谷氨酰胺在危重病患者中的应用

目的探讨危重病患者中早期经静脉应用谷氨酰胺（glutamine，Gl）的临床价值。方法42例患者随机分成两组（对照组和Gln组），Gln组进行Gln治疗（100mL／d，共7d）。治疗前后检测患者体质量、白蛋白、谷胱甘肽（GSH）、握力的变化和肠功能不全的发生率。结果体质量两组治疗前后比较差异无显著性（P〉0．05）。白蛋白、握力和GSH Gl治疗后非常显著高于治疗前（P〈0．01）；白蛋白对照组治疗后较治疗前显著增高（P〈0．05），但握力和GSH治疗前后均无显著变化（P〉0.05）；肠功能不全的发生率Gln组为4．8％，显著低于对照组（28．6％，P〈0．05）。结论在危重病患者疾病早期通过静脉途径外源性地补充Gln，有效改善了患者的营养状况；使患者血浆中的GSH水平增高，加强了机体的抗氧化能力；减少了患者肠功能不全的发生率。     

丁胱亚磺酰亚胺排空组织谷胱甘肽对大鼠心肌谷胱甘肽系统的影响

目的:观察采用谷氨酰半胱氨酸合成酶抑制剂--丁胱亚磺酰亚胺(BSO)排空大鼠心肌谷胱甘肽(GSH)是否影响大鼠心肌组织GSH的稳态,以及是否对GSH代谢相关酶活性及mRNA表达产生影响.方法:采用长时间力竭运动、注射BSO排空GSH两种实验模型,比较对照组与注射BSO组SD大鼠心肌在静息状态和长时间力竭运动后GSH状态及其代谢变化.结果:注射BSO 8天后,大鼠心脏GSH含量分别为对照组?%,且GSH的下降伴随着氧化型谷胱甘肽(GSSG)的下降,GSH/GSSG的比值无显著变化.GSH排空导致GSH代谢酶活性发生适应性变化,注射BSO后心肌中谷胱甘肽过氧化物酶(GPX)活性与对照组相比显著下降(P < 0.001).注射BSO组与对照组相比,心肌谷氨酰转肽酶(GGT)活性显著增加(P < 0.05).注射BSO力竭组与注射BSO组相比,心肌GGT活性显著增加(P < 0.001),心肌注射BSO抑制γ-谷氨酰半胱酸合成酶(GCS)活性,注射BSO力竭组大鼠心肌GCS mRNA表达量高于注射BSO组,表明极度排空谷胱甘肽后,GCS mRNA表达量的增加可能是机体产生的应激反应.     

Thiols decrease cytokine levels and down-regulate the expression of CD30 on human allergen-specific T helper (Th) 0 and Th2 cells

The thiol antioxidant N-acetyl- L-cysteine (NAC), known as a precursor of glutathione (GSH), is used in AIDS treatment trials, as a chemoprotectant in cancer chemotherapy and in treatment of chronic bronchitis. In vitro, GSH and NAC are known to enhance T cell proliferation, production of IL-2 and up-regulation of the IL-2 receptor. The 120-kD CD30 surface antigen belongs to the tumour necrosis factor (TNF) receptor superfamily. It is expressed by activated T helper (Th) cells and its expression is sustained in Th2 cells. We have analysed the effect of GSH and NAC on the cytokine profile and CD30 expression on human allergen-specific T cell clones (TCC). TCC were stimulated with anti-CD3 antibodies in the presence of different concentrations of GSH and NAC. Both thiols caused a dose dependent down-regulation of IL-4, IL-5 and IFN-gamma levels in Th0 and Th2 clones, with the most pronounced decrease of IL-4. Furthermore, they down-regulated the surface expression of CD30, and the levels of soluble CD30 (sCD30) in the culture supernatants were decreased. In contrast, the surface expression of CD28 or CD40 ligand (CD40L) was not significantly changed after treatment with 20 m M NAC. These results indicate that GSH and NAC favour a Th1 response by a preferential down-regulation of IL-4. In addition, the expression of CD30 was down regulated by GSH and NAC, suggesting that CD30 expression is dependent on IL-4, or modified by NAC. In the likely event that CD30 and its soluble counterpart prove to contribute to the pathogenesis in Th2 related diseases such as allergy, NAC may be considered as a future therapeutic agent in the treatment of these diseases.     

Lipid peroxidation and antioxidant status in human cervical carcinoma

Reactive oxygen species (ROS), represented by superoxide, hydrogen peroxide and hydroxyl radicals, have been implicated in many diseases including cancer. ROS have been known to play an important role in the initiation and promotion of multistep carcinogenesis. The cellular antioxidants play a crucial role in protection against neoplastic disease. However, very little is known about the antioxidant defense in cervical carcinoma. This is addressed in the present study. Lipid peroxides, glutathione content and the activities of antioxidant enzymes, together with vitamin C and E content, were estimated in patients who had carcinoma of the cervix, and the values were compared with those of normal women. The results showed a remarkable reduction in the content of glutathione, vitamin E and C. Activities of glutathione peroxidase and superoxide dismutase were also reduced in cervical cancer compared to normal controls (P < 0.001). This reduction was more marked in late stages (III, IV) than in early stages (I, II) (P < 0.001). Glutathione was reduced more in poorly differentiated tumors (grade III) than in well and moderately differentiated ones (grade I, II) (P < 0.05). Levels of lipid peroxides were found to be significantly higher in malignant than in normal tissue samples and their levels were correlated with advanced clinical stage (P < 0.001). Our results suggest impaired antioxidant status in carcinoma of the cervix. This impairment is related to tumor progression.     

护理专业医学生医患沟通技能及其心理影响因素研究

目的 了解职业技术类院校护理及助产专业医学生的心理对其医患沟通技能的影响作用,为职业技术类院校的医学生医患沟通技能提升提供指导。 方法 利用成熟的医学生医患沟通态度、技能以及心理学相关量表设计调查问卷,采用全部抽样的方式,对忻州职业技术学院护理专业学生进行调研,并最终获得264份有效问卷用于逐步进入法的多元线性回归分析。 结果 分析结果表明,医学生学习医患沟通技能的积极态度（r=0.39,P<0.001）、情绪疏泄能力（r=0.29,P<0.001）、观点采择意识（r=0.20,P<0.001）对其医患沟通技能水平的作用具有统计学意义。 结论 职业技术类院校在培养医学生的医患沟通技能时,应重点关注学生的积极学习态度、情绪疏泄能力和观点采择意识。     

用体外器官培养方法研究EDCs对新生小鼠睾丸的影响

目的 通过已建立的小鼠睾丸体外培养系统,研究四种内分泌干扰物（Endocrine Disrupting Chemicals,EDCs）对男性内分泌系统的影响。 方法 将新生小鼠的睾丸组织在体外环境中培养24h,而后在培养基中分别加入浓度为0.1μM, 1μM, 10μM and 100μM的四种（DEHP、MEHP、NP、p, p’-DDE）内分泌干扰物并培养72h,同时设置对照组;培养结束后进行组织学观察,测定冻存培养基中睾酮和抑制素βB (INH-βB)的分泌水平,同时测定细胞色素P450侧链裂解酶(P450Scc)、3β-羟基类固醇脱氢酶(3β-HSD)、细胞色素P45017α-羟化酶(P450C17)和波形蛋白（vimentin）的基因表达情况。 结果 所有剂量组中睾酮的分泌水平均发生改变;P450Scc、3β-HSD、P450C17和INH-βB蛋白质的表达及mRNA水平均受到四种内分泌干扰物的影响（P<0.05）;DEHP和MEHP降低了波形蛋白的mRNA水平（P<0.05）,而NP和p, p’-DDE对波形蛋白没有显著影响（P>0.05）。 结论 本研究建立的体外培养新生小鼠睾丸模型中,所选的四种已知EDCs改变了两种睾丸激素水平,三种类固醇合成酶以及与支持细胞功能相关的波形蛋白的表达。     

同位素稀释-气相色谱串联质谱法测定啤酒中4种亚硝胺类化合物

目的 建立啤酒中4种N-亚硝胺类化合物（N-亚硝基二甲胺、N-亚硝基二乙胺、N-亚硝基二丙胺、N-亚硝基二苯胺）的同位素稀释固相萃取-气相色谱串联质谱测定方法。 方法 样品经活性炭固相萃取小柱富集、二氯甲烷洗脱,洗脱液经氮吹浓缩定容后,采用INNOWAX毛细管色谱柱分离,多反应监测（MRM）模式检测,同位素稀释内标法定量。 结果 各物质在5 μg/L~200 μg/L范围内线性关系良好,相关系数均大于0.9995。方法的检出限为0.03-0.10 μg/L,定量限为0.10~0.33 μg/L。不同水平的加标回收率为72.1%~100.3%,相对标准偏差为1.5%~9.5%（n=6）。 结论 该方法操作简单,灵敏度和准确度高,适用于啤酒中4种N-亚硝胺类化合物的测定。     

云南省跨境婚姻家庭艾滋病、梅毒和乙肝检测现状分析

目的 了解云南省中-缅、中-老、中-越跨境婚姻家庭艾滋病、梅毒和乙肝检测情况,为完善跨境婚姻家庭预防母婴传播相关服务政策提供科学依据。 方法 对目前居住在云南省边境地区的中国籍和跨境婚姻家庭进行调查和访谈,收集一般人口学特征、最近一次怀孕期间三病检测情况等信息。经整理后,使用构成比和率对指标进行计算,使用卡方检验、秩和检验比较中国籍和跨境婚姻家庭各项检测服务状况。 结果 外籍媳妇主要以农民、文盲/小学、无经济收入的少数民族为主。配偶检测率,老挝籍低于当地中国籍媳妇（〖XC五号.EPS;P〗=7.87,P=0.005）,缅甸籍、越南籍与当地中国籍没有差异;缅甸籍高于老挝籍和越南籍（〖XC五号.EPS;P〗=41.84,P＜0.001）。三病检测点知晓率,缅甸籍媳妇低于当地中国籍媳妇（〖XC五号.EPS;P〗=6.11,P＜0.03）,越南籍、老挝籍与当地中国籍没有差异;老挝籍高于缅甸籍和越南籍（〖XC五号.EPS;P〗=44.03,P＜0.001）。获得预防母婴传播相关知识比例,三个外籍媳妇均低于当地中国籍（〖XC五号.EPS;P〗=19.84,P＜0.001;〖XC五号.EPS;P〗=7.52,P=0.006;〖XC五号.EPS;P〗=4.38,P=0.036）。 结论 边境地区针对跨境婚姻家庭开展艾滋病、梅毒和乙肝预防母婴传播相关工作取得实效,三病检测情况与当地中国籍基本一致,但在其他服务利用上仍存在一定差距,外籍媳妇孕早期三病检测率及其配偶检测率、相关预防母婴传播知识获取还有待提升,需要运用更加有效的服务管理模式来促进三病检测可及性的进一步提高。