抗HBV的联合、序贯治疗

目前对于慢性乙型肝炎(CHB)多采用综合治疗的方法,其中抗病毒治疗是重要的措施,近年来取得较大进展。而抗HBV联合、序贯治疗是CHB治疗的方向。 1 抗HBV联合、序贯治疗的必要性 1.1 CHB的难治性和复杂性 HBV在细胞内寄生和复制,抗病毒药物不易达到有效浓度,肝外组织中的HBV同样也不易清除。HBV DNA在复制过程中,以cccDNA作为模板,目前抗HBV药物     

综合序贯疗法治疗中晚期肝癌临床研究

目的：探讨肝动脉栓塞化疗术（ＴＯＣＥ另ＧＳ）、瘤内无水酒精注射术（ＰＥＩ）和门静脉介入治疗术（ＰＶＥ）即３介入治疗,联合特异性肿瘤细胞毒Ｔ淋巴细胞（ＣＴＬｓ）的综合序贯疗法在中晚期肝癌治疗中的优越性。方法：１２７例中晚期肝癌（Ⅱ～Ⅲ期,巨块型或结节型,肝功ＣｈｉｄｌＡ或Ｂ级）患者随机分Ａ、Ｂ、Ｃ３组。其中Ａ组５２例为治疗组,予综合序贯治疗,Ｂ组（４５例）、Ｃ组（３０例）为对照组,分别予ＴＯＣＥ、Ｇ     

赛若金联合拉米夫定序贯治疗慢性乙型肝炎疗效的观察

目的探讨干扰素联合拉米夫定序贯治疗慢性乙型肝炎的疗效。方法将观察病人随机分成二组,各30例。A组先用αlb-干扰素,3Mu或5Mu肌肉注射,每日1次×10天,以后改为隔日1次,应用半年停用,接着再服用拉米夫定,用法同B组;B组单用拉米夫定,100mg每日一次,疗程1年半。结果A组在第6、12个月时,肝功能复常率并不优于B组(P>0.05);但第6个月时,A组e抗原阴转率虽明显高于B组,但无显著性差异(p>0.05)。在第12、18个月时,则有显著性差异(P<0.05)。在第6月时,A组HBV DNA阴转率明显低于B组(P<0.01);两组在第6个月时相比,YMDD变异无显著性差异(P>0.05),但在第12、18个月时,有显著差异(P<0.05)。结论干扰素联合拉米夫定序贯治疗慢性乙型肝炎取得了较好的疗效。     

拉米夫定和干扰素联合序贯疗法治疗慢性乙型肝炎

拉米夫定和干扰素是目前抗乙型肝炎病毒(HBV)有效的药物,两者作用机制不同,临床疗效各异。联合用药是否能提高疗效取决于联合方法,本文总结一种较为理想的联合方法。     

社区获得性肺炎序贯治疗临床观察

目的探讨社区获得性肺炎序贯治疗的安全性及有效性。方法回顾性分析社区获得性肺炎患者临床资料,对比序贯治疗组（试验组）及全程静脉用药组（对照组）的治疗转归、胸片病灶吸收时间、静脉用药时间、住院时间及临床费用等指标。结果两组患者的临床有效率、胸片病灶吸收情况均无显著差异,静脉用药时间、住院天数及临床费用试验组明显低于对照组。结论社区获得性肺炎序贯治疗安全有效,不仅可节省静脉制剂与口服制剂的差价,还可节省其他治疗费用,减少护理工作量,从而缩短住院时间,节省医疗费用。     

序贯综合治疗脑梗死38例疗效观察

目的：探讨序贯综合治疗对脑梗死疗效的影响。方法：将70例脑梗死病人随机分成序贯综合治疗组和对照组，进行临床对照研究，两组均常规进行药物治疗，序贯综合治疗组增加氦氖激光血管内照射治疗和康复治疗。在病程第1天，第5天，第10天，第20天分别测试肌力。结果：序贯综合治疗组疗效明显优于对照组，起效时间明显提前。结论：序贯综合治疗脑梗死起效时间早，效果好。     

甘油果糖联合甘露醇序贯治疗创伤性脑水肿疗效观察

目的观察甘油果糖和甘露醇序贯治疗急性创伤性脑水肿的临床疗效。方法 65例创伤性脑外伤患者随机分为A、B、C、D组。A组(18例)应用20%甘露醇250 mL静脉输注,(3~4)次/天,4 d后全部改用甘油果糖静脉输注,(3~4)次/天,疗程3 d,总疗程7 d。B组(17例)以甘油果糖250 mL和20%甘露醇250 mL 6 h~8 h 1次交替静脉输注,疗程7 d。C组(14例)全部应用20%甘露醇250 mL静脉输注,3~4次/天,疗程7 d。D组(16例)全部应用甘油果糖250 mL静脉输注,3~4次/天,疗程7 d。上述各组7 d后依病情好转程度酌情减少脱水剂用量。观察各组临床症状、体征、脑水肿、肾功能及电解质等指标的变化。结果治疗效果各组间两两比较,A组与C组、B组与C组之间比较有统计学意义(χ2=5.286,P=0.022;χ2=4.930,P=0.026)。肾功能异常在第3天各组间比较无统计学意义(P>0.05),第7天比较C组与D组之间差异有统计学意义(χ2=4.038,P=0.044)。电解质变化各组间比较无统计学意义。结论甘油果糖联合甘露醇序贯治疗创伤性脑水肿疗效好,副反应低。     

腹腔镜联合内镜序贯性治疗老年胆石病232例

目前我国结石病的发病率大约在7%～10%,并且呈现明显上升趋势〔1,2〕。有报道称,年龄较大、女性、有结石病家族史的人是本病的高发人群〔3〕。现代人高热量、低纤维饮食居多,也是本病发生的后天性因素〔4,5〕。手术治疗是根治本病的唯一办法,目前临床手术中,以内镜下乳头括约肌切开术(EST)联     

叶下珠序贯治疗拉米夫定耐药性乙型肝炎的临床研究

2003年1月至2004年5月,我们采用叶下珠序贯治疗拉米夫定耐药性乙型肝炎(LRHB)患者36例,效果满意。现报告如下。     

综合序贯治疗中晚期食管癌

我院对无手术指征的中晚期食管癌或术后复发的患者。分别采用内镜下扩张、置管、放疗及免疫导向化疗等综合序贯疗法，经观察，对改善吞咽困难、提高晚期癌生活质量疗效显著。     

RNA干扰技术与骨质疏松症

骨组织的代谢平衡由成骨细胞(OB)和破骨细胞(OC)的骨形成和骨吸收过程相互偶联维持,以骨吸收占优势的偶联失衡持续进展将导致骨量减少和骨微结构改变,使骨密度下降、脆性骨折风险增大,表现为骨质疏松症。RNA干扰技术(RNAi)是一种转录后水平的基因沉默技术,已广泛应用于传染病、肿瘤等疾病治疗和研究。近年在骨质疏松研究领域有许多新的发现,本文梳理相关文献,介绍RNAi应用于骨质疏松治疗的切入靶点和需要解决的问题,旨在为防治骨质疏松症提供新的研究思路。     

四联疗法与序贯疗法在幽门螺杆菌根除补救治疗中的疗效比较

[目的]比较四联疗法与序贯疗法在幽门螺杆菌(Hp)根除补救治疗中的疗效及安全性,旨在寻找一种有效、安全、经济的补救治疗方案。[方法]将首次根除Hp治疗失败的90例慢性胃炎患者,随机分为四联疗法组和序贯疗法组,每组45例。四联疗法组患者治疗方案为埃索美拉唑、枸橼酸铋钾、阿莫西林、莫西沙星,疗程14d。序贯疗法组患者治疗方案为前5d给予埃索美拉唑、阿莫西林;后5d给予埃索美拉唑、克拉霉素、奥硝唑。所有患者在疗程结束停药4周后行14 C尿素呼气试验检测Hp。比较2组患者治疗前后的不良反应。[结果]四联疗法组Hp根除率(91.1%)显著高于序贯疗法组(75.6%),差异有统计学意义(P<0.05)。2组不良反应均很轻微,组间不良反应发生率比较差异无统计学意义(P>0.05)。[结论]对于Hp补救治疗,四联疗法较序贯疗法疗效更好,且不良反应小,患者依从性好,值得在临床上推广。     

骨质疏松的医学营养干预

营养因素在骨质疏松发生和防治中起重要作用。本文对与骨质疏松发生发展过程有关的蛋白质、钙和某些维生素的研究进展进行综述,并对医学营养干预作为骨质疏松基础治疗的重要性进行阐述。     

Lansoprazole-based sequential and concomitant therapy for the first-line Helicobacter pylori eradication

OBJECTIVE: The aim of this prospective study was to compare the efficacy of the first‐line lansoprazole‐based sequential therapy and concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) for Helicobacter pylori (H. pylori) eradication. METHODS: A total of 169 patients with H. pylori infection were randomly assigned to either the sequential therapy group (n = 85) or the concomitant therapy group (n = 84). A follow‐up endoscopy or urea breath test was examined at least 12 weeks after eradication. RESULTS: Comparable H. pylori eradication rate was observed in both the sequential therapy and concomitant therapy groups by either intention‐to‐treat analysis [sequential 80.0% (68/85) vs concomitant 88.1% (74/84); P = 0.27] or per protocol analysis [sequential, 85.3% (64/75) vs concomitant, 94.6% (70/74); P = 0.60]. Adverse effects were reported and good compliance was observed in both groups (P = 0.72). Although dual antibiotics resistance affected the therapeutic efficacy of sequential therapy (P = 0.03), not concomitant therapy (P = 0.74), it was not an independent factor for predicting the treatment outcome. CONCLUSION: First‐line lansoprazole‐based sequential and concomitant therapy were well‐tolerated and comparable in terms of their H. pylori eradication rate.     

盐酸头孢他美酯单药或联合头孢曲松序贯治疗下呼吸道感染的临床研究

目的观察口服盐酸头孢他美酯单药或静脉滴注头孢曲松联合口服盐酸头孢他美酯单药序贯治疗下呼吸道感染的临床疗效和安全性。方法采用开放性、多中心的临床研究方法,将广州医学院第一附属医院广州呼吸疾病研究所、广州医学院第二附属医院、广州军区总医院、广州市第一人民医院和广州市胸科医院2006年4月至2007年1月入选的141例下呼吸道感染的患者根据病情的严重程度分为口服组和序贯组。口服组(80例)予头孢他美酯0.5g,每日2次;序贯组(61例)予静脉滴注头孢曲松,待病情改善后改为口服头孢他美酯0.5g,每日2次。两组总疗程均为5～14d。比较治疗前、治疗后第4天和疗程结束时的疗效、症状评分、细菌学检查及不良反应。结果两组治疗下呼吸道感染的总有效率为87.9%,其中口服组为85.0%,序贯组为91.8%。两组对急性支气管炎的临床有效率均达100%,口服组与序贯组对肺炎的疗效分别为为88.0%和96.8%。支气管哮喘合并感染的有效率为87.5%,支气管扩张合并感染的有效率58.3%。与治疗前相比,两组患者治疗第4天与治疗后全身症状及呼吸系统的临床试验总评分较治疗前明显下降(P均<0.01)。两组总的不良反应发生率为7.3%,药物不良反应总发生率为5.5%,均可耐受。细菌培养的总阳性率37.6%,主要菌种为流感和副流感嗜血杆菌。口服和序贯两组细菌总的清除率为81.1%。药敏试验头孢他美酯对流感嗜血杆菌清除率达100%,副流感嗜血杆菌清除率为87.1%,对急性支气管炎和肺炎的细菌清除率合计为85.7%。结论盐酸头孢他美酯口服和序贯治疗均可作为治疗下呼吸道感染的有效方法,尤其对急性支气管炎和肺炎的临床疗效显著,且具有较好的耐受性和安全性。     

Estrogen and progestin therapy to prevent osteoporosis

Study objective:To assess combined hormone therapy (CHT) prescribing patterns, possible impediments to CHT prescribing, and use of endometrial biopsy to monitor therapy. Design:Mailed questionnaire survey. Subjects:Gynecologists and general internists at two Boston teaching hospitals. Measurements and main results:Based on a 71% response rate, 72% of internists and 100% of gynecologists reported ever having prescribed CHT. Almost 60% of internists, compared with 8% of gynecologists, reported that over half of their female patients were older than 50 years of age. By logistic regression analysis of the internists’ data, female gender of physician (odds ratio 11.0), belief that CHT decreases myocardial infarction risk (odds ratio 3.4), and knowledge of CHT’s benefits and risks (odds ratio 2.8) were associated with prescribing. Endometrial biopsy was performed by a majority of physicians only when unexpected vaginal bleeding occurred and in cases of unclear menopausal transition. Physicians who were concerned about litigation were seven times more likely to perform baseline endometrial biopsy. Conclusions:In the authors’ sample, as well as nationally, internists are more likely to provide care for menopausal women. Among internists, gender and knowledge are strongly associated with CHT prescribing. These findings have important educational implications if internists are to routinely provide information and counseling to women about osteoporosis and CHT. Part of this work was performed while Dr. Greendale was a Harvard Faculty Development Scholar in general internal medicine. Presented at the annual meeting of the American Gynecological and Obstetrical Society, September 8, 1989, in Hot Springs, Virginia.     

Efficacy of sequential N-butylphthalide therapy on psychiatric and behavioral functions in acute ischemic stroke

Background:Stroke can cause physical and mental problems. This study examined how the sequential therapy of N-butylphthalide (NBP) could effectively improve physical movement, life activities, and psychological disorders in stroke patients.Methods:This double-blind, randomized controlled trial included middle-aged or elderly patients with acute ischemic stroke that had commenced within 48 hours before enrolment in the study. The experimental group was administered 100 mL NBP injections twice a day in the first 14 days, and a sequential 200 mg NBP soft capsule 3 times a day for the next 76 days. The control group was administered 100 mL NBP placebo injections twice a day in the first 14 days and 200 mg sequential NBP placebo soft capsule 3 times a day for the next 76 days. Primary outcomes were the National Institutes of Health Stroke Scale, the Barthel Index of activities of daily living, and Modified Rankin Scale which were evaluated at day 0, day 14, and month 1 or at day 14, month 3, and month 6. Secondary outcomes included the Hamilton Anxiety Scale and the Hamilton Depression Scale, all were evaluated on day 0, month 3, and month 6. Moreover, the adverse reaction of NBP or other serious adverse events were evaluated at each time.Results:Our therapy significantly increased the Barthel Index of activities of daily living scores, decreased the National Institutes of Health Stroke Scale and Modified Rankin Scale scores, and the incidence of the Hamilton Anxiety Scale and the Hamilton Depression Scale of ischemic stroke patients (P < .05).Conclusion:Our results indicated that 90 days’ sequential therapy with NBP as an additional therapy in the treatment of ischemic stroke can better improve patients’ psychological and behavioral functions without significant side effects.     

The management of secondary osteoporosis

Secondary osteoporosis is common among patients being evaluated for osteoporosis. All men and premenopausal women with unexplained bone loss or a history of a fragility fracture should undergo a work-up for secondary osteoporosis. Also, postmenopausal women with risk factors for secondary osteoporosis should be carefully evaluated. The evaluation should include a thorough history, physical examination, bone mineral density testing, and laboratory testing. While there is no consensus for a cost-effective laboratory evaluation, some recommendations include: 25-hydroxyvitamin D, parathyroid hormone (PTH), serum and urine calcium, phosphate, creatinine, liver function tests, a complete blood count, testosterone in men, and thyroid-stimulating hormone. After a thorough review of the evaluation for secondary osteoporosis, this chapter reviews the pathophysiology and treatment of secondary osteoporotic disorders, including vitamin D insufficiency, osteomalacia, the osteoporosis of erosive inflammatory arthritis, ankylosing spondylitis, systemic lupus erythematosus, and osteoporosis related to anti-androgenic therapy for prostate cancer and aromatase inhibitor therapy for breast cancer. Physicians have a significant responsibility to evaluate and treat the underlying medical problem that is the cause of secondary osteoporosis and to optimize bone health in the individual patient.     

莫西沙星序贯治疗老年人社区获得性肺炎的临床研究

目的探讨莫西沙星序贯治疗老年社区获得性肺炎的临床疗效,安全性和治疗费用。方法70例老年社区获得性肺炎患者先给予莫西沙星注射液400mg／250ml静脉滴注,每天1次,治疗5～7d。临床症状改善后,随机分成序贯组和对照组。序贯组35例换予莫西沙星片剂400mg口服,每天1次。对照组35例继续使用莫西沙星注射液400mg／250ml静脉滴注,每天1次。两组总疗程14d。观察治疗效果,药物的不良反应和治疗费用。结果两组的治愈率无明显差异（P〉0．05）,分别为91．43％和94．29％。序贯组的治疗费用、不良反应均明显低于对照组（P〈0．01或P〈0．05）。结论莫西沙星序贯治疗老年社区获得性肺炎疗效确切,不良反应少,并可节省医疗费用。