Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There was no significant difference in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, or etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.
目的 比较进展性慢性肝病及重症肝炎患者原位肝移植(OLT)围手术期凝血功能的变化。方法 回顾性分析我中心2004年1月至2005年12月期间行OLT治疗进展性慢性肝病及重症肝炎患者各37例的围手术期血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化。结果 2组患者除术前PT、APTT,术后第5 d PLT、FIB和术后第7 d FIB的差异有统计学意义外（plt;0.05），其余时段2组患者的PLT、PT、APTT及FIB 间差异均无统计学意义（Pgt;0.05）, 提示重症肝炎患者凝血功能损害更为严重； OLT术后，2组患者的凝血功能均逐渐恢复正常, 但并非完全同步。结论 进展性慢性肝病与重症肝炎患者OLT围手术期凝血功能变化显著，应注意监测及处理，但术后2组间各指标间比较差异并不明显。
Objective To investigate and analyze the relationships among glucagon-like peptide-1 (GLP-1) level, chronic inflammation, and atherosclerosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods From October 2016 to February 2017, using cross-sectional investigation, the GLP-1 level, chronic inflammation, and atherosclerosis were investigated in 80 subjects (40 NAFLD patients in NAFLD group, and 40 non-fatty liver disease participants in control group) who underwent physical examination at Xi’an Road Community Hospital. Results Compared with those in the control group, GLP-1 fasting level in patients with NAFLD [(9.09±1.03) vs. (9.15±1.06) pmol/L, P=0.807] and postprandial plasma GLP-1 [(15.96±3.37) vs. (17.46±4.76) pmol/L, P=0.108] had no changes. The correlations of GLP-1 level with chronic inflammation and insulin resistance (IR) were not significant either. The increased risk of carotid intima-media thickness related cardiovascular disease (CVD) in the NAFLD group was greater than that in the control group, and the difference was statistically significant [22 (55.0%)vs.13 (32.5%), P=0.043]. When the plasma lipoprotein-associated phospholipase A2 level increased, the risk of NAFLD increased [odd ratio (OR)=1.16, 95% confidence interval (CI) (1.02, 1.32), P=0.023]. Plasma ceramide kinase (CERK) in the NAFLD group was lower than that in the control group, and the difference was statistically significant [(12.36±2.45) vs. (18.33±3.71) ng/mL, P<0.001]. When the plasma CERK level of the fasting plasma was elevated, the risk of NAFLD decreased [OR=0.30, 95%CI (0.12, 0.78), P=0.014]. The homeostasis model assessment of insulin resistance (HOMA-IR) in the NAFLD group was higher than that in the control group, and the difference was statistically significant (2.46±2.53 vs. 1.11±0.66, P=0.002). The Matsuda index in the NAFLD group was less than that in the control group, and the difference was statistically significant (5.88±4.09 vs. 10.46±7.90, P=0.002). When HOMA-IR increased, the risk of NAFLD increased [OR=2.75, 95%CI (2.49, 3.12), P=0.036]. Conclusions Plasma GLP-1 level is not a sensitive indicator of chronic inflammation and IR in patients with NAFLD. Patients with NAFLD are in an increased risk of atherosclerosis and CVD. It suggests that NAFLD might be involved in chronic inflammation and IR. Chronic inflammation can cause IR, and then chronic inflammation and IR can cause NAFLD and subclinical atherosclerosis. In return for this, NAFLD increases chronic inflammation and IR.
【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.
ObjectiveTo investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (HP) infection. MethodsMedical examination data of healthy physical examination participates who underwent carbon 14 urea breath test for detection of HP and abdominal ultrasound examination between March and June 2015 were analyzed. Cross sectional analysis was carried out. Based on the diagnostic criteria of NAFLD, the subjects were divided into two groups: NAFLD group and normal control group. HP infection was compared between the two groups. Logistics regression analysis was performed to analyze the relationship between HP infection and NAFLD. ResultsThe proportion of men, age, weight, body mass index (BMI), waistline, alanine aminotransferase (ALT), aspartate aminotransferase, glutamyl transferase, albumin, fasting blood-glucose (GLU), total cholesterol triacylglycerol (TG), low density lipoprotein-cholesterol, and blood pressure were all significantly higher in the NAFLD group than the control group (P < 0.05), while height and high density lipoprotein-cholesterol were significantly lower in the NAFLD group (P < 0.05). The detection rate of NAFLD in males was higher than that in females. The detection rates of NAFLD in different age groups were significantly different, and the highest detection rate of NAFLD was in the age group of 50-59 years old (P < 0.05). The rate of HP infection was not significantly different in subjects of different ages and genders (P > 0.05). The rate of HP infection in the NAFLD group was significantly higher than those of the control group in age groups of 18-29, 30-39, 40-49, 50-59, and 70-79 years old (P < 0.05). The logistic regression analysis revealed that age, HP infection, TG, ALT, BMI, GLU, and diastolic pressure were correlated with NAFLD (P < 0.05). ConclusionHP infection may be a risk factor in the development of NAFLD.
目的:探讨激素及免疫抑制剂导致乙肝病毒再激活所致的肝损害的危害性及治疗效果，指导临床治疗。方法：总结本院近2年收治的7例慢性乙肝病毒感染者在使用激素及免疫抑制剂致肝炎再激活并加重患者的临床资料进行分析。结果：慢性乙肝病毒感染者因各种原因使用激素及免疫抑制剂所导致的慢性乙肝的复发加重，病情发展迅速，病死率高。结论：抗乙肝病毒治疗是预防肝病复发并恶化的关键，在激素或免疫抑制剂治疗前和治疗中都应使乙肝病毒降至尽可能低的水平。
ObjectivesTo evaluate the quality of guidelines on nutrition in liver disease from 2017 to 2019, and to interpret these guidelines so as to provide references for clinical practice.MethodsComputer-assisted literature searches in CNKI, VIP, WanFang Data, Medline (Ovid), The Cochrane Library, PubMed and Medlive databases were performed by two reviewers for guidelines on nutrition in liver disease from January 2017 to July 2019. Two reviewers extracted data and assessed the methodological quality of the included guidelines using AGREE II, separately. Meanwhile, the intraclass correlation coefficient (ICC) was used to assess the degree of consistency.ResultsFour guidelines were included with 2 from China and 2 from Europe. Their average standardised scores in the 6 domains of scope and purpose, stakeholder involvement, rigour of development, clarity, applicability and independence were 79.17%, 71.53%, 78.13%, 85.42%, 61.98% and 43.75%, respectively. The Chinese and European guidelines had similar recommendations for energy and other nutrients, apart from differences in recommendations for protein intake. The European guidelines considered that restricting protein intake was not beneficial for patients with hepatic encephalopathy, while the Chinese guidelines argued that patients with severe hepatic encephalopathy were required to reduce or limit their protein intake.ConclusionsAll 4 guidelines are of average quality and are required to be strengthened in the ‘independence’ domain. Currently, the only consensus on nutrition therapy for liver disease and guidelines on nutrition in end-stage liver disease are available for references in China, with lower quality scores than that of the European guidelines. Therefore, the evidence-based guidelines on nutrition in liver disease should be developed by Chinese national conditions as soon as possible to provide references for clinicians, nurses and clinical nutritionists, enableing them to implement nutrition screening, evaluation, nutritional therapy and follow-up management for patrents with liver disease.
ObjectivesTo systematically review the association between serum high sensitivity C-reactive protein (HS-CRP) and nonalcoholic fatty liver disease (NAFLD).MethodsPubMed, EMbase, The Cochrane Library, CNKI, SinoMed and WanFang Data databases were electronically searched to collect case-control studies on the association between HS-CRP and NAFLD from inception to October, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 22 case-control studies involving 5 825 subjects were included. The results of meta-analysis showed that HS-CRP levels in NAFLD group were higher than non-NAFLD group (SMD=1.25, 95%CI 0.81 to 1.68, P<0.000 01). The results of subgroup analysis showed that, HS-CRP levels in NAFLD group were higher in Asian region (SMD=1.32, 95%CI 0.82 to 1.83, P<0.000 01), however not in American region (SMD=0.48, 95%CI −0.02 to 0.98, P=0.06). HS-CRP levels in NAFLD group were higher in BMI≥30 kg/m2 group (SMD=0.37, 95%CI 0.19 to 0.54, P<0.000 1), however not in BMI<30 kg/m2 group (SMD=1.19, 95%CI −0.28 to 2.66, P=0.11). Additionally, HS-CRP levels in NAFLD group were higher with or without diabetes (SMD=0.86, 95%CI 0.49 to 1.24, P<0.000 01; SMD=1.47, 95%CI 0.84 to 2.10, P<0.000 01).ConclusionsCurrent evidence shows that NAFLD patients have higher levels of HS-CRP than non-NAFLD patients, and are affected by high levels of BMI and geographical regions. Therefore, HS-CRP may play important roles in the non-invasive field of NAFLD detection. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
This study sought to investigate the in vivo antiviral effect of amantadine (AM) and biphenyl dimethyl dicarboxylate (DDB) on hepatitis B virus (HBV) in HBV replication mice. HBV replication-competent plasmid was transferred into male BALB/c mice by using hydrodynamics-based in vivo transfection procedure to develop HBV replication mouse model. The model mice were matched by body weigh, age and serum levels of hepatitis B e antigen (HBeAg) and were divided into four groups:AM group, DDB group, AM+DDB group and NS group, with the last one as control, and the mice of each group were administered corresponding agent orally twice a day, in a medication course lasting 3 d. On the third day, the mice were sacrificed 4-6 h after the last oral intake. HBV DNA replication intermediates in liver were analyzed by Southern blot hybridization. The serum hepatitis B surface antigen (HBsAg) and HBeAg were detected by enzyme linked immunosorbent assay (ELISA). Compared to the animals in the control group, HBV DNA replication intermediates in liver and HBsAg and HBeAg in serum from the AM and AM plus DDB group of mice decreased, and there was no difference between these two groups of mice. The levels of HBV DNA intermediate from liver and the serum HBsAg and HBeAg between the control and DDB group, however, were not obviously different. In conclusion, the inhibition effect of AM on HBV was detected, but treatment with DDB for 3 days did not influence the viral replication and expression of HBV in the HBV replication mice.