慢性移植肾肾病与巨细胞病毒感染的相关性研究

目的　探讨肾移植后巨细胞病毒 (CMV)感染与远期慢性移植肾肾病的关系。方法　 1999年 8月～ 2 0 0 1年 1月 ,将 166例肾移植受者根据术后 6个月内CMV pp65抗原血症的不同情形进行分组和穿剌活检 ,以免疫荧光检测活检组织中转移生长因子 β1(TGF β1)的表达 ;前瞻性观察各组患者肾功能 3年以上。结果　术后 6个月内长时间、高活动性CMV感染的患者 ,在肾移植达 6个月时 ,肾组织中TGF β1表达量明显大于其他患者 ,该组患者 3年内肾功能减损 (肌酐清除率减少 16.1ml/min± 8.6ml/min)、肾功能不全的病例数 (9/2 0 )均明显高于其它组。肾功能不全者病理证实均为慢性移植肾肾病。结论　肾移植术后早期长时间、高活动性CMV感染可能是导致慢性移植肾肾病的重要原因之一。     

肾移植早期巨细胞病毒感染对移植肾远期预后的影响

目的:探讨肾移植受者术后早期巨细胞病毒(CMV)感染与远期肾功能的关系. 方法:自1999年8月～2001年6月,根据肾移植术后6个月内CMV-pp65抗原血症指数(I)和持续时间,将96例随访达3年的肾移植受者分为CMV非感染组(I=0)、低感染组(I= 1～30)、短期高感染组(I >100,≤2周)和长期高感染组(I >100,≥8周),比较四组在肾移植6个月时肾功能、移植肾活检组织中转化生长因子β1(TGF-β1)蛋白和mRNA表达;随访3年期内肌酐清除率(Ccr)减损量、肾功不全发生率,并对出现肾功不全者在血肌酐(SCr)升高1个月内进行移植肾穿剌活检,以明确病因. 结果:在肾移植6个月时,四组肾功能无明显差异(P > 0.05),但"长期高感染组"肾组织中TGF-β1蛋白和mRNA表达量明显大于其他3组;在肾移植3年时,"长期高感染组" Ccr下降了(16.2±7.2)ml/min,43.5%(10/23)患者出现肾功能不全,二者均明显大于其他3组(P < 0.01,P <0.05).肾功不全者,移植肾活检均证实为慢性移植肾肾病. 结论:肾移植术后早期长时间严重的CMV感染是影响移植肾远期肾功能、导致慢性移植肾肾病的重要原因.     

移植肾输尿管坏死的原因探讨及其预防

目的探讨肾移植术后近期移植肾输尿管坏死的原因。方法比较750例肾移植患者供受体性别、年龄、移植物相关指标及巨细胞病毒（CMV）感染,探讨移植肾输尿管坏死的原因,并针对性的提出预防措施。结果与无坏死组相比,在输尿管坏死组中,急性排斥反应、移植肾功能延迟恢复及CMV感染的发生率较高;两组冷缺血时间和移植肾功能恢复时间的比较有统计学差异。结论急性排斥反应、移植肾功能延迟恢复、CMV感染和冷缺血时间在移植肾输尿管坏死的发生中起重要作用。     

肾移植急性排异诊断的新进展

肾移植急性排异诊断的新进展陈劲松南京金陵医院解放军肾脏病研究所（２１０００２）肾移植急性排异的诊断有时非常困难，在广泛应用ＣｓＡ的今天，仅凭临床表现和某些实验室检查往往难以明确诊断。近年，通过移植肾粗针穿刺活检和细针抽吸活检，对移植肾组织细胞学变化、...     

移植肾细针抽吸活检的评价

移植肾细针抽吸活检的评价殷立平关键词肾移植细针抽吸活检排异反应中图法分类号Ｒ６９９．２１９６８年，Ｐａｓｔｅｒｎａｃｋ首先将细针抽吸活检（ｆｉｎｅ－ｎｅｅｄｌｅａｓｐｉｒａｔｉｏｎｂｉｏｐｓｙ，ＦＮＡＢ）应用于移植肾急性排异的诊断。此后经过大量的动物...     

肾脏HLA-DR抗原表达在肾移植中的意义

应用免疫酶标技术对47例异体肾移植患者的95例次肾活检标本进行HLA-DR抗原的检测,并同时做光镜、电镜、免疫病理检查及淋巴细胞亚群的研究。结果显示:肾移植后近曲小管上皮细胞的DR抗原表达增加,肾小球的DR抗原表达减少;急、慢性排导反应,急性肾小管坏死时,肾小管及肾间质的DR抗原表达均明显增加;环孢素中毒时,肾单位的DR抗原表达正常,肾间质的DR抗原表达增加。肾脏HLA-DR抗原表达在肾移植后的变化,对于排异反应的诊断、鉴别诊断、判断预后及治疗决策具有重要意义。     

肾移植与感染

感染一直是肾移植术后最主要的并发症。在肾移植术后1年内。75％的移植肾受者至少发生1次感染。在肾移植术后任何一个阶段感染均构成移植肾受者的主要死亡原因。因而研究感染的特征及有效地预防及治疗,是肾移植成功与否的关键。在过去的30年中,肾移植经历了长足的发展(包括最佳的器官配型,移植前肾脏的保存、准备,手术方法的改进,选择性免疫抑制治疗方案的发展,以及人们对感染的进一步认识和有效处理),使得肾移植排异和感染的发生率均有所下降,特别是因某些技术因素面引起感染发生率明显下降。但是,由于抗排异治疗带来的免疫抑制必然使得移植肾受者易于     

程序性活检在肾移植受者中的应用

目的:通过Meta分析及系统性评价的方法为程序性活检在肾移植受者中的应用价值提供循证医学依据。方法:采用电子检索进行文献初检,电子检索数据库有Medline数据库、Embase和Cochrane图书馆。纳入涉及程序性活检在肾移植受者中应用的随机对照研究(RCT),数据由两名作者独立提取,纳入研究的偏倚风险采用Cochrane协作网推荐的偏倚风险评估工具进行评估,使用Cochrane协作网提供的专用RevMan5.0软件进行统计数据分析。结果:纳入5篇关于程序性活检在肾移植受者中的应用的RCT。在程序性活检对肾移植受者移植肾存活率、肾功能的影响进行了Meta分析,并从文献中提取亚临床排异、钙调神经蛋白抑制剂(CNI)中毒、BK病毒相关性肾病、程序性活检的不良反应及患者对程序性活检的顺应性等的发病学资料进行合并分析。Meta分析的结果提示:程序性活检可提高移植肾存活率,降低移植肾丢失率(RR 0.43,95%CI 0.26~0.70,P0.001)。程序性活检可使血清肌酐降低38.21μmol/L(95%CI 54.83~21.60,P0.001)。结论:程序性活检可发现亚临床阶段的排异反应、BK病毒感染、CNI中毒等疾病。对这些疾病的发现和及时干预可提高移植肾存活率。程序性活检可能提高长期肾功能,尤其是以环孢素为主要基础免疫抑制剂的患者。程序性活检严重不良反应发生率较低,可以认为是一个比较安全的临床措施。     

肾移植合并感染性疾病178例临床分析

目的　探讨肾移植患者术后感染时间、种类和病原体分布情况及现行抗排异和预防感染措施的效果。方法　对 178例肾移植患者的临床资料进行 6个月～ 2年的回顾性分析。结果　 178例患者中合并感染性疾病 5 5例 (3 0 .9% )。肺炎、尿路感染、乙型肝炎病毒 (HBV)、巨细胞病毒 (CMV)及单纯疱疹病毒 (HSV)感染的发生率分别为 9.5 5 %、5 .65 %、4.49%、2 .2 5 %和 3 .3 7% ;革兰阴性杆菌 (GNB)、真菌、HBV、CMV及HSV是肾移植患者最常见的病原体。肺炎、尿路感染和单纯疱疹多发生在移植后 1～ 6个月 ,乙型肝炎和CMV感染多见于移植术 6个月后。外周血白细胞、中性粒细胞及T淋巴细胞CD+ 4 /CD+ 8比值在感染组和非感染组比较差异有显著性 (P <0 .0 1)。环孢霉素 (CSA)、强的松 (Pred)、硫唑嘌呤 (AZA)及雷公藤多甙 (T) (方案CPAT)的抗排异方案和抗菌素的预防治疗可降低移植患者感染率。结论　肾移植患者各系统的感染率增加 ,通过实施有效的措施 ,其发生率可下降     

雷公藤对大鼠肾移植急性排异反应治疗作用的免疫机理探讨

利用大鼠肾移植模型,以血、尿及移植肾组织免疫活性细胞、白细胞介素为研究指标,探讨GTW抗大鼠急性排异作用机理。结果量示,GTW可抑制移植肾组织排异反应。可减少肾移植大鼠外周血MRC OX-8阳性细胞(Tc/s,NK细胞)数量,抑制W3/2S(Th,单核细胞)、MRCOX-8(Ts/c,NK细胞)、MRCOX-19(T细胞)和IL-2R阳性细胞在移植肾组织内的浸润,减少尿IL-6的产生.斑点杂交未证实GTW可抑制移植肾组织IL-1α,βmRNA的表达.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.