亲属肾移植患者术后肾功能与HLA配型和PRA相关性研究

目的研究活体亲属肾移植受者人类白细胞抗原(human leukocyte antigen,HLA)配合率、群体反应性抗体(panelreactive antibody,PRA)的产生和肾功能变化对移植肾存活的影响。方法将336例活体亲属肾移植患者分为5组:①父母给子女供肾组(118例)。②子女给父母供肾组(12例)。③兄弟姐妹间供肾组(107例)。④其他亲属供肾组(92例)。⑤夫妻间供肾组(7例)。进行HLA供受者配合率分析,并于肾移植术后1-4年追踪肾功能变化和PRA产生的情况。HLA分型检测采用美国One lanmbda公司提供的HLA-PCR-SSP分型试剂盒。PRA采用美国莱姆德公司和美国GTI公司提供的酶联免疫吸附试剂盒检测。结果第1组的118例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有22例抗原配合率高于单体型半相合。肾移植术后有36例患者出现肾功能下降,其中8例为PRA阳性。第2组的12例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有7例HLA抗原配合率高于单体型半相合。肾移植术后1例患者肾功能下降,且为再次肾移植患者。第3组的107例兄弟姐妹间HLA-A、B、DR、DQ配型完全相配合有18例,73例为单体型半相合或大于单体型半相合,其余为低于单体型半相合或不相合。肾移植术后中有13例患者肾功能下降,其中3例PRA阳性。第4组的92例其他亲属移植的供受者间HLA-A、B、DR、DQ等于或大于单体型半相合的有24例,完全不相合的有9例,虽然HLA抗原配合率大于4个抗原,但并不是单体型半相合抗原的有8例,等于或小于3个抗原配合的有51例。肾移植术后有11例患者肾功能下降,其中6例患者PRA阳性。第5组的7例夫妻间肾移植患者,HLA配合率均≤3个抗原。肾移植术后有2例患者肾功能下降,且为PRA阳性。结论父母、子女及兄弟姊妹等直系亲属肾移植供受者中HLA配合率高于其他亲属间移植供受者,但兄弟姊妹间HLA配型完全相同的则较低。HLA配型与近期移植肾存活无关,而与供者的年龄有关。良好的HLA配型与肾移植术后PRA生成的概率低有关。     

良好的HLA配型可改善PRA高敏受者的移植效果

报告5例淋巴细胞群体反应抗体（PRA）为48％～76％，采用理想的HLA配型，供受者间HLA－A、B、DR位点在3～5个抗原相合情况下进行移植，术后3例发生急性排斥反应，经用甲基强的松龙及OKT3冲击治疗后排斥逆转。5例全部成功，术后均获得随访，人／肾存活9个月～2年4例，3年半1例。讨论了PRA高敏感对移植物的影响，良好的HLA配型对移植效果的影响。     

糖尿病与HLA关联性的初步研究

对29例糖尿病病人做了HLA分型,并同59例健康人HLA分型结果进行了比较。发现糖尿病组DRw12、Cw9、DRw17、Bw75、A3、DR9、A2、DQw2、B35、DQw9、DRw53、Cw6、DR7等抗原频率均有明显增高,而Cw7、Cw1、B39、DR4、DRw16、A26、DR1、DQw5、DQw8、DQw6等抗原频率均有显著性降低。A2-B13、DRwl2-DQw7和B35～Cw93种单倍型,具有显著性水平的连锁不平衡,其△值为正值,呈明显正向连结;而Cw10-DQw6、Cw6-DRw12、Cw10-DRw15、B35-Cw10、A2-B35、Cw4-DQw9、Cw4-DR9、B60-Cw9、DRw12-DQw2、A24-Cw6、A3-B13等单倍型,具有显著性水平的负连锁不平衡,其△值为负值,呈明显负向连结。提示可能同频率降低的抗原一样,是有保护性意义的。     

HLA组织配型在PRA阳性受者肾移植中的应用

目的探讨人类白细胞抗原(HLA)组织配型在群体反应性抗体(PRA)高受者肾移植中的意义。方法对26例群体反应性抗体(PRA)高达38％～88％的肾功能衰竭患者用单克隆抗体分型板实施HLA组织配型。结果供受者HLA-A，B，DR位点各有一个抗原相配者5例；HLA-A位点1个抗原相配B位点1个抗原、DR位点2个抗原相配者8例；HLA-A位点2个抗原相配、B位点2个抗原相配、DR位点1个抗原相配者4例；HLA-A位点1个抗原相配、B位点2个抗原相配、DR位点2个抗原相配者9例。术后5例发生急性排斥反应，经抗排异治疗逆转4例，1例移植肾失功；25例肾功能恢复正常。结论良好的HLA配型对PRA高的受者的肾移植具有重要意义。     

肾移植致敏受者的配型研究及应用

目的:探讨人类白细胞抗原(HLA)配型在肾移植致敏受者中的应用及意义。方法:对32例PRA阳性的肾移植受者采用HLA交叉反应组(CREGs)配型原则选择供者,观察其供受者相配情况及移植效果。结果:按交叉反应组配型原则,供受者HLACREGS+DR0,1,2和3错配(MM)分别为8例(25％)、10例(31.25％)、12例(37.5％)和2例(6.25％),无4～6错配;而按传统的HLA-A,B,DR抗原配型原则,其0,1,2,3和4MM分别为2例(6.25％)、3例(9.38％)、10例(31.25％)、9例(28.12％)和8例(25％),其中0～1错配仅有5例。肾移植术后仅有9例发生急性排斥反应,经OKT_3治疗逆转,所有受者术后肾功能均恢复正常。结论:良好的HLA CREGs配型,可以显著提高供受者相配率,对减少致敏受者的排斥反应,提高移植肾存活率具有重要的意义。     

群体反应性抗体技术及HLA配型在1700例肾移植中的应用研究

目的探讨群体反应性抗体(panel reactive antibody,PRA)、HLA配型技术对肾移植近远期的效果。方法对拟行肾移植的患者运用PRA检测、HLA组织配型,要求HLA抗原3~6个位点相合,PRA阳性(20%以上)给予3~5次血浆置换,共1 700例作为第一组,未采用PRA、HLA组织配型的423例患者为第二组。观察两组肾移植术后免疫指标变化,近期急性排斥反应发生率以及HLA-A、B、DR位点对长期存活的影响。结果第一组肾移植术后环孢素A(cyclosporine A,CsA)用量减至5~7 mg·kg-1·d-1,移植肾功能恢复时间2~16 d,平均5 d,均未发生超急性排斥反应,发生急性排斥反应252例(14.8%),1年人/肾存活率高达98.6%/96.7%,3年人/肾存活率93.1%/87.3%,5年人/肾存活率88.1%/83.6%。第二组肾移植术后CsA用量8~12 mg·kg-1·d-1,移植肾功能恢复时间4~30 d,平均13 d,发生超急性排斥反应者9例(2.1%),急性排斥反应198例(46.8%),1年人/肾存活率86.7%/76.3%,3年人/肾存活率72.5%/67.9%,5年人/肾存活率69.5%/59.3%。结论PRA阴性加良好的HLA配型可杜绝超急性排斥反应的发生,降低急性排斥反应发生率,提高人/肾长期存活率。     

群体反应性抗体与HLA分型技术在肾移植上的联合应用

目的 总结群体反应性抗体（PRA）与HLA分型在肾移植联合应用上的意义。方法 PRA应用ELISA方法,HLA－Ⅰ、ⅡAg应用单克隆抗体分型技术,对20例肾移植病人手术前的PRA和HLA分型结果进行分析。结果受者PRA20％以下者12例,其余8例为20％－50％,供受者HLA－A、B、DR完全符合交叉反应组（CREG）为13例。其中A、B、DR分别有一相同抗原的为6例。术后11例发生急性排斥,经冲击治疗9例逆转,2例肾脏摘除91例PRA为20％,1例PRA为40％）。18例肾功能恢复。结论 PRA与HLA配型联合应用,可提高肾移植效果。     

149例肾移植交叉后反应组配型报道

目的：探讨人类白细胞抗原（HLA）交叉反应组（CREGs)配型原则在临床肾移植中的应用及意义。方法：应用单抗湿板法进行HLA－Ⅰ类抗原分型，对传统配型原则Ⅰ类抗原错配（MM）2个以上位点的149例肾移植，采用CREGs配型原则选择供受。观察其术后一年存活率及术后一月内急性排斥反应发生率情况。结果：在不考虑DR位点的情况下，按CREG s配型原则选择供受，供受HLA－Ⅰ类抗原0、1和2MM数分别为36例（16．67％），62例（41．61％）和51例（34．22％）；术后一月内急性排斥反应发生率分别为16．67％（6例）、27．40％（16例）和43．14％（22例）。术后一年存活率分别为97．22％（35例）、93．55％（58例）和82．35％（42例）。结论：在传统配型不满意的情况下，对HLA－Ⅰ类抗原采用CREGs配型原则选择供受，可以获得满意的移植肾一年存活率，减少术后排斥反应发生率，为等待供肾的患提供了更多机遇，同时亦为获得配型良好的供肾提供了机会。     

肾移植交叉反应组配原则临床应用分析

目的探讨人类白细胞抗原(HLA)交叉反应组(CREGs)配型原则在临床肾移植中的应用及意义.方法对传统配型原则Ⅰ类抗原错配(MM)2个以上位点的149例肾移植,采用CREGs配型原则选择供受者,观察其术后一年存活率及术后一月内急性排斥反应发生率情况.结果 在不考虑DR位点的情况下, 按CREGs配型原则选择供受者,供受者HLA-Ⅰ类抗原0、1和2MM数分别为36例(24.16%),62例(41.61%)和51例(34.22%);术后一月内急性排斥反应发生率分别为16.67%(6例)、27.40%(16例)和43.14%(22例);术后一年存活率分别为97.22%(35例)、93.55%(58例)和 82.35%(42例).结论 在传统配型不满意的情况下,对HLA-Ⅰ类抗原采用CREGs配型原则选择供受者,可以获得满意的移植肾一年存活率,减少术后排斥反应发生率,为等待供肾的患者提供了更多机遇,同时亦为获得配型良好的供肾提供了机会.     

沈阳地区汉族人群中HLA—DR、DQ抗原多态性分析

1.本文报道了HLA—DR、DQ抗原在沈阳汉族人群中的分布,HLA—DR基因频率为0.8132,尚有空白0.1868,HLA—DQ基因频率为0.7964,尚有空白0.2036。说明沈阳地区汉族人群无论HLA—DR或HLA—DQ均有新的抗原未被发现。2.HLA—DR1明显高于上海、湖北及四川;HLA—DR 3明显低于湖北,略低于上海;HLA—DR 4明显低于湖北,HLA—DR 7明显低于上海,HLA—DRw9明显低于上海、四川。HLA—DQw 3明显低于四川。3.本文首次在中国沈阳汉族人群中检测到HLA—DQw 2、DOwa、TA10。     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.