阿司匹林抵抗的产生机制与防治策略

阿司匹林属于非甾体类抗炎药,尽管被广泛应用于临床已有百余年,但有关其作用机制及临床应用的研究一直在进行。阿司匹林由最初的被用于解热、镇痛、抗炎等逐渐转变到用于抗血栓,尤其在心血管事件的二级预防中应用最广,减少了大约25%的心血管事件的发生。临床上有5%~60%的患者虽常规服用阿司匹林,却不能有效地抑制血小板的活性,这种现象被称为阿司匹林抵抗。导致这种现象的确切原因还不明确,可能与药物间的相互作用、剂量不足等有关。但到目前为止,仍无法用同一机制解释所有的阿司匹林抵抗,并且,很多研究所得出的结果是矛盾的。因此,认为在具有阿司匹林抵抗的人群中可能存在一定的群体特征性,也正因如此导致了阿司匹林抵抗的复杂性。期望用同一机制解释所有的阿司匹林抵抗现象是不可行的,应当针对不同群体做更多的研究工作。按照传统中医理论,结合心血管疾病多病程较长,且在存在阿司匹林抵抗的人群中多反复发作等特点,应将其归属于络病的范畴。联合应用具有扶正化浊,活血解毒通络功效的中药,发挥中医中药辨证论治和整体调节的优势,也许可以解决具有不同群体特征性的阿司匹林抵抗的问题,从而更有效地预防心血管疾病的发生。     

Current approaches to tuberculosis in the United States

Tuberculosis is a major threat to global health, infecting a third of the world's population. In the United States, however, control of tuberculosis has been increasingly successful. Only 3.2% of the US population is estimated to have latent tuberculosis and there are only 11,000 cases annually of active disease. More than half the cases in this country occur in individuals born outside the United States. Human immunodeficiency virus coinfection is not a major factor in the United States, since only approximately 10% of cases are coinfected. Drug resistance is also uncommon in this country. Because the United States has more resources for the diagnosis, therapy, and public health control of tuberculosis than many regions of the world, and because many hospitals have more cases of clinically significant nontuberculous mycobacteria than tuberculosis, the management approaches to tuberculosis need to be quite different in this country than in other regions. The resurgence in interest in developing new tools and the investment in public health infrastructure will hopefully be sustained in the United States so that the effect of tuberculosis on the US population will continue to diminish, and these new tools and approaches can be adapted to both high and low prevalence areas to meet the global challenge.     

鲍曼不动杆菌对β-内酰胺类抗生素耐药机制的研究进展

鲍曼不动杆菌是一种不发酵葡萄糖的革兰阴性球杆菌,近年来临床检出率呈上升趋势,是医院内感染中分离的重要病原菌.鲍曼不动杆菌由于其生存力强、耐药谱广及耐药率高的特点引起了广泛地关注.其耐药机制主要包括产生β-内酰胺酶、青霉素结合蛋白改变、外膜通透性降低和主动外排增强.该文对鲍曼不动杆菌耐β-内酰胺类抗生素机制,尤其是对外膜孔蛋白和主动外排系统机制进行了详细综述.     

鲍曼不动杆菌对β-内酰胺类抗生素耐药机制的研究进展

鲍曼不动杆菌是一种不发酵葡萄糖的革兰阴性球杆菌,近年来临床检出率呈上升趋势,是医院内感染中分离的重要病原菌。鲍曼不动杆菌由于其生存力强、耐药谱广及耐药率高的特点引起了广泛地关注。其耐药机制主要包括产生β-内酰胺酶、青霉素结合蛋白改变、外膜通透性降低和主动外排增强。该文对鲍曼不动杆菌耐β-内酰胺类抗生素机制,尤其是对外膜孔蛋白和主动外排系统机制进行了详细综述。     

368例流动人口活动性肺结核人口信息及临床表型的分析

目的 探讨广州市番禺区流动人口活动性肺结核病例人口信息、临床表型的特点及其与痰涂片结果的关系,为全区流动人口结核病防治策略制定提供依据。方法 符合纳入标准和排除标准的368例流动人口活动性肺结核病例,按痰涂片结果分为涂阳组和涂阴组,比较两组人口信息、影像学特点、结核病类型、耐药及一般基础疾病情况的差异;对痰涂片阳性与病变累及肺叶数、合并支气管结核、合并空洞进行相关性分析,研究痰涂阳性与临床表型的关系。结果 涂阳组40岁以上患者比例较涂阴组多（63例、39.38%）、病变累及2叶及以上为主（103例、64.38%）、合并空洞情况较多（73例、45.60%）,两组在年龄构成、病变累及肺叶数、合并空洞以及复治比例上差异有统计学意义（P＜0.05）;相关性分析表明涂阳与病变累及肺叶2叶以下呈负相关,与病变累及肺叶4叶以上呈正相关,与合并支气管结核或空洞呈正相关（均P=0.000）。结论 掌握全区流动人口活动性肺结核涂阳组和涂阴组不同的人口信息和临床表型特点及其相关性对我区结防策略制定具有指导意义。     

菊酯类杀虫剂对海口市白纹伊蚊的效果测定

目的了解常用菊酯类杀虫剂商品对海口市白纹伊蚊群体的杀虫效果。方法采集海口市白沙门公园等地的白纹伊蚊幼虫,带回实验室饲养至成蚊作为试虫,应用玻璃药膜法检测15种常见市售杀虫剂对其的杀虫效果,并应用接触筒法检测其对0.1%溴氰菊酯的敏感性。结果氯氰菊酯等11种杀虫剂对海口市白沙门公园的白纹伊蚊群体杀虫效果显著,混配的杀虫剂30 min击倒率和24 h死亡率均为100%;效果不显著的有4种,有效成分分别是高效氯氟氰菊酯、顺式氯氰菊酯和溴氰菊酯,效果最差的是溴氰菊酯(击倒率为17%,死亡率为34%)。溴氰菊酯对海口其他地区的白纹伊蚊群体,除干家村外,击倒率和死亡率至少有1项未达到标准,效果不显著。接触筒法测定在3个时间点采集的白沙门公园白纹伊蚊群体对0.1%溴氰菊酯的敏感性,结果显示受试蚊虫均已产生抗性。结论海口市多个地区的白纹伊蚊群体对溴氰菊酯、高效氯氟氰菊酯和顺式氯氰菊酯类杀虫剂商品的效果不明显,对氯氰菊酯等11种杀虫剂商品效果显著。在未来的蚊虫控制中,应加强对杀虫剂的抗药性监测,合理使用杀虫剂。     

多重耐药鲍曼不动杆菌主动外排系统adeA的分布

目的 探讨主动外排系统adeA与鲍曼不动杆菌多重耐药的关系.方法 采用聚合酶链反应(PCR)筛选鲍曼不动杆菌的主动外排基因adeA,应用琼脂稀释法检测主动外排抑制剂碳酰氰间氯苯腙(CCCP)联合抗菌药物对多重耐药鲍曼不动杆菌生长的影响.结果 收集的60株鲍曼不动杆菌临床分离株对亚胺培南、美罗培南耐药率分别80.0%和81.7%,对其它大多数抗菌药物的耐药率为90%以上;60株临床分离株检测出adeA主动外排基因52株,检出率为86.7%;CCCP可减少多重耐药鲍曼不动杆菌对抗菌药物的外排作用,增加抗生素对多重耐药鲍曼不动杆菌的抑制率.结论 鲍曼不动杆菌是医院感染重要的多重耐药病原菌,adeA主动外排作用可能在本地区鲍曼不动杆菌多重耐药中发挥非常重要的作用.     

抗菌药物在老年人中的应用及其使用的伦理原则

从药物的吸收、分布、代谢、排泄等方面了解老年人药物动力学特点及感染特点,对老年人的感染性疾病合理的应用抗菌药物：尽量避免使用毒性大的抗菌药物;尽量避免使用耐药性突出的抗菌药物;老年患者可减量应用毒性低的β-内酰胺类抗菌药物;老年患者感染宜用杀菌型抗菌药物。在感染治疗过程中严格遵循抗菌药物在老年人中使用的伦理原则：减少无目的使用抗菌药物;选择有效的抗菌药物;采用科学合理的给药方法;预防抗菌药物毒副反应和细菌耐药对老年人的危害;选择适合老年人经济状况的抗菌药物。     

The emergence of drug resistant HIV variants and novel anti-retroviral therapy

After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world; however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint.     

幽门螺杆菌与胃炎活动性关系的病理观察

目的:探讨胃癌高危人群幽门螺杆菌(Helicobacterpylori,Hp)与胃炎活动性的关系。方法:对胃癌高发区成年人群(533人)做内镜、快速尿素酶试验及胃粘膜活检组织学检查,Hp以组织学WS染色检查为标准,数据结果均做χ2检验。结果:(1)人群Hp的检出率为64.54%,活动性胃炎的检出率为69.42%。(2)活动性胃炎中Hp的检出率为92.43%。(3)Hp阳性组活动性胃炎的检出率为99.42%,明显高于Hp阴性组。(4)胃窦部及体小弯活动性胃炎的检出率高于胃底部;胃窦部高于体小弯。(5)Hp阳性者各活检部位的活动性胃炎组织中Hp的检出率均高。(6)Hp根除后活动性胃炎的检出率明显下降(5.77%),前后比较差异有极显著性。结论:(1)Hp与胃炎活动性密切相关。(2)Hp的检出提示胃内有活动性炎症的存在。     

南宁市2021年白纹伊蚊抗药性和病原学监测研究

目的 掌握南宁市白纹伊蚊对常用杀虫剂的抗药性程度和病毒携带率,为合理选择、使用杀虫剂及蚊媒生物传染病的风险评估和预测预警提供科学依据。方法 白纹伊蚊抗药性监测分别采用成蚊接触筒法、幼虫浸渍法对拟除虫菊酯类、氨基甲酸酯类和有机磷类杀虫剂进行敏感性测定,并运用SPSS 20.0进行统计学分析;白纹伊蚊病原学监测采用半巢式RT-PCR法对黄病毒属和甲病毒属进行检测。结果 2021年南宁市白纹伊蚊抗药性监测结果显示,白纹伊蚊幼虫对高效氯氰菊酯、残杀威LC₅₀分别为0.261、4.978 mg/L,抗性倍数分别为48.253、5.591,抗性水平分别为高抗和抵抗;成蚊高效氯氰菊酯、残杀威、马拉硫磷药纸死亡率分别为57%、80%、100%,抗性水平分别为抗性、可能抗性和敏感;2021年南宁市白纹伊蚊病原学监测结果显示,野外采集的白纹伊蚊雌性成蚊共2 199只,黄病毒属和甲病毒属病毒检测结果显示均未扩增出阳性条带。结论 南宁市白纹伊蚊幼虫及成蚊对高效氯氰菊酯和残杀威存在不同程度抗药性,应参照抗药性检测结果,结合当地实际情况,高抗或抗性杀虫剂应停用一段时间,低抗或疑似抗性杀虫剂应...     

细菌多重耐药性的组合遗传进化

近年来,抗生素耐药性日益严重,并且呈现多重耐药现象,已引起临床医生和微生物工作者的高度关注。耐药机制包括染色体基因突变、外膜孔蛋白改变、药物主动外排系统表达亢进和产生灭活酶等。细菌耐药基因通过接合性质粒、转座子、整合型噬菌体、整合子的水平传递等发生传递。现就整合子、插入序列、插入序列共同区域在细菌多重耐药性中的作用予以综述。     

廊坊市流动人口结核病耐药状况分析

目的初步了解河北省廊坊地区流动人口结核病耐药状况,为有效控制耐药结核病流行提供依据。方法采集2009-2013年流动人口中新发现的肺结核病人涂阳痰标本,经培养鉴定为结核分枝杆菌的菌株采用比例法测定对异烟肼、利福平、乙胺丁醇、链霉素、卡那霉素、氧氟沙星6种药物敏感性,并将分离自流动人口的菌株耐药性与常住人口进行比较。结果进行结核分枝杆菌耐药监测共1764株,耐药菌株819株,总耐药率为46.4％（819／1764）,耐多药率为11.5％（203／1764）,广泛耐药率为1.1％（20／1764）;其中流动人口总耐药率为55.1％（205／372）,耐多药率为15.1％（56／372）,广泛耐药率为1.9％（7／372）;常住人口总耐药率为44.1％（614／1392）,耐多药率为10.6％（147／1392）,广泛耐药率为0.9％（13／1392）。流动人口组的总耐药率、耐多药率、广泛耐药率均高于常住人口组,差异有统计学意义（X2值分别为14．3、5．8和2．4,P均〈0.05）。结论廊坊市流动人口的结核耐药率显著高于该地区常住人口的结核耐药率,应根据流动人口的特点加强结核病防治措施。     

Management of Helicobacter pylori infection--a Working Party Report of the Malaysian Society of Gastroenterology and Hepatology

The Working Party Report on the Management of Helicobacter pylori serves as a clinical practice guideline for Malaysian doctors. H. pylori is not uncommon in the Malaysian population. Marked racial differences and the consistently low prevalence rates amongst Malays are noted. The working party recommends that if endoscopy is to be performed, a rapid urease test should be used for diagnosis. Where suspicion of the infection is strong and the urease test is negative, histology should be performed on gastric biopsies. Culture should be used to monitor resistance patterns to antibiotics and regional laboratories should assume this responsibility. The urea breath tests are highly accurate tests for diagnosis of H. pylori but is as yet not widely available in Malaysia. The working party strongly recommends that all peptic ulcer patients infected with H. pylori whether active, in remission and complicated ulcers should be treated for the infection. Patients with low-grade gastric mucosal lymphoid tissue lymphoma should also be treated for H. pylori infection. It is considered advisable that patients on long term nonsteroidal antinflammatory drug (NSAID) treatment with a history of peptic ulcers or dyspepsia and patients following resection of early gastric cancer or those with a family history of gastric cancer should also be tested and treated for H. pylori. The working party recommends, as first line treatment a 7-day combination therapy of a proton pump inhibitor, clarithromycin and metronidazole or amoxicillin. High metronidazole resistance rates locally may adversely affect regimens containing the antibiotic. It should also be noted that regimens that yield lower eradication rates may result in higher long term expenditure.     

辽宁省阜新市2014—2018年报告活动性肺结核流行特征与耐药分析

目的 了解阜新市活动性肺结核流行特征与耐药现状,为有效提高结核防治效果及制定下一阶段防治方案提供有利依据。方法 对阜新市2014—2018年报告登记的活动性肺结核进行描述性分析。结果 2014—2018年阜新市共报告登记活动性肺结核5 080例,年平均报告登记率为56.82/10万,整体呈下降趋势（P<0.05）。报告登记病原学阳性肺结核1 772例（占34.88%）,年平均报告登记率为19.82/10万。男女性比例为2.69∶1,年龄以45岁及以上中老年人为主,共3 420例（占67.32%）,职业以农民和无业人员为主,共4 248例（占83.62%）。5 080例报告登记活动性肺结核患者中有680例(占13.39%)进行抗结核药物敏感性试验并获得检测结果,680例肺结核患者的总耐药率和耐多药率分别为14.26%和5.29%,初治患者与复治患者之间的总耐药率和耐多药率差别有统计学意义（P<0.05）。结论 2014—2018年阜新市活动性肺结核总体呈下降趋势,农民和无业者结核病疫情形势严峻,复治患者较初治患者耐药率高,需实施好初治肺结核患者全程规范化督导治疗,控制其复发与耐药的发展势头。     

Increased resistance to helminth infestation in an atopic population.

Faecal egg counts were compared in three groups in an area of universal hookworm infestation. Egg counts were lower in asthmatic and atopic non-asthmatic subjects than in a non-atopic population. The atopic population was defined by skin testing for immediate hypersensitivity responses. It is suggested that the atopic state may confer increased resistance to helminth infestation.     

Beyond DOtS: avenues ahead in the management of tuberculosis

India has almost 30% of the global burden of tuberculosis (TB)--one person dies of the disease every minute in our country. India has mounted the second-largest DOTS programme in the world to control this disease. However, DOTS has its limitations and newer approaches have been developed over the years to overcome the global burden of tuberculosis. Problems with health facilities, patients, drugs and the disease itself constitute some of the hurdles in the implementation of the DOTS programme. In an attempt to go beyond DOTS, the WHO launched the 'Stop TB Initiative' in 1988. Against the background of irrational antituberculosis drug use, which contributes to increasing drug resistance, the effective involvement of private healthcare providers is imperative to achieve better geographical and patient coverage for the implementation of DOTS. The WHO is currently addressing the issue of involving private practitioners in tuberculosis control in a programme called Public-Private Mix DOTS (PPM DOTS). The Stop TB Initiative is also active in the area of dual infection with HIV and tuberculosis, and the initiatives that have been taken in this area include 'ProTEST', community contribution to tuberculosis care, and development and dissemination of training materials and guidelines. The DOTS-Plus strategy for the management of multidrug resistant (MDR)-TB and the establishment of the Green Light Committee to review project applications in this area are initiatives taken to curb the problem of drug resistance in tuberculosis. Even decades after the introduction of the DOTS strategy, much needs to be done to expand the services to the entire population; it is now essential to develop strategies that go beyond DOTS.     

肿瘤多药耐药机制的研究进展

当前,恶性肿瘤是严重威胁人类健康和生命的疾病之一。在我国城镇居民人口中,肿瘤导致的死亡占各类疾病的25%。临床上治疗恶性肿瘤的常用方法有手术治疗、放疗和化疗3种治疗方案,其中化疗在恶性肿瘤治疗中占据着不可替代的位置。有些患者经过有效的化疗后仍会复发,其中最重要的原因就是肿瘤多药耐药(multidrug resistant,MDR)的产生限制了化疗的疗效。临床上应用联合化疗虽然能发挥最大的细胞毒作用,也因MDR的产生而失败。因此,克服肿瘤多药耐药是未来研究肿瘤治疗方法的关键。肿瘤多药耐药的产生是一个十分复杂的过程,受多种因素影响。肿瘤细胞通过多种途径导致多药耐药的产生,包括:耐药相关蛋白;DNA损伤和修复功能障碍;细胞自噬;减少药物积累和增加药物输出;代谢解毒;药物靶标和信号转导分子的改变等多种机制。肿瘤多药耐药与P-糖蛋白、乳腺癌耐药蛋白、多药耐药相关蛋白、肺耐药蛋白、拓扑异构酶以及细胞凋亡相关蛋白有关。目前有很多逆转剂应用于临床,但是疗效好、毒副作用小的MDR逆转剂还有待进一步研究。因此,对MDR机制的研究,并掌握癌细胞如何对抗癌药物产生抗性,将有助于研制出更加有效的抗肿瘤药物。本文现就国内外关于肿瘤细胞MDR产生的分子机制做一综述。      

Hepatitis C and diabetes mellitus

Hepatitis C virus infection in diabetes mellitus is more common than in non-diabetic population. Earlier it was thought to be due to more use of needles for insulin injections and frequent blood examination which has been recently antagonised by recent studies. Hepatitis C virus infection has shown to produce insulin resistance (because of liberated cytokines) insulin secretory defect (by viral infection or auto-immune damage). Hepatitis C virus infection also leads to non-alcoholic fatty liver disease (a probable component of insulin resistance syndrome) and increased iron increased iron storage in the body. All these factors may explain hepatitic C virus infection as an aetiology for diabetes mellitus. If future researches strongly establish this fact, antiviral or vaccines for hepatitis C virus infection should be thought of for preventing diabetes mellitus.     

外加呼吸阻力容许水平的测定

研究阻力性呼吸机械负荷的生理、心理影响,测出不同使用条件下呼吸防护装备(RPD)外加阻力容许水平,具有实际意义。我们以56名健康男性青年为实验对象,用概率单位分析方法,测出轻度体力负荷时外加呼吸阻力的容许水平。