免疫性疾病

原发性抗中性粒细胞胞质抗体相关性小血管炎临床诊断分析；艾滋病合并马尔尼菲青霉病12例；我国部分地区抗HIV治疗效果实验室评估和耐药变异的初步研究；系统性红斑狼疮患者T细胞上Fas受体分子数与治疗效果的相关性；迟发性系统性红斑狼疮的临床表现及血清免疫学特征。     

迟发狼疮性肾炎的临床与病理分析

目的:分析迟发狼疮性肾炎(LN)患者的临床与病理特点. 方法:21例发病年龄≥50岁,有肾脏损害的临床表现并行肾活检病理检查的LN患者作为迟发组,随机选取同期发病年龄<50岁的132例LN患者作为对照组.肾活检病理按照2003年ISN/RPS分型方案.回顾性分析迟发LN患者的临床与病理特点.结果:迟发组平均年龄(54.8±5.4)岁,对照组平均(28.7±7.5)岁;迟发组男性比例相对增多,女性与男性比例为6∶1,对照组为7.3∶1;高血压、肾功能损害的比例高于对照组,肾脏病理类型分布与对照组无差异;面部红斑、脱发的发生率低于对照组,白细胞减少的比例升高;血清A-dsDNA、抗心磷脂抗体阳性率、低C3血症的发生率较对照组高. 结论:迟发LN临床表现与对照组存在一定差异.     

结缔组织病合并长节段横贯性脊髓炎患者40例临床特征分析

目的分析探讨结缔组织病(CTD)合并长节段横贯性脊髓炎(LETM)患者的临床特征与预后。方法选2006年1月至2016年12月北京协和医院神经内科和风湿免疫科住院的40例合并LETM的CTD患者,根据是否出现视神经脊髓炎谱系疾病(NMOSD),将患者分为CTD-LETM-NMOSD者和CTD-LETM-非NMOSD者,回顾性分析患者一般资料、临床特征、自身抗体、影像学表现、治疗、预后和转归,采用Kaplan-Meier曲线分析疾病复发率。结果 40例患者中,系统性红斑狼疮24例,原发性干燥综合征16例。CTD-LETM-NMOSD者28例(70.0%),CTD-LETM-非NMOSD者12例(30.0%)。CTD-LETM-NMOSD者抗SSA抗体阳性率(75.0% 比 5/12,P<0.05)、抗水通道蛋白4(AQP4)抗体(AQP4-IgG)阳性率(89.3% 比 0,P<0.05)显著高于CTD-LETM-非NMOSD者。两者间CTD类型、CTD病程、脊髓炎首发比例、抗Sm抗体、抗U1核糖核蛋白抗体、抗双链DNA抗体、抗SSB抗体、抗核糖体核蛋白P抗体、抗磷脂抗体、脑...     

肝炎病毒性心肌炎临床和免疫学特征的观察

目的:探讨肝炎病毒性心肌炎临床和免疫学特征。方法:检测103例病毒性心肌炎患者甲、乙、丙肝炎病毒抗体,抗β_1-肾上腺素能受体抗体,肝功能,磷酸肌酸激酶(CK)和肌钙蛋白T(cTnT),心电图,超声心动图等的改变。结果:103例病毒性心肌炎中肝炎病毒感染28.16％,抗β_1-肾上腺素能受体抗体与肝炎病毒抗体具有相关性(P<.0.05),抗β_1-肾上腺素能受体抗体阳性的肝炎病毒性心肌炎患者心肌、肝脏损害程度较抗体阴性患者重(P<0.05～<0.01)。结论:肝炎病毒的感染和抗β_1-肾上腺素能受体抗体参与了心肌炎的发病;抗β_1-肾上腺素能受体抗体可能是肝炎病毒性心肌炎重要免疫标志物之一。     

迟发系统性红斑狼疮的临床特征

系统性红斑狼疮 (SLE)多累及 2 0～40岁女性 ,5 0岁以后很少发病 ,本文回顾对照分析 2 1例 5 0岁以后发病 (迟发SLE)和 185例年轻发病 (育龄SLE)患者的资料 ,以探讨迟发SLE的临床、免疫学及治疗特征。1　资料与方法1 1　病例选择　 1995年 1月～ 2 0 0 2年 9月我院风湿免疫科、肾科或皮肤科首次诊断为SLE的 2 0 6例患者 ,均符合美国风湿病学会 (ARA) 1982年制订的SLE诊断标准。迟发SLE组为 5 0岁以后发病 ,共2 1例 ,年龄 5 1～ 72岁 ,平均 ( 5 6 3± 4 3)岁 ,其中女 16例 ,男 5例。 16例女性患者中绝经者 14例 ,均未行雌激素替代…     

抗神经节苷脂抗体与神经精神性狼疮相关性研究

目的 探讨抗神经节苷脂抗体在神经精神性狼疮(NPSLE)中的意义.方法 采用酶联免疫吸附试验(ELISA)法,检测68份血清(包括NPSLE患者33例.无神经精神症状的狼疮患者35例)和18例脑脊液(包括NPSLE患者10例,非NPSLE的狼疮患者8例)中的抗神经节苷脂抗体IsG和IgM.结果 血清中抗神经节苷脂抗体IgG、IgM在系统性红斑狼疮患者中的阳件率分别为21%、24%,在NPSLE患者中的阳性率均为18%,在无神经精神症状的狼疮患者中的阳性率分别为22%、29%,二者在抗体水平和阳性率上差异无统计学意义(P＞0.05).脑脊液中抗神经节苷脂抗体IgG、IgM在系统性红斑狼疮患者中的阳性率分别为10/18、9/18,在神经精神性狼疮患者中的阳性率均为7/10、8/10,在非NPSLE的狼疮患者中的阳性率分别为3/8、1/8,二者在抗体水平和阳性率上差异有统计学意义(P＜0.05).结论 脑脊液中AGA与NPSLE密切相关.     

免疫学指标联合检测诊断系统性红斑狼疮的价值研究

目的探讨C3、C4、IgG、IgA、IgM、抗核抗体(ANAS)、可提取的核抗原(ENA)和抗双链脱氧核糖核酸抗体(ds-DNA)联合检测对于诊断系统性红斑狼疮(SLE)的价值。方法选取非活性期SLE 26例作为SLE非活动组、活性期SLE 24例作为SLE活动组、体检健康者48例作为对照组,对3组患者进行免疫学检验,然后将检测结果进行对比。结果 SLE活动组的IgM、IgA、IgG水平高于对照组,C3、C4水平低于对照组,差异有统计学意义(P<0.05)。SLE非活动组IgA、IgG水平高于对照组,差异有统计学意义(P<0.05);但C3、C4和IgM水平与对照组比较,差异无统计学意义(P>0.05)。结论采用单一的免疫学检测不可能完全准确地诊断SLE,采用多种血清学指标进行联合检测才可以准确地对SLE的病情发展、活动性、临床疗效和预后效果进行诊断,尽可能减少假阴性的发生。     

抗PR3抗体和抗MPO抗体的检测及临床研究

目的探讨抗蛋白酶-3(PR3)抗体、抗髓过氧化物酶(MPO)抗体和抗中性粒细胞胞质抗体(ANCA),在系统性血管炎患者中的检测及临床意义。方法对251例临床确诊为系统性血管炎和其他自身免疫性疾病患者血清,应用酶联免疫吸附试验(ELISA)检测抗PR3抗体和抗MPO抗体;用间接免疫荧光法(IIF)检测ANCA,并进行回顾性分析。结果①251例系统性血管炎患者与非血管炎病人的检测,经χ2检验,P<0.01,差异均有非常显著性。②33例韦格纳肉芽肿病(WG)患者主要表现为PR3和颗粒型抗中性粒细胞胞质抗体(cANCA)阳性均为22例,阳性率为67%;非血管炎病人,27例溃疡性结肠炎(UC)患者检测MPO和核周型抗中性粒细胞胞质抗体(pANCA)阳性分别为13和14例,阳性率分别是48%和52%;104例SLE患者检测MPO和pANCA阳性分别为19例、24例,阳性率分别为18%和23%。③ELISA法和IIF法阳性率,经χ2检验差异无显著性(P>0.05)。结论PR3、MPO抗体作为系统性血管炎的一种敏感标记抗体,有利于该疾病的早期治疗。     

自身抗体联合检测在系统性红斑狼疮诊断中的意义

目的研究抗细胞膜DNA(cmDNA)抗体、抗核小体抗体(AnuA)、抗脱氧核糖核蛋白(DNP)抗体及抗双链DNA(dsDNA)抗体等特异性抗体在系统性红斑狼疮(SLE)诊断中的意义,并与抗核抗体(ANA)的敏感性和特异性进行比较。了解特异性自身抗体联合检测在SLE的诊断及临床应用中的意义。方法测定了125例SLE及118例疾病对照组(包括原发性干燥综合征、多发肌炎、系统性硬化症、未分化结缔组织病、类风湿关节炎、骨关节炎、强直性脊柱炎及银屑病关节炎)患者血清中的自身抗体。利用间接免疫荧光法测定抗cmDNA抗体和ANA,酶联免疫吸附试验(ELISA)测定AnuA、乳凝法检测抗DNP抗体、金标法测定抗dsDNA抗体。结果AnuA、抗cmDNA抗体、抗DNP抗体、抗dsDNA抗体和ANA在SLE患者中的阳性率分别为68%、38.4%、51.2%、49.6%和95.2%,均明显高于疾病对照组(3.4%、4.2%、1.7%、0.8%和25.4%),差异有统计学意义(P<0.001)。ANA与AnuA的敏感性显著高于其他三种抗体,差异有统计学意义(P<0.05);AnuA、抗cmDNA抗体、抗DNP抗体、抗dsDNA抗体和ANA的特异性分别为95.8%、96.6%、98.3%、99.2%和74.6%;AnuA在抗DNP抗体、抗dsDNA抗体阴性的SLE中的阳性率明显高于其他抗体(P<0.05);自身抗体的联合检测可提高SLE诊断的敏感性,但特异性无明显改变。结论抗cmDNA抗     

65例系统性红斑狼疮患者抗中性粒细胞胞浆抗体的检测分析

目的探讨抗中性粒细胞胞浆抗体(ANCA)与系统性红斑狼疮(SLE)的关系及临床意义.方法回顾性分析65例SLE患者的ANCA检测结果; ANCA与SLE主要临床表现、实验室检查结果的关系; SLE患者病情活动组与非活动组ANCA阳性率的比较.结果 IIF法检测ANCA在SLE中的阳性率是61.5 %,ANCA阳性组中有血管炎皮损(67.5 %)及浆膜炎(55.0 %)者明显高于阴性组(P<0.05);同时ANCA阳性组与阴性组比较,在24 h尿蛋白大于0.5 g/L,血红蛋白低于90 g/L,抗ds-DNA抗体阳性,低补体血症方面差别有统计学意义(P<0.05).结论提示ANCA可能是判断SLE病情复发与缓解的一个有用指标,推测ANCA与活动性狼疮肾炎有关.     

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.     

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.     

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.     

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.