CD+8 T细胞激活分子CD38、HLA-DR与HIV-1载量的相关性研究

目的研究HIV/AIDS患者CD8^＋ T细胞表达激活分子CD38、HLA-DR水平与血浆病毒载量（VL）的相关性,以及用CD8CD38、CD8HLA-DR比例替代VL检测的可行性.方法用流式细胞术分析103例接受12个月高效抗逆转录病毒治疗（HAART）患者的CD＋8 T细胞表达CD38和HLA-DR水平;用分支DNA扩增技术检测血浆VL.用敏感性、特异性、准确性等参数分析能有效预测VL＜50拷贝/ml、VL＜500拷贝/ml、VL＞1000拷贝/ml和VL＞10 000拷贝/ml时CD8CD38和CD8HLA-DR的检测范围.结果103例艾滋病患者CD38、HLA-DR和VL在12个月治疗中均呈下降趋势;CD38和VL在HAART治疗前及治疗第1、3、6、9、12个月6个检测点的总相关系数为0.483（P＜0.001）、HLA-DR和VL的总相关系数为0.477（P＜0.001）.用CD8CD38和CD8HLA-DR的水平预测VL值有显著诊断价值：当CD38＜68.5%和＜72.5%时预测VL＜50拷贝/ml和＜500拷贝/ml有较高的灵敏度和特异性;当HLA-DR在＞39.5%和＞46.5%时预测VL＞1000拷贝/ml和＞10 000拷贝/ml有较高的灵敏度和特异性.结论在条件匮乏的艾滋病高发区,可以用CD8CD38和CD8HLA-DR激活亚群的结果来预测血浆VL,作为监测HIV疾病进展和评价抗病毒疗效的参考.     

人类免疫缺陷病毒感染者及艾滋病患者CD8+ CD38+ CD8+ HLA-DR+比IV载量的相关性研究

目的 研究人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者CD8+ T细胞激活分子CD38、人类白细胞Ⅱ类抗原(HLA-DR)与血浆HIV载量的相关性,分析用CD8+ CD38+、CD8+ HLA-DR+的比例替代HIV载量的可行性.方法 采集1998-2006年期间在北京协和医院初诊的HIV感染者或AIDS患者236例和56名同期健康献血员的抗凝静脉血,用流式细胞术分析CD8+ T细胞分别表达CD38和HLA-DR的比例,用分支DNA技术(bDNA)检测血浆病毒载量(VL).用受试者工作特征曲线(ROC)分别预测VL＞1×103拷贝/mL、＞1×104拷贝/mL和＞1×105拷贝/mL时CD8+ CD38+、CD8+ HLA-DR+比例的临界值范围.结果 236例患者的CD4+ T细胞计数138(16,262)×106/L,显著低于对照组(P＜0.01);CD8+ T细胞计数618(353,879),显著高于对照组(P＜0.05);CD8+ CD38+、CD8+ HLA-DR+的比例分别为85.4%(72.5%,92.2%)和40.3%(17.5%,59.7%),显著高于对照组(P＜0.01),与HIV载量的相关性分别为0.429(P＜0.01)和0.282(P＜0.01).用CD8+ CD38+＞80.4%预测VL＞1×103拷贝/mL的敏感度和特异度为80.6%和75.0%;用CD8+ HLA-DR+预测VL＞1×105拷贝/mL的敏感度和特异度为78.7%和81.4%.结论 对HIV感染或AIDS初诊的患者可以尝试用CD38和HLA-DR激活亚群来预测血浆HIV载量,这种替代检测方法具有一定的可行性.     

人类免疫缺陷病毒感染者及艾滋病患者CD8~ CD38~ CD8~ HLA-DR 比例与HIV载量的相关性研究

目的研究人类免疫缺陷病毒(HIV)感染者和获得性免疫缺陷综合征(AIDS,艾滋病)患者CD8 T细胞激活分子CD38、人类白细胞Ⅱ类抗原(HLA-DR)与血浆HIV载量的相关性,分析用CD8 CD38 、CD8 HLA-DR 的比例替代HIV载量的可行性。方法采集1998—2006年期间在北京协和医院初诊的HIV感染者或AIDS患者236例和56名同期健康献血员的抗凝静脉血,用流式细胞术分析CD8 T细胞分别表达CD38和HLA-DR的比例,用分支DNA技术(bDNA)检测血浆病毒载量(VL)。用受试者工作特征曲线(ROC)分别预测VL>1×103拷贝/mL、>1×104拷贝/mL和>1×105拷贝/mL时CD8 CD38 、CD8 HLA-DR 比例的临界值范围。结果236例患者的CD4 T细胞计数138(16,262)×106/L,显著低于对照组(P<0.01);CD8 T细胞计数618(353,879),显著高于对照组(P<0.05);CD8 CD38 、CD8 HLA-DR 的比例分别为85.4%(72.5%,92.2%)和40.3%(17.5%,59.7%),显著高于对照组(P<0.01),与HIV载量的相关性分别为0.429(P<0.01)和0.282(P<0.01)。用CD8 CD38 >80.4%预测VL>1×103拷贝/mL的敏感度和特异度为80.6%和75.0%;用CD8 HLA-DR 预测VL>1×105拷贝/mL的敏感度和特异度为78.7%和81.4%。结论对HIV感染或AIDS初诊的患者可以尝试用CD38和HLA-DR激活亚群来预测血浆HIV载量,这种替代检测方法具有一定的可行性。     

成人HIV／AIDS CD^4＋细胞数与病毒载量之间关系分析

目的分析成人HIV/AIDS患者CD4~+细胞数与病毒载量(VL)之间的关系。方法对1990年—2001年在本院就诊的200例HIV/AIDS患者进行跟踪分析。结果 CD4~+≥200/μl时,血浆VL(log10)为4.17±0.79;CD4~+<200/μl时,血浆VL(log10)为5.01±0.72,VL水平明显高于CD~+≥200/μl组(P<0.01)。其中CD4~+>350/μl时,血浆VL(log10)为3.95±0.82;CD4~+200～350/μl时.血浆VL(log10)为4.43±0.63;CD4~+100～200/μl时,血浆VL(log10)为4.85±0.68;CD4~+<100/μl时,血浆VL(log10)为5.16±0.68。结论 HIV/AIDS患者CD4~+细胞数与病毒复制有非常密切的关系,外周血CD4~+细胞数与血浆VL的变化呈负相关关系。当血浆VL(log10)>5.01±0.72时,应考虑患者已进入艾滋病期。     

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 …     

HIV/AIDS病人泌尿生殖道组织HIV-1总DNA的检测与分析

目的探讨泌尿生殖道组织作为艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)HIV储存库的可能。方法 20例接受高效抗反转录病毒治疗(HAART)至少6个月,需要行包皮切除术或泌尿道/生殖道腔镜手术的HIV/AIDS病人,检测标本组织和外周血单个核细胞(PBMC)的HIV-1总脱氧核糖核酸(DNA)。结果 20例病人平均年龄(45.8±14.7)岁,接受HAART(6～36个月),平均(14.1±7.9)个月,外周血HIV-1核糖核酸(RNA)均低于检测下限20拷贝/mL,CD4~+T淋巴细胞(简称CD4细胞)计数平均(417.3±151.3)个/μL,CD4细胞/CD8~+T淋巴细胞(简称CD8细胞)(CD4/CD8细胞)比值平均(0.55±0.35),泌尿生殖道组织和PBMC中均能检测到HIV-1总DNA,载量分别为(85.9～89 300)拷贝/10~6个细胞(中位数1 034.12拷贝/10~6个细胞)及(6.83～321 000)拷贝/10~6个细胞(中位数550拷贝/10~6个细胞),两者呈正相关(r=0.53,P=0.018)。但泌尿生殖道组织HIV-1总DNA载量与CD4细胞计数及CD4/CD8细胞比值变化均无明显相关性(r=-0.002,P=0.99;r=0.12,P=0.61)。结论泌尿生殖道组织可能是HIV感染者的病毒储存库之一。     

AIDS患者高效抗逆转录病毒联合治疗后外周血CD+8 CD+38T细胞与病毒载量同步变化

目的了解艾滋病(AIDS)患者高效抗逆转录病毒联合治疗(HAART)前后外周血CD+38抗原在CD+8T淋巴细胞上的表达情况.方法应用流式细胞仪采用双色荧光抗体检测技术检测CD+8 CD+38 T细胞;用罗式核酸扩增荧光定量聚合酶链反应(PCR)法检测血浆病毒载量(VL).结果 HAART后2周内CD+8 CD+38 T细胞数与VL开始同步下降,12周后83%AIDS患者的VL降至＜500拷贝/ml,同时CD+8 CD+38 T细胞计数与治疗前相比非常明显地降低(P＜0.001).而且63%的AIDS患者在血浆VL低于检测水平时,其CD+8 CD+38 T细胞数仍继续下降(与VL开始达到检测水平以下时相比,P＜0.001).结论 AIDS患者在HAART开始后,CD+8 CD+38 T细胞数与VL快速下降,在24周左右降至正常水平;并且CD+8 CD+38 T细胞数在VL达到检测不到时仍继续下降,提示在血浆VL低于检测水平时,CD+8 CD+38 T细胞数能够作为判断病毒是否复制的标记.     

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。     

佳息患联合施多宁治疗艾滋病病毒1型感染的免疫反应效果

目的　 观察非核苷类逆转录酶抑制剂施多宁与蛋白酶抑制剂佳息患联合用于治疗艾滋病病毒 1型 (HIV 1 )后的机体免疫反应。 方法　2 0例HIV 1慢性感染者 ,在治疗前后定期采集外周血 ,分离血浆及单个核细胞 ,检测病毒载量及T淋巴细胞亚群。 结果　治疗后 ,病人血浆中HIV 1核糖核酸 (RNA)含量降低 ,CD+ 4T淋巴细胞数量增多 ,其免疫系统活化指标趋向于正常。 结论　施多宁与佳息患联合治疗有效地抑制了HIV 1的复制 ,并提示机体免疫功能得以部分改善     

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.