关键词： 重症肺炎   头孢哌酮   舒巴坦   加替沙星  

摘要： 目的:分析重症肺炎患者采用头孢哌酮、舒巴坦联合加替沙星治疗对其炎症状态的影响。方法观察组则以头孢哌酮-舒巴坦联合加替沙星进行治疗,头孢哌酮-舒巴坦3g/次的用量治疗,q8h.。加替沙星则以0.4g的用量治疗,q.d。对照组以头孢哌酮-舒巴坦3g/次的用量治疗,q8h;均10d1个疗程。前后的血清炎性应激指标比较。结果两组治疗前后的血清PCT及IFN-γ水平比较治疗前对照组的血清PCT及IFN-γ水平分别为(6.50±1.33)μg/L及(30.59±4.68)pg/ml,观察组分别为(6.52±1.32)μg/L及(30.62±4.66)pg/ml,两组比较,>0.05。治疗后对照组分别为(4.27±0.65)μg/L及(20.76±3.53)pg/ml,观察组分别为(1.88±0.36)μg/L及(15.45±2.78)pg/ml。治疗后观察组低于对照组治疗后及本组治疗前,<0.05。治疗前对照组的血清PCT及IFN-γ阳性例数为48例和46例,阳性率为96.00%和92.00%,观察组阳性例数为50例和46例,阳性率为100.00%和92.00%,两组比较,>0.05。治疗后对照组阳性例数为24例和20例,阳性率为48.00%和40.00%,观察组阳性例数为6例和4例,阳性率为12.00%和8.00%,治疗后观察组低于对照组治疗后及本组治疗前,<0.05。结论联合应用加替沙星较单用头孢哌酮-舒巴坦在控制患者的血清PCT及IFN-γ水平与阳性率方面效果更为突出,说明联合用药对患者疾病炎性状态的控制效果更好。

关键词： 血液灌流   血液透析   微炎症  

摘要： 随着亚健康生活方式的增多和生活节奏加快,肾脏疾病的发病率明显增高,不同程度的肾脏疾病随着病情发展为尿毒症。随着血液净化技术的不断成熟,终末期肾病维持性血液透析(maintenance hemodialysis, MHD)患者的长期生存率显著提高,如何通过血液净化来更好的提高维持性血液透析患者的身体状况和生活质量已成为目前国内国际的热点问题。本文设计了对比试验对血液灌流联合血液透析对维持性血液透析患者营养不良及微炎症状况的影响,来评估两种不同血液净化技术对炎症因子的清除能力,为MHD患者选择最佳的血液净化治疗方式提供依据。

关键词： 高通量血液透析   微炎症状态   营养不良  

摘要： 目的探讨高通量血液透析(high flux hemodialysis,HFHD)对维持性血液透析(maintenance hemodialysis,MHD)患者微炎症状态及营养不良的影响。方法入选本透析中心的MHD患者30例,检测患者HFHD治疗前及治疗6个月后血红蛋白(Hb)、血清白蛋白(ALB)、高敏C反应蛋白(hs-CRP)、全段甲状旁腺激素(i PTH)、转铁蛋白(transferrin,TRF)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等指标,比较HFHD治疗前后各项指标变化。结果 HFHD治疗后患者Hb、ALB、TRF较治疗前升高(P<0.05),hs-CRP、IL-6、TNF-α、i PTH较治疗前降低(P<0.05)。结论 HFHD可有效改善MHD患者的微炎症状态及营养不良。

关键词： 全身炎症反应综合征   核转录因子-κB   肿瘤坏死因子-α   白介素-6   蛹虫草  

摘要： 目的探讨蛹虫草对内毒素所致大鼠全身炎症反应综合征(SIRS)的治疗作用及其机制。方法腹腔注射内毒素建立大鼠SIRS模型,将大鼠随机分为正常对照组、SIRS模型组和蛹虫草治疗组。SIRS模型组和蛹虫草组按观察时间分为3,6,12,24 h 4个亚组。采用酶联免疫吸附法(ELISA)检测血液单个核细胞中核转录因子-κB(NF-κB)活性、血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平。结果与正常对照组相比,SIRS模型组各时间点大鼠血液单个核细胞NF-κB活性、血清TNF-α和IL-6含量均明显增高(均P<0.05)。蛹虫草治疗组各时间点血液单个核细胞NF-κB活性、血清TNF-α和IL-6含量均显著低于SIRS组(均P<0.05)。结论蛹虫草可明显抑制SIRS大鼠的炎症反应,其作用机制可能是抑制NF-κB的活化。

关键词： 不稳定型心绞痛   盐酸川芎嗪   辅酶Q10   炎症反应   免疫功能  

摘要： 目的观察盐酸川芎嗪联合辅酶Q10对不稳定型心绞痛患者炎症反应和免疫功能的影响。方法将不稳定型心绞痛患者215例随机分为联合用药组110例和对照组105例。联合用药组在常规治疗基础上给予盐酸川芎嗪80 mg/d和辅酶Q1010 mg/d静点,对照组仅给予常规治疗。治疗2周后观察2组临床疗效,检测治疗前后炎性因子白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平,免疫球蛋白Ig A、Ig G、Ig M及免疫细胞亚群CD3+、CD4+、CD4+/CD8+水平。结果联合用药组的有效率为89.09%,对照组为78.10%,联合用药组有效率高于对照组(P<0.05);联合用药组心电图改善率为88.18%,高于对照组的75.24%(P<0.05);2组治疗后IL-2、TNF-α、hs-CRP水平较治疗前均明显降低(P均<0.05),且联合用药组治疗后各指标水平均低于同时点对照组(P均<0.05);治疗后2组Ig A、Ig G、Ig M、CD3+、CD4+、CD4+/CD8+水平均明显降低;与对照组比较,除CD4+/CD8+外,各指标水平联合用药组降低更为明显(P均<0.05)。结论盐酸川芎嗪联合辅酶Q10用于治疗不稳定型心绞痛效果良好,具有抑制全身炎症反应、改善免疫功能的作用。

关键词： 输尿管软镜   碎石术   尿培养   全身炎症反应综合征  

摘要： 目的探讨输尿管软镜碎石术术前中段尿培养与术后全身性炎症反应综合征(SIRS)之间的关系。方法回顾性分析2012年1月至2014年2月应用输尿管软镜碎石术治疗肾结石患者的临床资料,所有病例术前均常规行中段尿细菌培养和使用抗生素,分析评价术前中段尿培养与术后SIRS之间的关系。结果纳入分析105例,中段尿培养阳性者22例。输尿管软镜碎石术术后发生SIRS者共18例,其中,术前中段尿培养阳性者7例,阴性者11例。中段尿培养阳性患者术后发生SIRS率与阴性者相比,差异无统计学意义(P>0.05)。以尿培养来判断SIRS的灵敏度为38.8%。结论在应用抗生素情况下,输尿管软镜碎石术术前中段尿培养同术后SIRS的发生之间无明显相关性,不是有效的预测指标。

关键词： 慢性阻塞性肺疾病   全身麻醉   乌司他丁   炎症因子  

摘要： 目的分析乌司他丁辅助全身麻醉对慢性阻塞性肺疾病(COPD)患者接受腹腔镜手术时血清TNF-α、IL-6、IL-8水平的影响及其临床意义。方法选择在本院接受腹腔镜手术治疗的胆囊结石伴COPD患者作为研究对象,随机分为接受常规全身麻醉的对照组以及接受乌司他丁辅助全身麻醉的观察组,比较两组患者的气道峰压、炎症因子水平、肾功能等差异。结果观察组患者接受乌司他丁辅助全身麻醉后的各个时间段气道峰压都明显低于对照组患者(P<0.05)。观察组患者术中及术后1d的血清TNF-α、IL-6、IL-8水平均明显低于对照组患者(P<0.05)。观察组患者接受乌司他丁辅助麻醉后的各个时间段BUN、Cr水平均明显低于对照组患者(P<0.05)。结论乌司他丁辅助全身麻醉可以有效降低COPD腹腔镜手术患者的气道峰压,降低炎症因子水平,优化肾功能指标。

关键词： Diabetes mellitus   type 2   Lipid accumulation product   Subclinical inflammation   Oxidative stress  

摘要： Background: Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to risk of diabetes and cardiovascular disease. In this study, we assessed the association of LAP with glucose homeostasis, lipid and lipid peroxidation, and subclinical systemic inflammation in diabetic patients. Methods: Thirty-nine male and 47 female type 2 diabetic patients were assessed for anthropometrics and biochemical measurements. LAP was calculated as [waist circumference (cm)-65] x[triglycerides (mmol/L)] in men, and [waist circumference (cm)58] x[triglycerides (mmol/ L)] in women. Associations of LAP with fasting glucose, insulin, insulin resistance index, lipid and lipoprotein levels, malondialdehyde, and high-sensitive C-reactive protein (hs-CRP) were assessed. Results: Mean age and LAP index were 53.6+/-9.6 and 51.9+/-31.2 years, respectively. After adjustments for age, sex and body mass index status, a significant positive correlation was observed between LAP index and fasting glucose (r=0.39, P< 0.001), and homeostasis model assessment of insulin resistance (r=0.31, P< 0.05). After additional adjustment for fasting glucose levels, antidiabetic and antilipidemic drugs, the LAP index was also correlated to total cholesterol (r=0.45, P< 0.001), high density lipoprotein cholesterol (HDL-C) levels (r=-0.29, P< 0.05), triglycerides to HDL-C ratio (r=0.89, P< 0.001), malondialdehyde (r=0.65, P< 0.001), and hs-CRP levels (r=0.27, P< 0.05). Conclusion: Higher central lipid accumulation in diabetic patients was related to higher insulin resistance, oxidative stress and systemic inflammation.

关键词： micronutrient status   zinc   iron   asymptomatic malaria   ferritin   soluble transferrin receptor   acute phase proteins   retinol binding protein   biomarkers   deficiency  

摘要： Background: Biomarkers of iron [plasma ferritin (pF)], vitamin A [retinal binding protein (RBP)], and zinc status [plasma zinc (pZn)] are affected by the acute phase response, independent of micronutrient status. Objective: The objective of these analyses was to assess how asymptomatic malaria infection affects the interpretation of these biomarkers after adjustment for elevated acute phase proteins (APPs). Methods: Soluble transferrin receptor (sTfR), pF, RBP, and pZn concentrations were measured among 451 asymptomatic children aged 6-23 mo in Burkina Faso and adjusted for elevated APP (C-reactive protein >= 5 mg/L and/or alpha-1-acid-glycoprotein >= 1 g/L) based on a 4-group categorical model. Plasma histidine-rich protein II (HRP2) concentrations >= 0.75 mu g/L were considered indicative of current or recent malaria parasitemia. Results: Of the children in the study, 57.4% had at least 1 elevated APP, and 48.5% had elevated HRP2. After adjusting for APP, children with elevated HRP2 had higher pF (23.5 +/- 1.5 mu g/L vs. 11.1 +/- 0.8 mu g/L;P < 0.0011 and lower RBP (0.79 +/- 0.01 mu mol/L vs. 0.92 +/- 0.01 mu mol/L;P < 0.001) than those without, but there were no differences in pZn among those with and without elevated HRP2 (64.9 +/- 12.7 mu g/dL vs. 64.9 +/- 11.1 mu g/dL;P = 0.98). Children with elevated HRP2 had higher sTfR than those without (17.6 +/- 0.5 mg/L vs. 12.3 +/- 0.4 mg/L;P < 0.0001). After adjusting for HRP2, along with APP, the estimated prevalence of iron deficiency (pF < 12 mu g/L) increased from 38.7% to 50.6% and vitamin A deficiency (RBP < 0.84 mu mol/L) decreased from 33.4% to 27.7%. Conclusions: Asymptomatic malaria is associated with indicators of micronutrient status, even after adjusting for APP. Adjusting indicators of iron and vitamin A status based only on APP may inaccurately estimate the prevalence of micronutrient deficiencies in settings with a high prevalence of malaria and inflammation. This trial was registered at clinicaltrials.