拉米夫定治疗慢性乙型肝炎的疗效研究

目的：研究抗－HBV药拉米夫定治疗慢性乙型肝炎的抗乙型肝炎病毒DNA的疗效。方法：分治疗组和对照组，治疗组每日1次口服拉米夫定100mg，疗程一年；对照组用一般护肝药治疗。定期检测血常规、肝功能及病毒学指标等。结果：拉米夫定治疗慢性乙型肝炎疗程一年，ALT复常率为90．7％，HBV DNA阴转率为73．1％，与对照组相比差异有显著性（P＜0．05），HBeAg阴转率为50．0％，HBeAg／抗－HBe的血清转换率为38．2％，与对照组相比差异无显著性（P＞0．05），病情反复，ALT再次升高者治疗组为3．1％，与对照组相比较差异有显著性（P＜0．05），治疗2例重症肝炎患者，无1例死亡。结论：拉米夫定能有效地抑制HBV DNA的复制，使ALT恢复正常，降低慢性乙型肝炎的复发率，提高患者存活率。     

干扰素治疗慢性乙型肝炎疗效预测因素的研究进展

对于慢性乙型肝炎患者,干扰素-α常作为首选抗乙肝病毒的药物之一,具有疗程有限、疗效持久的优点,但因其毒副作用多且抗病毒效率低等缺点限制了干扰素的临床应用。因此如何在抗病毒前预测干扰素-α抗病毒疗效至关重要。本文就影响干扰素-α疗效的各种因素进行简要综述,为临床医生选择干扰素-α治疗慢性乙型肝炎患者提供参考。     

干扰素联合苦参素治疗慢性乙型肝炎的疗效观察

1　资料和方法1.1　病例选择90例慢性乙型肝炎病人 (诊断符合 2 0 0 0年 9月西安中华医学会传染病与寄生虫分会、肝病学分会联合修订的《病毒性肝炎防治方案》的标准 ) ,男性 6 1例 ,女性 2 9例 ,平均年龄 35 .2岁。血清学检测ＨＢｅＡｇ和ＨＢＶＤＮＡ均为阳性 ;血清总胆红素 <30μｍｏｌ/Ｌ ;肝功能ＡＬＴ为正常值上限的 2～ 6倍 ;无合并症、并发症及重叠感染 ;治疗前半年未接受过抗病毒及免疫调节治疗。1.2　治疗方法所有病例随机分为 3组 :干扰素组 30例 ,完成治疗的 2 8例 (其中 2例在治疗中因外周血ＷＢＣ <3×10 9/Ｌ、ＰＬＴ <4× 1…     

安福隆联合拉米夫丁治疗慢性乙型肝炎的疗效观察

我国是乙型肝炎的高发区。根据 1992年～ 1995年全国血清流行病学调查发现 ,全国ＨＢＶ感染率为5 7.6 3% ,ＨＢｓＡｇ携带率为 9.75 % 〔1〕,且易发展为慢性肝炎、肝硬化和肝癌 ,部分患者最终死于慢性乙型肝炎的相关性疾病 ,但迄今为止慢性乙型肝炎仍然没有满意的治疗方案。干扰素α - 2ｂ(安福隆 ,天津华立达生物工程有限公司生产 )和拉米夫丁目前被中国、美国等许多国家批准用于治疗慢性乙型肝炎且被证实有效的药物 ,而单用一种药物难以取得满意的效果〔2 ,3〕。因此 ,我们应用安福隆联合拉米夫丁治疗 35例慢性乙型肝炎患者 ,现报告如下。…     

经电子支气管镜局部化疗治疗支气管内膜结核的近远期疗效对照研究

目的探讨经电子支气管镜局部化疗治疗支气管内膜结核的近远期疗效。方法将226例确诊的初治涂阳支气管内膜结核病例随机分为两组,观察组116例采用全身化疗联合电子支气管镜局部化疗,对照组110例采用全身化疗联合超声雾化化疗,对比观察两组病例痰菌转阴时间、胸片及胸部CT病变吸收情况,以及支气管内膜病变好转情况。结果观察组痰菌阴转时间显著少于对照组（P〈0.001）,随访2年,痰菌复发率观察组低于对照组（P〈0.05）。治疗4周和终止时胸片及胸部CT病变吸收情况显示,观察组总有效率（53.77%、64.15%）高于对照组（29.59%、39.80%）（P〈0.05）。随访2年,病灶范围增加（复发率）观察组低于对照组（P〈0.05）。观察组治疗3及6个月支气管内膜病变好转率（48.28%、58.62%）均高于对照组（28.19%、40.91%）（P〈0.05）,第12及24个月两组好转率差异无统计学意义（P〉0.05）。结论经电子支气管镜局部化疗结合全身化疗,可加快痰菌转阴和局部病变好转的速度,并降低复发率。     

慢性乙型肝炎患者氧化损伤的研究

目的　探讨慢性乙型肝炎 (乙肝 )患者体内氧化损伤的情况。方法　检测 30例慢性乙肝患者氧化损伤指标 (丙二醛、总抗氧化能力、抗坏血酸 )、肝功能、乙型肝炎病毒 (HBVDNA) ,并做出统计分析。结果　慢性乙肝患者组与正常对照组比较 :丙二醛浓度明显升高 (P <0 0 5 ) ;ALT正常组与正常对照组比较 :抗坏血酸血清浓度明显升高 (P <0 0 1) ;ALT异常组与正常对照组及ALT正常组比较 :丙二醛血清浓度均明显升高 (P <0 0 5 )。在慢性乙型肝炎患者中 ,丙二醛浓度与ALT水平呈明显正相关 (r=0 6 1) ,抗坏血酸浓度与ALT水平呈明显负相关 (r =- 0 6 4 )。乙肝HBVDNA与抗氧化指标间无联系 (P >0 0 5 )。总抗氧化能力指标在各组间比较均无明显改变。结论　乙肝患者体内有氧化 抗氧化功能障碍。慢性乙肝患者ALT升高时 ,体内氧化损伤程度加重。慢性乙型肝炎患者ALT正常者 ,体内氧化损伤程度不高。氧化损伤指标与HBVDNA是肝炎患者中相对独立的检查指标。     

康宁胶囊联合谷膛甘肽治疗慢性乙型肝炎的疗效观察

目的 观察康宁胶囊联合谷胱甘肽治疗慢性乙型肝炎的临床疗效。方法 对照组79例用谷胱甘肽治疗,治疗组93例用谷胱甘肽加用康宁胶囊治疗,通过肝功能指标及纤维化指标评价疗效。结果 经4－8周治疗后,治疗组及对照组肝功能指标及纤维化指标均有明显改善,但在部分指标下,治疗组优于对照组。结论 康宁胶囊联合谷胱甘肽治疗慢性乙型肝炎有较好作用。     

Ara-AMP穴位注射治疗慢性乙型肝炎的疗效观察

近年来 ,我们利用小剂量单磷酸阿糖腺苷 (Ａｒａ ＡＭＰ)进行穴位注射合用胸腺素肌内注射治疗慢性乙型肝炎 ,取得了较好的疗效 ,现报告如下。1　材料和方法1.1　研究对象　 14 0例为我科 1999年 9月～ 2 0 0 1年 9月住院患者 ,均符合全国第 5次传染病与寄生虫病学术会议所修订的慢性乙型肝炎诊断标准。男性 12 2例 ,女性 18例 ,年龄16～ 4 5岁 ,病程 1～ 12 (5 .3± 2 .2 )年。治疗前ＨＢｓＡｇ、ＨＢｅＡｇ、抗 ＨＢｃ、ＨＢＶＤＮＡ均为阳性。ＡＬＴ值 >6 0ＩＵ Ｌ〔(85± 2 5 )Ｕ〕 ,总胆红素 <17 1μｍｏｌ Ｌ。1.2　药物　Ａｒａ ＡＭ…     

干扰素联合苦参素治疗慢性乙型肝炎疗效观察

2005年10月至2007年9月,我们应用干扰素联合苦参素治疗慢性乙型肝炎(CHB)近期疗效显著,现报告如下. 1 资料与方法 1.1 一般资料 本文CHB患者48例,男30例,女18例;年龄20-60岁,平均40岁.均符合2000年中华医学会第10次全国病毒性肝炎与肝病学术会议修订的诊断标准.人选标准:①入选前血清HBsAg、HBeAg持续阳性6个月以上,HBVDNA阳性;②血清ALT持续波动于正常值上限2-10倍之间达6个月以上,且血清胆红素小于正常值上限2倍以下.随即分为治疗组26例与对照组22例.两组一般资料具有可比性.     

慢性乙型肝炎患者NK细胞水平与HBV DNA的关系

我们将HBV DNA阴性的慢性乙型肝炎(CHB)患者(50例)与HBV DNA阳性的CHB患者(128例)比较NK细胞水平,并进行肝功能的比较,探讨CHB患者的NK细胞水平与HBV DNA的关系.     

Erectile dysfunction in patients with liver disease related to chronic hepatitis B

Background/Aims

Despite sexual function making an important contribution to the quality of life, data on erectile function are relatively scant in patients with chronic liver disease. We evaluated the prevalence of and risk factors for erectile dysfunction (ED) in patients with liver disease related to hepatitis B, especially among those with chronic hepatitis B (CHB) or early-stage cirrhosis.

Methods

In total, 69 patients (35 with CHB and 34 with hepatitis-B-related liver cirrhosis [HBV-LC]) aged 40-59 years were analyzed. Child-Pugh classes of A and B were present in 30 (88.2%) and 4 (11.8%) of the patients with HBV-LC, respectively. The erectile function of the patients was evaluated using the Korean version of IIEF-5.

Results

The prevalence of any ED was 24.6% for all patients, and 8.6% and 41.2% for those with CHB and HBV-LC, respectively (P=0.002). While there was only one (2.9%) CHB patient for each stage of ED, mild, moderate, and severe ED stages were seen in three (8.8%), one (2.9%), and ten (29.4%) of the HBV-LC patients, respectively. Multiple regression analysis identified the type of liver disease (P=0.010), hypertension (P=0.022), score on the Beck Depression Inventory (P =0.044), and the serum albumin level (P=0.014) as significant independent factors for the presence of ED.

Conclusions

The prevalence of ED was significantly higher in patients with early-stage HBV-LC than in those with CHB. Therefore, screening male patients with early viral cirrhosis for ED and providing appropriate support are needed, especially when the cirrhosis is accompanied by hypertension, depression, or a depressed level of serum albumin.     

Serum transferrin as a liver fibrosis biomarker in patients with chronic hepatitis B

Background/Aims

Transferrin and alpha-1 antitrypsin are reportedly associated with liver fibrosis. We evaluated the usefulness of serum transferrin and alpha-1 antitrypsin as new liver fibrosis markers in patients with chronic hepatitis B.

Methods

The study included 293 patients with chronic hepatitis B who underwent a liver biopsy between October 2005 and June 2009, and who had no history of hepatocellular carcinoma. Serum markers and liver fibrosis stages were compared.

Results

Univariate analysis revealed that age (P<0.001), serum platelet count (P<0.001), and serum alkaline phosphatase level (P=0.003) differed significantly between the patients with and without liver cirrhosis. Serum transferrin levels were significantly lower in advanced fibrosis than in mild fibrosis in both univariate analysis (P=0.002) and multivariate analysis (P=0.009). In addition, the serum transferrin level was significantly lower in cirrhotic patients than in noncirrhotic patients (P=0.020). However, the serum level of alpha-1 antitrypsin was not significantly associated with liver cirrhosis in patients with chronic hepatitis B.

Conclusions

Serum transferrin could be promising serum marker for predicting advanced liver fibrosis in patients with chronic hepatitis B.     

The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B

Background/Aims

Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS.

Methods

Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of ≤0 or >0 kPa, respectively, over a 1-year period), and their data were compared.

Results

No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic.

Conclusions

A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.     

肝癌、慢性乙肝和肝硬化患者血浆P-选择素的水平及临床意义

目的 观察肝癌、慢性乙肝和肝硬化患者血浆Ｐ－选择素（Ｐ－ｓｅｌｅｃｔｉｎ,Ｐ－ｓｅｌ）水平,并探讨其临床意义。方法 利用ＥＬＩＳＡ法检测了５３例不同期刊癌患者、２２例慢性乙型病毒性肝炎患者、１４例肝硬化患者和３０例健康人血浆中Ｐ－ｓｅｌ的含量。结果 显示各期肝癌组、乙型病毒性肝炎组及肝硬化组血浆Ｐ－ｓｅｌ含量均明显高于对照组,且肝癌组Ｐ－ｓｅｌ高于乙型肝炎和肝硬化组,肝硬化高于肝炎;肝癌患者中Ⅲ期     

Histology and virus expression in the liver: A prognostic puzzle in chronic hepatitis B

Summary Forty chronic untreated paediatric carriers of hepatitis B virus (HBV) infection, with no other causes of liver disease, were biopsied on presentation, when the disease was in the active viral replication phase. After a period ranging from 1 to 13 years, all patients underwent a control biopsy. At the time of the last biopsy, 31 of the patients were anti-HBe positive, whereas 9 persisted in the active replication phase. In this latter phase, necrotic and inflammatory lesions and the presence of nuclear HBcAg were found significantly more frequently than when replication had terminated. The necrotic and inflammatory lesions detected in the first biopsy of patients who subsequently underwent antiHBe seroconversion were significantly more severe than in patients failing to reach seroconversion. All patients who maintained viral replication showed generalized nuclear reactivity for HBcAg on presentation; such reactivity was also found in 16 of 31 (52%) patients who reached anti-HBeAg seroconversion. All these cases had piecemeal necrosis (PMN) in the biopsy. PMN may therefore be considered as a positive prognostic factor in that it identifies those patients who may seroconvert with significant remission of liver disease     

血浆置换联合恩替卡韦治疗慢性重型乙型病毒性肝炎的疗效观察

目的 探讨血浆置换联合恩替卡韦治疗慢性重型乙型病毒性肝炎的临床疗效.方法 将106例慢性重型乙型病毒性肝炎患者随机分为两组,各组53例.对照组给予恩替卡韦治疗;观察组给予血浆置换联合恩替卡韦治疗.结果 治疗12周后,观察组总有效率为75.47％,对照组者总有效率为41.51％,差异具有统计学意义(P＜0.01).治疗12周后,观察组患者TBIL(184.25±72.49)μmol/L、ALT(53.45±38.79) U/L、AST(45.69±34.14) U/L、Glo (20.51±3.96) g/L、PTA(21.34±4.70)％都低于对照组患者患者TBIL(268.41±87.62)μmol/L、ALT(136.28 ±52.86) U/L、AST(71.25±60.73) U/L、Glo(27.37±4.65) g/L、PTA(28.53±5.19)％,差异均有统计学意义(P＜0.05).治疗后4、8、12周时,观察组患者HBV-DNA转阴率都高于对照组,差异均有统计学意义(P＜0.01).结论 血浆置换联合恩替卡韦治疗慢性重型乙型病毒性肝炎患者疗效显著,可有效改善患者临床症状及体征,促进肝功能恢复.     

HBeAg阴性与阳性慢性乙型肝炎患者的临床特征对比分析

目的 探讨HBeAg阴性慢性乙型肝炎和HBeAg阳性慢性乙型肝炎患者的临床特征.方法 回顾性分析96例慢性乙型肝炎患者的临床资料,包括肝功能、HBV DNA定量及肝组织病理学检查等.结果 96例慢性乙型肝炎患者中,38例为HBeAg阴性慢性乙型肝炎患者,平均年龄为32±8岁;58例为HBeAg阳性患者,平均年龄为35±8岁,两组比较无统计学差异(t=1.546,P=0.125).两组患者在丙氨酸转氨酶(ALT)水平比较无统计学差异(x2=0.056,P =0.81).HBeAg阴性组HBVDNA水平为4.28±0.97 copies/mL,HBeAg阳性组HBV DNA水平为6.12±1.16 copies/mL,两组比较有统计学差异(t=10.32,P ＜0.001).45例患者进行了肝组织病理穿刺检查术,HBeAg阴性组11例,HBeAg阳性组34例.两组患者在炎症程度差别无统计学意义(x2=3.053,P=0.238),在纤维化程度差别有统计学意义(x2 =6.000,P=0.048).结论 HBeAg阴性患者的平均年龄与HBeAg阳性者没有统计学差异,HBV DNA载量低于HBeAg阳性组,肝脏组织纤维化程度较HBeAg阳性组严重.HBeAg阴性组ALT水平和肝脏组织炎症程度与HBeAg阳性组无差异.     

慢性乙型肝炎PBMC凋亡及淋巴细胞亚群的检测

目的了解慢性/慢性重型乙型肝炎外周血淋巴细胞激活诱导细胞死亡(AICD)现象的存在情况、各免疫细胞的状况、AICD与淋巴细胞状况的关系,以探讨乙型肝炎慢性化和重型化的机制.方法利用慢性、慢性重型乙型肝炎病人和健康献血员外周血单个核细胞(PBMC)在PHA-P刺激下培养72h,通过流式细胞仪检测PBMC的凋亡情况;采用流式细胞仪结合全自动血液分析仪对慢性、慢性重型乙型肝炎病人及正常对照组外周血各淋巴细胞亚群进行检测.结果慢性乙型肝炎组PBMC凋亡率高于慢性重型乙型肝炎组(P＜0.01),高于正常对照组(P＜0.01).慢性乙型肝炎组总淋巴细胞百分率高于慢性重型乙型肝炎组(P＜0.01),慢性重型乙型肝炎组淋巴细胞数低于正常对照组(P＜0.01);CD3+、CD3+CD4+细胞数低于正常对照组(P＜0.01),低于慢性乙型肝炎组(P＜0.05);CD3+CD8+细胞数低于正常对照组(P＜0.05),低于慢性乙型肝炎组(P＜0.05).单核细胞百分率高于正常对照组(P＜0.01),高于慢性乙型肝炎组(P＜0.05).结论慢性乙型肝炎患者外周血淋巴细胞活化与凋亡共存,慢性重型乙型肝炎患者外周血淋巴细胞消耗严重,AICD参与乙型肝炎慢性化、重型化的发生机理.     

Peroxidase-anti-peroxidase detection of hepatitis B surface and core antigen in liver biopsy specimens from patients with chronic type B hepatitis

Liver biopsy specimens from 58 American patients with chronic type B hepatitis were investigated for the presence and distribution of the hepatitis B core (HBcAg) and surface (HBsAg) antigens by peroxidase-anti-peroxidase techniques. HBsAg was detected in 43 (77%) and HBcAg in 52 (90%) patients. HBcAg was present in 50 of 51 (98%) patients with hepatitis B e antigen (HBeAg) but in only two of seven (29%) of patients with antibody to HBeAg (anti-HBe). There was no correlation between severity of hepatitis or height of aminotransferase activities and the amount of HBsAg or HBcAg in hepatocytes but there was a positive correlation between amount of HBcAg and height of HBV-DNA and DNA polymerase activity in serum. Follow-up liver biopsies, taken 1 to 3 yr later, were available from 39 patients. HBcAg remained detectable in 25 of 26 patients with persistence of HBeAg but disappeared in 12 patients who had lost HBeAg. In nine patients, HBcAg was cytoplasmic as well as nuclear in distribution. Seven of these patients had an intense lobular hepatitis with marked elevations in aminotransferase activities. These findings indicate that the amount of HBcAg in liver correlates with the amount of serum hepatitis B virus as quantified by serum levels of DNA polymerase and HBV-DNA. The amount of nuclear HBcAg does not correlate with the severity of the liver disease, but the presence of cytoplasmic HBcAg usually reflects an active and severe ongoing hepatitis.     

Mechanisms of liver cell damage in acute hepatitis B

Markers of hepatitis B viral infection and the evolution of immune response to these were compared with serum alanine aminotransferase (ALT) levels in adult male and non-pregnant and pregnant female patients with acute hepatitis B from the time of onset of disease to the seventh week. In the adult male and non-pregnant female patients, the peak ALT levels of about 360 IU/litre, seen at the time of onset, gradually declined during the course of the disease. Significantly, even in the seventh week, the median ALT level was abnormal (80 IU/litre). In contrast, the disease was mild in pregnant patients and the ALT levels declined rapidly, returning to normal by the third week. Markers associated with HBV replication, i.e., serum HBV-DNA and HBeAg, declined early in the course of the disease in both groups. The anti-HBc-IgM and anti-HBe responses were well evolved early in the course of the disease in both groups. HBsAg was present in the serum in large amounts (1-1.5 X 10(4) AU/100 microliter) early in the course of the disease and remained so up to the seventh week. Even the pregnant patients who had recovered clinically by the fourth week continued to have HBsAg in their sera in large amounts in spite of normal ALT levels. LMI and LTT responses to HBsAg, which were practically absent in the first week, gradually increased to a peak during the fourth week and remained elevated up to the seventh week in adult male and non-pregnant female patients. In contrast, LMI response to HBsAg was absent in pregnant patients with acute hepatitis B even up to the fourth week Thus, continued liver cell necrosis after the fourth week, as indicated by raised ALT levels, may be associated with T cell responses to HBsAg.