以咳嗽咳痰首发的合并多种自身免疫性疾病1例并文献复习

自身免疫性疾病(autoimmune diseases,AD)是指机体对自身组织或细胞成分产生病理性免疫应答,进而引起组织损害和器官功能障碍的一组疾病.包含以自身免疫性肝病(autoimmune liver disease,AILD)、自身免疫性甲状腺病(autoimmune thyroid disease,AITD)为代表的器官特异性疾病,和以系统性红斑狼疮等为代表的系统性疾病.多种AD可同时发病,也可前后发病.本文探讨临床所见1例支气管哮喘合并原发性胆汁性胆管炎(primary biliary cholangitis,PBC)、桥本甲状腺炎(hashimoto's thyroiditis,HT)病例,旨在了解三者之间的关系及同时存在时的诊治特点,以提高对AD的认识.     

桥本氏甲状腺功能减退的临床超声基础

正桥本甲状腺炎(Hashimoto’s thyroiditis,HT)是日本学者桥本策于1912年首先提出并进行报道的,故名桥本氏病、慢性淋巴细胞性甲状腺炎(Chronic lymphocytic thyroiditis),因为属于一种自身免疫性甲状腺疾病,又名自身免疫性甲状腺炎(Autoimmune thyroiditis),该病多无明显临床症状,以往漏诊率较高,随着医疗诊断技术的不断进步,人们已经发现该病不但是一种临床常见病,而且是导致甲状腺功能减退(Hypothyroid)的最常见原因,即桥本氏甲状腺功能减退(Hashimoto hypothyroidism),     

实验性自身免疫性甲状腺炎小鼠体内Th17细胞检测的意义

目的:研究Th17细胞及相关细胞因子IL-17在实验性自身免疫性甲状腺炎(experimental autoimmune thyroiditis,EAT)小鼠体内的变化.方法:利用小鼠甲状腺球蛋白(Tg)建立小鼠EAT模型.应用流式细胞术(FCM)分析小鼠脾脏细胞中Th17细胞的比例.采用qRT-PCR检测小鼠脾脏细胞...     

CD4+T细胞家族与自身免疫性甲状腺疾病

据目前研究结果所知,CD4+T细胞家族包括辅助性T细胞(T helper cells,Th,如Th0、Th1、Th2、Th9、Th17)及调节性T细胞(regulatory T cell,Treg,如Th3、Tr1)等亚群,自身免疫性甲状腺疾病(autoimmune thyroid disease,AITD)与该细胞家族关系密切.多数研究认为Graves病(Graves disease,GD)由Th2介导,桥本甲状腺炎(Hashimoto's thyroiditis,HT)中Th1占优势.近年来关于Th17细胞与自身免疫性疾病之间关系的研究不断深入展开.     

9例血液系统并发甲状腺自身免疫性疾病临床分析

特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)、自身免疫性溶血性贫血(autoimmune hemolytic anemia．AIHA)是血液系统常见的自身免疫性疾病,毒性弥漫性甲状腺肿(grave disease,GD)和桥本甲状腺炎(Hashimoto thyroiditis,HT)是甲状腺的自身免疫性疾病,并发两个系统的自身免疫疾病在临床工作中少见,我们在临床遇到9例患者,现结合文献分析如下。     

自身免疫性甲状腺炎(附7例报告)

自身免疫性甲状腺炎(Autoimmune thyroiditis)原称慢性淋巴细胞性甲状腺炎。本病最早由日本桥本策(1912年)报告,故又称桥本氏甲状腺炎(Hashimoto's thyroiditis)。50年代后期,许多学者相继对本病进行了有关免疫的探索,并在患者血清中检得甲状腺自身抗体,证实     

小鼠自身免疫性甲状腺炎模型构建

目的:建立小鼠实验性自身免疫性甲状腺炎(experimental autoimmune thyroiditis,EAT)模型,为自身免疫性甲状腺炎(autoimmune thyroiditis,AIT)发病机制的研究和治疗提供依据。方法:雌性昆明种小鼠随机分为模型组和正常组。模型组皮下多点注射完全弗氏佐剂猪甲状腺球蛋白(porcine thyrogiobulin,PTg)抗原连续2周,第3周起注射不完全弗氏佐剂PTg抗原连续3周,饮用高碘水;正常组注射等剂量生理盐水,饮用自来水。结果:与正常组相比,模型组出现摄食与活动减少、消瘦、突眼、皮毛欠光滑现象。模型组甲状腺部分腺泡扩张,腺泡腔内胶质稀薄;上皮细胞不同程度肿胀破坏;可见较多嗜酸性粒细胞浸润。模型组甲状腺自身抗体水平显著高于正常组。结论:皮下多点注射佐剂抗原加高碘法建立EAT模型符合AIT病理特征,是一种有效的建模方法。     

肠道菌群与自身免疫性甲状腺疾病的研究进展

自身免疫性甲状腺疾病(autoimmune thyroid disease, AITD)是一种最常见的器官特异性自身免疫性疾病,主要包括桥本甲状腺炎(Hashimoto′s thyroiditis, HT)和Graves病(Graves′ disease, GD)。其发病机制尚不明确,可能与遗传、环境及免疫等有关,其中免疫反应是核心因素。近年来研究发现肠道菌群紊乱会扰乱免疫平衡并破坏对自身抗原的兼容性,从而导致自身免疫性疾病的发生。粪菌移植(fecal microbiota transplantation, FMT)是证明肠道菌群与疾病之间存在相互作用的直接证据,多种疾病从FMT治疗中获益。本文就肠道菌群与AITD的研究进展作一综述,探究肠道菌群对AITD预防、诊断及治疗的指导意义。     

慢性淋巴细胞性甲状腺炎患者中医体质调查及相关指标分析

慢性淋巴细胞性甲状腺炎(chronic lymphocytic thyroiditis,CLT)又称为桥本甲状腺炎(hashimoto thyroiditis,HT),是一种常见的自身免疫功能异常性疾病,以淋巴细胞等浸润甲状腺组织为主要病理表现。本病起病隐匿,不易察觉,且无特异性临床表现,晚期可出现甲减倾向,易与其他甲状腺疾病混淆,故在临床中极易误诊与漏诊[1]。     

产后甲状腺炎发病机制的研究进展

产后甲状腺炎(postpartum thyroiditis)是一类多发于产后女性的甲状腺功能一过性或永久性紊乱的疾病。因其临床症状为一过性的甲亢，甲状腺不痛、无触痛，故大多数资料将其归属为无痛性甲状腺炎(painless thyroiditis)即亚急性淋巴细胞性甲状腺炎的一类。因其对育龄期妇女、产妇及胎儿的影响，近年来对它的发病机制有较深入的研究，现综述如下。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.