肝硬变患者若干免疫机能的改变及应用多抗甲素的影响

本文报道了30例失代偿期肝硬变患者白细胞吞噬功能、血浆纤维连接蛋白(FN)浓度、血清C_3浓度均明显低于正常人,而血浆内毒素浓度、血清IgG、IgM、IgA浓度均明显高于健康对     

冠心病患者免疫反应的变化研究

58例患者经冠状动脉造影后分为4组:心肌梗塞(AMI)组15例、不稳定性心绞痛(UAP)组10例、稳定性心绞痛(SAP)组11例与冠脉造影正常的对照组22例,测定血清免疫球蛋白IgG、IgA、IgM和补体C_3、C_4的水平,结果:AMI组的IgG、IgA、补体C_3、C_4     

体外循环过程中补体激活的观察

本文对14例在 CPB-F 作心内直视手术患者术中血浆 C_3、C_4和 B 因子进行了检测,结果提示,在 CPB 中,补体系统 C_3和 B 因子的变化主要是经旁路途径激活;但在 CPB 后,也可经经典途径激活;而 C_4则主要经经典途径激活。     

老年冠心病患者外周血T、B淋巴细胞亚群的变化

本文报告34例老年冠心病患者应用抗人T、B淋巴细胞单克隆抗体检测外周血单个核细胞(PBMC)中T、B淋巴细胞亚群的变化,同时测定血清IgG、IgA、IgM、C_3及Fn含量,并与28例老人进行对比。结果表明,老年冠心病患者CD~(1/3)、CD~(1/4)、CD~(1/8)细胞均比对照组减少;而CD~(1/4)/CD~(1/8)比值增高,CD~(1/20)、SmIgG~ 阳性细胞增多。老年冠心病患者血清IgG明显高于对照组,而IgA、IgM无差异;补体C_3高于对照组,Fn则低于对照组。上述结果提示老年冠心病患者存在明显的免疫异常。免疫也与衰老、冠心病的发病有密切关系。本文还讨论了免疫损伤对冠心病发病的作用。     

东方魔液抗自由基损伤的临床探讨

测定了22例老年Ⅱ型糖尿病患者应用东方魔液后血浆过氧化脂质(LPO)含量、红细胞超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH—Px)活性及免疫指标如免疫球蛋白IgG、IgA、血中总补体CH_(50)及补体C_3的变化。结果表明应用东方魔液后血浆LPO降低(P<0.05),红细胞SOD增高(P<0.01)、GSH—Px升高(P<0.01);此外,血中CH_(50)、C_3、IgG、IgA等升高(P<0.05),而对肝肾功能无明显影响。说明东方魔液具有抗自由基损伤和增强机体免疫力的作用。     

甲胎蛋白的免疫抑制作用

甲胎蛋白在体外对体液与细胞免疫均有抑制作用。从小鼠羊水所提纯的甲胎蛋白,自每毫升1微克的浓度开始,即可显著地抑制抗体反应。但抑制IgM的反应比抑制IgG与IgA的反应需要多10～100倍的甲胎蛋白,这提示甲胎蛋白有抑制T淋巴细胞的作用(IgG与IgA的反应必需有T淋巴细胞与B淋巴细胞的良好协作)。此外,小鼠的甲胎蛋白还能抑制PHA或刀豆蛋白A诱发的淋巴母细胞转化以及混合培养中淋巴细胞反应。这一免疫抑制作用,同样也可从每毫升1微克的浓度起获得,并且随甲胎蛋白浓度而增加。作者强调,这种抑制作用不是通过细胞毒性。甲胎蛋白对PHA淋巴母细胞转化的抑制作用,     

体外循环心脏停跳和不停跳心内直视手术对机体免疫功能的影响

目的观察体外循环心脏停跳和不停跳心内直视手术对机体免疫功能的影响。方法60例风湿性二尖瓣膜病变患者,随机分为实验组（不停跳组,40例）和对照组（停跳组,20例）,分别于10个时点抽取静脉血,测定T细胞亚群、NK细胞以及IgA、IgG、IgM。结果两组CD3＋、CD4＋、NK细胞以及IgA、IgG、IgM在转机后下降,CD8＋上升,两组比较P≤0.05,实验组CD3＋、CD4＋、CD8＋、NK细胞以及IgA、IgG、IgM恢复较对照组快（P均〈0.05）。结论体外循环不停跳心内直视手术对机体免疫功能影响较心脏停跳者轻。     

早期肠内营养支持对急性期卒中患者免疫功能的影响

目的探讨早期肠内营养支持对急性期卒中患者免疫功能的影响。方法选择卒中急性期伴吞咽障碍患者49例,随机分为研究组24例和对照组25例,于入院后72 h内分别给予鼻饲肠内营养支持和普通鼻饲饮食。两组患者分别于入院第1、7及21天测定总淋巴细胞计数(TLC)、免疫球蛋白A(IgA)、G(IgG)、M(IgM)及补体C3、C4含量。并观察营养指标的变化以及感染并发症的发生率。结果21 d后研究组TLC[(2.1±0.4)×109/L]、IgA[(2.7±0.5)g/L]、IgG[(11.1±2.2)g/L]、IgM[(1.7±0.7)g/L]和补体C3[(1.2±0.2)g/L]水平显著高于对照组TLC[(1.7±0.4)×109/L,P<0.05]、IgA[(2.0±0.4)g/L,P<0.01]、IgG[(8.9±2.5)g/L,P<0.01]、IgM[(1.3±0.6)g/L,P<0.05]和补体C3[(1.0±0.3)g/L,P<0.01]。研究组感染并发症发生率(29.2%)显著低于对照组(60.0%,P<0.05)。研究组的营养指标亦显著优于对照组。结论早期肠内营养支持可改善急性期卒中患者机体的免疫功能,降低感染并发症的发生率。     

感染隐孢子虫奶牛血液免疫和抗氧化指标的变化

目的检测感染隐孢子虫奶牛血液免疫和抗氧化体系指标。方法对安徽省某奶牛场325头奶牛粪样采用饱和蔗糖溶液漂浮法检测隐孢子虫感染情况。选择隐孢子虫感染强阳性的7头奶牛作为感染组,同时取7头隐孢子虫粪检阴性奶牛作为对照组,早晨饲喂前从奶牛颈静脉采血,分别测定总蛋白(TP)、白蛋白(ALB)、免疫球蛋白(IgG、IgM和IgA)、中性粒细胞吞噬率、T淋巴细胞转化率、白细胞介素-2(IL-2)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)、一氧化氮(NO)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、血糖(GLU)、甘油三脂(TG)、Cl-和Ca2+等19项指标。结果 325头奶牛隐孢子虫感染率为31.7%(103/325),根据卵囊的形态和大小,初步鉴定为安氏隐孢子虫(Cryptosporidium andersoni)。与对照组相比,感染组奶牛血清中TP、ALB、IgM、IgA、GSH-Px、ALT、AST、ALP和Cl-含量无显著变化(P>0.05);血清中MDA和NO含量分别升高59.9%和28.1%(P<0.05或0.01);而血清中IgG、SOD、GLU、TG、Ca2+和IL-2含量,以及T淋巴细胞转化率和中性粒细胞吞噬率分别降低了32.9%、11.1%、18.6%、78.9%、14.5%、7.0%、22.0%和20.2%(均P<0.05)。结论感染隐孢子虫奶牛部分免疫指标下降,抗氧化酶活性降低,清除体内自由基的能力减弱。     

SLE患者血清IL-17、IL-6相关性研究

目的:探讨系统性红斑狼疮(SLE)患者血清中的IL-17、IL-6水平及其与疾病活动性之间的相关性。方法:选取40例SLE患者和40例正常对照者,采用ELISA法测试其血清IL-17和IL-6,仪器法检测ESR,免疫比浊法检测血清C_3、C_4、IgG、IgA、IgM。结果:SLE患者组的血清补体C_3、C_4、IgG、IgM、IL-17、IL-6水平与正常对照组比较差异有统计学意义;患者组血清补体C_3水平与疾病活动指数(SLEDAI)呈负相关,IL-17、IL-6水平与SLEDAI呈正相关。同时发现IL-17与IL-6之间、IL-17/IL-6与SLEDAI之间也分别存在相关性。结论:IL-17、IL-6可能在SLE的发生和发展过程中起到较为重要的作用。     

Stimulation of lymphocytes from rheumatoid arthritis patients by mitogens and IgG.

In the first part of this work patients with rheumatoid arthritis (RA), 36 cases and normal subjects, 49 cases have been studied by lymphocyte cultures stimulated by phytohaemagglutinin (PHA), Concanavalin A (Con A), pokeweed mitogen (PWM) and Con A convalently bound to sepharose 4 B (Con A-S). The comparisons between the two groups have shown a significant difference between the RA lymphocytes and the control lymphocytes stimulated by PHA and Con A. However no statistical difference has been found between the two lymphocytes populations stimulated by PWM and Con A-S. In view to determining the lymphocyte population stimulated by each mitogen, separations of B- and T-cells from peripheral blood have been performed according to the ability for the T-cells population to bind the sheep red blood-cells (rosette forming cells). The T-cell rich population was only stimulated by PHA, Con A and PWM. Although the T-cell depleted one has shown no response to these mitogens, a response to Con A-S was elicited. In the second part of this work, patients with RA, patients with positive tuberculin (PPD) skin-tests and controls were studied. The lymphocytes from these groups were cultured in serum-free medium to obtain cell-free supernatants. These lymphocyte cultures were preincubated with the appropriate antigen or reconstituted after removal of the cells. Supernants from RA lymphocytes stimulated in vitro by undenaturated IgG induced an inhibition of the leucocyte migration, as well as the supernatants from tuberculin-sensitized lymphocytes. However, supernatants from non-RA lymphocytes or tuberculin-unsensitized lymphocytes did not show such an inhibition. These MIF like supernatants have been studied by Sephadex G-100 gel filtration. A MIF like activity has been found for PPD and IgG supernatants between the chymotrypsinogen (MW 23,000) and the lysozyme (MW 17,000). This MIF like activity could be due to RA lymphocytes stimulated by undenatured IgG.     

Effects of single administration of a phosphodiesterase III inhibitor during cardiopulmonary bypass: comparison of milrinone and amrinone.

The effects of phosphodiesterase III (PDE III) inhibitors administered after aortic declamping during cardiopulmonary bypass (CPB) for open heart surgery were investigated. Ten patients (group M) were administered milrinone (50 microg/kg) after aortic declamping during CPB, 10 patients were administered amrinone (1 mg/kg) at the same time during their surgery (group A), and 10 patients served as controls with no drug administered (group C). Soon after bolus infusion of the PDE III inhibitor, perfusion pressure dropped significantly in groups M and A. However, after release of CPB and at the end of surgery, there was no difference in aortic pressure between the 3 groups. There were also no differences between the groups in heart rate, pulmonary artery pressure, and pulmonary capillary wedge pressure. After weaning from CPB, the cardiac index was high and systemic vascular resistance index was low in groups M and A. There were no significant differences in the need for additional catecholamines and time for rewarming between groups. No adverse reactions were observed. A single administration of a PDE III inhibitor during CPB was useful for post-CPB management of patients undergoing open heart surgery. Amrinone reduced perfusion pressures more than milrinone, but cardiac indices and aortic pressures after weaning from CPB showed no differences between group M and group A patients.     

A study about the ability of interleukin-2 production, interleukin-2 receptor expression by lymphocytes from patients with lung cancer]

The ability of Interleukin-2 (IL2) production, IL2 receptors expression and proliferative response by lymphocytes from 48 patients with primary lung cancer and 50 normal controls were studied. The results indicated that after lymphocytes were stimulated with PHA for 48 hours, the IL2 activity produced by lymphocytes from lung cancer patients was significantly reduced, the mean IL2 activity was only about 30% of that of normal controls, with lung cancer progression, the lymphocytes IL2 production tended to be more depressed. The lymphocytes IL2 receptors expression and proliferative response in cancer patients were also significantly decreased. Our study suggested that impaired IL2 production and IL2 receptors expression by lymphocytes from lung cancer patients may depress the IL2 dependent anti-tumor reaction in vivo.     

Subnormal response of blood lymphocytes to phytohaemagglutinin in adult coeliac disease complicated by intestinal lymphoma

Surface markers and the response to phytohaemagglutinin (PHA) were determined in blood lymphocytes from five patients with adult coeliac disease (ACD) complicated by intestinal lymphoma, eight ACD patients without lymphoma, and control individuals without signs of ACD. The proportions of lymphocytes forming rosettes with sheep erythrocytes, lymphocytes with surface IgM, and lymphocytes with Fc IgG receptors were similar in all groups. A subnormal response to PHA was found in the patients with ACD and concomitant intestinal lymphoma. In ACD without lymphoma the PHA response was normal. In ACD patients with relapse of abdominal symptoms despite a gluten-free diet, the demonstration of a subnormal PHA response may strengthen the suspicion of a complicating intestinal lymphoma.     

艾司洛尔对不停跳心内直视手术心肌的保护作用

目的探讨β1受体阻滞剂艾司洛尔在不停跳心内直视手术中对心肌的保护作用。方法选择22例择期行房间隔修补手术患者,随机分为两组,每组11例,两组均在常温体外循环心脏不停跳心内直视下进行房间隔修补手术。实验组在体外循环开始前于预冲液中加入艾司洛尔1 mg/kg,转机过程中再以300μg.kg-1.min-1的速度从静脉持续输注艾司洛尔,直到手术完成。对照组给予等量的生理盐水代替艾司洛尔,其余和实验组相同。监测两组病例在各个时间点的血流动力学、血气分析、心肌损伤标志物及围手术期各项临床指标,并进行对比。结果在转机过程中,实验组心率(56±8)次/min显著低于对照组(64±9)次/min(P<0.05),实验组cTnI和CK-MB在术后6、12、24 h各个时间点均显著低于对照组(均为P<0.001),两组病例在手术开始前、转机开始前、转机过程中、停机后和手术结束后各个时间点的血气分析指标差异无统计学意义(均为P>0.05)。结论在常温体外循环心脏不停跳心内直视手术中应用艾司洛尔可以显著保护心肌并改善手术操作条件。     

Immunological reactivity in children with Wilms' tumor

Cellular immune reactivity was investigated in 49 newly diagnosed children with Wilms' tumor and compared to age-matched control. The level of total T (T4 degrees) and B lymphocytes was normal while the relative number of T lymphocytes with high affinity receptors for sheep erythrocytes (T29 degrees) was significantly decreased in the patients studied. The lymphocyte response to PHA in vitro was diminished but PHA-induced lymphokine production was not altered. The depression of T29 degrees level and lymphocyte reactivity to PHA was associated with high grade tumor rather than with the clinical stage. Lymphocytes of 42-47% patients reacted with autochthonous and allogeneic KCl tumor extracts in the migration inhibition test and the degree of reactivity was related to the histological differentiation of the tumor.     

慢性丙型肝炎病毒感染者外周血淋巴细胞增殖反应

目的　观察慢性丙型肝炎患者外周血淋巴细胞对丙型肝炎病毒（ＨＣＶ） 抗原刺激的增殖反应．方法　外周血单个核细胞（ＰＢＭＣ） 与ＨＣＶ 抗原ｃ２２ 、ｃ３３ 、ｃ１００ － ３ 、ＮＳ５ 和植物血凝素（ＰＨＡ） 分别共同孵育,加入胸腺嘧啶核苷（３ ＨＴｄＲ） ,然后收集细胞于液闪仪测定每分钟脉冲数（ｃｐｍ） ．结果　根据对不同ＨＣＶ 抗原的淋巴细胞增殖反应发现,以ｃ２２免疫原性最强,ｃ１００ － ３ 次之：淋巴细胞激活与ＨＣＶ 基因型关系不大;健康对照和慢性乙型肝炎患者对各ＨＣＶ 抗原未能显示有效的淋巴细胞增殖反应;与健康对照比较,慢性丙型肝炎和乙型肝炎患者对ＰＨＡ 刺激的淋巴细胞增殖反应降低．结论　ＨＣＶ 抗原ｃ２２ 免疫原性最强,丙型肝炎患者对ＨＣＶ 抗原的淋巴细胞增殖反应系特异性;慢性丙型肝炎和乙型肝炎患者存在抑制的细胞免疫应答．     

Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation

Anticoagulation management of patients with recent heparin-induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB) surgery is a serious challenge, and especially difficult in patients requiring urgent heart transplantation. As nonheparin anticoagulants during CPB bear a high risk of major bleeding, these patients are at risk of being taken off the transplant list. Short-term use of unfractionated heparin (UFH) for CPB, with restriction of UFH to the surgery itself, is safe and effective in patients with a history of HIT who test negative for antiplatelet factor 4 (PF4)/heparin antibodies. We present evidence that it is safe to expand the concept of UFH reexposure to patients with subacute HIT (ie, those patients with recent HIT in whom the platelet count has recovered but in whom anti-PF4/heparin IgG antibodies remain detectable) requiring heart transplantation, if they test negative by a sensitive functional assay using washed platelets. This can be lifesaving in patients with end-stage heart failure.     

糖尿病患者体外循环心脏手术后早期脑损伤的临床研究

目的　探讨糖尿病患者行体外循环心脏手术后早期脑损伤的情况。方法　随机选择行瓣膜置换术的糖尿病患者 16例为实验组 ,非糖尿病患者 2 0例为对照组。在体外循环结束后 5小时抽血 ,采用 EL ISA法检测血清 S10 0 B蛋白浓度 ,以判断脑损伤的发生。结果　实验组和对照组的术后早期脑损伤发生率分别为 94 %和6 5 % ,有显著性差异 (P<0 .0 5 )。结论　糖尿病患者在体外循环术后脑损伤的发生率明显高于非糖尿病患者。为减少糖尿病患者术后脑损伤的发生 ,术前必须严格控制血糖 ,术中严密观察血糖变化 ,术中和术后及时应用胰岛素控制血糖。