Objective The aim of this study was to meta analyze the clinical efficacy of granulocyte colony stimulating factor（G-GSF） in treatment of patients with severe alcoholic hepatitis（SAH）. Methods The PubMed, Embase, Chinese Journal Full-text Database, Wanfang Database, Chinese Science and Technology Journal Database, Chinese Medical Association digital Journal Database in Chinese and English were searched from the establishment of databases to May 2022. At the same time, we handed check related journals and conference proceedings. The randomized controlled trials（RCT） on the administration of G-CSF in the treatment of patients with SAH were analyzed to evaluate the 90-day survival rate in both G-CSF-treated and control groups, and the data were analyzed by RevMan 5.4. Results A total of 198 patients were included in 5 RCT studies obtained; at the base of conventional medical support therapy, 98 patients received G-CSF and another 100 patients received placebo; by the Meta-analysis, the 90-day survival in the G-CSF-treated group was 76.5%, much higher than 28.0% in the control group, and the difference was statistically significant（RR=2.74,95% CI: 1.96-3.83, P＜0.01）; there was no significant heterogeneity among the five studies（P=0.61, I~2=0%）. Conclusion In patients with SAH, the 90-day survival rate is significantly improved when the G-CSF treatment is given, which needs further clinical investigation.

Objective:To analyze the clinical features of an outbreak of extensive drug resistant typhoid fever, and to provide experience for the diagnosis and treatment of drug resistant typhoid fever.Methods:Seven patients with confirmed diagnosis of extensive drug resistant typhoid fever who visited Beijing You′an Hospital, Capital Medical University, from January 27 to February 15, 2022 were included. The clinical characteristics, drug sensitivity tests, consultation and treatment history and prognosis of the patients were analyzed through descriptive study.Results:Of the seven extensive drug resistant typhoid fever patients, three were male and four were female, one of whom was pregnant (at 32-week gestation), aged (29.8±6.8) years, with a range of 22 to 42 years. There were seven cases with fever, and the course of fever ranged from six to 20 days. There were five cases with diarrhea and lack of typhoid-specific manifestations such as rose spot, apathetic facial expression and relatively slow pulse. Four cases were complicated with intestinal bleeding and six cases developed liver function injury. Six cases had loss or decrease in eosinophil ratio and two cases had decreased white blood cell count. The results of drug susceptibility tests showed that seven strains of Salmonella typhi were resistant to chloramphenicol, ampicillin, sulfamethoxazole-trimethoprim, quinolones, ceftriaxone, cefepime, ceftazidime, cefuroxime, and sensitive to carbapenem antibiotics, tigecycline and piperacillin/tazobactam. All seven cases had a history of antimicrobial use before admission. One case was administered with intravenous ceftizoxime for seven days after admission. After discharge, cefixime was administered orally for seven days. Six patients were given intravenous piperacillin sodium/tazobactam sodium for 14 days. All blood/fecal cultures were negative and the patients were cured and discharged. During the follow-up, one patient developed splenic abscess. All the seven patients were residents of the same apartment in Beijing City, and there were water cuts and turbid odors in the incubation period, which were considered as typhoid fever outbreak caused by waterborne transmission. Conclusions:With the use of antimicrobial agents, the typical clinical manifestations of typhoid fever are absent, and the drug resistance rates to quinolone and third-generation cephalosporins increase. Appropriate antimicrobial agents should be selected and the anti-infection course should be prolonged.

我国目前疫情防控的压力仍比较大,既持续存在境外输入病例,也有本地散发疫情的风险.《工作方案》对节日期间的疫情防控给出具体的指导建议.下面,我将结合《工作方案》与《医疗机构内新型冠状病毒感染预防与控制技术指南(第三版)》(以下简称《技术指南》),梳理和讲解基层医疗机构在节日期间的工作注意要点.

前不久,多国报道不明病因儿童急性肝炎病例,患儿年龄集中在1个月到16岁之间,病例主要集中在欧洲,日本也出现了非常类似的病例.虽然国内尚未报告相似病例,但还没摆脱新冠肺炎,又来不明原因肝炎,家长们的担忧在所难免.急性肝炎到底是怎么回事呢?

传染病学是现代临床教学中必不可少的课程,而新发感染病又是传染病教学中一门基础课程.新型冠状病毒肺炎疫情的爆发再次让人们认识到新发感染病的危害性.对新型冠状病毒肺炎循序渐进的认识过程为传染病教学提供了一个真实完整的新发感染病的教学案例,体验式学习可以带来更好的教学效果.在传统的基于案例的学习和基于问题的学习教学法的基础上,再结合以慕课的形式进行教学方法的改进,充分利用互联网资源和多媒体人机互动方式,比如虚拟仿真系统通过智能化技术手段展示传染病演变过程、基于微课的翻转课堂等教学方法,打破时间、空间的限制,给学生们身临其境的体验式教学,可以提高传染病教学质量、改善教学效果.

目的 探讨两性霉素B联合氟康唑对获得性免疫缺陷综合征(AIDS)合并新生隐球菌性脑膜炎患者细胞免疫功能的影响.方法 选取2018年12月至2020年12月首都医科大学附属北京佑安医院收治的AIDS合并新生隐球菌性脑膜炎患者50例,应用随机数字表法分为对照组和观察组,各25例.对照组给予两性霉素B普通输液留置针静脉滴注治疗,观察组给予两性霉素B中心静脉导管置管联合氟康唑治疗.治疗2周为1个疗程,2组均治疗3个疗程.比较2组治疗前后细胞免疫功能和颅内压,临床疗效、置管并发症和不良反应发生率.结果 治疗前,2组CD3+、CD4+、CD8+ T淋巴细胞计数和颅内压比较差异均无统计学意义(均P＞0.05);治疗后,观察组CD3+、CD4+、CD8+ T淋巴细胞计数均高于治疗前且高于对照组[(1383±398)爪/μl比(1147±375)个/μl、(846±261)个/μl比(688 ±232)个/μl、(881±218)个/μl比(598±221)个/μl],2组颅内压均低于治疗前,且观察组低于对照组[(135 ±33)mmH2O(1 mmH2O =0.098 kPa)比(194 ±47) mmH2O](均P＜0.05).治疗3个疗程后,观察组总有效率高于对照组[96.0％(24/25)比76.0％ (19/25)](P=0.042).观察组置管渗液渗血和穿刺异常发生率均低于对照组(均P＜0.05),2组不良反应发生率比较差异无统计学意义(P=0.157).结论 两性霉素B联合氟康唑治疗可改善AIDS合并新生隐球菌性脑膜炎患者细胞免疫功能、降低颅内压、提高疗效,且安全性较好.

根据《医师法》的规定,"医师应当坚持安全有效、经济合理的用药原则,遵循药品临床应用指导原则、临床诊疗指南和药品说明书等合理用药".感染科医师经常使用的药物是抗感染药物,包括抗病毒药物和抗细菌药物,通常说明书中的适应证是比较明确的,允许超说明书用药的机会并不多,本文从抗病毒药物的一些使用现状来回顾一下感染科常见的超说明书用药情况.

目的 观察沙盘推演案例教学法在新发感染病课程教学中的应用效果.方法 选取2020年12月16日-12月25日于我院学习新发感染病的本科医学生80名,根据教学方法的不同,将学生随机分为对照组(n=40)和观察组(n=40).对照组采用传统教学方法,观察组采用沙盘推演案例教学法,设计教学问卷,比较两组教学质量,并调查学生感兴趣的教学方法及对教学的满意度.结果 在教学质量方面,观察组学生在对新发感染病定义的认识、传播途径、流行的影响因素、防治对策等方面评分高于对照组,但差异未见统计学意义;观察组的新发传染病概论总分数高于对照组(514.4±75.9 vs.463.4±77.3),差异有统计学意义(P<0.05),观察组与对照组之间在对新型冠状病毒肺炎(89.5±21.6 vs.93.1±20.6)及其他新发感染病(67.0±18.4 vs.62.0±18.0)方面的认识程度评分差异无统计学意义.观察组学生对教学方法的满意度(97.5％)高于对照组(87.5％).学生最感兴趣的教学方法是多种教学方式的组合(60％),不拘泥于传统教学方式.结论 在新发感染病教学中采用沙盘推演案例教学法的教学模式效果理想,能提高一定的教学质量,但对于具体的新发感染病认知并不优于传统教学方法,故认为可将沙盘推演案例教学法与传统教学相结合同时应用.

目的 分析影响新型冠状病毒肺炎(COVID?19)患者的新型冠状病毒(SARS?CoV?2)抗体持续阳性时间的影响因素.方法 回顾性分析我院于2020年1月21日至10月25日收治并随访时间超过6个月的43例COVID?19患者,比较发病后随访6个月时抗体转阴组患者与持续阳性组患者的临床特点.结果 随访超过6个月的43例患者中,有10例(25.6％)患者SARS?CoV?2 IgM和IgG均转阴,抗体持续阳性患者的年龄较大、淋巴细胞计数较低、发热比例较高(P<0.05);多因素回归分析显示淋巴细胞计数较低、发热是患者抗体持续阳性超过6个月的独立危险因素.结论 淋巴细胞计数偏低、发热的COVID?19患者的抗体阳性持续时间更长.

Background: Since April 2020, the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients Objective: To investigate the clinical features and prognostic risk factors of adult patients with COVID-19, offering a reference for clinical diagnosis and treatment of this disease Methods: A retrospective design was used Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020 They were categorized into common, severe and critical types by the most serious conditions during hospitalization, in accordance with the Diagnosis and Treatment Protocol for COVID-19(Trial Version 7)issued by the National Health Commission of the People's Republic of China Indications such as general information, major clinical manifestations, baseline laboratory parameters, APACHE II and SOFA scores within 24 hours of admission, imaging findings, comorbidities and complications, treatments and outcomes were collected Results: There were 57 cases of common type(61 3%), 22 of severe type(23 7%)and 14 of critical type(15 0%) The male ratio was slighter higher in critical group, and female ratio was slighter higher in other groups, but sex composition showed no significant differences across the groups(P>0 05) The median age for common, severe and critical groups was 45 0, 62 0 and 81 0 years, respectively, showing significant differences(P0 05) Dyspnea occurred in all severe or critical cases, showing a higher incidence than common cases(100 0% vs 31 6%)(P<0 05) The incidence of lymphocytopenia in critical group was 100%, which was significantly higher than that in common group(49 1%)or severe group(59 1%)(P<0 05) Acute liver injury was the most common complication(58 1%)in all cases, but its incidence was obviously increased in severe group (77 3%) or critical group(92 9%), than that of common group(42 1%)(P<0 05) Chinese medicine therapy was used in 75 3% of all cases, but the severe cases had a higher rate of treating with Chinese medicine than critical cases(90 9% vs 50 0%, P<0 05) The rate of corticosteroid use in severe cases(63 6%)or critical cases(64 3%)was significantly increased than that of common cases(5 3%)(P<0 05) Six patients(6 5%)were treated with invasive ventilation, but only 1 of them(16 7%)was successfully extubated ultimately Nine patients(9 7%)died in hospital due to all causes Logistic regression analysis revealed that age ≥74 years〔OR(95%CI)=33 714(3 021, 376 211), P=0 004〕and baseline SOFA≥2 5〔OR(95%CI)=15 447(1 331, 179 260), P=0 029〕were independent risk factors for in-hospital death Conclusion: COVID-19 mainly manifests as respiratory infections Severe patients are apt to appear tissue injury and dysfunction of organs like liver, kidney and heart, etc The majority of patients have a favorable outcome Age and baseline SOFA score would help to label the prognosis of patients at an early stage Copyright © 2021 by the Chinese General Practice

国家卫健委办公厅于2020年11月12日印发了《预防艾滋病、梅毒和乙肝母婴传播工作规范(2020年版)》[以下简称《工作规范(2020年版)》],其目的是贯彻落实《"健康中国2030"规划纲要》,进一步规范全国预防艾滋病、梅毒和乙肝母婴传播(以下简称预防母婴传播)工作,推进消除母婴传播进程,促进妇女、儿童健康.下面,笔者将为大家总结有关乙肝、艾滋病和梅毒患者妊娠期的母婴阻断问题.

BACKGROUND:We aim to investigate the clinical characteristics and survival rate of coronavirus disease 2019 (COVID-19) patients.METHODS:Ninety-seven COVID-19 patients were enrolled. The laboratory results, lung imaging and medical treatment were compared. Patients were followed up after 1 year, and the Kaplan-Meier test was used for survival analysis.RESULTS:Compared with the non-severe group, the age of the severe group was older, and the proportion of concomitant diseases were higher. As fever was the primary clinical manifestation, dyspnea and anorexia were more common in severe patients. Lung imaging manifestations and laboratory indicators were worse in the severe group. Accordingly, the treatment of glucocorticoid, antibiotics, and advanced life support were in high proportion. Of the 97 patients with COVID-19, 4 severe patients died within one month during the 1-year follow-up, with the median survival time of 47.0 weeks (95% CI: 45.1-48.9).CONCLUSIONS:Severe cases of COVID-19 are characterized by advanced age, more concomitant diseases and complications, which lead to a decreased short-term survival rate. However, there were no deaths after one month, which implied a good prognosis if the risk period were passed smoothly.

2021年8月9日,北京市疾控中心通报1例外地来京就诊的肺炭疽病例,患者来自河北省承德市围场满族蒙古族自治县,在当地有牛、羊及其制品接触史,发病4天后由救护车转运来京就诊.8月12日,山西省吕梁市文水县又报告陆续有9名村民出现四肢丘疹,继而变为水泡、溃破结痂变黑,且有水肿、淋巴肿等相似症状, 9人均从事肉牛饲养、屠宰和贩卖工作,初步判断为皮肤炭疽病例.目前,全国已有河北承德、山西吕梁、山东滨州三地出现了炭疽确诊病例,且根据国家卫健委疾病预防控制局官网数据显示,7月份我国报告了炭疽病例66例.

目的 分析2015-2019年北京佑安医院手足口病住院患者病原检测与临床指标间的关联.为提高手足口病不同病原感染的鉴别诊断和预后风险提供一定的科学依据.方法 采用描述性流行病学方法分析2015-2019年北京佑安医院手足口病住院患者的一般情况、临床表现、实验室病原检测及临床指标.结果 2015-2019年北京佑安医院因手足口病住院的患者共计353例,肠道病毒核酸检测阳性的253例(71.67％),分为3组:肠道病毒A组71型(enterovirus A71,EV-A71)阳性50例(19.76％),柯萨奇病毒A组16型(coxsackievirus A16,CV-A16)阳性14例(5.53％),其他肠道病毒阳性189例(74.70％).各组患者年龄均值从大到小依次为CV-A16组(3.88±6.35)岁,EV-A71组(2.84±1.94)岁和其他肠道病毒组(2.05±2.63)岁,3组间差异有统计学意义(x2 =16.755,P＜0.01).3组间重症构成比(EV-A71组84.00％,其他肠道病毒组50.79％,CV-A16组42.86％),差异有统计学意义(x2=18.975,P＜0.01).3组中手部皮疹发生率(EV-A71组92.00％,CV-A16组:71.43％,其他肠道病毒组:77.25％)、臀部皮疹发生率(EV-A71组:66.00％,CV-A16组:42.86％,其他肠道病毒组:40.21％)以及神经系统症状的发生率差异有统计学意义(x2=5.998,P=0.05;x2=10.646,P=0.005;x2=7.351,P=0.025).3组中C反应蛋白升高比例(EV-A71组:12.12％,CV-A16组:40.00％,其他肠道病毒组:70.23％),差异有统计学意义(x2=37,74,P＜0,01).结论 2015-2019年北京佑安医院手足口病住院患者的主要病原是其他肠道病毒.住院患者皮疹发生部位、神经系统症状、C反应蛋白等临床特征及指标在不同病原感染组间差异有统计学意义,提示其具有潜在临床诊断价值.

截至2021年4月6日,我国新冠病毒疫苗接种已经超过了1.45亿剂次.从国内外的接种反馈来看,我国新冠病毒疫苗具有良好的安全性和有效性.虽然我国新冠病毒疫苗接种的绝对数在全球位于前列,但是由于我国人口基数比较大,疫苗的覆盖率仍比较低,距离实现群体免疫需要的至少70％以上的接种率要求仍有很大差距.

目的 探讨重症新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)的相关危险因素.方法 选取2020年1月21日至2月19日首都医科大学附属北京佑安医院感染科收治的95例COVID-19患者,分为非重症组(轻型、普通型,66例)和重症组(重型、危重型,29例),收集两组患者的一般临床资料、实验室检测结果及影像学特征,采用多因素logistic回归分析,探讨重症COVID-19的相关危险因素.结果 单因素分析显示,与非重症组比较,重症组年龄,合并高血压、冠心病、脑血管疾病、慢性阻塞性肺疾病,出现呼吸困难、食欲减退,体温、MAP,WBC、中性粒细胞计数、中性粒细胞/淋巴细胞比值等显著增高(P＜0.05),SpO2、淋巴细胞计数、血清ALB等则显著降低(P＜0.05);影像学显示肺内出现双侧病变、中央及边缘同时受累、多肺叶受累以及出现胸腔积液、胸膜增厚表现均显著高于非重症组(P＜0.05),多因素logistic回归分析显示,CRP、年龄是重症COVID-19发生的独立危险因素.根据重症发生的独立危险因素,将患者分为低风险(年龄＜ 50岁且CRP＜ 27 mg/L)、中风险(年龄≥50岁且CRP＜ 27 mg/L或年龄＜50岁且CRP≥27 mg/L)和高风险(年龄≥50岁且CRP≥27 mg/L)3个等级,高风险患者的重症发生率为79.2％(OR=74.100,95％CI:13.149～417.586,P＜0.001),显著高于中风险(26.7％,OR=7.091,95％CI:1.382～36.381,P＜0.05)和低风险(4.9％)患者.结论 CRP、年龄是重症COVID-19发生的独立危险因素,根据独立危险因素制定的风险等级有助于重症患者的早期识别.

我们周围50岁以上的人对麻疹一般都不陌生,自己和家人,或者周围或多或少都可能有人感染过麻疹.50岁以下的人则可能对麻疹略感陌生,可能听说过,但见过的人很少.而30岁以下的90后们,可能对麻疹的印象更多来自新闻报道了.2019年来自美国等国家麻疹反弹的信息把麻疹带回到大家的视线中.医疗发达的美国都出现了麻疹疫情,我们国家会不会受到牵连呢?像2009年来自北美的大流感疫情那样很快殃及世界各国呢?

作为临床常用的抗逆转录病毒药物之一,依非韦伦在具有高度抗病毒活性的同时,也有较高的中枢神经系统不良反应发生率,因该不良反应而停药的患者比例可高达2.1％.目前,已有多个试图解释依非韦伦中枢神经系统不良反应的发生机制的假说.此外,依非韦伦导致中枢神经系统不良反应的剂量在不同个体间差异颇大,且该差异主要由依非韦伦代谢过程中,部分代谢酶的基因多态性所导致的药物代谢变异而决定.而基于基因多态性检测的个体化依非韦伦治疗,已经在临床研究中有力减少中枢神经系统不良反应的发生.本文综述依非韦伦的疗效和安全性,导致中枢神经系统不良反应的机制,归纳了基于基因多态性的个体化用药具体措施,为优化依非韦伦治疗方案提供依据.

目的 研究流行性感冒(流感)流行季节流感老年患者的临床特征,为流感老年患者预防治疗提供依据.方法 收集2019年1-3月确诊流感的成人患者临床资料,包括一般情况、基础疾病、临床症状、实验室检查结果等,同时留取患者的鼻咽拭子进行流感病毒核酸检测.结果 共收集流感老年(年龄≥65岁)患者64例,非老年患者39例,均未接种流感疫苗.老年患者中单纯甲型流感55例(85.9％),体温≥38.5℃的患者占65.6％;其他症状主要表现为咳嗽(95.2％)、咯痰(87.5％)、乏力(84.4％)、胸闷(46.9％)、流涕(45.3％);合并心肌损伤46例(71.9％),合并细菌性肺炎40例(62.5％);实验室检查显示C反应蛋白[中位数38.5(23.4,89.1) mg/L]、降钙素原[中位数0.09(0.05, 0.68) μg/L]轻度升高;病毒核酸检测转阴中位时间为6.0(5.0,8.0)d,共6例患者死亡,占9.4％.非老年患者的临床症状及合并症、实验室检查结果均较老年患者表现轻.老年患者中死亡组合并细菌性肺炎、既往器官功能障碍、多脏器功能衰竭、脓毒症、酸碱失衡的概率高于生存组,差异有统计学意义(P＜0.05).结论 目前流感疫苗接种率低,流感老年患者病情较重,易合并心肌损伤、细菌性肺炎等并发症,临床医师应关注流感老年患者脏器功能,进行综合多方位的防护,避免死亡的发生.

目的 分析认识46例首都医科大学附属北京佑安医院收治的新型冠状病毒肺炎确诊病例的中医临床特征.方法 采集患者的病史、中医证候及诊疗过程资料,分析不同分型患者证候演变及转归.结果 46例患者中疫毒袭肺证(普通型)27例,湿毒郁肺证(普通型)13例,疫毒闭肺证(重型)6例,所有患者均接受中药治疗,中成药26例,中药汤剂20例.早期(0~3 d)症状相对较少,但已表现出特征性舌质红或暗红、苔黄腻或白腻的特点,进展期(4~14 d)半数以上患者出现发热(89.13% )、咳嗽咳痰(71.40% )、口干口渴(68.60% )、乏力(60% )、咽干或咽痛(57.10% )、纳呆(54.30% ),重症患者舌腻而干或少苔.恢复期( ＞15 d)多数患者症状明显缓解,咳嗽咳痰(72.20% )、口干口渴(66.70% )、汗出(50% )仍较突出,舌苔由厚转薄,苔腻的程度有所改善、苔色由黄逐渐转白,舌象改变较为缓慢.普通型与重型的中位病程分别为16.5 d(14~26 d)和25 d(21~27 d),平均住院天数分别为(13.24 ± 4.36) d、(19.73 ± 2.33) d.病毒核酸中位转阴时间分别为11.41 d(4~22 d)、14.5 d(9~24 d),肺部电子计算机断层扫描(computed tomography,CT)检查病灶开始吸收的中位时间分别为10 d(5~19 d)、15.5 d(8~21 d).结论本病湿热证候突出,病程长,对中医不同证型特征的认识有助于指导中医辨证施治.