肝病患者血清TGFα含量与肝功能的关系研究

探讨肝病患者血清TGFα的变化规律及其与肝功能损害的关系。用放射免疫法测定 172例各型肝病患者血清TGFα含量 ,测定各项肝功能指标 :ALT、AST、γ -GT、AKP、TB、A/G、AFP等。 (1)急性肝炎、慢性肝炎、肝硬化代偿期、肝硬化失代偿期、肝癌患者血清TGFα含量 (x±s)分别为 :(14 19± 7 30 )pg/ml、(11 2 8± 6 84) pg/ml、(8 14± 5 5 5 ) pg/ml、(16 0 2± 9 81) pg/ml、(19 89± 9 0 9)pg/ml,明显高于对照组 (6 86± 0 ,89) pg/ml((P <0 0 5 )。 (2 )TGFα和肝功能指标ALT、AST、γ -GT、AFP的相关有显著性意义 (P <0 0 0 5 ) ;而和AKP、TB、A/G的相关无显著性 (P >0 5 0 )。TGFα与肝病的慢性化及肝功能损害严重程度相关 ,检测血清TGFα对慢性肝病的预后估计尤其是肝硬化恶变有一定的作用。     

肝硬化患者检测血浆神经肽Y的临床意义

研究肝硬化患者血浆神经肽Y的变化及其临床意义。肝硬化患者 6 4例。男 40例 ,女 2 4例 ,平均年龄 45岁± 2 3岁。其中乙型肝炎性肝硬化 5 7例 ,丙型肝炎性肝硬化 2例 ,酒精性肝硬化 4例 ,心源性肝硬化 1例 ,伴消化道出血 2 0例 ,腹水 36例 ,肝性脑病 12例和肝肾综合症 4例。按肝功能分级Child分级 :A级 2 8例 ,B级 2 3例 ,C级 13例。采用RIA法检测空腹血浆NPY水平 ,并与 40例 (男 2 6例 ,女 14例 ,平均年龄 42岁± 2 0岁 )健康人作对照。肝硬化A级患者血浆NPY含量 (12 1 6± 2 8 9) pg/ml低于健康对照组 (142 3± 40 5 ) pg/ml(P <0 0 5 )。肝硬化B级 (6 3 4± 2 4 8) pg/ml,C级 (4 5 6± 2 1 7) pg/ml患者血清NPY含量显著低于健康对照组及肝硬化A级患者 (P <0 0 1)。肝硬化患者血浆NPY含量显著低下 ,并随肝功能损害程度加重而下降更多 ,提示NPY可能参与了肝损害的病理过程 ,并与肝功能分级有关。     

培哚普利对急性冠状动脉综合征患者白介素-6和肿瘤坏死因子-α水平的影响

目的　观察急性冠状动脉综合征患者使用培哚普利治疗后白介素 - 6( IL- 6)和肿瘤坏死因子 ( TNF- α)水平的变化。方法　选择 10 0例诊断为不稳定型心绞痛 ( 73例 )和急性心肌梗死 ( 2 7例 )的病人分为两组 ,A组 ( 5 0例 )接受培哚普利治疗 2周 ,B组 ( 5 0例 )未接受培哚普利治疗。入院时和治疗 2周后分别检测 IL- 6和 TNF- α浓度。结果　入院时 A组 IL- 6和 TNF- α水平与 B组相比无显著性差异 ( 60 8.4± 112 .3 pg/ ml vs5 83 .1± 10 6.4pg/ m l,46.0±10 .4pg/ ml vs 44 .1± 8.8pg/ ml,P>0 .0 5 ) ,治疗两周后两组 IL - 6和 TNF-α水平均有降低 ,而 A组病人两周后 IL -6和 TNF- α水平与 B组相比有显著降低 ( 2 40 .5± 5 0 .4pg/ ml vs414.3± 98.6pg/ m l,16.2± 3 .5 pg/ m l vs3 2 .7± 6.2 pg/ ml,P<0 .0 5 )。结论　急性冠状动脉综合征患者应用培哚普利治疗后 IL - 6和 TNF-α水平降低 ,提示培哚普利可能有直接抗炎作用     

肝硬化患者血清—氧化氮和几种白细胞介素检测的临床意义

目的　探讨肝硬化患者血清一氧化氮 (NO)、白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 8(IL 8)及可溶性白细胞介素 2受体 (sIL 2R)变化的临床意义。方法　应用ELISA法测定肝硬化患者及正常对照组的血清IL 6、IL 8及sIL 2R含量 ;应用MTT法检测血IL 2活性 ;应用荧光法检测血清NO水平。结果　肝硬化患者血清IL 2、sIL 2R、IL 6、IL 8及NO水平 :(5 741.5 3± 4376 .5 2 )U/ml、(486 .76± 46 .41)U/ml、(15 .78± 3.0 4) pg/ml、(2 3.89± 2 .13)pg/ml及 (6 .33± 0 .37) μmol/L ,显著高于正常对照组 :(173.88± 92 .2 1)U/ml、(2 42 .36± 35 .78)U/ml、(6 .14± 3.12 ) pg/ml、(17.71± 1.32 )pg/ml及 (3.6 8± 0 .34 ) μmol/L ,并随肝功受损程度进行性增加。 结论　肝硬化患者血清IL 2、sIL 2R、IL 6及IL 8增加可能为NO增多的诱发因素 ;肝功能损伤可能是白细胞介素活性增加的重要原因。     

慢性肝病患者血清转化生长因子α水平检测的临床意义

采用放射免疫分析法测定98例慢性肝病(轻、中、重度乙型肝炎,肝硬变,肝癌)患者和30例健康查体者血清转化生长因子α(TGF-α)水平,同时检测各项肝功能指标。结果中度慢性肝炎、重度慢性肝炎、肝硬化失代偿期、肝癌患者血清TGF-α水平分别为(12.82±5.23)、(15.89±5.09)、(19.41±5.93)、(23.38±6.46)pg/ml,显著高于对照组(8.40±3.11)pg/ml;且慢性肝病患者血清TGF-α水平与肝功能指标谷丙转氨酶、谷草转氨酶、白蛋白呈正相关。     

sFas与sFasL在自身免疫疾病中的意义

目的　研究sFas与sFasL在系统性红斑狼疮 (SLE)等自身免疫疾病中的意义及抗单链DNA(ssDNA)抗体与sFas和sFasL介导凋亡的相关性。方法　采用夹心ELISA方法检测 31例SLE病人 ,32例类风湿关节炎 (RA)病人 ,2 0例 1型糖尿病 (IDDM )病人及 5例多发性硬化病 (MS)病人血清中sFas与sFasL含量及抗ssDNA抗体水平。结果　在SLE、RA、IDDM及MS患者血清中的sFas含量 (pg/ml)分别为 2 881± 16 5 3 ,988± 6 96 ,135 2± 413 ,15 40± 5 6 6 ,明显高于正常对照 (P <0 0 0 2 ) ,SLE病人sFas含量高于RA ,MS ,IDDM病人。SLE、RA患者血清sFasL含量 (pg/ml)分别为5 35± 431、12 38± 1184,明显高于正常对照 (P <0 0 2 ) ,MS、IDDM患者血清sFasL含量 (pg/ml)分别为 2 5 1± 140 ,2 11± 73 ,低于正常对照 (P >0 0 5 )。在SLE、RA病人中 ,高浓度sFasL者伴有高浓度sFas。在SLE病人中 ,所有抗ssDNA抗体阳性者均伴有高浓度sFas,所有抗sFas阴性者 ,ssDNA抗体也为阴性。结论　在SLE等疾病中sFas水平明显高于正常人 ,可作为疾病进展与治疗效果的判断指标。抗ssDNA抗体与sFas具有关联性。sFas与sFasL在疾病中的相互作用及动态变化有待进一步研究     

Il-6及TNF-α表达与粥样斑块稳定性及冠心病的相关性分析

目的：分析IL - 6和TN F - α的表达与粥样斑块稳定性及冠心病的相关性。方法：收集我科收治的临床诊断为冠心病的患者72例,另外收集健康体检者30例,将其分为稳定性板斑块组、不稳定性斑块组及正常对照组,检测三组患者白细胞介素6及肿瘤坏死因子α的表达情况及观察冠状动脉狭窄程度的Gensini积分与IL-6及TNF-α的相关性。结果：稳定性斑块组血清IL-6为28.43±13.16pg/ml,不稳定性斑块组为38.32±18.74pg/ml,远高于对照组血清IL-6的值3.75±2.42pg/ml,稳定性斑块组血清TNF - α为19.09±7.70pg/ml,不稳定性斑块组为35.26±14.72pg/ml,远高于对照组血清TNF - α的值3.53±1.99pg/ml,差异均具有统计学意义(P<0.05),血清IL - 6值与Gensini积分成正相关(r=0.692,P=0.000),血清TN F - α值与Gensini积分成正相关(r=0.599,P=0.000)。结论：IL-6及TNF-α与粥样斑块稳定性及冠心病之间具有相关性,且IL-6及TNF-α的血清值越高,冠状动脉血管损害越严重。     

肝肺综合征患者降钙素基因相关肽及内皮素含量检测

目的　肝肺综合征 (HPS)的发生与血循环或肺内扩张 /收缩血管物质失衡密切相关。检测HPS患者血浆中降钙素基因相关肽 (CGRP)和内皮素 (ET)含量 ,以探讨它们在HPS发病中的作用。方法　选择经肺灌注扫描及血气分析诊断的HPS患者 16例 ,无HPS的肝硬化患者 30例 ,用放射免疫分析法测定其血浆CGRP、ET含量 ,同时以 15名健康献血员作为对照。结果　HPS组血浆CGRP[(6 5± 15 )pg/ml]、ET[(78± 2 1) pg/ml]显著高于肝硬化组 [(5 1± 15 ) pg/ml,(6 0± 14 ) pg/ml,P <0 .0 1],也显著高于对照组 [(32± 12 ) pg/ml,(36± 11)pg/ml,P <0 .0 1];肝硬化组与正常对照组比较差异也有显著性(P <0 .0 1)。线性相关分析显示 ,HPS组患者血浆CGRP及ET含量与动脉血氧分压呈显著负相关 ,与肺内分流率大小无关。结论　HPS患者血浆CGRP、ET含量增高 ,其增高可能与HPS肺内血管扩张和动脉血氧分压下降有关。     

慢性乙型肝炎患者血清HBV DNA含量与肝功能损害程度的关系

目的 了解慢性乙型肝炎患者血清HBV DNA含量与肝功能损害程度的关系。方法 应用荧光能量转移定量聚合酶链反应检测233例慢性乙型肝炎患者血清HBV DNA含量。结果 HBeAg阳性患者血清HBV DNA含量(10~(6.18±2.04)拷贝/毫升)显著高于HBeAg阴性/抗-HBe阳性患者的含量(10~(4.16±1.78)拷贝/毫升)(P<0.001);不同ALT水平的慢性乙型肝炎患者血清HBV DNA含量无显著性差异(P>0.05);无黄疸组、轻度黄疸组、中度黄疸组、重度黄疸组的慢性乙型肝炎患者血清HBV DNA含量分别为:(10~(5.56±2.02)拷贝/毫升)、(10~(5.38±1.84)拷贝/毫升)、(10~(5.46±1.92)拷贝/毫升)、(10~(5.34±1.98)拷贝/毫升),四组间无显著性差异(P>0.05)。结论 HBV DNA含量与HBeAg密切相关;病毒复制程度与肝功能损害程度无关。     

重型肝炎患者血清血管内皮细胞生长因子的含量及其临床意义

目的 :研究重型肝炎患者血清血管内皮细胞生长因子 (VEGF)的含量与重型肝炎预后的关系。方法 :采用ELISA定量检测55例重型肝炎患者 (其中急性重型肝炎 2例 ,亚急性重型肝炎 9例 ,慢性重型肝炎 44例 )及健康体检者血清VEGF含量。结果 :正常对照组、重型肝炎患者存活组、死亡组血清VEGF含量分别为 :44.73± 1 4 .71pg/ml,80 .48± 1 0 .47pg/ml,37.99± 1 2 .70pg/ml。提示重型肝炎患者存活组血清VEGF水平与正常对照组相比显著升高 (P <0 .0 5) ,死亡组略降低但无统计学意义 (P >0 .0 5)。结论 :(1 )VEGF与肝细胞再生密切相关 ;(2 )动态检测血清VEGF水平变化可以预测重型肝炎患者的预后     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.