慢性乙型病毒性肝炎治疗新方法

就当前慢性乙肝治疗的新方法、新进展作一综述。     

脾囊肿7例报告

脾囊肿７例报告上海医科大学附属华山医院尹有宽，凌乔，吴树强，翁心华脾囊肿是脾脏的良性肿瘤，临床上较为罕见，我院在１９７５～１９９２年收治１３７，４７７例住院病人中，经手术确诊为脾囊肿者仅７例，现报告如下。临床资料一、一般情况：男性４例，女性３例；年龄...     

免疫缺陷宿主中的感染问题

兔疫缺陷可分为先天性和后天获得性两大类,临床上以后者较为多见。由于免疫缺陷,此类患者易遭受各种感染,常为死亡的主要原因。感染因子包括细菌、真菌、病毒和原虫等,其发病率因原发病而异,感染的临床表现亦与通常所见者不同,因此,对免疫缺陷宿主(简称CH)中感染的诊断、治疗和预防便成了现代医学的重要课题。     

缓症链球菌中毒性休克综合征的临床研究

目的：研究缓症链球菌中毒性休克综合征（TSS）的临床特征及致病机理。方法：对178例重症类猩红热进行临床观察,并对咽拭子培养菌株应用新西兰兔作动物实验,进行毒素分离鉴定。结果：本组病例临床特征为突起畏寒、高热,猩红热样皮疹,不同程度的休克,多脏器功能受损。大多数病人咽拭子培养有α-溶血的缓症链球菌生长,此菌株产生一种分子量为34KD新的致热性外毒素。结论：缓症链球菌可致中毒性休克综合征。     

变应性亚败血症18例临床分析及远期随访

变应性亚败血症是一组临床综合征,其临床表现及实验室检查均无特异性,早期诊断颇难。本文报告18个病例,主要表现为长期发热(18/18)、反复出现的一过性多形性皮疹(14/18)、关节症状(14/18)及咽喉炎(13/18)等。实验室检查白细胞及中性粒细胞增多(17/18)、血沉增速(18/18)、多次血培养无致病菌生长(17/18)。抗菌治疗无效,消炎痛、保太松、肾上腺皮质激素等非特异性抗炎药物可使症状缓解。对部分病例(11)的长期随访结果表明,预后大多良好(8/11)。目前对本症的病因及发病机理尚未完全阐明,有待于作进一步的探讨。     

非艾滋病相关隐球菌性脑膜炎的再认识

近年来,非艾滋病相关隐球菌性脑膜炎的临床诊治引起了极大关注,特别是我国非艾滋病相关隐球菌性脑膜炎的发病率呈明显上升趋势,总患病数是艾滋病相关隐球菌性脑膜炎的2倍,给隐球菌性脑膜炎的诊治带来了更大挑战。采用胶体金免疫层析法检测隐球菌荚膜多糖抗原,操作简便、快捷,具有较好的灵敏性和特异性,为临床早期诊断提供了可能。关于隐球...     

医院内深部真菌感染的前瞻性调查

目的　了解目标人群医院内真菌感染的危险因素、发病率和疾病谱。方法　对 1997年 10月～ 1999年 12月间在我院部分病房住院治疗的患者的医院内真菌感染进行前瞻性调查、分析 ,对分离到的其中 5 6株白色念珠菌进行药敏试验。结果　医院感染和医院内真菌感染的发病率分别为 12 .3%和 2 .5 7% ,医院内真菌感染的主要部位分别是口腔 ( 39.5 1% )、下呼吸道 ( 34.5 7% )和尿路 ( 17.2 8% ) ,主要的真菌为念珠菌 ( 90 .6 2 % ) ;医院内真菌感染的发生与免疫抑制剂治疗、多种广谱抗生素的使用 ( >3种 )、气管切开或插管、昏迷 ( >3d)、年龄≥ 6 5岁、留置导尿、恶性肿瘤性疾病等有关 ;白色念珠菌对两性霉素 B、氟康唑、氟胞嘧啶和伊曲康唑的敏感性分别为 10 0 %、94 .6 %、92 .86 %和 5 7.1%。结论　接受免疫抑制剂和多种广谱抗生素治疗、昏迷、体内留置导管的患者易发生医院内真菌感染 ;白色念珠菌仍是医院内真菌感染的主要病原 ;药敏试验表明 ,白色念珠菌对两性霉素 B、氟康唑、5 - FC高度敏感 ,而对伊曲康唑的敏感性较差     

Expression of type Ⅰ interferon in monocyte-derived dendritic cells after Toll like receptor 3 triggered in patients with chronic hepatitis B

Objective To detect the expression of type Ⅰ interferon in monocyte-derived dendritic cells(MoDCs)after Toll like receptor(TLR)3 triggered in patients with chronic hepatitis B(CHB),and to evaluate immune responses of CHB patients and its roles in the mechanisms of persistent infection of hepatitis B virus(HBV)and chronicity of hepatitis.Methods Peripheral blood mononuclear cells(PBMCs)were isolated and purified using magnetic beads(plasma was saved simultaneously)from 26 CHB patients and 18 healthy volunteers(HV).Dendritic cells(DCs)were induced and proliferated in a culture medium with recombinant human granulocyte macrophage colony stimulating factor(rhGM-CSF)and recombinant human interleukin(rhIL-4).EX3s were stimulated with Poly Ⅰ:C and the supernatants were collected at 0 h and 24 h after stimulation.Type Ⅰ interferon(IFN-α and IFN-β)in plasma and supernatants were examined by enzyme linked immunosorbent assay (ELISA).Results The levels of type Ⅰ interferon in plasma were not significantly different in groups of HV and CH B.IFN-α and IFN-β expressions in supernatants before Poly Ⅰ:C stimulation were(80.00±16.15)ng/L,(36.39±13.90)ng/L in CHB group and(76.76±15.90)ng/L,(37.14±13.68)ng/L in HV group,respectively.And there were no statistical differences between two groups(t=1.651,t=0.178;both P＞0.05).IFN-α expressions in supernatants at 24 h after stimulation in two groups were both higher than those before stimulation(at 0 h),but there were no statistical differences(t=1.534,t=1.243;both P＞0.05).IFN-β expressions in supernatants at 24 h after stimulation in HV group was(54.57±16.80)ng/L,which was significantly higher than that at 0 h(37.14±13.68)ng/L(t=4.061,P＜0.05).However,there was no significant difference at 24 h than tht at 0 h in CHB group(t=1.796,P＞0.05).At 24 h after stimulation.IFN-β level was(54.57±16.80)ng/L in HV group,which was significantly higher than that[(41.64±12.57)ng/L]in CHB group(t=2.921,P＜0.05).Conclusions Functions of MoDCs from CHB patients are impaired and MoDCs could not express type Ⅰ interferon normally.Expression of type Ⅰ interferon after TLR3 triggered in CHB patients is mainly IFN-β.     

Expression of type Ⅰ interferon in monocyte-derived dendritic cells after Toll like receptor 3 triggered in patients with chronic hepatitis B

Objective To detect the expression of type Ⅰ interferon in monocyte-derived dendritic cells(MoDCs)after Toll like receptor(TLR)3 triggered in patients with chronic hepatitis B(CHB),and to evaluate immune responses of CHB patients and its roles in the mechanisms of persistent infection of hepatitis B virus(HBV)and chronicity of hepatitis.Methods Peripheral blood mononuclear cells(PBMCs)were isolated and purified using magnetic beads(plasma was saved simultaneously)from 26 CHB patients and 18 healthy volunteers(HV).Dendritic cells(DCs)were induced and proliferated in a culture medium with recombinant human granulocyte macrophage colony stimulating factor(rhGM-CSF)and recombinant human interleukin(rhIL-4).EX3s were stimulated with Poly Ⅰ:C and the supernatants were collected at 0 h and 24 h after stimulation.Type Ⅰ interferon(IFN-α and IFN-β)in plasma and supernatants were examined by enzyme linked immunosorbent assay (ELISA).Results The levels of type Ⅰ interferon in plasma were not significantly different in groups of HV and CH B.IFN-α and IFN-β expressions in supernatants before Poly Ⅰ:C stimulation were(80.00±16.15)ng/L,(36.39±13.90)ng/L in CHB group and(76.76±15.90)ng/L,(37.14±13.68)ng/L in HV group,respectively.And there were no statistical differences between two groups(t=1.651,t=0.178;both P＞0.05).IFN-α expressions in supernatants at 24 h after stimulation in two groups were both higher than those before stimulation(at 0 h),but there were no statistical differences(t=1.534,t=1.243;both P＞0.05).IFN-β expressions in supernatants at 24 h after stimulation in HV group was(54.57±16.80)ng/L,which was significantly higher than that at 0 h(37.14±13.68)ng/L(t=4.061,P＜0.05).However,there was no significant difference at 24 h than tht at 0 h in CHB group(t=1.796,P＞0.05).At 24 h after stimulation.IFN-β level was(54.57±16.80)ng/L in HV group,which was significantly higher than that[(41.64±12.57)ng/L]in CHB group(t=2.921,P＜0.05).Conclusions Functions of MoDCs from CHB patients are impaired and MoDCs could not express type Ⅰ interferon normally.Expression of type Ⅰ interferon after TLR3 triggered in CHB patients is mainly IFN-β.     

新的诊断技术在肝病中的应用

近年来，人们运用诊断技术，特别是分子生物学技术诊断肝脏疾病。现就一些新的核酸检测技术、肝活检技术和血清标记物的临床应用做一总结。