慢加急性乙型肝炎肝衰竭患者血清IFN-γ基因多态性分析

目的 探究慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者血清γ-干扰素(IFN-γ)基因多态性分布特点。方法 2017年5月～2019年9月我院收治的HBV-ACLF患者60例,另选择同期健康体检者60例作为对照。采用Taqman探针荧光定量PCR法检测外周血IFN-γ基因多态性位点+874T/A和+2109A/G基因型,采用x²检验和Hardy-Weinberg平衡检验IFN-γ基因SNP位点+874T/A和+2109A/G基因型和等位基因频率分布差异。结果 在IFN-γ+874T/A位点,ACLF患者TT基因型为48.3%,显著低于健康人的56.7%,而AA基因型为31.7%,显著高于健康人的13.3%(P＜0.05),在等位基因频率分布方面,ACLF患者T等位基因频率为58.3%,显著低于健康人的71.7%,而A等位基因频率为41.7%,显著高于健康人的28.3%(P＜0.05);在IFN-γ+2109A/G位点,ACLF患者显性等位基因纯合子AA基因型频率为53.3%,显著低于健康人的66.7%,隐性等位基因纯合子GG基因型频率为28.3%,显著高于对照组的10.0%(P＜0.05),在等位基因频率分布方面,ACLF患者A等位基因频率为62.5%,显著低于对照组的78.3%,而G等位基因频率为37.5%,显著高于对照组的21.7%,差异具有统计学意义(P＜0.05)。结论 IFN-γ基因多态性与乙型肝炎患者发生ACLF可能存在某种关系,其中IFN-γ基因+874T/A位点中的A等位基因和+2109A/G位点中的G等位基因可能是患者发生HBV-ACLF的风险等位基因,监测外周血IFN-γ基因多态性对及时准确地预测ACLF的发生可能具有一定的临床意义。     

慢加急性乙型肝炎肝衰竭患者外周血IFN-γ基因多态性分析及其临床意义探讨

目的探讨乙型肝炎病毒感染引起的慢加急性肝衰竭患者血IFN-γ基因多态性。方法采用单核苷酸多态性(SNP)技术检测51例ACLF患者和50例健康人血IFN-γ基因内含子+874位点T/A和+2109位点A/G单核苷酸多态性。结果 ACLF患者+874位点TA+AA基因型频率(54.9%)显著高于健康人(24.0%),A等位基因频率(38.2%)显著高于健康人(22.0%,P0.05);ACLF组+2109位点AG+GG型基因型频率(51.0%)显著高于健康人(26.0%),G等位基因(32.4%)显著高于健康人(16.0%,P0.05);在3 m末,28例生存与23例死亡的ACLF患者+874、+2109位点等位基因和基因型频率分布无显著性差异(P0.05)。结论 IFN-γ基因+874位点A等位基因和基因型、+2109位点G等位基因和基因型是ACLF的遗传易感基因。     

IL-10基因多态性与乙肝肝硬化易感性的相关性研究

探讨白细胞介素10(IL-10)基因多态性与乙型肝炎肝硬化易感性的关系.采用聚合酶链反应-限制性片段长度多态性(PCR-PFLP)分析方法,检测100例乙肝肝硬化患者及124例健康对照组IL-10基因启动子-1082G/A、-592A/C位点的基因多态性,并确定了其基因型和等位基因频率的分布.肝硬化组与对照组IL-10基因启动子-592A/C位点基因型分布频率和等位基因频率差异无显著性(P＞0.1),肝硬化组-1082G/A位点AA基因型频率及A等位基因频率高于对照组(P＜0.05),G等位基因相对于A等位基因患肝硬化的机会比为0.373(95%CI:0.166～0.838).IL-10基因多态性与肝硬化易感性相关,基因启动子-1082G/A位点AA基因型携带者肝硬化易感性高.     

基质金属蛋白酶-2组织抑制剂基因多态性与慢性阻塞性肺病患者肺功能关系

目的研究基质金属蛋白酶-2组织抑制剂(TIMP-2)基因多态性与慢性阻塞性肺病(COPD)患者肺功能的关系。方法采用聚合酶链反应-限制性酶切片段长度多态性(PCR-RFLP)方法检测92例COPD患者TIMP-2基因+853位点单核苷酸多态性(SNPs),测定COPD患者肺功能,分析TIMP-2基因+853位点多态性与肺功能的关系。结果 TIMP-2基因+853位点基因型频率为G/G型73.9%、G/A 23.9%、A/A 2.2%,G/G型肺功能FEV1和FEV1/FVC(%)明显低于G/A型和A/A型(P0.05)。结论 TIMP-2基因+853位点G/G基因型与COPD患者肺功能的损害程度有关。     

白细胞介素-1β和干扰素-γ基因单核苷酸多态性与溃疡性结肠炎遗传易患性研究

目的探讨白细胞介素-1β(IL-1β)和干扰素-γ(IFN-γ)基因单核苷酸多态性与溃疡性结肠炎(UC)遗传易患性的关系。方法应用聚合酶链反应顺序特异性引物法(PCR-SSP),检测2005年5月至2006年8月在哈尔滨医科大学附属第一医院就诊的56例UC患者(UC组)和44名同期体检健康者(对照组)的IL-1β( 3962T/C位点)和IFN-γ( 874A/T位点)基因单核苷酸多态性,分析2组基因型频率和等位基因频率分布特点。结果UC组IL-1β 3962位点CT杂合子基因型的频率及T等位基因频率明显高于对照组,差异有显著性意义(P<0.01,P<0.05)。IL-1β 3962位点各基因型在UC不同发病部位之间的分布,差异无显著性意义(P>0.05)。IFN-γ基因 874位点各基因型的频率和等位基因的频率在2组中的分布差异无显著性意义(P>0.05)。结论IL-1β 3962位点CT基因型频率及T等位基因频率增高可能与UC遗传易患性有关,但与UC发病部位无关。IFN-γ基因 874位点的多态性与UC遗传易患性无关。     

MCP-1基因及CCR2基因多态性与河南地区多发性硬化的相关性研究

目的 研究MCP-1基因-2518位点及CCR2基因-190位点多态性与河南地区多发性硬化(MS)的相关性.方法 以来自河南地区的MS患者(MS组)和健康志愿者(对照组)为研究对象,利用PCR技术检测MCP-1基因及CCR2基因扩增产物酶切多态性.结果 MS组和对照组MCP-1基因-2518位点A/A、A/G、G/G三种基因型分布频率无统计学差异(P＞0.05).与对照组相比,MS组有较高的G等位基因频率,但两组差异未达统计学意义(P＞0.05).MS组和对照组CCR2基因- 190位点G/G、A/G、A/A三种基因型分布频率无统计学差异(P＞0.05),与对照组相比,MS组有较低的A等位基因频率,但两组差异未达统计学意义(P＞0.05).结论 未发现MCP-1基因-2518位点及CCR2基因- 190位点多态性与河南地区MS相关.     

葡萄糖激酶基因多态性与妊娠期糖尿病遗传易感性的关系

目的 探讨葡萄糖激酶(GCK)基因-259位点单核苷酸多态性与妊娠期糖尿病(GDM)发病的关系.方法 应用PCR-RFLP技术对80例GDM孕妇(GDM组)和80例正常孕妇(对照组)的GCK基因-259位点(A→T)进行单核苷酸多态性分析.结果 两组GCK基因-259位点各基因型频率分布均符合Hardy-Weinberg平衡检验,具有群体代表性;GDM组GCK基因-259位点T等位基因频率高于对照组 (P＜0.05),A等位基因频率、A/A基因型频率无统计学差异(P＞0.05),T/T基因型频率与GDM组呈正相关(OR值为3.235,P=0.031),结论 GCK基因-259位点单核苷酸多态性可能在GDM遗传易感性中起重要作用;T等位基因可能与GDM发生有关.     

肺结核患者肿瘤坏死因子-α基因多态性的研究

目的通过病例-对照研究,探讨肿瘤坏死因子-α(TNF-α)基因启动子区-238A/G、-308A/G位点单核苷酸多态性(SNP)与肺结核病的关系。方法采用序列特异性引物PCR(PCR-SSP)及测序技术检测深圳地区汉族人群肺结核患者200例及健康对照者197例TNF-α启动子区-238A/G、-308A/G位点基因多态性。采用直接计数法计算各组基因型频率及等位基因频率,并进行χ2检验;采用SHEsis软件进行单倍型分析。以P值0.05为具有统计学意义。结果2组人群TNF-α启动子区-238A/G、-308A/G位点基因型及等位基因分布频率差异无统计学意义(P0.05);两位点各种单倍型在2组间分布差异无统计学意义(P0.05)。结论TNF-α启动子区-238、-308位点基因多态性与中国汉族人群肺结核病易感性未见关联。     

TNF-α基因多态性与类风湿性关节炎相关性研究

目的:探讨肿瘤坏死因子-α(TNF-α)启动子区-308基因多态性与湖北汉族人类风湿性关节炎(RA)易感性的关系。方法:用聚合酶链反应和限制性片段长度多态性(PCR/RFLP)的方法对113例RA患者及126例健康人进行TNF-α的-308位点多态性分析。结果:RA组与对照组TNF-α的-308位点的基因型频率和等位基因频率G/G、G/A、A/A之间差异无统计学意义(P0.05);并且TNF-α的-308位点的基因多态性与RA活动期指标ESR和CRP高低无关。结论:TNF-α启动子区-308基因多态性不是类风湿性关节炎易感性和严重程度的一个风险因子。     

ET-1基因多态性与海南黎族人原发性高血压的相关性

目的研究内皮素1(ET-1)基因K198N、G8002A、+138A/-多态性与海南黎族人群原发性高血压(EH)的相关性。方法采用引物特异性片段长度多态性(PCR-SSP)方法分别检测98名海南籍黎族EH患者及244名海南籍黎族血压正常者组的ET1基因的+138A/-,K198N,G8002A位点多态性,基因频率采用基因计数法计算。研究对象与Hardy-Weinberg平衡的符合程度及组间基因型与等位基因频率比较均用χ2检验。以上统计学处理均采用SPSS16.0软件进行分析。结果海南籍黎族EH组+138A/-位点的4A3A基因型分布频率明显高于正常对照组(53.1 vs37.3)(P<0.001),高血压组中4A(+138/-)等位基因分布频率显著高于正常对照组(28.6 vs 15.78)(P=0.003)。海南籍黎族EH组K198N位点的GT基因型分布频率明显高于在正常对照组(53.1%vs37.3%)(χ2=6.595,P<0.05)。EH组G8002A位点的A等位基因分布频率明显高于正常对照组(34.7%vs 25.0%)(P<0.05)。结论 ET-1基因+138A/-、K198N多态性与海南黎族人EH相关,ET-1基因+138A/-位点的4A3A基因型和4A等位基因、K198N位点的GT基因型、G8002A位点的A等位基因与海南黎族人EH相关,4A3A基因型、GT基因型、A等位基因可能是黎族EH发生的危险因素。     

糖尿病合并肺结核降糖治疗现状调查

目的了解我院糖尿病合并肺结核患者糖尿病控制、治疗的状况。方法选2007年6月～2008年6月本院结核科住院治疗的糖尿病合并肺结核患者94例,回顾分析住院期间的降糖治疗资料,并采用门诊或电话随访方式了解其出院后的降糖治疗情况。结果79例患者出院前检测空腹血糖（FBG）为8．31±2．33mmol／L,36．71％患者的FBG〉8．3mmol／L;出院前检测餐后2h血糖（2h PBG）为12．70±2．42mmol／L,出院时39．24％患者达到糖尿病控制目标,相对来说FBG控制较好,2h PBG控制不理想。结论糖尿病合并肺结核患者住院期间FBG控制尚可,部分患者2h PBG达标不理想。表明治疗的糖尿病合并肺结核患者的总体糖代谢控制水平有待提高。     

糖尿病住院患者并发肺结核的临床特征分析

目的 了解糖尿病(包括1型、2型糖尿病患者)住院患者并发肺结核的发病率,以及对结核病活动状态的相关性进行分析。方法 回顾性分析2018年1月至2019年12月我院患糖尿病住院的2648例患者常规胸部影像学检查资料及临床资料,计算糖尿病患者并发肺结核的发病率,比较活动性与非活动性肺结核患者的基本情况,以及糖化血红蛋白(HbA1c)水平、糖尿病治疗情况。结果 2648例糖尿病患者中,2585例患者无肺结核证据,占97.62%(2585/2648);31例患者并发活动性肺结核,占1.17%(31/2648);32例患者并发非活动性肺结核,占1.21%(32/2648);活动性、非活动性肺结核均以男性为主,分别占90.32%(28/31)、84.38%(27/32);活动性肺结核患者的平均年龄为(51.16±13.06)岁,非活动性肺结核患者的平均年龄为(61.78±12.88)岁,二组比较差异有统计学意义(t=-3.236, P=0.002);活动性肺结核患者的HbA1c水平检测平均为(9.18±2.85)%,非活动性肺结核患者平均为(8.05±1.69)%,二组比较差异无统计学意义(t=1.884, P=0.070)。结论 糖尿病住院患者并发肺结核的比例高,以男性多见,应重视糖尿病住院患者的肺结核筛查和随访;血糖控制水平与糖尿病患者肺结核活动状态的相关性尚需进一步证实。     

Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study.

SETTING: Comparative studies of pulmonary tuberculosis images in diabetics have yielded conflicting results. OBJECTIVE: To assess radiological images of pulmonary tuberculosis in a large population of diabetic patients. DESIGN: Radiographs from in-patients admitted with pulmonary tuberculosis and diabetes (TBDM group, n = 192) were reviewed and compared with a control group of patients with pulmonary tuberculosis alone (TB group, n = 130). RESULTS: Both groups had a similar evolution time of tuberculosis (approximately 2 years). Statistical differences were observed as follows: TBDM patients were older (51.3+/-0.9 vs. TB group 44.9+/-1.8 years, mean +/- SEM), and had a decreased frequency of upper (17% vs. 56%), and an increased frequency of lower (19% vs. 7%) and upper + lower (64% vs. 36%) lung field lesions. More TBDM patients developed cavitations (82% vs. 59%) more often in the lower lung fields (29% vs. 3%). More multiple cavities were seen in TBDM patients (25% vs. 2%). TBDM group had a lower total leukocyte count (8836.7+/-219.5 vs. 10013.1+/-345.2 cells/mm3), mainly due to a lower number of non-lymphocyte cells (6815.8+/-221.8 vs. 8095.7+/-321.9 cells/mm3). Multiple logistic regression showed that being a diabetic patient was the most important factor determining lower lung field lesions and cavities. CONCLUSIONS: This study in a large number of diabetics with pulmonary tuberculosis confirmed that their chest X-ray images significantly depart from the typical presentation. Clinicians must keep this in mind to avoid misdiagnosis.     

Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes

Atypical radiologic images of pulmonary tuberculosis are common in elderly and in diabetic patients. To investigate the relationship of chest radiographic findings of tuberculosis to age in diabetic and nondiabetic patients, we compared the chest radiographic findings of 192 inpatients with pulmonary tuberculosis and diabetes with those of 130 patients with pulmonary tuberculosis alone. The proportion of patients with lower lung field lesions progressively increased with age (r(S) = 0.89, p < 0.01), whereas the frequency of cavitation steadily decreased with age (r(S) = -0.79, p < 0.05). In diabetic patients, a high frequency of lower lung lesions and cavitation was observed in all age groups. We speculated that, in older patients and in diabetics, the increased alveolar oxygen pressure in the lower lobes favors development of lower lobe disease in these groups.     

Pulmonary tuberculosis in diabetics.

Pulmonary tuberculosis is found predominantly in the lung apices. In diabetics it has been suggested that tuberculosis tended to occur predominantly in the lower lobes. A retrospective chart review was performed of all patients with a diagnosis of diabetes and pulmonary tuberculosis admitted to a health care facility to determine the presenting chest roentgenographic location of tuberculosis. Multiple lobe involvement was the predominant chest roentgenographic finding in both diabetics and nondiabetics with pulmonary tuberculosis. Since tuberculosis and diabetes frequently coexist in the population at risk for tuberculosis, clinicians should suspect tuberculosis in the diabetic with an abnormality on chest roentgenogram. Aggressive diagnostic measures and specific chemotherapy should be given and monitored to treat pulmonary tuberculosis.     

误诊为间质性肺疾病的肺结核12例临床分析

目的 对误诊为间质性肺疾病(ILD)的肺结核患者临床、影像学及病理学特征进行探讨,以减少误诊.方法 对2003年10月至2007年10月在北京协和医院住院的230例胸部CT表现为ILD样改变,并经病理活检确诊的患者进行回顾性分析.活动性肺结核的诊断标准为肺组织标本显示上皮样肉芽肿或抗酸染色阳性,经抗结核治疗后肺内病变吸收.结果 230例中12例为肺结核,男5例,女7例;年龄17～68岁,平均(38±11)岁;病程0.5～18个月,中位病程2个月.肺结核患者中发热11例,咳嗽9例,呼吸困难7例,浅表淋巴结肿大4例,肝脾肿大2例;胸部CT示磨玻璃影4例,多发性斑片影5例,树芽征1例,小叶中心性结节2例.12例肺结核患者经抗结核治疗后随访3～12个月(中位随访时间9个月),11例肺部病变吸收,1例死于糖尿病酮症酸中毒.结论 对病程短、发热及肝脾和淋巴结肿大、CT表现为ILD的患者应排除肺结核.     

Haptoglobin polymorphism and mortality in patients with tuberculosis.

SETTING: A rural Zimbabwean hospital and the surrounding community. OBJECTIVES: To determine whether a particular haptoglobin phenotype is associated with increased susceptibility to clinical pulmonary tuberculosis, and to determine the outcome of treatment for pulmonary tuberculosis according to haptoglobin phenotype. DESIGN: A case-control study, and a prospective cohort study. RESULTS: We studied 98 consecutive patients with sputum-positive pulmonary tuberculosis and 98 sex- and age-matched controls. The haptoglobin (Hp) phenotype distributions did not differ significantly between the tuberculosis patients and controls (P = 0.5). During the 18-month follow-up period after the start of tuberculosis treatment, 6/18 (33%) cases with Hp 2-2 phenotype died compared to 9/47 (19%) with Hp 2-1 and 3/31 (10%) with Hp 1-1. In a logistic regression model, the odds of dying were 6.1-fold greater with Hp 2-2 than with Hp 1-1 (95%CI 1.04-35.1, P = 0.04). CONCLUSION: Our results suggest that there is equal susceptibility to clinical pulmonary tuberculosis disease amongst different haptoglobin phenotypes. Nonetheless, tuberculosis patients with Hp 2-2 phenotype had a higher risk of mortality.     

免疫功能低下疾病患者肺结核的影像分析

目的探讨几种免疫功能低下疾病的肺结核患者的X线和CT所见。方法回顾分析糖尿病患者68例,肾病综合症患者20例,SLE患者12例,8例AIDS患者合并肺结核的X线及胸部CT所见。结果X线和CT表现,糖尿病肺结核:大片浸润病灶45例,浸润病灶内多发空洞40例,散在大小不等浸润病灶可不按肺段分布23例,支气管播散病灶21例;部分病例合并胸水10例。肾病综合症或SLE肺结核:急性血行播散性肺结核15例,大小不等浸润病灶17例,合并肺门及纵膈淋巴结肿大4例;AIDS肺结核:肺内斑片阴影合并有淋巴结肿大5例,急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病患者的肺结核,肺内结核病灶容易形成大片干酪病灶并合并空洞,结核肺内播散,急性血行播散性肺结核,肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

Pulmonary tuberculosis in patients with diabetes mellitus.

BACKGROUND: Diabetes mellitus has been reported to modify the presenting features of pulmonary tuberculosis, but there are varying data, particularly regarding the association with lower lung field involvement. OBJECTIVES: To determine whether diabetes mellitus alters the clinical and radiographic manifestations of tuberculosis in nonimmunocompromised hosts and to define the determinants of lower lung field involvement. METHODS: A retrospective review of the records of all patients with tuberculosis and diabetes mellitus seen during a 14-year period and of an age- and sex-matched nondiabetic control group with tuberculosis was carried out. The duration of symptoms, tuberculin reaction, bacteriologic and radiographic findings of the two groups were compared. RESULTS: The presence of diabetes mellitus was found not to have an effect on patients' symptomatology, bacteriology results, tuberculin reaction and localization of pulmonary infiltrates. On the other hand, fewer diabetic patients were smear-positive and fewer had reticulonodular opacities compared with the control patients. A higher number of insulin-dependent diabetic patients presented with cavitary disease as compared with nondiabetic controls. Lower lung field tuberculosis was significantly associated with female gender and, in patients older than 40 years, was more frequently observed in diabetics. CONCLUSION: These data show that diabetes does not affect the presenting features of pulmonary tuberculosis to a large extent and is only associated with lower lung field disease in older patients.     

肺结核合并糖尿病75例临床分析

目的分析肺结核合并糖尿病患者的临床特点。方法肺结核合并糖尿病患者75例和同期肺结核患者650例的临床资料进行比较。结果前者较后者痰抗酸杆菌涂片阳性率高、空洞形成多、治疗后痰菌阴转速度慢、肺部病灶吸收慢、空洞闭合少、抗痨疗程长。结论对于肺结核合并糖尿病患者需适当延长疗程,积极控制血糖是肺结核合并糖尿病者康复的关键。