29例甲型H1N1流感患者心肌标志物心肌酶的变化及临床意义

目的通过对甲型H1N1流感患者肝酶、心肌酶及心电图变化的研究,探讨甲型H1N1流感患者是否存在心肌损害。方法总结29例临床资料完整而无基础心脏疾病的甲型H1N1流感患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)和乳酸脱氢酶(LDH)活性的变化规律。并对甲型H1N1流感患者在病程初期和恢复期的心电图变化进行回顾性分析。结果甲型H1N1流感患者血清AST在病程初期即已升高,但其升高幅度小于ALT,并在治疗稳定期基本恢复正常[AST:(52±35)U/L,(30±29)U/L,(21±17)U/L;ALT:(79±54)U/L,(52±37)U/L,(45±54)U/L];CK、LDH亦在病程初期升高,并随病情好转逐渐降低[CK:(441±223)U/L,(318±146)U/L,(229±67)U/L;LDH:(172±101)U/L,(99±77)U/L,(64±49)U/L],但CK-MB、cTnT始终未见异常;9例(31.0%)患者出现一过性的心电图改变(包括窦性心动过速、房性期前收缩、室性期前收缩等情况)。结论甲型H1N1患者血清AST、ALT、CK、LDH呈一过性升高,但cTnT、CKMB不高,甲型H1N1流感病毒引起心肌损害的几率不高。     

271例甲型H1N1流感心肌酶学结果分析

目的分析甲型H1N1流感心肌酶学的变化特征。方法分析我院2009年收治的271例甲型H1N1流感病例心肌酶学的变化。结果 1、随着疾病的加重,心肌酶CK、CK-MB及LDH均值明显升高,LDH异常例数明显增多,异常均值明显升高,组间比较有统计学意义(P<0.05);CK及CK-MB异常例数及异常均值随疾病加重而有所增加,但组间比较无明显统计学意义(P>0.05)。2、病毒转阴时心肌酶CK、CK-MB及LDH恢复则随疾病加重而减慢;LDH异常例数减少程度及异常均值下降幅度均随疾病加重而减慢,组间比较有统计学意义(P<0.05);随疾病的加重CK及CK-MB异常例数减少程度及异常均值下降幅度亦有所减慢,但组间比较无明显统计学意义(P>0.05)。结论甲型H1N1流感心肌酶学CK、CK-MB及LDH异常例数随疾病的加重而明显增多,异常均值随疾病加重而明显升高。     

老年百草枯中毒患者血清酶学水平的动态变化

目的探讨老年百草枯中毒患者血清酶学水平的动态变化。方法选取56例老年百草枯中毒患者作为研究组,同期体检的健康人群70例作为健康对照组。检测老年百草枯中毒患者血清肌酸激酶(CK)、CK同工酶(CK-MB)、乳酸脱氢酶(LDH)、碱性磷酸酶(AST)等指标。结果与健康对照组比较,中毒第1天轻度组血清CK、CK-MB、LDH、AST水平差异无统计学意义(P0.05);但中度组和重度组患者血清CK、CK-MB、LDH、AST水平均高于健康对照组(P0.05);且三组间两两比较均有统计学差异(P0.05)。轻度组血清CK、CK-MB、LDH、AST水平在第3天达峰值,但在第7天开始下降。中度组和重度组血清CK、CK-MB、LDH、AST水平不断升高,在第7天达到峰值。第3、7天时,三组间血清CK、CK-MB、LDH、AST水平两两比较均有统计学差异(P0.05)。结论百草枯中毒可造成老年患者心肌损害持续性加重,且心肌损害程度与百草枯中毒程度相关。     

Th17淋巴细胞对甲型H1N1流行性感冒病毒清除作用的探讨

目的 探讨甲型H1N1流行性感冒(流感)患者Th17淋巴细胞表型、比例及其与病毒清除之间的关系.方法 将甲型H1N1流感患者70例、季节性流感患者30例、健康对照者68例分别纳入3组.通过细胞内染色,流式细胞技术测定3组人群外周血Th1、Th2、Th17、调节性T细胞(Treg)淋巴细胞比例;ELISA法测定血浆及外周血单个核细胞(PBMC)培养上清液中的IFN-γ、转化生长因子-β(TGF-β)、IL-6水平;RT-PCR检测鼻咽拭子甲型H1N1流感病毒载量.统计学方法采用单因素方差分析和线性相关分析.结果 甲型H1N1流感患者Th17淋巴细胞比例为(2.740±0.210)%,较健康对照者的(3.443±0.154)%及季节性流感患者的(3.443±0.277)%显著下降(F=4.242,P＜0.05),而3组间Th1、Th2、Treg淋巴细胞比例无明显差异;甲型H1N1流感患者血浆TGF-β水平为(10±8)ng/mL,较健康者的(43±32)ng/mL及季节性流感患者的(18±10)ng/mL显著下降(F=17.72,P＜0.01);甲型H1N1流感患者PBMC中TGF-β水平为(782±736)pg/mL,较健康者的(1462±315)pg/mL及季节性流感患者的(1481±348)pg/mL显著下降(F=5.730,P＜0.01);Th17淋巴细胞比例与病毒清除时间呈负相关(r=-0.38,P=0.02).结论 甲型H1N1流感患者Th17淋巴细胞比例显著降低,且与TGF-β水平密切相关,其降低可能导致机体延长排毒时间.     

我国重症及危重症甲型H1N1流感住院肥胖患者临床分析

目的探讨超重、肥胖甲型H1N1流感重症和危重症患者的临床特征及和正常体重患者的差异,以期为该类患者的诊疗提供更多科学依据。方法收集2009年9—12月中国27个省市自治区收治的住院重症和危重症甲型H1N1流感成人患者资料,按体重指数分正常体重、超重和肥胖组,用SPSS 17.0进行临床资料集指标比较和分析。结果纳入研究纳入研究669例,正常体重者308例(46.0%),超重者230例(34.4%),肥胖者131例(19.6%)。肥胖组合并高血压比例高于正常体重组(26.7%对14.0%,P=0.005)。随着体重指数的增加,咯血发生率升高(组间比较,均P<0.05)。肥胖组呼吸频率较正常体重组患者更快[23次/min(20～28次/min)对20次/min(20～24次/min),P=0.001]。此外,超重组和肥胖组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酐(Cr)水平高于正常体重组(P<0.01)。尽管3组间病死率差异无统计学意义,但肥胖组患者比正常体重组患者呼吸衰竭发生率以及ICU入住率更高(P<0.001),住院时间也明显延长(P<0.001)。结论重症及危重症甲型H1N1流感住院肥胖患者呼吸困难更明显,组织器官损伤更重,更易发生呼吸衰竭。     

轻型和重型甲型H1N1流行性感冒患者临床特征、病毒载量以及排毒时间分析比较

目的 了解轻型和重型甲型H1N1流行性感冒(流感)患者的临床和实验室特征、病毒载量及排毒时间.方法 对深圳地区70例轻型和16例合并肺炎的重型甲型H1N1流感患者采用实时荧光定量PCR方法,检测其甲型H1N1流感病毒载量.比较年龄＜14岁和≥14岁患者,以及轻型无肺炎和重型合并肺炎患者的病毒载量和病毒清除时间的差异.统计学方法采用t检验或卡方检验.结果 甲型H1N1流感患者最常见的临床表现是发热、咳嗽和扁桃体肿大.重型患者咳嗽、呼吸困难比例和最高体温较轻型患者显著增高(x2=10.9、14.3,t=3.65,均P＜0.01).重型患者WBC计数、ALT水平较轻型患者显著升高(t=3.2、2.4,均P＜0.05).重型患者胸部影像学类似间质性肺炎,多为磨玻璃样影.＜14岁患者的病毒载量和病毒清除时间较≥14岁的显著升高[(4.86±1.23)lg比(4.17±0.89)lg,t=2.3,P＜0.05]或延长[(5.33±0.49)d比(3.63±0.28)d,t=3.4,P＜0.01],重型患者病毒载量和病毒清除时间较轻型患者显著升高[(6.36±1.44)lg比(4.35±0.99)lg,t=6.1,P＜0.01]或延长[(5.75±1.77)d比(4.24±1.96)d,t=3.2,P＜0.01).结论 甲型H1N1流感患者年龄和病情严重程度与病毒载量和排毒时间存在显著相关性.     

重症新型甲型H1N1患者预后影响因素分析

目的分析影响新型甲型H1N1流感住院患者疾病严重程度和死亡的危险因素。方法对我院收治的92例新型甲型H1N1流感住院患者的临床资料进行回顾性分析,比较死亡组、危重症组和重症组患者之间的临床特征,采用多变量Logstic回归分析确定转归因素。结果死亡组和危重症组的起病确诊时间长于重症组。死亡组的K离子水平明显高于重症组和危重症组,死亡组和危重症组的Ca离子水平明显高于重症组。与重症组比较,死亡组的AST、碱性磷酸酶（ALP）、白蛋白（ALB）、肌酐（CR）、尿素氮（BUN）、乳酸脱氢酶（LDH）、血糖（GLU）高,总蛋白低;危重症组ALT、AST、总胆红素、ALP、ALB、LDH、GLU水平高;死亡组BUN、LDH高于危重症组。新型甲型H1N1流感患者死亡的危险因素是低钙血症（P=0．043,OR：0．018,95％CI：0．000—0．880）。结论低钙血症及肝肾功能损害是新型甲型H1N1流感患者的预后不良因素,应加强对危险因素的控制,以期降低重症和危重患者的病死率。     

伴肺炎与低氧血症的新型甲型H1N1流感二例报告

目的 分析2例重症新型甲型H1N1流感(简称甲型流感)合并肺炎患者的临床表现、影像学特点和治疗经过,提高对本病的认识.方法 回顾性分析2009年9月入住南京市第二医院南山分院的2例确诊为甲型流感合并肺炎患者的临床表现、胸部CT特点及治疗经过.结果 2例患者中1例为女性,54岁,无基础疾病;1例为男性,31岁,有支气管哮喘史.主要症状和体征为发热、咳嗽,肺部可闻及湿性哕音.2例患者胸部CT主要表现为实变影及磨玻璃影,以双下肺和胸膜下分布为主,累及多个肺叶、肺段,实变影内可见支气管充气征.2例患者咽拭子甲型H1N1流感病毒核酸阳性,确诊为甲型流感.2例患者入院时均存在低氧血症,白细胞计数和淋巴细胞计数下降,血乳酸脱氢酶(LDH)水平和肌酸激酶(CK)水平明显升高.2例患者均接受奥司他韦、糖皮质激素以及吸氧等对症支持治疗,其中1例间断接受无创通气.治疗后,临床症状缓解,胸部CT示实变影和磨玻璃影较入院时明显吸收.白细胞计数、LDH及CK水平恢复正常,复查咽拭子甲型H1N1流感病毒核酸阴性,康复出院.结论 部分甲型流感患者可合并肺炎,临床表现无特异性,胸部CT主要表现为双肺弥漫性分布的实变影及磨玻璃影;及时动态复查胸部CT对诊断和了解病情进展非常必要;糖皮质激素可缓解甲型流感合并肺炎患者咳嗽及气喘等症状,有助于肺部病变的吸收.     

甲状旁腺功能减退症患者血清心肌酶与血钙和心电图的动态分析

选择甲状旁腺功能减退症患者24例,正常对照24名,测定所有入选对象的血清心肌酶谱和血清总钙浓度,并对甲状旁腺功能减退症组进行心电监测.甲状旁腺功能减退症组患者血清肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(BHDH)、乳氢脱氢酶(LDH)、天冬氨酸转氨酶(AST)均较对照组升高(均P＜0.05),以CK、CK-MB升高为明显(P＜0.01),酶学异常患者心电图均提示不同程度的心肌缺血.治疗后,随血钙浓度升高,心肌酶及心电图均于8周左右基本恢复正常.提示了血清心肌酶水平的变化可作为甲状旁腺功能减退症患者病情程度及治疗效果判定的参考指标.     

儿童甲型H1N1流感63例临床观察

目的 探讨儿童甲型H1N1流感的流行特征、临床特点及实验室指标.方法　对我院收治的63例儿童甲型H1N1流感的流行病学史、临床表现、实验室指标、治疗及转归进行回顾性总结分析.结果　多数患儿有流感患者接触史,症状以发热(高热为主)、咳嗽及咽痛为主.实验窜检查:全部患儿ALT、肾功能及血钾均正常,部分患儿CK、LDH及α-...     

1-Naphthyl isocyanate and 1-naphthylamine as metabolites of 1-naphthylisothiocyanate

Abstract: The importance of the bioactivation of 1-naphthylisothiocyanate was studied. Forty minutes after 1-naphthylisothiocyanate administration to rats, bile was collected over a 2.5-h period; the liver was then excised and homogenized. 1-naphthylisothiocyanate and its metabolites in bile and liver of rats were identified and quantified using coupled gas chromatography-mass spectrometry. Three main compounds were found in all 1-naphthylisothiocyanate-treated animals. They were identified as 1-naphthyl isocyanate, 1-naphthylamine and the parent compound, 1-naphthylisothiocyanate. When rats were given cycloheximide, which attenuates 1-naphthylisothiocyanate toxicity, 30 min before 1-naphthylisothiocyanate (300 mg/kg), 1-naphthyl isocyanate concentration was significantly lower than in rats receiving only 1-naphthylisothiocyanate. The appearance of 1-naphthylamine was also inhibited by cycloheximide, although not to the same extent as 1-naphthyl isocyanate. On the other hand, phenobarbital, which potentiates 1-naphthylisothiocyanate hepatotoxicity, enhanced 1-naphthyl isocyanate and 1-naphthylamine formation. It is suggested that 1-naphthyl isocyanate, 1-naphthylamine and the highly reactive sulfur released from 1-naphthylisothiocyanate might be involved in the hepatotoxic effect of 1-naphthylisothiocyanate.     

Cytochrome 1A1 and 1B1 gene diversity in the Zanzibar islands

Amodiaquine (AQ) is a 4‐aminoquinoline widely used in the treatment of malaria as part of the artemisinin combination therapy (ACT). AQ is metabolised towards its main metabolite desethylamodiaquine mainly by cytochrome P450 2C8 (CYP2C8). CYP1A1 and CYP1B1 play a minor role in the metabolism but they seem to be significantly involved in the formation of the short‐lived quinine‐imine. To complete the genetic variation picture of the main genes involved in AQ metabolism in the Zanzibar population, previously characterised for CYP2C8, we analysed in this study CYP1A1 and CYP1B1 main genetic polymorphisms. The results obtained show a low frequency of the CYP1A1*2B/C allele (2.4%) and a high frequency of CYP1B1*6 (approximately 42%) followed by CYP1B1*2 (approximately 27%) in Zanzibar islands. Genotype data for CYP1A1 and CYP1B1 show a low incidence of fast metabolisers, revealing a relatively safe genetic background in Zanzibar’s population regarding the appearance of adverse effects.     

Genetic link with cholelithiasis among pediatric SCA Tunisian patients: Examples of UGT1A1, SLCO1A2 and SLCO1B1

Aims and background: Hyperbilirubinemia is often observed in chronic hemolysis and results in the formation of pigment cholelithiasis that could be increased by the presence of defected enzymes involved in the bilirubin metabolism. Indeed, this is the first report that interested in the study of polymorphisms in genes encoded for enzymes involved in the bilirubin metabolism: rs 4149056 of SLCO1B1 and rs4149000 of SLCO1A2 in combination with rs8175347 and rs887829 of UGT1A1 in order to find a correlation between the polymorphisms studied and the presence of gallstones in a population of sickle cell anemia (SCA) pediatric Tunisians.

Material and methods: Our study involved 102 unrelated Tunisian subjects. All SCA patients are children (less than 16 years old) and were characterized by hyperbilirubinemia and 52 of them have cholelithiasis. The polymorphisms of the candidate genes were analyzed for all subjects by PCR/sequencing. Genotype and allele frequencies between cases and controls were compared using Pearson's chi-square test with a significance threshold of P?<?0.05 (compare 2, version 1.02).

Results: The novelty of this report is that children carrying the combined genotype of the rs studied: (TA7TA7)/TT/TC/GA have a higher risk to develop gallstones (P?=?0.0027, RR?=?18.27 (20.0061–915.28)).

Conclusion: Altogether our data provide the implication of UGT1A1 and SLCO1A2 in sickle cell anemia-related cholelithiasis.     

PD-1/PD-L1抑制途径与自身免疫性糖尿病

PD-1(CD279)是一种负性协同刺激分子,属于CD28超家族成员,呈诱导性表达于活化的T、B和自然杀伤细胞表面.PD-L1(B7-H1,CD274)和PD-L2(B7-DC,CD273)是PD-1的两个配体.PD-1和PD-L1相互作用可以使活化的自身反应性T细胞获得负性信号,抑制其对自身抗原持续的免疫应答.若PD...     

Pandemic H1N1 influenza

The 2009 H1N1 influenza A virus that has targeted not only those with chronic medical illness, the very young and old, but also a large segment of the patient population that has previously been afforded relative protection - those who are young, generally healthy, and immune naive. The illness is mild in most, but results in hospitalization and severe ARDS in an important minority. Among those who become critically ill, 20-40% will die, predominantly of severe hypoxic respiratory failure. However, and potentially in part due to the young age of those affected, intensive care with aggressive oxygenation support will allow most people to recover. The volume of patients infected and with critical illness placed substantial strain on the capacity of the health care system and critical care most specifically. Despite this, the 2009 pandemic has engaged our specialty and highlighted its importance like no other. Thus far, the national and global critical care response has been brisk, collaborative and helpful - not only for this pandemic, but for subsequent challenges in years ahead.     

甲型H1N1流感合并肺炎的临床特点分析

目的通过对甲型H1N1流感合并肺炎的临床特点的分析。方法分析2009年月10月-2010年3月在我院入住的29例甲型H1N1流感合并肺炎患者的临床表现、实验室检查及胸部CT等资料。结果本组病例男性16例,女性13例。3例妊娠,13例合并有基础疾病。所有病例均有流感样前驱症状,呼吸道主要症状为发热、干咳少痰,严重者气短、呼吸困难、咯血。合并细菌感染时咯脓痰。肺部听诊无啰音或少啰音,合并哮喘时有哮鸣音,合并细菌感染时可有湿啰音。实验室检查65%白细胞不高或降低,41%心肌酶升高,58.6%存在低氧血症,35%呼吸衰竭。影像学表现多种多样：65.5%主要为单侧或双侧棉团样、团片样边界模糊高密度渗出影伴肺实变,其内见充气支气管征,病变沿支气管血管束分布。轻症及早期较局限,重症者及晚期病变融合呈双肺多发弥漫性改变。少数呈大叶及小叶性肺炎表现。预后大多良好,病死率6.9%。主要死亡原因为呼吸衰竭及大咯血。结论甲型H1N1流感合并肺炎是以甲型H1N1流感病毒肺炎为主要疾病的多种肺炎构成。甲型H1N1流感病毒肺炎临床表现具有流感病毒肺炎共性特点,其影像学表现有一定特征性。     

甲型H1N1与季节性H1N1流感病毒血凝素基因比较分析

目的分析泰安市2008～2009年度季节性流感与2009年度甲型H1N1流感病原学检测结果 ,比较季节性H1N1与甲型H1N1血凝素基因变异情况。方法选择国家级流感监测哨点医院以及暴发疫情的疫点,采集流感样病例的鼻咽拭子标本,通过RealtimePCR进行病毒检测,用MDCK细胞进行病毒分离,通过RT-PCR扩增血凝素HA1片段的基因并测序,利用生物信息学进行序列分析。结果 2008～2009年共检测鼻咽拭子标本283份,分离出流感病毒33株,分离阳性率为11.67%,其中季节性H1N1亚型31株。2009年5月1日～12月31日,检测鼻咽拭子标本996份,流感核酸检测阳性417份,阳性率为41.86%,其中甲型H1N1337份,季节性H1N1亚型1份。6株季节性H1N1病毒均在多个氨基酸位点上发生变异,与疫苗株A/Brisbane/59/2007(H1N1)比较,有11个位点发生了突变,其中5个位点位于抗原决定簇上;测序成功的6株甲型H1N1病毒在多个氨基酸位点发生变异,与疫苗株A/California/07/2009(H1N1)比较,有6个位点发生突变,其中1个位点位于抗原决定簇的B区。结论 2008～2009年度季节性H1N1为优势株,甲流暴发后,甲型H1N1成为绝对优势毒株。季节性H1N1分离株有多处氨基酸替换,抗原决定簇B区变异频繁;甲型H1N1病毒分离株的基因有变异,但关键位点第222位仍为D(天冬氨酸),与疫苗株相比抗原决定簇的关键位点变化不大。     

Role of CYP2D6, CYP1A1, CYP2E1, GSTT1, and GSTM1 genes in the susceptibility to acute leukemias

Acute leukemias (ALs) are heterogeneous diseases. Functional polymorphisms in the genes encoding detoxification enzymes cause inter-individual differences, which contribute to leukemia susceptibility. The CYP2D6, CYP1A1, CYP2E1, GSTT1, and GSTM1 polymorphisms in ALL (n = 156) and AML (n = 94) patients and 140 healthy controls were genotyped by PCR and/or PCR-RFLP using blood or bone marrow samples. No association was observed between the GSTT1 gene deletion and patients (OR = 0.8, 95% CI = 0.4-1.7 for AMLs and OR = 0.9, 95% CI = 0.5-1.6 for ALLs). Patients with ALL and AML had a higher prevalence of the GSTM1 deletions compared to controls but only the difference among adult AML patients (OR = 2.1, 95% CI = 1.0-4.2) was statistically significant. The CYP2D6*3 variant allele frequency was lower in the overall acute leukemia patients (0.6%) compared to controls (P = 0.03). CYP2D6*1/*3 genotype frequency also showed a protective association in AML patients (OR = 0.09, 95% CI = 0.01-1.7; P = 0.04). We also found a risk association for CYP2E1*5 in ALL and AML (OR = 3.6, 95% CI = 1.4-9.4 and OR = 3.9, 95% CI = 1.4-10.5, respectively). No association was found for the studied CYP2D6*4, CYP1A1*2A, and GSTT1"null" variants and the risk of acute leuke-mia (ALL or AML). This case-control study suggests a contribution of CYP2E1, CYP2D6, and GSTM1 "null" variants to the development of acute leukemias.