喘可治注射液改善COPD患者免疫功能的观察

目的观察喘可治注射液辅助治疗慢性阻塞性肺疾病(COPD)患者免疫功能的改善情况。方法共选40例COPD患者,随机分为治疗组和对照组各20例。2组均给予抗炎解痉止咳等治疗,治疗组加用喘可治注射液肌肉注射,喘可治4ml,qd,疗程14d,对照组只予上述常规治疗14d。观察治疗前后患者临床症状的改善情况,淋巴细胞亚群测定(CD3、CD4、CD8、CD19)情况。结果所有患者治疗前CD3和CD4淋巴细胞亚群水平均偏低,说明其细胞免疫功能异常,治疗后治疗组患者CD3和CD4淋巴细胞亚群水平较对照组明显(P<0.01),以CD19为标志的体液免疫指标也明显改善(P<0.01),两组治疗前后相比有显著差异(P<0.01)。结论喘可治注射液辅助治疗COPD患者可以改善患者免疫功能,且无不良反应,值得推广应用。     

老年慢性阻塞性肺疾病患者急性加重期T细胞免疫状况与免疫干预

目的探讨老年慢性阻塞性肺疾病(COPD)患者急性加重期T细胞免疫功能的改变及其影响因素,并观察免疫干预治疗的作用。方法采用随机的方法将75例老年COPD住院患者分为老年COPD干预组37例、老年COPD对照组38例,另设非老年COPD对照组28例,老年健康对照组20例。患者入院后行常规检查治疗,老年COPD干预组口服非特异免疫促进药匹多莫德,分别于第1天、第15天、第30天,用流式细胞仪检测患者外周血CD3+、CD4+、CD8+、CD4+／CD8+的改变,同时观察临床症状的改善情况对患者进行评估。结果老年COPD干预组、老年COPD对照组、非老年COPD对照组最终纳入分析患者分别为32、34、25例。老年COPD干预组和老年COPD对照组入院当天一般临床情况相似,两组的T细胞亚群与老年健康对照组及非老年COPD对照组比较,CD4+下降、CD8+上升、CD4+／CD8+倒置,差异均有统计学意义(分别为P<0．05、P<0．01)。老年COPD干预组治疗前CD3+、CD4+、CD8+、CD4+／CD8+值分别为(63．77±11．09、26．23±5．73、35．42±7．82、0．78±0．28),第30天分别为(67．83±10．04、36．80±9．82、27．28±10．00、1．36±0．46),差异有统计学意义(均为P<0．01)。老年COPD干预组住院时间(18．0±6．4)d,费用(10 266±6574)元,与老年COPD对照组比较,差异有统计学意义(均为P<0．05)。结论老年COPD患者在急性加重期细胞免疫功能下降。应用非特异性免疫促进剂匹多莫德,可改善其细胞免疫功能,同时减少了住院天数及费用。     

老年慢性阻塞性肺疾病合并2型糖尿病患者T淋巴细胞亚群免疫失衡状态及其免疫干预探讨

目的观察老年慢性阻塞性肺疾病(COPD)合并2型糖尿病(T2DM)患者T淋巴细胞亚群免疫失衡状态,并探讨针对性免疫干预。方法选取广西壮族自治区人民医院2011年1月—2014年6月收治的52例老年COPD患者,其中合并T2DM患者34例,随机分为COPD+T2DM未干预组16例和COPD+T2DM干预组18例;单纯COPD患者18例作为单纯COPD组;并选取同期体检健康的老年人20例作为对照组。单纯COPD组患者给予常规COPD对症治疗,COPD合并T2DM患者给予常规COPD及T2DM对症治疗;COPD+T2DM干预组在常规对症治疗基础上加用胸腺五肽免疫治疗,10 mg/d,皮下注射,连用14 d;COPD+T2DM未干预组不额外加用任何免疫制剂。记录对照组T淋巴细胞亚群(CD+4细胞分数、CD+8细胞分数、CD+4/CD+8细胞比值)和血清γ干扰素(IFN-γ)、白介素(IL-4)水平及IFN-γ/IL-4,比较治疗前后单纯COPD组、COPD+T2DM干预及为干预组患者CD+4细胞分数、CD+8细胞分数、CD+4/CD+8细胞比值和血清IFN-γ、IL-4水平及IFN-γ/IL-4变化。结果治疗前单纯COPD组、COPD+T2DM干预及未干预组患者CD+4细胞分数、CD+4/CD+8细胞比值均低于对照组,CD+8细胞分数均高于对照组,且COPD+T2DM干预及未干预组患者CD+4细胞分数、CD+4/CD+8细胞比值均低于单纯COPD组,CD+8细胞分数均高于单纯COPD组(P0.05);治疗后3组患者CD+4/CD+8细胞比值比较,差异无统计学意义(P0.05);治疗后COPD+T2DM干预组CD+4细胞分数高于单纯COPD组及COPD+T2DM未干预组,CD+8细胞分数低于单纯COPD组及COPD+T2DM未干预组(P0.05)。治疗前单纯COPD组、COPD+T2DM干预及未干预组患者血清INF-γ水平、INF-γ/IL-4均高于对照组,血清IL-4水平均低于对照组,且COPD+T2DM干预及未干预组患者血清INF-γ水平、INF-γ/IL-4均高于单纯COPD组,血清IL-4水平均低于单纯COPD组(P0.05);治疗后COPD+T2DM干预组血清INF-γ水平、INF-γ/IL-4低于单纯COPD组及COPD+T2DM未干预组,IL-4水平高于单纯COPD组及COPD+T2DM未干预组(P0.05)。结论老年COPD合并T2DM患者T淋巴细胞免疫功能低下,存在CD+4/CD+8细胞比值及Th1/Th2细胞比值失衡,Th细胞亚群向Th1细胞极化趋势明显,治疗中加用免疫调节剂胸腺五肽后可有效抑制Th1细胞极化趋势,改善T淋巴细胞免疫状态。     

喘可治注射液联合舒利迭对老年COPD急性加重期患者T淋巴细胞亚群、炎症介质和凝血功能的影响

目的探讨喘可治注射液联合舒利迭对老年慢性阻塞性肺疾病(COPD)急性加重期患者T淋巴细胞亚群、炎症介质和凝血功能的影响。方法纳入102例老年COPD急性加重期患者按照随机数字表法分为观察组(n=51)与对照组(n=51)。对照组采用舒利迭治疗,观察组在舒利迭基础上结合喘可治注射液治疗。两组疗程均为14 d。比较两组疗效,治疗前后T淋巴细胞亚群、炎症介质、凝血功能及肺功能变化。结果观察组总有效率(94. 12%)明显高于对照组(74. 51%,P0. 05);观察组治疗后CD3~+、CD4~+、CD4~+/CD8~+、第1秒用力肺活量(FEV1)、最大呼气流速(PEFR)和FEV1/用力肺活量(FVC)相比于治疗前明显升高,而CD8~+、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8、纤维蛋白原和D-二聚相比于治疗前降低(P0. 05);观察组治疗后CD3~+、CD4~+、CD4~+/CD8~+、FEV1、PEFR和FEV1/FVC明显高于对照组,而CD8~+、TNF-α、IL-6、IL-8、纤维蛋白原和D-二聚体明显低于对照组(P0. 05)。结论喘可治注射液联合舒利迭可提高老年COPD急性加重期患者免疫功能,改善凝血功能,减轻炎症反应。     

细菌溶解产物对慢性阻塞性肺疾病急性加重期患者免疫功能的影响

目的探讨细菌溶解产物对慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者免疫功能、临床疗效及肺功能的影响。方法192例AECOPD患者随机分为观察组与对照组各96例,观察组在常规治疗的基础上给予细菌溶解产物胶囊(泛福舒胶囊)治疗。3个疗程结束后,对两组外周血T淋巴细胞亚群、免疫球蛋白(Ig)、补体、Th17细胞、Treg细胞比例进行检测分析,记录并比较两组治疗过程中急性发作次数、急性发作时间及发作期间抗生素应用时间;对比两组治疗后肺功能改善情况。结果观察组治疗后CD3+细胞、CD4+细胞、CD4+/CD8+细胞比例、免疫球蛋白(Ig)A、Ig G、补体C3、C4水平均高于对照组,CD8+细胞低于对照组(P<0.05);观察组治疗后Th17细胞占CD4+T细胞比例高于对照组,Th17/Treg细胞比例高于对照组(P<0.05)。观察组治疗后急性发作次数、急性发作时间及抗生素应用时间均少于对照组(P<0.05)。观察组治疗12、24 w中发作及反复发作者比例低于对照组(P<0.05)。观察组治疗后肺功能改变情况优于对照组(P<0.05)。结论细菌溶解产物能提高AECOPD患者的体液免疫及细胞免疫功能,增强机体的抗感染能力,降低COPD急性发作及反复发作次数,改善COPD患者的肺功能状态。     

单克隆抗体CD4及CD8联合环孢素A治疗重型再生障碍性贫血临床研究

目的探寻降低重型再生障碍性贫血(SAA)患者早期死亡率以及提高疗效的安全方案。方法采用单克隆抗体CD4、CD8联合环孢素A(CSA)(治疗组)治疗SAA21例,并与抗淋巴细胞球蛋白(ALG)联合CSA(对照组)治疗SAA20例进行比较。结果两组总有效率分别为76·2%与65·0%相近(P>0·05),但早期血象的恢复快于对照组(P<0·05),早期感染率低于对照组(P<0·05)。而发热反应、血清病反应等副作用则显著少于对照组(P<0·01)。结论单克隆抗体CD4、CD8联合CSA是安全方便有效的治疗SAA方案。     

氨茶碱对慢性阻塞性肺疾病模型大鼠炎性因子及T淋巴细胞亚群的影响

目的探讨氨茶碱对慢性阻塞性肺疾病(COPD)模型大鼠炎性因子与T淋巴细胞亚群的影响。方法 32只雄性SD大鼠随机分为对照组、模型组、辛伐他汀组、氨茶碱组各8组,模型组、辛伐他汀组、氨茶碱组采用烟熏和气管内注入脂多糖的方法建立大鼠COPD模型,然后分别给予生理盐水1 ml/100 g、氨茶碱50 mg/kg、辛伐他汀5 mg/kg灌胃,1次/d;对照组每日予生理盐水1 ml/100 g灌胃。灌胃2个月后处死大鼠,观察肺组织病理改变,比较4组大鼠炎性因子、T淋巴细胞亚群变化。结果模型组肺组织可见纤毛粘连或坏死、大量炎性细胞浸润与毛细血管扩张充血,辛伐他汀组、氨茶碱组肺组织病变程度明显轻于模型组。模型组支气管肺泡灌洗液(BALF)中白细胞介素(IL)-8、IL-17、肿瘤坏死因子(TNF)-α含量均明显高于正常对照组(P0. 001);辛伐他汀组、氨茶碱组BALF中IL-8、IL-17、TNF-α含量明显低于模型组(P0. 05);氨茶碱组BALF中IL-8、IL-17、TNF-α含量明显低于辛伐他汀组(P0. 05)。模型组T淋巴细胞总数、CD4~+、CD4~+/CD8~+均明显低于对照组,CD8~+高于对照组(P0. 05);辛伐他汀组、氨茶碱组T淋巴细胞总数、CD4~+、CD4~+/CD8~+比值均明显高于模型组,CD8~+明显低于模型组(P0. 05);氨茶碱组T淋巴细胞总数、CD4~+、CD4~+/CD8~+比值均明显高于辛伐他汀组,CD8~+明显低于辛伐他汀组(P0. 05)。结论氨茶碱有助于降低COPD模型大鼠BALF中炎性因子水平,减轻气道炎症反应,改善机体免疫功能。     

慢性阻塞性肺疾病患者外周血可溶性白介素-2受体和IL-8及T淋巴细胞亚群检测的意义

目的探讨慢性阻塞性肺疾病（COPD）患者外周血可溶性白介素-2受体（SIL-2R）、IL-8、T淋巴细胞亚群（CD3、CD4、CD8）的相互关系及其意义。方法COPD患者急性发作期31例,缓解期31例,健康对照组30例,用ELIA法测定血清SIL-2R、IL-8,单克隆抗体免疫组化荧光染色法测定血清T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋,并进行统计学分析。结果COPD缓解期组与健康对照组比较,血SIL-2R、IL-8增高,CD3^＋降低,差异有统计学意义（P〈0．01）,CD4^＋、CD4^＋／CD8^＋、CD8^＋间差异无统计学意义（P〉0．05）。COPD急性发作期组与对照组比较,血SIL-2R、IL-8、CD3^＋、CD4^＋、CD4^＋／CD8^＋、CD8^＋间差异均有统计学意义（P〈0．05）。COPD急性发作期组与缓解期组比较,血SIL-2R、IL-8、CD3^＋、CD4^＋差异有统计学意义（P〈0．05）,CD4^＋／CD8^＋、CD8^＋差异无统计学意义（P〉0．05）。结论COPD患者由于病程长、长期营养状况差,机体免疫功能低下。急性发作期更明显。因此,在对COPD患者急性期的治疗过程中。给予增强免疫治疗,加强营养支持,对于缩短患者病程,减少反复呼吸道感染有一定价值。     

康艾注射液辅助化疗对老年中晚期非小细胞肺癌患者免疫功能及肿瘤标志物的影响

目的探讨康艾注射液辅助化疗对老年中晚期非小细胞肺癌患者免疫功能及肿瘤标志物的影响。方法老年中晚期非小细胞肺癌患者112例,根据入院时间单双号随机分为观察组和对照组各56例,对照组采用顺铂联合吉西他滨化疗方案,观察组联合应用康艾注射液,连续治疗4个周期,比较两组免疫功能、肿瘤标志物、近期疗效。结果观察组缓解率58. 93%明显高于对照组(37. 50%;χ~2=5. 149,P<0. 05); T淋巴细胞亚群CD3~+、CD4~+、CD4~+/CD8~+等明显高于对照组,CD8~+明显低于对照组(t=6. 952,7. 602,8. 429,8. 392,P<0. 05);血管内皮生长因子(VEGF)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)含量明显低于对照组(t=6. 451,8. 555,8. 498,P<0. 05)。结论康艾注射液辅助治疗有助于提高老年中晚期非小细胞肺癌临床疗效,可能改善患者细胞免疫功能、减少血清肿瘤标志物含量等因素有关。     

格雷夫斯病合并2型糖尿病淋巴细胞亚群研究

目的探讨格雷夫斯病(Graves病)合并2型糖尿病(T2DM)患者淋巴细胞亚群的变化及与单纯Graves病、T2DM的鉴别。方法对2001-11~2004-11内蒙古科技大学第一附属医院收治的Graves病合并T2DM患者15例分别测定甲状腺功能、甲状腺球蛋白抗体(TGA)、甲状腺微粒体抗体(TMA)、血糖等。所有患者治疗前后用免疫荧光双标记单克隆抗体和流式细胞仪行淋巴细胞亚群(T细胞CD3、CD4、CD8、CD4/CD8,B细胞CD19、自然杀伤细胞CD56)测定。同时与单纯Graves病15例、T2DM患者15例及正常健康人20名作比较。结果(1)治疗前Graves病合并T2DM组的CD19、CD4/CD8、CD4、自然杀伤细胞均较正常明显减少(P<0·05),与单纯Graves病组比较差异均无显著性意义(P>0·05),T2DM组患者只有CD4/CD8较正常对照低(P<0·05)。(2)Graves合并T2DM组及单纯Graves病组,用他巴唑治疗1~3个月甲状腺功能恢复正常、病情缓解后,各项指标与治疗前比较均有所恢复,单纯Graves病组改善较明显。结论Graves病合并T2DM发生免疫异常关键是Graves病的免疫缺陷,较单纯Graves病、T2DM明显,甲状腺功能恢复与免疫异常缓解不一致,Graves病免疫功能较Graves病合并T2DM组患者恢复明显。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.