Objective To judge the effect by understanding the change of the blood related indexes before and after the applica-tion of lamivudine combined with silibinin treatment for treating E antigen positive chronic hepatitis B to provide the basis for the individualized therapy.Methods 226 cases of E antigen positive chronic hepatitis B were selected and divided into the mild group (55 cases),moderate group (94 cases)and severe group(77 cases)according to the degree of liver function injury.The 3 groups were given oral lamivudine 100 mg once daily and oral silybinin 70mg,3 times a day.The course of treatment was 6 months;the re-lated blood indexes before and after treatment were analyzed.Results After 6 months of treatment,the recovery rate of ALT,E an-tigen negative conversion rate and HBV-DNA negative conversion rate in the mild group and the moderate group were improved in different degrees,and those in the severe group were significantly increased(P <0.05).Conclusion Lamivudine combined with sili-binin treatment can inhibit the replication of HBV-DNA more effectively,promote the recovery rate of serum ALT significantly,im-prove the E antigen negative conversion rate,especially for the patients with severe liver function injury;which improve the curative effect in the treatment of chronic hepatitis B in some extent.

Objective To investigate the risk factors for acute variceal bleeding (AVB) in acute-on-chronic liver failure (ACLF) and its influence on prognosis. Methods A total of 1409 ACLF patients who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2015 were followed up for 6 months, and according to the presence or absence of AVB, they were divided into AVB group and non-AVB group. The Student's t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier curves were plotted and the Log-rank test was performed to analyze mortality rate and progression during follow-up, and a binary Logistic regression analysis was used to investigate the risk factors for AVB. Results Among these 1409 patients, 167 (11.85%) experienced AVB. The 30-day survival rate was 43.42% in the AVB group and 67.79% in the non-AVB group ( χ 2 =33.558, P < 0.001), and the 180-day survival rate was 18.91% in the AVB group and 53.97% in the non-AVB group ( χ 2 =76.881, P < 0.001). The Log-rank test showed significant differences in 30- and 180-day survival rates between the AVB group and the non-AVB group ( χ 2 =40.950 and 89.320, both P < 0.05). The Logistic regression analysis showed that pleural effusion (odds ratio [ OR ]=1.522, 95% confidence interval [ CI ]: 1.071-2.162, P =0.019), acute kidney injury (AKI) ( OR =2.201, 95% CI : 1.415-3.426, P < 0.001), ABC subtype of ACLF ( OR =2.491, 95% CI : 1.489-4.168, P =0.001), ACLF stage ( OR =2.403, 95% CI : 1.687-3.421, P < 0.001), and urea( OR =2.567, 95% CI : 1.570-4.196, P < 0.001)were independently associated with AVB in ACLF patients. Conclusion AVB is an important influencing factor for the short-term survival of ACLF patients, and pleural effusion, AKI, BC subtype of ACLF, advanced ACLF, and urea are independent risk factors for the onset of AVB.