目的探讨IgE低亲和力受c体(FcεRⅡ,CD23)基因表达水平在哮喘组与正常组间有无差异及基因表达与TIgE水平有无相关。方法逆转录-聚合酶链反应(RT-Pc)检测FcεRⅡ基因表达水平,并用t检验作组间比较;直线相关分析基因表达与TIgE水平的相关性。结果哮喘组TIgE水平与正常对照组之间差异有显著性(t=5.15,P<0.01);FcεRⅡ基因表达水平在哮喘组与正常组之间差异有显著性(t=4.20,P<0.01);在哮喘组与正常对照组中,FcεRⅡ基因表达水平均与TIgE水平间呈正的直线相关。结论FcεRⅡ基因对血浆TIgE水平有调节作用,其功能变化在哮喘发病中可能有重要作用。

目的 观察10%高渗盐水治疗急性脑血管病的疗效及副作用.方法 将30例清醒急性脑血管病患者分为两组:高渗盐水治疗组(HS组)和甘露醇治疗组(M组).HS组静注10%盐水40 ml/12 h连续5 d;M组静滴20%甘露醇250 ml 30 min内滴完,1次/12 h连续5 d.用药前及用药后1、3、7 d测患者血清电解质、渗透压、肾功能.治疗前及治疗14 d后对患者进行神经功能缺损评分.结果 高渗盐水组患者治疗后第1、3、7天血清Na+、Cl-及渗透压虽有所升高但均无统计学意义,且患者无肾功能损害;甘露醇组患者治疗后第1、3、7天血清Na+、Cl-及渗透压无明显升高,但出现肾功能损害.治疗14 d后高渗盐水组及甘露醇组患者神经功能缺损状况均有明显改善.结论 10%高渗盐水可有效治疗急性脑血管病引起的颅内高压,与甘露醇相比效力相当且对肾功能无损害.10%高渗盐水作为降低急性脑血管病性颅内高压的药物是安全、有效的.

当各种原因引起腹内压(IAP)增高到一定程度时,会导致多个器官系统功能障碍,称为腹腔间隙综合征(ACS).国外文献报道ACS病死率高达29%～62%[1,2].随着急危重症医学的快速发展,国内相继建立了各种专科或综合性重症监护室(ICU),被报道的ACS病例逐渐增多.ACS的诊断与治疗直接关系到患者预后,现就其发生、发展、病因学、发病机制、诊断与治疗等方面综述如下.

Objective: To investigate the association between the point mutation G to A which is located in exon 9 of CD23 gene and incidence of asthma. Methods: The genetic polymorphism was identified by the polymerase chain reaction (PCR) followed by restriction enzyme digestion of the amplified DNA with restriction enzyme endonuelease Hpa Ⅱ . Results: G to A mutation in exon 9 of CD23 gene was not detected in this research, and no RFLP was available in the PAGE. Conclusion: RFLP in CD23 gene was not delected in our research.

支气管哮喘(简称哮喘)是一种常见病,全世界约有1亿多患者.在我国哮喘的发病率约1%～4%,全世界范围内哮喘发病呈逐年增加趋势[1].由于发病机制尚未完全阐明,对哮喘的防治存在很大困难.大量研究表明,哮喘发病与遗传因素和环境因素密切相关.近年来有关哮喘研究的一个重要进展是发现IgE低亲和力受体(CD23,FcεRⅡ).FcεRⅡ存在于B细胞、激活的单核细胞、嗜酸粒细胞、血小板中.部分T细胞上,为一条单链,具有调节IgE生成和B细胞分化、抗原递呈等功能.其在哮喘发病中的作用使人们自然地把目光转到其编码基因上.为此,我们对湛江地区哮喘人群和正常人群中该基因外显子9进行了多态性检测.

目的 以甘露醇作对照,探讨连续使用2 3.4 %高渗盐水治疗颅内高压的效果。方法 将14例昏迷的、有侧脑室引流指征的脑出血患者随机平均分成HS组和Mannitol组。根据颅内压（ICP）高低的不同,给每一病例使用降颅内压药物每6小时1次,连续使用4次。HS组静脉推注2 3 4 %氯化钠溶液30ml;Mannitol组静脉滴注2 0 %甘露醇2 5 0ml。持续监测用药前至用药后6h内的颅内压（ICP） ,记录ICP的最低值、最大降幅百分比、ICP回复用药前水平时间等。结果 HS组:4次治疗的ICP最低值及最大降幅百分比之间无差异（P ＞0 0 5 ） ;第2～4次治疗的ICP回复时间明显长于第1次（P ＜0 0 5 ）。Mannitol组:第4次治疗的ICP最低值高于第1次治疗（P ＜0 0 5 ） ,第4次治疗的ICP最大降幅百分比低于第1次治疗（P ＜0 0 5 ） ;4次治疗的ICP回复时间之间无差异（P ＞0 0 5 ）。结论 连续使用2 3 4 %高渗盐水能安全、有效地治疗颅内高压。与甘露醇相比,2 3 4 %高渗盐水的降颅压效力相对稳定,作用持久。

Objective To investigate the existence of the polymorphism G to A which is located in exon 9 of CD_(23) gene and the association between the mutation and asthma.Methods The DNA was extracted from 2ml venous blood from 100 nomal subjects and 100 asthma subjects.The genetic restriction fragment length polymorphism(RFLP) was identified by the polymerase chain reaction (PCR) followed by restriction enzyme digestion of the amplified DNA with restriction enzyme endonuclease HpaⅡ.If the mutation exist,χ~2 analysis is used to test allele frequency and genotype frequency.Results G to A mutation in exon 9 of CD_(23) gene was not detected in this research,and no RFLP was available in the polyacrylamide gel electrophoresis(PAGE).Conclusions RFLP in CD_(23) gene was not detected in our research.

Objective: To investigate the correlation between +1923C/T polymorphism in IL-13 gene intron and its impact on total plasm IgE levels. Methods: +1923C/T polymorphism in IL-13 gene and total plasm IgE levels in asthma and control groups were detected by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) and ELISA,respectively. Results: There were significant differences in C and T allele frequencies at +1923 locus (χ 2=9.30, P0.01), and in genetype distribution such as CC,CT and TT (χ 2=9.92, P0.01)between two groups . Allele T was associated with asthma, [OR (T/C) =1.87, 95% CI =1.25～2.80,P0.01].The total plasm IgE levels in T allele carriers and in asthma group were higher than those in another allele carriers and in control group,respectively.Conclusion:+1923 polymorphism in IL-13 gene could be an important candidate gene for asthma.Allele T is associated with asthma,which increases the total plasm IgE levels via enhancing IL-13 gene expression.

Objective: To compare the effects of 23.4% hypertonic saline with mannitol, used in patients with different degree intracranial hypertension. Methods: We presented 15 patients, who suffered with cerebral hemorrhage and had sign to have lateral ventricle drainage, and a total of 52 episodes of intracranial hypertension (IH). In every episode of IH, 23.4% hypertonic saline 30 mL (HS group) or 20% mannitol 250 mL (mannitol group) was used randomly by vessel. Intracranial pressure (ICP) was monitored from initiation of treatment to 6 hours flowing it. We recorded the ICP at initiation of treatment, the maximum decrease of ICP and the maximum decrease percent of ICP. Results: In HS group, the maximum decrease of ICP was positively correlated with the ICP at initiation of treatment (P 0.01), and the maximum decrease percent of ICP was not correlated with the ICP at initiation of treatment. In mannitol group, the maximum decrease of ICP was positively correlated with the ICP at initiation of treatment (P0.01), and the maximum decrease percent of ICP was positively correlated with the ICP at initiation of treatment too (P0.05). Conclusion: Intracranial hypertension can be reduced effectively by using 23.4% hypertonic saline or mannitol. The effect of 23.4% hypertonic saline is more stable than mannitol. Especially slight intracranial hypertension can be cured more efficiently with 23.4% hypertonic saline than with mannitol.

目的:了解湛江市区支气管哮喘的发病情况及相关危险因素.方法:采用统一的流行病学调查表格,按照分层整群不等比随机抽样方法进行调查.结果:共调查13035例,男6567例,女6468例.哮喘患者90例,总患病率为6.90‰,其中男性患病率高于女性(9.3‰∝4.5‰,P＜0.01);7-15岁年龄段及65-75年龄段的哮喘患病率较高,分别为9.9‰及24.3%.家族史、过敏史、环境因素、心理因素、吸烟、天气变化、剧烈运动、情绪激动等在哮喘患者中较常见.结论:本次调查结果有助于了解本地区哮喘发病情况,对制定本市哮喘防治战略有重要意义.

目的探讨无创正压通气在短期内治疗老年急性心源性肺水肿的临床疗效.方法将急诊抢救室和监护区救治的55例突发急性心源性肺水肿的老年患者随机分为两组,对照组25例予常规吸氧治疗;观察组30例予无创正压通气治疗.所有患者都同时接受常规抗心衰药物治疗;分别观察记录两组患者的临床表现及治疗前、治疗后0.5,1,2 h的血PaO2,PaCO2,体表指搏血氧饱和度、心率、呼吸频率等参数的变化,并作统计学分析.结果在0.5 h无创正压通气治疗组PaO2有显著提高,呼吸频率有显著的降低(P＜0.01),而对照组在1 h才有显著变化(P＜0.05).结论无创正压通气治疗老年急性心源性肺水肿的疗效肯定,快速、安全.

Objective To evaluate the effects of 23.4% Hypertonic saline used in patients with acute intracranial hypertension. Methods 15 patients who suffered with cerebral hemorrhage and had sign to have lateral ventricle drainage were divided into 2 groups randomly, 23.4% Hyperosmotic saline or 20% mannitol was used by vessel. Intracranial pressure (ICP), mean arterial pressure (MAP), central venous pressure (CVP), cerebral perfusion pressure (CPP), plasma electrolure and osmotic pressure were monitored from initiation of treatment to 6 hours flowing it. Results ICP was reduced (2.5±1.1) kPa (P0.01) when treated with 23.4% Hyperosmotic saline after (28±20) minutes and lasted for 3 hours, MAP was decreased as well; ICP was reduced (2.0±1.3) kPa (P0.01) when treated with 20% mannitol after (49±25) minutes and lasted for 1 hour. CVP, plasma electrolure and osmotic pressure had no difference between the two groups in 6 hours (P0.05). Conclusion 23.4% Hyperosmotic saline have more efficiency than 20% mannitol when treated in intracranial hypertension, can be selected to treat intracranial hypertension.

目的:探讨白细胞介素13(IL-13)在支气管哮喘发病机制中的作用.方法:采用酶联免疫法(ELISA)测定23例哮喘患者外周血单个核细胞(PBMC)培养上清中IL-13、峰流速仪测定最大呼气流速(PEF)占预计值%及直接测定外周血嗜酸细胞(Eos),并与20名健康正常者的结果进行比较.结果:哮喘患者PBMC中IL-13水平(5.54±1.075)、外周血Eos(0.398±0.115)×109/L水平高于对照组的IL-13水平(3.13±0.837)、Eos水平(0.155±0.082)×109/L(P＜0.01),哮喘患者PEF(59.0±10.28%)明显低于正常对照组PEF(87.2±10.87%)(P＜0.01).IL-13与Eos水平呈显著正相关(r＝0.88,P＜0.01),IL-13与PEF呈显著负相关(r＝-0.75,P＜0.01).结论:哮喘发作时IL-13表达水平及Eos明显增高,提示IL-13可能通过对Eos的调节从而参与哮喘的发病过程.

支气管哮喘(哮喘)是一种复杂的遗传性疾病,血清IgE在其发病中起重要作用.新近的研究表明第5、6、11、14、19号等染色体上有众多哮喘易感基因与血清IgE水平有关.