目的:观察乙型肝炎病毒(HBV)感染后外周血单个核细胞(PBMC)分泌功能的动态变化,为病毒免疫实验提供参考.方法:分离健康人PBMC,分为空白对照组和病毒干预组.空白对照组PBMC正常培养,病毒干预组PBMC加入HepG 2.2.15培养上清液中浓缩的HBV共培养.分别在培养4 h、8 h、12 h、24 h、36 h、48 h后收集培养上清液进行细胞因子(CK)检测.观察细胞因子随时间变化曲线,分析病毒刺激对PBMC分泌功能的影响.结果:病毒干预后IL-2的含量随时间变化呈上升趋势,其余各因子含量随时间变化呈先上升后下降趋势,IL-4、IL-17A、IFN-γ、TNF-ɑ分泌高峰在8 h,IL-6分泌高峰在36 h,IL-10分泌高峰在24 h;空白对照组PBMC中IL-4、IFN-γ各时间点含量高于病毒干预组(P<0.05),IL-6、TNF-ɑ各时间点含量低于病毒干预组(P<0.05);IL-2、IL-10、IL-17A、含量除个别时间点均低于病毒干预组(P<0.05).结论:病毒刺激后各细胞因子的分泌高峰不同,可根据各自分泌特点选择恰当的研究时间点;HBV感染导致的IFN-γ低表达和IL-6、IL-10高表达可能是乙型肝炎免疫耐受机制之一.

目的 探讨中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)联合检测在消化道恶性肿瘤(胃癌、结直肠癌、胰腺癌)中的诊断价值.方法 选取185例消化道恶性肿瘤患者(胃癌患者68例、结直肠癌患者90例、胰腺癌患者28例),以51名体检健康者为正常对照组.比较不同类型、不同分期消化道肿瘤患者与正常对照者NLR、PLR的差异.采用Spearman相关分析评估NLR、PLR与消化道恶性肿瘤的关系.结果 消化道恶性肿瘤各组NLR明显高于正常对照组(P<0.01);转移组NLR、PLR明显高于正常对照组和非转移组(P<0.01).Ⅳ期组NLR、PLR均明显高于正常对照组和Ⅰ～Ⅱ期组、Ⅲ期组(P<0.01).Spearman相关分析结果显示,NLR(r值分别为0.383、0.398,P<0.01)、PLR(r值分别为0.313、0.151,P<0.05)与消化道恶性肿瘤分期、是否转移具有一定相关性.结论 NLR、PLR联合检测在消化道恶性肿瘤中有一定的临床意义.

胃肠道肿瘤是最常见的恶性肿瘤,发病率和死亡率均较高,患者出现症状就医时,疾病已进入中、晚期[1].肿瘤生长可激活凝血过程并产生促凝物质,促凝物质又会诱发炎症反应,进一步刺激肿瘤细胞产生促凝物质.有研究发现,肺、胰腺、胃肠道、妇科恶性肿瘤患者更易出现高凝状态,其凝血及纤溶标志物水平升高与患者生存期呈负相关[2].本研究拟分析胃癌、结直肠癌患者血管内皮损伤及凝血、纤溶系统变化,为减少此类患者血栓事件发生提供参考.

目的 探讨恶性肿瘤患者血浆血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2抗纤溶酶复合物(PIC)、组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)4项标志物与肿瘤的关系.方法 采用化学发光酶免疫法分别检测164例恶性肿瘤患者(恶性肿瘤组,其中81例为呼吸道肿瘤组、83例为消化道肿瘤组)和52名体检健康者(正常对照组)血浆TM、TAT、PIC、t-PAI-C水平,分别比较恶性肿瘤组与正常对照组之间及恶性肿瘤有转移者和恶性肿瘤无转移者之间4项指标的差异.结果 恶性肿瘤组TM、TAT、PIC、t-PAI-C水平均明显高于正常对照组(P<0.01);呼吸道肿瘤组TM、TAT、PIC水平明显高于正常对照组(P<0.01),而t-PAI-C水平2个组之间差异无统计学意义(P>0.05);消化道肿瘤组TM、TAT、PIC、t-PAI-C与正常对照组比较差异均有统计学意义(P<0.01);恶性肿瘤有转移者TAT、PIC、t-PAI-C水平高于恶性肿瘤无转移者(P<0.01),而TM水平与恶性肿瘤无转移者比较差异无统计学意义(P>0.05);呼吸道肿瘤组和消化道肿瘤组中恶性肿瘤有转移者的TAT、P I C、t-PA I-C水平明显高于恶性肿瘤无转移者(P<0.01),TM二者间差异无统计学意义(P>0.05).结论 恶性肿瘤患者存在不同程度血管内皮损伤及凝血与纤溶系统功能紊乱.血浆TM、TAT、PIC、t-PAI-C水平可作为恶性肿瘤病情进展、疗效观察及预后判断的指标之一.

Objective According to ICSH guidelines for the evaluation of blood cell analyzers ,2014 edition to evaluate the clini-cal performance of celldif BCM-2 automated hematology analysis system for leukocyte differentiation .Methods 401 blood smears of hospitalized patients which complied with the rules of microscope re-examination and 101 blood smears of healthy controls were an-alyzed by celldiff automatic hematology analyzer and manual microscope of leukocyte classification .1 .We evaluated accordance rate :pre-classification results carried out by celldiff vs the results by manual correction .2 .Correlation analysis between the results by manual correction and the results by manual microscope .Results the absolute deviation of the hospitalized patients specimens from low to high was respectively :neutrophilic myelocyte(3 .3% ) ,neutrophilic segmented granulocyte(11 .8% ) ,monocyte(20 .5% ) ,eo-sinophils(28 .4% ) ,band form neutrophilic granulocyte (31 .6% ) ,lymphocyte (42% ) ,netrophilic metamyelocyte (68% ) ,basophlis (77 .1% ) ,atypical lymphocyte (100% ) ,prolymphocyte (100% ) ,blasts (236 .5% ) ,smear cell (306 .7% ) ,premyelocyte (413 .3% ) and NRBC (1321 .2% ) .The absolute deviation of healthy controls from low to high was respectively monocyte (0 .4% ) ,netrophilic segmented granulocyte(2 .1% ) ,band form neutrophilic granulocyte(14 .1% ) ,lymphocyte(15 .5% ) ,eosinophils(21 .8% ) ,basophils (69 .2% ) and smear cell (728 .6% ) .There was a significant difference correlation between the microscopic examination and the manual correction in the linearity of the basophils (P<0 .01) .There was no significant difference in the linearity of the other neutro-philic segmented granulocyte ,band form netrophilic granulocyte ,lymphocyte ,monocyte ,eosinophils and immature granulocyte .Con-clusion even though the results of pre-classification by celldiff is not very ideal ,the better correlation between the results by manu-al review and the results by manual microscope shows good clinical application and teaching value .And with the full automatic pe-ripheral blood production machine can improve the automation and standardization of leukocyte differentiation .

Objective To study the clinical diagnosis value and the clinical significance of anti-mitochondrial antibody(AMA-M2),antinuclear antibody(ANA)and immunoglobulin(IgG,IgM,IgA)in patients with Primary Biliary Cirrhosis(PBC) and hepar lesion or autoimmune diseases.Methods The serum levels of AMA M2,ANA and IgG,IgM,IgA were separately determined by ELISA,Western blot and scattering immunoturbidimetric assay in 12 patients with PBC,27 ones with viral hepatitis,21 ones with AIH,33 ones with SLE,34 ones with RF,26 ones with SS and 20 cases of nomal controls.Results The positive rate of PBC group was significantly higher than that in other groups(P<0.01).In humoral immunity,the serum level of IgG in patients with PBC was significantly higher than ones with SLE and RF,but it was no statistical significance comparing with viral hepatitis and AIH.Comparing with other groups,the serum level of IgA in patients with PBC was no statistical significance but IgM was significantly higher.Conclusion The results indicate that the measurement of AMA M2 is highly specific and sensitive in diagnosis PBC.It is useful for differentiation of PBC and viral hepatitis,AIH by detecting AMA M2 and ANA,and also for differentiation of PBC and SLE,RF,SS by detecting levels of immunoglobulin.

To evaluate the correlation of T cell subsets,serum immunoglobulin and complement levels with different kinds of syndromes of ZhongYi of post hepatitis liver cirrhosis,84 patients have been diagnosed as four kinds of syndrome of Zhong Yi including 40 patients with syndrome of accumulated dampness-heat(group①),20 patients with syndrome of blockade of dampness due to qistagnation(group②),12 patients with syndrome of Yin deficiency of liver and kidney(group③),11 patients with syndrome of Yang deficiency of spleen and kidney(group④).T-lymphocyte subsets(by flowcytometry) and serum immunoglobulin levels were measured for all the patients.Compared with control group,the IgA、IgG levels were increased significantly in all group(P0.05,P0.01).CD8+ T cells and NK amounts were decreased(P0.05)in group①.CD8+T cells were decreased significantly(P0.01),and CD4+ T cells were decreased(P0.05)in group②.CD4+/CD8+ ratio was significantly increased in group ② than in any other groups.The different kinds of syndrome of ZhongYi were related to status of immunity,and the syndrome of ZhongYi changed with the status of immunity.CD4+,CD8+,CD4+/CD8+ ratio,immunoglobulin levels determinations may help to define syndrome of ZhongYi and used to clinical diagnosis and treatment.

Objective To investigate the effect of Wenshen Qingwei Granule on serum PAIgG,TPO and its receptor c-MPL mRNA changes in patients with ITP.Methods A total of 60 patients were randomly divided into two groups: treatment group in which 30 cases were treated with Wenshen Qingwei Granule and control group in which 30 cases were treated with prednisone;and 20 healthy people were enrolled as normal group.The serum TPO and PAIgG in the two groups were detected by ELISA respectively after one-month,three-month and six-month treatments.The c-MPL mRNA in platelets was determined by semi-quantitative reverse transcription polymerase chain reaction(RT-PCR) in the two groups.Results After one-month treatment,the expressions of TPO and PAIgG in serum were higher and platelets quantity was lower in the treatment group than those in the control group(P0.05 or P0.01);c-MPL mRNA in platelets was of insignificant difference between two groups(P0.05).After three-month and six-month treatments,the TPO and PAIgG in serum were decreased and c-MPL mRNA levels in platelets were increased in the treatment group compared with those in the control group(P0.05 or P0.01),while the platelets quantity was elevated(P0.05 or P0.01).Conclusion Wenshen Qingwei Granule can inhibit PAIgG expression and c-MPL mRNA transcription to increase the platelet production.

目的:观察温肾清卫颗粒对特发性血小板减少性紫癜(ITP)患者CD45RA+细胞、NK细胞、P选择素(P-selectin)表达的影响,探讨温肾清卫颗粒疗效的机理。方法:将60例患者随机分为治疗组(温肾清卫颗粒)、对照组(强的松)各30例。2组经治3个月后,分别采用ELISA法检测CD45RA+细胞、NK细胞、P选择素(P-selectin)水平。结果:治疗3个月后,治疗组血小板计数高于对照组,CD45RA+细胞、NK细胞高于对照组,P选择素水平较治疗前下降,与对照组比较无统计学意义。结论:温肾清卫颗粒可能促进ITP患者CD45RA+细胞、NK细胞改善,减少P选择素表达,进而抑制血小板免疫破坏。