肠源性内毒素血症对肝炎患者免疫功能的影响

近年来 ,肠源性内毒素血症 (intestinalendotoxiemia ,IETM)与肝病的关系日益受到重视。许多动物实验证实 ,各种实验性肝损伤均可发生IETM。临床观察也表明 ,急慢性肝炎、肝硬化和重型肝炎患者内毒素血症也有不同程度的发生率。细胞免疫功能对肝炎病毒的清除与防止慢性化有着重要影响 ,而内毒素 ,特别是肠源性内毒素血症对慢性肝炎患者的免疫功能尤其是细胞免疫功能的影响研究甚少。我们对慢性肝炎患者内毒素水平及细胞免疫功能进行研究 ,以阐明二者之间的内在关系。资料与方法一、研究对象正常对照组为健康体检人群 ,共 2 0例 ,男 15例…     

精氨酸对梗阻性黄疸患者细胞免疫调节的意义

目的探讨精氨酸改善梗阻性黄疸细胞免疫功能和增强抗感染措施．方法梗阻性黄疸患者６６例，分为非精氨酸（Ａ组）３７例（含急性梗阻性化脓性胆管炎，ＡＯＳＣ１４例）和精氨酸组（Ｂ组）２９例（含１例ＡＯＳＣ），研究两组手术前后细胞免疫变化和感染性并发症．结果不论手术前、还是手术后，Ｂ组ＣＤ＋３，ＣＤ＋４显著高于Ａ组（Ｐ＜００１，手术前ｔ值分别为７７５和５７２，手术后ｔ值分别为８８８和１０２８），ＳＩＬＩＲ显著低于Ｂ组（Ｐ＜００１，术前ｔ＝５１４，术后ｔ＝８７６）．Ｂ组ＡＯＳＣ术后感染性并发症显著低于Ａ组（Ｐ＜００１，χ２＝１３４２）．结论精氨酸能增强机体细胞免疫功能和降低术后感染．     

口腔癌症患者细胞免疫功能检测的临床意义

检测了４４例口腔颌面恶性肿瘤患者和２０例正常者的血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平，以及２０例患者和２０例正常者的外周血Ｔ淋巴细胞亚群，ＮＫ细胞活性，结果显示，恶性肿瘤患者血清ｓＩＬ－２Ｒ水平高于正常，其水平与临床分期相关，Ⅲ，Ⅳ期者升高更明显，移植者比无转移者高，鳞状细胞癌与腺癌患者间的差异无统计学意义；肿瘤患者外周血ＣＤ＾＋３细胞与正常人无差异，ＣＤ＾＋４／ＣＤ＾＋８，ＮＫ细胞活性     

肝硬变时内毒素血症与细胞免疫功能的相关性

肝硬变时内毒素血症与细胞免疫功能的相关性冯志杰牛然明任锡玲姚希贤河北医科大学第二医院消化内科河北省石家庄市０５００００本课题为河北省科委资助项目（Ｎｏ．９６２１６１１４）．Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｌｉｖｅｒｃｉｒｈｏｓｉｓ／ｉｍｍｕｎｏ...     

肝硬化患者细胞免疫功能和内毒素血症的关系

目的 观察肝硬化患者T细胞免疫功能和肠源性内毒素血症之间的关系.方法 选取肝硬化患者40例,正常对照组20例,检测其血清中内毒素(ET)、CD3、CD4、CD8水平,并分析其相关性.结果 与正常对照组比较,肝硬化组血清ET水平显著升高;CD3、CD4、CD4/CD8均明显下降,CD8明显升高;ET水平与CD3、CD4、CD4/CD8水平呈负相关,与CD8的表达呈正相关.结论 肝硬化患者体内血清内毒素水平明显升高,且同时伴有显著的细胞免疫功能低下,两者呈明显负相关.     

乙型肝炎患者外周血T细胞亚群和可溶性IL_2R的研究

目的探讨急慢性乙型肝炎患者外周血Ｔ细胞亚群及可溶性ＩＬ＿２Ｒ水平的变化，为诊断病情演变和预后判定寻找可靠的依据．方法应用ＡＰＡＡＰ桥联酶标法和双抗体夹心ＥＬＩＳＡ法检测正常人３０例和各型乙型肝炎患者１７５例的Ｔ细胞亚群变化和血清可溶性ＩＬ＿２Ｒ（ｓＩＬ＿２Ｒ）水平．结果各组乙肝患者ＣＤ３，ＣＤ４，ＣＤ４／ＣＤ８比值明显降低，ＣＤ８则明显升高．乙肝患者血清ｓＩＬ＿２Ｒ水平均显著升高，其中慢重肝、肝硬变、急性乙肝和慢性肝炎增高最为显著，与正常对照组相比Ｐ均＜００１，且与ＨＢＶ复制有关．结论乙型肝炎患者存在Ｔ细胞比例失衡，血清ｓＩＬ＿２Ｒ水平均明显增高，其水平与机体免疫功能状态及肝细胞损伤程度相关．     

病毒性肝炎和原发性肝癌患者血清IL2相关指标的意义

目的研究病毒性肝炎和原发性肝癌（ＨＣＣ）患者ＩＬ２，ｓＩＬ２Ｒ，ＩＬ６，Ｔ细胞亚群的变化意义．方法采用双抗体夹心ＥＬＩＳＡ法，ＡＢＳＥＬＩＳＡ法和红细胞花环实验对９４例各型病毒性肝炎和１０例ＨＣＣ进行了ＩＬ２，ＩＬ６，ｓＩＬ２Ｒ和Ｔ细胞亚群的测定，并与６６例健康献血员进行了对照．结果急性肝炎（ＡＨ）ＩＬ２水平增高，恢复期下降；而慢性肝炎（中重）、肝炎肝硬变（ＬＣ）、ＨＣＣ患者血清ＩＬ２水平明显低于慢性肝炎（轻）（Ｆ＝２０２６，Ｐ＜００１）和正常对照（ＮＣ）组．在乙型肝炎、ＨＢＶＤＮＡ阳性组的ＩＬ２水平显著低于ＨＢＶＤＮＡ阴性组．在ＣＨ，ＬＣ，ＨＣＣ组，ＩＬ２与ＣＤ＋４／ＣＤ＋８比值正相关，在各型肝炎和ＨＣＣＩＬ２与ｓＩＬ２Ｒ，ＩＬ６无相关关系．ＨＣＣ组的ＩＬ６水平高出正常１０倍以上，较各型肝炎组也明显升高（Ｆ＝３００７，Ｐ＜００１）．结论在病毒性肝炎和ＨＣＣ存在免疫功能紊乱和低下，淋巴因子网络失衡，这与肝炎和ＨＣＣ的病理生理机制有关，也为临床ＩＬ２治疗提供了理论依据．ＩＬ６的极显著增高有助于ＨＣＣ的诊断．     

肝炎后肝硬变肝损害与细胞免疫功能(英文)

目的研究肝炎后肝硬变（ＰＨＣ）患者的细胞免疫状态及其与肝功能损害的关系．方法５１例ＰＨＣ患者，包括ＣｈｉｌｄＰｕｐｈＡ级２０例、Ｂ例１８例、Ｃ级１３例和２２例健康对照者，外周血经用ＦｉｃｏｌＨｙｐａｑｕｅ梯度离心分离单个核细胞后，采用３ＨＴｄＲ掺入技术测定了淋巴细胞转化，ＩＬ２和ＮＫ细胞活性．结果在ＰＨＣ患者淋巴细胞转化指数（ＳＩ）、ＩＬ２活性（ＳＩ）和ＮＫ细胞活性（％）较对照组均明显降低（１８１±１３０ＶＳ３４９±２１７，Ｐ＜００１；８１±６０ＶＳ１３６±５８，Ｐ＜００１；４０３±２１７ＶＳ６１３±２０５，Ｐ＜００１）．免疫功能缺陷与ＣｈｉｌｄＰｕｐｈ分级有关，Ｃ级明显低于Ａ、Ｂ级（Ｐ＜００１），Ｂ级低于Ａ级（Ｐ＜００５）．结论ＰＨＣ患者存在细胞免疫功能缺陷，且与肝损害程度有关．     

重型肝炎患者血清内毒素与细胞因子及细胞免疫相关性研究

检测重型肝炎患者血清内毒素（LPS）、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、白细胞介素-12（IL-12）、白细胞介素-18（IL-18）、T细胞亚群（CD4^＋、CD8^＋）。结果发现重型肝炎患者血清LPS水平明显高于健康对照组（P〈0．05），两组TNF-α、IL-6、IL-10、IL-12、IL-18水平也均有统计学差异（P〈0．05），重型肝炎患者治疗前与治疗后加重者血清LPS水平有显著差异，而TNR-α、IL-6、IL-12、IL-18水平均高于好转后，IL-10水平却在好转后升高。血浆置换后病情好转者血清LPS、IL-12、IL-18水平明显下降，TNF-α水平变化不大，病情加重者各项指标均无明显变化。表明重型肝炎患者血清LPS水平与CD4^＋／CD8^＋值呈负相关。联合检测对了解病情、判断顶后、改进治疗箫略有指导意义。     

External biliary drainage plus bile acid feeding is not equal to internal drainage in preserving the cellular immunity following prolonged obstructive jaundice

This study investigates the importance of intestinal bile flow in cellular immunity. Sprague-Dawley rats undergoing bile duct ligation (BDL) and sham ceiliotomy (Sham) for 14 and 21 days were investigated. Experimental animals following BDL were further divided into an external drainage (ED) group, an ED group with rat chow mixed with 2:2:1 cholic acid, chenodeoxycholic acid, and deoxycholic acid ( ED + BF), and an internal drainage (ID) group. Fourteen days later, they were killed and analyzed for spleen lymphocytic [³H] thymidine uptake (LHU) under mitogen stimulation with phytohemagglutinin, blood biochemistry, hemogram, and liver pathology. In the 14-day BDL experiment, LHU and serum albumin level were decreased in the BDL group (P < 0.05). After drainage, they were not significantly different among sham, ED, ED + BF, and ID groups. In the 21-day BDL experiment, the red cell volume was decreased (P < 0.05). After drainage, the ED, ED + BF, and ID groups still had a significantly lower LHU than the sham group (P < 0.05). However, the ID group had higher LHU than the ED and ED + BF groups (P < 0.05). The ED + BF group had a slightly higher LHU than the ED group but not statistically significant. Liver pathology returned to normal after drainage in the 14-day BDL model. In contrast, the 21-day BDL group had prominent periportal necrosis and developed periportal fibrosis after drainage. The present study reveals the duration of BDL determines the severity of hepatic damage. In the 14-day BDL groups, all kinds of drainage completely reverse the impaired liver function and cellular immunity. In the 21-day BDL group, 14-day drainage is inadequate for recovery because irreversible pathological changes are found. The reversal of cellular immunity in ID is better and faster, because it provides a better hepatic functional, nutritional, and hematological recovery besides the presence of primarily secreted bile acids.     

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Background—Altered matrix degradation contributesto fibrosis in some liver diseases but the role of matrix degradationin fibrogenesis associated with genetic haemochromatosis has not previously been addressed.
Aims—To measure serum concentrations of tissueinhibitor of metalloproteinase 1 (TIMP-1) and matrix metalloproteinases(MMP), MMP-1, MMP-2, and MMP-3 in patients with haemochromatosis and control subjects.
Patients—Forty patients with haemochromatosis and19 healthy control subjects. Ten of the 40 patients were studied before and after venesection therapy.
Methods—Serum levels of TIMP-1, MMP-1, MMP-2, andMMP-3 were measured by enzyme immunoassay and correlated to hepaticiron concentration and degree of histological fibrosis.
Results—Serum TIMP-1 was increased in patientswith haemochromatosis compared with controls (163 (30) versus 123 (28)ng/ml, p<0.0002). Mean serum TIMP-1 concentration of patients withhaemochromatosis without fibrosis was significantly higher than incontrols (153(16) versus 123 (28) ng/ml, p=0.03). Serum TIMP-1concentration correlated with both hepatic iron concentration andhepatic iron index (r=0.42, p<0.01; r=0.42,p<0.01). Serum MMP-2 concentrations correlated with increasing degreeof fibrosis in patients with haemochromatosis (r=0.38,p=0.01). The mean MMP-1:TIMP-1, MMP-2:TIMP-1 and age/sex matchedMMP-3:TIMP-1 ratios were significantly lower in patients withhaemochromatosis than controls (0.11 (0.06) versus 0.2 (0.14), p=0.02;3.32 (0.9) versus 3.91 (0.81), p=0.05; and 0.26 (0.12) versus 0.47 (0.27), p=0.007, respectively). Following venesection, MMP-2 and MMP-3concentrations increased by 11% (p=0.03) and 19% (p=0.03), respectively.
Conclusions—This study provides the firstevidence of an alteration in matrix degradation in haemochromatosisthat may be a contributing factor to hepatic fibrogenesis in this disease.

Keywords:hepatic stellate cell; hepatic fibrosis; matrixmetalloproteinase; tissue inhibitor of metalloproteinase-1; genetichaemochromatosis

     

大动脉炎患者体液免疫功能、细胞免疫功能检测及意义

目的探讨大动脉炎患者体液免疫功能及T淋巴细胞亚群变化的临床意义。方法检测31例大动脉炎患者(观察组)和30例体检正常者(对照组)IgG、IgA、IgM、IgE、C3、C4、CD3+、CD4+、CD8+、CD4+/CD8+水平。结果观察组IgG、IgM、IgE、C3、CD4+CD4+/CD8+水平较对照组明显升高而C4、CD3+水平明显下降(P均<0.05);IgA、CD8+两组间无显著差异。结论大动脉炎患者的体液免疫和T淋巴细胞亚群水平在发病时变化明显,对该病的发病机制研究和临床诊断有重要意义。     

Experimental study on the relationship of bile acids and myocardium damage in obstructive jaundice

ＥｘｐｅｒｉｍｅｎｔａｌｓｔｕｄｙｏｎｔｈｅｒｅｌａｔｉｏｎｓｈｉｐｏｆｂｉｌｅａｃｉｄｓａｎｄｍｙｏｃａｒｄｉｕｍｄａｍａｇｅｉｎｏｂｓｔｒｕｃｔｉｖｅｊａｕｎｄｉｃｅＭＵＹｉＰｉｎｇａｎｄＰＥＮＧＳｈｕＹｏｕＳｕｂｊｅｃｔｈｅａｄｉｎｇｓｃ...     

急性胆道梗阻肠黏膜屏障破坏与氯离子通道-2的关系

目的:探讨急性胆道梗阻肠黏膜屏障破坏与肠上皮细胞氯离子通道-2(chloride channel-2,CLC-2)的关系.方法:建立急性胆道梗阻(阻塞性黄疸)大鼠动物模型,术后7d连续注射Lubiprostone(Lu组)、类高血糖素多肽-2(GLP-2组)、两者共同使用(Lu+GLP组),以假手术组(Sham组)和阻...