炎症细胞因子与肾脏疾病

近来研究表明，炎症细胞因子作为细胞因子网络中的重要成份，通过促进系膜细胞增殖和系膜基质的增宽，在肾小球疾病中，尤其在系膜增殖性肾炎的发生，发展及病理类型的转为中起重要作用，细胞因子间的相互诱生，相互影响，为我们提出细胞因子网络概念，各种细胞因子间的相互作用导致系膜细胞不断增殖与硬化，是肾小球肾炎向终末期肾病发展的关键。     

炎症细胞因子与肾脏疾病

近来研究表明，炎症细胞因子作为细胞因子网络中的重要成份，通过促进系膜细胞增殖和系膜基质的增宽，在肾小球疾病中，尤其在系膜增殖性肾炎的发生、发展及病理类型的转变中起重要作用。细胞因子间的相互诱生、相互影响，为我们提出细胞因子网络概念。各种细胞因子间的相互作用导致系膜细胞不断增殖与硬化，是肾小球肾炎向终末期肾病发展的关键。     

早产儿慢性肺疾病的高危因素和预后分析

目的探讨早产儿慢性肺疾病(CLD)的患病危险因素及预后分析。方法统计我院新生儿重症监护病房(NICU)12年间收治的CLD患儿,总结患儿的出生体重、性别、有否围生期窒息、孕周、原发疾病、机械通气时间、用氧浓度、吸气峰压、呼吸暂停、并发症及预后。结果(1)12年间NICU收治的922例早产儿中,发生CLD52例,发生率为5·64%。出生体重1501~2500g早产儿、极低出生体重儿(1001~1500g)和超低出生体重儿(≤1000g)CLD发生率分别为2·37%、12·09%和23·52%,有非常显著性差异(χ2=42·92,P<0·01)。(2)出生体重≤1500g,有围生期窒息,胎龄≤32周,呼吸窘迫综合征机械通气,吸氧浓度≥60%,动脉导管未闭,呼吸暂停,气胸,感染是CLD的高危因素,而性别,吸气峰压与CLD无明显关系。结论早产儿CLD是由多种因素所致,需综合治疗。     

原发性肾小球疾病患儿外周血肿瘤坏死因子水平变化

研究目的探讨原发性肾小球疾病与外周血肿瘤坏死因子水平变化的关系。研究设计病例对照研究。患者和其他参与者急性肾炎患者7例，肾病综合征9例，对照组30例，均为正常儿童。处理方法所有患者和参与者均于清晨取空腹静脉血，分离血浆-20℃保存待检。检测和主要结果采用L929细胞生物学活性法，经重组人TNF（Sigma）校准（1U＝1．67pg），并经抗TNF血清中和试验证实。对照组，肾炎组、肾病组TNF水平分别为133．33±146．44、468．57±267．05，613．33±387．81U／ml，痊愈好转后复查与治疗前对照，TNF水平分别为271．11±201．52、595．0±341．88U／ml，观察组与对照组及治疗前后相比均有显著性差异。结论肾脏病患儿外周血TNF水平显著高于正常健康儿童，而且TNF水平的增高与肾功能损伤和病情密切相关，提示应用抗TNF血清治疗原发性肾小球疾病可能有效。     

细胞因子在中枢神经系统中的作用

本文重点介绍细胞因子（ＣＫ）中的白细胞介素（ＩＬ）－１、－２、－６及肿瘤坏死因子（ＴＮＦ）在中枢神经系统中的来源、受体分布及其生理、病理作用和与神经内分泌调节的关系。提示ＣＫ在中枢神经系统中具有广泛的生物活性，对其深入研究将有助于阐述中枢神经系统疾病的发生机制和提高对疾病的诊治水平。     

细胞因子在中枢神经系统中的作用

本文重点介绍细胞因子（ＣＫ）中的白细胞介素（ＩＬ）－１、－２、－６及肿瘤坏死因子（ＴＮＦ）在中枢神经系统中的来源、受体分布及其生理、病理作用和与神经内分泌调节的关系。提示ＣＫ在中枢神经系统中具有广泛的生物活性，对其深入研究将有助于阐述中枢神经系统疾病的发生机制和提高对疾病的诊治水平。     

细胞因子在早产儿慢性肺疾病发生中的作用

<正> 随着新生儿加强监护病房的发展和医疗技术的提高,小胎龄和低体重儿的成活率有了明显改善,但随之而来的早产儿慢性肺疾病(chronic lung dis-ease,CLD)的发生率也逐年增加。因其最终结局为肺组织纤维化,10％～15％患儿于生后1年内死于呼吸衰竭,存活者也需长期(数月或数年)依赖氧气或机械通气治疗。尽管CLD)发病机制极其复杂,但肺内炎症反应在其发生中的作用已倍受关注。目前细胞因子被认为是参与肺内炎症反应的主要介质,并在复杂的网络中相互作用,促进CLD的发生、发展。     

细胞因子与新生儿细菌感染

由于免疫反应能力低下,细菌感染是新生儿发病率和死亡率都比较高的疾病。早期足量使用抗生素是成功治疗的关键。新生儿细菌感染早期的临床表现隐匿且缺乏特异性,因此在怀疑细菌感染时,临床常常立即给予抗生素治疗,直至体液培养阴性或临床表     

过敏性紫癜肾炎患儿血清细胞因子水平变化及意义

目的 了解过敏性紫癜肾炎（HSPN）患儿血清白细胞介素2、4、10（IL-2、4、10）及肿瘤坏死因子α（TNF—α）的水平变化及其与血IgA、IgG、IgM、IgE、尿红细胞计数的关系,初步探讨细胞因子在HSPN发病中的作用及其机制。方法 采用ELISA法检测42例HSPN患儿及42例健康儿童的血清IL-2、IL-4、IL-10、TNF—α的含量,采用速率散射比浊法检测血IgA、IgG、IgM、IgE含量。结果 HSPN组血清IL-4、IL-10、TNF—α含量高于对照组（P〈0．05）,IL-2含量低于对照组（P〈0．05）;血IgA、IgE水平高于对照组（P〈0．05）,IgG、IgM水平与对照组相比差异无显著性（P〉0．05）;IL-10水平与IgA呈正相关（r=0．4066,P〈0．05）,IL-4水平与IgE呈正相关（r=0．5281,P〈0.05）;IL-2与尿红细胞计数呈负相关（r=-0．6187,P〈0．05）,TNF—α与尿红细胞计数呈正相关（r=0．7033,P〈0．05）。结论 血清IL-2、IL-4、IL-10、TNF-α、IgA、IgE与HSPN的发病过程密切相关,同时存在着细胞免疫与体液免疫功能的紊乱;IL-2和TNF—α在HSPN的发病中起相反作用,检测IL-2和TNF—α水平可作为初步估测HSPN患儿肾损害程度及预后的指标。     

基质金属蛋白酶与早产儿慢性肺疾病

早产儿慢性肺疾病(chrcmic lung disease,CLD)或支气管肺发育不良(bronchopulmonary dysplasia,BPD)是婴儿时期最常见的慢性肺疾患。近10余年随着医学科学的发展,早产低体重儿的存活率增加,CLD的发生有逐渐上升趋势。因目前尚无理想的预防和治疗CLD的方法,已严重影响存活早产儿的生活质量,并给家庭和社会带来了负担。     

早产儿慢性肺部疾病13例报告

目的　探讨早产儿慢性肺部疾病 (CLD)的临床表现形式、病因、治疗和预后。方法　对 1998年 10月至2 0 0 2年 3月在我院NICU住院的 13例CLD患儿的临床表现形式、病因、治疗和预后进行观察和总结。结果　①13例中 8例以感染性肺炎入院 ,5例胸片未见异常 ;② 6例应用机械通气 ,除 1例外 ,持续时间为 3～ 4d ,设置的PIP、FiO2 参数值均较低 ;其余患儿给予CPAP或面罩给氧 ,辅助用氧时间为 (48 38± 2 0 47)d[(30～ 92 )d];③ 10例合并“婴儿肝炎”综合征 ,5例死亡 ,5例治愈 ;④生后 3～ 4周时 5例胸片仍异常 ,8例胸片未见异常 ,后者行胸部CT检查 ,符合BPD特征性影像学改变 ;⑤ 6例生后第 4周应用地塞米松治疗 ,其中 1例存活 ;⑥ 6例CLD存活 ,其中 2例出院后易患呼吸系统感染 ;7例死亡。结论　CLD的非典型表现形式是其最常见形式 ;肺部CT在诊断CLD中具有重要价值 ;该病病死率高 ,寻找有效的治疗方案是亟待解决的问题。     

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目的探讨细胞外基质在早产儿慢性肺疾病(CLD)支气管肺泡灌洗液(BALF)中动态改变及其在CLD形成中的作用。方法对1999-12—2004-11在华中科技大学同济医院NICU住院需机械通气的62例患儿每日行支气管肺泡灌洗,并检测灌洗液中细胞总数及分类、透明质酸(HA)、Ⅲ型胶原(PCⅢ)及羟脯氨酸(Hyp)水平。病例分为4组:肺炎组20例;肺透明膜病(HMD)组13例;CLD组15例;对照组14例(无肺部疾病者)。结果(1)CLD组BALF中HA和PCⅢ水平分别较肺炎组及HMD组明显升高,并且也分别高于对照组BALF中的水平;(2)CLD组BALF中的HA和Hyp均分别与细胞总数和中性粒细胞数(%)呈正相关,而PCⅢ与肺泡巨噬细胞总数呈正相关。另外,HA、PCⅢ及Hyp之间均呈明显的正相关。结论CLD患儿肺内HA、PCⅢ及Hyp产生增多;BALF中HA、PCⅢ及Hyp的水平从不同侧面反映了疾病活动性并具有估计预后的作用。     

Management of infants with chronic lung disease of prematurity in Australasia

Chronic lung disease is common in extremely preterm infants born in Australasia. In 2002, 53% of surviving infants born before 28 weeks' gestation remained either oxygen-dependent or on other respiratory support at 36 weeks' postmenstrual age. In the first weeks of life oxygenation should be kept generally "lower", although what is the most appropriate level remains uncertain. During the mid-phase of the neonatal course, functional oxygen saturation levels around 90-95% probably confer the best benefit/risk balance. The most appropriate target saturation range for infants on home oxygen also remains uncertain. Definitive data to guide clinical practice is lacking regarding the use of postnatal corticosteroids, bronchodilators, and diuretics for either the treatment or prevention of chronic lung disease. Home oxygen programmes are effective in avoiding prolonged hospitalisation for infants with chronic lung disease, but require the coordination of a large, multidisciplinary team.     

Intratracheal N-acetylcysteine use in infants with chronic lung disease

To evaluate the effect of intratracheal administration of N-acetylcysteine (Mucomyst) on the clinical status, pulmonary function and gas exchange in premature infants with chronic lung disease, we conducted a randomized, placebo-controlled, crossover trial. Ten mechanically ventilated infants (gestational age 27 +/- 1 week; postnatal age 22 +/- 6 days) with clinical and radiological evidence of chronic lung disease and increased airway secretion were enrolled in the study. Each infant received tracheal administration of 5% N-acetylcysteine for one week and saline placebo every 4 h for another week. N-acetylcysteine was associated with a 59 +/- 26% increase in total airway resistance by the third day of treatment (p less than 0.01). A two-fold increase in airway resistance associated with an increased frequency of bradycardia and cyanosis spells was seen in two of the infants following three days of N-acetylcysteine administration, with a rapid improvement in their condition when subsequently switched to saline. Overall, N-acetylcysteine administration had no effect on the variables measured. We conclude that intratracheal administration of N-acetylcysteine to liquefy airway mucus neither improves the clinical condition nor hastens recovery in premature infants with chronic lung disease and its administration may lead to increased total airway resistance and cyanotic spells. The present data do not support the use of N-acetylcysteine as a mucolytic agent in premature infants with chronic lung disease.     

高氧致慢性肺疾病早产鼠肺组织CDK4 p21的表达及意义

目的：早产儿慢性肺疾病（CLD）的发病机制目前研究还不十分清楚,但CLD的最终病理变化与肺细胞增殖有关。该文采用高氧诱导早产鼠CLD模型为对象,探讨CDK4和p21基因动态表达与肺细胞增殖调控的关系。方法：高浓度氧致早产鼠CLD模型（实验组）和正常对照组各40例为研究对象,每组分别于实验后的1,3,7,14和21 d随机选取8只大鼠处死, 取出肺组织,常规制成5 μm切片。检测观察：①肺组织形态学;②肺组织纤维化评分;③采用免疫组化检测肺组织内PCNA表达;④采用原位杂交检测肺组织CDK4 mRNA和p21 mRNA的表达。结果：两组肺组织细胞PCNA指数：与对照组比较,实验组1 d,3 d PCNA表达均减弱（P﹤0.05）,7 d开始表达增强（P＜0.01）, 14 d和21 d明显高于对照组（P＜0.01）。两组肺组织细胞CDK4 mRNA表达强度： 从7 d开始实验组高于对照组（P﹤0.05）, 14 d,21 d明显高于对照组（P﹤0.01）。两组肺组织细胞p21 mRNA表达强度：实验组1 d,3 d表达明显高于对照组（P﹤0.01）, 7 d 后持续下降, 但也高于对照组（P﹤0.05）。7~21 d肺组织细胞CDK4 mRNA,p21 mRNA 表达分别与PCNA呈显著正、负相关（r分别为0.83和-0.81,P﹤0.05）。结论：高氧可诱导早产鼠肺细胞增殖。肺组织细胞CDK4基因的过度表达、p21基因的表达下降,可能是高氧诱导肺细胞增殖的机制之一。［中国当代儿科杂志,2007,9（6）：595-600］     

维生素A水平与早产儿疾病

维生素A(VA)是一种脂溶性维生素,是上皮细胞正常生长和发育所必需的营养物质,而且VA对视网膜、肺、胃肠道、脑及免疫系统等的正常生长和发育有非常重要的作用。研究证实,早产儿出生时低水平VA可持续到整个婴儿期。近年来对关于VA水平与早产儿疾病的发生尤为关注,研究热点主要是与早产儿呼吸窘迫综合征、慢性肺部疾病、早产儿视网膜病、坏死性小肠结肠炎、动脉导管未闭以及早产儿感染等的相关机制,但仍需进一步探讨。因此本文就目前国内外对VA水平与早产儿疾病的研究现状进行总结分析。此外,尽管有足够的证据表明补充VA对早产儿有益,然而目前推荐的VA补充途径以及补充剂量等尚缺乏相关循证依据,仍有待于进一步研究。     

Lung volume measurements in infants with and without chronic lung disease

Infants born prematurely who develop chronic lung disease (CLD) have airways obstruction and hence may have low lung volume. The aim of this study was to test that hypothesis and ascertain whether the nature of the comparison control group influenced the results. Sixteen infants who were oxygen dependent for more than 28 days (CLD) and eight infants without CLD had measurements of functional residual capacity (FRC) at 14 and 28 days. The 16 CLD infants consisted of eight less than 27 weeks gestational age (group A) and eight greater than 26 weeks gestational age (group B). The eight infants without CLD (group C) were each matched for gestational age and gender to infants in group B. Group A compared to group C had lower FRCs both at 14 days (median 18 ml/kg vs 27 ml/kg, P<0.01) and 28 days (median 20 ml/kg vs 26 ml/kg, P<0.05), but group A differed from group C with respect to both gestational age (P<0.01) and birth weight (P<0.01). The FRC results of group B were lower than those of their matched controls (group C) only at 28 days (median 22 vs 26 ml/kg, P<0.05). Overall, the FRC results at 14 and 28 days correlated significantly with the duration of oxygen and ventilator dependence and weakly with gestational age. Conclusion These results support the hypothesis that FRC results are lower in infants with CLD compared to those without CLD when measured in the neonatal period and emphasize the importance of an appropriate control group. Measurement of lung volume may facilitate assessment of the response to therapies for CLD. Received: 5 May 1997 / Accepted in revised form: 29 September 1997     

Eosinophilia in premature infants: correlation with chronic lung disease

We attempted to clarify the possible pathophysiological significance of eosinophilia in bronchopulmonary dysplasia (BPD). The subjects studied were 17 premature infants, i.e. seven with respiratory distress syndrome (RDS) followed by bronchopulmonary dysplasia (the BPD group: four with stage IV and three with stage III BPD) and 10 infants without BPD (the non-BPD group), who comprised seven with RDS, two with meconium aspiration syndrome and one with transient tachypnea of the newborn. Peripheral eosinophil counts, the number of nuclei of eosinophils and serum eosinophilic cationic protein (ECP) levels, and ECP and polymorphonuclear leukocyte (PMN) elastase levels of intratracheal aspirates (TA) were determined once a week during the first 4 weeks of life. Peripheral eosinophil counts were higher in infants with BPD than those in the non-BPD group. Hypersegmented nuclei of peripheral eosinophils with more than four nuclei were more frequently present in the infants with BPD. A good correlation was observed between peripheral eosinophil counts and serum ECP levels. ECP levels of the TA in the infants with BPD were significantly elevated. There was a good correlation between ECP and PMN elastase levels of the TA. Lung tissue specimens of two infants of the BPD group, both of whom had patent ductus arteriosus (PDA), were obtained from the lower portion of the left lung when they underwent an operative procedure for PDA at 24 and 25 days of life, respectively. Immunohistochemical staining of eosinophil-derived granular major basic protein (MBP) was performed on the lung tissue specimens. Infiltration of a few MBP-staining eosinophils was observed on the specimens from both infants. Our results suggest that peripheral eosinophils in sick premature infants may be activated and appear to be correlated with the severity of BPD. Further studies will be needed to more clarify the physiological role of eosinophils in premature infants.     

The effect of aerosolized furosemide in infants with chronic lung disease

To investigate whether aerosolized furosemide would improve pulmonary function in premature infants with chronic lung disease, we enrolled eight preterm ventilator-dependent infants in a cross-over, double-blind. placebo-controlled trial. Either aerosolized furosemide (2mg/kg) or placebo (0.9% saline) was administered, and serial pulmonary function tests were performed before and at 1 and 2h after each inhalation. After furosemide inhalation, static respiratory compliance increased significantly by 24.3% and 23.2% as percentage change from the baseline value at 1 and 2h ( p = 0.014 and 0.022, respectively). Also, tidal volume increased significantly by 33.8% and 28.7% at 1 and 2h, respectively ( p = 0.004 and 0.009). In contrast, no changes were observed in them after placebo inhalation. Total respiratory resistance was unchanged after both furosemide and placebo inhalation. There were no differences in urine volume in two groups. These data suggested that aerosolized furosemide improved pulmonary function in infants with chronic lung disease without excessive diuresis.