早期联合应用IL-1ra和甲强龙在预防SAP并发ARDS的临床研究

目的观察早期联合应用人白介素-1阻断剂（IL—1ra）和甲基强的松龙在预防重症急性胰腺炎（SAP）并发急性呼吸窘迫综合征（ARDS）的临床疗效。方法56例急症入院被诊断为重症胰腺炎（诊断依据临床症状及血清学、生化及辅助检查确诊）患者，随机分成试验组27例和对照组29例，对照组按重症胰腺炎治疗原则常规治疗（包括胃肠减压、禁食，生长抑素及抗酸、支持对症治疗），试验组除按上诉治疗外在诊断明确后即予以甲强龙60mg，每天2次，IL-1170．25mg／h微量泵静脉注入，疗程3～7天，观察两组并发ARDS情况及预后。结果试验组并发ARDS2例，死亡3例，其余病俞出院；对照组并发ARDS9例，死亡8例。结论早期联合使用甲强龙和人白介素-阻断剂能有效降低重症胰腺炎的渗出，阻止炎性介质释放，促进重症胰腺炎的良性转归，同时在积极有效治疗的基础上减少白介素-1阻断剂的用量，缩短住院周期。     

急性重症胰腺炎患者肠黏膜屏障功能的改变

目的:探讨急性重症胰腺炎(SAP)的肠道黏膜屏障功能改变的机制,以期提高对SAP的治疗策略。方法:36例SAP患者入院当天采血检测二胺氧化酶(DAO)、内毒素(endotoxin,ET)、肿瘤坏死因子(TNF-α)、一氧化氮(NO)的浓度。并用带特殊电化学检测器的高压液相色谱法(HPLC)检测尿中乳果糖与甘露醇排泄率比值。以30名健康志愿者作为正常对照组。结果:同正常对照组相比较,SAP患者尿中乳果糖与甘露醇排泄率比值明显升高(P<0.01);血中ET、NO、TNFα、DAO的水平显著增加(P<0.01)。结论:急性重症胰腺炎患者的肠黏膜屏障受损,肠黏膜通透性增高。ET、NO、TNFα单独或协同参与肠黏膜屏障的损害。DAO升高提示肠道黏膜的完整性受到破坏。     

重症急性胰腺炎与肝损害关系的临床研究

目的探讨重症急性胰腺炎（SAP）与肝损害的关系及发生机制。方法回顾分析162例AP病例,对其中104例AP合并肝损害的病例进行分析。结果半数以上的AP患者发生肝损害。结论SAP与肝损害的发生存在关联,联系呈正相关。肝损害可作为独立指标预测AP严重程度,并可研判预后。     

卒中相关性肺炎的临床特点及预测因子

目的探讨卒中相关性肺炎的临床特点和预测因子。方法选择2011年9～12月在我科治疗的脑卒中患者143例作为研究对象,回顾性分析其临床资料,从患者的基础状态、与卒中相关的因素、入院后相关治疗、入院当日首次血清降钙素原(PCT)、C-反应蛋白(CRP)、临床肺部感染评分(CPIS)等方面探讨卒中相关性肺炎的临床特点和预测因子。结果年龄>70岁,既往有脑卒中病史,合并有糖尿病、缺血性心脏病,出血性脑卒中,小脑和脑干卒中,出现吞咽困难、昏迷,使用胃黏膜保护剂,预防性使用抗生素、气管侵入性操作均与卒中相关性肺炎有相关性,PCT、CRP和CPIS可以作为SAP的预测因子(P均<0.01)。结论临床治疗中,应尽量避免过多的或不必要的侵入性操作,入院时的PCT、CRP和CPIS可以作为SAP的预测因子。     

CHD患者血浆ET-1、GMP-140和血清cTnI检测的临床意义

目的：探讨冠心病（CHD）患者血浆ET-1、GMP-140和血清心肌肌钙蛋白Ⅰ（cTnI）水平的变化及意义。方法：应用放射免疫分析和酶免法对96例CHD患者进行了血浆ET-1、GMP-140和血清cTnI水平的测定,其中稳定型心绞痛（SAP）36例,不稳定型心绞痛（UAP）41例,急性心肌梗死（AMI）19例。并与35例正常健康人作比较。结果：CHD患者血浆ET-1、GMP-140和血清cTnI水平均非常显著的高于正常人组（P〈0.01）,急性AMI组和UAP组又高于SAP组（P〈0.05）,且血清cTnI水平与血浆ET-1、GMP-140水平呈正相关。结论：检测CHD患者血浆ET-1、GMP-140和血清cTnI水平的变化对CHD的发生和发展以及疗效和预后观察均具有重要的临床意义。     

PDTC抑制大鼠重症急性胰腺炎肺损伤NF-κB的激活

目的观察重症急性胰腺炎(SAP)大鼠NF-κB在胰、肺组织内的表达情况,探讨其与肺损伤的关系。方法SD大鼠45只,随机分为对照组、SAP组、牛磺胆酸钠(二硫代氨基甲酸吡咯烷pyrrolidine dithiocarbamate,PDTC)预处理组(各组再分为3、6、12h3个亚组,对照组n=3,模型组n=6)。采用5%牛磺胆酸钠胰胆管逆行注射法建立重症胰腺炎模型,预处理组在建立模型前1h腹腔内注PDTC(100mg/kg)。取胰、肺组织行病理观察,免疫组化SP法观察NF-κB表达情况。结果对照组仅少量肺泡间质细胞表达NF-κB;SAP组与PDTC预处理组NF-κB阳性细胞数明显增加(P<0.05),并呈动态变化,6h达高峰,PDTC预处理6h和12h组明显低于SAP组(P<0.05),阳性信号主要位于胰腺腺泡细胞、中性粒细胞、单核/巨噬细胞、支气管黏膜上皮细胞、肺泡上皮细胞胞浆和胞核内。结论PDTC可能通过抑制NF-κB的激活减轻重症急性胰腺炎并发肺损伤。     

Comprehensive analyses and characterization of haemophagocytic lymphohistiocytosis in Vietnamese children

Haemophagocytic lymphohistiocytosis (HLH) is a fatal haematological disorder with diverse aetiology. This prospective study was undertaken to characterize HLH cases in Vietnamese children. Clinical and laboratory data, genetic analyses and outcome of the HLH patients were analysed. A total of 33 patients were enrolled from March 2007 to December 2008, with a median age of 3 years. Mutations of the SH2D1A ( SAP ) and PRF1 genes were detected in one patient, respectively. The virus association was high, up to 63·6% (21/33), including Epstein–Barr virus (19/33), cytomegalovirus (2/33) and dengue virus (2/33). Five patients had malignant lymphoma and two had autoimmune diseases. Twenty-eight patients were treated according to the HLH-2004 protocol. The first response rate was 64·3% (18/28), with an early death rate of 35·7% (10/28). High levels of interferon-γ, interleukin-10, MIG and interferon-inducible protein-10 (IP-10) were associated with early mortality ( P  <   0·05). Reactivation among the responders was high (9/18) and the uneventful resolution was low (3/18) after a median follow-up of 35 weeks. In conclusion, the majority of HLH cases are associated with virus infections in Vietnamese children. Familial HLH is rare. The frequent reactivation and high mortality demands a more appropriate therapeutic regimen in tropical areas like Vietnam.     

血液滤过在急性重症胰腺炎治疗中的应用

目的 探讨连续性静脉-静脉血液滤过(CVVH)在重症急性胰腺炎(SAP)治疗中的应用.方法 回顾性分析25例SAP患者,采用常规综合治疗的同时行CVVH,观察临床症状、治疗前后APACHEII评分及血生化指标的变化.结果 CVVH治疗过程中,25例SAP患者呼吸窘迫、烦躁、谵妄、腹痛、腹胀等症状逐渐缓解;与治疗前比较,治疗后APACHEII评分差异有显著性(P＜0.05);25例SAP患者经CVVH治疗24h后,血总胆红素(TB)、AST、AMS、APS均明显降低,与治疗前比较差异具有显著性(P＜0.05).结论 SAP患者早期及时、有效行CVVH等综合治疗,能有效缓解临床症状、改善生化指标、有助于维持水、电解质、酸碱平衡、内环境以及微循环稳定、改善心、肺、肾功能,是安全、有效的治疗措施之一.     

重症胰腺炎并发急性呼吸窘迫综合征的护理

目的:探讨急性重症胰腺炎(SAP)治疗过程中并发急性呼吸窘迫综合征(ARDS)的护理方法。方法对76例SAP并发ARDS患者的临床资料进行回顾性分析。结果增强CT检查发现胰周积液69例,胰腺坏死26例,出现局部并发症15例(假性囊肿9例、胰尾脓肿6例)。76例SAP中,痊愈53例,明显好转18例,好转4例,死亡1例。结论对SAP并发ARDS患者,应尽早查明原因和机制,早期诊断、早期治疗及早期精心护理是降低其病死率的关键。     

Truncated CASK does not alter skeletal muscle or protein interactors

CASK (Ca2+, calmodulin-associated serine/threonine kinase) is an essential mammalian cell junction protein and is also crucial at Drosophila neuromuscular synapses. We have shown that CASK is present in mammalian skeletal muscle at the postsynaptic membrane of the neuromuscular junction. CASK interacts biochemically with channels at central synapses, and studies in cultured cells have led to proposed functions for CASK. However, in vivo functions of CASK in skeletal muscle remain unknown. To test hypotheses of CASK functions, we generated two lines of transgenic mice, which overexpress full-length and truncated CASK protein in skeletal muscle. Extensive analyses showed that overexpression of CASK protein did not affect the morphology or physiology of skeletal muscle, the morphology of the neuromuscular junction, or the levels or distribution of protein interactors. These results contrast with previous cell culture experiments and emphasize the importance of in vivo analysis of protein function.