T淋巴细胞亚群和DNA倍体检测在腹水鉴别诊断中的价值

目的:探讨T淋巴细胞亚群和DNA倍体检测在腹水鉴别诊断中的价值.方法:腹水患者74例,其中结核性腹膜炎24例,肝硬化21例,癌性腹水29例,流式细胞仪测定腹水T淋巴细胞亚群和DNA倍体.结果:腹水中T淋巴细胞(CD3~ )、T辅助/诱导细胞亚群(CD4~ )、T辅助细胞亚群/T抑制细胞亚群(CD4~ /CD8~ )所占比例从大到小依次为结核性腹膜炎(CD3~ :86.2%±5.1%,CD4~ :64_3%±6.4%,CD4~ /CD8~ :3.20%±0.30%)、癌性腹水(65.7%±4.6%,32.5%±2.2%,1.04%±0.11%)、肝硬化腹水(15.1%±2.7%,3.6%±0.5%,0.36%±0.05%)(三组间P<0.01),CD8~ 比例从小到大依次为肝硬化腹水(10.1%±3.2%)、结核性腹膜炎(20.1%±4.3%)、癌性腹水(31.3%±5.2%)(三组间P<0.01).腹水DNA倍体阳性率癌性腹水达89.7%(26/29),与结核性腹膜炎4.2%(1/24)和肝硬化4.7%(1/21)具有显著性差异(P<0.01).结论:T淋巴细胞亚群和DNA倍体在结核性腹膜炎、肝硬化及癌性腹水存在显著差异,其检测可用于腹水的鉴别诊断.     

脾栓塞对肝硬化患者外周血T淋巴细胞亚群的影响

目的 :研究部分脾栓塞治疗脾功能亢进对肝硬化患者T淋巴细胞亚群的影响。方法 :57例肝硬化并脾功能亢进患者 ,32例采用部分脾栓塞治疗 ,2 5例采用脾全切治疗 ,1 5例正常人作为对照 ,比较两组治疗前后外周血T淋巴细胞亚群的变化。结果 :肝硬化患者外周血T淋巴细胞 (CD3+ )、T辅助 /诱导淋巴细胞亚群 (CD4+ )、T辅助淋巴细胞 /T抑制淋巴细胞亚群 (CD4+ /CD8+ )明显低于正常人 (P <0 .0 1 ) ;脾栓塞组治疗前后CD3+ 、CD4+ 、CD8+ 、CD4+ /CD8+ 无明显差异 (P >0 .0 5) ;脾全切组治疗后CD3+ 、CD4+ 、CD4+ /CD8+ 均较治疗前及部分脾栓塞组治疗后明显降低 (P <0 .0 1 )。结论 :肝硬化患者外周血CD3+ 、CD4+ 、CD4+ /CD8+ 降低 ,部分脾栓塞治疗脾功能亢进 ,对肝硬化患者外周血T淋巴细胞亚群无明显影响 ,显著优于脾全切治疗     

肝硬化患者外周血及腹水T淋巴细胞亚群的变化及意义

目的研究肝硬化患者外周血及腹水T淋巴细胞亚群的变化及意义。方法流式细胞仪测定31例肝炎后肝硬化患者外周血及腹水T淋巴细胞亚群，同时检测15例正常人的外周血T淋巴细胞亚群。结果肝硬化患者外周血T淋巴细胞（CD3^＋）、T辅助／诱导细胞亚群（CD4^＋）、T辅助淋巴细胞／T抑制淋巴细胞亚群（CD4^＋／CD8^＋）较正常对照明显降低（p＜0．01），腹水CD3^＋、CIM^＋、CD8^＋、CD4^＋／CD8^＋较外周血显著降低（P＜0．001）。结论肝硬化患者外周血及腹水T淋巴细胞亚群存在明显异常，表现为全身及腹膜腔局部的免疫力低下。     

细胞间粘附分子-1和P-选择素的检测在炎性腹水和非炎性腹水鉴别诊断中的价值

目的　通过检测肿瘤性腹水、结核性腹水和肝硬化腹水患者的细胞间粘附分子 1(I CAM 1)和P$C选择素 (P selection)水平 ,探讨其鉴别炎性和非炎性腹水的意义。方法　采用酶联免疫吸附法 (ELISA)检测 2 9例肿瘤性腹水、2 0例结核性腹膜炎腹水和 13例肝硬化性腹水患者腹水的ICAM 1和P 选择素水平。结果　肿瘤性腹水ICAM 1水平为 (63 .5 4± 3 7.68)ng/L ,结核性腹水水平为 (12 3 .85± 41.85 )ng/L ,肝硬化腹水水平为 (3 5 .95± 11.5 0 )ng/L ,肿瘤性腹水P 选择素水平为 (3 .0 3± 1.2 6)ng/L ,结核性腹水水平为 (4 .2 6± 1.63 )ng/L ,肝硬化腹水水平为 (2 .72±1.49)ng/L。结核性腹水患者ICAM 1和P 选择素水平明显高于肿瘤性腹水 (P <0 .0 5 )和肝硬化性腹水 ,两者水平在肿瘤性腹水和肝硬化腹水之间的差异无显著性 (P >0 .0 5 )。结论　ICAM 1和P 选择素的表达与机体炎症反应被激活有关 ,结核性腹膜炎患者腹水中ICAM 1和P 选择素水平明显增高 ,检测腹水中ICAM 1和P 选择素的水平对鉴别炎性和非炎性腹水有帮助     

原发性胆汁性肝硬化外周血T细胞亚群及细胞因子的检测

目的　探讨中国人原发性胆汁性肝硬化患者的T细胞亚群及细胞因子存在状况及意义。方法　选未经特殊治疗的原发性胆汁性肝硬化 (PBC) 2 5例 ,性别、年龄匹配的健康人 2 0例作为对照组。以双抗体夹心ELISA法检测外周血细胞因子IL_2、IFN_γ、IL_4、IL_10、TNF_α水平。以S_P法检测外周血T淋巴细胞亚群。结果　与对照组比较 ,PBC患者CD+ 4 T细胞升高 ,CD+ 8T细胞下降 ,CD+ 4 /CD+ 8比值上升 (P <0 0 1)。PBC组IL_2、IFN_γ、TNF_α明显升高 (P <0 0 1) ,IL_10轻度上升 (P <0 0 5 ) ,IL_4水平与对照组比较无差异 (P >0 0 5 )。结论　PBC外周血CD+ 4 T细胞和Th1细胞因子占优势 ,提示其在PBC发病机制中发挥重要作     

原发性胆汁性肝硬化T淋巴细胞亚群分析

目的 探讨原发性胆汁性肝硬化(PBC)患者的T淋巴细胞亚群及共刺激信号表达的特点及临床意义.方法 以未经治疗的98例PBC患者为研究组,性别、年龄匹配的健康人30名作为对照组.以流式细胞仪技术检测外周血淋巴细胞亚群以及T淋巴细胞表面的共刺激信号CD28.结果 PBC与对照组T细胞亚群差异有统计学意义:PBC组CD4+T淋巴细胞升高,CD8+T淋巴细胞下降,CD4+/CD8+比值上升(P<0.05);CD4+CD28-T细胞和CD8+CD28-T细胞明显增加(P<0.05).结论 PBC存在免疫调节功能的异常,其中CD28的表达明显减少;CD8+CD28-的细胞群可能在PBC中有一定的免疫调节作用.     

腺苷脱氨酶测定对结核性腹水的诊断价值

结核性腹膜炎是腹水的常见原因之一,临床上切盼有高敏感高特异而简单的筛检方法。腺苷脱氨酶(ADA)是嘌呤碱分解酶,将腺苷分解转化为肌苷,其活性在T淋巴细胞中较B淋巴细胞中更强,并与T细胞分化程度成反比。ADA值的增高取决于T细胞对分枝杆菌抗原的细胞介导免疫反应的成熟状态及其受刺激的程度。ADA测定在诊断结核性胸膜心包腔积液及结核性脑膜炎的价值早已肯定,本研究以测定ADA来评价其在诊断结核性腹水中的作用。作者测定了49例病人腹水ADA值,49例分为三级:A组19例,经腹腔镜、病理或细菌检查证实为结核性腹水;B组20例。病理或超声波检查证实为肝硬化(3例为酒精性肝硬化,17例为肝炎后肝硬化);C组10例,腹水细胞学检查证实为恶性腹水。结果,结核性腹水、肝硬化腹水和恶性腹水三组测     

肝硬化合并自发性细菌性腹膜炎患者外周血和腹水CD100水平和免疫调节作用

目的观察肝硬化合并自发性细菌性腹膜炎(SBP)患者外周血和腹水中CD100水平, 并在体外检测CD100对腹水中CD4+和CD8+T淋巴细胞活性的影响。方法入组肝硬化患者77例(肝硬化合并单纯腹水患者49例、肝硬化合并SBP患者28例), 采集外周血和腹水, 入组22例对照者采集外周血。酶联免疫吸附试验检测外周血和腹水中可溶型CD100(sCD100), 流式细胞术检测CD4+和CD8+T淋巴细胞表面膜结合型CD100(mCD100)。分选腹水中CD4+和CD8+T淋巴细胞, CD100刺激后检测CD4+T淋巴细胞增殖、关键转录因子mRNA和分泌细胞因子变化, 检测CD8+T淋巴细胞增殖、重要毒性分子mRNA和分泌细胞因子变化, 利用直接接触和间接接触培养系统检测CD8+T细胞的杀伤活性。符合正态分布的数据使用单因素方差分析、Studentt检验或配对t检验进行比较。不符合正态分布的数据使用Krusal-Willis检验或Mann-Whitney检验进行比较。结果血浆sCD100水平在肝硬化合并单纯腹水患者(1 415.0±434.1)pg/ml、肝硬化合并SBP患者(1 465.0±...     

结核性和癌性胸腔积液中白细胞介素-16的测定及其意义

目的通过检测结核性和癌性胸腔积液中IL-16水平,探讨其与T淋巴细胞亚群之间的关系。方法收集62例胸腔积液（32例结核性和30例癌性）患者的胸腔积液与静脉血,ELISA测胸腔积液上清液及血清中IL-16水平;流式细胞仪测胸腔积液中T淋巴细胞亚群;行胸腔积液中细胞计数及分类。结果62例胸腔积液者,胸腔积液中IL-16水平高于其血清水平。结核性胸腔积液中IL-16水平高于癌性胸腔积液中IL-16水平。胸腔积液中IL-16水平与淋巴细胞总数、T细胞数及CD4^＋细胞数呈正相关（r分别为0．526、0．638、0．701,P值均小于0．001）。结论与癌性胸腔积液相比,结核性胸腔积液中IL-16水平高,IL-16有可能在CD4^＋ T细胞浸润到胸腔的过程中具有重要的趋化作用。     

淋巴细胞亚群检测在小儿哮喘诊断中的临床价值

目的分析淋巴细胞亚群检测在小儿哮喘诊断中的临床意义。方法选取2018年1月至2019年10月徐州市儿童医院健康体检的小儿50名为健康对照组,哮喘小儿107例为病例观察组进行回顾性分析。病例观察组根据临床症状及病史问询结果分为急性发作组(共44例)和持续发作组(共63例)。分析3组小儿在T细胞亚群细胞(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)水平的差异。结果 3组小儿T淋巴细胞亚群CD3⁺、CD4⁺、CD4⁺/CD8⁺比较,急性发作组和持续发作组均低于健康对照组,且持续发作组低于急性发作组(P值均<0.05);3组小儿T淋巴细胞亚群CD8⁺比较,急性发作组和持续发作组均高于健康对照组,且持续发作组高于急性发作组(F=7.019,P值均<0.05)。结论与健康小儿比较,哮喘小儿的T淋巴细胞亚群表达存在差异,且持续性哮喘小儿的T淋巴细胞亚群表达差异更为显著,淋巴细胞亚群检测在小儿哮喘诊断中有一定的临床意义,尤其在反复持续性小儿哮喘临床诊断中的效果更佳。     

端粒酶活性检测在良恶性腹水鉴别诊断中的价值

目的　检测腹水脱落细胞端粒酶活性,为临床鉴别诊断提供依据。方法　收集各种类型腹水脱落细胞,用ＴＲＡＰＰＣＲＥＬＩＳＡ 银染法检测腹水脱落细胞端粒酶活性。结果　肝硬化、结核性腹膜炎腹水脱落细胞不能检出端粒酶活性,而癌性腹水８５．２９％ 端粒酶阳性。结论　癌性腹水端粒酶阳性。端粒酶活性检测可作为临床良恶性腹水鉴别诊断依据之一。     

The value of ADA in peritoneal tuberculosis]

The aim of this study was to confirm that ascitic fluid determination of adenosine deaminase activity (ADA) is useful for the diagnosis of tuberculous peritonitis. 109 patients with ascites have been studied; 4 had tuberculous peritonitis and 105 nontuberculous ascites. The mean value of ascitic fluid AQDA was 0.587 +/- 0.2 uKat/l in tuberculous peritonitis and 0.11 +/- 0.1 uKat/l in nontuberculous ascites (p less than 0.001). An ADA value upper than 0.40 uKat/l has a sensitivity of 100% and a specificity of 99% for diagnosing tuberculous peritonitis. Ascitic fluid determination of ADA is simple, cheap and has a good diagnostic accuracy. In countries with high incidence of tuberculosis, measurement of ADA in ascitic fluid should be used as screening test for tuberculosis.     

Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels

Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of greater than 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of greater than 0.6, and an ascitic fluid-serum protein ratio of greater than 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 +/- 49/cu mm) in chronic liver disease.     

Ascites Adenosine Deaminase Activity is Decreased in Tuberculous Ascites with Low Protein Content

The value of adenosine deaminase activity (ADA) in ascitic fluid was examined in 12 patients with confirmed peritoneal tuberculosis and compared with that of 96 patients with ascites of other different etiologies as an age-matched control group, to determine the diagnostic value of the ADA activity in tuberculous ascites. The mean adenosine deaminase activity (ADA) value in ascitic fluid of the tuberculous peritonitis group was 47.9 +/- 21.9 IU/L and in the control group 9.6 +/- 5 U/L (mean +/- SD); p less than 0.01. A different method than that usually reported in tuberculous peritonitis was used for ascites ADA estimation. The best sensitivity and specificity was obtained when greater than 32 U/L was used as a cutoff point. The ascites ADA activity correlated with the ascites total protein concentration in the tuberculosis group (r = 0.842). Our findings confirm other results and support the ADA activity determination in ascitic fluid as a useful noninvasive screening test in the diagnosis of peritoneal tuberculosis in endemic areas or in high risk patients. However, false-negative results may occur in those patients in which ascites total protein concentration is low.     

上皮细胞钙粘蛋白与β-连环蛋白在恶性腹水鉴别诊断中的价值

目的通过检测不同病因腹水中上皮细胞钙粘蛋白（E—cadherin）和β-连环蛋白（β-catenin）的含量,探讨其在鉴别良、恶性腹水性质中的意义。方法收集41例来自临床上已确诊患者的腹水标本,分为结核组（5例）、肝硬化组（11例）和恶性肿瘤组（25例）3组,采用酶联免疫吸附法（ELISA）检测E—cadherin和β—catenin的含量。结果结核性腹水E—cadherin水平为（7．57±0．48）ng／L,肝硬化腹水水平为（8．18±0．81）ng／L,恶性腹水水平为（9．35±1．84）ng／L。结核性腹水β-catenin水平为（0．76±0．13）ng／L,肝硬化腹水为（0．93±0．06）ng／L,恶性腹水为（1．67±1．16）ng／L。恶性腹水E—cadherin和β-catenin水平明显高于结核性腹水和肝硬化性腹水（P〈0．05）,两者水平在结核性腹水和肝硬化腹水之间比较差异无显著性（P〉0．05）。相关分析表明E—cadherin和β—catenin的表达具有正相关性（P〈0.01,r=0．479）。结论E-cadherin和β-catenin与肿瘤的浸润和转移有关,恶性腹水中两者的水平显著增高。E—cadherin和β—catenin对良、恶性腹水鉴别诊断有重要价值。     

Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients

Tuberculous peritonitis is a rare disease, which often goes unrecognized because of the subtle clinical clues and its insidous onset. We retrospectively analyzed the records of 37 cases of tuberculous peritonitis diagnosed over a 15-year period, and compared the clinical and diagnostic features of cirrhotic and noncirrhotic patients. In cirrhotic patients, tuberculous peritonitis can simulate ascites from liver disease or spontaneous bacterial peritonitis. The diagnosis is difficult in these patients because the ascitic fluid may not be of the exudative type as a result of the low albumin level in serum, and lymphocytes do not predominate in all cases. Adenosine deaminase (ADA) activity in ascitic fluid was elevated (higher than 40 U/L) in all 11 patients (four patients with hepatic cirrhosis). The time required to achieve a correct diagnosis was significantly longer in cirrhotic than in noncirrhotic patients. The overall mortality was 13%, with deaths occurring exclusively among cirrhotic patients. We emphasize that tuberculous peritonitis in cirrhotic patients can present an atypical picture. A considerable element of suspicion is necessary.     

Adenosine deaminase (ADA) in peritoneal tuberculosis: diagnostic value in ascitic fluid and serum

Simultaneous determination of ascitic fluid and serum adenosine deaminase (ADA) activity was evaluated as a diagnostic aid in peritoneal tuberculosis. The ascites was due to peritoneal tuberculosis (group 1), cirrhosis of the liver (group 2), cirrhosis of the liver with spontaneous bacterial peritonitis (group 3), peritoneal malignancy (group 4), Budd-Chiari Syndrome (group 5) and miscellaneous conditions (group 6). Serum from patients of pulmonary tuberculosis and healthy volunteers was analysed for enzyme activity. In patients with peritoneal tuberculosis the ascitic fluid and serum ADA activity was significantly higher than for the other groups (P less than 0.001). Levels above 36 u/l in ascitic fluid and above 54 u/l in the serum suggest tuberculosis. The ascitic fluid/serum ADA ratio was also higher in patients with peritoneal tuberculosis than with other causes of ascites (P less than 0.01). A ratio of more than 0.984 was suggestive of tuberculosis.     

Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis

The analysis of ascitic fluid has been complicated by several recently reported new tests. To simplify this assessment, we evaluated nine parameters prospectively and simultaneously in blood and ascitic fluid from 285 patients with ascites to determine which were the most reliable for immediate diagnosis of the etiology of the ascites and of its complications. Subjects were first divided into four groups: sterile cirrhotic ascites (n = 201), spontaneous bacterial peritonitis (n = 41), malignant ascites (n = 34), and miscellaneous ascites (n = 9). An ascitic fluid polymorphonuclear count greater than 500/microliters was the test with the greatest accuracy (96%) for the diagnosis of spontaneous bacterial peritonitis. Neither the most precise cutoff values for ascitic fluid pH (less than 7.32) and ascitic fluid lactate (greater than 32 mg/dl), nor their respective blood-ascitic fluid gradients (greater than 0.11 and less than -20 mg/dl) were more reliable indexes of spontaneous bacterial peritonitis, mainly due to the decreased ascitic fluid pH and increased ascitic fluid lactate observed in malignant ascites, tuberculous peritonitis, and pancreatic ascites. A blood-ascitic fluid albumin gradient less than 1.1 g/dl was the most accurate parameter for the diagnosis of malignant ascites (diagnostic efficacy, 93%). Therefore, the etiologic analysis of ascitic fluid might be simplified and the single practice of two tests, ascitic fluid polymorphonuclear cell count and blood-ascitic fluid albumin gradient, provides immediately useful information.