卡氏肺孢子虫肺炎

本文就卡氏肺孢子虫肺炎的病原体 ,感染途径 ,临床表现 ,诊断治疗及预防等方面作一概述 ,为卡氏肺孢子虫肺炎的预防控制提供参考。     

卡氏肺孢子虫感染的实验研究

为探索卡氏肺孢子虫肺炎的发病机制，将大鼠分为实验组和对照组。给予实验组大鼠肌注地塞米松以诱发肺孢子虫肺炎。每周剖杀，光镜及电镜下对其两组大鼠肺组织进行病原学和病理学观察。对照组大鼠健康，第８ｗｋ后体重增加４５％，肺组织未见病理改变，亦未观察到卡氏肺孢子虫。实验组大鼠慢性发病，第８ｗｋ后体重比原来减少约２６％。电镜下第４ｗｋ、光镜下第５ｗｋ开始查见卡氏肺孢子虫，第７～８ｗｋ达重度感染，阳性率为６６．７％。该虫在肺泡腔内多见，肺间质中少见，在中性粒细胞、肺泡巨噬细胞和Ⅱ型肺泡上皮细胞内也见到。肺组织在实验前４ｗｋ几乎没有什么改变，第５～６ｗｋ有少量虫体附着于肺泡壁，第７～８ｗｋ表现为卡氏肺孢子虫肺炎的典型组织病理学改变。大滋养体伸出丝状伪足与Ⅰ型上皮细胞粘连，该处上皮细胞发生变性改变，Ⅱ型上皮细胞发生凋亡。     

卡氏肺孢子虫感染的实验研究

为探索卡氏肺孢子虫肺炎的发病机制，将大鼠分为实验组和对照组。给予实验组大鼠肌注地塞米松以诱发肺孢子虫肺炎。每周剖杀，光镜及电镜下对其两组大鼠肺组织进行病原学和病理学观察，对照组大鼠健康，第８ｗｋ后体重增加４５％，肺组织未见病理改变，亦未观察到卡氏肺孢子虫。实验组大鼠慢性发病，８ｗｋ后体重比原来减少约２６％，电镜下第４ｗｋ，光镜下第５ｗｋ开始查见卡氏肺孢子虫，第７￣８ｗｋ达重度感染，阳性率为６６．７     

卡氏肺孢子虫

卡氏肺孢子虫(Peumocystis carinii,P.c.)是一种可引起免疫抑制个体卡氏肺孢子虫肺炎(PCP)的不典型真菌。近年来的研究进展很快。本综述了PC的生物学及流行病学方面的研究现状、DNA扩增技术在PC检测和PCP诊断中的应用、PC传染源、感染途径及抗药株的出现等问题。     

卡氏肺孢子虫

卡氏肺孢子虫 (Peumocystiscarinii,P .c.)是一种可引起免疫抑制个体卡氏肺孢子虫肺炎 (PCP)的不典型真菌。近年来的研究进展很快。本文综述了PC的生物学及流行病学方面的研究现状、DNA扩增技术在PC检测和PCP诊断中的应用、PC传染源、感染途径及抗药株的出现等问题。     

卡氏肺孢子虫病实验与临床研究 Ⅲ．抗卡氏肺孢子虫单克隆抗体杂交瘤细胞株的建株及鉴定

从感染肺孢子虫肺炎大鼠模型中分离纯化肺孢子虫包囊并免疫ＢＡＬＢ／ｃ小鼠，采用杂交瘤技术，获得１株能长期稳定分泌抗人源性肺孢子虫单克隆抗体杂交瘤细胞株４Ｄ７。其染色体众数为８２，分泌ＩｇＧ１亚型抗体。该单抗可识别５４ｋＤａ肺孢子虫包囊蛋白区带，并能准确识别肺孢子虫包囊，其灵敏性与特异性可达１００％（１１／１１）；并与正常人体组织、肺炎双球菌、白色念珠菌和新型隐球菌无交叉反应。     

卡氏肺孢子虫肺炎动物模型的实验研究

本文通过给大鼠高蛋白质食物，皮下注射醋酸考的松及其饮水中加入四环素的方法，建立了卡氏肺孢子虫大鼠模型。与传统方法比较，证明该方法能使动物模型的病死率降低，成活率提高和寿命延长。     

卡氏肺孢子虫肺炎5例

卡氏肺孢子虫肺炎５例安春丽，陈殿学，陈平，田边将信卡氏肺孢子虫肺炎（Ｐｎｅｕｍｏｃｖｓｔｉｓｃａｒｉｎｉｉｐｎｅｕｍｏｎｉａ，ＰＣＰ．）是ＡＩＤＳ患者常见的最严重的机会性感染性疾病，也是肿瘤化疗，器官移植等细胞免疫功能低下宿主容易感染的一种寄生虫病。...     

鸦胆子与补骨脂对大鼠卡氏肺孢子虫肺炎疗效的电镜观察

用鸦胆子和补骨脂合剂2 ml （鸦胆子0.12 mg+补骨脂1.0 mg） 分别治疗经地塞米松皮下注射诱导的卡氏肺孢子虫肺炎（Pneumocystis carinii pneumonia， PCP）的SD大鼠7天和14天，同时设阳性对照组和正常对照组。分别于治疗后剖杀各组大鼠，取肺组织制成切片。透射电镜下观察到治疗组大鼠受损肺组织病变减轻，肺间质、Ⅰ型和Ⅱ型肺泡上皮细胞形态结构修复。说明鸦胆子和补骨脂合剂对卡氏肺孢子虫肺炎病鼠有一定的疗效。     

卡氏肺孢子虫冻存复苏后增殖的实验研究

目的　研究卡氏肺孢子虫 (Pc)冻存复苏后在细胞培养的增殖情况。观察冻存Pc复苏后接种大鼠Pc感染发生率。方法　从免疫抑制大鼠肺中分离Pc,以不同浓度二甲亚砜和甘油作冻存液冻存Pc 3个月和 1年。解冻后 ,将其分别接种于HepG - 2细胞系和已免疫抑制 2周的大鼠。观察和比较冻存 3个月和 1年的Pc增殖情况及大鼠肺部Pc感染情况。 结果　以 15 %二甲亚砜冻存的Pc增殖幅度最大 ,第 4、5d可增长 7倍左右。冻存 1年与冻存 3个月的Pc增殖幅度无明显差异。接种冻存Pc后的大鼠 ,肺部Pc感染的发生率是对照组 4 .5倍。结论　 15 %二甲亚砜冻存的Pc复苏后增殖率最高。冻存 1年与冻存 3个月的Pc复苏情况显著性差异。用冻存Pc接种免疫抑制大鼠 ,可使诱发大鼠Pc感染模型时间明显缩短。     

大鼠肺孢子虫肺炎动物模型的实验研究

目的建立肺孢子虫肺炎(PCP)的大鼠实验动物模型。方法将34只雌性清洁级SD大鼠随机分成实验组和对照组,每组17只。实验组采取每周2次每次每只皮下注射地塞米松1mg诱导的方法建立PCP动物模型;对照组则注射与地塞米松等体积的灭菌生理盐水。所有大鼠的饮水中加入1g/L盐酸四环素预防继发性细菌感染。12周后解剖全部大鼠,并分别制作肺组织印片,姬氏染色,检查肺孢子虫包囊。同时制作肺组织病理切片,HE染色,观察肺组织的病理学变化。结果用地塞米松诱导大鼠5周,肺组织印片均查见肺孢子虫包囊,肺组织也出现典型的病理学改变。连续诱导12周,均未见实验鼠死亡。实验组大鼠体重下降明显,与对照组比较,差异有非常显著性(P<0.01)。结论应用皮下注射地塞米松免疫抑制诱导的方法可成功建立PCP的大鼠动物模型。     

大蒜素治疗大鼠肺孢子虫肺炎的实验研究

目的观察大蒜素对大鼠肺孢子虫肺炎(PCP)的治疗效果。方法采用皮下注射醋酸泼泥松龙的方法建立PCP大鼠模型。将受试大鼠随机分为正常对照组(A)、未治疗对照组(B)、TMP-SMZ治疗对照组(C)、大蒜素治疗组(D)和青蒿素治疗组(E)。各组从第7周开始灌服相应药物5d,停药后观察1周,用肺重/体重比和肺虫荷量考核疗效。结果PCP大鼠6周内的病死率为16.7%,满6周时抽样进行病原、病理检查,证实均已成功诱导PCP。5组受试大鼠的平均肺重/体重比分别为0.75±0.090、1.05±0.174、0.77±0.091、0.79±0.114和0.85±0.188。B~E组受试大鼠肺虫荷量分别为1490、74、296和219个包囊/mg肺。统计学分析显示,经大蒜素治疗的大鼠平均肺重/体重比、肺虫荷量均显著低于未治疗对照组(P<0.05),与TMP-SMZ治疗对照组和青蒿素治疗组比较差异无显著性(P>0.05)。结论大蒜素对大鼠PCP有显著疗效,效果与TMP-SMZ和青蒿素接近。     

艾滋病合并卡氏肺孢子虫肺炎的临床特点及诊断方法

目的　探讨艾滋病合并卡氏肺孢子虫肺炎 (PCP)的临床特点和诊断方法。方法　对1 999～ 2 0 0 1年经痰聚合酶链反应 (PCR)确诊的 1 2例艾滋病合并PCP进行分析。结果　 (1 )合并结核病 4例 ,细菌性肺炎 1例。 (2 )痰PCR阳性 1 2例 ,其中血PCR阳性 9例 ,姬姆萨染色阳性 6例 ,六胺银染色阳性 5例。 (3) 1 2例CD+ 4(5～ 1 55)× 1 0 6 /L ,平均CD+ 4(51± 48)× 1 0 6 /L ;其中CD+ 4<(1 0 0× 1 0 6 ) /L1 0例 (83 % ) ,CD+ 4<(50× 1 0 6 ) /L 9例 (75 % ) ;CD+ 4/CD+ 8:0 .0 1～ 0 .2 9。结论　 (1 )PCP是艾滋病晚期常见的合并症 ,常常合并其它机会性感染如结核等。 (2 )痰PCR阳性 +典型的临床表现可以确诊PCP。     

双氢青蒿素治疗对卡氏肺孢子虫肺炎大鼠脾细胞上清液一氧化氮水平的影响

目的研究双氢青蒿素治疗对卡氏肺孢子虫肺炎(PCD)大鼠脾细胞上清液一氧化氮(N0)水平的影响。方法以醋酸可的松皮下注射Wistar大鼠，建立卡氏肺孢子虫肺炎动物模型，用60mg／kg双氢青蒿素治疗实验大鼠，杀鼠取肺，胶原酶消化法分离脾细胞，脂多糖(LPS)刺激培养72h，用NO试剂盒检测大鼠脾细胞上清液NO活性，同时设有感染组和正常对照组。结果感染组和治疗组大鼠NO水平高于正常对照组，治疗组NO水平低于感染组。结论卡氏肺孢子虫(PC)感染可能引起大鼠脾细胞分泌高水平NO，发挥杀伤PC作用，同时加重宿主组织炎症反应，抑制宿主的免疫应答；经双氢青蒿素治疗后，PCP大鼠脾细胞分泌NO降低，组织炎症反应减轻，使宿主的免疫应答接近正常状态。     

苦参合剂对卡氏肺孢子虫肺炎大鼠细胞免疫应答的影响

卡氏肺孢子虫肺炎大鼠经苦参合剂治疗后脾脏CD3^＋、CD4^＋T淋巴细胞百分率升高，sIL-2R水平降低。表明苦参合剂治疗能增强卡氏肺孢子虫肺炎大鼠的细胞免疫应答。     

Prophylaxis for Pneumocystis carinii pneumonia: its impact on the natural history of HIV infection in men with haemophilia

It has been suggested that the range of AIDS-defining conditions witnessed in patients with HIV infection has changed since the early years of the HIV epidemic. In this paper we consider the range of AIDS-defining conditions in a cohort of 111 HIV-positive men with haemophilia registered at the Royal Free Hospital Haemophilia Centre. In particular we assess whether the incidence of Pneumocystis carinii pneumonia (PCP) has changed over time. The men were all infected between 1979 and 1985 after treatment with infected blood products and have now been followed prospectively for up to 13 years from HIV seroconversion. By the end of 1992, 44/111 patients had developed AIDS. Of the 44 men, 18 (41%) presented with PCP as their first AIDS-defining condition (ADC), mainly before the initiation of primary prophylaxis in 1989. The remaining 26 patients presented with a range of conditions as their first ADC, but there were no more than four cases in any one disease category. It is estimated that patients suffer from 0.7 further ADCs per year after being diagnosed with AIDS. After taking account of the increased levels of immuno-suppression in the cohort with time, it appears that the incidence of PCP, both as the first ADC or as any ADC, has declined since the introduction of primary prophylaxis for the disease in 1989. However, non-compliance with prophylaxis for PCP appears to have played a major role in the continuing occurrence of PCP since 1988. Improvements in compliance with therapy should result in a further reduction in the incidence of PCP both as a first ADC and as any ADC.     

中药鸦胆子与补骨脂素对卡氏肺孢子虫病大鼠免疫调节的影响

目的 探讨中药鸦胆子和补骨脂素合剂对卡氏肺孢子虫肺炎(PCP)大鼠的免疫调节及杀虫作用。方法 地塞米松皮下注射SD大鼠(2.5mg/只,每周2次,连续6周),建立PCP大鼠模型。药物治疗剂量,每鼠每天口饲中药鸦胆子0.12mg与补骨脂素1mg,连续7d或14d。同时设PCP阳性不治疗对照组及正常大鼠对照组。制作肺组织病理切片观察肺组织病变,制作肺组织印片计数肺孢子虫包囊数观察中药合剂杀虫效果。检测血液中CD4⁺T细胞、CD8+T细胞和α肿瘤坏死因子(TNF-α)的变化,观察中药合剂对PCP大鼠的免疫调节作用。结果 治疗组大鼠,受损的肺组织病变减轻或修复,体重明显回升,肺组织包囊数明显低于阳性对照组(P<0.05)。血液中CD4⁺T细胞、CD8⁺T细胞和TNF-α均较阳性对照组升高(P<0.05)。结论 中药鸦胆子和补骨脂素合剂治疗PCP大鼠,可增强免疫调节作用,并可抑制及杀灭卡氏肺孢子虫。     

A randomized,double-blind,placebo-controlled,multicenter clinical trial for efficacy and safety of traditional Chinese medicine combined with antibiotics in the treatment of bacterial pneumonia in children

Background:Pneumonia is the second leading cause of death in children worldwide after preterm birth and certification. Bacteria, viruses, mycoplasma, and other microorganisms are known to be the main causes of pneumonia, of which bacterial pathogenic factors account for 12.5% of cases. The invention and application of antibiotics have improved the prognosis of children with community-acquired bacterial pneumonia (CABP) to a certain extent, but with the emergence of antibiotic resistance worldwide, the mortality of children with CABP is still high. “Maxing Shigan Decoction” and “Qingfei Decoction” have significant efficacy in the treatment of CABP in children, but there is no standardized randomized controlled trial to systematically evaluate the outcomes.Methods:This study is a randomized, double-blind, placebo-controlled, multicenter clinical trial that will randomize 240 patients with CABP to group of Oral Maxing Shigan Decoction, group of Qingfei Decoction or group of placebos administered 3 times a day for 7 days. This study will observe a wide range of clinically relevant endpoints that have been used in clinical trials of pneumonia, including but not limited to clinical cure rate, antibiotic application days, complete antipyretic rate, complete antipyretic days, disease efficacy, traditional Chinese medicine syndrome effect, and antibiotic upgrade treatment rates. Safety will be assessed by monitoring for the incidence of adverse events during the study.Discussion:This clinical trial is the first to evaluate the efficacy and safety of “Maxing Shigan Decoction” and “Qingfei Decoction” in the treatment of children with CABP. The research results will provide a reference for future research design.Trial registration:Chinese Clinical Trial Registry, ChiCTR1900025354. Registered on 14th October 2019-Retrospectively registered, http://www.chictr.org.cn/.     

清肠利肝方对刀豆蛋白A所致急性肝损伤小鼠的防护作用

目的：探讨中药复方清肠利肝方对刀豆蛋白A （ Con A）所致急性肝损伤小鼠的防护作用。方法：将野生型C57BL/6（B6）雄性小鼠随机分为正常组、染毒组和清肠利肝方干预组;染毒组通过尾静脉注射Con A （35 mg/kg）诱导肝损伤,干预组先给予清肠利肝方（50 ml/kg）灌胃后再进行染毒。正常组仅给予生理盐水。观察比较各组小鼠的生存率、肝功能水平、组织病理学变化以及相关炎症分子的变化情况。结果：给予小鼠Con A能诱导明显的肝损伤,表现为血浆ALT、 AST水平显著升高,大量肝细胞发生凋亡坏死。清肠利肝方干预组小鼠的ALT、 AST水平低于染毒组,差异有显著性意义（P＜0.05）,病理结果显示肝损伤亦得到明显减轻;此外,干预组各项炎症分子如细胞外组蛋白、 IL-6, MCP-1, TNF-α等水平显著低于染毒组,差异有统计学意义（P＜0.05）。结论：清肠利肝方对Con A所致的小鼠急性肝损伤有显著防护作用,其机制可能与减少细胞外组蛋白和相关的细胞因子的水平而达到抗炎的效应有关。     

Comparative efficacy and safety of traditional Chinese patent medicine in the treatment of Mycoplasma pneumoniae pneumonia in children: A protocol for systematic review and meta-analysis

Background:Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children. Its incidence rate is increasing year by year. The drug resistance rate of macrolide antibiotics and other conventional treatment methods is higher, and there are limitations in clinical application. Traditional Chinese patent medicine (TCPM) is a powerful weapon to treat this disease. At present, there is no comparison of the safety and effectiveness of multiple TCPMs in the treatment of MPP in children. Therefore, we take the method of network meta-analysis to systematically compare the efficacy of various TCPMs in the treatment of this disease.Methods:We will conduct comprehensive searches of Cochrane Library, PubMed, Web of Science, Clinical Trials, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese BioMedical Literature, Wanfang Database, and other electronic databases. The time frame is set from the establishment of the database to October 2020. All randomized controlled trials that meet the inclusion criteria will be included in this study. The 2 researchers will independently screen the literature according to the inclusion criteria, extract the data, and assess the bias risk of the included study. We will evaluate all the obtained data and evidence through Bayesian network meta-analysis, and use Stata 15.0 to process and analyze the data.Results:Through this study, we will evaluate the efficacy and safety of a variety of TCPMs for the treatment of MPP in children.Conclusion:The purpose of this study is to provide a strong reference for clinical application of TCPMs in the treatment of MPP in children, and to provide an important basis for clinicians to make correct judgments and put forward accurate treatment plans.Ethics and dissemination:This review does not involve any human or animal experiments and therefore does not require ethical approval.INPLASY registration number:INPLASY 2020100108