黑龙江省慢性丙型肝炎病毒感染者的血清型及其临床意义

慢性丙型肝炎是危害人类健康的严重疾病.我国丙型肝炎的感染率为3.2%[1],国内HCV RNA基因型主要为1b和2a.不同地区丙型肝炎的血清型不同,不同血清型的致病性不同,对干扰素治疗的反应也不一致[2].我们随机选取黑龙江省120例慢性丙型肝炎病毒感染者进行HCV血清型的检测并探讨其与疾病严重程度的关系.     

乳果糖联合血浆置换治疗对慢性重型肝炎患者内毒素血症的影响

重型肝炎患者病情危重,病死率高,发病机制复杂.目前研究发现,内毒素及内毒素启动所致细胞因子瀑布效应是导致肝细胞凋亡坏死的重要原因之一,因此清除内毒素血症是重型肝炎患者康复的关键[1].血浆置换能有效清除重型肝炎患者体内蓄积的大量内毒素,乳果糖能有效地减少肠源性内毒素血症.本研究对血浆置换联合乳果糖治疗重型肝炎患者的内毒素、胆红素清除率和反弹率的影响进行了初步探讨.     

汉坦病毒通过线粒体途径诱导Vero E6细胞凋亡

目的 探讨汉坦病毒诱导非洲绿猴肾细胞Vero E6凋亡的机制.方法 汉坦病毒感染VeroE6细胞后应用Western blot检测胞浆内汉坦病毒核心蛋白(N蛋白)的表达情况,应用DNA-ladder和流式细胞术检测汉坦病毒感染Veto E6细胞诱导凋亡的发生,用Western blot方法检测凋亡相关蛋白Bcl -2、...     

HBsAg、HBcAg活化树突状细胞治疗慢性乙型肝炎的体外研究

目的 研究慢性乙型肝炎患者外周血树突状细胞(DC)经HBsAg、HBcAg活化后的免疫功能.方法 从慢性乙型肝炎患者外周血中培养扩增DC,在DC成熟前,加入纯的HBsAg、HBcAg刺激,用流式细胞仪检测DC表型,用液闪计数仪观察DC对T细胞的增殖作用,用ELISA法检测混合淋巴细胞反应(MLR)中细胞因子的分泌水平.结果 经HBcAg刺激DC的CD86表达率为(92.14±5.12)%,明显高于HBsAg刺激组和未加抗原组(P＜0.01);经HBcAg刺激组DC诱导同种异体静止T细胞增殖的能力每分钟液闪计数值(cpm)为34259±3127,明显高于HBsAg刺激组(20258±2917)和单个核细胞组(3469±417),P＜0.01;经HBcAg刺激组DC MLR中IL-12浓度为(342±42.3)ng/L,分别高于HBsAg刺激组和未加抗原组(P＜0.01).结论 体外经HBcAg刺激DC可有效提呈抗原病毒,并可进一步刺激T细胞产生.     

肾综合征出血热并发低钠性脑水肿临床特征及甘露醇联合高钠血液透析疗效分析

Objective To study the clinical features of patients with hemorrhagic fever with renal syndrome(HFRS)complicating hyponatremia encephaledema and therapeutic effect of manicol and high sodium hemodialysis.Methods Eighty-three patients with HFRS complicating hyponatremia encephaledema were randomly divided into high sodium hemodialysis treatment group(n=41)and control group(n=42).The serum levels of potassium,sodium,chlorine,creatinine,osmotic pressure,normalization rates and normalization time of serum sodium,mortality of patients in two groups post-treatment were compared.Statistical analysis was performed using t test or chi square test.Resalts The serum levels of sodium [(128.95±7.3)mmol/L],chlorine[(96.7±6.2)mmol/L],osmotic pressure[(253.1±7.5)mOsm/L]of patients post-treatment in high sodium hemodialysis treatment group were all significantly higher than those[(117.8±7.1)mmol/L],[(92.2±6.9)mmol/L],[(242.1±8.4)mOsm/L]of patients in control group (t=7.14,t=3.12,t=15.22,respectively;all P＜0.05).The serum sodium normalization number of patients(12/19 cases)with moderate encephaledema in high sodium hemodialysis treatment group was significantly higher than that(6/19 cases)in control group(X2=3.867,P=0.049).The serum sodium normalization time of patients with moderate encephaledema in high sodium hemodialysis treatment group WaS(4.9±1.3)d,which was significantly shorter than that[(8.3±1.9)d]in control group(t=6.438,P=0.001).The serum sodium normalization number of patients(7/14 cases)with severe encephaledema in high sodium hemodialysis treatment group was significantly higher than that(2/14 cases)in control group(X2=4.094,P=0.043).The serum sodium normalization time of patients with severe encephaledema in high sodium hemodialysis treatment group was(7.8±1.9)d,which was significantly shorter than that[(11.6±2.8)d]in control group(t=3.235.P=0.034).The mortality in high sodium hemodialysis treatment group was 36.6%(15/41 cases),which was significantly lower than that(61.9%,26/42 cases)in control group(X2=5.321,P=0.021).Conclusions The conditions of patients with HFRS complicating hyponatremia encephaledema tend to be severe.In patients with HFRS complicating moderate or severe encephaledema,manicol and high sodium hemodialysis can improve the normalization rate and normalization time of serum sodium,and reduce the mortality.     

抗病毒治疗对慢性丙型肝炎患者Treg/Th17细胞比例变化的影响

目的 了解抗病毒治疗对慢性丙型肝炎患者调节性T细胞(Treg) /Th17细胞比例变化的影响.方法 32例慢性丙型肝炎患者进行聚乙二醇干扰素α-2a联合利巴韦林治疗,20例健康人作为对照.在抗病毒治疗前和随访24周时,采用流式细胞仪检测患者外周血Treg和Th17细胞频率,ELISA法检测患者IL-17的水平,观察Treg/Th17细胞比例变化与患者获得持续性病毒学应答(SVR)的关系.统计学处理采用t检验.结果 抗病毒治疗前患者外周血中Th 17、Treg细胞频率和Treg/Th17比例明显高于对照组[(4.58±0.86)％与(2.48±0.60)％,t=2.399,P＜0.05;(8.58±2.20)％与(4.70±1.30)％,t=7.990,P＜0.01;(1.82±0.40)与(1.60±0.35),t=2.088,P＜0.05].抗病毒治疗后Th 17、Treg细胞频率和Treg/Th17比例分别为(5.35±0.79)％、(6.46±1.29)％、(1.25±0.21).获得SVR患者Th17细胞频率为(6.27±1.15)％,明显高于未获得SVR的(4.05±0.82)％(t=10.103,P＜0.01).获得SVR患者Treg细胞频率和Treg/Th17比例为(4.90±1.39)％、(0.80±0.15),明显低于未获得SVR的(7.42±1.95)％、(1.83±0.42)(t=5.718,8.752,P＜0.01).获得SVR患者IL-17水平为(143.5±31.2)pg/mL,明显高于未获得SVR患者组的(121.4±30.1 )pg/mL(t=2.028,P＜0.05).结论 慢性丙型肝炎患者Treg/Th 17细胞比例高于对照组,抗病毒治疗后Treg/Th17细胞比例下降,获得SVR患者下降更为明显.     

终末期肝病模型评分系统预测慢性重型肝炎患者预后的价值

慢性重型肝炎是常见的难治性疾病,病死率达60%～90%。本研究引入终末期肝病模型(modelforend stageliver disease,MELD)评分系统预测慢性重型肝炎患者的预后,并应用c统计值(concordancestatistic)评估MELD预测的准确性;同时探讨年龄、性别、病因、低钠血症、顽固性腹水对MELD评     

甘利欣对鼠酒精性肝病治疗作用研究

目的探讨甘利欣对酒精性肝病的治疗作用.方法 Wistar鼠随机分为正常对照组、模型组、未治组和治疗组, 56°白酒灌胃制造酒精性肝病模型,治疗组腹腔注射甘利欣,未治组腹腔注射生理盐水做对照;腹主动脉采血检测肝功、ELISA法检测肿瘤坏死因子(TNF-α)水平,取肝脏组织做病理组织学检查.结果正常对照组肝脏病理均为正常,模型组酒精性肝病按病理分级,4级13例,3级2例,2级1例;未治组(4级15例,3级3例,2级2例)与模型组无明显差异 ,P>0.05;治疗组正常3例,1级10例,2级5例,与未治组比较P<0.05;治疗组丙氨酸氨基转移酶(ALT)(36.3U/L±11.5U/L)、天门冬氨酸氨基转移酶(AST)(46.7U/L± 18.2U/L)、γ-谷胺酰转肽酶(γ-GT)(55.3U/L±12.3U/L)、TNF-α(1.6ng/ml±0.52 ng/ml)明显低于模型组和未治组(ALT 198.1U/L±66.3U/L,189.0U/L±69.7U/L,AST 253 .0U/L±62.1U/L,268.0U/L±60.5U/L,γ-GT 156.6U/L±38.7U/L,149.8U/L±38.1U/L, TNF-α 2.8ng/ml±0.65ng/ml,2.7ng/ml±0.60ng/ml),P<0.05.结论甘利欣通过降低血清TNF-α水平,改善肝组织治疗酒精性肝病.     

肾综合征出血热并发低钠性脑水肿临床特征及甘露醇联合高钠血液透析疗效分析

Objective To study the clinical features of patients with hemorrhagic fever with renal syndrome(HFRS)complicating hyponatremia encephaledema and therapeutic effect of manicol and high sodium hemodialysis.Methods Eighty-three patients with HFRS complicating hyponatremia encephaledema were randomly divided into high sodium hemodialysis treatment group(n=41)and control group(n=42).The serum levels of potassium,sodium,chlorine,creatinine,osmotic pressure,normalization rates and normalization time of serum sodium,mortality of patients in two groups post-treatment were compared.Statistical analysis was performed using t test or chi square test.Resalts The serum levels of sodium [(128.95±7.3)mmol/L],chlorine[(96.7±6.2)mmol/L],osmotic pressure[(253.1±7.5)mOsm/L]of patients post-treatment in high sodium hemodialysis treatment group were all significantly higher than those[(117.8±7.1)mmol/L],[(92.2±6.9)mmol/L],[(242.1±8.4)mOsm/L]of patients in control group (t=7.14,t=3.12,t=15.22,respectively;all P＜0.05).The serum sodium normalization number of patients(12/19 cases)with moderate encephaledema in high sodium hemodialysis treatment group was significantly higher than that(6/19 cases)in control group(X2=3.867,P=0.049).The serum sodium normalization time of patients with moderate encephaledema in high sodium hemodialysis treatment group WaS(4.9±1.3)d,which was significantly shorter than that[(8.3±1.9)d]in control group(t=6.438,P=0.001).The serum sodium normalization number of patients(7/14 cases)with severe encephaledema in high sodium hemodialysis treatment group was significantly higher than that(2/14 cases)in control group(X2=4.094,P=0.043).The serum sodium normalization time of patients with severe encephaledema in high sodium hemodialysis treatment group was(7.8±1.9)d,which was significantly shorter than that[(11.6±2.8)d]in control group(t=3.235.P=0.034).The mortality in high sodium hemodialysis treatment group was 36.6%(15/41 cases),which was significantly lower than that(61.9%,26/42 cases)in control group(X2=5.321,P=0.021).Conclusions The conditions of patients with HFRS complicating hyponatremia encephaledema tend to be severe.In patients with HFRS complicating moderate or severe encephaledema,manicol and high sodium hemodialysis can improve the normalization rate and normalization time of serum sodium,and reduce the mortality.