HBV慢性感染者血清IL-10 IFN-γ和IL-2水平检测及临床意义

目的:探讨乙型肝炎病毒(HBV)慢性感染者外周血IL-10、IFN-γ及IL-2的表达水平及其临床意义.方法:分离63例HBV感染者血清(无症状携带者组21例,慢性乙肝患者轻度组和中、重度组各21例),双抗体夹心法ELISA定量检测血清的IL-10、IFN-γ及IL-2表达水平,10例健康献血者为对照组.结果:中、重度组患者IFN-γ水平较对照组、无症状携带者组和轻度组明显升高(P<0.05);其中各组HBV-DNA高载量者(≥1.0×105)IL-10、IFN-γ水平均较低载量者(<1.0×105≥1.0×103)和对照组明显升高(P<0.05);轻度和中、重度组的IL-10水平明显高于对照组(P<0.05),无症状携带者及中、重度组IL-10水平明显高于轻度组(P<0.05);各组IL-2水平无显著差异(P>0.05).结论:乙型肝炎病毒慢性感染者免疫应答异常与IL-10 及IFN-γ表达水平有关;携带者IL-10浓度升高可能是诱导的免疫耐受的因素之一.     

HBV感染者血清IL-18的检测及其意义

目的:探讨白细胞介素18(IL-18)在乙型肝炎病毒(HBV)感染中的作用.方法:用ELISA法检测66例HBV感染者(无症状携带者16例,慢性肝炎患者38例,重型肝炎患者12例)和16例正常对照血清IL-18的水平.结果:重症乙肝患者IL-18血清水平明显高于其它组(P＜0.001).慢性乙肝明显高于正常对照(P＜0.05),但与无症状携带者比较差异无显著性(P＞0.05).无症状携带者与正常对照组之间差异无显著性(P＞0.05).IL-18水平与血清胆红素水平呈正相关(r=0.672,P＜0.05).结论:IL-18参与乙型肝炎免疫致病过程,与病情严重程度相关.     

乙肝患者血清IL-32的检测及其临床意义

目的 初步探讨慢性乙肝(CHB)患者血清IL-32表达水平及其临床意义.方法 采用ELISA 分别检测78例CHB患者(轻度组34例、中度组32例、重度组12例)和30例健康对照组的血清IL-32水平,同时检测各组血清ALT/GGT水平;荧光定量PCR检测各组患者血清HBV DNA载量,并分成HBV DNA低载量组(≤105拷贝数/ml),高载量组(>105拷贝数/ml).结果 CHB各组血清IL-32水平较对照组明显升高(P<0.05),且重度组显著高于轻度和中度组,差异有统计学意义(P<0.05);不同HBV DNA载量组血清IL-32水平无显著差异(P>0.05);CHB患者血清IL-32水平与血清ALT呈显著正相关(r=0.744,P<0.01),与血清GGT亦呈显著正相关(r=0.639,P<0.01).结论 IL-32可能参与了CHB的炎性损伤,在清除HBV的同时也造成了肝细胞炎性损伤;血清IL-32水平对判断CHB患者肝损害有一定临床意义;血清IL-32水平变化与HBV-DNA复制无关联.     

HBV感染者免疫调节细胞因子表达变化的研究

目的研究慢性乙型肝炎病毒（HBV）感染者免疫状况以及免疫调节细胞因子含量变化情况,了解病毒载量、肝功能与IFN-γ、IL-2、IL-4、IL-10、IL-12等细胞因子含量变化情况的临床意义。方法收集27例HBeAg阳性和肝功能ALT异常者为HBV感染现症患者为A组;22例HBeAg阳性和肝功能ALT持续正常者为无症状HBV携带者为B组;11例HBeAg阴性和肝功能ALT正常以及HBV-DNA阴性者为非活动性HBsAg携带者为C组;设正常对照组。采用双抗体夹心ELISA法定量检测IFN-γ、IL-2、IL-4、IL-10、IL-12血清含量。结果 HBV感染者各组IL-2、IL-12含量较正常对照组均下降,IL-4、IL-10均升高,差异有统计学意义（P〈0.05）,IFN-γ普遍降低但各组之间差异无统计学意义（P〉0.05）。A组现症患者IL-2、IL-12的活性显著高于B组无症状HBV携带组和C组非活动性HBsAg携带组（P〈0.05）;IL-4、IL-10含量各组均低于正常对照组,差异有统计学意义（P〈0.05）,患者各组间差异无统计学意义（P〉0.05）。病毒载量与细胞因子含量的关系：IFN-γ、IL-2各组与正常对照组比较显著下降（P〈0.05）,IFN-γ下降幅度为≥107组和105~6组〉、〈105组,差异有统计学意义（P〈0.05）。IL-12也普遍降低,各组差异无统计学意义（P〉0.05）。IL-4、IL-10含量各组明显高于对照组（P〈0.05）,含量随病毒载量增高而增加。中、高病毒载量组与低病毒载量组差异有统计学意义（P〈0.05）,低病毒载量组与正常对照组差异无统计学意义（P〉0.05）。结论 HBV感染状态和病毒量与免疫调节细胞因子IL-2、IL-12、IL-4、IL-10含量变化有一定的关联性。     

HBV感染者血清IL-18,IL-18BPa水平及外周血单个核细胞mRNA的表达

目的 探讨白细胞介素18(IL-18)和白细胞介素18结合蛋白(IL-18BP)在乙型肝炎病毒(HBV)感染中的作用.方法 分别用ELISA法及RT-PCR法检测93例HBV感染者(无症状携带者20例,慢性肝炎52例,重型肝炎21例)和18例正常对照血清IL-18,IL-18BPa亚群(IL-18BPa)的水平和外周血单个核细胞(PBMC)内IL-18 mRNA,IL-18BPa mRNA的表达水平.结果 不同临床类型HBV感染者IL-18,IL-18mRNA表达水平的差异均有显著性(P＜0.01),重型肝炎组最高,正常对照组最低,重型肝炎组和慢性肝炎组均明显高于正常对照组(P＜0.01);重型肝炎组、慢性肝炎组IL-18BPa水平和IL-18BPa mRNA表达水平都显著高于无症状携带者、正常对照组,无症状携带者明显高于正常对照组(P＜0.05或P＜0.01),重型肝炎组和慢性肝炎组差异无显著性(P＞0.05).结论 IL-18与IL-18BP可能参与了宿主对HBV的免疫应答,IL-18与病情严重程度相关,IL-18BP与IL-18的相对水平可能与转归和预后有关.     

慢性乙型肝炎患者196例病毒基因分型与临床的关系

目的探讨西安市中心医院感染科诊治的慢性乙肝患者血清中HBV基因型的分布状况及HBV基因型与临床特征的关系。方法采用巢式PCR法对196例慢性HBV患者的血清进行病毒基因型检测,并分析HBV基因型与患者临床特征的关系。结果 196例慢性HBV患者的基因分型结果为C型138例(70.4%)、B型40例(20.4%)、B/C混合型18例(9.2%),基因型的分布在性别上无统计学差异;各基因型在无症状携带者、慢性乙肝、肝硬化、肝癌中的分布差异也无统计学意义(P>0.05);C型感染者血清HBeAg阳性率(75.2%)高于B型感染者(14.2%),差异有统计学意义(P<0.05)。各基因型患者在HBV-DNA载量和ALT水平上无统计学差异(P>0.05)。结论西安市中心医院感染科诊治的HBV患者的基因型以C型和B型为主;基因C型患者血清HBeAg阳性率高于B型;基因C型患者与B型相比在肝脏炎症程度、HBV-DNA载量方面无显著差异;基因B型和C型患者临床特点相似。     

干扰素治疗对慢性乙肝患者细胞因子和抗病毒疗效的影响分析

目的探讨血清细胞因子(IL-2,IL-10,IL-12和sIL-2R)在慢性乙型肝炎中的作用及抗病毒治疗对其水平的影响.方法采用ELISA方法检测干扰素治疗前、治疗6个月后的91例慢性乙肝患者血清IL-2,IL-10,IL-12和sIL-2R活性含量;HBV-DNA定量检测采用PCR方法.结果治疗前慢性乙肝患者血清IL-10和sIL-2R活性含量均明显高于对照组差异显著(P＜0.05或P＜0.01);而血清IL-2和IL-12在Ⅱ组(有效组)、Ⅰ组(无效组)及对照组间无差异性(P＞0.05).治疗后Ⅱ组血清IL-10和sIL-2R含量明显降低,与对照组无差异性(P＞0.05);其血清IL-2和IL-12明显升高,同对照组、Ⅰ组相比差异显著(P＜0.01).结论 IL-2,IL-10,IL-12和sIL-2R均参与慢性乙肝的发病机制,并可作为评估干扰素抗病毒治疗的重要免疫指标.     

乙型肝炎病毒感染者血清和外周血单个核细胞培养上清细胞因子测定及临床意义

目的 观察不同HBV感染者血清和外周血单个核细胞(PBMC)培养上清中的细胞因子水平. 方法 采集不同HBV感染者血清;制备PBMC并用rHBcAg刺激,培养72h后收集培养上清.采用酶联免疫吸附法检测血清和培养上清中的IFN-γ和IL-4水平. 结果 血清IFN-γ水平,急性乙肝显著高于健康对照和HBV携带者(P<0.01和P<0.05),也高于慢性乙肝;慢性乙肝显著高于健康对照(P<0.05).血清IL-4水平,急、慢性乙肝均显著高于健康对照和HBV携带者(P<0.01和P<0.05),HBV携带者与健康对照相比差异无统计学意义.血清IFN-γ/IL-4比值,除慢性乙肝显著低于健康对照(P<0.01),其余组间差异无统计学意义.在PBMC培养上清中,急、慢性乙肝患者的IFN-γ水平显著高于健康对照和HBV携带者(P<0.05),急性肝炎组高于慢性组,但差异无统计学意义;HBV携带者与健康对照相比,差异无统计学意义.3个HBV感染组的IL-4水平与健康对照相比,差异无统计学意义. 结论 (1)与使用rHBcAg刺激后的PBMC培养上清相比,血清检测可能更加符合患者的真实细胞因子水平.(2)HBV感染时IFN-γ表达水平和IFN-γ/IL-4比值与疾病转归密切相关.     

肝穿刺病理学检查对肝功能正常HBV感染者诊断的临床意义

目的 评估肝穿刺组织病理学检查对肝功能正常的慢性乙型肝炎病毒(HBV)感染者的诊断价值.方法 选取肝功能正常的慢性HBV感染者244例,行肝穿刺病理检查,同时检测肝功能、血清HBV DNA及HBV血清学标志物.结果 244例患者中符合病毒携带者53例(21.7％);慢性乙型肝炎轻度143例(58.6％),中度34例(13.9％),重度14例(5.7％),肝硬化7例(2.9％).炎症分级G≥2者48例(19.7％);纤维化分期S≥2者54例(22.1％).HBeAg阴性组患者中如HBV DNA高水平复制,其病理炎症分级及纤维化分期均明显重于阳性组(P＜0.05).HBV DNA高载量和低载量(以105拷贝/毫升为界限)肝组织炎症分级统计学差异无显著意义,但是纤维化分期则差异明显.结论 多数肝功能正常的慢性HBV感染者有一定程度的病变损害,血清HBeAg及HBV DNA均不能完全反映肝脏病变情况,肝穿刺组织病理学检查在判定肝功能正常的HBV感染者的病情程度和指导治疗方面有重要价值.     

乙型病毒性肝炎患者血清炎症因子及趋化因子表达及意义

目的:探讨血清炎症因子（IL-6、IL-10和IL-12）及趋化因子（CXCL16和CXCL11）在乙型病毒 性肝炎（乙肝）患者体内的变化及意义。方法: 选取乙肝患者93例,其中轻度乙肝患者37例,中度乙肝 患者30例,重度乙肝患者26例,同时选取40例健康志愿者作为对照组,检测各组炎症因子（IL-6、IL-10 和IL-12）、趋化因子（CXCL16和CXCL11）和生化指标（AST、ALT、TC、TG和DBIL）。结果:轻度、中度 和重度组CXCL16和CXCL11明显高于对照组（P ＜0.05）;重度组IL-6、IL-10和IL-12明显高于轻度组、 中度组和对照组（P ＜0.05）;中度组IL-6、IL-10和IL-12明显高于轻度组和对照组（P ＜0.05）;轻 度、中度和重度组AST、ALT和DBIL明显高于对照组（P ＜0.05）,而TC明显低于对照组（P ＜0.05）; 重度组HBV DNA明显高于中度和轻度组（P＜0.05）;中度组HBV DNA明显高于轻度组（P ＜0.05）;IL-6 和IL-12与ALT成正相关（r =0.404和0.434,P ＜0.05）,而IL-10与ALT成负相关（r =-0.341,P ＜ 0.05）;CXCL16与生化指标无相关性（P ＞0.05）;IL-6、IL-12和IL-10与CXCL16、CXCL11无相关性（P ＞0.05）;HBV DNA与ALT、AST、CXCL16呈正相关（r =0.302、0.305和0.413,P ＜0.05）。结论:乙肝 患者IL-6、IL-10、IL-12以及CXCL16和CXCL11表达上调,其中IL-6、IL-10、IL-12和CXCL11可一定程度 反映肝功能损害程度。     

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.