关终末期肝病*

背景：肝移植已成为治疗脾亢相关终末期肝病最理想的方法,行肝移植过程中保留脾脏,是否会出现移植后脾功能亢进相关问题,目前尚无统一的认识。 目的：观察肝移植治疗脾功能亢进相关终末期肝病移植后脾功能的恢复过程。 方法：纳入肝移植治疗终末期肝病患者63例,按有无脾功能亢进分为脾亢组和非脾亢组。比较两组移植后血小板计数、彩超测定脾脏上下径、厚度、门静脉直径及随访15个月的结果。 结果与结论：纳入患者63例,死亡8例,55例进入结果分析。其中,肝移植并行切脾者4例,仅1例存活。脾亢组移植手术结束时血小板较移植前明显降低,移植后3 d降至最低,而后逐渐上升,移植后7 d明显增加(P < 0.05),稳定至15个月;非脾亢组血小板移植后5 d降至最低,17 d达到移植前水平,两组比较差异均有显著性意义(P < 0.05)。移植后7 d脾脏上下径及厚度开始明显减小(P < 0.05),3个月脾静脉直径明显减小(P < 0.05),至15个月稳定,患者均无门静脉高压曲张静脉破裂出血史。说明肝移植过程中若无绝对切除脾脏的适应症,应尽量保留脾脏。 关键词：脾功能亢进;肝移植;终末期肝病;门静脉;临床观察 doi:10.3969/j.issn.1673-8225.2012.05.003     

Minimal hepatic encephalopathy may be present despite the absence of non-invasive and elastography evidence of cirrhosis in patients with primary biliary cholangitis

PurposeMinimal hepatic encephalopathy (MHE) is an important complication of chronic liver disease (CLD); however, MHE burden in patients with primary biliary cholangitis (PBC) has not been determined yet. Therefore, our study aimed to assess the prevalence of MHE in a typical cohort of middle-aged, patients with PBC suspicion of liver fibrosis and to investigate the relationship between MHE, basic laboratory tests and the stage of liver fibrosis.Patients and methodsFifty-one patients (38 with PBC and 13 controls), were prospectively enrolled. Portosystemic Encephalopathy-Syndrome test was used to diagnose MHE. Elastography point qualification (ElastPQ) and non-invasive markers (APRI and FIB-4) were used to assess liver fibrosis. The severity of CLD was assessed using the Model of End-Stage Liver Disease (MELD) and Child-Pugh score.ResultsMHE was diagnosed in 9 patients (24.3%) with PBC and none in the control group. As many as 44.4% of the patients with MHE had neither advanced fibrosis nor cirrhosis, as demonstrated using non-invasive markers of liver fibrosis or ElastPQ. The MELD score was the only predictor of MHE with cut-off value 8.5 [AUC ​= ​0.753, CI_95% ​= ​0.569 to 0.938)] with sensitivity of 56%, specificity of 85% and accuracy of the test of 78%. Non-invasive markers of liver fibrosis and ElastPQ did not predict MHE.ConclusionsMHE may occur in PBC despite no evidence of advanced liver fibrosis or cirrhosis. The slightly elevated MELD score may indicate a substantially increased risk of MHE in patients with PBC.     

Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure

Background/Aims

Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.

Methods

Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.

Results

A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

Conclusions

Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.     

Comparison of the Child-Turcotte-Pugh classification and the model for end-stage liver disease score as predictors of the severity of the systemic inflammatory response in patients undergoing living-donor liver transplantation

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-α, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.