hbeag阳性/阴性慢性乙型肝炎的临床病理特征对比分析

目的 探讨hbeag阳性和阴性慢性乙型肝炎(chb)的临床病理学差异.方法 选择2002年6月-2010年1月在宁波市第二医院住院并做活体肝组织穿刺病理学诊断的chb患者665例,其中hbeag阳性组428例,hbeag阴性组237例,对两组患者的血清hbv dna载量、肝组织病理变化结果进行对比分析.采用spss 11.5软件进行统计学处理,计量资料采用t检验(正态分布)或mann-whitney u检验(偏态分布),计数资料用卡方检验,相关性分析采用pearson法.结果 hbeag阴性与阳性患者在肝组织炎症分级和纤维化分期的构成上差异有统计学意义(x2=7.92和10.35,p值均＜0.01),hbeag阴性组的炎症分级、纤维化分期高于hbeag阳性组.hbeag阴性患者血清hbv dna水平在＜3、≥3～＜5 log10拷贝/ml的比例明显高于hbeag阳性组(x2=105.16和36.92,p值均＜0.01),而≥7 log10拷贝/ml所占的比例较hbeag阳性组低(x2=110.18,p＜0.01).随着血清hbv dna水平的上升,hbeag阳性chb患者肝组织炎症分级和纤维化分期呈下降趋势(r=-0.287和-0.224,p＜0.01),而在hbeag阴性chb患者中则呈上升趋势(r=0.360和0.303,p＜0.01).结论 hbeag阴性chb患者肝组织损伤较hbeag阳性患者更加严重,须密切监测. abstract： objective to identify the differences in clinicopathological features between hbeag-positive and hbeag-negative chronic hepatitis b (chb). methods a total of 665 chb patients who were admitted to ningbo no. 2 hospital during june 2002 and january 2010 were enrolled, in which 428 were hbeag-positive and 237 were hbeag-negative. hbv dna loads, live histological inflammation grades and fibrosis stages were compared between two groups. spss 1 1. 5 was used for statistical analysis. for measurement data, t (for normal distribution) or mann-whitney u (for skew distribution) was performed; for enumeration data, chi-square test was performed; and pearson correlation analysis was conducted. results liver inflammatory grade and fibrosis staging in hbeag-negative chb patients were more severe than those in hbeag-positive patients (x2 = 7.92 and 10.35, p ＜ 0. 01 ). the ratio of serum hbv dna levels ＜ 3, ≥3- ＜ 5 log10 copies/ml in hbeag-negative chb patients were significant higher than those in hbeag-positive patients (x2 = 105.16 and 36.92 ,p ＜0.01 ) ; and the ratio of hbv dna ≥7 log10 copies/ml in hbeag-negative group was lower than that in hbeag-positive group (x2 = 110. 18, p ＜0. 01 ). with the rising of serum hbv dna levels, liver inflammatory grade and fibrosis staging in hbeag-positive patients had a descending tendency (r =-0. 287 and-0. 224, p ＜0.01 ), while those in the hbeag-negative group were ascending (r = 0. 360 and 0. 303, p ＜ 0. 01 ). conclusion compared with hbeag-positive chb patients, liver inflammation and tissue damage in hbeag-negative patients are more severe, which need close monitoring.     

不同人乳头状瘤病毒检测方法对宫颈高度病变的诊断价值

目的 评价杂交捕获Ⅱ代(hc-Ⅱ)与聚合酶链反应(pcr)技术对人乳头状瘤病毒(human papillomavirus,hpv)dna检测及宫颈高度病变的诊断价值.方法 选取宫颈薄层液基细胞学检查(tct)异常的200例妇女为研究对象,同时用hc-Ⅱ、导流杂交基因芯片技术(hybrimax)、实时荧光定量pcr法(fq-pcr)和流式荧光杂交法检测宫颈细胞hpv dna.以病理组织学检测结果为金标准,比较4种检测方法对宫颈上皮内瘤变(cin)≥Ⅱ的诊断效果.采用spss 13.0软件进行统计学处理.结果 hybrimax、fq-pcr、流式荧光法和hc-Ⅱ对200例hpv dna阳性检出率分别为72.5%(145/200)、71.5%(143/200)、70.0%(140/200)和69.0%(138/200).4种hpv dna检测方法对不同程度宫颈病变的hpv检测阳性率差异无统计学意义(x2=0.252、0134、0.012和0.027,p值均＞0.05),但在诊断cinⅡ及以上病变的敏感度、约登指数和阴性预测值等方面比较差异有统计学意义(x2=7.923、7.819和8.108,p＜0.05).结论 对组织病理学诊断结果为cinⅡ及以上的宫颈病变,hc-Ⅱ的诊断价值优于pcr方法. abstract： objective to evaluate the application of different assays for detection of human papillomavirus(hpv)in diagnosis of high grade cervical lesions.methods two hundred subjects with abnormal thinprep liquid-based cytology test(tct)results were selected for hpv dna detection by hybrid capture 2(hc-Ⅱ) and methods based on pcr including flow-through hybridization and gene chip (hybrimax),real-time fluorescent quantitative pcr(fq-pcr)and flow fluorescent hybridization assay.cytopathological results were used as gold standards to evaluate the test performance of the above assays for diagnosing cervical intraepithelial neoplasia(cin)≥Ⅱ. spss 13.0 software was used for statistical analysis.results hpv dna positive rates of 200 samples by hybrimax,fq-pcr,flow fluorescent hybridization assay and hc-Ⅱ were 72.5%(145/200),71.5%(143/200),70.0%(140/200)and 69.0%(138/200),respectively,and the differences were not statistically si(g)nificant(x2 =0.252,0134,0.012 and 0.027,p ＞ 0.05).the sensitivity,youden index and negative predictive value of the above assays were statistically different(x2 =7.923,7.819 and 8.108,p ＜0.05).conclusion hc-Ⅱ is superior to pcr methods in diagnosis of cin Ⅱ and above.     

聚合酶链反应相关技术对人乳头状瘤病毒的检测与分型

目的 鉴定和评估pcr联合限制性片段长度多态性(rflp)及基因测序技术对发生于外生殖器或肛周部位的5种皮肤病与性病进行hpv dna检测和分型的可行性.方法 应用hpv通用引物对(my09/11)检测组织中hpv dna,并对hpv dna阳性片段进行纯化和回收.利用4种限制性内切酶对hpv dna阳性的pcr产物进行酶切,聚丙烯酰胺凝胶电泳(page)对酶切产物进行分型,然后用pcr直接测序法验证分型结果并对难以分辨或少见图形进行检测.结果 50份经病理确诊的临床样本中,共有35份hpv dna阳性,其中26份来自尖锐湿疣患者,8份来自鲍温样丘疹病患者,1份来自鳞状细胞癌患者.hpv dna阳性样本中,hpv6型19份,hpv11型3份,hpv16型8份,hpv6合并hpv 11型4份,hpv62型1份.测序结果与pcr-rflp判读的hpv型别相符.结论 pcr-rflp方法可用于hpv dna检测与分型. abstract： objective to assess polymerase chain reaction(pcr)combined with restriction fragment length polymorphism(rflp)and gene sequencing technologies in the detection and typing of hpv dna.methods tissue specimens were collected from skin diseases and venereal disease in perianal or genitals.pcr was performed with hpv dna general primers(my09/11)in tissue samples. positive fragments of hpv dna were purified and digested by restriction enzymes.the digested fragments were typed by po]yacrylamide gel electrophoresis(page).the results were verified by direct sequencing.results in 50 clinical samples there were 35 hpv dna positive,including 26 from patients with condyloma acuminatum,8 from patients with bowenoid papulosis,and 1 from patients with squamous cell carcinoma.in hpv dna positive samples,19 were hpv6,3 were hpv11,8 were hpv16,4 were hpv6 and hpv 11,and i was hpv62.sequencing results were in accordance with the pcr-rflp results .conclusion pcrrflp method is effective in the detection and typing of hpv dna.     

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

Purpose It is a challenge for the primary hospitals to manage multiple trauma patients.In this article,we explored the advantage of establishing a surgical intensive care unit(SICU)predominant by cardiothoracic surgeons in the early management of multiple trauma.Methods This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups,based on time period and treat modes:group A(retrospective observation group)where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B(study group)where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018.Clinical data including demographics,injury severity score(ISS),causes of injury,time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected.Data were analyzed by SPSS 20.0 software.Categorical variables were presented as number and/or frequency and continuous variables as mean±SD.Results Altogether 406 patients were included in this study,including 217 patients in group A and 189 patients in group B.General data between the two groups revealed no significant difference:mean age(years)(35.51±12.97 vs.33.62±13.61,p=0.631),gender distribution(mean/female,130/87 vs.116/73,p=0.589)and ISS(15.92±7.95 vs.16.16±6.89,p=0.698).Fall from height were the dominant mechanism of injury,with 135 cases in group A(71.4%)and 121 cases in group B(55.8%),followed by traffic accidents.Injury mechanism showed no significant differences between two groups(p=1.256).Introduction of the SICU significantly improved the care of trauma patients,regarding speed and mortality.Time intervals between reception and entering SICU or operating room was(108.23±6.72)min and(45.67±7.96)min in group A and B,respectively(p=0.001).Mortality three days after injuries was 13.89%and 5.53%in group A and B,respectively(p=0.005).Conclusion Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.     

利奈唑胺经验治疗耐甲氧西林葡萄球菌肺炎的回顾性队列研究

目的 观察利奈唑胺经验治疗耐甲氧西林葡萄球菌(mrs)肺炎的临床效果及安全性.方法 采用回顺性队列研究,收集山东省滨州市人民医院2009年3月-2010年10月使用利奈唑胺治疗mrs肺炎的住院患者135例,将患者分为经验治疗组(75例),即入院后立即应用利奈唑胺0.6 g,静脉滴注,1次/12 h;目标治疗组(60例),待细菌培养确定为mrs感染后再选用利奈唑胺治疗.观察治疗后的病情评分、临床疗效及不良反应,并重点评价高危肺炎患者的治疗效果.采用spss 13.0软件进行统计学分析.结果 经验治疗组和目标治疗组治疗3 d和7 d后病情评分较治疗前均显著下降(t经验治疗=12.29和16.53,t目标治疗=9.36和11.49,p值均<0.05),且组间比较差异也有统计学意义(t=2.64和3.08,p值均<0.01).经验治疗组在肺炎吸收时间、icu住院天数及总的住院天数方面与目标治疗组相比,差异具有统计学意义(t=6.61、4.39和10.25,p值均<0.05).两组临床有效率分别为88.0%(66/75)和83.3%(50/60)(x2=0.60,p>0.05).对于高危人群肺炎患者,治疗后两组临床有效率分别为86.8%(33/38)和63.6%(14/22),差异有统计学意义(x2=4.42,p<0.05).经验治疗组不良反应发生率为6.7%(5/75),目标治疗组为5.0%(3/60),差异无统计学意义(x2=0.17,p>0.05).结论 利奈唑胺作为mrs所致肺炎的经验用药能较快缓解症状,临床有效率高,尤其针对高危人群肺炎患者,疗效确切,安全性较好. abstract： objective to evaluate the efficacy and safety of linezolid in empirical treatment of methicillin-resistant staphylococcus (mrs) pneumonia. methods one hundred and thirty-five hospitalized patients with msr pneumonia receiving linezolid from april 2009 to october 2010 were enrolled in this retrospective cohort study, and all subjects were assigned to two groups: 75 cases with empirical treatment (linezolid 0. 6 g by infusion q12h at admission) , and 60 cases with objective treatment (linezolid after the sputum culture). the severity score, clinical effect and adverse effect were observed, and the therapeutic effects in patients with high risk factors were especially evaluated. spss13.0 software was used for statistical analysis. results the scores were decreased significantly after finishing therapeutic causes for 3 and 7 days in both groups (tempirical =12.29 and 16.53, tobjective =9.36 and 11.49, p<0. 05). there were significant differences in severity scores after 3 and 7 days between empirical and objective treatment groups (t =2. 64 and 3. 08, p < 0. 01). there were significant differences in absorption time, length of icu and total hospital stay between two groups (t =6. 61 , 4. 39 and 10. 25, p <0. 05). in empirical and objective group, the effective rates were 88.0% (66/75) and 83.3% (50/60) (x2 = 0.60, p > 0.05 ). in the patients with high risk factors, the effective rates of two groups were 86. 8% (33/38) and 63. 6% (14/22) , and the difference was significant (x2 =4.42, p<0.05). the rate of adverse effects were 6.7% (5/75) in empirical group and 5.0% (3/60) in objective group, and the difference was not significant (x2 =0. 17, p > 0. 05). conclusion linezolid can be used as empirical treatment for mrs pneumonia with rapid symptoms relieve and high efficacy, especially for patients with high risk.     

痰噬菌体生物扩增法检测一线抗结核药物敏感性的临床应用研究

目的 观察噬菌体生物扩增(phab)法测定痰样本结核分枝杆菌的药物敏感性在临床应用的效果.方法 应用phab法检测143例涂阳肺结核患者痰样本中的结核分枝杆菌对一线抗结核药物的敏感性,并根据检测结果及时调整化疗方案,随访这些患者的痰菌转阴情况和临床疗效,与同期住院未行phab法检测的菌阳肺结核患者进行回顾性地对比.均数的比较采用成组t检验;计数指标采用卡方检验进行对比,其中若出现值为0时采用四格表精确检验法.结果 143例涂阳肺结核患者phab法检测的阳性率为94.4％( 135/143),三类患者的阳性率比较差异无统计学意义(x2=1.886,p＞0.05).phab组患者痰送检至获得药敏检测结果的时间为(6.6±1.8)d,对照组为(29.4±8.7)d,差异有统计学意义(t=29.01,p＜0.01).Ⅱ类肺结核患者中,phab组的2个月转阴率(63.2％ vs.35.1％,x2 =3.989,p＜0.05)和总治愈率较对照组高(100％ vs.78.4％,p＜0.05).Ⅰ类和Ⅲ类肺结核患者的phab组和对照组在转阴率和治愈率方面比较无明显差异.结论 phab法检测痰样本中的结核分枝杆菌药敏结果对涂阳肺结核的方案制订具有较好的指导意义. abstract： objective to evaluate clinical application of phage amplified biologically assay (phab) in susceptibility test of mycobacterium tuberculosis (mtb) in sputum. methods the drug susceptibility of mtb was detected by phab in 143 patients with sputum-positive pulmonary tuberculosis (ptb),and the chemotherapy regimens were adjusted according to the results of susceptibility test.independent samples t-tests were used for comparison of means.count numbers were compared with chisquare test.if there were count number of 0,fisher probabilities should be used.results the total positive rate of phab was 94.4％ (135/143) with no differences between three types of ptb (x2 =1.886,p ＞ 0.05 ).the duration of testing for phab group was (6.6 ± 1.8) days,while for control was (29.4 ±8.7) days (t =29.01,p ＜ 0.01 ).compared with control group,the 2-month negative-conversion rate (63.2％ vs.35.1％,x2 =3.989,p ＜ 0.05 ) and cure rate ( 100％ vs.78.4％,p ＜ 0.05 ) of phab group in type Ⅱ patients were significantly higher.but there were no differences between phab and control groups in type Ⅰ and Ⅲ ptb patients.conclusion the results of phab drug susceptibility test can be helpful for choosing effective chemotherapy regimen for ptb patients rapidly.     

耐碳青霉烯类抗生素肺炎克雷伯菌imp-1型金属β-内酰胺酶的检测

目的 对我院1株美罗培南耐药(纸片扩散法)的肺炎克雷伯菌进行基因型分析.方法 采用k-b法和微量肉汤稀释法进行耐药表型检测,应用改良hodge试验和edta协同试验检测金属酶.pcr法检测包括碳青每烯酶在内的多种β-内酰胺酶基因、Ⅰ类整合酶、Ⅰ类整合子,并进行测序分析.结果 多重耐药肺炎克雷伯菌除对氨曲南、庆大霉素、妥布霉索、阿米卡星、环丙沙星和左氧氟沙星敏感外,对碳青霉烯类、头孢菌素类、头孢西丁、氨苄西林和复方磺胺甲恶唑均耐药.pcr检测显示该菌株携带imp型金属β-内酰胺酶基因,dna测序分析显示扩增出的基因属于imp-1型,Ⅰ类整合酶、Ⅰ类整合子检测阳性.结论 首次在国内分离到产imp-1型金属β-内酰胺酶的肺炎克雷伯菌,该酶是引起肺炎克雷伯菌耐碳青霉烯类抗生素的主要原因,并且与Ⅰ类整合子有关. abstract： objective to study the genes of a carbapenem-resistant klebsiella pneumoniae strain isolated from a patient. methods the antibiotic sensitivity test of a multidrug-resistant klebsiella pneumoniae strain was done according to k-b and mic method. metallo-β-lactamase was detected by modified hodge test and edta-disk synergy test. both nine genes encoding β-lactamases, including blakpc, blaimp , blavim , blasme , blactx-m , blashv, bladha , blaact, class Ⅰ integrase and class Ⅰ integron were detected by pcr. positive products were sequenced. results the klebsiella pneumoniae was resistant to carbapenems, cephalosporins, cefoxitin, ampicillin and trimethoprim/sulfamethoxazole. only susceptible to aztreonam, gentamicin, tobramycin, amikacin, ciprofloxacin and levofloxacin. the blaimp-1 and class Ⅰ integron were positive. the blaimp gene was identified by pcr and dna sequencing confirmed that the gene belong to imp-1 type metallo-β-lactamase gene. the strain also carried class Ⅰ integron and imp-1 was located in class Ⅰ integron 5'. conclusions it is the first detection of imp-1 metallo-β-lactamase in klebsiella pneumoniae. the production of imp-1 carbapenemase is the main mechanism of carbapenem-resistant in klebsiella pneumoniae, and multidrug resistance is related to classⅠ integron.     

轻度慢性乙型肝炎患者肝脏细胞外基质和超微结构改变与临床相关性分析

目的 探讨轻度慢性乙型肝炎(chb)患者细胞外基质和肝脏超微结构改变与临床的相关性.方法 选择慢性hbv感染者为研究对象,将其分为轻度chb组(66例)和慢性hbv携带组(10例).对所有患者采集血清,并行肝穿刺活检,光镜和电镜下观察样本,将结果与血清生化学等指标进行对比分析.计量资料比较采用t检验,计数资料比较采用χ2检验,等级资料相关性使用非参数spearman 分析.结果 轻度chb组和慢性hbv携带组在alt和ast两项指标上比较差异有统计学意义(t=12.42和7.06,p＜0.05),但hbv dna水平差异无统计学意义(t=0.24,p＞0.05).两组患者血清肝纤维化指标(透明质酸、Ⅲ型胶原、Ⅳ型胶原和层黏连蛋白)差异均无统计学意义(t=0.45、0.95、0.76和1.21,p值均＞0.05).光镜组织学结果显示,轻度chb组中,g2、s2以上的患者为33例,慢性hbv携带组为2例,两组差异有统计学意义(χ2=4.17,p＜0.05).轻度chb组s3～4的患者(17例)明显多于慢性hbv携带组(0例,χ2=4.75,p＜0.05).电镜超微结构表现,狄氏间隙胶原纤维增生、汇管区扩大、贮脂细胞增生等反映肝脏纤维化相关的指标与光镜下纤维化分级相关系数分别为0.351、0.675和0.301(p值分别为0.004、0.000和0.014).结论 电镜下肝脏超微结构改变敏感性较光镜高,对轻度chb患者的病情评估具有重要价值. abstract： objective to investigate the correlations of extracellular matrix and hepatic ultramicrostructural changes with clinical manifestations in patients with mild chronic hepatitis b (chb).methods patients with chronic hbv infections were enrolled and were divided into mild chb group (n=66) and hbv carrier group (n=10).serum samples were collected from patients, and serum hbv markers, hbv dna load and liver fibrosis indexes were measured.all subjects received liver biopsy, and the tissue samples were observed by light microscope and electron microscope.t test and χ2 test were performed for measurement data and enumeration data, respectively.spearman test was used for ranked data.results the differences on alt and ast levels between mild chb group and hbv carrier group were significant (t=12.42, 7.06, p＜0.05), but there was no significant difference on hbv dna load between two groups (t=0.24, p ＞ 0.05).serum liver fibrosis indexes (hyaluronic acid, type Ⅲ collagen,type Ⅳ collagen and laminin protein) in mild chb group were not significantly higher than those in hbv carrier group (t=0.45, 0.95, 0.76 and 1.21, p ＞0.05).in mild chb group, there were 33 patients with ≥g2 and ≥s2, but in hbv carrier group were only 2 patients (χ2=4.17, p ＜ 0.05).seventeen patients in mild chb group were with s3-4, while that was not observed in hbv carrier group (χ2=4.75, p ＜0.05).in mild chb group, hepatic ultramicrostrutural changes on fat storing cell, collagen protein and portal area were correlated with fibrosis grades, and the correlation coefficients were 0.351, 0.675 and 0.301, respectively (p=0.004, 0.000 and 0.014).conclusion electron microscope is of higher sensitivity than light microscope in observing hepatic ultramicrostructural changes, which is effective in evaluating the severity of mild chb.     

hiv/hcv合并感染对抗反转录病毒治疗效果的影响

目的 探讨人免疫缺陷病毒(hiv)和丙型肝炎病毒(hcv)合并感染者高效抗反转录病毒治疗(haart)的疗效.方法 采用双盲法随机选择hiv/hcv合并感染者63例(a组),单纯hiv感染者62例(b组).其中a组通过spw-pb网络数据平台按1∶1∶1随机分为a1、a2和a3组,分别采用以奈韦拉平(nvp)、依非韦伦(efv)和洛匹那韦/利托那韦(lpv/r)为基础的三种haart方案治疗.观察免疫学、病毒学指标及不良反应发生率.采用spss 13.0软件进行统计学分析.多组间比较采用one-way anova,组间两两比较采用lsd-t检验.结果 治疗48周后,a组hiv rna转阴率为93.7％ (59/63),b组为98.4％( 61/62),两组间比较差异无统计学意义(x2=0.159,p＞0.05);a组cd4 +t淋巴细胞计数为(208±77)个/μl,明显低于b组(263±78)个/μl(t=-2.759,p =0.008);a组alt均值为(57±49) u/l,明显高于b组(31±14) u/l(t =2.027,p=0.047);a3组cd4 +t淋巴细胞计数明显高于a1组,差异有统计学意义(t=-2.191,p=0.045);a1组alt均值高于a2、a3组,差异有统计学意义(t=2.568和2.478,p值均＜0.05).hiv/hcv合并感染组治疗过程中药物性肝炎的发生率明显高于hiv单纯感染组(55.5％vs.27.4％),两组比较差异有统计学意义(x2= 10.182,p=0.001).结论 hiv/hcv合并感染不影响haart的病毒学疗效,但可能影响患者的免疫重建.hiv/hcv感染者haart期间肝脏毒性反应较常见,尤以nvp方案明显.推荐hiv/hcv感染者采用lpv/r的haart方案. abstract： objective to investigate the efficacy of highly active antiretroviral therapy (haart) for hiv/hcv co-infection patients. methods a randomized and double blinded trial was conducted in sixty-three hiv/hcv co-infected patients ( group a) and 62 hiv infected patients ( group b). the group a (study group) was further divided into a1, a2, a3 subgroups randomly by spw-pb network data system, and were given three different haart regimens based on nevirapine (nvp), efavirenz (efv) and lopinavir/ritonavir(lpv/r), respectively. cd4+ t lymphocyte counts, hiv virus load, glutamate-pyruvate transaminase (alt) were detected at baseline and at the endpoint of study (48 weeks). spss 13.0 was used for statistical analysis. one-way anova and lsd-t tests were performed. results after 48 weeks treatment, hiv rna became negative in 59 patients of group a (59/63, 93.7％ ), while that in group b was 61 (61/62, 98.4％ ) (x2 =0. 159, p ＞ 0.05 ). cd4+ t lymphocyte count in group a was (208 ± 77 )/μl, which was significantly lower than that in group b (263 ± 78)/μl (t =-2. 759, p = 0. 008 ).alt level in group a was (57 ±49)u/l, which was significantly higher than in group b (31 ± 14) u/l (t = 2. 027, p = 0.047). cd4 + t lymphocyte count in group a3 was significantly higher than that in a1 (t=-2. 191, p =0.045), while alt level in a1 was much higher than that in subgroups a2 and a3 ( t = 2.568 and 2.478, p ＜ 0. 05 ). the incurrence of drug-induced hepatitis in hiv/hcv co-infected group was much higher than that in hiv infected group (55.5％ vs. 27.4％, x2 = 10. 182, p = 0.001 ).conclusions hcv co-infection in hiv patients shows no impact on virological response to haart, but the immunological response is poorer. hepatotoxicity is common among patients receiving haart, especially those who are receiving nvp containing regimens. lpv/r based regimens are recommend for hiv/hcv coinfected patients.     

国内首次从多重耐药肺炎克雷伯菌中检出oqxa基因

目的 研究烧伤科多重耐药肺炎克雷伯菌抗菌制剂外排泵基因的流行情况.方法 收集从烧伤患者分离的多重耐药肺炎克雷伯菌20株,采用kb法检测其对14种常用抗菌药物的敏感性.用聚合酶链反应(pcr)检测抗菌制剂外排泵基因oqxa、smrkpn、qace、teha、mdfa和qaceΔlsul1.结果 20株多重耐药肺炎克雷伯菌除了对亚胺培南具有较高敏感性外,对其他抗菌药物的敏感率均在30％以下.抗菌制剂外排泵基因oqxa、qaceΔl-sul1和mdfa的检出率很高,分别为100％、100％和65％,smrkpn、qace和teha检出率很低,分别为0％、0％和15％.结论 从烧伤科分离的多重耐药肺炎克雷伯菌中检出oqxa基因,且携带率非常高. abstract： objective to investigate the prevalence of multidrug resistant genes in klebsiella pncumoniae.methods twenty strains of multidrug resistant klebsiella pneumoniae were isolated from burn patients.susceptibility of these strains to 14 antibiotics was detected by kb method.pcr was used to detect oqxa,smrkpn,qace,teha,mdfa and qaceΔl-sul1 genes.results the antibiotic sensitivity rates of 20 multidrug resistant klebsiella pneumoniae isolates to antibiotics tested were ＜ 30％ except that to imipenam.the positive rates of efflux pump genes mdfa,qaceΔl-sull and oqxa were 65％,100％ and 100％,respectively; while those ofsmrkpn,qace and teha were 0％,0％ and 15％.conclusion oqxa gene has been detected in multidrug resistant klebsiella pneumoniae from burn patients with high positive rate.