目的 观察阿德福韦酯联合胸腺五肽治疗乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎2年的疗效。 方法 2007年1月－2009年1月间178例慢性乙型肝炎患者随机分为试验组91例和对照组87例。试验组给予胸腺五肽1 mg，隔日皮下注射，疗程52周；同时阿德福韦酯10 mg/d口服104周。对照组给予阿德福韦酯10 mg/d，口服104周。治疗26、52、104周及停药52周时，分别检测血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乙型肝炎病毒（HBV）DNA含量及HBV血清标志物。 结果 治疗52周后，试验组在ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率与HBeAg/HBeAb血清转换率方面都比对照组高。停药52周时，试验组与对照组的ALT复常率、AST复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg/HBeAb血清转换率分别为74.73%与51.72%、75.82%与54.02%、25.27%与8.05%、26.37%与10.34%、18.68%与8.05%（χ2=10.652、9.313、9.421、7.574、4.313，P＜0.05）。 结论 阿德福韦酯联合胸腺五肽治疗HBeAg阳性慢性乙型肝炎比单独使用阿德福韦酯抗病毒治疗效果更好，有助于提高HBeAg/HBeAb血清转换率，减少停药后病毒学突破，并且使用安全。Objective To evaluate the efficacy of adefovir dipivoxil (ADV) combined with thymopentin on chronic hepatitis B patients with positive hepatitis B e antigen (HBeAg). Methods Between January 2007 and January 2009, 178 chronic hepatitis B patients with positive HBeAg were randomly divided into two groups: the treatment group (91 cases) and the control group (87 cases). All patients in two groups received 10 mg of ADV once a day for 104 weeks, while the patients in the treatment group received 1 mg of thymopentin for subcutaneous injection every other day for 52 weeks. The rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) normalization, serum hepatitis B virus (HBV) DNA clearance and HBeAg loss and anti- HBeAg seroconversion were evaluated at pretreatment, and 52, 104 and 156 weeks after treatment, respectively. Results After 52-week treatment, The rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion in the treatment group were higher than those in the control group. In 52-week follow-up after 104 weeks treatment, the rates of ALT and AST normalization , serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion of two groups were 74.73% versus 51.72%, 75.82% versus 54.02%, 25.27% versus 8.05%, 26.37% versus 10.34%, 18.68% versus 8.05%, respectively (χ2 = 10.652, 9.313, 9.421, 7.574, 4.313; P＜0.05). Conclusions It is more effective for adefovir dipivoxil combined with thymopentin on HBeAg-positive patients with chronic hepatitis B than using adefovir alone. Combination treatment could improve the rates of HBeAg seroconversion and reduce the breakthrough of HBV after drug withdrawal. And it is safe.
Objective To introduce the role of pancreatic stellate cells in pancreatic fibrosis and the progress in treatment of pancreatic fibrosis. MethodsRelevant literatures were collected and reviewed. Results Pancreatic stellate cells activation was closely related to pancreatic fibrosis. Inhibition of pancreatic stellate cells activation could provide a new approach in clinical treatment of chronic pancreatitis. Conclusion Pancreatic stellate cells are the key to pancreatic fibrosis, which are becoming the target for antifibrosis of the pancreas and treatment of chronic pancreatitis.
ObjectiveTo study the expressions of Ras trapping to Golgi (RasTG) genes in pancreatic carcinoma tissues and to observe the growth, proliferation and the impact of tumors formation of human pancreatic cancer cells (PANC-1), and to explore its mechanism. MethodsMade PANC1 as a target to research, transfected RasTG genes into PANC-1, used RNAi technology and observed the growth, proliferation and the impact of tumors formation of the cells. Meantime, contrasted the RasTG expressions between pancreatic ductal cancer and adjacent tissue by tissue microarray technology. Results①The expression of RasTG gene in tissues was not very differential， which was higher in the brain, liver, and adrenal gland. ②The expression of RasTG protein in pancreatic ductal carcinoma was significantly higher than that in adjacent tissues （Plt;0.05）. ③After RasTG RNAi in PANC-1 cells, the ability of growth and proliferation were decreased. ④The ability of tumors formation in PANC-1 cells after RNAi was decreased, carcinoma’s volume of transfected group was significantly smaller than that in the nontransfected group (Plt;0.05). ConclusionsRasTG gene is widely distributed in animals. RasTG protein in pancreatic carcinoma tissues is higher than that in adjacent tissues. The ability of proliferation, transformation and tumors formation in PANC-1 cells after RNAi of RasTG gene are restrained, RasTG gene is a positive regulatory factor.
ObjectiveTo explore clinical efficacy of Frey procedures for chronic pancreatitis. MethodsThirty two patients with chronic pancreatitis who underwent Frey procedures in our hospital from June 2000 to October 2009 were analyzed retrospectively. The rate of perioperative complications, pain relief, and especially endocrine and exocrine function of pancreas in longterm followup (mean 43 months) were analyzed. ResultsNo death occurred in all patients. Fat liquefaction of wound was found in two patients and pancreatic fistula was found in one patient, who was cured by conventional treatment. So the rate of perioperative complications was 9.4%(3/32). After Frey procedures, pain disappeared completely in sixteen patients (50.0%), pain relieved in fourteen patients (43.8%) and two cases were ineffective. Therefore, the rate of pain relief in longterm follow-up was 93.8%. The hospitalization was (11±2) d. After surgical treatment the illness of five patients with diabetes mellitus did not aggravate while new onset of diabetes mellitus was observed in three cases. For three cases who suffered from indigestion and steatorrhea, symptomatic relief was found in one patient treated by oral administration of pancreatin and inefficacy was observed in two cases. But four patients with new steatorrhea were found after operation. ConclusionUnder the strict surgical indications, Frey procedure is a safe and effective surgical method for the treatment of chronic pancreatitis.
ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
Objective To summarize the current advance of xenotransplantation. Methods Relevant literatures about current advance of xenotransplantation published recently domestic and abroad were collected and reviewed. Results Major progress of xenotransplantation had been made in the understanding of xenoimmunobiology in the last two decades and in the threshold of clinical application. However, many problems of immunological rejection were still needed to be explored and resolved. Conclusion Xenotransplantation as a transplantation source has an extensive potential to resolve the shortage of transplanted organs for end-stage organ failure, how to suppress rejection and prolong survival of grafts more effectively is a focal point of search in the future.
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.