肺炎支原体肺炎伴喘息患儿血IL-10、IL-17和VEGF的检测及其意义

目的 观察白细胞介素10(IL-10)、白细胞介素17(IL-17)和血管内皮生长因子(VEGF)在儿童肺炎支原体肺炎中的表达水平及其与喘息的相关性.方法 选取62例肺炎支原体肺炎患儿,分为伴喘息组(A组,32例)和无喘息组(B组,30例),另选取健康儿童30位作为对照组(C组),检测三组儿童血清中IL-10、IL-17和VEGF的浓度.结果 肺炎支原体肺炎伴喘息组和无喘息组患儿血清IL-17和VEGF的水平均高于对照组,差异有统计学意义(P＜0.01);肺炎支原体肺炎伴喘息患儿的IL-17和VEGF的水平高于不伴喘息者,差异有统计学意义(P＜0.01).与对照组相比,肺炎支原体肺炎伴喘息组和无喘息组患儿的IL-10水平明显降低,差异有统计学意义(P＜0.01);肺炎支原体肺炎伴喘息患儿的IL-10的水平低于不伴喘息者,差异有统计学意义(P＜0.01).结论 IL-10、IL-17和VEGF可能在小儿肺炎支原体肺炎导致喘息样发作中起重要作用.     

儿童肺炎支原体感染致大叶性肺炎免疫功能变化及意义

目的探究儿童肺炎支原体感染致大叶性肺炎免疫功能变化及意义。方法按照肺部影像学检查将67例肺炎支原体肺炎(MPP)患儿分为大叶性肺炎组及支气管肺炎组,另择同期于我院门诊查体的30例健康儿童作为对照组,比较各组受试者免疫水平。结果肺炎组患儿免疫球蛋白IgG、IgM及补体C_3、C_4水平显著高于对照组(P <0.05);大叶性肺炎组IgG、IgM、C_3水平显著高于支气管肺炎组,差异具有统计学意义(P<0.05);与对照组相比,肺炎患儿CD4^+T淋巴细胞比例及CD4^+/CD8^+比值显著下降(P <0.05),CD8^+T淋巴细胞比例显著上升(P <0.05);肺炎组患儿白介素-2(IL-2)水平较对照组显著降低(P<0.05),白介素-8(IL-8)、肿瘤坏死因子(TNF-α)水平显著升高(P<0.05);大叶性肺炎患儿降低或升高幅度显著大于支气管肺炎组,差异具统计学意义(P<0.05)。结论体液免疫、细胞免疫及细胞因子在MPP发病过程中均起重要作用,临床上可根据相关免疫指标水平进行病情评估及治疗效果评价。     

血清IL-8、IL-10、PCT在小儿肺炎支原体肺炎治疗中的临床应用

目的探讨血清中白介素-8(IL-8)、白介素-10(IL-10)和降钙素原(PCT)在小儿肺炎支原体肺炎发病中的临床价值。方法用ELISA法和化学发光法检测62例肺炎支原体肺炎患儿治疗前后及50例同期幼儿园和小学生健康体检者血清中IL-8、IL-10和PCT水平,结合临床相关检查资料,对检测结果采用SPSS18.0统计软件进行统计学分析,各组实验数据以均数±标准差(±)表示,各实验组间比较计量资料的t检验,<0.05为有统计学意义。结果 MPP组治疗前：IL-8(16.38±9.63 pg/ml)、IL-10(13.59±8.41 pg/ml)、PCT(0.68±0.52 mg/L)与对照组IL-8(4.66±3.92 pg/ml)、IL-10(5.67±3.03 pg/ml)、PCT(0.29±0.16 mg/L)浓度比较有显著性差异(<0.05);MPP组治疗6~8d后IL-8(5.15±4.49 pg/ml)、IL-10(6.42±5.06 pg/ml)、PCT(0.31±0.18 mg/L)浓度较治疗前均有明显下降,有显著性差异(<0.05),与健康对照组比较,两者差异无统计学意义(>0.05)。结论 MPP患儿入院治疗前、治疗后血清IL-8、IL-l0,PCT含量的变化对疾病的进展和疗效有一定指导意义,提示IL-8、IL-10和PCT在MPP发病机制中起重要作用。     

肺炎支原体感染儿童肌红蛋白和肌钙蛋白Ⅰ的分析

目的 检测并比较肺炎支原体(MP)感染患儿治疗前后血清中肌红蛋白(Mb)和肌钙蛋白Ⅰ(cTn-Ⅰ)的含量,以探讨其在肺炎支原体肺炎(MPP)合并心肌损害诊治中的意义.方法 抽取肺炎支原体感染并有心肌损伤表现的患儿(46例)急性期和恢复期的静脉血,测定并比较其血清中Mb和cTn-Ⅰ的含量变化,同时以健康儿童做为对照组.结果 MPP合并心肌损伤组患儿急性期血清中Mb和cTn-Ⅰ的含量显著高于健康对照组(P＜0.01).与急性期相比,MPP合并心肌损伤的患儿恢复期血清Mb和cTn-Ⅰ的含量明显下降(P＜0.01),但仍高于对照组(P＜0.05).结论 MPP患儿有部分患者急性期有不同程度的心肌损害.     

氨溴索辅助阿奇霉素治疗对儿童肺炎支原体肺炎患儿血清IFN-γ、MCP-4、IL-6水平及免疫功能的影响

目的探究氨溴索辅助阿奇霉素治疗对儿童肺炎支原体肺炎(MPP)患儿血清干扰素(IFN-γ)、单核细胞趋化蛋白(MCP-4)、白细胞介素(IL-6)水平及免疫功能的影响。方法选取本院儿科2016年5月至2018年3月期间收治的90例MPP患儿,以随机数字表法分为实验组和对照组,各45例。所有患儿均给予常规止咳、平喘等干预,对照组患儿给予阿奇霉素注射液静脉滴注,实验组患儿在此基础上辅助盐酸氨溴索雾化吸入治疗。治疗前、后采血检测血清IFN-γ、MCP-4、IL-6及免疫球蛋白IgG、IgA、IgM、IgE水平,并记录临床症状及体征改善进程。结果两组治疗前血清细胞因子与免疫球蛋白水平比较无统计学意义(P>0.05),治疗后血清IFN-γ、MCP-4、IL-6、IgA、IgM、IgE水平均明显下降(P<0.05),IgG无明显变化(P>0.05),但实验组血清IFN-γ、MCP-4、IL-6、IgA、IgM、IgE水平下降幅度较对照组更显著,差异有统计学意义(P<0.05)。与对照组相比,实验组患儿体温恢复正常时间、肺部湿啰音消失时间、咳嗽消失时间及住院时间明显缩短(P<0.05)。结论氨溴索辅助阿奇霉素治疗儿童MPP可有效缓解局部炎症反应,改善免疫功能紊乱,从而可促进患儿临床症状、体征恢复正常。     

肺炎支原体肺炎患儿外周血T淋巴细胞表面IL-18Rα的变化及意义

目的：探讨肺炎支原体肺炎（MPP）患儿外周血T淋巴细胞表面IL-18Rα表达的意义。方法：采用流式细胞术测定35例MPP患儿外周血T淋巴细胞亚群（CD3/CD4/CD8）和T淋巴细胞表面IL-18Rα的表达水平,并与正常对照组比较。结果：MPP患儿T细胞亚群与正常对照相比,CD3^＋细胞百分率降低（P〈0.05）,51.4%的MPP患儿CD4^＋/CD8^＋在1.0-1.9的范围之外。急性期MPP组CD4^＋T和CD8^＋T淋巴细胞表面IL-18Rα的表达较正常对照组明显升高,有显著性差异（P〈0.01）;恢复期与对照组比较有显著性差异（P〈0.05）。恢复期表达水平下降,与急性期比较有显著性差异（P〈0.05）。T细胞亚群异常组与正常组相比,CD4^＋T和CD8^＋T细胞IL-18Rα表达明显增高（P〈0.01）,T细胞亚群正常组与正常对照无明显差别（P〉0.05）。结论：MPP患儿存在细胞免疫功能紊乱,外周血T淋巴细胞存在Th1/Th2失衡,急性期表现为Th1优势应答。     

系统免疫炎症指数在难治性支原体肺炎患者预后中的预测价值

目的 探究系统免疫炎症指数(SII)对难治性肺炎支原体肺炎(RMPP)患儿预后的预测价值。方法 选取2020年1月至2021年12月本院收治的190例RMPP患儿、100例普通肺炎支原体肺炎(GMPP)患儿分别为RMPP组、GMPP组,另选取100例健康体检儿童为对照组。比较各组SII及血清白介素-6(IL-6)水平;单因素/多因素分析影响RMPP患儿预后的因素;比较不同预后GMPP患儿治疗前后SII及血清白介素-6(IL-6)动态水平;绘制受试者工作特征(ROC)曲线评估SII、血清IL-6对RMPP患儿预后的预测价值。结果 GMPP组、RMPP组患儿SII及血清IL-6水平均高于对照组(P<0.05),RMPP组患儿SII及血清IL-6水平均高于GMPP组(P<0.05);预后不良组RMPP患儿低体质量儿占比、SII及血清IL-6水平高于预后良好组(P<0.05);RMPP患儿预后良好组治疗前后SII和IL-6水平差异均具有统计学意义,且治疗后预后良好组SII和IL-6水平均小于预后不良组(P<0.05)。高水平SII、高水平IL-6是RMPP患儿预后不良的...     

MP-IgM、YKL-40、APOC1和IL-6在儿童支原体肺炎治疗及预后中的意义

目的探讨肺炎支原体抗体(mycoplasma pneumoniae immunoglobulin M,MP-IgM)、人软骨糖蛋白39(human cartilage glycoprotein 39,YKL-40)、载脂蛋白C1(apolipoprotein C-I,APOC1)和白细胞介素-6(interleukin 6,IL-6)在儿童支原体肺炎治疗及预后中的意义。方法选取2017年1月至2017年12月本院确诊的80例儿童支原体肺炎患儿为观察组给予对症治疗,选取同期健康体检儿童40例为对照组。分别检测两组儿童外周静脉血中MP-IgM、YKL-40、APOC1和IL-6表达水平。结果与对照组相比,观察组患儿血清YKL-40、APOC1和IL-6表达水平显著升高,血清MP-IgM呈明显阳性;观察组血清YKL-40、APOC1和IL-6表达水平治疗后显著降低,血清MP-IgM阳性(P <0.05)。儿童支原体肺炎血清YKL-40、APOC1和IL-6水平,MP-IgM阳性率与疾病严重程度存在显著的正相关关系,P<0.05。经ROC分析可知,MP-IgM、YKL-40、APOC1和IL-6这4项生物学标志物并联试验灵敏度为92.00%,串联试验特异性为100.00%,显著大于各单项生物学标志物检测(P<0.05)。与对照组相比,观察组患儿FEV_1/FVC(%)及FEV_1%预计值显著降低(P<0.05)。与治疗前相比,观察组患儿治疗后FEV_1/FVC(%)及FEV_1%预计值显著升高(P<0.05)。儿童肺炎支原体患儿YKL-40、APOC1和IL-6水平,MP-IgM阳性率与患儿肺功能存在显著的负相关关系,P<0.05。结论儿童支原体肺炎患儿血清MP-IgM、YKL-40、APOC1和IL-6表达水平异常升高;监测患儿血清MP-IgM、YKL-40、APOC1和IL-6水平变化对于辅助诊断和评价儿童支原体肺炎的病情程度和治疗具有一定的临床意义,值得推广研究。     

肺炎支原体感染儿童肌红蛋白和肌钙蛋白Ⅰ的分析

目的检测并比较肺炎支原体（MP）感染患儿治疗前后血清中肌红蛋白（Mb）和肌钙蛋白Ⅰ（cTn-I）的含量,以探讨其在肺炎支原体肺炎（MPP）合并心肌损害诊治中的意义。方法抽取肺炎支原体感染并有心肌损伤表现的患儿（46例）急性期和恢复期的静脉血,测定并比较其血清中Mb和cTn-I的含量变化,同时以健康儿童做为对照组。结果 MPP合并心肌损伤组患儿急性期血清中Mb和cTn-I的含量显著高于健康对照组（P〈0.01）。与急性期相比,MPP合并心肌损伤的患儿恢复期血清Mb和cTn-I的含量明显下降（P〈0.01）,但仍高于对照组（P〈0.05）。结论 MPP患儿有部分患者急性期有不同程度的心肌损害。     

Th17/Treg失衡在肺炎支原体肺炎患儿中的作用及其机制

目的：探讨Th17/Treg失衡在肺炎支原体肺炎患儿中的作用及其机制。方法：纳入2013年6月至2015年1月我院收治的60例肺炎支原体肺炎急性期患儿和30例同期体检的健康儿童为研究对象。流式细胞术分析两组儿童外周血Th17和Treg的百分率,ELISA分析Th17和Treg特异性细胞因子IL-17和IL-10的分泌水平,定量PCR测定Th17和Treg特异性转录因子RORγt和Foxp3 mRNA的表达水平,以及Notch信号分子(Notch1,Hes1和Hey1)的表达水平。结果：与健康儿童相比,肺炎支原体肺炎急性期患儿外周血的Th17的百分率,IL-17分泌水平以及特异性转录因子RORγt的表达水平均明显增高,差异均具有统计学意义(P<0.05),而急性期患儿外周血的Treg的百分率,IL-10分泌水平以及特异性转录因子Foxp3的表达水平均较健康儿童明显降低,差异均具有统计学意义(P<0.05)。进一步分析显示急性期患儿Notch1、Hes1和Hey1的表达水平均明显高于健康儿童,其差异均具有统计学意义(P<0.05)。结论：Th17/Treg失衡参与儿童支原体肺炎的发生发展,Notch信号通路可能通过调节免疫细胞分化和细胞因子分泌参与Th17/Treg失衡。     

Carcinomas with identical and with different specific antigens

Summary Immunological investigations demonstrated that certain human malignant neoplasms possess similar specific antigenic and immunogenic properties. On the other hand, there are tumors which have qualitatively different specific antigens. The immunological group to which the tumor belongs is not connected with localization of the tumor, its structure or blood group.Presented by Active Member of the AMN SSSR N. N. Zhukov-Verezhnikov     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Sleep in children with autism with and without autistic regression

The purpose of the present investigation was to characterize and compare traditional sleep architecture and non-rapid eye movement (NREM) sleep microstructure in a well-defined cohort of children with regressive and non-regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty-two children with non-regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5-10years, underwent standard overnight multi-channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens' Sleep Habits Questionnaire-CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non-regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non-regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non-regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro- or from a microstructural viewpoint.     

Allergy screening with Phadiatop® and CAP Phadiatop® in combination with a questionnaire in adults with asthma and rhinitis

The efficiency of the new screening tests for atopy, Phadiatop and CAP Phadiatop, was studied by comparing their results with a clinical diagnosis of atopy in 100 consecutive adults with asthma and/or rhinitis. Further, the diagnostic efficiency of a combination of Phadiatop and a few standardized questions was studied. The Phadiatop was found to have a specificity of 0.98, and a sensitivity of 0.92 and the CAP Phadiatop a specificity of 0.94 and a sensitivity of 0.96. When the Phadiatop was combined with a few questions, a sensitivity of 1.00 was achieved. It is concluded that Phadiatop and CAP Phadiatop have a higher diagnostic precision than other hitherto used methods for screening of atopic allergy. The place of Phadiatop in a diagnostic flow chart is suggested.     

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

Objective

To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS.

Methods

Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group.

Results

Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p < 0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2–0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0–12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3–1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7–1.0), independent of ethnicity-language.

Conclusion

Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret.

Practice implications

Use of professional interpreters may address communication-related disparities for these women.     

Satisfaction with communication in ICU patients and relatives: comparisons with medical staffs' expectations and the relationship with psychological distress

Objective

To study intensive care unit (ICU) patients’ and relatives’ satisfaction in regard to communication with medical staff (nurses and physicians), perceived support, environmental strain and their psychological distress. Further, to compare this with expectations of the medical staff.

Methods

Cross-sectional study, 4–6 weeks post-ICU discharge. Respondents to the questionnaire were: 255 (63%) patients, 354 (82%) relatives and 145 (74%) medical staff. Degree of satisfaction and distress were measured on a five-point Likert-scale (0 = low to 4 = high).

Results

The mean score for patient satisfaction with communication was 3.0 (95%CI 2.9–3.1) and for relatives 3.4 (3.3–3.5). This was significantly higher than expected by the staff for patients 2.5 (2.4–2.6) and relatives 2.8 (2.7–2.9), both p < 0.001. Relatives’ degree of psychological distress, 2.5 (2.4–2.6) was significantly higher than for patients’, 1.6 (1.5–1.7), but was significantly lower than expected by the staff, 2.9 (2.8–3.0) and 2.7 (2.6–2.8) respectively, both p < 0.001.

Conclusion

Patients and relatives were more satisfied with the communication than expected by the staff. The staff overestimated the patients’ and relatives’ psychological distress. Relatives report more psychological distress symptoms post-ICU discharge compared to the patients.

Practice implications

Medical staff is aware of psychological distress in ICU patients and relatives and effort to reduce this during ICU stay and afterwards should be implemented.     

几种具有抗疲劳、抗缺氧作用的藏药植物资源

由于藏民族主要生活在高海拔地区,因此在藏药中有许多著名的抗疲劳、抗缺氧药用植物资源,如红景天、沙棘等。本文整理了沙棘、冬虫夏草、蕨麻和红景天等几种(类)具有抗疲劳、抗缺氧作用藏药植物资源及其目前有关这些植物资源的开发利用研究状况,以期为开发运动员专用保健饮料和保健食品提供参考。