口服乳果糖对肝脏病患者血清内毒素和细胞因子的影响

目的：观察乳果糖治疗对急、慢性肝病患者血清内毒素、细胞因子水平及肝功能指标的影响。方法：在８９例急、慢 性肝炎、肝硬化患者中,４９例口服乳果糖２０日,检测两次血清内毒素、细胞因子、胆红素及转氨酶。结果：治疗前,３组 患者血清内毒素水平有差异,肝硬化患者最高（６９．３ｐｇ／ｍｌ± ２３．６ｐｇ／ｍｌ）,慢性肝炎患者最低 （２．４ｐｇ／ｍｌ± ７．９ｐｇ／ｍｌ）,内毒素与ＴＮＦ－α（ｒ＝０．５５５,Ｐ＜０．０１）、ＩＬ－６（ｒ＝０．５３１,Ｐ＜０．０１）、ＩＬ－８（ｒ＝０．４４０,Ｐ＜０．０５）、Ｇ－ＣＳＦ（ｒ＝０.４４ ０,Ｐ＜０．０５）呈正相关,口服乳果糖组血清内毒素,ＴＮＦ－α、ＩＬ－６、ＩＬ－８和Ｇ－ＣＳＦ水平下降及肝功能改善较未服药者明 显。结论：急、慢性肝病时内毒素可能是ＴＮＦ－α、ＩＬ－６、ＩＬ－８和Ｇ－ＣＳＦ的诱导物,其共同参与肝脏炎症反应。口服乳果糖 可能通过降低血清内毒素、细胞因子水平而对肝病患者有利。     

肾病综合征患者可溶性白介素2受体变化及意义

为了探讨肾病综合征（ＮＳ）患者可溶性白介素２受体（ＳＩＬ－２Ｒ）变化的临床意义，我们检测３６例ＮＳ血清及尿液ＳＩＬ－２Ｒ。结果表明：ＮＳ发作组血清及尿液ＳＩＬ－２Ｒ浓度明显高于ＮＳ缓解组（Ｐ＜０．０１）及健康对照组（Ｐ＜０．０１），而ＮＳ缓解组血清及尿液ＳＩＬ－２Ｒ浓度和健康对照组无显著性差异（Ｐ＜０．０５）。血ＳＩＬ－２Ｒ和血肌酐呈正相关（ｒ＝０．４４，Ｐ＜０．０１），尿　ＳＩＬ－２Ｒ和尿蛋白排泄量呈正相关（ｒ＝０．４８，Ｐ＜０．０１）。研究提示ＳＩＬ－２Ｒ浓度升高可作为ＮＳ活动及（或）肾功能恶化的指标。     

充血性心力衰竭时单核细胞诱生肿瘤坏死因子-α测定及临床意义

目的：研究外周血单核细胞诱生肿瘤坏死因子－α（ＴＮＦ－α）在充血性心力衰竭（ＣＨＦ）发病中的作用。 方法：体外培养１１３例心脏疾病患者（无ＣＨＦ组３７例,严重ＣＨＦ组５０例,ＣＨＦ并恶病质组２６例）外周血单核细胞,用固相酶放大敏感免疫法测定其培养液中外周血单核细胞经脂多糖诱生的ＴＮＦ－α（ＰＢＭＣ－ＴＮＦ－α）及血清ＴＮＦ－α浓度。 结果：①严重ＣＨＦ组血清ＴＮＦ－α浓度较无ＣＨＦ组明显增高（Ｐ＜０．０５）,ＣＨＦ并恶病质组增高更为显著（Ｐ均＜０．０１）;②无ＣＨＦ组、严重ＣＨＦ组、ＣＨＦ并恶病质组３组ＰＢＭＣ－ＴＮＦ亦有显著性差异（Ｐ均＜０．０１）;③ＰＢＭＣ－ＴＮＦ与心功能分级呈明显正相关（ｒ＝０． ４８,Ｐ＜０．０１）;④ＰＢＭＣ－ＴＮＦ－α与血清 ＴＮＦ－α浓度无明显相关性。 结论：外周血单核细胞的激活是ＣＨＦ的临床特征之一,其分泌的ＴＮＦ－α至少部分参与ＣＨＦ及ＣＨＦ恶病质的病理生理过程。     

重症细菌性感染体内炎症介质与血清钙变化的临床观察

观察１０例重症感染患者体内肿瘤坏死因子（ＴＮＦ－α）、白介素-２（ＩＬ-２）和血清钙的变化。结果显示,对照组ＴＮＦ－ａ６７．４±３５．４,ＩＬ-２６１０±２１０,血青钙２．０１±０．１５;病例组ＴＮＦ－ａ１７６．３±５８．４,ＩＬ-２８６６±２４０,血清钙１．８０±０．１８,与对照组相比较,Ｐ＜０．０５或Ｐ＜０．０１,差异有显著性。血清钙浓度降低与ＴＮＦ－ａ,ＩＬ-２浓度增加密切相关。结合文献探讨重症感染患者体内炎症介质和血清钙的关系及其临床意义。     

肝硬化患者血清肿瘤坏死因子－α含量变化及意义

应用放免法测定５１例肝硬化患者血清肿瘤坏死因子α（ＴＮＦ－α）含量。结果表明：肝硬化患者血清ＴＮＦ－α明显高于对照组（Ｐ＜０．０５），且与血清总胆红质（ＢＩＬ）及转氨酶（ＡＬＴ）呈正相关（Ｐ＜０．０１，Ｐ＜０．０５），按Ｃｈｉｌｄ肝功能分级，Ａ、Ｂ、Ｃ各级组血清ＴＮＦ－α含量依次递增，且各级组间有显著性差异（Ｐ＜０．０１）。肝硬化合并感染患者ＴＮＦ－α显著高于未感染者（Ｐ＜０．０１），且易发生肝─肾综合征（Ｐ＜０．０５）。     

肿瘤坏死因子单克隆抗体及肝细胞生长多肽对实验性肝坏死的保护

为了评估肿瘤坏死因子单抗（ｍＡｂ－ＴＮＦ）及肝细胞生长多肽（ＨＰＮ）的抗肝坏死效果，我们使用大肠杆菌内毒素和鸭乙型肝炎病毒（ＤＨＢＶ）联合诱导建立了鸭急性肝坏死模型。实验结果显示：ｍＡｂ－ＴＮＦ组及ＨＰＮ组血清肿瘤坏死因子活性水平明显低于对照组（Ｐ＜０．０１），且治疗组肝坏死程度也明显减轻（Ｐ＜０．０１）。此外，实验发现血清肿瘤坏死因子活性水平的高低与其急性肝坏死程度成正相关关系（ｒ’ｓ＝０．９０２７，Ｐ＜０．０１）。因此认为，ＨＰＮ是一种阻止实验性急性肝坏死的活性多肽，它的早期使用可抑制机体肿瘤坏死因子的释放。     

类风湿关节炎病人血清细胞因子水平以及与炎症指标的相关性

目的：进一步研究细胞因子在类风湿关节炎（ＲＡ）中的作用以及与疾病的关系。方法：随机就诊的７２名门诊及住院ＲＡ病人红细胞沉降率（ＥＳＲ）、Ｃ反应蛋白（ＣＲＰ）以及细胞因子白细胞介素１α（ＩＬ１α）、ＩＬ１β、ＩＬ２、ＩＬ６、肿瘤坏死因子α（ＴＮＦα）、粒细胞单核细胞集落刺激因子（ＧＭＣＳＦ）被测定。全部数据用于ＲＡ病人细胞因子水平的研究，并对细胞因子与炎症指标的相关性进行探讨。结果：ＲＡ病人血清ＧＭＣＳＦ、ＴＮＦα水平较健康对照组明显增高（Ｐ＜０００１）。ＩＬ６、ＧＭＣＳＦ与炎性指标ＥＳＲ（ｒ＝０２６，Ｐ＜００１；ｒ＝０２８，Ｐ＜００２）和ＣＲＰ（ｒ＝０４０，Ｐ＜００００１；ｒ＝０４７，Ｐ＜００００１）呈正相关。结论：ＲＡ病人血清ＩＬ６、ＧＭＣＳＦ、ＴＮＦα较其他细胞因子与ＲＡ疾病有更密切的相关性。细胞因子作为重要的免疫物质参与炎症反应在ＲＡ的病理过程中起到了重要作用。     

肾综合征出血热患者血清IL-6、尿液肿瘤坏死因子、IL-6、IL-8的检测

目的探讨细胞因子在肾综合征出血热（ＨＦＲＳ）发病中的作用。方法采用双抗体夹心ＥＬＩＳＡ法对４８例ＨＦＲＳ患者及２０例正常人血清白细胞介素（ＩＬ）－６、尿液肿瘤坏死因子（ＴＮＦ）、ＩＬ－６、ＩＬ－８进行动态检测。结果ＨＦＲＳ患者血清ＩＬ－６、尿液ＴＮＦ、ＩＬ－６、ＩＬ－８含量较对照组明显增高（Ｐ＜０．００１）；发热期已增高，低血压期继续增高，少尿期达峰值；其含量随病情加重而升高，各型间差异有显著性；血清ＩＬ－６与特异性抗体升高有明显关系，与血清β２－微球蛋白（β２－ＭＧ）、血尿素氮（ＢＵＮ）、血肌酐（Ｃｒ）均呈高度正相关；尿液ＩＬ－６与ＴＮＦ、ＩＬ－８呈显著正相关（ｒ＝０．５６２１，Ｐ＜０．００５；ｒ＝０．３８４５，Ｐ＜０．０１）。结论ＨＦＲＳ患者病程中ＴＮＦ、ＩＬ－６、ＩＬ－８均处于高活性状态，ＩＬ－６与体液免疫反应亢进所致的免疫病理损伤有关，ＩＬ－６、ＩＬ－８、ＴＮＦ参与肾脏的免疫损伤，可作为判定患者预后和转归的指标。     

载脂蛋白A多态性在老年冠心病中检测的临床意义

目的探讨老年冠心病（ＣＨＤ）和健康老年人载脂蛋白Ａ（ＡｐｏＡ）异构体多态性表型、脂蛋白（ａ）［Ｌｐ（ａ）］及血脂水平的临床关系。方法检测１０４例老年ＣＨＤ患者（陈旧性心肌梗塞３１例，稳定型心绞痛３８例，心律失常型２０例，心力衰竭型１５例）血清ＡｐｏＡ异构体多态性表型和血清Ｌｐ（ａ）及血脂水平，并与６８例健康老年人对照分析。结果ＣＨＤ组Ｌｐ（ａ）和血脂水平明显高于对照组（Ｐ＜０．０５或Ｐ＜０．０１）。ＣＨＤ组ＡｐｏＡ表型检出率为８２．７％，对照组为７５％。ＡｐｏＡ表型频率分布与ＡｐｏＡ表型分子量呈非常显著正相关（ＣＨＤ组ｒ＝０．９９２７，对照组ｒ＝０．９６９７，Ｐ＜０．０１）。结论ＡｐｏＡ多态性表型在临床上比Ｌｐ（ａ）及血清脂质更具有参考价值。     

白细胞介素－4和γ－干扰素与哮喘发病关系的探讨

为进一步探讨白细胞介素－４（ＩＬ－４）和干扰素（ＩＦＮ－ｒ）与哮喘发病的关系，对发作期哮喘病人及正常人各２０例，检测其外周血淋巴细胞（ＰＢＬＣｓ）培养上清中ＩＬ－４含量、ＩＦＮ－ｒ活性及血清ＩｇＥ总浓度。结果表明：发作期哮喘组ＩＬ－４和ＩｇＥ均非常显著地高于正常对照组（Ｐ＜０．００１）：ＩＬ－４与ＩｇＥ之间呈正相关（ｒ＝０．８２），Ｐ＜０．００１；ＩＬ－４与ＩＦＮ－及ＩＦＮ－与ＩｇＥ之间均呈负相关（ｒ＝０．４８，－０．７５），Ｐ＜０．０５，Ｐ＜０．０１。二组之间ＩＦＮ的活性无显著性差异，Ｐ＞０．０５。提示发作期哮喘病人ＩＬ－４的高水平分泌导致的ＩｇＥ过多合成，可能与哮喘的发病有直接的关系。ＩＬ－４与ＩＦＮ之间的失衡对血清ＩｇＥ的合成起了重要的调控作用。     

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.     

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.     

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.     

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.