套式及免疫套式聚合酶链反应检测乙型肝炎表面抗原阴性肝病患者血清中乙型肝炎病毒DNA

为了更准确、简便而又快速地了解乙型肝炎表面抗原（ＨＢｓＡｇ）阴性肝病患者的病因，建立了套式和免疫套式聚合酶链反应（ＰＣＲ）检测血清中乙型肝炎病毒（ＨＢＶ）ＤＮＡ的技术，结合丙型肝炎病毒（ＨＣＶ）感染指标的检测，对ＨＢｓＡｇ阴性肝病患者的病因进行了研究。发现套式ＰＣＲ能将单次ＰＣＲ的敏感性稳定地提高１０００倍；免疫套式ＰＣＲ可检测到０．１～０．０１ｐｇ／Ｌ水平。检测ＨＢｓＡｇ阴性肝硬化２２例（Ａ组）、ＨＢｓＡｇ阴性慢性肝炎１３例（Ｂ组）、ＨＢｓＡｇ阴性和乙型肝炎病毒核心抗体（抗－ＨＢｃ）阳性正常对照组３０例（Ｃ组）及ＨＢｓＡｇ（＋）／ＨＢｅＡｇ（－）肝硬化患者１２例（Ｄ组），分别有４５．５％、３０．８％、１３．３％和１００％患者血清中ＨＢＶＤＮＡ阳性。ＨＢＶＤＮＡ在一些抗－ＨＢｓ（＋）肝病患者和所谓健康人的血清中也存在。Ａ、Ｂ两组检出有ＨＢＶ和（或）ＨＣＶ感染患者分别占８１．８％和５３．８％。提示套式和免疫套式ＰＣＲ是简便、快速而又高度敏感的检测方法；ＨＢＶ感染可能是引起ＨＢｓＡｇ阴性慢性肝病的重要原因，且ＨＢｓＡｇ阴性肝病病因大多与病毒感染有关；应该重新认识自然感染者血清中抗－ＨＢｓ的临床意义。     

HGV-RNA阳性与阴性慢性乙型肝炎患者的对比研究

目的 研究慢性乙型肝炎（ＣＨＢ）患者庚型肝炎病毒（ＨＧＶ）感染的意义。方法 ＲＴ＿ＰＣＲ法对１４６例ＣＨＢ患者血清进行了ＨＧＶ－ＲＮＡ检测,并将ＨＧＶ－ＲＮＡ阳性与阴性患者进行临床与病理学对比。结果 ＨＧＶ－ＲＮＡ阳性２３例（１５．７５％）。ＨＧＶ－ＲＮＡ阳性与阴性２肝功能等生化指标水平,肝脏病理损害程度、ＨＢＶ－ＤＮＡ阳性率均无显著性差异。５例ＨＧＶ－ＲＮＡ阳性、１６例ＨＧＶ－ＲＮＡ阴性ＣＨＢ患     

血清HBeAg阴性与HBeAg/IC及A1896变异的关系

目的探讨血清ＨＢｅＡｇ阴性（双抗体夹心法）与ＨＢｅＡｇ／ＩＣ形成及ＨＢＶ变异株Ａ１８９６的关系，评价ＨＢｅＡｇ／ＩＣ检测的临床意义．方法单克隆抗ＨＢｅ固相ＥＬＩＳＡ检测血清中ＨＢｅＡｇ／ＩＣ；套式多聚酶链反应检测ＨＢＶＤＮＡ；３＇碱基特异多聚酶链反应判断Ａ１８９６变异；ＥＬＩＳＡ检测ＨＢｅＡｇ、抗ＨＢｅ，研究对象为１１７例慢性ＨＢＶ感染者，２０例健康对照统计处理采用卡方检验．结果ＨＢｅＡｇ／ＩＣ阳性血清中ＨＢＶＤＮＡ检出率明显高于ＨＢｅＡｇ／ＩＣ阴性血清，Ｐ＜０００１（９１３％ｖｓ３６２％）；２９份ＨＢｅＡｇ阴性、ＨＢＶＤＮＡ阳性血清中仅５例（１７２％）检出Ａ１８９６，而且其中２例与野毒株（Ｇ１８９６）混合感染并伴ＨＢｅＡｇ／ＩＣ阳性．２９份中１７份（５８７％）为ＨＢｅＡｇ／ＩＣ阳性的Ｇ１８９６感染；血清抗ＨＢｅ阳性组Ａ１８９６检出率高于抗ＨＢｅ阴性组，Ｐ＜００５（２５％ｖｓ３２％）．结论ＨＢｅＡｇ／ＩＣ为ＨＢＶ活跃复制指标；临床ＨＢｅＡｇ阴性、ＨＢＶＤＮＡ阳性患者仍多数为Ｇ１８９６感染，ＨＢｅＡｇ／ＩＣ形致双抗体夹心法不能检出ＨＢｅＡｇ；抗ＨＢｅ应答可能为促使前Ｃ变异的重要因素     

多重聚合酶链反应检测乙型肝炎和丙型肝炎病毒

在同一反应体系中同时快速检测乙型肝炎病毒（ＨＢＶ）和丙型肝炎病毒（ＨＣＶ），探讨多重聚合酶链反应（ＰＣＲ）在临床中的应用价值。方法自行设计了ＨＢＶ和ＨＣＶ各一对引物，应用多重ＰＣＲ对临床标本进行检测。结果５例ＨＢｓＡｇ和ＨＣＶ抗体均阳性者，其ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阳性；２０例单ＨＢｓＡｇ阳性标本，１１例单ＨＢＶＤＮＡ阳性，５例ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阳性；２０份单ＨＣＶ抗体阳性者，ＨＣＶＲＮＡ均阳性，３例合并ＨＢＶＤＮＡ阳性；１０例慢性非甲非乙型肝炎（ＮＡＮＢ）抗ＨＣＶ阴性肝炎标本８份ＨＣＶＲＮＡ阳性，１例ＨＢＶＤＮＡ和ＨＣＶＲＮＡ阳性。结论多重ＰＣＲ一次反应即可完成多次常规ＰＣＲ检测，是一种值得临床应用的方法。     

肝细胞癌患者乙、丙和丁型肝炎病毒感染状况

为探讨乙型、丙型和丁型肝炎病毒（ＨＢＶ，ＨＣＶ和ＨＤＶ）感染对肝细胞癌（肝癌）发生的意义，本文作者采用ＥＬＩＳＡ和聚合酶链反应法对７２例广东籍肝癌患者ＨＢＶ、ＨＣＶ和ＨＤＶ血清标志以及血浆ＨＢＶＤＮＡ和ＨＣＶＲＮＡ进行了检测。ＨＢｓＡｇ和抗－ＨＣＶ阳性率分别为８４．７％和１８．１％，显著高于１２８名健康对照者。ＨＢｓＡｇ和／或ＨＢＶＤＮＡ总阳性率为９３．１％，抗－ＨＣＶ和／或ＨＣＶＲＮＡ阳性率为２７．８％，ＨＢＶ和ＨＣＶ重叠感染率为２２．２％。其中６１例ＨＢｓＡｇ阳性肝癌的ＨＤＶ血清标志检出率为１４．８％，明显高于６１例ＨＢｓＡｇ阳性的肝炎对照者。结果表明，广州地区肝癌的发生，主要与ＨＢＶ和ＨＣＶ感染密切相关外，且可能与ＨＤＶ感染有关。     

多重和套式聚合酶链反应检测血液,腹膜透析患者血清中HBV D…

利用免疫学和聚合反应（ＰＣＲ）方法，对３５例血液透析（血透），１４例腹膜透析（腹透）患者的８４份血清进行了检测。血透组抗－ＨＣＶ阳性率８２．９％，ＨＣＶ ＲＮＡ ＰＣＲ阳性率５１．４％；腹透组抗－ＨＣＶ阳性率仅７．１％，ＨＣＶ ＲＮＡ ＰＣＲ均阴性。ＨＢｓＡｇ和（或）ＨＢｅＡｇ在二组的阳性率分别为２５．７％和２１．４％；ＨＢＶＤＮＡＰＣＲ阳性率分别为４５．７％和６４．２％。透析患者ＨＣＶ和ＨＢＶ感     

小儿乙型肝炎血清,病理及免疫病理分析

本文通过检测１５例小儿病毒性肝炎患者血清ＨＡＶ、ＨＢＶ、ＨＣＶ标志及肝组织内ＨＢｓＡｇ、ＨＢｃＡｇ发现ＨＡＶ和ＨＣＶ标志全部阴性，ＨＢＶ标志全部阳性。１５例ＨＢＶ感染中，血清ＨＢＶＤＮＡ阳性１１例。其中ＨＢｓＡｇ（＋）、ＨＢｅＡｇ（＋）９例，ＨＢｓＡｇ（＋）、ＨＢｅＡｂ（＋）２例。综合血清其它的感染指标与肝脏病理及免疫病理的变化对１１例血清ＨＢＶＤＮＡ阳性病例作了重要分析。进一步证实ＨＢｅＡｇ为临     

拉米夫定治疗HBeAg阴性的慢性HBV感染近期临床观察

观察和评价拉米夫定治疗ＨＢｅＡｇ阴性慢性ＨＢＶ感染的近期疗效。ＨＢｅＡｇ阴性／ＨＢＶ ＤＮＡ阳性的慢性ＨＢｖ感染者２６例（包括１１例乙肝肝硬化），ＨＢｅＡｇ阳性／ＨＢＶ　ＤＮＡ阳性的慢性ＨＢＶ感染者３０例（包括１０例乙肝肝硬化），均以拉米夫定治疗６个月后进行疗效评价，并继续观察５－１６个月。两组的ＡＬＴ／ＡＳＴ复常率分别为８４．７％／８８．５％和８６．７％／８６．７％（Ｐ＞０．０５），肝硬化患者Ｃｈｉｌｄ－Ｐｕｇｈ积分均明显下降，ＨＢＶ　ＤＮＡ全部阴转。ＨＢｅＡｇ阳性组３例发生ＹＭＤＤ变异，ＨＢｅＡｇ阴性组无１例变异。拉米夫定对于ＨＢｅＡｇ阴性／ＨＢＶ　ＤＮＡ阳性者，同样是十分安全有效的抗病毒治疗药物。ＨＢｅＡｇ阴性者的耐药发生率可能低于ＨＢｅＡｇ阳性者。     

HBV感染者血清HBeAg/IC和HBV DNA间的关系

资料与方法：ＨＢＶ感染者１１７例,正常对照２０例,研究对象排除其它肝炎病毒感染,半年内未经抗病毒及免疫治疗。采用ＥＬＩＳＡ及Ｎａｓｔｅｄ－ＰＣＲ方法分别检测ＨＢＶ感染者血清中ＨＢｅＡｇ／免疫复合物（ＩＣ）和ＨＢＶ ＤＮＡ。 结果：１１７例ＨＢＶ感染者血清中共检出ＨＢｅＡｇ／ＩＣ阳性２３例,ＨＢＶＤＮＡ阳性 ５５例, ＨＢｅＡｇ／ＩＣ阳性者中 ＨＢＶＤＮＡ阳性率为９１．３％（２１／２３例）,而ＨＢｅＡｇ／ＩＣ阴性的９４例中ＨＢＶ ＤＮＡ阳性３４例,阳性率为３６．２％,两组差异有非常显著性,ｘ２＝８．１５…     

聚合酶链反应评价原位杂交检测慢性HBV感染者肝内HBVDNA的结果

用地高辛素探针原位杂交检测慢性ＨＢＶ感染者肝内ＨＢＶＤＮＡ，聚合酶链反应（ＰＣＲ）检测血清ＨＢＶＤＮＡ评价病毒复制状态。发现肝内ＨＢＶＤＮＡ阳性肝细胞，在１４例肝组织病变不活动的ＨＢｅＡｇ阳性慢性无症状ＨＢＶ携带者（ＡｓＣ）呈弥漫性分布；而在ＨＢｅＡｇ阳性或阴性活动性肝病病人均聚合分布于肝细胞坏死区。上述慢性感染者９８％血清ＨＢＶＤＮＡ阳性。说明ＨＢＶ复制与肝组织病变有关但非肝损伤直接原因。１６例ＨＢｅＡｇ阴性ＡｓＣ中，９例肝内仅见局灶性ＨＢＶＤＮＡ阳性肝细胞，其中４例血清ＨＢＶＤＮＡ阳性，说明部分ＨＢｅＡｇ阴性ＡｓＣ也存在极低水平病毒复制。     

Serial left ventricular ejection fraction in acute myocardial infarction by cross-sectional echocardiography: correlation of changing ejection fraction with clinical course

Left ventricular volume and ejection fraction were measuredin 22 survivors of acute myocardial infarction by means of two-dimensionalechocardiography and using a Simpson's rule algorithm. Ten ofthe 22 patients experienced complications. For the group as a whole, there were no significant trends inleft ventricular volume and ejection fraction between the firstand third days and the third month after infarction. In thesubgroups with uncomplicated and complicated infarction, therewere trends towards increasing and decreasing ejection fractions,respectively, which Jailed to attain statistical significance,however. The difference in ejection fraction between both subgroupshad become significant at 3 months; 55.2+11.1% in uncomplicatedv. 41.3±6.9% in complicated cases (P>0.0l). Individualchanges in ejection fraction falling outside the limits of reproducibilityof the method as assessed previously were observed between day1 and day 3 in only 2 patients with uncomplicated and in 2 patientswith complicated infarction. Between day 1 and 3 months suchchanges occurred in 8 patients with uncomplicated infarction(upward in 5 and downward in 3), and in 8 patients with complicatedinfarcts (upward in 3 and downward in 5) We conclude that changes in ejection fraction as measured bytwo-dimensional echocardiography lend to correlate with complications.     

心肌梗死恢复期经皮冠状动脉腔内成形术前后心电图及运动耐量的变化

对２３例心肌梗死患者子发病后６±３周行经皮冠状动脉腔内成形术（ＰＴＣＡ），并于ＰＴＣＡ前（平均３±２天）后（平均６±３天）记心电图和做平板运动试验，结果ＰＴＣＡ成功１９例（管腔狭窄由９３．５±６．４％降至１６．３±１１．１％），其运动耐量、时间、最大心率及心率－收缩压乘积均明显增高，而心电图ＱＲＳ积分显著减低。结论，心肌梗死恢复期ＰＴＣＡ对患者有明显的临床效益。     

进展期胃癌新辅助化疗后超声内镜下TN分期准确率及化疗前后TN期变化与术后病理反应程度相关性的研究

目的评估超声内镜判断进展期胃癌患者新辅助化疗后TN,分期的准确率并探讨化疗前后TN分期变化与胃癌根治术后病理反应程度的相关性。方法2007年6月至2009年12月间22例进展期胃癌患者在签署知情同意书后首先接受了新辅助化疗,其中男15例i女7例,年龄36—80岁,平均64岁。采取Folfox6化疗方案治疗3个疗程,治疗结束后3～4周全部接受胃癌根治术（R0切除）治疗,化疗前1—2周和手术前1～2周分别对患者行内镜超声检查术（EUS）,并进行超声内镜下TN分期判断,以手术病理TN分期为金标准,统计胃癌新辅助化疗后超声内镜下TN分期的准确率,同时对化疗前后超声内镜下TN分期变化与手术后病理反应程度（根据瘤床内出现退变或坏死影响的肿瘤细胞的比例分级,分别计作0、1a和lb、2、3,从0到3表示反应程度逐渐变好）行相关性分析。结果胃癌新辅助化疗后超声内镜下T分期的总体准确率为63．6％（14／22）,无一例诊断不足,但存在8例（36．4％,8／22）过度诊断;N分期的总体准确率为54．5％（12／22）,有4例（18．2％,4／22）过度诊断和6例（27．3％,6／22）诊断不足。新辅助化疗后有10例超声内镜下TN分期发生降期（以T期＋N期降期例数进行统计,同时发生T期和N期降期时只计作1例）,包括9例T期（4例T3期降为T2期,5例T4期降为r乃期）和4例N期（4例N1期降为N0期）降期,发生TN期降期的患者手术后病理反应程度大多较好,其中7例降期患者术后病理反应程度为2,l例降期患者术后病理反应程度为3。结论进展期胃癌新辅助化疗后超声内镜下TN分期的准确率并不高,但化疗后出现超声内镜下TN分期降期的患者手术后病理反应程度大多较好。     

Changes in Antibodies to Specific Hepatitis C Virus Antigens with Interferon-α Therapy: Analysis by Recombinant Immunoblot Assay

Antibodies to hepatitis C virus NS3 (C33C), NS4 (5–1-1 and C100–3), and core (C22–3) proteins were tested for by a second-generation recombinant immunoblot assay of serum samples from 42 chronic hepatitis C patients treated with interferon-a. Antibodies to 5–1–1 and C100–3 were found in 83% (35/42) before therapy, and those to C22–3 and C33C in all patients. At 6 months after therapy withdrawal in patients with sustained virus clearance, only antibodies to 5–1–1 and C100–3 showed significant decreases ( p < 0.05) (5/5 and 7/7, respectively). Antibodies to C22–3 and C33C decreased less frequently in only 11% (1/9) ( p < 0.01) and 44% (4/9) ( p < 0.05), respectively. Thus, antibodies to 5–1–1 and C100–3 are prone to decrease following a decline in viremia. The antibody to the C22–3 (core) protein was least likely to decrease and may serve as a reliable marker of exposure to the virus.     

Electrocardiographic observations in clinically isolated, pure, chronic, severe aortic regurgitation: analysis of 30 necropsy patients aged 19 to 65 years

Certain electrocardiographic findings are described in 30 necropsy patients with clinically isolated pure, chronic, severe aortic regurgitation. They were 19 to 65 years old (mean 45). The hearts of the 22 men ranged in weight from 430 to 1,110 g (mean 717) and of the 8 women, from 375 to 950 g (mean 638). Four had grossly visible left ventricular (LV) scars. All but 1 patient was in sinus rhythm. The PR interval was greater than 0.20 second in 8 patients (28%) and the QRS duration was greater than or equal to 0.12 second in 6 patients (20%). Only 5 patients (17%) had 1 or more ventricular premature complexes recorded on the resting electrocardiogram analyzed. The mean QRS amplitude for each of the 12 leads averaged 23 mm. The highest mean QRS voltage occurred in leads V2 and V3 (each 38 mm), and the lowest in lead aVR (11 mm). The mean QRS voltage in V5 was higher than in V6 (33 vs 28 mm) and in 22 patients (73%) the QRS voltage in V5 was higher than in V6. The sum of the S wave in V1 plus the larger of the R wave in V5 or V6 (Sokolow-Lyon index) averaged 51 mm and in only 22 patients (73%) was it greater than 35 mm. The Romhilt-Estes voltage criteria for LV hypertrophy was fulfilled even less frequently, despite the severe degrees of LV hypertrophy in the patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)     

静脉联合超选择动脉溶栓治疗急性缺血性脑卒中的疗效及安全性

目的观察静脉联合超选择动脉溶栓治疗缺血性脑卒中的疗效及安全性。方法回顾分析2003年8月~2005年8月急性缺血性脑卒中患者67例,随机分为观察组34例和对照组33例,分别给予静脉联合动脉溶栓和单纯动脉溶栓治疗,比较两组患者间疗效。结果观察组与对照组再通率间差异有非常显著性意义(P<0·01);观察组发病3h内与3~6h溶栓患者再通率间差异有显著性意义(P<0·05)。结论静脉联合超选择动脉溶栓治疗缺血性脑卒中能明显提高闭塞血管的再通率,疗效好,见效快,明显改善预后,是治疗急性缺血性脑卒中有效和相对安全的方法。     

艾滋病合并肺孢子菌肺炎22例临床分析

目的探讨AIDS合并肺孢子菌肺炎(PCP)的临床特点,以提高对PCP的认识。方法回顾性分析我院22例AIDS合并PCP的临床资料,并进行相关文献复习。结果(1)22例患者中,男性占72·7%,年龄(35·0±9·4)岁。感染HIV途径主要经输血(54·5%)和性传播(27·3%);(2)最常见的临床表现为发热(21例)、进行性加重的呼吸困难(20例)、咳嗽(16例)、咳痰(12例)及体重下降(18例)。68·2%(15例)患者肺呼吸音正常或稍粗。外周PaO2<60mm Hg(1mm Hg=0·133kPa)者占63·6%(14例);(3)均为AIDS晚期患者,外周血CD4 T淋巴细胞(3~148)×106/L,其中<100×106/L者占90%(18/20)。CD4 /CD8 <0·20者占95%(19/20);(4)常见的胸部影像学表现为双侧肺间质纹理改变(19/22)和斑片影(14/22);(5)治疗药物主要为复方磺胺甲唑(SMZco)(100%)和肾上腺糖皮质激素(86·4%)。治愈13例、自动放弃5例、死亡4例。死亡患者CD4 T淋巴细胞计数明显低于治愈组(P=0·07)。结论PCP主要发生于AIDS晚期患者;临床遇有发热、呼吸困难、低氧血症、体重下降来诊的青壮年患者,胸部影像学提示间质纹理改变或斑片影,应警惕AIDS合并PCP的可能;临床怀疑AIDS合并PCP时应尽早给予SMZco治疗。     

经内镜钛夹封闭治疗胃、十二指肠急性穿孔

目的 探讨经内镜钛夹封闭对胃、十二指肠急性穿孔治疗的价值。方法 对22例消化性溃疡导致或内镜诊治时出现的胃、十二指肠急性穿孔患者进行内镜下钛夹封闭治疗。结果 内镜下钛夹封闭成功19例(86．4％)，其中一次封闭成功14例(73．7％)，24h后内镜复查补充封闭5例(26．3％)。封闭失败转外科手术治疗3例。内镜下钛夹封闭效果与胃、十二指肠穿孔部位、原因及大小有关。结论 内镜下钛夹封闭是治疗消化性溃疡导致或内镜诊治出现的胃、十二指肠急性穿孔的有效方法。     

胆管内超声对胆管微结石的诊断价值分析

目的 研究十二指肠镜下胆管腔内超声（intraductal uhrasonography,IDUS）对于内镜下逆行胆管造影（endoscopic retrograde cholangiography,ERC）不确定的肝外胆管微结石的诊断意义.方法 回顾2007年7月至2009年9月经IDUS联合内镜下括约肌切开取石明确诊断胆管微结石（胆管结石直径≤3 mm）的病例共计22例.总结分析患者的临床资料,以IDUS联合EST取石为胆管微结石诊断金标准,比较腹部超声、MRC、ERC对于诊断肝外胆管微结石的准确率.结果 腹部超声诊断胆总管微结石的确诊率是27.3%（6/22）,68.2%（15/22）的患者经腹部超声发现胆总管扩张.MRC对于胆总管微结石的确诊率为38.5%（5/13）,对于胆总管扩张的确诊率为84.6%（11/13）.ERC对于胆总管微结石的确诊率为27.3%（6/22）,ERC对于胆总管扩张的确诊率为68.2%（15/22）.2例患者以反复急性胰腺炎为主要表现,腹部超声、MRC以及ERC均未发现明确胆总管结石,最终IDUS证实了胆总管微结石的存在.结论 对于肝外胆管微结石,ERC的确诊率并不高于腹部超声以及MRC.IDUS是一种简单可行并且敏感性和准确性高的检查手段,有助于鉴别反复急性胰腺炎的病因.     

Incidence, timing and prognostic value of left ventricular aneurysm formation after myocardial infarction: a prospective, serial echocardiographic study of 158 patients

Serial 2-dimensional echocardiography was performed prospectively in 158 consecutive patients with first acute myocardial infarction (AMI) to determine the incidence of left ventricular (LV) aneurysm formation and the time course required for, and the clinical significance of, onset of LV aneurysm formation. Studies were performed throughout the first 5 days and after 3 months and 1 year. LV aneurysm was defined as an abnormal bulge in the LV contour during both systole and diastole. Eighty-four patients had anterior, 68 posterior and 6 anteroposterior AMI defined echocardiographically. During the study period, LV aneurysm was found in 35 of 158 patients (22%): in anterior AMI in 27, in posterior AMI in 6 and in anteroposterior AMI in 2. No new aneurysm developed after 3 months. Early aneurysm formation, during the first 5 days after AMI, was seen in 15 patients with anterior infarction. Twelve of these 15 (80%) died within 1 year (10 within 3 months), in contrast to 5 (25%) of the remaining 20 patients with LV aneurysm (p less than 0.05). Dyskinesia of the anterior wall in the acute stage usually resulted in aneurysm formation. Thus, LV aneurysm formation is seen in 22% of mostly anterior AMI and occurs within 3 months after AMI. Early aneurysm formation is associated with a high 3-month (67%) and 1-year (80%) mortality rate.