肝硬化后肠道细菌移位的发生与防治进展

肝硬化后易并发内毒素血症、细菌及真菌感染,肠道细菌移位是其并发感染,甚至多脏器功能衰竭的主要原因之一。有关动物实验研究及临床观察发现,肠粘膜屏障功能受损、机体免疫功能下降是发生肠道细菌移位的主要机制。预防和纠正肠道菌群紊乱、加强肠道营养支持、增强机体免疫功能等能有效防治肠道细菌移位。     

谷氨酰胺防治急性肝衰竭大鼠肠道细菌移位实验研究

目的探讨谷氨酰胺（Gln）对急性肝衰竭（AHF）大鼠肠道细菌移位防治作用及机制。方法SD大鼠随机分成4组，对照组（A组），防治组（B组），治疗组（c组），模型组（D组）。B组、c组、D组腹腔注射D．氨基半乳糖（GaIN）建立急性肝功能不全大鼠模型。A组及D组予生理盐水灌胃。B组造模前两天予Gln灌胃防治，C组造模后一天Gln灌胃治疗。4d后处死动物。进行肝脏病理评分；观察肠系膜淋巴结细菌移位及平均组织含菌量、肠组织学改变；测量回肠绒毛高度和隐窝深度；检测血浆二胺氧化酶含量。结果B组和C组肝脏病理评分明显低于D组。B组肠系膜淋巴结细菌移位率低于D组，有显著性差异。B组、C组的血浆二胺氧化酶含量低于D组。B组显著低于C组。B组及C组的回肠绒毛高度和隐窝深度明显高于D组。B组明显高于C组，差异显著。结论谷氨酰胺可改善AHF大鼠的肠道黏膜屏障功能，减少AHF大鼠的肠道细菌移位的发生。     

阿德福韦酯对HBeAg阳性慢性乙型肝炎的疗效研究

目的观察阿德福韦酯佐治拉米夫定耐药型HBeAg阳性慢性乙型肝炎的临床疗效,关注治疗对血清中白细胞介素-12(IL-12)和白细胞介素-18(IL-18)的影响。方法收集医院确诊的拉米夫定耐药型HBeAg阳性慢性乙型肝炎患者132例,依入院顺序和随机区组的原则分为两组,观察组66例,应用阿德福韦酯和拉米夫定进行临床治疗,对照组66例,单纯应用阿德福韦酯治疗,观察两种方法的疗效及对血清中IL-12和IL-18表达的影响,采用SAS6.12软件进行统计分析。结果观察组的ALT、AST、T-Bil的下降值分别为(175.42±34.24)U/L、(80.40±15.42)U/L、(29.64±8.57)μmol/L,对照组分别为(124.40±24.36)U/L、(56.57±12.87)U/L和(15.69±2.35)μmol/L,观察组明显高于对照组,两组比较差异有统计学意义(P<0.05);观察组HBV-DNA和HBeAg转阴率分别为69.70%和57.58%,对照组分别为46.97%和34.85%,观察组明显高于对照组,两组比较差异有统计学意义(P<0.05);观察组治疗后血清中IL-12和IL-18分别为(67.80±13.58)μmol/L和(79.75±19.86)μmol/L、对照组分别为(89.86±28.76)μmol/L和(97.80±24.46)μmol/L,观察组的表达明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论阿德福韦酯联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎的临床疗效理想,且能有效下调血清中IL-12和IL-18的表达,进而调节机体的内环境,临床治疗中可以积极应用。     

95例甲型H1N1流感患者危险因子及临床治疗分析

Objective To explore the curative effect of antivirus drugs to the patients with different degree A(H1N1) influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A( H1N1) influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, oseltamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor (5.3%, 18.2%,66.1%, P<0.05), persistent fever period (2.2 days,5.6 days, 9.4 days, P<0.01), courses of treatment of oseltamivir were (4.1 ±0.4) days, (6.3 ±0.5) days, (9.2±1.8) days respectively ( P < 0.05). There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral(P<0.01). Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticoeteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.     

复方鳖甲软肝片治疗酒精性肝硬化疗效观察

笔者应用复方鳖甲软肝片治疗酒精性肝硬化21例，取得了较好疗效，现报道如下。     

联合治疗原发性胆汁性肝硬化疗效观察

原发性胆汁性肝硬化（Primarybiliarycirrhosis，PBC）是一种病因未明的慢性进行性胆汁淤积性肝病，多见于中年女性，一般认为与自身免疫有关。发病率3～15／10万，并有逐年上升趋势。目前无特效治疗方法，通常采用糖皮质激素治疗，但疗效不佳，且副作用多。回顾杭州市第六医院6年收治的34例PBC患者疗效，发现联合治疗是治疗PBC的较好治疗方案，现报道如下。     

95例甲型H1N1流感患者危险因子及临床治疗分析

Objective To explore the curative effect of antivirus drugs to the patients with different degree A(H1N1) influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A( H1N1) influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, oseltamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor (5.3%, 18.2%,66.1%, P<0.05), persistent fever period (2.2 days,5.6 days, 9.4 days, P<0.01), courses of treatment of oseltamivir were (4.1 ±0.4) days, (6.3 ±0.5) days, (9.2±1.8) days respectively ( P < 0.05). There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral(P<0.01). Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticoeteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.     

95例甲型H1N1流感患者危险因子及临床治疗分析

目的 通过对确诊甲型H1N1流感成人患者救治手段,主要是药物治疗的综合分析,以探讨针对不同病情的甲型H1N1流感患者抗病毒药的临床应用和疗效以及合理的治疗方案.方法 收集2009年6月至2010年2月在我院确诊并治疗的甲型H1N1流感成人患者共95例,采用回顾性研究的方法,根据病情分3组:轻症、重症和危重症,分别对各组患者健康情况、住院天数、最高体温、发热持续时间、奥司 他韦服用情况及开始时间、联合其他抗病毒药情况及综合支持治疗等进行综合分析.结果 有重症化危险因素的人数在3组病例中所占比率分别为5.3%、18.2%、66.7%,两两比较差异均有统计学意义(P<0.05).持续发热的平均时间3组病例分别为2.2、5.6和9.4 d(P<0.01).开始口服奥司他韦平均时间危重组明显晚于其他两组(P<0.01);口服奥司他韦疗程分别为(4.1±0.4.)d、(6.3±0.5)d和(9.2±1.8)d(P<0.05);常规剂量奥司他韦不良反应极少.危重组患者的病毒清除时间明显延长.呼吸机辅助呼吸、抗生素应用、皮质类固醇激素应用、血浆支持等综合治疗对重症患者是必要的.结论 存在危重高危因素,尤其是有呼吸道及内分泌(特别是糖尿病)等基础疾病的患者更易重症化.发热时间越长,重症化倾向也越大.奥司他韦是安全有效的,但需尽早应用;重症患者,尤其是有呼吸道基础疾病的需延长疗效.对重症及危重患者的综合支持治疗至关重要.     

贞芪扶正胶囊对慢性乙型肝炎T淋巴细胞亚群的影响

2006年8月-2010年6月,笔者采用中西医结合的方法治疗慢性乙型肝炎（chronic hepatitis B,CHB）,以观察其对T淋巴细胞亚群的影响,现报道如下。     

重症甲型H_1N_1流感16例治疗与护理

甲型H1N1流感是一种新的甲型H1N1病毒引起的急性呼吸道传染病,具有较强的传染性,可以通过近距离飞沫和接触传播。人类对甲型H1N1流感病毒缺乏免疫力,普遍易感。