CHB患者抗病毒治疗过程中发生耐药、肾功能不全及周围神经炎1例

全球60多亿人口中,约20亿人曾感染过HBV,其中3.5亿人为慢性HBV感染,每年约有100万人死于HBV感染所致的肝衰竭、肝硬化和原发性肝细胞癌。我国现有慢性HBV感染者约9300万人,其中CHB患者约2000万例。预防CHB-肝硬化-肝癌“三部曲”的主要措施是抗病毒治疗。只要有适应证,就应进行规范的抗病毒治疗。     

慢性乙型肝炎免疫耐受期的新认识

HBV感染是一个全球性的公共卫生问题。全世界约20亿人曾经感染 HBV ,慢性 HBV感染者约有3．5至4亿人,每年有50万～120万人死于慢性 HBV感染及其导致的肝硬化和肝癌。据估计我国有1．2亿人为 HBV携带者,每年大约28万人死于HBV引起的相关慢性肝脏疾病［1］随着人们健康意识的增强,乙型肝炎患者的求治心理越来越迫切,然而有一大批人在拿到表明HBV大量复制的化验单后,却不被列入治疗的范畴,这就是免疫耐受期的患者。我国目前大约有5000万的慢性乙型肝炎患者处于免疫耐受期,倘若这些患者拒绝肝穿刺分型而不能及时进行抗病毒治疗,那么他们将成为 HBV的高危传染源,长期下去患者自身也会错失及时治疗的时机［2-3］。现就慢性乙型肝炎免疫耐受期的特点、形成机制、要不要打破免疫耐受期以及如何打破免疫耐受的研究作一综述。     

细胞自噬在慢性肝炎病毒感染中的作用

一、慢性肝炎病毒 (一)乙型肝炎病毒 HBV感染呈全球流行,据世界卫生组织报道,全球约20亿人曾感染过HBV,其中3.5亿为慢性HBV感染者,每年约有100万人死于HBV感染所致的肝衰竭、肝硬化和肝细胞癌(Hepatocellular carcinoma,HCC)[1].我国1～59岁普通人群的HBsAg携带率为7.18％[2].据此推算,我国现有的慢性HBV感染者约9 300万例,其中慢性乙型肝炎患者约2 000万例[3].我国每年死于与乙肝相关肝病的约30万例.HBV慢性感染不仅难以治愈,造成患者病情的反复发作,且与HCC的发生密切相关[4].     

老年乙型肝炎概述

HBV感染全球流行。全世界约有20亿人感染过 HBV,其中3．5亿为慢性 HBV感染者,每年约有100万人死于 HBV感染所致的肝衰竭、肝硬化和肝细胞癌（HCC）。我国1～59岁人群 HBsAg 携带率为7．18％［1］,现估算慢性 HBV 感染者约9300万,其中慢性乙型肝炎患者约2000万。     

慢性乙型肝炎免疫耐受期临床特征的研究

正HBV感染是一个全球性的公共卫生问题。据世界卫生组织报道,全球约20亿人曾感染HBV,其中2.4亿人为慢性HBV感染者~([1]),每年约有65万人死于HBV感染所致的肝功能衰竭、肝硬化和肝细胞癌(HCC)~([2])。而我国有慢性HBV感染者约9 300万人,其中CHB患者约2 000万例~([3])。我国肝硬化和HCC患者中,由HBV感染引起的比例分别为60%和80%~([4])。目前我国大约有5 000万的慢性乙型肝炎患者处于     

非活动性HBsAg携带状态的自然转归

HBV感染呈世界性流行,但不同地区HBV感染的流行程度差异很大。据WHO报道,全球约20亿人曾感染过HBV,其中3.5亿人为慢性HBV感染者,每年约有100万人死于HBV感染所致的肝衰竭、肝硬化和HCC。由于我国人口基数较大,现有的慢性HBV感染者约9 300万人,其中慢性乙型肝炎患者约2 000万例[2]。非活动性HBV携带状态是免疫控制的结果,临床多无症状,易被忽视,正确认识非活动性HBsAg携带状态的自然转归及影响,     

慢性HBV感染免疫控制期与免疫逃逸期研究进展

正HBV感染为全球公共健康问题,但不同区域HBV感染的流行强度有很大差异。据世界卫生组织报道,全球约20亿人曾感染HBV,其中2.4亿人为慢性HBV感染者[1],每年约有65万人死于HBV感染所致的相关并发症及终末期肝病。崔富强、庄辉[2]报道,我国现有慢性HBV感染者约9000万     

二维剪切波弹性成像评估慢性乙型肝炎肝纤维化临床应用指南

HBV感染是重大传染性疾病,全球约2.4亿人感染HBV[1],我国慢性HBV感染者达9300万人,其中慢性乙型肝炎（CHB）患者约2000万例[2]。CHB也是我国导致肝硬化、肝细胞癌（HCC）的主要病因之一,分别占60%和80%[3],严重危害健康。全球每年约有65万人死于HBV感染所致的肝功能衰竭、肝硬化和HCC[4]。     

化疗或免疫抑制状态下HBV再活化

2004年中国疾病预防控制中心对2002年中国居民营养与健康状况调查的血样检测结果表明,我国一般人群中约7亿人感染过HBV,其中慢性感染率高达9.09%,即约1.2亿人为慢性HBV感染者,约占全世界慢性HBV感染者的1/3。据推算,我国慢性乙型肝炎患者约3000万。随着医疗水平的提高,细胞毒性     

慢性乙型肝炎的治疗目标、终点和策略

慢性乙型肝炎是一种流行性、进展性传染病。全球乙型肝炎病毒（HBV）感染者约为3．5亿人，我国是HBV感染的高流行地区。根据2002年全国HBV感染者血清流行病学调查．乙型肝炎表面抗原（HBsAg）流行率为9．09％，约1．2亿人，其中慢性乙型肝炎患者约为3000万人，如无正确治疗．慢性乙型肝炎患者5年后约10%-20％可发展为肝硬化．20％-23％可发展为失代偿期肝硬化．6％～15％可发展为肝细胞性肝癌（HCC）。而5年存活率，代偿期肝硬化为55％，失代偿期肝硬化为14％。每年死于乙型肝炎相关性肝病者约30万人。此外．母亲为HBV携带者可通过垂直传播使婴儿受染，婴儿时期感染HBV者90％以上将成为慢性HBV携带者．随着年龄的增长，可反复发作肝炎．     

Role of the placenta in the control of the ante-partum surge of prolactin in the rat

A nocturnal surge of prolactin secretion occurs in the dark period preceding parturition in the rat. The aim of this study was to examine the role of the placenta in the control of this prolactin surge. Plasma prolactin and progesterone were measured by radioimmunoassay in serial blood samples collected after surgical removal of conceptuses during late pregnancy, and after intracerebroventricular (i.c.v.) injection of placental lactogen (PL) before the prolactin surge. In intact control animals, prolactin secretion remained low until a nocturnal surge of secretion occurred in the dark period preceding parturition, peaking at 269 +/- 51 (S.E.M.) micrograms/l at 03.00 h on day 21. Progesterone levels fell from greater than 200 nmol/l on day 19 to less than 40 nmol/l by 12.00 h on day 20 of pregnancy. PL levels during late pregnancy were modified by partial or complete removal of conceptuses at 10.00 h on day 19 of pregnancy. Removal of all but one or two conceptuses did not change the normal pattern of prolactin or progesterone secretion. Removal of all conceptuses, however, induced a large nocturnal surge of prolactin secretion, peaking at 211.7 +/- 78 micrograms/l at 03.00 h on day 20, 24 h earlier than the surge in intact animals. Progesterone levels after removal of all conceptuses fell to less than 40 nmol/l by 23.00 h on day 19, approximately 12 h before the decline in intact animals. Maintenance of increased progesterone levels after conceptus removal using silicone tubing implants significantly (P less than 0.05) reduced the peak of the premature prolactin surge to 79.7 +/- 18 micrograms/l at 05.00 h on day 20.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the Role of the Septal Area in the Development of Doca-Salt Hypertension in the Rat

The extensive destruction of forebrain noradrenergic nerve terminals by the intraventricular injection of 250 μg of 6-hydroxy-dopamine prevents the subsequent development of DOCA-salt experimental hypertension in rats while the lesser destruction of noradrenergic nerve terminals produced by 90 μg of 6-hydroxydopa does not. The greatest difference in brain part noradrenaline levels between these two neurotoxins was in the septal area where noradrenaline was less than 15% of controls after 6-hydroxydopamine but was the same as controls after 6-hydroxydopa. The non-specific destruction of the lateral septal area by radiofrequency lesions prevented the subsequent development of DOCA-salt hypertension. The relatively selective destruction of catecholamine nerve terminals in the lateral septal area by the injection of 1 μg 6-hydroxydopamine in 1 μl vehicle also prevented the development of DOCA-salt hypertension. These data suggest that the lateral septal area may be the location of the forebrain catecholaminergic neural activity that is necessary for the development of DOCA-salt experimental hypertension in rats.     

Tissue Oxygen Demand in Regulation of the Behavior of the Cells in the Vasculature

The control of arteriolar diameters in microvasculature has been in the focus of studies on mechanisms matching oxygen demand and supply at the tissue level. Functionally, important vascular elements include EC, VSMC, and RBC. Integration of these different cell types into functional units aimed at matching tissue oxygen supply with tissue oxygen demand is only achieved when all these cells can respond to the signals of tissue oxygen demand. Many vasoactive agents that serve as signals of tissue oxygen demand have their receptors on all these types of cells (VSMC, EC, and RBC) implying that there can be a coordinated regulation of their behavior by the tissue oxygen demand. Such functions of RBC as oxygen carrying by Hb, rheology, and release of vasoactive agents are considered. Several common extra‐ and intracellular signaling pathways that link tissue oxygen demand with control of VSMC contractility, EC permeability, and RBC functioning are discussed.     

Oxprenolol in the treatment of hypertension in the elderly

Controversy continues to surround the value of drug treatment of hypertension in the elderly. Epidemiologic evidence implicates hypertension as a major risk factor in the precocious development of stroke and coronary heart disease in the elderly subject as clearly as it is implicated in the younger person. The hemodynamic and neuroendocrine profiles of the older patient with essential hypertension are similar to those of younger patients in the stable phase of the disease. However, the arterial ravages induced by many years of sustained hypertension render the circulation of the elderly subject more sensitive to pharmacologic intervention. The benefit-risk ratio of most antihypertensive drugs appears to be inversely related to age. Diuretics reduce the blood pressure at rest but have no influence on the increases in systolic pressure during normal activity; in addition, they carry potentially serious metabolic hazards in the elderly hypertensive patient. Centrally acting drugs likewise lower the blood pressure at rest without influencing the high systolic pressures induced by exercise. They also enhance the tendency to endogenous depression. Adrenergic-neurone blocking drugs and alpha-adrenoceptor antagonists are contraindicated because of the frequency of impaired cardiovascular reflexes in the elderly. The beta-blocking drugs can reduce the risk of coronary and cerebrovascular disease in the older patient with hypertension. They appear to be well tolerated, but because of their impaired metabolic handling in many elderly patients they should probably be used in smaller doses than those prescribed in younger patients. The influence of antihypertensive treatment on cardiovascular morbidity and mortality in the elderly hypertensive patient is not known.     

社区老年高血压自我管理模式效果分析

目的评估社区老年高血压自我管理模式的效果。方法在浦东新区23个街镇中每个街镇各抽取1个老年高血压自我管理小组,对所有组员进行参加课程前后的效果进行问卷调查和血压测量。结果参与课程后,组员自评健康状况明显改善（P〈0．05）,体力活动、对控盐勺、控油壶的使用率、每周测量1次血压的比例均较参与课程前明显增加（P〈0．05）,每天摄入水果蔬菜、口味变清淡的比例较参与课程前增多。自我效能明显提高,收缩压下降了17mmHg,舒张压下降了10mmHg（P〈0．05）。结论对社区老年高血压患者以自我管理的方式进行管理,并针对性地进行行为干预,是控制老年高血压的有效手段。     

Prevention of the manifestation of diabetes in the elderly in the presymptomatic stage

Diabetes Mellitus is thought as the presymptomatic stage to cause various vascular diseases. From the point of view that diabetes is already a disease, this paper discusses the prevention of the manifestation of diabetes in the elderly. STOP-NIDDM study demonstrated that acarbose, an alpha-glucosidase inhibitor, reduced the onset of diabetes in impaired glucose tolerance (IGT) subjects by 24%. On the other hand, the Diabetes Prevention Program (DPP) study for IGT subjects revealed that intensive life style intervention prevented diabetes most powerfully by 58% and metformin treatment also reduced by 31%. Furthermore, HOPE, LIFE, and SCOPE studies against hypertension showed that ACI or ARB reduced diabetes by 20-32%, and the WOSCOT study that pravastatin, a HMG-CoA reductase inhibitor, reduced diabetes by 30%. These accumulated results suggest that the most suitable strategy to prevent diabetes in the elderly is intensive life style intervention, and in cases incapable of exercise and diet therapy, acarbose or metformin are recommended for IGT. When associated with hypertension and/or hyperlipidemia, the subjects have to receive ACI or ARB and statins to prevent diabetes.