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Objective To compare the impact of Telbivudine (LDT) and Entecavir (ETV) administration on estimates of glomerular filtration rate for anti-viral therapy in patients with hepatitis B virus (HBV)-related compensated cirrhosis by an open, prospective randomized controlled study.Methods Patients with HBV-related compensated cirrhosis at clinic or hospitalized in Shaoxing Municipal Hospital from January 2012 to June 2013 were included.A total of 170 patients were randomly divided into LDT (600 mg/d) or ETV (0.5 mg/d) groups at a ratio of 1∶1 according to the random number table method.All patients were treated for more than 36 months.The LDT group was optimized according to the roadmap.Patients with poor response or resistance in both treatment group were added with Adefovir dipivoxil (ADV) 10 mg/d for optimal treatment.The clinical outcome, creatinine (CR), estimated glomerular filtration rate (eGFR) of patients before and after 36 months of treatment were compared between two groups.All categorical data were analyzed using chi-square test and data accorded with normal distribution were compared by t test.Results After 36 months of treatment, the virological and biochemical responses in LDT group and ETV group were similar.The mean CR levels at month 24 and 36 in LDT group were (74.25±22.98) μmol/L and (70.72±24.75) μmol/L, respectively, which were both lower than baseline level ([83.09±17.68] μmol/L, t=2.811 and 3.145, respectively, both P<0.01).The mean CR levels at month 36 between two groups were statistically different (t=3.431, P=0.001).The mean eGFR levels at month 12, 24 and 36 in LDT group were all significantly lower than that at baseline (t=3.976,8.297 and 10.629, respectively, all P<0.01).The mean eGFR levels at month 24 and 36 between two groups were statistically different (t=9.684 and 15.019, respectively, both P<0.01).A total of 64 patients including 34 in LDT group and 30 in ETV group had mild nephritic injury at baseline.The mean eGFR in patients with mild nephritic injury at baseline in LDT group at month 12, 24 and 36 were significantly different compared to baseline (t=6.098,10.191 and 14.378, respectively, all P<0.01).The mean eGFR level at month 36 in ETV group had statistical difference compared to baseline (t=2.058, P<0.05).The mean eGFR levels at months 12, 24 and 36 were all statistical different between two groups (all P<0.01).The mean eGFR levels at month 24 and 36 in the optimized group were superior to ETV group (P<0.01).Conclusions In patients with HBV-related compensated cirrhosis, LDT and ETV treatment have similar clinical efficacy.LDT is more effective in protecting nephritic function than ETV.
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OBJECTIVE To investigate the antimicrobial-resistant genes in meticillin-resistant Staphylococcus aureus(MRSA).METHODS Forty strains of MRSA were clinically isolated.Nine kinds of antimicrobial-resistant genes were analyzed by polymerase chain reaction(PCR).RESULTS The positive rates of mecA,aac(6′)/aph(2′)and tetM were all 100.0%.The positive rates of ermA/B/C,aph(3′)-Ⅲ,qacA/B,PVL and ant(4′,4″) were 82.5%,67.5%,45.0%,10.0% and 2.5%,respectively.CONCLUSIONS There are higher positive percentages of relevant resistance genes in MRSA isolates clinically.MRSA can induce clone transmition in hospital which should pay,and attention to the disinfection and isolation.
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OBJECTIVE To evaluate the distribution and drug resistance of pathogens in patients of liver cirrhosis combined with spontaneous bacterial peritonitis(SBP),and provide the credible evidence with the clinic diagnosis and the treatment of SBP.METHODS Totally 113 cases of hospitalized cirrhotic patients with SBP were admitted to our hospital between Mar,2000 and Dec,2005.Ascitic fluids of all cases were cultured.The total 114 strains of pathogens were identified and the drug resistance was analyzed.RESULTS Escherichia coli among the pathogens infected the ascitic fluids rated the top(39.5%),the next were Klebsiella pneumoniae,Enterobacter cloacae and Acinetobacter baumannii.The drug resistance of E.coli to imipenem was the lowest,about 2.2%.CONCLUSIONS The diagnosis of SBP with cirrhosis mainly depended on both of ascites results and clinical symptoms.The clinic should reasonably choose the antibiotics according to the test results of the pathogens sensitivity to drugs.
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OBJECTIVE To investigate the prevalence of sulfamethoxazole/trimethoprim(SXT)-resistance genes and drug resistance in Escherichia coli isolates from the old patients.METHODS Drug resistance of 20 E.coli strains were analyzed.The SXT-resistance genes(sul1,dfrA1,dfrA12 and dfrA17)were detected by polymerase chain reaction(PCR).The PCR products were purified and sequenced.RESULTS In 20 E.coli strains,95.0% were SXT resistant.The positive rate of genes of sul1,dfrA12 and dfrA17 were 80.0%,20.0% and 65.0%.Gene of dfrA1 was not detected out,17 strains of E.coli were found dfrA gene.The SXT-resistance gene dfrA or sul1 was detected in 18 of the 20 strains.CONCLUSIONS The SXT resistance of E.coli can be caused mainly by gene expression of dfrA and sul1,and the genes of sul1,dfrA12 and dfrA17 are all firstly found and reported in China.
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OBJECTIVE To investigate the chloramphenicol-resistant gene in Escherichia coli strains isolated from the old patients.METHODS Twenty strains of E.coli were clinically isolated.The resistance genes were analyzed by polymerase chain reaction(PCR) and verified by DNA sequencing.RESULTS The positive rates of catB and cmlA were 20% and 20%,respectively.Two strains of E.coli were found containing catB gene and cmlA gene.CONCLUSIONS The resistance to chloramphenicol in these 20 strains of E.coli has a close relation to antimicrobial-resistance gene existed,and the genes of catB and cmlA in E.coli are all firstly found and reported in China.
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OBJECTIVE To investigate the ?-lactamases in Klebsiella pneumoniae strains isolated from the elderly patients.METHODS We had an observation on 20 strains of Klebsiella pneumoniae about 15 kinds of ?-lactamase gene test(blaTEM,blaSHV,blaLEN,laOKP,blaCTX-M-1 group,blaCTX-M-2 group,blaCTX-M-9 group,blaOXA-1 group,blaOXA-2 group,blaOXA-10 group,blaGES,blaPER,blaVEB,blaDHA,and blaACT-1).RESULTS Six kinds of ?-lactamase genes had been found out from these 20 strains of K.pneumoniae,namely,blaTEM,blaSHV,blaCTX-M-1 group,blaCTX-M-9 group,blaOXA-1 group,and blaDHA.Their positives were 95%,30%,50%,5%,5% and 15%.Among these 20 strains of K.pneumoniae,there were 19 ones of K.pneumoniae which at least contained 1 kind of ?-lactamase genes.Fifteen strains of K.pneumoniae were found containing more than 2 kinds of ?-lactamase genes,at the same time.Some were even tested out having 4 kinds of ?-lactamase genes.CONCLUSIONS The resistance of ?-lactamase antibiotics of these 20 strains of K.pneumoniae has a close relative to the number of ?-lactamase.