摘要:目的:分析本院住院城鎮及農村患者的乙型肝炎病毒感染及免疫情況,推測不同區域發病及免疫狀況,為免疫預防及臨床提供參考。方法:收集我科2000年度,2004年度,2008年度住院患者的乙肝五項檢測報告,按患者長期居住地分為農村組及城鎮組,對比分析兩組患者乙型肝炎病毒感染、具有免疫力及無免疫力年度變化情況及不同組別的差異。結果:同農村組相比,城鎮組乙型肝炎病毒感染率、無免疫率低于農村組,免疫率高于農村組。年度對比乙型肝炎病毒感染率及免疫率呈上升趨勢,無免疫率呈下降趨勢。結論:近年來乙型病毒性肝炎發病有上升趨勢,農村地區免疫普及率相對較低,仍為發病及預防免疫的重點區域,應給予足夠重視。Abstract: Objective: To observe the disposition of infection and immunifaction on type B hepatitis in patients from hospital, suppose the disposition of infection and immunifaction in differently region, and provide information for immunifaction and clinical treatment. Methods: Reports of type B hepatitis from patients in hospital were collected, and were divided into town group and country group according to the habitation of patients. The difference of infection, immunifaction and no immunifaction were compared between two groups. Results: In comparison with the country group, the percentage of infection and no immunifaction was lower in town, and immunifaction was higher, attack rate of type B hepatitis had a tendency to increasing and no immunifaction was decreased by contrasting with annum. Conclusion: Recent years, attack rate of type B hepatitis has a tendency to increasing, and the popular rate of immunifaction is lower in country, so country is still the focal point of immunifaction and infection, and sufficient attention must be paid.
Objective To study the relationship of hepatitis B virus （HBV） to spontaneous rupture of hepatocellular carcinoma （HCC-SR） and its mechanism. Method The related literatures about theory of HCC-SR were consulted and reviewed. Results The injury of small arteries was usually followed in patients with HCC-SR， which was related to vascular autoimmune injury caused by the HBV infection. The small arteries in which immune complex deposited were readily injured， as a result HCC-SR happened while vascular load increased. Conclusion The HBV infection resulted in vascular autoimmune injury maybe a important factor in the pathogenesis of HCC-SR.
Objective To evaluate the efficacy and safety of antiviral drugs for hepatitis B with YMDD motif variant. Methods We electronically searched MEDLINE (1989-April, 2004), EMBASE (1989-April, 2004), CBMdisc (expand) (1989-April, 2004), and handsearched unpublished Chinese conference proceedings. Randomized and quasi-randomized trials in patients with chronic hepatitis B with YMDD motif variant correlative to lamivudine were collected. Two reviewers extracted the data and assessed the quality of literature independently. The data were then analyzed by RevMan 4.2 software. Results Five studies involving 6 trials and 284 patients were included. According to the results of meta-analysis, antiviral therapy with adefovir plus lamivudine showed significantly better effects on the clearance of serum HBV-DNA and HBeAg and normalization of ALT than that of lamivudine alone (RR 16.61, 95%CI 2.29 to 120.71; RR 6.66, 95%CI 1.23 to 35.88 and RR 6.26, 95%CI 2.29 to 17.12 respectively); also, oxymatrine plus thymothin showed obviously better effects on the clearance of serum HBV-DNA and HBeAg (RR 2.96, 95%CI 1.26 to 6.93 and RR 2.51, 95%CI 1.05 to 5.98 respectively).But adefovir alone showed no better effects on clearance of serum HBV-DNA and HBeAg than that of lamivudine alone (RR 11.00, 95%CI 0.65 to 186.02 and RR 7.00, 95%CI 0.39 to 126.92 respectively); interferon plus lamivudine showed no better effects on the clearance of serum HBV-DNA, HBeAg and the normalization of ALT (RR 3.50, 95%CI 0.90 to 13.58; RR 4.90, 95%CI 0.70 to 35.10 and RR 2.80, 95%CI 0.91 to 8.12 respectively). Chinese herbs plus lamivudine showed no better effects on the clearance of serum HBV-DNA (RR 1.16, 95%CI 0.89 to 1.51). There were no significant side effects in the groups, except flu like symptom in the interferon group, slight kidney impairment in the adefovir group, and aggravation of rare cases in lamivudine group. Conclusions Antiviral therapy with adefovir plus lamivudine, or oxymatrine plus thymothin, shows better effects than with lamivudine alone in terms of antiviral therapy and clinical outcome improvement. However, the evidence is too weak to draw a definite conclusion in this systematic review. Larger sample size and rigorously designed randomized, double blind, placebo control trials are required for future study.
目的:觀察乙酰半胱氨酸注射液(NAC)治療慢性重型乙型肝炎的療效。方法:收治的慢性重型肝炎早、中期分為對照組(57例),治療組(58例),對照組給予一般支持治療、門冬氨酸鉀鎂,血漿或白蛋白等基礎治療及促肝細胞生長素100mg/d。治療組在對照組的基礎上加用乙酰半胱氨酸注射液8g/d靜脈滴注,療程30d,并于用藥前,用藥后15d,30d分別抽血查肝功,凝血酶原活動度。結果:治療組血清總膽紅素(TBil),凝血酶原活動度(PTA)的改善程度明顯優于對照組,差異有統計學意義。結論:乙酰半胱氨酸注射液能明顯降低患者血清TBil,提高PTA,對重型肝炎的治療有較好的幫助。
ObjectiveTo investigate the clinical value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of decompensated cirrhosis. MethodThe preoperative and postoperative clinical data of 4 patients who received small-for-size left lobe liver APOLT in 2023 were retrospectively described and analyzed. ResultsOne patient suffered metabolic liver disease cirrhosis and the other three suffered hepatitis B cirrhosis, all of whom presented with decompensated cirrhosis. Preoperative evaluation showed that the graft-to-recipient weight ratio was less than 0.6%. All recipients underwent left hemihepatectomy. The grafts were derived from living donors in 3 cases, from donation after citizen death in 1 case. After APOLT treatment, 4 patients and grafts survived, 1 patient experienced transplantation rejection and recovered after modified anti-rejection therapy. Three patients with hepatitis B cirrhosis were treated with nucleoside analogues and hepatitis B immunoglobulin, the hepatitis B virus DNA was negative at the end of follow-up, one of three patients with hepatitis B cirrhosis showed negative results for hepatitis B virus in the graft biopsy at month one after surgery. ConclusionsFrom the summary results of these cases, small-for-size left lobe liver APOLT can be used to treat decompensated cirrhosis. The application and popularization of this treatment regimen is expected to expand the donor pool and benefit more decompensated cirrhosis patients with lower Model for End-stage Liver Disease score.
Objective To investigate the prevention of HBV reinfection in the perioperative period of liver transplantation on HBV-related diseases． Methods Published papers were collected and reviewed． Results HBV-related diseases were the main indications of liver transplantation．The prevention for HBV reinfection affects the survivals remarkably. Nowadays, a lot of medication have been used in the prevention of HBV reinfection， and the therapeutic regimens were different from each other. Conclusion Liver transplantation is an effective treatment for HBV-related disease． Appropriate prevention of HBV reinfection in the perioperative period of liver transplantation is important for the survivals of patients．
ObjectiveTo systematically review the efficacy of lamivudine (LAM) plus adefovir (ADV) versus entecavir (ETV) monotherapy for LAM-resistant chronic hepatitis B patients. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 12, 2013), CBM, CNKI, VIP, WanFang Data from their inception to December 2013, to collect randomized controlled trials (RCTs) or cohort studies of LAM+ADV versus ETV for LAM-resistant chronic hepatitis B. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs and 5 cohort studies involving 1 336 patients were included. The results of meta-analyses of RCTs showed that:there were no significant differences between the LAM+ADV group and the ETV group in the negative rates of serum HBV-DNA (RR=1.00, 95%CI 0.91 to 1.10, P=0.94), HBeAg (RR=0.90, 95%CI 0.70 to 1.17, P=0.43), serum ALT recovery rate (RR=0.97, 95%CI 0.90 to 1.05, P=0.45) and serum HBeAg conversion rate (RR=0.71, 95%CI 0.40 to 1.24, P=0.22) at the 48th week. The results of meta-analyses of cohort studies showed that:there were no significant differences between the two groups in the negative rates of serum HBV-DNA (RR=1.37, 95% CI 0.91 to 2.06, P=0.13) and serum ALT recovery rate (RR=0.99, 95%CI 0.87 to 1.12, P=0.87), but the ETV group had higher serum HBeAg conversion rate (RR=0.24, 95% CI 0.07 to 0.79, P=0.02). ConclusionCurrent evidence shows that the efficacy of LAM+ADV is similar to ETV at the 48th week for LAM-resistant chronic hepatitis B patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.