Liver transplant candidates and recipients with hepatitis C virus(HCV)-related liver disease greatly benefit from an effective antiviral therapy. The achievement of a sustained virological response before transplantat...Liver transplant candidates and recipients with hepatitis C virus(HCV)-related liver disease greatly benefit from an effective antiviral therapy. The achievement of a sustained virological response before transplantation can prevent the recurrence of post-transplant HCV disease that occurs universally and correlates with enhanced progression to graft cirrhosis. Previous standard-of-care regimens(e.g.,pegylated-interferon plus ribavirin with or without first generation protease inhibitors,boceprevir and telaprevir) displayed suboptimal results and poor tolerance in liver transplant recipients. A new class of potent direct-acting antiviral agents(DAA) characterized by all-oral regimens with minimal side effects has been approved and included in the recent guidelines for the treatment of liver transplant recipients with recurrent HCV disease. Association of sofosbuvir with ribavirin and/or ledipasvir is recommended in liver transplant recipients and patients with decompensated cirrhosis. Other regimens include simeprevir,daclatasvir,and combination of other DAA. Possible interactions should be monitored,especially in coinfected human immunodeficiency virus/HCV patients receiving antiretrovirals.展开更多
Alcohol abuse and chronic hepatitis C virus(HCV)infection are two major causes of chronic liver disease in the United States.About 10%-15%of liver transplants performed in the United States are for patients with cirrh...Alcohol abuse and chronic hepatitis C virus(HCV)infection are two major causes of chronic liver disease in the United States.About 10%-15%of liver transplants performed in the United States are for patients with cirrhosis due to combined alcohol and HCV infection.Data on outcomes on graft and patient survival,HCV recurrence,and relapse of alcohol use comparing transplants in hepatitis C positive drinkers compared to alcohol abuse or hepatitis C alone are conflicting in the literature.Some studies report a slightly better overall outcome in patients who were transplanted for alcoholic cirrhosis vs those transplanted for HCV alone or for combined HCV and alcohol related cirrhosis.However,some other studies do not support these observations.However,most studies are limited to a retrospective design or small sample size.Larger prospective multicenter studies are needed to better define the outcomes in hepatitis C drinkers.展开更多
目的 探讨奥曲肽联合硫酸奈替米星对化脓性阑尾炎术后感染的预防作用及对患者辅助性T细胞17（helper T cell17,Th17）/调节性T细胞（regulatory T cells,Treg）失衡的影响。方法 选取2014年8月~2016年5月浙江象山中医医院收治的急性化...目的 探讨奥曲肽联合硫酸奈替米星对化脓性阑尾炎术后感染的预防作用及对患者辅助性T细胞17（helper T cell17,Th17）/调节性T细胞（regulatory T cells,Treg）失衡的影响。方法 选取2014年8月~2016年5月浙江象山中医医院收治的急性化脓性阑尾炎患者148例,随机分为观察组（n=74）和对照组（n=74）。2组均行腹腔镜阑尾炎切除术,术后对照组采用硫酸奈替米星联合奥硝唑抗感染,观察组同时加用醋酸奥曲肽皮下注射。检测治疗前后血清白细胞介素4（interleukin 4,IL-4）、IL-6、IL-10、IL-17、IL-23、转化生长因子β（transforming growth factorβ,TGF-β）及干扰素γ（interferonγ,IFN-γ）水平;检测Th17、Treg细胞比例及相关转录因子表达水平,分析Th17/Treg变化。结果 治疗后2组患者IL-4、IL-6、IL-10、IL-17、TGF-β均降低,IFN-γ升高（P〈0.05）,观察组各项指标改善情况优于对照组（P〈0.05）;治疗后2组患者Th17、Treg细胞比例及相关转录因子孤独核儿受体γt（orphan nuclear receptorγt,RORγt）、叉头/翼状螺旋转录因子（Forkhead box protein P3,Fox P3）表达水平降低,Th17/Treg降低（P〈0.01）,观察组各项指标低于对照组;2组患者术后切口感染、腹腔感染等不良反应发生率比较差异无统计学意义。结论 奥曲肽联合硫酸奈替米星可预防化脓性阑尾炎患者术后感染,调节Th17/Treg失衡,恢复免疫功能,且无明显不良反应。展开更多
文摘Liver transplant candidates and recipients with hepatitis C virus(HCV)-related liver disease greatly benefit from an effective antiviral therapy. The achievement of a sustained virological response before transplantation can prevent the recurrence of post-transplant HCV disease that occurs universally and correlates with enhanced progression to graft cirrhosis. Previous standard-of-care regimens(e.g.,pegylated-interferon plus ribavirin with or without first generation protease inhibitors,boceprevir and telaprevir) displayed suboptimal results and poor tolerance in liver transplant recipients. A new class of potent direct-acting antiviral agents(DAA) characterized by all-oral regimens with minimal side effects has been approved and included in the recent guidelines for the treatment of liver transplant recipients with recurrent HCV disease. Association of sofosbuvir with ribavirin and/or ledipasvir is recommended in liver transplant recipients and patients with decompensated cirrhosis. Other regimens include simeprevir,daclatasvir,and combination of other DAA. Possible interactions should be monitored,especially in coinfected human immunodeficiency virus/HCV patients receiving antiretrovirals.
文摘Alcohol abuse and chronic hepatitis C virus(HCV)infection are two major causes of chronic liver disease in the United States.About 10%-15%of liver transplants performed in the United States are for patients with cirrhosis due to combined alcohol and HCV infection.Data on outcomes on graft and patient survival,HCV recurrence,and relapse of alcohol use comparing transplants in hepatitis C positive drinkers compared to alcohol abuse or hepatitis C alone are conflicting in the literature.Some studies report a slightly better overall outcome in patients who were transplanted for alcoholic cirrhosis vs those transplanted for HCV alone or for combined HCV and alcohol related cirrhosis.However,some other studies do not support these observations.However,most studies are limited to a retrospective design or small sample size.Larger prospective multicenter studies are needed to better define the outcomes in hepatitis C drinkers.
