异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用

目的探讨钙拮抗剂异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用。方法45例轻型急性胰腺炎患者被随机分为3组常规治疗组、静脉治疗组及动脉灌注组。入院后,常规治疗组采取常规保守治疗;静脉治疗组行合理液体治疗,静脉注射异搏定;动脉灌注组液体补充同时采用持续动脉灌注异搏定1~2周。测定治疗后1、4及7d血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、黏附分子-1(ICAM-1)及P-选择素(P-selectin)水平。结果治疗后4、7d,血清TNF-α和P-selectin水平动脉灌注组较静脉治疗组及常规治疗组明显降低(P<0.05);血清IL-1β水平动脉灌注组和静脉治疗组均较常规治疗组明显降低(P<0.05);血清ICAM-1水平动脉灌注组明显低于常规治疗组(P<0.05)。结论持续区域动脉灌注异搏定可能通过减少细胞因子的产生,抑制黏附分子P-selectin和ICAM-1的上调,阻止急性胰腺炎重症化发展。     

急性缺血性卒中患者发生院内消化道出血的危险因素分析

目的 分析急性缺血性卒中患者（acute ischemic stroke，AIS）住院期间消化道出血（gastrointestinal
bleeding，GIB）的发生率、发生时间及危险因素。
方法 本研究纳入首都医科大学附属北京天坛医院急性卒中院内并发症队列（inhospital medical
complication after acute stroke，iMCAS）研究中AIS患者。收集患者临床信息，根据住院期间是否发生
GIB分为GIB组和无GIB组，采用多因素Logistic回归模型，分析AIS患者发生GIB相关危险因素。
结果 共纳入1129例AIS患者，平均年龄58.7±12.5岁，女性230例（20.4%）。47例住院期间发生GIB，
发生率为4.2%，卒中发作至GIB确诊时间为5（3～13）d。合并肝硬化（OR 10.06，95%CI 2.44～41.38）、
高入院NIHSS评分（OR 1.13，95%CI 1.08～1.19）、高白细胞计数（OR 1.25，95%CI 1.13～1.38）、住院时
间长（OR 1.05，95%CI 1.01～1.10）是AIS患者发生消化道出血的独立危险因素。
结论 本单中心研究数据提示合并肝硬化、高入院NI HSS评分、高白细胞计数、住院时间长是AI S患
者住院期间发生GIB的独立危险因素。     

Calcineurin Inhibitor Withdrawal from Sirolimus-Based Therapy in Kidney Transplantation: A Systematic Review of Randomized Trials

Calcineurin inhibitor (CNI) withdrawal has been used as a strategy to improve renal allograft function, however, it also carries risk of acute rejection. We conducted a systematic review of randomized trials that involved CNI withdrawal from a sirolimus-based immunosuppressive regimen. The search strategy yielded six trials (n = 1047 patients) reported in eight publications. CNI withdrawal from sirolimus-based therapy, was associated with an increased risk of acute rejection (risk difference, 6%; 95% CI 2-10%, p = 0.002) but a higher creatinine clearance (mean difference, 7.49 mL/min; 95% CI 5.08-9.89 mL/min, p < 0.00001) at 1 year compared to continued CNI and sirolimus therapy. Graft loss (relative risk, 0.87; 95% CI 0.46-1.64, p = 0.66) and death (relative risk, 0.88; CI 0.40-1.96, p = 0.76) were similar in both groups at 1 year. Hypertension was significantly reduced in the CNI withdrawal group (relative risk, 0.56; 95% CI 0.40-0.78, p = 0.0006). CNI withdrawal from sirolimus-based therapy is associated with an increased risk of acute rejection in the short term with a significant improvement in renal function and a reduction in hypertension. Longer follow-up is needed to determine if these changes will result in a significant improvement in patient and graft survival.     

急性病毒性心肌炎的发病机制和临床特征

急性病毒性心肌炎是由病毒侵犯引起心肌本身的病变,包括病毒感染对心肌的损害、细胞免疫以及多种细胞因子等介导的心肌损害和微血管损伤。这些变化损害心脏功能和结构,而危及生命。且近年发病呈逐年上升趋势,其发病症状隐匿突然,加重了其危害性。本文就急性病毒性心肌炎发病机制和临床特征进行总结。     

吡咯烷二硫氨基甲酸酯对大鼠重症急性胰腺炎的影响

目的　探讨核转录因子 (NF κB)抑制剂吡咯烷二硫氨基甲酸酯 (PDTC)对大鼠重症急性胰腺炎 (SAP)的影响。方法　将 3 6只Wistar大鼠随机分组 :假手术组 (n =6) ,假手术 静脉注射组 (n =6) ,SAP组 (n =12 )和试验组 (n =12 )。各组于造模 6h后 ,测定血清淀粉酶及脂肪酶含量 ,取胰腺组织进行病理学评分 ,采用免疫组织化学法检测NF κB激活水平及胰腺细胞凋亡情况。结果　SAP组和试验组的胰腺细胞内NF κB呈激活状态 ,存在胰腺细胞凋亡 ,与前两组差异有显著性 (P <0 .0 1) ,试验组大鼠的胰腺组织病理学评分、血清淀粉酶及脂肪酶含量、NF κB激活及细胞凋亡水平与SAP组差异存在显著性 (P <0 .0 5 )。结论　在SAP发病机制中 ,NF κB是多种炎症介质的始动因子 ,PDTC可以有效抑制胰腺细胞中NF κB的激活 ,促进胰腺细胞凋亡 ,减少胰酶释放 ,减轻胰腺组织的病理损害。     

Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Background The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat. Materials and methods Seventy male Wistar rats were divided into five pancreatitis groups (12 animals each) and a sham-operated group (10 animals). Pancreatitis was induced by intraductal infusion of 3% taurocholate under sterile conditions. Animals received two different antibiotic regimes (20 mg/kg imipenem or 20 mg/kg ciprofloxacin plus 20 mg/kg metronidazole) early at 2, 12, 20, and 28 h after induction of pancreatitis or late at 16 and 24 h after induction of pancreatitis or no antibiotics (control). Animals were examined after 30 h for pancreatic and extrapancreatic infection. Results Early and late antibiotic treatment with both regimes could significantly reduce pancreatic infection from 58 to 8–25%. However, extrapancreatic infection was only reduced by early antibiotic therapy. While quinolones also reduced bacterial counts in small and large bowel, imipenem did not. Conclusions In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.     

Clinical influence of vagotomy on postoperative acute phase response

BACKGROUND: Although there is increasing evidence suggesting that the vagus nerve functions as a connector between the nervous and immune systems in animals, little is known about the role of the vagus nerve in postoperative acute phase response in humans. MATERIALS AND METHODS: The extent of fever and acute phase protein response and the production of inflammatory cytokine during the early postoperative period were compared among the patients who had undergone total gastrectomy including truncal vagotomy (n = 13), those having distal gastrectomy with division of vagal branches (n = 14), and the patients with vagal nerve preserving gastrectomy (n = 12). RESULTS: There was no significant difference in serum levels of C-reactive protein, alpha-1-antirypsin, and interleukin-6 among the three groups. Also, postoperative maximum body temperature was similar. CONCLUSIONS: Vagotomy did not influence acute phase response after gastric cancer surgery. A multipathway mechanism for acute phase response including the induction of fever is suggested.     

分次灌注海水致兔呼吸窘迫综合征模型的建立

目的通过向兔气管插管内灌入海水，建立海水淹溺致急性呼吸窘迫综合征模型。方法14只新西兰大白兔被随机平分为C组（对照组，无任何处理）和S组（海水组，用海水灌注）。观察分次适量海水灌入气管插管后症状学、血气分析、血液动力学、血清中肿瘤坏死因子（TNF—α）和白细胞介素-6（IL-6）的变化。2h后给每组试验兔拍摄肺CT片，并观察其组织病理学变化。结果与C组相比，S组的O2和CO2指数显著降低（P〈0．01），呼吸动力学和血液动力学的情况明显恶化。TNF—α和IL-6增高，这一结果提示肺损伤发生于兔被海水灌注之后。另外，还发现模型兔有明显的肺水肿、肺泡隔断裂和炎性渗出。结论成功复制了既符合海水淹溺的实际情况，又符合国内外急性呼吸窘迫综合征诊断标准的海水淹溺致急性肺损伤动物模型。