布地奈德联合利巴韦林 氨溴索雾化吸入治疗毛细支气管炎的疗效观察

目的观察布地奈德联合利巴韦林、氨溴索雾化吸人治疗毛细支气管炎的疗效。方法将我院160例毛细支气管炎患儿随机分为观察组和对照组,每组80例。两组均给予常规治疗,观察组在常规治疗的基础上给予布地奈德联合利巴韦林、氨溴索雾化吸人治疗,观察两组的临床效果。结果观察组显效率为90．0％,总有效率为100．0％,明显高于对照组的51．3％和78．8％（P〈0．01）;观察组临床症状、体征恢复时间均较对照组明显缩短（P〈0．01）。结论布地奈德联合利巴韦林、氨溴索雾化吸人治疗毛细支气管炎疗效显著,有推广价值。     

Efficacy of Alfacalcidol on PEG-IFN/ Ribavirin Combination Therapy for Elderly Patients With Chronic Hepatitis C: A Pilot Study

Background

Serum vitamin D concentration is reported to show a decrease in older age. Patients with chronic hepatitis C (CHC) in Japan are older on average than those in Western countries. Moreover, the outcome of pegylated-interferon (PEG-IFN)/ ribavirin therapy combined with vitamin D in elderly patients is unclear.

Objectives

This pilot study explored the efficacy and safety of alfacalcidol as vitamin D source in PEG-IFN/ ribavirin combination therapy for elderly CHC patients infected with hepatitis C virus genotype 1b.

Patients and Methods

Consecutive twenty CHC patients aged ≥ 65 years were enrolled in this pilot study. Fifteen patients met the inclusion criteria and received PEG-IFN/ ribavirin therapy combined with alfacalcidol. Four-week lead-in of oral alfacalcidol was conducted, and it was subsequently and concurrently administered in PEG-IFN/ ribavirin combination therapy (vitamin D group). Age, gender, and IL28B genotype-matched patients, who received PEG-IFN/ ribavirin alone, were saved as control group (n = 15) to compare the treatment outcome with the vitamin D group.

Results

Subjects consisted of 14 males and 16 females, with a median age of 70 years (65-78). The serum 25 (OH) D3 concentration in females (20 ng/ml, 11-37) was significantly lower than males (27 ng/mL, 13-49) (P = 0.004). Sustained virological response (SVR) rates were 33.3% (5/15) in the control group and 80.0% (12/15) in the vitamin D group, respectively (P = 0.025). While no significant difference was shown in the (SVR) rate between the two groups among males (P = 0.592), in females the SVR rate was significantly higher in the vitamin D group (87.5%, 7/8) than the control group (25.0%, 2/8) (P = 0.041). The relapse rates in the groups with and without alfacalcidol were 7.7% (1/13) and 61.5% (8/13), respectively (P = 0.011). Interestingly, in females, the relapse in the control group was shown in 5 of 7 (71.4%), whereas in the vitamin D group the relapse rate was decreased (1/8, 12.5%) (P = 0.041). No specific adverse events were observed in the vitamin D group.

Conclusions

PEG-IFN/ ribavirin combined with alfacalcidol may be effective and safe in elderly CHC patients. In particular, concomitant administration of alfacalcidol may lead to a reduced relapse rate, and consequently improving the SVR rate in elderly females.     

Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy

Background

Rapid virological response (RVR) strongly predicts sustained virological response (SVR) in patients with chronic hepatitis C (CHC), and abbreviates antiviral therapy in some patients.

Objectives

To identify factors predicting virological relapse (VR) in CHC patients who attained RVR.

Patients and Methods

Medical records of 133 CHC patients with an RVR after completing 24 weeks of antiviral therapy (a combination of pegylated interferon-α and ribavirin) were analyzed. Baseline characteristics and on-treatment responses were compared between the patients with an SVR and those with VR. Patients with normal alanine aminotransferase (ALT) levels at weeks 4 and 12 and at the end-of-treatment (EoT) and patients with elevated, but constantly decreasing, ALT levels were classified as having favorable patterns of ALT change. A trend of increasing ALT levels either between weeks 4 and 12 or between weeks 12 and EoT was classified as unfavorable. A high viral load (HVL) was defined as a baseline HCV RNA ≥ 600000 IU/mL.

Results

In total, 116 (87.2%) patients had a SVR and 14 (10.5%) had VR. The VR rates were comparable between patients with genotype-1 (13.1%) and genotype-2 infection (8.7%) (P = 0.572). Multivariate analysis revealed that HVL (P = 0.015; odds ratio [OR] = 14.754; 95% confidence interval (CI) = 1.671–130.240), and unfavorable ALT patterns (P = 0.039; OR = 4.397; 95% CI = 1.078–17.930) independently predicted VR. In subgroup analysis, low viral load (LVL) patients had a minimal VR rate (1.8%). Among the HVL patients, the VR rate of those using peg-IFN-α-2a was relatively low (9.1%). Patients using peg-IFN-α-2b had a slightly higher VR rate (23.8%; P = 0.128), and patients with favorable patterns of ALT changes had a lower VR rate (10.3%) compared to the 53.8% in patients with unfavorable ALT patterns (P = 0.005).

Conclusions

In southern Taiwan, 24 weeks of antiviral therapy achieved a high SVR rate in patients with CHC attaining RVR, except in the subgroup of patients treated with peg-IFN-α-2b with HVL and on-treatment unfavorable ALT patterns.     

Ribavirin: A clinical overview

Ribavirin, a broad spectrum, non-interferon-inducing virustatic chemotherapeutic agent, demonstrates activity against a wide range of RNA and DNA viruses, including the retrovirus known to cause the acquired immune deficiency syndrome. The drug's proposed mechanism of action, as well as pharmacokinetics are discussed, and preclinical toxicity, safety and clinical efficacy studies are presented.To date, the best success has occurred in the use of ribavirin to treat respiratory syncytial virus infection in infants and young children and to treat influenza A and B virus infections in young adults. Viral infections, particularly viral pneumonia, are often life-threatening in infants with severe combined immunodeficiency disease (SCID), and ribavirin aerosol has been used successfully to treat respiratory syncytial virus and parainfluenza virus infection of immunodeficient children.Special note is taken of ribavirin's clinical benefit in treating severe and life-threatening infections caused by the Lassa fever virus and the significant improvement over either the use of immune plasma or supportive therapy alone. Indeed, ribavirin thus emerges as the first antiviral drug that is able to reduce mortality in a highly lethal systemic disease by more than 90%.Additional studies demonstrate the drug's efficacy in acute viral hepatitis, herpesvirus infections, and measles. Controlled clinical trials are underway to test the drug in patients infected with the AIDS virus.Corresponding author.     

利巴韦林治疗TTV型肝炎的疗效观察

目的:观察利巴韦林治疗TTV型肝炎的临床疗效。方法:收集40例TTV型肝炎患者,随机分成治疗组和对照组各20例;治疗组:利巴韦林150mg/次,3次/d×3月;对照组:常规护肝治疗。结果:治疗1个月后,对照组:ALT、AST复常率20％,TTV DNA转阴率0％,治疗组:ALT、AST复常率达60％,TTV DNA转阴率达50％。治疗2个月后,对照组:ALT、AST复常率30％,TTV DNA0％;治疗组:ALT、AST复常率达80.0％,TTV DNA阴转率达75％,治疗3个月后,对照组:ALT、AST复常率40％,TTV DNA阴转率0％;治疗组;ALT、AST复常率达90%,TTV DNA阴转率90%。两组治疗前后比较,差异显著(P<0.05)。结论:利巴韦林治疗TTV型肝炎有较好的改善患者的肝功能和使TTV DNA转阴的作用。     

Parainfluenza type 3 infection post stem cell transplant: high prevalence but low mortality

Parainfluenza type 3 (PIV 3) is a well-recognized cause of respiratory illness after stem cell transplantation (SCT), with an estimated incidence of 2-7% and a high mortality rate associated with lower respiratory tract infection (LRTI). A 12-month retrospective study was undertaken in which 23 positive cases of PIV 3 occurred in SCT recipients. The frequency of infection was 36.1% in matched unrelated donor SCT recipients, 23.8% in sibling allogeneic SCT recipients and 2.3% in autologous transplant recipients. Seventeen cases were outpatient or community acquired despite standard infection control measures. Eleven patients only developed upper respiratory tract symptoms. LRTI symptoms developed in 12 patients, of whom eight had a new infiltrate on chest X-ray. Overall mortality at 30 days from PIV 3 diagnosis was 4% (one patient). Four patients died within 100 days of PIV 3 diagnosis, but PIV 3 was not believed to be the primary cause of death in any of these patients. Early ribavirin was used in eight patients and only one patient who received ribavirin died. These results suggest a higher prevalence of PIV 3 but a lower mortality than documented previously, particularly in allogeneic transplant recipients. The authors propose that the high prevalence reflects the unit's policy of active surveillance for respiratory viruses and the difficulty in preventing transmission of PIV 3, especially in the outpatient setting during an outbreak period. Ribavirin treatment may improve outcome in patients with LRTI but is not required in all patients with PIV 3.     

炎琥宁治疗咽结合膜热及病毒性肠炎疗效观察

目的观察注射用炎琥宁治疗咽结合膜热及病毒性肠炎的疗效。方法选择咽结合膜热70例,随机分为两组,治疗组35例,对照组35例。同样的方法将病毒性肠炎70例,随机分为治疗组和对照组各35例。所有治疗组采用注射用炎琥宁静脉滴注,对照组选用利巴韦林注射液静脉滴注,比较两组疗效。结果咽结合膜热治疗组有效率为88．6％,对照组有效率为57．1％,两组疗效比较差异有统计学意义（x^2=8．74,P〈0．01）。病毒性肠炎治疗组有效率为80．0％,对照组有效率为57．1％,两组疗效比较差异有统计学意义（x^2=4．24,P〈0．01）。结论注射用炎琥宁治疗病毒性感染疾病疗效优于利巴韦林注射液。     

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效观察

目的:探讨慢性丙型肝炎(CHC)治疗的有效途径。方法:将116例CHC患者随机分组,在利巴韦林依给药基础上,对照组(56例)给予普通干扰素α-2b(INFα)3MU/次,3次/周,肌肉注射;观察组(60例)给予聚乙二醇干扰素α-2a(PEG-INFα)180μg,1次/周,皮下注射。疗程48周,停药后观察24周。结果:两组治疗结束和随访24周的ALT复常率分别为46.4%、86.7%和32.1%、70.0%,HCV-RNA阴转率,治疗结束时应答(ETVR)为32.1%和70.0%,持续病毒学应答(SVR)为46.4%和93.3%(P<0.01)。结论:PEG-INFα联合利巴韦林是治疗CHC的有效方法。