简介:Livertransplantation(LT)isalife-savingtreatmentforpatientswithend-stageliverdiseaseandforpatientswithlivercellcancerrelatedtoliverdisease.Acuteandchronicliverdiseasesrelatedtohepatitisvirusesarebetweenthemainindicationsforlivertransplantation.Theriskofviralreinfectionaftertransplantationisthemainlimitingfactorintheseindications.Beforetheavailabilityofantiviralprophylaxis,hepatitisBvirus(HBV)recurrencewasuniversalinpatientswhowereHBVDNA-positivebeforetransplantation.ThenaturalhistoryofrecurrentHBVwasacceleratedbyimmunosuppression,anditprogressedrapidlytograftfailureanddeath.Introductionofpost-transplantprophylaxiswithimmunoglobulinalonefirst,andassociatedtoantiviraldrugslater,drasticallyreducedHBVrecurrence,resultinginexcellentlong-termoutcomes.Onthecontrary,recurrenceofhepatitisCisthemaincauseofgraftlossinmosttransplantprograms.Overall,patientandgraftsurvivalafterLTforhepatitisCvirus(HCV)-associatedcirrhosisisinferiorcomparedwithotherindications.However,successfulpretransplantorposttransplantantiviraltherapyhasbeenassociatedwithincreasedgraftandoverallsurvival.Untilrecently,thecombinationofpegylatedinterferonandribavirinwasthestandardofcareforthetreatmentofpatientswithchronichepatitisC.Highlyactiveantiviralcompoundshavebeendevelopedoverthepastdecade,thankstonewinvitrosystemstostudyHCVentry,replication,assembly,andrelease.
简介:目的了解我国内镜治疗的临床科研现状。方法逐期逐页手工检索《中华消化内镜杂志》(1984~2002年)及《中国内镜杂志》(1996~2002年)中发表的临床对照实验,按cochrane协作网RCF、CCT资料库中的判定标准进行严格评价。结果《中华消化内镜杂志》19卷87期中共刊临床性文章1196篇,其中RCTs85篇(7.17%),CCTs4篇(0.34%)。《中国内镜杂志》7卷37期中共刊临床性文章1122篇,其中RCTs51篇(4.54%),CCTs6篇(0.53%)。结论我国临床内镜治疗的防治性研究RCTs的数量和质量,还不能满足临床实践的需要。