腔镜甲状腺手术对患者创伤应激的影响

目的:探讨腔镜甲状腺手术对患者机体创伤应激的影响.方法:62例腔镜甲状腺手术患者按手术顺序分为A组25例,B组37例,分别与同期40例开放甲状腺手术(C组)对比,分析围手术期白细胞(white blood cell,WBC)、C反应蛋白(C reactive protein,CBP)、白介素-6(interleukin...     

肾移植治疗ITP合并慢性肾衰竭1例报告并文献复习

目的探讨肾移植治疗特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)合并慢性肾衰竭的围手术期处理及移植效果。方法对1例ITP合并慢性肾衰竭患者施行亲属活体肾移植术。术前予以静脉滴注免疫球蛋白及重组人血小板生成素冲击治疗,使其手术当日血小板升至170×109/L,术中未予脾切除,术后常规给予免疫抑制剂、防治感染、支持等治疗。结果受者手术顺利。移植后肾功能恢复正常,随访4年,血小板水平高于术前,凝血指标正常。结论对于ITP合并慢性肾衰竭的患者,行同种异体肾移植手术是安全有效的治疗方法,术中不必行脾切除,适当的术前准备是手术成功的关键。     

胆汁回输联合早期肠内营养对良性梗阻性黄疸患者术后血清CRP及免疫功能的影响

目的 探讨胆汁回输联合早期肠内营养（early enteral nutrition,EEN）对良性梗阻性黄疸患者术后血清C反应蛋白（C-reactive protein,CRP）及免疫功能的影响.方法 将57例术后行胆汁外引流的良性梗阻性黄疸患者随机分为胆汁回输组（A组）、EEN组（B组）、胆汁回输联合早期肠内营养组（联合组,C组）,分别于术前1 d,术后第1、3、7天晨同一时间空腹抽取外周静脉血10 mL,测定CRP、C3、C4、IgA、IgM、IgG、T淋巴细胞亚群（CD3＋,CD4＋,CD8＋,CD4＋/CD8＋值）.观察患者病情转归情况,统计术后感染发生率.结果 联合组患者术后血清CRP水平低于EEN组及胆汁回输组（P＜0.05）.联合组与EEN组相比较,其T淋巴细胞功能恢复更迅速、恢复程度更高（P＜ 0.05）,免疫球蛋白及补体系统术后恢复较快（P＜0.05）;联合组与单纯胆汁回输组比较,两组术后免疫球蛋白及补体系统的恢复,在速度和程度上的差异不具有统计学意义（P＞ 0.05）.联合组术后感染发生率低于EEN组及胆汁回输组（P＜ 0.05）.结论 胆汁回输联合早期肠内营养能有效改善良性梗阻性黄疸患者的体液及细胞免疫功能,减轻术后炎症反应,降低术后感染发生率,促进术后快速康复.     

神经病理性疼痛对溃疡性结肠炎大鼠肠道炎症变化及免疫球蛋白浓度的影响

目的观察脊神经结扎(spinal nerve ligation,SNL)导致的疼痛对溃疡性结肠炎大鼠肠道病理改变及循环中免疫球蛋白浓度的影响。方法健康雄性大鼠36只,体重200~220g,采用随机数字表法分为三组:SNL模型组(SNL组)、假手术组(Sham组)和对照组(Con组),每组12例。建立稳定的疼痛模型后,三组大鼠均予以三硝基苯磺酸(TNBS)诱导产生溃疡性结肠炎。分别于SNL术前、TNBS造模前及造模后第7天和第14天采血检测血清免疫球蛋白(IgG、IgM)浓度变化,并于造模后第7天取病变明显部位的结肠组织观察炎症病理改变。结果三组大鼠术前IgG、IgM浓度差异无统计学意义;脊神经结扎后SNL组血清IgG浓度略低于Sham组,而血清IgM浓度明显低于Sham组(P0.05);TNBS造模第7天SNL组大鼠血清IgG、IgM浓度升高幅度明显小于Sham组和Con组(P0.01);TNBS造模第14天SNL组大鼠血清IgG浓度明显低于Sham组及Con组(P0.05);TNBS造模第7天,与Sham组和Con组比较,SNI组结肠病变范围更为广泛,炎症程度更为严重。结论神经病理性疼痛抑制机体体液免疫,使血清IgM、IgG浓度降低,从而加重肠道炎症病理改变程度。     

A case of membranous glomerulonephritis in renal allograft

A 39-year-old man who had been diagnosed with immunoglobulin A (IgA) nephropathy underwent renal transplant from his father. The operation was performed under cyclosporine, prednisolone and mizoribine treatment. Renal function was stable following transplantation, but proteinuria ranged between 1 g/day and 3 g/day. Protocol biopsy 1 year after transplantation revealed membranous glomerulonephritis, with IgG and C3 deposits under immunofluorescence, and subepithelial deposits detected on electron microscopy. The patient was treated by limiting protein intake, controlling blood pressure and administering candesartan. Proteinuria decreased from 5.6 g/day to 1 g/day, but a graft biopsy was performed 2 years after transplantation because of a slightly increasing creatinine level. There was no sign of rejection, and IgG and C3 deposits observed under immunofluorescence had decreased. After the graft biopsy, the creatinine level was stable and proteinuria decreased to 0.7 g/day. In conclusion, de novo nephropathy such as membranous glomerulonephritis should also be considered a possible cause of proteinuria following renal transplantation.     

Antimurine immunoglobulin antibody responses after the administration of murine monoclonal antibodies to rats are altered by small bowel allograft rejection

BACKGROUND: This study monitored the induction of antimurine immunoglobulin antibody responses after the administration of anti-CD4 (OX38) and anti-LFA-1 (WT.1) monoclonal antibodies to DA rats. METHODS: Monoclonal antibody was administered i.v. on 3 consecutive days to untransplanted DA rats, and DA recipients of PVG small bowel allografts. Control animals received no monoclonal antibody. Antimurine immunoglobulin antibody levels in serum samples were determined by enzyme immunoassay. RESULTS: No antimurine immunoglobulin antibody was detected in untransplanted animals receiving OX38 alone. Reactivity was apparent in WT.1-treated animals, but this response was totally abrogated by the co-administration of OX38. A combination of OX38 and WT.1 had no effect on allograft recipient survival and antimurine immunoglobulin antibody responses were detected in all allograft recipients, irrespective of the treatment regimen. CONCLUSIONS: Although OX38 inhibited the antibody response both to itself and to WT.1 in untransplanted animals, the immune reaction induced by small bowel allograft rejection overcame this inhibitory capacity.     

Medpor经紫外光照射前后生物相容性的变化

目的 探讨紫外光照射对生物材料Medpor生物相容性的影响.方法 将厚2mm的Medpor切成1 cm×1 cm片状材料模型.日本大耳白兔12只随机分成实验组与对照组,每组6只.无菌条件下每只兔距右耳根3～5 cm处做1.5 cm长的弧行切口,分离并去除约1 cm×1 cm软骨,实验组植入经紫外光照射的Medpor材料模型,对照组直接植入Medpor材料模型;分别于术前3 d和术后1、3、7、14、21、30、60、90 d检测血清总补体(CH50)含量;观察术区局部愈合情况,90 d后处死动物做大体标本观察及组织学观察.结果 实验组与对照组的CH50值变化趋势差异有统计学意义(P<0.05),实验组的变化趋势更平稳;对照组局部炎性反应重,与周围组织结合不够紧密,长人材料内部的纤维及组织成分少且结构紊乱;实验组局部炎性反应与皮瓣缺血坏死情况均较对照组轻,材料与周围组织结合较紧密,大量纤维及组织成分、甚至粗大的血管长入孔隙内,且结构整齐.结论 紫外光照射可以改善Medper的生物相容性,并促进组织修复.     

Chronic anemia as a complication of parvovirus B19 infection in a pediatric kidney transplant patient

. This is a report of unexplained anemia that persisted for 4 months in an adolescent renal transplant patient receiving immunosuppression that included prednisone, tacrolimus, and mycophenolate mofetil. This patient required monthly blood transfusions for fatigue, palpitations, and hematocrit levels between 15% and 17%. In addition, his posttransplant course was notable for the development of insulin-dependent diabetes mellitus. While receiving low-dose prednisone, he was switched from tacrolimus to cyclosporin and tapered off insulin injections over the next 2 months. At 4.5 months post-transplantation, further diagnostic evaluation was suggestive of parvovirus B19 infection as the cause for our patient’s chronic anemia. After testing negative for serum-specific parvovirus B19 IgM and IgG antibodies, parvovirus B19 infection was detected in blood by the polymerase chain reaction. Treatment with intravenous immunoglobulin (1 g/kg per day × 2 days) resulted in normalization of both his reticulocyte count and hematocrit within 6 weeks. At 4 months after receiving the immunoglobulin infusion, he has maintained a normal hematocrit level and stable renal function without requiring further blood transfusions. Received August 23, 1996; received in revised form and accepted November 20, 1996     

Solitary plasmacytoma of the skull: immunohistochemical study of angiogenic factors and syndecan-1--two case reports

Two cases of solitary plasmacytomas of the skull are presented, and some biological aspects of the tumor examined. A 75-year-old woman presented with a tumor in the right parietal region. The serum level of immunoglobulin G (IgG) was high and a urine test for Bence Jones protein was negative. A reddish vascular mass was totally removed at surgery. The serum level of IgG was within normal limits after the operation. Postoperative radiotherapy was not performed. A 58-year-old woman presented with a tumor in the occipital region. Serum levels of Igs were within normal limits. A urine test for Bence Jones protein was positive for Ig kappa chain. Bone marrow aspiration revealed no evidence of systemic myelomatosis. The tumor mass was totally removed at surgery and she received local radiation therapy (total 50 Gy). Three months after the surgery, Bence Jones protein (kappa chain) was detected in both the urine and serum and bone scintigraphy showed a weak hot spot in the iliac bone, suggesting development to multiple myeloma. Immunohistochemical studies showed that most tumor cells were positive for vascular endothelial growth factor and syndecan-1, and some tumor cells were strongly positive for basic fibroblast growth factor in both cases. The Ki-67 staining indices were 11.3% and 15.6%. Tumor tissues were negative for p53. These results suggest that solitary plasmacytoma of the skull expresses the angiogenic factors, vascular endothelial growth factor, and basic fibroblast growth factor, in accordance with the high vascularity of the tumors, and syndecan-1 may be an immunohistochemical marker of solitary plasmacytoma of the skull.     

利水渗湿法对髓核自身免疫模型大鼠血清IgG、IgM及IL-1β、IL-8的影响

目的：探讨利水渗湿法对大鼠髓核引起的自身免疫及免疫炎症反应的影响,为腰椎间盘突出症的中药免疫治疗提供依据。方法：将40只雄性Wistar大鼠按体重分层随机分组的方法分为假手术组（A组）、模型对照组（B组）、秋水仙碱片组（C组）、轻腰汤加味组（D组）,每组10只。B、C、D组进行造模：通过手术将大鼠尾椎髓核移植于臀部肌中,造成自身免疫及免疫炎症反应;A组只做假手术处理。各组大鼠于术后第3天开始灌胃,A组和B组用蒸馏水（10ml/kg）,C组和D组分别用秋水仙碱片混悬液（10ml/kg,0.01mg/ml）和轻腰汤加味水煎液（10ml/kg,1.035g/ml）,每天1次,连续18d。于术后21d处死动物,应用ELISA法检测血清中免疫球蛋白G（IgG）、免疫球蛋白M（IgM）及白介素1β（IL1β）、白介素8（IL8）的含量,并观察移植髓核周围组织的病理变化。结果：与A组比较,B组血清IgG、IgM及IL1β、IL8含量明显升高,差异有统计学意义（P〈0.01）;与B组比较,C、D组血清IgG、IgM及IL1β、IL8含量明显降低,差异有统计学意义（P〈0.05或P〈0.01）;病理切片显示,A组手术部位无明显免疫炎症反应,C、D组移植髓核周围组织局部免疫炎症反应与B组比较明显减轻。结论：利水渗湿法对大鼠髓核引起的自身免疫及免疫炎症反应,具有较好的抑制作用。     

A case of anaphylactic shock induced by latex during cesarean section

We report a 39-year-old woman who showed intraoperative anaphylactic shock during elective cesarean section in the 38th week of pregnancy. She underwent cesarean sections under general anesthesia at 33 years of age, and under spinal anesthesia at 37 years without any complication; other past history was unremarkable. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine 2.5 ml and analgesia level up to T2 was obtained 12 minutes later. The operation was uneventful at the birth of a neonate weighing 2700 g delivered with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Drip infusion of oxytocin was started after the delivery and uterine contraction was good. Five minutes later, blood pressure decreased abruptly to 70/40 mmHg, heart rate increased to 130 beats min(-1) and the patient complained of chest discomfort. Bolus injections of ephedrine and phenylephrine were ineffective, and continuous infusion of adrenaline was started to maintain blood pressure. The operation was finished and the patient was intubated for artificial ventilation to prevent airway obstruction. The tracheal tube was removed the following day and the postoperative course was uneventful thereafter. Plasma tryptase levels at 1 and 6 hours after the episode of hypotension were 9.0 and 1.3 ng x ml(-1). Postoperative blood tests revealed an increase in latex-specific immunoglobulin E, suggesting that anaphylactic shock was induced by latex.     

Impaired B lymphocyte function during open heart surgery

Sequential in vitro lymphocyte function tests in 13 patients undergoing cardiac operation were performed to study B lymphocyte function following operation. Lymphocytes were stimulated with phytohemagglutinin (PHA), pokeweed mitogen (PWM) and Staphylococcus aureus Cowan 1 (SAC). Mitogen responses were measured by 3H-labeled thymidine incorporation. The SAC responses were significantly depressed following operation. Immunoglobulin secreting cells were measured by protein A plaque forming cell assay. The numbers of immunoglobulin secreting cells induced by PWM or SAC decreased remarkably at least as long as 3 day after the operation. The percentage of circulating B lymphocytes increased significantly postoperatively. This indicates that the B lymphocytes remaining after the operation were functionally impaired.     

Endotoxemia in obstructive jaundice. Observations on cause and clinical significance

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).     

肠外营养对胰十二指肠切除术后患者急性炎症反应和血脂的影响

目的探讨肠外营养对胰十二指肠切除术后患者急性炎症反应、免疫细胞及脂质代谢的影响。方法选取80例胰十二指肠切除术后患者,将其分为试验组和对照组,每组40例,试验组用结构脂肪乳,对照组用中/长链脂肪乳,比较两组患者应用不同肠外营养前后的急性炎症反应、免疫细胞及脂质代谢的变化。结果(1)静脉输注肠外营养液两组患者术后第1天C反应蛋白(CRP),血前列腺素E 2(PGE2)较术前明显升高(P<0.05),术后第7天降至术前水平,但试验组下降速度显著快于对照组(P<0.05)。(2)两组患者CD^3+、CD4^+、CD8^+、CD4^+/CD8^+的水平较输注前均有明显提高,但试验组的免疫细胞上升趋势明显快于对照组(P<0.05)。(3)静脉输注肠外营养液3~7d后,对照组的血脂水平的上升速度明显高于试验组(P<0.05)。结论结构脂肪乳相对于中/长链脂肪乳能够明显减轻胰十二指肠切除术后患者的炎性反应,明显降低患者的血脂水平。     

电针对神经损伤后神经生长因子mRNA及胰岛素样生长因子-1 mRNA表达的影响

目的 观察电针对神经损伤后神经生长因子（ＮＧＦ） ｍＲＮＡ和胰岛素样生长因子－１（ＩＧＦ－１）ｍＲＮＡ表达的影响。方法 ＳＤ大鼠９０只切断右侧坐骨神经并缝合,随机分成对照组与实验组。实验组每天电针４５分钟。分别于术后１、２、４、６及１０周取吻合口远段的神经,抽提总ＲＮＡ。采用逆转录－多聚酶链反应技术检测损伤神经组织中ＮＧＦ、ＩＧＦ－１ ｍＲＮＡ的表达水平。结果 实验组ＮＧＦ ｍＲＮＡ的表达自伤后第     

Effect of Surgical Stress on Immune Function in Patients with Urologic Cancer

Background: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer.
Methods: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma.
Results: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes.
Conclusions: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.     

四肢骨折全麻术后患者早期进食的实证研究

目的探讨四肢骨折全麻术后患者早期进食的可行性及安全性。方法将60例四肢骨折择期手术患者按照手术时间分为对照组和观察组各30例。对照组给予常规饮食护理,患者由麻醉恢复室转入病房6h后开始进食;观察组转入病房后1h开始少量饮用温开水,饮水后未见不良反应后给予流质饮食。比较两组进食后口渴、饥饿程度、头晕以及进食后呛咳、误吸、恶心呕吐和术后便秘情况。结果观察组术后返回病房1h口渴程度显著低于对照组,返回病房5h口渴、饥饿程度及头晕发生率显著低于对照组,且进食后3d便秘发生率显著低于对照组(P0.05,P0.01)。结论四肢骨折全麻术后患者早期进食安全可行,利于缓解患者不适症状,体现对患者的人文关怀。     

外源性磷酸肌酸对冠状动脉搭桥病人围术期免疫系统的影响

目的 观察用外源性磷酸肌酶（ＣＰ）对冠状动脉搭桥（ＣＡＢＧ）病人围术期补体及免疫球蛋白的变化,评价其对免疫系统的影响。方法 ２８例ＣＡＢＧ病人随机分为ＣＰ组１７例,对照组１１例,ＣＰ组于术前、后备用ＣＰ３～７ｄ,每天２ｇ静脉滴注,术中将ＣＰ加入心脏停搏液中,对照组椁前、中、后均不用ＣＰ。观察两组病人术前１周、麻醉诱导后、术中阻断升主动脉后５、３５、６５ｍｉｎ（１４例病人）、术毕、术后２４ｈ、术后１