战伤分级救治体系对灾害医学救援的启示

野战外科学与灾害医学存在许多共同点：如组织管理、分级救治、独特的医学理论、救治对象为大批伤（病）员、救治条件甚为困难等。目前许多国家的军队医院相继设立了长期战备医疗机构-特种医疗部队，以便发生灾情时能快速进入灾区。这同时也表明了战时环境下伤员救治体系与平时条件下灾害医学救援体系的兼容性与互通性。现着重从战伤分级救治体系的起源、发展趋势以及对灾害医学救援的启示三个方面进行阐述。     

严重创伤合并ARDS患者血清C反应蛋白水平的动态观察及意义

目的探讨创伤患者血清C反应蛋白(CRP)的水平与创伤性ARDS之间的关系及其临床意义。方法将52例严重创伤患者(ISS评分≥16分)分为创伤后并发ARDS组13例(ARDS组)与创伤后未并发ARDS组39例(非ARDS组),另10例健康人为正常对照组。半随机对照实验。分别于伤后第1、2、3、7天收集外周血。运用ELISA方法测定外周血血清C反应蛋白(CRP)浓度。结果正常对照组CRP水平在各时相点变化不明显,而非ARDS组CRP水平先升高后降低,ARDS组CRP水平持续升高。与正常对照组相比,非ARDS组血清CRP水平升高了10倍多,而ARDS组的CRP水平升高了30多倍;与非ARDS组相比,ARDS组的CRP水平升高了2倍多。结论创伤后急性期CRP水平的升高程度不仅与创伤严重程度有关,而且与创伤性ARDS的发生密切相关。因此,测定严重多发伤急性期外周血血清CRP浓度对预测创伤性ARDS的发生具有一定价值。     

吲哚胺2,3-双加氧酶与树突状细胞

吲哚胺2,3-双加氧酶(IDO)是降解必需氨基酸色氨酸的限速酶,广泛表达于各种组织和细胞,在感染或炎症期间其表达量明显增高.而树突状细胞(DC)是专职的抗原提呈细胞,IDO在其内的表达可影响DC的表型和功能,进而抑制T细胞的免疫反应.研究IDO和DC的关系对深入理解IDO在免疫系统中的作用以及开发新的免疫调节策略都具有重要意义.     

外源性胍丁胺抑制脂多糖诱导的人脐静脉内皮细胞活化及损伤

目的研究胍丁胺对脂多糖诱导的人脐静脉内皮细胞活化及损伤的影响,并探究其与NF-κB、MAPK通路及活性氧（ROS） 的产生是否相关。方法体外培养人脐静脉内皮细胞（HUVECs）。MTT法检测0~4 mmol/L胍丁胺作用24 h对HUVECs细胞 活力的影响。HUVECs细胞机分为：①空白对照组;②脂多糖（10 μg/mL）组;③胍丁胺干预组：脂多糖（10 μg/mL）+胍丁胺 （0.125、0.5、1 mmol/L）。ELISA 法检测24 h 细胞上清中可溶性细胞间粘附分子-1（sICAM-1）、可溶性血管间粘附分子-1 （sVCAM-1）、可溶性E-选择素（sE-selectin）及单核细胞趋化因子-1（MCP-1）水平,确定胍丁胺最适干预浓度（1 mmol/L）。后续 实验中HUVECs细胞随机分为：对照组、脂多糖（10 μg/mL）组、胍丁胺（1 mmol/L）组及脂多糖（10 μg/mL）+胍丁胺（1 mmol/L） 共同组,作用1、6、24 h;抑制剂组即在脂多糖刺激前1 h,用10 μmol/L NF-κB（PDTC）、ERK1/2（PD98059）及p38（SB203580）抑 制剂进行预处理。qRT-PCR法检测ICAM-1、VCAM-1、E-selectin、MCP-1、血红素氧合酶（HO-1）、醌氧化还原酶（NQO1）mRNA 表达水平;DCFH-DA作为荧光探针检测细胞内活性氧（ROS）水平;Western blot 法检测细胞VCAM-1、ICAM-1、p65、磷酸化- p65（p-p65）、IκBα、p-IκBα、ERK、p-ERK、p38、p-p38、JNK、p-JNK蛋白表达水平。结果（1）HUVECs经10 μg/mL脂多糖刺激24 h 后,上清sVCAM-1、sICAM-1、sE-选择素、MCP-1 含量明显升高（P<0.05）,细胞内ROS明显增加（P<0.05）;刺激6 h 后各因子 mRNA水平升高（P<0.05）;（2）胍丁胺（1 mmol/L）干预后上述指标显著下调（P<0.05）,这与p38、ERK及NF-κB信号通路抑制剂 预处理细胞后的抑制效应相似;（3）胍丁胺干预组6 h HO-1 mRNA表达较脂多糖组明显增加（P<0.05）,而NQO-1无明显变化; （4）胍丁胺明显抑制脂多糖刺激引起的细胞内p38、ERK、核内p65（Ser536）与胞浆IκBα磷酸化,并上调胞浆IκBα蛋白水平。结 论胍丁胺可能通过抑制NF-κB、MAPK通路的激活下调粘附分子及趋化因子水平,并增强HO-1表达以减少活性氧产生对抗脂 多糖诱导的人脐静脉内皮细胞活化及损伤。     

慢性血吸虫感染对脓毒症小鼠保护作用的研究

Objective To preliminarily study the protective effect of chronic schistosoma japonica (SJ)infestation against sepsis in mice and its mechanism. Methods BALB/c male mice were used, and the experiment was divided into three parts. Experiment 1: chronic SJ infestation model was reproduced by SJ cercaria inoculation through abdominal skin for 8 weeks. Twenty mice were randomly grouped into normal group (n=10) and SJ group (n=10). The levels of interleukins (IL-4, IL-10), tumor necrosis factor-α(TNF-α) and interferon-γ (IFN-γ) in serum were detected by enzyme linked immunosorbent assay (ELISA).Real-time polymerase chain reaction (PCR) was employed to detect the levels of IL-10 mRNA and TNF-αmRNA in abdominal macrophages. This experiment was meant to evaluate immune state in mice with chronic SJ infestation. Experiment 2: lipopolysaccharide (LPS) was intraperitoneally injected to reproduce sepsis model. Thirty mice were randomly grouped into LPS group (n=15) and SJ-LPS group (n=15). The levels of cytokines were determined by ELISA at 0, 24, 48 and 72 hours after LPS injection. This experiment was meant to detect the effect of chronic SJ infestation in mice during the septic process. Experiment 3 : two types of sepsis model were reproduced by cecal ligation and puncture (CLP) and LPS injection, respectively. The survival rate of mice with chronic SJ infestation in 72 hours in either type of sepsis was evaluated. Results Experiment 1, compared with normal group [IL-4 (56.32±8.66) ng/L, IL-10 (48.17±7.23) ng/L],chronic SJ infestation showed an increase in serum IL-4 [(151. 35 ± 12. 24) ng/L] and IL-10 [(133. 22 ±11. 09) ng/L, both P＜0. 05]. Chronic SJ infestation also resulted in an increase in IL-10 mRNA expression (SJ group 4. 46±1. 82, normal group 1. 52±0. 60) and inhibited TNF-α mRNA expression (SJ group 1. 61±0.93, normal group 2. 32±1.03) in abdominal macrophages (both P＜0. 05), indicating that macrophages could be differentiated into alternative activated macrophages. Experiments 2 and 3 showed that the levels of serum IL-4 and IL-10 were increased at 0 hour after LPS injection, and then gradually decreased in SJ-LPS group, but the levels were still higher than those in LPS group at 72 hours [IL-4 (ng/L): 92. 2±7. 6 vs.41.5±4. 5; IL-10 (ng/L): 92. 1±7. 8 vs. 35. 6±4. 0, both P＜0. 05]; the levels of TNF-α and IFN-γ were increased at 24 hours, and then decreased in SJ-LPS group, and the levels were lower than those in LPSgroup at 72 hours [TNF-α (ng/L): 82. 9±5. 6 vs. 91. 5±5. 2; IFN-γ (ng/L): 44.1±4. 8 vs. 52. 6±4. 0,both P＜0. 05]. Therefore, chronic SJ infestation could improve the survival rate of mice with sepsis induced by CLP or LPS (CLP: 80% vs. 20%, LPS: 70% vs. 30%, both P＜0.05). Conclusion Chronic SJ infestation could elevate anti-inflammatory factors in septic mice, thus ameliorating the survival rate, so it has protective effect on mice with sepsis.     

截肢伤小鼠巨噬细胞对T细胞的直接接触抑制作用

利用小鼠截肢伤模型，观察创伤小鼠巨噬细胞对Ｔ细胞的直接接触抑制作用。结果显示：以２５μｇ／ｍｌ的丝裂霉素Ｃ处理巨噬细胞３０ｍｉｎ，可阻断巨噬细胞白介素１（ＩＬ－１）、白介素６（ＩＬ－６）、肿瘤坏死因子（ＴＮＦ）及前列腺素Ｅ２（ＰＧＥ２）的合成与分泌。创伤小鼠巨噬细胞经丝裂霉素Ｃ处理后，可明显抑制正常Ｔ淋巴细胞转化活性、白介素２（ＩＬ－２）ｍＲＮＡ及ＩＬ－２受体（ＩＬ－２Ｒα）ｍＲＮＡ水平、ＩＬ－２     

创伤后细胞免疫功能受抑的机理及中药免疫调理作用研究

创伤后细胞免疫功能受抑的机理及中药免疫调理作用研究Ａｓｔｕｄｙｏｎｔｈｅｍｅｃｈａｎｉｓｍｓｏｆｓｕｐｐｒｅｓｅｄｃｅｌｕｌａｒｉｍｍｕｎｉｔｙａｎｄｔｈｅｉｍ┐ｍｕｎｏｍｏｄｕｌａｔｉｏｎｏｆｃｈｉｎｅｓｅｈｅｒｂａｌｍｅｄｉｃｉｎｅａｆｔｅｒｔ...     

黄芪多糖、人参茎叶皂甙对手术病人细胞免疫功能的影响

手术病人术后２天和７天外周血单个核细胞（ＰＢＭＣ）的Ｔ淋巴细胞转化及白介素２（ＩＬ２）的生成均明显降低。５０～２５０μｇ／ｍｌ的黄芪多糖（ＡＰＳ）、０．１～１００μｇ／ｍｌ的人参茎叶皂甙（ＧＳＬ）在体外对术后７天ＰＢＭＣ的Ｔ淋巴细胞转化及ＩＬ２的生成均具有不同程度的升高作用，表明ＡＰＳ、ＧＳＬ对手术病人ＰＢＭＣ具有直接的刺激活性。