抗病毒治疗乙型肝炎相关慢加急性肝衰竭患者的临床研究

目的:探讨抗病毒治疗乙型肝炎相关慢加急性肝衰竭(acute on chronic liver failure,ACLF)的临床意义。方法:回顾性分析2007年8月~2013年8月我院收治的乙型肝炎相关慢加急性肝衰竭的住院患者80例,按照患者有无接受抗病毒治疗分为抗病毒治疗组(A组)50例和未抗病毒治疗组(B组)30例,分析患者接受治疗后的近期与远期疗效、并发症及生存率。结果:1出院时A组好转率70%;B组好转率33.3%。两组比较差异有统计学意义(x2=10.243,P=0.0010.05)。2治疗14周后A组乙肝病毒DNA阴转率72%;B组阴转率30%,两组比较差异有统计学意义(x2=13.440,P=0.0000.05)。3A组出现细菌感染45例,电解质紊乱41例,消化道出血5例,肝性脑病10例,肝肾综合征10例,B组出现细菌感染30例,电解质紊乱27例,消化道出血6例,肝性脑病10例,肝肾综合征12例,两组比较差异无统计学意义(x2=2.755,P=0.0970.05)。4随访5年,A组存活36例,死亡14例,12、36和60个月累积生存率分别为78.5%、71.2%、71.2%,B组存活5例,死亡25例,12、36和60个月累积生存率分别为35.4%、27.5%、27.5%,两组比较差异有统计学意义(P0.05)。结论:对乙型肝炎相关慢加急性肝衰竭患者给予抗病毒治疗可明显改善预后,提高生存率。     

骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后关节疼痛的影响

目的:探讨骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后患者关节疼痛的影响。方法:回顾性分析2012年2月-2013年8月我院收治的股骨颈骨折患者的临床病历资料,按照假体类型将其分为骨水泥型髋关节置换术(A组)和生物型髋关节置换术(B组),通过Harris与分项百分制髋关节疼痛评分比较两组患者术后髋关节的疼痛情况。结果:两组患者的手术时间、术中出血量以及术后引流量比较,差异无统计学意义(P0.05),A组的住院时间短于B组,差异有统计学意义(P0.05)。A组术后3、6个月的髋关节疼痛率均低于B组,术后12、24个月则高于B组,差异有统计学意义(P0.05);经x2趋势分析,A组患者术后髋关节疼痛率随时间增加呈逐渐上升趋势,差异有统计学意义(x2=10.837,P=0.001),B组患者术后髋关节疼痛率随时间增加呈逐渐下降趋势,差异有统计学意义(x2=9.842,P=0.002)。A组患者术后3、6个月的髋关节疼痛评分高于B组,术后12、24个月则低于B组,差异有统计学意义(P0.05);A组术后3、6个月的髋关节疼痛评分高于术后12、24个月,B组3、6个月的髋关节疼痛评分低于术后12、24个月,差异有统计学意义(P0.05)。结论:骨水泥型假体缓解髋关节疼痛近期效果优于生物型假体,而生物型假体远期效果优于骨水泥型假体。     

非梅毒螺旋体抗原血清学试验假阳性发生率及原因分析

目的分析非梅毒螺旋体抗原血清学试验假阳性发生率及原因。方法收集2018年1～12月我院门诊及住院患者3000例的送检血清标本进行梅毒甲苯胺红不加热血清试验(TRUST)和梅毒螺旋颗粒凝集试验(TPPA),并对试验结果进行分析。结果 3000例的血清标本中,TRUST假阳性率为0.53%(16/3000)。2018年上半年(1～6月份)TRUST试验假阳性率为0.62%(9/1452),2018年下半年(7～12月)TRUST试验假阳性率为0.45%(7/1548),上半年假阳性率略高于下半年,但差异无统计学意义(P0.05)。TRUST试验假阳性16例的血清标本中,系统性红斑狼疮2例,麻风病患者3例,皮肌炎2例,湿疹1例,孕妇1例,老年人1例,不明原因6例。结论 TRUST试验的假阳性时有发生,临床应高度重视;建议TRUST阳性者以TPPA等梅毒螺旋体抗原血清学试验进行确认。     

不同干预时机下复方嗜酸乳杆菌片联合四联疗法在根除幽门螺杆菌失败补救治疗中的应用

目的探讨不同干预时机下复方嗜酸乳杆菌片联合四联疗法在首次根除幽门螺杆菌(H. pylori)失败患者补救治疗中的作用。方法选择西安市第一医院消化内科90例经标准四联疗法根除H. pylori失败的患者为研究对象,随机分为研究组A(A组)、研究组B(B组)与对照组(C组),各30例。A组患者使用复方嗜酸乳杆菌片联合补救四联疗法治疗。B组患者在补救四联疗法结束后序贯使用复方嗜酸乳杆菌片2周。C组患者单独采用补救四联疗法治疗。比较3组患者临床症状、不良反应发生率及H. pylori根除率。结果A组、B组、C组患者总有效率分别为93.33%(28/30),90.00%(27/30),66.67%(20/30),差异有统计学意义(χ²=9.120,P=0.010)。A组、B组、C组患者总不良反应发生率分别为13.33%(4/30)、16.67%(5/30)、66.67%(20/30),差异有统计学意义(χ²=24.522,P<0.001)。A组、B组、C组患者H. pylori根除率分别为60.00%(18/30)、63.33%(19/30)、33.33%(10/30),差异有统计学意义(χ² =6.502,P=0.039)。A组与B组患者H. pylori根除率相比差异无统计学意义(χ²=0.071,P=0.791)。结论复方嗜酸乳杆菌片联合四联疗法可提高首次四联疗法根除H. pylori失败患者H. pylori根除率,改善患者临床症状,降低总体不良反应发生率,但不同干预时机下复方嗜酸乳杆菌片对H. pylori根除率无明显影响。     

XPA 及XPG 基因多态性与晚期非小细胞肺癌铂类药物化疗疗效及 预后的关系

目的:研究DNA修复基因XPAA23G及XPGC46T位点基因多态性与晚期非小细胞肺癌铂类化疗疗效及预后的关系。方法:经病理学确诊的晚期非小细胞肺癌患者89例,化疗前提取其外周血DNA,用DNA测序技术检测XPA、XPG基因型,所有患者均接受2-4个周期铂类药物为基础的化疗。结果:1)89例患者中,携带XPA23A/A及A/G+G/G基因型的化疗有效率分别为47.5%和24.5%,差异有统计学意义(x2=5.137,P=0.023);携带XPG46C/C及C/T+T/T基因型的患者治疗有效率分别为47.6%、23.4%,二者间也有统计学差异(x2=5.729,P=0.017),联合分析显示A/A及C/C型化疗有效率最高,达63.0%,而A/A及C/T+T/T型最低,仅15.4%,四组间有显著统计学差异(x2=14.080,P=0.003)。2)89例患者中位TTP为7个月,XPA23A/A基因型中位TTP为11个月,A/G+G/G基因型为6个月,两者比较差异有显著性(x2=44.640,P<0.01);XPG46C/C基因型中位TTP为10个月,C/T+T/T基因型为6个月,两者也有统计学差异(x2=32.236,P<0.01)。联合分析显示,XPAA/A+XPGC/C型中位TTP最长,达到11个月,而A/G+G/G及C/T+T/T基因型最短,仅有4个月,四组间差异有显著统计学意义(x2=59.295,P<0.01)。结论:XPAA23G及XPGC46T单核苷酸多态性可单独及联合用于预测晚期NSCLC病人对铂类药物的化疗疗效及TTP,初步提示可以根据患者基因型来指导个体化治疗。     

内江地区慢性乙型肝炎患者的基因型及拉米夫定联合阿德福韦酯抗病毒治疗效果

目的探讨内江地区慢性乙型肝炎患者的基因型及拉米夫定联合阿德福韦酯抗病毒的治疗效果。方法将201例慢性乙型肝炎患者进行HBV基因型的测定,其中120例HBeAg(+)慢性乙型肝炎患者随机分为三组:A组、B组和C组,每组40例。A组给予拉米夫定(LAM)治疗;B组给予恩替卡韦(ETV)治疗;C组给予LAM联合阿德福韦酯(ADV)治疗,比较治疗情况。结果 201例慢性乙型肝炎患者中B型119例(59.2%),C型68例(33.8%),B/C混合型10例(5.0%),未知型4例(2.0%),各分型之间的性别、年龄差异无统计学意义(P0.05)。C型感染者HBeAg阳性率为86.8%,显著高于B型的51.3%(P0.05)。HBeAg(+)的3组患者治疗12、24和48周时,B组和C组患者的ALT复常率、HBV DNA阴转率及48周时的HBeAg血清转换率均显著高于A组(P0.05);C组患者与B组比较差异无统计学意义(P0.05)。治疗期间均未见不良反应发生。C组患者(包括B型19例、C型21例)中B型的HBV DNA阴转率及HBeAg血清转换率显著高于C型(P0.05)。结论地处西南方的内江地区慢性乙型肝炎患者主要以B型为主,C型次之,B型和C型共占93.0%,其他型别仅占较少部分。ETV方案或LAM联合ADV方案治疗HBeAg(+)慢性乙肝疗效优于LAM治疗。初始LAM联合ADV治疗基因B型HBeAg(+)慢性乙型肝炎疗效优于C型。     

不同干预方式及干预时机对急性非ST 段抬高型心肌梗死伴多支病变的 临床效果研究

目的：评估肌钙蛋白I(cTnI)转归前后经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)与冠状动脉旁路移植术 (coronary artery bypass grafting,CABG)治疗急性非ST 段抬高心肌梗死(non-ST segment elevated myocardial infarction,NSTEMI)的 有效性及安全性。方法：入选2008 年1 月1 日至2013 年4 月30 日就诊于我院并接受PCI或CABG治疗的NSTEMI患者329 例,分为cTnI转归前PCI 干预组(A 组)、cTnI转归前CABG 干预组(B 组)、cTnI转归后PCI 干预组(C 组)和cTnI 转归后CABG干 预组(D 组)。计算和比较各组的临床终点事件的发生率,再灌注策略对临床终点事件的优势比(OR)。结果：四组患者的完全血运重 建率比较差异有统计学意义(P<0.05),B、C、D组显著高于A组(P<0.05),而B、C、D组之间比较无统计学差异(P>0.05)。术后24 个 月,再次血运重建率：A 组12.9%和B 组3.4%(OR=3.82,95%CI：1.03～16.60),A组12.9%和C 组5.1%(OR=2.55,95%CI：1.29～ 6.61);MACCE事件发生率：A组14.1%和C 组5.9%(OR=2.38,95%CI：1.15～5.79),以上结果比较差异均有统计学意义(P<0.05)。 结论：cTnI转归后行PCI治疗NSTEMI伴多支病变患者较cTnI转归前PCI更有利于减少MACCE事件和再次血运重建的发生, cTnI转归前行CABG 术在降低血运重建发生率方面较优于PCI治疗。     

光动力疗法治疗病理性瘢痕的疗效及预后分析

为了探讨光动力疗法治疗病理性瘢痕的疗效及预后,本研究选取2014年2月至2016年5月在我院治疗的病理性瘢痕患者62例,根据治疗方式分为A组(n=32)和B组(n=30),其中A组给予光动力疗法治疗,B组给予糖皮质激素皮损内注射治疗,观察两组治疗疗效、温哥华瘢痕量表(VSS)评分、不良反应及复发情况,同时检测瘢痕组织羟脯氨酸和β-半乳糖苷酶含量。研究显示,A组治疗疗效显著好于B组(p0.05),其中A组和B组总有效率分别为84.38%和56.67%;A组治疗后VSS评分为(4.73±1.01)分,显著低于B组(p0.05);A组治疗后瘢痕组织羟脯氨酸为(0.34±0.09) mmol/L,显著低于B组(p0.05),而β-半乳糖苷酶为(89.01±10.14) U/L,显著高于B组(p0.05);A组和B组复发率分别为0.00%和5.88%,差异比较无统计学意义(p0.05);A组和B组不良反应率分别为9.38%和16.67%,差异比较无统计学意义(p0.05)。本研究表明,光动力疗法治疗病理性瘢痕有较好的效果,可促进成纤维细胞老化,抑制瘢痕形成,值得临床使用。     

维生素B12对萼花臂尾轮虫种群的影响

温度为15℃时,添加20,40,80和100μg/mL维生素B12后,萼花臂尾轮虫(Brachionuscalyciflorus)种群密度随时间增加而增长,其回归方程依次为:y=e(0.1757+0.2974x),y=4.6765x1.2079,y=7.7798x1.0175和y=e(0.6117+0.3469x),密度显著高于对照组(t=4.56,8.15,8.53和9.86;P1.4366,y=7.7461x1.6533,y=6.3611x1.7790和y=9.064x1.6872,对照为y=7.5902x1.50192。各添加组的密度均显著高于对照组(t值分别为16.12,10.17,5.83和5.86;P(0.1376+0.4395x),y=e(0.2032+0.4856x),y=3.4615x1.9522和y=e(0.0220+0.48074x)。对照组除了和20ng/mL组间没有统计差异外(t=0.34,P>0.05),其他各实验组密度显著高出对照组(t值分别为3.66,10.23和2.13)。最高混交率分别为18.18%,7.60%,18.18%和16.67%,对照为66.70%。最大卵雌比依次为0.70,1.90,0.91,1.09,对照组为0.95。       

恩替卡韦治疗HBeAg 阳性乙型肝炎临床观察

目的:探讨恩替卡韦治疗HBeAg阳性乙型肝炎的疗效与安全性。方法:140例慢性乙肝患者随机分为2组:观察组予恩替卡韦0.5 mg/d,对照组予拉米夫定100 mg/d,疗程均为48周。观察两组HBV DNA阴转率、ALT复常率、HbeAg血清转换率以及不良反应发生情况。结果:在治疗12周后,观察组与对照组HBV DNA阴转率分别为47.1%、22.9%(P<0.01),ALT复常率分别为51.4%、31.4%(P<0.05),在治疗48周后,观察组与对照组HBV DNA阴转率分别为88.6%、48.6%(P<0.01),ALT复常率分别为90.0%、72.9%(P<0.01)。HbeAg血清转换率无统计学差异,两组患者未见严重不良反应。结论:恩替卡韦治疗HBeAg阳性乙肝患者,较拉米夫定起效快、作用强,且安全性好。     

Comparison of Serological Response to Doxycycline versus Benzathine Penicillin G in the Treatment of Early Syphilis in HIV-Infected Patients: A Multi-Center Observational Study

Background

While doxycycline is recommended as an alternative treatment of syphilis in patients with penicillin allergy or intolerance, clinical studies to compare serological response to doxycycline versus benzathine penicillin in treatment of early syphilis among HIV-infected patients remain sparse.

Methods

We retrospectively reviewed the medical records of HIV-infected patients with early syphilis who received doxycycline 100 mg twice daily for 14 days (doxycycline group) and those who received 1 dose of benzathine penicillin (2.4 million units) (penicillin group) between 2007 and 2013. Serological responses defined as a decline of rapid plasma reagin titer by 4-fold or greater at 6 and 12 months of treatment were compared between the two groups.

Results

During the study period, 123 and 271 patients in the doxycycline and penicillin group, respectively, completed 6 months or longer follow-up. Ninety-one and 271 patients in the doxycycline and penicillin group, respectively, completed 12 months or longer follow-up. Clinical characteristics were similar between the two groups, except that, compared with penicillin group, doxycycline group had a lower proportion of patients with secondary syphilis (65.4% versus 41.5%, P<0.0001) and a higher proportion of patients with early latent syphilis (25.3% versus 49.6%, P<0.0001). No statistically significant differences were found in the serological response rates to doxycycline versus benzathine penicillin at 6 months (63.4% versus 72.3%, P = 0.075) and 12 months of treatment (65.9% versus 68.3%, P = 0.681). In multivariate analysis, secondary syphilis, but not treatment regimen, was consistently associated with serological response at 6 and 12 months of follow-up.

Conclusions

The serological response rates to a 14-day course of doxycycline and a single dose of benzathine penicillin were similar in HIV-infected patients with early syphilis at 6 and 12 months of follow-up. Patients with secondary syphilis were more likely to achieve serological response than those with other stages.     

One Dose versus Three Weekly Doses of Benzathine Penicillin G for Patients Co-Infected with HIV and Early Syphilis: A Multicenter,Prospective Observational Study

Background

One dose of benzathine penicillin G (BPG) has been recommended for HIV-infected patients with early syphilis (primary, secondary, and early latent syphilis) in the sexually transmitted diseases treatment guidelines, but clinical data to support such a recommendation are limited.

Methods

We prospectively observed the serological response to 1 or 3 weekly doses of BPG in HIV-infected adults who sought treatment of early syphilis at 8 hospitals around Taiwan. Rapid plasma reagin (RPR) titers were followed every 3–6 months after treatment. The serological response was defined as a 4-fold or greater decline in RPR titers at 12 months of treatment. The missing values were treated by following the last-observed-carried-forward principle. We hypothesized that 1 dose was non-inferior to 3 weekly doses of BPG with the non-inferiority margin for the difference of serological response set to 10%.

Results

Between 2007 and 2012, 573 patients completed at least 12 months of follow-up: 295 (51.5%) receiving 1 dose of BPG (1-dose group) and 278 (48.5%) 3 doses (3-dose group). Overall, 198 patients (67.1%; 95% confidence interval [CI], 61.4–72.5%) in the 1-dose group achieved serological response at 12 months, as did 208 patients (74.8%; 95% CI, 69.3–79.8%) in the 3-dose group (one-sided 95% CI of the difference, 15.1%). In the multivariate analysis, secondary syphilis (adjusted odds ratio [AOR], 1.90; 95% CI 1.17–3.09), RPR titer ≥32 (AOR, 1.93; 95% CI, 1.38–2.69), and 3 doses of BPG (AOR, 1.68; 95% CI, 1.20–2.36) were independently associated with a serological response. The time to the first episode of treatment failure was 1184 (standard deviation [SD], 70.5) and 1436 (SD, 80.0) days for 1- and 3-dose group, respectively.

Conclusions

Single-dose BPG resulted in a higher serological failure rate and shorter time to treatment failure than 3 weekly doses of BPG in the treatment of early syphilis in HIV-infected patients.     

一期梅毒实验室诊断差异性研究

目的通过梅毒螺旋体初筛试验、确认试验和鉴别诊断试验,探讨一期梅毒实验室诊断差异性,最大限度减少漏诊与误诊,为深入研发新型早期梅毒诊断试剂奠定基础。方法依据2000年中国卫生部防疫司颁布的性病诊断标准,临床筛选一期梅毒患者86例（研究组）和非梅毒患者100例（对照组）,对患者血清进行甲苯胺红不加热血清试验（TRUST）初筛和梅毒螺旋体明胶颗粒凝集试验（TPPA）确认。筛选临床体征、TRUST法和TPPA法三者结果有差异的患者进一步鉴别诊断,鉴别诊断主要应用荧光定量PCR（FQ-PCR）法、免疫PCR法与自身抗体检测等试验。结果初筛TRUST法灵敏度和特异性分别为62．8％、93．0％;确认TPPA法灵敏度与特异性分别为66．3％、100％。TRUST法和TPPA法两者结果差异占12．8％;临床体征诊断、TRUST法和TPPA法三者结果差异占41．9％。TPPA法与TRUST法两者均阴性的一期梅毒患者中,FQ-PCR阳性率达88．0％,免疫PCR阳性率占40．0％。TPPA法阳性、TRUST法阴性的一期梅毒患者免疫PCR法与TPPA法结果一致;TPPA法阴性、TRUST法阳性11例患者中结核抗体阳性2例,类风湿因子阳性3例与抗Sm抗体结果阳性6例。结论一期梅毒患者实验室诊断结果差异性较大,漏诊与误诊的比例较高,有待研发新型的诊断试剂和提高诊断水平。     

阿德福韦酯短程联合拉米夫定治疗慢性乙型肝炎疗效分析

目的:观察阿德福韦酯短程联合拉米夫定治疗HBeAg(+)慢性乙型肝炎的疗效、病毒变异率、耐药发生率、HBV-DNA转阴率(≤5×102pies/ml)、HBeAg血清转换率等指标的观察,探讨更合理、有效、价廉的治疗慢性乙型肝炎的方案。方法:选择2008-2010年我院门诊及住院的HBeAg(+)的慢性乙型肝炎病人,根据用药不同分为三组,进行为期24月的治疗观察,予观察其肝肾功能、HBV-DNA、病毒变异、耐药发生率等指标的变化情况,并进行比较。结果:治疗24个月时,三组患者显效率分别为90%(27/30)、46.88%(15/32)、44.82%(13/29),三组显效率比较,2=53.982,P<0.05,显效率差异有统计学意义。总体有效率(显效+有效)A组96.67%、B组68.75%、C组72.41%。三组患者第3、6、12、24个月治疗效果均有差异(x2=18.746,P<0.05;x2=61.723,P<0.05;x2=26.821,P<0.05;x2=18.291,P<0.05)。三组患者第24个月ALT、AST、TSB、ALB和PT等肝肾功能指标比较,均有差异(t=2.107,P<0.05;t=3.113,P<0.01;t=2.764,P<0.01;t=2.155,P<0.01)。治疗结束时,三组HBeAg血清转换例数比较,2=8.220,P<0.05,三组HBeAg血清转换情况差异有统计学意义。采用t检验比较三组第3、6、12、24个月HBV-DNA中位值,均有差异(t=1.997,P<0.05;t=2.982,P<0.01;t=2.651,P<0.01;t=3.113,P<0.01)。阿德福韦酯短程联合拉米夫定组共发生3例不良反应,单用拉米夫定组发生4例不良反应,单药使用阿德福韦酯发生不良反应为3例。结论:阿德福韦酯短程联合拉米夫定治疗慢性乙型肝炎疗效和安全性均较高,用药方案具有合理性、有效性,效价比高,适合临床应用。     

Rapid Treponema pallidum Clearance from Blood and Ulcer Samples following Single Dose Benzathine Penicillin Treatment of Early Syphilis

Currently, the efficacy of syphilis treatment is measured with anti-lipid antibody tests. These can take months to indicate cure and, as a result, syphilis treatment trials require long periods of follow-up. The causative organism, Treponema pallidum (T. pallidum), is detectable in the infectious lesions of early syphilis using DNA amplification. Bacteraemia can likewise be identified, typically in more active disease. We hypothesise that bacterial clearance from blood and ulcers will predict early the standard serology-measured treatment response and have developed a qPCR assay that could monitor this clearance directly in patients with infectious syphilis. Patients with early syphilis were given an intramuscular dose of benzathine penicillin. To investigate the appropriate sampling timeframe samples of blood and ulcer exudate were collected intensively for T. pallidum DNA (tpp047 gene) and RNA (16S rRNA) quantification. Sampling ended when two consecutive PCRs were negative. Four males were recruited. The mean peak level of T. pallidum DNA was 1626 copies/ml whole blood and the mean clearance half-life was 5.7 hours (std. dev. 0.53). The mean peak of 16S rRNA was 8879 copies/ml whole blood with a clearance half-life of 3.9 hours (std. dev. 0.84). From an ulcer, pre-treatment, 67,400 T. pallidum DNA copies and 7.08x107 16S rRNA copies were detected per absorbance strip and the clearance half-lives were 3.2 and 4.1 hours, respectively. Overall, T. pallidum nucleic acids were not detected in any sample collected more than 56 hours (range 20–56) after treatment. All patients achieved serologic cure. In patients with active early syphilis, measuring T. pallidum levels in blood and ulcer exudate may be a useful measure of treatment success in therapeutic trials. These laboratory findings need confirmation on a larger scale and in patients receiving different therapies.     

不同剂量糖皮质激素治疗老年哮喘急性发作的对比研究

目的:探讨不同剂量吸入型糖皮质激素(ICS)治疗老年哮喘急性发作的疗效及安全性分析。方法:将108例老年哮喘急性发作患者随机分为A组(34例)、B组(38例)和C组(36例),分别吸入布地奈德200μg/d、400μg/d、800μg/d;治疗3个月后再随机分为低剂量组(200μg/d,n=)和高剂量组(400μg/d)进行维持治疗,并随访观察12个月。结果:治疗3个月后,三组的临床症状评分、肺功能较治疗前均有显著改善,差异有统计学意义(P<0.05);B组、C组治疗后的临床症状评分、肺功能及症状消失时间均显著优于A组,而B组、C组之间差异无统计学意义(P>0.05);A组和B组不良反应的发生率分别为5.9%,10.5%,显著低于C组30.6%,差异有统计学意义(P<0.05);维持治疗期间,低剂量组复发率为21.2%,高剂量组为20.4%,差异无统计学意义(P>0.05)。结论:老年哮喘急性发作患者给予ICS 400μg/d治疗剂量及200μg/d维持剂量即可取得较好的治疗效果,可减少不良反应,提高患者的耐受性。     

Factors Associated with Serological Cure and the Serofast State of HIV-Negative Patients with Primary,Secondary, Latent,and Tertiary Syphilis

Background

Some syphilis patients remain in a serologically active state after the recommended therapy. We currently know too little about the characteristics of this serological response.

Methods

We conducted a cohort study using the clinical database from Zhongshan Hospital, Medical College of Xiamen. In total, 1,327 HIV-negative patients with primary, secondary, latent, and tertiary syphilis were enrolled. Bivariate and multivariate analyses were utilised to identify factors associated with a serological cure and serofast state in syphilis patients one year after therapy. Chi-square tests were used to determine the differences in the serological cure rate across different therapy time points.

Results

One year after the recommended therapy, 870 patients achieved a serological cure, and 457 patients (34.4%) remained in the serofast state. The serological cure rate increased only within the first 6 months. The bivariate analysis indicated that male or younger patients had a higher likelihood of a serological cure than female or older patients. Having a baseline titre ≤1∶2 or ≥1∶64 was associated with an increased likelihood of a serological cure. The serological cure rate decreased for the different disease stages in the order of primary, secondary, latent, and tertiary syphilis. A distinction should be drawn between early and late syphilis. The multivariate analysis indicated that a serological cure was significantly associated with the disease phase, gender, age, and baseline rapid plasma reagin (RPR) titre.

Conclusions

The serofast state is common in clinical work. After one year of the recommended therapy, quite a few syphilis patients remained RPR positive. The primary endpoint of the study indicated that disease phase, gender, age and baseline RPR titre were crucial factors associated with a serological cure.     

心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者血压的影响

目的:研究心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者的血压影响。方法:选取2013年4月到2014年4月某院收治的老年高血压伴焦虑抑郁的患者110例,按照随机数字表法将患者分为研究组和对照组,每组55例,对照组给予常规降压治疗,研究组在对照组的基础上给予心理干预,同时服用氟哌噻吨美利曲辛片,治疗时间均为8周,应用抑郁自评量表(HAMD)和汉密尔顿焦虑自评量表(HAMA)的评分来评价患者的抑郁状态,比较两组降压疗效、HAMD评分、HAMA评分以及不良反应。结果:研究组降压总有效率94.5%(52/55),对照组降压总有效率为67.3%(37/55),两组比较差异具有统计学意义(x2=12.952,P=0.013);研究组治疗后HAMA评分和HAMD评分分别为(10.5±0.6)分、(11.9±1.1)分显著低于治疗前的(20.8±0.4)分、(31.2±0.7)分,与治疗前比较差异具有统计学意义(t=9.923,10.628,P=0.025,0.019),与对照组比较差异具有统计学意义(t=9.823,11.628,P=0.023,0.016);两组不良反应比较差异无统计学意义(x2=5.492,P=0.072)。结论:心理干预联合氟哌噻吨美利曲辛片治疗老年高血压伴焦虑抑郁者具有较好的降压效果,能改善患者焦虑抑郁状态,且无严重不良反应。     

Weaknesses in primary health care favor the growth of acquired syphilis

Acquired syphilis is a sexually transmitted infection that affects the general population and has been growing in recent years in many countries. A study was developed aiming to analyze the trends of acquired syphilis associated with sociodemographic aspects and primary health care in Brazil, in the period from 2011 to 2019. This study used secondary data from the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as socioeconomic and municipal demographic indicators. The trends of acquired syphilis at the municipal level were calculated from the log-linear regression, crossing them with variables of primary health care and sociodemographic indicators. Finally, a multiple model was built from logistic regression. 724,310 cases of acquired syphilis have been reported. In primary care units, 47.8% had partial coverage and 74.1% had health teams with poor or regular scores. 52.6% had rapid test for syphilis partially available. Male and female condoms are available in 85.9% and 62.9% respectively and 54.4% had penicillin available in the health facility. The increase in trends of acquired syphilis was associated with better availability of the rapid test; lower availability of male condoms; lower availability of female condoms; lower availability of benzathine penicillin; partial coverage of the teams in primary health care; limited application of penicillin in primary health care; higher proportion of teams classified as Poor/Regular in primary health care; higher proportion of women aged 10 to 17 years who had children; higher HDI; higher proportion of people aged 15 to 24 years who do not study, do not work and are vulnerable; and population size with more than 100,000 inhabitants. The following variables remained in the multiple model: not all primary health care teams apply penicillin; higher proportion of primary health care teams with poor/regular scores; population size >100000 inhabitants; partially available female condom. Thus, the weakness of primary health care linked to population size may have favored the growth of the acquired syphilis epidemic in Brazilian cities.     

梅毒住院患者63例血清学及脑脊液的临床分析

目的了解梅毒住院患者的流行病学、临床和血清学特征。方法对63例患者的临床资料及血清学、脑脊液等进行综合分析。结果87．30％（55例）患者血清TRUST呈低滴度表现（1：1～1：8）,14．29％（9例）为早期潜伏梅毒,15．87％（10例）为神经梅毒,52．38％（33例）为晚期潜伏梅毒,17．46％（11例）为无法判断病期的潜伏梅毒。73．02％（46例）传播途径为非婚性接触为主,性别分类中女性（49例）多于男性（14例）,低学历（54例）、待业者（18例）及性活跃期人群发病率高。结论潜伏（隐性）梅毒在梅毒分期中占有较大的比例;有必要对血清TRUST滴度持续（≥2年）不转阴患者进行神经梅毒的排查;有必要加强宣传性保护的重要性。