肝癌家庭HBV感染的病例-对照研究 条件Logistic回归模型的应用

用病例-对照研究的方法,结合条件Logistic回归模型,分析了肝癌家庭的乙型肝炎病毒五项感染标记(HBVM)。肝癌的HBV感染率为88.89%,对照为55.56%,差异有极显著性(P<0.01)。在条件Logistic回归方程中贡献最大的为指示者的HBsAg与抗-HBc的交互影响项以及指示者同胞的HBVM。两组配偶之间的HBVM及单项标记的差异均无显著性(P>0.05)。研究表明肝癌家族内有HBV感染的聚集性。     

颅脑手术使用两种不同引流装置发生颅内感染的临床研究

目的：对颅脑手术使用两种不同引流装置引发颅内感染因素分析,为临床提供参考。方法选取神经外科颅脑手术患者407例,观察组188患者使用的引流装置为一次性颅脑外引流器,对照组219例患者使用传统硅胶引流管外接一次性引流袋,对比分析2组患者发生颅内感染情况。结果对照组发生颅内感染21例（9.59%）,观察组发生颅内感染2例（1.06%）,2组比较差异有统计学意义(P<0.05)。2组颅内感染患者引流管留置管道比较,差异有统计学意义(P<0.05)。对照组颅内感染患者引流管留置时间显著比观察者时间长,差异有统计学意义(P<0.05)。结论神经外科颅脑手术患者使用一次性颅脑外引流器,能够缩短引流时间,提高手术成功率,有效降低颅内感染发生率,改善预后。     

启东乙型肝炎干预研究:2013年随访人群HBV感染及慢性肝病现患调查

目的 分析新生儿接种乙型肝炎(乙肝)疫苗人群在达到婚配年龄后罹患慢性乙肝、肝硬化的远期保护作用。方法 2013年1-10月采用横断面调查方法,对启东乙肝干预研究(QHBIS)的研究对象分层随机抽样,并行ALT、HBV感染血清学标志物(HBsAg、HBeAg、抗-HBs、抗-HBc、抗-HBe)检测及肝胆B超检查。计算HBV感染血清学标志物各指标的阳性率,慢性乙肝及肝硬化的患病率,疫苗组及对照组人群按性别分层后, χ²检验比较各组间率的差异。结果 共获得新生儿乙肝疫苗接种组(疫苗组)4 421人和对照组3 880人,平均年龄分别为(25.59±1.84)岁和(26.61±2.24)岁。疫苗组HBsAg、单独抗-HBs、抗-HBc、HBeAg、抗-HBe阳性率分别为2.38%、37.73%、3.78%、0.57%、2.15%,对照组分别为9.02%、29.41%、16.83%、2.73%、8.87%,两组间血清学标志物各指标的差异均有统计学意义(P <0.05)。疫苗组慢性乙肝活动期、肝纤维化及肝硬化患病率分别为0.45%和0.16%,对照组分别为1.29%和0.39%,组间差异均有统计学意义(P <0.05)。按性别分层后,疫苗组男性慢性乙肝活动期患病率高于女性,差异有统计学意义(P <0.05);在对照组,不管是慢性乙肝活动期患病率还是肝纤维化及肝硬化患病率,男性均高于女性,差异有统计学意义(P <0.05)。结论 新生儿接种乙肝疫苗对慢性HBV感染的保护作用可延长至婚配年龄后,而不同性别人群慢性乙肝与肝硬化现患保护作用的差异值得进一步研究。     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

临床胃镜检查适宜人群选择流行病学分析

胃镜检查适应证的盲目扩大使得检出阴性率大幅度升高,增加了病人痛苦与经济负担;而根据已有的评分系统选择胃镜检查对象又存在过于复杂的问题。本文拟通过胃部疾病发病相关危险因素的调查分析,旨在探讨临床如何合理选择胃镜检查的适宜人群。     

水溶性脂质体运载基因药物复合物治疗大鼠神经病理性痛

背景：有研究报道病毒载体运载N-甲基-D天冬氨酸受体1小干扰RNA可有效缓解大鼠炎性疼痛,但病毒载体存在安全隐患。 目的：探讨水溶性脂质体运载N-甲基-D天冬氨酸受体1小干扰RNA在体内外沉默N-甲基-D天冬氨酸受体1的效应和治疗神经病理性痛的可行性。 方法：将PC12随机分为阴性转染组、对照转染组和水溶性脂质体转染组,分别以N-甲基-D-天冬氨酸受体1 小干扰RNA、聚乙烯亚胺与N-甲基-D-天冬氨酸受体1 小干扰RNA的复合物及水溶性脂质体与N-甲基-D-天冬氨酸受体1 小干扰RNA的复合物转染PC12细胞,检测各组N-甲基-D-天冬氨酸受体1 基因mRNA及蛋白水平表达的变化。将48只SD大鼠随机分为假手术组、模型组、聚乙烯亚胺组及水溶性脂质体组,后3组建立大鼠神经病理性疼痛模型,并分别鞘内注射生理盐水、聚乙烯亚胺与N-甲基-D-天冬氨酸受体1 小干扰RNA的复合物和水溶性脂质体与N-甲基-D-天冬氨酸受体1 小干扰RNA的复合物;假手术组只暴露坐骨神经。 结果与结论：水溶性脂质体转染组N-甲基-D-天冬氨酸受体1的 mRNA与蛋白表达水平明显低于其他两组(P < 0.01)。与假手术组比较,模型组、聚乙烯亚胺组及水溶性脂质体组N-甲基-D-天冬氨酸受体1 的mRNA和蛋白表达上调,累积疼痛评分升高(P < 0.01);与模型组比较,水溶性脂质体转染组脊髓背角N-甲基-D-天冬氨酸受体1 mRNA与蛋白表达及累积疼痛评分下降(P < 0.01),聚乙烯亚胺组上述指标无明显变化(P > 0.05)。表明在体内条件下水溶性脂质体可有效运载N-甲基-D-天冬氨酸受体1 小干扰RNA,抑制N-甲基-D-天冬氨酸受体1 的过度表达,还可减轻大鼠神经病理性痛。     

进展期胃癌新辅助化疗的临床研究

目的观察新辅助化疗对进展期胃癌的疗效。方法将2004年2月至2006年12月本科行新辅助化疗的进展期胃癌患者46例（新辅助化疗组）,与2003年2月至2004年12月未接受新辅助化疗的患者86例（对照组）进行对照分析。结果新辅助化疗组总有效率为58．4％（27／46）,TMN分期降期转好30例（64％）;手术切除率85％（39／46）,其中根治性手术26例（67％）,姑息性手术13例（33％）。对照组手术切除率为78％（67／86）,其中根治性手术39例（58％）,姑息性手术28例（42％）。结论进展期胃癌患者接受新辅助化疗,可提高手术切除率,改善预后。