摘要:目的: 观察拉米夫定联合阿德福韦酯治疗E抗原阴性的慢性乙型肝炎患者的疗效和安全性。 方法 :2006～2007年来我院就诊的慢性乙型肝炎患者,给予拉米夫定100 mg/d,阿德福韦酯 100 mg/d,观察治疗前及治疗后12、24 及48周谷丙转氨酶水平、HBV DNA水平、乙型肝炎病毒血清标志物的应答效果及肾功能变化。 结果 :治疗12周、24周和48周时,HBV DNA转阴率分别为17%、43%和87%,且各组间差异具有统计学意义(P lt;005);ALT复常率分别为13%,67%和100%,且各组间差异具有统计学意义(P lt;005);治疗48周时,所有患者均未发生表面抗原的消失;整个治疗过程中,患者的耐受性良好,未发生一例严重不良事件。 结论 :拉米夫定联合阿德福韦酯治疗E抗原阴性的慢性乙肝患者,可获得较好的临床疗效,该治疗策略为临床抗病毒治疗提供了新的选择。Abstract: Objective: To observe the curative efficacy and safety of lamivudine combined with adefovir dipivoxil on HBeAgnegative initial treated chronic hepatitis B (CHB) patients. Methods : Outatients from our hospital between June, 2006 and August, 2007, who received lamivudine 100 mg and adefovir dipivoxil 10 mg per day were screened. And the level of ALT, HBV DNA, and urea nitrogen, as well as the statue of HBsAg and antiHBs were detected at week 12, 24, and 48 Results : The undetectable rates of HBV DNA were 17%, 43%, and 87% at week 12, 24, and 48 respectively, and the difference in response rate were statistic significantly (Plt;005). The ALT normalization rate were 13%, 67%, and 100% at week 12, 24, and 48 respectively, and the difference in response rate were statistic significantly (Plt;005); During the course of antiviral therapy, the loss of HBsAg was not observed and all patients were well tolerated. Conclusion : The combination of lamivudine and adefovir dipivoxil were effective for HBeAgnegative CHB patients, and this treatment strategy provided us a new option in clinical antiviral practice.
ObjectiveTo investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of hip arthrosis in patients with ankylosing spondylitis (AS). MethodsA retrospective analysis was made on the clinical data from 131 patients (195 hips) who underwent THA for AS between September 2001 and August 2011 with a follow-up period of more than 2 years. There were 100 males (152 hips) and 31 females (43 hips), aged 17-69 years (mean, 33.7 years). The average interval between AS onset and THA was 13.7 years (range, 1-50 years). The left hips were involved in 30 cases, the right hips in 37 cases, and bilateral hips in 64 cases. Preoperative Harris hip score was 18.0±13.7; the sum passive range of motion was (36.2±51.2)°; and the hip passive-flexion arc was (23.4±32.6)°. In 175 hips with passive flexion of less than 90°, 134 hips had flexion contracture. Based on preoperative X-ray films and CT scan, 195 hips were divided into the non-ankylosed subgroup (86 hips), fibrous ankylosed subgroup (43 hips), and bony ankylosed subgroup (66 hips); and the recovery of hip function was compared between subgroups after operation. ResultsIntraoperative complications included linear fractures of femoral calcar in 4 hips, fractures of acetabular posterior column in 1 hip, femoral shaft fractures in 2 hips, and iatrogenic sciatic nerve injury in 3 hips; postoperative complications included anterior dislocation in 2 hips. The average follow-up period was 51.3 months (range, 24-143 months). Bone healing was observed at 3-6 months after operation (mean, 3.9 months). At last follow-up, the average Harris hip score increased to 86.4±14.1, the sum passive range of motion increased to (202.0±28.0)°, and the hip passive-flexion arc increased to (93.2±15.3)°, all showing significant differences when compared with preoperative ones (P<0.05). Based on a four-class scale for subjective satisfaction, the patients were very satisfied, satisfied, and not satisfied with the results of THA in 100, 80, and 15 hips respectively. X-ray films showed radiolucent line (<2 mm) in 5 acetabular components (zones I and II); heterotopic ossification was observed in 49 hips after THA. There was no significant difference in the Harris hip score among 3 subgroups after THA at last follow-up (P>0.05). At last follow-up, the degree of passive flexion in the fibrous ankylosed subgroup and bony ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P<0.05), and the sum passive range of motion in the fibrous ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P<0.05), but no significant difference was found in the other variables among the 3 sub groups (P>0.05). ConclusionFor severe hip arthrosis in patients with AS, the overall outcomes after THA are ideal with a good midterm prosthetic survivorship, a low complication rate, and a high satisfaction of patients. However the hip function after THA is still less satisfactory.
ObjectiveTo explore the effectiveness of lamividine (LAM) combined with adefovir (ADV) versus entecavir (ETV) for lamivudine-resistant (LAM-R) hepatitis B in renal transplant recipients. MethodOutpatients and inpatients of lamivudine-resistant kidney graft recipients with chronic hepatitis B admitted to West China Hospital and the People's Hospital of Santai County during Jan 2007 to Mar 2012 were divided into A group (LAM+ADV) and B group (ETV). And the level of alanine aminotransferase (ALT), level of serum creatinine, HBV serological markers and HBV-DNA load were compared by SPSS 16.0 software. ResultsA total of 15 patients were included. The mean age was 36.7±6.6 years old, the majority of patients were male. After treatment for 4 weeks, 12 weeks, 24 weeks, 48 weeks, 96 weeks, no significant differences were found between two groups in liver function normalization rates, the HBV-DNA negative conversion rates and serum creatinine level. ConclusionsLAM add-on ADV combination therapy and ETV monotherapy were both safe and effective in LAM-R kidney transplants with CHB, but the load of HBV-DNA in some patients were still positive at the endpoint. Elevated serum creatinine level may occur in some patients who treated with ADV. Consequently, for HBsAg-positive kidney transplantation patients, those anti-HBV drugs that are more effective, safer and less resistant may be better in the beginning of treatment.
ObjectiveTo analyze the relation between regulatory T cell (Treg)/ helper T cell 17 (Th17) imbalance and the pathogenesis of acute pancreatitis (AP) and to explore the relation between Treg/Th17 cell imbalance and helper T cells 1, helper T cells 2 and cytokines in patients with AP, so as to provide a new therapeutic target for immunotherapy of AP. Methods From January to December 2020, 40 patients diagnosed with AP ( AP group) in The People’s Hospital of Xinjiang Uygur Autonomous Region and 40 healthy subjects who underwent physical examination (normal control group) during the same period in this hospital were selected as the research objects. Their peripheral bloods were collected and the proportion of Treg and Th17 cells was detected by flow cytometry. Plasma levels of interleukin-10 (IL-10) and interleukin-17 (IL-17) were detected. Results Compared with the normal control group, the proportions of Treg and Th17 cells increased before treatment in the AP group, the differences were statistically significant (t=5.78, P<0.001; t=5.82, P<0.001). The levels of IL-10 and IL-17 increased, the differences were statistically significant (t=7.14, P<0.001; t=35.22, P<0.001). After treatment, the AP group as compared with the normal control group, the proportions of Treg and Th17 cells increased but the differences were not statistically significant (t=1.87, P>0.05; t=0.29, P>0.05), the level of IL-10 increased and the difference was statistically significant (t=3.98, P<0.001), the level of IL-17 increased but the difference was not statistically significant (t=1.67, P>0.05). After treatment as compared with before treatment in the AP group, the proportions of Treg and Th17 cells decreased, the differences were statistically significant (t=3.07, P<0.01; t=4.99, P<0.001). The levels of IL-10 and IL-17 decreased, the differences were statistically significant (t=3.38, P<0.001; t=30.63, P<0.001). Conclusion In AP, Treg cells mediate immunosuppression and Th17 cells mediate inflammatory response, promoting the occurrence and development of inflammation in the disease. IL-10 and IL-17 may play an important role in regulating their differentiation and homeostasis.
目的总结胰腺损伤诊断和治疗的经验。方法回顾性分析我科2005年12月至2010年6月期间收治的35例胰腺损伤患者的临床资料。结果男32例，女3例; 年龄11～47岁，平均29岁。损伤程度: Ⅰ、Ⅱ级20例，Ⅲ级12例，Ⅳ级2例，Ⅴ级1例。根据病史、临床症状、血清淀粉酶、腹腔穿刺液淀粉酶检测、B超、CT等诊断。4例行非手术治疗; 31例行手术治疗，其中16例行胰腺被膜切开、清创、冲洗、引流，6例行损伤胰腺远端切除，6例行近端缝合、远端空肠Roux-en-Y吻合，2例胰腺主胰管吻合放置支撑管经空肠外引流，1例胰头部严重毁损行胰十二指肠切除术。术前明确诊断24例，术中明确诊断11例。本组死亡5例，均为胰腺复合伤，其中1例肠系膜上动脉损伤合并实质脏器损伤术后24 h死亡，4例胰腺严重毁损，术前抗休克后术中探查见胰腺损伤合并2个以上脏器损伤，术后肝、肾功能衰竭，经抢救无效死亡。治愈30例。结论胰腺损伤的术前诊断率较低，围手术期应积极剖腹探查弥补术前不足，外科治疗要根据损伤分级采取个体化方案，贯彻损伤控制性外科理念，不宜盲目扩大手术。
目的探讨非胆源性重症急性胰腺炎的治疗方式选择。方法回顾性分析2004～2010年期间我科收治的175例非胆源性重症急性胰腺炎患者的临床资料，其中157例非手术治疗，18例在非手术治疗的基础上，外科微创手术干预治疗。结果157例非手术治疗，治愈150例(95.2%)，死亡7例(4.8%),死亡原因为多器官功能衰竭; 手术干预18例，治愈13例(72.2%)，死亡5例(27.8%)，其中3例全身感染合并胰腺坏死，2例十二指肠瘘、胰瘘、腹腔内反复出血。结论非胆源性重症急性胰腺炎以非手术综合治疗措施为基础治疗，非手术治疗无效具备手术指征时，应综合患者情况适时进行外科微创手术干预。
ObjectiveTo evaluate mid-term results of total hip arthroplasty (THA) for treatment of osteoarthritis secondary to hip sepsis. MethodsBetween February 2003 and January 2009, 62 patients (62 hips) with osteoarthritis secondary to hip sepsis underwent THA. There were 32 males and 30 females with an average age of 39.9 years (range, 18-67 years). The original infection included pyogenic arthritis in 40 hips and tuberculosis in 22 hips. After infection, 35 patients underwent non-operative treatment, and 27 patients received operative management. The average time interval between initial infection and THA was 28.7 years (range, 12-53 years). The preoperative Harris hip score was 24.6±9.2. The Trendelenburg sign was positive in all hips. Leg discrepancy was observed in 25 cases, and the mean discrepancy of bilateral lower extremities was 3.8 cm (range, 2.6-6.5 cm) preoperatively. All hips had no evidence of active hip sepsis. ResultsAll patients were followed up 72 months on average (range, 54-115 months). Intraoperative complications included sciatic nerve injury (2 cases) and femoral shaft fractures (2 cases); postoperative complications included hip anterior dislocation (1 case) and periprosthetic infection (1 case). At last follow-up, 1 hip, 5 hips, 18 hips, and 38 hips were found to have severe pain, moderate pain, slight pain, and no pain respectively. Claudication occurred in 30 patients (mild in 19, moderate in 8, and severe in 3). The Trendelenburg sign was positive in 18 hips. After THA, only 5 patients had a leg length discrepancy of 2.9 cm on average (range, 2.6-3.5 cm). The Harris score was significantly increased to 82.3±11.4 at last follow-up when compared with preoperative one (t=-31.241, P=0.000). The results of subjective satisfaction were very satisfactory in 43 cases, satisfactory in 12 cases, unsatisfactory in 4 cases, and unsatisfactory at all in 3 cases. No sign of aseptic loosening of prosthesis was found during follow-up period. Roentgenographic results showed no radiolucent line or osteolysis in the other patients except 2 patients having local radiolucent. After THA, 12 hips had heterotopic ossification. ConclusionThe mid-term clinical and radiographic results of THA for treatment of osteoarthritis secondary to hip sepsis are good, with the advantages of high satisfactory rate, good function recovery, and low complication incidence.
ObjectiveTo observe the retinal microcirculation changes in chinchilla rabbit with branch retinal vein occlusion (BRVO), and to evaluate the feasibility of laser speckle imaging (LSI) technology as monitoring tool for retinal microcirculation. MethodsTen 4-month-old chinchilla rabbits were used for the experiment, selecting the right eye as the experimental eye. The main retinal vein, adjacent 0.5-1.0 mm to the optic of rabbit retina, was selected to the target vessel under surgical microscope. The software of LSI instrument was used to measure the diameter of target vein and blood flow of 0.2 mm2 area of target vein. The BRVO rabbit model was induced by photodynamic therapy, then measure the diameter and blood flow in the same region using the method as before and after 10 minutes modeled. ResultsThe retinal color pictures, infrared laser and the distribution of blood flow pseudo-color were synchronous displayed by LSI technology. Before and after modeling, the target vessel diameter were (0.104±0.009), (0.128±0.008) mm, and the 0.2 mm2 area blood flow of target vessel were (563.500±28.788), (256.000±53.319) PU. The diameter of target blood vessel after modeling was significantly thicker than before, with the significant difference (t=12.14,P=0.008). The blood flow in 0.2 mm2 area of target vessel was significantly lower than before, also with the significant difference (t=183.00,P=0.009). ConclusionsThe diameter of target vessel of the BRVO rabbit model is enlarged, and the target vessel area of 0.2 mm2 blood flow is reduced significantly. LSI system can monitor the retinal microcirculation real-time and quantitatively.
Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.