目的了解重庆地区急性肝衰竭(acute liver failure,ALF)的病因和结局,评价英国皇家学院(King's College Hospital,KCH)标准和终末期肝病模型(model for end-stage liver disease,MELD)评分对其结局的判断价值。方法回顾性分析第三军医大学西南医院1999年12月-2008年4月国际标准化比值≥1.5,且伴有肝性脑病的ALF住院患者的病因与结局,用KCH标准和MELD评分预测患者的结局。结果共323例符合标准,纳入研究。270例(83.6%)病因为HBV感染,22例(6.8%)病因不明,16例(5.0%)为药物引起,15例(4.6%)由其他原因引起。24例(7.4%)失访。获随访的299例中,240例(80.3%)死亡,59例(19.7%)自然康复。KCH标准预测ALF患者死亡或存活的灵敏度、特异度、阳性预测值、阴性预测值和正确率分别为74.2%、64.4%、89.4%、38.0%和72.2%;MELD评分预测ALF患者死亡或存活的上述指标分别为82.1%、61.0%、89.5%、45.6%和77.9%。结论重庆地区ALF的主要病因为HBV感染,KCH标准和MELD评分预测患者结局的阳性预测值较高,MELD评分的预测正确率高于KCH标准。
In order to screen potential mRNA locations of P gene in which targeting siRNAs can effectively inhibit HBV expression, 5 recombinant plasmids containing 4 targeting-specific siRNA fragments and a control were prepared and transfected into 2.2.15 cells respectively. The expression levels of HBx mRNA, HBs mRNA and HBc mRNA were detected by RT-PCR. The concentrations of the hepatitis B virus antigens, including HBsAg and HBeAg harvested from the culture supernatant of transfected 2.2.15 cells, were measured by ELISA. X protein was tested by Western blot. The results showed that four siRNAs against distinct mRNA locations of HBV polymerse gene had different inhibitory effects on their targeted mRNA. The plasmid-derived psiRNA1 and psiRNA2 could effectively inhibit the transcription and translation of HBs gene, whereas the inhibitory efficiency of psiRNA3, psiRNA4 for HBe gene was much higher than that of psiRNA1 and psiR.NA2. In comparison to the rest of psiRNAs in this study, psiRNA4 was the most effective to suppress the transcription and translation of HBx. It is suggested that siRNA can be considered as a powerful therapeutic agent for reducing HBV expression. The siRNAs against HBV polymerase are effective largely depending on the location of targeted sites. To enhance inhibitory efficiency, hunting for high effective target in polymerase gene is necessary and feasible.
