重组人干扰素α-1b联合胸腺肽α1治疗慢性乙型肝炎的远期疗效观察及随访情况

目的探讨重组人干扰素α-1b联合胸腺肽α1治疗慢性乙型肝炎的远期疗效。方法选取慢性乙型肝炎患者120例。联合治疗组60例采用重组人干扰素α-1b500万U,1次／d,连续用5～7d后改为隔日1次,疗程12个月。胸腺肽仅11．6mg／次,1周2次皮下注射,疗程6个月。干扰素对照组60例采用干扰素α-b500万u,1次/d,连续用5—7d后改为隔日1次肌肉注射,疗程12个月。观察两组疗效。结果两组均随访5年,联合治疗组失访2例,干扰素对照组失访3例。在随访结束后两组HBsAg、HBeAg、HBV-DNA转阴率差异均有统计学意义[分别为13．8％（8／58）比3．5％（2／57）、67．2％（39／58）比36．8％（21／57）、67．2％（39／58）比38．6％（22／57）,P〈0．05或〈0．01]。随访结束时两组肝硬化、肝癌发生率比较差异无统计学意义（P〉0．05）,病死率比较差异有统计学意义[1．7％（1／58）比14．0％（8／57）,P=0．035]。而两组的乏力、头痛、关节肌肉酸痛发生率比较差异无统计学意义（P〉0．05）。结论重组人干扰素α-1b联合胸腺肽α1治疗慢性乙型肝炎疗效显著,且病死率明显降低。     

长疗程低剂量α—干扰素口含治疗丙型肝炎合并瘐型肝炎的临床流行病学研究

目的：了解瘐型肝炎病毒（HGV）对α－干扰素治疗的反应以及治疗前后HGV与丙型肝炎病毒（HCV）合并感染病毒血症的动态变化，方法：对研究对象用药前，用药3和6个月时肝功能，血清HGV RNA及HCV RNA等的动态变化进行观察,以阳性率和阴转率为主要评价指标并经统计学分析，结果：经α－干扰素治疗3和6个月时，治疗组的ALT水平呈下降趋势，特别是治疗6个月时，ALT平均水平从治疗前的119．6IU／L降至56．21U/L,显低于6个月时空慰剂组ATL平均水平（126IU／L），治疗组血清HGV RNA阴率在治疗3和6个月时分别为64．7％和64．75，安慰剂组分别为60．0％和66．7％，两组无显笥差异，用α－干扰素治疗的17例病人中，于治疗6个月时，3例血清HGV RNA阴而CV RNA 仍为阳性的病人，其ALT水平仍维持在较高水平，分别国154，168和84IU／L，3例血清HGV RNA阳性而CV RNA阴转，其ALT水平均转为正常，分别为25，20和20IU／L，3例血清HGV和HCV RNA均阳性，其ALT水平仍为异常，8例HGV和HCV RNA均阳转，除1例ALT由70IU／L降至35IU／L外，其余7例病人降低至正常水平，结论；HGV感染具有较高的自限性，长闻程低剂量口含 α－干扰素对HGV RNA阴转无明显作用。     

外周血单核细胞IFN-α和IL-18表达与慢性丙肝患者干扰素应答的关系

目的检测慢性丙肝(CHC)患者外周血单核细胞(PBMC)α干扰素(IFN-α)及白细胞介素18(IL-18)mRNA的表达,探讨慢性丙肝患者细胞免疫功能与干扰素应答的关系。方法聚肌胞(PolyIC)体外刺激正常对照组和慢性丙型肝炎病毒(HCV)感染组患者PBMC,取培养上清利用病毒保护试验测定IFN-α2b治疗前后病人PBMC表达的干扰素抗病毒生物学活性。同时用脂多糖(LPS)体外刺激不同组PBMC,RT-PCR检测PBMC IL-18 mRNA水平的变化。结果治疗前干扰素治疗应答组患者(n=12)和无应答组患者(n=26)PBMC分泌的干扰素抗病毒生物学活性显著低于正常对照组(n=20)(均P<0.01)。应答组患者PB-MC分泌的干扰素活性随治疗时间延长而增加,1个月已显著高于无应答组患者(P<0.01);无应答组患者PBMC分泌的干扰素活性始终处于低下水平。治疗前,应答组患者和无应答组患者PBMC IL-18 mRNA水平也显著低于正常对照组(均P<0.01);治疗后,应答组患者IL-18 mRNA水平随治疗时间延长而升高,1个月时显著高于无应答组患者(P<0.01),无应答组患者IL-18 mRNA水平始终较低。PBMC IFN-α活性和IL-18 mRNA水平有良好的正相关性(r=0.873,P<0.01)。结论慢性HCV感染无应答组的细胞免疫功能受损,不能正常表达IFN-α和IL-18,而应答组经干扰素治疗后表达能力逐渐恢复。慢性丙肝患者PBMC IFN-α活性和IL-18 mRNA水平检测可以作为干扰素治疗预后的判断指标。     

对α-2b干扰素治疗呈持续效应的慢性丙型肝炎患者的两年生化学、病毒学和组织学随访

据报道,大约15％～35％的慢性丙型肝炎患者用α干扰素治疗会出现长期效应,但大多数研究者仅以血清丙氨酸转氨酶(ALT)水平作为疗效标志,而作者把血清HCV RNA的清除情况也作为衡量疗效的标准,因为在ALT正常患者的血清中常测得HCV RNA阳性。 1990～1992年期间,在瑞典各临床中心对40例HCV感染者进行试验性α-2b干扰素治疗。方法为每周3次皮下注射α-2b干     

我国部分地区丙型肝炎病毒基因分型研究

目的：研究中国丙型肝炎病毒（HCV）基因型分布。方法：应用AmplicorPCR试剂盒检测北京、青岛、固安和周口等地27例抗－HCV阳性的单采浆供血员和36例慢性丙型肝炎病人血清HCV RNA,并对其中36例HCV RNA阳性者用INNO－LiPA^TMHCV II试剂进行HCV基因分型。结果：抗－HCV阳性的单采浆供血员和慢性丙型肝炎病人HCV RNA检出率0分别为48.15％（13／27）和69.44%(25／36）,平均为60.32％（38／63）。对13例HCV RNA阳性的单采浆供血员和23例慢性丙型肝炎病人HCV基因分型结果表明,29例（80.55％）为1b型,5例（13.89％）为2型,另2例（5.56％）不能被分型。结论：上述调查地区流行的HCV基因型以1b型占优势。     

重组干扰素联合病毒唑治疗丙型肝炎2年后疗效评价

丙型肝炎（丙肝）者50％以上发展成慢性肝炎，其肝组织清理改变可日益加重。近年，国内外用干扰素治疗丙肝取得初步疗效［1～3］。本院于1992年起用重组α-2b干扰素（α－2b－IFN）联合病毒叹治疗丙肝19例，并与单用α－2b－IFN相对照，旨在提高治愈好转率，经随访已2年余，报告如下。1对象与方法1·1对象为我院1992年12月～1994年3月收治的丙肝37例，分为治疗组19例和对照组18例，商组年龄、性别、实验室检查等基本情况比较，无明显差异，具有可比性。病程均在6个月以上，诊为慢性丙肝（CH），5例经肝穿病理检查，临床与病理诊断相符。…     

干扰素联合胸腺肽治疗慢性乙型肝炎疗效观察

目的探讨干扰素、胸腺肽联合治疗慢性乙型肝炎的疗效。方法选取乙型肝炎患者60例,分为治疗组30例,应用重组干扰素α-2b联合胸腺肽α1;对照组30例,单纯应用重组干扰素α-2b。结果治疗组ALT值恢复比对照组高（P〈0．05）HBeAg和HBV-DNA的转阴率治疗组分别为72．4％和40．3％,比对照组的53．3％和23．3％为高（P〈0．05）。结论干扰素联合胸腺肽治疗效果较单独使用干扰素治疗效果更显著,值得推广。     

聚乙二醇干扰素α 2a治疗慢性丙型肝炎的疗效观察

目的研究聚乙二醇干扰素α-2a治疗慢性丙型肝炎的疗效。方法设观察组（接受聚乙二醇干扰素α-2a治疗,联合利巴韦林口服）36例,对照组（接受普通干扰素α-2a治疗,联合利巴韦林口服）32例,在治疗前、治疗中、48周治疗结束及随访24周后,分别检测丙型肝炎病毒（HCV）RNA、血清丙氨酸转氨酶（ALT）,比较两组治疗效果。结果48周治疗结束时,观察组的病毒学应答率和生物化学应答率均为88．89％,对照组分别为75．00％、81．25％,两组治疗结束时疗效无明显差异（均P〉0．05）。观察组早期病毒学应答率、持续应答率分别为47．22％、81）．55％,明显高于对照组的12．50％、31．25％（分别Χ^2=9．57,P〈0．05;Χ^2=16．84,P〈0．05）;观察组复发率为8．33％,显著低于对照组的43．75％（Χ^2=11．33,P〈0．05）。结论聚乙二醇干扰素α-2a治疗慢性丙型肝炎的疗效优于普通干扰素α-2a。     

干扰素对慢性丙型肝炎患者血清HCV RNA的影响

本文43例HCV RNA阳性的患者随机分别接受α干扰素(IFN-α)或β干扰素(IFN-β)6MU治疗。选出其中16例患者来评价IFN对HCV RNA的影响。这16例抗-HCV均阳性。在治疗前、治疗期间(第1、2和4周)和治疗后(每2个月1次,共6个月)采集血清标本。另选择16例抗-HCV和HCV RNA均阳性的慢性丙型肝炎(CHC)患者作为对照。用逆转录法和套式PCR法检测血清HCV RNA。结果表明,开始16例患者血清HCVRNA均阳性,经IFN治疗后第1周,有11例HCV RNA转阴,2例2周后转阴。在治疗期间,13例HCV RNA转阴的患者,其血清ALT水平恢复正常或接近正常。5     

微量元素与丙型病毒性肝炎的研究(3)

目的 探讨微量元素与丙型病毒肝炎的关系。方法 用原子吸收分光光度计测定HCV感染血清中的微量元素Cu、Fe、Zn、Se，以SPSS for windows 9.0进行统计分析。结果 抗－HCV阳性组及HCV患组血清Zn低于正常对照组，经统计学检验具有高度显性差异（P＜0．001）；抗－HCV阳性组血清Cu高于对照组，差异有高度显性差异（P＜0．001）。丙肝患组血清Se低于健康对照组，有显性差异（P＜0．001）。抗－HCV阳性组及丙肝患组Cu/Zn、Fe/Zn均高于对照组，有高度显性差异（P＜0．01）。Logistic回归分析，抗－HCV阳性组微量元素Cu、Zn进入回归方程，丙肝患组微量元素Se进入回归方程。结论 微量元素Zn、Se、Cu、Fe与病毒性肝炎存在密切关系，微量元素Cu、Zn对抗－HCV阳性组影响最大，微量元素Se对丙肝患影响最为显。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.