婴幼儿阻塞性黄疸临床分析

目的分析婴幼儿阻塞性黄疸的发病概况、退黄率及肝硬化率。方法回顾性分析2020年2—8月在郑州大学附属儿童医院儿童肿瘤外科接受治疗的52例婴幼儿阻塞性黄疸患儿的临床资料。其中36例出生2周内即发生黄疸并进行性加重的为先天阻塞性黄疸(先天组);16例出生后正常,2周后逐渐出现阻塞性黄疸症状的为后天阻塞性黄疸(后天组)。比较两组患儿胆道闭锁(BA)、胆汁淤积症及胆管发育不良等情况,并对两组患儿退黄率及肝硬化率进行分析。结果先天组36例阻塞性黄疸患儿中BA 32例(88.9%)、胆汁淤积症4例(11.1%);后天组16例阻塞性黄疸患儿中BA 10例(62.5%)、胆汁淤积症4例(25.0%)、胆管发育不良2例(12.5%)。两组患儿BA、胆汁淤积症及胆管发育不良情况比较,差异有统计学意义(P<0.05)。先天组及后天组BA患儿退黄率分别为75.0%(24/32)、40.0%(4/10),差异有统计学意义(P<0.05);先天组及后天组BA患儿肝硬化率分别为37.5%(12/32)、60.0%(6/10),差异无统计学意义(P>0.05)。结论先天组与后天组BA、胆汁淤积症及胆管发育不良的发生情况存在差异,且先天组BA患儿退黄率高于后天组。

Voxel-based analyses of magnetization transfer imaging of the brain in hepatic encephalopathy

AIM: To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).METHODS: Nineteen cirrhotic patients graded from neurologically normal to HE grade 2 and 18 healthy control subjects underwent magnetic resonance imaging. They gave institutional-review-board-approved written consent. Magnetization transfer ratio (MTR) maps were generated from MTI. We tested for significant differences compared to the control group using statistical non-parametric mapping (SnPM) for a voxelbased evaluation.RESULTS: The MTR of grey and white matter was lower in subjects with more severe HE. Changes were found in patients with cirrhosis without neurological defi cits in the basal ganglia and bilateral white matter. The loss in magnetization transfer increased in severity and spatial extent in patients with overt HE. Patients with HE grade 2 showed an MTR decrease in white and grey matter: the maximum loss of magnetization transfer effect was located in the basal ganglia [SnPM (pseudo-)t = 17.98, P = 0.0001].CONCLUSION: The distribution of MTR changes in HE points to an early involvement of basal ganglia and white matter in HE.

Pre-existing cirrhosis is associated with increased mortality of traumatic patients: Analysis of cases from a trauma center in East China

AIM:To determine the impact of cirrhosis on trauma patients and define the factors predicting death.METHODS:The data on patients admitted to the trauma center from January 2000-2005 were studied retrospectively.The clinical variables were recorded and compared to identify the factors differentiating cirrhotic trauma survivors from non survivors.Child's classification criteria were derived from the reviewed charts of cirrhotic trauma patients to evaluate their predictive value in cirrhotic trauma.Trauma registry was also used to generate a trauma control group by matching for age,sex,abbreviated injury score(AIS)over the same period of time.The outcome variables compared were mortality rate,time of ICU and hospital stay.Results were expressed as mean ± SD.These data were analyzed by SPSS.11.0 statistical software.Univariate analysis was performed to identify significant medical factors for survivor and non survivors subjected to chi-square test.Fisher's exact test and Student's t test were performed to determine the statistical difference between cirrhotic and control groups.P < 0.05 was considered statistically significant.RESULTS:Poor prognosis of traum patients was associated with one or more of the following findings:ascitcs,hyperbilirubinemia(more than 2 mg/dL),hypoalbuminemia(less than 3.5 mg/dL),and prolonged prothrombin time(more than 12.5 seconds).Although Child's classification was used to predict the outcome in cirrhotic patients undergoing portacaval shunt procedures,no significant difference was found in mortality rate as a function of Child's classification.CONCLUSION:Cirrhosis is associated with a highermortality,a longer time of ICU and hospital stay of trauma patients.It seems that treatment of trauma patients with pre-existing severe liver disease is a challenge to surgeons.

Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

AIM:To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations.RESULTS:When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.