四川省发热出疹性疾病血清流行病学分析

为了解四川省发热出疹性疾病 (RFIs)的血清流行病学特征 ,对 1999～ 2 0 0 1年收集的 5 15份血清标本 ,用酶联免疫吸附试验 (ELISA)同时检测麻疹、风疹IgM抗体。结果显示 ,麻疹、风疹IgM抗体阳性率分别为 4 9 71%和11 4 6 %。麻疹、风疹病例集中在 3月 ,以 4～ 14岁儿童为主。各级实验室应开展血清学鉴别诊断工作 ,提高麻疹监测质量。     

Cross-reactivity pattern of rash from current aromatic antiepileptic drugs

We have investigated cross-reactivity of rash among the current aromatic antiepileptic drugs, particularly between the new and the traditional compounds. A retrospective survey of medical records concerning all aromatic antiepileptic drug (AED) treatment in consecutive adult patients with epilepsy was performed. Altogether 663 patients were included comprising 2567 exposures to AEDs. Skin reactions occurred in 93 patients and sequential rashes related to aromatic drugs in 17. Phenytoin (PHT), carbamazepine (CBZ) and oxcarbazepine (OXC) caused rashes in the range of 27-35% in patients with a history of another AED-related rash, whereas lamotrigine (LTG) caused another rash in 17%. A history of an AED-related rash was significantly associated with reactions to PHT, CBZ, and OXC (p<0.001). The association was only borderline significant for LTG (p=0.05). Nevertheless, the occurrence was consistently increased in all subgroups with reactions to other AEDs. A CBZ rash was not significantly associated with an LTG reaction, and vice versa, but the number of patients was limited. Less than one third of patients with a CBZ rash also reacted to OXC. No evidence for increased severity of sequential rashes was found. Clinicians should be aware of the cross-reactivity of the aromatic AEDs regarding cutaneous adverse events, as well as their differences in this respect. LTG appears to be involved in cross-reactions less often than CBZ, OXC and PHT.     

新癀片治疗吉非替尼痤疮样皮疹的临床疗效观察及相关机制探讨

目的观察新癀片治疗吉非替尼痤疮样皮疹的临床疗效,探讨其可能的作用机制。方法将40例吉非替尼痤疮样皮疹患者随机分为2组。治疗组20例,予新癀片治疗;对照组20例,予安慰剂治疗。2组均治疗4周后统计疗效,比较2组治疗前后皮损分级情况及白细胞介素1β(IL-1β)水平变化,以及治疗后对患者肿瘤病情的影响。结果治疗组总有效率95.0%,对照组30.0%,治疗组总有效率优于对照组(P0.05);2组治疗后治疗组皮损分级情况比较差异有统计学意义(P0.05),治疗组皮损程度轻于对照组;治疗组治疗后IL-1β水平与本组治疗前及对照组治疗后比较差异均有统计学意义(P0.05),IL-1β水平降低,对照组IL-1β水平治疗前后比较差异无统计学意义(P0.05);2组治疗后肿瘤病情比较差异无统计学意义(P0.05),2组肿瘤病情情况相当。结论新癀片治疗吉非替尼痤疮样皮疹疗效确切,可明显改善患者临床症状,减轻皮损程度,且安全可靠,无明显不良反应,对患者肿瘤病情无影响,降低IL-1β水平,抑制炎症反应,可能是其治疗吉非替尼痤疮样皮疹的作用机制之一。     

厄洛替尼引起皮肤不良反应的小鼠模型建立

目的厄洛替尼(商品名:特罗凯)是治疗非小细胞肺癌的一种新型靶向药物,近些年来临床应用甚广,但副作用较多,其中以皮疹最为多见,且最令患者难以接受。本研究旨在观察应用特罗凯前后小鼠在表皮、病理、免疫组化等方面的改变,复制特罗凯所致皮疹的动物模型,为临床外用药物治疗皮疹提供模型。方法使用BALB/c雌性小鼠20只,随机分成4组。实验组(Ⅱ、Ⅲ、Ⅳ组)用浓度为10 g/L的特罗凯溶液按100 mg/kg灌胃,对照组(Ⅰ组)以等体积去离子水灌胃,每天1次。于给药前24 h在小鼠头颈、背、腰处脱毛,实验结束后剪取颈部、背部、腰部皮肤并观察实验组、对照组小鼠在肉眼皮肤、病理切片、免疫组化等方面的改变。结果 (1)四组小鼠之间在毛发再生天数、毛发完全再生天数、脱屑时间、出现皮疹时间、毛孔扩张数等5方面的差异存在统计学意义(P0.01或P0.05);(2)Ki67:四组间差异无统计学意义(P0.05)。结论 (1)此次实验印证了许多研究者关于"EGFRIs导致的皮疹为一种炎症反应"的观点;(2)该皮疹模型可靠实用,具有可重复性,适用于"EGFRIs所致皮疹动物模型"的大批建立,可推广以供临床、试验、研究所用。     

成人发热出疹性疾病的临床研究

目的 探讨成人发热出疹性疾病的临床特点。方法 回顾性分析我院近5年来420例成人发热出疹性疾病的临床特点、并发症和预后。结果 成人发热出疹性疾病大多数均有典型的临床表现;并发症主要以肝脏、肺脏为主;预后良好。麻疹IgM抗体阳性率为65%,风疹IgM抗体阳性率为15%,麻疹IgM抗体、风疹IgM抗体均为阴性者占20%。结论 血清学诊断是鉴别成人发热出疹性疾病的重要手段,为控制麻疹的发病率,除坚持疫苗接种、对特定人群（成人）强化免疫及对流动人口进行应急接种或加强新疫苗的研制外,还应继续推行风疹疫苗的接种。     

Phenotypic and molecular characterization of Arcanobacterium haemolyticum isolated from clinical samples

The aim of this study was to assess the phenotypic and genotypic diversity of 56 Arcanobacterium haemolyticum isolates isolated from 51 patients attending primary health care centres and emergency units in the health area of Santander (Cantabria, northern Spain). Phenotypic characterization was based on morphological, biochemical, and antigenic tests. Species identification was confirmed by amplification and sequencing of the 16S rDNA gene. Antimicrobial susceptibility testing was determined by microdilution following the Clinical and Laboratory Standards Institute recommendations for coryneform bacteria. Genetic diversity was evaluated using BOX-PCR and pulsed-field gel electrophoresis. Eighty percent of the isolates had an identical BOX-PCR pattern, suggesting the spread of a single clone. The present report provides extensive information on the phenotypic and genotypic characterization of A. haemolyticum.     

Transfer of peanut allergy from donor to recipient after liver transplant

31 years old female with a history of contact dermatitis, eczema, allergic rhinitis, pernicious anemia, alopecia areata and latent tuberculosis was treated concurrently with methotrexate along with isoniazid and pyridoxine. Five months into the therapy she developed acute onset jaundice progressing into fulminant liver failure with altered mentation and worsening liver function tests. Extensive workup including serological and histopathological evaluation revealed drug-induced liver injury as the etiology of her liver failure and she underwent a successful orthotropic liver transplant. On post-transplant follow-up at four months, she was noted to have an allergic reaction consisting of a perioral rash and swelling (without anaphylaxis) after receiving a kiss from her significant other who had just eaten a peanut butter chocolate. She denied any history of allergic reaction to peanuts prior to the transplant. Percutaneous skin testing revealed immediate hypersensitivity to peanut, hazelnut, and pecan believed to be acquired newly post-transplant. Further investigation revealed that the organ donor had a documented history of systemic anaphylaxis from the peanut allergy and a positive peanut-specific IgE level. Also, another parallel solid organ recipient (lung transplant) from the same organ donor experienced a serious anaphylactic reaction after peanut exposure. This is a case of food (peanut) allergy transfer from the donor to the recipient after the liver transplant. This case highlights the importance of incorporating known donor allergies as a part of pre-transplant screening, given the potentially serious consequences from the transfer of allergies to a previously anergic recipient.     

重组人干扰素α1b治疗小儿手足口病的临床疗效观察

目的 观察重组人干扰素α1b治疗小儿手足口病的临床疗效。方法 选择我院2018年6月~8月儿科门诊收治的手足口病患儿60例,随机分为治疗组和对照组,各30例。对照组患儿给予一般抗病毒对症治疗,治疗组在此基础上加用重组人干扰素α1b注射液治疗。观察两组患儿治疗后热退时间、咽部充血程度改善时间、口腔溃疡愈合时间及皮疹消退时间,比较两组患儿的临床疗效。结果 治疗组总有效率为93.33%,高于对照组的70.00%,差异有统计学意义（P＜0.05）;治疗组的热退时间、咽峡部充血程度改善时间、口腔溃疡愈合时间及皮疹消退时间均短于对照组,差异有统计学意义（P＜0.05）。结论 重组人干扰素α1b注射液治疗小儿手足口病疗效确切,可有效加快患者临床症状改善,缩短患儿病程。