Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B

Background Serum sodium predicts prognosis in chronic severe hepatitis B and may improve the prognostic accuracy of the model for end-stage liver disease （MELD） score, but the available information is limited. The present study was undertaken to study the clinical use of the serum sodium incorporated MELD （MELD-Na） and assess its validity by the concordance （c）-statistics in predicting the prognosis of the patient with chronic severe hepatitis B.
Methods A total of 426 adult patients with a diagnosis of chronic severe hepatitis B between January 1, 2007, and December 31, 2007 at a single center were studied. The scores of serum sodium, MELD, MELD-Na, and ΔMELD-Na （ΔMELD-Na=MELD-Na at 14 days after medical treatment -MELD-Na score on admission） of the patients with chronic severe hepatitis B were calculated. The 3-month mortality in the patients was measured, and the validity of the models was determined by means of the concordance （c） statistics.
Results The average MELD, MELD-Na scores of survival group were 25.70±5.08 and 26.60±6.90, and those of dead group were 35.60±6.78 and 42.80±9.57 on admission. There was a significant difference in MELD and MELD-Na between the survival and dead groups （P 〈0.01）. The average △MELD-Na score of the survival group was -0.97±3.51, and that of the dead group was 3.45±2.38 at 2 weeks after the treatment. There was a significant difference in △MELD-Na between the survival and dead groups （P 〈0.01）. The areas under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 months were 0.742, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group 〈25, 25-30, 31-34, 35-40 and 〉40 were 2.0%, 5.4%, 35.4%, 53.8 % and 86.9%, respectively. There was a significant difference in the 3-month mortality between the five groups （P 〈0.05）. The 3-month mortality of the △MELD-Na〉0 group was 65.9%, and that of the △MELD-Na ≤0 group was 15.8%; there was a significant difference in     

Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure

Background  Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD), MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV.

Methods  A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change (D) were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.

Results  The 3-month mortality was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8), followed by the MELD:sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores, DMELD (0.752), DMESO (0.729), and MELD plus sodium (MELD-Na) (0.728) scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy (OR=3.466), serum creatinine, international normalized ratio (INR), and total bilirubin at the end of 2 weeks of admission (OR=10.302, 6.063, 5.208, respectively), and cholinesterase on admission (OR=0.255). This regression model had a greater prognostic value (c=0.85, 95% CI 0.791–0.909) compared to the MELD score at the end of 2 weeks of admission (Z=4.9851, P=0.0256).

Conclusions  MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality.

     

Evaluation of the Potential Inhibitory Activity of A Combination of L. Acidophilus, L. Rhamnosus and L. Sporogenes on Helicobacter Pylori: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Objective: To investigate whether three strains of probiotics, L. acidophilus, L. rhamnosus, and L. sporogenes, had significant inhibitive effects on Helicobacter pylori(H. pylori). Methods: This is a 4-week, randomly assigned, parallel-group, doubled-blind, and placebo-controlled study. Fifty patients with a positive H. pylori infection urea breath test(△UBT) result 10% and without ulcer symptoms were randomized into a treatment group and a placebo group by a computer generated allocation sheet with 1:1. These subjects took one capsule of probiotics or placebo twice daily. The primary measurement was the change in △UBT values. Results: The △UBT values during the 4-week treatment period and the 2-week follow-up period were not significantly different between the treatment group and the placebo group, indicating that the inhibitive effects on H. pylori were comparable between both groups. The monocyte count(%) was 5.77±1.11 in the treatment group versus 5.09±1.12 in the placebo group(P=0.044), and the basophile count was 0.55±0.32 in the treatment group versus 0.36±0.23 in the placebo group(P=0.024) at week 2 of the treatment period, both of which reached statistical significance. The monocyte count was 5.75±1.26 in the treatment group and 4.72±0.99 in the placebo group at the end of the follow-up period(P=0.003). Conclusions: There was no significant inhibitive effects of the three probiotic strains(L. acidophilus, L. rhamnosus, and L. sporogenes) on H. pylori. Probiotics can not play the same role as antibiotics in the eradication of H. pylori, the role of probiotics is likely to be important as adjuvant to the triple or quadruple therapy for H. pylori, especially in resistance cases.     

Expression and Influence of Galectin-3 on Missed Abortion

Objective To explore the influence of galectin-3 on missed abortion. Methods Forty cases of normal intrauterine early pregnancy were randomly divided into 2 groups： surgical abortion group （group A, n=20） and medical abortion group （group B, n =20）. The third group was missed abortion group （group C, n =20） with the gestational age less than 13 weeks. Serum was isolated from the blood samples, collected and used for ELISA quantification of galectin-3. Villus and decidua tissues were collected from the abortus for immunohistochemical examination and real-time fluorescence relative quantitative PCR. Results The level of galectin-3 in the serum was the lowest in missed abortion group （P〈0.05）. Immunohistochemistry showed that galectin-3 expression in villus of missed abortion group was significantly lower than that of surgical abortion group （P〈0. 01）. Real-time fluorescence relative quantitative PCR showed that galectin-3 mRNA relative expression in villus of missed abortion group （2^-△△Ct=0. 04± 0. 01） was significantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00）. Galectin-3 mRNA relative expression in deciduas of medical abortion group （2-zact=o. 08 ± 0.02） was s!gnificantly lower than that of surgical abortion group （2^-△△Ct=1.00 ± 0.00） （P〈0. 01）. Conclusion Galectin-3 is related to the development of villus and decidua during early pregnancy. The decreased expression of galectin-3 may promote the occurrence of missed abortion.     

Effectiveness and Safety Evaluation of Qixiong Zhongzi Decoction (芪芎种子汤) in Idiopathic Asthenozoospermia Treatment: A Randomized Controlled Trial

Objective: To evaluate the clinical effectiveness and safety of the Chinese medicine(CM) Qixiong Zhongzi Decoction(芪芎种子汤, QZD) in the treatment of patients with idiopathic asthenozoospermia. Methods: A total number of 66 patients with idiopathic asthenozoospermia were included and randomly divided into treatment and control groups by SAS-generated code from January 2015 to August 2016, 33 patients in each group. Patients in the treatment group were administered with 150 m L of QZD twice a day, whereas those in the control group were given 1 g of levocarnitine oral liquid twice a day. The two groups received the indicated medication for 12 weeks and were then followed up for 4 weeks. The primary outcome was sperm motility, and the secondary therapeutic indices were sperm volume, density, pregnancy probability, and CM syndrome score. The comparison between groups was carried out at 4, 8 and 12 weeks, respectively. The safety was determined before and after treatment. Results:(1) Drop-off: 5 cases(7.58%) were lost after treatment(2 from the treatment group and 3 from the control group).(2) Primary outcomes: after 8-and 12-week treatment, the progressive sperms in the two groups were significantly higher than the baseline(all P0.05); however, the treatment group showed greater improvement compared with the control group at 12-week treatment(22.7%±9.0% vs. 14.1%±8.8%, P0.05). The increasement of non-progressive grade sperms at both groups was observed at 8-and 12-week treatment with statistical difference(all P0.05), however, the treatment group showed remarkable improvement compared with the control group at 12-week treatment(38.7%±14.1% vs. 26.2%±15.4%, P0.05).(3) Secondary outcomes: no significant statistical differences were found in semen volume and density(4, 8, and 12-week treatment) and pregnancy probability of patients' wives(12-week treatment) between two groups(all P0.05), however, the CM syndrome score of the treatment group significantly declined compared with baseline level at each time points(all P0.05).(4) Safety: no obvious side reactions were found during the treatment in both groups. Conclusions: QZD could improve the progressive and non-progressive grade sperm in the treatment of idiopathic asthenozoospermia. It is safe with no obvious side effects.     

电针对盐酸帕罗西汀治疗轻中度抑郁症患者起效时间及疗效的影响

目的 观察电针对盐酸帕罗西汀治疗轻、中度抑郁症患者的起效时间、疗效及汉密尔顿抑郁量表17项(HAMD)、抑郁自评量表(SDS)评分的影响.方法 将55例轻、中度抑郁症患者分为A组(盐酸帕罗西汀对照组)29例;B组(电针+盐酸帕罗西汀组)26例,疗程6周.观察治疗前及治疗1,2,4,6周后疗效及HAMD量表、SDS量表总评分变化情况.结果 A组治疗2周后,HAMD、SDS评分低于治疗前,差异有显著性意义(P＜0.05),B组在1周后,治疗前后比较差异有显著性(P＜0.05),A组HAMD评分总有效率71.4%,B组HAMD评分总有效率88.0%,两组间总有效率经单项有序卡方检验差异有显著性(X2=4.8041,P=0.0284,P＜0.05),SDS评分A组总有效率75.0%,B组总有效率84.0%,两组间总有效率经单项有序卡方检验差异有显著性(X2=4.1790,P=0.0408).结论 电针能够缩短帕罗西汀治疗轻中度抑郁症的起效时间且提高盐酸帕罗西汀治疗轻中度抑郁症的疗效.

Abstract：

Objective To observe the effect of electroacupuncture on onset time and effectiveness of Paroxetine for mild or moderate depression patients and on the scores of Hamilton depression rating scale for depression(HAMD) and self-rating depression scale(SDS). Methods Fifty-five patients with mild or moderate depression were randomly divided into A group( Paroxetine group,29 patients) and B group (Electroacupuncture combining with Paroxetine group,26 patients). Therapeutic periods for the two groups were 6 weeks. HAMD and SDS were used to evaluate the efficacy before the research and after treatment on 1 week,2 weeks,4 weeks,6 weeks.Results HAMD scores and SDS scores for A group were significant difference after 2 weeks treatment compared with the beginning of the research (P＜ 0.05 ) ;HAMD scores and SDS scores for B group were significant difference after 1 week treatment compared with the beginning of the research(P＜0. 05 ). Total effective rate of HAMD for A group was 71.4% ,total effective rate of SDS for A group was 75% ,total effective rate of HAMD for B group was 88% ,total effective rate of SDS for B group was 84%. The total effective rate between the two groups ordered by the individual chi-square test was significant difference( X2 = 4. 1790, P= 0. 0408). Conclusion Electroacupuncture can shorten the onset time and increase the effectiveness of paroxetine for mild or moderate depression patients.     

Activating Blood Circulation to Remove Stasis Treatment of Hypertensive Intracerebral Hemorrhage: A Multi-Center Prospective Randomized Open-Label Blinded-Endpoint Trial

Objective:To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation(TRABC) in treatment of hypertensive intracerebral hemorrhage(HICH).Methods:This was a multi-center prospective randomized open-label blinded-endpoint(PROBE) trial with HICH admitted to 12 hospitals.Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months.Primary outcome was degree of disability as measured by modified Rankin Scale(mRS).Secondary outcomes were the absorption of hematoma and edema,National Institutes of Health Stroke Scale(NIHSS) scores and patient-reported outcome measures for stroke and Barthel activities of daily living index.Adverse events and mortality were also recorded.Results:After 3 months of treatment,the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5%and 80.4%,respectively,and in the control group 48.1%and 63.9%,respectively,with a significant difference between groups(P0.01).Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group(P=0.038).Average Barthel scores in the treatment group after treatment was 89.11 ± 19.93,and in the control group 82.18 ±24.02(P=0.003).NIHSS scores of the two groups after treatment decreased significantly compared with before treatment(P=0.001).Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment(P0.05).There were 4 deaths,2 in each group,and 11 adverse events,6 in the treatment group and 5 in the control group.Conclusion:The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment,without increasing intracerebral hematoma expansion and re-bleeding.     

A randomized double-blinded sham-controlled trial of α electroencephalogram-guided transcranial magnetic stimulation for obsessive-compulsive disorder

Background Obsessive-compulsive disorder （OCD） is a highly prevalent and devastating psychiatric condition.Repetitive transcranial magnetic stimulation （rTMS） is a potential and non-invasive treatment for OCD.Diverse efficacies of rTMS have been reported in different locations or frequencies of the stimulation.The main objective of this study was to assess the treatment effect for OCD with alpha electroencephalogram （αEEG）-guided TMS over dorsal Iateral prefrontal cortex bilaterally.Methods There were 25 OCD patients in the αTMS treatment group and 21 OCD patients in the sham control group.Each subject received 10 daily treatment sessions （5 days a week）.The αTMS group had significant reduction in scores of Yale-Brown Obsessive Compulsive Scale and Hamilton Rating Scale for Anxiety （HAMA） compared with the control group at the end of 2-week treatment and 1-week follow-up.Analysis of variance with repeated measures was used to test the effects between the two groups.Results Significant difference in scores of obsession and HAMA were found between the two groups after treatment.No significant difference in scores of Hamilton Rating Scale for Depression was found between the two groups after the treatment,but statistical significance was shown at the end of 1-week follow-up.Conclusions αEEG-guided TMS may be an effective treatment for OCD and related anxiety.Delayed response to αTMS in depression suggests that it might be secondary to the improvement of primary response in OCD and anxiety.     

Effectiveness and Safety of Umbilicus Treatment with Modified Dinggui Powder(加味丁桂散)in Patients with Chronic Nonbacterial Prostatitis:A Randomized,Double-Blind,Placebo-Controlled Clinical Trial

Objective:To evaluate the effectiveness and safety of Chinese herbal external umbilicus treatment with Modified Dinggui Powder(加味丁桂散,MDGP)in patients with chronic nonbacterial prostatitis(CNP).Methods:A randomized,double-blind,placebo-controlled clinical trial was conducted among 72 patients with CNP.Participants were randomly allocated to a treatment group and a placebo group using computer software in a 1:1 ratio,and received either MDGP external umbilicus treatment(MDGP group,36 cases)or placebo(control group,36 cases)at acupoints Shenque(CV 8),twice a week for 4 weeks.In addtion,patients all received herbal medicine treatment twice a day for 4 weeks.The primary outcome was the US National Institutes of Health Chronic Prostatitis Symptom Scores Index(NIH-CPSI)with a questionnaire at weeks 2 and 4.The secondary outcomes including prostatic fluid examination(white blood cells and lecithin bodies),the clinical efficacy evaluation,and the adverse events were also assessed during the entire trial.Results:The NIH-CPSI scores regarding pain or discomfort scores showed greater improvement in the MDGP group than placebo control group at weeks 2(P=0.001)and week 4(P=0.004),respectively.NIH-CPSI scores of symptom severity,total scores and leukocytes number in the prostatic fluid in the MDGP group were significantly improved(P<0.05).There was no statistical difference in the urinary symptoms,quality of life,lecithin and other scores between two groups(P>0.05).The clinical effective rate was 73.53%(25/34)in the MDGP group,which was significally higher than the placebo control group with 48.39%(25/31,P<0.05).Patients were blinded successfully,and no serious adverse effects were found during the trial.Conclusion:A 4-week course of umbilicus treatment with modified Dinggui Powder seems to relieve pain and symptom severity effectively and increase the amount of leukocytes number in patients with CNP(Trial registration No.ChiCTRI 800014687).     

Minimally invasive puncture and drainage or patients with hypertensive spontaneous basal ganglia intracerebral hemorrhage: A prospective non-randomized comparative study of 198 cases

Background: The treatment of hypertensive spontaneous intracranial hemorrhage(ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage(MIPD) could provide improved patient outcome compared with decompressive craniectomy(DC).Methods: Eligible, consecutive patients with ICH(≥30 ml, in basal ganglia, within 24 hours of ictus) were nonrandomly assigned to receive MIPD(group A) or to undergo DC(group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale(GOS, scores range from 1 to 5, score 1 indicating death, ≥4 indicating functional independence, with lower scores indicating greater disability). Results: A total of 198 patients met the per protocol analysis(84 cases in group A and 114 cases in group B), including 9 cases lost during follow-up(2 cases in group A and 7 cases in group B). For these 9 patients, their last observed data were used as their final results for intention-to-treat analysis. The mean age of all patients was 57.1 years(range of 31-95 years), and 114 patients were male. The initial Glasgow Coma Scale(GCS) score was 8.1±3.4, and the National Institutes of Health Stroke Scale(NIHSS) score was 20.8±5.3. The mean hematoma volume(HV) was 56.7±23.0 ml(range of 30-144 ml), and there was extended intraventricular hemorrhage(IVH) in 134 patients(67.7%). There were no significant intergroup differences in the above baseline data, except group A had a higher mean age(59.4±14.5years) than the mean age of group B(55.3±11.1 years, P=0.025). The total cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B(30 days: 27.4% vs. 36.0%, P=0.203; 1 year: 36.1% vs. 48.2%, P=0.112, respectively). However, the mortality for patients ≤60 years, NIHSS<15 or HV≤60 ml was significantly lower in group A than that in group B(all P<0.05). The total     

三种终末期肝病模型预测慢性重型乙型肝炎患者预后

目的评价三种终末期肝病模型(model for end-stage liver disease,MELD)对慢性重型乙型肝炎患者短期预后的预测价值及准确性。方法对193例慢性重型乙型肝炎患者进行回顾性分析,分别应用MELD、MELD-Na(MELD with the incorporation of serum sodium)及MESO(MELD to sodium index)模型对患者进行评分,计算3个月内的病死率,并应用c-统计值评估预测准确性。结果 193例慢性重型乙型肝炎患者3个月死亡率为73.6%(142/193)。三种模型值中位数(范围)在死亡组、生存组分别为30(15～61)、35.0(19.0～84.9)、2.3(1.2～5.2);23(16～34)、24.0(16.0～49.9)、1.6(1.2～2.5),两组间差异有统计学意义(P<0.01)。三者中c-统计值最大是MESO(0.850),最小是MELD(0.830)。结论三种模型均可用于预测慢性重型乙型肝炎患者的短期(3个月)预后,且病死率随三者分值增加而上升,MESO临床价值优于前两者。     

MELD-Na模型评价自体骨髓干细胞移植治疗失代偿期肝硬化的疗效

目的:评价自体骨髓干细胞移植对肝硬化失代偿的作用,探讨干细胞移植治疗终末期肝病的合适时机.方法:将79例符合肝硬化失代偿期的患者分为治疗组36例和对照组43例,两组均给予内科综合治疗,治疗组在内科综合治疗的基础上行经门静自体骨髓干细胞移植术治疗,通过各项临床检验数据,建立MELD-Na评分,并统计两组短期(3个月)预后,比较两组的MELD-Na评分及ROC曲线下的面积及其预后.结果:治疗3个月后,治疗组平均MELD-Na分值明显低于对照组,在MELD-Na分值的分布上,治疗组MELD-Na分值在20以下者分布多.同时发现治疗组AOC曲线下的面积明显小于对照组.统计治疗组和对照组短期死亡率,发现治疗组死亡4例,对照组为16例,两者比较有明显差异.结论:自体骨髓干细胞经门静脉移植治疗失代偿期肝硬化可以使MELD-Na分值下降,影响患者短期预后,减少近期死亡率.其起效时间大概需要12周.本研究还提示自体骨髓干细胞移植对于MELD-Na分值大于20的患者效果不显著.     

终末期肝病模型评分对终末期肝病患者肝移植预后的预测价值观察

目的 探讨终末期肝病模型(MELD)评分对肝移植患者早期预后的预测价值.方法 回顾87例行肝移植治疗的终末期肝病患者,计算治疗前MELD评分,并与早期并发症的发生和生存率进行分析.结果 本组87例肝移植患者中各种严重并发症发生率为20.7%,住院28 d和术后3月生存率分别为89.7%和88.5%;非并发症组和生存组MELD评分均值分别为14.6、12.9,有统计学差异(P＜0.05),并发症组和死亡组MELD评分均值分别为21.6、29.4,亦有统计学差异(P＜0.05);与MELD≤15组相比,16～24组和≥25组并发症发生率均显著增加(P＜0.05);但16～24组生存率无统计学差异(P＞0.05),而≥25组生存率明显降低(P＜0.05).结论 终末期肝病患者术前MELD评分值越高.肝移植后早期严重并发症发生率和死亡率越高.高分值MELD(≥25)可能是肝移植患者术后并发症发生与死亡较好的预测指标.     

肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后的价值

目的 探讨肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后的价值。 方法 自2012年1月-2017年6月,回顾性收集宁波市第二医院收治的酒精性肝硬化伴肝功能衰竭患者126例,对患者随访1年,根据患者1年内是否死亡,将患者分为死亡组(34例)和存活组(92例)。分析2组患者慢性肝功能衰竭协会-器官功能衰竭评分(CLIF-COFs)、APACHE Ⅱ评分、SOFA评分、终末期肝病模型-钠评分和终末期肝病模型评分差异,同时采用ROC曲线分析上述指标在判断酒精性肝硬化患者1年内死亡中的价值。 结果 与存活组比较,死亡组患者CLIF-COFs显著增高(11.35±3.15 vs. 6.46±2.61,P<0.001);APACHE Ⅱ评分显著增高(15.85±6.37 vs. 12.01±5.65,P=0.001);SOFA评分显著增高(6.62±1.74 vs. 4.22±1.63,P<0.001);终末期肝病模型-钠评分显著增高(25.41±4.29 vs. 21.25±4.07,P<0.001);终末期肝病模型评分显著增高(22.94±5.07 vs. 17.88±6.20,P<0.001);Maddery评分显著增高(63.37±18.47 vs. 49.82±19.67,P=0.001)。CLIF-COFs、APACHE Ⅱ评分、SOFA评分、终末期肝病模型-钠评分、终末期肝病模型评分和Maddery评分在诊断酒精性肝硬化患者1年内死亡的曲线下面积分别为0.875、0.672、0.831、0.751、0.728、0.852,其中CLIF-COFs最高[0.875(0.811~0.939),P<0.001]。 结论 肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后具有较好价值,可进一步推广应用。      

Impact of MELD score in predicting short-term survival after primary liver transplantation

Objective： To study the efficacy of model for end-stage fiver disease （MELD） in predicting short-term outcomes in patients undergoing liver transplantation （LT）. Methods： The consecutive 62 patients who had received primary LT in our hospital from November 2000 to January 2005 were retrospectively analyzed. The pretransplantafion MELD and Child-Turcotte-Pugh （CTP） scores of these patients were calculated. Concordance c-statistic was used to assess the efficacies of MELD and CTP scores in predicting the first posttransplantation 3-month survival rate. Results： Among the 62 patients receiving primary LT, 12 died during the first 3-month period and the posttransplantation 3-month survival rate was 80.65%. The 3-month survival rate predicted by using CTP score and MELD score was 0.685 and 0.873, respectively. Unlike CTP calssificafion, MELD score indentified two subgroups of patients with CTP C with different overall survival （0.8824 vs 0.4545, ;X^2= 7.00, P = 0.0081 ）. Conclusion： Our present study shows that MELD score could offer more accurate prediction for short-term survival in patients who undergo primary LT than CTP score.     

MELD-Na联合血清胆固醇、D-二聚体对肝硬化失代偿期患者预后的判断价值

目的探讨MELD-Na评分联合血清胆固醇、D-二聚体浓度对肝硬化失代偿期患者预后的判断价值。方法回顾性分析失代偿期肝硬化住院患者176例,分别根据随访6月、12月及18月的生存、死亡情况分组,通过测定相关指标计算存活组与死亡组患者MELD-Na分值,测定血清胆固醇、D-二聚体浓度,探求MELD-Na分值联合血清胆固醇、D-二聚体浓度与肝硬化失代偿期患者预后相关性。结果随访6月,25例患者死亡;随访12月,59例患者死亡;随访18月,97例患者死亡,存活组与死亡组患者MELD-Na分值、血清胆固醇、D-二聚体浓度之间的差异有统计学意义。ROC判定MELD-Na分值、血清胆固醇、D-二聚体浓度对预测失代偿期肝硬化患者的死亡有很大应用价值。MELD-Na分值预测失代偿期肝硬化患者死亡的最佳临界值为30,MELD-Na分值增高患者死亡风险也增加;血清D-Dimer预测失代偿期肝硬化患者死亡的最佳临界值为1.4mg/L,血清胆固醇预测患者死亡的最佳临界值为≤1.65μmol/L,血清胆固醇、D-二聚体浓度增高可增加患者死亡风险。结论 MELD-Na评分联合血清胆固醇、D-二聚体浓度对肝硬化失代偿期患者预后有较高的判断价值。     

血浆渗透压评分对肝肾综合征的预后评价

目的 探讨血浆渗透压评分对肝肾综合征(hepatorenal syndrome HRS)预后的评价作用。方法 研究对象为106例HRS患者,按随访3月内的预后情况分为存活组(30例)和死亡组(76例),分别进行血浆有效晶体渗透压评分、胶体渗透压评分、血浆渗透压综合评分、终末期肝病模型(model for end-stage liver disease MELD)评分和Child Pugh评分,进行统计学分析,比较各评分对HRS预后的评价能力。结果 除血浆有效晶体渗透压评分外,HRS死亡组的其余各评分均显著高于存活组(P<0.01)。Child Pugh、MELD和血浆渗透压综合评分的曲线下面积(area under curve AUC)均>0.7,其余各项评分的AUC均<0.7。Youden指数以血浆渗透压综合评分为最高,MELD和Child Pugh评分次之。结论 Child-Pugh、MELD和血浆渗透压综合评分对HRS预后均具有良好的评价作用,其中以血浆渗透压综合评分的预测能力最佳。     

低钠血症与终末期肝病患者生存状况和门静脉高压并发症的关系

目的 探讨低钠血症与终末期肝病患者生存状况和门静脉高压并发症的关系.方法 选取本院消化内科2011年1月至2014年1月收治的252例肝硬化终末期肝病患者为研究对象,根据患者入院时血清钠水平分为正常组(>135 mmol/L) 102例,轻度低钠组(131~135 mmol/L) 58例,中度低钠组(121~130 mmol/L) 42例,重度低钠组(≤120 mmol/L) 50例.分析各组患者的血清钠水平与门静脉高血压并发症、Child-Pugh评分及终末期肝病模型(MELD)的关系,对患者随访6~22个月,观察患者生存现状.结果 三低钠血症组(轻、中、重度低钠组)门静脉高压并发症发生率[39.93%(22/58)、59.52%(25/42)、76.00%(42/50)]明显高于正常组[11.76%(12/102)],且重度低钠组也明显高于中度低钠组及轻度低钠组,两两比较差异均有统计学意义(P<0.05);三低钠血症组腹水量[(458.36±72.48) ml、(1252.25±245.25) ml、(2453.18±285.96) ml]、MELD评分[(12.92±2.93)分、(19.78±3.92)分、(25.97±4.79)分]、Child-Pugh评分[(9.32±2.18)分、(12.85±2.36)分、(15.86±3.42)分]及病死率[8.62%(5/58)、23.81%(10/42)、28.00%(14/50)]均明显高于正常组[(358.96±45.23) ml、(9.98±2.15)分、5.18±1.84)分、0.98%(1/102)],而平均生存时间则明显短于正常组[(14.25±2.39)个月、(11.88±1.45)个月、(8.96±063)个月vs (19.82±2.45)个月],两两比较差异均有统计学意义(P<0.05);Logistic多因素分析显示,血钠水平、MELD评分、Child-Pugh评分是终末期肝硬化患者死亡的独立危险因素.结论 低钠血症与终末期肝硬化患者门静脉高压、腹水水平、MELD评分、Child-Pugh评分有密切的关系,是患者死亡的独立危险因素,可作为终末期肝硬化患者预后的评价指标.