腺苷脱氨酶诊断结核性脑膜炎价值Meta分析

目的通过Meta分析确定检测脑脊液(CSF)中腺苷脱氨酶(ADA)的含量是否有助于结核性脑膜炎的早期诊断。方法检索Medline,Embase,BIOSIS和Cochrane等数据库,检索时间为1995年1月至2009年12月,收集关于测定CSF中ADA以诊断结核性脑膜炎的相关英文文献,并用QUADAS标准进行质量评价,采用Metadisc1.4和SPSS13.0软件,用随机效应模型汇总各研究中ADA诊断结核性脑膜炎的敏感度、特异度以及其他指标,绘制汇总受试者工作特征曲线并探讨其诊断特性。结果最终有9项独立研究纳入本次Meta分析,ADA诊断结核性脑膜炎的总体敏感度0.77(95%CI 0.72～0.82);特异度0.91(95%CI 0.90～0.93);阳性似然比7.93(95%CI 5.85～10.76),阴性似然比0.28(95%CI 0.19～0.41),合并受试者工作特征曲线下面积为0.9129,但在结核性脑膜炎与化脓性脑膜炎的鉴别诊断中特异度降为0.75(95%CI 0.67～0.82)。结论 ADA诊断结核性脑膜炎的敏感度、特异度均较高,检测CSF中的ADA有助于结核性脑膜炎的诊断,但在与化脓性脑膜炎相鉴别时诊断效力下降,需参考其他检测指标。     

胸腔积液腺苷脱氨酶对不同年龄段结核性胸膜炎的诊断价值研究

目的探讨胸腔积液腺苷脱氨酶(ADA)对不同年龄段的结核性胸膜炎的诊断价值。方法回顾性分析2010年5月至2016年4月经内科胸腔镜下活检明确诊断为结核性胸腔积液或恶性胸腔积液病例共592例,分为青年组、中年组和老年组,根据受试者工作曲线(ROC曲线)确定诊断结核性胸膜炎的ADA最佳临界值,并分析性别、年龄对ADA的影响。结果结核性胸腔积液的ADA水平在青年组、中年组和老年组均高于恶性胸腔积液,差异有统计学意义(P均0.05)。胸腔积液ADA的水平与患者性别无关(P0.05);不同年龄组的胸腔积液ADA不全相同(P0.05),进一步两两比较,任两组间差异均有统计学意义;进一步相关分析,ADA与年龄的相关系数为-0.682,表明ADA与年龄呈负相关。作ROC曲线,ADA诊断结核性胸腔积液的曲线下面积(AUC)为0.984,最佳临界值为28.5 U/L,其灵敏度为94.06%,特异度为98.94%。分别作青年组、中年组和老年组的ROC曲线,AUC分别为0.984、0.975和0.969,ADA最佳临界值为37.5 U/L、26 U/L和26 U/L。结论胸腔积液ADA对结核性胸膜炎的诊断有帮助,随着年龄增大ADA水平下降,根据ROC曲线选择最佳ADA临界值较使用传统的ADA临界值,也许能提高结核性胸膜炎诊断的准确性。     

DNA实时荧光恒温扩增法联合检测对结核性胸膜炎的早期诊断价值

目的:分析DNA实时荧光恒温扩增法(简称“恒温扩增法”)联合腺苷脱氨酶(adenosine deaminase, ADA)、外周血结核感染T细胞斑点试验(T-SPOT.TB)检测对结核性胸膜炎患者早期诊断的价值。方法:采用回顾性研究方法,选取2020年1月至2021年12月西安市胸科医院收治的不明原因胸腔积液患者427例作为研究对象。所有研究对象均进行胸腔积液恒温扩增法、胸腔积液ADA、胸腔积液结核分枝杆菌培养和外周血T-SPOT.TB检测。以临床综合诊断作为参考标准,评价恒温扩增法联合ADA、外周血T-SPOT.TB对结核性胸膜炎的早期诊断价值。结果:427例研究对象中,279例(65.3%)确诊为结核性胸膜炎(结核性胸膜炎组),148例确诊为非结核性胸膜炎(非结核性胸膜炎组)。ADA的最佳诊断界值为19.5 U/L。单一检测方法中,恒温扩增法的特异度为100.00%,敏感度为31.54%,与结核分枝杆菌培养类似(分别为100.00%和30.11%)。胸腔积液ADA和外周血T-SPOT.TB检测的敏感度分别为74.91%和84.95%,特异度分别为87.16%和74.91%。ADA+...     

腺苷脱氨酶诊断结核性胸膜炎价值的再评价

目的 探讨胸腔积液和血清中腺苷脱氨酶(ADA)对鉴别结核性胸膜炎及恶性胸腔积液的临床价值.方法 回顾性分析91例经内科胸腔镜胸膜活检病理确诊为结核性胸腔积液(结核组49例)和恶性胸腔积液(恶性组42例)患者的胸腔积液及血清中ADA活性,应用受试者工作曲线(ROC曲线)确定结核性胸膜炎患者胸腔积液ADA的最佳临界值.结果 结核组胸腔积液ADA活性和胸腔积液ADA与血清ADA比值分别为(46±26)U/L和4.1±4.0,明显高于恶性组的(16±8)U/L和1.7±1.2,差异均有统计学意义(t值分别为7.383和3.852,均P＜0.01),结核组和恶性组的血清ADA活性分别为(13±5)U/L和(12±6)U/L,差异无统计学意义(t=1.582,P＞0.05).应用ROC曲线确定胸腔积液ADA诊断结核性胸膜炎的最佳临界值为28.7 U/L,灵敏度为75.5%,特异度为95.2%.结论 胸腔积液ADA活性可以作为鉴别结核性和恶性胸腔积液的重要指标,对结核性胸膜炎有较高的临床诊断价值,而血清ADA活性对鉴别两者无临床意义.     

ADA、IFN-γ及结核分枝杆菌抗体联合检测对结核性胸膜炎的诊断价值

目的探讨ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测对结核性胸膜炎的诊断价值。方法检测56例已经经组织病理学或病原学明确诊断的结核性胸膜炎患者,20例经细胞学或组织病理学明确诊断的恶性胸腔积液患者,以及12例其他渗出性胸腔积液患者的胸液和血清中的ADA活性和IFN-γ含量以及抗结核分枝杆菌抗体阳性率,经统计学处理后,评价各项指标对结核性胸膜炎诊断的灵敏度、特异度及临床诊断符合率。结果结核性胸液中ADA活性、IFN-γ含量分别为（50.98±13.07）U/L、（139.46±70.43）pg/ml,结核分枝杆菌抗体阳性率60.7%,与恶性胸液组和其他组比较差别有统计学意义,P<0.05。以45U/L为临界值,ADA对结核性胸膜炎诊断的灵敏度为80.4%,特异度96.9%,临床诊断符合率为86.4%;IFN-γ以100pg/ml为临界值对结核性胸膜炎诊断的灵敏度为83.9%,特异度93.8%,临床诊断符合率为87.5%;胸液中结核分枝杆菌抗体检测对结核性胸膜炎诊断的灵敏度为 60.7%,特异度为87.5%,临床诊断符合率为70.5%。以3项指标联合检测任何2项阳性对结核性胸膜炎诊断的灵敏度为 92.9%,特异度100%,临床诊断符合率为95.5%。结论ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测可极大地提高结核性胸膜炎的诊断效能。     

胸腔积液腺苷脱氨酶、结核分枝杆菌-DNA联合血清脂阿拉伯甘露糖-免疫球蛋白G检测对结核性胸膜炎的诊断价值

目的 探讨胸腔积液腺苷脱氨酶(ADA)、结核分枝杆菌(TB)-DNA联合血清阿拉伯甘露糖(LAM)-免疫球蛋白(Ig)G检测对结核性胸膜炎(TP)的诊断价值。方法 回顾性纳入2019年8月～2022年8月因不明原因胸腔积液于本院就诊的患者200例，根据其是否为TP将其分为TP组(93例)和非TP组(non-TP组，107例)。比较两组患者一般临床资料及胸腔积液ADA、TB-DNA、血清LAM-IgG阳性率，分析胸腔积液ADA、TB-DNA及血清LAM-IgG单独以及联合检测对TP的诊断效能。结果 TP组患者胸腔积液ADA、TB-DNA及血清LAM-IgG阳性率均显著高于non-TP组(P<0.001)。胸腔积液ADA诊断TP的敏感度及特异度分别为87.09%、82.24%(Kappa=0.690),TB-DNA诊断TP的敏感度及特异度分别为84.94%、80.37%(Kappa=0.650);血清LAM-IgG诊断TP的敏感度及特异度分别为82.79%、78.50%(Kappa=0.610);胸腔积液ADA、TB-DNA联合血清LAM-IgG诊断TP的敏感度及特异度分别为92.4...     

胸腔积液腺苷脱氨酶对内科胸腔镜检查临床病例选择的意义

目的 探讨胸腔积液腺苷脱氨酶(ADA)对内科胸腔镜检查临床病例选择的意义.方法 回顾性分析2013年1月至2016年4月经内科胸腔镜检查的不明原因胸腔积液患者198例,分为青年组、中年组和老年组,以胸腔积液ADA≥45 U/L或ADA≥45 U/L联合淋巴细胞占白细胞比例≥50％作为诊断结核性胸膜炎的标准,确定其敏感度和特异度,并分析性别、年龄对ADA的影响.结果 内科胸腔镜对不明原因胸腔积液的诊断率为98.9％.胸腔积液ADA≥45 U/L诊断结核性胸膜炎的敏感度68.7％,特异度88.1％;胸腔积液ADA≥45 U/L联合淋巴细胞占白细胞比例≥50％诊断结核性胸膜炎的敏感度70.2％,特异度96.3％,尤其是在青年组,其诊断特异度达100％.结论 对于不明原因胸腔积液的青年患者,如果胸腔积液ADA≥45 U/L且淋巴细胞占白细胞比例≥50％,可考虑诊断性抗结核治疗;对中老年不明原因胸腔积液,建议常规行内科胸腔镜检查,避免误诊.     

腺苷脱氨酶和癌胚抗原检测对结核性与恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶(ADA)和癌胚抗原(CEA)检测对结核性与恶性胸腔积液的鉴别诊断价值。方法用氨试剂法和ELISA法对118例胸腔积液的ADA和CEA进行检测分析。结果结核组与恶性组ADA活性有显著差异(P0.01)。恶性组与结核组CEA活性有显著差异(P0.01)。结核组和恶性组中ADA的阳性率分别为94.3%和8.7%,差异有统计学意义(P0.01)。恶性组和结核组中CEA的阳性率分别为69.6%和6.9%,差异有统计学意义(P0.01)。ADA≥40 U/L诊断结核性胸腔积液的灵敏度为94.3%,特异度为90.3%。CEA≥10μg/L诊断恶性胸腔积液的灵敏度为69.6%,特异度为93.7%。以ADA≥40 U/L和CEA10μg/L为阳性界值诊断结核性胸腔积液的灵敏度为87.8%,特异度为95.3%。以CEA≥10μg/L和ADA40 U/L为阳性界值诊断恶性胸腔积液的灵敏度为63.5%,特异度为99.2%。结论胸腔积液ADA及CEA检测对结核性与恶性胸腔积液有鉴别诊断价值。     

胸腔积液中ADA活性的深入分析

目的探讨胸腔积液中腺苷脱氨酶(ADA)的特点及临床价值。方法分析200例已确诊患者的胸腔积液中ADA活性,明确ADA与疾病及患者年龄、性别的关系;应用ROC曲线确定ADA的最佳临界值。结果胸腔积液患者中男性与女性ADA的差异无显著性;不同年龄段患者ADA活性并无显著性差异;结核组胸腔积液ADA活性显著高于非结核组;胸腔积液ADA诊断结核性胸膜炎的最佳诊断界值为18U/L,敏感度95%,特异度90%。结论胸腔积液患者ADA活性不受年龄及性别的影响,对结核性胸膜炎有较高的临床诊断价值。     

多指标联合检测在结核性胸膜炎诊断中的应用价值

目的探讨重组人干扰素-γ（IFN-γ）含量、腺苷脱氨酶（ADA）活性、结核菌素（PPD）试验联合检测诊断结核性胸膜炎的价值。方法检测50例结核性胸膜炎（观察组）及40例非结核性胸腔积液患者（对照组）胸腔积液ADA活性、IFN-γ含量以及PPD试验阳性率,评价各项指标对结核性胸膜炎的灵敏度、特异性。结果观察组IFN-γ含量、ADA活性及PPD试验阳性率均高于对照组（P均〈0．05）。3项指标联合检测对结核性胸膜炎的诊断灵敏度及特异度均明显高于其中任何2项及单项检测（P均〈0．05）。结论多指标联合检测在结核性胸膜炎诊断中有较高的应用价值,可明显提高诊断阳性率。     

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.