儿童细小病毒B19感染的诊断方法

目的：评价巢式PCR，ELISA，间接免疫荧光法(IIF)诊断B19感染的价值．方法：用ELISA及巢式PCR对129例小儿血液病和结缔组织病患血清进行B19-IgM，DNA检测；用IIF及巢式PCR对50例血液病患骨髓进行B19抗原及DNA检测．结果：病例组129例，血清B19-DNA阳性41例，阳性率31．8％；IgM阳性28例，阳性率21．7％；B19-DNA及IgM同时阳性26例，仅IgM阳性2例，B19感染率为33．3％．对照组50例，B19-DNA阳性率2％，IgM阳性率0％，B19感染率为2％．血液病患50例骨髓B19-DNA阳性17例，阳性率34％；抗原阳性8例，阳性率16％．与巢式PCR相比，ELISA法的灵敏度为63．4％，特异度为97．7％，符合率为86．8％，阳性预告值为( PV)为92．8％，阴性预告值(-PV)为85．1％；IIF法的灵敏度为47．0％，特异度为100％，符合率为82．0％， PV为100％，-PV为78．6％．结论：ELISA及IIF敏感性低于巢式PCR，诊断B19感染时最好同时检测B19-DNA和IgM或抗原．     

人细小病毒B19感染在类风湿性关节炎发生中的作用

目的探讨人细小病毒B19感染与类风湿性关节炎（RA）的关系。方法采用聚合酶链反应和酶联免疫吸附法对56例类风湿性关节炎病人（观察组）及55例非类风湿性关节炎病人（对照组）进行血清B19-DNA和B19VP2IgM检测,并对31例RA病人和11例对照组病人骨髓进行了B19-DNA检测。结果观察组血清B19～DNA阳性率为33．9％,对照组为5．5％,两组差异有极显著性（Χ^2=14．69,P〈0．01）。观察组血清B19-VP2-IgM阳性率为25.0％,对照组为3．6％,两组差异有显著性（Χ^2=10,27,P〈0．05）。在56例RA病人中,12例B19～DNA、B19-VP2～IgM阳性,2例仅B19-VP2-IgM阳性,7例仅B19-DNA阳性,B19-DNA、B19VP2IgM同时阴性35例,两者一致率为83．9％（P〉0．05）。成年RA病人骨髓标本中B19DNA阳性率为51．6％,与对照组（9．1％）比较差异有显著性（P=0．02）。讨论RA病人B19病毒感染率较高,B19病毒感染与RA密切相关。     

B19病毒对先天性心脏病先天感染的探证及电镜观察

目的 证实部分先天性心脏病（CHD）患者心肌组织中微小病毒B19系先天感染所致,并观察CHD心肌组织超微结构变化。方法 采用ELISA,PCR,原位杂交（ISH）及透射电镜等技术,对42例CHD患者及对照组22例风湿性心瓣膜病患者的外周血,活检心肌组织分别进行B19－VP2－Ig M,B19-DNA的检测,并用透射电镜对心肌细胞的超微结构进行观察。结果（1）CHD组中B19－VP2－IgM阳性3例（7％）,对照组中阳性1例（5％）,两组间无显著差异（P＞0．05）,（2）CHD组中B19－DNA阳性8例（19％）,与对照组均阴性相比有显著性差异（P＜0．01）,且与8例心肌B19－DNA阳性标本配对的血中B19－VP2－IgM的均阴性。（3）ISH显示B19DNA定位于心肌细胞核内,电镜超微结构观察细胞胞质,核内均未见23nm病毒样颗粒,也无细胞器的损害。结论 B19病毒对先天性心脏病的感染系先天性感染所致,病毒基因可能整合于宿主细胞核内。     

巢式PCR检测恶性淋巴瘤患儿骨髓人细小病毒B19DNA

目的：用巢式聚合酶链反应（PCR）技术检测恶性淋巴瘤患儿骨髓中人细小病毒B19感染状态。方法：收集住院期间29例患有恶性淋巴瘤的患儿骨髓标本，对照组为非血液系统疾病的患儿骨髓标本26例行病例对照研究，用巢式PCR检测B19－DNA。结果：29例恶性淋巴瘤患儿骨髓中B19－DNA阳性9例，阳性率为31．0％，与对照组比较差异非常显（P＜0．01）；结论：提示恶性淋巴瘤患儿是B19－DNA的易感群体。化疗及免疫功能低下的淋巴瘤患儿发生B19感染易引起持续感染慢性贫血。     

小儿原发性血小板减少性紫癜病因的探究

目的探究小儿原发性血小板减少性紫癜的病因。方法应用ELISA技术对33例急性原发性血小板减少性紫癜（ITP）患儿的外周血进行了人类微小病毒（B19）、巨细胞病毒（cMv）及乙型肝炎病毒（HBV）和肺炎支原体（MP）的系列检测。结果病例组B19一IgM阳性,阳性率24．2％,CMV—IgM阳性率为18．2％;对照组中,未见B19一IgM阳性病例,CMV—IgM阳性病例1例。在33例ITP患儿中,2例HBsAg和HBeAg阳性。ITP患儿中,肺炎支原体IgM阳性者17例,阳性率为51．5％;对照组15例中,肺炎支原体IgM阳性者2例,阳性率为13．3％,有显著差异（P〈0．05）。结论儿童的ITP发生可能与上述病毒及支原体感染有关,故对难治性ITP的患儿可进行病毒学检查及支原体检测,给阳性结果患儿相应的抗病毒、抗支原体治疗是必要、恰当的,这为部分难治性rrP患儿提供了一个非免疫治疗的新办法。     

类风湿关节炎患者B19病毒感染及细胞因子变化

目的：了解国内类风湿关节炎（rheumatoid arthritis,RA)，幼年类风湿关节炎（juvenile rheumatoid arthritis,JRA)患人细小病毒B19（B19）的感染情况及其细胞因子（CK）IL－6，IL－8，sIL-2R和TNF－α水平的变化。方法：采用巢式PCR技术和丧心ELISA法对23例RA及30例JRA患血清（BS），4例JRA，6例骨性关节炎（OA）和9例半月板损伤（MT）关节液（SF）进行B19－DNA和IL－6，IL－8，sIL-2R,TNF-α等CK水平的检测。结果：（1）23例RA，30例JRA患BS B19－DNA均12例阳性，阳性率分别为52．1％和40．0％，与对照组比较差异显（P＜0．05）；（2＿4例JRA患SF中，3例B19－DNA阳性，6例OA和9例MT患均阴性；（3）23例RA，30例JRA患BS中，IL－6,SIL-2R水平与对照组相差非常显（P＜0．05）；（4）23例RA，30例JRA患B19－DNA阳性组与阴性组4种CK比较均无显差异（P＞0．05）；（5）SF标本中，4例JRA患的sIL-2R与其他两组有显差异（P＜0．01）。结果：（1）国内RA，JRA患有较高B19感染率，提示B19感染与RA，JRA密切相关；（2）IL－6 ,sIL-2R与RA，JRA活动性有关，是类风湿活动性的主要指标；（3）sIL-2R可能是参与JRA关节局部病理损伤最主要的CK之一；（4）BS中CK水平的变化与是否感染B19无关，即B19并非是导致RA，JRA的唯一因素。     

肺癌与人类巨细胞病毒感染关系的初步研究

目的：探讨肺癌与人类巨细胞病毒（HCMV）感染的关系。方法：对88例肺癌及117例肺非癌患者，用酶联免疫吸附试验（ELISA）法检测血清HCMV－IgG，IgM抗体，用聚合酶链反应（PCR）法检测尿HCMV－DNA。同时检测其中64例肺癌及67例肺非癌患者的病灶局部冲洗或支气管肺泡灌洗回收液HCMV－DNA。对肺癌组中抗癌化疗的患者于每一化疗周期复查血清HCMV－IgM，尿HCMV－DNA。结果：肺癌组血清HCMV－IgM阳性率26．1％，病灶局部冲洗或支气管肺泡灌洗回收液HCMV－DNA阳性率26．6％，均显著高于肺非癌组（P＜0．01）；血清HCMV－IgG及尿HCMV－DNA阳性率两组未见明显差别。42例肺癌到化疗第二周期时，血清HCMV－IgM16例由阴性转阳性，尿HCMV－DNA6例转阳性。结论：肺病与HCMV感染有统计学上的相关性；抗癌化疗使肺癌患者HCMV活动性感染明显增多，值得重视。     

先天性心脏病心肌组织中HPVB19,RV基因的检测

目的：探讨HPVB19和RV等病原感染与先心病的发病关系。方法：采用PCR，RT－PCR及ISH等分子生物技术，对79例先心病和46例非先心病的先心病心肌组织中HSVB19，RV，TOX等病原基因进行检测及B19病毒在心肌细胞内定位研究。结果：①在先心病心肌组织中B19，TOX，RV，HSV病原基因的检测阳性率分别为18％（12／66），13％（10／79），23％（7／30）和4％（3／79），前三与对照组间比较有显性差异（P＜0．05），而HSV在两组间无统计学意义（P＞0．05），提示B19，TOX，RV为先心病发病的重要危险因子。②对活检心肌组检测上述病原基因的阳性病例，同时作血清中B19，TOX，RV的特异性IgM检测均阴性。③通过原位杂交显示B19病毒DNA主要分布在心肌细胞核内，光学显微镜下心肌细胞无炎性浸润。结论：先心病心肌组织中可检测到HPVB19，TOX，RV基因，并有较高的阳性率，提示它们可能是先心病发病的重要感染病原。     

套式聚合酶链反应检测自然流产组织中人细小病毒B19

目的：进一步了解我国胎儿人细小病毒B19的感染状况及其与自然流产之间的关系．方法：用所建立的套式聚合酶链反应（PCR）技术对50例新鲜的和66例石腊包埋的自然流产组织及25例同期健康孕妇人工流产组织进行人细小病毒B19DNA检测．结果：显示病例组有34例阳性，阳性率为29．3％，而正常对照组存1例阳性，阳性率为4％．经统计学检验有显著性差异．结论：可能人细小病毒B19感染与自然流产有一定关联．人细小病毒B19可能是致自然流产的重要因素之一．套式聚合酶链反应检测自然流产组织中人细小病毒B19@王小仲…     

婴儿肝炎综合征巨细胞病毒感染的研究

目的：探讨人巨细胞病毒（HCMV）在婴儿肝炎综合征中的病因学地位，方法：52例以黄疸，肝肿大和血清转氨酶（ALT）升高为主要临床表现的婴儿肝炎综合征患儿为观察组，50例无黄疸，肝肿大和ALT升高的肺炎，败血症和腹泻病患儿为对照组，测定血清HCMV－IgG,IgM(ELISA法）和HCMV－DNA（PCR法），进行组间比较。，结果：观察组血清IgG,IgM和DNA的阳性率都高于对照组，分别是：IgG73%和50％（P＜0．05），IgM40%和4％（P＜0．001），DNA44％和24％。结论：HCMV是婴儿肝炎综合征的重要致病因子，HCMV肝炎约占婴儿肝炎综合征的40％左右。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.