清淋颗粒联合硝呋太尔治疗尿路感染的临床研究

目的 探讨清淋颗粒联合硝呋太尔治疗尿路感染患者的临床效果。方法 选择2016年10月-2017年10月荆州市中心医院收治的尿路感染患者175例,随机分成对照组（87例）和治疗组（88例）。对照组患者口服硝呋太尔片,2片/次,3次/d;治疗组患者在对照组基础上口服清淋颗粒,1袋/次,2次/d。两组患者均连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者细菌培养转阴率、尿液肝素结合蛋白（HBP）和尿液白细胞计数（WBC）及血清IL-8和降钙素原（PCT）水平。结果 治疗后,对照组临床有效率和细菌培养转阴率分别为88.51%和83.91%,均分别显著低于治疗组的97.73%和94.32%,两组比较差异均具有统计学意义（P<0.05）。治疗后,两组尿液HBP水平、尿液WBC个数均显著降低（P<0.05）,且治疗组患者两种指标明显低于对照组（P<0.05）。治疗后,两组患者血清IL-8、PCT水平显著降低（P<0.05）,且治疗组患者IL-8和PCT水平明显低于对照组（P<0.05）。结论 清淋颗粒联合硝呋太尔治疗尿路感染不但可减轻患者尿道炎症水平,而且对缓解尿道不适症状作用明显,具有一定的临床推广应用价值。     

苦甘颗粒联合注射用头孢西丁钠治疗急性气管–支气管炎的临床研究

目的探讨苦甘颗粒联合注射用头孢西丁钠治疗急性气管–支气管炎的临床疗效。方法选取2017年5月—2018年5月在绵阳市中医医院治疗的急性气管–支气管炎患者86例,根据用药的不同分为对照组(43例)和治疗组(43例)。对照组静脉滴注注射用头孢西丁钠,2.0 g加入100 mL生理盐水,2次/d;治疗组在对照组的基础上口服苦甘颗粒,8 g/次,3次/d。两组患者均经过2周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者临症状改善时间及血清超敏C反应蛋白(hs-CRP)、半胱氨酰白三烯(CysLTs)、降钙素原(PCT)、白细胞介素-1β(IL-1β)和人可溶性髓系细胞触发受体-1(sTREM-1)水平。结果治疗后,对照组临床有效率为81.40%,显著低于治疗组的97.67%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组热消退、咳嗽咳痰消失、肺部啰音消失和喘息症状消失时间均显著早于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清hs-CRP、CysLTs、PCT、IL-1β和sTREM-1水平均显著降低(P0.05),且治疗组患者这些炎症因子水平明显低于对照组(P0.05)。结论苦甘颗粒联合头孢西丁钠治疗急性气管–支气管炎有利于临床症状改善,还可降低机体hs-CRP、CysLTs、PCT、IL-1β、sTREM-1水平,具有一定的临床推广应用价值。     

京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期的临床研究

目的探讨京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期的临床研究。方法选取2017年1月—2018年12月中国人民解放军总医院和空军总医院收治的265例慢性阻塞性肺疾病急性发作期患者,随机分成与对照组(133例)和治疗组(132例)。对照组给予吸入用复方异丙托溴铵溶液,2.5 mL加入雾化器氧气驱动雾化吸入治疗,3次/d。治疗组在对照组基础上口服京制咳嗽痰喘丸,30粒/次,2次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组症状缓解时间、改良版英国医学研究委员会呼吸问卷(mMRC)评分、慢性阻塞性肺疾病患者自我评估测试问卷(CAT)评分、肺功能指标、血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是86.5%、95.5%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组咳嗽缓解时间、咳痰缓解时间、喘息缓解时间和肺部哮鸣音缓解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m MRC评分和CAT评分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组mM RC评分和CAT评分均显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、一氧化碳弥散量(DLCO)与肺泡通气量(VA)比值(DLCO/VA)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、FEV1占预计值百分比(FEV1占预计值%)均较治疗前显著增高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些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C反应蛋白(CRP)、降钙素原(PCT)、淀粉样蛋白A(SAA)、和肽素(CPP)、白三烯B4(LTB4)血清水平均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些血清学指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期具有较好的临床疗效,可迅速稳定患者病情,减轻加重的呼吸道症状,保护肺功能,缓解机体炎症应激状态,具有一定的临床推广应用价值。     

N-乙酰半胱氨酸辅助治疗对COPD急性加重期血清降钙素原、前白蛋白的影响

目的 探讨N-乙酰半胱氨酸（NAC）对慢性阻塞性肺疾病急性加重期（AECOPD）临床改善作用,并评估对血清降钙素原（PCT）、前白蛋白（PA）及抗氧化损伤的影响,分析其机制。方法 选择本院2015年2月～2017年3月收治的AECOPD患者98例,采用随机数字表法随机分为对照组和治疗组,两组各49例,对照组进行常规治疗,治疗组在对照组基础上应用NAC进行治疗。评估两组血气分析结果,对呼吸及症状的改善状况,并检测两组血清PCT、PA和丙二醛(MDA)水平。结果治疗组治疗后PaO2和PA分别为（74.20±7.39）mmHg和（274.83±15.74）mg/L,高于对照组（71.27±7.16）mmHg和（261.36±14.87）mg/L,差异具有统计学意义(P＜0.05);治疗组患者治疗后PaCO2、PCT、MDA和呼吸困难指数 (mMRC)和慢阻肺症状评分(CAT 评分)分别为（36.15±4.26）mmHg、（6.05±0.39）μg/L、（35.28±5.30）μmol/L、（1.63±0.42）分和（10.02±1.12）分,低于对照组（39.78±4.72）mmHg、（7.61±0.41）μg/L、（42.38±5.96）μmol/L、（1.85±0.49）分和（11.46±1.20）分,差异具有统计学意义(P＜0.05)。结论 对于AECOPD患者,应用NAC辅助治疗,能够显著改善患者症状和血养状况,下调PCT和MDA水平,提高血清前白蛋白水平,其作用机制与抗氧化损伤有关。     

Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia?

Purpose

This study aimed to evaluate the role of biomarkers as markers of pneumococcal bacteremia in severe community-acquired pneumonia (SCAP).

Materials and Methods

A prospective, single-center, observational cohort study of 108 patients with SCAP admitted to the intensive care department of a university hospital in Portugal was conducted. Leucocytes, C-reactive protein (CRP), lactate, procalcitonin (PCT), d-dimer, brain natriuretic peptide (BNP), and cortisol were measured within 12 hours after the first antibiotic dose.

Results

Fifteen patients (14%) had bacteremic pneumococcal pneumonia (BPP). They had significantly higher levels of median CRP (301 [interquartile range, or IQR], 230-350] mg/L vs 201 [IQR, 103-299] mg/L; P = .023), PCT (40 [IQR, 25-102] ng/mL vs 8 [IQR, 2-26] ng/mL; P < .001), BNP (568 [IQR, 478-2841] pg/mL vs 407 [IQR, 175-989] pg/mL; P = .027), and lactate (5.5 [IQR, 4.5-9.8] mmol/L vs 3.1 [IQR, 1.9-6.2] mmol/L; P = .009) than did patients without BPP. The discriminatory power evaluated by the area under the receiver operating characteristic curve (aROC) for PCT (aROC, 0.79) was superior to lactate (aROC, 0.71), BNP (aROC, 0.67), and CRP (aROC, 0.70). At a cutoff point of 17 ng/mL, PCT showed a sensitivity of 87%, a specificity of 67%, a positive predictive value of 30% and a negative predictive value of 97%, as a marker of pneumococcal bacteremia.

Conclusions

In this cohort, significantly higher PCT, BNP, lactate, and CRP levels were found in BPP, and PCT presented the best ability to identify pneumococcal bacteremia. A PCT serum level lower than 17 ng/mL could identify patients with SCAP unlikely to have pneumococcal bacteremia.     

Serum concentrations of A Proliferation-Inducing Ligand (APRIL) are elevated in sepsis and predict mortality in critically ill patients

Introduction

Inflammatory and autoimmune diseases have been associated with the tumor necrosis factor superfamily member “A PRoliferation Inducing Ligand” (APRIL). However, up to now, APRIL has not been investigated in critical illness or sepsis. We therefore analyzed APRIL serum concentrations in a large cohort of well-characterized intensive care unit patients.

Methods

Serum concentrations of APRIL were measured in 246 critically ill patients, of which 157 fulfilled sepsis criteria in comparison with 81 healthy controls. Clinical data were recorded and correlated with APRIL serum levels.

Results

We detected strongly elevated serum levels of APRIL in critically ill patients compared with healthy controls. Levels of APRIL were further elevated in sepsis and significantly correlated with classical markers of inflammation, bacterial infection, or multiorgan failure. Consequently, high APRIL levels were associated with an unfavorable prognosis and predicted mortality with higher diagnostic accuracy than established prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II score.

Conclusion

Serum levels of APRIL were significantly elevated in intensive care unit patients, with the highest concentrations in septic patients, and associated with unfavorable outcome. Besides being used as a single marker, APRIL may be implemented into established scoring systems to further improve their sensitivity and specificity in predicting patient's prognosis.     

浅谈PCT在少数民族院校口腔科学教学中的应用

口腔科学教学通常以向学生讲授为主，影响教学效果，而CT教学方法可发挥学生的主动性，教学方法灵活。本阐述了PCT教学在少数民族院校口腔科学教学中应用及以取得的良好教学效果。     

通宣理肺颗粒联合头孢丙烯治疗小儿急性上呼吸道感染的临床研究

目的 探讨通宣理肺颗粒联合头孢丙烯治疗小儿急性上呼吸道感染的临床疗效。方法 选取2021年1月—2022年10月广西中医药大学第一附属医院收治的226例急性上呼吸道感染患儿，按随机数字表法将所有患儿分为对照组和治疗组，每组各113例。对照组口服头孢丙烯颗粒，每次7.5 mg/kg，2次/d。治疗组在对照组基础上口服通宣理肺颗粒，1～3岁1/3袋/次；4～6岁1/2袋/次；7岁以上1袋/次；2次/d。两组疗程均为5 d。观察两组临床疗效、主要表现消失时间，比较治疗前后两组儿童睡眠习惯问卷（CSHQ）评分、儿少心理健康量表（MHS-CA）评分、儿童生活质量量表4.0（Peds QLTM4.0）评分及全血白细胞计数（WBC）、中性粒细胞比例（NEUT%）、C反应蛋白（CRP）、降钙素原（PCT）水平。结果 治疗后，治疗组总有效率为96.46%，显著高于对照组的88.50%（P＜0.05）。治疗组发热、咳嗽、咽痛、鼻塞、流涕消失时间均较对照组显著更短（P＜0.05）。治疗后，两组CSHQ评分均显著降低，而MHS-CA、Peds QLTM4.0评分均显著增高（P＜0.05）；且治疗后，CSHQ、MHS-CA、Peds QLTM4.0评分均以治疗组改善更显著（P＜0.05）。治疗后，两组全血WBC、NEUT%、CRP、PCT水平均显著下降（P＜0.05）；且治疗后，治疗组WBC、NEUT%、CRP、PCT水平低于对照组（P＜0.05）。结论 通宣理肺颗粒联合头孢丙烯治疗小儿急性上呼吸道感染具有较好的临床疗效，能有效加速患儿主要临床表现的消失，抑制机体感染及炎症状态，使睡眠、心理及生活质量得到有效改善，值得临床推广应用。     

PCT对发热病的诊断价值

[目的]探讨降钙素原（PCT）对发热性疾病的诊断价值。[方法]标本来自2004年8月～2005年1月全院19个科室发热伴有／不伴有全身炎症反应的83例病人，分为PCT阴、阳性两组各为41和42例，PCT检测，采用快速免疫金标法，试剂来自德国B．R．A．N．M．B．PCT-Q半定量检测，同时做各种疾病的相关检查，伴以细菌培养。[结果]其中以呼吸内科（RICU）和急诊内科（ICU）PCT阳性组各占50％和54．6％，儿科和外科（SICU）为100％。按此结果来判定感染性疾病与非感染性疾病PCT特异性各为42．24％（临床为95．2％）和73．17％。[结论]PCT检测适于临床各科，尤对ICU的监测。对感染性疾病敏感性和特异性为95％、45．2％（95．2％），今后应加强PCT和细菌培养的互利互补和动态随访。     

Validity of methods to predict the respiratory sensitizing potential of chemicals: A study with a piperidinyl chlorotriazine derivative that caused an outbreak of occupational asthma.

A piperidinyl chlorotriazine (PCT) derivative, used as a plastic UV-stabilizer, caused an outbreak of occupational asthma. We verified, in BALB/c mice, the sensitizing potential of PCT in comparison to a known respiratory sensitizer (toluene diisocyanate [TDI]) and a known dermal sensitizer (oxazolone), using three different methods in order to evaluate the validity of current models of sensitization. These included the local lymph node assay (LLNA) and the mouse IgE test. In addition, respiratory hyper-reactivity was assessed following a novel protocol involving dermal sensitization (20 microl of a 3% solution on each ear for three days) and intranasal challenge (0.1% or 1%, 10 microl per nostril on day 10), followed, after 24 h, by a methacholine challenge (using whole-body plethysmography), bronchoalveolar lavage, and histology. PCT was also used for structure-activity relationship (SAR) models for (respiratory) sensitization. High concentrations of PCT (10 and 20%) resulted in significant responses in the local lymph node assay (LLNA; stimulation indices (SI) of 2.7 +/- 0.9 and 3.2 +/- 0.6, respectively). The mouse IgE test was positive with 20% PCT only. Methacholine responsiveness was increased only in previously sensitized mice receiving a challenge with TDI or PCT. However, there was no evidence for pulmonary inflammation. The SAR studies indicated that PCT could be a respiratory sensitizer. Based on an approved test protocol such as the LLNA and the mouse IgE test, PCT proved to be a weak sensitizer when compared to TDI and oxazolone. However, in a protocol involving an intranasal challenge, PCT appeared to be a respiratory sensitizer of similar potency to TDI.