过敏性紫癜患儿外周血单个核细胞 TLR2、TLR4表达及其与 Th1和 Th2型免疫应答相关性观察北大核心CSCD

目的：研究Toll样受体（Toll-like receptor,TLR）2、TLR4在过敏性紫癜（HSP）患儿外周血单核细胞的表达及其与Th1和Th2型免疫应答的相关性,探讨TLR2、TLR4在HSP发病机制中的作用。方法选取2011年10月-2012年11月于我院儿内科收治的HSP患儿64例为研究对象,分为HSP无肾损害组（NHSPN,36例）及HSP有肾损害组（HSPN,28例）,另选取我院儿保科健康查体儿童30例作为正常对照组。采用流式细胞术检测外周血T淋巴细胞亚群及单核细胞TLR2及TLR4蛋白表达,实时荧光定量PCR技术检测外周血单核细胞TLR2 mRNA及TLR4 mRNA的基因相对表达量,ELISA法检测血浆IFN-γ、IL-4、IL-6水平。结果（1） HSP 患儿外周血单核细胞TLR2 mRNA、TLR4 mRNA相对表达量及TLR2、TLR4蛋白表达均显著高于正常对照组（P均＜0．01）,HSPN组外周血单核细胞TLR2 mRNA、TLR4 mRNA相对表达量及TLR2、TLR4蛋白表达均明显高于NHSPN组（P＜0．05;P＜0．01;P＜0．01;P＜0．01）。（2）HSP组CD3＋T细胞、CD3＋CD4＋T细胞显著降低,CD3＋CD8＋T细胞及CD3＋HLADR＋活化T细胞明显升高（P均＜0．01）。（3）HSP组血浆IL-4、IL-6水平显著高于正常对照组（P＜0．01,P＜0．01）,IFN-γ水平显著低于正常对照组（P＜0．05）,IFN-γ/IL-4比值显著低于对照组（P＜0．01）。（4）HSP组TLR2、TLR4蛋白表达与血浆IL-4、IL-6水平均呈显著正相关（P＜0．01,P＜0．05;P＜0．01,P＜0．01）;与IFN-γ/IL-4比值均呈显著负相关（P＜0．01;P＜0．01）。结论TLR2及TLR4活化可能参与了HSP的免疫发病机制,TLR2及TLR4的过度活化可能与HSP的肾损伤有关。 HSP患儿存在T淋巴细胞亚群失调,功能紊乱,Th1/Th2失衡。活化的TLR2及TLR4可能通过上调Th2型免疫应答介导HSP的免疫发病机制。     

急性轮状病毒腹泻小儿单个核细胞Toll样受体的变化

目的研究轮状病毒腹泻小儿单个核细胞Toll样受体的变化。方法收集3岁以下因急性轮状病毒腹泻来复旦大学附属儿科医院就诊的小儿75例,以荧光定量RT-PCR方法检测外周血单个核细胞TLR2,3、4、7、8 mRNA的表达情况。结果起病时间在3d以内的小儿外周血单个核细胞中TLR2、3、4、7、8 mRNA的表达水平都有明显升高,P均<0.05。其中TLR2、3、8 mRNA表达在发病7d和14d时仍高于对照组,P均<0.05。TLR4 mRNA的表达在病情较重的患儿比较轻的患儿高,P<0.05。结论多种TLR参与了轮状病毒引发的宿主免疫应答反应的启动和调节。     

TLR途经负性调节因子A20、IRF-4和TRAF4在川崎病免疫发病中的变化

目的 探讨Toll样受体（TLR）信号途径负性调控因子在川崎病（KD）免疫发病机制中的作用。方法 急性期KD患儿48例，正常同年龄对照组16例，感染性疾病对照组（ID）16例。采用逆转录．聚合酶链反应（RT．PcR）及荧光定量PCR检测外周血单核，巨噬细胞（MC）TLR4信号途径传导分子、负性调节因子及前炎症细胞因子mRNA的表达。结果 （1）急性期KD患儿TLR4、MD-2、MyD88、IRAK-4、TRAF6、TAK1、TAB1及TAB2mRNA表达明显高于正常同年龄对照组（P〈0．01）；（2）KD及ID患儿A20、IRF-4、TRAF4基因表达上调（P〈0．01）；KD患儿除．A20表达水平高于ID对照组外，IRF-4、TRAF4表达水平明显低于ID对照组（P〈0．01）；KD患儿前炎症细胞因子表达明显高于ID组（P〈0．01）；（3）经细菌脂多糖（LPS）刺激后，KD患儿及正常对照组A20、IRF-4及TRAF4表达明显增高（P〈0．01），但KD患儿3种负性调节因子基因表达显著低于正常对照组（P〈0．01）；（4）KD合并冠状动脉损伤组（KD-CAL^＋）MC负性调节因子IRF-4及TRAF4明显低于无冠状动脉损伤组（KD-CAL^-），A20表达则显著高于后者；KD-CAL^＋组前炎症细胞因子IL-1β、IL-6、TNF-α均高于KD-CAL^-组（P〈0．01）。结论 急性期KD患儿TLR信号途径负性调节因子相对表达不足可能与KD的免疫发病机制有关。     

IL-2等6种细胞因子与儿童支气管哮喘关系的研究

观察急性发作期、激素治疗后缓解期支气管哮喘患儿血浆细胞因子的变化,探讨儿童支气管哮喘与细胞因子的关系。采用免疫分析技术对64例急性发作期支气管哮喘患儿、45例缓解期患儿及20例正常儿童血浆IL-2、sIL-2R、IL-4、IL-5、IL-8、TNF-α、IgE等细胞因子水平进行测定;用逆转录聚合酶键反应技术（RT-PCR）对外周淋巴细胞IL-4、IL-5mRNA表达进行定量分析。结果:（1）发作期哮喘患儿血浆IL-2、sIL-2R、IL-4、IL-5、IL-8、TNF-α和IgE水平均明显高于正常对照组（P值均<0.001）,以IL-4、IL-5和IgE变化最为明显,缓解期均明显下降,但IL-4、IL-5及IgE水平仍高于正常水平（P<0.01）。（2）发作期患儿外周淋巴细胞IL-4、IL-5mRNA表达增强,治疗缓解后减弱,同时血浆IL-4、IL-5分别与IL-4、IL-5mRNA呈明显正相关关系。结论:（1）本研究结果提示细胞因子的释放与哮喘的发作密切相关。（2）外周淋巴细胞IL-4、IL-5强表达以及血浆IL-4、IL-5高水平提示哮喘发作期Th2亚群的激活;同时IL-8和TNF-α的升高表明中性粒细胞和单核巨噬细胞可能参与哮喘的发作。（3）糖皮质激素抑制多种细胞因子的释放,可能是其治疗哮喘的主要机制。     

瑞香素对人PBMC的细胞因子和TLRs mRNA表达的影响

目的观察瑞香素对人外周血单个核细胞的细胞因子和Toll样受体表达的影响,研究瑞香素增强淋巴细胞功能的作用机制。方法分离人外周血T、B细胞和单核细胞,分别加入瑞香素,37℃,5%CO2培养48 h后,采用实时荧光定量PCR检测瑞香素对T细胞IL-2、IFN-γ,B细胞IL-12,单核细胞IL-1 mRNA及T、B细胞TLR1～10的mRNA表达的影响;同时检测先用抗TLR4单抗封闭,再用瑞香素处理细胞后上述细胞因子和TLRs的mRNA表达变化。结果瑞香素能明显上调T细胞IL-2及IFN-γ、B细胞IL-12、单核细胞IL-1 mRNA和T细胞TLR1、TLR4,B细胞TLR4、TLR9 mRNA的表达(P﹤0.05),其中T细胞IL-2、B细胞IL-12、单核细胞IL-1 mRNA的表达和T细胞TLR4,B细胞TLR4、TLR9 mRNA表达可被抗TLR4单抗部分阻断。结论瑞香素增强淋巴细胞的免疫功能的可能机制是通过上调T细胞TLR1、TLR4,B细胞TLR4、TLR9的表达,分别参与其细胞内信号转导,从基因转录水平促进T、B细胞分泌细胞因子。     

实时定量PCR分析小鼠树突状细胞TLR4 mRNA表达及地塞米松的调节

目的: 建立检测小鼠Toll样受体4(TLR4)mRNA表达水平的SYBR GreenⅠ实时定量PCR实验; 观察小鼠骨髓源树突状细胞(DC)发育成熟过程中TLR4 mRNA表达水平的动态变化以及地塞米松(DEX)对DC TLR4 mRNA表达的影响.方法: (1)用细胞因子定向诱导的方法将小鼠骨髓细胞培养为DC; (2)构建pUCm-T/TLR4和pUCm-T/β-actin重组质粒, 建立检测小鼠TLR4 mRNA水平的实时定量PCR实验; (3)用实时定量PCR技术对体外培养4、 6、 8、 10、 12 d的DC TLR4 mRNA表达水平进行动态观察; (4)在DC培养体系中加入DEX, 与常规培养DC TLR4 mRNA表达水平进行比较.结果: (1)从小鼠骨髓细胞中成功诱导培养了DC, 经免疫磁珠纯化后其纯度可达90%以上; (2)建立了能精确分析小鼠TLR4 mRNA表达水平的SYBR GreenⅠ实时定量PCR实验; (3)在DC培养前期TLR4 mRNA表达水平变化不大, 后期则明显升高; (4)DEX可使DC TLR4 mRNA表达增强.结论: 小鼠骨髓源DC TLR4 mRNA表达水平与其发育成熟阶段密切相关; DEX促进DC TLR4 mRNA表达.     

EV71感染患儿Toll样受体表达初探

目的 探讨肠道病毒71型( EV71)感染患儿免疫活性细胞模式识别受体(pattern recognition receptor,PRR)及细胞因子水平的变化。方法 EV71感染患儿71例,其中轻症EV71感染组20例,重症EV71感染组25例,危重症EV71感染组26例,同年龄正常对照组20例。采用real -time PCR检测外周血单个核细胞维甲酸蛋白Ⅰ(retinoic acidinducible gene Ⅰ,RIG-Ⅰ)、黑色素瘤分化相关基因5（melanoma differentitation-associated gene 5,MDA5）及细胞因子(IL-12、IFN-α)表达;流式细胞术检测外周血单核/巨噬细胞( monocyte/macrophages,MC)、髓样树突状细胞(myloid dentritic cells,mDC)及浆样树突状细胞（plasmacytoid dentritic cells,pDC）Toll样受体(TLRs)表达率;ELISA检测细胞因子IL-12及IFN-α的变化。结果 (1)轻症患儿仅TLR7升高,重症EV71感染患儿外周血MC、mDC、pDCTLR7表达明显升高(P＜0.05),MC、mDC高表达TLR2、3、4,危重症患儿呈下降趋势。(2)EV71感染患儿胞内模式识别受体RIG- Ⅰ/MDA5 mRNA表达明显增加;(3)轻症患儿DC相关细胞因子有上升趋势,重症患儿DC相关细胞因子IL-12、IFN-α明显增高(P＜0.05),轻症及危重症患儿明显降低(P＜0.05)。结论 TLR7可能是免疫活性细胞识别EV71的主要模式识别受体;RIG-I/MDA5也可能参与识别EV71;合并细菌感染或细胞破坏释放的内源性配体导致TLR2或TLR4活化,诱导炎症反应。     

过敏性紫癜患儿外周血单核细胞TLR2表达及与免疫应答的相关性

背景：Toll样受体及其信号通路在自身免疫性疾病、超敏反应、炎症反应、细胞凋亡及移植排斥反应中发挥重要的作用,其在过敏性紫癜患儿免疫发病机制中的地位尚未完全阐明。目的：探讨过敏性紫癜患儿外周血单核细胞TLR2的表达及其与免疫应答的相关性。方法：64例过敏性紫癜患儿分为2组,即过敏性紫癜无肾损害组(36例)、过敏性紫癜肾损害组(28例),选择同期入院的30例健康体检儿童设置为对照组,采用流式细胞术检测外周血单核细胞TLR2表达,荧光定量PCR技术检测外周血单核细胞TLR2 mRNA相对表达量, ELISA检测血浆干扰素γ、白细胞介素4水平, ELISA法测定Treg细胞分泌的转化生长因子β、白细胞介素10水平。结果与结论：过敏性紫癜组干扰素γ、干扰素γ/白细胞介素4水平均显著低于对照组(P < 0.05),白细胞介素4水平显著高于对照组(P < 0.05);过敏性紫癜组TLR2 mRNA和蛋白表达显著高于对照组(P < 0.05);过敏性紫癜肾损害组TLR2 mRNA和蛋白表达显著高于过敏性紫癜无肾损害组(P < 0.05);过敏性紫癜组患者白细胞介素10和转化生长因子β表达显著高于对照组(P < 0.05)。结果表明过敏性紫癜患儿外周单核细胞TLR2 mRNA及蛋白表达增高,且患儿存在免疫表达失衡现象,TLR2参与过敏性紫癜免疫发病机制,转化生长因子β表达量能够评估Treg的免疫应答,可作为过敏性紫癜患儿诊断、治疗及预后参考依据。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

TLR4介导的BV-2细胞抗HCV固有免疫应答机制初步研究

目的:观察BV-2细胞感染HCV后IFN-β、IL-6分泌和TLR4表达相关性,初步探讨TLR4是否介导参与中枢神经系统抗HCV固有免疫应答及其可能机制。方法:将BV-2细胞接种于24孔培养板,贴壁后换用含20%HCV阳性血清的培养液感染细胞,为HCV实验组,同时设正常血清组和空白对照组。应用流式细胞术检测各组BV-2细胞TLR4蛋白水平的表达;用RT-PCR观察阻断TLR4后各组BV-2细胞TLR4mRNA表达变化;用ELISA检测阻断TLR4后各组BV-2细胞IFN-β、IL-6分泌变化。结果:HCV实验组TLR4表达和IFN-β、IL-6分泌均高于正常血清组及空白对照组(P<0.01);阻断TLR4的HCV实验组TLR4mRNA表达及IFN-β、IL-6分泌明显低于非阻断组(P<0.01)。结论:HCV感染中枢神经系统后,TLR4可通过启动下游细胞因子IL-6、IFN-β等的转录和翻译,介导参与宿主抗HCV固有免疫应答过程。     

过敏性紫癜患儿外周血单核细胞TLR2、TLR4、TLR6及与Treg相关细胞因子的表达

背景:Toll样受体介导的信号通路转导及调节性T细胞异常活化在过敏性紫癜发病中的作用不清楚。目的:研究Toll样受体TLR2、TLR4、TLR6在过敏性紫癜患儿外周血单核细胞的表达及调节性T细胞(Treg)的免疫应答,探讨TLR及Treg活化在敏性紫癜发病机制中的作用。方法:选择处于过敏性紫癜急性期的患儿42例为观察对象,另选取15名门诊健康查体儿童为正常对照组。采用流式细胞术检测外周血单核细胞的TLR2、TLR4、TLR6的蛋白表达量;应用反转录-聚合酶链反应(RT-PCR)及实时荧光定量PCR检测外周血单核细胞TLR信号途径分子MyD88 mRNA的基因相对表达量;ELISA法测Treg细胞分泌的转化生长因子β、白细胞介素10的血浆水平;两组间比较采用独立样本t或t’检验,相关性分析采用Pearson相关检验。结果与结论:过敏性紫癜患儿外周血单核细胞的TLR2、TLR4、TLR6蛋白的表达及MyD88 mRNA基因的相对表达量均显著高于对照组(P0.01);过敏性紫癜患儿血浆中转化生长因子β、白细胞介素10均高于对照组(P0.05);过敏性紫癜患儿TLR2、TLR4、TLR6的蛋白表达量与Myd88 mRNA的基因相对表达量呈正相关(P0.01),与血浆白细胞介素10、转化生长因子β水平无明显相关(P0.05)。提示TLR2、TLR4、TLR6活化后可能通过MyD88依赖的途径参与敏性紫癜的发病,而过敏性紫癜急性期Treg代偿性活化可能为机体的保护性免疫应答。     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Satellite RNA associated with bamboo mosaic potexvirus shares similarity with satellites associated with sobemoviruses

Summary A putative nonstructural protein encoded by a satellite RNA associated with bamboo mosaic potexvirus shares 46% identity with the capsid protein of satellite virus of panicum mosaic sobemovirus. The sequence similarity among satellite plant viruses which have no apparent relationship implies a common origin.     

拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒慢性感染的临床研究

目的 观察拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒(HBV)慢性感染的临床疗效。方法 慢性乙型肝炎患者90例。设联合治疗组28例，单用拉米夫定组30例，单用泛昔洛韦组32例。联合治疗组给予口服拉米夫定0．1g／d(PO)，泛昔洛韦1．5g／d(PO)，24周。拉米夫定、泛昔洛韦单用组剂量及疗程分别同联合治疗组。结果 3组均无明显副反应，丙氨酸转氨酶(ALT)复常率无差异。3组HBV DNA阴转率分别为89．3％、66．7％、40．6％，差异有显著性。乙型肝炎表面抗原(HBeAg)阴转率分别为28．6％、23．3％、21．9％，差异无显著性。结论 拉米夫定与泛昔洛韦联合用药安全、耐受性好，临床显示联合治疗对HBV DNA的抑制作用显著优于单用药。     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.