重型肝炎并医院内真菌感染临床分析

目的探讨重型肝炎并医院内真菌感染的临床及药敏特点及预后。方法应用回顾性调查方法对106例重型肝炎并医院内真菌感染的临床资料和相关因素进行分析。结果重型肝炎并医院内真菌感染率为20.1%（106/526）,研究组106例重型肝炎并医院内真菌感染病死率64.1%（68/106）,对照组病死率44.3%（47/106）,两组比较有显著性差异（P〈0.05）。真菌感染部位以上呼吸道为主,占48.11%。医院内真菌感染以白色念珠菌为主,占48.67%,其次为近平滑念珠菌,占15.27%,而曲霉菌和隐球菌少见。感染菌种对7种抗真菌药物的敏感性为：两性霉素B93.1%左右,氟康唑82.6%左右,益康唑、酮康唑、伊曲康唑、咪康唑有不同程度的耐药,而对制霉菌素有明显的耐药,达68%。应用广谱抗菌素、长期应用激素、侵入性操作、白细胞减少是重型肝炎并医院内真菌感染相关因素。结论重型肝炎并医院内真菌感染率高,预后差,病死率高。常用抗真菌药物对医院内真菌感染有一定的耐药性。预防医院内真菌感染是提高重肝患者生存率的重要因素。     

重型肝炎75例临床预后及分析

目的 :探讨重型肝炎的预后因素。方法 :从临床分型、实验室资料、并发症及舌象等因素对75例重型肝炎患者的预后进行了回顾性分析。结果 :急性重型肝炎病死率 85 .7% ,亚急性重型肝炎病死率3 8.5 % ,慢性重型肝炎病死率 73 .8% ;凝血酶原活动度 <3 0 % ,血清胆红素 >3 42 μmol/L者 ,病死率 92 % ;合并 2种或 2种以上并发症者 ,病死率 87.5 % ;并发肝肾综合征者 ,病死率 10 0 % ;绛红舌有裂纹舌苔干燥或伴黑腻苔者病死率 92 .9%。结论 :急性重型肝炎患者预后恶劣 ;凝血机制差、血清胆红素高者预后高度不良 ;并发症越多 ,预后越差 ,最严重的并发症是肝肾综合征 ;舌象的动态变化具有重要的预后判定价值。     

中老年肝硬化并发医院感染的原因素分析

目的:探讨老年乙型肝炎肝硬化患者发生医院感染的相关因素.方法:回顾性分析678例老年乙型肝炎肝硬化患者临床资料,分析其医院感染情况及其相关因素.结果:①本组资料678例乙肝肝硬化患者中,医院感染者203例,感染率29.49%;②感染部位依次为呼吸系统感染31.53%,自发性腹膜炎26.11%,胆道系统感染12.81%,肠道感染12.32%,泌尿系感染7.88%,皮肤及软组织感染5.91%,其他3.45%;③老年乙肝肝硬化患者医院感染与性别无关,与年龄、病情、合并肝性脑病、患有基础疾病、接受侵入性操作、使用广谱抗生素及住院时间有关.结论:老年乙肝肝硬化患者医院感是多种因素共同作用的结果,了解相关因素对于其预防和治疗有重要意义.     

慢性重型肝炎患者血清游离IGF-1检测及意义

目的分析血清游离IGF1水平变化与慢性重型肝炎患者的病情发展和预后的关系。方法应用ELISA方法检测44例慢性重型肝炎、46例肝硬化和43例慢性肝炎患者血清游离IGF1水平。并与肝功能各项指标、凝血酶原活动度和胆碱酯酶进行对照。结果慢性重型肝炎、肝硬化和慢性肝炎患者血清游离IGF1水平分别为0.24±0.15、0.33±0.17和1.06±0.70ng/ml,慢性重型肝炎与肝硬化和慢性肝炎有显著性差异(P<0.01);慢性重型肝炎早、中期IGF1水平比较,差异无显著性(P>0.05);早期与晚期比较,差异有显著性(P<0.0);中期与晚期比较,差异亦有显著性(P<0.05)。死亡组32例患者的血清游离IGF1平均低于0.2ng/ml,而存活组12例患者平均高于0.35ng/ml。结论在慢性重型肝炎患者血清游离IGF1显著下降,并与重型肝炎严重程度有关,因此可作为判断慢性重型肝炎预后的一个重要指标。     

动态观察肝炎、肝硬化病人甲胎蛋白升高的临床意义

目的探讨动态检测和观察甲胎蛋白(AFP)在急、慢性肝炎、重型肝炎及肝炎后肝硬化中的意义。方法对184例肝炎及肝硬化患者用放免法检测AFP。初次发现AFP升高者分别作B超、CT检查,排除肝癌者每3个月复查1次AFP、肝功、B超,连续进行5年追踪随访。结果初次检测184例中除6例重型肝炎外,其他178例AFP均升高。随访中发现AFP稳定上升的3例均发展为肝癌;反复波动和持续低浓度的患者发生肝癌率分别4.2%和6.6%;一过性升高者均未出现肝癌。重症肝炎患者AFP越高病死率越低。结论AFP升高的肝炎与肝硬化患者动态检测观察AFP的变化,对早期发现肝癌有重要价值。     

人工肝少量血浆置换+胆红素吸附在重型肝炎肝衰竭中的应用

目的 观察重型肝炎肝衰竭患者采取人工少量血浆置换+胆红素吸附治疗的临床效果,并分析患者预后的影响因素.方法 选取住院治疗的重型肝炎肝衰竭患者100例作为研究对象,采取人工少量血浆置换+胆红素吸附治疗,观察治疗前后各项肝肾功能生理指标变化及预后的影响因素.结果 100例重型肝炎肝衰竭患者中68例有效存活,存活率为68％;治疗后无效死亡的有32例,死亡率为32％.结论 年龄≥50岁、胆酶分离、肝性脑病、肝肾综合征、电解质紊乱、消化道出血以及肝脏萎缩等均是影响患者预后的因素,这为以后血浆置换联合胆红素吸附治疗肝衰竭患者的选择提供了一定的依据,且人工少量血浆置换+胆红素吸附治疗重型肝炎肝衰竭效果显著.     

MELD评分对重型肝炎的预后判断分析

目的探讨终末期肝病模型（MELD）评分系统对重型肝炎患者短期预后的预测判断价值,对重型肝炎患者MELD评分情况进行分析。方法回顾性分析80例重型肝炎患者的临床资料,按入院后3个月转归情况分为存活组与死亡组,进行MELD评分,观察MELD分值的差异。结果80例重型肝炎患者中死亡组MELD评分明显高于存活组,且MELD评分越高死亡率越高。结论MELD评分系统可以用于我国重型肝炎患者预后判断。     

失代偿性肝硬化合并自发性腹膜炎20例临床分析

自发性细菌性腹膜炎(SBP)指在已有腹水存在的基础上，腹腔内无明确感染灶或脏器破裂，也无直接污染途径而发生的腹膜细菌感染。常发生于失代偿性肝硬化或慢性重型肝炎合并腹水的患者，其发生率为10％～30％。文中就20例失代偿性肝硬化合并SBP患者的临床资料进行分析，旨在总结其临床特点，以求早期诊断，合理用药，减少危险因素。     

重型病毒性肝炎79例预后因素分析

重型肝炎是一类病死率甚高 ,严重危害人们健康的肝脏疾病。对其预后因素进行分析 ,有助于提高治愈率和降低病死率。现将我院 1 996年 1月～ 2 0 0 2年 5月收治的 79例重型肝炎的预后因素分析如下。1　对象和方法1 .1　对象　 79例均符合 1 995年全国传染病寄生虫病学术会议修订的病毒性肝炎防治方案的诊断标准[1 ] 。其中男性6 6例 (83.5 %) ,女 1 3例 (1 6 .5 %) ,年龄 1 9～ 75岁 ,平均年龄(45 .1± 1 3.2 )岁。存活出院 (治愈或好转 ,简称存活组 ) 35例(44 .3%) ,死亡 4 4例 (5 5 .7%)。其中 ,急性重型肝炎 2例(2 .5 %) ,存活 1例 ,死亡 …     

慢性重型肝炎门静脉系统血流动力学变化的研究

目的探讨慢性重型病毒性肝炎门静脉系统血流动力学变化.材料和方法应用多普勒超声检测30例慢性重型肝炎患者门静脉系统血流动力学变化,并与正常组(51例)、慢性肝炎组(61例)、代偿期肝硬化组(46例)、失代偿期肝硬化组(36例)进行对照研究.结果慢性重型肝炎门静脉直径稍宽于正常组,而明显低于失代偿期肝硬化,与慢性肝炎组及代偿期肝硬化无差异;门静脉血流速度、血流量显著低于对照各组;脾脏长径、脾静脉直径较正常组和慢性肝炎组增大、增宽,但明显小于失代偿期肝硬化,与代偿期肝硬化无差异;脾静脉血流量与各组比较均没有明显增加;脐静脉重开率显著高于慢性肝炎组及代偿期肝硬化组,与失代偿期肝硬化组无差异.结论慢性重型肝炎容易形成门静脉高压,门静脉血流灌注量明显减少,造成肝脏微循环障碍.     

慢性肝病患者发生肝性脑病的危险因素

 目的 探讨慢性肝病患者发生肝性脑病(hepatic encephalopathy, HE)的危险因素。方法 以2014—2019年医院收治的64例HE患者为研究对象。以HE患者首次明确诊断为肝炎或肝硬化的时间为研究起点,首次发作HE作为研究终点,通过单因素和多因素分析,探讨引发HE可能的独立危险因素。结果 单因素和多因素分析表明,年龄(OR:1.066,P<0.0001)、肝硬化(7.979,P<0.0001)、乙肝病毒(HBV)感染及治疗(5.838,P<0.0001)、脾脏肿大(2.722,P=0.003)、食管胃底静脉曲张(EGV, 1.986,P=0.024)和ALT水平高低(2.940,P<0.0001)是影响HE 发病的独立危险因素。肝病患者HE 1年、3年、5年、10年的发病率分别是14.06%、34.38%、42.19%和85.94%。结论 年龄、肝硬化、HBV感染及治疗、脾大、EGV和血清ALT水平是潜在预判肝病患者HE发作的临床指标。     

无肝硬化乙肝患者肝癌发病影响因素分析

 目的 探讨无肝硬化乙肝相关肝癌患者的发病因素。方法 收集2004-01至2015-12月我院就诊的原发性肝癌共1000例。根据是否有肝硬化分为肝硬化组(n=934例)及无肝硬化组(n=66例),回顾性分析2组患者的一般情况及实验室检查指标等资料,对无肝硬化乙肝相关肝癌患者的发病因素进行χ²检验及Logistic回归分析。结果 单因素分析表明2组患者在年龄、是否饮酒、是否重叠丙型肝炎病毒感染、是否合并高血压、基线血清e抗原状态及血清HBV DNA水平、是否行抗病毒治疗与是否有肝癌家族史方面差异有统计学意义(P<0.05);将其纳入多因素非条件Logistic回归分析,结果提示饮酒(OR=0.176,P=0.002)、有高血压病史(OR=0.505,P=0.039)、基线血清HBV DNA水平偏低(OR=0.031,P＜0.001)、既往未行抗病毒治疗(OR=7.268,P＜0.001)、有肝癌家族史(OR=0.487,P=0.010)是无肝硬化慢性乙型肝炎患者直接进展为原发性肝癌的独立危险因素。结论 对于有饮酒史、有高血压病史、基线血清HBV DNA水平偏低、既往未行抗病毒治疗及有肝癌家族史的无肝硬化慢性乙型肝炎患者,应密切监测肝癌的发生。     

Can Doppler sonography grade the severity of hepatitis C-related liver disease?

OBJECTIVE: Many authors have claimed that Doppler sonography indexes are of value in grading and assessing diffuse liver disease. However, there is much controversy regarding the reliability and reproducibility of these techniques. We performed a prospective study to evaluate whether these methods can grade disease in a well-stratified cohort of patients with hepatitis C virus (HCV)-related liver disease. SUBJECTS AND METHODS: Sixty-five patients with biopsy-proven HCV-related liver disease were recruited, and Doppler sonography was performed by one operator. The patients were classified into one of the following three groups on the basis of the Ishak-modified histologic activity index (HAI) fibrosis (F) and necroinflammatory (NI) scores: mild hepatitis (F < or = 2 and NI < or = 3), moderate or severe hepatitis (3 < or = F < 6 or NI > or = 4), or cirrhosis (F = 6/6). We measured the following Doppler indexes: main hepatic artery peak velocity (Vmax) and resistive index, main portal vein peak velocity (Vmax), and maximal portal vein diameter and circumference that allowed calculation of the portal vein congestive index (portal vein area and portal vein velocity). The ratio of the hepatic artery velocity (Vmax) to the portal vein velocity (Vmax) was also calculated, and the phasicity (triphasic, biphasic, or monophasic) of the hepatic veins of each patient was recorded. We also measured the maximal spleen length longitudinally. RESULTS: A total of 65 patients with liver disease (mild hepatitis, n = 20; moderate or severe hepatitis, n = 25; cirrhosis, n = 20) with biopsy-proven HCV-related liver disease were studied. Optimal hepatic arterial traces were obtained in only 30 patients and portal vein circumference in 18 patients. No significant differences were observed in the Doppler indexes with increasing severity of liver disease. Five (29%) of 17 patients with mild hepatitis had an abnormal hepatic vein trace (i.e., biphasic or monophasic) compared with 11 (55%) of 20 patients with moderate or severe hepatitis and 12 (60%) of 20 patients with cirrhosis. The only index to show a significant intergroup difference was splenic length (analysis of variance, p < 0.001), but there was still overlap between the groups. CONCLUSION: Doppler-derived indexes, which have previously been recommended for the assessment of severity in chronic liver disease, are difficult to reproduce reliably and therefore have a limited clinical role in the noninvasive assessment of hepatic fibrosis or inflammation.     

肝细胞癌肝动脉门静脉分流形成的相关因素分析

目的总结肝细胞癌(HCC)合并肝动脉门静脉分流(APS)、肝动脉肝静脉分流(AVS)的发生率,并探讨影响HCC APS形成的相关因素。方法回顾分析2009年1月-2010年12月经动脉栓塞(TAE)治疗的.497例HCC患者的影像学和病历资料,总结APS、AVS的发生率,采用单因素分析APS的发生与HCC患者性别、年龄、乙型肝炎病史、肝硬化基础、肝癌切除史、甲胎蛋白(AFP)、肿瘤类型、肿瘤数目和门静脉癌栓(PVTT)的相关性,并行多因素Logistic回归分析。结果HCC合并APS的发生率为10.5%(52/497),合并AVS的发生率为1.6%(8/497),同时合并APS与AVS的有3例(0.6%)。单因素分析显示:乙型肝炎病史、肝硬化基础、肿瘤类型、肿瘤数目和门静脉癌栓与HCC患者APS的发生相关;多因素Logistic回归分析显示:肝硬化基础、巨块型肿瘤、肿瘤多发、门静脉癌栓是HCC合并APS发生的危险因素。结论HCC患者有肝硬化基础、巨块型肿块、多发肿瘤、门静脉癌栓会诱发APS的发生     

NICU内重型颅脑损伤患者发生肺部感染的临床分析

目的对神经外科重症监护病房（NICU）内重型颅脑损伤患者发生肺部感染的相关危险因素及病原学分析,为防治肺部感染提供依据。方法回顾性分析NICU内收住的297例重型颅脑损伤患者的临床资料,统计院内肺部感染的发生率并分析发生的危险因素,对病原学检测结果进行分析,采取针对性防治措施。结果NICU内重型脑损伤患者院内肺部感染59例,发生率为19．9％,肺部感染的发生受到患者年龄、昏迷程度（GCS评分）、入住时间、机械通气、气管切开、是否手术、合并基础疾病以及吸烟史的影响（P〈0．05）;G菌及多重耐药菌感染呈上升趋势。结论针对重型颅脑损伤患者发生肺部感染的危险因素,并根据病原菌分布,采取严格的消毒隔离措施,规范使用抗菌药物,是降低院内感染发生率的关键。     

Treatment of anicteric acute hepatitis C with peginterferon alpha-2a plus ribavirin

BACKGROUND: Hepatitis C virus (HCV) infection is the most frequent cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma in the world. Acute hepatitis C is the most commonly asymptomatic liver disease with the development of chronic HCV infection in the majority of infected patients. Studies of the natural history of HCV infection suggest that only 15-30% of patients with acute infection recover spontaneously. Others, up to 85% of the infected patients develop chronic hepatitis C. Acute hepatitis C is so uncommon and with the unpredictable occurrence, and of the low frequency, that it is difficult to determine the optimal treatment of this disease. There have been many randomized, controlled trials of the therapy in patients with chronic hepatitis C, but none of an adequate size or rigor in patients with acute hepatitis C. Therefore, the causal treatment of patients with acute hepatitis C aimed at the prevention of chronic liver disease is necessary. CASE REPORT: We have treated a patient with anicteric form of acute hepatitis C after a three-month outpatient follow-up using a combined therapy: pegylated interferon-alpha 2a, 180 microg, subcutaneously, once a week plus ribavirin 1000 mg orally once a day. The treatment lasted 24 weeks. Stable biochemical and virological response was achieved both at the end of the treatment and 6 months after the completion of the therapy. CONCLUSION: We believe that the above mentioned might be one of the approaches to the treatment of acute hepatitis C. However, further prospective studies with significantly larger number of patients are necessary for the definite conclusions about the treatment of HCV infections.     

IgA抗-HBc检测对病毒性肝炎的临床意义

应用单克隆抗体建立的ELISA检测各型HBV感染者179例血清IgA抗-HBc。急性乙肝14例和重肝7例均为阳性,慢活肝50例阳性率为94％,慢活肝并肝硬化12例为83.3％,慢迁肝46例为56.5％,HBsAg无症状携带者50例为4％。提示IgA抗-HBc与肝损程度和范围密切相关,在乙肝诊断、鉴别诊断及预后判断上有一定实用价值。此外,IgA抗-HBc在慢性肝炎中与HBeAg呈正相关。     

Natural history of hepatocellular carcinoma and current treatment options

Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and the most severe complication of chronic liver disease. The annual number of new cases worldwide is approximately 550,000, representing more than 5% of human cancers and is the third leading cause of cancer-related deaths. The stages of the malignancy as well as the severity of the underlying liver disease are essential factors in planning the therapeutic approach. Curative treatment options are represented mainly by surgery (ie, resection or transplantation), but most patients are not candidates for a curative option, and only palliative treatment could be given to these patients. Among palliative treatments, only chemoembolization has been proven to be effective, but other options are currently being investigated. Major risk factors for HCC are well known and are dependent on the geographic area. In Europe, the United States, and Japan, the main risk factors are liver cirrhosis, hepatitis B and C virus, alcohol, and tobacco; in contrast, in Africa and Asia, these factors are hepatitis B and C virus, tobacco use, and aflatoxin exposure. Cirrhosis from any cause is a predisposing factor for HCC and could be considered as a premalignant condition. The present concept of carcinogenesis in HCC is a multistage process. This article describes the natural history of HCC and discusses the various treatment options available at present.