布地奈德吸入治疗时间对特应性毛细支气管炎婴幼儿后喘息的影响

目的探讨特应性毛细支气管炎婴幼儿使用布地奈德吸入治疗对喘息的影响。方法选择2006年1月～2007年3月就诊于襄樊市一医院儿科的83例特应性毛细支气管炎患儿,入院后均查外周血嗜酸性粒细胞、血清总IgE、血TH1/TH2水平,应用布地奈德吸入治疗,按应用布地奈德治疗的疗程随机分为1周组、3个月期组和1年期组,1周组仅在急性期用药1周,3个月组和1年组在急性期与1周组用药相同,急性期后继续予布地奈德吸入治疗。观察治疗后2年内患儿的复发情况。结果经治疗后2年内1周组复发23例占67.65%,3个月期组复发6例占22.22%,1年期组复发2例占9.09%。组间比较差异具有显著性（P〈0.001）。结论对特应性毛细支气管炎患儿,应早期使用糖皮质激素吸入治疗,疗效明显,可有效减少喘息的复发,但吸入激素持续时间并不能减少停药后2年内喘息的发生。     

呼出一氧化氮水平与反复喘息婴幼儿哮喘预测指数、血免疫球蛋白E水平的关系

目的探讨呼出一氧化氮(FeNO)水平与反复喘息婴幼儿哮喘预测指数(API)、血免疫球蛋白E(IgE)水平的关系。方法选取2015年10月至2016年10月收集我院呼吸科病房住院的反复喘息(既往喘息≥2次)婴幼儿68例为研究对象(观察组),测定患儿喘息急性期、喘息缓解24小时后、出院1月呼出气一氧化氮浓度,抽血化验血清总IgE水平,并选取同期在我院心外科、胸外科、泌尿外科术前6月～3岁患儿36例纳入对照组,测定呼出气一氧化氮浓度及血清总IgE水平,探讨呼出NO水平与反复喘息婴幼儿哮喘预测指数、血IgE水平的关系。结果对照组患儿FeNO、IgE、白介素-17(IL-17)水平均显著低于观察组各时期(喘息急性期、喘息缓解24小时后、出院1月)患儿,但最大呼气量(PEF)、一分钟用力呼气量(FEV_1)明显高于观察组各时期(喘息急性期、喘息缓解24小时后、出院1月)患儿(P0.05),喘息急性期、喘息缓解24小时后、出院1月患儿FeNO、IgE、IL-17水平呈现递减趋势,PEF、FEV_1呈现递增趋势;68例患者中API阳性者34例,API阴性者26例,且API阳性者FeNO、IgE水平均显著高于API阴性者(P0.05);反复喘息婴幼儿FeNO与API、IgE水平均呈正相关(P0.05);反复喘息婴幼儿PEF、FEV_1与FeNO、IgE、IL-17水平均呈负相关(P0.05)。结论反复喘息婴幼儿FeNO、API、IgE有增高趋势,且FeNO与API、IgE存在正相关,而FeNO、IgE、IL-17与患儿肺功能指标PEF、FEV_1也有一定关系,提示对反复喘息婴幼儿进行FeNO、API、IgE、IL-17检测,可为其尽早长期诊治提供依据。     

家庭雾化吸入治疗对毛细支气管炎后喘息的影响

目的探讨家庭雾化吸入治疗对毛细支气管炎后喘息的影响。方法选取我院2017年1月-2018年1月收治的毛细支气管炎患儿84例,将其随机的分为家庭雾化组和对照组,两组在常规治疗后出院,家庭雾化组给予吸入糖皮质激素治疗,对照组无特殊治疗,并对两组患儿进行半年的随访和观察,对比两组患儿出院后喘息再次发作的情况以及肺功能等指标的改善情况。结果在随访半年内,家庭雾化组患儿的急诊就诊次数、住院的次数显著低于对照组(P0.05);家庭雾化组肺功能改善明显优于对照组(P0.05)。结论家庭雾化吸入治疗对毛细支气管炎后喘息的疗效显著,值得临床推广应和应用。     

呼出气一氧化氮和过敏原检测在1～6岁儿童喘息性疾病中的应用价值

目的探讨呼出气一氧化氮(FeNO)和过敏原检测在1～6岁儿童喘息性疾病中的应用价值。方法选取2017年1月—2018年1月唐山市人民医院收治的1～6岁呼吸道疾病患儿257例,根据有无喘息症状分为喘息组163例和非喘息组94例。两组患儿均进行FeNO浓度检测和过敏原检测,比较两组患儿治疗前FeNO浓度和过敏原检测结果;并比较喘息组患儿治疗前后FeNO浓度,血清总免疫球蛋白E(tIgE)水平及尘螨、蛋清、牛奶特异性免疫球蛋白E(sIgE)水平。结果治疗前喘息组患儿FeNO浓度,食入性过敏原及吸入性过敏原阳性率,血清tIgE水平及尘螨、蛋清、牛奶sIgE水平高于非喘息组(P0.05)。治疗后喘息组患儿FeNO浓度,血清tIgE水平及尘螨、蛋清、牛奶sIgE水平低于治疗前(P0.05)。Pearson相关分析结果显示,FeNO浓度与1～6岁喘息性疾病患儿血清tIgE水平(r=0.514)及尘螨(r=0.429)、蛋清(r=0.824)、牛奶(r=0.415)sIgE水平呈正相关(P0.05)。结论 FeNO和过敏原检测有助于提高1～6岁儿童喘息性疾病的管理和评估水平。     

丙酸氟替卡松预防婴幼儿毛细支气管炎后喘息的临床观察

目的观察丙酸氟替卡松气雾剂吸入预防婴幼儿病毒诱发性喘息发作的临床效果。方法将145例符合毛细支气管炎诊断的婴幼儿随机分为预防组75例、对照组70例,两组在常规治疗出院后,预防组采用丙酸氟替卡松吸入3个月,而对照组不做相应处理。出院后随访1年,比较1年内两组婴幼儿喘息的发病构成比、喘息发作次数及发作持续时间。结果在随访一年内,预防组中有21例患儿未发生喘息,37例发生1次喘息,17例发生2次以上喘息;对照组有5例患儿未发生喘息,19例发生1次喘息,46例发生2次以上喘息。预防组发生喘息患儿平均喘息持续时间也较对照组明显缩短。结论吸入糖皮质激素早期干预可以缓解毛细支气管炎患儿后期病毒诱发性喘息反复发作。     

麻杏石甘汤灌肠治疗毛细支气管炎疗效评价

目的观察麻杏石甘汤化裁方灌肠给药途径对毛细支气管炎（痰热闭肺型）的临床疗效。方法将60例毛细支气管炎患儿随机分为口服组和灌肠组,两组均给予西医常规治疗,中药组成一致,分别通过口服和直肠注入给药。疗程7 d。观察两组患儿的临床疗效、退热时间及预后1 a喘息发作的情况。结果灌肠组完全退热时间、临床疗效、中医证侯疗效以及预后喘息发作情况方面均优于口服组。结论以麻杏石甘汤化裁方灌肠为主联合西药治疗毛细支气管炎具有较好的疗效。     

潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理价值探讨

目的探讨潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理临床价值。方法选取初次诊断儿童哮喘的低龄患儿108例为观察组,以同期来我院体检健康儿童80例为对照组;比较观察组和对照组的潮气呼吸肺功能指标水平、FeNO水平及观察组支气管舒张试验前后肺功能指标水平,并分析肺功能指标和FeNO水平的相关性。结果观察组急性期TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著低于缓解期、对照组(P0.05);观察组缓解期TPEF/TE、VPEF/VE及Ti/Te水平均显著低于对照组(P0.05);观察组急性期RR水平均显著高于缓解期、对照组(P0.05);观察组急性期支气管扩张剂应用后TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著高于应用前(P0.05);观察组急性期支气管扩张剂应用后RR水平显著低于应用前(P0.05);观察组急性期FeNO水平显著高于缓解期、对照组(P0.05);同时观察组缓解期FeNO水平显著高于对照组(P0.05);重度阻塞的哮喘患儿支气管舒张试验阳性率显著高于中度、轻度(P0.05);同时中度阻塞的哮喘患儿支气管舒张试验阳性率显著高于轻度(P0.05);Pearson相关性分析显示,哮喘急性期和缓解期患儿FeNO水平与潮气呼吸肺TPEF/TE和VPEF/VE间均无相关性(r=-0.035,-0.040,-0.043,-0.075,P=0.74,0.82,0.80,0.63)。结论潮气肺功能、FeNO检测及支气管舒张试验联合检测,可更为全面反映儿童哮喘患儿病变严重程度,有助于提高低龄儿童哮喘疾病管理水平。     

一氧化氮联合血清总IgE在诊断哮喘与慢性阻塞性肺气肿重叠综合征中的临床价值

目的:探讨呼出气一氧化氮(FeNO)联合血清总IgE在诊断哮喘与慢性阻塞性肺气肿重叠综合征(ACOS)中的临床价值。方法:纳入48例ACOS患者和15例单纯慢性阻塞性肺气肿患者、16例单纯哮喘患者,测定其FeNO和血清总IgE,采用受试者工作曲线和支持向量机分析两指标诊断及联合诊断ACOS的敏感性和特异性。结果:三组病例的FeNO值差异有统计学意义(F=4.38,P=0.041);三组病例的IgE值差异亦有统计学意义(F=6.67,P=0.027),FeNO与IgE的值哮喘组最高,其次为ACOS组,在慢性阻塞性肺气肿组中最低;ROC曲线结果表明:FeNO诊断的敏感性为0.833,特异性为0.677,IgE诊断的敏感性为0.771,特异性为0.710;FeNO联合IgE诊断的敏感性为0.896,特异性为0.645,准确性为0.797。结论:FeNO、IgE对诊断哮喘有较大意义大,而ACOS介于哮喘和COPD之间,对于ACOS的诊断,FeNO联合IgE的特异性较低,还需结合临床进行综合判断。     

毛细支气管炎患儿胸腺基质淋巴细胞生成素的表达水平与复发性喘息的相关性分析

目的分析毛细支气管炎患者胸腺基质淋巴细胞生成素的表达水平与发生复发性喘息的相关性。 方法选择2015年1月至2017年1月我院收治的151例毛细支气管炎患儿，根据治疗后1年内是否发生复发性喘息分为复发性喘息组(45例)，及对照组(106例)，并对两组患者的一般资料、呼吸窘迫评估工具(RDAI评分)及脉氧饱和度、细胞间黏附分子-1(ICAM-1)、尿白细胞三烯E4(尿LTE4)、血嗜酸性细胞阳离子蛋白(血ECP)及胸腺基质淋巴细胞生成素(TSLP)指标进行比较，并采用COX多因素分析对上述影响复发性喘息的危险因素进行分析，并应用受试者工作曲线(ROC)评估相关危险因素预测复发性喘息的诊断价值及诊断效能。 结果两组患者性别相比较无明显差异；复发性喘息组患者的年龄、出生体重及脉氧饱和度均明显低于对照组，住院天数、合并先天性心脏病患者的人数、RDAI评分、ICAM-1、尿LTE4、血ECP及TSLP均明显高于对照组(均P<0.05)；Cox回归分析示高RDAI评分及高ICAM-1、尿LTE4、血ECP、TSLP水平是复发性喘息的独立危险因素(HR＝1.323，1.008，1.003，1.051，1.125；均P<0.05)，而未合并先天性心脏病是保护因素(HR＝0.117；P<0.05)；ROC曲线示TSLP在预测复发性喘息方面具有较高的诊断效能(AUC＝0.844)，明显高于ECP、ICAM-1、尿LTE4、RDAI评分及合并先心病(Z＝3.143，2.683，3.173，3.251，5.532，均P<0.05)，其中，TSLP诊断的最佳截点为>54 ng/ml，此时其预测复发性喘息的敏感性为75.6%，特异性为84.0%。 结论患儿体内的TSLP水平在预测患儿是否出现复发性喘息方面，具有较高的诊断价值及诊断效能。     

干扰素联合益生菌对儿童特应性体质毛细支气管炎的疗效观察

目的探讨联合药物方案应用对特应性体质毛细支气管炎患儿近期疗效及实验室指标的影响。方法研究对象选取我院2015年1月-2017年6月收治特应性体质毛细支气管炎患儿共136例,随机分为对照组(68例)和试验组(68例),分别在对症干预基础上采用干扰素单用和干扰素+益生菌方案治疗;比较两组患儿近期治疗总有效率、急性发作持续时间、随访喘息发作次数、治疗前后临床症状评分、RR、SpO_2、EOS、Ig E、IL-17、TGF-β1水平及药物毒副作用发生率。结果试验组患治疗总有效率、急性发作持续时间及随访喘息发作次数均显著优于对照组(P 0. 05);试验组治疗后临床症状评分、RR及SpO_2均显著优于对照组、治疗前(P 0. 05);试验组治疗后EOS、Ig E、IL-17及TGF-β1水平均显著优于对照组、治疗前(P 0. 05)。结论联合药物方案治疗特应性体质毛细支气管炎能够有效缩短急性发作持续时间,避免喘息反复发作,缓解临床症状,提高肺部通气功能,调节EOS、Ig E、IL-17及TGF-β1水平,且安全性值得认可。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.