如何避免特应性皮炎由“一病”变“多病”

<正>特应性皮炎（AD）是一种常见但经常被误解的皮肤病,影响着无数人的生活。作为一种慢性、复发性、炎症性疾病,它不仅仅是皮肤表面的问题,而且影响着患者的身体健康和生活质量。AD的影响AD对患者生活的影响包括生理、心理、社交和生活质量等多个方面。1.生理影响AD的患者经常出现皮肤的慢性炎症,这不仅导致皮肤出现干燥、红斑、鳞屑,甚至还可能出现皮肤干裂、渗血、     

CpG ODN刺激的寻常性银屑病中性粒细胞培养上清液对HaCaT细胞增殖的影响

Objective To investigate the role of nentrophils in the pathogenesis of psoriasis vulgaris. Methods Neutrophils were isolated from venous blood samples of 25 patients with psoriasis vulgaris (including 13 cases of active psoriasis and 12 cases of inactive psoriasis) as well as 25 normal human con-trols, and cultured. Then, these neutrophils were grouped and treated with lipopolysaccharide (LPS, 100 g/L),CpG-A (50 mg/L), CpG-B (50 mg/L), and RPMI 1640 culture medium, respectively, for 24 hours followed by the collection of culture supematants. Human keratinocytes (HaCaT) were cultured in the presence of su-pematants of treated or untreated nentrophils for 72 hours followed by the detection of cell proliferation with MTT assay. To determine the role of proinflammatory factors, SOD/CAT and monoclonal antibody to IL-8 and TNF-alpha of 400 u/mL were used to pretreat HaCaT cells 1 hour prior to the stimulation with super-natants of neutrophils. Results Compared with culture medium, the supematant of unstimulated neutrophils from normal controls or patients with inactive psoriasis had no significant effect on the proliferation of HaCaT cells (P ＞ 0.05), but that from patients with active psoriasis markedly promoted the proliferation of HaCaT cells (t = 2.41, P < 0.05). ARe, stimulation by LPS, CpG-A and CpG-B, the supematant of active patient-derived neutrophils significantly promoted the proliferation of HaCaT cells compared with that of normal control-derived nentrophils (t = 3.11, 2.89, 2.29, respectively, all P < 0.05). In comparison with tmstimulated neutrophils, the supematant from LPS- and CpG-A stimulated nentrophiles significantly accelerated the pro-liferation of HaCaT cells. Furthermore, the proliferation of HaCaT cells induced by the supematants of LPS-,CpG-A-, CpG-B-stimulated neutrophils from psoriatic patients was statistically suppressed by the pretreat-ment with the monoclonal antibody to IL-8, TNF-alpha and SOD/CAT (all P < 0.05). Conclusions In patients with psoriasis vulgaris, there is an abnormal secretion of IL-8, TNF-alpha and superoxide by neutrophils in peripheral blood, and these proinflammatory factors could promote the proliferation of HaCaT cells.     

亲毛囊性蕈样肉芽肿伴嗜酸粒细胞增多一例

患者男,69岁。3年来,头、躯干和四肢出现散在红斑、毛囊性丘疹及痤疮样皮损（如粟丘疹、囊肿等）和脱发,病程中伴外周血嗜酸粒细胞增多。皮损组织病理检查示真皮内灶性慢性炎细胞浸润伴毛细血管增生,毛囊周围慢性炎细胞浸润伴血管增生,伴少许嗜酸粒细胞,考虑为毛囊炎,予抗组胺药和抗生素治疗后皮损炎症消退,瘙痒减轻。3个月后,枕部出现斑块伴脱发,组织病理检查示真皮内密集淋巴样细胞、嗜酸粒细胞浸润,毛囊周围大量淋巴样细胞浸润伴较多嗜酸粒细胞,可见不典型淋巴细胞,部分侵入毛囊,毛囊上皮黏液样变性。阿新蓝染色阳性。免疫组化染色：CD20、CD79a、EB病毒（EBV）、CD56、磷酸葡萄糖变位酶-1（PGM-1）、髓过氧化物酶（MPO）、CD7、抗角蛋白单克隆抗体AE1/AE3均阴性,异形细胞CD3、CD4、CD5、CD2、CD43、泛素羧基末端水解酶-L1（UCHL-1）均阳性。T细胞受体基因重排结果为阴性。诊断：亲毛囊性蕈样肉芽肿。予光化学疗法（PUVA）联合阿维A治疗,仍有新发皮损,目前患者在随访中。     

小组干预模式治疗大学生抑郁的效果

目的：探讨小组干预模式对大学生抑郁的干预效果，观察治疗前后组员的焦虑、抑郁、自我评价及行为改善情况，进行自身前后对照。方法：选择2004-05／07北京友谊医院临床心理科诊断为抑郁或抑郁状态的北京不同大学的1～4年级的在校学生10例。男5例，女5例，年龄19～24岁。采用小组治疗的方法对其进行干预。小组由组长和副组长两位治疗师带领，治疗1次／周，3h／次，干预8次。每次干预设有主题，采取半结构式治疗形式，安排活动，引发组员思考、讨论和领悟，并对组员引发出的问题给予关注和指导，去除一些情绪和不合理思维，增加彼此的共鸣与支持。治疗前后采用症状自评量表评估心理健康水平，采用焦虑自评量表评估患者的焦虑状态，采用抑郁自评量表评估患者抑郁程度，采用小组成员自我评价表进行成员的自我评定。数据进行配对t检验。结果：10例参加小组治疗的学生无脱落，全部进入结果分析。①小组治疗后症状自评量表的强迫因子评分比治疗前极显著降低（2．94&;#177;0．38，1．86&;#177;0．59，t=5.07，P〈0．01），人际关系、抑郁、焦虑、偏执等因子评分比治疗前明显降低（t=2．83，3．90，3．53，3．28，P〈0．05）。②治疗后焦虑自评量表、抑郁自评量表总分比较治疗前均显著降低（32．20&;#177;3．82，40．30&;#177;6．34，t=4．126，P〈0．01；35．50&;#177;5．31，48.60&;#177;7．16，t=4．701，P〈0．01）。③组员在对自己了解自己、了解别人、信赖自己、信任别人、关心别人、帮助别人、与他人沟通、与他人合作方面都有较高评价，自觉比以前开朗、自信，相信自己能够面对各种问题，掌握了一些调节情绪的技术和沟通的方法，对小组过程和活动比较喜欢。结论：小组治疗对于大学生抑郁是一种较有效的心理干预模式。治疗后小组成员自我评价升高，自觉有信心、有能力面对各种困难和问题。能有效改善抑郁大学生的情绪、行为，自我认知和应对模式。     

北京市朝阳区社区居民精神卫生知识与态度现况调查

目的 了解北京市朝阳区社区居民对精神卫生的知识和态度.方法 采用分层随机整群抽样的方法,在朝阳区4个社区3985名居民中进行《精神卫生与心理保健知识问卷》和《精神疾病有关态度问卷》调查.结果 ①朝阳区居民精神卫生知识知晓率平均达67.5％,平均得分（13.72±3.64）分,城市居民和农村居民间有显著差异[（15.05±3.36） vs.（12.46±3.44）,P＜0.0001];②朝阳区居民《精神疾病有关态度问卷》平均得分（34.10±5.52）分,城市居民和农村居民间有显著差异[（35.66±5.31）vs.（33.77±5.69）,P=0.005].结论 朝阳区社区居民精神卫生与心理保健知识知晓率已达到《全国精神卫生工作体系发展指导纲要（2008年-2015年）》的要求,但城市居民对精神卫生知识的了解程度要好于农村居民,且歧视程度轻于农村居民.     

CpG ODN刺激的寻常性银屑病中性粒细胞培养上清液对HaCaT细胞增殖的影响

Objective To investigate the role of nentrophils in the pathogenesis of psoriasis vulgaris. Methods Neutrophils were isolated from venous blood samples of 25 patients with psoriasis vulgaris (including 13 cases of active psoriasis and 12 cases of inactive psoriasis) as well as 25 normal human con-trols, and cultured. Then, these neutrophils were grouped and treated with lipopolysaccharide (LPS, 100 g/L),CpG-A (50 mg/L), CpG-B (50 mg/L), and RPMI 1640 culture medium, respectively, for 24 hours followed by the collection of culture supematants. Human keratinocytes (HaCaT) were cultured in the presence of su-pematants of treated or untreated nentrophils for 72 hours followed by the detection of cell proliferation with MTT assay. To determine the role of proinflammatory factors, SOD/CAT and monoclonal antibody to IL-8 and TNF-alpha of 400 u/mL were used to pretreat HaCaT cells 1 hour prior to the stimulation with super-natants of neutrophils. Results Compared with culture medium, the supematant of unstimulated neutrophils from normal controls or patients with inactive psoriasis had no significant effect on the proliferation of HaCaT cells (P ＞ 0.05), but that from patients with active psoriasis markedly promoted the proliferation of HaCaT cells (t = 2.41, P < 0.05). ARe, stimulation by LPS, CpG-A and CpG-B, the supematant of active patient-derived neutrophils significantly promoted the proliferation of HaCaT cells compared with that of normal control-derived nentrophils (t = 3.11, 2.89, 2.29, respectively, all P < 0.05). In comparison with tmstimulated neutrophils, the supematant from LPS- and CpG-A stimulated nentrophiles significantly accelerated the pro-liferation of HaCaT cells. Furthermore, the proliferation of HaCaT cells induced by the supematants of LPS-,CpG-A-, CpG-B-stimulated neutrophils from psoriatic patients was statistically suppressed by the pretreat-ment with the monoclonal antibody to IL-8, TNF-alpha and SOD/CAT (all P < 0.05). Conclusions In patients with psoriasis vulgaris, there is an abnormal secretion of IL-8, TNF-alpha and superoxide by neutrophils in peripheral blood, and these proinflammatory factors could promote the proliferation of HaCaT cells.     

社区重性精神病人安全风险评估量表的初步编制

目的:编制社区重性精神病人安全风险评估量表并测试其信度和效度。方法:随机抽取北京市朝阳区8个社区的860名重性精神疾病患者,使用社区重性精神病人安全风险评估量表进行风险评估。通过计算量表的内部一致性信度、评分者信度,各条目与总分的相关系数及探索性因子分析评价量表的信度和效度。结果:①量表的Cronbach α系数为0.86,评分者信度为0.92;②各条目与总分的Spearman相关系数在0.40～0.56之间;③探索性因子分析结果得到4个主要因子,累积贡献率为68.14%,10个条目负荷量在0.60～0.91之间;④高风险病人(量表评分≥35分)中发生轻微滋事者多于低风险病人(11.38%vs1.09%,P0.001)。结论:社区重性精神病人安全风险评估量表具有良好的信度和效度,可以作为社区重性精神病人安全风险度评估的工具在社区中使用。