TLR4基因多态性与中国汉族儿童结核病易感性的关联研究

目的：探讨TLR4的基因多态性与中国汉族儿童结核易感性的关系。方法收集348名汉族儿童结核病患者,并按照发病部位和严重程度分为肺内结核病、肺外结核病、重症结核病和非重症结核病亚组,以同期查体的389名儿童作为对照,采用病例对照研究,应用高通量MassARRAY技术对于TLR4基因的SNP位点进行基因分型研究。结果研究显示结核组和对照组TLR4基因rs1399431位点基因频率存在差异;rs1399431、rs1927907和rs11536889的基因型频率在亚组间的分布差异具有统计学意义。在显性模式下,rs1927907的A等位基因和rs1399431的T等位基因和正常组比较对于肺外结核病(Prs1927907=0．042和Prs1399431=0．012)具有保护作用;而rs1399431的T等位基因和非重症结核病比较,对于重症TB(Prs1399431=0．012)具有保护作用;在隐性遗传模式下rs11536889的C等位基因和正常组比较对于重症结核病(Prs1399431=0．024)具有易感作用。结论结果提示TLR4基因在结核病易感性方面,特别是结核病亚组之间具有一定作用。     

中国汉族儿童TIRAP基因单核苷酸多态性分析未显示其与结核病的易感相关

目的 探讨中国汉族儿童TIRAP基因Tag SNP位点的多态性与结核病易感性相关关系,以明确TIRAP基因在儿童结核病发病中的作用。方法 本课题组收集339名汉族儿童结核病患者,以同期查体的392名儿童作为对照,采用病例对照研究,应用高通量MassARRAY技术对于TIRAP基因的SNP位点进行基因分型研究。使用的是改进的盐析法进行基因组DNA的提取。结果 TIRAP基因的5个Tag SNPs(rs563011、rs8177400、rs1786704、rs8177375、rs8177352),除了1个SNP位点(rs563011)等位基因检出率<95%及1个(rs8177400)AA基因型在人群中的分布为0,另外3个SNPs位点(rs1786704、rs8177375、rs8177352)的等位基因、基因型以及单体型在结核病组和对照组的分布差异均无统计学意义(P>0.05)。结论 TIRAP基因多态性与中国汉族儿童结核病易感不存在相关性。     

TLR-9 基因多态性与膝骨关节炎的易感性研究

目的研究Toll样受体9(TLR9)基因rs187084和rs5743836位点单核苷酸多态性,探讨其与膝骨关节炎易感性之间的联系。方法采用直接测序法分析145例膝骨关节炎患者和145名健康对照组的TLR9基因rs187084-1486TC和rs5743836-1237CT位点单核苷酸多态性。结果rs187084位点C等位基因是膝骨关节炎发生保护因素(OR=0.599,95%CI=0.424-0.847,P=0.002)。rs5743836位点基因型频率在研究组和对照组之间差异无统计学意义(χ~2=5.14,P=0.08)。TLR9基因rs187084位点单核苷酸多态性与年龄、膝骨关节炎严重程度相关,rs5743836位点单核苷酸多态性与年龄、膝骨关节炎严重程度不相关。结论 TLR9基因rs187084-1486TC位点单核苷酸多态性与膝骨关节炎易感性相关,rs5743836-1237CT位点单核苷酸多态性与膝骨关节炎易感性不相关。     

xCT基因rs13120371位点单核苷酸多态性与肺结核易感性的相关性

目的 通过大样本病例与对照研究明确xCT基因功能性SNP与结核病易感性的相关性,明确其调控结核病发生发展的分子机制。方法 从健康对照和结核患者的全血样本中提取基因组DNA,采用TaqMan探针技术对xCT基因rs13120371位点进行基因分型并对基因频率进行关联性分析,结核菌特异性抗原IFN-γ斑点形成细胞的数量和放射影像学分数反应不同基因型与临床指标的相关性,Real-time PCR方法检测健康对照和结核患者外周血单个核细胞中xCT基因及其相关的CXCL1、CXCL2、IL1B基因的表达水平。结果 等位基因位点基因频率分布符合Hardy-Weinberg平衡定律(χ²=0.678,P>0.05),选择的样本具有群体代表性。rs13120371位点的单核苷酸多态性与结核病的易感性相关,其中结核患者组等位基因A的基因频率为70.2%,等位基因G的基因频率为29.8%;健康对照组等位基因A的基因频率为66.8%,等位基因G的基因频率为33.2%,两组之间的等率基因频率差异具有统计学意义(P=0.02,OR=0.86)。AA基因型患者的结核菌特异性刺激分泌的IFN-r斑点形成细胞数量及炎症反应指标明显高于基因型GG的患者,基因型AA的细胞xCT基因的表达水平也明显上调。结论 xCT基因rs13120371位点的单核苷酸多态性与汉族人群结核感染的易感性相关,并且rs13120371位点是功能性SNP,等位基因A可能增加结核菌感染的风险。     

转化生长因子β1基因rs2317130单核苷酸多态性与结核病易感性的关联分析

目的探究转化生长因子β1(transforming growth factorβ1, TGF-β1)基因单核苷酸多态性(single nucleotide polymorphism, SNP)与结核病易感性的关系,为结核病的诊断和治疗提供更多的参考依据。方法通过病例-对照(case-control)研究方法,以深圳市第三人民医院1 533例确诊的活动性结核病患者作为病例组(男980例,女553例),选取同期在该院体检的1 445例人员作为健康对照组。通过飞行时间质谱仪(TOF-MS)检测TGF-β1基因6个SNP位点rs2317130、rs17516265、rs8110090、rs3087453、rs2278422、rs1800469基因型,通过比较两组间SNP等位基因频率差异,初步筛选出与结核病易感性相关联的SNP位点。用结核分枝杆菌标准株H37Rv刺激不同基因型的健康人外周血单个核细胞(peripheral blood mononuclear cell, PBMCs),ELISA检测上清中TGF-β1含量,进一步验证TGF-β1基因SNP位点与结核易感性的关系。结果在6个SNP位点中发现仅rs2317130 CT位点等位基因频率在活动性结核组和对照组中差异有统计学(P0.05),结核病患者rs2317130 CT位点C等位基因频率显著增高(OR=1.14;95%CI=1.03～1.26;P0.01),其他5个SNP等位基因频率在两组之间差异无统计学意义(P0.05)。此外,ELISA实验结果表明,rs2317130 SNP位点CC纯合子基因型的患者TGF-β1表达量显著高于其他基因型(CT杂合子和TT纯合子基因型),TGF-β1表达量上调可加速结核病发展,进一步证实rs2317130位点C等位基因为结核易感基因。结论 TGF-β1基因rs2317130 CT位点与结核易感性相关,其C等位基因为结核易感基因,即携带C等位基因人群患结核风险升高。     

Ⅰ型干扰素受体1单核苷酸多态性与结核病易感性的关联性

目的 探究Ⅰ型干扰素受体1(typeⅠinterferon receptor 1,IFNAR1)单核苷酸多态性(single nucleotide polymorphism,SNP)与结核病易感性的关系。方法 应用病例-对照研究方法,以深圳市第三人民医院1 533例活动性结核病患者(包括1 432例肺结核、101例肺外结核)作为病例组,1 445例健康人群作为对照组。运用MassARRAY飞行时间质谱技术,通过检测Ⅰ型干扰素(interferon,IFN)基因rs72552343、rs2834191、rs1012334、rs17875752、rs2843710、rs1041868位点基因型,分析两组间SNP等位基因频率差异,同时进一步比较肺结核与肺外结核病患者rs72552343 TCC/Del位点等位基因频率差异。结果 用MassARRAY飞行时间质谱技术可以有效地检测6个SNP位点基因型。在6个SNP位点中,发现仅rs72552343 TCC/Del位点等位基因频率在活动性结核组和对照组中差异有统计学意义(P<0.05),结核病患者rs72552343 TCC/Del位点TCC等位基因频率显著增高(OR=0.46;95%CI=0.31~0.70;P=0.0002),其他5个SNP等位基因频率在两组之间差异无统计学意义(P>0.05)。另外,发现肺外结核病患者rs72552343 TCC/Del位点TCC等位基因的频率与肺结核病患者差异无统计学意义(OR=0.88;95%CI=0.20~3.74;P=0.86)。结论 IFN基因rs72552343 TCC/Del位点 SNP与结核易感性相关,其TCC等位基因为结核易感基因,但携带TCC等位基因的个体患活动性肺结核与肺外结核的风险一致。     

Toll样受体4基因多态性与汉族男性中风证型关联性研究

目的 探讨中国南方汉族人Toll 样受体4基因(TLR4)多态性rs1927914、rs10759932和rs11536889与中风证型（风痰瘀阻证、气虚血瘀证）易感性、基因表达水平、细胞因子及血脂代谢的相关性。方法 采用病例对照研究方法,将559例中风患者按中医辨证分气虚血瘀型组（248例）及风痰瘀阻型组（311例）,另设一性别、年龄相匹配健康对照组（605例）。所有研究对象均来自汉族。采用Sequenom Mass ARRAY 技术对TLR4基因的rs1927914、rs10759932和rs11536889进行基因分型检测,实时荧光定量PCR（qPCR）检测TLR4信使核糖核酸(mRNA)表达水平,酶联免疫吸附测定(ELISA)检测白细胞介素-1β(IL-1β)、白细胞介素-6（IL-6)、白细胞介素-8（IL-8)、白细胞介素-12（IL-12)、肿瘤坏死因子-α(TNF-α）水平,HITACHI日立7600全自动生化分析仪测定总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL）、低密度脂蛋白胆固醇（LDL）水平。结果 rs10759932的等位基因频率在中风气虚血瘀型男性病例与男性对照组之间的分布存在统计学差异（P<0.05）。rs1927914（显性模型:OR=0.65, 95% CI=0.43-0.96, Padj=0.031）、rs10759932（显性模型:OR=0.64, 95% CI=0.41-0.99, Padj=0.046）位点多态性与男性中风气虚血瘀证易感性显著关联。携带rs10759932位点TT基因型的中风气虚血瘀型患者的IL-8血清水平显著低于CC+CT者（P<0.01）。rs11536889多态性与中风气虚血瘀型男性患者的TG水平 (加性模型:P_adj=0.021, 显性模型:P_adj=0.013)、HDL (显性模型:P_adj=0.032)显著关联。结论 TLR4基因多态性影响汉族男性中风气虚血瘀证的发生及炎性反应和血脂代谢病理过程。      

CISH基因多态性与河北地区肺结核易感性的相关性研究

目的探讨细胞因子诱导含SH2结构域蛋白(cytokine-inducible SH2-containing protein,CISH)基因单核苷酸多态性(Single nucleotide polymorphism,SNP)在河北地区汉族人群中的分布及其与肺结核(Tuberculosis,TB)易感性的关系。方法利用SNa Pshot技术分析法检测河北地区205名健康人(汉族)和214例肺结核病人(汉族)CISH基因3个位点rs414171、rs2239751和rs6768300位点的多态性,并进行基因型频率和等位基因频率的比较,通过统计学方法分析这些基因位点的多态性与肺结核易感性之间的相关性。结果选取的214例肺结核病人和205名正常人的年龄(t=0.014,P0.05)、性别(χ~2=0.021,P0.05)差异均无统计学意义,rs414171、rs2239751和rs6768300位点的基因频率分布均符合Hardy-Weinberg平衡定律(P0.05)。与对照组相比,结核组的rs414171位点的基因型(TT、TA、AA)(χ~2=4.052,P0.05)、等位基因(T/A)(χ~2=2.189,P0.05),rs2239751位点的基因型(AA、AC、CC)(χ~2=1.265,P0.05)、等位基因(A/C)(χ~2=1.177,P0.05),rs6768300位点的基因型(AA、AC、CC)(χ~2=0.908,P0.05)、等位基因(A/C)(χ~2=0.729,P0.05)差异均无统计学意义。结论 CISH基因的rs414171、rs2239751和rs6768300位点多态性与河北地区汉族人群的肺结核易感性没有显著的相关性。     

重庆汉族儿童IL-18基因启动子-137G/C多态性及蛋白表达与结核病易感性的关系

目的:探讨重庆汉族儿童白介素-18(Interleukin 18,IL-18)18基因启动子单核苷酸多态性(Single nueleotide polymorphism,SNP)与结核病易感性的关系及其对蛋白表达能力的影响.方法:序列特异性引物-聚合酶反应(Sequence specific pfimers-pdy merase chain reaotion,SSP-PCR)方法分析113名重庆汉族结核病患儿及167名健康儿童IL-18基因启动子(-607C/A和-137G/C)多态性;ELISA检测46例重庆汉族健康儿童PBMCs培养上清中IL-18的表达水平.结果:结核患儿组IL-18-137GG基因型的分布频率(81.4%)显著高于健康对照组(67.7%)(P=0.01),-137GC基因型的分布频率(16.8%)显著低于健康对照组(28.7%)(P=0.02);结核患儿组IL-18-137等位基因C分布频率(10.2%)明显低于健康对照(18.0%)(P=0.01);而结核患儿IL-18-607位各基因型及等位基因频率与健康对照比较无显著性差异.携带IL-18-137GG基因型儿童的PBMCs体外自发或经PMA A23187活化后,表达IL-18蛋白的水平显著低于-137GC基因型者(P＜0.01).结论:IL-18-137位基因多态性可能与重庆儿童结核病易感性有关,等位基因G可能使IL-18蛋白低表达,是结核病的易感基因,而IL-18-607位基因多态性则可能与结核病易感性无关.     

TLR8基因多态性与中国东北地区汉族肺结核病的关联性分析

目的：探讨Toll样受体8(TLR8)基因的4个位点单核苷酸多态性（SNP）与我国东
北地区汉族人群结核病的关联性,分析其基因型频数分布在肺结核病与其他肺病间的差异。方法
：采用病例-对照的研究方法。选择中国东北地区368例汉族肺结核病患者 (病例组)和355
例汉族其他肺病患者 (对照组)为研究对象。应用连接酶特异检测技术检测2组患者TLR8基因4个位
点rs3764880、rs3761624、rs3788935和rs3764879的基因型,比较2组患者等位基因频数分布差异,
计算其危险系数(OR),并比较不同性别患者组间基因型频数分布的差异。 结果 ： TLR8基因
rs3764880、rs3761624、rs3788935和rs3764879位点等位基因型频数在2组间分布差异无统计学意义(P>0.05);不同性别的2组患者T
LR8基因4个位点等位基因频数分布差异无统计学意义(P>0.05)。结论：TLR8基因位点rs37
64880、rs3761624、rs3788935和rs3764879的SNP在我国东北地区汉族肺结核患者与其他肺病
患者中的分布相同,提示上述TLR8基因4个位点的SNP与结核病的发生无关联性。     

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.     

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…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.