Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA. This retrospective case–control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed. Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00

原发性肝癌是我国常见恶性肿瘤及主要肿瘤致死病因之一,其中肝细胞癌(hepatocellular carcinoma,HCC)占 75%～85%.早期预防、规范监测、及时诊断、科学治疗、预防复发是改善患者预后生存的关键.针对HCC的预防措施包括一级、二级和三级预防.其中三级预防是采取有效措施以减少 HCC患者肿瘤复发、转移,降低病死率和改善生存状况的措施.本文从临床角度结合国内外 HCC相关最新循证学证据对 2022 年版《原发性肝癌三级预防共识》进行解读,以期为临床医生提供有关 HCC根治性治疗后复发的监测、诊断、预防的合理建议和决策参考.

肝衰竭是一类严重临床肝病症候群,病情危重、病死率高,除肝移植外,缺乏理想的根治性治疗手段.肝衰竭发病机制复杂且尚未完全阐明,多种影响肝细胞坏死与再生平衡的因素参与其中.本文总结了自噬这一维持细胞稳态的关键性途径,指出自噬通过调控NLRP3炎症小体活化、对抗氧化应激、抑制细胞凋亡等多种方式在肝衰竭发病机制中发挥重要保护作用.同时认为外泌体、过氧化物酶体增殖物激活受体α等以自噬为靶点的分子信号通路参与拮抗肝衰竭发生、发展,将成为肝衰竭分子靶向治疗的重要思路和方向.

感染病学是临床医学一门重要分支,具有特殊专业性.强化医学人文教育与专业实践并重,全面提升感染病学专业住院医师职业人文修养,对培养符合现代医学发展需求的高素质专业人才至关重要.笔者教学团队在基于感染病专业传统教学模式基础上,强化住院医师规范化培养中的医学人文教育,有效提升了教学质量,对培养具有高素质医学人文情怀的感染病学专科医师发挥了重要作用.

Background:Increased interferon (IFN)-gamma inducible protein-10 (IP-10) level has been shown to be associated with sustained virologic responses (SVRs) to pegylated interferon-alpha 2a/ribavirin-based therapy in patients with chronic hepatitis C (CHC). We investigated the relationship between IP-10 and treatment response in patients with CHC treated with direct-acting antiviral agents (DAAs) therapy.Methods:We measured the dynamic changes of IP-10 in samples from 90 patients with CHC. The serum IP-10 levels, intrahepatic expressions of IP-10 mRNA, and protein were determined, respectively. For the in vitro experiments, the expression changes of IP-10 in hepatitis C virus (HCV)-replicating Huh-7 cells with or without non-structural protein 5A (NS5A) inhibitor were analyzed using real-time reverse transcription-polymerase chain reaction and Western blotting.Results:Patients with chronic hepatitis C had increased baseline IP-10 levels, intrahepatic IP-10 mRNA, and protein expression. After initiating DAAs therapy, serum IP-10 levels decreased gradually in patients who achieved cure, whereas in patients who failed the therapy, IP-10 levels did not change significantly or recovered from the initial decline. Multivariate logistic regression analysis confirmed that baseline IP-10 level ≤ 450 pg/ml and decline >30% at 12 weeks independently predicted the SVR in patients with CHC who received DAAs. In vitro, the expression of IP-10 mRNA and protein in HCV-replicating Huh-7 cells increased significantly. However, such activities were downregulated by NS5A inhibitor, followed by the reduction of HCV RNA levels and a decline in IP-10 levels.Conclusion:IP-10 interfered with HCV replication in hepatocytes and the dynamic decline in IP-10 levels during DAA treatment predicted the SVR in patients with CHC.

病原学诊断对感染性疾病精准诊疗的价值至关重要.随着宏基因组学测序技术的普及推广,第二代测序技术(metagenomics next generation sequencing,mNGS)以其无偏倚、广覆盖、高通量、快速精准等优势,逐渐应用于临床感染性疾病的病原检测.尤其对于临床可疑、疑难复杂血流、中枢神经系统、呼吸道及局灶性感染,或免疫抑制患者继发感染具有重要临床价值.需要强调,mNGS在临床应用过程中同样要求规范其应用范围和诊断标准,强调正确样本采集、分析解读和诊断客观评价,以最大限度发挥其临床应用价值.本文从临床角度就mNGS的适用范围与诊断效能、样本采集与运输质量控制、结果判读与验证等方面分别对《中国宏基因组学第二代测序技术检测感染病原体的临床应用专家共识》进行解读,以期加深临床医师对共识的认知和理解,全方位提升mNGS的临床应用效能.

受肝衰竭免疫炎症状态变化的影响，传统炎症指标如白细胞计数、中性粒细胞比例、C反应蛋白等对肝衰竭合并感染诊断的灵敏度和特异度下降。血清降钙素原是一种被广泛用于诊断细菌感染的生物标志物，有助于细菌感染的早期诊断和指导抗菌药物的合理使用，因此具有早期诊断肝衰竭合并感染的潜在价值，但其诊断效能、最佳临界值等尚存在争议。此外，有研究证实未合并感染的肝衰竭患者血清降钙素原水平也会升高，且与肝损伤严重程度相关，提示降钙素原可判定非感染状态下肝损伤严重程度，甚至可以作为肝衰竭早期诊断与评价病情严重程度的生物标志物。本研究对降钙素原的来源和生物学功能、其在肝衰竭中的变化规律，以及其应用价值和在临床应用中的局限性进行综述。