庚型肝炎病毒感染550例临床分析

自1995年底Simmons和1996年初Linnen等成功分离了庚型肝炎病毒（GBV—C／HGV，简称HGV），关于HGV的致病性一直争论不休。我国也证实了HGV感染的存在并对其基因进行克隆，测定了该基因全序列。由于HGV多为重叠或混合其他病毒感染，研究比较困难。至今仍未能证明HGV是肝炎或其他已知肝病的病原，以及它的致病性。笔者于1997年1月至1999年12月对HGV的致病性进行了研究，现将结果报告如下。     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎病毒学应答的预测因素分析

目的 探讨阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)患者病毒学应答的预测因素.方法 对203例HBeAg阳性CHB患者采用ADV 10 mg/d治疗48周,PCR-限制性片段长度多态性检测TNF-α-238及TNF-α-308位点基因多态性,ELISA测定基线血清TNF-α水平,荧光定量PCR或HBV S基因直接测序法检测HBV基因型、亚型,Logistic回归分析影响ADV应答的因素.结果 203例患者ADV治疗24周和48周时HBV DNA转阴率、ALT复常率、HBeAg转阴率及转换率、联合应答率分别为31.5%(64/203)、59.1%(120/203)、15.8%(32/203)、8.9%(18/203)、13.3%(27/203)和58.6%(119/203)、78.3%(159/203)、29.6%(60/203)、16.7%(34/203)、25.6%(52/203).HBV基因型B、TNF-α-308G/A基因型、较高水平基线ALT及较低载量基线HBV DNA易于24周时HBV DNA转阴[OR=0.405,95%CI(0.191～0.859),P=0.019;OR=0.292,95%CI(0.132～0.643),P=0.002;OR=0.933,95%CI(0.989～0.997),P＜0.01;OR=2.089,95%CI(1.412～3.092),P＜0.01];24周HBV DNA高转阴率、较高水平基线ALT有利于48周时HBV DNA转阴[OR=0.029,95%CI(0.007～0.126),P＜0.01;OR=0.995,95%CI(0.991～0.999),P=0.016].结论 HBeAg阳性CHB患者ADV治疗24周病毒学应答的预测因素是HBV基因型、TNF-α-308基因型、基线ALT水平及HBV DNA载量;48周的预测因素是24周HBV DNA转阴率、基线ALT水平.

Abstract：

Objective To investigate the predictive factors of virological response in HBeAg-positive chronic hepatitis B (CHB)patients treated with adefovir dipivoxil (ADV).Methods A total of 203 HBeAg-positive CHB patients treated with ADV (Mingzheng)10 mg once daily for 48 weeks were recruited.The gene polymorphisms at positions-238 and-308 in tumor necrosis factor (TNF)-α promoter region were determined by the restriction fragment length polymorphism assay of products amplified using polymerase chain reaction (PCR-RFLP).The serum levels of TNF-a at baseline were measured by enzyme linked immunosorbent assay (ELISA).Hepatitis B virus (HBV)genotypes were tested by real-time fluorescent quantitative PCR and HBV subgenotypes were tested by HBV S gene sequencing.Factors related to ADV response were determined by Logistic regression analysis.Results The HBV DNA negative rate,alanine aminotransferase (ALT)normalization rate,HBeAg loss rate and seroconversion rate,and combined response rate at week 24 and 48 of treatment in 203 patients were 31.5% (64/203),59.1% (120/203),15.8% (32/203),8.9% (18/203),13.3% (27/203)and 58.6% (119/203),78.3% (159/203),29.6% (60/203),16.7% (34/203),25.6% (52/203),respectively.HBV DNA negative rate at week 24 was higher in patients with HBV genotype B,that was higher in patients with TNF-α-308G/A genotype,and that was higher in patients with higher baseline ALT level or lower baseline HBV DNA level [OR = 0.405,95 % CI (0.191 - 0.859),P =0.019;OR=0.292,95%CI(0.132-0.643),P=0.002;OR=0.933,95%CI(0.989-0.997),P＜0.01 ;OR=2.089,95%CI (1.412-3.092),P＜0.01].Meanwhile,HBV DNA negative rate at week 48 were higher in patients with higher HBV DNA negative rate at week 24 or higher baseline ALT level [OR=0.029,95%CI(0.007-0.126),P＜0.01;OR= 0.995,95%CI(0.991-0.999),P=0.016].Conclusions HBV genotype,TNF-α-308 genotype,baseline levels of ALT and HBV DNA are predictors of virological response at week 24 in HBeAg-positive CHB patients treated with ADV.And the HBV DNA negative rate at week 24 and baseline ALT level are predictors of virological response at week 48.     

toll样受体9基因多态性与hbv感染结局的相关性研究

目的 研究toll样受体(tlr)9基因单核苷酸多态性(snp)与hbv感染临床转归的相关性.方法 应用实时荧光定量pcr方法检测96例慢性乙型重型肝炎患者、156例慢性乙型肝炎患者和151例hbv感染自发清除者tlr9基因启动子区a-1923c、t-1486c、t-1237c 3个位点的snp分型,分析各位点的基因型及组间差异.计量资料采用方差分析,计数资料采用χ2或fisher精确概率法检验.结果 tlr9基因a-1923c位点ac基因型在慢性乙型肝炎组的频率(3.8%)低于hbv感染自发清除组(11.3%)(χ2=6.082,p＜0.05),但在慢性乙型重型肝炎组(8.3%)与hbv感染自发清除组间基因型频率分布没有统计学差异(χ2=0.552,p＞0.05);重型肝炎组与自发清除组、慢性乙型肝炎组与自发清除组间t-1486c和t-1237c位点的基因型频率分布差异无统计学意义(χ2值分别为1.534和0.745,p值均＞0.05).结论 tlr9基因a-1923c位点ac基因型与hbv感染的自发清除存在相关性,但与hbv感染的慢性化和重症化无明显相关性;t-1486c、t-1237c位点的基因多态性与hbv感染结局之间没有相关性. abstract： objective to investigate whether the clinical outcomes of hbv infection are associated with single nucleotide polymorphisms of toll-like receptor (tlr) 9 gene promoter region.methods the polymorphisms of three positions at tlr9 gene promoter region including a-1923c, t-1486c and t-1237c were detected using real-time fluorescence quantitative polymerase chain reaction in 96 patients with severe chronic hepatitis b, 156 patients with chronic hepatitis b and 151 cases of hbv spontaneous clearance, then the differences between the groups were analyzed.analysis of variance was performed for measurement data,and χ2 test or fisher exact probability test were used for enumeration data.results the frequency of ac genotype at tlr9 gene a-1923c site in chronic hepatitis b group was 3.8%, which was significantly lower than that in hbv spontaneous clearance group (11.3%) (χ2=6.082, p ＜ 0.05), but no significant difference was found between severe chronic hepatitis b group (8.3%) and hbv spontaneous clearance group (χ2=0.552, p ＞0.05).no significant differences of genotype distribution were found between chronic severe hepatitis b group and hbv spontaneous clearance group , chronic hepatitis b group and hbv spontaneous clearance group at polymorphism sites of t-1486c and t-1237c (χ2=1.534 and 0.745, p ＞ 0.05).conclusions genotype ac at tlr9 gene a-1923c site is associated with hbv spontaneous clearance, but not correlated with chronic hbv infection and liver failure; there is no correlation of polymorphisms in t-1486c and t-1237c at tlr9 gene promoter region with the clinical outcomes of hbv infection.     

人胎肝细胞悬液治疗重症肝炎25例初步观察

自1988年6月～1990年6月,我们采用人胎肝细胞悬液(以下简称FLC)静脉输注治疗重症肝炎25例(下称治疗组)。全部病例的诊断均符合1984年南宁全国病毒性肝炎会议修订的标准,部分病例经病理证实。以同期未用FLC治疗的重症肝炎10例作为对照(下称对照组)。现将结果报告如下。临床资料一、一般情况治疗组25例中,亚急性重症肝炎(下称亚重肝)12例、慢性重症肝炎(下称慢重肝)13例;男性24例,女性1例;年龄最小6岁,最大59岁。对照组10例中,亚重肝4例,慢重肝6例;男性7例,女性3例;年龄最小9个月,最大57岁。两组并发症     

手足口病202例临床分析

目的探讨手足口病的临床特点,总结重症手足口病或并发脑炎病例的诊治经验。方法回顾性分析我院2010年5～7月收治的202例手足口病患儿的临床资料。结果 202例手足口病患儿中,≤3岁173例（85.6%）;普通型101例,重症99例,危重症2例,其中重症及危重症病例合并脑炎47例。咽拭子查EV71/CoxA16病毒特异性核酸,重症及危重症病例中EV71阳性61例,CoxA16阳性3例;轻症病例中EV71阳性29例,CoxA16阳性7例。结论手足口病好发于年龄≤3岁的幼儿;EV71所致手足口病重症或合并脑炎病例较多。早期大剂量甲泼尼龙、丙种球蛋白冲击等治疗措施有助于危重症患儿的恢复。     

30例肝移植病例MELD分析

目的探讨终末期肝病模型（MELD）评分评估终末期肝病患者行肝移植术后,受者短期预后、肝移植的手术时机以及MELD与肝脏病理的关系。方法对30例肝移植病例进行回顾性分析,比较术后随访30天后存活组（12例）与死亡组（18例）的术前MELD评分,以MELD分值25和30为界线将病例分组,比较存活率以及肝脏病理,分析大块、亚大块肝细胞坏死与非大块、亚大块肝细胞坏死病例的MELD分值。结果所有患者术前MELD评分平均值为28．92±13．45,术后随访3个月总生存率为40％,其中存活组与死亡组术前MELD评分分别为21．56±11．83和33．82±12．43（P〈0．05）;以MELD评分25为界将患者分为两组,术后3个月存活率为63．6％和26．3％（P〈0．05）;以MELD评分30为界将患者分为两组,术后3个月存活率为53．3％和26．7％（P〉0．05）：大块、亚大块肝细胞坏死组与非大块、亚大块肝细胞坏死组患者术前MELD值相比有显著差异,分别为22．38±12．69和33．28±12．41（P〈0．05）。结论MELD评分可评估肝移植受术者的短期预后,肝移植受者MELD评分值在25分时比30分时行肝移植术更有意义,MELD评分与肝细胞坏死面积有关。     

拉米夫定配合小剂量雷公藤多苷为主治疗乙型肝炎病毒相关性肾炎

<正>乙型肝炎病毒相关肾炎(HBV-GN)目前无特效药物治疗。笔者2001年首先报道以拉米夫定为主治疗HBV-GN3例取得良好的疗效[1]。为进一步观察合理用药的组合,我们应用该药配合小剂量雷公藤多苷等,并与前期以雷公藤多苷等     

口腔鳞状细胞癌患者唾液硫氧还蛋白的水平变化及临床意义

目的：探究口腔鳞状细胞癌(OSCC)患者唾液硫氧还蛋白(Trx)水平变化及其诊断和预后价值。方法：选取2016年1月至2019年12月在武汉科技大学附属普仁医院就诊的106例OSCC患者(OSCC组)和212例健康志愿者(对照组)为研究对象。收集两组年龄、性别等社会人口学信息、吸烟、饮酒等与健康相关的行为变量以及牙周炎、高血压等可能的影响因素,采用酶联免疫吸附法检测唾液Trx水平。随访记录患者的总生存期(OS)。结果：OSCC患者的唾液Trx水平显著高于对照组(P<0.001)。在控制各种混杂因素后,唾液Trx水平升高与OSCC发病风险有关(OR=1.042,P<0.001)。经受试者工作特征曲线分析,基线唾液Trx诊断OSCC的曲线下面积为0.958(95%CI:0.928～0.988,P<0.001)。OSCC患者唾液Trx水平在随访中持续下降,术后9个月唾液Trx水平较基线下降74.8%,但仍高于对照组(P<0.05)。绘制Kaplan-Meier生存曲线,高Trx亚组和低Trx亚组总生存率分别37.25%(19/51)和70.0%(35/50)(Log ...     

公立医院养老保险改革现状、困境及对策研究△

目的：通过调研江苏省公立医院编内及非在编人员参加养老保险的现状,分析其存在的困境,提出相应的对策建议。方法：对江苏省内公立医院发放调研问卷,收集数据整理后运用统计分析和比较分析法描述其运营概况、编内及非在编人员参加养老保险的情况,运用公平理论分析公立医院养老保险存在的问题。结果：江苏省公立医院编内人员参加机关事业单位养老保险,非在编人员参加城镇职工养老保险;省属公立医院非在编人员占比最高;编内人员缴费基数及养老待遇均显著高于非在编人员;编内人员参加职业年金,非在编人员尚未建立年金计划。结论：树立底线公平理念,完善养老保险制度体系;改革完善非在编人员年金计划政策;建立健全参保成本财政分担机制。     

泛昔洛韦治疗慢性乙型肝炎的远期疗效

<正> 我国是乙型肝炎的高发地区,推算有慢性患者约3000万人。由于乙肝病毒(HBV)是造成慢性乙型肝炎(CHB)肝损害的病原体,故抗病毒治疗是治疗CHB的主要措施。近年来研究表明核苷类抗病毒药有很强的抑制HBV的作用。自1999年起我们用泛昔洛韦治疗CHB7例,现将疗效报告如下。