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To evaluate the clinical efficacy and safety of integrative medical program based on blood cooling and detoxification recipe (BCDR) in treating patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) of heat-toxicity accumulation syndrome (HTAS).Adopting randomized controlled clinical design, a total of 105 HBV-ACLF patients of HTAS were randomly assigned to the trial group (64 cases) and the control group (41 cases). Patients in the control group were treated with comprehensive Western therapy, while those in the trial group were treated with comprehensive Western therapy plus BCDR. All were treated for 8 weeks and followed up for 40 weeks. Effect and safety of the treatment were assessed, including fatality, liver functions [total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), and aspartate transaminase (AST)], and prothrombin activity (PTA) after treatment and at week 48 of follow-ups.After 8-week treatment, there was statistical difference in the overall fatality rate (15.63% vs 34.15%), the fatality rate in the mid-term (25.0% vs 64.7%), TBIL at week 8 (64.54 +/- 79.75), AST [at week 2: (178.97 +/- 44.24) U/L vs (288.48 +/- 58.49) U/L; at week 4: (61.65 +/- 27.36) U/L vs (171.12 +/- 89.11) U/L] and PTA [at week 4: (58.30 +/- 15.29) vs (42.56 +/- 15.27); at week 6: (60.77 +/- 20.40) vs (43.08 +/- 12.79)] (all P0.05). At week 48 of the followup, the fatality rate of the trial group (21.88%) decreased by 17. 14% when compared with that of the control group (39.02%; P0.05). No obvious adverse event occurred in the two groups during the 8-week treatment period.BCDR could significantly reduce the mortality of HBV-ACLF patients.

To explore the effects of Xinganbao Capsule (Cordyceps Sinensis) on the chronic hepatitis B liver fibrosis.Sixty patients with chronic hepatitis B were randomly assigned to the trail group (40 cases) and the control group (20 cases). The trail group was treated with Xinganbao Capsule, 8 capsules each time, three times a day. The control group was given Heluo Shugan Tablet, 5 pills each time, thrice daily. Six months consisted of one therapeutic course. The liver function, four indicators of serum fibrosis, liver histology, and other items were detected.Xinganbao Capsule could reduce serum ALT and AST levels, serum HA, PC-III and LN levels (all P0.05), showing statistical difference when compared with before treatment. The HA and LN levels decreased more significantly in the control group when compared with before treatment (P0.05). Totally 21 patients (53% of the recruited cases) in the trial group completed the liver biopsy twice. After treated with Xinganbao Capsule, 81% patients (17/21) had decreased liver inflammation 1 grade or more, 52% patients (11/21) had decreased fibrosis staging one or more, and 33% (7/21) patients had no change in fibrosis.Xinganbao Capsule could improve the liver function, reduce liver inflammation, and fight against hepatic fibrosis.

To study the relationship between TCM syndrome type and expression of human leucocyte antigen-DRB1 (HLA-DRB1) in patients with chronic hepatitis B.Using PCR method to amplify the related segments of DNA extracted from peripheral leucocytes by the routine methods, and gene array analysis was performed to detect the expression of HLA-DRB1.HLA-DRB1 * 13 was expressed in healthy person in the control group, but was not expressed in chronic hepatitis B patients, showing significant difference between the two groups. In the patients with five different syndrome types, i.e. the dampness blocking middle-jiao type (A), the Gan-stagnancy with Pi-deficiency type (B), the blood stasis blocking collaterals type (C), the Gan-Shen yin-deficiency type (D) and the Pi-Shen yang-deficiency type (E), the former three belonged to the excessive syndrome and the latter two were deficient syndrome. Most of the CHB patients were differentiated as excessive syndrome.Difference of HLA-DR expression exists between chronic hepatitis B patients and healthy persons, the action of the difference is remained for further confirmation. HLA-DR expression in patients with different syndrome types, excessive or deficient, might be different, too.

To evaluate the relationship between mortality and HBVDNA and HBeAg expression of severe hepatitis B patients.The mortality rates of different types of severe hepatitis patients in our hospital during the last five years were analysed. HBV DNA was detected using the fluorescence quantitative PCR method and the HBeAg expression of severe hepatitis B was studied using a microparticle method.(1) Hepatitis B morbidity was 83.5% in each type of severe hepatitis, and severe chronic hepatitis B morbidity was 96.77% in each type of severe chronic hepatitis. (2) The mortality rate of those with HBV DNA more than 1 x 10(5) copies/ml was 53.25% and the mortality of those with HBV DNA less than 1 x 10(5) copies/ml was 34.50% (P less than 0.01). The HBeAg expression had no influence on the death rate. (3) The death rate descended to 30.38% from 54.64% (HBV DNA more than 1 x 10(5) copies/ml) when treated with Lamivudine (P less than 0.01).In severe hepatitis the quantity of virus carried in the patient is one of the key factors of mortality; antivirus treatment can lower mortality.

To describe the blood gas features and short-term outcomes of noninvasive positive pressure ventilation (NPPV) treatment for acute respiratory failure (ARF) in patients with severe acute respiratory syndrome (SARS) in this retrospective case series study sought.Between April 22 and May 1, 2003, 120 clinically compatible SARS patients were admitted to a special hospital for infectious diseases in Beijing. All patients' records were reviewed. The outcome variables of NPPV therapy were analyzed.At 6 weeks of SARS onset, 25% (30/120) patients had respiratory failure with ALI/ARDS. 16 (53%) had hypercapnia (PaCO(2)45 mm Hg) during the course of SARS. 28 of them received NPPV therapy. One was intolerable to NPPV treatment. In the remaining 27 patients, NPPV was initiated 1.2 +/- 1.6 (0 - 10) days after onset of respiratory failure. One hour of NPPV therapy led to significant increases in PaO(2), SpO(2) and PaO(2)/FiO(2), and decrease in respiratory rate (all P0.01). 18 of the 27 patients were weaned successfully from NPPV. The mean duration of NPPV use was 10 +/- 6 (5 - 30) days. In addition to one patient who was intolerable to NPPV treatment, intubation was required in other 9 patients who initially had a favorable response to NPPV. Remarkable pulmonary barotrauma was noted in 7 of the 120 (5.8%) patients with SARS, among which 1 developed 2 days after intubation, and 6 occurred while the patients were on NPPV, the incidence being 22% (6/27) in patients using NPPV. The fatality rate at 13 weeks of SARS onset was 6.7% (8/120) in the patient cohort, and 26.7% (8/30) in the ALI/ARDS patients. No SARS occurred in medical staff taking care of NPPV patients.Some of the SARS patients with ALI/ARDS could experience CO(2) retention, which might be related to the impairment of respiratory muscles. It is proved to be feasible and appropriate for NPPV treatment of respiratory failure in SARS patients who were at high risk of intubation related complications. As there was a high incidence of remarkable barotrauma, a careful lung protective strategy is necessary during the administration of NPPV as well as invasive mechanical ventilation.

To clarify the difference and significance of T-lymphocyte subsets in differential diagnosis between severe acute respiratory syndrome SARS) and common atypical pneumonia.Totally 100 patients hospitalized in Beijing Ditan Hospital since March to June 2003 with clinical diagnosis of SARS were involved in this study. These patients courses of disease were over 3 weeks. These patients were divided into two groups, SARS group and common atypical pneumonia group (non-SARS group). The counts of CD3+, CD4+ and CD8+ T-lymphocyte of two groups were systematically recorded and analyzed.Sixty-five of the patients were confirmed to have common type of SARS, including 26 males and 39 females, 50 cases received methylprednisolone treatment. Thirty-five cases had common atypical pneumonia (non-SARS), 21 were males while 14 were females, 20 cases received methylprednisolone treatment. All the cases of two groups were cured in the end. The SARS patients T-lymphocyte counts decreased first and then increased. Before 15 days of disease course, mean CD3+, CD4+, CD8+ T-lymphocyte counts of SARS patients were decreased apparently (694+/-568/microl, 441+/-356/microl, 309+/-462/microl). After 15th day of disease course, the counts gradually returned to normal CD3+, CD4+, CD8+ T-lymphocyte counts of non-SARS patients were normal. Compared with patients of the same group who were not treated with glucocorticoids, T-lymphocyte counts of non-SARS patients treated with glucocorticoids had no obvious difference. But glucocorticoids had some effect on SARS patients recovery of cellular immune function, i.e., it delayed the recovery by about 6 days.With or without treatment with glucocorticoids,the lowered CD3+, CD4+, CD8+ T-lymphocyte counts in the early stage are of very important significance in differential diagnosis between severe acute respiratory syndrome and common atypical pneumonia.

To investigate the therapeutic effect of integrative Chinese and western medicine (ICWM) in treating severe acute respiratory syndrome (SARS) and its influence on T-lymphocyte subsets.Comparative study was conducted in 133 SARS inpatients in Beijing Ditan Hospital, who were divided into 3 groups according to the treatment applied, the basic treated group, the low dose steroid group and the high dose steroid group, and all the 3 groups were subdivided into two groups, Chinese herbs and non-Chinese herbs added, respectively. Chinese drugs for clearing-up heat, dispelling dampness, detoxication, removing stasis, supplementing Qi and nourishing Yin were selected according to patients' syndrome and given additionally to all the three ICWM groups. Retrospective analysis for significance test on changes of T-lymphocyte subsets before and after treatment were carried out.T-lymphocyte counts, including CD3+, CD4+, CD8+, lowered in all patients before treatment, but increased significantly after treated for 3 weeks, the increment in all the low dose steroid treated groups was higher than that in the basic treated groups, and that in ICWM groups was higher than that in non-ICWM groups, respectively.Glycocorticosteroid and Chinese herbal medicine treatments could promote the recovery of T-lymphocyte profile, rationally use of them is the effective therapeutic method.