联合多种自身抗体检测对炎症性肠病的诊断价值研究

目的:联合检测核周型抗中性粒细胞胞浆抗体(pANCA)、抗酿酒酵母菌抗体(ASCA)、抗胰外分泌腺抗体(PAB)和抗小肠杯状细胞抗体(GAB)在炎症性肠病(IBD)中的表达,以探讨其对炎症性肠病中的克罗恩病(CD)和溃疡性结肠炎(UC)的诊断与鉴别诊断价值。方法:空腹采集静脉血2ml,用间接免疫荧光法测定113例UC组、96例CD组、43例肠道疾病对照组及20例正常对照组血清pANCA、ASCA、PAB、GAB的表达。结果:在4个组中,UC组的pANCA阳性率为40.7%,明显高于其他3组(P0.01)。ASCA在UC组与CD组的阳性率分别为5.3%和4.2%,2组之间及与疾病对照组、正常对照组比较均无显著性差异(P0.05)。GAB在UC组及CD组的阳性率分别为13.3%和12.5%,2组比较差异无显著性意义(P0.05),与疾病对照组及正常对照组比较差异有显著性意义(P0.05)。PAB各组无一例阳性。联合检测4种抗体诊断IBD的敏感性、特异性和阳性阴性预测值分别为41.6%、96.8%、97.8%和33.3%。pANCA+/ASCA-诊断UC的敏感性和特异性为40.7%和96.8%,pANCA-/GAB+诊断CD的敏感性和特异性为11.5%和100%。结论:炎症性肠病相关抗体检测的特异性高,但敏感性低,联合检测能显著提高敏感性。pANCA对UC的诊断和鉴别诊断有意义,GAB对IBD的诊断较有意义,而ASCA和PAB对IBD的诊断价值不大。联合检测pANCA和GAB,可用于UC和CD的鉴别诊断。     

儿童系统性红斑狼疮患者血清抗核小体抗体检测

目的探讨抗核小体抗体(anti-nucleosome antibodies,AnuA)对儿童系统性红斑狼疮(systemic lupus erythematosus,SLE)诊断的意义,并与成人SLE进行比较。方法选取87例儿童SLE患者,30例非SLE儿童疾病对照组(包括幼年类风湿关节炎、脊柱关节病、皮肌炎、干燥综合征和血管炎),122例成人SLE和55例其他结缔组织病患者,采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测血清AnuA。结果 87例儿童SLE中67例AnuA阳性,30例儿童疾病对照组中2例AnuA阳性,AnuA对儿童SLE诊断的敏感性和特异性分别为77.01%和93.33%,ROC曲线下面积为0.852;阳性预测值和阴性预测值分别为97.10%和58.33%。AnuA对成人SLE患者诊断的敏感度和特异度分别为68.85%和90.91%。AnuA对儿童SLE诊断的敏感度高于成人SLE,对儿童SLE诊断的特异度与成人比较无明显差异(P0.05)。在抗dsDNA抗体和抗Sm抗体阴性的儿童SLE患者中AnuA的阳性率分别为56.52%(26/46)和76.71%(56/73)。结论 AnuA对儿童SLE的诊断具有较高的敏感度和特异度,有助于抗dsDNA抗体和抗Sm抗体阴性儿童SLE的诊断。     

抗核小体抗体对系统性红斑狼疮的诊断价值及临床意义

目的评价抗核小体抗体(AnuA)对系统性红斑狼疮(SLE)诊断的敏感性和特异性。方法选取2004-01—2004-12天津市第一中心医院风湿免疫科住院患者及门诊健康体检者,用酶联免疫吸附法(ELISA)检测64例SLE患者、46例疾病对照组和30例正常对照组血清中的AnuA。结果64例SLE患者血清AnuA阳性率为73·44%,46例疾病对照组为13·04%,正常对照组全部为阴性;AnuA对SLE诊断的敏感性和特异性分别为73·44%、88·68%。AnuA在狼疮肾炎中的阳性率比在非狼疮肾炎中高(χ2=5·246,P=0·022)。在抗dsDNA抗体、抗Sm抗体、抗组蛋白抗体(AHA)阴性的SLE患者中AnuA阳性率分别为60·71%、69·57%、64·10%。结论AnuA在SLE血清中水平明显增高,AnuA测定在SLE诊断和治疗中有重要意义,特别对抗dsDNA抗体、抗Sm抗体、抗组蛋白抗体阴性的SLE的诊断有重要意义。     

人巨细胞病毒感染与大肠癌临床相关性

目的:探讨大肠癌患者人巨细胞病毒(human cytomegalovirus,HCMV)感染情况及其临床相关性.方法:采用化学发光(CLIA)法对大肠癌组(n=60)、大肠息肉组(n=60)及健康对照组(n=60)的外周血清进行HCMV免疫球蛋白G(immunoglobulin G,Ig G)、Ig M抗体检测;巢式PCR技术结合原位杂交方法检测32例大肠癌组织及癌旁正常肠黏膜组织中HCMV-UL138基因表达;用Fisher确切概率法比较两组间阳性率,均数比较采用t检验或单因素方差分析.P0.05为差异有统计学意义.结果:大肠癌组、大肠息肉组、健康对照组血清H C M V-I g G阳性率为分别为95.0%(57/60)、98.3%(59/60)、96.7%(58/60);血清HCMV-Ig M阳性率分别为5.0%(3/60)、1.7%(1/60)、1.7%(1/60),3组血清H C M VIg G、Ig M差异无统计学意义(P0.05).32例大肠癌组织巢式PCR检测HCMV-UL138阳性率为65.6%(19/32),相应癌旁正常肠黏膜组织中为12.5%(4/32),原位杂交法检测癌组织HCMV-UL138阳性率为62.5%(20/32),癌旁正常肠黏膜组织中为9.4%(3/32),大肠癌组织HCMV阳性检出率较癌旁正常组织显著升高(P0.01).未发现HCMV感染与大肠癌患者的年龄、性别、肿块位置、肿块大小、组织病理分化类型、转移及Dukes分期有显著性关联.结论:大肠癌组织中存在HCMV感染,且H C M V相较于癌旁正常组织更倾向感染癌灶,提示HCMV感染可能参与大肠癌的发生发展过程.     

不同PCR引物检测胆囊结石中纳米细菌效果的研究

目的评价不同PCR引物检测胆囊结石患者胆汁和结石中纳米细菌(NB)的临床价值.方法 对30例结石标本,43例胆汁标本采用间接免疫荧光染色,透射电镜扫描和PCR检测标本中的NB.结果 PCR引物1,2检测NB阳性率分别为56.1%和86.4%,培养物间接免疫荧光染色(CIIFS)阳性率为54.5%,对比评价表明引物1特异性更高,与CIIFS结果一致率高,两者阳性率无统计学差异(P > 0. 05),引物1检测NB的敏感性为75.0%,特异性为66.7%,阳性预测价值为73.0%,阴性预测价值为69.0%.引物1未培养组阳性率为29.6%,培养组阳性率为50%,两者阳性率有统计学差异(P<0.05),培养后可明显提高NB的检出率.引物1结石组阳性率为46.7%,胆汁组阳性率为63.9%,两者阳性率无统计学差异(P>0.05).结论 PCR引物1检测胆囊结石患者NB结果与CIIFS有较高的一致性,培养后可明显提高NB的检出率,为NB相关疾病的检测提供了一种快速,可靠的方法,具有重要的参考价值.     

胰腺癌患者血浆miR-155检测及其诊断价值

目的 检测胰腺癌患者血浆miR-155表达量,评价其对胰腺癌的诊断价值.方法 收集62例胰腺癌、61例慢性胰腺炎(CP)及36例正常对照者的血标本,抽提血浆RNA,应用实时PCR检测miR-155表达量,并分析其与胰腺癌临床参数的关系.应用接受者操作特征(ROC)曲线下面积(AUC)评价血浆miR-155表达量对胰腺癌的诊断价值.结果 胰腺癌、CP和正常对照组的血浆miR-155表达量分别为5.41±3.14、2.59±2.49和0.77±1.17,胰腺癌血浆miR-155表达量显著高于CP及正常对照组(P＜0.01).胰腺癌血浆miR-155表达量与患者年龄、性别、肿瘤大小等均无显著相关性,而与肿瘤TNM分期呈显著负相关(r=-0.323,P=0.01).经ROC分析,胰腺癌对正常对照组的AUC为0.943(95%CI0.902～0.985),敏感性和特异性分别为87.1%和83.3%;胰腺癌对CP的AUC为0.762(95%CI0.678～0.846),敏感性和特异性分别为64.5%和73.8%;胰腺癌对正常对照组+CP组的AUC为0.829(95%CI0.767～0.892),敏感性和特异性分别为62.9%和84.5%.结论 胰腺癌患者血浆miR-155表达量显著升高,对胰腺癌的诊断可能有一定的应用价值.     

贵州省抑郁症患者刚地弓形虫感染状况调查及其基因型鉴定

目的了解贵州省抑郁症患者弓形虫感染状况及弓形虫基因型。方法 ELISA检测141例抑郁症患者和150例健康对照外周血弓形虫特异性抗体(IgG、IgM)和循环抗原(CAg),PCR扩增血样弓形虫高重复DNA片段(529 bp),多重-巢式PCR-限制性片段长度多态性(Mn-PCR-RFLP)方法鉴定弓形虫529 bp阳性样本的基因型。结果 ELISA检测结果显示,抑郁症患者组和健康对照组弓形虫抗体阳性率分别为21.3%(30/141)和7.3%(11/150),两者间差异有统计学意义(χ~2=11.674,P0.05);抑郁症患者组的IgG、IgM、CAg阳性率分别为18.4%(26/141)、1.4%(2/141)、1.4%(2/141);健康对照组IgG阳性率为7.3%(11/150),与抑郁症患者组间差异有统计学意义(P0.05),未检测到IgM和CAg。PCR结果显示,抑郁症患者组检测出1例弓形虫核酸阳性,经Mn-PCR-RFLP方法鉴定其基因型,结果为非典型Toxo DB#9(Chinese 1型)。结论贵州省抑郁症患者弓形虫抗体阳性率高于健康人群,1例抑郁症患者感染的弓形虫基因型为Chinese 1型。     

炎症性肠病患者血清中自身抗体检测的临床意义

目的研究抗酿酒酵母抗体(ASCA)和抗中性粒细胞胞浆抗体(pANCA)在炎症性肠病诊断与鉴别诊断中的意义。方法间接免疫荧光生物薄片法检测29例溃疡性结肠炎(UC)、34例克罗恩病(CD)及25例正常对照者血清中ASCA和pANCA的表达。结果pANCA在CD组、UC组和正常对照组中的阳性率分别为47.1%、69.0%和16.0%,UC组显著高于CD组(P<0.05)和正常对照组(P<0.05)。ASCA在上述3组中的阳性率分别为11.8%、58.6%和8.0%,UC组亦显著高于CD组(P<0.05)和正常对照组(P<0.05)。ASCA /pANCA-诊断CD的敏感性、特异性、阳性预测值分别是0、89.7%和0;pANCA /ASCA-诊断UC的敏感性、特异性和阳性预测值分别是20.7%、64.7%和33.3%。结论ASCA和pANCA阳性有利于炎症性肠病的诊断却不能敏感地筛选患者;ASCA和pANCA联合检测不能作为汉族UC和CD鉴别诊断的指标。     

抗核小体抗体测定在系统性红斑狼疮诊断中的意义

目的　评价抗核小体抗体 (AnuA)对系统性红斑狼疮 (SLE)诊断的敏感性和特异性 ,并了解其与SLE活动性的关系及与其他自身抗体的关系。方法　用酶联免疫吸附 (ELISA)测定方法检测SLE患者、疾病对照组 (包括原发性干燥综合征、多发性肌炎、皮肌炎、系统性硬化症 )和正常对照组血清中的AnuA ,并记录SLE患者的各种临床表现及实验室指标 ,分析其与AnuA的关系。结果　 10 3例SLE患者中 6 9 9%血清AnuA阳性 ,6 6例疾病对照组仅 3 0 %阳性 ,30名正常对照组全部阴性 ;SLE组患者AnuA阳性率显著高于疾病对照组和正常对照组 (P <0 0 1) ,AnuA在SLE中检测的敏感性和特异性分别为 6 9 9%和 97 9%。AnuA阳性组的SLE患者肾损害、皮肤损害的发生率(6 1 1%、70 8% )明显高于AnuA阴性组 (2 9 0 %、32 3% ) (P <0 0 5 ) ;AnuA阳性组与AnuA阴性组相比 ,在年龄、性别、病程上差异无显著性 (P >0 0 5 )。AnuA滴度的高低与SLE患者的SLEDAI评分有明显相关性 (r=0 2 82 ,P <0 0 5 )。抗dsDNA抗体、抗Sm抗体、快速狼疮因子 (DNP)、抗组蛋白抗体 (AHA)阴性的SLE患者AnuA的阳性率分别为 6 5 6 %、6 8 0 %、6 3 9%、6 4 1%。结论　AnuA对SLE诊断的敏感性高、特异性强 ;它与SLE疾病活动性密切相关 ,对抗dsDNA抗体、Sm、DNP及AHA     

海南省病毒性腹泻病原学流行特征分析

目的分析病毒性腹泻患者病原学及流行病学特点,为病毒性腹泻的预防和控制提供参考。方法搜集2015-2017年海口市中医医院就诊的腹泻患者粪便标本857份,采用荧光定量PCR检测轮状病毒和杯状病毒核酸,PCR检测肠道腺病毒核酸,星状病毒核酸检测采用RT-PCR,用SPSS22.0对检测结果与流行病学资料进行统计分析。结果 857份粪便标本病毒阳性367份,阳性率为42.82%,其中杯状病毒的阳性检出率最高,为14.12%,其他病毒分别为轮状病毒(12.25%)、肠道腺病毒(5.02%)、星状病毒(2.80%);混合感染占8.63%。1~岁年龄组病毒阳性率最高,为55.61%(114/205),其次为50~岁年龄组,为55.25%(36/64),2~岁年龄组为48.85%(64/131),各年龄组间差异有统计学意义(χ2=1.698,P=0.428)。男性病毒阳性率42.54%,女性为43.31%,差异无统计学意义(χ2=0.048,P=0.826);病毒性腹泻呈现出一定的季节性特点,流行高峰为秋冬季。其中,杯状病毒检出在1~2岁组最高,轮状病毒检出率在40~49岁组最高,两种病毒均在秋冬季较为流行。结论病毒性腹泻病原体以杯状病毒和轮状病毒为主,具有明显季节性,同时存在混合感染。病毒性腹泻防控重点人群为2岁以下儿童。     

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.     

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.     

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.     

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.