系统性红斑狼疮患者外周血Th1和Th2平衡的研究

目的 通过检测系统性红斑狼疮（SLE）患外周血中CD4^ 和CD8^ T淋巴3细胞分泌细胞因子的情况以及γ干扰素（IFN-γ)和白介素－4（IL－4）的水平，探讨T淋巴细胞亚群与SLE发病的关系。方法 采用流式细胞术分析SLE患和正常健康人外周血中淋巴细胞内细胞因子（IFNγ、IL－4）和表面抗原（CD4、CD8），用Dot blot法检测IFN－γ和IL－4mRNA的表达。以ELISA法测定血清中IFN－γ和IL－4的水平。结果 与对照组相比，SLE患外周血中1类辅助T细胞（Th1)、Th1/Th2比率、IFN－γmRNA的表达和IFN－γ水平和IFN－γ／IL－4比值均明显降低（P＜0．01），而Th2细胞、Th0细胞和IL－4 mRNA表达的水平及其外周血中IL－4的水平则无明显改变（P＞0．05）。结论 在SLE患外周血中，Th1细胞的数量及其分泌的细胞因子的水平均明显下调，提示Th1/Th2细胞的失衡在SLE发病中有着重要的作用。     

SLE患者血清IL—4、IFN—γ水平测定及意义

目的：通过检测系统性红斑狼疮（systemic lupus erythematosus,SLE)患血清细胞因子细胞介素－4（interlukin-4,IL-4)，γ－干扰素（interferon-gamma,IFN-γ）水平，探讨T淋巴细胞亚群与SLE发病的关系。方法：采用酶联免疫吸附法（ELISA）测定SLE患和健康志愿血清IL－4和IFN－γ水平。结果：（1）SLE活动组血清IL－4水平和IL－4／IFN－γ值明显升高，与非活动组、对照组比较有显性差异（P＜0．001）。（2）血清IFN－γ水平3组（SLE活动组，非活动组和对照组）间比较差异无显意义（P＞0．05）。（3）SLE患激素治疗后血清IL－4水平明显降低。结论：IL－4、IFN－γ作为区分CD4T细胞亚群的指标之一，间接反映了Th1,Th2细胞活化状态；SLE患血清IL－4水平，IL－4／IFN－γ值明显升高，且与病情活动性相关；IFN－γ水平无明显变化，说明活动性SLE患存在Th2细胞优势活化状态，破坏了体人Th1/Th2正常平衡状态。血清IL－4水平可作为SLE病情活动性监测指标之一，并可作为疗效判断指标之一。寻找有效方法调节SLE患血清IL－4水平，从而调节体内Th1-Th2平衡，将为治疗SLE开辟一条新途径。     

IL-18对慢性乙型肝炎患者Th1/Th2细胞分化的影响

目的：观察IL—18对慢性乙肝患者Thl／Th2细胞分化的影响。方法：分离40例慢性乙型肝炎患者外周血单个核细胞(peripheral blood monoclear cells，PBMC)，分别与植物血凝素(PHA，100mg/L)、HBcAg(1mg／L)、HBeAg(1mg/L)单独或联合IL—18(10μg／L)体外培养48h，ELISA法检测培养液中IL—2、IFN—γ、IL-4、IL—10水平。20例健康人群作对照。结果：IL—18对健康人群PBMC产生的Thl／Th2类细胞因子无明显影响，但对慢性乙肝患者在IL—18和HBcAg或IL—18和HBeAg联合诱导下则显著增强PBMC产生的Thl类细胞因子IL—2和IFN—γ，但对Th2类细胞因子IL-4和IL—10无明显影响。结论：IL—18增强慢性乙肝患者Thl类细胞因子的优势表达，从而促进Thl细胞的优势分化，而对Th2类细胞因子的表达无影响。     

卡莫氟对强直性脊柱炎Th1/Th2类细胞因子表达影响的研究

目的：观察卡莫氟(1-hexylcarbamoyl-5-fluorouracil,HCFU) 和柳氮磺胺吡啶(sulfalazine,SSZ)治疗强直性脊柱炎(ankylosing spondylitis, AS)后体内Th1/Th2类细胞因子的变化。方法：19例AS患者随机分为2组，分别给予HCFU(9例)和SSZ （10例），RT-PCR检测其治疗前后外周血单个核细胞(peripheral blood mononuclear cells,PBMC)中细胞因子γ-干扰素（IFN-γ）、白细胞介素-2（IL-2）、肿瘤坏死因子-α（TNF-α）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）mRNA片段的表达。结果:HCFU治疗后AS患者PBMC中IFN-γ、TNF-α mRNA的表达率分别为33.33%、44.44%，与治疗前相比差异有统计学意义（P＜0.05），IL-2、IL-4及IL-6 mRNA的表达差异无统计学意义。SSZ治疗后AS患者PBMC中IFN-γ mRNA的阳性表达率为70%,半定量结果显示，治疗后PBMC中IFN-γ mRNA的表达水平明显降低（P＜0.05)。80% AS患者在治疗后PBMC中IL 4 mRNA呈阳性表达，较治疗前21.05%明显升高（P＜0.05）。IL-2、IL-6和TNF-α mRNA的表达无明显变化（P＞0.05）。结论：HCFU能使TNF-α mRNA表达降低，促进AS患者的免疫应答从Th1型向Th2型转变，小剂量即可使病情缓解。SSZ未发现对TNF-α mRNA表达有明显影响，可促使AS患者的免疫应答从Th1型向Th2型转变。     

慢性乙型肝炎患者PBMC内IL—4与IFN—γmRNA的表达

目的 阐明Th1/Th2类细胞因子与慢性乙型肝炎肝脏炎症活动的相关性以及这些细胞因子作为慢性乙型肝炎症活动调节剂的作用。方法 用RT-PCR法检测慢性乙型肝炎患外周血单个核细胞（PBMC）内白细胞介素-4（IL-4）及干扰素-γ（IFN-γ）mRNA的表达。结果 在静息期,无明显的IL-4及IFN-γ RNA的表达,在活动期IFN-γ的表达率（100%）明显高于恢复期（50%)(P<0.05);相反,在恢复期IL-4mRNA的表达率（87.5%)明显高于活动期(12.5%)(P<0.05).结论 在慢性乙型肝炎发病机理中,在mRNＡ的水平,ＩＦＮ－γ作为正向免疫调节性细胞因子,而ＩＬ－４作为免疫抑制性细胞因子发挥作用,结果证实Ｔhi细胞因子上调、Th2细胞因子下调慢性乙型肝炎肝脏炎症。     

系统性红斑狼疮患者IL-10、IFN-γ、IP-10和IL-12的异常表达及环孢素A和环磷酰胺对其的影响

目的:探讨系统性红斑狼疮(SLE)患者外周血单个核细胞(PBMCs)的干扰素(IFN)-γ、白细胞介素(IL)-10、干扰素-γ诱生蛋白(IP)-10和IL-12的表达水平及环孢素A(CsA)和环磷酰胺(CY)对其的影响。方法:应用酶联免疫吸附法检测血清及PBMCs培养上清上述细胞因子水平;运用流式细胞术检测CD4 T细胞中分泌IFN-γ和分泌IL-10的细胞百分率。结果:SLE患者血清及PBMCs培养中IFN-γ、IL-10、IL-12和IP-10水平增高,PBMCs中表达IL-10的CD4 T细胞比例明显增高(P<0.05),表达IFN-γ的CD4 T细胞的比例亦有所增高;CsA及CY均能抑制SLEPBMCs培养中IL-10水平,并对PHA刺激下的IFN-γ、IP-10和IL-12分泌增高有抑制作用,且CsA的抑制作用更为显著;CsA和CY还能抑制PBMCs中表达IFN-γ及表达IL-10的CD4 T细胞的比例增高,且CsA的抑制幅度更大。结论:SLE患者体内存在细胞因子网络失调。CsA与CY均能干扰SLE的细胞因子网络失调的免疫病理过程,且CsA的调节作用更为显著。     

地塞米松和甲基泼尼松龙对哮喘儿童外周血Th1/Th2类细胞因子平衡的影响

目的：观察支气管哮喘儿童外周血单个核细胞（PBMC）中CD4^4T细胞中两个功能性亚群（Th1/Th2)的功能状态及地塞米松和甲基泼尼松龙对其的影响。方法：15例哮喘及14名健康儿童，取静脉血，密度梯度离心 法分离PBMC，分别用10^-8mol/L地塞米松和甲基泼尼松龙体外干预培养48h后，用ELISA法测定培养上清中的干扰素－γ（IFN－γ）、白细胞介素－4（IL－4）和IL－10的浓度。结果：地塞米松和甲基泼尼松龙均可明显抑制哮喘儿童PBMC分泌-γ(P值分别为0．004和0．002）和IL－4（P值分别为0．002和0．001）；若以IFN－γ／IL－4表示Th1/Th2间的平衡，则甲基泼尼松龙（P＜0．05）可恢复Th1/Th2平衡；地塞米松和甲基泌尼松龙都不曩IL－10的分泌。结论：地塞米松和甲基泼尼松龙均可抑制IFN－γ和IL－4的产生，但甲基泼尼松龙抑制作用更强，从而可恢复哮喘儿童体内Th1/Th2平衡。     

人白细胞介素—16真核表达载体的构建及其对Th2型肿瘤细胞的促逆转作用

目的：构建人IL－16真核表达载体,分析其对Th2型肿瘤细胞的逆转作用。方法：用RT－PCR技术从人外周血单个核细胞中获取IL－16cDNA,插入PUC－18T载体并测序,构建并鉴定真核表达载体PcDNA3-IL-16,转染KarpasT淋巴瘤细胞,分析阳性克隆中IFNγ,IL-2,IL-4,IL-6,IL-13,TNFα和IL－16等细胞因子的表达状况。结果：序列测定显示所克隆的人IL－16cDNA与基因库中所登录的序列完全一致,EcoRI和BamHI双酶切及PCR鉴定显示所构建的真核表达载体PcDNA3-IL-16完全正确,RT－PCR显示转染PcDNA3-IL-16的KarpasT淋巴细胞高表达IL－16mRNA,同时,Th1类细胞因子IFN－γ表达明显增高,Th2类细胞因子IL－4,IL－6,IL－13表达降低,MTT法显示KarpasT淋巴瘤细胞的增殖受到明显抑制。结论：成功构建了真核表达载体PcDNA3-IL-16,转染KarpasT淋巴瘤细胞后使其细胞因子类型由Th2型向Th0型逆转,且生长受到明显抑制,表明向肿瘤细胞转染人IL－16是一种有用的肿瘤生物治疗方法。     

狼疮肾炎患者血清及外周血单个核细胞中IL-10和γ干扰素的表达及意义

目的探讨Th1型和Th2型细胞因子在LN发病机制中的作用。方法活动期和非活动期LN患者各30例、健康对照者30例，分别采取外周静脉血，应用逆转录-荧光定量-聚合酶链反应（RT-FQ-PCR）技术及ELISA方法定量分析LN患者外周血单个核细胞（PBMC）中白介素-10（IL-10）和γ干扰素（IFN-γ）mRNA及血清中IL-10、IFN-γ的自然表达水平。结果活动期和非活动期LN患者血清和PBMC的IL-10水平均显著高于正常对照组，而活动期与非活动期LN患者的IL-10水平比较。差异无显著性。活动期LN患者IFN-γ水平显著高于正常对照组，而非活动期LN患者IFN-γ水平虽有增加趋势，但与正常对照组相比差异无显著性。活动期和非活动期LN患者血清和PBMC的IL-10／IFN-γ的比值与正常对照组比较，差异无显著性。结论LN患者血清和PBMC的IL-10自然表达水平明显增高。但其增高程度与疾病活动度无明显相关；活动期LN患者IFN-γ的表达也显著增高，提示Th1和Th2型细胞因子均可能参与活动期LN的炎症反应及组织损伤。     

慢性乙型肝炎患者PBMC内IL4与IFN-γ mRNA的表达

目的阐明Th1/Th2类细胞因子与慢性乙型肝炎肝脏炎症活动的相关性以及这些细胞因子作为慢性乙型肝炎炎症活动调节剂的作用.方法用RT-PCR法检测慢性乙型肝炎患者外周血单个核细胞(PBMC)内白细胞介素-4(IL-4)及干扰素-γ(IFN-γ)mRNA的表达.结果在静息期,无明显的IL-4及IFN-γ mRNA的表达,在活动期IFN-γ的表达率(100%)明显高于恢复期(50%)(P＜0.05):相反,在恢复期IL-4 mRNA的表达率(87.5%o)明显高于活动期(12.5%)(P＜0.05).结论在慢性乙型肝炎发病机理中,在mRNA水平,IFN-γ作为正向免疫调节性细胞因子,而IL-4作为免疫抑制性细胞因子发挥作用,结果证实Th1细胞因子上调、Th2细胞因子下调慢性乙型肝炎肝脏炎症.     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.