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981.
Fang-Yuan Gao Yao Liu Xiao-Shu Li Xie-Qiong Ye Le Sun Ming-Fan Geng Rui Wang Hui-Min Liu Xiao-Bing Zhou Li-Li Gu Yan-Min Liu Gang Wan Xian-Bo Wang 《World journal of gastroenterology : WJG》2015,21(27):8373-8381
AIM: To establish a clinical scoring model to predict risk of acute-on-chronic liver failure(ACLF) in chronic hepatitis B(CHB) patients.METHODS: This was a retrospective study of 1457 patients hospitalized for CHB between October 2008 and October 2013 at the Beijing Ditan Hospital, Capital Medical University, China. The patients were divided into two groups: severe acute exacerbation(SAE) group(n = 382) and non-SAE group(n = 1075). The SAE group was classified as the high-risk group based on the higher incidence of ACLF in this group than in the non-SAE group(13.6% vs 0.4%). Two-thirds of SAE patients were randomly assigned to risk-model derivation and the other one-third to model validation. Univariate risk factors associated with the outcome were entered into a multivariate logistic regression model for screening independent risk factors. Each variable was assigned an integer value based on the regression coefficients, and the final score was the sum of these values in the derivation set. Model discrimination and calibration were assessed using area under the receiver operating characteristic curve and the Hosmer-Lemeshow test. RESULTS: The risk prediction scoring model includedthe following four factors: age ≥ 40 years, total bilirubin ≥ 171 μmol/L, prothrombin activity 40%-60%, and hepatitis B virus DNA 107 copies/m L. The sum risk score ranged from 0 to 7; 0-3 identified patients with lower risk of ACLF, whereas 4-7 identified patients with higher risk. The Kaplan-Meier analysis showed the cumulative risk for ACLF and ACLF-related death in the two risk groups(0-3 and 4-7 scores) of the primary cohort over 56 d, and log-rank test revealed a significant difference(2.0% vs 33.8% and 0.8% vs 9.4%, respectively; both P 0.0001). In the derivation and validation data sets, the model had good discrimination(C index = 0.857, 95% confidence interval: 0.800-0.913 and C index = 0.889, 95% confidence interval: 0.820-0.957, respectively) and calibration demonstrated by the Hosmer-Lemeshow test(χ2 = 4.516, P = 0.808 and χ2 = 1.959, P = 0.923, respectively).CONCLUSION: Using the scoring model, clinicians can easily identify patients(total score ≥ 4) at high risk of ACLF and ACLF-related death early during SAE. 相似文献
982.
目的 分析聚乙二醇干扰素(PEG-IFNα-2a)联合阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)患者48 w时的疗效及其预测因素。方法 将196例HBeAg阳性CHB患者分为PEG-IFNα-2a治疗64例,ADV治疗66例和PEG-IFNα-2a联合ADV治疗66例,疗程均为48 w。采用ELISA法检测INF-γ和IL-10;采用Achitect(Abbott)微粒子化学发光免疫分析法检测HBeAg定量。结果 在治疗48 w时,联合组HBV DNA阴转率、HBeAg阴转率、HBeAg转换率和ALT复常率分别为74.2%、24.2%、48.5%和80.3%,显著高于干扰素组(53.1%、10.9%、29.7%和54.7%,P<0.05)和阿德福韦组(62.1%、13.6%、9.1%和65.2%,P<0.05);联合组INF-γ水平为(45.3±11.3) pg/ml,显著高于干扰素组[(37.1±10.3) pg/ml,P<0.05]和阿德福韦组[(36.3±11.5) pg/ml,P<0.05];联合组IL-10水平为(10.3±14.6) pg/ml,显著低于干扰素组[(17.1±11.3) pg/ml,P<0.05]和阿德福韦组[(18.3±10.5) pg/ml,P<0.05];联合组治疗48 w时HBeAg血清学转换与治疗24 w时HBeAg水平下降的百分比有关,即治疗24 w时HBeAg水平较基线下降大于89.1%的阳性预测值为88.7%,阴性预测值(NPV)为81.9%,灵敏度为83.1%,特异度为87.9%。结论 PEG-IFNα-2a联合ADV治疗HBeAg阳性慢性乙型肝炎能增强机体细胞免疫应答,疗效优于单药治疗,其中治疗24 w时HBeAg下降的百分比可预测48 w时的疗效。 相似文献
983.
Background
Risk stratification is widely used in the prognostic assessment of patients with a variety of clinical disorders on the unquestioned assumption that the intensity of treatment should be proportionate to the threat of an adverse event over some finite period of time (risk). However, just as the physical trajectory of an object depends on its current magnitude of displacement (velocity) and the concurrent rate of change of that displacement (acceleration), the prognostic trajectory of a patient depends on the current magnitude of risk and the concurrent rate of change of that risk (hazard). Clinical risk stratification nevertheless relies only on the former.Methods
We therefore integrated the quantitative assessment of risk and hazard by way of a kinetic model that characterizes the development of an adverse event as a series of exponential state-to-state transitions—from stable to unstable to event. This model serves to shift the clinical emphasis from prognosis (the assessment of risk) to treatment (the improvement in outcome). In this context, treatment is well advised (even in low-risk individuals) when the hazard is large (risk is rising), and is less well advised (even in high-risk individuals) when the hazard is small (risk is stable).Results
The kinetic model outlined here thereby promises to supersede the superficial practice of risk stratification with a more sophisticated strategy of therapeutic triage that allows one to predict the incremental clinical benefit of alternative treatment strategies. 相似文献984.
Achenbach P Warncke K Reiter J Williams AJ Ziegler AG Bingley PJ Bonifacio E 《Diabetologia》2006,49(12):2969-2976
Aims/hypothesis Combinations of autoantibody characteristics, including antibody number, titre, subclass and epitope have been shown to stratify type 1 diabetes risk in islet autoantibody-positive relatives. The aim of this study was to determine whether autoantibody characteristics change over time, the nature of such changes, and their implications for the development of diabetes.Methods Five-hundred and thirteen follow-up samples from 141 islet autoantibody-positive first-degree relatives were tested for islet autoantibody titre, IgG subclass, and GAD and IA-2 antibody epitope. All samples were categorised according to four risk stratification models. Relatives had a median follow-up of 6.8 years and 48 developed diabetes during follow-up. Survival analysis was used to determine the probability of change in risk category and of progression to diabetes.Results For each stratification model, the majority of relatives (71–81%) remained in the same risk category throughout follow-up. In the remainder, changes occurred both from lower to higher and from higher to lower risk categories. For all four models, relatives aged < 15 years were more likely to change risk category than those aged >15 years (0.001 < p < 0.03). Relatives whose autoantibody status changed from low- to high-risk categories had a higher risk of diabetes than relatives who remained in low-risk categories, and inclusion of autoantibody status during follow-up improved diabetes risk stratification in Cox proportional hazards models (p < 0.001).Conclusions/interpretation Changes in islet autoantibodies are relevant to pathogenesis, and are likely to signal alterations in the disease process. Detection of changes through follow-up measurement will improve diabetes risk stratification, particularly in young individuals. 相似文献
985.
子痫前期(PE)是妇女孕期特发的多系统疾病,是导致孕产妇和围产儿患病和死亡的主要原因之一。临床发病多出现在妊娠20周以后,其主要临床表现血压升高、水肿、蛋白尿等与众多因素有关,如何从中找到准确预测PE的方法一直是人们研究的重点。本文对PE预测现状作一综述,并对以后的预测研究作一展望。 相似文献
986.
Tsubuku T Akao T Kurkin SA Fukushima K 《Experimental brain research. Experimentelle Hirnforschung. Expérimentation cérébrale》2006,168(3):427-435
The smooth-pursuit system interacts with the vestibular system to maintain the image of a moving target on the fovea. Efficient tracking performance requires information about the velocity and the initiation of target motion. Previous studies in monkeys have shown that training with orthogonal pursuit and whole body rotation results in adapted eye movement direction during chair rotation. In addition, the latency of the pursuit shortens and initial eye velocity increases in a task-dependent manner. To examine whether these adapted eye movements are predictive pursuit, we studied whether our monkeys could predict the timing of smooth eye movement initiation during chair rotation. Two young Japanese monkeys were rotated horizontally in a trapezoidal waveform (20°/s, ±10°) with random inter-trial intervals. A laser spot was moved vertically with the same trajectory at a constant delay ranging from 100 to 700 ms after the onset of the chair motion. The monkeys were required to pursue the spot. After this training, the latencies of pursuit eye movements following the onset of chair motion were examined in the presence of the target motion. The target was also briefly (for 500–700 ms) extinguished at 80 ms after the onset of chair rotation. Pursuit eye movements after training were initiated before the onset of target motion and the latencies were proportional to the delays used for training. The latencies and response magnitudes of pursuit with or without target blanking were similar. The auditory–pursuit training did not induce an initial pursuit response similar to that induced by vestibular–pursuit training. These results indicate that smooth eye movements during the chair rotation after the vestibular–pursuit training included a predictive pursuit component. The monkeys’ estimate of the delays revealed by the latencies of pursuit was shorter by 22–36% than the actual delays. 相似文献
987.
机器学习在脑血管疾病诊疗中的应用是目前研究的热点.作者从急性缺血性卒中并发症的角度,总结不同机器学习模型在急性缺血性卒中并发症的发生、危险因素预测、影像图像分割及发病机制应用中的研究进展,以期为国内研究者提供参考. 相似文献
988.
Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury
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Keisuke Kakisaka Yuji Suzuki Kojiro Kataoka Yohei Okada Yasuhiro Miyamoto Hidekatsu Kuroda Yasuhiro Takikawa 《Journal of gastroenterology and hepatology》2018,33(1):277-282
Background and Aim
Acute liver failure (ALF) is defined as acute liver injury (ALI) associated with coagulopathy. A follow‐up strategy for ALI and characterization of ALI patients with a risk of progressing to ALF have never been established. To establish predictive markers for progression from ALI to ALF, this study compared the clinical characteristics and laboratory data on the day of registration to data from a regional referral system of patients with ALI.Methods
This prospective, observational study enrolled 365 consecutive patients with ALI/ALF between 2007 and 2016. We evaluated 109 ALI patients, 27 of whom satisfied the ALF criteria during observation and another 82 patients who recovered without progression to ALF.Results
Four patients died; all were in the ALF group. The variables of age, incidence of autoimmune hepatitis, model of end‐stage liver disease score, values for total bilirubin and prothrombin time (PT)‐international ratio, and Japan Hepatic Encephalopathy Prediction Model (JHEPM) probability at registration were significantly higher in ALF patients than in ALI patients. In multivariate analysis, PT and JHEPM were identified as risk factors for progression to ALF. The cut‐off values of 13%, 4.9%, 65%, and 1.32% for the model of end‐stage liver disease score, JHEPM probability, PT, and PT‐international ratio values, respectively, had high negative predictive values. Furthermore, among patients whose JHEPM was underestimated, none died due to ALF.Conclusion
The JHEPM probability is a predictive parameter that can be used to decide a follow‐up treatment strategy for ALI patients. 相似文献989.
990.
目的 探讨基础生命体征在判断重症手足口病患儿机械通气时机和死亡风险预测中的临床价值。方法 回顾性分析2012年4月~2016年10月我院收治的554例重症手足口病患儿的临床资料,根据病情进展情况分为非机械通气组445例,机械通气组80例,死亡组29例,采用方差分析、直线回归、Logistic回归分析和非参数统计等方法分析患儿入院前发热天数、峰热及心率、呼吸频率、收缩压和舒张压在判断重症手足口病患儿机械通气时机和死亡风险预测中的临床价值。结果 三组患儿的入院前发热天数、HR、RR、SBP、DBP比较,差异具有统计学意义(P<0.05);RR、SBP、DBP与机械通气相关,当RR≥63次/min或血压≥170/100 mmHg,提示需要机械通气的概率增大;机械通气时间与死亡相关,机械通气到第5天时,死亡率增加到70%以上。结论 入院前发热天数、HR、RR、SBP、DBP在预测重症手足口病机械通气时机及死亡中有临床价值,当呼吸、心率增快,血压升高时,要及早机械通气治疗,合理地缩短机械通气时间可以降低死亡率。 相似文献