不同免疫调节方式对烧伤脓毒症大鼠炎性反应的影响

Objective To investigate the effect of Thymosin and growth hormone(GH) on inflam-matory response in burn rats or burn rats with sepsis. Methods Sixty-four SD rats were randomly divided into normal control group (NC, without treatment), sepsis group (S, with injection of LPS), sepsis + Thy-mosin group (ST, with successive injection of Thymosin and LPS), sepsis + GH group [SGH, with succes-sive injection of recombinant human GH (rhGH) and LPS], burn group, burn + sepsis group (BS, with in-jection of LPS after burn), burn + sepsis + Thymosin group (BST, with successive injection of Thymosin and LPS after burn), burn + sepsis + GH (BSGH, with successive injection of rhGH and LPS after burn), with 8 rats in each group. Specimens of spleen tissues were harvested to determine HLA-DR in lymphocyte and e-valuate inflammatory cell infiltration (score). Specimens of peripheral blood were collected to determine Toll-like receptor 4 (TLR4) level in monocyte and serum level of TNF-α, IL-4, IL-6, IL-10. Results Compared with those in NC group, serum level of IL-10 in S group decreased obviously, while other indices increased obviously (P<0.01). The levels of HLA-DR and TLR4 and serum level of TNF-α were similar between SGH and ST groups (P>0.05). Compared with those in SGH group [(2.87±0.04) score, and IL-6 (0.0083±0.0018) μg/mg, IL-4 (0.0102±0.0021) μg/mg, IL-10 (0.0310±0.0027) μg/mg, re-spectively], degree of inflammatory cell infiltration (1.50±0.76) score and serum levels of IL-6, IL-4, IL-10 of rats in ST group decreased obviously (0.0064±0.0012, 0.0058±0.0024, 0.0230±0.0021 μg/mg, respectively, P<0.01). The levels of HLA-DR, TLR4 and inflammatory cell infiltration degree of spleen in B group were respectively higher than those in NC group and lower than those in BS group. Com-pared with those in NC group, serum levels of TNF-α, IL-6 in B group increased significantly, while IL-4, IL-10 showed an opposite tendency. There was no obvious difference between BST and BSGH groups in ser-um levels of HLA-DR and IL-6 (P>0.05). Compared with those in BST group, inflammatory cell infiltra-tion degree in spleen and the levels of TLR, TNF-α obviously decreased (P<0.01), while IL-4 and IL-10 levels increased in BSGH group (P<0.01). Conclusions Inhibitive effects between Thymosin and GH on extensive inflammatory reaction were similar with or without trauma, and GH has better effect as compared with Thymosin when with trauma.     

rhGH预治疗对烧伤后并发脓毒症大鼠早期免疫反应的影响

目的 研究重组人生长激素(rhGH)预治疗对烧伤后并发脓毒症大鼠免疫和炎症反应的影响.方法 64只SD大鼠根据烧伤和(或)脓毒症模型建立及预治疗情况进行随机分组.ELISA法测定大鼠血清致炎因子(IL-1、IL-6、TNF-α)和抑炎因子(IL-4、IL-10)水平;制备大鼠脾脏组织标本,HE染色计数中性粒细胞,免疫组化染色检测淋巴细胞HLA-DR的表达.结果 与烧伤并发脓毒症未预治疗组比较,相应rhGH预治疗组血清IL-1、IL-6和TNF-α水平显著降低(0.0064±0.0022 us 0.0139±0.0018、0.0058 4±0.0010 us 0.0128±0.0014、0.0055±0.0030 us 0.0145±0.0020)(P<0.05),而血清IL-4和IL-10水平则明显上升(0.0178±0.0045 us 0.0082 4±0.0026、0.0251 4±0.0104 us 0.0143 4±0.0029)(P<0.05);脾脏中性粒细胞浸润减少(0.38 4±0.52 us 1.73±1.49)(P<0.05),淋巴细胞HLA-DR表达下降(0.0280 4±0.0167 us 0.0594 4±0.0336),仍明显高于烧伤对照组(P<0.05).rhGH预治疗对未烧伤脓毒症大鼠的炎性细胞浸润和HLA-DR表达无明显影响.结论 在有创伤因素存在时,rhGH在降低致炎因子表达同时提高抑炎因子表达;在烧伤或烧伤并发脓毒症时,rhGH不但可以显著降低炎症反应,还可显著减少炎症细胞在外周的浸润,有效调控外周淋巴细胞HLA-DR的表达.     

异种脱细胞真皮基质膜修复全层皮肤损伤的疗效和安全性分析——多中心、随机、对照试验

背景:目前,国内尚无批准上市的植入性异种真皮基质.目的:评价异种脱细胞真皮基质修复真皮组织缺损创面的疗效和安全性.设计、时间及地点:多中心、随机、空白自身对照.选择2006-03/2007-07来自上海交通大学附属瑞金医院灼伤整形科、解放军第叫军医大学两京医院烧伤科、解放军兰州军区兰州总医院烧伤整形科3个研究中心72例患者.对象:72例真皮层缺损患者,男61例,女11例,其中火焰烧伤35例、电击伤11例、化学烧伤4例、烫伤9例、整形美容1例、其他12例.平均年龄(35.6±10.7)岁,修复的缺损面积甲均(59.2 33.8)cm2.采用随机数字表法创面分为试验区或对照区,各72个创面.脱细胞真皮基质由烟台正海生物技术有限公司生产并提供.方法:试验区进行脱细胞真皮基质及自体薄皮片复合移植;对照区单纯自体薄皮片移植.主要观察指标:试验区、对照区复合移植成活率及移植后3、6个月瘢痕增生情况.结果:移植后4周,试验区植皮成活率为(98.4±11.8)%;对照区植皮成活率为(99.2 5.9)%.两者疗效差异无显著性(P=0.992).随访病例移植后3,6个月温哥华瘢痕评分中,试验区各项评分及总分均显著低于对照区(P<0.05,P<0.01).移植后6个月试验区各项评分及总分均显著低于3个月时(P<0.05),移植后6个月对照区色泽、色素评分及总分均显著低于3个月时(P<0.05).试验过程中未见与材料有关的实验事检查异常及其他不良反应.结论:该异种脱细胞真皮基质町作为安全的真皮替代物,与自体薄皮片复合移植后有利于真皮组织缺损的修复,减轻创面愈合后瘢痕增生.     

大面积深度烧伤应用混合皮肤嵌植与微粒皮移植的比较

目的 了解大而积深度烧伤后混合皮肤嵌植与微粒皮移植疗效的差异. 方法 回顾性总结笔者单位1992-2008年17年间收治的101例大面积深度烧伤患者临床资料.将患者分为混合嵌植组52例、微粒皮组49例.比较2组患者首次自体供皮面积、首次自体皮覆盖创面面积,首次自体皮移植成活率、自体皮理论扩展倍数、自体皮实际扩展倍数、自体供皮总面积,以及术后残余创面情况、大关节功能状况等. 结果 混合嵌植组、微粒皮组的首次自体供皮面积分别为(3.25±0.48)%、(3.01±0.21)%TBSA,首次自体皮覆盖创面面积分别为(30.4±3.6)%、(41.4±1.3)%TBSA,首次自体皮移植成活率分别为(99.9±1.9)%、(87.5±6.8)%,自体皮理论扩展倍数分别为(9.5±1.3)、(13.9±1.4)倍,自体皮实际扩展倍数分别为(9.5±1.3)、(12.0±1.5)倍,上述指标组间比较,差异均有统计学意义(P<0.05);混合嵌植组、微粒皮组自体供皮总面积分别为(14.2±1.9)%、(14.0±2.1)%TBSA,2组比较,差异无统计学意义(P>0.05).混合嵌植组、微粒皮组残余创面超过0.5%TBSA者分别有23例占44.2%、37例占75.5%;混合嵌植组大关节功能状况较好者34例占65.4%,微粒皮组18例占36.7%. 结论 微粒皮移植法自体皮扩展倍数明显大于混合嵌植法,能更充分利用有限皮源;混合嵌植法创而愈合质量和大关节功能恢复状况优于微粒皮移植法.     

去甲万古霉素和替考拉宁治疗烧伤后感染的疗效分析

感染是导致烧伤病人死亡的主要原因之一。在诸多感染源中,最常见的是金黄色葡萄球菌。随着抗菌药物的大量应用,灼伤病房中耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）的检出率呈逐渐上升趋势。本文通过比较两种糖肽类抗生素——去甲万古霉素和替考拉宁的疗效,寻求治疗金黄色葡萄球菌的有效手段。     

去甲万古霉素和替考拉宁治疗烧伤后感染的疗效分析

感染是导致烧伤病人死亡的主要原因之一[1].在诸多感染源中,最常见的是金黄色葡萄球菌[2].随着抗菌药物的大量应用,灼伤病房中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA) 的检出率呈逐渐上升趋势[3,4].本文通过比较两种糖肽类抗生素--去甲万古霉素和替考拉宁的疗效,寻求治疗金黄色葡萄球菌的有效手段.     

ADA和AFU在肝病诊断中的意义

目的:观察腺苷脱氨酶(ADA)、α-L岩藻糖苷酶(AFU)在不同肝病患者中的水平,探索二者在肝病诊断中的意义。方法:用日立7600型全自动生化分析仪检测80例健康体检者及95例不同肝病患者的ADA、AFU,各组结果进行分析比较。结果:与正常对照组比较,原发性肝癌组ADA、AFU均明显增高,差异有显著性(P<0.001)。肝硬化失代偿组ADA有明显增高,差异有显著性(P<0.01),AFU升高不明显,差异无显著性(P>0.05)。黄疸性肝损害组与对照组ADA、AFU差异无显著性(P>0.05)。结论:联合检测ADA、AFU在肝病诊断中有重要意义,可用于原发性肝癌和肝硬化的鉴别诊断,对监测原发性肝癌的疗效和愈后、复发也有重要意义。     

早期应用乌司他丁对严重烧伤患者脏器功能的保护

目的 探讨早期应用乌司他丁(UTI)对严重烧伤患者重要脏器功能的影响.方法 将收治的伤后24 h内入院、烧伤面积≥50%总体表面积的严重烧伤患者84例,分为UTI治疗组和常规治疗组,每组42例.UTI治疗组在常规治疗的基础上加用UTI 30万IU静脉滴注,3次/d,连续14 d.烧伤后1、3、7、14 d检测两组血常规和肝肾功能指标,并观察其临床效果.结果 UTI治疗组用药后能较好度过休克期、感染期和围手术期,病程相对平稳.UTI治疗组各项检测指标恢复较明显,患者28 d生存率为100%,死亡率为2.38%,与常规治疗组比较有显著性差异(P＜0.05).UTI治疗组伤后第7、14天全身炎症反应综合征、多器官功能障碍综合征的发生率明显低于对照组(P＜0.05).结论 早期应用UTI治疗严重烧伤患者,可以从多个环节抑制细胞的损伤,保护脏器,能显著减轻炎症反应程度,有效保护严重烧伤患者的脏器功能,具有良好的临床疗效.     

烧伤病房铜绿假单胞菌耐药率及抗菌药使用变化

Objective To study changes in the drug-resistance of Pseudomonas aeruginosa (PA)and the use of antibiotics in burn wards so as to optimize the use of antibiotic in the future. Methods Bacteria were isolated from specimens of blood, venous catheter, stool, sputum, urine, wound tissue from 5717 patients hospitalized in our burn wards within the duration of January 2005 to December 2009. The number of specimens examined and positive rates of bacteria were calculated. Changes in constituent ratio of cocci and bacilli, spectrum of bacteria, the drug-resistance rate of PA, and the usage of antibiotics were analyzed. The number of specimens examined, constituent ratio of cocci and bacilli, drug-resistance rate were processed with chi-square test. Bivariate correlation analysis was performed between the usage of antibiotics and the drug-resistance rate. Results (1) The number of specimens examined showed no statistical difference during the five years ( with rates from 73.2% to 76.1% , x 2 = 5. 583, P ＞ 0.05 ) , while constituent ratio of cocci and bacilli showed statistical difference (with ratios from 105:134 to 169: 126, x 2 =14. 806, P ＜0.01 ). The positive rates of bacteria were increasing in the five years. (2) One thousand six hundred and seventy-five strains were identified during the five years from different kinds of specimens, with 29 from blood, 39 from venous catheter, 3 from stool, 157 from sputum, 13 from urine, and 1434 from wound tissue. Among them, Staphylococcus aureus accounted for 28% to 42% , PA accounted for 10% to 25% , Acinetobacter baumannii accounted for 10% to 19% , and they were the predominant strains. (3)The difference among drug-resistance rates of PA to each kind of 12 antibiotics during the five years were statistically significant (with x2 values from 47. 911 to 308. 095, P values all below 0.01 ). The drug-resistance rates of PA to some antibiotics showed downward trend in the former four years, including amikacin,ceftazidime, and imipenem/cilastatin, but it rebounded in the fifth year. (4) There was descending trend in usage of cefoperazone/sulbactam and levofloxacin, but vancomycin was always used widely. (5) Drug-resistance rates of PA to 7 antibiotics, including amikacin, imipenem/cilastatin, and ciprofloxacin, etc. , were positively correlated with usage of various antibiotics (with r values from 0. 879 to 0. 978, P ＜ 0. 05 or P ＜0. 01). Conclusions In our burn wards, drug-resistant PA was prevalent. Disinfection and isolation measures,appropriate use of antibiotics,etc. can reduce PA infection.     

早期应用乌司他丁对严重烧伤患者脏器功能的保护

目的探讨早期应用乌司他丁(UTI)对严重烧伤患者重要脏器功能的影响。方法将收治的伤后24 h内入院、烧伤面积≥50%总体表面积的严重烧伤患者84例,分为UTI治疗组和常规治疗组,每组42例。UTI治疗组在常规治疗的基础上加用UTI30万IU静脉滴注,3次/d,连续14 d。烧伤后1、3、7、14 d检测两组血常规和肝肾功能指标,并观察其临床效果。结果UTI治疗组用药后能较好度过休克期、感染期和围手术期,病程相对平稳。UTI治疗组各项检测指标恢复较明显,患者28 d生存率为100%,死亡率为2.38%,与常规治疗组比较有显著性差异(P<0.05)。UTI治疗组伤后第7、14天全身炎症反应综合征、多器官功能障碍综合征的发生率明显低于对照组(P<0.05)。结论早期应用UTI治疗严重烧伤患者,可以从多个环节抑制细胞的损伤,保护脏器,能显著减轻炎症反应程度,有效保护严重烧伤患者的脏器功能,具有良好的临床疗效。