生活方式对企事业单位人群代谢综合征患病影响的调查

目的 探讨生活方式对企事业单位人群代谢综合征（ＭＳ） 患病的影响。 方法 以 ２０１７ 年来我院体检的上海地区人群为研究对象，收集相关体检数据以及婚姻、职业、家族史、膳食、运动、吸烟和饮酒等生活方式信息，比较各因素在 ＭＳ 患者和非 ＭＳ 患者间的差异，分析 ＭＳ 的影响因素。 结果 ＭＳ 患病率为 １５ ６７％ （ 男２０． ５０％ ，女 ５． ０１％ ）。 男性（ＯＲ ＝ ３． ７５，９５％ ＣＩ：３． ０２ ～ ４． ６７）、年龄（ＯＲ ＝ １． ０７，９５％ ＣＩ：１ ０６ ～ １ ０７）、高血压家族史（ＯＲ ＝ １． ５１，９５％ ＣＩ：１． ３３ ～ １． ７０）、肥胖家族史（ＯＲ ＝ １． ３６，９５％ ＣＩ：１． １０ ～ １． ７０）、肉类及肉制品摄入２００ ～ ２９９ ｇ（ＯＲ ＝ ２． ０４，９５％ ＣＩ：１． ２５ ～ ３． ３３）和≥３００ ｇ（ＯＲ ＝ ２． ７０，９５％ ＣＩ：１． １８ ～ ６． ２０）、蛋类摄入 ２ 个（ＯＲ ＝１． ６５，９５％ ＣＩ：１． １３ ～ ２． ４２） 和≥３ 个（ＯＲ ＝ １ ７４，９５％ ＣＩ：１． ２２ ～ ２． ５２）、吃饭过快（ＯＲ ＝ １． ５８，９５％ ＣＩ：１ ３９ ～１ ８０）和吃饭过饱（ＯＲ ＝ １． ４８，９５％ ＣＩ：１． ２７ ～ １． ７２）、饮食喜咸（ＯＲ ＝ １． １７，９５％ ＣＩ：１ ０４ ～ １ ３３）、戒烟（ ＯＲ ＝１ ２２，９５％ ＣＩ：１ ０１ ～ １ ３２）和偶尔吸烟（ ＯＲ ＝ １． ２９，９５％ ＣＩ：１． ０２ ～ １． ６５） 及吸烟（ ＯＲ ＝ １． ３８，９５％ ＣＩ：１． １３ ～１ ６８）是 ＭＳ 的危险因素；主食摄入 ４００ ～ ５４９ ｇ（ ＯＲ ＝ ０． ６４，９５％ ＣＩ：０． ４２ ～ ０． ９８）、奶类摄入 ＜ ２５０ ｍｌ（ ＯＲ ＝０ ８０，９５％ ＣＩ：０． ６８ ～ ０． ９４）和 ２５０ ～ ４９９ ｍｌ（ ＯＲ ＝ ０． ８４，９５％ ＣＩ：０． ７２ ～ ０． ９８）、豆类摄入 ＜ １００ ｇ（ ＯＲ ＝ ０． ７５，９５％ ＣＩ：０． ６０ ～ ０． ９５）和 ２００ ～ ２９９ ｇ（ＯＲ ＝ ０． ５５，９５％ ＣＩ：０． ３３ ～ ０． ９３）、水果摄入 １００ ～ ３９９ ｇ（ ＯＲ ＝ ０ ７０，９５％ＣＩ：０． ５４ ～ ０． ９１）和 ４００ ～ ６９９ ｇ（ＯＲ ＝ ０． ６２，９５％ ＣＩ：０． ４０ ～ ０． ９５）、中度（ＯＲ ＝ ０． ７７，９５％ ＣＩ：０ ６４ ～ ０ ９３）和重度运动（ＯＲ ＝ ０． ４０，９５％ ＣＩ：０． １８ ～ ０． ９１）是 ＭＳ 的保护因素。 结论 ＭＳ 受多种生活方式因素综合作用的影响，应开展针对性的健康教育，促使该人群自觉采纳有益于健康的膳食结构、改变不良饮食习惯及喜好，加强运动锻炼，消除或减轻不良生活方式对 ＭＳ 的影响。     

原发性高血压为Ⅱ型糖尿病发病独立预测因素──非糖尿病人群465例6年前瞻性观察

报告４６５例非糖尿病人群中（ＮＧＴ３１６人，ＩＧＴ１４９人）高血压对糖尿病发病率的影响。调整年龄、性别影响后高血压组（ｎ＝１４０例）之６年糖尿病发病率为４４．６％，显著高于非高血压组的１９．７％（ｎ＝３２８例）。多因素（１ｏｇｉｓｔ）回归分析显示排除空腹血糖与ＢＭＩ这两个与６年糖尿病发病显著正相关的重要因素影响后高血压组较血压正常组仍有较高的糖尿病发病危险（ＯＲ＝１．８，９５％可信限１．０３～３．２１，Ｐ＜０．０５）。剔除服用降压药物者及未到实验终点而失访的８６例后再分析结果仍显示收缩压（ＳＢＰ）高者有较高的糖尿病发病危险（ＳＢＰ升高２０ｍｍＨｇ之糖尿病发病ＯＲ为１．５，９５％Ｃｉ１．１～２．３，Ｐ＝０．０２６），表明非糖尿病人群中高血压是糖尿病发病的独立预测因素。     

先天性心脏病与巨细胞病毒感染的关系探讨

采用配对病例对照研究，探讨先天性心脏病（先心病）与巨细胞病毒（ＣＭＶ）感染的关系。先心病组１０３例，ＣＭＶ－ＩｇＧ阳性７８例，阳性率７５．７３％；对照组１０３例，ＣＭＶ－ＩｇＧ阳性５３例，阳性率５１．４６％，两组差异有显著性（Ｘ２＝１５．４９，Ｐ＜０．０５，ＯＲ＝３．７８，９５％ＣＩ＝１．８１～７．８８）。条件Ｌｏｇｉｓｔｉｃ回归分析先心病与ＣＭＶ感染的关系，ＯＲ＝４．４２，９５％ＣＩ＝１．８３～１０．６７。表明先心病与ＣＭＶ感染间的病因联系强度具有统计学意义，先心病与母亲流产史、母亲妊娠初期感染史也有关。     

血吸虫病肝纤维化患者转化生长因子β_1mRNA的水平及其临床意义

目的：研究血吸虫病患者 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平及其临床意义。方法：用 Ｒ Ｔ Ｐ Ｃ Ｒ 加 ｄｏｔｂｌｏｔ法测定血吸虫病患者 Ｐ Ｂ Ｍ Ｃ中 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平,与肝硬变和肝癌患者作比较,并研究了部分肝脏组织（肝癌患者１６ 例,肝血管瘤患者正常肝组织 ５ 例）中 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平与 Ｐ Ｂ Ｍ Ｃ中水平的关系。同时,测定血清中 Ｈ Ａ、 Ｌ Ｎ、 ＣｏｌⅠⅤ和 Ｐ ＣⅢ水平,作为衡量肝纤维化活动与否的指标。结果： Ｐ Ｂ Ｍ Ｃ内 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平在晚期血吸虫病患者组（ｎ＝ ２１,１２６±０１４）,肝硬变患者组（ｎ＝ １５,２０５±０８１）和肝癌患者组（ｎ＝ ２５,１８３±１２９）均显著高于正常对照组（ｎ＝ １６,０６２±０４０）（ Ｐ＜ ００５）。其中晚期血吸虫病患者组又显著低于肝硬变患者组或肝癌患者组（ Ｐ＜ ００５）,后两组差异无显著性（ Ｐ＞ ００５）。肝组织与 Ｐ Ｂ Ｍ Ｃ内 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平差别无统计学意义（ Ｐ＞ ００５）。血清 Ｈ Ａ、 ＣｏｌⅣ和 Ｌ Ｎ 异常组的 Ｔ Ｇ Ｆβ１ ｍ Ｒ Ｎ Ａ 水平显著高于正常组（ Ｐ＜ ００５）。结论： Ｐ     

原发性肝细胞癌患者转化生长因子β1的基因表达及临床意义

目的研究转化生长因子β１（ＴＧＦβ１）ｍＲＮＡ在原发性肝细胞癌患者中的表达及其临床意义。方法用ＲＴ－ＰＣＲ加ＤｏｔＢｌｏｔ法检测原发性肝细胞癌患者肝组织和外周血单个核细胞（ＰＢＭＣ）中ＴＧＦ－β１ｍＲＮＡ水平，并以正常肝组织和正常人的ＰＢＭＣ为对照。结果ＴＧＦ－β１ｍＲＮＡ水平在原发性肝细胞癌患者组肝组织（２．２２±０．８４，ｎ＝１６）和ＰＢＭＣ中（１．８３±１．２，ｎ＝２５）比较，差异无显著性（Ｐ＞０．０５），但两者均高于正常肝组织（０．９４±０．７６，ｎ＝５）和正常人的ＰＢＭＣ（０．６２±０．４０，ｎ＝１６）水平。结论ＴＧＦ－β１ｍＲＮＡ水平与原发性肝细胞癌有关，ＰＢＭＣ中ＴＧＦ－β１ｍＲＮＡ检测可望作为一项代替肝组织活检的指标，其表达水平与肝癌有关。     

载脂蛋白E内含子1内增强子多态性与散发性Alzheimer病的关系

目的 探讨载脂蛋白Ｅ（ａｐｏＥ）增强子元件基因多态性与散发性Ａｌｚｈｅｉｍｅｒ病（ＡＤ）的关系。方法 应用聚合酶链反应－限制性片段长度多态性（ＰＣＲ－ＲＦＬＰ）技术检测ａｐｏ内含子１内增强子元件（ＩＥ１）基因型。结果 散发性ＡＤ组（ｎ＝４２）ａｐｏＥ ＩＥ１ Ｇ／Ｇ基因型频率０．５９５，而对照组（ｎ＝１０８）则为０．３９８，散发性ＡＤ组显著高于对照组（Ｐ〈０．０５）。Ｇ／Ｇ基因型个体患ＡＤ风险为Ｇ     

血吸虫病肝纤维化患者转化生长因子β_1mRNA的水平及其临床意义

目的：研究血吸虫病患者 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平及其临床意义。方法：用 Ｒ Ｔ Ｐ Ｃ Ｒ 加 ｄｏｔｂｌｏｔ法测定血吸虫病患者 Ｐ Ｂ Ｍ Ｃ中 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平,与肝硬变和肝癌患者作比较,并研究了部分肝脏组织（肝癌患者１６ 例,肝血管瘤患者正常肝组织 ５ 例）中 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平与 Ｐ Ｂ Ｍ Ｃ中水平的关系。同时,测定血清中 Ｈ Ａ、 Ｌ Ｎ、 Ｃｏｌ ⅠⅤ和 Ｐ ＣⅢ水平,作为衡量肝纤维化活动与否的指标。结果： Ｐ Ｂ Ｍ Ｃ内 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平在晚期血吸虫病患者组（ｎ＝ ２１,１２６±０１４）,肝硬变患者组（ｎ＝ １５,２０５±０８１）和肝癌患者组（ｎ＝ ２５,１８３±１２９）均显著高于正常对照组（ｎ＝ １６,０６２±０４０）（ Ｐ＜ ００５）。其中晚期血吸虫病患者组又显著低于肝硬变患者组或肝癌患者组（ Ｐ＜ ００５）,后两组差异无显著性（ Ｐ＞ ００５）。肝组织与 Ｐ Ｂ Ｍ Ｃ内 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平差别无统计学意义（ Ｐ＞ ００５）。血清 Ｈ Ａ、 Ｃｏｌ Ⅳ和 Ｌ Ｎ 异常组的 Ｔ Ｇ Ｆ β１ ｍ Ｒ Ｎ Ａ 水平显著高于正常组（ Ｐ＜ ００５）。结论： Ｐ     

血管紧张素原基因M235T分子变异与原发性高血压的关系

目的：探讨血管紧张素原（ＡＧＴ）基因Ｍ２３５Ｔ分子变异与中国人原发性高血压的关系。　　方法：对８９ 例原发性高血压（原发性高血压组）及９１ 例正常者（正常对照组）用多聚酶链式反应法及限制性片段长度多态性技术对ＡＧＴ基因Ｍ２３５Ｔ多态性进行了检测。　　结果：原发性高血压组Ｔ等位基因频率０．８０,ＴＴ基因型频率０．６７,与正常对照组（０．６６,０．４３）比较有显著性差异,（Ｐ＝ ０．０２３,Ｐ＝ ０．００４）;ＴＴ基因型较ＭＴ＋ ＭＭ 基因型对原发性高血压的比值比为２．７６（９５％ 可信区间为１．５０～５．０６,Ｐ＝ ０．００１）。　　结论：ＡＧＴ基因ＴＴ基因型可能与中国人群原发性高血压发病有关联。     

肝损伤小鼠肝组织氧化／抗氧化平衡的变化及其与TXA2／PGI2？…

目的：探讨氧自由基（ＯＦＲ）及ＴＸＡ２－ＰＧＩ２在实验性肝损伤中的作用。方法：检测肝损伤小鼠肝组织过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）含量以及血浆ＴＸＡ和ＰＧＩ２浓度。结果：与对照组比较肝损伤小鼠ＬＰＯ明显升高、ＳＯＤ明显降低，当归可逆转ＬＰＯ和ＳＯＤ的变化；肝损伤小鼠血浆ＴＸＢ２高于对照组，其浓度与肝细胞ＬＰＯ含量呈正相关（ｒ＝０．９５，Ｐ〈０．０１）。结论：ＯＦＲ与ＴＸＡ２／ＰＧＩ２     

尿激酶和前列腺素E1联合溶解深静脉血栓的临床研究

目的：观察静脉内联用尿激酶（ＵＫ）和前列腺素Ｅ１（ＰＧＥ１）对下肢深静脉血栓（ＤＶＴ）患者的溶栓效果。方法：将８９例经静脉造影确诊为ＤＶＴ患者分为联合溶栓组［ＵＫ＋ＰＧＥ１ｎ＝５１，第１组（病程＜２周）：先静脉注射ＵＫ１０万ＩＵ，接着静脉滴注ＵＫ（３万ＩＵ／ｈ）及ＰＧＥ１（１００μｇ／ｄ）持续２～３天，之后持续静脉滴注肝素钠５～７天，再服用华法林（使凝血酶原时间为基础对照的１．５～２．０倍）３～６个月；第２组（病程＞２周）：静脉注射ＵＫ１０万ＩＵ后，静脉滴注ＵＫ２０万ＩＵ及ＰＧＥ１１００μｇ，每日１次，连用７～１０天，再服华法林３～６个月］和常规治疗组（肝素，ｎ＝３８，剂量同上）。以血管造影为标准判断溶栓效果。结果：联合溶栓组的疗效明显优于常规治疗组（Ｐ＜０．０１）；其疗效与病程长短关系密切，病程小于２个月者疗效显著（显效率７５％，总有效率９６．５％）；无严重并发症发生。结论：静脉内联用ＵＫ和ＰＧＥ１治疗ＤＶＴ是一种安全、有效的治疗方法。     

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。     

Inhibition of procarcinogen-bioactivating human CYP1A1, CYP1A2 and CYP1B1 enzymes by melatonin

Abstract:  Administration of melatonin to rodents decreases the incidence of tumorigenesis initiated by benzo[ a ]pyrene or 7,12-dimethylbenz[ a ]anthracene, which requires bioactivation by cytochrome P450 enzymes, such as CYP1A1, CYP1A2 and CYP1B1, to produce carcinogenic metabolites. The present study tested the hypothesis that melatonin is a modulator of human CYP1 catalytic activity and gene expression. As a comparison, we also investigated the effect of melatonin on the catalytic activity of CYP2A6, which is also a procarcinogen-bioactivating enzyme. Melatonin (3–300 μ m ) decreased 7-ethoxyresorufin O -dealkylation catalyzed by human hepatic microsomes and recombinant CYP1A1, CYP1A2 and CYP1B1, whereas it did not affect coumarin 7-hydroxylation catalyzed by hepatic microsomes or recombinant CYP2A6. Melatonin inhibited CYP1 enzymes by mixed inhibition, with apparent K _i values (mean ± S.E.M.) of 59 ± 1 (CYP1A1), 12 ± 1 (CYP1A2), 14 ± 2 (CYP1B1) and 46 ± 8 μ m (hepatic microsomes). Additional experiments indicated that melatonin decreased benzo[ a ]pyrene hydroxylation catalyzed by hepatic microsomes and CYP1A2 but not by CYP1A1 or CYP1B1. Treatment of MCF-10A human mammary epithelial cells with melatonin (up to 300 μ m ) did not affect basal or benzo[ a ]pyrene-inducible CYP1A1 or CYP1B1 gene expression. Consistent with this finding, melatonin did not influence reporter activity in aryl hydrocarbon receptor-dependent pGudluc6.1-transfected MCF-10A cells treated with or without benzo[ a ]pyrene, as assessed in an in vitro cell-based luciferase reporter gene assay. Overall, melatonin is an in vitro inhibitor of human CYP1 catalytic activity, and it may be useful to develop potent analogues of melatonin as potential cancer chemopreventive agents that block CYP1-mediated chemical carcinogenesis.     

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。