疑似或可能埃博拉病毒病患者32例的医学观察及诊治体会

目的 总结埃博拉治疗中心(Ebola Treatment Unit,ETU)4级防护隔离条件下对疑似或可能埃博拉病毒病(EVD)患者进行医学观察和临床诊治的体会。方法 选取2015年1月14至3月14日利比里亚中国ETU留观收治的32例疑似或可能EVD患者为研究对象,医生在4级个人防护隔离条件下查房,以询问病史为主要诊断疾病依据,给予双氢青蒿素哌喹片(3 片,1次/d)、左氧氟沙星(0.5 g,1次/d)、多维元素善存片(1片,1次/d)、口服补液盐Ⅲ(2包,3次/d)、全能营养素(40 g,3次/d)为基础用药联合对症处理的经验性治疗。采用回顾性方法对患者流行病学史、临床症状及体征、诊断、治疗措施、疾病转归及不良反应等临床资料进行分析。结果 32例患者平均年龄(40.53±13.89)岁(14~83岁),男22例、女10例。发病后就诊时间中位数4.5(1~30) d。所有患者均有发热,平均最高体温(38.36±1.01)℃。主要伴随症状包括乏力25例(78.12%)、关节肌肉酸痛22例(68.75%)、恶心呕吐17例(53.12%)、头痛16例(50.00%)、食欲下降15例(46.88%)、腹泻14例(43.75%)、腹痛14例(43.75%)、咳嗽12例(37.50%)、胸痛10例(31.25%)、呼吸困难5例(15.62%)、吞咽困难4例(12.50%)、呃逆3例(9.38%)、消化道出血2例(6.25%)。32例患者平均住院时间(3.94±2.29) d。出院诊断包括急性胃肠炎13例,急性呼吸道感染7例,上消化道出血1例,腹水原因待查、肝癌可能1例,黄疸原因待查、肝炎可能1例,哮喘急性发作1例,疟疾1例,不完全性肠梗阻1例。26例好转出院,6例死亡,好转率81.25%(26/32)。体温恢复到正常者23例,平均发热恢复正常时间(3.51±1.60) d。患者未出现治疗无法耐受现象及严重不良反应。结论 在ETU对疑似或可能EVD患者进行密切医学观察并熟练扎实地应用问诊、查体等医学基本功是诊断疾病的重要手段;经验性口服药物治疗联合对症处理安全、有效,具有一定的临床应用价值。     

川崎病治疗前发热时间与丙种球蛋白耐药的相关性临床研究北大核心CSCD

目的 探讨川崎病(Kawasaki disease,KD)患儿丙种球蛋白(intravenous immunoglobulin,IVIG)治疗前发热时间与IVIG耐药的关系。方法 回顾性收集2018年1月至2020年12月收治KD患儿317例的病例资料,根据IVIG治疗前发热时间分为短热程组(发热时间≤4 d,n=92)和长热程组(发热时间>4 d,n=225),根据是否发生IVIG耐药将每组再分为耐药组和非耐药组。分析比较不同热程耐药组及非耐药组的基线资料及实验室结果,并采用多因素logistic回归分析IVIG耐药的影响因素。结果 短热程组中IVIG耐药19例(20.7%),并发冠状动脉瘤5例(5.4%);长热程组中IVIG耐药22例(9.8%),并发冠状动脉瘤19例(8.4%);短热程组IVIG耐药率明显高于长热程组(P<0.05),而冠状动脉瘤发生率在两组间差异无统计学意义(P>0.05)。短热程组中,耐药患儿治疗前血钠水平低于非耐药患儿,而降钙素原、C反应蛋白及N末端B型利钠肽原水平则明显高于非耐药患儿(P<0.05)。长热程组中,耐药患儿治疗前血钠及肌酸激酶水平低于非耐药患儿(P<0.05)。多因素logistic回归分析显示,血钠水平降低与长热程组KD患儿IVIG耐药有关(P<0.05)。结论 KD患儿IVIG耐药因IVIG治疗前发热时间不同而异。在治疗前发热时间>4 d的KD患儿中,血钠降低与IVIG耐药具有相关性。     

Association of FCGR2A p.R131H and CCL2 c.-2518 A > G gene variants with thrombocytopenia in patients with dengue virus infection

FCGR2A and CCL2 gene variants are important in dengue pathogenesis and were investigated in 122 dengue patients (DENs) [89 dengue fever (DF) and 33 dengue hemorrhagic fever (DHF)] and 107 healthy controls (HCs) to find out their association with severity of dengue. Genotype frequencies of FCGR2A p.R131H and CCL2 c.-2518 A > G polymorphisms were not different between DF, DHF and HC. Significantly higher frequency of R/R genotype of FCGR2A p.R131H was observed in DEN cases with thrombocytopenia (TP) while the G/G genotype of CCL2 c.-2518 A > G was observed only in DEN cases with TP (p < 0.005). These results suggest that FCGR2A and CCL2 gene variants were associated with the risk of TP in dengue infections.     

新疆天山,阿尔泰山山地森林脑炎自然疫源地考察报告

1964～1966年我们考察了位于新疆天山山脉的15个县的林区及阿尔泰山山脉的3个县的林区,发现全沟硬蜱(Ixodes persulcatus)分布于海拔1500～1800m的森林草原景观中。并从天格尔山北坡的乌鲁木齐(N43°33′,E87°07′)、昌吉县林区(N43°30′,E86°55′),依连哈比尔尕山北坡的玛纳斯(N43°53′,E86°06′)、沙湾县林区(N43°56′,E85°12′),婆罗克努山南坡的尼勒克县林区(N44°02′,E82°38′),科古琴山南坡的霍城县林区(N44°28′,E81°10′),那拉提山北坡的新源(N43°16′,E84°01′)、巩留县林区(N43°11′,E82°44′)和哈尔克山北坡的特克斯(N43°59′,E81°55′)、昭苏县林区(N42°48′,E80°35′)采集的全沟硬蜱分离出森林脑炎病毒(Tick-borne encephalitis flavivirus)。从而判定上述地区存在森林脑炎自然疫源地。全沟硬蜱为主要媒介,其带毒率介于14.3％～47.7％。狍(Capreolus capreolus)、狐(Vulpes vulpes)、灰旱獭(Marmotabaibacina)、牛、马和羊均可作为该蜱的天然饲养者,从它们的血清中均检出森林脑炎病毒中和抗体。在疫源地内有散发病例发生。查布察尔(N43°34′,E81°08′、哈巴河(N48°28′,E86°42′)、奇台(N43°38′,E89°42′)、吉木萨尔(N43°49′,E89°)因采集材料过少尚不能确定     

Native Medicinal Plant Richness Distribution Patterns and Environmental Determinants of Xinjiang, Northwest China

Objective To comprehensively map the distribution patterns of native medicinal plants of Xinjiang Uygur Autonomous Region, China; To find the environmental determinants and to give suggestions for the conservation planning of medicinal plants in Xinjiang region. Methods Firstly, we compiled the distribution data of native medicinal plants at a county level in Xinjiang region, including the source plants of Chinese Materia Medica(CMM), Uygur Medicine(UM), and Kazak Medicine(KM); Secondly, we divided the distribution data into grid with a resolution of 0.1°× 0.1° and overlaid it on the topography and climate data in Arcgis 10.0; Finally, we analyzed the correlations of medicinal plant richness and environmental variables with ordinary least square(OLS) regressions and partial regressions. Results UM has more non-native species in Xinjiang region than KM. The species richness of medicinal plants is high in Altay Mountains, western Tianshan Mountains, and part of Kunlun Mountains. The richness of medicinal plants is highly correlated with the vascular plant species richness and climate, and further, the independent effects of vascular plant species richness are higher than the independent effects of climate. The whole plant, root rhizome, and seed fruit are more frequently used than stem and leaf for CMM in Xinjiang region. Conclusion The distribution patterns of medicinal plants are concordant with vascular plant species, which could be carefully considered in the conservation planning of this region. Taking full advantage of current nature reserves is a low-costing approach to the conservation of medicinal plants although they were not originally established for medicinal plant protection. Nevertheless, it is urgent to further study the distributions and protection status of medicinal plants in the nature reserves of Xinjiang region.     

基孔肯雅热临床特点及治疗与预后

目的 探讨基孔肯雅热临床特点及治疗与转归.方法 选取2010年9月至2010年11月东莞市诊治的133例基孔肯雅热患者为研究对象,所有患者行3年随访,分析其临床特征及治疗与预后.结果 基孔肯雅热病常见临床症状为发热、皮疹及关节疼痛,发生率分别为100.00％、91.72％和90.98％;关节疼痛中膝关节、脚踝及肘部关节受累较多,发生率分别为69.92％、64.66％和48.87％;关节疼痛女性明显多于男性,15岁以上患者易发生关节疼痛;关节疼痛症状在1年内基本消失,部分患者在2年甚至3年内消失,个别患者在3年后仍未消失.结论 基孔肯雅热病主要以发热、皮疹及关节痛为主要临床表现,关节疼痛受年龄等因素影响,治疗后1年患者内关节疼痛基本可消失,对症、支持治疗对基孔肯雅热有显著治疗效果.