脓毒症抗炎治疗现状

抗炎治疗一直是脓毒症治疗研究的热点问题。本文通过对活化蛋白C、抑制核因子-κB(NF-κB)、白介素-10、热休克蛋白、血液净化、糖皮质激素及阻断内毒素治疗的阐述,以指导临床合理应用抗炎治疗,抑制全身炎症反应综合征(SIRS)发展,进一步降低脓毒症患者的病死率。而Toll样受体与脓毒症相关性及脓毒症PAMP-TLR跨膜信号转导通路的研究为脓毒症的治疗和研究展现了良好的前景。     

脓毒症与炎性细胞

脓毒症是指各种致病微生物或其毒素存在于血液或组织中,是世界范围内重症病患的首位死亡原因,是ICU所面临的医学难题之一。脓毒症是机体对感染的一种全身性炎性反应,发病机制相当复杂,既可由感染因素引起,亦可由非感染因素所引起,往往不是由单一的因素所造成,可能同时存在促炎性反应及抗炎性反应,免疫麻痹、凝血机制的异常亦可能参与了脓毒症的发生发展。单核细胞、多形核白细胞和多种免疫细胞受炎性介质的作用,在脓毒症的炎性反应的过程中发挥了重要的作用。     

探讨脓毒症诊断和治疗新策略

尽管重症医护的技术在不断改善,国外脓毒症(sepsis)的发病率仍以每年1 5 %～8 0 %的速度上升[1,2 ] 。美国每年有70万人患脓毒症,其中死亡2 1万人,病死率高达30 %～70 % [3] 。其发病率增高的原因尚不清楚。目前对脓毒症已有以下的共识:由于宿主对炎症反应调节的失控,脓毒症总是与全身炎症反应综合征(SIRS)相伴存;病情的严重程度和病死率总是与抗炎治疗的有效性密切相关。因此,对脓毒症制定较确切的定义及临床诊断标准,对每例病人的病情进行具体分析归类,并制定包括抗炎治疗的详尽处理方案,就显得十分重要。一、有关脓毒症的定义及诊断标…     

槲皮素抗白血病作用的研究进展

槲皮素作为一种天然黄酮类化合物 ,广泛存在于蔬菜和水果中。由于具有诸多方面的生理活性 ,如抗炎、抗氧化、抗肿瘤、降血脂等 ,目前正受到医学界的普通关注。实验研究表明 ,槲皮素尚可以预防肿瘤的发生 ,并对多种恶性肿瘤细胞生长有明显抑制及促凋亡作用 [1～ 3 ] ,诱导某些白血病细胞的分化 [4,5]。值得注意的一点 ,槲皮素可逆转肿瘤细胞的多药耐药性 [6～ 9]。本文就近年来有关槲皮素抗白血病细胞作用的研究及其可能机制进行综述。1　槲皮素抗细胞增殖作用　　槲皮素可抑制多种白血病细胞的增殖 ,其可能机制 :1.1　抑制蛋白质合成 :最近 …     

NLR对脓毒症患者预后评估的研究进展

脓毒症具有高病死率的特点,其发病机制主要与机体“炎症风暴”导致的免疫反应失衡密切相关。中性粒细胞与淋巴细胞的比值(neutrophil to lymphocyte ratio, NLR)为血常规中的两项指标之比,可反映机体炎症与免疫状态。脓毒症早期机体启动固有免疫,中性粒细胞迅速增殖并通过趋化、边集、贴附到达病灶,以脱颗粒及呼吸爆发式等形式对病菌进行杀灭。到了脓毒症代偿性抗炎反应期,适应性免疫系统被激活,但由于机体持续的“炎症风暴”消耗抗炎介质过多,抑制淋巴细胞增殖及加速凋亡,造成机体免疫抑制甚至麻痹。本文着重分析了NLR在脓毒症发生炎症及免疫过程中的机制,从脓毒症的发病机制、中性粒细胞及淋巴细胞在脓毒症时的变化进展等方面进行论述,以期探究NLR对评估脓毒症患者预后价值。     

槲皮素的药理作用

槲皮素是广泛分布于植物界的黄酮类化合物,具有多种药理活性。着重介绍槲皮素在抗肿瘤、抗炎、抗病毒等实验研究中的作用,并从分子水平阐述其作用机理。     

脓毒症患者凝血功能改变及治疗对策

脓毒症的发病机制是感染或非感染因素引起的一系列全身炎性反应、机体应答失控、组织损伤.脓毒症患者合并多脏器功能障碍时,病死率高达30%～50%.凝血系统是机体天然免疫的重要组成部分,在炎性反应向多脏器功能衰竭的发展过程中,除细胞因子外,凝血功能异常起着重要作用.近年来的研究证明炎性介质和组织因子激活了凝血系统,导致凝血功能异常,并贯穿于脓毒症发展的始终.因此,凝血功能的异常是影响脓毒症患者预后的一个重要因素.     

右美托咪定对脓毒症大鼠炎性递质的影响研究

目的：分析右美托咪定对脓毒症大鼠炎性递质的影响。方法选取雄性大鼠60只,随机分成3组,分别为正常组、脓毒症组以及治疗组,每组20只。正常组大鼠静注氯化钠溶液,脓毒症组和治疗组借助静脉注射毒素建立脓毒症大鼠模型,但采取不同的治疗方法,定时抽血,对脓毒症大鼠模型48 h以内活动变化和病死率进行对比。采取 ELISA 法对大鼠血液的初期炎性递质肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）以及晚期大鼠炎性递质高迁移率族蛋白 B1（HMGB1）的含量改变情况进行检测。结果在 TNF-α、IL-6、HMGBl含量变化中,脓毒症组与治疗组均呈先上升后下降,正常组相对平稳,与正常组相比,其他2组含量均增高,差异存在统计学意义（P<0.05）。治疗组与脓毒症组比较,各指标上升趋势相近,下降过程治疗组更明显,且治疗组各指标含量比脓毒症组低,差异显著（P<0.05）。3组病死率比较,脓毒症组>治疗组>正常组,差异存在统计学意义（P<0.05）。结论右美托咪定能降低脓毒症大鼠的炎症递质表达,从而降低脓毒症大鼠的病死率。     

槲皮素对细胞凋亡的"干涉"作用

槲皮素(1,3,4,5,7-五羟基黄酮,Quercetin)是自然界分布最广的生物类黄酮化合物,广泛存在于蔬菜和水果中,同时它也是多种中草药的成分.槲皮素具有抗肿瘤、降血压、降血脂、抗炎、抗过敏、抗病毒等多种生物学活性,所以对人类肿瘤、衰老、感染、心血管疾病的治疗和预防具有重要意义[1].最近的研究表明,槲皮素一方面可以诱导多种肿瘤细胞凋亡[2～6],另一方面又可以阻止一些非肿瘤细胞凋亡的发生[7～8].关于这两方面内容的阐述,对进一步了解槲皮素的作用机制,掌握其多种生物学活性,更加科学、合理地开发利用这一天然植物药提取物,具有重要意义.     

肝脏在脓毒症发生发展中的作用及机制

肝脏在脓毒症的发生发展中起着核心作用,其清除细菌、调节免疫炎症反应的作用必不可少,同时肝脏也是脓毒症相关损伤的靶点。脓毒症相关肝损伤主要表现为低氧性肝炎、胆汁瘀积、凝血功能障碍等,肝功能损害会严重影响脓毒症预后。脓毒症的病理生理学机制复杂,治疗难度高,在脓毒症治疗中适度调节促炎反应与抗炎反应间的平衡以及肝脏免疫应答值得深入研究。     

不同抗生素治疗化脓性脑膜炎疗效比较

目的：通过不同的抗生素及抗炎药，探讨更为有效的治疗化脑的方法。方法：A组：使用磺胺嘧症 青霉素 氯霉素。B组：使用先锋必素 青霉素 和或氯霉素。C组：菌必治 青霉素，地塞米松0．15mg/kg/次，4次／日，共4天。结果：A组治愈率80％，死亡率12．3％。B组治愈率85．4％，死亡率6．3％。C组治愈率95．5％，无死亡率。结论：化脑是细菌成份及其产生的细胞因子所介导的炎症反应，常见病原菌所致化脑抗菌治疗首选菌必治，强调抗炎治疗并首选地塞米松。     

鱼油在脓毒血症中的应用

脓毒血症伴有极高的病死率。鱼油中富含的ω-3多不饱和脂肪酸具有抗炎和免疫调节的功能。ω-3脂肪酸作为特殊的免疫营养底物,在参与提供能量的同时具有改善脏器功能和调节促炎／抗炎症因子的作用,其理想作用的发挥取决于剂量、起用和持续时间。     

鱼油在脓毒血症中的应用

脓毒血症伴有极高的病死率.鱼油中富含的ω-3多不饱和脂肪酸具有抗炎和免疫调节的功能.ω-3脂肪酸作为特殊的免疫营养底物,在参与提供能量的同时具有改善脏器功能和调节促炎/抗炎症因子的作用,其理想作用的发挥取决于剂量、起用和持续时间.     

Corticosteroid resistance in chronic obstructive pulmonary disease: new uses of theophylline

Chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising morbidity and mortality,which is expected to account for about 27％ of tobacco related deaths and is anticipated to move from the fifth to the fourth leading cause of death worldwide from 2002 to 2030.1 COPD is characterized by the abnormal and chronic inflammation induced by cigarette smoking and other inflammatory insults in both small airway and lung parenchyma.2,3 Glucocorticosteroids (also called glucocorticoids,corticosteroids or steroids) are the most effective anti-inflammatory drugs available for the treatment of many chronic inflammatory and immune diseases.4 However,corticosteroids have limited benefit in treating stable COPD5 defined as (relative) steroid insensitivity or resistance6 and may be characteristic of all phenotypes of COPD.Although anti-inflammatory treatments are expected to effectively treat inflammation of COPD,almost all anti-inflammatory approaches risk increasing the extent of infection by blunting host defence mechanisms.Their effectiveness in humans has been limited by various side effects.5 Therefore,it is important to develop a treatment to enhance corticosteroid anti-inflammatory action in COPD.     

Changes in birth-cohort pattern of peptic ulcer mortality in England and Wales

Previous epidemiological studies have described the secular trends in peptic ulcer mortality in England and Wales as being characteristic of a cohort phenomenon. The most recent data on ulcer mortality, however, show increasing mortality rates from duodenal ulcer in women over 65 and from gastric ulcer in women over 75 years. While the rise in mortality rates in the oldest age groups is partly explained by their greater life expectancy, the increase in mortality from duodenal ulcer in older women shows evidence of an environmental (period) effect being superimposed on female cohorts born between 1895 and 1925. This effect could partly be due to the increasing consumption of non-steroidal anti-inflammatory drugs which coincides with the rise in mortality rates.     

Gastrointestinal and Cardiovascular Risk of Nonsteroidal Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) confer a gastrointestinal (GI) side effect profile and concerns regarding adverse cardiovascular effects have emerged associated with considerable morbidity and mortality. NSAIDs are highly effective in treating pain and inflammation, but it is well recognized that these agents are associated with substantial gastrointestinal toxicity. Cyclo-oxygenase-2 inhibitors may also reduce the risk for gastrointestinal events, although they may increase cardiovascular adverse events. The selection of an appropriate analgesic or anti-inflammatory agent with or without gastroprotective therapy should be individualized.     

脂联素在冠心病发生发展中的作用

脂联素(adiponectin)是新近发现的脂肪细胞分泌的特异性蛋白质,循环血液中含量较丰富。脂联素通过抗炎和抗动脉粥样硬化在冠心病的发生和发展中起保护作用,在控制冠心病的危险因素如肥胖、2型糖尿病及胰岛素抵抗中也起到重要作用。它为降低冠心病发病率和病死率提供一个新的思路。     

Asthma.

Bronchial asthma is now recognised to be a major cause of morbidity and even mortality in people of all ages. Two important ideas have changed our approach to asthma management. The first is understanding that asthma is a chronic inflammatory disorder which needs regular treatment with anti-inflammatory drugs such as inhaled corticosteroids to prevent further attacks. The second development is the availability of prescribable peak flow meters, which allows both confident diagnosis and early prediction of relapse. Asthma management guidelines provide a logical treatment framework for most patients, but a few difficult cases still consume large amounts of medical time. The commonest problem is one of compliance with treatment which may respond to patient education, although this is not universally so. Other problems include misdiagnosis, acid reflux and, rarely, true corticosteroid-resistant asthma. Several potentially important new treatments have been developed. These include longer acting anticholinergic drugs, drugs with bronchodilator and some anti-inflammatory properties which antagonise or inhibit the production of leukotrienes, sub-types of phosphodiesterase inhibitor with anti-inflammatory properties and immunosuppressive drugs such as cyclosporin. Ultimately these new treatments must be rigorously tested and integrated into a care plan that remains centred on patient education.     

急性胰腺炎治疗的实验研究

严重急性胰腺炎(SAP)由于全身炎性反应综合征导致多器官衰竭而引起较高的病死率。至今,除了支持性重症监护疗法之外还没有治疗SAP的有效方法。为降低病死率,一些新的药物应用于实验性胰腺炎。最常用于实验研究的急性胰腺炎(AP)动物模型有三种,即蛙皮素、牛磺酸钠和无胆碱而乙硫氨酸充足的饮食(CDE)引起的水肿性或出血性胰腺炎。本文依据不同模型复制方法,对近年来实验治疗或取得的结果进行综述。许多方法包括蛋白酶抑制剂,抗炎性因子治疗,超氧化物治疗,核因子κB抑制剂治疗,血管加压素治疗,高压氧治疗等,已经显示出抗胰腺炎的保护作用。     

Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids

Although non-steroidal anti-inflammatory drugs are known to cause peptic ulcer and its complications, controversy exists about the number of deaths from ulcer which are attributable to their use. A case-control study was therefore performed to determine whether prior use of non-steroidal and other anti-inflammatory compounds was associated with an increased case fatality rate from complications of peptic ulcer. Non-steroidal anti-inflammatory drugs were used by 39% of a series of 80 patients who had died from peptic ulcer complications and by 37% of 160 controls who were survivors matched for sex, age, ulcer site, and nature of complication (odds ratio 1.1; 95% confidence interval 0.6 to 2.1). Similarly, the rates of prior use of aspirin by cases and controls were almost identical (odds ratio 1.2; 95% confidence interval 0.5 to 1.9). Thus neither nonsteroidal anti-inflammatory drugs nor aspirin were associated with increased case fatality rates from peptic ulcer complications. In contrast, corticosteroids were associated with an increased mortality (odds ratio 4.2; 95% confidence interval 0.9 to 25.6). Although this increase in the estimated relative risk was not statistically significant, a review of the case records indicated that most deaths in steroid users were due to serious sepsis, indicating that there might be a causal association between use of the drugs and the mode of death.