慢性乙肝和慢性重型乙肝患者外周血清IL-6的变化

目的探讨慢性乙型肝炎和慢性重型乙型肝炎患者血清白细胞介素6（IL-6）的变化及意义。方法ELISA法检测30例正常对照、31例慢性乙型肝炎患者和30例慢性重型乙型肝炎患者外周血清IL-6的水平，荧光定量PCR法检测血清HBVDNA并取对数作为复制水平的指标，总胆红素（TB）、白蛋白（A）、球蛋白（G）和凝血酶原时间（PT）的检测按照本院常规检测。均数间的比较采用Student-t检验；两组数据间的相关性分析采用线性相关分析；P〈0．05为有统计学意义。结果自正常对照组到慢性乙型肝炎组及慢性重型乙型肝炎组外周血清IL-6水平均依次升高，且各组间比较均具有显著性差异；慢性重型乙型肝炎组与慢性乙型肝炎组比较血清HBVDNA对数值间无显著差异；外周血清IL-6水平与TB及PT呈现显著的正相关，与A／G比值间呈现显著的负相关，但与血清HBVDNA对数值问无显著的相关性。结论IL-6可能参与慢性乙型肝炎及慢性重型乙型肝炎的发病。     

慢性乙肝和慢性重型乙肝患者血单核细胞Toll 样受体2的变化

 【目的】 探讨慢性乙型肝炎和慢性重型乙型肝炎患者外周血单核细胞Toll样受体2（TLR2）的变化情况及其意义。【方法】 随机选取慢性乙型肝炎患者31例，设定为慢性乙型肝炎组，慢性重型乙型肝炎患者30例设定为慢性乙型肝炎组，健康志愿者30例为正常对照组，用流式细胞仪检测各组外周血单核细胞表面Toll样受体2的表达，ELISA法检测血清肿瘤坏死因子α（TNF-α）的水平，荧光定量PCR法检测血清HBV DNA并取对数作为复制水平的指标，总胆红素（TB）和凝血酶原时间（PT）的检测按照本院常规检测。三组均数间的比较采用单因素方差分析和Scheffe 检验进行两两间的比较；两组计量资料间的比较采用Mann-Whitney U秩和检验；两组数据间的相关性分析采用线性相关分析；P<0．05为有统计学意义。【结果】 正常对照组、慢性乙型肝炎组及慢性重型乙型肝炎组外周血单核细胞TLR2表达强度和外周血清TNF-α水平均分别为（21．5 ± 2．7）MFI、（39．0 ± 4．1）MFI、（47．7 ± 21．4）MFI和（54 ± 38）ng/L、（164 ± 90）ng/L、（360 ± 140）ng/L，依次逐渐升高，且各组间比较均具有显著性差异；外周血单核细胞TLR2表达水平与血清TNF-α表达水平呈现显著的正相关。慢性重型乙型肝炎组与慢性乙型肝炎组TB，PT和血清HBV DNA对数值分别为（470 ± 225）μmol/L与（101 ± 131）μmol/L， （35．1 ± 21．1）s与（15．4 ± 2．2）s和5．9 ± 2．0与5．4 ± 1．6；慢性重型乙型肝炎组与慢性乙型肝炎组比较，TB、PT显著升高而血清HBV DNA对数值无显著性差异；外周血单核细胞TLR2表达水平与TB及PT呈现显著的正相关，但与血清HBV DNA对数值间无显著的相关性。【结论】 TLR2可能与慢性乙型肝炎及慢性重型乙型肝炎的发病有关。     

慢性乙型肝炎患者外周血单个核细胞肿瘤坏死因子检测

目的通过检测慢性乙型肝炎患者外周血单个核细胞胞内肿瘤坏死因子生成量和血清HBV DNA含量,探讨慢性乙型肝炎慢性化进程中外周血细胞肿瘤坏死因子生成变化与血清HBV DNA含量关系.方法采用双色荧光分析方法和设门技术,运用流式细胞术分析正常对照人群(11例)、慢性活动性B型肝炎患者(14例)外周血单个核细胞(PBMCs)TNF-α表达率、细胞内TNF-α水平,定量PCR检测HBV DNA滴度、酶法测定患者血清ALT水平.结果 HBV组外周血PBMCs TNF-α阳性率显著高于对照组(P<0.01),胞内TNF-α量对照组和HBV组间无差别;实验组对照组淋巴细胞群TNF-α阳性细胞率统计学分析无显著差异,然而胞内TNF-α的量对照组明显高于HBV组(P<0.01);实验人群CD14+细胞占PBMC总量的2.06%～5.82%,两组间无显著差别;HBV组CD14/TNF-α+细胞率高于对照组(P<0.05),细胞内TNF-α水平与对照组间无差别(P>0.05).HBV患者乙型肝炎慢性轻度组、乙型肝炎慢性中度组和乙型肝炎原发性肝癌组观察的TNF-α相关指标中,CD14+/TNF-α+双阳性细胞占外周血CD14+细胞比率原发性肝癌、乙型肝炎慢性中度患者高于乙型肝炎慢性轻度组、对照组(P<0.01),乙型肝炎慢性轻度组与对照组间没差别.患者PBMCs、T细胞、单核细胞TNF-α阳性率,胞内TNF-α水平各项观测指标与血清HBV DNA拷贝数经统计分析均无相关性.结论随慢性肝炎乙型病情进展TNF-α生成细胞增高,以慢中型、原发性肝癌较高,慢肝轻度次之,TNF-α生成量与血清HBV DNA拷贝数无相关性.     

中药结肠灌洗联合血浆置换对慢性重型乙型肝炎患者血清肿瘤坏死因子-α、白介素-18及内毒素水平的影响简

目的 观察中药结肠灌洗联合血浆置换对慢性重型乙型肝炎患者肝功能、血清TNF-α、IL-18及内毒素水平的影响,并探讨其机理.方法 选择慢性重型乙型肝炎患者112例,分为中药结肠灌洗联合血浆置换组（治疗组）、血浆置换组（对照组）,分别检测治疗前后肝功能、血清TNF-α、IL-18及内毒素水平的变化.结果 治疗组治疗后血清TNF-α、IL-18及内毒素水平较治疗前显著下降（P＜0.05）;同对照组比较血清总胆红素、血氨、血清TNF-α、IL-18及内毒素水平有显著性差异（P＜0.05）.结论 中药结肠灌洗联合血浆置换治疗慢性重型乙型肝炎可更有效降低肝功能、血清TNF-α、IL-18及内毒素的水平,提高重型肝炎患者的存活率.     

重型肝炎患者外周血Toll样受体信号通路负性调节因子基因表达的初步研究

目的：探讨Toll样受体（toll-like receptors,TLRs）信号转导通路负性调控因子在重型乙型肝炎患者免疫发病机制中的作用。方法：采用荧光定量PCR检测慢性乙型肝炎组20例、重型肝炎早期组17例,重型肝炎中晚期组9例患者及健康对照组18例外周血单个核细胞TLRs信号通路负性调节因子髓样分化蛋白88短臂（myeloid-differentiation-88-short,MyD88s）、白介素1受体相关激酶-M（interleukin-1R-associated-kinase-M,IRAK-M）、单免疫球蛋白白细胞介素1受体相关蛋白（single-im－munoglobulin-interleukin-1R-related-molecule,SIGIRR）、锌指蛋白A20及TLR4基因的表达;ELISA法检测血浆肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白介素-10（interleukin-10,IL-10）的水平。结果：与健康对照组相比,MyD88s、IRAK-M、A20的基因表达水平及血清TNF-α、IL-10水平随病情加重逐渐升高（P<0.05）;而IL-10在慢性乙型肝炎组与重型肝炎早期组比较,差异无统计学意义（P >0.05）;TLR4 mRNA在慢性乙型肝炎组、重型肝炎早期组、重型肝炎中晚期组均高于健康对照组,重型肝炎中晚期组低于早期组（P<0.05）。相关性分析显示,慢性乙型肝炎组、重型肝炎早期组TLR4 mRNA与同组TNF-α、总胆红素水平正相关（P<0.05）,与凝血酶原活动度呈负相关（P<0.05）。结论：TLRs信号通路负性调节因子参与慢性肝炎和重型肝炎的发生,且负性调节因子持续升高可能导致重型肝炎患者免疫抑制。     

血清IFN-γ水平与重型乙型肝炎的关系

目的探讨血清γ-干扰素（IFN-γ）水平与重型乙型肝炎（SHB）的关系。方法采集40例SHB患者入院时、血浆置换（PE）后5天血清,根据SHB患者PE后5天病情转归分为好转组及恶化组;采集20例慢性乙型肝炎（CHB）患者及20例健康对照组血清;双抗体夹心ELISA法检测血清IFN-γ、TNF-α水平,荧光定量聚合酶链反应（PCR）仪检测HBVDNA水平。结果 SHB及CHB组血清IFN-γ均高于健康对照组,SHB与CHB组、SHB两组间血清IFN-γ差异均不明显,PE后5天SHB两组间血清IFN-γ差异不明显;SHB患者血清IFN-γ与TNF-α呈正相关,与PTA呈负相关,与TB及HBVDNA相关性不明显。结论 IFN-γ参与了SHB肝脏的免疫病理损伤;但血清IFN-γ水平与肝脏炎症损害程度关系不明显,不能较好反应SHB患者病情发展及转归。     

慢性肝炎及肝硬化患者血清中MMP-13 、TNF-α及IL-6的表达

目的研究基质金属蛋白酶（MMP-13）在慢性乙型肝炎及乙型肝炎后肝硬化患者血清中的表达水平，同时检测患者血清中的肿瘤坏死因子α（TNF-α）、白细胞介素-6（IL-6）以了解其与MMP-13之间的关系。方法采用双抗体“夹芯”酶联免疫吸附测定（ELISA）方法对13例慢性乙型肝炎患者及28例乙型肝炎后肝硬化肝功能失代偿患者进行血清MMP-13、TNF—α及IL-6检测，并分别对健康对照组进行检测。结果乙型肝炎后肝硬化患者的MMP-13与对照组及慢性乙型肝炎组相比较，有显著增高（P〈0．05）。慢性乙型肝炎及乙型肝炎后肝硬化患者的血清中TNF—α及IL-6水平与对照组相比较，均有显著增高（P〉0．05）。慢性乙型肝炎及乙型肝炎后肝硬化患者血清中TNF-α及IL-6水平与MMP-13水平无明显相关性（P〉0．05）。结论MMP-13在肝纤维化形成过程中具有重要作用。TNF—α及IL-6对慢性乙型肝炎与乙型肝炎后肝硬化患者血清中MMP-13表达的影响甚小。     

复方甘草酸苷注射液联合多烯磷脂酰胆碱注射液治疗慢性乙型肝炎疗效观察

目的探讨复方甘草酸苷注射液联合多烯磷脂酰胆碱注射液治疗慢性乙型肝炎的临床疗效。方法 90例慢性乙型肝炎患者分为3组,每组30例。Ⅰ组患者给予复方甘草酸苷注射液治疗,Ⅱ组患者给予多烯磷脂酰胆碱注射液治疗,Ⅲ组患者给予复方甘草酸苷注射液和多烯磷脂酰胆碱注射液联合治疗,疗程均为30 d。治疗前后检测3组患者外周血肿瘤坏死因子-α(TNF-α)、丙氨酸氨基转移酶(ALT)和总胆红素(TB)水平及血浆白蛋白和球蛋白的比值(A/G),并进行比较。结果治疗前3组患者血清TNF-α水平比较差异无统计学意义(P>0.05);3组患者治疗后血清TNF-α水平显著低于治疗前(P<0.05);治疗后Ⅰ组与Ⅱ组患者血清TNF-α水平比较差异无统计学意义(P>0.05);治疗后Ⅲ组患者血清TNF-α水平显著低于Ⅰ组和Ⅱ组(P<0.05)。3组患者治疗前血清ALT和TB水平及A/G比较差异均无统计学意义(P>0.05);3组患者治疗后血清ALT和TB水平显著低于治疗前(P<0.05),3组患者治疗后A/G显著高于治疗前(P<0.05);治疗后Ⅰ组与Ⅱ组患者血清ALT和TB水平及A/G比较差异均无统计学意义(P>0.05);治疗后Ⅲ组患者血清ALT和TB水平显著低于Ⅰ组和Ⅱ组(P<0.05);治疗后Ⅲ组患者A/G显著高于Ⅰ组和Ⅱ组(P<0.05)。结论复方甘草酸苷注射液联合多烯磷脂酰胆碱注射液治疗慢性乙型肝炎可显著改善患者血清TNF-α水平和肝功能。     

抑郁症患者肿瘤坏死因子-α与生活事件及应对方式的相关研究

目的：研究抑郁症患者血清肿瘤坏死因子-α水平变化及其与生活事件、应付方式间的关系。方法：入组60例未经药物治疗的抑郁症患者进行生活事件量表（LES）、应付方式问卷和汉密尔顿抑郁量表（HAMD）的临床评定。用酶联免疫吸附方法对60例患者进行血清肿瘤坏死因子-α（TNF-α）检测,并与60名正常人群做比较。结果：血清肿瘤坏死因子-α水平在两组间差异无统计学意义（p〉0.05）;抑郁症患者中血清TNF-α水平与应付方式、生活事件总频度及强度、负性事件频度及强度无明显相关性（p〉0.05）;抑郁症患者较健康人群经历更多的负性生活事件,且较多采用不成熟应付方式,其差异有统计学意义（p〈0.05）。结论：抑郁症患者血清中肿瘤坏死因子-α分泌水平有待进一步研究;抑郁症患者较健康人群经历更多的生活事件,而多采用不成熟应付方式;血清TNF-α水平与生活事件及应付方式的相关性有待进一步研究。     

病毒性肝炎患者血清IL-6和TNF—α的测定及临床意义

目的 探讨病毒性肝炎患者血清白细胞介素-6（IL-6）和肿瘤坏死因子（TNF—α）的浓度变化及其临床意义。方法 对30例健康体检者和50例病毒性肝炎患者的血清采用放射免疫分析（RIA）测定IL-6和TNF—α的浓度，同期检测其HBVDNA。结果 病毒性肝炎患者的IL-6和TNF—α水平显著高于正常对照组（P〈0．01）。肝炎后肝硬化组显著高于慢性乙型肝炎组（P〈0．01），HBVDNA阳性组显著高于HBVDNA阴性组（P〈0．01）。结论 病毒性肝炎患者IL-6和TNF—α的测定能反映机体免疫损伤状况，对判断患者病情和预后有一定的临床价值。     

慢病管理对慢性乙型肝炎治疗效果的评价

目的观察慢病管理对慢性乙肝治疗的干预效果。方法将180例慢性乙肝患者随机分为观察组90例和对照组90例。对观察组进行慢痛管理干预,对照组未进行干预。采用疾病认知、依从性、生活方式测定量表对患者进行评价。结果观察组干预后疾病认知度、治疗依从性及生活方式积分较干预前明显提高,干预前后比较差异有统计学意义（P〈0．01）;干预后积分与对照组比较,差异有统计学意义（P〈0．05）。时照组干预前后治疗依从性评分比较,差异有统计学意义（P〈0．05）,疾病认知度及生活方式积分观察前后比较,差异无统计学意义（P〉0．05）。结论实施慢病管理干预可以提高乙肝患者对乙肝的认知度及治疗依从性,改善不良的生活方式。     

Prolonged chronic phase in chronic myelogenous leukemia after homoharringtonine therapy

Background Homoharringtonine （HHT） is effective in treating late stage chronic myelogenous leukaemia （CML）, but little is known about long term maintenance during complete cytogenetic response. Long term efficacy and toxicity profiles of low dose HHT were evaluated in this study. Methods One hundred and six patients with CML received 1.5 mg/m^2 of HHT alone by continuous daily infusion for seven to nine days every four weeks. Of 79 patients in the control group, 31 were treated with interferon α （IFN-α） and 48 with hydroxycarbamide. For 17 patients who failed to achieve cytogenetic response within 12 months＇ treatment of IFN-α, HHT was administered. Quantitative RT-PCR was used to detect the BCR-ABL mRNA expression in 36 Philadelphia positive CML patients enrolled after 2007. Haematological and cytogenetic responses were evaluated in all patients at the 12th month of follow-up. Long term efficacy was assessed in a follow-up with a median time of 54 months （12 months-98 months）. Results After 12 months of therapy, cytogenetic response rate of the HHT, IFN-α and hydroxycarbamide groups were 39/106, 14/31 and 3/48, and corresponding molecular cytogenetic response rates 6/18, 3/8 and 0. Of the 17 patients who received HHT as salvage treatment, 6 achieved cytogenetic response （3 major）. At the 48 months＇ follow-up, cytogenetic response was maintained in 32/39 patients treated with HHT. Patients who had cytogenetic response in HHT group or treated with IFN-α also showed longer median chronic durations, which were 45 months （12 months-98 months） and 49 months （12 months-92 months） respectively, indicating a longer survival time. Conclusions Low dose HHT alone showed considerable short term and long term efficacy in the treatment of late stage CML. It may also be a good choice for patients who have failed imatinib, IFN-α treatment or haematopoietic stem cell transplantation or cannot afford these treatments.     

四种方法治疗慢性淋巴水肿、淋巴管（结）炎的比较研究

目的应用四种常用方法,比较治疗慢性淋巴水肿和淋巴管（结）炎的疗效。方法采用音频电疗结合绑扎、桑叶注射液结合绑扎、香豆素、消肿乳糜清制剂分组治疗。结果音频电疗结合绑扎、桑叶注射液结合绑扎、香豆素、消肿乳糜清制剂组对慢性淋巴水肿疗后基本治愈和显效率分别为36．36％、68．75％、41．07％和61．78％,对慢性淋巴管结炎的治愈率分别为54．17％、83．33％、69．64％、95．85％。结论消肿乳糜清制剂是慢性淋巴水肿、淋巴管（结）炎患者最理想的天然治疗药物。     

Approaching chronic cough

Chronic cough is one of the most common reasons for referral to a respiratory physician. Although fatal complications are rare, it may cause considerable distress in the patient’s daily life. Western and local data shows that in patients with a normal chest radiograph, the most common causes are postnasal drip syndrome, postinfectious cough, gastro-oesophageal reflux disease and cough variant asthma. Less common causes are the use of angiotensin-converting enzyme inhibitors, smoker’s cough and nonasthmatic eosinophilic bronchitis. A detailed history-taking and physical examination will provide a diagnosis in most patients, even at the primary care level. Some cases may need further investigations or specialist referral for diagnosis.     

Tropical chronic pancreatitis

Tropical chronic pancreatitis (TCP) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. The classical triad of TCP consists of abdominal pain, steatorrhoea, and diabetes. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes (FCPD) which is thus a later stage of TCP. Some of the distinctive features of TCP are younger age at onset, presence of large intraductal calculi, more aggressive course of the disease, and a high susceptibility to pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis of TCP and in non-calcific cases ductal dilation on endoscopic retrograde cholangiopancreatography, computed tomography, or ultrasound helps to identify the disease. Diabetes is usually quite severe and of the insulin requiring type, but ketosis is rare. Microvascular complications of diabetes occur as frequently as in type 2 diabetes but macrovascular complications are uncommon. Pancreatic enzyme supplements are used for relief of abdominal pain and reducing the symptoms related to steatorrhoea. Early diagnosis and better control of the endocrine and exocrine dysfunction could help to ensure better survival and improve the prognosis and quality of life of TCP patients.     

慢性支气管炎患者慢性阻塞性肺疾病发病影响因素的研究

目的 研究慢性支气管炎患者慢性阻塞性肺疾病（COPD）发病的影响。方法 1992年对≥15岁的67251名农民普查发现1999例未发生COPD的慢性支气管炎患者,收集吸烟、COPD家族史、炉灶情况、粉尘接触、肺功能等基线资料。整群随机分为干预区和对照组,对干预区实施戒烟宣传等干预措施。2000年采用分层随机抽样方法抽取1114例进行复查。结果 应答且资料完整者869例（占1114例的78．0％）。吸烟、基线COPD家族史阳性使第1秒用力呼气量（FEV1）和／或第1秒用力呼气量百分比（FEV1／FVC）随年龄下降速度加快,戒烟者与不吸烟者下降速度无显著差异。COPD8年累积发病与基线年龄、吸烟、COPD家族史阳性呈独立的正相关,而与基线FEV1和FEV1／FVC呈独立的负相关,戒烟与不吸烟者发病危险差异无显著意义。结论 衰老、吸烟、COPD家族史、肺功能低下且慢性支气管炎患者COPD发病独立的危险因素,特别不是独立的危险因素,戒烟可使吸烟者发病危险降低至近似于不吸烟者的水平。     

Fluoxetine ameliorates symptoms of refractory chronic prostatitis/chronic pelvic pain syndrome

Background  Category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common syndrome of unclear etiology with significant impact on quality of life. Because the outcomes of multiple therapies for CP/CPPS have been far from approving, the possible psychological factors have been considered to play an important role in CP/CPPS. Based on this, we investigated the role of antidepressant drug (fluoxetine) in men with refractory CP/CPPS.

Methods  In this study, 42 men diagnosed with refractory CP/CPPS without response to standard therapy (include multiple antibiotic courses and α-blockers) were referred for fluoxetine therapy. All patients received fluoxetine (20 mg/d) for three months and were clinically evaluated before (baseline), and after 4, 8 and 12 weeks of therapy. The evaluation included a National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) and a Beck depression inventory (BDI) questionnaire. Moreover, the subjective global assessment (SGA) was assessed at the 4th, 8th and 12th week of therapy.

Results  Significant decreases were observed for total NIH-CPSI (28.55 to 9.29), NIH-CPSI pain (14.69 to 5.19), NIH-CPSI urinary (4.95 to 1.88 ), NIH-CPSI quality of life (8.83 to 2.20), and BDI (34.67 to 13.95) scores compared with baseline, all P values <0.05. Twenty-nine (69.05%) reported marked improvement on the subjective global assessment and 33 (78.57%) had a greater than 50% decrease in NIH-CPSI at the end of therapy (12th week). At the same time, the Pearson correlation coefficient analysis demonstrated a positive correlation between BDI score and each CPSI score. No adverse events were reported in this study.

Conclusions  Fluoxetine appears to be a safe and effective treatment in improving symptoms in, and the quality of life of, men with difficult CP/CPPS. Moreover, amelioration of difficult CP/CPPS-related symptoms could be related to a decrease in depressive symptoms.