急性乙型肝炎临床特征和病毒标志物动态变化分析

目的 探讨急性乙型肝炎(AHB)临床特征和病毒标志物动态变化规律及其与慢性乙型肝炎(CHB)急性发作的鉴别诊断.方法 通过比较2005-2009年同期住院的105例AHB患者和102例CHB急性发作息者的肝功能、乙型肝炎三系和HBV DNA定量变化,总结AHB动态变化规律及区别于CHB急性发作的鉴别指标.结果 AHB组入院时一般情况、ALT、TBil、HBsAg、HBeAg、HBV DNA水平与CHB组差异无统计学意义,但AHB组抗-HBc-Igm滴度为(26.34±3.74)S/CO,明显高于CHB组的(14.46±3.10)S/CO,差异有统计学意义(P<0.05).治疗2周后,AHB组ALT、TBil下降值分别达(1540.50±225.54)IU/L、(103.60±46.48)μmol/L,明显高于CHB组;AHB组HBsAg、HbeAg、HBeAg、HBV DNA分别下降(2558.46±644.26)IU/mL、(285.20±66.20)S/CO、(4.53±1.42)log10拷贝/mL,均明显高于CHB组,差异有统计学意义(P<0.05);两组抗-HBc-IgM滴度下降值比较差异无统计学意义(P>0.05).AHB患者入院时,19.04%的患者HBV DNA已经阴转.AHB患者HBsAg和HBeAg阴转迅速,随防结束时,AHB患者90.47%出现HBsAg血清转换;94.24%出现HBeAg血清转换;ALT下降快速但其复常明显较病毒清除慢.结论 入院时AHB和CHB急性发作患者的临床特征基本相似,但经治疗后AHB组的肝功能恢复明显较CHB组快.抗-HBc-IgM持续强阳性(≥20 S/CO)、病毒标志物的快速下降和早期阴转或血清转换、ALT≥20×ULN且快速下降和复常缓慢是AHB区别CHB急性发作的主要鉴别指标.     

中西医结合治疗泌尿系结石40例

1993年1月～1998年12月,我们采用中西医结合的方法治疗泌尿系结石40例,并与单纯西药治疗组40例作对照观察疗效,现将结果报告如下。临床资料80例患者均有不同程度的腰痛或胁腹痛、血尿等症状,并经Ｂ超和腹部Ｘ光平片检查确诊,其中右肾结石13例,左肾结石22例,双肾结石9例,右输尿管结石9例,左输尿管结石13例,肾和输尿管结石5例,膀胱结石7例,尿道结石2例,伴肾盂积水28例,结石直径03×02ｃｍ～10×10ｃｍ。80例随机分为中西医结合组(治疗组)和单纯西药治疗组(对照组)。治疗组40例,男29例,女11例,年龄21～57岁,平均341岁,病程15小时～5年,平均15年,其中结石直径<0     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

753例重型肝炎病原学及预后相关因素分析

目的了解各型重型肝炎患者的病原学及影响其预后的危险因素。方法采用回顾性调查分析方法,对753例重型肝炎患者的病原学、年龄、各项生化、PTA和病毒指标等预后相关因素应用SPSS13.0软件包进行统计分析。结果①各型重型肝炎的预后不同,各组间有显著性差异;②乙型肝炎是慢性重型肝炎的最主要病因;③年龄、凝血酶原活动度(PTA)、总胆红素(TB)、总胆固醇(CHO)是影响预后的重要的实验室指标;④乙肝HBeAg阴性且HBV-DNA高表达者,病死率增高,有显著差异。结论重型肝炎以慢性乙型重型肝炎为主,年龄、凝血酶原活动度(PTA)、总胆红素(TB)、总胆固醇(CHO)以及乙肝前C区基因变异与慢性重型肝炎预后相关,可作为评价预后的重要指标。     

派罗欣治疗慢性乙型肝炎20例临床观察

聚乙二醇化干扰素α-2a通过在干扰素α-2a上增加一个大体积分枝状40-KD聚乙烯乙二醇分子，在用药期间的7d内都能维持有效的血清浓度，可以每周给药1次，且疗效较传统α-干扰素更为优越。本科2003年9月至2005年1月，用聚乙二醇化干扰素（商品名派罗欣）治疗慢性乙型肝炎20例，效果满意。     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

急性心肌梗塞引起心脏骤停30分钟抢救成功1例

1 临床研究:患者男58岁,因突然抽搐,跌倒在地,意识不清急诊入院。查体:意识丧失,颈动脉无搏动,心音无,呼吸停止,瞳孔散大。心电图显示:心室颤动。立即给予人工呼吸,胸外心脏按压,迅速建立静脉通道,先后反复给予肾上腺素,利多卡因,磷酸氢钠静推、可拉明持续静点,同时进行气管插管,机械通气,并以200瓦秒～400瓦秒功率进行了4次电击除颤。     

功能性便秘患者结肠通过时间及四逆散干预的临床研究

目的探讨功能性便秘（functional constipation,FC）患者的结肠传输特点及中药四逆散干预作用。方法FC组36例,健康对照组22例,采用结肠传输试验按Hinton法计算全结肠通过时间,用Arhan法计算各分段结肠通过时间,比较两组间的一般情况和结肠通过时间;中药四逆散干预FC组7天,观察干预前后结肠通过时间的变化。结果FC组体重指数高于正常对照组,全结肠通过时间和左半结肠及乙状结肠直肠通过时间较正常对照组长（P〈0．05）,右半结肠通过时间两组比较差异无显著性（P〉0．05）;四逆散干预后FC组全结肠、左半结肠、乙状结肠直肠通过时间明显缩短（P〈0．05）。结论FC患者体重指数升高,存在结肠传输缓慢,具有各节段结肠运输时间分布不均匀、以左半结肠和乙状结肠直肠区为主的特点;四逆散能缩短FC患者的结肠通过时间。     

中西医结合治疗慢性萎缩性胃炎100例临床分析

慢性萎缩性胃炎是临床上常见病,目前尚无特殊性药物治疗。我院自1993-01～1998-08采用中药丸剂“平胃宁”与西药甲硝唑联合治疗慢性萎缩性胃炎100例,取得满意疗效,现报告如下。