难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素(IFN)的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林(RBV)的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则(RGT)治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

导言：重视慢性乙型肝炎特殊人群的抗病毒治疗

随着抗病毒药物包括聚乙二醇干扰素（PEG—IFN）和核苷（酸）类似物（NAs）在临床上的长期和广泛应用,加之我国慢性乙型肝炎防治指南的颁布和不断更新,同时肝病学会和感染病学会的专家对《指南》的广泛巡讲、解读,使包括基层医院在内的广大肝病工作者对慢性乙型肝炎抗病毒治疗的认识不断提高,越来越多的患者接受了抗病毒治疗。     

趋化因子10与临床疾病关系的研究进展

趋化因子10（CXCL10）是由干扰素诱导产生,过去又把它称为干扰素-γ诱导蛋白10（IFN—γIndueible protein 10）。其具有强大的招募中性粒细胞、促进多种细胞因子分泌及抑制部分肿瘤生长等多种生物学作用。在慢性炎症、过敏性炎症、自身免疫性疾病、移植物排斥反应和肿瘤等多种疾病的病理过程中起重要作用。     

TIPS在肝移植术后难治性腹水中的应用

两例肝移植术后患者出现难治性腹水,明确病因、改善一般状况及肝肾功能后,给予TIPS治疗.TIPS术后1周,两例患者腹水消失,至今已分别随访15月、37月,均未出现肝性脑病、肝功能异常等并发症.肝移植术后TIPS的主要适应症为难治性腹水、食道静脉曲张出血及流出道梗阻.TIPS是治疗肝移植术后难治性腹水一种安全、有效的方法,具有一定的临床治疗意义.     

ARDS:现状与挑战

ALI/ARDS是以难治性低氧性呼吸衰竭为主要临床特点的症候群,是重症医学最具挑战性的领域之一.近期其诊断标准更新为“柏林标准”;治疗方面除了常规机械通气策略之外,因潜在的降低病死率的作用,高频震荡通气(HFOV)、体外膜肺氧合(ECMO)的价值越来越受到重视,而大环内酯类抗生素和干细胞基因治疗则成为药物治疗的热点.根据现有趋势,相信未来ALI/ARDS的病死率将会随着研究的深入和新疗法的开展而逐渐降低.     

MRI对儿童难治性、局灶性癫痫的临床诊断及预后判断

癫痫外科的临床病理研究表明,儿童局灶性皮质发育不良(FCD)及海马硬化是儿童难治性局灶性癫痫常见的致病因素.但在术前的常规的MRI检查中,这些结构上的异常经常被忽视,从而造成延误诊断.临床医生在阅片判断上的失误可能是一个原因,但癫痫的影像专业知识的不全面是重要因素.本文结合MRI技术在癫痫临床诊断领域的应用进展,阐述了儿童难活性、局灶性癫痫患者MRI影像中可能出现的结构性病变;重点阐述了临床易于忽视的局灶性皮质发育不良(FCD)及海马硬化的MRI研究、应用进展.     

肝癌的个体化治疗策略

肝细胞癌（肝癌）治疗手段已较10年前有较大变化,但国内尚缺乏较为统一的治疗指南。制定治疗指南的工作需以生存为主要评价指标,并采用临床病理指标或生物学指标将患者分类,然后比较各种治疗方案对该类患者生存的影响。     

慢性非细菌性前列腺炎患者焦虑、抑郁情绪分析与治疗

慢性非细菌性前列腺炎是男科常见病,因常规的药物和物理治疗效果不佳,我们的调查显示,多数患者存在明显的焦虑、抑郁情绪,成为其求诊和持续接受治疗的障碍.本研究发现对这些患者,在常规治疗基础上给予心理干预可有效改善治疗效果和提高治疗依从性.     

焦虑抑郁障碍误诊为慢性胃炎的临床分析

探讨焦虑抑郁障碍与慢性胃炎之间的关系。统计半年内在心理科门诊及住院治疗的焦虑抑郁障碍患者中曾被误诊为“慢性胃炎”的情况。结果有38例患者做胃镜检查,其中37例患者显示“浅表性胃炎”或“糜烂性胃炎”,仅1例患者胃镜报告正常。40％（15例）按“慢性胃炎”治疗能暂时减轻症状,而60％（23例）按“慢性胃炎”治疗不仅无效,症状反而加重。研究结果提示浅表性胃炎或糜烂性胃炎与人的情绪紧密相关,是焦虑抑郁障碍最常见的躯体症状之一。     

心理因素和慢性前列腺炎关系的思考

慢性前列腺炎患者大多伴有不同程度的心理障碍,应重视患者的心理状态和精神活动,改善患者的生存质量.对这些患者,单纯的药物治疗,效果往往不佳,辅以相应的心理认知疗法,可以明显提高治愈率.经过心理治疗的患者复发率低,并对其周围的慢性前列腺炎患者有良好的诱导和表率作用,具有一定的临床和社会意义.     

慢性乙型肝炎治疗路线图的评价——应答指导的临床治疗策略

慢性乙型肝炎治疗路线图是根据患者对抗病毒药物应答的不同、用病毒及其抗原水平在治疗的整个过程中对患者进行科学管理、制定治疗策略、确定治疗时间的一种优化治疗方案。本文将从它的可行性和意义、重要性、治疗策略的确定及在临床上应用的局限性等方面进行论述。     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

A telehealth intervention for veterans on antiviral treatment for the hepatitis C virus

The standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.     

慢性乙型肝炎合并妊娠患者的抗病毒治疗

母婴垂直传播是我国乙型肝炎病毒（HBV）感染的主要传播方式,新生儿标准的主动一被动免疫即高效价乙肝免疫球蛋白联合乙肝疫苗大大降低了母婴垂直传播的比例,但母体高HBVDNA水平可以增加胎儿宫内感染HBV的风险,导致HBV母婴垂直传播。因此,妊娠期抗病毒治疗尤为关键。计划妊娠的育龄期的慢性乙型肝炎患者应尽可能在妊娠前完成抗...     

从临床试验结果谈替比夫定的慢性乙型肝炎治疗路线图

“路线图”的概念根据以替比夫定为代表的核苷类药物治疗过程中HBVDNA下降的幅度与出现耐药性病毒突变明显相关的现象提出的。其核心内容是治疗后12周～24周的病毒学效应,对于预测和评估疗效具有重要意义。本文通过对“路线图”的概念、替比夫定“路线图”的临床试验依据及意义的介绍,阐明替比夫定治疗后12～24周的病毒学效应,对于预测和评估疗效具有重要意义;“路线图”对慢性乙型肝炎患者应用替比夫定治疗过程中调整治疗策略的指导意义,以规范临床治疗行为,规避耐药发生。     

The Use of Psychoeducation for a Patient with Hepatitis C and Psychiatric Illness in Preparation for Antiviral Therapy: A Case Report and Discussion

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48?weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50?year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.     

要重视慢性乙型肝炎的抗病毒治疗

慢性乙型肝炎是我国常见的慢性传染病之一,严重危害人民健康。围绕着乙型肝炎的防治,带来巨大的经济负担,已成为不可忽视的社会问题。在慢性乙型肝炎-肝硬化-HCC的发生发展过程中,HBV病毒载量起着重要的作用,抗病毒治疗是目前治疗慢性乙型肝炎的有效手段。因此,要重视和规范抗病毒治疗。     

exploring drug users' illness representations of hiv,hepatitis b and hepatitis c using repertory grids

Abstract

Hepatitis B and C viruses are more prevalent among injecting drug users than HIV. This study explored drug users' illness representations of hepatitis B and C using repertory grid methodology. Initially, nine drug users were presented with six elements including hepatitis B and C, and HIV. Constructs were elicited via the sequential form variation of the method of triads. Elements were rated on elicited constructs using a five-point scale, and analyzed using “Flexigrid”. In a second quantitative research stage, 52 drug users were presented with six elements and supplied constructs. Results of the first stage indicated participants were able to generate constructs relating to Leventhal et al.'s (1980) features of illness representations. Most constructs, however, were causal in nature. Participants perceived hepatitis B, C and HIV similarly along the causal component. This similarity on the causal component was largely replicated in the second research stage. Participants, however, distinguished HIV from hepatitis B and C along serious, cure and timeline features. Participants did not distinguish hepatitis B from hepatitis C. The implications of these results for health promotion are discussed.     

Neurobehavioral Correlates of Chronic Hepatitis C

Chronic infection with the hepatitis C virus is a major public health concern in the United States and worldwide, and persons with psychiatric histories are more likely to have chronic hepatitis C (CHC). Neurobehavioral consequences of CHC are common in all phases of the disease process and significantly contribute to morbidity. Antiviral treatment also is associated with neurobehavioral difficulties that can interfere with successful completion of treatment and result in fewer patients clearing the virus. Fatigue, depression, cognitive dysfunction, and anxiety are the most common neuropsychiatric symptoms reported by patients with CHC regardless of treatment status. Behavioral health care professionals can play a vital role in decreasing the personal and societal burden of CHC by being active members of the treatment team and by furthering knowledge of how to manage neurobehavioral correlates of CHC.