海洛因依赖者免疫功能变化的研究

目的：研究海洛因依赖者免疫功能的变化及机制。方法：采用APAAP法、^3HTdR掺入法，检测50例海洛因依赖者外周血T细胞亚群、IL－2R^+细胞数和白介素－2（Interleukin-2,IL-2)水平；采用红细胞C3b受体花环（RBC－C3bRR)、红细胞免疫复合物花环（RBC－ICR）、粘附增强因子活性（RFER）及抑制因子活性（RFIR）试验，观察海洛因依赖者红细胞免疫功能的变化。结果：海洛因依赖者外周血T细胞总数（56．6&;#177;3．4）、IL－2R^+细胞数（15．0&;#177;4．2）及血清IL－2水平（33&;#177;7）与对照组比较显著降低（P＜0．01），而CD4^+细胞（40．5&;#177;3．2）和CD4^+/CD8^+比值（1．65&;#177;0．18）与对照组比较显著升高（P＜0．01）。海洛因依赖者RBC－C3bRR（15．3&;#177;2．1）、RFER（71．4&;#177;8．5）与对照组比较明显下降（P＜0．01），而RBC－ICR（4．8&;#177;1．2）、RFIR（28．1&;#177;4．7）与对照组比较显著则明显升高（P＜0．01）。结论：长期吸食海洛因可降低人体免疫功能。     

幽门螺杆菌感染与慢性胃炎红细胞免疫功能变化的关系

目的：探讨幽门螺杆菌感染与慢性胃炎患者红细胞免疫功能的影响。方法：采用红细胞C35受体花环（RBC-C3b RR）试验、免疫复合物花环（RBC-ICR）试验、免疫粘附促进因子（RFER）百分率及抑制因子（RFIR）百分率试验,检测315例慢性胃炎患者与30例健康体检者红细胞免疫功能情况。结果：慢性胃炎组RBC-C3bRR、RFER明显低于对照组（P＜0.01,R＜0.05),RBC-ICR、RFIR高于对照组（P＜0.05,P＜0.01);Hp阳性组RBC-C3bRR明显低于Hp阴性组（P＜0.05),RBC-ECR明显高于HP阴性组（P＜0.05),RFER、RFIF两组间比较未见显著差异;对186例Hp阳性根除治疗前、后红细胞免疫功能对比发现治疗后RBC-ICR明显低于根除前,其余指标无显著改变。结论：Hp的感染可能导致宿主红细胞免疫功能紊乱,其感染可能是慢性胃炎患者红细胞免疫功能下降的主要原因。     

促红细胞生成素对脐血红细胞C3bRR及ICR表达的影响

目的探讨促红细胞生成素(EPO)对脐血与成人外周血红细胞免疫功能表达的影响。方法无菌采集正常孕妇分娩时胎儿脐血及献血者外周血各28份。应用ELISA法检测EPO;应用红细胞C3b受体花环试验和红细胞免疫复合物花环试验检测红细胞C3b受体活性率(RBC-C3bRR)和红细胞粘附免疫复合物率(RBC-ICR)。同时考查不同浓度的EPO对脐血体外培养红细胞C3bRR、ICR表达的影响。结果脐血EPO、RBC-C3bRR及RBC-ICR与成人外周血比较差异有显著性意义(P<0.01);脐血体外培养,随着EPO浓度的增加,RBC-C3bRR活性逐渐增强,对RBC-ICR产生的抑制率逐渐减弱;当EPO浓度达40mIU/ml时,脐血体外培养各时间段的RBC-C3bRR、RBC-ICR与EPO为0mIU/ml时比较差异有显著性意义(P<0.01)。结论脐血EPO及红细胞C3bRRI、CR高于成人外周血。细胞因子EPO在脐血体外培养中,促进RBC-C3bRR的生成,抑制RBC-ICR的表达。     

肝硬化患者低氧血症对红细胞免疫功能的影响

目的:探讨肝硬化患者低氧血症对红细胞免疫功能的影响。方法:采用红细胞酵母菌混合花环法检测48例肝硬化患者红细胞C3b受体花环率(RBC-C3bRR)和红细胞免疫复合物花环率(RBC-ICR);同时测定动脉血氧分压(PaO2)水平。结果:肝硬化患者RBC-C3bRR明显降低(P<0.01),RBC-ICR明显升高(P<0.01);PaO2降低,在肝性脑病(HE)组更明显。在动脉低氧血症时,RBC-C3bRR降低,RBC-ICR升高更加显著(P均<0.05)。结论:肝硬化患者红细胞免疫功能低下,在低氧血症时加重红细胞C3b受体的损害。     

电针足三里对大鼠脑肠肽含量的影响及神经免疫调控作用

背景针刺对红细胞免疫和T细胞亚群均有正向调节作用,但其机制尚未完全阐明.目的探讨免疫系统在针刺治疗相关疾病中的调控作用及可能的机制.设计随机对照实验研究.地点和对象实验地点解放军第四军医大学唐都医院消化内科实验室.将SD大鼠40只随机分成正常对照组、非经非穴组、免疫抑制组、足三里组、足三里+免疫抑制组(n=8).干预应用放射免疫法测定脑垂体和外周血P物质放免活性(ir-SP)和血管活性肠肽放免活性(ir-VIP)含量的变化;应用流式细胞仪技术,通过微量全血直接免疫荧光染色法测定外周血T细胞亚群以反映细胞免疫功能;应用红细胞C3b受体-酵母菌花环试验和红细胞-IC花环试验检测红细胞免疫功能.主要观察指标各组大鼠的ir-SP和ir-VIP含量;T细胞亚群和红细胞免疫功能的变化.结果足三里组大鼠外周血和脑垂体中P物质(substance P,SP)、血管活性肠肽(vasoactive intestinal peptide,VIP)含量[外周血SP(591.83±142.59)pg/L,VIP(92.05±22.11)pg/L;脑垂体SP(47.00±9.12)pg/L,VIP(308.36±34.16)pg/L、T4(CD4+)细胞百分率[(65.55±8.42)%]、C3b受体花环率(RBC-C3bRR)[(15.88±2.99)%]、红细胞免疫复合物花环率(RBC-ICR)[(12.14±1.22)%]明显高于正常对照组[(569.36±8,04)pg/L,(20.45±6.74)pg/L,(27.86±7.67)pg/L,(236.71±22.83)pg/L,(43.06±3.14)%,(8.63±2.13)%,(6.75±2.32)%](P均＜0.01);且CD4+与外周血和脑垂体中P物质、血管活性肠肽含量的变化(r=0.744,P＜0.05;r=0.738,P＜0.05;r=0.822,P＜0.05r=0.848,P＜0.05)、CD4+与C3b受体花环率(RBC-C3bRR)呈显著正相关(r=0.719,P＜0.05).免疫抑制组外周血和脑垂体中SP,VIP含量均下降,与正常对照组相比有统计学差异(P＜0.01),T4(CD4+)细胞百分率[(34.50±2.52)%]、C3b受体花环率(RBC-C3bRR)[(5.25±1.17)%]明显低于正常对照组(P＜0.01,P＜0.05).结论针刺治疗可以提高机体免疫力,其机制可能与相应脑肠肽合成和释放增多有关,通过这些免疫递质对神经-内分泌-免疫调节网络发挥作用.     

鸦胆子油乳膀胱灌注对膀胱癌患者红细胞免疫功能的影响

目的分析鸦胆子油乳膀胱灌注预防膀胱癌术后复发的临床效果,探讨其对膀胱癌患者红细胞免疫功能的影响。方法检测行保留膀胱手术的30例膀胱移行细胞癌患者手术前后不同时期的红细胞Ⅰ型补体受体花环率(C3bRR)、免疫复合物花环率(ICR)、红细胞免疫促进因子(RFER)、红细胞免疫抑制因子(RFIR)、促肿瘤红细胞花环试验(ETER)、协同肿瘤红细胞花环试验(ATER)及自然肿瘤红细胞花环试验(NTER),同时测定20例健康献血员的红细胞免疫指标作为对照。结果膀胱移行细胞癌组术前C3bRR、RFER、3项肿瘤红细胞花环率均降低,ICR、RFIR增高;鸦胆子油乳灌注后C3bRR、RFER、ETER、ATER、NTER升高,ICR、RFIR降低,在术后2个月达到峰值,6个月后恢复到正常人水平。结论膀胱移行细胞癌患者红细胞免疫功能低下;鸦胆子油乳膀胱灌注化疗可提高膀胱癌患者红细胞免疫功能。     

肝病患者红细胞免疫功能的检测及临床分析

目的观察肝病患者红细胞免疫功能的状况并探讨其临床意义.方法对肝病患者采用受体粘附法检测肿瘤红细胞花环(TER)、红细胞C3b受体花环(RBC-C3bRR)和红细胞免疫复合物花环(RBC-ICR).结果各组病例的RBC-ICR与对照组比较明显升高(P<0.01);与对照组比较肝硬化患者的RBC-C3bRR明显下降(P<0.01);肝癌患者的RBC-C3bRR下降(P<0.05);各组的TER值与对照组比较,肝癌患者明显下降(P<0.01);急性肝炎、慢性肝炎、肝硬化组的TER降低(P<0.05).结论肝病患者免疫功能受损,各组肝病患者均表现为不同程度的红细胞免疫功能继发性低下.监测上述各项指标,对临床的诊治具有参考价值.     

急性心脑血管疾病患者红细胞免疫功能的改变

目的探讨急性心脑血管疾病患者(ACCVD)红细胞(RBC)免疫功能的改变。方法采用免疫粘附酵母菌花环法。结果ACCVD组与健康组相比,红细胞C3b受体花环(RBC-c3bRR)率与红细胞免疫粘附促进因子(RFER)百分率明显降低(P<0.01),红细胞免疫复合物(RBC-ICR)花环率与红细胞粘附抑制因子(RFIR)百分率明显增加(P<0.01)。结论ACCVD患者红细胞免疫功能较健康人低,红细胞免疫功能低下亦可能是血栓形成的原因之一。     

慢性胃炎患者红细胞免疫功能的变化

目的探讨慢性胃炎（CG）患者红细胞免疫功能的变化。方法对88例慢性胃炎患者进行红细胞免疫功能检测。结果萎缩性胃炎患者红细胞C3b受体花环率（RBc—C3bRR）、免疫粘附促进因子（RFER）明显低于对照组（P〈0．05）,免疫复合物花环率（RBC-ICR）、免疫粘附抑制因子（RFIR）明显高于对照组（P〈O．05）;而浅表性胃炎患者RBC—C3bRR、RBC—ICR、RFER、RFIR与对照组比较差异无统计学意义（P〉O．05）。结论检测慢性胃炎患者红细胞的免疫功能对于鉴别诊断和评估愈后具有十分重要的临床意义。     

自身免疫性脑炎与外周血免疫指标及红细胞免疫指标的相关性研究

目的探讨自身免疫性脑炎(AE)患儿病情与外周血免疫指标以及红细胞免疫指标的相关性。方法选取80例AE患儿纳入观察组,另选取体检的40例健康儿童纳入对照组,比较2组患儿的细胞免疫指标水平,并分析其与AE的相关性。结果观察组CD3~+、CD4~+、CD4~+/CD8~+及自然杀伤细胞(NK细胞)水平均显著低于对照组(P 0.05),CD8~+水平显著高于对照组(P 0.05)。观察组患儿红细胞免疫亲和力受体(FEER)、红细胞免疫因子复合物花环(RBC-ICR)、红细胞C3b免疫受体花环(RBC-C3bR)、电泳指数、聚集指数、刚性指数均显著低于对照组(P 0.05)。以AE为自变量,以CD3~+、CD4~+、CD4~+/CD8~+、CD8~+、NK细胞、FEER、RBC-ICR、RBC-C3bR为因变量,相关性分析显示AE与CD8~+呈正相关性(r=0.657,P 0.05),AE与CD3~+、CD4~+、CD4~+/CD8~+、NK细胞、FEER、RBC-ICR、RBC-C3bR细胞水平呈负相关性(r值分别为-0.758、-0.635、-0.768、-0.814、-0.987、-0.765、-0.854,均P 0.05)。结论 AE患儿体内的外周血免疫指标、红细胞免疫指标水平与疾病存在相关性。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.