BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degre...BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.展开更多
Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjec...Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.展开更多
BACKGROUND Immune checkpoint inhibitors(ICIs)can lead to immune-related hepatitis(IRH)and severe liver damage,which is life-threatening in the absence of specific treatment.CASE SUMMARY A 75-year-old man was admitted ...BACKGROUND Immune checkpoint inhibitors(ICIs)can lead to immune-related hepatitis(IRH)and severe liver damage,which is life-threatening in the absence of specific treatment.CASE SUMMARY A 75-year-old man was admitted to our hospital complaining of loss of appetite,yellow urine,and abnormal liver function for the past 2 wk.Three months prior to admission,he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer.Although liver function was normal before treatment,abnormal liver function appeared at week 5.Capecitabine and camrelizumab were discontinued.Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered.Liver function continued to deteriorate.Prothrombin time and international normalized ratio were 19 s and 1.8,respectively.The patient was diagnosed with acute liver failure.A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+cells,thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab.Subsequently,we performed sequential dual-molecule plasma adsorption system(DPMAS)treatment with plasma exchange(PE).After two rounds of treatment,the patient's appetite significantly improved,the yellow color of urine reduced,and liver function improved(total bilirubin level decreased)after five rounds of treatment.Liver function normalized 4 wk after discharge.CONCLUSION The use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood,and regulate immune cell activity,which may be effective in the treatment of severe ICI-induced IRH.展开更多
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 plas...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.展开更多
BACKGROUND: Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever...BACKGROUND: Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare. METHODS: A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever. RESULTS: Urethritis was confirmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered. CONCLUSION: The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of complications.展开更多
Background:thrombotic thrombocytopenic purpura(TTP)is an autoimmune disease with high mortality.An AD AMTS 13(a disintegrin and metallopro-tection with a thrombospondin type 1 motif,member 13)activity level of less th...Background:thrombotic thrombocytopenic purpura(TTP)is an autoimmune disease with high mortality.An AD AMTS 13(a disintegrin and metallopro-tection with a thrombospondin type 1 motif,member 13)activity level of less than 10% supports the diagnosis of TTP in appropriate clinical contexts.Historically,nearly all patients died during the first month of illness with severe hemolytic anemia,abundant schistocytes,profound thrombocytopenia,neurological deficits,renal injury,and fever.Most such patients have severe ADAMTS13 deficiency.Currently,the first-line treatment of TTP including plasma exchange therapy and preemptive B-cell depletion with rituximab can increase the survival rate and reduce the recurrence rate.Case presentation:a 34-year-old male patient who presented with hemato-chezia and progression of disorder of consciousness was misdiagnosed with esophageal and gastric varices bleeding and hepatic encephalopathy based on his history of hepatitis B.However,he was diagnosed with TTP based on clinical and laboratory results.He received comprehensive and systemic treatments including taking methylprednisolone,rituximab,and multiple sessions of plasmapheresis.The patient recovered well after active treatment.Conclusion:in this article,we reported a patient diagnosed as TTP and reviewed the disease characteristics,pathogenesis,and treatment of TTP in order to deepen the understadning of TTP and to reduce its missed diagnosis and misdiagnosis.展开更多
文摘BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.
文摘Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.
文摘BACKGROUND Immune checkpoint inhibitors(ICIs)can lead to immune-related hepatitis(IRH)and severe liver damage,which is life-threatening in the absence of specific treatment.CASE SUMMARY A 75-year-old man was admitted to our hospital complaining of loss of appetite,yellow urine,and abnormal liver function for the past 2 wk.Three months prior to admission,he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer.Although liver function was normal before treatment,abnormal liver function appeared at week 5.Capecitabine and camrelizumab were discontinued.Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered.Liver function continued to deteriorate.Prothrombin time and international normalized ratio were 19 s and 1.8,respectively.The patient was diagnosed with acute liver failure.A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+cells,thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab.Subsequently,we performed sequential dual-molecule plasma adsorption system(DPMAS)treatment with plasma exchange(PE).After two rounds of treatment,the patient's appetite significantly improved,the yellow color of urine reduced,and liver function improved(total bilirubin level decreased)after five rounds of treatment.Liver function normalized 4 wk after discharge.CONCLUSION The use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood,and regulate immune cell activity,which may be effective in the treatment of severe ICI-induced IRH.
基金supported by grants from the National Natural Science Foundation of China(NO.82270690)to Huimin Yithe National Natural Science Foundation of China(NO.82200732)to Xuxia Wei+1 种基金the Guangdong Natural Science foundation(NO.2022A1515012519)to Xuxia Weithe Guangdong Natural Science foundation(NO.2022A1515011919)to Huimin Yi.
文摘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.
基金supported by grants from the EleventhFive-year Key Program(07Z007-A)the 122 Training Planof the Department of Health,Nanjing Military Area(122-1A)
文摘BACKGROUND: Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare. METHODS: A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever. RESULTS: Urethritis was confirmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered. CONCLUSION: The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of complications.
文摘Background:thrombotic thrombocytopenic purpura(TTP)is an autoimmune disease with high mortality.An AD AMTS 13(a disintegrin and metallopro-tection with a thrombospondin type 1 motif,member 13)activity level of less than 10% supports the diagnosis of TTP in appropriate clinical contexts.Historically,nearly all patients died during the first month of illness with severe hemolytic anemia,abundant schistocytes,profound thrombocytopenia,neurological deficits,renal injury,and fever.Most such patients have severe ADAMTS13 deficiency.Currently,the first-line treatment of TTP including plasma exchange therapy and preemptive B-cell depletion with rituximab can increase the survival rate and reduce the recurrence rate.Case presentation:a 34-year-old male patient who presented with hemato-chezia and progression of disorder of consciousness was misdiagnosed with esophageal and gastric varices bleeding and hepatic encephalopathy based on his history of hepatitis B.However,he was diagnosed with TTP based on clinical and laboratory results.He received comprehensive and systemic treatments including taking methylprednisolone,rituximab,and multiple sessions of plasmapheresis.The patient recovered well after active treatment.Conclusion:in this article,we reported a patient diagnosed as TTP and reviewed the disease characteristics,pathogenesis,and treatment of TTP in order to deepen the understadning of TTP and to reduce its missed diagnosis and misdiagnosis.
