利巴韦林的安全性和有效性--Meta分析结果的系统综述

本文对利巴韦林有效性和安全性的meta分析进行了综述,在丙型肝炎患者中,与干扰素单独治疗相比,利巴韦林/干扰素联合治疗对丙型肝炎有更好的疗效,但增加了不良反应的发生率.利巴韦林治疗婴儿呼吸道合胞病毒感染的疗效尚无充分证据,需要进行更大的随机对照试验.     

利巴韦林雾化吸入治疗新生儿合胞病毒肺炎的临床分析

合胞病毒肺炎是常见呼吸系统疾病,严重危害新生儿健康,西医缺乏对呼吸道合胞病毒肺炎的特异性治疗,主要是对症、支持治疗。利巴韦林是用于治疗呼吸道合胞病毒高危患者的药物之一。本研究旨在分析利巴韦林雾化吸人治疗新生儿合胞病毒肺炎的临床疗效。     

利巴韦林在新型冠状病毒肺炎治疗中的应用及注意事项

目前针对新型冠状病毒肺炎尚无特效药物,一些药物可能在体外研究中有效,但仍处于临床试验阶段,临床应用需谨慎。利巴韦林是核苷类广谱抗病毒药物,临床上多用于治疗呼吸道合胞病毒引起的病毒性肺炎与支气管炎、皮肤疱疹病毒感染等。本文以国内外文献为基础,对利巴韦林的抗病毒作用机制、药代动力学、药效学、体外研究、既往冠状病毒中的应用、临床应用、用法用量、治疗药物监测及不良反应等方面进行综述,为利巴韦林的临床应用提供参考。     

干扰素联合利巴韦林治疗丙型肝炎临床疗效分析

目的研究干扰素联合利巴韦林治疗丙型肝炎的疗效。方法回顾本院60例慢性丙型肝炎患者,随即分为治疗组与对照组,分别使用干扰素及干扰素联合利巴韦林进行治疗,观察疗效。结果治疗组ALT复常率及HCV-RNA阴转率均高于对照组,不良反应发生率高于对照组。结论干扰素联合利巴韦林治疗丙型肝炎,只要注意选择病例及用量,是一种有效的方法。     

利巴韦林在丙型肝炎治疗中的应用

目的：探讨利巴韦林在治疗丙型肝炎中的应用。方法：对近年来国外公开报道的有关利巴韦林的临床应用情况进行分析。结果：在丙型肝炎治疗方案中，联合应用利巴韦林可取得较好疗效。结论：利巴韦林在丙型肝炎治疗中值得推广。     

利巴韦林联用细辛脑空气压缩泵雾化吸入治疗小儿呼吸道合胞病毒感染的疗效探讨

目的:探讨利巴韦林联用α-细辛脑雾化吸入治疗小儿呼吸道合胞病毒感染的疗效。方法:对确诊的163例患毛细支气管炎患儿随机分为治疗组和对照组,治疗组利巴韦林联用细辛脑雾化吸入治疗组应用α-细辛脑注射液加入利巴韦林雾化吸入,对照组应用利巴韦林,加入生理盐水中雾化吸入,以上治疗均每日2次。结果:两种治疗方案中,治疗组疗效优于对照组,患儿气促、肺部罗音的消失时间及住院时间均缩短。结论:利巴韦林联合α-细辛脑治疗小儿呼吸道合胞病毒感染效果好。     

利巴韦林的安全性问题

利巴韦林为合成的核苷类抗病毒药,20世纪70年代在国外上市,我国研制的利巴韦林于80年代上市。目前,利巴韦林在临床上主要用于呼吸道合胞病毒引起的病毒性肺炎与支气管炎,皮肤疱疹病毒感染等病毒性疾病的治疗。目前,世界卫生组织(WHO)药品不良反应数据库中,有关利巴韦林的不良反     

治疗慢性丙型肝炎新药——聚乙二醇干扰素α-2b

目的:介绍治疗慢性丙型肝炎新药聚乙二醇干扰素α-2b的有效性和安全性.方法:检索国外有关文献,进行文献综述.结果:表明聚乙二醇干扰素α-2b是目前治疗慢性丙型肝炎最有效的药物之一,与利巴韦林合用可明显提高疗效.该药最常见的不良反应为流感样综合征和血液学毒性反应.结论:聚乙二醇干扰素α-2b值得临床推广应用,但须注意其不良反应.     

静脉滴注痰热清佐治重症呼吸道合胞病毒性毛细支气管炎疗效观察

目的：观察痰热清注射液治疗重症呼吸道合胞病毒性毛细支气管炎的临床疗效。方法：用直接免疫荧光法检测呼吸道脱落上皮细胞中的呼吸道合胞病毒抗原,选出42例阳性患者并符合重症毛细支气管炎诊断标准的患儿进行研究,将患儿随机分成两组,观察组、对照组各21例,观察组在常规治疗的基础上加用痰热清注射液,对照组加用利巴韦林。结果：痰热清注射液组总有效率为90％,利巴韦林组有效率为62％,两组比较有显著性差异。结论：痰热清注射液佐治重症呼吸道合胞病毒性毛细支气管炎疗效满意。     

a-干扰素治疗慢性丙型肝炎的不良反应及疗效观察

目的观察a-干扰素治疗慢性丙型肝炎过程中的不良反应、疗效。方法 134例慢性丙型肝炎患者均采用a-干扰素联合利巴韦林片抗病毒治疗,疗程为48个月,治疗期间注意观察对血液系统、消化系统、神经系统、皮肤等各个系统的影响。结果治疗过程中a-干扰素表现出多个系统的药物不良反应,近期效果较好。结论 a-干扰素在临床应用中出现多种不良反应,应引起临床医师的重视。     

利巴韦林治疗新型冠状病毒肺炎可能性系统评价

目的系统评价利巴韦林治疗新型冠病毒肺炎的可能性。方法检索PubMed,Embase,The Cochrane Library,以及中国期刊全文数据库(CNKI)、万方数据库(WangFang DATA)、中国生物医学文献数据库(CBM)等有关利巴韦林治疗严重急性呼吸综合征(SARS)和中东呼吸综合征(MERS)的文献,同时回溯纳入文献的参考文献。应用世界卫生组织(WHO)推荐的快速系统评价方法,并对文献质量进行评价,评估利巴韦林治疗2019新型冠状病毒肺炎(COVID-19)的可能性。结果共检索到437篇文章,最终纳入18项研究。SARS疫情期间,我国大陆、香港以及加拿大等国家或地区都有应用高剂量利巴韦林联合干扰素、激素、洛匹那韦/利托那韦(LPV/r)治疗的经验,高剂量利巴韦林的不良反应有贫血、心动过缓、肌痛、低氧血症、电解质紊乱等,这些不良反应可能导致停止药物治疗或不良结局。结论利巴韦林可在联合应用干扰素、激素、LPV/r并严密监测相关不良反应的基础上尝试用于COVID-19的治疗,但其临床有效性还有待更多的随机对照试验来证实。     

病毒唑超声雾化吸入治疗80例小儿呼吸道感染疗效分析

目的分析并评价病毒唑超声雾化吸入治疗小儿呼吸道合胞病毒感染的临床疗效。方法对我院自2008年10月-2010年12月期间收治的80例呼吸道合胞病毒感染患儿进行随机分组,在相同的治疗条件下,观察组40例进行病毒唑超声雾化吸入治疗,对照组40例进行病毒唑静脉滴注治疗。结果观察组总有效率为80．0％,明显高于对照组的42．5％,差异有极显著性（P〈0．01）。对照组的发热持续时间、喘息时间、肺部湿罗音以及哮鸣音持续时间均长于观察组,差异有极显著性（p〈0．01）。结论病毒唑雾化吸入方式在治疗呼吸道合胞病毒感染方面的临床疗效明显好于病毒唑静脉滴注治疗。     

Hepatitis C virus-related extra-hepatic disease--aetiopathogenesis and management

Summary Hepatitis C virus infection is often associated with extra-hepatic manifestations, secondary to the elicitation of autoimmune reactions, generalized deposition of immune complexes and lymphoproliferative disorders. The most clearly established associations are those linking chronic hepatitis C with mixed cryoglobulinaemia (and the related glomerulonephritis and cutaneous vasculitis), as well as with the presence of autoantibodies. Less well-documented disorders include non-Hodgkin's lymphoma, thrombocytopenia, sialadenitis, thyroid disease, lichen planus, porphyria cutanea tarda, rheumatoid disorders and neurological disorders. Extra-hepatic manifestations are most frequent in patients of female sex, advanced age, long-lasting infection and cirrhosis. Optimal treatment strategies should be based on the predominant manifestation of the disease. In the case of autoimmune disorders not clearly attributable to the viral infection, corticosteroids may be the most effective option. Interferon-alpha alone or in combination with ribavirin may be indicated for those disorders related to immune complex deposition, such as mixed cryoglobulinaemia, although relapses of extra-hepatic signs often occur on discontinuation of treatment. In some cases, interferon-alpha may induce or exacerbate some extra-hepatic manifestations.     

Effect of an educational program on the treatment of RSV lower-respiratory-tract infection.

The effectiveness and outcomes of an educational program to decrease ribavirin and antimicrobial prescribing rates and associated costs for patients with respiratory syncytial virus (RSV) lower-respiratory-tract infection are described. An educational program on the appropriate treatment for RSV infections was conducted for attending physicians and medical residents with multiple methods and forums during the 1994-95 RSV season. A retrospective chart review of 2396 patients admitted to a pediatric teaching hospital from July 1, 1991, through June 30, 1998, was conducted to measure the frequencies of ribavirin and antimicrobial prescribing in infants and young children hospitalized with RSV lower-respiratory-tract infection. The results before and after the educational program were compared. Ribavirin was prescribed for 37.9% of patients before the program, and only 9.0% received it afterward (p < 0.001). Before the program, 24.8% of patients with no risk factors received ribavirin compared with 1.6% of patients after the program (p < 0.001). However, more patients with three or more risk factors for morbidity and mortality received ribavirin before the program than afterward (97.8% versus 39.2%, respectively). A broad-spectrum i.v. antimicrobial was prescribed for 85.6% of patients before the program while 60.6% received one afterward (p < 0.001). The cost savings for ribavirin and antimicrobials during the three-year period after the program were $1,235,484 and $34,839, respectively. Hospital length of stay decreased from 5.6 to 5.1 days (p < 0.001). No readmissions occurred during the study period. A multifaceted educational intervention program may have been somewhat effective in modifying physician's prescribing habits for the treatment of RSV lower-respiratory-tract infection.     

抗呼吸道合胞病毒候选药物的研究进展

呼吸道合胞病毒(RSV)感染是引发婴幼儿细支气管炎、肺炎的主要病因之一,会导致严重的呼吸系统疾病,会增加罹患哮喘的风险。帕利珠单抗和利巴韦林可用于预防和治疗RSV感染,两者均推荐用于RSV感染风险最高的患者,但其有益作用尚有争议。抗RSV药物的研究主要集中于不同的作用机制如抑制病毒融合、靶向非融合靶点和靶向病毒宿主的抑制剂。因此,预防或治疗呼吸道合胞病毒感染,深入研究抗病毒策略,指导候选药物筛选尤显突出,但是至今仍没有抗病毒药物或疫苗被批准用于RSV感染的治疗或预防。随着病毒学的深入研究,研究者将开发针对病毒靶点蛋白或宿主细胞因子的一系列的抗病毒药物,这些药物研发将为抗病毒提供新的途径。     

利巴韦林注射液2种剂型治疗急性上呼吸道感染比较

目的 :评价利巴韦林葡萄糖注射液对急性病毒性上呼吸道感染的疗效及安全性并与利巴韦林注射液进行比较。方法 :160例体温在 38.5℃以上的急性病毒性上呼吸道感染病人 ,采用区组随机对照法分为利巴韦林葡萄糖注射液组 (验证组 ) 10 0例和利巴韦林注射液组 (对照组 ) 60例 ,剂量均为 50 0mg ,iv ,gtt,bid× 5d。结果 :验证组和对照组的临床有效率为 97%和 92 % ,组间经 χ2 检验 ,差别无显著意义 (P >0 .0 5) ;2组有显著的退热作用和抗病毒作用 ,不良反应轻微。结论 :利巴韦林葡萄糖注射液是与利巴韦林注射液相同的安全有效的治疗急性病毒性上呼吸道感染的药物     

The ABC of viral hepatitis

Viral hepatitis has long been under-diagnosed. Hepatitis A is an acute disease, while patients infected by hepatitis B and hepatitis C viruses are likely to develop chronical infections and severe complications (cancer, cirrhosis). The current treatment of hepatitis B and C consists in alpha interferon (preferably under its pegylated form), in combination with ribavirin for hepatitis C. The frequent and severe adverse effects of interferon-based therapy constitute, however, a major limiting factor (reactions at the injection site, flu-like syndrome, neurological disorders, ...). For hepatitis B, two alternatives are available so far, namely lamivudine and adefovir (used as a prodrug with highe oral bioavailability).     

JAK抑制剂治疗中重度COVID-19患者临床疗效及安全性的Meta分析

目的:采用Meta分析方法评估JAK抑制剂治疗中重度COVID-19患者的临床疗效及安全性。方法:从PubMed、Web of Science, Cochrane Library数据库检索了2020年1月1日至2022年4月的685篇相关文章,最终纳入13篇文献到RevMan 5.4.1软件中进行主要临床结局的研究。Cochrane风险评估工具和Newcastle-Ottawa Scale(NOS)量表分别评估随机对照实验和队列研究的文献质量。亚组分析研究了用药剂量、种类、合并用药对临床死亡率的影响。结果:最终纳入13项研究,包括4 402名患者,大多为感染SARS-CoV-2的中重度或重度老年患者。研究全因死亡率时,实验组与对照组相比有更低的临床死亡风险(RR=0.55,95%CI:0.47～0.65),且实验组总体严重不良反应风险和机械通气的需求率均低于对照组(总体严重不良反应：RR=0.78,95%CI:0.67～0.91;机械通气：RR=0.63,95%CI:0.46～0.85)。按照系统分析了实验组和对照组发生严重不良反应的差异。实验组发生继发性感染、泌尿系统和呼吸系统严重不...     

Seasonal allergic rhinitis: limited effectiveness of treatments

(1) Seasonal allergic rhinitis, otherwise known as hayfever, is a harmless condition, although it can cause major discomfort and interfere with activities of daily living. We conducted a review of the literature, based on our in-house methodology, to determine the risk-benefits of treatments used in this setting. (2) Placebo-controlled trials show that sodium cromoglicate relieves symptoms, especially if it is used before symptoms appear. Adverse effects are rare with sodium cromoglicate nasal solutions and eye drops. (3) Nasal steroids have well-documented efficacy. Beclometasone is the best choice. Adverse effects include epistaxis, nasal irritation and, occasionally, systemic disorders. (4) Oral antihistamines are less effective than nasal steroids. They also provoke adverse effects, especially drowsiness. Nasal azelastine seems to have a similar efficacy as oral antihistamines. (5) The adverse effects of systemic steroids must not be overlooked, especially with long-term use. Oral administration is an alternative for severe symptoms that do not respond to other treatments, although this is rarely the case. Long-acting intramuscular steroids carry an increased risk of adverse effects. (6) Despite evaluation in several randomised controlled trials, there is no firm evidence that homeopathic preparations have any specific efficacy in allergic rhinitis. (7) Vasoconstrictors, ipratropium and montelukast, have negative risk-benefit balances in hay fever. (8) When a single allergen is responsible (grasses, ragweed, birch), clinical trials suggest that specific desensitisation can provide a modest improvement. However, this treatment carries a risk of local adverse effects, as well as a risk of rare but severe anaphylactic reactions, especially in patients who also have unstable severe asthma. (9) Sublingual desensitisation seems to be even less effective than subcutaneous desensitisation in adults. Follow-up is too short to know whether there is a risk of severe anaphylactic reactions. The results of paediatric studies are even less convincing. (10) In practice, when drug therapy is needed to relieve symptoms of seasonal allergic rhinitis, sodium cromoglicate is the first-line treatment. If a nasal steroid solution is chosen, it should be used for the shortest possible period.     

头孢曲松钠的不良反应

目的探讨头孢曲松钠的药物不良反应类型及其相应的不良反应机制。方法检索CNKI、维普、Pubmed、OVID等数据库中头孢曲松钠不良反应、产生不良反应的机制和对应的预防处理措施的相关报道,进行回顾性分析。结果头孢曲松钠所致的不良反应涉及人体多个系统,以变态反应最多,最严重的是过敏性休克;其次为神经系统、血液系统、泌尿系统、消化系统等不良反应。部分不良反应是由给药途径不同、剂量过大、不合理配伍用药所致。结论通过对头孢曲松钠的不良反应及其不良反应机制的分析,以期合理应用头孢曲松钠。