住院处方中糖皮质激素应用的调查分析

目的 分析我院住院处方中糖皮质激素类药物的使用情况.方法 随机抽取我院2014年1月～7月住院处方静脉或口服糖皮质激素类药物病历1200例,对药物的使用率、指征、剂量等指标进行统计分析.结果 分析得出我院以治疗呼吸系统疾病和自身免疫性疾病为主,用量最多的为地塞米松注射液,销售金额最大的为注射用甲泼尼龙.结论 通过分析,我院糖皮质激素的用药比较合理,但在临床上要更加科学化、规范化.     

停用糖皮质激素致精神异常一例

患者，男，79岁，以“上消化道穿孔”于2005年5月12日行“十二指肠球部溃疡穿孔修补术”。术后第二天夜间入眠困难，自述腹痛，给予镇痛药物效果不佳，至清晨7时患者出现谵妄、坐卧不宁。急查血糖正常，检查神经系统无异常体征，给予镇静药物。白天病人安静，腹痛明显减轻。次日清晨病人再次述说腹痛，烦躁不安，欲跳楼自杀。查体：右侧腹部有压痛，无明显反跳痛及肌紧张。     

人糖皮质激素受体调控靶基因的生物信息学分析

目的分析糖皮质激素受体（GR）靶基因在人类基因组的分布及功能,明确其生物学意义。方法通过生物信息学的方法,在人类基因组中找出所有含有糖皮质激素反应元件（GRE）保守序列的基因。通过NCBI的基因注释得到基因名称、功能、基因的蛋白产物及其对应的基因本体学（Gene Ontology,GO）号等,然后对这些基因的功能进行GO分类,最后重点分析这些基因在免疫、炎症反应中的作用。结果含有GRE-1保守序列（5′-AGAACAnnnTGTTCT-3′）的基因共有225个,其中有18个位于基因启动子区域,10个位于基因外显子区域,197个位于内含子区域;含有GRE-2保守序列的基因有94个,其中有13个位于基因启动子区域,5个位于基因外显子区域,76个位于内含子区域。结论含有GRE的基因中F2R、DAXX、PAG1、ULBP3、OR8D4、RIMS1、NPY2R与激素代谢、免疫以及应激响应相关。     

人糖皮质激素受体调控靶基因的生物信息学分析

目的 分析糖皮质激素受体(GR)靶基因在人类基因组的分布及功能,明确其生物学意义.方法 通过生物信息学的方法,在人类基因组中找出所有含有糖皮质激素反应元件(GRE)保守序列的基因.通过NCBI的基因注释得到基因名称、功能、基因的蛋白产物及其对廊的基因本体学(Gene Ontology,GO)号等,然后对这些基因的功能进行GO分类,最后重点分析这些基因在免疫、炎症反应中的作用.结果 含有GRE-1保守序列(5'-AGAACAnnnTGTTCT-3')的基因共有225个,其中有18个位于基因启动子区域,10个位于基因外显子区域,197个位于内含子区域;含有GRE-2保守序列的基因有94个,其中有13个位于基因启动子区域,5个位于基因外显子区域,76个位于内含子区域.结论 含有GRE的基因中F2R、DAXX、PAG1、ULBP3、OR8D4、RIMS1、NPY2R与激素代谢、免疫以及应激响应相关.     

兔体外循环中糖皮质激素受体变化及应用大剂量糖皮质激素的效应

本文应用兔体外循环（ＣＰＢ）模型研究ＣＰＢ中糖皮质激素受体（ＧＲ）的变化及早期应用大剂量糖皮质激素（ＧＣ）的效应。结果发现，兔胸腺高亲和力ＧＲ数目在ＣＰＢ６０ｍｉｎ较ＣＰＢ前显著下降（－３５％），ＣＰＢ中血浆ＧＣ浓度显著升高，同时伴有血浆磷脂酶Ａ２（ＰＬＡ２）活性和肺血管外含水量（ＥＶＬＷ／ＢＦＤＬ）显著升高；在ＣＰＢ前５ｍｉｎ静注琥珀酸钠氢化考的松２０ｍｇ／ｋｇ，虽使胸腺ＧＲ水平进一步下降（－６９％），但能显著提高ＣＰＢ期间血浆ＧＣ浓度，并能显著抑制血浆ＰＬＡ２活性和ＥＶＬＷ／ＢＦＤＬ的升高。提示ＣＰＢ能引起ＧＲ水平下降，从而降低ＧＣ效应；ＣＰＢ术中早期应用大剂量ＧＣ能在ＣＰＢ中ＧＲ减少的情况下维持或提高ＧＣ的效应，但其作用很可能并非完全通过高亲和力ＧＲ介导。     

多发性骨髓瘤糖皮质激素受体研究进展

糖皮质激素是多发性骨髓瘤联合化疗的主要药物，通过与糖皮质激素受体持异结合抑制骨髓瘤细胞增殖，对糖皮质激素耐药的骨髓瘤细胞不仅糖皮质激素受体数量减少，而且功能异常。     

糖皮质激素在小儿围术期的应用

糖皮质激素（GCs）具有抗炎、免疫抑制和抗过敏、抗休克等作用,是围术期常用的药物之一。但由于小儿用药的特殊性,对于小儿围术期的GCs应用仍存在争议。本文重点探讨GCs在围术期对患儿全身炎症、骶管麻醉时间、术后疼痛和恶心呕吐、以及对出血和认知功能的影响,以期对小儿围术期的GCs应用提供参考。     

The association between bacteria colonizing the upper respiratory tract and lower respiratory tract infection in young children: a systematic review and meta-analysis

BackgroundBacteria colonizing the upper respiratory tract (URT) of young children play a key role in the pathogenesis of lower respiratory tract infection (LRTI).ObjectivesTo systematically review the literature on the association between bacteria colonizing the URT and LRTI among young children.Data sourcesMEDLINE, Academic Search Premier, Africa-Wide Information and CINAHL, Scopus and Web of Science.Study eligibility criteriaStudies published between 1923 and 2020, investigating URT bacteria from LRTI cases and controls.ParticipantsChildren under 5 years with and without acute LRTI.MethodsThree reviewers independently screened titles, abstracts and full texts. Meta-analysis was done using Mantel–Haenszel fixed- or random-effects models.ResultsMost eligible studies (41/50) tested nasopharyngeal specimens when investigating URT bacteria. Most studies were of cross-sectional design (44/50). Twenty-four studies were performed in children in lower- or lower-middle-income countries (LMICs). There was higher prevalence of Haemophilus influenzae (pooled OR 1.60; 95% CI 1.23–2.07) and Klebsiella spp. (pooled OR 2.04; 95% CI 1.17–3.55) from URT specimens of cases versus controls. We observed a positive association between the detection of Streptococcus pneumoniae from URT specimens and LRTI after excluding studies where there was more antibiotic treatment prior to sampling in cases vs. controls (pooled OR 1.41; 95% CI 1.04–1.90). High density colonization with S. pneumoniae (>6.9 log¹⁰ copies/mL) was associated with an increased risk for LRTI. The associations between both Streptococcus and Haemophilus URT detection and LRTI were supported, at genus level, by 16S rRNA sequencing. Evidence for the role of Moraxella catarrhalis and Staphylococcus aureus was inconclusive.ConclusionsDetection of H. influenzae or Klebsiella spp. in the URT was associated with LRTI, while evidence for association with S. pneumoniae was less conclusive. Longitudinal studies assessing URT microbial communities, together with environmental and host factors are needed to better understand pathogenesis of childhood LRTI.     

Human bocavirus infection diagnosed serologically among children admitted to hospital with community-acquired pneumonia in a tropical region

Human bocavirus (HBoV) is a human virus associated with respiratory disease in children. Limited information is available on acute infection with HBoV among children admitted to hospital with community-acquired pneumonia in tropical regions and the current diagnosis is inadequate. The aims were to diagnose and describe acute HBoV infections among children hospitalized for community-acquired pneumonia. In Salvador, Brazil, 277 children with community-acquired pneumonia were prospectively enrolled. Paired serum samples were tested by IgG, IgM, and IgG-avidity enzyme immunoassays (EIAs) using recombinant HBoV VP2. HBoV DNA was detected in nasopharyngeal aspirates and serum by a quantitative polymerase-chain reaction (PCR). HBoV DNA was detected in nasopharyngeal aspirates of 62/268 (23%) children and 156/273 (57%) were seropositive. Acute primary HBoV infection was reliably diagnosed (bearing at least two acute markers: Positive IgM, a fourfold increase/conversion of IgG, low IgG avidity or viremia) in 21 (8%) of 273 patients, 90% of 20 had HBoV DNA in nasopharyngeal aspirates, 83% with a high DNA load. The median age of infection with HBoV was 16 months, range 5-36. Community-acquired pneumonia was confirmed radiographically in 85% of 20 patients with acute HBoV infection diagnosed serologically. HBoV DNA was found in nasopharyngeal aspirates of 42/246(17%) children without an acute primary HBoV infection and available nasopharyngeal aspirate. Four children with HBoV secondary immune responses were detected, lacking both IgM and viremia. HBoV infection was diagnosed accurately in children aged 5-36 months with community-acquired pneumonia confirmed radiographically. PCR of nasopharyngeal aspirates is not a reliable marker of acute HBoV infection.     

Habitual physical activity levels and health outcomes of Ontario youth

Physical activity, sport participation, attitude towards physical education, aerobic fitness, body composition and frequency of upper respiratory tract infections (URTI) were investigated in 256 adolescents [mean age 14.3 (0.3) years] from the Niagara Region Public Schools in Canada. Subjects performed the 20-m shuttle run for prediction of aerobic fitness, and bioelectrical impedance analysis was used to assess relative body fat (%BF). Standardized questionnaires were used to determine physical activity-related variables and frequency of URTI. Males were more active, demonstrated higher shuttle run score, lower %BF and recorded fewer sickness days. In the complete cohort and in males, those who spent less time in sporting activities showed significantly (P<0.05) higher %BF, lower aerobic fitness and higher URTI frequency. Active females differed from hypoactive females only in %BF. Girls also showed significantly (P<0.05) less enjoyment of physical education than boys, which may explain their lack (P<0.05) of participation in sporting activities. Electronic Publication     

体温改变对血液流变性的影响及其临床意义

对４８例确诊为上呼吸道感染具有发热症状患者进行血液流变学测定，与正常对照组比较具有显著性差异。并对感染和发热致血液流变性异常的机理作了进一步研究。临床上许多疾病具有发热症状或伴有感染，这时血液流变性异常改变，一般有微循环障碍，导致组织脏器一系列病理生理变化。因此，控制感染、降低体温有助于疾病治疗和症状缓解。     

Effect of moderate exercise on salivary immunoglobulin A and infection risk in humans

The incidence of upper respiratory tract infections (URTI) and salivary immunoglobulin A concentrations [IgA_s] of nine individuals were examined during 12 weeks of moderate exercise training, and compared to ten sedentary controls. Changes in maximal oxygen uptake were assessed at initial, mid-point and final evaluations (T1–3), while changes in [IgA_s] and salivary immunoglobulin concentration-salivary albumin concentration ratio ([IgA_s]:[Alb_s]) were monitored at T1 and T3. During the 12 week period, symptoms of URTI were self-recorded daily. During the period of training the level of fitness significantly increased (P<0.05) in the exercise group. The number of days recording symptoms of influenza, but not of cold, and total light URTI symptoms was significantly reduced in the exercise group during the last weeks of training. A significant increase in [IgA_s] and in [IgA_s]:[Alb_s] was found in the exercise group after training. Both [IgA_s] and [IgA_s]:[Alb_s] were significantly related to the number of days showing symptoms of influenza (P<0.01) and the total number of days of sickness (P<0.05). These data provide quantitative support for the belief that regular, moderate exercise results in an increased [IgA_s] at rest and [IgA_s]:[Alb_s], which may contribute to a decreased risk of infection. Electronic Publication     

痰热清注射液治疗小儿上呼吸道感染伴发烧的临床疗效观察

目的观察痰热清注射液治疗小儿上呼吸道感染的临床疗效。方法将上呼吸道感染患儿80例随机分为治疗组和对照组,治疗组用痰热清注射液以0.6-0.8ml/kg·d加入5%葡萄糖溶液100-250ml中静滴,对照组用双黄连注射液1-2ml/kg·d加入5%葡萄糖溶液100-250ml中静滴,评定疗效。结果治疗组40例病人中痊愈24例,显效9例,有效6例,总有效率97.5%。结论痰热清注射液治疗上呼吸道感染起效快、效果好、无不良反应、,值得临床推荐和应用。     

254例急性呼吸道感染病例病原学调查分析

目的 分析急性呼吸道感染病例的病毒病原构成,掌握主要病原体活动水平及变化规律,了解丰台地区急性呼吸道感染病原谱.方法 以2010-2012年成人急性呼吸道感染病例为研究对象,收集病例基础信息,采集鼻咽拭子标本,使用多重PCR及RT-PCR对流感病毒、呼吸道合胞病毒、腺病毒、副流感病毒、偏肺病毒、冠状病毒、鼻病毒、博卡病毒和肺炎支原体等9种病原进行检测,数据分析使用SPSS 17.0软件.结果 254例标本中154例检测阳性,阳性率为60.63％,男女阳性检出率无统计学差异.冬春季致病病原体以流感病毒、副流感病毒及支原体为主,夏季仅检出副流感和支原体.流感样病例的主要病原体为流感病毒及副流感病毒;肺炎病例致病病原体主要为肺炎支原体.2010-2011年流感流行季甲型流感病毒为优势病原,2011-2012年流感流行季乙型流感病毒为优势病原.结论 2010-2012年间,北京丰台地区引起成人急性呼吸道感染的主要病原为流感病毒、支原体和副流感病毒.不同季节的优势病原不同.     

呼吸道感染标本嗜血杆菌的分布及耐药性分析

目的了解本院呼吸道感染标本中嗜血杆菌的临床分布及耐药情况。方法标本接种于嗜血杆菌巧克力平板,对分离到的嗜血杆菌进行鉴定、β-内酰胺酶试验和药敏试验。结果嗜血杆菌β-内酰胺酶的产生率为21．8％．对氨苄西林、阿莫西林／棒酸、头孢呋辛、头孢噻肟、左旋氧氟沙星、红霉素、复方新诺明的耐药率分别为28．4％、16．4％、10．2％、3．1％、31．1％、90．2％和52．9％。结论嗜血杆菌是呼吸道感染的主要致病菌。阿莫西林／棒酸和二代三代头孢菌素的敏感率高于其他抗生素。加强嗜血杆菌耐药谱监测．合理使用抗生素是延缓耐药菌株快速上升的最好方法。