意外抗体对ABO血型鉴定的干扰

目的：分析意外抗体在ABO血型鉴定中的干扰作用,为ABO疑难血型鉴定提供思路和对策。方法：对全自动血型仪检测的ABO血型正反定不合的样本结合盐水试管法、抗体筛查及鉴定结果以及病史资料综合分析。结果：26例引起正反定不合的抗体中IgM18例,IgG8例,分别是抗-M10例、抗-Lea2例、抗-N1例、抗-P12例、抗-JKa1例、抗-D2例、抗-E2例、抗-C1例、抗-c1例、抗-Fya1例、自身抗体3例。结论：IgM和IgG两类意外抗体均能引起ABO血型正反定不合,反定细胞应该选用常见意外抗体对应抗原表位缺失的红细胞。     

微柱凝胶法检测Rh血型免疫性抗体的分析

目的：探讨Rh血型免疫性抗体筛查及特异性鉴定在临床输血和新生儿溶血病预防中的意义,观察微柱凝胶法检测Rh血型免疫性抗体的敏感性。方法：应用微柱凝胶法对患者输血前和孕妇产前做Rh血型免疫性抗体筛查,对筛查阳性者进一步做抗体特异性鉴定及效价测定。结果：在9878例患者中检出Rh血型免疫性抗体阳性86例（0.87%）,其中抗D12例（14.0%）,抗E25例（29.1%）,抗C11例（12.8%）,抗c9例（10.5%）,抗e4例（4.7%）,抗Ce7例（8.1%）,抗CE5例（5.8%）,抗CD6例（6.9%）,抗cD3例（3.5%）,抗cE4例（4.7%）。结论：在输血前和产前对拟输血患者和夫妇血型不合的孕妇进行Rh血型免疫性抗体筛查、特异性鉴定及效价测定,对确保输血安全及优生优育有重要的临床意义。     

对比两种免疫因素产生同种抗体的结果分析

目的：对比临床输血、妊娠2种免疫因素导致产生同种抗体的机率大小。方法：采用微柱凝胶过滤和离心技术,利用免疫化学抗原抗体特异性反应的原理,对2个实验组即有输血史实验组和有妊娠史实验组的患者进行不规则抗体的筛查和鉴定。结果：检出不规则抗体9例,阳性率为0．6％,其中500例有输血史实验组检出不规则抗体阳性5例,阳性率为1．0％,1000例有妊娠史实验组检出不规则抗体阳性4例,阳性率为0．4％。结论：统计结果表明,虽然本实验室2者产生免疫性同种抗体差异无统计学意义,但通过输血免疫产生抗体的百分比要大于妊娠免疫。     

单中心输血前患者意外抗体筛查结果分析

目的:分析单中心患者输血前血浆中意外抗体筛查阳性率和分布情况。方法:统计2016—2020年意外抗体筛查人次及其阳性病例,并随机抽取同一时段意外抗体筛查阴性病例,通过回顾性病例对照研究分析意外抗体筛查阳性率在不同性别、输血史和妊娠史以及不同疾病中的分布情况,同时对意外抗体的消逝和持续性进行分析。结果:调查时间段内进行意外抗体筛查219 386人次,其中1 488人次为阳性,阳性率为0.68%;选取意外抗体阳性的1 147例患者作为观察组,随机抽取同时段意外抗体筛查阴性的1 159例患者作为对照组,单因素分析显示,意外抗体阳性率在性别、输血史、血液疾病、自身免疫性疾病、肿瘤、肝脏疾病、心脏疾病等方面,差异有统计学意义(P<0.05);多因素分析显示输血史、血液疾病、自身免疫性疾病和肝脏疾病为意外抗体产生的影响因素(P<0.05);1 147例意外抗体筛查阳性患者中42例转变为阴性,消逝率为3.66%(42/1 147);意外抗体消逝率在血液疾病患者中显著高于非血液疾病(P<0.05);消逝的中位时间为109 d。结论:有输血史、血液疾病、自身免疫性疾病和肝脏疾病患者产生...     

42例红细胞血型同种抗体分析

目的总结分析广西南宁地区临床输血患者中不规则抗体筛查情况,探索其在输血医学中的临床意义,为预防和治疗免疫性输血反应提供依据。方法应用盐水介质法、抗人球蛋白法、凝聚胺法对2007年1月至2010年6月南宁地区各医院送检的免疫血液学检测标本1 042例进行不规则抗体检测。结果鉴定确认同种特异性抗体42例,分别为：抗-E 22例,抗-c 9例,抗-Mur5例,抗-D 2例,抗-Ce 1例,抗-M 1例,抗-Leb 1例,抗-e 1例等。结论各级医院应积极开展输血前不规则抗体筛查工作,进行Rh血型的E抗原同型输注,对减少溶血性输血反应、保证临床输血的安全与有效有着重要意义。     

147例Rh血型系统意外抗体致新生儿溶血病回顾性分析

目的:回顾性分析2012-2019年在新疆维吾尔自治区人民医院新生儿科确诊为Rh新生儿溶血病患儿147例,调查Rh血型意外抗体致新生儿溶血病患儿的病情严重程度及治疗方式,探讨Rh血型意外抗体致新生儿溶血病的合理有效预防控制措施.方法:调取147例Rh新生儿溶血病患儿病例资料,鉴定患儿血型意外抗体特异性,搜集患儿入院期间...     

输血前血型和抗体筛检与医疗风险的相关性探讨

目的：探讨输血前血型和抗体筛检工作的重要性及其与医疗风险的相关性。方法：对2814例备血患者,特别是外科患者ABO血型、Rh血型、不规则抗体检查结果和用血情况进行统计分析。结果：2814例备血患者中A型895例（31．81％）,B型736例（26．15％）,O型881例（31．31％）,AB型302例（10．73％）;Rh阴性17例（0．60％）,其中2例因手术前未备血而引发了医疗纠纷,5例患者因备血不及时而延期手术;检出不规则抗阳性者6例（0．21％）,其中2例患者未能及时找到相合的血液,不能及时进行输血治疗而引起患者不满;外科备血2092例,有1097例（52．44％）只进行了检查而没有输血。结论：对外科手术患者术前常规进行血型鉴定和抗体筛检是安全输血的重要保证,它关系到能否及时为患者提供合适的血液制品进行输血治疗,必须引起高度重视,避免潜在的医疗风险和由此引发的医疗纠纷。     

临床输血病人ABO以外的血型抗体

输血前针对ABO以外血型进行化验是保证输血安全的重要措施。ABO以外血型不规则抗体也是引发血型鉴定障碍、输血配型难、输血出现不良反应、新生儿溶血病等重要原因之一〔1,2〕。进行输血时,应对受血者血浆及血清做好常规抗体筛选,如出现不规则抗体,应及时指导输血,保障受血者健康。本文旨在分析ABO以外血型抗体。     

甲状腺过氧化物酶抗体在自身免疫性甲状腺疾病中的表现

甲状腺功能亢进（甲亢）、甲状腺功能低下（甲低）和亚临床甲低患者甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）和甲状腺微粒体抗体（TMAb）的阳性率和阳性患者的抗体水平均高于正常对照组，TPOAb阳性率在各组中又明显高于同组的TGAb和TMAb阳性率。甲状腺功能恢复正常的复诊组TPOAb阳性患者的抗体水平明显低于甲亢组、甲低组和亚临床甲低组。提示TPOAb对自身免疫性甲状腺疾病的诊断、治疗及预后评估具有一定的临床意义。     

Primary neuroendocrine tumour of the common hepatic duct: An unexpected Klatskin-like lesion

The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.     

基于网络药理学及分子对接探讨灵芝的免疫调节机制

［摘要］　目的　通过网络药理学及分子对接探讨灵芝调控免疫功能的作用机制。方法　通过中药系统药理学数据库和分析平台(TCMSP)检索和筛选灵芝有效成分,使用Swiss Target Prediction数据库预测其潜在作用靶点。从GeneCards、DrugBank、OMIM、PharmGKB、TDD数据库中获取免疫调控相关靶点,整合药物靶点和疾病靶点,取交集靶点。使用Cytoscape软件构建药物-活性成分-作用靶点-疾病网络图,筛选核心成分。利用String平台构建蛋白互作(PPI)网络,筛选核心蛋白。利用R软件进行GO富集分析和KEGG通路分析。通过分子对接技术进行活性成分和核心靶点的分子对接验证。结果　共获取灵芝活性成分43个,作用靶点499个,免疫相关靶点12 454个,药物与疾病的交集靶点483个。KEGG通路分析显示交集基因主要富集于神经活性配体-受体相互作用、cAMP信号通路、蛋白多糖与癌症等信号通路。GO富集分析显示,交集基因主要参与脂质代谢过程的调节、肽基-丝氨酸磷酸化、肽基-丝氨酸修饰等过程。分子对接结果显示,主要核心成分与核心蛋白有较好的结合活性。结论　研究构建的灵芝“成分-靶点-通路-疾病”网络,一定程度上揭示了灵芝多成分、多靶点的复杂作用机制,为灵芝的临床应用和产品开发提供理论基础。     

四种常见贫血患者红细胞寿命的研究

目的:研究自身免疫性溶血性贫血(AIHA)患者的红细胞寿命,并与常见贫血患者的红细胞寿命比较。方法:回顾性分析AIHA、骨髓增生异常综合征(MDS)、重型再生障碍性贫血(SAA)和缺铁性贫血(IDA) 4组共55例患者的临床资料,以同期12例健康志愿者为正常对照组。采用一氧化碳(CO)呼气法测定红细胞寿命,比较4种贫血患者和健康志愿者红细胞寿命并作分析。结果:AIHA患者红细胞寿命为(30.41±31.12)d,比MDS(53.44±32.61)d、SAA(54.53±22.56)d和IDA(58.75±31.29)d患者的红细胞寿命均缩短(P0.05),4组患者红细胞寿命均较12例健康志愿者红细胞寿命(118.16±25.88)d显著缩短(P0.01)。结论:红细胞寿命缩短参与了AIHA、MDS、SAA和IDA患者贫血的发生,但在不同贫血疾病中所起作用程度不尽相同。     

Immunoregulatory effects of intravenous immune serum globulin therapy in common variable hypogammaglobulinemia

Because of evidence of immunoregulatory effects of short-term administration of pooled donor gamma globulins, the effects of intravenous immune serum globulin were studied in nine adult patients with common variable hypogammaglobulinemia over a two-year period. Baseline assessment prior to immune serum globulin replacement included evaluation of B cell function, suppressor cell activity, and T cell subsets. These analyses were subsequently performed during the course of a first-year treatment period of intravenous immune serum globulin at doses of 100 to 200 mg/kg per month and a second-year trial at doses of 300 to 400 mg/kg per month. Five patients were re-evaluated following discontinuation of the intravenous immune serum globulin therapy for four months between the first and second treatment periods. During both treatment periods with intravenous immune serum globulin, suppressor cell activity increased markedly compared with baseline, and declined following discontinuation of drug therapy in the five patients. Suppressor cell activity was reversed by either irradiation of the T cell fraction or removal of the T8-positive cell fraction by flow cytometry. There was a reduction in the absolute number of total lymphocytes, the T3-positive cells (total T cells), and the T4-positive cells (helper cells) following intravenous immune serum globulin therapy; however, the percentages of the T cell subsets did not change significantly. Following immune serum globulin therapy, the number of T8-positive cells was not significantly changed but the T4:T8 ratio decreased from 2.1 at baseline to 1.5 after therapy (p greater than 0.05). These data demonstrate that long-term intravenous immune serum globulin administration modulates the immune system by increasing suppressor T cell functional activity but is not accompanied by changes in the number of T8-positive cells in the peripheral blood.     

Conversion to open surgery during laparoscopic common bile duct exploration: predictive factors and impact on the perioperative outcomes

BackgroundLaparoscopic common bile duct exploration (LCBDE) is an effective treatment for choledocholithiasis. The aim of this study was to determine the predictive factors associated with conversion during LCBDE and to assess the implications of conversion on the patients’ postoperative course.MethodsA retrospective cohort study based on patients undergoing LCBDE between 2000 and 2018 was conducted. Uni- and multivariate regression analyses were performed.ResultsA total of 357 patients underwent LCBDE, and the conversion rate was 14.2%. The main reasons for conversion were lithiasis extraction (21; 41%) and difficult dissection (13; 26%). Independent predictors for conversion were increasing levels of serum bilirubin prior to surgery (OR=4.745, 95% CI: 1.390-16.198; p=0.013), and emergency setting (OR=4.144, 95% CI: 1.449-11.846; p=0.008). Age was independently associated with lower odds of conversion (OR=0.979, 95% CI: 0.960-0.999; p=0.036). Conversion had a negative impact on the patients’ postoperative course, including severe complication (21.6% vs. 5.2% p<0.001) and surgical reintervention (11.8% vs. 2.6% p=0.002) rates.ConclusionConversion to open surgery during LCBDE was associated with increased postoperative morbidity. Emergency surgery and increasing levels of serum bilirubin previous to surgery independently increase the probability of conversion; however age was independently associated with lower odds of conversion.