慢性乙型肝炎患者的心理韧性

<正>我国是慢性乙型肝炎的高流行区[1],报告病例多年来一直居法定传染病的首位[2]。有调查表明,近60%的乙肝患者因患病而产生各种心理问题[3]。以往研究多集中在对心理问题的描述和分析,本研究采用量表法对慢性乙肝患者的心理韧性进行断面调查。1对象与方法1.1对象选取2014年9月-2015年3月在长沙市某三级甲等医院感染科住院及门诊就诊的符合《慢性乙型肝炎防治指南》[4]诊断标准的慢性乙肝患者,     

慢性肝病肝纤维化指标的临床研究

目的探讨肝纤维化指标包括透明质酸（ＨＡ）、Ⅲ型前胶原（ＰＣⅢ）、层粘蛋白（ＬＮ）及 Ⅳ型胶原（Ⅳ－Ｃ）等与慢性肝病的关系方法应用放免法检测１０３例慢性乙型肝炎患者、４２例肝细胞癌和６４例肝炎肝硬变患者及４０例正常人的ＨＡ、ＰＣⅢ、ＬＮ和Ⅳ－Ｃ的值．结果慢性乙型肝炎轻、中、重度病人这四项血清学指标依次升高;慢性肝炎（重度）、肝硬化、肝细胞癌的四项指标均有明星升高．结论慢性乙型肝炎（重度）、肝炎肝硬变和肝细胞癌患者与肝纤维化有密切关系;上述四项指标的联合应用有助于慢性肝病肝纤维化的诊断．     

慢性乙肝病人的心理健康状况及相关因素的调查分析

慢性乙肝病人的心理健康状况及相关因素的调查分析蔡太生，谢小明，王丽湖南医科大学附二院慢性乙型肝炎是临床上一种常见而多发的疾病，它具有传染性较强、慢性病程、预后较差的特点，从而给病人的心身健康造成较大危害。该病致病机制复杂，已有的研究发现［１］，其发病...     

慢性乙型肝炎患者心身症状和应对方式对生活质量的影响

目的 :研究慢性乙型肝炎患者的心身症状水平和应对方式对生活质量的影响。方法 :对 15 2名住院慢性乙肝病人用慢性肝病问卷 (CLDQ)、症状自评量表 (SCL - 90 )、医学应对问卷 (MCMQ)进行调查。结果 :慢性乙肝患者SCL - 90得分与常模和对照组有显著差异 ,各因子与CLDQ各维度呈负相关 ,以SCL - 90总均分 0 .4 4为划界分将病人分成阳性组和阴性组 ,阳性组CLDQ各维度得分均低于阴性组。患者面对应对低于常模 ,回避和屈服应对高于常模 ,阳性组比阴性组患者更倾向于采用回避和屈服应对 ,这两种消极的应对方式与生活质量呈负相关。结论 :慢性乙肝患者的心身症状及不良的应对方式对患者的生活质量有较大影响 ,要想通过心理干预减轻患者心身症状 ,提高患者的生活质量 ,重点应该放在改变不良应对方式上     

乙型肝炎后肝硬化病人的辅助-诱导和抑制- 诱导T淋巴细胞亚群分析

乙型肝炎后肝硬化病人体内长期有乙型肝炎病毒存在,肝功能损害反复出现,病情不断进展,其机理被认为是机体对病毒感染的免疫应答所致。为了研究乙型肝炎后肝硬化病人Ｔ淋巴细胞亚群的变化与机体免疫紊乱的关系,我们采用单抗致敏花环ＰＡＰ双染色法及间接免疫荧光法对乙型肝炎后肝硬化病人外周血中的不同Ｔ细胞亚群进行检测,从亚群数目变化的角度对肝功能的损害及细胞、体液免疫的异常进行了解释,以指导临床治疗。１　对象与方法１．１　检测对象　所有病人组均经临床明确诊断为乙型肝炎后肝硬化;对照组为健康成人,均无慢性疾病和免…     

慢性乙型肝炎患者血清褪黑素的变化

褪黑素 (ｍｅｌａｔｏｎｉｎ ,ＭＴ)是由松果体分泌的一种吲哚类激素。近年来已在抗肿瘤、抗炎和抗氧化及调节神经、内分泌、免疫及治疗肝病等领域展示了其活性[1～ 3] 。慢性乙肝患者 ,免疫功能异常 ,内分泌失调 ,因而褪黑素有可能成为治疗慢性乙型肝炎的一种新方法。当前国内外对病毒性肝炎患者血清褪黑素的变化了解尚少。为此 ,我们探讨了慢性乙型肝炎患者血清褪黑素的变化 ,为临床应用提供理论依据。1　资料和方法35例慢性乙型肝炎 ,均为我所 1999年 6月～ 2 0 0 1年 4月住院患者 ,年龄 2 2～ 5 2岁 ,诊断标准按照《全国病毒性肝炎防治…     

重组白细胞α_1干扰素对乙型肝炎病毒感染的治疗

慢性乙型肝炎病人产生α干扰素能力有缺陷,这是作者用干扰素治疗此病的理由。本文提供用重组白细胞α_1干扰素治疗HBs-Ag阳性的慢性乙型肝炎的结果,以及对此药在HBsAg阳性慢性肝病临床使用问题进行了讨论。病人包括Ⅰ期治疗8人,Ⅱ期治疗24     

肝穿刺活体组织检查术

肝穿刺活体组织检查术简称肝活检,可以明确肝病病因和肝脏病变程度(肝脏病理变化),有以下几点: ①有利于多种肝病的鉴别诊断:许多临床上诊断起来比较困难的慢性肝病,如各型病毒性肝炎、酒精性肝炎、肝结核、肝肉芽肿、血吸虫病、肝肿瘤、脂肪肝、肝脓肿、原发性胆汁性肝硬变及各种代谢性肝病(肝豆状核变性、肝糖原累积病、肝脏淀粉样变性)等,往往需要通过肝穿刺来了解病人的肝脏病变,为明确诊断提供重要的甚至可能是决定性的依据.     

RNA干扰在抗HBV感染中作用的研究进展

乙型肝炎病毒(HBV)可引起慢性肝炎,慢性乙型肝炎(慢性乙肝)最终可能发展为肝硬化、肝癌[1,2],所以慢性肝炎是严重危害人类健康的一种疾病。目前用干扰素或核苷类似物如拉米夫定、阿德福韦等治疗慢性乙肝,但疗效不理想,特异性差,易出现耐药性[3,4]。RNA干扰(RNAi)是一种普遍存在     

心理干预对慢性乙型肝炎患者肝功能和生活质量的影响

目的探讨心理干预对慢性乙型肝炎患者肝功能和生活质量的影响。方法实验组50例,在药物治疗的基础上进行心理干预,对照组40例单纯进行常规药物治疗,在干预前后分别测试慢性肝病问卷（CLDQ）和化验肝功,比较两次评估结果,以观察心理干预的效果。结果心理干预前两组患者肝功能、生活质量无差别,干预后两组患者ALT、AST、ALB差别有显著意义,除了腹部症状,生活质量其他各维度都有统计学意义。实验组经过心理干预生活质量各维度都有改善,但对照组生活质量的情感功能指标没有改善。结论在常规药物治疗基础上配合心理干预,可以有效改善慢性乙肝患者的肝功能和生活质量。     

大学生学习拖延、强迫症状和应对方式之间的关系

目的:探讨学习拖延、强迫症状与应对方式的关系。方法:采用学习拖延量表、大学生强迫症状调查问卷、简易应对方式量表对514名大学生的学习拖延、强迫症状与应对方式进行测量。结果:消极应对与拖延频率(r=0.259,P0.01)、拖延困扰(r=0.143,P0.01)、强迫症状呈显著正相关(r=0.293,P0.01)。强迫症状在学习拖延与消极应对方式之间起部分中介(效应比为42.38%,P0.01)。结论:学习拖延既直接影响大学生的应对方式,又通过强迫症状对其产生间接影响。     

癌症病人的应对方式与心身症状

目的 :探讨癌症病人的应对方式特点 ,影响因素以及与心身症状的关系。方法 :使用MCMQ、EPQ、SCL -90对 13 0例癌症病人进行问卷测定。结果 :①癌症病人的应对方式受年龄、文化程度、病程及人格特征的影响 ;②回避是癌症病人有效的应对方式 ,而屈服是癌症病人不利的应对方式。结论 :癌症病人需要心理辅导和心理支持。     

HEPATOCELLULAR CARCINOMA AND CHRONIC PERSISTENT HEPATITIS

The morphologic type of cirrhosis that is followed most frequently by hepatocellular carcinoma is posthepatitic cirrhosis. Furthermore, HB Ag is detected in a high rate among cases with hepatocellular carcinoma suggesting the intimate causal relationship between hepatitis B virus and hepatocellular carcinoma. It has been considered that hepatocellular carcinoma might develop during destruction and regeneration of fully developed liver cirrhosis. However, hepatocellular carcinoma is combined with not only liver cirrhosis but also with mild liver fibrosis. An attempt was made to determine HBs Ag in the liver tissue of liver fibrosis with hepatocellular carcinoma. HBs Ag was found in non-cancerous liver tissue of 40% of those cases. Therefore, it may be concluded that, at least some of those fibrosis is caused by chronic viral hepatitis and hepatocellular carcinoma may develop not only on posthepatitic cirrhosis but also on chronic persistent hepatitis. This evidence also suggests the carcinogenicity of hepatitis B virus.     

Hepatocellular carcinoma and chronic persistent hepatitis.

The morphologic type of cirrhosis that is followed most frequently by hepatocellular carcinoma is posthepatitic cirrhosis. Furthermore, HB AG is detected in a high rate among cases with hepatocellular carcinoma suggesting the intimate causal relationship between hepatitis b virus and hepatocellular carcinoma. It has been considered that hepatocellular carcinoma might develop during destruction and regeneration of fully developed liver cirrhosis. However, hepatocellular carcinoma is combined with not only liver cirrhosis but also with mild liver fibrosis. An attempt was made to determine HBs Ag in the liver tissue of liver fibrosis with hepatocellular carcinoma. HBs Ag was found in non-cancerous liver tissue of 40 percent of those cases. Therefore, it may be concluded that, at least some of those fibrosis is caused by chronic viral hepatitis and hepatocellular carcinoma may develop not only on posthepatitic cirrhosis but also on chronic persistent hepatitis. This evidence also suggests the carcinogenicity of hepatitis B virus.     

Liver histopathology in patients with concurrent chronic hepatitis C and HIV infection

To investigate the influence of human immunodeficiency virus (HIV) coinfection on preexisting long-term chronic C hepatitis (HCV) 68 liver biopsies from 22 HIV/HCV-coinfected, 13 HIV and 33 HCV-monoinfected patients and 71 livers obtained at autopsy from 26 HIV/HCV-coinfected and 45 HIV-monoinfected patients were studied by histo- and immunohistochemistry. All HIV patients had reached the advanced stage of immunodeficiency (stage III CDC), except for 3 haemophiliacs (stage II CDC). HCV infection was associated with a higher degree of portal, periportal and lobular inflammation — regardless of whether there was concurrent HIV infection. HIV/HCV coinfection was associated with a significantly higher rate of granulocytic cholangiolitis than HCV and HIV monoinfection (P < 0.05), a histological feature uncommon in C hepatitis. In HIV/HCV coinfection cholestasis was a predominant histological feature. HCV monoinfection and HCV/HIV coinfection were associated with the highest fibrosis index. In HIV/HCV coinfection centrilobular fibrosis was significantly more marked than in HCV monoinfection (P < 0.05), suggesting an HIV associated fibrogenic effect. Patients with chronic C hepatitis showed a significantly increased rate of posthepatitic cirrhosis compared with the patients without HCV infection (P < 0.05). At autopsy, 10 of the 20 HIV/HCV-coinfected haemophiliacs had developed cirrhosis because of chronic C hepatitis, whereas cirrhosis was found in only 2 of 6 HIV/HCV-coinfected non-haemophiliacs (1 case of chronic B and C hepatitis, and 1 case of chronic alcohol abuse). No cirrhosis was observed in the 45 autopsy patients with HIV monoinfection. The findings suggest that HIV coinfection aggravates the course of preceding long-term chronic C hepatitis by a more marked (centrilobular) fibrosis. HIV/HCV-coinfected patients are threatened by a higher rate of posthepatitic cirrhosis —particularly in multitransfused haemophiliacs — and cholestatic hepatopathy.     

105例乙型病毒性肝炎肝阻抗血流图分析

目的:了解不同病期乙型病毒性肝炎的肝血液循环变化.方法:将105例乙型病毒性肝炎患者分为:急性(21例)、慢性轻度(22例)、慢性中度(22例)、慢性重度(20例)及肝硬化(20例)五组.正常对照组20例为本院健康职工.空腹、平卧、平静呼气末屏气检测,存盘分析.结果:与对照组比较,各病期肝炎形态异常率和各定量指标由急性、慢性轻度、慢性中度、慢性重度、肝硬化,差异逐渐明显(P＜0.05,P＜0.01).结论:乙型病毒性肝炎由急性肝炎到肝硬化,随着病情进展,肝阻抗血流图异常渐明显,表明肝脏血液循环障碍渐加重.     

医学生心理压力与应付方式的关系研究

目的探讨医学生不同程度心理压力与不同应付方式的关系。方法使用心身压力测试量表、应对方式问卷对426名学生进行调查。结果①24.4%的大学生心理压力程度较高,39.2%的大学生心理压力适中,36.4%的大学生心理压力程度较低;②高、中、低3个不同程度心理压力组学生应付方式各因子得分都有显著性差异(F=15.797,26.284,5.086,16.327,7.630,3.073;P<0.05);③心理压力较高的学生倾向于采取非成熟的应付方式,心理压力适中、较低的学生倾向于采取成熟的应付方式;④自责、幻想及解决问题对心理压力有非常显著的预测作用(R2=0.169,0.197,0.223;P<0.001)。结论倾向使用非成熟应付方式的医学生心理压力较高。     

Psychopathology and psychotherapy in chronic physically ill patients.

Within the scope of psychosomatic medicine somato-psychic diseases are of great importance theoretically as well as practically, especially in view of problems dealing with the patient's attitude toward his illness and his coping with the disease. Among the somato-psychic illnesses chronic physical diseases are of primary interest. The knowledge of their general and specific psychological and psychopathological symptoms are of great importance for a better understanding of these patients and in view of a favourable direction in therapy. This is demonstrated in the form of extracts with three groups of the chronic physically ill: (1) hemophiliacs; (2) patients on regular hemodialysis treatment and following renal transplantation, and (3) diabetics.     

乙肝患者心理健康状况及有关因素的调查

社会心理因素对身心健康的影响是一个复杂的过程 ,个体的心理健康不仅与社会心理刺激的强度、频率和持续时间有关 ,同时 ,还受到许多因素的影响和调节 ,如个人的认知评价、防御与应对方式、社会支持、个性特征、遗传因素等。本研究旨在探讨乙肝病人的心理健康水平与应对方式、社会支持等中介变量的关系。结果报告如下。1　资料与方法1.1　研究对象58例乙肝患者均为本院传染科入院一周内的病人 ,诊断符合 1990年上海全国病毒性肝炎会议修订标准。其中男 4 2例 ,女 16例。平均年龄 38.0 4±12 .30岁。干部 2 2例 ,工人 2 1例 ,其它 15例。文化…