肝移植术后肠道菌群失调的诊疗策略

肝移植术后会发生多种近期以及远期并发症。在术后早期,由于多重耐药菌的产生很容易导致各种感染,其中之一表现为肠道菌群失调。在过去的十年中,一系列研究发现肠道菌群在维持肠道稳态方面具有重要功能。肠道菌群通过多种途径与其他器官相互影响,其中肠肝轴是最关键的体内微环境调节通道之一。肠道菌群在数量和成分上的改变均能导致肠道菌群失调。无论在局部还是全身系统,肠道菌群与免疫系统都存在广泛的交互作用。本文着重探讨肝移植术后肠道菌群失调发生的危险因素、肠道菌群失调对肝移植受者的影响以及相关的治疗方案。     

效能水平与高血压人群健康行为因素关系

目的 分析社区老年高血压人群效能水平与心血管健康行为和健康因素的关系。方法 选取河北省唐山市荣华里、吉庆里、新华里、龙泉西里、团结楼和红星楼6个社区中已确诊为高血压的2 592例老年人作为研究对象,采用一般自我效能感量表（GSES）进行效能水平评测,结合随访1年期间高血压主要事件,分析老年高血压人群效能水平与心血管健康行为和健康因素的关系。结果 唐山市社区老年高血压人群效能水平高组心血管健康行为吸烟、BMI、饮食、锻炼4项处于理想状态者分别占60%、60.2%、58.4%、59.4%,效能水平中组分别占39.4%、38.5%、36.5%、39.4%,效能水平低组分别占23.2%、24.5%、23.8%、22.5%;效能水平高组心血管健康因素血压、血糖、血脂3项处于理想状态者分别占55.8%、59.3%、54.9%,效能水平中组分别占36.7%、39.2%、38.1%,效能水平低组分别占23.5%、24.3%、24.1%;效能水平高组理想心血管健康行为和因素组合项目分布比率、患者1年内累积高血压事件发生率及脉压差变化情况优于效能水平中、低组。结论 效能水平与心血管健康行为和健康因素相关,高效能水平可增加理想心血管健康行为和健康因素,预防老年高血压人群不良心脑血管事件的发生。     

地沟油标准物质候选物研制

目的 为制备“地沟油”标准物质候选物探讨和选择适当原料、工艺路线和质控指标。方法 选择“地沟油”目前最常用和最易得的原料、最有可能采用的精炼工艺路线,以外观、气滋味、色泽、水分及挥发物、酸价为质控指标,制备“地沟油”标准物质候选物。结果 选择餐厨废弃油脂为原料,通过蒸馏脱臭-碱炼脱酸-吸附脱色制备“地沟油”标准物质候选物,各批次候选物的色泽（1”,R）在4.0~5.1,水分及挥发物在0.02%~0.05%,酸价在5.60 ~6.30 mg/g。结论 利用该候选物可制备“地沟油”特定内源性成分和外源性成分标准物质或测试参比样品,可全面寻找其中特定的内源性和外源性标志物,验证选定标志物的特异性、灵敏度和检出限。     

肾移植受者耶氏肺孢子菌肺炎的临床及流行病学特征分析

目的 探讨肾移植受者耶氏肺孢子菌肺炎（PJP）的临床及流行病学特征。 方法 收集2021年7月至2021年12月68例肾移植受者的临床资料,根据肺部感染情况分为PJP组（11例）、普通肺部感染组（24例）、非肺炎组（33例）。分析肾移植术后PJP的发生及治疗情况,比较各组受者的基本特征及实验室指标,分析PJP患者的基因分型及传播图谱。 结果 64例肾移植受者中,11例明确诊断PJP,最常见的临床表现为体温升高、干咳伴进行性呼吸困难。所有患者胸部CT表现为双肺弥漫性间质炎症,磨玻璃样改变。确诊后,均口服复方磺胺甲唑3~4周。2例患者由于严重肺部感染和呼吸困难,使用无创呼吸机辅助呼吸,其余受者均使用鼻导管吸氧。1例患者出院时血清肌酐升高,发生移植肾失功,其余10例PJP受者移植肾功能正常,无受者死亡。与非肺炎组比较,PJP组排斥反应发生率较高,住院时间较长,淋巴细胞计数较少,淋巴细胞比例较低,C-反应蛋白、血清肌酐、乳酸脱氢酶水平较高,血清白蛋白水平较低,CD4+T细胞计数较少（均为P < 0.05）。与普通肺部感染组比较,PJP组淋巴细胞计数较少,淋巴细胞比例较低,CD4+T细胞计数较少,1, 3-β-D-葡聚糖（BDG）水平较高（均为P < 0.05）。在检测的12例样本中,10例样本未发现新的基因分型。考虑PJP主要存在2条传播链,以及2例独立传播个体。 结论 由于细胞免疫功能受损,肾移植受者更易感染耶式肺孢子菌（PJ）,最常见的临床表现为体温升高、干咳伴进行性呼吸困难,部分同时出现头痛,乏力,胸部CT表现为双肺弥漫性间质炎症、磨玻璃样改变。PJ可通过呼吸道传播,在肾移植随访门诊存在小规模的PJP爆发可能,应及时做好预防工作。     

髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响

目的  分析髂内动脉钙化与肾移植受者移植物功能延迟恢复（DGF）及近期预后的相关性。方法  回顾性分析222例肾移植受者的临床资料。依据肾功能恢复情况分为DGF组（50例）和移植物功能正常恢复（IGF）组（172例）,根据是否合并髂内动脉重度钙化将DGF组和IGF组分为DGF高危组（22例）、DGF低危组（28例）、IGF高危组（41例）以及IGF低危组（131例）。比较两组供受者临床资料,总结肾移植术后DGF及髂内动脉钙化发生情况,分析肾移植术后发生DGF的危险因素、髂内动脉钙化与临床指标的相关性以及DGF合并髂内动脉重度钙化受者近期预后。结果  本研究中DGF发生率为22.5%（50/222）。肾移植受者中28.4%（63/222）合并髂内动脉重度钙化,DGF组中44%（22/50）合并髂内动脉重度钙化,高于IGF组中的23.8%（41/172）（P < 0.05）。单因素分析结果显示供者终末血清肌酐（Scr）高、男性供者,受者甘油三酯水平高和髂内动脉重度钙化是肾移植术后发生DGF的危险因素（均为P < 0.05）。多因素logistic回归分析显示供者Scr≥143 μmol/L及受者髂内动脉重度钙化是肾移植术后发生DGF的独立危险因素（均为P < 0.05）。相关性分析结果显示髂内动脉钙化与受者年龄和肾动脉吻合方式均呈弱相关（均为P < 0.05）。DGF组受者术后1个月的Scr高于IGF组,估算肾小球滤过率（eGFR）低于IGF组（均为P < 0.05）;DGF高危组受者术后12个月的eGFR低于DGF低危组、IGF高危组以及IGF低危组（均为P < 0.05）。结论  髂内动脉钙化不仅是影响移植肾功能恢复的危险因素,也对移植肾功能的近期预后造成不良影响。     

共刺激信号通路在异种移植中的作用研究进展

器官短缺是限制器官移植发展的重要因素,异种移植有望解决器官短缺问题,因此成为新的研究热点。T细胞调节相关的共刺激信号通路研究是当前异种移植免疫方面的热点话题。自从共刺激分子CD28发现以来,已经发现了多种共刺激分子,包括共刺激和共抑制受体及其相关配体。针对移植供体的特异性T细胞活化是引起急性免疫排斥反应的关键因素,不同免疫阶段共刺激分子在T细胞上表达和诱导有所不同,这些共刺激分子在维持T细胞耐受性以及T细胞免疫反应的平衡中发挥着关键作用。目前共刺激信号通路在器官移植领域的作用越来越受到重视,本文就异种移植免疫相关的共刺激信号通路的最新研究进行综述,以期为异种移植免疫抑制方案优化提供参考。     

Use of specific contrast-enhanced CT regions of interest to differentiate renal oncocytomas from small clear cell and chromophobe renal cell carcinomas

PURPOSEWe aimed to examine the usefulness of utilizing a specific contrast-enhanced computed tomography (CT) region of interest (ROI) to differentiate renal oncocytoma (RO) from small clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (chRCC).METHODSA retrospective analysis of pre-contrast phase (PCP), corticomedullary phase (CMP), and nephro­graphic phase (NP) contrast-enhanced CT images of the histopathologically confirmed initial cohort (27 ROs, 74 ccRCCs, and 36 chRCCs) was conducted. Small, medium, large, and whole ROIs (S-ROI, M-ROI, L-ROI, and W-ROI, respectively) were utilized for CT attenuation value of tumor (AVT), lesion-to-cortex attenuation (L/C), and heterogeneous degree of tumor (HDT) calculations. Differences in these parameters were then compared between RO and ccRCC/chRCC, with receiver operating characteristic (ROC) curves being utilized to gauge the diagnostic utility of the statistically significant parameters. Logistic regression analyses were employed to identify key factors capable of differentiating RO and ccRCC/chRCC, with predictive models further being established. A validation cohort (6 ROs, 30 ccRCCs, and 12 chRCCs) was then employed to validate the performance of the predictive models.RESULTSOf the parameters evaluated using different ROIs, L/C-CMP (S-ROI) (0.88 ± 0.15 vs. 1.13 ± 0.25, P < .001) and HDT-CMP (W-ROI) (23.02 (12.00-51.21) vs. 37.81 (16.09-89.45), P < .001) were best suited to differentiating RO and ccRCC, yielding respective area under the curve (AUC) values of 0.803 and 0.834. AVT-NP (S-ROI) (122.85 ± 18.87 vs. 86.50 ± 18.65, P < .001) and AVT-NP (M-ROI) (119 (86-167) vs. 81.5 (53-142), P < .001) were better able to differentiate RO and chRCC, yielding respective AUC values of 0.918 and 0.906. Logistic regression analyses revealed that L/C-CMP (S-ROI) and HDT-PCP, as well as AVT-NP (S-ROI) and HDT-CMP, were the primary factors capable of differentiating RO from ccRCC and chRCC, respectively. The predictive model developed to differentiate between RO and ccRCC exhibited a sensitivity of 66.67% and 55.14% in the initial and validation cohorts, respectively, with corresponding specificity of 94.59% and 93.55%, accuracy of 87.13% and 86.84%, and AUC of 0.908 and 0.876. The predictive model developed to differentiate between RO and chRCC exhibited a sensitivity of 85.19% and 100.00% in the initial and validation cohorts, respectively, with corresponding specificity of 94.59% and 92.86%, accuracy of 87.30% and 95.24%, and AUC of 0.944 and 0.959.CONCLUSIONThese data demonstrate that a combination of quantitative parameters measured with particular ROIs can enable the efficient and reliable differentiation of RO from ccRCC and chRCC for use in routine patient differential diagnosis.

Main points

• Quantitative computed tomography (CT) parameters measured using different regions of interest (ROIs) exhibit varying levels of diagnostic efficacy when differentiating renal oncocytoma (ROs) from small clear cell renal cell carcinomas (ccRCCs) and chromophobe renal cell carcinomas (chRCCs).
• Lesion-to-cortex attenuation- corticomedullary phase (CMP) (small ROI (S-ROI)) and attenuation value of the tumor-nephrographic phase (S-ROI) were identified as the most reliable enhancement degree-related quantitative parameters when distinguishing ROs from ccRCCs and chRCCs, respectively.
• Heterogeneous degree of tumor (HDT), which was defined based upon the standard deviation for CT values, can serve as a quantitative measure of heterogeneity when differentiating ROs from ccRCCs and chRCCs, with HDT-CMP exhibiting the highest degree of differential diagnostic efficacy.
• Predictive models combining the above S-ROI-based enhancement degree parameters and whole ROI-based HDT values exhibit excellent diagnostic efficacy when differentiating ROs from ccRCCs and chRCCs.

An estimated 20%-30% of solid masses < 4 cm in size are benign, with renal oncocytomas (ROs) accounting for over half of these cases while the remaining 70%-80% are renal cell carcinomas (RCCs), among which clear cell RCCs (ccRCCs) are the most prevalent, followed by papillary RCCs (pRCCs) and chromophobe RCCs (chRCCs).^1,2 Given that ROs exhibit a benign disease course and affected patients have an excellent prognosis, accurately differentiating between RO and RCC is critical to guide appropriate patient treatment.³Computed tomography (CT) is the most common approach used for the diagnosis and evaluation of renal masses. Several reports have described the differentiation between ROs and RCCs based upon both qualitative and quantitative CT findings, with the enhancement degree and heterogeneity being 2 key indicators.^4-8 Owing to a lack of reference standard uniformity, however, these studies utilized different approaches to define the regions of interest (ROIs) to obtain CT parameter values, potentially contributing to inconsistencies or opposing findings among studies. Also, tumor heterogeneity is also considered to be a largely subjective determination of limited clinical utility.^7-8 Rosenkrantz et al.⁹ found the use of a small ROI (S-ROI) to be more accurate than a large ROI (L-ROI) when differentiating between RCCs and cysts, with this approach being most effective when comparing pRCCs and cysts. Wang et al.¹⁰ also reported that S-ROI-based enhancement degree and whole ROI (W-ROI)-based enhancement heterogeneity were superior to medium ROI (M-ROI) when differentiating between small ccRCC and fat-poor angiomyolipoma (AML).To date, no studies have explored the use of different ROIs to differentiate between ROs and RCCs on contrast-enhanced CT images. Given that pRCCs are typically hypovascular, efforts to distinguish between ROs and RCCs are generally focused on the chRCCs and ccRCCs.^11-12 This study was thus developed to explore the effect of ROI size in differentiating ROs from ccRCCs and chRCCs in an effort to define the most effective quantitative parameters for routine differential diagnosis.     

肝、肺并发上皮样血管内皮瘤2例报告

目的探讨肝、肺并发上皮样血管内皮瘤的临床特点,提高对其认识。方法报告2例肝肺并发上皮样血管内皮瘤病例,结合相关文献分析该病的临床特点。结果EHE是一种少见的低度恶性血管性肿瘤,肝肺并发者极为罕见,且易误诊为转移瘤。结论肝肺并发EHE临床表现无特异性,肝脏EHE影像学有一定的特征性,病理仍然是确诊EHE的唯一手段。     

丹皮酚对人结肠癌LoVo细胞增殖抑制机制的研究

目的 研究丹皮酚对人结肠癌LoVo细胞增殖、凋亡的影响,探讨丹皮酚抗肿瘤的作用机制.方法 用丹皮酚作用于体外培养的人结肠癌LoVo细胞,用MTT(四甲基偶氮唑蓝)比色法检测LoVo细胞的生长活性,光镜下观察细胞形态学改变,流式细胞仪测定细胞凋亡率以及Bcl-2蛋白表达水平.结果 丹皮酚在0.047-1.504μmol/L剂量下对体外培养的结直肠癌Lovo细胞的增殖具有抑制作用,且呈明显的剂量、时间效应关系(P＜0.05或P＜0.01).丹皮酚0.094-1.504 μmol/L作用48 h后,光镜可见LoVo细胞呈典型的凋亡形态学改变;流式细胞仪检测结果 显示,细胞凋亡率升高,呈药物剂量依赖性,Bcl-2基因表达显著下调,与对照组相比,差异有统计学意义(P＜0.01).结论 丹皮酚对人结肠癌LoVo细胞生长具有抑制作用,其机制可能与下调Bcl-2基因表达,诱导肿瘤细胞凋亡有关.     

IL—6抗化疗药所致血细胞和巨噬细胞功能减低效应的观察

将5-氟脲嘧啶（5－Fu125mg／kg）为化疗组；注入小鼠后5h后再给IL－6（10000U／0．5ml每日1次）为IL－6组；给生理盐水为阴性对照组。第1、3、5、7天后，阴性对照组血白细胞、血小板数值无明显变化，化疗组则呈明显下降趋势，应用IL－6后在第3天以后白细胞下降趋势略小于化疗组，血小板下降明显小于化疗组。化疗组巨噬细胞吞噬率（％）和指数明显下降，应用IL－6后则升高，并发现脾组织红髓中大量巨噬细胞增生，白髓中大量淋巴细胞及母细胞聚集。说明IL－6可促进受抑制造血和免疫机能恢复。