严重急性呼吸道综合征并发肝脏损害的临床特点与机制探讨

目的 探讨严重急性呼吸道综合征(SARS)并发肝脏损害的临床特点,分析其可能的原因,以进一步阐明SARS的发病机制,为临床治疗提供依据。方法 对154例SARS患者,观察了临床症状、体征、肝功能等。其中46例患者系统检测了血清白细胞介素(IL)-1 β、IL-2、IL—4、IL—6、IL—8、IL—10、肿瘤坏死因子(TNF)α、内毒素和甲～戊型肝炎病毒标志物。部分病例进行了肝脏B型超声和病理学检查。另有15例健康者及22例同期住院的慢性肝病患者作为对照。结果 37.7％的SARS患者入院时丙氨酸氨基转移酶(ALT)或/和天门冬氨酸氨基转移酶(AST)升高,其中43.1%轻度升高(<80 U/L),56.9%中度升高。肝功能异常以ATL单项增高为主(70.7％),其次为ALT与AST同时异常(22.4％),少数单纯AST增高。75.9％患者转氨酶在2周内恢复正常,有4例入院时转氨酶正常而在住院过程中升高。重型SARS患者转氨酶异常率显著高于轻型,x~2=19.28,P<0.05。住院期间24.0％患者血清白蛋白下降,28.6％前白蛋白降低,8.4％总胆红素升高,72.7％患者入院时肌酸激酶或(和)心肌型肌酸激酶同功酶异常。IL-1等6种白细胞介素与TNF—α在急性期均显著高于恢复期、正常对照组和慢性肝病组,t=1.67～6.48,P<0.05～0.01。ALT异常组IL-1 β、IL-6和IL-10显著高于ALT正常组,t-2.36～     

炎性相关细胞因子和心肌梗死微循环再灌注状态的关系

目的　观察急性心肌梗死 (AMI)患者梗死相关血管 (IRA)开通前后炎性细胞因子的动态变化及其与心肌组织水平灌注状态的关系。方法　 (1)测定 8例健康人和 2 2例AMI患者急诊冠状动脉介入治疗术 (PCI)前即刻 ,术后 12、2 4h ,血浆白细胞介素 (IL) 1β、肿瘤坏死因子 (TNF)α、IL 10的变化。 (2 )按照再灌注后 2h心电图ST段回落是否 >70 % ,将 2 2例AMI患者分为 :A组 (ST回落≥ 70 % )12例和B组 (ST回落 <70 % ) 10例 ,比较两组患者IL 1β、TNFα、IL 10的变化幅度。 结果　 (1)治疗前A、B两组AMI患者血浆TNFα、IL 10略高于健康对照组 ,但差异无统计学意义 (P >0 0 5 ) ;而IL 1β显著高于健康对照组 (P <0 0 5 ) ;再灌注后 12、2 4hA、B两组血浆IL 1β和TNFα均较术前显著增高 (P <0 0 1,P <0 0 5 ) ,B组血浆IL 10较术前显著增高 (P <0 0 5 ) ,A组则无此变化 (P >0 0 5 )。 (2 )A、B两组间比较 ,治疗前TNFα、IL 1β、IL 10差异均无显著性 (P >0 0 5 ) ;成功PCI、IRA血流达TIMI 3级者 ,B组患者血浆IL 1β、TNFα、IL 10 ,在再灌注 12h显著高于A组 (P <0 0 1,P <0 0 5 ,P <0 0 5 ) ,再灌注 2 4h ,IL 1β、IL 10仍然高于A组 (P <0 0 5 )。 (3)A、B两组患者抗炎因子IL 10的升高幅度均显著低于致炎     

慢性乙型肝炎患者血清IL-10与HBVDNA复制水平检测及临床意义

检测慢性乙型肝炎 (CHB)患者血清IL - 10与HBVDNA、ALT水平 ,探讨乙型肝炎慢性化的机理。检测 77例CHB临床血清标本 ,用实时荧光定量聚合酶链反应 (FQ -PCR)测HBVDNA含量 ;用双抗体夹心ELISA法定量检测血清IL - 10水平。CHB患者血清IL - 10浓度明显高于正常对照组 (P <0 0 1) ,HBVDNA阳性组高于HBVDNA阴性组 ;CHB组患者血清ALT异常者的IL - 10浓度明显高于ALT正常组 ;IL - 10水平与HBVDNA复制程度呈正相关。CHB患者血清IL - 10水平升高与HBV持续感染、HBVDNA高复制合并肝损害有关。     

严重急性呼吸综合征肝损伤的临床特征

目的　了解严重急性呼吸综合征 (SARS)肝损伤的临床特征及其发生机制。方法　对 168例SARS患者住院期间肝功能和肝脏病理检查结果进行回顾性分析。结果　血清丙氨酸转氨酶 (ALT)异常率在入院时和住院第 1、2、3周分别占住院患者的 52 .5%、71.8% ,85.7%和 85.2 % ,ALT的均值分别是 56.0 7± 51.57、86.46± 69.93、10 6.69± 10 2 .50和 111.3 2± 160 .2 4;血清白蛋白 (Alb)平均值在入院时和住院第 1、2、3周分别是 3 7.2 5± 5.3 7、3 5.82± 4.74、3 4 .49± 5.0 4和 3 4 .2 6± 4.70 ;ALT异常的幅度与血氧饱和度下降和发热程度无显著相关 ;肝组织病理检查为非特异性炎性改变。结论　SARS患者肝损伤出现早、发生率高、持续时间较长 ,以血清白蛋白显著下降和ALT轻至中度增高为特征。低氧血症和发热不是导致肝损伤的直接原因 ,肝损伤可能是SARS相关病毒直接作用的结果     

散发性和输血后丙型肝炎临床特点病理变化及HCV-RNA水平的比较

回顾性研究2 6例散发性丙型肝炎(SHC)和35例输血后丙型肝炎(PTHC)患者的临床资料,以比较两者的临床特点、病理变化及HCVRNA水平。SHC组中15例无任何自觉症状,2 2例肝功能反复异常,但仅抗-HCV阳性的14例ALT水平超过10 0U/L ,其他8例一直低于10 0U/L ;PTHC组急性期ALT值均超过2 0 0U/L ,33例反复ALT异常,其中2 1例常高于2 0 0U/L ;SHC组的肝脏病理组织炎症活动程度较PTHC组为轻;SHC组血清HCVRNA含量显著低于PTHC组(P <0 . 0 5 ) ;SHC患者起病隐匿,病情发展缓慢,大多无自觉症状,临床症状的发生率、病毒血症水平、ALT值和肝损害程度均显著低于PTHC患者。     

重症急性呼吸综合征患者血浆细胞因子水平的动态改变

目的　探讨重症急性呼吸综合征 (SARS)患者肺部严重炎症反应的发生机制。方法　选择 2 4例本院确诊的SARS患者 ,于发病第 1、第 2、第 3～ 4周及康复出院后 1个月 (发病 8～ 9周 )收集抗凝静脉血 ,以定量ELISA法检测其血浆白细胞介素 (IL) 1β、IL 2、IL 4、IL 8、IL 10、IL 12 p70、干扰素γ(IFNγ)及肿瘤坏死因子α(TNFα)水平在病程中的改变。并选择 12例正常人作为对照。结果　数据以中位数 (四分位数间距 )表示 ,与正常对照组 [IL 8:6 2 8ng/L( 3 4 3ng/L) ;TNFα :3 77ng/L( 3 4 0ng/L) ]相比 ,所有SARS病人在发病第 1周血浆IL 8浓度明显升高 [31 2 3ng/L( 78 5 1ng/L) ],P <0 0 1,75 % ( 18/2 4 )的病人在发病 3～ 4周达到最高峰 14 9 6 5ng/L( 2 4 5 97ng/L) ,P <0 0 1,至出院后 1个月 (发病 8～ 9周 )平均血浆IL 8浓度降至 8 2 3ng/L( 8 0 7ng/L)。血浆TNFα浓度也有异常升高 ,在发病第 2周为 2 3 12ng/L( 2 6 7 33ng/L) ,P <0 0 1,发病 3～ 4周达到高峰136 35ng/L( 4 76 83ng/L) ,P <0 0 5 ,出院后 1个月下降至 94 88ng/L( 2 77 18ng/L) ,仍高于正常水平 (P <0 0 1)。其他 6种细胞因子与对照组比较 ,差异无显著性。结论　SARS病人体内发生着复杂的细胞因子网络性连锁反应 ,由此产     

成人获得性风疹患者肝功能损害的病理及临床观察

目的 探讨成人获得性风疹患者肝功能损害的临床及病理学特点,为临床诊治及判断预后提供依据.方法 36例成人获得性风疹患者,分别于入院次日及以后每隔5～10 d抽取静脉血,全自动生化分析仪定量检测患者血清总胆红素、直接胆红素、ALT、AST、血清总蛋白和血清白蛋白等肝功能指标,对其并发肝功能损害情况进行了连续动态观察,并对其中2例典型病例进行了肝活组织病理检查.无肝功能损害患者与并发肝功能损害患者住院天数比较采用秩和检验.结果 成人获得性风疹患者并发肝功能损害发生率高达77.8%,但其肝功能损害多轻微,多以ALT和(或)AST升高为主,其中以退疹后的第6～10日肝功能损害发生率最高,达72.2%,且此时肝功能损害亦最明显.肝脏活组织病理学检查发现其肝脏组织结构完整,仅有肝脏组织轻微炎症改变,并发现其病毒包涵体.并发肝功能损害患者组平均住院18.2 d,与无并发肝功能损害患者组平均住院7.8 d比较,差异有统计学意义(u=3.596,P＜0.05).结论 近年成人获得性风疹患者并发肝功能损害发生率高,但其肝功能损害多轻微,多以ALT升高为主.但一旦出现AST异常或黄疸,说明肝功能损害较重,除积极治疗外,要严密观察,防止发生急性肝衰竭.如本病患者并发肝功能损害,则明显延长了病程及住院时间.     

急性呼吸窘迫综合征患者血浆白细胞介素4等含量变化的研究

目的　观察急性呼吸窘迫综合征 (ARDS)患者血浆白细胞介素 4(IL 4)、IL 10和IL 13含量的变化 ,探讨在ARDS发病机制中抗炎机制变化的意义。方法　采用酶联免疫吸附试验 (ELISA)方法 ,检测 2 2例ARDS患者 (ARDS组 )、8例全身炎症反应综合征 (SIRS)患者 (SIRS组 )和 10名健康志愿者 (正常对照组 )的动脉血血浆IL 4、IL 10和IL 13的含量。结果　ARDS组患者的血浆IL 4、IL 10和IL 13含量分别为 (2 61± 5 5 ) μg/L、(45 8± 112 ) μg/L、(5 2 1± 2 0 2 ) μg/L ,SIRS组分别为 (15 5± 2 6)μg/L、(2 60± 5 4) μg/L、(1 69± 0 3 9) μg/L ,正常对照组分别为 (43± 13 ) μg/L、(13 5± 15 ) μg/L、(0 3 3±0 10 ) μg/L ,三组间比较差异具有非常显著性 (P均 <0 0 1) ;SIRS组与正常对照组比较 ,差异也有显著性 (P <0 0 1)。结论　抗炎性细胞因子IL 4、IL 10和IL 13的释放异常 ,可能是ARDS和SIRS的重要发病机制之一。     

炎症在高血压病患者肾功能损害中的作用

目的探讨炎症介质在高血压肾功能损害中的作用.方法 38 例高血压病患者(分为肾功能正常组(19例)、肾功能异常组(19例))和38例健康人,分别用放免法测定血浆肿瘤坏死因子α(TNFα)、白介素1 β(IL1β)、白介素6(IL6)及尿微量白蛋白(ALB)、α1微球蛋白(α1 MG)、β2微球蛋白(β2 MG),用免疫比浊法测定血浆C反应蛋白(CRP),酶免法测量尿视黄醇结合蛋白(RBP).比较各组之间血浆CRP、TNFα、IL1β、IL6及尿ALB、α1 MG、β2MG、RBP水平及各指标之间相关分析.结果血浆CRP、TNFα、IL1β、IL6水平在高血压病患者升高,随肾脏功能损害的加重而进一步升高.多元线性回归分析,尿ALB、β2 MG、α1 MG与SBP呈直线相关,SBP与血浆IL1β、TNFα呈直线关系,尿RBP与血浆IL6呈直线相关.结论 SBP是肾脏功能损害的独立危险因素,炎症在高血压病肾脏功能损害中起重要作用.     

ALT水平正常或轻度升高慢性乙型肝炎的肝组织学改变及临床特征分析

目的研究ALT水平正常或轻度升高的慢性乙型肝炎(CHB)患者肝组织学改变与临床指标的关系,为指导抗病毒治疗提供依据。方法回顾性收集四川省人民医院2011年10月-2018年8月行肝穿刺活检的CHB患者903例,比较性别、年龄、血清HBeAg状态、血清ALT、HBV DNA水平与ALT 2倍正常值上限(ULN) CHB患者肝脏炎症活动度和纤维化程度的关系,计数资料两组间比较采用χ~2检验。结果 903例CHB患者肝脏炎症活动度分级在G1～G4之间,其中以G2为主,占67. 6%,G≥2的患者有831例(92. 0%);肝纤维化分期在S0～S4之间,以S1为主,占78. 2%,S≥2的患者有159例(17. 6%)。男性患者的肝脏炎症活动度分级和纤维化分期明显高于女性患者(χ~2=6. 120、15. 098,P值均0. 05)。ALT 1×ULN、1×ULN≤ALT 1. 5×ULN、ALT≥1. 5×ULN患者显著肝脏炎症坏死(G≥2)所占比例分别为91. 2%、92. 1%、94. 8%,差异有统计学意义(χ~2=28. 125,P 0. 05);三组患者的显著肝纤维化(S≥2)所占比例分别为12. 7%、22. 9%、24. 4%,差异亦有统计学意义(χ~2=18. 004,P 0. 05)。随着CHB患者年龄增大,肝脏炎症活动度和纤维化程度均加重,差异均有统计学意义(χ~2=65. 768、56. 056,P值均0. 05)。随着血清HBV DNA水平降低,肝脏炎症活动度和纤维化程度均加重,差异均有统计学意义(χ~2=21. 712、29. 461,P值均0. 05)。HBeAg阴性患者肝脏炎症活动度分级和纤维化分期均明显高于HBeAg阳性患者(χ~2=30. 798、26. 380,P值均0. 05)。年龄≥30岁且1. 5×ULN≤ALT 2×ULN的HBeAg阳性和HBeAg阴性患者显著肝脏炎症坏死的比例分别为100%(40/40)和97. 8%(45/46)。结论 ALT水平正常或轻度升高的CHB患者中大多数具有显著的肝脏炎症和不同程度的肝纤维化,特别是年龄≥30岁的男性患者,建议完善肝组织病理学检查评估抗病毒治疗指征,以免延误治疗。     

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.     

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.     

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.     

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.