阿奇霉素序贯疗法联合双黄连口服液治疗小儿支原体肺炎的临床疗效及其对血清炎性因子水平和免疫功能的影响

目的观察阿奇霉素序贯疗法联合双黄连口服液治疗小儿支原体肺炎的临床疗效,探讨其对血清炎性因子水平和免疫功能的影响。方法选取枣庄矿业集团枣庄医院2014年1月—2015年1月收治的支原体肺炎患儿100例,按照随机数字表法分为对照组和观察组,每组50例。两组患儿入院后均给予对症支持治疗,对照组患儿给予阿奇霉素序贯疗法,连续治疗2个疗程;观察组患儿在对照组基础上联合双黄连口服液连续治疗2周。比较两组患儿临床疗效,治疗前后血清炎性因子〔白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)〕水平、T淋巴细胞亚群(CD+3细胞分数、CD+4细胞分数和CD+8细胞分数)及治疗期间不良反应发生情况。结果观察组患儿临床疗效优于对照组(P0.05)。治疗前两组患儿血清IL-6、IL-8和TNF-α水平比较,差异无统计学意义(P0.05)。治疗后观察组患儿血清IL-6、IL-8和TNF-α水平低于对照组(P0.05);两组患儿治疗后血清IL-6、IL-8和TNF-α水平低于治疗前(P0.05)。治疗前两组患儿CD+3细胞分数、CD+4细胞分数和CD+8细胞分数比较,差异无统计学意义(P0.05);治疗后观察组患儿CD+3细胞分数、CD+4细胞分数高于对照组,CD+8细胞分数低于对照组(P0.05);两组患儿治疗后CD+3细胞分数、CD+4细胞分数高于治疗前,CD+8细胞分数低于治疗前(P0.05)。两组患儿治疗期间不良反应发生率比较,差异无统计学意义(P0.05)。结论阿奇霉素序贯疗法联合双黄连口服液治疗小儿支原体肺炎的临床疗效确切,可有效降低血清炎性因子水平,改善免疫功能,且安全性较高。     

匹多莫德对支原体肺炎患儿免疫及炎性因子的影响

目的探讨匹多莫德对支原体肺炎患儿免疫功能和血清炎性因子水平的影响。方法将我院收治的129例支原体肺炎患儿按照随机分层分组法分为观察组和对照组,对照组给予阿奇霉素治疗,观察组在此基础上加用匹多莫德,观察两组患儿血清炎性因子水平、淋巴细胞亚群及预后情况。结果观察组血清炎性因子中IL-4、IL-6、IL-10及TNF-α含量均显著低于对照组,两组差异有统计学意义(P0.05)。观察组CD+3T细胞和CD+4T细胞的绝对值及比例均显著高于对照组(P0.05),但观察组CD+8T细胞的绝对值及比例与对照组无显著差异(P0.05)。随访6个月,观察组患儿病情反复次数、持续时间及抗生素使用天数均显著少于对照组(P0.05),但两组不良反应发生率无显著差异(P0.05)。结论匹多莫德能显著提高患儿免疫功能,降低血清炎性因子水平,对于减少病情反复及持续时间具有重要的临床应用价值。     

中药穴位贴敷联合布地奈德治疗小儿支原体肺炎的疗效及对炎症水平、免疫功能的影响

目的 探究中药穴位贴敷联合布地奈德治疗小儿支原体肺炎的疗效及对炎症水平、免疫功能的影响。方法 选取124例支原体肺炎患儿作为研究对象,将其随机分为对照组和观察组,每组62例。对照组行布地奈德雾化吸入治疗,观察组在对照组的基础上行中药穴位贴敷治疗,两组均连续治疗2周。比较两组患儿临床疗效、治疗前后的炎症指标水平和免疫功能,以及治疗期间不良反应的发生情况。结果 治疗2周后,观察组的治疗总有效率高于对照组(96.77%比83.87%),差异具有统计学意义(P<0.05);两组肿瘤坏死因子受体相关因子6和核因子κB的mRNA相对表达量,以及血清CD8⁺、干扰素(IFN)-γ和白细胞介素(IL)-4水平均降低,且观察组均低于对照组(均P<0.05);两组血清CD3⁺、CD4⁺、免疫球蛋白(Ig)A、IgG、IgM水平、CD4⁺/CD8⁺和IFN-γ/IL-4均升高,且观察组均高于对照组(均P<0.05)。两组治疗期间不良反应的发生情况,差异无统计学意义(P>0.0...     

复方甘草酸苷对小儿哮喘T淋巴细胞及NK细胞的影响

目的分析复方甘草酸苷对小儿哮喘T淋巴细胞及自然杀伤(NK)细胞的影响。 方法选取2020年2月至2021年4月我院收治的81例小儿哮喘患儿为对象,随机分为观察组42例与对照组39例。对照组患儿行抗感染、抗炎、抗喘、止咳、化痰、吸氧等常规治疗,并静脉滴注氢化可的松注射液,观察组患儿在对照组基础上加用复方甘草酸苷。比较两组患儿的治疗效果及治疗期间的不良反应发生率,比较两组患儿治疗前后第1 s末用力呼气量(FEV₁)、用力肺活量(FVC)、呼气流量峰值(PEF)、T淋巴细胞(CD4⁺、CD8⁺、CD4⁺/CD8⁺)及NK细胞水平的差异。 结果观察组总有效率92.86%显著高于对照组76.92%(P<0.05);两组治疗后,观察组FEV₁、FVC、PEF显著高于对照组(P<0.05);两组治疗后CD4⁺、CD4⁺/CD8⁺、NK细胞水平显著高于治疗前,CD8⁺水平显著低于治疗前(P<0.05),观察组治疗后CD4⁺、CD4⁺/CD8⁺、NK细胞水平显著高于对照组,CD8⁺水平显著低于对照组(P<0.05);两组治疗期间不良反应总发生率比较差异无统计学意义(P>0.05)。 结论复方甘草酸苷用于小儿哮喘的治疗能调节患儿T淋巴细胞和NK细胞水平,使CD4⁺、CD4⁺/CD8⁺、NK细胞水平上升,CD8⁺水平下降。     

哌拉西林舒巴坦联合阿奇霉素治疗儿童支原体肺炎的临床疗效及其对血清炎性因子水平的影响

目的探究哌拉西林舒巴坦联合阿奇霉素治疗儿童支原体肺炎的临床疗效及其对血清炎性因子水平的影响。方法选取荆州市中心医院2014年1月—2015年1月收治的支原体肺炎患儿98例,按照入院时间分为对照组47例和观察组51例。两组患儿均接受常规治疗及护理,对照组患儿在此基础上给予阿奇霉素注射液及阿奇霉素分散片序贯治疗,观察组患儿在对照组基础上联合哌拉西林舒巴坦治疗。比较两组患儿临床疗效及不良反应发生情况,治疗前后血清炎性因子〔C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)〕水平及红细胞沉降率(ESR)。结果观察组患儿临床疗效优于对照组(u=3.978,P0.05)。两组患儿恶心、呕吐、腹泻、皮疹发生率比较,差异无统计学意义(P0.05)。两组患儿治疗前血清CRP、IL-6、TNF-α水平及ESR比较,差异无统计学意义(P0.05);观察组患儿治疗后血清CRP、IL-6、TNF-α水平及ESR低于对照组(P0.05)。结论哌拉西林舒巴坦联合阿奇霉素治疗儿童支原体肺炎的临床疗效确切,能有效改善患儿血清炎性因子水平,且未增加不良反应发生率。     

益生菌辅治小儿哮喘及对S100β蛋白、TLR4与炎性免疫因子的影响

目的分析益生菌辅治小儿支气管哮喘(BA)及对S100β蛋白、TLR4与炎性免疫因子的影响； 方法选择我院2016年1月至2019年12月收治的BA患儿78例，按照随机数字表法分为观察组41例、对照组37例，对照组给予常规治疗+沙美特罗替卡松粉吸入剂治疗。观察组在对照组基础上给予布拉氏酵母菌散治疗。观察两组哮喘控制情况，不良反应。两组治疗前后最大呼吸流量(PEF)、第一秒用力呼吸容积(FEV₁)、用力肺活量(FVC)等肺功能指标，血清CD₄⁺、CD₈⁺、CD₄⁺/CD₈⁺等免疫因子水平，血清S100β蛋白、TLR4水平；血清IL-17、IL-22、IL-35等炎性因子水平； 结果治疗后，观察组FPE、FEV₁、FVC均高于对照组(P<0.05)。治疗后，观察组CD₄⁺、CD₄⁺/CD₈⁺均高于对照组，CD₈⁺小于对照组(P<0.05)。治疗后，观察组100β蛋白、TLR4低于对照组(P<0.05)。治疗后，观察组IL-17、IL-22均低于对照组，IL-35高于对照组(P<0.05)。观察组总控制率(92.19%)大于对照组(78.13%)(P<0.05)。治疗期间两组均无显著不良反应； 结论益生菌辅治小儿支气管哮喘可提高免疫功能，缓解机体炎性反应，改善血清炎性因子水平，抑制100β蛋白、TLR4生成，疗效显著，安全。     

头孢曲松钠与比阿培南治疗重症肺炎临床效果对比观察

目的 对比观察头孢曲松钠与比阿培南治疗重症肺炎的临床效果。方法 将80例重症肺炎患者按随机数字表法随机分为观察组和对照组各40例。对照组在常规对症支持治疗基础上予头孢曲松钠静脉滴注，观察组在常规对症支持治疗基础上予比阿培南静脉滴注，连续治疗2周。比较两组临床疗效，治疗前后炎性因子[降钙素原(PCT)、肿瘤坏死因子α(TNF-α)、IL-6、高敏C反应蛋白(hs-CRP)]水平、细胞免疫功能(CD4⁺、CD8⁺T淋巴细胞及CD4⁺/CD8⁺)、动脉血气分析相关指标[动脉血二氧化碳分压(PaCO₂)、动脉血氧分压(PaO₂)、动脉血氧饱和度(SaO₂)]以及不良反应情况。结果 观察组总有效率高于对照组(P<0.05)。两组治疗后血清PCT、TNF-α、IL-6、hs-CRP水平以及CD8⁺T淋巴细胞和PaCO₂均低于治疗前，而CD4⁺T淋巴细胞、CD4⁺     

观察针灸辅治消化性溃疡的疗效及血清肿瘤坏死因子、白细胞介素-8、胃泌素水平变化

目的:观察针灸辅治消化性溃疡的疗效及血清肿瘤坏死因子(TNF-α)、白细胞介素-8(IL-8)、胃泌素水平变化。方法:选取2018年6月—2020年6月我院收治的消化性溃疡患者101例,根据数字表法将入选者分为对照组50例和观察组51例。2组均予以基础治疗,对照组加以常规西药治疗,观察组在对照组基础上实施针灸辅助治疗。比较2组短期(4周内)临床疗效,并记录其治疗前、治疗4周后的炎性因子[TNF-α、IL-8、热休克蛋白60(HSP60)]、血清胃肠功能指标[胃泌素(GAS)、生长抑素(SS)、胃动素(MTL)]、外周血T淋巴细胞亚群(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)变化及不良反应发生情况。结果:2组临床疗效分级比较发现,2组患者治疗4周后比较,差异有统计学意义(P<0.05),观察组总有效率为94.12%,对照组总有效率为80.00%,2组比较差异有统计学意义(P<0.05);2组患者治疗4周后IL-8、TNF-α、HSP60、GAS、MTL、CD...     

调强放疗联合香菇多糖注射液同期TP化疗对中晚期NSCLC临床分析

目的 分析调强放疗联合香菇多糖注射液同期TP(多西他赛+顺铂)化疗对中晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)疗效及安全性。方法 选取2017年9月至2020年8月我院收治的中晚期NSCLC患者86例,根据治疗方法分为观察组45例,对照组41例。对照组采用强调放疗同期TP化疗,观察组在对照组基础上联用香菇多糖注射液治疗。比较两组近期临床疗效、免疫指标、生活质量及治疗期间的不良反应。结果 观察组疾病控制率(DCR)84.44%(38/45)高于对照组63.41%(26/41)(P<0.05)。两组治疗后CD3⁺、CD4⁺、NK细胞比率及CD4⁺/CD8⁺升高,CD8⁺降低(P<0.05);与对照组比较,观察组治疗后CD3⁺、CD4⁺、NK细胞比率及CD4⁺/CD8⁺升高(P<0.05),CD8⁺无明显差异(P...     

超分割放疗对局限期小细胞肺癌患者T淋巴细胞亚群和肿瘤标记物的影响

目的 探讨超分割放疗对局限期小细胞肺癌患者T淋巴细胞亚群和肿瘤标记物的影响。方法 选取64例局限期小细胞肺癌患者，按照随机数字表法分成观察组与对照组，各32例。两组均给予化疗，对照组予常规分割放疗，观察组另予超分割放疗，比较两组T淋巴细胞亚群(CD4⁺、CD8⁺、CD4⁺CD8⁺)、肿瘤标记物[(癌胚抗原(CEA)、糖类蛋白-125(CA-125)、细胞角蛋白19可溶性片段(CYFRA21-1)]水平，观察两组近期疗效、不良反应发生及生存时间。结果 观察组治疗总有效率(87.50%)较对照组(65.63%)高(P<0.05);两组治疗后CD4⁺、CD4⁺CD8⁺较治疗前升高，CD8⁺较治疗前降低，观察组治疗后CD4⁺、CD4⁺CD8⁺较对照组升高，CD8⁺较对照组降低(P<0.05);两组治疗后CEA、CA-125...     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.