问题解答

北京管庄医院杨振威医生问：社区对脑卒中如何进行康复指导？ 北京市垂杨柳医院袁伟红医生答：根据患者的具体情况，制定相应的训练计划与内容，教会患者及家属在家中进行康复训练和注意事项，鼓励其持之以恒，不懈努力，以获得最大限度的功能改善。     

脑卒中急性期不同时间开始康复的初步探索

目的观察脑卒中急性期不同时间开始康复治疗的效果。方法将急性脑卒中患者120例随机分成3个不同时间开始康复训练3周的康复组和1个对照组,比较四组的康复效果。结果各康复组其简化Fugl—Meyer运动功能评定表（FMA）、Fugl—Meyer平衡功能评定表（平衡功能）、日常生活活动能力评定表（MBI）及汉密尔顿抑郁量表（HRSD）的评定数值与对照组比较差异有统计学意义（P〈0．01）,而各康复组之间差异均无统计学意义（P〉0．05）。结论脑卒中早期康复治疗可以明显改善脑卒中患者运动功能、日常生活活动能力及情绪。脑卒中病情稳定8d内不同时间开始康复治疗的短期康复效果相仿。     

应用循证实践思想 构筑糖尿病全面防线

在循证实践思想的指导下,对糖尿病前期和糖尿病的认知、自我预测危险度及强化饮食、运动、药物干预等多方面进行探讨,旨在为糖尿病高危人群构筑其全面防线,降低其罹患糖尿病的概率,减轻群体及国家的健康和经济上的负担。     

大鼠髓样细胞表达激发受体-1／人IgG融合蛋白真核表达载体的构建表达与鉴定

目的 构建大鼠髓样细胞表达激发受体-1（TREM-1）/人IgG融合蛋白的真核表达载体,并在家蚕Bm细胞中实现稳定表达。方法 克隆大鼠TREM-1胞外段与人IgGFe段,片段连接后PCR扩增,再与病毒穿梭载体BAC1连接,基因克隆,构建重组质粒。利用杆状病毒表达系统（Bar-to-Bar）筛选重组杆状病毒,在Bm细胞中进行融合表达,并用Western blot法行蛋白鉴定。结果 重组质粒酶切测序正确,确认克隆载体构建成功。Western blot结果说明该蛋白样品可被抗大鼠TREM-1抗体特异性识别,证明该蛋白为TREM-1/IgG融合蛋白。结论 成功构建了大鼠TREM-1/IgG融合蛋白真核表达载体,并在Bm细胞中稳定表达。     

社区水平的多学科综合管理对脑梗死患者二级预防效果研究

目的 研究社区水平的多学科综合管理对恢复期脑梗死患者的二级预防效果。      

髓样细胞表达的激发受体-1与急性胰腺炎的研究进展

髓样细胞表达的激发受体-1(TREM-1)是新近发现的一种在炎性反应的触发及放大过程中具有重要作用的蛋白;TREM-l通过特殊的细胞信号转导途径促进促炎介质的产生、抑制抗炎介质的表达而激活和放大炎症级联反应,因此在脓毒症、急性胰腺炎合并感染等炎症相关性疾病的发病过程中发挥着重要作用。     

重症急性胰腺炎继发感染早期肝损伤时髓样细胞表达激发受体-1的诊断价值

目的 探讨髓样细胞表达激发受体-1(TREM-1)在重症急性胰腺炎继发感染(SISAP)早期肝损伤中的诊断价值和作用机制.方法 24只雄性SD大鼠随机分为对照组、重症急性胰腺炎组(SAP组)、SISAP组.通过腹腔注射L-精氨酸、大肠杆菌构建动物模型,造模后24 h测定血淀粉酶活性、谷氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)及TREM-1表达变化;取血清和腹水进行细菌培养,取部分胰腺及肝组织光学显微镜下进行组织病理学评分;实时聚合酶链反应(RT-PCR)和western 印迹检测肝组织中TREM-1 mRNA和蛋白的表达.结果 SAP组和SISAP组胰腺及肝脏病理评分、血清淀粉酶活性、ALT和AST均明显高于对照组(P<0.05),且SISAP组较SAP组增高(P<0.05).SAP组和SISAP组的CRP、TNF-α均明显高于对照组(P<0,05),但两组间差异无统计学意义(P值分别=0.262和0.359).血清和腹水细菌培养阳性率,对照组为0/8,SAP组为1/8,SISAP组为8/8.SAP组肝脏组织TREM-1 mRNA的表达量为2.10±0.33,SISAP组为4.58±1.00,均明显高于对照组(1.00,P<0.05),且SISAP组较SAP组增高(P<0.05).SISAP组TREM-1蛋白处于较高表达水平,表达明显强于对照组和SAP组.结论 TREM-1可能在SISAP引起的早期肝损伤中具有重要作用.

Abstract：

Objective To explore the diagnosis value and the mechanism of triggering receptor expressed on myeloid cells-1 (TREM-1) in early liver damage of severe acute pancreatitis with secondary infection. Methods Twenty-four male SD rats were randomly divided into the control group, the severe acute pancreatitis (SAP) group and the secondary infection of SAP (SISAP) group.The animal model was established by intraperitoneal injection of L- arginine and E. coli. After 24 hours, the serum levels of amylase, glutamate aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and the variation of TREM-1 expression were tested. The blood and peritoneal fluid samples were collected for bacterial culture.Part of the pancreas and liver tissue were taken for histopathological score under microscope. The expression of TREM-1 at mRNA and protein level in liver tissue was detected through Real-time PCR and Western Blot. Results The histological score of pancreas and liver, serum amylase, ALT and AST were significantly higher in the SAP and SISAP groups than those in C group (P<0. 05), and higher in SISAP group than in SAP group (P<0. 05). The CRP and TNF-a expression in SAP and SISAP groups were higher then those in control group, while there was no significant difference between the two groups (P=0. 262 and 0. 359 , respectively). The positive ratio of bacterial culture in blood and peritoneal fluid was 0(0/8), 12. 5% (1/8), and 100% (8/8) in control group, SAP group and SISAP group respectively. The expression of TREM-lmRNA in liver was 2. 10 ± 0. 33 in SAP group and 4. 58+ 1. 00 in SISAP group, which were significantly higher than that in control group (1. 00,P<0. 05) , and the expression of TREM-1 mRNA in SISAP group was higher than that in SAP group (P < 0.05). The expression of TREM-1 at protein level was higher in SISAP group,significantly stronger than that in control and SAP group. Conclusions TREM-1 may play an important role in the early liver damage caused by severe acute pancreatitis.     

髓样细胞表达激发受体-1对急性坏死性胰腺炎大鼠继发感染的判断价值

目的 探讨髓样细胞表达激发受体-1(TREM-1)在急性坏死性胰腺炎(ANP)大鼠继发感染早期的表达变化及其判断价值.方法 24只雄性SD大鼠按数字表法随机分为对照组、ANP组、ANP继发感染(SI)组.通过腹腔注射L-精氨酸、大肠杆菌建模.制模后24 h取血和腹水行细菌培养,测血清淀粉酶、C-反应蛋白(CRP)、TNF-α及TREM-1水平,胰腺组织常规病理检查,实时PCR和蛋白质印迹法检测胰腺组织TREM-1 mRNA和蛋白的表达.结果 ANP组和SI组的胰腺病理评分、血清淀粉酶水平均明显高于对照组,且SI组血和腹水细菌培养阳性率达100%,表明制模成功.SI组血CRP、TNF-α水平分别为(18.7±3.1)mg/L和(185.7±10.9)mg/L,与ANP组的(16.5±3.6)、(176.0±18.6)mg/L无显著差异.SI组的血清TREM-1水平、胰腺组织TREM-1 mRNA及蛋白表达量分别为(9.3±0.9)ng/ml、14.84.±3.45、316.2±59.2,均显著高于ANP组的(5.5±0.3)ng/ml、4.51±1.44、188.6±42.4(P值均<0.05).结论 血清TREM-1水平对急性胰腺炎继发感染早期具有一定的判断价值.     

对急诊脑梗塞患者实施绿色通道的效果观察

目的:探讨建立科学、规范化的急诊绿色通道对脑梗塞患者静脉溶栓效果的影响。方法:记录比较实施急诊绿色通道前后,对照组和观察组各30例发病小于6 h的脑梗塞患者的溶栓评估时间、影像检查时间、护士准备时间、溶栓前入院总等待时间、神经功能缺损评分。结果:观察组在溶栓评估时间、检查时间、护士准备时间、溶栓前入院总等待时间比对照组明显缩短(P0.05);患者在接受溶栓后1周、2周神经功能缺损评分(ESS)较对照组均有统计学差异(P0.05)。结论:应用急诊绿色通道能够缩短溶栓准备时间,提高脑梗塞患者静脉溶栓效果。