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The MELD scoring system for predicting prognosis in patients with severe hepatitis after plasma exchange treatment

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 492-496页

作者： Yu, Jian-Wu Wang, Gui-Qiang Zhao, Yong-Hua Sun, Li-Jie Wang, Shu-Qin Li, Shu-Chen Harbin Med Coll Dept Infect Dis Affiliated Hosp 2 Harbin 150086 Peoples R China Peking Univ First Hosp Dept Infect Dis Beijing 100034 Peoples R China

BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. in this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system. METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score. RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P0.05). CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.

关键词： severe hepatitis model for end-stage liver disease plasma exchange mortality

Gene heterogeneity of hepatitis B virus isolates from patients with severe hepatitis B

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Hepatobiliary & Pancreatic Diseases International 2005年第4期4卷 530-534页

作者： Wei Wu, Yu Chen, Bing Ruan and Lan-Juan Li Hangzhou, China Department of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Infectious Diseases of Health Ministry of China, Hangzhou 310003, China Department of Infectious Diseases First Affiliated Hospital Zhejiang University School of Medicine Key Laboratory of Infectious Diseases of Health Ministry of China Hangzhou 310003 China.

BACKGROUND: The pathogenesis of severe hepatitis B remains unknown. Reports have indicated that hepatitis B virus (HBV) mutations are important factors in the pathogenesis of this disease. This study was to investigate the genetic heterogeneity of HBV strains from serum samples of patients with fulminant hepatitis B. METHODS: Full-length HBV genomes from 4 patients with severe hepatitis B were cloned and sequenced to observe mutations in every open reading-frame ( ORF). Serum samples of another 25 patients with severe hepatitis B, 30 patients with chronic hepatitis B, and 25 HBV carriers were collected for sequencing and comparison of mutations in preS2, preC and core promoter regions. RESULTS: Of 4 HBV full-length genome sequences, 3 had a G to A mutation at nucleotide A1896 in the preC region and 1 had double mutations of T1762-A1764 in the core promoter region. The 4 sequences showed mutations in the known B or T cell epitopes of the preS2 and C regions. For the other 3 groups, more mutations were seen in the preS2 region in the HBV isolates from the patients with severe hepatitis B than those from the patients with chronic hepatitis B and HBV carriers (P severe hepatitis B and those with chronic hepatitis B or HBV carriers (P severe hepatitis B, but none of these mutations were observed in the patients with chronic hepatitis B group or HBV carriers (P severe hepatitis B, 40.0% in the patients with chronic hepatitis B (P severe hepatitis B and the patients with chronic hepatitis B (P < 0. 05 ) o

关键词： hepatitis B virus severe hepatitis virus genome gene heterogeneity preS2 preC core promoter

Clinical Observation on the Treatment of Chronic severe hepatitis B by Retention Enema with Huchang Jiedu Decoction(护肠解毒汤)

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Chinese Journal of Integrative Medicine 2010年第4期16卷 348-352页

作者：李勇王磊苏超孙欢娜 Department of Hepatopathy the Affiliated Hospital of Shandong University of Traditional Chinese Medicine

Objective： To observe the efficacy of retention enema with Huchang Jiedu Decoction （护肠解毒汤, HJD） in treating chronic severe hepatitis B （CSHB）. Methods： Sixty patients of CSHB were equally randomized into the treated group and the control group. Both groups were treated with conventional integrative medicine, but to patients in the treated group, retention enema with HJD was given in addition, once every day for 3 weeks. The dominant symptoms, physical signs, and related biochemical indices, as well as the incidence of complications in patients before and after treatment, were observed. Results： Good therapeutic effects were shown in the treated group, with a total effective rate better than that in the control group （83.3% versus 60.0%, P〈0.05）, superior in terms of lowering alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）, globulin （GIb）, and endotoxin （ET） levels and increasing prothrombin activity （PTA）, total cholesterol （TC）, and calcium （Ca） levels, as well as eliminating ascites and preventing hepatic encephalopathy （P〈0.05）; especially in treating middle/early stage patients with Chinese medicine syndrome differentiated as water-toxin accumulation pattern. Conclusion： Retention enema with HJD is surely effective in treating CSHB, and its primary mechanism may be related to the mitigation of enterogenous endotoxemia.

关键词： Huchang Jiedu Decoction severe hepatitis type B retention enema endotoxemia

Blood Puriifcation for severe hepatitis in Vivo and Vitro

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国际感染病学（电子版） 2013年第1期2卷 43-46页

作者： Ming Luo Xian-jun Zhang Wu-kui Cao Tianjin Liver Disease Institute Tianjin Infectious Disease Hospital Tianjin 300192 China

Exterior and interior blood purification (EIBP) refers to the combined therapy of interior blood purification (IBP) and exterior blood puriifcation (EBP) for severe hepatitis. For one thing, integrated traditional Chinese and Western medicine therapy should be applied in IBP to reduce and prevent the generation and absorption of harmful substances in vivo. For another, EBP such as the artiifcial liver support system (ALSS) can extract blood from the body and various kinds of existing harmful substances in the blood can be cleared in vitro, using the treatment of plasma exchange, plasma perfusion, plasma adsorption, hemoifltration, hemodialysis. Therefore, IBP should be cooperated with EBP for the treatment of severe hepatitis, and EIBP can prevent the deterioration of this disease and lower the mortality of patients.

关键词： severe hepatitis Blood puriifcation Vivo Vitro

Nursing of Artificial Liver Support System in the Treatment of severe

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Journal of Clinical and Nursing Research 2020年第3期4卷 82-84页

作者： Jieyu Rao Yanyun Chen Xiaoxi Cai Jinglan Luo The First Affiliated Hospital of Jinan University Guangzhou 510630Guangdong ProvinceChina

Objective:Research on nursing method of artificial liver support system applied in severe hepatitis ***:Selected 50 severe hepatitis patients in our hospital during the period of January 2018 and January 2019,observed and analyzed the clinical intervention effect of all treated by artificial liver support system cooperating with related nursing ***:After the treatment,the clinical symptoms and abdominal distension of the patients were relieved,whose spirit took a turn for the better and the jaundice *** these patients,68%got improved enough to be released,26.00%gave up for financial concerns and 6.00%*** and after treatment,the patients’PT and INR,APTT,TT improved obviously,and the difference were quite a lot(P0.05).Conclusion:During the treatment and intervention of severe hepatitis patients with artificial liver support system,effective nursing interventions are needed,mainly including completely preoperative,intraoperative and postoperative care so as to ensure the treatment effect and promote the recovery of intervention,which has remarkable significance to clinical development.

关键词： Artificial liver system severe hepatitis Nursing method A pplication result