哮喘及反复呼吸道感染患儿T淋巴细胞亚群和IgE的测定与分析

目的探讨哮喘及反复呼吸道感染（RRTI）患儿T淋巴细胞亚群和IgE的变化及临床意义.方法应用SPA直接花环法及酶联免疫吸附试验测定38例哮喘患儿发作期和缓解期、28例RRTI患儿T淋巴细胞亚群和IgE.对照组为22例健康儿童.结果哮喘发作期和缓解期CD^＋4、CD^＋4/CD^＋8及IgE高于对照组（P＜0.01,P＜0.05）,发作期CD^＋3、CD^＋8低于对照组（P＜0.01,P＜0.05）.发作期CD^＋4、CD^＋4/CD＋8及IgE高于缓解期（P＜0.05,P＜0.01）,CD^＋3低于缓解期（P＜0.05）.RRTICD^＋3、CD^＋4、CD^＋4/CD＋8低于对照组（P＜0.05,P＜0.01）,CD^＋8及IgE高于对照组（P＜0.01,P＜0.05）.结论哮喘发作期和缓解期、RRTI均存在免疫功能紊乱,提示哮喘患儿应长期抗变应性炎症治疗,加强免疫调节治疗,RRTI患儿适当使用免疫调节剂和免疫增强剂.     

小儿支气管哮喘发作期细胞免疫及体液免疫的改变

目的 :对 84例支气管哮喘发作期患儿进行了外周血T淋巴细胞亚群及总IgE测定 ,并与健康儿童对照组进行比较。方法 :采用单克隆抗体检测T淋巴细胞亚群试剂盒检测病儿外周血T淋巴细胞亚群阳性细胞百分率 ;应用微粒子化学发光法测定外周血总IgE水平。结果 :哮喘组中CD4+ 平均值为 47.2 8± 8.6 4,对照组平均值为 31.10± 6 .86 ,CD4+ 值高于对照组 (P <0 0 5 ) ;哮喘组CD8+ 平均值 32 .19± 5 .2 1,对照组平均值为 37.14± 5 .6 1,CD8+ 值低于对照组 (P <0 .0 5 )。哮喘组总IgE平均值为 80 4± 14 4 ,对照组平均值为 2 76± 12 5 ,总IgE值高于对照组 (P <0 .0 5 )。结果提示 :小儿支气管哮喘发作期CD4+ 细胞升高 ,CD8+ 细胞下降和血清总IgE升高。     

IL-17、IL-5、IL-4、 IL-33等细胞因子在哮喘发病机制中的作用

目的 探讨白细胞介素-17(IL-17)、白细胞介素-33(IL-33)、白细胞介素-4(IL-4)、白细胞介素-5(IL-5)等细胞因子在哮喘发病机制中的作用.方法 选择浙江省乐清市人民医院2011年2月～2014年8月收治的82例哮喘患者作为研究对象,根据患者的临床表现分为急性发作组(45例)、缓解期组(37例),并选取同期健康人群40例作为对照组,比较三组患者相关指标的差异及其相关性.结果 缓解期组呼气流量峰值(PEF)、第1秒用力呼气量(FEV1)、第1秒用力呼气量/用力肺活量(FEV1/FVC)、哮喘控制测试评分(ACT)均显著高于急性发作组(P＜0.01).急性发作组IL-17、IL-5、IL-4、IL-6、IL-8、IFN-γ、IgE值均显著高于缓解期组、对照组,IL-2显著低于缓解期组、对照组(P＜ 0.05);缓解期组IL-17、IL-5、IL-4、IL-8、IFN-γ、IgE值显著高于对照组,IL-2显著低于对照组(P＜0.05).三组CD3+、CD4+、CD4+/CD8+测定值比较差异有高度统计学意义(P＜0.01),急性发作组CD3+、CD4+、CD4+/CD8+值显著高于缓解期组、对照组(P＜0.05);缓解期组患者的CD3+、CD4+、CD4+/CD8+值显著高于对照组(P＜0.05).结论 哮喘患者的T细胞亚群、细胞因子与健康人群存在显著差异,急性发作期患者与缓解期患者的T细胞亚群、细胞因子、肺功能指标差异显著,提示免疫功能紊乱、炎症介质分泌增加与哮喘发作关系密切.     

玉屏风颗粒对小儿支气管哮喘缓解期免疫功能的影响

目的:观察玉屏风颗粒对小儿支气管哮喘缓解期免疫功能的影响。方法:选取72例支气管哮喘缓解期患儿随机分为治疗组和对照组,每组36例,治疗组予玉屏风颗粒口服,对照组予以安慰剂口服,3个月为1个疗程。观察2组临床疗效,并检测治疗前后血清IgE及外周血CD4+、CD8+和CD4+/CD8+的变化。结果:治疗组临床疗效优于对照组(P<0.01),治疗后,治疗组IgE、CD4+和CD4+/CD8+较对照组显著下降(P<0.01),CD8+水平较对照组显著升高(P<0.01),差异均有统计学意义。结论:玉屏风颗粒防治小儿支气管哮喘疗效确切,其作用机制可能与其调节T淋巴细胞亚群和降低血清IgE水平,改善患儿免疫功能有关。     

急性发作期哮喘患儿外周血辅助性T淋巴细胞亚群及血浆总IgE水平分析

目的:检测急性发作期哮喘患儿外周血辅助性T淋巴细胞(Th)亚群和血浆总IgE水平,并对二者的相关性进行分析。方法:以流式细胞术检测哮喘急性发作期患儿(30例)和对照组健康儿童(30例)的外周血辅助性T淋巴细胞亚群,并采用化学发光法检测其血浆总IgE水平。结果:(1)与对照组比较,急性发作期哮喘患儿Th1亚群百分比(14.7%±3.3%)和Th1/Th2比值(0.904±0.455)均显著降低(P<0.05,P<0.01),而Th2亚群百分比(14.7%±3.3%)显著升高(P<0.05)。(2)急性发作期哮喘患儿血浆总IgE水平为272.2±129.7,明显高于对照组(46.8±28.5),(P<0.01)。(3)急性发作期哮喘患儿Th2亚群与血浆总IgE水平呈明显正相关(!=0.920,P<0.01);同时,其Th1/Th2比值与血浆总IgE水平呈明显负相关(γ=-0.832,P<0.05)。结论:急性发作期哮喘患儿外周血辅助性T淋巴细胞处于明显失衡状态,表现为Th1亚群百分比和Th1/Th2比值明显降低、Th2亚群百分比明显升高。同时,辅助性T淋巴细胞亚群状态与其血浆总IgE水平密切相关。     

反复呼吸道感染患儿免疫功能状态变化的临床意义

目的 探讨反复呼吸道感染(RRTI)患儿T细胞亚群和血清免疫球蛋白的变化.方法 对44例RRTI患儿分别在急性发作期和缓解期采用流式细胞仪收获和分析T细胞亚群(CD3 、CD3 CD4 、CD3 CD8 、CD3 CD4 /CD3 CD8 )及血清免疫球蛋白(IgG、IgA、IgM)情况,并与50例正常儿童进行比较.结果 (1)RRTI患儿急性发作期和缓解期T细胞亚群CD3 、CD3 CD 4百分率和CD3 CD4 /CD3 CD 8比值均显著低于对照组(P＜0.01);CD3 CD8 百分率急性发作期显著高于对照组(P＜0.01),而缓解期与对照组差异无显著性意义(P＞0.05);RRTI患儿急性发作期的CD3 百分率低于缓解期差异有显著性意义(P＜0.05),而CD3 CD4 、CD3 CD8 百分率和CD3 CD4 /CD3 CD8 比值在急性发作期与缓解期比较差异无显著性意义(P＞0.05).(2)RRTI急性发作期和缓解期血清IgA水平均显著低于对照组(P＜0.05);IgG水平急性发作期显著低于对照组(P＜0.01),而缓解期与对照组比较差异无显著性意义(P＞0.05);血清IgM水平三组之间比较及血清IgG、IgA、IgM水平在急性发作期与缓解期比较差异均无显著性意义(P＞0.05).结论 免疫功能紊乱是小儿RRTI发病的一项重要因素,提示抗感染与免疫调节是治疗RRTI的两个重要环节.     

过敏性哮喘患儿T、B淋巴细胞亚群的变化

目的　观察过敏性哮喘患儿T、B淋巴细胞亚群的变化 ,以探讨免疫致病机制。方法　以 43例急性发作过敏性哮喘患儿、2 0例缓解期过敏性哮喘患儿及 2 0例健康儿童为主要研究对象 ,采用流式细胞术测定CD 4+、CD 4+/3 0 +、CD 8+,CD 8+/2 8+T淋巴细胞亚群和CD19+B淋巴细胞亚群。采用ELISA法测定其血清中白介素 (IL 4)与IgE浓度 ,同时行CD 4+/3 0 +与IL 4、IgE以及CD19与IgE相关性分析。结果　过敏性哮喘急性发作时 ,CD 8+/2 8+T淋巴细胞亚群为 ( 13 .7± 2 .8) % ,较哮喘缓解组的 ( 10 .6± 2 .8) %和正常组的 ( 11.9± 1.5 ) %显著上升 (P <0 .0 1) ;哮喘急性发作组CD 4+/3 0 +T淋巴细胞亚群与CD 19+B淋巴细胞亚群分别为 ( 2 .4± 0 .5 ) %和 ( 2 0 .6± 4.1) % ,缓解组分别为 ( 2 .0± 0 .3 ) %和 ( 17.8± 3 .3 ) % ,均较正常组的 ( 1.6± 0 .5 ) %和 ( 15 .8± 2 .9) %呈不同程度升高。CD 4+/3 0 +与IL 4、IgE以及CD 19与IgE均呈正相关 (P <0 .0 1)。结论　过敏性哮喘患儿T、B淋巴细胞功能状态出现紊乱 ,可能在过敏性哮喘致病过程中具有重要作用     

哮喘患者血清IL-12、IL-13及IgE的测定及意义

目的 检测哮喘患者血清中的IL-12、IL-13和IgE水平,明确IL-12、IL-13和IgE相关性及与哮喘的关系.方法 采用ELISA法测定47例哮喘患者(其中急性发作期27例,缓解期20例)血清白细胞介素IL-12、ILL-13和IgE水平,并与体检正常25例健康人(对照组)进行对照;对哮喘发作期IL-12、IL-13与IgE水平行相关分析.结果 急性发作期患者血清IL-12水平显著低于缓解期和对照组(P＜0.05),而IL-13和IgE水平显著高于缓解期和对照组(P＜0.05).IL-12与IgE呈负相关(r=-0.429,P＜0.05),IL-13与IgE呈正相关(r=0.517,P＜0.05).结论 初步认为IL-12和IL-13参与支气管哮喘发病的整个过程;检测血清IL-12、IL-13及IgE水平可反映支气管哮喘的炎症状态及评价治疗效果.     

儿童哮喘血免疫球蛋白和T细胞亚群的动态观察及临床意义

目的　探讨儿童哮喘发作期与缓解期血免疫球蛋白和T细胞亚群的动态变化及临床意义 ;方法　应用免疫荧光技术对 38例哮喘患儿的哮喘发作期与缓解期和 2 0例健康对照儿童的外周血免疫球蛋白和T细胞亚群进行测定 ;结果　 (1 )哮喘发作期lgG ;1 1 .83± 7.54与对照组 1 0 .1 6± 2 .65比较有显著差异 (P <0 .0 5) ;(2 )哮喘发作期及缓解期CD3 +、CD4+、CD4+/CD8+值与正常对照组比较有显著差异 (P <0 .0 5) ;发作期及缓解期CD8+与对照组比较无明显差异 (P >0 .0 5) ;结论　儿童哮喘存在着lgG的改变 ,CD4+T细胞增加 ,CD8+T细胞数量或和功能不足导致免疫功能紊乱是哮喘的主要发病机制。     

过敏性哮喘发作期患者T淋巴细胞亚群及IgE变化

应用免疫组化技术检测 2 8例过敏性哮喘发作期病人外周血T细胞亚群 ,采用ELISA双抗体夹心法测定血清IgE和白细胞介素 -4 (IL -4 )水平。结果过敏性哮喘患者发作期血清IgE、IL -4水平明显升高 ,CD+ 8下降 ,CD+ 4/CD+ 8比值升高 ,与缓解期和对照组差异有高度显著性 (P <0 .0 1) ,且血清IgE与IL -4水平有明显的正相关 (r =0 .796)。说明T淋巴细胞激活及其释放的IL -4在哮喘发病中起重要作用 ,IgE合成增加是过敏性哮喘发作的关键。     

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.