中西医结合结肠透析治疗慢性重型肝炎的临床研究

目的：观察中西医结合结肠透析疗法对慢性重型肝炎的临床疗效。方法：78例重型肝炎患者随机分为治疗组36例与对照组42例；对照组给予常规护肝、对症和支持治疗，治疗组在给予对照组治疗的基础上加用结肠透析治疗，每3天1次，疗程为15天。结果：治疗组临床有效率63．88％，对照组47．73％；观察组疗效明显优于对照组（P〈0．05）。结论：中西医结合结肠透析配合内科综合治疗重型肝炎疗效显著。     

拉米夫定治疗慢性乙型重型肝炎近期疗效的观察

目的观察拉米夫定治疗慢性乙型重型肝炎的疗效。方法对25例慢性乙型重型肝炎患者临床资料进行回顾性分析。治疗组11例，对照组14例。对照组接受综合治疗，治疗组在综合治疗的基础上加用拉米夫定100mg口服，每日一次。结果治疗组存活9例(81．8％)，对照组存活4例(28．6％)。结论拉米夫定治疗伴有乙型肝炎病毒复制的慢性重型肝炎患者，可提高成活率。     

解毒化瘀汤治疗慢性乙型肝炎重型早期疗效分析

目的观察解毒化瘀汤治疗慢性重型肝炎的临床疗效。方法将46例慢性重型肝炎患者随机分为两组，治疗组26例口服解毒化瘀汤，对照组20例口服菌栀黄。观察治疗前后的症状、体征、肝功能、凝血酶原活动度的变化。结果治疗组疗效优于显效对照组（P〈0．05）；患者症状及体征有明显改善，与对照组比较，差异有显著性（P〈0．05）；TBIL、ALT、GLB明显降低，ALB、PTA升高，与对照组比较，TBIL、ALB、PTA水平差异有显著性（P〈0．05）。结论解毒化瘀汤能提高慢性重型肝炎的疗效，改善症状、体征及生化指标。     

血浆置换术治疗慢性重型肝炎

目的 观察应用血浆置换术治疗慢性重型肝炎的疗效。方法 自2005年1月至2006年5月,我科在内科综合治疗基础上采用血浆置换术治疗19例慢性重型肝炎患者，与仅进行内科综合治疗12例的对照组相比．观察治疗前后临床症状、肝功能、凝血酶原活动度、胆碱酯酶的变化以及预后。结果 治疗组19例重型肝炎患者中好转出院14例、自动出院3例、死亡2例；对照组12例中好转3例、自动出院3例、死亡6例。结论 血浆置换术是治疗慢性重型肝炎安全、有效的方法，可以明显改善临床症状及相关指标，提高重型肝炎的生存率。     

复方861对肝炎肝纤维化疗效的病理组织学分析

目的：以肝穿病理组织学研究中药复方８６１对慢性乙型肝炎及早期肝硬化的疗效。方法：中药８６１治疗慢性乙型肝炎及肝炎肝硬化１２例，另设对照组１０例，治疗前及治疗半年后行肝穿病理组织学检查。结果：肝炎症计分由治疗前１８．２５±７．４下降至治疗后８．５±２．７（Ｐ值＜０．００１），纤维化计分由１０±９．９２下降至２．５８±２．０７（Ｐ值＜０．０１）。对照组治疗后则无改变。平滑肌α－ａｃｔｉｎ染色见治疗前肝组织炎症区域中有较多肌成纤维细胞，治疗后显著减少。治疗前后血清乙肝指标无明显变化。结论：中药复方８６１治疗慢性肝炎肝纤维化半年，能明显减轻肝纤维化程度。肝组织炎症亦同步减退。     

思美泰治疗慢性重型肝炎的疗效观察

目的观察思美泰对慢性重型肝炎的治疗作用。方法将20例慢性重型肝炎患者分为观察组与对照组,各10例。比较两组疗效。结果治疗组显效率和总有效率与对照组相比,差异有统计学意义;治疗组胆红素下降幅度明显大于对照组,肝功能恢复较快;治疗过程中未发现不良反应。结论思美泰对慢性重型肝炎有较好的治疗作用。     

慢性重型肝炎患者血小板活化因子水平变化的意义

血小板活化因子（ＰＡＦ）是一生物活性很强的脂质介质，与内毒素有着密切的关系，后者对肝脏的损害较为明确。ＰＡＦ参与了缺血再灌流肝损伤和内毒素性肝损伤，且有中心放大作用［１］。但关于ＰＡＦ在病毒性肝炎中的作用报道甚少。我们对４８例慢性重型肝炎（重肝）患者血中ＰＡＦ水平进行观察，并探讨其与发病机制的关系。材料与方法一、病例选择对照组２０例，男１５例，女５例，平均年龄４１岁，均为健康献血员。４８例慢性重型肝炎患者均为西南医院住院患者，男３４例，女１４例，年龄２３～６７岁，平均（４５．２±１２．８）岁。诊…     

肝胆平口服液治疗病毒性肝炎500例

目的观察肝胆平口服液治疗病毒性肝炎的效果．方法应用肝胆平口服液（主要由大黄、胆草等组成）治疗病毒性肝炎500例．男350例，女150例，急性肝炎420例，慢性活动型肝炎10例，慢性迁延型肝炎8例，瘀胆型肝炎62例．所有患者口服肝胆平20mL，2次／d，5d为一疗程．重症者连用2～3个疗程对照组采用菌桅黄、门冬氨酸钾镁等国内常用保肝退黄药物治疗．通过1mo治疗对比两组治疗效果．结果服用肝胆平口服液组，用药15d后，退黄显效率75％．对照组显效率22％（P＜0．01）．用药20d后，治疗组和对照组降酶率分别为75％和23％（P＜0．01）．治疗组和对照组降浊分别为54％和20％（P＜0．01）用药40d，治疗组和对照组转阴率（HBsAg）分别为42％和20％．结论经非煎煮方法制备纯中药制剂（肝胆平口服液）对各种类型肝炎的治疗，可起到意想不到的疗效．可明显减轻症状，减少并发症发生率，提高HBsAg转阴率，尤其对于顽固性高胆红素血症患者，疗效独特，具有速效、高效、长效的作用．与相同药物经煎煮所得之药液相比，临床疗效更佳．     

肝炎灵联合猪苓多糖治疗慢性乙型肝炎疗效观察

将慢性乙型肝炎２７０例随机分为肝炎灵联合猪苓多糖组、猪苓多糖组、肝炎灵组和对照组进行疗效比较，结果表明；联合治疗组远期疗效高于肝炎灵组（Ｐ＜０．０５）、猪苓多糖组（Ｐ＜０．０５）及对照组（Ｐ＜０．０１）。在整个治疗过程中，未见明显副作用，在慢性乙型肝炎无特效疗法的今天，此疗法值得推广。     

ALSS对慢性重型肝炎血清胆碱酯酶的影响及预后判断

探讨人工肝支持系统（ALSS）对慢性重型肝炎血清胆碱酯酶（ChE)的影响及预后判断。设ALSS(88列）和对照组（70例）。两组治疗前后均进行ChE检测。ALSS治疗后血清ChE值明显回升，与好转率呈正相关，与对照组有显著性差异。治疗组民对照组好转率分别为47．7％，18．6％。ALSS治疗对慢性重型肝炎早期最佳，好转率达81．8％，而中，晚期为68．4％，17．9％。ALSS治疗可显著升高慢性重型肝炎ChE值，并提高好转率。血清ChE可作为ALSS治疗后的预后判断指标之一。     

病原未定型肝炎的临床研究

目的探讨病原未定型肝炎的临床特征。方法以43例慢性乙型肝炎和30例急性乙型肝炎为对照组,对62例病原未定型肝炎患者进行临床分析,比较病原未定型肝炎的流行病学、临床表现、实验室检查及肝组织学改变。结果62例病原未定型肝炎患者发病以冬末及春季多见;发病年龄以青、中年(18岁~50岁)占92.2%;临床表现有急性和慢性,多数症状轻、肝病体征少;血清转氨酶水平呈轻、中度升高;肝活检组织病理学显示炎症轻;绝大多数预后良好。结论病原未定型肝炎的致病因子仍不清楚。     

Histological evolution of chronic hepatitis C. Factors related to progression

We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positive to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver biopsies were carried out for each patient, with an interval ranging between 12 and 126 months (mean 50.2±30.7). In all cases the usual histological classification was applied and the histological activity index scoring system according to Knodell et al. was determined. Fifteen cases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patients (18.5%) in the second liver biopsy. Epidemiological, clinical, biochemical and histological parameters were compared between the group without histological progression and the group with impairment in liver histology. Factors related to histological worsening were: more advanced age (p=0.002), high levels of aspartate aminotransferase (p=0.04), high global histological activity index (p=0.03) and piecemeal necrosis and bridging necrosis scores (p=0.02) at first biopsy. The histological activity index can be applied to assess the natural history of chronic viral hepatitis, and is a good tool to evaluate the prognosis. Thus chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.     

Absence of anti-LKM-1 antibody in hepatitis C viral infection in the United States of America

Summary. Several studies from Europe have observed a relationship between hepatitis C virus infection and anti-liver/kidney microsome-1 (anti-LKM-1) positive chronic hepatitis. It has been suggested that hepatitis C may induce an autoimmune phenomenon that leads to the development of a specific type (type II anti-LKM-1 positive) autoimmune chronic hepatitis. We evaluated 204 sera from patients with well-documented hepatitis C infection from two centres in the United States of America and compared them with sera from 428 French patients from three centres. We evaluated the serological prevalence of anti-smooth muscle antibodies, anti-nuclear antibodies, anti-liver cytosol antibodies, and anti-mitochondrial antibodies subtype anti-M₂ in patients with chronic hepatitis C. The two groups were matched in their ages, gender, mode of transmission of hepatitis C infection and severity of liver disease. Anti-LKM-1 was not observed in the patients from the USA at a time when it was noted in 3.7% of French patients. There were no differences, however, in the expression of other auto-antibodies, which were often in low titres. Absence of anti-LKM-1 in USA sera in comparison with French sera suggests that there may be differences in induction of anti-LKM-1 related to environmental and/or host genetic factors, and/or genomic variation in the hepatitis C virus.     

Detection of HBV core promoter and precore mutations helps distinguish flares of chronic hepatitis from acute hepatitis B

Background and Aim: Acute exacerbation of chronic hepatitis B has to be distinguished from acute hepatitis, because treatment strategies differ between them. Methods: Mutations in the core promoter and precore region of hepatitis B virus (HBV) were determined in 36 patients with acute exacerbation of chronic hepatitis B, in whom alanine aminotransferase (ALT) increased above 500 IU/L, as well as the 36 patients with acute hepatitis. Results: Mutations in the core promoter (A1762T/G1764A) and precore region (G1896A) were more frequent in patients with acute exacerbation of chronic hepatitis than acute hepatitis (81% vs 19%; P < 0.0001 and 58% vs 6%; P < 0.0001, respectively). Of the 19 patients with mutations in both the core promoter and precore region, 17 (89%) had acute exacerbation of chronic hepatitis. In contrast, among the 32 patients with the wild‐type for both the core promoter and precore region, 29 (89%) developed acute hepatitis. By multivariate analysis, the double mutation in the core promoter was predictive of acute exacerbation in chronic hepatitis with the highest odds ratio at 26.4. Conclusions: In patients with hepatitis B having ALT levels >500 IU/L, mutations in the core promoter and precore region are useful in distinguishing acute exacerbation of chronic from acute HBV infection. Detection of these mutations would be useful for commencing prompt antiviral treatments on patients with acute exacerbation of chronic hepatitis for a better prognosis.     

A case of transfusion-acquired hepatitis C

Summary The Blood Transfusion Service introduced screening for Hepatitis C antibody (HCV) in September 1991. This is done by second generation enzyme linked immunosorbent assay (ELISA) tests. We present a case of post-transfusion hepatitis C hepatitis in a patient with myeloma. Infection was acquired before screening was introduced. Both the patient and the infected blood donor were diagnosed using ELISA assays and the polymerase chain reaction (PCR). In this way we prevented the blood donor from spreading the virus via subsequent blood donations. There were some interesting discrepancies in the HCV assays. Blood samples, when tested by different methods, gave both positive and negative results. The results also varied according to when the blood samples to be tested were taken. The case illustrates the importance of confirming positive results and that no single laboratory test is entirely satisfactory in diagnosing HCV infection.     

The medical impact of hepatitis D virus infection in Asia and Africa; time for a reappraisal

Although hepatitis D is believed to be an important medical problem in Africa and many areas of Asia, the geographical distribution and prevalence rates of infection with the hepatitis D virus (HDV) vary considerably, are often inconsistent and sometimes conflicting. Discrepancies may depend on methodological problems, primarily on different modalities of patients' recruitment; these are analysed in this mini‐review, in order to provide a uniform clinical approach when testing patients with chronic HDV disease.