链球菌中毒性休克综合征研究进展

链球菌中毒性休克综合征研究进展卢洪洲，翁心华自１９７８年Ｔｏｄｄ等首次报告噬菌体－１群金黄色葡萄球菌中毒性休克综合征（ＴＳＳ）以后［１］，ＴＳＳ已为人们所熟知。１９８３年Ｗｉｌｌｏｕｇｈｂｙ等报道链球菌也可引起相似的综合征［２］，并称为链球菌中毒性休...     

2例链球菌中毒性休克综合征

链球菌中毒性休克综合征（Streptococcal Toxic Shock syndrome STSS）为与A组溶血性链球菌感染相关的严重疾病。它主要表现为皮疹,高热,休克,急进性的多器官功能障碍,病死率极高,预后不良。现报告2例链球菌中毒性休克综合征患者     

链球菌感染中毒综合征30例临床分析

1998年、1999年夏季 ,江苏省海安、如皋、通洲、泰兴等部分地区曾两度发生人与猪的突发感染性疾病 ,引起数十人和数万头猪死亡。经流行病学调查 ,临床观察 ,病原体分离鉴定 ,猪的人工感染试验及菌株 PCR指纹图同源性分析等 ,确定这是由血液链球菌引起的感染中毒综合征 ,为人猪同患疾病 ,人群中发病死亡是由猪感染而来〔1〕。两年来 ,我院收治了共 30例病人 ,本文着重临床特点分析 ,现报道如下。1　临床资料1.1　一般资料　 30例中男 2 8例 ,女性 2例 ,年龄 2 9～ 75岁 ,平均 5 2岁 ,2 6例为屠宰工 ,4例为农民 ,均有与屠宰病猪或售病猪肉接…     

中毒性休克综合征

中毒性休克综合征(简称TSS)是晚近认识的一种严量的临床感染性病征,目前已引起国内外     

血清总胆汁酸在婴幼儿肝炎综合征中的临床意义

[目的]研究血清总胆汁酸（TBA）在婴幼儿肝炎综合征（IHS）中的表达及其临床意义。[方法]采用全自动生化分析技术,测定婴儿IHS组84例与非肝胆疾病患儿（对照组）32例的TBA水平,同时对其肝功能相关项目进行测定,并进行比较分析。IHS组分为肝炎型48例、瘀胆型36例。[结果]①IHS组的TBA表达明显高于对照组（P〈0．01）;②IHS组瘀胆型血清TBA、总胆红素（TB）、直接胆红素（DB）、丙氨酸氨基转移酶（ALT）、r-谷氨酰转肽酶（r-GT）均高于肝炎型（P〈0．01）;③IHS患儿TBA与血清TB、DB、ALT、r-GT呈正相关（P〈0．01）。[结论]IHS患儿均存在不同程度胆汁瘀积,瘀胆型IHS胆汁瘀积程度更严重。血清TBA的表达在反映肝功能损伤方面是一个敏感的指标,对婴幼儿IHS的早期诊断、治疗有重要临床意义。     

血液链球菌感染中毒综合征11例

目的 正确认识江苏省海安县等地区１９９８年夏季流行突发感染性疾病。方法 对流行病学调查及临床观察结果分析,并对分离菌株进行生化特征鉴定,结果 患者均有屠宰病猪或售病猪肉史,起病刀骤,有严重的毒血症状,伴有红色斑丘诊或出血点,很快发生休克、ＤＩＣ、可有脑膜刺激征,流行后期病例以化脑征象为主。周围血白细胞明显升高,多有肝１、肾功能受损。联合应用菌必治、青霉素抗感染有效。结论 本次人群流行疾病是一起由血     

侵袭性A族链球菌感染和链球菌性中毒性休克综合征的有关问题

侵袭性Ａ族链球菌感染和链球菌性中毒性休克综合征的有关问题上海市静安区卫生防疫站（２０００４１）徐大麟综述上海医科大学流行病学教研组（２０００３２）徐志一审校概况［１～３］八十年代后期，侵袭性Ａ族链球菌（ｇｒｏｕｐＡｓｔｒｅｐｔｏｃｏｃｃｉ，ＧＡＳ）感...     

缓症链球菌外毒素的致病性研究

目的：从中毒性休克综合征爆发流行现场获取的病原菌,进行增菌培养,从病原菌分泌物中分离、纯化外毒素蛋白,以对其致病性进行实验研究。方法：将现场分离的缓症链球菌增菌培养后,所得上清液分别经20％、40％、60％、80％硫酸铵盐析,进一步经快速蛋白液相色谱系统（EPLC）最终纯化,分别皮下注射新西兰兔,观察有否发热。引起新西兰兔对大肠杆菌内毒素致死性休克的敏感性实验：先给实验组新西兰兔皮下注射纯化的链球菌外毒素10μg,4h后静脉注射10μg大肠杆菌内毒素,对照组仅注射10μg大肠杆菌内毒素。结果：经FPLC最终纯化的20％硫酸铵盐析蛋白（分子量34000）有致热性,可使新西兰兔平均体温升高1℃左右,病理见脾脏有丝分裂增加。纯化的链球菌外毒素可增加新西兰兔对大肠杆菌内毒素的对照组动物无上述表现。结论：缓症链球菌外毒素蛋白是一种新的链球菌外毒素蛋白是一种新的链球菌致热性外毒素。     

川崎病血清总胆汁酸水平研究

为探讨川崎病血清总胆汁酸（ｔｏｔｏｌ ｂｉｌｅ ａｃｉｄｓ，ＴＢＡ）变化以及与总胆红素（ＴＢ）、丙氨酸转氨酶（ＡＬＴ）、Ｃ－反应蛋白（ＣＲＰ）之间的的关系，本文对５８例确衣川崎病患儿进行检测。结果表明急性期ＴＢＡ明显升高（Ｐ〉０．０１），２４．１４％的患儿ＴＢＡ〉２０μｍｏｌ／Ｌ，恢复期降至正常（Ｐ〉０．０５），５例ＴＢＡ〉８０μｍｏｌ／Ｌ的患者中，有２例合并冠状动脉扩张。ＴＢＡ与ＴＢ、ＡＬＴ、Ｃ     

血清总胆汁酸测定对急性、慢性肝炎诊断的价值

目的 探讨急性、慢性肝炎血清总胆汁酸（ＴＢＡ）测定的可能作用。方法 经肝穿刺活检病理证实为急性、慢性病毒性肝炎９２例,对ＴＢＡ含量进行了测定,并与ＡＬＴ及ＴＢｂｉｌ进行对比分析。结果 急性肝炎与慢性肝炎ＴＢＡ与正常组比较有显著性差异（Ｐ均〈０．００１）,慢性肝炎轻、中、重型三组ＴＡＢＡ经Ｘ＾２和t检验,各组生差异（Ｐ〉 ０．０５）。结论 急性肝炎时ＴＢＡ检测与ＡＬＴ同样具有高度为敏性,在慢性肝炎ＴＢ     

血清总胆汁酸测定的意义及其局限性

目的　阐明空腹血清总胆汁酸（TBA）测定的临床意义。方法　收集913例临床资料,用SPSS软件及四格表法进行统计分析。结果　（1）正常人TBA平均（4.0±3.2）μmol/L。肝病组TBA显著高于正常人和非肝病组(P＜0.01)。（2）急性肝炎患者TBA平均为（167.2±132.4）μmol/L,最高达449.5μmol/L,与其他各组相比差异有显著性(P＜0.01),表明TBA是反映急性肝细胞损伤的敏感指标。（3）TBA对肝硬化的敏感性为85.8%,优于其他肝功能试验,TBA是反映肝硬化侧支循环的有价值的指标。（4）TBA对慢性轻度肝炎的敏感性仅为30.5%,不及ALT和总胆红素（TBIL）。（5）TBA水平与病情轻重有一定关系,但与TBIL不完全平行,对病情的判断不如TBIL有价值。结论　TBA特异性高,敏感性尚可,对肝病、特别是急性肝炎和肝硬化有重要诊断价值,但对慢性轻度肝炎的敏感性差,对病情的判断不如TBIL有意义。     

胆结石患者血清结合胆汁酸测定的临床研究

目的 探讨血清结合胆汁酸对于胆结石的治疗及早期预防的价值。方法 应用高效液相色谱法（ＨＰＬＣ）,定量测定２０例胆结石病人和１５例正常对照者血清中七种结合胆汁酸含量。结果 胆结石组血清总结合胆汁酸量及ＣＧＡ、ＴＣＡ、ＧＤＣＡ、ＴＤＣＡ、ＴＣＤＣＡ量均较对照组高（Ｐ〈０．０５～０．０１）。而且ＣＡ／ＣＤＣＡ比值及ＤＣＡ％ 也同于正常对照组（Ｐ〈０．０５）。结论 胆结石的形成与胆汁酸代搞紊乱密切相关,Ｃ     

Mechanisms of triglyceride metabolism in patients with bile acid diarrhea

Bile acids(BAs) are essential for the absorption of lipids. BA synthesis is inhibited through intestinal farnesoid X receptor(FXR) activity. BA sequestration is known to influence BA metabolism and control serum lipid concentrations. Animal data has demonstrated a regulatory role for the FXR in triglyceride metabolism. FXR inhibits hepatic lipogenesis by inhibiting the expression of sterol regulatory element binding protein 1c via small heterodimer primer activity. Conversely, FXR promotes free fatty acids oxidation by inducing the expression of peroxisome proliferator-activated receptor α. FXR can reduce the expression of microsomal triglyceride transfer protein, which regulates the assembly of very low-density lipoproteins(VLDL). FXR activation in turn promotes the clearance of circulating triglycerides by inducing apolipoprotein C-Ⅱ, very low-density lipoproteins receptor(VLDL-R) and the expression of Syndecan-1 together with the repression of apolipoprotein C-Ⅲ, which increases lipoprotein lipase activity. There is currently minimal clinical data on triglyceride metabolism in patients with bile acid diarrhoea(BAD). Emerging data suggests that a third of patients with BAD have hypertriglyceridemia. Further research is required to establish the risk of hypertriglyceridaemia in patients with BAD and elicit the mechanisms behind this, allowing for targeted treatment.     

急性冠脉综合征患者胆固醇、总胆汁酸及总胆红素检测的临床意义

目的探讨急性冠脉综合征（ACS）患者血清总胆固醇（TC）、总胆汁酸（TBA）及总胆红素（TBIL）的变化及临床意义。方法选取住院治疗的100例ACS患者为观察组,其中稳定型心绞痛（SA）39例,不稳定型心绞痛（UA）38例,急性心肌梗死（AMI）23例。同期健康体检者100例为对照组,检测两组血清总胆固醇（TC）、总胆汁酸（TBA）及总胆红素（TBIL）的水平,并做相关统计学分析。结果观察组的TC及TBA水平高于对照组,差异有统计学意义（P〈0.05）;且观察组的TC及TBA水平由SA、UA到AMI依次升高,差异有统计学意义（P〈0.05）;观察组的TBIL水平低于对照组,差异有统计学意义（P〈0.05）;观察组的TBIL水平由SA、UA到AMI依次减低,差异有统计学意义（P〈0.05）。结论 TC、TBA及TBIL联合检测对ACS的诊断及病情发展评价有重要的临床意义。     

Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation

Objective. Bile acids are derived from cholesterol and are potent physiological laxatives. The aim of this study was to investigate whether bile acid synthesis is altered in constipation. Material and methods. Female patients with constipation (23 IBS-C, 4 functional constipation (FC)) were studied and compared with non-constipated subjects (16 IBS-D, 20 healthy women). Body mass index (BMI), blood lipids, lanosterol, sitosterol, colonic transit (oro-anal transit time (OATT), reference=4.3 days) and stool frequency were measured. C4 (7-α-hydroxy-4-cholesten-3-one) levels reflecting bile acid synthesis were measured at 0800 h and 1300 h. Results. When all the groups of constipated and non-constipated subjects were compared, it was found that only stool frequency and OATT differed between groups (p <0.001). When constipated patients were categorized according to OATT, absence of the usual C4 increase at lunchtime was noted in 82% of patients with delayed OATT compared with 17% in subjects with normal OATT (p <0.001). Symptom severity did not differ between groups. A subset of the patients with severely delayed OATT had markedly elevated C4 levels. Conclusions. Patients with IBS-C and FC have marked changes in bile acid synthesis in relation to colonic transit. The diurnal rhythm is altered in the slow transit colon when there is no C4 peak at lunchtime. Alterations in bile acid metabolism may be implicated in the pathophysiology of constipation.     

肠易激综合征患者胃食管胆汁反流的临床意义

目的　探讨肠易激综合征患者胆汁反流的临床意义。方法　用便携式胆红素监测仪 (Bilitec 2 0 0 0 )对 2 4例确诊为肠易激综合征和 6例健康人进行 2 4h食管腔内胆红素监测。结果　肠易激综合征患者胆汁反流总时间 % (10 .11± 5 .82 )明显高于健康对照组 (4 .0 9± 2 .3 7) ;其中便秘型患者胆汁反流总时间 % (14 .0 9± 5 .3 9)显著高于腹泻型患者 (8.48± 5 .2 9)。结论　肠易激综合征患者中存在碱反流 ,便秘型患者更为突出     

Invasive group A streptococcal infections in a large tertiary center: epidemiology,characteristics and outcome

Background: Invasive group A streptococcal (GAS) infections are increasing alarmingly worldwide. Patients and Methods: To determine the clinical and epidemiologic characteristics of invasive GAS in a large tertiary medical center, we retrospectively surveyed microbiology and medical records of patients with invasive GAS infections (isolation of Group A Streptococcus from a normally sterile site) treated in our hospital from January 1995 to December 1997. Results: 70 patients with a median age of 48 years (range 2 months–88 years) were identified. Of the 70 identified, 53 (76%) were adults (age ≥ 19 years). The most common co-morbid diseases for invasive GAS in adults were diabetes mellitus, congestive heart failure (CHF), malignancy and immunosuppression. A probable port of entry was identified in 31 (44%) of the cases. In children, varicella lesions were the major port of entry. Overall mortality rate was 17%: The difference in mortality between pediatric and adult cases was significant (0/17 vs 12/53, respectively; p = 0.03). Toxic shock syndrome (TSS) and necrotizing fasciitis were identified in 8.6% and 5.7% of the cases, respectively, with mortalities of 83.3% and 25%. Hyponatremia and hypocalcemia were more frequently observed among the severely ill. Conclusion: Invasive GAS infections tend to have an unexpected course and a broad clinical spectrum, ranging from local skin or pharyngeal involvement to deeply invasive fasciitis with TSS and high mortality. The elderly and those with underlying medical conditions are at utmost risk for invasive GAS. Clear-cut guidelines for early therapeutic strategy, i. e. antibiotic administration and preemptive hospital admission are needed for community-based physicians. Received: December 21, 2000 · Revision accepted: January 9, 2002     

肝硬化患者血总胆汁酸水平、粪便pH值的临床意义

[目的]探讨血清胆汁酸(TBA)水平和粪便pH值在肝硬化中的临床价值。[方法]对70例肝硬化患者(肝硬化组)、40例慢性胃炎患者(对照组)采用全自动生化分析仪检测其TBA、精密pH试纸检测其粪便pH值。[结果]肝硬化组患者外周血TBA水平、粪便pH值分别为(52.88±47.88)μmol/L、6.88±0.71,对照组分别为(8.695±4.70)μmol/L、5.860±0.27;2组比较,血清TBA水平及粪便pH值均差异有统计学意义(P0.01)。肝硬化组患者随着Child-pugh分级升高而TBA水平升高,各级间比较差异有统计学意义(P0.05);但不同Childpugh分级患者粪便pH值无改变。外周血TBA水平、粪便pH值与肝硬化病因无明显相关性。[结论]TBA、粪便pH值是反映肝硬化患者肝细胞损害的敏感指标之一,由于影响粪便pH值的因素较多,其预测及判断肝硬化预后及病情的严重程度的敏感性、特异性不如TBA。