中药治疗200例HIV感染者/AIDS患者的结果分析

目的　分析中药治疗艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者后的实验室数据及临床变化特点。方法　采用治疗前后自身对照的方法,对1 999～2 0 0 2年在北京佑安医院接受中药治疗的2 0 0例HIV感染者/AIDS患者的实验室数据及临床症状进行分析。结果　(1 )病毒载量(VL)的变化:接受治疗的2 0 0例中,VL下降超过1log 2例(%) ,VL下降超过0 .5log 1 8例(9%)。(2 )CD+ 4 细胞数的变化:在CD+ 4 ≥2 0 0 /μl的1 2 9例患者中,治疗后5 6例(43. 4%)患者的CD+ 4 细胞数上升>5 0 /μl;在CD+ 4 细胞数<2 0 0 /μl的71例患者中,只有6例(8 5 %)CD+ 4 细胞数上升>5 0 /μl。同时,有85 %的患者在接受中药治疗后临床症状都有不同程度的改善。结论　中药能部分改善HIV感染者/AIDS患者的免疫功能和临床症状,但在病毒抑制方面的作用较弱。中药治疗时间越早,疗效越好;晚期治疗则疗效较差。     

HIV感染者/AIDS患者与肿瘤病人T淋巴细胞亚群数量的比较

目的　探讨艾滋病病毒 (HIV)感染者和艾滋病 (AIDS)患者与肿瘤病人CD+4和CD+8T淋巴细胞 (TH 和TS 细胞 )数量的变化并进行比较。方法　用流式细胞仪检测 78例HIV感染者 /AIDS患者和 37例肿瘤病人外周血中TH 和TS 细胞的数量以及计算TH/TS 的比值 ,组间比较采用双侧t检验。结果　HIV感染者 /AIDS患者TH细胞显著减少 ,且下降的幅度大 ,TH<5 0 0 / μl的占 83 3% ,其中 <2 0 0 / μl的占 5 6 4 % ,TH/TS 平均为 0 2 9;肿瘤病人TH 细胞计数也明显降低 ,TH<5 0 0 / μl的占 70 3% ,其中 <2 0 0 / μl的占 18 9% ,TH/TS 平均为 1 2 6。同一水平CD+4T细胞计数所对应的CD+8T细胞数量 ,HIV感染者 /AIDS患者高于肿瘤病人 ;两组病人TS 数量都随TH 数量的升高而增加。HIV感染者 /AIDS患者TH 细胞计数 <肿瘤病人 ,TS 细胞计数 >肿瘤病人 ,HIV感染者 /AIDS患者TH/TS 比值倒置 ,而肿瘤病人TH/TS 比值 >1。结论　HIV感染者 /AIDS患者和肿瘤病人存在不同程度的细胞免疫功能损害 ,T淋巴细胞亚群的检测可作为两者免疫诊断和免疫功能监测的指标之一 ,对于病人的治疗和预后有一定的意义     

中药(XQ-9302)治疗HIV感染者/AIDS患者CD4细胞计数和病毒载量变化的评价

目的　探讨中药 (XQ 930 2 )对艾滋病病毒 (HIV)感染者 /艾滋病 (AIDS)患者的治疗作用。方法　测定XQ 930 2治疗 2 1例HIV感染者 /AIDS患者的CD4细胞计数和病毒载量 ,并与仅进行对症治疗的HIV感染者 /AIDS患者对照组比较。结果　经XQ 930 2治疗后 ,4 2 9%HIV感染者 /AIDS患者的CD4细胞计数上升 >5 1% ,为显效 ;33 3%患者的CD4细胞计数升高 11%～ 5 0 % ,为有效 ,总有效率为 76 2 % ;CD4细胞计数上升 <10 %为无效 ,无效率为 2 3 8%。 5 2 4 %HIV感染者 /AIDS患者的病毒载量下降≥ 1log ,呈显效 ;38 1%的HIV感染者 /AIDS患者病毒载量无变化或下降 <1log ,为有效 ;仅 9 5 %HIV感染者 /AIDS患者病毒载量上升 ,为无效。所有HIV感染者 /AIDS患者的临床症状均获改善。对照组HIV感染者 /AIDS患者病毒载量呈稳定及上升状态 ,临床症状均未获改善 ,呈无效。结论　XQ 930 2对HIV感染者 /AIDS患者的CD4细胞计数上升以及病毒载量下降有效 ,且能改善临床症状。     

HIV抗体阳性者短期内发展至AIDS的危险

为了探明影响艾滋病病毒 (HIV)抗体阳性者的病情发展到艾滋病 (AIDS)的因素 ,英国学者利用未开展高效抗逆转录病毒联合治疗 (HAART)之前的数据 ,对 32 2 6名HIV感染者发展至AIDS的危险进行评估。在病毒载量 (VL)和CD4细胞计数已知的情况下 ,1年间随访 5 12 6人 ,已发现有 2 19人发展至AIDS。本研究提出CD4细胞计数、VL和 3～ 6个月患者发展至AIDS存在相关关系如下 :CD4 细胞计数 VL(拷贝 /ml)3～ 6个月发展至AIDS的危险 (% )<2 0 0 / μl1 <1 0 0 0 0 4 92 1 0 0 0～ 2 99991 2 73 30 0 0 0～ 99990 1 7 74 ≥ 1 0 0 …     

艾滋病合并HIV视网膜病变85例临床分析

目的探讨艾滋病(AIDS)病人艾滋病病毒(HIV)视网膜病变的发病特点及临床表现特征。方法回顾273例有眼底照片的AIDS病人的资料,分析85例有HIV视网膜病变病人的CD4+T淋巴细胞计数、棉絮斑部位及数量、出血部位、眼别等,探讨HIV视网膜病变的发病特点和临床表现。结果273例AIDS病人中,发现有HIV视网膜病变的85例,发病率为31.14%。单、双眼均可发病,主要表现为眼底棉絮斑,大多部分伴有出血,单纯出血和Roth斑较少。大多位于眼底后极部,可自行消退;HIV视网膜病变病人的CD4+T淋巴细胞计数小于200细胞/μl,86%的病人CD4+T淋巴细胞计数低于100细胞/μl,近50%的病人CD4+T淋巴细胞计数低于50细胞/μl;不同CD4+T淋巴细胞水平间患眼棉絮斑数量比较,差异无统计学意义;各水平间棉絮斑、出血构成比比较差异无统计学意义。结论AIDS病人视网膜病变主要表现为棉絮斑,出现在细胞免疫水平较低的病人。随着免疫功能降低而发病率增加。AIDS病人应做常规眼科检查。     

接受抗病毒治疗HIV/AIDS的CD4+T淋巴细胞计数与病毒载量相关性评价

目的评价接受抗病毒治疗且服药依从性良好的艾滋病病毒感染者/病人(HIV/AIDS)体内CD4+T淋巴细胞水平与艾滋病病毒载量的相关性。方法选择2018年4月—2019年4月,新疆伊宁市接受抗病毒治疗且依从性良好(≥95%)的HIV/AIDS 111例,接受抗病毒治疗满一年后定量检测其血液样本中病毒载量(HIV-RNA)及CD4+T淋巴细胞计数,并分析统计学相关性。结果抗病毒治疗前后CD4+T淋巴细胞计数有效率从30.63%增至44.14%,病毒载量有效率从20.72%增至68.47%;免疫破坏组(CD4200/μl)、恢复组(200/μl≤CD4500/μl)和正常组(CD4≥500/μl)的病毒载量(H检验),差异有统计学意义(χ2=22.618,P0.05),且均值呈降低趋势;CD4+T淋巴细胞计数和病毒载量呈负相关(r=-0.479,P0.05)。结论积极接受抗病毒治疗的病人体内病毒载量与CD4+T淋巴细胞计数在总体趋势上呈负相关;应结合指标变化调整并制定合理的抗病毒治疗方案以取得更好的效果。     

HIV/AIDS病人合并HBV和HCV感染状况分析

目的分析艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)的流行现状及其特点,为AIDS的防控和治疗提供科学依据。方法选取2011-2015年期间准备开始高效抗反转录病毒治疗(HAART)的HIV/AIDS病人986例,采用酶联免疫吸附试验检测HIV/AIDS病人血液中的乙型肝炎表面抗原(HBsAg)和/或丙型肝炎病毒抗体(HCV-Ab)。计数资料样本率的比较采用χ2检验,计量资料的比较采用t检验。结果 HIV/AIDS病人合并HBV感染率为6.06%(59/974),合并HCV感染率为4.12%(40/972),合并HBV/HCV双重感染率为0.42%(4/960),HIV/AIDS病人合并HBV和HCV感染率的差异无统计学意义。血液途径感染HIV者的合并HBV感染率为15.79%,合并HCV感染率为41.03%,均显著高于性途径合并HBV和HCV的感染率(5.01%和1.68%)。合并乙型肝炎病人的CD4+T淋巴细胞200个/μL的比例,明显高于合并丙型肝炎病人CD4+T淋巴细胞200个/μL的比例。合并HBV和HCV感染的病人的天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素均没有显著性差异。结论郑州市HIV/AIDS病人合并HBV和HCV总体感染率低于普通人群,HIV合并HBV/HCV感染的趋势有所控制。但血液途径感染HIV者合并HBV和HCV感染率仍高于普通人群,要加大防控力度。     

HIV/AIDS患者并发贫血的临床研究

目的　了解艾滋病病毒 /艾滋病 (HIV/AIDS)患者贫血并发情况 ,探讨贫血程度对判定HIV/AIDS患者病情进展的意义。方法　对未经治疗的HIV/AIDS患者检测免疫功能指标 (CD+ 4 T细胞 )和全血细胞计数。遵循美国疾病控制与预防中心 (CDC) 1993年诊断标准 ,对 94例HIV/AIDS患者按病情阶段分为A、B、C组。对血红蛋白浓度 (HGB)和病情阶段及CD+ 4 T细胞之间的关系进行统计学分析。结果　 94例HIV/AIDS患者中有 37例并发贫血 ,在A、B、C组贫血的发生率分别为 5 6 %、2 4 1%、6 1 7% ,贫血发生率在 3组间差异有非常显著的统计学意义 (χ2 =2 1 2 6 3,P <0 0 0 1)。 37例贫血患者的HGB在 3组间差异有显著的统计学意义 (F =4 978,P =0 0 13)。对 94例AIDS患者的CD+ 4 T细胞与HGB进行曲线拟合分析 ,发现二者之间存在曲线相关 (P <0 0 0 1) ,曲线回归方程为HGB =2 3 2 4 6×ln(CD+ 4 )。结论　AIDS患者贫血的发生率较高 ,贫血的发生率及严重程度随着病情的进展而发展。HGB随着免疫功能的衰减而下降。贫血的程度对AIDS患者的病情评判有重要意义     

95例HIV/AIDS合并机会性感染病例的临床特征

目的分析收治的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)合并机会性感染的临床特点,以及感染发生与CD+4T淋巴细胞(简称CD4细胞)计数之间的关系。方法将解放军302医院于2010-2013年期间收治的139例HIV/AIDS病人,按入院时基线CD4细胞计数分为两组,并对95例发生机会性感染的HIV/AIDS病人分别从临床表现、实验室及影像学检查结果、免疫水平等方面进行回顾性调查与分析。结果入院时基线CD4细胞计数200个/μL的110例病人中,有93例发生了机会性感染,感染率为84.5%;而入院时基线CD4细胞计数≥200个/μL的29例病人中,有2例(6.9%,2/29)发生了机会性感染,两组比较差异有统计学意义(P0.05)。95例机会性感染病人的主要临床症状包括发热、咳嗽咳痰、乏力、胸闷等。呼吸系统机会性感染发生的比例(94.7%)最高,消化系统机会性感染发生的比例(74.7%)占第二位。结论 CD4细胞计数水平与HIV/AIDS病人机会性感染的发生概率密切相关;呼吸系统、消化系统、皮肤软组织为HIV/AIDS病人发生机会性感染最常见的易感部位;细菌、真菌、病毒为最常见的病原体。因此,定期检测CD4细胞计数,及时预防和控制各种机会性感染,有利于提高艾滋病病人的生活质量,延长生命。     

HIV感染/AIDS者结核感染的影响因素分析

目的 分析HIV感染/AIDS者结核感染情况及其影响因素。方法 于2017年1—7月采用随机整群抽样的方法,抽取江苏省常州地区3家社区医院,以其10年累计登记的HIV感染/AIDS者作为研究对象,最终纳入475例,平均年龄(44.44±13.85)岁,其中,男378例(79.58%),女97例(20.42%);HIV感染者273例(57.47%),AIDS患者202例(42.53%)。收集研究对象的社会人口学信息及临床相关信息;采集研究对象外周静脉血,检测HIV病毒载量,并选取CD4 ⁺T细胞计数>200个/μl者采用QuantiFERON ^®-TB Gold (QFT)检测结核感染情况;分析研究对象结核感染情况,并采用多因素非条件logistic回归分析结核感染的影响因素。结果 研究对象中CD4 ⁺T细胞计数>200个/μl者有429例,结核感染率为10.02%(43/429)。单因素分析显示,CD4 ⁺T细胞计数>200个/μl者中有结核病接触史者结核感染率(30.30%,10/33)高于无接触史者(8.33%,33/396);CD4 ⁺T细胞计数>500个/μl者结核感染率(13.15%,33/251)高于CD4 ⁺T细胞计数为200~500个/μl者(5.62%,10/178),差异均有统计学意义(χ ²分别为16.30、6.55,P值均<0.05)。进一步的非条件logistic回归分析显示,CD4 ⁺T细胞计数>200个/μl的HIV感染/AIDS者中,有结核病患者接触史者结核感染风险是无接触史者的4.61倍[调整OR值(95%CI值)为4.61(2.00~10.63)];CD4 ⁺T细胞计数>500个/μl的HIV感染/AIDS者结核感染风险是CD4 ⁺T细胞计数200~500个/μl者的2.47倍[调整OR值(95%CI值)为2.47(1.17~5.21)]。结论 免疫水平低下的HIV感染/AIDS者结核感染检出率低;结核病患者接触史、免疫水平是HIV感染/AIDS者结核感染的重要影响因素。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.