不同介入模式治疗伴失代偿性肝硬化肝癌

目的 探讨伴失代偿性肝硬化原发性肝癌(HCC)不同介入模式的临床价值.方法 在内科治疗稳定后,132例伴肝功能失代偿HCC患者接受不同介入模式治疗;36例采用肝动脉化疗栓塞(TACE,A组),54例采用肝动脉节段性化疗栓塞治疗(S-TACE,B组),42例采用S-TACE后序贯射频消融(RFA)和无水乙醇局部注射(PEI)的综合介入治疗(C组).结果 随访3～48个月,A组、B组和C组患者AFP复常率分别为23.3%、60.5%(P＜0.05)和75.0%(P＜0.01),瘤体缩小(＞50%)分别占8.3%、31.5%(P＜0.05)和54.8%(P＜0.01和P＜0.05),中位生存期分别为4.1个月、9.4个月(P＜0.05)和14.1个月(P＜0.01和P＜0.05),累计生存率6个月分别为22.2%、51.8%(P＜0.05)和78.6%(P＜0.05和P＜0.01),12个月分别为5.6%、31.5%(P＜0.05)和40.5%(P＜0.05),24个月分别为0、9.3%和19.1%(P＜0.05);单变量分析显示包括HBV DNA在内的14项因素与预后显著相关,多因素COX模型分析显示肝功能Child-Pugh分级、ICGR15、门静脉癌栓、治疗模式及AFP术前升高者介入治疗后变化与预后显著相关.结论 综合介入治疗是伴肝功能失代偿HCC的有效治疗方法,对HBV DNA阳性患者应该考虑抗病毒治疗.     

乙型肝炎肝硬化失代偿期患者抑郁焦虑状态的影响因素及其对短期预后的影响

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。     

Optimizing systemic therapy for advanced hepatocellular carcinoma: the key role of liver function

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.     

Radiological and clinical outcome of selective thoracic fusion for patients with Lenke 1C and 2C adolescent idiopathic scoliosis with a minimum follow-up of 2 years

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.

乙肝肝硬化失代偿期60例治疗体会

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。     

Watchful Waiting in Aortic Stenosis: The Problem of Acute Decompensation

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.

Neurologic evaluation of dysphagia

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.     

A Study Into the Risk of Exacerbation of Chronic Hepatitis B After Liver Resection for Hepatocellular Carcinoma

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     

肝炎肝硬化失代偿期患者首发食管胃底静脉出血或腹水的临床特征探讨

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。