Long-term antiviral efficacy of entecavir and liver histology improvement in Chinese patients with hepatitis B virus-related cirrhosis

AIM: To evaluate the clinical outcomes of 240-wk treatment with entecavir(0.5 mg) in Chinese nucleosidenaive patients with cirrhosis.METHODS: A total of 204 nucleoside-naive patients with compensated(n = 96) or decompensated(n = 108) hepatitis B virus(HBV)-induced cirrhosis at the Department of Gastroenterology of the China-Japan Union Hospital(Jilin University, Changchun, China) who were treated with entecavir(0.5 mg) for 240 wk were enrolled in this study. Liver biopsy samples obtained from 38 patients prior to treatment(baseline) and at week 240 were evaluated by different independent histopathologists. Efficacy assessments included the proportions of patients who achieved an HBV DNA level < 500 copies/m L, the association of interleukin-28 B genetic variation with antivirus therapy, clinical outcomes, and histologic improvement. Changes in liver disease severity were analyzed, and liver histologic evaluation was performed in 38 patients with paired biopsies. Student t tests were used to compare the means of continuous variables between the groups, and the proportions of patients who achieved the endpoints were compared using the χ2 test.RESULTS: At week 240, 87.5% of the patients with compensated cirrhosis and 92.6% of the patients with decompensated cirrhosis achieved a HBV DNA level < 500 copies/m L. Three patients had genotypic entecavir resistance within the 240-wk period. No significant association was observed between virologic response and interleukin-28 genotype(CT, 88.2% vs CC, 90.6%). The proportion of patients with Child-Pughclass A disease was significantly increased at week 240(68%) from the baseline(47%; P < 0.01). The proportion of patients with Child-Pugh class B disease was significantly decreased at week 240(25%) from the baseline(39%; P = 0.02). In the patients with paired liver biopsies, the mean reduction in the Knodell necroinflammatory score from the baseline was 3.58 ± 1.03 points(7.11 ± 1.80 vs 3.53 ± 1.35, P < 0.01). The mean reduction in Ishak fibrosis score from the baseline was 1.26 ± 0.64 points(5.58 ± 0.50 vs 4.32 ± 0.81, P < 0.01).CONCLUSION: Entecavir is an effective treatment option for patients with HBV-related compensated or decompensated cirrhosis that can result in sustained virologic suppression and histologic improvement.

硫酸软骨素联合盐酸氨基葡萄糖治疗膝骨关节炎临床疗效及不良反应观察

目的:观察硫酸软骨素联合盐酸氨基葡萄糖治疗活动性膝骨关节炎临床疗效及不良反应。方法:将117例活动期膝骨关节炎患者随机分为治疗组、对照1组、对照2组,每组39例。3组均使用非甾体抗炎药并进行健康教育,对照1组加用硫酸软骨素,对照2组加用盐酸氨基葡萄糖,治疗组加用硫酸软骨素联合盐酸氨基葡萄糖,治疗3个月。观察各组患者关节疼痛、压痛、肿胀、功能障碍指数和生活质量改变情况,以及不良反应。结果:治疗后,治疗组与对照1组、对照2组比较,膝关节疼痛、压痛、肿胀明显减轻,功能障碍明显改善,差异有统计学意义(P<0.05);患者生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康8个维度评分及综合评分均有明显改善,差异有统计学意义(P<0.01)。3组不良反应比较,差异无统计学意义(P>0.05)。结论:硫酸软骨素联合盐酸氨基葡萄糖治疗活动性膝骨关节炎,能降低病情活动指标,提高患者生活质量,有较好的安全性。

Correlations between endoscopic and clinical disease activity indices in intestinal Behcet's disease

AIM:To develop a novel endoscopic severity model of intestinal Behcet's disease(BD) and to evaluate its feasibility by comparing it with the actual disease activity index for intestinal Behcet's disease(DAIBD).METHODS:We reviewed the medical records of 167 intestinal BD patients between March 1986 and April 2011.We also investigated the endoscopic parameters including ulcer locations,distribution,number,depth,shape,size and margin to identify independent factors associated with DAIBD.An endoscopic severity model was developed using significant colonoscopic variables identified by multivariate regression analysis and its correlation with the DAIBD was evaluated.To determine factors related to the discrepancy between endoscopic severity and clinical activity,clinical characteristics and laboratory markers of the patients were analyzed.RESULTS:A multivariate regression analysis revealed that the number of intestinal ulcers(≥ 2,P = 0.031) and volcanoshaped ulcers(P = 0.001) were predictive factors for the DAIBD.An endoscopic severity model(Y) was developed based on selected endoscopic variables as follows:Y = 47.44 + 9.04 × non-Ileocecal area + 11.85 ×≥ 2 of intestinal ulcers + 5.03 × shallow ulcers + 12.76 × deep ulcers + 4.47 × geographicshaped ulcers + 26.93 × volcano-shaped ulcers + 8.65 ×≥ 20 mm of intestinal ulcers.However,endoscopic parameters used in the multivariate analysis explained only 18.9% of the DAIBD variance.Patients with severe DAIBD scores but with moderately predicted disease activity by the endoscopic severity model had more symptoms of irritable bowel syndrome(21.4% vs 4.9%,P = 0.026) and a lower rate of corticosteroid use(50.0% vs 75.6%,P = 0.016) than those with severe DAIBD scores and accurately predicted disease by the model.CONCLUSION:Our study showed that the number of intestinal ulcers and volcano-shaped ulcers were predictive factors for severe DAIBD scores.However,the correlation between endoscopic severity and DAIBD(r = 0.434) was weak.

银杏达莫注射液联合前列地尔在急性脑梗死急诊治疗中对患者血液流变学、血小板活性指标和神经功能的影响

目的:探讨银杏达莫注射液联合前列地尔在急性脑梗死急诊治疗中对患者血液流变学、血小板活性指标、神经功能和炎性因子的影响。方法:210例急性脑梗死急诊治疗患者,随机数表法分为观察组和对照组,每组105例。观察组患者予银杏达莫注射液联合前列地尔治疗,对照组患者予前列地尔治疗,比较两组患者治疗后血液流变学、血小板活性指标、神经功能和炎性因子水平。结果:观察组患者治疗后全血黏度高切、全血黏度低切、血浆黏度、红细胞比积、红细胞沉降率和D-二聚体水平分别为(4.11±0.49)m Pa/s、(6.22±0.69)m Pa/s、(1.59±0.18)m Pa/s、(43.09±3.17)%、(15.35±1.32)mm/h、(310.31±35.27)ng/m L,均低于本组治疗前和对照组,差异有统计学意义(P<0.05);观察组患者治疗后CD-63、CD62P和PAC-1水平分别为(0.21±0.10)ng/L、(1.31±0.47)ng/L、(15.62±2.97)ng/L,均低于本组治疗前和对照组,差异有统计学意义(P<0.05);观察组治疗后NIHSS评分为(13.96±2.51)分,低于本组治疗前和对照组;Barthel评分为(69.72±21.36)分,高于本组治疗前和对照组,差异有统计学意义(P<0.05);观察组治疗后hs-CRP、IL-6和TNF-α水平分别为(6.04±1.07)mg/L、(30.89±6.92)pg/L、(48.47±8.87)pg/L,均低于本组治疗前和对照组,差异有统计学意义(P<0.05)。结论:银杏达莫注射液联合前列地尔治疗急性脑梗死临床效果较好,降低血液黏度,改善血液流变学指标,提高神经功能康复,抑制血小板激活,改善微循环,减轻炎性反应。

外周血淋巴细胞亚群在系统性红斑狼疮患者中表达及与狼疮性肾炎的关系

目的 观察系统性红斑狼疮(systemic lupus erythematosus,SLE)及狼疮性肾炎(lupus nephritis,LN)患者外周血淋巴细胞亚群变化,探讨其与SLE患者发生LN的关系。方法 134例SLE患者(SLE组)根据是否发生LN分为LN组52例和非LN组82例;90例体检健康者为对照组。采用流式细胞术检测SLE组和对照组外周血淋巴细胞亚群,包括T淋巴细胞、抑制性T(suppressor T,Ts)细胞、辅助性T(helper T,Th)细胞、B淋巴细胞、自然杀伤(natural killer,NK)细胞计数;检测红细胞沉降率、C反应蛋白、IgG、补体C3、补体C4、抗双链DNA抗体、尿蛋白定量,评估SLE疾病活动性指数-2000(systemic lupus erythematosus disease activity index-2000,SLEDAI-2000)。采用Spearman相关法分析SLE患者尿蛋白定量与淋巴细胞亚群的相关性;采用多因素logistic回归分析SLE患者发生LN的影响因素。结果 SLE组T淋巴细胞计数、Th细胞计数、B淋巴细胞计数、NK细胞计数均低于对照组(P<0.05),Ts细胞计数与对照组比较差异无统计学意义(P>0.05)。LN组T淋巴细胞计数[831.47(554.60,1 291.12)×10^(6)/L]、Ts细胞计数[402.48(262.20,712.92)×10^(6)/L]、Th细胞计数[350.95(213.41,524.58)×10^(6)/L]、B淋巴细胞计数[80.42(42.53,155.89)×10^(6)/L]、NK细胞计数[93.00(53.37,131.24)×10^(6)/L]、补体C3水平[(0.82±0.36)g/L]均低于非LN组[1 194.42(926.71,1 757.97)×10^(6)/L、595.58(388.38,913.66)×10^(6)/L、536.77(360.95,695.66)×10^(6)/L、130.37(63.87,240.19)×10^(6)/L、162.48(89.15,240.79)×10^(6)/L、(0.94±0.28)g/L](P<0.05),红细胞沉降率[31.00(20.00,51.50)mm/h]、C反应蛋白[6.15(2.51,20.00)mg/L]、尿蛋白定量[2.65(1.69,5.83)g/d]、SLEDAI-2000[7(6,9)]均高于非LN组[22.00(12.00,37.25)mm/h、3.05(1.00,8.12)mg/L、0.11(0.10,0.15)g/d、2(0,4)](P<0.05),IgG、补体C4、抗双链DNA抗体水平与非LN组比较差异均无统计学意义(P>0.05)。SLE患者尿蛋白定量与T淋巴细胞计数、Th细胞计数、NK细胞计数均呈负相关(r=-0.175,P=0.043;r=-0.255,P=0.003;r=-0.231,P=0.007)。NK细胞计数(OR=0.993,95%CI:0.988~0.998,P=0.004)、SLEDAI-2000(OR=1.491,95%CI:1.251~1.778,P<0.001)是SLE患者发生LN的影响因素。结论 SLE患者T淋巴细胞、Th细胞、B淋巴细胞、NK细胞计数降低,发生LN时更低;NK细胞计数减少、SLEDAI-2000增高的SLE患者易发生LN。

清养透解合剂联合西药对系统性红斑狼疮患者血管损伤的影响

目的观察清养透解合剂联合西药治疗系统性红斑狼疮(SLE)患者的临床疗效及其对血管损伤的影响。方法采用前瞻性单盲随机对照的方法,将42例SLE阴虚证患者随机分为治疗组22例和对照组20例,并设健康体检者12名作为健康组。治疗组在西医基础治疗同时加用清养透解合剂,每天1剂;对照组在西医基础治疗同时加用安慰剂,每天1剂,两组均治疗6个月。观察两组治疗前后狼疮活动性评分(SLEDAI)、中医证候积分、泼尼松用量及不良反应;并与健康组比较人可溶性血栓调节蛋白(sTM)、血管假性血友病因子(vWF)的表达。结果与本组治疗前比较,两组治疗后SLEDAI评分、中医证候积分、泼尼松片用量均明显降低(P<0.01);治疗后治疗组SLEDAI评分、中医证候积分、泼尼松片用量均明显低于对照组(P<0.01或P<0.05)。治疗前治疗组及对照组与健康组比较血清vWF、sTM水平均明显升高(P<0.01);治疗组治疗后较治疗前血清vWF、sTM水平明显降低(P<0.01)。治疗组不良反应例数明显少于对照组(P<0.01)。结论清养透解合剂联合西药能改善SLE阴虚证患者临床症状,减少激素用量,明显降低血管损伤因子vWF、sTM的表达,从而减轻血管损伤。