目的 调查2007-2016年我国东部地区老年戊型肝炎的流行病学特点.方法 收集南京中医药大学附属解放军第八一医院2007年1月至2016年12月老年戊型肝炎患者(≥60岁)的临床资料,包括性别、年龄、地区、发病季节、肝功能、有无基础肝病和预后等,分析老年戊型肝炎发病的性别、年龄和季节特点,比较合并基础肝病患者与无并发症患者的临床特征.结果 2007年1月至2016年12月本院共收治老年戊型肝炎患者161例,均为散发,男性127例,女性34例.60～69岁、70～79岁和≥80岁年龄段发患者数分别为106例、43例和12例.161例患者中29例合并基础肝病,其中合并慢性HBV感染者16例.79例患者来自城市,82例患者来自农村.1～4季度发病例数分别为84例、44例、21例和12例.第1季度患者数最多,占发病总人数的52.2％(84/161),其次为第2季度,占27.3％(44/161).经保肝等综合治疗,多数患者预后良好,但仍有少数患者治疗无效,共21例病死,其中男性19例,女性2例.21例病死患者中,10例合并其他基础肝病.与无并发症的戊型肝炎患者相比,有基础肝病患者的TBil值更高、PT延长、PTA降低、CHE降低、住院时间延长,差异均有统计学意义(P均<0.05).无并发症的老年戊型肝炎患者病死率为8.3％(11/132),有基础肝病患者的病死率为34.5％(10/29),差异有统计学意义(χ2=14.3,P=0.001).结论 老年戊型肝炎主要发生在第1季度,男性患者发病率显著高于女性,有基础肝病患者的病死率显著增高.

患者，女，60岁。2014年5月发现左侧颈部一类圆形结节，约0．8 cm×0．5 cm，2个月后增大至约4．5 cm×4．5 cm，于2014年7月行左颈部肿块切除术，术后病理诊断为弥漫性大 B细胞淋巴瘤（非生发中心来源）。术后在我院肿瘤内科接受化疗。患者有慢性 HBV 感染病史10余年，近5年来定期复查肝功均正常，HBsAg、抗-HBe（＋），HBV DNA＜500拷贝／mL，病情处于非活动期。

目的：评估恩替卡韦、拉米夫定治疗 HBV 相关重型肝炎的疗效和安全性。方法选择2010年1月1日至2015年12月31日在本科住院治疗 HBV 相关慢加亚急性肝衰竭患者157例，分3组，恩替卡韦组52例，拉米夫定组55例，对照组50例。3组患者均接受内科综合治疗，恩替卡韦、拉米夫定组分别口服恩替卡韦、拉米夫定抗病毒治疗。观察指标包括：24周生存率，12周 HBV DNA 转阴率、肝功能、凝血酶原活动度（PTA）变化，住院时间，腹水、肝性脑病、消化道出血、肝肾综合征、自发性腹膜炎等并发症的发生率。结果恩替卡韦、拉米夫定组患者的24周生存率分别为69．2％（36／52）、72．7％（40／55），高于对照组56％（28／50）（P 均＜0．05）。治疗12周，恩替卡韦、拉米夫定组较对照组患者的 TBil、ALT、AST 均显著下降（P 均＜0．05）、PTA 显著升高（P ＜0．05）；HBV DNA 的转阴率分别为88．5％（46／52）、85．5％（47／55），高于对照组10％（5／50）（P 均＜0．05）。恩替卡韦、拉米夫定组肝性脑病、肝肾综合征、腹水发生率均低于对照组（P 均＜0．05），平均住院时间分别为（85±48．6）d、（79±44．3）d，低于对照组（124．3±58．5）d（P 均＜0．05）。结论恩替卡韦、拉米夫定可提高乙型重型肝炎患者的生存率、减少并发症、缩短住院时间，安全性良好。

Objective To compare the therapeutic efficacy between Fuzheng Huayu capsule and AnLuo HuaXian pill.Methods Ninety-nine patients with liver fibrosis were randomly divided into two groups.Group one received Fuzheng Huayu capsule treatment and group two received AnLuo HuaXian pill treatment.All patients received treatment for 12 months.Fibroscan value,liver fibrosis indexes,color ultrasound images and liver pathology were measured before and after treatment.Results After treatment,the Fibroscan value of Fuzheng Huayu capsule group was 8.25 KPa, liver fibrosis indexes were HA: 143.4 ng/mL、LN:95.9 ng/mL、PC-III: 109.3 ng/mL、Ⅳ-C:72.1 ng/mL, respectively.The inside diameter of portal vein was 10.13 mm and thickness of spleen was 38.40 mm.The Fibroscan value of AnLuo HuaXian pill group was 13.04 kPa,liver fibrosis indexes were HA:208.7 ng/mL、LN:155.5 ng/mL、PC-III:110.0 ng/mL、Ⅳ-C:117.5 ng/mL,respectively.The inside diameter of portal vein was 12.61 mm and thickness of spleen was 45.01 mm.There were significant differences in the indexes above between the two groups (P <0.05 ), What is more,Fuzheng Huayu capsule showed a better effect on improving the fibrosis grades (P <0.05).Conclusion Fuzheng Huayu capsule is more effective for liver fibrosis treatment than AnLuo HuaXian pill.

OBJECTIVE:To analyze the etiology, clinical features and prognosis of liver injuries caused by different drugs.METHODS:The types of suspected drugs related to liver injury, clinical manifestations, liver biochemical parameters, clinical outcomes and other associated data were retrospectively assessed for 140 patients with drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method (RUCAM) was used to assess the causality between drugs and liver injury.RESULTS:The most prevalent agents inducing DILI were Chinese traditional drugs (62.1%), followed by antipyretic analgesic drugs (10%) and antibiotics (5%). The ratio of male to female patients in the study cohort was 1:1.69, with 71 of the total patients (50.7%) being between the ages of 40 and 60 years-old. The RUCAM scale was not less than 3 points for any of the patients.In general, the clinical manifestations and biochemical results were not specific. The percentages of hepatocellular injury type, cholestatic injury type and mixed injury type were 51.4%, 30.7% and 17.9% respectively. The median age of patients with cholestatic liver injury was 55.6 years, which was older than that of patients with hepatocellular injury (47.1 years) or mixed injury (49.9 years).CONCLUSION:Although antipyretic analgesics and antibiotics are considered as common drugs that can induce DILI, Chinese traditional drugs have emerged as another important group of liver injurious agents. Cholestatic DILI was found to occur more often in elderly patients than in younger patients.

患者,男性,54岁,因上腹部持续隐痛不适2月余于2012年5月9日入院.病程中患者偶有上腹部饱胀不适,食欲较前稍减退,无发热,无恶心、呕吐,无腹泻、便血.外院腹部B超提示肝内多发占位,我院门诊查血清AFP 1 306.69 μg/L(正常参考值0～20 μg/L).上腹部CT平扫+增强(见图1):肝内多发低密度影,部分边缘欠清;肝胃间隙内类圆形软组织密度影,内似有钙化样密度,与胰体及胃分界欠清,考虑占位性病变;右侧腹壁类圆形低密度影,脂肪瘤可能性大.否认既往病毒性肝炎、酒精性肝病及其他肝损害疾病史.

药品是特殊的商品,对药品实施有效监管,关系到广大消费者的用药安全,关系到公众生命健康权益的维护和保障。我国农村药品安全监督网络的建设主要存在五大问题,笔者试提出解决方法。

患者,男性,46岁.于2006年4月初无明显诱因出现全身乏力,上腹发胀,胃纳显著减少,恶心.随后出现深黄色尿,进行性皮肤、巩膜黄染.

Objective To investigate the curative effect of kurorinone combined with thymus peptide in the treatment of chronic hepatitis B(CHB),in order to find out an effective method.Methods Group 1,including 52 hospital-patients,were given intravenous injection for 12 weeks using 600mg kurorinone and 100mg thymus peptide,one time per day,then took orally for 12 weeks.Group 2 were taken interferon-α(INF) 5 000 000U,tertian subcutaneous injection,thymus peptide 100mg,intramuscular injection,2 times per week for 24 weeks.All the patients were only infected with HBV,HBsAg / HBeAg / HBcAb positive,HBV DNA≥10~5 copy/L,ALT≥150U/L.Did contrastive research in these two groups.Results After twenty-four-week treatment,for group 1,the normalization rate of ALT was 75%(39/52 cases).For group 2,the normalization rate of ALT was 79.2%(38/48 cases) in the 24th week.The normalization rates of ALT of two groups were not different significantly(P>0.05).For group 1,HBeAg and HBV DNA of 31 in 52 cases(59.6%) converted to negative.For group 2,HBsAg of 1(2.1%) and HBeAg of 27(56.2%) and HBV DNA of 29(60.2%) in 48 cases(60.4%) converted to negative.The negative conversion rates of HBV DNA of two groups were not different significantly(P>0.05).After halting treatment and follow-up study for 12~24 weeks,for group 1,CHB of 18 in 31(58.1%) patients who were cured in the near future recrudesced,ALT mounted up,HBeAg and HBV DNA converted to positive.For group 2,CHB of 10 in 29(34.5%) patients who were cured recently now recrudesced.The long-dated effect wasn't different significantly(χ~2=1.09,P>0.05).Conclusion There is no significant difference in the treatment of CHB using between kurorinone and interferon,whatever in the near future or long-dated.We can use kurorinone for the treatment of CHB,but should prolong the period of treatment and combining with other immunomodulator,under this state the effect may be stronger.