Validation of a new automated irradiation system for off-line ECP

Extracorporeal photopheresis (ECP) is a cell therapy originally employed for cutaneous T cell lymphoma and later for GvHD, solid organ rejection and other immunological diseases demonstrating an excellent safety profile. Mononuclear cell (MNCs) apoptosis triggered by UV-A light irradiation in the presence of 8-methoxypsoralene has a key role in priming the cells, ultimately leading to immunomodulation. We report preliminary data about an evaluation of the new automated irradiator device LUMILIGHT (Pelham Crescent srl) for off-line ECP. Fifteen MNCs samples collected by apheresis from 15 adult patients undergoing ECP at our Center were cultured immediately after irradiation along with untreated samples and evaluated at 24, 48 and 72 h timepoints for T cell apoptosis and viability by flow cytometry with Annexin V and Propide Iodidum staining. Post irradiation Hematocrit (HCT), calculated by the device, was compared with that of the automated cell counter. Bacterial contamination was also tested. In irradiated samples after 24–48 and 72 h, the average total apoptosis was 47 %, 70 % and 82 %, respectively, showing a significant difference from untreated samples; residual viable lymphocytes at 72 h were, on average, 18 %. The greatest initiation of apoptosis occurred from 48 h of irradiation onwards. Average early apoptosis of irradiated samples decreased over time (26 %, 17 % and 10 % at 24, 48 and 72 h, respectively). HCT measured by LUMILIGHT was over-estimated, possibly due to the low pre irradiation red blood cell contamination. Bacterial tests resulted negative. Our study showed the LUMILIGHT device to be a valid instrument for MNCs irradiation with good handling and no major technical problems as well as no adverse events in the patients. Our data need to be confirmed in larger studies.     

金贝痰咳清颗粒联合孟鲁司特钠治疗儿童喘息性支气管炎的临床研究

目的研究金贝痰咳清颗粒联合孟鲁司特钠咀嚼片治疗儿童喘息性支气管炎的临床疗效。方法选取2016年6月—2018年6月乐东黎族自治县人民医院治疗的80例喘息性支气管炎患儿作为研究对象,采用计算机单盲随机分组法将患者分为对照组和治疗组,每组各40例。对照组患儿口服孟鲁司特钠咀嚼片,4mg/次,1次/d;治疗组患儿在对照组治疗的基础上口服金贝痰咳清颗粒,7g/次,3次/d。两组患儿均连续治疗14d。观察两组患者的临床疗效,同时比较两组的临床症状缓解时间、门诊治疗时间、肺功能指标和炎症因子水平。结果治疗后,对照组和治疗组的总有效率分别为75.00%、92.50%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组喘息缓解时间、哮鸣音消失时间、咳嗽缓解时间和门诊治疗时间均显著短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组峰值呼气流速(PEF)、第1秒用力呼气容积(FEV1)和FEV1/FVC水平均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后治疗组肺功能指标显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、白三烯E4(LTE4)和嗜酸性细胞阳离子蛋白(ECP)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组炎症因子水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。结果金贝痰咳清颗粒联合孟鲁司特钠咀嚼片可有效改善喘息性支气管炎患儿的临床症状,提高疗效,改善肺功能和炎症状态,且不良反应小,具有一定临床推广应用价值。     

氨溴索联合哌拉西林舒巴坦对老年重症肺炎患者的疗效及对肺功能、IL-8、ECP的影响

目的 研究氨溴索联合哌拉西林舒巴坦对老年重症肺炎患者的疗效及对肺功能、白介素-8（IL-8）、嗜酸性细胞阳离子蛋白（ECP）的影响。方法 选择2013年1月-2017年12月宝鸡市中医医院收治的101例老年重症肺炎患者,随机分为两组。对照组静脉滴注哌拉西林舒巴坦,2.5 g/次,2次/d;观察组联合静脉滴注氨溴索,15 mg/次,2次/d。两组均治疗2周。比较两组的住院时间、临床症状改善时间、肺功能、IL-8和ECP水平。结果 观察组治疗的总有效率为92.00%,显著高于对照组的78.43%（P<0.05）。观察组的临床症状改善时间、平均住院时间均显著短于对照组（P<0.05）。两组治疗后的第一秒最大呼气量（FEV1）、用力肺活量（FVC）、用力呼气25%流速（MEF25）、最大呼气流速峰值（PEF）以及用力呼气50%流速（MWV50）均显著升高（P<0.05）;且观察组显著高于对照组（P<0.05）。两组治疗后的血清IL-8、ECP水平均显著降低（P<0.05）,且观察组显著低于对照组（P<0.05）。结论 氨溴索联合哌拉西林舒巴坦对老年重症肺炎患者的疗效显著优于单纯使用哌拉西林舒巴坦,不仅能改善其肺功能,还能有效对抗炎症反应。     

支气管哮喘患者血清特异性IgE与ECP的关系

本文对174例支气管哮喘患者进行血清特异性IgE（Phadiatop法）和其中的46例同时作了血清嗜酸性阳离子蛋白（ECP）水平的检测。结果表明，支气管哮喘患者中有67．7％是由吸入性变应原所引起，与IgE介导的变态反应有关，血清特异性IgE水平与血清ECP小平是显著的线性正相关，说明ECP水平在一定程度上反映了吸入型（外源性）哮喘的变态反应水平，可对支气管哮喘的诊断分型提供帮助。     

成人咳嗽变异型哮喘血清嗜酸粒细胞阳离子蛋白检测的临床意义

目的:探讨嗜酸粒细胞阳离子蛋白(ECP)在成人咳嗽变异型哮喘(CVA)中检测的意义。方法:通过对43例CVA患者“哮喘阶梯治疗方案”治疗前后进行第1秒用力肺活量(FEV1)和血清ECP浓度检测,同时取30例健康人作为对照组。结果:CVA组治疗前:FEV1及ECP与治疗后比较有显著性差异(P>0.01);CVA治疗前FEV1及ECP与对照组比较亦均有显著性差异(P<0.05)。结论:血清ECP水平与CVA病情变化一致。ECP浓度可反映CVA体内炎性细胞激活的程度,可作为气道炎症变化的指标,同时又可用于指导CVA的治疗。     

CAP检测系统在过敏性鼻炎诊疗中的应用

目的观察过敏原检测CAP系统检测的过筛项目在过敏性鼻炎诊疗中的临床意义。方法用PharmaciaUniCAP100系统对86例过敏性鼻炎患者进行血清嗜酸细胞阳离子蛋白（ECP）、总IgE、吸入性变应原Phadiatop和食物性变应原fx5E测定,并选定20例非过敏性鼻炎患者作对照。结果过敏性鼻炎组血清ECP升高（〉15μg/L）者65例,占75.6%,对照组血清ECP升高者1例,占5.0%。总IgE升高（〉120kU/L）者80例,占93.0%,对照组血清总IgE升高者2例,占10.0%;Phadiatop阳性者76例,占88.4%,对照组3例,占15.0%。Phadiatop阳性中,D1阳性70例,D2阳性74例,H1阳性70例,分别占81.4%、97.4%和92.1%,有67.2%的患者血清有2种及以上的过敏原呈阳性反应,提示存在多种过敏原综合致敏的情况。fx5E阳性仅2例,占2.3%,对照组则阴性。结论用CAP变应原检测系统是一种可用于筛查和寻找过敏性鼻炎过敏原的体外检测手段,可为过敏性鼻炎预防、诊断和治疗提供依据。     

糖皮质激素不同给药方式治疗老年支气管哮喘的疗效评估

目的：评估糖皮质激素局部雾化吸入、全身使用及两者序贯应用在治疗老年哮喘患者中的疗效。方法老年急性发作期哮喘患者63例随机均分为3组,A组给予全程全身糖皮质激素治疗;B组全程局部雾化吸入糖皮质激素;C组先全身应用再局部雾化吸入糖皮质激素。疗程结束后,评估患者临床疗效,测定患者诱导痰EOS、ECP值及肺功能。结果 C组临床疗效高于其他治疗组（P〈0.05）,肺功能的改善程度高于其他组（P〈0.05）,诱导痰EOS、ECP水平降低,与其它治疗组有显著性差异（P〈0.05）。结论治疗老年人哮喘序贯性使用糖皮质激素较单一局部雾化吸入或全身应用疗法临床效果更佳。     

Update on extracorporeal photopheresis in heart and lung transplantation

Transplant rejection of solid organs remains a threat to thousands of patients despite modern immunosuppressive regimens. The currently available drugs are associated with severe complications such as hypertension, diabetes mellitus, renal failure, risk of infections, and malignancies among many others and, often enough, still allow episodes of rejection. New and less-toxic immunologic measures are desperately needed to accomplish the desired tolerance to the transplant without the undesirable side effects. Extracorporeal photopheresis (ECP) has been shown to benefit especially patients with cardiac transplants, but also those who received lung allografts. ECP likely modulates the recipient's antigen-specific immune responses and inflammation in transplantation by in vivo generation of apoptotic leukocytes. This review will highlight the need for ECP, how it is thought to act, and the published evidence for its role in cardiac and pulmonary transplantation.     

中医药对支气管哮喘ECP影响的研究

参阅相关文献,就中药复方、单味中药及提取物、穴位敷贴和其他外治法方面对支气管哮喘嗜酸性粒细胞阳离子蛋白(ECP)影响的研究现状做简要综述,从而更好地揭示中医药治疗哮喘的作用机制.