小儿豉翘清热颗粒治疗疱疹性咽峡炎临床研究

目的:观察小儿豉翘清热颗粒治疗疱疹性咽峡炎的临床疗效及安全性。方法:选取79例疱疹性咽峡炎患儿,随机分为对照组39例和治疗组40例,对照组常规给予利巴韦林气雾剂治疗,治疗组使用小儿豉翘清热颗粒联合利巴韦林气雾剂治疗。比较2组患儿临床症状、体征消失时间,观察2组总体疗效及用药安全性。结果:与对照组比较,治疗后治疗组症状体征恢复时间均更短,总体疗效更优,差异有统计学意义(P<0.05)。2组患儿用药期间不良反应发生情况比较,差异无统计学意义(P>0.05)。结论:小儿豉翘清热颗粒联合利巴韦林气雾剂治疗小儿疱疹性咽峡炎,可缩短临床症状、体征消失的时间,增加总疗效率且不增加药物不良反应,比传统抗病毒治疗更加有效。     

长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响*

目的 探讨应用长效α-干扰素联合利巴韦林治疗慢性丙型肝炎(CHC)患者疗效及静息能量消耗和营养状态的变化。方法 2017年4月～2019年4月我院收治的CHC患者48例,采用随机数字表法分为观察组24例和对照组24例,分别给予聚乙二醇干扰素α-2a(peg-IFNα-2a)和利巴韦林治疗或干扰素α-2a(IFNα-2a)联合利巴韦林治疗48 w。测量静息能量消耗(REE)和预测静息能量消耗(pREE),常规检测血清前白蛋白(PA)和白蛋白(ALB)水平,计算体质指数(BMI)。结果 在治疗48 w结束和随访6 m时,观察组完全应答率分别为62.5%和54.2%,显著高于对照组的37.5%和29.2%,差异有统计学意义(P＜0.05);在观察组,用药前REE和pREE分别为(1504.6±481.5)kcal/d和(1432.3±229.3)kcal/d,在治疗结束时显著增加至(1822.1±546.7)kcal/d和(1241.8±208.6)kcal/d,对照组用药前REE和pREE分别为(1505.2±482.1)kcal/d和(1433.5±231.2)kcal/d,在治疗结束时,显著增加至(1824.4±547.6)kcal/d和(1243.1±208.8)kcal/d, 但两组之间REE和pREE变化无显著性差异(P>0.05);治疗前,观察组BMI及血清PA和ALB水平分别为(19.2±2.0)kg/m²、(161.5±45.2)mg/L和(38.4±4.2)g/L,在治疗结束时分别降为(17.1±1.5)kg/m²、(135.8±40.2)mg/L和(34.2±3.2)g/L,治疗前对照组BMI及血清PA和ALB水平分别为(19.3±2.1)kg/m²、(161.3±45.0)mg/L和(38.5±4.4)g/L,在治疗结束时分别降为(17.2±1.5)kg/m²、(136.3±40.2)mg/L和(34.2±3.1)g/L,但两组之间这些指标的变化无显著性差异(P>0.05)。结论 相对于IFNα-2a与利巴韦林联合,应用peg-IFNα-2a与利巴韦林联合治疗CHC患者能够获得更好的治疗效果,但无论何种治疗方案,均增加了能量消耗,降低了体质量和血清白蛋白水平,提示标准方案抗病毒治疗的不良反应还是值得重视的。     

Hepatitis C virus-specific cytotoxic T cell response restoration after treatment-induced hepatitis C virus control

Hepatitis C virus(HCV)-specific cytotoxic T cell(CTL) response plays a major role in viral control during spontaneous infection resolution. These cells develop an exhausted and pro-apoptotic status during chronic onset, being unable to get rid of HCV. The role of this response in contributing to sustained viral response(SVR) after anti-HCV is controversial. Recent studies show that after successful interferon-based anti-HCV treatment, HCV traces are still detectable and this correlates with a peak of HCV-specific CTL response activation, probably responsible for maintaining SVR by subsequent complete HCV clearing. Moreover, SVR patients’ serum is still able to induce HCV infection in na?ve chimpanzees, suggesting that the infection could be under the control of the immune system after a successful treatment, being transmissible in absence of this adaptive response. At least theoretically, treatmentinduced viral load decrease could allow an effective HCV-specific CTL response reestablishment. This effect has been recently described with anti-HCV interferonfree regimes, based on direct-acting antivirals. Nevertheless, this is to some extent controversial with interferon-based therapies, due to the detrimental immunoregulatory α-interferon effect on T cells. Moreover, HCV-specific CTL response features during anti-HCV treatment could be a predictive factor of SVR that could have clinical implications in patient management. In this review, the recent knowledge about the role of HCV-specific CTL response in the development of SVR after anti-HCV treatment is discussed.     

连花清瘟颗粒联合利巴韦林和康复新液治疗疱疹性口腔炎的疗效观察

目的：观察连花清瘟颗粒联合利巴韦林和康复新液治疗疱疹性口腔炎的临床疗效。方法选择2012年1~10月份在医院儿科门诊进行诊治的疱疹性口腔炎的患儿80例,完全随机平分为治疗组和对照组各40例,2组除给予维生素 C 和维生素 B2等支持、对症治疗以外,均给予利巴韦林注射液静脉滴注10~15mg·kg _1·d _1,分2次给药和口服康复新液,＜3岁患儿每次5ml,＞3岁患儿每次10ml,均3次∕ d,治疗组患儿在此治疗基础上加用连花清瘟颗粒口服（石家庄以岭药业股份有限公司,6g∕袋）,≤3岁3g∕次,3次∕ d;＞3岁 6g∕次,3次∕ d,均治疗5d。结果治疗组总有效率为97,5％明显高于对照组的87,5％（p ＜0,01）,治疗组热退时间,口腔炎疱疹溃疡愈合时间为（1,4±0,7）d、（2,9±0,6）d 比较对照组的（3,2±1,2）d、（3,7 ± 0,9）d 明显缩短,差异有统计学意义（p ＜0,01）。结论连花清瘟颗粒联合利巴韦林和康复新液治疗疱疹性口腔炎,能迅速缓解临床症状,疗效确切,值得临床推广和应用。     

纳洛酮分别联合更昔洛韦与病毒唑对病毒性脑炎患儿血清 IL－1、TNF－α水平的影响比较

目的：观察纳洛酮分别联合更昔洛韦与病毒唑治疗小儿病毒性脑炎的疗效及对血清白细胞介素－1（IL－1）、肿瘤坏死因子－α（TNF－α）水平的影响。方法将病毒性脑炎患儿120例随机分为试验组和对照组各60例,给予所有患儿常规治疗和护理,试验组给予纳洛酮联合更昔洛韦治疗,对照组给予纳洛酮联合病毒唑治疗,治疗1周后评价2组患儿治疗效果,并于治疗前后抽取2组患儿静脉血,检测并评价血清IL－1、TNF－α水平变化。结果试验组患儿治疗总有效率为93．33％高于对照组的76．67％;治疗后2组患儿血清IL－1、TNF－α水平均呈下降趋势,但试验组降幅大于对照组,差异均有统计学意义（ P＜0．05）。结论纳洛酮联合更昔洛韦治疗小儿病毒性脑炎的治疗效果优于纳洛酮联合病毒唑治疗,且对血清IL－1、TNF－α水平下降幅度的影响更为显著。     

Herbal medicine Ninjinyoeito ameliorates ribavirin-induced anemia in chronic hepatitis C： A randomized controlled trial

AIM: Ribavirin (RBV) shows a strong antiviral effect on hepatitis C virus when used in combination with interferon. However, RBV-induced anemia is a major problem in this therapy. It would be of great clinical importance to ameliorate the anemia without reducing the RBV dose. We report here that, Ninjinyoeito (NYT), a herbal medicine can reduce the RBV-induced anemia. METHODS: Twenty-three patients with chronic hepatitis C were treated with interferon alpha 2b plus RBV with (NYT group) or without (control group) NYT by a randomized selection. Eighteen patients completed the treatment schedule, and hemato-biochemical and virological effects were evaluated. RESULTS: There was no significant difference in biochemical and virological responses between the two groups. However, anemia was significantly reduced in the NYT group compared with the control group. The maximal decrease of Hb in the NYT group (2.59±1.10 g/dL) was significantly (P= 0.026) smaller than that in the control group (3.71±0.97 g/dL). There was no significant difference in serum glutathione peroxidase activity, serum RBV concentration, and Thl/Th2 balance between the two groups. There was no specific adverse effect in NYT administration. CONCLUSION: These results suggest that NYT could be used as a supportive remedy to reduce the RBV-induced anemia in the treatment of chronic hepatitis C.     

不同冻干保护剂对利巴韦林冻干粉针的影响研究

目的研究Emprove低内毒素蔗糖、无水乳糖、Emprove低内毒素葡萄糖、Emprove低内毒素甘露醇、Emprove低内毒素山梨醇、Emprove低内毒素氯化钾、Emprove低内毒素甘氨酸7种不同类型常用冻干保护剂对利巴韦林冻干粉针性能的影响。方法以外观和复溶效果为指标,考察了预冻时间、冻干保护剂用量、冻干时间的影响。测定了空白粉针剂和利巴韦林粉针剂冻干后含水量、p H值和利巴韦林质量分数。结果以无水乳糖为冻干保护剂,预冻时间6 h,冻干时间9 h,保护剂用量4%;以Emprove低内毒素氯化钾为冻干保护剂,预冻时间9 h,冻干时间9 h,保护剂用量4%;以Emprove低内毒素甘露醇为冻干保护剂,预冻时间6 h,冻干时间6 h,保护剂用量4%;以Emprove低内毒素甘氨酸为冻干保护剂,预冻时间12 h,冻干时间9 h,保护剂用量4%。所得冻干粉针外观饱满、平整,迅速、完全复溶。结论无水乳糖、Emprove低内毒素氯化钾、Emprove低内毒素甘露醇、Emprove低内毒素甘氨酸4种冻干保护剂更适合制备利巴韦林冻干粉针,可为水溶性药物冻干粉针剂的制备提供了参考。