小儿支原体肺炎的免疫分析和匹多莫德治疗后免疫变化

目的:通过比较小儿支原体肺炎(MPP)的体液和细胞免疫的变化特点,为免疫治疗的可能性提供依据,并予匹多莫德治疗证实免疫的变化。方法:对40例MPP患儿和35例健康儿童的外周血,采用流式细胞仪技术检测细胞免疫,以及采用免疫透射比浊法分析体液免疫的表达。40例分2组,阿奇霉素 匹多莫德治疗组和阿奇霉素治疗组阿奇霉素的剂量,疗程相同。结果:MPP患儿与健康儿童对照组的体液免疫IgG、IgM、IgA比较无显著性差异。但CD3~ 、CD4~ 、CD4~ /CD8~ 低于健康儿童对照组,两组比较有显著性差异(P<0.05)。CD8~ 两组间无显著差异。阿奇霉素 匹多莫德治疗组患儿经匹多莫德治疗后CD3~ 、CD4~ 、CD4~ /CD8~ 较阿奇霉素治疗组明显升高。结论:MPP患儿的免疫存在异常,主要区别住CD3~ 、CD4~ 的改变。而患儿血清免疫球蛋白水平与健康儿童对照组比较差异无显著性差异。在常规治疗的同时,加用调节机体细胞免疫功能的药物能促进MPP的恢复。     

2型糖尿病肾病患者细胞黏附分子的表达

目的探讨2型糖尿病肾病（Diabetic nephropathy，DN）患者细胞黏附分子（Cell adhesion molecules CAMs）的表达水平与肾脏微血管病变及尿白蛋白的相关性关系。方法采用酶联免疫法、流式细胞术和放射免疫法分别测定95例2型糖尿病患者（其中65例DN）和35例健康对照者外周血中SICAM-1水平及CD11b、CD62P、CD63阳性表达率和尿微量白蛋白排泄率（Urinary Albttmin Excretion，UAER）。结果糖尿病各组SICAM-1水平和CD11b、CD62P、CD63的阳性表达率均明显高于对照组（P〈0．05及0．01）；微量蛋白尿组和临床蛋白尿组的SICAM-1水平和CD11b、CD62P、CD63阳性表达率与未并发肾病组（正常蛋白尿组）比较，均随着病情的加重而增加，差异均有显著性（P〈0．05及0．01）；相关分析SICAM-1水平和CD11b、CD62P、CD63的阳性表达率均与UAER呈正相关（r分别为0．576，0．489，0．445，0．463，P〈0．05）。结论2型糖尿病患者CAMs的高表达与肾脏微血管病变密切相关．并能反映DN严重程度，联合UAER检测对诊断、观察病情及预防肾脏微血管病变的发生发展均有意义。     

河南省汉族IgA肾病患者外周血白细胞内皮细胞固有型一氧化氮合酶基因多态性检测

目的:研究河南省汉族人内皮细胞固有型一氧化氮合酶(ecNOS)基因多态性与IgA肾病的关联性.方法:采用聚合酶链反应法对河南省198例IgA肾病患者和206例正常人群的ecNOS基因第4内含子的可变串联重复序列(VNTR)4a/b多态性进行基因型分析,比较2组间基因频率、等位基因频率分布情况.结果:2组患者ecNOS基因的可变串联重复序列表现为ecNOS4a/4a,ecNOS4b/4b,ecNOS4a/4b 3种基因型.IgA肾病患者组和正常对照组之间的ecNOS基因的基因型和等位基因频率差异无统计学意义.结论:ecNOS基因第4内含子的VNTR多态性与IgA肾病血管病变的发生无明显关联.     

尿铜蓝蛋白与糖尿病肾病关系的研究

目的 研究尿铜蓝蛋白(CP)与糖尿病肾病(DN)的关系.方法 将236例2型糖尿病患者分为正常白蛋白(Alb)尿组(DMN组)129例,微量Alb尿组(DMMA组)107例,另选择81例健康体检者作为对照组(C组).检测尿CP、Alb、肌酐(Cr)和血清CP等.结果 (1)尿CP/Cr中位数在DMMA组为2.55 ng/mmol,在DMN组为1.18 ng/mmol,均显著高于C组0.92 ng/mmol,P<0.01;血清CP在各组间比较差异均无统计学意义(P>0.05).(2)2型糖尿病患者尿Alb/Cr与尿CP/Cr呈显著正相关(r=0.188,P<0.01),糖尿病病程为尿CP/Cr和Alb/Cr升高的危险因素.结论 2型糖尿病患者尿CP与尿Alb排泄量有一致性升高的趋势.2型糖尿病患者尿CP升高,其与DN的发生和严重程度有较好的相关性,尿CP可以用来监测DN的发生、病情进展和治疗效果.     

核心蛋白聚糖Ⅱ过表达对肾组织细胞基质金属蛋白酶2和9表达的影响

目的 观察高水平表达的核心蛋白聚糖Ⅱ(DCN)对高糖培养的大鼠肾组织细胞基质金属蛋白酶2(MMP-2)和基质金属蛋白酶9(MMP-9)表达的影响.方法 用大鼠DCN重组腺病毒载体(Ad/DCN)和抗转化生长因子(TGF)-β1中和抗体分别处理不同糖浓度培养条件下的大鼠肾系膜细胞(RMC)和肾小管细胞(HK-2),用Western印迹法观察转染72 h后DCN蛋白水平变化及其对TGF-β1和Ⅳ型胶原(C-Ⅳ)以及MMP-2和MMP-9表达水平的影响.结果 在RMC细胞中,TGF-β1和C-Ⅳ的蛋内表达在高糖条件下升高(分别为1.63±0.02和0.52±0.01),经抗TGF-β1中和抗体或用Ad/DCN转染处理72 h有明显下降(TGF-β1均下降至0,C-Ⅳ分别为0.29±0.01和0.21±0.01,均P＜0.05);MMP-2和MMP-9在高糖条件下表达下降(分别为0.01±0.00和0.32±0.01),经抗TGF-β1中和抗体或用Ad/DCN转染处理72h有明显上升(MMP-2分别上升至0.65±0.01和0.67±0.01,MMP-9分别上升至0.89±0.01和0.73±0.01,均P＜0.05).而在HK-2细胞中,TGF-β1和C-Ⅳ的蛋白表达在高糖条件下也升高(分别为1.45±0.0l和0.41±0.01),且MMP-2的表达升高(0.27±0.01),经抗TGF-β1中和抗体或用Ad/DCN转染处理72h则有明显下降(TGF-β1分别为0.06±0.01和0.08±0.01,C-Ⅳ分别为0.11±0.01和0.01±0.00,MMP-2分别为0.14±0.01和0.06±0.01,均P＜0.05).结论 高糖对肾小球系膜细胞和小管细胞的基质金属蛋白酶表达的影响是不同的,降低TGF-β1活性可使肾小球系膜细胞和小管细胞基质金属蛋白酶表达转变.     

黄芪注射液对糖尿病肾病患者血小板活化功能的影响

目的:探讨糖尿病肾病(DN)患者血小板活化功能的变化及黄芪对其的影响。方法:23例肾病综合征患者随机分为两组,A组12例进行常规治疗;B组11例在常规治疗基础上给予黄芪注射液40 g(20 mL)/d静脉滴注,疗程为15 d。治疗前、后应用流式细胞仪测定外周血血小板CD62P及血小板膜Fg含量,并以10例健康人作对照。结果:糖尿病肾病患者血小板CD62P及血小板膜Fg含量均显著高于健康人(P<0.01);治疗后显著低于治疗前(P<0.01),治疗后B组低于A组(P<0.01)。结论:糖尿病肾病患者血小板活化程度在其发病中起一定作用,黄芪注射液能有效降低糖尿病肾病患者血小板活化功能。     

γ-谷氨酰基转移酶在糖尿病肾病中的诊断价值研究

目的 探讨GGT及UN、CRE、β2-MG在糖尿病肾病中的诊断价值，为临床早期诊断提供依据。方法在日立全自动生化分析仪上测定糖尿病非肾病和糖尿病。爵病患者各75例γ-谷氨酰基转移酶（GGT）、尿素（UN）、肌酐（CRE）和β2微球蛋白（β2-MG），结果采用t检验分析。结果糖尿病肾病组中UN、GGT、CRE、β2-MG均高于糖尿病非肾病组。结论GGT在糖尿病肾病的早期诊断中有意义，联合其它肾功能指标能更加灵敏。     

Intestinal IgA deposition in Henoch-schönlein purpura with severe gastro-intestinal manifestations

Abstract In patients with Henoch-Schönlein purpura (HSP) presenting with severe gastro-intestinal (GI) symptoms, IgA deposition was studied in endoscopically obtained mucosal biopsies. A total number of 11 patients (male, 7; female, 4) were enrolled in this study; 7 patients underwent upper GI endoscopy and biops 1 underwent sigmoidoscopy and 3 underwent both. Upper GI endoscopy in each patient showed various mucosal changes including redness, petechiae, erosions, and ulcerations, most predominant in the second part of the duodenum. Sigmoidoscopy demonstrated no abnormality in two of four patients. Intestinal deposition of IgA was positive in 7 of 11 patients with HSP. Histological examination showed non-specific inflammation of varying degrees in each patient, but no small vessel vasculitis was observed. IgA deposits were seen in only 2 of 23 control subjects with various GI diseases. Positive rate of IgA deposition per patient was significantly higher in patients with HSP than in controls (P<0.005).Conclusion IgA deposition in the GI tract, as in the skin kidneys, is characteristic of HSP. Intestinal IgA deposition complements the diagnostic criferia of HSP.Presented in part at the 4th Pan-Pacific Congress of Paediatric Gastroenterology and Nutrition, Tokyo, September 1994     

Serum and salivary antigliadin antibodies and serum IgA anti-endomysium antibodies as a screening test for coeliac disease

Serum and salivary IgA and IgG antigliadin antibodies were determined by an enzyme-linked immunosorbent assay in 18 children with villous atrophy and 30 children on a gluten-free diet for coeliac disease in whom normal intestinal mucosa was found. Serum IgA anti-endomysium antibodies were also determined by an immunofluorescence method in these children. Serum IgG antigliadin and IgA anti-endomysium antibodies had the highest sensitivity (100 and 94.4%, respectively), followed by serum IgA antibodies to gliadin (72.2%), salivary IgA antigliadin (61.2%) and IgG antigliadin (50%) antibodies. The highest specificity was found for serum IgA anti-endomysium (100%) and IgA antigliadin (96.6%) antibodies and salivary IgA and IgG antigliadin antibodies (93.3%), while serum IgG antigliadin antibodies were found to be least specific (63.3%)     

Primary vesicoureteral reflux in infants with a dilated fetal urinary tract

Vesicoureteral reflux (VUR) was recognized neonatally by voiding cystography in 25 of 117 infants with a dilated fetal urinary tract. There was a male preponderance (76%) and a high percentage (40%) of associated urinary malformations. Thirtynine refluxing units were studied. All grades of VUR were detected but gross dilating VUR dominated (59%). Spontaneous resolution was excellent in lower grades of VUR but was poor in gross VUR. Surgery was successfully performed in 13 renal units of nine patients with gross reflux [8], additional ipsilateral malformations [4], or pyelonephritis during antibiotic prophylaxis [1]. Segmental renal scars developed in four kidneys after urinary infections, and a diffuse parenchymal lesion was noted in nine kidneys even at birth. One boy with duplication had a non-functioning refluxing system. Our results in a small number of infants show differences to children with VUR detected after urinary infections and seem to support the existence of a congenital reflux nephropathy.