[Characteristics of acid-base balance in patients with chronic severe hepatitis: analysis of 126 cases]

OBJECTIVE

To investigate the characteristics of acid-base balance in patients with chronic severe hepatitis.

METHODS

Samples of venous blood and arterial blood were collected from 126 patients with chronic severe hepatitis, 106 males and 20 females, aged 44 +/- 13 (25 - 74), to undergo measurement of the potassium, sodium, and chloride ions, and urea nitrogen and creatine, blood electrolytes and blood gas analysis respectively.

RESULTS

Acid-base disturbance (ABD) was found in 115 of the 126 patients (91.3%). 40 of the 115 patients with ABD (31.7%) had respiratory alkalosis combined with metabolic alkalosis, 32 of them (25.4%) had respiratory alkalosis combined with metabolic acidosis; 28 of them (22.2%) had pure respiratory alkalosis, and 8 (6.3%) had pure metabolic acidosis. Five patients had triple acid-base disturbance, 4 of which had respiratory alkalosis (combined with metabolic alkalosis and metabolic acidosis, 3.2%), and 1 of which had respiratory acidosis (combined with metabolic alkalosis and metabolic acidosis, 0.8%). There was no significantly difference in the prevalence rates of pure acid-base disturbance and multiple acid-base disturbances between the patients with cirrhosis-base chronic severe hepatitis and those with chronic hepatitis-based chronic severe hepatitis. Hypoxia symptoms were seen in 34 patients (27%). 103 patients died. All the 15 patients with their blood pH < 7.35 died.

CONCLUSION

ABD in the patients with chronic severe hepatitis is mainly alkalosis with respiratory alkalosis as the basic ABD type. The appearance of ABD is not associated with the underlying illness. Patients of chronic severe hepatitis often suffer from hypoxia. Low blood pH is an important factor causing death.

[Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy]

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.