Objective To investigate the prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome (SIRS).Methods A total of 136 liver cirrhosis patients with SIRS were analyzed retrospectively,and were divided into death group (n=52) and survival group(n=84) by the outcome of the disease.The clinical data in 2 groups were compared.The independent risk factors of death in liver cirrhosis patients with SIRS were analyzed by Logistic regression.Results The result of single-factor analysis revealed that the levels of albumin (ALB) and cholinesterase (CHE) in death group were (27.68±-4.84) g/L and (2 647.12±1 057.18) U/L,and were both lower than those in survival group (t=0.007,P＜0.0 1;t=0.0 17,P＜0.05).The levels of serum creatinine (Cr),fasting blood-glucose (FBS),total white blood cell count,serum CRP and PCT in death group were 175.40 μmol/L,5.43 mmol/L,8.10×109/L,24.00 mg/L and 1.20 μg/L,and were higher than those in survival group (Z=0.000,0.000,0.009,0.012 and 0.013,Pall ＜0.05).In addition,the neutrophil proportion,incidence rates of hepatic encephalopathy,gastrointestinal hemorrhage,Child-pugh C grade,sepsis,pulmonary infection and multiple sites of infection in death group were (76.73±14.02)％,28.85％,34.62％,44.23％,34.62％,73.08％ and 90.38％,and were higher than those in survival group (t=0.009,x2=28.950,42.81 0,18.260,16.680,41.177 and 78.440,Pall ＜0.05).Logistic regression stepwise screening results showed that Cr＞165 μmol/L (OR=6.590,95％CI:1.907-22.778),gastrointestinal hemorrhage (OR=29.207,95％CI.4.506-189.290),CRP＞25 mg/L (OR=9.757,95％CI:1.732-54.969),PCT＞1 μg/L (OR=20.350,95％CI:2.617-158.264) and multi-site infection (OR =30.760,95％ CI:2.934-322.572) were significant factors.Conclusions Cr＞165 μmol/L,gastrointestinal hemorrhage,CRP＞25 mg/L,PCT＞ μg/L and multi-site infection are regarded as independent risk factors of mortality for liver cirrhosis patients with SIRS.

近年来我国部分地区出现以发热伴血小板减少为主要表现的感染性疾病,主要通过蜱叮咬传播,其病原体有人粒细胞无形体和一种新型布尼亚病毒,后者可引起发热伴血小板减少综合征(SFTS).浙江省人民医院感染病科曾收治2例危重型新型布尼亚病毒感染者,现报道如下.

目的 评价系统性红斑狼疮(SLE)患者左、右心室纵向收缩功能.方法 对49例SLE患者(SLE组)与33名健康对照者(对照组)均行超声心动图检查,并应用二维斑点追踪及组织多普勒技术获取三尖瓣瓣环位移(TAPSE)、三尖瓣瓣环等容收缩期速度(IVCv)和三尖瓣瓣环收缩期速度(PSv).应用QLab 9.0软件分析获得左心室整体纵向应变值(GLS).结果 SLE组GLS值、TAPSE、IVCv及PSv均低于对照组,差异均有统计学意义(P均＜0.01).SLE组中抗心肌抗体(AMA)阴性者TAPSE和PSv低于对照组(P均＜0.05).GLS与左心室射血分数(LVEF)、TAPSE、IVCv及PSv有一定的相关性(r=-0.57、-0.76、-0.81、-0.78,P均＜0.01).结论 SLE患者左、右心室纵向收缩功能有不同程度的受损.

目的 应用超声心动图评价系统性红斑狼疮(SLE)患者存在和不存在肺动脉高压(PH)时的右心室收缩功能,探讨反映右心室收缩功能减退的敏感指标.方法 选取62例SLE患者,按照肺动脉收缩压(PASP)高低分为SLE无PH组和合并PH组;健康对照组26例.测定13项指标,比较组间指标的差异,分析肺血管阻力(PVR)和PASP对右心室收缩功能的影响.结果 三尖瓣瓣环位移(TAPSE)在SLE无PH组较对照组降低(P＜0.05);有12项指标能够反映SLE合并PH组和无PH的差别(P＜0.05);右室射血效率(RVEe)与PVR、PASP存在曲线关系.结论 SLE患者右心室收缩功能受损的程度同PVR及PASP升高的程度相关.RVEe在评估右心室收缩机械机制和可塑性方面可能有重要作用.

Objective To compare the efficacy of telbivudine(LdT) and entecavir (ETV) in treatment of hepatitis B virus e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients with high viral load (HBV DNA ≥ 107copies/mL).Methods Eighty-one HBeAg-positive CHB patients with high viral load were divided into LdT group (n=41) and ETV group (n=40).All patients received a 144-consecutive-week treatment.HBV DNA level,HBV serological markers,biochemical index,related complications,and drug resistance were observed and compared at the same time points between two groups.Results Baseline data of two groups were comparable.At 4,8 and 12 weeks,HBV DNA negative rates of LdT group were 24.4％,63.4％ and 80.5％,higher than 12.5％,27.5％ and 70.0％ of ETV group with significant differences (x2=5.102,P＜0.05); but no significant difference in HBV DNA negative rates at 144 weeks was noted between two groups (97.6％ vs 100.0％,x2=3.374,P＞0.05).After 144-week treatment,HBeAg seroconversion rate of LdT group was 63.4％,higher than 25.0％ of ETV group with a significant difference (x2=12.183,P＜0.01).In LdT group,2 cases (4.9％) had HBsAg seroconversion,5 cases (12.2％) developed drug resistance,and 8 cases (19.5％) had an elevation of creatine kinase.The total cost of LdT treatment was lower than that of ETV.Conclusions HBeAg-positive CHB patients with high viral load can obtain complete viral suppression after long-term (144 weeks) treatment with LdT or ETV.ETV has the advantage of low drug resistance and no adverse reaction,while LdT has higher rate of early viral suppression and seroconversion,and low cost.

Objective To compare the 144-week efficacy of de-novo combination therapy with lamivudine (LAM) and adefovir dipivoxil (ADV) to that of optimize combination for chronic hepatitis B (CHB) patients.Methods A total of 83 cases with CHB were divided into 3 groups:the de-novo combination group (group A,28 cases),after 24-week mono-therapy to optimize combination group (group B,32 cases),after 48-week mono-therapy to optimize combination group(group C,23 cases).The virological,serological,biochemical indicators at baseline,week 24,48,96 and 144 were detected respectively.The gene resistance mutations of of HBV P region were analyzed for the patients whose HBV DNA were still positive (HBV DNA≥ 103 copies/mL) at week 96,144,respectively.Data of 3 groups were analyzed by the pharmacoeconomics cost-effectiveness analysis.Results HBV DNA negative conversion rates in 3 groups after 96-week therapy were 92.9％,90.6％,87.0％.There were no significant differences among 3 groups (x2 =0.509,P ＞0.05); HBV DNA negative conversion rates in 3 groups after 144-week therapy were 96.4％,93.8％,91.3％,and the differences among them were not statistically significant(x2 =0.590,P ＞ 0.05).There was 1 patient with virologic breakthrough at 144-week treatment in group A.The mutation sites in HBV P genes were L180M and M204V.HBeAg-positive patients with seroconversion rates in 3 groups after 96-week therapy were 27.8 ％,19.2％,35.7 ％,and the differences were not statistically significant (x2 =1.340,P ＞ 0.05).The seroconversion rates in 3 groups at week 144 were 38.9％,30.8％,42.9％,and the differences were not statistically significant (x2 ＝ 0.364,P ＞ 0.05).The ALT normalization rates in 3 groups at week 96 were 94.1％,90.9％,88.9％,and the differences were not statistically significant (x2 =0.303,P ＞ 0.05) ; The ALT normalization rates in 3 groups after 144-week therapy were 100.0 ％,95.5 ％,94.4％,and the differences were not statistically significant(x2=0.911,P ＞ 0.05).The cost-effect analysis showed that the initial combination group was superior to the optimize combination group.Conclusions The effects of virology negative conversion rate,seroconversion rate,ALT normalization rate and reduction the incidence of drug resistance in LAM + ADV de-novo combination therapy and optimized combination therapy are good,but optimized combination therapy is more economic than de-novo combination therapy,so optimized combination therapy can be recommended for use.

Though nucleos(t)ide analogs (NAs) and interferon have been considered as the main drugs for treatment of chronic hepatitis B,the monotherapy of NAs or interferon is prone to induce low or non-response,antiviral drugresistance and unbearable adverse reactions.Therefore antiviral drugs combination treatment for chronic hepatitis B re-at-tracts clinical attention.This paper reviews the application of antiviral drugs combination treatment for chronic hepatitis B.