隐睾患儿抗精子抗体检测及临床意义

目的　检测隐睾患儿抗精子抗体 (AsAb)的阳性率 ,探讨AsAb与睾丸位置、年龄、手术等因素的关系及其产生的可能机制。方法　自 2 0 0 0年 11月～ 2 0 0 1年 11月 ,我科收治隐睾患儿 6 8例 ,年龄自 9个月～ 12岁 ,6 0例行睾丸固定术 ,8例行精索遗迹切除术。正常对照组共 2 0例。采用EALISA间接法测定外周血抗精子抗体IgG和IgM。结果　 6 8例隐睾患儿中AsAb阳性者 2 2例 ,正常对照组中仅 3例阳性。 5岁以下患儿 ,4 1例中 12例AsAb阳性 ,2 7例 5岁及以上患儿中 ,10例AsAb阳性。隐睾患儿AsAb的检出率明显高于对照组 ,随年龄增大 ,AsAb检出率增大 (P <0 .0 5 )。 4例二次手术者 ,2例AsAb阳性。 38例睾丸位于外环口者中 ,12例AsAb阳性 ,而 2 2例睾丸位于外环口以上者中 ,8例AsAb阳性。 7例曾行HCG治疗者中仅 1例AsAb阳性。结论　隐睾患儿的AsAb检出率明显高于正常儿 ,随年龄增长AsAb检出率增高 ;AsAb产生与手术和温度升高等造成的血睾屏障破环、附睾发育畸形造成的输精管梗阻及患儿免疫调节失调等因素有关     

隐睾与抗精子抗体

隐睾(cryptorchidism)是小儿泌尿外科最常见的先天性畸形之一。尽管对于隐睾的研究已有近200年的历史,但是仍有许多方面存在争议。目前普遍认为未经治疗的隐睾有较大的危害。自从Thom asA nnandale于1877年成功地实施第一例睾丸下降手术以来犤1犦,隐睾的治疗方法也在不断完善。但是研究发现隐睾患儿虽经手术等治疗,但是成年后不育率的发生率仍较正常者为高。同时研究发现在成年人中有隐睾患病史的人其血清中抗精子抗体(A nti-sperm antibodies,A SA)出现的几率也较正常人高许多。而抗精子抗体是一些成年人不育的重要原因。因此,近年来隐…     

川崎病患儿抗心磷脂抗体检测的意义

目的：检测川崎病(KD)患儿血清中抗心磷脂抗体(ACA),探讨ACA与KD血管损害的关系。方法：55例急性期KD患儿,采用ELISA方法检测血中ACA-IgG,IgM和IgA三种亚型。结果：55例急性期KD患儿血清ACA-IgG阳性31例,ACA-IgM阳性13例。急性期KD组ACA-IgG,IgM阳性率比对照组显著增高(P<0.01);治疗后ACA-IgG阳性率仍高于对照组(P<0.05),而ACA-IgG阳性或阴性两组的临床表现比较差异均无显著性(P>0.05),但6例伴有血栓形成者有5例ACA-IgG阳性。结论：ACA-IgG是KD常见的抗体,ACA-IgG阳性与KD血栓性血管损害关系密切,但对病情判断无作用。     

抗心磷脂抗体检测在肾脏病患儿中的意义

目的：抗心磷脂抗体(ACA)与多种自身免疫性疾病有关。检测肾脏病患儿血清中ACA的阳性率,以探讨ACA与肾脏病的关系。方法：采用ELISA方法检测22例肾脏病患儿和30例健康儿童血中ACA-IgG、IgM和IgA三种亚型。同时检测血尿素氮、肌酐、胆固醇、血清白蛋白,24h尿蛋白定量。结果：22例肾脏病患儿血清ACA-IgM阳性10例(45.5%),对照组ACA-IgM均为阴性,肾脏病组阳性率比对照组显著增高(P＜0.01＝;其中过敏性紫癜肾炎ACA-IgM阳性6例(6/12)、单纯性肾病综合征ACA-IgM阳性4例(4/7),急性期肾小球肾炎ACA-IgM均阴性。ACA-IgM阳性组血小板计数均≥350×109/L,ACA-IgM阴性组仅3例血小板计数≥350×109/L。ACA-IgM与血尿素氮、肌酐、胆固醇、血清白蛋白,24 h尿蛋白定量无相关性。结论：ACA-IgM是肾脏病患儿常见的抗体,ACA-IgM阳性提示肾脏病患儿存在高凝状态,对病情判断有一定的作用,但与肾脏功能和尿蛋白无关。     

人绒毛膜促性腺激素对内分泌型双侧隐睾大鼠生精细胞凋亡的影响

目的探讨人绒毛膜促性腺激素(HCG)对内分泌型双侧隐睾大鼠生精细胞凋亡的影响。方法取60只SD大鼠,随机抽取20只作为正常对照组,余40只采用皮下注射17-β雌二醇方法制成双侧隐睾模型,随机分为隐睾+HCG组、隐睾+9 g.L-1盐水组(隐睾+NS组)。隐睾+HCG组自日龄26 d起隔日肌注HCG 20 U,共10次;隐睾+NS组自日龄26 d起隔日肌注9 g.L-1盐水1 mL,共10次。于日龄45 d、60 d每组各抽10只采集血清,取其睾丸组织后处死。采用ELISA间接法测定其血清抗精子抗体(AsAb)水平,放射免疫方法测其血清雌二醇(E2)、睾酮(T)水平,生物素-脱氧尿嘧啶核苷三磷酸(dUTP)/酶标亲和素(TUNEL)法检测其生殖细胞凋亡指数(AI)。结果日龄45 d和60 d时,隐睾+HCG组双侧睾丸生殖细胞AI均明显高于同日龄其他各组(Pa<0.01);隐睾+HCG组血清E2水平较同日龄其余各组均显著增高(Pa<0.01),而血清T水平均降低(Pa<0.01);隐睾+HCG组AsAb水平均高于同日龄其他组(Pa<0.01)。结论 HCG注射治疗双侧隐睾大鼠不仅能增加AsAb产生,且能加重睾丸生殖细胞的凋亡。     

川崎病患儿抗中性粒细胞胞浆抗体和抗心磷脂抗体检测

为了探讨抗中性粒细胞胞浆抗体(ANCA)和抗心磷脂抗体(ACA)对川崎病(KD)血管损害的意义,采用ELISA方法,检测50例急性期KD患儿血中ANCA的2种靶抗原蛋白酶3(PR3)和髓过氧化物酶(MPO)以及ACA的IgG、IgM和IgA 3种亚型。结果显示,50例急性期KD患儿血清ANCA-MPO阳性37例;ACA-IgG阳性29例,ACA-IgM阳性10例。急性期KD组ANCA-MPO和ACA-IgG阳性率比对照组显著增高,P<0.005;治疗后KD组ANCA-MPO和ACA-IgG阳性率仍高于对照组,P<0.005。急性期冠状动脉扩张组比无冠状动脉扩张组ANCA-MPO阳性率明显增高,P<0.05;而ACA在两组间比较差异无显著性,P>0.05,但5例伴有血栓形成中4例ACA-IgG均阳性。28例KD患儿同时出现ANCA-MPO和ACA-IgG阳性,但两种抗体之间无相关性(r=0.35,P>0.05)。提示MPO为ANCA的主要靶抗原,血清MPO阳性有助于KD诊断,对判断预后亦具有一定意义;ACA-IgG阳性与KD血栓性血管损害关系密切,但对病情判断无作用。     

川崎病患儿血清抗内皮细胞抗体和抗中性粒细胞胞浆抗体检测的临床意义

目的 探讨抗内皮细胞抗体（AECA）和抗中性粒细胞胞浆抗体（ANCA）在川崎病（KD）及其冠状动脉损害（CAL）中的临床意义。方法 应用酶联免疫吸附试验定量检测42 例KD 患儿急性期、缓解期血清AECA 和ANCA 水平,并行心脏超声心动图了解CAL 发生情况。随机选取20 例因呼吸道感染发热患儿和15 例外科择期手术患儿分别作为发热对照组和普通对照组。结果 急性期KD 组AECA、ANCA 水平均显著高于两对照组（PPPPr=0.88,P结论 AECA、ANCA 可能参与了KD 血管炎及其CAL 的发生。急性期血清AECA、ANCA 对早期难以确诊的KD 有参考价值,ANCA 水平异常增高对CAL 有一定的预警价值。     

病毒性心肌炎患儿检测抗心磷脂抗体的临床价值

病毒性心肌炎（ＶＭ）的发病机制与免疫异常有关。抗心磷脂抗体（ＡＣＡ）为能与细胞膜的磷脂相结合的自身抗体,国内外对ＶＭ的ＡＣＡ研究甚少。我们对ＶＭ患儿测定了ＡＣＡ,同时检测心肌酶、心电图、血清超氧化物歧化酶（ＳＯＤ）活力等,以研究ＡＣＡ对ＶＭ诊断、判断病情和估计预后的价值。对象：ＶＭ组、扩张型心肌病（ＤＣＭ）组及健康对照组。ＶＭ组６２例,男３８例,女２４例;年龄８个月～１２岁,平均７．６岁,均符合第六届全国小儿心血管会议修订的ＶＭ诊断标准。ＶＭ患儿均有ＰＣＲＣｏｘＢ（柯萨奇病毒Ｂ）或ＣｏｘＢＩ…     

Hypothalamo-Hypophyseal-Testicular Function in Prepubertal Boys with Acute Lymphoblastic Leukemia following Chemotherapy and Testicular Radiotherapy

ABSTRACT. Hypothalamo-hypophyseal-testicular function was studied in twenty-eight prepubertal boys with ALL in clinical and haematological remission. Eighteen were treated with combined systemic chemotherapy (24–36 months) and the other ten, who had testicular leukemic infiltrates, received chemotherapy (38–60 months) and testicular radiotherapy (2000 rad). Plasma levels of LH and FSH were measured before and after stimulation with LHRH (100 μg i.v.) and plasma levels of testosterone before and after stimulation with hCG (1500 IU/48 h/7 doses). In patients treated with chemotherapy alone, mean basal LH and FSH, mean responses to LHRH stimulation and mean testosterone levels after stimulation with hCG did not significantly differ from those of the controls. Five of these patients who had normal testosterone values after three doses of hCG had testosterone values below the normal range after seven doses. In patients treated with chemotherapy and testicular radiotherapy, mean basal FSH and mean responses to LHRH stimulation were significantly higher than those of the controls. Testosterone values after stimulation with hCG were low in three and very low in the other seven. In both groups of patients data from testicular biopsies were consistent with functional results. We conclude that chemotherapy causes slight testicular damage, but chemotherapy and testicular radiotherapy produce severe testicular damage in patients with testicular leukemic infiltrates.     

不同日龄隐睾复位大鼠睾丸组织结构观察

目的 观察不同13龄隐睾复位大鼠睾丸组织结构的变化.方法 72只21 d雄性SD大鼠随机分为单侧隐睾组、双侧隐睾组、假手术对照组各24只.建立单、双侧隐睾动物模型.2周后行隐睾大鼠睾丸下降固定术,于日龄40、60 d处死取睾丸,采用苏木素.伊红染色光镜下观察各组大鼠精曲小管生育力指数(TFI)和平均精曲小管直径(MTD);生物素-dUTP/酶标亲和素法(TUNEL法)检测睾丸生殖细胞凋亡情况.结果 隐睾侧睾丸MTD、TFI显著低于阴囊内睾丸,而隐睾生殖细胞凋亡指数(AI)明显增高于阴囊内睾丸(P＜0.05);单侧隐睾组阴囊内睾丸TFI低于相应日龄的假手术对照组,但无统计学意义(P＞0.05).40 d时单侧隐睾组隐睾侧睾丸生殖细胞AI较双侧隐睾组低(P＜0.05),日龄60 d,各组隐睾侧睾丸AI较40 d时明显降低(P＜0.05),但单侧隐睾和双侧隐睾AI比较无统计学差异(P＞0.05).结论 实验隐睾复位大鼠睾丸AI升高,同时单侧隐睾鼠对侧睾丸组织存在不同程度的损害.随着复位时间的延长,隐睾组织的病理损害有恢复的趋势.     

青春期前尿道下裂小儿内分泌变化的研究

对３５例尿道下裂小儿及２０例正常儿作黄体素释放激素（ＬＨ－ＲＨ）兴奋试验和人绒毛膜促性腺激素（ＨＣＧ）试验，应用放射免疫法测定了血清黄体素（ＬＨ）、卵泡刺激素（ＦＳＨ）、及睾酮（Ｔ）浓度。检查结果发现，尿道下裂患儿ＬＨ－ＲＨ刺激后的血清ＬＨ、ＦＳＨ浓度高于正常对照组，而注射ＨＣＧ３天后的血清Ｔ浓度较正常对照组低下。并对以上内分泌异常及其可能在尿道下裂形成过程中的作用进行了讨论     

激素治疗小儿隐睾的系统评价

目的评价激素治疗隐睾的效果,为进一步的临床研究与实践提供参考。方法制定原始文献的纳入标准、排除标准及检索策略,在美国医学索引MEDLINE(1966~2004)、荷兰医学文摘EMBASE(1974~2004)、Cochrane图书馆的图书馆临床对照试验资料库(2004年第4期)、中国生物医学文献光盘数据库CBMdisc(1978~2004)、中国期刊全文数据库(1994~2004)和万方数据库(1980~2004)内检索、收集激素治疗隐睾的相关随机对照试验(RCT),并手检相关参考文献,进行质量评价和资料提取。应用Rev Man 4.2版软件进行数据的Meta分析处理;本系统评价疗效资料均为分类变量,故以比数比或相对危险度(Peto OR或RR)及其95%可信区间(95%CI)表示效应量。结果共检索到相关文献500篇,其中RCT 29篇,排除18篇,符合纳入标准11篇进入Meta分析。结果2个研究组设立人绒毛膜促性腺激素(HCG)治疗组和对照组,其睾丸完全下降率分别为25.2%与5.48%,PetoOR值及其95%CI分别为4.67[2.94,7.43];10个随机化组比较促性腺激素释放激素(GnRH)治疗组和对照组的效果,其睾丸完全下降率分别是17.2%与3.04%,Peto OR值及其95%CI分别为4.73[3.34,6.68];3个组比较HCG治疗组和GnRH治疗组,其睾丸完全下降率分别为24.0%与13.1%,Peto OR值及其95%CI分别为2.11[1.38,3.21];两组比较HCG或GnRH治疗单侧隐睾和双侧隐睾的效果,其睾丸完全下降率分别为25.0%与20.9%,其RR值及其95%CI分别为1.16[0.69,1.95]。结论按照目前已有资料分析,HCG较GnRH治疗隐睾有效,GnRH较安慰剂有效;激素治疗双侧隐睾效果较单侧隐睾好。但由于这些试验RCT数量较少,且可能存在一定程度的偏倚,因此其结果只能供临床参考。     

Influence of Treatment Modalities on Prepubertal Growth in Children with Acute Lymphoblastic Leukemia

The statural growth of 85 prepubertal children treated for acute lymphoblastic leukemia was evaluated in a longitudinal study over 4.5 years. Patients were divided into three groups according to central nervous system prophylaxis: 37 patients received cranial irradiation with a dose of 24 Gy, 15 received a dose of 18 Gy, and 33 were not irradiated. According to the risk of leukemia, patients were divided into normal-risk (n = 74) and high-risk (n = 11) groups. The duration of treatment was 2 years, during which all patients showed growth retardation. The relative standard deviation score for height declined from 0 to -0.7 for the irradiated patients and from 0 to -0.2 for the non-irradiated group (P = 0.0001). There was no difference in growth pattern between cranial irradiation with 18 versus 24 Gy and chemotherapeutic treatment according to high-risk versus normal-risk protocols. However, a negative synergistic effect of more intensive chemotherapy and cranial irradiation on growth was demonstrated.     

Acquired Cryptorchidism in a Boy with Disorder of Sex Development

Recently, it has been reported that boys with severe hypospadias are at increased risk for acquired cryptorchidism. The reports suggested that prenatal and postnatal androgen disruption might be correlated with this condition. We experienced a case of ovotesticular disorder of sex development (DSD), which was ultimately diagnosed at surgery for acquired cryptorchidism. Ascent of the scrotal contents of the left side was detected in a 7-yr-old boy with the 46, XX karyotype, who had a history of perineal hypospadias repair. Intraoperative findings revealed the left gonad consisted of 2 segments, and this was histologically diagnosed as ovotestis by biopsy specimen. Resection of the ovarian segment was performed simultaneously. Exploration of the contralateral gonad showed the same findings. This is the first report of acquired cryptorchidism observed in a patient with DSD presenting with ambiguous genitalia.     

生脉注射液对青春前期大鼠睾丸扭转/复位缺血再灌注的保护作用

目的观察青春前期大鼠睾丸单侧扭转复位后对双侧睾丸氧自由基的远期影响,探讨生脉注射液对其的保护作用。方法 5周龄健康SD雄性大鼠24只,随机分为实验组(生脉注射液组)、对照组(9 g.L-1盐水组)和假手术组,每组8只。实验组和对照组建立左侧睾丸扭转复位模型,假手术组游离睾丸,不予扭转。于术后7周取各组大鼠双侧睾丸,分别测定大鼠睾丸组织内超氧化物歧化酶(SOD)、一氧化氮合酶(NOS)活性和丙二醛(MDA)水平。结果与对照组比较,实验组和假手术组大鼠双侧睾丸中SOD活性升高,NOS活性和MDA水平下降(Pa<0.05)。与假手术组比较,实验组大鼠双侧睾丸组织中SOD活性下降,NOS活性和MDA水平升高(Pa<0.05)。结论生脉注射液可提高大鼠睾丸组织中的SOD活性,提高机体抗氧化能力,清除氧自由基,抑制脂质过氧化反应,减轻MDA对细胞膜的损伤,对睾丸缺血再灌注损伤具有一定的保护作用。     

绒毛膜促性腺激素对双侧隐睾大鼠睾丸生殖细胞凋亡的影响

目的探讨绒毛膜促性腺激素(HCG)对双侧隐睾生殖细胞凋亡的影响。方法SD雄性幼鼠于日龄22d制备双侧隐睾模型(模型组)后开始隔日肌注HCG20U,共7次。假手术组作为对照。日龄35、60d时处死取睾丸,采用生物素-dUTP/酶标亲和素(TUNEL)法检测生殖细胞凋亡情况。结果模型组双侧隐睾睾丸凋亡指数(AI)高于假手术组。35d假手术HCG治疗组AI高于假手术HCG未治疗组(P<0.05)。60d各HCG治疗组睾丸的AI高于相应HCG未治疗组,组间比较无显著差异(P>0.05)。结论隐睾时睾丸生殖细胞凋亡增加;HCG可增加生殖细胞的凋亡。     

Specific Antibodies to Poliovirus Type I in Breastmilk of Unvaccinated Mothers before and Seven Years after Start of Community-Wide Vaccination of Their Infants with Live, Oral Poliovirus Vaccine

ABSTRACT. Secretory IgA (SIgA) antibodies against poliovirus type 1 were determined using the ELISA method in breastmilk samples obtained each month from 100 young, healthy, unvaccinated mothers living in urban slum areas of Lahore, Pakistan. The study covered two different groups, one in 1980–1981 and the other in 1987, before and seven years after a nation-wide expanded programme of childhood immunization (EPI) had started. The SIgA titres did not change neither with duration of lactation nor with time after vaccination in the infants of the mothers studied. The seasonal breastmilk IgA antibody titres to poliovirus type 1 corresponded to the epidemiological conditions existing both before (1980–81) and after general vaccination coverage with live, oral poliovirus vaccine (OPV) had reached 80% of the infant population (1987). Neutralization titres did not seem to correlate well with ELISA titres although colostrum samples had high levels of neutralizing antibodies. The wide variation between high (> 10 000) and low (<500) individual breastmilk IgA antibody titres observed during various seasons could be of consequence for the breast-fed baby. Colostrum, which was also found to have significant neutralization capacity, might interfere with the OPV now often given on the day of birth.     

Antibodies to Gliadin in Children with Coeliac Disease

ABSTRACT. We have measured antibodies to gliadin (AGA), bovine β-lactoglobulin, and chicken egg ovalbumin with a four-layer solid phase radioimmunoassay (RIA) in 62 children and adolescents with coeliac disease and in 36 healthy controls. The geometric mean titre of IgG AGA in patients at initial diagnosis was more than 100-fold that of controls ( p <0.0001). Even patients on gluten-free diet had significantly higher IgG AGA titres than the controls ( p = 0.0001), the difference being more than 5-fold. All the 42 patients with active disease (30 at initial diagnosis and 12 after gluten challenge) had their IgG AGA titre above 1000, as compared with 2 (5.7%) of the 35 controls ( p <0.0001). Both IgG and IgA AGA were quite sensitive and specific in identifying children with coeliac disease; the sensitivities for IgG and IgA AGA were 100% and 95.2%, the specificities 94.3% and 97.2%, respectively. We conclude that determination of IgG and IgA AGA with RIA is suitable for monitoring dietary compliance in children with coeliac disease, and the method is sensitive and specific for screening for coeliac disease in children.