糖皮质激素对重症肌无力患者外周血T淋巴细胞Fas表达的影响

目的 探讨糖皮质激素治疗重症肌无力(MG)与Fas介导的细胞凋亡的关系.方法 选择17例MG患者,其中6例接受糖皮质激素治疗(糖皮质激素治疗组),11例未接受糖皮质激素治疗(无糖皮质激素治疗组);另选择同期健康自愿献血者13例作为健康对照组,采用流式细胞技术检测三组外周血T淋巴细胞表面CD4、CDs及Fas的表达.结果 糖皮质激素治疗组外周血T淋巴细胞表面CD4-CD8+表达高于健康对照组[(36.75±11.56)%比(26.31±9.00)%],CD4-CD8-表达低于健康对照组[(30.56±9.72)%比(42.96±11.54)%],差异有统计学意义(P=0.027、0.018);糖皮质激素治疗组外周血T淋巴细胞表面CD4-CD8+表达高于无糖皮质激素治疗组[(36.75±11.56)%比(25.24±7.63)%],差异有统计学意义(P=0.019).糖皮质激素治疗组外周血T淋巴细胞表面Fas+、CD8+Fas+表达高于健康对照组[(46.10±7.13)%比(31.22±13.00)%,(62.86±12.29)%比(45.59±11.50)%],差异有统计学意义(P=0.006、0.003).糖皮质激素治疗组CD8+Fas+表达高于无糖皮质激素治疗组[(62.86±12.29)%比(50.84±8.31)%],差异有统计学意义(P=0.034).结论 糖皮质激素治疗对MG患者外周血T淋巴细胞亚群分布具有影响.Fas介导的细胞凋亡可能是糖皮质激素治疗MG的机制之一.

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Objective To investigate the relation between Fas-mediated apoptosis and glucocorticoid treatment in myasthenia gravis (MG). Methods In 17 patients with MG, 6 patients received glucocorticoid treatment (glucocorticoid treatment group),and 11 patients were treated without glucocorticoid (nonglucocorticoid treatment group). Meanwhile, 13 healthy cases were selected as healthy control group. CD4,CD8 and Fas expressions in peripheral blood T lymphocyte were detected by flow cytometry in three groups and analyzed. Results The percentage of CD4-CD8+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in healthy control group[(36.75 ± 11.56)% vs. (26.31 ±9.00)%, P = 0.027], while the percentage of CD4-CD8- cells was significantly lower [(30.56 ± 9.72)% vs.(42.96 ± 11.54)%, P =0.018]. The percentage of CD4-CD8+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in non-glucocorticoid treatment group [(36.75 ± 11.56)% vs. (25.24 ±7.63)% ,P =0.019]. The percentages of Fas+ and CD8 +Fas+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group were significantly higher than those in healthy control group[(46.10 ± 7.13)% vs. (31.22 ± 13.00)%, P=0.006; (62.86 ± 12.29)% vs. (45.59 ±11.50)%, P = 0.003]. The percentage of CD8+ Fas+ cells in peripheral blood T lymphocyte in glucocorticoid treatment group was significantly higher than that in non-glucocorticoid treatment group [(62.86 ± 12.29)%vs (50.84 ± 8.31 )%, P = 0.034]. Conclusions Glucocorticoid treatment may have influence on peripheral blood T lymphocyte subsets in patients with MG. Fas-mediated apoptosis may be involved in the mechanism of glucocorticoid treatment in MG.     

特发性血小板减少性紫癜患者血清白细胞介素11水平、淋巴细胞亚群及NK细胞变化的临床意义

目的 检测特发性血小板减少性紫癜(ITP)患者血清白细胞介素11(IL-11)水平、淋巴细胞亚群及NK细胞的变化,探讨相关因素在ITP发病中的作用.方法 应用酶联免疫吸附法(ELISA)、流式细胞术分别检测50例ITP(ITP组)和30例健康体检者(对照组)血清IL-11水平、淋巴细胞亚群及NK细胞的变化.结果 ITP组的血小板计数[(30.21±19.40)×109/L]明显低于对照组[(207.21±31.55)×109/L](P＜0.05),ITP组患者血清IL-11水平[(255.72±163.43)ng/L]明显高于对照组[(40.60±5.57)ng/L](P＜0.05),相关分析表明ITP患者血清IL-11水平与血小板计数呈负相关(r=-0.557,P＜0.05);ITP组患者CD3+、CD4+T淋巴细胞百分比及CD4+/CD8+明显低于对照组(P＜0.05),CD8+T淋巴细胞百分比明显高于对照组(P＜0.05);CD3-CD(16+56)+NK细胞百分比明显低于对照组(P＜0.05).结论 IL-11水平、淋巴细胞亚群及NK细胞变化与ITP的发病密切相关,且IL-11水平与血小板计数可能存在负反馈调节作用.

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Objective To detect the serum level of interleukin (IL)-1 1, lymphocyte subsets and NK cells in patients with idiopathic thrombocytopenic purpura (ITP), and explore the related factors in the pathogenesis of ITP. Methods The serum level of IL-11, lymphocyte subsets and NK cells were detected by double antibody sandwich enzyme linked immunosorbent assay (ELISA) and flow cytometry in 50 ITP patients (ITP group) and 30 controls (control group). Results The platelet in ITP group [ (30.21 ± 19.40) ×109/L] was lower than that in control group [ (207.21 ± 31.55 ) × 109/L] obviously (P ＜ 0.05 ); the serum level of IL-11 in ITP group [(255.72 ± 163.43) ng/L] was significantly higher than that in control group [ (40.60 ± 5.57 ) ng/L ] (P ＜ 0.05 ). The correlation analysis indicated that the blood serum levels of IL- 11 had negative relationship with the platelet (r = -0.557 ,P ＜ 0.05). The percentage of CD3+ and CD4+ T lymphocyte percentage, CD4+/CD8+ in ITP group were lower and the percentage of CD8+ T lymphocyte was higher than those in control group obviously (P ＜ 0.05 ). The percentage of CD3- CD(16+56) +NK cell in ITP group was lower than that in control group (P ＜ 0.05). Conclusion IL-11, lymphocyte subgroup and NK cell change correlate with ITP morbidity closely, and the IL-11 level and the platelet possibly have the negative feedback control action.     

斯奇康注射液辅助治疗肺结核的临床研究

目的 观察斯奇康注射液辅助治疗肺结核的临床疗效、对细胞免疫功能的影响及不良反应的发生情况,为肺结核的辅助治疗提供一种安全、有效且价格低廉的药物.方法 将60例肺结核患者按随机数字表法分为治疗组和对照组,每组30例,两组均予标准抗结核化疗方案,治疗组加斯奇康注射液,观察患者的症状、病灶影像学改变、血常规、肝肾功能及T淋巴细胞亚群变化.结果 治疗后两组症状均较治疗前明显改善(P＜0.05),但治疗组明显优于对照组(P＜0.05);治疗组的有效率及控制率分别为36.7%(11/30)、96.7%(29/30),显著高于对照组的23.3%(7/30)、86.7%(26/30)(P＜0.05);治疗后,两组CD3、CD4和IL-2均升高,CD8下降,治疗组改善优于对照组(P＜0.05);治疗组白细胞减少率[10.0%(3/30)]明显低于对照组[33.3%(10/30)](P＜0.05).两组对肝肾功能损害程度差异无统计学意义.结论 斯奇康注射液治疗肺结核患者,能有效改善肺结核的症状,提高病灶吸收好转率,提高机体细胞免疫力,减轻结核化疗所致的白细胞下降的发生率,对肝肾功能无明显影响,临床用药较安全.

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Objective To evaluate the effectiveness, the influence on cellular immune function and the side-effect of bacillus of Calmette-Guerin polysaccharide nucleic acid(BCG-PSN)combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis. Methods A total of 60 pulmonary tuberculosis patients were divided into treatment group(30 patients)and control group(30 patients)by random digits table. All patients accepted the same standard antituberculous chemotherapy, meanwhile patients in treatment group were injected with BCG-PSN. Observed and compared the clinical symptom,the size of the focas nidus,the change of toxic response and immunity. Results The symptoms were significantly relieved in both groups after treatment(P＜0.05), but it was significantly better in treatment group(P＜0.05), the effective rate and control rate in treatment group[36.7%(11/30),96.7%(29/30)]were significantly higher than those in control group[23.3%(7/30), 86.7%(26/30)](P ＜ 0.05). After treatment,the levels of CD3,CD4 and IL-2 were higher, and the level of CD8 was lower, but the treatment group improved significantly better than control group(P ＜ 0.05). The rate of leukopenia was lower in treatment group than that in control group[10.0%(3/30)vs. 33.3%(10/30),P ＜0.05]. As to the safety,no other toxicities were observed in the treatment group. Conclusions BCG-PSN combined with antituberculous chemotherapy in the treatment of pulmonary tuberculosis contributes to relieve the symptom, reduce size of the nidus, decrease leukopenia incidence and enhance the cell immunity. It is safe.     

卵巢癌患者化疗前后淋巴细胞亚群分析

目的 探讨化疗对卵巢癌患者免疫功能的影响.方法 收集卵巢癌行化疗患者34例(卵巢癌组),以同期体检的健康妇女30例作为对照组.检测两组外周血淋巴细胞亚群CD3+、CD4+、CD8+、CD25+等指标,分析各淋巴细胞亚群情况.结果 卵巢癌组患者外周血CD3+、CD4+以及CD4+/CD8+均较对照组显著降低(0.5524±0.1121比0.6685±0.0869、0.3183±0.0864比0.4139±0.0524、1.06±0.29比1.43±0.21),CD4+CD25+较对照组显著上升(0.1026±0.0418比0.0287±0.0132),差异有统计学意义(P<0.05).卵巢癌组患者外周血淋巴细胞亚群化疗后1周与化疗前比较差异无统计学意义(P>0.05);化疗后3周CD3+、CD4+以及CD4+/CD8+均较化疗前显著升高,CD4+ CD25+较化疗前显著下降,差异有统计学意义(P<0.05).结论 卵巢癌患者体内淋巴细胞亚群比例失调,化疗可改善卵巢癌的免疫抑制状态,恢复正常的淋巴细胞亚群比例.

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Objective To detect the effects of chemotherapy on the immune function of patients with ovarian cancer.Methods Thirty-four patients with ovarian cancer(ovarian cancer group)who accepted chemotherapy were collected.Thirty healthy women were used as control group.The lymphocyte sub-cluster CD3+,CD4+,CD8+ and CD25+of peripheral blood were detected by flow cytometry.Results The peripheral blood CD3+,CD4+ and CD4+/CD8+ in ovarian cancer group were lower than those in control group(0.5524±0.1121 vs.0.6685±0.0869,0.3183±0.0864 vs.0.4139±0.0524,1.06±0.29 vs.1.43±0.21),CD4+ CD25+was higher than that in control group(0.1026±0.0418 vs.0.0287±0.0132),there was significant difference between two groups(P<0.05).There was no significant changes observed 1 week after chemotherapy(P>0.05).Three weeks after chemotherapy,the CD3+,CD4+ and CD4+/CD8+ in ovarian cancer group were higher and CD4+ CD25+ was lower,there were significant difference between two groups(P<0.05).Conclusions The ratio of lymphocyte sub-cluster is imbalance in the patients with ovarian cancer.Chemotherapy can improve the immunosuppression condition and recovery the ratio of lymphocyte sub-cluster in the patients with ovarian cancer.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

正畸修复治疗牙周病所致前牙移位的临床研究

目的 观察正畸修复治疗牙周病所致前牙移位的临床疗效.方法 47例牙周病所致前牙松动、移位患者按治疗方法不同分为研究组(26例)和对照组(21例),研究组采用牙周基础治疗联合正畸修复治疗,对照组仅采用牙周基础治疗,观察并比较两组治疗前后的牙周袋深度、出血指数、前牙覆盖、覆(牙合)、牙槽骨高度的变化.结果 研究组治疗后的牙周袋深度、出血指数、前牙覆盖和覆(牙合)分别为(3.12±0.53)mm、(27.30±4.25)%、(2.53±0.76)mm和(2.18±0.53)mm,均较治疗前的(5.35±0.68)mm、(97.60±7.53)%、(6.22±1.43)mm、(4.53±2.25)mm显著降低,差异有统计学意义(P＜0.05),而且下降的幅度比对照组更为明显,差异亦有统计学意义(P＜0.05);对照组上述指标治疗后虽亦有下降,但与治疗前比较差异无统计学意义(P＞0.05);两组治疗前后牙槽骨高度均无明显变化.结论 牙周基础治疗联合正畸修复治疗能够矫正牙周病导致错位的前牙,并能稳定地改善牙周健康,有较好的应用前景.

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Objective To observe the clinical efficacy of orthodontic treatment for displacement of anterior tooth caused by periodontal disease. Methods Forty-seven patients with displacement of anterior tooth caused by periodontal disease were divided into study group (26 cases) and control group (21 cases)according to the therapy method, the study group received periodontal basic treatment combined with orthodontic treatment, while the control group only received periodontal basic treatment, the changes of periodontal pocket depth, bleeding index, anterior coverage, overbite, alveolar bone height in two groups before and after treatment were observed and compared. Results The periodontal pocket depth, bleeding index, anterior coverage and overbite of study group after treatment were (3.12±0.53) mm, (27.30±4.25)%, (2.53 ± 0.76) mm and (2.18 ± 0.53 ) mm respectively and which were significantly lower than those before treatment [(5.35 ± 0.68 ) mm, (97.60±7.53 )%, (6.22±1.43 ) mm, (4.53±2.25)mm], the difference was statistically significant (P＜ 0.05 ), and the decrease extent was more obvious than the control group, the difference between two groups was statistically significant(P＜0.05); the above indicators in control group after treatment also dropped, but compared with those before treatment there was no significant difference (P ＞0.05); the alveolar bone height in both groups had no obvious change before and after treatment.Conclusion Periodontal basic treatment combined with orthodontic treatment can correct the malposed anterior teeth, improve the periodontal conditions, it has good application prospects.     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

无创间歇正压通气治疗尘肺并发呼吸衰竭的疗效观察

目的 探讨无创间歇正压通气(NIPPV)治疗尘肺并发呼吸衰竭的疗效.方法 将46例尘肺并发呼吸衰竭患者随机分为治疗组26例和对照组20例.对照组采用常规治疗方法,治疗组在常规治疗的基础上,联合NIPPV治疗,比较两组患者治疗后心率、呼吸频率和PH、二氧化碳分压(PaCO2)、氧分压(PaO2)的变化.结果 治疗组治疗有效率为88.5%(23/26),对照组为60%(12/20),两组治疗有效率的差异有统计学意义(P＜0.05);治疗后治疗组患者心率为(95.38±10.75)次/min,较对照组[(103.00±12.56)次/min]下降;治疗组呼吸频率[(21.69±1.37):次/min]较对照组[(22.60±1.57)次/min]减慢;治疗组PaCO2[(52.88±10.75)mmHg]比对照组[(59.66±11.49)mm Hg]降低;治疗组PaO2[(100.77±25.3)mm Hg]较对照组[(71.82±17.94 mm Hg]明显升高;两组比较,差异均有统计学意义(P＜0.05).结论 NIPPV对治疗尘肺并发呼吸衰竭患者有效,可提高治疗有效率,改善动脉血PaO2和PaCO2.

Abstract：

Objective To evaluate the value of noninvasive intermittent positive-pressure ventilation (NIPPV) in treatment of patients with pneumonoconiosis combined with respiratory failure. Method There were 46 inpatients with pneumonoconiosis combined with respiratory failure. Tetwenty-six inpatients treated with conventional therapy and NIPPV were categorized as treatment group; Tetwenty inpatients just treated by conventional therapy served as control group. Compared with the changes of HR、RR and arterial blood gas index (PH、PaCO2、PaO2) in two groups after treatment. Results The effective ratio of treatment group was 88.5%, control group was 60%, which had significant difference (P＜0.05); The HR in treatment group after treatment was(95.38±10.75)beats per minute, control group was [(103.00±12.56)beats per minute; The RR in treatment group was (21.69±1.37) breaths per minute, control group was [(22.60± 1.57)breaths per minute];The PaCO2 in treatment group was (52.88±10.75)mm Hg, control group was [(59.66± 11.49)mm Hg];All of those were significantly decreased than those in control group (P＜0.05). The PaO2 in treatment group was (100.77±25.3)mm Hg, control group was [(71.82±17.94) mmHg];Compared with the control group, PaO2 in the treatment group increased significantly (P＜0.05). Conclusion NIPPV is beneficial to pneumonoconiosis combined with respiratory failure in different degrees.     

幽门螺杆菌根除疗法治疗慢性特发性血小板减少性紫癜的对照研究

目的 观察幽门螺杆菌(Hp)根除疗法治疗Hp阳性的慢性特发性血小板减少性紫癜(ITP)的疗效.方法 59例Hp阳性的慢性ITP患者,按随机数字表法分为抗Hp组(治疗组,30例)和安慰剂组(对照组,29例),随访3个月后,比较两组的疗效.结果 治疗组有效率(63.3%,19/30)明显高于对照组(27.6%,8/29)(x2=7.59,P＜0.05),治疗组血小板计数升高值[(33.5±21.6)×109/L]明显高于对照组[(12.6±19.5)×109/L](t=5.52,P＜0.05).结论 Hp根除疗法可升高轻中度Hp阳性慢性ITP患者的血小板计数.

Abstract：

Objective To assess the effect of anti- Helicobacter pylori (Hp) treatment on patients with chronic idiopathic thrombocytopenic purpura (cITP). Methods Fifty-nine patients with cITP and positive-Hp were divided into two groups by random digits table:Hp eradication group (30 cases,given a standard anti-Hp treatment) and placebo controlled group (29 cases,received a placebo). The platelet response of two groups was compared after three months' follow-up. Result The platelet response in Hp eradication group (63.3%, 19/30) was significantly higher than that in placebo controlled group (27.6%,8/29 )(χ2 = 7.59, P ＜ 0.05 ), and the increasing level of platelet count in Hp eradication group [ (33.5 ± 21.6)× 109/L] was higher than that in placebo controlled group [(12.6 ± 19.5) × 109/L] (t = 5.52,P ＜0.05).Conclusion Hp eradication treatment can promote the platelet recovery in mild and moderate cITP patients with positive-Hp.     

急性白血病患者化疗后应用白介素-2对T淋巴细胞亚群的影响

目的 探讨急性白血病患者化疗后应用白介素-2治疗对细胞免疫功能的影响及其临床意义.方法 将79例急性白血病患者随机分为两组,化疗加白介素-2组（治疗组）40例和单纯化疗组（对照组）39例,治疗组于化疗后第1天加用白介素-2 40万U静脉滴注,连用14 d;对照组单用常规化疗,化疗前后均未予白介素-2治疗.检测化疗前及治疗后T淋巴细胞亚群的变化.结果 治疗后14 d,治疗组的CD4^＋、CD4^＋/CD8^＋水平明显高于对照组（P〈0.05）,化疗后白细胞谷值、中性粒细胞谷值,对照组明显低于治疗组（P〈0.05）.结论 白介素-2能明显提高患者化疗后CD4^＋、CD4^＋/CD8^＋水平,从而改善接受化疗机体的免疫状态.白介素-2对急性白血病化疗后骨髓抑制具有防治作用.     

CD69在急性髓系白血病患者外周血T淋巴细胞的表达及意义

目的检测急性髓系白血病患者外周血T淋巴细胞CD69的表达,评估T细胞活化状态,了解急性髓系白血病的免疫功能、状态。方法采用流式细胞术检测15例急性髓系白血病患者化疗前后外周血T淋巴细胞CD69的表达,同时以正常外周血标本作对照。结果急性髓系白血病组化疗前、化疗后CD69的表达均显著低于正常对照组(P<0.05),但化疗后CD69的表达较化疗前明显升高(P<0.05)。结论急性髓系白血病存在T细胞活化受抑、免疫功能受损。T细胞活化受抑可能是急性髓系白血病免疫逃逸的重要机制。CD69可能成为疗效评价的辅助指标及免疫治疗的潜在靶点。     

血必净注射液对重症脓毒症患者机体炎性反应和细胞免疫功能的影响

目的 评价血必净注射液对重症脓毒症患者机体炎性反应和细胞免疫功能的影响.方法 选择2008年9月至2009年8月ICU收治的62例确诊重症脓毒症患者,按随机数字表法分为治疗组30例和对照组32例,两组均给予脓毒症集束化治疗,治疗组加用血必净注射液100ml静脉滴注,2次/d,连续使用7d,观察两组患者治疗前后血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-10、C反应蛋白(CRP)以及外周血T淋巴细胞亚群CD4+、CD8+、CD4+CD8+和CD14+单核细胞人类白细胞抗原(HLA)-DR表达的变化.结果 两组患者治疗前血清TNF-α、IL-6、IL-10和CRP水平以及外周血CD4+、CD8+、CD4+/CD8+和CD14+单核细胞HLA-DR表达比较差异无统计学意义(P＞0.05).与对照组比较,治疗组治疗后血清TNF-α、IL-6、IL-10、CRP水平显著降低[(64.4±13.5) ng/L比(96.1 ±22.1) ng/L,(153.8 ±23.8) ng/L比(180.1 ±21.7) ng/L,(73.8±13.8) ng/L比(101.1±11.7)ng/L,(53.7±18.8) mg/L比(91.3±32.8) mg/L,P＜ 0.05],而外周血CD4+、CD8+、CD4+/CD8+升高(0.311±0.021比0.424±0.035,0.201±0.017比0.238±0.038,1.78±0.21比1.56±0.18,P＜ 0.05 ),CD14+单核细胞HIA-DR表达上调[(38.4±11.5)％比(18.1±12.1)％,P＜0.05].结论 血必净注射液可降低重症脓毒症患者机体炎性反应,纠正细胞免疫功能紊乱,有助于改善患者病情.     

急性白血病化疗前后血浆TF、TFPI的动态变化及其临床意义

目的比较急性白血病化疗前后血浆组织因子(TF)和组织因子途径抑制物(TFPI)的变化,探讨其在在病情进展、疗效观察及预后判断中的价值。方法选择2011年1月～2011年10月32例急性白血病患者为研究对象,分别于化疗前及缓解期采用酶联免疫吸附法(ELISA)测定两组血浆TF和TFPI含量。同时选择同期健康体检者30例为正常对照组。结果化疗前,急性白血病组患者血浆TF和TFPI分别为(77.9±12.2)ng/L、(160.3±20.2)ng/ml,明显高于正常对照组的(32.6±2.8)ng/L、(132.8±12.5)ng/ml,差异均有统计学意义(P﹤0.05)。32例患者化疗2个疗程后,24例缓解,8例未缓解。缓解组患者血浆TF及TFPI含量较化疗前明显下降,差异有统计学意义(P﹤0.05);未缓解组患者血浆TF及TFPI含量与化疗前比较,差异无统计学意义(P﹥0.05)。结论血浆TF及TFPI含量对急性白血病患者的病情进展及治疗效果具有一定的预测价值。     

亚低温治疗重型颅脑损伤疗效及对T细胞亚群的影响

目的 研究亚低温治疗重型颅脑损伤对T细胞亚群及预后的影响.方法 选择某院重型颅脑损伤患者87例,分治疗组49例和对照组38例;两组均经常规手术治疗,治疗组用亚低温和冬眠疗法,持续至术后4～7 d,当颅内压降至正常后,12 h内将体温恢复至正常;对照组维持正常体温;检测患者亚低温治疗前与治疗后7d、14 d患侧颈动脉最低血流速度(Vmin)和颈动脉最低血流量(Qmin);检测治疗前和治疗后14dT细胞亚群的变化;观察两组治疗后14 d神智清醒率;并进行统计分析.结果 治疗组与对照组治疗前、治疗后7d、14 d Vmin (cm/s)分别为7.51±0.59与7.61±0.74、10.93±0.82与8.32±0.69、11.97±0.84与8.97±0.43,Qmin (ml/s)分别为2.47±0.31与2.42±0.29、4.49±0.34与3.45±0.31、4.97±0.31与3.852±0.41,脑水肿体积(cm3)分别为92.51±11.62与93.88±10.87、78.21±9.54与86.35±8.87、72.42±7.56与84.54±9.33,两组治疗后7d、14 d与治疗前比较,两组治疗后7d、14 d间比较差异均有统计学意义(P＜0.05);两组治疗后神智清醒发生率分别为21例(占43.85％)和9例(占24.59％),两组间比较差异有统计学意义(P＜0.05);治疗组与对照组治疗前和治疗后14 d CD3+、CD4+、CD8+、CD4+/CD8+分别为51.53±7.56和68.39±9.68与49.74±8.27和52.27±9.32、34.76±5.65和51.23±8.46与35.26±6.13和38.67±7.53、18.61±5.26和13.85士4.37与17.94±6.13和15.91±6.08、1.51±0.19和4.17±1.27与1.47±0.21和2.52±1.34,治疗组治疗后14 d与治疗前比较,及治疗后14d与对照组比较差异均有统计学意义(P＜0.05).结论 亚低温治疗重型颅脑损伤疗效显著,并可提高患者CD3+和CD4+值升高,CD8+值降低,提高患者的免疫功能和创伤的耐受能力,促进脑组织的康复具有重要的作用.     

Influence of chemotherapy on the lipid peroxidation and antioxidant status in patients with acute myeloid leukemia

Chemotherapeutic agents used in patients with cancer cause to generate the enormous amounts of free radicals associated with cell injury. In this study we assess the effects of chemotherapy regimen on oxidant/antioxidant status in patients with acute myeloid leukemia (AML). 38 newly diagnosed patients with acute myeloid leukemia were recruited in this study. All patients received cytarabine and daunorubicin as chemotherapy regimen. Plasma levels of malondialdehyde (MDA), total antioxidant status (TAS), and the levels of erythrocyte activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were determined before chemotherapy and 14 days after chemotherapy with cytarabine and daunorubicin. Plasma MDA concentrations increased significantly (from 2.68±0.89 nmol/L to 3.14±1.29 nmol/L) during the 14days post-chemotherapy period (P=0.04). Plasma TAS concentrations changed with chemotherapy from 1.09±0.15 mmol/L to 1.02±0.14 mmol/L with P=0.005. Erythrocyte SOD and GPX activity decreased overtime from 1157.24±543.61 U/g Hb to 984.01±419.09 U/g Hb (P=0.04) and 46.96±13.70 U/g Hb to 41.40±6.44 U/g Hb (P=0.02) respectively. We report here that there is an increase in malondialdehyde levels and a decrease in the levels of antioxidant enzymes and total antioxidant status. This suggests that chemotherapy causes these changes as a result of enormous production of reactive oxygen species in the patients with AML. Antioxidant supplementation must be approached with caution because of the probability of reduction the therapeutic efficacy of these cytotoxic drugs.     

大剂量胸腺肽对急性白血病医院感染的干预作用及其对细胞免疫功能的影响

目的观察大剂量胸腺肽对急性白血病化疗患者医院感染的干预作用及其作用机制. 方法 42例观察组患者在化疗的同时使用大剂量胸腺肽治疗(200 mg/d静滴,连用14～18 d);对照组单独使用化疗,方案与观察组相同;对两组患者的感染率、死亡率进行调查,并对治疗前后的细胞免疫功能进行检测并进行相应的统计学处理. 结果观察组患者医院感染率及病死率明显低于对照组(P<0.05及P<0.01),治疗后观察组患者的细胞免疫功能(T4、T4/T8及NK细胞活性)明显高于对照组(P<0.05及P<0.01). 结论大剂量胸腺肽在增加化疗效果的同时可显著增加机体的细胞免疫功能,增加机体的抗感染能力,降低医院感染的发生率及相关死亡率.     

卡介菌多糖核酸对尖锐湿疣患者外周血TCRγδ^＋T细胞的影响及临床疗效

目的研究卡介菌多糖核酸（BCG-PSN）对尖锐湿疣（CA）患者外周血T细胞受体（TCR）γδ^＋T细胞的影响及临床疗效。方法采用流式细胞仪检测了20例正常对照者和60例CA患者（BCG-PSN组40例和病例对照组20例）治疗前后外周血CD3^＋T、TCRγδ^＋T和TCRαβ^＋T细胞进行了检测；并对BCG-PSN治疗CA的临床疗效进行了分析。结果治疗前CA患者外周血CD3^＋T、TCRγδ^＋T细胞百分率低于正常对照（47.64±7．19vs68．92±6.15，t=12．00；2.27±0．68vs4.65±0．99，t=12．17；P〈0，01）；TCRαβ^＋T细胞百分率与正常对照组相比差异无统计学意义（23．55±4.71vs25．09±5．30，t=1.24，P〉0．05）。治疗后BCG-PSN组患者外周血CD3^＋T、TCRγδ^＋T、TCRαβ^＋T细胞百分率明显升高（70．21±9．64vs47、62±7.91，35.55±4.77vs23，54±4．71，4．52±1．21vs2．25±0．68，P〈0．01）；病例对照组无显著变化（P〉0．05）；BCG-PSN组与病例对照组治疗前后CD3^＋T、TCRγδ^＋T、TCRαβ^＋T细胞百分率差值比较，差异有统计学意义（P〈0．01）。临床观察证荚BCG—PSN能够显著提高CA临床治愈率，降低CA的复发率。结论CA患者存在TCRγδ^＋T细胞缺陷；BCG—PSN可提高CA患者的TCRγδ^＋T细胞百分率，从而加强患者的T细胞免疫功能，以提高其临床疗效、减少其复发。