核苷类似物联合干扰素治疗慢性乙型肝炎的疗效研究

目的:探究慢性乙型肝炎(简称乙肝)患者采取核苷类似物与干扰素联合治疗的临床效果及意义。方法:研究慢性乙肝患者126例,通过随机数字表法将其分为对照1组、对照2组与观察组,每组42例。对照1组患者行干扰素a-2b治疗,对照2组行核苷类似物阿德福韦治疗,观察组行干扰素α-2b联合阿德福韦治疗,对三组患者治疗48周HBV DNA阴转率进行比较,同时比较三组患者治疗48周及72周时HBeAg阴转率、HBs Ag阴转率、HBeAg血清转换率、HBs Ag血清转换率、血清ALT复常率及不良反应发生率。结果:观察组患者治疗48周HBV DNA阴转率显著高于对照1组及对照2组,治疗48周、72周时患者HBeAg阴转率、HBs Ag阴转率、HBeAg血清转换率、HBs Ag血清转换率、血清ALT复常率均显著高于对照1组及对照2组,数据差异有统计学意义(P <0. 05);三组患者不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论:核苷类似物与干扰素联合治疗慢性乙肝疗效显著优于干扰素单用,因此该种治疗方案值得在临床中进行推广。     

核苷(酸)类似物联合干扰素治疗144例慢性乙肝患者的药效评估

目的:探讨核苷(酸)类似物联合干扰素治疗慢性乙型肝炎的临床价值。方法:将在本院2008年2月～2011年8月收治的144例慢性乙肝患者随机分成两组:对照组72例,单纯采用重组人干扰素α-2b治疗;实验组72例,采用重组人干扰素α-2b+拉米夫定治疗。观察和比较两组的临床疗效、乙肝病毒脱氧核糖核酸(HBV DNA)转阴率、乙肝病毒e抗原(HBeAg)转阴率、HBeAg血清转换率和患者肝功能指标水平的变化情况。结果:实验组的总有效率明显高于对照组(P<0.05);实验组治疗后的HBV DNA转阴率、HBeAg转阴率、HBeAg血清转换率均显著高于对照组(P<0.05);实验组患者治疗后的丙氨酸转氨酶(ALT)、冬氨酸转氨酶(AST)、总胆红素(TBiL)水平显著低于对照组(P<0.05)。结论:临床应用核苷(酸)类似物联合干扰素治疗慢性乙型肝炎能提高乙肝标志物转阴率,改善患者的肝功能水平。     

聚乙二醇干扰素α－2a 对慢性乙型肝炎 HBeAg 阳性患者的临床治疗研究

目的：研究聚乙二醇干扰素α－2a对慢性乙型肝炎HBeAg 阳性患者的临床疗效;方法：选择2012年7月至2014年6月在接受治疗的慢性乙型肝炎HBeAg阳性患者68例,按照随机数字表法平均分成干扰素组与对照组,两组患者一般资料比较,无统计学差异（P＞0．05）。对照组口服阿德福韦酯治疗。治疗早期保肝治疗使用还原型谷胱甘肽。干扰素组在对照组治疗的基础上皮下注射聚乙二醇干扰素α－2a治疗。观察两组患者治疗前后ALT、TBIL、ALB、AST等指标,以及治疗24周、48周HBsAg阴转率、HBeAg血清转换率、ALT复常率、HBV－DNA阴转率情况;结果：治疗后干扰素组ALT、TBIL、ALB、AST等指标均显著优于对照组（ P＜0．05）。治疗24周、48周,干扰素组患者HBsAg 阴转率、HBeAg血清转换率、ALT复常率、HBV－DNA阴转率均优于对照组,且治疗48周两组患者HBsAg阴转率、HBeAg血清转换率、ALT复常率、HBV－DNA阴转率组间对应比较存在显著统计学差异（ P＜0．05）。两组患者均未见严重不良事件发生;结论：联合应用阿德福韦酯与聚乙二醇干扰素α－2 a治疗慢性乙型肝炎疗效显著,不良事件发生率低,值得应用于临床。     

恩替卡韦治疗失代偿期乙型肝炎肝硬化

【摘要】目的 探究恩替卡韦治疗失代偿期乙型肝炎肝硬化的疗效及对患者血浆结缔组织生长因子(CTGF)、血小板衍生生长因子(PDGF)水平的影响。方法 回顾性分析2017年1月~2018年1月我院238例失代偿期乙型肝炎肝硬化患者临床资料,根据其治疗方法分为拉米夫定联合阿德福韦酯治疗组（对照组,109例）及恩替卡韦治疗组（观察组,129例）。记录两组治疗24、48周乙型肝炎病毒脱氧核糖核酸(HBV DNA)阴转率、谷丙转氨酶(ALT)复常率、耐药率及治疗期间不良反应发生情况,并比较两组治疗前及治疗48周后肝功能（Child Pugh评分）、肝纤维程度［瞬时弹性测定检测肝脏硬度值(LSM)、超声量化评分］及血清学指标（CTGF、PDGF）。结果 治疗24、48周时,观察组HBV DNA阴转率、ALT复常率均高于对照组（P＜005）。两组耐药率及治疗期间不良反应发生情况比较差异无统计学意义（P＞005）。治疗48周后,两组Child Pugh评分,肝纤维程度（LSM、超声量化评分）,血清学指标（CTGF、PDGF）均较治疗前降低（P＜005）,且观察组低于对照组（P＜005）。结论恩替卡韦治疗失代偿期乙型肝炎肝硬化效果优于拉米夫定联合阿德福韦酯,抗病毒作用更佳,能使患者肝功能及肝纤维化程度改善,安全性也较高,临床应用价值高。     

干扰素联合口服苦参素胶囊治疗慢性乙型肝炎

目的探讨干扰素联合苦参素胶囊治疗慢性乙型肝炎的疗效。方法110例患者随机分成治疗组（干扰素联合苦参素胶囊组）、对照组（单用干扰素组），观察两组的ALT、HBeAg、HBV—DNA的变化情况。结果治疗结束及停药6个月后两组ALT下降，ALT复常率差异无统计学意义（P〉0．05）；HBeAg阴转率、HBV—DNA阴转率治疗组明显高于对照组（P〈0．05）；停药随访6个月完全应答率治疗组明显高于对照组（P〈0．01）。结论联合治疗效果优于单用干扰素，长期疗效肯定。     

干扰素α-2b联合阿德福韦酯治疗慢性乙型肝炎临床观察

目的观察干扰素Ⅸ一2b联合阿德福韦酯治疗慢性乙型肝炎的疗效。方法将78例慢性乙型肝炎患者随机分为对照组和观察组各39例,对照组单用德福韦酯治疗,观察组给予干扰素仅一2b和阿德福韦酯联合治疗,比较两组治疗效果。结果对照组总有效率为84．62％,观察组总有效率为94．87％,两组比较差异有统计学意义（P〈0．05）;观察组ALT复常率、HBeAg和HBV—DNA转阴率及HBeAg／,HBeAb转换率均显著高于对照组（P〈0．05）。结论干扰素d一2b联合阿德福韦酯治疗慢性乙型肝炎疗效优于单用阿德福韦酯,可提高患者ALT复常率、HBeAg和HBV—DNA转阴率,值得推广应用。     

核苷(酸)类似物经治慢性乙肝患者序贯聚乙二醇干扰素治疗疗效观察

目的 探讨慢性乙肝患者经核苷(酸)类似物长期治疗后序贯聚乙二醇干扰素治疗的效果.方法 选取48例核苷(酸)类似物经治慢性乙肝患者,随机分成两组.实验组26例给予聚乙二醇干扰素治疗,对照组22例给予核苷(酸)类似物(拉米夫定)治疗.两组均治疗24周.治疗结束后,观察和分析两组患者的血清乙型肝炎E抗原(HBeAg)转阴率及转换率、乙肝表面抗原(HBsAg)清除率、乙肝病毒的脱氧核糖核酸(HBV-DNA)应答率、谷丙转氨酶(ALT)复常率和不良反应.结果 实验组HBV-DNA应答率92.31%、HBeAg转换率69.23%、HBeAg阴转率80.77%、HBsAg清除率61.54%、ALT复常率80.77%.各值均高于对照组,两组比较差异具有统计学有意义(P<0.05).实验组的血细胞减少23例,明显多于对照组的13例(P<0.05);实验组寒战或发热7例、头痛6例、恶心9例,与对照组差异无统计学意义.结论 核苷(酸)类似物经治慢性乙肝患者序贯聚乙二醇干扰素治疗可以提高患者的治疗效果,用药安全性较好,值得在临床上推广应用.     

聚乙二醇干扰素α-2a联合胸腺肽α1治疗慢性乙型肝炎随机对照观察

目的观察聚乙二醇干扰素α-2a（PEG INFα-2a）联合胸腺肽α1（Tα1）治疗慢性乙型肝炎（CHB）的疗效。方法将78例CHB患者随机分为聚乙二醇干扰素α-2a联合胸腺肽α1组和聚乙二醇干扰素α-2a组,观察两组的HBV DNA阴转率、ALT复常率、HBeAg阴转率、HBeAg／抗-HBe血清转换率的变化。结果治疗结束时联合组的HBV DNA阴转率、ALT复常率、HBeAg阴转率、HBeAg／抗-HBe血清转换率的改善均明显高于对照组（P〈0．05）。随访6个月联合组的HBV DNA、HBeAg、抗-HBe等指标仍优于对照组（P〈0．05）。结论聚乙二醇干扰素α-2a联合胸腺肽α1是治疗CHB的有效组合。     

大剂量胸腺肽联合干扰素治疗慢性乙型肝炎的临床疗效观察

本文选择慢性乙型肝炎90例,分大剂量胸腺肽联合干扰素组,大剂量胸腺肽组和干扰素组。结果表明,大剂量胸腺肽联合干扰素治疗可以促进ALT复常,促使HBeAg、HBcAg、HBV－DNA阴转率与对照大剂量的胸腺肽治疗及干扰素治疗组比较,疗效显著（P＜0．05）。故认为大剂量胸腺肽联合干扰素治疗慢性乙型肝炎（CHB）是阻断或抑制HBV复制且疗效显著的一种新疗法。     

干扰素联合拉米夫定治疗e抗原阳性的HBV患者临床疗效分析

目的 分析e抗原阳性的HBV患者应用干扰素联合拉米夫定治疗的临床效果。方法回顾分析本院自2012年7月至2014年7月本科室治疗的105例e抗原阳性HBV患者的临床资料,将应用拉米夫定治疗的患者52例列为对照组,拉米夫定联合应用聚乙二醇干扰素的53名患者列为研究组,疗程均为12个月。观察对比两组疗效,并对比两组治疗前后HBV DNA、HBV抗原转阴率,谷丙转氨酶(ALT)水平,及治疗期间不良反应发生率的差异。结果在总有效率方面,与对照组的82.69%相比,研究组总有效率显增高为92.45%(P＜0.05);在各指标变化方面,与对照组相较,研究组HBeAb/HBeAg转换率、HBsAg阴转率、HBV DNA阴转率均呈明显增高(P＜0.05)。ALT水平在治疗3个月、12个月后,研究组显著低于对照组(P＜0.05)。两组不良反应发生率无差别。结论e抗原阳性HBV患者应用干扰素联合拉米夫定治疗,可以改善血清ALT、HBV DNA水平,提高HBeAb/HBeAg转换率、HBsAg及HBV DNA阴转率,不良反应少,安全有效,应予推广。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.