烟曲霉引起肺部感染1例

近年来随着皮质激素、免疫抑制荆、各种广谱抗生素等在临床的大量应用以及临床各种侵入性检查和治疗技术的不断开展,使烟曲霉感染呈上升趋势。2006年8月,我们从1例支气管哮喘患者痰液中两次分离出烟曲霉,现报道如下。1病例简介患者女性,54岁。因反复咳嗽、咳痰、喘息40年并加重     

髓过氧化物酶和过氧化氢酶基因多态性及其酶活力与燃煤污染型地方性砷中毒关系的探讨

Objective To detect genetic polymorphism of myeloperoxidase (MPO) gene and catalase (CAT) gene and their activities, and to analyze their relationship with arsenic poisoning caused by coal-burning. Methods One hundred and thirty arsenic poisoning patients were chosen as case group in Jiaole Village, Xingren County, Guizhou Province(an endemic area). One hundred and forty healthy residents living in 13 km away were chosen as control group. Their blood was collected. Polymerase chain reaction-restriction fragment length polymorphism technique(PCR-RFLP) was used to detect polymorphism of MPO-463G/A and CAT-262C/T. Ultraviolet spectmphotometer method was used to detect myeloperoxidase activity. Chromatometry method was used to detect catalase activity. Results The genotype frequency of MPO-463G/A at GG, GA, AA site was 47.24%(60/127), 44.09%(56/127),8.67% (11/127) in case group and 42.34% (58/137),48.17% (66/137)1,9.49% (13/137) in control group, respectively. The difference between the two groups was not significant(χ2 = 0.642, P > 0.05). The genotype frequency of CAT-262C/T, at CC, CT, TT site was 65.60%(82/125),28.80%(36/125),5.60%(7/125) in case group and 76.51%(101/132), 18.94% (25/132) ,4.55% (6/132) in control group, respectively, without significant difference (χ2 =3.845, P>0.05). The relationship between polymorphism of MPO-463G/A and CAT-262C/T and the risk of arsenic poisoning was not found in this study(ORadj= 1.36, 95%CI: 0.74-2.50 for MPO; ORadj=1.35, 95%CI: 0.69-2.63 for CAT). The activities of MPO and CAT were (25.30±8.70)U/L and (2.80± 1.09)×103 U/L in case group, while (22.76±7.59)U/L and (3.90±1.01)×103U/L in control group with a significant difference(F=0.760 for MPO, F=0.855 for CAT, all P < 0.05). The genotype of MPO-463G/A and CAT-262C/T was not found to have relationship with the activities of MPO, CAT(F=1.312,2.822 for MPO; F= 0.151,0.036 for CAT, P>0.05). Conclusions Genetic polymorphism of MPO-463G/A and CAT-262C/T is not found to have relationship with arsenic poisoning. Arsenic can lead to the change of MPO and CAT activity, which, however, may not be affected by MPO-463G/A and CAT-262C/T polymorphism.     

老年高血压病患者血管内皮功能与氧化低密度脂蛋白变化关系的探讨

目的探讨老年高血压患者血管内皮功能与氧化低密度脂蛋白变化关系，寻求较好的治疗方法。方法按WHO高血压诊断标准，选择年龄为60—72岁的Ⅱ期老年高血压患者60例，与30例正常健康者进行对照，比较两组一般特点，同时检测氧化低密度脂蛋白（OX—LDL）、内皮依赖舒张因子（NO），血管内皮素（ET），血管内皮细胞计数（CEC）。结果两组结果显示，正常对照组与高血压组在年龄，性别组成方面无显著差异，但两组的血压比较则有显著差异（P〈0．001），高血压组的OX—LDL、ET、CEC结果均高于正常对照组，NO结果则低于正常对照组。结论本研究结果提示与Ⅱ期老年高血压发生发展有肯定关系，提示临床在治疗中不仅注重血管内皮功能保护，同时加强抗氧化治疗，延缓高血压发展。     

354例女性生殖道支原体感染调查及药敏分析

目的了解本地区女性生殖道支原体感染情况及药敏现状。方法对妇科就诊的354例疑似非淋菌性尿道炎（NCU）患者进行生殖道分泌物支原体培养及药敏试验。结果454例疑似NCU患者共分离出支原体124株（35．0％），其中单纯UU感染100株（80．6％）；UU合并MH感染24株（19．4％）。UU对强力霉素与美满霉素敏感率分别为83．0％及88．0％。结论本地区女性生殖道支原体的感染主要以UU为主。支原体对9种抗生素出现不同程度的耐药现象。治疗支原体感染时，不能仅凭经验用药，必须作支原体的体外药敏试验分析，以便为治疗提供可靠依据，减少耐药菌株的发生。美满霉素和强力霉素可作为本地区治疗支原体感染的首选抗生素。     

加强护理安全管理强化护士法律意识

针对当前护理安全面临的挑战，强化护士法律意识已非常必要，要求护理人员认真学法、懂法、守法，工作中用法律来保护自己。同时充分认识到护理行为与病人生命的密切关系，并在工作中以规章制度、法律法规来约束自己，以不断提高自身素质和护理质量，加强护理安全管理，对不安全因素提出相应的防范措施和对策，减少或杜绝医疗差错和事故的发生，以维护医患双方的合法权益。     

燃煤型砷中毒患者血清中细胞外基质成分测定的临床意义

目的通过对血清中Ⅳ型胶原(Ⅳ鄄C)、层粘蛋白(LN)、纤维连接蛋白(FN)和Ⅲ型前胶原(PC鄄Ⅲ)的联合检测,了解砷中毒患者细胞外基质成分的变化,探讨其在砷中毒疾病诊治中的临床意义及可能的发病机制。方法将病区有砷煤接触史,并有慢性砷中毒症状的患者分为轻、中、重度3个实验组,检测血清Ⅳ鄄C、LN、FN和PC鄄Ⅲ,检测结果在各中毒组间比较,同时各实验组再与正常组进行比较。结果轻、中、重度3个实验组的PC鄄Ⅲ水平均高于对照组;中、重度组的Ⅳ鄄C、LN也较对照组高,经统计学处理差异均有显著意义(P<0.05,P<0.01);中、重度组的FN则显著低于对照组(P<0.05);轻度组的Ⅳ鄄C、LN、FN与对照组比较均有增高或降低趋势,但差异无显著意义(P>0.05)。结论煤砷慢性中毒患者细胞外基质的主要成分合成降解失衡,胶原在细胞内大量沉积,导致机体主要脏器功能障碍,这可能是砷中毒的发病机制之一;细胞外基质成分的检测对砷中毒病程发生发展及疗效均有重要意义。     

老年COPD患者并发肺部真菌感染的相关因素分析及控制对策

目的探讨老年COPD患者并发肺部真菌感染的相关诱因，为有效控制老年COPD患者肺部真菌感染提供依据。方法对本院住院61例老年COPD患者并发肺部真菌感染病例进行分析。结果免疫功能低下、广谱抗生素的使用、侵入性操作及住院时间过长等是老年COPD患者并发肺部真菌感染的主要诱因。结论应加强对相关诱因的控制，从而有效减少老年COPD患者并发肺部真菌感染的发生。     

眼球穿孔伤后蜡样芽胞杆菌化脓性眼内炎1例

化脓性眼内炎是眼球穿孔伤最严重的并发症，发病率约为10％，由蜡样芽胞杆菌引起的化脓眼内炎临床较为少见，现报道1例。     

髓过氧化物酶和过氧化氢酶基因多态性及其酶活力与燃煤污染型地方性砷中毒关系的探讨

Objective To detect genetic polymorphism of myeloperoxidase (MPO) gene and catalase (CAT) gene and their activities, and to analyze their relationship with arsenic poisoning caused by coal-burning. Methods One hundred and thirty arsenic poisoning patients were chosen as case group in Jiaole Village, Xingren County, Guizhou Province(an endemic area). One hundred and forty healthy residents living in 13 km away were chosen as control group. Their blood was collected. Polymerase chain reaction-restriction fragment length polymorphism technique(PCR-RFLP) was used to detect polymorphism of MPO-463G/A and CAT-262C/T. Ultraviolet spectmphotometer method was used to detect myeloperoxidase activity. Chromatometry method was used to detect catalase activity. Results The genotype frequency of MPO-463G/A at GG, GA, AA site was 47.24%(60/127), 44.09%(56/127),8.67% (11/127) in case group and 42.34% (58/137),48.17% (66/137)1,9.49% (13/137) in control group, respectively. The difference between the two groups was not significant(χ2 = 0.642, P > 0.05). The genotype frequency of CAT-262C/T, at CC, CT, TT site was 65.60%(82/125),28.80%(36/125),5.60%(7/125) in case group and 76.51%(101/132), 18.94% (25/132) ,4.55% (6/132) in control group, respectively, without significant difference (χ2 =3.845, P>0.05). The relationship between polymorphism of MPO-463G/A and CAT-262C/T and the risk of arsenic poisoning was not found in this study(ORadj= 1.36, 95%CI: 0.74-2.50 for MPO; ORadj=1.35, 95%CI: 0.69-2.63 for CAT). The activities of MPO and CAT were (25.30±8.70)U/L and (2.80± 1.09)×103 U/L in case group, while (22.76±7.59)U/L and (3.90±1.01)×103U/L in control group with a significant difference(F=0.760 for MPO, F=0.855 for CAT, all P < 0.05). The genotype of MPO-463G/A and CAT-262C/T was not found to have relationship with the activities of MPO, CAT(F=1.312,2.822 for MPO; F= 0.151,0.036 for CAT, P>0.05). Conclusions Genetic polymorphism of MPO-463G/A and CAT-262C/T is not found to have relationship with arsenic poisoning. Arsenic can lead to the change of MPO and CAT activity, which, however, may not be affected by MPO-463G/A and CAT-262C/T polymorphism.     

儿童急性再障误诊为特发性血小板减少性紫癜1例分析

对儿童急性再障误诊为特发性血小板减少性紫癜1例分析如下。 1 病历要 女，10岁。因鼻衄15d，面色苍白伴全身皮肤紫癜1周，发热3d入院。患15d前无明显诱因出现鼻衄现象，3次／d，每次出血量较多，无发热、腹痛等不适。在当地诊所对症治疗（用、药不详）后有明显好转，但未进一步诊治。