良性颅内压增高与心磷脂抗体关系的临床研究

目的探讨心磷脂抗体（ACA）与良性颅内压增高（BIH）之间的关系及其临床意义。方法对27例BIH患者和30名健康对照组采用ELISA法检侧ACA-IgG及ACA-IgM,根据检测结果将BIH组分为ACA（＋）组和ACA（-）组,并对两组之间抗凝治疗的疗效进行比较。结果BIH组血清中ACA-IgG、ACA-IgM的阳性率均明显高于对照组（P〈0.01）;ACA阳性患者经抗凝治疗颅内压较快恢复正常,与ACA阴性患者比较差异有统计学意义（P〈0.05）。结论心磷脂抗体与BIH密切相关,抗凝治疗在一定程度上可改善其预后。     

乙型肝炎病毒感染者血清抗心磷脂抗体检测结果分析

目的了解抗心磷脂抗体（ACA）在乙型肝炎病毒（HBV）感染者血清中的分布及检出情况。方法采用金标法检测158例HBV感染者（HBV感染组）和150名正常对照者（正常对照组）血清ACA。结果HBV感染者的ACA阳性率显著高于正常对照组（P〈0．01）,肝功能异常的HBV感染者ACA阳性率显著高于肝功能正常的HBV感染者（P〈0．01）。结论ACA可在HBV感染者血清中检出,其滴度高低与病情严重程度有一定关系。     

中西医结合治疗73例偏头痛发作期的效果分析

目的分析中西医结合治疗偏头痛发作期的临床效果。方法73例偏头痛患者被随机分为对照组和治疗组，对照组给予养血清脑颗粒剂，治疗组在对照组治疗的基础上加用尼莫地平片，30天后观察疗效、脑动脉平均血流速度和甲襞微循环的变化。结果对照组和治疗组的总有效率分别为75．8％和97．5％（P〈0．05）；治疗组大脑前动脉（ACA）和基底动脉（BA）的平均血流速度减慢与对照组差异有极显著性（P〈0．01）；两组的血管形态、血液流态、襻周状态及总积分值治疗组与对照组差异有显著或极显著性（P〈0．05或P〈0．01）。结论中西医结合治疗偏头痛发作期有明显的协同作用。     

原发性肾病综合征患者外周血树突状细胞抗原提呈功能的研究

目的了解原发性。肾病综合征患者外周血树突状细胞的抗原提呈能力。方法采用流式细胞仪检测细胞表面标记表达,混合淋巴细胞反应评价初发原发性。肾病综合征病人组（14例）和对照组（21例）外周血树突状细胞的抗原递呈能力。结果原发性。肾病综合征患者外周血单核细胞能向树突状细胞分化,分化后的树突状细胞表达CD11c、CD40、CD80和CD83的阳性率显著低于对照组（P〈0．01）,刺激淋巴细胞增殖的能力显著弱于对照组（P〈0．05）。结论原发性。肾病综合征患者外周血单核细胞向树突状细胞分化的能力减弱,分化后的树突状细胞具有较弱的抗原递呈能力。     

狼疮性肾炎患者可溶性内皮细胞蛋白C受体水平变化及意义

研究对象为46例单纯SLE患者（SLE组）、52例并发狼疮性肾炎（LN）的SLE患者（LN组）及28例健康献血员（正常对照组），采用酶联免疫吸附试验（ELISA）和反向聚合酶链反应（RT—PCR）技术对其血浆可溶性内皮细胞蛋白C受体（sEPCR）水平及外周血循环系统sEPCR mRNA表达进行检测。结果LN组和SLE组血浆sEPCR水平及sEPCR mRNA表达均明显高于正常对照组（P〈0．01、0．05），且LN组显著高于SLE组（P〈0．01、0．05）。认为sEPCR在SLE及LN发病中可能起重要作用，可作为LN早期诊断标志物；以血管内皮细胞蛋白C受体（EPCR）为靶位可能成为治疗SLE的新方法。     

哮喘患者儿童期与成人期变态反应对比研究

采用瑞典pharmacia UniCAP100变应原检测系统，对57例儿童和51例成人哮喘患者的血清进行吸入性过敏原过筛实验、食物过敏原过筛实验和总IgE（TigE）的检测。儿童患者对食物过敏19例（33．3％），对吸入物过敏31例（54．4％）；成人患者分别为3例（5．9％）和18例（35．3％）；对食物过敏者的比例两组间有显著性差异（P〈0．01）；成人患者TigE水平亦显著低于儿童患者（P〈0．01）。认为随年龄增长，过敏反应程度逐渐减轻，成人期很少对食物过敏原过敏。     

抗心磷脂抗体、蛋白C与肝硬化门静脉血栓的关系

目的 研究肝硬化门静脉血栓(PVT)患者抗心磷脂抗体(ACA)和蛋白C(PC)的变化.方法 收集2006年1月至2007年12月肝硬化PVT患者20例作为血栓组,肝硬化非血栓患者40例作为对照组,对两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、ACA和PC进行检测,对比血栓组和对照组各项指标的差异.根据两组患者肝功能Child-Pugh分级,比较各级别上述各指标差异.结果 血栓组ACA阳性患者7例(35%),对照组4例(10%,P=0.045).血栓组ACA-IgG为(10.15±5.31)U/ml、PC为(2.47±0.62)mg/L,对照组分别为(6.70±3.75)U/ml和(2.93±0.88)mg/L,两组比较差异有统计学意义(P<0.05);而两组的PT、APTT、Fib和ACA-IgM结果相似(P>0.05).PT、APTT、Fib和PC在Child-Pugh各级间比较差异均有统计学意义(P值均<0.05);ACA-IgG和ACA-IgM随肝功能恶化而升高,但各级间比较差异均无统计学意义(P值均>0.05).血栓组ACA阳性率为35%(7/20),而对照组ACA阳性率为10%(4/40),两组比较差异有统计学意义(P=0.045).结论 肝硬化患者凝血和抗凝系统存在明显异常.肝硬化PVT患者与无PVT患者相比,ACA-IgG明显升高而PC则明显降低,ACA-IgG和PC在肝硬化PVT形成中可能起有重要作用.     

乙型肝炎的自身抗体检测分析及临床意义

目的：检测乙型肝炎自身抗体的阳性率,探讨乙型肝炎自身抗体存在的临床意义。方法：分别采用间接免疫荧光法（IIF）和免疫印迹法（Western-blot）检测453例乙型肝炎、162例自身免疫性肝炎（AIH）和96例正常人抗核抗体（ANA）的阳性率、ANA阳性滴度、核型和抗双链DNA抗体（dsDNA）的阳性率以及肝炎相关自身抗体：抗平滑肌抗体（SMA）、抗肝肾微粒体抗体（LKM）的阳性率。应用酶法检测患者的ALT和AST,实时荧光定量PCR技术检测HBV DNA。结果：①乙肝组ANA的阳性率为22．7％,ANA以低滴度（1：100）为主,仅3例乙肝后肝硬化的滴度为1：320;ANA核型以均质型为主,仅5例为斑点型,显著低于AIH组（P〈0．01）。其中急性乙肝、慢性乙肝、重症乙肝和乙肝后肝硬化ANA的阳性率分别为5．2％、22．8％、24．2％和37．9％,慢性乙肝、重症乙肝和乙肝后肝硬化患者ANA的阳性率显著高于急性乙肝（P〈0．05或P〈0．01）,乙肝后肝硬化组明显高于乙肝炎组（P〈0．05或P〈0．01）。②ANA阳性乙肝患者伴有dsDNA抗体,用Western-blot法检测dsDNA的阳性率为10．34％,显著高于ANA阴性的乙肝患者（P〈0．05）,乙肝组如DNA的阳性率为2．42％与AIH组差异无统计学意义（P〉0．05）。③乙型肝炎存在SMA和LKM,但仅有较低的阳性率分别为4．63％和3．31％,显著低于AIH组（P〈0．01）。④乙型肝炎ANA阳性组的ALT、AST水平和HBVDNA阳性率显著高于ANA阴性组（P〈0．05）;乙肝组ALT、AST水平和HBVDNA阳性率显著高于AIH组（P〈0．01）。结论：HBV感染不仅引起肝组织损害,还诱导产生多种以低滴度为主的自身抗体。自身抗体的产生与肝损伤程度有一定相关性,并与HBV复制水平相关;其在探讨乙肝发生、发展机制和病因研究中有一定的意义。     

血清幽门螺杆菌抗体谱与上消化道疾病相关性研究

目的探讨幽门螺杆菌（ Helicobacter pylori, Hp ）感染患者血清中抗体与上消化道疾病的关系。方法利用蛋白芯片技术检测394例患者血清中np的5种抗体（CagA、VacA、Ure、Hsp60、RdxA）水平，其中慢性胃炎120例、消化性溃疡178例、上消化道肿瘤38例以及门诊体检者58例，计算其阳性率，用统计学方法比较各组间差异性。结果慢性胃炎组的5种抗体的阳性率分别为28．3％、4．2％、48．3％、2．5％和5．0％；消化性溃疡组则分别为47．3％、6．7％、57．3％、4．5％、和3．9％；消化道肿瘤组分别为47．4％、7．9％、57．9％、44．7％和5．3％；对照组分别为10．3％、3．4％、43．1％、1．7％和6．9％。慢性胃炎组、消化性溃疡组及上消化道肿瘤组的CagA抗体阳性率均明显高于对照组（P〈0．01），以消化性溃疡组及上消道肿瘤组尤为显著（P〈0．001）。上消化道肿瘤组Hsp60抗体阳性率与其他3组比较有显著性差异（P〈0．001）。而VacA、Ure、RdxA3种抗体阳性率在各组间无显著性差异（P〉0．05）。结论不同抗体的存在与各种上消化道疾病的发生关系密切，Ure抗体普遍存在于人群中，CagA及Hsp60阳性Hp为上消化道疾病主要致病菌株。     

血清IgA—纤维连接蛋白聚合物在IgA肾病诊断中的意义

为探讨血清ＩｇＡ－纤维连接蛋白（ＦＮ）聚合物在ＩｇＡ肾病中的辅助诊断价值，对９１例ＩｇＡ肾病、１４例过敏性紫癜性肾炎、１１７例非ＩｇＡ肾脏病、２４例非肾脏病及２３４例健康人采用ＥＬＩＳＡ方法检测了血清中ＩｇＡ－ＦＮ聚合物水平。结果显示，ＩｇＡ肾病血清该聚合物水平及阳性率（６１．５％）显著高于狼疮性肾炎（３０．８％）、其他非ＩｇＡ肾脏病（８．８％）、非肾脏病（０．０％）及健康人群（５．１％）（Ｐ＜０．０５），但与过敏性紫癜性肾炎组（４２．９％）差异无显著性（Ｐ＞０．０５）。提示该聚合物对ＩｇＡ肾病具有一定的辅助诊断价值。但因在过敏性紫癜性肾炎及狼疮性肾炎时也有较高的阳性率，应注意鉴别。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.