研究茵栀黄汤联合双歧杆菌三联活菌治疗新生儿黄疸的临床疗效

目的:探讨研究茵栀黄汤联合双歧杆菌三联活菌治疗新生儿黄疸的临床疗效。方法:选取我院2019年1-5月收治的90例新生儿为研究对象,新生儿均已确诊合并黄疸,采用电脑抽签的方式将其随机分为两组,施以不同类型的治疗方法,对照组接受常规治疗措施,观察组在其基础上给予茵栀黄汤联合双歧杆菌三联活菌治疗方式,通过对比两组新生儿治疗有效率、血清胆红素变化、心肌酶水平、黄疸消退情况及不良反应发生率等指标之间的差异,继而探究茵栀黄汤联合双歧杆菌三联活菌治疗。结果:观察组新生儿治疗有效率显著高于对照组,血清胆红素变化、心肌酶水平、临床指标改善效果显著优于对照组,不良反应发生率低于对照组,P<0.05。结论:茵栀黄汤联合双歧杆菌三联活菌治疗新生儿黄疸疗效显著,能够有效改善患儿心肌酶水平,缓解胆红素异常,稳定T淋巴细胞变化,降低临床不良反应,安全性高,值得推广。     

微生态制剂在胃溃疡抗幽门螺杆菌治疗中的作用探讨

目的探讨胃溃疡(GU)患者抗幽门螺杆菌(HP)过程中使用微生态制剂对肠道微环境的影响。方法收集2017-2020年法库县卫生健康服务中心收治的GU患者100例,随机分为对照组和观察组各50例。对照组患者采用四联抗HP治疗,观察组在其基础上加用双歧杆菌三联活菌片,两组均治疗14 d。比较两组患者肠道菌群菌落数量、血清指标水平改善情况;并比较两组治疗3个月、6个月的HP转阴率和1年后HP感染复发率。结果两组患者治疗后双歧杆菌、乳酸杆菌、肠球菌、大肠杆菌菌落数量差异有统计学意义(P<0.05);血清胃泌素(GAS)、胃动素(MTL)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平差异有统计学意义(P<0.05);治疗3个月、6个月的HP转阴率和1年后的HP感染复发率差异有统计学意义(P<0.05)。结论在GU患者抗HP治疗过程中加用微生态制剂,可以进一步改善肠道菌群和血清学指标,并且能进一步根除HP及减少复发,值得临床推广应用。     

Acanthamoeba castellanii supports extracellular survival of Helicobacter pylori in co-culture

This study aimed to demonstrate whether Helicobacter pylori is able to survive in co-culture with a protozoan, Acanthamoeba castellanii, in order to further investigate a possible aqueous environmental mode of transmission. Numbers of H. pylori in co-culture with A castellanii were assessed by colony forming unit (CFU) assay and cell morphology was observed by electron microscopy. Viable and intact H. pylori in co-culture were detected and the number of H. pylori in co-culture with A. castellanii was significantly higher than in bacterial single culture. It was also shown that co-culture of H. pylori with A. castellanii physically separated by a filter membrane negated this survival effect, suggesting that adherence of H. pylori to A. castellanii affects its survival. Scanning electron microscopy revealed helical forms of H. pylori in co-culture with A. castellanii, but not in single culture. These results imply that mutual interaction between H. pylori and A. castellanii in the environment is critical for survival of H. pylori. In addition, the H. pylori gene expression profile was found to differ between single and co-cultured cells using RNA-sequence analysis.     

阿莫西林和克拉霉素的铋剂四联方案作为初次根除幽门螺杆菌治疗的1年随访结果

目的 评估含阿莫西林和克拉霉素的铋剂四联方案作为初次根除幽门螺杆菌(Hp)治疗的疗效、复发情况及安全性。方法 以2015年12月至2017年6月在北京协和医院门诊经 ¹³C或 ¹⁴C-尿素呼气试验证实的102例Hp感染者为研究对象,给予铋剂四联方案(艾司奥美拉唑镁20 mg+枸橼酸铋钾220 mg+阿莫西林1000 mg+克拉霉素500 mg,每日2次,疗程14 d)作为初次Hp根除治疗。治疗结束后4周、8周、6个月和12个月分别复查 ¹³C或 ¹⁴C-尿素呼气试验以评估根除疗效和复发情况,同时对根除治疗前有消化不良相关症状患者评估其症状缓解情况。在整个治疗和随访期间记录药物相关不良反应以评估安全性。 结果 102例患者中,1例因皮肤过敏反应停药,101例按方案完成治疗,其中65例患者根除治疗前存在消化不良相关症状。Hp根除治疗结束后4周按意向原则(ITT)数据分析的根除率为88.2%,按符合方案(PP)数据分析的根除率为89.1%;根除治疗后8周的复发率为2.4%,根除治疗后6个月和12个月的复发率均为0,根除治疗后1年的总体复发率为2.4%。根除治疗结束后4周、8周、6个月和12个月的症状缓解率分别为81.5%、75.4%、71.2%和70.2%。101例患者中有11例(10.9%)患者服药过程中发生轻度不良反应,停药后症状自行逐渐消失。结论 含阿莫西林和克拉霉素的铋剂四联方案在临床实践中具有较高的Hp根除率,1年复发率<3%,安全性高,可推荐作为Hp初次根除治疗的标准方案。     

Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines

SummaryTrial Design: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B.Methods67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. Inclusion Criteria: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 μg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking.ResultsThe participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred.ConclusionsThe use of Fendrix®, is a viable vaccine alternative for NHS workers classified as “non-responders”. Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events.Trial registration: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23).Funding: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013–2016 and co-financed by and the European Regional Development Fund (ERDF).     

秘剂四联疗法与序贯疗法治疗幽门螺杆菌感染的Meta分析

目的 系统评价10天秘剂四联疗法和10天序贯疗法治疗中国患者幽门螺旋杆菌(Hp)感染的疗效和安全性。方法 利用中英文数据库,查找使用两种方案治疗中国患者Hp感染患者的随机对照实验(RCT)。根据纳入排除标准选取研究,提取资料,并使用Jadad量表评价研究质量,采用STATA12统计软件进行Meta分析。结果 纳入14项RCT研究,1518名患者,秘剂四联疗法和序贯疗法的Hp清除率按意向分析(ITT)分别为82.75%和84.13 %(RR = 0.99(0.95,1.04),P=0.658),两种疗法Hp根除率方面的差异无统计学意义。秘剂四联疗法与序贯疗法的不良反应发生率分别是14.19%和12.45 %(RR = 1.30(0.99,1.69),P=0.056),不良反应发生率差异也无统计学意义。结论 当前证据表明,10天铋剂四联疗法和10天序贯疗法治疗中国患者Hp感染的疗效和安全性相当,可以作为中国患者的一线治疗方案。     

枯草杆菌二联活菌对结肠癌患者小肠细菌过度生长的影响

目的探讨结肠癌患者小肠细菌过度生长(SIBO)的检测及枯草杆菌二联活菌对其的影响。方法选取2015年1月~2016年5月于我院接受结肠癌手术治疗的患者86例为观察组,同时选取同期来院体检的健康者62例为对照组。所有研究对象均进行葡萄糖氢呼气试验,检测SIBO情况。将表现为SIBO阳性的结肠癌患者随机分为A、B两组。A组患者仅进行利福昔明治疗,B组在A组基础上服用枯草杆菌二联活菌颗粒。观察两组研究对象SIBO阳性率、治疗前后A、B两组胃肠道症状积分及治疗后A、B两组SIBO转阴率情况。结果观察组SIBO阳性率为60.47%(52例),明显高于健康体检者组成的对照组的SIBO阳性率9.68%(6例)(P0.05)。治疗前,A、B两组的胃肠道症状积分得分相比,差异无统计学意义(P0.05)。A、B两组治疗后的胃肠道症状积分均低于治疗前(P0.05)。治疗后,A组的胃肠道症状积分为(9.11±0.83)分,明显高于B组的(8.75±0.57)分(P0.05)。治疗后,A组的SIBO转阴率为34.62%,明显低于B组的88.46%(P0.05)。结论结肠癌术后患者相对于健康人发生SIBO可能性更高。枯草杆菌二联活菌联合利福昔明治疗结肠癌术后SIBO效果较好,能够明显改善患者的胃肠道状况,提高SIBO的转阴率。     

双歧杆菌LTA上调ICAM-1表达及其在LAK抗肿瘤中的作用

目的 探讨双歧杆菌脂磷（ｌｉｐｏｔｅｉｃｈｏｉｃ ａｃｉｄ，ＬＴＡ）作用于ＬｏＶｏ细胞后是否能增强ＬＡＫ对该细胞的识别和杀伤，以及ＩＣＡＭ－１在其中的作用。方法采用ＭＴＴ方法观察了ＬＡＫ对ＬｏＶｏ细胞的识别和杀伤作用，并用流式细胞仪和ＥＬＩＳＡ的方法检测了ＬｏＶｏ细胞表面ＩＣＡＭ－１的表达。结果５０μｇ／ｍｌ ＬＴＡ作用３ｄ，ＬＡＫ对ＬｏＶｏ细胞的粘附率由９．６２％增加到２４．４２％，ＬｏＶｏ细胞     

31P-MRS在缺血性心脏病中的应用研究

目的探讨31P-MRS在缺血性心脏病心肌活性判断中的临床应用价值.方法对10名健康志愿者和10名急性心肌梗死的患者进行MRI及31P-MRS检查.结果心肌灌注磁共振成像、延迟扫描图像所显示的非透壁心梗区,局部PCr SNR、PCr/ATP下降, Pi /PCr比值升高;透壁心梗区,PCr峰明显下降,以致PCr SNR无法检出,β-ATP SNR亦减低.结论 31P-MRS可以显示心肌梗死后心肌能量代谢的变化,从而评价局部心肌活性.     

小剂量多巴酚丁胺负荷超声心动图结合多普勒组织成像技术评估存活心肌的研究

目的在经皮冠脉介入治疗术(PCI)前后,运用多普勒组织成像(DTI)技术检测小剂量多巴酚丁胺负荷超声心动图(LDDSE)过程中的存活心肌,探讨DTI及LDDSE结合DTI技术识别存活心肌的价值。方法20例冠心病患者均行PCI术,术前1周内,行LDDSE、DTI检查,并于术后2周、术后3个月复查二维超声(2DE)及DTI,测得收缩期室壁运动(S波)的峰值运动速度(Vs),舒张早期室壁运动(e波)的峰值运动速度(Ve)和舒张晚期室壁运动(a波)的峰值运动速度(Va)。结果LDDSE过程中,多巴酚丁胺(Dob)5μg室壁运动计分指数(WMSI)不变,Dob10μg时WMSI下降的异常室壁运动节段共有10个。Dob5μg时与静息相比,Ve增加(P<0.05);Dob10μg与5μg相比,Vs、Va增加(P<0.05)。以PCI术后3个月作为判断存活心肌的时间标准,共有存活节段123个,坏死节段16个。术后2周:存活心肌的Ve较术前增加(P<0.05);术后3个月:存活心肌的Vs、Va较术后2周增加(P<0.05)。结论通过LDDSE结合DTI技术,观察LDDSE过程中及PCI前后心肌舒张功能的变化,可更早发现及提高识别存活心肌的能力。