目的 观察不同剂量卡介苗核酸(Bacille Calmette-guerin DNA , BCG-DNA)在不同干预时间对哮喘小鼠气道高反应性及气道炎症的干预作用。方法 1.将Balb/c雌鼠随机分为哮喘模型组、NS对照组、BCG- DNA干预组。干预组根据干预的时间和干预制剂剂量的不同分为-7DNA1 μg、-7DNA10 μg、-7DNA100 μg、10DNA1 μg、10DNA10 μg、10DNA100 μg、17DNA1 μg、17DNA10 μg、17DNA100 μg组。2.在末次激发48小时后,测定各浓度级乙酰甲胆碱激发下的增强的呼气间歇 (Enhanced Pause, Penh)值,将其与小鼠激发前吸入NS后的Penh的百分比(Penh%NS),作为其气道反应性评价指标;其次对肺泡灌洗液进行细胞学分析。结果 1.气道反应性:①-7DNA1 μg组从Mch为3.12～50 mg/mL之间的Penh%NS显著低于哮喘组(P<0.05);②-7DNA10 μg组和-7DNA 100 μg组从Mch为6.25～25 mg/mL之间的Penh%NS显著低于哮喘组(P<0.05);③10DNA10 μg组从Mch为12.5～25 mg/mL之间的Penh%NS显著低于哮喘组(P<0.05);④10DNA100 μg组从Mch为3.12、12.5～50 mg/mL之间的Penh%NS显著低于哮喘组(P<0.05);⑤17DNA1 μg组在Mch为3.12、12.5 mg/mL的Penh%NS显著低于哮喘组(P<0.05);⑥17DNA10 μg组在Mch为12.5 mg/mL之间的Penh%NS显著低于哮喘组(P<0.05) 2.气道炎症:10DNA1 μg、-7DNA10 μg、10DNA10 μg和17DNA10 μg组的BALF细胞分类Eos%分别为:35.34±3.81、27.30±6.91、38.20±6.56、42.17±5.17;显著低于哮喘组的Eos%(48.8±6.12)(P<0.05);10DNA1 μg组的Eos%显著低于-7DNA1 μg组的Eos%(P<0.05);-7DNA10 μg组的Eos%显著低于10DNA10 μg、17DNA10 μg、-7DNA1 μg和-7DNA100 μg组的Eos%(P<0.05)。结论 BCG-DNA能降低哮喘小鼠的气道高反应性,减轻哮喘小鼠的气道炎症,早期(－7 d)中小剂量的干预效果较佳。

Objective To investigate the effect of Bacille Calmette-Guerin BCG-DNA on airway hyperresponsiveness and airway inflammation in asthmatic mouse model. Methods 1.According to different intervention, mouse were divided into asthma groups, NS control group, BCG-DNA group. According to different time and dosage intervened with asthma model, the BCG-DNA group were subdivided into -7DNA1 μg、-7DNA10 μg、-7DNA100 μg、10DNA1 μg、10DNA10 μg、10DNA100 μg、17DNA1 μg、17DNA10 μg and 17DNA100 μg group. 2.48 hours after the final incitation, the mice were stimulated with increasing concentrations of methacholine, and the airway resistance was measured. Enhance pause (Penh) was taken for each group. Bronchoalveolar lavage cytology was performed to evaluate the airway inflammation. Results 1.Airway hyperresponsiveness: ① Penh%NS of-7DNA1 μg group was significantly lower than the asthma group when Mch was 3.12~50 mg/mL (P<0.05); ② Penh%NS of -7DNA10 μg group and -7DNA100 μg group were significantly lower than the asthma group when Mch was 6.25~50 mg/mL (P<0.05);③ Penh%NS of 10DNA10 μg group was significantly lower than the asthma group when Mch was 12.5~25 mg/mL (P<0.05); ④ Penh%NS of 10DNA100 μg group was significantly lower than the asthma group when Mch was 3.12,12.5~50 mg/mL (P<0.05); ⑤ Penh%NS of 17DNA1 μg group was significantly lower than the asthma group when Mch was 3.12 or 12.5 mg/mL (P<0.05);⑥Penh%NS of 17DNA10 μg group was significantly lower than the asthma group when Mch was 12.5 mg/mL(P<0.05). 2.Airway inflammation: The Eos% of 10DNA1 μg, -7DNA10 μg,10DNA10 μg and 17DNA10 μg group (35.34±3.81、27.30±6.91、38.20±6.56、42.17±5.17) were lower than the asthma group (P<0.05); The Eos% of 10DNA1 μg group was lower than the -7DNA1 μg group (P<0.05); The Eos% of -7DNA10 μg group was lower than the 10DNA10μg, 17DNA10 μg,-7DNA1 μg and -7DNA100 μg group (P<0.05). Conclusion BCG-DNA can inhibit the airway inflammation and hyperresponsiveness in asthmatic mouse model. Early interventions with middle dose bring better results.

目的 探讨腹腔镜手术与传统开腹手术对右半结肠癌患者免疫功能指标及临床疗效的影响。方法 选取80例右半结肠癌患者,随机分成两组,各40例分别行腹腔镜手术及传统开腹手术,分别比较两组患者手术前后免疫功能指标及相关临床疗效的差异。结果 腹腔镜组及开腹组术后免疫指标CD3⁺、CD4⁺、CD8⁺均出现不同程度下降,但腹腔镜组免疫指标CD3⁺、CD4⁺均优于开腹组(P＜0.05);腹腔镜组术中出血量、术后胃肠排气功能恢复时间、住院时间均优于开腹组(P＜0.05);两组手术时间及淋巴结清扫个数方面无显著差异(P＞0.05)。结论 腹腔镜手术治疗右半结肠癌不仅对患者免疫功能损害较低,还较开腹术具有术中出血量少、术后恢复快等优点,值得临床推广。

目的 观察甲氨蝶呤(MTX)联合激素、羟氯喹治疗轻、中度活动性系统性红斑狼疮(SLE)的实验室结果分析及临床应用价值。方法 选择我院收治的系统性红斑狼疮患者60例,随机分成研究组(n=30)与对照组(n=30),对照组给予糖皮质激素0.5～1.0 mg/(kg·d)及羟氯喹治疗,研究组给予口服MTX片剂每周一次7.5～15 mg联合糖皮质激素及羟氯喹(用法同对照组),比较分析两组患者的实验室检查结果差异。结果 与治疗前相比,研究组患者的ANA、抗ds-DNA滴度及ESR、CRP的下降都明显优于对照组(P＜0.05);研究组患者的ALT、AST、BUN、SCr及血象(WBC、Hb、PLT)指标也明显优于对照组(P＜0.05);研究组患者补体(C3、C4) 也明显高于对照组(P＜0.05)。结论 加用MTX治疗SLE有效,安全性良好,且联合治疗能更好地控制疾病,减少复发,防止及延缓重要脏器的损害。缓解患者的临床症状,为SLE患者提供一个安全、有效的治疗方案。

目的 探究曲美他嗪对慢性心力衰竭患者血清炎症因子水平及心功能的影响。方法 选择2015年4月—2016年3月我院收治的慢性心力衰竭患者94例,根据随机数表法分为两组,每组47例。对照组实施阿托伐他汀治疗,观察组在此基础上予以曲美他嗪治疗。比较两组患者治疗6个月后血清炎症因子和脑利钠肽(BNP)、心功能以及临床疗效。结果 观察组血清C-反应蛋白(CRP)、BNP、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P＜0.05);观察组左收缩末期内径(LVESD)、左室舒张末期内径(LVEDd)水平较对照组明显降低,而左室射血分数(LVEF)高于对照组,差异有统计学意义(P＜0.05);观察组患者治疗有效率与对照组相比明显提高,差异有统计学意义(P＜0.05)。结论 对慢性心力衰竭患者实施曲美他嗪治疗,能有效提高患者临床疗效,降低患者血清炎症因子,改善心功能,值得临床推广与应用。

Objective To investigate the effect of Trimetazidine on serum inflammatory factors levels and cardiac function in patients with chronic heart failure (CHF). Methods 94 CHF patients admitted into our hospital from April 2015 to March 2016 were divided into two groups randomly, 47 cases in each. Control group took Atorvastatin, and on this basis observation group was given Trimetazidine. The serum inflammatory factors levels, brain natriuretic peptide (BNP), cardiac function and clinical efficacy of two groups after treatment for 6 months were compared. Results The serum C-reactive protein (CRP), BNP, Tumor necrosis factor-α (TNF-α) levels of observation group were lower than control group (P<0.05); The left ventricular end-systolic diameter (LVESD), Left ventricular end-diastolic diameter (LVEDd) levels of observation group significantly decreased compared with control group, but left ventricular ejection fraction (LVEF) was higher than control group (P<0.05); The curative effective rate of observation group significantly increased compared with control group (P<0.05). Conclusion Trimetazidine for treating CHF patients may effectively increase clinical efficacy, decrease serum inflammatory factors and improve cardiac function, which is worthy of clinical promotion and application.

目的 分析研究不同类型脑梗死患者睡眠结构及其与抑郁的相关性,为脑梗死患者睡眠障碍及抑郁的治疗提供新的思路及理论支持。方法 抽取我院2012年4月—2015年5月接收的124例脑梗死患者进行分组研究,根据脑梗死不同发生部位将患者分为四组,分别为小脑梗死组30例、皮层梗死组33例、脑干梗死组29例及皮层下梗死组32例,对比观察四组患者睡眠结构及睡眠参数和睡眠障碍、HAMD评分的相关性。结果 四组患者睡眠结构相比存在明显差异,脑干梗死组和皮层下梗死组觉醒时间远多于小脑梗死组和皮层梗死组,小脑梗死组NREM 1+2期、NREM期明显短于皮层梗死组、脑干梗死组及皮层下梗死组,小脑梗死组REM期、NREM 3+4期明显大于皮层梗死组、脑干梗死组及皮层下梗死组,各项数据对比差异均有统计学意义(P＜0.05);HAMD评分、PSQI评分和NREM1+2期、觉醒指数呈正相关关系(P＜0.05,r＞0);与REM期和NREM 3+4期呈负相关关系(P＜0.05,r＜0)。结论 皮层下梗死睡眠结构紊乱发生率更高,并且睡眠结构的变化和脑梗死后抑郁评分、睡眠障碍评分具有一定关系。

Objective To study the correlation between sleep structure and depression in patients with different types of cerebral infarction,to provide new ideas and theoretical support for the treatment of sleep disorders and depression in patients with cerebral infarction. Methods 124 patients with cerebral infarction in our hospital from April 2012 to May 2015 were selected. They were divided into four groups according to the different parts of the cerebral infarction, respectively, 30 cases of cerebellar infarction group, 33 cases of cortical infarction group, 29 cases of brainstem infarction group and 32 cases of subcortical infarction group. The correlation of sleep structure and sleep parameters, sleep disorder and HAMD score of the four groups were observed and compared. Results There was a significant difference in sleep structure between the four groups. Brainstem infarction group and subcortical infarction group awakening time was far more than that of cerebellar infarction group and cortex infarction group.Cerebellar infarction group NREM 1+2, NREM period was significantly shorter in cortical infarction, brain stem infarction group and subcortical infarction group. Cerebellar infarction group of REM and NREM stage 3+4 were significantly greater than that of cortical infarction death group, brain stem infarction group and cerebral cortex infarction group. The differences were statistically significant(P<0.05);HAMD score, PSQI score and NREM1+2 period, arousal index was positively correlated (P<0.05, r> 0); And REM phase and 3+4 NREM phase was negatively correlated (P<0.05, r< 0). Conclusion Subcortical infarction sleep structure disorder incidence is higher, and the sleep structure changes and infarction depression score, sleep disorder score has a certain relationship.

目的 观察分析急性左心衰竭患者应用不同剂量硝酸甘油对血浆中氨基末端B型脑钠肽(NT-proBNP)的影响。方法 选取我院120例急性左心衰竭患者作为研究对象,采用随机数字表法进行分组,其中对照组给予小剂量硝酸甘油,观察组患者采取大剂量硝酸甘油,观察并比较两组患者用药后NT-proBNP的变化情况及临床疗效。结果 经不同剂量药物治疗后,观察组总有效率(96.67%)明显高于对照组(68.33%),差异有统计学意义( χ²=16.681,P＜0.05);用药前,两组患者NT-proBNP水平相近,差异无统计学意义(t=0.384,P＞0.05);用药后6 h、12 h及24 h,观察组患者NT-proBNP指标水平有明显降低,较对照组改善明显,差异有统计学意义(t=17.470、13.988、13.900,P＜0.05)。结论 在常规治疗基础上,应用硝酸甘油微泵注入,采用大剂量硝酸甘油给药治疗急性左心衰竭,可在短时间内降低患者NT-proBNP指标水平,缓解患者症状,临床效果显著。

Objective To observe and analyze the influence and significance of different doses of nitroglycerin on plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute left ventricular failure. Methods One hundred and twenty patients with acute left heart failure were randomly assigned into control group and observation group. Patients in the control group were treated with low dose of nitroglycerin, while patients in the observation group were given high dose of nitroglycerin. NT-proBNP and clinical efficacy in the two groups were observed and compared after treatment. Results After different doses of drug treatment, the overall response rate in the observation group (96.67%) was significantly higher than that in the control group (68.33%), with statistically significant difference (χ²=16.68, P<0.05). Before treatment, NT-proBNP levels were similar, without statistically significant difference (t=0.384, P>0.05). At 6, 12 and 24 hours after treatment, NT-proBNP level was obviously decreased, which was improved than the control group, there were statistically significant differences (t=17.470, 13.988, 13.900, P<0.05). Conclusion Conventional treatment combined high-dose nitroglycerin micro-injection may reduce NT-proBNP indicator levels, relieve symptoms, and have significant clinical effect in patients with acute left heart failure.

目的 探讨醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效。方法 选取我院2014年6月—2016年6月收治的76例脓毒症相关性脑病患者作为研究对象,按照随机数字表法将其分成两组,每组38例。观察组给予醒脑静联合连续肾脏替代疗法治疗,对照组给予连续肾脏替代疗法治疗,比较两组患者的临床疗效,治疗前后格拉斯哥昏迷(Glasgow coma scale,GCS)评分、神经元特异性烯醇化酶(neuron-specifie enolase,NSE)含量、C-反应蛋白(C-reactive protein,CRP)含量及治疗后退热时间、恢复意识时间的长短。结果 观察组总有效率为89.47%,相对于对照组明显上升(P<0.05);观察组治疗后GCS评分较对照组明显升高,NSE含量、CRP含量较对照组明显降低,差异均有统计学意义(P<0.01);观察组治疗后的退热时间、恢复意识时间较对照组明显降低(P<0.01)。结论 醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效显著,可有效缩短退热及恢复意识时间,降低患者痛苦,值得临床推广应用。

Objective To investigate the curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy. Methods 76 cases of sepsis associated encephalopathy in our hospital from June 2014 to June 2016 were selected as the research objects, and they were divided into two groups according to the random number table method, 38 cases in each group. The observation group were treated with Xingnaojing combined with continuous renal replacement therapy. The control group was given continuous renal replacement therapy. The clinical efficacy of two groups were compared before and after treatment about the Glasgow coma (Glasgow coma scale, GCS) score, neuron specific enolase (neuron-specifie enolase, NSE) content, C- reactive protein (C-reactive protein, CRP)content, and the length of the consciousness recovery time and pyretolysis time. Results In the observation group, the total effective rate was 89.47%. Compared with the control group. it increased significantly (P<0.05); After treatment the GCS score in the observation group was significantly higher than the control group, the content of NSE and CRP were significantly lower than the control group, the differences were statistically significant (P<0.01); In the observation group, after treatment the pyretolysis time, consciousness recovery time was significantly lower than the control group(P<0.01). Conclusion The curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy is significant and may effectively shorten the pyretolysis and the recovery of consciousness time, which is worthy of clinical application.

目的 探讨多维铁口服液联合维生素AD滴剂治疗婴幼儿缺铁性贫血的疗效。方法 将首次诊断缺铁性贫血的336例婴幼儿依家长意愿分为2个治疗组(A组和B组)与1个对照组,A组予多维铁口服液联合维生素AD滴剂治疗,B组予多维铁口服液联合维生素D滴剂治疗,对照组饮食调理并补充维生素AD,于治疗4周后(3天内)采末梢血行血细胞分析,比较三组患儿贫血治疗显效率、总有效率差异。结果 治疗4周后,A组显效率为71.70%,总有效率为97.17%;B组显效率为41.05%,总有效率为90.30%;对照组显效率为6.25%,总有效率为32.29%。A组贫血治疗显效率、总有效率高于B组和对照组,差异均有统计学意义(P<0.05)。结论 铁剂联合维生素A制剂可显著提高婴幼儿缺铁性贫血的治疗效果。

Objective To observe the curative effect of multivitamin iron oral solution combined with vitamin AD drops on the treatment of iron deficiency anemia in infants. Methods 336 cases of infants who was found with iron deficiency anemia for the first time were divided into two treatment groups (group A and group B) and one control group in accordance with their parents' will. Group A was treated with multivitamin iron oral solution combined with vitamin AD drops. Group B was treated with multivitamin iron oral solution combined with vitamin D drops. The control group was taken just dietary therapy combined with vitamin AD drops. All subjects were tested blood analysis after 4 weeks of treatment (within 3 days). The differences of the treatment excellence rates and the total effective rates were compared in the three groups. Results After 4 weeks of treatment, the excellence rate in group A was 71.70%. The total effective rate in group A was 97.17%. The excellence rate in group B was 41.05%. The total effective rate in group B was 90.30%. The excellence rate in control group was 6.25%. The total effective rate in control group was 32.29%. The differences of the treatment excellence rates and the total effective rates in group A were significantly higher than those in group B or in the control group. The differences were statistically significant (P<0.05). Conclusion Multivitamin iron combined with vitamin A can significantly improve the curative effect of the treatment of iron deficiency anemia in infants.

目的 了解非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病患者免疫功能低下发生率,以及免疫支持的应用状况、探讨免疫支持治疗对患者2月末痰菌阴转及病变吸收的影响,为临床实施免疫干预提供参考依据。方法 分析广州市胸科医院2014年1月—2015年12月确诊的资料完整的381例NTM肺病患者免疫功能情况以及免疫支持的应用状况,观察组(加用免疫调节剂母牛分枝杆菌菌苗)228例与同期对照组(未使用免疫调节剂)153例进行2月末痰菌阴转及病变吸收情况比较。结果 381例患者中,免疫功能低下的发生率为45.67% (174／381);免疫支持率为59.84% (228／381)。细菌学改变:治疗前所有患者痰抗酸杆菌涂片和培养均为阳性。治疗2个月后两组的阴转率分别为67／228(29.38%)、17／153(11.11%),χ²=17.79,P<0.05。 影像学改变:两组的病变吸收有效率分别为62／228(27.19%)、16／153(10.45%),χ²=15.75,P<0.05;空洞吸收有效率分别为61／228(26.75%)、15／153(9.80%),χ² =20.42,P<0.05。结论 非结核分枝杆菌肺病患者存在较高比例的免疫功能低下风险,观察组的痰茵阴转、病灶吸收和空洞闭合的疗效高于对照组。

Objective To explore the immune status of patients with nontuberculous mycobacterial(NTM) pulmonary disease, and the application of immunotherapy. to evaluate the influence of immunotherapy on sputum negative conversion and lesion absorption at the end of two months. provide reference data for immunotherapy. Methods The immune function and immunotherapy of 381 patients diagnosed as NTM pulmonary disease were retrospectively analyzed from January 2014 to December 2015 in Guangzhou Chest Hospital. Curative group (treated with antitubercular agents and immunomodulator mycobacterium vaccae) were compared with control group(treated with antitubercular agents alone) in sputum negative conversion and lesion absorption at the end of two month treatment. Results Of the 381 cases,45.67%(174／381)of the patients were immunocompromised, 59.84% (228／381)received immunotherapy. Bacteriologic changes: Both sputum smear and sputum culture were positive in all patents before treatment. after two months treatment, negative conversion in two groups were 67／228(29.38%),17／153(11.11%),χ²=17.79,P<0.05. 3. Radiological change: The rate of lesion absorption in curative group and control group were respectively 62／228(27.19%),16／153(10.45%),χ²=15.75,P<0.05;The rate of promoting cavity closure were respectively 61／228(26.75%),15／153(9.80%),χ²=20.42,P<0.05. Conclusion The immune function of NTM pulmonary disease had high ratio of being compromised. Curative group showed a significant effect of sputum negative conversion, lesion absorption and promoting cavity closure compared to the control group. Added to chemotherapy, M. vaccae is helpful in the treatment of nevertreated TB patients in terms of improving both Immunotherapy with M. vaccae had a beneficial influence on sputum negative conversion and X-ray appearances.

目的 研究鼻内镜下三线减张矫正术治疗鼻中隔偏曲的疗效及安全性。方法 纳入2010年9月—2015年9月我院120例鼻中隔偏曲患者作为研究对象,采用随机数表法分为两组,各60例。观察组行鼻内镜下三线减张鼻中隔偏曲矫正术,对照组行鼻内镜下传统鼻中隔黏膜下切除术。比较两种手术方法对患者鼻塞、头痛、鼻出血等临床症状的改善情况,随访记录两组术后疼痛、鼻阻力及并发症发生情况,评价疗效和安全性。结果 观察组术后鼻塞、头痛及鼻出血症状评分分别为(1.05±0.16)分、(1.3±0.14)分及(1.63±0.14)分,均显著低于对照组和术前水平(P＜0.05)。观察组术后1周、2周及4周各时间点VAS评分和鼻阻力值均显著低于对照组(P＜0.05)。观察组术后鼻中隔血肿和黏膜撕裂发生率均为1.67%,无鼻中隔穿孔和外形改变病例,发生率显著低于对照组,差异有统计学意义(P＜0.05)。结论 鼻内镜下三线减张矫正术能显著改善鼻中隔偏曲患者鼻塞、头痛及鼻出血症状,促进鼻腔通气功能恢复,有效降低术后并发症发生率,安全性高。