拉米夫定治疗慢性乙型肝炎病毒感染者四年或以上耐药及疗效分析

目的通过分析拉米夫定治疗慢性乙型肝炎病毒（HBV）感染者4年或以上的耐药情况及疗效,以优化拉米夫定的治疗。方法 54例入组患者口服拉米夫定100mg/d,若患者HBV DNA载量连续两次（间隔1个月）超出检测下限1.0log10拷贝/ml时,则采用拉米夫定100mg/d联合阿德福韦酯10mg/d长期治疗;而另一部分患者在拉米夫定100mg/d联合阿德福韦酯10mg/d治疗3个月后停用拉米夫定,继续单用阿德福韦酯长期治疗。结果末次随访时,45例患者（83%）HBV DNA低于检测下限,52例患者（96%）丙氨酸氨基转移酶（ALT）复常,31例HBeAg（＋）患者中出现HBeg血清学转换者14例（45%）,无患者进展为肝细胞癌;17例患者在使用拉米夫定过程中出现病毒学突破,需加用或换用阿德福韦酯,在3年内出现病毒学突破需更改治疗方案的患者13例,占需要更改治疗方案患者人数的76%;曾停药患者7例,停药后均出现HBV DNA反弹,其中伴ALT升高者6例,再次服药后全部病例HBV DNA低于检测下限,ALT恢复正常。结论长期使用拉米夫定抗病毒治疗,安全性好,70%以上的病毒学突破发生在治疗3年内,若及时更改治疗方案,可使80%以上的患者维持HBV DNA低于检测下限,90%以上的患者ALT正常;拉米夫定停药后容易复发,但再次使用拉米夫定仍有效。     

慢性乙型肝炎临床抗病毒治疗的一些实际问题

慢性乙型肝炎的反复活动会导致肝脏纤维组织增生,最终发展为肝硬化,部分患者会发展为肝细胞癌、重型肝炎,严重影响生活质量,甚至危及生命.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

Objective To investigate the efficacy of by combining a 12-week course of lamivudine in those HBeAg-positive hepatitis B patients receiving peginterferon alfa-2a (peg-IFN α-2a) therapy. Methods A total of 58 patients initiated a 52-week course of peginterferon alfa-2a were enrolled and divided into 3 groups. The patients with HBV DNA undetectable or HBeAg negative at week 12 were divided into group A, in this group treatment continued to week 52 with peg-IFN α -2a alone; The rest paitents were divided into group Bl and B2, in group Bl, lamivudine was combined at a course of 12 weeks, while in group B2 treatment continued to week 52 with peg-IFN α -2a alone. Clinical responses were assessed at week 52. Results 8 out of 58 patients achieved undetectable HBV DNA or HBeAg loss at week 12 and divide into group A. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100% (8/8) respectively at the end of treatment. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100%(8/8) respectively at the end of treatment. The rest 50 patients without early response to peg-IFN α -2a at week 12 were divided into group Bl (24 patients enrolled) and B2 (26 patients). At the end of treatment, the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate in Group B1 were 50% (12/24), 38% (9/24), 4% (1/24) and 63% (15/24) respectively, and 31% (8/26), 27% (7/26), 0% (0/26) and 35% (9/26) respectively in group B2. Conclusions Those patients with early responses to peg-IFN α -2a therapy can achieve high clinical responses at the end of 52-week treatment. The combining therpay of lamivudine for a course of 12-weeks can improve the clinical responses for the patients without early responses to peg-IFN α-2a.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

Objective To investigate the efficacy of by combining a 12-week course of lamivudine in those HBeAg-positive hepatitis B patients receiving peginterferon alfa-2a (peg-IFN α-2a) therapy. Methods A total of 58 patients initiated a 52-week course of peginterferon alfa-2a were enrolled and divided into 3 groups. The patients with HBV DNA undetectable or HBeAg negative at week 12 were divided into group A, in this group treatment continued to week 52 with peg-IFN α -2a alone; The rest paitents were divided into group Bl and B2, in group Bl, lamivudine was combined at a course of 12 weeks, while in group B2 treatment continued to week 52 with peg-IFN α -2a alone. Clinical responses were assessed at week 52. Results 8 out of 58 patients achieved undetectable HBV DNA or HBeAg loss at week 12 and divide into group A. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100% (8/8) respectively at the end of treatment. In this group the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate were 100% (8/8), 75% (6/8), 0% (0/8) and 100%(8/8) respectively at the end of treatment. The rest 50 patients without early response to peg-IFN α -2a at week 12 were divided into group Bl (24 patients enrolled) and B2 (26 patients). At the end of treatment, the HBV DNA loss rate, HBeAg seroconversion rate, HBsAg loss rate and ALT normalization rate in Group B1 were 50% (12/24), 38% (9/24), 4% (1/24) and 63% (15/24) respectively, and 31% (8/26), 27% (7/26), 0% (0/26) and 35% (9/26) respectively in group B2. Conclusions Those patients with early responses to peg-IFN α -2a therapy can achieve high clinical responses at the end of 52-week treatment. The combining therpay of lamivudine for a course of 12-weeks can improve the clinical responses for the patients without early responses to peg-IFN α-2a.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

目的 探讨通过短程联合拉米夫定以提高聚乙二醇干扰素α-2a 疗效的新治疗方法.方法 所有患者以聚乙二醇干扰素α-2a 135μg开始治疗,在治疗12周时,若HBV DNA或HBeAg转阴,继续单独使用干扰素治疗至52周(A组),未达到上述条件者(B组)分为B1组及B2组,B1组短程联合拉米夫定治疗12周后继续干扰素治疗并完成52周疗程,B2组继续单独用干扰素治疗并完成52周疗程.符合正态分布的计量资料采用t检验;符合偏态分布的计量资料用中位数(全距)表示,采用秩和检验.结果共有58例患者入组,8例患者在治疗12周时出现HBV DNA或HBeAg转阴,单用干扰素完成52周疗程,治疗结束时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为8/8、6/8、0/8及8/8.B1组患者24例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为50%(12/24)、38%(9/24)、4%(1/24)及63%(15/24);B2组患者26例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为31%(8/26)、27%(7/26)、O(0/26)及35%(9/26).结论 聚乙二醇干扰素α-2a治疗取得早期应答的患者治疗52周的应答率高;通过对早期疗效不佳的患者短程联合拉米夫定治疗,可提高干扰素的疗效,但有待更大样本量的随机临床试验证实.     

传染性非典型肺炎的临床X线表现分析--附32例报告

目的：探讨传染性非典型肺炎的临床及X线表现特征，提高对本病的认识。方法：依据广东省传染性非典型肺炎诊断标准，总结经临床及X线诊断的传染性非典型肺炎32例，分析其临床、X线表现特征。结果：32例均有发热，21例干咳，13例有全身酸痛、乏力，4例患以发热，腹痛、腹泻为主要症状；29例血白细胞正常或降低。胸片表现可分为三期：即肺间质性炎变期(25例)，肺实变期(32例)、吸收消散期(转归期)。结论：本病具有一定的临床特点，综合：分析X线表现和实验室检查，可作出传染性非典型肺炎的诊断。     

肝纤维化的研究进展

肝纤维化是慢性肝病的共同病理学改变，肝纤维化的诊断对慢性肝病的临床治疗和预后判断有重要的意义。目前肝纤维化诊断最可靠的方法仍然是肝组织活检，但不能为大多数患者所接受，因此非创伤性诊断研究日益受到重视。本文就肝纤维化的病理诊断、血清学诊断、影像学诊断及治疗进行综述。