不同预防方案对肝移植受者术后巨细胞病毒感染率的影响

目的:了解肝移植受者术后巨细胞病毒(cytomegalovirus,CMV)感染情况,探讨预防方案对肝移植受者术后CMV感染的预防作用.方法:回顾分析复旦大学附属中山医院肝移植中心2004年1月-2007年3月309例肝移植患者术后1年内的临床资料.结果:术前受体CMV-IgG阳性的肝移植患者中,3个预防组(PG组)分别采用更昔洛韦(ganciclovir,GCV)、阿昔洛韦(acyclovir,ACV)和GCV+ ACV预防后,CMV隐性感染发生率分别为10.5％、15.9％和7.9％;CMV病发生率分别为10.5％、8.3％和3.2％,与未预防组(NPG组)的42.3％和15.4％相比有显著差异(P＜0.01).3个PG组患者的1年总生存率分别为86.8％、78.0％和88.9％,其中GCV+ ACV组和NPG组的差异有统计学意义(P＜0.05).结论:静滴GCV[2.5mg/(kg·d)]、口服ACV(0.2 g,3次/d)、静滴GCV[2.5 mg/(kg·d)]后序贯口服ACV(0.2g,3次/d)3种方式预防用药均可明显降低术前受体CMV-IgG阳性肝移植患者术后CMV感染发生率和病死率;GCV+ ACV可明显提高肝移植受者术后的1年生存率.     

不同季铵化程度的N-三甲基壳聚糖对阿昔洛韦滴眼液离体角膜渗透促进作用考察

摘 要 目的:研究不同季铵化程度（DQ）的N-三甲基壳聚糖（TMC）对阿昔洛韦（ACV）滴眼液角膜渗透促进作用的规律,为TMC作为眼部渗透促进剂的应用奠定实验基础。方法: 以浓度为0.5%,DQ分别为20%、40%及60%的TMC（TMC20,TMC40,TMC60）为促渗剂,用于ACV滴眼液中;以同浓度壳聚糖（CS）ACV滴眼液为阳性对照,以不加促进剂的普通ACV滴眼液为阴性对照,采用Franz扩散池法考察TMC对ACV滴眼液离体角膜渗透促进作用,并对其眼部刺激性进行初步评价。结果:与阴性对照相比,CS及各种TMC均能显著增加ACV滴眼液的黏性,且促渗作用呈现一定的时滞;与CS相比,各种TMC的时滞差异无统计学意义,均在给药20 min后发挥明显的促进作用,且TMC20的促进作用较弱,TMC40作用与CS相似,而TMC60的作用明显较强（P<0.05）;与阴性对照及阳性对照相比,TMC对家兔眼部不产生明显的刺激性。结论: TMC对ACV的离体角膜渗透有明显的促进作用,且与DQ呈现正相关。     

干扰素联合无环鸟苷治疗慢性乙型肝炎30例疗效观察

目的　观察干扰素联合无环鸟苷治疗慢性乙型肝炎的临床疗效。方法　选取 60例慢性乙肝患者 ,随机分为A、B组 ,A组、B组均用一般保肝药物 ,A组加用α - 1b干扰素 30 0万u肌注 ,每周 3次 ,无环鸟苷口服 ,每次 0 .4 g ,每日 3次 ,疗程 3个月～ 6个月。 结果　干扰素联合无环鸟苷对症状、体征改善及肝功能恢复及HBeAg、HBsAg转阴较对照组疗效显著 (P <0 .0 5) ,而且副作用少。 结论　干扰素联合无环鸟苷是很有效的治疗慢性乙型肝炎的药物     

复方阿昔洛韦凝胶的制备及质量控制

目的:制备复方阿昔洛韦凝胶并建立其质量控制方法。方法:以阿昔洛韦、双氯芬酸钠为主药,卡波姆-940等为基质制备凝胶;色谱柱为ZORBAX-SB-C18,流动相为甲醇-水-36%冰醋酸(70∶30∶2),检测波长为260nm。结果:所制凝胶为乳白色细腻半固体物;阿昔洛韦检测浓度在8.6768～60.7376μg/ml范围内线性关系良好(r=0.9997),平均回收率为104.34%,RSD=1.05%;双氯芬酸钠检测浓度在3.4408～34.408μg/ml范围内线性关系良好(r=0.9996),平均回收率为98.92%,RSD=1.19%。结论:本制剂易于涂布,所建立的质控方法可同时测定其中2主药的含量,且简便、灵敏、可靠。     

Aciclovir and Trifluorothymidine in herpetic keratitis preliminary report of a multicentered trial

The efficacy of Aciclovir and Trifluorothymidine (TFT) treatment was tested in a double blind trial of thirty-eight patients with dendritic keratitis. All twenty patients treated with Aciclovir healed within 10 days with an average healing time of 5.0 days. Two of the eighteen patients treated with TFT failed to heal within 22 days, the others healed within ten days, the average healing was 6.6 days. Punctate keratopathy was seen in 70% of both groups. Intense conjunctival hyperaemia developed in two TFT patients.     

Abnormal thymus development and impaired function of the immune system in rats after prenatal exposure to aciclovir

Aciclovir (synonym: acyclovir) causes abnormal thymus development in rats. After treatment on day 10 of gestation a weight reduction of the organ is obvious in 21-day-old fetuses which persists postnatally. Adult male rats exposed in utero to one or three injections of 100 mg aciclovir/kg body wt given to the dam on day 10 of pregnancy showed a reduction of the thymus weight to 333±158 mg and 276±61 mg (control: 428±92 mg;n=10). Corresponding alterations were detectable in female offspring. Liver weight was also decreased and spleen weight (in relation to body wt) was significantly increased in the offspring after the three exposures. In a host resistance model withTrichinella spiralis the function of the immune system of rats prenatally exposed to aciclovir was examined. Six weeks postnatally 10–12 randomly selected male rat offspring of one control and two treatment groups (1 or 3 injections of 100 mg aciclovir/kg body wt on day 10 of gestation) were infected orally with 500Trichinella spiralis muscle larvae. Before and several times after the infection blood was taken from a tail vein or obtained by decapitation for examination of the antibody titers (IgM, IgG, IgA, IgE) to antigens ofT. spiralis. Six weeks after the infection the weight of relevant organs was determined and tongue preparations were used forT. spiralis muscle larvae counting. Aciclovir exposed animals showed a different immune response than control rats. IgM titers in both treatment groups werehigher than in controls two weeks after the infection but not different by the end of the experiment. The IgG and IgE titers in the high dose group werelower than in the other groups at the end of the observation period. IgA antibody titers in the high dose group were alsolower than controls, but only 2 weeks after the infection. The number ofT. spiralis muscle larvae in tongue preparations was higher in the 3×100 mg aciclovir group than in the low dose group or in controls. Our results indicate that morphological thymus alterations and functional deficits of the immune system can be induced by prenatal exposure of rats to aciclovir on day 10 of gestation.     

阿昔洛韦凝胶皮肤刺激性和过敏性实验研究

目的:观察阿昔洛韦凝胶对动物皮肤的毒性作用。方法:用健康家兔进行皮肤刺激试验,用健康豚鼠进行皮肤过敏试验。结果:阿昔洛韦凝胶对家兔完整皮肤和破损皮肤均无刺激性,对豚鼠完整皮肤无致敏性。结论:阿昔洛韦凝胶皮肤局部用药对实验动物较为安全。     

有并发症的流行性腮腺炎49例临床分析

目的 探讨有并发症的流行性腮腺炎的临床表现与治疗对策。方法 分析该病并发症的类型及发生时间和数量与临床表现的关系，总结该病及其并发症的治疗措施，探讨有关新药在该病治疗中的应用价值。结果 该病并发症多种多样，发生越早、数量越多其临床表现越重，疗程越长。阿昔洛韦、胸腺肽及干扰素抗病毒和调节免疫疗效显著。结论 在对症治疗的基础上选用阿昔洛韦、胸腺肽或干扰素，疗效确切。     

Disseminated neonatal herpes simplex virus (HSV) type 2 infection diagnosed by HSV DNA detection in blood and successfully managed by liver transplantation

We report a case of neonatal herpes presenting with liver failure and disseminated coagulopathy which followed unrecognised maternal primary genital herpes and was diagnosed by herpes simplex virus DNA detection in blood by polymerase chain reaction 2 weeks after initiation of empiric intravenous aciclovir. The child underwent liver transplantation while receiving suppressive antiviral therapy and remains well after 10 months of follow-up. Conclusion:our case highlights potential pitfalls in the diagnosis of neonatal herpes and indicates a role for blood herpes simplex virus polymerase chain reaction as a sensitive diagnostic tool in disseminated infection. It is one of very few reports where liver transplantation has been successfully carried out in a neonate with herpes simplex virus-induced liver failure.Abbreviations HSV herpes simplex virus - PCR polymerase chain reaction