我国城乡基层“2 + X”家庭医生团队现状与预测研究

目的 预测“十四五”期间我国城乡人口和基层医疗卫生机构“2 + X”家庭医生团队数量,探究我国城乡家庭医生服务覆盖情况,为家庭医生健康发展提供科学依据。方法 依据2013—2019年相关数据,采用GM(1,1)灰色预测模型预测2020—2025年我国城乡人口数和“2 + X”家庭医生团队数量和相关卫技人员数。观察每 2000 服务人口标准下,2018—2025年我国城乡“2 + X”家庭医生团队服务人数和服务覆盖率。结果 2020—2025年我国城镇人口数逐年增长,到2025年增至98 831万人;城市基层医疗卫生机构全科医生数、注册护士数、家庭医生团队数量逐年增长,到2025年分别增至171 712人、848 324人、171 712个;全科医生与护士比逐年上升,到2025年升至1∶4.94;2018—2025年我国城市“2 + X”家庭医生团队服务人口覆盖率逐年上升,到2025年升至35%。2020—2025年我国乡村人口数逐年下降,到2025年降至48 053万人;乡镇基层医疗卫生机构全科医生数、注册护士数、家庭医生团队数量逐年增长,到2025年分别增至447 672人、854 976人、447 672个;全科医生与护士比逐年下降,到2025年降至1:1.91;2018—2025年我国乡村“2 + X”家庭医生团队服务人口覆盖率逐年上升,理论上2022年实现全面覆盖。结论 2018—2025年我国城乡“2 + X”家庭医生团队数量逐年增加,但城市家庭医生缺口较大,应加强全科医学人才培养,增强家庭医生职业吸引力,缩小城乡全科医生薪资差距,优化家庭医生服务覆盖均衡性。     

Component-Resolved Diagnosis of Hazelnut Allergy in Children

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.     

老年慢性病患者肺部感染与CD14及HLA基因多态性的关系

目的分析老年慢性病患者肺部感染与白细胞分化抗原14(CD14)和人类白细胞抗原(HLA)基因多态性的关系。方法选取2017年10月-2019年10月菏泽市单县中心医院老年慢性疾病患者615例,以其中合并肺部感染者97例(15.77%)为研究组,另在未合并肺部感染者中随机抽取92例为对照组,采集两组临床资料,检测并比较两组CD14-159 C/T、CD14-260 C/T和HLA-A、HLA-B和HLA-DRB1基因分布。结果两组患者性别、年龄、体质量指数(BMI)及基础疾病等临床资料比较差异无统计学意义,研究组合并慢性疾病种类较对照组多(P<0.05);两组CD14-159 C/T基因型分布差异显著(P<0.05),研究组CD14-159 C等位基因频率显著低于对照组,T等位基因频率显著高于对照组(P<0.05),两组CD14-260 C/T基因型及等位基因频率比较差异无统计学意义;研究组HLA-A*0101等位基因频率高于对照组,HLA-B*5201和HLA-DRB1*1502等位基因频率低于对照组,差异有统计学意义(P<0.05)。结论合并慢性疾病种类较多的老年慢性疾病患者容易发生肺部感染,感染可能与CD14和HLA基因多态性有关,CD14-159 TT和HLA-A*0101可能为易感基因。     

胆道结石术后继发急性胆管炎病原菌及sCD14-ST和IL-8的诊断价值

目的探讨胆道结石术后继发急性胆管炎病原菌及可溶性CD14亚型(sCD14-ST)、白细胞介素-8(IL-8)的诊断价值。方法选择海南医学院第一附属医院2017年1月-2019年6月收治的胆道结石术后继发急性胆管炎患者62例作为研究对象,纳入研究组,选择同期医院收治的胆道结石术后未继发急性胆管炎的患者60例设为对照组;对研究组患者病原菌进行统计;比较不同急性胆管炎程度、不同预后结局患者血清sCD14-ST、IL-8水平;采用受试者工作特征曲线评估血清sCD14-ST、IL-8水平对于患者不良预后的诊断价值。结果 62例患者共培养分离病原菌67株,其中革兰阴性菌43株占64.18%,革兰阳性菌21株占31.34%,真菌3株占4.48%,以大肠埃希菌为主;重度急性胆管炎患者血清sCD14-ST、IL-8分别为(91.38±25.67)pg/ml、(45.28±13.61)pg/ml高于中度患者分别为(74.34±19.65)pg/ml、(32.06±10.44)pg/ml及轻度患者(P均<0.001),中度患者血清sCD14-ST、IL-8水平高于轻度患者(P均<0.001);预后不良患者急性胆管炎血清sCD14-ST、IL-8分别为(89.84±25.09)pg/ml、(41.94±12.28)pg/ml高于预后良好患者(P<0.05);sCD14-ST、IL-8对胆道结石术后急性胆管炎患者预后的截断值分别为65.65、29.31 pg/ml,其曲线下面积分别为0.841、0.768。结论胆道结石术后继发急性胆管炎病原以革兰阴性菌为主;运用血清sCD14-ST、IL-8可较好区分疾病严重程度,且对患者预后具有一定预测价值。     

Binding of lipopeptide to CD14 induces physical proximity of CD14, TLR2 and TLR1

Lipoproteins or lipopeptides (LP) are bacterial cell wall components detected by the innate immune system. For LP, it has been shown that TLR2 is the essential receptor in cellular activation. However, molecular mechanisms of LP recognition are not yet clear. We used a FLAG-labeled derivative of the synthetic lipopeptide N-palmitoyl-S-[2,3-bis(palmitoyloxy)-(2R,S)-propyl]-(R)-cysteinyl-seryl-(lysyl)(3)-lysine (Pam(3)CSK(4)) to study the roles of CD14, TLR2 and TLR1 in binding and signaling of LP and their molecular interactions in human cells. The activity of Pam(3)CSK(4)-FLAG was TLR2 dependent, whereas the binding was enabled by CD14, as evaluated by flow cytometry and confocal microscopy. Using FRET and FRAP imaging techniques to study molecular associations, we could show that after Pam(3)CSK(4)-FLAG binding, CD14 and Pam(3)CSK(4)-FLAG associate with TLR2 and TLR1, and TLR2 is targeted to a low-mobility complex. Thus, LP binding to CD14 is the first step in the LP recognition, inducing physical proximity of CD14 and LP with TLR2/TLR1 and formation of the TLR2 signaling complex.     

FT-2 antigen for distinguishing lymphocyte subpopulations in the developing thymus

The surface phenotypes of lymphoid cells in the developing embryonic thymus were characterized by using monoclonal antibodies. FT-2 antigen thus defined was predominantly expressed on thymocytes in the earlier embryonic stages in all the inbred mouse strains tested. The immunofluorescence and immunoperoxidase tests indicated that, like FT-1 antigen, the proportion of FT-2+ fetal thymocytes rapidly decreased with increase in gestation time, and these cells disappeared by day 19 of gestation. The treatment of fetal thymocytes with anti-FT-1 plus complement eliminated not only FT-1+, but also FT-2+ cells, whereas the treatment with anti-FT-2 failed to eliminate approximately 40% of FT-1+ cells, suggesting that embryonic thymocytes can be provisionally divided into at least three subpopulations, FT-1+2+, FT-1+2- and FT-1-2-.     

Clonal proliferation of cyclin D1-positive mantle lymphocytes in an asymptomatic patient: an early-stage event in the development or an indolent form of a mantle cell lymphoma?

Mantle cell lymphoma (MCL) is a B-cell neoplasm with a relatively aggressive clinical course. There is a very small subgroup of patients who present with atypical lymphocytes in peripheral blood, with or without lymphocytosis, lymphadenopathy, or splenomegaly, and with an indolent clinical course. They frequently show mutated IgV(H) genes and CD5 negativity. We report an asymptomatic elderly patient who presented with a single submandibular lymphadenopathy. The biopsy showed immunophenotype and t(11;14)(q13;q32) consistent with MCL. The abnormal lymphoid population was also detected in peripheral blood and bone marrow. The patient has remained asymptomatic for 5 years without receiving any therapy. It is uncertain whether these cases represent an early-stage event in the development or an indolent form of MCL. The existence of such asymptomatic patients with an indolent clinical course should induce a strict clinical judgment in terms of therapeutic decisions.     

内毒素血症小鼠巨噬细胞膜脂改变对CD14表达及TNFα分泌的影响

目的 以小鼠内毒素血症为模型,研究小鼠腹腔巨噬细胞膜脂改变,及其对受体CD14表达及血浆TNFα产生的影响。方法 48只小鼠分为3组。①对照线（n=8）;②内毒素血症组：小鼠尾静脉注射LPS,200μg/只,分1、3、5、8 4个观察时相点,每个时相点8只动物;③脂质体预处理组（n=8）：小鼠腹腔注射卵磷脂脂质体1ml(1mg/ml),18h后尾静脉注射LPS,200μg/只,5h后观察巨噬细胞膜脂成分、膜流动性及CD14阳性率、血浆中TNFα含量的变化。结果 LPS刺激下,巨噬细胞主要膜脂成分降解,细胞膜荧光偏振度、微粘度和分子排列有序系数增加,膜流动性显著降低;CD14阳性率增加,5h达高峰,8h降至正常水平;TNFα含量显著升高,3h达高峰,8h降至正常水平。磷脂脂质体预处理后,膜损伤减轻,CD14阳性率及TNFα含量均明显降低。结论 内毒素血症小鼠腹腔巨噬细胞膜磷脂降解,细胞膜从相对比较流动变为相对固化,这可能是膜受体CD14阳性率增加,TNFα产生增多的重要原因。脂质体预处理能修复膜损伤,减少膜CD14表达,减轻炎症反应。     

Non-endotoxinic tumour necrosis factor-{alpha}-inducing factors in haemodialysis

A transmembrane passage of endotoxins may account for the dysfunctionof cytokine production which has been often reported in haemodialysis.We developed an assay based on the ability of patient serumto stimulate tumour necrosis factor (TNF) secretion in normalperipheral blood mononuclear cells. Three groups of subjectswere investigated: normal controls (n=14), patients with chronicrenal failure, CRF (n=15), and patients dialysed with poly-acrylonitrile(n=7), polysulphone (n=8), and cellulose acetate (n=7). Serafrom dialysed patients displayed a significantly higher TNF-inducingactivity than those of controls and CRF patients. The abilityof serum to elicit TNF secretion was neither modified duringthe dialysis session nor influenced by the type of haemodialysismembrane. TNF-inducing activity in serum was not inhibited bypolymyxin B, known to impair endotoxin-dependent cell responses,thus suggesting that it was not related to circulating endotoxins.We conclude that non-endotoxinic factors are present in serumfrom dialysed patients and are able to induce cytokine secretion.     

烫伤后脂多糖受体CD14和肿瘤坏死因子-α基因表达的变化规律

目的 观察烫伤后机体主要脏器脂多糖受体ＣＤ１４（ＣＤ１４）和肿瘤坏死因子－α（ＴＮＦ－α）ｍＲＮＡ的表达的变化规律及二者的相互关系。方法 采用大鼠３５％Ⅲ度烫伤模型,分别于伤前,伤后１２,２４,４８,７２小时活杀动物,留取组织标本或分离腹腔巨噬细胞,检测组织或巨噬细胞ＣＤ１４,ＴＮＦ－αｍＲＮＡ表达。结果 烫伤后肝,肺,肾,肠等组织ＣＤ１４ｍＲＮＡ水平均有不同程度增高,分别于伤后１２小时和４８小时