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1.
目的探讨和分析在治疗乙型病毒性肝炎肝硬化合并糖尿病患者的过程中,恩替卡韦与阿德福韦酯两种药物对患者不同的治疗效果,以更好地指导临床用药。方法选取2017年7月-2018年8月来该院接受治疗的82例乙型病毒性肝炎肝硬化合并糖尿病患者为对象展开此次研究;患者被随机分成各41例的研究组和参考组,分别提供恩替卡韦与阿德福韦酯给予治疗;对比两组患者的治疗效果。结果两组患者治疗后,肝功能、血糖水平均有显著改善,但恩替卡韦治疗的研究组患者的Tbil、DBil、ALT、AST、Alb、空腹血糖和糖化血红蛋白均显著优于参考组患者,差异有统计学意义(P<0.05)。另外,研究组中患者的病毒学应答率80.5%显著高于参考组的58.5%,差异有统计学意义(χ^2=4.661,P<0.05)。并发症率两组患者差异无统计学意义(P>0.05)。结论治疗乙型病毒性肝炎肝硬化合并糖尿病患者,恩替卡韦与阿德福韦均能够具有较好的治疗效果;但是恩替卡韦更加有利于患者肝功能恢复,且在控制血糖方面也更优效;综合来说恩替卡韦的疗效比阿德福韦酯更好。  相似文献   

2.
目的了解恩替卡韦(ETV)对核苷(酸)类药物初治和经治的慢性乙型肝炎患者长期治疗的疗效、安全性和耐药性。方法回顾性分析本院感染科门诊随访恩替卡韦单药治疗的87例慢性乙型肝炎患者,观察肝功能、HBV DNA定量、HBsAg定量、HBeAg阴转、耐药发生率等指标。结果 87例患者中,32例(37%)为恩替卡韦初治患者,55例(63%)为拉米夫定(LAM)或阿德福韦酯(ADV)经治换用恩替卡韦的患者。恩替卡韦初治组,阿德福韦酯经治组和拉米夫定经治组,7年累计病毒学应答率分别为100%(32/32),97%(30/31)和62%(13/21);7年累计耐药率分别为3%(1/32),3%(1/31)和38%(8/21);7年累计HBeAg阴转率为47%(9/19),45%(13/29)和20%(3/15);其中阿德福韦酯经治组有两例患者达到HBsAg清除。在所有的患者中,HBeAg阴性患者较HBeAg阳性患者早期病毒学应答率更高(P=0.012),7年累计病毒学应答率分别为91%(21/23)和89%(57/64)。在恩替卡韦初治患者中,HBeAg阴性患者同样比HBeAg阳性患者早期病毒学应答率高(P=0.001),累计病毒学应答率分别为100%(13/13)和100%(19/19)。3组病毒学应答率比较,恩替卡韦初治患者早期病毒学应答率高于阿德福韦酯经治患者和拉米夫定经治患者(P0.001)。结论恩替卡韦初治患者长期疗效佳,耐药低,安全性好,阿德福韦酯经治患者序贯恩替卡韦仍能取得较好的长期疗效,但是对于拉米夫定经治患者来说,选用恩替卡韦长期治疗存在较高的耐药风险。  相似文献   

3.
目的 观察马来酸恩替卡韦、恩替卡韦和阿德福韦酯抑制鸭乙型肝炎病毒(DHBV)复制的情况,比较抗病毒疗效的差异,考核药物的抗病毒效果.方法 实验动物为垂直传播感染、DHBVDNA检测阳性的麻鸭.分设马来酸恩替卡韦组、恩替卡韦组、阿德福韦酯对照组和DHBV DNA阳性、阴性对照组.马来酸恩替卡韦和恩替卡韦组各分为高、中、低3个剂量组,每日1次给药;阿德福韦酯组每周3次给药,均为口服,连续6周.分别在实验前、给药第2、4、6周和停药2周后静脉取血.实验结束后以TaqMan实时荧光定量PCR方法进行血清DHBV DNA定量检测,取对数后以配对资料的t检验统计分析.结果 马来酸恩替卡韦、恩替卡韦的低、中、高剂量组以及阿德福韦酯组在治疗前后,血清DHBV DNA的含量均显著降低.马来酸恩替卡韦高剂量组在治疗前及用药6周后的DHBV DNA含量分别为(7.34±1.33)和(2.12±2.50)1g拷贝/mL(P<0.01);恩替卡韦高剂量组在治疗前及用药6周后的DHBV DNA含量分别为(8.02±0.56)和(4.36±1.64)lg拷贝/mL(P<0.01).停药2周后各组的:DHBV DNA含量出现一定程度反跳.马来酸恩替卡韦和恩替卡韦起效迅速,抗病毒能力强,各剂量组用药前后DHBV DNA水平的差异大于阿德福韦酯,抗病毒效果优于阿德福韦酯,而马来酸恩替卡韦的抗病毒效果又更为显著,且停药后其持续疗效更好.结论 马来酸恩替卡韦和恩替卡韦的抗DHBV作用强于阿德福韦酯,而马来酸恩替卡韦又优于思替卡韦.鸭乙型肝炎动物模型适用于筛选和评价抗病毒药物及制剂.  相似文献   

4.
目的对恩替卡韦与阿德福韦酯在乙型肝炎肝硬化合并肝源性糖尿病患者当中的治疗效果进行探究。方法该研究的样本来自于2017年3月—2019年4月间收治的乙型肝炎肝硬化合并肝源性糖尿病患者,从中抽取68例作为研究对象,观察组患者服用恩替卡韦进行治疗,对照组患者服用阿德福韦酯进行治疗,同时均进行胰岛素控制血糖以及饮食指导等,对两组患者的治疗效果进行比较。结果在该次研究当中,观察组患者在服用恩替卡韦进行治疗之后,患者的治疗效果明显提升,病毒学应答率为88.24%,对照组为70.59%(χ^2=4.231,P<0.05),观察组的血糖以及糖化血红蛋白与对照组之间同样存在较大的差异,观察组分别为(7.44±1.12)mmol/L以及(8.37±1.14)%,对照组则为(7.24±0.61)mmol/L以及(7.91±0.78)%,从肝脏硬度来看,观察组患者为(16.84±5.47)kPa,而对照组为(19.57±5.24)kPa(t=2.314,P<0.05)。结论在当前的临床治疗来看,通过采用服用恩替卡韦的治疗方案,能够显著改善乙型肝炎合并肝源性糖尿病患者的治疗效果,实现患者肝功能的改善,对患者的血糖进行有效的调节,在临床推广方面有着更高的价值。  相似文献   

5.
目的 探讨阿德福韦酯联合恩替卡韦对拉米夫定联合阿德福韦酯治疗失败(包括发生疗效欠佳及病毒学突破)的慢性乙型肝炎患者的临床疗效及安全性.方法 将70例对拉米夫定联合阿德福韦酯治疗失败的慢性乙型肝炎患者随机分为对照组和优化组.对照组继续予拉米夫定(100 mg/d)联合阿德福韦酯(10 mg/天)治疗;优化组在服用阿德福韦酯(10 mg/d)的同时,联合使用恩替卡韦(0.5 mg/d)优化治疗.所有患者均治疗48周.治疗前、治疗12周、24周和48周分别进行生物化学、病毒学、血清学检测.回顾性分析、比较两组患者上述治疗时间点的生物化学应答率(BR)、完全病毒学应答率(CVR)、病毒学突破率(VBR)和HBeAg/HBeAb血清学转换率.结果 优化组患者治疗48周后BR、CVR、VBR分别为75.0%(12/16)、81.8% (27/33)、3.0%(1/33),对照组分别为26.3% (5/19)、32.4% (12/37)和21.6% (8/37),两组比较差异具有统计学意义(P值均<0.01).但两组患者治疗48周后,HBeAg/HBeAb血清学转换率分别为5.9%(1/17)和13.3% (2/15),两组比较差异无统计学意义(P>0.05).两组患者耐受性良好,无1例患者出现严重不良反应而导致停药.结论 对于拉米夫定联合阿德福韦酯治疗失败的慢性乙型肝炎患者,阿德福韦酯联合恩替卡韦是一种行之有效的优化治疗方案.  相似文献   

6.
目的:观察阿德福韦酯和恩替卡韦治疗初治的 HBeAg 阳性慢性乙型肝炎患者96 w 的临床疗效及不良反应。方法在初治的 HBeAg 阳性慢性乙型肝炎患者中,接受阿德福韦酯治疗的患者38例,接受恩替卡韦治疗的患者30例,比较两组患者治疗前基线 ALT、HBV DNA、HBsAg、HBeAg、肌酐及治疗96 w 时的疗效。结果阿德福韦酯治疗患者基线 ALT 水平为(186.6±124.5) U/L,HBV DNA 水平为(7.3±1.1) log10拷贝/毫升,恩替卡韦治疗患者基线 ALT 水平为(190.8±116.8) U/L,HBV DNA水平为(7.5±1.5) log10拷贝/毫升 ml,两组具有可比性(P<0.05);在治疗96 w 时,恩替卡韦治疗患者 HBV DNA 阴转率为98.2%,显著高于阿德福韦酯治疗患者的60.2%(P<0.05);恩替卡韦组 ALT 复常率为97.1%,与阿德福韦酯组的92.7%相比,无显著性相差(P>0.05);恩替卡韦组 HBeAg 阴转率28.8%,与阿德福韦酯组的26.2%相比,无显著性相差(P>0.05)。结论恩替卡韦在降低患者血清 HBV DNA 载量方面优于阿德福韦酯,但在血清 HBeAg 转阴率、ALT 复常率方面两者相似。  相似文献   

7.
董宇 《肝脏》2016,(2):132-134
目的探讨核苷类似物序贯方案对干扰素治疗无应答伴肝脏损害慢性乙型肝炎的作用。方法随机选取我院2012年5月至2015年5月收治的90例干扰素治疗无应答伴肝脏损害慢性乙型肝炎患者,依据随机数字表法将患者分为替比夫定组(n=30)、恩替卡韦组(n=30)及阿德福韦酯组(n=30)3组。治疗后对三组患者的临床疗效及不良反应发生情况进行统计分析。结果替比夫定组和阿德福韦酯组患者的完全应答率均显著高于恩替卡韦组(P0.05),部分应答率均显著低于恩替卡韦组(P0.05),复发率均显著高于恩替卡韦组(P0.05),而替比夫定组患者的复发率又显著高于阿德福韦酯组(P0.05);替比夫定组患者的不良反应发生率显著高于恩替卡韦组和阿德福韦酯组(P0.05)。结论替比夫定、恩替卡韦、阿德福韦酯序贯治疗干扰素治疗无应答伴肝脏损害慢性乙型肝炎的效果均较好。  相似文献   

8.
目的 观察分别利用拉米夫定和阿德福韦酯联合治疗与换用恩替卡韦单药治疗拉米夫定应答不佳慢性乙型肝炎患者的临床疗效.方法 80例拉米夫定应答不佳的慢性乙型肝炎患者采用随机数字表法分为联合组和单药组,联合组服用拉米夫定100 mg/d和阿德福韦酯10mg/d;单药组服用恩替卡韦0.5 mg/d,观察两组患者治疗48周时的疗效.结果 治疗48周后,联合组的HBV DNA应答率、HBeAg转换率、ALT复常率分别为90.0%、40.0%和95.0%,远高于单药组的70.0%、15.0%和80.0%,两组比较差异均有统计学意义(P<0.05).治疗48周后,联合组未出现病毒学突破病例;单药组共有2例患者出现病毒学突破.结论 对于拉米夫定应答不佳的慢性乙型肝炎患者,加用阿德福韦酯联合治疗的疗效优于换用恩替卡韦单药治疗,且可降低病毒耐药的发生率.  相似文献   

9.
目的观察拉米夫定联合阿德福韦酯与恩替卡韦单药治疗HBeAg阳性慢性乙型肝炎96周的疗效,以探讨理想的初始抗病毒治疗方案。方法选择HBeAg阳性慢性乙型肝炎患者86例,随机分为单药治疗组44例和联合治疗组42例,分别给予恩替卡韦或拉米夫定联合阿德福韦酯治疗,观察96 w的疗效。结果在96 w治疗结束时,恩替卡韦治疗患者ALT复常率、血清HBV DNA阴转率和HBeAg阴转率分别为95.5%、84.1%和38.6%,而联合治疗患者则分别为88.1%、42.9%(P〈0.05)和31.0%;两组均无患者血清HBsAg转阴。两组均未发生严重的不良反应。结论应用恩替卡韦单药治疗对于HBeAg阳性慢性乙型肝炎初始抗病毒治疗在96 w时的病毒学应答率显著优于拉米夫定和阿德福韦酯联合治疗。  相似文献   

10.
目的探究恩替卡韦和阿德福韦酯治疗乙型病毒性肝炎肝硬化合并糖尿病临床效果。方法据该院资料显示,该院在2016年5月—2017年5月共接诊治疗过120例乙型病毒性肝炎肝硬化合并糖尿病患者,经患者及患者家属同意后,将其随机分成对照组和观察组,每组60例患者,两组患者均给予糖尿病患者血糖控制、饮食控制及综合护肝、降酶等基础制治疗。对照组患者在基础治疗上给予阿德福韦酯进行治疗,观察组患者在基础治疗上给予恩替卡韦进行治疗。治疗结束后,医护人员将两组患者的肝功能情况、血糖值及病毒学应答情况进行详细记录并对。结果治疗后,观察组患者与对照组患者总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶及直接胆红素情况均有所改善,观察组患者总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶及直接胆红素水平均低于对照组患者,数据差异有统计学意义(P0.05);治疗后,观察组患者与对照组患者糖化血红蛋白值及空腹血糖值均有所改善,观察组患者糖化血红蛋白值及空腹血糖值低于对照组患者,数据差异有统计学意义(P0.05)。结论恩替卡韦和阿德福韦酯对乙型病毒性肝炎肝硬化合并糖尿病患者的治疗均有明显作用,相比之下,恩替卡韦能够明显改善患者肝功能及血糖情况,对患者及病情的控制有很好的效果,值得被广泛推广使用。  相似文献   

11.
Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.  相似文献   

12.
Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm2) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.  相似文献   

13.
Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.  相似文献   

14.
The immunoneuroendocrine role of melatonin   总被引:19,自引:0,他引:19  
Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.  相似文献   

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Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.  相似文献   

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Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.  相似文献   

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Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.  相似文献   

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