OBJECTIVES:Hepatitis E virus (HEV) is a global health concern that causes acute hepatitis with severe consequences, particularly in patients with chronic liver disease. Despite the availability of a recombinant hepatitis E vaccine (Hecolin), its safety and immunogenicity in patients with pre-existing liver cirrhosis remain uncertain. This study aimed to assess the safety and immunogenicity of Hecolin in individuals with compensated liver cirrhosis who have chronic hepatitis B (CHB). METHODS:This study was conducted in Shenzhen City, China, from November 2019 to June 2022. The adult participants were stratified into untreated CHB, CHB treatment, CHB cirrhosis, and control groups based on their disease status. Safety assessment included adverse events and liver function tests. Serological samples were collected before vaccination and 1 month after both the first and third doses of vaccination to assess anti-HEV IgG antibodies. RESULTS:A total of 162 eligible participants, including 43 with CHB cirrhosis, 50 with treated CHB, 50 with untreated CHB, and 19 controls were included in the study. A total of 157 (96.9%) participants received three doses of the vaccine. Safety analysis revealed 7-day local adverse events in 13.95.0%, 24.0%, 12.0%, and 5.26% and systemic adverse events in 6.98%, 12.0%, 4.0%, and 0% across the cirrhosis, treated, untreated, and control groups, respectively. No serious adverse events were deemed to be causally related to vaccination. In the per-protocol set for immunogenicity, all vaccinated participants with cirrhosis (95% CI, 88.1-100%) were seroconverted, and 82.8% (24/29) had anti-HEV IgG levels higher than 1.0 WU/mL at 1 month after the final dose (median, 38 days; interquartile range, 31-44). DISCUSSION:This study suggests that Hecolin is safe and immunogenic in patients with CHB with compensated liver cirrhosis, supporting its use in preventing HEV superinfection in this high-risk population.

Purpose: The purpose was to review relevant clinical data and formulate recommendations supporting the use of saline as a simple rinse for an early reassuring intervention to reduce the occurrence of re-positive COVID-19 patients.Methods: We conducted a single-centre retrospective cohort study, which enrolled patients with confirmed re-testing positive COVID-19 during 7-60 days after discharge from Third People's Hospital of Shenzhen. By one-to-two propensity score matching for age and sex, the control group of those not re-testing positive during the same period served as matched control.Results: A total of 223 patients were included in our study, 94 in re-positive group and 129 in non-re-positive group. The result shows that the rates of nasal douche treatment in the non-re-positive group were considerably higher than that of the re-positive group. And the Ct value of nasal douche group increased faster than that of non-nasal douche group after the Ct value reaching >35. Further analysis revealed that the higher the Ct value at the time of readmission, the shorter the time of average Ct values to reach >35. Conclusion: These findings suggest that nasal douche is beneficial to shorten the time of virus nucleic acid turning negative, thereby reducing the incidence of re-positive. The prevention and control of epidemics focuses on re-positive patients with Ct values <35.

With the ongoing COVID-19 pandemic and the emergence of various SARS-CoV-2 variants, a comprehensive evaluation of long-term efficacy of antibody response in convalescent individuals is urgently needed. Several longitudinal studies had reported the antibody dynamics after SARS-CoV-2 acute infection, but the follow-up was mostly limited to 1 year or 18 months at the maximum. In this study, we investigated the durability, potency, and susceptibility to immune evasion of SARS-CoV-2-specific antibody in COVID-19 convalescents for 2 years after discharge. These results showed the persistent antibody-dependent immunity could protect against the WT and Delta variant to some extent. However, the Omicron variants (BA.1, BA.2, and BA.4/5) largely escaped this preexisting immunity in recovered individuals. Furthermore, we revealed that inactivated vaccines (BBIBP-CorV, CoronaVac, or KCONVAC) could improve the plasma neutralization and help to maintain the broadly neutralizing antibodies at a certain level. Notably, with the time-dependent decline of antibody, 1-dose or 2-dose vaccination strategy seemed not to be enough to provide immune protection against the emerging variants. Overall, these results facilitated our understanding of SARS-CoV-2-induced antibody memory, contributing to the development of immunization strategy against SARS-CoV-2 variants for such a large number of COVID-19 survivors.

Objective: The pulmonary sequelae of coronavirus disease 2019 (COVID-19) have not been comprehensively evaluated. We performed a follow-up study analyzing chest computed tomography (CT) findings of COVID-19 patients at 3 and 6 months after hospital discharge.Methods: Between February 2020 and May 2020, a total of 273 patients with COVID-19 at the Shenzhen Third People's Hospital were recruited and followed for 6 months after discharge. Chest CT scanning was performed with the patient in the supine position at end-inspiration. A total of 957 chest CT scans was obtained at different timepoints. A semi-quantitative score was used to assess the degree of lung involvement.Results: Most chest CT scans showed bilateral lung involvement with peripheral location at 3 and 6 months follow-up. The most common CT findings were ground-glass opacity and parenchymal band, which were found in 136 (55.3%) and 94 (38.2%) of the 246 patients at 3 months follow-up, and 82 (48.2%) and 76 (44.7%) of 170 patients at 6 months follow-up, respectively. The number of lobes involved and the total CT severity score declined over time. The total CT score gradually increased with the increasement of disease severity at both 3 months follow-up (trend test P < 0.001) and 6 months follow-up (trend test P < 0.001). Patients with different disease severity represented diverse CT patterns over time.Conclusions: The most common CT findings were ground-glass opacity and parenchymal bands at the 3 and 6 months follow-up. Patients with different disease severity represent diverse CT manifestations, indicating the necessary for long-term follow-up monitoring of patients with severe and critical conditions.

The long-term effect of coronavirus disease 2019 (COVID-19) has been rarely known. This study aimed to investigate healthy outcomes of COVID-19 survivors up to 2 years after the infection. A total of 155 COVID-19 patients, who were discharged from Shenzhen Third People's Hospital from February 2020 to April 2020, were enrolled and followed up until March 4, 2022. COVID-19 survivors received questionnaires of long COVID symptoms and psychological symptoms, pulmonary function tests, chest computed tomography (CT) scans and routine laboratory tests. Two years after infection, 36.6% of patients had at least one symptom of long COVID. Vision impairment and fatigue were the most common symptom. 35.0% of participants still had at least one psychological symptom of anxiety, depression, post-traumatic stress symptoms, and sleep difficulties. Radiographic abnormalities were presented in 50.7% of patients, with the most common features of fibrosis-like lesions and residual ground-glass opacity. Diffuse dysfunction (24.0%) was the main abnormalities of pulmonary function tests. Most laboratory parameters returned to normal range, while persistent abnormalities in kidney and liver function test were observed in a subset of participants after discharge. Two years after COVID-19 infection, persistent symptoms of long COVID and psychological symptoms, as well as abnormalities in pulmonary function tests and CT, were still common in a subset of recovering individuals. These findings were limited by the lack of a healthy control group and pre-COVID assessments, which should be confirmed by further large-scale studies.

Although Omicron appears to cause less severe acute illness than the original strain, the potential for large numbers of patients to experience long COVID is a major concern. Little is known about the recovery phase in cases of Omicron, highlighting the importance of dynamically monitor long COVID in those patients. Subjects of the current study were patients available for a three-month follow-up who were admitted from January 13 to May 22, 2020 (period of the original strain) and from January 1 to May 30, 2022 (period of Omicron). Twenty-eight-point-four percent of patients infected with the original strain had long-term symptoms of COVID-19 and 5.63% of those infected with the Omicron strain had such symptoms. The most common symptom was a cough (18.5%), followed by tightness in the chest (6.5%), in patients infected with the original strain. Fatigue (2.4%) and dyspnea (1.7%) were the most commonly reported symptoms in patients infected with the Omicron strain. The respiratory system is the primary target of SARSCoV-2. Supportive treatment is the basis for the treatment of respiratory symptoms in patients with COVID-19. Quality sleep and good nutrition may alleviate fatigue and mental issues. Further knowledge about a long-term syndrome due to Omicron needs to be discussed and assembled so that healthcare and workforce planners can rapidly obtain information to appropriately allocate resources.

Background Clinical data on patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant are limited, especially on clinical status after the application of antibody therapy. Methods We evaluated clinical status in patients with the SARS-CoV-2 delta variant after BRII-196 and BRII-198 treatment in an infectious disease hospital in China. We collected data on clinical symptoms, laboratory tests, radiological characteristics, viral load, anti-SARS-CoV-2 antibodies, treatment, and outcome. Results In mid-June 2021, 36 patients with delta variant infection were identified in Shenzhen. The most common symptoms at illness onset were cough (30.6%), fever (22.2%), myalgia (16.7%), and fatigue (16.7%). A small number of patients in this study had underlying diseases, including diabetes (5.6%) and hypertension (8.3%). The application of BRII-196 and BRII-198 can rapidly increase anti-SARS-CoV-2 IgG. The median peak IgG levels in the antibody treatment group were 32 times higher than those in the control group ( P < 0.001). The time from admission to peak IgG levels in the antibody treatment group (mean: 10.2 days) was significantly shorter than that in the control group (mean: 17.7 days). Chest CT score dropped rapidly after antibody therapy, with a mean duration of 5.74 days from admission to peak levels. Conclusion The results of this study suggest that the application of BRII-196 and BRII-198 antibody therapy improved clinical status in patients with SARS-CoV-2 delta variant infection.

Background The long-term clinical status of coronavirus disease 2019 (COVID-19) in recovered patients remains largely unknown. This prospective cohort study evaluated clinical status of COVID-19 and explored the associated risk factors. Methods At the outpatient visit, patients underwent routine blood tests, physical examinations, pulmonary function tests, 6-min walk test, high-resolution computed tomography (CT) of the chest, and extrapulmonary organ function tests. Results 230 patients were analyzed. Half (52.7%) reported at least one symptom, most commonly fatigue (20.3%) and sleep difficulties (15.8%). Anxiety (8.2%), depression (11.3%), post-traumatic symptoms (10.3%), and sleep disorders (26.3%) were also reported. Diffusion impairments were found in 35.4% of the patients. Abnormal chest CT scans were present in 63.5% of the patients, mainly reticulation and ground-glass opacities. Further, a persistent decline in kidney function was observed after discharge. SARS-CoV-2-specific antibodies of IgA, IgG, and IgM were positive in 56.4%, 96.3%, and 15.2% of patients, respectively. Multivariable logistic regression showed that disease severity, age, and sex were closely related to patient recovery. Conclusions One year after hospital discharge, patients recovered from COVID-19 continued to experience both pulmonary and extrapulmonary dysfunction. While paying attention to pulmonary manifestations of COVID-19, follow-up studies on extrapulmonary manifestations should be strengthened.

目的 探讨非活动性乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)携带者乙型肝炎病毒(hepatitis B virus,HBV)再激活的发生率及临床特征.方法 以2014年1月至2019年12月于深圳市第三人民医院随访的64例非活动性HBsAg携带者为研究对象,6～12个月随访1次,收集HBV再激活发生情况、肝功能[包括丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBil)和γ-谷氨酰转移酶(gamma-glutamyltransferase,GGT)]及肝组织病理学结果、HBV再激活发生后的临床结局等.采用Kaplan-Meier法估计累积HBV再激活率;采用单因素和多因素Cox比例风险模型进行HBV再激活的影响因素分析.结果 与基线相比,发现HBV再激活时研究对象的ALT[7.69％(2/26)vs 0％(0/26)]、AST[0％(0/26)vs 0％(0/26)]、TBil[19.23％(5/26)vs 19.23％(5/26)]和GGT[3.85％(1/26)vs 0％(0/26)]异常率差异均无统计学意义(P均>0.05).基线和发现HBV再激活时研究对象HBV DNA≥2000 IU/ml比例分别为0％(0/26)、46.15％(12/26),差异有统计学意义(χ2=15.600,P<0.001);HBV再激活者基线HBeAg均为阴性,发现HBV再激活时有1例HBeAg复阳(P=1.000).HBV再激活后共6例进行了肝脏穿刺病理检查,4例为G1S1,1例为G1-2S2,1例为G1S2.多因素Cox比例风险模型分析表明基线HBV DNA≥100 IU/ml者发生HBV再激活的风险是基线HBV DNA<100 IU/ml者的2.62倍(HR=2.62,95％CI:1.04～6.58,P=0.041).随访12个月时累积HBV再激活率为37.1％(26/64,95％CI:21.4％～49.6％).基线HBV DNA≥100 IU/ml者随访12个月时累积HBV再激活率(43.8％,95％CI:22.4％～59.3％)显著高于基线HBV DNA<100 IU/ml者(24.3％,95％CI:2.9％～40.9％),差异有统计学意义(Log-rankχ2=4.50,P=0.03).HBV再激活后的2次随访发现,累积3例未经抗病毒治疗实现病毒学抑制,5例启动抗病毒治疗后实现了病毒学抑制,1例实现HBsAg自发清除;随访患者ALT均在正常范围内.结论 非活动性HBsAg携带者可出现HBV再激活,基线较高的HBV DNA水平(≥100 IU/ml)是非活动性HBsAg携带者HBV再激活的独立危险因素.提示对于非活动性HBsAg携带者应加强随访,及时发现HBV再激活,并对HBV再激活者采取更积极的组织学检查和抗病毒治疗策略.

目的:探讨清肝化瘀汤辅助治疗乙肝肝硬化的效果.方法:选取2020年1-6月我院收治的50例乙肝肝硬化患者作为研究对象,按照随机数表法分为两组,各25例.对照组给予常规抗病毒药物(恩替卡韦+多烯磷脂胆碱)治疗,观察组在对照组基础上联合清肝化瘀汤治疗,观察两组肝功能情况、肝瞬时弹性硬度及脂肪变测定.结果:观察组AST、ALT、TBIL水平均低于对照组(P＜0.05);观察组肝瞬时弹性硬度及脂肪变水平低于对照组(P＜0.05);观察组不良反应发生率(20.00％,5/25)与对照组(24.00％,6/25)对比差异无统计学意义(P＞0.05).结论:清肝化瘀汤辅助治疗乙肝肝硬化化可有效改善患者肝功能情况,并降低肝硬度及脂肪变水平,且不会增加不良反应的发生.

目的 探讨绝经后女性非酒精性脂肪性肝病(NAFLD)患者性激素水平与胰岛素抵抗、肝酶学异常的关系.方法 回顾性分析本院2017年3月至2019年3月治疗的96例绝经后女性NAFLD患者的临床资料,设为观察组,并选择100名同年龄段绝经后健康女性为对照组,通过化学发光法测定血清总睾酮(TT)、雌二醇(E2)和胰岛素(INS),通过酶联免疫分析法测定血清雌酮(E1),胰岛素抵抗指数(HOMA-IR)评价用稳态模型,肝肾功能及血脂水平测定用全自动生化分析仪,对2组TT、E1、E2、INS、HOMA-IR指标进行比较.结果 观察组患者天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)水平与对照组相比差异无统计学意义(P>0.05),丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)水平与健康对照组,差异有统计学意义(P<0.05);观察组患者INS、HOMA-IR明显高于对照组,血清TT明显低于对照组,差异有统计学意义(P<0.05);2组E2、血清E1水平比较差异无统计学意义(P>0.05).结论 绝经后女性NAFLD患者TT、E1、E2和HOMA-IR可能有负相关关系,和ALT、GGT水平可能有正相关关系,且与NAFLD的肝酶学异常紧密相关,可用于指导临床诊断与治疗.

目的:了解深圳市第三人民医院4年来门诊就诊患者插队此种不规范就诊行为的原因分析及针对措施.方法:统计第三人民医院肝病门诊2010年1月—2013年12月来我院就诊有插队行为的患者,分析其插队的原因,为医院提供相应的解决措施.结果:7880例我院就诊患者中2010年就诊人数302人次?,2011年就诊1642人次,2012年就诊2300人次,2013年就诊3636人次.插队患者2010年发生15次,2011年发生105次,2012年发生240次,2013年发生505次;2010年插队发生率4.96％;2011年插队发生率6.39％;2012年插队发生率10.43％;2013年插队发生率13.88％;插队发生率每年逐渐升高;其中插队原因中:见别人插队也要求插队有405次,只是来开药插队要求先就诊234次,因自己是老病人,觉得因优先就诊109次,流程不熟悉而插队57次,有特殊原因如赶飞机等急事插队就诊138次,其他原因22次.不同性别、不同文化程度、不同年龄及不同病程的患者在是否会发生插队行为上也是有差异的;结论:我院每年门诊就诊量的提高,插队此种不规范就医行为的发生率也有所增加,其中插队原因中占最重要的是因别人插队也要求插队,男性、病程长、年龄大、文化程度低的患者比较容易发生插队行为.因此要针对引起插队的原因采取有效的针对措施,如增加专科门诊满足患者专门开药的要求;简单明了、简化就医流程;提供更多的指导、便民服务等,特别是针对那些年龄大、病程长的患者及时做好宣教和沟通,避免其发生插队的行为;从而提高患者就诊满意度,促进医患关系和谐发展.

目的:分析并探讨乙型肝炎病毒(HBV)感染相关中晚期原发性肝癌(PLC)生存时间及影响因素.方法:选取1997年1月1日至2017年12月31日,在深圳市第三人民医院确诊为HBV感染相关中晚期原发性肝癌在院死亡患者199例,回顾性分析患者生存时间及其主要影响因素.结果:199例死亡患者首次确诊中晚期原发性肝癌后平均生存时间(4.985±1.262)月,中位生存时间2.00月.规律复诊、AFP、胆道系统结石、抗病毒治疗、手术及其他治疗、是否参与医保是患者生存时间的影响因素(P＜0.05).其中规律复诊、抗病毒治疗、手术及其他治疗、AFP是影响患者生存时间的独立因素,前面三个因素为影响生存时间的保护因素,而AFP反之.结论:本组HBV感染相关中晚期原发性肝癌死亡患者生存时间较短,规律复诊、抗病毒治疗、手术等干预对延长生存期有一定帮助.

目的:探讨随访工作对肝性脑病患者的依从性及再复发情况的影响,明确随访工作的重要性,并更好的指导和帮助患者.方法:将在2016年1月至2018年2年内我院住院期间,发生肝性脑病的患者纳入研究按分为对照组和对照组各60例,两组患者出院时均进行详细的告知及相关指导、注意事项;观察组患者出院后到慢病随访科登记并进行随访工作,时间为1周～3个月,对照组为未进行随访工作的患者;比较两组患者出院后依从性及再复发情况情况.结果:观察组患者出院后的依从性及再复发率均优于对照组,差异有计学意义(P<0.05).结论:长期随访工作能提高肝性脑病患者的依从性,以及降低肝性脑病的再复发情况.

Objective To investigate the related factors of anxiety in patients undergoing liver puncture,so as to provide better clinical care and psychological intervention for patients to ensure the successful completion of liver puncture. Methods From January 2008 to January 2014,310 cases of patients from the Third People's Hospital of Shenzhen with liver puncture were selected as the research object. The patients' general condition and self rating Anxiety Scale were investigated. Results The SAS score of the patients who would undergo liver puncture was(47.25±0.44)points,and the incidence of anxiety symptoms was 91.3%. The results of univariate and multivariate analysis showed that the effect of patients with anxiety before liver biopsy can explain the variation of the size of the corresponding factors:whether accompanied by family members, payment methods,awareness of the disease,ear of liver failure,the education level,and gender(β' =0.617, 0.352,0.114,0.102,0.082、0.043;P < 0.05). Conclusions Before the liver puncture,the patients show a state of anxiety. The main factors affecting the anxiety status are whether to have family members,to pay for the disease,to understand the disease,to worry about the failure of liver failure,the degree of education and gender medical staff should provide targeted nursing intervention for patients to alleviate anxiety and promote rehabilitation on the basis of the above factors and the relevant circumstances.

ObjectiveTo investigate the influencing factors and nursing experiences of patients who underwent liver biopsy.Methods Total of 510 patients who underwent liver biopsy from January 2000 to January 2011 in Guangdong Medical College afifliated to Shenzhen Third People’s Hospital were selected. Effects of gender, age and whether accompanied by family members on pain, blood pressure, anxiety and adverse reactions of the patients were compared. The anxiety level was assessed by Zung Self-rating Anxiety Scale (SAS) measurement, and the degree of pain in the liver area was assessed by the McGill question and answer classiifcation.Results①The changes of blood pressure, the degree of pain and the anxiety were more obvious of female patients than those in male patients, the differences were statistically signiifcant (P< 0.05), and there was no significant difference in adverse reactions (χ2 = 1.213,P = 0.271).②Change of blood pressure, liver area pain sense, anxiety level and adverse reactions occurred in patients with ages≥ 40 years old were more obvious than those of patients with ages< 40 years old, and the differences were statistically significant (P< 0.05).③Patients with no family accompanied in the changes of blood pressure, liver area pain and anxiety level were more obvious than those in patients with family members accompanied, the differences were statistically signiifcant (P< 0.05), and there was no signiifcant difference in adverse reactions (χ2 = 0.332,P = 0.564).Conclusions For women patients, who were older than 40 years old and&nbsp;without family accompanying, the pain in the liver area, blood pressure changes, anxiety, adverse effects were more obvious in liver biopsy. For these patients, propaganda, education, psychological intervention, emotional counseling and full care should be done by the nurse before the operation, and the condition changes of the patient should be monitored closely.