疫苗老慢支可以打肺炎

去年入冬以来，许多老人都出现了咳嗽、咯痰等症状。在各大医院呼吸科门诊中患有慢性阻塞性肺疾病（简称慢阻肺，英文缩写为COPD）的老年人明显增多。[编者按]     

学习与实践,不断提高临床诊治水平

编辑部嘱我为《医学殿堂》写几句话,这使我想起1987～1989年中华内科杂志创立的“医家自述”。当时许多内科学界的前辈回顾他们从医的经历和心得体会,既亲切又激励青年医师,对我有很大的启发与教育。15年过去了,而今《中国呼吸与危重监护杂志》设立了《医学殿堂》栏目,并约我撰     

脾腔静脉分流术治门静脉高压症五例

自1979年我们采用脾静脉、下腔静脉端侧吻合术治疗门静脉高压症5例,效果良好,报告如下:一般资料 5例均为男性,年龄在17—58岁,全组病例皆有肝炎,上消化道出血史技充血性脾肿大、脾功能亢进。钡透     

最大呼气流量—容积曲线和小气道病变对比观察

目的比较最大呼气流量－容积曲线（ＭＥＦＶ）和肉眼观察小气道功能病变的关系。方法根据ＭＥＦＶ测定将１３例慢性支气管炎（１１例）与支气管哮喘（２例）分为ＭＥＦＶ正常组与异常组，用纤维支气管镜（纤支镜）和超细纤维支气管镜观察其大气道和周围小气道病变，气道病变依病变程度计分表示（本文规定的计分及Ｔｈｏｍｐｓｏｎ的气管炎指数－ＢＩ）。结果两组大气道总分相近差异无显著性。ＭＥＦＶ异常组总分为７．７±０．８（Ｂ     

实验性肺纤维化肺灌洗液磷脂组分分析

对博莱霉素肺纤维化大鼠模型不同时期作支气管肺泡灌洗液(BALF)细胞计数与分类、蛋白含量测定和磷脂及其组分测定,并与肺病理变化作对照分析。结果发现BALF细胞计数和分类与肺组织细胞浸润基本一致,BALF蛋白含量增加,磷脂酰甘油(PG)随病变进展而下降,磷脂酰肌醇(PI)和磷脂酰乙醇胺(PE)升高。PG／PI比值下降,PG／PI比值可作为肺纤维化的一种标志。     

Effect of ipratropium bromide on airway and pulmonary muscarinic receptors in a rat model of chronic obstructive pulmonary disease

Objective　To observe the level of muscarinic receptors in airway and lung tissues, and the effect of inhaled ipratropium bromide on these receptors in a rat model of chronic obstructive pulmonary disease (COPD). Methods　This model was developed by exposure of rats to 250 ppm SO2 gas, 5?h/d, 5d/wk, for a period of 7 wk. The COPD rats inhaled 0.025% aerosolized iratropium bromide for 20 min, 2 times daily, in an airtight chamber. Muscarinic receptors in airway and lung tissues of normal rats, ipratropium bromide-treated COPD rats and the recovering COPD rats were measured by the radio-ligand binding assay. Results　Airway/lung pathology and pulmonary function tests showed that chronic SO2 exposure caused pathophysiologic changes similar to those observed in human COPD. The density (0.038±0.011, pmol/mg protein) and affinity (Kd, 23±11 pmol/L) of muscarinic receptors in airway and lung tissues of COPD rats were not changed compared with those of normal control rats (0.030±0.008 and 29±19, respectively, P>0.05). Densities of the muscarinic receptors were not changed after inhalation of ipratropium bromide for 5 days, but increased significantly after inhalation for 30 days, as compared with those of the untreated COPD rats. The muscarinic receptors returned the normal levels at day 6 after cessation of ipratropium bromide treatment. There were no differences among different groups of rats in equilibrium dissociation constants (Kd). Conclusion　A rat model of COPD with pathophysiologic changes similar to the human counterpart was developed using chronic SO2 exposure. There was no significant change in the number and function of muscarinic receptors in airway and lung tissues of the COPD rats, but upregulation of the muscarinic receptors was observed after long-term inhalation of ipratropium bromide.     

阴沟肠杆菌Amp C酶的诱导性及对酶抑制剂的敏感性研究

目的 探讨阴沟肠杆菌Amp C酶的特性及对酶抑制剂的敏感性,方法 用琼脂稀释法研究第四代头孢菌素头孢吡肟,第三代头孢菌素头孢他啶,头孢噻肟与β-内酰胺酶抑制剂舒巴坦联合对10株头孢他啶耐药菌的体外抗菌活性。应用紫外法和反转录多聚酶链反应（RT－PCR）研究临床常用β-内酰胺类抗生素对AmpC酶的诱导作用以及3种抑制剂对Amp C酶的抑制作用。结果 舒巴坦不能增强头孢他啶的抗菌作用,第四代头也菌素头孢吡肟对头孢他啶耐药菌有较好的抗菌活性。亚胺培南对Amp C酶的诱导作用较强,酶抑制剂R0481220具有较好的抑制作用,结论 产Amp C酶的阴沟肠杆菌引起的感染可考虑选用第四代头孢菌素头孢吡肟进行治疗。     

慢性支气管炎大鼠内皮素和肾上腺髓质素水平的变化及牛磺酸的作用

目的:探讨内皮素(endothelin,ET)和肾上腺髓质素(adrenomedullin,AdM)在慢性支气管炎大鼠血浆、支气管肺泡灌洗液(bronchoalveolarlavagefluid,BALF)和肺组织中含量的变化及牛磺酸的影响。方法:实验分为慢支组、牛磺酸组和对照组,每组6只大鼠。大鼠吸入含10-6(体积分数)二氧化硫的混合空气建立慢性支气管炎模型。放免法测定ET1和AdM含量。结果:血浆、BALF和肺组织ET1含量,慢性支气管炎动物比对照动物分别增加239%、243%和367%(P<0.01),牛磺酸组比慢支组分别降低31.7%、36.7%和62.6%(P值分别小于0.05、0.01和0.01)。血浆、BALF和肺组织AdM含量,慢支组大鼠比正常对照大鼠分别增加40%、100%和138%(P<0.01),牛磺酸组大鼠比慢支组分别减少18.6%、28.5%和29.5%(P值分别小于0.05、0.01和0.01)。结论:慢性支气管炎病程中ET1和AdM可能发挥一定作用;牛磺酸可能通过阻止ET1和AdM调节紊乱的发生发挥保护作用。