粘附分子P选择素在老年肾病综合征患者肾组织中的表 …

目的：探讨粘附分子Ｐ选择素（ＣＤ６２Ｐ）在老年肾病综合征（ＮＳ）中的变化。方法：采用流式细胞术和直接免疫荧光标记单克隆抗体对老年ＮＳ患者周围血和肾活检组织进行了ＣＤ６２Ｐ的研究。结果：（１）２６例老年ＮＳ患者周围血ＣＤ６２Ｐ表达量较正常组显著增高，；（２）肾组织中显示ＣＤ６２Ｐ表达２２例（８４．６２％），表达部位常见于肾小球系膜区、血膜袢，其次为肾小管、间质小血管及球囊壁。（３）ＣＤ６２Ｐ在周围血     

不同龄SHR心肌细胞内Ca~（2＋）及心肌组织NE含量的变化

采用荧光探针结合计算机图像处理技术测定幼年、成年、老年ＳＨＲ心肌单细胞内游离Ｃａ~（２＋）浓度，采用高压液相色谱法测定幼年、成年、老年ＳＨＫ心肌去甲肾上腺素（ＮＥ）含量。结果显示随着年龄增加，ＳＨＲ心肌细胞内游离Ｃａ~（２＋）增加，而心肌组织ＮＥ含量下降。与老年ＷＫＹ大鼠比较，老年ＳＨＲ心肌细胞内Ｃａ（２＋）含量较高（Ｐ＜０．０１），而其心肌组织ＮＥ含量却较少（Ｐ＜０．０５）。本研究提示心肌组织ＮＥ与ＳＨＲ的血压升高及心肌细胞内游离Ｃａ~（２＋）增多无直接关系。＊Ｐ＜０．０１，ａ．ｖｓ．ＳＨＲ２ｍ，ｂ．ｖｓＳＨＲ６ｍ，ｃ．ｖｓ．ＳＨＲ１２ｍ３不同年龄阶段ＳＨＲ心肌组织ＮＥ含量ＳＨＲ的年龄越大，其心肌组织ＮＥ的含量越少，各年龄组之间均有显著差异（Ｐ＜０．０１）。与老年ＷＫＹ大鼠比较．老年ＳＨＲ是心肌组织ＮＥ含量明显降低（Ｐ＜０．０５）（Ｆｉｇ３）。Ｆｉｇ３ＮＥｃｏｎｔｅｎｔｓｉｎｃａｒｄｉａｃｔｉｓｓｕｅｓＩｎＳＨＲｓｏｆｖａｒｉｏｕｓａｇｅｓａｎｄｅｌｄｅｒＷＫＹｒａｔｓ：Ｐ＜０．０５．＊：Ｐ＜０．０１，ａ．ｖｓ．ＳＨＲ２ｍ，ｂ．ｖｓＳＨＲ６ｍ．ｃ．ｖｓＳＨＲ１２ｍ．ＤＩＳＣＵＳＳＩＯＮＦｕｒａ－２能选择性地     

血清,唾液铜锌超氧化物岐化酶测定在呼吸病中的应用

作者测定了呼吸系疾病患者血清、唾液ＣｕＺｎ－ＳＯＤ含量，并与正常组对照比较，结果显示：重度肺结核血清ＣｕＺｎ－ＳＯＤ含量显著低于轻、中度患者（Ｐ＜０．０１），轻、中度肺结核治疗后ＣｕＺｎ－ＳＯＤ较治疗前明显降低（Ｐ＜０．０１）。肺癌组显著低于肺炎组（Ｐ＜０．０１）。     

补体膜攻击复合物和CD59在不同免疫病理类型IgA肾病发病机理中的作用

为进一步阐明导致不同免疫病理类型ＩｇＡ肾病（ＩｇＡＮ）患者预后不同的机理，应用ＰＡＰ四层法对２８例肾小球单纯ＩｇＡ沉积（单纯ＩｇＡ组）及３２例ＩｇＧ、ＩｇＡ、ＩｇＭ共同沉积（ＧＡＭ组）ＩｇＡＮ患者肾组织膜攻击复合物（ＭＡＣ）和ＣＤ５９的分布情况，结合其肾小球内沉积的补体成分以及病理改变和临床特点进行了分析，结果表明：单纯ＩｇＡ组临床表现、病理改变轻，ＧＡＭ组临床表现、病理改变重。ＧＡＭ组肾组织经典途径补体成分Ｃｌｑ、Ｃ４沉积（均为Ｐ＜０．０１），肾小球系膜区及毛细血管袢ＭＡＣ沉积（分别为Ｐ＜０．０５、Ｐ＜０．０１），肾小球硬化＞２５％（Ｐ＜０．０５）和中重度小管间质病变的发生率（Ｐ＜０．０５），均较单纯ＩｇＡ组明显增多，且ＧＡＭ组皮质区域间质面积较单纯ＩｇＡ组明显增宽（Ｐ＜０．０１）。尽管ＣＤ５９在两组中分布无统计学差异，但若按肾小球ＣＤ５９分布强度将患者分为Ａ组（＋）和Ｂ组（２＋），结果发现ＣＤ５９Ａ组肾小球硬化＞２５％（Ｐ＜０．０５），中重度小管间质病变的发生率明显增多（Ｐ＜０．０１），皮质区域间质面积明显增宽（Ｐ＜０．０１）。在硬化的肾小球内ＭＡＣ分布多而ＣＤ５９分布少     

非小细胞肺癌组织蛋白酶D的表达及与预后的关系

目的探讨组织蛋白酶Ｄ（ＣＤ）表达与肺癌患者预后的关系。方法采用链霉抗生物素蛋白－过氧化物酶（Ｓ－Ｐ）快速免疫组织化学法检测非小细胞肺癌（ＮＳＣＬＣ）患者肺癌组织和配对淋巴结标本中ＣＤ表达。结果６６％（４２／６４）的肺癌组织ＣＤ表达阳性，其中鳞癌为５７％（１７／３０），腺癌为７４％（２５／３４）。在３５例转移淋巴结标本中，２０例５７％ＣＤ阳性。Ⅲ～Ⅳ期肺癌病例中，肺癌组织ＣＤ表达高于Ⅰ～Ⅱ期病例（Ｐ＜０．０５）。腺癌伴有淋巴结转移组，ＣＤ表达显著高于淋巴结阴性组（Ｐ＜０．０１）。结论肺癌组织ＣＤ高表达与肿瘤临床分期和腺癌的淋巴结转移关系密切，ＣＤ有可能作为ＮＳＣＬＣ患者的预后指标。     

扩张型心肌病白细胞介素2受体的初步研究

检测２０例扩张型心肌病（ＤＣＭ）及２０例正常人（ＮＣ）的血清可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）及外周血单个核细胞膜白细胞介素２受体（ＩＬ－２Ｒ）的表达。结果发现，ＤＣＭ患者ＳＩＬ－２Ｒ明显高于ＮＣ组（Ｐ＜０．００１），而膜ＩＬ－２Ｒ表达低于ＮＣ组（Ｐ＜０．０１），提示ＩＬ－２Ｒ在ＤＣＭ发病中可能有一定意义。     

老年高血压患者血压昼夜节律与胰岛素抵抗

目的为了探讨高血压病患者２４ｈ血压昼夜节律变化与糖、胰岛素（ＩＳ）代谢的关系。方法４６例老年高血压病患者，按昼夜血压节律不同，分为杓型组（ＤＧ）与非杓型组（ＮＤＧ），行葡萄糖耐量试验和ＩＳ释放试验。结果ＤＧ与ＮＤＧ２组各时相血糖、血糖面积及空腹ＩＳ水平无显著性差异（Ｐ＞００５）；而ＮＤＧ在糖负荷后的６０ｍｉｎ、１２０ｍｉｎＩＳ水平和ＩＳ释放指数（ＩＲＩ）以及ＩＳ面积（ＩＡＵＣ）明显高于ＤＧ（Ｐ＜００１、００５、００１、０００１、００１）；ＤＧ的ＩＳ敏感指数（ＩＳＳＩ）明显大于ＮＤＧ（Ｐ＜００１）；夜间平均血压下降率与ＩＡＵＣ、１２０ｍｉｎＩＲＩ及６０ｍｉｎＩＳ水平呈显著负相关（γ＝－０５９８、－０５１１和－０４８６，Ｐ＜００１、００１和００５），与１２０ｍｉｎＩＳＳＩ呈显著正相关（γ＝０４６２，Ｐ＜００１）。结论老年高血压节律异常者有更显著的胰岛素抵抗及高胰岛素血症。     

冠心病患者周围血一氧化氮、肿瘤坏死因子变化的意义及开搏通的影响

本文通过对４８例冠心病（ＣＨＤ）患者外周血一氧化氮（ＮＯ）、肿瘤坏死因子（ＴＮＦ）的测定及开搏通治疗前后的对比，结果显示：ＣＨＤ患者周围血ＮＯ明显降低（Ｐ＜０．０１），ＴＮＦ显著高于正常（Ｐ＜００１），且与病情严重程度相一致，接受开搏通治疗三周后，ＮＯ有所回升，ＴＮＦ明显下降，治疗前后比较有显著差异（Ｐ＜００１），提示ＮＯ，ＴＮＦ参与ＣＨＤ的发病过程开搏通具有治疗意义。     

氧疗及正压通气对慢性阻塞性肺病患者夜间低氧血症的疗效

为了观察夜间氧疗及加用持续正压通气对急性加重期慢性阻塞性肺病（ＣＯＰＤ）患者夜间低氧血症的治疗效果，用脉搏氧饱和度仪对５８例患者进行监测描记，并作动脉血气分析。结果表明，白天动脉血氧分压（ＰａＯ２）、动脉血二氧化碳分压（ＰａＣＯ２）及基础脉搏氧饱和度（ＳｐＯ２）与夜间平均脉搏氧饱和度（ＭＳｐＯ２）之间有显著的正相关（ｒ＝０．７０２，ｒ＝０．６１３，ｒ＝０．６０５，Ｐ值均＜０．０１），与夜间呼吸空气时比较，３７例患者夜间氧疗效果良好，夜间平均ＳｐＯ２、平均最低ＳｐＯ２（ｍＳｐＯ２）升高（Ｐ＜０．０１），氧降累计时间百分比（ＣＴＮＯＤ％）降低（Ｐ＜０．０１）。其余２１例患者疗效不佳，改用夜间氧疗加持续正压通气（ＢｉＰＡＰ）后效果极好，夜间ＭＳｐＯ２、ｍＳｐＯ２与ＣＴＮＯＤ％三项指标均显著改善（Ｐ＜０．０１），且睡后ＰａＯ２升高（Ｐ＜０．０１），ＰａＣＯ２降低（Ｐ＜０．０１）。证实夜间氧疗能纠正多数ＣＯＰＤ患者的夜间低氧血症，对疗效不良者加用无创持续正压通气可获满意效果。     

CD44在肺癌中表达的临床研究

目的观察标准型白细胞分化抗原（ＣＤ４４ｓ）及变异型白细胞分化抗原（ＣＤ４４ｖ６）在肺癌中的表达情况及同肺癌淋巴结转移的关系。方法以ＳＰ法对９６例原发性肺癌及１２例转移淋巴结行免疫组化研究。结果在小细胞肺癌（ＳＣＬＣ）中，未见ＣＤ４４表达；而在非小细胞肺癌（ＮＳＣＬＣ）中，鳞癌（ＳＣＣ）的ＣＤ４４表达明显高于腺癌（ＡＤＣ）（Ｐ＜０．０１）；在１２例转移淋巴结中，１０例（８３％）表达ＣＤ４４ｖ６阳性；同未发生淋巴结转移的原发性肺癌（５１％）相比，发生转移的原发性肺癌中ＣＤ４４ｖ６表达明显增多（９１％，χ２＝１４．９２，Ｐ＜０．０１）；ＣＤ４４ｓ及ＣＤ４４ｖ６表达同肺癌分化程度无关；按ＴＮＭ分期，Ⅲ＋Ⅳ期中ＣＤ４４ｖ６表达显著高于Ⅰ＋Ⅱ期肺癌（χ２＝６．０５，Ｐ＜０．０５）。结论ＣＤ４４大部分表达于ＮＳＣＬＣ中，且主要在ＳＣＣ中；ＣＤ４４ｖ６阳性可能预示ＮＳＣＬＣ发生淋巴结转移的倾向，并可能对肺癌临床分期起到一定作用     

Left atrial platelet activity with rheumatic mitral stenosis: correlation study of severity and platelet P-selectin expression by flow cytometry

BACKGROUND: Previous studies have demonstrated that platelet activation, evaluated by measuring the secretory substances of platelets (ie, platelet factor 4 and beta-thromboglobulin), occurs in the peripheral blood of patients with rheumatic mitral stenosis (MS). However, the differences in platelet activation between peripheral and atrial blood, and the relationship between regional left atrial platelet P-selectin expression and the severity of MS have never been investigated. METHODS AND RESULTS: A total of 16 patients with symptomatic MS undergoing percutaneous transluminal mitral valvuloplasty were studied (group 1). The fractions of platelets expressing P selectin in the prevalvuloplasty left atrial, right atrial, peripheral venous, and arterial blood were determined by flow cytometry. The mitral valve area was calculated by means of the Doppler pressure half-time method. Peripheral venous platelet activity also was evaluated in 23 control patients (including 15 healthy volunteers who were in sinus rhythm [group 2] and 8 patients who had chronic lone atrial fibrillation [group 3]). The fraction of peripheral venous platelets expressing P selectin among group 1 patients was significantly higher than that of group 2 or 3 patients (p = 0.008). In group 1 patients, the fraction of platelets expressing P selectin in the left atrium was significantly higher than that in the right atrium, the femoral vein, or the femoral artery (p < 0.01). Correlation analysis demonstrated that there was a significantly direct relationship between the severity of MS and the fraction of left atrial platelets expressing P selectin (p = 0.01; r = -0.620). The fraction of peripheral venous platelets expressing P selectin among group 2 patients did not differ from that of group 3 patients CONCLUSIONS: In patients with rheumatic MS, increased regional left atrial platelet P-selectin expression had a significantly direct relationship with the severity of MS. The increased regional left atrial platelet P-selectin expression was not reflected in peripheral venous blood samples.     

膜性肾病合并Alport综合征

报道1例中年男性患者临床为肾病综合征伴血压升高,无听力及视力的下降,无肾脏病家族史;肾活检光镜及常规免疫荧光符合肾小球膜性病变,但肾间质见簇状分布的泡沫细胞,进一步行肾组织IV型胶原染色及电镜检查,最终明确合并Alport综合征。     

Immunopathology of the nephrotic syndrome associated with renal vein thrombosis. Report of two cases and brief review of the literature

Renal tissue from two patients with the nephrotic syndrome and renal vein thrombosis was studied by immunofluorescence microscopy in addition to conventional histologic and electron microscopic technics. Granular deposits of immunoglobulins G (IgG), M (IgM) and beta₁ C/beta₁ A globulin (one case) were seen by fluorescence microscopy along the basement membranes in a pattern similar to that observed in patients with chronic membranous nephropathy and in the experimental model of chronic serum sickness. Renal vein thrombosis, associated with the nephrotic syndrome, is not clearly separated clinically or pathologically from primary glomerular disease with the nephrotic syndrome. In view of the lack of experimental evidence to show that either the glomerular lesion or the proteinuria is the result of elevated venous pressure alone, the pathogenesis of the lesion must remain in doubt.     

Immune-complex glomerulonephritis in a patient with mixed connective tissue disease.

Renal involvement and hypocomplementemia in mixed connective tissue disease are reported to be rare. A patient is described here with mixed connective tissue disease and persistently low serum C'3 levels in whom renal insufficiency and nephrotic syndrome developed secondary to immune-complex glomerulonephritis. Light microscopy of the renal biopsy specimen showed predominantly a membranous lesion. Immunofluorescent staining showed granular deposition along the basement membrane of immunoglobulin G, immunoglobulin M, fibrinogen and C3. Electron microscopy showed numerous electron-dense deposits along the glomerular capillary membrane and in the mesangium.     

Glomerular deposition of tumor antigen in membranous nephropathy associated with colonic carcinoma

Renal biopsy in a 60 year old man with idiopathic nephrotic syndrome revealed the characteristic light, immunofluorescent and electron microscopic features of membranous nephropathy. Elevated serum levels of carcinoembryonic antigen (CEA) were present, and a colonic carcinoma was found and resected. CEA could not be demonstrated in the glomerular immune deposits. An antibody was demonstrated in the patient's serum 1 week after resection of the tumor which was reactive with an antigen deposited on the glomerular basement membrane. This reactivity was specifically abolished by absorption of the serum with homogenates of the patient's tumor, but it was not altered by absorption with normal colon, colonic polyps, liver or spleen. The nephrotic syndrome persisted after resection of the tumor. A renal biopsy 4 months later showed evidence of complex resolution, and the tumor-associated antigen was no longer detectable in glomeruli.The nephrotic syndrome associated with colonic carcinoma in this patient appeared to be mediated by glomerular deposition of immune complexes containing a tumor antigen. Apparent complete removal of the source of antigen was followed by evidence of complex resolution but had no effect on the nephrotic syndrome.     

Paediatric T cell Lymphoma with Nephrotic Syndrome: A Rare Association

Renal involvement is frequent in hematologic malignancies especially Hodgkin’s lymphoma. Renal complications in children with malignancies primarily arise from tumour lysis syndrome, malignant infiltration or obstruction of the urinary tract, deposits of immunoglobulin fractions or crystals, renal infiltration by malignant cells, paraneoplastic or storage glomerulopathies. Nephrotic syndrome has been described in B cell type Non Hodgkin’s lymphomas. There are very few reports of association of T cell lymphoma and nephrotic syndrome in pediatric patients. We present a case of peripheral T cell lymphoma with nephrotic syndrome in a 10 year old boy.     

Spontaneous remission of the nephrotic syndrome in diabetic nephropathy

A 28 year old woman, with diabetes since age 18, had the nephrotic syndrome, hypertension and renal insufficiency. The initial renal biopsy specimen revealed diffuse glomerulosclerosis with early nodular changes. After an initial decline in renal function, her creatinine clearance progressively improved and has remained normal. Within 2 years she had a spontaneous remission of the nephrotic syndrome despite the presence of more pronounced nodular glomerular lesions. Although the renal hemodynamic functions were normal, certain tubular functions were impaired. Since we found no etiology for the nephrotic syndrome other than diabetic glomerulopathy, the complete remission of the nephrotic syndrome and improvement in renal function were very unusual events.     

Nephrotic syndrome in Hodgkin's disease. Evidence for pathogenesis alternative to immune complex deposition.

The nephrotic syndrome has been reported to occur in patients with Hodgkin's disease even in the absence of amyloidosis, tumor infiltration of renal vein thrombosis. Three patients are presented with Hodgkin's disease and the nephrotic syndrome whose renal biopsy specimens studied with light, immunofluorescence and electron microscopy were compatible with "lipoid nephrosis" (minimal change disease). A review of the literature reveals 35 patients with Hodgkin's disease and the nephrotic syndrome. Renal tissue was available for examination in only 27 patients. The majority of patients apparently had glomerular alterations consistent with lipoid nephrosis. The nephrotic syndrome in most of these patients remitted with a variety of methods of therapy (including excision, irradiation, prednisone and cyclophosphamide) and tended to relapse with a recurrence of Hodgkin's disease. In three-fourths of the patients with Hodgkin's disease and the nephrotic syndrome, the Hodgkin's disease was of a mixed cellularity type. The etiology of lipoid nephrosis, although unclear, may be a consequence of altered lymphocyte function. Hodgkin's disease is a malignancy involving T lymphocytes, and the nephrotic syndrome occurring in the course of Hodgkin's disease may be a result of an adverse effect of glomeruli by products of tumor lymphocytes rather than of glomerular deposition of immune complexes.     

Comparison of renal disease severity and outcome in patients with primary antiphospholipid syndrome, antiphospholipid syndrome secondary to systemic lupus erythematosus (SLE) and SLE alone

OBJECTIVE: To ascertain the clinical presentation, histopathology and outcome of renal involvement in patients with primary antiphospholipid syndrome (PAPS), antiphospholipid syndrome secondary to systemic lupus erythematosus (SAPS) and systemic lupus erythematosus alone. METHOD: A retrospective analysis was undertaken of 20 patients with PAPS, 25 patients with SAPS and 275 patients with systemic lupus erythematosus to ascertain the frequency and pattern of renal involvement. RESULTS: Renal involvement was found most frequently in patients with SAPS, in whom it occurred in 68% of patients. Renal disease was equally common in patients with PAPS and systemic lupus erythematosus alone where it was seen in 30% of patients. Patients with systemic lupus erythematosus most frequently presented with nephrotic syndrome due to glomerulonephritis, whereas those with PAPS and SAPS were more likely to present with hypertension and reduced glomerular filtration rate. No patients with PAPS developed end-stage renal failure compared with 5.9% of patients with SAPS and 16.9% of patients with systemic lupus erythematosus alone; 23.5% of patients with SAPS died compared with 15.7% of patients with systemic lupus erythematosus alone and no patients with PAPS. CONCLUSION: Renal involvement is a major feature of both PAPS and SAPS, where renal thrombosis frequently leads to reduced glomerular filtration rate and hypertension. One-third of patients with systemic lupus erythematosus alone develop glomerulonephritis leading to renal disease which most commonly presents with nephrotic syndrome. Patients with PAPS were less likely to develop end-stage renal failure or die during the follow-up period.     

狼疮肾炎患者肾组织中载脂蛋白E的表达及意义

目的 了解狼疮肾炎(LN)肾组织中载脂蛋白E(APOE)的表达,并探讨其与LN肾脏病理改变和肾功能损害的关系.方法 用免疫组织化学方法对40例LN患者.肾组织APOE的表达进行检测,并对其与LN的肾脏病理改变和肾功能损害的相关性进行分析.结果 健康肾脏组织有较弱的ApoE表达;LN肾组织APOE的表达较健康肾组织明显增高[肾小球(31.2±11.0)与(3.0±1.6);肾小管(71.64±8.90)与(0.60±0.06)],并且Ⅳ型LN患者肾组织APOE表达量高于非Ⅳ型LN患者[肾小球(38.4±4.5)与(18.0±4.6);肾小管间质(77.6±2.5)与(60.0±3.2)];Spearman相关分析显示LN肾组织ApoE的表达与LN肾脏病理活动指数和肾功能呈显著相关(P＜0.01).结论 LN患者肾脏组织中ApoE的表达增高,尤以Ⅳ型LN为著,其表达量可反映LN肾脏活动性病变及肾脏损害情况.