胆道梗阻患者血清白细胞介素-2和可溶性白细胞介素-2受体水平及精氨酸治疗的研究

为探讨白细胞介素-2(IL-2)／可溶性白细胞介素-2受体(SIL-2R)系统平衡紊乱对胆道梗阻患者免疫状况的影响，我们对胆道梗阻患者围手术期血清IL-2活性和SIL-2R表达状况及精氨酸的免疫调节作用进行分析，报告如下。     

梗阻性黄疸病人围手术期血清可溶性白介素-Ⅱ受体的表达及意义

目的 为了解梗阻性黄疸病人围手术期血清可溶性白介素-Ⅰ受体(SIL-2R)的表达及其临床意义。方法 采用双抗体夹心ELISA法动态测定一组梗阻性黄疸病人减黄手术前后血清SIL-2R的水平．病人按疾病的良恶性分为两组。结果 1．良恶性两组术前血清SIL-2R都明显高于对照组：术后血清SIL-2R逐渐下降．但良恶性两组的下降幅度差异明显。2．胆红素<171mmol/ml即可导致血清SIL-2R明显升高．且黄疸程度愈深．SIL-2R水平愈高。3．在良性组．胆道的内外引流术式对血清SIL-2R表达的恢复存在着显著的差异。结论 梗黄病人体内存在着血清SIL-2R的过度表达，检测血清SIL-2R有助于了解病情、判断预后及鉴别梗黄的性质。胆道外引流相对不利于血清SIL-2R的恢复，推测可能与肠源性内毒素血症有关。     

肝细胞癌病人血清可溶性白细胞介素2受体水平变化及其临床意义

目的：研究肝细胞肝癌（HCC）病人血清可溶性白细胞介素2受体（SIL-2R）水平的变化情况及其临床意义。方法：用酶联免疫吸附试验方法（ELISA）检测60例HCC病人、30例良性肝胆疾病病人以及20例健康对照者血清SIL-2R水平,结合临床资料分析其临床意义。结果：HCC组血清SIL-2R水平显著性高于其他两组（P＜0.01),良性肝胆疾病组与健康对照组血清SIL-2R水平无显著性差异（P＞0.05)。HCC组中血清SIL-2R水平与疾病分期有较好的相关性,随HCC分期升高,SIL-2R水平增高。血清SIL-2R水平与AFP水平无相关性（r=0.197,P＞0.05)。血清SIL-2R水平可作为HCC早期诊断的良好指标,以100pmol/L为切割值,其灵敏度为81.7%,特异度为100%,诊断符合率90%。血清SIL-2R水平变化受手术因素影响。术后SIL-2R水平先升高后降低,降低程度与肿瘤切除与否有关。术后肿瘤复发病人血清SIL-2R水平升高。结论：血清SIL-2R水平可作为HCC病人早期诊断、病情判断、复发监测的重要指标。     

梗阻性黄疸患者手术前后sIL—2R水平的动态观察

目的探讨梗阻性黄疸(梗黄)患者围手术期血清可溶性白细胞介素-2受体(sIL-2R)水平的变化及意义.方法应用双抗体夹心(ELISA)法检测30例梗黄患者手术前后血清sIL-2R的水平. 结果梗黄患者血清sIL-2R明显高于正常组,其表达分别与梗阻程度、梗阻时间和营养状况呈显著正相关(r=0.734, P<0.01; r=0.646, P<0.01; r=0.594, P<0.05 ).恶性梗阻性黄疸(恶性梗黄)组术前血清sIL-2R显著高于良性梗阻性黄疸(良性梗黄)组(P<0.05)和正常对照组(P<0.01); 恶性梗黄组中有转移者,血清sIL-2R水平显著高于无转移者(P<0.05).围手术期免疫功能呈现暂时抑制到逐渐恢复的过程,术后第21天,良性梗黄患者血清sIL-2R恢复到正常水平,而恶性梗黄患者则仅恢复到术前水平.结论梗黄患者存在免疫抑制,其血清sIL-2R异常表达与梗阻类型、梗阻程度、梗阻时间、营养状况以及是否转移有关.检测梗黄患者血清sIL-2R可作为其免疫状况评价、病情、治疗和预后评估的有用指标.     

阻塞性黄疸病人淋巴细胞膜高,低亲和力白细胞介素—2受体的变化

为了解阻塞性黄疸病人的细胞免疫状态，我们用放射性配基结合分析法测定５３例阻塞性黄疸病人胆道引流前后淋巴细胞膜白细胞介素－２受体（ＩＬ－２Ｒ）的表达。病人按疾病的良、恶性分为两组。结果：①高亲和力ＩＬ－２Ｒ位点数良、恶性两组都低于对照组。胆道引流２１天后，良性组恢复正常，恶性组虽比引流前有明显提高，却仍低于对照组，胆道引流４２天后恶性组进一步提高，但仍未达到正常水平；②低亲和力ＩＬ－２Ｒ位点数在胆道引流前后无变化，但恶性组都低于对照组和良性组。③在恶性组，胆道的内外引流对淋巴细胞膜高亲和力ＩＬ－２Ｒ表达的恢复无明显影响。结论：阻塞性黄疸可抑制淋巴细胞膜形成高亲和力ＩＬ－２Ｒ的能力，恶性肿瘤的存在可增强该抑制作用；胆道引流后这种抑制作用基本恢复，而恶性肿瘤的抑制作用是不能恢复的。     

阿法D3冲击治疗对尿毒症继发甲旁亢患者甲状旁腺素、白细胞介素2及其可溶性受体的影响

活性维生素D，即1，25(0H)2D3，缺乏是尿毒症患者继发性甲状旁腺功能亢进(SHPT)及免疫功能紊乱的重要发病机制。活性维生素D与皮质醇激素有着同源基因，可在T细胞mRNA的水平上抑制白细胞介素2(IL-2)合成，致使可溶性白细胞介素2受体(SIL-2R)代偿性升高，有免疫抑制作用。维生素D能强烈阻止PTH的分泌；而PTH却有同维生素D     

SIL-2R在胃癌诊断及治疗中的作用(文献综述)

血清可溶性白细胞介素2受体(SIL-2R)是由细胞膜表面的IL-2R脱落入血而形成,在免疫缺陷病、结核、恶性淋巴瘤等疾病时血清SIL-2R浓度增高。本文阐述了SIL-2R在胃癌诊断、预测有无淋巴结转移 评估手术及化疗的疗效以及指导胃癌过继免疫治疗方面的作用,并对研究SIL-2R的前景作了展望。     

谷氨酰胺对梗阻性黄疸大鼠可溶性白细胞介素2受体的影响

梗阻性黄疸（简称梗黄）是普外科常见疾病，围手术期易发生感染、脓毒症等并发症，严重影响患者预后，免疫功能低下是其主要原因之一。本研究通过建立大鼠梗黄模型，给予力太（Dipeptiven，丙氨酰谷氨酰胺注射液，含L谷氨酰胺13．46g／100m1），探讨谷氨酰胺（Gln）对梗黄大鼠可溶性白细胞介素2受体（sIL-2R）的影响。     

动态检测血中可溶性白细胞介素2受体诊断器官移植术后急性排异反应

采用ELISA法对6例心、肝、肾异体移植术后病人,连续动态检测血清可溶性白细胞介素2受体(SIL-2R),发现:①急性排异反应时,SIL-2R水平明显升高,与其他各种情况比较均有明显差异(P<0.05—P<0.01);②与排异反应有关的SIL-2R升高在时间上较临床症状出现要提早48—72小时。提示:动态检测SIL-2R水平变化对异体移植术后早期急性排异反应具有早期、灵敏,较为特异的诊断价值。     

可溶性白细胞介素2受体(sIL-2R)与大肠癌(文献综述)

恶性肿瘤血清可溶性白细胞介素2受体（SIL－2R）水平增高是由肿瘤诱导的免疫反应所致。大肠癌血清SIL－2R水平明显比正常人群高，且与大肠癌临床分期有关，根治性大肠癌切除术后2周SIL－2R可降至正常水平。研究表明sIL－2R水平与大肠癌患者的免疫状态及病情严重程度有关。     

恶性阻塞性黄疸患者引流术前后免疫功能变化和血清白细胞介素Ⅱ受体检测意义的研究

本文观测１８例恶性阻塞性黄疸患者胆道引流术前１天、术后１、３、７、１４和２１天免疫功能变化。另设２０例良性阻塞性黄疸患者为对照。结果显示：总补体、补体Ｃ３参与术后的炎症反应；ＳＩＬ－２Ｒ术后先上升后下降，而后又再次上升，表明减黄术对改善恶性阻塞性黄疸患者免疫功能有效；ＳＩＬ－２Ｒ为一敏感指标。     

恶性梗阻性黄疸患者IAP和SIL-2R测定的意义

目的 了解恶性梗黄疸患者细胞免疫功能被抑制状况及减黄术前后的变化。方法 应用单向免疫扩散法和酶联免疫吸附法动态监测６０例恶性梗黄疸患者围减黄手术期外周血免疫抑制酸性蛋白（ＩＡＰ）的可溶性白介素Ⅱ受体（ＳＩＬ－２Ｒ）水平的变化并与同期２５例良性梗阻性黄疸患者及４０例正常人进行比较。结果 恶性梗黄患者血清ＩＡＰ和ＳＩＬ－２Ｒ水平术前１天,术后１０天及２０天明显高于良性梗塞疸患者及正常人（Ｐ〈０．０１）     

Soluble interleukin-2 receptor level as an indicator of liver allograft rejection

We studied the serum levels of soluble interleukin-2 receptors (SIL-2R) in liver allograft recipients: a control group without rejection or CMV disease, a group with only rejection episodes, and a group with only cytomegalovirus disease. Rejection was diagnosed by the presence of compatible laboratory and histologic abnormalities and absence of other causes of graft dysfunction. CMV disease was diagnosed by isolation of CMV in blood or liver specimen cultures or identification of cytomegalic inclusions in the liver biopsy specimen. Of 82 consecutive recipients treated with cyclosporine and prednisone, 12 were in the control group, 20 in the rejection group, and 5 in the CMV disease group. The remaining 45 had other or multiple complications. In the control group the SIL-2R levels (determined by an ELISA) decreased by a mean of 4% per day after transplantation; in the rejection group the levels increased by a mean of 17% per day in the 10 days prior to the diagnosis of rejection; in the CMV disease group the levels tended to increase prior to the diagnosis of CMV disease. The rejection group had significantly higher SIL-2R levels than the control group at comparable times. Thus, SIL-2R levels were significantly increased at the time of allograft rejection compared with levels in a control group, and recipients with CMV disease had increased levels of SIL-2R but they were not as high as in recipients with rejection episodes.     

左旋卡尼汀对维持性血液透析患者红细胞免疫和SIL-2R的影响

目的探讨左旋卡尼汀对MHD患者红细胞免疫功能和血清可溶性白细胞介素-2受体（S102R）的影响。方法选择我院MHD患者70例,将其随机分为治疗组和对照组,每组35例。两组患者均使用血液透析和红细胞生成素治疗,治疗组在此基础上应用左旋卡尼汀1．0克加生理盐水稀释至15ml于每次透析结束时缓慢静脉注射,每周2次、治疗12周。治疗前及治疗12周时检测外周血WBC、RBC、Hb、PLT、白蛋白（Alb）、总胆固醇（TC）、三酰甘油（TG）、红细胞免疫功能、SIL-2R。结果治疗组和对照组贫血均明显改善;治疗组RBC、Hb、红细胞免疫功能、SIL-2R水平较对照组显著提高;治疗前后WBC数量两组比较无差异。结论左旋卡尼汀可改善MHD患者的红细胞免疫功能和细胞免疫功能。     

Soluble IL-2 receptor in patients with primary nephrotic syndrome

The soluble interleukin-2 receptor (SIL-2R) levels in 46 patients with primary nephrotic syndrome were examined. The values in the nephrotic patients exceeded those in healthy controls (p less than 0.05), and were the same at the nephrotic and non-nephrotic stages. The serum interleukin-2 (IL-2) levels in the nephrotic patients were low and did not correlate with the serum SIL-2R levels. Only at the nephrotic stage were the latter closely correlated with the serum IgG (p less than 0.001) but not with the serum IgA or IgM. The SIL-2R production by phytohemagglutinin stimulated peripheral blood lymphocytes (PBL) in the nephrotic patients was less at the nephrotic and non-nephrotic stages than that in the healthy controls. The IgG production by pokeweed mitogen stimulated PBL was low at the nephrotic stage but not at the non-nephrotic stage. Based on these findings, it is suggested that SIL-2R determinations should prove useful in clarifying the relationship between cellular and humoral immunological disorders in nephrotic syndrome.     

肾移植后血清白细胞介素2、可溶性白细胞介素2受体和白细胞介素6的监测

动态监测６０例肾移植患者术后２个月内血清白细胞介素２（ＩＬ－２）、可溶性ＩＬ－２受体（ｓＩＬ－２Ｒ）和白细胞介素６（ＩＬ－６）的变化。结果发现发生急性排斥反应时，上述细胞因子的升高较临床诊断提早数天，并且显著高于环孢素Ａ肾中毒组；对甲泼尼龙敏感的排斥反应，抗排斥治疗数天后上述因子下降到排斥前水平。提示肾移植术后动态监测患者血清ＩＬ－２、ｓＩＬ－２Ｒ和ＩＬ－６有助于急性排斥反应的早期诊断、鉴别诊断、及时治疗和甲泼尼龙抗排斥的疗效评价。     

Lymphocyte subpopulations,interleukin-2 and interleukin-2 receptor expression in childhood nephrotic syndrome

Abnormal T lymphocyte function and reduced interleukin-2 (IL-2) production have been implicated in the pathogenesis of the nephrotic syndrome (NS). We investigated: (1) lymphocyte subpopulations and expression of IL-2 receptor (IL-2R) on T cells using two-colour flow cytometry, (2) serum IL-2 and (3) the soluble component of IL-2R (sIL-2R) in serum, using enzyme-linked immunosorbent assay, in 38 children with NS. All children, except those in remission, had marked proteinuria. They were divided into groups according to renal pathology: (1) steroid-sensitive NS (SSNS) not receiving prednisolone therapy, (2) SSNS on prednisolone, (3) focal segmental glomerulosclerosis (FSGS), (4) SSNS in remission and not receiving prednisolone therapy, (5) congenital NS (CNS). Results were compared with 26 age-matched controls. Total T lymphocytes (CD3) were reduced in groups 1 and 2; CD4 count was reduced in groups 1–4; CD8 count increased in groups 2 and 3; CD8 and CD19 (B lymphocytes) were significantly reduced in group 5. Increased IL-2R expression (CD25) on CD4 lymphocytes was noted in groups 1, 2 and 3 implying activation of these cells. In patients with SSNS, increased serum sIL-2R was recorded during relapse (1,273±497 U/l vs. 913±401 U/l in remission,P<0.005) but free serum IL-2 was not detectable at any stage. The specific alterations in lymphocyte subpopulations in SSNS and FSGS would imply an involvement of the immune system distinct from that in CNS.     

SIL-2R在恶性梗阻性黄疽及其并发SIRS中的变化和意义

目的:探讨sIL-2R在恶性梗阻性黄疸及其并发SIRS中的变化规律及应用价值。方法:采用ELISA法检测血清sIL-2R,46例恶性梗阻性黄疸患者sIL-2R水平和健康对照组比较,并观察与黄疸持续时间、黄疸轻重程度以及是否并发SIRS时的变化规律,以及减黄手术前后sIL-2R的变化。结果:恶性梗阻性黄疸患者的sIL-2R明显高于健康对照组,并且随黄疸持续时间延长和黄疸的加重而升高,其中并发SIRS组明显高于无并发SIRS组,患者行减黄手术后,sIL-2R逐渐降低至接近健康人水平。结论:sIL-2R可以作为恶性梗阻性黄疸患者免疫功能状态、病情严重程度和预后判断的指标。