目的观察中山市HIV/AIDS患者应用抗病毒治疗的临床疗效。方法选取我院2006年1月～2011年12月治疗的239例HIV/AIDS患者作为研究对象,均给予抗病毒治疗,观察临床疗效、免疫学和病毒学疗效及不良反应情况。结果 239例患者死亡20例,失访12例,停药16例,在治191例。在治191例患者治疗前WHO临床Ⅲ期、Ⅳ期分别有40例和57例,最近一次随访WHO临床Ⅲ期、Ⅳ期分别有2例和1例;191例患者CD4+T淋巴细胞数值均有显著增高(P<0.01),具有统计学意义;171例治疗一年以上的在治患者中HIV病毒载量<50copies/ml者150例(87.7%),病毒载量>1000copies/ml者11例(6.4%);在治191例患者因药物不良反应更换治疗方案86例次。结论当前应用一线治疗方案治疗HIV/AIDS患者具有较高的病毒学、免疫学及临床疗效,但应注意治疗过程中存在的不良反应情况,应根据具体情况及时更换治疗方案,以改善患者预后。

目的:研究急性乙型肝炎患者发病后血清病毒水平与病情慢性化之间的关系。方法:对238例急性乙肝患者于发病初诊时、4周、12周进行HBV-DNA定量测定,按HBV-DNA水平进行分组,观察各组患者慢性化发生率。结果:急性乙型肝炎患者发病初期血清HBV-DNA水平与慢性化发生率之间无明显关系。发病4周时,HBV-DNA﹥105拷贝/mL组慢性化发生率高达46.43%,显著高于HBV-DNA103～105拷贝/mL组(13.46%)和HBV-DNA﹤103拷贝/mL组(3.94%)(P<0.01);HBV-DNA103～105拷贝/mL组慢性化率显著高于HBV-DNA﹤103拷贝/mL组(P<0.01)。12周时血清HBV-DNA﹥105拷贝/mL组慢性化发生率高达81.81%,显著高于HBV-DNA103～105拷贝/mL组(29.41%)和HBV-DNA﹤103拷贝/mL组(7.89%)(P<0.01);HBV-DNA103～105拷贝/mL组慢性化率显著高于HBV-DNA﹤103拷贝/mL组(P<0.01)。结论:急性乙型肝炎发病初期HBV-DNA水平与慢性化发生率之间无明显相关性;发病4周和12周HBV-DNA水平越高,慢性化发生率越高。

Objective To investigate the clinical features of chronic hepatitis B virus (HBV) infected patients superinfected with hepatitis E virus (HEV),and the risk factors of acute sporadic HEV case.Explore reasonable treatment to reduce the incidence of severe viral hepatitis and mortality in the HBV/HEV superinfection.Methods The clinical characteristics of the patients with HBV and HEV superinfection were compared with those simple HEV infection.Results A total of 115 hepatitis E cases were all acute attack with an average of (42 ± 15) years old and the ratio of male to female was 2.83∶ 1.The 44 cases of them were HBV/HEV superinfection,the other 71 cases were the simple hepatitis E.In the HBV/HEV superinfection group the sever jaundice (TB ＞ 200 μmol/L),the severe abnormal coagulation function( PTA ＜40％ ),the hypoalbuminemia was obviously more than that in the simple hepatitis E group( P ＜ 0.05).The incidence of hepatic encephalopathy was 15.90％,the severe hepatitis rate was 38.64％,obviously higher than that in the simple hepatitis E group (P ＜ 0.05 ).ALSS has good effects in the treatment of the patients with severe viral hepatitis.Conclusions Seafood were the risk factors in the infection of HEV.Superinfection of HBV and HEV can cause chronic and more severe hepatitis,with high mortality.Combined hepatotherapy with ALSS has good effects,the general survival rate is higher,especially in early stage.

Objective:To observe the changes of liver function indexes of patients with decompensate type B hepatitis cirrhosis(DBHC) by using recombinant human colony-stimulating factor(CSF) to mobilize bone marrow stem cells,and to release them into blood circulation.Methods:One hundred and thirty-two DBHC patients who had accepted nucleoside analogue anti-hepatitis B virus treatment for consecutive 3 months but liver function index could improve no more were randomly divided into treatment group(group T) and control group(group C) with 66 in each group.Patients in group T were given CSF 300 μg once daily for consecutive 5 days.Liver functions were observed in 12,24 and 48 weeks.Results:Compared with group C,liver function indexes such as serum alanine aminotransferase,albumin,total bilirubin and cholinesterase of patients in group T ameliorated in 12,24 and 48 weeks after CSF treatment respectively(P<0.01),but globulin did not change significantly(P>0.05).Conclusions:Bone marrow stem cell orthotopic transplantation can ameliorate liver functions in patients with severe cirrhosis.

总结了本院2006年1月~2008年12月抗病毒治疗的76位有吸毒行为的艾滋病患者影响服药依从性的调查,发现感染者服药依从性低,而且失访人员多。资料显示,服药依从性低中有吸毒行为的占57%,失访人员中有吸毒行为的占60%。于2009年1月~2011年1月进行护理干预,特别针对吸毒人群,主要方法包括有多种形式的健康教育、用药督导、建立良好的医患关系、心理指导、科学网络管理。认为提供有效的干预措施,可有效提高有吸毒行为的艾滋病患者服药的依从性。

Objective To explore the clinical features of patients with chronic hepatitis B virus(HBV) superinfected with hepatitis E virus(HEV). Methods The clinical characteristic of the patients with HBV and HEV superinfection were compared with those simple HEV infection. Results Totally 78 hepatitis E cases were all acute attacked with an average of (46±17) years old and the ratio of male to female was 2.39: 1. The 35 cases of them were HBV/HEV superinfection ,the other 43 cases were the simple hepatitis E. In the HBV/HEV superinfection group the level of total serum bilirubin was (256±141 )μmol/L,the hepatic encephalopathy rate was 14.3% ,the severe hepatitis rate was 40.0%, obviously more than that in the simple hepatitis E group( P <0.05).Conclusion Superinfection of HBV and HEV can cause chronic and more severe hepatitis, the poorer prognosis.

Objective To investigate prevalence of SEN virus in patients with different subtypes of hepatitis in Zhongshan area.Methods According to published gene sequences,Type specific primers to SENV-D and SENV H were designed and synthesized.SENV-D/H DNA were detected by nested-PCR in 60 samples from healthy voluntary blood donors,73 from hepatitis B virus carriers,124 from patients with chronic hepatitis B infection,58 from patients with severe hepatitis B infection,63 from patients with liver cirrhosis and 57 from patients with non-A-E hepatitis.PCR products of one SENV-D and one SENV H were cloned and sequenced.Results By sequencing,the specificity of genotype-specific PCR was confirmed.SENV-D/H DNA was detected in 66.67% of patients with non-A-E hepatitis,which was significantly higher than that in the healthy blood donors(26.67%)(P0.01).The prevalence of SENV among patients with non-A-E hepatitis was similar to that among patients with chronic hepatitis B infection(52.42%),patients with server hepatitis B(53.97%)and patients with cirrhosis of liver(56.90%)(P0.05),but significantly higher than that among the healthy blood donors and hepatitis B virus carriers(27.39%)(P0.01).The prevalence of SENV among the hepatitis B virus carriers was no significant difference compared to that among blood donors(P0.05).Conclusion The relationships of infection of SEN virus are associated in part with the development of non-A-E hepatitis.SEN virus may play a very important roles in activation and aggravation of infection of hepatitis B virus.

目的:探讨B超介导下肝穿刺活检术的术前、术中及术后的护理.方法:对134例患者行该手术的患者在术前、术中、术后各期进行相应的护理.结果:本院134例患者均成功取得肝组织且无出现并发症,住院观察一天出院.结论:B超介导下肝穿刺术是一种简便安全、易行的有效检查方法,细致、周到的护理是手术成功的主要保证.

目的探讨上矢状窦和横窦损伤的诊断及手术方法,提高患者的生存率及生存质量.方法分析21例外伤性上矢状窦和横窦损伤的临床特点、手术方法以及死亡原因.结果外伤性颅内静脉窦损伤术前诊断困难,损伤类型只有术中才能确定,迅速控制致命性大出血及恢复静脉窦畅通是手术关键.结论根据静脉窦损伤的不同类型,选择不同方法修补或重建静脉窦,同时正确处理颅内出血和脑挫裂伤,是提高患者生存率和生存质量的关键.