慢性乙肝患者拉米夫定耐药后出现肝功能衰竭的危险因素

 【目的】探讨慢性乙型肝炎患者拉米夫定耐药后出现肝功能衰竭的危险因素。【方法】拉米夫定耐药后导致病情加重的慢性乙型肝炎患者56例纳入研究．记录拉米夫定治疗前病程、诊断、拉米夫定疗程，检测并记录临床耐药时的肝功能、乙肝两对半、HBVDNA定量、YMDD变异及前C区变异。按病情加重后的诊断分为肝功能衰竭组和慢性乙型肝炎组进行比较。【结果】肝功能衰竭组患者年龄（45±13）岁，大于慢性乙型肝炎组（37±131岁（P〈0．05）；肝功能衰竭组临床耐药时HBV DNA载量高于慢性乙型肝炎组[（2．8×10^8＋4．9×10^8）拷贝／mL vs（3．1×10^6±2．9×10^6）拷贝／mL；P〈0．05]；肝功能衰竭组出现HBeAg／Anti—HBe血清学转换（54．6％）高于慢性乙型肝炎组（18．4％，P〈0．05）。年龄和拉米夫定治疗前诊断为肝硬化都是耐药后出现肝功能衰竭的独立危险因素。【结论】拉米夫定治疗前年龄大、诊断为肝硬化，临床耐药时病毒载量高，耐药后出现HBeAg／Anti—HBe血清学转换可能是拉米夫定治疗耐药后出现肝功能衰竭的危险因素。有肝硬化基础患者一旦发生耐药变异，应及时使用能治疗耐药变异的阿德福韦或恩替卡韦。     

慢性乙型重肝病人免疫与肝生化指标变化的意义

目的探讨慢性乙型重型肝炎早期、中期、晚期病人的免疫和肝生化指标变化与预后的关系。方法检测120例慢性重型肝炎病人（早期60例，中期40例，晚期20例）和120例慢性乙型肝炎病人的T细胞亚群、HBV DNA载量、免疫学及肝功能指标，并总结分析其临床意义。结果晚期慢性乙型重型肝炎病人细胞免疫状态最差，与慢性乙型肝炎病人相比差异显著，NK细胞分别为（7．47±4．19）％vs（13．29±4．68）％，P〈0．05；CD4／CD8比值为（0．39±0．16）vs（1．12±0．26），P〈0．05；CD3^＋（73．11±13．16）％vs（56．12±9．54）％；P〈0．05；CD8^＋（56．74±13．91）％vs（34．26±10．58）％，P〈0．05；晚期慢性乙型重型肝炎的肝功能损害与慢性乙型肝炎相比同样有显著性差异：白蛋白分别为（20．82±3．46）g／L vs（43．11±5．74）g／L，P〈0．05；血清总胆红质（TB）（519．42±156．18）μmol／Lvs（25．91±17．38）μmol／L，P〈0．05；凝血酶元活动度（PTA）（15．21±6．38）％vs（92．45±10．56）％，P〈0．05。结论慢性乙型重型肝炎晚期病人的CD4／CD8、NK细胞显著下降，病人淋巴细胞亚群的失衡可加重肝脏的损伤。     

慢性乙肝患者停用拉米夫定后出现肝功能衰竭的危险因素

[目的]研究慢性乙型病毒性肝炎(chronic hepatitis B,慢性乙型肝炎)患者停用拉米夫定后出现肝功能衰竭的危险因素.[方法]停用拉米夫定治疗后复发的慢性乙型肝炎患者71例纳入研究,记录治疗前病程、诊断、拉米夫定疗程,用拉米夫定前、停用时和复发后的生化指标、免疫学指标、病毒学指标及YMDD变异、前C区变异,按复发后的诊断分为肝功能衰竭组和慢性乙型肝炎组进行比较.[结果]肝功能衰竭组患者中位年龄38.0岁,大于慢性乙型肝炎组31.5岁(Z=3.49,P＜0.01);年龄(Wald=10.13,P＜0.05)和拉米夫定治疗前诊断为失代偿性肝硬化(Wald=7.61,P＜0.05)都是停药反跳后出现肝功能衰竭的独立危险因素.肝功能衰竭组服拉米夫定前总胆红素异常患者20.0%(x=16.50,P＜0.01),停拉米夫定后未随访者86.7%(x2=17.57,P＜0.01),停拉米夫定时未出现Anti-HBe阳转者85.2%(x2=8.04,P＜0.01),复发时HBV DNA载量3.0×108±4.8×108(Z=4.46,P＜0.01),前C区联合YMDD变异者56.0%(x=11.69,P＜0.01),均高于慢性乙型肝炎组.[结论]拉米夫定治疗前年龄大、总胆红素异常、诊断为失代偿性肝硬化,停药时未发生Anti-HBe阳转,停药后无随访,复发时HBV DNA载量超过1×108拷贝/mL、出现前C区联合YMDD变异可能是停拉米夫定后出现肝功能衰竭的危险因素.     

羟基脲加不同干扰素治疗原发性血小板增多症的临床疗效

目的：观察羟基脲加不同干扰素治疗原发性血小板增多症（PT）的临床疗效。方法：将29例阴患者分为单用化疗组、α干扰素组、γ干扰素组，每组均包括有临床症状组及无临床症状组。结果：有临床症状组的患者发病时外周血血小板计数明显高于无临床症状组（P〈0．01），三组治疗前后血小板计数分别为（1063．00±576．50）×10^9/L vs（754．50±459．43）×10^9／L，（1176．00±345．60）×10^9／L VS（464．81±238．02）×10^9／L和（1135．00±272．70）×10^9／L VS（438．64±148．87）×10^9／L，总有效率分别为70％、80．0％和100％（P〈0．01）。对α干扰素无效的2例患者改用γ干扰素，结果 1例缓解，1例进步。结论：对于阴患者，α干扰素组与γ干扰素组疗效优于单用化疗组；对于α干扰素疗效欠佳的患者可以考虑改用γ干扰素，可能有效。     

骨形态发生蛋白-4对人始基卵泡的作用

【目的】观察骨形态发生蛋白-4（BMP-4）对人卵巢组织体外培养中始基卵泡存活和生长发育的影响。【方法】34例卵巢组织切成2mm×2mm×1mm皮质片，每例标本的皮质片均随机分成3组：研究组（BMP-4组）、对照组和非培养组，培养15d后行组织学检查、雌孕激素测定和凋亡分析。【结果】培养结束后对照组和研究组始基卵泡比例分别为58％±35％和48％±40％，低于非培养组（91％±9％），P〈0．05；窦前卵泡比例分别为52％±40％和42％±35％，高于非培养组（9％±9％），P〈0．05。研究组间质细胞凋亡指数和培养液孕激素浓度分别为（0．16±0．08）μg／L和（3．6±2．0）μg／L，低于对照组，对照组分别为（0．41±0．16）μg／L和（6±4）μg／L（P〈0．05）。【结论】BMP-4可以促进始基卵泡向窦前卵泡转化，降低细胞凋亡率，抑制孕激素分泌，是卵泡生长发育过程中的促进因子。     

EDTA抗凝剂所致假性血小板减少症的临床观察

【目的】探讨乙二胺四乙酸（EDTA）抗凝剂所致假性血小板减少症（EDTA—PTCP）的临床特点及原因分析。【方法】回顾性分析我院1999—2007年间10例EDTA抗凝剂所致假性血小板减少症的患者经不同抗凝剂仪器检测、手工法计算血小板数及血涂片瑞-姬氏染色法观察血小板形态的情况，探讨假性血小板减少的原因。[结果]EDTA抗凝剂仪器测出血小板数为（18．7±10）×10^9/L，换用枸橼酸钠法、手工法检测血小板数分别为（165．1±42）×10^9／L、（186．8±52．0）×10^9／L，与EDTA抗凝法比较，P均〈0．01，中位误诊时间为21d（7～30d），基础疾病分别颅咽管瘤1例、鼻咽癌1例、慢性肾炎尿毒症期2例、乙型肝炎1例、冠心病1例、上呼吸道感染1例、子宫肌瘤1例、高血压病1例、健康体检1例．基础疾病与假性血小板减少程度的无关系。【结论】EDTA抗凝剂所致假性血小板减少症发病率较低，极易误诊，对于临床上无出血倾向的血小板减少的患者应注意排除EDTA—PTCP的可能。     

标准桃金娘油对慢性阻塞性肺疾病大鼠气道炎症的影响

[目的]研究标准桃金娘油对慢性阻塞肺疾病（COPD）大鼠模型气道炎症的影响。[方法]24只Wistar大鼠随机分为3组：①对照组：不加任何干预;②COPD组：吸烟14支／次×2次／d×6d／周×12周;③标准桃金娘油组：吸烟情况同COPD组,每日吸烟前给予标准桃金娘油灌胃治疗至第12周末。12周后测定肺功能;行支气管肺泡灌洗计数白细胞;用ELISA法测定肺部TNF—α、IL-6的含量;用HE染色评估肺部病理改变;用免疫组化法测定气道上皮ICAM-1的表达。[结果]①COPD组和标准桃金娘油组大鼠出现明显肺气肿病理改变和气流阻塞。②BALF细胞总数及中性粒细胞数结果：正常对照组分别为（1．30±0．10）×10^7／L与（0．09±0．04）×10^7／L,COPD模型组分别为（1．99±0．94）×10^7／L与（0．27±0．13）×10^7／L,P均〈0．05;标准桃金娘油组为（1．71±0．97）×10^7／L与（0．15±0．05）×10^7／L,较COPD模型组减少（P均〈0．05）。③支气管上皮ICAM—1表达及肺组织内TNF—α、IL-6表达：COPD模型组分别为6．99±0．81,（860．82±53．62）pg／mL,（689．01±49．05）pg／mL,较对照组[分别为4．22±0．74,（159．08±46．65）pg／mL,（411．5±26．60）pg／mL]增高（P均〈0．05）;标准桃金娘油组表达分别为5．04±0．88,（668．36±31．07）pg／mL,（589．64-4-19．03）ps／mL,较COPD组降低（P均〈0．05）。④COPD组BALF中性粒细胞数与支气管上皮ICAM-1表达强度呈正相关（r=0．571,P〈0．05）,也与肺组织中TNF-α、IL-6含量呈显著正相关（r=0．623、0．691,P均〈0．05）。[结论]吸烟可增加大鼠气道炎症反应,标准桃金娘油能改善由吸烟导致的气道炎症。     

冠心病患者妊娠相关血浆蛋白A含量与血管内皮功能关系探讨

【目的】探讨冠心病患者血循环妊娠相关血浆蛋白A（PAPP—A）水平与内皮功能的关系。【方法】64例冠心病患者，其中稳定型心绞痛组34例，急性冠脉综合征组30例，分别检测其相关内皮功能，包括肱动脉血流介导的血管舒张反应（FMD）和高敏C-反应蛋白（hs—CRP）、内皮素（ET）、一氧化氮（NO）水平，并用酶联免疫法检测血清PAPP—A。【结果】稳定型心绞痛组患者同急性冠脉综合征组相比PAPP—A[（6×10^-3±5×10^-1U／L与（19×10^-3±13×10^-3）U／L，P〈0．05]、hs-CRP[（0．5±0．3）mg／L与（3．6±2．2）mg／L，P〈0．01]、NO[（57±4）μmol／L与（45±5）μmol／L，P〈0．05]和FMD（6．0％±0．8％与3-3％±1．2％，P〈0．05）的差异有统计学意义。逐步选择多重回归分析，按α=0．10水准，发现PAPP—A与hs—CRP和FMD存在直线关系，Lnhs—CRP的偏相关系数为0．333（95％置信区间：0．138-0．527，P〈0．01），FMD的偏相关系数为-0．623（95％CI：-1．144—0．102，P〈0．051，其中常数项为5．570。高PAPP—A（〉11．094×10^-3U／L）患者hs—CRP明显增高[（5．3±4．2）mg／L与（1．3±0．6）mg／L，P〈0．01），FMD则降低（3.3％±2．4％与6．2％±3．6％，P〈0．05）。【结论】PAPP-A可作为间接评估冠心病患者血管内皮功能的指标之一。     

HBV基因型与阿德福韦酯治疗的病毒学应答

【目的】评价阿德福韦酯治疗慢性乙型肝炎的疗效，研究HBV基因型与阿德福韦酯治疗后病毒学应答的关系。【方法】56例血清HBVDNA载量≥106拷贝／mL并符合其他入选标准、不符合排除标准的慢性乙型肝炎患者进入此研究。头12周随机分为阿德福韦酯治疗组和安慰剂治疗组，比较12周时两组HBVDNA水平差异。12周后所有患者使用阿德福韦酯治疗，所有患者接受阿德福韦酯治疗40周，比较40周治疗后和基线相比HBVDNA载量的变化、ALT复常率及HBeAg血清转换率。HBVDNA载量检测采用实时定量PCR法，HBV基因型采用线性探针分析法（INN0.—LiPA）检测。【结果】12周双盲治疗结束时，阿德福韦酯组和安慰剂组的HBVDNA载量较基线分别下降3．1±1．4log拷贝／mL和0.．3±1．1log拷贝／mL。所有患者治疗40周后，HBVDNA载量平均下降3．6＋1．2log拷贝／mL，71％（40／56）的患者ALT复常，20％（9／46）基线HBeAg阳性患者发生HBeAg血清转换，29％（16／56）出现完全应答。52例进行了HBV基因型检测，28（54％）为B型，24（46％）例为C型，未检测到其他基因型。两种基因型患者基线HBVDNA载量、ALT水平及HBeAg状态无明显统计学差异。阿德福韦酯治疗40周后，两组基因型患者HBVDNA载量、ALT复常率及HBeAg血清转换率无统计学差异。【结论】阿德福韦酯能明显抑制HBV复制，促进ALT复常和HBeAg血清转换。阿德福韦酯抑制HBV疗效与感染HBV基因型B型或C型无关。     

改变组织醛固酮及其受体表达对SHR大鼠肾脏纤维化的影响

【目的】观察改变肾组织醛固酮及其受体水平对自发性高血压大鼠肾脏纤维化的影响。【方法】8周龄的雄性自发性高血压大鼠（SHR）24只及同源正常京都大鼠（WKY）8只，SHR分为贝那普利干预组[30ing／（kg·d）]、大剂量安体舒通干预组[100mg／（kg·d）]和高血压模型对照组，同时设同源的正常对照组，干预时间为8周，检测收缩压、尿蛋白、血白蛋白、尿素氮、肌酐、肾组织醛固酮受体、TGF-β1的mRNA和蛋白表达。【结果】贝那普利能下调组织醛固酮【（15．8±2．6）vs（22．2±0．6）pg／mg]及其受体水平【（15±4）vs（13±5）PU]并减轻肾脏纤维化[（17．0±1．8）vs（20．0±2．3）PU]，均为P〈0．05；大剂量安体舒通能上调组织醛固酮[（24．3±4．6）vs（22．2±0．6）pg／mg]及其受体水平[（16±6）vs（13±5）PU]并加重肾脏纤维化[（22．6±3．0）vs（20．0±2．3）PU]，均为P〈0．05。【结论】肾组织醛固酮及其受体水平的改变可能影响高血压肾脏纤维化的过程。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.