ObjectiveTo explore the effectiveness of lamividine (LAM) combined with adefovir (ADV) versus entecavir (ETV) for lamivudine-resistant (LAM-R) hepatitis B in renal transplant recipients. MethodOutpatients and inpatients of lamivudine-resistant kidney graft recipients with chronic hepatitis B admitted to West China Hospital and the People's Hospital of Santai County during Jan 2007 to Mar 2012 were divided into A group (LAM+ADV) and B group (ETV). And the level of alanine aminotransferase (ALT), level of serum creatinine, HBV serological markers and HBV-DNA load were compared by SPSS 16.0 software. ResultsA total of 15 patients were included. The mean age was 36.7±6.6 years old, the majority of patients were male. After treatment for 4 weeks, 12 weeks, 24 weeks, 48 weeks, 96 weeks, no significant differences were found between two groups in liver function normalization rates, the HBV-DNA negative conversion rates and serum creatinine level. ConclusionsLAM add-on ADV combination therapy and ETV monotherapy were both safe and effective in LAM-R kidney transplants with CHB, but the load of HBV-DNA in some patients were still positive at the endpoint. Elevated serum creatinine level may occur in some patients who treated with ADV. Consequently, for HBsAg-positive kidney transplantation patients, those anti-HBV drugs that are more effective, safer and less resistant may be better in the beginning of treatment.
目的 探討結核病在18氟-脫氧葡萄糖（18F-FDG）正電子發射斷層掃描術（PET）中的影像學表現，提高對PET/CT在肺部包塊診斷作用的認識，減少誤診。 方法 回顧分析2010年3月收治的1例肺結核合并縱隔淋巴結結核病患者的誤診及診斷治療經過，分析誤診原因并總結診治經驗，結合文獻復習肺部包塊在PET/CT中的表現及臨床特點。 結果 患者為肺部包塊伴縱隔淋巴結包塊，胸部CT提示肺癌伴縱隔淋巴結轉移，PET/CT也考慮左肺下葉肺癌伴淋巴結轉移。最后經縱隔鏡淋巴結活檢確診結核，并抗結核治療好轉。 結論 結核等感染性疾病常可導致18F-FDG的攝取增加而造成PET/CT陽性結果，因此在18F-FDG PET/CT呈現陽性結果時須注意鑒別病變良惡性，其中高標準攝入值包塊尤其需要注意與結核病相鑒別。
目的 通過分析影響四川地區慢性乙型肝炎患者抗病毒治療依從性的因素，探討提高患者治療依從性的策略。 方法 選擇2011年4月－2012年4月在四川大學華西醫院接受核苷（酸）類似物抗病毒治療的324例慢性乙型肝炎患者作為研究對象。采用問卷調查的方法，對患者一般情況、心理狀態、文化程度、經濟情況、疾病認知情況、抗病毒療效、服藥持續性等相關因素進行分析，評估這些因素對患者治療依從性的影響。 結果 324例患者中能夠完全遵照醫囑者78例（24.07%），不能完全依從者246例（75.93%）。心理狀態良好者132例（40.74%），其中依從性良好者54例；心理負擔較重者192例（59.26%），其中依從性良好者24例。初中及以上學歷204例（62.96%），依從性良好者72例；初中以下學歷者120例（37.04%），依從性良好者僅6例。不同心理狀態、文化程度的患者依從率差異有統計學意義。患者經濟狀況、年齡差異對于依從性也有一定影響。 結論 慢性乙型肝炎患者對抗病毒治療的依從性與心理狀態、文化程度者及經濟狀況密切相關。改善患者醫療費用償付能力，對患者進行疾病認知教育以及減少社會歧視等措施有助于提高患者治療依從性。