环丙沙星在机械通气下呼吸道重症感染患者中的肺组织渗透性研究

目的评价环丙沙星在机械通气的下呼吸道重症感染患者的药代动力学和肺组织渗透性研究。方法入选用有创通气治疗的下呼吸道重症感染患者12例,静脉滴注环丙沙星0.2 g或0.4 g,给药间隔为12 h或24 h,给药后3 h进行支气管镜和肺泡灌洗,治疗72 h后开始留取血清标本,用高效液相色谱(HPLC)法检测血清和肺泡灌洗的药品浓度。结果共检测环丙沙星血清药品浓度84份,肺泡灌洗药品浓度12份。环丙沙星0.2 g患者Cmax和给药3 h的肺泡上皮衬液浓度分别为(4233.4±1165.9)和(1202.5±291.5)ng·m L-1,肺组织渗透率为(0.72±0.54)。环丙沙星0.4 g患者Cmax和给药3 h的肺泡上皮衬液浓度分别为(5342.7±1210.2)和(2219.4±612.7)ng·m L-1,肺渗透率为(0.90±0.67)。环丙沙星0.4 g的肺组织渗透率显著高于0.2 g(P<0.05)。结论环丙沙星在有创机械通气的下呼吸道重症感染患者有较好的肺组织渗透性,且提高单次使用剂量可明显增强感染患者肺组织渗透性。     

一种感染性非人灵长类实验装置的生物安全研究

目的 拟设计一种在无操作时能完全隔离感染动物,又能在日常照料动物时形成定向气流的实验装置,保证非人灵长类动物正常生物学特性表达的同时还能有效防止气溶胶感染。方法 使用具有氯霉素抗性的大肠杆菌(Cl+, E.coli, Rosetta菌株)作为指示微生物,观察处于本实验装置中非人灵长类在实验中的生物学特性,并采用气溶胶采集装置及沉降菌采集的方法对本实验装置内外的指示微生物进行监测。结果 在内笼指示菌富集时,本实验安全装置的外笼无论在开启还是关闭状态下,房间内、笼外及外笼均未检测到指示菌及气溶胶。结论 本实验装置能保证非人灵长类正常生物学特性的表达,并可有效防止气溶胶感染。     

呼吸机相关性气管支气管炎对慢性阻塞性肺疾病预后的影响

目的探讨呼吸机相关性气管支气管炎(VAT)对慢性阻塞性肺疾病(COPD)患者预后的影响,为临床治疗提供参考依据。方法选取2012年1月-2013年12月RICU住院进行有创机械通气治疗的COPD患者136例,其中13例确诊为VAT,设为VAT组,配对病例13例,设为对照组,比较两组患者预后。结果 13例VAT患者送检标本检出细菌共19株,其中18株为多药耐药菌,占94.7%,对照组7株占77.8%(P<0.05);VAT组混合感染患者6例占46.2%,对照组3例占23.1%(P<0.05);VAT相关的常见病原菌为铜绿假单胞菌、鲍氏不动杆菌和MRSA;VAT组机械通气时间明显延长,为22d,对照组仅为13d(P<0.05);VAT组患者ICU住院时间也明显延长为28d,对照组仅为16d(P<0.05);VAT组中使用恰当抗菌药物治疗的患者为6例占46.2%,与使用非恰当抗菌药物的患者相比,机械通气时间较短,分别为12d和20d,ICU住院时间较短,分别为17d和23d,但上述差异无统计学意义。结论 VAT会导致COPD患者机械通气和ICU住院时间延长,恰当的初始抗菌药物治疗有助于改善VAT患者预后。     

Excretion and detection of SARS coronavirus and its nucleic acid from digestive system

AIM: To study whether severe acute respiratory syndrome coronavirus (SARS-CoV) could be excreted from digestive system. METHODS: Cell culture and semi-nested RT-PCR were used to detect SARS-CoV and its RNA from 21 stool and urine samples, and a kind of electropositive filter media particles was used to concentrate the virus in 10 sewage samples from two hospitals receiving SARS patients in Beijing in China. RESULTS: It was demonstrated that there was no live SARS-CoV in all samples collected, but the RNA of SARS-CoV could be detected in seven stool samples from SARS patients with any one of the symptoms of fever, malaise, cough, or dyspnea, in 10 sewage samples before disinfection and 3 samples after disinfection from the two hospitals. The RNA could not be detected in urine and stool samples from patients recovered from SARS. CONCLUSION: Nucleic acid of SARS-CoV can be excreted through the stool of patients into sewage system, and the possibility of SARS-CoV transmitting through digestive system cannot be excluded.     

TSHR第三胞内袢基因突变与毒性多结节性甲状腺肿发病的相关研究

目的探讨促甲状腺激素受体(TSHR)第三胞内袢基因突变在毒性多结节性甲状腺肿(TMG)自主高功能性形成中的作用。方法将16例TMG患者手术切除标本及其作为对照的甲状腺正常组织,用酚-氯仿-异戊醇法提取基因组DNA,对目的基因片断进行聚合酶链反应(PCR)及行DNA测序。结果在16例TMG 标本中,发现3例为622位密码子的点突变。异亮氨酸被苯丙氨酸置换(I622F,ATT→TTT),2例为单碱基插入性突变,在1928位和1929位核酸之间播入了一个鸟嘌呤核苷酸(G),使该密码子609位以后氨基酸发生了移码突变。在对照组中,未发现TSHR基因突变。结论 TSHR第三胞内袢基因突变,可能在TMG发病中起重要作用。     

脑梗死患者颅内血管狭窄的危险因素分析

目的分析脑梗死患者颅内血管狭窄的危险因素。方法对186例脑梗死患者行经颅多普勒超声检查,检测血尿酸和血脂包括总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯。结果血管狭窄组患者总胆固醇(5.04±1.23 mmol/L)和低密度脂蛋白胆固醇水平(2.99±1.01 mmol/L)均显著高于无狭窄组患者(分别为4.60±1.12 mmol/L和2.59±0.69 mmol/L,P<0.05);Pearson相关分析表明,颅内血管峡窄与高血压史(r=0.206,P=0.005)、糖尿病史(r=0.238,P=0.001)、总胆固醇(r=0.181,P=0.016)、低密度脂蛋白胆固醇(r=0.227,P=0.003)及尿酸(r=0.132,P=0.016)相关;Logistic回归分析表明,高血压、糖尿病、低密度脂蛋白胆固醇、尿酸进入回归方程,它们对颅内血管狭窄的OR值分别为2.345、2.554、1.764和1.006(P<0.05)。结论除高血压和糖尿病外,尿酸和低密度脂蛋白胆固醇亦是脑梗死患者颅内血管狭窄形成的独立危险因素。     

重组人粒细胞集落刺激因子对兔颈动脉粥样硬化球囊损伤后再内皮化和内膜增生的影响

Objeelive To investigate the effect of rhG-CSF on mobilizing bone marrow-MSCs, reendothelialization and intima hyperplasia in carotid artery of rabbits post balloon catheter injury, nethods Rabbits were treated with rhG-CSF (25 μkg, twice daily, i. p, n =35) or saline (n =32) for 5 days, then, carotid arteries of rabbits were injured by balloon catheter. The number of peripheral MSCs was detected with FACS. The morphology of injuried artery was examined with hematoxylin and eosin stain, PCNA was determined with immunohistochemistry. Results (1) Number of peripheral MSCs was similar at baseline and significantly increased at 24 hours and peaked at 7 days and remained increased till 14 days post rhG-CSF. (2) Significant endothelial cell deletion was evidenced in the control group, while scatter endothelial cells was observed in the rhG-CSF group at 1 week post injury. Two weeks after injury, new endothelial area was significantly higher in rhG-CSF group compared to control group. At 4 weeks post injury, endothelial connection was evidenced and regularly displayed in rhG-CSF treated group. (3) PCNA-positive cells in the tunica intima were significantly lower in rhG-CSF treated rabbits at 7, 14 and 28 days compared that in control rabbits (all P ＜ 0.01). Conclusion rhG-CSF could mobilize the bone marrow-MSCs and promote re-endothelialization and attenuate intima hyperplasia post balloon catheter injury in carotid arteries of rabbits.     

MTP基因多态性与2型糖尿病血管并发症的关系

目的 探讨微粒体甘油三酯转移蛋白（MTP）基因多态性与2型糖尿病（T2DM）血管并发症的关系。方法 采用PCR—RFLP法和基因测序技术测定MTP-493位点基因型，根据大血管并发症分组进行统计学分析。结果 （1）MTP-493位点存在G—T的单碱基变异。MTP基因型频率和T等位基因频率在T2DM有或无大血管并发症组间差异有统计学意义（χ^2=9．162，P=0．01；χ^2=10．322，P=0．001）。（2）与GG或GT组相比，TT组患者的TG、TC、VLDL—C、LDL-C水平均明显升高（P〈0．05），HDL-C明显降低（P=0．009）或有降低趋势。（3）Logistic多元逐步回归分析显示T等位基因、年龄、糖尿病病程、舒张压、TC是T2DM大血管病变的独立危险因素。HDL-C与T2DM大血管病变发生呈负相关。结论 携带MTP-493TT基因型者易出现致动脉硬化性血脂异常，该基因型的糖尿病患者易出现大血管并发症。