皮质醇和促肾上腺皮质激素在危重症患者血清中的变化及临床意义

目的:探讨皮质醇(COR)和促肾上腺皮质激素(ACTH)在危重症患者血清中的变化及及临床价值。方法:40例危重症患者(危重症组)和40例健康查体者(对照组)为研究对象,采用化学发光法测定血清COR和ACTH水平,计算游离皮质醇(FC)水平。并对COR的水平和ACTH的水平相关性分析。结果:危重症组患者血清COR、ACTH、FC水平显著高于对照组,相比较有显著性差异(P0.05);MODS组患者血清COR、ACTH、FC水平显著高于非MODS组,相比较有显著性差异(P0.05);危重症组患者COR水平和ACTH水平呈显著正相关性(r=0.5782,P=0.001)。结论:危重症患者血清COR、ACTH水平明显升高,且与病情危重程度相关,COR和ACTH可以做为判定危重症患者预后的可靠指标。     

硫酸镁联合孟鲁司特钠治疗对小儿支气管哮喘肺功能及免疫功能的影响分析

目的分析硫酸镁联合孟鲁司特钠治疗对小儿支气管哮喘肺功能及免疫功能的影响。方法回顾性分析2018年2月至2019年10月本院收治的89例支气管哮喘患儿临床资料,按照治疗方法的差异分为联合组(n=43)和对照组(n=46)。对照组在常规药物治疗基础上加用硫酸镁治疗,联合组则采用硫酸镁联合孟鲁司特钠片治疗。比较两组患者治疗前后肺功能、免疫功能、临床疗效及不良反应发生情况。结果联合组临床总有效率为95.35%,显著高于对照组的78.26%(P0.05);联合组治疗后FVC、FEV_1、FEV1/FVC水平均显著高于对照组(P0.05);治疗后两组患者免疫功能各指标均有所升高,且联合组IgM、IgG、IgA、CD_(4+)、CD_(4+)/CD_(8+)均显著高于对照组(P0.05);两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论硫酸镁联合孟鲁司特钠治疗小儿支气管哮喘效果显著,可明显改善患儿肺功能并调节其免疫功能,安全性高,值得临床推广。     

褪黑素水平对抑郁症患者下丘脑-垂体-肾上腺轴功能的影响

目的探讨抑郁症患者褪黑素(MT)水平对下丘脑-垂体-肾上腺轴(HPA)功能的影响。方法对86例抑郁症患者,检测血清MT、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(COR),并分析其相互关系。结果1以MT中位数(51.3ng/L)为切点,将所有抑郁症患者分为MT高值组(51.3ng/L,n=43)与MT低值组(51.3ng/L,n=43),前者血清CRH、ACTH、COR均显著低于后者(t=3.330,3.315,2.314;P0.01,0.01,0.05);2血清MT水平与CRH、ACTH水平负相关(r=-0.414,-0.329;P0.01,0.05)。结论褪黑素对抑郁症患者的HPA轴功能可能有一定的抑制作用。     

中药内服外敷对慢性阻塞性肺疾病合并高黏血症患者的临床疗效

目的:观察中药内服外敷协同治疗慢性阻塞性肺疾病(简称慢阻肺,COPD)合并高黏血症患者的临床疗效。方法:100例COPD合并高黏血症患者分为观察组和对照组,每组各50例。对照组给予西药常规治疗;观察组在此基础上加用自拟豁痰化瘀中药方口服及穴位贴敷治疗。一疗程(14天)后观察两组临床疗效、肺功能水平及血液流变学指标变化。结果:观察组临床痊愈率明显高于对照组(44.00%vs 24.00%,P0.01),无效率显著低于对照组(10.00%vs 26.00%,P0.01)。对照组治疗后肺功能指标中只有一秒呼气量(FEV1)与肺活量(FVC)比值(FEV1/FVC)较治疗前升高(P0.05),而观察组治疗后肺功能指标FEV1、FEV1占预计值百分比和FEV1/FVC均较治疗前增加(P0.05,P0.01);且观察组治疗后FEV1/FVC明显大于对照组治疗后(P0.05)。对照组治疗前后血流变5项指标全血高切、低切表观黏度、红细胞压积、红细胞聚集指数、血浆黏度水平下降无统计学差异(P0.05),观察组治疗后上述5项指标均较治疗前明显降低(P0.05,P0.01),且显著低于对照组治疗后水平(P0.05,P0.01)。结论:中西医结合治疗COPD合并高黏血症,较之单纯应用西药能更明显提高临床痊愈率,更显著改善血液流变状态。     

麻疹疫苗反复注射对哮喘患儿IL-12、IL-13水平的影响

目的与方法:通过观察轻-中度发作期哮喘患儿麻疹疫苗反复注射前后IL-12,IL-13及血清总IgE水平的变化,探讨麻苗治疗对哮喘患儿的免疫影响及其治疗小儿哮喘的作用机制。采用生物素-亲合素双抗夹心酶联免疫(ABC-ELISA)法测定麻苗治疗前后13例哮喘患儿(麻苗治疗组)血浆及外周血单个核细胞(PBMC)培养上清中的IL-12、IL-13与血清总IgE水平,并与12例单纯对症治疗组哮喘患儿及17例正常对照组小儿比较。结果:麻苗治疗后,IL-12水平与对症治疗组无显著差异(P＞0.05),IL-13与血清总IgE水平显著降低(P＜0.05)。血浆IL-12水平与血清总IgE水平呈负相关(r=-0.437,P＜0.05),PBMC培养上清中的IL-12水平与血清总IgE水平无相关性;血浆及PBMC培养上清中的IL-13水平与血清总IgE水平呈正相关(r=0.657及r=0.485,P＜0.01);血浆及PBMC培养上清中的IL-12水平与IL-13水平呈负相关(r=-0.460及r=-0.383,P＜0.05)。结论:麻疹疫苗反复注射是通过下调哮喘患儿IL-13水平,进而降低血清总IgE水平,而对IL-12水平无显著影响。     

支气管哮喘患者血清CCR5、eotaxin水平变化及其对免疫Th17、Treg细胞平衡的影响

目的观察支气管哮喘患者血清细胞趋化因子受体5(cell chemokine receptor 5,CCR5)、嗜酸性粒细胞趋化因子eotaxin水平变化,并分析其对免疫Th17、Treg细胞平衡的影响。方法选取我院2019年5月至2020年4月收治的120例支气管哮喘患者作为研究对象。根据疾病严重程度分为轻中度支气管哮喘组(n=72)、重度支气管哮喘组(n=48),选取50例健康人群作为对照组。采用ELISA法检测血清中CCR5、eotaxin含量,并通过流式细胞术测定患者外周血Th17/Treg等T细胞亚群分布。同时检测血清中白介素-17(interleukin-17,IL-17)白介素-6(interleukin-6,IL-6)水平及肺功能用力肺活量(forced vital capacity,FVC)、第1秒用力呼气量(forced expiratory volume in 1s,FEV_1)及FEV_1/FVC比值(FEV_1/FVC%)。Pearson相关性分析评估CCR5、eotaxin水平与Th17/Treg比值的关系。结果重度及轻中度哮喘组患者血清CCR5、eotaxin、IL-6及IL-17含量均明显高于对照组,且重度哮喘组患者高于轻中度组,两两比较差异均有统计学意义(P0.05)。重度及轻中度哮喘组患者外周血Th17细胞、Treg细胞百分比及Th17/Treg比值均显著高于对照组,而Treg细胞百分比较对照组明显降低,差异均有统计学意义(P0.05);但重度哮喘组上述指标和轻中度哮喘组患者差异无统计学意义(P0.05)。重度及轻中度哮喘患者肺功能水平均显著低于对照组,差异有统计学意义(P0.05)。Pearson相关性分析结果显示,哮喘患者CCR5及eotaxin水平与Th17细胞百分比及Th17/Treg比值呈明显正相关性,而与Treg细胞百分比呈显著负相关性。结论随着哮喘严重程度增加,患者肺功能下降,且CCR5水平及eotaxin水平增加,促进Th17细胞百分比增加,Treg细胞百分比下降,Th17/Treg比值失衡,免疫功能紊乱,哮喘病情加重。     

多发性肌炎/皮肌炎患者糖皮质激素治疗前后其受体的改变及意义

为了探讨多发性肌炎 /皮肌炎 (PM/DM )患者外周血白细胞糖皮质激素受体 (GCR )的变化与意义及应用糖皮质激素(GC)疗效的关系 ,应用放射配体结合法 ,以3H标记地塞米松 ( 3H Dex)为配体 ,测定 2 4例PM/DM患者应用激素治疗前后白细胞GCR的变化 ,同时采用放射免疫分析法测定血浆皮质醇浓度。结果表明PM/DM患者应用GC治疗前其GCR特异结合量 ( 3 673± 1195位点 /细胞 )低于正常对照组 ( 4 966± 12 10位点 /细胞 ) ,有显著性差异 (P <0 0 1)。应用GC治疗后 ,激素抵抗组其GCR降低幅度 ( 85 9± 10 8位点 /细胞 )高于激素敏感组降低幅度 ( 62 6± 12 7位点 /细胞 ) ,差异有显著性 (P <0 0 0 1)。PM/DM患者应用GC治疗前后其GCR水平与相对应的血浆皮质醇浓度之间 ,无相关性 (P >0 0 5 )。提示PM/DM患者外周血白细胞GCR水平的变化与PM/DM的发病机制、应用GC治疗的疗效判定、预测预后等可能有密切关系 ,GCR对于PM/DM合并恶性肿瘤患者的意义尚待进一步研究     

慢阻肺引发肺动脉高压预后评价与ET-1、H2S、NO的相关性研究

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)引发肺动脉高压(pulmonary arterial hypertension,PAH)预后评价与内皮素(ET-1)、内源性硫化氢(H_2S)和一氧化氮(NO)的相关性研究。方法选取2016年1月至2017年12月本院确诊的慢阻肺并发肺动脉高压患者120例,按肺动脉压水平分为并发轻度PAH组(45例)、中度PAH组(42例)、重度PAH组(33例),选取COPD不并发肺动脉高压的患者为对照组(40例)。分别检测各组受试者外周静脉血中ET-1、H_2S和NO表达水平。结果与对照组相比,慢阻肺并发PAH患者血浆内ET-1水平显著升高,H_2S和NO水平显著降低(P <0. 05);随着疾病程度的加重,患者血清内各指标变化趋势更为显著(P <0.05)。与治疗前相比,各组患者血清内ET-1水平显著降低,H_2S和NO水平显著升高(P<0.05)。与对照组相比,慢阻肺并发PAH患者FEV_1/FVC(%)及FEV_1%预计值显著降低(P<0.05)。随着疾病程度的加重,患者FEV_1/FVC(%)及FEV_1%预计值降低更为明显(P<0.05)。与治疗前相比,患者FEV_1/FVC(%)及FEV,%预计值显著升高(P<0.05)。血浆H_2S、NO水平与FEV_1/FVC(%)、FEV_1%预计值呈显著正相关(P<0.05),ET-1水平则与其呈明显负相关(P<0.05)。血浆H_2S、NO水平与患者肺动脉压力呈显著负相关(P<0.05),ET-1水平则与其呈明显正相关(P <0.05)。血浆H_2S水平和NO水平与呼吸系统评分、循环系统评分、躯体功能评分、认知功能评分、社会功能评分及生活质量评分呈显著正相关,ET-1水平与呼吸系统评分、循环系统评分、躯体功能评分、认知功能评分、社会功能评分及生活质量评分呈负相关。结论慢阻肺并发肺动脉高压患者体内ET-1、H_2S和NO表达水平与肺功能及病情变化密切相关,可作为监测病情严重程度的良好指标。     

健康宣教指导在小儿支气管哮喘遵医行为中的应用效果分析

目的分析健康宣教指导在小儿支气管哮喘遵医行为中的应用效果。方法选择2017年6月至2019年6月本院收治的124例支气管哮喘患儿作为研究对象,按照是否进行健康宣教指导分为研究组(n=63)和对照组(n=61)。对照组患儿采用普通健康宣教,研究组患儿在此基础上增加健康宣教指导。记录所有研究对象临床资料及随访情况,测量患儿随访前与随访1年后用力肺活量(FVC)、第一秒用力呼气量(FEV_1)及第一秒用力呼气量/用力肺活量(FEV_1/FVC),比较两组患儿随访1年后遵医行为情况及随访1年内复诊率、再次住院率、急性发作次数。结果研究组患儿随访1年后FVC、FEV1、FEV1/FVC水平均显著高于对照组(P0.05);研究组患儿掌握疾病相关知识、正确合理用药、指导患儿合理饮食及家居、参加户外及体育活动及正确处理急性期发作人数显著多于对照组(P0.05);研究组患儿随访1年内复诊率、再次住院率显著低于对照组,1年内急性发作次数明显少于对照组(P0.05)。结论健康宣教指导可提高支气管哮喘患儿遵医行为,改善其肺功能,对降低支气管哮喘复发率、延长发作间隔时间有积极意义,值得临床推广。     

全程多学科合作管理模式对老年哮喘急性期患者心理状态、肺功能及生活质量的影响

目的:探讨多学科协作管理模式对老年哮喘急性期患者心理状态、肺功能及生活质量的影响。方法:选取2018年4月至2020年4月在某院接受治疗的老年哮喘患者90例。依据干预方法的不同将入选患者分为观察组和对照组,每组45例。对照组采用常规干预模式,观察组采用多学科协作干预模式。分别于干预前后采用焦虑自评量表(self-report anxiety scale, SAS)和抑郁自评量表(self-report depression scale, SDS)对患者焦虑抑郁状况评分;采用肺功能仪测量肺功能指标,包括1秒用力呼气容积占预计值百分比(forced expiratory volume in one second expressed as percent predicted, FEV1%)以及FEV1/用力肺活量(forced vital capacity, FVC);采用哮喘生命质量调查问卷(asthma quality of life questionnaire, AQLQ)对患者生活质量评分。结果:干预2个月后,对照组SAS与SDS评分与干预前比较均显著下降(t=19.464,16.639;P0.01),观察组SAS与SDS评分与干预前比较均显著下降(t=23.776,21.840;P0.01),且观察组SAS与SDS评分均显著低于对照组(t=-5.651,-6.139,-6.099;P0.01)。干预2个月后,对照组FEV1%与FEV1/FVC与干预前比较均显著增高(t=-6.519,-7.287;P0.05),观察组FEV1%与FEV1/FVC与干预前比较均显著增高(t=-10.361,-10.575;P0.01),且观察组FEV1%与FEV1/FVC均显著高于对照组(t=3.408,3.730;P0.01)。干预2个月后,对照组AQLQ各维度评分及总分与干预前比较均显著增高(t=8.095,6.819,8.243,8.641,13.062;P0.05),观察组AQLQ各维度评分及总分与干预前比较均显著增高(t=8.095,6.819,8.243,8.478,16.662;P0.01),且观察组AQLQ各维度评分及总分均显著高于对照组(t=3.269,4.828,2.592,3.292,5.197;P0.05)。结论:多学科协作模式可以有效降低老年哮喘急性期患者焦虑、抑郁负面情绪,改善肺功能,提高生活质量。     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.     

Satellite RNA associated with bamboo mosaic potexvirus shares similarity with satellites associated with sobemoviruses

Summary A putative nonstructural protein encoded by a satellite RNA associated with bamboo mosaic potexvirus shares 46% identity with the capsid protein of satellite virus of panicum mosaic sobemovirus. The sequence similarity among satellite plant viruses which have no apparent relationship implies a common origin.