影响哮喘控制水平的相关危险因素探究

目的探究不同控制水平下,哮喘患儿的影响因素。方法回顾性分析120例哮喘患儿的病案,根据哮喘测试量表(ACT)得分将全部病例进行分级,其中病情完全控制的85例患儿纳入完全控制组,未控制和部分控制的35例患儿纳入未完全控制组;采用哮喘相关健康生命质量量表评价两组患儿生命质量;采用独立样本t检验或χ~2检验进行组间两两比较;采用二项Logistic回归筛选影响哮喘控制水平的独立危险因素。结果完全控制组的生命质量量表评分较未完全控制组高(88.27±6.51 vs. 77.72±4. 45);两组患儿的家族史、家长吸烟情况、是否使用哮喘控制药物、是否严格遵医嘱治疗、近3个月内发生呼吸道感染次数、过敏性鼻炎史、天气变化以及接触粉尘有害气体率比较,差异均有统计学意义(P0.05);二项Logistic回归分析显示接触粉尘有害气体、家族史、近3个月发生呼吸道感染、过敏性鼻炎史、未使用哮喘控制药物、未严格遵医嘱,是哮喘控制水平的危险因素(P0. 05)。结论接触粉尘有害气体、家族史、家长吸烟情况、近3个月内发生呼吸道感染次数、过敏性鼻炎史、天气变化等,是哮喘患儿控制水平的影响因素,积极预防并有效规避这些危险因素,对减少哮喘发作,改善患者的预后提高患儿生命质量具有重要意义。     

3～6岁儿童支气管哮喘的临床特征及影响因素分析

目的探究3～6岁儿童支气管哮喘的临床特征及影响因素。方法选取2019年2月～2020年9月期间我院收治的3～6岁急性发作期儿童支气管哮喘150例及同期3～6岁健康体检儿童150例作为研究对象,分别作为病例组(n=150)及对照组(n=150),收集全部入院儿童的临床资料,总结临床特征,采用logistic回归分析剖析3～6岁儿童支气管哮喘的影响因素。结果病情严重程度:轻度为70例,中度为48例,重度为32例。logistic回归分析结果表明,哮喘家族史、粉尘、食物过敏、湿疹、过敏性鼻炎、被动吸烟、宠物、装修、花粉接触史、维生素D缺乏、近期呼吸道感染、Ig E升高、IL-17A升高是儿童支气管哮喘的危险独立因素,母乳喂养是儿童支气管哮喘的保护因素,(P0.05)。结论儿童支气管哮喘主要症状是上呼吸道感染,其影响因素众多,哮喘家族史、粉尘、食物过敏、湿疹、Ig E升高、IL-17A升高等因素,是儿童支气管哮喘的危险独立因素,母乳喂养是保护因素,临床上主要注意控制危险因素。     

上海市宝山区支气管哮喘患病率和危险因素调查

目的:了解上海市宝山区哮喘患病率情况及其危险因素的分布,为开展哮喘防治工作提供依据。方法:按照分层整群不等比随机抽样对照方法对上海宝山区进行哮喘流行病学问卷调查,采取入户问卷填写方式,调查人群年龄≥4岁。结果:共调查4 956人,哮喘患者95例,总患病率为1.92%。儿童患病率为3.89%,成人患病率为1.81%。男、女患病率分别为1.5%和2.3%,男女之比为0.7∶1。相关因素分析显示,哮喘患者中精神紧张[比值比(OR)=12.474,95%可信区间(CI):8.019～19.405]、冷空气(OR=3.43,95%CI:2.41～4.90)、刺激性气体(OR=12.47,95%CI:8.015～19.40)、接触粉尘(OR=20.311,95%CI:12.52～32.97)为主要诱因;哮喘伴有过敏性鼻炎者为45.26%(OR=16.425,95%CI:10.739～25.12),有哮喘家族史者46.32%(OR=19.496,95%CI:12.724～29.872)。回归分析显示哮喘家族史和过敏性鼻炎对哮喘的发生影响最大。结论:本次流行病学调查获得了上海市宝山区哮喘患病率及相关危险因素的资料,为今后开展上海地区支气管哮喘的防治工作提供了依据。     

542名学龄期儿童呼吸系统健康状况调查

目的了解甘肃省兰州市城关区学龄期儿童呼吸系统的健康状况及其影响因素,为学龄期儿童呼吸系统健康的防控提供理论依据。方法 2014年9—11月随机抽取兰州市城关区某小学学龄期儿童进行问卷调查,分析学龄期儿童呼吸系统患病情况及其影响因素。结果兰州市城关区居民住宅有82.29%为框架结构,93.73%的家庭做饭使用的燃料以传统燃料为主,33.00%的家庭冬季采用火炉或天然气供暖;本次调查的某小学学龄期儿童呼吸系统疾病主要以慢性支气管炎、肺炎、过敏性鼻炎和哮喘为主,患病率分别为21.2%、26.2%、4.6%和2.9%,男、女各疾病患病率差异无统计学意义(P0.05)。学龄期儿童因呼吸系统疾病所致的住院率男生为20.4%,女生为23.9%,差异无统计学意义(χ2=0.991,P0.05);在家长室内二手烟暴露环境下,学龄期儿童感冒(χ2=58.58)、肺炎(χ2=20.21)、支气管炎(χ2=53.14)和哮喘(χ2=89.80)的患病率分别为61.6%、56.8%、61.1%和64.4%,明显高于非暴露组患儿呼吸系统疾病患病率38.4%、43.2%、38.9%和36.6%,差异均有统计学意义(均P0.01)。结论兰州市城关区学龄期儿童呼吸系统疾病的患病率与全国平均水平相比基本一致,家庭使用传统燃料和被动吸烟可能是引起学龄期儿童出现呼吸系统疾患的主要诱因。     

变应原疫苗免疫治疗对过敏性支气管哮喘合并鼻炎的疗效分析

目的评估标准化变应原疫苗免疫治疗（allergeni mmunotherapy,AIT）对过敏性哮喘合并鼻炎患者的近期疗效。方法设计调查问卷,对我院门诊接受标准化变应原疫苗-安脱达（Alutard（SQ）AIT治疗的39例过敏性哮喘合并鼻炎患者进行问卷调查,应用哮喘控制水平分级和哮喘控制测试（ACT）评分评价哮喘的疾病控制水平,应用鼻炎病情评分（RCT）评价过敏性鼻炎的控制情况。结果 39例患者治疗前后的哮喘控制水平分级（Z=-7.235,P〈0.05）、ACT评分（t=16.533,P〈0.05）、RCT评分（t=16.650,P〈0.05）、情绪（χ2=34.873,P〈0.05）等均有较大程度的改善。结论标准化AIT治疗能明显改善过敏性哮喘合并鼻炎患者的临床症状。     

上海市某社区成年人变应性鼻炎患病情况及其危险因素分析

目的了解上海市某社区成年人变应性鼻炎(AR)患病情况及其危险因素,为开展有针对性的AR防治工作提供参考。方法 2017年9月—2018年2月,采用简单随机抽样方法选取上海市徐汇区枫林街道社区的18～70岁常住居民500例,进行问卷调查并记录其AR患病情况;社区成年人AR的影响因素分析采用多因素Logistic回归分析。结果 (1)共发放问卷500份,回收有效问卷469份,问卷有效回收率为93.80%,其中自报有AR典型症状、体征、病史和经二级及以上医院诊断为AR的患者有99例,AR患病率为21.11%(99/469)。(2)不同年龄、学历及有无遇花粉或灰尘后过敏、哮喘、荨麻疹、食物过敏史、药物过敏史、AR家族史、哮喘家族史社区成年人AR患病率比较,差异有统计学意义(P0.05)。(3)多因素Logistic回归分析结果显示,遇花粉或灰尘后过敏〔OR=3.188,95%CI(1.791,5.672)〕、AR家族史〔OR=3.166,95%CI(1.646,6.090)〕、哮喘家族史〔OR=2.783,95%CI(1.118,6.930)〕是社区成年人AR的独立影响因素(P0.05)。结论上海市徐汇区枫林街道社区成年人AR患病率为21.11%,遇花粉或灰尘后过敏、AR家族史、哮喘家族史是社区成年人AR的危险因素。     

136例支气管哮喘患者临床特点及相关危险因素分析

目的 探讨支气管哮喘发作的危险因素.方法 收集哮喘患者136例以及同期就诊的非哮喘人群,利用病例对照研究方法,对哮喘的临床特点以及发作危险因素进行分析.结果 支气管哮喘患者多在夜间及秋季发病,常反复发作,以轻、中度为主,超过患者曾被误诊,26.47%接受过健康教育,单因素分析发现支气管哮喘发作与过敏史、家族史、吸烟、感染、天气变化、室内装修、接触粉尘有害气体等因素有关,多因素分析家族史、感染、接触粉尘有害气体是支气管哮喘的独立危险因素.结论 积极预防避免接触各危险因素,对减少哮喘急性哮喘发作,改善患者的预后具有重要意义.     

河北省邢台市城乡居民高血压患病情况及其影响因素的流行病学调查研究

目的调查河北省邢台市城乡居民高血压患病情况及其影响因素。方法采用多阶段整群分层随机抽样方法于2013年9月抽取邢台市6个居民委员会和6个村民委员会年龄≥15周岁的常住居民4 010人。参照《全国心脑血管病危险因素监测资料》调查表,结合本研究目的自行设计调查表,调查内容包括年龄、性别、文化程度、婚姻状况、吸烟情况、健身锻炼情况及家族史(包括高血压、高脂血症、糖尿病、脑卒中及冠心病)等一般资料,腰围、身高、体质量及外周血压等体格检查指标,食盐量及食油量等饮食习惯,采用非条件logistic回归分析筛选高血压的影响因素。结果本调查共发放4 010份调查表,回收3 801份,回收率为94.8%。邢台市城乡居民高血压患病率为19.0%(724/3 801),且城市居民〔18.3%(343/1 903)〕与农村居民〔20.2%(383/1 898)〕高血压患病率比较,差异无统计学意义(P0.05)。单因素分析结果显示,高血压患病率随年龄增长呈上升趋势(χ2趋势=213.32,P=0.00);不同文化程度、婚姻状况,是否吸烟,不同健身锻炼情况,有无高血压家族史、高脂血症家族史、糖尿病家族史、脑卒中家族史及冠心病家族史及是否为中心性肥胖、不同体质指数(BMI)、不同食盐量邢台市城乡居民高血压患病率比较,差异有统计学意义(P0.05);不同性别、食油量邢台市城乡居民高血压患病率比较,差异无统计学意义(P0.05)。非条件logistic回归分析结果显示,年龄〔OR=1.814,95%CI(1.691,1.947)〕、婚姻状况〔OR=1.485,95%CI(1.146,1.923)〕、吸烟〔OR=1.906,95%CI(1.463,2.483)〕、高血压家族史〔OR=3.111,95%CI(2.452,3.946)〕、中心性肥胖〔OR=1.430,95%CI(1.147,1.783)〕、BMI〔OR=1.982,95%CI(1.703,2.306)〕及食盐量〔OR=1.323,95%CI(1.121,1.562)〕是邢台市城乡居民高血压的独立危险因素,文化程度是其保护因素〔OR=0.729,95%CI(0.654,0.814)〕。结论邢台市城乡居民高血压患病率较高,且年龄较大、婚姻状况差、吸烟、有高血压家族史、肥胖或超重及食盐量大的城乡居民高血压发生风险较高。     

南昌市社区老年性痴呆患病率及其影响因素

目的了解南昌地区老年性痴呆的患病率及影响因素。方法选择南昌市洪都社区60岁以上的老年人为研究对象,以简易智能状态量表(MMSE)作为筛查工具,以临床确诊为依据。通过调查问卷收集资料,采用χ2检验分析数据。结果南昌市社区老年人的痴呆患病率为6.29%,其中阿尔茨海默病(AD)患病率为4.44%。χ2分析提示,年龄、性别、文化程度、吸烟、体育锻炼、社会活动、痴呆家族史等与AD患病率有关(P0.05),而在不同婚姻状况(P=0.084)与是否饮酒(P=0.732)者中无明显差异。结论南昌市社区老年人AD患病率较高,影响因素较多,需要简便有效的AD早期筛查诊断方法提供AD早期预防策略,从而提高老年人生活质量。     

异氰酸酯作业工人职业性支气管哮喘患病情况及其危险因素研究

目的 研究异氰酸酯作业工人职业性支气管哮喘患病情况及相关危险因素.方法 采用横断面研究,选2011年3-6月某企业发泡车间429名异氰酸酯暴露工人为研究对象,通过问卷调查、体检、实验室检查调查职业性支气管哮喘患病率,检测受试者诱导痰中炎性细胞计数,多因素logistic回归分析其可能的危险因素.结果 (1)共有366名资料完整者纳入本研究,最终11例诊断为异氰酸酯职业性支气管哮喘,患病率为3.0％.(2)异氰酸酯职业性支气管哮喘工人诱导痰中中性粒细胞计数明显增加[上班前为42.00 (34.00,55.00)％,上班后为59.00 (51.00,70.00)％;Z=-2.940.P ＜0.05].(3)工龄(OR=3.096,P=0.025)、鼻炎(OR=1.901,P=0.008)是异氰酸酯职业性支气管哮喘致病的独立危险因素,采取防护措施(OR=0.074,P=0.015)是其保护因素.结论 异氰酸酯接触可导致工人发生中性粒细胞性气道炎症,定期健康检查、采取有效防护措施能降低其职业性支气管哮喘患病率.     

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.     

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.     

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.     

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.