Objective To study the efficacy of thymosin α1 in the treatment of chronic hepatitis B virus( HBV) infection with low viral load. Method Seventy- six patients with low- viral load chronic HBV infection admitted to our hospital from June 2011 to June 2013 were randomly assigned to treatment group,and forty- one patients were assigned to control group. The treatment group received subcutaneous injection of 1. 6 mg thymosin α1 twice a week,and the treatment stopped at 3 months if the patients were negative for serum HBV DNA; otherwise,the treatment was extended to 6 months. The control group did not receive any treatment. The serum HBV DNA clearance rates at months 3 and 6 of treatment were measured in both groups. Comparison of continuous data between two groups was made by t test,and comparison of categorical data was made by χ2test. Results The treatment group showed significantly higher HBV DNA clearance rates than the control group at months 3 and 6 of treatment( χ2= 10. 61,P < 0. 01; χ2= 13. 09,P < 0. 01). At month 6 in the treatment group,the HBV DNA clearance rate in patients who had HBV DNA < 104 copies / ml and were positive for HBe Ag showed no significant difference from that in those who were negative for HBe Ag( χ2= 0. 02,P > 0. 05),but was significantly higher than that in patients with HBV DNA ≥104copies / ml( χ2= 7. 52,P < 0. 01). Conclusion Thymosin α1 significantly promotes HBV DNA clearance in patients with low- viral load chronic HBV infection. The clearance rate is negatively correlated with the DNA load,but shows no correlation with the HBe Ag status.
而BE在理论上可能降低PD术后DGE的发生,故近些年部分研究者[1-4, 7]将BE引入PD中。有研究[1-2, 7, 20]发现,BE方式可以降低PD术后DGE、碱性反流性胃炎或边缘性溃疡的发生。部分研究[7, 21]甚至报道其降低了胰瘘的发生率。在Hochwald等[7]的研究中,BE组在DGE总体发生率、尽早拔除胃管、尽早进食、尽早出院等方面与非BE组有统计学差异,而临床相关的DGE(B级+C级)差异更加明显(7% vs 31%,P<0.01)。Xu等[2]研究发现,BE组DGE发生率显著降低(6.7% vs 26.87%,P<0.001),且多因素分析显示BE是唯一的独立危险因素;同时BE组有着更低的临床胰瘘发生率(P<0.001)。Meng等[1]研究显示,胰腺残端连续缝合加BE能显著降低DGE(P<0.01)及临床相关PF发生率(P<0.05),但是该实验未能明确BE在结果中的具体作用,亦有可能是连续缝合降低了胰瘘的发生进而降低DGE的发生。部分循证学研究[22]同样支持BE可降低DGE发生率的观点。但是不同研究之间在重建消化道距离(BE口与胃肠吻合口)和BE吻合口径上不一致,并在术后治疗和护理方案上均存在差[1-4, 7],部分研究[3-4]结果并不支持BE可以降低DGE发生率的观点。