下颌下腺保存治疗新技术体系的建立与应用

The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.     

FeNO联合IgE检测对学龄前儿童哮喘的早期识别价值

目的 探讨反复喘息学龄前儿童呼出气一氧化氮（fractional exhaled nitric oxide,FeNO）水平与血清免疫球蛋白E（immunoglobulin E,IgE）水平的关系。方法 回顾性分析2019年6月至2021年5月南充市中心医院收治的132例学龄前喘息患儿的临床资料,根据6岁以下儿童哮喘诊断标准模型分为哮喘组（n=67）和非哮喘组（n=65）,检测并比较两组患儿的FeNO、IgE水平,分析两组患儿FeNO与IgE的关系。结果 哮喘组患儿的FeNO、IgE水平均显著高于非哮喘组,差异均有统计学意义（P<0.05）。哮喘组和非哮喘组患儿的FeNO与IgE均呈正相关（r>0）,FeNO水平对IgE水平有显著正向影响。结论 哮喘患儿的FeNO、IgE水平均明显升高,且两者呈正相关,FeNO和IgE联合检测有利于学龄前儿童哮喘的早期识别。     

益气通腑散穴位贴敷对腹腔镜直肠癌Dixon术后患者胃肠功能及免疫指标的影响

目的:观察益气通腑散穴位贴敷对腹腔镜直肠癌直肠低位前切除术(Dixon)术后患者胃肠功能及免疫指标的影响。方法:将67例接受腹腔镜直肠癌Dixon术患者采用随机双盲法分成2组,在常规治疗基础上,治疗组予益气通腑散穴位贴敷,对照组予安慰剂穴位贴敷,观察比较2组胃肠功能、T淋巴细胞亚群(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)、免疫球蛋白(IgA、IgG、IgM)、血清白蛋白(Alb)、前白蛋白(PA)、不良反应发生率及住院时间等情况。结果:治疗组肠鸣音恢复时间、肛门首次排气时间、首次排便时间、胃管留置时间、住院时间均短于对照组,且胃管引流量较对照组少(P<0.05);治疗后,2组T淋巴细胞亚群指标、免疫球蛋白、血清Alb及PA均优于治疗前(P<0.05),且治疗组优于对照组(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:益气通腑散穴位敷贴能促进腹腔镜直肠癌Dixon术后患者胃肠功能恢复、改善营养状况、增强免疫功能。     

鼻康片联合氯雷他定片治疗变应性鼻炎临床研究

目的:观察鼻康片联合氯雷他定片治疗变应性鼻炎的临床疗效。方法:将变应性鼻炎患者102例随机分为对照组和治疗组各51例,对照组给与氯雷他定片进行治疗,治疗组在对照组的基础上加用鼻康片治疗,2组均以1周为1个疗程,共治疗2个疗程。统计2组临床疗效,治疗前后中医证候积分及血清白细胞介素-4 (IL-4)、白细胞介素-2 (IL-2)、免疫球蛋白E(IgE)水平变化。结果:治疗组总有效率为98.04%,对照组为86.27%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组证候积分均较治疗前降低(P<0.05),且治疗组积分低于对照组(P<0.05)。治疗后,2组血清IL-4、IL-2、lgE水平均较治疗前明显降低(P<0.05),且治疗组各项指标均低于对照组(P<0.05)。结论:鼻康片联合联合氯雷他定片治疗变应性鼻炎效果确切,可显著缓解患者临床症状,下调IL-4、IL-2、lgE水平,疗效优于单纯氯雷他定片治疗。     

14种食物特异性IgG抗体检测在肠易激综合征中的应用价值

目的：研究肠易激综合征（irritable bowel syndrome，IBS）患者食物过敏原的变态反应状况，为临床提供诊断和防治IBS的依据。方法：采用ELISA法检测118例IBS组和20例正常对照组对14种食物过敏原的IgG浓度。结果：118例IBS患者血清食物过敏原IgG检测结果阳性率依次为：鸡蛋52．6％，虾40．8％，蟹28．9％，西红柿15．8％，鳕鱼9．2％，玉米和大米7．9％，牛肉3．9％，蘑菇2．6％，牛奶、猪肉、大豆和鸡肉均为1．3％。正常组仅鸡蛋和虾特异性IgG抗体轻度增高，阳性率分别为2．6％和1．3％。结论：血清食物过敏原IgG检测可以及时发现IBS对哪些食物过敏，并尽早将这些食物剔除，此方法是诊断和防治IBS的重要措施之一。     

加味五虎汤联合孟鲁司特钠治疗儿童咳嗽变异性哮喘临床观察

目的:观察加味五虎汤联合孟鲁司特钠治疗儿童咳嗽变异性哮喘的临床疗效及对患者相关临床指标的影响。方法:选取98例咳嗽变异性哮喘(CVA)患儿作为观察资料,按随机数字表划分为西药组与联合组,西药组给予孟鲁司特钠治疗,联合组给予加味五虎汤联合孟鲁司特钠治疗; 治疗30 d后评价两组临床疗效,观察治疗前后两组患儿肺功能、血清指标的变化情况,统计治疗期间两组患儿不良反应发生情况。结果:联合组临床疗效优于西药组且总有效率(93.88%)高于西药组(77.55%),差异有统计学意义(P<0.05); 治疗后,两组患儿肺活量(FVC)、第 1 秒用力呼吸量(FEV₁)、最大呼气峰流速(PEF)均较治疗前好转,联合组均优于西药组(P<0.05); 治疗后,两组患儿转化生长因子-1β(TGF-1β)、白细胞介素-13(IL-13)、免疫球蛋白E(IgE)、嗜酸性粒细胞(Eos)均较治疗前好转,联合组均优于西药组(P<0.05); 联合组不良反应发生率(4.08%)低于西药组(16.33%),差异有统计学意义(P<0.05)。结论:加味五虎汤联合孟鲁司特治疗儿童咳嗽变异性哮喘疗效良好,能够进一步改善患儿肺功能与临床血清相关指标,对于预防复发有较好疗效。     

血清食物特异性IgG与慢性荨麻疹相关性研究

目的探讨慢性荨麻疹发病与血清中食物特异性IgG抗体的关系。方法应用酶联免疫吸附试验（ELISA）检测111例慢性荨麻疹患者（慢性荨麻疹组）血清中食物特异性IgG抗体水平,并与30例健康受试者（对照组）资料进行对比研究。结果111例慢性荨麻疹患者中,食物特异性IgG抗体阳性79例（阳性率为71．17％）,与对照组阳性率（43．33％）比较,差异有统计学意义（X2=8．071,P〈0．01）。且慢性荨麻疹组以鸡蛋特异性IgG抗体阳性率最高（51．35％）,其次是虾（43．24％）、牛奶（38．74％）、螃蟹（34．23％）、大豆（27．93％）,慢性荨麻疹组鸡蛋、虾、螃蟹、鳕鱼、大豆特异性IgG抗体阳性率与对照组比较,差异有统计学意义（P〈0．05）。结论食物特异性IgG抗体与慢性荨麻疹发病具有相关性,血清食物特异性IgG水平检测对慢性荨麻疹的预防和治疗具有重要意义。     

The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients

Background

Sepsis complication is a major cause of death in multiple trauma critically ill patients. Defensin (cysteine rich anti-microbial peptides), as an important component of immune system, might play an important role in this process. There is also rising data on immunological effects of N-acetyl-cysteine (NAC), a commonly used anti-oxidant in oxidative stress conditions and glutathione (GSH) deficiencies. The aim of the present study was to evaluate the potential beneficial effects of NAC administration on multiple trauma patients with sepsis.

Methods

In a prospective, randomized controlled study, 44 multiple trauma critically ill patients who were mechanically ventilated and met the criteria of sepsis and admitted to the intensive care unit (ICU) were randomized into two groups . Control group received all standard ICU therapies and NAC group received intravenous NAC 3 gr every 6 hours for 72 hours in addition to standard therapies. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, length of ICU stay, ICU mortality were recorded. Levels of serum Immunoglobulin M (IgM), Human β-Defensin 2 (HβD2) and GSH were assessed at baseline and 24, 72, 120 hours after intervention.

Results

During a period of 13-month screening, 44 patients underwent randomization but 5 patients had to be excluded. 21 patients in NAC group and 18 patients in control group completed the study. For both groups the length of ICU stay, SOFA score and systemic oxygenation were similar. Mortality rate (40% vs. 22% respectively, p = 0.209) and ventilator days (Mean ± SD 19.82 ± 19.55 days vs. 13.82 ± 11.89 days respectively, p = 0.266) were slightly higher for NAC group. IgM and GSH levels were similar between two groups (p = 0.325, 0.125 respectively), HβD2 levels were higher for NAC group (at day 3).

Conclusion

High dose of NAC administration not only did not improve patients’ outcome, but also raised the risk of inflammation and was associated with increased serum creatinine.     

Cerebral arteriostenosis associated with elevated serum-immunoglobulin E level in young adults without risk factors for ischemic stroke: A possible manifestation of cerebral vasculitis?

We report a series of young adults with symptomatic cerebral arteriostenosis characterized by elevated serum immunoglobulin (Ig) E levels. All patients had no definite risk factors for cerebral vascular diseases. The clinical data of 26 young adults (age 18–50 years) with ischemic stroke, characterized only by increased serum IgE levels and without risk factors for cerebral vascular disease, were retrospectively reviewed. Arteriostenosis was surveyed and followed-up by digital subtraction angiography (DSA), and the stenosis rate was estimated using the warfarin–aspirin symptomatic intracranial disease technique. All patients were treated with corticosteroids according to the common strategy for vasculitis. There was no recurrent stroke during follow-up. The mean degree of stenosis before and after treatment was 69.3 ± 29.8% and 47.9 ± 45.1%, respectively. The difference of stenosis rates between initial and follow-up DSA evaluation was significant using a paired samples test (21.31 ± 26.88, 95% confidence interval [CI] 13.58–29.03, t = 5.55, p < 0.001). Kaplan–Meier survival analysis revealed that the 13-month cumulative improved lesion rate was 40.3 ± 8.7%. This remained the same at 18 months. The mean time to lesion improvement was 12.58 ± 0.96 months (95% CI 10.70–14.46) and median time was 13 ± 3.88 months (95% CI 5.39–20.61). To our knowledge, cerebral arteriostenosis with only elevated IgE serum levels has not been reported. Our data showed that corticosteroid treatment can achieve clinical and artery improvement. This suggests that the cerebral arteriostenosis seen in our study might be caused by some specific type of vessel inflammation.