我国部分地区抗HIV治疗效果实验室评估和耐药变异的初步研究

目的研究中国HIV/AIDS患者应用高效抗逆转录病毒治疗后,其病毒学、免疫学疗效以及对耐药变异的影响。方法对辽宁、吉林、河南三省HIV/AIDS患者采用三种治疗方案治疗前后进行病毒载量、CD4+T淋巴细胞数、耐药变异基因型监测。结果经HAART治疗6个月,辽宁病例病毒载量下降5.7log10拷贝/ml,有8/11的病例病毒载量达到最低检测限(LDL)以下,病毒抑制率为72.7%。吉林病例病毒载量下降幅度3.8log10拷贝/ml,有11/24的病例病毒载量达到LDL以下,病毒抑制率为45.8%。差异均有统计学意义(P<0.05)。辽宁HIV/AIDS患者治疗6个月后CD4+T淋巴淋巴细胞平均增加164个/mm3,吉林患者平均增加24个/mm3,个体差异很大。在应用逆转录酶抑制剂后有耐药变异发生,且交叉耐药、多药耐药常见。结论在应用逆转录酶抑制剂时一定要加强监测,规范化管理,及时调整用药以节省有限的药物资源并防止耐药株的传播。     

中医药配合HAART对HIV/AIDS患者CD4+T细胞及病毒载量影响的研究

目的:观察中医药配合HAART对HIV/AIDS患者CD4+T细胞及病毒载量的影响。方法:将180例HIV/AIDS患者随机分成2组,治疗组予以芩花解毒胶囊,艾可清颗粒以及HAART治疗,对照组予以HAART治疗,分别于治疗前后检测患者CD4+T细胞、病毒载量变化以及安全性指标。结果:治疗前后CD4+T细胞绝对计数治疗组与对照组比较均能显著提高(P0.05),治疗组与对照组CD4+T细胞计数与CD4+T细胞上升幅度无显著性差异(P0.05)。安全性方面治疗组并未出现血常规、肝功能以及肾功能,相反,血常规和肝肾功能方面有改善的趋势。结论:艾可清颗粒与芩花解毒胶囊没有影响HAART的免疫学疗效,同时可以改善HIV/AIDS患者血常规、肝肾功能方面的问题以及尿黄、盗汗和便秘等症状。     

获得性免疫缺陷综合症患者高效抗反转录病毒治疗效果评价

目的:探讨获得性免疫缺陷综合症(AIDS)患者的高效抗反转录治疗(HAART)效果与不良反应。方法:应用国家免费提供的抗病毒治疗药品,对符合治疗条件的HIV/AIDS患者进行规范抗病毒治疗,并检测患者的CD4T淋巴细胞计数与病毒载量。结果:HAART开始12个月后,患者的CD4T淋巴细胞计数平均增长83.13个/μl,病毒载量均低于检测下限。结论:抗病毒治疗效果显著,能够实现部分免疫重建,但也存在较多不良反应。     

T细胞第二信号受体-CD28分子在HIV/AIDS患者中的异常改变

目的研究T细胞第二信号受体-CD28分子在人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者中的异常改变,探讨其临床意义。方法采用流式细胞术检测HIV/AIDS患者外周血CD4 T细胞表面CD28分子的表达,对278例未接受过高效抗逆转录病毒治疗(HAART)的患者进行横断面研究,对其中59例接受规律HAART的患者于开始治疗前,治疗后第1、3、6、9、12月末进行随访。以56例健康献血员作为正常对照。结果HIV/AIDS患者外周血CD4 T细胞表面CD28分子表达显著下调(P<0.001),且CD28分子表达比例与其CD4 T细胞计数呈正相关(r=0.484,P<0.001),与血浆病毒载量呈负相关(r=-0.300,P<0.001)。给予HAART1个月后CD4 T细胞的CD28表达比例中位数由75%快速恢复至90%(P<0.001)。HAART期间6个时间点的CD28表达比例中位数与病毒载量中位数呈负相关(r=-0.829,P=0.042),与CD4 T细胞计数中位数之间未发现显著相关性。结论HIV/AIDS患者外周血CD4 T细胞表面CD28分子表达明显减少,HAART可有效重建CD4 T细胞功能亚群(CD4 CD28 T)的数量,HAART后CD28表达上调可能与病毒载量的控制密切相关。     

抗反转录病毒治疗HIV/AIDS初治患者232例结果分析

目的观察艾滋病（HIV/AIDS）初治患者接受国产药为主的高效抗反转录病毒治疗（HAART）的疗效,为规范抗病毒治疗提供依据.方法对232例初治HIV/AIDS患者提供国产药为主的HAART并进行定期随访,分析随访3年来的临床疗效、毒副反应及耐药情况.结果 232例患者接受HAART后24、36个月HIV-1病毒载量小于50拷贝/mL的百分比分别为94.8%、85.3%.CD4＋T淋巴细胞计数基线均值（160.1±80）个/mL,接受HAART治疗后,患者CD4＋T淋巴细胞计数逐渐增高,对0、3、6、9、12、18、24、30、36个月来所检测到的CD4＋T淋巴计数进行检验P〈0.01.常见的毒副反应是肝功能损害、外周神经炎、外周脂肪分布异常、骨髓造血功能抑制、皮疹.9例患者治疗过程中出现临床耐药.结论 HIV/AIDS初治患者经国产药为主的抗病毒治疗后虽然毒副反应较大,但病毒学及免疫学应答效果好,临床耐药低.     

AIDS/TB双重感染82例临床治疗分析

目的观察HAART(高效抗反转录病毒)联合常规抗结核和左氧氟沙星治疗AIDS/TB(艾滋病合并肺结核)双重感染患者的疗效。方法回顾我院2008年11月1日～2011年12月30日期间诊治的AIDS/TB双重感染患者82例。结果在接受HAART后3个月后,与常规抗结核组比较,常规抗艾抗结核联合左氧氟沙星组和常规抗艾组绝大部分患者CD4+T细胞计数均显著上升,并且常规抗艾组比常规抗艾抗结核联合左氧氟沙星组和常规抗结核组明显增高(P﹤0.01)。结论 HAART联合常规抗结核和左氧氟沙星治疗艾滋病合并肺结核,疗效确切,值得推广。     

逐级放大和PCR扩增技术检测HIV/AIDS患者治疗前后病毒载量变化

目的探讨HIV/AIDS患者治疗前后病毒载量的变化状况。方法采用逐级放大和PCR扩增技术分别检测177例HIV/AIDS患者治疗前后的病毒载量。结果 177例HIV/AIDS患者治疗后病毒载量降低163例,升高14例。治疗前病毒载量值为(90 647±28 795)拷贝/ml,治疗后病毒载量值明显降低为(3 384±342)拷贝/ml(P<0.01);治疗前男性病毒载量低于女性,治疗后男性病毒载量高于女性(P均<0.05)。结论逐级放大和PCR扩增技术检测HIV/AIDS患者治疗前后病毒载量对抗反转录病毒治疗方案制订、疗效观察有参考价值。     

HIV/AIDS患者长期高效抗逆转录病毒治疗后眼底动脉硬化发生及影响因素分析

目的探讨HIV/AIDS患者长期高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)后眼底动脉硬化情况及影响因素。方法收集2020年1月—2022年6月南宁市第四人民医院收治的203例HIV/AIDS患者HAART前后临床基本资料和眼底检查资料,评估患者眼底动脉硬化发生情况,并对其影响因素进行分析。结果203例HIV/AIDS患者出现眼底动脉硬化159例,发生率为78.33%,其中Ⅰ级33例(20.75%)、Ⅱ级87例(54.72%)、Ⅲ级28例(17.61%)、Ⅳ级11例(6.92%);HAART前,眼底动脉硬化组及正常组患者CD4^(+)T淋巴细胞计数、CD8^(+)T淋巴细胞计数、病毒载量、白细胞计数、血小板计数、血红蛋白、血肌酐、血尿素氮、三酰甘油、总胆固醇、空腹血糖、谷丙转氨酶、谷草转氨酶及血清总胆红素两组间比较差异无统计学意义(P>0.05);在HAART 6个月后,动脉硬化组CD8^(+)T淋巴细胞计数、甘油三酯、空腹血糖值显著高于正常组,两者比较差异有统计学意义(P<0.05);在HAART 6个月后CD4^(+)、CD8^(+)淋巴细胞计数分层比较中,动脉硬化组CD4^(+)淋巴细胞计数(CD4^(+))<200个/μL患者比例显著高于正常组患者,CD4^(+)淋巴细胞计数CD4^(+)≥500个/μL患者比例显著低于正常组患者;而CD8^(+)淋巴细胞计数CD8^(+)≥800个/μL患者比例显著大于正常组(P均<0.05)。二元Logistic回归分析结果显示,机会性感染、HIV病程、HAART后CD4^(+)T、CD8^(+)T淋巴细胞计数及三酰甘油是影响HIV/AIDS患者发生眼底动脉硬化独立危险因素(P<0.05)。结论HIV/AIDS患者眼底动脉硬化发生率高,>4年HIV病程、合并机会性感染、HAART 6个月后较低的CD4^(+)T淋巴细胞计数,较高的CD8^(+)T淋巴细胞计数和三酰甘油值是患者发生眼底动脉硬化的独立危险因素。应对此类人群在HAART前后均需进行眼底筛查,针对心血管疾病风险,制定HAART方案,并在治疗过程中加强心血管疾病风险管理改善患者结局。     

816例初始抗病毒治疗免疫学和病毒学疗效分析

目的 评价我国现行高效联合抗逆转录病毒治疗(HAART)48周在成人初治HIV/AIDS患者中的免疫学和病毒学疗效.方法 回顾性研究我院初次接受HAART的HIV/AIDS患者816例,分析治疗前后的免疫学和病毒学疗效.结果 816例中男749例(91.8％),女67例(8.2％);年龄19～70岁,平均(32.0±18.8)岁.传播途径以男男同性性行为(681例,83％)为主.在治疗48周后,CD4细胞均值由223个/μl升高至437个/μl,CD4细胞在200个/μ1以下者由39.7％降至12.5％,CD4细胞201～350个/μl者由50.2％降至26.2％,CD4细胞＞350个/μ1者由10.0％增至61.3％.病毒载量平均值由13 490拷贝/ml下降至42拷贝/ml,病毒载量小于50拷贝/ml者占90.9％.结论 现行的艾滋病HAART疗效较好,值得推广.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.