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结核分枝杆菌感染和免疫逃逸机制研究进展
许多病毒、细菌都有导致潜伏感染的能力,这是它们和宿主之间发生复杂的相互作用的一个重要方面,需要我们从细菌和宿主的相互作用方面去理解这种现象的发生。当病原微生物第一次感染宿主的时候,宿主的天然免疫和获得性免疫系统通常会有一个剧烈的反应过程,如果经过开始的和病原菌的相互作用过程,宿主仍然能够存活,获得性免疫系统通常会将病原菌清除。然而,某些病原菌能在宿主细胞内长期留存,即使宿主获得性免疫应答已经启动、细胞产生炎症反应等抗菌机制的情况下细菌仍能够保持感染状态,这种状态可称为持续滞留感染( persistent bacterial infection, PBI)或者潜伏感染[1]。能够潜伏感染的细菌中危害大的是结核分枝杆菌( Mycobacterium tuberculosis, Mtb)。 Mtb菌株能够建立长期稳定的感染状态,在临床上可以表现为急性或者慢性的病理状态,或没有症状但在后期具有演变成活动性结核病的潜力[2]。其和宿主免疫系统相互作用的机制十分复杂,并且在宿主的感染和发病过程中有关键作用,因此值得我们深入探讨和研究。
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Objective To compare and analyze serum levels of procalcitonin (PCT) of children with viral and bacterial infection and probe into the importance of determining the level of serum PCT in the diagnosis of bacterial infection in order to provide evidences of the clinical use of antibiotics.
Methods A total of 85 cases of children with an average age of 8.9 years (10 months-12 years) were enrolled in this study, 53 cases were with viral infection and 32 cases with bacterial infection. We determined serum levels of PCT by semi-quantitative solid phase immunoassay, and the serum levels of PCT were divided into four grades as<0.5μg/L,≥ 0.5μg/L,≥2.0μg/L and≥10μg/L forχ2 test and Ridit analysis.
Results The serum level of PCT of the group with bacterial infection were signiifcantly higher than that of the group with viral infection (P<0.001). The sensitivity of diagnosis of bacterial infection in children with determination of serum levels of PCT was 87.50%while the speciifcity was 92.13%, and positive predictive value was 73.68%while negative predictive value was 91.49%, and positive likelihood ratio was 4.65 while negative likelihood ratio was 0.15, and the diagnostic accuracy was 83.53%.
Conclusions Serum PCT is a bacterial sensitive marker of bacterial infection in children, and the determination of the level of serum PCT is helpful for the diagnosis of bacterial infection, which can also be a basis for the use of antibiotics. -
肝移植细菌感染的临床特征与肠道通透性的变化
细菌感染是肝移植术后的主要并发症,也是术后死亡的首位原因[1].引起感染的致病菌主要来源于肠道,包括G-杆菌和G+球菌[2].笔者的研究旨在探讨肝移植术后细菌感染的特征及其与肠道通透性的关系.
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病毒与细菌感染引起小儿急性发热的鉴别
急性发热是小儿常见的就诊原因,初步判断细菌和病毒感染对于及时控制病情,减少抗生素的不合理应用非常重要.虽然目前尚无能够绝对区别细菌或病毒感染的指标,但在临床上,根据病史、体格检查,结合实验室检测的一些证据可以预测患儿是否有细菌感染,常用于鉴别细菌与病毒感染的证据如下.
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输血传播性细菌感染
输血传播性细菌感染(transfusion-transmitted bacterial infection,TTBI)对受血者构成极大的威胁.研究显示,血液制品的细菌污染为41.9/100 000单位[1].加拿大血小板制品细菌污染占全部血液制品细菌污染的1/3.细菌污染导致约17%的输血相关性死亡.其死亡风险是病毒类感染的200~400倍.引起TTBI常见的血液制品是血小板.本文对其污染源、污染菌、检测方法、临床判断、预防措施等综述如下.
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观察生理盐水冲洗剖宫产切口预防感染的效果分析
剖宫产术属于绝对的无菌手术。存在细菌感染的可能性。剖官产手术时,0.9%生理盐水冲洗腹部切E l及官腔,同时常规配合静点抗生素。预防和减少术后切El及官腔感染,取得了良好的效果。
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中枢神经系统细菌感染诊断及治疗中的若干问题
在导致中枢神经系统感染的病原菌中以细菌性感染为常见,神经内、外科,感染科以及普通内科医师均面临此类疾病.笔者拟对其诊断及治疗中存在的一些问题论述如下.
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1例左膝关节结核伴细菌混合感染性脓肿伤口的护理
伤口愈合是一个复杂的过程,受很多因素影响,特别是感染性、坏死性伤口更是一大难题[1].伤口护理中湿性愈合理论在国外早已广泛应用,近年来国内医院的医护人员也慢慢地认识和接受了这一理论,越来越多的医护人员开始使用湿性敷料为病人换药[2].化脓性膝关节炎为膝关节内化脓性感染,关节内感染病灶能否早期、彻底的清扫,对治疗化脓性关节炎非常重要[3].
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重症急性胰腺炎继发胰周细菌感染的手术时机
重症急性胰腺炎(SAP)的死亡往往可以归为早期的多器官功能障碍和后期的胰腺、胰周的严重感染,随着对疾病过程的认识和重症监护的发展,相当比例的病人度过了早期疾病本身导致的多器官损害,而后期感染所致的二次炎症状态造成的多器官损害则凸显,目前约半数以上的死亡原因与感染有关[1,2].因此,重视胰周感染的防治是提高重症急性胰腺炎治愈率重要的一环.
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幽门螺杆菌基因多态性的地域差异对感染临床结局的影响
已知幽门螺杆菌(H.pylori)是引起人类慢性胃十二指肠疾病的主要致病菌.流行病学资料显示,全球半数以上人群存在H.pylori感染,但大多数感染者胃内并不发生病变,或表现为轻度慢性胃炎,仅小部分感染者发展为萎缩性胃炎、消化性溃疡、胃癌、胃黏膜相关淋巴组织(MALT)淋巴瘤等严重疾病.H.pylori感染临床结局的多样性与宿主遗传因素、环境因素、细菌本身的毒力因子及其间的相互作用有关.
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左氧氟沙星序贯治疗社区获得性下呼吸道细菌感染疗效观察
左氧氟沙星是新一代氟喹诺酮类抗菌药物,具有抗菌谱广、组织渗透性好、不良反应少等特点,故可用于治疗社区获得性下呼吸道感染.头孢呋辛和头孢克洛均为第二代头孢菌素,也常用于下呼吸道感染.本研究旨在评价左氧氟沙星序贯治疗社区获得性下呼吸道细菌感染的有效性及安全性,以头孢呋辛/头孢克洛序贯治疗为对照,采用随机对照试验方法,进行临床观察.
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Early T cell depletion occurs prior to the development of an effective immune response to infections.Both antigen-specific and non-specific T cells are induced to express early activation markers soon after microbial infections.This is followed by massive depletion of non-specific T cells and extensive proliferation of antigen-specific T cells.Proliferating antigen-specific cells exhibit a broad spectrum of late activation markers while non-specific cells exhibit no sign of further activation before succumbing to apoptosis.These results have crucial implications for the understanding of early events in the development of a robust T cell response.
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肠易激综合征是一种细菌感染性疾病吗?
Pimental及其同道[1]的近期研究表明:肠易激综合征(irritable bowel syndrome,IBS)是一种可用抗生素治疗的细菌感染性疾病,他们发现:根据乳果糖呼气实验检测结果,78%的IBS患者有小肠细菌过度生长,根除过度生长的细菌可减轻IBS患者的腹泻、腹痛症状,并可使48%的IBS病人"痊愈".
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小儿单纯型和化脓型阑尾炎的细菌学探讨和治疗
近年来,阑尾炎厌氧菌感染已引起人们的注意.本文总结了我院1984年6月至1985年5月81例小儿单纯型和化脓型阑尾炎的细菌学检查结果和治疗效果.
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慢性阻塞性肺疾病与细菌感染
20世纪五六十年代,一些学者认为反复细菌感染是COPD发病机制中的重要因素,之后吸烟被证实是更为主要的病因.到七八十年代时,越来越多的学者认为细菌感染可能只是COPD发病中有较小致病意义的一个附带现象,而更有可能是导致慢性阻塞性肺疾病急性加重(AECOPD)的原因并因此作用于COPD的发展.近年来,新的分子学、细胞通讯作者:赖国祥,E-mail:laiguoxiang2007@163.com
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于福興實驗室研究計劃
1 Molecular regulation of corneal wound healing Rapid healing of the corneal epithelium in response to injury is essential for maintenance of its barrier function. The long-term goal of this project is to obtain basic information about the molecular and cell biology of corneal wound healing. The project will test the hypotheses that amyloid β/A4 precursor-like protein controls serine proteinase activity, mediates cell adhesion, and promotes cell migration during corneal reepithelialization. This study should provide the basis to begin constructing a detailed nap of the molecular pathways and interconnecting networks of proteins functioning in wound repair and to develop therapeutics for treatment of corneal diseases like recurrent erosions and persistent defects of the epithelium.2 Developing an ex vivo model for ocular irritation testThe objective of this project is to develop an ex vivo assay system to predict ocular irritation potential of test chemicals and consumer products. Our hypothesis has been that activation of these transcription factors and disruption of corneal integrity can be used as endpoints/ markers for evaluating ocular toxicity in organ culture. Our goal is to develop a sensitive, efficient, economical and reliable ex vivo model for predicting irritation potential of a chemical or consumer product with mechanistic basis.3 Modulation of epithelial barrier function during corneal infectionThe long-term goal of this project is to understand the mechanisms underlying the induction of the inflammatory reaction and breakdown of the epithelial barrier in the cornea upon infection. We will test the hypothesis that in the cornea TLRs confer responsiveness of HCE cells to pathogens, and PA challenge-induced TLR signaling, through activation of NF-?B and/ or mitogen-activated protein kinase (MAPK), contributes to infection-induced epithelial barrier breakdown. The following studies will be carried out. An understanding of how TLRs transmit signals that lead to epithelial response, including modulation of barrier function,may allow the development of therapeutic agents that prevent breakdown or enhance recovery of barrier function during infection and, as an adjuvant therapy, eliminate the corneal scarring and vision loss associated with bacterial keratitis.4 Developing an adjuvant therapy to reduce inflammatory response induced by bacterial infection of the cornea (bacterial keratitis).