非典型病原体所致社区获得性肺炎的临床研究

目的探讨社区获得性肺炎（community-acquired pneumonia，CAP）各种病原体的构成及非典型病原体所致CAP的临床特点，以提高诊断与治疗水平。方法收集2004年2月至2006年12月在本院诊治的成人CAP病例，采用间接免疫荧光法（检测肺炎支原体IgM抗体、肺炎衣原体IgM抗体及军团菌IgG抗体）和痰液细菌分离培养检测患者的病原体。分析CAP病原体的构成。选取31例（占27．4％）由非典型病原体（肺炎支原体、肺炎衣原体）所致CAP患者为观察组，46例（占40．7％）细菌性肺炎患者为对照组，分别对两组患者的临床表现、辅助检查、治疗及转归情况进行回顾性分析。结果肺炎支原体24例（21．2％）是最常见的病原体，其后依次为肺炎链球菌14例（12．4％）、流感嗜血杆菌9例（8．0％）、肺炎衣原体7例（6．2％）、大肠埃希菌2例（1．8％）、军团菌1例（0．8％）、卡他莫拉菌1例（0．8％）。有6例患者（5．3％）为非典型病原体与细菌混合感染。观察组的临床症状以干咳（P〈0．05）、咳白黏痰（P〈0．01）、胸闷、气促（P〈0．01）多见；观察组中外周血白细胞计数正常及中性粒细胞比例正常的患者较多（P〈0．01，P〈0．05）；观察组的胸部X线片表现以斑点状或斑片状阴影为主（P〈0．05），双肺纹理增粗明显（P〈0．05），多叶浸润比例高（P〈0．05）。结论非典型病原体（肺炎支原体、肺炎衣原体、军团菌）是CAP的主要病原体。对有这类表现的CAP患者要及早检测肺炎支原体抗体、肺炎衣原体抗体、军团菌抗体以期及早明确诊断，抗生素治疗上首选大环内酯类或喹诺酮类。     

血清降钙素原在肺炎诊断及严重程度判断中的研究

目的:评价血清降钙素原(PCT)对肺炎诊断及严重程度评估中的应用价值。方法:本研究为前瞻性,收集肺炎患者51例,检测患者的血清PCT、C-反应蛋白(CRP)、内毒素(LPS)、白细胞(WBC)计数及白细胞介素-6(IL-6)。结果:1.痰细菌培养阳性肺炎组PCT水平较支原体肺炎或衣原体肺炎组高,差异有统计学意义(P<0.01),较病原学检测阴性肺炎组高,差异有统计学意义(P<0.01),病原学检测阴性肺炎组PCT水平较支原体肺炎或衣原体肺炎组高,差异无统计学意义(P>0.05)。2.有并发症组的PCT水平较无并发症组高,差异有统计学意义(P<0.05)。PCT水平在中高危组较低危组高,差异有统计学意义(P<0.05);PCT阳性率在中高危组较低危组高,差异有统计学意义(P<0.05)结论:血清PCT水平对肺炎的病原学诊断有一定的预测价值,而CRP、内毒素、WBC计数及IL-6组间,差异无统计学意义;血清PCT作为肺炎患者严重程度的一项评价指标可能具有一定意义。     

降钙素原在老年社区获得性肺炎的临床应用价值

目的评价降钙素原(PCT)在老年社区获得性肺炎(CAP)的临床应用价值。方法以124例老年CAP为研究对象,观察不同严重程度老年CAP患者PCT变化情况,研究PCT与肺炎严重指数(PSI)及CURB-65评分相关性,并比较不同病原体引起CAP患者PCT的检测情况。结果重症肺炎组、普通肺炎组及对照组PCT均有统计学差异(P0.05);PCT与PSI(r=0.533,P0.05)、CURB-65评分(r=0.698,P0.05)均呈正相关;124例CAP患者血细菌培养阳性患者PCT高于血细菌培养阴性患者,差异有统计学意义(P0.05)。结论在老年CAP患者中PCT能较好的反映患者的病情严重程度,对病原体的初判及抗生素的合理使用均有重要临床应用价值。     

北京地区成人社区获得性肺炎非典型病原体流行病学调查

目的　对引起社区获得性肺炎 (CAP)的病原体进行流行病学调查 ,加强对非典型致病原重要性的认识。方法　收集 2 0 0 1年 11月至 2 0 0 2年 6月CAP患者共 10 3例。分别检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。应用聚合酶链反应 (PCR)分别扩增肺炎支原体P1黏附蛋白基因及肺炎衣原体 16SrRNA基因。应用酶免疫测定 (EIA)方法检测尿中嗜肺军团菌抗原。取患者急性期痰标本进行细菌培养 ,应用常规方法分离鉴定细菌。结果　 10 3例CAP患者 ,病原体检出率为 48.5%。 2 3例 (2 2 .3 % )检出肺炎支原体 ,3例 (2 .9% )检出嗜肺军团菌 ,2例 (1.9% )检出肺炎衣原体。 12例分离出肺炎链球菌 (11.7% )、9例分离出流感嗜血杆菌 (8.7% )、7例分离出肺炎克雷伯菌 (6.8% )。 6例患者存在混合感染 (5.8% ) ,其中 5例为肺炎支原体混合其他病原体。结论　非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位 ;肺炎链球菌和流感嗜血杆菌仍为常见的致病细菌 ;混合感染不容忽视     

老年社区获得性肺炎病原学分析

目的研究老年社区获得性肺炎患者的病原体分布。方法收集2005年6月-2008年5月在我院住院的128例老年CAP患者,留取呼吸道分泌物进行细菌培养,分离鉴定细菌并进行药物敏感性试验,同时检测患者急性期和恢复期肺炎支原体、肺炎衣原体、嗜肺军团菌血清抗体。结果 128例CAP患者60例（46.9%）病原学检查阳性,病原菌45株,其中主要为流感嗜血杆菌14株,肺炎克雷伯杆菌12株,肺炎链球菌10株。非典型病原阳性18例,主要为肺炎支原体13例,肺炎衣原体4例,3例为混合感染。流感嗜血杆菌对氨苄西林耐药率为14.3%;肺炎链球菌对青霉素不敏感率为30%,对阿齐霉素耐药率为60%;肺炎克雷伯菌产酶率16.7%,对含β-内酰胺酶抑制剂的复方抗生素制剂和亚胺培南敏感。结论老年患者肺炎以革兰阴性菌为优势菌株,对喹诺酮类和第3代头孢菌素具有不同程度的耐药性,对革兰阴性菌选用含有酶抑制剂的复方抗生素制剂或亚胺培南,非典型病原体的感染也占重要地位。     

梧州地区住院患者呼吸道病毒及非典型病原体的抗体检测分析

目的探讨梧州地区急性呼吸道感染住院患者呼吸道病毒和非典型病原体感染的情况。方法2014年7月至2015年6月在广西梧州市工人医院住院的急性呼吸道感染患者血清,应用间接免疫荧光法(IFA)定性检测九种呼吸道感染病毒及非典型病原体Ig M抗体,分别是流感病毒A/B、副流感病毒、呼吸道合胞病毒、腺病毒、嗜肺军团菌、肺炎支原体、肺炎衣原体、Q热立克次体。结果呼吸道病原体血清抗体总阳性率为20.97%,其中肺炎支原体阳性率最高,其次B型流感病毒、副流感病,分别是15.80%、2.43%、1.97%。一年中,秋季血清阳性率最高(50.00%),其次冬季(20.13%),与春季、夏季比较差异有统计学意义(P0.05)。不同年龄段中,青年血清阳性率最高,老年组血清阳性率最低。18例B型流感病毒血清阳性中,合并支原体血清阳性9例(9/18=50.00%),12例副流感病毒中,合并支原体7例(7/12=58.33%)。结论 :梧州地区急性呼吸道感染住院患者吸道病毒和非典型呼吸道病原体感染率较高,并以肺炎支原体最高,其次B型流感病毒、副流感病毒;且青年组较老年组发病率高;以秋、冬季节高发;流感病毒、副流感病毒血清阳性混合感染肺炎支原体发生率较高。     

血清降钙素原和内毒素检测在感染性肺炎患儿诊断中的临床应用价值

目的探讨降钙素原(procalcitonin,PCT)和内毒素(endotoxin,ET)检测在小儿感染性肺炎中的诊断价值。方法选择感染性肺炎患儿100例,其中衣原体肺炎8例,支原体肺炎14例,病毒性肺炎23例,细菌性肺炎55例。另选取45例健康体检儿童为对照组。比较各组血清PCT和ET水平,对细菌性肺炎患儿痰液标本分离菌株进行鉴定和药敏试验。结果细菌性肺炎组患儿血清PCT和ET分别为(10.93±3.07)ng/ml和(0.26±0.07)EU/ml,与健康对照组(0.23±0.14)ng/ml和(0.04±0.02EU/ml)比较差异均有统计学意义(P0.05);与衣原体肺炎组、支原体肺炎组及病毒性肺炎组PCT(0.24±0.12)ng/ml~(0.29±0.18)ng/ml和ET(0.04±0.02)EU/ml~(0.05±0.03)EU/ml比较差异均有统计学意义(P0.05),其中革兰阴性菌组血清ET水平显著高于革兰阳性菌组(P0.05);衣原体肺炎组、支原体肺炎组及病毒性肺炎组血清PCT和ET与健康对照组比较差异均无统计学意义(P0.05)。55例细菌性肺炎患儿痰标本中分离出73株病原菌,其中革兰阴性菌45株,占61.64%。革兰阴性菌中的肺炎克雷伯菌和大肠埃希菌对氨苄西林耐药率在90%以上,对头孢呋辛和头孢噻肟耐药率在30%以上。革兰阳性菌28株,占38.36%,其中的金黄色葡萄球菌和肺炎链球菌对青霉素耐药率在77%以上,对红霉素耐药率在58%以上。结论细菌性肺炎患儿血清PCT和ET升高,因此可通过血清PCT和ET检测鉴别儿童感染性肺炎的致病菌种类。临床医师应根据病原菌的耐药状况及时选用敏感性药物治疗,以减少重症肺炎的发生。     

降钙素原检测在儿童CAP中的早期诊断价值

目的探讨血清降钙素原(PCT)在儿童社区获得性肺炎(CAP)中的早期诊断价值。方法检测60例细菌性肺炎患儿(细菌性肺炎组),60例肺炎支原体肺炎患儿(肺炎支原体肺炎组)和30例病毒性肺炎患儿(病毒性肺炎组)及30例健康儿童(对照组)的血清PCT及C-反应蛋白(CRP)水平及白细胞计数(WBC),比较各组血清PCT和CRP水平及WBC结果。结果 CAP患儿血清PCT及CRP水平及WBC计数均明显高于对照组(P0.05);细菌性肺炎组血清PCT及CRP浓度及WBC计数均明显高于肺炎支原体肺炎组、病毒性肺炎组(P0.05)。CAP患儿PCT的ROC曲线下面积明显高于CRP(P0.05)。结论血清PCT在CAP患儿中的鉴别诊断价值优于CRP。     

老年呼吸道感染患者肺炎衣原体、肺炎支原体感染情况分析

目的了解我院老年呼吸道感染患者肺炎衣原体(CP)和肺炎支原体(MP)感染状况,为临床诊断和治疗提供依据。方法采用胶体金法定性对263例老年呼吸道感染患者进行CP和MP及其血清抗体Ig G、Ig M检测。结果 263例老年呼吸道感染患者中,CP阳性52例,阳性率为19.8%;MP抗体阳性69例,阳性率为26.2%;MP阳性率略高于CP阳性率,但差异无统计学意义(P0.05)。CP和MP阳性患者共121例,阳性率为46.0%。在52例CP阳性患者中,CP-Ig G阳性33例,阳性率为63.5%;CP-Ig M阳性19例,阳性率为36.5%;CP-Ig G阳性率显著高于CP-Ig M阳性率,差异有统计学意义(P0.01)。在69例MP阳性患者中,MP-Ig G阳性43例,阳性率为62.9%;MP-Ig M阳性26例,阳性率为37.7%;MP-Ig G阳性率显著高于MP-Ig M阳性率,差异有统计学意义(P0.01)。结论老年呼吸道感染患者中CP抗体和MP抗体阳性率较高,CP、MP阳性患者的Ig G阳性率高于Ig M阳性率,对于老年呼吸道感染患者,在进行痰细菌培养检测的同时应进行肺炎衣原体、支原体Ig G、Ig M的检测,才能做到早发现、早诊断,对患者进行正确的治疗。     

不同时期老年社区获得性肺炎患者不典型病原检测结果分析

目的 调查3个时期老年社区获得性肺炎(CAP)住院患者病毒、支原体、衣原体及军团菌感染状况,为临床流行病学研究提供参考. 方法 选取2001年10月至2004年6月[称为围严重急性呼吸综合征(SARS)期]、2005年7月至2007年10月及2008年1月至2010年12月(称为围甲流期)于河北联合大学附属医院住院的492例老年患者作为研究对象,于入院当天及入院后7～10d行血清支原体、衣原体、军团菌IgM抗体及7种常见病毒IgM抗体检查,对3个期间的资料进行分析. 结果 492例患者支原体IgM抗体阳性80人次(16.26％)、衣原体IgM抗体阳性46人次(9.35％)、军团菌IgM抗体阳性25人次(5.08％)、病毒IgM抗体阳性118人次(23.99％).“围SARS期”不典型病原体总检出率及军团菌、合胞病毒、巨细胞病毒、单纯疱疹病毒及风疹病毒检出率明显高于其他2个时期.不典型病原体抗体在起病20d内的检出率较高. 结论 不典型病原体仍为老年CAP的重要致病原,其中以支原体感染最为常见.前后对比围SARS期间病毒感染更为普遍.老年CAP患者不典型病原体感染率无明显上升,部分有下降趋势.在起病20 d内多数不典型病原体感染患者IgM抗体可检出阳性.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.