抗心磷脂及β2糖蛋白Ⅰ抗体滴度值对妊高病母儿结局的影响

目的：分析抗心磷脂抗体（ACA）及抗β2糖蛋白Ⅰ（β2-GPI）抗体的滴度值对妊高病患者妊娠结局的影响。方法选取冠县人民医院2013年9月至2015年9月收治的120例妊娠高血压患者作为观察组,按照病情轻重将60例轻度子痫前期患者作为观察组A,将60例重度子痫前期患者作为观察组B,另选择同时期收治的正常分娩产妇60例作为对照组,采用ELISA法对三组产妇的血清抗心磷脂抗体及抗β2-GP1抗体的滴度值进行检测,并对比三组患者的妊娠结局。结果观察组B较观察组A、对照组相比,ACA-IgG、ACA-IgM及抗β-GPI抗体水平升高,差异具有统计学意义（t＝3．45～6．89,均P＜0．05）。观察组A与对照组相比,胎儿生长受限、早产、围生儿死亡、胎盘早剥、死胎发生率明显增加,差异具有统计学意义（χ2＝4．45～7．12,均P＜0．05）。观察组B较观察组A、对照组相比胎儿生长受限、早产、围生儿死亡、胎盘早剥、死胎发生率明显增加,差异具有统计学意义（χ2＝4．92～7．34,均P＜0．05）。 ACA-IgM与胎儿生长受限有显著相关性（r＝0．42,P＜0．05）。 ACA-IgG及抗β-GPI抗体水平与早产发生率呈显著相关性,随着抗体水平的升高,早产发生率也相应增高（ r值分别为0．54、0．68,均P＜0．05）。 ACA-IgG、ACA-IgM及抗β-GPI抗体水平3者之间两两存在显著的相关性（ r值分别为0．619、0．616、0．382,均P＜0．05）。结论血清抗心磷脂抗体及抗β2-GPI抗体可能均参加了子痫前期的发生发展过程,子痫前期患者不良妊娠结局率较高,早期检测ACA及β2-GPI抗体的滴度值具有好的应用价值。     

三种不同类型抗心磷脂抗体在小儿病毒性心肌炎中的价值

采用酶联免疫吸附试验（ＥＬＩＳＡ）法测定６２例ＣｏｘＢ组病毒引起的病毒性心肌炎（ＶＭ）患儿和４０名健康儿童的血清抗心磷脂抗体（ＡＣＡ）。结果：ＶＭ组ＡＣＡ－ＩｇＧ、ＡＣＡ－ＩｇＡ、ＡＣＡ－ＩｇＭ阳性率（分别为４５．２％、３０．６％、３３．９％）均显著高于正常对照组（分别为２．５％、０、０）;ＶＭ发病早期ＡＣＡ－ｉｇＡ、ＡＣＡ－ＩｇＭ阳性显著多于ＡＣＡ－ｉｇＧ阳性恩赐 ＡＣＡ－ＩｇＧ阳性者的ＣＫ－Ｍ     

抗心磷脂抗体检测及其影响因素的研究

目的：研究血清样品稀释度、温度、离子强度以及样品检测间隔时间对血清抗心磷脂抗体（ＡＣＡ）检测结果的影响。方法：采用酶联免疫吸附测定法（ＥＬＩＳＡ）检测ＡＣＡ。结果：血清样品最佳稀释度为１：５０;３７℃时光吸收值比２２℃和２５℃的光吸收值显著下降;１５ｍｏｌ／Ｌ ＮａＣｌ可明显抑制ＡＣＡ与抗原结合（Ｐ〈０．０１）,抑制率平均为４５．４％,包被１４ｄ以上的检测结果明显高于１ｄ和７ｄ的测定结果（Ｐ〈０．     

ELISA检测心磷脂抗体在胎儿发育方面的应用

目的:探讨胎儿生长迟缓(IUGR)与抗心磷脂抗体(ACA)的相关性。方法:用酶免疫吸附法ELISA检测5330例正常孕妇血清的ACA,同时对IUGR合并ACA阳性产妇产后胎盘进行免疫荧光检查,了解其结构改变。结果:正常孕妇ACA阳性发生率为2.70%,其中IUGR发生率15.28%,ACA阴性的孕妇IUGR发生率为1.77%,两者比较,差异有极显著性(P<0.01)。新生儿IUGRIgG阳性5例,胎盘免疫荧光检查发现胎盘组织均出现免疫球蛋白荧光抗体和补体阳性着色。结论:ACA阳性是IUGR发生的病因之一,ACA检测给IUGR的病因诊治提供了新的研究途径。     

Impaired carbon monoxide diffusing capacity as a marker of limited systemic sclerosis

Background

As impairment of diffusing capacity for carbon monoxide (DLCO) likely reflects underlying pulmonary vasculopathy in limited systemic sclerosis (lSSc), we examined whether DLCO could help to distinguish secondary from idiopathic Raynaud's phenomenon (iRP).

Methods

We compared pulmonary function test (PFT) results in 145 lSSc patients and 24 age- and sex-matched iRP patients. RP duration at time of PFT was similar in the two groups.

Results

DLCO values were low (< 80% of predicted) in 106 (73%) of the 145 lSSc patients, and in 69 (71%) of the 97 patients with early lSSc. Interstitial lung disease (ILD) was found in 10% of lSSc patients. DLCO was significantly lower in lSSc than in iRP (72 ± 15% versus 89 ± 9%, p < 0.0001). When evaluated, alveolar capillary membrane conductance (Dm) was markedly lower in lSSc patients without ILD than in iRP patients (45 ± 12% versus 71 ± 2.5%, p = 0.003), although capillary blood volume was not different. DLCO was low in 3 iRP patients (12.5%). The sensitivity and specificity of low DLCO values for early lSSc diagnosis in patients with Raynaud's phenomenon were 71% and 87.5%, respectively. Sensitivity was similar to that of anti-centromere-antibodies (75%) and nailfold capillary abnormalities (81%). A DLCO cutoff of < 70% had a sensitivity and specificity of 41% and 100%, respectively.In multivariable analysis, age and low DLCO were the only independent predictors of death; the hazard ratio for DLCO ≤ 50% was 7.9 (95% CI 2.3-26, p = 0.0007).

Conclusion

Isolated DLCO impairment is significantly more frequent in patients with lSSc than in patients with idiopathic iRP. DLCO measurement could be a useful diagnostic tool for lSSc.     

安子合剂对ACA阳性先兆流产患者CD4~+CD25~+FOXP3~+Treg细胞免疫调节的影响

目的:观察安子合剂对ACA阳性先兆流产患者CD4+CD25+FOXP3+Treg细胞免疫调节的影响。方法:选取ACA阳性先兆流产患者为治疗组(27例),给服中药安子合剂,125ml,2次/日,连服4周;选取正常孕妇为对照组(15例)。检测患者治疗前后及正常孕妇外周血CD4+CD25+FOXP3+Treg细胞的比例,并测定患者治疗前后血清ACA指标、B超检查胚胎发育情况等。结果:治疗组患者治疗前CD4+CD25+FOXP3+Treg细胞的比例显著低于正常妊娠对照组(P<0.01);治疗后,其细胞比例显著高于治疗前(P<0.01)。27例患者中20例ACA阳性的转阴率达85.00%,7例ACA定量滴度较治疗前显著下降(P<0.01)。保胎的成功率达92.59%。结论:ACA阳性先兆流产患者外周血CD4+CD25+FOXP3+Treg细胞的比例低于正常妊娠妇女,存在免疫调节异常;安子合剂治疗ACA阳性先兆流产的作用机理之一与增加CD4+CD25+FOXP3+Treg细胞的比例、调节妊娠期机体免疫功能有关。     

The Evolving Health Policy Landscape and Suggested Geriatric Tenets to Guide Future Responses

We cannot view the future of healthcare but we can sense that big changes are afoot. Many revolve around the plans to “repeal and replace” the Affordable Care Act. We speculate on some potential areas of change in the context of a set of tenets about what care for older persons should address.     

Early assessment of sub-clinical cardiac involvement in systemic sclerosis (SSc) using delayed enhancement cardiac magnetic resonance (CE-MRI)

Objectives

Systemic sclerosis heart involvement (SHI) is one of systemic sclerosis (SSc) most frequent complications, both in diffuse (dcSSc) and limited (lcSSc) cutaneous forms of disease. Nowadays, SHI is a major factor decreasing SSc survival rate because, when clinically evident, is associated with 70% of mortality at 5 years. SHI shows different forms, primary and/or secondary. Primary myocardial SHI is characterized by fibrosis. Aim of our study is to assess the presence and pattern of fibrosis as detected by cardiac magnetic resonance (CMR) in systemic sclerosis.

Methods

In this study, we used CE-MRI (contrast enhanced-MRI) in 58 female SSc patients. Images were evaluated to obtain functional parameters and to see presence, location and pattern (nodular, linear or diffuse) of myocardial LE, sign of fibrosis. CE-MRI findings were correlated with patients clinical setting.

Results

Myocardial fibrosis was detected in 25 of 58 patients (43%). The main finding observed in 16 of these 25 patients was a late enhancement showing a linear pattern, without coronary distribution and sparing the sub-endocardial myocardial layers. A patchy nodular enhancement pattern was observed in 9 patients (36%). Patients with linear pattern presented dcSSc, on the contrary patients with nodular LE displayed the lcSSc form.

Conclusions

This study shows that CE-MRI is a reliable technique to detect SHI earlier than other methods. SHI increase passive myocardial stiffness, proportional to collagen deposition degree, leading to cardiac remodelling with possible development of heart failure, even with normal ejection fraction. An early treatment of SHI might improve SSc patients outcome.     

清固方对抗磷脂抗体综合征受孕小鼠ACA及胚胎吸收率的影响

目的:观察清固方对抗磷脂抗体阳性受孕小鼠抗心磷脂抗体(ACA)、胚胎吸收率的影响。方法:通过建立β_2糖蛋白Ⅰ(β_2 GPI)所致小鼠体内产生抗磷脂综合征的模型,观察中药复方清固方对抗磷脂抗体阳性抗磷脂综合征受孕小鼠ACA、胚胎吸收率的影响。结果:清固方对小鼠体内ACA、胚胎吸收率有明显的降低作用,并呈剂量相关性。结论:清固方能够有效降低抗磷脂综合征受孕小鼠体内的ACA、胚胎吸收率水平,并抑制抗磷脂抗体的产生及其对胚胎的损害,从而达到保胎的目的。     

ACA抑制肿瘤形成的机制

引言癌症严重威胁着人类的生命。药物在癌症治疗中起着举足轻重的作用。研究抗癌药物的作用机制,对癌症的防治具有重要的意义。本文就ACA抑制肿瘤形成的机制做一简单综述。1ACA的来源及抑制肿瘤效果ACA((1’S)1’acetoxychavicolacetate)是Languasgalanga(Zingiberacease)根的提取物,这种植物主要种植在中国、印度、以及东南亚的一些国家,Languasgalanga(Zingiberacease)的根被认为具有抗氧化的活性。近年来的研究表明,ACA在抗癌症方面更加表现出诱人的前景。2ACA抑制肿瘤形成的机制2.1ACA抑制了自由基迸发细胞受到外界刺激,会诱导自由基的迸发。当防御系统功能低下时,异常增多和积累的自由基对生物机体造成一系列的氧化损伤,导致细胞膜损伤,DNA碱基氧化,DNA链断裂,染色体变形,蛋白质失活等。已有研究表明,自由基参与了肿瘤形成的信号传导途径,在致癌过程中起着重要的作用。Nakamura等[1]在TPA诱导鼠皮肤癌形成的实验中,用Genistein和HC(1’hydrooxychavicol)做对照实验,结果发现ACA抑制了TPA诱导的细胞H...