喜炎平注射液联合阿奇霉素序贯疗法对肺炎支气管肺炎患者血清IL-33、IL-6及TNF-α水平的影响

目的:探讨喜炎平注射液联合阿奇霉素序贯疗法对肺炎支气管肺炎患者血清白介素-6(IL-6)、白介素-33(IL-33)、肿瘤坏死因子-α(TNF-α)水平的影响。方法:收集我院就诊或住院治疗的840例支气管肺炎患者,随机分为实验组和对照组,每组420例。对照组患者给予阿奇霉素治疗。实验组在对照组基础上给予喜炎平静脉滴注治疗。观察并比较两组患者血清白介素-6(IL-6)、白介素-33(IL-33)、肿瘤坏死因子-α(TNF-α)水平以及临床疗效。结果:与治疗前相比,两组患者治疗后血清IL-6、IL-33、TNF-α水平均显著下降(P0.05);与对照组相比,实验组患者的血清IL-6、IL-33、TNF-α水平较低(P0.05),临床治疗有效率较高(P0.05)。结论:喜炎平注射液联合阿奇霉素序贯疗法能够提高肺炎支气管肺炎患者的临床疗效,可能与其降低患者血清IL-33、IL-6及TNF-α水平有关。     

乌司他丁联合痰清宁雾化吸入对重症肺炎患者肌钙蛋白水平及心肌酶谱的影响

目的:探讨乌司他丁联合痰清宁雾化吸入对重症肺炎患者肌钙蛋白水平、心肌酶谱的影响。方法:收集2014年3月至2016年3月于我院治疗的104例重症肺炎患者,52例行常规治疗患者作为对照组,52例于常规治疗基础上行乌司他丁联合痰清宁雾化吸入患者作为观察组,比较两组体征及症状消失时间、肌钙蛋白[心肌肌钙蛋白T(cTnT)、心肌肌钙蛋白I(cTnI)]、心肌酶谱[谷草转氨酶(AST)、乳酸脱氢酶(LDH)\氢丁酸脱氢酶(HBDH)、肌酸激酶同工酶(CK-MB)]、临床症状积分、临床疗效及不良反应的发生情况。结果:观察组体征及症状消失时间明显短对照组(P0.05);治疗后,观察组cTnT、cTnI低于对照组,差异有统计学意义(P0.05);观察组AST、LDH、HBDH、CK-CB低于对照组,差异有统计学意义(P0.05);观察组临床症状积分低于对照组(P0.05);观察组有效率96.15%高于对照组82.69%(P0.05);两组不良反应发生率比较无统计学差异(P0.05)。结论:乌司他丁联合痰清宁雾化吸入治疗重症肺炎的临床疗效好,且可有效降低肌钙蛋白及心肌酶谱水平,减轻心肌损伤。     

肺炎支原体肺炎患儿外周血白介素的表达与肺功能变化的相关性

目的:探讨肺炎支原体(MPP)肺炎患儿外周血中IL-10、IL-17的表达水平与肺功能变化的相关性。方法:选取70例肺炎支原体肺炎患儿为研究对象,以是否有哮鸣音分为喘息组和非喘息组,以30例健康儿童为对照组,空腹采血5ml,分离血清,ELISA检测血清中IL-10、IL-17的表达水平,肺功能检测仪检测受检者的第一秒用力呼气容积(PEV1),最大呼气流量(PEF),用力肺活量(FEV1/FVC)。结果:喘息组中IL-10的表达水平与对照组相比差异显著(P0.05),喘息组中IL-10的表达水平与非喘息组相比差异显著(P0.05),喘息组中IL-17的表达水平与对照组相比差异显著(P0.05),喘息组中IL-17的表达水平与非喘息组相比差异显著(P0.05)。喘息组和非喘息组中IL-10水平均低于对照组,喘息组和非喘息组中IL-17水平均高于于对照组。非喘息组较喘息组PEV1、PEF、PVE1/FVC值高,差异显著(P0.05)。肺炎支原体肺炎患儿血清中的IL-10的水平与PEV1、PEF、PVE1/FVC呈正相关,肺炎支原体肺炎患儿血清中的IL-17的水平与PEV1、PEF、PVE1/FVC呈负相关。结论:肺炎支原体肺炎患儿血清中IL-10、IL-17的表达水平与肺功能密切相关。     

人SP-B蛋白转基因小鼠及细菌性肺炎模型的构建

目的:构建携带人SP-B蛋白+1580 SNP不同等位基因的转基因小鼠并进行细菌性肺炎模型的造模。方法:利用受精卵原核注射技术将hSP-B基因整合至小鼠染色体上获得F0代小鼠,将其与mSP-B基因敲除鼠进行交配,逐步去除转基因小鼠体内m SP-B基因。利用PCR技术鉴定小鼠基因型,通过测序确定+1580位点的等位基因。将铜绿假单胞菌经支气管灌注接种至小鼠肺内进行细菌性肺炎造模,对照组注射等量灭菌生理盐水。结果:F2代小鼠只表达人SP-B蛋白而不表达鼠SP-B蛋白,蛋白表达量与人肺内含量相近,即为构建成功的转基因小鼠。3个小鼠家系+1580位点等位基因为T,1个家系为C。细菌接种(1×10~6CFU/mouse)后24小时,小鼠肺泡内炎症渗出明显,大量中性粒细胞浸润,SP-B蛋白含量明显降低,但不同等位基因间在此条件下无明显差异。结果:成功构建只表达人SP-B蛋白的转基因小鼠模型,细菌性肺炎模型造模成功,为今后进一步研究人SP-B蛋白的生理功能及+1580基因多态性与肺疾病的关系提供了有力的工具。     

替加环素对重症呼吸机相关性肺炎患者呼吸力学与血清炎症因子的影响

目的:研究替加环素治疗重症呼吸机相关性肺炎的疗效及对患者呼吸力学及血清炎症因子水平的影响。方法:选取2014年9月至2016年8月本院收治的88例重症呼吸机相关性肺炎患者,根据投硬币法分为观察组和对照组,44例每组。对照组采用常规治疗方案,观察组在常规治疗基础上采用替加环素治疗。观察并比较两组患者治疗前后呼吸力学、血清炎症因子指标及临床疗效。结果:治疗后,观察组临床总有效率高于对照组(P0.05)。观察组肺部感染控制时间、治愈时间均短于对照组(P0.05)。观察组呼吸做功、气道峰压、气道阻力均低于对照组,动态顺应性高于对照组(P0.05)。观察组IL-6、IL-8、TNF-α水平低于对照组(P0.05)。结论:重症呼吸机相关性肺炎患者经替加环素治疗后,能有效改善患者呼吸力学与血清炎症因子水平,临床疗效良好。     

MiR-181b serves as diagnosis and prognosis biomarker in severe community-acquired pneumonia

Severe community-acquired pneumonia (SCAP) is a common critical disease in the intensive care unit (ICU). This study aims to evaluate the clinical significance of miR-181b in SCAP, which has been revealed to be dysregulated in acute respiratory distress syndrome events due to SCAP. There were 50 SCAP patients and 26 healthy volunteers were recruited in this study. The expression of miR-181b was detected by RT-qPCR and the difference between SCAP and healthy controls was evaluated. The diagnosis and prognosis value of miR-181b was assessed by the receiver operating characteristics (ROC), Kaplan-Meier, and Cox regression analysis. miR-181b was significantly downregulated in SCAP compared with healthy controls. The downregulation of miR-181b showed a significant association with the white blood cell count, absolute neutrophils, and the C-reactive protein of patients. The downregulation of miR-181b could distinguish SCAP patients from healthy controls and predicate the poor prognosis of SCAP patients. Downregulated miR-181b serves as a diagnosis and prognosis biomarker for SCAP, which may be useful biological information for the early detection and risk estimation of SCAP.     

SARS及其病原体研究进展

严重急性呼吸道综合症(SARS)的病原体己被认定为一种新的冠状病毒-SARS冠状病毒。关于SARS冠状病毒的基因组和蛋白组研究也已取得重要进展,这为探索SARS病毒的来源与进化、研制SARS诊断试剂、开发SARS疫苗和治疗药物奠定了坚实基础。本文对严重急性呼吸道综合症病原学研究取得的一些进展进行了综述。     

PCR-based detection and eradication of mycoplasmal infections from various mammalian cell lines: a local experience

A total of 200 cell lines including different human, monkey, mice, hamster and rat cell types were examined for mycoplasma infection status. PCR assay using generic-specific universal primers showed that 40 (20%) of the cell lines are contaminated with mycoplasma. Employment of species-specific primers within these infected cell lines revealed infection with M. hyorhinis (42.5%), M. fermentas (37.5%), M. arginini (37.5%), M. orale (12.5%) and A. laidlawii (7.5%). A number of the cultures were coinfected with 2 or 3 different species. Contaminated samples were treated with BM-Cyclin, Ciprofloxacin and mycoplasma removal agent (MRA). Mycoplasma eradication was subsequently checked by PCR following 2 weeks continuous culture of treated cells in antibiotic free culture medium. Mycoplasmal infections were eradicated in 100, 70 and 42% of infected cell lines when the samples were treated with BM-Cyclin, MRA and Ciprofloxacin, respectively. However, 12% (BM-Cyclin), 62.5% (MRA) and 82.5% (Ciprofloxacin) of mycoplasma regrowth was observed 4 months after the treatment. Notably, the risk of spontaneous culture death was 17.5, 12.5 and 0% for BM-Cyclin, MRA and Ciprofloxacin, respectively.     

机械通气患儿气管导管表面细菌生物膜形成及病原分析

目的观察儿科重症监护病房（PICU）机械通气（mechanical ventilation,MV）患儿气管导管（endotraeheal tube,mr）表面细菌生物膜（biofilm,BF）内细菌分布情况及BF形态学特征。方法以我院治疗的35例MV患儿为研究对象。收集第1次拔除或更换的ETT,经碘化丙啶（PI）和异硫氰酸荧光索标记刀豆蛋白A（FITC-ConA）染色后,激光共聚焦显微镜观察ETT-BF内细菌及胞外多糖（EPS）分布情况,并收集ETT表面和下呼吸道分泌物进行细菌分离、培养和鉴定。结果（1）35例MV患儿中,E1-r表面细菌培养阳性31例（88．57％）;17例EIT表面和下呼吸道分泌物同时分离出相同菌种,占ETT培养阳性的54．83％。在EIT-BF和下呼吸道分泌物中以金黄色葡萄球菌,肺炎克雷伯菌,大肠埃希菌,阴沟肠杆菌最常见。（2）CLSM观察可见,气管插管12h后,ETT-11表面已出现细菌黏附;48h时ETT表面可见大量短棒状或球状细菌黏附聚集,EPS较12h时显著增多,初步形成BF结构;72h左右细菌粘连成团块状,被EPS包裹,可见成熟BF结构形成;7d后细菌粘连成大片状,在其周围可见散在的微菌落。（3）35例MV患儿中,19例发生了呼吸机相关性肺炎（ventilated—associated pneumonia,VAP）。其中经口插管10例,经鼻插管9例。结论MV时细菌极易在ETT表面黏附,形成细菌BF。ETF表面细菌定植及BF形成与长时间MV患儿伴发呼吸机相关性肺炎之间可能存在一定相关性。     

The diagnostic accuracy of high-mobility group box 1 protein and twelve other markers in discriminating bacterial, viral and co-infected bronchial pneumonia in Han children

Pneumonia in children is common and can lead to grave consequences if not addressed in a proper and timely manner. In the management of pneumonia, early identification of the causative infective agent is of obvious importance for treatment, as it allows selection of the appropriate antibiotics. However, such identification requires laboratory test results, which may not be immediately available. The aim of this study was to evaluate the accuracy and usefulness of 13 markers in differentiating between viral and bacterial pneumonia in Han children (34 healthy controls and 78 patients). It was found that WBC counts were more accurate in diagnosis of the type of agent responsible for infection than was the degree of expression of HMGB1. Among the 13 markers investigated, HMGB1 was the best at discriminating between co-infected (bacterium and virus) and single-infected (bacterium or virus) children with bronchial pneumonia. HMGB1 expression of less than 1.0256, excluded most co-infections (the negative predictive value was greater than 89.7%). Diagnosed sole viral pneumonia clinically overlapped with bacterial pneumonia, but bacterial pneumonia was more often associated with higher white blood cell (WBC) counts (WBC ≥ 13,000 cells/mm(3)). When the two marker readouts--HMGB1 < 1.0256 and WBC ≥ 13,000 cells/mm(3)--were combined, the positive predictive value for bacterial pneumonia alone was 92.3%. These findings can help clinicians discriminate between bronchial pneumonia caused by virus, bacterium or both with a high specificity.