慢性乙型肝炎病毒感染者血清MIF、IL-17和IL-10水平变化

目的探讨HBV感染者外周血巨噬细胞移动抑制因子(MIF)、IL-17和IL-10水平变化的临床意义。方法收集60例慢性无症状HBV携带者、60例慢性乙型肝炎患者、60例乙型肝炎肝硬化患者、60例肝癌患者和50例健康对照者空腹血清,采用ELISA法检测血清MIF、IL-17和IL-10水平;采用荧光定量PCR法检测血清HBV DNA载量;采用全自动生化分析仪检测血清肝功能指标。结果与健康对照组[(1.9±1.4)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血MIF水平均显著升高[分别为(5.7±2.8)ng/ml、(10.5±4.1)ng/ml、(17.7±7.4)ng/ml、(19.8±9.9)ng/ml,P0.01],其中HCC组最高,ASC组最低;与健康对照组[(4.4±2.2)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血IL-17水平均显著升高[分别为(8.6±4.3)ng/ml、(20.7±6.6)ng/ml、(23.4±15.1)ng/ml、(16.0±8.7)ng/ml,P0.01或P0.05],其中LC组最高,ASC组最低;与健康对照组[(12.9±4.6)ng/ml]比,ASC组、CHB组、LC组和HCC组外周血IL-10水平均显著升高[分别为(237.2±72.9)ng/ml、(184.68±59.0)ng/ml、(356.6±150.8)ng/ml、(287.9±88.8)ng/ml,P0.01],其中LC组最高,CHB组最低。结论 MIF、IL-17和IL-10在慢性HBV感染过程中可能起重要作用,检测血清细胞因子水平可作为评估慢性乙型肝炎病情严重程度的重要指标。     

巨噬细胞移动抑制因子启动子区基因多态性与成人斯蒂尔病的关系研究

目的 研究成人斯蒂尔病(AOSD)患者巨噬细胞移动抑制因子(MIF)基因5’端启动子区-173和-794位点核苷酸多态性与疾病易感性的关系.方法 采用酶联免疫吸附法检测82例AOSD患者和55名健康志愿者血浆MIF的表达.从AOSD患者和健康者中提取基因组DNA.聚合酶链反应-限制性片段长度多态性分析法(PCR-PFLP)检测5’端启动子区-173位点核苷酸多态性,并对-794位点微卫星序列PCR产物直接进行基因分型.病例组与健康对照组之间-173 G/C SNP和-179 CATT重复序列的基因与基因型频率比较采用Pearson x2检验,血浆MIF数值采用非参数Mann-Whitney U检验.结果 AOSD患者组血浆MIF水平为(119±113) ng/ml,显著高于健康对照组(55±29) ng/ml(P＜0.01).携带有-173*C等位基因的个体疾病易感性增加[ OR=1.776;95％可信区间(CI) 1.101～2.864;P=0.017];携带有-794*5-CATT等位基因的个体患AOSD风险增加(OR=1.81;95％CI 1.27～2.58;P=0.001).结论 MIF基因启动子区-173和-794位点核苷酸多态性影响AOSD的易感性.     

系统性红斑狼疮患者血清中可溶性人类白细胞抗原-G表达水平的研究

目的 探讨血清可溶性人类白细胞抗原(HLA)-G(sHLA-G)在系统性红斑狼疮(SLE)患者中表达水平及与疾病活动度相关性.方法 采用酶联免疫吸附试验(ELISA)方法检测58例SLE患者与60名健康人血清sHLA-G水平.结果 SLE患者血清sHLA-G水平(120±92)ng/ml显著高于健康对照组(35±33)ng/ml(P＜0.01);SLE活动期组血清sHLA-G水平(170±70)ns/mJ显著高于SLE缓解期组血清sHLA-G水平(95±88)ng/ml(P＜0.01);血清sHLA-G水平与SLEDAI呈正相关(r=0.30,P=0.01);与抗双链DNA(dsDNA)、C3、C4及抗核抗体滴度无显著相关性(P＞0.05).结论 SLE患者血清中sHLA-G表达增高,且与疾病活动度呈正相关,sHLA-G在SLE疾病发生、发展中可能发挥了一定的作用.     

老年肺结核患者血清血管活性肠肽的变化及临床意义

目的 探讨血管活性肠肽(VIP)在老年肺结核患者血清中的改变及与白细胞介素4(IL-4)、γ干扰素(IFN-γ)的相关性.方法 采用放射免疫分析(RIA)法检测40例老年活动性肺结核患者(老年活动性肺结核组)、30例老年非活动性肺结核患者(老年非活动性肺结核组)、30例中青年活动性肺结核患者(中青年活动性肺结核组)及20例老年健康人(健康组)血清VIP水平,酶联免疫吸附(ELISA)法检测血清IFN-γ、IL-4水平.老年活动性肺结核组中,病灶范围大或有空洞形成患者17例,病变范围小患者23例.结果 老年活动性肺结核组血清VIP、IL-4水平高于老年非活动性肺结核组及健康组(均P ＜0.01).老年活动性肺结核组IFN-γ水平低于健康组,差异有统计学意义(P＜0.05).病灶范围大或有空洞形成患者血清VIP、IL-4水平高于病变范围小患者(P＜0.05).老年活动性肺结核患者血清VIP、IL-4及IFN-γ水平与中青年活动性肺结核患者比较差异无统计学意义.老年活动性肺结核患者血清VIP与IL-4呈正相关(r=0.672,P＜0.01),与IFN-γ呈负相关(r=-0.406,P＜0.01).老年非活动性肺结核组、健康组血清VIP与IL-4、IFN-γ之间均无相关性.结论 VIP可能对评价老年肺结核病情严重程度、活动性以及判断其转归具有一定的参考意义.     

巨噬细胞移动抑制因子在桥本甲状腺炎患者外周血中的表达及其临床意义

以实时定量PCR及ELISA法检测桥本甲状腺炎(HT)患者和健康对照者外周血单个核细胞(PBMC)中巨噬细胞移动抑制因子(MIF)mRNA表达及血清中MIF蛋白水平,结果显示HT患者PBMC(Z=-4.276,P＜0.01)、血清中MIF(Z=-5.358,P＜0.01)水平增高,与甲状腺特异性自身抗体及TSH水平正相关.     

血清增殖诱导配体在原发性干燥综合征中的临床意义

目的 探讨血清增殖诱导配体(APRIL)对原发性干燥综合征(pSS)患者的临床意义.方法 采用ELISA法分别检测38例pSS确诊患者和40名正常健康体检者的血清APRIL水平,并分析其与pSS患者临床指标相关性.结果 PSS患者的血清APRIL高于健康对照组[(26.37±16.18)ng/ml比(16.33±15.61)ng/ml,P＜0.05],且与pSS患者ESR(r=0.427,P＜0.05) 、唇腺淋巴细胞灶数(r=0.446,P＜0.05)呈一定程度相关性,与外周血白细胞(WBC)、血小板(PLT)计数呈负相关(P＜0.05).结论 pSS患者血清APRIL水平异常增高,与临床指标的相关性,提示该系统可能参与pSS的发病过程.     

肝癌患者可溶性肿瘤坏死因子受体Ⅱ检测的临床意义

目的 进一步了解肝癌患者的异常免疫状态,探讨血清、腹水sTNFRⅡ检测的临床意义.方法 用双单抗夹心酶免疫吸附法检测25例肝癌、25例肝硬化患者血清腹水中和30例正常人血清sTNFR Ⅱ水平.结果 肝癌病人血清sTNFR Ⅱ浓度[(9.39±4.10)ng/ml]显著高于正常人和肝硬化患者(P＜0.01),同时肝硬化患者血清sTNFR Ⅱ浓度[(0.58±0.18)ng/ml]明显高于正常人[(0.31±0.16)ng/ml,P＜0.01].肝癌病人腹水sTNFRⅡ浓度[(9.13±5.26)ng/ml]亦显著高于肝硬化腹水sTNFR Ⅱ水平[(0.52±0.15)ng/ml,P＜0.01].肝癌、肝硬化患者血清、腹水sTNFR Ⅱ水平显著相关(r=1.00,P=0.00).肝癌血清sTNFRⅡ水平与外周血AFP和血小板数量呈正相关(r=0.432,P=0.05和r=0.513,P=0.03).结论 sTNFRⅡ的检测对反映肝癌患者的异常免疫状态,对肿瘤诊断具有实用价值.     

陷阱因子3在类风湿关节炎患者血清及外周血单核细胞中的表达研究

目的 研究类风湿关节炎(RA)患者血清及外周血单核细胞中DcR3的表达情况.方法 选取已确诊的60例类风湿因子(RF)(+)的RA患者并按照DAS28评分将其分为RAa组和RAb组,以30名体检健康者作为对照,酶联免疫吸附试验( ELISA)法检测各组血清可溶性陷阱因子3(DcR3)的表达情况.同时荧光实时定量聚合酶链反应(PCR)检测各组外周血单核细胞中DcR3的表达情况.采用t检验和X2检验进行统计学分析.结果 DcR3血清表达水平在DAS28＞2.6的RAb组为(264+72) ng/ml较健康对照组为(48±39) ng/ml明显升高(r=0.251,P＜0.05).而在DAS28＜2.6的RAa组则没有差异.DcR3基因的扩增倍数在RAb组为23.5±5.4,健康对照组为8.3±3.6,差异具有统计学意义(r=0.336,P＜0.05).结论 DcR3在RA患者血清及外周血单核细胞中表达增高,而其血清表达水平在风湿活动较高的患者则更加明显.     

强直性脊柱炎外周血破骨细胞前体细胞活性的研究

目的 研究强直性脊柱炎(AS)患者外周血破骨细胞前体细胞(OCP)的数量及其与血清核因子(NF)-κB受体活化因子配体(RANKL)和骨保护素(OPG)浓度以及与病情活动性的相关性.方法 采用RANKL和巨噬细胞集落刺激因子(M-CSF)体外诱导8例As患者和5名健康对照的外周血培养破骨细胞(OC).应用组织化学染色法对OC中抗酒石酸酸性磷酸酶(TRAP)染色.计数染色阳性胞核≥3个的细胞.骨吸收实验考察OC的功能.运用酶联免疫吸附试验(ELISA)法检测23例As患者和17名健康对照血清RANKL和OPG水平.对AS疾病活动性进行评估包括Bath强直性脊柱炎疾病活动指数(BASDAI)、红细胞沉降率(ESR)、C反应蛋白(CRP).对AS患者OCP数量与血清RANKUOPG比值及与病情活动性进行相关分析.统计分析采用t检验t'检验、Spearman相关分析.结果 ①As组外周血生成OC数量显著高于健康对照组(10.9±3.4与6.2±1.3,P<0.05);②AS组血清RANKL浓度、OPG浓度、RANKL/OPG比值显著高于健康对照组[(5.4±3.8)pg/ml与(1.6±0.8)pg/ml,(157±49)pg,ml与(105±20)pg/ml,0.037±0.026与0.016±0.008,P均<0.01)];③外周血生成OC数量与RANKL、RANKL/OPG比值呈正相关(r=0.692, P=0.009;r=0.813,P=0.001);④AS患者血清OPG浓度与BASDAI呈负相关(r=-0.444,P=0.044),血清RANKL浓度与BASDAI呈正相关(r=0.543,P=0.011),RANKL/OPG比值与BASI)AI呈正相关(r=0.672,R=0.001).结论 ①As患者外周血OCP数量显著增高,与关节骨质破坏程度密切相关可能是造成关节骨质破坏的机制;②AS患者OC活性增高的机制可能是炎症引起RANKL产量增多,RANKUOPG比值升高所致.     

类风湿关节炎患者血清可溶性人白细胞抗原-Ⅰ类抗原的检测分析

目的 探讨山西汉族人群血清可溶性人白细胞抗原-Ⅰ (sHLA-Ⅰ)水平与类风湿关节炎(RA)的关系.方法 酶联免疫吸附测定(ELISA)法检测血清sHLA-Ⅰ类抗原水平.将不同浓度的标准品和待检血清分别加人包被有特异性sHLA-Ⅰ抗体的酶标板,与生物素化的sHLA-Ⅰ、辣根过氧化物酶(HRP)标记的链霉亲和素共同孵育,弃上清并用洗涤液洗涤,加底物应用液四甲基联苯胺(TMB)显色,以酶标仪450 nm测定吸光度(A)值,根据不同浓度标准品显色后测得的A值绘制标准曲线.测定RA患者与健康人的sHLA-Ⅰ含量.结果 ①血清sHLA-Ⅰ类抗原水平:80名健康人为(390±106)ng/ml;80例RA患者为(632±169)ng/ml,其中50例活动期RA患者为(739±144)ng/ml,30例缓解期RA患者为(524±114)ng/ml,与健康人相比,活动期和缓解期RA患者血清sHLA-Ⅰ均显著增高(P＜0.01),且活动期RA患者显著高于缓解期患者(P＜0.0).②26例活动期RA患者治疗前血清sHLA-Ⅰ类抗原水平为(744±148)ng/ml,经治疗病情缓解后为(533±106)ng/ml,治疗前显著高于治疗后(P＜0.01).结论 RA患者血清sHLA-Ⅰ类抗原水平明显增高,且以活动期增高更为显著.     

先天性巨结肠类缘病的治疗探讨

目的探讨先天性巨结肠类缘病(HAD)的治疗方法。方法分析7例HAD患儿的治疗方案。术前或术中明确诊断的4例HAD患儿中,1例行根治性手术,1例行延期根治性手术,1例根治性手术后继续保守治疗,1例行肠造瘘术后等待根治术时机;3例按先天性巨结肠(HD)行根治术,术后复习病理切片才明确诊断,及时随诊,2例分别在首次术后3个月和8个月再行根治术,1例继续扩肛治疗。结果7例HAD患儿排便情况满意。结论根治手术对HAD治疗至关重要,保守治疗是HAD治疗的必要补充。     

Aspirin-exacerbated respiratory disease: burden of disease

Aspirin-exacerbated respiratory disease (AERD) is characterized by adult onset of asthma, chronic rhinosinusitis (CRS), nasal polyposis, and aspirin sensitivity. In this syndrome, each disease component has deleterious effects on the patient's health and quality of life. Latest figures from the Centers for Disease Control indicate 8.2% of the U.S. population has asthma and among adult asthmatic patients, up to 9% have AERD. Approximately 13% of the population suffers from CRS and 15% of patients with CRS with nasal polyposis have AERD. A review of the impact that each component of AERD has on patients will delineate the considerable burden of AERD, especially when considering the cumulative effects of the tetrad.     

Long-term evolution of disease behavior of Crohn's disease

BACKGROUND: The Vienna classification of Crohn's disease (CD) distinguishes three patient subgroups according to disease behavior: stricturing, penetrating, and inflammatory. Our aim was to assess the long-term evolution of the disease behavior of CD and to determine the predictive factors and prognostic implications of this evolution. METHODS: Occurrence and predictive factors of a stricturing and/or a penetrating complication were searched for in 2,002 patients with CD studied retrospectively. In addition, the 1995-2000 disease course was assessed prospectively in a cohort of 646 patients with disease duration >5 years, classified according to their previous disease behavior. RESULTS: 1,199 patients (60%) developed a stricturing (n = 254) or a penetrating (n = 945) complication. Twenty-year actuarial rates of inflammatory, stricturing, and penetrating disease were 12, 18, and 70%, respectively. The initial location of lesions was the main determinant of the time and type of the complication. In the cohort study, year-by-year activity and therapeutic requirements did not show significant sustained differences between behavioral subgroups. CONCLUSION: Most patients with CD will eventually one day develop a stricturing or a perforating complication. Initial location determines the type of the complication. Classification of patients into a behavioral group from previous history has no impact upon activity during the following years.     

Mechanisms of disease: immunopathogenesis of celiac disease

Celiac disease is a genetic inflammatory disorder with autoimmune components that is induced by the ingestion of dietary gluten. Refractory sprue and enteropathy-associated T-cell lymphoma are rare but distinctive complications of the disease. Although the importance of the adaptive immune response to gluten has been well established, observations now also point towards a central role for the gluten-induced innate stress response in the pathogenesis of celiac disease and its malignant complications.     

Periodontal disease and systemic disease

Periodontal diseases are now recognized as bacterial infections among the chronic diseases of humans. The influence of the oral environment on systemic health, especially the periodontium, has long been supported by scientific evidence. However, an evidence base for the influence of periodontal disease on vital organs such as heart, lung has only recently begun to be established. We are hopeful that this information will stimulate new collaborations between physicians and dentist and serve as basis for studies to help improve the total health.     

Lung disease in Niemann-Pick disease

BACKGROUND: Lung involvement in children with Niemann-Pick disease has rarely been studied systematically. OBJECTIVE: To assess the involvement of the lung and the value of bronchoalveolar lavage in children with Niemann-Pick diseases. DESIGN: Retrospective analysis of patient records. PATIENTS: Thirteen patients, with type A (n = 1), type B (n = 10), and type C (n = 2) Niemann-Pick disease, aged 2 months to 9 years at diagnosis, were included in the study. INTERVENTIONS: Lung involvement was assessed by clinical evaluation, chest radiograph, lung computed tomography (CT) scan, pulmonary function tests, and bronchoalveolar lavage fluid analysis. RESULTS: Respiratory symptoms were present at diagnosis in 10 patients and developed during follow up in the three other patients. All patients showed signs of interstitial lung disease on chest X-ray and lung CT scan. Bronchoalveolar lavage fluid analysis (n = 7) revealed a marked accumulation of foamy macrophages (Niemann-Pick cells) in all patients. At follow up, one patient died of respiratory failure, five patients required long term oxygen therapy and seven other patients presented a chronic obstructive pulmonary disease (n = 6) or chronic cough (n = 1). CONCLUSION: Lung disease was observed in all the patients included in the present study. Bronchoalveolar lavage may be useful in Niemann-Pick diseases by showing the presence of characteristic Niemann-Pick cells.     

Buerger's disease and coronary disease

The authors report the case of a 33 year old man with distal occlusive arterial disease diagnosed as Buerger's disease, with two previous transient ischaemic attacks and coronary disease resulting in myocardial infarction. Coronary angiography showed narrowing of the second segment of the left anterior descending artery, occluded distally and not suitable for revascularisation. The observation of coronary artery disease is very rare in Buerger's disease and data of coronary angiography are very sparse in this context. The occurrence of myocardial infarction and the angiographic appearances of the left anterior descending artery raise the question of coronary involvement of Buerger's disease.     

Gallstone disease: Epidemiology of gallbladder stone disease

Gallstone disease is common: >700,000 cholecystectomies and costs of approximately 6.5 billion dollars annually in the U.S. The burden of disease is epidemic in American Indians (60-70%); a corresponding decrease occurs in Hispanics of mixed Indian origin. Ten to fifteen per cent of white adults in developed countries harbour gallstones. Frequency is further reduced in Black Americans, East Asia and sub-Saharan Africa. In developed countries, cholesterol gallstones predominate; 15% are black pigment. East Asians develop brown pigment stones in bile ducts, associated with biliary infection or parasites, or in intrahepatic ducts (hepatolithiasis). Certain risk factors for gallstones are immutable: female gender, increasing age and ethnicity/family (genetic traits). Others are modifiable: obesity, the metabolic syndrome, rapid weight loss, certain diseases (cirrhosis, Crohn's disease) and gallbladder stasis (from spinal cord injury or drugs like somatostatin). The only established dietary risk is a high caloric intake. Protective factors include diets containing fibre, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity.     

Association of asymptomatic celiac disease and Crohn's disease

A 24-year-old woman had Crohn's colitis which had been diagnosed in 1997. The patient was given sulfazalazine and responded well. Antiendomysial and antigliadin antibodies were positive. Diagnosis of celiac disease was confirmed by duodenal biopsy showing villous atrophy and an increased number of lymphocytes infiltrating the epithelium. Few cases associating Crohn's disease and celiac disease have been reported. This case illustrates the complexity of the pathogenic mechanisms in these two disease. Our patient required a gluten-free diet although the celiac disease was asymptomatic, basically to avoid the risk of malignancy associated with celiac disease.