INTRODUCTIONHepatic encephalopathy ( HE) is a frequent complication of chronic liver disease .It is defined as a characteristic functional and reversible alteration of the mental state ,due to impaired liver function ...INTRODUCTIONHepatic encephalopathy ( HE) is a frequent complication of chronic liver disease .It is defined as a characteristic functional and reversible alteration of the mental state ,due to impaired liver function and / or increased portosystemic shunting .展开更多
AIM To investigate the impact of hepatic encephalopathybefore orthotopic liver transplantation(OLT) and neurological complications after OLT on employment after OLT.METHODS One hundred and fourteen patients with chron...AIM To investigate the impact of hepatic encephalopathybefore orthotopic liver transplantation(OLT) and neurological complications after OLT on employment after OLT.METHODS One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-SyndromeTest yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS), completed a questionnaire concerning their occupation and filled in the short form 36(SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight(59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45(66.2%) male], and 46(40.4%) patients were included directly after OLT. RESULTS Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics(employed: Academic/non-academic 16(34.0%)/31 vs not employed 10(17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy(HE)(yes/no; employed 15(30.6%)/34 vs not employed 32(49.2%)/33, P = 0.05) and achieved worse results in psychometric tests(RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients(18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median(range, min-max) employed 47(42, 18-60) vs not employed 50(31, 29-60), P = 0.01], achieved better results in the psychometric tests(RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life(SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT(P < 0.001), age(P < 0.01) and SF-36 sum score 12 mo after OLT(P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT.CONCLUSION HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermo...BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.展开更多
目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者...目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者的凝血酶原时间(PT)、凝血酶时间(TT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(T-BILI)、直接胆红素(D-BILI)和总胆汁酸(TBA)等生化指标的变化;同时观察2组患者的临床症状及体征的改变,评价整体疗效,并在统计分析患者病情分期、并发症与血浆置换治疗重型肝炎疗效的关系后,做出临床评判。结果 1)PE组治疗前后凝血功能和肝功能生化指标分别为:PT(s)24.5±9.19 vs17.8±6.71、TT(s)16.6±3.87 vs 17.9±11.82、ALT(U/L)281.2±271.16 vs 69.4±91.97、AST(U/L)285.8±247.91vs 64.8±43.94、T-BILI(μmol/L)407.0±178.99 vs 238.2±143.76、D-BILI(μmol/L)316.1±131.09 vs 167.4±110.85、TBA(μmol/L)141.7±83.56 vs 140.6±86.26;2)总体有效率(%),PE与对照组为56.41 vs 30.00,其中早、中、晚期的重型肝炎有效率分别为81.25 vs 41.67、53.85 vs 40.00、20.00 vs 12.50(P<0.05);3)并发自发性腹膜炎的患者治疗后的有效率(%),PE与对照组分别为70.00 vs 40.00。结论 PE是治疗重型肝炎的1种安全、有效方法;对于早期重症肝炎患者疗效优于中晚期重症肝炎患者,对合并自发性腹膜炎患者的疗效优于单纯内科综合疗法。展开更多
基金This work was supported by Deutsche Forschungsgemeinschaft (Sonderforschungsbereich 503"Molekulare und zellulare Mechanismen exogener Noxen"and SFB 575"Experimentelle Hepatologie")
文摘INTRODUCTIONHepatic encephalopathy ( HE) is a frequent complication of chronic liver disease .It is defined as a characteristic functional and reversible alteration of the mental state ,due to impaired liver function and / or increased portosystemic shunting .
基金Supported by The German Federal Ministry of Education and Research,No.01EO0802
文摘AIM To investigate the impact of hepatic encephalopathybefore orthotopic liver transplantation(OLT) and neurological complications after OLT on employment after OLT.METHODS One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-SyndromeTest yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS), completed a questionnaire concerning their occupation and filled in the short form 36(SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight(59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45(66.2%) male], and 46(40.4%) patients were included directly after OLT. RESULTS Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics(employed: Academic/non-academic 16(34.0%)/31 vs not employed 10(17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy(HE)(yes/no; employed 15(30.6%)/34 vs not employed 32(49.2%)/33, P = 0.05) and achieved worse results in psychometric tests(RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients(18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median(range, min-max) employed 47(42, 18-60) vs not employed 50(31, 29-60), P = 0.01], achieved better results in the psychometric tests(RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life(SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT(P < 0.001), age(P < 0.01) and SF-36 sum score 12 mo after OLT(P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT.CONCLUSION HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.
文摘目的评价血浆置换(PE)治疗重型肝炎的疗效及安全性。方法回顾性分析69名重型肝炎患者的临床资料,按其治疗方式的不同分为治疗(PE)组:39名,在内科综合治疗基础上行血浆置换;对照组:30名,单纯内科综合治疗。于治疗前、后24 h检测PE组患者的凝血酶原时间(PT)、凝血酶时间(TT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(T-BILI)、直接胆红素(D-BILI)和总胆汁酸(TBA)等生化指标的变化;同时观察2组患者的临床症状及体征的改变,评价整体疗效,并在统计分析患者病情分期、并发症与血浆置换治疗重型肝炎疗效的关系后,做出临床评判。结果 1)PE组治疗前后凝血功能和肝功能生化指标分别为:PT(s)24.5±9.19 vs17.8±6.71、TT(s)16.6±3.87 vs 17.9±11.82、ALT(U/L)281.2±271.16 vs 69.4±91.97、AST(U/L)285.8±247.91vs 64.8±43.94、T-BILI(μmol/L)407.0±178.99 vs 238.2±143.76、D-BILI(μmol/L)316.1±131.09 vs 167.4±110.85、TBA(μmol/L)141.7±83.56 vs 140.6±86.26;2)总体有效率(%),PE与对照组为56.41 vs 30.00,其中早、中、晚期的重型肝炎有效率分别为81.25 vs 41.67、53.85 vs 40.00、20.00 vs 12.50(P<0.05);3)并发自发性腹膜炎的患者治疗后的有效率(%),PE与对照组分别为70.00 vs 40.00。结论 PE是治疗重型肝炎的1种安全、有效方法;对于早期重症肝炎患者疗效优于中晚期重症肝炎患者,对合并自发性腹膜炎患者的疗效优于单纯内科综合疗法。
