目的:构建可用于预测乙型肝炎病毒相关慢加急性肝衰竭患者结局的风险模型.方法:以国家"十二五"科技重大专项课题"慢加急性肝衰竭中西医结合治疗方案优化研究"入组的乙型肝炎病毒相关慢加急性肝衰竭患者为研究对象,按照2:1分为训练集、测试集.在训练集人群中建立死亡风险模型并通过Cox回归分析,在测试集中验证模型的区分度与一致性.结果:年龄(HR=1.02,95％CI 1.01～1.04)、总胆红素(HR=1.04,95％CI 1.02～1.07)、国际标准化比值(HR=2.58,95％CI 1.98～3.37)、肝性脑病(Ⅰ/Ⅱ期:HR=2.20,95％CI 1.25～3.87;Ⅲ/Ⅳ期:HR=23.67,95％CI 7.74～72.37)、肝肾综合征(HR=3.64,95％CI 1.69～7.82)、低钠血症(HR=1.86,95％CI 1.22～2.84)、血小板计数(20～60:HR=1.42,95％CI 1.89～2.27;>60:HR=2.42,95％CI 1.94～6.20)是预后的独立影响因素;基于上述7项因素建立的列线图可以准确预测乙型肝炎病毒相关慢加急性肝衰竭人群结局;列线图在预测28、336 d结局方面优于终末期肝病模型(MELD)及MELD-Na评分(0.87 vs 0.79/0.80,0.82 vs 0.73/0.75);在预测90 d结局时优于MELD评分(0.86 vs 0.79,P=0.042),但与MELD-Na评分差异无统计学意义(0.86 vs 0.82,P=0.140).结论:以年龄、总胆红素、国际标准化比值、肝性脑病、肝肾综合征、低钠血症、血小板计数等7个关键因素构建而成的列线图,在预测乙型肝炎病毒相关慢加急性肝衰竭患者死亡风险方面具有一定的价值.

目的 探讨血浆透析滤过联合自体骨髓干细胞移植治疗慢加急性乙型肝炎肝衰竭患者的疗效.方法 入组120例慢加急性乙型肝炎肝衰竭早中期患者,均接受内科综合治疗和血浆透析滤过(PDF)治疗,其中58例接受PDF联合自体骨髓干细胞移植治疗,观察患者症状、体征、生存率、活动状态评分(ECOG)、终末期肝病模型(MELD)评分、CTP分级和肝功能的变化.结果 在治疗24 w和48 w,干细胞移植组患者生存率分别为70.7％和55.2％,显著高于血浆透析滤过组的51.6％和32.2％(P<0.05),干细胞移植组患者ECOG评分≥2级者分别为27.5％和12.5％,显著低于血浆透析滤过组的56.3％和40.0％(P<0.05);在治疗24 w,干细胞移植患者MELD评分和吲哚菁绿15分钟存留率(ICGR15)分别为(18.6±4.1)和(20.6±8.1)％,显著低于血浆透析滤过患者[分别为(20.4±5.2)和(28.7±10.3)％,P<0.05];58例行自体骨髓干细胞移植治疗患者术中未出现严重不良反应.结论 自体骨髓干细胞移植治疗经血浆透析滤过术后的早中期患者可明显提高患者生存率,并且有良好的安全性.

Objective To observe the histological changes of the liver in chronic HBV carriers aged above 40 years.Methods A total of 442 chronic HBV carriers aged above 40 years who underwent liver biopsy in Hepatology Hospital of Jilin Province from August 2012 to August 2015 were enrolled.Liver tissue samples were collected from all patients using ultrasound-guided rapid puncture,and the proportion of patients with grade ≥ G2S2 liver fibrosis or liver cirrhosis was calculated.The association of medical history of HBV infection,liver function,body mass index (BMI) and FibroScan with histological changes of the liver was analyzed.The t-test was used for comparison of continuous data between groups,relative risk (RR) was used to analyze risk factors,and a Kappa analysis was used for consistency test.Resuits Of all 442 chronic HBV carriers aged ≥40 years,56.56％ had grade ≥ G2S2 liver fibrosis and 20.14％ had liver cirrhosis.The length of the medical history of HBV infection and BMI were correlated with the degree of liver fibrosis,and medical history ＞ 10 years(OR=64.06,95 ％ C I:33.72-121.69,P ＜ 0.001) and B MI ≥ 24 (OR =6.93,95 ％ CI:4.64-10.35,P ＜ 0.001) were risk factors for liver fibrosis and cirrhosis.There were significant differences between grade ＜ G2S2 liver fibrosis patients and grade ≥ G2S2 liver fibrosis patients in the levels of alanine aminotransferase,aspartate aminotransferase,adenosine deaminase,gamma-glutamyl transpeptidase,alkaline phosphatase,and prealbumin (t =40.00,2.16,25.35,47.73,12.62,and 13.38,all P ＜ 0.05).The consistency analysis of FibroScan and liver biopsy in the diagnosis of liver cirrhosis showed a Kappa value of 0.76,suggesting that there was a good diagnostic consistency between these two methods.Conclusion Monitoring and management of chronic HBV carriers aged above 40 years should be taken seriously in clinical practice,and liver biopsy should be performed as soon as possible for those with ALT ＞ 30 U/L and marked liver fibrosis suggested by FibroScan.

Objective To explore the predictive factors of early diagnosis of liver cirrhosis in chronic HBV carriers (≥ 40 years old).Methods Total of 442 chronic HBV carriers (≥ 40 years old) underwent liver biopsy in Hepatology Hospital of Jilin Province form August 2012 to August 2015,the fibrosis stage of 89 cases were G4S4 (liver cirrhosis group) and 194 cases were below G2S2 (control group),these 283 cases were selected as investigate objects.Liver function,peripheral blood cell counts,HBV DNA levels,HBsAg quantitative and Fibroscan in both groups were analyzed and compared.Results The age,history of HBV infection,BMI and proportion of drinkers in liver cirrhosis group were higher than those in control group,the difference were statistically significant (P ＜ 0.05).The ALT,AST,ADA,ALP,GGT and PALB of patients in liver cirrhosis group were (32.9 ± 7.4) U/L,(31.2 ± 10.3) U/L,(31.4 ± 10.1) U/L,(72.7 ± 31.6) U/L,(198.7 ± 32.8) U/L and (112.9 ± 31.4) g/L,respectively;the corresponding indicators of patients in control group were (15.3 ± 3.6) U/L,(29.8 ± 9.7) U/L,(10.7 ± 1.2) U/L,(22.6 ± 9.7) U/L,(102.8 ± 12.7) U/L and (311.7 ± 89.8) g/L,respectively,the differences were statistically significant (P ＜ 0.05).PLT ＜ 110 × 109/L and NEUT ＜ 2.0 × 109/L were independent risk factors for liver cirrhosis (OR =29.33,14.42,P ＜ 0.05).Fibroscan showed good coherence with liver biopsy,and Kappa value was 0.75.HBV DNA levels and HBsAg had no correlation with liver cirrhosis.Conclusion For chronic HBV carriers over 40 years,the age,history of hepatitis B,obesity,alcohol intake,PLT ＜ 110 × 109/L and NEUT ＜ 2.0 × 109/L were risk factors for liver cirrhosis.Fibroscan showed good coherence with liver cirrhosis.

在全球22个结核病高发地区中，我国是结核病高发地区，居全球第二。国家卫生部2000年第4次结核流行病学调查中显示，我国全年龄组结核分枝杆菌（ MTB ）感染率已达到44．5％，全国约5．5亿人感染了该菌，感染率高于全球人口感染率约1／3水平〔1〕。结核病是MTB通过微核传播的一种呼吸道疾病，与结核患者密切接触而感染MTB导致潜伏结核感染（ LTBI）的人数是非常惊人的，潜伏感染者数目也十分庞大。大部分潜伏感染的转归终将会是活动性结核。本文就LTBI的新型诊断方法作一综述。

BACKGROUND:Chronic hepatitis B virus infection can impact the biological characteristics of bone marrow mesenchymal stem cel s. Adipose-derived mesenchymal stem cel s have gained more and more attention due to their high safety, little invasiveness, easy purification and rapid proliferation. OBJECTIVE:To establish the isolation and culture method of adipose-derived mesenchymal stem cel s from patients with hepatitis B virus infection in vitro, and to observe the biological characteristics of cel s. METHODS:Adipose-derived mesenchymal stem cel s were isolated from the subcutaneous fat of hepatitis B virus infection patients by col agenase digestion and adherent method. Growth curve of adipose-derived mesenchymal stem cel s were detected by MTT method and cel phenotypes were detected by flow cytometry. The adipogenic and osteogenic differentiation potential of adipose-derived mesenchymal stem cel s were detected in vitro. RESULTS AND CONCLUSION:(1) Adipose-derived mesenchymal stem cel s from 10 patients with hepatitis B virus infection were al isolated and cultured successful y. The primary passage time of adipose-derived mesenchymal stem cel s was (8.3±1.2) days. The growth curve of cel s was“S”shaped. Cel s came into a logarithmic phase at days 3-4, and came into platform at day 7. (3) Passage 3 adipose-derived mesenchymal&nbsp;stem cel s highly expressed CD29, CD166, HLA-ABC and CD44, but did not express or lowly expressed CD34 and HLA-DR. (3) Adipose-derived mesenchymal stem cel s differentiated into adipocytes after adipogenic induction, and differentiated cel s were positive for oil red O staining;after osteogenic induction, adipose-derived mesenchymal stem cel s differentiated into osteoblasts that were positive for alkaline phosphatase staining. These findings indicate that the col agenase digestion and adherent method can be used to effectively isolate adipose-derived mesenchymal stem cel s from patients with hepatitis B virus infection, and the cel proliferation is rapid so that a large number of cel s can be obtained in the short term.

Objective To determine whether the dynamic changes of the model for end-stage liver disease (MELD) scores were superior to baseline MELD scores in predicting the prognosis of HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A prospective study was made on HBV-ACLF patients hospitalized in four hospitals in China from 2009 to 2011. The clinical data including clinical manifestations, laboratory findings and the prognosis were observed, and the relationship between the dynamic changes of MELD scores and the prognosis was analyzed. Results The 90-day mortality rate of the enrolled 82 HBV-ACLF patients was 37.80%. The average baseline MELD scores in the non-survivor group and the survivor group were 25.50±4.77 and 23.72± 4.68, respectively, and the difference between the two groups was not significant (P=0.101). The MELD scores gradually increased in the non-survivor group, and decreased in the survivor group from the 7th day of enrollment. The differences were significant between the two groups at the following time-points. MELD scores of the survivors were significantly less than those of the non-survivors in the low-risk group (with the baseline MELD scores less than or equal to 23) from the 14th day of enrollment (16.04±4.00 vs 29.39± 12.30, P<0.05), and MELD scores of the survivors were significantly less than those of the non-survivors in the high-risk group (with the baseline MELD scores more than 23) from the 7th day of enrollment (22.38±4.91 vs 28.92±6.76, P=0.001). The variations became greater as time went on. Conclusion Dynamic changes of MELD scores should be considered additionally in predicting the prognosis of HBV-ACLF besides baseline MELD scores, which will help improve the accuracy of predicting the prognosis.

目的:探讨自体骨髓干细胞移植对终末期肝病患者的治疗作用.方法:56例终末期肝病患者无菌采集骨髓,负收集法分离纯化骨髓干细胞,经肝固有动脉注入肝脏.术后观察肝脏储备功能和合成功能,同时观察患者症状体征和不良反应.结果:患者骨髓采集量为120 ～ 180al,分离细胞数为5.8×107～9.6×108个,与术前比较,术后1周91.6％的患者食欲改善,87.5％的患者体力明显改善;术后12周吲哚氰绿血浆清除率(ICGK)升高,吲哚氰绿15min滞留率(ICGR15)下降,与术前比较差异有显著性意义(P＜0.05);血清血蛋白(Alb)在术后4周开始升高,12周达到最高,与治疗前比差异有显著性意义(P＜0.05);胆碱酯酶(CHE)、凝血酶原时间(PT)移植术后持续改善,12周时较术前增加最明显,差异有显著性意义(P＜0.05);18例并发腹水者,有11例患者腹水消失,有5例腹水减轻但没有消退.结论:自体骨髓干细胞移植技术治疗终末期肝病,患者肝脏储备功能、合成功能改善明显,术后无不良反应,安全可行.

目的:观察肝衰竭各阶段的肝脏储备情况,探讨肝脏储备功能检测在肝衰竭人工肝治疗中的应用价值。方法:将我院收治的肝衰竭患者178例纳入研究,并根据其临床表现的严重程度,按照早、中、晚三期,将入组患者分为3期。并对其中89例患者行人工肝治疗,另外89例予常规治疗,作为对照组。结果:肝衰竭早、中、晚期的肝脏储备功能逐渐下降,各组间比较差异有统计学意义。人工肝手术组肝衰竭早中期的死亡率明显低于常规治疗组,肝衰竭晚期的死亡率与常规治疗组无明显差异。人工肝治疗前后肝脏储备功能无明显变化。经人工肝治疗后,肝脏储备功能较好的肝衰竭早期患者死亡率较肝脏储备功能较差的肝衰竭晚期患者死亡率低。结论:人工肝治疗不能在短时间内改善肝脏储备功能,肝脏储备功能检测可协助指导肝衰竭患者的人工肝治疗。

>失代偿期肝硬化属于终末期肝病(end stage liver disease,ESLD)最常见的类型,是肝硬化的晚期阶段,其主要特征为肝细胞数量与功能不能满足人体的生理需求。肝脏是机体营养物质代谢的中心器官,肝损害会引起机体不同程度的物质与能量代谢障碍。营养不良的严重程度与该类患者的预后及并发症的发生又关系密切。因此,营养支持治疗在失代偿期肝硬化治疗中占重要的地位。但因为种种原因,我国在这一领域研究较少。本研究针对失代偿期肝硬化患者进行了初步肠内营养干预,现将结果报告如下。一、资料与方法1.研究对象:选择2011年9月至2012年1月在我院住

目的：观察替比夫定联合阿德福韦酯治疗乙型肝炎肝硬化的治疗效果。方法：A组61例，给予替比夫定每日600毫克联合阿德福韦酯每日10毫克治疗，疗程96周，B组61例，给予替比夫定每日600毫克治疗，疗程96周， C组61例，给予阿德福韦酯每日10毫克治疗，疗程96周。结果：联合治疗96周时的转氨酶复常率高达92%，而单用替比夫组定及单用阿德福韦组转氨酶复常率均为60.7%。联合治疗组96周时HBVDNA 阴转率为88.5%，单用替比夫定组96周时HBVDNA 阴转率为55.7%，单用阿德福韦组96周时HBVDNA 阴转率为44.3%。联合治疗组治疗96周时HBeAg血清学转换率为52.63%，而单用替比夫定组96周时HBeAg血清学转换率为31.25%，单用阿德福韦酯相应指标为22.86%。此外，联合治疗组在治疗96周时耐药率为0，单用替比夫定组96周耐药率为13.2%，单用阿德福韦酯组96耐药率为5.71%。结论：替比夫定联合阿德福韦酯的转氨酶复常率、HBVDNA阴转率及 HBeAg血清学转换率均高于单药治疗组，而耐药率低于单药治疗组。现报告如下：

目的:观察替比夫定联合阿德福韦酯与单用恩替卡韦治疗HBeAg阳性乙型病毒性肝炎的疗效。方法:治疗组(替比夫定联合阿德福韦酯)58例,给予替比夫定每日600毫克联合阿德福韦酯每日10毫克治疗,疗程96周;对照组(单用恩替卡韦)53例,给予恩替卡韦每日0.5毫克治疗,疗程48周。结果:治疗组与对照组治疗96周时的转氨酶复常率分别为94.8%及92.5%;96周时HBVDNA阴转率分别为93.1%及94.3%;96周时HBeAg血清学转换率分别为50.0%及17.0%。治疗96周时对病毒学完全应答的部分患者进行停药并随访6个月,治疗组病毒学突破率为13.2%;对照组病毒学突破率为42.5%。结论:对于HBeAg阳性乙型病毒性肝炎患者,替比夫定联合阿德福韦酯的HBeAg血清学转换率高于单用恩替卡韦,而停药后复发率低于恩替卡韦。

<正>全球乙型肝炎病毒(HBV)感染者约3.5亿～4亿,占世界人口5%,其中33%感染者在中国[1]。我国的慢性乙型肝炎病毒(hepatitisBvirus,HBV)感染者约有30%～50%是通过母婴传播的,而HBV母婴传播主要发生在围生期[2]。近年来,国内外众多学者在阻断HBV母婴传播方面进行了大量的临床研究,并取得了一定进展,但阻断失败的人群仍然存在,现就乙型肝炎母婴阻断失败的原因及补救措施作一综述。1HBV母婴阻断失败的影响因素1.1HBeAg及是否联合免疫对母婴阻断的影响众多研究表明,HBsAg和HBeAg双阳性母亲的阻断失败率高于HBsAg阳性、HBeAg阴性的母亲。单

Objective To explore the method of nursing care with partial splenic embolization(PSE) of hypersplenism on liver cirrhosis.Methods Total of 183 cases were given PSE with Seldinger technique,and careful nursing care were given before and after operation.Results After operation,white blood cells,platelet count of all cases gradually increase to normal level.The rate of pain in spleen,fever and ascite were 97.81%,86.34% and 15.85%,respectively,which returned to normal after two weeks,and serious complications such as splenic abscess did not appear.Conclusions PSE for liver cirrhosis patients with spleen function hyperthyroidism was a safe method with significant curative effect.Assessing the patients' condition carefully and control indications strictly before operation,paying attention to observation and nursing care can decrease the complications.

Objective To evaluate the diagnostic value on measles virus(MV)from throat swab and urine residue in children measles cases by indirect immunofluorescence assay(IFA).Methods Total of 68 suspected children measles cases were detected for MV antigen from throat swab and urine residue.The positive rate of two kinds of sample were analyzed and some patients were followed-up for short period.Results Total of 62 patients were diagnosed as measles.The positive rates of MV antigen detection in throat swabs and urine residue were 91.9%(57/62)and 96.8%(60/62),respectively,the differences were not statitically significant(χ2 = 1.363,P>0.05).All of 45 patients were diagnosed as typical measles,the MV antigen detection positive rates of throat swabs and urine residue were 95.6%(43/45)and 97.8%(44/45),respectively,the differences were not statitically significant(χ2 = 0.345,P>0.05);There were 17 patients diagnosed as atypical measles,whose MV antigen detection positive rates of throat swabs and urine residue were 82.4%(14/17)and 94.1%(16/17),respectively,the differences were not statitically significant(χ2 = 1.133,P>0.05).Conclusions The detection of MV antigen from throat swab and urine residue by IFA is a rapid and sensitive method.

背景:对于诱导骨髓间充质干细胞成肝细胞样细胞的研究,在大鼠及小鼠及人类中已有相关报道.甲胎蛋白和白蛋白均为肝细胞系较为特异的标志.目的:进一步验证肝细胞生长因子对骨髓间充质干细胞的诱导分化作用.方法:采用密度梯度离心和贴壁培养法相结合分离培养人骨髓间充质干细胞,以含20 μg/L肝细胞生长因子和10 μg/L碱性成纤维细胞生长因子的低糖DMEM培养基诱导培养,对照组取同代细胞,常规培养液培养.诱导培养7,14,21和28d采用免疫组织化学方法检测甲胎蛋白和白蛋白的表达及RT-PCR技术检测白蛋白mRNA表达.结果与结论:诱导组骨髓间充质干细胞呈类上皮样细胞.诱导组在培养7d时,甲胎蛋白表达阳性率为81.5%,随着培养时间延长,甲胎蛋白阳性表达率逐渐减弱,而白蛋白阳性表达率及白蛋白mRNA表达逐渐增强,至培养28d,白蛋白阳性表达率达91.2%,对照组细胞均无白蛋白、白蛋白mRNA及甲胎蛋白表达.结果证实,肝细胞生长因子可诱导骨髓间充质干细胞表达甲胎蛋白和白蛋白.