3例普乐可复引起脑白质病病人的急救护理

异基因造血干细胞移植后，为了移植成功及预防移植物抗宿主病（GVHD）的发生，通常使用免疫抑制剂环胞霉素A（CSA）。近年来认为普乐可复（FK506）作为一种新型免疫抑制剂的药物更为有效，但是FKS06在临床使用中发生毒害神经，引起的病症称为脑白质病。这一严重不良反应起病急、过程快，严重者危及病人生命。现介绍我科住院病人应用FK506后发生脑白质病3例的急救护理过程。     

他克莫司在肾小球疾病的应用

他克莫司(FK506)是一种新型免疫抑制药物,属于神经钙蛋白抑制剂[1-2]。可以抑制白细胞介素2(IL-2),IL-10的产生[3-4],从而发挥抗T淋巴细胞和B淋巴细胞增殖,进而达到免疫作用。通过抑制细胞免疫和体液免疫双重机制来发挥强大的免疫抑制作用,他克莫司的免疫抑制作用比环孢霉素A强100倍[2]。1989年美国匹兹堡大学医学院将FK506首次用于临床器官移植术后免疫排斥反应的预防和治     

3例普乐可复引起脑白质病病人的急救护理

异基因造血干细胞移植后,为了移植成功及预防移植物抗宿主病(GVHD)的发生,通常使用免疫抑制剂环胞霉素A(CSA)。近年来认为普乐可复(FK506)作为一种新型免疫抑制剂的药物更为有效,但是FK506在临床使用中发生毒害神经,引起的病症称为脑白质病[1]。这一严重不良反应起病急、过程快,严重者危及病人生命。现介绍我科住院病人应用FK506后发生脑白质病3例的急救护理过程。1病例介绍[例1]病人,女,23岁。在我院行无关供者外周血干细胞移植,在回输干细胞当天夜间发生急性移植物抗宿主病(aGVHD)Ⅰ度,加强抗GVHD治疗,静脉输注CSA,3d后出现肝脏…     

他克莫司血药浓度与临床疗效及不良反应关系的研究

目的探讨肾移植患者他克莫司（FK506）血药浓度与效应关系。方法采用微粒子酶免疫法测定56例肾移植术后患者口服FK506后12h的全血药浓度，对患者随访，观察排斥反应的发生及药物的肾毒性，并进行回顾性分析。结果肾移植术后FK506的适宜治疗浓度范围0～1个月为9～14ng／ml，2～3个月为8—12ng／ml，4～6个月为6～10ng／ml，〉7个月为4～6ng／ml。术后发生排斥反应3例，药物肝毒性2例，血糖升高10例。经减药治疗后仍有4例需要胰岛素控制血糖。术后发生感染5例。结论FK506具有良好的免疫抑制效果，其在上述治疗窗范围内，既能达到满意的免疫抑制效果，又能减少排斥反应和肾毒性反应的发生。     

肾移植术后钙神经蛋白抑制剂相关性脑病

由于钙神经蛋白抑制剂是目前肾移植术后的主要免疫抑制剂,其药物的毒副作用愈来愈受到临床重视,其中较为严重的有肝毒性、肾毒性和脑神经毒性.脑毒性表现为：头痛、视觉障碍、昏迷及抽搐等.自2003年7月以来,本院完成肾移植202例,免疫抑制方案基本为钙神经蛋白抑制剂（环孢霉素A、FK506）＋ MMF ＋ 类固醇激素,其中2例在术后近期出现与钙神经蛋白抑制剂相关的严重脑病,经抗高血压及脱水等处理,尽管免疫抑制剂未减量,患者的症状均缓解和消除.现总结报道如下.     

CYP3A5基因型与肾移植患者他克莫司血药浓度关系的系统评价

目的 系统评价CYP3A5基因型与肾移植术后他克莫司（FK506）血药浓度的关系。方法 计算机检索PubMed（1966.1～2013.7）、Sciverse（1823.1～2013.7）、The Cochrane Library（2013年第7期）、CNKI（1994.1～2013.7）、VIP（1989.1-2013.7）、CBM（1978.1～2013.7）及WanFang Data（1995.1～2013.7）,查找关于CYP3A5基因型与肾移植术后他克莫司（FK506）血药浓度/剂量关系的文献。根据纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果 共纳入12篇文献,包含956例对象。Meta分析结果显示：在肾移植术后7天［MD=54.61,95%CI（–67.67,–41.54）,P〈0.000 01］、1个月［MD= –74.84,95%CI（–83.39,–66.29）,P〈0.000 01］、3个月［MD= –96.09,95%CI（–107.55,–84.64）,P〈0.000 01］、6个月［MD= –107.30,95%CI（–125.65,–88.95）,P〈0.000 01］和1年［MD= –78.32,95%CI（–123.02,–33.61）,P=0.000 6］,携带CYP3A5 ＊3/＊3基因型患者的FK506 血药浓度/剂量值明显较携带其他基因型患者高;而携带＊1/＊1患者的FK506 血药浓度/剂量值较低。结论 肾移植术后FK506血药浓度/剂量值与CYP3A5基因型相关。因此在肾移植术后应用FK506作为免疫抑制治疗时,有必要对患者进行CYP3A5基因型检测,以指导临床治疗。     

非遗传因素(年龄、性别)对肾移植患者他克莫司药物浓度影响的研究

目的 探讨肾移植患者接受他克莫司（FK506）治疗后药物浓度与年龄、性别的关系.方法 应用全自动化学发光免疫分析仪器测定不同年龄、性别的86例（804例次）患者在肾移植术后口服FK506后的血药浓度.结果 年龄＜45岁和≥45岁的女性患者术后第2个月时FK506的血药浓度分别为（9.68±1.21）和（10.55±0.77） μg·L-1;术后＞3个月时FK506的血药浓度分别为（5.13±1.54）和（5.19±1.57）μg· L-1.年龄＜45和≥45年龄男性患者术后第2个月时FK506的药物浓度分别为（10.03±2.13）和（11.17±3.92）μg· L-1;术后＞3个月时FK506的药物浓度分别为（4.94±1.75）和（5.03±1.83） μg· L-1.随着年龄增大,FK506的血药浓度也有所增高,但差异无统计学意义（均P＞0.05）;不同性别的患者对FK506的血药浓度均不产生影响.结论 肾移植术后男性及女性不同年龄各时间段的FK506全血浓度分析发现,随着年龄的增大,血药浓度亦有所增高;不同性别对FK506的血药浓度均不产生影响.     

普乐可复联合激素治疗难治性肾病综合征的护理

普乐可复（FK506）和环孢素同属神经钙调蛋白（calcineurin）抑制剂,都能阻断钙调磷酸酶的作用,进一步影响白介素-2（IL-2）等多种细胞因子的产生,抑制T细胞的活性。FK506还能抑制TH2细胞（辅助型T细胞2）及白介素-10（IL-10）的产生,减少B细胞自身抗体。FK506作为一种高效率的新型免疫抑制剂,已广泛应用于肾移植术后的抗排异治疗,鉴于其独特的免疫抑制效应,     

儿童严重激素依赖肾病综合征应用FK506的临床价值

严重激素依赖肾病综合征是儿童肾病综合征的常见类型。激素替代药物如钙调蛋白抑制剂，常被用来减轻激素治疗的不良反应。FK506常作为环孢素A治疗抵抗和不良反应明显的儿童肾病综合征维持治疗的药物。那么，环孢素A和FK506的安全性、有效性有何差异尚有待于回答，新近的一项研究工作初步回答了这一问题，研究结果刊登在最新一期的Nephrology Dialysis and Transplantation上。     

移植术的最新武器FK506

脏器移植常因慢性排异而失败。本文介绍了免疫抑制剂 FK506的试验及应用过程。与环胞素相比,FK506的发现,将大大提高脏器移植的成功率。     

LEUCOPROTEASE AND ANTI-LEUCOPROTEASE OF MAMMALS AND OF BIRDS

The inhibiting action of the blood serum upon the enzyme of the polynuclear leucocytes, leucoprotease, is exerted by the albumin fraction of the serum. The albumin fraction contains no proteolytic enzymes. The globulin fraction of the serum contains no anti-enzyme for leucoprotease; it contains, on the contrary, an enzyme which digests proteids in a neutral or alkaline medium. This enzyme resembles leucoprotease which is present in the polynuclear leucocytes of an inflammatory exudate and in the bone marrow from which these cells are derived, and is doubtless identical with the similar enzyme occurring in smaller quantity in the spleen. This enzyme which is present in the blood serum is held in check by its anti-enzyme, but the latter is in such excess that the serum as a whole is capable of checking the action of leucoprotease when added in considerable quantity. Leucoprotease of one mammalian species is inhibited by sera of other mammalian species, but the anti-enzymotic activity of various sera differs; the anti-enzyme of the rabbit''s serum is stronger than that of dog''s serum, when tested either with dog''s or with rabbit''s leucoprotease. The co-existence in the rabbit of leucoprotease with feeble strength and anti-body of great activity may explain the absence in these animals of typical suppuration with liquefaction of tissues. The serum of birds which have been tested, namely, pigeon and hen, almost completely fails to inhibit mammalian leucoprotease (of dog). The polynuclear leucocytes, the bone marrow and the spleen of the hen do not contain an enzyme resembling leucoprotease of mammals. The absence of anti-enzyme in the serum is associated with absence of a corresponding enzyme in the leucocytes.     

旅店业卧具污染及清洗消毒效果调查

通过对宾馆和小型招待所卧具(被罩、床单、枕套)抽样检测,了解细菌污染程度及其消毒效果。结果,使用过的卧具细菌总数超标率为50％,大肠菌群检出率为28.8％,以招待所床单污染最严重,细菌总数超标率达到72％。宾馆卧具污染程度较小型招待所轻,两者有显著差异。清洗消毒后的卧具(备用品)细菌总数超标率为5％,大肠菌群检出率为2.5％,说明清洗消毒效果显著。为此提示,对旅店业卧具的监督管理重点是小型招待所,主要是抓好卧具的清洗消毒,以保障卧具安全卫生。     

Fraxiparin对巨核细胞－血小板系统刺激增生作用的研究

Ｆｒａｘｉｐａｒｉｎ是一种小分子量肝素。研究结果表明，Ｆｒａｘｉｐａｒｉｎ可刺激鼠巨核细胞－血小板系统增生。在体外试验，Ｆｒａｘｉｐａｒｉｎ可刺激鼠巨核系祖细胞的增生和巨核细胞的成熟，其刺激增生作用与其中和血小板第４因子的作用有关。鼠的体内研究结果进一步证实Ｆｒａｘｉｐａｒｉｎ对巨核细胞有刺激增生作用。小剂量Ｆｒａｘｉｐａｒｉｎ也有刺激作用，但其刺激增生作用持续时间较短。Ｆｒａｘｉｐａｒｉｎ注射后５天，血小板计数较对照组略有升高，但无统计学意义。无论体内或体外，Ｆｒａｘｉｐａｒｉｎ对ＣＦＵ－ＧＭ均无刺激作用。     

思瑞康和维思通治疗精神分裂症的临床研究

目的　以维思通为对照组 ,探讨思瑞康治疗精神分裂症的疗效和副作用。方法　将 65例符合CCMD 3的精神分裂症患者随机分为两组 ,分别给予思瑞康和维思通治疗 8周。采用阳性症状和阴性症状量表 (PANSS)评定临床疗效 ,副反应量表 (TESS)评定副反应。结果　治疗 8周后的疗效相当 (P >0 .0 5 ) ;思瑞康组和维思通组的显效率差异无显著性 (P >0 . 0 5 ) ;思瑞康组的副反应发生率低于维思通组 ,但差异无显著性 (P >0 . 0 5 ) ;维思通组锥体外系副反应和内分泌改变的发生率均明显高于思瑞康组 (P <0. 0 5 ) ,但两药引起的副反应一般为轻度或中度 ,患者耐受性较好。结论　思瑞康和维思通对精神分裂症的疗效相当 ,但副作用有所不同。     

DETECTION OF THE VIRUS OF POLIOMYELITIS IN THE NOSE AND THROAT AND GASTRO-INTESTINAL TRACT OF HUMAN BEINGS AND MONKEYS

Five strains of virus were recovered from nasal washings and feces. Four strains were of human origin, the fifth strain came from a monkey sacrificed at the height of the disease. Of the four human strains the first was isolated from the feces of a 14 year old child 7 days after the onset of illness. The second strain was from the nasal washings of a 6½ year old child, 5 days after the onset of illness. The third and fourth strains were recovered from the same patient, a 2½ year old child, 9 days after the onset of illness. One of these strains was obtained from nasopharyngeal washings and the other from the feces. The single monkey strain was isolated from the upper intestinal segment and appears to be the only instance of its isolation from this source in the literature. We believe that the detection of the virus in the nasal washings of two additional patients during convalescence lends further support to the belief that the virus of poliomyelitis is spread by human contact. Furthermore, the recovery of the virus from the gastro-intestinal tract with as great or greater frequency as from the upper respiratory tract, need not, it appears to us, alter our concept of the mode of entrance of the virus into the body, namely, by way of the upper respiratory tract. If the presence of the virus is conceded, then a consideration of the physiologic passage of nasal and oral secretions into the gastro-intestinal tract by reflex swallowing would serve to explain adequately the presence of the virus in those organs. It might even be further predicated that since the gastro-intestinal tract functions as a temporary reservoir for secretions from the upper respiratory tract, the gut should, after a time, contain the virus in higher concentration than any single sample of secretion obtained from the upper respiratory tract by nasal washing. It appears to us that failures to detect the virus in the gastro-intestinal tract are perhaps more indicative of inadequate procedures for its detection than of its absence. The recovery of the virus from the feces 7 and 9 days after the onset of illness takes on added significance. It indicates first, that the virus withstands the gastric acidity which under normal physiological conditions tends to keep gastric contents relatively free of bacteria. It further suggests that improper disposal of feces from patients with poliomyelitis may have serious public health consequences, particularly in smaller communities where inadequate sewage disposal may result in contamination of surrounding beaches or even local water systems.     

急慢性疼痛病人电针感觉阈和痛阈的调查分析

目的:了解急性和慢性疼痛病人的电针感觉阈和痛阈的特点,以便选用适宜的电针参数进行镇痛治疗。方法:测定正常人、急性疼痛病人和慢性疼痛病人三组人群的感觉阈和痛阈,并进行相互比较。结果:急性疼痛病人的感觉阈和痛阈均低于正常人(均P<0. 01),明显低于慢性疼痛病人(均P<0. 01)。结论:急、慢性疼痛病人有不同的电针感觉阈和痛阈基础,急性疼痛病人相对较低,慢性疼痛病人相对较高。电针镇痛治疗时,电针强度的运用应因人而异。     

ENHANCEMENT OF ANTIBIOTIC ACTIVITY OF COLICINE K AND ALTERATION OF SEROLOGICAL PROPERTIES OF COLICINE K AND ENDOTOXINS

Hemoglobin, its chains, and myoglobin enhance the antibiotic activity of colicine K. These proteins also interact with colicine K and other O antigens to alter their serological activity. The hemoglobin proteins did not alter the serological activities of three Pneumococcus polysaccharides or T4 bacteriophage DNA antigens but did alter the antigenic activity of fetuin. Interaction of hemoglobin and colicine K resulted in a retardation of colicine K antibiotic moiety as measured by gel filtration but did not affect the gel filtration properties of the lipopolysaccharide moiety.     

《疼痛知信行调查问卷》的研制及信效度检验

目的:编制适合全髋关节置换术患者疼痛知识、疼痛信念、疼痛控制行为问卷,检测其信效度。方法:采用知信行理论为问卷构架,在文献阅读、专家咨询、专题小组讨论的基础上初步编制疼痛知信行问卷。采取方便抽样法抽取盐城某三甲医院骨科75名拟行全髋关节置换术的患者,并进行问卷调查。采用Cronbach'α系数、分半信度进行信度检测,选用内容效度、探索因子分析检验问卷效度。结果:本问卷编制了36个条目,包括疼痛知识、疼痛信念、疼痛控制行为三个子问卷。问卷总的内部一致性信度为0.853,子问卷的内部一致性信度分别为0.817、0.814、0.919,子问卷的内容效度系数分别为0.837、0.946、0.902。对子问卷进行因子分析,累积贡献率分别为53.33%、61.26%、71.33%,每个项目的共性方差均超过0.4。结论:编制的《疼痛知信行调查问卷》具有良好的信效度,可以作为评鉴全髋关节置换术患者疼痛认知、疼痛信念、疼痛控制行为现状以及调查影响因素的可靠工具。     

非小细胞肺癌组织Slug和E-cadherin表达及意义

目的检测E-钙黏素（E-cadherin）和锌指转录因子Slug在非小细胞肺癌（NSCLC）组织及相应淋巴结转移灶中的表达,探讨二者的相关性及与NSCLC转移的关系。方法应用免疫组化SP法,检测80例NSCLC及相应淋巴结转移灶中Ecadherin和Slug蛋白的表达情况。结果 Ecadherin和Slug在NSCLC原发灶与相应淋巴结转移灶中阳性表达强度差异有显著性（Z=-2.009,P〈0.05）。在NSCLC组织中,Ecadherin和Slug蛋白的阳性表达与癌组织的分化程度、TNM分期及有无淋巴结转移有关（Z=-3.142～-2.110,P〈0.05）;在NSCLC组织中Ecadherin和Slug蛋白的表达呈负相关（r=-0.228,P〈0.05）。结论 Ecadherin和Slug蛋白可能在NSCLC浸润转移中发挥着重要作用。