修正后Chlid记分在乙型肝炎相关性疾病中预后预测研究

Objective To evaluate whether the traditional Child-Turcotte-Pugh ( CTP) can be improved by adding serum creatinine and/or serum sodium values, and to assess whether the modified CTP score can challenge the short-term prognostic ability of the MELD score. Methods 187 patients with hepatitis B related disease were studied. CTP score, Child-Pugh-Na (CTP-Na) , Child-Pugh-creatinine (CTP- Cr)score,Child-Pugh-Na-creatinine ( CTP-Na-Cr) score,model for End-Stage Liver Disease ( MELD) score and MELD the incorporation of serum sodium ( MELD-Na) score were calculated. The 3-month and 1 year mortality in the patients was measured,and the validity of each models was analyzed. Results At 3-month and 1 year enrollment, the prognostic score of survival group was significantly lower than that of death group in each prognostic score model,P <0. 05. There were no significant difference between the same group in 3- month and 1 year enrollment of each prognostic score,P>0. 05. The CTP-Na-Cr score and MELD-Na score had a significantly higher AUC in comparison with MELD, CTP-Na and CTP at 3-month enrollment (P < 0. 05)and CTP-Na-Cr score also had a significantly higher AUC in comparison with MELD,CTP-Na and CTP at 1 year enrollment. There was no significant difference between 3-month AUC data and 1 year enrollment one of each prognostic score,P >0. 05. Conclusions The CTP-Na-Cr score model is a more accuracy model than other score models,it deserve further research.

HCV核心抗原动态监测抗HCV疗效的临床研究

Objective To evaluate the performance of Hepatitis C virus (HCV) core antigen and HCV RNA PCR in the determining of the efficacy of HCV antiviral therapy in patients infected with HCV. Methods HCV core antigen and HCV RNA were measured in sera of 35 chronic HCV infected Chinese patients. Concentrations of HCV core antigen and HCV RNA were analyzed at 5 time points before, during and at the end of antiviral therapy. Results This study showed that the HCV core antigen and HCV RNA concentrations in 35 HCV patients were significantly correlated. Decrease of HCV core antigen and HCV RNA concentrations at the 4th, 12th,24th and 48th week were observed during the antiviral therapy. However,HCV core antigen levels at week 12 and 24 of therapy were significantly lower than those at week 4 (P < 0. 05 ). In contrast,no further decrease was observed in HCV RNA concentrations at weeks 12 and 24 (P >0. 05). HCV core antigen testing may be advantageous in some cases,in particular,the low levels of HCV core antigen at week 4 may be predictive of satisfactory outcome of treatment. Conclusions HCV core antigen represents a stable and sensitive marker of viral replication and could be used to monitor the clinical efficacy of HCV antiviral therapy.

Objective To investigate the quantitation of hepatitis B e antigen (HBeAg) at week 24 in predicting the efifcacy of pegylated-interferon alfa-2a (Peg-IFN-α2a) in HBeAg-positive chronic hepatitis B (CHB) patients at week 48 and to find a useful predictor for treatment efficacy and investigate individualized treatment of antiviral therapy.
Methods Ninety-six HBeAg-positive CHB patients with detectable HBeAg who were treated with Peg-IFN-α2a were enrolled in this trial. They were categorized into 3 groups according to the changes of HBeAg in week 24:HBeAg decline>2 log10 group (group A), HBeAg decline between 1 1og10-2 log10 (group B), HBeAg decline<1 log10 group (group C), and group C was randomly distributed into C1 and C2. The patients in group A, group B, and group C1 continued the original therapy and the patients in group C2 were given lamivudine plus Peg-IFN-α2a for 24 weeks. At week 48, the treatment efifcacy and hepatitis B virus covalently closed circular DNA (HBV cccDNA) in liver biopsies were analyzed.
Results At week 48, mean reduction of serum HBV DNA:group A:5.8 log10 copies/ml, group B:3.8 log10 copies/ml, group C1:2.8 log10 copies/ml, group C2:5.7 log10 copies/ml, the reduction of HBV DNA in group A was greater than groups B and C1 (P<0.01), that in group C1 was greater than group C2 (P<0.01), the difference between groups B and C1 had no statistical signiifcance (P=0.19). Mean reduction of HBeAg:group A:2.7 log10S/CO, group B:1.9 log10S/CO, group C1:0.9 log10S/CO, group C2:1.5 log10S/CO, the difference among groups A, B and C1 and between groups C1 and C2 were statistically signiifcant (P<0.01). At week 48, HBV DNA undetectable rate in group A, group B, group C1 and group C2 were 87.5%, 34.5%, 17.4%and 81.9%, respectively, the rate in group A was greater than groups B and C1 (P<0.01),that in group C1 was greater than group C2 (P<0.01). HBeAg seroconversion rate were 75.0%, 24.1%, 13.0%and 22.7%, respectively, that in group A was greater than groups B and C1 (P<0.01). Group A had lower cccDNA in liver tissue than group B and group C1 (P<0.01). The difference of HBV cccDNA between groups B and C1 and that between groups C1 and C2 had no statistical signiifcance.
Conclusions HBeAg decline > 2 log10 at week 24 in Peg-IFN-α 2a-treated hepatitis B patients suggested a better efficacy at week 48; HBeAg decline < 2 log10 at week 24 suggests a worse efficacy at week 48, the combined therapy of Peg-IFN-α and lamivudine could improve the clinical responses. The change of quantitative of HBeAg at week 24 may be used as a predictor of treatment effects at week 48.

Abstract BACKGROUND: Calcium dobesilate (calcium dihydroxy-2, 5-benzenesulfonate) has been widely used to treat chronic venous insufficiency and diabetic retinopathy, especialy many clinical studies showed that calcium dobesilate as vasoprotective compound ameliorates renal lesions in diabetic nephropathy. However, there are few literatures reported calcium dobesilate in the treatment of chronic renal alograft dysfunction after renal transplantation. OBJECTIVE:To observe the efficacy and safety of calcium dobesilate on chronic renal dysfunction after renal transplantation. METHODS:A total of 152 patients with chronic renal alograft dysfunction after renal transplantation were enroled from the Military Institute of Organ Transplantation, Changzheng Hospital, Second Military Medical University of Chinese PLA. They were randomly divided into the treatment group (n=78) and the control group (n=74). Patients in the treatment group received 500 mg of calcium dobesilate three times daily for eight weeks. Al patients were treated with calcineurin inhibitor-based triple immunosuppressive protocols and comprehensive therapies. RESULTS AND CONCLUSION: For patients receiving calcium dobesilate, serum creatinine, blood urea nitrogen and uric acid decreased significantly at two weeks after treatment and maintained a stable level (P < 0.05). However, serum creatinine and blood urea nitrogen returned to the original level soon after drug withdrawal. No significant difference was observed in blood cel count, liver function, blood lipids, electrolytes, blood pressure and 24-hour urine output between the two groups before and after therapy (P > 0.05). Administration of calcium dobesilate did not change the general condition of patients with renal insufficiency, nor did it affect blood concentrations of the immunosuppressive agents. Calcium dobesilate may help to delay the progress of graft injury in patients with chronic renal graft dysfunction by conjugating with creatinine, ameliorating the impaired microcirculation and its antioxidant property. The decline in serum creatinine aleviates patients’ anxiety and concern arising from the elevation of creatinine. However, the negative interference with serum creatinine caused by calcium dobesilate should be cautious in order to avoid misjudgment of patients’ condition.

To prove the effectiveness and safety of sodium nitroprusside (SNP) in the treatment of chronic congestive heart failure, 58 patients with heart failure and normal renal and hepatic function were selected and divided into 3 groups and treated differently. Group A was treated with routine vasodilators; Group B was treaeted intermittently with SNP (12.5 -75mg/24hrs);Group C was treated continuously with SNP (continuous infusion of 100-300mg/24hrs) Positively inotropie agents and diuretic agents were used in each group.The results showed that the highly effective rates of the three groups were 46.9％ (15/32), 90.5％ (19/21)and 100％ (12/12) respectively. The effective rates were 81.3％ (26/32), 100％ (21/21), 100％(12/12) respectively. The highly effective rates of group B and C were much higher than that of group A (P＜0.005, P＜ 0.005) . The reduction of blood pressure of group B and C was greater than that of group A ( P ＜ 0. 025) . Among the patients we studied, no body had severe side effects. We concluded that the use of SNP in the treatment of chronic congestive heart failure is safe, with better effect than routine treatment,and continous infusion of SNP is the best choice.