引起中药不良反应的常见因素及预防

随着医疗改革的不断深入，中医药事业的蓬勃发展，人们不但用中药治病，而且越来越多的用于预防和保健。但中药的不良反应临床上屡有报道，在整个药物不良反应中占有相当大的比例，达39．48％．这不能不引起人们的重视。     

非处方药（OTC）进入社区的适用范围及注意事项

随着我国社会主义市场经济的发展和人民文化、物质生活水平的提高，医疗保健体制改革的深入，为加强药品的监督管理，确保人民用药安全、有效，减轻国家与人民在医疗方面的负担，方便群众，将药品分为处方药(RX)和非处方药(OTC)两大类。国家决定实行非处方药管理制度，有利于     

乙型肝炎肝衰竭患者发生肝性脑病的多因素分析

目的 探讨乙型肝炎肝衰竭患者发生肝性脑病的危险因素,以便于临床早期干预,减少肝性脑病的发生.方法 收集976例乙型肝炎肝衰竭患者的基础临床资料(性别、年龄、家族史、肝硬化、糖尿病、腹腔感染、肺部感染、肝肾综合征、上消化道出血)和临床检测指标[白蛋白、球蛋白、总胆红素、直接胆红素、ALT、AST、Y-谷氨酰转移酶、碱性磷酸酶、胆固醇、胆碱酯酶、血钾、血钠、肌酐、国际标准化比值(INR)、甲胎蛋白、HBV DNA、白细胞计数、血红蛋白和血小板],进行单因素和多因素回归分析,筛选乙型肝炎肝衰竭患者肝性脑病发生的危险因素.结果 多元logistic回归分析结果显示,上消化道出血(回归系数为0.993,比值比为2.699,95％可信区间为1.567～4.651)、肺部感染(回归系数为1.043,比值比为2.839,95％可信区间为1.680～4.797)、INR(回归系数为0.257,比值比为1.293,95％可信区间为1.220～1.370)、AST(回归系数为0.001,比值比为1.001,95％可信区间为1.000～1.001)和肝硬化(回归系数为0.569,比值比为1.815,95％可信区间为1.112～2.965)是影响肝衰竭患者肝性脑病发生的危险因素.结论 上消化道出血、肺部感染、INR延长、AST升高以及肝硬化是诱发肝衰竭患者发生肝性脑病的重要危险因素.     

HBeAg阳性慢性乙型肝炎患者HBV基因型和亚型与肿瘤坏死因子α的关系

目的探讨福建部分地区HBeAg阳性慢性乙型肝炎(CHB)患者HBV基因型、亚型的分布与血清肿瘤坏死因子α(TNF-α)水平及其基因启动子区-238、-308位点基因多态性的关系。方法选取福建部分地区203例HBeAg阳性CHB患者,采用HBV基因分型(B、C基因型)荧光定量PCR法检测HBV基因型或HBVS基因为直接测序法检测HBV基因型、亚型;聚合酶链反应-限制性片段长度多态性分析(PCR-RFLP)的方法检测TNF-α-238及-308位点基因多态性,酶联免疫吸附试验(ELISA)测定血清TNF-α水平,并对结果进行统计分析。结果 HBV基因型B、C分别占58.6%、41.4%,其中150例HBVS基因为直接测序,Ba亚型81例,Ce亚型69例;B基因型患者平均年龄和体重指数(BMI)小于C型(P=0.020)。HBV基因型B、C的TNF-α水平、TNF-α-238和-308位点基因多态性的分布无统计学差异(P0.05)。结论福建部分地区HBeAg阳性CHB患者HBV基因型以B型为主,其次是C型,仅见Ba和Ce亚型;B基因型患者较年轻,BMI小于C型;但HBV基因型B、C与TNF-α水平、TNF-α-238和-308位点基因多态性可能无关。     

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.     

浅谈应用中医药辅助治疗胃癌的临床进展

近年来,应用中医药辅助治疗胃癌的方法受到了临床医师的重视.过去以中药单方为主治疗胃癌的方法已经被扶正、祛邪相结合的中医疗法所取代.本文主要对近年来应用中医药辅助治疗胃癌的分子机制研究成果及相关疗法进行总结,以分析应用中医药辅助治疗胃癌的疗效.     

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.     

人巨细胞病毒蛋白pp71的研究进展

研究表明，人巨细胞病毒(HCMV)感染和多种疾病相关，特别是在接受移植的患者和免疫缺陷的人群中，HCMV的感染常常导致严重的并发症。随着医学的发展，HCMV致病的有关机制也在不断的深入研究和了解之中，本文就其在致病过程中起重大作用的磷酸化的胞膜蛋白71(pp71)的作用作一介绍。     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎患者的生化学应答预测因素分析

阿德福韦酯(ADV)对HBV野生株和拉米夫定耐药变异株均有活性,且耐受性好,不易出现耐药[1].但临床中ADV治疗慢性乙型肝炎(CHB)时,有的疗效较好,有的疗效欠佳,而影响疗效的因素主要包括宿主及病毒.TNF-α是具有广泛生物活性的细胞因子,其单核苷酸多态性反映了不同种族和个体之间的遗传差异[2];而HBV基因型是否影响ADV疗效,相关研究也未得出较一致的结论.为此,本研究同时分析宿主和病毒因素,探讨ADV治疗HBeAg阳性CHB患者48周生化学应答的预测因素,以期提高疗效.     

HBeAg阳性慢性乙型肝炎患者肿瘤坏死因子α基因启动子区-238和-308位点基因多态性分析

目的探讨HBeAg阳性慢性乙型肝炎(CHB)患者肿瘤坏死因子α(TNF-α)基因启动子区-238和-308位点基因多态性及其与血清TNF-α水平的关系。方法对203例HBeAg阳性CHB患者,采用聚合酶链反应-限制性片段长度多态性分析法检测TNF-α-238和-308位点基因多态性;采用ELISA法测定血清TNF-α水平。结果 TNF-α-238G/G、G/A基因型频率分别为84.7%和15.3%,-308G/G、G/A、A/A基因型频率分别为76.8%、22.7%和0.5%;TNF-α-238G/A基因型患者血清TNF-α水平低于G/G基因型(201.2±36.3pg/ml对215.7±34.7pg/ml,x2=4.355,P=0.037),-308G/A基因型TNF-α水平高于G/G基因型(234.6±37.5pg/ml对207.4±32.3pg/ml,x2=14.653,P0.001)。结论 TNF-α-238G/G或-308G/A基因型患者血清TNF-α水平相对较高。