目的:评估索磷布韦/维帕他韦/伏西瑞韦(Sofosbuvir/Velpatasvir/Voxilaprevir，SOF/VEL/VOX)再治疗直接抗病毒药物(Direct acting antivirals，DAAs)治疗失败的不同基因型慢性丙型肝炎(Chronic hepatitis C，CHC)的有效性和安全性。方法:回顾性分析2022年1至10月16家医疗机构中DAAs治疗失败的21例CHC患者接受12周SOF/VEL/VOX抗病毒治疗的临床资料。分析患者基线、治疗4周、12周和治疗结束后12周的HCV RNA水平，以及基线和治疗结束后12周的血常规、肝肾功能等指标。收集患者治疗和随访期间的不良事件。采用SPSS 25.0对数据进行统计分析。结果:所有患者治疗4周、12周及治疗结束后12周均实现了病毒学应答。治疗结束后12周，丙氨酸转氨酶、天冬氨酸转氨酶和APRI均较治疗前下降( Z＝－3.940、－3.680和－3.889， P值均<0.001)，丙氨酸转氨酶复常率为95.2%(20/21)。2例(9.5%，2/21)患者出现胃肠道反应，包括腹痛、腹泻，恶心和呕吐。1例(4.8%，1/21)患者出现头痛，1例(4.8%，1/21)患者出现疲劳，未发生因不良反应引起的严重不良事件、死亡或中止治疗的情况。 结论:SOF/VEL/VOX对CHC患者是一种有效且安全的再治疗方案，对于DAAs治疗失败的不同基因型患者具有良好的病毒学应答率，耐受性良好。
Objective:To construct a non-invasive predictive model for liver fibrosis in HBeAg positive chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) lower than 2 upper limit of normal (ULN).Methods:The clinical data of 279 HBeAg positive CHB patients with ALT<2×ULN admitted in Zhejiang Provincial People’s Hospital from October 2014 to December 2020 were retrospectively analyzed. According to the pathological results of liver biopsy, there were 117 cases of mild liver fibrosis (S0-S1) and 162 cases of significant liver fibrosis (S2-S4). The independent predictors of liver fibrosis were analyzed by multivariate logistic regression analysis and a noninvasive predictive model was constructed. The model for predicting the severity of liver fibrosis was evaluated by receiver operating characteristic curve (ROC).Results:Multivariate logistic regression analysis showed that age, prothrombin time (PT), aspartate aminotransferase (AST), anti-HBc and HBV DNA were independent predictors of liver fibrosis ( OR=1.055, 1.365, 1.027, 1.231, 0.763, all P<0.05). The area under the ROC curve (AUR) of the model was 0.772 (95% CI: 0.716-0.828, P<0.05), the sensitivity and specificity for the diagnosis of significant liver fibrosis were 79.5% and 70.9% at the cut-off value of 0.504. The AUC of APRI model and FIB-4 index model for assessing significant liver fibrosis in CHB patients with HBeAg-positive and ALT<2×ULN were 0.720 and 0.671, respectively, which were lower than that of the current model (all P<0.05). Conclusion:The noninvasive predictive model constructed in this study has a high diagnostic value for evaluating the severity of liver fibrosis in CHB patients with HBeAg positive and ALT<2×ULN.
麻疹孪生球菌是一种革兰阳性球菌，是寄生在人类口咽、上呼吸道、胃肠道、女性生殖道的条件致病菌，当机体免疫力下降时感染风险明显增加，易引起感染性心内膜炎、脑膜炎、心包炎、脓肿、败血症等多种疾病。现报道1例20岁男性患者无明显诱因出现发热伴乏力和意识不清，血培养和脑脊液高通量测序均为麻疹孪生球菌，头颅CT提示硬膜下脓肿和多发性脑脓肿，经脓肿穿刺引流和使用敏感抗生素治疗后，症状缓解出院。在6个月随访中未再发热，最终治愈。
