患者,男性,70岁,因“反复双下肢浮肿10余年,加重4月余”于2017年8月入院.查体:生命体征平稳,慢性病面容,全身皮肤、黏膜轻度黄染,无蜘蛛痣、肝掌.全身浅表淋巴结无肿大.腹部饱满,腹壁静脉曲张,脐上血流方向向上,肝脾肋下未触及肿大,肝区无叩击痛,移动性浊音阳性,肠鸣音正常,双下肢中度浮肿.既往史:“高血压病”病史10余年,血压最高160/100mmHg,血压控制不理想;无外伤史及手术史.

目的 比较经颈静脉肝内门体静脉分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(GCVE)对肝硬化患者Child-Pugh评分的影响.方法 收集2014年3月至2017年3月我院34例TIPS肝硬化患者和24例TIPS联合GCVE肝硬化患者,收集术前和术后的Alb、TBil、PT、腹水及肝性脑病等数据,获得Child-Pugh,采用t检验或卡方检验进行统计分析.结果 TIPS组的Child-Pugh评分在术后第1、3个月与术前相比,差异有统计学意义(P<0.05),在术后6、12个月与术前相比差异无统计学意义(P>0.05),而TIPS联合GCVE组术后的1、3、6、12月的Child-Pugh评分与术前相比均差异无统计学意义(P>0.05).TIPS组的术后Child-Pugh评分为8.56±1.82、8.01±1.68、7.58±1.32、7.29±1.45,显著差于TIPS联合GCVE组的(7.53±1.91)、(7.16±1.34)、(6.69±1.57)、(6.08±1.21),(P<0.05).TIPS组术后总胆红素逐渐升高,在第1、3、6月分别为(38.1±10.5)μmol/L、(49.4±10.8)μmol/L和(52.3±11.7)μmol/L,显著高于术前的(26.7±8.6)μmol/L(分别为t=4.898,P<0.01;t=9.587,P<0.01;t=10.28,P<0.01),术后第12月TBil为(30.8±10.9)μmol/L与术前相比差异无统计学意义(t=1.722,P=0.089),而TIPS联合GCVE的TBil在术后第3、6、12月显著低于TIPS组(分别为t=6.187,P<0.01;t=7.006,P<0.01;t=3.958,P<0.01).TIPS组术后凝血酶原时间(PT)逐渐升高,与术前相比均差异有统计学意义(均P<0.01),TIPS联合GCVE在术后第3、6、12月的PT显著优于TIPS组(分别为t=2.082,P=0.042;t=3.137,P<0.01;t=2.04,P=0.046).结论 TIPS联合GCVE对肝硬化患者术后Child-Pugh评分较单纯T IPS组恢复快.

Objective To investigate the changes of serum Golgi protein 73 (G73) of patients with influenza and the effect on the outcome of prognosis. Methods From July 2017 to October 2018, a total of 83 patients with influenza (influenza group) who were hospitalized in the 910th Hospital of the People’s Liberation Army were collected, and 50 healthy cases for physical examination were selected as the control group. Serum GP73 concentration was detected by ELISA method. The changes of serum GP73, procalcitonin (PCT) and interleukin-6 (IL6) levels were detected in patients with influenza at the timepoints of admission with fever, after fever and 1 month after discharge from hospital. The levels of serum GP73, PCT and IL-6 were expressed by median (quartile spacing). Variance analysis was applied to compare the differences of the above indexes between patients of the two groups. Wilcoxon test was applied to analyze the changes of each index before and after treatment, and linear regression and Spearman rank correlation coefficient (r) were used to evaluate the correlation between variables. Results Total of 72 patients (86.75%) with influenza A virus infection and 11 cases (13.25%) of influenza B virus infection were detected among 83 patients with influenza. Among the 72 cases with influenza A virus infection, 65 cases (90.28%) were H3 subtype and 7 cases (9.72%) were H1 subtype. No other subtypes of influenza virus, such as H5, H7, H9 and so on were detected. The serum GP73 concentration of influenza patients with fever was 137.7 (100.6, 179.4) ng/ml, which was significantly higher than that of control group [32.9 (23.0, 52.25) ng/ml], with significant difference (F = 12.30, P < 0.001). The IL-6 concentration of patients with influenza when admitted to hospital with fever was [12.98 (11.28, 19.80)] ng/ml, significantly higher than that of control group [1.52 (1.31, 1.72) ng/ml], with significant difference (F = 15.61, P < 0.001), and the level of serum PCT was 0.032 (0.022, 0.082) ng/ml, slightly higher than that of control group [0.025 ng/ml (0.019, 0.035) ng/ml], but with no significant difference (F = 1.52, P = 0.253). The serum G73 content of patients with influenza was significantly decreased, and the content of serum G73 was 80.13 (60.20, 96.54) ng/ml and 46.65 (40.47, 55.59) ng/ml after fever and follow-up for 1 month; and compared with the concentration of serum G73 [137.7 (100.6, 179.4) ng/ml] of the patients with fever when admitted to hospital, both with significant differences (afer fever vs. at fever: Z =-9.46, P < 0.001; follow-up for 1 month vs. at fever: Z =-15.23, P < 0.001). Conclusions The concentration of serum GP73 of influenza patients with fever increased significantly and decreased rapidly after fever. Serum GP73 may be involved in the process of inflammatory injury and repairment of patients with influenza , which could be taken as a rapid reaction protein for injury or repairment of acute inflammation. Key words: Influenza virus; Golgi protein 73 (GP73); Clinical characteristics; Prognosis

Objective To analyze the risk factors and analysis of drug resistance of nosocomial infection in patients with severe hepatitis and cirrhosis.Methods Clinical data of 2510 cases with severe hepatitis and cirrhosis in our hospital from September 2013 to September 2015 were retrospectively analyzed, the bacterial culture of the infection sites was performed. The bacteria were identified by the automated microbiology system bioMerieux, drug susceptibility test was performed by disk diffusion method (K-B method), ESBLs was detected by double disk synergy test method. The relationship between the incidence of infection and age, length of stay, course of disease, basic diseases, complications, invasive operation and use of antibiotics were analyzed.Results Total of 122 among 2510 cases were infected, the infection rate was 4.86%. The incidence rate was closely related to age, hospital stays, course of disease, underlying diseases, complications, invasive procedures and the use of antibiotics. The infection sites were mainly in respiratory tract and accounting for 27.05% (33/122). Total of 139 clinical pathogens including 95 Gram-negative bacilli (68.35%), 30 Gram-positive cocci (21.58%) and 14 fungus (10.07%) were isolated from the 122 examined samples. Gram-negative bacilli were sensitive to imipenem and amikacin and had a high rate of resistance to ampicillin,&nbsp;piperacillin faction and norlfoxacin. Klebsiella was also sensitive to ceftazidime and cefoperazone. Gram-positive cocci was sensitive to vancomycin, non drug resistant strains occured, but it had a high resistance rates to penicillin, ampicillin, cefoperazone and erythromycin.Conclusions Ages, hospital stays, course of disease, underlying diseases, complications, invasive procedures and the use of antibiotics were the mainly risk factors of the nosocomial infection in patients with severe hepatitis and cirrhosis. Clinical pathogens distributed widely, Gram-negative bacteria like Escherichia coli, Pseudomonas aeruginosa, and Klebsiella were mainly included. The infection sites were mainly in respiratory tract. Gram-negative bacilli were sensitive to imipenem and amikacin and Gram-positive cocci were sensitive to vancomycin.

Objective To investigate the serum Golgi protein 73 (GP73) expression and the compensated stage of HBV-related decompensated cirrhosis ( HLC) in correlation of liver function of patients. Methods 150 patients of HBV-re-lated decompensated cirrhosis patients during January 2012 and March 2014 were selected. All patients were treated with ser-um ELISA, and enzyme-linked immunosorbent assay was used to detect GP73 levels in patients. According to the GP73 level, 150 patients were divided into high GP73 group (82. 50 μg/L), medium GP73 group (57. 98 ~ 82. 50 μg/L) and low GP73 group ( < 57. 98 μg/L). Serum alanine aminotransferase ( ALT), aspartic aminotransferase ( AST), and total bilirubin ( TBIL) level in the three groups were detected and compared. Correlation analysis of liver function and GP73 level in HLC patients was carred out. Results AST, TBIL level content of high GP73 patients were significantly higher than low-GP73 and medium-GP73 groups, AST, TBIL level content of medium GP73 groups were significantly higher than low-GP73 group, and the differences were statistically significant (P<0. 05). Serum GP73 levels of gradually increased with in crease of ALT, AST, TBIL content and ALT, AST, TBIL content showed a positive correlation ( r =0. 632, r =0. 646, r =0. 726; P<0. 001). There was no statistically significant difference of the HBV-DNA content in the three group (P>0. 05). Conclusion Serum GP73 level is closely related to liver damage of HLC patients. It is one of the important indicators in the diagnosis of HLC, but has nothing to do with the level of HBV replication.

Ligation of splenic artery (LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a 47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopenia and thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization (PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.

Objective To investigate the efficacy of intrahepatic transplantation of autologous bone marrow mesenchymal stem cells (BMSCs) in the treatment of patients with decompensated alcohol-induced liver cirrhosis (ALC). Methods Twenty-eight patients with decompensated alcohol-induced liver cirrhosis were recruited for intrahepatic transplantation of BMSCs from 2007 to 2012,and other 28 patients with ALC were selected by propensity scores matching for age,gender and complications of liver cirrhosis. Results The serum alanine aminotransferase levels declined to nearly normal levels,total bilirubin decreased,albumin (ALB) increased, prothrombin times shorten,and Child-Pugh scores (CPS) were improved gradually;The model of end stage liver disease scores were significant decreased to (20.6±5.2) at forth week,and significantly lower than in the control group(P=0.009),however,there was no remarkable differences after 72 weeks (P=0.536) between the two groups;The survival rates at 144 weeks in the two groups were not significantly different (32.1% vs. 25.6%,P=0.125);Further analysis showed that the survival rates in patients with CPS class B in the two groups were significantly different (66.7% vs. 36.4%,P=0.046),while there was no significant difference in patients with CPS class C (12.5% vs. 17.6%,P=0.788). Conclusions The short-term efficacy of BMSCs transplantation in the treatment of patients with decompensated ALC is favorable,but the long-term efficacy needs further investigation.

AIM:To assess the efficacy and safety of bone marrow-derived mesenchymal stem cell (BM-MSC) in the treatment of decompensated liver cirrhosis.METHODS:The search terms "bone marrow stem cell" "chronic liver disease" "transfusion" and "injection" were used in the Cochrane Library, Med-Line (Pub-Med) and Embase without any limitations with respect to publication date or language. Journals were also hand-searched and experts in the field were contacted. The studies which used BM-MSC in the treatment of any chronic liver disease were included. Comprehensive Review Manager and Meta-Analyst software were used for statistical analysis. Publication bias was evaluated using Begg's test.RESULTS:Out of 78 studies identified, five studies were included in the final analysis. The studies were conducted in China, Iran, Egypt and Brazil. Analysis of pooled data of two controlled studies by Review Manager showed that the mean decline in scores for the model for end-stage liver disease (MELD) was -1.23 [95%CI: -2.45-(-0.01)], -1.87 [95%CI: -3.16-(-0.58)], -2.01 [95%CI: -3.35-(-0.68)] at 2, 4 and 24 wk, respectively after transfusion. Meta-analysis of the 5 studies showed that the mean improvement in albumin levels was -0.28, 2.60, 5.28, 4.39 g/L at the end of 8, 16, 24, and 48 wk, respectively, after transfusion. MELD scores, alanine aminotransferase, total bilirubin levels and prothrombin times improved to some extent. BM-MSC injections resulted in no serious adverse events or complications.CONCLUSION:BM-MSC infusion in the treatment of decompensated liver cirrhosis improved liver function. At the end of year 1, there were no serious side effects or complications.

Objective To explore the accuracy of serum golgi protein-73 levels in diagnosis of patients with hepatocellular carcinoma(HCC). Methods 400 patients with HCC,200 with liver cirrhosis(LC),100 with chronic hepatitis B(CHB)and 100 healthy controls(HC)were collected in this study. Enzyme linked immunosorbent assay and electrochemiluminescence immunoassay were used to detect serum GP-73 and alpha fetal protein(AFP),re- spectively. The ability of GP73 and AFP in diagnosis of patients with HCC was evaluated by the area under the receiver operating characteristic curves(AUROC). Results Serum GP73 levels in patients with HCC,CHB and LC were 243.6±163.1ng/ml,85.6±35.3ng/ml and 81.9±36.4ng/ml,respectively,all of which were significantly higher than that in HC(78.2±33.9ng/ml,P<0.05);The optimal cut-off value of GP-73 and AFP for diagnosis of HCC were 150.7ng/ml and 19.7ng/ml,respectively and the AUROC of GP73 was 0.846,with a sensitivity of 69.2% and a specificity of 90.5%,which were both better than AFP(0.828,57.6% and 88.1%,respectively,P<0.05);When GP73 in combination with AFP,they led to an enhanced sensitivity of HCC detection up to 73.5% and the AUROC was 0.887;There was no difference in the positive rate of GP-73 between AFP positive or negative HCC subjects. Conclusion Serum GP-73 has a better accuracy than AFP for the diagnosis of HCC,and serum GP73 in combi- nation with AFP might further increase the accuracy for HCC diagnosis.

Objective To assess the efficacy and safety of transcatheter arterial chemoembolization(TACE) combined with percutaneous ethanol injection(PEI) versus TACE alone in the treatment of patients with hepatocellular carcinoma(HCC).Methods A systematic search of literatures in PubMed,the Cochrane Library,Embase,Chinese Biomedicine Literature Database,Wan Fang Database since database establishment to December,2012 was performed;All randomized controlled trials(RCTs) on TACE combined with PEI versus TACE alone were collected;The literatures were screened according to inclusive and exclusive criteria,and data were extracted and the quality of included studies were assessed;A Meta-analysis was conducted by using RevMan 5.1.Results A total of 13 RCTs with 962 patients was included and the results showed that the 1-,2-and 3-year survival rates of TACE combined with PEI were better than that of TACE alone,with the OR-value of 3.78(95%CI=2.79 to 5.12),3.07(95%CI=2.27 to 4.17) and 5.84(95%CI=2.86 to 11.93),respectively;A total of 6 RCTs with 294 patients out of 14 papers showed that the combination therapy was better than TACE alone(OR=4.0,95%CI=2.24 to 7.15)in the rate of AFP normalization,but the reduction of≥25%(not to normal) in AFP was not significant(OR=1.24,95%CI=0.68 to 2.27);Both Combination therapy and TACE alone did not show serious adverse reactions.Conclusion The survival and AFP normalization rate in TACE combine with PEI is better than TACE alone,and there is no increased serious adverse reaction following the improved survival rate.