感染中毒症合并应激性高血糖患者胰岛素强化治疗的疗效观察

目的:探讨胰岛素强化治疗对感染中毒症合并应激性高血糖患者的疗效及其可能的机制。方法:将52例感染中毒症合并应激性高血糖患者随机配对分成强化组(用胰岛素将血糖控制在4.4~6.1mmol/L)和常规组(血糖控制在10.0~11.1mmol/L)。观察并比较两组患者呼吸机使用天数、抗生素使用天数、ICU住院天数、MODS的发生率及ICU住院病死率。同时分别于转入ICU后1、3、5、7d采用ELISA检测血清TNF-α及IL-6水平,并监测CRP变化。结果:强化组的呼吸机使用天数、抗生素使用天数及ICU住院天数均较常规组缩短,其差异有统计学意义(P<0.05)。强化组有5例(19.2%)并发MODS,常规组有12例(46.2%)并发MODS,两者差异有统计学意义(P<0.05)。强化组ICU病死率较常规组有所下降,但无统计学意义(P>0.05)。治疗后3、5、7d强化组TNF-α、IL-6及CRP血浆浓度明显低于常规组,其差异有统计学意义(P<0.05)。结论:胰岛素强化治疗可减少感染中毒症合并应激性高血糖患者呼吸机与抗生素的使用时间,缩短ICU住院时间,降低MODS的发生率,其机制可能与促进合成代谢作用及其抗炎效应相关。     

46例感染中毒症临床资料分析

目的分析46例感染中毒症患者血培养致病菌的种类、耐药谱、临床特征及预后。方法对我院住院诊断为感染中毒症的46例患者血培养和药敏结果及临床资料进行回顾性分析。结果46例感染中毒症患者血培养共分离出致病菌49株革兰阳性菌24株(49.0%),革兰阴性菌20株(40.8%),真菌5株(10.2%)。多种菌株对常用抗生素出现多重耐药。46例患者治愈33例(71.7%),死亡5例(10.9%),自动出院8例。结论随着新型抗生素在临床的广泛应用,革兰阳性菌感染中毒症有上升的趋势,并且呈多重耐药。     

感染中毒症发病机制及其相关治疗进展

感染中毒症是指由感染引起的全身性炎症反应综合征（systemic inflammatory response syndrome,SIRS）,是感染、休克、创伤、烧伤、大手术等临床急危重症患者的严重并发症之一,也是诱发感染性休克、多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）的重要原因。     

感染中毒症患者血清神经元特异性烯醇化酶的变化

目的：探讨感染中毒症患者血清神经元特异性烯醇化酶（NSE）的变化及意义。方法：用双抗体夹心法测定52例感染中毒症患者血清NSE浓度。结果：感染中毒症组血清NSE浓度显著高于对照组（P〈0．05）;严重感染中毒症和感染中毒症休克组血清NSE浓度显著高于普通感染中毒症组（P〈0．01）,普通感染中毒症组血清NSE浓度与对照组相比差异无统计学意义（P=0．055）。结论：血清NSE浓度升高可作为提示感染中毒症患者神经元细胞受损的辅助性指标,也是判断病情预后的指标之一。     

乙肝免疫球蛋白阻断宫内感染HBV临床观察

为了阻断母亲乙肝病毒对胎儿感染,对50例乙肝病毒双阳母亲实行乙肝免疫球蛋白产前注射,获得较好的阻断效果,现将结果报告如下。1 临床资料 50例均为乙肝病毒携带的妊娠妇女,诊断符合2000年西安学术会议修订的病毒性肝炎防治标准,HBsAg 、HBeAg 、抗HBc 35例。HB-     

静脉滴注免疫球蛋白治疗狼疮性肾炎并发感染的临床观察

目的 :探讨采用静脉滴注免疫球蛋白 (IVIG)治疗狼疮性肾炎 (LN)并发感染的疗效及适应证。方法 :13例LN并发感染患者 ,采用IVIG 4 0 0mg/ (kg·d) ,连用 3～ 5d ,此后给予泼尼松 (pred) 1mg/ (kg·d) ,4周后 ,按系统性红斑狼疮活动指数比较治疗前后病情控制情况、2 4h尿蛋白、尿红细胞数、C3 、C4、抗ds DNA抗体、血小板数以及抗核抗体。结果 :IVIG治疗 4周后 ,13例肺部感染全部治愈 ,上述指标于治疗前、后均有显著或非常显著差异 (P <0 .0 5或P <0 .0 1) ,5 / 13例ANA转阴性。结论 :IVIG联合 pred治疗LN并发感染是一有效治疗措施 ,尤其对LN并发感染并有血小板明显减少、体质差 ,暂时无法使用大剂量甲泼尼龙及 /或免疫抑制剂治疗的患者更为适宜     

肺螨症患者血清免疫球蛋白测定

本文采用免疫单扩散法测定了51份肺螨症患者血清的免疫球蛋白IgG、IgA和IgM含量,并以生物素-亲和素酶联免疫吸附试验(ABC-ELISA)测定了其中16份血清的IgE含量。结果显示患者IgM水平与对照组相近,而IgG(169.77±46.91/ml)、IgA(308.39±91.83U/ml)和IgE(458.90±273.64U/ml)则明显增高。提示螨类吸入肺部后可刺激机体引起体液免疫反应。     

活化蛋白C治疗感染中毒症及其所致急性肺损伤的研究进展

近来的研究表明活化蛋白C（APC）在感染中毒症中具有抗凝、促纤溶和抗炎作用。重组人活化蛋白C（rhAPC）可显著降低感染中毒症患者的病死率。但rhAPC在临床应用中的适应证及其有效性仍存在争议。细胞学研究提示APC可通过与细胞表面受体结合,激活细胞内的各种蛋白酶,使其磷酸化或去磷酸化,诱导细胞内信号转导,调节炎症相关基因的表达,从而调节参与感染中毒症的多个重要病理生理过程。此外,APC可能对感染中毒症所致急性肺损伤起到保护性作用。     

糖皮质激素和(或)免疫球蛋白治疗替罗非班诱导重度血小板减少症的临床观察

目的:观察糖皮质激素和(或)免疫球蛋白治疗替罗非班诱导产生的重度血小板减少症的临床疗效.方法:回顾性收集2008年9月-2016年11月在我院心脏内科住院期间出现的19例替罗非班诱导产生重度血小板减少症患者的基本临床资料、糖皮质激素及免疫球蛋白用法用量、血小板计数、血小板计数减少期间出血事件,依据是否使用糖皮质激素和(...     

乙型肝炎免疫球蛋白阴 HBV宫内感染的疗效

已经发生宫内感染的胎儿出生后使用乙型肝炎疫苗 (或和乙型肝炎免疫球蛋白 [ＨＢＩｇ]联用 )预防感染无效 ,这些新生儿极易成为慢性ＨＢＶ携带者。乙型肝炎免疫球蛋白可以和ＨＢｓＡｇ结合形成抗原抗体复合物 ,促使免疫系统清除乙型肝炎病毒 ,我们在妊娠晚期给ＨＢｓＡｇ阳性孕妇肌注ＨＢＩｇ ,观察其阻断宫内感染的疗效 ,同时探讨其使用的指征。材料与方法一、研究对象以我院 1998年 6月～ 1999年 10月产前门诊筛选无症状ＨＢｓＡｇ携带者的孕妇 86例为研究对象 ,排除甲、丙、戊、庚型肝炎病毒感染 ,未进行过抗病毒治疗。年龄 2 2～ 33岁。…     

The Effectiveness of Intravenous Human Immunoglobulin Treatment After Plasmapheresis in Restoring Serum Immunoglobulin Levels: A Preliminary Study

Abstract: This study was performed to examine the effects of intravenous human immunoglobulin (IVIG) on the level of serum immunoglobulin G (IgG) and its subclasses after plasmapheresis in patients with autoimmune disorders. Twenty‐nine patients with predominantly rheumatoid arthritis were enrolled in this study. The plasmapheresis was performed by the use of double‐filtration plasmapheresis (DFPP). Immediately after DFPP, IVIG (2.5 g, 50 ml) was intravenously administered. The treatment with IVIG had almost no effect on subjective and objective symptoms. Immediately after DFPP, the total of serum IgG was decreased by approximately 40%. After 24 h, the total of serum IgG recovered to 16% reduction in IVIG‐treated patients whereas it remained at 32% reduction in nontreated patients. The beneficial effect of IVIG was significantly observed in patients who had shown 1,000–1,800 mg/dl IgG in their sera. After DFPP, IgG subclasses were decreased without change in the ratio of subclasses. Twenty percent to 30% of IgG subclasses were supplemented by the treatment with IVIG without change in the ratio of subclasses. These results suggested that the treatment with IVIG at minimal amount was safe and effective to supplement IgG for hypogammaglobulinemia after DFPP.     

Comparing the Autoantibody Levels and Clinical Efficacy of Double Filtration Plasmapheresis,Immunoadsorption, and Intravenous Immunoglobulin for the Treatment of Late-onset Myasthenia Gravis

The aim of this study was to investigate the effects of double-filtration plasmapheresis (DFPP), immunoadsorption (IA) and intravenous immunoglobulin (IVIg) in the treatment of late-onset myasthenia gravis (MG). A total of 40 late-onset MG patients were randomly divided into three groups: 15 patients were treated with DFPP; 10 patients were treated with IA; and 15 patients received IVIg. The titers of titin antibodies (Titin-ab), acetylcholine receptor antibodies (AChR-ab), presynaptic membrane antibody (Prsm-ab) were detected before and after the treatment, and the quantitative MG score (QMG score) was assessed by blinded examiners before and immediately after the entire course of treatment. The clinical efficacy, duration of respiratory support, hospital stay, and the correlation between the three antibodies and the QMG score were also analyzed. Compared to pre-treatment, the values of Titin-ab, AChR-ab, and PrsmR-ab were all dramatically decreased (P < 0.05); meanwhile the value of Titin-ab in the DFPP and IA groups decreased much more than in the IVIg group (P < 0.01); however, no statistical difference was found between the DFPP and IA groups (P > 0.05). Although the QMG score significantly improved in all three groups, it decreased much more in both the DFPP and IA groups than that in the IVIg group (P < 0.01). Symptoms were also effectively ameliorated by all treatments, but the clinical efficacy of the DFPP and IA groups was higher than the IVIg group (P < 0.05), as was the remission time (P < 0.01), the duration of hospital stay (P < 0.05), and the number of respiratory supports required (P < 0.05). Using Pearson's correlation, the decrease of Titin-ab showed a longitudinal correlation with the decrease of QMG score (r = 0.6107, P < 0.01). Both DFPP and IA showed better short-term clinical effectiveness than immunoglobulin transfusion, rapidly and effectively clearing the pathogenic antibodies in late-onset MG patients, especially for Titin-ab.     

Intravenous Immunoglobulin in the Treatment of Adalimumab-associated Optic Neuritis

Optic neuritis (ON) is a rare complication of tumor necrosis factor (TNF)-α inhibitors. The autoantibody serostatus, treatment, and outcome of TNF-α inhibitor-associated ON remain unclear. We herein report a 50-year-old woman with ON following adalimumab therapy. The patient presented with decreasing visual acuity of the right eye, quickly diminishing to light perception. Anti-aquaporin-4 (anti-AQP4) and anti-myelin oligodendrocyte glycoprotein antibodies were negative. Adalimumab was discontinued, and intravenous methylprednisolone and intravenous immunoglobulin (IVIg) were administered. However, her visual acuity improved only up to counting fingers. IVIg may be ineffective depending on the pretreatment severity.     

静脉铁剂科莫非治疗缺铁性贫血的临床观察

目的:观察静脉铁荆科莫非治疗缺铁性贫血(IDA)的有效性及安全性.方法:分析收集科莫非治疗28例缺铁性贫血患者的临床资料,观察临床疗效和不良反应.结果:经过8～17 d的科莫非静脉补铁治疗再序贯口服铁剂补铁,8周后,28例患者贫血症状完全消失,血Hb,RBC,Hct,SF,SI明显上升至正常或接近正常,sTfR明显下降,较治疗前均有显著性差异(P＜0.05或P＜0.01).无患者发生过敏性休克,出现面色潮红和轻度恶心各1例,经对症治疗后好转.所有患者经适当护理均能完成科莫非治疗.结论:对严重IDA,采用先科莫非静脉补铁,再口服铁剂补铁,疗效确切,在滴注科莫非时,应加强对过敏反应的预防和观察.     

脓毒症患者血NO、SOD水平测定及其临床意义

目的:探讨脓毒症患者血浆中NO、SOD水平与病情发展和转归的关系。方法:采用硝酸还原酶法和黄嘌呤氧化酶法测定血浆中一氧化氮(NO)、超氧化物歧化酶(SOD)的水平。结果:脓毒症组、非脓毒症组与健康对照组比较,NO、SOD水平均有显著降低(P<0.01)。脓毒症组与非脓毒症组间比较,NO无显著差异(P>0.05),SOD显著降低(P<0.01)。脓毒症患者发展为多脏器功能不全综合征(MODS)和非MODS间的比较,SOD有显著性差异(P<0.05)。结论:脓毒症和非脓毒症患者血中NO、SOD含量可能反映病情严重程度。     

Experience with Intravenous Immunoglobulin Treatment in Neonates and Pregnant Women

Abstract. Results of 2 methods to treat infection in the neonate are reported. One study demonstrates a decrease in mortality and recurrent infection when neonates with septicemia were given intravenous immunoglobulin (IVIG). In another study, IVIG was administered to pregnant women with symptoms of infection and at risk for preterm delivery. IVIG infused at high doses after 32 weeks of gestation significantly decreased infection in newborns without affecting term.     

持续静脉应用地尔硫（卓）治疗不稳定型心绞痛的疗效观察

目的 :探讨持续静脉应用地尔硫苴卓(Dil)治疗不稳定型心绞痛 (UA)的临床疗效及可能的作用机制。方法 :5 4例硝酸酯药物治疗效果不佳的UA患者静脉应用Dil,首先按初始剂量 1μg /kg·min-1的速度持续静脉注入。Dil静脉维持治疗期间若仍有心绞痛发作 ,则剂量由 1μg /kg·min-1增加至 3μg /kg·min-1;最大至 5 μg /kg·min-1,心绞痛发作消失即按有效剂量维持 4 8h后改为口服。如果在 5 μg /kg·min-1剂量下心绞痛仍不缓解或仍有发作 ,则认为治疗无效 ,需更改治疗方案。用药过程中同时观察患者的心率、血压、心电图变化及有无低血压、心律失常、心功能不全等副作用。结果 :5 4例UA患者开始应用Dil前 4 8h内平均心绞痛发作次数为 3.19± 3.35 (1～ 2 0 )次 ,给予Dil治疗后 ,初始剂量 1μg /kg·min-1的有效率为 83% (45 / 5 4 ) ,其余 9例患者加大Dil剂量至 3μg /kg·min-1后心绞痛亦全部得到控制 ,总有效率高达 10 0 %。治疗过程中 ,随用药时间的延长和 /或药物剂量的增加 ,其心率、血压和率压积均逐渐下降 ,与基础值相比差异显著 (P <0 .0 5 ) ,无 1例在Dil治疗期间新发生急性心肌梗死 ,除 2例发生可逆性I°房室传导阻滞外无其它严重副作用。结论 :对于硝酸酯药物治疗效果不佳的不稳定型心绞痛 ,Dil是