Objective To investigate the clinical efficacy of domestic terlipressin in the treatment of type II hepatorenal syndrome(HRS-II).Methods A total of 25 HRS-II patients admitted to our hospital from November 2011 to June 2014 were recruited into the treatment group,and 28 HRS-II patients treated with dopamine before 2011 were recruited into the control group.Patients in the treatment group were randomly divided into two subgroups: one subgroup(n = 12) was given terlipressin once every 8 h,and the other subgroup(n = 13)was given terlipressin once every 12 h.Both groups received albumin(Alb) infusion to expand the blood volume before treatment with terlipressin or dopamine,and the course of treatment was 7 days.The improvement in clinical symptoms,levels of blood urea nitrogen(BUN),serum creatinine and electrolytes,urine volume,changes in liver function,and ascites disappearance in the two groups before and after treatment were compared.Comparison of categorical data between the two groups was made by χ2test,and comparison of continuous data was made by t test.Results Patients in the control group showed no obvious symptom relief,but those in the treatment group had varying degrees of improvement in clinical symptoms.Neither group had significant changes in liver function and serum sodium level after treatment.The treatment group had significantly more patients whose ascites volume had decreased from large to medium than the control group(χ2=5.705,P < 0.05).There was a slight but not significant decrease in the levels of BUN and serum creatinine in the control group after treatment with dopamine(all P > 0.05),whereas the urine volume showed significant difference after the treatment(t = 15.534,P < 0.01).The treatment group showed significant differences in the levels of BUN and serum creatinine and urine volume after terlipressin treatment(t= 11.535,9.941,and 19.685,respectively; all P < 0.01),and significant differences in those levels were also observed compared with the control group after dopamine treatment(t = 7.317,9.284,and 9.839; all P < 0.01).Larger changes in BUN,serum creatinine,and urine volume were observed in the subgroup receiving terlipressin every 8 h than in that receiving terlipressin every 12 h,but the differences were not significant(all P > 0.05).Patients treated with terlipressin had mild and tolerable adverse reactions.Conclusion The domestic terlipressin combined with albumin infusion has good clinical efficacy and mild adverse effects in treating HRS-II.Its clinical application is highly recommended.

Objective To explore the value of magnetic resonance imaging(MRI) specifically enhanced with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA) in assessing the liver function in general population.Methods Upper abdominal MRI images and Gd-EOB-DTPA-enhanced images,as well as some clinical information,were collected from 41 cases meeting the inclusion and exclusion criteria.Taking the spleen as the control organ,liver-spleen signal intensity contrast(SIliver / spleen) and relative liver enhancement(RLE) were calculated at 10 min and 20 min after injecting Gd-EOB-DTPA.Differences were evaluated using the independent-samples t-test or Mann-Whitney U test.Corrections were analyzed via Spearman's rank correlation.Results Both SIliver / spleenat 10 min and 20 min after injection of contrast agent were correlated with Child classification(P < 0.05).SIliver / spleenat 20 min had a greater correlation coefficient(r =-0.526) than that at 10 min.The SIliver / spleenwith plain scan had no significant correlation with Child classification(P > 0.05).RLE at 20 min,but not at 10 min,was correlated with Child classification(r =-0.362,P = 0.049).Between the cirrhotic and non-cirrhotic groups,SIliver / spleenshowed no significant difference(P > 0.05).However,SIliver / spleenat 10 min and 20 min,as well as RLE20 min,showed significant differences between the cirrhotic and non-cirrhotic groups(P < 0.05).SIliver / spleenat 20 min also exhibited a significant difference between the elevated and normal ALT and TBil groups(both P < 0.05).Conclusion Gd-EOB-DTPA-enhanced MRI can monitor liver function changes,and SIliver / spleenat 20 min may have an important value in assessing the liver function in general population.

Objective To investigate the levels and clinical significance of serum 25-hydroxy vitamin D[25(OH) D] in patients with chronic liver disease.Methods A total of 153 hospitalized patients with chronic liver disease in the First Affiliated Hospital of Jilin University from June 2012 to September 2013 were enrolled in the study group.The levels of serum 25(OH) D were measured by liquid chromatography tandem mass spectrometry.The serum samples from 300 healthy volunteers who underwent physical examination in our hospital were used as controls.The study group was divided into three subgroups: non-cirrhosis,liver cirrhosis [Child-Pugh(CP) grades A,B,and C],and primary biliary cirrhosis.Comparison of continuous data between groups was made by t test and analysis of variance,and comparison of categorical data was made by chi-square test.Correlation between different variables was investigated by Pearson linear regression analysis.Results Of the 153 patients with chronic liver disease,the percentages of those who had vitamin D adequacy(≥30 ng / ml),insufficiency(20-30 ng / ml),deficiency(10-20 ng / ml),and severe deficiency(< 10 ng / ml) were 20.3%,22.9%,35.9%,and20.9%,respectively.The percentages of patients with vitamin D deficiency and severe deficiency were significantly higher in the cirrhosis subgroup than in the non-cirrhosis and primary biliary cirrhosis subgroups(41.7%,25.0% vs 27.5%,12.5% and 23.5%,17.6%,respectively; χ2= 6.261-18.474,P = 0.001-0.012).The serum 25(OH) D levels in patients with cirrhosis were significantly lower compared with those in patients without cirrhosis and in controls(18.58 ± 12.48 vs 23.78 ± 11.81 and 25.69 ± 12.39 ng / ml,P = 0.029 and0.001).CP class C cirrhotic patients had significantly lower serum levels of 25(OH) D compared with CP class A patients(P = 0.009).Conclusion Serum 25(OH) D deficiency is common in patients with chronic liver disease.25(OH) D levels in cirrhotic patients,especially in CP class C patients,are markedly lower than those in non-cirrhotic patients.

Objective To provide a basis for clinical differential diagnosis of hemolytic jaundice based on laboratory analysis of the characteristics of this disease.Methods A total of 44 patients with hemolytic jaundice,who suffered from hereditary hemolytic disorders or hemolytic disorders with hepatitis virus infection and were admitted to Shajing Hospital affiliated to Guangzhou Medical University from June 2011 to December 2013,underwent multiple laboratory tests.Analysis was performed on the laboratory results,including hematological tests,biochemical markers,and glucose-6-phosphate dehydrogenase(G-6-PD) activity.Results Patients with G-6-PD deficiency-associated hemolytic jaundice might not have anemia.Most patients with thalassemia-associated hemolytic jaundice developed microcytic hypochromic anemia with mean corpuscular volume(MCV) and mean corpuscular hemoglobin(MCH) lower than normal values.Hemoglobin A2(Hb A2) was reduced in patients with alpha-thalassemia but increased in those with beta-thalassemia.Reticulocytes could be within or above normal limits.As for urine tests,urobilirubin was negative and urobilinogen level was normal or elevated.Biochemical results showed normal direct bilirubin(DB) and mildly or moderately increased indirect bilirubin(IB) that accounted for 70%-80% of total bilirubin(TB).Alanine aminotransferase(ALT),aspartate aminotransferase(AST),and alkaline phosphatase(ALP) appeared normal.For hemolytic jaundice patients complicated with hepatitis virus infection,a number of indices,including ALT,AST,ALP,gamma-glutamyl transpeptidase,TB,DB and IB,showed significant elevation.Conclusion For patients with jaundice of unknown origin or not attributed to hepatitis,as well as those with mild or moderate jaundice with IB accounting for 70%-80% of TB,hemolytic diseases should be considered,and G-6-PD activity test and Hb electrophoresis screening are recommended.

Objective To investigate the clinical characteristics and drug resistance in elderly patients with hepatobiliary disease and bloodstream infections caused by Escherichia coli,and to provide a basis for clinical therapy.Methods A retrospective analysis was performed on the clinical characteristics and drug susceptibility of 57 elderly inpatients with hepatobiliary disease and bloodstream infections caused by Escherichia coli in our hospital from 2009 to 2012.Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi-square test.Results The majority of patients had liver cirrhosis,and spontaneous bacterial peritonitis was the major infection source.A total of 57 strains of Escherichia coli were isolated from elderly patients with hepatobiliary disease,and 24(42.1%) out of them were positive for extended-spectrum β-lactamase(ESBL).ESBL-positive strains had a significantly higher level of drug resistance than ESBL-negative strains(P < 0.05),except for imipenem / cilastatin,meropenem,cefoperazone / sulbactum,ticarcillin / clavulanate,and minocycline.However,there were no significant differences in age,gender,basic disease,infection source,peak body temperature,white blood cell count,and the percentage of neutrophils between the ESBL-positive group and the ESBL-negative group(P > 0.05).The case-fatality rate in patients with septic shock,hepatic encephalopathy,or acute kidney injury was significantly higher than that in patients with no complications(χ2= 9.541,7.622,9.733,respectively,P < 0.05).Conclusion Elderly patients with hepatobiliary disease and bloodstream infections caused by ESBL-positive Escherichia coli had a high level of drug resistance and a poor prognosis for severe complications.Antibiotic therapy combined with prevention and control of severe complications should be taken as early as possible to reduce the case-fatality rate.

Objective To study the relationship between Epstein-Barr virus(EBV) DNA and EBV antibody levels.Methods A retrospective study was conducted on 143 patients who underwent EBV DNA testing in serum and lymphocytes from January to August,2014.The clinical data,including age,sex,blood routine and biochemical examination,serum / lymphocyte EBV DNA,EBV-VCA-Ig M,and EBV-VCA-Ig G were recorded.Spearman correlation analysis was used to measure the degree of the relationships.Kruskal-Wallis H test or Mann-Whitney U test were applied to compare the differences between three or two groups.Results The spearman rank correlation coefficient between serum EBV DNA and EBV-VCA-Ig M levels was 0.434(P = 0.00),while the correlation coefficients of serum EBV DNA level and EBV-VCA-Ig M level with lymphocyte EBV DNA,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),white blood cells(WBC),and heterotypic lymphocytes ranged from0.169 to 0.693(P < 0.05) and from 0.153 to 0.434(P < 0.05),respectively.The spearman rank correlation coefficient of lymphocyte EBV DNA with serum EBV DNA,EBV-VCA-Ig M,AST,ALP,WBC,and heterotypic lymphocytes ranged from 0.207 to 0.693(P <0.05).The positive rates of EBV DNA in lymphocytes and serum were 70.6%(101 /143) and 32.2%(46 /143),respectively.The EBV-VCA-Ig M positive rate was 22.4%(32 /143),and 22.5%(25 /111) of the patients with negative EBV-VCA-Ig M were positive for serum EBV DNA.The overall positive rate for EBV-VCA-Ig G was 91.6%(131 /143).The EBV-VCA-Ig M positive rate in patients with positive serum EBV DNA(21 /46,45.7%) was significantly higher than that in patients with positive lymphocyte EBV DNA(29 /101,28.7%)(χ2= 7.95,P < 0.01).Conclusion Serum EBV DNA level is strongly correlated with EBV-VCA-Ig M level.Moreover,serum EBV DNA exhibits a higher positive rate than EBV-VCA-Ig M.Simultaneous detection of serum EBV DNA and EBV-VCA-Ig M may benefit the diagnosis of current EBV infection.