慢性乙型肝炎病人社会支持状况调查分析

目的 了解慢性乙型肝炎(下称慢性乙肝)病人社会支持状况，为实施临床整体护理干预提供依据。方法 应用社会支持评定量表，对62例慢性乙肝住院病人进行社会支持状况调查。结果 慢性乙肝病人获得的社会支持总分较正常人高，病人社会支持的主要来源为家庭，其希望得到社会支持种类依次为精神支持、信息支持及物质支持。结论 慢性乙肝病人获得较多的社会支持，但在临床护理中仍应加强对病人家属的健康教育，以满足病人的需求和有利于家属向病人提供适当的社会支持。     

膦甲酸钠治疗慢性乙型肝炎病人的护理

探讨膦甲酸钠 (PFA)治疗慢性乙型肝炎的疗效及其护理对策。随机将 6 8例病人分两组 ,治疗组 4 8例接受PFA治疗 ,对照组 2 0例接受干扰素治疗。结果两组慢性乙型肝炎病人DNA转阴率相近 ,差异无显著性意义 (P >0 .0 5 )。提示PFA疗效确切 ,治疗期间应加强护理 ,密切观察病情变化 ,以防不良反应发生。     

层流病房病人的心理障碍调查及心理干预

目的探讨层流病房病人的心理状况及其影响因素,从而采取针对性的心理干预,减轻其心理障碍。方法随机选择60例层流病房病人为层流组,另选60例普通血液病房病人为普通组,比较两组心理障碍发生率,分析层流组心理障碍的影响因素。在存在心理障碍的50例层流组病人中抽取40例,将其随机分为干预组与对照组各20例。干预组采取针对性的心理干预,对照组仅给予常规解释,比较两组心理障碍改善情况。结果 层流组心理障碍发生率显著高于普通组(χ~2=30.86,P相似文献   

健康教育对慢性乙型肝炎患者肝功能的影响

目的探讨健康教育地慢性乙型肝炎（慢性乙肝）患者肝功能的影响。方法采用自制慢性乙肝患者问卷调查表对200例慢性乙肝患者进行调查，了解其肝功能波动的诱因，将200例患者随机分为对照组和观察组，对照组给予常规健康教育，观察组采用黑板报，健康手册，口头讲解等形式对患者进行针对性的健康教育。结果慢性乙肝患者肝功能波动的诱因依次为用药不规范（10.0%），过度疲劳（36.0%），情绪波动（34.0%） ,饮食不当（33.0%）等。通过健康教育，观察组ALT异常率显著低于对照组（χ^2=15.69,P〈0.01），结论通过健康教育使慢性乙肝患者明确坚持系统治疗，注意合理膳食，保持良好心态，养成良好生活习惯，对保证肝功能稳定具有重要意义。     

血浆置换辅助治疗慢性重症乙型肝炎的护理

目的探讨血浆置换辅助治疗慢性重症乙型肝炎的护理方法。方法对68例慢性重症乙型肝炎患者在常规治疗的基础上行血浆置换。结果治愈率58．82％，总好转率79．41％，病死率20．59％；肝功能及凝血功能指标治疗前、后比较．差异有显著性意义（P〈0．05，P〈0．01）。结论血浆置换辅助治疗慢性重症乙型肝炎疗效肯定，严密的术前、术中及术后护理是保证治疗顺利、预防并发症的基础。     

慢性乙型病毒性肝炎118例患者的心理分析及护理对策

目的分析并探讨慢性乙肝与心理社会因素的相关性以及应采取的护理对策。方法对118例慢性乙肝患者实施针对性较强的心理护理。结果 118例慢性乙肝患者中具有沮丧与痛苦心理的患者人数最多,共112例,占94.92%。位居第2、3位的分别为被嫌弃或歧视110例（93.22%）及思念家庭100例（84.75%）。其他心理问题按人数多少依次为：孤独忧虑及抑郁、情绪急躁、焦躁不安、恐惧感以及绝望。结论慢性乙肝患者的心理状态受到其自身的性格特征、性别、年龄、家庭、经济水平、文化层次以及其所处的社会环境等影响,大多数慢性乙肝患者存在各种心理问题。     

精神分裂症病人父母心理状况及其心理干预

采用症状自评量表 (SCL 90 )、焦虑自评量表 (SAS)及抑郁自评量表 (SDS)对 116例精神分裂症病人的父母(观察组 )及 6 8例正常者的父母 (对照组 )进行评定 ,并根据测评病人父母存在的心理问题进行 4周针对性的心理干预。结果观察组SCL 90各因子 (除敌对及偏执外 )、SAS及SDS评分均明显高于对照组 (P <0 .0 5或P <0 .0 1) ;经过 4周的心理干预后 ,观察组SCL 90各因子 (除敌对及偏执外 )、SAS及SDS评分均明显低于心理干预前 (P <0 .0 5或P <0 .0 1)。提示精神分裂症病人父母存在着不同程度的心理问题 ,针对性的心理干预有利于缓解其焦虑、抑郁情绪 ,提高其心理承受能力 ,减轻心理应激反应程度。     

不同类型肝硬化患者心理状态调查分析

目的了解不同类型肝硬化患者的心理状态，为采取针对性的护理干预措施提供依据。方法采用症状自评量表（SCL-90）分别对60例病毒性肝炎肝硬化患者（肝炎组）、60例酒精性肝硬化患者（酒精组）进行问卷调查。结果肝炎组SCL-90总分及抑郁、焦虑、偏执因子分显著高于常模（P〈0．05，P〈0．01）；酒精组焦虑、敌对、偏执因子分显著高于常模（P〈0．05，P〈0．01）。两组焦虑、敌对、偏执因子分比较，差异有显著性意义（均P〈0．01）。肝炎组B／C级与A级在抑郁、精神病性、饮食睡眠方面差异有显著性意义（P〈0．05，P〈0．01），而酒精组除饮食睡眠外，其它各项差异有显著性意义（均P〈0．01）。结论不同类型肝硬化患者心理健康状况均较差，应采取针对性的护理措施进行干预。     

不同类型肝硬化患者心理状态调查分析

目的 了解不同类型肝硬化患者的心理状态,为采取针对性的护理干预措施提供依据.方法 采用症状自评量表(SCL-90)分别对60例病毒性肝炎肝硬化患者(肝炎组)、60例酒精性肝硬化患者(酒精组)进行问卷调查.结果 肝炎组SCL-90总分及抑郁、焦虑、偏执因子分显著高于常模(P＜0.05,P＜0.01);酒精组焦虑、敌对、偏执因子分显著高于常模(P＜0.05,P＜0.01).两组焦虑、敌对、偏执因子分比较,差异有显著性意义(均P＜0.01).肝炎组B/C级与A级在押郁、精神病性、饮食睡眠方面差异有显著性意义(P＜0.05,P＜0.01),而酒精组除饮食睡眠外,其它各项差异有显著性意义(均P＜0.01).结论 不同类型肝硬化患者心理健康状况均较差,应采取针对性的护理措施进行干预.     

健康教育对慢性乙型肝炎患者肝功能的影响

目的探讨健康教育对慢性乙型肝炎(慢性乙肝)患者肝功能的影响。方法采用自制慢性乙肝患者问卷调查表对200例慢性乙肝患者进行调查,了解其肝功能波动的诱因。将200例患者随机分为对照组和观察组,对照组给予常规健康教育,观察组采用黑板报、健康手册、口头讲解等形式对患者进行针对性的健康教育。结果慢性乙肝患者肝功能波动的诱因依次为用药不规范(40.0%)、过度疲劳(36.0%)、情绪波动(34.0%)、饮食不当(33.0%)等。通过健康教育,观察组ALT异常率显著低于对照组(χ2=15.69,P<0.01)。结论通过健康教育使慢性乙肝患者明确坚持系统治疗,注意合理膳食,保持良好心态,养成良好生活习惯,对保证肝功能稳定具有重要意义。     

慢性肝炎病人抑郁状况分析及护理

为了解慢性肝炎病人的抑郁状况相关因素，为心理干预提供依据，采用Zung抑郁自评量表（SDS）和问卷表对120例住院慢性肝炎病人进行调查，结果62．5％慢性肝炎病人存在不同程度的抑郁状态，在分组比较中，中年和文化程度在大专及以上都抑发生率偏高，慢性肝炎病人抑郁发生与性别无相关性，提示慢性肝炎病人易发生抑郁状态，临床护理人应给予足够的重视，采取多种护理措施，缓解其抑郁情绪，以维护病人的心理健康。     

Hemodialysis Reduces the Viral Load in Uremic Patients with Chronic Hepatitis B Infection

Background and aims. The effect of hemodialysis (HD) to change the viral load of hepatitis B virus (HBV) in uremic patients with chronic HBV infection has never been studied. In this study, we investigated the HBV viral loads and their changes between the HD procedure in the uremic patients. Patients and methods. A total of 38 chronic HBV-infected uremic patients were enrolled, but eight cases were excluded due to HCV co-infection and under anti-viral therapy. To evaluate the HBV DNA levels and their changes through the course of HD, we quantified serial serum samples from each patient immediately before HD, at the end of HD, and 48 hours later—immediately before the next HD. Results. Most of our HBV-infected uremic patients had a relatively lower HBV viral load; 80% cases with HBV DNA %4 Log₁₀copies/mL, in comparison with the Taiwan epidemiologic study for community base HBV carriers. There was no significant difference of HBV DNA level between HBeAg-positive and -negative patients, but a significant higher DNA level in the high ALT group (p = 0.029) and liver cirrhosis patients (p = 0.002). The mean HBV DNA levels, before and after HD, respectively, in our 30 patients were 3.823 ± 1.130 Log₁₀copies/mL and 3.686 ± 1.114 Log₁₀copies/mL. It was a significant decrease on HBV DNA level in chronic HBV-infected patients through HD procedure (p = 0.004). The mean HBV DNA level of two days after HD was 3.702 ± 1.094 Log₁₀copies/mL, which was not significantly different from the HBV DNA level before (p = 0.076) or after (p = 0.267) HD; however, the mean reduction of HBV DNA by a single HD was 0.11 ± 0.38 Log₁₀copies/mL. Patients with low viral load also had a significant high platelet count (p = 0.03), high serum albumin (p = 0.016), and low AST level (p = 0.002). Conclusions. Most uremic patients with chronic HBV infection under regular HD in Taiwan had a relatively lower viral load, of which the major mechanism could be due to the elimination of serum HBV viral load by the HD procedure.     

Prevalence of Occult Hepatitis B and Hepatitis C Virus Infections in Turkish Hemodialysis Patients

Background and Objective. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important causes of morbidity and mortality in maintenance hemodialysis patients. Although their exact prevalence is not known, HBV and HCV viral infections and occult viral hepatitis are frequent in these patients. This study aimed to determine the prevalence of occult HBV and HCV infections in maintenance hemodialysis patients. Materials and Methods. One hundred and eighty-eight end-stage renal disease patients on maintenance hemodialysis (100 male, mean age 49±29 [16–80] years, and mean duration of hemodialysis 98±66 [12–228] months) were enrolled in this study. Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA) by using commercial diagnostic kits (Access and BioRad, Beckman-Coulter). HCV-RNA (Cobas Amplicor HCV kit) and HBV-DNA (Artus GmbH HBV kit) were determined quantitatively by polymerase chain reaction. Results. Among the patients screened, 25 (13.3%) had HBV infection alone and 38 (20.2%) had HCV infection alone, while seven (3.7%) had dual infection of both viruses. Serological markers for occult hepatitis B and occult hepatitis C were positive in five (2.7%) and nine (4.8%) of the patients, respectively. Isolated anti-HBc was positive in 12 (6.4%) of all patients, three (7.9%) of the patients with anti-HCV and two (40%) of the patients with occult hepatitis B. Isolated anti-HBc positivity was more frequent in patients with occult hepatitis B than in those without (40% [2/5] vs. 5.5% [10/183], p=0.002). None of the patients with HCV had occult hepatitis B. Conclusions. Both occult and non-occult forms of HCV infection are more prevalent than HBV infection in hemodialysis patients. Especially the patients with isolated anti-HBc positivity should be tested for probable occult hepatitis B infection.     

乙型肝炎产妇乳汁乙肝病毒标志物检测与哺乳指导

目的：探讨乙型肝炎产妇产后能否进行母乳喂养。方法：选择住院分娩 的乙型肝炎产妇150例（肝功能均正常），其中血清HBsAg阳性79例为单阳组，HBsAg及HBeAg均阳性71例为双阳组，分别留取产后3－5d的初乳进行乳汁乙肝病毒标志物（HBV－M）检测，结果：两组乳汁中HBsAg,HBeAg,HBcAb,HBV DNA阳性率比较，差异有显著性意义（P＜0．05），结论：根据HBV－M各项指标阳性的临床价值分析产妇初乳中HBeAg,HBV DNA阳性及产妇血清中双阳者（HBsAg,HBeAg阳性）不宜哺乳，初乳中单纯HBsAg阳性，而HBV DNA为阴性的产妇可以哺乳，但应给予正确的哺乳指导。     

Natural History of Patients with Recurrent Chronic Hepatitis C Virus and Occult Hepatitis B Co-Infection after Liver Transplantation

It is uncertain whether occult hepatitis B virus co-infection will hasten progressive liver disease in chronic hepatitis C patients after liver transplantation. This study evaluated fibrosis progression and severe fibrosis in 118 consecutive hepatitis B surface antigen-negative patients with virological and histological evidence of recurrent chronic hepatitis C infection co-infected with occult hepatitis B virus after liver transplantation. HBV DNA was detected from serum at the time of recurrent chronic hepatitis C infection by polymerase chain reaction. Each subject underwent a repeat liver biopsy 5 years post-liver transplantation. Occult hepatitis B virus co-infection was present in 41 of the 118 (34.7%) patients. At 5 years post-liver transplantation, 13 of the 41 occult hepatitis B virus co-infected patients compared with 16 of the 77 patients without occult hepatitis B virus co-infection developed fibrosis progression (31.7% vs. 20.8%, respectively, p = 0.39). Eight of 41 the occult hepatitis B virus co-infected patients compared with 13 of the 77 patients without occult hepatitis B virus co-infection had severe fibrosis (19.5% vs. 16.9%, respectively, p = 0.97). In conclusion, occult hepatitis B virus co-infection in patients with recurrent chronic hepatitis C infection was not associated with accelerated fibrosis progression or severe fibrosis after liver transplantation.     

Clinical Characteristics and Treatment of Patients with IgA Nephropathy and Hepatitis B Surface Antigen

Background: The aim of this study is to investigate the clinical characteristics and our experience of treating patients with IgA nephropathy (IgAN) and IgA nephropathy with hepatitis B surface antigen (HBs-IgAN). Methods: From 1996 to 2011, biopsy-proven IgAN was diagnosed in 477 patients and 22 (4.6%) had hepatitis B surface antigen (HBsAg). Of these, we included 360 patients who had more than 6-month follow-up period, and compared clinical characteristics and renal function decline between the patients with IgAN and HBs-IgAN. Results: Of 360 patients, 22 were classified as HBs-IgAN. There were no differences in the clinical characteristics and renal function decline between idiopathic IgAN and HBs-IgAN (–0.01 vs. –0.17 mL/min per 1.73 m²/month, p = 0.319). Of 22 patients with HBs-IgAN, nine had hepatitis B virus (HBV) replication marker (RM), of which six were treated with anti-viral agents. However, there were no differences in renal function decline and urinary protein excretion between patients who did or did not receive anti-viral therapy. Five patients with HBs-IgAN received corticosteroid therapy. Of these, three without HBV RM and one with HBV RM who received entecavir did not exhibit active viral replication, whereas the other patients with HBV RM experienced viral replication after lamivudine was discontinued. Conclusion: There were no differences in the clinical characteristics and prognosis between the patients with IgAN and HBs-IgAN. Further, there were no differences in renal function decline and urinary protein excretion between patients with and without anti-viral therapy. Anti-viral therapy may be considered for treating patients with HBs-IgAN receiving immunosuppressants according to HBV RM.     

Efficacy of a Pre-S Containing Vaccine in Patients Receiving Lamivudine Prophylaxis after Liver Transplantation for Chronic Hepatitis B

Lamivudine monoprophylaxis against hepatitis B virus (HBV) reinfection after liver transplantation is associated with recurrence due to escape mutants and second generation recombinant HBV vaccine is not effective. We studied the efficacy of two courses each of three double-doses (20 microg) of third-generation recombinant pre-S containing vaccine (Sci-B-Vac) in 20 patients on lamivudine prophylaxis at a median of 637 days (range, 390-2666 days) after transplantation. At enrollment, all patients were seronegative for HBsAg, anti-HBs and HBVDNA (by qPCR). Lamivudine (100 mg/day) was continued throughout the study. Five patients (25%) responded to the first course and five additional patients responded after the second course (overall response rate 50%). The response rate was 88% in patients younger than 50 years old and 25% in older patients (p = 0.02). The median peak anti-HBs titer was 153 mIU/mL with six responders having a titer >100 mIU/mL and seven sustained >6 months. Among seven previous nonresponders to second generation recombinant vaccine, three (44%) responded. At the end of the study, all patients remained seronegative for HBsAg. In conclusion, Sci-B-Vac is effective in about 50% of patients receiving lamividine prophylaxis and may prevent recurrence due to escape mutants.     

Comparison of Intramuscular and Intradermal Applications of Hepatitis B Vaccine in Hemodialysis Patients

This study compared the application of intramuscular recombinant hepatitis B vaccine in hemodialysis patients with the application of accelerated intradermal recombinant hepatitis B vaccine, which can be applied with one-tenth of the standard dose. Sixty seronegative patients for hepatitis B were randomly separated into two groups. Twenty μg of the recombinant hepatitis B vaccine was intramuscularly applied at 0-, 1-, 2-, and 6-month intervals to the first group (32 cases). One more dose was applied at month 12 to those whose anti-HBs titers remained below 100 mIU/mL at month 7. The same vaccine was intradermally applied at 2μg dose six times with one-month intervals to the second group (28 cases). Vaccine applications were continued in those whose anti-HBs titers remained below 100 mIU/mL at month 7 until antibody titers reached above this value or until the dose number became 12. Measurements of antibody titers were repeated at month 13 in both groups. As a result, in the vaccination of hemodialysis patients against hepatitis B, the accelerated ID application of hepatitis B vaccine with a dose reduced to one-tenth is more cost-effective than the standard dose vaccination schedules. Especially for hemodialysis patients, the time has come for routine application of ID hepatitis B vaccine as an alternative vaccination method.