抗乙型肝炎病毒药物疗效的比较

慢性乙型肝炎治疗相当复杂,抗病毒治疗是关键.已被批准的6种抗病毒药物大多已广泛应用于临床,抗病毒治疗取得很大的进展.此文对常用的几种抗病毒药物疗效进行综述.     

散发性麻疹的流行特征

由于麻疹减毒活疫苗的广泛应用，麻疹发病率大大下降，临床已呈散发，平均发病年龄后移，流行特征有了新的变化。本文对1999～2004年本科收治31例麻疹患者对其流行特征进行分析，现报告如下。     

程序性细胞凋亡基因单核苷酸多态性与慢性乙型肝炎患者干扰素早期病毒学应答的相关性

Objective To investigate the relationship between the single nucleotide polymorphisms (SNP) of programmed cell death-1 (PD-1) gene and early virologic response of interferon-α (IFN-α) in patients with chronic hepatitis B (CHB). Methods A total of 135 CHB patients were prospectively enrolled in this study. SNP of PD-1.1 and PD-1.2 genes were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in these patients.Then its relationship with early virologic response to IFN-α treatment was analyzed. The data were analyzed by x2 test. Results Among the 135 patients, 33 (24.4%) achieved early virologic response to IFN-α. There were 35, 77, and 23 patients with AA, AG, GG genotgpe of PD-1.1. The early virologic response was achived in 5(14.3%), 25(32.5%) and 3(13.0%) among patients with AA,AG, GG genotypes of PD-1.1, respectively. There were statistically different (x2 = 6. 258, P =0. 044). The subjects with AG genotype showed higher response rate than those with AA or GG genotypes (x2 = 6. 246, P= 0. 012). However, the early virologic response rates were not significant different among subjects with AA, AG or GG genotype of PD-1. 2 ( x2= 3.957, P= 0. 138).Conclusion SNP of PD-1.1 gene may be used as a marker to predict the early virologic response to IFN-α treatment in Chinese CHB patients.     

拉米夫定联合母牛分枝杆菌菌苗治疗慢性乙型肝炎临床观察

目的　观察拉米夫定联合母牛分枝杆菌菌苗治疗慢性乙型肝炎 (CHB)的疗效。方法　 64例CHB患者随机分成治疗组 3 1例 (拉米夫定联合母牛分枝杆菌菌苗组 )和对照组 3 3例 (拉米夫定组 ) ,观察两组患者肝功能、HBeAg及HBVDNA的变化情况。结果　治疗组ALT复常率明显高于对照组 ( 3个月时P >0 .0 5 ,6个月、9个月、12个月时P <0 .0 5 ) ,HBVDNA阴转率也高于对照组 ,但差异无显著性 (P >0 .0 5 )。结论　拉米夫定联合母牛分枝杆菌菌苗治疗CHB较单用拉米夫定效果好 ,可以提高抗病毒疗效     

干扰素治疗慢性乙型肝炎出现HBsAg/抗-HBs血清转换后病情复发

目的探讨干扰素治疗慢性乙型肝炎出现HBsAg血清转换后再转为阳性对病情的影响。方法 5例慢性乙型肝炎患者在使用干扰素治疗发生HBsAg血清转换,而后再现HBsAg阳性的病史特点、临床表现以及治疗过程中的肝功能、HBV DNA和HBeAg等变化情况。结果 5例患者接受干扰素治疗时间为3～15个月,在治疗开始后3～18个月发生HBsAg转阴;3例HBeAg阳性患者在HBsAg转阴之前或同时出现HBeAg转阴,但未发生HBeAg/抗HBe血清转换;5例患者HBsAb持续存在6～18个月后消失,且HBsAg在同时或之后复阳;1例患者在治疗后30个月时HBV DNA为3.36×106copies/ml,ALT为98u/L,开始接受替比夫定治疗;1例患者在干扰素治疗过程中发生白癜风。结论干扰素治疗慢性乙型肝炎患者出现HBsAg血清转换后再转为阳性可能与患者未出现HBeAg血清学转换、治疗时间不够长或肝内存在HBV cccDNA等有关。     

甘草酸二铵联合恩替卡韦治疗老年慢性乙型肝炎的效果及对炎症标志物、MCP-1、VEGF和sST2水平的影响

目的 探讨甘草酸二铵联合恩替卡韦对老年慢性乙型肝炎(慢乙肝)患者疗效及对炎症标志物、单核趋化蛋白(MCP)-1、血管内皮生长因子(VEGF)和可溶性生长刺激表达基因(sST)2水平影响。方法 选择慢乙肝患者126例，依据随机数字表法分为对照组与治疗组各63例。对照组给予恩替卡韦治疗，治疗组在恩替卡韦治疗基础上联合甘草酸二铵。两组治疗疗程12 w。比较两组临床疗效，治疗前与治疗12 w肝功能、肝纤维化、炎症标志物、MCP-1、VEGF和sST2水平变化及不良反应。结果 治疗组治疗总有效率显著高于对照组(P<0.05)。两组治疗12 w天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)和丙氨酸氨基转移酶(ALT)水平显著低于治疗前，且治疗组显著低于对照组(P<0.05)。两组治疗12 w透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原Ⅳ端肽(PC-Ⅲ)和Ⅳ型胶原(Ⅳ-C)水平显著低于治疗前，且治疗组显著低于对照组(P<0.05)。两组治疗12 w白细胞介素(IL)-4、IL-6和肿瘤坏死因子(TNF)-α水平显著低于治疗前；且治疗组显著低于对照组(P<0.05)。两...     

干扰素-α治疗HBeAg阳性慢性乙型肝炎患者的疗效及影响因素分析

目的探讨HBeAg阳性慢性乙型肝炎(CHB)患者干扰素-α(IFN-α)疗效的影响因素。方法收集105例HBeAg阳性CHB患者,检测IFN-α治疗前及治疗12周时的ALT、HBV-DNA、HBsAg、HBsAb、HBeAg、HBeAb、HBcAb;分析年龄、性别、ALT基线水平、HBV-DNA基线水平对IFN-α疗效的影响。结果不同年龄段组间IFN-α疗效差异有统计学意义(P<0.05);ALT基线水平>120 U/L(<400 U/L),HBV-DNA基线水平<107拷贝/ml均能取得较好的疗效。结论 ALT基线水平、HBV-DNA基线水平、年龄可以作为预测IFN-α疗效的指标。     

基因多态性和慢性乙型肝炎干扰素疗效的相关性

影响慢性乙型肝炎(CHB)IFN疗效的因素很多,宿主免疫遗传背景的差异是重要原因之一.最近关于基因多态性和CHB患者IFN疗效的相关性研究越来越多,此文就相关的研究进展进行了简要综述.     

程序性细胞凋亡基因单核苷酸多态性与慢性乙型肝炎患者干扰素早期病毒学应答的相关性

目的 探讨程序性细胞凋亡基因-1(PD-1)单核苷酸多态性(SNP)与IFN-α治疗慢性乙型肝炎(CHB)患者发生早期病毒学应答的关系.方法 采用前瞻性队列研究方法,应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析技术,检测135例中国汉族抗病毒初治CHB患者的PD-1.1和PD-1.2的SNP,并分析其与IFN-α早期病毒学应答的关系.分类变量资料采用x2检验.结果 135例CHB患者IFN-α治疗获得早期病毒学应答有33例,占24.4%.PD-1.1的AA、AG、GG基因型各占35、77和23例,IFN-α的早期病毒学应答各有5、25和3例,分别占14.3%、32.5%和13.0%(x2＝6.258,P＝0.044),AG基因型相对AA、GG基因型有较高的病毒学应答率(x2＝6.246,P＝0.012).在PD-1.2的AA、AG、GG基因型之间比较IFN-α的早期病毒学应答,差异无统计学意义(x2＝3.957,P=0.138).结论 PD-1.1的SNP与中国汉族CHB患者IFN-α治疗早期病毒学应答有关.

Abstract：

Objective To investigate the relationship between the single nucleotide polymorphisms (SNP) of programmed cell death-1 (PD-1) gene and early virologic response of interferon-α (IFN-α) in patients with chronic hepatitis B (CHB). Methods A total of 135 CHB patients were prospectively enrolled in this study. SNP of PD-1.1 and PD-1.2 genes were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in these patients.Then its relationship with early virologic response to IFN-α treatment was analyzed. The data were analyzed by x2 test. Results Among the 135 patients, 33 (24.4%) achieved early virologic response to IFN-α. There were 35, 77, and 23 patients with AA, AG, GG genotgpe of PD-1.1. The early virologic response was achived in 5(14.3%), 25(32.5%) and 3(13.0%) among patients with AA,AG, GG genotypes of PD-1.1, respectively. There were statistically different (x2 = 6. 258, P =0. 044). The subjects with AG genotype showed higher response rate than those with AA or GG genotypes (x2 = 6. 246, P= 0. 012). However, the early virologic response rates were not significant different among subjects with AA, AG or GG genotype of PD-1. 2 ( x2= 3.957, P= 0. 138).Conclusion SNP of PD-1.1 gene may be used as a marker to predict the early virologic response to IFN-α treatment in Chinese CHB patients.     

阿德福韦酯治疗慢性乙型肝炎原发性无应答患者基因型耐药分析

目的：观察阿德福韦酯治疗慢性乙型肝炎原发性无应答患者基因型耐药的发生情况。方法：阿德福韦酯治疗慢性乙型肝炎原发性无应答患者155例,应用荧光定量PCR法检测其rtN236T、rtAl81V、rtAl81T耐药位点。结果：155例患者共检出基因型耐药16例,发生率为10．3％,其中rtN236T位点3例、rtAl81V位点7例、rtAl81T位点2例、rtAl81V＋rtAl81T位点2例、rtAl81T＋rtN236T位点1例、rtN236T＋rtAl81V＋rtAl81T位点1例。结论：阿德福韦酯治疗慢性乙型肝炎原发性无应答患者基因型耐药发生率并不高,疗效不佳可能与阿德福韦酯抑制乙型肝炎病毒DNA能力较弱,病毒水平下降速度较慢有关。