目的 探讨外周血中未成熟血小板分数(IPF)、白细胞分类在自身免疫性肝炎患者中的临床运用价值.方法 85例自身免疫性肝炎患者作为本院2017年6月-2018年6月研究对象,其中活动期40例、缓解期45例,并以同期健康体检者40例作为对照组,对比不同病情患者外周血中白细胞分类计数、未成熟血小板分数,采用Pearson或Spearman相关性分析探讨未成熟血小板分数、白细胞分类与自身免疫性肝炎患者临床特点的关系,Logistic回归分析探讨患者肝功能不全的独立危险因素.结果 活动期患者中性粒细胞/淋巴细胞比值、IPF比例明显高于缓解期、对照组患者(P＜0.05),N/L、IPF与ALT、AST、TB、ANA滴度、病情活动度均呈正相关(P＜0.05) ANA滴度、N/L、IPF均是患者肝功能不全的独立危险因素(P＜0.05).结论 未成熟血小板分数和中性粒细胞/淋巴细胞与自身免疫性肝炎的病情及预后密切相关.

报道乙肝相关性肝细胞癌全身转移合并皮肌炎1例并回顾相关文献。

戊型病毒性肝炎(戊肝)是由戊肝病毒( HEV)引起的急性病毒性肝炎,经粪-口传播,以水型流行最常见,少数为食物型爆发或日常生活接触传播,可引起爆发或流行. 戊肝作为主要的病毒性肝炎已被列入乙类传染病管理.

肝小静脉闭塞病（hepatic veno-occlusive disease， HVOD)是由某些原因所致肝小叶中央静脉和小叶下静脉等小静脉内膜炎及其纤维化，而导致管腔狭窄，广泛闭塞，甚至引起肝细胞坏死，肝纤维化的一种肝血管疾病。临床表现为肝脏肿大，右上腹疼痛，胆红素升高及腹水。急性型HVOD往往并发多脏器功能衰竭，预后差，慢性型HVOD因肝纤维化进而形成肝硬化[1]。病理组织学是HVOD诊断的金标准,表现为中央静脉和小叶下静脉内皮损伤、内膜肿胀、内膜增生增厚和结缔组织增生纤维化[2]。其发病机制可能与肝脏静脉内皮细胞受药物、免疫、炎症等损害有关[3]，服用含吡咯烷类生物碱的中草药是致病的一个重要因素[4]，目前发病机制尚不十分清楚。HVOD临床上少见，近年来该病的报道逐年增多。现对我院2005年12月—2013年12月收治的25例HVOD患者的流行病学、临床特点，预后进行回顾性分析。

Objective To compare the 144-week efficacy of de-novo combination therapy with lamivudine (LAM) and adefovir dipivoxil (ADV) to that of optimize combination for chronic hepatitis B (CHB) patients.Methods A total of 83 cases with CHB were divided into 3 groups:the de-novo combination group (group A,28 cases),after 24-week mono-therapy to optimize combination group (group B,32 cases),after 48-week mono-therapy to optimize combination group(group C,23 cases).The virological,serological,biochemical indicators at baseline,week 24,48,96 and 144 were detected respectively.The gene resistance mutations of of HBV P region were analyzed for the patients whose HBV DNA were still positive (HBV DNA≥ 103 copies/mL) at week 96,144,respectively.Data of 3 groups were analyzed by the pharmacoeconomics cost-effectiveness analysis.Results HBV DNA negative conversion rates in 3 groups after 96-week therapy were 92.9％,90.6％,87.0％.There were no significant differences among 3 groups (x2 =0.509,P ＞0.05); HBV DNA negative conversion rates in 3 groups after 144-week therapy were 96.4％,93.8％,91.3％,and the differences among them were not statistically significant(x2 =0.590,P ＞ 0.05).There was 1 patient with virologic breakthrough at 144-week treatment in group A.The mutation sites in HBV P genes were L180M and M204V.HBeAg-positive patients with seroconversion rates in 3 groups after 96-week therapy were 27.8 ％,19.2％,35.7 ％,and the differences were not statistically significant (x2 =1.340,P ＞ 0.05).The seroconversion rates in 3 groups at week 144 were 38.9％,30.8％,42.9％,and the differences were not statistically significant (x2 ＝ 0.364,P ＞ 0.05).The ALT normalization rates in 3 groups at week 96 were 94.1％,90.9％,88.9％,and the differences were not statistically significant (x2 =0.303,P ＞ 0.05) ; The ALT normalization rates in 3 groups after 144-week therapy were 100.0 ％,95.5 ％,94.4％,and the differences were not statistically significant(x2=0.911,P ＞ 0.05).The cost-effect analysis showed that the initial combination group was superior to the optimize combination group.Conclusions The effects of virology negative conversion rate,seroconversion rate,ALT normalization rate and reduction the incidence of drug resistance in LAM + ADV de-novo combination therapy and optimized combination therapy are good,but optimized combination therapy is more economic than de-novo combination therapy,so optimized combination therapy can be recommended for use.

Objective To compare the efficacy of combination therapy with lamivudine(LAM) and adefovir dipivoxil(ADV) for LAM-poorly responsed and LAM-resistant to those de novo combination therapy for chronic hepatitis B (CHB).Methods Twenty CHB patients with poorly response to LAM were selected as group A,20 LAM-resistant patients as group B,other 20 CHB patients received combination therapy for the first time as group C.All the patients were given LAM ( 100 mg/d) and ADV (10 mg/d) for 48 weeks,the level of HBV DNA,ALT and HBeAg in patients were detected and HBV mutation was detected for whose HBV DNA were still positive after treatment.Results The negative rate of HBV DNA in group A,B and C were 85％,80％,90％ ( F =0.784,P ＞ 0.05),and the negative rate of HBeAg were 31.3 ％,30.8 ％,33.3 ％ ( F =0.025,P ＞ 0.05) in group A,B,C,respectively.The level of HBV DNA and ALT decreased remarkably after 48 combination treatment in group A,B,C ( t =9.706,10.871,11.807,P ＜ 0.01 ;t =2.157,2.109,2.653,P ＜ 0.05).HBV DNA in 9 patients were still positive after treatment,but no HBV mutations were detected in three groups.Concusions The combination therapy of LAM and ADV can effectively inhibit HBV replication,improve ALT level in CHB patients,but the efficacy in HBeAg seroconversion rate are not obvious.The efficacy of combination therapy in three groups are similar.No HBV mutations are detected for three groups.

麻疹是儿童常见的急性呼吸道传染病之一,6月龄内婴儿因为有母传麻疹抗体的保护一般很少发病.但近年来发现6月龄内婴儿麻疹病例明显增多[1].为了提高对6月龄内婴儿麻疹的诊治水平,现对我院2008年1-6月收治的142例 6月龄内麻疹患儿进行流行病学、临床特点及预后分析.

麻疹是儿童常见的急性呼吸道传染病之一,多见于8月龄以上的儿童.但近年来,8月龄以下婴儿麻疹发病例明显增多[1].为了提高对婴儿麻疹的诊治水平,现将我院2008年1-6月收治的298例8月龄内未接种过麻疹疫苗的麻疹患儿流行病学及临床特点、预后进行回顾性分析.