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丙型病毒性肝炎相关性冷球蛋白血症二例

The association between levels of serum leptin and hepatitis C virus: a meta-analysis

ObjectivesTo systematically review the association between serum leptin level and hepatitis C virus.MethodPubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect case-control studies on the association between serum leptin level and hepatitis C virus from 2007 to July, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 studies including 1 115 patients were included. The results of meta-analysis showed the serum leptin level was higher in hepatitis C patients than in healthy people (SMD=0.68, 95%CI 0.44 to 0.91, P<0.000 01). The results of subgroup analysis showed that, in hepatitis C patients whose serum leptin levels detected by RIA and European population, serum leptin levels were higher. Women had higher serum leptin levels than men in hepatitis C virus patients (P<0.000 01).ConclusionThe serum leptin level is associated with hepatitis C virus and the serum leptin levels of women are higher than those in men. Due to limited quantity and quality of the included studies, more high quality studies are required to verify above conclusions.

免疫检查点抑制剂治疗合并乙型肝炎或丙型肝炎的晚期非小细胞肺癌的安全性及疗效分析

目的 探讨合并乙型肝炎或丙型肝炎的晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）治疗的安全性和疗效。方法 回顾性分析5例合并乙型肝炎或丙型肝炎的NSCLC，观察谷丙转氨酶（alanine aminotransferase，ALT）水平、病毒载量和总生存期。结果 1例活动性乙型肝炎和1例活动性丙型肝炎启动ICIs治疗时，ALT升高，加用抗病毒和保肝治疗，ALT即恢复正常。2例活动性和1例慢性乙型肝炎ICIs治疗，ALT持续正常水平。2例完全缓解，3例部分缓解，目前死亡2例，最长总生存期35.7个月，其余3例仍在随访中。结论 乙型肝炎或丙型肝炎不影响ICIs在NSCLC中的治疗地位，包括在部分NSCLC的一线治疗，全程监测肝功能和病毒拷贝数，推荐联合抗病毒治疗（特别对合并乙型肝炎），个体化调整抗病毒时机及疗程。