Background &Aims: Kinetic modeling of hepatitis C virus(HCV) response to inte rferon (IFN)-based therapy provides insights into factors associated with treat ment outcomes.HCV/human immunodeficiency virus (HIV)-co...Background &Aims: Kinetic modeling of hepatitis C virus(HCV) response to inte rferon (IFN)-based therapy provides insights into factors associated with treat ment outcomes.HCV/human immunodeficiency virus (HIV)-co-infected patients show lower response rates vs. HCV-monoinfected patients. Reasons for this remain un clear. This study evaluated kinetic parameters and treatment responses in co-in fected vs monoinfected patients. Methods: Co-infected patients were randomized within a US multicenter trial (ACTG 5071) to receive pegylated-interferon (PEG -IFN) alfa-2a +ribavirin vs.IFN alfa-2a +ribavirin. Monoinfected controls w ere matched prospectively for treatment, genotype, age, sex, race, and histology .Quantitative HCV-RNA testing was performed at hours 0,6, 12, 24, 48, and 72; d ays 7, 10, 14, 28, and 56; and weeks 12,24, 48, and 72. Results: Twelve HCV/HIV -co-infected and 15 HCV-monoinfected patients underwent viral kinetic samplin g.Among HIV-positive patients the mean CD4+count was 325 cells/mm3. Seventy-f ive percent of patients were genotype 1.The HCV-RNA level was undetectable at 7 2 weeks in 25%and 40%of co-infected and monoinfected patients, respectively.P hase 1/2 declines, free virus clearance rate, and infected hepatocyte death rate were not affected by co-infection status but differed by treatment. Efficiency (e) ≥90%at 60 hours was associated with viral clearance (P =. 02). Modeling w ith pooled parameters suggests baseline viral load is a key factor in time to re sponse in this cohort. Predicted clearance time increased by 28%in co-infected patients. Conclusions: Co-infection status did not affect key kinetic paramete rs. Among kinetic parameters, efficiency was associated significantly with viral clearance. Co-infected patients may require longer treatment duration thanmono infected patients given their generally higher baseline viral loads.展开更多
目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未...目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。展开更多
文摘Background &Aims: Kinetic modeling of hepatitis C virus(HCV) response to inte rferon (IFN)-based therapy provides insights into factors associated with treat ment outcomes.HCV/human immunodeficiency virus (HIV)-co-infected patients show lower response rates vs. HCV-monoinfected patients. Reasons for this remain un clear. This study evaluated kinetic parameters and treatment responses in co-in fected vs monoinfected patients. Methods: Co-infected patients were randomized within a US multicenter trial (ACTG 5071) to receive pegylated-interferon (PEG -IFN) alfa-2a +ribavirin vs.IFN alfa-2a +ribavirin. Monoinfected controls w ere matched prospectively for treatment, genotype, age, sex, race, and histology .Quantitative HCV-RNA testing was performed at hours 0,6, 12, 24, 48, and 72; d ays 7, 10, 14, 28, and 56; and weeks 12,24, 48, and 72. Results: Twelve HCV/HIV -co-infected and 15 HCV-monoinfected patients underwent viral kinetic samplin g.Among HIV-positive patients the mean CD4+count was 325 cells/mm3. Seventy-f ive percent of patients were genotype 1.The HCV-RNA level was undetectable at 7 2 weeks in 25%and 40%of co-infected and monoinfected patients, respectively.P hase 1/2 declines, free virus clearance rate, and infected hepatocyte death rate were not affected by co-infection status but differed by treatment. Efficiency (e) ≥90%at 60 hours was associated with viral clearance (P =. 02). Modeling w ith pooled parameters suggests baseline viral load is a key factor in time to re sponse in this cohort. Predicted clearance time increased by 28%in co-infected patients. Conclusions: Co-infection status did not affect key kinetic paramete rs. Among kinetic parameters, efficiency was associated significantly with viral clearance. Co-infected patients may require longer treatment duration thanmono infected patients given their generally higher baseline viral loads.
文摘目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。
