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1.
目的探讨白细胞介素17(IL17)与子宫内膜异位症(内异症)发病的关系。方法应用酶联免疫吸附(ELISA)法检测36例不同期别内异症患者(内异症组)和26例非内异症患者(对照组)腹腔液中的IL17水平。结果内异症组和对照组腹腔液IL17水平分别为(5.7±1.9)ng/L和(5.3±1.4)ng/L,两组比较,差异无统计学意义(P>0.05)。按1985年美国生育学会内异症分期标准(rAFS)进行分期,Ⅰ~Ⅱ期内异症患者(16例)腹腔液IL17水平为(6.4±1.7)ng/L,Ⅲ~Ⅳ期内异症患者(20例)为(5.1±1.8)ng/L,两者比较,差异有统计学意义(P<0.05)。卵泡期和黄体期腹腔液IL17水平在两组间比较,差异均无统计学意义(P>0.05)。内异症不孕患者腹腔液IL17水平为(6.4±1.8)ng/L,内异症未合并不孕患者为(5.1±1.8)ng/L,两者比较,差异有统计学意义(P<0.05)。结论IL17水平变化可能与早期内异症及内异症不孕的发病有关。  相似文献   

2.
目的 探讨腹腔液中细胞因子在子宫内膜异位症 (内异症 )发病中的作用。方法 采用酶联免疫吸附试验 ,检测 31例内异症患者 (Ⅰ、Ⅱ、Ⅲ期各 8例 ,Ⅳ期 7例 )、2 2例非内异症患者 (对照 )腹腔液中白细胞介素 6 (IL 6 )、白细胞介素 8(IL 8)及转化生长因子 β1(TGF β1)的含量 ;并对内异症患者腹腔液中细胞因子浓度与美国生育协会修正标准分期 (R AFS)及痛经评分进行相关性分析。结果 内异症患者腹腔液中IL 6及IL 8含量 [( 1.8± 0 .4)ng/L ,( 1.7± 0 .5 )ng/L]明显高于对照者 [( 1.2±0 .2 )ng/L ,( 1.4± 0 .3)ng/L ,P <0 .0 5 ];TGF β1含量两者比较 ,差异无显著性 (P >0 .0 5 )。IL 6与R AFS评分有显著相关性 (P <0 .0 5 )。 3个细胞因子与痛经评分均无相关性 (P >0 .0 5 )。结论 内异症患者腹腔液中异常水平的IL 6及IL 8是腹腔免疫动态环境失衡的部分原因  相似文献   

3.
目的:探讨子宫内膜异位症(内异症)患者血清和腹腔液瘦素水平的变化及其在内异症发病中的作用。方法:采用RIA的方法测定35例内异症患者和15例非内异症患者(对照组)血清和腹腔液中瘦素的含量,并与R-AFS评分进行相关性分析。结果:两组间体重指数差异均无显著性(P>0.05),内异症患者血清瘦素水平与对照组间比较差异无显著性(分别为2.992±2.169μg/L,1.977±1.549μg/L)(P>0.05),其腹腔液中瘦素水平明显高于对照组(分别为4.502±2.935μg/L,1.633±0.979μg/L)(P<0.01)。轻度及重度内异症患者腹腔液瘦素水平均明显高于对照组,轻度组又较重度组明显升高(分别为5.546±3.106μg/L,3.806±2.666μg/L,1.633±0.979μg/L)(P<0.05),内异症患者腹腔液瘦素水平与R-AFS评分间呈直线负相关关系。结论:内异症患者腹腔液中瘦素水平明显升高,并随疾病的严重程度而降低,可能在内异症的发生发展中发挥重要作用,而血清瘦素水平不能影响该疾病的发生及发展。  相似文献   

4.
子宫内膜异位症患者T辅助细胞亚群功能失衡的研究   总被引:13,自引:0,他引:13  
目的 探讨T辅助细胞 (Th)失衡与子宫内膜异位症 (内异症 )的关系。方法 对 30例内异症患者 (内异症组 )及 15例健康生育年龄妇女 (对照组 )的外周血单个核细胞 (PBMC)加入植物血凝素进行体外培养诱生。采用酶联免疫吸附试验测定血浆及PBMC培养上清液中Th1类因子干扰素γ(IFN γ)、Th2类因子白细胞介素 4(IL 4)的水平。结果  ( 1)在PBMC诱生培养上清液中 ,内异症组IL 4的诱生水平 [( 32 .8± 12 .5 )ng/L]比对照组 [( 2 4.3± 3.5 )ng/L]明显升高 (P <0 .0 1) ,而IFN γ的诱生水平内异症组 [( 10 95 .6± 375 .6 )ng/L]较对照组 [( 15 49.3± 36 1.9)ng/L]下降 ,内异症组的IFN γ/IL 4比值 ( 37.7± 17.5 )下降 ,与对照组 ( 71.1± 12 .1)比较 ,差异均有极显著性 (P <0 .0 1)。 ( 2 )在血浆中 ,除内异症组IL 4水平 [( 32 .0± 2 2 .6 )ng/L]高于与对照组 [( 2 3.3± 4.3)ng/L](P <0 .0 5 )外 ,IFN γ的诱生水平及IFN γ/IL 4比值与对照组比较 ,差异均无显著性 (P >0 .0 5 )。结论 内异症患者体内存在Th1/Th2失衡 ,使子宫内膜能够逃避免疫监视及杀伤而在异位种植 ,引起内异症的发生发展  相似文献   

5.
子宫内膜异位症患者辅助性T细胞亚群免疫状态的研究   总被引:8,自引:0,他引:8  
目的 探讨辅助性T细胞 (Th)亚群在子宫内膜异位症 (内异症 )发病中的作用。方法 采用酶联免疫吸附法检测 30例内异症患者 (内异症组 )及 2 0例非内异症患者 (对照 1组 )血清及腹腔液中白细胞介素 (IL) 2、6的水平 ;用免疫组化技术分别检测IL 2、IL 6在内异症组患者异位内膜组织和 10例子宫肌瘤患者 (对照 2组 )的正常子宫内膜组织中的表达。结果 内异症组患者血清及腹腔液中位数IL 6水平分别为 5 3、2 1ng/L ,对照 1组患者血清及腹腔液中位数IL 6水平分别为 2 5、0 9ng/L ,两组妇女血清和腹腔液中IL 6水平分别比较 ,差异均有统计学意义 (P <0 0 5 ) ;内异症组Ⅲ~Ⅳ期患者血清及腹腔液中位数IL 6水平分别为 13 6、4 1ng/L ,Ⅰ~Ⅱ期患者血清及腹腔液中位数IL 6水平分别为 3 7、1 6ng/L ,Ⅲ~Ⅳ期患者与Ⅰ~Ⅱ期患者血清及腹腔液中位数IL 6水平比较 ,差异均有统计学意义 (P <0 0 5 ) ;内异症组IL 2 /IL 6比值在血清及腹腔液中分别为 0 7、1 1,均分别低于对照组的 0 8、6 2 ,差异也有统计学意义 (P <0 0 5 )。内异症组患者腹腔液与血清IL 6水平呈正相关 (r =0 74 5 ,P <0 0 1) ,血清及腹腔液中IL 6水平与IL 2 /IL 6比值均呈负相关 (r =- 0 4 0 6 ,P <0 0 5 ;r =- 0 4 80 ,P <0 0 5 )  相似文献   

6.
目的:研究子宫内膜异位症(EM)患者血清血管内皮生长因子(VEGF)水平的动态变化及其在EM疗效和预后评价中的意义。方法:应用双抗体夹心酶联免疫吸附法分别检测正常健康妇女(正常组,35例)及子宫内膜异位症患者(EM组,65例,其中Ⅰ~Ⅱ期26例,Ⅲ~Ⅳ期39例)手术前后外周血清中VEGF的水平。结果:EM组术前血清中VEGF水平250.70±88.84ng/L明显高于正常组103.20±49.18ng/L(P<0.01),Ⅲ~Ⅳ期内异症患者血清VEGF的水平305.02±69.74ng/L显著高于Ⅰ~Ⅱ期169.21±36.12ng/L(P<0.01)。术前血清中VEGF水平250.70±88.84ng/L高于术后1周VEGF水平153.97±58.64ng/L(P<0.05)。随访期间29例未复发的EM患者综合治疗结束后血清VEGF水平呈下降趋势,6例复发的EM患者综合治疗结束后血清VEGF水平呈增高趋势。结论:VEGF与EM密切相关,动态检测EM患者外周血VEGF的水平变化有可能作为EM疗效评价、复发及预后的重要指标。  相似文献   

7.
目的:探讨子痫前期患者血清中氧化应激产物H2O2对可溶性人类白细胞抗原G(sHLA-G)表达的影响,分析早发型及晚发型子痫前期的病因。方法:选择早发型和晚发型子痫前期孕妇各15例为研究组,以同期正常孕妇15例为对照组。采用比色法及ELISA法分别检测3组研究对象血清中H2O2含量和sHLA-G表达,并进行相关性分析。结果:(1)早发型及晚发型子痫前期组孕妇血清中H2O2呈高水平表达[(58.43±3.56)μmol/L,(29.84±7.67μmol/L)],与正常妊娠组相比[(21.61±4.25)μmol/L],差异均有统计学意义(P均<0.05);早发型子痫前期组孕妇血清中H2O2含量显著高于晚发型子痫前期组(P<0.05)。(2)早发型及晚发型子痫前期组孕妇血清中sHLA-G呈低水平表达[(28.65±9.16)U/ml,(51.84±8.67)U/ml],与正常妊娠组[(98.13±13.26)U/ml]相比,差异有统计学意义(P均<0.05);早发型子痫前期组孕妇血清中sHLA-G表达量显著低于晚发型子痫前期组(P<0.05)。(3)正常妊娠、子痫前期孕妇血清中的H2O2水平与sHLA-G表达呈负相关(r=-0.835,P<0.05)。结论:早发型子痫前期发病早,受氧化应激损伤更严重,血清中sHLA-G表达量更低;氧化应激产物H2O2可能潜在下调sHLA-G表达,与子痫前期发病及病情轻重程度相关。  相似文献   

8.
目的:探讨子宫内膜异位症(内异症)患者血清和腹腔液肿瘤坏死因子α(TNF-α)及血管内皮生长因子(VEGF)水平的变化及其在内异症发病中的作用.方法:采用t检验和Pearson相关分析的方法,测定39例内异症患者(内异症组)和25例非内异不孕症患者(对照组)腹腔液中TNF-α及VEGF的含量,进行相关性分析.结果:内异症患者血清和腹腔液TNF-α水平分别为44.18±13.52 pg/ml和57.98±19.70 pg/ml,与对照组(分别为34.95±9.81 pg/ml和42.50±10.32 pg/ml)比较,差异有统计学意义(P<0.05).内异症患者血清和腹腔液VEGF水平分别为39.89±7.26ng/ml和71.97±14.19ng/ml,与对照组(分别为33.88±10.14 ng/ml和43.48±9.12 ng/ml)比较,差异有统计学意义(P<0.05).内异症患者血清中,TNF-α与VECF水平无明显相关性(r=0.115,P>0.05),而腹腔液,TNF-α与VEGF水平呈明显正相关(r=0.558,P<0.01);内异症患者Ⅰ~Ⅱ期血清和腹腔液中的TNF-α和VECF水平均较Ⅲ~Ⅳ期患者明显低,差异有统计学意义(P<0.05).结论:①内异症患者血清和腹腔液中TNF-α水平及VEGF水平明显升高,并随疾病的严重程度而升高,可能在内异症的发生发展中发挥重要作用;②内异症患者腹腔液TNF-α与VEGF水平呈明显正相关,而血清中TNF-α与VEGF水平呈无明显相关性,为内异症的子宫内膜种植学说提供一定的依据.  相似文献   

9.
目的 探讨单核细胞趋化蛋白-1(MCP-1)和正常T细胞表达和分泌的调节活化因子(RANTES)在子宫内膜异位症(EM)发病中的作用.方法 2005年5月至2006年3月在贵阳医学院附属医院采用ELISA法检测30例EM患者(EM组),30例非内异症患者(对照组)腹腔液中MCP-1及RANTES的含量,并对EM患者腹腔液中趋化因子浓度与R-AFS及痛经评分进行相关性分析.结果 EM组患者腹腔液中RANTES及MCP-1水平[(1228.41±317.96)ng/L,(996.24±246.84)ng/L]均较对照组显著增高[(259.78 ±138.19)ng/L,(171.50±104.93)ng/L],P均<0.001,EM组Ⅲ、Ⅳ期患者腹腔液中RANTES和MCP-1的含量与I、Ⅱ期比较差异有统计学意义(P<0.05).MCP-1与RANTES水平与R-AFS评分有显著相关性(P<0.01).EM患者腹腔液中RANTES与MCP-1含量呈显著相关(P<0.001),但研究发现RANTES与MCP-1水平与痛经评分均无相关性(P>0.05).结论 MCP-1和RANTES可能在EM的发生发展中起重要作用.  相似文献   

10.
目的:分析子宫内膜异位症患者合并子宫内膜息肉的情况,探讨血清CA125水平与痛经、内异症rAFS分期、病灶部位的相关性,为临床上更好地解读CA125水平提供依据。方法:回顾性分析2010年1月至12月我院术中或术后病理诊断为子宫内膜异位症的175例患者的临床资料。结果:(1)20.0%的子宫内膜异位症患者合并子宫内膜息肉;(2)36.6%的内异症患者有中、重度痛经,痛经程度与血清CA125水平无相关性;(3)Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期内异症患者的平均CA125水平分别为21.5U/ml、28.4U/ml、38.6U/ml、57.1U/ml,Ⅲ~Ⅳ期内异症患者血清CA125水平高于Ⅰ~Ⅱ期患者(P<0.05);(4)腹膜型、混合型、卵巢型内异症患者血清CA125的阳性率分别为21.4%、63.0%和67.4%,混合型、卵巢型内异症患者血清CA125阳性率显著高于腹膜型(P<0.001)。结论:血清CA125水平不能作为内异症合并子宫内膜息肉的预测指标;血清CA125水平可用于辅助鉴别内异症的分期和病灶部位,但是CA125对于内异症的早期诊断缺乏敏感性。  相似文献   

11.
子解子宫内膜内异症患者腹腔液肿瘤坏死因子α和白细胞介素6(IL-6)水平的变化及对人精子活动力和鼠胚胎发育的影响。方法将行诊断性腹腔镜检查的不孕患者25例,根据术后诊断分为内异症组(14例)和对照组(11例,盆腔正常),利用双抗体夹心法检测其腹腔液和腹腔巨噬细胞培养上清液中TNF-α和IL-6和水平。并将两组的腹腔液分别与人精子和鼠2细胞期胚进行体外培养,观察萁 上人精子活动力鼠2细胞期胚胎发育的  相似文献   

12.
Peritoneal fluid obtained at laparoscopy from 49 women was measured for its content of prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), 6-keto-prostaglandin F1 alpha (6-KF), and thromboxane B2 (TxB2) by specific radioimmunoassays. In normal women (n = 10), the concentrations of prostaglandins in peritoneal fluid were (mean +/- SE): PGE2 = 0.79 +/- 0.26, PGF2 alpha = 0.60 +/- 0.18, 6-KF = 0.48 +/- 0.19, and TxB2 = 0.23 +/- 0.09 ng/ml; in women with endometriosis (n = 16): PGE2 = 1.43 +/- 0.72, PGF2 alpha = 1.52 +/- 0.59, 6-KF = 3.32 +/- 0.71, and TxB2 = 1.14 +/- 0.69 ng/ml; in women with chronic pelvic inflammatory disease and/or obstructed tubes (n = 19): PGE2 = 1.94 +/- 1.04, PGF2 alpha = 1.20 +/- 0.61, 6-KF = 1.55 +/- 0.40, and TxB2 = 0.64 +/- 0.24 ng/ml; in women with pelvic pain without any visible pathologic condition (n = 4): PGE2 = 1.11 +/- 0.66, PGF2 alpha = 0.73 +/- 0.55, 6-KF = 1.35 +/- 0.35, and TxB2 = 0.39 +/- 0.17. The mean volumes of peritoneal fluid recovered were 10 to 16 ml and were not significantly different between the groups. Except for a significantly elevated concentration of 6-KF in the peritoneal fluid of women with endometriosis compared to normal women (p = less than 0.02), the prostaglandins measured did not differ significantly between the groups of women studied. The possible significance of elevated 6-KF in the peritoneal fluid of women with endometriosis is discussed.  相似文献   

13.
OBJECTIVE: To verify whether nitric oxide in peritoneal fluid is associated with endometriosis and infertility. STUDY DESIGN: Twenty-five women with idiopathic infertility and 38 with endometriosis were recruited, and 18 cases of uterine myomata and 2 cases of ovarian cyst served as controls. Peritoneal fluid samples were aspirated from the pouch of Douglas during laparoscopy or laparotomy. Metabolites of nitric oxide (nitrite and nitrate) in peritoneal fluid were determined by a method using nitrate reductase and the Griess reaction. RESULTS: Peritoneal concentrations of nitrate/nitrite in both infertile women (42.02 +/- 12.98 mmol/L) and patients with endometriosis (41.75 +/- 16.42 mmol/L) were significantly higher than that in controls (33.96 +/- 13.07, P < .05 for both). No significant difference in peritoneal nitrate/nitrite level was found between infertile women and patients with endometriosis (P > .5). Peritoneal levels of nitrate/nitrite were comparable among patients with endometriosis at different stages (P > .5). Patients with endometriosis had more peritoneal fluid than controls and idiopathic infertile women, while controls and idiopathic infertile women had comparable amounts of peritoneal fluid. CONCLUSION: An increased peritoneal level of nitric oxide is a common alteration in endometriosis, endometriosis-associated infertility and idiopathic infertility and may be associated with the pathogenesis of these diseases.  相似文献   

14.
The aim of this study was to determine serum and peritoneal interleukin (IL)-2, IL-4, and monocyte chemotactic protein-1 levels as diagnostic markers of endometriosis in adolescent girls. The design of the study encompassed 50 adolescent girls, aged 13 to 19 years after menarche, with chronic pelvic pain who qualified for diagnostic laparoscopy. The patients were allocated into 2 groups: group I (endometriosis) consisted of subjects with diagnosed endometriosis (n = 33, 66%) and group II (control) whose laparoscopic examinations revealed no evidence of endometriosis (n = 17, 34%). IL-2, IL-4, and Monocyte chemotactic protein 1 concentrations in serum and peritoneal samples were assessed using commercially available human enzyme-linked immunosorbent assay kits. The results were analyzed statistically with the Statistica 8.0 computer software. The value of P < 0.05 was the level of statistical significance. The results in adolescents with endometriosis had significantly higher concentrations of serum IL-4 (3.90 ± 1.58 pg/mL vs. 3.04 ± 1.72 pg/mL; P = 0.04) and peritoneal fluid IL-4 (5.03 ± 8.92 pg/mL vs. 2.74 ± 1.11 pg/mL; P = 0.03), and lower peritoneal fluid IL-2 (92.44 ± 292.75 pg/mL vs. 174.23 ± 389.77 pg/mL; P = 0.01) compared with the control. In a receiver-operating characteristic analysis, serum IL-4 as well as peritoneal fluid IL-2 and IL-4 provided the best discriminative ability between subjects with endometriosis and controls. Using cutoff points for serum IL-4 (3.00 pg/mL), peritoneal fluid IL-2 (21.00 pg/mL) and IL-4 (2.7 pg/mL), relatively high odd ratios were obtained in the prediction of endometriosis in adolescents (3.2; 6.4; 3.3). The Serum IL-4, peritoneal IL-2 and IL-4 provided a good method of discrimination between subjects with endometriosis and controls.  相似文献   

15.
Gao Y  Liu Y  Luo L 《中华妇产科杂志》2001,36(12):723-726
目的探讨子宫内膜异位症(内异症)病灶分泌的细胞因子与腹腔液之间的关系及其对生殖的影响.方法对因内异症进行手术治疗或不孕症行腹腔镜检查的妇女43例,其中内异症24例(内异症组)及正常盆腔19例(对照组),采用单核细胞趋化实验分析、斑点杂交分析、酶链免疫吸附测定及胞浆游离钙浓度([Ca2+]i)测定等方法,测定两组患者的腹腔液、腹腔巨噬细胞及异位内膜细胞的特性,并比较两组腹腔液及异位内膜细胞对精子活动力及鼠胚胎卵裂率的影响.结果内异症组及对照组患者腹腔液趋化单核细胞移动的距离分别为(87.2±9.4) μm、(51.9±3.7) μm,两组比较,差异有极显著性(P<0.01);腹腔巨噬细胞数分别为(1.47±0.87)×106/ml、(0.67±0.73)×106/ml(P<0.01);异位内膜细胞可表达低水平的单核细胞趋化蛋白(MCP)-1[吸光度(A)值为18.34±3.95],经白细胞介素(IL)-1β及肿瘤坏死因子(TNF)-α刺激后,其分泌MCP-1mRNA A值分别为56.84±3.21、41.58±2.48,刺激前后比较,差异有极显著性(P<0.01);内异症组腹腔液及异位内膜细胞明显抑制精子的活动力和鼠胚的发育.结论异位症病灶与腹腔液微环境相互影响,腹腔巨噬细胞和异位症病灶合成及分泌某些细胞因子的能力增强,同时可干扰生殖过程的某些环节.  相似文献   

16.
Prostaglandin F2 alpha (PGF2 alpha) metabolite (13,14-dihydro-15-keto PGF2 alpha) and prostaglandin E2 (PGE2) were assayed in the cul-de-sac fluid aspirated from 15 patients with endometriosis, in saline peritoneal washings of 5 patients with unexplained infertility, and in 5 control subjects. The fluid from the cul-de-sac of patients with endometriosis showed wide variations in the concentrations of PGF2 alpha metabolite and PGE2. There was no correlation between the concentration of these prostaglandins (PGs) and the stage of the cycle. Saline peritoneal washings from patients with unexplained infertility had significantly higher concentrations of PGF2 alpha metabolite than the control subjects. The concentration of PGE2 in the saline peritoneal washings was higher in the group with unexplained infertility than in the control group; however, the difference was not significant. The concentration of PGF2 alpha metabolite and PGE2 in the peritoneal saline washings from patients with unexplained infertility were no different from the concentrations of these PGs in the peritoneal fluid (PF) from patients with endometriosis. PG concentration in PF of infertile patients with or without endometriosis is a new variable for evaluation in these patients.  相似文献   

17.
M Hao  Y Shi  M Dong 《中华妇产科杂志》2000,35(6):329-331
OBJECTIVE: To investigate the role of cytokines in peritoneal fluid on pathogenesis of endometriosis (EM). METHODS: Interleukin-6 (IL-6), interleukin-8(IL-8) and transforming growth factor-beta 1 (TGF-beta 1) contents in peritoneal fluid (PF) of 31 cases with EM were detected by enzyme linked immunoabsorbent assay (ELISA) and compared with the counterparts of 22 cases without EM (controls). The correlation analyses between cytokine concentrations in peritoneal fluid of EM patients and the severity of EM or dysmenorrhea score were performed. RESULTS: The peritoneal fluid from patients with EM contained significantly greater amounts of IL-6 [(1.8 +/- 0.4) ng/L] and IL-8 [(1.7 +/- 0.5) ng/L] than those in controls [(1.2 +/- 0.2) ng/L and (1.4 +/- 0.3) ng/L respectively, P < 0.05]. However, in the amounts of TGF-beta 1 there were no significant difference (P > 0.05) between the two groups. The highest PF IL-6 and IL-8 concentrations were found in stage II, III and stag I, II EM respectively. A significant correlation between PF IL-6 content and the severity of disease was noted but there were no evidences of a relationship between concentrations of IL-8 and TGF-beta 1 and the severity of EM as well as between concentrations of three cytokines and dysmenorrhea score. CONCLUSION: Unusual levels of IL-6 and IL-8 in PF of EM patients partly account for imbalance of the immunologically dynamic environment in peritoneal cavity of EM patients.  相似文献   

18.
异位子宫内膜细胞的凋亡与增殖的研究   总被引:35,自引:2,他引:33  
Gao Y  Luo L  He F 《中华妇产科杂志》1999,34(9):536-539,I013
目的 探讨异位子宫内膜细胞的凋亡特性及雌二醇(E2)、孕酮(P)、米非司酮对体外培养的人异位子宫内膜细胞表皮生长因子受体(EGFR)基因表达的影响。方法 对15例子宫内膜异位症(内异症)患者的异位内膜组织(异位内膜组)及11例非子宫内膜异位患者的在位内膜组织(在位内膜组)进行体外细胞培养,采用流式细胞术检测两组细胞的细胞凋亡指数,同时应用原位杂交方法检测细胞中bcl-2的表达水平。应用逆转录聚合酶  相似文献   

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