肝癌患者可溶性肿瘤坏死因子受体Ⅱ检测的临床意义

目的 进一步了解肝癌患者的异常免疫状态,探讨血清、腹水sTNFRⅡ检测的临床意义.方法 用双单抗夹心酶免疫吸附法检测25例肝癌、25例肝硬化患者血清腹水中和30例正常人血清sTNFR Ⅱ水平.结果 肝癌病人血清sTNFR Ⅱ浓度[(9.39±4.10)ng/ml]显著高于正常人和肝硬化患者(P＜0.01),同时肝硬化患者血清sTNFR Ⅱ浓度[(0.58±0.18)ng/ml]明显高于正常人[(0.31±0.16)ng/ml,P＜0.01].肝癌病人腹水sTNFRⅡ浓度[(9.13±5.26)ng/ml]亦显著高于肝硬化腹水sTNFR Ⅱ水平[(0.52±0.15)ng/ml,P＜0.01].肝癌、肝硬化患者血清、腹水sTNFR Ⅱ水平显著相关(r=1.00,P=0.00).肝癌血清sTNFRⅡ水平与外周血AFP和血小板数量呈正相关(r=0.432,P=0.05和r=0.513,P=0.03).结论 sTNFRⅡ的检测对反映肝癌患者的异常免疫状态,对肿瘤诊断具有实用价值.     

肝硬化患者转化生长因子和激活素A的检测及其意义

目的 探讨肝硬化患者血清转化生长因子(TGF)-β1及血清激活素A的变化及其意义.方法 经病史、临床生化、B超检查确诊的35例肝硬化患者,并以35名健康人作健康对照,应用酶联免疫吸附法(ELISA)测定其血清TGF-β1及激活素A的含量.结果 健康对照组血清TGF-β1[(31.9±11.9)ng/ml vs (53.2±18.7)ng/ml]及激活素A含量[(0.82±0.36)ng/ml vs(1.27±0.84)ng/ml]明显低于肝硬化组(P＜0.05).结论 测定肝硬化患者血清TGF-β1及ACT含量的变化,对肝硬化患者的早期诊断、治疗及预防有重要意义.     

类风湿关节炎急性期患者血清中瘦素及相关因子水平的变化

目的检测类风湿关节炎(RA)急性期患者血清中瘦素(leptin)及相关因子水平的变化,探讨Leptin在RA急性期发生过程中可能存在的意义。方法用高灵敏的放射免疫分析法及酶联免疫吸附试验(ELISA)测定RA患者血清中Leptin、白细胞介素(IL)-1β、IL-2及C反应蛋白(CRP)的水平。结果①RA组男性[(3．84±0．50)ng/ml]与正常对照组中男性[(0．89±0．13)ng/ml]相比,血清Leptin水平显著升高(P＜0．05)、RA组女性[(9．77±0．52)ng/ml]与正常对照组中女性[(1．78±0．26)ng/ml]相比,血清Leptin水平显著升高(P＜0．05)；②RA组患者与正常对照组相比,血清IL-1β、IL-2及CRP水平均显著升高(P＜0．05)；③经相关性分析发现各组Leptin水平的变化与IL-1β、IL-2及CRP水平的变化均无显著相关性。结论提示Leptin可能作为一种独立的炎症应答因子,在RA急性期发生过程中发挥重要作用。     

肝硬化患者血清和腹水激活素A的测定

目的　观察肝硬化患者血清和腹水激活素A浓度变化及其影响因素。方法　采用ELISA法分别测定 45例肝硬化患者 (Child PughA级 10例 ,B级 2 3例 ,C级 12例 )血清和腹水激活素A ,采用ELISA法测定 2 0名正常人血清激活素A。采用标准酶法测定血清门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶 (ALT)、碱性磷酸酶 (ALP)及尿素氮。结果　肝硬化患者血清激活素A的水平 ( 2 .71ng/ml± 1.90ng/ml)较对照组 ( 0 .2 1ng/ml± 0 .15ng/ml)明显升高 (P <0 .0 1)。Child PughA、B、C级肝硬化患者血清激活素A分别为 ( 1.44± 0 .16)ng/ml、( 1.95± 0 .45 )ng/ml和 ( 3 .0 8± 0 .65 )ng/ml,各级间比较差异有显著性 (P <0 .0 1)。血清激活素A与Child Pugh分级 (r =0 .894,P =0 .0 41)、ALT(r =0 .64 7,P =0 .0 0 0 )、AST(r =0 .5 5 0 ,P =0 .0 0 0 )及ALP(r=0 .3 2 8,P =0 .0 2 8)具有正相关性。肝硬化患者腹水激活素A水平为 ( 0 .43± 0 .2 4)ng/ml,Child PughA、B、C级肝硬化患者腹水激活素A分别为 ( 0 .3 9± 0 .2 1)ng/ml、( 0 .48± 0 .2 7)ng/ml和 ( 0 .41± 0 .2 2 )ng/ml ,各级之间比较差异有显著性 (P <0 .0 1) ;腹水激活素A与血清激活素A无相关性 ;与肾功能呈负相关 (r =-0 .415 ,P =0 .0 0 3 )。结论　肝硬化     

2型糖尿病合并乙型肝炎肝硬化患者不同糖化血红蛋白水平的血清细胞因子变化及其临床意义

目的观察T2DM合并乙型肝炎肝硬化(HBLC)患者不同HbA1c水平的血清细胞因子的变化。方法选取T2DM合并HBLC患者65例,根据HbA1c水平分为血糖控制良好组及血糖控制欠佳组,检测两组血清IL-2、IL-4、IL-6、IL-8、IL-10、干扰素γ(INF-γ)及TNF-α水平。结果血糖控制良好组血清细胞因子IL-2、TNF-α[(42.7±20.5)pg/ml、(30.5±20.2)ng/ml]低于血糖控制欠佳组[(58.2±23.8)pg/ml、(43.5±33.7)ng/ml],血糖控制良好组IL-4、IL-6、IL-8水平[(3.2±1.1)、(7.1±3.7)、(58.3±50.8)pg/ml]高于血糖控制欠佳组[(1.1±0.5)、(3.0±1.3)、(35.5±17.6)pg/ml,P0.05]。血清IL-8、INF-γ水平两组间差异无统计学意义(P0.05)。结论 T2DM合并HBLC患者血糖控制良好组对比血糖控制欠佳组辅助性T细胞1和2(Th1/Th2)细胞因子差异明显,其意义有待进一步探究。     

缬沙坦和尼群地平对原发性高血压患者血清可溶性粘附分子影响的对比研究

目的　对比研究缬沙坦和尼群地平对原发性高血压 (EH )患者血压及血清可溶性粘附分子sICAM 1,sVCAM 1水平的影响。方法　随机对照方法设计 ,将 6 4例轻中度原发性高血压患者分为两组 ,分别予缬沙坦 (80mg/d)和尼群地平 (10～ 30mg/d)治疗 6周 ,治疗前后抽血 ,用酶联免疫方法 (ELISA)测定外周血清中可溶性粘附分子sICAM 1,sVCAM 1水平。另选择 2 5例健康人作为对照组。结果　治疗前与对照组比较 ,高血压患者血清中可溶性粘附分子sICAM 1,sVCAM 1水平升高 ,分别为 [(318 2± 2 7 5 ) μg/Lvs (2 71 5± 2 6 8) μg/L ,P <0 0 5 ]和 [(5 90 6± 4 0 1) μg/Lvs (4 17 9± 38 7) μg/L ,P <0 0 1]。治疗后两组的血压均明显下降 (P <0 0 5 ) ,两组间无差异。缬沙坦组可溶性粘附分子sICAM 1,sVCAM 1水平均较治疗前明显下降 ,分别为[(32 0 5± 2 3 6 ) μg/Lvs (2 80 2± 2 5 4 ) μg/L ,P <0 0 5 ]和[(5 86 2± 4 2 5 ) μg/Lvs (4 5 1 2± 38 9) μg/L ,P <0 0 1]。而尼群地平组可溶性粘附分子sICAM 1,sVCAM 1水平较治疗前无明显下降 (P >0 0 5 )。结论　与尼群地平比较 ,缬沙坦不仅能有效降低血压 ,还能抑制血管壁的炎症反应 ,有利于预防和延缓动脉粥样硬化的发生和发展。     

丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化患者疗效及其对血清BGP水平的影响

目的探讨应用丁二磺酸腺苷蛋氨酸肠溶片联合复方甘草酸苷治疗酒精性肝硬化患者的疗效及其对血清骨钙素(BGP)水平的影响。方法 2016年3月～2018年2月我院诊治的酒精性肝硬化患者276例,采用随机数字表法分为观察组(n=138)和对照组(n=138)。给予对照组患者丁二磺酸腺苷蛋氨酸肠溶片口服,观察组患者在对照组治疗的基础上给予复方甘草酸苷注射液静脉滴注,治疗3 w。采用放射免疫法检测血清BGP水平,采用ELISA法检测血清胰岛素样生长因子1(IGF-1)水平,采用化学发光免疫法检测血清透明质酸(HA)、黏连蛋白(LN)、Ⅳ型胶原(IV-C)和Ⅲ型前胶原(PC-Ⅲ)水平。结果在治疗结束时,观察组血清ALB为(36.8±10.3) g/L,显著高于对照组[(29.4±9.2) g/L,P0.05],血清TBIL为(26.4±5.1)μmol/L,显著低于对照组[(47.3±9.4)μmol/L,P0.05],血清GGT水平为(158.6±72.8) U/L,显著低于对照组[(254.6±100.4) U/L,P0.05];观察组血清HA为(72.6±18.4)μg/L,显著低于对照组[(158.4±30.5)μg/L,P0.05],LN为(87.4±8.3)μg/L,显著低于对照组[(165.3±19.8)μg/L,P0.05],PC-Ⅲ为(94.5±31.3)μg/L,显著低于对照组[(147.4±42.5)μg/L,P0.05],IV-C为(64.3±9.5)μg/L,显著低于对照组[(98.4±26.4)μg/L,P0.05];观察组血清IGF-1水平为(198.2±34.6)ng/ml,显著高于对照组[(162.5±30.5) ng/ml,P0.05],BGP为(8.8±3.9) ng/ml,显著高于对照组[(6.7±3.0) ng/ml,P0.05]。结论应用丁二磺酸腺苷蛋氨酸肠溶片联合复方甘草酸苷治疗酒精性肝硬化患者近期疗效显著,可显著改善患者肝功能指标,可能与升高了血清IGF-1和BGP水平有关。     

血清sCD14与腹水乳铁蛋白在肝硬化自发性细菌性腹膜炎诊治中的意义

[目的]研究血清sCD14与腹水乳铁蛋白(LF)在肝硬化自发性细菌性腹膜炎诊治中的意义。[方法]选取我院在2014年3月~2016年7月期间收治的88例肝硬化患者,根据病患者病情将患者分成肝硬化自发性细菌性腹膜炎组(A组=30例)与单纯性腹水肝硬化组(B组=58例),同时另选取44例来我院做常规检查的健康居民作为对照组。抽取患者的血液以及腹水送至实验室进行检查,采用免疫层析法检测腹水乳铁蛋白,采用细胞分流术检测sCD14的表达水平,观察腹水乳铁蛋白与sCD14对肝硬化自发性细菌性腹膜炎患者的诊治意义。[结果]A组患者sCD14、WBC、ALT、AST为[(47.59±11.34)mg/L、(16.75±3.25)×10~9/L、(156.85±32.61)U/ml、(132.65±23.51)U/ml],显著高于B组与对照组[(3.64±0.57)mg/L、(8.41±1.21)×10~9/L、(45.26±6.61)U/ml、(36.43±9.62)U/ml,(0.52±0.11)mg/L、(7.45±1.03)×10~9/L、(37.24±5.14)U/ml、(31.24±5.41)U/ml,(P0.05)];A组患者LF阳性表达率为(90.00%)、表达水平为(162.52±37.21)ng/ml,显著高于B组[(17.24%)、(76.49±11.24)ng/ml、(P0.05)];经Spearman等级相关性分析显示,血清sCD14、腹水LF水平随自发性细菌性腹膜炎患者Child-Pugh分级升高而增加[r=0.814、r=0.734,P0.05]。组间比较,Child-PughC级患者血清sCD14与LF水平最高,Child-PughB级患者血清sCD14与LF水平次之,Child-PughA级患者血清sCD14与LF水平最低,经综合治疗后,A组患者sCD14与LF值为[(4.63±1.02)mg/L、(35.62±11.02)ng/ml],显著低于治疗前[(47.59±11.34)mg/L、(162.52±37.21)ng/ml,(P0.05)],B组患者治疗后sCD14与LF值为[(0.51±0.12)mg/L、(33.02±10.34)ng/ml],显著低于治疗前[(0.76±0.21)mg/L、(76.49±11.24)ng/ml,(P0.05)]。[结论]血清sCD14与腹水LF在肝硬化自发性细菌性腹膜炎的早期诊断中具有重要的临床意义,对自发性细菌性腹膜炎与无菌性腹膜炎具有鉴别诊断意义,并且还能用于预测Child-Pugh的分级,为临床上疾病评估提供相应的参考依据。     

肝硬化患者血清激活素A的变化

目的　观察肝硬化患者血清激活素A浓度变化及影响因素。方法　肝硬化 83例 (Child PughA级 3 2例 ,B级 3 0例和C级 2 1例 ) ,正常对照组 3 2例。血清激活素A、Ⅲ型前胶原肽、IV型胶原均采用酶联免疫吸附试验测定。结果　肝硬化患者血清激活素A升高 (1 3 3± 0 83ng/ml ,P <0 0 1) ;Child PughC级 (1 45± 0 3 9ng/ml)和B级 (1 47± 0 81ng/ml)分别较A级 (1 0 0± 0 3 5ng/ml,P <0 0 1)和正常对照组 (0 76± 0 .3 1ng/ml,P <0 0 1)升高 ,而A级与正常对照组、C级与B级之间血清激活素A水平无明显变化 (P>0 0 5) ,血清激活素A大于 1 13ng/m1的肝硬化患者中Chid PughB级和C级占 76 2 % (3 2 / 41)。在相应的Child Pugh分级中 ,并发肝性脑病、上消化道出血、继发感染及腹水患者中血清激活素A无明显变化 (P >0 0 5)。血清激活素A与Ⅲ型前胶原肽、IV型胶原和丙氨酸转氨酶 (ALT)呈正相关 (r=0 3 7,P <0 0 5;r=0 3 1,P <0 0 5;r=0 .2 4,P <0 .0 5) ,而与天门冬氨酸转氨酶 (AST)、胆汁酸、胆红素、清蛋白、凝血酶原时间无相关性 (P >0 0 5)。结论　肝硬化患者血清激活素A水平升高 ,激活素A可能参与了肝硬化的形成     

慢性乙型肝炎病毒感染者血清MIF、IL-17和IL-10水平变化

目的探讨HBV感染者外周血巨噬细胞移动抑制因子(MIF)、IL-17和IL-10水平变化的临床意义。方法收集60例慢性无症状HBV携带者、60例慢性乙型肝炎患者、60例乙型肝炎肝硬化患者、60例肝癌患者和50例健康对照者空腹血清,采用ELISA法检测血清MIF、IL-17和IL-10水平;采用荧光定量PCR法检测血清HBV DNA载量;采用全自动生化分析仪检测血清肝功能指标。结果与健康对照组[(1.9±1.4)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血MIF水平均显著升高[分别为(5.7±2.8)ng/ml、(10.5±4.1)ng/ml、(17.7±7.4)ng/ml、(19.8±9.9)ng/ml,P0.01],其中HCC组最高,ASC组最低;与健康对照组[(4.4±2.2)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血IL-17水平均显著升高[分别为(8.6±4.3)ng/ml、(20.7±6.6)ng/ml、(23.4±15.1)ng/ml、(16.0±8.7)ng/ml,P0.01或P0.05],其中LC组最高,ASC组最低;与健康对照组[(12.9±4.6)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血IL-10水平均显著升高[分别为(237.2±72.9)ng/ml、(184.68±59.0)ng/ml、(356.6±150.8)ng/ml、(287.9±88.8)ng/ml,P0.01],其中LC组最高,CHB组最低。结论 MIF、IL-17和IL-10在慢性HBV感染过程中可能起重要作用,检测血清细胞因子水平可作为评估慢性乙型肝炎病情严重程度的重要指标。     

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.     

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.     

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.     

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.