阻塞性黄疸患者总胆汁酸的表达及与血脂水平的关系研究

目的:探讨阻塞性黄疸(OJ)患者血清总胆汁酸(TBA)水平与血脂水平的关系。方法:选择2015年5月到2015年12月我院收治的70例OJ患者作为观察组,同期选择70例健康人员作为对照组。检测并比较两组血清TBA、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白AI(Apo AI)、载脂蛋白B(Apo B)、脂蛋白α[Lp(α)]、总胆红素(T-Bil)及直接胆红素(D-Bil)水平,并分析血清TBA与血脂水平的关系。结果:观察组患者的血清TBA、TG、TC、Apo B、T-Bil及D-Bil水平均明显低于对照组,血清LDL-C、HDL-C、Apo AI及Lp(α)水平均明显高于对照组,差异均具有统计学意义(P0.05)。Pearson直线相关性分析结果表明,血清TBA水平与血清TG、TC、Apo B、T-Bil及D-Bil呈正相关性,与血清LDL-C、HDL-C、Apo AI及Lp(α)水平呈负相关性。结论:OJ患者体内存在血脂水平紊乱,血清TBA可能是导致OJ患者血脂代谢紊乱的重要因素。     

脂肪细胞型脂肪酸结合蛋白的研究进展

脂肪细胞型脂肪酸结合蛋白（adipocyte fatty acid binding protein,AFABP/aP2）作为脂肪酸结合蛋白（FABPS）超家族成员之一,广泛存在于各种正常的组织细胞中,参与脂肪酸贮存,运输与降解等过程。近年来,对脂肪细胞型脂肪酸结合蛋白的研究已成为热点,本文就其主要特征及其与各类疾病的关系作一简要综述。     

Enfermedad hemolítica del feto y del recién nacido por aloanticuerpos contra el antígeno M

There are few case reports of hemolytic disease in fetuses and newborns (HDFN) caused by alloantibodies against the MNS blood group system. The reason for this dearth is that antibodies toward these antigens are usually IgM, which not only cannot cross the placental circulation but also react at temperatures below 37°C. They are, therefore, of minimal clinical importance. Nevertheless, cases have been reported in which the presence of anti-M IgG antibodies caused severe HDFN and even intrauterine death in the presence of maternal-fetal MNS incompatibility indicating that they could have a high clinical impact. The hemolytic pattern observed in these cases is similar to that caused by anti-Kell antibodies. Progressive anemia is mediated and developed through hematopoietic suppression inducing the destruction of bone marrow precursor cells with the resulting absence of reticulocytes in peripheral blood.This occurred in the case of a woman at 38.5 weeks of gestation who showed a discrepancy between direct and reverse blood type determination. A direct Coombs test was performed on the newborn’s blood, which was positive in the absence of maternal-fetal ABO incompatibility. Further tests were performed and anti-M antibodies were found in the maternal serum screening. Our final diagnosis was largely due to discrepancy issues in maternal blood. Although anti-M antibodies do not usually play a significant role in HDFN, this case stresses the importance of identifying the presence of antibodies that can be crucial in preventing HDFN and lead to new recommendations for the screening and prompt treatment of hemolysis in newborns.     

Biomarkers of some pulmonary diseases in exhaled breath

Analysis of various biomarkers in exhaled breath allows completely non-invasive monitoring of inflammation and oxidative stress in the respiratory tract in inflammatory lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), bronchiectasis and interstitial lung diseases. The technique is simple to perform, may be repeated frequently, and can be applied to children, including neonates, and patients with severe disease in whom more invasive procedures are not possible. Several volatile chemicals can be measured in the breath (nitric oxide, carbon monoxide, ammonia), and many non-volatile molecules (mediators, oxidation and nitration products, proteins) may be measured in exhaled breath condensate. Exhaled breath analysis may be used to quantify inflammation and oxidative stress in the respiratory tract, in differential diagnosis of airway disease and in the monitoring of therapy. Most progress has been made with exhaled nitric oxide (NO), which is increased in atopic asthma, is correlated with other inflammatory indices and is reduced by treatment with corticosteroids and antileukotrienes, but not (β₂-agonists. In contrast, exhaled NO is normal in COPD, reduced in CF and diagnostically low in primary ciliary dyskinesia. Exhaled carbon monoxide (CO) is increased in asthma, COPD and CF. Increased concentrations of 8-isoprostane, hydrogen peroxide, nitrite and 3-nitrotyrosine are found in exhaled breath condensate in inflammatory lung diseases. Furthermore, increased levels of lipid mediators are found in these diseases, with a differential pattern depending on the nature of the disease process. In the future it is likely that smaller and more sensitive analysers will extend the discriminatory value of exhaled breath analysis and that these techniques may be available to diagnose and monitor respiratory diseases in the general practice and home setting.     

睡眠呼吸暂停综合症与炎症反应及血管内皮调节相关性的研究进展

阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea,OSA)是一种发病率高,具有一定潜在危险的全身性疾病,同时也是心脑血管疾病的一个独立危险因素。其主要病理生理改变是睡眠过程中反复发生低氧和再氧合而引起的氧化应激反应,引发炎症反应而导致心、脑血管为主的多系统损害。流行病学研究证据表明,一些循环水平的炎症因子在OSA患者中升高,与心脑血管疾病发病风险相关。包括细胞粘附分子如粘附分子-1(intercellular adhesion molecule-1,ICAM-1)和选择素(selectins),细胞因子如肿瘤坏死因子α(TNF-a)和白细胞介素-6(interleukin-6,IL-6),趋化因子如白细胞介素-8(interleukin 8,IL-8)和C-反应蛋白(C-reactive protein)。此外,动脉粥样硬化是OSA导致心脑血管疾病的重要的机制,OSA后的炎症反应在动脉粥样硬化形成及发展的过程中起着至关重要的作用,本文重点对OSA后炎症因子启动及血管内皮调节的新近研究进行综述。     

茵栀黄口服液联合布拉酵母 对新生儿黄疸的治疗

目的探讨茵栀黄口服液联合布拉酵母治疗新生儿黄疸的效果。方法回顾性分析2012年5月至2016年2月我院收治的108例新生儿黄疸患儿的临床资料,根据治疗方法的不同将患儿分为对照组(50例)和观察组(58例)。两组患儿均给予蓝光处理,对照组同时给予布拉酵母治疗,观察组在对照组的基础上联用茵栀黄口服液进行治疗。比较两组患儿凝血指数、血气指标、生化指标及治疗效果。结果观察组患儿治疗后有效率高于对照组(98.28%vs 90.00%,χ~2=24.92,P0.05)。观察组患儿治疗后PaCO_2、pH、BE及Ca~(2+)和Mg~(2+)水平均低于对照组,差异有统计学意义(均P0.05)。观察组患儿治疗后PT、APTT、FIB、TT异常发生率与对照组比较差异无统计学意义(均P0.05)。观察组患儿治疗后血清总胆红素水平低于对照组,住院时间及黄疸消退时间均短于对照组,差异有统计学意义(均P0.05)。结论茵栀黄口服液联合布拉酵母治疗新生儿黄疸效果显著,能够明显缩短黄疸消退时间,改善血气分析指标及生化指标水平,安全有效。     

Importance of Mast Cell Prss31/Transmembrane Tryptase/Tryptase-γ in Lung Function and Experimental Chronic Obstructive Pulmonary Disease and Colitis

Protease serine member S31 (Prss31)/transmembrane tryptase/tryptase-γ is a mast cell (MC)-restricted protease of unknown function that is retained on the outer leaflet of the plasma membrane when MCs are activated. We determined the nucleotide sequences of the Prss31 gene in different mouse strains and then used a Cre/loxP homologous recombination approach to create a novel Prss31^−/− C57BL/6 mouse line. The resulting animals exhibited no obvious developmental abnormality, contained normal numbers of granulated MCs in their tissues, and did not compensate for their loss of the membrane tryptase by increasing their expression of other granule proteases. When Prss31-null MCs were activated with a calcium ionophore or by their high affinity IgE receptors, they degranulated in a pattern similar to that of WT MCs. Prss31-null mice had increased baseline airway reactivity to methacholine but markedly reduced experimental chronic obstructive pulmonary disease and colitis, thereby indicating both beneficial and adverse functional roles for the tryptase. In a cigarette smoke-induced model of chronic obstructive pulmonary disease, WT mice had more pulmonary macrophages, higher histopathology scores, and more fibrosis in their small airways than similarly treated Prss31-null mice. In a dextran sodium sulfate-induced acute colitis model, WT mice lost more weight, had higher histopathology scores, and contained more Cxcl-2 and IL-6 mRNA in their colons than similarly treated Prss31-null mice. The accumulated data raise the possibility that inhibitors of this membrane tryptase may provide additional therapeutic benefit in the treatment of humans with these MC-dependent inflammatory diseases.     

Effect of melatonin on cholestatic oxidative stress under constant light exposure

This study was designed to evaluate the effect of melatonin on cholestatic oxidative stress under constant light exposure. Cholestasis was induced by double ligature and section of the extra-hepatic bile duct. Melatonin was injected i.p.(1000 microg kg(-1) day(-1)). Malondialdehyde, reduced glutathione, catalase, superoxide dismutase, glutathione reductase, peroxidase and transferase were determined in liver. After bile-duct obstruction and under constant light exposure, an increase in malondialdehyde (p < 0.05) and a slight decrease in reduced glutathione were seen. Enzyme activity, with the exception of glutathione reductase, had significantly diminished. After melatonin administration, malondialdehyde fell (p < 0.001), whereas there was an increase in reduced glutathione (p < 0.0001) compared with untreated controls. Constant light exposure was associated with an increase in hepatic oxidative stress. Treatment with melatonin decreased lipid peroxide synthesis, and permitted a recovery of both reduced glutathione and scavenger enzyme activity.     

茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸的临床研究

目的:探讨茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸的临床疗效和安全性。方法:选择2016年9月-2018年3月我院收治的胆汁淤积性黄疸儿童94例,按随机抽签方式分为对照组及观察组,每组47例。对照组给予熊去氧胆酸胶囊治疗,观察组在对照组基础上给予茵栀黄口服液治疗,比较两组患儿治疗前后血清胆红素水平、肝功能及免疫指标水平的变化及不良反应的发生情况。结果:治疗后,两组总胆红素(Total Bilirubin,TBil)、直接胆红素(Direct Bilirubin,DBil)、谷丙转氨酶(Alanine transaminase,ALT)、谷草转氨酶(Aspartate aminotransferase,AST)、碱性磷酸酶(Alkaline phosphatase,ALP)、谷氨酰转肽酶(Glutamyl transpeptidase,GGT)、CD8~+水平均较治疗前显著下降(P0.05),且观察组TBil、DBil、ALT、AST、ALP、GGT、CD8~+水平均显著低于对照组[(86.29±11.07)μmol/L vs.(132.75±16.53)μmol/L、(53.47±6.71)μmol/L vs.(86.72±9.09)μmol/L、(76.53±8.60) U/L vs.(127.05±11.79) U/L、(138.59±12.14) U/L vs.(160.08±15.82) U/L、(206.88±79.04) U/L vs.(270.40±68.19) U/L、(223.04±89.59) U/L vs.(280.62±96.17) U/L、(22.80±3.79)%vs.(26.52±4.30)%](P0.05)。治疗后,两组CD4~+、CD4~+/CD8~+均较治疗前显著上升(P0.05),且观察组CD4~+、CD4~+/CD8~+[(38.91±7.20)%、(1.69±0.55)]均显著高于对照组[(34.67±6.26)%、(1.31±0.49)](P0.05)。治疗期间,两组患儿均没有出现相关不良反应。结论:茵栀黄口服液联合熊去氧胆酸胶囊治疗胆汁淤积性黄疸患儿可有效改善其胆红素水平及肝功能,且具有一定的免疫调节作用。     

儿童与成人阻塞型睡眠呼吸暂停低通气综合征代谢 异常特征的比较

目的:探讨儿童及成人阻塞型睡眠呼吸暂停低通气综合症(OSAHS)发病原因、睡眠呼吸紊乱严重程度及合并代谢异常程度的差别。方法:对我院2003年1月1日至2010年7月1日71例诊断为OSAHS住院患者进行回顾性调查,登记年龄、性别、发病原因、血压、白细胞计数、中性粒细胞比率、淋巴细胞比率、呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度、微觉醒指数。根据年龄进行分组,年龄<18岁者为A组,年龄≥18岁者为B组。比较两组发病原因、睡眠呼吸紊乱及合并代谢异常程度的差别。结果:1.A组慢性扁桃体炎和(或)腺样体肥大发生率明显高于B组(P<0.01),鼻中隔偏曲发生率明显低于B组(P<0.01)。2.与B组比较,A组AHI及微觉醒指数降低,夜间最低血氧饱和度升高(P<0.01);3.与B组比较,A组高血压、中性粒细胞比率、谷丙转氨酶比例降低(P<0.05)。结论:A组睡眠呼吸紊乱程度及代谢异常较B组程度轻,更需关注成人阻塞型睡眠呼吸暂停低通气综合症的综合治疗。