Search

目的　分析抗病毒治疗的慢性乙型病毒性肝炎(CHB)患者发生低病毒血症的影响因素。方法 CHB患 者 230例, 给予规范抗病毒治疗至少 48周。治疗后检测乙型肝炎病毒(HBV)DNA, 以 HBV DNA<20 IU/mL为完全 病毒学应答, 20 ~ 2 000 IU/mL为低病毒血症。比较完全病毒学应答患者与低病毒血症患者的人口学资料, 治疗前 乙肝免疫学指标[乙肝表面抗原(HBsAg), 乙肝e抗原(HBeAg)], HBV DNA水平, 肝功能指标(AST, ALT), 甲胎蛋白 及肝纤维化 4因子指数(FIB-4)。采用二元 Logistic回归分析 CHB患者发生低病毒血症的影响因素。结果 230例 患者中, 完全病毒学应答 121 例, 低病毒血症 109 例。低病毒血症患者 FIB-4≥3. 25 比例高于完全病毒学应答患者 (P<0. 05)。低病毒血症患者年龄小于完全病毒学应答患者, 治疗前HBsAg, HBeAg, HBV DNA水平高于完全病毒学 应答患者(P均<0. 05)。将低病毒血症与完全病毒学应答患者基线资料比较 P<0. 1的指标, 包括年龄, 治疗前 HB‐ sAg, HBeAg, HBV DNA, FIB-4及抗病毒药物类型纳入多因素 Logistic 回归分析, 结果显示, 治疗前高 HBeAg水平是 CHB患者抗病毒治疗后发生低病毒血症的危险因素。结论 CHB患者抗病毒治疗前HBV NDA, HBsAg, HBeAg水 平升高是治疗后发生低病毒血症的危险因素, 对治疗前高HBV NDA, HBsAg, HBeAg的患者应在抗病毒治疗过程中 密切监测, 以早期识别低病毒血症, 调整抗病毒治疗方案。 [ABSTRACT FROM AUTHOR]

Primary sclerosing cholangitis （PSC） is an immune-mediated chronic cholestatic liver disease and can progress to end-stage liver diseases such as liver cirrhosis and liver failure， and there are still no effective treatment methods at present. Studies have found that T lymphocytes are closely associated with the development and progression of PSC. This article reviews the role of T lymphocytes in PSC, so as to provide new ideas for research on the pathogenesis of PSC and the clinical diagnosis and treatment of PSC. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of Charlson comorbidity index（CCI） in predicting the short-and long-term risks of death in patients with acute-on-chronic liver failure（ACLF）. Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic（ROC） curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225（71.0%） male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease（MELD） score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index（ACCI）, and follow-up time（all P＜0.05）. The multivariate Cox regression analysis showed that the CCI（hazard ratio [HR]=1.351, 95% confidence interval [CI]: 1.112-1.641, P=0.002）, ACCI（HR=1.200, 95%CI: 1.011-1.423, P=0.037）, and MELD score（HR=1.076, 95%CI: 1.054-1.099, P＜0.001） were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022（all P＜0.001）. CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short-and long-term prognosis of ACLF patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Hepatology / Linchuang Gandanbing Zazhi is the property of Journal of Clinical Hepatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)