唐山市306例新发现HIV感染者首次CD_4~+T淋巴细胞检测结果

目的了解唐山市新发艾滋病病毒(HIV)感染者CD+4T淋巴细胞(简称CD4细胞)的水平,为HIV感染者治疗时机的选择提供依据。方法对306例新发现HIV感染者,采用流式细胞仪(FACS Calibar)检测首次CD4细胞绝对值。结果 306例新发现HIV感染者的首次CD4细胞检测结果是:200个/mm3的80例,占26.1%,200~350个/mm3之间的60例,占19.6%,351~500个/mm3的76例,占24.8%,500个/mm3的90例,占29.4%。70.6%的新发感染者处于治疗阶段。不同年龄组,不同年份感染者CD4细胞数的差异有统计学意义。结论唐山市新发现HIV感染者的CD4细胞水平普遍偏低,大部分已进入治疗阶段,应加强艾滋病宣传力度,做到早发现、早治疗。     

凉山州首次接受抗病毒治疗的AIDS病人死亡情况分析

目的了解四川省凉山州首次接受抗病毒治疗(ART)的艾滋病(AIDS)病人,因AIDS死亡的情况及其影响因素。方法对2005-2012年中国艾滋病ART信息管理系统中的5525例凉山州艾滋病病人的基本情况、死亡时间、治疗情况、CD+4T淋巴细胞(简称CD4细胞)计数检测结果等数据资料进行分析。结果共死亡430例,其中287例(66.7%)死于AIDS相关疾病。病人接受治疗时的平均年龄为(34.5±9.0)岁,男性占86.4%(248/287),经静脉吸毒感染占76.0%(218/287),从确认HIV抗体阳性到接受ART的时间平均为(21.0±19.1)个月,9.6%(26/271)的病例治疗前最近一年患有肺结核。按照世界卫生组织临床分期,50.4%(140/278)的病死病例在治疗开始时为临床I期;开始治疗时CD4细胞计数检测平均为(219.9±130.1)个/mm3,88.9%(240/270)在350个/mm3。34.1%(98/287)的病例开始治疗前3个月出现AIDS相关疾病/症状;平均时间为(12.7±10.6)个月。52.3%(150/287)是在治疗开始后的12个月内病死。不同性别、感染途径、临床分期、首次CD4细胞计数检测结果、治疗前最近一年是否患有肺结核的AIDS病人,其病死率的差异有统计学意义。结论因AIDS相关疾病死亡是凉山州接受ART病人死亡的主要原因;AIDS病人应定期进行随访和CD4细胞检测,及早接受ART。     

中药治疗连续60个月的565例HIV/AIDS病人的CD_4T淋巴细胞消长特征

目的观察连续接受中医药治疗60个月的艾滋病病毒（HIV）感染者及艾滋病（AIDS）病人（HIV/AIDS病人）,CD4T淋巴细胞计数的变化。方法收集全国19个省（自治区、直辖市）从2004-2011年采用中医药治疗的HIV/AIDS病人565例,对6个时间点（治疗0、12、24、36、48、60个月）的CD4T淋巴细胞计数变化、分层分析（≤200个/mm3、201～350个/mm3、351～500个/mm3、〉500个/mm3）比较。结果 CD4T淋巴细胞计数≤200个/mm3以西药抗病毒治疗为主,中医药为辅,中西医组占90.90%（100/110）,CD4T淋巴细胞计数平均每年上升约6个/mm3;中医组占9.09%（10/110）,CD4T淋巴细胞平均每年下降约7个/mm3。CD4T淋巴细胞计数201～350个/mm3以中医药治疗为主,中医组占80.73%（155/192）,CD4T淋巴细胞平均每年下降约3个/mm3;中西医组占19.27%（371/192）,CD4T淋巴细胞平均每年下降约2个/mm3。CD4T淋巴细胞计数351～500个/mm3以中医药治疗为主,中医组占92.19%（118/128）,CD4T淋巴细胞平均每年上升约3个/mm3;中西医组占15.63%（20/128）,平均每年上升约8个/mm3。CD4T淋巴细胞计数〉500个/mm3以中医药治疗为主,中医组占92.00%（115/125）,CD4T淋巴细胞平均每年上升约4个/mm3;中西医组占8.00%（10/125）,CD4T淋巴细胞平均每年上升约14个/mm3。结论长期服用中医药可使CD4T淋巴细胞保持稳定或者延缓其下降速度,远期疗效较好。     

2012年新疆克州艾滋病病毒感染者及艾滋病患者CD4+T淋巴细胞检测结果分析

目的对新疆克孜勒苏柯尔克孜自治州(简称克州)艾滋病病毒感染者及艾滋病患者CD4+T淋巴细胞检测结果进行统计分析,评价艾滋病病毒感染者及艾滋病患者的免疫状况、预测疾病进程并提供可靠的抗病毒治疗依据。方法用美国Beckman Coulter EPICS-XL流式细胞仪对2012年克州160份艾滋病病毒感染者及艾滋病患者检测CD4+T淋巴细胞数。结果 160份艾滋病病毒感染者及艾滋病患者的K3EDTA抗凝全血的CD4+T淋巴细胞计数,≥500/mm3有41份,占25.6%;350~499/mm343份,占26.9%;200~349/mm344份,占27.5%;<200/mm332份,占20.0%;≤350/mm376份,占47.5%;41例患者为艾滋病临床Ⅰ-B期,占25.6%,属无免疫抑制;43例为艾滋病临床Ⅱ-A期,占26.9%,有轻度免疫抑制;44例为艾滋病临床Ⅱ-B期,占27.5%,有中度免疫抑制;32例为艾滋病临床Ⅲ期(HIV感染晚期/艾滋病期),占20.0%,有重度免疫抑制;有47.5%的HIV感染者达到了抗病毒治疗标准。结论 CD4+T淋巴细胞检测是了解艾滋病病毒感染者及艾滋病患者的机体免疫状态、临床分期和抗病毒治疗的有效指标;本次检测结果显示受检的全部艾滋病病毒感染者及艾滋病患者的CD4+T淋巴细胞计数异常,均低于正常标准。     

高效抗逆转录病毒治疗43例血友病合并丙型肝炎和艾滋病患者3年临床观察

目的了解经高效抗逆转录病毒治疗(HAART)血友病合并丙型肝炎和艾滋病患者的临床疗效与不良反应。方法采用流式细胞仪定期检测CD4、CD3、CD8、自然杀伤细胞(NK)细胞计数;采用FDA推荐的病毒载量检测方法(bDNA)随访血浆病毒载量。结果43例患者在治疗3年后CD4+T淋巴细胞平均上升至257/mm3(P<0.001);HIVRNA平均降低至(2.26±1.10)log/ml(P<0.01)。结论HAART能有效抑制血友病合并丙型肝炎和艾滋病患者体内HIV的复制,有利于免疫功能重建。     

中药对807例HIV/AIDS病人CD_4淋巴细胞计数的影响

目的观察中医药治疗艾滋病试点项目中,连续接受中药治疗36个月的807例艾滋病病毒(HIV)/艾滋病(AIDS)病人CD4淋巴细胞计数的变化情况,以探讨长期中药治疗对病人免疫功能的影响。方法用自身前后对照的方法 ,对807例HIV/AIDS病人经中医药治疗后7个时点(疗前、6、12、18、24、30、36个月)的CD4计数变化、分层分析(200个/mm3、200～350个/mm3、350个/mm3)、不同病期、不同干预手段、可能感染时间等方面进行分析,并对7个时点主要症状积分的变化进行观察。结果中药对CD4计数200个/mm3和200～350个/mm3之间的病人效果较好;可能感染时间集中在1990-1995年之间的病人,服用中药3年CD4的水平基本保持稳定;中西药合用的效果优于单纯使用中药。结论长期服用中药可以稳定病人的免疫功能,远期疗效较好。     

去羟肌苷、司他夫定联合奈韦拉平治疗艾滋病患者临床观察

目的观察2核苷类逆转录酶抑制剂(NRTI)联合1非核苷类逆转录酶抑制剂(NNR-TI)抗逆转录病毒方法治疗艾滋病的效果和不良反应。方法用去羟肌苷(ddI)、司他夫定(d4T)联合奈韦拉平(NVP)治疗20例HIV-1感染者和艾滋病患者(HIV/AIDS),将其分为A组(进口药)、B组(国产药)并进行为期1年的观察。随访指标为病毒载量、T淋巴细胞计数和不良反应。结果治疗1年,A组中2例因严重不良反应而终止。治疗1个月后两组的血浆病毒载量平均值明显下降,A组比治疗前下降2.12lg拷贝/ml,B组比治疗前下降2.55lg拷贝/ml。A、B两组分别在4.3个月和2个月时,均检测不到病毒载量。CD4细胞计数和CD4/CD8比例逐渐升高,由治疗前A组(231.50±156.02)/mm3、0.25±0.21,B组(49.60±45.41)/mm3、0.07±0.05,上升至治疗后A组(423.70±225.79)/mm3、0.46±0.31,B组(186.00±92.47)/mm3、0.20±0.11。两组比较,治疗前后的血浆HIVRNA降幅、CD4细胞计数和CD4/CD8比例增幅无统计学意义。治疗前CD4>200/mm3者,治疗后CD4细胞计数和CD4/CD8比例升高的绝对值明显高于CD4<200/mm3者。治疗初期不良反应有胃肠道反应、中枢神经系统症状和皮疹,不需治疗可自行缓解,严重的不良反应是周围神经病变。结论该药物组合能够很快地使病毒载量水平明显降低,同时也能够使大多数患者的免疫功能得以重建。严重的不良反应表现有周围神经病变。     

HIV/AIDS患者中CD4细胞计数与总淋巴细胞计数间相关性研究

目的评价总淋巴细胞计数与CD4细胞计数间的相关性.方法回顾性分析了226例艾滋病病毒(HIV)阳性患者共330对同一天获得的CD4细胞计数与总淋巴细胞计数间的相关性,阳性预测值(PPV)、敏感性、特异性分别在不同的总淋巴细胞计数范围对应于CD4细胞计数<200个/mm3和CD4细胞计数<350个/mm3时获得.结果 330对CD4细胞计数与总淋巴细胞计数之间存在相关性(r=0.528,P<0.01),总淋巴细胞计数<1 400个/mm3对应于CD4细胞计数<200个/mm3有70.11%的阳性预测值,72.61%的敏感性,88.46%的特异性,总淋巴细胞计数<1 900个/mm3对应于CD4细胞计数<350个/mm3有80.97%的阳性预测值,70.92%的敏感性,74.54%的特异性.结论总淋巴细胞计数可以作为评价患者患机会性感染的危险程度及何时开始药物治疗的一种低消费的监测手段.阳性预测值(PPV)、敏感性、特异性分别在总淋巴细胞计数<1 400个/mm3对应于CD4细胞计数<200个/mm3和总淋巴细胞计数<1 900个/mm3对应于CD4细胞计数<350个/mm3时表现最为明显.     

吸毒成瘾HIV/AIDS患者抗逆转录病毒治疗的初步探讨

目的 评价国产艾滋病抗病毒药物治疗吸毒成瘾艾滋病病毒感染者/病人(HIV/AIDS)的疗效及对治疗时机的探讨. 方法 采用回顾性研究方法,调查随访2004～2007年在北京佑安医院确诊并经抗病毒治疗的吸毒成瘾HIV/AIDS患者114例,按照疾病进展将随访对象分成艾滋病组( AIDS)和HIV感染组(free of AIDS) ,所有患者均用3种抗病毒药物(奈韦拉平 司他夫定 拉米夫定)治疗,疗程48周.常规方法检测患者治疗前后血CD4 T淋巴细胞数,核酸序列扩增技术(NASBA)测定病毒载量. 结果 114例吸毒成瘾HIV/AIDS患者CD4细胞数平均增加(182.39±90.70)个/mm3;其中35例吸毒成瘾HIV/AIDS患者中85.71%病毒载量下降至50 copies/ml以下, 下降2.5个Log数;艾滋病组与HIV感染组治疗后3、6、9和12个月CD4 T淋巴细胞差异有统计学意义(P＜0.05);治疗6个月后,HIV感染组病毒载量下降趋势较艾滋病组明显,但治疗12个月后 HIV感染组病毒载量较艾滋病组有反弹现象. 结论 吸毒成瘾HIV/AIDS患者选用国产艾滋病抗病毒药物奈韦拉平 司他夫定 拉米夫定治疗取得良好效果,并且对艾滋病患者的疗效好于HIV感染者.     

手术联合抗结核和抗病毒治疗颈部淋巴结结核并发艾滋病患者(附12例临床效果分析)

搜集2012年4月至2018年6月于苏州大学附属传染病医院经保守治疗无效,行外科手术治疗的12例(能耐受手术)颈部淋巴结结核(CTL)并发艾滋病患者的临床资料。男10例,女2例;年龄19~62岁,平均(38.0±11.3)岁。均在规范的抗结核、抗病毒药物治疗的同时辅以手术治疗,对比分析术前与术后3个月CD4 ⁺ T淋巴细胞水平、CD4 ⁺ T淋巴细胞/CD8 ⁺ T淋巴细胞比值、血红细胞沉降率(ESR)等。术后3个月CD4 ⁺ T淋巴细胞为(267.07±77.89)个/μl,术前为(156.80±84.83)个/μl,CD4 ⁺/CD8 ⁺ T淋巴细胞比值为0.68±0.53,术前为0.47±0.32,差异均有统计学意义(t=28.30,P=0.019;t=20.37,P=0.033)。术后ESR为(15.88±11.08)mm/1h,术前为(52.32±17.12)mm/1h,差异有统计学意义(t=12.92,P=0.025)。12例患者均获得随访,11例患者手术切口均一期愈合、CTL症状消失;1例切口延期愈合,经过2个月局部换药愈合;3例CTL复发再行二次手术,术后切口愈合良好;1例在治疗过程中死亡,死亡原因为艾滋病晚期且并发肺孢子虫肺炎。可见,规范的抗结核、抗病毒药物控制,联合适当时机合理精准的手术干预对CTL并发艾滋病患者治疗疗效较好。     

CD4+T淋巴细胞和CD8+T淋巴细胞对新型冠状病毒肺炎的临床分型及其预后的价值

目的探讨CD4⁺T淋巴细胞和CD8⁺T淋巴细胞对新型冠状病毒肺炎(COVID-19)的临床分型及其预后的价值。方法纳入2020年1月至3月上海市(复旦大学附属)公共卫生临床中心收治的95例COVID-19患者,比较普通型、重型、危重型患者及临床转归为治愈、好转、未愈、死亡患者的CD4⁺T淋巴细胞计数和CD8⁺T淋巴细胞计数。采用受试者操作特征曲线下面积评估CD4⁺T淋巴细胞计数和CD8⁺T淋巴细胞计数对COVID-19临床分型及预后的价值。组间比较采用曼-惠特尼U检验。结果95例COVID-19患者中,普通型68例,重型11例,危重型16例。治疗前普通型、重型和危重型患者的CD4⁺T淋巴细胞计数分别为419(309,612)、267(212,540)和141(77,201)/μL,CD8⁺T淋巴细胞计数分别为238(153,375)、128(96,172)和92(51,144)/μL,差异均有统计学意义(Z=24.322、15.956,均P<0.01)。死亡、未愈、好转和治愈病例的CD4⁺T淋巴细胞计数分别为149(143,349)、315(116,414)、344(294,426)和745(611,966)/μL,CD8⁺T淋巴细胞计数分别为106(43,501)、176(67,279)、194(188,432)和429(276,564)/μL,差异均有统计学意义(Z=36.083、16.658,均P<0.01)。评估危重型患者的CD4⁺T淋巴细胞计数最佳临界值为237/μL,曲线下面积为0.911[95%可信区间(confidence interval, CI) 0.833~0.989,P<0.01],灵敏度和特异度分别为86.1%和87.5%;评估(危)重型患者治疗有效性的CD4⁺T淋巴细胞计数最佳临界值为405/μL,曲线下面积为0.863(95%CI 0.727~0.999,P=0.001),灵敏度和特异度分别为78.6%和74.6%。结论COVID-19的病情可能随CD4⁺T淋巴细胞计数和CD8⁺T淋巴细胞计数减少呈加重趋势,CD4⁺T淋巴细胞计数可用作COVID-19临床分型诊断和评估(危)重型病例预后的指标。     

Association of cholesterol with risk of pancreatic cancer:A meta-analysis

AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowledge Infrastructure and China Biology Medicalliterature database for relevant articles published in English or Chinese. Pooled relative risks(RRs) with 95% confidence intervals(CIs) were calculated with a random-effects model. RESULTS: We included 14 published articles with 439355 participants for dietary cholesterol, and 6 published articles with 1805697 participants for serum TC. For the highest vs lowest category of dietary cholesterol, the pooled RR(95%CI) of pancreatic cancer was 1.308(1.097-1.559). After excluding two studies(RR > 3.0), the pooled RR(95%CI) was 1.204(1.050-1.380). In subgroup analysis stratified by study design, the pooled RRs(95%CIs) were 1.523(1.226-1.893) for case-control studies and 1.023(0.871-1.200) for cohort studies. The association of dietary cholesterol with the risk of pancreatic cancer was significant for studies conducted in North America [1.275(1.058-1.537)] and others [2.495(1.565-3.977)], but not in Europe [1.149(0.863-1.531)]. No significant association [1.003(0.859-1.171)] was found between the risk of pancreatic cancer and serum TC. CONCLUSION: Dietary cholesterol may be associated with an increased risk of pancreatic cancer in worldwide populations, except for Europeans. The results need to be confirmed further.     

Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study

BACKGROUND: The SMART study randomized 5,472 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL to intermittent antiretroviral therapy (ART; the drug conservation [DC] group) versus continuous ART (the viral suppression [VS] group). In the DC group, participants started ART when the CD4+ cell count was <250 cells/microL. Clinical outcomes in participants not receiving ART at entry inform the early use of ART. METHODS: Patients who were either ART naive (n=249) or who had not been receiving ART for >or= 6 months (n=228) were analyzed. The following clinical outcomes were assessed: (i) opportunistic disease (OD) or death from any cause (OD/death); (ii) OD (fatal or nonfatal); (iii) serious non-AIDS events (cardiovascular, renal, and hepatic disease plus non-AIDS-defining cancers) and non-OD deaths; and (iv) the composite of outcomes (ii) and (iii). RESULTS: A total of 477 participants (228 in the DC group and 249 in the VS group) were followed (mean, 18 months). For outcome (iv), 21 and 6 events occurred in the DC (7 in ART-naive participants and 14 in those who had not received ART for >or= 6 months) and VS (2 in ART-naive participants and 4 in those who had not received ART for 6 months) groups, respectively. Hazard ratios for DC vs. VS by outcome category were as follows: outcome (i), 3.47 (95% confidence interval [CI], 1.26-9.56; p=.02); outcome (ii), 3.26 (95% CI, 1.04-10.25; p=.04); outcome (iii), 7.02 (95% CI, 1.57-31.38; p=.01); and outcome (iv), 4.19 (95% CI, 1.69-10.39; p=.002 ). CONCLUSIONS: Initiation of ART at CD4+ cell counts >350 cells/microL compared with <250 cells/microL may reduce both OD and serious non-AIDS events. These findings require validation in a large, randomized clinical trial.     

CT血管成像与MR血管成像对颅内动脉瘤诊断价值的Meta分析

目的通过Meta分析,比较CT血管成像（CTA）与MR血管成像（MRA）对颅内动脉瘤的诊断价值。方法检索维普中文科技期刊数据库、中国生物医学文献数据库、中国期刊全文数据库、数字化期刊数据库、PubMed、EMBASE、Web of Science、Cochrane Library,按照纳入标准筛选关于CTA和MRA对颅内动脉瘤诊断的研究,检索时间均由建库至2012年4月。采用Metadisc 1.4软件对数据进行分析,计算诊断的敏感度、特异度、比值比（OR）及95%CI,异质性采用I2检验分析,绘制出汇总受试者工作特征曲线（SROC）,并计算曲线下面积。结果共纳入6篇符合标准的文章（均为前瞻性研究）,合计370例患者。Meta分析结果示,CTA对颅内动脉瘤诊断的敏感度为0.91（95%CI：0.87～0.94）,特异度为0.92（95%CI：0.86～0.96）,OR为78.29（95%CI：28.27～216.77）,SROC曲线下面积为0.9593。MRA诊断的敏感度为0.85（95%CI：0.80～0.89）,特异度为0.92（95%CI：0.86～0.96）,OR为41.94（95%CI：18.50～95.09）,SROC曲线下面积为0.9304。结论 CTA对于颅内动脉瘤的诊断价值高于MRA。但仍需大样本的研究进一步加以证实。     

Alterations in CD8 cell distribution in gut-associated lymphoid tissues (galt) of the aging fischer 344 rat: a correlated immunohistochemical and flow cytometric analysis

The distribution of CD8⁺ phenotype (cytotoxic/suppressor) T lymphocytes in Peyer;s patches and intestinal lamina propria in young adult (3–6 months) and old (24–29 months) Fischer 344 rats was examined using immunohistochemical and flow cytometric analyses. Flow cytometric analysis confirmed previous reports indicating no change with age in the proportion of Peyer's patch CD8⁺ cells in the rat. Immunohistochemical analysis showed discrete zones of densely stained CD8⁺ cells in the interfollicular areas and weakly stained cells within the follicles in Peyer's patches in youngadult animals. In old rats, the number of intensely stained CD8⁺ cells between the follicles was markedly reduced and positively stained cells were distributed throughout the Peyer's patches. In addition, the population density of CD8⁺ cells is more diffuse in old animals, the number of CD8⁺ lymphocytes in the intestinal lamina propria increased 2.5-fold with aging from 533±59 cells/mm² in young adult to 1312±83 cells/mm² in old rats. The findings suggest that CD8⁺ cell distribution in the inductive and effector sites of gut associated lymphoid tissue undergoes age-related shifts.     

Safety and efficacy of single-incision laparoscopic surgery for appendectomies: A meta-analysis

AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LAwere pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A. RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively. CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.     

胸腺五肽辅助治疗复治菌阳肺结核疗效和安全性的Meta分析

目的 系统评价胸腺五肽辅助治疗复治菌阳肺结核的疗效和安全性。方法 采用在线检索的方法,检索PubMed、the Cochrane Library、中国生物医学文献数据库、万方数据库、中国知网、维普中文科技期刊数据库,检索时间从建库至2019年8月1日。中文检索词:胸腺五肽、肺结核;英文检索词:thymopentin、pulmonary tuberculosis。按照检索策略,初步检索到相关文献326篇,其中,中文文献322篇,英文文献4篇,最终纳入18篇。采用RevMan 5.3软件对复治菌阳肺结核2个月末痰菌阴转率,6个月末痰菌阴转率、病灶吸收率、空洞闭合率,药物不良反应发生率,CD4 ⁺和CD8 ⁺T淋巴细胞水平进行分析。结果 Meta分析结果显示,与常规治疗方案相比,胸腺五肽辅助治疗复治菌阳肺结核可提高患者治疗2个月末痰菌阴转率[风险比(RR)(95%CI)=1.28(1.17~1.40)]、6个月末痰菌阴转率[RR(95%CI)=1.24(1.18~1.29)]、病灶吸收率[RR(95%CI)=1.27(1.19~1.37)],以及空洞闭合率[RR(95%CI)=1.39(1.26~1.54)];而药物不良反应发生率差异无统计学意义[RR(95%CI)=0.82(0.63~1.07)]。胸腺五肽辅助治疗复治菌阳肺结核能提升患者的CD4 ⁺T淋巴细胞水平[加权均数差(WMD)(95%CI)=11.03(8.79~13.27)],降低CD8 ⁺T淋巴细胞水平[WMD(95%CI)=-8.34(-12.54~-4.14)],提升CD4 ⁺/CD8 ⁺水平[WMD(95%CI)=0.51(0.26~0.75)]。结论 胸腺五肽辅助治疗复治菌阳肺结核安全有效。     

Calcium supplementation for the prevention of colorectal adenomas: a systematic review and meta-analysis of randomized controlled trials

AIM: To determine the efficacy of calcium supplementation in reducing the recurrence of colorectal adenomas.METHODS: We conducted a systematic review and meta-analysis of published studies. We searched Pub Med, Scopus, the Cochrane Library, the WHO International Clinical Trials Registry Platform, and the Clinical Trials.gov website, through December 2015. Randomized, placebo-controlled trials assessing supplemental calcium intake for the prevention of recurrence of adenomas were eligible for inclusion. Two reviewers independently selected studies based on predefined criteria, extracted data and outcomes(recurrence of colorectal adenomas, and advanced or "high-risk" adenomas), and rated each trial's riskof-bias. Between-study heterogeneity was assessed, and pooled risk ratio(RR) estimates with their 95% confidence intervals(95%CI) were calculated using fixed- and random-effects models. To express the treatment effect in clinical terms, we calculated the number needed to treat(NNT) to prevent one adenoma recurrence. We also assessed the quality of evidence using GRADE.RESULTS: Four randomized, placebo-controlled trials met the eligibility criteria and were included. Daily doses of elemental calcium ranged from 1200 to 2000 mg, while the duration of treatment and follow-up of participants ranged from 36 to 60 mo. Synthesis of intention-to-treat data, for participants who had undergone follow-up colonoscopies, indicated a modest protective effect of calcium in prevention of adenomas(fixed-effects, RR = 0.89, 95%CI: 0.82-0.96; randomeffects, RR = 0.87, 95%CI: 0.77-0.98; high quality of evidence). The NNT was 20(95%CI: 12-61) to prevent one colorectal adenoma recurrence within a period of 3 to 5 years. On the other hand, the association between calcium treatment and advanced adenomas did not reach statistical significance(fixed-effects, RR = 0.92, 95%CI: 0.75-1.13; random-effects, RR = 0.92, 95%CI: 0.71-1.18; moderate quality of evidence). CONCLUSION: Our results suggest a modest chemopreventive effect of calcium supplements against recurrent colorectal adenomas over a period of 36 to 60 mo. Further research is warranted.     

咖啡与脑卒中风险的剂量-反应Meta分析

目的:用Meta分析方法评估咖啡与脑卒中风险之间的关系。方法:计算机检索Pubmed、EMBASE、Cochrane图书馆、中国生物医学文献、中国知网、万方和维普数据库,收集关于咖啡与脑卒中风险关系的前瞻性队列研究,由2位研究员按纳入排除标准独立筛选文献、提取资料并用卡斯尔-渥太华量表(NOS)评价文献质量。用Stata/SE 15.0软件进行统计分析。结果:共纳入17项前瞻性队列研究、1142274例受试者,其中包括83433例脑卒中患者。Meta分析结果显示,咖啡可明显降低脑卒中风险(RR=0.80,95%CI:0.75~0.85),但并不能降低日本人群的脑卒中风险。剂量-反应Meta分析显示,咖啡摄入量与脑卒中风险之间呈非线性关系(非线性P值<0.001)。与从不喝咖啡者相比,每天喝2、4、6、8杯咖啡者的脑卒中相对风险分别为0.87(95%CI:0.82~0.92)、0.83(95%CI:0.76~0.90)、0.84(95%CI:0.74~0.95)、0.86(95%CI:0.72~1.03)。结论:咖啡摄入量与脑卒中风险呈非线性关系,适量摄入咖啡与脑卒中风险呈负相关,每天喝4~5杯咖啡时脑卒中风险最低。但现有的研究证据不能证明喝咖啡能明显降低亚洲人群的脑卒中风险。     

HIV/AIDS患者外周血程序性死亡受体-1的表达及临床意义

目的 探讨HIV感染及抗病毒治疗对程序性死亡受体-1(programmed death-1, PD-1)表达的影响。方法 根据是否接受抗病毒治疗将61例HIV/AIDS患者分为治疗组及未治疗组,并以35例健康者作为对照。利用逆转录聚合酶链反应(RT-PCR)技术探究基因PD-1 mRNA在人外周血单个核细胞(PBMC)中的表达;通过双夹心抗体ELISA法测定血清中可溶性PD-1(sPD-1)表达水平。并比较不同CD4⁺ T淋巴细胞数的HIV/AIDS患者血清sPD-1的差异。结果 未治疗组、治疗组、健康组研究对象PBMC中PD-1 mRNA的相对表达量均数分别为0.337 8±0.064、0.578 2±0.073和0.771 5±0.124,健康组与未治疗组差异极显著,健康组与治疗组、治疗组与未治疗组之间差异显著(P=0.031、P=0.043);未治疗组、治疗组、健康组血清sPD-1浓度分别为42.22±2.21 ng/mL、38.24±2.79 ng/mL和29.88±1.41 ng/mL。健康组与未治疗组、治疗组,治疗组与未治疗组分别具有显著性差异(P=0.008、P=0.040和P=0.020)。差异性分析结果表明,未治疗组、治疗组CD4⁺T淋巴细胞数<350 个/mm³患者血清sPD-1水平均显著高于CD4⁺T淋巴细胞数>350 个/mm³患者。结论 抗病毒治疗在一定程度上使高水平sPD-1表达下调以促使PD-1/PD-L1通路的恢复,从而促进机体免疫重建。监测PD-1 mRNA及sPD-1的表达在HIV的辅助诊断和推断病情发展上具有一定的价值。