50例老年慢性肺源性心脏病T细胞亚群变化

采用花环法检测50例老年慢性肺源性心脏病病人(年龄66.8±5.6岁),30例冠心病病人(年龄66.6±6.6岁),30例健康对照组(年龄43.0±12.9岁)外周血T细胞亚群。结果显示老年慢性肺心病组CD4/CD8为1.23±0.24明显低于冠状动脉硬化性心脏病组的1.90±0.28及健康对照组的1.55±0.24(P<0.01)。提示老年慢性肺心病存在细胞免疫功能降低,与临床上慢性肺心病易并发感染及难以恢复相一致。所以增强老年慢性肺心病病人细胞免疫功能,非常必要。     

百令胶囊对2型糖尿病肾病患者细胞免疫功能的影响

目的　探讨百令胶囊对2型糖尿病肾病患者外周血淋巴细胞亚群分布的影响。方法　108例患者随机分为治疗组和对照组,每组54例,另选择40例健康体检者作为健康组。对照组予常规治疗,治疗组加服百令胶囊,12周为一疗程。测定主要生物化学指标,流式细胞术检测患者T细胞（CD3＋、CD3＋CD4＋、CD3＋CD8＋）、B细胞（CD3－CD19＋）、NK细胞（CD3－CD16＋CD56＋）、NKT细胞（CD3＋CD16＋CD56＋）分布水平,并与健康组比较。结果　两组治疗后血清胱抑素C（CysC）、24　h尿蛋白定量显著降低（P<0.05）,且治疗组降低更为明显（P<0.05）。治疗前两组患者淋巴细胞亚群分布与健康组相比均有显著性差异（P<0.05）,即存在细胞免疫功能紊乱;治疗后,对照组淋巴细胞亚群分布无明显改变,治疗组CD3＋T细胞亚群、CD3＋CD4＋T细胞亚群和CD3＋CD8＋T细胞亚群、CD3－CD16＋CD56＋NK细胞亚群及CD3＋CD16＋CD56＋NKT细胞亚群比例上升,CD3－CD19＋B细胞亚群比例下降,CD4＋/CD8＋比值明显降低（P<0.05）,且与对照组相比均有显著性差异（P<0.05）。结论　百令胶囊可明显改善2型糖尿病肾病患者细胞免疫功能紊乱。     

老年原发性高血压患者外周血淋巴细胞亚群及活化状态的研究

目的：探讨老年原发性高血压患者外周血淋巴细胞亚群活化状态变化。方法采用流式细胞术检测65岁以上老年原发性高血压患者（观察组）170例和体检健康者（对照组）50例外周血淋巴细胞亚群以及活化状态。结果观察组B淋巴细胞表达的 CD3-CD19＋高于对照组,T 淋巴细胞活化表达的 CD3＋CD8＋CD38＋高于对照组,CD3＋HLA- DR＋, CD3＋CD8＋HLA- DR＋以及NK细胞表达的CD16＋CD56＋高于对照组（均P＜0.05）。T淋巴细胞表达的CD3＋低于对照组（均P＜0.05）。T细胞亚群表达的CD3＋CD4＋、CD3＋CD8＋比例下降,调节性T细胞CD3＋CD4＋CD25＋比例上升,但与对照组比较差异无统计学意义（均P＞0.05）。结论老年原发性高血压患者B淋巴细胞、NK淋巴细胞和CD8＋T细胞的活化能力显著增加。     

脑梗死患者血清T淋巴细胞亚群、免疫球蛋白检测及意义

目的探讨T淋巴细胞亚群（CD3＋、CD4＋、CD8＋、CD4＋／CD8＋）与免疫球蛋白（IgG、IgM、IgA）在早期老年脑梗死发病中的作用。方法选择早期老年脑梗死患者60例（观察组）,老年健康体检者60例（对照组）,采用间接免疫荧光法检测两组T淋巴细胞亚群水平,采用免疫散射比浊法检测免疫球蛋白水平。结果观察组CD3＋、CD4＋、CD4＋／CD8＋、IgG、IgA水平低于对照组,IgM、CD8＋水平高于对照组,P均〈0．01。结论早期老年脑梗死患者的细胞免疫与体液免疫均受到抑制,免疫功能降低可能是导致脑动脉血管壁损伤的原因之一。     

老年结肠癌患者树突细胞免疫治疗后免疫功能的变化及其疗效

目的观察老年结肠癌患者树突细胞(DC)免疫治疗后免疫功能的变化及其治疗效果。方法选取该院收治的96例老年结肠癌患者为研究对象,按照入院顺序随机均分为观察组和对照组,观察组患者在手术治疗和化疗基础上给予DC免疫治疗,对照组患者给予手术治疗和化疗,比较两组患者免疫功能的变化和临床疗效。结果对照组患者治疗后CD3+、CD4+、CD8+、CD4+/CD8+T淋巴细胞亚群比例与治疗前比较无明显差别(P>0.05)。观察组治疗后CD3+、CD4+、CD8+、CD4+/CD8+T淋巴细胞亚群比例与治疗前比较均增加(均P<0.05);且高于对照组治疗后(均P<0.05)。观察组患者治疗有效率为60.42%高于对照组有效率(χ2=7.07,P<0.05)。结论结肠癌患者的DC免疫治疗可明显提高患者免疫功能和肿瘤清除效果,术后化疗联合细胞免疫治疗可获得较单纯术后化疗更为满意的治疗效果。     

肠易激综合征患者外周血T淋巴细胞亚群分析

目的　肠易激综合征 (IBS)的发病机制是否与炎症免疫有关 ,有待于进一步证实。调查IBS患者血中T淋巴细胞计数及其亚群比例 ,旨在探讨IBS发病新机制。方法　对符合罗马Ⅱ诊断标准的 30例IBS患者及 30名健康对照者的外周血淋巴细胞总数用AC 92 0全血细胞分析仪检查分析 ,采用免疫荧光法并用SimulSET自动软件分析方法进行T淋巴细胞亚群检测。结果　患者外周血淋巴细胞的平均值为 (2 .1± 0 .5 )× 10 9/L ,健康对照组为 (2 .2± 0 .6 )× 10 9/L ,两组差异无显著性 (P >0 .0 5 ) ;T淋巴细胞亚群分析 ,IBS患者外周血CD8值明显高于健康对照组 (P <0 .0 5 ) ,CD4值明显低于健康对照组 ,CD4/CD8比值下降 (P <0 .0 5 ) ,CD3 值与健康对照组相比差异无显著性 (P >0 .0 5 )。结论　IBS患者外周血淋巴细胞总数正常 ,但CD8升高 ,CD4下降 ,CD4/CD8比值下降 ,CD3 正常 ,提示腹泻型IBS可能与免疫下降有关     

梅尼埃患者外周血T淋巴细胞亚群免疫球蛋白、补体水平变化

目的观察梅尼埃患者血清中T淋巴细胞亚群、免疫球蛋白、补体水平变化,并探讨其意义。方法选择梅尼埃患者（观察组）、健康人（对照组）各41例,分别采用ELISA法、全自动生化分析仪及免疫比浊法检测外周血中的免疫球蛋白、T淋巴细胞亚群及补体。结果观察组外周血血清IgA、IsG、IsM、C3、C4、CD8＋淋巴细胞水平均明显高于对照组（P均〈0．05）,而CD;及CD4／CD8水平低于对照组（P均〈0．05）。发作期梅尼埃患者的血清IgA、IgG、IgM、C3、C4、CD8＋水平均明显高于缓解期（P均〈0．05）,而CD3＋及CD4／CD8水平低于缓解期（P均〈0．05）。结论梅尼埃患者血清T淋巴细胞亚群中c珑、免疫球蛋白、补体水平增高,CD3＋及CD4／CD8水平降低,可能与梅尼埃病的发生发展有关。     

慢性阻塞性肺疾病病人外周血T淋巴细胞的检测及意义

目的检测慢性阻塞性肺疾病(COPD)患者体内各类T淋巴细胞的亚群,了解COPD患者的细胞免疫功能状态。方法采用免疫荧光双标记法和流式细胞仪检测COPD患者外周血中的T淋巴细胞及其亚群。结果与健康对照组相比较,急性期COPD组患者CD3+T细胞及CD4+T细胞亚群下降,CD8+T亚群细胞升高,导致CD4+/CD8+比值下降并倒置;CD4+CD45RA+亚群、CD4+CD45RA+/CD4+CD45RO+比值下降,CD4+CD45RO+亚群上升;CD8+CD45RA+亚群、CD8+CD45RO+亚群和CD8+CD45RA+/CD8+CD45RO+比值均有所上升;自身免疫性疾病有关的CD4+CD28+亚群下降。结论 COPD患者体内存在细胞免疫功能的紊乱。     

登革病毒感染者外周血T淋巴细胞亚群数量的变化及其临床意义

目的观察登革热患者外周血T淋巴细胞亚群数量变化的特点并探讨其临床意义。方法用流式细胞仪检测不同发病时间71例登革热患者外周血中总T淋巴细胞(CD3+)、CD4+T淋巴细胞和CD8+T淋巴细胞的数量,并将急性期患者、恢复期患者及正常人T淋巴细胞及其亚群数量进行比较,组间数据比较采用t检验。结果与正常对照组相比,急性期登革热患者T细胞和CD4+T细胞都显著减少(P<0.01)、CD4+T/CD8+T比值显著降低(P<0.01),恢复期登革热患者上述指标没有显著性差异(P>0.05);与急性期相比,恢复期登革热患者CD4+T细胞显著升高(P<0.01);急性期、恢复期登革热患者和正常对照组CD8+T细胞数量没有显著性差异(P>0.05)。登革热患者T淋巴细胞亚群数量和CD4+T/CD8+T比值随着发病时间的增加而逐渐上升。结论登革热患者急性期细胞免疫异常,通过治疗可以逐渐恢复。T淋巴细胞亚群的检测可作为监测登革热患者免疫功能的一个指标,对于病人的治疗和预后有一定的意义。细胞免疫异常可能在登革热的发病中起重要作用。     

中晚期HCC患者T淋巴细胞亚群和红细胞免疫功能变化及介入治疗对其的影响

目的探讨中晚期原发性肝癌(HCC)患者介入治疗前后T淋巴细胞亚群和红细胞免疫功能变化特点。方法对40例原发性肝癌患者(观察组)及40名正常体检者(对照组)采用微量全血直接免疫荧光法检测T淋巴细胞亚群,采用受体黏附法检测红细胞免疫功能。结果观察组总T细胞(CD3+)、辅助/诱导T淋巴细胞(CD4+)、CD4+/CD8+和肿瘤红细胞花环(DTER)、红细胞C3b受体花环(RBC-C3bRR)显著低于对照组(P<0.05,P<0.01),红细胞免疫复合物花环(RBC-ICR)显著高于对照组(P<0.01)。TACE治疗后CD3+、CD4+、CD4+/CD8+及RBC-C3bRR均值较治疗前稍有降低,RBC-DTER治疗后较治疗前升高,但无统计学意义,RBC-ICR治疗后较治疗前明显升高(P<0.05)。结论中晚期原发性肝癌患者T淋巴细胞亚群及红细胞免疫功能低下,介入治疗后细胞免疫功能降低,提示对中晚期原发性肝癌患者介入治疗后应重视细胞免疫功能调节治疗。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.