应用两种评分系统对409 例肝硬化和重型肝炎病例的评估分析

目的应用两种评分方法对409名肝硬化及重型肝炎患者进行评估比较，对两种评估结果及有关的上消化道出血及死亡等因素进行相关性分析。方法统计409名肝硬化及重型肝炎患者的相关资料，应用Child和MELD评分法分别计算后应用Chiss软件进行统计学分析。结果各种计算比较结果见表格。结论Child-Pugh分级法和MELD评分系统各有特点，将两种评分方式与多因素分析与经验有机结合，才是符合临床实际的判断严重肝病预后的较科学手段。     

肝硬化腹水患者的临床护理效果

目的探析优质护理应用于肝硬化腹水患者的临床效果。方法选取本院于2018年2月-2019年12月收治的50例肝硬化腹水患者,采用随机数表法分为对照组与观察组,对照组实施常规护理,观察组在此基础上实施优质护理,各25例。对比分析两组患者的肝脏储备功能(Child-Pugh)分级水平、生存质量评分。结果观察组Child-Pugh评分低于对照组;躯体疼痛、生活幸福感、角色功能、生理状态四项指标评分水平高于对照组,差异均具统计学意义(P<0.05)。结论为肝硬化腹水患者开展优质护理有助于改善肝功能,提高生存质量,促进机体康复,延长生存时间。     

肝硬化患者血清胆碱酯酶与透明质酸和Child-Pugh分级的关系

目的 探讨肝硬化患者血清胆碱酯酶(CHE)活性与透明质酸(HA)和Child-Pugh分级的相关性。方法 采用速率法和放射免疫法(RIA)测定了81例肝硬化患者、对照组30例血清CHE活性和肝纤维化标志物HA水平。结果 肝硬化Child-A、Child-B、Child-C级患者，CHE活性依次降低，肝纤维化标志物HA水平依次升高，且相差显著。CHE活性与HA水平呈显著负相关。CHE活性降低和HA水平升高与Child-Pu小分级具有一致性。结论 血清CHE活性水平可反映肝硬化的严重程度，血清CHE活性是评估肝硬化患者肝组织纤维化敏感而准确的指标，对评估手术治疗风险、病情变化及预后有一定的临床参考价值。     

肝硬化患者血清miR-122的表达及与Child-Pugh分级的关系

目的探讨肝硬化患者血清MicroRNA(miR)-122的表达水平与肝硬化Child-Pugh分级及并发症的关系。方法肝硬化患者87例,采用PCR实时荧光定量法测定患者血清miR-122水平,根据Child-Pugh分级对肝硬化患者进行分级,分析血清miR-122与肝硬化分级的关系。结果并发肝硬化腹水、消化道出血、自发性细菌性腹膜炎及失代偿期患者血清miR-122表达水平均高于未发生患者(P<0.05);不同肝硬化Child-Pugh分级血清中miR-122水平有统计学差异(P<0.05),A级与B级肝硬化患者血清miR-122水平无显著差异(P>0.05),A级和B级患者水平均显著低于C级(P<0.05)。多变量线性相关性显示,血清miR-122与丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)呈正相关(P<0.05);与国际标准化比值(INR)及肌酐(Cr)水平呈负相关(P<0.05)。结论血清miR-122水平上升提示肝硬化已经失代偿,并与腹水、消化道出血、肝肾衰竭有关。因此,血清miR-122可作为评价肝硬化患者肝脏功能及预后的潜在生物学指标。     

人血白蛋白在原发性肝癌肝切除术后的应用分析

目的 对东方肝胆外科医院原发性肝癌行肝切除术后使用人血白蛋白的情况进行合理性评价。 方法 回顾分析2012年6月至2013年6月期间150例原发性肝癌患者行肝切除术后应用人血白蛋白治疗的临床资料,比较患者术后应用人血白蛋白前后临床指标、生化指标,及人血白蛋白用药剂量相关因素分析,评价该院人血白蛋白的用药合理性。 结果 在统计的150份病历中,白蛋白总用量11 212.5 g(897瓶),总金额527 744元,占药品总费用的近20%,占住院总费用的近10%。患者在术后使用人血白蛋白后肝功能异常指标阳性率降低(P<0.05),人血白蛋白的使用剂量与患者用药前肝功能的Child-Pugh评分存在正相关(P<0.05)。 结论 该院原发性肝癌肝切除术后使用人血白蛋白较为合理,可达到预期的治疗效果。     

失代偿期肝硬化患者的终末期肝病模型预后分析

目的尝试性研究终末期肝病模型(MELD)评分系统与失代偿期肝硬化患者短期(3个月) 预后的关系;研究Child—Pugh分级与失代偿期肝硬化患者3个月预后的关系。方法应用MELD模型公式及Child—Pugh分级对110例住院治疗的失代偿期肝硬化患者进行评分及分级,同时了解其3个月内的病死率。结果39例患者在3个月内死亡。MELD10～19、20～29、≥30分患者3个月的病死率分别为38.18%、64.71%、75.00%,明显高于MELD≤9分患者(11.76%,P<0.05)。MELD≥18分患者3个月的病死率明显高于MELD<18分患者(58.06%与26.58%,x2=9.643,P<0.01)。Child A级患者3个月病死率为14.89%,B级为42.55%,C级为75.00%。结论MELD模型能准确预测肝硬化失代偿期患者短期的临床预后,而Child—Pugh分级也可准确预测失代偿期肝硬化患者3个月的病死率。     

Carbohydrate Deficient Transferrin in Abstaining Patients With End-Stage Liver Disease

BACKGROUND: Carbohydrate deficient transferrin (CDT), a biochemical marker of chronic alcohol consumption, is used by researchers and clinicians alike in a variety of populations. Levels of CDT may be affected by certain types of medical illnesses and conditions. Thus the interpretation of CDT results may need to be carefully examined in these populations. Because CDT is synthesized, glycosylated, and secreted by the liver, the use of CDT values in patients with liver disease has been an area of focused interest. METHODS: We evaluated the CDT values of 79 abstaining patients with end-stage liver disease. These patients were recruited from a liver transplant clinic while they were listed and waiting for transplantation. Patients were determined to be abstaining both by interview and by random blood alcohol levels in those with a diagnosis of alcoholic liver disease. The severity of the liver disease was categorized by the Child-Pugh score. Correlations were determined between CDT values and liver enzymes, and Child-Pugh scores and liver diagnosis. RESULTS: Nearly 50% of the patients had a CDT value of 2.6% or above, indicating a clinically positive value. There were strong correlations between CDT and a number of biochemical and physical variables, most importantly the Child-Pugh score (r = 0.52, p = 0.000). Specific liver diseases were not associated with absolute CDT values. However, patients with hepatitis C (HCV) had a significantly higher chance of having a clinically positive CDT compared with patients with other types of liver diseases. CONCLUSIONS: These results suggest that an elevated CDT value may not accurately represent alcohol consumption in patients with advanced liver disease. In fact, in such patients, the CDT may become a marker for the degree of liver impairment in alcoholic and nonalcoholic liver disease. CDT values should be viewed with caution in any patient with liver disease especially when the degree of cirrhosis reaches a Child-Pugh score of C (total score of 10 or above).     

肝硬化患者门脉系统血流动力学指标与Child-Pugh分级的相关性研究

研究肝硬化患者脾静脉和门静脉血流量及其比值(Qsv/QPv)与肝脏储备功能Child-Pugh分级的关系.采用彩色多普勒超声仪对168例肝炎后肝硬化患者(ChildA级43例,B级67例,C级58例)和59例健康成年人检测了门静脉、脾静脉的内径、流速,再计算出相关的血流量,并进行了比较分析.结果显示,随着Qsv/Qpv的升高,肝硬化患者的肝功能不断下降,各组之间比较有非常显著性差异(P＜0.01).肝硬化患者肝功能损害越重,脾静脉血流量占门静脉血流量的比值越高.如果将Qsv/Qpv的截断值定于40%,则其提示肝硬化患者肝功能下降至B级或以下的敏感性、特异性、准确性分别达80.80%、74.42%和79.17%.彩色多普勒超声测量门静脉系统及其血流动力学指标用于判断肝硬化患者的肝功能状态是一个较好的临床手段.     

Alteration of laboratory findings after radiofrequency ablation of hepatocellular carcinoma: relationship to severity of the underlying liver disease and the ablation volume

Background/Aims

To investigate sequential changes in laboratory markers after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and the relationship of these changes to the severity of the underlying liver disease.

Methods

This retrospective analysis included 65 patients (44 males, 21 females) who underwent RFA of HCC. Hematologic and biochemical markers were assessed at the pre-RFA period and 1 day, 2-3 days, and 1-2 weeks after RFA. We classified the subjects into two groups: Child-Pugh A (n=41) and Child-Pugh B (n=24). The ablative margin volume (AMV) of each patient was measured. We analyzed the changes in laboratory profiles from the baseline, and investigated whether these laboratory changes were correlated with the AMV and the Child-Pugh classification.

Results

Most of the laboratory values peaked at 2-3 days after RFA. AMV was significantly correlated with changes in WBC count, hemoglobin level, and serum total bilirubin level (Pearson''s correlation coefficient, 0.324-0.453; P<0.05). The alanine aminotransferase (ALT) level varied significantly over time (P=0.023).

Conclusions

Most of the measured laboratory markers changed from baseline, peaking at 2-3 days. The ALT level was the only parameter for which there was a significant difference after RFA between Child-Pugh A and B patients: it increased significantly more in the Child-Pugh A patients.     

盐酸多柔比星脂质体治疗晚期肝细胞癌的临床研究

目的探讨盐酸多柔比星脂质体治疗晚期肝细胞癌的临床疗效。方法选取2017年1月—2018年3月在东莞市人民医院接受治疗的93例晚期肝细胞癌患者,随机分成对照组46例和治疗组47例。两组患者均接受TACE治疗,对照组术中使用盐酸多柔比星注射液,治疗组使用盐酸多柔比星脂质体注射液,每日20mg/m2。两组患者均接受1次治疗。观察两组的临床疗效,比较两组治疗前后肿瘤最大直径、Child-Pugh评分和甲胎蛋白的变化情况。结果治疗后,对照组和治疗组的总有效率分别是54.35%、74.47%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者肿瘤最大直径、Child-Pugh评分、甲胎蛋白显著下降,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组肿瘤最大直径、Child-Pugh评分和甲胎蛋白显著低于对照组,两组比较差异具有统计学意义(P0.05)。对照组和治疗组的生存率分别是32.61%、42.55%,两组比较差异有统计学意义(P0.05)。结论脂质体多柔比星治疗肝细胞癌晚期临床效果明显,能够有效减少肿瘤直径、改善肝功能,降低甲胎蛋白水平,具有一定的临床推广应用价值。