中国首部《慢性乙肝防治指南》开启乙肝防治新里程

我国首部针对乙型肝炎的防治指南于近日在京发布。《慢性乙肝防治指南》秉承循证医学的原则，只纳入被公认、已经得到严格临床验证的方案。同时，明确了医务人员治疗乙肝应当遵循什么样的标准。这部指南是在卫生部和中华医学会的领导下，由中华医学会肝病学分会和中华医学会感染病学分会、中国肝炎防治基金会联合制订的。     

慢性乙型肝炎防治指南

慢性乙型肝炎是我国常见的慢性传染病之一,严重危害人民健康.为进一步规范慢性乙型肝炎的预防、诊断和治疗,中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家,在参考国内外最新研究成果的基础上,按照循证医学的原则,制订了《慢性乙型肝炎防治指南》（以下简称《指南》）.其中推荐意见所依据的证据共分为3个级别5个等次,文中以括号内斜体罗马数字表示.     

慢性乙型肝炎防治指南

慢性乙型肝炎是我国常见的慢性传染病之一,严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗,中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家,在参考国内外最新研究成果的基础上,按照循证医学的原则,制订了《慢性乙型肝炎防治指南》（以下简称《指南》）。其中推荐意见所依据的证据共分为3个级别5个等次,文中以括号内斜体罗马数字表示。     

慢性乙型肝炎防治指南(节选)

慢性乙型肝炎是我国常见的慢性传染病之一，严重危害人民健康。为进一步规范慢性乙型肝炎的预防、诊断和治疗，中华医学会肝病学分会和中华医学会感染病学分会组织国内有关专家，在参考国内外最新研究成果的基础上，按照循证医学的原则，制定了《慢性乙型肝炎防治指南》（简称《指南》）。其中推荐意见所依据的证据共分为3个级别5个等次，文中以括号内斜体罗马数字表示。     

《慢性乙型肝炎防治指南》解读

2006年3月，由中华医学会肝病学分会和感染病学分会主办的《慢性乙型肝炎防治指南》（简称《指南》）专家讨论会分别在北京和上海举行，来自全国各地的感染病学、肝病学和预防医学界的100余名专家参加了讨论会。参与《指南》撰写的中华医学会肝病学分会主任委员庄辉院士、感染病学分会主任委员翁心华教授，以及贾继东、成军、魏来、王贵强和万谟彬等教授，对《指南》进行了解读。     

《慢性乙型肝炎防治指南》专家解读

2006年3月，由中华医学会肝病学分会和感染病学分会主办的《慢性乙型肝炎防治指南》（《指南》）专家讨论会分别在北京和上海市举行，来自全国各地的感染病学、肝病学和预防医学界的100余名专家参加会议。参与《指南》撰写的中华医学会肝病学分会主任委员庄辉院士、感染病学分会主任委员翁心华教授，以及贾继东、成军、魏来、王贵强和万谟彬等教授，在会上对《指南》进行了解读。     

对我国《丙型肝炎防治指南》的解读

丙型肝炎易转为慢性，常隐匿进展为肝纤维化、肝硬化，甚至肝癌。因此，要重视丙型肝炎的预防与治疗。2004年，在卫生部和中华医学会的支持下，中华医学会肝病学分会和传染病与寄生虫病学分会组织国内有关专家，按照循证医学的原则，参照国内外最新研究成果，制订了我国《丙型肝炎的防治指南》（以下简称指南）。     

解读《慢性乙肝防治指南》

我国是慢性乙型肝炎（以下简称慢性乙肝）的高发区。为了规范和指导我国医务人员对慢性乙肝的诊断、治疗和预防工作，加强对公众的健康教育，中华医学会肝病学分会和感染病学分会于2005年12月10日正式发布了《慢性乙型肝炎防治指南》（以下简称《指南》）。现对该《指南》的主要内容作一解读。     

解读《慢性阻塞性肺疾病基层诊疗指南》

慢性阻塞性肺疾病,简称"慢阻肺",是一种严重危害人类健康的常见病和多发病,严重影响患者的生命质量,病死率较高,并给患者及其家庭以及社会带来沉重的经济负担。中华医学会等机构组织全国著名呼吸病学专家结合中国慢阻肺的现状,制定了《慢性阻塞性肺疾病基层诊疗指南(2018年)》,以期指导基层医生和大众开展慢阻肺防治工作。下面对该指南的主要内容做一简要介绍。     

慢性乙型肝炎防治指南（2010精华版）

我国是肝炎大国，尤其是乙型肝炎在我国发病率很高。《慢性乙肝防治指南》是在卫生部和中华医学会的领导下，由中华医学会肝病学分会和中华医学会感染病学分会，中国肝炎防治基金会联合制订的，为广大医护人员正确认识乙型肝炎、制定合理的诊疗方案提供了很大的帮助。应读者戴南华的要求，我刊选编《慢性乙肝防治指南》的部分内容，期望对广大读者有所帮助。     

交通损伤性肝破裂急救体会

目的探讨交通损伤性肝破裂的急救治疗措施。方法回顾性分析笔者所在医院近4年来对52例交通损伤性肝破裂患者的急救治疗资料。结果52例外伤性肝破裂患者急救手术治疗44例，非手术治疗8例，除2例术后不足24h死亡外余均康复。结论对于交通性肝破裂的病例，要尽快的明确诊断，建立静脉通道，根据伤情及整体情况决定实施手术治疗和非手术治疗，而非手术治疗应慎重，手术治疗要坚决，但无论采取何种治疗方法，原则上应痛苦少、恢复快、效果好、经济实惠。     

卵巢早衰的临床诊治

卵巢早衰(premature ovarian failure,POF)导致40岁以前的妇女出现闭经、不孕、潮热多汗、性欲低下为主要特征的围绝经期症状,是一种较为严重的威胁生殖能力的疾病,严重影响了患者的身心健康和生活质量。POF的诊疗规范尚需完善,宗旨是早发现、早治疗,评估患者的卵巢储备功能,制定合理的、个体化雌孕激素替代治疗(hormone replacement therapy,HRT)方案。面对POF患者应采取积极的医疗行为-心理指导-社会生活综合治疗,提供科学的预防措施,并对其进行按期随访和关爱。     

Hungarian consensus guideline for the diagnosis and treatment of B, C, and D viral hepatitis

More than 1% of the Hungarian population is infected with hepatitis B, C, or D viruses. Since 2006 the diagnostics and therapy of these infections are carried out in treatment centers according to national guidelines - since 2010 according to financial protocols. The consensus-based guidelines for 2012 are published in this paper. The guidelines stress the importance of quick and detailed virologic evaluations, the applicability of transient elastography as an acceptable alternative of liver biopsy in this regard, as well as the relevance of appropriate consistent follow up schedule for viral response during therapy. The first choice of therapy in chronic hepatitis B infection is pegylated interferon for 48 weeks or continuous entecavir therapy. The later must be continued for at least 6 months after hepatitis B surface antigen (HBsAg) seroconversion. Tenofovir disoproxil fumarat is not yet reimbursed by the National Health Insurance Fund. Adefovir dipivoxil is recommended mainly in combination therapy. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection. Treatment naive chronic hepatitis C patients should initially receive pegylated interferon and ribavirin dual combination therapy. In genotype 1 infection if response is insufficient at 4 or 12 weeks one of the two new direct acting antivirals (boceprevir or telaprevir) should be added. The length of treatment is usually 48 weeks; in cases of extended early viral response shorter courses are recommended. Previous treatment failure patients with genotype 1 infection should receive a protease inhibitor backed triple combination therapy, mostly for 48 weeks. However, relapsers without cirrhosis and with extended rapid viral response, shorter telaprevir based combination therapy is sufficient. Drug-drug interactions as well as emergence of viral resistance are of particular importance. For genotype 2 or 3 HCV infections 24 weeks, for genotype 4 infections 24, 48 or 72 weeks of pegylated interferon plus ribavirin therapy is recommended in general. The guidelines published here become protocols when published as official publications of the Hungarian Health Authority.     

糖皮质激素治疗乙型肝炎相关肝衰竭的研究进展

乙型肝炎相关肝衰竭发病机制复杂,目前临床上缺乏有效的治疗手段.糖皮质激素具有抑制免疫应答、减少炎症介质的产生,发挥强大而迅速的抗内毒素血症作用,同时还能稳定溶酶体膜、保护肝细胞、减轻肝细胞的坏死.糖皮质激素以其特有的生物学特性已在临床广泛应用.该文对糖皮质激素治疗乙型肝炎相关肝衰竭的现状进行综述.     

The practice guideline 'Diagnosis and pharmaceutical treatment of dementia'

The practice guideline 'Diagnosis and pharmaceutical treatment of dementia' emphasizes that a nosological diagnosis should be made and that it is important to assess the extent of need for care. The guideline recommends the use of diagnostic criteria for the various conditions that can cause dementia. With respect to ancillary investigations, the burden to the patient should be weighed against the benefits of increasing diagnostic confidence. Observation of the course of the disease, laboratory and cerebrospinal-fluid investigations, neuropsychological and EEG examinations, and neuroimaging all increase diagnostic confidence. Treatment with a cholinesterase inhibitor or memantine should always be embedded in a comprehensive-treatment protocol that includes explicit discussion of treatment goals and expectations at baseline, in combination with criteria for starting and stopping treatment. Guidelines for evaluating the effects of treatment with cholinesterase inhibitors or memantine are specified. If psychosis, depression or behavioural disturbances occur in patients with dementia, antidepressants, antipsychotics or anticonvulsants may be indicated.     

心力衰竭的诊断与治疗进展

心力衰竭 (CHF)是一种复杂的临床症状群 ,是高血压、冠状动脉硬化性心脏病、瓣膜性心脏病、心肌病和糖尿病等常见病引起的临床综合征 ,是各种病因心脏病的严重阶段。文献报道 ,成年人群中心力衰竭发生率 1 5 % ,心力衰竭诊断后 4年病死率达 4 0 % ,6年病死率男、女分别为 80 %和 6 5 %。心力衰竭患者住院率只占同期心血管病的 2 0 % ,死亡率却达 4 0 %。1　诊　断心力衰竭按病程发展的速度可分为急性和慢性心力衰竭 ,按部位分为左心、右心和全心衰竭 ,按心脏缩舒功能变化又分为收缩性和舒张性心力衰竭。1 1　急性心力衰竭　急性心力衰竭是…     

The Dutch Institute for Health Care Improvement (CBO) guideline for the diagnosis and treatment of aspecific acute and chronic low back complaints

Under the auspices of the Dutch Institute for Healthcare Improvement (CBO), a guideline has been developed for the diagnosis and treatment of aspecific low-back pain, based on the recent scientific literature. So-called 'red flags' are used to identify physical disorders. To obtain insight into psychosocial factors, 'yellow flags' are used. Acute low-back pain (0-12 weeks) is treated in a time-contingent manner. Staying active is better than bed rest. If chronicity threatens, exercise therapy can be advised. As part of an activating management, manipulation can be used. For pain relief, paracetamol is the drug of choice. The treatment of chronic low-back pain is aimed at the optimisation of the patients' functionality. Staying active is preferred here as well. Varied exercise therapy is advised. Back training may be considered. Manipulation can be used as part of an activating management. Paracetamol is preferred for pain relief. There is a limited role for percutaneous lumbar facet denervation. Behaviour therapy can be employed and there is a place for multidisciplinary programmes if other methods of treatment have proved insufficiently effective.