丙肝宁冲剂治疗慢性丙型肝炎的临床研究

目的：观察中药复方丙肝宁冲剂治疗慢性丙型肝炎的临床效果,方法,以肝功能和病毒感染学指标为主要疗效考察指标,用丙肝宁冲剂治疗慢性现型肝炎140例,并设西药干扰素（赛若金）对照组52 ,疗程6个月,随访6个月,结果：治疗组总有效率为70％,治疗后HCVRNA（丙型肝炎病毒抗原）转阴率52．10％,随访6个月为47．86％,对照组分别为71．15％,63．41％和44．23％,结论：丙肝宁冲剂治疗慢性丙型肝炎有良好的临床疗效,与干扰素相近。     

慢性丙型肝炎患者采用α2b干素治疗前后PBMC内HCV—RNA的变化

目的：探讨α2b干素对慢性丙型肝炎（丙肝）患者的治疗效果。方法：采用国产α2b干素（300MU／d）治疗，3个月为一疗程，共2个疗程，并设常规治疗组（VitC、门冬氨酸）为对照。于疗程结束后分别检测患者PBMC内HCV－RNA和血清内CV-RNA、抗－HCV。结果：α2b干素治疗组2个疗程后慢性丙肝患者PBMC、血清内HCV－RNA和抗－HCV转阴率分别为42．31％、57．69％、65．38％，常规治疗组慢性丙肝患者PBMC、血清内HCV－RNA和抗－HCV转阴率分别为13．64％、22．73％、27．27％，两组差异均有显著性（P＜0．05－P＜0．01）。结论：α2b干素对血清及PBMC内HCV－RNA具有肯定的治疗作用，其疗效优于常规治疗组，但对PBMC内HCV－RNA的疗效似有比抗血清内HCV－RNA和抗－HCV疗效弱的趋势。     

聚乙二醇干扰素α-2a治疗慢性丙型肝炎合并糖尿病疗效观察

目的探讨聚乙二醇干扰素α-2a治疗慢性丙型肝炎合并糖尿病的疗效及安全性。方法应用聚乙二醇干扰素α-2a治疗28例合并糖尿病和20例非合并糖尿病的慢性丙型肝炎患者,分别于治疗12周、48周及随访24周时评价疗效及血糖变化。结果合并糖尿病组患者治疗12周和48周,丙肝病毒阴转率分别为46．4％和78．6％,持续病毒应答（SVR）率为64．29％,与非糖尿病组相比差异无统计学意义（P〉0．05）;两组治疗前后空腹血糖变化差异均无统计学意义（P〉0．05）;患者肝功能随抗丙肝病毒治疗有效而好转。结论聚乙二醇干扰素α-2a治疗慢性丙型肝炎合并糖尿病是安全有效的：     

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎的疗效分析

目的 探讨聚乙二醇干扰素(PEG-IFNα)治疗慢性丙型肝炎的疗效.方法 104例慢性丙肝患者随机分为观察组和对照组,观察组应用PEG-IFNα-2a联合利巴韦林,对照组应用IFNα-2a联合利巴韦林,疗程均为48周.结果 治疗后观察组ALT复常率及HCV RNA转阴率均显著优于对照组,两组比较差异有统计学意义(P<0.05),两组治疗期间均未见严重不良应.结论 PEG-IFNα联合利巴韦林治疗慢性丙型肝炎疗效优于IFNα联合利巴韦林,是一种理想的慢性丙肝治疗方法.     

重组复合干扰素治疗普通干扰素治疗复发和无应答的慢性丙型肝炎32例

目的探讨复合干扰素(consensus Interferon,CIFN)干复津治疗复发及无应答慢性丙型肝炎的疗效。方法对32例普通干扰素治疗无应答或治疗后复发的慢性丙型肝炎患者,用干复津15μg治疗,每周3次,皮下注射,疗程24周。观察治疗过程中、结束时及停药半年后随访的临床症状、体征、ALT、HCV-RNA持续应答率及不良反应情况。结果31例患者完成治疗,治疗24周时完全应答率和随访6月时持续应答率分别为67.74%和41.93%。普通干扰素治疗的复发组和无应答组经干复津治疗结束后HCV-RNA持续阴转率分别为67.8%和19.35%(P<0.05),复发组较无应答组具有较好的疗效。两组均未发现严重不良反应。结论复合干扰素15μg单独用于治疗复发或无应答的慢性丙型肝炎有较好的疗效。     

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎87例临床观察

目的临床观察聚乙二醇干扰素α-2α（PEG—IFNα-2α）联合利巴韦林治疗慢性丙型肝炎（CHC）患者应答情况及疗效的影响。方法使用聚乙二醇干扰素α-2α（PEG—IFNα-2α）联合利巴韦林治疗87例慢性丙型肝炎48周,停药随访24周,分析HCV RNA载量、ALT与疗效的影响。结果87例慢性丙型肝炎取得持续病毒学应答（SVR）60．91％：低病毒载量组取得持续病毒学应答（SVR）59,25％,高病毒载量组取得持续病毒学应答（SVR）61．67％,两小组无明显差异（P〈0．05）。ALT正常组取得持续病毒学应答（SVR）57．14％,ALT升高组取得持续病毒学应答（SVR）63．46％两小组无明显差异（P〈0．05）结论;聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效明显。病毒载量、ALT对持续病毒学应答（SVR）无明显差异（P〈0．05）     

干扰素联合胸腺肽治疗慢性乙型肝炎的疗效观察

目的：观察干扰素联合胸腺肽治疗慢性乙型肝炎的疗效。方法：对66例符合条件的患者随机分为A、B两组，A组给予干扰素联合胸腺肽治疗，B组单给予干扰素治疗，对治疗结束及随访6月HBeAg转阴率、HBVDNA转阴率、谷丙转氨酶（ALT）复常率进行对比。结果采用χ^2检验。结果：治疗结束及随访6个月A组HBeAg转阴率分别为73.3％和70％，B组分别为25％和21．4％（P〈0．01）；治疗结束及随6个月A组HBVDNA转阴率分别为76．6％和66．7％，B组分别为42．8％和35．7（P〈0．05）；随访6个月ALT复常率A、B两组分别为83．3％和42．8％（P〈0．01），两组HBeAg转阴率、HBVDNA转阴率、随访6个月ALT复常率有统计学意义（P〈0．05）；ALT复常率治疗结束时A、B组分别为86．7％和78．5％，差异无统计学意义（P〉0．05）。结论：干扰素联合胸腺肽治疗慢性乙型病毒性肝炎有协同作用，增加持续应答。     

宿主白介素28B基因多态性与慢性丙型肝炎抗病毒疗效的研究分析

目的 分析我国四川地区慢性丙型肝炎(丙肝)患者白介素28B(IL28B) rs12979860位点基因多态性的特点,并探讨其对聚乙二醇化干扰素(PEG-IFN)联合利巴韦林(RBV)治疗慢性丙肝的疗效的预测价值.方法 对56例慢性丙肝患者进行PEG-IFN α-2a联合RBV治疗48周,治疗结束随访24周,同时对宿主IL28Brs12979860位点进行基因测序,分别分析不同IL28B基因多态性、丙肝病毒(HCV)的基因型、基线病毒载量患者的慢性丙肝抗病毒治疗疗效.结果 56例慢性丙肝患者的IL28B rs12979860位点基因型以CC型为主,占76.8％(43/56),CT型占23.2％(13/56),未发现TT型.患者性别、年龄、体质量、感染时间、治疗前基线谷丙转氨酶(ALT)水平、基线HCV RNA载量以及感染的HCV基因型在不同IL28B rs12979860位点基因型间的差异均没有统计学意义(P＞0.05).PEG-IFN联合RBV治疗慢性丙肝疗效显著,其持续病毒学应答(SVR)率可达82.1％.CC型患者的SVR率高于CT型(90.7％ vs.53.8％,P=0.009).高病毒载量组(≥6×105 IU/mL)与低载量组(＜6×105 IU/mL)的SVR率分别为79.5％和88.2％,差异无统计学意义(P=0.684);感染HCV基因1型和非基因1型组的患者SVR率分别为76.9％和92.9％,差异无统计学意义(P=0.363).但是在高病毒载量组和感染HCV基因1型组的患者中,CC型患者的SVR率仍高于CT型(87.5％ vs.42.9％,P=0.033; 89.7％ vs.50.0％,P=0.025).结论 我国四川地区慢性丙肝患者的IL28B rs12979860位点基因型以CC型为主,CC型患者抗HCV疗效优于CT型,宿主IL28B的基因型较HCV的基因型以及基线病毒载量对疗效的预测更有价值.     

拉米夫定停药后肝炎复发再治疗临床观察

目的观察拉米夫定停药后慢性乙型肝炎复发再治疗临床疗效。方法选择慢性乙型肝炎首次应用拉米夫定治疗完全应答、停药后肝炎复发病例47例，随机分为A、B、C三组，各组在应用相同护肝药物基础上，分别应用拉米夫定、干扰素α-2b、苦参素抗病毒治疗，观察三组病例肝功能、HBV—M、HBV—DNA变化，并进行统计学分析。结果三组病例治疗后肝功能改善明显(ALT复常率分别为83．3％、86．7％、78．6％)，HBV—DNA能得到有效抑制(阴转率分别为72．2％、73．3％、64．3％)，未出现明显耐药性，无明显不良反应发生，总疗效差异无显著性。结论拉米夫定停药后肝炎复发，应用拉米夫定、干扰素α-2b、苦参素再行抗病毒治疗．仍可取得较好的疗效。     

实时荧光PCR检测丙型肝炎病毒核酸及其临床意义

目的：探讨实时荧光PCR检测技术在丙型肝炎病原诊断及在监测干扰素-α治疗慢性丙型肝炎早期病毒学应答反应(EVR)中的临床意义。方法：采用一种新的丙型肝炎病毒核酸(HCV—RNA)扩增(PCR)定量检测方法——实时荧光PCR检测HCV—RNA，对96例慢性丙肝(其中20例随机接受Pegasys或Referun-α治疗，每例思者分别采集治疗前后系列血清7份)、30例其它肝病、15例非肝病和86例健康献血员的血清标本进行HCV—RNA检测，部分血清标本与Amplicor(Roche)进行核对。结果：96例慢性丙肝患者血清HCV—RNA检出率85.4％(82／96)、其它肝病、非肝病和健康献血员中均未检出HCV—RNA；部分标本经与Amplicor核对呈较好相关性，r(log)＝0．91。随机接受Pegasys或Referon-α治疗的20例丙肝患者治疗前后EVR显示，前者的EVR似较后者明显，但因病例数太少，无明显统计学差异(G＝4.467,P＞0.05)。结论：实时荧光PCR检出的HCV—RNA载量可较客观地反映丙肝患者体内病毒复制水平，支持干扰素治疗慢性丙型肝炎EVR可用于预测长期疗效。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…