类风湿关节炎患者外周血B淋巴细胞共刺激分子的表达及其意义

目的 初步探讨类风湿关节炎(RA)患者免疫功能紊乱的机制。方法 采用流式细胞仪检测RA患者外周血B淋巴细胞共刺激分子CD80、CD86、CD40的表达并用ELISA检测RA患者血清和关节滑膜液中Th1细胞分泌的细胞因子白细胞介素(IL)-2、干扰素-γ和Th2细胞分泌的细胞因子IL-6、IL-10的水平。结果 RA患者外周血B淋巴细胞CD86表达比正常对照组明显下降(P＜0．01),B淋巴细胞CD40表达比正常对照组明显增多(P＜0．05),而B淋巴细胞CD80表达与正常对照组之间差异无显著性(P＞0．05),同时RA患者血清及滑膜液中IL-2、干扰素-γ的水平比正常对照组明显升高(P＜0．01或P＜0．05),而IL-6、IL-10的水平降低(P＜0．01或P＜0．05)。结论 B淋巴细胞共刺激分子CD86、CD40的异常表达可能与RA患者Th1／Th2细胞分泌的细胞因子失衡密切相关,这将为临床治疗RA提供新的思路。     

日本血吸虫感染小鼠CD_4~+ T淋巴细胞协同刺激分子表达谱及其在介导Th1/Th2极化中的作用

目的观察日本血吸虫感染小鼠不同病期体内及体外培养后脾CD4+T淋巴细胞表面的协同刺激分子表达谱,探讨协同刺激分子介导Th1/Th2极化的作用。方法收集血吸虫感染后4w、7w、12w、16w和20w小鼠及正常小鼠脾CD4+T淋巴细胞,以及上述不同病期经SEA诱导72h后脾淋巴细胞培养上清,用流式细胞术检测细胞表面协同刺激分子CD80、CD86、ICOS、CD40、OX40、4-1BB及PD1表达水平,用ELISA法检测培养上清中的Th1细胞因子IFN-γ,Th2细胞因子IL-4、IL-5、IL-10、IL-13。结果血吸虫感染后小鼠脾CD4+T淋巴细胞表面CD86、ICOS、CD40和OX40的表达均随感染时间延长而上调,其中ICOS和CD86表达上调最为显著;经SEA诱导培养72h后CD86、ICOS亦显著上调表达;培养上清检测发现IFN-γ在4w时呈高表达,7w开始随感染时间延长呈下调表达;IL-4、IL-5、IL-10和IL-13的表达水平则从7w开始明显升高,IL-5的峰值出现在12w,其余均16w达高峰,致20w仍维持在较高水平。结论日本血吸虫感染小鼠CD4+T淋巴细胞协同刺激分子表达水平与Th1/Th2免疫偏移密切相关,其中ICOS、CD86在介导Th2极化中可能具有重要作用。     

rhG-CSF未经动员与动员后供者外周血淋巴细胞与干细胞采集物的细胞构成及功能比较

目的比较重组人粒细胞集落刺激因子（rhG-CSF）动员后供者外周血干细胞（PBSC）采集物与未经动员供者外周血淋巴细胞采集物的细胞构成及功能。方法取异基因造血干细胞移植供者的rhG-CSF动员后PBSC采集物（A组）和未经动员的淋巴细胞采集物（B组）,以流式细胞术测定采集物组分、T细胞亚群、树突细胞（DC）及其亚群、CD14^＋细胞和CD19^＋细胞B7分子的表达、CD4^＋T细胞IL-4和IFNγ等细胞因子的分泌情况,四甲基偶氮唑盐法测定T淋巴细胞增殖能力。结果两组采集物的CD3^＋、CD4^＋、CD34^＋、CD14^＋细胞比例有明显差异,A组DC细胞及其亚群的比例明显高于B组,尤以DC2升高为著（P=0．000）,CD14^＋细胞上B7分子的表达A组明显低于B组,CD19^＋细胞上B7分子的表达无明显差异,分析两组CD4细胞内因子的分泌情况,A组的Ⅱ类细胞因子IL-4及IL-4／IFNγ均明显高于B组（P值分别为0．044,0．012）,经rhG—CSF动员后采集物的T淋巴细胞增殖能力明显下降。结论动员后的PBSC采集物较未经动员的淋巴细胞采集物富集了更多的CD34^＋、CD14^＋细胞,同时rhG—CSF动员后DC2比例的明显升高使得CD4细胞向Th2分化,PBSC含有更多的Ⅱ类细胞因子和其T细胞增殖能力的下降、共刺激分子的下调均提示PBSC较供者淋巴细胞输注更少地引起急性移植物抗宿主病的发生。     

B7-1阻断剂对实验性小鼠支气管哮喘的治疗作用

支气管哮喘（简称哮喘）最重要的免疫学异常是Th1／Th2亚群数目和（或）功能比例失衡，表现为Th2亚群数目增多和功能亢进，Th1亚群数目减少和功能降低。抗原递呈细胞（APC）能刺激CD4^＋T淋巴细胞向Th2细胞分化，是诱导哮喘发病的第一步，APC／T淋巴细胞相互识别中，B7家族协同刺激信号和其配体的结合是诱导Th2效应的关键，分子中与哮喘关系最密切的是B7-1（CD80）和B7-2（CD56），其中B7-1／CD28是激活T淋巴细胞最重要的协同刺激通路是B7-1／CD28通路，其在哮喘的发病和治疗中具有重要研究价值。我们的实验以小鼠哮喘模型为研究对象，观察阻断B7-1／CD28协同刺激通路对哮喘的治疗作用，为探讨哮喘治疗的新途径提供实验资料。     

白介素23受体在支气管哮喘小鼠脾源性CD4^＋T细胞中的表达及意义

-23R）的表达及在哮喘发病中的作用。方法建立急性哮喘小鼠模型,免疫磁珠分离小鼠脾源性CD4^＋T细胞,培养24h后,检测CD4^＋T细胞表面IL-23R的表达、Th17细胞的阳性率及细胞培养上清液中的IL-17水平。结果哮喘小鼠脾脏CD4^＋T细胞表面IL-23R的表达明显高于正常组（P〈0．01）;哮喘小鼠脾脏CD4^＋T细胞中Th17细胞的阳性率明显高于正常组（P〈0．01）;哮喘小鼠脾脏CD4^＋T细胞分泌IL-17浓度明显高于正常组（P〈O．01）;小鼠脾脏CD4^＋T细胞表面IL-23R的表达与Th17细胞的阳性率和IL-17的浓度呈正相关。结论IL-23R在急性哮喘的发病机制中可能起重要作用。     

氧化苦参碱对慢性HBV携带者外周血树突状细胞及细胞因子的影响

目的：研究氧化苦参碱对慢性乙型肝炎病毒（ HBV ）携带者外周血树突状细胞及细胞因子的影响。方法：分离60例慢性HBV携带者外周血单核细胞后在诱导培养树突状细胞过程中治疗组加入氧化苦参碱,对照组不加,每组各30例,然后提取两组成熟的树突状细胞,计数后采用双标记流式细胞分析技术检测其活性,再用表位多肽刺激后,和自体淋巴细胞共育,分别检测IL-2和IFN-γ（ Th1分泌）及IL-4和IL-10（ Th2分泌）。结果：治疗组其树突状细胞数目增多,共刺激分子CD1a、 CD80、 CD86明显高于对照组（P＜0.05）。与自体淋巴细胞共育后产生的IL-2、 IFN-γ明显高于对照组（P＜0.05）; IL-4、 IL-10与对照组差异无显著性意义（P＞0.05）。结论：氧化苦参碱可增多、增强HBV携带者外周血树突状细胞的活性,当其与自体淋巴细胞共育时,可增强Th1类细胞因子的表达,对Th2类细胞因子无明显影响。     

外周血单个核淋巴细胞表面IL-21受体表达与类风湿关节炎的相关性

目的探讨外周血单个核淋巴细胞表面IL-21受体（IL-21R）在类风湿关节炎（RA）发生过程中的作用。方法收集32例RA患者（观察组）和22例健康成人（对照组）外周血标本,分离外周血单个核淋巴细胞,采用流式细胞仪检测CD4^＋、CD8^＋细胞、B细胞和NK细胞表面IL-21R的表达。结果观察组IL-21R表达水平明显高于对照组（P〈0．05）。药物治疗症状控制后,IL-21R表达水平明显下降（P〈0.05）。结论RA患者外周血单个核淋巴细胞表达IL-21R水平明显升高,提示IL-21R在RA的病情进展中起重要作用,其机制可能为诱导关节滑膜炎症病变、参与关节滑膜组织及全身的免疫病理损伤。     

成纤维滑膜细胞p53基因表达对类风湿关节炎患者CD4+T淋巴细胞的调节

目的 研究人成纤维滑膜细胞(FLS)p53基因表达对类风湿关节炎(RA)患者CD4+T淋巴细胞的调节作用.方法 采用小分子干扰RNA(siRNA)转染抑制FKS内p53基因表达,并与RA患者外周血CD4+T淋巴细胞共同培养.检测转染后FLS中骨保护素(OPG)表达及白细胞介素(IL)-6分泌.并对与之共培养的CD4+细胞膜胞质内蛋白干扰素(IFN)-γ、IL-17、IL-4和CD25以及IFN-γ孤儿核受体γt(RORγt)、IL-17、Foxp3 RNA水平进行测定.结果 p53基因被抑制后,FLS分泌IL-6减少,但OPG表达未受影响.p53基因被抑制的FLS使共培养的CD4+T淋巴细胞内IL-17及IFN-γ蛋白和RNA表达上调,但对CD4+T淋巴细胞RORγt RNA影响不大.虽可上调Foxp3表达,但CD4+CD25high细胞阳性率并无明显变化.结论 FKS内D53表达对RA外周血Th1、Th17有调节作用.     

溃疡性结肠炎患者外周血Th17/Treg免疫平衡的研究

目的研究溃疡性结肠炎（UC）患者外周血Th17细胞（CD4＋IL-17＋T细胞）与Treg细胞（CD4^＋CD25^＋T细胞）数量以及相关细胞因子的表达水平,分析Th17／Treg细胞免疫平衡在UC发病机制中的作用。方法收集UC患者（UC组）和健康体检者（对照组）的外周肝素抗凝静脉血,分离纯化T淋巴细胞。分别以PE-CD4与FTTC—CD25单抗,PE-CD4与FITC—IL-17的单抗作双色流式细胞术,分析溃疡性结肠炎患者外周血Th17、Treg细胞的百分率,ELISA法检测血清中相关细胞因子IL-17和TGF—β1的水平。结果与对照组比较,溃疡性结肠炎患者外周血Th17细胞百分率升高,Treg细胞的百分率显著下降,Th17／Treg比值升高（P〈0．05）,血清中细胞因子IL-17升高、TGF-β1降低,并且IL-17／TGF-β1比值升高。结论溃疡性结肠炎患者外周血存在细胞免疫功能失调;Th17／Treg细胞数量与免疫平衡状态发生改变,T淋巴细胞耐受机制的破坏可能与溃疡性结肠炎的发病机制有关。     

骨桥蛋白介导类风湿关节炎发病机制的初步研究

目的研究骨桥蛋白(OPN)介导类风湿关节炎(RA)发病和促进炎症因子产生的作用。方法采用实时定量聚合酶链反应(PCR)的方法检测OPN在RA患者外周血、关节液和关节滑膜组织和在T淋巴细胞亚群中的表达;从蛋白水平分析RA患者关节液中促炎症细胞因子和抗炎症细胞因子的分泌格局,分析OPN与细胞因子的相关性。结果RA患者关节滑液和关节滑膜组织的OPN表达远远高于外周血单个核细胞的OPN基因表达,CD4 T细胞OPN基因表达均高于CD8 T细胞;RA患者关节液中OPN的表达显著高于血清,白细胞介素(IL)-10,干扰素(IFN)-γ和肿瘤坏死因子(TNF)-α水平比自身血清及对照组血清增高,IL-18和IL-12水平比正常对照组明显升高。结论OPN可能通过调节病灶部位的细胞因子的分泌来调控RA病理过程中的炎症反应。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.