目的 认识主动脉夹层患者的急诊症状，减少漏诊与误诊。 方法 对2006年1月－2012年7月21例急性主动脉夹层患者的首发症状、辅助检查、临床诊断进行回顾性分析，总结误诊的原因。 结果 首发症状为剧烈胸痛和（或）腹痛15例（71.4%），胸闷、呼吸困难4例（19.0%），胸痛伴肢体偏瘫1例（4.8%），无痛性晕厥1例（4.8%）。15例行心电图检查，10例（66.7%）异常；17例行急诊胸部X线片检查，7例（41.2%）异常；9例行急诊增强螺旋CT检察，均发现真假两腔（100.0%）；10例行急诊超声心动图检查，8例（80.0%）见假腔形成；15例行心肌梗死3项（肌酸激酶同工酶、肌红蛋白、肌钙蛋白I）检查，4例（26.7%）异常；12例行D-二聚体检查，3例（25.0%）异常。15例急诊拟诊主动脉夹层，6例误诊为其他疾病。 结论 主动脉夹层临床表现复杂，提高认识及必要的辅助检查有助于早期诊断。
Sepsis is a worldwide problem. Although there are many related researchs and animal experiments about sepsis, the mortality of sepsis is still high. In the early stage of sepsis, after the pathogenic bacteria invade the body, the immune response produced by the body promotes the synthesis and secretion of a series of cytokines. Among them, there are proinflammatory cytokines that promote inflammatory response and anti-inflammatory cytokines that inhibit inflammatory response. These cytokines interact with each other and maintain a dynamic balance in complex cell grid. This is to restore the steady state of the body after resisting and eliminating the invaders.Anti-inflammatory cytokines play an important role in it. They act on specific immune cells or immune regulatory receptors. Anti-inflammatory cytokines limit persistent or excessive inflammatory responses after killing invaders, and reduce or block pro-inflammatory cytokine activities. These anti-inflammatory cytokines also can heal body to restore the normal immune physiological level of the organism. This article will review the related research of anti-inflammatory cytokines in sepsis.
ObjectiveTo investigate the clinical signification of plasma interleukin-17 (IL-17) 1evel in patients with acute respiratory distress syndrome (ARDS).MethodsForty-five adult ARDS patients and 22 healthy controls were enrolled in this study. The plasma cytokine levels of IL-17, IL-6 and IL-10 were measured by enzyme linked immunosorbent assay. Meanwhile, the baseline data of demographic and clinical tests including oxygenation index, procalcitonin and brain natriuretic peprtide were collected, the acute physiological and chronic health Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score were recorded. The main outcome was defined as hospital mortality within 28-day follow-up.ResultsThe plasma concentration of IL-17, IL-6 were higher in the ARDS patients (P<0.05) compared with the controls and the mean levels of IL-17, IL-6 and the APACHEⅡ score and the SOFA score in the non-survivors was higher than those in the survivors (P<0.05). In particular, there was a significant correlation between the plasma levels of IL-17 and IL-6 (P<0.05). Logistic regression and COX multivariate survival analysis suggested that age and SOFA score may be prognostic factors for ARDS.ConclusionsThe plasma concentration of IL-17 is significantly increased in ARDS patients, and its expression is linearly related to the proinflammatory factor IL-6. Both are important inflammatory markers in the acute phase of ARDS and may be important disease severity and prognostic indicators in addition to age and SOFA score.