免疫检查点抑制剂治疗后肝功能异常的组织病理学分析

目的:探讨单独使用免疫检查点阻断剂(immune checkpoint inhibitors,ICI)、ICI与靶向抗血管生成的酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)联合使用两种情况下,免疫反应介导性肝炎(immune-mediated hepatitis,IMH)的组织学表现差异。方法:收集2015至2019年在复旦大学附属中山医院接受抗ICI治疗发生肝功能异常且获得肝组织标本的病例21例。其中10例使用单药ICI,另11例使用ICI及靶向抗血管TKI联合治疗,观察组织病理形态,使用免疫组织化学方法检测程序性死亡配体1、2(programmed cell death-ligand 1,PD-L1/2)表达情况。结果:单药ICI治疗的IMH表现为程度不等、均匀分布于肝小叶及汇管区的炎性病变,并可出现小胆管炎、静脉内皮炎、Kupffer细胞活化及紫癜样变。8例(8/10)出现轻度肝损伤,2例(2/10)出现轻-中度肝损伤。在使用ICI及抗血管TKI联合治疗的患者中,肝损伤往往较为严重,其中4例(4/11)出现中-重度肝损伤,肝细胞桥接坏死、大片坏死,汇管区中-重度炎性病变,部分小胆管上皮变性,伴显著界面性肝炎。在较严重IMH的病例中,较多CD8+的T淋巴细胞聚集在汇管区及肝窦内,且有部分肝窦内皮细胞表达PD-L1。单药治疗、联合治疗中各有2例发生死亡,其中联合治疗组中有1例发生急性多发性肝炎,肝组织大片凝固性坏死,肝功能不可逆损伤,最终患者因多系统免疫失调,多器官衰竭而死亡。结论:与单用ICI相比,联合使用ICI及抗血管TKI有可能造成肝细胞的叠加损伤,引起严重IMH的可能性更高。     

National survey of patients with hemophilia and other congenital bleeding disorders in Thailand

A national survey of patients with hemophilia and other congenital bleeding disorders in Thailand was conducted in the years 2000 to 2002. Questionnaires were sent to physicians working at hospitals throughout the country. Although the overall response rate to the questionnaires was 19%, the two highest rates of 80% and 73.7% were found at university and regional hospitals, respectively, where most of the patients received their diagnosis and treatment. A total of 1,450 patients comprised of hemophilia 1,325 cases, von Willebrand disease, 69 cases, congenital factor VII deficiency, 15 cases, hereditary platelet dysfunction, 22 cases, and undefined causes of congenital bleeding disorders, 19 cases. Most were pediatric patients <15 years of age. Treatment was mainly given on demand for a bleeding episode, while only 8.6% received additional home treatment for early bleeding episodes. Replacement therapy primarily relied on fresh frozen plasma, cryoprecipitate and cryo-removed plasma. Factor concentrate was seldom used because of the high price. As a result, hemophilia care services in Thailand should be strengthened by providing comprehensive education for medical personnel, making available simple laboratory kits to determine hemophilia A and B, ensuring an adequate supply of blood components and affordable factor concentrate, and establishing home care treatment.     

Influenza viruses in Thailand: 7 years of sentinel surveillance data, 2004-2010

Please cite this paper as: Chittaganpitch et al. (2012) Influenza viruses in Thailand: 7 years of sentinel surveillance data, 2004–2010. Influenza and Other Respiratory Viruses 6(4), 276–283. Background The re‐emergence of avian influenza A (H5N1) in 2004 and the pandemic of influenza A (H1N1) in 2009 highlight the need for routine surveillance systems to monitor influenza viruses, particularly in Southeast Asia where H5N1 is endemic in poultry. In 2004, the Thai National Institute of Health, in collaboration with the US Centers for Disease Control and Prevention, established influenza sentinel surveillance throughout Thailand. Objectives To review routine epidemiologic and virologic surveillance for influenza viruses for public health action. Methods Throat swabs from persons with influenza‐like illness and severe acute respiratory illness were collected at 11 sentinel sites during 2004–2010. Influenza viruses were identified using the standard protocol for polymerase chain reaction. Viruses were cultured and identified by immunofluorescence assay; strains were identified by hemagglutination inhibition assay. Data were analyzed to describe frequency, seasonality, and distribution of circulating strains. Results Of the 19 457 throat swabs, 3967 (20%) were positive for influenza viruses: 2663 (67%) were influenza A and able to be subtyped [21% H1N1, 25% H3N2, 21% pandemic (pdm) H1N1] and 1304 (33%) were influenza B. During 2009–2010, the surveillance system detected three waves of pdm H1N1. Influenza annually presents two peaks, a major peak during the rainy season (June–August) and a minor peak in winter (October–February). Conclusions These data suggest that March–April may be the most appropriate months for seasonal influenza vaccination in Thailand. This system provides a robust profile of the epidemiology of influenza viruses in Thailand and has proven useful for public health planning.     

宫颈病变筛查方法的比较研究

目的探讨早期宫颈癌及癌前病变的最佳筛查方法。方法通过对280例受检病例进行巴氏、液基细胞学及人乳头瘤病毒(HPV)DNA检测,以组织学为金标准,以灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性拟然比、阴性拟然比为评价指标,评价3种方法对宫颈癌及癌前病变的筛查价值。结果巴氏细胞学、液基细胞学、第2代杂交俘获试验(HC2)灵敏度分别为72.9%、91.5%、85.9%;特异度分别为82.3%、84.1%、69.1%;准确性分别为80.9%、87.6%、76.8%;阳性预测值为76.1%、84.3%、70.1%;阴性预测值为79.7%、91.4%、85.4%;阳性拟然比为4.12、5.75、2.78;阴性拟然比为0.33、0.10、0.20。结论联合应用液基细胞学和HPV DNA检测是检测宫颈病变的有效筛查方法,细胞学异常或临床怀疑异常,应结合阴道镜做进一步诊断,有利于提高宫颈病变的检出率。     

彩色多普勒超声对脐带绕颈诊断结果易变性的研究

目的研究彩色多普勒血流显像(CDFI)对脐带绕颈的诊断价值和对分娩方式及对新生儿预后的影响。方法应用CDFI对389例疑脐带绕颈的晚期孕妇进行了检查,并对其脐动脉S/D比值进行了测定。结果(1)CDFI对脐带绕颈的诊断率与CDFI检查距分娩时间密切相关,分娩前1周内超声诊断率较2周及3周显著增高(P<0.01);(2)脐带绕颈组合并宫内窘迫者脐动脉收缩期/舒张期血流速度(S/D)比值(2.97±0.56)较无宫内窘迫者(2.32±0.47)显著增高(P<0.001);(3)经阴道分娩时,羊水中脐带呈直线状新生儿窒息发生率较羊水中脐带呈曲线状增高(P<0.01);(4)当脐动脉S/D值>3.0,且胎心率有改变或羊水中脐带呈直线状时,应及时行剖宫产结束分娩;(5)对晚期孕妇追踪结果显示脐带绕颈结果易变,与诸多因素有关,需追踪观察。结论CDFI对脐带绕颈的诊断率与CDFI检查距分娩时间密切相关;脐动脉S/D比值及羊水中脐带的曲直状态对预测胎儿宫内窘迫及分娩时新生儿窒息的发生率有较大的临床价值。可用来指导临床正确处理产程和及时选择合适的分娩方式。     

细胞间粘附分子-1在乙型肝炎后肝细胞癌表达的免疫组化研究

为探讨细胞间粘附分子－１（ＩＣＡＭ－１）在原发性肝细胞癌的表达状况及其在肝癌发生中的作用，利用免疫组织化学技术链菌素亲生物蛋白（ＬＳＡＢ）法检测３０例乙型肝炎后肝细胞癌及癌旁肝组织ＩＣＡＭ－１的表达情况，结果 肝癌组织中，ＩＣＡＭ－１存在一定程度的表达，其中癌组织阳性率为４３．３％，多为弱表达，癌旁肝组织明显高于癌组织，阳性率为７８．６％，多呈弥漫强阳性表达，二者差异有显著性（Ｐ〈０．１０）。结论     

社区老年人认知衰弱风险预测模型的构建及验证

目的 构建并验证社区老年人认知衰弱风险预测模型。方法 2020年8月—2021年7月便利选取广州市某社区卫生服务中心526名体检老年人,分为建模集368名和验证集158名,采用一般状况调查表及认知衰弱评定工具收集资料。采用Logistic回归确定影响因素,应用R软件建立预测认知衰弱发生风险的列线图模型;采用加强Bootstrap法做模型内部验证,以验证集做外部验证,采用C统计量、校准曲线评价模型的预测性能。结果 模型变量包括工具性日常生活能力、自评健康状况、日间精神状态自评、慢性病数量、年龄、营养状况及体育锻炼,受试者操作特征曲线下面积为0.920（95%CI：0.892~0.947）,最佳临界值为0.401,灵敏度为79.7%,特异度为89.1%。内外部验证C统计量分别为0.910（95%CI：0.863~0.936）、0.850（95%CI：0.785~0.915）,校准曲线和Brier得分均显示拟合良好。结论 预测模型的区分度和校准度良好,可直观、简便地甄别社区认知衰弱高风险老年人,为早期筛查与干预提供参考。     

原发性肝透明细胞癌的 CT 及 MRI 表现

目的：评价 CT 和 MRI 对原发性透明细胞型肝癌(PCCCL)的诊断价值。方法回顾性分析38例经手术病理证实的PCCCL 的 CT 和 MRI 表现。26例行 CT 检查,23例行 MRI 检查,其中11例同时进行了 CT 及 MRI 检查。结果CT 平扫表现为低密度(n=24,92.3%)、稍高密度(n=2,7.7%)。MR T1 WI 呈低信号(n=19,82.6%)或混杂高信号(n=4,17.4%),脂肪抑制后信号均有不同程度下降。T2 WI 病灶为高或稍高信号(n=22,95.7%),1例为等低信号(n=1,4.3%),CT/MR 动态增强后动脉期所有病灶均强化(n=38),门静脉期病灶呈相对低密度(n=35,92.1%)或稍高密度/高信号(n=3,7.9%)。肿瘤内结节状强化共14例。环形包膜样强化26例(26/38,68.4%)。结论PCCCL 既有普通型肝癌“快进快出”的强化方式和包膜样强化的特征,又有自身特点即肿瘤内结节状强化和瘤内脂肪成分。