目的:了解評價血漿置換(PE)治療慢性乙型重型肝炎的臨床療效及價值。方法:觀察重型肝炎患者PE前后總膽紅素、白蛋白5項指標及乏力、腹脹等臨床癥狀變化,比較治療組和對照組治療后好轉率的差異。統計分析PE治療及次數與患者預后的關系。檢測部分患者PE前后內毒素(LPS)濃度,探討LPS與患者預后的關系。結果:治療組和對照組早中期患者好轉率分別為54.4％和27.8％(Plt;0.01);晚期患者的好轉率分別為8.3％和1.4％(Pgt;0.05)。PE治療2到4次,患者的好轉率分別為39.4％、43.6％和42.9％,但PE次數在不同組別患者的好轉率之間差異無統計學意義(Pgt;0.05)。PE治療后好轉患者血清內毒素濃度下降(Plt;0.01)。結論:PE能明顯改善患者肝功能指標,提高早中期患者的好轉率。PE次數為2到4次時,患者的好轉率較高,但不同的PE次數未顯示相應患者的臨床轉歸之間有統計學意義的差異。血清LPS濃度與患者預后有相關性,治療前血清LPS濃度低且治療后下降者,預后較好;相反,治療前血清LPS濃度高且治療后下降不明顯者,預后較差。
ObjectiveTo analyze the clinical features and prognosis of coronavirus disease 2019 (COVID-19) patients.MethodsA total of 379 confirmed COVID-19 patients admitted to Public Health Clinical Center of Chengdu from January 16 to November 30, 2020 were divided into two groups including an elderly group (42 patients, ≥60 years) and a non-elderly group (337 patients, <60 years) by age. The epidemiology, clinical features, laboratory tests, treatment and prognosis of the two groups were compared.ResultsAmong the 379 patients, 286 (75.5%) were males and 93 (24.5%) were females, aged from 2 months to 87 years, with an average age of 41.2 years. The average age of the elderly group was 69.5 years, and 61.9% of them were females. They were imported from Wuhan or local secondary patients (73.8%), mainly common or critical type (88.1%). While, the average age of the non-elderly group was 37.8 years, and males were more common (80.1%). There were mostly from foreign input (75.7%), mainly mild or ordinary type (95.0%). A total of 179 patients (47.2%) had one or more underlying diseases. Hypertension (15 patients, 35.7%) and diabetes (11 patients, 26.2%) were more common in the elderly group, while non-alcoholic steatohepatitis (132 patients, 39.2%) was more frequent in the non-elderly group. The most common clinical manifestations were fever (138 patients, 36.4%) and cough (129 patients, 34.0%). Fever, cough, dyspnea, and fatigue were more common in the elderly group than those in the non-elderly group (P<0.05). Compared with the non-elderly group, the elderly group had lower total lymphocyte count, CD4+ and CD8+ T-cell count, higher level of myocardial injury or inflammation markers (P<0.05). Abnormal echocardiography in 139 patients (36.7%) was mainly caused by decreased left ventricular diastolic function (22.7%) and heart valve regurgitation (14.0%), and the rate in the elderly group was significantly higher than that in the non-elderly group (85.7% vs. 30.6%, P<0.05). After treatment, 3 patients in the elderly group died, and the others were cured and discharged. The hospitalization duration of the elderly group was longer than that of the non-elderly group (22.1 d vs. 18.8 d, P=0.033).ConclusionsElderly COVID-19 patients are mainly imported from Wuhan or secondary to the local population, mainly common or critical type, often associated with basic diseases such as hypertension or diabetes. While, non-elderly COVID-19 patients are mainly imported from abroad, mainly mild or common type, often associated with non-alcoholic steatohepatitis. After treatment, most of the patients have a good prognosis.