补肾清解方联合聚乙二醇干扰素α-2b治疗低HBe Ag载量慢性乙型肝炎患者的临床研究

目的:观察补肾清解方联合聚乙二醇干扰素α-2b治疗恩替卡韦(ETV)在治低HBe Ag载量慢性乙型肝炎的临床疗效及安全性评价。方法:将46例ETV在治(治疗时间> 2年)且HBe Ag <200 IU/ml的慢性乙型肝炎患者随机分为治疗组和对照组。治疗组患者给予聚乙二醇干扰素α-2b联合补肾清解方,对照组患者单用聚乙二醇干扰素α-2b,疗程均为6个月。观察两组患者治疗前后肝功能、HBV DNA变化、HBe Ag阴转率、HBs Ag水平、中医证候评分及综合疗效,观察两组患者不良反应发生率和治疗第96 w时HBe Ag和HBs Ag水平。结果:治疗6个月后,治疗组与对照组相比,患者肝功能(ALT、AST及γ-GT)、HBV DNA情况无明显变化,HBe Ag阴转率高于对照组,差异有统计学意义(P <0.05);治疗组HBs Ag血清转换率较对照组高,差异无统计学意义(P>0.05);治疗组的中医证候评分低于对照组,中医证候改善和评分均较对照组多;不良反应发生率方面,治疗组在白细胞减少的发生率方面较对照组降低(P <0.05)。两组患者96周随访时的HBe Ag...     

恩替卡韦联合胸腺肽α1治疗HBeAg阳性慢性乙型肝炎的临床疗效

目的观察恩替卡韦联合胸腺肽α1治疗HBe Ag阳性慢性乙型肝炎的临床疗效。方法将120例HBe Ag阳性慢性乙型肝炎患者随机分为两组,对照组60例予以口服恩替卡韦48 w,治疗组给予恩替卡韦联合胸腺肽α1治疗48 w。观察两组患者治疗后的肝功能变化、HBe Ag阴转率、HBe Ag血清转换率及HBV DNA阴转率。结果两组患者治疗后,治疗组症状改善、肝功能指标改善、HBe Ag阴转率、HBe Ag血清转换率及HBV DNA阴转率下降幅度均明显优于对照组(P0.05)。结论恩替卡韦联合胸腺肽α1治疗HBe Ag阳性慢性乙型肝炎能显著促进肝功能恢复,持续抑制病毒复制,疗效优于单用恩替卡韦。     

非酒精性脂肪性肝病对慢性乙型肝炎肝纤维化及α-干扰素抗病毒疗效的影响

目的探讨非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)对慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化及α-干扰素抗病毒疗效的影响。方法回顾性分析2011年1月-2013年12月湖北医药学院附属人民医院经α-干扰素抗病毒治疗的85例CHB初治患者的临床资料,其中53例为单纯CHB,32例经B超诊断为CHB合并NAFLD。所有患者均采用干扰素α1b抗HBV治疗,比较两组在第12、24、48周时ALT复常率、HBV DNA阴转率、HBe Ag阴转率及血清转换率。结果单纯CHB组年龄、体质量指数(BMI)、腰围、血脂(TC、TG)、空腹血糖(FBG)、尿酸(UA)及肝纤指标(HA、LN、PcⅢ)均明显低于CHB合并NAFLD组(P0.05),而高密度脂蛋白(HDL)高于CHB合并NAFLD组(P0.05)。治疗第48周时,单纯CHB组ALT复常率和HBV DNA阴转率分别为60.4%和66.0%,明显高于CHB合并NAFLD组的37.5%和40.6%,差异有统计学意义(P0.05)。两组在第12、24周的ALT复常率、HBV DNA阴转率及第12、24、48周时HBe Ag阴转率和HBe Ag转换率差异均无统计学意义(P0.05)。结论 NAFLD对CHB肝纤维化及α-干扰素抗病毒疗效具有一定的影响。     

自体细胞因子诱导的杀伤细胞治疗慢性乙型肝炎患者的临床观察

目的观察自体细胞因子诱导的杀伤细胞(CIK)治疗慢性乙型肝炎(CHB)患者的疗效及安全性,探索CHB治疗的新策略。方法收集2009年12月1日至2012年12月1日南京军区福州总医院收治的84例CHB患者,称为CIK治疗组,采集其外周血单个核细胞,在体外经干扰素γ、白细胞介素2、抗CD3单克隆抗体等细胞因子诱导成CIK,分次自体回输,观察治疗前及治疗后12、24、48周患者肝功能、HBV血清标志物变化及HBV DNA水平;50例接受恩替卡韦(ETV)治疗的患者作为对照组,称为ETV治疗组。将两组HBe Ag阳性和HBe Ag阴性患者分组进行比较分析,同时对不良反应和肾功能进行评估。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果随着观察时间延长,CIK治疗组无论是HBe Ag阳性患者还是HBe Ag阴性患者,其ALT水平均降低,其中HBe Ag阳性患者治疗12、24周时与ETV治疗组相比,两组差异均具有统计学意义(t值分别为5.03、4.72,P值均0.01);CIK治疗组在不同时间点的HBe Ag阴转率和血清转换率均高于ETV治疗组,其中治疗24周和48周时两组间的HBe Ag阴转率差异均有统计学意义(χ2值分别为6.85、4.83,P值均0.05)。无论是HBe Ag阳性还是HBe Ag阴性,在治疗12、24、48周后,CIK治疗组的HBV DNA阴转率均低于ETV组,尤其两组HBe Ag阳性患者的HBV DNA阴转率差异均有统计学意义(χ2值分别为45.62、26.89、12.54,P值均0.01),但随着观察时间延长,CIK治疗组HBV DNA阴转率逐渐升高。结论 CIK治疗CHB后在48周随访观察期内是安全有效的。虽然与ETV治疗相比,HBV DNA下降水平较低,但治疗后随着观察时间的延长,HBe Ag阴转率和血清转换率明显高于ETV治疗组,提示CIK治疗后可能存在持久的免疫应答效应。     

胸腺肽α_1联合恩替卡韦对慢性乙型肝炎患者肝功能及血清HBeAg转阴率的影响

目的探究胸腺肽α1联合恩替卡韦对慢性乙型肝炎(CHB)患者肝功能及血清乙型肝炎e抗原(HBe Ag)转阴率的影响。方法 CHB患者118例随机分组,各59例。对照组予以恩替卡韦治疗,观察组在对照组基础上予以胸腺肽α1治疗。对比治疗前后两组谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)变化,治疗后两组血清HBe Ag转阴率、HBe Ag/乙型肝炎e抗体(HBe Ab)转换率及HBV DNA转阴率。结果治疗后观察组AST、ALT、TBIL水平均低于对照组(P0.05);血清HBe Ag转阴率、HBe Ag/HBe Ab转换率高于对照组(P0.05)。结论胸腺肽α1联合恩替卡韦治疗CHB患者,可明显改善患者肝功能,提高血清HBe Ag转阴率及HBe Ag/HBe Ab转换率,安全性高。     

恩替卡韦联合百令胶囊治疗对干扰素α-2b无应答的HBeAg阳性的慢性乙型肝炎患者疗效研究

目的探讨恩替卡韦(ETV)联合百令胶囊治疗对干扰素α-2b无应答的HBeAg阳性慢性乙型肝炎(CHB)患者的临床疗效及安全性。方法 76例对干扰素α-2b治疗无应答的HBeAg阳性CHB患者被分为对照组37例和观察组39例,给予对照组贯ETV治疗,观察组接受恩替卡韦和百令胶囊治疗,观察2年。采用荧光定量PCR法检测血清HBV DNA载量,采用化学发光微粒子免疫测定法定量检测血清HBsAg和HBeAg水平,采用ELISA法检测血清TGF-βl、CPK、MDA、SOD和GSH。结果在治疗2年时,两组血清HBV DNA载量无显著差异(P0.05),观察组血清HBsAg和HBeAg水平显著低于对照组;观察组ALT、AST、CPK和MDA水平显著低于对照组,而血清SOD和GSH水平显著高于对照组(P0.05)。结论在应用ETV抗病毒的同时加用百令胶囊治疗对干扰素α-2b无应答的HBeAg阳性CHB患者可提高疗效。     

替诺福韦与恩替卡韦对高病毒载量HBeAg阳性慢性乙型肝炎患者的疗效比较

目的观察高病毒载量HBe Ag阳性慢性乙型肝炎(CHB)患者应用替诺福韦(TDF)和恩替卡韦(ETV)治疗48周的临床疗效和安全性。方法选取该院收治的高病毒载量HBe Ag阳性慢性乙型肝炎(CHB)患者80例,随机分成两组,每组40例。TDF组应用TDF,300 mg顿服,1次/d;ETV组应用ETV 0.5 mg顿服,1次/d。观察治疗4、12、24、48周时HBV-DNA转阴率、HBe Ag转阴率、ALT水平等。结果 TDF组治疗4、12、24和48周时HBV-DNA转阴率分别是62.5%、77.5%、95.0%、100%,ETV组分别是25.0%、55.0%、72.5%、95.0%,两组差异有统计学意义(P0.05)。两组治疗4、12周时HBe Ag转阴率差异无统计学意义(P0.05)。TDF组治疗24、48周时HBe Ag转阴率(65.0%、77.5%)高于ETV组(37.5%、50.0%),P0.05。两组在ALT复常率差异无统计学意义(P0.05)。结论 TDF治疗高病毒载量HBe Ag阳性CHB疗效较ETV好,值得临床推广应用。     

聚乙二醇干扰素α-2a联合阿德福韦治疗HBeAg阳性慢性乙型肝炎疗效系统评价

目的探讨聚乙二醇干扰素α-2a(Peg-IFNα-2a)联合阿德福韦(ADV)治疗HBe Ag阳性慢性乙型肝炎(CHB)患者的临床疗效。方法通过检索2004年1月~2014年1月期间Pubmed、万方数据库(CECDB)、中文科技期刊数据库(VIP)、中国学术期刊全文数据库(CNKI)等有关Peg-IFNα-2a联合阿德福韦治疗HBe Ag的CHB患者的随机对照试验(RCT),对纳入文献的质量进行严格评价和资料提取,应用Stata/SE version 12.0软件对纳入研究进行系统评价。结果最终纳入7篇RCT,共529例患者,其中实验组261例(接受Peg-IFNα-2a联合ADV治疗),对照组268例(接受Peg-IFNα-2a治疗)。系统评价结果显示,相比单药治疗,经联合治疗48 w时CHB患者HBV DNA阴转率显著提高[OR=1.20,95%CI=(1.01,1.43)];48 w时CHB患者HBe Ag血清转换率显著提高[OR=1.24,95%CI=(1.02,1.52)],但联合治疗对ALT复常率的影响,系统评价显示结果存在显著偏倚[bias_P=0.012、bias_95CI=(1.442998,6.467852)],不具有推广性。结论 Peg-IFNα-2a联合ADV治疗HBe Ag阳性CHB患者能显著提高患者HBV DNA阴转率及HBe Ag血清转换率。     

国产聚乙二醇化干扰素α治疗HBeAg阳性慢性乙型肝炎患者疗效研究

目的观察国产聚乙二醇化干扰素α-2b(peg-IFN-α-2b)治疗血清HBe Ag阳性的慢性乙型肝炎(CHB)患者的效果。方法 2015年1月～2017年12月纳入血清HBe Ag阳性的CHB患者500例,被分为A组150例,给予国产peg-IFN-α-2b治疗,和B组350例,给予peg-IFN-α-2a治疗。两组均治疗24～48 w。在治疗结束后,随访24 w。结果治疗前,A组血清HBV DNA定量为(6.1±0.7) lg cps/ml、谷丙转氨酶(ALT)为(81.1±29.8)u/l、体质指数为(22.1±2.9)、血清HBe Ag定量为(3.1±0.6) lg s/co和HBs A定量为(4.4±0.6) IU/ml,与B组的(6.2±0.67) lg cps/ml、(80.7±27.9) U/L、(21.9±2.9)、(3.1±0.1) lg s/co和(4.4±0.5) IU/ml比,差异均无统计学意义(P0.05);在随访24 w结束时,A组血清ALT复常率为64.0%,血清HBV DNA阴转率为60.0%,与B组的66.9%和62.9%比,差异均无统计学意义(P0.05);两组不良反应发生率也无显著性相差(P0.05)。结论应用国产peg-IFN-α-2b治疗血清HBe Ag阳性的CHB患者能获得与peg-IFN-α-2a治疗相似的疗效,但价格便宜,具有临床应用价值。     

IFN-α 1b治疗核苷（酸）类似物经治未达满意终点的CHB多中心疗效分析

目的评估序贯联合重组人干扰素α1b（IFN-α1b）治疗核苷（酸）类似物（NAs）经治HBe Ag阳性CHB患者48周的疗效与安全性。方法 159例NAs治疗12-36个月HBV DNA检测不到但未发生血清学应答的HBe Ag阳性CHB患者,77例接受序贯联合IFN-α1b治疗48周,82例继续NAs单药治疗48周。基线和治疗期间每12周进行生物化学、病毒学和血清学评估。计量资料采用t检验,计数资料采用χ^2检验。结果治疗48周,试验组HBe Ag低于检测下限和转换率分别为21.74%和20.29%,对照组HBe Ag低于检测下限和转换率分别为5.63%和5.63%,差异有统计学意义（χ^2=7.738、6.709,P〈0.05）。试验组和对照组HBs Ag清除率分别为7.25%和0%,差异有统计学意义（χ^2=5.335,P〈0.05）。试验组和对照组病毒学反弹率分别为0%和4.22%,差异无统计学意义（χ^2=2.979,P〉0.05）。无论是试验组还是对照组,HBs Ag基线水平高的患者（〉2000 IU/ml）的HBe Ag血清学转换率高于基线水平低（≤2000 IU/ml）的患者;差异无统计学意义（χ^2=2.833、0.147,P〉0.05）。HBs Ag下降幅度与HBe Ag下降幅度具有相关性（r=0.606）。NAs基础治疗时间可能对序贯联合干扰素后的HBe Ag低于检测下限和转换有一定影响,但无论基础治疗时间长短,序贯联合干扰素均可增加HBe Ag应答率。结论序贯联合IFN-α1b有助于提高NAs经治未达满意治疗终点的HBe Ag阳性CHB患者的血清学应答率。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。