女性HIV感染患者性满意度的临床调查研究

目的研究HIV感染的女性患者的性满意度及性功能障碍情况,观察性激素变化程度与性满意度的关系,以及影响性满意度的其他因素.方法对患者进行有关性满意度及性功能障碍的问卷调查,同时采用放射免疫法测定研究对象的性激素,分析其与性满意度的相关性.结果在问卷调查中,性满意度为（4.5±1.0）,明显低于常模平均水平;性功能障碍发生率92%,以轻度障碍为主;且性满意度与激素T值无相关.结论（1）HIV感染女性患者性满意度较低,存在较高的性功能障碍;（2）性满意度的高低与性激素水平无相关关系.     

193例HIV/AIDS合并视网膜炎的临床特征分析

目的 分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者视网膜炎发生的临床特征及治疗后反应.方法 收集2015-2017年在重庆市公共卫生医疗救治中心住院的193例HIV/AIDS合并视网膜炎的患者,男性156例,女性37例,年龄(43.9±11.9)岁;分为巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMV R)组和HIV微血管病(HIV microangiopathy,HIV M)组,对其临床资料、检测指标、眼科检查结果及抗病毒治疗效果进行回顾性分析.结果 HIV/AIDS合并有视网膜炎的患者,CD4+T细胞计数明显低于非视网膜患者,而HIV RNA显著高于非视网膜患者(t=5.6、-2.3,P＜0.05).HIV M和CMV R无眼科症状的患者分别占44.4％、41.7％;CMV R以双眼病变为主,占77.4％;视网膜炎的总发生率为45.7％,并随着CD4+T细胞的降低逐渐增高,CD4+T细胞＜200个/μL时视网膜炎的发生率为30％,CD4+T细胞＜ 50个/μL时视网膜炎发生率最高,达58.6％.人巨细胞病毒DNA(human cytomegalovirus DNA,HCMV DNA)阳性的视网膜炎患者给予抗巨细胞病毒治疗后HCMV DNA转阴率在70％以上;CMV R视力恢复及病灶吸收率明显高于HIV M患者(x2=9.526、24.206,P＜0.05).结论 HIV/AIDS患者发生视网膜炎的风险与CD4+T细胞水平密切相关,呈负相关性;对于CD4+T细胞＜200个/μL的患者推荐行眼科相关检查,对于CD4+T细胞＜50个/μL的患者建议常规开展眼科相关检查;全身抗巨细胞病毒治疗可有效控制病毒,改善眼部症状,提高生活质量.     

单独感染HCV与HCV/HIV共感染患者外周血T淋巴细胞分化分析

目的 探讨单独感染HCV与HCV/HIV共感染患者外周血T淋巴细胞分化情况.方法 采集单独感染HCV患者(12例)、HCV/HIV共感染患者(27例)以及正常人群(13例)的外周静脉血,检测ALT、AST等生化指标;提取外周血单个核细胞(PBMC),通过流式细胞检测技术检测CD4+T和CD8+T细胞比例.结果 HCV/HIV共感染患者ALT水平[(53.08±9.78) U/L]显著高于单独感染HCV患者[(26.22±4.25)U/L],差异有统计学意义(P=0.0064).处于中期分化状态的CD4+T细胞,在正常人群中所占比例为(35.13±3.24)％,显著高于单独感染HCV患者[(9.01±3.70)％]和HCV/HIV共感染患者[(8.10±2.14)％],差异有统计学意义(P＜ 0.001).正常人群、单独感染HCV患者与HCV/HIV共感染患者晚期分化的CD4+T细胞所占比例分别为(2.52±2.54)％、(14.30±9.85)％及(15.23±11.58)％,正常人群晚期分化的CD4+T细胞比例显著高于单感染HCV与HCV/HIV共感染患者的比例,差异有统计学意义(P＜0.05),单独感染HCV与HCV/HIV共感染患者之间无差异.正常人群处于早期分化和中期分化的CD8+T细胞的比例分别为(42.73±2.08)％、(36.17±2.85)％,均显著高于单独感染HCV患者同期水平[(28.27±4.36)％、(13.15±4.23)％]及HCV/HIV共感染患者[(18.02±2.01)％、(16.60±3.06)％],差异均有统计学意义(P＜0.05);单独感染HCV患者的早期分化CD8+T细胞比例也显著高于HCV/HIV共感染患者,差异有统计学意义(P＜0.05).而处于晚期分化的CD8+T细胞,正常人群所占比例为(12.02±1.54)％,显著低于单独感染HCV患者[(49.30±3.85)％]及HCV/HIV共感染患者[(54.23±2.58)％],差异有统计学意义(P＜0.05).结论 单独感染HCV及HCV/HIV共感染影响T淋巴细胞的分化状态;HCV/HIV共感染影响处于早期分化的CD8+T细胞比例.     

HIV感染者和AIDS患者外周血T淋巴细胞亚群的变化

目的　通过对艾滋病患者和HIV感染者外周血T淋巴细胞亚群的表达和绝对计数检测 ,研究细胞免疫情况。方法　利用白细胞分类计算和流式细胞分析法对 15例HIV感染者和 2 6例AIDS患者外周血淋巴细胞中CD3 + ,CD4+ ,CD8+ 的表达及绝对数进行检测。结果　AIDS患者组CD3 + 淋巴细胞数较正常值显著下降 (P <0 0 5 ) ;HIV感染组与艾滋病患者组的CD4+ T淋巴细胞数较正常组显著下降 (P <0 0 1) ;CD8+ T淋巴细胞数显著增高 (P <0 0 1) ;CD4+ /CD8+ 的比值显著倒置。结论　人类感染HIV后 ,外周血T淋巴细胞亚群发生显著变化 ,CD4+ 细胞绝对数和CD4+ /CD8+ 比值对于HIV感染的临床进展可以起到指示作用。     

HIV感染患者外周血自然杀伤细胞的表达及其意义

目的 探讨自然杀伤(NK)细胞对人获得性免疫缺陷病毒(HIV)感染分期的判断价值.方法 选择2017年1月至2019年12月南通市第三人民医院首次就诊的HIV感染患者1188例(艾滋病期584例、无症状期604例)作为HIV感染组,另外选取2019年10-12月体检健康者55例作为健康对照组,采用实时荧光PCR检测受试者外周血HIV RNA,采用流式细胞技术检测外周血CD4+T淋巴细胞计数、CD8+T淋巴细胞计数、NK细胞计数并进行比较分析.绘制受试者工作特征(ROC)曲线,分析NK细胞计数判断HIV感染分期的价值.结果 HIV感染组患者外周血CD4+T淋巴细胞、CD8+T淋巴细胞、NK细胞计数与健康对照组比较,差异有统计学意义(P<0.005);艾滋病期HIV感染患者CD4+T淋巴细胞、CD8+T淋巴细胞、NK细胞计数及HIV RNA表达水平均明显低于无症状期患者(P<0.001);NK细胞计数与CD4+T淋巴细胞计数、CD8+T淋巴细胞计数呈正相关(rs=0.381、0.354,均P<0.001),与HIV RNA呈负相关(rs=-0.064,P=0.028);NK细胞计数判断HIV感染分期的ROC曲线下面积为0.694[95％CI(0.664,0.724),P<0.001],截断值为147个/微升,灵敏度为74.7％,特异度为57.8％.多因素分析发现,N K细胞计数判断H IV感染后进入艾滋病期的Exp(B)值为1.003[95％CI(1.002,1.004),P<0.001].结论 HIV感染患者NK细胞计数降低,且随疾病进展进一步下降,可作为HIV感染分期的判断指标之一.     

41例HIV携带者及艾滋病患者外周血中Naive/Memory T细胞亚群的变化

目的 :通过对艾滋病患者以及HIV感染者的外周血T细胞亚群进行分析 ,研究HIV病毒感染后 ,Naive/MemoryT细胞亚群的变化和细胞的免疫情况。方法 :利用白细胞分类计算和流式细胞分析法对 15例HIV感染者和 2 6例AIDS患者外周血淋巴细胞中CD4 5RO ,CD4 5RA ,CD8和CD38的表达及各型T细胞绝对数进行检测。结果 :AIDS患者组与正常对照组相比 ,CD8+ CD38+ 、CD4 5RO+ 细胞数显著性增加 (P <0 .0 1) ,CD4 5RA+ 和CD6 2L+ 细胞数明显下降 (P <0 .0 1)。HIV感染组与对照组相比 ,CD8+ CD38+ 和CD4 5RO+ 细胞数显著性增加 (P <0 .0 1) ,CD4 5RA+ 细胞数明显下降 (P <0 .0 1)。AIDS患者组与HIV感染组相比 ,CD6 2L+细胞数明显下降 (P <0 .0 1)。结论 :人类感染HIV病毒后 ,外周血T淋巴细胞亚群发生显著变化 ,幼稚型T细胞数目减少 ,成熟型T细胞的数目增加 ,有助于对HIV病毒破坏人体免疫系统机制的研究。     

河南输血感染HIV患者外周血T淋巴细胞亚群的变化

目的了解河南输血感染的艾滋病患者和HIV携带者外周血T淋巴细胞亚群的表达。方法利用白细胞分类和流式细胞分析法对20例HIV携带者和20例AIDS患者外周血淋巴细胞中CD3+,CD4+,CD8+的表达及绝对数进行检测。结果 AIDS患者组CD3+淋巴细胞数较正常值显著下降（P<0.05）;HIV感染组与艾滋病组的CD4+ T淋巴细胞数显著下降（P<0.01）;CD8+淋巴细胞数显著增高（P<0.01）;CD4+/CD8+比值显著倒置。结论感染HIV后外周血CD4+ T淋巴细胞显著下降,随病情进展下降更显著。     

男男性接触者HIV早期感染CD4+T细胞亚群的动态分析

目的 分析北京市男男性接触(men who have sex with men,MSM)人群人类免疫缺陷病毒(human immunodeficiency virus,HIV)早期感染者CD4+T细胞及其亚群的动态变化规律.方法 选择HIV阴性对照组12例和HIV急性期感染者18例,均来自于北京佑安医院所建的MSM队列和HIV急性期感染者队列.取HIV急性期感染者随访第4,12,24和48周外周血,监测CD4+T细胞的变化.流式细胞术检测CD4+T细胞表面CCR7和CD45RA分子的表达.结果 与HⅣ阴性对照组相比,HIV急性期感染者CD4+T细胞的数量、效应记忆CD4+T细胞(effector memoryT cell,Tem)的比例和绝对数均显著减少,两组间比较差异有统计学意义(P＜0.05).CD4+ Tem绝对数的变化与CD4+T细胞绝对数呈显著正相关(r=0.5768,P=0.0001),而与血浆病毒载量呈负相关(r=-0.2962,P=0.0296).结论 效应记忆性CD4+T细胞数量的下降也可作为HIV早期感染者疾病进展的早期预测指标.     

HIV感染者调节性T细胞消耗可导致HIV特异CD8~+细胞凋亡

目的了解在HIV感染患者CD4+CD25+FoxP3+调节性T细胞(Treg)的降低是否能够引起HIV特异CD8+细胞过度凋亡。方法本研究对75例没有治疗的HIV患者进行研究,检测其外周血中Treg细胞计数及CD8+细胞的活化及凋亡情况并分析其相关性;同时纯化Treg细胞及CD8+细胞,在体外进行共培养,用五聚体检测HIV特异CD8+细胞的活化情况。结果在HIV感染患者,Treg细胞与CD8+细胞的活化及凋亡呈负相关,Treg细胞能够抑制HIV特异的CD8+细胞的凋亡。结论 HIV感染患者Treg细胞的降低可导致CD8+细胞、尤其HIV特异CD8+细胞的凋亡增加。     

人类免疫缺陷病毒感染与T淋巴细胞损伤

人类免疫缺陷病毒(HIV)是具有包膜的正链RNA病毒,以人体免疫系统中最重要的CD4+T淋巴细胞为感染和攻击目标,通过损伤细胞膜、干扰细胞自身蛋白合成直接杀伤CD4+T细胞,诱导感染细胞生成某些细胞因子间接杀伤CD4+T细胞,gp120与CD4分子交联,诱导CD4+T细胞凋亡。在HIV感染及多种细胞因子作用下,T淋巴细胞分化为细胞毒性T细胞,特异性识别和清除病毒感染的细胞;分化为调节性T细胞,发挥免疫抑制功能,防止免疫过激;分化为记忆性T细胞,介导再次免疫应答。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.