失代偿期肝硬化患者血尿酸水平的变化

目的 探讨肝硬化失代偿患者血尿酸(UA)水平的变化及意义.方法 应用酶法测定81例肝硬化失代偿患者和32例健康对照者血UA值,并计算其肾小球率过滤(GFR).结果 肝硬化失代偿组、肝功能各分级组、腹水组的UA值与健康对照组比较,差异均无统计学意义(P＞0.05);肝硬化失代偿患者肾小球滤过率水平分组的UA值与健康对照组比较,差异均有统计学意义(P＜0.05).结论 肝硬化失代偿患者血尿酸水平与肝功能损害程度无明显关系,尿酸水平不能作为判断肝硬化失代偿患者腹水程度的指标,UA水平可在一定程度上反映肝硬化失代偿患者肾功能的变化.     

联合检测PT、HA和血小板在慢性乙型肝炎肝硬化中的应用

目的 探讨凝血酶原时间(PT)、透明质酸(HA)及血小板计数(PLT)在判断乙型肝炎肝硬化程度中的价值.方法 选取60例健康体检者(对照组),检测PT、HA及PLT,同时检测53例乙型肝炎肝硬化代偿期患者(代偿组)及61例失代偿患者(失代偿组)的相应指标并进行比较.结果 乙型肝炎肝硬化代偿组和失代偿组患者PT、HA、PLT较健康组有明显提高;失代偿组较代偿组相应指标有明显升高,差异均具有统计学意义.结论 PT、HA、PLT的检测可以反应肝损程度和病情轻重,在指导临床对肝硬化的诊断及预后判断上有重要意义.     

循证护理在老年乙肝肝硬化失代偿期的应用效果

目的探讨循证护理对老年乙肝肝硬化失代偿期的应用效果。方法选取2015年2月—2017年1月收治的老年乙肝肝硬化失代偿期患者180例,随机分为对照组和观察组各90例。对照组采取常规护理措施,观察组采取针对性循证护理干预。对比干预前后两组并发症发生概率、焦虑与抑郁评分情况。计量资料比较采用t检验;计数资料比较采用χ~2检验。P0.05为差异有统计学意义。结果观察组上消化道出血、肝性脑病、肝肾综合征、肝肺综合征等并发症的发生率低于对照组(均P0.05),观察组抑郁评分(SDS)与焦虑评分(SAS)优于对照组(均P0.05)。结论循证护理能够有效减少老年乙肝肝硬化失代偿期患者的并发症发生率,改善患者的不良情绪。     

失代偿期肝硬化患者血清钠代谢的临床意义

目的 了解失代偿期肝硬化患者钠代谢及临床意义。方法 以自动生化分析仪检测患者血清钠、钾、氯及肝功能。结果 126例失代偿期肝硬化患者低钠血症发生率高；伴腹水者发生率高于不伴腹水者；Child—Pugh B级 C级与A级比较，低钠血症发生率有统计学意义(P＜0．05)；低钠血症与血清钠正常者比较，肝性脑病、肝肾综合征、病死率均有统计学意义(P＜0．05)。结论 失代偿期肝硬化患者易发生低钠血症，且伴腹水者发生率高于不伴腹水者；Child—Pugh B级 C级低钠血症发生率高于A级；低钠血症患者肝性脑病、肝肾综合征、病死率高于正常血钠者。     

乙型肝炎肝硬化门脉高压诊治

乙型肝炎肝硬化是消化科常见病,进入失代偿期的肝硬化患者5年生存率仅24％～30％.门静脉高压(PH)是肝硬化失代偿期的重要临床表现,是发生食管胃底静脉曲张破裂出血、顽固性腹水、肝肺综合征、肝性脑病、肝肾综合征等的常见原因.早期诊断门静脉高压对于延缓肝病病变发展、减少并发症、提高患者的生存率具有重要意义.     

L-FABP联合IL-18检测在肝硬化失代偿期急性肾损伤中的诊断价值

目的 探讨肝型脂肪酸结合蛋白(L-FABP)联合白介素-18(IL-18)检测在肝硬化失代偿期急性肾损伤(AKI)中的诊断价值。方法 选取2017年5月—2018年5月我院收治的肝硬化失代偿期患者76例,根据其是否合并急性肾损伤(AKI)分成非急性肾损伤(AKI)(44例),急性肾损伤(AKI)组32例,另选取40例健康体检者作为对照组,均测定L-FABP、IL-18、24 h蛋白尿定量、血肌酐、肾小球滤过率(GFR)水平,并进行分析。结果 AKI组肝型脂肪酸结合蛋白(L-FABP)、白介素-18(IL-18)、24h蛋白尿定量、血肌酐水平均高于对照组及非AKI组,肾小球滤过率(GFR)水平低于对照组与非AKI组,差异具有统计学意义(P<0.05);经Pearson分析,L-FABP、IL-18与肝硬化失代偿期AKI呈正相关,差异具有统计学意义(r>0,P<0.05);肝硬化失代偿期AKI患者L-FABP、IL-18单一及联合检测在ROC曲线下面积分别为0.732、0.743、0.752,灵敏度为0.969、0.906、0.971,特异度为0.977、0.977、0.981。结论 L-FABP 联合 IL-18检测在肝硬化失代偿期AKI的诊断中具有较高的应用价值。     

肝硬化失代偿期妊娠妇女的妊娠安全及结局分析

目的:探讨肝硬化失代偿期妊娠妇女的临床特点、妊娠结局及处理措施。方法:回顾性分析该院2010年9月~2013年9月收治的85例肝硬化合并妊娠妇女的临床资料,分为肝硬化代偿期64例(代偿期组)、肝硬化失代偿期组21例(失代偿期组),对两组妇女的临床指标、妊娠结局进行比较、分析。结果:妊娠合并肝硬化妇女失代偿期的乏力、腹胀、尿黄、腹水、上消化道出血、肝性脑病、肝肾综合征、脾功能亢进、凝血功能障碍发生率均显著高于代偿期组妊娠妇女(P<0.05)。失代偿期组妊娠妇女的肝功能指标丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、门静脉直径、凝血功能指标PT、PLT均显著大于代偿期组,差异具有统计学意义(P<0.05),白蛋白(ALB)显著低于代偿期妊娠妇女(P<0.05)。失代偿期组的早产率(33.33%)、胎儿宫内窘迫发生率(28.75%)、胎死宫内发生率(19.05%)、产后出血发生率(19.05%)、上消化道出血率(14.29%)均显著高于代偿期组(P<0.05)。结论:肝硬化失代偿期妊娠妇女的肝功能、凝血功能等指标较代偿期妊娠妇女有统计学差异,妊娠不良结局发生率显著增高。     

彩色多普勒超声联合尿NAG检测亚临床肝肾综合征的临床价值

目的探讨彩色多普勒超声检查联合化验室检查在诊断亚临床肝肾综合征（preclinical HRS）中的应用价值。方法应用多普勒超声检测肾功能正常的肝硬化代偿期患者和肝硬化失代偿期患者的肾动脉（主肾动脉、段动脉、叶间动脉）血流动力学指标,同时测量各节段动脉管腔内径,检测患者尿中NAG活性。以上各指标与正常健康者对照。结果代偿组各节段肾动脉收缩期峰值流速（PSV）、舒张期流速（EDV）、阻力指数（RI）与对照组比较差异无统计学意义（P〉0．05）。代偿组肾动脉内径与对照组比较差异无统计学意义（P〉0．05）。失代偿组以上各血流指标及管腔内径与对照组和代偿组比较差异有统计学意义（P〈0．05）。失代偿组尿NAG值与其他两组比较差异有统计学意义（P〈0．05）。以尿NAG值大于对照组-x±3s为亚临床肝肾综合征的诊断标准,失代偿组中70％可诊断为亚临床肝肾综合征,并RI值均〉0．7;而RI〉0．7的患者中63．6％可诊断为亚临床肝肾综合征。结论肝硬化患者在病程进展中,肾动脉管径逐渐变细,阻力逐渐增加,肾小球滤过率发生异常变化。多普勒超声联合化验室检查结果能敏感、客观地反应肾脏血流动力学的改变,对亚临床HRS的诊断有重要价值。     

预见性护理应用于肝硬化失代偿期患者的效果观察

目的 进一步研究和探讨我院针对肝硬化失代偿期患者所提出的预见性护理措施的临床实际效果,从而为临床实践提供帮助和指导.方法 本研究选取了2010年12月至2012年12月期间我院收治的244例肝硬化失代偿期患者为研究对象,并分为干预组(n=122)和对照组(n=122).对照组患者采用常规的保肝对症治疗及护理,干预组患者在采取常规的保肝对症治疗及护理的基础上,采取预见性护理措施.比较两组患者采用不同护理干预措施后的相关情况.结果 干预组的122例肝硬化失代偿期患者的病死率为12.30％,肝性脑病发病率为20.49％;对照组的122例肝硬化失代偿期患者的病死率为22.13％,肝性脑病发病率为36.89％.病死率与肝性脑病发病率组间比较,对照组患者均明显高于干预组患者水平,且P均＜0.05,差异具有统计学意义.结论 在临床实践过程中,我院针对肝硬化失代偿期患者所提出的预见性护理措施的临床效果显著,是预防肝性脑病的可靠选择.     

β2-MG在肝硬化上的应用

为了解β2-MG与肝硬化的关系,我们分别提取健康人群和肝硬化失代偿期患者血清和尿样等监测,结果显示失代偿期患者血和尿中β2-MG浓度分别高于健康人群,有显著差异.     

Survey of ethylenethiourea (ETU) in ethylenebis(dithiocarbamate) (EBDC) fungicides

Ethylenethiourea (ETU) has been recognized as a compound with adverse toxicological properties. It may occur in ethylenebis(dithiocarbamate) (EBDC) fungicides as a by-product and/or a degradation product. Restrictions have been issued by the Italian Health Authority to keep the level of ETU in EBDC formulations under 0.5% (on an EBDC technical product basis). A survey was carried out on 85 samples of commercial formulations from the Italian market to verify compliance with the above limitation. ETU was extracted by methanol and determined by gas chromatography with a flame ionization detector. Three of the 85 samples (3.5%) exceeded the limit of 0.5% established by the Italian legislation for ETU.     

Diagnostic image (5) (Ileum pathology)

In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.     

Crusted (Norwegian) scabies in Dakar (Senegal)

Between January 1993 and June 1997, 30 patients with crusted scabies were seen at the dermatological clinic in Dakar (Senegal). Seventeen of these patients were male and 13 were female. Six were children aged 5 to 15 years and 24 were adults aged 18 to 70 years. Diagnosis of crusted scabies was straightforward because this condition, which was rare in Dakar before 1990, has become much more common and is now familiar to Senegalese dermatologists. The infection presented as an extensive scaly or crusted eruption with symmetrical lesions affecting the hands, feet, knees, elbows and ears in particular. Scalp involvement was reported in 25 patients. Erythrodermia was present in 4 cases and pachyonychia in 4 cases. Twenty-seven of the 30 patients had moderate or severe pruritus, whereas an absence of pruritus is regarded as a classical characteristic of crusted scabies. Diagnosis was readily confirmed by examination of hyperkeratotic material under the microscope: numerous mites and eggs were present. The two most common etiological factors were auto-immune diseases (6 cases, 4 of whom were receiving no steroid or other immunosuppressive treatment at the time of onset of crusted scabies) and malnutrition (5 of the 6 children in the study). The other associated conditions identified were: physical debilitation (4 cases), HIV infection (3), mental disability-Down's syndrome (3) and long term use of topical steroids for artificial depigmentation (2). Two patients were immunocompetent and 5 patients died shortly after diagnosis, before any underlying conditions could be identified. Seven patients were cured with benzyl benzoate. Seven others, all adults, received a single oral dose of ivermectin (200 mg/kg) and topical kerolytic drugs. Ivermectin was ineffective in 1 case, and an improvement was observed in another case, although a complete cure was achieved only after a second dose. The other patients were all cured and showed no signs of scabies one month after ivermectin treatment. A recurrence was observed in 3 patients a few months later however, suggesting that these patients were reinfected. No side effects were reported in any of the patients treated with ivermectin.