慢性乙型肝炎患者恩替卡韦治疗的临床疗效观察

目的观察恩替卡韦分散片治疗慢性乙型肝炎患者的疗效和安全性。方法未经过抗病毒治疗的慢性乙型肝炎患者194例进行回顾性分析,予以恩替卡韦分散片0.5mg,口服每日1次,分别检测治疗0、4、12、24、48、72周时患者血清的乙型肝炎病毒脱氧核糖核酸(HBV-DNA)水平、表面抗原(HBsAg)与e抗原(HBeAg)状态和肝功能情况,同时观察治疗过程中药物的安全性。结果恩替卡韦分散片治疗至72周时HBV-DNA水平平均下降幅度达到3.60log10,HBV-DNA未检出率达到96.37%,谷丙转氨酶(ALT)复常率达到97.93%;HBeAg和HBsAg血清学转换率为7.81%和3.13%;治疗前基线ALT水平>5ULN组HBV-DNA阴转率和HBeAg转阴率明显高于ALT 2⁵ULN组和ALT<2ULN组,差异有统计学意义(P<0.01),HBeAg转换率与ALT<2ULN组比较差异有统计学意义(P<0.01);HBV-DNA<107 copies/ml组在HBV-DNA阴转率、HBeAg转阴率及转换率方面均高于HBV-DNA>1075ULN组和ALT<2ULN组,差异有统计学意义(P<0.01),HBeAg转换率与ALT<2ULN组比较差异有统计学意义(P<0.01);HBV-DNA<107 copies/ml组在HBV-DNA阴转率、HBeAg转阴率及转换率方面均高于HBV-DNA>107¹08 copies/ml组和HBV-DNA>108 copies/ml组,差异有统计学意义(P<0.05),HBeAg转阴率与HBV-DNA>108 copies/ml组,差异有统计学意义(P<0.01)。结论恩替卡韦分散片治疗慢性乙型肝炎患者在抑制病毒复制、提高HBeAg血清转换率方面均有疗效,且安全有效。     

替比夫定与阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的临床观察

目的评价替比夫定治疗HBeAg阳性慢性乙型肝炎48周的疗效和安全性。方法将HBeAg阳性慢性乙型肝炎患者104例分为两组,治疗组53例,对照组51例。治疗组口服替比夫定600mg,每日1次,疗程48周;对照组口服阿德福韦酯10mg,每日1次,疗程48周。观察两组治疗12、24、36、48周时的HBV-DNA阴转率、ALT复常率、HBeAg阴转率、HBeAg血清转换率及治疗过程中的不良反应。结果治疗12、24、36、48周时,两组HBV-DNA阴转率、ALT复常率相比较差异有统计学意义(P﹤0.05),而HBeAg阴转率及HBeAg血清转换率相比较差异无统计学意义(P﹥0.05)。治疗组在服药期间未出现严重不良反应。结论替比夫定治疗HBeAg阳性慢性乙型肝炎是有效的和安全的。     

恩替卡韦联合复方甘草酸苷治疗HBeAg阳性慢性乙肝临床研究

目的探讨恩替卡韦联合复方甘草酸苷治疗HBeAg阳性慢性乙型肝炎的疗效。方法将120例慢性乙型病毒性肝炎患者随机分为研究组和对照组,研究组:复方甘草酸苷片50mg/次,3次/d,口服;恩替卡韦0.5mg/次,1次/d,口服,疗程48周。对照组:恩替卡韦0.5mg/次,1次/d,疗程48周。比较两组患者治疗结束时的ALT复常率、HBV-DNA及HBeAg转阴率。结果在治疗结束时,研究组ALT96.7%保持正常,对照组为81.7%,差异有统计学意义(P<0.05)。研究组HBeAg转阴率为55.0%,优于对照组的35.0%,差异有统计学意义(P<0.05),HBV-DNA转阴率研究组为91.7%,对照组为88.3%,无统计学差异(P>0.05)。结论联合应用恩替卡韦与复方甘草酸苷治疗HBeAg阳性慢性乙型肝炎,可促进HBeAg转化,降酶效果更好。     

自拟复肝汤联合恩替卡韦治疗慢性乙型肝炎(湿热中阻证)的临床观察

目的:观察自拟复肝汤联合恩替卡韦治疗慢性乙型肝炎(湿热中阻证)的临床疗效.方法:将80例慢性乙型肝炎(湿热中阻证)患者分为治疗组50例和时照组30例,治疗组给予自拟复肝汤联合恩替卡韦治疗,对照组单用恩替卡韦治疗,分别观察两组治疗3个月、6个月、9个月、1年后的血清ALT复常率、HBV-DNA阴转率、HBeAg血清转换率.结果:(1)两组在治疗3个月、6个月、9个月及1年后的ALT复常率比较,差异均无显著性意义(P＞0.05);(2)治疗组治疗3个月后HBV-DNA阴转率优于对照组(P＜0.01),但在治疗6个月、9个月及1年后HBV-DNA阴转率比较差异均无显著性意义(P＞0.05);(3)治疗组治疗3个月后HBeAg血清转换率与对照组比较差异无显著性意义(P＞0.05),但在治疗6个月、9个月及1年后HBeAg血清转换率均优于对照组(P＜0.05或P＜0.01).结论:自拟复肝汤联合恩替卡韦能更有效地促进HBV-DNA阴转,同时提高HBeAg血清转换率.     

e抗原阳性慢性乙型肝炎患者临床抗病毒治疗的效果分析

目的探讨替比夫定和恩替卡韦治疗e抗原(HBeAg)阳性的慢性乙型肝炎患者的疗效,以针对不同的患者选择最佳治疗方案。方法选取2013年1月-2014年5月于医院诊治的76例HBeAg阳性的慢性乙型肝炎患者,将其随机分为替比夫定治疗组、恩替卡韦治疗组,每组各38例;两组患者治疗疗程均为48周,比较两组患者治疗4、12、24、48周时ALT下降率、HBV-DNA转阴率及HBeAg血清转换率;采用SPSS13.0软件对数据进行统计分析。结果两组患者在4、12、24、48周的ALT复变率比较差异无统计学意义;4、12、48周的HBV-DNA的转阴率差异均无统计学意义,治疗24周替比夫定组的HBV-DNA转阴率显著高于恩替卡韦组,差异有统计学意义(P0.05);血清HBeAg转换率在4、12周比较,差异有统计学意义(P0.05);24、48周的HBeAg血清转换率替比夫定组要显著高于恩替卡韦组,差异有统计学意义(P0.05)。结论替比夫定与恩替卡韦对HBeAg阳性的慢性乙型肝炎患者治疗效果相当,替比夫定在治疗24周后对患者的HBeAg血清转阴率效果稍高于恩替卡韦。     

替比夫定与恩替卡韦治疗慢性乙型肝炎疗效比较

目的：观察替比夫定与恩替卡韦治疗慢性乙型肝炎的疗效及安全性。方法：74例慢性乙型肝炎患者随机分为替比夫定组和恩替卡韦组，每组36例，分别给予口服替比夫定600mg／d，或恩替卡韦0．5mg／d，持续治疗48w。观察两组治疗24、48w时血清HBV—DNA阴转率、生物化学指标、HBeAg血清转换率、乙肝病毒耐药。结果：治疗24w时，替比夫定组和恩替卡韦组患者ALT复常率分别为77．8％和72．2％，HBV—DNA阴转率分别为72．2％和66．7％，HBeAg血清学转换率分别为19．4％和16．7％，治疗48w时两组ALT复常率分剐为83．3％和77．8％，HBV—DNA阴转率分别为77．8％和72．2％，HBeAg血清学转换率分别为27．8％和19．4％。治疗48w时替比夫定组出现2例YMDD变异。结论：治疗48w时，替比夫定组HBeAg血清转换率优于恩替卡韦组。两组未发现不良反应。     

观察替比夫定与恩替卡韦治疗HBeAg阳性慢性乙型肝炎52周疗效

目的观察和比较替比夫定与恩替卡韦治疗HBeAg阳性慢性乙型肝炎的52周疗效。方法按随机数字表法将我院2011年6月—2014年6月收治的60例HBe阳性慢性乙型肝炎患者分为对照组和观察组,每组30例。对照组采用恩替卡韦进行治疗,观察组采用替比夫定治疗,比较两组患者治疗24周和52周时的疗效。结果治疗24周后,对照组HBV-DNA转阴23例,占76.67%;ALT复常26例,占86.67%;HBeAg转阴5例,占16.67%;HBeAg血清学转换3例,占10.00%。观察组HBV-DNA转阴25例,占83.33%;ALT复常24例,占80.00%;HBeAg转阴15例,占50.00%;HBeAg血清学转换8例,占26.67%,两组患者的HBV-DNA转阴率、ALT复常率和HBeAg血清转换率比较差异无统计学意义（P〉0.05）,但观察组的HBeAg转阴率明显高于对照组,比较差异具有统计学意义（P〈0.05）。治疗52周后观察组的HBeAg血清学转换12例,占40.00%;对照组的HBeAg血清学转换5例,占16.67%,组间比较差异具有统计学意义（P〈0.05）。结论替比夫定和恩替卡韦治疗CHB疗效相当,但采用替比夫定治疗24周时患者HBeAg阴转率和52周时HBeAg血清学转换均高于恩替卡韦治疗。     

异甘草酸镁联合恩替卡韦治疗乙型肝炎肝硬化失代偿期的临床效果

目的 分析治疗乙型肝炎肝硬化失代偿期中应用异甘草酸镁联合恩替卡韦的临床效果。方法 选取广东省佛山市顺道区伦教医院在2018年1月1日-2021年11月9日收治的乙型肝炎肝硬化失代偿期患者40例作为研究对象,并采取数字表法将其划分为治疗组和对照组,每组各为20例,对照组行恩替卡韦治疗,治疗组予以异甘草酸镁联合恩替卡韦治疗,并对比两组的治疗指标、不良反应和治疗前后的肝功能改善情况。结果 治疗组的HBeAg阴转率、HBV-DNA阴转率与对照组差异不显著,不具有统计学意义（P>0.05）;治疗组的不良反应发生率低于对照组,组间比对结果呈差异性（P<0.05）;在两组肝功能改善情况（TBIL、ALB、AST）比对中,治疗前两组无明显差异性（P>0.05）;治疗后,治疗组的肝功能改善情况较对照组肝功能得到改善,组间比对结果呈差异性（P<0.05）。结论 使用异甘草酸镁联合恩替卡韦治疗乙型肝炎肝硬化失代偿期患者,治疗效果十分显著,可改善患者的肝功能情况,增强患者的机体免疫力,降低不良症状发生率,也能提升整体治疗安全性,临床上适合对两种结合药物进行推广和应用。     

恩替卡韦分散片联合双环醇片治疗HBeAg阳性慢性乙型肝炎的临床观察

目的探讨恩替卡韦分散片联合双环醇片治疗HBeAg阳性慢性乙型肝炎的临床效果。方法选择2010年3月—2012年3月收治的HBeAg阳性慢性乙型肝炎患者100例,随机分为研究组和对照组各50例,研究组给予恩替卡韦分散片0.5 mg口服,1次/d;双环醇片25 mg口服,3次/d。对照组给予恩替卡韦分散片0.5 mg口服,1次/d。两组均治疗48周后比较ALT复常率、HBeAg及HBV-DNA转阴率。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 ALT复常率研究组96.00%,对照组86.00%,两组比较差异有统计学意义(P<0.05);HBeAg转阴率研究组44.00%,对照组28.00%,两组比较差异有统计学意义(P<0.05);HBV-DNA转阴率研究组92.00%,对照组86.00%,两组比较差异有统计学意义(P<0.05)。结论恩替卡韦分散片联合双环醇片治疗慢性乙型肝炎保肝、降酶效果好,HBeAg转阴率较高,抑制病毒能力强,值得临床推广使用。     

α-干扰素联合恩替卡韦治疗慢性乙型肝炎的效果观察

目的：探讨慢性乙型肝炎行α—干扰素联合恩替卡韦治疗的临床疗效。方法：将50例慢性乙型肝炎患者随机分为观察组与对照组各25例,对照组行α—干扰素治疗,观察组则在其基础上施加恩替卡韦治疗,对比两组临床疗效。结果：两组经治疗后,观察组血清HBV DNA不可检测率、血清HBeAg阴转率、血清HBeAg转换率均明显优于对照组（P＜0.05）。结论：慢性乙型肝炎患者采用α—干扰素联合恩替卡韦治疗的疗效确切,具推广价值。     

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.     

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.     

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。     

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.