目的 探讨华南地区自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)临床特点,提高对该病的认识。方法 回顾性总结2010年1月—2020年1月期间收治的居住在华南地区AIH-PBC OS患者37 例,对患者的临床表现、血清学、影像学和病理学特点,伴发肝外自身免疫性疾病等情况进行分析。结果 37例AIH-PBC OS以女性(94.6%)为主,平均发病年龄(48.3±10.3)岁,确诊年龄(50.4±9.2)岁,病程(2.7±2.5)年。83.8%患者存在临床症状,以乏力纳差,身目黄染、尿黄及瘙痒最为常见。在所有患者中,诊断为慢性肝炎为45.9%,代偿性肝硬化为18.9%,失代偿性肝硬化为35.1%,合并肝外自身免疫性疾病占35.1%,以自身免疫性甲状腺疾病和干燥综合征最常见。血清谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、碱性磷酸酶、总胆红素、总胆固醇、低密度脂蛋白胆固醇水平均升高,失代偿肝硬化期患者血红蛋白和白蛋白下降(P<0.05)。近一半患者血清免疫球蛋白G、免疫球蛋白M和免疫球蛋白A水平升高,失代偿肝硬化期患者免疫球蛋白G升高最为明显(P<0.05)。自身抗体包括抗核抗体阳性率、抗线粒体抗体和(或)抗线粒体抗体M2型抗体阳性率、抗平滑肌抗体阳性率、抗核点蛋白抗体阳性率、抗核包膜蛋白抗体阳性率分别为92%、67.6%、10.8%、11.1%、13.8%。病理学提示AIH-PBC OS患者可见汇管区淋巴细胞和浆细胞浸润,肝小叶界面炎,并伴有不同程度小胆管病变,70.2%同时伴有AIH-PBC特征。肝脏影像学显示在所有患者中,29.7%存在肝硬化,18.9%存在门静脉高压,62.2%存在脾大,18.9%存在腹腔积液。结论 AIH-PBC OS同时具有AIH及PBC疾病的临床特点,病情较复杂、发病较隐蔽;同时伴有血脂代谢障碍,且容易并发肝外自身免疫性疾病。

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法 采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

目的 在原来研究的基础上进一步研究Wnt-1信号通路蛋白-3（WISP-3）在高氧诱导肺上皮细胞凋亡中的作用。方法 通过Western blot检测和免疫组化检测不同肺上皮细胞中WISP-3的蛋白表达量。利用质粒转染和siRNA的方法在Beas-2B细胞中高表达和基因沉默WISP-3,通过细胞活性检测和流式细胞学技术检测高氧刺激后细胞的凋亡情况。结果 与空气对照相比,高氧刺激使肺上皮细胞的WISP-3蛋白表达量下降;WISP-3基因沉默或高表达使高氧诱导的肺上皮细胞凋亡增加或减少。结论 高氧刺激下,肺上皮细胞中WISP-3表达下降,WISP-3对高氧诱导的肺上皮细胞凋亡具有保护作用。

Objective To explore how Wnt-1 inducible signaling pathway protein-3 （WISP-3） participate in and play a regulatory role in the process of hyperoxia induced apoptosis in lung epithelial cells. Methods The expression of WISP-3 was detected via Western blot and immunohistochemistry. High expression and low expression of WISP-3 were performed by plasmid transfection and siRNA. Cell viability and flow cytometry were executed to detect the hyperoxia-induced apoptosis in Beas-2B. Results Compared to the group of air control,the expression of WISP-3 protein in lung epithelial cells decreased obviously after hyperoxia. Cell survival decrease and apoptosis increased after hyperoxia in Beas-2B cells with low expression of WISP-3. Vice versa. Conclusion The expression of WISP-3 decreased after hyperoxia in lung epithelial cells. The role of WISP-3 in this process may be protective.

目的 确定CD4⁺CD25⁺Treg调节性T细胞在重症肺炎克雷伯菌肺炎中的表达以及意义,探讨CD4⁺CD25⁺Treg在重症肺炎克雷伯菌肺炎的免疫抑制中的调控作用。方法 通过气管内滴注肺炎克雷伯菌菌液建立重症肺炎模型。采用流式细胞仪检测CD4⁺CD25⁺Treg细胞及酶联免疫吸附法(ELISA)等方法检测各种细胞因子。结果 重症肺炎克雷伯菌肺炎大鼠的脾脏和肺中CD4⁺CD25⁺Treg的数量增加。使用了CD25抗体(PC61)去除机体内源性的CD4⁺CD25⁺Treg,分别去除脾脏和肺的94%和90%的CD4⁺CD25⁺Treg。CD25抗体组在建模4 h,12 h及24 h后,肺部MPO及血清IL-1,IL-6,MIP-2较对照组高(P<0.05),肺和BLA比对照组高(P<0.05),CD25抗体组大鼠生存率比对照组低(P<0.05)。结论 内源的CD4⁺CD25⁺Treg对大鼠抑制重症肺炎克雷伯菌肺炎的过度免疫损害反应起到保护作用。

Objective To confirm the expression and meaning of the T regular cell in the severe Klebsiella pneumonia, and to evaluate the regular and control affect in the immunologic suppression of the severe Klebsiella pneumonia. Methods To build the severe pneumonia model by intratracheally inoculated with Klebsiella pneumoniae bacteria. To check sorts of inflammation factors by the methods of ELISA and flow cytometry. Results The quantity of the CD4⁺CD25⁺Treg in the splenic and lungs of the mice with severe Klebsiella pneumonia were increased. Anti-CD25Ab(PC61) was used to remove endogenousCD4⁺CD25⁺Treg. Anti-CD25 treatment remove 90% of CD4⁺CD25⁺Treg cells. The cytokine production(IL-1β,IL-6,MIP-2)in the anti-CD25-treated group were significantly increased. And it also increased significantly in the airway neutrophil infiltration, while the survival rate had been decreased. Conclusion Endogenous CD4⁺CD25⁺Treg can provide obvious protection effect to the restraining the over immunity damage of the severe Klebsiella pneumonia for the mice.

目的 通过建立大鼠泛耐药铜绿假单胞菌肺炎模型,对其进行联合用药,观察疗效,以便为治疗泛耐株引起的感染提供理论基础。方法 选择体外药敏实验中各药物组合同时有效的一株铜绿假单胞菌建立小鼠肺炎模型,于感染后6小时给药,对照组腹腔注射0.5 mL生理盐水,治疗组分别用头孢他啶+阿米卡星+环丙沙星以及头孢他啶+阿米卡星+环丙沙星+氨氯地平两组用药方案连续治疗三天后,根据肺组织匀浆细菌计数及病理结果评价疗效。结果 体内药敏试验显示用药组不管有无氨氯地平干预,对细菌的清除作用与对照组比较差异有统计学意义(P﹤0.05),而两用药组之间比较,差异无统计学意义。结论 对泛耐药铜绿假单胞菌感染后肺炎模型,联合应用体外单药药敏试验耐药的抗菌药后对细菌仍有一定的清除作用,但加入氨氯地平干预未显示有明显的治疗效应。