原发性和继发性干燥综合征肺间质病变的临床分析

目的了解原发性和继发性干燥综合征(SS)肺间质病变的发生情况、临床特点、肺功能、影像学检查及相关因素,以早期发现SS的肺部病变。方法回顾性分析我院2002年1月至2005年7月资料完整的原发性和继发性SS患者136例的临床资料,包括抗SSA抗体和抗SSB抗体,胸部X线、肺高分辨CT(HRCT)、肺功能等。结果①抗SSA抗体阳性的原发性SS(pSS)患者易出现肺间质病变,而且病变较重;②肺HRCT示继发性SS(sSS)肺间质病变程度比pSS肺间质病变程度重,可能受其病程长的影响;③pSS肺间质病变者其肺容量减少、顺应性降低较sSS肺间质病变者更多见,sSS肺间质病变者以阻塞性通气障碍为主,二者肺功能损害均以小气道及弥散功能损害为主。结论SS患者应早期做肺HRCT及肺功能检查,以早期诊断和治疗肺间质病变,尤其是抗SSA抗体阳性pSS患者。     

2型糖尿病患者胸部CT表现及短期随访观察

目的 探讨T2DM患者胸部CT表现及随访肺内病变变化与临床的关系。方法回顾性观察60例T2DM患者胸部CT图像,用CT视觉评分方法定量分析肺内病变,并与CT复查图像进行对照,分析肺内病变变化特征与临床的关系。结果60例T2DM患者中胸部CT表现正常9例（15％）、磨玻璃样影31例（52％）、小叶间隔增厚32例（53％）,多于胸膜下线8例（13％）、支气管血管束增厚3例（5％）、小叶内间质增厚3例（5％）等病变（X2=76．979,P＜0．01）。肺内病变具有周围分布、下肺分布为主的特点。复查后仅14例磨玻璃样病变有不同程度吸收,与磨玻璃影积分值无变化组相比,磨玻璃影积分值变化组病程较短（t=2．485,P=O．023）,HbA1c较低（u=2．831,P=0．015）。结论CT及其随访检查的半定量分析肺内病变,对评估糖尿病肺损害的短期变化及与临床的关系有一定价值。     

抗SSA和SSB抗体均阳性的原发性干燥综合征患者的临床资料分析

原发性干燥综合征(pSS)是一种以侵犯泪腺、唾液腺等外分泌腺体,具有高度淋巴细胞浸润为特征的弥漫性结缔组织病[1].pSS患者血清中可出现抗核抗体(ANA)、抗SSA抗体、抗SSB抗体和抗着丝点抗体(ACA)等多种自身抗体.国内外文献多报道抗SSA抗体(或)抗SSB抗体阳性pSS患者的临床特点[2-4].本研究分析了抗SSA抗体、抗SSB抗体均阳性的pSS患者的临床资料,旨在了解其临床特点.     

原发性干燥综合征患者外周血B细胞FcγRⅡb的表达及临床意义

目的 探讨原发性干燥综合征(pSS)患者外周血B细胞FcγRⅡb的表达及其临床意义.方法 流式细胞术检测19例pSS患者、15名健康对照外周血B细胞FcγRⅡb的平均荧光强度(MFI);酶联免疫吸附试验( ELISA)方法测定19例pSS患者血清抗SSA、SSB抗体水平,统计学分析采用t检验、单因素方差分析、SNK-q检验及Pearson相关分析.结果 pSS患者CD 19+CD27+记忆性B细胞亚群的百分率[(20.8±2.7)％,19例]显著低于健康对照组[(37.8±2.2)％,15名](t=-4.002,P＜0.01);活动期pSS患者外周血CD19+CD27+记忆性B细胞FcγRⅡb的MFI[( 74±8),13例]低于非活动期组[(132±11),6例]及健康对照组[(139±12),15名](F=10.699,P＜0.01);pSS患者外周血CD19+CD27+记忆性B细胞FcγRⅡb的MFI与pSS疾病活动指数(SSDAI)呈负相关(r=-0.744,P=0.0003);抗SSA、SSB抗体阳性组pSS患者CD19+CD27+记忆性B细胞FcγRⅡb的MFI[分别为(75±3),12例;(48±7),5例]显著低于抗SSA、SSB抗体阴性组[分别为(122±11),7例;(108±9),14例](t分别为-4.336和-3.776,P均＜0.01);抗SSA抗体阳性组pSS患者CD19+CD27+记忆性B细胞FcγRⅡb的MFI与抗SSA抗体滴度呈负相关(r=-0.685,P=0.014).结论 pSS患者活动期外周血记忆性B细胞FcyRⅡb表达与SSDAI呈负相关,并与抗SSA抗体呈负相关.FcγR Ⅱb表达异常可能在pSS免疫发病机制中起重要作用.     

系统性硬化症肺部高分辨率CT影像学表现分析

目的探讨系统性硬化症(SSc)肺部高分辨率CT(HRCT)影像学特征。方法回顾性分析2013-02~2017-04该院临床确诊15例SSc肺部HRCT影像学表现。结果 15例SSc患者肺部正常4例,表现以两肺外围分布为主的间质性纤维化11例。HRCT主要表现支气管血管束扭曲变形、小叶间隔增厚,可见条索状影、胸膜下线及弧形线9例,呈网格状改变7例。沿支气管血管束及小叶间隔分布小结节状影,胸膜下见小结节影10例。单纯以磨玻璃样改变5例,轻度胸膜增厚或少量胸腔积液9例。小片状实变影及蜂窝肺4例。结论 HRCT显示SSc的间质性细微病变,在SSc的诊断和随访治疗中具有重要价值。     

以肾损害为首要表现的抗SSA/SSB抗体阴性的原发性干燥综合征1例报告

<正>原发性干燥综合征（primary Sj?gren’s syndrome,pSS）以口眼干燥为主要临床表现,抗SSA/SSB抗体是本病的标志性抗体,多个pSS国际分类标准将抗SSA抗体/抗SSB抗体阳性作为诊断条件之一。然而,当患者抗SSA/SSB抗体阴性,口眼干燥的症状轻微,并同时以突出的肾脏损害为首要表现时,诊断较为困难。现报道1例以肾损害为首要表现的抗SSA/SSB抗体阴性的pSS病例,以期进一步提高临床医生对该病的认识,避免漏诊或误诊。     

高分辨CT扫描技术在肺间质性病变中的应用价值

目的 探讨高分辨CT扫描技术,对肺间质性病变的诊断价值.方法 采用Philips MX8000 Dual 螺旋CT机对30例肺间质性病变患者,行高分辨CT技术扫描.结果 高分辨CT可清晰显示肺间质性病变的各种征象,肺间质性病变的高分辨CT主要表现为:(1)磨玻璃样密度影;(2)肺小叶间隔增厚;(3)小叶内间质增生;(4)网格状影;(5)胸膜下弧线影;(6)蜂窝肺;(7)牵拉支气管扩张;(8)胸膜增厚.病变分布以两肺中外带、胸膜下为主,病灶自肺尖向肺底逐渐加重,两肺基底部病变明显.结论 高分辨CT扫描具有良好的空间分辨率,能细致、准确地反映肺间质病变的影像特征,对肺间质性病变具有重要的诊断价值.     

结膜印迹细胞学在干燥综合征患者干眼诊断中的应用及相关免疫学影响因素分析

目的:探讨结膜印迹细胞学检查在pSS诊断中的作用及相关结膜病变的免疫学影响因素。方法:纳入以干眼为主诉的患者57例,其中pSS患者38例,非pSS患者19例。对所有患者进行结膜印迹细胞学检查,并用Nelson法评分。pSS中31例进行了自身抗体、免疫球蛋白、补体等血清学检查。采用t检验及秩和检验比较相关数据之关联。结果:以结膜印迹细胞学Nelson分级≥2级为阳性界值,结膜印迹细胞学在pSS诊断的敏感度为68.4%,特异度为89.5%,受试者工作特征曲线(ROC)曲线下面积为0.767。在pSS患者中,结膜印迹细胞学检查的不同Nelson分级之间,ANA(χ^2=4.664,P=0.031)、抗SSA抗体(χ^2=8.58,P<0.01)、抗SSB抗体(χ^2=6.13,P=0.013)、抗SSA-52抗体(χ^2=6.48,P=0.011)、IgG(t=-4.344,P<0.01)和RF(U=25.0,P<0.01)差异具有统计学意义。结论:结膜印迹细胞学检查在pSS的诊断中有一定价值,可作为评估SS结膜病变的重要依据。血清ANA、抗SSA抗体、抗SSB抗体、抗SSA-52抗体、IgG、RF水平与结膜病变程度有显著相关,可能是结膜受累的免疫学诱发因素。     

原发性干燥综合征继发支气管肺淀粉样变一例并文献复习

目的 探讨原发性干燥综合征(pSS)继发支气管肺淀粉样变的临床特征.方法 回顾分析我院确诊1例及文献报道42例pSS继发支气管肺淀粉样变患者的临床表现、影像学特征、诊断、治疗及预后.结果 43例患 者中,女性42例(98％),年龄29～79岁,中位年龄57岁.确诊原发病至继发淀粉样变的时间间隔0～30年,中位时间8.9年.淀粉样物质以AL蛋白为主(21/28,75％).88％( 38/43)为局限性支气管肺淀粉样变.临床主要表现为咳嗽(18/38,47％)、气促(13/38,34％)、咳痰(9/38,24％)、咯血或咳血痰(5/38,13％)等.24％(9/38)的患者无临床症状.影像学以肺部结节或团块(40/43,93％)、肺大泡或空腔囊肿(16/43,37％)、肺间质病变(16/43,37％)、气道壁增厚或狭窄(8/43,19％)等为主要表现.17例患者行肺功能检查,以中重度弥散功能障碍为主(8/17,47％).43例患者均经病理确诊,见大量均质嗜伊红物质沉积,刚果红染色阳性.治疗以原发病为主,大多为良性经过.随访2～96个月,中位随访时间26.5个月,仅2例死亡.结论 pSS继发支气管肺淀粉样变常无其他系统累及,临床表现与气道受累的部位和程度有关.对于肺CT表现为多发的伴钙化或空洞的肺部结节的pSS患者,需考虑有无继发淀粉样变的可能.目前无特效疗法,多数进展缓慢.     

112例SARS急性期的X线和CT表现特征分析

经临床诊断的SARS病例112例,男43例,女69例,年龄范围16-82岁,平均年龄35岁。所有患者在发病后1周内均行胸部X线检查,22例同时行胸部CT扫描。结果:112例患者在发病早期最常见的影像学表现为斑片状磨玻璃影(胸片79.5％、CT 81.8％)和磨玻璃影与不规则实变或肉芽肿样病变的混合影(胸片分别为21.4％和14.％、CT分别为45.5％和27.3％)。病灶多位于中下叶(70.9％)并呈外周分布(69％)。CT可见其他改变包括小叶内间隔和小叶间隔增厚(即碎石路样改变)(36.4％)、细支气管扩     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.