慢性HBV携带者血清中肝功能相关蛋白检测的临床意义

目的了解慢性HBV携带者血清中肝功能相关蛋白胆碱脂酶(Ch E)、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)、铁蛋白(FRT)、C反应蛋白(CRP)、铜蓝蛋白(CER)的水平,并且探讨这些蛋白对慢性HBV携带者的诊断价值。方法选取2012年1月至2014年7月在重庆医科大学附属永川医院就诊的86例慢性HBV携带者作为观察组,另外选取102例健康体检者作为对照组,分别检测其血清中Ch E、Alb、PA、TRF、FRT、CRP、CER等生化指标,并对部分观察组人群进行肝穿刺活组织检查。计量资料组间比较采用独立样本t检验。结果观察组与对照组的CER水平分别为(0.20±0.04)g/L、(0.29±0.06)g/L,差异有统计学意义(t=2.03,P=0.03),其他指标差异均无统计学意义(P值均0.05);观察组中,肝脏炎症程度高或纤维化程度高的患者血清中CER水平下降明显,差异均有统计学意义[(0.23±0.01)g/L vs(0.18±0.02)g/L,t=-2.6,P=0.01;(0.22±0.02)g/L vs(0.17±0.04)g/L,t=-3.2,P=0.004)。结论血清中CER水平的变化能反映早期肝脏炎症和纤维化程度,并可能成为慢性HBV携带者早期诊断与治疗的重要指标。     

HBV感染者血清趋化因子IP-10和RANTES的表达及其临床意义探讨

目的探讨HBV感染者血清IP—10和RANTES水平及其临床意义。方法采用ELISA定量检测正常人、自限性HBV感染者、慢性HBV携带者和慢性乙型肝炎患者血清IP-10和RANTES水平。结果与正常人比,自限性HBV感染者、慢性HBV携带者和慢性乙型肝炎患者血清IP-10（P=0．002,P=0．002,P=0．01）和RANTES（P=0．01,P=0．02,P〈0．001）表达均明显上调;自限性HBV感染者、慢性HBV携带者和慢性乙型肝炎患者之间血清IP-10水平无显著性差异（P〉0．05）,但自限性HBV感染者血清RANTES水平较其他两组明显升高（P±0．005,P=-0．03）;慢性乙型肝炎患者血清IP-10（P=0．001）和RANTES（P=0．02）水平均明显高于慢性HBV携带者;HBeAg阴性和阳性者之间两指标无显著性差异（P=0．08,P=0．42）;HBVDNA阳性者血清IP-10（P=-0．016）和RANTEs（P=0．02）水平均明显高于HBV DNA阴性者。结论IP-10和RANTES的趋化作用广泛参与了机体对HBV免疫应答的各个阶段,并在肝脏组织的炎性损伤中发挥了作用。     

添加整蛋白型肠内营养粉剂对肝硬化患者营养状况及肝功能的影响

目的：探讨肠内营养对肝硬化患者营养状况及肝功能的影响。方法参照2006年欧洲肠内肠外营养学会（ESPEN）肝病肠内营养指南推荐,选取日总热量摄入低于推荐值的肝硬化患者57例,按患者意愿分成整蛋白型肠内营养粉剂支持治疗组30例,对照组（常规饮食组）27例。参照2006年 ESPEN 肝病肠内营养指南推荐给予营养支持治疗,治疗组给予添加整蛋白型肠内营养粉剂补充日热量摄入,对照组常规饮食。分别于24周和48周测定患者的上臂肌围（AMC）、检测总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）和总胆红素（TBil）;并观察随访期内两组肝硬化相关并发症的发生情况。组间比较采用独立样本 t 检验和χ2检验。结果入组前及第24周时,包括 AMC 在内的各项相关指标差异无统计学意义。第48周时,治疗组 AMC、TP、PA、Alb 均高于对照组,差异均有统计学意义 AMC 为（24．29±1．66比23．42±1．51,t＝2．05,P ＜0．05）、TP（62．76±2．26比60．25±2．61,t ＝3．87,P ＜0．05）、Alb（35．86±2．81比34．14±2．56,t＝2．41,P ＜0．05）、PA（109．72±16．71比101．62±15．92,t ＝2．09,P ＜0．05）,而48周时 TBil 在两组差异无统计学意义。随访期内治疗组肝性脑病和感染并发症发生较对照组显著减少（χ2＝4．780,P ＜0．05;χ2＝3．964,P ＜0．05）,而肝肾综合征和消化道出血两组比较差异无统计学意义。结论添加整蛋白型肠内营养粉剂能有效改善肝硬化患者营养状况及肝功能,减少部分肝硬化相关并发症的发生。     

慢性 HBV 携带者外周血巨噬细胞移动抑制因子、白细胞介素10和17水平的变化及其与临床指标的相关性

目的：探讨 HBV 携带者外周血巨噬细胞移动抑制因子（MIF）、白细胞介素（IL）17和 IL －10水平变化,及其与肝功能水平和 HBV DNA 定量的相关性。方法收集2012年2月－2013年12月于兰州市第二人民医院就诊的60例 HBV 携带者空腹血清样本,其中慢性 HBV 携带者39例,非活动性 HBsAg 携带者21例;采用 ELISA 法检测血清细胞因子 MIF、IL －17和 IL －10水平;采用荧光定量 PCR 法测定各组 HBV DNA 定量,应用全自动生化分析仪检测血清肝功能水平,进行临床相关性分析。同期50例健康体检者为对照组。计量资料组间比较采用配对 t 检验,相关性比较采用 Pearson 相关分析。结果与健康对照组相比,慢性 HBV 携带者组和非活动性 HBsAg 携带者组外周血 MIF、IL －17和 IL －10水平均显著升高,差异有统计学意义（t 值分别为4．50,3．11,9．99;6．28,4．11,14．96;P 值均＜0．01）,其中慢性 HBV 携带者组 MIF、IL －17和 IL －10水平低于非活动性 HBsAg 携带者组,但差异无统计学意义（P 值均＞0．05）。慢性 HBV 携带者中中病毒载量组患者 MIF 和 IL －17较其他组低,而 IL －10水平高于另外两组,但差异均无统计学意义（P 值均＞0．05）;HBV 携带者外周血 MIF、IL －17和 IL －10水平与 ALT、AST、TBil、Alb 以及 HBV DNA定量均无相关性（P 值均＞0．05）。结论细胞因子 MIF、IL －17和 IL －10在慢性 HBV 感染过程中可能起重要作用,检测血清细胞因子 MIF、IL －17和 IL －10水平可作为评估 HBV 携带者肝脏炎症严重程度的重要指标。     

慢性肾功能衰竭患者血脂质变化

为研究慢性肾功能衰竭患者血脂质变化，检测40例慢性肾功能衰竭患者血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白AI和B水平。结果显示，慢性肾功能衰竭患者血清甘油三酯及载脂蛋白B较对照组明显升高（1．27±0．60mmol／L比0．79±0．23mmol／L，P＜0．01；0．89±0．18g／L比0．80±0．17g／L，P＜0．05）；高密度脂蛋白胆固醇、载脂蛋白AI和载脂蛋白AI／B比值均明显降低（分别为1．07±0．47mmol／L比1．41±0．29mmol／L；1．26±0．28g／L比1．46±0．10g／L；1．41比1．82，P均＜0．01）。以上提示，慢性肾功能衰竭患者脂质代谢紊乱主要表现为甘油三酯和载脂蛋白B浓度升高，高密度脂蛋白胆固醇和载脂蛋白AI浓度降低。     

倍他乐克对慢性心力衰竭患者肿瘤坏死因子受体Ⅱ的影响

目的探讨倍他乐克对慢性心力衰竭患者血清sTNFR—Ⅱ水平治疗前后的影响。方法采用酶联免疫双抗体夹心法测定正常对照组（26例）及慢性心力衷竭患者（60例）血清sTNFR—Ⅱ水平。其中60例心力衰竭患者随机分为常规治疗组（30例）及倍他乐克治疗组（30例），疗程4周，治疗组患者治疗前、后采血测sTNFR—Ⅱ。结果心力衰竭患者治疗前较正常对照组血清sTNFR—Ⅱ水平明显升高，差异有统计学意义[（8．93±4．13）μg／L和（2．34±0．76）μg／L，P〈0．05]；心力衰竭常规治疗组及倍他乐克组治疗后血清sTNFR-Ⅱ水平均较治疗前明显降低，差异有统计学意义[（8．85±5．12）μg／L和（4．38±1．76）μg儿，（9．04±4．76）μg／L和（4．67±2．15）雌儿，P〈0．05]，但两组治疗后血浆STNFR—Ⅱ水平比较差异无统计学意义[（4．38±1．76）μg／L和（4．67±2．15）μg／L，P〉0．05]。结论慢性心力衰竭患者血清sTNFR—Ⅱ水平增高，倍他乐克不影响慢性心衰患者血浆sTNFR—Ⅱ水平。     

RA患者血清免疫球蛋白、急性时相蛋白、IL-27水平变化及意义

目的探讨血清免疫球蛋白、急性时相蛋白及IL-27在类风湿关节炎（RA）发病中的作用。方法选择56例RA患者（RA组）和同期健康体检者30例（对照组）,分别采用免疫散射比浊法测定血清免疫球蛋白（IgM、IgG、IgA）、急性时相蛋白[C反应蛋白（CRP）、α1-酸性糖蛋白（AAG）、触珠蛋白（HP）、铜蓝蛋白（CER）、转铁蛋白（TRF）、C3]及类风湿因子（RF）,ELISA法检测血清IL-27水平,魏氏法测定红细胞沉降率（ESR）;并对各指标之间的关系行Pearson相关性分析。结果RA组血清IgG、IgA、CRP、AAG、HP、CER、C3及IL-27均明显高于对照组,TRF明显低于对照组（P均〈0．05）;RA组血清IgG、IgA、CRP、AAG、HP、CER及C3与CRP、ESR均呈直线正相关（P均〈0．05）,TRF与CRP、ESR呈直线负相关（P均〈0．05）,CRP、AAG、HP、CER、TRF及C3与RF无明显相关性（P〉0．05）,IL-27与CRP、ESR及RF均无明显相关性（P〉0．05）。结论IgG、IgA、CRP、AAG、HP、TRF、C3及IL-27均参与了RA的发病过程,检测此类指标有助于RA的早期发现与诊断。     

肝硬化患者单纯腹水与合并自发性腹膜炎的鉴别诊断

目的寻找肝硬化单纯腹水与合并自发性腹膜炎（SBP）的临床鉴别指标。方法选取27例肝硬化腹水合并SBP患者（观察组）及32例单纯肝硬化腹水患者（对照组）,抽取清晨空腹时静脉血10mL,采用全自动生化分析仪检测两组血常规、肝功能指标[ALT、AST、TBIL、ALB、前白蛋白（PA）]、血清总胆固醇（TCH）、血清CRP,采用自动血凝分析仪检测血浆凝血酶原时间（PT）。两组均经腹腔穿刺抽取腹水60mL,全自动生化分析仪检测腹水常规和生化。结果两组肝功能指标、TCH及PT比较,P均〉0．05;两组血WBC及中性粒细胞比例、腹水WBC、ALB比较,P均〉0．05。观察组腹水中性粒细胞比例、血清／腹水蛋白梯度、血清CRP分别为70．69％±12．0％、（19．59±3．51）g／L、（16．59±12．34）mg／L,对照组26．94％±13．56％、（21．87±3．28）g／L、（10．57±9．45）mg／L,两组比较,P均〈0．05。结论腹水常规中性粒细胞比例、血清／腹水蛋白梯度、血清CRP可以作为鉴别诊断肝硬化单纯腹水与合并SBP的指标。     

虎眼万年青对四氯化碳致大鼠急性肝损伤防治作用的实验研究

目的研究虎眼万年青对大鼠急性肝损伤的防治作用。方法将实验大鼠随机分为正常对照组、四氯化碳（CCl4）急性肝损伤组、甘草酸二胺防治组和虎眼万年青防治组。观察各组大鼠肝功能和肝组织的变化。结果造模2周后，急性肝损伤组大鼠血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、前白蛋白（PA）分别为1012．5±443．74U／L、955．10±436．89U／L、14．7±2．58mg／L，虎眼万年青防治组分别为359．70±385．04U／L、451．50±297．84U／L、26．2±4．21mg／L，说明虎眼万年青能显著降低急性肝损伤大鼠血清ALT、AST的活性（P〈0．05），提高大鼠血清PA水平（P〈0．05），并改善肝组织炎性反应，作用与甘草酸二胺防治组无显著性差异（P〉0．05）。结论虎眼万年青对四氯化碳致大鼠急性肝损伤有明显的防治作用。     

丙型肝炎病毒感染者的血清甘露聚糖结合凝集素分析

目的分析丙型肝炎病毒（HCV）感染者的血清甘露聚糖结合凝集素（MBL）,探讨血清MBL水平与HCV感染及其致病程度的关系。方法收集HCV感染者128例,分成HCV携带者、轻度慢性丙型肝炎患者和中度慢性丙型肝炎患者三组。通过酶联免疫吸附法测定血清MBL的水平。结果HCV感染者血清MBL浓度均值为（1．729±0．529）μg／ml,高于正常对照组均值（0．974±0．305）μg／ml（P〈0．01）,且血清MBL水平随患者肝功能损害程度加重而增加。结论作为急性时相反应蛋白,血清MBL可反应HCV感染导致的慢性病理状态,它可能也参与肝脏纤维化的过程。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.