密闭式吸痰预防VAP的临床观察

将67例同期行机械通气的患者随机分为A、B、C三组,A组行开放式吸痰,B、C组接受密闭式吸痰(吸痰套更换周期分别为1d和2d)。结果A组呼吸机相关性肺炎(VAP)发生率为52.0%(13/25),显著高于B组20.0%(4/20)和C组22.7%(5/22),P<0.05;B组和C组患VAP的时间分别为行机械通气后(9±2)d和(8±3)d,P<0.05;各组发生VAP患者中,感染相关的器衰竭评分(SOFA)及临床肺部感染评分(CP IS)分值于插管后第4天开始A组明显高于B、C组,至第8天B、C组分值升高,与A组比较无明显差异。认为密闭式吸痰可以减少VAP的发生,且使发生时间延迟;密闭式吸痰套每天更换1次与每2天更换1次对VAP发生率无影响。     

CPIS评分联合PCT在新生儿VAP的诊断及预后意义

目的分析肺部感染评分(CPIS评分)联合降钙素原(PCT)在新生儿呼吸机相关性肺炎(VAP)的诊断及预后意义。 方法选择2018年11月至2020年11月在我院新生儿重症监护室接受治疗且机械通气时间超过48 h的患儿55例。分为VAP组34例,非VAP组21例。观察VAP组与非VAP组两组患儿第2 d、第5 d时PCT水平及CPIS评分的变化。30 d内VAP患儿是否存活分为存活组及死亡组,其中存活组30例,死亡组4例,比较两组患儿PCT水平及CPIS评分的变化。 结果随着机械通气时间的增加,两组患儿PCT水平及CPIS评分均有所增加,差异无统计学意义(P>0.05);与VAP组相比,第2 d及第5 d非VAP组患儿PCT及CPIS评分均明显降低,差异有统计学意义(P<0.01)。存活组与死亡组相比,存活组患儿PCT及CPIS水平均明显低于死亡组(P<0.01)。PCT+CPIS联合检测时特异度及敏感度均明显升高。新生儿VAP的PCT、CPIS及PCT+CPIS曲线下面积分别为0.79、0.72、0.85,PCT、CPIS单独检测敏感性及特异度较PCT+CPIS检测低。 结论PCT联合CPIS对诊断新生儿VAP具有较高的特异性及敏感度,能够有效评估VAP患儿病情的严重程度及预后意义。     

肺结核合并 VAP 患者动态观察 CPIS 的变化及其意义

目的：探讨临床肺部感染评分(CPIS)在肺结核并发呼吸机相关性肺炎(VAP)患者中的动态变化及其临床意义。方法选取2013年1月至2015年12月收治90例肺结核并进行机械通气治疗的患者进行回顾性分析,根据最终纤维支气管镜、BALF 及血培养结果确诊 VAP 患者47例(VAP 组)、非 VAP 患者43例(非 VAP 组),对比两组患者的 CPIS 评分变化趋势,并根据治疗结局将 VAP 患者分为存活组和死亡组进行亚组分析。结果气管插管时,VAP 组和非 VAP 组患者的CPIS 评分差异无统计学意义(P >0.05);在机械通气第3天、第7天、第14天,VAP 组患者 CPIS评分均显著的高于非 VAP 组患者(P <0.05);VAP 组机械通气治疗时间、RICU 治疗时间、住院时间、病死率均显著的高于非 VAP 组患者,差异有统计学意义(P <0.05);VAP 组存活28例患者、死亡19例患者,VAP 患者中存活患者在机械通气第3天、第7天、第14天 CPIS 评分均显著的低于死亡组患者(P <0.05)。结论肺结核并发 VAP 患者的 CPIS 评分较非 VAP 患者呈显著的升高趋势,死亡 VAP 患者的 CPIS 评分显著的高于存活 VAP 患者,CPIS 评分在诊断 VAP 及评估患者预后中具有一定的意义。     

降钙素原与临床肺部感染评分在呼吸机相关性肺炎预后评估中的价值

目的探讨降钙素原(PCT)与临床肺部感染(CPIS)评分在呼吸机相关性肺炎(VAP)预后评估中的价值。方法 65例VAP患者根据临床转归分为生存组和死亡组,动态监测两组患者入院第1天、第5天及转出或死亡前PCT、CPIS评分及APACHEⅡ评分的动态变化,并分析三者之间的相关性。结果两组患者在年龄、入住ICU时间、机械通气时间、CPIS评分及APACHEⅡ评分等方面比较无显著差异性(P0.05);生存组第5天和转出或死亡前PCT、CPIS评分及APACHEⅡ评分等指标明显低于死亡组(P0.05);PCT与CPIS评分呈正相关(r=0.647,P0.01),PCT、CPIS评分均与APACHEⅡ评分呈正相关(r=0.735,P0.01和r=0.548,P0.01)。结论动态监测PCT与CPIS评分对VAP患者预后评估具有较好的临床价值。     

外周血中性粒细胞CD64指数对呼吸机相关性肺炎的早期诊断价值

目的:观察外周血中性粒细胞CD64指数在呼吸机相关性肺炎(VAP)患者中的表达及探讨早期诊断价值。方法:选择380例行机械通气时间48 h的患者,根据是否发生VAP将其分为VAP组78例与非VAP组302例;选择同期50例体检者为健康对照组。采用流式细胞术检测外周血中性粒细胞CD64指数,记录临床肺部感染评分(CPIS)情况。分别比较3组患者外周血中性粒细胞CD64指数及C-反应蛋白(CRP)、白细胞计数(WBC)水平的差异以及分析中性粒细胞CD64指数水平与CPIS评分的相关性。结果:与非VAP组和健康对照组比较,VAP组中性粒细胞CD64指数水平显著升高(P0.05);抗感染治疗3 d、7 d后,VAP组患者外周血中性粒细胞CD64指数、CRP、WBC水平及CPIS评分均较治疗前显著降低(P0.05);相关性分析显示,外周血中性粒细胞CD64指数与CPIS评分呈正相关(r=0.78,P0.01)。ROC曲线分析显示,以外周血中性粒细胞CD64指数5.83为界限时,诊断VAP的敏感性和特异性分别为84.2%和89.8%,ROC曲线下面积(AUC)为0.865(95%CI 0.786~0.903)。结论:VAP患者外周血中性粒细胞CD64指数呈高表达,其可作为早期诊断VAP的有效指标,动态观察其水平变化对于判断感染程度及治疗效果具有一定的临床意义。     

纤维支气管镜治疗老年人呼吸机相关性肺炎的疗效探讨

目的探讨纤维支气管镜吸痰对老年呼吸机相关性肺炎(VAP)病人的应用效果。方法将2013年5月至2016年5月期间进行气管插管或切开实施机械通气后发生VAP的老年病人112例随机分成观察组与对照组,观察组使用纤维支气管镜吸痰治疗,对照组进行常规治疗,比较2组的临床肺部感染评分(CPIS)、机械通气时间、VAP治愈时间以及住院时间、KPS评分等。结果治疗后第3天和第5天,观察组的CPIS评分明显低于对照组,差异具有统计学意义(P0.05);观察组的机械通气时间、VAP治愈时间以及住院时间明显短于对照组,差异有统计学意义(P0.05)。结论纤维支气管镜治疗老年VAP能够有效降低感染,加快病情恢复,提高日常活动能力。     

重症监护室住院机械通气患者GER与呼吸机相关性肺炎相关性分析

目的分析重症监护室住院机械通气患者GER与呼吸机相关性肺炎（VAP）发生的相关性。 方法收集2016年5月至2017年6月,新疆维吾尔自治区人民医院重症监护室住院并进行机械通气治疗的65例重症患者,分别在机械通气治疗第1、2、3及5天时收取气管分泌物,采用ELISA法检测标本中胃蛋白酶浓度,并对患者进行临床肺部感染分析,以分析胃蛋白酶浓度与VAP关系。 结果65例患者在第1天气管胃蛋白酶阳性检出率为12.31%,第2天阳性检出率为40.00%,第3天阳性检出率为66.15％,第5天阳性检出率80.00%,随机械通气时间延长而阳性检出率增高（P<0.05）;65例患者中有28例发生VAP,VAP患者第2、3及5天时气管分泌物中胃蛋白酶浓度均显著高于非VAP患者,差异有统计学意义（P<0.05）;VAP患者气管胃蛋白酶浓度与VAP发生呈正相关（R>0,P<0.05）。 结论随机械通气时间延长而阳性检出率增高,VAP患者气管胃蛋白酶浓度显著高于非VAP患者,VAP患者气管胃蛋白酶浓度与CPIS评分正相关。     

降钙素原联合临床肺部感染评分在呼吸机相关性肺炎诊断和预后的价值

目的:观察并探究降钙素原(PCT)联合临床肺部感染评分(CPIS)在呼吸机相关性肺炎(VAP)的诊断及预后中的价值。方法:选取接受机械通气超过48 h的患者为研究对象,其中48例为VAP患者,56例为非VAP患者。在诊断当天对两组患者的C-反应蛋白(CRP)、PCT及CPIS等差异进行比较;在诊断后的第28天对VAP组的存活患者及死亡患者上述指标间差异进行比较,并开展受试者工作特征曲线(ROC曲线)分析。结果:VAP患者的CRP、PCT及CPIS相比于非VAP患者发生明显升高;CRP的诊断准确性比较低,PCT及CPIS则具有中等准确性,在联合应用PCT与CPIS后,诊断特异度得到显著提高(P<0.05)。在VAP患者中,死亡患者的PCT与CPIS则显著高于存活患者;在联合应用PCT与CPIS后,诊断特异度提高至84.8%。结论:在诊治VAP患者过程中,联合应用PCT与CPIS可有效提高诊断的准确性及特异度,能很好地反映病情危重程度,具有很好的临床实用价值,值得推广应用。     

肺癌术后呼吸机相关性肺炎患者纤维支气管镜治疗的研究

目的探讨采用纤维支气管镜治疗肺癌根治术后呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者的治疗效果,为临床治疗提供参考依据。方法选取2013-12~2015-12该院接受肺癌根治术后并发VAP患者60例,按照不同的治疗方式分为治疗组和对照组,每组30例。治疗组实施纤维支气管镜吸痰处理,对照组实施常规吸痰处理,比较两组患者治疗前后的p H、动脉氧分压(Pa O2)、动脉二氧化碳分压(Pa CO2)、血氧饱和度(Sp O2)、机械通气时间、胸部X线好转时间、ICU治疗时间,并应用SPSS19.0统计学软件进行统计分析。结果两组患者治疗前后动脉血气分析指标比较表明,治疗后治疗组患者p H、Pa O2、Pa CO2及Sp O2各项指标结果优于对照组,对比差异有统计学意义(P0.05)。两组患者CPIS评分比较,治疗前两组患者CPIS评分无明显差异,治疗后治疗组在治疗第1天、第3天、第5天CPIS评分低于对照组,对比差异有统计学意义(P0.05)。治疗组治疗后机械通气时间、胸部X线好转时间、ICU治疗时间均短于对照组,差异有统计学意义(P0.05)。结论纤维支气管镜吸痰治疗有助于胸外科肺癌术后VAP患者减轻感染、改善临床症状、促进康复和提高呼吸机脱机的成功率,是治疗VAP安全有效的方法,值得临床推广。     

肺部感染评分对卒中相关性肺炎患者预后的评估作用

目的分析肺部感染评分(CPIS)对卒中相关性肺炎(SAP)患者预后的评估作用。方法选取2009年3月-2011年5月在我院诊治的126例SAP患者,根据其预后分为生存组(n=95)和病死组(n=31),对比分析两组患者CPIS差异。结果两组发病第1 d时CPIS均显著高于发病前(P0.05),存活组第3、5、7 d时明显下降(P0.05),病死组第3、5、7 d时持续升高(P0.05),存活组CPIS明显低于病死组(P0.05)。结论 CPIS是评价SAP患者预后的良好指标。     

Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury

BACKGROUND: We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP). METHODS: Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures). RESULTS: We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25-75 percentiles, 0.14-0.78; vs median, 0.2 ng/mL; 25-75 percentiles, 0.76-2.4, p<0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6+/-1.1 vs 1.5+/-1.1, p<0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes. CONCLUSIONS: PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.     

持续声门下吸引预防呼吸机相关性肺炎的前瞻性随机对照临床研究

目的 评价持续声门下吸引预防呼吸机相关性肺炎(VAP)的意义.方法 选2004年10月-2006年4月收住东南大学附属中大医院急诊与危重病医学科需要建立人工气道实施机械通气的18岁以上成年患者,随机分为持续声门下吸引组(CASS组)与不行声门下吸引组(NASS组).用VAP临床诊断标准和简化临床肺部感染评分(CPIS)进行VAP评估.记录声门下引流量、VAP发生情况、28 d病死率等.结果 共有101例患者入选,机械通气48 h以上CASS组48例,NASS组43例,2组患者平均APACHE Ⅱ为(20.8±6.1)分,诊断VAP时CPIS为(5.6±1.0)分.CASS组患者第一个24 h声门下引流量平均为(27.2±21.2)ml.CASS组、NASS组VAP发生率分别为25.0%、46.5%(P=0.032).发生时间分别为(7.3±4.2)d、(5.1±3.0)d(P=0.100).NASS组发生VAP的患者下呼吸道标本革兰阳性球菌比例明显高于CASS组(P=0.004).发生VAP的患者第一个24 h声门下引流量明显少于未发生者(P=0.006).发生VAP患者机械通气时间明显延长、住院病死率和28 d病死率显著增加(P值分别为0.000、0.009、0.035).结论 有效的声门下吸引可显著降低早发性VAP的发生率.     

Value of APACHE II, SOFA and CPIS scores in predicting prognosis in patients with ventilator-associated pneumonia

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent infection with high mortality rates in intensive care units (ICUs) and the prediction of outcome is important in the decision-making process. OBJECTIVE: To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Clinical Pulmonary Infection Score (CPIS) in the prediction of mortality during VAP episodes in pulmonary patients. METHODS: This study was a prospective observational cohort study. Sixty-three patients who were admitted to the ICU and developed VAP were included in the study consecutively. Clinical and laboratory data conforming to the APACHE II and SOFA scores were recorded on admission and APACHE II, SOFA and CPIS scores on the day of the diagnosis of VAP. The outcome measure was the ICU mortality. Logistic regression and receiver operating characteristic (ROC) curve analyses and the area under the curve (AUC) were used to estimate the predictive ability of the scoring systems. RESULTS: Mortality rate was 54%. The mean APACHE II (21 +/- 6, 14 +/- 5; p = 0.001), SOFA (7 +/- 3, 4 +/- 2; p = 0.002) and CPIS (8 +/- 2, 7 +/- 3; p = 0.025) scores determined at the time of VAP diagnosis were significantly higher in nonsurvivors than in survivors. Discrimination was excellent for APACHE II (ROC AUC: 0.81; p = 0.001) and acceptable for SOFA (ROC AUC: 0.71; p = 0.005) scores. Of the three scores only APACHE II >16 was an independent predictor of the mortality (OR: 5; 95% CI: 1.3-18; p = 0.019) in the logistic regression analysis. CONCLUSION: These results suggest that APACHE II determined at the time of VAP diagnosis may be useful in predicting mortality in the pulmonary ICU patient population who develops VAP.     

髓系细胞触发受体-1、降钙素原分别联合临床肺部感染评分对呼吸机相关性肺炎的诊断价值

目的探讨TREM-1、PCT分别联合CPIS在VAP中的诊断价值。方法选取2020年1月5月我院ICU收治的气管插管或气管切开接受有创机械通气治疗的住院患者156例,根据病情分为VAP组(66例)和非VAP组(90例),比较两组患者在机械通气后第1 d、3 d、7 d的血清TREM-1、PCT及CPIS间的差异。绘制ROC曲线评估血清TREM-1、PCT分别联合CPIS诊断VAP的应用价值。结果对两组患者TREM-1、PCT、CPIS进行重复测量方差分析显示:①TREM-1的时间效应、处理效应和交互效应均有统计学意义(F_时间=135.684,P<0.001;F_处理=577.117,P<0.001;F_交互=62.408,P<0.001);②PCT的时间效应、处理效应和交互效应均有统计学意义(F_时间=35.129,P<0.001;F_处理=158.284,P<0.001;F_交互=31.220,P<0.001);③CPIS的时间效应、处理效应和交互效应均有统计学意义(F_时间=14.445,P<0.001;F_处理=148.629,P<0.001;F_交互=4.968,P=0.008)。血清TREM-1、PCT和CPIS诊断VAP的AUC分别为0.977、0.907和0.922。而TREM-1+CPIS评分和PCT+CPIS评分联合诊断VAP的AUC分别为0.976和0.944,均明显高于3项指标的单独应用。结论TREM-1尤其是TREM-1+CPIS评分对机械通气患者早期诊断VAP具有优势,TREM-1+CPIS评分对评估VAP具有更高的诊断效能。     

慢性阻塞性肺疾病急性呼吸衰竭患者从有创过渡到无创机械通气的时机探讨

目的探讨慢性阻塞性肺疾病(COPD)急性呼吸衰竭从有创过渡到无创机械通气的适宜时机。方法24例COPD急性呼吸衰竭患者有创机械通气3天后随机分成两组,每组12例。A组予拔除气管导管改面罩机械通气,B组继续有创机械通气。观察两组呼吸机相关性肺炎(VAP)例数、死亡例数、机械通气时间、住院时间。结果A、B两组发生VAP的例数分别为0和7例(P=0.027);死亡例数为0和3例(P=0.217);有创机械通气3天后尚需机械通气时间为（7±5）天和（15±12）天(P<0.05);住院时间为（16±6）天和（25±12）天(P<0.05)。结论COPD急性呼吸衰竭有创机械通气3天后拔除气管导管改面罩机械通气能降低VAP发生率,缩短机械通气时间和住院时间。     

Predictors and outcomes of scleroderma renal crisis: the high-dose versus low-dose D-penicillamine in early diffuse systemic sclerosis trial

OBJECTIVE: The reported frequency of scleroderma M01-R renal crisis (SRC) in diffuse systemic sclerosis (SSc; scleroderma) is 15-20%. Early use of angiotensin-converting enzyme (ACE) inhibitors has markedly improved outcome. The present analysis reexamines the prognostic factors for and outcome of SRC in a prospective cohort of patients with early diffuse SSc. METHODS: We retrospectively evaluated the cohort of SSc patients who participated in the High-Dose Versus Low-Dose D-Penicillamine in Early Diffuse SSc trial. Patients with diffuse cutaneous scleroderma were enrolled if their disease duration was <18 months. Because the trial failed to show a difference between treatment groups, the data were pooled. RESULTS: One hundred thirty-four SSc patients entered the observation period a mean +/- SD of 0.8 +/- 0.3 years after onset of SSc. SRC occurred in 18 patients a mean +/- SD of 0.9 +/- 1.1 years after entry. During a mean +/- SD 4.0 +/- 1.1 years of followup after entry, 9 of the 18 patients died (mean +/- SD 0.6 +/- 0.9 years after SRC onset). Baseline characteristics that predicted SRC included a modified Rodnan skin thickness score of >or=20 (P < 0.01), enlarged cardiac silhouette on radiograph (P = 0.04), large joint contractures (wrist, elbow, knee) (P = 0.008), and prednisone use at entry (P = 0.01). Baseline characteristics that did not predict SRC included age, sex, race, Health Assessment Questionnaire score, fist closure, handspread, lung involvement, muscle weakness, erythrocyte sedimentation rate, and platelet count. In 5 of 10 subjects for whom at least 2 sequential skin scores were available, skin scores increased significantly (P = 0.012) in the 6 months before onset of SRC. CONCLUSION: SRC occurred in 13% of patients soon (mean 11 months) after entry into the cohort. Predictors of SRC identified in this study included higher than average skin score, prednisone use at study entry, large joint contractures, and heart enlargement. Our data suggest, however, that low-dose prednisone alone was not associated with the onset of SRC, except in the appropriate clinical setting. Although ACE inhibitors and dialysis are now readily available, SRC continues to be associated with poor survival (in this study, 50% of patients with SRC died).     

ECG evidence of limited myocardial infarction following coronary occlusion treated by early intravenous rt-PA infusion

Serial 12-lead surface electrocardiograms (ECGs) were analysed in 110 patients with first evolving myocardial infarction entered in a double-blind placebo-controlled trial of intravenous rt-PA within 2.5 h (mean 1.9 +/- 0.5 (SD)) of pain onset. ECG analysis was performed by two 'blinded' analysts. QRS scoring (by the modified Selvester method) was used as an index of myocardial necrosis. Patient results were analysed according to infarct location. There was no difference between the two treatment groups in ST-segment elevation or QRS score at entry or up to 24 h after symptom onset. However from 24 h, QRS score was lower in patients with anterior infarction given rt-PA than in those given placebo: 5.4 +/- 2.8 vs 7.7 +/- 4.1 (P = 0.02) at 48 h; 4.7 +/- 3.2 vs 8.0 +/- 4.0 (P = 0.01) at 4-10 days; and 4.6 +/- 3.9 vs 7.5 +/- 3.9 (P = 0.01) at 21 days. For patients with inferior infarction, rt-PA treatment also resulted in a lower QRS score although this was not significantly different from the score of the placebo group (P = 0.07). Comparison of QRS scores with ejection fraction measured from the contrast ventriculogram taken at 21 days showed a moderate correlation (r = 0.46) in patients with anterior infarction but a poor correlation in patients with inferior infarction. These ECG results indicate that in evolving anterior myocardial infarction, there is limitation of infarct size from early rt-PA infusion.     

The mobilization of CD34 positive mononuclear cells after myocardial infarction is abolished by revascularization of the culprit vessel

BACKGROUND: The mobilization of hematopoietic progenitor cells from bone marrow has been proposed to play a role in cardiac regeneration after myocardial infarction (MI). Accordingly, an increase in CD34 positive cells (CD34+) has been observed in the peripheral blood of patients after acute myocardial infarction. Here, we evaluated the influence of an acute percutaneous coronary intervention (PCI) of the occluded artery on the mobilization of CD34+ in acute MI. METHODS: CD34 positive cells were quantified by flow cytometry (FACS analysis) and expressed as number per million white blood cells. Peripheral blood was obtained and analyzed at day 5 after the onset of symptoms from patients with acute MI without early PCI (n=11, age 63+/-5 years), acute MI with rapid PCI (n=7, age 63+/-3), patients with pneumonia (n=5, age 51+/-6), patients without angiographical signs of coronary artery disease (control, n=5, age 66+/-8) and young healthy volunteers (n=11, age 28+/-1). RESULTS: Patients with MI but without PCI had a higher CD34+ count at day 5 (312+/-48 per 10(6) leukocytes) than control (156+/-40, P=0.03) and MI with PCI (173+/-31, P=0.03). No increase in CD34+ was observed in patients who underwent PCI vs. control. Patients with pneumonia had higher CD34+ (350+/-44) than patients with MI with PCI (P=0.01) and control (P=0.01). Healthy individuals who were much younger than all other groups (28+/-1 years, P<0.0001 vs. all groups) had the highest CD34+ (526+/-51, P=0.006 vs. MI without PCI, P=0.00003 vs. MI with PCI, P=0.02 vs. pneumonia, P=0.00006 vs. control). CONCLUSIONS: Shorter time of ischemia and reduced cell death may be the reasons for reduced CD34+ cell count after acute MI with early percutaneous intervention vs. acute MI without intervention. Besides ischemia, also inflammation as present in pneumonia may cause a mobilization of CD34+ cells. Age may be a major factor that influences the mobilization of CD34+ cells and the regenerative capacity of the heart.     

Amino acid challenge in patients with cirrhosis: a model for the assessment of treatments for hepatic encephalopathy.

BACKGROUND/AIMS: To mimic episodic hepatic encephalopathy after gastrointestinal bleeding under controlled conditions, cirrhotic patients were challenged with an amino acid mixture of comparable composition to haemoglobin. METHODS: Basal EEG, psychometric score (HE test), reaction times and venous blood ammonia were recorded. Following a 54 or 108 gm oral amino acid challenge, blood ammonia levels and EEG were recorded at 30-min intervals, and psychometric testing was repeated at 180 min. Ten controls (57 +/- 2) and 31 cirrhotics (52 +/- 2) of which 21 were Child's grade A or B and 10 grade C underwent the challenge. Nine had a transjugular intrahepatic porta-systemic shunt in situ. RESULTS: Seventeen patients had abnormal baseline HE scores. Basal blood ammonia and reaction time A were significantly greater in patients (52 +/- 5 micromol/l and 478 +/- 20 ms, respectively) than controls (19 +/- 2 micromol/l and 372 +/- 14 ms) (P < 0.001). Following the challenge, in patients with advanced liver disease (Child's grade B and C) the slowing of reaction time A (+85 +/- 38 and +71 +/- 31 ms, respectively; P < 0.03) and EEG (ratio of slow to fast wave activity +0.31 +/- 0.12 and +0.58 +/- 0.19; P < 0.02) were significantly greater than in controls (-3.3 +/- 8 ms and 0.00 +/- 0.03, respectively). Patients with an abnormal basal HE score had the most pronounced changes (reaction time A +110 +/- 39 ms, P < 0.01, EEG +0.52 +/- 13, P < 0.01, respectively). The change in EEG ratio correlated with the dose of amino acid administered (r = 0.96; P < 0.008). CONCLUSION: The amino acid challenge constitutes a reproducible human model of episodic, Type C hepatic encephalopathy unaffected by the complications usually encountered in clinical practice.