术前合并脓毒症的人类免疫缺陷病毒感染者急诊腹部手术治疗体会

近年来,HIV （human immunodeficiency virus）感染者发病率增多和有效抗病毒药物的使用,患者生存期明显延长［1-3］,HIV 感染者合并外科疾病需要外科手术治疗的需求增加,但为 HIV 感染者进行手术有极大的职业暴露及手术风险［4］,已经成为我国关注的社会问题。笔者先前的研究报道为术前未合并脓毒症的患者进行腹部手术有较高的术后脓毒症发生率［5-6］,但对术前合并脓毒症的 HIV 感染者显然有更大的手术风险,但这类患者往往需要急诊手术,目前国内外也鲜见文献报道,临床经验缺乏。为此,本文总结分析了10例在进行急诊腹部手术治疗的术前合并脓毒症的 HIV 感染者,现报道如下。     

个体化护理干预对慢性丙型肝炎患者抗病毒治疗期间自我效能的影响

目的探讨个体化护理干预对慢性丙型肝炎患者抗病毒治疗期间自我效能的影响。方法将121例接受抗病毒治疗的慢性丙型肝炎患者分为对照组59例和干预组62例,对照组抗病毒治疗采取常规健康教育指导,干预组抗病毒治疗中采用一对一健康教育与电话随访服务。分别在干预前、干预后4周、12周、24周时评价两组患者自我效能。结果干预组患者自我效能总分及各维度得分在治疗4周、12周、24周时均高于对照组(P0.01或P0.05)。结论个体化护理干预能有效提高慢性丙型肝炎患者抗病毒治疗期间的自我效能水平,帮助患者顺利完成抗病毒治疗。     

自发性细菌性腹膜炎的发病机制及治疗现状

自发性细菌性腹膜炎（spontaneous bacterial peritonitis,SBP）指无腹腔内局灶感染或脏器穿孔的条件下发生的急性细菌性腹膜炎,腹水培养有细菌生长,而且多形核白细胞（Pol-ymorphonuclear,PMN）≥0.25×10^9/L。SBP是肝硬化腹水患者常见的严重并发症,在住院的肝硬化腹水患者中,SBP发生率为10％～30％。     

艾滋病合并播散性马尔尼菲青霉菌感染一例

患者女,35岁.囚反复发热、咳嗽7个月余,发现HIV抗体阳性4个月入院.入院前7个月,患者出现刺激性干咳,无发热,给予左氧氟沙星治疗1周,无缓解,且有发热,给予氟康唑治疗10 d,仍有发热及咳嗽.     

Long term treatment of lamivudine in chronic hepatitis B patients with severe liver fibrosis——ten-year follow-up outcomes of NUCB 4006 trial

Objective To evaluate the clinical and histological outcomes in a cohort of chronic hepatitis B (CHB) patients who had histologically confirmed severe liver fibrosis and received lamivudine (LAM) therapy for up to 10 years. Methods Thirty-nine CHB patients with severe liver fibrosis (Ishak fibrosis score≥4) were treated with LAM for up to 10 years. Disease progression liver histological improvement, virological and biochemical responses were evaluated during follow-up. Data were analyzed using paired t test, Fisher exact test and Willcoxon test. Results Twenty-eight patients completed the 10-year follow-up. There were 5 (17.9% ) patients with disease progression.At the end of follow up, 16 patients received a second liver biopsy, which showed significant improvement of histological activity index (1.1 ± 1.4 vs 7. 1 ± 3.2, t =- 0.82, P＜0.01 ) and Ishak fibrosis score (3.6±2.2 vs 5.3±0.7, t= -2.89, P＜0.05) compared to baseline. There were 3 cases with Ishak fibrosis score improved from F5 to F0. Among 27 patients, 3(11% ) cases achieved hepatitis B surface antigen (HBsAg) loss and 2 (7 % ) achieved HBsAg seroconversion. At the end of follow-up, 19 out of 23 (83% ) hepatitis B e antigen (HBeAg) positive patients obtained HBeAg loss and 9 (39 % ) obtained HBeAg seroconversion. During LAM treatment, 11 patients experienced virological breakthrough or detected documented LAM-related resistance mutation. The viral loads of all patients were below 1 ×103 copy/mL at the end of follow-up after rescued by add-on or switch to another nucleotide analog.Conclusions Long-term LAM therapy can delay the disease progression in CHB patients with severe liver fibrosis, increase HBsAg and HBeAg loss rates, sustain suppression of HBV replication at a low level and even totally reverse the liver fibrosis in some patients. The effect of LAM resistance mutation on disease outcomes would be reduced by rescue therapy.     

耐氟康唑光滑念珠菌ERG11基因突变分析

Objective To study the mutations of ERG11 gene which encodes P450 lanosterol 14-α demethylase, and to explore the possible role of ERG11 gene in inducing fluconazole resistance in Candida glabrata. Methods ERG11 genes of 9 fluconazole-resistant Candida glabrata isolates and 10 fluconazole-sensitive Candida glabrata isolates were cloned into pUC57-T vector. The open reading frame of ERG11 gene were sequenced by two directional sequencing using universal primers. All sequences were compared with the published sequence. Results Ten kinds of synonymous point mutation were found. Neither missense mutation nor frame-shifting mutation was found. Among the 10 kinds of synonymous point mutation, 5 were found in both fluconazole-resistant and fluconazolesensitive Candida glabrata isolates, and 3 were only found in fluconazole-resistant isolates, 2 were only found in fluconazole-sensitive ones. The majority of the point mutations were located between 1320-2200 base pair of ERG11 gene. Conclusions There are ERG11 gene polymorphisms in clinical strains of Candida glabrata. ERG11 gene mutations are not found to be involved in the development of fluconazole resistance in Candida glabrata.     

携带新德里金属β-内酰胺酶基因-1的细菌在全球蔓延

自2008年10月Yong D等首次报道以来,携带新德里金属β-内酰胺酶基因(NDM)-1的细菌感染已经相继在瑞典、中国香港、英国、美国、加拿大、澳大利亚、荷兰、德国等多个国家和地区被发现.由于这些菌株对除替加环素和多黏菌素以外的几乎全部抗菌药物耐药,新闻报道中称之为"超级细菌"(superbugs).     

肝硬化失代偿期并发自发性细菌性腹膜炎临床分析

肝硬化患者、腹水患者由于防御机制不足,表现出较高的细菌易感性.其中最常见且最严重的感染性并发症是自发性细菌性腹膜炎(SBP),国外报道其发病率为25%[1].为了更准确、及时地诊断和治疗SBP,笔者对我院收治的48例肝硬化并发SBP患者的临床表现、腹水常规及病原学检查、药敏试验及治疗结果进行回顾性分析,现报道如下.     

三个品种豚鼠血液蛋白多态性的比较分析

新生隐球菌是一种具荚膜的酵母样真菌,主要侵犯中枢神经系统和肺脏,好发于免疫功能低下的成人。近年来隐球菌病的发病率越来越高,因而引起国内外真菌学家的高度重视。系统研究新生隐球菌感染导致疾病的关键是动物实验。该菌感染最常用的动物模型主要是小鼠、大鼠和豚鼠,其他动物如兔、猪和一些非哺乳动物也已被用于制作新生隐球菌动物模型。这些动物模型的构建对进一步研究新生隐球菌发病机制、免疫学变化、疫苗的开发和有效的药物的筛选等有极其重要的作用,现就近几年新生隐球菌感染动物模型的进展作一综述。     

上海市金山地区乙型肝炎病毒感染危险因素分析

为探讨上海市金山区乙型肝炎病毒（HBV）感染的危险因素,我们以65例HBsAg阳性者为研究对象,采用1：2病例对照研究,对照组130例,均为HBV血清学阴性的患者。单因素分析发现HBV感染的危险因素有乙肝家族史、口腔诊疗史、无乙肝疫苗接种史。进一步多因素分析显示乙肝家族史（OR=1．91）、无乙肝疫苗接种史（OR=0．49）和口腔诊疗史（OR=2．06）是HBV感染的独立危险因素。加强乙肝疫苗接种和乙肝防治知识的健康宣教,改变不良生活习惯,规范口腔诊所诊疗行为是降低本地区乙肝感染率的重要措施。