α-干扰素联合中药方剂治疗慢性乙型肝炎的临床研究

目的研究α-干扰素联合中药方剂治疗慢性乙型肝炎的临床疗效及其机理。方法选择慢性乙型肝炎患者134例,分别给予α-干扰素联合中药方剂或单用治疗6个月,观察患者治疗前后肝功能、乙型肝炎病毒标志物的变化情况。结果在肝功能复常方面,治疗组优于两对照组,但无统计学差异(P>0.05);在HBeAg、HBV DNA阴转方面,治疗组明显优于两对照组,差异有统计学意义(P<0.01或0.05)。结论α-干扰素联合中药方剂治疗慢性乙型肝炎具有较好疗效,中药方剂能明显提高α-干扰素的抗病毒效果。     

康氏乙肝合剂联合干扰素治疗慢性乙型肝炎41例

目的：研究康氏乙肝合剂联合干扰素治疗慢性乙型肝炎的临床疗效。方法：选择慢性乙型肝炎的病例，应用康氏乙肝合剂联合干扰素进行治疗，以单独应用康氏乙肝合剂和单独应用干扰素治疗的患者进行对比观察，疗程均为6个月。观察患者治疗前后肝功能、乙肝病毒标志物的变化情况。结果：在肝功能复常方面，治疗组优于两对照组，但无统计学差异，P＞0．05：在HBeAg、HBVDNA阴转方面，治疗组明显优于对照组，统计学处理差异有显著性意义，P＜0．01或0．05。结论：康氏乙肝合剂联合干扰素治疗慢性乙型肝炎具有较好疗效，康氏乙肝合剂能明显提高干扰素的抗乙肝病毒效果。     

中药方剂联合干扰素治疗慢性乙型肝炎74例临床分析

目的　中药方剂联合干扰素抗病毒与单纯干扰素抗病毒临床疗效的分析。方法　随机将74例慢性乙型肝炎患者分为中西医结合治疗组3 5例和干扰素治疗对照组3 9例。治疗前后检测HBVM及HBVDNA。结果　HBeAg及HBVDNA阴转率治疗组为74%、77%。明显高于对照组46%、41%。两组相比。HBeAg及HBVDNA阴转率差异非常显著(P <0 .0 1)。结论　中药方剂联合干扰素治疗慢性乙型肝炎总有效率优于对照组。     

干扰素α-2b联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎近期疗效观察

目的探讨干扰素a-2b联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的近期疗效及安全性。方法将HBeAg阳性慢性乙型肝炎患者随机分为单药治疗组（40例）和联合治疗组（42例）,分别应用干扰素a-2b单药治疗或联合阿德福韦酯抗病毒治疗,疗程48周。结果在治疗结束时,联合治疗组ALT复常率为85．7％,HBVDNA阴转率为71．4％,HBeAg转阴率为61．9％,HBeAg血清学转换率为45．2％,均显著高于单药治疗组（分别为60．0％、45．0％、37．5％、25．0％,P〈0．05）;联合治疗组不良反应发生率与单药治疗组比无统计学差异（P〉0．05）。结论干扰素联合阿德福韦酯可提高慢性乙型肝炎抗病毒疗效且安全性良好。     

胸腺肽α1联合苦参素胶囊治疗拉米夫定耐药的慢性乙型肝炎疗效观察

探讨治疗拉米夫定耐药的慢性乙型肝炎的中西医结合疗法。102例拉米夫定耐药的慢性乙型肝炎患者随机分成对照组、干扰素组和联合治疗组,三组病例常规给予甘利欣、能量合剂、维生素等护肝治疗。疗程均为6个月。治疗前各组间肝功能和肝纤维化指标差异无显著性(P＞0．05),治疗后联合治疗组的ALT复常率、HBVD- NA和HBeAg阴转率及抗-HBe阳转率均明显高于对照组和干扰素组(P＜0．05或P＜0．01)。对照组治疗前后血清纤维化指标无显著性差异(P＞0．05),干扰素组和联合治疗组治疗前后均有非常显著性差异(P＜0．01)。治疗后联合治疗组HA、LN、PCⅢ与干扰素组间差异也有显著性(P＜0．05)。胸腺肽α1联合苦参素胶囊可有效治疗拉米夫定耐药的慢性乙型肝炎。     

痰热清注射液联合凯西莱治疗慢性乙型肝炎98例

目的：观察痰热清注射液联合凯西莱治疗慢性乙型肝炎的临床疗效，并探究其治疗机制。方法：将98例慢性乙型肝炎患者随机分为两组，治疗组49例，采用痰热清注射液联合凯西莱治疗，对照组49例仅用凯西莱，观察比较两组患者疗效及肝功能和肝纤维化指标变化情况。结果：治疗后治疗组患者肝功能TBil与对照组比较差异有显著性意义（P〈0．05）；肝纤维化指标HA（透明质酸）、PC-Ⅲ（Ⅲ型前胶原）、C-Ⅳ（Ⅳ型胶原）与对照组比较，差异也有显著性意义（P〈0．05）；两组疗效比较，治疗组优于对照组。结论：痰热清注射液联合凯西莱治疗慢性乙型肝炎是一种较好的疗法。     

拉米夫定和α-干扰素序贯联合治疗慢性乙型肝炎疗效观察

目的探讨拉米夫定与干扰素序贯联合治疗慢性乙型肝炎的疗效。方法30例慢性乙型肝炎患者接受拉米夫定100mg／13口服，直到血清HBVDNA转阴后，联合应用重组人IFN-α2b3MU肌肉注射24周，停拉米夫定，再单用IFN-α24周；对照组30例单用拉米夫定100mg口服，疗程1年。结果治疗结束时ALT复常率治疗组和对照组分别为90．0％和86．7％，两组差异无统计学意义（p〉0．05）。但随访6个月时ALT复常率治疗组和对照组分别为83．3％和56．7％，两组相比有显著性差异（P〈0．05）；治疗组治疗结束时及随访6个月时HBeAg阴转率分别为60．0％和56．7％，对照组阴转率分别为23．3％和20．0％（P〈0．01）；HBeAg转换率治疗组治疗结束时及随访6个月时分别为53．3％和53．3％，对照组分别为20．0％和20．0％（P〈0．01）；治疗结束时HBVDNA阴转率治疗组和对照组分别为86．7％和83．3％，两组差异无统计学意义（P〉0．05），但随访6个月时治疗组和对照组分别为70．0％和43．3％（P〈0．05）。结论拉米夫定与干扰素序贯联合治疗慢性乙型肝炎能明显提高抗病毒疗效，持续应答优于单用拉米夫定治疗者。     

乙肝泰胶囊治疗慢性乙型肝炎的远期疗效观察

目的：观察乙肝泰胶囊治疗慢性乙型肝炎（CHB）患者的远期疗效。方法：将120例慢性乙型肝炎患者随机分为治疗组60例、对照组60倒。治疗组服用乙肝泰胶囊，对照组服用拉米夫定片，治疗12月，于治疗前后及停药12个月后检测肝功能及乙肝病毒标志物的变化。结果：治疗结束后，两组均能明显改善患者血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、白蛋白（ALB）、球蛋白（GLB），其中治疗组升高Alb、降低Glb水平的作用优于对照组（P〈0．05）。停药12个月后，治疗组在改善ALT、Alb、Glb方面优于对照组（P〈0．05）；治疗结束后。对照组DNA阴转率优于治疗组（P〈0．05）。停药12个月后治疗组与对照组的DNA阴转率无显著性差异（P〉0．05）。对照组的反跳率明显高于治疗组（P〉0．05）。结论：乙肝泰胶囊可能降低慢性乙型肝炎患者耶VDNA含量．改善肝功能。远期疗效优于拉米夫定。     

单磷酸阿糖腺苷联合胸腺肽治疗慢性乙型肝炎疗效观察

研究单磷酸阿糖腺鞋联合胸腺肽治疗慢性乙型肝炎的临床疗效。选择62例慢性乙型肝炎患者，分为两组，A组用单磷酸阿糖腺苷联合胸腺肽，B组用干扰素α-2a，评估两组肝功能及乙肝病毒复制近、远期疗效。两组ALT复常率、HBeAg及HBV DNA阴转率均无明显差异(P＞0．05)。初步肯定了单磷酸阿糖腺苷联合胸腺肽治疗慢性乙型肝炎抗乙肝病毒的效果。     

恩替卡韦联合中药内服外敷治疗乙型肝炎肝硬化随机多中心临床研究

目的评价中药内服外敷治疗乙型肝炎肝硬化的临床疗效及安全性。方法入组病例随机分组为对照组与治疗组,对照组单用恩替卡韦抗病毒治疗,治疗组加用中药内服外敷;观察肝功能、凝血功能、肝纤维化指标、超声、肝脏硬度值及中医证候积分。结果与对照组相比,中药内服外敷治疗24周患者ALT、AST、TBil、Alb、PT 明显改善（P＜0．01或 P＜0．05）;治疗48周AST、Alb、PT明显改善（P＜0．01）。与对照组相比,治疗组24周 HA、LN、PⅢP、Ⅳ-C及48周时HA、LN、Ⅳ-C均明显改善（P＜0．01）。肝脏硬度值（LSM ）基线水平比较,治疗组较高（P＜0．01）,治疗48周后,治疗组LSM下降显著（P＜0．05）。与对照组相比,内服外敷联合恩替卡韦治疗乙型肝炎肝硬化48周时,HBsAg滴度下降程度差异有统计学意义（P＜0．01）;治疗组48周脾脏厚度缩小程度差异有统计学意义（P＜0．05）。与对照组相比,治疗组24周中医证候积分未见明显改善（ P＞0．05）;治疗组48周显效率明显提高（ P＜0．01）,总有效率差异无统计学意义（93．3％比85％,P＞0．05）。结论中药内服外敷可有效改善乙型肝炎肝硬化患者肝功能,抑制肝纤维化及脾肿大进展程度,改善中医临床证候,对HBV有一定的抑制作用。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

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.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.