肺炎支原体肺炎初诊患儿免疫状态分析

目的探讨初诊肺炎支原体肺炎(MPP)患儿机体免疫功能指标的改变及临床意义。方法收集2018年6月至2019年3月在南京医科大学附属无锡人民医院儿童住院部初诊172例MPP患儿作为研究对象,其中轻症105例重症67例;同期选取性别、年龄相匹配的63名健康体检者作为对照组。流式细胞术检测各组外周全血T淋巴细胞亚群分子指标CD3~+、CD4~+、CD8~+、CD4~+/CD8~+,并采用免疫比浊法测定各组血清免疫球蛋白IgG、IgM、IgA的水平。结果轻症和重症MPP组CD3~+、CD4~+、CD4~+/CD8~+水平低于对照组,且重症MPP组CD3~+、CD4~+、CD4~+/CD8~+水平低于轻症组[(43.1±16.7)%比(55.3±18.8)%、(16.1±6.8)%比(24.3±8.1)%、0.64±0.28比0.97±0.29](P <0.05),各组CD8~+比较差异无统计学意义(P>0.05)。轻症和重症MPP组血清IgG、IgM、IgA水平均较对照组明显升高(P <0.05)。结论未接受药物治疗的初诊重症MPP患儿T淋巴细胞亚群CD3~+、CD4~+、CD4~+/CD8~+水平较健康对照和轻症患儿明显降低,Ig水平升高。初诊MPP患儿的免疫状态检测可为临床诊疗提供参考依据。     

肺炎支原体肺炎患儿免疫球蛋白及CD23变化的临床研究

目的探讨肺炎支原体肺炎（MPP）患儿急性期免疫功能的变化及临床意义。方法实验分成3组,即MPP轻症组（22例）、重症组（18例）、正常对照组（40例）。采用流式细胞仪检测外周血淋巴细胞CD23的表达,采用免疫比浊法检测血清免疫球蛋白的含量。结果与正常对照组比较,MPP轻症组和重症组患儿外周血淋巴细胞CD23的表达、IgM水平显著增高（P〈0.01）。重症组外周血CD23的表达及血清IgA、IgG水平显著高于轻症组（P〈0.01或〈0.05）,而重症组的血清IgM水平与轻症组比较无明显差异。结论MPP患儿外周血淋巴细胞CD23的表达及血清IgM含量显著升高,重症MPP患儿IgA、IgG也显著升高。MPP患儿存在体液免疫失调。     

肺炎支原体肺炎患儿机体免疫功能变化

目的探讨肺炎支原体肺炎(MPP)发病机制中的免疫功能变化。方法收集30例MPP住院患儿作为观察组,并选取同期来院体检的健康儿童33例为对照组,分别检测T淋巴细胞亚群及免疫球蛋白、C3、NK细胞指标。结果与对照组相比,观察组CD+3、CD+4、CD+4/CD+8较对照组表达降低(P<0.05),具有统计学意义,NK细胞下降明显(P<0.05),而CD+8水平与对照组差异无统计学意义(P>0.05);观察组患儿IgG、IgM、IgA及C3水平明显升高,与对照组差异有统计学意义(P<0.05)。结论 MPP患儿存在T淋巴细胞免疫功能低下和B淋巴细胞异常活化,同时补体系统被大量激活,参与了MPP的发病。     

肺炎支原体肺炎患儿免疫功能的变化与分析

目的分析肺炎支原体肺炎(MPP)患儿T淋巴细胞亚群和免疫球蛋白水平的变化,探讨免疫功能在肺炎支原体肺炎发病机制中的作用。方法收集2009年3月-2011年2月收治的MPP住院患儿50例作为观察组,另选取同期来院体检的健康儿童20例作为对照组,分别检测T淋巴细胞亚群及免疫球蛋白指标。结果与正常对照组相比,观察组CD3+、CD4+、CD4+/CD8+明显下降(P<0.05),而CD8+水平与正常对照组相比差异无统计学意义(P>0.05);与正常对照组相比,观察组患儿IgM、IgA水平明显升高,差异有统计学意义(P<0.05),而IgG水平与正常对照组相比差异无统计学意义(P>0.05)。结论 MPP患儿存在T淋巴细胞免疫功能低下和B淋巴细胞异常活化,细胞免疫与体液免疫功能紊乱在MPP发病机制中起重要作用。     

肺炎支原体肺炎儿童免疫功能变化分析

目的观察分析肺炎支原体肺炎(MPP)患儿外周血T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)含量变化和免疫球蛋白的水平变化。方法选取我院2018年2月至2019年4月收治的50例咽拭子肺炎支原体阳性的支气管肺炎患儿作为观察组,50例肺炎支原体阴性的支气管肺炎患儿作为对照组。用郑州安图生物肺炎支原体培养试剂检测肺炎支原体。T淋巴细胞亚群检测采用Semi BiO全自动可视化细胞检测仪收获细胞,检测两组儿童的外周血T淋巴细胞亚群的百分比,用散射比浊法检测血清免疫球蛋白IgG、IgA和IgM的含量。结果分析观察组和对照组外周血T淋巴细胞亚群,观察组CD3~+、CD4~+、CD4/CD8均低于对照组,差异具有统计学意义(P0.05),CD8~+细胞差异不具有统计学意义(P 0.05);比较两组儿童的免疫球蛋白水平,观察组IgG和IgA与对照组IgG和IgA相比,差异不具有统计学意义(P 0.05),观察组IgM高于对照组,差异具有统计学意义(P0.05)。结论肺炎支原体肺炎患儿的机体免疫功能下降,使免疫调节功能紊乱,T淋巴细胞介导的免疫反应占有一定程度的优势。     

肺炎支原体肺炎患儿细胞免疫、体液免疫情况分析

目的：探讨肺炎支原体肺炎（MPP）患儿细胞免疫、体液免疫变化,以期能为临床免疫治疗提供理论参考依据。方法：选取急性期MPP患儿196例（MPP组）,其中轻型152例,重型44例,选取同期外科择期手术7岁以下儿童50例为对照组,检测IgA、IgG、IgM水平及CD3^＋、CD4^＋。结果：MPP组IgG、IgM水平高于对照组,比较差异具有统计学意义（P〈0．05）,MPP组轻型患儿XgG、IgM水平均高于对照组,重型患儿IgM水平高于轻型患儿及对照组,比较差异具有统计学意义（P〈0．05）;MPP组CD3^＋、CD4^＋均低于对照组,比较差异具有统计学意义（P〈0．05）,MPP组轻型患儿CD4^＋低于对照组,重型患儿CD4^＋低于对照组,CD3^＋低于对照组及轻型患儿,比较差异具有统计学意义（P〈0．05）。结论：MPP感染患儿存在B淋巴细胞异常活化及T淋巴细胞低下,重型肺炎患儿表现更明显。     

儿童肺炎支原体肺炎合并胸腔积液的临床特征及实验室检查结果分析

目的探讨并比较儿童肺炎支原体肺炎(MPP)及MPP合并胸腔积液(PE)的临床及实验室检查特征,为临床诊治提供依据。方法回顾性分析2015年1月至2016年12月住院的MPP患儿共774例,分为单纯MPP组716例及MPP合并PE组58例,收集临床及实验室检查资料并分析。结果单纯MPP组平均年龄为(3.17±2.66)岁,MPP合并PE组平均年龄为(5.10±2.55)岁,差异有统计学意义(P<0.05),后者学龄期儿童比例占41.4%,差异有统计学意义(P<0.05)。MPP合并PE组的热程及住院时间均长于单纯MPP组,差异有统计学意义(P<0.01)。MPP合并PE组多为以肺实变为主的大叶性肺炎(82.8%),高于单纯MPP组(22.5%),差异有统计学意义(P<0.01)。MPP合并PE组的CRP及LDH值均高于单纯MPP组,差异有统计学意义(P<0.05)。MPP合并PE组的CD3+、CD3+CD4+T淋巴细胞比例和CD4+/CD8+比值均低于单纯MPP组(P<0.01),而CD3+CD8+T淋巴细胞比例则高于后者(P<0.01)。MPP合并PE组的Ig A值高于单纯MPP组(P<0.05),而Ig M、Ig G值两组间差异无统计学意义。结论MPP合并胸腔积液时患儿的临床特征及实验室检查结果与单纯MPP患儿存在明显差异,证实MPP并发胸腔积液时存在更为严重的免疫损伤。     

难治性支原体肺炎与免疫功能指标的相关性分析

目的观察分析难治性肺炎支原体肺炎(RMPP)与免疫功能指标的相关性。方法选取该院2017年4月至2019年4月收治的肺炎支原体肺炎(MPP)患儿120例,其中50例患儿采取大环内酯类抗生素治疗7 d及以上者症状未缓解甚至加重定义为RMPP组,剩余的70例为MPP组,比较两组患儿T淋巴细胞亚群(CD3~+、CD4~+、CD8~+与CD4~+/CD8~+)、血清免疫球蛋白(Ig)相关指标[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)与免疫球蛋白M(IgM)]和血清超敏C反应蛋白(hs-CRP)水平变化。结果 RMPP组患儿CD3~+、CD4~+与CD4~+/CD8~+比较低于MPP组,CD8~+高于MPP组,差异有统计学意义(P0.05)。RMPP组IgA与IgG少于MPP组,比较差异无统计学意义(P0.05);RMPP组IgM与hs-CRP高于MPP组,比较差异有统计学意义(P0.05)。结论 RMPP与患儿免疫功能的紊乱紧密相关,通过检测免疫功能相关T淋巴细胞亚群、Ig与hs-CRP指标,在RMPP患儿的诊断治疗中具备较高价值。     

重症71型肠道病毒感染手足口病患儿的免疫指标分析

目的 探讨71型肠道病毒感染手足口病患儿的免疫指标变化情况,分析其临床意义.方法 选取2013年5月至2016年5月我院收治的71型肠道病毒感染所致的手足口病患儿170例为研究对象,按照疾病程度的不同将其分为轻症组80例以及重症组90例,另取同期于我院进行体检的同龄健康儿童70例作为对照组.对三组儿童细胞免疫(免疫表型及炎性因子)以及体液免疫(免疫球蛋白及补体)各指标检测结果进行回顾性分析与比较.结果 重症组患儿CD3+T细胞数量为(59.41±6.08)％、CD3+ CD4+T细胞数量为(17.44±4.20)％,CD3+ CD8+T细胞数量为(26.25±4.58)％;均低于轻症组[分别为(66.33±7.52)％、(20.01±3.86)％、(39.66±4.93％]及对照组[(73.58±7.94)％、(23.75±3.11)％、(51.32±5.07)％]差异有统计学意义(P＜0.05),重症组CD19+B细胞数量为(19.24±8.05)％,高于轻症组(14.68±6.71)％及对照组(12.03±5.22)％,差异均有统计学意义(P＜0.05).三组儿童CD4+/CD8+以及CD16+ CD56+ NK细胞数量相比差异无统计学意义(P＞0.05).重症组患儿IL-6、IL-10以及TNF-α表达水平均高于轻症组及对照组,差异均有统计学意义(P＜0.05).重症组患儿免疫球蛋白及补体表达水平高于轻症组及对照组,差异有统计学意义(P＜0.05).结论 重症71型肠道病毒感染手足口病患儿存在明显的细胞免疫及体液免疫功能紊乱,临床应根据患儿具体情况适当开展免疫治疗.     

Influence of Dexamethasone on Immune Indexes of Mycoplasma Pneumonia Children with Extrapulmonary Complications

目的:探讨支原体肺炎肺外并发症患儿早期应用地塞米松治疗前后部分体液及细胞免疫指标的变化及临床恢复情况,并分析相关作用机理.方法:将40例支原体肺炎并肺外并发症患儿随机分为地塞米松组和非地塞米松组,两组均用包括阿奇霉素等基础治疗方案,其中地塞米松组早期应用小剂量地塞米松(0.2～0.3mg·kg-1·d-1),逐渐减量治疗5d,设立对照组20例.测定相关血清免疫学指标并进行比较,评价疗效.结果:治疗前两组患儿外周血IgG、IgM、IgA、CD8+T细胞均高于对照组(P＜0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值低于对照组(P＜0.05);治疗后地塞米松组IgG、IgM、IgA与治疗前差异无统计学意义(P＞0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值较治疗前升高(P＜0.05),CD8+T细胞较治疗前降低(P＜0.05);非地塞米松组IgG、IgM、IgA、CD8+T细胞均较治疗前升高(P＜0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值较治疗前降低(P＜0.05);地塞米松组的发热时间、肺部罗音消失时间及肺外症状消失时间均较非地塞米松组短(P＜0.05).结论:支原体肺炎并肺外并发症患儿的体液及细胞免疫均存在紊乱,小剂量地塞米松早期干预可对患儿的免疫功能起到调节作用,并加快病情的恢复.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.