集落刺激因子治疗终末期酒精性肝病的临床对照研究

目的评价重组人粒细胞集落刺激因子(G-CSF)治疗终末期酒精性肝病患者疗效和安全性。方法将36例终末期酒精性肝病患者随机分为2组,试验组18例,对照组18例。对照组给予基础治疗,试验组在基础治疗的同时给予G-CSF治疗,G-CSF剂量和用法为:5μg/kg,1次/12 h,皮下注射,连续7 d。结果试验组对比对照组MDF及MELD评分在1、2、3个月均有显著降低(P0.05)。试验组相对对照组CD34+细胞计数下降显著(0.46±0.58对0.15±0.2,P=0.020)。90 d内试验组生存率显著高于对照组(χ~2=14.995,P=0.000)。治疗期间无严重不良反应。结论 G-CSF能够提高终末期酒精性肝病患者的生存率,并且安全性较高。     

替比夫定治疗乙型肝炎相关慢加急性肝衰竭患者疗效分析

目的探讨替比夫定(LDT)治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)的临床效果。方法收集2012年1月至2014年10月在广西玉林市红十字会医院肝病科住院治疗的91例HBV-ACLF患者的临床资料。根据治疗方法不同将91例患者分为观察组(45例)和对照组(46例)。对照组患者给予保肝利胆、补充能量、血浆、白蛋白,促进肝细胞再生、改善肝脏微循环、调节酸碱、水电解质平衡、防治各种并发症等综合治疗;观察组患者在此基础上加服LDT治疗,600 mg/次,1次/d;两组患者均治疗12周。观察比较两组患者治疗前后症状、体征,血生化血指标[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、前白蛋白(PA)、胆碱酯酶(CHE)、凝血酶原活动度(PTA)],HBV-DNA载量水平。结果治疗前两组患者ALT、TBIL、PA、CHE、PTA、及HBV-DNA载量水平比较,差异无统计学意义(P0.05)。治疗12周后,观察组患者ALT,TBIL,PA,CHE,PTA均优于对照组(P均0.05),HBV-DNA载量水平低于对照组(P0.05)。观察组12周生存率高于对照组(P0.01);观察组12周病死率低于对照组(P0.05)。治疗12周后,观察组患者转阴率(56.4%)显著高于对照组(0.0%),差异具有统计学意义(P0.01)。两组患者均无严重不良反应发生。结论在常规综合治疗的基础上加用LDT治疗HBV-ACLF,能有效改善患者ALT、TBIL等生化学指标,抑制HBV复制,显著提高患者的生存率,降低病死率,不良反应轻微,是治疗HBV-ACLF较理想的方法。     

血浆吸附灌流联合血浆置换加用恩替卡韦治疗乙型肝炎相关慢加急性肝衰竭的临床疗效

目的观察血浆吸附灌流(PP)联合血浆置换(PE)的组合型人工肝方法加恩替卡韦抗病毒治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)的临床疗效。方法将PP和使用少量血浆的PE联合在1次治疗模式中完成,治疗35例68例次肝衰竭患者,检测治疗前、结束时及治疗结束72 h时患者血清总胆红素(TBil)、凝血酶原活动度(PTA)、血清白蛋白(Alb),与同期进行的34例66例次单纯PE治疗患者做对照,两组患者皆予恩替卡韦抗病毒治疗。结果 (1)治疗1个月时并发症发生率2组间差异无统计学意义(P>0.05)。治疗1个月时HBV DNA下降超过100倍的患者比率分别为治疗组68.6%,对照组61.8%,2者差异无统计学意义(P>0.05)。(2)治疗组和对照组患者治疗1个月时好转率(62.9%,61.8%),生存率(68.6%,64.7%),累积3个月生存率(65.7%,64.7%),6个月生存率(65.7%,61.8%),差异皆无统计学意义(P均>0.05)。(3)2组患者治疗结束及治疗结束72 h时TBil均明显低于治疗前水平(P均<0.05),治疗组在治疗结束时TBil下降幅度更大(P<0.05),在治疗结束72 h时2组间比较差异无统计学意义(P>0.05)。治疗组患者在治疗结束时PTA无明显升高(P>0.05),而对照组在治疗结束时PTA升高(P<0.05)。治疗组患者在治疗结束时Alb较治疗前无明显变化(P>0.05),而对照组在治疗结束时Alb显著升高(P<0.05)。结论本研究建立的PP联合PE及恩替卡韦抗病毒治疗方法,血浆用量少,抗病毒疗效好,治疗HBV-ACLF患者安全有效。     

DVCLP方案联用粒细胞集落刺激因子对成人急性淋巴细胞白血病诱导缓解治疗的临床研究

目的研究粒细胞集落刺激因子(G-CSF)与DVCLP方案联用治疗初治成人急性淋巴细胞白血病(ALL)的疗效。方法40例患者接受DVCLP方案诱导化疗。随机分为两组:试验组(20例)在化疗前3天至化疗的第7天给予G-CSF;对照组(20例)则在化疗时ANC<1.5×109/L中给予G-CSF。结果患者ANC<1.5×109/L的天数试验组要明显短于对照组[16天±7天,21天±5天(P<0.05)]。完全缓解率、复发率、生存中位数时间、一年生存率试验组依次为85%、22%、11个月、45%;对照组依次为75%、55%、6个月、19%(P>0.05)。结论成人ALL诱导化疗早期应用G-CSF可明显缩短粒细胞减少时间,但对提高完全缓解率、减少复发率和改善长期生存的影响未达到统计学差异。     

交替使用留置针对盐酸艾司洛尔致静脉炎的有效性及安全性研究

目的 分析交替使用留置针对盐酸艾司洛尔注射液致静脉炎的有效性及安全性。方法 以我院心血管内科2021年8月至2022年10月收治的80例心律失常患者为本次研究对象,并以随机数字法分为对照组(40例,连续使用留置针泵入)和试验组(40例,交替使用留置针泵入),对比分析两组方案治疗效果。结果 (1)试验组静脉炎的发生率为30%,Ⅱ级以上静脉炎发生率为7.5%,均低于对照组的65%和25%。(2)试验组患者的满意度92.5%显著高于对照组患者的满意度62.5%,差异有统计学意义(P<0.05)。结论 交替使用留置针泵入盐酸艾司洛尔注射液可降低患者静脉炎的发生率,降低静脉炎的严重程度,可取得安全高效理想治疗效果,同时能提高患者的满意度。     

MELD动态评分对人工肝治疗HBV-ACLF短期预后的预测价值

目的:比较人工肝支持系统(ALSS)治疗不同临床类型乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)的疗效，寻找ALSS治疗不同临床类型HBV-ACLF短期预后的有效预测因子。方法:回顾性分析十堰市太和医院感染科于2016年1月至2020年12月接受ALSS治疗的HBV-ACLF患者临床资料。比较ALSS治疗3种类型HBV-ACLF的疗效。采用多因素COX回归分析HBV-ACLF患者经过ALSS治疗后90 d预后影响因素。结果:最终纳入313例HBV-ACLF患者，A型121例、B型59例、C型133例。ALSS治疗A型HBV-ACLF患者临床有效率为68.8%,显著高于B型(55.9%)与C型(22.6%),差异有统计学意义(P<0.001);多因素COX回归分析显示，ALSS治疗1周时ΔMELD是HBV-ACLF患者90 d预后的独立影响因素。ΔMELD在A、B、C三型HBV-ACLF中预测90 d预后的cut-off值分别为-5.7、-4.5、-1.5。三型HBV-ACLF患者在ALSS治疗1周后，ΔMELD低于cut-off值的患者累积生存率均明显高于ΔMELD高于cut-...     

自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者疗效初步研究

目的 探讨采取自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者的疗效。方法 2017年5月~2018年12月在我院肝肾内科就诊的94例HBV-ACLF患者,被随机分为对照组47例和观察组47例,在内科综合治疗的基础上分别给予血浆透析滤过(PDF)和PDF联合经肝动脉自体骨髓干细胞移植治疗。采用美国东部肿瘤协作组评分(ECOG)和终末期肝病模型(MELD)评分评价生活质量和肝功能状态。结果 在治疗24周和48周时,观察组生存率分别为72.3%和53.2%,均显著高于对照组的48.9%和31.9%(P<0.05);在治疗24周末,34例观察组生存患者血清白蛋白(ALB)水平为(35.8±3.9)g/L,显著高于25例对照组【(32.3±3.5)g/L,P<0.05】;在治疗24周和48周时,观察组ECOG评分≥2级发生率为26.5%和12.0%,显著低于对照组56.5%和40.0%(P<0.05);在治疗48周时,观察组MELD评分为(9.7±1.3)分,显著低于对照组【(11.4±1.5)分,P<0.05】。结论 采取PDF联合自体骨髓干细胞移植治疗HBV-ACLF患者可显著促进蛋白合成,降低病死率,提高ECOG评分。        

HBV相关慢加急性肝衰竭预后危险因素分析及解毒逐瘀汤灌肠的临床疗效

目的:评价解毒逐瘀方灌肠治疗HBV相关慢性急性肝衰竭(HBV-ACLF)的临床疗效。方法:236例HBV-ACLF患者,根据入组时是否采用解毒逐瘀方灌肠分为灌肠组55例和对照组181例。比较两组患者临床特征、灌肠治疗短期疗效及分析影响预后的因素。结果:Kaplan-Meier生存分析显示,灌肠组患者总生存期显著优于对照组(P=0.003),灌肠治疗可显著改善早期HBV-ACLF患者总生存期(P=0.021),但对中晚期HBV-ACLF患者总生存期影响差异无统计意义(P>0.05)。Cox回归分析显示年龄、肝性脑病、白细胞计数、凝血酶原活动度及总胆红素水平是影响HBV-ACLF患者总生存期的危险因素(P<0.01);肝肾综合征、白细胞计数、凝血酶原活动度及天门冬氨酸氨基转移酶水平为早期HBV-ACLF患者总生存期的危险因素(P<0.01)。结论:解毒逐瘀方灌肠可有效改善早期HBV-ACLF患者的总生存率。     

片仔癀联合伽马刀治疗原发性肝癌的临床研究

[目的]观察片仔癀联合伽马刀立体定向放疗治疗原发性肝癌的临床疗效和安全性。[方法]182例原发性肝癌患者分为试验组(n=92)和对照组(n=90),对照组采用伽马刀立体定向放疗治疗,试验组同时口服片仔癀,2次/d,0.6 g/次。以患者中位生存期和累积生存率进行生存分析,并比较2组患者不良反应。采用Cox比例风险模型分析患者预后独立因素。[结果]试验组和对照组的1、2、3年累积生存率分别为48%、21%、12%和34%、19%、13%,中位生存时间为10.3个月和6.2个月,生存分析显示,2组差异有统计学意义(P0.05)。试验组的恶心呕吐、食欲减退、乏力、谷丙转氨酶升高和总胆红素升高的不良反应较对照组少(P0.05)。Cox比例风险模型分析显示,片仔癀是独立的保护因素。[结论]片仔癀联合伽马刀立体定向放疗不良反应少,能延长原发性肝癌患者生存时间。     

甘露消毒丹影响慢加急性肝衰竭患者肿瘤坏死因子α和白介素6表达的临床研究

目的:观察甘露消毒丹对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)湿热证患者肿瘤坏死因子(TNF)α和白介素6表达变化的干预影响,探讨其治疗机制。方法:选取HBV-ACLF湿热证患者108例,随机分为治疗组(54例)和对照组(54例)。两组患者均给予内科基础治疗,治疗组则在内科基础治疗前提下加用甘露消毒丹中药汤剂治疗。观察两组患者治疗前后临床症状、肝功能和凝血功能指标(ALT、AST、TBil、ALB、PTA)、血清TNF-α和IL-6的变化,分析疗效。结果:两组患者治疗后肝功能和凝血功能指标、血清TNF-α和IL-6均较治疗前明显减低(P0.05),且治疗组指标降低幅度明显优于对照组(P0.05);治疗组临床总有效率94%,对照组76%,治疗组优于对照组(P0.05)。结论:甘露消毒丹联合内科基础治疗,降低肝衰竭患者血清TNF-α和IL-6的含量,从而提高HBV-ACLF湿热证患者的临床疗效。     

Efficacy of short‐term dexamethasone therapy in acute‐on‐chronic pre‐liver failure

Aim: Acute‐on‐chronic pre‐liver failure (pre‐ACLF) is defined as a severe acute episode of chronic hepatitis B characterized by serum bilirubin of 171 µmol/L or more, alanine aminotransferase of five times or more the upper limit of normal and prothrombin activity of more than 40%, having a potential for progression to acute‐on‐chronic liver failure (ACLF). This study is to evaluate the efficacy of short‐term dexamethasone in pre‐ACLF. Methods: One hundred and seventy patients were assigned to dexamethasone therapy and control group at a ratio of 1:2. For the two groups, we compared biochemical indicators, the incidence of ACLF and mortality. The influential factors on the mortality of patients with pre‐ACLF were studied by Cox proportional hazards models. Results: The significantly lower incidence of ACLF and higher survival rate were observed in patients on dexamethasone therapy (8.9%, 96.4%, respectively) than in control patients (70.2%, 52.6%, respectively; P < 0.001). Dexamethasone treatment was an independent factor influencing the survival rate (P < 0.001, odds ratio = 0.055, 95% confidence interval = 0.013–0.225). During 4 weeks of treatment, serum bilirubin levels of survival patients were significantly lower in the dexamethasone group than control group. Conclusion: Five‐day dexamethasone therapy is effective in improving the liver function and survival rate of patients with pre‐ACLF.     

Granulocyte-colony stimulating factor therapy improves survival in patients with hepatitis B virus-associated acuteon-chronic liver failure

AIM:To evaluate the safety and efficacy of granulocyte-colony stimulating factor(G-CSF) therapy in patients with hepatitis B virus(HBV)-associated acuteon-chronic liver failure(ACLF).METHODS:Fifty-five patients with HBV-associated ACLF were randomized into two groups:the treatment group and the control group.Twenty-seven patients in the treatment group received G-CSF(5 μg/kg per day,six doses) treatment plus standard therapy,and 28 patients in the control group received standard therapy only.The peripheral CD34 + cell count was measured consecutively by flow cytometry.Circulating white blood cell count,biochemical parameters,and other clinical data of these patients were recorded and analyzed.All patients were followed up for a period of 3 mo to evaluate the changes in liver function and survival rate.RESULTS:The peripheral neutrophil and CD34 + cell counts in the G-CSF group increased on day 3 from the onset of therapy,continued to rise on day 7,and remained elevated on day 15 compared to those of the control group.Child-Turcotte-Pugh score of patients in the treatment group was improved on day 30 from the onset of G-CSF therapy,compared to that in the controls(P = 0.041).Model for End-Stage of Liver Disease score of patients in the treatment group was improved on day 7(P = 0.004) and remained high on day 30 from the onset of G-CSF therapy(P < 0.001) compared to that in controls.After 3 mo of follow-up observation,the survival rate in the treatment group(48.1%) was significantly higher than that in the control group(21.4%)(P = 0.0181).CONCLUSION:G-CSF therapy promoted CD34 + cell mobilization in patients with HBV-associated ACLF,and improved the liver function and the survival rate of these patients.     

拉米夫定联合六味五灵片治疗e抗原阳性慢性乙型肝炎疗效观察

目的观察拉米夫定（LAM）联合六味五灵片治疗e抗原阳性慢性乙型肝炎（CHB）效果。方法 100例e抗原阳性慢性乙型肝炎患者分为治疗组50例及对照组50例。治疗组每次给予LAM100mg,每日1次;六味五灵片每次2g,每日3次。对照组每次给予LAM100mg,每日1次;护肝片每次1.4g,每日3次,两组疗程均为24周,疗程结束后继续口服LAM,并对两组ALT、HBV-M、HBV DNA载量及血清肝纤维化指标等进行观察。结果治疗结束时,治疗组显效18例、有效26例,总有效率88%;对照组显效6例、有效21例,总有效率54%。两组有效率相比P〈0.05,差异有统计学意义。两组治疗后肝纤维化各项指标比较P〈0.05,差异均有统计学意义。结论 LAM联合六味五灵片具有较好抑制乙型肝炎病毒（HBV）复制、恢复肝功能及抗纤维化的作用,是临床治疗慢性乙型肝炎值得推荐的方法。     

Granulocyte colony-stimulating factor versus placebo in addition to penicillin G in a randomized blinded study of gram-negative pneumonia sepsis: analysis of survival and multisystem organ failure

Sepsis is a common cause of morbidity and mortality. Neutrophils are the major defense against bacterial invasion, and granulocyte colony- stimulating factor (G-CSF) augments both neutrophil number and function. In our study, 160 rabbits were inoculated transtracheally with 0.5 mL of a solution containing 10(4) colony forming units per milliliter of Pasteurella multocida. Twenty-four hours later, chest x- rays and quantitative blood cultures demonstrated pneumonia and bacteremia. Therapy was then begun with penicillin G and either recombinant human G-CSF (rG-CSF; 5 to 8 micrograms/kg subcutaneously) or placebo every day for 5 days. Arterial blood gases and 23 other parameters of organ function were performed before inoculation and serially thereafter. All rabbits underwent histologic examination of organs at the time of septic death or when sacrificed on day 6. A total of 149 rabbits survived long enough to initiate therapy. A significant increase in leukocytes by day 4 was found in the rG-CSF-treated group. There was a trend towards improved survival in the rG-CSF group (77% v 67%; P = .13, n = 149). Analysis of pretreatment variables revealed sepsis-induced leukopenia (< or = 2,800/microL) as the only predictor of significantly improved survival with rG-CSF treatment (57% v 39%; P = .04, n = 73). The majority of the survival benefit occurred within the first 24 hours of treatment. This was before the time that a significant difference in mean white blood cell (WBC) count was observed between the study groups, making intravascular leukocytosis an unlikely explanation for the survival advantage in the rG-CSF group. No significant difference in laboratory variables reflecting organ function was demonstrated between the groups. Histologic grading of inflammation (0, normal, to 6, necrosis) in seven organs revealed that the surviving rabbits had mild but statistically significant increased inflammation in the liver, spleen, and noninoculated lung in the rG-CSF versus placebo groups (liver: 2.6 v 1.5, P < or = .0001; spleen: 3.2 v 2.3, P < or = .0001; and noninoculated lung: 2.9 v 2.5, P = .04). Administration of rG-CSF, in addition to penicillin G, in immune competent rabbits with gram-negative sepsis complicated by leukopenia significantly improved survival over antibiotics alone. The administration of rG-CSF in early sepsis for a short therapeutic duration was not associated with any clinically evident toxicity. Clinical trials using rG-CSF in septic patients with leukopenia are indicated.     

High frequency of thrombocytopenia in patients with acute-on-chronic liver failure treated with linezolid

BACKGROUND:Linezolid is an effective antibiotic reagent for Gram-positive bacterial infection;its most common side effect is thrombocytopenia.However,the incidence of thrombocytopenia in patients with acute-on-chronic liver failure(ACLF)who underwent linezolid therapy was unclear.The present study was to evaluate the incidence of thrombocytopenia in ACLF and non-ACLF patients treated with linezolid and the risk factors of thrombocytopenia in these patients.METHODS:Thirty-five patients with ACLF who had been subjected to intravenous administration of 600 mg linezolid every 12 hours for more than 7 days were categorized as a ACLF treatment(ACLF-T)group,72 patients without ACLF treated with the same dosage of linezolid were recruited as a non-ACLF treatment(NACLF-T)group,and 70 patients with ACLF without linezolid treatment served as an ACLF control(ACLF-C)group.The incidences of thrombocytopenia in different groups were compared at day 14.Risk factors were investigated using logistic regression analysis.RESULTS:The incidence of thrombocytopenia at day 14 was significantly higher in the ACLF-T group than in the ACLF-C group(20/35 vs 24/70,P=0.025)and in the NACLF-T group(20/35 vs 9/72,P0.001).Multivariate analysis showed that the ratio of platelet count(day 7/day 0)1(OR=10.021;P=0.012) and the baseline platelet count(OR=0.985;P=0.036)were independent risk factors of thrombocytopenia at day 14 of linezolid therapy.CONCLUSIONS:The benefits of linezolid treatment should outweigh the risk of thrombocytopenia in patients with ACLF Moreover,it is necessary to closely monitor the platelet count during linezolid therapy especially in the patients with de creased platelet count at day 7 of linezolid therapy.     

加减平胃四逆方联合恩替卡韦治疗乙型肝炎失代偿期肝硬化临床研究

目的观察加减平胃四逆方联合ETV治疗乙型肝炎失代偿期肝硬化的临床疗效。方法将50例乙型肝炎失代偿期肝硬化患者分为治疗组和对照组各25例,对照组给予综合治疗并口服ETV分散片0.5 mg/次,每日1次;治疗组在此基础上加服加减平胃四逆方,每日1剂,分两次服用。两组患者疗程均为24周。观察患者治疗前后肝功能、PTA、HBV DNA定量、Child-Pugh评分变化情况。结果治疗组在改善肝功能、PTA、降低Child-Pugh评分方面疗效显著优于对照组;在HBV DNA低于检测下限的比率方面,两组差异无统计学意义。结论加减平胃四逆方联合ETV治疗乙型肝炎失代偿期肝硬化在改善肝功能、PTA、降低Child-Pugh评分方面疗效确切。     

Artificial Liver Support System Improves Short- and Long-Term Outcomes of Patients With HBV-Associated Acute-on-Chronic Liver Failure: A Single-Center Experience

For patients with acute-on-chronic liver failure (ACLF), artificial liver support system (ALSS) may help prolong lifespan and function as a bridge to liver transplantation (LT), but data on its long-term benefit are lacking. We conducted this prospective, controlled study to determine the efficacy of ALSS and the predictors of mortality in patients with hepatitis B virus (HBV)-associated ACLF.From January 2003 to December 2007, a total of 234 patients with HBV-associated ACLF not eligible for LT were enrolled in our study. They were allocated to receive either plasma exchange centered ALSS plus standard medical therapy (SMT) (ALSS group, n = 104) or SMT alone (control group, n = 130). All the patients were followed-up for at least 5 years, or until death.At 90 days, the survival rate of ALSS group was higher than that of the control group (62/104 [60%] vs 61/130 [47%], respectively; P < 0.05). Median survival was 879 days in the ALSS group (43% survival at 5 years) and 649 days in the control group (31% survival at 5 years, log-rank P < 0.05). ALSS was found to be associated with favorable outcome of these patients by both univariate and multivariate analysis. Multivariate Cox regression analysis also revealed that lower serum sodium levels, higher grades of encephalopathy, presence of cirrhosis, hepatorenal syndrome, and higher model for end-stage liver disease scores were independent predictors for both 90-day and 5-year mortality due to ACLF.Our findings suggest that ALSS is safe and may improve the short- and long-term prognosis of patients with HBV-associated ACLF.     

Entecavir vs lamivudine therapy for na?ve patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure

AIM:To investigate the short-term and long-term efficacy of entecavir versus lamivudine in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure(ACLF).METHODS:This was a single center,prospective cohort study.Eligible,consecutive hospitalized patients received either entecavir 0.5 mg/d or lamivudine 100mg/d.All patients were given standard comprehensive internal medicine.The primary endpoint was survival rate at day 60,and secondary endpoints were reduction in hepatitis B virus(HBV)DNA and alanine aminotransferase(ALT)levels,and improvement in Child-Turcotte-Pugh(CTP)and model for end-stage liver disease(MELD)scores at day 60 and survival rate at week 52.RESULTS:One hundred and nineteen eligible subjects were recruited from 176 patients with severe acute exacerbation of chronic hepatitis B:65 were included in the entecavir group and 54 in the lamivudine group(full analysis set).No significant differences were found in patient baseline clinical parameters.At day 60,entecavir did not improve the probability of survival(P=0.066),despite resulting in faster virological suppression(P<0.001),higher rates of virological response(P<0.05)and greater reductions in the CTP and MELD scores(all P<0.05)than lamivudine.Intriguingly,at week 52,the probability of survival was higher in the entecavir group than in the lamivudine group[42/65(64.6%)vs 26/54(48.1%),respectively;P=0.038].The pretreatment MELD score(B,1.357;95%Cl:2.138-7.062;P=0.000)and virological response at day30(B,1.556;95%Cl:1.811-12.411;P=0.002),were found to be good predictors for 52-wk survival.CONCLUSION:Entecavir significantly reduced HBV DNA levels,decreased the CTP and MELD scores,and thereby improved the long-term survival rate in patients with spontaneous reactivation of hepatitis B presenting as ACLF.     

Clinical characteristics and long‐term outcome of acute kidney injury in patients with HBV‐related acute‐on‐chronic liver failure

Acute kidney injury (AKI) is a common complication in patients with decompensated cirrhosis and is also an important cause for poor outcome. This study aimed at investigating the clinical characteristics and long‐term prognosis of AKI in patients with hepatitis B virus (HBV)‐related acute‐on‐chronic liver failure (ACLF). A total of 1167 patients with HBV‐related ACLF from January 2010 to January 2015 were enrolled and divided into two groups, AKI group (n=308) and non‐AKI group (n=859). All patients were followed up to investigate clinical characteristics, long‐term overall survival (OS) and risk factors. AKI occurrence was found to be 26.4% in patients with HBV‐related ACLF. The patients in the AKI group and the non‐AKI group had a 30‐day OS of 44.8% and 70.3%, 90‐day OS of 17.9% and 55.4%, and 1‐year OS of 15.6% and 51.2%, respectively. Significant differences were observed in the 30‐day, 90‐day and 1‐year OS among subgroups with different AKI stages. It was found that high WBC, neutrophil, ALT and MELD score were risk factors for 30‐day mortality, whereas hepatic encephalopathy, high MELD score, mean arterial pressure and PLT were risk factors for 90‐day mortality. Two criteria, the KDIGO and AKIN, showed parallel results in staging AKI in patients with HBV‐related ACLF (κ=0.807, P<.001). AKI is closely associated with increased short‐term mortality in Chinese HBV‐related ACLF patients, particularly in those with infection and high MELD score. Both KDIGO and AKIN criteria can be used for staging AKI in patients with HBV‐related ACLF.     

胆石片治疗伴胆囊结石的慢性胆囊炎肝胆气郁证：随机、双盲、对照临床试验

[目的]评价胆石片治疗伴有胆囊结石的慢性胆囊炎（肝胆气郁证）的有效性和安全性.[方法]采用随机、双盲、安慰剂平行对照、多中心临床试验设计.120例伴有结石的慢性胆囊炎患者符合本试验纳入标准,试验组和对照组各60例,分别采用胆石片（6粒/次,3次/d）及胆石片模拟剂（6粒/次,3次/d）进行为期4周的治疗.以中医证候积分（包括右胁胀痛、口苦、咽干、嗳气、恶心、厌食油腻、纳食减少、胃脘痞满、上腹饱胀、右上腹部压痛和大便秘结）和腹部超声检查进行疗效评价.以血、尿、大便常规,肝功能（ALT、AST、TBIL、DBIL）、肾功能（Bun、Cr）和心电图检查结果作为安全性评价的依据.[结果]治疗4周后,主要疗效：临床愈显率对照组为1.72％,试验组为15.25％,组间差异有统计学意义（P＜0.01）;总有效率对照组为20.69％,试验组为55.93％,组间差异有统计学意义（P＜0.01）.中医证候疗效：临床愈显率对照组为5.17％,试验组为22.03％,组间差异有统计学意义（P＜0.01）.总有效率对照组为34.48％,试验组为71.19％,组间差异有统计学意义（P＜0.01）.影像学疗效：愈显率对照组为15.38％,试验组为30.00％,组间差异无统计学意义;总有效率对照组为50.00％,试验组为72.00％,组间差异有统计学意义（P＜o.05）.安全性：2组均无严重不良事件发生.[结论]胆石片能有效治疗伴有胆囊结石的慢性胆囊炎,并有良好的安全性.