类风湿性关节炎患者的血清脂蛋白a水平与炎症指标相关性分析

目的 通过对类风湿性关节炎(RA)患者组与对照组(正常健康者)脂蛋白a(Lp-a)与脂代谢水平的比较,分析RA患者血清中的Lp-a水平与系统性炎症进展的风险相关性.方法 选取30例RA患者(血清类风湿因子阳性)与30例正常健康者,年龄为25～80岁,性别分布相同,采集血样并检测其脂代谢水平(Lp-a、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和极低密度脂蛋白胆固醇(VLDL-C))与炎症反应指标(肿瘤坏死因子α(TN F-α)、白细胞介素6(IL-6)和C反应蛋白(CRP)),对数据进行统计学分析.结果 与对照组比较,RA患者组的血清Lp-a水平显著增高(P＜0.001),HDL-C水平显著降低(P＜0.05),而TC、TG、LDL-C与VLDL-C水平则无明显变化,差异均无统计学意义(P＞0.05).同时,RA患者组的TNF-α、IL-6及CRP水平较对照组均显著增高(P＜0.05),且TNF-α与Lp-a水平的升高有相关性(r=0.753,P＜0.001).结论 RA患者常伴有高水平的Lp-a,且Lp-a水平的升高与RA患者的全身性炎症反应增强具有相关性,Lp-a水平可作为RA患者的风险评价指标.     

不同成因DIC临床表现及转归与患者凝血指标和临床评分的关系

目的:分析不同成因弥散性血管内凝血(DIC)的临床表现及转归与患者凝血指标和临床评分的关系。方法:485例DIC患者,依据原发病分为感染组(n=208)、手术创伤组(n=94)、恶性肿瘤组(n=105)、病理产科组(n=22)、严重肝病组(n=48)和器官功能损伤组(n=8),比较各组患者临床表现和不同治疗方案(对症支持治疗、替代治疗、抗凝治疗)的临床疗效;分析不同疗效(有效、无效)DIC患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)和国际血栓与止血学会(ISTH)DIC显性积分分值(5分、6分、7分、8分)分布的差异,以及凝血指标和显性积分与DIC患者临床疗效的相关性。结果:不同成因DIC组患者出血、休克、器官衰竭发生率及疗效有明显差异;病理产科组出血发生率最高(72.73%),但与合计出血发生率(65.36%)差异无统计学意义(P0.05);手术创伤组休克发生率最高(79.79%),且高于合计休克发生率(68.04%)(P0.05);感染组器官衰竭发生率最高(95.19%),但与合计器官衰竭发生率(91.55%)差异无统计学意义(P0.05);病理产科组治疗有效率最高(59.09%),明显高于合计有效率(25.15%)(P0.05);严重肝病组治疗无效率最高(83.33%),但与合计无效率(74.85%)差异无统计学意义(P0.05);恶性肿瘤组死亡率最高(52.38%),明显高于合计死亡率(41.86%)(P0.05)。替代治疗和抗凝治疗有效率明显高于对症治疗(P0.05),且替代治疗和抗凝治疗两者疗效差异无统计学意义(P0.05)。治疗有效组PT、APTT及D-D低于无效组(P0.05),FIB高于无效组(P0.05);PT、APTT缩短及D-D降低与患者治疗有效率呈负相关(r=-0.256、-0.202、-0.116,均P0.05)。FIB升高与患者治疗有效率呈正相关(r=0.102,P0.05)。治疗有效组病例ISTH各级显性积分的分布显著小于治疗无效组(P0.01),且随ISTH显性积分(6-8分)升高,治疗有效率降低,两者呈明显负相关(r=-0.150,P0.05)。结论:DIC转归不甚乐观,合理应用凝血指标和ISTH显性积分的监测作用对临床提高疗效和改善预后有益。     

SIRT3与RA的相关性研究进展

氧化应激的活性氧类(reactive oxygen species, ROS)在RA病理过程中起着重要作用。长期关节疼痛和功能受限会使RA患者处于应激状态,机体出现ROS生成増加及清除能力下降的现象。ROS可直接或间接参与关节滑膜炎症与骨质基本结构破坏,导致关节炎临床症状的产生。SIRT3为依赖于烟碱腺嘌呤二核苷酸(NAD)的新兴去乙酰化蛋白,是一种氧化还原酶,它通过去乙酰化作用调节ROS的产生,抑制ROS的病理性蓄积,与氧化应激关系密切。SIRT3主要涉及到相关的线粒体代谢调节、相关能量代谢酶调节、抗ROS调节等。文章对SIRT3与RA的相关性研究进展进行总结,为RA的深入研究提供参考。     

RA 患者心肺功能的变化与氧化应激指标、外周血淋巴细胞衰减因子的相关性

目的:探讨类风湿关节炎心肺功能变化进行研究,并分析类风湿关节炎心肺功能变化与氧化应激及外周血淋巴细胞衰减因子的相关性。方法:以130 例住院类风湿关节炎患者为病例组研究对象,50 例健康体检为正常对照。分别检测两组入选对象心功能参数EF%、SV%、FS%、E、A、E/ A;肺功能参数FVC、FEV1、MVV、PEF;B、T 淋巴细胞衰减因子表达频率及相关活化水平;酶联免疫吸附法检测外周血细胞因子(IL-17、TNF、IL-4、IL-35) 及氧化应激指标(MDA、ROS、SOD、TAOC)。结果:病例组研究对象心功能各项指标明显低于正常对照组。病例组130 例患者中,有103 例心功能指标异常,占病例组研究对象的79郾23%,而E/ A 异常率最高。病例组与正常对照组相比,LADd 增厚,A 峰升高,EF、E 峰、E/ A 降低,相比差异有统计学意义(P<0.05);与正常对照组相比,病例组肺功能各项参数明显降低;病例组130 例患者中,有88 例肺功能指标异常,占病例组研究对象的67.69%。而其中PEF 异常率最高。病例组肺功能各项指标明显低于对照组,相比差异有统计学意义(P<0.05);相关分析显示心功能指标EF 与CD24+细胞和CD19+ CD24+ 细胞的相关系数分别为-0.353 及-0.457,具有负相关性,与ROS 的相关系数为0.459,具有正相关性。心功能指标FS 与CD24+ 细胞、CD19+ CD24+ 细胞的相关系数为-0.395和-0.421,具有负相关性;A 峰与CD19+ cell 的相关系数为0.423,具有正相关性,E/ A 与BTLA 的相关系数为0.393,具有明显的正相关性; SV 与MDA、SOD 呈正相关;肺功能的各项参数均与Hs-CRP 及ESR 呈明显的负相关;肺功能参数FVC 与BTLA及CD19+ CD24+的相关系数0.513 和0.596,具有明显正相关性,与CD24+ BTLA+ 、TNF的相关系数为-0.451 和-0.351,呈明显负相关性;参数FEV1 与CD19+ CD24+ 、TAOC、IL-4 的相关系数分别为0.535、0.466 及0.519,呈明显正相关性,与CD24+BTLA+ 、MDA 的相关系数为-0.461 和-0.358,呈明显负相关性;PEF 与SOD、TAOC、IL-4、IL-35 的相关系数分别为0.547、0.482、0.643 及0.452,呈明显正相关性,与MDA、ROS、IL-17 的相关系数为-0.451、-0.423 及-0.417,呈明显负相关性(P<0.05)。结论:RA 氧化应激失衡及细胞免疫失调贯穿于心肺功能损伤的整个过程,因此,在临床上治疗RA 患者关节症状的同时,要探讨如何恢复机体氧化还原稳态,以上调BTLA 水平,活化B、T 细胞,从而抑制免疫炎症反应,降低心肺功能损伤。     

同位素标记相对和绝对定量技术在RA患者血清中的应用研究

采用同位素标记相对和绝对定量(isobaric tags for relative and absolute quantitation, iTRAQ)技术寻找能够用于RA诊断、疗效评估或预后判断的新血清标志物,探索RA发病机制。对10例活动期RA患者、10例稳定期RA患者与10例健康对照者血清采用iTRAQ技术结合串联质谱技术进行差异蛋白质组学分析,得到差异蛋白。通过DAVID软件鉴定差异蛋白,分析差异蛋白在RA发病过程中所起的生物学作用。结果显示共鉴定出303个蛋白质,其中RA活动组与健康对照组差异倍数≥1.5的蛋白质27个,表达显著上调和下调的蛋白质分别为13和14个,差异蛋白的功能涉及到蛋白质代谢、脂类代谢、补体系统、凝血系统等多个系统。通过DAVID软件的在线分析得到了差异蛋白的基因本体论(gene ontology, GO)生物学过程、细胞组分和分子功能的富集分析结果。通过对差异蛋白的研究可以为阐明RA的发病机制及发现新的生物标志物提供新的途径。     

火把花根片有效减轻RA患者临床症状与其抑制炎症反应相关

目的观察火把花根片治疗类风湿关节炎(rheumatoid arthritis,RA)的临床疗效及相关机制。方法 40例RA患者进行口服火把花根片治疗12周,治疗前后采集静脉血5ml,酶联免疫吸附测定(ELISA)抗环瓜氨酸抗体(ACPA),乳胶法检测C-反应蛋白(CRP)、免疫比浊法检测类风湿因子(RF)、魏氏法检测红细胞沉降率(ESR),同时监测疾病活动度:包括疼痛视觉模拟评分(VAS)、基于红细胞沉降率的28处关节疾病活动度评分(DAS28-ESR),并记录治疗前后的血常规、肝、肾功能及不良发应。结果治疗后RA患者CRP、ESR水平明显下降(P=0.0081、P=0.0318),VAS、DAS28-ESR评分也显著下降(P0.0001、P0.0001),但RF、ACPA改变不明显,差异无统计学意义(P0.05);治疗前后血常规、肝、肾功能比较无明显变化(P0.05)。结论火把花根片有效减轻RA患者临床症状与其抑制炎症反应相关,并对肝肾功能及血液系统无明显副作用。     

类风湿性关节炎患者血清中Ⅱ型胶原抗体的检测及临床意义

<正> 自身免疫是类风湿性关节炎(RA)发病中的重要因素,患者血清中存有抗自身IgG的抗体——类风湿因子。1977年,David和Threntham首次发现了50％的患者血清中存有抗Ⅱ型胶原的抗体,此种抗体与类风湿的发病和反复出现的症状有明显联系,我们应用ELISA检测,并对实验条件做了优选,取得满意结果。     

脂联素促进HIF-1α及炎症因子表达参与RA发病机制的研究

通过研究脂联素(adiponectin,AD)对低氧诱导因子(hypoxia-inducible factor 1α,HIF-1α)及炎症因子IL-6、IL-17及TNF-α表达的促进作用,为进一步探讨AD参与类风湿关节炎(rheumatoid arthritis,RA)发病机制提供理论与实验依据。体内实验:给于所构建的胶原诱导关节炎模型鼠(collagen-induced arthritis,CIA)关节腔内注射AD观察对CIA小鼠发病的影响,并采用实时荧光定量PCR(real-time PCR)检测HIF-1α、IL-6、IL-17及TNF-αmRNA表达变化。体外实验:以不同浓度AD刺激RA滑膜成纤维细胞(synovial fibroblast,SF)72h,采用real-time PCR和western blot的方法检测HIF-1α、IL-6、IL-17及TNF-α的表达。结果:CIA小鼠注射AD后,关节局部组织中HIF-1α(P<0.05)、IL-6(P<0.001)及IL-17mRNA(P<0.05)的表达增高;体外实验中,AD呈剂量依赖性地促进RASF中HIF-1α(P<0.001)、IL-6(P<0.05)及IL-17αmRNA(P<0.05)和HIF-1α蛋白表达。提示AD能通过促进HIF-1α及促炎因子的表达而参与RA发病。     

胃癌根治术后肺部感染的血清炎症指标、病原菌分布及危险因素

目的:研究胃癌根治术后并发肺部感染患者血清炎症指标、病原菌分布状况及其危险因素,为临床提供指导.方法:选择2017年7月至2020年7月在六安市人民医院进行胃癌根治术治疗的胃癌患者为研究对象,其中感染患者45例,非感染患者55例.比较两组血清炎症指标、病原菌分布状况并分析感染的危险因素.结果:感染组的血清炎症指标,包括...     

慢性肝炎肝组织炎症活性指标与肝功能相关性的探讨

应用肝组织炎症活性指标,对102例慢性肝炎切片进行复核、评分并与肝功能进行对照分析。结果表明该指标与血清胆红素、转氨酶、白蛋白、球蛋白、凝血酶原时间等均有良好相关性。     

Admission clinical characteristics and early clinical outcomes among acute ischemic stroke patients

The purpose of the present study was to investigate the association between admission clinical characteristics and outcomes at discharge among acute ischemic stroke patients in the Chinese population.A total of 2,673 patients with acute ischemic stroke were included in the present study.The clinical characteristics at admission and other study variables were collected for all patients.The study outcome was defined as neurological deficiency(National Institute of Health Stroke Scale score ≥ 10) at discharge or in-hospital death.Compared with the subjects without neurological deficiency at discharge or in-hospital death,the subjects with neurological deficiency at discharge or in-hospital death had a significantly higher prevalence of hyperglycemia or history of atrial fibrillation at admission.Age≥ 80 years,hyperglycemia,hypertension,and history of atrial fibrillation were significantly associated with neurological deficiency at discharge or in-hospital death after adjustment for other variables.It is concluded that old age(≥ 80 years),hyperglycemia,hypertension and history of atrial fibrillation are significantly associated with neurological deficiency at discharge or in-hospital death among patients with acute ischemic stroke.     

Folate-related polymorphisms in gastrointestinal stromal tumours: susceptibility and correlation with tumour characteristics and clinical outcome

The folate metabolism pathway has a crucial role in tumorigenesis as it supports numerous critical intracellular reactions, including DNA synthesis, repair, and methylation. Despite its importance, little is known about the influence of the folate pathway on gastrointestinal stromal tumour (GIST), a rare tumour with an incidence ranging between 6 and 19.6 cases per million worldwide. The importance of folate metabolism led us to investigate the influence of polymorphisms in the genes coding folate-metabolising enzymes on GIST susceptibility, tumour characteristics and clinical outcome. We investigated a panel of 13 polymorphisms in 8 genes in 60 cases and 153 controls. The TS 6-bp deletion allele (formerly rs34489327, delTInsTTAAAG) was associated with reduced risk of GIST (OR=0.20, 95% CI 0.05–0.67, P=0.0032). Selected polymorphisms in patients stratified by age, gender, and other main molecular and clinical characteristics showed that few genotypes may show a likely correlation. We also observed a significant association between the RFC AA/AG genotype and time to progression (HR=0.107, 95% CI 0.014–0.82; P=0.032). Furthermore, we observed a tendency towards an association between the SHMT1 variant allele (TT, rs1979277) and early death (HR=4.53, 95% CI 0.77–26.58, P=0.087). Aware of the strengths and limitations of the study, these results suggest that polymorphisms may modify the risk of GIST and clinical outcome, pointing to the necessity for further investigations with information on folate plasma levels and a larger study population.     

Differential microRNA expression in the serum of patients with nephrotic syndrome and clinical correlation analysis

Many different microRNAs existed in nephrotic syndrome patients, and they may be involved in nephrotic syndrome occurrence. In order to further clarify miRNAs expression changes in nephrotic syndrome patients and their correlation with clinical features, this study investigated differential microRNA expression in the peripheral serum of patients with nephrotic syndrome and analyzed the correlation between miRNA with largest overexpression level and clinical features. miRNAs microarray was applied to screen different expressed miRNAs in nephrotic syndrome patients. Real-time PCR was performed to verify miRNA expression level. SPSS software was used to analyze correlation between miRNA expression and clinical features. Compared with healthy subjects, 35 miRNAs overexpressed and 24 miRNAs down-regulated in patients. After real-time PCR verification, 6 miRNAs up-regulated in nephrotic syndrome patients, including hsa-miR-181a, hsa-miR-210, hsa-miR-30a, hsa-miR-942, hsa-miR-192 and hsa-miR-586. miRNA-30a significantly overexpressed in nephrotic syndrome patients and with no difference between genders. miRNA-30a expression level in drug resistant nephrotic syndrome patients was obviously higher than the drug sensitive patients. miRNA-30a up-regulated most significantly in mesangial proliferative glomerulonephritis among different pathology types, while it decreased most obviously in glomerular lesions. miRNA differently expressed in the serum of nephrotic syndrome patients. miRNA-30a could be treated as the molecular marker in predict drug resistance and pathological type of nephrotic syndrome.     

Association of Ureaplasma urealyticum biovars with clinical outcome for neonates, obstetric patients, and gynecological patients with pelvic inflammatory disease.

In this prospective study, the prevalence of the two Ureaplasma urealyticum biovars, parvo and T960, was determined in pregnant women and in gynecological patients colonized by ureaplasmas. Furthermore, we investigated the association of these biovars with gynecological complications and adverse pregnancy outcome. Isolates of U. urealyticum from 254 women were biotyped by a PCR method recently developed. The parvo biovar was found in 81% (206 of 254) of the patients, and the T960 biovar was found in 30% (76 of 254) of the patients; 6% (14 of 254) of the women were coinfected. Identical biovars were detected in mothers and their infants. Serial isolations or cultures from different sampling sites of the same individual revealed the same biovar. T960 was dominant in patients with pelvic inflammatory disease (57%) and patients who had had a miscarriage (42%), showed a higher rate of tetracycline resistance than did parvo isolates (55 versus 18%), and seemed to have more adverse effects on pregnancy outcome with regard to birth weight (2,500 versus 1,720 g), gestational age (35 versus 30 weeks), and preterm delivery (35 versus 77%).     

The characteristics and clinical outcome of adult patients with aplastic anemia and abnormal cytogenetics at diagnosis

The characteristics and clinical outcome of 600 adult patients with aplastic anemia (AA) that had successful cytogenetic studies at the time of diagnosis were retrospectively evaluated. Among these, 572 (95.3%) had normal cytogenetics and 28 (4.7%) had abnormal cytogenetics. The most frequent abnormality was trisomy 8 (n = 15), followed by monosomy 7/deletion of 7q (n = 5), and deletion of 1q (n = 5). There were no statistically significant differences with respect to gender, hepatitis viral infection, paroxysmal nocturnal hemoglobinuria, or severity of disease between the patients in the normal and abnormal cytogenetics groups; however, the patients with abnormal cytogenetics were generally younger than those with normal cytogenetics (P < 0.001). Abnormal cytogenetics was associated with a higher cumulative leukemic transformation rate (P < 0.001) and lower leukemic transformation‐free survival (P = 0.021). Furthermore, abnormal cytogenetics was an independent predictor of a poor response to immunosuppressive therapy (HR = 0.255; 95% CI = 0.077–0.839; P = 0.024). These analyses suggest that patients with AA and abnormal cytogenetics have different clinical characteristics compared to patients with AA and normal cytogenetics. © 2010 Wiley‐Liss, Inc.     

血清CysC、Hcy、hs-CRP和U-mAlb联合检测对糖尿病早期肾损害的临床价值研究

目的探讨糖尿病（DM）患者血清中胱抑素C（CysC）、同型半胱氨酸（Hcy）、超敏C反应蛋白（hs-CRP）和尿微量清蛋白（U-mAlb）水平的联合检测对糖尿病肾病（DN）早期诊断的临床价值。方法采用免疫透射比浊法和比色法分别检测126例2型糖尿病（T2DM）患者（观察组）及80例健康体检者（对照组）血清CysC、Hcy、hs-CRP和U-mAlb含量,并对检测结果进行统计学分析。结果观察组血清CysC、Hcy、hs-CRP和U-mAlb水平均明显高于对照组,差异有统计学意义（P〈0.01）;CysC、Hcy、hs-CRP和U-mAlb单项指标检测对DM早期肾损害的阳性检出率分别为60.32%、75.40%、84.13%、63.49%,特异性为95%～100%,与对照组比较,差异有统计学意义（P〈0.001）;4项指标联合检测,敏感性可提高至96.83%,且敏感性和特异性之和最大。血清CysC与Hcy、hs-CRP和U-mAlb水平均呈显著正相关（r=0.952、0.971、0.926,P〈0.01）。结论血清CysC、Hcy、hs-CRP和U-mAlb可作为DN早期诊断的敏感指标,联合检测更具实用价值。     

正五聚体蛋白3、IL-6和CRP水平与RA疾病活动度的相关性

为探讨正五聚体蛋白3(pentraxin 3, PTX-3)、IL-6和CRP水平与RA疾病活动度的相关性,以90例RA患者为研究组,其中疾病低度活动者30例(33.3%),中度活动者44例(48.9%),高度活动者16例(17.8%)。同期纳入60例健康者为对照组,分析研究组与对照组血清中PTX-3、IL-6及CRP水平的差异。结果显示,研究组中PTX-3和CRP水平远高于对照组(P0.001)。随着RA病情的发展,疾病活动指数DAS 28评分越高的患者,IL-6和CRP水平越高(均P0.001),同时,ESR在高度活动组中水平更高(P0.001)。此外,低、中、高度活动组中PTX-3水平均远高于对照组(均P0.001)。CRP、IL-6和ESR水平与DAS 28评分呈低度正相关(r=0.654,P0.001;r=0.555,P0.001;r=0.557,P0.001),IL-6与ESR水平也呈正相关(r=0.489,P0.001)。由此PTX-3、IL-6、CRP可作为RA的生物标志物,几项指标的联合监测可有效反映病情发展状况,为临床治疗提供实验依据。     

The role of IL-12 in inflammatory activity of patients with rheumatoid arthritis (RA)

The aim of this study was to investigate the role of IL-12 in patients with RA. IL-12 (p70) and its associated cytokines were measured in sera and synovial fluid (SF) using an enzyme-linked immunosorbent method. Seven American College of Rheumatology (ACR) core set measures as well as IL-12 levels were sequentially monitored at the commencement and 4 months after treatment with a low-dose steroid and disease-modifying anti-rheumatic drugs (DMARDs). In sera, 64 (42.2%) of 152 RA patients had detectable concentrations of IL-12 (p70), whereas one (1.4%) of 69 osteoarthritis (OA) patients and five (10%) of 50 healthy controls had detectable IL-12 (P < 0.001). The median level of circulating IL-12 was also higher in RA patients (P < 0.001). In SF, the number of patients with detectable IL-12 and the median IL-12 levels were significantly higher in RA patients (n = 53) than in OA patients (n = 22). In paired samples (n = 53) of sera and SF from RA patients, IL-12 levels were higher in the SF than in sera (P < 0.001). Patients with detectable IL-12 (n = 51) in sera had higher tender joint scores (P = 0.003), swollen joint scores (P < 0.001) and C-reactive protein (CRP; P = 0.036), than those without (n = 55). Four months after treatment with DMARDs, the improved group showed a larger IL-12 decrease than the non-improved group (P = 0.017). The levels of IL-12 correlated positively with those of IL-2, interferon-gamma, IL-6, and tumour necrosis factor-alpha, but were correlated inversely with those of IL-10. Our results demonstrate that IL-12 levels reflect RA disease activity and that IL-12 is involved in the production of proinflammatory cytokines. An IL-12 blockade could be useful for the treatment of RA.     

Circulating dendritic cells and interferon-alpha production in patients with tuberculosis: correlation with clinical outcome and treatment response

Dendritic cells (DC) have been characterized recently as having an important role in the initiation and control of immunological response to Mycobacterium tuberculosis infection. Blood DC have been subdivided into myeloid (mDC) and plasmacytoid (pDC) subsets, on the basis of differences in phenotype markers and function. Little is known about the enumeration and functional evaluation of circulating DC in patients with tuberculosis and their correlation with clinical outcome during the course of anti-tuberculous treatment. We assessed circulating mDC and pDC counts measured by a newly developed single-platform flow cytometric assay based on TruCOUNT, as well as the production of interferon (IFN)-alpha after in vitro stimulation by herpes simplex virus (HSV-1) in 24 patients with active tuberculosis (TB) and 37 healthy donors. Absolute numbers of both DC subsets were decreased significantly in patients with active TB compared to controls. Similarly, the production of IFN-alpha was highly impaired. In 13 patients these parameters were assessed longitudinally, before and after the specific anti-microbial treatment. Most interestingly, in all nine patients with successful anti-tuberculous therapy there was a significant and marked increase of pDC counts and IFN-alpha production. In contrast, no significant longitudinal variations in DC counts and IFN-alpha production were observed in four patients with lack of response to specific treatment. In conclusion, active TB is associated with a defect in blood DC numbers and IFN-alpha production that is restored after bacterial clearance and clinical improvement, as a result of effective anti-tuberculous treatment.