目的 評估替比夫定與阿德福韋酯聯合治療優化阿德福韋酯單藥治療應答不佳的陽性慢性乙型肝炎患者的療效。 方法 選擇2008年6月－2009年8月間共26例阿德福韋酯治療至少12個月且病毒學應答不佳的乙型肝炎病毒e抗原（HBeAg），陽性的慢性乙型肝炎患者，在10 mg阿德福韋酯治療的基礎上，加用600 mg替比夫定。肝功能和乙型肝炎病毒（HBV） DNA每3個月評估1次，乙型肝炎兩對半和腹部B型超聲每半年評估1次。 結果 在第1年的治療期間，所有患者血清HBV DNA水平均呈進行性下降，其中24例（92.3%）血清HBV DNA水平在聯合治療12個月時低于檢測值下限，有25例（96.2%）患者丙氨酸轉氨酶水平復常。治療6個月時，分別有7例（26.9%）和2例（7.7%）患者發生HBeAg消失和血清學轉換；治療12個月時，分別有11例（42.3%）和8例（30.8%）患者發生HBeAg消失和血清學轉換。整個治療期間，26例患者均未出現病毒學突破。 結論 阿德福韋酯單藥治療應答不佳時，加用替比夫定可有效控制病毒，使患者獲得較好的病毒學、生化學和免疫學應答。Objective To evaluate the curative efficacy of telbivudine combined with defovir dipivoxil on positive-HBeAg chronic hepatitis B patients with suboptimal response to adefovir dipivoxil. Methods A total of 26 HBeAg-positive patients with suboptimal response to adefovir dipivoxil (treated with adefovir dipivoxil for more than 12 months) were treated with adefovir dipivoxil 10 mg in addition to telbivudine 600 mg between June 2008 and August 2009. Liver function and serum hepatitis B virus (HBV) DNA tests were assessed at the baseline and 3-month intervals, whereas HBV serological markers and abdominal ultrasonography were carried out every 6 months. Results During the first year of treatment, all patients showed a progressive decline of serum HBV DNA levels; while undetectable serum HBV DNA and normalization of alanine aminotransferase was achieved in 24(92.3%) and 25 (96.2%) patients, respectively, at the end of the first year of treatment. The 6- and 12-month cumulative rates of HBeAg loss were 26.9% (7/26) and 42.3% (11/26), respectively; and corresponding cumulative rates of HBeAg/anti-HBe seroconversion were 7.7% (2/26) and 30.8 (8/26), respectively. During the observation period, no virological breakthrough was detected. Conclusion Telbivudine combined with defovir dipivoxil may be a good choice for patients with suboptimal response to adefovir dipivoxil, which could induce effective viral inhibition and help patients obtain more virological, biochemical and immunological responses.
【摘要】 目的 分析腺苷蛋氨酸治療慢性乙型肝炎高膽紅素血癥的臨床療效。 方法 回顧性分析2010年1-12月28例接受腺苷蛋氨酸（2 000 mg靜脈滴注，1次/d）治療慢性乙型肝炎高膽紅素血癥患者的臨床資料，并對腺苷蛋氨酸治療慢性重癥乙型肝炎高膽紅素血癥后癥狀、體征及實驗室檢測指標的改變情況進行總結，利用多因素logistic回歸分析方法探索與療效相關的預測因素。根據相關癥狀、體征和實驗室結果的不同，將療效分為顯效、有效和無效3類。 結果 28例患者使用腺苷蛋氨酸治療4周后，顯效20例（71.4%），有效4例（14.3%），無效4例（14.3%）。多因素logistic回歸分析提示病程短、并發癥少是影響腺苷蛋氨酸療效的獨立預測因素。 結論 腺苷蛋氨酸是治療慢性乙型肝炎高膽紅素血癥有效，發病時間短及并發癥少的患者退黃效果更好。【Abstract】 Objective To investigate the curative efficacy of ademetionine in the treatment of hyperbilirubinemia for chronic hepatitis B patients. Methods The clinical data of 28 chronic hepatitis B patients with intrahepatic cholestasis receiving intravenous ademetionine treatment (2 000 mg per day) were retrospectively analyzed. Patients’ symptoms, body signs and laboratory examination results were summarized, and predictors for efficacy were investigated using multiple regression analysis. In this study, the curative efficacy was classified into remarkable efficacy, efficacy and inefficacy, according to the clinical data. Results After one-month treatment with ademetionine, the percentage for remarkable efficacy, efficacy and inefficacy was 71.4%, 14.3%, and 14.3% respectively. Multivariate logistic regression analysis showed that short disease duration and fewer complications were independent predictors for remarkable efficacy of ademetionine treatment. Conclusion Ademetionine is an effective agent for the treatment of hyperbilirubinemia in chronic hepatitis B patients, and the result is especially good for patients with short duration and fewer complications.
Objective To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus. Methods A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus. Results All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels (P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels (P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups (P<0.05), while there was no significant difference in the other two changes (P>0.05). Conclusion Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.
