乌司他丁联合血必净治疗感染性休克的临床研究

目的 观察乌司他丁(UTI)联合血必净治疗感染性休克临床疗效.方法 237例感染性休克患者分为对照组、血必净组、UTI组及联合治疗组,脉搏指示心输出量连续监测(PiCCO)心输出量(CO)、心指数(CI )、血管阻力(SVR)等,测定血浆脑型利钠肽(BNP)、降钙素原(PCT)及IL-6浓度,评估心肺功能.结果 四组患者BNP、CO、CI下降,SVR回升(P＜0.05),PCT、IL-6( P＜0.05),明显下降,心肺功能好转,联合治疗效果最好.结论 联合治疗有效治疗感染性休克,与强效抗感染、改善心肺功能有关.     

乌司他丁对二尖瓣置换患者血浆TNF-α、IL-6、IL-8水平的影响及意义

目的探讨乌司他丁（UTI）对二尖瓣置换患者血浆TNF-α、IL-6、IL-8水平的影响。方法40例二尖瓣置换患者随机平分为A、B两组。A组预冲液中加入UTI1．5万U／kg，B组不加。分别于术前、主动脉及心脏插管体外循环（CPB）后30min、开放升主动脉后1h、6h及术后24h从中心静脉插管采集血标本共5次，用放免法检测血浆TNF-α、IL-6、IL-8水平。结果两组术后TNR-α、IL-6和IL-8水平均比术前明显升高（P〈0．05），开放升主动脉后1h达高峰，之后逐渐下降。两组TNF-α和IL-8水平在术后24h后基本恢复正常．而IL-6仍保持较高水平。B组TNF-α、IL-6和IL-8水平在开放升主动脉后1h、6h均显著高于A组（P〈0．05）。结论UTI能明显降二尖瓣置换患者血浆TNF-α、IL-6、IL-8水平，从而有效降低由CPB引发的炎症反应，对心、肺、肝、肾等重要脏器有保护作用。     

生长抑素联合乌司他丁对急性胰腺炎患者血清白细胞介素-6及肿瘤坏死因子-α水平的影响

目的 探讨生长抑素联合乌司他丁对急性胰腺炎（AP）的临床疗效及对患者血清白细胞介素-6（IL-6）及肿瘤坏死因子（TNF）-α水平的影响.方法 收集我院2010年1月～2012年1月收治的急性胰腺炎患者184例,并将其随机分为对照组90例,给予乌司他丁;联合用药组94例,在对照组的基础上加用生长抑素.两组均以10天为1个疗程,观察两组患者治疗后临床疗效、IL-6及TNF-α水平及临床症状（腹痛缓解时间、通便时间、血淀粉酶、胃肠功能评分）改善情况.结果 （1）联合用药组总有效率为94.7％ （89/94）,对照组为85.6％ （77/90）,联合用药组临床疗效显著优于对照组,两组比较差异有统计学意义（P＜0.05）.（2）两组患者治疗后IL-6及TNF-α水平与同组治疗前比较,差异有统计学意义（P＜0.05）,治疗后两组患者炎性水平均改善.联合用药组IL-6及TNF-α水平改善显著优于对照组（P＜0.05）.（3）联合用药组患者腹痛缓解时间、胃肠功能评分、通便时间、血淀粉酶显著优于对照组（P＜0.05）.结论 生长抑素联合乌司他丁治疗急性胰腺炎疗效确切,改善IL-6与TNF-α水平,可有效改善患者临床症状.     

血必净联合乌司他丁治疗重症急性胰腺炎的疗效及对血清炎症因子的影响

目的分析血必净联合乌司他丁治疗重症急性胰腺炎的疗效及对血清炎症因子的影响。方法选取该院2015-09~2016-04收治的重症急性胰腺炎患者70例作为研究对象,按照随机数字表法分为两组,各35例。对照组单纯采用乌司他丁治疗,观察组在乌司他丁治疗基础上加用血必净,均连续治疗7 d。对比两组治疗前后血清炎症因子水平、内毒素含量。结果观察组痊愈18例,显效11例,有效4例,无效2例。对照组痊愈12例,显效10例,有效5例,无效8例。观察组疗效优于对照组(P0.05)。治疗前两组患者血清炎症因子、内毒素含量比较差异无统计学意义(P0.05)。治疗后,对照组患者超敏C反应蛋白(hs-CRP)、内毒素、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均高于观察组,白细胞介素-10(IL-10)水平低于观察组,差异有统计学意义(P0.01)。结论血必净联合乌司他丁治疗重症急性胰腺炎临床疗效显著,可有效提高IL-10水平,降低内毒素、IL-6、IL-8、TNF-α水平,减轻炎症对患者造成的影响,值得在临床应用中推广。     

乌司他丁联合丹红注射液治疗急性肺损伤/急性呼吸窘迫综合征疗效观察

目的探讨乌司他丁联合丹红注射液治疗对创伤后急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）的效果及机制。方法将36例ALI/ARDS患者随机分为治疗组和对照组各18例,两组常规治疗相同,治疗组加用乌司他丁与丹红注射液治疗。观察两组治疗后住院时间、住ICU时间、病死率、血气分析指标,并测定血浆TNF-α、IL-6水平。结果治疗组住院时间、住ICU时间少于对照组（P均〈0.01）,血气分析指标改善程度优于对照组（P均〈0.01）,TNF-α、IL-6水平均低于对照组（P均〈0.01）。结论乌司他丁联合丹红注射液治疗能显著改善ALI/ARDS预后,缩短治疗时间。     

乌司他丁治疗脓毒症临床疗效观察

目的评价乌司他丁治疗脓毒症的临床疗效。方法采取随机、对照的方法将60例脓毒症患者分为两组,对照组给予西医综合治疗,治疗组在对照组基础上静脉注射乌司他丁20万U、8 h 1次,连用7 d,观察两组治疗后心率、呼吸、体温、血WBC的变化,治疗前后抽取静脉血检测血清降钙素原（PCT）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白介素6（IL-6）水平。结果治疗组体温、呼吸频率、心率及WBC在治疗后改善情况均明显优于对照组,两组治疗后PCT、CRP、TNF-α、IL-6水平均较明显下降,但治疗组下降更明显。结论乌司他丁能够缩短脓毒症病程,尤其在降低体温、改善全身炎症反应方面有独特的优势。     

血必净注射液治疗脓毒血症31例临床观察

目的评价血必净辅助治疗脓毒血症的临床效果。方法将同期收治的56例脓毒血症患者随机分为观察组31例和对照组24例,两组均予常规抗生素、对症及营养支持等治疗,在此基础上观察组加用血必净注射液100ml静滴,连续7d。观察两组入院时及治疗7d后外周血白细胞计数、中性粒细胞百分比、C反应蛋白（CRP）、前降钙素（PCT）、急性生理和慢性健康状况（APACHEⅡ）评分及病死率。结果治疗7d后两组各项指标均较入院时显著改善,其中观察组血清CRP水平、APACHEⅡ评分及病死率显著低于对照组（P〈0．05）。结论血必净注射液能对脓毒血症发病的多项环节起阻断作用,明显降低其病死率,改善预后。     

血必净对老年脓毒血症患者超敏C-反应蛋白及降钙素原的影响

正脓毒血症是感染、重症医学科及外科的常见疾病,可导致脓毒性休克,病死率较高[1-2]。老年人常合并多种基础性疾病,易发生脓毒血症,增加脓毒血症治疗的难度。研究表明血必净对脓毒血症患者具有一定疗效,能改善脓毒血症患者的预后[3-4]。为此本研究通过在老年脓毒血症患者中应用血必净治疗,观察其对超敏C-反应蛋白(hs-CRP)及降钙素原(PCT)的影响,探讨血必净对老年脓毒血症患者的临床疗效。     

血必净、乌司他丁联合治疗脓毒症时对凝血机制的影响

目的：探讨血必净、乌司他丁联合治疗对脓毒症患者血D-二聚体水平及凝血机制的影响。方法：选择脓毒症患者43例,随机分为试验组（n=20）和对照组（n=23）,对照组给予常规治疗＋静脉滴注血必净注射液50ml,2次／d;试验组患者在对照组治疗的基础上加用乌司他丁60万U,静脉滴注,2次／d,连用7d。观察2组患者治疗前、后急性生理学与既往健康状况Ⅱ评分及D-二聚体、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原和血小板计数的变化。结果：D-二聚体在试验组明显下降,并且在治疗3、7、10d与对照组比较,差异有统计学意义（P〈0．05）,其他凝血功能也有改善。结论：血必净与乌司他丁联合应用可以改善脓毒症患者恶化的全身炎症反应状态和凝血功能,降低脓毒症的病死率。     

参附注射液联合低剂量氢化可的松对重度脓毒血症患者炎症因子及免疫功能的影响

目的观察参附注射液联合低剂量氢化可的松对重度脓毒血症患者炎症因子及免疫功能的影响。方法 65例重度脓毒血症患者按数字随机法分为对照组与观察组。对照组(32例)接受基础治疗(抗生素+早期液体复苏+纠正酸中毒等),观察组(33例)在此基础上应用参附注射液与低剂量氢化可的松联合治疗。分别在治疗前、后检测肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)的浓度和外周血T淋巴细胞亚群情况。结合患者7天内的病情情况分析参附注射液联合低剂量氢化可的松对重度脓毒血症患者的治疗效果及对免疫功能的影响。结果治疗前,两组患者TNF-α、IL-1β、IL-10的浓度和外周血T淋巴细胞亚群的情况差异无统计学意义(P0.05)。与对照组比较,观察组治疗后1天时肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)的浓度和外周血T淋巴细胞亚群,差异无统计学意义(P0.05);观察组治疗后3天和5天肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)的浓度水平降低和外周血T淋巴细胞亚群数目增加,差异有统计学意义(P0.05);对照组治疗后7天对照组好转17例,迁延8例、死亡7例,观察组好转24例,迁延7例、死亡2例,差异有统计学意义(χ2=7.74,P=0.03)。结论参附注射液联合低剂量氢化可的松可促进患者的转归,与调节机体免疫功能、减轻炎症反应有关。     

乌司他丁联合血必净治疗急性呼吸窘迫综合征临床研究

目的 探讨联合应用乌司他丁和血必净注射液治疗急性呼吸窘迫综合征(ARDS)的临床疗效及安全性.方法 将符合诊断标准的96例患者随机分为治疗组A(乌司他丁和血必净)、治疗组B(血必净)及对照组各32例,观察治疗前后患者呼吸频率、血氧饱和度、氧合指数等指标,抽取外周血测定血清肿瘤坏死因子α、白介素6的浓度,并记录住重症监护...     

血必净注射液对脓毒症大鼠肺损伤的保护作用

目的：探讨血必净注射液对脓毒症大鼠肺损伤的保护作用及机制。方法：采用盲肠结扎穿孔法（CLP）建立脓毒症模型,雄性Wistar大鼠80只,随机分成4组：正常对照组（N组,8只）;假手术组（S组,8只）;脓毒症组（CLP）（C组,32只）和血必净治疗组（X组,32只）,C组和X组分别于CLP后经大鼠颈静脉注射生理盐水或血必净注射液2ml/kg,分别于CLP后3、6、12和24h各处死8只动物,取肺组织,比色法检测丙二醛（MDA）和髓过氧化物酶（MPO）,酶联免疫吸附法检测血清肿瘤坏死因子α（TNF-α）水平。结果：脓毒症时各时间点肺组织MDA、MPO和血清TNF-α浓度较对照组显著升高,而血必净治疗后则有明显下降（P〈0.01）。结论：血必净注射液可减轻脓毒症时的肺损伤,其机制可能与减少肺组织MDA、MPO和血清TNF-α表达有关。     

Exogenous surfactant restores lung function but not peripheral immunosuppression in ventilated surfactant-deficient rats

The authors have previously shown that mechanical ventilation can result in increased pulmonary inflammation and suppressed peripheral leukocyte function. In the present study the effect of surfactant therapy on pulmonary inflammation and peripheral immune function in ventilated surfactant-deficient rats was assessed. Surfactant deficiency was induced by repeated lung lavage, treated rats with surfactant or left them untreated, and ventilated the rats during 2 hours. Nonventilated rats served as healthy control group. Expression of macrophage inflammatory protein (MIP)-2 was measured in bronchoalveolar lavage (BAL), interleukin (IL)-1beta, and heat shock protein 70 (HSP70) were measured in total lung homogenates. Outside the lung phytohemagglutinin (PHA)-induced lymphocyte proliferation, interferon (IFN)-gamma and IL-10 production, and natural killer activity were measured in splenocytes. After 2 hours of mechanical ventilation, expression of MIP-2, IL-1beta, and HSP70 increased significantly in the lungs of surfactant-deficient rats. Outside the lung, mitogen-induced proliferation and production of IFN-gamma and IL-10 reduced significantly. Only natural killer cell activity remained unaffected. Surfactant treatment significantly improved lung function, but could not prevent increased pulmonary expression of MIP-2, IL-1beta, and HSP70 and decreased peripheral mitogen-induced lymphocyte proliferation and IFN-gamma and IL-10 production in vitro. In conclusion, 2 hours of mechanical ventilation resulted in increased lung inflammation and partial peripheral leukocyte suppression in surfactant-deficient rats. Surfactant therapy ameliorated lung function but could not prevent or restore peripheral immunosuppression. The authors postulate that peripheral immunosuppression may occur in ventilated surfactant deficient patients, which may enhance susceptibility for infections.     

血必净对严重脓毒症并发呼吸机相关性肺炎发病率的影响

目的观察血必净注射液对严重脓毒症患者呼吸机相关性肺炎发生的影响。方法严重脓毒症并发呼吸衰竭需要机械通气的成年住院患者100名，随机分为血必净治疗组和常规对照组，观察两组病人呼吸机相关性肺炎的发生率，28天病死率，ICU住院时间，呼吸机治疗时间以及抗生素使用天数。结果血必净治疗组呼吸机相关性肺炎的发生率，病死率降低，ICU住院时间，呼吸机治疗时间以及抗生素使用天数缩短，有统计学差异。结论血必净可以降低严重脓毒症患者发生呼吸机相关性肺炎的发病率。     

乌司他丁对慢性阻塞性肺疾病患者血清IL-8及肺功能的影响

目的研究乌司他丁对慢性阻塞性肺疾病（COPD）患者血清IL-8及肺功能影响。方法慢性阻塞性肺疾病急性发作期患者随机分为两组,治疗组加用乌司他丁治疗,治疗前后观察血清IL-8、肺功能变化。结果两组治疗后均能改善血清IL-8表达,改善患者肺功能指标,且治疗组优于对照组。结论乌司他丁可显著抑制慢性阻塞性肺疾病急性发作期患者气道炎性反应并显著改善改善肺功能。     

miR-126-5p expression in the plasma of patients with sepsis-induced acute lung injury and its correlation with inflammation and immune function

Objective

This work was implemented to elucidate the miR-126-5p expression in the plasma of patients with sepsis-induced acute lung injury (ALI) and its correlation with inflammation and immune function.

Methods

The peripheral blood of patients with sepsis-induced ALI was obtained, and the levels of inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP], and procalcitonin [PCT]) were determined. Meanwhile, T lymphocyte subsets (CD3+, CD4+, and CD8+), and immunoglobulins (IgA, IgM, and IgG) were tested. miR-126-5p and TRAF6 mRNA expression in plasma was assessed. Receiver operating characteristic (ROC) curve was performed to assess the diagnostic accuracy of miR-126-5p in sepsis without ALI and sepsis with ALI. Correlation between miR-126-5p expression and clinical indicators was analyzed. The targets of miR-126-5p were predicted using the bioinformatics method, and the direct targets were verified through investigations.

Results

miR-126-5p expression in plasma of patients with sepsis-induced ALI was reduced than that of patients with sepsis without ALI. miR-126-5p expression was negatively correlated with IL-6, CRP, and PCT but positively correlated with IgA, IgM, and IgG as well as CD3+, CD4+, and CD8+ in patients with sepsis-induced ALI. ROC curve suggested that miR-126-5p (AUC: 0.777; 95%CI: 0.689–0.866) could distinguish patients with sepsis with ALI from patients with sepsis without ALI. TRAF6 expression in patients with sepsis-induced ALI was higher than that in patients with sepsis without ALI. TRAF6 was a target gene of miR-126-5p,

Conclusion

This research highlights that miR-126-5p is reduced in the plasma of patients with sepsis-induced ALI, and miR-126-5p relates to systemic inflammation and immune function indicators.     

血清降钙素原和常用炎症指标与老年脓毒症的相关性及结合重症评分对其预后的评价

目的探讨血清降钙素原(PCT)和常用炎症指标[白介素6 (IL-6)、C反应蛋白(CRP)]与老年脓毒症的相关性,以及它们联合重症评分急性生理学与慢性健康状况评分(APACHE-Ⅱ)、简化急性生理评分(SAPS-Ⅱ)对老年脓毒症患者预后的价值评估。方法回顾性分析2018年1月-2020年10月期间复旦大学附属上海市第五人民医院老年医学科和呼吸危重症医学科(PCCM)患者的临床资料,入院24h内测定PCT、IL-6、CRP,脓毒症组进一步测乳酸并评估APACHE-Ⅱ、SAPS-Ⅱ评分,统计患者30 d预后。分析脓毒症组和非脓毒症组PCT、IL-6、CRP的差异,绘制受试者工作特征曲线(ROC),评价PCT、IL-6、CRP诊断脓毒症的效能。根据预后,分析非休克组和休克组、存活组和死亡组患者 PCT、IL-6、CRP、APACHE-Ⅱ、SAPS-Ⅱ评分的差异,绘制 ROC 曲线,评价 PCT、IL-6、CRP 与 APACHE-Ⅱ、SAPS-Ⅱ评分对老年脓毒症患者预后的预测效能。结果共纳入脓毒症组患者117例,非脓毒症组58例。与非脓毒症组比较,脓毒症组PCT、IL-6、CRP均升高(P<0.001),PCT、CRP的AUC值相同,高于IL-6。非休克组77例,休克组40例,休克组APACHE-Ⅱ、SAPS-Ⅱ评分高于非休克组(P<0.001),PCT的AUC值高于IL-6、CRP及乳酸,低于两种重症评分标准,SAPS-Ⅱ评分的AUC值高于APACHE-Ⅱ评分。死亡组61例,存活组56例,死亡组PCT高于存活组,APACHE-Ⅱ、SAPS-Ⅱ评分高于存活组(P<0.001),PCT的AUC值高于CRP,但低于IL-6及乳酸,SAPS-Ⅱ评分的AUC值高于APACHE-Ⅱ评分,PCT联合SAPS-Ⅱ评分的AUC则进一步升高,达0.958。结论 PCT是老年感染患者脓毒症诊断的重要参考指标,SAPS-Ⅱ评分对老年脓毒症预后评价能力优于APACHEⅡ评分,PCT结合SAPS-Ⅱ评分更有利于对老年脓毒症的预后评估。     

血必净注射液治疗AECOPD的疗效研究

目的研究应用血必净注射液治疗AECOPD的疗效。方法将60例AECOPD患者随机分为对照组及治疗组,每组30例,对照组采用常规治疗,治疗组在对照组治疗基础上加用血必净注射液,静脉滴注,连用7天,监测治疗前后血清肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)及肺功能的变化。结果与治疗前相比,治疗组血清TNF-α、CRP、FEV1/FVC及FEV1/预计值均明显改善(P<0.01)。治疗组治疗前后TNF-α、CRP、FEV1/FVC及FEV1/预计值的变化程度较对照组更明显,具有统计学差异(P<0.01)。结论血必净注射液有助于减轻TNF-α及CRP介导的炎症反应,改善肺功能,治疗AECOPD效果显著。     

Bronchoalveolar lavage studies in a HTLV-1-positive case associated with interstitial pneumonia

A 64-year-old housewife was hospitalized because of cough and dyspnea. Chest X-rays on admission showed diffuse interstitial shadows and loss of lung volume, suggesting acute interstitial pneumonia. Pulmonary function tests revealed decreased vital capacity and severe hypoxemia. Bronchoalveolar lavage studies showed that total cell counts and a proportion of lymphocytes were increased. Lymphocytes increased in lavage fluid consisted mainly of T cells with an elevated CD4+/CD8+ ratio. Furthermore, these lymphocytes spontaneously proliferated and responded well to recombinant IL-2 when cultured in vitro for 5 days, suggesting that lymphocyte activation occurred in the lung. Such lavage findings and lymphocytes activation in association with the presence of HTLV-1-specific IgA antibody in lavage fluid have been demonstrated in patients with HTLV-1-associated myelopathy. In this patient positive for HTLV-1, however, it could not be determined whether the pulmonary lesions were primarily related to HTLV-1 infection, because no IgA antibody specific for HTLV-1 was demonstrated in lavage fluid. In conclusion, when pulmonary abnormalities are found in HTLV-1 carriers, we should be careful in determining whether such pulmonary involvements are etiologically related to HTLV-1 infection.