梅毒与系统性红斑狼疮患者抗心磷脂抗体的比较研究

目的 对梅毒和系统性红斑狼疮(SLE)患者血清中抗心磷脂(ACL)抗体的反应强度以及类型进行比较研究。方法 应用ELISA法对99例梅毒和75例SLE患者的血清中ACL抗体的反应强度以及ACL抗体的IgG与IgM类型进行检测。结果 SLE和梅毒患者血清中IgG型ACL抗体阳性率分别为48.00%和40.40%;梅毒的阳性血清反应强度高于SLE患者(P<0.001);IgM型ACL抗体的阳性率在SLE和梅毒患者中分别为18.67%和61.62%,梅毒的ACL抗体阳性率显著高于SLE患者(P<0.001),且梅毒患者IgM型ACL抗体阳性血清反应强度高于SLE患者(P<0.005)。结论 这种ACL抗体IgG、IgM阳性率与反应强度的差异,反映了SLE患者和梅毒患者产生ACL抗体的机理与功能有所不同。     

CCL27和CCR10在寻常性银屑病皮损的表达及与PASI的相关性

目的 探讨皮肤特异性趋化因子CCL27及其受体CCR10在寻常性银屑病皮损中的表达和表达强度与疾病活动性的相关性.方法 SP免疫组化染色检测20例寻常性银屑病皮损区皮损和10例正常人皮肤中CCL27、CCR10的表达,以PASI评分评价银屑病患者疾病活动性.结果 ①CCL27在20例寻常性银屑病皮损和10例正常人皮肤中表达的阳性率分别为95%和20%,两者差异有统计学意义(X²=17.86,P<0.01);CCR10在20例寻常性银屑病皮损和10例正常人皮肤表达的阳性率分别为85%和10%,两者的差异有统计学意义(X²=15.63,P<0.01).②CCL27和CCR10在皮损中的表达水平与PASI评分均呈明显正相关,r值分别为0.82和0.83,P值均<0.01.结论 CCL27和CCR10的过度表达与银屑病患者的疾病活动性相关.     

银屑病患者外周血肝细胞生长因子和粒细胞-巨噬细胞集落刺激因子水平改变

目的 探讨肝细胞生长因子(HGF)和粒细胞-巨噬细胞集落刺激因子(GM-CSF)与银屑病的关系。方法 采用双抗体夹心酶联免疫吸附试验(ELISA)检测寻常性银屑病患者和正常人血清中HGF和GM-CSF水平。结果 进行期寻常性银屑病患者血清中HGF水平明显高于静止期及正常人对照(P<0.01),而静止期患者血清中HGF水平与正常人对照比较差异无统计学意义(P>0.05);进行期银屑病患者血清中GM-CSF水平明显高于正常人对照及静止期(P<0.01),静止期患者血清中GM-CSF水平亦高于正常人对照(P<0.05);进行期泛发性与局限性皮损患者之间血清HGF及GM-CSF水平差异均无统计学意义;患者血清HGF和GM-CSF水平与PASI计分均呈正相关(分别为r=0.38和r=0.30,P<0.002和P<0.02)。结论 寻常性银屑病患者外周血循环HGF和GM-CSF水平明显增高,HGF和GM-CSF可能参与银屑病发病。     

银屑病患者外周血单核细胞向树突状细胞分化能力的研究

目的 了解银屑病患者外周血单核细胞向树突状细胞(DC)分化的能力。方法 采用流式细胞仪检测细胞表面抗原表达,同种混合淋巴细胞反应评价细胞的抗原递呈能力。结果 银屑病患者外周血单核细胞能向DC分化,分化而成的DC表达CD40、CD80、CD86和HLA-DR的阳性率显着高于正常人(P<0.01),刺激淋巴细胞增殖的能力显着强于正常人(P<0.01)。结论 银屑病患者外周血单核细胞向DC分化的能力增强,分化而成的DC具有很强的抗原递呈能力。     

硬皮病患者皮损转化生长因子β1、β2 mRNA的表达

目的 探讨转化生长因子(TGF)β1和β2在硬皮病发病中的作用。方法 采用原位逆转录聚合酶链反应技术检测17例硬皮病患者皮损中TGF-β1、β2mRNA的原位表达情况,并以10例正常人皮肤组织作为对照。结果 TGF-β1mRNA在硬皮病组表达阳性率和表达程度均高于对照组(P<0.05);TGF-β2mRNA在硬皮病组表达阳性率和表达程度与对照组相近(P>0.05);硬皮病皮损中TGF-β1mRNA表达阳性率和表达程度均高于TGF-β2mRNA(P<0.05).结论 TGF-β1mRNA在硬皮病皮损中高度表达,提示其在硬皮病病理纤维化的形成过程中起一定作用。     

假性黑棘皮病患者血清瘦素及可溶性受体与胰岛素的测定

目的 探讨假性黑棘皮病患者血清瘦素及其受体与胰岛素之间的关系.方法 分别采用放射免疫分析法、酶联免疫吸附实验和葡萄糖氧化酶法检测25例假性黑棘皮病、20例单纯肥胖者瘦素、胰岛素、C肽可溶性受体与血糖水平,并与正常人对照组比较.结果 假性黑棘皮病患者和单纯肥胖者体质量、体质指数、脂肪百分比、腰臀围比明显高于正常人对照组,两组差异有统计学意义(P<0.01).假性黑棘皮病患者和单纯肥胖者胰岛素、C肽水平明显高于正常人对照组(P<0.01),胰岛素敏感指数低于正常人对照组(P<0.01);单纯肥胖者血糖水平和正常人对照组相比,差异无统计学意义(P>0.05);假性黑棘皮病患者与单纯肥胖者血清中瘦素水平和正常人对照组相比显著升高(P<0.01),可溶性瘦素受体水平显著降低(P<0.01).结论 假性黑棘皮病患者存在瘦素抵抗、高胰岛素血症和胰岛素抵抗,瘦素抵抗在假性黑棘皮病患者高胰岛素血症、胰岛素抵抗与肥胖中起一定的作用.     

复发性生殖器疱疹患者外周血单一核细胞CD40和CD40L的表达

目的 探讨复发性生殖器疱疹患者外周血单一核细胞CD40、CD40L的表达。方法 利用流式细胞仪对30例复发性生殖器疱疹患者和20例正常人对照者外周血单一核细胞(PBMC)CD40、CD40L的表达及T淋巴细胞亚群进行检测。结果 病例组PBMC中CD40阳性细胞百分数较对照组显著降低(P=0.0061);CD40L阳性细胞百分数较对照组明显降低(P=0.041);CD3⁺T细胞和CD4⁺T细胞百分数亦显著低于对照组(其P值分别为0.025和0.032)。结论 CD40-CD40L共刺激作用低下是生殖器疱疹复发的重要原因之一。     

天疱疮患者血清细胞因子的检测及其与病情的相关性

目的 研究天疱疮患者血清细胞因子的动态变化及其与病情严重程度的相关性.方法 用双抗体夹心ELISA方法检测31例急性发病期和治疗后缓解的天疱疮患者以及15例正常人对照血清白介素4(IL-4)、白介素10(IL-10)、γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α)和可溶性IL-2受体(sIL-2R)水平,并以间接免疫荧光法检测患者血清抗体滴度,同时用烧伤面积九分法记录皮损面积.结果 天疱疮患者急性发病期IL-10水平低于正常人(P<0.05),且与皮损面积呈负相关(r=-0.25,P<0.05);sIL-2R和IFN-γ水平高于正常人(P<0.05),且与皮损面积呈正相关(分别为r=0.60,P<0.05;r=0.41,P<0.05);天疱疮抗体滴度与皮损面积无相关性(P>0.05).结论 天疱疮发病中存在细胞因子的异常,IL-10、sIL-2R和IFN-γ水平与病情严重程度有明显的相关性,其水平的检测可用于监控疾病的严重程度并指导临床治疗.     

阿维A治疗前后对银屑病患者血管内皮生长因子表达的影响

目的 研究阿维A对血管内皮生长因子(VEGF)促银屑病血管生成的调节作用,探讨阿维A治疗银屑病的机制。方法 免疫组化法检测32例银屑病患者经阿维A治疗前后皮损的微血管密度和VEGF蛋白的表达情况。应用双抗体夹心酶联免疫吸附法(ELISA)检测32例银屑病患者经阿维A治疗前后外周血清中VEGF水平。结果 ①银屑病患者经阿维A治疗前皮损VEGF蛋白的表达及微血管密度值显著高于治疗后(P<0.05)和正常人对照组(P<0.001)。②银屑病患者阿维A治疗前的血清VEGF水平高于治疗后(P<0.001)及正常人对照组(P<0.001)。结论 VEGF在银屑病新生血管生成中起重要作用。阿维A可能通过抗新生血管生成的作用来治疗银屑病。     

尖锐湿疣患者皮损中SOCS1和PIAS1的表达及意义

目的 探讨尖锐湿疣(CA)皮损角质形成细胞中细胞因子信号转导JAK/STAT通路负调控蛋白细胞因子信号抑制剂-1(SOCS1)和活化STAT的蛋白抑制剂-1(PIAS1)的表达。方法 采用SP免疫组化染色技术检测40例CA患者皮损、20例宫颈癌和20例正常人皮肤(包皮)中SOCS1和PIAS1的表达及分布。结果 ①CA患者皮损中SOCS1和PIAS1的表达阳性细胞分布主要位于棘细胞层,为棕黄着色,阳性反应定位胞质;宫颈鳞状细胞癌亦为胞质阳性表达,棕黄着色,呈弥漫性分布;而正常包皮少数阳性着色主要定位于基底层细胞的胞质,呈浅黄着色。②CA皮损中SOCS1和PIAS1的表达阳性率分别为85%和80%,高于在正常人上皮中的表达(阳性率分别为30%和35%),两组比较差异均有统计学意义(前者χ²=18.15,P<0.01;后者χ²=11.87,P<0.01);宫颈癌中SOCS1和PIAS1的表达阳性率分别为90%和85%,虽较CA有升高,但两者比较差异均无统计学意义(两者均P>0.05)。③CA中SOCS1与PIAS1的表达无显著相关性(r_s=0.14,P>0.05)。结论 CA皮损中可能通过细胞因子信号转导负调控蛋白SOCS1和PIAS1在角质形成细胞过度增殖或恶性转化过程中起调控作用。     

Sexually transmitted diseases in 1161 HIV-positive patients: a 38-month prospective study in southern Spain

Background HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection in certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV-1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of HIV infection and without correlation with CD4 cell counts. No STD data is included in those studies. Objective To determine the incidence of STDs in a cohort of 1161 HIV-1-positive patients from Spain, in the previous medical history and during the prospective study. Methods We prospectively examined 1161 HIV-1-positive patients for 38 months, 986 men and 175 women. IDU was the risk factor in 74%, while homosexuality was a risk factor in only 9%. CDC stage II was predominant (51%), while stage IV was less frequent (39%). The mean CD4 cell count was 353/mm³. Patients' past and present medical history of STDs was obtained. CD4 cells/mm³ counts were measured at each visit. Results Six hundred and eighty-four patients had a past history of STD, whilst new infections were diagnosed in 258 individuals (22%) during the 38-month study. Pediculosis pubis (26%), gonorrhoea (22%), syphilis (13%), genital Candida infection (11%) and condyloma acuminatum (10%) were the commonest previous STDs, followed by non-gonococcal urethritis (NGU) (5%), genital herpes (4%) and trichomoniasis (2%). During the 38-month study period and with strong recommendation of condom use for sexual intercourse, condyloma acuminatum (7%), scabies (6%), syphilis (4%) and genital herpes (3%) were commonly diagnosed, followed by gonorrhoea (1.8%), NGU (1.6%), genital Candida infection (1,5%), pediculosis pubis (0.6%) and trichomoniasis (0.3%). Only genital herpes had a statistically significant association with advanced stage (P= 5.12 × 10^-6) and low CD4 cell counts (180 ± 166 cells/mm³). Conclusion Despite the predominance of the IDU factor among our patients, the incidence of STDs in the past medical history was surprisingly high. The incidence of STD during the study was also high, despite the advice of using condoms after the diagnosis of HIV infection. STDs may accelerate the course of HIV infection and be a poor prognostic indicator in these patients. If an HIV-1-positive patient can acquire an STD, he/she can also transmit HIV infection. This indicates that new publicity campaigns are still needed to stop HIV and STDs infection among HIV-positive patients as well as in the general population.     

性传播疾病病原检测方法的比较研究

目的回顾总结本科性病门诊的性传播疾病的流行病学资料,比较万倍显微镜与C learview快速诊断试剂盒检测、分离培养及染色涂片检测的检出符合率。方法回顾性调查本科性病门诊自应用万倍显微镜以来的所有病例,分别选取30例患者与C learview快速诊断试剂盒检测、分离培养及染色涂片检测结果进行比较。结果单发性病中以非淋菌性尿道炎菌性尿道炎、淋病、梅毒为主,其发病率分别为38.49%,16.17%和11.83%,其中男性分别为38.00%,16.96%和11.43%;女性分别为39.78%,14.36%和12.64%。复合感染中以淋病合并非淋菌性尿道炎菌性尿道炎为多(1 0.4 4%),其次是非淋菌性尿道炎菌性尿道炎合并梅毒(4.3 9%),非淋菌性尿道炎菌性尿道炎合并生殖器疱疹(2.17%)。万倍显微镜与C learview快速诊断试剂盒检测、分离培养及染色涂片检测的检出符合率达90%以上。结论万倍显微镜具有操作简单,监测范围广、检出率高、费用低等优点,适用于性病门诊对性传播疾病的快速准确诊断。     

The psychosocial impact of testing individuals with no history of genital herpes for herpes simplex virus type 2

BACKGROUND: Although approximately 20% of the population has a genital herpes (HSV-2) infection, 80% of these infections are unrecognized or asymptomatic. Serologic identification of HSV-2 leads to recognition of infection, which could lead to behavioral changes that reduce transmission. However, there has been concern that HSV-2 testing among persons without symptoms will cause substantial psychosocial harm. GOAL: The goal of this study was to assess the psychosocial impact of an HSV-2 diagnosis among individuals without a history of genital herpes attending a sexually transmitted disease (STD) clinic. STUDY: We conducted a cohort study of persons with no history of genital herpes attending an STD clinic and seeking herpes testing. Two follow-up interviews were conducted 1 week and 3 months after persons received their test results. Serum was tested using HerpeSelect 2. Psychosocial morbidity was assessed at baseline and each follow up using a mental health score, sexual attitude score, and perception of genital herpes score. RESULTS: Twenty-one percent (41 of 196) of participants tested positive for HSV-2 antibody. Among patients who were HSV-2-positive, there was no significant change in mental health score from baseline during either follow-up visit, nor was there any difference compared with persons who were HSV-2-negative. Patients who were HSV-2-positive did have a decline (P = 0.01) in their sexual attitude scores at the 1-week follow up compared with persons who were HSV-2-negative, indicating a decrease in positive sexual attitude, but this difference no longer remained at the 3-month follow up (P = 0.74). Patients who were HSV-2-positive viewed having genital herpes as significantly less traumatic than patients who were HSV-2-negative at both follow-up visits (P <0.01). CONCLUSION: There was no apparent lasting adverse psychosocial impact of detecting HSV-2 infection among individuals without a history of genital herpes seeking herpes testing at an STD clinic.     

451例STD患者的生殖支原体感染

为了解性传播疾病（STD）患者中感染生殖支原体（Mg)的状况及其临床意义，在本所的STD门诊部收集451例患者的尿道（宫颈）分泌物作了Mg检测。标本接种于改良的SP－4培养基作Mg分离培养，并同时用聚合酶链反应（PCR）进行Mg检测，以PCR结果作为最终判断依据。患者中69例非淋病性尿道炎（NGU）病人还作了咽部拭子的Mg检测。结果证明，Mg阳性患者有67例（14．9％），其中NGU 59例（20．6％），其他STD仅8例（4．9％），二者差异有统计学显著性（P＜0．0001），表明Mg感染与NGU发生关系密切。尿道（宫颈）分泌物及咽拭子同时检测Mg的69例NGU病人中，7例在二部位均检出Mg，提示有口淫的可能性。     

男性STD患者念珠菌性尿道炎213例临床研究

目的：研究男性性病患者念珠菌性尿道炎的流行病学和抗真菌药物疗效。方法：对已确诊为非淋菌性尿道炎、尖锐湿疣、淋病、生殖器疱疹、梅毒等有尿道炎症状者，用患者尿道分泌物或尿道拭子作真菌培养，并观察斯皮仁诺、氟康唑治疗念珠菌性尿道炎的临床治愈率和真菌学治愈率。结果：男性病患者念珠菌尿道炎的感染率由2．50％逐年上升至17．64％，NGU患者中检出最多，共193例(90．61％)；念珠菌性尿道炎合并Ct和／或Uu感染者为26．42％；以白念珠菌感染导致念珠菌性尿道炎最为多见，共166例(77．93％)；斯皮仁诺、氟康唑治疗187例念珠菌性尿道炎的临床治愈率、细菌学治愈率分别为77．71％、95．18%和80．95%、90．48％。结论：男性病患者念珠菌尿道炎感染率呈逐年上升趋势，NGU患者感染率最高。尤以白念珠菌感染最为多见。斯皮仁诺、氯康唑可以作为治疗念珠菌性尿道炎首选药物。     

生殖器溃疡病征处理修订方案的有效评价

目的 评价经修改的生殖器溃疡病征处理方案的有效性。方法 选择两家性病门诊就诊、具有生殖器溃疡表现的首诊患者，按病征处理原则进行处理。以复合PCR、暗视野显微镜检查及梅毒血清学试验作病原学诊断。结果 在227例患者中，78（34.4%)患有梅毒，43例（18.9%）患有生殖器疱疹，28例（12.3%)同时患梅毒和生殖器疱疹、78例（34.4%)未检出病原体。未发现软下疳。病征诊断对于梅毒和生殖器疱疹的敏感性分别为88.7%，69.0%，特异性95.0%，50.0%，阳性预期值94.0%，38.6%，阴性预期值90.6%，78.0%，在128例随访的患者中，总有效率为89.0%。结论 病征诊断对梅毒的敏感性尚不足，约有10%的梅毒患者被漏诊。对生殖器溃疡的病征处理方案仍需进一步修改和验证。由于在本组患者中未发现软下疳病例，因此在修改后的方案中目前不包含软下疳的治疗可能是可行的。     

A study on the present scenario of STD management in an urban clinic in Kolkata

A total of 4129 patients attended the STD clinic from 1996 to 1999. Of those 25.75% were STD cases. Male and female cases comprised 86% and 14% respectively. Majority were in the age group between 18 to 38 years. Chancroid was the commonest STD (37.7%). Other STDs in order were syphilis (30.66%), NGU (15.71%), gonorrhoea (7%), venereal wart (3.57%), candidiasis (2.53%), trichomonal vaginitis (1.6%), herpes genitalis (0.65%) and LGV (0.47%). No case of Donovanosis or HIV was detected. 13.7% of STD cases were reactive for VDRL test and 8% of the antenatal attendants were strongly VDRL test reactive. The urethral discharge on gram staining was positive for gonococcus, in 29%. 68% of the clinic attendants were given safer sex education and served condom.     

Changing trends in sexually transmitted diseases in North Eastern India

A retrospective data analysis was carried out to find the trends in frequency and distribution of different STDs in North Eastern (NE) India during 1995-1999. The commonest STD was chancroid (25.7%) followed by condylomata acuminata (CA), nongonococcal urethritis (NGU), lymphogranuloma venereum (LGV), syphilis, gonorrhoea (GONO), herpes genitalis (HG), mixed infection (MI) and balanoposthitis (BP). Interestingly no case of donovanosis (Dono) was seen. HIV infection accounted for 9.62% of the total STD patients. A comparison of the present data with that reported a decade back (1986-1990) revealed a sharp decline in the incidence of syphilis, chancroid, GONO, whereas a conspicuous upward trend in CA and NGU. Factors responsible for these variations are analysed briefly.     

249例性病患者流行病学调查分析

目的:了解和掌握新疆博尔塔拉蒙古自治州三年来性病流行特征,以便进一步采取相应预防控制措施。方法:收集博尔塔拉蒙古自治州两县一市249例性病患者报告资料,并通过卡方检验进行统计分析。结果249例性病患者中,男性占72.69%(181/249),女性占27.31%(68/249),男女之比为1∶0.38;21～40岁组发病占61.04%(152/249);职业分布中不详者占49.79%(124/249),无业者占24.49%(61/249);汉族发病121例(占48.59%),蒙古族66例(26.51%);已婚者发病占67.87%(169/249);文盲、小学和初中文化水平感染率为77.51%(193/249)。从时间分布统计分析,除了梅毒从2007年的2例上升到2009年的25例外,淋病、尖锐湿疣、非淋菌性尿道炎三年发病处于下降趋势。来自国外、内地经商的流动人口发病164例,占65.86%,本地户口发病85例(占34.14%)。性病病种的感染状况统计分析:三年尖锐湿疣占26.92%,非淋菌性尿道炎占全部病例的24.89%,淋病占总病例的23.69%,其次是梅毒病例占18.07%,生殖器疱疹只占全部病例的6.43%。结论:根据调查结果看,应进一步加强本地区道德和精神文明建设,加强对低文化流动人口的培训教育,提高公民的自我防护意识。     

Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review.

In the United States statistics on sexually transmitted diseases (STDs), other than gonorrhoea and syphilis, are meagre. In this study the relative and seasonal incidences of most STDs in an American clinic where 34,938 patient visits were recorded over a two-year period (1975-76) are assessed. Gonorrhoea was the most common STD in male and female patients combined (18%), while nongonococcal urethritis (NGU) was most common in men (23%), and vaginitis (trichomonal 7.5%, yeast 7.1%, and non-specific 7.1%) was the most common in women. A significantly higher incidence of NGU occurred in Caucasian (63%) than in black (42%) men (P less than 0.005). No other STD was diagnosed in more than 5% of patients, and 31% had normal findings on clinical examination and investigation, and could be described as the 'worried well'. Two or more STDs co-existed in 4.2% of patients. In 1976 the incidence of genital herpes and scabies decreased in contrast to other STDs and total patient visits, which increased. A seasonal peak in late summer and early autumn was observed for most STDs. These observations indicate the importance of a comprehensive approach when attempting to compile accurate statistics on selected epidemiological aspects of sexually transmitted diseases.