中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2019 Vol. 35, No. 11

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Editorial
Development and innovation of liver transplantation in China
Shen ZhongYang
2019, 35(11): 2377-2385. DOI: 10.3969/j.issn.1001-5256.2019.11.001
Abstract:
After 20 years of rapid development,liver transplantation in China has become an important part of this field in the world. In response to hepatitis B-associated liver disease and liver cancer,China has issued the guidelines and standards for liver transplantation in line with our own national conditions and has thus further expanded the number of liver transplantation recipients. At the same time,the improvement in science and technology has effectively promoted the continuous innovation of the surgical techniques of liver transplantation in China,and China has become one of the leading countries in the fields of laparoscopic donor surgery,xenogeneic liver transplantation,non-ischemic liver transplantation,and living donor liver transplantation. At present,donor shortage remains one of the important factors that limit the development of liver transplantation in China. The organ donation work in China has a long way to go. There is still a long way to go for organ donation in China.
Discussions by experts
Tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation
Liu YiHe, Zheng Hong, Shen ZhongYang
2019, 35(11): 2386-2390. DOI: 10.3969/j.issn.1001-5256.2019.11.002
Abstract:
With the continuous improvement of liver transplantation techniques and the innovation of related disciplines,great changes have been observed in the etiology and clinical outcome of middle-and long-term complications after liver transplantation,and thus related prevention and treatment strategies are worthy of exploration and adjustment. In recent years,breakthroughs have been made in the prevention and treatment of post-transplantation complications including the recurrence of hepatitis,but standardized diagnosis and treatment should be strengthened in order to maximize the benefits of recipients. So far,the prevention and treatment of middle-and long-term complications with unknown pathogenesis and complicated causes after liver transplantation still rely on the long-term monitoring,prevention,and control of related risk factors. The main tasks of long-term management of liver transplantation recipients is to maintain the function of transplanted liver,control the recurrence of primary diseases,prevent and treat the new-onset diseases,and continue to treat the concomitant diseases before surgery. This article elaborates on the tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation.
Risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma and related control strategies
Zheng WeiPing, Shen ZhongYang
2019, 35(11): 2391-2395. DOI: 10.3969/j.issn.1001-5256.2019.11.003
Abstract:
Tumor recurrence after liver transplantation for hepatocellular carcinoma is the main cause of significant reductions in the survival rates of patients and grafts. Risk factors for tumor recurrence after liver transplantation include pathological and biological features,factors associated with the recipient,factors associated with the donor and donor liver,and surgery-related factors. Immunosuppression regimen and various adjuvant therapies may help to prevent tumor recurrence. For patients undergoing liver transplantation for hepatocellular carcinoma,further studies are needed to investigate early identification of risk factors for tumor recurrence and related comprehensive prevention and treatment measures.
An analysis of related issues in long-term survival in children after liver transplantation
Lu YeFeng, Xia Qiang, Qiu BiJun, Feng MingXuan, Wan Ping
2019, 35(11): 2396-2401. DOI: 10.3969/j.issn.1001-5256.2019.11.004
Abstract:
Liver transplantation is a mature treatment for children with end-stage liver disease. With the development of surgical techniques,immunosuppressive therapy,and infection monitoring in recent years,there have been significant increases in the survival rates of patients and liver transplants,helping children to achieve long-term survival. Meanwhile,several issues have emerged,such as viral infection,complications,new-onset tumors,quality of life,and self-management. Therefore,this article reviews related issues in long-term survival in children after liver transplantation from the two aspects of medical treatment and nursing and provides several regimens for reference,so as to provide a basis for long-term high-quality survival in children after liver transplantation. Here,these issues are reviewed.
Research advances in immune tolerance in children receiving liver transplantation
Wang Kai, Gao Wei
2019, 35(11): 2402-2407. DOI: 10.3969/j.issn.1001-5256.2019.11.005
Abstract:
Compared with adult recipients,pediatric liver transplantation recipients have urgent needs for immune tolerance,with a higher probability of successful realization of immune tolerance. However at present,there is still a lack of effective experimental regimens,immune monitoring methods,and graft histological evaluation after long-term discontinuation of immunosuppressive agents in clinical practice,which results in the fact that immune tolerance stays in the theoretic stage and is not effectively implemented in clinical practice. This article reviews the advances and difficulties in immune tolerance in pediatric liver transplantation recipients in recent years,in order to provide help for operational immune tolerance in future.
Guidelines
Expert recommendations on standardized diagnosis and treatment for fatty liver disease (2019 revised edition)
Committee of Hepatology, Chinese Research Hospital Association, Fatty Liver Expert Committee, Chinese Medical Doctor Association, National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, National Workshop on Liver and Metabolism, Chinese Society of Endocrinology, Chinese Medical Association
2019, 35(11): 2426-2430. DOI: 10.3969/j.issn.1001-5256.2019.11.007
Abstract:

Nonalcoholic fatty liver disease( NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician,this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows:( 1) the framework of NAFLD treatment centre or clinic;( 2) screening and evaluation: who should be screened,initial evaluation items,non-invasive assessment of steatohepatitis and advanced fibrosis,when to obtain a liver biopsy in patients with NAFLD,and other metabolic disorders and cardiovascular risk assessment;( 3) managements of patient with NAFLD: lifestyle intervention( dietary,exercise and weight loss),drug treating metabolic co-morbidities such as hyperlipidemia,type 2 diabetes mellitus and hypertension,and steatohepatitis and fibrosis;( 4) management of special populations with NAFLD: children,pregnant or lactating women,patients co-existence with alcoholic liver disease,chronic HBV and/or HCV infection,and autoimmune disorders;( 5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.

Guidelines for the diagnosis and treatment of hepatoblastoma (2019)
Compilation and Examination Expert Group for Guidelines for the diagnosis and treatment of hepatoblastoma (2019)
2019, 35(11): 2431-2434. DOI: 10.3969/j.issn.1001-5256.2019.11.008
Abstract:
Expert recommendation for operational norms of laparoscopic radical resection of perihilar cholangiocarcinoma
The Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma, Editorial Board of Chinese Journal of Surgery
2019, 35(11): 2441-2446. DOI: 10.3969/j.issn.1001-5256.2019.11.010
Abstract:

Radical resection is the only curable treatment for perihilar cholangiocarcinoma. With the continuous renewal of laparoscopic instruments and the continuous improvement of technology,laparoscopic radical resection of perihilar cholangiocarcinoma has been gradually carried out in China,and its feasibility and safety have been recognized by some domestic peers. In order to standardize clinical diagnosis and treatment behavior,ensure patients receive safe and standardized treatment and improve prognosis,so that the operation can be standardized application and development. Based on the principles of treatment of perihilar cholangiocarcinoma and the corresponding technical norms of laparoscopic operation,the Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma and Editorial Board of Chinese Journal of Surgery have organized relevant domestic expels to formulate expert recommendations for laparoscopic radical resection of perihilar cholangiocarcinoma,so as to facilitate clinical practice and standardized application.

Recommendations for diagnosis and treatment of alcohol-related liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases
Li ZhiGuo, Zhu Shun, Li Shuo, Ye YongAn
2019, 35(11): 2447-2448. DOI: 10.3969/j.issn.1001-5256.2019.11.011
Abstract:
Original articles_Viral hepatitis
Change in the level of T-cell receptor rearrangement excision circles after antiviral therapy in patients with chronic hepatitis B
Xiong Fang, Ma YanPin, Bao XuLi, Lu: Jun
2019, 35(11): 2449-2452. DOI: 10.3969/j.issn.1001-5256.2019.11.012
Abstract:
Objective To investigate the change in the level of T-cell receptor rearrangement excision circles( TREC) after antiviral therapy with thymopentin( TP5) and entecavir( ETV) in HBeAg-positive chronic hepatitis B( CHB) patients. Methods A total of 30 HBeAg-positive CHB patients who were diagnosed and treated in Beijing YouAn Hospital,Capital Medical University,from October 2014 to September 2016 were enrolled. All patients were given ETV combined with TP5 for 48 weeks. Real-time PCR was used to measure the level of TREC in peripheral blood mononuclear cells( PBMCs),and the change in TREC after treatment was analyzed. The correlation of TREC level with HBV DNA,HBeAg,and HBsAg was analyzed. The t-test was used for comparison of continuous data between two groups,and a Spearman correlation analysis was used to investigate the correlation between two indices. Results After the combined treatment for 48 weeks,24 patients achieved virologic response,and 3 achieved HBeAg clearance. The level of TREC significantly increased from 6. 03 ± 1. 71 copies/103 PBMCs before treatment to 10. 61 ± 2. 08 copies/103 PBMCs after treatment( t = 9. 32,P < 0. 000 1). The patients in the virologic response group had a significant increase in the level of TREC after treatment( 11. 21 ± 1. 71 copies/103 PBMCs vs5. 79 ± 1. 84 copies/103 PBMCs,t = 10. 57,P < 0. 000 1),while those in the non-virologic response group had no significant change in the level of TREC after treatment( 8. 21 ± 2. 08 copies/103 PBMCs vs 7. 03 ± 0. 28 copies/103 PBMCs,t = 1. 38,P = 0. 20). Before treatment,there was no significant difference in the level of TREC in PBMCs between the virologic response group and the non-virologic response group( P > 0. 05),while after treatment,the virologic response group had a significantly higher level of TREC than the non-virologic response group( t = 3. 69,P = 0. 001). A bivariate Spearman correlation analysis was performed for the levels of TREC,HBsAg,and HBeAg,HBV DNA load,and the degree of reductions from baseline to 48 weeks of treatment,and no statistical significance was found.Conclusion TP5 combined with ETV can increase thymic output function in HBeAg-positive CHB patients.
Value of cystatin C in the diagnosis of early renal injury in patients with viral hepatitis
Zhu YaGe, Wang Jing, Liu JinFeng, He YingLi
2019, 35(11): 2453-2455. DOI: 10.3969/j.issn.1001-5256.2019.11.013
Abstract:
Objective To investigate the value of serum cystatin C( Cys C) in the diagnosis of early renal injury in patients with viral hepatitis. Methods A retrospective analysis was performed for the clinical data of 270 patients with chronic hepatitis B virus( HBV) or hepatitis C virus( HCV) infection. According to the fibrosis degree determined by FibroScan,the patients were divided into non-significant liver fibrosis group( F0-F2),significant liver fibrosis group( F2-F3),progressive liver fibrosis group( F3-F4),and liver cirrhosis group( >F4). The four groups were compared in terms of urea nitrogen,creatinine,Cys C,and estimated glomerular filtration rate( e GFR). The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. A Pearson correlation analysis was used to investigate correlation. Results Among the 270 patients,200 had HBV infection and 70 had chronic HCV infection. There were significant differences in e GFR and Cys C between the four groups( F = 2. 714 and 3. 081,P = 0. 032 and 0. 017). Further comparison between two groups showed that the liver cirrhosis group had a significantly lower eGFR than the non-significant liver fibrosis group( 99. 61 ± 6. 92 ml·min-1·1. 73 m-2 vs 105. 32 ± 1. 86 ml·min-1·1. 73 m-2,t = 2. 655,P = 0. 008); compared with the non-significant liver fibrosis group,the other three groups had significant increases in the serum level of Cys C( significant liver fibrosis group: 1. 01 ± 0. 08 mg/L vs 0. 84± 0. 03 mg/L,t =-2. 218,P = 0. 028; progressive liver fibrosis group: 1. 02 ± 0. 04 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 218,P < 0. 001;liver cirrhosis group: 1. 07 ± 0. 05 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 675,P < 0. 001). For the patients with HBV or HCV infection,the patients with liver cirrhosis had a significantly higher serum level of Cys C than those without significant liver fibrosis( patients with HBV infection: 1. 06 ± 0. 36 mg/L vs 0. 84 ± 0. 13 mg/L,t =-3. 192,P = 0. 003; patients with HCV infection: 1. 04 ± 0. 22 mg/L vs 0. 86 ± 0.15 mg/L,t =-2. 318,P = 0. 029). Liver stiffness measurement was positively correlated with the serum level of Cys C( r = 0. 247,P = 0.003),while there was no correlation between liver stiffness measurement and eGFR( r =-0. 002,P = 0. 975). Conclusion Cys C can be used for the diagnosis of early renal injury in patients with viral hepatitis,and regular monitoring of Cys C level has a positive significance in the prevention and treatment of hepatorenal syndrome in such patients.
Clinical features of hepatitis C patients with failure or recurrence after treatment with pegylated interferon-α combined with ribavirin and the clinical effect of direct-acting antiviral agents
Zhang YaoDi, Zhang YueRong, Wang Hui, Lin Yan, Zhou Ning, Wu LiYang, Wei ShiFang, Li XiangLin
2019, 35(11): 2456-2460. DOI: 10.3969/j.issn.1001-5256.2019.11.014
Abstract:
Objective To investigate the clinical features of patients with failure or recurrence after treatment with PEG-IFN combined with ribavirin( PR regimen) in the real world and the clinical effect of different direct-acting antiviral agent( DAA) regimens in such patients. Methods A retrospective analysis was performed for the clinical data of 106 patients with chronic hepatitis C or hepatitis C-related compensated liver cirrhosis who attended the outpatient service or were hospitalized in The First Peoples' s Hospital of Lanzhou from March2014 to January 2018,and these patients experienced failure or recurrence after the treatment with the standard PR regimen. There were 54 male and 52 female patients. According to the response to PR treatment,the patients were divided into failure group with 13 patients,recurrence group with 51 patients,and sustained virologic response group with 42 patients. All patients underwent IL-28 B rs12979860/rs8099917 detection,baseline biochemical examination,Cobas HCV RNA test,and viral genotyping,and these results were compared between groups. The clinical outcomes of patients with failure or recurrence after PR treatment were observed after the treatment with different DAA regimens. The chi-square test was used for comparison of categorical data between groups; a one-way analysis of variance was used for comparison between multiple groups. Results The failure group and the recurrence group had a significantly higher age than the sustained virologic response group( F = 14. 05,P < 0. 001). Among the patients in the failure group,86. 4% had viral genotype 1 b,while among those in the recurrence group,72. 5% had viral genotype 2 a,and there was a significant difference between the three groups( χ2=17. 269,P = 0. 002). Among the patients in the failure group,92. 3% had a baseline HCV RNA level of ≥106 IU/L,and the failure group had a significantly higher proportion of such patients than the recurrence group and the sustained virologic response group( χ2= 10. 407,P =0. 005). There were no significant differences in sex and liver cirrhosis between the three groups( all P > 0. 05). Among the patients with primary treatment failure,100% patients had the non-protective genotype of IL-28 B rs12979860 CT/TT,and 92. 3% had the non-protective genotype of IL-28 B rs8099917 TG/GG; among the patients with recurrence,84. 3% patients had the non-protective genotype of IL-28 B rs12979860 CT/TT,and 86. 3% had the non-protective genotype of IL-28 B rs8099917 TG/GG; among the patients in the sustained virologic response group,85. 7% gad genotype CC at IL-28 B rs12979860 and 88. 1% had genotype TT at IL-28 B rs8099917.There were significant differences in the constituent ratios of rs12979860 and rs8099917 gene polymorphisms between the three groups( χ2= 57. 263 and 59. 651,both P < 0. 001). The patients with failure or recurrence after PR treatment achieved a sustained virologic response rate of 100% after the treatment with three different DAA regimens based on sofosbuvir. Conclusion Viral genotype and non-protective genotypes at IL-28 B rs12979860 and rs8099917 are influencing factors for failure and recurrence after PR treatment. The three different DAA regimens based on sofosbuvir achieves a sustained virologic response rate of 100% and has good safety in patients with failure or recurrence after PR treatment,which is not affected by the factors including IL-28 B single nucleotide polymorphism and viral replication level in the host.
Original articles_Liver fibrosis and liver cirrhosis
Correlation of the levels of angiotensin Ⅱ and angiotensin (1-7) with the degree of chronic hepatitis B liver fibrosis
Yu Chong, Gu YuLing, Li Min, Gu ErLi
2019, 35(11): 2461-2465. DOI: 10.3969/j.issn.1001-5256.2019.11.015
Abstract:
Objective To investigate the differences in the plasma levels of angiotensin Ⅱ( Ang Ⅱ) and angiotensin( 1-7) [Ang( 1-7) ]in different stages among patients with chronic hepatitis B( CHB) liver fibrosis and their significance in the pathogenesis of liver fibrosis.Methods A prospective study was performed. A total of 86 patients with hepatitis B virus( HBV) infection who attended our hospital from March 2017 to March 2019 were enrolled and divided into CHB group( group A) with 25 patients,compensated hepatitis B cirrhosis group( group B) with 31 patients,and decompensated hepatitis B cirrhosis group( group C) with 30 patients. The double-antibody sandwich method was used to measure the plasma levels of Ang Ⅱ and Ang( 1-7),and FibroTouch scan was used for liver stiffness measurement( LSM). A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A binary linear correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with LSM; a Spearman rank correlation analysis was used to investigate the correlation of the plasma levels of Ang Ⅱ and Ang( 1-7) with the progression of CHB liver fibrosis; a logistic regression analysis was used to evaluate the value of Ang Ⅱ,Ang( 1-7),and LSM in predicting hepatitis B cirrhosis. Results With the progression of liver fibrosis from group A to group C,there was a significant increase in course of disease( 5. 2 ± 1. 3 years vs 7. 8 ± 1. 6 years vs 10. 1 ± 1. 5 years,F = 4. 266,P = 0. 002),a significant reduction in the proportion of patients receiving antiviral therapy( 76. 00% vs 64. 52% vs 53. 33%,χ2= 5. 544,P < 0. 001),significant increases in Ang II( 51. 01 ±8. 68 pg/ml vs 74. 38 ± 10. 05 pg/ml vs 102. 78 ± 13. 22 pg/ml,F = 520. 260,P < 0. 001),Ang II/Ang( 1-7) ratio( 1. 06 ± 0. 41 vs2. 32 ± 0. 23 vs 5. 82 ± 1. 24,F = 18. 860,P < 0. 001),and LSM( 6. 85 ± 1. 26 kP a vs 18. 25 ± 3. 22 kP a vs 26. 84 ± 7. 57 kP a,F = 93. 260,P <0. 001),and a significant reduction in Ang( 1-7)( 45. 93 ± 10. 24 pg/ml vs 31. 52 ± 9. 62 pg/ml vs 16. 55 ± 9. 48 pg/ml,F = 209. 860,P <0. 001). Ang II and Ang II/Ang( 1-7) ratio were positively correlated with LSM( r = 0. 623 and 0. 813,both P < 0. 01),while Ang( 1-7) was negatively correlated with LSM( r =-0. 677,P < 0. 01). Ang II,Ang II/Ang( 1-7) ratio,and LSM gradually increased with the progression of liver fibrosis( r = 0. 639,0. 886,and 0. 712,all P < 0. 01),while Ang( 1-7) was negatively correlated with the progression of liver fibrosis( r =-0. 653,P < 0. 01). Ang II/Ang( 1-7) ratio and LSM had an early warning effect for liver cirrhosis in patients with HBV infection( odds ratio = 1. 884 and 2. 015,both P < 0. 01). Conclusion In patients with HBV infection,there are gradual increases in Ang II and Ang II/Ang( 1-7) ratio and a gradual reduction in Ang( 1-7) with the aggravation of liver fibrosis. Dynamic monitoring of the plasma levels of Ang II and Ang( 1-7) can provide a reference for real-time assessment of liver fibrosis and decision-making in clinical diagnosis and treatment.
Value of serum liver fibrosis markers in the diagnosis of liver fibrosis
Zhang Yu, Tang ShiXiao
2019, 35(11): 2466-2471. DOI: 10.3969/j.issn.1001-5256.2019.11.016
Abstract:
Objective To investigate the value of the four serum liver fibrosis markers,i. e.,procollagen Ⅲ( PCⅢ),type Ⅳ collagen( C-Ⅳ),hyaluronic acid( HA),and laminin( LN),in the diagnosis of liver fibrosis. Methods A retrospective analysis was performed for the clinical data of 155 patients with liver cirrhosis,42 patients with liver cirrhosis and primary hepatic carcinoma( PHC),and 150 patients with chronic hepatitis who were admitted to The First Affiliated Hospital of Southwest Medical University from April 2018 to April2019,and 73 healthy individuals who underwent physical examination were also enrolled. The serum levels of the above four markers were measured for all subjects and were compared between groups. The receiver operating characteristic( ROC) curve was plotted to compare the diagnostic efficiency of these four markers. The t-test was used for normally distributed continuous data between two groups; the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups,and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results The patients with liver cirrhosis and the patients with liver cirrhosis and PHC had significantly higher serum levels and positive rates of the four markers than the patients with chronic hepatitis and the healthy subjects( all P < 0. 05). while there were no significant differences in the levels and positive rates of PCⅢ,C-Ⅳ,and HA between the patients with liver cirrhosis and the patients with liver cirrhosis and PHC( all P > 0. 05). Although the patients with liver cirrhosis and PHC had a significantly higher serum level of LN than those with liver cirrhosis( P < 0. 05),there was no significant difference in the positive rate of LN between the two groups( P > 0. 05). The patients with alcoholic cirrhosis had significantly higher serum levels of PCⅢ and C-Ⅳ than those with viral cirrhosis,viral-alcoholic cirrhosis,or autoimmune cirrhosis( all P < 0. 05),the patients with autoimmune cirrhosis,alcoholic cirrhosis,or viral-alcoholic cirrhosis had a significantly higher serum level of HA than those with viral cirrhosis( all P < 0. 05),and the patients with viral-alcoholic cirrhosis,viral cirrhosis,or alcoholic cirrhosis had a significantly higher serum level of LN than those autoimmune( all P < 0. 05). The patients with chronic hepatitis of different etiologies had significantly lower serum levels and positive rates of these four markers than those with liver cirrhosis( all P < 0. 05),and the patients with severe viral hepatitis had significantly higher positive rates of the four markers than the other patients( all P < 0. 05). PC Ⅲ,C-IV,HA,LN,and the combination of these four markers had an area under the ROC curve of 0. 836,0. 832,0. 895,0. 808,and 0. 901,respectively,in the diagnosis of liver cirrhosis. HA had a significantly larger area under the ROC curve than PCⅢ,C-Ⅳ,and LN( all P < 0. 05),while there was no significant difference between HA and the combination of these four markers( P >0. 05). Conclusion HA has a high diagnostic efficiency in liver fibrosis.
Establishment of a predictive model of death within 30 days for patients with liver cirrhosis and bacterial ascites
Huang YunYi, Wang XianBo
2019, 35(11): 2472-2477. DOI: 10.3969/j.issn.1001-5256.2019.11.017
Abstract:
Objective To investigate the risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and to establish a predictive model of death within 30 days. Methods A retrospective analysis was performed for the clinical data of 86 patients with liver cirrhosis and bacterial ascites who were admitted to Beijing Ditan Hospital,Capital Medical University,from January 2012 to April 2018.The patients were followed up for 30 days,and according to their prognosis,they were divided into survival group with 73 patients and death group with 13 patients. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the influencing factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and a predictive model was established based on these influencing factors. The area under the receiver operating characteristic curve was used to evaluate the predictive value of each independent influencing factor and the predictive model. Results The multivariate logistic regression analysis showed that there were significant differences between the survival group and the death group in ascites albumin( odds ratio [OR]= 0. 615,95% confidence interval [CI]: 0. 424-0. 893,P = 0. 011),neutrophil-to-lymphocyte ratio( NLR)( OR =1. 170,95% CI: 1. 011-1. 354,P = 0. 035),and Model for End-Stage Liver Disease( MELD) score( OR = 1. 341,95%CI: 1. 111-1. 618,P = 0. 002). A scoring model was established based on the results of the multivariate analysis to predict death within 30 days in patients with liver cirrhosis and bacterial ascites,and based on this model,the patients were divided into high-risk group with death within 30 days( score ≥2 points) and low-risk group with death within 30 days( score < 2 points). There was a significant difference in mortality rate with 30 days between the two groups( 60. 0% vs 5. 6%,P < 0. 001). Conclusion Ascites albumin ≤3. 5 g/L,NLR ≥6. 5,and MELD score ≥20 are independent risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites. The predictive model established on this basis can effectively evaluate the population at high risk of death within 30 days.
Influence of alcohol consumption on liver function and rebleeding in alcoholic cirrhotic patients with esophageal and gastric varices
Ma JiaLi, He LingLing, Li Ping, Jiang Yu, Hu JuLong, Zhou YuLing, Liang XiuXia, Wei HongShan
2019, 35(11): 2478-2482. DOI: 10.3969/j.issn.1001-5256.2019.11.018
Abstract:
Objective To investigate the influence of alcohol consumption on liver function and prognosis in alcoholic cirrhotic patients.Methods A total of 211 alcoholic cirrhotic patients