IDDM患者外周血总T淋巴细胞及其亚群的观察

用单克隆抗体技术测定了16例病程在1.5年以上的IDDM患者和18例正常人外周血总T淋巴细胞及其亚群,显示两组间OKT_3、OKT_4、OKT_8、OKT_4/OKT_8差异均无显著性。提示病程超过1.5年的IDDM者的细胞免疫功能已趋于稳定。且16例IDDM患者的总T淋巴细胞及其亚群在胰岛移植前、后差异也没有显著性,认为目前国内应用的胡氏胰岛组织培养法有利于降低胰岛组织对人IDDM受体的免疫原性。     

CLINICAL AND ENDOSCOPIC HEALING AFTER INFLIXIMAB TREATMENT IN PATIENTS WITH CROHN's DISEASE

Background: Intestinal mucosal lesions in Crohn's disease were endoscopically evaluated before and after giving infliximab, and the usefulness of this treatment was investigated. Patients and methods: The present study included 12 patients with active Crohn's disease who could undergo colonoscopy before and after giving infliximab. (i) The treatment assessment consisted of evaluations of short‐term and long‐term therapeutic effects. The clinical evaluation was conducted using the Crohn's disease activity index (CDAI). The results of the clinical evaluation were compared with those of the colonoscopic evaluation. (ii) The endoscopic evaluation findings were divided into polyposis, ulcer and stenosis, and the area ranging from the rectum to the terminal ileum. The scores for the findings at seven sites were totaled. In the short‐term therapeutic effect, characteristics of ulcer morphology and background factors were investigated endoscopically. Results: (i) The efficacy rate was 92% clinically and 67% endoscopically in the evaluation of short‐term therapeutic effects. The efficacy rate was 86% clinically and 86% endoscopically in the evaluation of long‐term therapeutic effects. (ii) On the endoscopic evaluation, the ulcer score was significantly (P = 0.03) improved after giving infliximab, while there was no remarkable change in the polyposis score and the stenosis score tended to worsen. On the evaluation of therapeutic effects based on ulcer morphology, infliximab was endoscopically effective in patients with longitudinal ulcers. On the evaluation of therapeutic effects based on background factors, the treatment was effective in patients given a combination of infliximab and immunosuppressants. Conclusion: The ulcerative lesions were found to be markedly improved, but the intestinal stenosis tended to worsen, after giving infliximab. It is necessary that the severity of intestinal stenosis be adequately understood before giving infliximab. Giving immunosuppressants should be used for combined treatment.     

ARTHROPATHY IN ACROMEGALIC PATIENTS BEFORE AND AFTER TREATMENT: A LONG-TERM FOLLOW-UP STUDY

The medical records of 90 patients with acromegaly were reviewed. Arthralgias were noted in 76% of the patients with 17% having the onset of joint pain concomitant with the clinical onset of acromegaly. Of 47 patients followed prospectively for 5 or more years after pituitary irradiation, six (12.8%) were unaffected by arthralgias. A statistically higher mean baseline growth hormone level was found for the 19 (40.4%) radiotherapy patients who had severe and disabling arthropathy. Mean intervals between clinical onset of acromegaly and the development of arthropathic symptoms were shorter (4.1 years) for patients over 40 years of age and longer (9.7 years) for those under 31 years of age. Severely affected patients tended to have increased joint spaces in both weight-bearing and non-weight-bearing joints followed by a progressive decrease in joint spaces. Arthropathy is a common complication of acromegaly and may progress independently of a fall in growth hormone, induced by any form of treatment, once significant cartilage overgrowth develops. Cartilage overgrowth is a predisposing factor in the development of an arthropathy associated with the wide range of growth hormone levels characteristic of acromegaly.     

LONG-ACTING THYROID STIMULATOR AND THYROID FUNCTION IN RELATIVES OF PATIENTS WITH GRAVES''DISEASE

In ten families, fifty relatives and seven husbands of ten patients with untreated Graves’disease were submitted to clinical examination, biological and immunological investigations. They were compared with fifty control subjects. In the relatives, thyroid diseases were found in 26%, positive LATS-IgG responses in 30%, thyroid antibodies in 23% and abnormal NBEI in 30%. The mean LATS response was significantly greater than in controls. With one exception no overt hyperthyroidism was found in the relatives on the basis of serum PBI, T₃ resin uptake test, total T₄ and TSH level. From the analysis of the pedigrees, no definite mode of inheritance can be found for LATS and NBEI. These data suggest the existence of a thyroid metabolic anomaly in the families of patients with thyrotoxicosis and argue against LATS as the cause of the hyperthyroidism of Graves’disease.     

T-CELL SENSITIZATION TO AUTOLOGOUS THYROID CELLS AND NORMAL NON-SPECIFIC SUPPRESSOR T-CELL FUNCTION IN GRAVES'' DISEASE

We have employed a syngeneic system utilizing thyroid cell monolayers initiated following thyroid surgery co-cultured with autologous T cells to demonstrate T cell autosensitization in patients with Graves' disease. Antigen-induced blastogenesis was monitored using 24 h [3H]thymidine uptake. Control experiments with 5 d cultured normal human thyroid cells from tissue around benign adenomata showed no evidence of syngeneic T cell autosensitization. Human thyroid cells alone were unable to incorporate [3H]thymidine in the presence of bTSH. In three of four experiments with Graves' thyroid cells there was significant induction of autologous T cell blastogenesis with a mean stimulation index of 220%. In parallel experiments we explored the non-specific helper and suppressor T cell function of these and similar patients with Graves' disease. In normal controls (n = 6) increasing numbers of T cells added to a constant number of B cells (consisting of a T cell depleted peripheral mononuclear cell preparation) showed a marked helper effect measured as increasing IgG secretion. As the ratio of T:B cells increased above 4:1 there was a suppression of IgG secretion. One of two hyperthyroid Graves' patients was observed to have deficient T cell function as demonstrated by lack of IgG suppression. The remaining five patients (all but one of whom were euthyroid at the time of testing) had results similar to the controls indicating normal suppressor T cell function in this disease. Such data showed that patients with Graves' disease possessed circulating T cells which exhibited autosensitization to syngeneic thyroid cell surface antigens, a phenomenon not demonstrable in control individuals. Furthermore, this specific T cell autosensitization did not interfere with non-specific T cell function as judged by its influence on IgG secretion.     

肾病综合征合并慢性乙型肝炎患者强的松长期治疗后肝组织学的初步观察

本文采用常规HE和免疫组织化学染色的方法观察了16例肾病综合征合并慢性乙型肝炎(CHB)患者长期使用强的松后肝组织病理变化和B7-1、HBcAg表达情况。结果显示:16例患者肝组织损害轻微,伴大量毛玻璃样细胞,均有HBcAg胞核强表达,仅1例B7-1弱表达;其中3例患者停药3个月后肝组织病变仍轻,无毛玻璃样细胞及B7-1表达,但仍有HBcAg胞核强表达。提示:肾上腺皮质激素有可能减轻肝细胞损害及纤维化,抑制细胞毒性T淋巴细胞(CTL)的活化、增殖过程;但停药后“免疫反跳”作用可疑。     

55岁以上继发孔型房间隔缺损的外科治疗

目的总结55岁以上继发孔型房间隔缺损(ASD)外科手术治疗的经验.方法回顾分析1997年1月-2003年12月外科手术治疗的48例55岁以上ASD的病例.结果全组48例无手术死亡,无神经系统及其他严重并发症.结论年龄不是ASD手术治疗的禁忌证;ASD一经诊断,只要不并发严重的肺血管阻塞性病变,无论有无症状,仍应考虑手术治疗;同期有效处理并发症,预防并发症的发生是手术成功的关键.     

心脏外科手术后脑部并发症的高压氧治疗

从１９８３年１０月到１９９３年１月，我科对于一些心脏手术后出现脑部并发症的患者给予了高压氧治疗。本组患者１０例，其中人造瓣膜替换术６例，房缺修补术１例，室缺修补术１例，法乐氏四联症矫治术１例，胸主动脉瘤切除人造血管移植术１例。根据脑损伤程度，中型４例，重型６例，完全治愈６例，好转２例，另有２例死于其他并发症。作者认为，对心脏手术后脑部并发症的患者，高压氧治疗是有效的。     

EVIDENCE FOR THYROID ANTIGEN-REACTIVE T LYMPHOCYTES INFILTRATING THE THYROID GLAND IN GRAVES''DISEASE

We have investigated the relative distribution and some in vitro functions of thyroid-infiltrating immunocompetent cells obtained at fine-needle aspiration biopsy in twelve patients with Graves' disease and thirteen patients with Hashimoto's thyroiditis. In both disorders the predominant (57--59%) thyroid-infiltrating cell was a small lymphocyte. Significant numbers of plasma cells (10%) were seen only in Hashimoto's thyroiditis. Mononuclear phagocytes (monocytes plus macrophages) were present in similar numbers (12--18%) in both disorders. In both Graves' and Hashimoto's disease there was a relative reduction of (thymus-dependent) lymphocytes in the thyroid gland as compared to the blood. Blood and thyroid-infiltrating T lymphocytes were tested for in vitro cell-mediated immunity (CMI) to thyroid antigen in the leucocyte migration inhibition test (LMT). CMI was readily demonstrated in the blood of most patients with Graves' and Hashimoto's disease. When the thyroid-infiltrating lymphocytes were tested for CMI in the LMT, only the infiltrating cells from patients with Graves' disease displayed CMI, whereas the thyroid-infiltrating lymphocytes in Hashimoto's disease were negative. Fractionation of the immunocompetent cells demonstrated that the thyroid antigen-induced LMT response of blood and thyroid-infiltrating lymphocytes in Graves' disease is a T lymphocyte-dependent phenomenon.     

T3 KINETICS IN EUTHYROID GRAVES'' DISEASE PATIENTS WHO EXHIBIT HYPER-RESPONSIVENESS TO TRH AFTER RADIOIODINE TREATMENT

A major reduction in T3 turnover has been demonstrated previously in clinically hypothyroid patients. We have used non-compartmental (NC) and monocompartmental (MC) analysis to study ten patients with Graves' disease who, following treatment with radioactive iodine (RAI), are now clinically euthyroid but who showed hyper-responsiveness to TRH although serum T3 and T4 concentrations are within the normal range. T3 production rate (PR), metabolic clearance rate (MRC) and fractional-turnover (K) were all significantly reduced in patients compared with seven controls (P less than 0.01). T3, MCR and PR were consistently higher, and T3 K lower, when calculated by MC, than values calculated by NC analysis. The difference in T3 production rates between patients (mean 16.6 nmol/day) and controls (mean 38.9 nmol/day) raises the question of replacement therapy in patients who are apparently euthyroid but TRH hyper-responsive.     

CLINICAL VALUE OF DETECTING T LYMPHOCYTE SUBSET AND NK CELL ACTIVITY IN PATIENTS WITH COLORECTAL CANCER

Objective To study on the expression and clinical significance of T lymphocyte subset and NK cell activity (NKA) in patients with colorectal cancer. Methods Fifty-seven cancer patients and 33 healthy controls were enrolled in this study. T lymphocyte subset was measured by SAP technique and NKA by LDH release assay based on K_(562) cells, which served as target cells.     

湖南省高血压防治10年对脑血管意外疗效评估

高血压防治的目的是达到有效的降低脑血管意外的发生率和病死率。本研究为单盲随机多中心临床试验。分两阶段：第一阶段（１９８５年１月至１９８９年１２月）观察病例９８４例，时间５年；第二阶段（１９９０年１月至１９９４年１２月）观察２０８０例，随机分为治疗组和对照组，时间５年。结果表明高血压患病率呈上升趋势；第二阶段治疗组经尼群地平治疗后血压均值下降，与对照组和第一阶段组比较有统计学意义（Ｐ＜０．０５）。脑血管意外的发生率和病死率较对照组和第一阶段组均明显下降（Ｐ＜０．０１）。在各类死因中，脑血管意外所占比例较其他两组下降明显，且脑血管意外的病因构成发生了变化。从而提出积极开展高血压防治是降低高血压并发症脑血管意外发生和死亡的重要环节。     

CELLULAR AND HUMORAL IMMUNITY IN PATIENTS WITH HYPERTHYROID GRAVES'' DISEASE BEFORE, DURING AND AFTER ANTITHYROID DRUG TREATMENT

Many reports of thyroid stimulating immunoglobulins (TSI) in relation to treatment of Graves' disease have been published and with variable results concerning prediction of permanent remission or relapse after therapy. A range of methods has been used and little has been published measuring TSI by using their ability to stimulate cyclic AMP production in human thyroid cells in monolayer culture. We therefore conducted a prospective study of the predictive value of such an assay in patients with hyperthyroid Graves' disease before, during and after treatment of one year with methimazole and thyroid hormone substitution. Furthermore, the possible relationship between activated suppressor T lymphocytes and TSI in patients followed before, during and after medical therapy has been studied. Patients were divided into two groups; group I, 15 patients, who stayed in remission and group II, 14, who relapsed during the first year after discontinuation of therapy. Mean TSI activity did not differ between the two groups before and during the first half year of medication. In the second half year of treatment, however, mean TSI activity was significantly lower in group I. TSI activity at the end of treatment appeared to have no value in predicting final outcome. Increased TSI activity in group II during treatment was reflected in an increased pertechnetate thyroidal uptake as compared to that in group I. There was no relationship between changes in TSI activity and T cell subsets (Leu 1, 2a, 3a). We found no difference in T lymphocytes between the two groups at any time during observation. Subsets of T lymphocytes in both patient groups did not differ from normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

ORAL ULCERATION AND LYMPHOCYTE REACTIONS IN RHEUMATOID-ARTHRITIS PATIENTS ON GOLD THERAPY

In an attempt to determine if oral ulceration in rheumatoidarthritis patients on gold therapy had an immunological basis,peripheral blood lymphocytes have been examined for mitoticactivity, migration inhibition factor and cytotoxic lymphokines.Healthy and rheumatoid controls were compared with rheumatoidpatients under treatment with gold. The latter group was furthersubdivided according to the development of oral ulceration whilstundergoing chrysotherapy, since abnormalities in lymphocytebehaviour have been found in subjects with aphthous ulceration.The only difference found between rheumatoid patients with gold-inducedoral ulceration and those on gold without oral lesions was slightdepression of specific mitogenic reactivity. With the phytohacmagglutininstimulation index, the rheumatoid group as a whole differedfrom controls in having a significantly higher rate of turnover.     

EFFECTS OF LONG TERM DEXAMETHASONE TREATMENT IN ADULT PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA

We have followed nine adult patients with congenital adrenal hyperplasia (CAH) for between 7-77 months on dexamethasone (DXM) 0.5 mg mane and 0.25 mg nocte, reducing to 0.5 mg mane. Twenty-four hour profiles of ACTH, 17-hydroxyprogesterone (17OHP), and androstenedione were performed; the areas under the curves (AUC) and the heights of the morning peaks were used to assess biochemical control. Comparisons were made between treatment before DXM (pre-DXM), 0.75 mg for 2 weeks (DXM-ST), 0.75 mg for at least 3 months (DXM-LT), and 0.5 mg for at least 3 months (DXM-0.5). None of the three males suffered any significant side-effects. All women had menstrual disturbance but in three ovulation was induced. One female developed Cushing's syndrome and two developed hirsutism which resolved on stopping DXM. Overall there was no significant difference between DXM-ST and DXM-LT (mean AUCs for ACTH: DXM-ST 660, DXM-LT 383, for 17OHP: DXM-ST 1177, DXM-LT 587, for androstenedione DXM-ST 232, DXM-LT 121). Reduction of the dose from 0.75 mg to 0.5 mg led to significant deterioration in control (Mean AUC's for ACTH DXM-0.5, 1123 (P less than 0.02), for 17OHP DXM-0.5, 2068 (P less than 0.002), for androstenedione DXM-0.5, 213 (P less than 0.5). We conclude that DXM is a satisfactory regime but the dose must be adjusted for each patient.     

ANALYSIS OF PROGNOSTIC FACTORS IN PATIENTS WITH GASTRIC VARICES AFTER ENDOSCOPIC TREATMENT

Background: The prognostic factors, including gastric variceal bleeding itself, in patients with gastric varices (GV) after endoscopic treatment remain unclear. The aim of this study was to analyze prognostic factors in patients with GV after endoscopic treatment as well as to evaluate safety and efficacy of our endoscopic treatment. Patients and Methods: This study enrolled 115 patients who underwent endoscopic treatment for GV between October 1988 and December 2003 using cyanoacrylate and 5% ethanolamine oleate. Successful hemostasis, recurrence rates, rebleeding rates, survival rates, complications and prognostic factors after the treatment were retrospectively reviewed. Results: Treatment sessions for GV were performed 3.4 ± 2.5 times. All cases, including 14 emergency cases, were treated successfully. The cumulative recurrence rates at 1, 3 and 5 years after the treatment were 7.0%, 15.6% and 20.0%, respectively, and the cumulative rebleeding rates at 1, 3 and 5 years were 3.5%, 8.7% and 14.8%, respectively. The overall survival rates were 78.3%, 63.7% and 51.5% at 1, 3 and 5 years, respectively. Grade B or C in Child–Pugh classification, emergency or elective cases, and association with hepatocellular carcinoma were identified as significant negative prognostic factors after endoscopic treatment by multivariate analysis. Although several complications were observed, there was no mortality. Conclusions: Grade B or C in Child–Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.     

SERUM THYROGLOBULIN IN NORMAL SUBJECTS AND PATIENTS WITH HYPERTHYROIDISM DUE TO GRAVES''DISEASE: EFFECTS OF T3, IODIDE, 131 I AND ANTITHYROID DRUGS

A sensitive, reproducible radioimmunoassay for thyroglobulin (Tg) in unextracted human serum is described. The mean (± SD) serum thyroglobulin concentration in ninety-three normal subjects was 8±8 ± 5±1 ng/ml. The mean serum Tg concentration in forty-seven patients with hyperthyroidism due to Graves’disease was 162 ± 145 ng/ml, and in nine patients with subacute thyroiditis 140 ± 75 ng/ml. The administration of T3, 75 /μg daily for 3 weeks to normal subjects, produced parallel and significant decreases in both serum Tg and T4 concentrations. Administration of iodide to normal subjects for 13 days resulted in significant increases in serum Tg concentrations, associated with increases in serum TSH and decreases in serum T4 concentrations. In patients with hyperthyroidism due to Graves’disease, iodide administration had no effect on serum Tg concentrations in five of six patients studied, though all had a reduction in serum T4 and T3. Administration of radioactive iodine, with or without iodide, to hyperthyroid patients resulted in acute increases in serum Tg concentrations in all patients. In patients with hyperthyroidism due to Graves’disease treated with antithyroid drugs, serum Tg concentrations were initially lower (mean 109 ng/ml) and declined to or towards normal during therapy in those who subsequently achieved remission. Initial serum Tg concentrations were higher (mean 207 ng/ml) and serum Tg concentrations did not change in the patients who developed recurrent hyperthyroidism when antithyroid drug therapy was decreased or discontinued. These data suggest that: (1) Tg release by the thyroid is normally under TSH control; (2) iodide inhibits thyroidal T4 and T3 release without affecting Tg secretion; (3) thyroidal injury results in marked increases in serum Tg concentrations; and (4) initial and/or serial Tg determinations may be useful in predicting remission in patients with hyperthyroidism due to Graves’disease treated with antithyroid drugs.     

慢性乙型肝炎血清五种免疫球蛋白与T细胞亚群的关系

对确诊的ASC、CPH和CAH病人(共计86例)检测IgE与T细胞亚群及其它免疫球蛋白。结果表明,IgE和IgG明显升高,二者均与CD_4/CD_3比值呈负相关,IgE较其它免疫球蛋白能更灵敏地反映肝脏损害程度。     

长期血液透析患者继发性甲状旁腺机能亢进症与肾性骨营养不良相关因素探讨

将６０例慢性肾功能衰竭（ＣＲＦ）行血液透析（ＨＤ）患者分式４个组进行临床研究，４０例ＨＤ５年以上，２０例ＨＤ２年以下，各分别服用及不服用罗钙全治疗，分别测定甲状旁腺素（ＰＴＨ）、降钙素（ＣＴ）、碱性磷酸酶（ＡＫＰ）并进行Ｘ线骨照片。结果显示：全部患者ＰＴＨ、ＣＴ明显升高，ＨＤ５年以上者高于２年以下者，不用罗钙全治疗者高于用罗钙全治疗者。ＨＤ５年以上不用罗钙全治疗者有９５％肾性骨营养不良（ＲＯＤ）、用罗钙全治疗者６５％有ＲＯＤ、透析时间越长，ＲＯＤ发生率越高。