1242例受血患者输血前相关病原标志物检测结果分析

目的：对受血患者进行输血前相关病原学标志物的检测，了解患者输血前状况，预防临床输血引起的医疗纠纷。方法：用酶联免疫吸附试验技术（ELISA）对1242例受血患者进行乙肝病毒标志物以及艾滋病（HIV）抗体、丙型肝炎（HCV）抗体检测；用甲苯胺红不加热血清反应素试验对梅毒进行检测。结果：1242例受血患者HBsAg阳性率为10．15％；HBcAb（IgG）阳性率为10．15％；HBeAg阳性率为2．90％；HBeAb阳性率为6．28％；HCV抗体阳性率为0．97％；HIV抗体阳性率为0％；梅毒阳性率为0．32％。结论：HIV、病毒性肝炎及梅毒等感染途径多种多样，判断是否由输血所致，必须对受血患者进行输血前相关病原学标志物的检测，及时发现阳性患者，否则感染来源难以界定，极易造成医疗纠纷。     

抗环瓜氨酸肽抗体对类风湿关节炎和丙型肝炎相关关节病鉴别诊断的意义

目的检测血清抗环瓜氨酸肽抗体（抗CCP抗体）和类风湿因子（RF）在类风湿关节炎（RA）和丙型肝炎病毒（HCV）相关关节病中的阳性率，探讨抗CCP抗体检测在RA和HCV相关关节病鉴别诊断中的意义。方法42例RA和38例HCV感染患者作为研究对象；30名健康体检者为正常对照组。采用酶联免疫吸附试验（ELISA）定量检测抗CCP抗体浓度，采用免疫散射比浊法定量测定RF浓度。结果血清抗CCP抗体在RA组阳性率为86％（36／42），而在HCV感染组和正常对照组均为阴性。同HCV感染组和正常对照组相比，RA组血清抗CCP抗体水平差异有统计学意义（86％ VS 0，P〈0.01）。血清RF在RA组阳性率为79％（33／42）：HCV感染组阳性率是42％（16／38），健康对照组阳性率是7％（2／30）。而在16例RF阳性HCV感染患者中，HCV相关关节病占81％（13／16），无关节受累者占19％（3／16）；13例HCV相关关节病中，多关节痛者占85％（11／13），RA样多关节受累者占15％（2／13）；RF在HCV相关关节病与RA之间差异无统计学意义（81％ VS 79％，19〉0．05）。结论血清抗CCP抗体测定更有助于RA与HCV相关关节病的鉴别诊断。     

干扰素α联合利巴韦林治疗丙型肝炎病毒与人类免疫缺陷病毒混合感染

目的观察干扰素α联合利巴韦林对中国人丙型肝炎病毒（HCV）与人类免疫缺陷病毒（HIV）混合感染（HCV／HIV）患者的治疗效果及不良反应，并与其对单独HCV患者的治疗进行对比。方法10例HCV／HIV患者和17例HCV患者，以肌肉注射干扰素α5MU，隔日1次，口服利巴韦林0．3g，3次／d，动态观察两组的HCV RNA水平和HIV RNA水平，CD^4＋和CD8^＋ T淋巴细胞计数，主要的肝功能和血细胞指标，以及主要的不良反应。结果HCV／HIV患者与HCV患者治疗l2周和24周，HCV RNA较用药前平均分别下降1．14log（t-3．843，P〈0．01）和2．08log（f=6．564，P〈0．01），1．48log（f=6．438，P〈0．01）和2．33log（t=7．343，P〈0．01）;同时HIV RNA也较用药前平均下降了1．22log（t=3．662，P〈0．01）和1．73log（t=6．119，P〈0．01），但两组用药前后的CD4^＋、CD8^＋T淋巴细胞计数变化不大；27例患者的氨基转移酶除2例稍高以外其余均降至正常值。用药过程中部分病例发生流感样症状和消化道反应（多见于用药早期），白细胞总数和血红蛋白各有4例轻度下降；未发现明显精神神经异常和自身免疫疾病表现。结论以干扰素α联合利巴韦林治疗中国人HCV／HIV患者，用药24周的抗HCV效果不低于两种药物联合治疗单独HCV患者的效果，并有一定的抗HIV作用。两组的生化反应和不良反应差异无统计学意义。     

AIDS相关型卡波西肉瘤的内镜表现

目的探讨获得性免疫缺陷综合征（AIDS）相关型卡波西肉瘤（KS）的内镜下表现及内镜诊断价值。方法回顾分析16例确诊为HIV／AIDS且行胃镜检查患者的临床资料,总结其中胃镜检查发现的3例KS患者的内镜下表现。结果KS阳性发现率为18．75％（3／16）,其中单发者1例（占33．3％）、多发者2例（占66．6％）。3例以胃部KS为主,内镜下主要表现为斑丘疹样、息肉样及结节样改变;其中1例多发者伴十二指肠降部KS,表现为小的红褐色扁平病变。结论AIDS相关型KS在胃内的表现形式多样,平坦或隆起性病变表面丰富的毛细血管是较突出的特征,内镜检查对HIV／AIDS患者的诊断具有一定临床意义。     

湖南地区3545例结核病患者梅毒螺旋体感染情况分析

目的：分析湖南地区结核病（ TB）患者中梅毒螺旋体（ TP）感染状况及特征。方法采集3545例TB患者静脉血进行TP相关血清学检测,同时收集患者临床资料并行流行病学调查。结果3545例TB患者中共检出TP感染106例（2．99％）。不同年份TB患者TP感染率差异有统计学意义（P＜0．01）,且总体呈上升趋势。男性TP感染率（3．75％）高于女性（2．04％）,P＜0．01。21～50岁组感染率（4．53％）、51～88岁组感染率（3．20％）高于6～20岁组（1．03％）,P均＜0．01。职业不详（含不便分类者）感染率（5．25％）＞工人组（2．68％）＞农民组（2．56％）,P均＜0．01。检出3种合并感染模式,共计17例（占16．04％）。其中TP合并HBV、TP合并HCV双重感染分别为12例（0．34％）、4例（0．11％）;TP、HBV、HIV三重感染1例（0．28‰）。结论湖南地区TB患者有着较高的TP感染率,且伴有HCV和HIV合并感染的趋势。应进一步加大TB患者中TP、HBV、HIV、HCV监测力度,制定有针对性的防治对策。     

HIV并HCV和（或）HBV临床及流行病学特点分析

目的探讨人类免疫缺陷病毒（HIV）感染并乙型肝炎病毒（HBV）和（或）丙型肝炎病毒（HCV）的临床及流行病学特点。方法回顾性分析89例HIV感染并HBV和（或）HCV患者的临床流行病学资料。结果HBV混合感染25例,其中10例出现肝酶升高,6例伴黄疽;HCV混合感染56例,其中22例出现肝酶升高,4例伴黄疸;HIV、HBV、HCV三重感染8例,6例出现肝酶升高,3例出现黄疸。HBV混合感染、HCV混合感染及三重感染对肝酶影响无显著性差异,黄疸发生率三重感染最高,HCV混合感染最低;输血、性传播、单采血浆、不详途径以及吸毒的构成比为48．3％、20．2％、16．9％、10．0％、5．6％。结论HIV患者HCV混合感染发生率高于HBV混合感染;黄疸发生率HCV混合感染最低;性传播途径呈上升趋势。     

云南省616例艾滋病病毒感染者死亡报告的临床临床表现分析

目的：通过分析云南省艾滋病病毒（HIV）感染者死亡报告的临床表现和死因，为HIV感染者的关怀提供参考。方法：用EPI软件进行资料的输入和数据处理。结果：（1）报告死亡数呈逐年上升趋势。（2）在616例HIV感染死亡者中，354例具有死亡报告中所列的主要症状，进行性体重下降上95．2％（337／354），持续发热占72．3％（256／354），持续腹泻占51．1％（181／354）。（3）在290例具有次要临床表现的HIV感染死亡者中，持续性咳嗽者79．3％（230／290），口腔白色念珠菌感染占25．2％（73／290），持续性全身淋巴结肿大占19．3％（56／290），全身多形性皮疹占12．1％（35／290）。（4）在106例具有特殊临床表现的HIV感染死亡者中，结核病占54．7％（58／106），神经系统病变占44．3％（47／106）。此外，报告的HIV感染死亡者，一般情况较差，具有乏力，纳差，极度消瘦乃至恶病质，占死亡者报告的占87．4％（188／215）。（5）艾滋病（AIDS）和疑似AIDS是HIV感染的主要死因，占57．8％（356／616）；吸毒过量占20．6％（127／616），艾滋病相关综合征（ARC）和非疾病因素（自杀、意外伤害和打架）分别占了6．0％（37／616）和6．3％（39／616）；1．5％（9／616）死于疟疾，注射假毒品和引产，有63．3％（390／616）的HIV感染者在诊断HIV感染或AIDS时已经死亡。81．1％（353／435）的HIV感染者死于家中，4．65（20／435）死于医院，14．3％（62／435）死于其它地方。还有181例死亡地点不详。结论：云南省HIV感染者的死亡呈逐年上升趋势，HIV感染者急需得到医疗和翔服务。开展抗病毒治疗和控制HIV感染者的各种机会性感染，加强健康教育和减少毒品危害，加强对HIV感染者的社会和家庭关怀，加强基层对HIV／AIDS的识别诊断能力，早发现和早治疗是降低HIV／AIDS病死率，提高感染者生命质量的重要措施。     

HBV和戚HCV协同感染与接受HAART治疗HIV／AIDS患者肝损害之间的关系研究

目的探讨接受HAART治疗的HIV／AIDS患者肝损害的相关危险因素。方法收集接受HAART治疗的71例HIV／AIDS患者病例资料，比较两组患者的年龄、性别、感染途径、饮酒状况、CD4^＋T细胞数、HAART治疗方案、肝毒性药物的使用、HBV和／或HCV协同感染等对肝功能的影响。结果71例患者中HBV感染者9例，HCV感染者35例，其中HBV、HCV共同感染者5例；51例患者出现了肝功能异常。肝功能异常组与肝功能正常组HBV和／或HCV协同感染比率分别为63％和35％，差异有统计学意义（P=0．035），年龄、性别、感染途径、饮酒状况、CD4^＋T淋巴细胞数（〈50）、HAART治疗方案、使用肝毒性药物的比率差异无统计学意义（P〉0．05）。Logist回归分析HBV和／或HCV的协同感染是HAART患者肝功能损伤的危险因素。结论HBV和／或HCV与HIV的协同感染十分普遍，是HAART治疗HIV／AIDS患者肝功能损伤的重要危险因素。     

有偿供血员HCV、HIV和HBV感染的调查分析

目的 了解有偿供血员感染丙型肝炎病毒（HCV）、艾滋病病毒（HIV）和乙型肝炎病毒（HBV）的情况,分析HCV和HIV感染对HBsAg的影响。方法 检测296名供血员血清抗－HCV、抗－HIV和HBV的5项标志物（HBsAg、抗－HBs、HBeAg抗－HBe及抗－HBc）。结果 296例有偿供血员中,抗－HCV阳性194例,占65.5%。抗－HCV阳性者中,抗－HIV阳性为145例,占HCV总阳性的75％。本组AIDS患者均死于肝外感染或肿瘤而非肝病。HCV合并HIV感染组的HBsAg阳性率为2.8%,明显低于单纯HCV和单纯HIV感染者（10％）,两组比较差异有显著性（P＜0.05）。结论 在HIV高发区,抗－HCV阳性有偿献血员常合并HIV感染,是AIDS高危人群。HCV合并HIV感染,可能干扰HBsAg的合成。     

老年丙型肝炎的流行病学特点分析

目的：了解老年丙型肝炎的感染途径及输血后丙型肝炎的自然病程。方法收集我院收治的433例70岁以上老年丙型肝炎、肝硬化及丙型肝炎相关性肝癌患者的病例资料，统计患者丙型肝炎病毒（HCV）的感染途径、HCV RNA分型，并统计输血后丙型肝炎患者自输血发展至肝硬化及肝癌的时间。结果（1）感染途径以输血为主，在433例患者中，输血后感染丙型肝炎有207人，占总人数47．81％；经牙科治疗感染人数为49人，占总人数11．32％；有131人无明确感染途径，占总人数30．25％。（2）HCV RNA 分型：175人在治疗过程中未检查 HCV RNA 分型，占总人数40．42％。在检查 HCV RNA分型的患者中，1型145人，占56．20％；2型101人，占39．15％。（3）输血后丙型肝炎的进程：自输血至肝硬化的年数中位数为18年，至肝癌的年数中位数为20年。不同 HCV RNA 分型的输血后丙型肝炎患者的进程无统计学差异。结论老年丙型肝炎患者的感染途径以输血为主，输血后18～20年可进展为肝硬化或肝癌。对于高危人群，要定期检查肝功能，必要时检查抗-HCV、HCV RNA，早期明确诊断并行抗病毒治疗，以减少丙型肝炎肝硬化及肝癌的发生。     

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.