肾综合征出血热地鼠肾细胞Ⅱ型灭活疫苗的安全性、免疫性及其流行病学效果考核

目的：考核HFRS地鼠肾细胞Ⅱ型灭活疫苗的安全性、免疫法及其流行病学效果。方法：采用间接免疫荧光抗体试验（IFA）、微量细胞变性中和试验（MCPENT），检测接种者血中荧光抗体及中和抗体水平；调查接种组与对照组发病情况。结果：以怀宁、广德两县18个村为疫苗观察现场，接种组7499人，对照组7261人，中强反应率为224％（5／223）。3针全程免疫后中和抗体阳转率为63．33％（19／30），荧光抗体阳转率为38.58％（27／70）；接种后1年内接种组无发病，对照组发病3例。结论：该疫苗的安全性较好；有一定水平的免疫应答，但防病效果应进一步观察确证。     

须恙螨作为肾综合征出血热宿主的初步调查及实验研究

通过本次流行病学调查和实验研究，发现须恙螨主要分布于肾综合征出血热流行区，其地理分布与疫区的病例分布基本一致。主要传染源黑线姬鼠鼠体带螨指数为２５．１；从鼠肺抗原阳性鼠体所采集的须恙螨幼虫和小黑板采集经叮刺吸食已感染本病病毒的小白鼠乳鼠体液后的游离螨幼虫，分别分离到１株病毒，证明须恙螨具备传播媒介的先决条件。     

肾综合征出血热病毒气溶胶的物理稳定性实验研究

本文采用荧光素钠正常鼠脑悬液做模拟示踪物质，对肾综合征出血热病毒气溶胶在空气中的物理稳定性进行了测定，并与其生物稳定性做了比较。结果表明：病毒气溶胶的粒子大小在１ｕｍ左右，它随气溶胶的胶龄增长而减少，且其分散度变窄。初始气溶胶的物理回收率及其各胶龄的物理存留率均明显地高于它的生物回收率和生物存活率。本文还就肾综合征出血热病毒气溶胶的物理稳定性和生物稳定性，对本病空气传播的影响进行了讨论。     

Serum antibodies to structural proteins of Hantavirus arise at different times after infection.

An enzyme-linked immunosorbent assay (ELISA) was developed for the quantification of serum antibodies against group-specific epitopes of the glycoproteins (G1, G2) and nucleoprotein (NP) of the genus Hantavirus. This assay was used to study the kinetics of the development of serum antibodies after natural infection with Puumala-like virus in humans. To this end a panel of 34 serum samples collected from individuals at different times after natural infection was tested by the ELISA. The samples were also tested for specific IgM and IgG levels against Puumala-like virus, which provided confirmatory data about the presumed timing of infection. It was shown that serum antibodies against the G1 epitope were present in the acute and early convalescent period just before antibodies to the NP epitope could be demonstrated. In contrast, antibodies to two G2 epitopes were present not earlier than in the convalescent and late convalescent period. Since all these categories of antibodies seem to persist for long periods, antibodies against the G1 epitope and the NP epitope may be of specific diagnostic value. Furthermore, levels of G1-specific antibodies and antibodies to either NP or G2 may allow estimation of the time elapsed following initial infection.     

江苏省肾综合征出血热单价灭活疫苗中期免疫效果观察

观察HFRS单价灭活疫苗中期免疫效果。方法：采用IFAT法及MCPENT法检测荧光抗体及中和抗体。结果：3个试区加强接种人数分别为4052、4407和6354人。加强后，Ⅰ型苗荧光抗体阳性率为72．73％，GMT为14.14；中和抗体阳性率为54．55％，GMT为6．67。D型苗荧光抗体阳性率为75.00％，GMT为11.85；中和抗体阳性率为60％，GMT为9．44。加强后1年，Ⅰ型苗年均保护率为65．52％，Ⅱ型苗则为94．24％。同期，Ⅰ型苗荧光抗体阳性率维持在40％，中和抗体维持在35．00％；Ⅱ型苗荧光抗体阳性率降至10．34％，中和抗体维持在53．85％。结论：两型疫苗均有较好的中期防病效果。     

肾综合征出血热患者血清炎性细胞因子与疾病进程及预后的相关性

目的分析肾综合征出血热患者不同临床分期及不同临床分型血清中C反应蛋白、白细胞介素-1、白细胞介素-6、肿瘤坏死因子-α水平与疾病的相关性,为HFRS临床诊治提供依据。方法以2018年6月至2020年1月在锦州医科大学附属第一医院住院的37例HFRS患者和15例健康体检者(对照组)为研究对象,用ELISA法分别检测患者血清炎性细胞因子CRP、IL-1、IL-6和TNF-α水平,并分析其与临床分期、临床分型的相关性。结果临床分期为急性期和恢复期的患者血清中CRP、IL-1、IL-6和TNF-α水平均高于正常组(P<0.01),且急性期各细胞因子显著高于恢复期(P<0.01);临床分型轻型、中型、重型、危重型患者血清CRP、IL-1、IL-6和TNF-α水平较比对照组有不同程度的增加(P<0.05)。Spearman相关分析显示,CRP、IL-1、IL-6和TNF-α水平与不同临床分期呈负相关(r=-0.48,P<0.01;r=-0.59,P<0.01;r=-0.33,P=0.03;r=-0.47,P<0.01);与不同临床分型呈正相关(r=0.42,P=0.01;r=0.56,P<0.01;r=0.52,P<0.01;r=0.34,P=0.04);与预后(存活)呈负相关(r=-0.32,P=0.02;r=-0.46,P<0.01;r=-0.40,P<0.01;r=-0.37,P=0.01)。结论HFRS患者血清炎性细胞因子水平与疾病严重程度及预后密切相关。     

肾综合征出血热(HFRS)并发ARDS临床特征及抢救

目的　探讨肾综合征出血热 (HFRS)并发急性呼吸窘迫综合征 (ARDS)临床特征及诊断和抢救措施。方法　对 8例HFRS并发ADRS临床特征及血气、X检查进行分析诊断及其抢救措施。结果　 8例中 3例治愈(早期 2例 ,中期 1例 )。 5例死亡 (皆为中晚期 )。治愈率为 37 5% (3/ 8) ;病死率 6 2 5% (5/ 8)。结论　ARDS发病期别与预后关系较大。其发病机理主要是各种致病因素 ,尤其是严重感染和休克 ,使体内产生大量炎性介质、可使毛细血管扩张 ,通透性增加 ,引起间质性肺水肿。由于中性粒细胞和血小板被活化 ,可释放大量自由基 ,使肺微血管损伤和通透性增加 ,使肺含水量增高所致。救治措施 ,积极治疗和纠正原发病 ,迅速纠正缺氧 ,限制液体入量 ,早期使用胶体液 ,减轻肺水肿。早期大量肾上腺皮质激素应用 ;α受体阻滞剂 -酚氨拉明及抗胆碱能药物 -东莨菪碱应用 ,均对改善肺水肿有益。     

Hospital Frailty Risk Score Outperforms Current Risk Stratification Models in Primary Total Hip and Knee Arthroplasty

BackgroundModels for risk stratification and prediction of outcome, such as the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Method (ECM), the 5-factor modified Frailty Index (mFI-5), and the Hospital Frailty Risk Score (HFRS) have been validated in orthopedic surgery. The aim of this study is to compare the predictive power of these models in total hip and knee replacement.MethodsIn a retrospective analysis of 8250 patients who had undergone total joint replacement between 2011 and 2019, CCI, ECM, mFI-5, and HFRS were calculated for each patient. Receiver operating characteristic curve plots were generated and the area under the curve (AUC) was compared between each score with regard to adverse events such as transfusion, surgical, medical, and other complications. Multivariate logistic regression models were used to assess the relationship among risk stratification models, demographic factors, and postoperative adverse events.ResultsIn prediction of surgical complications, HFRS performed best (AUC: 0.719, P < .001), followed by ECM (AUC: 0.578, P < .001), mFI-5 (AUC: 0.564, P = .003), and CCI (AUC: 0.555, P = .012). With regard to medical complications, other complications, and transfusion, HFRS also was superior to ECM, mFI-5, and CCI. Multivariate logistic regression analyses revealed HFRS as an independent risk stratification model associated with all captured adverse events (P ≤ .001).ConclusionThe HFRS is superior to current risk stratification models in the context of total joint replacement. As the HRFS derives from routinely collected administrative data, healthcare providers can identify at-risk patients without additional effort or expense.     

肾综合征出血热疫苗效果免疫(感染)增强和免疫策略研究

目的:研究肾综合征出血热疫苗效果免疫(感染)增强和免疫策略。方法:在疫苗试区设立对照组和接种组,观察期为1995年8月至1998年12月,全程接种3针,1年后加强1针。结果:全程接种了10178人,对照人群全程观察16159人,当年发病减少数为33例,4年平均保护率达93.89％。人群接种后局部和全身反应较明显。全程接种后2周荧光(IFA)抗体和中和抗体阳转率分别为100％和44.44％,一年后分别下降到28.57％和14.80％;加强后2周IFA抗体和中和抗体阳转率分别反弹至83.33％和55.56％,其抗体几何平均滴度(GMT)也随之下降和回升。结论:疫苗是安全有效的,有较好的血清学效果和流行病学效果,有免疫增强反应,但未发现感染增强反应。此外,加强免疫很有必要。