糖蛋白贮积症等的实验诊断及应用

溶酶体贮积症是由于溶酶体中某些酸性水解酶的遗传性缺陷,导致相应的底物降解障碍而贮积在溶酶体中,造成细胞结构和功能障碍,进而影响了整个器官结构和功能.按贮积物质的性质分类,有神经鞘脂贮积症(sphingolipidosis),粘多糖贮积症(mucopolysaccharidosis),糖蛋白贮积症(glycoproteinosis)及糖原贮积症(glycogenosis).我室在建立了三种神经鞘脂贮积症的实验诊断及产前诊断方向后,又建立了正常人白细胞、经培养的皮肤成纤维细胞及羊水细胞中α及β-葡糖苷酶,α-甘露糖苷酶及α-岩藻糖苷酶的活性测定。为诊断及产前诊断糖原贮积症亚型(Pompe氏病),神经鞘脂贮积症中的Gaucher氏病及糖蛋白贮积症中的α-甘露糖苷贮积症及α-岩藻糖苷贮积症打下基础。前两种病是溶酶体贮积症中较常见者,后两者是粘多糖贮积症鉴别诊断常涉及者。有关粘多糖贮积症的实验诊断方法见另文.     

应重视戈谢病的实验室诊断

戈谢病是一种溶酶体贮积病,主要是由于缺乏溶酶体内酸性葡萄糖脑苷脂酶,而导致其不能代谢的底物葡萄糖脑苷脂在单核细胞和(或)巨嗜细胞系贮积,主要影响脾、肝脏和骨髓.     

戈谢病的临床研究进展

戈谢病(GD)是溶酶体贮积症病(lysosomal storage disorder,LSD)中最常见的一种,为常染色体隐性遗传病.该病主要因为β-葡糖脑苷脂酶(β-glucocerebrosidase,GC)缺乏,致使葡糖脑苷脂(glucocerebroside)不能被水解而聚积在巨噬细胞溶酶体中,导致细胞失去原有的功能而产生一系列症状.     

Fabry病神经系统损害的研究进展

Fabry病(法布里病)是X染色体连锁隐性遗传的溶酶体贮积病,其发病机制为编码α半乳糖苷酶A的GLA基因发生突变,导致患者血浆α半乳糖苷酶A的活性部分或全部消失,从而引起神经酰胺三己糖苷为主的鞘糖脂类物质不能分解而聚集各种细胞内,造成各脏器功能受损。其中神经系统损害包括小纤维神经病及脑血管疾病等,对于不明原因的神经疼痛和早发脑卒中患者应考虑Fabry病的可能,以期早期诊治。     

中国戈谢病诊治专家共识

戈谢病(Gaucher disease)是最常见的溶酶体贮积病之一,属常染色体隐性遗传病.该病由于基因突变导致机体葡萄糖脑苷脂酶(glucocerebrosidase,又称酸性β葡萄糖苷酶,acid β-lucosidase)活性缺乏,造成其底物葡萄糖脑苷脂(glucocerebroside)在肝、脾、骨骼及肺、甚至脑的巨噬细胞溶酶体中贮积,形成典型的贮积细胞即戈谢细胞,导致受累组织器官出现病变.     

α-L-岩藻糖苷酶在原发性肝癌诊断中的应用

目的:探讨α-L-岩藻糖苷酶活性增高与原发性肝癌的关系.方法:对原发性肝癌组31例及对照组进行α-L-岩藻糖苷酶活性检测,比较原发性肝癌组与对照组之间α-L-岩藻糖苷酶活性的差异.结果:原发性肝癌组的α-L-岩藻糖苷酶活性明显高于对照组,经统计学处理差异有显著性(P＜0.01).结论:α-L-岩藻糖苷酶活性增高能对原发性肝癌做出早期、准确的临床诊断.     

α-L-艾杜糖苷酶活性测定诊断粘多糖贮积症I型

目的:用二种酶活性测定方法诊断粘多糖贮积症I型(MPS I)患者及杂合子.方法:用4MU-α-L-iduronide及phenyl-α-L-iduronide二种底物测定临床疑似MPS I型的患者及杂合子的白细胞α-L-艾杜糖苷酶活性,与正常人对照做出诊断.结果:用4MU-α-L-iduronide做为底物,α-L-艾杜糖苷酶活性正常人均值为1 h 14.98nmol/mg蛋白,杂合子7.01,患者范围0～0.09.用phenyl-α-L-iduronide做为底物,正常人均值为18 h 225 nmol/mg蛋白,杂合子均值为125,患者范围0～7.7.结论:二种方法均可以应用于MPS I型诊断,以荧光法为优.phenyl-α-L-iduronide法诊断杂合子宜慎重.     

以心悸和全身神经性疼痛为首发表现的法布里病1例

该文报道1例法布里病患者, 女性, 36岁, 临床表现为心悸及全身神经性疼痛, 实验室检查提示α-半乳糖苷酶基因活性下降。法布里病临床罕见, 且症状缺乏特异性, 需结合临床表现、酶活性、生物标志物及基因检测等综合作出诊断。     

54例荷兰籍迟发性Pompe病患者的临床表现和自然病程

迟发性Pom pe病(酸性麦芽糖酶缺乏症,Ⅱ型糖原贮积病)是由α-葡萄糖苷酶缺乏所致的一种慢性进行性肌病。接受酶替代治疗的患者需要症状性质、严重程度以及疾病自然病程等方面的详细资料,为此研究人员制订了有关患者病史和目前情况的详细调查问卷,并在54例荷兰籍患者中收集信息。受试者的年龄为48.6±15.6岁,多在28.1±14.3岁时起病,主要表现为活动障碍和肢带无力。58%的成年患者在儿童期曾出现轻微的肌肉症状。28%的患者从发病首次就诊到最终确诊的时间>5年。调查问卷完成时,48%的患者要依靠轮椅生活,37%需借助人工通气,2/3以上的问卷反馈…     

溶酶体贮积症的产前诊断

溶酶体贮积症是一组遗传性疾病,是由于基因突变导致溶酶体的有关酸性水解酶缺陷,以致其天然底物在溶酶体中贮积而造成的。绝大多数为常染色体隐性遗传,无有效治疗方法。因此对高危孕妇进行产前诊断,是防止患儿出生的唯一有效措施。我们利用羊水细胞测酶活性在国内首次进行产前诊断成功两例。 材料与方法 用已建立的酶活性测定法,对先证者作出确诊。两例先证者,一例为黑矇性痴呆(Tay-Sachs氏病,简称TSD),一例为粘脂贮积症Ⅲ型(Mucolipidosis Ⅲ,简称ML Ⅲ),他们的母亲再次妊娠时,     

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.