拉米夫定对慢性乙型肝炎患者外周血Th_1/Th_2细胞因子和肝纤维化指标的影响

目的观察拉米夫定对慢性乙型肝炎患者外周血Th1/Th2细胞因子、HBV-DNA含量及肝纤维化指标的影响。方法选择轻中度慢性乙型肝炎患者50例作为治疗组,给予拉米夫定100mg、每日1次,疗程6个月,分别于治疗前和治疗6个月后检测患者外周血Th1和Th2细胞因子、HBV-DNA含量及肝纤维化指标的变化,并选择正常健康体检者30例作为对照组。结果与对照组比较,治疗组患者外周血培养上清液外周血单核细胞（PBMC）中干扰素-γ（IFN-γ）水平明显下降,而白细胞介素-4（IL-4）水平明显上升（P〈0.01）;经拉米夫定治疗6个月后,治疗组患者外周血培养上清PBMC中IFN-γ水平明显上升,而IL-4水平和HBV-DNA含量明显下降（P〈0.05或P〈0.01）;患者经拉米夫定治疗6个月后,肝纤维化指标均较治疗前明显下降（P〈0.05）。结论慢性乙型肝炎患者存在Th1/Th2平衡失调,拉米夫定通过调节Th1/Th2细胞的平衡,可有效抑制HBV-DNA病毒的复制,降低患者血清中肝纤维化指标水平,进而达到清除细胞内病毒、防治肝纤维化的目的。     

苦参素对慢性乙型肝炎患者外周血Th1/Th2平衡的调控作用

目的 观察苦参素对慢性乙型肝炎患者外周血Th1/Th2细胞因子的调节作用. 方法 选择40例轻中度慢性乙型肝炎患者,予以苦参素胶囊300 mg,tid,po（治疗组）,治疗6个月后检测患者外周血HBV-DNA和白细胞介素（IL）-4﹑γ-干扰素（IFN-γ）含量的变化. 另取20例正常健康人作为对照组. 并根据HBV-DNA复制指标及HBeAg/HBeAb转换情况将治疗组分为治疗有效组与治疗无效组. 结果 与对照组相比较,治疗组患者外周血培养上清单个核细胞（PBMC）中IL-4水平明显上升,而IFN-γ水平明显下降. 经过苦参素治疗6个月后,患者外周血培养上清PBMC中IL-4水平和HBV-DNA含量明显下降,而IFN-γ水平明显上升. 治疗有效组外周血培养上清PBMC中IFN-γ水平明显高于治疗无效组,而IL-4水平、HBV-DNA含量则明显低于治疗无效组. 结论 慢性乙型肝炎患者存在Th1/Th2平衡失调,而苦参素既能抑制HBV-DNA复制,又能调节Th1/Th2细胞因子比例平衡,使免疫反应由Th2型向Th1型逆转.     

阿德福韦酯对慢性乙型肝炎患者外周血HBV-DNA和Th1/Th2平衡的调节作用

目的 观察阿德福韦酯对慢性乙型肝炎患者外周血HBV-DNA和Th1/Th2细胞因子的调节作用.方法 选择40例轻中度慢性乙型肝炎患者作为治疗组,予阿德福韦酯10 mg口服,每日1次,连续服用12周,检测治疗前和治疗12周后患者外周血HBV-DNA和白细胞介素4(IL-4)、干扰素-γ(IFN-γ)含量的变化,并根据HBV-DNA复制指标及HBeAg/HBeAb转换情况将治疗组分为治疗有效组与治疗无效组.另选择30例正常健康体检者作为对照组.结果 与对照组比较,治疗组患者外周血培养上清单个核细胞(PBMC)中IL-4水平明显上升,而IFN-γ水平明显下降(P均小于0.01).治疗12周后患者外周血培养上清PBMC中IL-4水平和HBV-DNA含量明显下降,而IFN-γ水平明显上升(P<0.05或P<0.01).治疗有效组外周血培养上清PBMC中IFN-γ水平明显高于治疗无效组,IL-4水平和HBV-DNA含量则明显低于治疗无效组(P均小于0.01).结论 慢性乙型肝炎患者存在Th1/Th2平衡失调.阿德福韦既能抑制HBV-DNA复制又能调节Th1/Th2细胞因子比例平衡,使免疫反应由Th2型向Th1型逆转.     

干扰素联合阿德福韦酯对慢性乙肝患者血清IFN-γ／IL-10的影响

目的探讨干扰素联合阿德福韦酯对慢性乙肝患者血清干扰素-γ（IFN-γ）／白细胞介素-10（IL-10）的影响。方法82例慢性乙肝患者随机分为两组,观察组41例,对照组41例,观察组采用干扰素联合阿德福韦酯治疗,对照组采用阿德福韦酯治疗,治疗12月后观察疗效。治疗前后测定血清IFN-1和IL-10。结果观察组患者的ALT复常率、HBV-DNA阴转率和HbeAg阴转率均高于对照组（P〈0．05）。两组治疗后均可升高血清IFN-γ、降低IL-10和升高IFN-γ／IL-10,并且观察组改善上述指标更明显对照组（P〈0．05）。结论干扰素联合阿德福韦酯可以通过改善Th1／Th2平衡改善慢性乙肝病情。     

不同基因型慢性乙型肝炎患者Th1／Th2细胞因子平衡研究

目的探讨不同基因型慢性乙型肝炎（乙肝）患者体内Th1／Th2细胞因子平衡性。方法检测39例不同基因型慢性乙肝患者外周血细胞因子（IL-12、IFN-γ、IL-4）的表达,并作统计学分析。结果慢性乙肝患者与健康对照组比较,外周血IL-12、IFN-γ、IL-4表达明显升高（P〈0．01或P〈0．05）。基因型C型组与B型组比较,ALT、IL-12、Th1／Th2明显升高（P〈0．05）,IL-4明显降低（P〈0．05）。结论慢性乙肝患者体内存在Th分化的不平衡,C基因型慢性乙肝患者体内Th1优势应答。     

拉米夫定治疗变异后慢性乙型肝炎患者血清IFN-γ和IL-10的测定及临床意义

目的评估拉米夫定治疗的慢性乙型肝炎患者在治疗后及病毒变异后血清中Th1型[γ干扰素（IFN-γ）]和Th2型[白细胞介素（IL）-10]细胞因子水平,探讨拉米夫定治疗乙型肝炎病毒变异后的细胞因子动态变化。方法选取拉米夫定治疗而发生病毒变异及未变异的慢性乙型肝炎患者各20例,另选取20例健康人作为对照,检测患者血清IFN-γ、IL-10的水平。结果在治疗后6个月时,未变异组血清IFN-γ、IL-10水平与变异组相比差异无统计学意义（P〉0.05）;但在病毒变异后,变异组IFN-γ水平均低于未变异组,IL-10水平则高于未变异组,差异有统计学意义（P〈0.01）。结论拉米夫定抗病毒治疗出现变异后,机体细胞因子表达发生改变。     

银连祛风汤治疗慢性荨麻疹的临床疗效及对辅助性 T细胞因子表达水平的调节作用*

目的：探讨银连祛风汤治疗慢性荨麻疹的疗效及对外周血辅助性T细胞（Th1/Th2）相关细胞因子表达水平的影响。方法：将92例慢性荨麻疹患者随机分为银连祛风汤组和地氯雷他啶分散片组,各46例,分别用上述药物治疗,疗程均为8周,观察临床疗效和复发率。另选健康体检者30例作为正常对照组。采用ELISA法测定血清Thl、Th2细胞因子IFN-γ、IL-2、IL-4的表达水平。结果：银连祛风汤组有效率89.13％（41/46）与地氯雷他啶分散片组的有效率80.43％（37/46）比较差异无统计学意义（P＞0.05）;银连祛风汤组复发率14.63％（6/41）,低于地氯雷他啶分散片组的35.14％ Chronic Urticaria; Yinlianqufeng Decoction; Helper T Cell; Clinical efficacy; IFN-γ; IL-2; IL-4（13/37）,差异有统计学意义（P＜0.05）。治疗前,两组患者血清IFN-γ、IL-2、IL-4水平差异无统计学意义（P＞0.05）;治疗后,两组均明显升高IFN-γ、IL-2水平,降低IL-4水平,与治疗前比较,差异均有统计学意义（P＜0.01）,银连祛风汤组升高IFN-γ、IL-2水平、降低IL-4水平更明显,与地氯雷他啶分散片组比较,差异均有统计学意义（P＜0.05 or P＜0.01）。结论：银连祛风汤治疗慢性荨麻疹疗效显著,可能是通过纠正失衡的Th1/Th2相关细胞因子的表达水平发挥了作用。     

复方甘草酸苷对过敏性紫癜患儿外周血T辅助细胞功能影响

目的：观察复方甘草酸苷对过敏性紫癜（HSP）患儿外周血T辅助细胞功能的影响。方法选取急性期HSP患儿39例,随机分为复方甘草酸苷治疗组20例、糖皮质激素治疗组19例,选取22例健康儿童为正常对照组。复方甘草酸苷组在常规治疗基础上给予复方甘草酸苷（3~5岁80mg qd、5~8岁120mg qd、＞8岁160mg qd）治疗7~10d,糖皮质激素组在常规治疗基础上给予甲基强的松龙（1~2mg/（kg·d）,bid）治疗7~10d。留取治疗前后血浆,采用双抗体夹心酶联免疫吸附（ELISA）法检测血浆干扰素-γ（IFN-γ）、白介素-4（IL-4）、白介素-17（IL-17）水平变化。结果（1）HSP组患儿治疗前血浆IL-4、IL-17水平明显高于正常对照组（P＜0.05,P＜0.01）, IFN-γ水平与正常对照组无显著性差异（P＞0.05）;治疗前复方甘草酸苷组与糖皮质激素组血浆IFN-γ、IL-4、IL-17水平均无显著性差异（均P＞0.05）。（2）复方甘草酸苷组治疗前后血浆IFN-γ水平变化无显著性差异（P＞0.05）,而IL-4、IL-17水平治疗后显著降低（P＜0.01,P＜0.05）;糖皮质激素组用药后血浆IFN-γ、IL-4、IL-17水平均较治疗前均显著下降（P＜0.05,P＜0.01,P＜0.05）。（3）糖皮质激素组用药后血浆IFN-γ、IL-4、IL-17水平下降幅度均显著大于复方甘草酸苷组（P均＜0.05）。结论复方甘草酸苷可能通过抑制HSP患儿Th2、Th17细胞活化而发挥抗炎和免疫调节作用,但其作用强度不及糖皮质激素明显。     

rhIL-18对慢性乙型肝炎患者免疫功能的调节作用

为了探讨rhIL-18对慢性乙型肝炎（以下称乙肝）患者免疫功能的调节作用,分离55例慢性乙肝及40例正常人的外周血单个核细胞（PBMC）,在HBcAg及不同浓度rhIL-18刺激下培养72h,收集其培养上清液,采用ELISA法检测其中IL-2、IL-4、γ干扰素（IFN-γ）和单核巨噬细胞集落刺激因子（GM-CSF）的含量。结果表明,PHA单独刺激下慢性乙肝组IL-2、IFN-γ和GM-CSF的含量比正常对照组显著降低,其差异具有显著性（P〈0.01）;HBcAg单独刺激下慢性乙肝组IL-2、IFN-γ和GM-CSF的含量升高,但仍低于正常对照组,其差异没有显著性（P〉0.05）;HBcAg联合不同浓度的rhIL-18刺激下,慢性乙肝组IL-2、IFN-γ和GM-CSF的含量均高于PHA组和HBcAg组,其差异具有显著性（P〈0.01）,但与正常对照组没有显著性（P〉0.05）;PBMC培养上清液中IL-2、IFN-γ和GM-CSF的水平在慢性乙肝组中随着IL-18浓度的增加呈现出增强的趋势;但各组IL-4含量变化不明显。结论：IL-18能够促进慢性乙肝患者PBMC产生大量的IL-2、IFN-γ和GM-CSF,因此在调节免疫功能和增强机体杀伤病毒感染细胞方面具有很好的应用前景。     

1型糖尿病并发血管病变患者Th1/Th2细胞亚群的研究

目的探讨1型糖尿病并发血管病变患者体内Th1/Th2细胞亚群的变化。方法用酶联免疫吸附测定（ELISA）检测了15例1型糖尿病合并有下肢血管病变患者血清中Th1型细胞亚群分泌的细胞因子IFN-γ、TNF-α和Th2型细胞亚群分泌的细胞因子IL-4、IL-10的水平变化,20例无糖尿病早期合并症患者和20例健康志愿者做为对照组。结果1型糖尿病患者血清中Th1型细胞因子IFN-γ、TNF-α的水平显著高于对照组（P〈0.01）;Th2型细胞因子IL-4、IL-10的水平明显低于对照组（P〈0.01）;糖尿病并发血管病组Th1型细胞因子IFN-γ、TNF-α显著高于单纯糖尿病组（P〈0.05）,而Th2型细胞因子IL-4、IL-10的水平明显低于单纯糖尿病组（P〈0.05）。结论当1型糖尿病并发血管病变时,患者体内Th1/Th2细胞亚群发生了Th2-Th1的漂移改变。     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。     

人文关怀在手术室护理中的应用

目的探讨在手术室护理中人文关怀的作用。方法将2012年5月至2012年11月200例手术患者随机分为两组,对照组100例,采取术前、术中常规护理,观察组100例,在对照组的基础上给予患者人文关怀,对比两组护理满意度及疗效。结果对照组各项指标满意度低于实验组(P<0.05),与对照组比较,实验组的住院时间明显缩短,痛苦小,并发症发生率低,P<0.05,差异均有统计学意义。结论 "以人为本"的人文关怀理念应用于手术室中,可充分提高护理质量及患者的满意度。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

Adenosine mechanisms in the regulation of breathing in the rat

The central respiratory effects of various adenosine (A) analogues were studied in halothane-anesthetized rats. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) injections of the A analogues (2-Cla, L-PIA, CHA and NECA) reduced minute ventilation (VE) due to decreases in respiratory frequency (f) as well as tidal volume (VT). Dose-dependent effects were seen after i.c.v. L-PIA in both normal and vagotomized rats. Analysis of the A-induced changes using the occluded breath technique revealed an increase in expiratory time (TE) as well as a decrease in inspiratory drive. NECA, a relatively specific A2 agonist seemed to be somewhat more potent in eliciting respiratory depression than a relatively specific A1 agonist like L-PIA. Pretreatment with the methylxanthine theophylline completely antagonized the respiratory depression induced by L-PIA. It is concluded that central A receptors are involved in the central regulation of breathing and that A interacts with the respiratory control system mainly by decreasing inspiratory neural drive and prolonging expiratory time.     

Recent advances in the pharmacotherapy for hyperbilirubinaemia in the neonate

Jaundice is a common cause for diagnostic works-up and therapeutic intervention in neonates. This is motivated by the risk for severe neurological sequelae (kernicterus). The mainstays of treatment for the past decades have been exchange transfusion and phototherapy. Exchange transfusion is now becoming rare due to immune prophylaxis in Rhesus-negative women, and treatment of sensitised infants with intravenous immunoglobulin. Several different pharmacological approaches have been studied as far as the treatment of neonatal jaundice. Of these, the focus of attention in recent years has been on the haem oxygenase inhibitors (metal meso- and protoporphyrins). These are effective inhibitors of bilirubin production and have been shown to significantly reduce peak serum bilirubin levels in several clinical trials, both when used prophylactically and therapeutically. However, questions remain regarding long-term safety, as well as the advisability of whole-scale inhibition of bilirubin production. Nevertheless, in selected infants with a high risk of severe jaundice, the use of haem oxygenase inhibitors may be acceptable. Pharmacotherapy in jaundiced infants is fraught with risks, as many drugs may increase the entry of bilirubin into the brain and presumably, the risk for neurotoxicity. Both the displacement of bilirubin from its albumin binding and interference with the function of phosphoglycoprotein in the blood–brain barrier are documented mechanisms in this respect.     

Serotonin in the control of the sleep-like states in frogs

It has been established that brain serotonin (5-HT) is involved in the control of behavioral phenomena in amphibians. The transition of frogs from active wakefulness to sleep-like states was accompanied by alteration of brain 5-HT metabolism, i.e., in sleep-like state with plastic muscle tone 5-hydroxyindoleacetic acid (5-HIAA) level was reduced and in sleep-like state with rigid muscle tone both brain 5-HIAA and 5-HT were decreased. An experimental decrease of brain 5-HT level by inhibition of its biosynthesis by p-chlorophenylalanine (200 mg/kg) induced the sleep-like state of catatonic type, i.e., the state which was characterized by lowered brain 5-HT.     

Piracetam in the treatment of cognitive impairment in the elderly

Reisberg, B., S.H. Ferris, M.K. Schneck, J. Corwin, P. Mir, E. Friedman, K.A. Sherman, M. McCarthy, and R.T. Bartus : Piracetam in the treatment of cognitive impairment in the elderly. Drug Dev. Res. 2: 475–480, 1982. Piracetam (Nootropil, 2-oxopyrrolidone acetamide) has been extensively investigated for the treatment of cognitive impairment. Initial studies on normal subjects and patients with mild or moderate cognitive decline have been somewhat encoruaging. Accordingly, we conducted a further evaluation of the effects of piracetam in the treatment of elderly outpatients 60 to 85 years of age with mild to moderate memory impairment consistent with a diagnosis of Primary Degenerative Dementia (PDD). In our first study, we examined the effects of piracetam in 20 patients. All patients received 7.2 g of piracetam and placebo for 4 weeks in accordance with a double-blind, randomized treatment order, crossover design with 1-week washout periods prior to each crossover period. Hence, the total study period for each patient was 10 weeks (1-4-1-4). An analysis of 43 psychometric measures revealed significant improvement (P < 0.05) in only three measures, all favoring the treatment condition. Recent findings support a rationale for examining the effects of piracetam in conjunction with cholinergic precursors in patients with cognitive decline. In our second study we conducted a 1-week open trial of 1.6 g of piracetam t.i.d. in conjunction with 3 g of choline cholride t.i.d. in 15 patients. Four patients were rated as clinically improved. These “responders” were all subjects with moderate cognitive impairment. The responders showed much higher RBC choline levels than the nonresponders, both at baseline and during treatment. We conclude that the present evidence indicates that the effects of piracetam treatment alone in elderly outpatients with mild to moderate congnitive decline are subtle and not of proven clinical significance. However, studies of longer duration and of piracetam in combination with other agents may eventually show genuine clinical utility.     

上海市社区卫生服务中心医务人员伦理学知识调查及建议

目的:调查上海社区卫生服务中心医务人员的伦理学知识认知情况.方法:采取分层抽样方式,于2016年6—8月对上海市245家社区卫生服务中心的7552名医务人员进行问卷调查.结果:医务人员对伦理学知识非常了解、基本了解、了解很少和完全不了解的人数分别为536人(7.1%)、5411人(71.7%)、1536人(20.3%)和69人(0.9%).不同岗位、职称、学历的医务人员之间存在着明显的伦理学知识认知差距.结论:上海社区卫生服务中心医务人员的伦理学知识了解程度仍有待提高,需加强伦理学知识的学习和应用.