To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ...To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)展开更多
目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 ...目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。展开更多
Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endosc...Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals;group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cut-off value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cut-off value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.展开更多
目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检...目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系。结果伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P<0.05)。APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P<0.001)。APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3~4级5.75±1.27,1级<2级<3~4级,差异有统计学意义(H=6.704,P=0.035)。血氨值在不同HE分级中的分布:1级(108.0±6.1)μg/dl、2级(130.4±23.4)μg/dl、3~4级(170.5±12.5)μg/dl,1级<2级<3~4级,差异有统计学意义(H=10.95,P=0.004)。APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8%,特异度为96.9%。结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值。展开更多
文摘To study whether liver cirrhosis associated with Helicobacter pylori ( H pylori ) infection will induce increased serum ammonia and whether the peripheral serum ammonia reflects the level of portal vein serum ammonia Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H pylori infection and non cirrhotic patients (splenic rupture) with and without H pylori infection, and the serum ammonia was measured Results The mean levels of serum ammonia in the group of cirrhotic patients with H pylori infection were 167 82±8 97?μmol/L (portal vein) and 142 2±13 35?μmol/L (cubital vein) They were increased significantly as compared with cirrhotic patients without H pylori infection (47 68±12 03?μmol/L portal vein and 37 23±7 04?μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H pylori infection ( P <0 01) There was no significant difference between the serum ammonia level of the cubital vein and portal vein ( P >0 05) Conclusions H pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method Eradication of H pylori in cirrhotic patients may prevent hepatic encephalopathy (HE)
文摘目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。
文摘Introduction and Aim of the Work: The identification of cirrhotic patients with esophageal varices or other portosystemic collateral by non-invasive means is appealing in that it could decrease the necessity of endoscopic screening. This study was to evaluate the diagnostic utility of venous ammonia level with other ultrasonographic parameters as non-invasive markers for the presence of portosystemic shunts. Patients and methods: The study included 3 groups of Child Pugh class A and early B patients. Group (A): 25 patients with evidence of both esophageal varices and portosystemic collaterals;group (B) 25 patients with neither evidence of varices nor portosystemic collaterals and group (C): 25 patients with evidence of varices but no collaterals. Measurement of venous ammonia level was done for all patients. Results: serum ammonia level was significantly higher in group A (222.8 ± 54 μg/dL) than that in group B (85 ± 21.1 μg/dL) and group C (148.2 ± 19.6 μg/dL). The cut-off value of serum ammonia level 113 μg/dL was a good predictor for the presence of esophageal varices, while the cut-off value of serum ammonia level at 133 μg/dL was a good predictor for the presence of both esophageal varices and abdominal collaterals. Combination of portal vein diameter > 13mm + splenic vein diameter > 8.9mm + ammonia level > 133 μg/dL gives 100% of sensitivity and 96% of specificity for the prediction of the presence of portosystemic shunts. Conclusion: Determination of serum ammonia level, splenic, portal vein and splenic vein diameters are considered as good predictors for the presence of portosystemic shunts in patients with liver cirrhosis.
