肠道菌群失调与皮肤科常见结缔组织病相关性概述

【摘要】 越来越多的研究发现，肠道菌群与结缔组织病具有相关性。本文概述肠道菌群的特点及其在结缔组织病中的作用机制，重点阐述肠道菌群失调在红斑狼疮、系统性硬化病、干燥综合征中的相关性、可能作用机制及相关假说。通过益生菌调节肠道菌群失调可作为这些常见结缔组织病的治疗手段之一。     

首发精神分裂症病人家属心理问题与家庭干预的对照研究

目的探讨首发精神分裂症病人家属的心理问题,评估家庭干预效果.方法采用症状自评量表(SCL=90),对住院164例首发精神分裂症病人的家属和根据病人性别、年龄、居住地、婚姻状况、有无公费医疗等因素配对的健康人家属进行评定.在为期1年的治疗中对精神分裂症病人及家属采取综合式家庭干预措施,包括进行精神病知识教育、心理疏导、支持、帮助与指导;采用认知棗行为家庭干预措施,如药物处理模式、交流技巧、解决难题训练、应对应激等.结果首发精神分裂症病人入组时病人家属的躯体化、强迫、抑郁、焦虑、敌意、精神痛性、其他等7个方面评分高于健康人家属,差异显著;在病人治疗1年后病人家属各因子评分与健康人家属比较均无显著差异;自身比较,病人入组时病人家属强迫、人际敏感、抑郁、焦虑、敌意、其他6个因子评分高于病人治疗1年后,差异显著.结论首发精神分裂症病人家属在病人入组时存在较严重的心理健康问题,但通过综合式家庭干预,可以提高病人家属心理健康水平.     

162 对从外周静脉置入中央输液导管治疗的评估

从外周静脉置入中央输液导管 (PICC)是将导管由肘前静脉插入至上腔静脉 ,使药物、血制品等直接输入上腔静脉 ,避免了化疗药物对周围末梢静脉的损害 ,同时减少了病人晕针、恐惧及治疗过程中多次静脉穿刺。PICC是由柔软的硅制输液管和封闭的顶端阀门组成 ,该阀门可让液体进入 ,并阻止回血或气泡栓塞。由外周静脉穿刺比在中心静脉置管增加了安全性 ,同时减少了导管冲洗(不用时 ,每 7d用生理盐水冲洗一次即可 )。作者回顾了布里斯托血液与肿瘤中心自应用 PICC治疗至 2 0 0 0年 4月共 6 6例病人的治疗效果。该中心由专职护士执行 PICC输液…     

补血回生汤治疗化疗后不良反应48例临床观察

目的：探讨补血回生汤治疗化疗后不良反应的临床疗效。方法选取2010年2月—2014年2月在我科接受肿瘤化疗的患者96例,随机分为观察组和对照组,每组患者48例。观察组患者在化疗后给予服用补血回生汤,对照组患者只进行化疗不采取其他治疗手段,对比观察2组患者的不良反应情况。结果观察组患者疾病的有效治疗率为95.83%,对照组有效治疗率为81.25%,观察组患者治疗总有效率明显高于对照组,差异具有统计学意义（P<0.05）。观察组患者不良反应总发生率为29.17%,明显低于对照组的83.33%,差异具有统计学意义（P<0.05）。观察组患者满意度为81.25%,而对照组仅为62.50,观察组患者满意度明显高于对照组,差异具有统计学意义（P<0.05）。结论化疗后采用补血回生汤治疗,可以有效提高疾病治疗率,降低不良反应的发生,提高患者的满意度,适于在临床上推广。     

趋化因子CCL21与自身免疫性内分泌疾病

趋化因子CCL21是趋化因子受体(CCR)7的一个配体。它在次级淋巴器官(胸腺、淋巴结、脾脏)中组成性高表达。CCL21在自身免疫性疾病尤其是在糖尿病和自身免疫性甲状腺疾病的发生、发展中有重要作用。CCL21通过诱导内皮引导T细胞进入炎症和感染部位,刺激淋巴细胞增殖、诱导形成淋巴样结构,从而促进自身免疫的进展。     

碘过量对NOD和Balb/c鼠甲状腺TRAIL和TRAIL-sR1表达的影响

Objective To investigate the influence of iodine excess on expression of TRAIl/TRAIL-sR1 in NOD and Balb/c mice and to study the effect of TRAIl/TRAIL-sR1 on the pathogenesis of experimental autoimmune thyroiditis(EAT). Methods Both Balb/c and NOD mice were divided randomly into control and iodine excess group by feeding with water containing no NaI or 0.05% Nal. The mice were sacrificed after 8 weeks. TRAIL and TRAIL-sR1 mRNA levels were detected by RT-PCR. The function, morphology and apoptosis of thyroids were also observed by ELISA and Tunnel stain. Results Treated by HI, enlarged follicles and flattened epithelium by accumulation of colloid were found in thyroids of both NOD and Balb/c mice. But significant lymphoid cell infiltration and local fibrosis were only found in thyroids of NOD HI group. The relative weight of thyroids of NOD mice in HI group[(104.8±14.5)mg/kg]was heavier than that of control group [(71.8±20.4)mg/kg]. The level of TT4 declined in HI group[(30.77±3.59)mmol/L]compared with control group[(36.43±2.66)mmol/L], meanwhile, the level of TSH was higher in HI group[(6.98±0.66)μg/L]than that in control group [(5.55±0.56)μg/L]. The difference being statistically significant(t=7.773,-9.526,-4.458, all P < 0.05). The relative weight of thyroids of Balb/c mice of HI group[(155.8±20.8)mg/kg]also heavier than that of control group [(105.1±22.0) mg/kg]. The level of TT4 droped in HI group [(19.75±3.32) mmoL/L]was higher than that in control group[(23.46±6.21)mmoL/L], the level of TSH in HI group[(4.14±1.71)μg/L]was higher than that in control group[(3.55±1.41)μg/L], the difference being statistically significant(t=7.554,-7.239,3.140, all P< 0.05). A great deal of apoptotie ceils observed in NOD (3.97±0.91) and Balb/c mice (1.05±0.45) by Tunnel stain were greater than control groups (0.21±0.15, 0.10±0.03), the difference being statistically significant in beth of the two species(t=-7.167,-17.772, both P < 0.05). The apoptosis index of thyroid follicular epithelium in NOD was obviously higher than Balb/c(t=-7.625, P<0.05). The level of TRAIL mRNA did not remarkably change in Balb/c between control group(0.000 59±0.000 39) and HI group(0.001 24±0.000 46, t=-1.940, P>0.05), but it increased apparently in NOD mice HI group(0.018 88±0.005 77) than that of control group(0.009 61± 0.00591, t=-2.71, P<0.05). The level of the expression of TRAIL-sR1 mRNA increased in HI groups of NOD (0.000 53±0.000 15) and Balb/c mice(0.000 42±0.000 09) than that in control groups of NOD(0.000 28± 0.000 05) and Balb/c mice (0.000 17±0.000 06) and the differences were statistically significant between the two species(t=3.050,3.990, all P<0.05). The differences of the expression of TRAIL and TRAIL-sR1 mRNA between the two species were significant(t=-3.37,-4.76, all P<0.05). Conclusions Iodine excess induces colloid goiter in beth species of mice and thyroiditis in NOD mice. The increase of TRAIL and TRAIL-sR1 influenced by iodine excess is one of the molecular bases of follicular epithelium apoptosis and inflammation in thyroids. Genetic factor is a key factor in the pathogenesis of thyroiditis.     

氯普鲁卡因骶管麻醉在肛门直肠部手术中的应用

氯普鲁卡因是短效酯类局部麻醉药,具有起效迅速、作用强、毒性小、恢复快等优点。本文选择2010年4月至6月120例需骶管麻醉的肛门直肠部手术患者,与利多卡因作对照观察,探讨氯普鲁卡因在此类手术中应用的优越性,现报告如下。     

碘过量和多聚肌苷酸-聚胞苷酸及甲状腺球蛋白诱发小鼠甲状腺炎对Toll样受体3表达的影响

Objective To observe the effect of iodine excess(HI),polyinosinic-polycytidylic acid[Poly(I:C),Poly]and thyroglobulin(TG)on the thyroid of mice by the expression of Toll-like receptor 3(TLR3)to reveal the functional role of TLR3 in autoimmune thyroiditis.Methods Forty-two non-obese diabetic mice,body weight (20±3)g,were divided into six groups:control group,HI group,Poly group,TG group,HI+TG group,HI+Poly group. Fed with deionized water and injected intraperitoneally with physiological saline 0.1 ml each day for a week, the mice in control group were injected with physiological saline every other day at the same dose for 1 week before they were sacrificed; HI group drank 0.05% NaI water and were injected intraperitoneally with physiological saline same as control group; Poly group drank deionized water and were injected intraperitoneally with poly 0.1 ml (1 g/L)each day of the week, then the mice were injected with Poly every other day at the same dose for 1 week before they were sacrificed; TG group drank deionized water and were injected intraperitoneally with physiological saline same as control group, immunized with 0.1 mg TG by subcutaneously injecting and the immunization was enhanced after they were fed half dose for 4 and 8 weeks separately. In HI + Poly group, the treatment was the same as HI group and Poly group; HI + TG group: the treatment was the same as HI group and TG group. Eight weeks later, mice were sacrificed and thyroids were taken to make frozen sections, Hematoxylin-Eosin (HE) staining was employed to observe the morphological change of the thyroids. The expression of TLR3 of thyroids was observed under fluorescence microscope after Immumofluorescence using TLR3 antibody and TR3-positive cells were analyzed in the thyroid density. Results HE staining showed thyroids of Poly group had no inflammation under microscope.There were different degrees of inflammatory cell infiltration in HI group and TG group. The inflammatory cell infiltration and the damage of follicular thyroid of HI + TG group and HI + Poly group were serious, and the degrees of inflammation were higher over "++". Thyroid follicular epithelial cell with TLR3 expression could be seen in Poly group and HI group, meanwhile, there were TLR3 strong positive inflammatory cells in HI group under fluorescent microscope. Using stereological analysis of TLR3-positive cell density in the thyroid, the difference between groups was statistically significant(F=7.870, P<0.01 ). TLR3-positive cell density in the thyroid of HI + Poly group was higher[ (9.287 ± 0.522)mm2] than control group[ (0.062 ± 0.025)mm2, P < 0.01] significantly, meanwhile, the density in HI + Poly group was higher than HI group [ (2.574 ± 0.257 )mm2] and Poly group[ (1.361 ± 0.148 )mm2, all P < 0.01]. The density in HI + TG group[ (4.843±0.405)mm2] was higher than HI group and TG group[(1.601 ±0.268)mm2, all P < 0.01 )]. Conclusions Excessive iodine and thyroglobulin can induce thyroiditis, and stimulate the expression of TLR3 in the thyroid follicular epithelial, Poly aggravated thyroiditis induced by iodine excess in NOD mice; TLR3 positive inflammatory cells also appeared in inflammatory region, suggesting that TLR3 is involved in the pathogenesis of autoimmune thyroiditis     

华法林预防老年非瓣膜病慢性心房颤动患者缺血性脑卒中的临床研究

目的观察调节剂量的华法林和阿司匹林预防老年非瓣膜病慢性心房颤动患者缺血性脑卒中的效果及安全性。方法 97例60-75岁非瓣膜病慢性心房颤动患者随机分为两组。华法林治疗组每日口服华法林1次,调节剂量使国际标准化比值(INR)维持在 2．0-3．0。阿司匹林治疗组每日口服阿司匹林300 mg,分两次。观察两组缺血性脑卒中及出血等不良反应的发生情况。结果华法林治疗组缺血性脑卒中的年发生率为 0．94％,阿司匹林治疗组的年发生率3．97％。两组比较差异有显著性(P<0．05)。两组的主要不良反应皆为少量出血,发生率比较差异无显著性(P>0．05)。无大量出血病例。结论预防老年非瓣膜病慢性心房颤动患者脑卒中的发生,调整剂量的华法林比阿司匹林具有更显著的效果,且安全性好。