慢性前列腺炎患者病耻感现状及影响因素分析

<正>慢性前列腺炎(chronic prostatis,CP)是中青年男性的常见病、多发病,躯体表现为骨盆区或会阴部疼痛或不适,极易产生病耻感~([1])。病耻感是指由于患病患者内心产生的一种的耻辱感觉,是一种负性的心理应激反应,感觉被标签化、被疏远、被歧视,这不仅给患者带来精神上的困惑,而且会对疾病的治疗产生负面影响~([2])。本研究通过问卷调查,了解患者病耻感的严重程度及相关影响因素,为治疗CP和减轻患者痛苦提供帮助。     

年轻乳腺癌术后患者病耻感的调查研究

采用一般资料调查表、社会影响量表对符合纳入和排除标准的123例接受乳腺癌手术的年轻患者进行现状调查。社会影响量表总分中社会排斥维度得分最高,经济歧视得分最低。提示年轻乳腺癌术后患者存在一定程度的病耻感,家庭和朋友应给予患者更多的关心和帮助;护理人员应该进行有效心理辅导,以减轻患者的病耻感。     

患者病耻感的干预研究进展

病耻感是一个涉及医学、社会学、心理学等众多学科的复杂问题。通过阐述病耻感的概念及其公众病耻感和自我病耻感两个层面之间的关系,并归纳总结国内外应对病耻感的干预方法,旨在为护理专业人员应对患者病耻感提供参考。     

女性不孕症患者病耻感及不孕相关压力评分影响因素的调查研究

目的以问卷形式调查女性不孕症患者的病耻感及不孕相关压力现状,并分析其相关影响因素。方法采用便利抽样法,选取2019年5月至2019年7月期间,于武汉大学人民医院生殖医学中心门诊就诊的233位不孕女性作为研究对象。通过一般资料调查表、女性不孕症患者羞辱感量表、生育问题调查问卷等方式对研究对象展开问卷调查。结果不孕症女性的病耻感得分为(51.95±16.54),条目得分为(1.92±0.61)分;不孕相关压力得分为(137.69±29.42)分,条目得分为(2.99±0.64)分。不孕症女性的文化程度、家庭收入、女方是否为独生子女、女方对生育问题的重视程度、家中是否已有子女以及自身压力评估均是其病耻感和不孕相关压力的影响因素(P<0.05)。结论不孕症女性患者的病耻感与不孕相关压力均表现为中等水平,其影响因素包括文化程度、家庭收入、女方是否为独生子女、女方对生育问题的重视程度、家中是否已有子女以及自身压力等。     

农村精神分裂症患者精神卫生知晓率与病耻感相关分析

目的：了解重性精神疾病管理治疗项目救助的农村精神分裂症患者精神卫生知晓率与病耻感相关因素,为社区综合干预提供基础资料。方法随机抽取新乡县2011年重性精神疾病管理治疗项目救助的107例精神分裂症患者为调查对象。测查患者精神卫生知识知晓率、评估获得社会支持及病耻感状况,分析相关因素。结果对精神卫生知识知晓的有47例,占43.9%,与对照组相比较在价值否定和社交退缩方面差异具有显著性（P＜0.01）。结论影响精神分裂症患者病耻感存在多方面因素,应强化社区综合干预,提高精神卫生公众教育与知晓率。     

年轻乳腺癌患者病耻感及影响因素研究

目的了解年轻乳腺癌患者病耻感现状及其影响因素,为制定针对性干预措施提供参考。方法采用Link病耻感系列量表、自尊量表、社会支持评定量表调查304例术后年轻乳腺癌患者。结果患者病耻感量表贬低-歧视感知(3.83±0.31)、误解(2.87±0.39)、保密(2.81±0.43)、退缩(2.71±0.36)、教育(2.93±0.36)、挑战(3.09±0.43)和分离(2.73±0.42)维度得分显著高于量表中点(均P0.05)。年龄大、已婚、受教育程度高、家庭收入高、自尊和社会支持水平高是病耻感的保护性因素,而术后时间长、乳房全切除是病耻感的危险因素(均P0.05)。结论年轻乳腺癌患者存在一定程度的病耻感,年龄、受教育程度、家庭人均月收入及自尊水平越高者、已婚者病耻感越低,而术后时间长及乳房全切除者病耻感越高。     

早泄患者病耻感的影响因素分析及列线图预测模型的构建

目的 了解早泄患者病耻感的影响因素，并构建列线图风险预测模型。方法 采用便利抽样法，选取太原市某三甲医院212例早泄患者进行一般情况问卷、社会影响量表调查，采用SPSS 26.0统计软件对数据进行单因素和多因素Logistic回归分析，并利用R软件构建列线图风险预测模型。结果 早泄患者病耻感发生率为67%,学历、疾病经济负担、合并疾病、疾病了解程度、伴侣性生活满意度、性健康知识状况是早泄患者病耻感的影响因素；列线图预测早泄患者病耻感产生风险的ROC曲线下面积为0.860(95%CI:0.813～0.952),校正曲线一致性及Hosmer-Lemeshow拟合优度(χ²=2.704,P=0.259)良好；决策曲线分析(DCA)显示模型净收益水平较高，具有良好的临床实用价值。结论 早泄患者易产生病耻感且受多种因素的影响，构建的列线图风险预测模型区分度、校准度以及临床实用价值良好，可为临床医护人员评估筛查易出现病耻感的高危患者及采取针对性干预措施提供参考与借鉴。     

良性前列腺增生患者病耻感护理研究进展

良性前列腺增生常发于中老年男性,影响生理健康的同时,也会引发不同程度的病耻感,导致患者治疗依从性和生活质量降低。本文从病耻感的概念发展、良性前列腺增生患者病耻感现状、病耻感来源及影响、病耻感调查工具、干预措施方面进行阐述,以期提高医务人员对病耻感的认识,为采取有效护理干预提供依据。     

肠造口患者病耻感研究现状

肠造口患者的病耻感是指肠造口患者由于其自身身体形态的改变而引起的一种内心被他人歧视、排斥的负性情绪体验,对患者社会功能的恢复以及生活质量均产生了不利的影响,已经成为一个不容忽视的问题,因此笔者通过对国内外关于病耻感的概念、测量工具以及肠造口患者病耻感的相关研究进行综述,为临床工作者开展肠造口患者病耻感的相关研究提供依据.     

无精子症患者病耻感质性研究

<正>无精子症是男性不育的原因之一,据国外文献报道,无精子症约占男性不育症患者的15%～20%[1],其发病率在近几十年来呈现不断上升趋势[2]。男性生育能力涉及男子气概[3],因无精子导致生殖功能缺陷,对于患者而言,无疑在身体和心理上都是一种沉重的打击和痛苦。患者害怕因生殖繁衍功能缺陷而被与正常人区别对待,使患者常常感到自卑,甚至产生羞辱感,临床上将患者这种想象被羞辱,表现为自责和自我贬损,害怕被排斥的心理,称之为病耻感[4],过重的病耻感     

Prevalence of hepatitis B and hepatitis C in haemodialysis patients

The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B exposure and antibodies against the hepatitis C virus (anti-HCV) was assessed in 86 haemodialysis patients at the National Kidney and Transplant Institute (NKTI) using the commercial radioimmunoassay and ortho HCV ELISA assay. Of the 86 patients included in the study, 42 were male with a mean age of 44.9 years and a mean duration of dialysis of 2.4 years. Forty-four were female with a mean age of 48.4 years and a mean duration of dialysis of 2.3 years. Hepatitis B exposure was 57% and 12.8% of haemodialysis patients were positive for HBsAg, whereas 39.8% of patients were positive for anti-HCV. There was a significant correlation ( P =0.00007) between anti-HCV positivity and the length of time on haemodialysis. However, there was no significant correlation found between the number of blood transfusions received and anti-HCV positivity. There was also no significant correlation found between HBsAg and antibodies to hepatitis B core antigen (anti-HBc) positivity and the number of blood transfusions or the length of time on haemodialysis, nor between hepatitis B and C exposure and elevated aminotransferase levels.     

Prevalence of hepatitis B and hepatitis C in haemodialysis patients

SUMMARY: The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B exposure and antibodies against the hepatitis C virus (anti-HCV) was assessed in 86 haemodialysis patients at the National Kidney and Transplant Institute (NKTI) using the commercial radioimmunoassay and ortho HCV ELISA assay. of the 86 patients included in the study, 42 were male with a mean age of 44.9 years and a mean duration of dialysis of 2.4 years. Forty-four were female with a mean age of 48.4 years and a mean duration of dialysis of 2.3 years. Hepatitis B exposure was 57% and 12.8% of haemodialysis patients were positive for HBsAg, whereas 39.8% of patients were positive for anti-HCV. There was a significant correlation ( P = 0.00007) between anti-HCV positivity and the length of time on haemodialysis. However, there was no significant correlation found between the number of blood transfusions received and anti-HCV positivity. There was also no significant correlation found between HBsAg and antibodies to hepatitis B core antigen (anti-HBc) positivity and the number of blood transfusions or the length of time on haemodialysis, nor between hepatitis B and C exposure and elevated aminotransferase levels.     

慢性乙型肝炎肝病患者骨质疏松性椎体压缩骨折的调查研究

目的调查慢性乙型肝炎患者骨质疏松性椎体压缩骨折的发生率,并与正常人群作对比研究。方法随机选取300例慢性乙型肝炎患者为实验组,选取年龄、性别、身高、体重相匹配的100例健康志愿者作为对照组,进行胸腰椎X线片检查诊断脊椎压缩骨折,测定跟骨骨密度,对相关数据进行相应的统计学分析。结果慢乙肝组的跟骨SI与对照组SI比较有显著统计学差异(P0.05)。肝硬化A组、B组、C组患者SI值明显低于对照组SI。肝硬化A组、B组、C组)SI有明显降低趋势。慢性乙型肝炎患者共有30例(10%)发生椎体压缩骨折,正常对照组3例(3%)发生椎体压缩骨折,差异显著有统计学意义(P0.01)。结论慢性乙型肝炎患者组硬度指数较正常对照组明显减低。数据说明慢性乙肝肝硬化的患者更容易出现骨质疏松性椎体压缩骨折,骨质疏松性椎体压缩骨折患病率随着肝硬化的严重程度逐渐升高。     

Efficacy of the accelerated hepatitis B vaccination schedule used in haemodialysis patients post-exposure to virus: a single-centre experience.

BACKGROUND: The hepatitis B (HB) vaccination regime currently recommended for use in the UK for both preventative and post-exposure purposes is the accelerated regime, although there have been no recent reports of its efficacy. This observational study reports on the response rate achieved and longevity of protection conferred with this regime in a large number of haemodialysis patients following an episode of HB exposure. METHODS: One-hundred and five patients received primary vaccination (vaccine administered at 0, 1 and 2 months). Eighty-six completed the regime, receiving a booster dose at month 12. Measuring antibodies to HB surface antigen (anti-HBS) 6 weeks after receiving the third and fourth doses assessed patients' response. Seventy-seven patients subsequently had anti-HBs measured at month 24. RESULTS: The response rate (anti-HBS >10 mIU/ml) to primary vaccination and the complete regime was 33 and 73%, respectively. Non-European patients responded better to primary vaccination than Europeans (P=0.014). Those receiving steroids responded less well to the complete vaccination regime (P=0.007). Patient's age, sex, renal diagnosis, diabetes mellitus, time on dialysis, dialysis adequacy, erythropoietin dose, hepatitis C or body weight did not affect response rates. By month 24, 24 responders (44%) had lost seroprotection. Antibody levels achieved with vaccination by transient responders was significantly lower than persistent responders. No patients became HB surface antigen positive during the 2-year study. CONCLUSION: Reserving the accelerated vaccination to the post-exposure scenario will expose many more patients to the risk of HB cross-infection than if used prophylactically. Regular monitoring is required if seroprotection is to be maintained.     

Current state of kidney transplantation in patients with HIV,hepatitis C,and hepatitis B infection

Human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common chronic viral infections in the end-stage kidney disease (ESKD) patient population that were once considered relative contraindications to kidney transplantation. In this review, we will summarize the current state of kidney transplantation in patients with HIV, HCV, and HBV, which is rapidly evolving. HIV+ patients enjoy excellent outcomes in the modern transplant era and may have new transplant opportunities with the use of HIV+ donors. Direct-acting antivirals for HCV have substantially changed the landscape of care for patients with HCV infection. HBV+ patients now have excellent patient and allograft survival with HBV therapy. Currently, kidney transplantation is a safe and appropriate treatment for the majority of ESKD patients with HIV, HCV, and HBV.     

Long‐term outcome of patients with lamivudine after early cessation of hepatitis B immunoglobulin for prevention of recurrent hepatitis B following liver transplantation

Yuefeng M, Weili F, Wengxiang T, Ligang X, Guiling L, Hongwei G, Wencai L, Xiaoguang W, Wei M, Zhongyi F. Long‐term outcome of patients with lamivudine after early cessation of hepatitis B immunoglobulin for prevention of recurrent hepatitis B following liver transplantation.
Clin Transplant 2011: 25: 517–522. © 2010 John Wiley & Sons A/S. Abstract: Background: The aim of this study is to examine the efficacy of long‐term prophylaxis with lamivudine (LAM) after a course of post‐operative hepatitis B immunoglobulin (HBIG) in patients who underwent liver transplantation (LT) for hepatitis B virus (HBV)‐related disease. Result: The medical records of HBV‐infected patients who underwent a LT in our institution between July 2001 and May 2005 were reviewed. There were 15 liver transplant recipients who were administered HBIG for <18 months and used LAM as a maintenance prophylaxis regime enrolled in this study. At enrollment, all patients were hepatitis B surface antigen (HBsAg) positive and three patients were HBeAg positive. There were 13 patients who were HBV DNA positive with a mean viral load of 5.4 log copies/mL, and among them, 12 recipients were on antiviral therapy with LAM (100 mg/d orally) for 12–168 d, resulting in HBV DNA negative levels in nine patients prior to their transplant. HBV recurrence post‐LT was noted in two patients who had very high‐HBV DNA levels pre‐LT. Both of these patients showed LAM‐resistant mutation at the time of recurrence. The 11 patients who were HBV DNA negative before LT (low‐risk patients) had no HBV recurrence during a follow‐up at a median of 58 months post‐LT. This included five patients who had intermittent low‐level HBV DNA post‐LT (HBsAg negative), of whom two had YMDD mutation and these two were given adefovir in addition to LAM. Conclusion: Our retrospective study demonstrated excellent long‐term outcomes in the low‐risk patients treated with LAM after a short course of HBIG.     

慢性重型乙型肝炎Th1／Th2平衡状态与预后关系的研究

目的研究慢性重型乙型肝炎Th1／Th2类细胞因子的水平及其对预后的影响。方法采集112例慢性重型乙型肝炎患者外周血,以30例慢性乙型肝炎（CHB）患者和30名健康体检者作为对照,应用ELISA法检测IL-4和IFN-γ水平,荧光PCR法检测HBVDNA载量,分析重型肝炎患者不同分期细胞因子水平以及与HBVDNA载量及短期预后的关系。结果慢性重型乙型肝炎患者外周血IL-4、IFN-γ水平和Th1／Th2比值明显高于CHB患者和健康体检者（z值分别为8．968,10．004和26．067,P值分别为0．009,0．007和0．000）;晚期重型肝炎患者的IL-4水平明显高于早、中期患者（z值分别为3．672和3．158,P值分别为0．000和0．002）,但Th1／Th2比值低于早、中期患者（Z值分别为3．161和2．166,P值分别为0．002和0．030）;不同HBVDNA复制水平的重型肝炎患者IL4、IFN-γ及Th1／Th2比值差异无统计学意义（z值分别为4．431,2．626和0．140,P值分别为0．219,0．403和0．987）;但患者外周血IL4浓度越高,12周的病死率越高。结论Th1／Th2失衡导致重型肝炎的发生,随着病情加重,Th1／Th2比值下降,提示短期预后不良。     

对比乙型与丙型肝炎背景下肝细胞癌患者经微波消融治疗后预后

目的 对比观察微波消融（MWA）治疗乙型（HB）与丙型肝炎（HC）背景下肝细胞癌（HCC）的预后。方法 回顾性分析HCC伴HB（HB-HCC）及HCC伴HC（HC-HCC）各159例患者资料,比较组间肿瘤学结局,分析患者死因,观察HCC患者MWA后总生存期（OS）的危险因素。结果 HC-HCC组OS率低于HB-HCC组（P=0.045）,组间无病生存率（P=0.095）及癌症特异性生存率（P=0.189）差异均无统计学意义。相比HB-HCC组,HC-HCC组患者死于肝硬化并发症的风险更高（HR=2.339,P=0.043）。Child-Pugh B级（HR=3.082,P＜0.001）、肝炎病毒载量＞500 IU/ml（HR=1.654,P=0.006）及病灶最大径≥3.0 cm（HR=1.541,P=0.017）均为HCC患者MWA后OS的独立危险因素。结论 相比HB-HCC患者,HC-HCC患者MWA后OS较短。     

Effectiveness of adenine arabinoside 5'-monophosphate in kidney transplant recipients with chronic active hepatitis B

Hepatitis B virus infection is responsible for both morbidityand mortality in kidney transplant recipients. Adenine arabinoside5'-monophosphate (ARA-AMP), a synthetic punne nucleotide withanti-viral activity, leads to a sustained interruption of HBVreplication in approximately 40% of immunocompetent patients.We report the results of a pilot study using ARA-AMP to treatHBV-related chronic active hepat itis in kidney transplant recipients. Ten patients (2 females and 8 males, mean age 44 years, meantime post-transplantation 163 months) received a 28-day courseof ARA-AMP intramuscu larly: 5 mg/kg twice daily for the first5 days during hospitalization and subsequently 5 mg/kg oncedaily at home for the remaining 23 days. Mean follow-up was18 months, ranging from 7 to 28 months. All patients but onehad biopsy-proven chronic hepatitis, including five cases ofcirrhosis. All patients had been chronic HBs Ag carriers formore than 1 year and had active replication as assessed by thepresence of serum HBV DNA (mean titre, 270 pg/ml, ranging from12 to 997 pg/mi, Genostics method). HBe Ag was present in 7of the 10 patients. Pretreatment creatinine was normal. In four of the 10 patients, HBV DNA became undetectable respectively1, 1, 5, and 11 months after beginning ARA-AMP. In five patients,HBV DNA decreased during ARA-AMP therapy but subsequently increasedalthough no change was noted during the follow-up period. Intwo partial responders, a second 4-week course of ARA-AMP wasgiven 8 and 9 months after the first course, and resulted ina sustained HBV DNA loss 1 and 4 months later: HBV DNA reappeared3 months later in the former. Two of the responders relapsedwith reappearance of HBV replication 2 and 22 months after treatment:HBV DNA disappeared 1 year later in the former. ARA-AMP waswell tolerated in nine patients, without side-effects in fiveand mild muscular pain in four, although one patient com plainedof severe but reversible peripheral neuropathy Renal functionremained stable in all patients during follow-up. Our results suggest that a 4-week course of ARA AMP interruptsHBV replication in 40% of kidney recipients with chronic activehepatitis. Repetition of the treatment may enhance the efficacyof ARA-AMP in partial responders. Efficacy and tolerance seemtherefore to be at least comparable to what has been previouslyreported in immunocompetent patients.     

182例肝移植病人术后19个月乙肝复发的临床随访观察

目的 肝移植病人术后乙肝复发的临床随访观察.方法 复诊与随访表调查.结果 拉米呋啶和HBIG联用的情况下,8个分中心的182例肝移植病人术后19个月随访期的乙肝复发率为0.55%.若将术后1周内230个研究病例中血清HBsAg未阴转的9个病例(3.91%)视为乙肝复发病例,术后19个月试验与对照组复发率分别为6.89%(6/87),4.21(4/95).采用循证医学方法,分析世界范围内单用HBIG、拉米呋啶及拉米呋啶和HBIG联用3种方法,认为均有不同程度防治肝移植病人术后乙肝复发的效果.结论 该次临床随访时间与多数的历史文献对照观察时间点形成重叠,临床研究与随访的乙肝复发率与既往文献结果吻合,拉米呋啶和HBIG联用是较优的防治策略.