CG、TBA联合AFP和PIVKA-Ⅱ检测在HBV感染相关肝脏疾病诊断中的应用价值

目的 探讨CG、TBA联合AFP和PIVKA-Ⅱ检测在HBV感染相关肝脏疾病诊断中的意义.方法 应用回顾性研究模型,选取2019年1月至2020年10月于徐州医科大学第二附属医院住院的肝病患者为研究对象,其中乙肝患者60例(肝炎组)、肝硬化患者60例[肝硬化组(肝硬化代偿组36例)、(肝硬化失代偿组24例)]、原发性肝癌患者60例(肝癌组),选取同期健康体检者60例为健康对照组.所有入组者均进行血清甘胆酸(CG)、总胆汁酸(TBA)、甲胎蛋白(AFP)、维生素K缺乏Ⅱ诱导蛋白(PIVKA-Ⅱ)等肝病生物学指标水平测定,比较各指标水平在肝脏疾病中的差异,绘制受试者工作特征曲线(ROC),并比较各指标单独检测和联合检测对肝脏疾病的诊断中效能.结果 肝癌组的AFP、PIVKA-II、CG和TBA水平均高于肝硬化组、肝炎组和健康对照组,差异均有统计学意义(均P<0.05).肝硬化代偿组的AFP、PIVKA-II、CG和TBA水平均低于肝硬化失代偿组,差异均有统计学意义(均P<0.05).CG诊断早期肝硬化的AUC最大;AFP鉴别肝硬化代偿期与肝硬化非代偿期及肝炎的AUC最大;PIVKA-II鉴别肝硬化失代偿期和肝癌的AUC最大.四项指标联合诊断早期肝硬化的AUC最高为0.974,灵敏度(98.3％)和特异性(91.7％)高于其他单一指标;四项指标联合鉴别肝硬化代偿期与肝硬化非代偿期的特异性最高为88.9％;AFP+PIVKA-II联合鉴别肝硬化失代偿期和肝癌的灵敏度最高为100％;AFP+CG联合检测鉴别肝硬化代偿期和肝炎的特异性最高为95.0％.结论 CG、TBA、AFP和PIVKA-Ⅱ检测在HBV感染相关肝脏疾病诊断中均具有一定的诊断价值,联合检测对HBV感染相关肝脏疾病的鉴别诊断及评估肝脏受损程度具有重要的临床意义.     

白细胞介素17在乙肝肝纤维化中的表达及意义

目的:探讨白细胞介素17(IL-17)与慢性乙型肝炎病毒(HBV)相关件肝病特别足乙肝肝纤维化发生的相关性.方法:酶联免疫吸附试验(ELISA)及逆转录一多聚酶链反应(RT-PCR)法分别测定36例慢乙肝、42例肝硬化(Child-pughA、B、C分别为15、12、15例)、34例原发性肝癌、30例慢性重型乙型肝炎及20例健康对照者血清中的IL-17和外周血单个核细胞(PBMC)中IL-17mRNA水平及肝硬化Child-pugh分级患者血清中的IL-17和肝纤维化指标Ⅳ型胶原(C-Ⅳ),层黏连蛋白(LN),透明质酸(HA)的浓度.结果:与正常对照组相比,血清IL-17和PBMC中IL-17mRNA.水平在4组病人中表达升高(P<0.01);与其他各组相比,IL-17及mRNA水平在肝硬化中升高尤其明显(P<0.01).肝硬化患者血清IL-17及肝纤维化指标水平在Child-pugh C组高于Child-pugh A和Child-pugh B组,Child-pugh B组高于Child-push A组(P<0.01).IL-17水平与Child-push分级评分及C-Ⅳ,LN,HA浓度均呈正相关(r=0.582、0.568、0.682、0.764,P<0.01).结论:IL-17在慢性HBV相关性肝病尤其是乙肝肝硬化中表达明显升高,IL-17可能与慢性HBV相关性肝病尤其是乙肝肝纤维化的发生有明显的相关性.     

慢性肝病患者外周血Ghrelin与炎性细胞因子的水平检测及其相关性研究

目的:探讨外周血Ghrelin与炎性细胞因子TNF-α、IL-1及IL-6表达水平与慢性乙型肝炎、肝炎肝硬化、非酒精性脂肪性肝病肝脏损害程度的相关关系.方法:慢性肝病患者组和健康对照组血浆中Ghrelin、TNF-α、IL-1及IL-6表达水平检测采用酶联免疫吸附实验(ELISA).结果:慢性乙型肝炎、肝炎肝硬化患者外周血Ghrelin表达明显升高,与正常对照组比较差异显著(P＜0.05,P＜0.01),失代偿期肝硬化(B、C级)患者外周血Ghrelin水平明显高于慢性乙型肝炎组(P＜0.05);Ghrelin在非酒精性脂肪肝病患者组外周血明显降低,与正常对照组比较差异显著(P＜0.01);慢性肝炎、肝炎肝硬化患者外周血Ghrelin表达与炎性细胞因子TNF-α、IL-1及IL-6呈正相关(慢性肝炎组r值分别为0.587、0.995、0.985,肝硬化组r值分别为0.730、0.966、0.979),而在NAFLD疾病组则呈负相关(r值分别为-0.660、-0.873、-0.894).结论:Ghrelin在慢性乙型肝炎、肝炎肝硬化患者组外周血高表达,而在非酒精性脂肪性肝病患者组外周血低表达,Ghrelin表达水平与慢性肝病的发生发展过程相关.     

可溶型B7-H3在原发性肝细胞癌患者血清中的表达及临床意义

目的 检测协同刺激分子B7-H3在肝细胞癌患者血清及组织中的表达,并探讨其临床意义.方法 选取原发性肝细胞癌63例患者的癌组织和血清标本;5例肝血管瘤的瘤旁组织作为正常肝组织对照;同期收取50例健康体检人员外周血标本为正常对照.采用ELISA检测肝癌患者和正常人血清中可溶型B7-H3(sB7-H3)的含量,免疫组化检测正常肝组织和肝细胞癌组织中B7-H3的表达.结果 肝细胞癌患者外周血清sB7-H3含量为(4143.47±976,27) pg/mL,显著高于正常对照组(2076.18±605.42)pg/mL(P ＜0.05);且其表达水平与临床分期,是否远处转移及肝癌组织中是否阳性表达B7-H3等参数有关(P＜0.05),与年龄、性别、组织学类型、淋巴结转移及肿瘤大小等临床病理参数无关;与血清学指标CA19-9呈明显正相关(P＜0.05),但与AFP和CEA水平无相关性.结论 肝癌患者血清中sB7-H3表达明显高于正常人,B7-H3表达与疾病临床病理指标相关,表明检测sB7-H3可能对原发性肝癌的诊断有一定价值.     

HBV pgRNA在HBV相关疾病中的表达及其临床意义

目的 探讨血清HBV 前基因组RNA(pgRNA)在HBV相关疾病中的表达及其临床意义。方法 收集90例慢性乙型肝炎、54例乙肝肝硬化和44例HBsAg阳性原发性肝癌患者血清样本,进行HBsAg、HBeAg、HBV DNA和HBV pgRNA检测。结果 血清HBV pgRNA水平在慢性乙型肝炎组、肝硬化组、肝癌组患者中的中位数分别为7.08、5.16 和4.08 log copies/mL ,差异有统计学意义(χ^2=24.743, P <0.001)。在HBeAg阳性患者中,HBV pgRNA水平在慢性乙型肝炎组、肝硬化组、肝癌组患者中逐渐降低,差异有统计学意义(χ^2=14.864, P <0.001);且血清HBV pgRNA水平与血清HBV DNA、HBsAg水平及HBeAg滴度呈正相关。而在HBeAg阴性患者中,血清HBV pgRNA水平与血清HBV DNA、HBsAg水平及HBeAg滴度无相关性。结论 血清HBV pgRNA水平在慢性乙型肝炎、肝硬化和肝癌患者中逐渐降低,且与HBV DNA、HBsAg水平及HBeAg滴度呈正相关。     

人可溶性B7-H3酶联试剂盒的研制及在肝病患者血清中水平的检测

目的:建立定量检测人的可溶性B7-H3(sB7-H3)酶联检测试剂盒,并分析肝病患者外周血中sB7-H3水平及其临床意义。方法:在已获得2株识别位点不同的小鼠抗人B7-H3单克隆抗体(4H7和2E6)基础上,采用单抗4H7为包被抗体,以经生物素标记的抗体2E6为检测抗体,以重组人可溶性B7-H3为标准品,建立可溶性B7-H3分子的酶标检测方法。在此基础上对健康献血者和不同肝病患者的血清样本进行了检测并分析其临床意义。结果:研制了sB7-H3酶联检测试剂盒,检测的线性范围是8.192～2 000 ng/L,批内、批间变异系数分别为3.35%和6.97%。酶标检测板在4℃放置1个月,变异系数(CV%)<±8.6,回收率为94%～117%,特异性试验显示无交叉反应,提示该检测试剂盒具有良好的灵敏度、稳定性和特异性。用该试剂盒分析不同肝病患者外周血sB7-H3水平后发现,(1)乙肝患者以及乙肝合并肝硬化或肝癌患者与健康对照组之间并不存在差异(P>0.05);(2)重症肝炎患者血清B7-H3水平低于健康对照组(P=0.0183);(3)血吸虫性肝硬化患者血清B7-H3水平显著高于健康对照组(P<0.01)。结论:建立了灵敏、特异的人sB7-H3酶联检测试剂盒,对肝病患者检测的结果表明,不同的肝病患者外周血sB7-H3表达水平不同,显示该试剂盒具有潜在的应用价值。     

原发性肝癌组织中B7-H3表达与浸润的CD8~+ T细胞数负相关

目的探讨原发性肝癌组织中B7-H3的表达与CD8+T细胞浸润之间的关系。方法采用免疫组织化学技术分析原发性肝癌组织和正常肝组织中B7-H3的表达、CD8+T细胞的浸润数量,对B7-H3的表达与CD8+T细胞浸润数量的相关性进行统计学分析。结果 63例肝癌患者中B7-H3高表达26例(41.3%),低表达37例(58.7%),总阳性率为90.5%,其中正常肝组织基本不表达B7-H3。B7-H3高表达组CD8+T细胞浸润数量明显低于B7-H3低表达组,CD8+T细胞浸润数量与肝癌组织中B7-H3的表达呈负相关。肝癌组织中B7-H3的表达和CD8+T细胞数量在肝癌患者的临床病理分期、是否有局部淋巴结转移以及远隔器官转移等方面具有显著性差异。结论原发性肝癌组织中高表达B7-H3,与肿瘤组织中CD8+T细胞浸润呈负相关。     

慢性乙肝、肝硬化和肝癌患者Th1/Th2细胞因子检测及临床应用

目的:应用流式微球技术(cytometric bead array,CBA)技术检测慢性乙肝、肝硬化及肝细胞性肝癌(hepatic cellular cancer,HCC)患者血浆中Th1/Th2细胞因子水平,探讨其临床应用。方法:选择慢性HBV感染者71例,HBV阳性肝硬化患者33例,HBV阳性肝癌患者25例,用CBA方法检测其血清中Th1类细胞因子TNF-α、IFN-γ、IL-2,Th2类细胞因子IL-4、IL-5、IL-10的表达情况。结果:肝癌患者血清中Th1类细胞因子TNF-α、IFN-γ、IL-2,Th2类细胞因子IL-5表达显著高于慢性乙肝和肝硬化患者,而IL-4、IL-10在三组患者中的表达无显著性差异。结论:肝癌患者机体强势分泌Th1类细胞因子,处于高免疫反应状态。检测乙肝患者Th1/Th2类细胞因子对于肝病慢性化的进展成为一项新的临床预测指标。     

原发性肝癌组织中B7-H3表达与浸润的CD8^+ T细胞数负相关北大核心CSCD

目的探讨原发性肝癌组织中B7-H3的表达与CD8+T细胞浸润之间的关系。方法采用免疫组织化学技术分析原发性肝癌组织和正常肝组织中B7-H3的表达、CD8+T细胞的浸润数量,对B7-H3的表达与CD8+T细胞浸润数量的相关性进行统计学分析。结果 63例肝癌患者中B7-H3高表达26例(41.3%),低表达37例(58.7%),总阳性率为90.5%,其中正常肝组织基本不表达B7-H3。B7-H3高表达组CD8+T细胞浸润数量明显低于B7-H3低表达组,CD8+T细胞浸润数量与肝癌组织中B7-H3的表达呈负相关。肝癌组织中B7-H3的表达和CD8+T细胞数量在肝癌患者的临床病理分期、是否有局部淋巴结转移以及远隔器官转移等方面具有显著性差异。结论原发性肝癌组织中高表达B7-H3,与肿瘤组织中CD8+T细胞浸润呈负相关。     

HA RIA对肝病的诊断价值

本文对183例肝病患者血清中HA浓度测定,探讨HA在旰病诊断中的价值。 材料和方法 一、对象: (一)正常组:健康献血员40例(男24例,女16例),平均年龄34.1岁。 (二)肝病组:所检183例(男168,女15)肝病患者均系我院住院病人,平均年龄41.33岁。其中慢性迁延性肝炎(CPH)45例,慢性活动性肝炎(CAH)44例,无症状HBsAg(携带者ASC)47例,肝炎后肝硬化36例,均符合1990年上海肝炎会议诊断标准,酒精性肝硬化11例。47例肝硬化(LC)均经肝活检、B超确诊,并按Child标准将肝硬化组分为肝功能代偿组与失代偿组,其中代偿组24例,失代偿组23例。     

Modes of reinforcement and gender and culture of experimenter and subject: effects of "alien" and external reinforcement for Japanese and American men and women

In this study, we examined external and "alien" reinforcement (ER and AR. respectively) as a factor in social learning, and studied the combined effects of culture and reinforcement mode. A female (Experiment 1) and a male (Experiment 2) experimenters conducted experimental sessions. Both men and women, who grew up in the same culture as the experimenter, participated and performed the experimental task. A three-way interaction effect of experimenter gender, culture, and reinforcement mode was found on task performance. And the effect was more pronounced for a Japanese experimenter. A female and a male experimenters conducted Experiments 3 and 4, respectively; however participants this time were men and women who grew up in different cultures than the experimenter. Results indicated that the pattern of the subject gender and reinforcement mode interaction effect, when the experimenter was Japanese with American subjects, was exactly opposite to that when the experimenter was American. These experiments showed that AR was as effective for social learning as ER, and that the cultural backgrounds of experimenter and subject influenced AR and ER effectiveness.     

Timing and intensity of early fevers and the development of allergies and asthma

BACKGROUND: Early childhood fevers appear to protect against later allergies and asthma. What is not known is the time in which fevers exert this effect and whether the degree of temperature increase is important. OBJECTIVE: We sought to examine the relationship between the time and degree of early fevers and later allergies and asthma. METHODS: Eight hundred thirty-five children from southeast Michigan were enrolled at birth. Clinic records from their first 2 years were abstracted for episodes of fever. At age 6 to 7 years, children underwent allergy testing. We examined fevers occurring within 6-month intervals in the first 2 years of life and outcomes at age 6 to 7 years. The primary outcome measures were allergic sensitization, asthma, asthma with allergic sensitization, and asthma without allergic sensitization. RESULTS: In the unadjusted analysis each episode of fever between 7 and 12 months of age was associated with a lower odds of allergic sensitization (odds ratio [OR], 0.71; 95% CI, 0.54-0.93) and asthma with allergic sensitization (OR, 0.43; 95% CI, 0.21-0.90) at age 6 to 7 years. Likewise, every 1 degrees C increase in the maximum temperature between 7 and 12 months was associated with a lower odds of allergic sensitization (OR, 0.77; 95% CI, 0.61-0.96) and asthma with allergic sensitization (OR, 0.62; 95% CI, 0.40-0.94). After adjusting for potential confounders, each episode of fever between 7 and 12 months was associated with a lower likelihood of asthma with allergic sensitization (adjusted OR, 0.33; 95% CI, 0.11-0.94) at age 6 to 7 years. CONCLUSIONS: Both the timing and intensity of childhood fevers appear to be important factors in the development of allergies and asthma.     

Rates of oxygen consumption and of anaerobic glycolysis in renal cortex and medulla of adult and new-born rats and guinea-pigs

1. Rates of oxygen uptake and of anaerobic glycolysis were estimated in slices from the renal cortex and medulla (a) of adult rats and guinea-pigs, (b) of new-born (1-, 5- and 21-day-old) rats and of guinea-pigs of 1, 12, 21, 24 and 120 hr age.2. In the adult rat, Q(O2) values for the cortex were 12.55 +/- 0.20 (22) and for the medulla: 8.56 +/- 0.17 (22) mul./hr.mg dry weight, while in the new-born rat (24 hr old) they were 10.99 +/- 0.46 (12) and 9.33 +/- 0.18 (9) mul./hr.mg dry weight respectively.3. Values for Q(CO2) (N2) (anaerobic glycolysis) in the 14 hr old new-born rat were in the renal cortex 9.65 +/- 0.35 (5) and in the medulla 7.39 +/- 0.43 (5) mul./hr.mg dry weight; while in the adult they were 2.25 +/- 0.08 (16) and 5.76 +/- 0.14 (16) mul./hr.mg dry weight, respectively.4. In the adult guinea-pig values for Q(CO2) (N2) were of the same order as in the adult rat, though the rate of O(2) uptake was for the cortex 8.12 +/- 0.22 (12) and for the medulla 5.02 +/- 0.23 (11) mul./hr.mg dry weight.5. Though the Q(O2) values in the renal cortex and medulla were smaller in the 1 hr old new-born guinea-pig, they were already increasing in the 12 hr old neonate.6. The results are discussed in the light of enzyme changes occurring during the process of maturation of the nephron as indicated by histochemical observations.     

Association between functional alterations of senescence and senility and disorders of gait and balance

OBJECTIVES:

Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil.

METHODS:

Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale.

RESULTS:

Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores.

CONCLUSIONS:

Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity.     

男性乳腺发育症临床病理分析及雌,孕激素受体检测

对１１３例男性乳腺发育症进行临床病理分析。同时检测其中３０例乳腺组织中雌激素受体和孕激素受体分布情况，结果发现两者阳性率分别为８０．０％和８３．３３％。结合文献讨论了男性乳腺发育症的发生与高血清激素浓度及乳腺组织高受体水平的关系。     

Lay theories of psychotherapy and perceptions of therapists: A replication and extension of furnham and wardley

This study examined laypersons' perceptions of psychotherapy, the experience of psychotherapy clients, and therapist credibility. Most of Furnham and Wardley's recent findings of positive and realistic lay views on psychotherapy and therapists were replicated. Age, sex, and psychological experience mediated some beliefs about therapy and clients' experiences. Although positive views were associated with higher ratings on some aspects of therapist credibility, only the modality of the therapy (behavior vs. client-centered vs. rational-emotive individual therapy) influenced perceptions of overall credibility. Neither the fee charged nor the participant's sex had any effect on perceptions of therapist credibility.