肠道微生物群的病理生理学进展

Before the technique of advanced high-throughput sequencing comes up, less is known about the human gut microbiota. It has been understood that trillions of microbes, in which 99% are bacteria, inhabit the human gut, forming a complicated ecological community. The gut microbiota has a great impact on human physiology and susceptibility to disease through its integrative metabolic activities and interactions with the host. In physiology, gut microbiota contributes to the host acquisition of nutrition and energy from diets, promoting development and maturation of gastrointestinal tract and immune system, and protecting host from invasion of enteropathogens. In pathology, dysbiosis underlying altered gut microbiota is associated with the susceptibilities to various diseases, including inflammatory bowel disease, type 1 diabetes, asthma, obesity, metabolic syndrome, autism and cancer. Understanding of the factors that underlie alterations in the composition and function of gut microbiota will be helpful in the development of drugs and the design of therapies that target it. This goal is formidable. It is because that the compositions of gut microbiota are immensely diverse, varying between individuals in a population and fluctuating over time in an individual, especially during early development and diseases. Viewing the gut microbiota with an ecological perspective will provide new insights into how to improve our health by targeting this microbial community in clinical treatments.     

三黄地榆散对多重耐药铜绿假单胞菌的抑制作用研究

目的 探讨三黄地榆散对多重耐药铜绿假单胞菌的抑制效果,为其临床应用提供依据.方法 首先制备中药含药血清用于体外最小抑菌浓度(MIC)、最小杀菌浓度(MBC)测定.然后建立烫伤大鼠感染多重耐药铜绿假单胞菌模型,分别给予西药硫酸庆大霉素和中药三黄地榆散灌胃,正常组和模型组灌胃等容量的无菌生理盐水;在给药后的第3、7、10天检测血液中炎性细胞和炎性因子的水平.结果 体外抑菌实验显示,三黄地榆散含药血清与庆大霉素对多重耐药铜绿假单胞菌的MIC、MBC均为512μg/mL.体内实验结果显示,与模型组比较均能显著下调大鼠血清WBC、IL-1β、TNF-α的水平(P<0.05).结论 三黄地榆散能抑制多重耐药铜绿假单胞菌的生长,对多重耐药铜绿假单胞菌感染烫伤大鼠治疗具有较好的疗效,机制可能与调节IL-1β、TNF-α水平有关.     

胎膜早破孕妇宫颈支原体和衣原体感染情况及支原体药敏分析

目的 了解湖州市妇幼保健院因胎膜早破住院分娩的孕妇宫颈支原体和衣原体感染情况及支原体药敏分析。方法 选择湖州市妇幼保健院胎膜早破孕产妇208例为观察组,无胎膜早破分娩孕产妇100例为对照组,对观察组及对照组孕产妇的宫颈分泌物进行支原体培养+药敏检测。结果 观察组支原体、衣原体总感染率为47.12%（98/208）,支原体感染率44.71%（93/208）,沙眼衣原体感染率为5.28%（11/208）,与对照组比较,观察组的UU、MH、CT总感染率及UU、MH感染率、CT感染率均较对照组升高（P<0.05）,且两组孕妇支原体感染中均无单一人型支原体MH感染,人型支原体MH感染均以与UU混合感染形式存在。沙眼衣原体感染中亦多半以与UU混合感染形式存在。支原体阳性标本药敏试验显示,解脲支原体UU、MH及UU联合MH对强力霉素、美满霉素、交沙霉素的敏感度较高,可达100%。结论 胎膜早破孕妇宫颈支原体检出率高提示孕妇胎膜早破与宫颈支原体感染密切相关,衣原体检出率虽然不高,但与对照组相比却明显升高,提示孕妇胎膜早破与沙眼衣原体感染也有一定的相关性,故建议在计划妊娠前、妊娠早、中晚期应进行筛查,做到早发现早治疗,性伴侣同时治疗,减少PROM的发生,提高生育质量。支原体药敏试验提示支原体对多种药物耐药,但对强力霉素、美满霉素、交沙霉素敏感度较高。     

rs671和rs1801157基因多态性与云南汉族人群心肌梗死的易感性分析

目的对云南高海拔地区汉族人群rs671 和rs1801157 单核苷酸多态性（SNP）进行分析,探讨其与心肌梗死（MI）易感性的关系。方法Sequenom MassArray 系统基因分型方法对500 例云南高海拔地区汉族MI患者和350例对照组患者671和1801157的基因多态性进行检测,结合患者CAD/MI主要独立危险因素（性别、年龄、高血压、糖尿病、脂质浓度、肥胖程度、烟酒史及家族史等）,分析MI 与SNP变化之间的潜在关联性。结果rs671 和rs1801157 基因型在MI组和对照组中达到遗传平衡（P >0.05）。MI 组中rs671AA、AG 及A 等位基因频率与rs1801157的、及等位基因均高于对照组,而rs671的基因型和rs1801157的AA频率、等位基因低于对照组（P <0.05）。加性模型下,rs671 A等位基因能增加MI的患病风险[OR=2.57（95%CI：1.96,3.37）P <0.05],而 1801157基因型G等位基因能增加MI的患病风险[OR=2.68（95%CI：1.84,3.15）P <0.05];在显性模型下,671 A 等位基因能增加 MI 的患病风险[OR=3.69（95%CI：2.68,5.08）P <0.05];在隐性模型下,rs671和 rs1801157 与 MI 无相关,OR=3.86（95%CI：0.88,17.03, P=0.074）和 2.06（95%CI：0.68,4.89, P=0.12）。在非饮酒患者中 671 A 等位基因能增加 MI 的患病风险[OR=1.27（95%CI：1.05,2.93）P =0.032];在饮酒患者中 671A 等位基因不能增加 MI 的患病风险OR=1.58（95%CI：0.84,1.87,P =0.36）,在饮酒与否的患者中 rs1801157 均不增加MI 的患病风险。结论rs671 和rs1801157 位点的多态性变异与MI 遗传易感性相关,rs671A 和rs1801157 等位基因能增加MI 患者的患病风险。     

不同类型冠心病患者Lp-PLA2基因N133K位点多态性的意义

目的 检测人脂蛋白相关磷脂酶A2(Lp-PLA2)基因N133K位点多态性与不同类型冠心病之间的相关性及临床意义.方法 以心绞痛患者426例为心绞痛组、心肌梗死患者415例为心梗组,以同期体检健康者400例为对照组.应用聚合酶链反应(PCR)分析技术结合DNA直接测序技术,对入选者Lp-PLA2基因N133K(C/G)位点多态性进行分型.采用多因素logistic回归分析Lp-PLA2基因N133K多态位点与不同类型冠心病的相关性.同时检测入组者血脂及Lp-PLA2水平等指标.结果 总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Lp-PLA2水平在3组间差异有统计学意义(均P<0.05),其中心梗组TC、TG、LDL-C、Lp-PLA2高于心绞痛组和对照组,HDL-C低于心绞痛组和对照组,心绞痛组TC、TG、LDL-C、Lp-PLA2高于对照组,HDL-C低于对照组(均P<0.05).心梗组和心绞痛组1个月后复查时,Lp-PLA2水平均明显降低(均P<0.05).心梗组GG、GC基因型以及G等位基因的分布频率明显高于心绞痛组和对照组,心绞痛组GG、GC基因型以及G等位基因的分布频率明显高于对照组(均P<0.05).Logistic回归分析发现,Lp-PLA2基因N133K(C/G)多态位点GG基因型与冠心病的发生有显著的相关性(P<0.01).结论Lp-PLA2基因N133K(C/G)多态位点基因突变可能与冠心病病情有关.     

定量磁敏感图对脑微出血的诊断价值

目的 探讨定量磁敏感图(quantitative susceptibility mapping,QSM)在脑微出血(cerebral microbleeds,CMBs)中的临床应用价值。方法 对122例拟诊脑血管病患者进行头颅MRI常规序列扫描(包括T1、T2、T2FLAIR序列)并做SWI及QSM序列成像检查,这些患者全部在1周内做了头颅CT平扫,全部患者检查成功,分别获得基底节区及基底节区以外区域的CMBs个数,并做相应统计学分析。结果 122例拟诊脑血管病患者中,80例有CMBs,42例未检出,二者共检出CMBs 481个,其中QSM序列共检出CMBs 481个,SWI序列共检出CMBs 447个,比较2种序列对CMBs总的检出率,差异有统计学意义(P<0.05),2种序列对基底节及基底节外区CMBs检出率,差异具有统计学意义(P<0.05)。结论 QSM序列对CMBs检出率优于SWI序列,是一种准确可靠的诊断CMBs的影像学方法。     

泌尿生殖道支原体感染及体外药敏试验分析

目的:分析本地区解脲脲原体(Uu)和人型支原体(Mh)的感染状况和耐药性,并对耐药机制进行讨论.指导临床合理用药.方法:对1 612例疑为非淋菌性尿道炎(NGU)患者的泌尿生殖道标本进行支原体检测,并对阳性标本进行抗生素敏感试验.结果:1612例标本中,支原体检出1160例,感染率为72%.其中Uu、Mh、Uu Mh感染率分别为71%、19.7%、9.3%,Uu感染明显高于Mh感染,男性Uu感染率(75.5%)高于女性(68%),女性Mh感染率(22.1%)高于男性(16.0%),总感染率女性(59.6%)高于男性(40.4%),差异有统计学意义(P＜0.05).Uu和Mh对强力霉素、交沙霉素、原始霉素较为敏感.耐药率都在5%以下.Uu和Mh对氟喹诺酮类药物耐药率较高.Mh对红霉素、阿奇霉素、克拉霉素耐药率较高.而Uu对其敏感.结论:NGU患者中支原体是主要病原体之一,鉴于耐药菌株的不断变化,建议在进行支原体检测时进行药敏试验,加强对耐药性的监测,并对其耐药机制进行深入研究,对指导临床治疗具有重要意义.新一代四环素类药物可作为Uu和Mh感染的一线药物.     

Assay of cytomegalovirus susceptibility to ganciclovir in renal and heart transplant recipients

Ganciclovir (GCV) prophylaxis or pre-emptive therapy significantly reduce the rate of cytomegalovirus (CMV) disease and viremia, but increase the potential for emergence of ganciclovir-resistant CMV strains. The inhibitor concentration at 50% (IC(50)) of GCV from 156 CMV isolates from 59 renal or heart transplant recipients was calculated by means of a rapid phenotypic susceptibility assay. Twenty-seven strains were from 14 patients undergoing GCV therapy. The IC(50) was higher in patients under the prophylaxis regimen. One CMV strain, from a heart transplant recipient, became GCV-resistant after 1 month of therapy (IC(50)=13.7 micromol/l). These data, together with clinical and virological markers, suggested that a switch to foscarnet was necessary, and good evolution was observed. Thus, assay of CMV susceptibility to GCV could be helpful in clinical management.     

颅内脑外型海绵状血管瘤MRI表现与误诊分析

［摘要］ 目的 分析颅内脑外型海绵状血管瘤（ECMs）的MRI表现及误诊原因,以提高术前诊断准确率。方法 回顾性分析9例经手术病理确诊ECMs患者的MRI表现,观察病变部位、信号特点,结合病理特点,进行误诊分析。结果 本组9例病例中,多发病灶2例,即内听道并脑内型海绵状血管瘤,单发病灶7例,其中病变位于海绵窦区3例,颅中窝、侧脑室后角、第四脑室、窦汇区各1例。周围组织水肿1例,无水肿8例。信号不均匀者5例,均匀者4例,以T1WI呈等信号、T2WI与FLAIR呈高信号为主,增强后早期明显强化,强化程度同血管样强化。4例SWI呈等、低、高混杂信号,2例呈等信号。DWI呈稍低信号3例,1例呈等低混杂信号,ADC图呈稍高信号4例。MRS中Cho、NAA峰位于基线水平者3例,发现Lac1例。PWI提示低灌注1例。结论 ECMs以T2WI、FLAIR高信号为主、常见“环铁征”、低灌注的脑组织外血管畸形病变,少见周围组织水肿。利用SWI、MRS及PWI等影像新技术,提高ECMs的诊断准确性,为临床治疗提供全面、准确的信息。     

IL‐16 polymorphism and risk of renal cell carcinoma: Association in a Chinese population

Objectives: Interleukin‐16 (IL‐16) plays a fundamental role in inflammatory diseases, as well as in the development and progression of tumors. A T‐to‐C polymorphism at the ‐295 position in the promoter region of the IL‐16 gene has been described. This variation might lead to altered IL‐16 expression, and might modulate an individual's susceptibility to cancer. The objective of the present study was to determine if IL‐16 polymorphism is associated with risk of renal cell carcinoma (RCC). Methods: A case–control study including 335 RCC cases and 340 cancer‐free controls was carried out. All subjects were genetically unrelated ethnic Han Chinese recruited from a single institution between July 2006 and July 2009. The IL‐16 ‐295 T>C polymorphism was determined by using the polymerase chain reaction‐restriction fragment length polymorphism method. Serum samples were available for 70 RCC cases and 96 controls to detect IL‐16 concentration. Results: Compared with the IL‐16 ‐295 TT genotype, the CC genotype had a significantly decreased RCC risk (adjusted odds ratio [OR] = 0.34, 95% confidence interval [CI] = 0.18–0.66). Furthermore, a significant decreased risk of RCC was found in the combined variant genotypes CT + CC compared with the TT genotype (adjusted OR = 0.68, 95% CI = 0.50–0.93). In addition, the serum IL‐16 levels in RCC patients were significantly lower than those in controls (P < 0.001). Furthermore, patients carrying CC genotype or CT genotype had higher serum IL‐16 levels than TT carriers. Conclusion: IL‐16 ‐295 T>C polymorphism is significantly associated with a higher risk of developing RCC in Chinese population.