Functional cure of chronic hepatitis B-hope or hype?

Chronic hepatitis B constitutes a substantial disease burden worldwide.The steps advocated by the World Health Organization in 2016 to eradicate hepatitis B by 2030 has failed to achieve significant progress,especially with respect to immu-nization coverage and linkage to care.The lack of governmental and public awar-eness regarding the long-term implications of hepatitis B burden cause under-funding of developmental projects.The presently approved treatment modalities have limited efficacy in complete viral eradication,hence the need for newer molecules to achieve functional cure(sustained undetectable hepatitis B surface antigen(HBsAg)and hepatitis B virus DNA in peripheral blood after a finite period of therapy).However,preliminary results from trials of novel therapies show their inadequacy to achieve this end by themselves but better performance with a low baseline serum HBsAg with nucleos(t)ide analogues(NA)treatment which need to be combined with/without pegylated interferon as an immu-nomodulator.Such therapy is limited by cost and adverse events and need to show incremental benefit over the standard of care(long-term NA therapy)with respect to efficacy and drug toxicities,making the development process tenuous.Thus,while such therapies continue to be tested,strategies should still focus on prevention of transmission by non-pharmaceutical measures,vaccination and increasing linkage to care.

Short-term entecavir versus lamivudine therapy for HBeAg-negative patients with acute-on-chronic hepatitis B liver failure

BACKGROUND: Selection of drugs for antiviral therapy of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) remains difficult. This study was undertaken to evaluate the short-term efficacy of entecavir versus lamivudine on hepatitis B e antigen (HBeAg)-negative patients with ACLF. METHODS: The data of 182 HBeAg-negative patients with ACLF were retrospectively collected from patient profiles of the hospital. In these patients, 93 HBeAg-negative patients with ACLF were treated orally with 0.5 mg of entecavir and 89 were treated orally with 100 mg of lamivudine every day. The gender and age were matched between the two groups. Biochemical items, the model for end-stage liver disease (MELD) score, and HBV DNA level were matched at baseline between the two groups and monitored during treatment. The 3-month mortalities of the two groups were compared. RESULTS: No significant differences were found in biochemical items, MELD score, and HBV DNA level at baseline (P】0.05). HBV DNA level decreased within 3 months in both groups (P【0.05), regardless of the pretreatment MELD score. In patients with the same range of pretreatment MELD scores, treatment duration, posttreatment HBV DNA levels, percentage of HBV DNA level 【2.7 lg copies/mL, biochemical items, MELD scores and 3-month mortality were similar in the two groups (all P】0.05). Pretreatment MELD score was not related to posttreatment HBV DNA levels (P】0.05), but related to a 3-month mortality in both groups (both P【0.001).CONCLUSIONS: In HBeAg-negative patients with ACLF, the short-term efficacy of entecavir versus lamivudine was similar. The degree of pretreatment liver failure significantly affected the outcome of treatment.

Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation

Acute on chronic liver failure(ACLF)is a disease entity with a high mortality rate.The acute event arises from drugs and toxins,viral infections,bacterial sepsis,interventions(both surgical and non-surgical)and vascular events on top of a known or occult chronic liver disease.ACLF secondary to reactivation of chronic hepatitis B virus is a distinct condition;the high mortality of which can be managed in the wake of new potent antiviral therapy.For example,lamivudine and entecavir use has shown definite short-term survival benefits,even though drug resistance is a concern in the former.The renoprotective effects of telbivudine have been shown in a few studies to be useful in the presence of renal dysfunction.Monotherapy with newer agents such as tenofovir and a combination of nucleos(t)ides is promising for improving survival in this special group of liver disease patients.This review describes the current status of potent antiviral therapy in patient with acute on chronic liver failure due to reactivation of chronic hepatitis B,thereby providing an algorithm in management of such patients.

Effect of naked eukaryotic expression plasmid encoding rat augmenter of liver regeneration on acute hepatic injury and hepatic failure in rats

AIM: To study the protective effect of eukaryotic expression plasmid encoding augmenter of liver regeneration (ALR) on acute hepatic injury and hepatic failure in rats. METHODS: The PCR-amplified ALR gene was recombined with pcDNA3 plasmid, and used to treat rats with acute hepatic injury. The rats with acute hepatic injury induced by intraperitoneal injection of 2 mL/kg 50% carbon tetrachloride (CCl4) were randomly divided into saline control group and recombinant pcDNA3-ALR plasmid treatment groups. Recombinant pcDNA3-ALR plasmid DNA (50 or 200 μg/kg) was injected into the rats with acute hepatic injury intravenously, intraperitoneally, or intravenously and intraperitoneally in combination 4 h after CCl4 administration, respectively. The recombinant plasmid was injected once per 12 h into all treatment groups four times, and the rats were decapitated 12 h after the last injection. Hepatic histopathological alterations were observed after HE staining, the expression of proliferating cell nuclear antigen (PCNA) in liver tissue was detected by immunohistochemical staining, and the level of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was determined by biochemical method. The recombinant plasmid DNA (200 μg/kg) and saline were intraperitoneally injected into the rats with acute hepatic failure induced by intraperitoneal injection of 4 mL/kg 50% CCl4 after 4 h of CCl4 administration, respectively. Rats living over 96 h were considered as survivals.RESULTS: The sequence of ALR cDNA of recombinant pcDNA3-ALR plasmid was accordant with the reported sequence of rat ALR cDNA. After the rats with acute hepatic injury were treated with recombinant pcDNA3-ALR plasmid, the degree of liver histopathological injury markedly decreased. The pathologic liver tissues, in which hepatic degeneration and necrosis of a small amount of hepatocytes and a large amount of infiltrating inflammatory cells were observed, and they became basically normal in the most effective group after four times of injection of recombinant pcDNA3-ALR plasmid. The indexes of PCNA significantly increased in the recombinant pcDNA3-ALR plasmid treatment groups compared to model group. The level of serum AST and ALT remarkably reduced in recombinant pcDNA3-ALR plasmid treatment groups compared to model group. The results showed that the effect of 200 μg/kg recombinant pcDNA3-ALR plasmid in the rats with acute liver injury was stronger than that of 50μg/kg pcDNA3-ALR DNA.The effect of intravenous injection of recombinant pcDNA3ALR plasmid was better. After the rats with acute hepatic failure were treated with recombinant pcDNA3-ALR plasmid,the survival rate (40%) significantly increased in treatment groups compared to control group (15%, P＜0.01).CONCLUSION: The ALR gene may play an important role in relieving acute hepatic injury and hepatic failure by promoting hepatic cell proliferation and reducing level ofAST and ALT in CCl4-intoxicated rats.

Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure

AIM: To investigate the clinical features, response to corticosteroids, and prognosis of autoimmune hepatitis (AIH)-induced liver failure in China.

Effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as CTGF and TGF-β1 content in patients with chronic renal failure

Objective:To analyze the effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 content in patients with chronic renal failure.Methods:80 patients with chronic renal insufficiency treated in our hospital between March 2013 and March 2016 were selected for study and randomly divided into observation group (n=40) and control group (n=40). Control group received conventional therapy and observation group received conventional + adjuvant salvia miltiorrhiza and ligustrazine therapy. After 3 months of treatment, differences in renal function indexes, illness-related indexes, renal blood perfusion, CTGF and TGF-β1 content, and so on of two groups of patients were determined. Results: After 3 months of treatment, serum urea nitrogen (BUN), serum creatinine (Scr),β2 microglobulin (β2-MG), intermedin (IMD), fibroblast growth factor 23 (FGF23), cystatin C (CysC), CTGF and TGF-β1 content as well as 24 h urine albumin excretion rate (UAER) level in urine of observation group were significantly lower than those of control group (P<0.05) while glomerular filtration rate (GFR) level and serum adiponectin (APN) content were significantly higher than those of control group (P<0.05);renal perfusion parameters renal cortex Tmax (ATc) and medulla Tmax (ATm) levels of observation group were significantly lower than those of control group while cortex peak intensity change (ΔAc), medulla peak intensity change (ΔAm) and peak intensity (PI) levels were significantly higher than those of control group.Conclusions:Adjuvant salvia miltiorrhiza and ligustrazine therapy can effectively control the overall condition of patients with chronic renal failure, and plays a positive role in improving renal function and increasing renal blood perfusion.

Framework nucleic Acid-MicroRNA mediated hepatic differentiation and functional hepatic spheroid development for treating acute liver failure

The specific induction of hepatic differentiation presents a significant challenge in developing alternative liver cell sources and viable strategies for clinical therapy of acute liver failure (ALF). The past decade has witnessed the blossom of microRNAs in regenerative medicine. Herein, microRNA 122-functionalized tetrahedral framework nucleic acid (FNA-miR-122) has emerged as an unprecedented and potential platform for directing the hepatic differentiation of adipose-derived mesenchymal stem cells (ADMSCs), which offers a straightforward and cost-effective method for generating functional hepatocyte-like cells (FNA-miR-122-iHep). Additionally, we have successfully established a liver organoid synthesis strategy by optimizing the co-culture of FNA-miR-122-iHep with endothelial cells (HUVECs), resulting in functional Hep:HUE-liver spheroids. Transcriptome analysis not only uncovered the potential molecular mechanisms through which miR-122 influences hepatic differentiation in ADMSCs, but also clarified that Hep:HUE-liver spheroids could further facilitate hepatocyte maturation and improved tissue-specific functions, which may provide new hints to be used to develop a hepatic organoid platform. Notably, compared to transplanted ADMSCs and Hep-liver spheroid, respectively, both FNA-miR-122-iHep-based single cell therapy and Hep:HUE-liver spheroid-based therapy showed high efficacy in treating ALF in vivo. Collectively, this research establishes a robust system using microRNA to induce ADMSCs into functional hepatocyte-like cells and to generate hepatic organoids in vitro, promising a highly efficient therapeutic approach for ALF.

Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure

AIM:To investigate the survival rates and prognostic factors in patients with hepatitis B virus-related acuteon-chronic liver failure(HBV-ACLF).METHODS:Clinical data in hospitalized patients with HBV-ACLF admitted from 2006 to 2009 were retrospectively analyzed.Their general conditions and survival were analyzed by survival analysis and Cox regression analysis.RESULTS:A total of 190 patients were included in this study.The overall 1-year survival rate was 57.6%.Patients not treated with antiviral drugs had a significantly higher mortality[relative risk(RR)=0.609,P=0.014].The highest risk of death in patients with ACLF was associated with hepatorenal syndrome(HRS)(RR=2.084,P=0.026),while other significant factors were electrolyte disturbances(RR=2.062,P=0.010),and hepatic encephalopathy(HE)(RR=1.879,P<0.001).CONCLUSION:Antiviral therapy has a strong effect on the prognosis of the patients with HBV-ACLF by improving their 1-year survival rate.HRS,electrolyte disturbances,and HE also affect patient survival.

Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure

BACKGROUNDHepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is animportant type of liver failure in Asia. There is a direct relationship between HBVACLFand gastrointestinal barrier function. However, the nutritional status ofHBV-ACLF patients has been poorly studied.AIMTo investigate the nutritional risk and nutritional status of HBV-ACLF patientsand evaluated the impact of nutritional support on the gastrointestinal barrier and28-d mortality.METHODSNutritional risk screening assessment and gastrointestinal barrier biomarkers ofpatients with HBV-ACLF (n = 234) and patients in the compensatory period ofliver cirrhosis (the control group) (n = 234) were compared during the periodbetween 2016 and 2018. Changes were analyzed after nutritional support in HBVACLFpatients. Valuable biomarkers have been explored to predict 28-d death.The 28-d survival between HBV-ACLF patients with nutritional support (n = 234)or no nutritional support (2014-2016) (n = 207) was compared.RESULTSThe nutritional risk of the HBV-ACLF patients was significantly higher than thatof the control group. The nutritional intake of the patients with HBV-ACLF waslower than that of the control group. The decrease in skeletal muscle and fatcontent and the deficiency of fat intake were more obvious (P < 0.001). Thecoccus-bacillus ratio, secretory immunoglobulin A, and serum D-lactate weresignificantly increased in HBV-ACLF patients. The survival group had a lowernutritional risk, lower D-lactate, and cytokine levels (endotoxin, tumor necrosisfactor alpha, interleukin-10, and interleukin-1). Interleukin-10 may be a potentialpredictor of death in HBV-ACLF patients. The 28-d survival of the nutritionalsupport group was better than that of the non-nutritional support group (P =0.016).CONCLUSIONPatients with HBV-ACLF have insufficient nutritional intake and high nutritionalrisk, and their intestinal barrier function is impaired. Individualized and dynamicnutritional support is associated with a better prognosis of 28-d mortality in HBVACLFpatients.

Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

Early plasma exchange and continuous renal replacement therapy improve puerperal prognosis in hepatitis B virus-related acute-on-chronic liver failure in pregnancy

Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients

Hepatocellular carcinoma(HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with liver cirrhosis.Liver resection is considered the most potentially curative therapy for HCC patients when liver transplantation is not an option or is not immediately accessible.This review is aimed at investigating the current concepts that drive the surgical choice in the treatment of HCC in cirrhotic patients;Eastern and Western perspectives are highlighted.An extensive literature review of the last two decades was performed,on topics covering various aspects of hepatic resection.Early post-operative and long-term outcome measures adopted were firstly analyzed in an attempt to define an optimal standardization useful for research comparison.The need to avoid the development of post-hepatectomy liver failure represents the "conditio sine qua non" of surgical choice and the role of the current tools available for the assessment of liver function reserve were investigated.Results of hepatic resection in relationship with tumor burden were compared with those of available competing strategies,namely,radiofrequency ablation for early stages,and trans-arterial chemoembolization for intermediate and advanced stages.Finally,the choice for anatomical versus non-anatomical,as well as the role of laparoscopic approach,was overviewed.The literature review suggests that partial hepatectomy for HCC should be considered in the context of multi-disciplinary evaluation of cirrhotic patients.Scientific research on HCC has moved,in recent years,from surgical therapy toward non-surgical approaches and most of the literature regarding topics debated in the present review is represented by observational studies,whereas very few well-designed randomized controlled trials are currently available;thus,no robust recommendations can be derived.

Advanced therapeutic strategies for HBV-related acute-on-chronic liver failure

Acute-on-chronic liver failure （ACLF） is increasingly recognized as a distinct clinical entity and is as- sociated with a high short-term mortality. The most common cause of ACLF is chronic hepatitis B worldwide. Currently, there is no standardized approach for the management of ACLF and the efficacy and safety of therapeutic modalities are uncertain. DATA SOURCES： PubMed and Web of Science were searched for English-language articles. The search criteria focused on clinical trials and observational studies on the treatment of patients with HBV-related ACLF. RESULTS： Therapeutic approaches for ACLF in patients with chronic hepatitis B included nucleos（t）ide analogues, artificial liver support systems, immune regulatory therapy, stem cell therapy and liver transplantation. All of these therapeutic ap- proaches have shown the potential to improve liver function and increase patients＇ survival rate, but most of the studies were not randomized or controUed. CONCLUSION： Substantial challenges for the treatment of HBV-related ACLF remain and further basic research and ran- domized controlled clinical trials are needed.

Low-dose intermittent interferon-alpha therapy for HCV-related liver cirrhosis after curative treatment of hepatocellular carcinoma

AIM: To assess the efficacy of low-dose intermittent interferon (IFN) therapy in patients with hepatitis C virus (HCV)-related compensated cirrhosis who had received curative treatment for primary hepatocellular carcinoma (HCC). METHODS: We performed a prospective case controlled study. Sixteen patients received 3 MIU of natural IFN- alpha intramuscularly 3 times weekly for at least 48 wk (IFN group). They were compared with 16 matched historical controls (non-IFN group). RESULTS: The cumulative rate of first recurrence of HCC was not significantly different between the IFN group and the non-IFN group (0% vs 6.7% and 68.6% vs 80% at 1- and 3-year, P = 0.157, respectively). The cumulative rate of second recurrence was not also significantly different between the IFN group and the non-IFN group (0% vs 6.7% and 35.9% vs 67% at 1- and 3-year, P = 0.056, respectively). Although the difference in the Child-Pugh classification score between the groups at initial treatment of HCC was not signifi cant, the score was signifi cantly worse at the time of data analysis in the non-IFN group than IFN group (7.19 ± 1.42 vs 5.81 ± 0.75, P = 0.0008). The cumulative rate of deviation from objects of any treatment for recurrentHCC was also higher in the non-IFN group than IFN group (6.7% and 27% vs 0 and 0% at 1- and 3-year, P = 0.048, respectively). CONCLUSION: Low-dose intermittent IFN-alpha therapy for patients with HCV-related compensated cirrhosis after curative HCC treatment was effective by making patients tolerant to medical or surgical treatment for recurrent HCC in the later period of observation.

Past,present,and future of long-term treatment for hepatitis B virus

The estimated world prevalence of hepatitis B virus(HBV)infection is 316 million.HBV infection was identified in 1963 and nowadays is a major cause of cirrhosis and hepatocellular carcinoma(HCC)despite universal vaccination programs,and effective antiviral therapy.Long-term administration of nucleos(t)ide analogues(NA)has been the treatment of choice for chronic hepatitis B during the last decades.The NA has shown a good safety profile and high efficacy in controlling viral replication,improving histology,and decreasing the HCC incidence,decompensation,and mortality.However,the low probability of HBV surface antigen seroclearance made necessary an indefinite treatment.The knowledge,in recent years,about the different phases of the viral cycle,and the new insights into the role of the immune system have yielded an increase in new therapeutic approaches.Consequently,several clinical trials evaluating combinations of new drugs with different mechanisms of action are ongoing with promising results.This integrative literature review aims to assess the knowledge and major advances from the past of hepatitis B,the present of NA treatment and withdrawal,and the future perspectives with combined molecules to achieve a functional cure.

HFNC治疗AECOPD合并呼吸衰竭的疗效及安全性研究

目的探讨经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭的疗效及安全性。方法选择2021年1月至2023年1月新乡医学院第一附属医院收治的80例AECOPD合并呼吸衰竭患者进行研究,按随机数表法分为观察组和对照组各40例。对照组患者给予无创正压通气(NIPPV)治疗,观察组患者给予HFNC治疗,两组患者均连续治疗1周。比较两组患者的临床疗效及治疗前后的肺功能指标[第一秒最大呼气容积(FEV_(1))、FEV_(1)与用力肺活量比值(FEV_(1)/FVC)%、最大呼气流量(PEF)]、动脉血气指标[动脉氧分压(PaO_(2))、动脉二氧化碳(PaCO_(2))、血氧饱和度(SpO_(2))]、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)]水平,并记录两组患者的并发症发生情况。结果观察组患者的治疗总有效率为95.00%,明显高于对照组的80.00%,差异有统计学意义(P<0.05);观察组患者治疗后的FEV_(1)、FEV_(1)/FVC、PEF水平分别为(1.85±0.36)L、(68.64±6.73)%、(3.80±1.04)L/s,明显高于对照组的(1.53±0.38)L、(62.48±6.24)%、(3.26±0.98)L/s,差异均具有统计学意义(P<0.05);观察组患者治疗后的PaO_(2)、SpO_(2)水平分别为(88.46±6.73)mmHg、(86.25±12.31)%,明显高于对照组的(82.33±7.94)mmHg、(78.37±13.62)%,PaCO_(2)水平为(34.30±8.51)mmHg,明显低于对照组的(40.62±6.44)mmHg,差异均具有统计学意义(P<0.05);观察组患者治疗后的CRP、TNF-α、IL-4、IL-6水平分别为(5.16±0.32)mg/L、(30.93±2.60)mg/L、(40.81±6.54)pg/L、(41.02±7.60)pg/L,明显低于对照组的(7.57±1.02)mg/L、(52.78±3.83)mg/L、(57.04±7.40)pg/L、(64.86±8.91)pg/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的鼻舌干燥、腹胀、面部压伤的发生率分别为5.00%,2.50%,0,明显低于对照组的22.50%,17.50%,12.50%,差异均有统计学意义(P<0.05),而两组患者的低血压发生率比较差异无统计学意义(P>0.05)。结论HFNC治疗AECOPD合并呼吸衰竭能提高患者的肺功能,改善动脉血气指标,降低炎症指标和并发症的发生率,临床应用效果显著。

富马酸丙酚替诺福韦与恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者效果比较研究

目的分析比较富马酸丙酚替诺福韦与恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者的疗效。方法2020年1月~2023年1月我院收治的64例高血清病毒载量(HBVDNA为1×106 IU/mL或以上)的代偿期乙型肝炎肝硬化患者,被随机分为对照组32例和观察组32例,分别给予恩替卡韦和富马酸丙酚替诺福韦治疗,连续治疗观察12个月。使用高效液相色谱分析法检测尿液乳果糖/甘露醇(L/M)比值,采用比色法检测血清D-乳酸,采用紫外比色法检测血清二胺氧化酶(DAO),采用ELISA法检测血清内霉素和白细胞介素-7(IL-7),采用化学发光免疫分析法检测血清降钙素原(PCT),采用免疫荧光定量法检测肝素结合蛋白(HBP)。结果在观察治疗12个月末,两组均获得病毒学和生化学应答,两组血清TBIL、ALT和AST水平无显著性相差(P>0.05);观察组血清DAO、D-乳酸、内霉素和尿L/M比值分别为(2.8±0.6)U/mL、(7.9±1.8)μg/mL、(0.5±0.1)EU/mL和(7.3±1.6)%,与对照组【分别为(3.0±0.5)U/mL、(7.8±2.2)μg/mL、(0.6±0.1)EU/mL和(8.1±1.9)%,P>0.05】比,无显著性差异;观察组血清PCT、HBP和IL-7水平分别为(0.01±0.00)μg/L、(43.1±3.7)ng/mL和(768.9±20.3)pg/mL,与对照组【分别为(0.02±0.01)μg/L、(47.6±3.2)ng/mL和(743.4±21.5)pg/mL,P>0.05】比,无显著性差异。结论应用富马酸丙酚替诺福韦或恩替卡韦治疗高血清病毒载量的代偿期乙型肝炎肝硬化患者疗效肯定,对肠道屏障功能无明显的影响。

血浆置换在肝癌患者不同原因所致高胆红素血症中的疗效分析

目的探究血浆置换在肝癌患者不同原因所致高胆红素血症中的疗效。方法选取2022年7月至2023年7月赣州市人民医院收治的84例肝癌患者作为研究对象,根据高胆红素血症的发生原因分为肝衰竭组、胆道梗阻组及免疫治疗相关性肝炎组,每组28例。3组均在常规综合治疗后接受血浆置换治疗。比较3组治疗前后肝功能指标、凝血指标、血小板计数及临床疗效。结果治疗后,3组总胆红素、谷丙转氨酶、总胆汁酸水平均低于治疗前,白蛋白水平高于治疗前,免疫治疗相关性肝炎组总胆红素、总胆汁酸水平均低于肝衰竭组、胆道梗阻组,胆道梗阻组总胆红素、总胆汁酸水平均低于肝衰竭组,差异有统计学意义(P<0.05)。治疗后,3组凝血酶原活动度高于治疗前,血小板计数低于治疗前,差异有统计学意义(P<0.05);治疗后,3组凝血酶原活动度和血小板计数比较差异无统计学意义。3组4周治疗总有效率和12周生存率比较差异无统计学意义。结论血浆置换对肝癌肝衰竭、胆道梗阻、免疫治疗相关性肝炎所致高胆红素血症患者均有效果,但对肝癌胆道梗阻、免疫治疗相关性肝炎所致高胆红素血症的治疗效果更佳。

个性化的容量管理联合运动疗法对慢性心力衰竭病人预后的影响

目的:探讨个性化的容量管理联合运动疗法对慢性心力衰竭(CHF)病人预后的影响。方法:选择医院2020年5月—2023年2月收治的80例慢性心力衰竭病人作为研究对象,使用随机数字表法将其分为研究组与对照组,每组40例,对照组采取CHF常规治疗方案以及临床管理干预,研究组在其基础上采取个性化的容量管理联合运动疗法干预,两组均干预2个月,比较两组干预前后心功能指标、心功能级别、6 min步行距离、生活质量,随访至出院后12周,比较两组随访期间再入院和病死率情况。结果:干预后两组左心室射血分数(LVEF)均明显升高(P<0.05),LVEDD和NT-proBNP均明显降低(P<0.05),研究组各指标变化均较对照组更加明显(P<0.05);干预后两组心功能级别均明显降低,6 min步行距离均明显升高(P<0.05),研究组变化较对照组更加明显(P<0.05);干预后研究组MLHFQ评分明显降低(P<0.05),且低于对照组(P<0.05);研究组再入院率明显低于对照组(P<0.05),两组病死率无显著差异(P>0.05)。结论:个性化的容量管理联合运动疗法能显著改善了慢性心力衰竭病人的心功能、预后和生活质量。

呼吸衰竭新生儿应用呼吸支持治疗的效果

目的 探讨呼吸衰竭新生儿呼吸支持治疗的应用效果。方法 纳入2022年1月至2023年7月于寿光市人民医院住治疗的呼吸衰竭新生儿40例。用简单随机化分组,试验组和对照组各20例。对照组使头罩吸氧进行治疗,试验组使鼻塞持续呼吸道正压呼吸支持进行治疗。对两组患儿的治疗相关指标、血气分析指标及不良反应进行对比。结果 相比较对照组,试验组患儿各项治疗相关指标比较短,动脉氧分压和动脉血氧饱和指标较高,动脉二氧化碳分压较低,不良反应发生率较低(均P <0.05)。结论 采用鼻塞持续呼吸道正压呼吸支持治疗呼吸衰竭新生儿的效果较明显,患儿的血气分析水平得倒改善,同时还可以提升患儿肺功能,提高患儿的治愈率,降低患儿死亡率。