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中华临床感染病杂志

中华临床感染病杂志

CSCD

CSTPCD

Chinese Journal of Clinical Infectious Diseases
2008年4月，中国科学技术协会主管，中华医学会主办。本刊为“中国科技论文统计源期刊”，重点报道感染病领域的最新科研成果和临床诊治经验，以感染病专业临床、预防、科研和教学工作者为读者对象。杂志为双月刊，设有标准与指南、专家论坛、论著、诊疗分析、护理园地、病例报告和综述等栏目。投稿和订阅请直接联系编辑部。
  • 发文量：1447
  • 被引量：917
  • H指数：1
  • 开始收录时间：2008(1)
  • CNKI综合因子：0.869
  • 维普期刊影响因子： 1.232
  • 万方期刊影响因子：1.53
  • 创刊时间：2008
  • 国内刊号/CN：11-5673/R
    国际刊号/ISSN：1674-2397
  • 发行周期：双月刊
    邮发代号：-
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华临床感染病杂志-联系信息
  • 主编：-
  • 电话：0571-87236590
  • 邮箱：cjcid@cmaph.org
  • 地址：浙江省杭州市庆春路79号
  • 邮编：310003
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  • 摘要：@@ 曲霉在自然界中广泛存在,其中引起疾病的主要是烟曲霉和黄曲霉.近年来,侵袭性曲霉病的发病率逐年升高,特别是在有免疫功能缺陷的人群中.有报道显示,侵袭性曲霉病在造血干细胞移植患者中的发病率为2%～26%,在实体器官移植患者中的发病率为1%～15%[1].在病死率方面,艾滋病、白血病、骨髓移植患者并发侵袭性曲霉病的病死率分别为85.7%、49.3%和86.7%[2],而在器官移植患者中为74%～92%[3].
  • 摘要：Objective To evaluate the immune reconstitution of HIV-1 infected individuals after long-term highly antiretroviral therapy (HAART). Methods Twenty-five HIV-1 infected individuals receiving HAART, 17 without HAART and 15 healthy controls were included in the study. CD4 +T, CD8 +T,CD8/human leukocyte antigen DR (HLADR) + T, CD8/CD38 +T cells, and the expression of CD127 on CD3 +T cells from peripheral blood samples were measured by flow cytometry. IL-7 in peripheral blood was measured by enzyme-linked immunosorbort assay (ELISA) in HAART group. t test was performed to compare the measurement data among the groups. Results Before HAART, the count of CD4 + T cells in HIV-1 infected group was lower than that of the healthy control (t =9. 12, P ＜0. 01 ), while the counts of CD8 + T,CD8/HLADR+T, and CD8/CD38 +T cells were higher than those of the healthy control (t = 4.48, 4.89 and 3.88, P＜0. 01 ). Ater 7 years' antiviral therapy, CD4 +T cells increased, CD8 +T cells decreased, but both of them didn' t reach to the normal levels ( t = 2.66 and 2.43, P ＜ 0.05 ). While the counts of CD8/HLADR+T cells and CD8/CD38 +T cells almost reached to the normal levels (t = 0. 86 and 1.39, P ＞0.05). Before HAART, the concentration of IL-7 in HIV-1 infected group was higher than that in healthy controls (t =5.31, P ＜0.01 ). It decreased with HAART, but was still higher than the normal level (t =2. 81, P ＜ 0. 05 ). The expression of CD127 on CD3 + CD8 + T cells in non-HAART group was significantly lower than that in healthy control ( t =- 6.01, P ＜ 0.01 ), while that in HAART group was higher ( t = 2.32,P ＜0.05), but still not reached to the normal level ( t = 4.49, P ＜ 0. 05 ). CD127 expression on ( CD45RA + ) CD3 + CD8 + T cells almost increased to the normal level ( t= 0. 28, P ＞ 0. 05 ), while that on ( CD45RO + ) CD3 + CD8 + T cells was still remarkably lower than the normal ( t = 4. 86, P ＜ 0. 05 ). Conclusion Long-term HAART can partially restore the count and function of lymphocyte subsets in HIV-1 infected individuals, and the abnormal immune activation can be inhibited.%目的 探讨长期高效抗反转录病毒疗法(highly active antiretroviral therapy,HAART)对HIV-1感染者免疫重建的作用.方法 收集42例HIV-1感染者作为研究对象,将其分为HAART治疗组(25例)和未治疗组(17例),另选15名健康人群作为对照,采用流式细胞仪检测受试者外周血CD4+T细胞、CD8+T细胞、CD8/人白细胞DR抗原(HLADR)+T细胞、CD8/CD38+T细胞计数,以及CD127在CD3+T细胞的表达情况,采用酶联免疫吸附试验(ELISA)检测HAART治疗组外周血IL-7浓度.样本均数采用t检验.结果 HAART治疗组治疗前CD4+T细胞计数明显低于健康对照组(t=9.12,P＜0.01),CD8+T细胞、CD8/HLADR+T细胞和CD8/CD38+T细胞计数明显高于健康对照组(t=4.48、4.89和3.88,P值均＜0.01).HAART治疗7年后,HIV-1感染者CD4+T细胞计数明显上升,CD8+T细胞计数明显下降,但均未达到正常水平(t=2.66和2.43,P值均＜0.05),CD8/HLADR+T细胞和CD8/CD38+T细胞则逐渐降至正常水平(t=0.86和1.39,P值均＞0.05).治疗前HIV-1感染组外周血IL-7显著高于健康对照组(t=5.31,P＜0.01),经HAART治疗,IL-7水平逐年下降,但仍高于健康对照组(t=2.81,P＜0.05).未治疗组患者CD3+CD8+T细胞表面CD127表达明显低于健康对照组(t=6.01,P＜0.05),HAART治疗组CD3+CD8+T细胞表面CD127表达高于未治疗者(t=2.32,P＜0.05),但仍低于健康对照组(t=4.49,P＜0.05);处女型(CD45RA+)CD3+CD8+T细胞表面CD127表达基本接近健康对照组(t=0.28,P＞0.05),而记忆型(CD45RO+)CD3+CD8+T细胞表面CD127的表达仍然明显低于健康对照组(t=4.86,P＜0.05).结论 长期有效的HAART能使HIV-1感染者淋巴细胞亚群在数量和功能上得到一定程度的恢复,体内的异常免疫激活得到明显抑制.
  • 摘要：@@ 截至2009年底,我国HIV/AIDS人数已达326 000例,其中AIDS患者107 000例,累计死亡54 000例.高效抗反转录病毒疗法(HAART)是目前治疗AIDS最有效的方法,可显著降低HIV/AIDS的病死率.我国自2003年实施免费抗病毒治疗以来,接受免费治疗的人数累计达8万人,病死率已从22.6%降至4%～5%[1],但其间仍面临诸多挑战.
  • 摘要：@@ 随着人们生活水平的不断提高,家庭饲养宠物日益增多,动物源性疾病的发生也随之增多.猫抓病是一种较为常见的人畜共患传染病,2000-2004年,仅浙江省德清县就报道了101例猫抓病患者[1].本病常规治疗多使用抗菌药物,一般为红霉素、四环素及强力霉素等.
  • 摘要：@@ 在我国,慢性乙型肝炎是导致肝硬化最常见的原因.已有研究表明,HBV复制活跃的乙型肝炎肝硬化患者更容易发生肝功能衰竭和(或)原发性肝细胞癌,而抗病毒治疗抑制HBV复制是控制病情进展的关键[1].为了评价核苷(酸)类似物治疗乙型肝炎肝硬化的效果和安全性,本研究对乙型肝炎肝硬化患者的治疗情况进行了观察.
  • 摘要：@@ 拟菌病毒(Mimivirus)于1992年在英格兰北部Bradford市一座冷却水塔的水中发现,当时认为是新发现的一种革兰阳性球菌,称为Bradford球菌.
  • 摘要：目的 研究树突细胞特异性细胞间黏附分子-3结合非整合素因子(dendritic cells specific intercellular adhesion molecule-3-grabbing nonintegrin,DC-SIGN)启动子区-139和-336位点多态性与HIV易感性、感染途径以及疾病进展的关系.方法 比较160例HIV感染者和178名健康对照人群DC-SIGN启动子区-139位点和-336位点基因型分布的差异,采用Spearman秩和相关检验分析DC-SIGN启动子区-139和-336多态性与HIV感染的关系.结果 在160例HIV感染者中,出现92例(57.5%)-139C和68例(42.5%)-139T,29例(18.1%)-336C和131例(81.9%)-336T.-139T/C和-336T/C基因型分布在HIV感染者与健康对照者中的差异无统计学意义(χ2=0.121和1.754,P值均＞0.05).通过性接触或静脉注射毒品而感染HIV的患者中,-139T/C和-336T/C分布差异无统计学意义(χ2=0.435和0.103,P值均＞0.05).在所有研究对象中,-139C基因型的个体多伴随-336C基因型(r=0.359,P＜0.01).在外周血CD4+T细胞计数≤50个/μL的患者中,-139T基因型出现的频率(27.9%)高于-139C基因型(23.0%)(χ2=4.055,P＜0.05).-139T/C和-336T/C对HIV RNA载量影响不明显(t=-0.643和-1.637,P值均＞0.05).结论 DC-SIGN启动子区-336C常与-139C耦联出现;-139或-336位点多态性与HIV的易感性和感染途径无明显相关性,但-139T基因型患者更易出现CD4+T细胞数量的下降.%Objective To investigate the polymorphisms of-139 and -336 nucleotides in dendritic cells specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) promoter region in context of HIV susceptibility, infection routines and HIV/AIDS progress. Methods Polymorphisms of -139 and -336 nucleotides in DC-SIGN were examined in 160 HIV-positive subjects and 178 healthy controls;the Spearman test was performed to analyze their associations with HIV infection status. Results In 160 HIV-positive subjects, there were 92 (57.5%) with-139C, 68 (42.5%) with-139T, 29 (18.1%) with-336C and 131 (81.9%) with -336T. The frequencies of -139T/C and -336T/C in HIV-positive subjects were similar to those in the healthy controls (χ2 =0. 121 and 1. 754, P ＞0.05 ). No differences were found in the distribution of -139T/C or -336T/C in HIV-positive subjects infected via sex intercourse or intravenous drug (χ2 =0. 435 and 0. 103, P ＞ 0. 05 ). -139C was usually companied with -336C ( r = 0. 359, P ＜ 0.01 ).-139T (27.9%) were more frequently presented in patients with CD4 +T cells ≤50 cells/μL than -139C( 23.0%, χ2 = 4.055, P ＜ 0.05 ). -139T/C and -336T/C were not related to HIV RNA levels ( t = - 0. 643and - 1. 637, P ＞ 0.05). Conclusions Genotype -139C in DC-SIGN promoter region usually coexist with -336C. Polymorphisms of -139 and -336 are not related to HIV susceptibilities or HIV infection routes.-139T genotype may be related to serious depletion on CD4 + T cells.
  • 摘要：@@ 2009年3月,在墨西哥暴发的人感染猪流感是一种新型的甲型H1N1流感,人群对此普遍易感.虽然大部分患者病情较轻,但一些高危人群,如妊娠期妇女以及伴有慢性疾病、免疫功能低下等人群感染后,较易发展为重症或危重症患者,且病死率高[1].
  • 摘要：@@ 梅毒传染性强,临床表现多种多样,尤其是近年来不典型病例在临床上增多,极易造成误诊和误治[1].笔者回顾性分析了河南省商丘市35例被误诊的梅毒患者,以提高对该疾病的诊断水平.
  • 摘要：@@ 患者男,39岁.因发热、咳嗽、咳痰、盗汗、消瘦40 d,胸部CT提示肺部团块状阴影伴两肺多发结节、纵隔淋巴结肿大、左侧胸腔积液,院外考虑肺癌转移住院化疗2周,期间出现骨髓抑制,检查发现抗-HIV阳性,于2007年3月16日转入我院,体温39 ℃,鹅口疮,无皮疹,3月20日胸片及23日胸部CT(图1～3)显示左上肺尖后段可见3 cm×3 cm×4 cm大小的团块状阴影.
  • 摘要：Objective To investigate the expression of CD127 (interleukin-7 receptor α, IL-7Rα)and its association with apoptosis of CD8 + T lymphocytes in patients with chronic HIV-1 infection. Methods The expression of CD127 on T lymphocytes and spontaneous apoptosis of CD8+ T lymphocytes were measured by flow cytometry in peripheral blood from 24 patients with chronic HIV-1 infections and 12 healthy subjects. The associations of CD127 expression with CD4 +T lymphocytes counts, HIV RNA loads and cell apoptosis were analyzed. Mann-Whitney U test was performed to compare between the groups, and Spearman test was used for correlation analysis. Results The expression of CD127 on CD8 + T lymphocytes was significantly down-regulated in HIV-1 infected subjects (Z = -4.796, P ＜ 0. 01 ), which was positively correlated with CD4 + T lymphocytes (r = 0.817, P ＜ 0.01 ) and negatively correlated with HIV RNA load and CD8+T lymphocytes apoptosis (r= -0.442 and -0.688,P＜0.05 and ＜0.01). Conclusion CD127 down-regulation may play an important role in the descended ability of receiving survival signals and ascended apoptosis of CD8 + T lymphocytes during chronic HIV-1 infection, which indicates that IL-7 might be a novel strategy in treatment of HIV infection.%目的 研究HIV-1慢性感染者CD8+T淋巴细胞表面CD127(白细胞介素-7受体α链,IL-7Rα)分子的表达及临床意义.方法 收集24例HIV-1慢性感染者和12名健康人群的外周血,分离外周血单核细胞(PBMC),用直接免疫荧光染色法标记并用流式细胞仪检测T淋巴细胞表面CD127表达和CD8+T淋巴细胞的自发凋亡,并对CD8+T淋巴细胞CD127的表达与CD4+T淋巴细胞计数、HIV RNA载量以及CD8+T淋巴细胞自发凋亡作相关性分析.组间比较采用Mann-Whitney U检验,Spearman评价组间相关性.结果 与健康对照组比较,HIV-1慢性感染组中CD8+T淋巴细胞CD127的表达显著下降,差异具有统计学意义(Z=-4.796,P＜0.01).CD8+T淋巴细胞CD127的表达与患者CD4+T淋巴细胞计数呈显著正相关(r=0.817,P＜0.01),与血浆HIV RNA载量和CD8+T淋巴细胞的自发凋亡呈显著负相关(r=-0.442和-0.688,P＜0.05和＜0.01).结论 HIV-1慢性感染组CD8+T淋巴细胞CD127表达进行性下降可能是导致细胞接受存活信号能力降低和发生凋亡的重要原因,提示IL-7可能是治疗HIV感染的新途径.
  • 摘要：@@ 恙虫病(tsutsugamushi disease)又称丛林斑疹伤寒(scrub typhus),是由恙虫病立克次体(Rickettsiatsutsugamushi)所致的急性自然疫源性传染病.鼠类是主要的传染源,因通过恙虫幼虫(恙螨)叮咬传播而得名.
  • 摘要：Objective To determine the incidence, clinical manifestation and risk factors of immune reconstitution inflammatory syndromes (IRIS) in highly active antirctroviral therapy (HAART) for HIV/AIDS patients. Methods Two hundred and twelve HIV/AIDS patients received HAART, and were followed up for 6 months. The incidence time and disease spectrum of IRIS were observed. Multiple logistic regression analysis was performed to identify the risk factors for IRIS. Results Among 212 patients, there were 59 (27.8%) experienced an IRIS event during the first 6 months of HAART, 2 of which died (2/59,3.39% ). Median time of IRIS onset was 21 days form HAART initiation. The disease spectrum included tuberculosis, herpes virus infections, pneumocystis jirovecii pneumonia, cryptococcal meningitis and penicillium marneffei infection. Risk factors of IRIS included baseline infections ( OR = 1. 655, P =0.010),fever during HAART ( OR = 2. 344, P= 0.006), and baseline CD4 + count ( OR = 1. 556, P = 0. 034).Conclusions IRIS usually occurred within the first month from HAART initiation, and tuberculosis and herpes virus infection are most common. The occurrence of IRIS is associated with the antigens burden and the decreased baseline CD4 + count.%目的 了解高效抗反转录病毒疗法(highly active antiretroviral therapy,HAART)中发生的免疫重建炎性综合征(immune restoration inflammatory syndromes,IRIS),并分析发生IRIS的危险因素.方法 采用前瞻性研究方法对初次启动HAART的212例HIV/AIDS患者进行为期6个月的跟踪随访观察,统计IRJS的发生率、发生时间和临床疾病谱,采用多元逐步Logistic回归法分析发生IRIS的危险因素.结果 212例患者中,59例在HAART开始的6个月内发生IRIS,发生率为27.8%,其中2例死亡,IRIS病死率为3.39%.IRIS发生的中位时间为HAART后的第21天.发生的疾病谱包括结核病、疱疹病毒感染、肺胞子菌肺炎、隐球菌性脑膜炎和马尔尼菲青霉病等.Logistic 多元逐步回归分析显示,基础感染的数量(OR=1.655,P=0.010)、HAART时患者发热情况(OR=2.344,P=0.006)以及CD4+T淋巴细胞基线值(OR=1.556,P=0.034)与IRIS的发生相关.结论 IRIS多发生于HAART开始后的1个月内,常见疾病谱为结核病和疱疹病毒感染等.HAART开始时抗原负荷愈多、基线CD4+T淋巴细胞水平愈低,越易发生IRIS.在HAART开始前尽可能控制基础感染,有利于减少IRIS的发生.
  • 摘要：@@ 浙江省嘉兴市是全国血吸虫病流行的区域之一,患者众多.肝纤维化是血吸虫病患者发病以及导致严重并发症的病理学基础[1].近年来,免疫学成为血吸虫病的研究重点之一,为进一步探索肝纤维化程度对免疫功能的影响,本文对239例血吸虫肝纤维化(即晚期血吸虫病)患者进行了监测.
  • 摘要：@@ 近年来,深部曲霉感染已成为血液病免疫功能低下致患者死亡的重要原因.伊曲康唑在预防和治疗真菌感染方面具有重要作用,但对于心脏的安全性在医学界一直存在争议[1].现对伊曲康唑治疗2例血液病合并严重心脏病患者并发侵袭性真菌感染进行报道,探讨其对心脏的安全性.
  • 摘要：@@ 患者男,66岁,因"刺激性干咳伴胸、背部疼痛2月余,双下肢乏力1周"于2010年2月5日收治人院.患者2个月前出现刺激性干咳伴胸背部疼痛入住本院,查胸部CT示右肺上叶后段见占位灶,有分叶和胸膜凹陷征,两肺见多发性结节影,右侧第三、第四后肋及第三、第四胸椎骨破坏,周围形成软组织影;纤维支气管内窥镜活检切片检查示肺腺癌.
  • 摘要：@@ 肝结核比较少见,加上缺乏特异性的临床表现及辅助检查,往往难以及时作出诊断,常被误诊为肝炎、肝癌及肝脓肿等.近年来,临床肝结核的报道有所增加,现对我院1997年1月-2010年3月收治的4例肝结核患者的病历资料进行回顾性分析,以期提高对肝结核的诊断及认识.
  • 摘要：目的 探讨对重症肺结核伴正常甲状腺病态综合征(euthyroid sick syndrome,ESS)的患者应用小剂量左甲状腺素钠治疗的有效性.方法 将120例重症肺结核伴ESS住院患者按性别、年龄、病程、疾病严重程度随机分为治疗组和对照组.治疗组在常规抗结核及控制感染、营养对症支持治疗的基础上加服小剂量左甲状腺素钠(12.5μg/d),对照组按常规治疗,治疗时间均为2周.比较两组甲状腺功能、临床症状改善、白蛋白升高、痰涂片抗酸杆菌减少、影像学改善情况及病死率.结果 治疗2周后,两组患者发热、咳嗽、盗汗等症状有不同程度好转,其中治疗组中显效者19例(31.7%),对照组中显效者8例(13.3%),两组比较差异有统计学意义(χ2=5.73,P＜0.05).治疗组痰菌转阴15例(25.0%),对照组4例(6.7%),两组比较差异有统计学意义(χ2=7.50,P＜0.01).治疗组患者治疗后血清白蛋白升高至(34.2±0.4)g/L,明显高于对照组的(29.1±0.6)g/L,经比较两组的差异具有统计学意义(t=2.42,P＜0.05).两组患者的T3、FT3在治疗后均明显上升,但治疗组升高尤为显著,两组治疗前后差值比较差异有统计学意义(t值分别为59.42和50.66,P值均＜0.01).治疗组与对照组均未见空洞闭合,但有部分患者的结核病灶出现吸收好转,其中治疗组治疗有效56例(93.3%),对照组治疗有效46例(76.7%),两组比较差异有统计学意义(χ2=6.54,P＜0.05).治疗组未出现死亡病例,对照组病死率为3.3%(2/60).结论 对重症肺结核伴ESS的患者在常规治疗的前提下,再辅以小剂量左甲状腺素钠治疗安全有效,低T3的改善是整个病情好转的重要指标.%Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome(ESS). Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients(31.7%)of treatment group and 8 patients (13.3%)of control group(χ2 = 5. 73, P ＜ 0.05). Clearance rate of acid-fast bacilli in treatment group was 25.0%(15/60), but that in the control was only 6.7%(4/60)(χ2 = 7. 50, P ＜ 0.01). Serum albumin in the treatment group was increased to(34.2 ±0.4)g/L after the treatment, and that in the control group was(29.1 ±0.6)g/L(t =2.42, P＜0.05). T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group(t = 59. 42 and 50. 66, P ＜ 0. 01). No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group(93.3% vs. 76.7%, χ2 =6. 54, P＜0.05). Two patients in control group died(2/60, 3. 3%), while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.
  • 摘要：@@ 患儿女,4个月大,2009年1月3日开始出现发热,体温最高达39 ℃,无寒战及抽搐,伴阵发性轻咳,无喘息、声嘶及呼吸困难等症状,发病第2天先后到烟台山医院和烟台东方医院就诊.患儿曾接种卡介苗,但接种部位无反复感染不愈情况发生.
  • 摘要：@@ 病例1 患者女,67岁,因"反复气喘4年,加重3周"于2008年10月24日入院.患者2004年无明显诱因出现反复气喘,当时步行上3楼感气短,夜间可平卧,伴心悸、乏力,经治疗后好转,平时未规则服用药物.
  • 摘要：@@ 颈部淋巴结结核以颈部肿块为主要表现,临床症状常不典型,易出现误诊、漏诊而延误治疗时机.常规超声检查能显示淋巴结部位、大小、包膜及内部回声,但显示微小血管的能力有限,因此对颈部淋巴结结核的诊断有一定的局限性[1].
  • 摘要：@@ 2010年2月,山东省淄博市解放军第148医院肿瘤血液科收治了1例急性粟粒性肺结核继发嗜血细胞综合征患者,在发病早期,患者主要表现为不明原因发热、外周血三系血细胞进行性下降、红细胞沉降率(ESR)增高、肝功能受损、腹腔淋巴结和脾脏肿大,骨髓中可见典型的嗜血细胞.
  • 摘要：@@ 最近受到媒体广泛关注的所谓"超级细菌(superbug)"实际上是一种产新发现的碳青霉烯酶--新德里金属β-内酰胺酶-1(New Delhi metallo-beta-lactamase-1,NDM-1)的肠杆菌科细菌,产此酶的NDM-1基因(blaNDM-1)常见于大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌等,已在南亚发现高度耐药的感染病例,受到医学界高度重视.
  • 摘要：@@ 脊柱结核是最常见的骨关节结核,约占骨结核的50%,占全部结核病的3%～5%[1].复杂复合脊柱结核病常见于临床,包括合并肺结核、结核性脓胸和肾结核等常需要手术治疗的脊柱结核病,多发节段脊柱结核、经多次手术仍未治愈以及合并截瘫等情况.
  • 摘要：Objective To evaluate the clinical efficacy of oropharyngeal decontamination combined with gastrointestinal excitomotor in preventing hospital-acquired lower respiratory tract infection(HALRTI)in elderly inpatients. Methods Totally 110 elderly inpatients with high risks of HALRTI were randomized into intervention group and control group. Patients of the intervention group were administrated by cetylpyridinium chloride gargle twice daily for gargling(20 mL for each), combined with moshabili three times daily orally(5 mg for each). Exact Sig. l-sided was performed to compare the occurence of HALRTI,and Spearman test was performed to evaluate the correlation between positive rate of the phyarynx swabs and the hospitalized time. SPSS 12.0 software was used for statistical analyzing. Results Patients suffered from HALRTI were 1 case(2.00%)in intervention group and 7 cases(13.73%)in control group respectively,and the difference was of statistical significance(P ＜ 0.05). As hospitalized time went on, the positive rate of the phyarynx swabs microbial culture in the control group increased(r = 0.450, P ＜ 0.05), while the intervention group showed no significant change during the whole intervention time(r = -0.023, P ＞0.05). Conclusion The combined intervention of oropharyngeal decontamination with the gastrointestinal excitomotor may be beneficial to elderly inpatients with high risk of HALRTI in the prevention of HALRTI.%目的 探讨口腔脱污染联合胃肠动力药物对预防老年人医院获得性下呼吸道感染(hospital-acquired lower respiratory tract infection,HALRTI)的有效性.方法 选择具有发生HALRTI高危因素的110例老年住院患者,随机分为干预组和对照组.干预组予西吡氯铵含漱液漱口(每次20 mL,2次/d),并口服莫沙比利片(每次5 mg,3次/d).两组下呼吸道感染发生率比较采用精确概率法(单侧),咽拭子培养阳性率与住院时间相关性采用Spearman秩相关检验,采用SPSS 12.0软件包进行统计分析.结果 干预组和对照组的HALRTI发生率分别为2.00%(1/50)和13.73%(7/51),差异有统计学意义(P=0.031).对照组咽拭子培养阳性率随着住院时间延长显著增高(r=0.450,P＜0.05),而干预组咽拭子培养阳性率则无显著增高(r=-0.023,P＞0.05).结论 西吡氯铵含漱液漱口联合莫沙必利口服可有效预防高危老年住院患者HALRTI的发生.
  • 摘要：@@ 水痘是一种由水痘-带状疱疹病毒(VZV)引起的急性传染病,以较轻的全身症状和皮肤黏膜分批出现斑疹、丘疹、水疱和痂疹为特征,多见于小儿,但近年来成人水痘有所增多.为此,笔者总结了166例水痘患者的临床资料,对成人水痘与儿童水痘进行分析比较.
  • 摘要：@@ 患者女,26岁,既往无肺结核病史.患者入院前3 d流产后出现反复发热,体温最高达39.7℃,伴头痛、恶心、呕吐,并感右下肢乏力、麻木,经"头孢哌酮/舒巴坦"抗感染治疗后症状无明显缓解,遂转入我科进一步诊治.
  • 摘要：目的 探讨干扰素(IFN)应答相关基因在预测丙型肝炎抗病毒疗效中的作用.方法 采用功能分类基因芯片方法对IFN治疗前慢性丙型肝炎患者外周血单个核细胞(PBMC)IFN相关基因的表达进行检测,结合临床资料进行分析.采用SPSS 12.0软件进行统计学处理.结果 17例慢性丙型肝炎患者中,IFN治疗快速病毒学应答者(RVR)10例,非快速病毒学应答者(N-RVR)7例.与健康对照组比较,RVR患者PBMC中发现9个差异表达基因,其中1个为上调基因,8个为下调基因;N-RVR患者有18个差异表达基因,均为下调基因.RVR与N-RVR患者比较,发现5个差异表达基因,其中4个为上调基因,分别为PRKCZ、PRKRA、IRF5和TNFSF10(t=5.44、3.13、5.24和2.30,P=0.000、0.010、0.005和0.044),1个下调基因为IFIT5(t=2.43,P=0.035).17例患者中,12例为HCV1b型,5例为HCV2a型,HCV1b型与HCV2a型患者比较,发现2个下调基因,分别为IFI6和IFI44(t=2.42和2.45,P=0.038和0.033).结论 IFN应答相关基因下调可能与慢性丙型肝炎患者对IFN治疗的应答有关.HCV1b型患者比HCV2a型患者更容易诱导IFN相关基因表达的下调,从而产生IFN抵抗.%Objective To explore the application of interferon(IFN)response-related genes in predicting the outcome of antiviral treatment in chronic hepatitis C. Methods SuperArray microarray was used to detect the expression of IFN response-related genes in peripheral blood monocytes(PBMC)from chronic hepatitis C patients before treatment. SPSS 12.0 was used for statistical analysis. Results Ten patients were classified as rapid responders(RVR)and seven patients as non-RVRs according to the serum HCV RNA level after 4 weeks of treatment in 17 patients. Compared with healthy controls, nine differentially expressed genes were found in RVR patients, one up-regulated and eight down-regulated; eighteen differentially expressed genes were found in N-RVR patients, all down-regulated. Five differentially expressed genes were found between the patients with RVR and N-RVR: four up-regulated genes were PRKCZ, PRKRA, IRF5 and TNFSF10(t =5.44, 3.13, 5.24 and 2.30, P=0. 000, 0.010, 0.005 and 0. 044); one up-regulated gene was IFIT5(t = 2.43, P = 0. 035). Of seventeen patients, 12 were HCV genotype 1b, 5 were HCV genotype 2a. Compared with HCV2a, IFI6 and IFI44 gene in HCV1b were downregulated(t = 2.42 and 2.45, P = 0. 038 and 0. 033). Conclusions The expression of IFN responserelated genes is associated with response to IFN treatment. HCV genotype 1 b is more successful in inducing the down-regulation of IFN response-related genes than that of HCV genotype 2a, thus leading to the resistance to IFN.
  • 摘要：@@ 2010年9月9-12日,中华医学会第十一次全国感染病会议在重庆国际会议展览中心胜利召开.本次大会由中华医学会感染病学分会主办,重庆市医学会及第三军医大学西南医院感染病专科分院承办.

    中华临床感染病杂志的期刊信息

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