不同麻醉方式对非小细胞肺癌患者围术期免疫功能的影响

目的探讨不同麻醉方式对非小细胞肺癌(NSCLC)患者围术期T淋巴细胞亚群、自然杀伤(NK)细胞和细胞因子白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子(TNF)-α和干扰素(INF)-γ的影响。方法 60例行肺癌根治术的NSCLC患者随机分为观察组(静脉丙泊酚复合硬膜外麻醉)和对照组(全凭静脉麻醉)。采用流式细胞仪检测两组麻醉前30 min(T0)、术毕(T1)、术后2 h(T2)、2 d(T3)和5 d(T4)外周血CD3~+、CD4~+、CD8~+、CD4~+/CD8~+和NK细胞表达,酶联免疫吸附试验(ELISA)检测各期血浆细胞因子IL-6、IL-8、IL-10、TNF-α和INF-γ水平并进行统计分析和主成分分析(PCA)建模。结果两组CD3~+、CD4~+、CD4~+/CD8~+和NK细胞比例均在T1期显著下降、T2期降至最低(P0.05)。两组CD8~+均于T1期上升,其中对照组上升显著(P0.05)。观察组CD3~+、CD4~+和CD4~+/CD8~+在T4期显著高于对照组(P0.05)。两组INF-γ、TNF-α水平均在T1期下降,T2～T3期降至最低、T3～T4期逐渐恢复。观察组INF-γ水平在T2～T4期恢复较对照组快,而TNF-α在T2恢复较对照组慢(P0.05)。两组IL-6、IL-8和IL-10水平均在T1期显著升高,并于T3～T4期逐渐恢复正常。观察组IL-6和IL-8水平在T2期显著低于对照组,而IL-10在T1期显著高于对照组(P0.05)。PCA模型表明,两组围术期T细胞亚群、NK细胞比例和5种细胞因子的代谢均发生了显著紊乱,但观察组恢复较对照组快。结论静脉丙泊酚复合硬膜外麻醉对T淋巴细胞亚群、NK细胞和血浆细胞因子IL-6、IL-8、IL-10、TNF-α和INF-γ水平的综合影响优于全凭麻醉,更有利于机体免疫功能的快速恢复。     

慢性阻塞性肺疾病合并活动性肺结核患者血清细胞因子表达水平及其与疾病的相关性

目的 分析慢性阻塞性肺疾病(COPD)合并活动性肺结核患者第1秒用力呼气容积(FEV₁)水平与血清细胞因子水平间的相关性,为临床干预提供依据。方法 将2019年1月至2022年4月于陕西省第四人民医院呼吸与危重症医学科就诊的COPD合并活动性肺结核患者纳入研究,并纳入同期COPD对照组、结核对照组及常规对照组患者,比较四组患者的年龄、性别、肺功能等一般资料,比较并分析患者外周血自然杀伤细胞(NK细胞)、T淋巴细胞亚群及细胞因子的表达水平,并对患者肺功能与T淋巴细胞亚群及细胞因子表达水平间的相关性进行分析。结果 四组患者年龄、吸烟史、肺功能、NK细胞表达率、CD4⁺T淋巴细胞、CD8⁺T淋巴细胞水平及CD4⁺/CD8⁺比值间存在显著差异(均P<0.05),COPD合并结核患者SIL-2R、IL-6、IFN-γ及TNF-α水平显著高于COPD患者(均P<0.05);患者FEV₁水平与SIL-2R、TNF-α及IL-6水平呈负相关(r=-0.476,...     

肺炎支原体肺炎患儿TNF-α、IL-6、IL-8及T细胞亚群变化意义

目的探讨肺炎支原体肺炎（MPP）患儿外周血TNF-α、IL-6、IL-8及T细胞亚群（CD3＋/CD4＋/CD8＋）变化和临床意义。方法选择25例正常患儿作为对照组,25例轻症MPP作为实验A组,25例重症MPP为实验B组,采用酶联免疫吸附试验（ELISA）方法测定外周血TNF-α、IL-6、IL-8浓度变化以及采用流式细胞术测定外周血T淋巴细胞亚群（CD3＋/CD4＋/CD8＋）的表达水平。结果 MPP患儿急性期外周血TNF-α、IL-6、IL-8浓度明显高于对照组,且实验B组显著高于实验A组,P〈0.05;MPP患儿CD3＋、CD3＋CD4＋细胞百分率及CD4＋/CD8＋比对照组明显降低,实验B组比实验A组显著下降,P〈0.05。结论 MPP患儿病情严重程度与TNF-α、IL-6、IL-8浓度变化呈正相关,与T细胞亚群CD3＋、CD3＋CD4＋细胞百分率及CD4＋/CD8＋变化呈负相关。     

老年肺癌患者淋巴细胞亚群、白细胞介素-6、肿瘤坏死因子-α在外周血中的表达及意义

目的探讨老年肺癌患者淋巴细胞亚群、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α在外周血中的表达及意义。方法流式细胞仪检测老年肺癌患者抗凝全血中淋巴细胞亚群的表达;通过酶联免疫吸附法(ELISA)检测血清IL-6、TNF-α的水平,并分别与正常老年人结果进行对比。结果小细胞肺癌组与非小细胞肺癌组CD3~+、CD3~+CD4~+、CD4~+/CD8~+和自然杀伤(NK)细胞表达水平均明显低于正常组(P<0.05);CD3~+CD8~+、CD3~-CD19~+略高于正常组,但无统计学差异(P>0.05)。与正常组比较,小细胞肺癌组与非小细胞肺癌组血清IL-6、TNF-α水平均明显高于正常组(P<0.05)。Ⅲ~Ⅳ期组CD3~+、CD3~+CD4~+、CD4~+/CD8~+、CD3~-CD19~+和NK细胞数均低于Ⅰ~Ⅱ期组,且CD3~+CD8~+细胞数高于Ⅰ~Ⅱ期组,但差异无统计学意义(P>0.05),Ⅲ~Ⅳ期组血清IL-6、TNF-α水平明显高于Ⅰ~Ⅱ期组(P<0.05)。结论老年肺癌患者存在免疫功能及细胞因子网络紊乱,共同参与了肺癌的发病机制。     

重症病毒性脑炎患儿T淋巴细胞亚群变化及其临床意义分析

目的观察重症病毒性脑炎患儿T淋巴细胞亚群变化,探讨其临床意义。方法选取2009年6月—2012年6月山东大学齐鲁儿童医院收治的病毒性脑炎患儿60例,其中轻、重型患儿各30例,分别作为轻型组、重型组。同时选取健康儿童30例作为对照组。轻型组患儿给予常规治疗,重型组患儿在常规治疗基础上给予大剂量甲泼尼龙联合丙种球蛋白治疗。比较3组受试者T淋巴细胞亚群及重型组不同预后患儿治疗前后T淋巴细胞亚群。结果轻型组患儿CD+3、CD+4、CD+8细胞分数及CD+4/CD+8细胞比值与对照组比较,差异均无统计学意义(P0.05);重型组患儿CD+3、CD+4细胞分数均低于对照组、轻型组,CD+8细胞分数、CD+4/CD+8细胞比值均高于对照组、轻型组(P0.05)。重型组预后良好患儿治疗后CD+3、CD+4细胞分数及CD+4/CD+8细胞比值均高于治疗前,CD+8细胞分数低于治疗前(P0.05);重型组预后不良患儿治疗后CD+3、CD+4细胞分数及CD+4/CD+8细胞比值高于治疗前(P0.05),而治疗前后CD+8细胞分数比较,差异无统计学意义(P0.05)。结论重症病毒性脑炎患儿常伴有T淋巴细胞亚群改变,检测重症病毒性脑炎患儿T淋巴细胞亚群有助于判断病情严重程度及预后效果。     

老年肺癌患者外周血T淋巴细胞亚群和自然杀伤细胞的临床及意义

目的探讨老年肺癌患者T淋巴细胞亚群和自然杀伤(NK)细胞水平及临床意义。方法该校附属医院80例老年肺癌患者作为观察组,回顾分析外周血T淋巴细胞亚群和NK细胞检测结果,与另选的80例健康受检者(对照组)进行对比分析,并于术后20 d复查肺癌患者的外周血T淋巴细胞亚群和NK细胞,对比缓解者与未缓解者的检查结果。结果外周血T淋巴细胞亚群与NK细胞表达水平检测中,观察组CD3+、CD4+、CD4+/CD8+比值与NK细胞水平较对照组明显降低(P0.05),CD8+表达水平明显高于对照组(P0.05)。观察组于术后20 d复查T细胞亚群和NK细胞,根据结果分为两组进行分析,发现缓解组CD3+、CD4+、CD4+/CD8+和NK表达均较化疗前明显上升,CD8+表达显著降低(P0.05)。而未缓解组各项指标化疗前后无明显变化(P0.05)。结论 NK细胞与外周血T淋巴亚群对诊断、评价肺癌的疗效、判断预后具有重要价值。     

支原体肺炎患儿血清IgM、IgG、IgA、T细胞亚群及炎症因子水平观察

目的 观察支原体肺炎患儿血清IgM、IgG、IgA、T细胞亚群、炎症因子水平,并分析其临床意义。方法 选取2015年2月—2019年2月在我院接受治疗的支原体肺炎患儿为观察对象,同时选取同期在我院体检的健康儿童作为对照,观察2组研究对象以及不同病情程度的支原体肺炎患儿血清IgM、IgG、IgA、T细胞亚群、炎症因子水平的差异。结果 支原体肺炎患儿IgA、CD3+T细胞水平均低于对照组(P均<0.05),CD4+T细胞、CD8+T细胞、IL-6、超敏C-反应蛋白(hypersensitiveC-reactiveprotein,hs-CRP)水平均高于对照组(P均<0.05),2组的IgM、IgG水平差异均无统计学意义(P均>0.05)。重症组患儿IgA、CD3+T细胞水平低于轻症组,CD4+T细胞、CD8+T细胞、IL-6、hs-CRP水平均高于轻症组(P均<0.05),2组的IgM、IgG水平差异均无统计学意义(P均>0.05)。结论 支原体肺炎患儿IgA、CD3+T细胞水平较低,CD4+T细胞、CD8+T细胞、IL-6、hs-CRP水平较高,且与患儿的病情严重程度有关。     

白塞病患者血清T淋巴细胞亚群和细胞因子变化初探

目的 探讨白塞病(BD)患者外周血T淋巴细胞亚群和细胞因子的变化。方法 用流式细胞仪和放射免疫法分别检测BD在患者血清T淋巴细胞亚群(CD3、CD4、CD8、CD16^ /CD56^ 、CD19)和细胞因子[白细胞介素(IL)-1β、IL-2、sIL-2R、IL-6、IL-8、肿瘤坏死因子(TNF)-α]的水平。结果 BD组CD8细胞显著高于对照组，CD4、CD4/CD8比值及自然杀伤细胞(NK)(CD16^ /CD56^ )细胞显著低于对照组，而CD3和CD19细胞两组间差异无显著性；BD组血清sIL-2R和IL-8水平显著高于对照组，而IL-1、IL-2、IL-6及TNF-α两组间差异无显著陛。结论 BD患者存在细胞免疫紊乱，血清sIL-2R和IL-8升高可能是疾病活动指标之一。     

手足口病患儿体内淋巴细胞亚群和细胞因子水平变化及意义

目的观察手足口病(HFMD)患儿体内淋巴细胞亚群及细胞因子浓度改变,探讨其免疫学状态变化。方法研究对象为115例HFMD住院患儿(HFMD组)和20例查体健康儿童(对照组),采用流式细胞术检测CD3+、CD4+、CD8+、CD8+0、CD8+6、CD1+6/CD5+6、CD1+9表达量;采用ELISA法检测血清中IL-13、IL-10、TGF-β浓度。结果HFMD组重症患儿外周血淋巴细胞含量明显低于轻症患儿及对照组(P<0.01),且其治疗后CD4+/CD8+升高(P<0.05);两组CD16/CD56无显著差异,但重症患儿治疗后下降(P<0.05);与对照组相比,HFMD组外周血树突状细胞含量较高(P<0.01);两组B淋巴细胞无显著差异,但重症患儿治疗后升高(P<0.05);血清中IL-13、IL-10、TGF-β浓度在HFMD重症患儿、轻症患儿及对照组呈依次递增趋势(P<0.01),但重症患儿治疗后无显著变化。结论HFMD患儿体内存在显著细胞免疫和体液免疫变化,及时检测相关指标可为临床诊治提供依据。     

慢性阻塞性肺病患者的细胞免疫及细胞因子水平变化

目的观察慢性阻塞性肺疾病(COPD)患者细胞免疫功能和白介素(IL)-6,IL-8、肿瘤坏死因子(TNF)-α的变化及其与肺功能参数的关系。方法以30名COPD患者为研究对象,30名健康志愿者为对照组,测定血清T细胞亚群,自然杀伤细胞(NK)细胞水平及治疗前后血清IL-6、IL-8、TNF-α水平,并与第1秒用力呼气容积(FEV1)做相关分析。结果 COPD组急性发作期血清CD3+、Th(CD3+CD4+)、Th/Ts,NK细胞水平均低于健康对照组,差异有统计学意义(P0.01),Ts(CD3+CD8+)在各组间均无统计学差异,血清T细胞亚群水平、NK细胞水平与FEV1无明显相关(P0.05);COPD患者治疗前后血清IL-6、IL-8及TNF-α水平均明显高于健康对照组,差异有统计学意义(P0.01),且治疗前血清IL-6、IL-8及TNF-α水平又高于治疗后,差异有统计学意义(P0.05)。COPD急性发作期血清IL-8、IL-6、TNF-α与FEV1呈负相关(r=-0.72,P0.05;r=-0.74,P0.05;r=-0.75,P0.05);COPD急性发作期血清IL-6、IL-8水平与TNF-α水平呈正相关(r=0.60,P0.05;r=0.65,P0.05)。结论 COPD急性发作期细胞免疫功能显著降低,存在T细胞亚群失衡和NK细胞水平下降;血清中IL-6、IL-8、TNF-α过度分泌,这些变化在COPD的发展过程中起着重要的作用,可作为监测病情、观察疗效的重要指标。     

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.