IL-10基因启动子-592A/C多态性与HBV感染预后的关系

摘 要 目的：探讨湖北汉族人白细胞介素-10（IL-10）基因启动子区-592位点单核苷酸多态性与乙型肝炎病毒（HBV）感染、转归的关系。方法：采用聚合酶链反应-限制性片段长度多态性分析（PCR-RFLP）方法，检测231例慢性HBV感染者（其中慢性乙型肝炎75例，无症状携带156例），165例HBV感染自愈者和135例正常对照者IL-10基因启动子区-592A/C位点基因型。结果：IL-10基因启动子区-592A/C位点基因型和等位基因在慢性HBV感染组、HBV感染自愈组和正常对照组之间的分布频率比较差异无显著性（P>0.05），在血清HBV-DNA<1×103copies/mL的慢性HBV感染者组和HBV-DNA≥1×103 copies/mL组之间的分布频率比较差异亦无显著性（P>0.05）；但IL-10基因启动子区-592位点AA基因型和A等位基因在慢性乙型肝炎组出现的频率明显高于HBV无症状携带组，两组之间分布比较差异有显著性（P<0.05）。结论：汉族人IL-10基因启动子区-592位点多态性可能与人群对HBV易感性及感染后的病毒血症水平无显著相关性，但该位点基因多态性与HBV感染后的肝脏炎症反应有关。≥≥≥≥≥     

IL-10-592位点基因多态性与儿童EV71脑炎易感性关系

目的研究白细胞介素10（IL-10）基因启动子区-592C/A（IL-10-592C/A）位点基因多态性与肠道病毒71（EV71）易感性的关系,探讨不同基因型对EV71感染患病风险的影响。方法运用多重高温连接酶检测反应技术,检测EV71感染病儿及对照儿童IL-10-592C/A位点的基因多态性。结果 EV71感染重症组病儿基因型AC＋AA、等位基因A频率的分布与轻症组病儿比较差异有显著性（χ2=9.071、18.143,P〈0.05）。结论 IL-10-592C/A位点等位基因A、基因型AC＋AA的病儿感染EV71后易发展为重症。IL-10-592C/A位点基因型CC和C等位基因为EV71感染后不易发展为重症的保护基因。     

黏病毒抗性蛋白A基因多态性与HBV感染转归的关系

目的 探讨干扰素诱导的黏病毒抗性蛋白A(MxA)基因单核苷酸多态性(SNP)对乙型肝炎病毒(HBV)感染自然转归的影响.方法 收集湖北地区160例HBV自限感染者和243例慢性HBV感染者的外周血标本,应用聚合酶链反应-限制性片段长度多态性分析方法,检测MxA启动子-88,-123位点基因型.结果 MxA启动子-88G/T位点基因型和等位基因在慢性HBV感染者和自限性感染者中的分布差异有高度显著性.HBV自限性感染者MxA启动子-88位点GG基因型和G等位基因频率分别为41.3%和62.8%,均较慢性感染者频率52.7%和74.9%低(P=0.025和P= 0.001),而TT基因型和T等位基因频率分别为15.6%和37.2%,均较慢性感染者频率2.9%和25.1%高(P=0.000和P= 0.001),比值比为6.24,95%可信限2.63～14.81.然而,MxA启动子-123位点不同基因型和等位基因在HBV自限性感染组和慢性感染组间的分布频率差异均无统计学意义(P＞0.05).结论 MxA启动子-88G/T位点多态性与HBV感染后的结局有关,其中TT基因型或T等位基因的存在可能有利于HBV感染后的清除.     

MxA启动子和elF-2a调节区2基因多态性对HBV感染自然转归的影响

目的探讨干扰素诱导的黏病毒抗性蛋白A(MxA)和真核细胞起始因子2a调节区2(elF-2a-reg2)基因的单核苷酸多态性(SNP)对乙型肝炎病毒(HBV)感染自然转归的影响。方法收集湖北地区160例HBV自限感染者和243例慢性HBV感染者的外周血标本,应用聚合酶链反应-限制性片段长度多态性分析方法,检测MxA启动子-88、-123位点及elF-2a-reg2基因型。结果 MxA启动子-88G/T位点基因型和等位基因在慢性HBV感染者和自限性感染者中的分布差异有统计学意义(P<0.05)。HBV自限性感染者MxA启动子-88位点GG基因型和G等位基因频率分别为41.3%、62.8%,均较慢性感染者频率52.7%、74.9%低(P=0.025和P=0.001),而TT基因型和T等位基因频率分别为15.6%、37.2%,均较慢性感染者频率2.9%、25.1%高(P=0.000和P=0.001),比值比为6.24,95%可信限2.63～14.81。然而,MxA启动子-123位点、elF-2a-reg2基因的不同基因型和等位基因在HBV自限性感染组和慢性感染组间的分布频率差异均无统计学意义(P>0.05)。结论 MxA启动子-88G/T位点多态性与HBV感染后的结局有关,其中TT基因型或T等位基因的存在可能有利于HBV感染后的清除。     

白细胞介素-18基因多态性与肺结核病易感性的关系

目的：通过病例-对照研究,探讨白细胞介素-18（IL-18）基因启动子区-607C/A、-137G/C位点单核苷酸多态性（SNP）与肺结核病的关系。方法：采用序列特异性引物PCR（PCR-SSP）及测序技术检测深圳地区汉族人群肺结核患者200例及健康对照者197例IL-18启动子区-607 C/A 、-137G/C位点多态性基因型。采用直接计数法计算各组基因型频率及等位基因频率,进行χ2 检验。以P值＜0.05为具有统计学意义。结果：肺结核患者IL-18启动子区-607位点A/A纯合子、A/C杂合子、C/C纯合子基因型频率分别为19.5%、55.0%、25.5% ;A、C等位基因频率分别为47.0%、53.0%。健康对照者A/A纯合子、A/C杂合子、C/C纯合子基因型频率分别为22.8%、46.7%、30.5%;A、C等位基因频率分别为46.2%、53.8%。两组人群-607位点基因型及等位基因分布无明显差异(P>0.05)。肺结核患者IL-18启动子区-137G/C位点C/C纯合子、C/G杂合子、G/G纯合子基因型频率分别为4.5%、18.5%、77.0%;C、G等位基因频率分别为13.8%、86.2%。健康对照者C/C纯合子、C/G杂合子、G/G纯合子基因型频率分别为5.6%、25.9%、68.5%;C、G等位基因频率分别为18.5%、81.5%。两组人群-137位点基因型分布无明显差异(P>0.05)。结论：IL-18启动子区-607、-137位点基因多态性与中国汉族人群肺结核病易感性无关。     

IL-10基因位点多态性与ACS的相关性分析

[目的]探讨急性冠脉综合征(ACS)与白介素-10(IL-10)基因位点4259A/G、-1082G/A、-592C/A、-819C/T多态性分布的相关性.[方法]选择2010年5月至2015年9月常州市溧阳人民医院心内科和武进人民医院心内科收治的ACS患者471例(观察组),选择同期两个医院心内科收治的197例非ACS者为对照组,采用基因测序技术检测所有标本IL-10基因型,分析其与ACS发病相关危险因素.[结果]两组在年龄、吸烟、合并糖尿病、血清TC、TG、LDL-C方面比较,差异均具有统计学意义(P<0.05).在两组研究对象中,IL-104259A/G位点仅发现AA一种基因型;但是在两组研究对象中发现IL-10-1082G/A位点上有GG、AG、AA三种基因型、IL-10-582C/A位点上有CC、AC和AA三种基因型、IL-10-819C/T位点上有CC、CT和TT三种基因型.与对照组作比较后,尚未发现各种基因型之间分布频率、等位基因分布频率有统计学差异;对每一种基因型行引起ACS发病传统危险因素多元Logistic回归分析显示IL-10基因-592C/A、-819C/T、-1082G/A基因型与ACS的发病无相关性.[结论]在常州地区心血管疾病住院患者IL-10基因4259A/G仅有AA一种基因型;IL-10基因-1082G/A、-592C/A、-819C/T具有多态性,但其多态性分布与本地区汉族人群ACS的发病无相关性.     

IL-18基因编码区105位点多态性及其血清含量相关性研究

目的了解白细胞介素-18(in terleuk ine-18,IL-18)基因编码区105A/C位点多态性在汉族人中的分布频率及其与血清IL-18含量间的关系。方法采用聚合酶链反应-限制性片段长度多态性分析(polym erase cha inreaction-restrictionfragm en t length polym orph ism,PCR-RFLP)的方法,对87例健康个体IL-18编码区105A/C位点基因多态性进行观察,同时检测血清IL-18水平,探讨其与基因型间的关系。结果健康汉族人IL-18编码区105A/C位点基因型以AA型最为多见,占64.4%,其次为AC型和CC型,分别为33.3%和2.3%;等位基因A和C频率分别为81.0%和19.0%。经等级资料和相关分析,IL-18基因编码区105位点A→C单核苷酸突变与血清IL-18含量呈正相关(χ2=6.29,P<0.05,r=0.311)。结论汉族人IL-18基因编码区105A/C位点多态性与其血清含量存在相关性,提示该位点多态性可能与个体在某些疾病遗传易感性方面有一定联系。     

白细胞介素6基因启动子-572 C/G多态性与心绞痛的相关性研究

目的探讨白细胞介素6(IL-6)基因启动子-572C/G多态性各等位基因及基因型在心绞痛患者中的分布频率,并分析其基因型及血清水平与心绞痛的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测121例心绞痛患者及140例对照者IL-6基因启动子-572C/G多态性,同时用ELISA法检测心绞痛和对照者血清IL-6水平。结果心绞痛组IL-6血清水平显著高于对照组(P<0.01),IL-6基因启动子-572C/G基因型频率和等位基因频率在心绞痛组和对照组间比较差异有显著性(P<0.05),等位基因频率的相对风险分析发现,G等位基因携带者患心绞痛的风险是C等位基因的1.665倍(OR=1.665,95%CI:1.089~2.544);结论IL-6基因启动子-572C/G多态性与心绞痛的发病具有相关性。     

我国广东地区汉族人群类风湿性关节炎患者IL-6启动子基因多态性的研究

目的了解我国广东地区汉族人群白细胞介素-6(IL-6)基因启动子-572C/G和-174G/C位点单核苷酸多态性对类风湿性关节炎(RA)的影响。方法应用序列特异性引物-聚合酶链反应(PCR-SSP)检测168名体检健康者和120例RA患者的IL-6基因启动子-572和-174位点的基因型。结果我国广东地区汉族人群IL-6基因启动子-572位点存在C→G的突变,其基因型和等位基因频率分布在RA组和对照组比较差异有统计学意义(基因型频率:2χ=16.14,P=0.003;等位基因频率:2χ=16.71,P<0.001),其G等位基因在RA患者中明显低于健康对照组[比值比(OR)=0.36,95%可信区间(CI):0.21~0.61];-174位点存在G→C的突变,其基因型和等位基因分布频率在两组间差异亦有统计学意义(基因型频率:2χ=25.75,P<0.01;等位基因频率:2χ=25.99,P<0.01),其C等位基因在RA组明显高于健康对照组(OR=2.26,95%CI:1.91~2.68)。结论我国广东地区汉族人群IL-6基因启动子存在-572C/G与-174G/C的单核苷酸多态性,且这2个位点多态性与RA有关,其中IL-6-572位点的G等位基因可能对RA有保护作用,而IL-6-174位点等位基因C可能与RA发病的易感性有关。     

白细胞介素-18基因多态性与慢性乙型病毒性肝炎病毒感染关系的研究

目的 探讨白介素-18(IL-18)基因启动子区-137G/C(rs187238)和-607C/A(rs1946518)单核苷酸多态性(SNP)与慢性乙型病毒性肝炎(乙肝)病毒感染之间的关系。 方法 选取2007年3月至2010年10月期间就诊于桂林市疾病预防控制中心和桂林医学院附属医院的慢性乙肝患者作为病例组,共264例;另外选取同期在上述两个单位进行体检,均无慢性乙肝病史的健康者作为对照组,共300例。采用序列特异性引物-聚合酶链反应技术(SSP-PCR),检测上述二组研究对象IL-18基因启动子-137G/C(rs187238)、-607C/A(rs1946518)单核苷酸多态性位点基因型,分析病例组和对照组基因型和等位基因频率分布。 结果 病例组IL-18基因多态性位点rs1946518的基因型和等位基因的频率与对照组相比差异无统计学意义(P0.05)。但是,病例组IL-18基因SNP位点rs187238 G等位基因的频率高于对照组(OR=1.353,95%CI:1.009~1.815,P=0.043)。携带rs187238 GG基因型的患者发生慢性乙肝的风险较高(OR=1.629,95%CI:1.152~2.305,P=0.006)。分层分析发现,rs187238位点上GC基因型和C等位基因的频率与慢性乙肝的关联在乙肝e抗原(HBeAg)阳性组的患者中更加显著(P=0.022,P=0.011)。 结论 IL-18基因启动子区-137G/C(rs187238)多态性与慢性乙肝易感性具有相关性,而且,rs187238位点上GC基因型和C等位基因的频率与HBeAg阳性的慢性乙肝患者具有相关性。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.