聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效的影响因素研究

目的 分析聚乙二醇干扰素联合利巴韦林（pegylated interferon plus ribavirin,pegIFN-α/RVB）治疗慢性丙型肝炎（chronic hepatitis C,CHC）疗效的影响因素,以便辅助判断治疗效果及合理变换治疗方案。方法 收集来自江苏省句容市人民医院CHC临床治疗患者的基线资料,采用单因素及多因素Logistic回归进行分析。结果 本研究纳入371例CHC患者,总持续性病毒学应答（sustained virological response,SVR）率为64.7%。多因素Logistic回归分析结果显示,基线病毒载量HCV RNA高（OR=0.95,95%CI:0.91~0.99,P=0.012）、甲胎蛋白（alpha fetoprotein,AFP）水平异常（OR=0.87,95%CI:0.78~0.97,P=0.014）及空腹血糖（blood glucose,GLU）水平异常（OR=0.86,95%CI:0.78~0.95,P=0.004）者更不易获得SVR。结论 pegIFN-α/RVB治疗CHC患者的SVR率较高,基线病毒载量、AFP及GLU均是影响持续病毒学应答的危险因素。     

直接抗病毒药物清除HCV后肝细胞肝癌发生风险因素的调查研究

目的　通过前瞻性队列研究,探索慢性丙型肝炎（chronic hepatitis C, CHC）患者接受直接抗病毒药物（direct-acting antiviral agents, DAAs）治疗获得持续病毒学应答（sustained virologic response, SVR）后肝细胞肝癌（hepatocellular carcinoma, HCC）发生的高危因素,为HCC的精准诊疗提供依据。方法　以2015年10月起来我中心就诊的、符合抗病毒治疗指征的CHC患者为研究对象,采用全口服DAAs治疗12～24周,以获得SVR（定义为停药12周后HCV RNA低于最低检测下限）为进入队列的起始时间,之后每12周进行1次随访,通过腹部彩超及AFP对HCC进行监测,终点为明确HCC诊断（增强核磁共振或肝活检）。采用COX比例风险模型分析HCC相关高危因素。结果　最终纳入506例患者,46.2%（234例）为男性,平均年龄（49.1±11.8）岁、身体质量指数（23.7±3.3）kg/m2、HCV RNA定量为（6.1±1.2）log10 IU/ml,肝硬化患者占16.2%（82例）,基因1b型占73.3%（371例）,中位随访时间36.6个月,HCC的累积1、2、3年新发率分别为1.2%、 3.5%、5.9%。COX比例风险模型分析提示合并糖尿病、年龄≥55岁、血小板低于正常值下限以及合并肝硬化（LSM＞17.5 kPa）为HCC新发的高危因素。结论　DAAs治疗不能完全避免HCC的发生,获得SVR后仍须对具有高危因素的个体进行严密的HCC监测。     

2型糖尿病合并不同基因型丙型肝炎抗病毒疗效的影响

本研究旨在比较2型糖尿病合并不同基因型丙型肝炎(HCV)患者聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗效果。入组17例基因1b型HCV,其中合并2型糖尿病者7例;基因2a型HCV 38例,其中合并2型糖尿病者14例,分别给予聚乙二醇干扰素α-2a(180μg/周)联合利巴韦林(1 000mg/d)抗病毒治疗,基因1b型HCV感染者疗程48周,基因2a型HCV感染者疗程24周,并分别在治疗第4、12、24、48周进行随访观察,比较不同基因型HCV感染者中合并与未合并2型糖尿病感染者的持久病毒学应答(SVR)率。结果显示,基因1b型的HCV感染者中合并2型糖尿病者SVR率为57.14%,未合并2型糖尿病者SVR率为90.00%;基因2a型的HCV感染者中合并2型糖尿病者(14例)及未合并2型糖尿病者(24例)均获得SVR。2型糖尿病合并基因2a型HCV感染者的SVR无明显影响,但基因1b型HCV感染者的SVR明显降低(P<0.05)。HCV基因型是合并2型糖尿病HCV感染者聚乙二醇干扰素和利巴韦林抗病毒治疗疗效的关键影响因素。     

格卡瑞韦/哌仑他韦治疗HCV/HIV合并感染患者的临床研究

目的 分析格卡瑞韦/哌仑他韦治疗丙型肝炎病毒(HCV)/人类免疫缺陷病毒(HIV)合并感染患者的临床效果和安全性, 以期为临床治疗提供科学依据。 方法 选择2021年1月—2022年1月凉山州布拖县某医院收治的89例HCV/HIV合并感染无肝硬化的初治患者, 均予以8周的格卡瑞韦/哌仑他韦治疗, 随访12周。观察并记录治疗结束时的病毒学应答率、治疗结束12周后的持续病毒性应答率(SVR12)及不良反应发生情况。 结果 89例HCV/HIV合并感染无肝硬化的初治患者多为中青年已婚男性(79例, 88.8%), HIV感染主要经性接触传播(62例, 69.7%) 和静脉注射毒品传播(27例, 30.3%)。HCV基因型最常见的是基因1b型(33例, 37.1%) 和基因3b型(25例, 28.1%)。全部患者均顺利完成8周治疗, 且治疗结束时HCV RNA载量均低于检测值下限(＜25 IU/mL)。其中, 8例患者未能完成随访, 余81例(100%)患者均获得持续病毒学应答。患者观察期间均未出现严重不良反应, 但有11例患者发生轻度不良反应。 结论 格卡瑞韦/哌仑他韦8周方案治疗基因1、3、6型HCV/HIV合并感染无肝硬化的初治患者SVR12达100%, 且安全性和耐受性均较好, 可以作为此类患者临床治疗的优先选择。     

Telaprevir与聚乙二醇IFN联合或不联合利巴韦林治疗慢性HCV感染

聚乙二醇IFN／利巴韦林联合治疗48周是Ⅰ型HCV慢性感染的标准疗法,其持续病毒学应答率（SVR）为40％～50％。Telaprevir是一种新型的HCV丝氨酸蛋白酶抑制剂,对HCV感染治疗有一定的价值。为此,法国巴黎大学的Hezode等进行了相关的研究,他们将334例初治的Ⅰ型HCV慢性感染者随机分成4组,     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎的疗效分析

丙型肝炎是由HCV引起的一种主要经血液传播的慢性进展性肝病.HCV感染发病隐匿,缺乏典型的症状和体征,且感染后60％-80％的患者可慢性化,其中约20％的患者在感染20-30年可进展为肝硬化甚至肝细胞癌,目前,聚乙二醇IFN(PegIFNa-2a)联合利巴韦林(RBV)仍是亚太地区HCV感染的标准治疗方案[1].而抗病毒治疗应答受多种因素影响,本文重点研究了PegIFNα-2a联合RBV治疗慢性丙型肝炎(CHC)患者临床与生化和心理指标等相关因素,旨在探讨持续病毒学应答率(SVR)的预后因素,为临床治疗决策提供指.     

可溶性白细胞介素-2受体测定在预测干扰素治疗后复发中的意义

目前在慢性丙型肝炎(CHC)的干扰素治疗中何时应该终止用药,还没有一个可靠的指标。尽管治疗期间GPT降为正常,血清HCV RNA转阴,甚至肝组织中HCVRNA也转阴,但在停用干扰素后CHC仍有可能复发,因为在这些患者中有残存的HCV,机体的免疫应答持续存在。作者检测作为T细胞活化指标的可溶性白细胞介素     

慢性丙型肝炎直接抗病毒药物临床试验的有效性和安全性研究 ——美国FDA和欧洲EMA指南解读

丙型肝炎病毒（hepatitis C virus，HCV）感染是一个重要的全球健康问题，起病隐匿，慢性化程度高，是导致肝硬化和肝癌的最主要病因。直接抗病毒药物（direct acting antiviral agents, DAAs）较聚乙二醇干扰素α（pegylated interferon, peg IFN）联合利巴韦林（ribavirin, RBV）治疗方案可获得更高的持续病毒学应答（sustained virological response, SVR）率，并可缩短治疗时间，前景良好。DAAs 新药开发将成为未来抗HCV治疗研究的趋势。2009年，欧洲药物管理局（European Medicines Agency，EMA）颁布的《慢性丙型肝炎直接抗病毒药物治疗的临床评价指南》和2013年10月美国食品药品监督管理局（Food and Drug Administration，FDA）新发布的《抗丙型肝炎病毒的直接抗病毒药物临床药物研究指南》为DAAs临床试验的有效性和安全性研究提供了指导性建议，如人群纳入、研究方案、研究设计、研究终点、药物安全性等，另外还对肝功能失代偿者、肝移植患者、人免疫缺陷病毒（HIV）/HCV共同感染者等特殊人群的药物研究提出了特别要求，这些内容有助于指导DAAs临床试验设计     

胰岛素抵抗不能影响社区HIV／HCV感染者的持续病毒学应答

为评价胰岛素抵抗对持续病毒学应答的影响,从接受聚乙二醇干扰素和利巴韦林联合治疗的HIV/HCV合并感染者中选择155名研究对象进行多中心队列研究,主要的结果变量是持续病毒学应答.研究结果显示:55名患者获得持续病毒学应答,其中42名胰岛素抵抗指数小于4的患者获得持续病毒学应答,13名HOMA >4的患者获得持续病毒学应答,但无统计学差异(P=0.27).对基因1型和4型感染者分析结果显示:HOMA <4和>4的患者的持续病毒学应答无统计学差异(P=0.8).多变量分析结果显示:基因3型、基线HCV病毒载量和基线LDL胆固醇水平能够影响HIV/HCV合并感染者的持续病毒学应答,而胰岛素抵抗对持续病毒学应答无影响.     

替比夫定和拉米夫定治疗乙肝肝硬化失代偿期患者疗效观察及护理体会

目的：观察替比夫定与拉米夫定治疗乙肝肝硬化失代偿期患者的疗效、安全性及耐药发生率,从而得到有效的护理。方法：94例肝硬化失代偿期并乙肝病毒复制的患者,随机分为替比夫定组42例和拉米夫定组52例,分别给予替比夫定与拉米夫定抗病毒治疗,在治疗12周、24周、48周观察病毒学、生化指标、Child-Pugh积分和病毒突破率等变化情况。结果：替比夫定组和拉米夫定组患者血清HBV-DNA阴转率、HBeAg/抗-HBe转换率在12周、24周和48周无显著性差异,在12周时替比夫定组有95%（40/42）的患者HBV-DNA阴转,拉米夫定组有92%（48/52）的患者HBV-DNA阴转,在24周时2组患者的HBV-DNA阴转率均达到100%,2组患者生化及Child-Pugh积分等指标均较治疗前明显改善（P〈0.05）,但2组之间差异未见统计学意义,治疗48周时替比夫定组病毒突破率为0%,拉米夫定组有8例（15%）发生病毒学突破。结论：对于乙肝肝硬化失代偿期患者在有效抑制病毒复制及改善肝脏储备功能方面,替比夫定组与拉米夫定组比较差异未见统计学意义。在治疗期间,病毒学突破拉米夫定组发生率高。     

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.     

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.     

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。     

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.     

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.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.