Senescent remodeling of the immune system and its contribution to the predisposition of the elderly to infections

Objective  To review the senescent remodeling of the immune system with aging and its relevance to the increased susceptibility of the elderly to infectious diseases, along with an outlook on emerging immunological biomarkers.

Data sources  The data selected were from PubMed with relevant published articles in English or French from 1995 to the present. Searches were made using the terms “immunosenescence” and “aging” paired with the following: “innate immunity”, “T-cell”, “B-cell”, “adaptive immunity” and “biomarkers”. Articles were reviewed for additional citations and some information was gathered from web searches.

Study selection  Articles on aging of both the innate and adaptive immunity were reviewed, with special attention to the remodeling effect on the ability of the immune system to fight infectious diseases. Articles related to biomarkers of immunosenescence were selected with the goal of identifying immunological biomarkers predisposing the elderly to infections.

Results  Innate immunity is generally thought to be relatively well preserved or enhanced during aging compared with adaptive immunity which manifests more profound alterations. However, evidence, particularly in the last decade, reveals that both limbs of the immune system undergo profound remodeling with aging. Reported data on adaptive immunity is consistent and changes are well established but conflicting results about innate immunity were reported between in vivo and in vitro studies, as well as between murine and human studies. Epidemiological data suggests increased predisposition of the elderly to infections, but no compelling scientific evidence has directly linked senescent immune remodeling to this increased susceptibility. Recently, growing interest in identifying immunological biomarkers and defining “immune risk phenotypes/profiles” (IRP) has been expressed. Identification of biomarkers is in its early days and few potential biomarkers have been identified, with the Swedish having defined one IRP based on the adaptive immune response.

Conclusions  Aging does not necessarily lead to an unavoidable decline in immune functions. Instead, a complex remodeling occurs. Despite the lack of compelling scientific evidence, senescent immune remodeling surely is a significant contributing factor to the increased risk and severity of infections in the elderly. Although, no immunological biomarker has been formally linked to the increased risk of infections in the elderly, biomarkers remain a promising tool to predict the likelihood of healthy aging, the level of immune competence, and mortality risk in the elderly. Hence, more research is required to define healthy aging and identify immunological biomarkers.

     

透明质酸钠治疗膝关节骨性关节炎60例分析

目的：观察透明质酸钠关节腔内注射治疗膝关节骨性关节炎的临床疗效。方法：应用透明质酸钠注射液对门诊确诊的60例膝关节骨性关节炎患者进行关节腔内注射治疗,并运用Bristol膝关节评分系统对治疗后患者膝关节疼痛和功能改善情况进行对比分析。结果：除2例无明显好转外,余58例治疗后关节疼痛和功能活动均得到明显改善。结论：透明质酸钠注射液对膝关节骨性关节炎具有较好疗效,无明显不良反应。     

经皮气管切开术在院前急救中的应用20例分析

目的:探讨经皮气管切开术(percutaneous tracheostomy,PT)的院前应用价值.方法:对我科在院前急救中采取PT建立人工气道的20例进行回顾性分析.结果:PT手术时间短,出血量少,并发症少,术后均安全转送病房.结论:PT值得在院前急救中推广应用.     

奥美拉唑不同途径、不同剂量给药抑制胃酸的效果

目的 :研究不同途径、不同剂量奥美拉唑抑制胃酸的效果 ,指导临床合理用药。方法 :将 10 0例内窥镜证实为活动期消化性溃疡病人分成A组 4 0例 ,静脉推注奥美拉唑 4 0mg ,bid ;B组 36例 ,口服奥美拉唑 2 0mg ,bid ;C组 2 4例 ,口服奥美拉唑 2 0mg ,qd。监测用药后d 3～ 5胃内 2 4hpH值变化 ,对A ,B 2组中各 10例 (为A2 ,B2 组 )测定了首次给药后的药物起效时间。结果 :A ,B组的抑酸效果相仿 (P >0 .0 5) ,胃内 pH值分别为 7.0 7±s0 .15和6 .9± 0 .6 ,与C组胃内 pH值 5.8± 1.4相比 ,差异有非常显著意义 (P <0 .0 1) ;A2 组起效时间为 (0 .7± 0 .6 )h ,B2 组为 (4.8± 1.0 )h ,差异有非常显著意义 (P <0 .0 1)。结论 :不同途径 3种剂量的奥美拉唑均有良好的抑酸效果 ,A ,B组更佳 ;静脉用药起效更迅速     

国产克拉霉素的短程三联疗法根除幽门螺杆菌感染的疗效

目的 :观察国产克拉霉素的短程三联疗法根除幽门螺杆菌 (Hp)感染的疗效及不良反应。方法 :91例Hp阳性的消化性溃疡或糜烂性胃窦炎病人 ,分为A组 ( 4 7例 ,男性 4 0例 ,女性 7例 ,年龄 57a±s14a)和B组 ( 4 4例 ,男性 4 0例 ,女性 4例 ,年龄59a± 15a)。A组以奥美拉唑 2 0mg、替硝唑 50 0mg及国产克拉霉素 2 50mg ,po ,bid ;B组治疗同A组 ,只是将国产克拉霉素改为进口克拉霉素 ,疗程均为 7d。疗程结束 1mo后复查胃镜及Hp。结果 :A ,B 2组Hp根除率分别为 85%和 91% ,不良反应发生率分别为 11%和 14% ,但均能耐受 ,2组比较差异无显著意义 ,P >0 .0 5。每例抗Hp费用A组为 4 70元、B组 550元。结论 :A ,B 2组疗效相近 ,均无严重不良反应 ,但A组费用较低 ,提示国产克拉霉素可替代进口克拉霉素用于Hp根除     

四种短程三联疗法根除幽门螺杆菌的随机对照临床研究

目前,根除幽门螺杆菌（Ｈｐ）是治疗消化性溃疡及慢性胃窦炎的主要措施之一。以质子泵抑制剂（ＰＰｌｓ）为基础的短程三联疗法是近几年来国外最常用的Ｈｐ根除方案［１］,但国内仅有少量文献报道［２］。我们以ＰＰｌｓ为基础,采用不同的药物及剂量搭配,构成４种短程...     

3967例上消化道出血胃镜检查结果分析

上消化道出血是内科常见急症,为探讨其病因分布规律,本文对我院1988～1997年3967例上消化道出血患者的胃镜检查结果作一回顾性分析。     

老年人肝功能异常病因分析及影像学诊断意义(附247例病例报告)

目的 探讨老年人肝功能异常病因及影像学诊断意义。方法 对247例60～95岁老年肝功能异常分别进行相关实验室检查和影像学检查．后包括B超，CT和MRI。结果 本组中肝脏本身疾病引起肝功能异常134例，肝外疾病引起105例，原因不明8例。其中72例是由影像学方法加以明确的。结论 选择合适的实验室和影像学检查对老年人肝功能异常的病因诊断有很大价值。     

奥美拉唑治疗老年人反流性食管炎

目的：观察奥美拉唑对我国老年人反流性食管炎的疗效。方法：老年人反流性食管炎４５例，男性４１例，女性４例，年龄７５±ｓ５ａ，单以奥美拉唑２０ｍｇ，ｐｏ，ｑｄ，治疗８ｗｋ。结果：治疗８ｗｋ临床全部有效，内镜检查的愈合率９３％，愈合者停药２ｍｏ，６ｍｏ，１２ｍｏ累积复发率分别为６０％，８２％，９１％；３９例复发者１５例需２０ｍｇ，ｑｄ，１９例需２ｄ服２０ｍｇ，５例需３ｄ服２０ｍｇ维持治疗，观察３～１２ｍｏ，症状缓解率分别为１００％，８９％，６０％。结论：奥美拉唑对我国老年人反流性食管炎的近期及维持治疗均有良好疗效，但停药后复发率高，需维持治疗，且维持剂量不宜过低     

零度位复位法治疗急性肩关节前脱位20例体会

探讨零度复位法治疗急性肩关节前脱位的临床疗效。对运用该方法治疗的20例病例资料进行回顾性分析。门诊随访3个月~2年,肩关节功能恢复良好,未见明显并发症及习惯性脱位发生。该方法具有操作简单、省力、易于掌握、安全度高等优点,值得临床推广应用。