系统性红斑狼疮患者外周血中IL-17和IL-18水平变化

【目的】探讨IL-17、IL-18在系统性红斑狼疮患者外周血清中的变化及其与该疾病活动性的关系。【方法】采用双抗体夹心酶联免疫吸附试验（ELISA）方法测定45例SLE患者外周血中的IL-17、IL-18水平,并与40例正常人群做对照。【结果】45例SLE患者与40例正常人群比较,其外周血中IL-17、IL-18的水平明显增高,差异有显著统计学意义（P〈0.01）;25例活动期患者与20例稳定期患者比较,其IL-18水平差异有统计学意义（P〈0.01）,而外周血IL-17在两组之间的差异无统计学意义（P〉0.05）;同时25例活动期患者其外周血中的IL-17、IL-18水平与该疾病的活动指数（SLEDAI）有一定的相关性（P〈0.05）。【结论】IL-17、IL-18在SLE的发病中可能发挥着重要的作用,且与该疾病的活动性有一定的相关性。     

IL-17在高危型HPV阳性宫颈癌中的表达

目的： 通过检测高危型人乳头瘤病毒（HPV）阳性宫颈癌患者体内IL-17的表达水平,探讨IL-17所介导的特异性免疫反应在高危型HPV感染的宫颈癌发生、发展中可能发挥的作用。 方法： 选取高危型HPV阳性的宫颈浸润性鳞癌患者（宫颈癌组）28例、宫颈高危型HPV感染者（HPV感染组）25例以及对照组30例。 采用ELISA法检测各组患者外周血清及宫颈局部组织匀浆上清液中IL-17 的表达水平。 结果： ①宫颈癌组患者外周血清中IL-17水平较对照组明显升高（ P＜0.05）,与HPV感染组比差异无统计学意义（均P＞0.05）,HPV感染组与对照组间差异无统计学意义（ P＞0.05）;②各组宫颈局部组织匀浆上清液中IL-17的表达水平均明显高于外周血清表达水平,差异均有统计学意义（均P＜0.05）;③宫颈局部组织匀浆上清液中IL-17表达水平各组间的差异均有统计学意义（均P＜0.05）,且宫颈癌组局部组织匀浆上清液中IL-17的表达水平高于HPV感染组,HPV感染组高于对照组,差异均有统计学意义（均P＜0.05）。 结论：IL-17所介导的免疫反应可能参与并促进了高危型HPV的持续性感染,与宫颈癌的发生、发展进程相关。     

系统性红斑狼疮患者维生素D与T淋巴细胞亚群及α干扰素的相关性

目的 探讨系统性红斑狼疮(SLE)患者维生素D水平与T淋巴细胞亚群及α干扰素(IFN-α)水平的相关性.方法 选取SLE 80例(SLE组)分为缓解期40例(缓解期组)、活动期40例(活动期组),健康体检者30例作为健康对照组.酶联免疫吸附试验(ELISA)检测外周血浆中25 (OH)D、IFN-α水平;流式细胞术(FCM)测定外周血中T淋巴细胞亚群水平.结果 (1)SLE组外周血25(OH)D水平低于健康对照组,差异有统计学意义(P＜0.05);活动期组外周血25(OH)D水平低于缓解期组,差异有统计学意义(P ＜0.05);(2) SLE组外周血T淋巴细胞、Th淋巴细胞及Th/Ts与健康对照组相比显著降低,差异有统计学意义(P＜0.05),其中活动期组患者低于缓解期组,差异有统计学意义(P ＜0.05);SLE组与健康对照组两组间Ts细胞计数相比差异无统计学意义(P ＞0.05);(3)SLE组外周血IFN-α水平高于健康对照组,差异有统计学意义(P＜0.05),活动期组高于缓解期组,差异有统计学意义(P＜0.05);(4)SLE组外周血25(OH)D、T细胞、Th细胞计数及Th/Ts及IFN-仅水平均与病情活动度具有相关性(P＜0.05);(5)SLE组外周血25(OH)D与T细胞、Th细胞计数、Th/Ts计数比值呈正相关,与IFN-α水平呈负相关(P＜0.05).结论 在SLE患者体内,维生素D水平与T淋巴细胞亚群及IFN-α水平具有显著的相关性,推测维生素D可能通过调控T淋巴细胞亚群动态平衡以及IFN-α水平引发机体的免疫异常.     

慢性乙型肝炎患者替比夫定治疗后血清IL-17的变化及意义

目的 比较慢性乙型肝炎（CHB）患者替比夫定（LdT）治疗前后血清白细胞介素-17（IL-17）水平的变化,探讨IAT对CHB患者血清中IL-17的影响.方法 收集105例CHB患者血清,以35例健康体检人群IL-17为基线评价指标,采用ELISA方法检测血清IL-17的水平,特异性荧光探针PCR法检测血清HBV-DNA水平;CHB组加用替比夫定抗病毒治疗24周,观察治疗前后血清中IL-17及HBV-DNA的变化.结果 （1）治疗前CHB患者较健康对照组血清中IL-17水平明显升高（P＜0.05）,轻、中、重度CHB患者治疗前血清IL-17水平组间比较,重度＞中度＞轻度,差异有统计学意义（P＜0.05）;（2）治疗后血清IL-17及HBV-DNA水平较治疗前下降（P＜0.05）,CHB轻、中、重度各组血清IL-17水平与该组治疗前水平相比均降低（P＜0.05）,治疗后轻、中、重度各组组间比较差异无统计学意义（P＞0.05）;（3）血清中HBV-DNA含量与IL-17水平呈正相关（r=0.722,P ＜0.05）.结论 替比夫定通过抑制HBV复制能够降低CHB患者血清IL-17水平,使肝细胞功能得到一定恢复.     

寻常型天疱疮血清白介素-1、白介素-10、肿瘤坏死因子-α的检测

目的：探讨白介素-1（IL-1）、白介素-IO（IL-10）、肿瘤坏死因子-ot（TNF—d）在寻常型天疱疮（PV）发病机制中的作用。方法：采用ELISA方法检测32例PV患者活动期和缓解期血清IL-1、IL-10、TNF-α水平。结果：PV患者活动期血清IL-1、TNF-α较对照组明显升高（P〈0．01），缓解期与对照组相比差异无统计学意义（P〉0.05）；活动期血清IL-10较对照组降低（P〈0．01），缓解期与对照组相比差异无统计学意义（P〉0．05）。结论：IL-1、IL-10及TNF-α在PV发病中起了重要的作用。     

非小细胞肺癌患者血清IL-17、VEGF水平与临床分期和预后的相关性研究

目的研究非小细胞肺癌（NSCLC）患者血清IL-17、血管内皮生长因子（VEGF）水平与临床分期和生存预后的相关性。方法采用酶联免疫吸附实验（ELISA法）检测103例NSCLC患者和50例正常对照者血清IL-17、VEGF水平。分析NSCLC患者血清IL-17和VEGF水平两者之间的关系,分析IL-17、VEGF水平与TNM分期和预后的关系,采用Cox比例风险回归模型进行多因素预后分析。结果NSCLC患者血清IL-17和VEGF水平较正常对照组显著增高（均P＜0.01）。Ⅰ~Ⅱ期与Ⅲ、Ⅳ期患者血清VEGF水平两两比较差异均有统计学意义（均P＜0.05）;血清IL-17水平Ⅰ~Ⅱ期与Ⅲ、Ⅳ期比较,差异均有统计学意义（均P＜0.01）,而Ⅲ、Ⅳ期之间比较差异无统计学意义（P＞0.05）。NSCLC患者血清IL-17与VEGF水平呈正相关（r2=0.745,P＜0.01）。血清IL-17、VEGF水平高的患者中位生存时间较短,差异有统计学意义（均P＜0.01）。多因素分析显示,血清IL-17、VEGF水平和TNM分期是独立的预后影响因素（均P＜0.05）。结论NSCLC患者血清IL-17、VEGF水平与NSCLC的TNM分期及生存预后密切相关,两者可作为NSCLC诊断和判断预后的检测指标。     

免疫指标对妊娠合并系统性红斑狼疮患者妊娠结局的指导意义研究

目的 探讨免疫指标对妊娠合并系统性红斑狼疮（SLE）患者妊娠结局的指导意义。方法 选取2003年1月-2015年12月到首都医科大学附属北京世纪坛医院就诊的妊娠合并SLE患者20例,均进行规律孕期监测和治疗。选取抗核抗体、血清补体水平及红细胞沉降率为免疫指标,比较不同免疫情况患者的妊娠结局和妊娠期并发症发生率。结果 20例患者中,抗核抗体阳性13例,血清补体水平下降5例,红细胞沉降率加快5例。抗核抗体阳性患者的早产例数高于抗核抗体阴性患者,平均孕周、平均新生儿体质量低于抗核抗体阴性患者,差异有统计学意义（P＜0.05）;而死胎例数与抗核抗体阴性患者比较,差异无统计学意义（P＞0.05）。血清补体水平下降患者的早产例数高于血清补体水平正常患者,平均孕周、平均新生儿体质量低于血清补体水平正常患者,差异有统计学意义（P＜0.05）;而死胎例数与血清补体水平正常患者比较,差异无统计学意义（P＞0.05）。红细胞沉降率加快患者的早产例数、死胎例数高于红细胞沉降率正常患者,平均孕周、平均新生儿体质量低于红细胞沉降率正常患者,差异有统计学意义（P＜0.05）。不同抗核抗体滴度、血清补体水平、红细胞沉降率患者的并发症发生率比较,差异无统计学意义（P＞0.05）。结论 妊娠合并SLE患者的不良妊娠结局发生风险较高,不同免疫情况患者间存在差异,推测抗核抗体阳性、血清补体水平下降、红细胞沉降率加快预示着不良妊娠结局的发生。     

女性系统性红斑狼疮患者CA125、CA199检测的意义

目的探讨女性系统性红斑狼疮（SLE）患者血清肿瘤指标CA125和CA199测定的临床意义。方法采用化学发光微粒子免疫分析法检测100例女性SLE患者血清中CA125和CA199含量,并统计各患者的临床资料和其他实验室检查结果。结果 SLE活动期组的CA125、CA199水平及阳性率均较缓解期组明显升高,比较差异有统计学意义（P〈0.05）;SLE伴浆膜腔积液组的CA125、CA199水平及阳性率均较无浆膜腔积液组明显升高,比较差异有统计学意义（P〈0.05）;伴单一胸水或单一腹水的SLE患者,其CA125、CA199水平及阳性率均较伴单一心包积液的患者明显升高,比较差异有统计学意义（P〈0.05）。结论血清CA125、CA199的表达水平和阳性率可反应不同程度的女性SLE患者的病情。     

糖皮质激素对药物性肝损害患者血清中IL-17A水平的影响

目的探讨糖皮质激素（GC）对药物性肝损害（DILI）患者血清中IL-17A水平的影响。方法选择90例DILI患者为对象，其中采取GC治疗（GC组）和非GC治疗（NG组）各45例；并与同期45例健康体检者进行对照。采用ELISA法检测与比较3组受检者血清中IL-17A表达水平。结果治疗前，与健康对照组比较，GC组、NG组IL-17A水平均明显较高（均P＜0.01）；而GC组与NG组比较差异无统计学意义（P＞0.05）。治疗1周后，GC组IL-17A水平明显降低（P＜0.01），NG组治疗前后比较差异无统计学意义（P＞0.05）；GC组明显高于NG组（P＜0.01）。GC组病情重症化率为11.11%，明显低于NG组的31.11%（P＜0.05）。结论IL-17A可能在DILI发生、发展中发挥着重要作用；GC治疗可降低DILI患者血清中IL-17A水平，从而阻止病情的进一步发展。     

系统性红斑狼疮患者外周血CD3+CD56+NKT水平与Th1/Th2细胞表达的相关性

目的 探讨系统性红斑狼疮（SLE）患者外周血CD3+CD56+NKT水平与相关机制的关系。方法 选取2019年8月～2020年12月重庆市九龙坡区中医院收治的112例SLE患者（SLE组）,按SLEDAI评分分为非活动期72例,活动期40例,另选取同期健康自愿者50例（健康组）。采集受试者血采用流式细胞技术测定CD3+CD56+NKT水平,采用酶联免疫法测定血清中相关细胞因子,分析各指标与病情的相关性。结果 SLE组外周血CD3+CD56+NKT细胞计数及占比均较健康组明显减小,差异有统计学意义（P＜0.05）;SLE活动期组外周血CD3+CD56+NKT细胞计数及占比、IFN-γ、IFN-γ/IL-4明显低于非活动期组,SLEDAI评分、24 h UPQ、IL-4明显高于非活动期组,差异有统计学意义（均P＜0.05）;Pearson相关分析结果显示,CD3+CD56+NKT细胞与SLE患者SLEDAI评分、24 hUPQ及IL-4呈负相关（r=-0.573、-0.682、-0.374,P＜0.05）,而与IFN-γ无显著相关性（r=0.016,P＞0.05）。结论 CD3+CD56+NKT细胞参与了SLE免疫调节过程,其表达水平与患者SLEDAI评分呈显著负相关,CD3+CD56+NKT细胞可能通过分泌Th1/Th2细胞相关因子发挥SLE免疫调节作用,值得临床借鉴。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.