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排序方式: 共有99条查询结果,搜索用时 15 毫秒
1.
目的 探讨乙型肝炎肝硬化失代偿期患者抑郁、焦虑状态的影响因素,同时分析其对患者短期预后的影响。方法 选取2020年6月至2021年6月就诊于华中科技大学同济医学院附属协和医院的乙型肝炎肝硬化失代偿期患者206例为研究对象,病情稳定后即采用抑郁症筛查量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)对其抑郁、焦虑状态进行评价;根据3个月内随访结果将患者分成生存组(n=133)和死亡组(n=73),比较两组患者抑郁、焦虑评分差异,采用受试者工作特征(ROC)曲线分析抑郁、焦虑评分对乙型肝炎肝硬化失代偿期患者3个月内预后的预测价值。结果 206例乙型肝炎肝硬化失代偿期患者随访3个月,其中73例患者死亡,占比35.44%,其中死亡占比由高到低分别为抑郁合并焦虑、单焦虑、单抑郁、无抑郁和焦虑,组间比较差异有统计学意义(P<0.05)。谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、清蛋白水平、凝血酶原时间、是否合并上消化道出血以及GAD-7、PHQ-9得分是影响乙型肝炎肝硬化失代偿期患者短期预后的影响因素(P均<0.05)。ROC曲线分析结果显示,PHQ-9量表和GAD-7量表得分对乙型肝炎肝硬化失代偿期患者短期预后预测的曲线下面积分别为0.784、0.840,敏感度分别为0.822、0.904,特异度分别为0.619、0.739。结论 乙型肝炎肝硬化失代偿期患者短期预后受多种因素影响,抑郁、焦虑情分对其短期预后有较高的预测价值。 相似文献
2.
《Digestive and liver disease》2022,54(4):452-460
The number of effective systemic therapies for the treatment of advanced hepatocellular carcinoma (HCC) is rapidly increasing, and the advent of immunotherapy has changed the treatment paradigm for these patients, leading to significantly improved survival outcomes. However, many patients with HCC will continue to receive tyrosine kinase inhibitors, partly because of contraindications to immune checkpoint inhibitors. Currently, the best sequential first- and second-line systemic treatment remains elusive. Maintenance of optimal liver function is crucial, it is likely to impinge on temporary or permanent treatment discontinuation, and should also be considered when defining the treatment sequence. Hepatic decompensation, which does not always coincide with disease progression, is part of this complex dynamically evolving system, and must be promptly recognized and adequately managed to allow the patient to continue in the therapeutic course. The purpose of this review is to highlight and summarize the evidence on the efficacy and safety of systemic agents, with a focus on the impact of underlying cirrhosis, and to suggest new clinical outcomes for randomized controlled trials for advanced HCC to better assess the net health benefit in this specific setting. 相似文献
3.
Mun Keong Kwan Chee Kidd Chiu Pheng Hian Tan Xue Han Chian Xin Yi Ler Yun Hui Ng Sherwin Johan Ng Saw Huan Goh Chris Yin Wei Chan 《The spine journal》2018,18(12):2239-2246
Background Context
In Lenke 1C and 2C curves, the choice between selective thoracic fusion (STF) versus non-selective thoracic fusion as the optimal surgical treatment is controversial.Objective
This study aimed to assess the radiological and clinical outcome of patients with Lenke 1C and 2C curves treated with STF.Study Design
This is a retrospective study.Patient Sample
A total of 44 patients comprised the study sample.Methods
Forty-four patients with Lenke 1C and 2C curves with adolescent idiopathic scoliosis who underwent STF were reviewed. Radiological parameters and Scoliosis Research Society (SRS)-22r scores were assessed preoperatively, postoperatively, and on final follow-up. The incidence of coronal decompensation, lumbar decompensation, and adding-on phenomenon were reported.Results
Mean follow-up duration was 45.1±12.3 months and mean age was 17.0±5.1 years. The preoperative middle thoracic and thoracolumbar/lumbar (MT:TL/L) Cobb angle ratio was 1.4±0.3 and the MT:TL/L apical vertebra translation (AVT) ratio was 1.6±0.8. Final follow-up coronal balance was ?13.0±11.5?mm, main thoracic AVT was 6.9±11.8?mm, and lumbar AVT was ?20.4±13.8?mm (p<.05). Lumbar Cobb angle improved from 47.5°±7.8° to 24.9°±8.2° after operation and 23.3°±9.8° at final follow-up. The spontaneous lumbar curve correction rate was 50.9%. There were 9 patients (20.5%) who had coronal decompensation, 4 patients (9.1%) who had lumbar decompensation, and 11 patients (25.0%) who had adding-on phenomenon. We did not perform any revision surgery. The SRS-22r scores improved significantly in the overall scores, self-image, and mental health domain.Conclusions
Selective thoracic fusion led to improvement in the radiological and clinical outcome for patients with Lenke 1C and 2C. Although no patients required revision surgery, the rate of coronal decompensation, lumbar decompensation, and adding-on phenomenon are significant. 相似文献4.
乙肝肝硬化失代偿期60例治疗体会 总被引:1,自引:0,他引:1
目的:观察恩替卡韦(ETV)联合安络化纤丸对乙肝肝硬化失代偿期患者的疗效。方法:对我院2009年1月~2010年1月收治的乙肝肝硬化失代偿期患者按照知情同意的原则分为对照组和治疗组,各30例。对照组给予综合治疗,治疗组在综合治疗基础上加用ETV0.5mg/d,1次/d;安络化纤丸6g口服,2次/d。疗程1年。观察治疗前、后患者肝功能、HBV-DNA定量水平、Child-Pugh评分变化情况。结果:与对照组比较,治疗组的肝功能有所改善,乙型肝炎病毒(HBV)被抑制,Child-Pugh评分降低(P<0.01)。结论:ETV联合安络化纤丸对乙肝肝硬化失代偿期患者疗效显著,能改善肝功能,控制HBV复制,降低Child-Pugh评分。 相似文献
5.
David S. Wald Sam Williams Fatima Bangash Jonathan P. Bestwick 《The American journal of medicine》2018,131(2):173-177
Background
Acute decompensation with heart failure, angina, or syncope may be the first indication of undiagnosed aortic stenosis, but should be uncommon when the disorder is known and managed by watchful waiting. There is a lack of information on the proportion of patients with acute decompensated aortic stenosis with and without a prior diagnosis and their outcomes.Methods
We examined the records of patients with aortic stenosis (International Classification of Diseases code 135.0) admitted to 3 UK hospitals between January 2015 and January 2016. We determined the number of admissions with acute decompensation and the proportion in whom aortic stenosis was and was not previously known. The characteristics and outcomes in the 2 groups were compared.Results
Of 684 patients with aortic stenosis, 543 (79%; 95% confidence interval [CI], 76-82) were elective admissions and 141 (21%; 95% CI, 18-24) were emergencies with acute decompensation; 86 of 141 patients (61%; 95% CI, 52-69) with known aortic stenosis were under watchful waiting and 55 of 141 patients (39%; 95% CI, 31-48) did not have a prior diagnosis. In-hospital mortality was 16% versus 13%, respectively (P = .48). There were no statistically significant differences in characteristics or clinical presentation between the 2 groups (P > .1 for all comparisons).Conclusions
Approximately 1 in 5 patients admitted to the hospital with aortic stenosis have life-threatening complications due to their disorder. More than half of such patients are actively monitored for aortic stenosis before admission, exposing shortcomings of the watchful waiting management strategy. Measures to identify symptomatic patients earlier and shorten the time between symptom onset and surgery have the potential to substantially reduce morbidity and mortality. 相似文献6.
David Buchholz M.D. 《Dysphagia》1987,1(4):187-192
Unexplained dysphagia is often caused by unrecognized neurologic disease. A previous article (Buchholz 1987) discussed the
many neurologic diseases that may cause dysphagia. This article reviews a neurologist's approach to dysphagia of possible
neurologic origin. As with most medical problems, a careful history provides more information about dysphagia than any other
data-gathering technique. Therefore, history-taking is discussed first, followed by review of pertinent aspects of the general
and neurologic examinations and ancillary testing. 相似文献
7.
Teck Joo Kelvin Thia Hock Foong Lui Lucien London Ooi Yaw Fui Chung Pierce Kah-Hoe Chow Peng Chung Cheow Yu Meng Tan Wan Cheng Chow 《Journal of gastrointestinal surgery》2007,11(5):612-618
Liver resection is commonly performed for solitary hepatocellular carcinoma (HCC) in well-compensated cirrhotic and noncirrhotic
patients. Data concerning exacerbation of chronic hepatitis B (ECHB) post-liver resection are scant. To determine the incidence,
risk factors, and clinical outcomes of ECHB in patients who underwent hepatic resection for HCC. The methods consisted of
a retrospective review of consecutive patients with chronic hepatitis B virus (HBV) infection who had undergone liver resection
for HCC from January 2002 to December 2004. Seventy-seven patients underwent 82 liver resections; the mean age was 58.0 ± 12.1 years;
87% male; 20% hepatitis B e-antigen positive. Incidence of all causes of postoperative hepatitis was 25.6% (n = 21), and ECHB was 8.5% (n = 7). Both groups had their peak alanine aminotransferases, 231.0 IU/L (74–1,400) and 312 IU/L (147–1,400), respectively,
observed at day 84 postresection. Three patients died as a result of ECHB within 4 months postsurgery. One- and 2-year survival
rates were poorest for the ECHB group at 42.9 and 21.4%, compared with those with postoperative hepatitis due to other causes
at 60.3 and 45.2% and those without postoperative hepatitis at 87.7 and 73.5% (p < 0.001). Liver resection for HCC in patients with chronic HBV infection carries a risk for ECHB, and affected patients have
poorer clinical outcomes. There is a need for close monitoring of these patients preoperatively and in the early postoperative
period.
This paper was presented as a poster in the American Association for the Study of Liver Disease Liver Meeting in San Francisco
in November 2005 相似文献
8.
目的探讨肝炎肝硬化失代偿期患者首发食管胃底静脉曲张破裂出血或腹水临床特征。方法将90例肝炎肝硬化失代偿期患者随机分为出血组40例和腹水组50例。2组均予实验室检查,包括血液分析:血红蛋白、血小板总数;电解质:血钾、血钠;肝功能试验:白蛋白;血糖;肾功能:尿素氮、肌酐;凝血功能:凝血酶原时间(PT)、凝血酶原时间活动度(PTA)、部分凝血酶原时间(APTT)。腹部B型超声测量门、脾静脉宽度。结果出血组血红蛋白水平低于腹水组,血糖及钠离子水平高于腹水组,差异均有统计学意义(P<0.05)。2组血小板总数、血钾、白蛋白、血尿素氮、肌酐、PT、PTA、APTT和门、脾静脉宽度等方面差异无统计学意义(P>0.05)。结论肝炎肝硬化失代偿期患者首发食管胃底静脉曲张破裂出血者多见高血糖和低血红蛋白,首发腹水者更多见低血钠。 相似文献
9.
10.