抗结核药物导致肝损伤的临床特征及危险因素分析

目的总结分析抗结核药物导致肝损伤的临床特征及危险因素。方法选取2017年1月—2018年12月在深圳市第三人民医院诊断为抗结核药物导致肝损伤的129例住院患者,分为肝功能异常组51例(39.53%),药物性肝损伤组78例(60.47%),其中肝衰竭13例(10.08%)。回顾性分析患者的实验室指标、治疗和预后资料。计数资料两组间比较采用χ~2检验,正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验。通过多因素logistic回归分析药物性肝损伤、肝衰竭的风险因素。结果药物性肝损伤组和肝功能指标异常组间合并慢性HBV感染比例(χ~2=5.616,P=0.018)、无症状肝损伤比例(χ~2=9.451,P=0.002)、肝衰竭比例(χ~2=9.453,P=0.002)、需调整抗结核方案比例(χ~2=16.787,P0.001)、首次肝损伤时间(Z=-4.001,P 0.001)、肝功能恢复时间(Z=-1.735,P 0.001)、肝性脑病比例(χ~2=4.114,P=0.043)比较,差异均有统计学意义。多因素logistic回归分析显示,首次肝损伤时间 8周(OR=3.94,95%CI:1.02～15.25,P=0.047)、无症状肝损伤(OR=7.64,95%CI:1.63～35.86,P=0.010)是发生药物性肝损伤的独立危险因素。合并慢性HBV感染(OR=14.42,95%CI:2.66～78.09,P=0.002)、首次肝损伤时间8周(OR=11.97,95%CI:2.03～70.50,P=0.006)是发生肝衰竭的独立危险因素,Alb≥35 g/L(OR=0.07,95%CI:0.01～0.51,P=0.010)是其保护因素。结论抗结核药物会导致严重肝损伤,合并HBV感染、无症状肝损伤、发现肝损伤时间晚、低蛋白会增加严重肝损伤发生风险。定期随访、肝功能监测、适当营养支持和HBV筛查对降低抗结核期间的肝损伤风险具有重要意义。     

抗结核药物性急性肾损伤31例临床分析

目的 总结抗结核药物性急性肾损伤(AKI)的发病情况及危险因素,为本病的防治提供理论依据.方法 抗结核药物性AKI患者31例,分析其年龄、性别、用药及合并症等情况.结果 31例抗痨药物性AKI患者中,男25例,女6例;年龄＞50岁25例(80.6％);合并低蛋白血症23例(74.2％),入量不足12例(45.1％),贫血13例(54.8％).结论 抗结核药物性AKI病因复杂,除药物因素外,患者的年龄、性别及合并的低蛋白血症、入量不足、贫血均加重了抗痨药物对肾脏的损害.     

肺结核药物性肝损害的相关因素分析

目的分析肺结核初治患者化疗期间发生肝损害的相关因素。方法采用历史性列队研究,回顾性分析2010年3月-2014年12月初治肺结核病历资料592例,采用单因素χ2检验(P0.05)和非条件Logistic回归模型对抗结核药物所致肝损害的相关因素进行分析。结果肺结核患者化疗引起肝损害的危险因素为性别(OR=0.166 CI 0.062-0.442)、年龄(OR=2.209 CI 1.468-3.326)、饮酒史(OR=2.165CI1.338-3.503)、营养状况(OR=2.555 CI 1.399-4.665)、HBV感染者(OR=3.13 CI 1.61-6.085)、未使用护肝药物((OR=6.349 CI 3.562-11.319)、未使用免疫药物(OR=3.614 CI 1.986-6.576)结论男性、高龄、营养不良、嗜酒、HBV感染、未使用护肝和免疫药物,是抗结核药物性肝损害的危险因素。     

老年肺炎呼吸衰竭患者有创机械通气治疗失败的危险因素探讨

目的探讨老年肺炎呼吸衰竭患者有创机械通气治疗失败的危险因素。方法 83例进行了有创机械通气的老年肺炎呼吸衰竭患者根据是否成功脱机分为失败组及成功组,采用单因素分析及二分类Logistic回归分析患者有创机械通气失败的危险因素。结果 2组患者年龄、贫血比例、血清白蛋白浓度、机械通气前抗感染时间比较差异有统计学意义(P0.05或P0.01),二分类Logistic回归分析显示机械通气前抗感染时间(OR=1.347,95%CI:1.152~1.575)及低蛋白血症(OR=0.716,95%CI:0.582~0.881)是有创机械通气失败的独立危险因素。结论机械通气前抗感染时间及低蛋白血症可预判老年肺炎呼吸衰竭患者有创机械通气的治疗效果。     

肺结核伴药物性肝损伤患者遵医行为及其影响因素研究

背景据统计,抗结核药物所致肝损伤发生率约为11.90%,而20%～82%肺结核患者不按医嘱服药,因此探讨肺结核伴药物性肝损伤患者遵医行为及其影响因素具有重要现实意义。目的分析肺结核伴药物性肝损伤患者的遵医行为及其影响因素。方法选取2013年1月—2015年6月在江苏省某三级传染病专科医院诊断为药物性肝损伤的肺结核患者350例,采用自行设计的肺结核患者遵医行为调查表收集其性别、年龄、婚姻状况、文化程度、医疗费用支付方式、耐多药情况及有无合并症等;通过查询患者取药记录计算药物空白时间比例(CMG值)以判断患者遵医行为;肺结核伴药物性肝损伤患者遵医行为的影响因素分析采用非条件多因素Logistic回归分析。结果共发放调查表350份,回收有效调查表318份,有效回收率为90.8%。318例肺结核伴药物性肝损伤患者中男性占72.6%(231/318),年龄为30～59岁者占58.5%(186/318),已婚者占72.3%(230/318),文化程度为高中者占45.0%(143/318),医疗费用支付方式为社会基本医疗保险者占86.8%(276/318),耐多药者占5.0%(16/318),无合并症者占55.3%(176/318),遵医行为较差者占58.5%(186/318)。非条件多因素Logistic回归分析(逐步法)结果显示,婚姻状况〔OR=6.328,95%CI=(3.598,13.374)〕、合并症〔OR=44.801,95%CI=(15.850,126.636)〕是肺结核伴药物性肝损伤患者遵医行为的影响因素(P0.05)。结论肺结核伴药物性肝损伤患者遵医行为较差,婚姻状况、合并症是肺结核伴药物性肝损伤患者遵医行为的影响因素。     

无锡地区一线口服抗结核药物所致药物性肝损伤多因素分析

目的分析无锡地区结核病专科医院住院患者由于一线抗结核药物所致药物性肝损伤的主要因素。方法选择2013年1月至12月在无锡市第五人民医院抗结核治疗患者共830名,分成药物性肝损组(102例)和非药物性肝损组(728例),并对其采用单因素和多因素条件logistic回归分析。结果通过单因素分析发现,有5项因素差异有统计学意义,包括HIV感染,乙肝病毒携带,嗜酒,含吡嗪酰胺的抗结核方案及营养不良。多因素条件logistic回归分析显示,乙肝病毒携带,含吡嗪酰胺的抗结核方案及营养不良为抗结核药致药物性肝损伤的危险因素。结论乙肝病毒携带,含吡嗪酰胺的抗结核方案及营养不良是服用一线抗结核药物发生药物性肝损伤的主要因素,在临床工作中应当重视上述相关的危险因素,并给予必要的干预。     

心内科住院患者医院内感染危险因素的分析

目的:分析心内科住院患者医院内感染的发病率及危险因素,为临床提供参考。方法:回顾性分析1999年至2002年2287例心内科住院患者的院内感染情况,采用Logistci回归分析法对其中11种可能的危险因素进行统计分析。结果:心内科住院患者院内感染发病率为6.43%,感染部位以下呼吸道最多(79.59%),院内感染的危险因素按危险性大小依次为:住院天数(OR=59.934,P<0.05)、低蛋白血症(OR=47.913,P<0.05)、餐后及空腹血糖水平升高(OR=35.128,30.478,P均<0.05),血肌酐水平升高(OR=24.738,P<0.05)以及心功能不全(LVEF≤40,OR=22.469,NYHA心功能≥级,OR=21.872,P均<0.05)。结论:心内科住院患者易于并发医院内感染,感染因素多,临床应予针对性预防。目的:分析心内科住院患者医院内感染的发病率及危险因素,为临床提供参考。方法:回顾性分析1999年至2002年2287例心内科住院患者的院内感染情况,采用Logistci回归分析法对其中11种可能的危险因素进行统计分析。结果:心内科住院患者院内感染发病率为6.43%,感染部位以下呼吸道最多(79.59%),院内感染的危险因素按危险性大小依次为:住院天数(OR=59.934,P<0.05)、低蛋白血症(OR=47.913,P<0.05)、餐后及空腹血糖水平升高(OR=35.128,30.478,P均<0.05),血肌酐水平升高(OR=24.738,P<0.05)以及心功能不全(LVEF≤40,OR=22.469,NYHA心功能≥级,OR=21.872,P均<0.05)。结论:心内科住院患者易于并发医院内感染,感染因素多,临床应予针对性预防。     

体外循环心脏术后低蛋白血症的危险因素分析

目的:探讨体外循环(CPB)心脏术后低蛋白血症发生的围术期危险因素。方法:回顾性分析2018年7月至2020年10月在我院择期行心脏手术的成人患者201例,比较术前、术后血清白蛋白(ALB)水平,按术后48 h内的最低血清ALB浓度分为低白蛋白血症组(≤35 g/L)和非低白蛋白血症组(35 g/L),并对两组围术期危险因素进行单因素及多因素Logistic分析。结果:201例心脏病患者术后发生低蛋白血症55例,发生率为27.36%,无院内死亡。CPB术后低蛋白血症单因素分析提示年龄、性别、脂肪肝、术前ALB水平、CPB时间、主动脉阻断时间与术后发生低蛋白血症有关。多因素二元Logistic回归分析提示年龄(OR=1.052,95%CI:1.013～1.093,P=0.008)、CPB时间(OR=1.025,95%CI:1.003～1.048,P=0.029)是CPB心脏术后低蛋白血症的独立危险因素。低蛋白血症组术后气管带管时间(P=0.025)、术后住院时间(P=0.049)明显延长,术后肺部感染发生率明显升高(P0.001)。结论:年龄、CPB时间是CPB心脏术后低蛋白血症的独立危险因素;术后低蛋白血症患者术后气管带管时间、术后住院时间明显延长,肺部感染发生率显著增加。     

老年人群慢性肾脏疾病流行病学研究

目的 了解我国老年人群慢性肾脏疾病(CKD)的患病率及其影响因素.方法 对2004年1月至2007年1月长期在北京医院老年病房进行健康查体及疾病治疗、病历资料完整的老年人进行回顾性调查.分别记录受检者年龄、身高、体质量、血压、血尿、蛋白尿、血红蛋白、血肌酐、血尿素、血脂、血尿酸、乙肝表面抗原、影像学检查结果 以及既往诊断疾病情况,采用公式法估算肾小球滤过率,并对影响蛋白尿及CKD的危险因素进行二分类Logistic回归分析.结果 1082例老年人中,蛋白尿检出率为4.9%,肾功能下降为47.2%,CKD检出率为48.4%;多因素Logistic回归分析表明,糖尿病(OR=2.257)和镜下血尿(OR=5.324)是老年人发生蛋白尿的危险因素(P<0.05),高血压(OR=1.459)、冠心病(OR=3.290)、慢性阻塞性肺病(OR=2.094)、恶性肿瘤(OR=2.072)、高尿酸血症(OR=1.928)、贫血(OR=8.122)、血尿(OR=1.604)是发生CKD的危险因素(P<0.05).结论 初步估计我国特殊老年人群的CKD患病率为48.4%,相关危险因素有糖尿病、高血压、高尿酸血症、贫血等,与发达国家水平相似.     

住院结核患者抗结核药物性肝损伤的Nomogram风险预测模型构建

目的探讨住院结核患者发生抗结核药物性肝损伤(ATB-DILI)的影响因素,并建立Nomogram风险预测模型。方法回顾性收集2017年1月至2021年6月贵阳市公共卫生救治中心收治的5681例住院结核病患者作为研究对象,其中男3342例,女2339例,将住院治疗过程中发生ATB-DILI的患者作为病例组(214例),非ATB-DILI患者作为对照组(5427例)。回顾性分析患者的基线特征、结核病情、行为及疾病相关资料等,经卡方检验和多因素logistic回归筛选分析影响因素,据此构建Nomogram模型并进行验证。使用决策曲线评估模型的临床实际应用价值。结果本次研究中共有3.8%(214/5681)例患者发生ATB-DILI。经多因素logistic回归分析得出肺外结核(OR=1.876,P<0.001)、营养不良(OR=4.411,P<0.001)、合并基础肝病(OR=4.961,P<0.001)以及间断使用护肝药(OR=2.137,P=0.007)是其发生ATB-DILI的独立危险因素;全程使用护肝药(OR=0.292,P<0.001)是其保护因素。将以上5个相关影响因素构建Nomogram模型,ROC曲线下面积为0.749(95%CI:0.713~0.786),敏感度0.640,特异度0.752。使用Bootstrap法内部重复抽样1000次进行验证,平均绝对误差0.003,校正曲线和理想曲线基本拟合,预测值和实际值一致性较好。Hosmer-lemeshow检验显示,模型具有较好拟合度(χ²=3.068,P=0.381)。决策曲线显示Nomogram模型在高风险阈值范围(0.10~0.68)时,有着一定的临床实用性。结论本次研究所构建的住院结核患者抗结核药物性肝损伤Nomogram风险预测模型具有较好的预测性、一致性和临床实用性,能为临床在抗结核治疗过程中防控ATB-DILI并制定个体化治疗方案提供依据。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.