Glisson蒂横断式解剖性肝切除120例治疗体会

目的探讨Glisson蒂横断式解剖性肝切除术的应用价值。方法回顾性分析临沧市人民医院2014年1月至2017年3月行Glisson蒂横断式解剖性肝段切除术120例患者的临床资料。其中原发性肝癌65例,胆管细胞癌4例,肝门部胆管癌4例,胆囊癌6例,肝内胆管结石33例,肝血管瘤8例,肝寄生虫病10例。采用Glisson蒂横断式解剖性肝切除Ⅰ段切除3例,Ⅰ+Ⅱ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅳ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段切除1例,左外叶(Ⅱ+Ⅲ段)切除33例,左半肝(Ⅱ+Ⅲ+Ⅳ段)切除22例,左三叶(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段)切除3例,Ⅳb+Ⅴ段切除6例,Ⅳ+Ⅴ+Ⅷ段切除3例,右半肝切除(Ⅴ+Ⅵ+Ⅶ+Ⅷ段)25例,右三叶切除(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段)3例,右前叶(Ⅴ+Ⅷ段)切除5例,Ⅵ段切除2例,右后叶切除术(Ⅵ+Ⅶ段)4例,Ⅶ段切除2例,Ⅷ段切除4例。其中9例同时行肝管空肠RouxY吻合术。结果全组均完成手术。术中平均出血量630 mL。平均手术时间3.7 h。术后发生并发症34例(28.33%),为胆漏、胸腔积液、多重耐药菌感染等。结论 Glisson蒂横断式解剖性肝切除术操作简便,快速安全,能明显减少出血,提高疗效,是一种可选择的手术方式。     

不同分期前列腺癌患者外周血CD4~+ CD25~+ Foxp3~+调节性T细胞的变化及与胰岛素抵抗的相关性

目的 :观察不同分期前列腺癌患者外周血单个核细胞CD4+CD25+Foxp3+调节性T细胞的变化及与胰岛素抵抗的关系。方法:采用流式细胞术检测62例前列腺癌患者(患者组,临床TNM分期Ⅰ期5例、Ⅱ期16例、Ⅲ期21例、Ⅳ期20例)外周血单个核细胞(PBMC)中CD4+CD25+Foxp3+调节性T细胞数目,计算CD4+CD25+Foxp3+调节性T细胞占CD4+T淋巴细胞的百分率;并检测其空腹胰岛素及空腹血糖水平,计算胰岛素抵抗指数(HOMA-IR);采用ELISA法测定外周血胰岛素样生长因子1(IGF-1)水平,分析CD4+CD25+Foxp3+调节性T细胞与胰岛素抵抗的相关性,并与42例健康体检者进行对照。结果:与健康对照组相比,前列腺癌患者HOMAIR明显升高(6.68±1.66 vs 3.68±1.42),IGF-1水平明显下降[(96.39±21.21)ng/ml vs(164.56±30.58)ng/ml],PBMC CD4+CD25+Foxp3+Treg占CD4+T淋巴细胞的百分率[(13.88±0.96)%vs(5.33±0.65)%]及CD4+CD25+Foxp3+Treg绝对值[(3.55±0.29)×107vs(1.99±0.78)×107]明显升高(P0.05,P0.01)。患者PBMC CD4+CD25+Foxp3+Treg占CD4+T淋巴细胞的百分率及CD4+CD25+Foxp3+Treg绝对数﹑HOMA-IR均随TNM分期逐渐加重而增加,IGF-1逐渐下降;相关性分析表明:CD4+CD25+Foxp3+Treg/CD4+T及CD4+CD25+Foxp3+Treg绝对数均与HOMA-IR呈明显正相关(r分别为0.689、0.722,P0.01),与IGF-1呈明显负相关(r分别为-0.896、-0.747,P0.01)。结论:前列腺癌患者存在不同程度的胰岛素抵抗,且随着疾病程度的加重,外周血CD4+CD25+Foxp3+调节性T细胞数目和比例及胰岛素抵抗逐渐加重;CD4+CD25+Foxp3+调节性T细胞可能通过调节胰岛素抵抗参与其形成和发展。     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

LC+LCBDE+PS与ERCP+EST+LC治疗胆囊结石合并胆总管结石的临床对比

目的 探讨腹腔镜胆囊切除术+胆总管探查取石+一期缝合（LC+LCBDE+PS）与经内镜逆行胆胰管造影+内镜十二指肠乳头切开取石+腹腔镜胆囊切除术（ERCP+EST+LC）治疗胆囊结石合并胆总管结石的临床效果。方法 回顾性分析上海市第十人民医院、上海市同仁医院、泰州市第四人民医院2016年1月至2021年12月间收治的胆囊结石合并胆总管结石患者病例资料,根据治疗方法分为LC+LCBDE+PS组（n=1 036）和ERCP+EST+LC组（n=428）,并采用倾向性评分匹配法（PSM）对两组病例进行匹配,匹配后每组398例。对两组治疗效果、围术期相关指标及术后并发症情况进行比较。结果 PSM后,LC+LCBDE+PS组成功实施382例,ERCP+EST+LC组成功实施320例。与ERCP+EST+LC组相比,LC+LCBDE+PS组手术成功率更高、术后住院时间及住院总费用更低,但引流管留置时间更长,差异均有统计学意义（P<0.05）。两组总手术时间、术中出血量差异无统计学意义（P>0.05）。与LC+LCBDE+PS组比较,ERCP+EST+LC组术后胆漏发生率更低,但胰腺炎发...     

脑源性神经营养因子对大鼠瑞芬太尼麻醉后切口痛的影响

目的 观察脑源性神经营养因子(BDNF)对瑞芬太尼麻醉后切口痛大鼠行为的影响,探讨瑞芬太尼诱发痛觉过敏的机制.方法 60只SD大鼠术前6d鞘内置管,随机分为5组(n=12):对照组C组(鞘内注射生理盐水),切口痛I +NS组(切口并鞘内注射生理盐水),切口痛I+BR组(切口并鞘内注射BDNF抗体),瑞芬太尼I+R+NS组(应用瑞芬太尼、切口并鞘内注射生理盐水),瑞芬太尼I+R+BR组(应用瑞芬太尼、切口并鞘内注射BDNF抗体).按照Brennan法行切口模型手术,生理盐水、瑞芬太尼和BDNF抗体均在术中给予.分别于术前24 h(基础值),术后24、48h测定机械痛阈.结果 与术前24h比较,C组术后机械痛阈值差异无统计学意义(P＞0.05),I+NS组、I+BR组、I+R+NS组及I+R+BR组机械痛阈明显降低(P＜0.05).术后24 h及48 h机械痛阈,与C组比较,I +NS组、I+BR组、I+R+NS和I+R+BR组机械痛降低(P＜0.05);与I+NS组比较,I+BR组机械痛阈升高,I+R+NS组和I+R+BR组机械痛阈降低(P＜0.05);与I+BR组比较,I+R+NS组和I+R+BR组机械痛阈降低(P＜0.05);与I+R+NS组比较,I+R+BR组机械痛阈升高(P＜0.05).结论 瑞芬太尼可能通过上调切口痛大鼠中枢神经系统BDNF表达而诱导痛觉过敏.     

IL-2调控慢性丙型肝炎患者外周血CD4^＋CD25^＋调节性T细胞的抑制效应

目的 探讨慢性丙型肝炎患者外周血中HCV特异性CD4+CD25+调节性T细胞的抑制活性以及外源性IL-2对CD4+CD25+Treg细胞抑制效应的影响.方法 采用免疫磁珠分选18例慢性丙型肝炎患者与15例正常人外周血中CD4+CD25+T细胞与CD4+CD25- T细胞,在此两种细胞共同培养体系中加入不同浓度外源性IL-2和IL-4,检测CD4+CD25+T细胞的抑制能力以及对HCV特异性CD4+T细胞的影响.结果 与正常对照相比,慢性丙型肝炎患者的CD4+CD25+Treg细胞的抑制增殖活性高 (P=0.034);CD4+CD25+ Treg细胞显著抑制HCV特异性CD4+T细胞的增殖;当IL-2浓度为2 000 U/ml时,能够显著改变CD4+CD25+ Treg细胞的低增殖能力,而且IL-2与IL-4的共同作用改变更明显,其中高浓度的IL-2能够阻断CD4+CD25+Treg细胞对CD4+CD25- T细胞的抑制功能.结论 慢性丙型肝炎患者外周血中CD4+CD25+Treg细胞的抑制活性增强,高浓度IL-2可阻断CD4+CD25+Treg细胞的抑制效应.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

目的 总结肾移植后使用不同免疫抑制方案的效果和不良反应,以提高人/肾的长期存活率.方法 对单中心3102例肾移植受者的临床资料进行回顾性分析,所采用的免疫抑制方案有环孢素A(CsA)+硫唑嘌呤(Aza)+泼尼松(Pred)、低剂量CsA+吗替麦考酚酯(MMF)+Pred、低剂量他克莫司(Tac)+MMF+Pred、低剂量CsA(或Tac)+西罗莫司(SRL)+Pred等方案,分析各方案的效果和不良反应.结果 低剂量CsA+MMF+Pred方案的人/肾1、5、10年存活率均高于CsA+Aza+Pred方案,而高血压、震颤、高尿酸、肝肾毒性、白细胞下降等的发生率显著低于CsA+Aza+Pred方案(P＜0.05),腹泻发生率显著高于CsA+Aza+Pred方案(P＜0.05).低剂量Tac+MMF+Pred方案的高血糖发生率显著高于低剂量CsA+MMF+Pred方案(P＜0.05),多毛症发生率显著低于低剂量CsA+MMF+Pred方案(P＜0.05);低剂量CsA(或Tac)+SRL+Pred方案的腹泻、高尿酸血症、肝肾毒性和多毛症等的发生率显著低于低剂量CsA(或Tac)+MMF+Pred方案(P＜0.05),但高血脂发生率显著高于后者(P＜0.05).以低剂量Tac为基础的方案者高血糖发生率显著应用低剂量CsA者.结论 低剂量CsA(或Tac)+MMF+Pred方案改善了肾移植受者和移植肾的存活,降低了不良反应发生率,尤以低剂量Tac+MMF+Pred方案为优;调整免疫抑制方案或剂量,改善饮食习惯,加强锻炼,优化降血压、降血脂、控制血糖的治疗措施对预防和控制不良反应尤为重要.

Abstract：

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

胃癌患者围手术期CD28及调节性T细胞的动态变化

目的:探讨胃癌患者手术前后外周血CD4+CD25+T细胞和CD8+CD28+的表达变化及其意义,探讨其在胃癌的发病机制中的作用.方法:用流式细胞仪检测89例胃癌患者手术前后外周血淋巴细胞表面的调节性T细胞和CD28的表达,并与健康对照组及胃良性肿瘤组作比较.结果:①术前胃癌组外周血中CD8+CD28+水平明显低于健康对照组和胃良性肿瘤组,CD4+CD25+水平显著增高;②胃癌组CD4+CD25+及CD8+CD28+表达水平随着临床分期的进展而有显著变化;③根治性及姑息性切除肿瘤后,CD8+CD28+表达显著升高;CD4+CD25+的表达明显降低.结论:胃癌患者外周血中CD8+CD28+表达水平低下,而具有免疫抑制活性的CD4+CD25+调节性T细胞的数量较健康人明显增高,提示胃癌患者机体免疫功能低下,施行手术切除肿瘤有助于改善患者的细胞免疫功能.     

LCBDE+LC与ERCP+LC治疗胆囊结石合并胆总管结石的网状Meta分析

目的 近年来,腹腔镜胆囊切除术（LC）、腹腔镜胆总管探查术（LCBDE）、内镜逆行胰胆管造影术（ERCP）普遍应用于胆系结石的治疗,本Meta分析比较了三种治疗胆囊结石合并胆管结石的手术方式的疗效及安全性,即LCBDE+LC、术前ERCP（PreERCP）+LC、术中ERCP（IntraERCP）+LC。方法 计算机检索Medline、PubMed、Cochrane Library、Embase数据库,查找1990—2019年关于LCBDE+LC、PreERCP+LC、IntraERCP+LC治疗胆囊结石合并胆总管结石的随机对照试验（RCT）研究。按照纳入与排除标准,选择文献、评价质量、提取数据,采用Stata软件进行网状Meta分析。计算累积排序概率曲线下面积（SUCRA）,用于预测各手术方式的有效性及安全性,主要结局指标为结石清除率,病死率,胰腺炎、胆漏、出血,以及中转开腹率。结果 共有19篇RCT研究纳入分析,共计2 627例患者。网状Meta分析结果显示：（1）结石清除率：IntraERCP+LC优于LCBDE+LC、PreERCP+LC,差异具有统计学意义（P＜0.05）;（2）病死率：LCBDE+LC、PreERCP+LC、IntraERCP+LC三者之间的差异均无统计学意义（P＞0.05）;（3）胰腺炎：PreERCP+LC的发生率高于LCBDE+LC、IntraERCP+LC,差异具有统计学意义（P＜0.05）;（4）出血：LCBDE+LC、PreERCP+LC、IntraERCP+LC三者之间的差异均无统计学意义（P＞0.05）;（5）胆漏：LCBDE+LC的发生率高于PreERCP+LC、IntraERCP+LC,差异具有统计学意义（P＜0.05）;（6）中转开腹率：PreERCP+LC与IntraERCP+LC、LCBDE+LC与IntraERCP+LC之间的差异均无统计学意义（P＞0.05）,而LCBDE+LC发生率高于PreERCP+LC,差异具有统计学意义（P＜0.05）。结论 LCBDE+LC、PreERCP+LC、IntraERCP+LC三种手术方式均可用于治疗胆囊结石合并胆总管结石,其中IntraERCP+LC的结石清除率最高,LCBDE+LC的胆漏风险较大,而PreERCP+LC的胰腺炎风险最高。     

肾Na~+-K~+-ATPase及在肾衰早期的改变

钠—钾ATP酶(Na~+-K~+-ATPase)是位于细胞膜上的一种特殊蛋白质,与ATP的分解和细胞内外Na~+、K~+的转运有密切关系。由于肾脏组织中含有丰富的Na~+-K~+-ATPase,且肾功能与该酶的活性紧密相关,故近年来对肾脏Na~+-K~+-ATPase的研究引起了人们广泛的注意。一、Na~+-K~+-ATPase的生物学特性 Na~+-K~+-ATPase已从哺乳动物的肾、脑等组织中提纯,它深埋于细胞膜之中,不溶于水,用十二烷基硫酸钠(SDS)处理后,行等密度梯度离     

CD44+-ESA+在结肠癌干细胞分选中的应用

目的 分选结肠癌细胞株SW480细胞中的CD133+-CD44+-ESA+亚群细胞,并观察其致瘤性.方法 用流式细胞仪分选SW480细胞中CD133+-CD44+-ESA+、CD133--CD44+-ESA+及CD133--CD44--ESA-亚群细胞.将这3组细胞分别接种于NOD/SCID小鼠,每组5只,观察肿瘤生长...     

自体血液回收技术对红细胞膜ATP酶的影响

目的　探讨血液回收技术对红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性的影响。方法　将 2 4例患者麻醉前静脉血、术野回收原血及回收红细胞血液标本采用沈茂星法测定红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性 ,并予统计分析。结果　经血液回收技术处理后的红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性与术野回收原血值比较均有显著降低 (P<0 0 5 )。结论　自体血液回收技术能使红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性明显降低。     

肝癌病人外周血中CD4+CD25+FOXP3+调节性T淋巴细胞表达水平的临床研究

目的 了解CD4+CD25+FOXP3+T调节性T细胞在肝癌病人外周血中的表达水平并探讨其临床意义.方法 应用流式细胞术测定18例肝癌病人外周血CD4+CD25+FOXP3+调节性T细胞占CD4+T淋巴细胞百分比,并与26例l临床对照者和24例健康对照者进行比较.结果 肝癌病人外周血中CD4+CD25+T细胞占CD4+T细胞百分比(4.25%±3.98%)明显高于临床对照组(1.34%±1.14%)及健康对照组(1.29%±0.95%)(P＜0.01),而两个对照组之间并无显著性差异(P＞0.05).CD4+CD25+FOXP3+T细胞在肝癌病人外周血所占CD4+T细胞比率(2.94%±0.91%)也较临床对照组(0.76%±0.34%)及健康对照组(0.81%±0.29%)显著升高(P＜0.001),且升高幅度强于CD4+CD25+T细胞水平,两个对照组之间并无显著性差异(P＞0.05).结论 CD4+CD25+FOXP3+T细胞是更为准确的调节性T细胞,其在肝癌病人外周血中表达水平明显升高,检测CD4+CD25+FOXP3+T水平对肝癌的预防治疗具有重要临床意义.     

CD4+CD25+调节性T细胞对小鼠肝脏移植自发性免疫耐受的影响

目的 研究CD4+CD25+调节性T细胞在诱导自发性肝脏免疫耐受中的作用.方法 向受体和供体注射抗CD25抗体(PC61)后进行小鼠原位肝脏移植,观测其生存时间.术后20～30 d切取移植肝脏行HE染色,同时观察CD4+CD25+T细胞对CD4+T细胞和CD8+T细胞功能的影响.结果 去除受体而不是供体小鼠的CD4+CD25+T细胞可以导致肝移植排斥反应.而且,去除CD4+CD25+T细胞使移植物的白细胞浸润明显增多,组织损伤加重.同时,去除CD4+CD25+T细胞导致CD4+T细胞的增殖活性和CD8+T细胞的细胞毒活性明显增强.结论 受体来源的CD4+CD25+调节性T细胞在小鼠肝脏移植免疫耐受诱导中起重要作用.

Abstract：

Objective To examine the contribution of CD4+ CD25+ regulatory T cells to liver transplant tolerance. Methods After injection of anti-CD25 monoclonal antibody (mAb, PC61), mouse orthotopic liver transplantation was performed and survivals were determined. The paraffin-embedded sections of hepatic allografts were cut and stained with hematoxylin and eosin (HE). Furthermore, the effect of CD4+ CD25+ regulatory T cells on proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells was examined by depleting these regulatory T cells. Results Depletion of these cells in the recipients but not in the donors before liver transplantation caused rejection. Histological analyses of hepatic allografts with PC61 treatment showed extensive leukocyte infiltration and tissue destruction, whereas those in the control group showed minimal changes. Moreover, elimination of CD4+CD25+ T cells resulted in the enhancement of both proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells against donor-type alloantigen. Conclusions These results suggest that CD4+CD25+ regulatory T cells were important for tolerance induction to hepatic allografts.     

Na+、K+-ATP酶及麻醉药对其影响

Na+、K+-ATP酶广泛分布于各类细胞质膜上,形成和维持了Na+、K+在膜内外正常的浓度差,产生并维持细胞膜电位,维持神经细胞的兴奋性和传导性。麻醉药对Na+、K+-ATP酶具有抑制作用。本文综述了Na+、K+-ATP酶的分子结构、分布、生理功能及麻醉药对其影响。     

胃癌患者CD4+CD25+Foxp3+调节性T细胞与TGF-β1检测的意义

目的:探讨胃癌患者外周血CD4+CD25+Foxp3+调节性T细胞(CD4+CD25+Foxp3+Tergs)以及血清TGF-β1水平的变化及意义。方法:检测并比较42例胃癌患者(胃癌组)与24例健康体检者(对照组)外周血CD4+CD25+Foxp3+Tergs与血清TGF-β1水平,分析两者水平与胃癌患者临床病理因素的关系。结果:胃癌组CD4+CD25+Foxp3+Tergs和TGF-β1水平均明显高于对照组(均P<0.05)。胃癌患者外周血CD4+CD25+Foxp3+Tergs水平与TNM分期、淋巴结转移有关(均P<0.05),而血清TGF-β1的表达水平与TNM分期、分化程度、淋巴结转移有关(均P<0.05);胃癌组患者外周血内CD4+CD25+Foxp3+Tergs的表达水平与血清内TGF-β1的表达水平呈明显正相关(r=0.801,P<0.05)。结论:胃癌患者外周血CD4+CD25+Foxp3+Tergs水平及血清TGF-β1水平升高,检测两者水平有助于患者病情与预后的判断。     

骨髓或外周血中CD4+CD25+Foxp3+调节性T淋巴细胞与aGVHD的关系

目的 研究患者异基因造血干细胞移植(allo-HSCT)前后骨髓或外周血单个核细胞中CD4+CD25+Foxp3+调节性T淋巴细胞(以下简称CD4+CD25+Foxp3+T细胞)的比率、Foxp3 mRNA和Foxp3蛋白的表达与急性移植物抗宿主病(aGVHD)的关系.方法 选择37例行HIA相合异基因造血干细胞移植(allo-HSCT))的患者作为研究对象.采用流式细胞术检测患者allo-HSCT前7天(-7 d)、移植当天(0 d)、移植后30天(+30d)、+60 d和+90 d时骨髓或外周血单个核细胞中CD4+CD25+Foxp3+T细胞所占的比率;定量聚合酶链反应(PCR)检测Foxp3 mRNA相对表达量;蛋白印迹(Western blot)法检测Foxp3的蛋白表达水平.结果 37例患者存移植后100 d内发生aGVHD 13例(aGVHD组),未发生aGVHD 24例(无aGVHD组).CD4+CD25+Foxp3+T细胞的比率在0 d时最低,与-7、+30、+60、+90d时比较.差异均有统计学意义(P<0.01);与aGVHD组比较,无aGVHD组患者的CD4+CD25+Foxp3+T细胞的比率明显升高,差异有统计学意义(P<0.01).aGVHD组患者移植后Foxp3的表达水平逐渐升高,但明显低于无aGVHD组,尤其在+60和+90 d时的差异有统计学意义(P<0.01).Western blot法检测结果 表明,aGVHD组受者的Foxp3蛋白表达也明显低于无aGVHD组.结论 CD4+CD25+Foxp3+T细胞对防止发生aGVHD具有重要作用,监测患者骨髓或外周血中CD4+CD25+Foxp3+T细胞的比率可以预测aGVHD的发生.     

七氟醚后处理对大鼠心肌缺血再灌注时Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶活性的影响

目的 评价七氟醚后处理对大鼠心肌缺血再灌注时Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶活性的影响,探讨其减轻心肌缺血再灌注损伤的机制.方法 健康雄性Wistar大鼠45只,体重250～280 g,随机分为3组(n=15):假手术组(S组)、缺血再灌注组(I/R组)和七氟醚后处理组(Spo组).I/R组和Spo组采用结扎左冠状动脉前降支30 min时进行再灌注的方法制备心肌缺血再灌注模型,S组仅在左冠状动脉前降支下穿线.Spo组再灌注前1 min开始吸入2.5%七氟醚持续5 min.于再灌注2 h时取心肌组织,测定心肌梗死体积、Na+-K+-ATP酶活性和Ca2+-Mg2+-ATP酶活性.结果 与S组比较,I/R组心肌梗死体积扩大,心肌组织Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性降低(P＜0.05);与I/R组比较,Spo组心肌梗死体积缩小,心肌组织Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性升高(P＜0.05).结论七氟醚后处理可提高Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性,从而减轻大鼠心肌缺血再灌注损伤.