慢性乙型肝炎病毒感染者外周血T细胞亚群变化分析

目的分析慢性乙型肝炎(下称乙肝)病毒(HBV)感染者外周血T细胞亚群的特征及病程不同阶段的变化及意义。方法采用流式细胞仪对43例HBV感染者的外周血T细胞亚群进行检测,分析其差异及意义并与健康对照组26例相比较。结果慢性乙肝、肝硬化患者的外周血CD4+T细胞、CD8+T细胞百分比及CD4+T/CD8+T较急性肝炎组及健康对照组明显减少;HBV DNA阳性组、HBeAg阳性组外周血CD4+T细胞、CD8+T细胞百分比及CD4+T/CD8+T较健康对照组明显减少。结论HBV感染者体内存在T淋巴细胞亚群失衡和细胞免疫功能紊乱。外周血T淋巴细胞亚群与HBV感染的慢性化及肝病的临床发生和发展有关。     

Hereditary hemochromatosis: pathophysiology, diagnosis, and management

Hereditary hemochromatosis (HH) is an autosomal recessive genetic disease resulting in inappropriate intestinal iron absorption leading to iron overload and end-organ disease. The disease is most prevalent in white individuals of European descent. The C282Y mutation on the HFE gene accounts for most cases of HH; however, other genetic mutations have been identified. End-organ damage results in cirrhosis, diabetes mellitus, and cardiomyopathy. Therapeutic phlebotomy to deplete excessive iron stores is the standard treatment of HH and results in normal longevity if therapy is initiated before end-organ disease occurs.     

Hemochromatosis (HFE) gene sequence analysis of formalin-fixed, paraffin-embedded liver biopsy specimens.

BACKGROUND: Hereditary hemochromatosis (HH) is a common disease predominantly characterized by mutations of the HFE gene. METHODS AND RESULTS: We investigated the utility of HFE gene sequence analysis in the diagnosis of HH in 61 prospectively accrued formalin-fixed, paraffin-embedded liver biopsy specimens with clinical or histologic features suggestive of HH. Mutations in codons 63 or 282 of the HFE gene were identified by direct sequencing; in 21 of these samples, quantitative hepatic iron testing was also performed. Changes characteristic of HH were present in 16 (26%) of the cases, and 54% of the cases showed HFE gene mutations. The most common alteration was homozygous mutation of codon 282 (11 cases, 18%), followed by the combined 63 + 282 heterozygous mutation (3 cases, 5%). Two cases (3%) showed biallelic mutation of codon 63. The other 28 cases (46%) showed no sequence abnormalities. Weak iron staining did not exclude HH; intense staining did not reliably predict HH. CONCLUSION: When HH is clinically and/or histologically suspected, HFE gene sequencing of formalin-fixed, paraffin-embedded liver biopsy specimens is a rapid and cost-effective approach to genotypic diagnosis of HH.     

HFE mutations and hemochromatosis in Danish patients admitted for HFE genotyping

Analysis of the common C282Y and H63D mutations in the HFE gene is widely used to diagnose hereditary hemochromatosis (HH). The aim of this study was to evaluate the efficiency with which different hospitals and general practitioners select patients for HH genotype and to determine the distribution of HFE mutations in such patients. Nine hundred unrelated patients from Danish hospitals and general practitioners (group A) and 69 consecutive patients from a specialized liver unit (group B) were examined for HFE substitutions using multiplex real-time polymerase chain reaction. In group A we found 13.0% (0%) C282Y homozygotes, 5.8% (2.6%) H63D/C282Y compound heterozygotes and 1.9% (3.1%) S65C heterozygotes. The values for 420 Danish blood donors are shown in parentheses. The distribution of genotypes in group B was similar to that of the blood donors. Serum ferritin, transferrin iron saturation and pathological data were collected from 38 randomly selected C282Y homozygotes, 36 H63D/C282Y compound heterozygotes, 19 H63D heterozygotes, 17 S65C heterozygotes and 144 wild-types. All of the C282Y homozygotes and 28% of the compound heterozygotes were diagnosed as HH patients. There was no evidence of HH in the H63D homozygotes or S65C heterozygotes. Moreover, 7 wild-type patients, 2 C282Y heterozygote patients and one H63D heterozygote patient fulfilled the criteria for HH. The significant enrichment of HH among associated genotype samples submitted for HFE testing indicates that the clinical selection is generally adequate. However, the study showed substantial deviation in the selection efficiency among the various hospitals and general practitioners.     

HFE mutations and hemochromatosis in Danish patients admitted for HFE genotyping

Analysis of the common C282Y and H63D mutations in the HFE gene is widely used to diagnose hereditary hemochromatosis (HH). The aim of this study was to evaluate the efficiency with which different hospitals and general practitioners select patients for HH genotype and to determine the distribution of HFE mutations in such patients. Nine hundred unrelated patients from Danish hospitals and general practitioners (group A) and 69 consecutive patients from a specialized liver unit (group B) were examined for HFE substitutions using multiplex real-time polymerase chain reaction. In group A we found 13.0% (0%) C282Y homozygotes, 5.8% (2.6%) H63D/C282Y compound heterozygotes and 1.9% (3.1%) S65C heterozygotes. The values for 420 Danish blood donors are shown in parentheses. The distribution of genotypes in group B was similar to that of the blood donors. Serum ferritin, transferrin iron saturation and pathological data were collected from 38 randomly selected C282Y homozygotes, 36 H63D/C282Y compound heterozygotes, 19 H63D heterozygotes, 17 S65C heterozygotes and 144 wild-types. All of the C282Y homozygotes and 28% of the compound heterozygotes were diagnosed as HH patients. There was no evidence of HH in the H63D homozygotes or S65C heterozygotes. Moreover, 7 wild-type patients, 2 C282Y heterozygote patients and one H63D heterozygote patient fulfilled the criteria for HH. The significant enrichment of HH among associated genotype samples submitted for HFE testing indicates that the clinical selection is generally adequate. However, the study showed substantial deviation in the selection efficiency among the various hospitals and general practitioners.     

肝硬化患者外周血T淋巴细胞亚群变迁与免疫功能状态

目的 了解肝硬化(LC)患者外周血T淋巴细胞亚群的变化规律,探讨患者T细胞免疫功能状态.方法 采用流式细胞术检测32例代偿期LC患者(CC组)、35例失代偿期LC患者(LCC组)和63例健康者(对照组)外周血T淋巴细胞亚群水平.结果 与对照组比较,CC组和LCC组总T细胞及其各亚群细胞的绝对含量均下降,T4/T8比值升高,双阴性T细胞百分含量下降(P＜0.05);CC组T4/T8比值较LCC组更高(P＜0.05).结论 LC患者存在明显的T细胞免疫功能紊乱,包括各亚群细胞数量的减少及T4细胞相对于T8细胞的功能亢进.随着病情加重,T4细胞的应答能力进一步减退.     

SARS患者白细胞及T细胞亚群的变化

[目的]探讨严重急性呼吸综合征(SARS)患者外周血白细胞和T淋巴细胞亚群的变化及其临床意义。[方法]用全自动血细胞分析仪检测44例SARS患者外周血白细胞计数及分类．用流式细胞仪检测SARS患者外周血T淋巴细胞亚群;并与正常对照组比较。[结果]与对照组比较．SARS组患者白细胞总故显著下降,淋巴细胞百分数和绝对数显著下降．粒细胞绝对数显著下降,粒细胞百分数显著增如：CD、CD2^-和CD8^-细胞绝对数显著下降,CD3^-、CD4^-、CD8^-细胞百分数和CD4^-／CD8^-比值与对照组比较无显著性差异。1年后,恢复期SARS患者的上述各项指标均恢复正常。[结论]SARS冠状病毒感染损伤患者中性粒细胞和细胞免疫功能,但这种损伤是可逆的。     

Iron loading in HFE p.C282Y homozygotes found by population screening: relationships to HLA-type and T-lymphocyte subsets

Iron loading in p.C282Y homozygous HFE hemochromatosis subjects is highly variable, and it is unclear what factors cause this variability. Finding such factors could aid in predicting which patients are at highest risk and require closest follow-up. The degree of iron loading has previously been associated with certain HLA-types and with abnormally low CD8?+?cell counts in peripheral blood. In 183 Norwegian, p.C282Y homozygotes (104 men, 79 women) originally found through population screening we determined HLA type and measured total T-lymphocytes, CD4?+?and CD8?+?cells, and compared this with data on iron loading. In p.C282Y homozygous men, but not in homozygous women, we found that the presence of two HLA-A*03 alleles increased the iron load on average by approximately 2-fold compared to p.C282Y homozygous men carrying zero or one A*03 allele. On the other hand, the presence of two HLA-A*01 alleles, in male subjects, apparently reduced the iron loading. In p.C282Y homozygous individuals, the iron loading was increased if the CD8?+?cell number was below the 25 percentile or if the CD4?+?cell number was above the 75 percentile. This effect appeared to be additive to the effect of the number of HLA-A*03 alleles. Our data indicate that homozygosity for the HLA-A*03 allele significantly increases the risk of excessive iron loading in Norwegian p.C282Y homozygous male patients. In addition, low CD8?+?cell number or high CD4?+?cell number further increases the risk of excessive iron loading.     

CD4+ T-lymphocytopenia and systemic immune activation in patients with primary and secondary liver tumours

Using flow cytometry, we evaluated peripheral blood leucocyte subsets in 84 patients with primary and secondary liver cancer. The patients had significantly lower absolute (659+/-386 vs. 906+/-360 cells per microl, p=0.004) numbers of CD3+ CD4+, relative (9+/-5 vs. 12+/-4%, p=0.02) and absolute (154+/-115 vs. 221+/-83 cells per microl, p=0.02) numbers of CD8+ CD28+, absolute numbers of CD3+ and relative and absolute numbers of CD19+. Relative and absolute numbers of CD3+ DR+, CD3+ CD69+ and CD14+ CD16+ cells were significantly elevated in patients compared to controls. The phenotype was similar in 54 patients exposed to chemotherapy compared to 30 untreated patients. Urinary neopterin, a marker of systemic immune activation, was significantly higher in patients with liver tumours compared to controls. A negative correlation was observed between urinary neopterin and the absolute numbers of CD3+ CD4+ (Spearman rank correlation coefficient, rs = -0.54, p<0.0025) and CD19+ (rs = -0.49, p<0.01) in untreated patients. We conclude that, independently of prior chemotherapy, patients with liver present with markedly decreased numbers of CD3+ CD4+ lymphocytes as well as with other abnormalities of peripheral blood leukocyte phenotype. Similar to patients with human immunodeficiency virus infection, the decrease in CD3+ CD4+ lymphocytes is associated with systemic immune activation.     

新冠肺炎患者外周血T淋巴细胞亚群的变化及意义

目的探讨外周血T淋巴细胞亚群在新型冠状病毒肺炎（COVID-19）患者中的变化及意义。 方法回顾性分析2020年1月23日至3月10日武汉大学人民医院收治的507例COVID-19患者外周血淋巴细胞亚群变化。其中,普通型249例,重型217例及危重型41例。 结果507例COVID-19患者中,普通型、重型及危重型患者外周血CD3⁺、CD4⁺、CD8⁺ T细胞数均存在差异,随着疾病程度加重,均呈下降趋势;与普通型相比,重型、危重型的CD3⁺、CD4⁺、CD8⁺ T细胞数显著降低,差异有统计学意义（P均＜0.05）,且危重型患者上述T淋巴细数目较重型下降更显著,差异有统计学意义（P＜0.05）;此外,341例COVID-19患者中,死亡病例组CD3⁺、CD4⁺、CD8⁺ T淋巴细胞数目较治愈组显著降低,差异有统计学意义（P均＜0.01）。 结论重型、危重型COVID-19患者细胞免疫功能损伤更显著,外周血T淋巴细胞亚群变化与COVID-19疾病分型及预后显著相关,有助于评估疾病严重程度及判断预后。     

阿德福韦酯抗病毒治疗对慢性乙肝患者免疫功能的影响

目的探讨阿德福韦酯抗病毒治疗对慢性乙型肝炎患者外周血淋巴细胞各亚群的影响。方法对41例慢性乙型肝炎患者采用流式细胞术检测阿德福韦酯(ADV-dpv)治疗前、治疗12周和24周后与11例对照者外周血T淋巴细胞亚群进行比较,并结合血清丙氨酸氨基转移酶(ALT)和总胆红素(TbiL)水平及乙肝病毒DNA(HBV-DNA)载量水平进行统计学分析。结果治疗前各组患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显低于对照组,差异有统计学意义(P<0.05)。各组患者血清中ALT、TBiL水平及HBV-DNA载量水平与T淋巴细胞亚群失衡存在一致性,表现为慢性乙型肝炎(CHB)组和慢性重型肝炎(SH)组的ALT高于肝炎肝硬化(LC)组,差异有统计学意义(P<0.05),LC组和SH组患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显低于CHB组患者,差异有统计学意义(P<0.05)。ADV-dpv治疗12周和24周患者外周血T淋巴细胞CD3+、CD4+、CD8+绝对计数值明显高于治疗前,差异有统计学意义(P<0.05);各组患者ALT和TBiL水平及HBV-DNA载量较治疗前明显好转。结论慢性乙型肝炎在发展为重度和肝硬化的过程中外周血T淋巴细胞随病情的进展显著减少,经ADV-dpv抗病毒治疗后,肝功能明显改善,HBV-DNA复制明显减少,外周血淋巴细胞亚群绝对细胞数CD3+、CD4+、和CD8+进行性升高,T细胞亚群的状态呈逐渐改善的趋势。     

原发性胆汁性肝硬化患者外周血穿孔素的表达及其临床意义

  目的  研究原发性胆汁性肝硬化(primary biliary cirrhosis, PBC)患者外周血穿孔素(perforin, 又称pore-forming protein, PFP)的表达, 探讨PFP在PBC发病机制中的作用及其临床意义。  方法  应用荧光定量PCR检测86例PBC、56例慢性乙型肝炎(chronic hepatitis type B, CHB)和69名健康对照者的外周血单个核细胞(peripheral bloodmono nuclear cells, PBMCs)中PFP mRNA基因表达的差异; 采用流式细胞术分别检测CD3-CD56+自然杀伤细胞(natu-ral killer cells, NK)、CD3+CD8+细胞毒性T细胞(cytotoxic Tlymphocytes, CTL)和CD3+CD56+自然杀伤性T细胞(natural killer Tlymphocytes, NKT)的PFP蛋白表达量。  结果  PBC组PBMCs中PFP mRNA基因表达较健康对照者升高(P < 0.05);PBC、CHB患者和健康对照者NK、CTL和NKT占PBMCs的比例无明显差别(P>0.05), PBC患者NK、CTL和NKT中表达PFP蛋白的细胞较健康对照者明显升高(P < 0.01)。PFPmRNA基因表达量及NK、CTL和NKT表达PFP蛋白的细胞比例与PBC患者Mayo危险评分呈显著负相关(P < 0.01), PBC患者总胆红素水平与NK、CTL表达PFP蛋白的细胞比例呈负相关(P < 0.05)。  结论  PBC患者PFP的异常表达, 提示PFP可能参与PBC的发病。PBC患者NK、CTL和NKT表达PFP蛋白的细胞比例可做为PBC患者生存预后的有效指标。     

HFE mutations do not account for transfusional iron overload in patients with acute myeloid leukemia

BACKGROUND: Hereditary hemochromatosis (HH) is a HFE gene-linked disorder affecting 1 of 200 to 400 persons in white populations. It has been proposed that patients with a hematologic malignancy who are receiving frequent RBC transfusions should be screened for HFE mutations. This would identify C282Y homozygotes, who have a high risk of developing severe iron overload. STUDY DESIGN AND METHODS: DNA samples from 128 controls and 23 adult long-term survivors of acute myeloid leukemia (AML) treated at the Oulu University Hospital (Oulu, Finland) from 1987 to 2000 were examined for the presence of the C282Y and H63D mutations in HFE. All the patients were severely iron-overloaded, as determined from high serum ferritin values and/or increased storage iron in bone marrow. Phlebotomies were performed in five patients because of the symptoms of iron overload. DNA extracted from the blood was used to amplify HFE gene fragments by the PCR method, after which the amplification products were digested with restriction endonucleases SnaB I and Bcl I, and the restriction fragments were analyzed on agarose gels. RESULTS: No chromosomes with the C282Y mutation were found among the AML patients, and 5 patients (21.7%) were heterozygous for the H63D mutation. In the control group, 13 persons (10.2%) were heterozygous for the C282Y mutation and 26 (20.3%) for the H63D mutation, including 3 C282Y/H63D double heterozygotes. CONCLUSION: HFE mutations do not account for the harmful iron overload that develops in AML patients who receive large quantities of RBC concentrates after intensive chemotherapy.     

CD81和趋化因子CC受体5与丙型肝炎合并人类免疫缺陷病毒感染的相关性研究

目的 检测外周血CD4＋及CD8＋T淋巴细胞表面CD81、CCR5的表达,探讨与丙型肝炎病毒（HCV）单纯感染、人类免疫缺陷病毒（HIV）单纯感染和HCV/HIV合并感染的关系.方法 采用流式细胞术,检测HCV感染组（n=21）、HIV感染组（n=14）、HCV/HIV感染组（n=28）及正常对照组（n=30）人外周血CD4＋及CD8＋T淋巴细胞表面CD81和CCR5的表达.结果 与正常对照组相比,外周血CD4＋T淋巴细胞表面CD81,在HCV感染组表达变化不明显,而在HIV感染组和HCV/HIV合并感染组中低表达;CD8＋T淋巴细胞表面CD81,在HCV感染组、HIV感染组和HCV/HIV合并感染组中都呈高表达.外周血CD4＋T和CD8＋T淋巴细胞表面CCR5,在HIV感染组高表达,而在HCV感染组和HCV/HIV合并感染组中低表达.结论 HCV/HIV合并感染中,影响外周血CD4＋及CD8＋T淋巴细胞表面CCR5表达的主要因素是HCV感染;而合并感染对CD4＋及CD8＋T淋巴细胞表面CD81的表达,其影响作用是不相同的.     

甲型H1N1流感患者实验室指标变化与临床的关系

目的 分析208例甲型H1N1流感患者实验室检测指标,探讨其变化特点对甲型H1N1流感诊断及评估病情发展变化的价值。 方法 在病程中进行血常规、肝、肾功能指标、T淋巴细胞亚群以及其他感染性实验室指标的检测。对检验结果进行回顾性总结和统计学分析。 结果 入院初期绝大多数患者红细胞、血小板计数在正常范围内;43.3%患者白细胞总数下降,有36.1%患者中性粒细胞和16.8%患者淋巴细胞数降低;入院初期绝大多数患者肝、肾功能生化指标正常,部分患者存在电解质紊乱;CD3+、CD4+、CD8+T淋巴细胞数下降比较显著,特别是重症患者,并在入院数天后降至极低值,又随病情好转而回升正常。 结论 CD3+、CD4+、CD8+T淋巴细胞及血常规检查的淋巴细胞计数,是甲型H1N1流感患者早期鉴别诊断以及病情严重程度的重要指标,动态观察其变化对患者的病情发展、疗效观察及预后判断等方面有重要的指导价值。     

乙型肝炎病毒相关慢加急性肝衰竭患者外周血T淋巴细胞比例的特征及其意义

目的探讨乙型肝炎病毒相关慢加急性肝衰竭患者外周血T淋巴细胞的变化及意义。方法乙型肝炎病毒相关慢加急性肝衰竭患者（肝衰竭组）与慢性乙型肝炎患者（慢乙肝组）各50例,以门诊同期健康体检者（健康对照组）20名为对照,应用流式细胞仪测定外周血CD3’T淋巴细胞所占比例、CD4＋和CD8＋T淋巴细胞所占比例及比直、CD4＋CD25＋调节l生T淋巴细胞所占比例。结果肝衰竭组外周血CD31淋巴细胞[（35．48±23．44）％]、CD8＋T淋巴细胞[（37．66±13．28）%]、CD4＋CD25＋调节陡T淋巴细胞[（0．72±1．07）％]所占比例与健康对照组[分别为（50．31±12．09）％、（42．05±9．26）％、（2．93±1．31）％]和慢乙肝组[分别为（49．72±20．11）％、（41．95±8．63）％、（3．47±2．29）％1比较均下降,差异有统计学意义（P〈0．05）。结论乙型肝炎病毒相关慢加急性肝衰竭一旦形成,有别于慢性乙型肝炎时期,外周血总T淋巴细胞、CD8＋T淋巴细胞以及CD4＋CD25＋调节性T淋巴细胞等效应T淋巴细胞便处于耗损状态。     

Clinical utility and outcome of HFE-genotyping in the search for hereditary hemochromatosis

BACKGROUND: Hereditary hemochromatosis (HH), a disease involving iron accumulation in internal organs, occurs in about 1 in 200-400 Caucasians. The gene mutated in this disorder is termed HFE. The present study was designed to evaluate the diagnostic utility and outcome of genetic testing for HH in the service of public health care. METHODS: 137 subjects were referred by health clinics and general hospitals for HFE genotyping from various parts of Finland during the period 1999-2001. Two major mutations (C282Y and H63D) were determined for each patient. Reasons contributing to referrals and sets of values for serum transferrin saturation (s-TS) and iron and ferritin concentrations were also determined. RESULTS: 16.8% of the subjects were homozygous for the C282Y mutation, together with seven C282Y/H63D compound heterozygotes (5.1%). The rate of positive findings for the most typical mutations responsible for HH was found to have increased steadily during the period 1999-2001. CONCLUSIONS: Our data support a role for active testing for the C282Y and H63D mutations in health care. The fairly low number of genotyping requests nevertheless suggests that a large number of patients even with typical clinical signs or symptoms continue to escape detection.     

原发性胆汁性肝硬化患者肝硬化期外周血淋巴细胞计数及T细胞亚群检测与分析

目的探讨原发性胆汁性肝硬化(PBC)患者肝硬化期外周血淋巴细胞总数及T细胞亚群的特点并分析影响因素及临床意义。方法对86例肝硬化期PBC患者的临床资料、实验诊断数据进行回顾性分析,比较40例代偿期和46例失代偿期PBC患者肝功、免疫学指标和外周血淋巴细胞亚群特点,对可能的影响因素进行相关性分析。结果失代偿期PBC患者年龄、血清总胆红素(TBil)水平、血清总IgA水平、Mayo评分高于代偿期患者(P0.05),而ALT、ALB、外周血淋巴细胞绝对数(LYMPH)、淋巴细胞百分率(LYMPH%)、T淋巴细胞绝对数(CD3+)、T辅助细胞绝对数(CD3+CD4+)和T抑制细胞绝对数(CD3+CD8+)均低于代偿期患者(P0.05);LYMPH、LYMPH%、CD3+、CD3+CD4+和CD3+CD8+结果中,失代偿期减低者频率均高于代偿期(45.7%vs.10%,34.8%vs.7.5%,58.7%vs.17.5%,45.7%vs.5%,60.9%vs.27.5%,P0.05),失代偿期增高者频率均低于代偿期(54.3%vs.90%,6.5%vs.27.5%,0 vs.20%,2.2%vs.22.5%,2.2%vs.10%,P0.05)。在可能的影响因素中,年龄、Mayo评分、上消化道出血、脾大或脾切除、腹水等肝硬化失代偿表现对结果影响呈负相关;而ALT、ALB对结果影响呈正相关。结论随着肝硬化程度的加深,PBC患者外周血淋巴细胞总数及T细胞亚群数量降低;从淋巴细胞定量角度分析,随着疾病的进展,PBC患者免疫水平下降。     

免疫调理治疗对脓毒症患者血CD4+CD25+T细胞的影响

目的 了解脓毒症患者外周血调节性T细胞(CD4+CD25+Tregs)比例水平及其与机体细胞免疫之间的关系,并探讨免疫调理治疗对其水平的影响.方法 选择滕州市中心人民医院住院治疗的脓毒症患者40例,随机分成治疗组和对照组,治疗组加用乌司他丁和胸腺肽α1作抗炎和免疫调节治疗,分别于治疗前和治疗后第3,第8天抽外周静脉血,检测T淋巴细胞亚群、CD4+CD25+Tregs,TNF-α,IL-6,IL-10水平,同时APACHEⅡ评分.结果 治疗前两组患者CD4+CD25+Tregs细胞水平明显升高,总淋巴细胞数、T细胞比例下降,其中以CD4+T细胞下降更明显,CD4+/CD8+明显下降,IL-6,TNF-αt水平升高;治疗后,两组患者CD4+C125+Tregs降低,总淋巴细胞数、CD4+/CD8+比值升高,APACHEⅡ评分和IL-6,TNF-αt水平均下降,治疗组改善更明显.结论 外周血CD4+CD25+Tregs细胞比例水平,可以作为评价机体免疫能力及预后新指标;联合应用胸腺肽α1和乌司他丁治疗脓毒症,可提高患者免疫力,显著降低APACHEⅡ评分、IL-6,TNF-α水平,改善患者病情.

Abstract：

Objective To investigate the percentage of CD4 + C125 +Tregs in peripheral blood of patients with sepsis and its effect on cell immunity so as to unravel the effect of immunomodulatory therapy on it. Method Fourty patients with sepsis in ICU were randomly (random number) divided into experimental group and control group . The patients of experimental group were treated with Ulinastatin and immunoregulation agent (Thymosin αl) as well. The blood specimens were collected just before treatment, 3 days and 8 days after treatment. The percentages of CD4 + CD25 + Tregs and lymphocyte subsets were detected by using FCM (flow cytometry), and TNF-α, IL-6 and IL-10 assayed by using ELISA, and APACHE Ⅱ scores were calculated. Results Before treatment, the percentage of CD4 + CD25 + Tregs increased, and the number of lymphocytes and the percentage of T lymphocytes decreased, especially the CD4 + T lymphocytes and CD4+/CD8+ decreased more markedly, and the levels of IL-6 and TNF-α increased. After treatment,the percentage of CD4+ CD25 + Tregs was decreased, the number of lymphocytes and CD4 +/CD8 + increased, and the levels of APACHE Ⅱ score, IL-6 and TNF-α decreased especially in the experimental group decreased more significantly (P ＜ 0. 05). Conclusions The percentage of CD4 + CD25+ Tregs in peripheral blood can reflect the immune status of patients with sepsis and become a novel indicator to estimate the progress of sepsis, and the immunity and prognosis of patients. Treating the patients with Thymosin αl and Ulinastatin can raise their immunity, decrease the levels of IL-6, TNF-α and APACHE Ⅱ score and improve their prognosis.     

疣状胃炎外周血T淋巴细胞亚群变化及亮菌口服液干预作用

目的探讨疣状胃炎外周血T淋巴细胞亚群变化及亮菌口服液干预作用。方法采用流式细胞分析仪检测30例疣状胃炎和30例浅表性胃炎患者外周血CD3+、CD4+及CD8+,30例疣状胃炎患者经过亮菌口服液干预治疗再检测外周血CD3+、CD4+及CD8+。结果疣状胃炎患者外周血T细胞亚群CD3+、CD8+低于浅表性胃炎,经过亮菌口服液干预后两者CD3+差异消失;Hp阳性疣状胃炎较Hp阴性疣状胃炎T细胞亚群CD4+高,经过亮菌口服液干预后CD4+下降;疣状胃炎合并胆汁反流与不合并胆汁反流CD3+、CD4+及CD8+无差异。结论疣状胃炎存在外周血T淋巴细胞亚群异常,亮菌口服液可改善疣状胃炎T细胞免疫作用。