目的 通过分析影响四川地区慢性乙型肝炎患者抗病毒治疗依从性的因素，探讨提高患者治疗依从性的策略。 方法 选择2011年4月－2012年4月在四川大学华西医院接受核苷（酸）类似物抗病毒治疗的324例慢性乙型肝炎患者作为研究对象。采用问卷调查的方法，对患者一般情况、心理状态、文化程度、经济情况、疾病认知情况、抗病毒疗效、服药持续性等相关因素进行分析，评估这些因素对患者治疗依从性的影响。 结果 324例患者中能够完全遵照医嘱者78例（24.07%），不能完全依从者246例（75.93%）。心理状态良好者132例（40.74%），其中依从性良好者54例；心理负担较重者192例（59.26%），其中依从性良好者24例。初中及以上学历204例（62.96%），依从性良好者72例；初中以下学历者120例（37.04%），依从性良好者仅6例。不同心理状态、文化程度的患者依从率差异有统计学意义。患者经济状况、年龄差异对于依从性也有一定影响。 结论 慢性乙型肝炎患者对抗病毒治疗的依从性与心理状态、文化程度者及经济状况密切相关。改善患者医疗费用偿付能力，对患者进行疾病认知教育以及减少社会歧视等措施有助于提高患者治疗依从性。
Objective To evaluate the efficacy and safety of antiviral drugs for hepatitis B with YMDD motif variant. Methods We electronically searched MEDLINE (1989-April, 2004), EMBASE (1989-April, 2004), CBMdisc (expand) (1989-April, 2004), and handsearched unpublished Chinese conference proceedings. Randomized and quasi-randomized trials in patients with chronic hepatitis B with YMDD motif variant correlative to lamivudine were collected. Two reviewers extracted the data and assessed the quality of literature independently. The data were then analyzed by RevMan 4.2 software. Results Five studies involving 6 trials and 284 patients were included. According to the results of meta-analysis, antiviral therapy with adefovir plus lamivudine showed significantly better effects on the clearance of serum HBV-DNA and HBeAg and normalization of ALT than that of lamivudine alone (RR 16.61, 95%CI 2.29 to 120.71; RR 6.66, 95%CI 1.23 to 35.88 and RR 6.26, 95%CI 2.29 to 17.12 respectively); also, oxymatrine plus thymothin showed obviously better effects on the clearance of serum HBV-DNA and HBeAg (RR 2.96, 95%CI 1.26 to 6.93 and RR 2.51, 95%CI 1.05 to 5.98 respectively).But adefovir alone showed no better effects on clearance of serum HBV-DNA and HBeAg than that of lamivudine alone (RR 11.00, 95%CI 0.65 to 186.02 and RR 7.00, 95%CI 0.39 to 126.92 respectively); interferon plus lamivudine showed no better effects on the clearance of serum HBV-DNA, HBeAg and the normalization of ALT (RR 3.50, 95%CI 0.90 to 13.58; RR 4.90, 95%CI 0.70 to 35.10 and RR 2.80, 95%CI 0.91 to 8.12 respectively). Chinese herbs plus lamivudine showed no better effects on the clearance of serum HBV-DNA (RR 1.16, 95%CI 0.89 to 1.51). There were no significant side effects in the groups, except flu like symptom in the interferon group, slight kidney impairment in the adefovir group, and aggravation of rare cases in lamivudine group. Conclusions Antiviral therapy with adefovir plus lamivudine, or oxymatrine plus thymothin, shows better effects than with lamivudine alone in terms of antiviral therapy and clinical outcome improvement. However, the evidence is too weak to draw a definite conclusion in this systematic review. Larger sample size and rigorously designed randomized, double blind, placebo control trials are required for future study.
目的:分析艾滋病患者抗病毒治疗后的临床疗效,比较不同基线CD4+T淋巴细胞计数增长情况。方法:纳入51例符合治疗标准的初治患者,采用国家标准抗病毒治疗一线方案和卫生部统一提供的免费药物,通过对服药后半月、1月、3月、6月、12月的时段进行临床评估和实验室检查,并比较不同基线CD4+T淋巴细胞计数水平治疗后的增长情况。结果:治疗12月后,各方案组疗效无差异,不同基线CD4+T淋巴细胞计数的增长有显著差异。毒副反应为肝损伤、过敏性皮疹,消化道反应为主。结论:HAART可显著的抑制体内HIV病毒的复制,重建机体的免疫功能,缓解患者病情,有利于存活期的延长。严重的毒副作用发生较少。
ObjectiveAntiviral treatments could benefit chronic hepatitis B (CHB) patients with the regression or improvement of liver fibrosis. However, the degree of dynamic change of liver fibrosis for patients who had not received antiviral treatment remained to be studied. The current study aimed to observe the long-term variation of liver stiffness measurement (LSM), virological and biochemical response on patients without standard antiviral therapy.MethodsA total of 220 patients who were diagnosed with chronic HBV infection, who had not reached the standard of antiviral therapy, and completed a follow-up date of over 2 years in the First Affiliated Hospital of Xi’an Jiaotong University from 2012 to 2018 were retrospectively enrolled. According to the changes of LSM in baseline and follow-up period, the patients were divided into regression group, non-progressive group, and progressive group. The virological and biochemical characteristics of each group were analyzed.ResultsAmong the 220 patients, 153 patients (69.5%) had no progress in LSM degree. Alanine aminotransferase (ALT), HBV DNA, and HBsAg in a few patients increased or slightly decreased, while the vast majority remained in a relatively stable state. 89.5% (137/153) of the non-progressive patients were in grade F0. In addition, 58 patients showed spontaneous improvement with a decreasing rate of 0.460 kPa per year. Patients with ALT of 1-2 ULN had a statistically significant decrease in LSM improvement compared to patients with normal ALT. 82.8% of the LSM-improving patients showed baseline LSM of F1-F3. Only 9 patients showed LSM deterioration, however, which could not be explained by virus replication or necroinflammatory activity. ConclusionsFor patients unsatisfying standard antiviral therapy, most patients with baseline LSM of F0 grade fail to progress, and patients with baseline LSM of F1-F3 show a decrease during follow-up, LSM progression occurs in 4.1% of patients.
Objective To assess the effect of early antiretroviral therapy on acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture. Methods A total of 1 037 patients who underwent antiretroviral therapy between January 1st 2012 and December 31st 2013 in Butuo Coungty were divided into 2 groups. The early treatment group (with CD4+ lymphocyte count >350 /mm3) was group A (n=459) and delayed treatment group (with CD4+ lymphocyte count≤350 /mm3) was group B. After 18-month treatment, the treatment retention rate, clinical effect and the side effects of medication in two groups were observed and analyzed. Results After 18 months, there were 297 (64.7%) and 320 (55.4%) patients who were persisting in treatment in group A and B, respectively; while the mortality was 6.1% (28/459) and 14.4% (83/578), respectively in group A and B. The differences were significant (P<0.001). The rate of virological suppression in group A and B was 64.0% (190/297) and 63.8% (204/320) respectively without any significant difference (P>0.05). Compared with baseline CD4+ T lymphocyte counts, the growth rate of CD4+ T lymphocyte count in group A and B was 5.7% and 37.5%, respectively; the difference was significant (P<0.001) Conclusions Early treatment for acquired immune deficiency syndrome in Butuo County, Liangshan Autonomous Prefecture is effective, however, its growth rate of CD4+ T lymphocyte count is lower than that of delayed treatment. Early treatment doesn’t cause the increasement of the risk of common adverse reactions of medication, and it can reduce the mortality.
ObjectiveTo investigate the psychological status of patients with chronic hepatitis B during the anti-virus treatment. MethodThe questionnaires of 150 outpatients with chronic hepatitis B treated between May 2013 and May 2014 were collected. And the date was properly processed. ResultsAll the patients were suffering from different degrees of worries, and the top 3 rates of worries were:the recurrence after stop using drugs (88.00%), the side effects of long-term medication (78.00%) and discrimination from people seeing the package of drugs (69.33%). ConclusionsPatients with chronic hepatitis B are in different degrees of psychological hazard during the treatment of anti-virus; further nursing work in psychological counseling and health education are needed to eliminate the hidden trouble, as to enhance the curative effect.
At present, the most commonly used nucleoside (acid) anaog (NAs) treatment regimen in clinical practice cannot completely cure chronic viral hepatitis B (CHB). However, although the polyethylene glycol interferon treatment regimen is superior to the NAs regimen in terms of immune mechanism, it has the disadvantage of low hepatitis B virus DNA response rate. In recent years, the cure of CHB is being studied all over the world. Various mechanisms and drug targets are being explored, and diversified therapeutic strategies are also being used. Clinical cure of hepatitis B is possible, but it is still in the early stage, and many potential drugs and better therapeutic strategies are still being tested. This article mainly reviews the latest progress in the treatment of CHB based on the recent research achievements in direct antiviral drugs and host immunotherapy as well as the research progress in combination therapy.