孕妇乙型肝炎病毒感染与胎儿宫内感染的关系

目的探讨孕妇血清中乙型肝炎病毒血清学标志物(HBVM)和DNA(HBV DNA)与胎儿宫内乙型肝炎病毒感染的关系。方法应用电化学发光和荧光定量聚合酶链反应(FQ-PCR)对65例乙肝表面抗原(HBsAg)阳性孕妇的母血及产后婴儿外周血的乙型肝炎血清学标志物和DNA进行检测。结果65例HBsAg阳性孕妇血清中HBeAg和HBV DNA的检出率分别为32.2%、46.2%;所生婴儿外周血中HBsAg、HBeAg和HBV DNA的检出率分别为16.9%、23.1%、4.6%。HBeAg和HBV-DNA阳性孕妇所生婴儿外周血HBsAg检出率分别为38.1%和36.7%,显著高于HBeAg和HBV-DNA阴性者的4.5%和0(<0.01)。婴儿外周血中HBsAg阳性率随孕妇HBV DNA含量增加而增加。结论孕妇血清中HBeAg和HBV DNA阳性是胎儿宫内感染HBV的高危因素,胎儿宫内感染率随母血中HBV DNA含量增加而增加。     

胎儿宫内感染乙型肝炎病毒的实验研究

目的探讨胎儿宫内乙型肝炎病毒(HBV DNA)感染的实验诊断方法及其临床意义.方法应用酶联免疫吸附试验(ELISA)和荧光定量聚合酶链反应(FQ-PCR)对156例乙肝表面抗原(HBsAg)阳性孕妇的母血和产后婴儿脐血及婴儿外周血的乙型肝炎血清学标志物(HBV-M)和HBV DNA进行检测.结果156例HDsag阳性孕妇所生婴儿脐血和婴儿外周血HBsAg的检出率为8 3%(13/156)、6.4(10/156),HBeAg检出率分别为7.1%(11/156)、5.1%(8/156),母血、脐血、婴儿外周血HBV DNA阳性检出率分别为36.5%(57/156)、28.2%(44/156)、23.7%(37/156);57例HBV DNA阳性孕妇血病毒含量(拷贝数/ml的对数值)为7.34±2.28,37例阳性婴儿外周血HBV DNA含量为6.08±0.96;与婴儿外周血检测结果相比较,脐血中HBsag、HBeAg的阳性率不仅存在23.1%和37.5%的假阳性,HBV DNA也存在16.7%(7/42)的假阳性;在HBeAg或HBV DNA阳性孕妇中,婴儿外周血HBV DNA的检出率分别为73.8%(31/42)、64.9%(37/57),显著高于HBeAg或HBV DNA阴性者5.3%(6/114),(P＜0.01):婴儿外周血中HBV DNA阳性率随孕妇HBVDNA含量增加而显著增加(P＜0.005),其HBV DNA的含量与母血呈正相关,(r=0.39).结论婴儿脐血HBV检测是诊断胎儿宫内HBV感染的筛选指标,而婴儿外周血的检测才具有确诊意义;HBV DNA定量检测是胎儿宫内HBV感染和感染程度最为直接、敏感的诊断方法;孕妇HBeAg、HBV DNA阳性是胎儿宫内感染HBV的高危因素.     

乙型肝炎病毒前S1抗原(Pre-S1)应用价值的探讨

目的:分析HBsAg阳性血清乙型肝炎前S1蛋白(Pre-S1)与乙型肝炎病毒DNA(HBV-DNA)含量检测的关系.探讨Pre-S1的应用价值.方法:用荧光定量PCR技术检测225例HBsAg阳性血清HBV-DNA的含量,同时用酶联免疫吸附试验(ELISA)法检测Pre-S1蛋白.结果:在HBsAg、HBeAg、HBcAb同时阳性标本中Pre-S1Ag阳性率为89.3%、HBV-DNA阳性率为98.6%.在HBsAg、HBeAb、HBcAb同时阳性标本中Pre-S1Ag阳性率为34.6%、HBV-DNA阳性率为30.7%.在不同HBV血清模式(HBV-M)中Pre-S1Ag的出现与HBV-DNA的含量有正相关的关系.结论:Pre-S1Ag与HBeAg、HBV-DVA有较好的相关性,Pre-S1Ag与HBV-DNA一样可以作为HBV复制的指标,对乙肝五项检测有重要补充作用,尤其适合县市级以下基层医院开展.     

前S1抗原检测在乙型肝炎临床诊断中的应用价值

目的 探讨乙型肝炎病毒前S1抗原(Pre-S1Ag)与乙肝病毒五项(HBsAg﹑HBsAb﹑HBeAg﹑HBeAb﹑HBcAb)及HBV DNA相关性,探讨Pre-S1Ag检测的临床应用价值.方法 从2014年1月-2015年6月期间在徐州医学院第二附属医院感染科住院的乙型肝炎患者中筛出HBsAg阳性病例159例,采用ELISA法检测乙肝血清标志物和Pre-S1Ag,荧光定量PCR法检测标本HBV DNA.结果 血清中HBeAg﹑Pre-S1Ag和HBV DNA的阳性率分别为59.2%﹑81.7%和83.1%,Pre-S1Ag阳性率明显高于HBeAg阳性率,HBeAg抗原阳性组Pre-S1Ag的阳性率为97.8%.而HBeAg抗原阴性组Pre-S1Ag阳性率为58.5%,HBeAg阳性患者血清的Pre-S1Ag的阳性率明显高于HBeAg阴性患者,差异有统计学意义(P<0.05).Pre-S1Ag阳性率与HBV-DNA阳性率差异无统计学意义(P>0.05).结论 Pre-S1Ag与HBV DNA符合率较高,对无条件检测HBV DNA而HBeAg阴性的血清,Pre-S1Ag可作为HBV存在复制和传染性的重要检测指标.     

HBsAg阳性孕妇血清HBV-DNA含量与胎儿宫内感染

目的:通过对血液HBsAg阳性孕妇及其所生婴儿进行荧光定量PCR方法检测HBV-DNA含量,探讨母体血中HBV-DNA含量与胎儿宫内感染HBV的关系。方法:选择住院分娩的HBsAg阳性孕妇,使用荧光定量PCR方法检测孕妇及其新生儿脐血血清中HBV-DNA含量。结果:128例HBsAg阳性孕妇分娩的婴儿中有27例脐带血HBV-DNA阳性,即宫内感染率为21.09%(27/128)。HBsAg阳性孕妇中PCR检测HBV-DNA阳性的孕妇宫内感染率为28.13%(27/96)。孕妇血清HBV-DNA含量<103copy/ml无一例婴儿发生宫内感染;宫内感染主要发生在血清HBV-DNA含量≥105copy/ml的孕妇,发生率为50%(26/52);HBV-DNA含量≥108copy/ml的孕妇其新生儿感染乙肝的几率显著增高(84.62%)。结论:HBsAg阳性孕妇可发生HBV宫内感染,随着孕妇血清HBV-DNA含量的升高宫内感染率逐渐增高,阻断HBV的宫内感染,必须有效降低孕妇血中的HBV-DNA含量水平。     

乙型肝炎病毒前S1抗原（Pre-S1）应用价值的探讨

目的：分析HBsAg阳性血清乙型肝炎前S1蛋白(Pre-S1)与乙型肝炎病毒DNA(HBV-DNA)含量检测的关系。探讨Pre-S1的应用价值。方法：用荧光定量PCR技术检测225例HHsAg阳性血清HBV-DNA的含量，同时用酶联免疫吸附试验(ELISA)法检测Pre-S1蛋白。结果：在HBsAg、HBeAg、HBcAb同时阳性标本中Pre-S1Ag阳性率为89．3％、HBV-DNA阳性率为98．6％。在HBsAg、HBeAb、HBcAb同时阳性标本中Pre-S1Ag阳性率为34.6％、HBV-DNA阳性率为30．7%。在不同HBV血清模式(HBV-M)中Pre-S1Ag的出现与HBV-DNA的含量有正相关的关系。结论：Pre-S1Ag与HBeAg、HBV-DVA有较好的相关性,Pre-S1Ag与HHV-DNA一样可以作为HBV复制的指标．对乙肝五项检测有重要补充作用，尤其适合县市级以下基层医院开展。     

HBV感染者血清前S1抗原与病毒载量和肝功能相关性分析

目的：探讨乙型肝炎病毒（HBV）感染者血清前S1抗原（Pre-S1Ag）与HBV-DNA及肝功能的相关性。方法：选择HBV感染者933例和健康体检者200例,进行血清Pre-S1Ag、HBV-DNA和肝功能检测。结果：HBV感染者933例中Pre-S1Ag阳性率为68.49％,其中HBsAg（＋）HBeAg（＋）HBcAb（＋）模式阳性率最高,为80.04％,与其他HBV阳性模式比较,差异均有统计学意义（P<0.05）。Pre-S1Ag阳性组的HBV-DNA阳性率为79.97％,高于Pre-S1Ag阴性组的41.84％,差异有统计学意义（P<0.01）。Pre-S1Ag阳性检出率与HBV-DNA阳性检出率相关系数0.98（P<0.001）,Pre-S1Ag与HBeAg相关系数0.92（P<0.01）。Pre-S1Ag阳性患者ALT和AST升高率分别为90.92%和93.27%,高于Pre-S1Ag阴性患者的29.26%和34.70%,差异均具有统计学意义（P<0.05）。结论：Pre-S1Ag与HBeAg及HBV-DNA高度相关,是反映乙肝病毒感染与复制的可靠指标,并与肝功能损害有关,可为临床治疗提供依据。     

HBV前S1抗原、HBV-DNA和谷丙转氨酶联合检测评价HBV感染的临床价值

目的探讨HBV前S1抗原(Pre-S1Ag)、HBV-DNA和谷丙转氨酶(ALT)联合检测评价HBV感染的临床价值。方法Pre-S1Ag、HBsAg采用ELISA法;HBV-DNA采用实时荧光定量PCR法;ALT采用IFCC速率法。结果HBsAg阳性组的Pre-S1Ag、HBV-DNA和ALT检出率显著高于HBsAg阴性组(P<0.005)。在双阳性组和单阳性组间Pre-S1Ag、HBV-DNA和ALT差异均无显著性(P<0.05)。HBV-DNA与Pre-S1Ag具有良好的相关性(P<0.01)。HBV感染者的Pre-S1Ag和HBV-DNA表达与肝功能的损伤相关:Pre-S1Ag、HBV-DNA阳性组与阴性组间的ALT异常检出率差异具高度显著性(P<0.005)。结论Pre-S1Ag、HBV-DNA和ALT联合检测有助于判断HBV复制情况和预测肝功能受损程度。     

乙型肝炎患者血清病毒前S1抗原的检测及其临床应用

目的 探讨乙型肝炎病毒前S1抗原(Pre-S1Ag)与乙型肝炎病毒DNA(HBV DNA)、e抗原(HBeAg)、抗HBe(anti-HBe)的相关性及临床价值.方法 对848例乙肝患者血清用酶联免疫吸附法(ELISA)检测乙肝病毒血清标志物(HBV-M)、Pre-S1Ag,用荧光定量PCR测定HBV DNA、用速率法检测丙氨酸氨基转移酶(ALT).同时对乙肝HBV-M全阴性的305例健康人检测血清Pre-S1Ag.结果 848例乙肝患者中HBeAg阳性率为76.2%,Pre-S1Ag总阳性率为62.5%.其中,646例HBeAg阳性患者组中检出Pre-S1Ag阳性率62.2%;202例HBeAg阴性患者中检出 Pre-S1Ag阳性率63.4%,两组的Pre-S1Ag阳性率无明显差异(P＞0.05).Pre-S1Ag阳性患者比Pre-S1Ag阴性患者的ALT异常率显著增高(P＜0.01).结论 无论HBeAg阴性还是阳性,Pre-S1Ag同HBV的复制指标HBV DNA都有较好的一致性,是判断乙型病毒活动性的指标,是无条件开展HBV DNA检测时的最佳选择.     

不同乙型肝炎的前S1抗原与DNA结果分析及其诊断意义

目的通过对HBV-M乙肝血清标志物、乙肝病毒前S1抗原(Pre-S1-Ag)、HBV-DNA之间的对比分析,探讨乙肝病毒前S1抗原检测的临床意义。方法对957例患者血清用酶联免疫法(ELISA)检测HBVPre-S1-Ag和HBV血清标志物,用荧光定量PCR(FQ-PCR)检测HBV-DNA含量。结果 957例乙肝患者中HBV-DNA总检出率为46.8%,HBeAg阳性率为35.6%,Pre-S1-Ag阳性率为79.3%;在HBsAg、HBeAg和HBcAb同时阳性者中,HBV-DNA和Pre-S1-Ag的阳性检出率分别为88.4%和92.1%,差异无统计学意义;616例HBeAg阴性患者中,HBV-DNA和Pre-S1-Ag的阳性率为23.5%和72.2%,两者差异有统计学意义;在HBV-DNA448例阳性标本中,Pre-S1-Ag阳性397例,占88.6%。结论 HBeAg、HBV-DNA和Pre-S1-Ag有较高的符合率,Pre-S1-Ag可作为HBV复制的指标。     

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.