SARS患者血清细胞因子临床意义探讨

目的　探讨严重急性呼吸综合征 (SARS)患者病情进展的宿主免疫机制。方法　使用流式细胞仪检测急性SARS感染患者 5 0例和正常对照 2 0例的细胞因子 (IL 2、IL 4、IL 6、IL 10、IFN γ、TNF α)。按照疾病预后分成死亡组和治愈组 ,前瞻性设计分析细胞因子在 2组患者中的异同及对病情发展的影响。结果　治愈组与死亡组患者的细胞因子 (IL 2、IL 4、IL 6、IL 10、IFN γ、TNF α)均明显高于正常对照组 ,差异有显著性 (P <0 .0 5 )。治愈组和死亡组比较 :治愈组IFN γ高于死亡组 ,差异有显著性 (P <0 .0 5 ) ,死亡组IL 6、IL 10明显高于治愈组 ,差异有显著性 (P <0 .0 5 )。结论　SARS病毒感染确实引起机体的免疫系统紊乱。功能受损的程度与疾病的预后有一定相关性 ;TH2类细胞因子免疫反应过强 ,TH1类细胞因子免疫反应相对减弱 ,造成的机体免疫自稳平衡失调可能是SARS患者死亡的因素之一     

SARS临床病理讨论

1　病历摘要1 1　病历 1患者女性 ,3 3岁 ,已婚 ,护士 ,北京人。因发热1 9天于 2 0 0 3年 5月 8日就诊于我院发热门诊。病人于 4月 1 9日开始出现发热 ,体温超过 3 8℃伴咳嗽及呼吸困难 ,无咯痰、头痛、肌痛、腹泻等。发病前有护理照顾SARS确诊患者的接触史 ,外院确诊为SARS患者 ,已治疗 1 0d ,具体方案为利复星 0 4qd×1d( 5月 3日 ) ,后改为 0 2bid× 2d( 5月 4日～ 5日 ) ,罗氏芬 2 0qd× 1d( 5月 6日 ) ,泰能 0 5tid× 1d( 5月7日 ) ,阿齐霉素 0 5qd× 1d( 5月 3日 ) ,0 2 5qd× 2d( 5月 4日～ 5日 )。激素用法 :甲强龙 80mg…     

SARS患者与抗SARS医务人员心理健康对比分析

目的 :了解“非典”患者与抗非典医务人员的心理健康水平。方法 :抽取“非典”患者和抗“非典”医务人员各 40名进行SDS、SAS、SCL -90量表检测 ,并进行比较。结果 :SARS患者及抗SARS医务人员的SDS评分均在≥ 5 0以上 ,两者差异无显著性 ,而患者SAS均值明显高于医务人员的分值 (t =4 69,P<0 0 1)。SCL -90评分 ,患者的躯体化 (t=2 79)、人际关系 (t =8 83 )、抑郁 (t =4 42 )、焦虑 (t =8 0 3 )、敌对 (t=10 2 5 )、恐怖 (t=1 69) (P <0 0 5～ 0 0 1)的因子分明显高于医务人员得分。而在人际关系 (t =8 83 )、敌对 (t =10 2 5 )、偏执 (t=1 5 1)分值上医务人员显著低于常模 (P <0 0 5～ 0 0 1)。     

SARS肺的病理鉴别诊断

目的 分析严重急性呼吸综合征(severe acute respiratory syndrome，SARS)肺部病变的临床病理形态学特征及与其他肺部炎性疾病的鉴别诊断。方法 对3例行尸体解剖的SARS病例的肺组织进行组织形态学、免疫组织化学和电镜下超微结构的观察，对其临床表现、病理形态学特征及主要鉴别诊断进行探讨，并与病理资料完整的16例病毒性肺炎、13例间质性肺炎的肺部病变进行鉴别诊断。结果 死亡的SARS病人肺部病变主要表现为弥漫性的肺部损伤，但是各处病变轻重不一。肺泡腔内可见细颗粒样或泡状水肿液，其中可见脱落的肺泡上皮细胞。肺泡间隔表面可见透明膜覆盖，有的区域肺泡腔内出现机化性改变，肺泡腔和肺问质内可见大量的巨噬细胞浸润。同时，肺间质内的小动脉壁出现明显的损伤性改变。结论 SARS的肺部病理形态学特征可与其他肺部炎症性疾病鉴别。     

三种检测SARS抗体试剂盒的临床使用效果比较

目的 :对重组双抗原夹心法ELISA、全病毒间接法ELISA和免疫荧光分析法 3种SARS抗体诊断试剂盒进行临床应用效果评价 ,比较不同试剂的使用效果。方法 :使用 3种试剂检测了 2 5 7例临床确诊SARS患者的血清标本 2 79例和其他非SARS患者标本 2 4例、健康体检者血清标本 80份。结果 :临床确诊SARS患者发病 1～ 2 0d的病例中双抗原夹心法ELISA检出率最高 ,间接免疫荧光法与其接近 ,全病毒间接法ELISA检出率最低。在发病 2 0d后 ,三者检出率接近 (94 %左右 ) ,3种方法的符合率在 97%以上。在 10 4例非SARS病例中 ,双抗原夹心法ELISA和免疫荧光法均未见出阳性结果 ,全病毒间接法ELISA检出阳性结果 3例 ,假阳性率 2 .9%。结论 :检测SARS抗体双抗原夹心法ELISA试剂盒、免疫荧光试剂盒具有类似的灵敏度和特异性 ,其灵敏度和特异性高于全病毒间接法ELISA。     

SARS患者脾树突状细胞和巨噬细胞的免疫组织化学观察

目的 对严重急性呼吸综合征(SARS)患者脾树突状细胞、巨噬细胞数量和巨噬细胞大小进行定量分析,为SARS的病理变化和发病机制的探讨提供证据.方法 通过免疫组织化学技术对6例SARS死亡患者脾和6例意外死亡者正常脾S-100 、CD68 、 HLA-DR 、CD83 细胞的分布进行观察,并采用图像分析系统对阳性细胞数量或体积进行分析.结果 SARS死亡患者脾内白髓中S-100 树突状细胞数较正常平均减少80.49%,有的甚至完全消失;脾红髓中CD68 巨噬细胞数量较正常平均减少39.48%,体积是正常平均值的2.21倍.脾白髓中HLA-DR 抗原呈递细胞明显减少.SARS死亡患者脾与正常脾中均无CD83 成熟树突状细胞.结论 SARS患者免疫系统中抗原呈递系统遭到严重破坏,支持SARS是一种病毒性免疫缺陷病.SARS病毒不能引发树突状细胞成熟.巨噬细胞的体积增大处于激活状态,提示巨噬细胞在SARS发病机制中起一定作用.     

53例SARS早期患者的临床分析

目的研究SARS早期的临床特点.方法对53例SARS早期病例的流行病学、临床、实验室及影像学资料进行回顾性分析.结果53例患者中男性24例,女性29例,平均年龄(38±16.7)岁(10～85岁),发病年龄以20～50岁患者居多(67.9%),平均潜伏期(7.3±7.0)d(3～14 d),职业分布居多者为职员(11例,占20.8%),其次是医护人员(9例,17.0%).临床症状以发热(100%),咳嗽(49.1%),肌肉酸痛(24.5%),乏力(17.0%),胸闷憋气(20.8%),腹泻(5.7%)等为主要表现.在病程的第1～5天患者白细胞＜4.0×109/L 33例(62.3%),(4.0～10.0)×109/L 18例(34.0%),67.9%患者淋巴细胞计数减少,13.2%患者血小板计数减少.X线胸片主要病变呈肺部斑片状渗出性阴影,其中双侧受累占15.1%,单侧受累75.4%.血气分析示PO2＜90mm Hg(1kPa=7.5 mm Hg)26例(占49.1%),出现酸碱平衡紊乱者9例(17.0%),其中代谢性酸中毒4例(10.8%)及代谢性碱中毒合并呼吸性酸中毒4例(10.8%).SARS常合并多脏器损伤,其中肝功能(ALT、AST)异常占37.7%,肾功能(BUN、SCR)损伤占11.3%,心肌酶(LDH、CK、HBDH)异常占43.4%.结论本病临床表现复杂,密切监测血常规、胸片及血气分析对于早期诊断意义重大.     

SARS患者临床心理干预模式及疗效评估

目的 :对北京解放军小汤山医院SARS患者实施心理危机干预措施并评估疗效和影响因素 ,探索对封闭环境下急性病人进行临床心理干预的有效模式。方法 :总共 680名SARS患者 (其中男性 3 79名 ,女性 3 0 1名 ) ,对 483名干预组患者进行综合心理干预 ,包括电话心理咨询 (主动和被动 )、文字材料自我调适以及面对面危机干预 (临床医务人员和心理医生 )。采用SCL -90对干预组和对照组进行入院时和出院前的心理健康状况评估 ,并采用自编的“心理干预效果评定表”对干预对象进行干预效果评定。结果 :患者入院时SCL -90各因子分值明显高于地方常模的分值 ,差异有显著性。入院时干预组和对照组的SCL -90各因子均分没有明显差异 ,而出院时干预组和对照组患者SCL -90各因子均分相比 ,在多个因子上干预组均分均显著低于对照组 (t=2 1～ 5 7,P <0 0 1～ 0 0 5 )。其中患者主动电话咨询的有效率最高 ( 95 7% ) ,文字材料的有效率最低 ( 19 5 % ) ,临床主管医生经过培训后进行临床心理干预的效果和心理医生进行心理干预的有效率都很高 ,均高达 80 %以上。主动求助、被动求助以及文字干预对文化程度较低的患者效果要低于文化程度较高者 ,但经过培训的临床医生和心理医生其干预效果无明显差异。结论 :SARS患者在接受药     

严重急性呼吸综合征(SARS)患者血清超氧化物歧化酶含量测定及其临床意义

为观察SARS患者血清超氧化物歧化酶(SOD)含量变化，本文采用RIA检测了66例SARS患者血清SOD含量，并与对照组比较。患者SOD含量明显低于对照组，重型的SARS患者SOD含量明显低于普通型的。恢复期患者SOD含量回升，但仍低于对照组。SARS患者体内产生过量的自由基，使SOD过度消耗。SOD含量变化可以反映SARS病情的严重程度。为此，检测血清SOD有助于观察病情的变化。采用清除机体自由基的药物可能是一种治疗措施。     

广东地区严重急性呼吸综合征(SARS)患者血清的IFA检测

目的：证实新分离出的冠状病毒与SARS患者的关糸。方法：应用IFA诊断试剂做免疫荧光染色，检测2003-02-04-04-13期间，广东地区3所医院临床诊断为SARS的72例患者血清特异性抗体，以及直接参加救治SARS患者但末发生感染的109名医护人员的血清标本，并以疾病流行期间70例健康体检者作为正常对照组。结果：72例SARS患者中，62例血清特异性：IgG呈阳性；而109例密切接触但末发生感染的医护人员及70例SARS流行期间健康体检者，血清特异性IgG和IgM均呈阴性。结论：SARS冠状病毒是引发广东地区SARS的病原体。     

Concurrent xanthogranulomatous orchiepididymitis and seminoma in the same testis

Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma.     

Pathological changes in masked palm civets experimentally infected by severe acute respiratory syndrome (SARS) coronavirus

Masked palm civets are highly susceptible to infection with the severe acute respiratory syndrome coronavirus (SARS-CoV). Infected animals become less aggressive and develop pyrexia, lethargy and diarrhoea. The present study describes the spectrum of histopathological changes in the lung, spleen, lymph node, liver, small intestine, kidney and cerebrum of civets infected experimentally with SARS-CoV. In-situ hybridization (ISH) with probes specific for the RNA polymerase gene demonstrated viral RNA in the lung, small intestine and cerebrum only. In-situ labelling was employed in order to demonstrate cellular apoptosis in the cerebrum, but there was no evidence of apoptosis within the myocardium. These results indicate that SARS-CoV causes multi-organ pathology in civets, similar to that observed in human SARS patients. These parallels suggest that civets may be used as an animal model of this infection to gain insight into the pathogenesis of SARS and for evaluation of candidate vaccines and antiviral drugs.     

严重急性呼吸综合征死亡患者睾丸炎的病因

目的:研究严重急性呼吸综合征(SARS)死亡患者睾丸的病理变化以及原因。方法:原位杂交方法检测6例SARS尸检的睾丸标本内是否存在病毒。免疫组化方法检测睾丸内的自身抗体IgG、IgA。结果:6例病例均表现为睾丸炎的病理改变。原位杂交没有检测到睾丸内存在SARS病毒,但是在生精上皮内存在大量的自身抗体IgG和IgA。结论:自身抗体的损伤可能是SARS患者产生睾丸炎的主要因素。     

Experimental inoculation of the adult rat testis with Sendai virus: effect on testicular morphology and leukocyte population

BACKGROUND: Surprisingly little is known about the interactions between viruses and the male uro-genital tract. These are important, as viral testicular orchitis, induced by mumps or human immunodeficiency virus (HIV) infection for example, can lead to sterility. Moreover, semen is an essential vector in the propagation of sexually transmissible viral diseases. Here, we studied the effects of testicular infection with Sendai virus, a virus related to mumps virus, on the cellular distribution of viral particles and on testicular morphology, with particular attention to the testicular leukocyte population. METHODS: At 5, 9, 11 or 24 h post-injection of Sendai virus through the scrotum, the testes were fixed for morphological and immunohistological studies. Localization of virus particles and numeration of leukocytes were performed using specific antibodies and morphological criteria. RESULTS: As early as 5 h post-injection, a rapid and massive infiltration of leukocytes was observed in the interstitial tissue. The peritubular cell layer and the most external part of the basal portion of the seminiferous tubules were altered. The virus was diffusely located within the interstitial tissue 9 h following the injection whereas, after 24 h, viral proteins were restricted to the cytoplasm of infiltrated leukocytes. The number of leukocytes increased with time post-injection. Thus, 24 h post-injection, CD3+ T-cell number was 3-fold higher, ED1+ monocyte number was 4-fold higher and polynuclear cell number was 600-fold higher than in the control testes (P<0.001 all observations). In contrast, the population of resident macrophages was unaffected by Sendai virus. CONCLUSIONS: Testicular viral infection causes inflammation including rapid recruitment of leukocytes. The experiments presented here provide a model for further studies on the etiopathology of viral orchitis, in particular that caused by mumps virus.     

Herpes simplex virus inoculation in murine rete testis results in irreversible testicular damage

This study aimed to establish the influence of herpes simplex virus (HSV) on testis morphology and germ cell development using a model of ascending urogenital HSV infection in mice. Adult C57BL/6J mice were inoculated with 100 plaque‐forming units of HSV1 in rete testis. Viral proteins and HSV DNA were detected from 3 days postinoculation (DPI), while capsids and virions could be visualized at 6 DPI. Infectious activity of HSV was revealed by rapid culture method in testes from 3 to 14 DPI, and virus DNA by PCR – from 3 to 100 DPI. Germ and Sertoli cells were infected during the early stages of the infection, whereas interstitial cells only occasionally contained the virus at 21 and 45 DPI. Microscopic analysis revealed severe degeneration of the germinal epithelium in the infected testes. By 21 DPI, testes became atrophic and most Sertoli cells were destroyed. No testicular regeneration and no spermatozoa in the epididymis were observed at 45 and 100 DPI. From 3 DPI, inflammatory cells accumulated in the interstitium between damaged tubules; a significant increase in the number of CD4⁺, CD8⁺ T lymphocytes and F4/80⁺ cells was observed in the infected testes. This study shows that in the case of HSV retrograde ascent into seminiferous tubules, the acute viral infection results in irreversible atrophy of the germinal epithelium, orchitis and infertility. These results may be used to further study viral orchitis and the influence of HSV on spermatogenesis and male fertility.     

RT-PCR测定SARS患者粪便及漱口液中SARS CoV RNA及其临床意义

目的　对 4 6例SARS患者 2 0 6份粪便及漱口液标本 ,检测SARSCoV ,探讨SARS患者恢复期排毒的情况。方法　对住院的 4 6例临床确诊SARS病人 ,留取粪便及同期漱口液各 10 3份 ,提取RNA后利用 14对SARSCoV特异性引物 ,对每份标本同时进行 7次套式RT PCR扩增 ,凡 1次RT PCR结果阳性 ,该标本即判定为阳性。结果　 10 3份粪便标本中 ,6 3份 (6 1.2 % )SARSCoV阴性 ,4 0份(38.8% )阳性 ,阳性者的病程为 30 .75d± 11.2 7d(12d～ 6 4d)。 10 3份漱口液标本中 ,81份 (78.6 % )阴性 ,2 2份 (2 1.4 % )阳性 ,阳性者的病程为 2 9.82d± 12 .4 6d(12d～ 6 4d)。病程最长 6 4d时粪便及漱口液中依然发现SARSCoV病原学依据。患者同期粪便及漱口液RT PCR检测结果一致的有 6 1份(5 9.2 % ) ,不一致的有 4 2份 (40 .8% )。结论　SARS患者恢复期排毒可长达 6 4d ,对SARS患者恢复期的消毒隔离应该得到足够的重视。SARS患者粪便SARSCoVRNA阳性 ,而同期漱口液SARSCoVRNA阴性 ,提示SARSCoV可以直接经消化道传播。     

An interferon-gamma-related cytokine storm in SARS patients

Fourteen cytokines or chemokines were analyzed on 88 RT-PCR-confirmed severe acute respiratory syndrome (SARS) patients. IFN-gamma, IL-18, TGF-beta, IL-6, IP-10, MCP-1, MIG, and IL-8, but not of TNF-alpha, IL-2, IL-4, IL-10, IL-13, or TNFRI, were highly elevated in the acute phase sera of Taiwan SARS patients. IFN-gamma was significantly higher in the Ab(+) group than in the Ab(-) group. IFN-gamma, IL-18, MCP-1, MIG, and IP-10 were already elevated at early days post fever onset. Furthermore, levels of IL-18, IP-10, MIG, and MCP-1 were significantly higher in the death group than in the survival group. For the survival group, IFN-gamma and MCP-1 were inversely associated with circulating lymphocytes count and monocytes count, but positively associated with circulating neutrophils count. It is concluded that an interferon-gamma-related cytokine storm was induced post SARS coronavirus infection, and this cytokine storm might be involved in the immunopathological damage in SARS patients.     

大鼠睾丸Cx43蛋白表达的加龄变化

目的:研究Cx43蛋白在大鼠出生后不同周龄睾丸中表达和定位,探讨Cx43蛋白与大鼠睾丸发育和精子发生的相关性。方法:应用免疫组织化学研究Cx43蛋白在1、3、5、7、9、11、13周龄SD雄性大鼠睾丸中的表达,利用血细胞计数板检测5~13周龄精子的数量。结果:Cx43蛋白于第1周开始在支持细胞、精原细胞中表达,第3周在精母细胞中表达,第5周开始在间质细胞、精母细胞、精子细胞中表达,随周龄增加而表达增加;第5周开始出现精子,随周龄增加而增加,Cx43蛋白表达与精子数量呈正相关。结论:Cx43蛋白在大鼠睾丸发育和精子发生的各个阶段均有表达,提示其参与睾丸发育和精子发生的调节。     

Different fixatives influence morphology,antigen preservation,and TUNEL staining in chicken (Gallus gallus) testis

The optimized fixative for testis is still controversial. This study investigated the effects of Modified Davidson’s Fluid (mDF), 4% Paraformaldehyde (4% PFA), and Bouin’s Fluid (BF) fixatives on chicken testes in normal/cadmium (Cd) feeding groups using hematoxylin and eosin (HE), immunohistochemistry (IHC), and Terminal Transferase dUTP Nick End Labeling (TUNEL) staining. Compared to the mDF, we established that the testes fixed with 4% PFA and BF in the normal group had severe shrinkage in tubular and interstitial compartments. Moreover, compared with 4% PFA, the number of GATA4-positive Sertoli cells/mm² reduced by 67.61% in mDF and 80.57% in BF for one seminiferous tubule. The TUNEL assay illustrated that more positive cells/mm² in mDF group (28.47 ± 11.38) than in 4% PFA (10.49 ± 7.89). In Cd-treated testes, mDF showed more morphological details than 4% PFA and BF. In contrast, the number of GATA4-positive Sertoli cells/mm² of 4% PFA was higher than that of mDF by 65.78% and BF by 64.80% in a seminiferous tubule. The number of TUNEL positive cells/mm² in mDF (272.60 ± 34.41) were higher than in 4% PFA (175.91 ± 19.87). These results suggest that mDF fixative is suitable for normal and Cd-treated testis fixation for HE and TUNEL staining in chicken, whereas 4% PFA fixative is better for IHC examination.