目的 探究晚期肝癌生物靶向治疗的临床效果。方法 选取 2019 年 5 月至 2020 年 8 月在我院诊治的晚期肝癌（HCC）患者 120 例为研究对象，随机分为四组，每组 30 例。A 组给予一般对症支持治疗；B 组给予阿帕替尼治疗 +一般治疗；C 组给予卡瑞利珠单抗治疗 + 一般治疗，D 组给予一般治疗 + 阿帕替尼 + 卡瑞利珠单抗联合治疗。比较四组的治疗效果。结果 治疗后，D 组 ECOG 评分、AFP、VEGF 及 AST 水平均优于 A 组、B 组、C 组，差异均有统计学意义（P ＜ 0.05）。四组 CR 比较，差异无统计学意义（P ＞ 0.05）；D 组 PR、SD、PD、ORR、DCR 均优于 A、B、C 组，差异均有统计学意义（P ＜ 0.05）。D 组≥ 3 级不良反应发生率低于 A 组、B 组、C 组，差异均有统计学意义（P ＜ 0.05）。随访结束后，D 组中位生存时间为 12 个月，长于 A 组的 4 个月、B 组的 7 个月、C 组的 8 个月，差异均有统计学意义（F=78.668，P ＜ 0.05）。D 组 1 年生存率（83.33%）高于 A 组（40%）、B 组（63.33%）、C 组（70%），差异均有统计学意义（χ2=6.442，P ＜ 0.05）。结论 卡瑞利珠单抗联合阿帕替尼治疗晚期 HCC 的疗效高于单独用药，可延长中位生存时间及生存率，降低不良反应，值得临床推广使用。

Background: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) began in Wuhan and rapidly spread globally. The speed and scope of the spread of COVID-19 makes it urgent to define clinical characteristics, serological and radiological changes of the affected patients. Methods: Seven patients with laboratory-confirmed COVID-19 who were admitted to the Third Affiliated Hospital of Sun Yat-Sen University Yuedong Hospital from January 2020 to March 2020 were retrospectively enrolled and their clinical features, serological and radiological longitudinal changes were analyzed. Results: Among the 7 patients, all (100%) had a clear epidemiological history. The most common symptoms were respiratory symptoms 6 (85.7%), and only 2 (28.6%) of the patients had fever at their first visit. The cohort included 4 (57.1%) common types and 3 (42.9%) severe types. Two (28.6%) common type patients developed to severe type in a short time. All of the 7 patients (100%) had abnormal liver function, normal renal function, and normal procalcitonin. The detection time of specific antibody in 7 patients was 5 - 13 days after symptoms. Before the specific antibody could be detected, the absolute value of lymphocytes decreased in 2 (28.6%) common type cases transferred to severe type cases accompanied with obvious progress in pulmonary imaging. The phenomenon of decreased albumin and elevated globulin occurred in 6 patients (85.7%). The predominant pattern of lung lesions observed was bilateral (71.4%) and mainly near the pleura at the first diagnosis. Bilateral pulmonary involvement occurred in 6 cases (85.7%) during the course of disease. In 4 cases (57.1%) with obvious pulmonary lesions, the absolute value of lymphocytes decreased, albumin decreased, and globulin increased during the course of the disease. Conclusions: Serum specific antibodies can be detected within 2 weeks of onset. Close observation of the dynamic changes of absolute value of blood lymphocytes, serum albumin, and globulin which were related to pulmonary imaging changes in patients will contribute to assessment of COVID-19.

Low-density lipoprotein cholesterol (LDL-C) is a well-known risk factor for coronary heart disease but protects against infection and sepsis. We aimed to disclose the exact association between LDL-C and severe 2019 novel coronavirus disease (COVID-19). Baseline data were retrospectively collected for 601 non-severe COVID-19 patients from two centers in Guangzhou and one center in Shenzhen, and patients on admission were medically observed for at least 15 days to determine the final outcome, including the non-severe group (n = 460) and the severe group (severe and critical cases) (n = 141). Among 601 cases, 76 (12.65%) received lipid-lowering therapy; the proportion of patients taking lipid-lowering drugs in the severe group was higher than that in the non-severe group (22.7 vs. 9.6%). We found a U-shaped association between LDL-C level and risk of severe COVID-19 using restricted cubic splines. Using univariate logistic regression analysis, odds ratios for severe COVID-19 for patients with LDL-C ≤1.6 mmol/L (61.9 mg/dL) and above 3.4 mmol/L (131.4 mg/dL) were 2.29 (95% confidence interval 1.12–4.68; p = 0.023) and 2.02 (1.04–3.94; p = 0.039), respectively, compared to those with LDL-C of 2.81–3.40 mmol/L (108.6–131.4 mg/dL); following multifactorial adjustment, odds ratios were 2.61 (1.07–6.37; p = 0.035) and 2.36 (1.09–5.14; p = 0.030). Similar results were yielded using 0.3 and 0.5 mmol/L categories of LDL-C and sensitivity analyses. Both low and high LDL-C levels were significantly associated with higher risk of severe COVID-19. Although our findings do not necessarily imply causality, they suggest that clinicians should pay more attention to lipid-lowering therapy in COVID-19 patients to improve clinical prognosis.

Background. The outbreak of coronavirus disease 2019 (COVID-19) has aroused global public health concerns. Multiple clinical features relating to host profile but not for virus have been identified as the risk factors for illness severity and/or the outcomes in COVID-19. Methods. The clinical features obtained from a cohort of 195 laboratory-confirmed, nasopharynx-sampled patients with COVID-19 in Guangdong, China from January 13 to February 29, 2020 were enrolled to this study. The differences in clinical features among 4 groups (mild, moderate, severe, and critical) and between 2 groups (severe vs nonsevere) were compared using oneway analysis of variance and Student's t test, respectively. Principal component analysis and correlation analysis were performed to identify the major factors that account for illness severity. Results. In addition to the previously described clinical illness severity-related factors, including older age, underlying diseases, higher level of C-reactive protein, D-dimer and aspartate aminotransferase, longer fever days and higher maximum body temperature, larger number of white blood cells and neutrophils but relative less lymphocytes, and higher ratio of neutrophil to lymphocytes, we found that the initial viral load is an independent factor that accounts for illness severity in COVID-19 patients. Conclusions. The initial viral load of severe acute respiratory syndrome coronavirus 2 is a novel virological predictor for illness severity of COVID-19.

目的:研究异甘草酸镁治疗慢性乙肝的有效性与安全性.方法:选择2016年6月-2019年6月本院收治的80例慢性乙肝患者,根据随机数表法分为两组,每组40例.对照组行复方甘草酸苷注射液治疗,观察组行异甘草酸镁注射液治疗.观察两组临床疗效、血清丙氨酸氨基转移酶(ALT)水平及不良反应.结果:观察组的总有效率(95.00％,38/40)高于对照组(80.00％,32/40),差异具有统计学意义(x2=4.114,P=0.043);治疗7d后,观察组的血清ALT水平较对照组低,差异具有统计学意义(t=7.319,P=0.000);两组不良反应发生率差异无统计学意义(x2=1.385,P=0.239).结论:异甘草酸镁治疗慢性乙肝可有效调节体内血清ALT水平,安全性较高,疗效较好.

The novel coronavirus pneumonia (NCP) has spread from Wuhan to all parts of China since December 2019, and the prevention and control of NCP is a top priority for medical staff. Now report three cases of NCP patients, whose viral nucleic acids still positive in stool after throat swab detection turned negative. In view of the highly homologous and similar clinical manifestations between the 2019 novel coronavirus (2019-nCoV) and the severe acute respiratory syndrome(SARS) related coronaviruses, it is recommended to attach great importance to the detection of the viral nucleic acids in stool, with the reference of SARS prevention and control experience. In order to minimize the risks of gastrointestinal spread, the detection of 2019-nCoV nucleic acids in stool may be recommended as the reference standard of disisolation and discharge. Key words: Novel coronavirus pneumonia; Stool; Throat swab; Prevention and control

BACKGROUND Coronavirus disease (COVID-19) has affected more than 100 countries worldwide and the discharge criteria of patients with COVID-19 vary across different countries. In China, patients with two negative respiratory viral RNA tests taken at least one day apart can be discharged with no further quarantine required. Currently, PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in fecal sample is not routinely performed. METHODS We present a patient with COVID-19, whose respiratory swabs became negative but fecal sample remained positive for SARS-CoV-2 RNA. RESULTS Stool sample collected on 27th of February was still positive for SARS-CoV-2 RNA, 24 days after the first negative respiratory swab. CONCLUSIONS Based on the experience from the 2003 SARS epidemic, we recommend that fecal RNA testing of SARS-CoV-2 should be incorporated into the discharge criteria to minimize the risk of transmission from the gastrointestinal tract.

目的 探讨乳果糖灌肠联合门冬氨酸鸟氨酸对肝性脑病患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(ALT)及血氨水平的影响.方法 选取2016年7月至2019年7月本月中山大学附属第三医院粤东医院的60例肝性脑病患者作为研究对象,根据随机数字表法分为对照组与观察组,每组30例.对照组行注射用门冬氨酸鸟氨酸治疗,观察组在对照组基础上联合乳果糖灌肠治疗,比较两组临床疗效、ALT、AST、血氨水平以及不良反应发生情况.结果 观察组治疗有效率(96.67％)高于对照组(76.67％),差异有统计学意义(P<0.05);治疗2周后,观察组血清ALT为(94.97±25.75)U/L、AST为(102.73±30.36)U/L略低于对照组(98.63±27.34)U/L、(104.98±31.21)U/L,差异无统计学意义(P>0.05);治疗2周后,观察组血氨(59.01±17.32)μmol/L低于对照组(97.41±26.49)μmol/L,差异有统计学意义(P<0.05);观察组不良反应发生率20.00％(6/30)略高于对照组13.33％(4/30),但差异无统计学意义(P>0.05).结论 应用乳果糖灌肠联合门冬氨酸鸟氨酸治疗肝性脑病可调节血清AST、ALT水平,且可有效降低患者体内血氨水平,疗效显著,且不增加不良反应发生.

目的 探讨肝病治疗仪治疗脂肪肝的临床效果.方法 选取我院2016年4月至2018年4月收治的92例脂肪肝患者作为研究对象,随机分为对照组和实验组,各46例.对照组采用常规疗法,实验组在常规疗法基础上采用肝病治疗仪治疗,比较两组患者的治疗效果.结果 实验组的临床治疗总有效率为93.5％,明显高于对照组的78.3％(P<0.05).治疗前,两组的ALT、AST、TC、TG水平差异均无统计学意义(P>0.05);治疗后,实验组的ALT、AST、TC、TG水平均明显低于对照组(P<0.05).结论 采用肝病治疗仪治疗脂肪肝的效果明显,可促进患者健康状况的改善,值得推广应用.

目的 探析丁二磺酸腺苷蛋氨酸治疗胆汁淤积性肝炎的效果. 方法 选取2016年1月～2017年10月我院收治的102例胆汁淤积性肝炎患者为主要研究对象,运用数字随机表法将所有患者分为对照组和观察组,每组51例.两组患者均接受常规保肝治疗,观察组在常规治疗基础上增加丁二磺酸腺苷蛋氨酸治疗,对两组的临床治疗效果进行对比分析. 结果 (1)临床总有效率:观察组的治疗总有效率为92.16%,明显高于对照组的74.51%,两组对比差异有统计学意义(P＜0.05);(2)肝功能:经治疗后,观察组患者的各项肝功能指标(血清碱性磷酸酶、血清γ-谷胺酰转肽酶、丙氨酸氨基转移酶、血清总胆红素、结合胆红素)较治疗前有明显改善,且明显优于对照组,差异有统计学意义(P＜0.05);(3)安全性:两组患者的不良反应发生率比较,差异无统计学意义(P＞0.05). 结论 丁二磺酸腺苷蛋氨酸治疗胆汁淤积性肝炎的效果颇为理想,可改善患者的肝功能指标,且治疗安全性高,值得在临床治疗上进一步推广应用.

目的:研究核苷类似物治疗慢性乙肝联合及序贯干扰素后停药的安全性.方法:选择慢性乙肝患者90例,2015年4月～2016年4月是研究时间选择区域,并随机分为研究组、对照组,研究组联合干扰素治疗3个月后停用核苷类似物,继续干扰素治疗9个月,对照组不进行停用核苷类似物治疗;比较临床治疗总有效率和病毒反弹发生率.结果:研究组与对照组的临床治疗总有效率和病毒反弹发生率存在较大差异,其中,研究组的临床治疗总有效率更高,病毒反弹发生率更低,P<0.05.结论:核苷类似物治疗慢性乙肝联合及序贯干扰素后停药的安全性更高,能够改善患者肝功能且治疗效果确切.