膀胱肿瘤患者外周血源性树突状细胞表型及免疫功能变化

目的 探讨膀胱肿瘤患者外周血源性树突状细胞(dendritic cells,DCs)的表型及免疫功能变化.方法 通过密度梯度离心法从膀胱肿瘤患者和正常人外周血分离单个核细胞,加rhGM-CSF和rhlL-4诱导培养树突状细胞,采用流式细胞仪检测2组DCs表达程序性死亡配体-1(PD-L1)、CDla、HLA和CD83的变化,混合淋巴细胞反应检测其刺激T淋巴细胞增殖能力和ELISA法检测分泌IL-10和IL-12的变化.结果 膀胱肿瘤患者外周血DCs表达PD-L1[(95.06±4.06)％ vs (76.63±6.90)％]和分泌IL-10[(214.00±13.75) pg/mL vs(83.78±7.95) pg/mL]的水平显著高于正常组(P＜0.05),DCs表达CD83[(16.20±1.91)％ vs (35.53±1.58)％]及刺激淋巴细胞增殖的能力均低于正常组水平(P＜0.05).结论 膀胱肿瘤患者外周血源性树突状细胞高表达PD-L1、低表达CD83及过多分泌IL-10可能是膀胱肿瘤发生免疫逃逸的原因之一.     

胃癌患者外周血MoDCs功能活性检查及意义

目的以胃癌患者外周血单个核细胞培养树突状细胞(monocyte derived dendritic cells,MoDCs)为研究对象,检测功能表达,分析其临床意义,并初步探索改进MoDCs功能的方法.方法胃癌患者及健康成人外周血单个核细胞体外经GM-CSF/IL-4诱导培养MoDCs,检测其CD40、CD80和CD83表达.在DCs培养中分别加入不同浓度LPS和TNF-α,检测对DCs表面分子表达及T淋巴细胞刺激增值作用的改变.结果胃癌患者外周血培养获成熟MoDCs数量较少,其CD40、CD80、CD83表达较正常对照显著下调,对T淋巴细胞的刺激增殖作用显著低于正常.LPS(100ng/ml)和TNF-α(1 000 U/ml)能刺激CD40、CD80和CD83表达上调并改善其活化T淋巴细胞功能.结论胃癌患者MoDCs与正常成人相比有很大差异,免疫功能差.LPS、TNF-α可显著改善MoDCs功能状态,可作为以DCs为基础的胃癌生物治疗细胞来源.     

终末期肾病维持性血透患者树突状细胞分化成熟能力的研究

目的 研究终末期肾病(ESRD)患者外周血中树突状细胞(DC)分化成熟能力的变化,探讨ESRD患者免疫功能低下的可能机制.方法 采集接受维持性血液透析治疗的ESRD患者(ESRD组,n=20)外周血,利用粒-巨噬细胞集落刺激因子(GM-CSF)、白介素4(IL-4)和脂多糖(LPS)联合培养体系体外诱导培养DC,经流式细胞仪检测DC表面分子CD40、CD80、CD86 、CD83、CCR7和HLA-DR的表达,采用酶联免疫吸附法(ELASA)测定DC细胞培养上清液中细胞因子IL-12的含量.设立正常对照组(n=20).结果 与正常对照组比较,ESRD组DC表面分子CD40 、CD80 、CD86、CD83、CCR7和HLA-DR的表达率显著降低,组间比较差异均有统计学意义(P ＜0.05和P＜0.01);同时,ESRD组DC培养上清液中IL-12的含量显著高于正常对照组(P＜0.01).结论 ESRD患者外周血单核细胞源性的DC发育不成熟,其趋化迁移功能以及外源性抗原递呈能力下降,免疫激活能力降低,可能导致T细胞功能缺陷,从而最终诱导机体特异性的免疫耐受.     

非甲基化CG的寡脱氧核苷酸链对慢性乙型肝炎患者树突状细胞功能的影响

目的:探讨非甲基化CG的寡脱核苷酸链(CPG ODN)对慢性乙型肝炎(CHB)患者树突状细胞(DCs)功能的影响.方法:对10例慢性乙型肝炎患者,10例HBV携带者及10例健康对照者外周血来源DCs进行体外培养.应用流式细胞技术检测DCs的表面分子HLA-DR,CD80和CD86的表达,ELISA检测DCs培养上清中IL-12水平,并在电镜下观察DCs的改变.结果:体外培养第6天的DCs,加入CpG ODN继续培养24 h后,透射电镜下观察,与完全培养基对照组DCs相比,其表面的空起丰富、增粗,粗面内质网增多,空泡减少甚至消失.流式细胞仪分析显示, CpG ODN刺激组CD80,CD86及HLA-DR在CHB患者、HBV携带者及正常人DCs上的表达阳性率均较完全培养基对照组明显升高(P＜0.05).CHB患者、HBV携带者及正常人DCs均用完全培养基培养时,CHB患者及HBV携带者DCs上的HLA-DR,CD86和CD80的表达阳性率较正常人明显下降(P＜0.05),但CHB患者和HBV携带者之间比较差异无统计学意义(P＞0.05).CHB患者、HBV携带者及正常人DCs均用CpG ODN刺激时,CHB患者DCs上的HLA-DR和CD86表达阳性率较HBV携带者及正常人明显下降(P＜0.05),但HBV携带者和正常人之间比较却无统计学差异(P＞0.05);CHB患者和HBV携带者DCs的CD80表达阳性率较正常人明显下降(P＜0.05),但CHB患者和HBV携带者之间比较却无统计学差异(P＞0.05).ELISA检测发现CpG ODN刺激组DCs分泌IL-12的水平无论在CHB患者、HBV携带者及正常人均较完全培养基对照组明显升高(P＜0.05).无论是完全培养基培养还是CpG ODN刺激,CHB患者及HBV携带者DCs分泌IL-12较正常人明显下降(P＜0.05),但CHB患者和HBV携带者之间比较却无统计学差异(P＞0.05).结论:CpG ODN能够明显促进CHB患者外周血DCs成熟,为CpG ODN治疗CHB提供了实验基础.     

慢性粒细胞白血病患者树突状细胞抗原加工递呈和迁移功能观察

目的:研究细胞因子体外联合诱导培养的慢性粒细胞白血病(CML)患者树突状细胞(DCs)的表型和抗原递呈、分泌和迁移功能的变化.方法:分离CML患者(CML组)和健康志愿者(正常组)外周血单个核细胞(PMNCs),经培养获取贴壁细胞,将CML组和正常组的贴壁细胞及K562细胞用细胞因子rhGM-CSF、rhIL-4、TNF-α体外诱导10 d后,流式细胞仪检测细胞的免疫表型;培养5 d后,用ELISA检测细胞的内吞功能;应用混合淋巴细胞培养分析3组DCs对静息T细胞的免疫刺激活性.结果:正常组、CML组、K562组DCs的特异性标志CD83和共刺激分子标记CD80和CD86以及CD11和HLA-DR的表达差异无统计学意义(P＞0.05);DCs的抗原吞噬、迁移能力和对T细胞的免疫刺激活性,CML组和K562组之间差异无统计学意义(P＞0.05),CML组和正常组间差异有统计学意义(P＜0.05).结论:CML患者DCs的免疫表型和正常人相似,但其抗原捕获、递呈和迁移功能有缺陷.     

口服抗原对巨噬细胞共刺激分子CD80/CD86表达的影响

目的 探讨口服抗原对巨噬细胞(Mφ)共刺激分子CD80/CD86表达的影响及其在诱导妊娠免疫耐受中的作用.方法 自然流产小鼠(CBA/J×DBA/2)分为免疫组和未免疫组, 免疫组分别口服滋养细胞膜抗原(TMA2)和卵清蛋白(OVA),以正常妊娠小鼠(CBA/J×BALB/c)作为对照组.采用双标记流式细胞分析技术,分别检测各组小鼠脾脏及肠系膜淋巴结 (MLN) CD80 Mφ和CD86 Mφ的表达.结果 MLN内,未免疫组CD80 Mф表达明显高于对照组(P＜0.05),而CD86 Mφ含量明显低于对照组(P＜0.001);TMA2免疫组CD80 Mφ含量明显低于未免疫组(P＜0.05);OVA 免疫组CD86 Mφ含量明显高于未免疫组(P＜0.001).脾脏内,CD80 Mφ表达在各组间比较无显著差异;CD86Mφ表达, 未免疫组明显低于对照组(P＜0.05),TMA2免疫组显著低于未免疫组(P＜0.05),OVA免疫组则显著高于未免疫组(P＜0.001).结论 流产的发生与Mφ表面共刺激信号CD80/CD86异常有关;口服适当抗原可改变CD80/CD86 Mφ表达模式,诱导妊娠免疫耐受的形成.     

慢性乙型肝炎患者树突状细胞与CD4+Th细胞分化的关系

目的 探讨慢性乙型肝炎患者树突状细胞(dendritic cells,DCs)与CD4+Th细胞亚群分化的关系.方法 分离慢性乙型肝炎患者外周血单核细胞,以rhlL-4(50ng/mL)、rhGM-CSF(10ng/mL)和rhTNF-α(100μ/mL)诱导培养DC.以流式细胞仪检测DCs表面CD1a、CD83、CD80、CD和HLA-DR分子的表达情况.免疫磁珠分离外周血CD4+T细胞亚群,PMA+Ionomycin刺激后胞内荧光染色,流式细胞仪检测Th细胞内特征性细胞因子IFN-γ/IL-4以判断Th1/Th2分化.ELISA法检测DCs或Th细胞培养上清中IL-6、IL-12、IFN-γ和IL-4的含量.结果 慢性乙型肝炎患者的DCs表达CD1a、CD83、CD80、CD86和HLA-DR分子的水平明显低于正常人;培养至第7天.慢性乙型肝炎患者DCs分泌的IL-12水平低于正常人,而分泌的IL-6水平高于正常人.与正常人相比,慢性乙型肝炎患者外周血中Th1细胞占CD4+T细胞的百分比较低,Th细胞培养上清中IFN-γ的量也较低.患者DCs与同种异体的健康人Th细胞共培养,刺激Th1型细胞因子IFN-γ产生的能力低于正常人.结论 慢性乙肝患者体内DCs功能的异常可能导致了外周血Th1分化不足.     

CD80、CD86表达水平与免疫性血小板减少症患者免疫功能相关性

目的探究共刺激信号分子(CD80、CD86)表达水平与免疫性血小板减少症(ITP)患者免疫功能的相关性。方法纳入初诊ITP患者60例(初诊组),另取完全缓解患者45例(缓解组),健康志愿者30例(对照组),采用流式细胞技术检测各组外周血CD19~+CD80~+、CD19~+CD86~+及CD19~+B细胞内抗体IgG和IgM的表达情况。对初诊组进行治疗后根据治疗效果分为治疗后难治组(18例)和治疗后缓解组(42例),对比分析CD80、CD86表达与患者免疫功能及疗效的相关性。结果初诊组CD19~+CD80~+、CD19~+CD86~+、IgG、IgM、Th1、Th1/Th2表达水平高于缓解组和对照组,差异有统计学意义(P0.05);治疗后缓解组CD19~+CD80~+、CD19~+CD86~+、IgG、IgM、Th1、Th1/Th2表达水平显著低于治疗前,差异有统计学意义(P0.05);外周血CD19~+CD80~+、CD19~+CD86~+、IgG、IgM、Th1、Th1/Th2表达水平与ITP治疗效果密切相关(P0.05)。CD19~+CD80~+与CD19~+B细胞内抗体IgG、IgM的表达存在线性正相关关系(r=0.227、0.582,P0.05),CD19~+CD86~+与CD19~+B细胞内抗体IgG、IgM的表达存在线性正相关关系(r=0.453、0.276,P0.05)。结论 ITP患者外周血CD80、CD86通过影响CD19~+B细胞活化来介导免疫紊乱,参与ITP的发生、发展,其表达水平与血小板抗体水平、糖皮质激素治疗效果和预后密切相关。     

滋补肾阴、温补肾阳法对HBV免疫耐受患者DCs功能的影响

目的比较滋补肾阴法、温补肾阳法对HBV免疫耐受患者DCs功能影响。方法采集20例HBV免疫耐受患者和10例健康者外周血,免疫磁珠法分离单个核细胞(PBMCs),分离提取、培养DC细胞,采用滋补肾阴、温补肾阳药物制备的大鼠含药血浆进行培养干预,检测DCs表面CD80、CD86、HLA-DR、IL-12水平。结果药物血浆处理免疫耐受组DCs后CD80、CD86、HLA-DR、IL-12表达率升高,以CD80、IL-12升高最为明显(p 0. 05),温补肾阳药物血浆优于滋补肾阴组药物血浆和桂附汤血浆,六味地黄组优于桂附组。结论温补肾阳法和滋补肾阴法含药血浆均能提高HBV免疫耐受患者来源的DCs细胞功能,温补肾阳法对HBV免疫耐受患者DCs功能有着更显著的影响。     

活动性肺结核患者外周血髓样树突状细胞中 BTLA与B7-H4共表达检测及临床意义

目的 检测活动性肺结核患者(APT)外周血髓样树突状细胞(myeloid dendritic cell,mDC)中BTLA和B7-H4的表达,分析其与mDC表面成熟标志分子CD83、抗原递呈分子HLA-DR以及共刺激分子CD86表达的相关性,探究其临床意义。方法 采用流式细胞术检测46例APT外周血中mDC共表达BTLA和B7-H4的情况,以23例健康志愿者作为对照,同时对10例患者进行治疗后(1个月)的跟踪检测。比较BTLA和B7-H4双阳性mDC(DP-mDC)中CD83、HLA-DR及CD86的表达差异。结果 APT外周血中DP-mDC的表达显著高于健康对照组,在复治患者中表达显著高于初治患者,经过1个月治疗DP-mDC比例显著降低。在健康对照和患者外周血中,DP-mDC表达CD83和HLA-DR都显著高于DN-mDC,而CD86在DP-mDC中的表达水平低于DN-mDC。APT外周血中DP-mDC和DN-mDC表达HLA-DR的水平显著低于健康对照,CD86和CD83水平都显著高于正常对照。结论 APT中mDC高表达BTLA和B7H4分子,并与其表面分子的表达存在相关性,提示BTLA和B7H4的表达可能对mDC抗结核免疫中发挥调节作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.