目的 研究失代偿期肝硬化并发肝性脑病的前瞻性护理价值.方法 选取2017年2月—2018年2月在本院治疗的失代偿期肝硬化并发肝性脑病的患者80例作为研究对象,按照随机数表法分为研究组(前瞻性护理)和对照组(传统护理)两组,每组各40例.对两组患者的临床护理效果以及各项临床指标进行观察比较.结果 研究组的肝性脑病意识障碍加重率和并发症发生率低于对照组(P<0.05);研究组TBIL、ALT以及NH3含量水平均明显低于对照组(P<0.05).结论 对失代偿期肝硬化脑病进行前瞻性护理能够使患者的病情得到明显的改善,有利于病情的恢复,并能够提高护理满意度,具有临床推广价值.

目的 分析重症肺炎机械通气患者血清纤维蛋白原(FIB)、胆碱酯酶(CHE)及血糖(GLU)与急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分的相关性.方法 选取郑州大学第一附属医院2016年6月至2017年6月收治的91例重症肺炎机械通气患者为观察组,同期收治的109例普通肺炎患者为对照组.根据患者预后将观察组分为好转亚组及恶化亚组.比较两组患者血清FIB、CHE和GLU水平,对患者急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分与血清FIB、CHE、GLU的相关性进行分析.结果 观察组患者血清FIB、GLU水平高于对照组,CHE水平低于对照组,差异有统计学意义(P<0.05).重症肺炎患者中恶化亚组血清FIB、GLU水平高于好转组,CHE水平低于好转亚组,差异有统计学意义(P<0.05).相关性分析显示,血清FIB、GLU水平均与APACHEⅡ评分呈正相关(r=0.533、0.522,P<0.05),血清CHE水平与APACHEⅡ评分呈负相关(r=-0.523,P<0.05).结论 对重症肺炎机械通气患者进行血清FIB、CHE、GLU水平检测,有助于评估及预测患者病情严重程度及预后.

目的:分析系统性红斑狼疮(SLE)的临床特征、治疗及预后,提高医生对SLE合并脏器损伤导致猝死的认识.方法:回顾性分析1例确诊为SLE合并肺部感染猝死的临床特征及治疗过程并结合文献进行复习.以"系统性红斑狼疮猝死"及"Sudden death of systemic lupus erythematosus"为关键词检索1984年1月至2017年2月万方数据库、中国知网及PubMed数据库的相关文献,共获得文献9篇,其中中文2篇,英文7篇.结果:患者女性,26岁,主要临床表现为面部蝶形红斑、发热、胸闷.肾穿刺活检:局灶增生性狼疮性肾炎基底膜增厚,胸部CT示双肺炎症,治疗过程中突然出现室颤而导致死亡.经文献检索共检索到11例SLE猝死患者,5例女性,3例男性,3例性别不详,其中4例资料不全,年龄22～64岁.结论:SLE常合并多系统损伤,当出现心血管症状时,由于常合并其他脏器受累容易被忽视,所以应及时进行心电图、心肌酶、肌钙蛋白等检查,并加强对患者的监护,防止猝死的发生.

目的 研究重症肺炎患者血清纤维蛋白原(FIB)、胆碱酯酶(CHE)及血糖(GLU)与病情严重程度及预后的关系.方法 回顾性分析郑州大学第一附属医院呼吸重症监护室2016年6月至2017年5月200例肺炎患者的临床资料,根据病情严重程度分为普通肺炎组(109例)和重症肺炎组(91例),其中重症肺炎组根据患者预后分为好转组和恶化组.对所有患者行APACHEⅡ评分,测定血清FIB、CHE、GLU水平,分析患者病情严重程度及预后与血清FIB、CHE、GLU水平的关系.结果 重症肺炎组血清FIB、GLU水平高于普通肺炎组,CHE水平较普通肺炎组低,差异有统计学意义(P均<0.05).重症肺炎恶化组血清FIB、GLU水平高于好转组,CHE水平较好转组低,差异有统计学意义(P均<0.05).相关性分析显示,血清FIB、GLU水平均与APACHEⅡ评分呈正相关(r=0.533、0.522,P<0.05),血清CHE水平与APACHEⅡ评分呈负相关(r=-0.523,P<0.05)结论 重症肺炎患者血清FIB、GLU水平升高,CHE水平降低,有助于评估及预测患者病情严重程度及预后.

Objective To investigate the changes of Th17 cell function by testing the transcription regulative factor RORγt and the main effect factor cytokine interleukin-17(IL-17)of Th17 cells,and the effect of human immunoglobulin on Th17 cell function in immunosuppressed mice with Pseudomonas aeruginose(PA)pneumonia.Methods Ninety BALB/c mice were divided into five groups randomly:control group,PA group,immunosuppressed group,immunosuppressed+PA group and human immunoglobulin group(named group A,B,C,D and E,n=18 each).All mice were sacrificed at 4,8 and 24 h after the establishment of the experimental models.Gross examination was performed and the lungs were excised for routine histological analysis.The expression level of RORγt mRNA was detected by reverse-transcriptase polymerase chain reaction(RT-PCR)and the concentration of IL-17 was measured in the peripheral blood by enzyme-linked immune sorbent assay(ELISA).Results Histological findings demonstrated that the lung tissues had no inflammatory changes in group A and C.But inflammatory changes,such as congestion of red blood cells in capillaries,edema,infiltration of many inflammatory cells and enlarged alveolar septum,occurred in group B,D,and E.Such changes were most significant at 8 h.The lung jury score was the highest in group D than in any other groups(P<0.01).The levels of RORγt mRNA in the lung were higher in group B,D and E than in group A and C(P<0.01),and they reached the peak at 4 h.The concentration of IL-17 in the peripheral blood was higher in group B,D and E than in group A and C(P<0.01),and it reached the peak at 8 h.All the observed indexes including the lung injury score,the level of RORγt mRNA and the concentration of IL-17 were much higher in group D than in group B(P<0.01),and they were even lower in group E than in group B(P<0.01).Conclusion The over-stimulation of Th17 cells derived from immunosupressed mice with PA pneumonia leads to excessive inflammatory responses and the organ and tissue injuries.Human immunoglobulin can inhibit the inflammatory reactions caused by Th17 cells,and therefore relieve the deterioration of the disease.

目的 探讨血清白细胞介素(IL)-10评估不同年龄免疫功能受损并重症肺炎患者病情严重程度及预后的价值.方法 180例免疫功能受损并重症肺炎患者,根据年龄分为非老年组(年龄<60岁,112例)、老年组(年龄≥60岁,68例);入院后行APACHEⅡ评分、淋巴细胞亚群及血清IL-10水平检测;比较两组患者病情严重程度及结局差异,血清IL-10表达水平差异及与病情严重程度的关系.结果 相比于非老年组,老年组病情重,APACHEⅡ评分较高〔非老年组(24.22±7.51)分,老年组(36.53±13.52)分〕,死亡率高(非老年组51.79%,老年组73.53%;P<0.05);老年患者血清IL-10水平〔(6.72±1.97)mg/dl〕低于非老年组〔(9.66±2.58)mg/dl,P<0.05〕;相关性分析显示,血清IL-10水平与APACHEⅡ评分呈负相关.结论 检测免疫受损合并重症肺炎患者血清IL-10水平,有助于评估及预测病情严重程度及预后.

Aim The present study aimed to investigate the effect of intravenous immunoglobulin (IVIG) on regulatory T (Treg) cells derived from immunosuppressed mice with Pseudomonas aeruginosa (PA) pneumonia. Methods A total of 108 BALB/c mice were randomly divided into the following groups: control group (Control), immunosuppressed group (IS), PA pneumonia group (PA), PA pneumonia in immunosuppressed group (IS + PA), PA pneumonia with IVIG treatment in immunocompetent group (PA + IVIG) and PA pneumonia with IVIG treatment in immunosuppressed group (IS + PA + IVIG). Each group comprised 18 mice. The combined PA pneumonia in immunosuppressed model and the treatment models were established. The mice in each group were sacrificed at 4, 8, and 24 h time points. The general condition and pathological changes in the lung tissues of the mice were monitored. Reverse transcription-polymerase chain reaction was used to detect the forkhead box P3 (FOXP3) mRNA relative expression level in the lung tissues. The enzyme-linked immunosorbent assay was used to detect the serum concentration of active transforming growth factor beta (TGF-β). Results No inflammatory response were exhibited in the lung tissues of the mice in Control group and IS group, while varying degrees of acute lung injury were revealed in the mice in PA group, IS + PA group, PA + IVIG group and IS + PA + IVIG group. Lung tissue injury was most apparent at the 8 h time point, and it indicated the greatest effect in IS + PA group. Whereas tissue damages were alleviated in PA + IVIG group and IS + PA + IVIG group compared with IS + PA group. In addition, tissue damage lessened in PA + IVIG group compared with PA group and IS + PA + IVIG group. FOXP3 mRNA expression levels in the lung tissues and the serum concentration of TGF-β were lower in IS group, PA group, IS + PA group and IS + PA + IVIG group at the 4, 8 and 24 h time points, respectively compared with Control group. FOXP3 mRNA expression levels decreased in PA + IVIG group at the 4h time point and TGF-β serum concentrations decreased at the 4 and 8h time points compared with Control group, and subsequently increased. Conclusions In the immunosuppred model with PA pneumonia, the immune system was greatly compromised. IVIG partially restored the immunosuppressed functions of Treg cells, suppressed the overactivated immune system and ameliorated the development of the disease.

Pseudomonas aeruginosa (PA) pneumonia is a refractory, even lethal complication in immunosuppressive individuals and immune disturbances may promote the pathological process. We aimed to investigate the regulatory T (Treg) cell activity in an immunosuppressive mice model of PA pneumonia by estimating levels of main transcription factor and the main effector of Treg cells, i.e., Forkhead box protein 3 (FOXP3) and interleukine-10 (IL-10). Seventy-two BALB/c mice were divided into four groups randomly: control (A), PA pneumonia (B), immunosuppression (C) and immunosuppression with PA pneumonia (D). Mice were sacrificed at 4, 8 and 24 h after establishing experimental models. The pathological changes of lung tissue were graded, and the FOXP3 mRNA and serum IL-10 levels were detected. Histological analysis of lung tissues showed there were no significantly pathological changes in groups A and C, but significantly pathological changes were found in groups B and D, especially in group D at 8 h (P<0.05). The expression levels of FOXP3 mRNA in groups A and C showed no significant changes at the three time points, which were significantly lower than those in groups B and D (P<0.05). FOXP3 mRNA levels were lowest at 4 h, and there was significant difference between groups B and D (P<0.05). The serum levels of IL-10 in groups A and C were almost normal at the three time points, but decreased significantly in groups B and D (P<0.05). The serum levels of IL-10 decreased to the lowest at 8 h, especially in group D (P<0.05). The results indicate that PA pneumonia in immunosuppressive individuals worsens rapidly, which may be associated with Treg cells function disturbance. And Treg cells may be promising as adjuvant therapeutics for PA pneumonia in immunosuppressive individuals.

Objective To evaluate the diagnostic value of monitoring 1,3-beta-D-glucan (G test) in patients with autoimmune disease complicated with invasive fungal disease (IFD).Methods A retrospective study was performed in hospitalized patients in the First Affiliated Hospital of Zhengzhou Universisty who were diagnosed as autoimmune disease with lung infection during the immunosuppressive therapy between January 2014 and January 2016.A total of 372 patients were enrolled in this study.All subjects were classified according to the 2006 diagnostic criteria and treatment of invasive pulmonaary fungal infection,with serum 1,3-β-D-glucan results not included in the diagnosis.There were 18 cases with proven IFD,35 cases with probable IFD,and 70 ceses with possible IFD.Fifty-three patients with proven IFD or probable IFD were as a case group,and another 249 patients with no evidence for IFD were as a control group.The value of the G test for diagnosis of automimmune disease with IFD was analyzed by ROC curve.Results The serum 1,3-β-D-glucan level was significantly higher in the case group when compared with the control group [median (interquartile range):135.0 (63.1 to 319.0) pg/ml vs.75.9 (41.2 to 88.1) pg/ml,P＜0.05].When the cut-offvalue of serum 1,3-β-D-glucan level was set at 93.8 pg/ml,the sensitivity,specificity,positive predictive value,and negative predictive value for diagnosis of autoimmune disease with IFD were 0.65 (95％ CI 0.56 to 0.73),0.87 (95％ CI 0.83 to 0.92),0.70 (95％ CI 0.64 to 0.81),and 0.83 (95％ CI 0.79 to 0.88),respectively.Conclusion The 1,3-beta-D-glucan test is a valuable method for diagnosis of IFD in patients with autoimmune disease.