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1.
目的 研究聚乙二醇干扰素(pegylated interferon,Peg-IFN)α-2a联合利巴韦林(ribavirin,RBV)治疗慢性丙型肝炎(chronic hepatitis C,CHC)对肝脏硬度测定(liver stiffness measurement,LSM)值的影响.方法 选择我院2010年10月-2012年9月接受Peg-IFN α-2a(180 μg/周)联合RBV[10.6~15.0 mg/(kg·d)]治疗48周的基因1b和非1b/2a型CHC患者91例,观察基线水平、治疗第12、24、48周以及停药后第24、48周的LSM值、HCV RNA和ALT水平的变化,分析抗病毒治疗对上述指标的影响.结果 治疗后,LSM值、HCV RNA和ALT水平明显降低,与治疗前相比,差异有统计学意义(P<0.05).持续病毒学应答(sustained virological response,SVR)率为79%,获得SVR的患者中有4例复发,复发患者具有高龄、高LSM值且均为基因1b型等特征.结论 Peg-IFN α-2a联合RBV治疗有效降低CHC患者体内HCV RNA和ALT水平,可改善肝纤维化.  相似文献   

2.
目前国际国内所有权威指南均明确指出,慢性丙型肝炎(chronic hepatitis C,CHC)的标准治疗是聚乙二醇干扰素α(Peg-IFN α)联合利巴韦林(ribavirin,RBV),基因1型HCV感染患者疗程48周,基因2/3型HCV感染患者疗程24周[1-2].我国最新的全国多中心临床研究结果显示,我国CHC患者经过规范化标准治疗的持续病毒应答(sustainedvirologic response,SVR)率可高达80%以上.  相似文献   

3.
严喜章 《山东医药》2010,50(23):89-90
目的 观察聚乙二醇-IFNα干扰素(PEG-IFNα)联合利巴韦林(RBV)治疗慢性丙型肝炎(CHC)的疗效和安全性.方法 将73例CHC患者随机分为观察组37例和对照组36例,均予RBV口服,并分别予PEG-IFNα及IFNα皮下注射,疗程均为48周.用药12周、疗程结束及停药后6个月时观察两组HCV-RNA阴转率、ALT复常率及不良反应.结果 观察组在治疗结束和停药后6个月ALT复常率显著高于对照组,且治疗12周、治疗结束和停药后6个月HCV-RNA阴转率均显著高于对照组(P均〈0.05);两组均未发生严重不良反应,均完成治疗.结论 PEG-IFNα联合RBV治疗CHC具有良好的疗效和安全性.  相似文献   

4.
目的观察肾功能衰竭(chronic renal failure,CRF)合并慢性丙型肝炎(chronic hepatitis C,CHC)行血液透析(hemodialysis,HD)患者采用干扰素(interferon,IFN)联合利巴韦林(Ribavirin,RBV)抗病毒治疗临床疗效及影响因素。方法对19例CHC合并CRF并行HD患者采用IFN联合RBV进行抗病毒治疗,对其临床资料(体质量指数、肝功能、基线HCV RNA载量、基因型、IL28基因分型等)进行总结,对快速病毒学应答(RVR)、早期病毒学应答(EVR)、持续病毒学应答(SVR)及其治疗过程中不良反应进行分析。结果 19例患者中,获得RVR 9例(47.4%),获得EVR 16例(84.2%),获得SVR 16例(84.2%);基因1型获得SVR 13例(68.4%),非基因1型获得SVR 3例(15.8%)。HCV RNA非高病毒载量8例(42.1%),均获得SVR。IL28B rs12979860位点基因型为CC、CT、TT各17、2、0例,基因1型患者rs12979860 CC型共14例(73.7%),13例(68.4%)获得SVR。1例(5.3%)因严重贫血停用RBV,1例(5.3%)因不能耐受药物不良反应终止治疗。结论 IFN联合RBV抗病毒治疗CRF合并CHC行HD患者治疗效果好,且基因1型非高载量的、宿主基因IL28b CC型能达到较高的SVR率。患者不良反应能够耐受。  相似文献   

5.
目的探讨基因1型慢性丙型肝炎(CHC)慢应答患者复发与疗程的相关性。方法收集2010年4月-2013年3月焦作市第三人民医院、焦作市人民医院住院或门诊的基因1型CHC患者157例,采用干扰素α-1b联合利巴韦林治疗,其中51例获得慢应答患者在治疗6个月时随机分为A(24例)、B(27例)两组,分别继续原方案治疗6、12个月,停药后随访1年。观察不良反应对抗病毒治疗方案的影响,比较两组治疗结束时HCV RNA阴转率、ALT复常率,停药后6个月、1年的复发率及ALT复常率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗中两组患者不良反应的发生率比较,差异均无统计学意义(P值均0.05)。治疗结束时两组患者HCV RNA阴转率(95.65%vs 92.59%)、ALT复常率(95.65%vs 88.89%)比较差异均无统计学意义(χ2值分别为0.02、0.13,P值均0.05)。停药6个月、1年后,B组患者复发率均显著低于A组(20.00%vs 50.00%;36.00%vs 68.18%),差异具有统计学意义(χ2值分别为4.69、4.85,P值均0.05);停药6个月、1年后,B组患者ALT复常率均高于A组(84.00%vs 59.09%;72.00%vs 50.00%),但差异均无统计学意义(χ2值分别为3.63、2.40,P值均0.05)。结论基因1型CHC慢应答患者延长疗程6个月可明显减少复发。  相似文献   

6.
雷华  庄林  王晴晴  田波  柏保利  陈洁 《肝脏》2016,(8):658-660
目的研究丙型肝炎病毒(HCV)基因3型感染者对普通干扰素和利巴韦林联合治疗的疗效。方法对2012年5月-2015年6月在我院就诊的抗-HCV和HCV RNA双阳性的1677例HCV患者进行基因分型,将其中2012年6月至2013年12月的120例HCV 3型初治患者采用普通干扰素(皮下注射IFN-α1b 5 MU/d,连续15 d;此后1次/隔日)联合利巴韦林(RBV 15 mg/kg·d)抗病毒治疗48周的方案;20例HCV 3型初治患者采用PegIFN-α2b(80μg/周)联合利巴韦林(RBV 15 mg/kg·d)治疗24周作为对照组。将普通干扰素联合利巴韦林抗病毒治疗获得快速病毒学应答(RVR)的患者,按照病毒载量分两组:≤1×10~5 IU/L(低病毒载量),A1组;1×10~5 IU/L(高病毒载量),A2组;获得早期病毒学应答(EVR),B组;未获得早期病毒学应答,C组。治疗前后和随访中检测患者血浆HCV RNA水平作为疗效评价的指标。结果在1677份标本中,检测到5种基因型,其中HCV基因lb型有263例,HCV基因2a型195例,HCV基因3a型314例,HCV基因3b型697例,HCV基因6a型67例,不能确定型别141例;其中基因3型(3a和3b)占总数的60.3%。治疗组112例患者完成既定治疗方案,92例(76.7%)患者获得SVR;其中A1组37例患者,33例(89.1%)获得SVR;A2组34例患者,28例(82.3%)获得SVR;B组(EVR)41例,31例(75.6%)获得SVR;C组(未获得EVR)8例:3例患者将普通干扰素调整为PegIFN,5例患者终止治疗。对照组20例均完成既定治疗方案:18例获得SVR,SVR率为90%,A1、A2组与对照组差异无统计学意义(P0.05)。结论(1)昆明地区慢性丙型肝炎患者以基因3型为主。(2)普通干扰素联合利巴韦林治疗获得RVR的3型慢性丙型肝炎患者疗效好。  相似文献   

7.
相对于慢性乙型肝炎(chronic hepatitis B,CHB)而言,慢性丙型肝炎(chronic hepatitis C,CHC)抗病毒治疗的效果较好。因此,只要诊断明确,有临床抗病毒治疗的适应证,都要进行积极的抗病毒治疗。目前,聚乙二醇化干扰素(Peg-IFN)联合利巴韦林(ribavirin,RBV)仍然是国际上公认的CHC抗病毒治疗的标准方案。这一方案治疗基因2型或3型CHC患者的持续应答率约为80%,但治疗基因  相似文献   

8.
<正>基因1型是目前慢性丙型肝炎(CHC)难以获得完全病毒学应答的重要因素之一[1]。聚乙二醇干扰素(PEG-IFN)联合利巴韦林(RBV)仍然是目前国内治疗基因1型CHC的标准方案[2]。但PEG-IFN价格昂贵,对于我国广大不发达地区患者难以承受。本研究应用小剂量干扰素(IFN)α-1b联合RBV、胸腺肽(thymosin,T)α1治疗基因1型CHC取得了与标准治疗  相似文献   

9.
目的 研究丙型肝炎病毒(HCV)基因型对慢性丙型肝炎(CHC)和丙型肝炎肝硬化患者接受干扰素α-2a治疗的影响。方法 2015年1月~2020年4月我院收治的CHC患者198例和丙型肝炎肝硬化患者200例,均接受肝活检和干扰素α-2a治疗24 周,随访24周。采用实时荧光定量PCR法检测血清HCV RNA水平,采用基因序列测定法检测HCV基因分型,采用单因素和多因素回归分析影响治疗应答的因素。结果 肝硬化组HCV基因1b型检出率为31.0%,显著高于86例≤S1的15.1%或112例S2~3组的18.8%(P<0.05);212例无应答组HCV基因1b型检出率显著高于186例治疗应答组(29.7%对17.7%),1a型检出率显著低于治疗应答组(17.9%对28.0%,P<0.05);应答组早期应答率为60.8%,显著高于无应答组的18.9%(P<0.05),应答组治疗前血清HCV RNA高水平比率为37.1%,显著低于无应答组的47.6%(P<0.05);HCV基因1b型(OR为0.553,95%CI为0.316~0.969)是影响干扰素治疗应答的危险因素,而早期应答(OR为1.704,95%CI为1.008~2.881)为影响干扰素治疗应答的保护因素。结论 HCV基因型可影响干扰素α-2a治疗慢性HCV感染者的应答反应,检测病毒基因型可能对选择合适的治疗方案或疗程有指导意义。  相似文献   

10.
目的:观察探讨聚乙醇干扰素-2a(PEG-IFN-2a)联合利巴韦林(RBV)的基础上加用中药芪参二莲汤治疗基因Ⅰ型高病毒载量慢性丙型肝炎(CHC)的临床疗效。方法:选取我院2012年05月—2013年03月HCV RNA4×105IU/ml的I型CHC患者75例,分为两组,治疗组38例采用PEG-IFN-2a联合RBV的基础上加用芪参二莲汤治疗;对照组37例应用PEG-IFN-2a联合RBV治疗,疗程48周,疗程结束后随访24周。治疗前后进行慢性肝病问卷(CLDQ)计分、肝功能、HCV RNA检测并作对照。结果:治疗患者早期病毒学应答(EVR)为57.89%、治疗结束时病毒应答(ETVR)为76.32%、持续病毒学应答(SVR)为68.42%;对照组分别为51.35%、62.16%、48.65%。两组病毒学应答比较,治疗组EVR、ETVR、SVR较对照组疗效显著,其差异均具有统计学意义(P0.05)。两组患者治疗后同时段组间CLDQ计分比较,乏力(FA)、全身症状(SS)、活动(AC)三个维度,治疗组较对照组疗效显著,其差异均具有统计学意义(P0.05);而腹部症状(AS)、情感功能(EF)、焦虑(WO)三个维度,两组比较差异均无统计学意义(P0.05);而乏力(FA)、活动(AC)两个维度治疗组治疗后与治疗前对照,其差异均具有明显统计学意义(P0.01)。治疗48周时治疗组患者ALT、AST、TBil与本组治疗前比较,差异均具有明显统计学意义(P0.01或P0.05);对照组ALT、AST与本组治疗前比较,差异均具有统计学意义(P0.05),TBil与本组治疗前比较,差异无统计学意义(P0.05)。两组患者治疗48周时,治疗组ALT、TBil优于对照组,差异均具有统计学意义(P0.05),而AST差异无统计学意义(P0.05)。两组患者治疗期间骨髓抑制、发热、甲状腺功能异常、胃肠道反应、精神症状等不良反应发生情况比较,差异有统计学意义(P0.05)。结论:芪参二莲汤联合PEG-IFN-2a和RBV治疗基因Ⅰ型高病毒载量CHC患者疗效显著,能更明显抑制高载量HCV RNA复制,显著改善患者肝功能,明确减轻不良反应,明显优于单用PEG-IFN-2a联合RBV的临床疗效。值得临床进一步研究及推广。  相似文献   

11.
BACKGROUND AND AIMS: The efficacy of interferon (IFN)-based antiviral therapy for chronic hepatitis C (CHC) varies depending on predictive factors such as hepatitis C virus (HCV) genotype and viral load. For patients with good predictive factors, a low dose and short course of IFN-based therapy may be adequate. However, there is no evidence about the optimal duration of IFN-based therapy for these patients. The aim of this study was to clarify whether the duration of IFN therapy could be shortened to less than the conventional treatment period for patients with good predictive factors. METHODS: A total of 25 treatment-naive CHC patients with genotype 2a were randomized to receive either IFN monotherapy for 24 wks (group A: long-term IFN therapy, n = 13) or for 6 wks (group B: short-term IFN therapy, n = 12). Patients were monitored for HCV RNA and routine liver function tests during and following treatment, and data were examined according to intention-to-treat analysis. RESULTS: Eleven of 13 patients in group A and all patients in group B completed IFN therapy according to the original planned schedule. At the end of the treatment, viral clearance occurred in all patients. However, 4 patients in group A and 5 in group B relapsed within 6 months of follow-up. There was no significant difference of sustained response rate between group A (53.8%) and group B (58.3%). Among patients who had HCV viral load of <100 kIU/ml, the sustained response rate was 83.3% (5/6) in group A and 100% (5/5) in group B. CONCLUSIONS: In this study, our results suggest that the duration of IFN therapy can be shortened to less than 24 wks in patients with good predictive factors. Further studies, however, should examine the optimal regimen of IFN therapy based on the backgrounds of patients.  相似文献   

12.
目的观察中西医结合治疗方案对慢性肝衰竭患者病死率、并发症发生率以及中医症状改善率的影响。方法采用随机对照设计,将纳入对象随机分配入试验组和对照组,分别给予中西医结合和内科综合治疗。结果经χ2检验,在治疗第8周、第12周、第24周和第48周,2组病死率差异无统计学意义,生存分析表明试验组的生存率略低于对照组,但经Log-rank检验,2组生存曲线差异无统计学意义;治疗第5周、第6周、第7周及第24周4个时间点试验组腹水发生率低于对照组(P<0.05),在治疗第48周试验组的肝性脑病发生率低于对照组(P<0.05);在改善乏力、腹胀、水肿等中医临床症状方面试验组优于对照组。结论个体化复杂干预的中西医结合治疗方案与单纯西医治疗比较,在降低慢性肝衰竭病死率方面未显示出优势,但在控制腹水、肝性脑病等并发症方面有一定作用,特别是在改善中医症状方面具有明显优势。  相似文献   

13.
In chronic hepatitis C (CHC), treatment duration may be individualized according to time to first undetectable hepatitis C virus (HCV) RNA, with patients who attain undetectable HCV RNA early in treatment being candidates for shorter regimens. The aim of this study was to determine the relapse rate in patients with CHC genotype (G) 1 infection and low baseline viral load who achieved undetectable HCV RNA by week 4 [rapid virologic response (RVR)] when treated for 24 weeks. This was an open-label, multicentre, noninterventional study. Adult patients with G1 CHC infection and baseline viral load <600,000 IU/mL who attained RVR were treated with peginterferon alfa-2b (1.5 μg/kg/week) plus ribavirin (800-1200 mg/day) for 24 weeks, then followed for a further 24 weeks. The primary endpoint was relapse rate, defined as the proportion of patients with undetectable HCV RNA at treatment week 24 and detectable HCV RNA at week 24 follow-up. The secondary efficacy endpoint was sustained virologic response (SVR). Overall, 170 patients were included in the efficacy-evaluable population. The relapse rate was 9.7% (16/165, 95% confidence interval: 0.06-0.15), and SVR was attained by 149 of 170 patients (87.6%). Virologic outcomes were consistent regardless of age, gender, body weight and genotype. Seven patients reported treatment-emergent serious adverse events (AEs), and four patients discontinued treatment because of an AE. This study further demonstrates that peginterferon alfa-2b plus weight-based ribavirin for 24 weeks is an effective treatment strategy for treatment-naive patients with G1 CHC and low viral load who attain RVR.  相似文献   

14.
江宇泳  王融冰 《传染病信息》2010,23(5):263-265,284
慢性丙型肝炎的西医治疗以干扰素联合利巴韦林的抗病毒治疗为基础。对标准治疗无持续病毒学应答的难治性丙型肝炎,蛋白酶抑制剂等特异性靶向抗病毒治疗有助于HCV的清除,多药联合同时可能加重某些不良反应如皮疹、贫血等,影响治疗的依从性。中西医结合治疗在减轻丙型肝炎抗病毒药物不良反应如发热、肌肉酸痛、抑郁、贫血及白细胞下降等,改善患者对治疗的依从性,提高持续性病毒学应答,减少停药后的复发及保肝抗炎、抗肝纤维化等方面显现一些优势。  相似文献   

15.

Background

The prevalence of hepatitis C virus (HCV) infections in elderly patients has been increasing in a number of countries. A few reports concerning pegylated interferon-α (PEG-IFN-α)-based combination treatment in elderly chronic hepatitis C (CHC) patients have been published, with slightly different treatment outcomes.

Objectives

We investigated the treatment response and safety of PEG-IFN-α plus ribavirin combination therapy in elderly patients with CHC.

Patients and Methods

Among a total of 181 treatment-naïve CHC patients (60 patients with genotype 1, 121 patients with genotype 2 or 3), 38 were aged ≥ 65 years (defined as the elderly group) and 143 were aged < 65 years (defined as the non-elderly group).

Results

The overall sustained virologic response (SVR) was lower in the elderly group than in the non-elderly group, but it was not significantly different (65.8 % vs. 76.2 %, P = 0.15). In a subgroup analysis, among patients with genotype 1, the elderly group had a significantly lower SVR rate than the non-elderly group (30.8 % vs. 66.0 %, P = 0.03). However, the SVR rate in patients with HCV genotype 2 or 3 was comparable between the two groups (84.0 % vs. 81.3 %, P = 0.85). HCV genotype was significantly associated with SVR in the elderly patients (genotype 1 vs. 2 or 3, odds ratio: 0.18, 95% confidence interval: 0.000-0.869, P = 0.03). The incidence of premature discontinuation of treatment (21.1 % vs. 9.1 %, P = 0.05) and dose modification (52.6 % vs. 31.5 %; P = 0.02) due mainly to adverse events or laboratory abnormalities, were higher in the elderly group than in the non-elderly group.

Conclusions

PEG-IFN-α plus ribavirin combination therapy might be considered for elderly CHC patients, especially for genotype 2 or 3, with vigilant monitoring of adverse events.  相似文献   

16.
OBJECTIVE: The treatment of patients with hepatitis C virus (HCV) genotype 1 infection remains disappointing. METHODS: In 1999, we started a multicentre study comparing two regimens of recombinant interferon (IFN) alpha-2b plus ribavirin. Group A (90 patients) received ribavirin plus IFN alpha-2b 5 MU/day for 1 month (induction therapy) followed by IFN alpha-2b 5 MU thrice weekly for 5 months. Group B (85 patients) received ribavirin plus IFN alpha-2b 5 MU thrice weekly for 6 months. Responders in both arms received IFN alpha-2b 3 MU thrice weekly for a further 6 months. A follow-up evaluation was performed at 18 months. RESULTS: One hundred and seventy-five consecutive treatment-naive patients with HCV genotype 1 infection were enrolled in the study. A sustained virological response (SVR) was obtained in 51 (29%) patients: 28 in group A (31%) and 23 in group B (27%). HCV-RNA clearance was greater at 3 months among patients who received induction therapy (57 vs 39%; p < 0.02). Age, sex, and initial viral load did not influence the achievement of a SVR. HCV clearance at the end of the study was lower in cirrhotic patients (3/26 vs 48/149; p < 0.05). The only SVR in patients with cirrhosis occurred in those from group A (p < 0.05). Both regimens were well tolerated. CONCLUSIONS: This study confirms the low rate of SVR in treatment-naive patients with HCV genotype 1 infection treated with IFN alpha-2b plus ribavirin. A 4-week induction regimen was slightly superior to standard IFN alpha-2b plus ribavirin. Although the number of patients with cirrhosis was low, induction therapy seemed to be more effective in cirrhotics. Given its safety and tolerability, the induction regimen evaluated here may be a therapeutic option in treatment-naive patients with HCV genotype 1 infection.  相似文献   

17.
目的 对进行过根除幽门螺杆菌(H.pylori)治疗而失败的患者,应用含铋剂、质子泵抑制剂的四联疗法和中医药联合补救治疗并观察根除疗效.方法 120例H.pylori阳性患者随机分成两组,每组60例;对照组应用埃索美拉唑镁肠溶片20 mg,枸橼酸铋钾胶囊(商品名丽珠得乐)0.6g(相当于铋0.22 g),阿莫西林(珠海联邦制药股份有限公司)1000 mg,呋喃唑酮(商品名痢特灵,上海利生制药厂生产)100 mg,2次/d,共7d;而治疗组除应用对照组药物外,同时服用中药14 d,观察上腹痛、反酸、饱胀感、嗳气等症状缓解情况,并在补救治疗结束1个月后复查胃黏膜快速尿素酶试验和组织学染色或查14C-尿素呼气试验,观察其根除率.结果治疗组58例完成治疗,其中53例H.pylori转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为88.33% (53/60)和91.38%(53/58),对照组55例完成治疗,其中48例转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为80.00%(48/60)和87.27%(48/55),两组间比较有显著性差异(P<0.05).治疗后两组症状缓解率分别为94.83%(治疗组)和83.64%(对照组),两组间比较有显著性差异(P<0.05).结论 对H.pylori根除治疗失败的患者,应用四联疗法和中医药联合补救疗法不仅能获得较高的H.pylori根除率,对临床症状的改善也有良好作用,且副反应较小,值得临床推广.  相似文献   

18.
目的探讨病证结合优化方案治疗支气管哮喘的临床疗效。方法选择江苏省中西医结合医院2011年1月—2014年1月门诊及住院支气管哮喘患者72例,根据治疗方案分为中药组26例,西药组20例,中西医结合组26例。中药组患者采用病证结合优化方案,西药组患者吸入沙美特罗替卡松,中西医结合组患者联合应用中药组和西药组治疗方案。3组患者均连续治疗10 d,为1个疗程。观察3组患者临床疗效、治疗前后FEV1及治疗期间不良反应情况。结果中药组、西药组、中西医结合组均未出现无效患者,总有效率均为100%(P0.05)。3组患者治疗前后FEV1比较,差异均无统计学意义(P0.05),各组治疗后FEV1均高于治疗前(P0.05)。治疗期间,西药组患者出现心悸2例,中西医结合组出现咽喉炎1例,中药组患者未出现明显不良反应。结论单纯中药治疗、单纯西药治疗及病证结合优化方案治疗支气管哮喘临床疗效相当,均可有效改善患者FEV1,且不良反应较少,安全性较高。  相似文献   

19.
目的:研究冠心病慢性心力衰竭患者室性心律失常患者的临床治疗资料,为后期治疗提供可靠的参考数据。方法选取我院2012年3月-2013年2月收治的180例冠心病慢性心力衰竭患者,随机把患者分为对照组及观察组各90例,对照组采用西药,观察组在对照组基础上加以中药联合治疗,分析对比两组患者用药后的临床疗效及不良反应。结果观察组疗效及不良反应均优于对照组,观察组总有效率为90%,而对照组总仅仅达到72.2%,组间总有效率比较,具有显著差异性。结论应用中西医结合治疗冠心病慢性心力衰竭并发室性心律失常,其临床疗效显著,可有效地控制心律失常,减少不良反应,是临床用药的好方法,值得临床上大力推广。  相似文献   

20.
目的观察中西医结合治疗慢性肾功能衰竭的临床疗效。方法 60例患者按照就诊时间的先后顺序编号,单号为观察组(30例),双号为对照组(30例),对照组采用纯西药治疗,观察组给予中西医结合治疗。结果观察组总有效率为80.0%,对照组总有效率为53.3%,两组比较差异有统计学意义(P0.01)。结论中西医结合治疗慢性肾功能衰竭疗效比单纯西药治疗好。  相似文献   

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