替比夫定防止134例胎儿宫内乙型肝炎病毒感染的疗效研究

目的：替比夫定阻断妊娠中晚期胎儿宫内感染乙型肝炎（简称乙肝）病毒（HBV）的疗效及安全性研究。方法：选择2009年1月—2011年1月在武汉市江夏区第一人民医院就诊的确诊为合并慢性乙肝的妊娠中晚期患者134例,基于患者意愿,分为治疗组（86例）和对照组（48例）。妊娠22-32周,治疗组口服替比夫定抗病毒治疗,对照组口服复方甘草酸苷片治疗。足月分娩时均抽取脐带血检测乙肝全项,24 h内给新生儿各注射乙肝疫苗10μg及乙肝免疫球蛋白200 IU,同时序贯给予乙肝疫苗免疫。结果：治疗前2组患者年龄、孕周、HBV拷贝数、血丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）差异无统计学意义（均P〉0.05）。经过替比夫定治疗后,治疗组患者分娩时HBV拷贝数下降,肝功能好转,产后出血发生率降低（均P〈0.05）。治疗组新生儿出生时脐带血HBV感染率低于对照组（P〈0.05）,但2组新生儿肝功能均正常（P〉0.05）。不同分娩方式新生儿1年后HBV感染率差异无统计学意义（χ2CMH=0.067 8,P=0.794 5）。结论：口服替比夫定阻断乙肝宫内感染治疗安全有效,值得进一步推广。     

替比夫定对乙肝孕妇T淋巴细胞亚群的影响

目的:分析孕晚期应用替比夫定(Ld T)对乙肝孕妇细胞免疫功能的影响,为降低乙肝高病毒血症孕产妇死亡率提供临床依据。方法:收集2013年3月至12月我院收治的乙肝表面抗原阳性(HBs Ag)阳性、乙肝e抗原(HBe Ag)阳性、HBV DNA≥106IU/ml的59例孕妇,根据孕晚期是否服用Ld T,分为Ld T治疗组和未治疗组。同时收集同期HBs Ag(+)、HBe Ag(-)、HBV DNA106IU/ml的孕妇30例为低病毒组,HBs Ag(-)的孕妇30例为正常对照组。运用流式细胞术分析Ld T对乙肝孕妇外周血CD3~+T细胞、CD4~+T细胞、CD8~+T细胞及CD4+CD25+Treg细胞(Tregs)的影响。结果:正常组、低病毒组、高病毒未治疗组和高病毒Ld T治疗组的CD3~+T细胞比例无明显差异;与正常组比较,高病毒和低病毒组中CD4~+T细胞比例升高、CD8~+T细胞降低、CD4~+/CD8~+比值进一步升高,Tregs比例显著升高。经Ld T治疗后,T细胞亚群基本处于正常水平。与高病毒未治疗组相比,Ld T治疗组的CD4~+T细胞比例下降,CD8~+T细胞比例也有上升趋势,CD4~+/CD8~+比值显著下降,Tregs比例显著降低。结论:乙肝高病毒血症孕妇体内细胞免疫功能紊乱。Ld T治疗可能解除Tregs对乙肝孕妇机体细胞免疫功能的抑制作用,恢复CD4~+T细胞与CD8~+T细胞之间的平衡状态。Ld T治疗可能通过免疫调节在有效阻断母婴垂直传播的同时,还有可能降低重型肝炎发生率,从而降低孕产妇死亡率。     

乙型肝炎孕期抗病毒治疗对母婴结局的影响

乙型肝炎病毒感染的妇女孕期抗病毒治疗不仅在于疾病本身的治疗,还在于阻断宫内垂直传播。临床应重视孕期根据母体病毒载量及肝病的严重程度关注抗病毒时机和药物选择,以获得良好的妊娠结局。     

常规免疫预防阻断乙型肝炎病毒母婴感染的效果

目的 评价免疫预防措施在实际应用中阻断乙型肝炎病毒(hepatitis B virus,HBV)母婴感染的效果,阐明孕妇孕晚期使用乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)能否减少HBV母婴感染.方法 将2002年7月至2004年8月江苏省14个县市的419例乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性孕妇所分娩子女作为研究组,同地区同期的453例 HBsAg-孕妇分娩的子女作为对照组,于2009年10月至2010年3月期间对2组研究对象进行随访,调查母亲孕期HBIG使用情况以及子女出生后HBIG和乙型肝炎疫苗接种情况,检测儿童HBV血清标志物.率的比较采用χ2分析或者Fisher精确概率法,均数的比较采用t检验.结果研究组实际随访298例(71.12%),其中11例(3.69%) HBsAg+;而随访的328例(72.41%)对照组中,HBsAg阳性率为0.00 (χ2=12.32,P<0.01).共11例儿童HBsAg+,其母亲均为HBsAg和HBeAg同时阳性,除1例具体情况不详外,9例儿童在出生时明确没有使用HBIG或延迟接种疫苗,仅1例同时规范使用了HBIG和乙型肝炎疫苗.2组儿童抗-HBs阳性率分别为69.46%和69.21% (χ2=0.01,P=0.95).孕晚期注射HBIG的92例孕妇中,2例(2.17%)儿童HBsAg+;未使用HBIG的197例孕妇中,9例(4.57%)儿童HBsAg+ (χ2=0.98,P=0.51).结论 江苏省常规免疫预防措施在阻断母婴HBV感染方面取得了良好的效果,但对HBV携带孕妇(特别是HBeAg+者)的新生儿仍需强调及时注射HBIG.孕妇孕晚期使用HBIG不能减少母婴HBV感染.

Abstract：

Objective To assess the protective effect of vaccination in routine application on hepatitis B virus (HBV) exposed infants and to clarify whether hepatitis B immunoglobulin (HBIG) administration of pregnant women may reduce the risk of maternal-fetal transmission of HBV. Methods Serum samples of 6398 pregnant women at gestation of 15-20 weeks from 6 urban and 8 rural areas across Jiangsu province were previously tested for serologic markers of HBV by ELISA from July 2002 to August 2004. In this study, infants born to 419 HBV carrier mothers were taken as the study group, while infants born to 453 non-carrier mothers were taken as the control group by stratified random sampling. They were followed-up and screened for HBV markers during October 2009 to March 2010. Information including HBIG administration during pregnancy, HBV vaccination and HBIG administration of the infants were collected. χ2 test or Fisher′s exact method were used to compare the rates and the comparison of the means was by t test. Results The follow-up rates of the study group and control group were 71.12% (298/419) and 72.41% (328/453), respectively. Of the 298 infants born to HBV carrier mothers, 11 (3.7%) were positive for HBsAg, while none of the 328 infants born to non-carrier mothers was HBsAg positive (χ2=12.32, P<0.01). All of the 11 children were born to mothers with both HBsAg and HBeAg positive, and nine of the 11 children were not injected HBIG or not immunized with hepatitis B vaccine within 24 hours after birth, with only one received regular vaccination and detailed information was unknown in one case. The positive rates of anti-HBs in the study group and the control group were 69.46% and 69.21% respectively (χ2=0.01, P=0.95). HBsAg positive rate of the children born to pregnant women treated with HBIG during late pregnancy (n=92) was 2.17% (n=2), whereas that in the children born to women not treated with HBIG (n=197) was 4.57% (χ2=0.98, P=0.51). Conclusions The protective effect of immunoprophylaxis in routine application against perinatal HBV infection in Jiangsu province is good. Efforts are required to emphasize the importance of HBIG administration in infants born to HBV carrier mothers, especially in HBeAg positive mothers within 24 hours after delivery. Treatment of HBsAg positive pregnant women with HBIG in third trimester would not decrease the risk of maternal-fetal transmission of HBV.     

曲贝替定应用于复发性卵巢癌治疗进展

曲贝替定（Yondelis R ,Trabectedin）是一种新的非铂类抗肿瘤药物,有独特的抗肿瘤机制,不良反应主要为可逆性肝脏损害。 Trabectedin的心脏毒性低,可以和蒽环类抗肿瘤药物联合应用,目前已应用于复发性卵巢癌的治疗。临床可选用的治疗方案有单药3周方案、单药周疗和联合蒽环类药物方案,其中联合方案疗效最好。Trabectedin对铂类敏感的复发性卵巢癌有较好的疗效,特别是对无铂间隔期（treatment-free interval,TFI）为6~12个月的复发性卵巢癌疗效显著,但对铂类耐药及难治性卵巢癌的疗效不明显。应用Trabectedin可延长TFI,为以后再次进行铂类药物治疗创造条件。     

孕妇HBsAg阳性对新生儿初次免疫后三年内乙肝表面抗体稳定性的影响

目的 探讨孕妇HBsAg阳性对其新生儿出生后3年内乙肝表面抗体(HBsAb)稳定性的影响,观察定期检查和及时加强/重复免疫对维持儿童乙肝疫苗免疫效果的作用.方法 对20例HBsAg阴性孕妇及24例HBsAg阳性孕妇分娩的新生儿初次全程乙型肝炎基因疫苗免疫效果进行3年的随访,对儿童中有HBsAb滴度下降至低于保护性滴度或转阴者(即不稳定者)及时复种,比较两组儿童HBsAh不稳定者所占比例,比较初次免疫后1个月及3岁时HBsAb的阳性率.结果 孕妇HBsAg阴性及孕妇HBsAg阳性两组儿童HBsAb不稳定者所占比例分别为[20.0%(4/20)和79.2%(19/24,),P<0.05];两组HBsAb阳性率在7月龄时分别为100.0%(20/20)和62.5%(15/24)(P<0.05),3岁时分别为85.0%(17/20)、91.7%(22/24)(P>0.05).结论 孕妇HBsAg阳性将降低其新生儿初次全程免疫后3年内HBsAb稳定性,通过每间隔半年至一年的定期检查和及时加强/重复免疫可维持乙肝疫苗免疫效果.     

妊娠合并肝癌2例报告

<正>1病例简介病例1,患者,女,29岁,G_2P_0,因"停经37周,胎动频繁半天"于2010年2月1日入院。2000年发现HBsAg(+)、HBeAg(+)、HbcAb(+),肝功能反复异常,考虑乙型肝炎活动,于当地医院住院治疗。2007年5月肝脏超声发现肝硬化,肝脏右叶占位4.5cm×3.2cm×2.7cm,查甲胎蛋白(AFP)1210ng/ml,伴有肝功能异常,HBV DNA 2.1×10~5copies/ml。     

恩替卡韦治疗肝硬化96例的临床观察

目的：观察恩替卡韦治疗乙肝后肝硬化失代偿期的近期疗效。方法：将96例乙肝后肝硬化失代偿期患者在患者知情同意基础上随机分成对照组48例,治疗组48例。对照组给予综合治疗,治疗组在综合治疗的基础上给予恩替卡韦0．5mg／d口服,疗程6个月,观察治疗前后患者临床症状、肝功能、凝血功能、乙肝病毒标志物。结果：治疗组在死亡率、HBV—DNA阴转率方面与对照组比较差异有统计学意义,治疗组治疗前后肝功能比较差异有显著性（P〈0.05）。结论：恩替卡韦可改善肝硬化失代偿期患者的肝功能,阻止病情发展,提高生存质量,延长患者生存期。     

替勃龙临床应用研究进展

替勃龙是一种组织选择性雌激素活性调节剂,本身激素活性很弱,主要依赖于组织局部酶的活性和组织的特异性代谢机制,在不同组织发挥不同的效应.现主要应用于围绝经期缓解血管舒缩症状,改善绝经后泌尿生殖道萎缩症状,预防骨质丢失,降低骨折的发生率,提高性功能,稳定情绪.其可能改善围绝经期功能性消化不良患者的胆囊动力以及治疗绝经后加重...     

阿帕替尼治疗耐铂型卵巢癌短期疗效与安全性观察

目的:探讨阿帕替尼治疗耐铂型卵巢癌的短期疗效与安全性。方法:收集2015年7月2019年1月在郑州大学第一附属医院治疗的耐铂型卵巢癌患者,根据治疗方案分为2组:单纯化疗组(吉西他滨+奥沙利铂)和阿帕替尼联合化疗组(阿帕替尼+吉西他滨+奥沙利铂)。评价2组患者的客观缓解率(ORR)和疾病控制率(DCR),并比较2组的不良反应发生率。结果:阿帕替尼联合化疗组的ORR(52.4%vs.24.0%)及DCR(61.9%vs.32.0%)均优于单纯化疗组,且治疗后CA125水平明显低于单纯化疗组,差异均有统计学意义(P<0.05)。阿帕替尼联合化疗组的高血压、手足皮肤反应发生率较单纯化疗组高(P<0.05),所有不良反应对症支持治疗后均可缓解。结论:阿帕替尼联合化疗治疗耐铂型卵巢癌安全有效。     

Determinants of hepatitis B vaccine uptake among pregnant Chinese women in Hong Kong

Objective

To determine the prevalence of a history of hepatitis B vaccination among pregnant Chinese women in Hong Kong, and to identify factors associated with vaccine uptake at their own expense.

Methods

A prospective, cross-sectional survey was conducted in a university obstetric unit in Hong Kong. Pregnant Chinese women who attended the prenatal clinic were invited to complete a self-administered questionnaire, which requested details of their history of hepatitis B vaccination and sociodemographic characteristics.

Results

The prevalence of hepatitis B vaccine uptake was 33%. The following factors were associated with higher hepatitis B vaccine uptake: employment as a healthcare worker; a higher education level; higher monthly family income; routine medical checkups; and premarital checkups.

Conclusion

The findings suggest that the public has insufficient awareness of hepatitis B infection in the community and that providing better information and education to the general public is necessary.     

Seroprevalence of hepatitis B surface antigen among pregnant women in Jiangsu, China, 17 years after introduction of hepatitis B vaccine

Objective

To estimate the prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in Jiangsu Province, eastern China, 17 years after vaccination against hepatitis B virus (HBV) was introduced.

Methods

From August 2002 to July 2004, serum samples from 6398 women between 15 and 20 weeks of pregnancy and from 6 urban and 8 rural areas across Jiangsu Province were tested for markers of HBV. The results were then compared with the rates before 1980.

Results

The overall rates of 6.71% for HBsAg and 36.84% for anti-HBs were significantly lower and higher, respectively, than the prevaccination rates. The rate for HBsAg was lower in urban areas than in rural areas (5.75% vs 7.14%, P = 0.04). Although the rate used to be much higher in the northern part of Jiangsu Province, which is less prosperous than the southern part, the rates are now similar in both parts (6.60% vs 6.97%).

Conclusion

These findings demonstrate a drop in the prevalence of HBsAg among pregnant women in Jiangsu Province since the introduction of vaccination programs in 1980, and indicate that HBV infection can also be controlled in less prosperous areas.     

乙型肝炎表面抗原与乙型肝炎e抗原阴性孕妇乙型肝炎病毒宫内感染的研究

目的 探讨应用套式PCR方法检测乙型肝炎表面抗原(HBsAg)及乙型肝炎e抗原(HBeAg)阴性孕妇乙型肝炎病毒(HBV)宫内感染的状况。方法 选择HBsAg与HBeAg阴性,其他HBV血清标志物阳性孕妇及其新生儿24例作为病例组,同期HBV血清标志物全部阴性孕妇及其新生儿16例作为对照组。采用套式PCR方法检测两组孕妇及其新生儿的血清及外周血单个核细胞(PBMC)中HBV-DNA。结果(1)病例组24例孕妇中,血清HBV-DNA阳性8例,阳性率为33％;PBMC中HBV-DNA阳性10例,阳性率为42％r。其中血清与PBMC均阳性3例,总阳性率为63％r(15／24)。(2)病例组24个新生儿中,血清HBV-DNA阳性3例,阳性率为13％,PBMC中HBV-DNA阳性6例,阳性率为25％。其中血清与PBMC均阳性1例,宫内感染率为33％(8／24)。(3)病例组24例孕妇中,血清阴性而PBMC阳性共7例,其新生儿4例发生宫内感染,感染率为4／7。(4)对照组16例孕妇及其新生儿血清及PBMC中HBV-DNA全部阴性。结论 HBsAg及HBeAg阴性孕妇也可发生HBV宫内感染,采用灵敏度高的套式PCR方法检测孕妇及其新生儿血清及PBMC中HBV-DNA,对诊断HBV宫内感染具有重要临床意义。     

Prevalence and risk factors for hepatitis C virus (HCV) infection among pregnant Brazilian women

Objectives: To determine the prevalence and the risk factors associated with HCV infection among women at childbirth, and to assess potential for infectivity of anti-HCV-positive women. Methods: A total of 6995 women were interviewed and screened for HCV antibodies. Association and logistic regression analyses were conducted. Results: The anti-HCV prevalence was 1.5% by EIA-3 and 0.8% by RIBA-3; HCV-RNA (RT-PCR) was detected in 74% of the RIBA-positive samples. Blood transfusion, race (blacks), alcohol abuse, a history of STD and anti-HBc positivity were independent risk factors for HCV positivity. Except for parenteral exposure, independent predictors of anti-HCV were a history of STD, anti-HBc positivity, a sex partner with multiple sex partners and a sex partner with a history of hepatitis. Conclusions: The prevalence of anti-HCV is higher in pregnant women than in blood donors. Sexual exposure may facilitate the spread of HCV and there is a high potential for mother-to-infant transmission.     

孕妇产前进行免疫阻断与新生儿乙型肝炎基因疫苗免疫效果关系的研究

目的探讨采用乙型肝炎免疫球蛋白(HBIG)阻断孕妇乙型肝炎病毒(HBV)感染对新生儿乙型肝炎(简称乙肝)基因疫苗免疫效果的影响。方法对55例HBV标志物阳性孕妇于产前28周、32周和36周分别给予HBIG 200IU免疫阻断作为阻断组；31例HBV标志物阳性孕妇未给予HBIG免疫阻断作为未阻断组；同期选择HBV标志物阴性孕妇42例作为对照组。对三组新生儿分别给予乙肝基因疫苗的免疫接种，并分别于1个月、2个月、7个月和12个月龄采集外周血检测HBV标志物及丙氨酸转氨酶(ALT)。结果阻断组、未阻断组和对照组新生儿免疫保护率分别为87.3%(48/55)、77.4%(24/31)和97.6%(41/42)；未阻断组与对照组间比较具有统计学意义(P<0.01)；对“大三阳”孕妇的阻断效果最好，新生儿抗HBs阳转率从33.3%上升到71.4%。结论对HBV感染孕妇采用HBIG免疫阻断，可以降低宫内感染及母婴传播的发生率；分娩时孕妇HBV感染状态对新生儿抗HBs阳转率可能产生一定程度的影响。