硬红斑患者免疫复合物检测及其临床意义

应用直接免疫荧光（ＤＩＦ）技术及抗Ｃ３－酶联免疫吸附试验（ＥＩＴＳＡ）分别检测了２５例硬红斑（ＥＩ）皮损血管壁上组织沉积免疫复合物（ＴＩＣ）和血清中循环免疫复合物（ＣＩＣ），结果显示：（１）ＥＩ血管壁上存在着ＩｇＧ、ＩｇＭ及ＩｇＣ，其总阳率为８４％（２１／２５），且ＩｇＭ、ＩｇＧ－ＴＩＣ为主（７２％，５２％），ＴＩＣ有两种方式，（２）８４％ＥＩ血清ＣＩＣ阳性，且以ＩｇＭ、ＩｇＧ－ＣＩＣ为主（７６％，５６％），ＩｇＭ－ＣＩＣ与ＩｇＧ－ＴＩＣ、ＩｇＧ－ＣＩＣ与ＩｇＧ－ＴＩＣ之间呈显著性一致，治疗后ＩｇＭ、ＩｇＧ－ＣＩＣ明显降低。上述结果首次证实ＥＩ为ＩＣ型血管炎，ＴＩＣ来自ＣＩＣ，Ⅲ型变态反应参与了ＥＩ的发病机理，动态观察ＥＩ血清ＣＩＣ可以做为ＥＩ的发病机理，动态观察ＥＩ血清ＣＩＣ可以做为ＥＩ治疗效果评估的指标。     

肌源性肌病的免疫活性表达及其临床意义

目的研究３０例肌源性肌病，包括进行性肌营养不良症（ＰＭＤ）、多发性肌炎（ＰＭ）／皮肌炎（ＤＭ）、先天性肌病（ＣＭＤ）和代谢性肌病（ＭＭＤ）骨骼肌活检组织的体液免疫、细胞免疫与免疫调控等免疫活性表达，探讨其临床意义及与病变之间的关系。方法免疫酶组化ＳＰ法检测抗体ＣＤ３、ＣＤ４、ＣＤ８、ＣＤ６８和ＨＬＡ－ＤＲ，免疫荧光一步法检测免疫球蛋白ＩｇＧ、ＩｇＭ和补体Ｃ３。结果（１）ＰＭＤ肌组织中免疫球蛋白ＩｇＭ、ＩｇＧ和补体Ｃ３免疫复合物的阳性率分别为５０％，３１．１％和１１．１％，以ＩｇＭ有统计学意义（Ｐ＜０．０５），主要定位于肌膜和间质小血管壁上，并与ＰＭＤ肌纤维的萎缩性病变有关。（２）ＰＭＤ肌组织中有单核炎症细胞浸润，以巨噬细胞和Ｔ淋巴细胞为主，其阳性反应率分别为１００％和５５．５％。巨噬细胞多位于坏死纤维中，Ｔ淋巴细胞分布于变性坏死肌纤维和肌束衣小血管周围，ＣＤ８＋Ｔ细胞数量增多，Ｔ４／Ｔ８＜１。（３）ＨＬＡ－ＤＲ染色显示ＰＭＤ肌组织中变性萎缩的小纤维周围有ＨＬＡ－ＤＲ＋的激活单核炎症细胞浸润，与神经源性肌病组及正常对照组比较差别均有显著性（Ｐ＜０．０５）。肌纤维ＨＬＡ－ＤＲ阳性反应者占２２％（４／１８），表明     

乳腺导管扩张病与局部免疫复合物研究

应用免疫组化法检测１９例乳腺导管扩张病病灶组织中的Ｃ_３、ＩｇＧ、ＩｇＭ、ＨＬＡ－ＤＲ，结果Ｃ_３阳性率８９．４％，ＩｇＧ６８．４％，ＩｇＭ４２．１％，ＨＬＡ－ＤＲ阴性，组织切片免疫复合物沉积区域与组织病理改变相一致，沉积物呈颗粒状或堆集呈节段线型分布于细胞膜上。伴有Ｃ_３阳性的ＩｇＧ、ＩｇＭ阳性率差异无显著性（Ｐ＞０．０５），证实乳腺导管扩张病发病机理中有２种Ｉｇ结合补体事与免疫反应；自身组织抗原与ＨＬＡ－ＤＲ无相关性。结果提示：除ＩｇＧ和ＩｇＭ外可能还有其它类型Ｉｇ抗体参与本病免疫反应。     

不明原因智力低下学生弓形虫感染的调查

采用ＥＬＩＳＡ方法，对６６例不明原因的先天智力低下学生及３４例健康人进行了弓形虫循环抗原（ＣＡｇ），ＩｇＭ和ＩｇＧ的检测，智力低下组弓形虫ＣＡｇ，ＩｇＭ和ＩｇＧ的阳性率分别为１６．６７％（１１／６６），１９．７０％（１３／６６），３７．８８％（２５／６６）对照组弓形虫ＣＡｇ，ＩｇＭ和ＩｇＧ的阳性率分别为是２．９４％（１／３４），１１．７６％（４／３４），结果显示，智力低下组弓形虫感染效率与对照组有     

用间接免疫荧光法和PCR技术重新评价抗CMV－抗体检测的临床意义

为了正确评价临床常用的检测抗巨细胞病毒（ＣＭＶ）抗体的临床意义，用间接免疫荧光法（ＩＦＡ）和聚合酶链反应技术（ＰＣＲ）检测了５０例急性黄疸型甲型肝炎患儿血白细胞中ＣＭＶ早期抗原（ＥＡ）和晚期抗原（ＬＡ）、血白细胞及尿沉渣ＣＭＶ－ＤＮＡ，阳性率分别为５８％、２２％、６８％、６２％。同期检测抗ＣＭＶ－ＩｇＧ、抗ＣＭＶ－ＩｇＭ，并观察ＩｇＧ急性期／恢复期是否升高４倍以上（ＩｇＧ↑↑），阳性率分别为８６％、３４％及４６％。仅检测１次ＩｇＧ，１４％的患者会漏诊；动态监测ＩｇＧ，４３．９％的活动性ＣＭＶ感染者会漏判；仅检测１次ＩｇＭ，５８．５％的活动性ＣＭＶ感染者会漏判。７９％的ＩｇＧ阳性患者为活动性感染（ＥＡ、ＬＡ、ＩｇＧ↑↑或ＩｇＭ任何１项阳性）；原发性及继发性活动性ＣＭＶ感染者的ＩｇＧ↑↑、ＥＡ、ＩｇＭ阳性率分别为１００％、４２．９％、２８．６％和４７．０％、７６．５％、４４．１％，表明原发感染诊断主要依靠ＩｇＧ↑↑，而继发活动感染则需多种指标。同期检测了２２名健康ＣＭＶ感染儿童的上述指标，与之无显著差异。     

血透患者病毒感染状况初步调查

目的与方法：对４３例血液透析患者的五种肝炎相关病毒（ＨＢＶ、ＨＣＶ、ＨＥＶ、ＨＧＶ和ＣＭＶ）标志物进行了检测。结果：以单项抗－ＨＣＶＩｇＧ检出率最高,达５８．１％;抗－ＣＭＶＩｇＭ检出率次之,为４１．９％;其持依次为ＨＢｓＡｇ３０．２％,抗ＨＣＶＩｇＭ２５．６％,抗－ＨＢｃ１８．６％,抗－ＨＢｓ１６．３％,抗－ＨＧＶＩｇＧ９．３％,ＨＢｃＡｇ７．０％,抗ＨＢｅ４．７％,抗ＣＮＭＶ－ＩｇＧ４．７5,ry     

免疫球蛋白在多发性肌炎和皮肌炎组织中的沉积

目的探讨多发性肌炎（ＰＭ）和皮肌炎（ＤＭ）骨骼肌组织损伤的免疫机制。方法采用免疫荧光一步法检测１８例ＰＭ／ＤＭ肌组织中免疫球蛋白ＩｇＧ－ＩｇＭ和补体Ｃ３的表达和分布。结果ＰＭ和ＤＭ肌组织中ＩｇＧ，ＩｇＭ，Ｃ３的阳性表达率分别为６０％，３０％，２０％和７５％，３７．５％，５０％，其中ＩｇＧ的差别与对照组相比统计学意义（Ｐ〈０．０５），分布于小血管壁，肌膜和肌浆中的Ｉｇｓ／Ｃ３免疫复合物阳性率分别为３     

抗HCV-IgM抗体测定及临床初步应用

将市售ＨＣＶ－ＩｇＧ诊断试剂盒加以改良，建立了ＨＣＶ－ＩｇＭ抗体检测方法，与抗ＨＢｃ－ＩｇＭ，抗ＨＢｓ－ＩｇＭ，抗ＣＭＶ－ＩｇＭ，抗ＲＶ－ＩｇＭ，ＲＦ及抗核抗体（ＡＮＡ）阳性血清均不起反应。正常人群中抗ＨＣＶ－ＩｇＭ阳性率为１．５％（１／６８），抗ＨＣＶ－ＩｇＧ阳性的４３例血透患者检出抗ＨＣＶ－ＩｇＭ１４例（３２．６％），１２例输血后肝炎抗ＨＣＶ－ＩｇＭ全部阳性。以上结果表明，抗ＨＣＶ－ＩｇＭ可作为输血后ＨＣＶ感染的一个敏感指标     

免疫球蛋白在多发性肌炎和皮肌炎肌组织中的沉积

探讨多发性肌炎（ＰＭ）和皮肌炎（ＤＭ）骨骼肌组织损伤的免疫机制。方法采用免疫荧光一步法检测１８例ＰＭ／ＤＭ肌组织中免疫球蛋白ＩｇＧ、ＩｇＭ和补体Ｃ３的表达和分布。结果ＰＭ和ＤＭ肌组织中，ＩｇＧ、ＩｇＭ、Ｃ３的阳性表达率分别为６０％，３０％，２０％和７５％，３７．５％，５０％，其中ＩｇＧ的差别与对照组相比有统计学意义（Ｐ＜０．０５）；分布于小血管壁、肌膜和肌浆中的Ｉｇｓ／Ｃ３免疫复合物阳性率分别为３０％，５０％，３０％和８７．５％，５０％，３０％，其中ＤＭ肌组织中血管壁的分布与对照组相比有显著差异（Ｐ＜０．０５）。结论体液免疫在ＰＭ／ＤＭ发病机理中占重要位置，补体介导的血管损害参与皮肌炎病变的发展过程。     

重症肌无力自身抗体、T淋巴细胞亚群及其临床意义的探讨

目的：探讨重症肌无力（ＭＧ）抗乙酰胆碱受体抗体（ＡｃｈＲａｂ）、抗突触前膜受体抗体（ＰｓｍＲａｂ）和Ｔ淋巴细胞亚群与临床的关系。方法：应用ＥＬＩＳＡ法检测４０例重症肌无力病人血清中上述两种自身抗体，应用Ｔ淋巴细胞亚群单克隆抗体微量细胞毒法检测该组病人Ｔ淋巴细胞亚群。结果：①ＡｃｈＲａｂＩｇＧ型阳性２４例（６０％）、ＩｇＭ型阳性１５例（３７．５％），ＰｓｍＲａｂＩｇＧ型阳性２４例（６０％）、ＩｇＭ型阳性１１例（２７．５％）；②仅ＡｃｈＲａｂＩｇＧ型阳性３例（７．５％）、ＩｇＭ型阳性１例（２．５％），只有ＰｓｍＲａｂＩｇＧ型阳性２例（５％），二种抗体的ＩｇＧ型和ＩｇＭ型均阴性７例（１７．５％）；③ＡｃｈＲａｂ与ＰｓｍＲａｂ存在直线正相关；④本组病人ＣＤ＋４增高、ＣＤ＋８降低、ＣＤ＋４／ＣＤ＋８比率增高；⑤ＣＤ＋４／ＣＤ＋８比率与这两种自身抗体无相关关系；⑥年龄大于４０岁组的ＣＤ＋８低于４０岁以下组，而ＣＤ＋４／ＣＤ＋８高于４０岁以下年龄组；⑦病程大于或等于３年组的ＣＤ＋８、ＣＤ＋４／ＣＤ＋８分别低于、高于病程小于３年组。结论：ＭＧ病人存在体液免疫和细胞免疫的异常；ＭＧ可受到ＡｃｈＲａｂ和ＰｓｍＲａｂ的免疫性损害     

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.