免疫性血小板减少性紫癜患者脾脏T淋巴细胞亚群的变化

目的 探讨免疫性血小板减少性紫癜(ITP)患者脾脏T淋巴细胞亚群的变化及其临床意义.方法 收集2005年12月至2008年5月本科室收治的ITP患者47例,分为激素依赖(SD)组29例和激素抵抗(SR)组18例,以急诊外伤性脾破裂行脾切除术者12例作为对照组.免疫组化法检测脾脏组织标本CD3~+、CD4~+和CD8~+细胞的表达情况,观察脾脏组织动脉周围淋巴鞘(PALS)中染色阳性细胞的百分数,并计算CD4~+与CD8~+细胞的比值.分析3组CD3~+、CD4~+,CD8~+细胞百分数和CD4~+/CD8~+比值的差异. 结果3组间PALS中CD3~+、CD4~+细胞百分数差异均无统计学意义(均P>0.05).对照组PALS中CD8~+T淋巴细胞百分数低于SD组和SR组(28.70±22.19比43.80±20.77,49.27±14.10,均P<0.05),而CD4~+/CD8~+比值高于SD组和SR组(6.27±4.64比0.95±0.93,0.89±0.51,均P<0.05).SD组和SR组PALS中CD8~+细胞百分数及CD4~+/CD8~+比值的差异均无统计学意义(均P>0.05).结论 ITP患者脾脏细胞免疫存在异常.术前激素治疗反应性与脾脏T淋巴细胞亚群百分数的改变无明显关联.     

免疫性血小板减少性紫癜患者脾切除术前后外周血T细胞亚群的检测意义

目的探讨免疫性血小板减少性紫癜（ITP）患者脾切除术前后外周血T淋巴细胞亚群及CD56＋NKT细胞的变化及血液学疗效与各检测指标的关系。方法应用流式细胞技术,检测34例ITP患者腹腔镜脾切除术前后7d外周血T细胞亚群（CD3＋、CD3＋CD4＋和CD3＋CD8＋）及CD56＋NK细胞的百分数。根据不同的血液学疗效,将患者分为手术有效组（A组,22例）和无效组（B组,12例）。应用SPSS13.0forWindows软件对比分析两组术前后T细胞亚群、CD56＋NK细胞的百分数及CD4＋/CD8＋比值的差异及各组术前后各指标的变化。结果 A组和B组术前CD3＋CD4＋细胞百分数分别为（32.83±8.07）%和（26.23±6.17）%（P=0.045）,术前CD4＋/CD8＋比值分别为（1.30±0.51）和（0.84±0.42）（P=0.022）。余两组术前后各指标差异无统计学意义;B组术前后CD3＋细胞百分数分别为（65.51±4.54）%和（60.38±12.97）%（P=0.017）,CD3＋CD8＋细胞百分数分别为（37.27±12.47）%和（32.96±13.18）%（P=0.025）。余各组术前后各指标差异无统计学意义。结论脾切除疗效不同的ITP患者存在不同的细胞免疫发病机制。术前外周血CD3＋CD4＋细胞百分数及CD4＋/CD8＋比值有助于预测手术疗效。     

免疫性血小板减少性紫癜脾切除血液学疗效与脾脏细胞免疫异常的关系

目的探讨免疫性血小板减少性紫癜(ITP)脾切除血液学疗效与脾脏细胞免疫的关系。方法应用免疫组织化学技术,采用抗人CD3、CD4、CD8单克隆抗体和抗人S100多克隆抗体,分别检测33例脾切除有效(A组)和14例脾切除无效(B组)的ITP患者的脾脏组织标本CD3+细胞、CD4+细胞、CD8+细胞和S100+细胞的表达情况,对照组为12例因外伤性脾破裂行脾切除术的脾脏组织标本(C组)。显微镜下观察脾脏组织动脉周围淋巴鞘(PALS)中染色阳性细胞的百分数,并计算CD4+/CD8+比值。分析3组CD3+、CD4+、CD8+、S100+细胞百分数和CD4+/CD8+细胞比值的差异。结果 3组PALS中CD3+、CD4+细胞百分数差异均无统计学意义;A组CD8+细胞百分数高于B组(P=0.001)和C组(P0.01),而C组PALS中CD4+/CD8+比值分别高于A组(P=0.001)和B组(P=0.001);A组PALS中S100+细胞百分数高于B组(P=0.015)。结论 ITP患者脾脏细胞免疫存在异常。脾切除血液学疗效与脾脏细胞免疫异常有密切关系。     

热休克蛋白27在大鼠反流性食管炎食管组织的表达

Background  Little attention has been paid to the expression of heat shock protein 27 (HSP27) in patients with reflux esophagitis (RE), and few studies of the importance of HSP27 in esophagitis have been carried out in animal models. This study aimed to explore the expression of HSP27 in the esophageal tissue of rats with RE.

Methods  Eighty female Wistar rats were randomly divided into experimental groups A and B and control groups C and D (n=20 in each group). To establish RE, rats in the two experimental groups received pylorus and forestomach ligations, while rats in the control group received gastrostomy and gastric perforation repair. The rats in groups A and C were sacrificed 7 days after surgery, and the rats in groups B and D were sacrificed 14 days after surgery. In groups A and B, 10 and 8 rats were diagnosed with RE by pathological examination, respectively (they were included in groups A’ and B’, respectively). The histopathological diagnosis of all the lower esophageal tissues in groups C and D was normal and 20 normal specimens were randomly selected for groups C’ and D’ with 10 specimens in each group. Macroscopic and microscopic esophagitis scores were assessed for the specimens in groups A’ and B’. Lower esophageal tissues were collected from groups A’, B’, C’, and D’, and paraffin-embedded slices were made using part of the tissues. The expression of HSP27 in the tissues was detected using the two-step streptavidin-peroxidase immunohistochemical method. Some collected tissues were frozen, and expressions of HSP27 mRNA were detected using fluorescence quantitative polymerase chain reaction (FQ-PCR).

Results  Median macroscopic and microscopic esophagitis scores in groups A’ (n=10) and B’ (n=8) were 1.0 and 1.5, and 2.0 and 2.5, respectively. There were no significant differences in the macroscopic or microscopic esophagitis scores between the two groups (Z=–0.330, P=0.741; Z=–0.142, P=0.887, respectively). Immunohistochemical staining showed that HSP27 was expressed in all layers of the esophageal epithelia in RE and control rats. FQ-PCR showed that HSP27 mRNA levels in the lower esophageal tissue in RE group (groups A’ and B’) were higher than those in control group (groups C’ and D’) (Z=–0.249, P=0.001). HSP27 mRNA expression in the lower esophageal tissue was significantly different in groups B’ and D’ (Z=–3.027, P=0.002). And the levels of HSP27 mRNA expression in severe RE group (microscopic esophagitis score: 3) were higher than in mild RE group (microscopic esophagitis score: 1–2) and control group (Z=–3.396,P=0.001; Z=–3.855, P <0.001).

Conclusions  HSP27 mRNA expression in the lower esophageal tissue of rats with RE is significantly higher than in the normal controls. Although reflux is a persistent stimulating factor, increased expression of HSP27 in the lower esophageal tissue of rats with RE requires aggravated esophageal injury.