NEC诱导的SIRS模型大鼠肠道中组织因子mRNA表达水平的变化

目的研究SIRS模型肠组织中TFmRNA的表达,探讨TF在SIRS发生中的作用。方法40只新生Wistar大鼠,出生36h～48h,随机分成正常对照组（A组）10只及模型组（B组）30只。48小时后处死动物,根据血液白细胞总数及呼吸改变确定为SIRS。将B组分为未发生SIRS组（B1组）和发生SIRS组（B2组）。实时荧光定量聚合酶链反应（QRT—PCR）检测肠组织TFmRNA的表达。结果肠组织Ⅱ1瑚RNA表达水平（2-△△Ct值）：A组1．01±0．04,B1组2．14±0．19,B2组3．78±1．2,三组间比较差异有显著性（P〈0．05）。结论从转录水平证实,SIRS新生大鼠模型中,TF水平增加．提示TF参与炎症反应。     

β型甲状腺激素抵抗综合征患者临床特点分析

背景　β型甲状腺激素抵抗综合征（RTHβ）属于罕见内分泌疾病,临床极易误诊、误治。目的　总结RTHβ患者的临床特点,为临床医师了解本病提供帮助。方法　选取2013-2016年于中国医科大学附属第一医院内分泌与代谢病科诊断为RTHβ的患者6例。回顾性分析6例RTHβ患者的临床资料,包括性别、诊断年龄、发病年龄、家族史、主诉、心电图检查结果、甲状腺触诊结果、甲状腺超声检查结果、甲状腺核素静态显像结果、甲状腺功能指标〔游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）〕、促甲状腺素受体抗体（TRAb）、性激素结合蛋白（SHBG）、血清铁蛋白、脂代谢指标、骨代谢指标、骨密度、基因测序情况等。结果　6例RTHβ患者的诊断年龄均高于发病年龄,患者在确诊RTHβ之前均被误诊为甲状腺功能亢进症,长期服用抗甲状腺药物治疗。患者主诉均存在心悸、多汗,3例伴心房颤动。6例患者甲状腺核素静态显像均显示甲状腺双叶摄取率增高。5例RTHβ患者甲状腺超声显示有甲状腺肿大,4例显示多发结节。6例RTHβ患者血清FT3、FT4水平升高,TSH水平在参考范围,且TRAb均为阴性;血清SHBG和血清铁蛋白均在参考范围;甲状腺激素受体（TR）β基因测序均存在点突变。结论　RTHβ的临床表现存在高度异质性,临床诊断时需注意与甲状腺功能亢进症和甲状腺功能减退症区分,同时注意并非所有的RTHβ患者能检测出TRβ基因突变。对于高度怀疑为RTHβ的患者,可以采用促甲状腺素释放激素（TRH）兴奋试验、左旋-三碘甲腺原氨酸（L-T3）抑制试验或TRH兴奋试验联合L-T3抑制试验进行临床诊断。     

Exploring an Integrative Therapy for Treating COVID-19: A Randomized Controlled Trial

Objectives: To develop a new Chinese medicine(CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome(ARDS) in COVID-19 patients. Methods: A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy(alpha interferon inhalation, 50 μg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy(control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed. Results: An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants(24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution(P=0.035), and a significant reduction in the development of ARDS(P=0.048). Conclusions: Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients.(Trial registration No. NCT 04251871 at www.clinicaltrials.gov)     

重视新型冠状病毒肺炎对心脏的损害

【摘要】目前2019新型冠状病毒（2019 nCov）感染的肺炎疫情进入了一个严峻且复杂的局面,疫情防控和救治形势十分严峻。现对新型冠状病毒肺炎（NCP）病情演化规律的认识,疾病确切的发病机理,尤其是发生重症化的机理尚不完全清楚。本文从肾素-血管紧张素系统（RAS）分子通路的角度,以血管紧张素转换酶2（ACE2）靶点,探讨2019-nCov可能对NCP患者的心脏损害及对心血管疾病患者的危害。