帕米磷酸二钠联合沙立度胺对平台期多发性骨髓瘤患者血清VEGF及IL-6的影响及临床意义

目的:探讨帕米磷酸二钠联合沙立度胺维持治疗对平台期多发性骨髓瘤患者血清内皮生长因子(VEGF)及白细胞介素-6(IL-6)的影响。方法:32例患者分为治疗组和观察组,16例治疗组患者应用帕米磷酸二钠每月1次,每次60~90mg,沙立度胺口服200~400mg/d,共6个月。16例观察组患者行支持治疗。用ELISA方法检测治疗前后及2组VEGF和IL-6水平。并以18例正常人作对照。结果:治疗前2组患者血清VEGF和IL-6水平显著升高,差异无统计学意义(P>0.05),与正常对照组比较差异有统计学意义(P<0.01),治疗后2组患者血清VEGF和IL-6水平对照差异有统计学意义(P<0.05),治疗组治疗前后VEGF和IL-6水平差异有统计学意义(P<0.05)。结论:帕米磷酸二钠联合沙立度胺维持治疗明显降低平台期多发性骨髓瘤患者血清VEGF和IL-6水平,对改善多发性骨髓瘤患者预后有重要作用。     

肝炎患者血清IL-12、IFN-γ和IL-10检测的意义

目的:探讨检测IL-12、IFN-γ和IL-10对病毒性肝炎患者的临床意义。方法:利用ELISA法检测97例病毒性肝炎患者血清IL-12、IFN-γ和IL-10水平,动态观察45例接受免疫增强剂治疗的慢性肝炎患者上述细胞因子的变化。结果:急性肝炎患者血清IL-12及IFN-γ水平均明显升高(P<0.01);慢性肝炎、肝硬化患者血清中IL-10明显高于正常对照组(P<0.01)。免疫增强剂治疗获得完全应答反应的患者治疗期间血清IL-12、IFN-γ水平明显上升(P<0.01),IL-10水平下降(P<0.05),无应答者治疗过程中上述细胞因子无明显变化。结论:Thl型免疫应答对机体清除病毒起关键作用;Th2型免疫应答与感染慢性化及疾病持续发展有关;免疫治疗可使部分Th2型免疫应答占优势的慢性肝炎患者转化为Th1型占优势。     

阿德福韦酯对慢性乙型肝炎患者外周血IFN-γ和IL-18的影响

目的:观察阿德福韦酯治疗前后慢性乙型肝炎患者外周血干扰素-γ(IFN-γ)和白细胞介素-18(IL-18)的变化,探讨阿德福韦酯抗乙型肝炎病毒(HBV)的免疫效应机制。方法:选择参加阿德福韦酯Ⅱ期临床试验的42例慢性乙型肝炎患者作为研究对象,检测阿德福韦酯治疗前、治疗4、12、24、48周末患者血清IFN-γ和IL-18水平,以及HBV DNA及ALT水平变化。结果:治疗前患者IFN-γ及IL-18水平明显高于正常对照组(P<0.01)。治疗后,HBV DNA水平逐渐降低,各检测时间点之间比较差异均有统计学意义(P<0.01),ALT在治疗4周时较治疗前有所升高(P<0.05),然后逐渐下降直至正常。IFN-γ及IL-18水平逐渐升高,在12周时达到高峰(P<0.01),然后逐渐降低。完全应答组治疗前INF-γ和IL-18水平高于部分应答组和无应答组(P<0.01)。完全应答和部分应答组治疗后INF-γ和IL-18水平与治疗前比较均明显升高(P<0.01),而无应答组IFN-γ和IL-18治疗前后比较,差异无显著性意义(P>0.05)。结论:阿德福韦酯除直接抑制病毒复制外,可促进Th1型细胞因子分泌,调动机体对HBV的细胞免疫,有利于HBV的清除。     

急性淋巴细胞性白血病患者血清IL-12、IFN-γ及LDH测定的临床意义

目的探讨急性淋巴细胞性白血病(ALL)患者血清白细胞介素12(IL-12)、γ干扰素(IFN-γ)及乳酸脱氢酶(LDH)测定的临床意义。方法采用酶联免疫吸附(ELISA)法测定36例ALL患者不同阶段IL-12、IFN-γ水平,全自动生化分析仪酶法测定LDH水平,并与正常对照组比较。结果ALL初诊组血清IL-12、IFN-γ明显低于正常对照组(P<0.01,<0.05),LDH明显高于正常对照组(P<0.01);IL-12与IFN-γ呈显著正相关(P<0.01)。完全缓解组血清IL-12和IFN-γ明显升高,与对照组无统计学差异;LDH较治疗前明显下降但仍高于正常对照组(P<0.01)。结论IFN-γ、IL-12和LDH变化可能与白血病细胞的生长及机体抗肿瘤免疫功能受损有关。     

青春双歧杆菌对溃疡性结肠炎患者血清相关因子的影响

目的研究青春双歧杆菌对溃疡性结肠炎(UC)患者血清相关因子的影响。方法采用酶联免疫吸附试验(ELISA)法检测UC患者治疗前后及正常对照组血清肿瘤坏死因子(TNF)-α,干扰素(IFN)-γ,白细胞介素(IL)-6及IL-10的水平,并分别比较各组细胞因子水平的差异。结果UC患者血清TNF-α、IFN-γ、IL-6水平明显高于正常对照组,而IL-10水平明显低于正常对照组(P0.05);传统治疗组及双歧杆菌治疗组血清TNF-α、IFN-γ、IL-6水平较治疗前下降,而IL-10水平较治疗前升高(P0.05),两治疗组与正常对照组相比无明显差异(P0.05)。结论青春双歧杆菌可以降低UC患者血清促炎因子TNF-α、IFN-γ及IL-6水平,还可升高抑炎因子IL-10水平,调节肠黏膜的细胞免疫功能,可用于UC的治疗。     

尿毒症血液透析患者血清瘦素和Th1/Th2型细胞因子平衡的临床研究

目的 观察尿毒症血液透析(HD)患者血清瘦素、Th1/Th2型细胞因子水平的改变及其相互关系,探讨其在HD患者免疫功能异常中的作用.方法 选择终末期尿毒症行HD患者35例及健康对照者20例,双抗体夹心酶联免疫吸附法(ABC-ELISA)测定血清白细胞介素(IL)-2、干扰素(IFN)-γ、IL-4和IL-10水平,放射免疫分析法(RIA)测定两组血清瘦素水平.直线相关分析它们之间的相关性.结果 HD患者血清瘦素水平较对照组明显升高(P<0.01),与男性患者相比,女性患者升高尤为显著(P<0.01).HD患者血清Th1型细胞因子IL-2、IFN-γ水平明显升高,与对照组比较差异均有统计学意义(P<0.01);Th2型细胞因子IL4、IL-10水平较对照组降低,但差异无统计学意义(P>0.05),Th1/Th2比值升高.直线相关分析表明HD患者血清瘦素水平与IL-2(r=0.43,P<0.01)、IFN-γ(r=0.51,P<0.01)呈显著正相关,与IL-4(r=-0.39,P<0.01)、IL-10(r=-0.32,P<0.05)呈负相关.结论 HD患者存在高瘦素血症及以Th1型细胞因子占优势的Th1/Th2细胞因子平衡失调;患者血清细胞因子水平改变与瘦素水平相关.     

胸腺肽α1对AECOPD患者的免疫调节作用

目的 探讨胸腺肽α1对AECOPD患者的免疫调节作用.方法 80例AECOPD患者随机分为两组,A组(n=40)仅采用常规方法治疗,B组(n=40)在A组治疗基础上加用胸腺肽α1治疗,同期选择40例健康体检者作为对照组(C组).观察治疗前后各组血清Th1型细胞因子(IFN-γ)和Th2型细胞因子(IL-4)的表达水平.结果 B组治疗总有效率(90.0%)明显高于A组治疗总有效率(77.5%) (P<0.05);两组治疗前IFN-γ、IL-4表达水平及IL-4/IFN-γ较C组明显增高(P<0.05),治疗后A、B组IFN-γ、IL-4表达水平及IL-4/IFN-γ较治疗前明显下降(P<0.05),且B组下降较A组更为明显(P<0.05).结论 胸腺肽可纠正患者体内Th1/Th2细胞因子平衡紊乱现象,改善COPD患者的免疫系统功能.     

组合型人工肝对肝功能衰竭患者血清Th1/Th2型细胞因子的影响

[目的]探讨组合型人工肝对肝功能衰竭患者血清Th1/Th2型细胞因子(IL-2、TNF-α、IFN-γ、IL-4、IL-6、IL-10)的影响。[方法]采用流式细胞仪方法检测肝功能衰竭患者、肝损伤患者、正常人血清Th1/Th2型细胞因子的水平,检测肝功能衰竭患者行血浆置换(PE)、双重血浆吸附(DPMAS)、PE+DPMAS治疗前后Th1/Th2型细胞因子水平。[结果]肝功能衰竭患者血清Th1/Th2型细胞因子水平与肝损伤及正常人比较差异有统计学意义(P0.01)。PE+DPMAS组治疗前、后细胞因子水平比较均差异有统计学意义(P0.05);PE组治疗前、后IL-2、IFN-γ、IL-6、IL-10比较差异有统计学意义(P0.05),IL-4、TNF-α比较无差异(P0.05);DPMAS组治疗前、后IL-6比较差异有统计学意义(P0.01),其他细胞因子无差异(P0.05)。PE组、DPMAS组、PE+DPMAS组治疗前Th1/Th2型细胞因子水平比较均差异无统计学意义(P0.05),治疗后PE+DPMAS组与PE组、DPMAS组比较差异显著(P0.01),PE组与DPMAS组比较无差异(P0.05)。[结论]肝功能衰竭患者Th1/Th2型细胞因子IL-2、TNF-α、IFN-γ、IL-4、IL-6、IL-10水平均明显高于正常人和肝损伤患者。PE+DPMAS对肝功能衰竭患者血清Th1/Th2型细胞因子的清除率明显优于单纯PE或DPMAS。     

OPN、IFN-γ、IL-10检测对活动性肺结核病情及预后判定的临床意义

目的探讨OPN、IFN-γ、IL-10检测对活动性肺结核病情及预后判定的临床意义。方法选择2015年1月-2018年1月我院收治的92例活动性肺结核患者作为实验组,并选择同期50例门诊健康体检者作为对照组,采用酶联免疫吸附法(ELISA)检测所有研究对象血清OPN、IFN-γ、IL-10的水平;并比较治愈患者与未治愈患者在治疗前后血清OPN、IFN-γ、IL-10的水平变化情况。结果实验组患者的血清OPN、IFN-γ、IL-10的水平均明显高于对照组(P 0. 05);且痰菌阳性患者的血清OPN、IFN-γ、IL-10的水平均明显高于痰菌阴性患者(P 0. 05);治疗前,治愈患者与未治愈患者的血清OPN、IFN-γ、IL-10的水平无明显差异(P0. 05),治疗后所有患者各细胞因子水平均较治疗前明显降低(P 0. 05),但治愈患者各细胞因子水平明显低于未治愈患者(P 0. 05)。结论活动性肺结核患者血清OPN、IFN-γ、IL-10的水平显著升高,对患者病情及预后评估具有重要价值。     

拉米夫定治疗对慢性乙型肝炎患者干扰素-γ和白细胞介素-4的影响

目的 观察拉米夫定治疗慢性乙型肝炎患者血清IFN-γ和IL-4水平的动态变化.方法 ELISA法分别检测66例慢性乙型肝炎患者在拉米夫定治疗前,治疗后第3、6、9、12个月时的血清IFN-γ和IL-4水平.选取20名健康献血员作为健康对照.治疗前后比较用t检验,计数资料采用非参数秩和检验.结果 HBeAg阳性患者拉米夫定治疗前.完全应答组IFN-γ水平为(21.03±4.44)ng/L,明显高于部分应答组的(13.85±3.92)ng/L及无应答组的(10.63±3.11)ng/L(t=7.56,t=11.87,均P<0.01);以IFN-γ为15.66 ng/L为界,治疗前IFN-γ高水平患者完全应答率明显高于低水平患者(31.0%比8.7%,x2=8.391,P<0.01),无应答率明显低于低水平患者(13.8%比52.2%,x2=4.256,P<0.01).治疗后完全应答组患者IFN-γ/IL-4接近或高于对照组,部分应答组和无应答组低于对照组;HBeAg阴性患者拉米夫定治疗后IFN-γ/IL-4缓慢上升,但未达对照组水平.结论 拉米夫定治疗慢性乙型肝炎可增加IFN-γ释放,抑制IL-4释放,治疗应答程度与治疗后辅助性T淋巴细胞(Th)1/Th2平衡的恢复及治疗前IFN-γ水平有关.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.