原发性胆汁性肝硬化患者自身抗体谱检测分析

目的：对确诊PBC患者自身抗体AMA/AMA-M2、ANA进行分析,为临床诊断提供实验室参考.方法：间接免疫荧光法检测55例确诊PBC患者与71例AIH患者血清ANA、AMA/AMA-M2等抗体.结果：55例PBC患者中AMA检出率为80％（44/55）,AMA-M2检出率为58.1％（32/55）,37例ANA阳性,检出率67.3％,其中11例（20％）均质型,7例（12.7％）为着丝点型,6例（10.9％）核膜型,5例（9.1％）为颗粒型,3例（5.5％）为核点型,6例（10.9％）为混合型;而71例AIH患者中AMA检出率为14.1％ （10/71）,AMA-M2检出率为2.8％（2/71）,40例ANA阳性,检出率56.3％,其中4例（5.6％）均质型,3例（4.2％）为着丝点型,7例（9.9％）核膜型,9例（12.7％）为颗粒型,7例（9.9％）为核点型,10例（14.1％）为混合型.结论：PBC患者AMA的检出率明显高于其他自身抗体指标,且AMA-M2仅见于PBC患者与AIH＋ PBC重叠综合征的患者;ANA在PBC患者中的检出率仅次于AMA,但是不能单独用于PBC的诊断.     

间接免疫荧光法和酶联免疫吸附法检测抗线粒体抗体的分析与比较

目的:对临床上常用的2种抗线粒体抗体(AMA)的检测方法进行分析比较,探讨抗线粒体抗体M2亚型(AMA-M2)在原发性胆汁性肝硬化(PBC)和其他结缔组织病(CTD)中的抗体滴度特点。方法 :回顾性分析2011年1月~2013年6月我科采用间接免疫荧光法(IIF)检测AMA和酶联免疫吸附法(ELISA)检测AMA-M2共726例患者的资料。结果 :ELISA检测抗线粒体抗体阳性率(13.1%)略高于IIF(6.5%)。IIF诊断PBC的敏感度和特异度为78.1%和97.4%,ELISA分别为100%和91.6%。55例AMA-M2阳性而AMA阴性的患者,8例诊断为PBC,35例诊断为其他CTD。PBC组AMA-M2抗体滴度(中位数为64.8RU/ml)略高于其他CTD组(中位数为54.9RU/ml)。结论 :将IIF和ELISA同时应用于抗线粒体抗体的检测,有助于PBC的临床诊断。     

新疆维吾尔族自身免疫性肝病患者自身抗体谱的研究分析

目的：分析新疆维吾尔族不同类型自身免疫性肝病患者的自身抗体阳性率及其诊断意义。方法选取2012年10月至2014年10月该院门诊和住院的维吾尔族自身免疫性肝病患者51例,其中自身免疫性肝炎（AIH）20例（AIH组）,原发性胆汁性肝硬化（PBC）31例（PBC组）,采用间接免疫荧光法、免疫印迹法检测其血清生化指标和自身抗体,并进行比较分析。结果两组各项生化指标水平均明显增高,其中两组丙氨酸氨基转移酶（ALT）、γ‐谷氨酰转肽酶（γ‐GT）、碱性磷酸酶（ALP）及免疫球蛋白M（IgM）水平比较,差异均有统计学意义（P＜0．05）。AIH组患者抗核抗体（ANA）、抗平滑肌抗体（SMA）、抗肝肾微粒体‐1（LKM‐1）抗体、抗肝细胞溶质抗原1型（LC‐1）抗体、抗可溶性肝抗原／肝胰抗原（SLA／LP）抗体及抗线粒体抗体（AMA）阳性率分别为65．0％、40．0％、10．0％、5．0％、10．0％、5．0％;PBC组患者ANA、AMA及其M2亚型（AMA‐M2）的阳性率分别为61．3％、100．0％和96．8％。结论新疆地区维吾尔族自身免疫性肝病患者的自身抗体谱具有一定的特征,自身抗体谱的检测对自身免疫性肝病诊断、分型及鉴别诊断具有重要的意义。     

抗线粒体抗体亚型在原发性胆汁性肝硬化中的诊断价值

目的研究抗线粒体抗体（AMA）及其分型对原发性胆汁性肝硬化（PBC）的诊断价值。方法应用间接免疫荧光法测定血清中AMA抗体,用免疫印迹法检测AMA-M2、M4、M9亚型。78例PBC患者、35例其他肝病患者和20名健康体检者检测AMA及M2,其中30例PBC患者检测M4、M9型。结果78例PBC患者中74例（94.9%）AMA及M2均阳性。35例其他肝病患者M2均阴性。20名健康体检者AMA及M2均阴性。结论AMA及其分型,特别是M2抗体检测可作为临床诊断PBC的重要血清免疫学指标。     

714例疑似自身免疫性肝病患者相关自身抗体的检测

目的:观察在疑似自身免疫性肝病(AILD)患者相关自身抗体的阳性率及自身免疫性肝病检出率.方法:采用间接免疫荧光法检测714例疑似AILD患者血清标本中的抗线粒体抗体(AMA)、抗核抗体(ANA)及抗平滑肌抗体(SMA),免疫印迹法检测抗线粒体抗体亚型-丙酮酸脱氢酶复合物(AMA-M2)、抗肝肾微粒体抗体(LKM-1)、肝细胞溶质抗原Ⅰ型抗体(LC-1)、可溶性肝抗原/肝胰抗原抗体(SLA/LP),并查阅临床资料进行确诊.结果:ANA、AMA、SMA、AMA-M2、LC-1、SLA/LP、LKM-1阳性率分别为37.67％、11.34％、1.97％、16.94％、1.68％、1.40％、0.56％,确诊原发性胆汁性肝硬化(PBC)68例(9.52％),自身免疫性肝炎(AIH)疑似患者4例(0.56％),未检出原发性胆管炎(PSC)患者.结论:AILD中,以PBC最常见,间接免疫荧光法和免疫印迹法联合应用检测自身抗体可减少AILD的漏诊.     

肝病相关抗体的检测及临床应用

[目的]探讨肝病相关抗体在肝脏疾病中的应用价值。[方法]选取乙型肝炎病毒（HBV）感染者（HBsAg、抗HBc阳性）53例;丙型肝炎病毒（HCV）感染者（抗HCV阳性）83例;不明原因肝功能异常者（各类肝炎病毒感染指标均阴性,但ALT或AST升高〉40IU／L）86例,同时选择健康体检者60例作为对照组。采用间接免疫荧光法（IIF）检测各组抗核抗体（ANA）、抗平滑肌抗体（SMA）、抗线粒体抗体（AMA）;采用免疫印迹法检测抗可溶性肝抗原／肝胰抗原（SLA／LP）抗体、抗肝肾微粒体抗体I型（LKM-1）、抗肝细胞浆抗体1型（LC-1）、抗线粒体抗体Ⅱ型（AMA-M2）,并分析各组阳性率。[结果]在间接免疫荧光法检测中,ANA、AMA、SMA的阳性率分别为正常对照组6．7％、0．0％、0．0％;乙型肝炎组39．6％、1．8％、3．8％;丙型肝炎组,53．0％、15．7％、20．5％;不明原因肝功异常组,53．5％、12．8％、17．4％。经x^2检验除乙型肝炎组的AMA和SMA外,其他各病例组3项抗体阳性率均与正常对照组有显著性差异（P〈0．01）。在免疫印迹法检测中,抗可溶性肝抗原／肝胰抗原（SLA／LP）抗体阳性1例,抗肝肾微粒体抗体（LKM-1）3例,抗肝细胞浆抗体1型（LC-1）1例,抗线粒体抗体Ⅱ型（AMA-M2）5例。[结论]肝病相关抗体的检测在慢性肝病的诊断和鉴别诊断中有重要的临床意义。     

自身抗体分析在慢性胆汁淤积性肝病鉴别诊断中的价值

目的分析多种自身抗体在慢性胆汁淤积性肝病鉴别诊断中的价值。方法选取186例慢性胆汁淤积性肝病的患者,包括107例原发性胆汁性肝硬化（PBC）、48例原发性硬化性胆管炎（PSC）、18例AMA阳性的自身免疫性肝炎（AIH）、13例其他肝内胆汁淤积患者,用酶联免疫吸附试验（ELISA）检测这些患者血清中传统的抗AMA-M2、抗AMA-M2-3E（BPO）IgG、抗AMA-M2-3E（BPO）IgA、抗gp210抗体、抗Sp100抗体、抗PML抗体、抗SLA/LP抗体、抗ACA抗体。结果 107例PBC患者抗M2-3E ELISA法AMA-M2 IgG的检出率为86.9%。在AMA-M2 IgG阳性病人中抗gp210和抗Sp100抗体明显高于抗PML抗体、抗SLA/LP抗体、抗ACA抗体差别具有统计学意义（P〈0.05）。27例AMA-M2阴性的PBC患者中有11例患者AMA-M2 IgG阳性,16例患者存在AMA-M2-3E IgG、抗Sp100抗体、抗gp210抗体1种或几种的组合。抗Sp100抗体、抗gp210抗体只在PBC患者和AMA阳性的自免疫性肝炎患者中被检测到,且抗gp210抗体出现在愈后差的患者中。结论 AMA和抗核抗体（ANA）检测在慢性胆汁淤积性肝病鉴别诊断中具有重要作用。     

自身抗体和免疫球蛋白检测对鉴别诊断原发性胆汁性肝硬化的评价

目的:探讨自身抗体和免疫球蛋白检测在原发性胆汁性肝硬化(PBC)诊断和鉴别诊断中价值和临床意义。方法:采用间接免疫荧光法和生化检测法分别对40例PBC患者、43例病毒性肝炎患者、14例干燥综合征患者以及30例同期健康体检者进行检测,对各组患者的自身免疫性肝病指标和血清免疫球蛋白指标进行比较。结果:PBC患者的抗核抗体(ANA)、抗线粒体抗体(AMA)以及抗线粒体抗体-M2亚型(AMA-M2)阳性率明显高于其余各组,差异具有统计学意义(P<0.05);PBC患者的Ig G、Ig M水平明显高于其余各组,差异有统计学意义(P<0.05),Ig A水平差异无统计学意义(P>0.05)。结论:ANA、AMA抗体检测、免疫球蛋白检测对于PBC具有较高的临床诊断价值,值得临床推广。     

自身抗体谱在原发性胆汁性肝硬化诊断中的作用

目的分析原发性胆汁化肝硬化（PBC）患者的自身抗体谱和免疫功能,探讨其对PBC的诊断价值。方法用免疫印迹法检测107例PBC、100例疾病对照组和30例健康体检者血清中的抗线粒体抗体（AMA）M2亚型、AMAM2—3E（BPO）、抗Spl00抗体、抗gp210抗体、抗肝肾微粒体1型（LKM一1）抗体、抗早幼粒细胞性白血病（PML）抗体、抗肝特异性胞质抗体-1（LC-1）、抗可溶性肝抗原,肝胰抗原抗体（SLA／LP）。结果1．AMA—M2、AMAM2—3E（BPO）、抗Spl00抗体、抗PML抗体、抗gp210抗体对PBC诊断的敏感性、特异性分别为74．7％、90．2％,86．9％、95．1％,32．7％、97．1％。27．1％、97．5％,39．3％,98．3％。未检测到抗LKM-1抗体、抗LC～1抗体、抗SLA几P抗体。2．在118例疾病对照组中AMA—M2、AMAM2—3E（BPO）、抗Sp100抗体、抗PML抗体、抗gp210抗体检出率分别为16％、11％、3％、1％、3％,未检测到抗LKM-1抗体、抗LC-1抗体、抗SLA／LP抗体。在正常对照组上述8种抗体的检出率均为0。3．AMA—M2呈阳性的患者（n=97）比呈阴性的患者（n=lO）有更加严重的疾病。这可通过更加严重的组织学变化和更高的IgG,IgM和ALP平均值看出;抗gp210抗体呈阳性的患者肝功能衰竭发生率明显高于呈阴性的患者（P〈0．05）。结论PBC患者血清中可检测到多种自身抗体,其中抗Spl00抗体、抗PML抗体、抗gp210抗体在PBC诊断中特异性高,可协助诊断PBC。     

慢性肝病自身抗体的检测及其与自身免疫性肝病的相关性

目的 研究慢性肝病患者中自身免疫性肝病存在状况、自身抗体检测的阳性率及其临床意义。方法 选择2001年1月至2005年5月同济医院慢性肝病住院患者共367例，包括慢性乙型肝炎124例、慢性丙型肝炎45例、自身免疫性肝病122例及其它76例，采用间接免疫荧光法、免疫条带法、ELISA法检测自身抗体和自身抗体亚型。结果367例慢性肝病患者自身免疫性肝炎（AIH）、原发性胆汁性肝硬化（PBC）、原发性硬化性胆管炎（PSC）及AIH／PBC重叠综合征（overlap syndrome）所占比例分别为9．81％、10．90％、7．63％及4．90％。抗核抗体（ANA）、抗线粒体抗体（AMA）及AMA—M2、核周型抗中性粒细胞胞质抗体（pANCA）检出阳性率各病例组组间比较差异有显著性意义（P〈0．01或P〈O．05）。抗肝。肾微粒体抗体1型（antiLKMl）、抗可溶性肝抗原／肝胰抗原（anti—SLA／LP）抗体检出阳性率分别为5．73％、4．1％。未检出抗肝细胞溶质抗原1型抗体（anti—LC-1）。自身抗体总阳性率为20．41％。慢性病毒性肝炎患者ANA检测阳性组AST、TBil与ANA阴性组比较，差异有显著性意义（均P〈0．05）。结论 自身抗体与肝损伤程度有一定相关性。自身抗体及肝抗原自身抗体的检测是提高自身免疫性肝病检出率的有效途径。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.