肠内营养在重症急性胰腺炎综合治疗中的作用

目的 探讨肠内营养（EN）在重症急性胰腺炎（SAP）综合治疗措施中的作用。方法 回顾分析近两年我科收治的52例SAP患者的临床资料，按是否接受EN分成EN组（27例）和常规组（25例），比较两组患者主要治疗经过及临床转归，以及APACHEⅡ评分和血清白蛋白和前白蛋白的变化。结果 52例患者全部治愈，除6例（11．5％）并发假性囊肿外，无其他并发症。EN组患者于入院后5d左右开始实施EN，均能较好耐受，其治疗前后APACHEⅡ评分变化显著大于常规治疗组（P〈0．05），且血清白蛋白、前白蛋白水平均高于常规治疗组（P〈0．05）。结论 EN具有安全、可行、易操作等特点。合理应用有助于改善SAP机体的营养状况。     

Drainage tube endoscopy: a contribution to the management of severe acute pancreatitis?

Peritoneal lavage is one of the interventional approaches that have gained some attention in the early, toxaemic phase of acute pancreatitis. Additionally some kind of drainage is necessary for suppurative collections that characterize the late phase of the disease. In both the above situations tube plugging is a common problem and it is usually associated with a relapse of the patient's septic state and newly formed collection(s) on abdominal CT. Two cases are presented, in early and in late phases respectively, in which drainage tube adoscopy (DTE) re-established tube patency and ensured drainage. DTE may represent an alternative to surgery or to CT-guided paracentesis and evacuation of newly formed intra-abdominal collections secondary to tube obstruction. Received: 24 March 1997 Accepted: 7 August 1997     

外源性ghrelin在大鼠重症急性胰腺炎并肾损伤中的作用

目的：探讨外源性ghrelin在大鼠SAP肾损伤中的作用及机制。方法72只Wistar大鼠随机分为假手术组（SO组,n=24）、重症急性胰腺炎模型组（SAP组,n=24）和ghrelin干预组（G组,n=24）。 SAP组、G组均用3.5%牛磺胆酸钠（1ml/kg）按胰胆管逆行注射法制成重症急性胰腺炎模型,G组在制模前30min和制模后3h腹腔内注射ghrelin（10nmol/kg）,SO组、SAP组于相同时间注射等量生理盐水,各实验组大鼠于制模后6h、12h和24h分批取材。光学显微镜下对胰腺和肾脏组织进行病理学评分,全自动生化仪检测血清淀粉酶,酶联免疫吸附法检测血清IL-6、TNF-α、肌酐。结果①SAP组6h、12h、24h血清淀粉酶、肌酐、TNF-α、IL-6,胰腺及肾脏病理评分均较同时间点SO组升高,差异有统计学意义（P<0.05）;②G组6h、12h、24h血清淀粉酶、肌酐、TNF-α、IL-6,胰腺及肾脏病理评分均较同时间点SAP组下降,差异有统计学意义（P<0.05）,但均较同时间点SO组升高,差异有统计学意义（P<0.05）。结论外源性ghrelin通过降低TNF-α、IL-6的水平,减轻炎症反应来减轻SAP的严重程度,同时保护肾脏的生理功能。     

Chicken SLAMF4 (CD244, 2B4), a receptor expressed on thrombocytes,monocytes, NK cells,and subsets of αβ-, γδ- T cells and B cells binds to SLAMF2

The SLAM family of membrane receptors is involved in the regulation of immune responses by controlling cytokines production, cytotoxicity as well as cell development, differentiation and proliferation, but has only been described in chickens, recently. The aim of this study was to characterize the avian homologue to mammalian SLAMF4 (CD244, 2B4), a cell surface molecule which belongs to the SLAM family of membrane receptors. We generated a SLAMF4 specific monoclonal antibody (mab) designated 8C7 and analyzed the SLAMF4 expression on cells isolated from various lymphoid organs. Subsets of αβ and γδ T cells found in peripheral blood lymphocytes (PBL) and spleen coexpressed SLAMF4. The expression was restricted to CD8α⁺ T cells, whereas CD4⁺ T cells and all thymocytes showed little or no reactivity upon staining with the 8C7 mab. Blood and splenic γδ T cells could be further differentiated according to their expression levels of SLAMF4 into two and three subsets, respectively. SLAMF4 was absent from bursal and splenic B cells, however, it was expressed by a distinct fraction of circulating B cells that were characterized by high level expression of Bu1, Ig, and CD40. SLAMF4 was also present on NK cells isolated from intestine of adult chickens or embryonic splenocytes identified by their coexpression of the 28-4 NK cell marker. Moreover, SLAMF4 expression was found on thrombocytes and monocytes. The interaction of SLAMF4 with SLAMF2 was proven by a reporter assay and could be blocked with the 8C7 mab. In conclusion, the avian SLAMF4 expression markedly differs from mammals; it binds to SLAMF2 and will be an important tool to discriminate several γδ T cell subsets.     

Hemophagocytic lymphohistiocytosis and primary immune deficiency disorders

Hemophagocytic lymphohistiocytosis (HLH) is characterized by uncontrolled immune activation and is traditionally associated with inherited gene defects or acquired causes. In addition to abnormalities in cytotoxic granules and lysosomes, various primary immune deficiency disorders (PID) have been identified among patients suffering from HLH. Our purpose was twofold: to better characterize and detail the association between PID and HLH.     

重症胰腺炎死亡早期危险因素分析

目的：探讨入院24h内影响重症急性胰腺炎转归的危险因素。方法：回顾性分析2000年-2006年间本院收治的重症急性胰腺炎（SAP）49例，按预后分为生存组31例和死亡组18例，分析2组入院24h内临床和实验室检查资料的差异，并进行统计学处理：结果：两组间平均年龄、血糖、动脉血氧分压、并发症及MOF发生率的差异有统计学意义（P〈0．05）。结论：高平均年龄、高血糖、低动脉血氧分压、多并发症及多器官衰竭（MOF）是SAP死亡的早期危险因素。     

重症急性胰腺炎入院24 h内死亡因素剖析

目的探讨重症急性胰腺炎死亡因素.方法应用SPSS10.0软件对52例重症急性胰腺炎病人入院24h内临床资料进行Logistic回归分析,筛选重症急性胰腺炎死亡的危险因素,并建立Logistic回归方程式.结果在调查的27个因素中血pH值、APACHEⅡ评分、早期休克、合并多脏器功能衰竭与死亡关;单因素Logistic回归分析发现休克、胸腔积液、血pH值、APACHEⅡ评分以及并发症的发生与死亡有关,而多因素分析发现只有血pH值与重症急性胰腺炎的死亡有关.结论该回归方程在病程早期对预测重症急性胰腺炎的预后及临床治疗有一定帮助;重症急性胰腺炎早期治疗中应强调维护全身脏器功能,积极纠正水电解质和酸碱平衡的紊乱,对降低死亡率具有重要的作用.     

Disruption of the NMDA receptor-PSD-95 interaction in hippocampal neurons with no obvious physiological short-term effect

PSD-95 binds to and co-localizes with NMDA receptors at postsynaptic sites. Their co-expression in COS7 cells induces the formation of aggregates containing both proteins. These findings have lead to the hypothesis that PSD-95 helps to cluster NMDA receptors at postsynaptic sites. In addition, PSD-95 binds various regulatory proteins including Src, Pyk2, SynGAP, and nNOS and may recruit signaling proteins to NMDA receptors. We tested whether synaptic transmission or plasticity was affected by acute dissociation of the PSD-95-NMDA receptor interaction with various peptides that bound to the first two PDZ domains of PSD-95 and its homologs and with antibodies directed against the very C-terminus of the NR2A and NR2B subunits of the NMDA receptor. Membrane-impermeable peptides injected via whole cell patch electrodes distributed within minutes throughout dendritic branches into spines in acute hippocampal slices and membrane-permeable peptides containing 11 arginine residues effectively accumulated in neurites in slices and primary hippocampal cultures. Neither peptides nor antibodies showed any effect on basal synaptic transmission or induction of long-term potentiation (LTP) in hippocampal slices. Pharmacologically isolated NMDA receptor activity was also not affected. However, the membrane-permeable peptide disrupted the NMDA receptor-PSD-95 interaction in slices as tested by immunoprecipitation and subsequent immunoblotting. These findings suggest that acute dissociation of PSD-95 and its homologs from the NMDA receptor and likely from other protein complexes does not result in any easily detectable physiological effects in hippocampal slices. However, we cannot exclude a role of PSD-95 in early events that lead to clustering of NMDA receptors or of other proteins including stargazin and AMPA receptors at postsynaptic sites nor do these experiments address the possibility of long-term changes in the slices. In fact, incubation of primary hippocampal cultures with the membrane-permeable peptide lead to a moderate decrease in the number of dendritic clusters of PSD-95 and NMDA receptors and their colocalization by 20-30%, suggesting some role of PSD-95 and its homologs in NMDA receptor clustering.     

肺炎衣原体与急性冠脉综合征关系的临床研究

目的观察急性冠脉综合征患者肺炎衣原体感染情况,研究冠心病炎症与CPn感染的关系。方法99例疑诊"冠心病"收住兰州大学第一医院心内科患者,入院24h内清晨空腹静脉血标本留置,综合相关检查、治疗及病情转归情况确诊分为:ACS组48例(其中UAP组31例,AMI组17例),SAP组17例,非冠心病对照组13例;另门诊健康检查者30例经各相关检查后确定的10例健康者为健康对照组,用微量免疫荧光法测定血清中CPnlgG和lgM抗体滴度。结果各组实验对象CPnlgM抗体均为阴性。各组实验对象CPnlgG滴度值经Spearman等级相关分析(秩相关分析),相关系数无统计学意义(rs=0.175,P=0.102),说明各组lgG滴度与分组无关,分组与CPn慢性感染无关。结论本研究48例ACS,17例SAP均无CPn急性感染。各组CPn慢性感染率均高,本研究为断面研究、非动态研究,所选病人均是已发生ACS者,至于CPn与ACS启动在研究中未涉及。     

国产生长抑素治疗急性重症胰腺炎35例的临床疗效观察

目的:观察国产生长抑素治疗重症急性胰腺炎的临床疗效及其对血浆内毒素和肿瘤坏死因子(TNF-α)水平的影响。方法:35例重症急性胰腺炎患者使用生长抑素治疗7～10d后,观察患者的症状、体征变化,血尿淀粉酶、肝功能恢复以及血浆内毒素和TNF-α水平等。结果:经过7～10d生长抑素治疗后,患者的症状、体征、血尿淀粉酶、肝功能以及血浆内毒素和TNF-α水平均得到不同程度的恢复,总有效率为84%。结论:国产生长抑素可以有效地控制重症急性胰腺炎的临床症状,迅速降低血浆内毒素和TNF-α水平,降低患者的死亡率和不良反应发生率。