肺螨病在不同职业人群中流行情况的研究

目的 调查不同职业人群中肺螨病的流行情况。方法 询问病史、痰检及部分痰螨阳性者进行血检（白细胞分类计数）和Ｘ线胸片检查。结果 对１５４２人作痰检,螨阳性者８３例,检出率５．３８％,其中工作中密切接触中药者８２６人,螨阳性者５３人,检出率６．４２％;工作中密切接触粮食者６８６人,螨阳性者２９人,检出率４．２３％;纺织工人３０人,螨阳性者１人,检出率３．３３％,检出的螨经鉴定有１４种,即粗脚粉螨、腐食     

济宁市不同职业人群肺螨病患病情况调查及治疗评价

[目的]了解肺螨病的流行状况、分布特征与治疗效果,为大面积防治本病提供科学依据。[方法]2000年6月至2006年6月,采用询问病史、螨渗液皮试、痰检等方法,在济宁市部分粮库、粮食加工厂、农村磨坊、中药房（库）、中药厂、卷烟厂和图书馆（室）的工作人员中进行调查,对确诊的肺螨病病人进行治疗效果观察。[结果]调查2113人,确诊肺螨病者160例,患病率为7．57％。肺螨病患病率．农村磨坊、面粉厂、粮库、中药店、中药厂、图书馆（室）、烟厂工作人员分别为14．53％、11．11％、8．39％、7．14％、6．12％、5．06％、4．15％,其他对照人群96人均为阴性（P〈0．01）;46岁以上、36～45岁、26～35岁和16～25岁分别为14．19％、9．81％、7．94％、3．41％（P〈0．01）;工龄0～9、10～19年、20～29年、30年以上者分别为5．81％、8．49％、16．18％、23．s3％（P〈0．01）。痰检685人,痰螨阳性的160例,检出的螨有12种,分隶属5科10属。160例病人服用甲硝哒唑治疗3个疗程,141例自觉症状消失或改善;痰检133例,126例痰螨阴性。[结论]肺螨病的发病与职业有密切关系,采用甲硝哒唑治疗效果显著。     

ABC-ELISA法诊断肠螨病的研究

目的：探讨生物素-亲和素酶联免疫吸附试验（ABC—ELISA）在肠螨病诊断中的应用价值。方法：采集48例肠螨病患者血清，用ABC—ELISA法检测血清螨特异性抗体IgG，并与葡萄球菌A-蛋白酶联免疫吸附试验（SPA—ELISA）进行比较。结果：用ABC—ELISA法和SPA—ELISA法检测48例肠螨病患者血清螨特异性抗体IgG阳性率分别为89.58％（43／48）和56.25％（27／48），两者比较，差异具显著性（χ^2=13．50，P〈0．01）。结论：ABC—ELISA法比SPA—ELISA法更有效诊断肠螨病。     

肺螨病流行状况的调查与防治

目的掌握山东地区肺螨病病原的种类,以及肺螨病在该地区的流行状况,探讨肺螨病的防治方法。方法采用访问法、螨渗液皮肤点刺试验法,估计该地区的肺螨病发病数和发病率。结果调查省内8个地区、16个县市正常人群及从事不同行业的重点人群共4 622人,肺螨的总感染率为4.37%,平均发病率为3.89%。其中从事粮食加工人员的发病率最高,为13.80%,其次为粮食搬运工为10.78%。调查表明感染与发病主要与接触螨类孳生环境的时间长短有关。年龄及性别差异无显著性。结论调查显示肺螨病的流行与特定的职业人群有关,在存有螨类环境中工作的人员中工作年限越长,感染和患病率越高。因此,对特定人群要加强个人保护。     

不同职业人群中哮喘患者尘螨过敏情况的调查

目的了解不同职业人群中哮喘患者对尘螨的过敏情况。方法选取不同的职业人群并采用问卷调查方法，选择127名符合哮喘症状的志愿者，利用皮肤点刺试验（SPT）及血清特异性IgE（sIgE）检测其对尘螨变应原的过敏情况。结果工作中密切接触中药材的哮喘患者其SPT阳性率达60．0％，sIgE阳性率为51．1％；工作中密切接触粮食的哮喘患者其SPT阳性率达58．3％，sIgE阳性率为45．8％；而纺织车间工人中哮喘患者的阳性率为29．4％，sIgE阳性率20．6％；差异均有统计学意义（P〈0．05）。结论不同职业中哮喘患者对尘螨的过敏情况似与职业环境相关，应加强对特定职业人群的劳动保护。     

妊娠妇女巨细胞病毒及单纯疱疹病毒感染与免疫状态研究

为了解妊娠期间巨细胞病毒（ＣＭＶ）及单纯疱疹１８３名妊娠妇女、２２名反复自发流产妇女和３２名非妊娠妇女进行病毒分离、抗体测定、病毒抗原特异性淋巴细胞增殖反应（ＬＰＲ）测定。早期和晚期妊娠妇女ＨＳＶ阳检率分别为２．７％（５／１８３）和１．０％（１／１０１），ＣＭＶ阳检率为１．１％（２／１８３）和２．０％（２／１０１）。妊娠妇女、反复自发流产妇女和非妊娠妇女ＣＭＶ抗体阳检率为５１．６％、５０％和３４．     

安徽省农村居民储藏物中孳生粉螨调查

目的调查安徽省农村居民储藏物巾粉螨的孳生状况。方法采用电热集螨法、水膜镜检法进行分离，制片后计数、签定。结果从40种（700份）储藏物中分离的粉螨共计31种，隶属于7科20属；全部样本中均有粉螨孳生，孳生密度以芝麻中最高为（332．67±7．85）只／g，尖椒中最低为（13．43±5．28）只／g；腐食酪螨生境分布最广，23种储藏物中有分布。结论安徽省农村居民储藏物中孳生粉螨种类较多，孳生环境广泛，危害较严重，应采取防制措施。     

人体蠕形螨感染调查与分析

目的 了解人体蠕形螨感染情况及其影响因素。方法 采用随机方法对北京市丰台区部分人群进行感染调查，用透明胶带粘贴法检查螨虫，并就年龄、性别、职业和皮肤状况等进行问卷调查，采用多因素Logistic回归分析提取主要相关因素。结果 人群蠕形螨感染率为2198％(273／1242)，男性感染率为21．03％(114／542)，女性为22．61％(156／690)；感染虫种以毛囊蠕形螨为多，占69．60％，皮脂蠕形螨占19．80％，混合感染占10．60％。感染率主要与年龄相关。结论 人群蠕形螨感染较为普遍，感染虫种以毛囊蠕形螨为主。     

工作场所与居室粉螨变应原含量相关性研究

目的：探讨特定职业人群工作场所与居室粉螨变应原的相关性。方法：选取面粉、中药材及粮食加工人员（粉螨变应原暴露人群）各10名为实验组，对其工作场所的浮尘、落尘及居室内地板尘、床铺尘进行取样，另取本校教职工10名为对照，同样取样共160份。ELISA法检测样品中粉螨变应原的含量。结果：实验组工作场所变应原含量明显高于居室内；浮尘变应原含量与床铺尘、地板尘具有相关性（r6=0．40，P〈0．0l；r6=0．32，P〈0．05），对照组工作场所与居室内变应原含量无明显差异，浮尘与床铺尘变应原含量无显著相关性。结论：粉螨变应原暴露人群的工作场所及居室内粉螨变应原污染严重，并存在从工作场所向居室的变应原转移。     

尿螨病临床症状的初步观察

目的探讨尿螨病的临床症状,为诊治提供依据.方法对经流行病学确诊的69例尿螨病患者进行尿常规检查、血常规检查、血清总IgE、螨特异性IgE检测、皮肤挑刺试验;对11例尿螨病患者进行膀胱镜检查.结果尿螨病患者的主要临床症状为夜间遗尿和尿频、尿急、尿痛等尿路刺激症状,其次为颜面和/或下肢水肿、尿量异常、蛋白尿、大量上皮细胞尿等.白细胞计数在(5.3～11.4)×109/L之间,多数患者白细胞分类中的嗜酸性粒细胞有不同程度的增高,一般在0.05～0.09之间,最高达0.48;嗜酸性粒细胞计数多在0.5×109/L～0.14×109/L之间.尿螨阳性患者血清总IgE、螨特异性IgE水平明显高于尿螨阴性者,差异有显著性(P＜0.01,P＜0.05).皮肤挑刺试验结果显示""者39例,""者41例,"+"者36例,"±"者25例,"-"者1 853例,阳性率分别为1.96%、2.06%、1.81%,可疑者为1.25%,阴性率为92.92%.11例患者膀胱镜检查发现,膀胱三角区粘膜上皮增生、肥厚,固有膜内有浆细胞、淋巴细胞浸润,有聚集的粉红色脓肿,膀胱内壁轻度小梁性改变,侧壁局部呈充血样改变,毛细血管充血扩张.结论尿螨病的临床症状虽与泌尿系统其他疾病有雷同之处,但仍有诊断依据可循,如尿螨阳性,血清总IgE、螨特异性IgE水平均增高等.     

某医科大学生蠕形螨感染率及影响因素调查

目的 为了解某医科大学生面部蠕形螨的感染状况,探讨蠕形螨感染的危险因素.方法 以某医科大学的641名在校大学生为调查对象,采用透明胶带法收集样本,并进行镜检.同时,采用自行设计的问卷调查,x2检验等方法分析蠕形螨感染的相关因素.结果 受检学生641人,检出感染人体蠕形螨74人,感染率11.5％,其中男生感染率为9.7％ (26/269),女生感染率为12.9％ (48/372),差异无统计学意义(P=0.206);2011级学生的检出率为14.8％ (37/250),2012级学生的检出率为9.5％ (37/391),差异有统计学意义(P=0.039);油性或混合性肤质者感染率为13.1％比干性或中性皮肤者感染率(6.1％)高(P =0.026);感染者的感染度以轻度(1～5条)为主,占95.9％ (71/74),1人最多检出14条蠕形螨.结论 该校的蠕形螨感染率偏低.随集体宿舍生活时间的增加,感染率上升;偏油性肤质者比偏干性肤质者更容易发生感染.     

螨过敏性哮喘患者居室一年四季尘螨密度与发病关系

目的探索螨过敏性哮喘患者一年四季居室内尘螨密度与哮喘发病的关系。方法对43例螨浸液皮试阳性的哮喘患者，每季度采集其卧室中床垫、被褥、沙发和枕头等处的积尘，用解剖显微镜计数尘螨，同时由患者逐日记录哮喘发作状况、早晚呼气峰流速值和用药情况等。结果居室一年四季间尘螨密度差异有显著性(P<0．05)。秋季尘螨密度最高[秋季(149．93±83．11)N／0．25m2，春季(45．64±28．50)N／0．25m2，夏季(65．25±23．41)N／0．25m2，冬季(8．11±3．56)N／0．25m2]，且秋季哮喘发作次数较频，峰流速较低，用药品种较多，与其他季节相比差异有显著性(P<0．05)。结论螨过敏性哮喘患者卧室中尘螨密度与哮喘发病有关，控制尘螨孳生有可能减轻或控制哮喘发作。     

Metabolism of oxamyl in mice and twospotted spider mites

The metabolic fate of oxamyl was examined in mice and twospotted spider mites,Tetranychus urticae Koch. Mice treated intraperitoneally with oxamyl-¹⁴C eliminated 96.4% of the dose in the urine (88.7%) and feces (7.7%) by 96 hr; 75.7% of the dose was eliminated during the initial 6 hr. Organosoluble urinary radioactive material ranged from 24.6% at 6 hr to 6.5% at 72 hr and consisted of oxamyl, methylN-hydroxy-N,N-dimethyl-1-thiooxamimidate (DMTO), methylN-hy-droxy-N-methyl-1-thiooxamimidate (MTO),N,N-dimethyl-1-cyanoforma-mide (DMCF), N,N-dimethyloxamic acid (DMOA),N-methyloxamic acid (MOA), methylN-methyl-N-[(methylcarbamoyl)oxy]-1-thiooxamimidate (DMO), and several unknowns. Although some of the water-soluble urinary radioactive material was cleaved with-glucuronidase and aryl sulfatase, most of it was resistant to cleavage by enzymes and acid (9% HCl). Tissue levels of radiocarbon were low. Oxamyl metabolites formedin vitro by mouse liver subcellular fractions included DMCF, DMOA, MOA, DMTO, DMO, and several unknowns. Twospotted spider mites absorbed and metabolized oxamyl. The total internal radioactive material increased from 6.1% at 1 hr to 44.5% at 24 hr. Radioactive compounds isolated from two-spotted spider mites in addition to oxamyl included DMCF, DMOA, MOA, DMTO, DMO, and several unknowns.Contribution from the Missouri Agricultural Experiment Station, Columbia. Journal Series no. 8248.     

女性尿路感染者病原学监测

目的了解女性尿路感染者病原学状况. 方法采集76例女性尿路感染者进行了阴道分泌物常规涂片微生物学检查、阴道加德纳菌(Gv)和解脲脲支原体(Uu)核酸检测,并收集中段尿液作常规细菌培养分离鉴定、Gv和Uu核酸检测. 结果76例女性尿路感染者阴道分泌物中共有70例(92.1%)检出病原菌,其中Gv58例(76.3%)、Uu49例(64.5%)、滴虫4例(5.3%)、念珠菌属8例(10.5%);中段尿液中共有65例(85.5%)检出病原菌,其中Gv45例(59.2%)、Uu26例(34.2%)、细菌25例(32.8%);无论阴道分泌物标本还是中段尿液标本存在多种病原菌混合感染. 结论Gv、Uu已是女性尿路感染的重要病原菌.     

常用感染指标在新生儿尿路感染中诊疗价值的探讨

目的探讨临床检测常用感染指标在新生儿尿路感染中的诊疗价值,为临床诊疗新生儿尿路感染提供有效的实验室依据。方法回顾性分析近5年于我院新生儿科住院治疗,并且有尿细菌培养记录的患儿实验室检测结果和临床信息,比较细菌培养阳性患儿和细菌培养阴性患儿实验室检测指标。结果近5年我院新生儿尿培养阳性率为5.15%(83/1611),尿培养阳性新生儿中男性比例高于女性(68.67%vs 31.33%);大肠埃希菌38株(45.78%)、肺炎克雷伯菌16株(19.28%)和肠球菌13株(15.66%)是最常见的致病菌。发热(24.10%)和黄疸(32.53%)是最常见的临床表现,但其发生率与尿培养阴性组无统计学差异;尿培养阳性组尿WBC显著高于尿培养阴性组,血WBC、CRP、PCT等实验室检测指标在尿培养阳性组和尿培养阴性组间无显著差异。结论血WBC、CRP、PCT等实验室常用检测指标在诊断新生儿尿路感染中的应用价值有限,在临床工作中应联合尿常规检测结果和尿细菌培养结果进行新生儿泌尿系统感染的诊疗。     

Early detection of nephrotoxic effects due to low-dose exposure of cadmium among cigarette smokers

The effects of low-level exposure to cadmium due to cigarette smoking on renal function were judged by the estimation of urinary levels of total proteins, cadmium, alpha-1-microglobulin (alpha1M) and glutathione S-transferase (GST) activity among 50 males (38 smokers and 12 control non-smokers). Elevated urinary cadmium levels [2.408-28.160; 9.31 +/- 7 .1 microg Cd/gm urine creatinine] were observed among the majority of smokers (24 cases, 63.16%) and these levels showed a positive correlation with age and smoking index. Furthermore, urine total proteins [115.18-652.14; 242.89 +/- 121.88 mg protein/gm urine creatinine) were increased suggesting glomerular involvement among 20 cases (52.63%) of smokers. In addition, urinary alpha1M levels (14.645-86.053; 34.05 +/- 16.83 mg alpha1M/gm urine creatinine) and urinary GST activity [0.0-0.008; 0.00015 +/- 0.0002 micromol/min/100 microl/gm urine creatinine] were elevated among 18 (47.37%) and 20 (52.63%) cases of smokers respectively. Since urinary alpha1M and GST originate from renal proximal tubules, the data of the present investigation could reflect early low-level cadmium exposure nephrotoxic effect on both the glomeruli and tubules.     

Biological monitoring of workers exposed to 4,4′-methylene-bis-(2-orthochloroaniline) (MOCA)

OBJECTIVES: The objectives of the study were to investigate the best urinary marker of exposure to MOCA in urine samples of exposed workers and to study its applicability in exposure evaluation in polyurethane resin production plants. In addition, our intention was to contribute to the question of biological target value in order to reduce exposure levels. METHODS: Urinary MOCA markers were measured in urine samples collected at the end of the workshifts. 40 workers from four factories were observed for three consecutive days in the same week. "Free" MOCA in non-acid-stabilized urines, "total" MOCA in urines after alkaline hydrolysis, "acid-labile" MOCA in sulfamic or citric acid-protected urines were measured in all urine samples. MOCA liberated by heating the non-acid-stabilized urines ("heat-labile" MOCA) was also measured in 17 urine samples of exposed workers. RESULTS: The median value of "free" MOCA was lower than that of "sulfamic acid-labile" MOCA: 6.0 and 12.5 micrograms/l respectively. The difference between "free" and "total" MOCA was statistically significant (Mann-Whitney test, P = 0.023) for the urine samples collected without acid. Correlations between urinary MOCA concentrations in hydrolysed and non-hydrolysed urine samples were high (r = 0.984, 0.966 and 0.950; P < 0.001) for urine samples with sulfamic acid, with citric acid and without acid respectively. For all the factories, the postshift urinary MOCA concentrations ranged between 1 microgram/l (detection limit) and 570 micrograms/l; 25% of "sulfamic acid-labile" MOCA concentrations exceeded 50 micrograms/l. Workers handling crystallized MOCA excreted the highest amounts of MOCA in urine. The urinary MOCA concentrations (median) were: 84.0 micrograms/l (mixer), 15.5 micrograms/l (moulder). 59.0 micrograms/l (maintenance) and 3.0 micrograms/l (others). CONCLUSIONS: MOCA measured in sulfamic acid-protected urine samples without hydrolysis provides a more practical and reliable biomarker than "total" MOCA (after hydrolysis) or "free" MOCA. A biological guiding value of 20 micrograms/l expressed as "sulfamic acid-labile" MOCA is proposed.     

中段尿培养1 348份标本病原菌分布及其耐药性分析

目的分析了解尿路感染患者中段尿培养标本中病原菌分布及其耐药性,为临床用药提供参考和依据。 方法对2015年6月至2016年5月期间,南京金域医学检验所收集的来自江苏全省13个地市州的500多家基层医院送检的尿路感染患者1 348份标本,采用血琼脂平皿和麦康凯平皿35℃培养箱培养方法进行中段尿培养;然后,用VITEK COMPACT全自动微生物分析系统和API鉴定板条对菌落计数>10⁵ cfu/ml的革兰阴性菌和菌落计数>10⁴ cfu/ml革兰阳性菌进行菌种鉴定,并根据2015年美国临床实验室标准化协会标准判断药敏结果。 结果从1 348份中段尿培养标本的450份标本中分离出病原菌,阳性率为33.38%。其中革兰阴性菌358株,占79.56%;革兰阳性菌76株,占16.89%;真菌16株,占3.56%。选取全部菌种中6类主要菌(大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌、凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌)进行药敏分析,其中大肠埃希菌对氨苄西林、哌拉西林、头孢唑林、头孢呋辛的耐药率分别为84.16%、80.37%、87.12%、93.98%;粪肠球菌对四环素、利福平、奎奴普汀-达福普汀、米诺环素的耐药分别为81.40%、86.67%、100%、83.33%。 结论大肠埃希菌和粪肠球菌是尿路感染的主要致病菌。病原菌对青霉素、头孢类、四环素类和利福霉素类耐药严重。分析尿路感染病原菌抗菌药物敏感性试验结果对指导临床合理使用抗菌药物有着重要意义。     

Annals Journal Club: Toward A Simple Diagnostic Index for Acute Uncomplicated Urinary Tract Infections

PURPOSE

Whereas a diagnosis of acute uncomplicated urinary tract infection (UTI) in clinical practice comprises a battery of several diagnostic tests, these tests are often studied separately (in isolation from other test results). We wanted to determine the value of history and urine tests for diagnosis of uncomplicated UTIs, taking into account their mutual dependencies and information from preceding tests.

METHODS

Women with painful and/or frequent micturition answered questions about their signs and symptoms (history) of UTIs and underwent urine tests. A culture was the reference standard (10³ colony-forming units per milliliter). A diagnostic index was derived using logistic regression with bootstrapped backward selection and parameter-wise shrinkage. Risk thresholds for UTI of 30% and 70% were used to analyze discriminative properties. Six models were compared: (1) history only, (2) history+ urine dipstick, (3) history+ urine dipstick + urinary sediment, (4) history+ urine dipstick+ dipslide, and (5) history+ urine dipstick+ urinary sediment+ dipslide; we then added (6) a test only for patients with an intermediate risk (between 30% and 70%) after the preceding test.

RESULTS

One hundred ninety-six women were included (UTI prevalence 61%). Seven variables were selected from history (3), dipstick (2), sediment (1), and dipslide (1). History correctly classified 56% of patients as having a UTI risk of either <30% or >70%. History and urine dipstick raised this to 73%. The 3 models with the addition of urinary sediment and dipslide, separately and in combination, performed hardly better. The sixth model, in which those at intermediate risk after history and received an additional test, correctly classified 83%. The patient’s suspicion of a UTI and a positive nitrite test were the strongest indicators of a UTI.

CONCLUSIONS

Most women with painful and/or frequent micturition can be correctly classified as having either a low or a high risk of UTI by asking 3 questions: Does the patient think she has a UTI? Is there at least considerable pain on micturition? Is there vaginal irritation? Other women require additional urine dipstick investigation. Sediment and dipslide have little added value. External validation of these recommendations is required before they are implemented in practice.