非药物治疗极低出生体重儿喂养不耐受的临床观察

目的:将非药物性干预措施与传统药物方法治疗极低出生体重儿喂养不耐受的临床疗效进行观察比较。方法:选取哈尔滨医科大学附属第二医院2011年1月至2013年4月出生的喂养不耐受极低出生体重儿110例。按入院顺序随机分为药物治疗组(MED)55例、非药物治疗组(NON-MED)55例。药物治疗组采用红霉素;非药物治疗组采用腹部按摩法与非营养性吸吮。结果:两组患儿经治疗后,MED组腹胀消失天数(4.4±0.5)、呕吐天数(2.2±0.5)、每日呕吐次数(3.5±0.8)、胃潴留量占每日喂养量(18.3±0.8)、达全肠道喂养天数(8.2±0.7);NON-MED组腹胀消失天数(3.7±0.1)、呕吐天数(1.9±0.6)、每日呕吐次数(2.8±0.1)、胃潴留量占每日喂养量(12.6±0.4)、达全肠道喂养天数(6.1±0.3)。各项治疗指标的对比中,差异均有统计学意义(P0.05)。MED组治疗有效率76.4%;NON-MED组治疗有效率83.6%。结论:非药物性干预措施可有效改善极低出生体重儿喂养不耐受。     

Correlation of urinary inflammatory and oxidative stress markers in very low birth weight infants with subsequent development of bronchopulmonary dysplasia

Abstract

Currently, bronchopulmonary dysplasia (BPD) occurs almost exclusively in pre-term infants. In addition to prematurity, other factors like oxygen toxicity and inflammation can contribute to the pathogenesis. This study aimed to compare urinary inflammatory and oxidative stress markers between the no/mild BPD group and moderate/severe BPD group and between BPD cases with significant early lung disease like respiratory distress syndrome (RDS) (‘classic’ BPD) and with minimal early lung disease (‘atypical’ BPD). A total of 60 patients who were a gestational age < 30 weeks or a birth weight < 1250 g were included. Urine samples were obtained on the 1^st, 3^rd and 7^th day of life and measured the levels of leukotriene E₄ (LTE₄) and 8-hydroxydeoxyguanosine (8-OHdG). The 8-OHdG values on the 3^rd day showed significant correlation to duration of mechanical ventilation. The 8-OHdG levels on the 7^th day were the independent risk factor for developing moderate/severe BPD. In ‘classic’ BPD, the 8-OHdG values on the 3^rd day were higher than those of ‘atypical’ BPD. In ‘atypical’ BPD, the LTE₄ values on the 7^th day were higher than the values in ‘classic’ BPD. These results suggest that oxidative DNA damage could be the crucial mechanism in the pathogenesis of current BPD and the ongoing inflammatory process could be an important mechanism in ‘atypical’ BPD.     

呼吸窘迫综合征早产儿血清VA、PCT、TNF-α及CRP水平的表达及临床意义

目的:探讨呼吸窘迫综合征(RDS)早产儿血清维生素A(VA)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平的表达及临床意义。方法:选取2015年2月～2018年5月期间青岛市妇女儿童医院收治的90例RDS早产儿纳入观察组,根据RDS分级将观察组分为轻度组48例,中重度组42例。另选取同期于本院出生的非RDS早产儿35例作为对照组。根据血清VA水平将125例早产儿分为VA缺乏组(n=72),亚临床VA缺乏组(n=36),正常组(n=17)。比较观察组与对照组、轻度组与中重度组早产儿血清VA、PCT、TNF-α及CRP水平,比较不同血清VA水平早产儿的RDS发病情况,分析观察组早产儿血清VA与PCT、TNF-α及CRP水平的相关性。结果:观察组早产儿血清VA水平明显低于对照组(P0.05),而观察组早产儿血清PCT、TNF-α、CRP明显高于对照组(P0.05)。中重度组早产儿血清VA水平与轻度组比较差异无统计学意义(P0.05),而中重度组早产儿血清PCT、TNF-α、CRP水平明显高于轻度组(P0.05)。随着血清VA水平的升高,RDS发病率逐渐降低,组间比较差异有统计学意义(P0.05)。Pearson相关性分析显示,观察组早产儿血清VA与PCT、TNF-α及CRP水平无显著相关性(P0.05)。结论:RDS早产儿血清VA与PCT、TNF-α及CRP水平均存在明显异常,但四者无明显相关性,血清VA相对较低者更易发生RDS,临床可通过及时干预VA水平以降低RDS的发生风险。     

脂联素在早产儿血清中的表达及其与体格指标、载脂蛋白和骨密度的关系

目的:探讨脂联素在早产儿血清中的表达水平及其与体格指标、载脂蛋白和骨密度的相关性。方法:选择2017年1月至2018年5月期间我院新生儿科住院的早产儿72例作为研究组,另外选择同期我院出生的足月新生儿58例作为对照组。对比两组新生儿的一般资料、脂联素、载脂蛋白和骨密度水平,分析早产儿血清脂联素水平与体格指标、载脂蛋白和骨密度的相关性,同时分析影响血清脂联素水平的危险因素。结果:两组受试新生儿的性别、胸围、低密度脂蛋白(LDL-C)及高密度脂蛋白(HDL-C)之间的差异无统计学意义(P0.05);研究组新生儿的胎龄、体质量指数(BMⅠ)、身长、头围、总胆固醇(TC)及三酰甘油(TG)明显低于对照组(P0.05);与对照组相比,研究组新生儿血清脂联素、载脂蛋白A-Ⅰ(Apo A-Ⅰ)及左胫骨中段超声波在骨骼中的传播速度(SOS)水平明显下降,而载脂蛋白B(Apo B)和Apo B/Apo A-Ⅰ水平均显著升高,且差异均具有统计学意义(P0.05);早产儿血清脂联素水平与胎龄、BMⅠ、头围、TC、TG、Apo A-Ⅰ及SOS呈正相关(P0.05),与Apo B和Apo B/Apo A-Ⅰ水平呈负相关(P0.05);Logistic回归结果显示,胎龄、BMⅠ、Apo B/Apo A-Ⅰ及SOS是早产儿血清脂联素水平的影响因素(P0.05)。结论:早产儿血清脂联素水平低于足月儿,血清脂联素水平与体格指标、载脂蛋白及骨密度密切相关,可能对新生儿的生长发育具有重要的调节作用。     

两种高危型HPV假病毒的构建及其在血清中和抗体测定中的应用

目的 构建人乳头瘤病毒(human papillomavirus, HPV)16型(HPV16)和18型(HPV18)假病毒,探索优化假病毒制备的条件,并利用制备的假病毒评价HPV疫苗血清抗体的中和活性。方法 将优化后的HPV16和HPV18 L1、L2和EGFP基因片段分别插入pcDNA3.1+载体中,通过多质粒共转染293FT细胞制备假病毒。对转染试剂、多质粒共转染比例、转染时间和细胞裂解时间进行摸索优化,通过测定假病毒的滴度,确定假病毒制备的最佳条件。收获的假病毒用30%的碘克沙醇作为介质进行超速离心纯化,纯化后的假病毒用于电镜观察。利用假病毒中和试验对制备的原核表达复性蛋白HPV16 L1免疫血清以及HPV16和HPV18病毒样颗粒(virus-like particles, VLP)免疫血清进行中和活性评价。结果 成功构建了假病毒,并确定了假病毒制备的最佳条件:pL1∶pL2∶pEGFP等3种质粒共转染比例为1∶0.1∶0.5,总量为4μg;转染时间为72 h,细胞裂解时间为24 h时获得的假病毒滴度最高。透射电镜观察结果显示,HPV16和HPV18假病毒颗粒基本呈规则圆形,形态上与天然病毒颗粒相似。中和试验结果显示,当用原核表达复性蛋白HPV16 L1免疫血清中和HPV16假病毒时,并不能抑制假病毒的感染活性;但HPV16和18 VLP免疫血清能明显的抑制HPV16和HPV18假病毒的感染活性。结论 成功构建并制备了2种高危型HPV假病毒,并可用于中和试验评价HPV疫苗血清抗体的中和活性。     

Structural–functional approach to identify post-disturbance recovery indicators in forests from northwestern Patagonia: A tool to prevent state transitions

The disruption of the natural post-disturbance recovery process, either by changes in disturbance regime or by another disturbance, can trigger transitions to alternative degraded states. In a scenario of high disturbance pressure on ecological systems, it is essential to detect recovery indicators to define the period when the system needs more protection as well as the period when the system supports certain use pressure without affecting its resilience. Recovery indicators can be identified by non-linear changes in structural and functional variables. Fire largely modulates the dynamic and stability of plant communities worldwide, and is this the case in northwestern (NW) Patagonia. The ultimate goal of this study is to propose a structural–functional approach based on a reference system (i.e. chronosequence) as a tool to detect post-disturbance recovery indicators in forests from NW Patagonia. In NW Patagonia (40–42°S), we sampled 25 Austrocedrus chilensis and Nothofagus spp. communities differing in post-fire age (0.3–180 years). In each community we recorded structural (woody species cover and height, solar radiation, air temperature, relative humidity) and functional (annual recruitment of woody and tree species) attributes. We modeled these attributes in function of post-fire age and analized the relationship between a functional attribute and a Structural Recovery Index (SRI). Communities varying in time-since-last-fire were structurally and functionally different. Moreover, response variables showed non-linear changes along the chronosequence, allowing the selection of recovery indicators. We suggest to use vegetation variables instead of environmental variables as structural recovery indicators. Horizontal and Vertical Vegetation Heterogeneity indices provided the information necessary to describe vegetation spatial reorganization after fire. Tree species annual recruitment was a good indicator of the functional recovery of forest communities. The relationship between a functional attribute and SRI allowed us to detect phases with high- and low-risk of degradation during post-fire succession. High-risk phases (<36 years old) had the highest horizontal vegetation heterogeneity and scarce tree seedling density (<7000 seedlings ha⁻¹ year⁻¹). Whereas, low-risk phases (>36 years old) had the highest vertical vegetation heterogeneity and tree species seedling density (>10,000 seedlings ha⁻¹ year⁻¹). Due to the low structural–functional levels, communities at high-risk phases would be more vulnerable to antropic pressure (e.g. livestock raising, logging) than communities at low-risk phases. The proposed approach contributes to the sustainable management of forest communities because it allows to estimate the minimum structural–functional levels from which forest communities could be harvested.     

α-干扰素针肌肉注射协同重组干扰素α-2b栓治疗高危型乳头瘤病毒感染的疗效观察

目的探讨α-干扰素针肌肉注射协同重组干扰素α-2b栓治疗高危型乳头瘤病毒(HPV)感染。方法选择妇产科门诊治疗宫颈高危型HPV感染患者68例,随机分为联合组和对照组,每组均为34例。两组患者均于月经结束后3 d予以重组干扰素α-2b栓阴道内放置,1枚/晚,连用10 d,下次月经后开始下一个疗程,连用3个疗程。联合组患者在此基础上予以α-干扰素1 000 000U肌内注射,1次/隔天,连用10d,下次月经后开始下一个疗程,连用3个疗程。观察并记录两组患者临床疗效及不良反应,比较治疗后随访半年和1年后HPV的转阴率。结果治疗3个疗程后,联合组患者临床总有效率(94.12%)明显优于对照组(76.47%)(χ2=4.22,P0.05)。对照组和联合组治疗中分别出现不良反应4例和10例,症状均较轻微,两组患者不良反应发生率比较差异无统计学意义(χ2=3.24,P0.05)。治疗后随访半年和1年后,联合组的HPV的转阴率分别为96.88%和90.63%,均明显高于对照组的73.08%和65.38%(χ2=4.98或5.57,P0.05)。结论α-干扰素针肌肉注射协同重组干扰素α-2b栓治疗高危型HPV感染的临床效果较显著,安全性较佳,且其中远期临床效果亦较佳,能更有效提高HPV的转阴率。