IL-6、CRP和CD64在新生儿感染性疾病诊断中的价值

目的： 探讨白介素6(IL-6)、C反应蛋白(CRP)、中性粒细胞表面标志物CD64在新生儿感染性疾病中的诊断价值。方法： 选取宜兴市人民医院新生儿科2005年1月至2011年12月收住的107例患儿进行回顾性分析,107例患儿分为败血症组35例,非细菌感染组30例,健康对照组42例,对3组间IL-6、CRP阳性率及CD64水平进行比较。结果： 败血症组、非细菌感染组及健康对照组CRP阳性率分别为80.0%、63.3%和23.8%,败血症组与健康对照组之间、非细菌感染组与健康对照组间差异均有统计学意义。3组IL-6阳性率分别为85.7%、33.3%和9.5% ,败血症组与非细菌感染组、败血症组与健康对照组间差异均有统计学意义(P均<0.05)。3组间CD64水平差异有统计学意义（H=77.818,P<0.01）,败血症组明显高于健康对照组和非细菌感染组（P均<0.05）。联合检测IL-6+CRP+CD64对新生儿败血症的特异性为94.6%,与IL-6、CRP、CD64、IL-6+CD64、CRP+CD64间差异均有统计学意义（P均<0.05）。结论: 联合检测IL-6+CRP+CD64可提高对细菌感染的特异性,为临床工作提供早期诊断依据。     

腹腔镜直肠癌根治术和Dixon直肠癌根治术的疗效分析

目的:探究比较腹腔镜直肠癌根治术和Dixon直肠癌根治术的临床治疗效果。方法:选取60例直肠癌患者,按照随机数表法分成观察组和对照组,每组30例,其中观察组采用腹腔镜直肠癌根治术,对照组采用Dixon直肠癌根治术,对两组治疗效果、免疫功能指标、不良反应发生率及患者3年生存率和复发率等进行比较。结果:观察组治疗效果明显高于对照组(P<0.05);观察组患者术中出血量、手术时间、术后肛门排气时间均明显小于对照组(P<0.05);治疗前,两组C反应蛋白(CRP)、白细胞介素6(IL-6)、CD3~+、CD4~+、CD4~+/CD8~+比较无统计学差异(P>0.05);治疗后3 d,两组患者的CRP、IL-6明显升高,CD3~+、CD4~+、CD8~+、CD4~+/CD8~+明显降低,治疗后5天相对于治疗后3 d的CRP、IL-6明显降低,CD3~+、CD4~+、CD8~+、CD4~+/CD8~+明显升高,且观察组明显优于对照组(P<0.05);观察组患者术后恢复期间不良反应发生率明显小于对照组(P<0.05);患者3年生存率和复发率比较,观察组明显优于对照组(P<0.05)。结论:患者采用腹腔镜下直肠癌根治术治疗创伤小、恢复快,对患者的免疫功能影响较小,并发症较少,患者生存率得到明显提升,复发率低。     

URSA患者血清IL-2、IL-10及MCP-1与细胞免疫功能相关性研究

目的:探究原因不明复发性流产(URSA)患者外周血中IL-2、IL-10及MCP-1与细胞免疫功能相关性.方法:选取2014年6月~2016年4月我院收治的71例原因不明复发性流产患者作为观察组,选取76例行人工流产的妇女作为对照组.结果:观察组患者E2水平明显高于对照组,差异具有统计学意义;观察组患者IL-2水平高于对照组,观察组患者血清IL-10、MCP-1水平低于对照组,差异均具有统计学意义;观察组患者CD4+、CD8+及CD4+/CD8+水平明显高于对照组,差异均具有统计学意义;观察组患者血清IL-2与CD4+/CD8+呈现正相关,IL-10、MCP-1与CD4+/CD8+呈现负相关.结论:URSA可能与体内Th1/Th2细胞因子失衡有关,IL-2,IL-10、MCP-1异常表达可能会引起免疫功能异常从而引发复发性流产.     

盐酸羟考酮注射液超前镇痛对腹腔镜胆囊切除术患者血清炎性因子、神经递质指标及免疫功能的影响

目的:探讨盐酸羟考酮注射液超前镇痛对腹腔镜胆囊切除术患者血清炎性因子、神经递质指标及免疫功能的影响。方法:113例行腹腔镜胆囊切除术患者依据随机数据表法分为对照组(n=57)和观察组(n=56),对照组患者给予枸橼酸舒芬太尼注射液镇痛,观察组给予盐酸羟考酮注射液镇痛,比较术前及术后1d两组血清炎性因子[血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)],神经递质指标[5-羟色胺(5-HT),P物质]及免疫功能[CD4~+、CD8~+、CD4~+/CD8~+]变化。结果:术前,两组间TNF-α、IL-6、5-HT、P物质、CD4~+、CD8~+、CD4~+/CD8~+水平比较,差异无统计学意义(P>0.05)。与组内术前水平相比,术后1d两组TNF-α、IL-6、5-HT、P物质、CD8~+水平均明显升高,且观察组明显低于对照组,差异比较有显著性(P<0.05);两组术后1dCD4~+、CD4~+/CD8~+水平均显著低于组内术前水平,且观察组水平明显高于对照组,差异比较有显著性(P<0.05)。结论:腹腔镜胆囊切除术患者盐酸羟考酮注射液超前镇痛可有效减少血清炎性因子及神经递质指标的释放,改善机体免疫功能,具有重要临床价值。     

肠内营养对行肝动脉化学治疗栓塞术原发性肝癌患者血清炎性因子及免疫细胞的影响

目的探讨肠内营养(EN)对原发性肝癌(PLC)患者肝动脉化学治疗栓塞(TACE)术后血清炎性因子、免疫细胞水平及预后的影响。方法选择2014年6月至2016年6月在开滦总医院肝胆外科接受TACE治疗的90例肝癌患者为观察对象,根据术后营养支持方案分为观察组(n=42)和对照组(n=48)。对照组患者术后给予流食、半流食等,观察组患者在对照组治疗基础上给予EN;分别于术前及术后7、14、21 d检测2组患者血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及CD3+、CD4+、CD8+水平;观察2组患者术后3个月并发症发生情况及术后24个月生存状态。结果 2组患者术后7、14 d血清IL-1、IL-6、TNF-α及CRP水平显著高于术前(P <0. 05);对照组患者术后21 d血清IL-6、TNF-α水平与术前比较显著增高(P <0. 05);观察组患者术后21 d血清IL-1水平与术前比较显著增高(P <0. 05)。对照组患者术后14、21 d血清IL-6、TNF-α、CRP水平及术后21 d血清IL-1水平均显著低于术后7 d(P <0. 05);对照组患者术后21 d血清IL-1、IL-6水平均显著低于术后14 d(P <0. 05)。观察组患者术后14、21 d血清IL-1、IL-6、TNF-α及CRP水平均显著低于术后7 d(P <0. 05);观察组患者术后21 d的血清IL-6、TNF-α及CRP水平显著低于术后14 d(P <0. 05)。2组患者术前及术后7 d血清IL-1、IL-6、TNF-α及CRP水平组间比较差异均无统计学意义(P> 0. 05);术后14、21 d,观察组患者血清IL-1、IL-6、TNF-α及CRP水平均低于对照组(P <0. 05)。对照组患者术后7 d CD3+、CD4+、CD8+、CD4+/CD8+及术后14 d CD8+、CD4+/CD8+和术后21 d CD3+、CD8+与术前比较显著降低(P <0. 05)。观察组患者术后7 d CD3+、CD4+、CD8+、CD4+/CD8与术前比较显著降低(P <0. 05),观察组患者术后14 d CD3+、CD4+/CD8+及术后21 d CD4+/CD8+与术前比较显著升高(P <0. 05)。对照组患者术后14 d CD3+、CD4+、CD8+、CD4+/CD8+及术后21 d CD4+、CD4+/CD8+显著高于术后7 d,观察组患者术后14 d CD3+、CD4+/CD8+及术后21 d CD3+、CD4+、CD8+、CD4+/CD8+显著高于术后7 d (P <0. 05)。与术后14 d比较,对照组患者术后21 d CD3+显著降低(P <0. 05);观察组患者术后21 d CD3+、CD4+、CD8+CD4+/CD8+与术后14 d比较差异无统计学意义(P> 0. 05)。2组患者术前及术后7 d CD3+、CD4+、CD8+、CD4+/CD8+水平组间比较差异均无统计学意义(P> 0. 05);术后14、21 d观察组患者CD3+、CD4+、CD8+、CD4+/CD8+均高于对照组(P <0. 05)。对照组与观察组患者术后3个月内并发症发生率分别为41. 67%(20/48)、21. 43%(9/42),观察组患者并发症发生率显著低于对照组(χ2=5. 347,P <0. 05)。对照组患者术后6、12、18、24个月生存率分别为97. 92%(47/48)、81. 25%(39/48)、56. 25%(27/48)、37. 50%(18/48),观察组患者术后6、12、18、24个月生存率分别为100. 00%(42/42)、88. 10%(37/42)、73. 81%(31/42)、59. 52%(25/42),观察组患者的生存率明显高于对照组(Log-rankχ2=4. 964,P <0. 05)。结论 EN可以降低TACE治疗术后PLC患者的血清炎性因子水平,提高免疫细胞水平,降低患者术后并发症发生率,提高术后生存率,有助于改善患者的预后。     

术后静脉镇痛对HIV感染者免疫功能的影响

目的:探讨术后静脉镇痛对AIDS/HIV感染者细胞免疫功能的影响。方法:将70例拟行手术治疗的AIDS/HIV感染者随机分为观察组和对照组,每组各35例。观察组术后给予静脉自控镇痛,对照组术后不给予静脉镇痛。观察两组围术期免疫功能(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)、炎性反应指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)]的变化和差异。结果:观察组患者术后24 h、48 h血清IL-6、TNF-α、PCT、CRP水平均低于对照组,差异均有统计学意义(P<0.05);CD4~+、CD8~+、CD4~+/CD8~+高于对照组,差异均有统计学意义(P<0.05)。结论:术后静脉镇痛可减轻AIDS/HIV感染患者炎症反应和免疫功能损伤,具有较好的免疫保护作用。     

连续血液净化对严重脓毒症患者T细胞亚群及炎性反应的影响

目的:探讨连续血液净化(CBP)对严重脓毒症患者T细胞亚群及炎性反应的影响,为更好的救治严重脓毒症患者提供科学依据。方法:选取本院收治的严重脓毒症患者96例作为研究对象,随机分为观察组和对照组,每组均为48例,对照组采取脓毒症的常规治疗,观察组在此基础上采取CBP疗法,分别于治疗前及治疗后7d采集患者空腹静脉血,比较两组治疗前后IL-6、TNF-α、CRP水平及CD3+、CD4+、CD8+淋巴细胞百分比及CD4+/CD8+比值的变化。结果:两组治疗前IL-6、TNF-α、CRP水平比较,差异无统计学意义(P>0.05)。两组治疗后IL-6、TNF-α均显著下降,观察组CRP显著降低,且观察组的IL-6、TNF-α、CRP水平低于对照组治疗后,差异有统计学意义(P<0.05)。两组治疗前T细胞亚群百分比无统计学差异(P<0.05)。两组治疗后CD3+、CD4+、CD8+及CD4+/CD8+均显著升高,差异有统计学意义(P<0.05)。治疗后,观察组CD3+、CD4+及CD4+/CD8+显著高于对照组,差异有统计学意义(P<0.05)。结论:CBP疗法可有效降低严重脓毒症患者炎症因子水平,减轻炎性反应,并可有效改善患者的免疫功能,效果显著。     

糖皮质激素辅助治疗儿童肺炎支原体感染性大叶性肺炎的效果

目的:观察糖皮质激素辅助治疗儿童肺炎支原体感染性大叶性肺炎的效果。方法:选取收治的60例肺炎支原体感染性大叶性肺炎患儿作为研究对象,依据随机数字表法分为对照组和观察组,每组30例。对照组予常规治疗,观察组在对照组基础上联合糖皮质激素辅助治疗,比较两组相关临床指标,临床疗效,治疗前后免疫指标水平[免疫球蛋白(Ig)G、IgM、IgA、IgE,CD4^+、CD8^+、CD4^+/CD8^+],以及炎性指标[C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、白细胞介素(IL)-2、IL-6、IL-10、IL-17、IL-33]水平。结果:观察组退热时间、咳嗽缓解时间、胸部X线恢复时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。观察组患儿总有效率高于对照组,差异有统计学意义(P<0.05)。两组IgG、IgM、IgE,CD8^+水平均低于治疗前,且观察组低于对照组,CD4^+、CD4^+/CD8^+水平均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);两组IgA水平比较,差异无统计学意义(P>0.05)。两组CRP、ESR、PCT,IL-2、IL-6、IL-10、IL-17水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组IL-33水平比较,差异无统计学意义(P>0.05)。结论:糖皮质激素辅助治疗儿童肺炎支原体感染性大叶性肺炎临床效果较好,可改善血清CRP、IL-6、PCT表达水平。     

血必净联合胸腺五肽辅助抗生素治疗老年重症肺炎对免疫功能及炎症因子的影响

目的:探讨血必净联合胸腺五肽辅助抗生素治疗老年重症肺炎对免疫功能及炎症因子的影响。方法:选择老年重症肺炎患者100例,根据入组序列号奇偶数分为观察组与对照组,每组50例,其中对照组给予机械通气、退热、祛痰、抗感染等常规重症肺炎治疗,同期给予血必净静脉滴注;观察组在常规治疗的基础上采取血必净联合胸腺五肽静脉滴注治疗,比较两组治疗前、治疗7、14dT淋巴细胞亚群水平及血清炎症因子CRP、IL-6、IL-1、TNF-α水平。结果:两组不同时间点CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平差异有统计学意义(P<0.05),其中CD3~+、CD4~+、CD4~+/CD8~+水平:T2>T1>T0,CD8~+水平:T2相似文献   

健脾解郁法在脑卒中后肝郁脾虚型抑郁症中的临床应用

目的探讨健脾解郁法在肝郁脾虚型卒中后抑郁症中的临床效用。方法收集脑卒中后抑郁症60例,分为治疗组与对照组各30例。治疗组给予经验方健脾解郁汤治疗,对照组应用抗抑郁药黛力新治疗,6周后观察对比两组临床效果。结果治疗后两组患者的HAMD抑郁量表评分及中医症候量表评分较治疗前均降低,治疗效果优于对照组。两组治疗前后血清CRP、5-HT水平变化明显(P0.05),且治疗组治疗后血清CRP水平低于对照组,5-HT水平高于对照组,差异有统计学意义(P0.05)。结论肝郁脾虚型脑卒中后抑郁症应用健脾解郁法论治具有良好的治疗作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.