肝炎病毒-相关性肾小球疾病:组织学及临床特征

病毒是多种肾小球疾病的致病原，其诊断标准包括临床和实验室资料以及组织学的分子分析。乙型肝炎病毒(HBV)是亚洲人群中膜性肾小球肾(membranous glomerulonephritis，MGN)，膜增生性肾小球肾炎(membranoprolif-erative GN，MPCN)和IgA肾病(IgA nephropathy IgAN)的常见原因。除了冷球蛋白血症-相关性肾小球肾炎(cryoglobu-linemia—mediated glomerulone—phritis)以外，丙型肝炎病毒(HCV)，也是其他类型肾小球肾炎(GN)的原因。肾病综合征和进行性肾功能不全是主要的临床表现。     

Sarcoidosis and membranous glomerulonephritis: a significant association

Three patients were seen who had sarcoidosis associated with glomerulonephritis. Subsequent review of published reports of cases in which the two conditions occurred simultaneously showed a pattern of histological type of glomerulonephritis different from that seen in patients without associated disease. In sarcoidosis with glomerulonephritis there appeared to be a dearth of minimal-change disease and an excess of membranous glomerulonephritis compared with the prevalence that would be expected if the renal disease was merely a chance occurrence. These findings may provide evidence for an important relation between sarcoidosis and glomerulonephritis.     

Membranoproliferative glomerulonephritis due to Hepatitis C in renal allograft

Membranoproliferative glomerulonephritis type 1 is an etiologically divergent disorder. Hepatitis C with or without cryoglobulinemia is considered one of the principal causes of de novo and post transplant membranoproliferative glomerulonephritis type 1. A 49-year-old male who underwent renal allograft for end stage renal disease developed proteinuria and positive hepatitis C serology during the post-transplant period. This was associated with moderate hepatic dysfunction, which necessitated both liver and renal biopsies. Features of both chronic active hepatitis and membranoproliferative glomerulonephritis type 1 were seen as a result of histological examination of both liver and renal biopsies. Ultra structural studies showing mesangial and membranous deposits which are characteristic of membranoproliferative glomerulonephritis have been observed. The case is reported with a review of pertinent medical literature.     

性病门诊651例梅毒血清学检测结果分析

目的了解近年来皮肤科性病门诊患者梅毒感染情况及流行趋势和特征,为防治梅毒传播提供依据。方法对2008-2010年前来青海省疾病预防控制中心专科门诊就诊的651例疑为梅毒感染的患者血清标本进行TRUST和TPPA梅毒螺旋体血清学检测,并结合流行病学史及临床表现进行梅毒流行病学调查。结果 651份血清样本中检出确诊梅毒321例,总阳性率为49.3%,其中男性占41.4%,女性占58.6%;阳性患者中一期梅毒占10.3%,二期梅毒占19.6%,隐性梅毒占70.1%。结论本地区以隐性梅毒为主,且以女性感染者居多。应对性病门诊就诊者、特种行业的从业人员及高危人群加强梅毒血清学检测。     

Observations on Therapeutic Effects of Huangdan Decoction and Tripterygium Wilfordii Compound Tablet on Membranous Glomerulon

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I-Aβ1基因表达与小鼠膜性肾小球肾炎

目的：探讨I—Aβ1基因与实验性小鼠膜性肾小球肾炎发病之间的相关性。方法：复制并鉴定小鼠膜性肾小球肾炎动物模型，提取实验组和对照组总RNA，实时荧光定量PCR检测I—Aβ1基因mRNA表达量。结果：模型组I—Aβ1基因mRNA表达量明显高于N-BSA组、NS组和空白对照组（P〈0．01）差异有统计学意义；N—BSA组、NS组和空白对照组彼此之间的差异无统计学意义。结论：I-Aβ1基因过量表达参与了实验性小鼠膜性肾小球肾炎发病过程，可能是通过I-Aβ1基因转录、翻译活性上调使小鼠对外源性抗原反应性增强，促进了小鼠膜性肾小球肾炎发生。     

42例早期梅毒临床及治疗分析

目的：进一步了解早期梅毒的临床特征和治疗效果。方法：对42例早期梅毒患者的临床资料及治疗效果进行分析。结果：42例患者中一期梅毒11例，二期梅毒18例，早期潜伏梅毒13例，RPR、TPHA检查均阳性。患者经治疗后皮疹消退，苄星青霉素治疗者RPR 1年均转阴。结论：多数一、二期梅毒都有典型皮疹，长效青霉素是治疗梅毒的首选药物，早期潜伏梅毒是防治的重点。     

Destructive bone disease in early syphilis.

Although destructive bone disease is a well-known complication of tertiary syphilis, osteitis or osteomyelitis are not commonly recognized as complications of early (primary or secondary) syphillis. A patient with secondary syphilis characterized by generalized lymphadenopathy, perianal condyloma lata, and positive rapid plasma reagin (RPR) and fluorescent treponemal antibody-absorption (FTA-ABS) tests also complained of headache, right should pain, and right anterior chest pain and swelling. Roentgenograms showed mottled osteolytic lesions consistent with previously described luetic bone disease. Biopsy confirmed the diagnosis of syphilitic osteomyelitis, and treatment with penicillin resulted in prompt resolution of symptoms.     

异基因造血干细胞移植后迟发性肾病综合征临床分析

目的探讨异基因造血干细胞移植（allo-HSCT）后迟发性肾病综合征（NS）的临床表现、病理特点、诊疗体会及转归,分析可能的致病因素。方法2001年2月至2006年8月allo-HSCT后生存期大于3个月的恶性血液病患者167例,对迟发性NS患者的临床表现、病理特点和治疗反应进行分析总结,并分析患者性别、年龄、移植方式、预处理方案、人类白细胞抗原（HLA）配型、供受者关系、急性移植物抗宿主病（aGVHD）、慢性移植物抗宿主病（cGVHD）和巨细胞病毒抗原（CMV-Ag）定性与发生迟发性Ns的关系。统计学分析采用SPSS11．0统计学软件单因素和多因素Logistic回归分析方法。结果167例ano-HSCT患者中5例发生迟发性NS患者,发病率为2,99％,其中膜性肾病（MGN）4例,微小病变型肾病（MCD）1例,肾脏免疫球蛋白（Ig）免疫组化3例为IgG,1例IgM,1例为为IgG和IgM同时存在;2例血清ANA阳性,1例IgG升高、1例Ign升高。糖皮质激素联合环磷酰胺为主的治疗方案效果较理想,1例完全有效、3例部分有效、1例稳定。Logistic回归分析结果显示：移植后迟发性NS的发生与性别、年龄、移植方式、预处理方案、HLA配型、供受者关系、aGVHD、cGVHD和CMV-Ag定性关联均无统计学意义。结论allo-HSCT后迟发性NS病理以MGN为主,其次为MCD。其发病机理可能与体液免疫异常有关,采用糖皮质激素联合环磷酰胺为主的治疗方法具有一定疗效。     

Observations on therapeutic effects of Huangdan Decoction andTripterygium Wilfordii compound tablet on membranous glomerulonephritis in rats

Summary The model of membranous glomerulonephritis (MGN) in rats was successfully established using self-made cationic bovine serum albumin (C-BSA) and treated with Huangdan Decoction (HDD) andTripterygium Wilfordii Co. tablet (TW). Results indicated that the levels of urinary protein, blood urea nitrogen (BUN) and serum creatinine (Scr) in treated groups (groups A, B and C) were significantly decreased as compared with the control group (group D) (P<0. 01). By light and electron microscope and immunofluorescent technique, the damage to kidney in groups A, B and C was found much milder than that in group D with lesion in group A being slightest. These findings suggest that HDD and TW may alleviate the pathological lesions of MGN, prevent or retard its progression, and have remarkable therapeutic effects on MGN.     

The Great Imitator:Atypical Cutaneous Manifestations of Primary Syphilitic Chancre

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study.The clinical data including the patients' age,sex,skin lesions,HIV status,syphilis serologic test results,treatment,and follow-up results were collected.Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema.The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum.Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre,at atypical locations,or with a nonreactive nontreponemal test result,tends to be missed or misdiagnosed.     

中枢神经系统梅毒性血管炎的临床观察(附4例报告)

目的分析中枢神经系统梅毒性血管炎的临床特征并为早期诊断提供依据。方法回顾分析我院收治的4例梅毒性血管炎患者的临床资料。结果中枢神经系统梅毒性血管炎的临床特征：①可表现为亚急性或慢性起病,进行性发展,出现与病变部位相关的多种临床症状;②腰穿检查可发现脑脊液白细胞及蛋白轻度升高,糖及氯化物无明显变化;③血清及脑脊液梅毒快速血浆反应素试验（RPR）与梅毒螺旋体明胶凝集试验（TPPA）阳性是确诊的必要依据;④影像上病灶多变、呈游走性;⑤脑血管造影及组织病理学检查具有重要诊断意义,但无特异性。结论中枢神经系统梅毒性血管炎的诊断应结合个人生活史、实验室检查及影像学检查结果,临床上对于脑卒中,尤其是无高血压、糖尿病等脑血管病危险因素的青年卒中患者,要高度重视血清及脑脊液梅毒抗体检测。     

神经梅毒6例临床分析

目的探讨神经梅毒的临床特点。方法结合文献分析本院收治的6例神经梅毒的临床、影像学特点、治疗经过、预后等。结果6例患者,年龄25～70岁,均无明确梅毒感染的全身症状。其中脑血管梅毒3例,脊髓脑膜血管梅毒2例,脑膜梅毒1例。MR及CT表现有：单发的梗死灶、脊髓脱髓鞘样改变、颈段脊髓空洞、双侧脑室及3脑室扩张。结论神经梅毒以男性多见,尤其是青壮年,均以CNS症状起病,梅毒全身症状可不明显,容易误诊。     

南通市性病门诊男性就诊者梅毒感染及影响因素分析

目的了解性病门诊男性就诊者梅毒感染情况及相关影响因素,为制订性病控制措施提供依据。方法对350名性病门诊男性就诊者进行检测和横断面调查,采用单因素分析方法探讨影响梅毒感染的可能因素。结果南通市性病门诊男性就诊者梅毒感染率为8.29%。单因素分析结果显示:婚烟状况、最近1年与暗娼(CSW)是否发生过性行为、最近3个月与临时性伴侣是否发生过性行为以及最近3个月发生性行为的临时性伴数等,均与梅毒感染存在统计学关联。结论我市今后梅毒的防控工作中需加大对性病门诊男性就诊者的宣传教育,对有非婚性接触史的就诊者及其性伴加强梅毒筛查。     

全葡萄膜炎合并口腔、外阴溃疡误诊为白塞病2例分析及文献复习

对于表现为口腔溃疡、外阴溃疡和葡萄膜炎的患者,风湿科医生很容易考虑白塞病的诊断,但是并非很多风湿科医生了解获得性免疫缺陷综合征（acquired immune deficiency syndrome,AIDS）也可以出现类似的表现。 本文报道了2例在口腔溃疡和外阴溃疡的基础上合并葡萄膜炎的患者经眼科医生转诊至风湿免疫科,首诊均考虑为白塞病,经过糖皮质激素治疗后均效果欠佳,在进一步完善全身检查时发现患者为梅毒合并AIDS。本文报道并分析此2例患者的临床表现及诊疗过程,旨在提醒风湿科医生在临床工作中应警惕疑似白塞病的性传播疾病,提高风湿科医生认识和鉴别诊断的能力。     

荧光PCR技术检测梅毒螺旋体DNA的意义

目的：评估荧光定量聚合酶链反应（FQ-PCR）技术检测梅毒螺旋体DNA的应用价值。方法：使用FQ-PCR技术检测硬下疳、一期横痃、二期梅毒皮损、梅毒患者全血、室温保存1～3年半的梅毒螺旋体DNA阳性标本以及部分生活污染品中的梅毒螺旋体DNA含量。结果：该技术的特异性为100％,敏感性分别为一期梅毒100％,二期梅毒90％,早期梅毒全血为20％,无症状梅毒全血为0％,其敏感性主要受到治疗药物和梅毒病程的影响;与梅毒口腔黏膜斑密切接触的污染品中1个茶杯获得阳性结果;室温保存的梅毒螺旋体DNA阳性标本均阳性。结论：FQ-PCR技术适用于确认未经治疗的形态各异的早期梅毒疹;对一期梅毒后期或二期梅毒早期患者血中梅毒螺旋体DNA检查有价值;梅毒螺旋体DNA在常温下可长期保持稳定;该技术对探明梅毒间接传播途径可能有价值。     

咽喉部梅毒5例诊治体会

目的：分析以咽部疼痛、咽部异物感、声音嘶哑为首发症状的咽喉部梅毒的临床特点及诊治体会,以减少误诊、误治。方法：对5例咽喉部梅毒患者的临床资料进行回顾性分析,并复习相关文献。结果：5例患者均有咽部或喉部黏膜白色病损,经甲苯胺红不需加热血清试验和梅毒螺旋体颗粒凝集试验进行梅毒血清学检查均呈阳性。经治疗后症状消失,复查甲苯胺红不需加热血清试验滴度下降。随访0.5-2年,1例复发。结论：咽喉部梅毒的诊治关键在于明确诊断,诊断主要依据接触史、典型临床表现,同时结合实验室检查;当接触史不明确或临床难于确诊时,则依靠相应病原性检查及病理学检查。     

丙型肝炎病毒感染后肾小球肾炎

为探讨丙型肝炎病毒(HCV)感染与肾小球肾炎的关系,本文应用免疫组化技术以抗-HCVNS_3和抗-HCV NS_5单克隆抗体对21例丙肝石蜡包埋尸解肾组织中的丙肝抗原(HCAg)进行了检测。结果:检测出阳性13例(61.9%),其中膜增殖性肾炎(MPGN)11例和系膜增殖性肾炎(MsPGN)1例.另有1例未见明显病变。HCAg 阳性颗粒定位于肾小球系膜区、系膜细胞及肾小管上皮细胞胞浆内。HCAg阴性病例中包括 MsPGN2例、膜性肾病(MN)及毛细血管内增生性肾炎(PSGN)各1例,4例大致正常。同本文抽选的乙型肝炎病毒(HBV)感染对照组肾脏病理变化相比,丙肝患者出现肾小球肾炎更为多见,尤其是 MPGN 型(X~2=101,P<0.01),且呈多样化。本文肾组织中 HCAg 的检出为 HCV 相关性肾炎的存在提供了新的形态学依据。     

二期梅毒皮疹中梅毒螺旋体基因检测和浸润细胞研究

目的：探讨二期梅毒皮疹的形成机制和细胞免疫在梅毒皮疹形成中的作用。方法：用巢式PCR方法对24例10％甲醛溶液固定、石蜡包埋的二期梅毒疹标本进行了梅毒螺旋体DNA检测；用免疫组化方法对二期梅毒皮损中的浸润细胞进行检测。结果：24份二期梅毒疹标本中10例(45．8％)检出了梅毒螺旋体DNA，所有标本银染色未发现苍白螺旋体(TP)。二期梅毒皮损浸润细胞中CD45RO( )T细胞100％阳性，68．2％有CD68( )巨噬细胞，此外还有少量CD20( )B淋巴细胞和CD57( )NK细胞。结论：二期梅毒疹的形成原因可能为螺旋体感染皮肤局部所致；二期梅毒疹皮损中浸润细胞主要为T淋巴细胞和巨噬细胞，细胞免疫在二期梅毒皮损发病中可能发挥重要作用。     

Congenital syphilis in an immunocompromised neonate: case report

Syphilis is a notifiable and preventable disease, congenital syphilis more so. Consequently, attention has been recently focused on prenatal diagnosis of foetal syphilis by the use of ultrasonography apart from the conventional serologic screening. Congenital syphilis has not been reported from the Kingdom of Lesotho. We report the case of a 3.0 kg male neonate with florid joint and bone lesions of congenital syphilis associated with HIV infection seen at the Queen Elizabeth II Hospital, Maseru, Kingdom of Lesotho. Co-existing HIV infection influences the clinical manifestation of syphilis, the progression of neurosyphilis and the response to standard therapy. The baby had the recommended standard treatment with good response and he was followed-up for a period of twelve months with serologic screening and radiographic evaluation.