超声导向肝组织自动活检术239例临床观察

1　引　言超声导向自动活检术(USGAB)是近年来发展起来的安全、高效、实用的活检方法。本文总结了作者采用USGAB技术进行病毒性肝炎肝组织活检239例的临床经验,旨在探讨USGAB法在肝脏弥漫性病变活检中的应用价值。2　资料和方法2.1　临床资料本组239例,为我院传染病科1996年10月至1998年7月门诊及住院病人。男197例,女42例。年龄8～60(中位数29)岁。慢性病毒性肝炎210例,肝硬化18例,不明原因转氨酶升高4例,自身免疫性肝炎3例,黄疸待查、脂肪肝、慢性及亚急性重症肝炎各1例。2.2　仪器及器材美国BIOSOUNDAU4型超声诊断仪,3.5MHz腹…     

肝静脉管径及多普勒频谱与慢性病毒性肝炎肝纤维化的相关性研究

目的：探讨慢性病毒性肝炎肝静脉管径及多普勒频谱改变与肝组织病理纤维化程度的关系。方法：应用彩色多普勒超声观测了１１３例慢性病毒性肝炎患者肝中静脉直径（ＨＶＤ）及多普勒频谱改变,并与肝组织病理纤维化分期（Ｓ）进行相关性分析。结果：ＨＶＤ随肝纤维化程度的加重而变窄,与Ｓ呈显著性负相关关系;肝静脉多普勒频谱改变与肝纤维化分期有关,亦与肝静脉管径有关。分别将Ｓ０－１、Ｓ２－３、Ｓ４归为轻度、中度、重度纤维化,不同程度纤维化之间肝中静脉管径及多普勒频谱的差异均有显著性。结论：肝静脉管径及多普勒频谱的变化在判别慢性病毒性肝炎肝纤维化的程度方面有重要诊断价值。     

慢性病毒性肝炎胆囊声像异常与肝组织炎症坏死程度的关系

目的：探讨慢性病毒性肝炎胆囊声像异常与肝组织炎症程度的关系。方法：分析了１１２例慢性肝炎患胆囊壁厚度,光滑度,胆囊大小异常,合并胆囊结石及息肉的发生率,并与肝组织病理炎症坏死程度分级进行比较及相关分析。结果：胆囊声像异常总发生率为５７．１４％,胆囊壁厚在轻、中、重度慢性肝炎相互间比较差异均有显性,与肝脏炎症坏死程度呈显性正相关（ｒ＝０．６７,Ｐ〈０．０００１）。胆囊壁不光滑及胆囊大小异常发生     

钩端螺旋体病患者的护理

通过对４２例钩端螺旋体病患的观察及护理，指出严密观察生命体征及尿量的改变，及早发现大出血、赫氏反应及急性肾功能衰竭，是提高抢救成功率的关键。危重病人应就地抢救，减少搬动及转院。     

超声引导下肝穿刺活检306例的体会

肝活体组织穿刺检测术,是临床上确定肝组织病变的主要依据,旧的肝穿刺方法危险性大,病人术后疼痛不适症状明显,我科于1996年10月至1999年1月对306例不同临床类型的病毒性肝炎病人采用B超引导肝组织穿刺自动活检术,现将穿刺观察报告如下: 材料与方法 本组306例,年龄8～60岁,其中男259例,女47例,慢性乙型病毒性肝炎240例,丙型病毒性肝炎17例,肝炎后肝硬化15例,黄疸查     

慢性肝炎肝纤维化的病理分期与脾脏声像及血流动力学改变

目的： 探讨慢性病毒性肝炎脾脏声像及血流动力学改变及其与肝纤维化病理分期的关系。方法： 采用临床与病理对照的方法, 用彩色双功多普勒超声检测了 １１２ 例慢性病毒性肝炎伴不同程度肝纤维化患者的脾脏厚度及长径、脾动静脉直径、脾动静脉血流量、脾静脉最大流速、脾动脉收缩期峰值速度及脾动脉阻力指数。结果： 除脾动脉阻力指数外慢性肝炎患者上述所有指标均高于正常人 （Ｐ＜ ０．０１）; 脾脏增大的患者脾动静脉血流参数除脾动脉阻力指数外均高于脾脏不大者 （Ｐ＜ ０．０１）; 脾脏厚度、长径及脾静脉直径在不同肝纤维化程度之间 （Ｓ０～Ｓ４ 期） 比较差异均有统计学意义, 并与肝组织纤维化程度有显著相关 （Ｐ＜ ０．０１）, 其余指标在Ｓ０～４ 组比较差异均无显著性,且与Ｓ 无显著性相关。结论： ①在慢性肝炎及早期肝硬化阶段即可出现脾循环亢进, 这一变化与脾脏动脉性充血有关; ②脾脏厚度及长径、脾静脉管径较脾动静脉血流参数能更好地反映病毒性肝炎纤维化病变程度。     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

Objective To investigate the efficacy of by combining a 12-week course of lamivudine in those HBeAg-positive hepatitis B patients receiving peginterferon alfa-2a (peg-IFN α-2a) therapy. Methods A total of 58 patients initiated a 52-week course of peginterferon alfa-2a were enrolled and divided into 3 groups. The patients with HBV DNA undetectable or HBeAg negative at week 12 were divided into group A, in this group treatment continued to week 52 with peg-IFN α -2a alone; The rest paitents were divided into group Bl and B2, in group Bl, lamivudine was combined at a course of 12 weeks, while in group B2 treatment continued to week 52 with peg-IFN α -2a alone. Clinical responses were assessed at week 52. Results 8 out of 58 patients achieved undetectable HBV DNA or HBeAg loss at week 12 and divide into group A. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100% (8/8) respectively at the end of treatment. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100%(8/8) respectively at the end of treatment. The rest 50 patients without early response to peg-IFN α -2a at week 12 were divided into group Bl (24 patients enrolled) and B2 (26 patients). At the end of treatment, the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate in Group B1 were 50% (12/24), 38% (9/24), 4% (1/24) and 63% (15/24) respectively, and 31% (8/26), 27% (7/26), 0% (0/26) and 35% (9/26) respectively in group B2. Conclusions Those patients with early responses to peg-IFN α -2a therapy can achieve high clinical responses at the end of 52-week treatment. The combining therpay of lamivudine for a course of 12-weeks can improve the clinical responses for the patients without early responses to peg-IFN α-2a.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

目的 探讨通过短程联合拉米夫定以提高聚乙二醇干扰素α-2a 疗效的新治疗方法.方法 所有患者以聚乙二醇干扰素α-2a 135μg开始治疗,在治疗12周时,若HBV DNA或HBeAg转阴,继续单独使用干扰素治疗至52周(A组),未达到上述条件者(B组)分为B1组及B2组,B1组短程联合拉米夫定治疗12周后继续干扰素治疗并完成52周疗程,B2组继续单独用干扰素治疗并完成52周疗程.符合正态分布的计量资料采用t检验;符合偏态分布的计量资料用中位数(全距)表示,采用秩和检验.结果共有58例患者入组,8例患者在治疗12周时出现HBV DNA或HBeAg转阴,单用干扰素完成52周疗程,治疗结束时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为8/8、6/8、0/8及8/8.B1组患者24例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为50%(12/24)、38%(9/24)、4%(1/24)及63%(15/24);B2组患者26例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为31%(8/26)、27%(7/26)、O(0/26)及35%(9/26).结论 聚乙二醇干扰素α-2a治疗取得早期应答的患者治疗52周的应答率高;通过对早期疗效不佳的患者短程联合拉米夫定治疗,可提高干扰素的疗效,但有待更大样本量的随机临床试验证实.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

Objective To investigate the efficacy of by combining a 12-week course of lamivudine in those HBeAg-positive hepatitis B patients receiving peginterferon alfa-2a (peg-IFN α-2a) therapy. Methods A total of 58 patients initiated a 52-week course of peginterferon alfa-2a were enrolled and divided into 3 groups. The patients with HBV DNA undetectable or HBeAg negative at week 12 were divided into group A, in this group treatment continued to week 52 with peg-IFN α -2a alone; The rest paitents were divided into group Bl and B2, in group Bl, lamivudine was combined at a course of 12 weeks, while in group B2 treatment continued to week 52 with peg-IFN α -2a alone. Clinical responses were assessed at week 52. Results 8 out of 58 patients achieved undetectable HBV DNA or HBeAg loss at week 12 and divide into group A. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100% (8/8) respectively at the end of treatment. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100%(8/8) respectively at the end of treatment. The rest 50 patients without early response to peg-IFN α -2a at week 12 were divided into group Bl (24 patients enrolled) and B2 (26 patients). At the end of treatment, the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate in Group B1 were 50% (12/24), 38% (9/24), 4% (1/24) and 63% (15/24) respectively, and 31% (8/26), 27% (7/26), 0% (0/26) and 35% (9/26) respectively in group B2. Conclusions Those patients with early responses to peg-IFN α -2a therapy can achieve high clinical responses at the end of 52-week treatment. The combining therpay of lamivudine for a course of 12-weeks can improve the clinical responses for the patients without early responses to peg-IFN α-2a.     

慢性乙型肝炎随访门诊的建立与管理

慢性乙型肝炎是我国常见的慢性传染病之一,部分患者可发展至肝硬化或原发性肝细胞癌,严重危害人民健康.各国的慢性乙型肝炎防治指南都有共识,对慢性乙肝患者应进行全程监测,及时合理进行于预治疗,尤其是正确使用十扰素和核苷(酸)类似物进行抗病毒治疗能改善预后和提高生存率[1].由于国内患者的治疗依从性差,失访率高,且现无有效方法和模式指导医生如何进行全程监控,患者难以得到规范治疗.因此,建立一个完善的慢性乙型肝炎门诊随防系统十分必要.自2008年1月,我科随防门诊逐渐探索出以患者为中心、知名专家主导、年轻医生和专职护士协助的团队运作模式,效果显著.