癌症术后并发肝炎的治疗

我们采用 α-干扰素治疗 45例癌症术后并肝炎的患者 ,取得较好疗效 ,现报告如下。临床资料 :本组男 2 7例 ,女 18例 ;年龄 2 8～ 6 9岁 ,肺癌2 7例、食管癌 9例、乳腺 4例、贲门癌 5例。其中 10例为乙肝病毒携带者 (术前 )。术后第 2 9～ 90天查肝功异常 ,多数仅AL T升高 ,其中抗 - HCV及 HCV- RNA阳性 35例 (诊为丙型病毒性肝炎 ,简称丙肝 ) ,HBs Ag及 HBV- DNA阳性 9例 (诊为慢性乙型病毒性肝炎 ,简称慢乙肝 ) ,1例 HCV- RNA及HBV- DNA均阳性 (诊断为乙、丙肝重叠感染 )。患者的临床症状均较轻 ,仅有全身乏力、食欲下降等。…     

上海地区输血后丙型肝炎病毒感染者临床流行病学分析

目的 分析上海地区输血后HCV感染者的临床流行病学特点.方法 采用PCR检测HCV RNA载量、ELISA检测抗-HCV,分析输血后HCV感染者的年龄、原发病因、暴露年份、输血成分与输血量、潜伏期和肝功能损害等.计数资料采用x2检验,计量资料采用t检验和相关分析.结果 327例中的279例(85.3%)感染者HCV RNA载量≥3.0 log10拷贝/mL、中位数为5.99 log10拷贝/mL;19.7%病例为3.0～4.0 logl0拷贝/mL,69.9%为5.0～6.0 log10拷贝/mL.HCV RNA定性阳性率为81.6%(40/49),抗-HCV阳性率达99.7%(383/384),其阳性敏感度高于HCV RNA定量和定性检测(F=57.138,P=0.000;F=63.149,P=0.000).输血后HCV感染以30～60岁年龄段多见,84.4%病例暴露时间为1990年至1994年问,感染者中10%以上总病例数的疾病分别为妇产科、骨科疾病和胃肠道出血.输入全血者占80.0%,输血至临床诊断时间平均为(86.0±54.6)个月.89.0%感染者有肝功能损伤,但大多数ALT升高水平≤5×正常值上限(ULN).结论 输血后HCV感染以成年人居多,常伴有肝功能损伤,但ALT升高≤5×ULN;血清HCV RNA载量多为中等水平.     

输血后丙型肝炎病毒感染者临床转归研究

目的 观察输血后丙型肝炎病毒(HCV)感染者的远期预后,并分析影响其转归的危险因素.方法 对87例输血后HCV感染者进行回顾性调查及随访.输血时间为1989～1995年.随访时间为11～18年,平均随访时间(14.9±1.7)年.结果 ①全组患者中,转变为慢性肝炎、肝硬化、肝癌者共71例,转慢性化率为81.6%.HCV-RNA阳性者61例,阳性率为85.9%;其中13例检查了HCV-RNA分型,Ib型者7例、Ⅱ型者6例,阳性率分别为53.8%和46.2%.②全组患者中,HBV的重叠感染率高达28.7%(25/87).合并HBV感染患者转变为肝硬化者的比率(40.0%)明显高于单纯HCV感染者(14.5%)(x2=6.778,P:0.009).③单纯HCV感染者是否发展为慢性肝病,与患者感染HCV时的年龄和性别无显著相关性,但由于男性患者乙型肝炎重叠感染的比率(39.7%)远高于女性患者(6.9%),因而全组中男性患者的慢性化率(87.9%)明显高于女性患者(68.9%)(x2=4.633,P=0.031).④23例有饮酒嗜好者(饮酒量≥40 g/d)的慢性化率(95.7%)显著高于64例无饮酒嗜好者(75.0%)(P=0.035).⑤12例慢性丙型肝炎患者接受α干扰素、利巴韦林联合治疗12月,观察3～5年,有效率达75%.结论 输血后HCV感染者慢性化率较高;合并HBV感染患者、男性患者、嗜酒是促进输血后HCV感染者疾病进展的重要危险因素;干扰素α联合利巴韦林抗病毒治疗疗效显著.     

慢性丙型肝炎的规范性抗病毒治疗及研究进展

0 引言丙型肝炎是由丙型肝炎病毒(HCV)引起的一种以肝脏为靶器官的传染性疾病.我国肝炎患者为数众多,据1992-1995年全国病毒性肝炎血清流行病学调查表明, 我国抗HCV阳性者占3.2%,约4 200万人,其中约70-80%的感染者将发展为慢性,即HCV感染后持续6 mo以上可以检测到HCV RNA.慢性患者由于进行性的     

HCV感染者检测血清及外周血单个核细胞HCV RNA的意义

丙型肝炎病毒(HCV)是输血后肝炎的主要致病因素。至少50％以上的急性丙型肝炎转为慢性,其中又有10％～20％发展为肝硬变,部分病例最终发展为肝细胞肝癌。HCV感染慢性化的原因一直是研究的热点。近几年来,国外学者报道HCV可以感染外周血单个核细胞(PBMC),但国内报道甚少。作者对一批慢性HCV感染者进行血清及PBMC HCV RNA检测,旨在探讨同时检测HCV感染者血清及PBMC中HCV RNA的意义及HCV感染慢性化的原因,现报道如下。 1 材料和方法 1.1材料 HCV感染者31例系我院传染科1998-12/1999-05门诊和住院患者。男19例,女12例,平均年龄46岁;均有输血     

西藏地区藏族人群HCV感染状况及HCV基因型分析

目的和方法:西藏族地区不同人群HCV感染状况及HCV基因现分析,对采自西藏地区藏族不同人群781份血清分别进行了抗-HCV ELISA和HCV RNA基因型检测结果,结果显示:该地区自然人群、急性肝炎、慢性迂延性肝炎、慢性活动性肝炎、肝硬化和肝细胞癌患者中抗-HCV阳性率分别为2.4%、8.3%、15.8%、25.9%、34.8%及24.3%,HCV感染者中有5l.6%具有输血史及使用血制品史.结论:本实验结果提示经血传播是该地区HCV的主要感染途径.该地区人群HCV基因型分布以Ⅱ型为主(51.4%),其次是Ⅲ型(27.0%)和Ⅰ型(6.8%),并有少量混合型(14.8%).     

儿童丙型肝炎病毒感染84例分析

84例HCV感染儿中，63.1%有输血制品史；5例≤6月龄婴儿（1例有输血史）母亲HCV标志阳性；1例在其父患输血后丙肝21月后筛查发现血清HCV RNA和抗HCV阳性。除外原有其他肝病者，62例患儿临床上以急性无黄疸型（25.8%)、亚临床型（20.9%)和无症状感染（25.8%)多见。仅5例为急性黄疸型（8.1%)，慢性型占19.4%。并见HAV、HBV和HCV三重感染2例；HCV与HAV和HBV二重感染各6例和16例；与CMV混合感染3例。慢性和无症状HCV感染儿中混同HBV感染最多见（11／16，68.8%)，1例肝活检证实有肝硬变。血清HCV标志检测表明，HCV RNA在免疫发育不完善的婴儿、免疫抑制者及感染早期特异性抗体未能检出时更具诊断价值。9例接受α－干扰素辅以病毒唑治疗，近期病毒清理率达55.6%。     

惠福仁治疗乙型肝炎和丙型肝炎33例报道

惠福仁(Wellferone)系一种高度纯化的人类天然α-干扰素,由人类淋巴母细胞经Sandai病毒诱导产生,其成份包含糖基化干扰素亚型共22种。我们于1994～1995年间用此干扰素治疗慢性乙型肝炎和丙型肝炎共33例,取得良好效果。惠福仁3MU隔日肌注,3个月为一疗程。结果19例慢性乙型肝炎HBeAg阴转率47%(8/17)、抗-HBe阳转率47%(8/17),HBV DNA阴转率44%(8/18):肝功能均恢复正常。丙型肝炎13例经治疗一月后肝功能全部(100%)恢复正常,HCV RNA阴转率41.6%(5/12),抗-HCV无转阴;乙型肝炎重叠丙型肝炎病毒感染1例,经治疗肝功能恢复正常,HBV DNA、HBeAg转阴,但抗-HCV及HCV RNA仍为阳性。观察表明,惠福仁因系人类天然干扰素,组织相容性较好,不良反应较轻,疗效较好。     

由一个献血员所致83例丙型肝炎病毒感染者10年的自然转归

目的 了解输血后丙型肝炎病毒感染者的临床特征及其自然病史.方法 采用横断面调查与回顾性调查相结合的方法,对1998年1月-2002年7月输受同一供血者血液的83侈HCV感染患者进行临床资料调查,同时进行抗-HCV,HCV RNA,肝功能生物化学指标,腹部B型超声检查.计量资料用7检验,计数资料用x2检验,等级资料用秩和检验.结果 抗-HCV阳性83例,HCV RNA阳性56例,丙型肝炎慢性化率为67.4%,其中男性76.3%(29/38),女性60.00%(27/45),两者差异无统计学意义(x2=2.99,P=0.11).HCV RNA阳性组的平均年龄为(36.54±14.37)岁,HCV RNA阴性组平均年龄为(27.43±12.51)岁,差异有统计学意义(T=-2.41,P=0.018).供血者感染HCV基因为1b型.HCV RNA阳性患者中有10例表现为轻度乏力、纳差、腹胀,9例ALT轻度升高,12例B型超声检查提示有慢性肝炎改变,1例为肝硬化失代偿期.结论 输血后感染HCV者临床表现隐匿,慢性化与受感染时的年龄有一定关系.

Abstract：

Objective To find out clinical characteristics and natural history of post transfusion HCV infection. Methods 83 subjects who have received the blood from a same blood donor from January 1998 to July 2002 were investigated by the method combining cross-sectional study with retrospective study. HC V-antibody, HCV RNA, liver function, abdomen B-ultrasound and Fibroscan were detected. Results The HCV-antibody were all positive. The HCV RNA of 56 out of the 83 cases were positive. The chronicity rates of hepatis C were 76.3% (29/38) in male patients and 60.00% (27/45) in female patients respectively, without significant difference (x2 = 2.99, P = 0.11). The average age of the HCV RNA positive patients was (36.54 ± 14.37) years old. The average age of the HCV RNA negative patients was (27.43 ± 12.51) years old. A significant difference (T = -2.41, P = 0.018) existed between. The HCV genotype was typelb. Among the HCV RNA positive patients, 10 cases were with mild asthenia, anorexia and abdominal distention, 9 cases with increased serum ALT, 12 cases.with chronic hepatitis and 1 case was diagnosed with decompensated liver cirrhosis. Conclusion The clinical manifestations of HCV infection are occult and chronic. The chronicity rate is related to gender and the age when infection was caught.     

外周血单个核细胞内HCV RNA是慢性丙型肝炎干扰素治疗效果的预测因子

目的 探讨慢性丙型肝炎干扰素(IFN)治疗结束时，外周血单个核细胞(PBMC)中HCV RNA检测对持续性应答的预测作用。方法 对因输血而感染的慢性HCV肝炎患者进行IFN治疗24周，在治疗12周即取得完全应答的患者，24周治疗结束时检测PBMC中HCV RNA，并对患者进行长期的血清HCV RNA监测。结果 治疗结束时，有9例患者的PBMC HCV RNA为阳性，7例为阴性。在PBMC中HCV RNA阳性患者，停止治疗的6个月内9例中8例血清HCV RNA阳转，1年内所有患者的HCV RNA复发。而PBMC HCV RNA阴性者，随访至停药6月时，7例中仅1例HCV RNA阳转，1年内共2例HCV RNA复发，其余5例，随访至3．5年，血清中HCV RNA仍阴性。结论 IFN治疗结束时PBMC中HCV RNA检测能预测慢性丙型肝炎的治疗效果。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.