弥散性血管内凝血的输血治疗

弥散性血管内凝血是一种发生在许多疾病基础上,引起全身出血的综合征。如不及时治疗,可危及患者的生命。本文综述了成分输血治疗弥散性血管内凝血的几种方法。     

内皮细胞与脓毒症

血管内皮细胞是凝血启动和炎症反应激活过程中最重要的效应细胞,而脓毒症的主要病理生理学变化是严重全身感染引起的炎症反应过度激活及凝血机能障碍。因此,血管内皮细胞活化和功能障碍是脓毒症发展恶化的中心环节。更好地理解血管内皮细胞功能对于脓毒症治疗的探索及对预防多器官衰竭和弥漫性血管内凝血发生有重要意义。本文就这方面的研究进展作一简要综述。     

白念珠菌与血管内皮细胞黏附后的作用机制

白念珠菌与血管内皮细胞的相互作用是其是否造成血源性播散感染的中心环节,两者的黏附仅仅是作用的初级阶段、黏附的程度对两者作用的性质一感染控制和感染播散之间的关系并不明确。而在黏附后的相互作用研究中提示白念珠菌进入血管内皮细胞并造成其损伤继而进入其他组织,同时血管内皮细胞对白念珠菌感染也具有重要的保护作用,这种作用与血管内皮细胞对白念珠菌的内吞也密切相关。本文对两者黏附后血管内皮细胞对白念珠菌的吞噬,白念珠菌对血管内皮细胞的损伤以及血管内皮细胞对白念珠菌感染的保护作用方面作一综述。     

镰刀菌所致皮肤感染的文献回顾

镰刀菌主要为植物致病菌,但也可引起严重人类感染。镰刀菌病临床表现形式多样,本文主要综述相关的皮肤感染,分为局限性皮肤感染及播散性感染,诊断多较困难。由于该属真菌对抗真菌药物存在天然耐药,播散性镰刀菌病死亡率可达80%-90%。本文对Medline和中文文献数据库中的相关文献进行了系统查阅和分析,综合归纳了镰刀菌所致皮肤感染的致病种、地域分布、危险因子、临床表现形式、药物敏感性及其诊疗方案等,该综述对全面了解镰刀菌病的特征及对临床医师对本病的诊断具有重要的意义。     

白念珠菌黏附、侵袭黏膜屏障机制的研究进展

随着深部真菌感染率的上升,白念珠菌病已成为国内、外学者的研究热点.白念珠菌之所以能引起全身播散性的感染,黏附并侵袭黏膜屏障在其致病过程中发挥着非常关键的作用.本文总结目前国内外研究成果,对白念珠菌黏附、侵袭黏膜屏障相关的机制做一综述,为更好的了解和治疗念珠菌病提供理论依据.     

镰刀菌感染的流行病学及其诊治进展

镰刀菌是一种腐生菌,与免疫力正常宿主的软组织感染、角膜炎、甲真菌病有关。由于应用细胞毒性药物治疗白血病以及器官移植增多,侵袭性和播散性镰刀菌感染病例近20年内逐年增多。镰刀菌可以通过皮肤黏膜、呼吸道等部位引起感染,感染可局限也可播散。播散性镰刀菌病几乎仅发生于免疫受损患者。急性髓性白血病较之急性淋巴细胞白血病更易发生镰刀菌感染。镰刀菌病的诊断主要根据宿主因素、临床表现（75%的镰刀菌病会有皮肤表现）、真菌培养、组织病理学检查。分子生物学技术的应用可以将形态学难以区分的镰刀菌鉴定到种。镰刀菌病很难治疗,尤其是播散性镰刀菌病的病死率很高。体外药敏试验结果表明氟康唑、伊曲康唑、氟胞嘧啶对镰刀菌无抗菌活性,目前主要治疗方法是联合应用伏立康唑和两性霉素B,尤其是单独应用抗真菌药无效的病例。     

球孢子菌病的流行病学、临床表现及诊治进展

球孢子菌病是球孢子菌感染人类所致的疾病。传统认为其流行区域仅限于美洲部分地区,但随着全球人口流动,非疫区的输入性病例报道日渐增多。一些新近研究也对其传统流行病学观念提出了挑战。此外,球孢子菌病的临床表现多样,从轻微的自限性呼吸道感染到严重的全身播散性感染均可发生,给诊断带来了很大的困难。因此,尽管中国并非传统概念上的球孢子菌病疫区,国内感染病工作者仍有必要对其现状有所了解。本文针对球孢子菌病的流行现状及诊疗进展进行综述。     

艾滋病并马尔尼菲青霉病临床特征及诊治进展

<正>马尔尼菲青霉(Penicillium marniffei,PM)是青霉属中惟一的双相真菌。PM可引起局限性和播散性感染,其在HIV流行前播散性马尔尼菲青霉病(penicilliosis marneffei,PSM)是一种罕见的真菌疾病,主要见于免疫受损的宿主。随着艾滋病的流行,有关该菌感染的报道日渐增多已成为我国南方艾滋病(AIDS)患者重要的机会性感染病原菌之一,是     

以皮肤受累为首发表现的播散性念珠菌病1例并文献复习

目的：播散性念珠菌病是一种致命性真菌感染性疾病,在免疫缺陷患者中发病率逐年增多,报道1例以双下肢多发皮下结节为首发表现,伴有肺及脑受累的播散性念珠菌病,并文献复习播散性念珠菌病的皮肤受累临床表现。方法患者女,37岁。因双下肢多发皮下结节6个月余就诊。有局灶节段性肾小球硬化病史,口服强的松及他克莫司2a余。取患者皮损组织行病理学检查,皮损组织、脓液、血、痰、尿、粪、脑脊液进行真菌镜检及真菌培养,并文献检索统计播散性念珠菌病皮肤受累患者临床特点。结果皮损组织病理见假菌丝,皮损组织、脓液、痰、尿、粪标本直接涂片均见假菌丝并培养出白念珠菌,CT显示肺受累,诊断为播散性念珠菌病,予抗真菌治疗,患者皮损愈合及肺部病灶部分吸收,但因自行停药,最终出现颅内播散。结论以皮损为首发表现的播散性念珠菌病临床罕见,临床诊疗中应重视应用免疫抑制剂患者皮损的组织病理及微生物检查,及早进行诊断和治疗,防止出现系统性播散,从而降低死亡率。     

PCR法评价伊曲康唑注射液治疗播散性白念珠菌病兔模型疗效

目的通过静脉内接种的方法,构建播散性白念珠菌感染的兔模型,并用PCR评价伊曲康唑注射液治疗播散性念珠菌病的疗效。方法在接种后24h,用伊曲康唑注射液5rag／kg对兔模型进行治疗,1次／d,共14d。在不同的时间段取兔模型的静脉血,进行血培养和真菌通用引物以及白念珠菌特异性引物的PCR检测,监测伊曲康唑注射液治疗播散性白念珠菌感染的疗效。结果在接种白念珠菌后1h、6h,外周血中用PCR方法就能检测到白念珠菌,且能持续到8—10d;实验兔外周血血培养1h后阳性,持续到18h。实验结束后解剖实验兔,治疗组较对照组内脏器官的组织培养阳性率及菌落数低。结论PCR是一种快速和敏感的检测播散性念珠菌病的方法,伊曲康唑注射液治疗播散性白念珠菌病有效,但是真菌的清除率特别是肾脏组织的真菌清除率并不理想,治疗结束7d后,组织匀浆真菌培养仍然阳性。     

The effects of Lepeophtheirus salmonis infections on the stress response and immunological status of Atlantic salmon (Salmo salar)

This study was conducted to determine the effects of a high level of infection of the parasitic copepod L. salmonis on the stress response and immunological status of Atlantic salmon. An initial low-level initial infection was carried out 14d prior to a second infection in which twice as many parasites were introduced. Plasma cortisol and prostaglandin E(2) (PGE(2)) levels were monitored concurrent to the expression of six immune-related genes over five sample times (9, 21, 26, 33 and 40days post initial infection, dpii). The mean lice counts on the infected fish increased significantly from the first infection (16.3+/-1.89 at 9dpii) to the second (142.8+/-12.8 at 26dpii). Plasma cortisol levels increased significantly at 26, 33 and 40dpii in infected fish compared to controls. Plasma PGE(2) levels were significantly higher in infected fish at 9, 33 and 40dpii, when compared to controls. At 9dpii, expression of interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNFalpha)-like cytokine, major histocompatibility class II (MH II), transforming growth factor-beta (TGFbeta)-like cytokine and cyclooxygenase-2 genes were increased in infected fish compared to controls. The expression of most of these genes returned to control levels at 21dpii when the highest expression of the MH class I gene was observed in infected fish (significantly higher than controls). Major histocompatibility class I gene expression remained higher in infected fish at 26 and 33dpii compared to controls and this was observed for the TNFalpha-like gene. By 33dpii, MH class II and TGFbeta-like genes had higher expression in infected fish compared to controls. Interleukin-1beta and TNFalpha-like gene were the only genes that showed significantly higher expression in infected fish compared to controls at 40dpii, while MH class I gene expression was significantly depressed in infected fish at this time. The expression of nearly all immune-related genes studied here increased following initial infection with L. salmonis, however, immunological stimulation did not reduce parasite numbers or protect against re-infection.     

Effect of dietary n-3 fatty acids on HMG-CoA reductase and ACAT activities in liver and intestine of the rabbit

The regulation of hepatic and intestinal 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase and acyl-CoA; cholesterol acyltransferase (ACAT) activities by dietary fish oil was examined in the rabbit. Rabbits were fed 10% menhaden oil or menhaden oil plus 1% cholesterol for 14 days. They were compared with animals fed a control diet or one enriched with long-chain saturated fats consisting of 10% cocoa butter oil or cocoa butter oil plus 1% cholesterol. Plasma cholesterol was increased in rabbits fed the fish oil and the two cholesterol-containing diets. In the liver, ACAT activity was increased and HMG-CoA reductase activity was decreased in rabbits ingesting the fish oil. The same was true for animals ingesting both cholesterol-containing diets. In the intestine, ACAT activity was not affected by the ingestion of the fish oil compared to control rabbits; however, it was significantly higher in animals fed the fish oil compared to animals ingesting the cocoa butter. HMG-CoA reductase activity was decreased in the distal two-thirds of the intestine in animals fed the menhaden oil compared to activities observed in controls. In animals ingesting the cholesterol diets, intestinal reductase was significantly decreased, whereas intestinal ACAT activity was increased in rabbits ingesting the cocoa butter and cholesterol diet when compared to their controls. Lipid analysis of hepatic and intestinal microsomes demonstrated an enrichment of n-3 polyunsaturated fatty acids in membranes from rabbits ingesting the menhaden oil.(ABSTRACT TRUNCATED AT 250 WORDS)     

Heparin treatment in abruptio placentae

Two cases of abruptio placentae with disseminated intravascular coagulation (DIC) were treated with heparin, and coagulation was monitored by thromboelastography as well as the usual hematology tests. The cases demonstrated the vagaries of DIC and both showed decreased overt hemorrhage after heparin treatment was started. Heparin may be indicated for the management of abruptio placentae where delivery is not imminent, where significant disseminated intravascular coagulation exists, and when adequate serial coagulation studies are available.     

Experience with disseminated intravascular coagulation in a children's hospital

A study was initiated to determine the frequency and significance of disseminated intravascular coagulation (DIC) in the pediatric age group. With the aid of a scoring system, DIC was diagnosed in 48 patients in a period of slightly over one year in a pediatric referral centre with 7000 annual admissions. Sixty percent of all DIC occurred in infants under one month of life. Sixty-six percent of all DIC was associated with sepsis, usually from gram-negative infections. Seventy-nine percent of affected neonates were septic. Laboratory findings of diagnostic importance were anemia with red cell fragmentation, thrombocytopenia, elevated titres of fibrin split products, abnormal thrombin time, and low factor V activity. Mortality was 64% in all ages regardless of cause. Results of management of DIC by treatment of the underlying disease with or without anticoagulation were disappointing.     

弥漫性血管内凝血产妇围术期凝血与纤溶系统指标的检测及临床意义

目的:探讨弥漫性血管内凝血(DIC)产妇围术期凝血与纤溶系统指标检测的临床意义。方法:选择2017年1到2017年12月在我院接受治疗的DIC孕妇57例(DIC组)为研究对象,采取分层抽样的方法选择同期在我院进行产检的正常孕妇57例(健康孕妇组)及在我院体检的健康非孕妇57例(非孕妇组)作为对照,比较各组凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)及血小板计数(PLT)变化,根据DIC组的治疗结果分为有效组和无效组,并比较两亚组治疗前PT、TT、APTT、FIB、D-D、PLT,采用Pearson相关分析法分析DIC组治疗前各检测指标间的相关性。结果:与健康孕妇组、非孕妇组比较,DIC组PT、TT、APTT延长(P0.05),D-D水平升高(P0.05),FIB、PLT水平降低(P0.05);与非孕妇组比较,健康孕妇组PT、TT、APTT缩短(P0.05),D-D水平降低(P0.05),FIB、PLT水平升高(P0.05)。DIC组患者治疗后有效组治疗前的PT、TT、APTT短于无效组(P0.05),D-D水平低于无效组(P0.05);FIB、PLT水平高于无效组(P0.05)。Pearson相关分析结果显示,除PT与APTT之间无明显相关性(P0.05)外,其他凝血、纤溶系统指标之间均存在一定的相关性(P0.05)。结论:DIC孕妇围术期凝血与纤溶系统指标异常改变,检测凝血与纤溶系统指标对DIC孕妇的诊疗具有重要意义。     

Comparative evaluation of whole blood D-dimer test to plasma D-dimer test for diagnosis of disseminated intravascular coagulation

Three rapid D-dimer test methods were compared for the diagnosis of acute disseminated intravascular coagulation (DIC). These were (a) SimpliRED, an autologous red cell agglutination assay. (b) DIMERTEST latex agglutination assay, containing monoclonal antibody DD-3B6/22(6), and (c) D-DI latex agglutination assay containing mouse anti-human D-dimer monoclonal antibodies. The D-DI latex method having higher sensitivity (100%) and specificity (81%) in clinically acute DIC was postulated as the gold standard and compared with the other two methods. The results suggest that D-DI latex agglutination assay containing mouse anti-human D-Dimer monoclonal antibodies are the better assay methods amongst all the three kits analyzed. It is advisable to look for the nature of the antibody used to coat the latex particles in plasma based kits. In emergency setting RBC kits may be of some use as rapid diagnosis is advantageous.     

Biochemical and hemato-immunological parameters in juvenile beluga (Huso huso) following the diet supplemented with nettle (Urtica dioica)

The present study investigated the effects of different dietary nettle (Urtica dioica) levels on biochemical, hematological and immunological parameters in beluga (Huso huso). Fish were divided into 4 groups before being fed for 8 weeks with 0%, 3%, 6% and 12% of nettle. The blood samples were collected on week 4 and 8. The use of nettle did not significantly change the mean cell volume, mean cell haemoglobin, lymphocytes, eosinophils, albumin, glucose, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lysozyme activity on week 4 and 8. After 4 weeks, the total red blood cell (RBC) and hematocrit (Ht) showed a significant increase in 12% nettle group compared to the 3% nettle and control groups but haemoglobin (Hb) had a significant change in 12% nettle compared to the control. At the same time was not found a significant change in the mean cell haemoglobin concentration (MCHC), total white blood cell (WBC), neutrophils, respiratory burst activity (RB), total immunoglobulin (Ig) and total protein (TP), triglyceride (Tri) and cholesterol (Chol). After 8 weeks, the fish treated with nettle exhibited significantly increase in neutrophil and Hb levels compared to the control and between treatment groups, 12% nettle group shown the highest Hb while RBC and Hct values significantly rose in fish fed by 12% compared to the control. Supplementing 6% and 12% nettle increased the WBC and MCHC compared to the other groups. The group fed 12% showed a highly significant difference in RB, TP and Ig after 8 weeks. However, Tri and Chol were significantly decreased in the juvenile beluga fed by the 6% and 12% nettle diet compared to the other groups. The results suggest that by using this herb there will be an improvement in hemato-biochemical parameters and immune function of juvenile beluga.     

Disseminated intravascular coagulopathy during experimental pneumococcal sepsis: studies in normal and asplenic rhesus monkeys.

Disseminated intravascular coagulation (DIC) was induced in both normal and asplenic rhesus monkeys by intravenous challenge with Streptococcus pneumoniae. Our observations in the infected monkeys have led us to conclude that (1) pneumococcal capsular polysaccharide (PCP), immune complexes and complement may not have primary roles in the initiation of DIC; (2) intact pneumococci may be catalysts for the development of DIC; (3) the initial event in DIC may be activation of Hageman factor; and (4) evidence of activation of Hageman factor-dependent systems is present regardless of severity of infection.     

Erythrocyte and plasma trace element levels in clinical assessments

On the basis of original investigations on zinc, copper, and selenium levels in plasma and erythrocytes of Down's syndrome (DS), cystic fibrosis (CF), and control subjects, the possible importance of erythrocytic trace element concentrations in clinical analysis is emphasized. Red blood cell levels of copper and zinc were found significantly increased in both groups of diseased patients as compared to age-matched controls, although plasma levels did not statistically differ. Plasma selenium levels were significantly lower in both investigated groups, but red blood cell levels were only decreased in CF and were not different from controls in DS. Significant differences were also found between zinc, copper, and selenium levels in erythrocytes of two control groups originating from distinct geographic areas, although plasma levels were not statistically different. Some factors likely to modify trace element concentrations in erythrocytes are examined and a more systematic determination of these levels is suggested for use in clinical analysis.     

Levels of glycosylated haemoglobin in the Arabian camel (Camelus dromedarius)

Proportions of glycosylated haemoglobin (Hb) were determined in 10 Arabian camels (Camelus dromedarius) and were compared with normal controls (n = 59) and diabetic patients (n = 47) using the thiobarbituric acid (TBA) method. The level of glycosylated haemoglobin (5.5%) in camels is significantly different from that of normal healthy humans (4.9%) (P less than 0.001). Whereas the glucose levels were comparable, this difference in percentages of glycosylated haemoglobin may be explained by the difference in survival time between human and camel red blood cells.