肝功能异常患者中自身抗体及自身免疫性肝病的检测

目的 自身免疫性肝病临床流行病学调查,观察在肝功能异常患者中自身抗体检测的阳性率、自身免疫性肝病检出率及临床意义。方法 连续收集就诊病例中肝功能异常患者丙氨酸氨基转移酶(ALT)大于40 U/L血清511份,分别进行相关自身抗体(ANA)检测,并查阅临床资料。结果 511份血清检测出ANA阳性率为14.09％,抗平滑肌抗体(SMA)阳性率0,59％,抗线粒体抗体(AMA)阳性率2.94％,抗线粒体抗体亚型-丙酮酸脱氢酶复合物(AMA-M2)阳性率0.98％;ANA谱中的SS-A阳性率0.59％、SS-B阳性率0.20％、JO-1阳性率0.20％,dsDNA阳性率0.78％;未检出抗肝肾微粒体抗体(LKM-1)、可溶性肝抗原/肝胰抗原(SLA/LP)、抗肝细胞溶质抗原1型抗体(LC-1)及ANA谱中其他抗体。从ALT升高的患者中收集到的511份血清,可查到完整临床资料者共469例。原发性胆汁性肝硬化(PBC)及自身免疫性肝炎(AIH)患者检出率分别为1.06％及0.43％,未检出原发性硬化性胆管炎患者。自身抗体阳性患者77.78％诊断为病毒性肝炎及相关疾病。病毒性肝炎及相关疾病中自身抗体阳性率为18.29％。结论 高滴度(>1:320)自身抗体对自身免疫性肝病诊断有意义。PBC及AIH患者检出率近似丙型及戊型肝炎检出率,临床不能忽视,病毒性肝炎及相关疾病中可检测出自身抗体。     

自身免疫肝病抗体谱检测的临床意义

目的通过自身免疫肝病抗体谱的检测,为临床对自身免疫性肝炎（AIH）的诊断及治疗提供一项科学依据。方法采用线性免疫（Liver-lia）分析法对肝功能异常患者进行血清自身免疫肝病抗体谱检测。结果本研究共检测955例患者,其中有一项或多项自身抗体阳性的患者共112例,自身抗体阳性检出率为11.7%;抗线粒体（AMAM2）抗体、抗-SP100抗体、抗-gp210抗体在原发性胆汁性肝硬化（PBC）及隐源性肝炎患者中检出率显著高于其他各类型肝炎（P〈0.05）,抗肝肾微粒体1（LKM-1）抗体在酒精性肝炎患者中检出率显著高于其他各类型肝炎（P〈0.05）。结论自身免疫肝病抗体谱检测,有利于临床对Ⅰ～Ⅲ型AIH的诊断及鉴别诊断,尤其对隐源性肝炎患者确诊为PBC及AIH提供了科学依据。     

药物性肝损害伴自身抗体阳性患者临床特征及转归

随着自身抗体检测技术的提高及临床医帅对自身免疫性肝病认识程度的不断提高,肝功能异常伴自身抗体阳性特别是高滴度自身抗体阳性患者的诊断、鉴别诊断及治疗问题越来越受到临床医师的关注,因为自身抗体阳性虽是诊断自身免疫性肝病的主要条件之一,但在部分病毒性肝炎、药物性肝损害、酒精性及非酒精性脂肪性肝炎中也均可检测到自身抗体,特别是非特异性自身抗体,如抗核抗体、抗线粒体抗体及抗平滑肌抗体等,是一种疾病伴随自身免疫现象还是两种疾病共同存在,如何诊断及鉴别诊断,有时成为摆在临床医师面前较棘手的问题,也是临床亟待解决的问题,此节主要讨论药物性肝损害患者检测出自身抗体时如何诊断及治疗,是药物诱导了自身免疫样肝炎还是药物伴随自身免疫现象?如何与自身免疫性肝炎鉴别?因自身免疫性肝炎治疗需较长期应用激素及免疫抑制剂,而非自身免疫性肝炎患者短期应用或不应用上述治疗.如上述诊断及鉴别诊断不全面,使治疗不得当,会加重或延误病情,给患者带来痛苦.     

西南地区三种自身免疫性肝病的临床特点分析

目的：分析西南地区各型自身免疫性肝病的临床特点,以期提高早期诊断率。方法回顾性分析比较第三军医大学西南医院收治的436例自身免疫性肝病患者的一般资料、临床表现、血清生化学、自身抗体、肝组织病理等指标的差异,其中包括自身免疫性肝炎（AIH）211例,原发性胆汁性肝硬化（PBC）145例,自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征（OS）80例。结果患者平均发病年龄为49．7岁,男女比为1∶6;各组临床表现无显著差异;各组 ALT、GGT、TBil等血清学指标差异有统计学意义（P＜0．05）;AIH 组血清自身抗体以ANA（＋）为主,PBC 组中以AMA（＋）、AMA-M2（＋）为主,OS组兼有AIH 及PBC自身抗体的特点;各组肝组织病理主要表现为肝细胞变性、坏死、炎细胞浸润、小胆管炎症及纤维增生。结论在我国西南地区AIH、PBC、OS多为50岁左右的围绝经期女性。综合分析临床表现、血清生化学指标、免疫球蛋白亚型、自身抗体等指标有助于确诊不同类型的自身免疫性肝病,肝活组织检查为重要的辅助诊断手段。     

自身抗体在自身免疫性肝病中的预测价值

自身抗体作为自身免疫性肝病的诊断标志物已经在临床上得到了广泛应用,但其在病情严重程度及预后判断方面的价值报道并不多,事实上某些自身抗体除本身的诊断价值外,还具有预测病情的作用：如抗可溶性肝抗原抗体、抗肌动蛋白抗体、抗肝细胞溶质抗原Ⅰ型抗体、抗去唾液酸糖蛋白受体抗体、抗染色体抗体、抗环瓜氨酸多肽抗体和抗肝肾微粒体Ⅲ型抗体与自身免疫性肝炎的发生、发展及恶化有一定的相关性,其中抗可溶性肝抗原抗体与某些自身免疫性肝炎患者严重肝组织学改变、长期维持治疗、停药后再度恶化以及肝衰竭的发生相关;抗gp210抗体、抗Sp100抗体和抗着丝点抗体在原发性胆汁性肝硬化中有一定的预测意义,其中抗gp210抗体可提示原发性胆汁性肝硬化患者有较严重的界面性肝炎、小叶炎症以及易进展为肝衰竭等。     

自身抗体与Ⅰ型自身免疫性肝炎关系的研究进展

自身免疫性肝炎是由于自身耐受破坏后肝内发生自身免疫反应引起的持续性肝细胞损害,是一种进行性的炎性反应性肝病,以高球蛋白血症、循环高血清自身抗体和门脉区碎屑样坏死为特征。在实验室检查中,除了常规的病毒学指标、肝脏酶学检查、血清蛋白定量、血清蛋白电泳外,自身抗体的检查具有重要的诊断和鉴别诊断意义。此文就一系列自身抗体与Ⅰ型自身免疫性肝炎相关性进行综述。     

抗核抗体及肝组织病理对男性自身免疫性肝病患者的诊断意义分析

目的探讨抗核抗体(ANA)对于诊断男性自身免疫性肝病的意义及肝组织病理在自身免疫性肝病检查中的作用。方法选取2016年12月-2018年6月于南京市第二医院就诊的不明原因肝病男性患者84例,其中ANA阳性36例,阴性48例。将2组患者的肝组织病理、实验室检查及诊断情况进行对比分析。正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;偏态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验,进一步两两比较采用Nemenyi检验。计数资料组间比较采用χ~2检验。结果 ANA阳性组中,自身免疫性肝炎5例,重叠综合征1例; ANA阴性组中自身免疫性肝炎5例,重叠综合征5例。2组确诊自身免疫性肝病的比例差异无统计学意义(16. 7%vs 20. 8%,χ~2=0. 23,P 0. 05)。将所有患者分为自身免疫性肝炎组(n=10)、重叠综合征组(n=6)、药物性肝损伤组(n=17)及其他组(n=51),4组间IgG、球蛋白水平比较,差异均有统计学意义(F值分别为2. 977、6. 972,P值均0. 05)。10例自身免疫性肝炎患者均可见界面性肝炎; ANA阳性组淋巴-浆细胞浸润出现4例,ANA阴性组3例; ANA阳性组与阴性组肝细胞玫瑰花环样改变各2例;有2例患者可见淋巴细胞穿入; 1例患者见多核巨肝细胞。6例重叠综合征患者主要病理学表现为中-重度界面性肝炎或碎屑样坏死及门静脉区域的炎性浸润,其中2例存在肝细胞玫瑰花环样改变,2例表现为小叶间胆管损伤,胆管周围淋巴细胞浸润/肉芽肿形成,继发肝纤维化。结论对于不明原因肝病男性人群,ANA是否阳性对自身免疫性肝病(自身免疫性肝炎和重叠综合征)的诊断意义不大,应结合肝组织病理学检查结果综合分析,以提高确诊率。     

自身免疫性肝病20例临床特点分析

目的　比较自身免疫性肝炎 (AIH)、原发性胆汁性肝硬化 (PBC)和原发性硬化性胆管炎 (PSC)的临床特点 ,以利于临床早期鉴别诊断。方法　分析我院 1998～ 2 0 0 1年 2 0例自身免疫性肝病 (AIH 9例 ,PBC 10例 ,PSC 1例 )的临床资料 ,并对其肝功能特点及自身抗体进行比较。结果　 2 0例患者中 ,男女之比为 2∶18,平均年龄 (5 4.7± 11.0 )岁。AIH与PBC患者各项指标比较 ,PBC肝功能异常以碱性磷酸酶升高为特点 ,其余指标比较差异无显著性 ;AIH免疫学指标以γ 球蛋白、主要是免疫球蛋白IgG升高为特点 ,而PBC以γ 球蛋白、主要是IgM升高为特点 ;AIH循环自身抗体以抗核抗体、抗平滑肌抗体为主 ,而PBC患者以抗线粒体抗体及其分型M2 为主。结论　AIH及PBC临床表现、肝功能检查有许多相似之处 ,但仍然有其各自特异的临床诊断依据     

Clinical analysis in 208 patients with autoimmune liver disease

目的 分析自身免疫性肝病(AILD)的临床、生化及免疫学特点.方法 选择2005年1月～ 2010年12月我院消化内科收治的自身免疫性肝病患者208例,采用回顾性分析方法收集入选患者的临床资料,分析208例自身免疫性肝病患者的临床表现、生化及免疫学特点.结果 自身免疫性肝病的发病以40岁以上女性多见,30.8％ (64/208)的患者确诊时已进展为肝硬化失代偿期,临床症状无特异性,自身免疫性肝炎患者以丙氨酸氨基转移酶(ALT)、血清免疫球蛋白G(IgG)及γ球蛋白升高更为明显(P＜0.05),而原发性胆汁性肝硬化患者以碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、血清免疫球蛋白M(IgM)升高更为明显(P＜0.05).自身免疫性肝病患者常合并1种或多种肝外自身免疫性疾病,其合并干燥综合征最为常见,自身免疫性肝炎组及原发性胆汁性肝硬化组合并干燥综合征的发生率均达30％以上.自身免疫性肝病患者均有1种或多种自身抗体阳性,其中自身免疫性肝炎组抗核抗体(ANA)阳性率为88.2％,抗线粒体抗体(AMA)阳性率为7.4％,抗线粒体抗体Ⅱ型(AMA-M2)阳性率为4.4％;原发性胆汁性肝硬化组ANA阳性率为86.6％,AMA阳性率为97.6％,AMA-M2阳性率为95.9％.自身免疫性肝炎患者主要应用糖皮质激素治疗,其中共51例(60.0％)患者单用或联用熊去氧胆酸治疗后肝脏酶学指标改善.结论 生化、免疫学、自身抗体等检查对自身免疫性肝病的诊断与鉴别诊断具有重要临床意义,熊去氧胆酸在自身免疫性肝炎的治疗中有一定的作用.     

不同肝病患者血清自身抗体谱阳性率调查

目的 调查不同肝病患者血清自身抗体谱阳性率的差异。方法 2019年3月～2022年3月我院诊治的自身免疫性肝病(ALD)患者92例【其中自身免疫性肝炎(AIH)51例,原发性胆汁性胆管炎(PBC)27例和原发性硬化性胆管炎(PSC)14例】,慢性乙型肝炎(CHB)61例,慢性丙型肝炎(CHC)15例,非酒精性脂肪性肝炎(NASH)患者34例,药物性肝损伤(DILI)患者27例健康体检者68例,使用免疫印迹法检测血清自身抗体。结果 ALD患者血清抗线粒体抗体M2亚型(AMA-M2)、抗可溶性肝抗原/抗肝胰抗原抗体(SLA/LP)、抗肝肾微粒体抗体Ⅰ型(LKM-1)、抗跨膜糖蛋白210(gp210)、抗肝细胞溶质抗原Ⅰ型(LC-1)、抗3E、抗早幼粒细胞性白血病(PML)和抗Ro-52阳性率分别为23.9%、13.0%、33.7%、19.6%、26.1%、33.7%、23.9%和55.4%,显著高于其他肝病组(P<0.05); AIH组患者血清抗SLA/LP、抗LKM-1和抗LC-1阳性率显著高于PBC组或PSC组(P<0.05),而PBC患者血清AMA-M2、抗gp210和抗...     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Use of fab fragments of digoxin-specific antibodies in the therapy of massive digoxin poisoning

A case of massive digoxin ingestion with multiple arrhythmias, consisting of high grade A-V block and ventricular ectopy not responsive to lidocaine, is described. The arrhythmias ceased following administration of digoxin-specific Fab fragments. The patient improved and was transferred to the psychiatric unit.     

Comparison of intravenous and oral routes of theophylline loading in acute asthma

In a prospective, randomized clinical trial, 19 patients with an acute exacerbation of asthma were given a loading dose of aminophylline by the IV (n = 10) or oral route (n = 9) of administration following treatment with epinephrine. Plasma concentrations of theophylline were measured prior to giving the loading dose, and one, two, three, and 24 to 48 hours later. Therapeutic effectiveness was evaluated by analyzing spirometric measurements prior to giving the loading dose, and one, three, and 24 to 48 hours later. Side effects also were recorded. In the IV group, the mean peak plasma theophylline concentration was 15.1 micrograms/mL one hour after loading, and in the oral group the mean peak serum theophylline concentration was 14.2 micrograms/mL three hours after loading. There was no correlation between theophylline concentrations and normalized change in spirometric values. There was no significant difference in spirometric values between the IV and oral groups. Nausea was slightly more common in the IV group. We conclude that there is no therapeutic advantage to giving a loading dose of aminophylline by the IV route rather than orally in patients with mild-to-moderate exacerbation of asthma initially treated with epinephrine.     

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma (MM) is a malignant disease caused by clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage. Despite the uniform clinical signs, the disease is very diverse in terms of the nature and sequence of the underlying molecular events. Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow. Specifically, the process of angiogenesis, triggered by the interactions between the malignant MM cells and the stroma cells around them, was found to be critical for MM progression. In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different microRNAs.     

Application of Granular Biocomposites Based on Homogenised Peat for Absorption of Oil Products

Among the various methods for collecting oil spills and oil products, including from the water surface, one of the most effective is the use of sorbents. In this work, three-component bio-based composite granular adsorbents were produced and studied for oil products’ pollution collection. A bio-based binder made of peat, devulcanised crumb rubber from used tyres, and part fly ash as cenospheres were used for absorbent production. The structure, surface morphology, porosity, mechanical properties, and sorption kinetics of the obtained samples were studied. Composite hydrophobicity and sorption capacity to oil products, such as diesel fuel (DF) and motor oil (MO), were determined. The obtained pellets are characterised by a sufficiently pronounced ability to absorb oil products such as DF. As the amount of CR in the granules increases, the diesel absorption capacity increases significantly. The case of 30-70-0 is almost three times higher than the granules from homogenised peat. The increase in q is due to two factors: the pronounced surface hydrophobicity of the samples (Θ = 152°) and a heterogeneous porous granule structure. The presence of the cenosphere in the biocomposite reduces its surface hydrophobicity while increasing the diesel absorption capacity. Relatively rapid realisation of the maximum saturation by the MO was noted. In common, the designed absorbent shows up to 0.7 g·g⁻¹ sorption capacity for MO and up to 1.55 g·g⁻¹ sorption capacity for diesel. A possible mechanism of DF absorption and the limiting stages of the process approximated for different kinetic models are discussed. The Weber–Morris diffusion model is used to primarily distinguish the limiting effect of the external and internal diffusion of the adsorbate on the absorption process.     

安徽巢湖市丝虫病控制、消除历程和监测报告

【摘要】 目的  回顾并总结巢湖市丝虫病的流行、控制,以及消除丝虫病的历程。 方法  统计分析1970~1989年在该市采取以消灭传染源、切断传播途径为主的防治策略,以及展开大规模防治的各个阶段。 结果  1989年,采用分层整群抽样调查方法调查,微丝蚴率下降至0.032%,以行政村为单位,微丝蚴率已控制在1.0%以下,达到卫生部规定的基本消灭丝虫病标准;1991年,经省级调查考核,认定全市已达到卫生部规定的基本消灭丝虫病标准。1996年,省级审评确认已达到卫生部颁布的消灭丝虫病标准。经过10年的监测和跟踪治疗,到2005年,全市丝虫病病原学监测未查见微丝蚴阳性者,解剖镜检人房内淡色库蚊1 348只,蚊体内均未查见人体幼丝虫。 结论  巢湖市达到了消除丝虫病的标准。     

RNA-Seq在老年神经退行性疾病研究中的应用

阿尔茨海默病及帕金森病是老年人最常见的两种神经退行性疾病,但其发病机制及治疗是研究的热点。随着高通量测序技术的进步及成本的下降,RNA-Seq也成为神经退行性疾病机制研究及生物标志物发现的有力手段。RNA-Seq相对于microarray具有高灵敏度、高准确性、高重复性以及噪声低等优势,在阿尔茨海默病及帕金森病研究中有较为广泛的应用,包括检测差异表达基因,可变剪接、新长链非编码RNA预测分析和miRNAs调控等,但是容易受病理复杂性及样本等因素影响。目前阿尔茨海默病及帕金森病转录组研究相比于癌症等还不够深入,在临床诊断及治疗应用还面临较大挑战。但是随着新技术及新方法的发展,RNA-Seq将进一步推动神经退行性相关疾病的研究和临床转化。     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。     

Advanced Evaluation of the Freeze–Thaw Damage of Concrete Based on the Fracture Tests

This paper presents the results of an experimental program aimed at the assessment of the freeze–thaw (F–T) resistance of concrete based on the evaluation of fracture tests accompanied by acoustic emission measurements. Two concretes of similar mechanical characteristics were manufactured for the experiment. The main difference between the C1 and C2 concrete was in the total number of air voids and in the A300 parameter, where both parameters were higher for C1 by about 35% and 52%, respectively. The evaluation of the fracture characteristics was performed on the basis of experimentally recorded load–deflection and load–crack mouth opening displacement diagrams using two different approaches: linear fracture mechanics completed with the effective crack model and the double-K model. The results show that both approaches gave similar results, especially if the nonlinear behavior before the peak load was considered. According to the results, it can be stated that continuous AE measurement is beneficial for the assessment of the extent of concrete deterioration, and it suitably supplements the fracture test evaluation. A comparison of the results of fracture tests with the resonance method and splitting tensile strength test shows that all testing methods led to the same conclusion, i.e., the C1 concrete was more F–T-resistant than C2. However, the fracture test evaluation provided more detailed information about the internal structure deterioration due to the F–T exposure.