毛细支气管炎患儿血清白细胞介素-4及尿白三烯E4水平的临床观察

目的 探讨毛细支气管炎患儿血清IL4及尿白三烯E4(LTFA)水平变化与病情分度的关系.方法 选择2006年12月至2008年12月我院小儿呼吸科住院毛细支气管炎患儿100例,按病情程度分为轻度、中重度两组,轻度组52例,中重度组48例.另选择健康体检儿50例为对照组.采用酶联免疫吸附法测定血清IL-4及尿LIFA水平.结果 毛细支气管炎患儿发病急性期血清IL-4水平为(11.34±7.56)ng/L,尿LTFA(20.3±4.75)pmol/μmol Cr;恢复期血清IL-4(6.84±5.64)ng/L及尿LTE4(3.6±1.12)pmol/μmol Cr;健康组IL-4(5.72±2.24)ng/L及尿LTFA(1.43±0.14)pmol/μmolCr.毛细支气管炎患儿发病急性期血清IL-4及尿LTE4明显增高(P<0.01).中重度组血清IL-4为(15.32±6.85)ng/L,及尿LTE4为(28.8±4.71)pmoL/μmol Cr,高于轻症组IL-4[(7.64±4.31)ng/L]及尿LTE4[(18.1±3.52)pmol/μmol Cr],两组问差异有显著性(P<0.05).恢复期IL-4为(6.84±5.64)ng/L 及尿LTFA为(3.6±1.21)pmol/μmol Cr;正常健康对照组IL-4(5.72±2.24)ng/L及尿LTE4(1.43±0.14)pmol/μmol Cr,两组间差异无显著性(P>0.01).血清IL-4与尿LTE4检测结果呈正相关,r值分别为0.628、0.564(P<0.01).结论 血清IL-4及尿LTE4水平可作为毛细支气管炎病情严重程度的指标之一,有利于指导临床诊治.     

呼吸道合胞病毒毛细支气管炎患儿尿白三烯测定及临床意义

目的 探讨呼吸道合胞病毒(RSV)毛细支气管炎(毛支)患儿尿白三烯E4(LTE4)的临床意义.方法 采用竞争性酶联免疫吸附试验技术检测20例健康婴儿和30例RSV毛支患儿急性期和恢复期的尿LTE4水平;采用潮气分析测定急性期患儿呼吸频率(RR)、达峰时间比(tPTEF/tE)及达峰容积比(vPTEF/vE),分析其与尿LTE4水平的相关性.结果 RSV毛支患儿急性期的尿LTE4比恢复期、正常健康组明显增高(P＜0.01),恢复期与正常健康组相比差异无统计学意义(P＞0.05);急性期毛支患儿潮气肺功能中RR增快、tPTEF/tE和vPTEF/vE下降,与正常健康组比较,差异有统计学意义(P＜0.0001);急性期尿LTE4浓度与RR呈正相关(r=0.4376,P=0.0126),与tPTEF/tE和vPTEF/vE呈负相关(r=-0.6895,-0.6636,P均＜0.001).结论 RSV毛支患儿尿LTE4增高,与肺功能指标呈负相关;尿LTE4浓度可作为RSV毛支临床诊治的非创伤性炎性指标.     

急性肺损伤患儿血浆血小板活化因子和尿白三烯E_4水平变化及其临床意义

目的探讨急性肺损伤(acute lung injury)患儿血浆血小板活化因子(platelet-activating factor,PAF)和尿白三烯E4(leukotriene E4,LTE4)的动态变化及其临床意义。方法采用ELISA法分别检测肺损伤患儿血浆中急性期及恢复期PAF的水平以及尿液中LTE4的变化。同时检测吸入氧浓度、血气分析、C-反应蛋白及胸片、心超等。同期接受健康体检的儿童为对照组,检测其PAF和LTE4。结果急性肺损伤患儿急性期PAF较恢复期水平明显升高,差异有统计学意义(P<0.01),恢复期PAF与正常对照组比较差异有统计学意义(P<0.01);LTE4水平急性期较恢复期和正常对照组高,差异有统计学意义(P<0.01)。结论PAF和LTE4参与了急性肺损伤的发病过程,可作为肺损伤急性期指标之一,反映其病情变化及预后。     

哮喘患儿应用孟鲁司特后血与尿白三烯变化观察

目的探讨孟鲁司特对哮喘患儿血、尿白三烯的影响。方法选择2007年5至12月在中国医科大学盛京医院小儿呼吸内科病房及PICU住院的哮喘急性中重度发作患儿40例,采用随机数字表法随机分为两组:(1)孟鲁司特组:接受常规治疗及孟鲁司特治疗。(2)常规治疗组:只接受常规治疗。哮喘急性发作治疗前后分别留取血及尿标本,待测白三烯。另取同期儿保体检健康儿童19例作为健康对照组。结果 (1)在哮喘急性发作期,孟鲁司特组与常规治疗组白三烯质量浓度差异无统计学意义(P>0.05);在哮喘症状缓解期,孟鲁司特组白三烯质量浓度明显低于常规治疗组(P<0.01);两组白三烯水平下降值差异有统计学意义(P<0.05)。(2)健康对照组血白三烯C4(LTC4)为(105.87±17.38)ng/L,尿白三烯E4(LTE4)为(91.76±33.73)ng/L;在哮喘症状缓解期,孟鲁司特组血LTC4(152.74±31.50)ng/L,尿LTE4(129.35±42.76)ng/L;常规治疗组患儿血LTC4(188.95±39.31)ng/L,尿LTE4(170.67±52.86)ng/L。3组血与尿白三烯质量浓度差异均有统计学意义(P<0...     

细支气管炎患儿血清嗜酸性细胞趋化因子测定及肺功能检查的临床意义

目的探讨细支气管炎(简称毛支)患儿嗜酸性细胞趋化因子(eotaxin)水平及肺功能改变的临床意义。方法采用双抗体夹心酶联免疫吸附试验方法,对30例毛支急性期、20例恢复期患儿的外周血标本进行血清eotaxin水平测定,同时采用美国森迪公司2600婴儿肺功能仪进行肺功能检查,并与20例健康对照组儿童相比较。结果毛支恢复期组患儿血清eotaxin水平比急性期组明显下降(P<0.01),但两组均明显高于健康对照组儿童(P均<0.01);毛支恢复期组患儿呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF)及潮气呼气中期流速/潮气吸气中期流速(ME/MI)比急性期组明显升高(P<0.01),但25/PF仍低于对照组(P<0.01),而ME/MI与对照组相比无显著性差异(P<0.05);毛支患儿急性期组血清eotaxin水平与25/PF呈负相关(r=-0.42,P<0.05),与ME/MI无相关性(r=0.05,P>0.05)。结论毛支患儿急性期肺功能主要表现为阻塞性通气功能障碍,eotaxin参与了毛支的发病过程。     

毛细支气管炎患儿血清白细胞介素-4及尿白三烯E4水平的临床观察

目的 探讨毛细支气管炎患儿血清IL4及尿白三烯E4(LTFA)水平变化与病情分度的关系.方法 选择2006年12月至2008年12月我院小儿呼吸科住院毛细支气管炎患儿100例,按病情程度分为轻度、中重度两组,轻度组52例,中重度组48例.另选择健康体检儿50例为对照组.采用酶联免疫吸附法测定血清IL-4及尿LIFA水平.结果 毛细支气管炎患儿发病急性期血清IL-4水平为(11.34±7.56)ng/L,尿LTFA(20.3±4.75)pmol/μmol Cr;恢复期血清IL-4(6.84±5.64)ng/L及尿LTE4(3.6±1.12)pmol/μmol Cr;健康组IL-4(5.72±2.24)ng/L及尿LTFA(1.43±0.14)pmol/μmolCr.毛细支气管炎患儿发病急性期血清IL-4及尿LTE4明显增高(P<0.01).中重度组血清IL-4为(15.32±6.85)ng/L,及尿LTE4为(28.8±4.71)pmoL/μmol Cr,高于轻症组IL-4[(7.64±4.31)ng/L]及尿LTE4[(18.1±3.52)pmol/μmol Cr],两组问差异有显著性(P<0.05).恢复期IL-4为(6.84±5.64)ng/L 及尿LTFA为(3.6±1.21)pmol/μmol Cr;正常健康对照组IL-4(5.72±2.24)ng/L及尿LTE4(1.43±0.14)pmol/μmol Cr,两组间差异无显著性(P>0.01).血清IL-4与尿LTE4检测结果呈正相关,r值分别为0.628、0.564(P<0.01).结论 血清IL-4及尿LTE4水平可作为毛细支气管炎病情严重程度的指标之一,有利于指导临床诊治.     

毛细支气管炎患儿血清白细胞介素-4及尿白三烯E4水平的临床观察

目的 探讨毛细支气管炎患儿血清IL4及尿白三烯E4(LTFA)水平变化与病情分度的关系.方法 选择2006年12月至2008年12月我院小儿呼吸科住院毛细支气管炎患儿100例,按病情程度分为轻度、中重度两组,轻度组52例,中重度组48例.另选择健康体检儿50例为对照组.采用酶联免疫吸附法测定血清IL-4及尿LIFA水平.结果 毛细支气管炎患儿发病急性期血清IL-4水平为(11.34±7.56)ng/L,尿LTFA(20.3±4.75)pmol/μmol Cr;恢复期血清IL-4(6.84±5.64)ng/L及尿LTE4(3.6±1.12)pmol/μmol Cr;健康组IL-4(5.72±2.24)ng/L及尿LTFA(1.43±0.14)pmol/μmolCr.毛细支气管炎患儿发病急性期血清IL-4及尿LTE4明显增高(P<0.01).中重度组血清IL-4为(15.32±6.85)ng/L,及尿LTE4为(28.8±4.71)pmoL/μmol Cr,高于轻症组IL-4[(7.64±4.31)ng/L]及尿LTE4[(18.1±3.52)pmol/μmol Cr],两组问差异有显著性(P<0.05).恢复期IL-4为(6.84±5.64)ng/L 及尿LTFA为(3.6±1.21)pmol/μmol Cr;正常健康对照组IL-4(5.72±2.24)ng/L及尿LTE4(1.43±0.14)pmol/μmol Cr,两组间差异无显著性(P>0.01).血清IL-4与尿LTE4检测结果呈正相关,r值分别为0.628、0.564(P<0.01).结论 血清IL-4及尿LTE4水平可作为毛细支气管炎病情严重程度的指标之一,有利于指导临床诊治.     

尿白三烯E4检测在监测儿童支气管哮喘转归中的应用

目的 探讨尿白三烯E4(LTE4)检测在监测儿童支气管哮喘(哮喘)转归中的作用及哮喘患儿尿LTE4与呼吸道阻力(Rint)、外周血嗜酸性粒细胞(EOS)计数的关系.方法 选取30例1～5岁未服用过白三烯受体拮抗剂孟鲁司特钠的哮喘患儿(哮喘组),分为急性发作期、慢性持续期(服用孟鲁司特钠1个月)及临床缓解期(服用孟鲁司特钠3个月);另选取20例健康儿童作为健康对照组.采用竞争性ELISA法检测4组儿童尿LTE4水平,并测定Rint与EOS.结果 哮喘组急性发作期、慢性持续期及临床缓解期患儿尿LTE4及Rint水平均明显高于健康对照组(Pa＜0.01);3个哮喘组尿LTE4,Rint及外周血EOS比较差异均有统计学意义(F=870.08、496.58、195.98,Pa＜0.01).急性发作期哮喘患儿的尿LTE4水平与Rint无相关性(r=0.11,P＞0.05).与EOS亦无相关性(r=-0.12,P＞0.05).结论 哮喘患儿急性发作期尿LTE4水平明显升高,随着哮喘症状的好转,尿LTE4水平也逐渐下降;动态监测哮喘患儿尿LTE4水平,可以为儿童哮喘的临床诊断,白三烯受体拮抗剂治疗哮喘的疗效评估提供客观依据.     

特应性体质对毛细支气管炎患儿血清糖皮质激素受体水平的影响

目的探讨特应性体质(简称特应质)对毛细支气管炎(简称毛支)患儿糖皮质激素受体(GR)表达的影响。方法采用ELISA法测定和比较毛支组(77例,包括34例特应质患儿)和肺炎组(68例)患儿血清中GRα、GRβ水平的变化。38例同期住院的非感染性小儿外科术前患儿,且无特应性及过敏性疾病家族史的患儿作为对照组。结果与对照组比较,毛支组和肺炎组中血清GRα、GRβ水平均明显升高(P0.01);毛支组血清GRα、GRβ水平高于肺炎组(P0.01)。毛支组GRα/GRβ比值较对照组和肺炎组明显升高(P0.01)。毛支组特应质和非特应质患儿血清GRα、GRβ水平与对照组比较均明显升高(P0.01);毛支组非特应质患儿GRβ水平明显高于特应质患儿(P0.01);毛支组特应质患儿GRα/GRβ比值较对照组和毛支组非特应质患儿明显升高(P0.01)。结论毛支患儿血清GRα、GRβ表达水平增强;特应质毛支患儿表现为GRα/GRβ比值增加,提示特应质毛支患儿对糖皮质激素有较高的敏感性。     

毛细支气管炎患儿血清白细胞介素-13及肺功能检测的意义

目的探讨毛细支气管炎(毛支)患儿血清IL-13及肺功能检测的意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA),对30例毛支急性期、20例恢复期患儿外周血行血清IL-13水平测定;同时采用美国森迪公司2600婴儿肺功能仪进行肺功能检查,并与20例健康对照组儿童比较。结果毛支恢复期组患儿血清IL-13水平较急性期组明显下降(P<0.01),但两组均明显高于对照组(P均<0.01);毛支恢复期组肺功能指标中呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF)及潮气呼气中期流速/潮气吸气中期流速(ME/MI)均较急性期组明显升高(P均<0.01),但25/PF仍低于对照组(P<0.01),而ME/MI与对照组比较无显著性差异(P>0.05)。毛支患儿急性期组血清IL-13水平与25/PF呈显著负相关(r=-0.38 P<0.05),与ME/MI无相关性(r=-0.002 P>0.05)。结论IL-13参与毛支发病过程,降低其水平有助于毛支的痊愈;毛支患儿急性期肺功能主要表现为小呼吸道阻塞性通气功能障碍。     

过敏性紫癜肾炎患儿白三烯表达水平的临床及病理研究

目的 探讨白三烯(LTs)在过敏性紫癜肾炎(HSPN)发生发展中的作用,为临床使用LTs拮抗剂治疗HSPN提供科学实验依据.方法 收集患儿及健康对照儿童共77例,分成3组,HSPN组34例(18例进行肾穿刺活检术),过敏性紫癜(HSP)组27例,健康对照组16例.分别采集血清和尿液,采用酶联免疫吸附试验法检测各组血清、尿液白三烯B4(LTB4)水平;酶免疫分析法检测各组尿液白三烯E4(LTE4)水平;间接免疫荧光法检测18例进行肾穿刺活检术HSPN患儿肾组织中白三烯C4(LTC4)合酶表达,以3例薄基底膜病、4例临床诊断单纯性血尿(光镜和电镜基本正常)活检标本作对照组;检测HSPN组患儿24 h尿蛋白.结果 (1)HSPN组血清、尿液LTB4及尿液LTE4水平分别为(1164.33 ±300.28)、(841.19 ±115.23)和(1252.31 ±251.62)ng/L,高于HSP组[分别为(559.60 ±180.23)、(574.42±101.17)和(805.93 ±185.52)ng/L]及对照组[分别为(211.95±67.72)、(227.33 ±76.12)和(149.51 ±33.66)ng/L](P均＜0.01);(2)随HSPN病理分级加重,HSPN组血清、尿液LTB4及尿液LTE4水平有升高趋势;(3)随尿蛋白水平的增加,HSPN血清、尿液LTB4及尿液LTE4表达水平逐渐增加(P＜0.01或P＜0.05);(4)与对照组相比,HSPN各组肾活检组织LTC4合酶荧光强度均增强,该荧光表达与其病理分级呈密切正相关.结论 LTs参与并促进HSPN的发生发展,其在肾脏表达水平与HSPN病理分级及尿蛋白排泄密切相关.     

新生儿缺氧缺血性脑病合并心肌损伤血浆N端脑利钠肽前体的变化及与预后的相关性

目的 探讨N端脑利钠肽前体(NT-proBNP)在缺氧缺血性脑病(HIE)合并心肌损伤患儿中的变化,为临床早期诊断、治疗及预后判断提供依据.方法 选择我院收住的40例HIE患儿为研究对象(心肌损伤16例,非心肌损伤24例),以20例正常新生儿为对照组,应用ELISA方法测定血浆NT-proBNP水平;超声心动图测定患儿的心脏收缩功能.结果 (1)心肌损伤患儿NT-proBNP水平[(350±56)pmol/L]显著高于非心肌损伤组[(135±37)pmol/L]和正常对照组[(117±23)pmol/L],差异有统计学意义(P＜0.05);(2)轻、中、重度HIE组NT-proBNP水平分别为(132±34)pmol/L、(247±43)pmol/L和(343±53)pmol/L,中、重度HIE组显著高于对照组;轻、中、重度HIE组间比较差异有统计学意义(P＜0.05);(3)心肌损伤组急性期血浆NT-proBNP水平[(350±56)pmol/L]明显高于恢复期[(250±78)pmoyl/L],差异有统计学意义(P＜0.05);(4)HIE患儿NT-proBNP水平和肺动脉收缩压、左室收缩功能密切相关.结论 HIE合并心肌损伤急性期血浆NT-proBNP水平升高,有助于早期诊断心肌损伤,判断HIE病情.

Abstract：

Objective To investigate the changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury. Methods Forty neonates with HIE ( 16 cases with concurrent myocardial injury and 24 cases without) were enrolled. Twenty healthy neonates were used as control. Plasma NT-proBNP levels were measured using enzyme immunoassay. Cardiac function was measured by echocardiography. Results ( 1 ) The mean plasma NT-proBNP levels in patients with myocardial injury[(350 ± 56) pmol/L]were significantly higher than those in patients without myocardial injury[(135 ± 37 ) pmol/L]and in the control group [(117 ±23) pmol/L](P ＜0. 05). (2) The NT-proBNP levels in mild,moderate and severe HIE neonates were ( 132 ±34) pmol/L, (247 ±43) pmol/L and (343 ±53) pmol/L. Compared with the control group,the NT-proBNP levels in the neonates with moderate and severe HIE significantly increased. There were significant differences in the NT-proBNP levels among the mild, moderate and severe HIE neonates ( P ＜ 0. 05 ).(3) In patients with myocardial injury,the NT-proBNP levels significantly decreased in the convalescent phase [(250±78) pmol/L]compared with those in the acute phase[(350±56) pmol/L](P ＜0.05). (4) The NT-proBNP levels were significantly related with left ventricular ejection fraction. Conclusion Plasma NT-proBNP levels increase in neonates with HIE complicated with myocardial ischemic injury in the acute phase.Detection of NT-proBNP levels maybe useful in the diagnosis of myocardial ischemic injury and severe HIE.     

Urine leukotriene E4 and eosinophil cationic protein in nasopharyngeal aspiration from young wheezy children

Respiratory syncytial virus (RSV) infection is a risk factor for the development of asthma. It is very hard to distinguish bronchiolitis with respiratory virus infection from allergic asthma at first wheezing attack in early childhood. To distinguish wheezing children with RSV bronchiolitis from asthmatic children, we measured leukotriene E(4)(LTE(4)) in urine and ECP in nasopharyngeal aspiration (NPA) at first day of admission with wheezing attack. Thirty-two non-atopic children younger than the age of 3 yr with RSV induced bronchiolitis, 35 atopic asthmatic children with/without respiratory viral infection, and 23 children who exhibited no evidence of atopy, asthma, or virus infections as controls were selected in this study. We measured urinary LTE(4) and ECP level in NPA from subjects. Urinary LTE(4) concentrations in children with asthma were significantly higher than urinary LTE(4) in bronchiolitis and in controls (240.8 +/- 129.8 vs. 162.8 +/- 73.9 vs. 85.1 +/- 31.6 pg/ml). Children with RSV infection demonstrated higher urinary LTE(4) levels compared to children without RSV infection among asthmatic children. ECP in NPA was significantly correlated with urinary LTE(4) (r = 0.57, p < 0.01) in children entered this study who had detectable levels for both LTE(4) and ECP. In summary, Urinary LTE(4) concentrations may be suggested to useful mediators for differential diagnosis of wheezy diseases in early childhood. RSV infection also is associated with synergizing LT biosynthesis and this study demonstrated ECP in NPA was significantly correlated with urinary LTE(4) and may suggest that cysteinyl leukotriene initiate the production of ECP in early childhood, which could contribute to the development of wheeze.     

Airway eicosanoids in acute severe respiratory syncytial virus bronchiolitis

We prospectively studied the levels of eicosanoids in intubated patients with severe bronchiolitis and compared them to electively intubated non-infected infants. LeukotrieneE(4) (LTE(4)), leukotrieneB(4) (LTB(4)), and prostaglandinE(2) (PGE(2)) levels were significantly increased (P <.01) from endotracheal (ET) aspirates of infants with bronchiolitis compared with controls, as were urinary LTE(4) levels (P <.001). We conclude that eicosanoids are increased in the tracheal aspirates and urine of children with bronchiolitis.     

Nasal lavage leukotrienes in infants with RSV bronchiolitis

Respiratory syncytial virus (RSV) bronchiolitis is a very common infection in infants and, after the acute phase, a number of patients develop a reactive airway disease that lasts for years. Although the pathogenesis of the lung damage after RSV bronchiolitis is still largely unknown, previous studies suggest that leukotrienes may play an active part in it. The aim of this study was to measure leukotriene levels in the nasal lavage fluid (NLF) collected in infants during RSV bronchiolitis and 1 month later. Cysteinyl leukotrienes (Cys-LTs) and leukotriene B(4) (LTB(4)) were measured in the NLF of 22 infants with their first episode of RSV bronchiolitis and 16 healthy infants. A second NLF sample was collected to measure leukotriene levels 1 month after the acute disease. NLF Cys-LT levels were significantly higher in infants with RSV bronchiolitis than in healthy controls [950 pg/ml (285.5-2155.9) vs. 110.5 pg/ml (66.5-451.3), p = 0.01], and they remained so a month after the acute infection (p = 0.02). A subanalysis showed no difference in Cys-LTs concentrations, either between bronchiolitis infants with and without a family history of atopy, or between those with and without passive exposure to cigarette smoke. No significant difference was found between the LTB(4) levels measured in the bronchiolitis cases and the control children. Cys-LTs are significantly increased in the NLF of infants with acute RSV bronchiolitis, and remain so at 1-month follow-up, suggesting a possible role of these eicosanoids in the pathogenesis of the disease.     

N端脑利钠肽前体在新生儿缺氧缺血性心肌损伤中的变化

目的：探讨N端脑利钠肽前体(NT-proBNP)在缺氧缺血性脑病(HIE)合并心肌损伤患儿中的变化,为临床早期诊断及治疗提供理论依据。方法：选择我院收住的35例HIE患儿为研究对象(心肌损伤17例,非心肌损伤18例),以20例正常新生儿为对照组,应用ELASA方法测定血浆NT-proBNP 水平。结果：①心肌损伤患儿NT-proBNP水平(338.8±76.2 fmol/mL) 显著高于非心肌损伤组(137.5±45.1 fmol/mL) 和对照组(113.7±53.6 fmol/mL), 均P<0.01。②轻、中、重度HIE组NT-proBNP水平分别为141.3±41.6、271.8±118.1和347.2±85.1 fmol/mL,中、重度HIE组显著高于对照组（P<0.01）;轻、中、重度HIE组间比较差异有显著性,P<0.05。③心肌损伤组急性期血浆NT-proBNP水平明显高于恢复期(338.8±76.2 fmol/mL vs 225.0±80.0 fmol/mL), P<0.01。结论：心肌损伤患儿急性期NT-proBNP水平升高。对HIE患儿检测血浆NT-proBNP有助于早期诊断心肌损伤,判断HIE病情。［中国当代儿科杂志,2009,11（12）：973-975］     

儿童急性白血病不同治疗阶段血液和脑脊液TNF-α变化的研究(英文)

目的：探讨急性白血病儿童血液和脑脊液中肿瘤坏死因子(TNF-α)的变化及其临床意义。方法：采用放射免疫分析法检测31例儿童急性白血病治疗前、完全缓解时及连续完全缓解期血液和脑脊液TNF-α水平。结果：急性淋巴细胞白血病(ALL)和急性髓细胞白血病(AML)治疗前血液TNF-α水平［(24.35±4.84) pmol/L,(28.65±5.12) pmol/L］明显高于正常对照［(11.28±1.69) pmol/L］(P0.05)。合并中枢神经系统白血病(CNSL)者脑脊液TNF α明显高于未合并CNSL者［(26.47±7.14)pmol/L vs (13.15±0.92) pmol/L］,P<0.01。脑脊液TNF α与脑脊液白细胞数呈正相关(r=0.942,P<0.05),经鞘内注射治疗后脑脊液中TNF α逐步恢复正常,但较白细胞恢复慢。结论：血液和脑脊液TNF-α水平可反映白血病患者的肿瘤负荷及CNS的受累程度,是指导治疗的有益指标。     

卡介菌多糖核酸对毛细支气管炎喘息反复发作的预防作用

目的：探讨卡介菌多糖核酸(BCG-PSN)对毛细支气管炎患儿喘息反复发作的预防作用及机制。方法：40例毛细支气管炎患儿随机分为 干预组和未干预组,并取20例健康体检者作正常对照。干预组(19例)在毛细支气管炎愈后3个月给予BCG-PSN注射液1 ml(含卡介菌多糖 0.35 mg,核酸不低于30 μg)肌注,每周 2次,共24次,而未干预组(21例)在毛细支气管炎愈后未予以干预作空白对照。于干预前及 干预后1年用ELISA法测定3组外周血单个核细胞培养上清中IFN-γ,IL-4及血清IgE含量;并随访1年,观察喘息发作情况。结果：与正常对照组比较,两组毛细 支气管炎患儿干预前IFN-γ水平和IFN-γ/IL4降低,而IL-4,IgE水平增高(P0.05 );干预组患儿1年内有两次和/或以上喘息发作者(15.8%) 较未干预组婴儿(52.4% )少(P<0.05)。结论：BCG-PSN具有预防毛细支气管炎反复喘息 的作用,其机制可能与BCG-PSN能提高IFN-γ产生,抑制IL-4分泌,提高IFN-γ/IL-4 ,减少IgE生成有关。     

呼吸道合胞病毒毛细支气管炎特应性与血清IL-10及病情恢复的关系

为探讨呼吸道合胞病毒(RSV)毛纫支气管炎患儿特应性与血清白介素10(IL-10)水平及病情恢复的关系，应用酶联免疫吸附法分别检测17例年龄50天--12月，特应性体质的RSV毛细支气管炎患儿急性期与恢复期血清IL-l0水平，并以24例非特应性患儿及37例正常儿为对照组。结果显示，急性期待应性组IL—10水平与正常对照组相比，差异无显著性(P＞0．05)，但明显低于无特应性组(P＜0．001)；特应性组喘憋和肺部体征消失均较非特应性组慢，住院时间延长(P＜0．05)；恢复期两组IL-l0差异无显著意义。提示特应性体质患儿RSV感染后不能上调IL-l0产生，结果可导致病变恢复缓慢。