苦参素联合α-干扰素治疗慢性丙型肝炎36例临床观察

目的 :探讨苦参素联合α 干扰素治疗慢性丙型肝炎的临床疗效。方法 :将慢性丙型肝炎患者 72例随机分为治疗组和对照组各 3 6例 ;治疗组给予苦参素联合干扰素 αlb 3MU ,对照组单用干扰素 αlb。两组疗程均 2 4周。观察治疗前后肝功能、HCVRNA、肝纤维化指标变化情况。结果 :两组患者肝功能均有明显改善 ;治疗组和对照组HCVRNA阴转率分别为 5 8 3 %和 3 3 3 % ,两组患者血清透明质酸 (HA)、Ⅲ型前胶原肽 (PⅢP)、Ⅳ型胶原 (C Ⅳ )和层粘蛋白 (LN)浓度与治疗前相比明显下降 ,差异均有显著性意义 (P <0 0 1) ;治疗组在HCVRNA阴转率、HA、C Ⅳ的改善方面优于对照组 (P <0 0 5 )。结论 :苦参素联合干扰素 αlb治疗慢性丙型肝炎能有效改善肝功能 ,在抗病毒方面有协同作用 ,并能增强抗肝纤维化的效果     

苦参素治疗慢性乙型病毒性肝炎57例

2003年1月～2005年11月，我们应用苦参素注射液治疗慢性乙型病毒性肝炎（CHB）57例，疗效较好。现报告如下。     

上海地区71例慢性丙型病毒性肝炎患者基因型分布研究

目的：观察上海地区慢性丙型肝炎（慢丙肝）患者的丙肝病毒（HCV）基因型分布情况。方法：提取血清HCVRNA，套式PCR扩增方法扩增目的片段，纯化后直接测序。结果：71例血清标本检测示，1b型占87．32％（62／71），2a型占12．68％（9／71），共有22个突变。1b型的突变率为33．87％（21／62），2a型的突变率为11．11％（1／9）。两种基因型突变率比较，具统计学差异（P〈0．05）。结论：该研究中HCV基因型为1b和2a两型。1b型占多数，1b型的突变率高于2a型。     

干扰素治疗慢性丙型病毒性肝炎致缺血性肠病2例

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丙型病毒性肝炎干扰素治疗现状

丙型病毒性肝炎干扰素治疗现状唐振亚郝连杰同济医科大学附属同济医院临床免疫研究室湖北省武汉市４３００３０主题词肝炎，丙型／治疗干扰素类／治疗应用ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓｈｅｐａｔｉｔｉｓＣ／ｔｈｅｒａｐｙｉｎｔｅｒｆｅｒｏｎｓ／ｔｈｅｒａｐ...     

恩替卡韦联合苦参素片治疗HBeAg阳性慢性乙型肝炎52例疗效观察

目的:观察恩替卡韦联合苦参素片治疗HBeAg阳性慢性乙型肝炎(CHB)的疗效。方法:102例HBeAg阳性CHB患者随机分为治疗组和对照组。治疗组52例给予恩替卡韦联合苦参素片治疗,对照组仅用恩替卡韦治疗,疗程1年。结果:治疗组HBeAg阴转率、HBeAg/HBeAb转换率及HBV DNA阴转率明显高于对照组,差异有显著性意义(P<0.05);两组患者血清丙氨酸转氨酶(ALT)复常率差异无显著性意义(P>0.05);治疗组患者治疗后CD4+T淋巴细胞百分率以及CD4+/CD8+比例明显回升,CD8+T淋巴细胞百分率下降,与治疗前比较,差异有显著性意义(P<0.05);对照组患者治疗后CD4+T淋巴细胞百分率、CD4+/CD8+比例及CD8+T淋巴细胞百分率同治疗前比较,差异无显著性意义(P>0.05);治疗组患者治疗后肝纤维化3项指标明显好转,与对照组比较差异有显著性意义(P<0.05)。结论:恩替卡韦联合苦参素片治疗CHB,能增强抗病毒效果,同时具有调节免疫和抗肝纤维化的效果。     

慢性丙型病毒性肝炎抗病毒治疗的新进展

由丙型病毒性肝炎病毒(HCV)感染引起的慢性丙型病毒性肝炎(简称慢性丙型肝炎,CHC),聚乙二醇化干扰素(PEG-IFN)联合利巴韦林的治疗方案,持续病毒学应答(SVR)可以达到65%左右。因此,对于诊断明确而又适合抗病毒治疗的患者,应积极进行正规的抗病毒治疗。对于无应答(non-responder)     

疏肝健脾方联合拉米夫定治疗肝郁脾虚型慢性乙型肝炎的临床研究

目的:观察疏肝健脾方联合拉米夫定治疗慢性乙型肝炎肝郁脾虚型患者的临床疗效。方法:采用随机表将120例患者随机分为疏肝健脾方联合拉米夫定的治疗组(62例)和单纯服用拉米夫定的对照组(58例),经治疗12个月及随访6个月,观察两组患者血清肝功能、HBV DNA定量、临床症候、总有效率等。结果:治疗组在治疗后及随访期其肝功能复常率、改善临床症候、降低临床耐药发生率、总有效率等方面,与对照组相比差异有显著性意义(P<0.05)。结论:疏肝健脾方对恢复慢性乙型肝炎肝郁脾虚型患者肝功能,改善临床症候,减少拉米夫定耐药的发生均有一定的疗效。     

苦参素联合山豆根注射液治疗慢性乙型肝炎临床观察

苦参素具有抗炎、免疫调节、保肝、抗病毒等多种作用 ,近年来广泛应用于乙型肝炎抗病毒治疗 ,但我们在使用过程中 ,发现部分患者ALT升高 ,影响药物的使用。山豆根注射液对病毒性肝炎有明显降酶作用。我们将苦参素和山豆根注射液联合使用治疗慢性乙型肝炎取得一定效果。材料和方法一、病例选择全部病例均为 2 0 0 0年 1月～ 2 0 0 1年 7月本院门诊和住院患者 ,共 89例 ,所有患者HBsAg、HBeAg和HBVDNA均阳性 ,血清ALT异常 ,且水平在正常值上限 1～ 5倍。所有病例随机分成联合治疗组和单独应用苦参素组。治疗组共 43例 ,男 3 1例 ,女 1…     

低分子右旋糖酐氨基酸注射液联合人重组生长激素治疗慢性病毒性肝炎的临床观察

目的:观察低分子右旋糖酐氨基酸注射液(利佑安)联合人重组生长激素(安苏萌)治疗慢性病毒性肝炎的效果。方法:将86例慢性病毒性肝炎患者随机分为治疗组和对照组,治疗组在常规综合疗法的基础上加用利佑安和安苏萌,对照组在常规综合疗法的基础上加用肝水解肽注射液(百扶苷),连用1个月为1个疗程。于治疗1个月后观察患者临床症状,血生化指标和肝纤维化指标。结果:治疗组总有效率为88.4%,对照组的总有效率为62.8%,差异有显著性意义(P<0.01)。治疗组与对照组在改善临床症状、血生化指标、肝纤维化指标上差异均有显著性意义(P<0.05)。结论:利佑安联合安苏萌治疗慢性病毒性肝炎疗效显著。     

Short- and long-term effect of interferon therapy for chronic hepatitis C

AIM: To study the short and long-term effect of interferon therapy for chronic hepatitis C.METHODS: Sixty-eight patients with chronic hepatitis C were treated with interferon (3 × 10⁶ IU, im/2 d, for a course of three months) with 1 to 5 courses of treatment and followed for 1.5 to 3 years after the therapy.RESULTS: According to antiviral effect of interferon, 76.5% (52/68) of the cases had a complete response by the end of the first therapy course, while 20.6% (14/68) and 2.9% (2/68) had a partial response or non-response. Over a half of the patients with a complete response (27/52, 51.9%) relapsed within 6 to 10 mo after the first course. Of the original cohort, nineteen patients received two courses of therapy, while one patient received three and another three received five courses of therapy. The follow-up for these patients was between 1.5 to 3 years, at which time 29 (42.7%) of the patients sustained a complete response, with four of them having HCV RNA positive serum, while the others had either a partial (37/68, 2.9%) or non-response.CONCLUSION: Interferon therapy had a high short-term complete response but a low long-term complete response in the treatment of chronic hepatitis C.     

干扰素治疗慢性丙型肝炎近期与远期疗效

目的研究干扰素治疗慢性丙型肝炎近期疗效与远期疗效．方法３×１０６ＩＵ，ｉｍ，１次／２ｄ×３个月为１疗程，接受１～５个疗程干扰素治疗的慢性丙型肝炎患者６８例，治疗结束后随访观察１５年～３年．结果根据干扰素疗效的生物化学评判标准，第１个疗程治疗结束时，分别有７６５％（５２／６８），２０６％（１４／６８）和２９％（２／６８）的患者表现为完全应答、部分应答和不应答．５１９％（２７／５２）的完全应答者在第１个疗程结束后６个月～１０个月的间歇内复发．分别有１９，１和３例患者接受了共计２，３和５个疗程治疗．在１～５个疗程干扰素治疗结束之后１５年～３年的随访观察中，２９例（４２７％）患者表现为持续完全应答，其中４例患者ＨＣＶＲＮＡ检测结果持续阳性；３７例（５４４％）患者为部分应答；２例（２９％）患者无应答．结论慢性丙型肝炎患者干扰素治疗的早期疗效较好，但完全应答者的复发率较高．     

Clinical study of cryoglobulinaemia in Chinese patients with chronic hepatitis C

Cryoglobulinaemia is the most common immunological disorders seen in patients with chronic hepatitis C virus (HCV) infection. We evaluated the incidence and clinical significance of cryoglobulinaemia in 122 Chinese patients with chronic hepatitis C. The pathogenic roles of HCV genotypes and viraemia in this phenomenon were also evaluated. Fifty-four (44%) of the 122 patients with chronic hepatitis C had cryoglobulinaemia. Eleven (20%) of the patients with cryoglobulinaemia had symptoms and signs of cutaneous vasculitis, arthralgia, neuropathy and renal involvement. The patients with cryoglobulinaemia were predominantly female and had a significantly higher mean serum level of rheumatoid factor and a lower mean serum C4 level compared with patients without cryoglobulinaemia (50 vs 29%, 23 vs 15 IU/mL, 25 vs 31 mg/dL, respectively, P < 0.05). The mean serum HCV RNA level, HCV genotype, the presence of serum auto-antibodies, and the rate of cirrhosis were not significantly different between the two groups. Univariate logistic regression analysis showed female serum levels of alanine aminotransferase (> 90 U/L), rheumatoid factor (> 15 IU/mL), C3c (< 100 mg/dL) and C4 (< 20 mg/dL) to be significant predictors of cryoglobulinaemia in chronic hepatitis C patients. However, multivariate analysis showed only serum C4 levels (< 20 mg/dL) as a significantly independent predictor. We concluded that 44% of Chinese patients with chronic hepatitis C had cryoglobulinaemia. Serum C4 levels were significantly lower in chronic hepatitis C patients with cryoglobulinaemia and the serum C4 level was the only clinical independent predictor associated with this phenomenon. Hepatitis C virus genotype and serum viral load were not clinical independent predictors.     

温法干预治疗慢性乙型重型肝炎阳黄湿热内蕴(湿重于热)证的临床疗效与安全性研究

目的:比较清热利湿法加与不加温阳健脾药物治疗慢性重型肝炎(阳黄、湿重于热型)的疗效。方法:采用随机、对照方法,将60例中医辨证为湿重于热的慢性重型肝炎分为两组,分别给予甘露消毒丹(非温法干预组)和甘露消毒丹加附片、白术(温法干预组)治疗。结果:治疗4周,温法干预组和非温法干预组有效率分别为93.1%和72.41%。两组患者的TBil均有明显下降,温法干预组的下降幅度较非温法干预组明显,治疗前后差值分别为(228.62±89.18)和(176.70±97.94)μmol/L,两组比较,P0.05。PTA水平都有不同程度的升高,温法干预组PTA水平上升的幅度大于非温法干预组,上升幅度均数比较,P0.05。未发现温法干预组患者出现感染、出血及黄疸加重等不良反应。结论:清热利湿法加用附片、白术可提高慢性重型肝炎湿重于热证的疗效,且安全性良好。     

A randomized controlled trial of kurorinone versus interferon-alpha2a treatment in patients with chronic hepatitis B

It has recently been shown that a Chinese traditional medicine, kurorinone, extracted from Sophora Flavescens Ait, possesses antiviral properties. We evaluated the efficacy and safety of kurorinone treatment in patients with chronic hepatitis B. Ninety-four patients with abnormal alanine transaminase (ALT) levels and hepatitis B e antigen (HBeAg) and/or hepatitis B virus (HBV) DNA-positivity were randomly assigned to receive either kurorinone 400 mg daily (45 patients) or 3 million units (MU) of interferon-α (IFN-α) (49 patients, daily for 1 month, every other day for 2 months) for 3 months. Patients were followed-up for 12 months. At baseline, both groups were comparable regarding age, gender and serological parameters. At the end of treatment, complete response (defined as ALT normalization and HBeAg and/or HBV DNA loss) occurred in 50% of the kurorinone group and in 61.3% of the IFN-α-treated group ( P  > NS). At the end of the 12-month follow-up period, a complete response (sustained response) occurred in 26.7–36.7% of kurorinone-treated patients with moderate or mild liver damage and in 44.4–46.7% of IFN-α-treated patients with similar liver injury. In kurorinone- as well as in IFN-α-treated patients, there was no statistical significant difference with respect to complete response rates between HBeAg-positive and hepatitis B e antibody-positive subgroups. Kurorinone had no untoward side-effects except for local pain at injection sites. The results of this trial suggest that kurorinone is able to inhibit HBV replication and improve disease remission in patients with chronic hepatitis B.     

拉米夫定联合苦参素治疗慢性乙型肝炎68例临床观察

目的　探讨拉米夫定(LAM)联合苦参素治疗慢性乙型肝炎(CHB)患者的临床疗效。方法　将慢性乙型肝炎患者13 4例随机分为治疗组(68例)与对照组(66例)。治疗组给予LAM联合苦参素治疗;对照组单用LAM。疗程6个月,随访6个月。观察治疗前后的血生化,HBeAg ,HBVDNA等指标的变化情况。结果　疗程结束后和停药6个月后,治疗组患者血清HBeAg、HBVDNA等指标显著下降,与对照组比较差异有显著性(P <0 .0 5或P <0 .0 1)。结论　LAM联合苦参素治疗CHB疗效优于LAM单一用药。     

肝苏颗粒治疗慢性乙型肝炎肝纤维化的临床研究

目的：观察肝苏颗粒治疗慢性乙型肝炎肝纤维化的疗效。方法：选择慢性乙型肝炎肝纤维化患者160例,随机分为两组,对照组（78例）采用常规保肝治疗,治疗组（82例）在常规治疗的基础上加用肝苏颗粒,观察治疗后两组患者临床症状、体征、肝功能以及肝纤维化相关指标如PGA指数、肝纤3项（HA、LN、CⅣ）和肝血流动力学变化。结果：两组均能明显改善患者临床症状,但以治疗组为优（P〈0.01）;治疗组患者ALT、AST、γ-GT、TBil和肝纤3项、PGA指数均明显降低,且显著优于对照组（P〈0.01或0.05）;同时彩色多谱勒显示治疗组患者门、脾静脉内径、血流量值皆明显下降（P〈0.01）。结论：肝苏颗粒能较好地改善慢性乙型肝炎肝纤维化患者临床症状,具有降酶、退黄、促进肝功能恢复作用,且对阻断及逆转肝纤维化进程有一定疗效。     

慢性丙型肝炎患者自身抗体检测的临床意义

目的 探讨慢性丙型肝炎患者自身抗体检测的临床意义.方法 应用ELISA方法检测117例慢性丙型肝炎患者血清中自身抗体,并比较其与HCV RNA、肝硬化发生率、年龄、性别的关系.结果 117例慢性丙型肝炎患者中有55例至少有1项自身抗体阳性,总阳性率为47.00%,明显高于健康对照组(6.66%,P＜O.01).HCV RNA阳性组与HCVRNA阴性组自身抗体的检出率无显著性差异(P＞O.05).自身抗体阳性组中丙型肝炎肝硬化发生率(40/55)明显高于自身抗体阴性组(31/62)(P＜O.01).自身抗体阳性组中≥40岁的患者比例明显高于自身抗体阴性组(P＜0.05).两组间性别比较,差异无统计学意义.结论 慢性丙型肝炎患者中普遍存在自身免疫现象,自身抗体的检出率与患者的年龄和肝硬化发生率明显相关.在常规诊疗中检测自身抗体,对于慢性丙型肝炎患者的诊断和治疗具有一定的指导意义.     

A double-blind,placebo-controlled,pilot trial of thymosin alpha 1 for the treatment of chronic hepatitis C

Abstract: A randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy and safety of thymosin alphal (α₁) in treating chronic hepatitis C. Nineteen Italian patients with chronic active hepatitis C, proven by biopsy were randomly assigned to receive a six month course of thymosin α₁ (900 μg/m² of body surface area twice weekly) or a placebo. All had HCV-RNA in their serum (by PCR), with serum ALT levels more than double the upper limit of the normal range for at least six months before enrollment. After treatment, patients were followed for an additional six months. All patients completed the trial. One patient treated with thymosin α₁, but no patient in the placebo group, normalized serum ALT levels by the end of the treatment. This patient, however, relapsed at the sixth month of the follow-up. Overall, there were no significant changes in mean serum ALT levels in either group during the treatment or follow-up period. No patient cleared HCV-RNA. No side effects were reported except for local discomfort at the injection sites, reported by some patients treated with thymosin α₁. In conclusion, this regimen of thymosin α₁ is not effective in the treatment of chronic hepatitis C.