新型甲型H1N1流感危重症存活和死亡病例的临床特点分析

Objective To understand the clinical features of critically ill patients with pandemic 2009 influenza A(H1N1)and investigate the risk factors associated with death cases. Methods The clinical features of 55 critically ill patients with pandemic 2009 influenza A(H1N1)viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15,2009 were retrospectively analyzed,and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. Results There were 31 males and 24 females.The age ranged from 10 months to 84 year old,and the mean(SD)was 38(20)year old.The critically ill cases were more in patients under age 65(48/55),with obesity(33/49),with underlying diseases(26/49),and pregnancy(6/24).Both the survivors and non-survivors of patients had high fever,cough,sputum(some sputum with blood),dyspnea,r(a)les of both lungs fields.and all further developed severe pneumonia.The patients also showed respiratory failure(54/55)and ARDS(26/55).All of them received oseltamivir therapy,and 38 patients received mechanical ventilation and 30 were giyen steroid therapy.Secondary infection occurred in 27 cases.and ventilatorassociated pneumonia happened in 10 patients.In the early stage of onset,C-reactive protein(CRP) increased [ (131 ± 130)mg/L] and low counts of T lymphecytes were present [ CD4+ , CD8+T was (217 ±139)/μl and (162 ± 82)/μl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P <0. 05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks ( OR was 6. 512, 19. 631 respective0ly, both of P value was low than 0. 05 ). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. Conclusions Critical illness in pandemic 2009 influenza A (H1N1)was associated with patients under age 65, with obesity,underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.     

重症急性胰腺炎并发乳糜腹水3例

乳糜腹水常见病因多为肿瘤或感染导致的淋巴管破裂,胰腺炎并发乳糜腹水临床罕见,如延误诊断,病死率甚高.现报道我科收治3例重症急性胰腺炎合并乳糜腹水病例,并结合文献总结分析如下. 资料与方法 2009年1月-2012年3月我科收治3例重症急性胰腺炎并发乳糜腹水患者,男1例,女2例,年龄分别为53、65、78岁.3例均无肝硬化、结核病、丝虫病及外伤史,1例因重症急性胰腺炎胰周脓肿行引流术.实验室检查血甲胎蛋白、癌胚抗原、CA199均阴性.入院查CT,2例提示坏死性胰腺炎合并胰周积液、腹水;予禁食、抑制胰酶分泌、静脉营养及肠内营养支持、腹腔坏死物引流等治疗,腹胀缓解,腹水减少,但分别于18、20 d腹胀加重,复查CT提示坏死性胰腺炎、胰腺假性囊肿形成、腹水;再予腹腔穿刺,引流液呈乳白色不透明乳糜样.1例为胰周脓肿引流术后,CT示腹水,即行腹腔穿刺置管持续引流,引流液为乳白色浑浊液体.腹水检查:外观为乳白色液体,乳糜定性均阳性,细胞总数分别为750× 106/L、420 × 106/L、6180×106/L,淋巴细胞＞80％,腹水甘油三酯分别为7.13 mmol/L、9.40mmol/L、90.0 mmol/L;腹水淀粉酶分别为3103、39、30 U/L.重症急性胰腺炎并发乳糜腹水诊断明确.     

精治细防 去根除苗——读《婴童哮论》有感

《婴童哮论》一书,是导师王烈教授撰写的防治小儿哮喘的专著,由吉林科技出版社出版。全书分昔医论哮、当代治哮、治哮实践及家长须知4部分。该书问世1年,深受读者和广大哮喘患儿家长的欢迎。不久前还被中华中医药学会评为优秀中医药著作并获奖。我们不仅有幸阅读此书,而且亲历王老防治婴童哮喘的实践。特别是王老总结临证研究防治哮喘,历60年的经验,概括为精治细防,去根除苗的理论,成     

恩替卡韦临床应用专家共识:2015年更新

<正>恩替卡韦(entecavir,ETV)是当前慢性乙型肝炎(chronic hepatitis B,CHB)患者抗病毒治疗的一线药物之一。2005年美国食品与药品管理局与中国国家食品药品监督管理局相继批准ETV用于CHB治疗。为了规范与优化ETV的临床应用,《中华实验和临床感染病杂志(电子版)》编辑部、《中国肝脏病杂志(电子版)》编辑部曾于2009年邀请国内部分感染病学与肝病学领域专家召开了     

新型甲型H1N1流感危重症存活和死亡病例的临床特点分析

Objective To understand the clinical features of critically ill patients with pandemic 2009 influenza A(H1N1)and investigate the risk factors associated with death cases. Methods The clinical features of 55 critically ill patients with pandemic 2009 influenza A(H1N1)viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15,2009 were retrospectively analyzed,and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. Results There were 31 males and 24 females.The age ranged from 10 months to 84 year old,and the mean(SD)was 38(20)year old.The critically ill cases were more in patients under age 65(48/55),with obesity(33/49),with underlying diseases(26/49),and pregnancy(6/24).Both the survivors and non-survivors of patients had high fever,cough,sputum(some sputum with blood),dyspnea,r(a)les of both lungs fields.and all further developed severe pneumonia.The patients also showed respiratory failure(54/55)and ARDS(26/55).All of them received oseltamivir therapy,and 38 patients received mechanical ventilation and 30 were giyen steroid therapy.Secondary infection occurred in 27 cases.and ventilatorassociated pneumonia happened in 10 patients.In the early stage of onset,C-reactive protein(CRP) increased [ (131 ± 130)mg/L] and low counts of T lymphecytes were present [ CD4+ , CD8+T was (217 ±139)/μl and (162 ± 82)/μl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P <0. 05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks ( OR was 6. 512, 19. 631 respective0ly, both of P value was low than 0. 05 ). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. Conclusions Critical illness in pandemic 2009 influenza A (H1N1)was associated with patients under age 65, with obesity,underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.     

慢性萎缩性胃炎胃镜活检时两种活检钳取材深度的对比分析

目的：探讨并对比分析无针胃钳与有针胃钳对慢性萎缩性胃炎活检时的取材深度。方法：四位医生对245例慢性萎缩性胃炎胃镜下活检,使用无针胃钳136例,使用有针胃钳109例,依据病理诊断,比较两组取材深度有无差异。结果：①慢性萎缩性胃炎的内镜诊断与病理诊断无明显差异。②四位医生使用两种活检钳时取材深度无明显差异。③两种活检钳取材深度一致性较好,无明显差异。结论胃镜下活检时,取材深度与活检钳类型无关,有针胃钳可用无针胃钳代替。     

血红素加氧酶-1调节哮喘豚鼠的氧化-抗氧化失衡

目的 探讨血红素加氧酶-1(heme oxygenase-1,HO-1)在哮喘氧化-抗氧化反应中的作用及机制.方法 30只豚鼠完全随机分为3组,每组10只.哮喘组:参照Huston法,用卵蛋白(ovalbumin,OVA)建立哮喘豚鼠模型.地塞米松组:应用地塞米松防治哮喘豚鼠模型.正常对照组:用0.9%生理盐水代替OVA致敏豚鼠,诱发同哮喘组.各组豚鼠应用分光光度法分别检测肺组织HO-1活性、血清及肺组织脂质过氧化物丙二醛(MDA)含量、血清抗氧化物胆红素含量,观察肺组织病理变化及HO-1蛋白表达.结果 哮喘组肺组织HO-1活性增加[生成胆红素量为(901.12±321.53)pmol/(mg protein · h)]、血清和肺组织MDA增加[血清MDA为(12.25±2.49)mmol/ml,肺组织MDA为(69.38±7.49)nmol/mg protein]、血清胆红素减少[(0.54±0.23)pmol/L],与正常对照组和地塞米松组比较差异均有统计学意义(P<0.01).哮喘组肺组织HO-1蛋白表达为3~4级.地塞米松组前3项指标较哮喘组显著下降(P<0.01),而血清胆红素水平较哮喘组显著上升(P<0.01),而与正常对照组比较差异无统计学意义(P>0.05);肺组织HO-1蛋白表达为1~2级.结论 哮喘发作时体内HO-1蛋白表达和活性增加,用以代偿胆红素的减少,调节哮喘的氧化-抗氧化失衡,保护机体防御氧化应激损伤,减轻哮喘过敏症状或气道高反应性.

Abstract：

Objective To explor the antioxidant effects of heme oxygenase-1(HO-1) for asthma and its mechanism.Methods Thirty two months old healthy male guinea pigs were randomly assigned to 3 groups,all of them were feed under the same management condition.Asthmatic group,refering to Huston′s research results,were sensitized by exposure to aerosolized ovalbumin(OVA) in order to build the guinea pig modle of asthma.Dexamethasone group(DG),were also sensitized by exposur to aerosolized ovalbumin as well as the asthmatic group had done and then treated with dexamethasone.Normal control group(NCG):were treated with 0.9% sterile sodium chloride.All the tested animals were measured the activity of lung HO-1,levels of malondialdehyde (MDA) in the lung tissue or serum and bilirubin in the serum by spectrophotometry.And the pathology and expression of HO-1protein in the lung tissue were observed.Results In the OVA induced asthmatic group,the HO-1 activity and level of MDA in lung tissue or serum were markedly increased compared with the groups of NCG and DG (P<0.01) and the expression of lung HO-1 protein was as 3~4 grade.While level of bilirubin was markedly reduced compared with NCG and DG.For example,in asthmatic group,the activity of lung HO-1 was,the level of bilirubin formed,(901.12±321.53)pmol/(mg MDA was(69.38±7.49)nmol/mg protein,and the level of bilirubin in serum was (0.54±0.23)pmol/L.In DG,the data of HO-1 and MDA as described above were markedly reduced compared with the OVA induced asthmatic group(P<0.01),and lung protein expression was 1~2 grade,while the level of bilirubin in the serum was increased(P<0.01).But,all datas of DG had no significant difference compared with NCG(P>0.05).Conclusion The guinea pigs′ in vivo lipid peroxide level increases and the level of bilirubin,an antioxidant,markedly decrease during asthma attacks,which induce the imbalance of oxidant and antioxidant.Content level and activity of HO-1 protein can increase in asthma body in order to compensate the reduce of bilirubin level,regulate the imbalance of oxidant and antioxidant,protect lung tissues from oxidizing reaction damage and relieve allergy or asthma symptoms.     

丙型肝炎病毒感染的流行病学研究进展

丙型肝炎病毒(hepatitis C virus, HCV)感染呈全球性流行,不同年龄、性别及种族对HCV均易感[1-3]。WHO提出了在2030年前消除病毒性肝炎的战略,HCV多呈隐匿性感染,多数人感染后并不知情,完成该战略需要诊断出90%的HCV感染者,且诊断出的感染者80%以上接受治疗[4]。1丙型肝炎病毒感染全球流行现状既往资料显示,全球有1.3亿~1.5亿HCV感染者[5]。近期,一项应用马尔可夫模型回顾了2000年1月至2016年3月期间的HCV流行病学相关文献的研究显示[6],2015年全球约有7100万HCV感染者。