胃癌患者抑郁程度与血清细胞因子水平间的相关性分析

目的研究胃癌患者抑郁程度与血清细胞因子水平间的相关性。 方法共选取胃癌患者76例,根据其健康问卷（PHQ-9）评分将其分为有抑郁组（34例）及无抑郁组（42例）,同时选取性别、年龄均与胃癌患者相匹配的健康体检者38例纳入健康组。采用酶联免疫吸附法(ELSIA)检测各组对象血清白介素-2(IL-2)、可溶性白细胞介素-2受体（SIL-2R）及肿瘤坏死因子-α（TNF-α）表达水平。对各组对象检测数据进行组间比较,同时采用Pearson′s相关系数分析各细胞因子表达水平与抑郁程度间的相关性。 结果3组对象IL-2、sIL-2R及TNF-α表达水平组间差异均具有统计学意义(P<0.05);有抑郁组TNF-α水平［(２００.５５±４８.６１)pg/ml］、无抑郁组TNF-α水平［(１８９.９８±４３.２１)pg/ml］组间差异无统计学意义(P&rt;0.05),但2组患者TNF-α水平均明显高于健康组［(７２.４８±２３.８１)pg/ml］(P<0.01);有抑郁组IL-2水平［(６４.５８±１８.２３)pg/ml］明显低于无抑郁组［(７8.５４±２０.８９)pg/ml］(P<0.01);且2组患者IL-2水平均明显低于健康组［(９５.１１±２４.８６)pg/ml］(P<0.05);有抑郁组SIL-2R水平［(１1７.8４±２2.6９)pg/ml］明显高于无抑郁组［(9９.１0±18.66)pg/ml］(P<0.01);且2组患者SIL-2R水平均明显高于健康组［(8４.66±１4.6３)pg/ml］(P<0.05)。经相关性分析发现,胃癌患者抑郁严重程度与IL-2水平呈负相关(r=-0.295,P<0.05),与sIL-2R水平呈正相关(r=0.334,P<0.05)。 结论IL-2、sIL-2R水平与胃癌患者抑郁程度间具有一定相关性,推测上述细胞因子在胃癌患者抑郁发病过程中可能起主要中介作用。     

高血压脑出血患者IL-2、sIL-2R表达意义的研究

目的研究高血压脑出血患者外周血中白细胞介素2(IL-2)、可溶性白细胞介素2受体(sIL-2R)表达的变化规律,探讨其间相互关系及临床意义。方法采用酶联免疫吸附法(ELISA)测定患者IL-2、sIL-2R的含量。结果高血压脑出血组IL-2含量(pg/ml)为67.76±32.62,与健康对照组(127.15±57.05)相比明显降低(P<0.01),sIL-2R含量(pg/ml)为96.91±50.14,与健康对照组(92.11±34.1)相比则明显升高(P<0.05)。结论高血压脑出血患者出现免疫功能低下,临床检测患者IL-2、sIL-2R含量在高血压脑出血的发生、发展、治疗、转归及预后方面具有重要的临床指导意义。     

可溶性IL-2受体水平在监测急性GVHD中的作用

由T细胞激活引起的疾患多有可溶性白细胞介素-2受体(slL-2R)水平增高。作者对30例异基因骨髓移植(allo-BMT)受者进行血清sIL-2R检测,重点评价其在监测急性GVHD中的作用。 30例allo-BMT患者,分别于施行预处理方案前及BMT后至少每周2次采集血标本,采用ELISA方法进行sIL-2R及血清α-肿瘤坏死因子(α-TNF)检测。以10名健康者血清sIL-2R及α-TNF水平作为对照,其正常值定为sIL-2R252±66U/ml及α-FNF<2.5gp/ml。 结果BMT后17例患者发生急性GVHD(Ⅰ 组),13例未发生GVHD(Ⅱ组)。BMT前两组sIL-2R水平无明显差异,Ⅰ、Ⅱ组分别为631±93U/ml和443±72U/     

急性白血病患者血清sIL-2R,MCP-1及IFN-γ联合检测的临床意义

目的 探讨急性白血病患者血清可溶性白细胞介素-2受体(soluble interleukin-2 receptors,sIL-2R),单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1)及γ-干扰素(interferon-γ,IFN-γ)联合检测的临床意义。方法 选取2015年6月～2018年7月收治的急性白血病患者86例为观察组,另选同期接受体检的健康者86例为对照组,对两组血清sIL-2R,MCP-1及 IFN-γ水平予以检测,并观察三种指标联合检测与单独检测的诊断准确度、特异度、灵敏度。结果 观察组血清sIL-2R,MCP-1和IFN-γ分别为492.57±35.28 U/ml,18.25±2.71 μg/L和16.32±3.02 pg/ml,与对照组156.31±18.45 U/ml,4.91±0.93 μg/L和33.46±5.28 pg/ml对比,差异均有统计学意义(t=78.325,43.178,26.132,均P<0.01); 急性淋巴细胞白血病患者血清sIL-2R,MCP-1和IFN-γ分别为563.18±39.54 U/ml,22.53±2.85 μg/L和10.26±2.14 pg/ml,与急性髓细胞白血病患者(431.27±33.17 U/ml,14.74±2.69 μg/L和18.63±2.51 pg/ml)对比,差异均有统计学意义(t=23.702,18.434,23.532,均P<0.01); sIL-2R,MCP-1和IFN-γ联合检测准确度、特异度和灵敏度分别为86.05%,87.04%和84.38%,与单项检测对比,均明显升高,差异有统计学意义(P<0.05)。结论 急性白血病患者血清sIL-2R,MCP-1及 IFN-γ水平存在明显异常,且不同类型急性白血病患者上述指标有较大差异,三者联合检测在急性白血病诊断中具有较高价值。     

脑脊液白细胞介素2测定在结脑与病脑鉴别诊断中的意义

白细胞介素 2 ( IL - 2 )是机体复杂免疫网络中起调节作用的重要淋巴因子 ,在保障机体免疫功能中起着重要作用 [1 ] 。目前已证实 ,某些病理情况下 ,如恶性肿瘤、某些病毒感染等患者的体内 IL- 2的产生减少 [2 ]。有关 IL- 2水平在中枢神经系统感染性疾病时的变化报道甚少。作者对 78例脑膜炎患者进行了脑脊液 IL- 2测定 ,以探讨其在结核性脑膜炎 (结脑 )与病毒性脑膜炎 (病脑 )鉴别诊断中的价值。1　对象和方法1 .1　对象　结脑 39例 ,男 2 1例和女 1 8例 ,年龄 1 7～ 6 2岁 ,平均 30岁± 1 4岁 ,经脑脊液常规、生化、PCR检查及抗结核…     

急性脑出血患者脑脊液IL—6和CRP的不同变化与意义

目的研究急性脑出血(ACH)后脑脊液〈CSF〉中IL-6和CRP的变化与急性脑血管损伤程度的关系.方法采用ELISA和透射免疫比浊法分别测定20例对照组、15例脑出血患者CSF中IL-6和CRP含量,并分析IL-6和CRP的相关性.结果对照组、脑出血IL-6含量分别为23.33±10.73、427.03±596.31pg/ml;CRP含量分别为1.46±0.47、1.39±0.58ng/ml;脑出血患者IL-6明显高于对照组(Z=4.90,P＜0.01),而CRP无明显变化(t=0.63,P＞0.05);脑室出血者IL-6(n=7,839.13±612.33pg/ml)较无脑室出血者(n=8,212.85±201.82pg/ml)显著增高(Z=3.24,P＜0.01).结论脑出血急性期CSF中IL-6显著升高,应是脑组织局部合成和分泌所致,并与脑损伤程度有关.     

脑出血后不同时间脑脊液中可溶性白细胞介素6受体的变化

背景在脑血管病脑损伤中有许多细胞因子的参与,而白细胞介素6(interleukin-6,IL-6)被认为在中枢神经系统中具有神经保护和神经营养作用,而脑出血急性期脑脊液可溶性IL-6受体(solubleinterleukin-6 receptor,sIL-6R)的研究国内外报道较少.目的研究脑出血急性期脑脊液中sIL-6R变化与继发性脑损伤的关系.设计病例对照研究.单位暨南大学医学院第五附属医院检验科、神经外科、神经内科联合进行课题研究.对象从1999-01/2003-12收治的脑出血患者627例中,选择经临床诊断和CT证实的自发性脑出血后48 h内入院的患者,并排除创伤性脑出血和其他脑血管疾病,符合以上标准的32例患者作为研究对象(脑出血组),其中脑实质出血破入脑室者23例,单纯脑实质出血者7例,单纯脑室出血2例.13例同期住院的非神经系统疾病就诊者为对照组.方法患者于入院后2 d内腰穿取脑脊液2 mL离心沉淀取上清液放-80℃超低温冰箱保存待测,12例患者出血后第1,2,3,5,10～13天进行动态观察.采用酶联免疫吸附试验(ELISA)测定对照组和脑出血患者脑脊液中sIL-6R含量.主要观察指标对照组和脑出血患者脑脊液中sIL-6R含量.结果13例对照组和32例脑出血急性期患者脑脊液中sIL-6R含量分别为(380.54±93.05)ng/L,(1 220.18±878.71)ng/L,两者之间差别有显著意义(t'=5.332 3,P＜0.05).脑实质出血破入脑室者sIL-6R水平[(1 350.79±762.63)ng/L]显著高于单纯脑实质出血者[(609.21±398.99)ng/L],差异有显著性意义(t=2.462 3,P＜0.05).脑出血第1天时sIL-6R水平已达最高(1 503.01±775.13)ng/L,此后仍维持在较高水平.结论脑出血急性期患者sIL-6R含量显著升高,与继发性脑损伤程度和炎症反应有关.     

精神分裂症患者康复过程中血浆白细胞介素-6及其受体的变化

目的探讨精神分裂症患者在康复过程中白细胞介素-6(IL-6)及其可溶性受体(sIL-6R)的动态变化。方法使用ELSIA方法检测45例首发精神分裂症患者治疗前后IL-6、sIL-6R的含量。结果研究组IL-6水平犤(21.2±2.0)ng/L犦较对照组犤(18.1±3.4)ng/L犦增高(t=2.419,P<0.05);sIL-6R水平犤(32.0±14.3)ng/L犦较对照组犤(24.3±14.9)ng/L犦增高(t=2.435,P<0.05);氯氮平治疗后血浆IL-6水平为(23.5±2.4)ng/L较治疗前增高,(t=2.251,P<0.05),IL-6升高幅度与氯氮平药物剂量呈正相关(R2=0.533,P=0.000);治疗后sIL-6R含量为(22.4±17.5)ng/L,较治疗前含量明显降低(t=2.174,P<0.05)。结论精神分裂症患者IL-6及其受体含量增高,精神分裂症患者存在细胞因子的失衡;在康复过程中IL-6及sIL-6R存在不同的变化趋势。     

HTLV-Ⅰ相关性HAM/TSP患者血清及脑脊液IL-6的测定及其意义

【目的】探讨白细胞介素6(IL-6)在人嗜T淋巴细胞病毒Ⅰ型相关性脊髓病/热带痉挛性瘫痪(HAM/TSP)发病中的作用。【方法】应用免疫放射方法检测8例HAM/TSP患者血清及脑脊液中IL-6水平。【结果】HAM/TSP患者血清及脑脊液中IL-6含量分别为(194.76±30.01)pg/ml;(184.12±36.39)pg/ml,而其他神经系统疾病(OIND)组血清及脑脊液中IL-6含量分别为(132.61±21.76)pg/ml;(124.95±15.39)pg/ml,正常对照组(NC)组血清IL-6含量为(127.08±22.05)pg/mL。HAM/TSP患者血清及脑脊液IL-6水平均明显高于正常对照组(P<0.01);但HAM/TSP患者血清中IL-6含量与脑脊液中IL-6含量水平不呈线性相关。【结论】IL-6在HAM/TSP发病的免疫机制中可能起到重要作用。     

急性病毒性肝炎患者血清可溶性白介素—2受体测定

本文用自行建立的双抗体夹心ELISA动态监测了20例急性病毒性肝炎患者血清可溶性白介素-2受体(sIL-2R)。结果显示在急性病毒性肝炎起病第1周病人血清sIL-2R水平(380.99±125.61U/ml)显著高于正常对照(193.70±92.55U/ml)及病人对照(237.56±144.24μ/ml),随着谷丙转氨酶恢复正常,4周后病人血清sIL-2R也降至正常,并且病人血清sIL-2R与sGPT成显著的正相关。提示T淋巴细胞激活在急性病毒性肝炎中起重要作用。sIL-2R可作为急性病毒性肝炎炎症活动的指标之一。     

常见中枢神经系统感染临床、CSF特征及鉴别诊断

目的分析常见中枢神经系统感染性疾病在临床表现及脑脊髓液（CSF）特征的异同点。方法回顾性总结296例中枢神经系统感染性疾病的临床表现及CSF表现。结果高热以病毒脑和化脑常见（62％和67％）,以头痛为首发症状者隐脑多见（60％）;抽搐多见于病毒脑（63％）;隐脑出现视力改变（40％）、听力下降（45％）、视神经乳头水肿（74％）及脑疝（41％）的比例明显高于其他组;54％的病毒脑出现肢体瘫痪;化脑外周血白细胞显著升高且以多核细胞为主（64％超过20×10^9／L）。CSF检查结果：隐脑的CSF压力升高最明显（91％大于3．96kPa）;化脑白细胞升高明显（76％大于400×10^6／L）;化脑（74％）和结脑（82％）氯化钠浓度下降;结脑蛋白质升高最显著（48％大于2g／L）。结论隐脑、结脑在临床及CSF变化上相似,CSF压力及蛋白质含量是鉴别的重要指标。化脑、病毒脑的临床诊断相对容易。     

脑脊液热休克蛋白70水平对小儿中枢神经系统感染的鉴别诊断价值

目的 探讨脑脊液(CSF)中热休克蛋白70(HSP70)的变化及其在小儿中枢神经系统感染中的诊断价值.方法 采用蛋白质免疫印迹技术检测13例化脓性脑膜炎(化脑组)、38例病毒性脑膜炎(病脑组)、7例结核性脑膜炎(结脑组)及46例非中枢神经系统感染患儿(对照组)CSF中HSP70水平.常规生化检测CSF的细胞总数、白细胞数、乳酸脱氢酶(LDH)、蛋白定量、腺苷脱氨酶、葡萄糖、压力及氯(Cl-) 水平.结果 化脑组(76.61±27.69)、病脑组(33.65±16.93)及结脑组(65.85±33.16)的HSP70水平均高于对照组(23.28±19.77),差异有显著性(P＜0.05或P＜0.01);化脑组及结脑组HSP70水平均高于病脑组(P均＜0.01);化脑组与结脑组之间HSP70水平差异无显著性(P＞0.05).相关性分析显示:HSP70水平增高程度与CSF的细胞总数(r=0.298,P=0.002)、白细胞数(r=0.274,P=0.005)、LDH(r=0.322,P=0.001)、蛋白定量(r=0.629,P＜0.001)、腺苷脱氨酶水平(r=0.363,P=0.001)均呈显著正相关,与CSF中葡萄糖水平呈显著负相关(r=-0.443,P＜0.001),与CSF压力(r=0.001,P=0.993)及Cl-水平(r=0.148,P=0.133)无相关性.结论 小儿中枢神经系统感染时,CSF中HSP70增高;检测CSF中HSP70水平有助于化脑、结脑与病脑的鉴别诊断.     

Cerebrospinal fluid alpha-1-antitrypsin alpha-1-antitrypsin-elastase complex levels in meningitis

Alpha-1-antitrypsin (A-1-AT) and A-1-AT-elastase complex levels in cerebrospinal fluid have been evaluated in 11 children with viral meningitis (VM), 14 with bacterial meningitis (BM), 10 with tuberculous meningitis (TBM) and 10 investigated for, but found not to have meningitis (NM). A-1-AT concentrations in the NM group were lower than in the BM group (P = 0.0002) and the TBM group (P = 0.0005) but did not differ from the concentrations in VM; those in the VM group were lower than in the BM group (P = 0.0001) and the TBM group (P = 0.003) but no difference was found between the BM and TBM groups. A-1-AT-elastase complex concentrations in CSF were lower in the NM group than the BM group (P = 0.0001) or the TBM group (P = 0.0089), however those in the BM group were significantly higher than in the TBM group (P = 0.0001). A significant correlation existed in CSF between the protein concentrations and neutrophil counts as well as the A-1-AT and A-1-AT-elastase complex concentrations.     

The spectrum of meningitis in a population with high prevalence of HIV disease

We studied the spectrum of meningitis and impact of HIV infection retrospectively (8 months) and prospectively (5 months) in 284 adult patients with meningitis hospitalized in Soweto, South Africa. Tuberculous meningitis (TBM) was the most common cause of meningitis (25.4%) followed by acute bacterial meningitis (ABM; 22.5%), acute viral meningitis (14.1%) and cryptococcal meningitis (13%). The in-hospital mortality was &gt;40% in TBM, ABM, cryptococcal meningitis, the neurosurgery and the parameningeal/parenchymal groups. At least 37.3% of all patients were HIV-seropositive (only 67% of patients were tested). In at least 27% of the study group the meningitis was an AIDS-defining illness (TBM, cryptococcal meningitis). Only 56.2% of patients with ABM has positive cultures (CSF or blood), of which <it>Streptococcus pneumoniae</it> was by far the most frequently found organism (35.8%). The spectrum of meningitis in HIV-affected communities in Africa can be expected to change towards a predominance of TBM and cryptococcal meningitis.      

颅内感染患者脑脊液中磷脂酶A2活性的研究

目的　探讨常见颅内感染患者脑脊液中磷脂酶A2(PLA2)活性变化及其临床意义。方法　采用(     

ELISA in tuberculous meningitis: using two mycobacterial antigens does not improve the diagnostic yield compared to either antigen alone

The prevention of the devastating sequelae of tuberculous meningitis (TBM) requires the availability of a reliable test for the rapid diagnosis of this condition. This study was carried out by enzyme-linked immunosorbent assay (ELISA) to measure antimycobacterial immunoglobulin (Ig) G, IgM and IgA in the cerebrospinal fluid (CSF) of 11 patients with culture-proven TBM using a whole cell sonicate of heat-killed M. tuberculosis antigen (MTb) and Bacilli-Calmette Guérin (BCG) antigens. The findings were compared to controls consisting of 13 CSF specimens from patients with proven pyogenic meningitis (PM) and 20 control CSF specimens from individuals with normal findings. The ELISA sensitivity, specificity, positive predictive and negative predictive values for IgG were 73%, 91%, 73% and 91%, respectively, against both antigens. The optical density results for IgM and IgA in the CSF of patients with TBM and controls were too low against both antigens to be considered in any analysis. Although ELISA for detection of anti-mycobacterial antibodies in the CSF provides improvement over conventional methods of microscopy and culture, this approach still needs considerable refinement to make it suited for routine clinical use.     

结核性脑膜炎患者脑脊液中腺苷脱氨酶的动态观察

目的　动态观察结核性脑膜炎患者脑脊液中腺苷脱氨酶的变化 ,以期对结核性脑膜炎的早期诊断和预后判断提供依据。方法　采用比色法动态检测 4 3例结核性脑膜炎患者脑脊液中腺苷脱氨酶活力的变化 ,并以 2 2例病毒性脑膜炎患者作为对照组。结果　 4 3例结核性脑膜炎患者酶活性较对照组明显升高 ,差异有统计学意义 (P <0 .0 5 ) ,治疗后 2周内结核性脑膜炎患者腺苷脱氨酶活力较其他时间明显增高 ,此后腺苷脱氨酶活力随治疗时间的延长呈进行性下降趋势。另外 8例有不同程度的神经系统并发症结核性脑膜炎患者呈现持续高水平。结论　检测脑脊液中腺苷脱氨酶是早期诊断结核性脑膜炎的一个简单而可靠的方法 ;动态观察腺苷脱氨酶还能对疾病的预后判断提供依据。     

Normal cerebrospinal fluid protein and associated clinical characteristics in children with tuberculous meningitis

BackgroundAlthough abnormal cerebrospinal fluid (CSF) protein can be used to predict the outcome of tuberculous meningitis (TBM) and diagnose TBM, normal CSF protein remains a concern in patients with TBM. This retrospective study aimed to assess the clinical characteristics associated with normal CSF protein, to resolve the dilemma of CSF protein in the management of childhood TBM.MethodsBetween January 2006 and December 2019, consecutive child patients (≤15 years old, a diagnosis of TBM, and tested for CSF protein) were included for analysis. CSF protein was tested on a chemistry analyzer using the pyrogallol red-molybdate method. Abnormal CSF protein was defined as >450 mg/L. Patient characteristics were collected from the electronic medical records. Then, characteristics associated with normal CSF protein were estimated in the study, using univariate and multivariate logistic regression analysis.ResultsA total of 125 children who met the criteria were enrolled during the study period. Twenty-nine patients had a normal CSF protein and 96 had an abnormal CSF protein. Multivariate analysis (Hosmer–Lemeshow goodness-of-fit test: χ²=2.486, df = 8, p = .962) revealed that vomiting (age- and sex-adjusted OR = 0.253, 95% CI: 0.091, 0.701; p = .008) and serum glucose (>5.08 mmol/L; age- and sex-adjusted OR = 0.119, 95% CI: 0.032, 0.443; p = .002) were associated with the normal CSF protein in childhood TBM.ConclusionIn suspected childhood TBM, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.

KEY MESSAGES

• In suspected childhood tuberculous meningitis, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.

     

3种不同性质脑膜炎患者脑脊液细胞学及特殊染色的动态观察

目的 探讨脑脊液细胞学及特殊染色方法诊断结核性脑膜炎(结脑)、化脓性脑膜炎(化脑)和隐球菌性脑膜炎(隐脑)的临床价值.方法 对三种疾病共179例患者脑脊液细胞学资料进行回顾性分析.所有病例均进行脑脊液细胞学MGG染色、阿立新兰染色和墨汁染色的动态观察,70例结脑同时应用免疫荧光和免疫细胞化学方法进行结核抗原的检测.结果 ①结脑特征性的细胞学表现为混合细胞反应.早期嗜中性粒细胞比例可达80%以上,随治疗逐渐下降,1～2个月后以淋巴样细胞反应为主.免疫荧光法和免疫细胞化学法检测脑脊液单核细胞内结核抗原,敏感性分别为82.9%和85.7%.②化脑急性期脑脊液中以嗜中性粒细胞为主,抗生素治疗后迅速下降.③MGG染色、阿立新兰染色和涂片墨汁染色诊断隐脑的阳性率分别为83.3%、81.8%和76.5%.结论 脑脊液细胞学的动态观察联合应用特殊染色方法,可大大提高颅内感染性疾病的诊断和鉴别诊断,并对治疗及预后判断有指导意义.     

儿童化脓性脑膜炎及结核性脑膜炎临床特点及预后不良危险因素的对比分析

目的:比较儿童化脓性脑膜炎(PM)及结核性脑膜炎(TBM)临床特点及预后不良危险因素。方法:收集PM患儿70例及TBM患儿44例的临床资料,比较2种疾病的临床特点,联合采用单因素及多因素Logistic回归分析法分析2种疾病预后不良的危险因素。结果:PM组患儿脑膜刺激征少于TBM组(P=0.004),但PM组患者脑脊液(CSF)氯化物平均值高于TBM组(P=0.020)。单因素分析发现年龄、意识障碍和CSF葡萄糖水平对PM患儿预后有显著影响(P=0.001,0.013,0.031);临床分期对TBM患儿预后有显著影响(P=0.039)。多因素Logistic回归分析发现患儿年龄(OR=1.811,95%CI 1.911-2.755,P=0.006)及意识障碍(OR=0.099,95%CI 0.017-0.584,P=0.011)是PM预后不良的危险因素;临床分期(OR=0.227,95%CI 0.081-0.633,P=0.005)是TBM患儿预后不良的危险因素。结论:脑膜刺激症和CSF氯化物可作为临床鉴别PM与TBM的参考指标;患儿年龄及意识障碍是PM预后不良的危险因素,临床分期是TBM患儿预后不良的危险因素。