重型肝炎、活动性肝硬化医院感染预后因素分析

目的：探讨影响重型肝炎、活动性肝硬化患者医院感染预后的危险因素及其防治措施，方法：前瞻性调查1996年4月至2000年12月住院的重型肝炎，活动性肝硬化患者医院感染情况并进行统计分析，结果：重型肝炎、活动肝硬化医院感染病死率为37．36％（34／91），单因素分析表明血清胆红素、PT、补体C3、血清胆固醇、血钠、白细胞总数、中性粒细胞比例、感染类型，并发症种类，侵袭性操作与预后有相关性，多因素分析表明低补体C3及低胆固醇预后严重不良。结论：医院感染是导致重型肝炎，活动性肝硬化患者死亡的重要因素，血清低补体C3及低胆固醇是影响预后的高危因素。     

重症肝炎、肝衰竭患者疾病认知与心理痛苦状况的相关性

目的 观察重症肝炎、肝衰竭患者心理痛苦状况,分析患者疾病认知与心理痛苦的关系.方法 选取2019年3月～2020年4月海南省干部疗养院收治的63例重症肝炎、肝衰竭患者,设计一般资料调查问卷,询问患者基线资料情况,采用心理痛苦管理筛查工具(DT评分)评估患者并分为心理痛苦严重组和心理痛苦轻微组;评估并比较两组疾病认知,分...     

老年人重症肺炎并发肝功能损害临床分析

目的探讨老年人重症肺炎并发肝功能损害的原因和治疗。方法回顾分析解放军第八五医院院2006年1月—2009年6月收治的48例社区获得性老年人重症肺炎患者的临床资料。结果48例老年人重症肺炎患者中,20例(41.7%)出现肝功能损害,治愈及好转者为45.0%;而28例不伴有肝功能损害的重症肺炎,治愈及好转者为75.0%,两组比较差异有统计学意义(P0.05);肝功能损害组的酸中毒发生率显著高于无肝功能损害组(35.0%vs7.1%,P0.05)。结论老年人重症肺炎常并发肝功能损害,需要临床医生及时诊断和积极治疗。     

Past excessive alcohol consumption: a major determinant of severe liver disease among newly referred hepatitis C virus infected patients in hepatology reference centers, France, 2001

PURPOSE: Our study aimed to identify factors associated with the occurrence of severe liver disease in hepatitis C virus (HCV) positive patients at first referral to hepatology reference centers in France in 2001. METHODS: Patients reported through the national hospital-based hepatitis C surveillance system in 2001 were included. The definition of severe liver disease was based on clinical, biological, and morphological evaluation; cirrhosis (+/- complication) and primary liver cancer were classified as severe liver disease. Patient characteristics were compared for those with and without severe liver disease. RESULTS: Of the 3404 newly referred patients in the 26 participating centers, 391 (11.5%) had severe liver disease. Male gender (adjusted odds ratios [aOR]=1.4; 95% confidence interval [CI], 1.0-1.9), age over 39 years at referral (aOR=3.8; 95% CI, 2.7-5.3), past excessive alcohol consumption (aOR=2.6; 95% CI, 1.9-3.5), and HIV seropositivity (aOR=1.9; 95% CI, 1.1-3.3) were each independently associated with an increased risk of severe liver disease. In the subgroup of patients with known age at time of HCV exposure, age over 39 years at time of exposure (aOR=1.6; 95% CI, 1.1-2.4), duration of HCV infection over 15 years (aOR=2.6; 95% CI, 1.8-3.7), known HBs antigen positivity (aOR=2.4; 95% CI, 1.1-5.2), and past excessive alcohol consumption (aOR=2.7; 95% CI, 1.8-3.9) were each associated with increased risk of severe liver disease. CONCLUSIONS: Our findings underscore the important role of past excessive alcohol consumption on the development of severe liver disease for HCV patients.     

急性砷化氢中毒患者肝脏损害的临床特点

目的 探讨急性砷化氢中毒患者肝脏损害的临床特点。 方法 对28例急性砷化氢中毒住院病例的肝功能指标以及肝脏B超结果进行分析,对数据进行统计学处理。 结果 患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)、间接胆红素(IB)四项肝功能指标均在中毒第一天即开始升高,其中ALT至第5天达到高峰,随后逐渐降低,2周后基本正常;AST、TB、IB到达高峰时间约在中毒第3天,较ALT早,而恢复正常时间与ALT基本一致;急性轻度砷化氢中毒患者存在相当比例的肝功能或肝脏B超异常,15例重度中毒患者肝功能指标(除IB外)异常率较轻度中毒患者明显升高,两组各项指标(除IB外)异常率比较,差异均有统计学意义(P<0.05)。轻度砷化氢中毒患者中有3例符合轻度中毒性肝病(占23.1%),1例符合中度中毒性肝病(占7.7%),重度中毒患者中有8例符合重度中毒性肝病(占53.3%),符合轻度和中度中毒性肝病的分别为2例(占13.3%)和4例(占26.7%)。 结论 急性砷化氢中毒早期即可出现肝脏损害,即使是轻度中毒患者中也有较多的肝脏损害症状,损害程度与中毒程度基本一致,一般预后较好。     

Relation of Liver Siderosis to Liver Fibrosis in Hemodialysis Patients With Severe Hyperferritinemia Secondary to High Doses of Intravenous Iron Supplementation

ObjectiveAggressive iron substitution in hemodialysis (HD) patients leads to iron overload. The association between liver siderosis and fibrosis is still debatable. We studied the association of liver siderosis with liver fibrosis in HD patients. Furthermore, we studied the performance of liver stiffness measurements (LSMs) in identifying advanced liver fibrosis. We investigated the performance of biochemical indicators of iron status in identifying advanced liver fibrosis.MethodsFifty-five HD patients (average HD duration 6 ± 2 years) with hyperferritinemia secondary to intravenous iron supplementation (weakly iron dose 252.7 ± 63 mg; median blood transfusions 3 [2-5]) were recruited. The liver fibrosis grade was determined with Fibroscan, aminotransferase-to-platelet ratio index (APRI), and Fib-4 index. Liver iron concentration (LIC) was estimated with magnetic resonance imaging (MRI). Iron parameters and liver function biochemical indicators were also assessed.ResultsThe median serum ferritin and transferrin saturation (TSAT) were 3531 μg/L and 77%, respectively. 34.5%, 20%, and 45.5% of the patients showed mild, moderate, or severe liver siderosis, respectively. All patients with severe liver siderosis showed advanced liver fibrosis. Patients with severe liver siderosis and advanced liver stiffness showed higher serum iron, TSAT, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum bilirubin, APRI, and Fib-4 index scores than those with mild liver siderosis. Serum iron and TSAT showed good utility in identifying advanced liver fibrosis determined with Fibroscan, APRI, and Fib-4 index. Liver stiffness exhibited good utility in identifying advanced liver fibrosis diagnosed with APRI and Fib-4 index.ConclusionsHigh weekly intravenous iron dose associated with severe hyperferritinemia, high serum iron, and TSAT might lead to severe liver siderosis and concomitant liver fibrosis in HD patients. Serum iron, TSAT, Fibroscan, Fib-4, and APRI scores might offer noninvasive tools for identifying advanced liver fibrosis in those patients.     

AFU、PT、Cp、T4联合检测在乙型肝炎患者中的临床意义

目的探讨乙型肝炎患者血清甲状腺素（T4）、铜蓝蛋白（Cp）、α-L-岩藻糖苷酶（AFU）和凝血酶原时间（PT）水平变化与肝功能损害程度的相关性及其临床意义。方法187病例分成慢性肝炎组、重型肝炎组和肝硬化组,同时选择同期进行体检的健康人作为对照组,分别检测T4、Cp、AFU和PT,并进行统计学分析。结果各病例组AFU、PT和T4与正常对照组比较,差异均具有统计学意义（P＜0．05）;肝硬化组AFU明显低于其他两个病例组（P＜O．01）;各病例组PT之间差异均具有统计学意义（P＜0．05）;慢性肝炎组T。高于其他病例组（P＜0．05）;重型肝炎组cp低于正常对照组及其他病例组（P＜0．05）,但慢性肝炎组和肝硬化组cp与正常对照组之间无显著性差异（P＞0．05）。结论联合检测T4,Cp,ALT和PT对病毒性肝炎的早期和鉴别诊断、病情判断以及疗效和预后评估有重要参考价值。     

Effect of ATP on liver function tests in experimental diabetes

Liver function tests were performed in severe and mild diabetic rats and under the influence of ATP. In mild diabetics the serum cholesterol was significantly increased, while in severe diabetes the serum cholesterol was significantly lower than in mild diabetes. The decreased serum cholesterol in severe diabetes may be an indication for the development of fatty liver. The serum alkaline phosphatase and serum bilirubin were significantly increased in both the severe and mild diabetic states, while the thymol turbidity test was insignificantly changed in both states of diabetes. Serum albumin was significantly decreased in 10 days mild diabetes, while it was insignificantly changed in 48 hrs severe diabetic animals. The effect of ATP was investigated in mild diabetes. ATP resulted in a significant increase in serum albumin and a decrease in total globulins with the resultant increase in A/G ratio. The serum alkaline phosphatase exhibited a significant reduction under the influence of ATP. The elevated cholesterol of mild diabetic rats remained significantly elevated and was not reduced by ATP, though the fat content of the liver showed a significant reduction. This may be due to more rapid mobilisation of fat from the liver under the influence of ATP. ATP showed no significant effect on serum bilirubin and thymol turbidity test. the histopathological examination of the liver revealed that administration of ATP to alloxan diabetic rats had a beneficial effect. It resulted in disappearrance of the fat globules from the liver cells.     

乙型肝炎与肝癌关系的流行病学研究—广西HBsAg携带者及肝损害者的分布及发生肝癌的前瞻性研究

本文对20岁以上22830人按HBsAg状况和肝损害表现分队列进行随访,平均追踪6.8年,在肝癌高发区和低发区均以HBsAg携带者并有重度肝损害者(肝大+肝功能异常)的肝癌死亡率和相对危险性最高,相对危险性分别为37.3和22.5倍。以无肝大和肝功能异常的非携带者最低,肝癌的发生和肝损害的程度呈平行关系。HBsAg携带者发生肝癌死亡的相对危险性高于非携带者7倍,并发现HBsAg携带并有重度肝损害的肝癌死亡的平均年龄显著提前。认为肝癌高发区人群中HBV的持续感染和肝损害的广泛存在是导致肝癌高发和早发的重要因素。     

肝病患者医院感染的前瞻性研究

目的 了解我院肝病患者的医院感染情况及其危险因素。方法 对１９９６年４月１日￣１９９８年３月３１日新入院的８４８例肝病患者的医院感染进行前瞻性调查。结果 医院感染率为９．２０％,。其中重型肝炎的感染率最高,其次为肝硬化和重度慢性肝炎;医院感染部位分布,呼吸道占４４．３３％,腹腔１５．４６％,肠道１２．３７％,胆系８．２５％,口腔部位７．２２％,其他１２．３７％。结论 肝病患者病情危重、免疫功能低下     

A severe case of hyperemesis gravidarum necessitating prolonged total parenteral nutrition

A patient with severe hyperemesis gravidarum persisting throughout pregnancy is described. She had marked abnormalities of liver function and failed to respond to conservative management. Total parenteral nutrition was used to maintain her nutritional status as well as that of the foetus. Her vomiting continued and was complicated by severe oesophagitis. On delivery her symptoms settled, but she later developed an oesophageal stricture. Changes in liver function tests are described.     

甲型肝炎病毒(HAV)感染普通狨猴的病理学观察

观察使用ＨＡＶ疫苗株和野毒株感染普通狨猴后引起的病理变化，并对病变作分级描述。结果显示，疫苗株感染的狨猴未见异常，而野毒株致全部动物肝脏出现甲肝病变     

Liver failure is uncommon in adults receiving long-term parenteral nutrition

BACKGROUND: Abnormal liver enzymes and endstage liver disease are reported to occur in 25%-100% and 15%-40% of adult patients receiving long-term parenteral nutrition (PN), respectively. The purpose of this historic cohort study was to investigate the incidence of and possible factors leading to the development of liver disease in our large home PN population. METHODS: All patients on home PN for at least 6 months from July 1991 through June 2002 were eligible. Patients were excluded if they had active malignancy, underlying liver disease, or exposure to a hepatotoxin. The presence of PN-associated liver disease was only considered if test results were elevated on more than 1 occasion over at least 6 or more months. The severity of liver-associated enzymes was based on the degree of elevation and was stratified as mild (<2 times normal), moderate (2-5 times normal), and severe (>5 times normal). Severe liver dysfunction was defined as having all of the following criteria: total bilirubin >3 mg/dL; albumin <3.2 g/dL; and prothrombin time >3 seconds prolonged. A cumulative logit model was used to compare age, gender, underlying disease, PN indication, and PN formulas in patients with normal vs abnormal laboratory test results. RESULTS: Two hundred eight patients received PN for more than 6 months, 36 had exclusion criteria, and 10 could not be analyzed, because of incomplete laboratory test results, leaving 162 in the study group. The average PN duration was 2.14 +/- 2.19 years (maximum, 10.28 years). Abnormal liver tests occurred in 154 patients, with most having a moderate elevation of alkaline phosphatase or aspartate aminotransferase; severe liver dysfunction occurred in 7 patients; 1 patient had completely normal liver enzymes. On average, patients received a PN formula that was high in amino acids (1.45 +/- 0.65 g/kg/d), modest in energy (24.7 +/- 13.4 kcal/kg/d), and in most cases with enough lipid emulsion to meet essential fatty acid requirements (0.28 +/- 0.25 g/kg/d). Only female gender was found to be associated with a greater likelihood of liver failure (p = .02). There was a trend toward a greater amount of total calories, dextrose calories, and duration of PN exposure leading to the development of severe liver dysfunction. CONCLUSIONS: When long-term PN is given with a modest amount of total energy and a minimal amount of lipid emulsion, abnormal liver enzymes are common, but severe liver dysfunction is unusual.     

前列地尔注射液对重度有机磷农药中毒后急性肝损伤的保护作用

目的研究前列地尔脂微球载体制剂（Lipo-PGE1,商品名：凯时）对急性有机磷农药中毒患者急性肝损伤的保护作用。方法将60例重度有机磷农药中毒患者随机分为2组,每组30例。对照组（n=30）给予洗胃、氯磷定、阿托品及对症处理;治疗组在对照组治疗基础上加用Lipo-PGE1注射液10μg/d静脉滴注,连续7 d。同时监测肝功能。结果治疗组治疗3、7 d后丙氨酸转氨酸（ALT）、天冬氨酸转氨酶（AST）及总胆红素（TBil）值较对照组明显下降,差异有统计学意义（P〈0.05）,临床症状改善更明显。结论 Lipo-PGE1对有机磷农药中毒患者急性肝损伤具有保护作用。     

我国癌症患者心理护理现状及展望

本文结合癌症患者的心理护理,介绍心理护理的概念、原则及意义,癌症患者常见心理反应类型,并针对我国当前对癌症患者心理护理中存在的不足,参考国外同领域发展最新成果,提出癌症患者临床护理的未来趋势。癌症患者的临床治疗护理康复中,心理护理将日益受到重视。针对不同类型的心理反应,大量信效度良好的测量工具将提供客观的辅助评估,除一般的支持性心理治疗外,以认知行为治疗等为代表的新技术将应用于心理护理实践,对癌症患者的心理护理也进一步拓展至癌症患者的照顾者,体现对患者社会支持系统的综合强化。     

血清中肝X受体α、Endoglin水平变化在妊娠期高血压疾病中的临床意义

目的:探讨妊娠期高血压疾病患者血清中肝X受体α、Endoglin水平变化的临床意义及二者之间的相关性。方法:选择2010年8月～2011年4月北京军区总医院产科收治44例妊娠期高血压疾病患者(妊娠期高血压15例、轻度子痫前期14例、重度子痫前期15例)及16例正常妊娠妇女(对照组),采用酶联免疫吸附双抗体夹心法(ELISA)检测两组血清中肝X受体α及Endoglin水平。结果:①妊娠期高血压疾病组肝X受体α水平明显高于对照组(P<0.05)。妊娠期高血压、轻度子痫前期、重度子痫前期患者肝X受体α水平逐渐升高(P<0.05)。肝X受体α作为检测指标的敏感性为65.91%,特异性为87.50%,阳性拟然比为5.27,阴性拟然比为0.39。②妊娠期高血压疾病组Endoglin水平明显高于对照组(P<0.05)。妊娠期高血压、轻度子痫前期、重度子痫前期患者血清中Endoglin水平逐渐升高(P<0.05)。Endoglin作为检测指标的敏感性为59.09%,特异性为87.50%,阳性拟然比为4.73,阴性拟然比为0.47。③妊娠期高血压疾病组及正常妊娠组血清中肝X受体α水平与Endoglin水平均呈正相关(r=0.477,P<0.01;r=0.654,P<0.01)。结论:血清中肝X受体α及Endoglin水平升高可能与妊娠期高血压疾病的发病关系密切,有望成为该病的预测指标。     

重型肝病患者的预后生存模型的研究

目的研究影响重型肝炎患者预后的各种因素,建立适合我国肝病特点的预后判断模型。方法选择2001年3月至2006年6月确诊为重型肝炎的527例患者的临床指标和随访资料,用COX比例风险模型进行单因素和多因素分析,建立生存模型。用400例病例进行验证,评价模型判断能力。结果COX回归分析结果显示消化道出血、年龄、腹水程度、丙氨酸转氨酶、谷草转氨酶,丙氨酸转氨酶、总胆红素、胆固醇、血清肌酐、凝血酶原活动度是影响预后的重要因素;验证结果显示模型ROC曲线下面积好于CTP、MELD评分。结论本预后判断模型适合我国以病毒性肝炎为主的特点,对评价我国重型肝炎患者的预后及对临床选择治疗方法有较高的指导意义。     

老年肝病患者医院感染特点及相关危险因素的研究

目的探讨老年肝病患者医院感染特点及相关危险因素. 方法对1995年1月～2003年1月收治的232例老年肝病患者进行临床调查分析. 结果 44例发生医院感染,感染率为18.97%,感染时间多发生在住院的2～20 d(63.64%),其中重症肝炎患者医院感染率最高,其次为肝癌、肝炎后肝硬化;感染部位以呼吸道感染为主(56.8%),其次为腹腔内组织感染(22.2%);导致感染的危险因素依次为侵袭性操作、抗菌药物使用、肝肾综合征、腹水存在等;与非感染对照组相比,医院感染患者并发肝性脑病、肝肾综合征、上消化道出血、电解质紊乱、病死率明显增高. 结论老年肝病患者医院感染发生率高,严重并发症多见,病死率高,临床医务人员应高度重视,采取综合措施加以防治.     

Combined antiviral treatment in a patient with recurrent chronic hepatitis C after liver transplantation

BACKGROUND: Hepatitis C virus infection persists after liver transplantation and causes recurrent liver injury in the majority of the patients. We report a case of orthotopic liver transplantation with more than five years survival despite the early recurrence of hepatitis C virus. CASE REPORT: A 49-year old woman underwent orthotopic liver transplantation because of liver cirrhosis following chronic hepatitis C virus infection. Twelve years before she received blood-transfusion. The chronic liver disease was diagnosed four years later. However, then it was thought to be a drug induced liver damage. After the liver transplantation hepatitis C chronic hepatitis recurred within one year. The serotype analysis (1b) proved the autoreinfection. The combined antiviral treatment (interferon plus ribavirin) resulted significant improvement. She was asymptomatic nearly for two years. The liver biopsy showed a significant histological improvement. However the virologic response and remission was transient. Four years after the transplantation recurrence occurred again. The liver biopsy proved cirrhosis. Antiviral therapy with pegylated interferon plus ribavirin was started but it had been stopped because of severe cytopenia. Lack of adequate antiviral treatment her condition became progressively worse. Finally, five years after the transplantation she died because of bilateral haemorrhagic ovarian necrosis and severe circulatory insufficiency thanks to the low albumin level. CONCLUSIONS: In the case of liver cirrhosis caused by hepatitis C virus the liver transplantation could prolongs the life with years. The presented case illustrate that the hepatitis C virus injures the transplanted liver by autoreinfection. However, the combined antiviral therapy could result sustained virologic response in these cases as well. Our patient survived five years thanks to the transplantation and the following antiviral therapy.     

声触诊组织量化技术在脂肪肝分度诊断中的应用价值分析

目的探讨声触诊组织量化技术（Virtual Tough Tissues Quantification,VTQ）在脂肪肝分度诊断中的应用价值。方法将105例脂肪肝患者分为轻度（n=52）、中度（n=33）、重度（n=20）3个亚组,另设正常对照组30例。对所有受检者进行常规超声扫描后,再应用VTQ技术进行检查,测量其剪切波速。结果脂肪肝各亚组间剪切波速均值比较差异有统计学意义（P〈0.05）。正常对照组与轻度脂肪肝亚组剪切波速均值比较差异无统计学意义（P〉0.05）,与中度、重度脂肪肝亚组剪切波速均值比较差异有统计学意义（P〈0.05）。结论 VTQ技术在评价脂肪肝程度中具有独特的优势和广阔的应用前景。