再生障碍性贫血和特发性血小板减少性紫癜患者血小板生成素的检测及意义

目的测定再生障碍性贫血(AA)和特发性血小板减少性紫癜(ITP)二组血小板减少患者血小板生成素(TPO)质量浓度并探讨其临床意义.方法采用ELISA法测定13例初治AA和20例初治ITP患者血清TPO质量浓度,以17例健康体检者为正常对照.结果正常对照组血清TPO质量浓度为(99.41±73.84)ng/L,AA患者血清TPO质量浓度为(683.48±414.73)ng/L,明显高于正常对照组(P＜0.01);ITP患者血清TPO质量浓度为(100.67±79.59)ng/L,与正常对照组相比,差异无显著性(P＞0.05).相关分析表明AA患者TPO质量浓度与血小板计数呈负相关(r=-0.71,P＜0.01);而ITP患者TPO质量浓度与血小板计数无相关性(P＞0.05).结论血清TPO的质量浓度受循环中血小板数目和骨髓巨核细胞总体数量的双重调节.由于血小板生成减少所致的血小板减少症其血清TPO质量浓度明显升高;而由于血小板破坏过多所致者其血清TPO质量浓度处于正常水平.     

ITP患者血清血小板生成素水平与临床治疗效果的关系

目的 探讨血小板生成素（TPO）对特发性血小板减少性紫癜（ITP）临床治疗效果的影响。方法 将25例初治ITP患者按治疗效果分为有效组和无效组,另设正常对照组22例。采用ELISA法和放免法分别检测治疗前后血清TPO水平,取治疗前骨髓涂片计数巨核细胞数量。结果 无效组TPO水平明显高于有效者及对照组（P均〈0．05）,有效者与对照组间无显著性差异;无效者巨核细胞计数则显著低于有效者（P〈0．01）。结论 血清高水平TPO可能预示ITP治疗困难;TPO治疗有效与无效者的发病机理可能存在差异。     

促血小板生成素受体激动剂治疗再生障碍性贫血及骨髓增生异常综合征研究进展

正促血小板生成素(TPO)是重要的内源性血小板生成调节因子,其受体位于巨核系祖细胞(HPC)上,通过刺激一系列转导信号促进巨核细胞增殖、成熟以及血小板释放[1]。TPO由肝脏合成,并且受血小板、巨核细胞表面的TPO受体调节。再生障碍性贫血(AA)中TPO水平明显增高,免疫性血小板减少性紫癜(ITP)患者的TPO水平在正常范围内或轻度增加。近年来TPO受体激动剂逐步应用于AA、骨     

CMV和EBV感染与儿童ITP的关系

目的 :探讨巨细胞病毒 (CMV)和Epstein Barr病毒 (EBV)感染与儿童特发性血小板减少性紫癜 (ITP)的关系。方法 :采用基础PCR方法检测了 44例ITP患儿外周血白细胞中CMV和EBV的感染情况 ,并结合实验室及临床特征进行分析。结果 :①ITP患儿CMV感染阳性率较高 ,达 6 1.4% ;在慢性反复发作的患儿中 ,CMV阳性率更高 (71.9% ) ,显著高于急性ITP患儿 (33.3% ) (χ2 =5 .47,P <0 .0 5 )。CMV阳性患儿血小板自身抗体阳性率较高 ,血小板及巨核细胞数均较低 ,出血症状明显 ,激素治疗效果较差。② 5 0 %的ITP患儿外周血EBVDNA阳性 ,急性患儿较多见 ,但与慢性患儿比差异无显著性意义。EBV阳性患儿血小板自身抗体阳性率也较高 ,以抗GPⅡb/Ⅲa升高最明显 ,显著高于EBV阴性患儿 (χ2 =4.96 ,P <0 .0 5 )。与CMV阳性患儿相比 ,EBV阳性患儿血小板减少多为轻、中度 ,骨髓中巨核细胞数正常或增多 ,出血症状少见 ,预后较好。结论 :CMV和EBV感染与部分儿童ITP的发病有关 ,不同的病毒感染有不同的发病机制和临床特征。     

促血小板生成素及其抗体在系统性红斑狼疮伴发血小板减少中的作用

目的探讨促血小板生成因子(TPO)和抗TPO抗体在系统性红斑狼疮(SLE)患者血小板减少中的作用。方法于2016年3月至2017年5月纳入在四川大学华西医院、川北医学院附属医院、新疆自治区人民医院、四川省简阳市人民医院风湿免疫科住院治疗的SLE伴血小板减少患者50例和SLE血小板正常患者43例,同期选择基线资料匹配的健康体检者27人。采用ELISA法测定受检者血清TPO水平和抗TPO抗体滴度,评估TPO在SLE患者血小板减少中的作用,同时评估受检者血清TPO水平和抗TPO抗体滴度与血小板计数变化的关系。采用MMT法测定抗TPO抗体对体外培养的巨核细胞增生的影响。结果正常对照组、SLE血小板正常组和SLE伴血小板减少组受检者血清TPO质量浓度分别为(63. 7±20. 6)、(98. 5±28. 7)和(80. 0±24. 8) pg/ml,SLE血小板正常组患者血清TPO水平明显高于SLE伴血小板减少组和正常对照组,差异均有统计学意义(P=0. 003、0. 002)。正常对照组、SLE血小板正常组和SLE伴血小板减少组血清抗TPO抗体滴度分别为0. 476±0. 165、0. 679±0. 300和0. 763±0. 348,SLE血小板正常组和SLE伴血小板减少组患者抗TPO抗体滴度明显高于正常对照组,差异有统计学意义(P=0. 000、0. 007)。SLE伴血小板减少组患者血小板计数与血清抗TPO抗体滴度呈明显负相关(r=-0. 268,P=0. 048),与血清TPO水平无线性相关(r=0. 133,P=0. 393)。SLE伴血小板减少组和SLE血小板正常组受检者血清抗TPO抗体阳性率分别为32. 0%(16/50)和25. 6%(11/43),SLE伴血小板减少组与SLE血小板正常组患者血清抗TPO抗体阳性率差异无统计学意义(χ2=0. 462,P=0. 497)。MTT试验结果显示,随着抗TPO抗体滴度增加,TPO诱导的巨核细胞的增生活力逐渐下降,差异均有统计学意义(均P0. 01)。结论 SLE患者血清可检测出抗TPO抗体,在TPO分泌相对不足的情况下,抗TPO抗体通过抑制巨核细胞增生而在SLE伴发血小板减少的过程中发挥作用。     

特发性血小板减少性紫癜患者血小板抗体等四项参数测定的价值

目的　探讨特发性血小板减少性紫癜 (ITP)患者血小板抗体 (PAIgG)、血小板膜蛋白(CD62P)、网织血小板 (RP)及淋巴细胞亚群变化及意义。方法　应用流式细胞术检测 5 8例ITP组及 2 0例正常对照组外周PAIgG、血CD62P、RP、淋巴细胞亚群的表达。结果　ITP组的血小板数明显低于正常对照组 (P <0 .0 1) ,PAIgG、CD62P、RP均明显高于正常对照组 (P <0 .0 1)。在淋巴细胞亚群中 ,ITP组CD3、CD4、CD4/CD8比值明显低于正常对照组 (P <0 .0 1) ,CD8、CD19细胞则显著高于正常对照组 ,而CD16+ 5 6与正常对照组无明显差异。结论　PAIgG、CD62P、RP及淋巴细胞亚群的变化可较好地反映ITP这一病理过程 ,对提高诊断水平及指导临床有一定实用价值。     

特发性血小板减少性紫癜患者网织血小板的测定

目的 :观察慢性血小板减少性紫癜 (c ITP)患者网织血小板百分率 (RP% )和绝对值水平及其在治疗过程中的变化。方法 :采用噻唑橙染色 ,流式细胞仪检测 6 4例正常人和 47例 c ITP患者的 RP%和 RPs绝对值。结果 :c ITP组 RP%〔(2 9.31± 16 .30 ) %〕明显高于对照组〔(5 .83± 1.81) %〕,RPs绝对值明显低于对照组 ,分别为 (6 .33± 4.5 0 )× 10 9/ L 和 (8.70± 2 .6 0 )× 10 9/ L,分别与对照组比较 ,差异有显著性意义 (P <0 .0 5 ) ;患者在接受治疗后 ,RP%和成熟巨核细胞明显降低 ,产板巨核细胞明显增高 ,分别与治疗前比较 ,差异有显著性意义 (P <0 .0 5 ) ;还观察到 ,在血小板升高前 ,RP%升高达峰值 ,此后随血小板升高 ,RP%逐渐下降。结论 :RP%和 RPs绝对值能反映 c ITP患者骨髓血小板生成活性 ,且 RP%能作为血小板恢复的预测指标     

特发性血小板减少性紫癜患者免疫相关指标的检测及其临床意义

目的 检测特发性血小板减少性紫癜(ITP)患者免疫相关指标的变化,探讨其在ITP发病机制中的作用及其临床意义.方法 应用酶联免疫斑点技术(ELISPOT)、改良血小板抗原单克隆抗体固相化检测技术(MAIPA)、流式细胞术及夹心法ELISA分别检测64例1TP患者及31例正常对照者分泌GPⅡb/Ⅲa抗体B细胞、血小板特异性抗体(抗GPⅡb/Ⅲa抗体、抗GP I b/Ⅸ抗体)、T淋巴细胞亚群、网织血小板(RP)及血小板生成素(TPO)的变化.结果 ITP患者分泌GPⅡb/Ⅲa抗体B细胞频数[急性ITP组患者为7.6±4.6/105个外周血单个核细胞(PBMC),慢性ITP组患者为5.3±3.0/105个PBMC]、血小板特异性抗体(抗GPⅡb/Ⅲa抗体、抗GPI b/Ⅸ抗体)的吸光度值(急性ITP组患者为0.51±0.11、0.48±0.06,慢性ITP组患者为0.49±0.10、0.46±0.09)、CD8+T淋巴细胞百分比[(27.09±9.86)%]、RP百分比[巨核细胞增多组为(24.85±19.18)%,巨核细胞正常组为(23.89±18.90)%]明显高于正常对照组[1.3±0.5/105个PBMC,0.33±0.06,0.41±0.03,(22.08±4 54)%,(8.19±2.46)%,P值均＜0.05],其中急性ITP患者分泌GPⅡb/Ⅲa抗体B细胞高于慢性ITP患者(P＜0.05).ITP组CD3+T淋巴细胞百分比、CD4+T淋巴细胞百分比及CD4+/CD8+比值[(60.88±14.59)%、(28.41±10.55)%、1.18±0.59]均低于正常对照组[(69.89±6.43)%、(35.38±5.05)%、1.64±0.29,P值均＜0.05].ITP患者巨核细胞增多组TPO水平(72.09±41.64)明显低于ITP患者巨核细胞正常组(118.60±70.72,P＜0.05),与正常对照组(75.37±26.32)之间差异无统计学意义(P＞0.05).结论 分泌GPⅡb/Ⅲa抗体B细胞、血小板特异性抗体、T淋巴细胞亚群、RP%及TPO在ITP诊断及指导定向干预治疗中有一定的意义.     

系统性红斑狼疮患者转移生长因子-β和白细胞介素-10水平的变化

目的　探讨系统性红斑狼疮 (SLE)患者血清转移生长因子 β(TGF β)和白细胞介素 10 (IL 10 )的变化。方法　根据SLEDAI评分法 ,将 38例SLE患者分为疾病活动度轻、中、重度三组 ;应用ELISA方法测定 38例SLE患者及 30名正常对照组血清TGF β及IL 10水平。 结果　SLE患者血清TGF β水平明显低于对照组 ( P <0 .0 5 ) ,但在疾病活动度轻、中、重三组之间比较差异无显著性 (P >0 .0 5 ) ;与对照组比较 ,SLE组血清IL 10水平显著升高 (P <0 .0 1) ,并且与疾病活动度指数成明显正相关 (r =0 .496 ,P <0 .0 1)。结论　临床上联合检测SLE患者血清TGF β和IL 10水平 ,对指导临床治疗及病情的评估具有实际意义。     

重组血小板生成素联合地塞米松治疗原发免疫性血小板减少症的疗效

目的探讨重组血小板生成素(rh TPO)联合地塞米松治疗原发免疫性血小板减少症(ITP)的临床效果。方法选择2012年2月至2014年3月在该院接受治疗的60例ITP患者。以数字法随机分成观察组和对照组各30例,观察组予地塞米松联合rh TPO治疗,对照组单纯使用地塞米松治疗,1个疗程(28 d)后比较两组临床疗效、血小板水平变化及不良反应情况。结果观察组的总有效率〔93.33%(28/30)〕显著优于对照组〔73.33%(22/30)〕(χ2=7.283,P=0.007)。两组在治疗前、治疗1~7 d的血小板水平差异均无统计学意义(t=0.432,0.588;P=0.682,0.312);治疗后7~14 d、14~28 d观察组血小板水平均显著高于对照组(t=13.981,12.925;均P=0.000)。观察组不良反应率为23.33%(7/30),对照组为16.67%(5/30),两组比较差异无统计学意义(χ2=2.857,P=0.091)。结论 rh TPO联合地塞米松治疗ITP疗效显著,不良反应少,值得推广。     

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.