拉米夫定阻断乙型肝炎病毒宫内传播的临床探讨

目的 研究拉米夫定对HBsAg阳性孕妇的乙肝病毒（HBV）宫内阻断作用。方法 拉米夫定组43例，孕28周起口服拉米夫定，每天100mg至产后30d。对照组52例，未予用药。两组孕妇于孕28周、分娩前，其新生儿于生后24h内免疫接种前抽静脉血检测HBsAg、HBeAg及HBV的定量。结果 拉米夫定组孕妇HBV的DNA水平显著下降（P＜0．05），其新生儿宫内感染率（16．3％）明显低于对照组（32．7％），P＜0．05。两组孕妇有其新生儿未发现有不良反应。结论 携带HBV孕妇产前服用拉为定可有效减少HBV宫内感染发生率。     

拉米夫定阻断乙型肝炎病毒母婴传播的疗效观察

目的:评价妊娠中期应用拉米夫定对乙型肝炎病毒(HBV)传播的影响及安全性,寻求最佳预防宫内传播的方法。方法:拉米夫定组52例孕妇于孕20~26周开始服用拉米夫定100mg/d至分娩后,乙型肝炎免疫球蛋白(HBIG)组61例孕妇于孕28周开始使用HBIG 200 IU行宫内阻断治疗,2组新生儿出生均予主、被动联合免疫,观察新生儿宫内感染发生情况、抗病毒疗效及母婴异常情况,随访到婴儿1岁,并分别在0、1、7、12个月龄时监测其血清HBVDNA、HBsAg和抗-HBs定量变化。数据行t检验和χ2检验。结果:拉米夫定组孕妇于分娩前HBV DNA显著下降(t=18.72,P<0.05),转阴率为34.6%,肝功能异常者全部恢复正常。该组52例新生儿随访至1月龄时HBsAg或HBV DNA均为阴性,宫内感染率为0,与HBIG组宫内感染率(14.8%)相比,差异有统计学意义(χ2=9.40,P<0.05)。2组婴儿1岁时的血清抗-HBS水平无差异(t=0.71,P>0.05),拉米夫定组HBV慢性感染为0,HBIG组9例宫内感染婴儿均为HBsAg、HBeAg、抗-HBc、HBV DNA阳性,2组孕妇及婴儿均未发现不良反应。结论:对于HBV水平较高的孕妇,妊娠中期采用拉米夫定降低病毒含量,阻断HBV母婴垂直传播(宫内传播及产时传播)是行之有效的,且用药安全,未见明显不良反应。     

乙肝表面抗原阳性孕妇肌注乙肝免疫球蛋白预防母婴传播52例分析

①目的　探讨经母体对胎儿行被动免疫在预防乙型肝炎病毒 (HBV)宫内感染中的作用。②方法　对自孕 2 0周起多次肌注乙肝免疫球蛋白 (HBIG)的HBsAg(+)孕妇 52例 (A组 )及未注射的 32例HBsAg(+)孕妇 (B组 ) ,用固相放免法和套式PCR检测母血HBsAg、HBV -DNA及新生儿血HBsAg、抗HBs、HBV -DNA。③结果　A组 52例新生儿中 48例血清抗HBs(+) ,与B组相比具有显著差异 (P <0 .0 5)。A组新生儿血HBsAg、HBV -DNA检出率均明显低于B组。A组孕妇用药后血HBsAg滴度及HBV -DNA水平较用药前明显降低。④结论　经母体对胎儿行被动免疫可有效的预防HBV宫内感染     

孕期应用乙型肝炎病毒免疫球蛋白阻断其母婴垂直传播的效果

①目的　观察孕期应用乙型肝炎 (乙肝 )病毒免疫球蛋白阻断其母婴垂直传播的效果。②方法　将88例乙肝表面抗原 (HBsAg)阳性孕妇随机分为两组 :治疗组 4 4例 ,于孕 2 8、32、36周肌肉注射乙肝病毒免疫球蛋白 (HBIG) 3次 ;对照组 4 4例 ,仅随访查体不用药。胎儿娩出后 ,检测所有出生新生儿股静脉血HBsAg、乙肝表面抗体 (HBsAb)及HBV DNA ,所有新生儿出生后均给予HBIG和乙肝疫苗注射 ,随访新生儿至生后 8个月时 ,复查上述指标。血HBV DNA含量的测定采用荧光定量PCR(FQ PCR)技术。③结果　孕期预防性应用HBIG被动免疫组孕妇的宫内感染率显著低于对照组 ,新生儿血HBsAg和HBV DNA阳性率显著低于对照组 (χ2 c=7.4 3、6 .5 6 ,P <0 .0 5 ) ,HBsAb阳性率两组无差异 (χ2 c=5 .88,P >0 .0 5 )。随访新生儿至 8个月时 ,两组婴儿HBsAg、HBsAb及HBV DNA阳性率差异有显著性 (χ2 c=9.38、8.81 ,χ2 =4 .36 ,P <0 .0 1、0 .0 5 )。④结论　孕期应用HBIG能显著降低乙肝病毒宫内传播 ,联合新生儿主被动免疫 ,尚能提高婴儿HBsAb阳性率     

妊娠中期注射HBV免疫球蛋白对其宫内阻断作用

目的探讨妊娠中期开始注射乙型肝炎免疫球蛋白(HBIG)对HBsAg和HBeAg双阳性孕妇乙型肝炎病毒(HBV)的宫内阻断作用。方法将病人随机分为2组,治疗组32例,孕16周起肌注HBIG,每4周1次至分娩;对照组31例未予用药。结果治疗组孕妇HBV DNA水平比对照组显著下降(t=24.202,P<0.05),其新生儿宫内感染率明显低于对照组(χ2=5.671,P<0.05)。两组孕妇及其新生儿未发现有不良反应。结论HBsAg和HBeAg双阳性孕妇孕中期多次注射HBIG可有效减少HBV宫内感染发生率。     

乙肝免疫球蛋白在预防HBV宫内感染中的作用

目的 :探讨乙肝表面抗原阳性HBsAg( )孕妇肌注乙肝免疫球蛋白 (HBIG)在预防乙肝母婴传播中的作用。方法 :自孕 7个月起多次肌注HBIG的HBsAg( )孕妇 30例 (A组 ) ,及未经注射的 2 4例HBsAg( )孕妇 (B组 ) ,用固相放免法和套式PCR检测母血HBsAg ,HBVDNA及新生儿血HBsAg ,抗HBs,HBVDNA。结果 :A组 30例新生儿中 2 8例血清抗HBs( )与B组相比具有显著差异 (P <0 .0 5 )。A组新生儿血HBsAg ,HBVDNA阳性检出率明显低于B组。结论 :经母亲对胎儿行被动免疫可有效预防HBV宫内感染。     

穴位注射乙型肝炎免疫球蛋白阻断乙型肝炎病毒母婴传播的临床研究

目的　探讨乙型肝炎病毒 (HBV) 阳性孕妇孕期足三里穴位注射乙型肝炎免疫球蛋白 (HBIg) 预防HBV宫内感染的作用效果。方法　2001年 11月~2003年 10月青岛大学医学院附属烟台毓璜顶医院将 190例乙肝表面抗原 (HBsAg) 阳性孕妇分为两组: 足三里穴位注射组 92例, 于孕 20、24、28、32、36周足三里穴位注射HBIg共 5次, 每次 200IU。肌肉注射组 98例, 于相同时间肌肉注射HBIg。采用酶联免疫法, 检测用药前、后孕妇血清及新生儿脐血清的HBsAg、HBeAg及HBsAb, 采用核酸扩增 (PCR) 荧光定量法检测HBV-DNA含量。结果　92例足三里穴位注射者, 新生儿宫内感染 8例, 宫内感染率为 8 7%, 低于肌肉注射组 (P<0 01)。穴位注射组新生儿脐血清HB sAb检出率显著高于肌肉注射组 (P<0 05)。穴位注射组临产前血清中HBV-DNA含量显著低于肌肉注射组 (P<0 05)。结论　孕妇通过足三里穴位注射HBIg, 可有效减少HBV的宫内感染, 未发现任何副作用。     

HBV 宫内感染预测指标的探讨

 【目的】 探讨HBsAg阳性孕妇的新生儿乙肝联合免疫前的HBV-M和HBV DNA预测HBV宫内感染的实用价值&;#65377; 【方法】 对我院2006年6月至2008年2月间分娩的HBsAg阳性孕妇的420例婴儿,其中新生儿HBsAg或HBV DNA阳性为33例,HBsAg和HBV DNA双阳性共6例,对其满6月龄时进行随访,复查HBV-M以确诊HBV宫内感染&;#65377;【结果】 HBV宫内感染率为0.95%(4/420),新生儿HBsAg或HBV DNA阳性诊断HBV宫内感染的阳性似然比为14.3,而HBsAg和HBV DNA双阳性时诊断宫内感染的阳性似然比为208.3&;#65377; 【结论】 HBsAg阳性孕妇的新生儿乙肝联合免疫前的HBsAg和HBV DNA双阳性对HBV宫内感染具有较准确的预测作用,可以作为HBV宫内感染的初步临床诊断&;#65377;     

孕妇HBIG被动免疫阻断HBV母婴垂直传播的临床研究

目的 :研究HBV阳性孕妇孕期应用高效价乙肝免疫球蛋白HBIG预防HBV宫内感染的作用机理。方法 :将 1 0 0例乙肝表面抗原HBsAg阳性孕妇随机分为两组 ,预防组 6 0例 ,于孕 2 8、32、36周肌肉注射HBIG三次 ,每次2 0 0IU ;对照组 4 0例 ,只随访查体不用药。两组孕妇所生婴儿均于出生后 2 4小时内肌肉注射HBIG 1 0 0IU一次 ,注射乙肝疫苗时间和剂量均按正常婴儿的操作方案进行。母儿血清HBsAg ,HBeAg和抗 -HBs用固相放免法检测 ,HBV -DNA用荧光定量PCR检测。结果 :HBIG预防组孕妇的婴儿HBV感染率显著低于对照组 (P <0 .0 5 ) ;预防组婴儿血清抗 -HBs检出率显著高于对照组 (P <0 .0 0 1 ) ;HBV -DNA含量显著低于对照组 (P <0 .0 5 )。结论 :孕妇于孕期多次注射HBIG进行被动免疫可有效地阻断乙型肝炎病毒母婴传播 ,减少婴儿HBV感染率     

先天性异常与优生学

021210产前注射乙型肝炎免疫球蛋白预防乙型肝炎病毒宫内感染的临床研究/池美珠…//中国当代儿科杂志一2002,4(2)一127一128 目的:减少新生儿宫内感染乙型肝炎病毒(HBv),探讨孕妇被动免疫预防HBv宫内感染的作用。方法:将141例无症状HBsAg(十)孕妇随机分为两组,预防组69例,自孕28周起每月注射1次乙型肝炎免疫球蛋白(HBIG),每次200 IU;对照组72例,不注射HBIG。在孕妇孕28周、分娩前和新生儿出生时分别检测静脉血HBsAg,HBeAg和抗一HBs,部分产妇检测乳汁HBsAg,HBcAg。结果:预防组新生儿血清HBsAg检出率(5 .8%)明显低于对照组(16.7…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.