目的 采用干擾素和阿德福韋酯治療慢性乙型肝炎患者經拉米夫定治療后出現YMDD變異，比較兩種治療策略的臨床療效。 方法 選擇2002年2月-年12月經100 mg拉米夫定治療后出現YMDD變異的慢性乙型肝炎患者76例。其中，男52例，女24例；年齡18~55歲，平均年齡33歲。服用100 mg拉米夫定52～156周發生YMDD變異，HBV DNA低于治療前水平，丙氨酸轉移酶(alanine aminotransferase，ALT)lt;2×ULN/L患者分為A組(26例)，繼續用100 mg拉米夫定治療48周；服用100 mg拉米夫定52～156周發生YMDD變異，HBV DNA定量檢測高于或等于治療前水平，ALTgt;2×ULN/L，根據患者自愿分為B組(27例)和C組(23例)。B組用100 mg拉米夫定聯合10 mg阿德福韋酯治療48周；C組用干擾素治療48周。分別觀察3組ALT復常率及HBV DNA轉陰率、HBeAg陽性患者血清學轉換率。 結果 治療48周時，B、C組患者ALT復常率分別是74.1%和78.3%，明顯高于A組的34.6%，差異有統計學意義(Plt;0.05)；B、C組患者HBV DNA轉陰率分別是77.7%和73.9%，明顯高于A組的11.5%，差異有統計學意義(Plt;0.05)；3組HBeAg陽性患者血清學轉換率比較，差異均無統計學意義(Pgt;0.05)。 結論 慢性乙型肝炎患者經拉米夫定治療后出現YMDD變異，繼續用拉米夫定治療療效不理想，改用干擾素或聯合阿德福韋酯治療更安全有效。
Objective To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. Methods A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups (P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant difference in interval from injury to operation (P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, the length of hospital stay, fracture healing time, elbow function assessed by Flynn criteria at 3 months after operation, and complications, were compared. Results Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss (P<0.05). There was no significant difference in the length of hospital stay between the two groups (P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group, showing no significant difference between the two groups (P>0.05). There was no significant difference in the fracture healing time between the two groups (P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group (P<0.05). In the early operation group, there was 1 case of fracture non-union and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was significant difference in the incidence of complications between the two groups (P<0.05). One case of the early operation group and 10 cases of the delayed operation group underwent secondary operation, showing no significant difference in the incidence of secondary operation between the two groups (P>0.05). ConclusionFor pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.