危重型甲型H1N1流感患者外周血白细胞及T细胞亚群的变化及其临床意义

目的 探讨危重型甲型H1N1流感患者外周血白细胞和T淋巴细胞亚群的变化及其临床意义.方法 检测18例危重型甲型H1N1流感患者(危重组),18例普通型H1N1流感患者(普通组)和18例健康人(对照组)外周血白细胞计数及分类,流式细胞术测上述患者外周血T淋巴细胞各亚群CD3+、CD4+、CD8+、CD8+CD28+、CD8+CD28-、CD4+CD25+high的百分比.结果 与对照组比较,甲型H1N1病毒感染患者,尤其是危重型组,淋巴细胞绝对数及百分比显著下降,且外周血T淋巴细胞各亚群CD3+、CD4+、CD8+、CD8+CD28+、CD4+CD25+high百分比明显降低,而CD8+CD28-百分比明显增高(P<0.05).结论 甲型H1N1流感病毒感染损伤患者淋巴细胞和细胞免疫功能.外周血淋巴细胞及T淋巴细胞各亚群的百分比改变可反映甲型H1N1流感患者病情的严重程度.     

甲型 H1N1流感 73例 T淋巴细胞亚群分析

目的检测甲型 H1N1流感病人外周血 T淋巴细胞亚群的变化,探讨甲型 H1N1流感对其细胞免疫功能的影响。方法总结 2009年 11月 5日至 2017年 1月 15日甘肃省人民医院及兰州大学第二医院所收治的 73例临床资料完整且没有基础免疫疾病的甲型 H1N1流感病人血清总 T淋巴细胞、 CD4抗原阳性的 T淋巴细胞(CD4+T淋巴细胞)、 CD8抗原阳性的 T淋巴细胞(CD8+T淋巴细胞)活性的变化规律。结果甲型 H1N1流感病人 CD8+T淋巴细胞在诊断初期即已升高(42.27±11.13)cells/ul,并在恢复期基本恢复正常(29.26±12.99)cells/ul;总 T淋巴细胞、 CD4+T淋巴细胞则在诊断初期有不同程度下降(44.09±13.51)、(47.27±7.73)cells/ul,并随病情好转逐渐恢复, CD4+T淋巴细胞与 CD8+T淋巴细胞比值在病程中没有统计学差异差异无统计学意义(F=0.294,0.415,0.618;P=0.892,0.106,0.082),但随病情好转有升高趋势。结论甲型 H1N1流感病人免疫功能低下。     

甲型H1N1流感免疫学研究

目的探讨甲型H1N1流感病毒感染后,人体免疫细胞及细胞因子的变化。方法检测36例甲型H1N1流感确诊病例的早期及恢复期CD4＋、CD8＋、IL-2、TNF-α变化。结果人感染甲型H1N1流感后,CD4＋和CD8＋T淋巴细胞均有下降,IL-2较正常人明显下降,而TNF-α较正常人明显升高。结论人感染甲型H1N1流感病毒后,细胞免疫功能减弱,炎症细胞因子表达增强,在治疗上要增强细胞免疫,预防继发感染。     

胸腺肽α1辅助治疗甲型H1N1流感并肺炎的疗效

目的：观察胸腺肽α1对甲型H1N1流感并肺炎的临床疗效。方法：选取62例临床确诊为甲型H1N1流感并肺炎的患者,随机分为观察组、对照组各31例,两组均采用常规治疗,观察组在对照组基础上给予胸腺肽α1 1．6mg,隔日1次皮下注射,疗程2—4周。观察患者外周血常规、T细胞亚群的变化,同时观察临床症状、体温、胸片等进行疗效评价。结果：两组患者治疗前白细胞计数、淋巴细胞比例及CD3＋、CD4＋均低于正常值,中性粒细胞比例均高于正常值;治疗4—8d后,观察组淋巴细胞比例、CD3＋、CD4＋及CD4＋／CD8＋比值均高于对照组（P〈0．01）,白细胞计数先低到高再逐渐下降及中性粒细胞比例下降值低于对照组（P〈0．05）。结论：胸腺肽d,可提高甲型H1N1流感并肺炎患者的淋巴细胞比例及CD3＋、CD4＋及CD4＋／CD8＋比值,从而提高了机体T细胞免疫功能,有利于炎症控制,提高疗效。     

重症及危重症甲型H1N1流感74例临床分析

目的分析ICU救治甲型H1N1流感重症及危重症患者的临床特点。方法回顾性分析174例H1N1患者的临床资料,对其发病特点、治疗方法及转归等资料进行分析。结果 74例重症及危重症甲型H1N1患者主要临床特点为高热,呼吸困难,白细胞数及炎症反应指标升高,免疫功能紊乱,胸部影像改变特点为进展快,双肺多叶受累,以广泛肺实质浸润为主,部分病例出现肺间质渗出。结论甲型H1N1流感重症及危重症病情进展快,以呼吸困难、低氧血症为突出表现,肺部病变广泛,进展迅速,妊娠、有基础疾病或合并细菌感染是死亡的高危因素,早期奥司他韦抗病毒及合理使用糖皮质激素、呼吸支持、控制混合感染等综合治疗是降低病死率的关键。     

甲型H_1N_1流感重症和危重症55例的护理

目的：探讨甲型H1N1流感重症和危重症病例的护理方法。方法：总结55例甲型H1N1流感重症和危重症的治疗和护理。结果：55例中,痊愈出院53例,死亡2例,1例为孕产妇,1例并发了多器官功能衰竭。结论：甲型H1N1流感一旦诊断成立,及早应用抗病毒、抗感染药物和激素冲击治疗及配合心理护理,并对使用呼吸机、血透的患者专人特护,营养支持配合治疗,是疾病恢复的关键。     

新型甲型H1N1流感危重症23例临床分析

目的探讨新型甲型H1N1流感危重症的临床特征、诊断及治疗方法。方法对已经确诊的23例新型甲型H1N1流感危重症患者的临床特点、治疗过程、治疗效果进行综合分析。结果新型甲型H1N1流感危重症孕妇患病率达到47.9%,60%患者体温高于38.5℃。症状以咳嗽、咳痰、胸闷为主,且80%患者有湿啰音。影像为片絮状影,弥散实变影。血常规检查提示白细胞计数偏低,中性粒细胞、淋巴细胞、血小板与正常相比无统计学意义。生化检查中,谷草转氨酶、碱性磷酸酶明显升高,总胆红素及直接胆红素升高。乳酸脱氢酶及α-羟丁酸脱氢酶明显升高。患者的血肌酐、尿素氮正常,尿酸升高。血浆中钠、钾、氯、钙均降低。结论新型甲型H1N1流感危重症的体征、影像、生化均有别于其他病毒性肺炎,预后与就诊时间、妊娠密切相关,尽早终止妊娠与机械通气,糖皮质激素的早期大量应用可改善预后。     

7例危重症H1N1甲型流感肺炎患者的临床特征与治疗

目的：总结危重症H1N1甲型流感肺炎患者的主要临床特点,探索临床有效的治疗方法及机械通气在危重症患者抢救中的作用。方法：回顾性分析入住本院重症监护室及呼吸科的7例危重症H1N1甲型流感肺炎患者的临床资料和治疗方法。结果：7例患者中孕产妇、有慢性基础病者6例;进行性呼吸困难、咳嗽、痰中带血是主要症状,双肺多发实变影6例（85.71%）。血清中乳酸脱氢酶（LDH）平均值为（1 857.29±3 613.86）U/L,血清白蛋白平均值为（30.44±4.56）g/L。7例患者均用抗病毒治疗（奥司他韦剂量150 mg/次,2次/d）,全部用激素及抗感染、气管插管机械通气治疗,死亡1例,病死率14.29%。结论：血清中LDH升高、白蛋白降低是危重症H1N1甲型流感肺炎患者预后不佳的预测指标;早期有创机械通气支持治疗对于肺内广泛实变者效果理想,有助于提高抢救成功率。     

影像检查在孕妇甲型H1N1流感重症肺炎中的诊断价值

甲型H1N1流感是一种急性呼吸道传染病,如果治疗不及时,部分患者病情可迅速发展,重症及危重症病例可并发严重肺炎,甚至死亡[1].高危人群包括妊娠期妇女.本文回顾性分析我院收治的15 例妊娠期甲型H1N1流感并发重症肺炎患者的胸部影像表现,以进一步探讨该类患者影像学特点.     

妊娠感染甲型H1N1流感的探讨

昆明医学院第一附属医院ICU作为云南省甲型H1N1流感危重症的定点收治科室,在2009年10月～12月收治了多名妊娠感染甲型H1N1流感危重症患者,现报告探讨如下。病例1女,23岁,初产妇,妊娠26+周,因"发热、咽痛、咳嗽、痰中带血、呼吸困难1周"     

The aminomethylation of 1-cyano-isochromane and 1-cyano-isothiochromane

The Aminomethylation of 1-Cyano-isochromane and 1-Cyano-isothiochromane Aminomethylation of 1-cyano-isochromane (1a) and 1-cyano-isothiochromane (1i) can be achieved via reaction of carbanions 2 with α-haloamines 3 . Dialkylaminomethyl and dialkylaminobenzyl compounds 4 are formed.     

Preferential induction of CYP1A1 and CYP1B1 in CCSP-positive cells.

Both benzo[a]pyrene (BaP) and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) are potent ligands of aryl hydrocarbon receptors (AhR). Although animal studies indicate that both compounds induce pathological changes in the peripheral lung, the specific cell type involved remains unclear. Clara cells, expressing Clara cell specific protein (CCSP) and abundant in cytochrome P450, are nonciliated bronchiolar epithelial cells in the peripheral lung. Here we explore the hypothesis that CCSP-positive Clara cells are highly responsive to AhR ligands and are the primary cell type involved in BaP- and TCDD-induced toxicities. The responsiveness to AhR ligands was evaluated by measuring the respective mRNA and protein levels of cytochrome P450 1A1 (CYP1A1) and 1B1 (CYP1B1) using real-time RT-PCR and immunocytochemistry assays. Two in vitro models were used: primary cultures of human small airway epithelial (SAE) cells and rat lung slice cultures. In the presence of calcium, human SAE cells differentiated into CCSP-positive cells. BaP- and TCDD-induced mRNA and protein levels of CYP1A1 and CYP1B1 levels were significantly elevated in CCSP-positive cell cultures. Similarly, AhR mRNA and protein levels were increased in CCSP-positive cell cultures, as determined by real-time RT-PCR and Western blot analysis. When rat lung slice cultures were treated with BaP or TCDD for 24 h, CYP1A1 and CYP1B1 proteins were strongly induced in Clara cells. These results indicate that, in the peripheral lung of both rats and humans, CCSP-positive cells (Clara cells) may be more sensitive to AhR ligands than other cell types.     

Influence of genetic polymorphisms of CYP1A1 and GSTM1 on the urinary levels of 1-hydroxypyrene

The aim of the present study is to evaluate the influence of the genetic polymorphism of two enzymes involved in the biotransformation of xenobiotics, cytochrome P450 1A1 (CYP1A1) and glutathione-S-transferase M1 (GSTM1), on the urinary levels of 1-hydroxypyrene (1-OH-P) in workers exposed to polycyclic aromatic hydrocarbons (PAHs) and in unexposed workers (controls). The study group consisted of 30 controls recruited among employees of a service company and 171 PAHs-exposed workers from two electric steel plants and an iron foundry (all males, ranging between 18 and 60 years of age). Determination of airborne PAHs and urinary 1-OH-P was performed by high-performance liquid chromatography (HPLC) with fluorimetric detection. Polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) was used to determine the genetic polymorphisms of CYP1A1 (CYP1A1*2A and CYP1A1*2B) and GSTM1. No influence of the genetic polymorphism of CYP1A1 and GSTM1 on the urinary levels of 1-OH-P was observed in this study.