sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情转归关系探究

目的 探讨可溶性白细胞分化抗原14（soluble cluster of differentiation antigen 14,sCD14）、血管生成素2（angiopoietin 2,Ang2）、C反应蛋白（C-reactive protein,CRP）与急诊创伤骨折伴多发伤患者病情转归的关系及意义。 方法 选取创伤骨折伴多发伤患者324例,根据患者出院时病情转归情况分为良好组（275例）、不良组（49例）,比较2组一般资料、sCD14、Ang2、CRP水平,应用Pearson分析sCD14、Ang2、CRP与损伤严重程度评分（injury severity score,ISS）关系,采用Cox回归分析急诊创伤骨折伴多发伤患者病情转归的相关影响因素,采用受试者工作特征曲线（receiver operating characteristic,ROC）分析sCD14、Ang2、CRP对病情转归预测价值。 结果 不良组ISS评分高于良好组（P＜0.05）;不良组sCD14、Ang2、CRP高于良好组（P＜0.05）;sCD14（r=0.785）、Ang2（r=0.778）、CRP（r=0.842）与ISS评分呈正相关（P＜0.05）;sCD14、Ang2、CRP均是预后相关独立危险因素（P＜0.05）;sCD14、Ang2、CRP预测病情转归的ROC下面积（area under the curve,AUC）依次为0.813、0.757、0.749;挑选出预测敏感度最高（sCD14）、特异度最高（Ang2）的两个指标进行sCD14+Ang2的联合ROC分析显示,两者联合预测病情转归的AUC为0.935,大于任一单一指标（P＜0.05）。 结论 sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情严重程度及病情转归有关,均可作为预测病情转归的标志物,但联合检测sCD14、Ang2能提高预测可靠性,为临床诊疗及护理提供更准确的参考信息。     

活动性肺结核患者血清Fad D9重组蛋白、sCD14-ST及单核细胞P糖蛋白水平及其临床意义

目的探讨活动性肺结核(APTB)患者血清Fad D9重组蛋白、可溶性白细胞分化抗原14亚型(sCD14-ST)、单核细胞P糖蛋白(Pgp)表达及其临床意义。 方法选取96例APTB患者(APTB组),按照肺部病灶有无空洞和病灶肺叶数分亚组。同期选择体检健康且经γ干扰素释放试验检测阴性者(健康对照组,HC组)及阳性者(结核潜伏感染组,LTBI组)各48例。比较各组血清Fad D9重组蛋白、sCD14-ST、Pgp水平。评估Fad D9重组蛋白、sCD14-ST、Pgp诊断APTB和鉴别APTB、LTBI的价值。 结果Fad D9重组蛋白、sCD14-ST、Pgp水平APTB组＞LTBI组＞HC组,且有空洞者高于无空洞者,病灶肺叶≥3个者高于＜3个者(P＜0.05)。Fad D9重组蛋白、sCD14-ST、Pgp对APTB诊断和APTB、LTBI鉴别有良好效能(P＜0.05)。 结论APTB患者血清Fad D9重组蛋白、sCD14-ST及Pgp明显升高,且与肺部病灶的严重程度有关。     

Biocompatibility Study Based on Differential Sequestration Kinetics of CD14+CD16+ Blood Monocyte Subsets with Different Dialyzers

The immune defect in hemodialysis (HD) patients is associated with a monocyte dysfunction, including an increase in the production of proinflammatory cytokines. Blood membrane contact leads to an increase in cellular activation and sequestration into the capillary bed of the lung. The influence of the sequestration on the number of mature monocytes was studied by analyzing the fate of monocytes, particularly, the CD14+CD16+ subpopulation, during HD treatment.

In thirty stable HD patients, the distinct cell populations were determined by differential blood counts and flow cytometry. Patients with diabetes or systemic vasculitis, those showing evidence of infectious complications or malignancy, or those taking immunosuppressive medications were excluded from the study. Cells from this study population were analyzed before the start, 30 min thereafter, and at the end of HD treatment, each time using a different dialyzer: hemophan, methylmethacrylate (PMMA), triacetate membrane, cuprophane/vitamin E, acrylonitrile, and sodium methallylsulfonate polymer (AN69).

The CD14+CD16+ subset decreased at 30 min and remained suppressed for the course of dialysis. To examine whether currently used biocompatible membranes differ in their effect on the sequestration of monocyte subpopulations, temporal monocytic changes were comparatively analyzed during HD with a different dialyzer. The drop in the first 30 min until the end of HD treatment was significant (p<0.05), very uniform, and sharp in all patients, and was independent upon membrane type.

The CD14+CD16+ monocyte subpopulation showed increased and longer margination from the blood circulation during HD. Given the fact that CD14+CD16+ monocytes represent a sensitive marker for inflammation or cellular activation, the depletion of these cells may offer an easily accessible parameter that is more sensitive than complement activation for biocompatibility studies on forthcoming, improved dialyzer membranes.     

Imaging and retention measurements of selenium 75 homocholic acid conjugated with taurine,and the carbon 14 glycochol breath test to document ileal dysfunction due to late radiation damage

In order to assess ileal dysfunction in patients with complaints after pelvic radiation therapy, retention measurements and scintigraphic imaging with selenium 75 homocholic acid conjugated with taurine (⁷⁵Se-HCAT), combined with the carbon 14 glycochol breath test, were evaluated in 39 patients. In 22 patients without ileal resection the results of the⁷⁵Se-HCAT test and the breath test differentiated between a normal functioning ileum (both tests negative) and ileal dysfunction as a cause of complaints (one or both tests positive). Among the patients with ileal dysfunction, the combination of both tests permitted those with bacterial overgrowth (breath test positive,⁷⁵Se-HCAT negative) to be separated from patients with evidence of bile acid malabsorption (⁷⁵Se-HCAT positive, breath test positive or negative). In 17 patients with small-bowel resection, the⁷⁵Se-HCAT test helped to estimate the severity of bile acid malabsorption with implications for therapy. In this group the breath test was false-negative in 7 cases with abnormal⁷⁵Se-HCAT. Additional systematically performed scintigraphic imaging improved the accuracy of the⁷⁵Se-HCAT test, revealing cases with prolonged colonic accumulation of the radiopharmaceutical, causing spurious retention values. In conclusion, assessment of ileal dysfunction by nuclear medicine techniques in post-irradiation conditions provides information about the aetiology and therefore the possibility of adjustment in the clinical management. Offprint requests to: R.A. Valdes Olmos     

内毒素的跨膜信号转导及其在全身炎症反应综合征中的作用

失控性炎症反应是目前临床上最为常见的病理现象，是创伤后并发症发生发展的重要机制。细菌脂多糖（LPS）是最常见的诱导失控性炎症反应的主要因素之一。单核／巨噬细胞表面LPS相关受体是机体识别并启动炎症反应的始动因素，是诱导炎症反应失控的关键环节之一，单核／巨噬细胞膜表面存在多种LPS相关受体，其中清道夫受体（SR）、CD14、Toll样受体4（TLR4）为高亲和力或敏感性LPS受体。SR与单核／巨噬细胞清除、灭活LPS有关；CD14和TLR4是介导LPS激活细胞的重要受体。TLR2、β2整合素、L-selectin等为低亲和力LPS受体，作为“二级受体”在促进LPS诱导的促炎症和抗炎症反应中可能发挥重要的“催化作用”。TLR4可能是LPS激活血管内皮细胞的受体途径。单核／巨噬细胞表面防御性受体（如SR）下调、兴奋性受体（如CD14、TLR4、TLR2等）上调，可能是感染过程中单核／巨噬细胞由早期的防御性（清除、灭活LPS）转化为后期的效应性（释放大量的炎症和抗炎症介质）的重要机制。深化研究LPS跨膜信号转导的分子机制，可望为有效控制失控性炎症反应提供新思路。     

内毒素血症时血浆氧化型低密度脂蛋白的变化及其对库普弗细胞-内毒素反应的影响

目的：探讨内毒素血症时血浆氧化型低密度脂蛋白（Ox-LDL)的变化规律及Ox-LDL对库普弗细胞（KC）－内毒素（LPS）反应的影响。方法：Wistar大鼠36只，随机分为对照组（6只）和LPS组（分为1，5，10mg/kg三组，每组10只），复制大鼠内毒素血症模型，采用ELISA方法检测对照组及注射内毒素后0.5,1,3,5,8h时血浆Ox-LDL水平变化及其与LPS的量效关系。分离培养小鼠KC，分别用Ox-LDL(10-100μg/ml），抗小鼠清道夫受体（SR）单抗（10μg/ml）及抗CD14单抗（10μg/mol)＋Ox-DLD(100μg/ml）预处理KC1h后，再分别与1，10ng/mlLPS孵育3h，观察以上预处理对LPS诱导KC释放肿瘤坏死因子－α(TNF-α）的影响及其与KC表面CD14的关系。细胞上清TNF－α水平采用ELISA法检测。结果：注射LPS后，3组大鼠血浆Ox-LDL水平均显著增高，以10mg/kg组升高最明显。Ox-LDL预处理KC，能显著增强内毒素对KC的激活作用，表现为TNF－α含量明显升高，呈明显的量效关系。Ox-LDL的这种增强作用。结论：内毒素血症早期血浆Ox-LDL水平明显增高，与LPS呈明显的量效关系；Ox-LDL能明显增强LPS对KC的激活作用，其机制可能与促进LPS与细胞表面CD14结合有一定关系。     

The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma

Background

We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma.

Methods

Over a 49-month period, 132 patients with malignant pleural mesothelioma underwent surgery. Fifty-three underwent extrapleural pneumonectomy and 79 underwent nonradical procedures. Time to evidence of clinical disease progression was recorded, as was the site(s) of that disease.

Results

One-hundred nineteen patients were evaluable, of which 59% (22 radical; 48 nonradical) had disease progression. Overall 30-day mortality was 8.5% (7.5% radical; 9% nonradical). The median time to overall disease progression was considerably longer after extrapleural pneumonectomy than debulking surgery (319 days vs 197 days, p = 0.019), as was the time to local disease progression (631 days vs 218 days, p = 0.0018). There was no preponderance of earlier stage disease in the radical surgery group. There was a trend toward prolonged survival in those undergoing radical surgery, but no significant difference between the groups (497 days vs 324 days, p = 0.079). In those who had extrapleural pneumonectomy, time-to-disease progression significantly decreased with N2 disease compared with N0/1 involvement (197 days vs 358 days, p = 0.02).

Conclusions

Extrapleural pneumonectomy may be preferable to debulking surgery in malignant pleural mesothelioma to delay disease progression and give greater control of local disease. Involvement of N2 nodes is associated with accelerated disease progression and is therefore a contraindication to extrapleural pneumonectomy.     

Large-conductance Ca2+-activated K+ channel involvement in suppression of cerebral ischemia/reperfusion injury after electroacupuncture atShuigou (GV26) acupoint in rats

Excess activation and expression of large-conductance Ca2+-activated K+ channels (BKCa channels) may be an important mechanism for delayed neuronal death after cerebral ischemia/reperfusion injury. Electroacupuncture can regulate BKCa channels after cerebral ischemia/reperfusion injury, but the precise mechanism remains unclear. In this study, we established a rat model of cerebral ischemia/reperfusion injury. Model rats received electroacupuncture of 1 mA and 2 Hz atShuigou (GV26) for 10 minutes, once every 12 hours for a total of six times in 72 hours. We found that in cerebral ischemia/reperfusion injury rats, ischemic changes in the cerebral cortex were mitigated after electroacupuncture. Moreover, BKCa channel protein and mRNA expression were reduced in the cerebral cortex and neurological function noticeably improved. These changes did not occur after electroacupuncture at a non-acupoint (5 mm lateral to the left side of Shuigou). Thus, our ifndings indicate that electroacupuncture atShuigou improves neurological function in rats following cerebral ischemia/reperfu-sion injury, and may be associated with down-regulation of BKCa channel protein and mRNA expression. Additionally, our results suggest that theShuigou acupoint has functional speciifcity.     

The effect of apolipoprotein A on in vitro apolipoprotein C binding and in vivo removal of artificial triacylglycerol-rich particles

Although the presence of apolipoprotein A on the surface of chylomicrons and its exchange for apolipoprotein C in the mesenteric lymph is known, the functional role of apolipoprotein A in triacylglycerol transport has not been elucidated. Mimicking the in vivo situation, artificial triacylglycerol rich particles (TGRP) with which apolipoprotein AI had been associated, were incubated with high-density lipoproteins (HDL). It was found that apo AI-TGRP bound approximately twice as much apolipoprotein C from HDL as nonprotein-containing TGRP, losing 75% of the apolipoprotein AI originally present. To test whether an increased apolipoprotein C binding in vitro implicated an increased removal rate in vivo, boluses of apolipoprotein AI preincubated and control TGRP were given intravenously (IV) to six hypertriacylglycerolemic patients. The fractional catabolic rate was 35% (range 6% to 65%) higher for apolipoprotein AI preincubated TGRP than for control TGRP. In accordance with the in vitro incubations, the molar ratio of apolipoprotein C to phospholipid on TGRP reisolated 30 minutes after injection was 39% (range 12% to 115%) higher for apo AI triacylglycerol rich particles (TRP) than for control TGRP. The maximal removal capacity of apo AI-TRP, tested in one patient by constant infusion, was increased 53% as compared to control TGRP. Thus, the function of apolipoprotein AI in triacylglycerol transport may be to enhance apolipoprotein C binding to chylomicrons, which are comparable to TRP, and in doing so to enhance their removal from the plasma compartment.     

CD14基因-260A/G位点多态性与前列腺癌易感性的研究

目的研究CD14基因-260A/G位点多态性与前列腺癌易感性的关系。方法提取168例前列腺癌患者和208例对照组的外周血DNA标本,应用聚合酶链反应-连接酶特异检测技术（polymerase chain reaction-ligase detection reaction,PCR-LDR）分析前列腺癌患者CD14-260A/G位点多态性,比较不同基因型和前列腺癌易感性的关系,并探讨不同基因型与前列腺癌患者年龄、体重指数（body mass index,BMI）、吸烟、饮酒及肿瘤家族史的关系。结果总体来说CD14基因-260A/G多态性与前列腺癌易感性之间无显著相关性（P=0.284,OR=1.27,95%CI=0.82～1.94）;饮酒（P=0.003）和肿瘤家族史（P〈0.001）与前列腺癌的发生密切相关;在分层分析中,年龄〈70岁的男性携带CD14-260G（AG＋GG）等位基因者能增加前列腺癌的易感性（P=0.011,OR=2.93,95%CI=1.28～6.70）。结论 CD14基因-260A/G位点多态性在总体上与前列腺癌易感性无显著相关性,但在年龄小于70岁男性中,携带有CD14-260G等位基因者患前列腺癌的危险性却明显增高。