Melanoma is a highly malignant tumor of melanocyte origin that is prone to early metastasis and has a very poor prognosis. Early melanoma treatment modalities are mainly surgical, and treatment strategies for advanced or metastatic melanoma contain chemotherapy, radiotherapy, targeted therapy and immunotherapy. The efficacy of chemotherapy and radiotherapy has been unsatisfactory due to low sensitivity and strong toxic side effects. And targeted therapy is prone to drug resistance, so its clinical application is limited. Melanoma has always been the leader of immunotherapy for solid tumors, and how to maximize the role of immunotherapy and how to implement immunotherapy more accurately are still urgent to be explored. This review summarizes the common immunotherapies and applications for melanoma, illustrates the current research status of melanoma immunotherapy delivery systems, and discusses the advantages and disadvantages of each delivery system and its prospects for clinical application.

Background: HCA587 antigen is called tumor-testicular antigen, which is highly expressed in a large number of malignant tumors and shows superior immunogenicity. Combined with adjuvants is considered to be an effective tumor immunotherapy strategy. Objective: To explore the inhibitory effect and mechanism of HCA587 protein combined with 12 μg self-made ISCOMATRIX and CpG ODN adjuvant (referred to as "HCA587 protein vaccine") on angiogenesis of melanoma in mice. Methods: C57BL/6J mice were subcutaneously inoculated with B16-HCA587 tumor cells on the right side of the abdomen to establish a tumor-bearing mouse model, and HCA587 protein vaccine was used to treat the mice. The effect of HCA587 protein vaccine on tumor neovascularization was analyzed by hematoxylin-eosin (HE) staining, tumor immunohistochemical staining and immunofluorescence staining, and the effect of HCA587 protein vaccine on tumor angiogenesis was detected by alginate encapsulated B16-HCA587 tumor cells in mice immunized with HCA587 protein vaccine. Real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and Western-blot assay were used to detect the expression of angiogenesis-related molecules and apoptosis-related proteins in tumor tissue. TUNEL staining was used to evaluate the apoptosis of mouse melanoma. Results: After treatment with HCA587 protein vaccine, the tumor tissue necrosis and microvessel density decreased significantly. The experiment of alginate encapsulated tumor cells showed that HCA587 protein vaccine inhibited the angiogenesis of mouse melanoma, while HCA587 protein vaccine significantly increased the expression of PEDF in mouse melanoma tissue and promoted cell apoptosis. In addition, the protein vaccine significantly up-regulated the expression of phosphorylated p38 (p-p38), pro-apoptotic proteins Bax, caspase3, caspase8 and caspase9 in tumor tissues. Conclusion: HCA587 protein vaccine significantly inhibits neovascularization of melanoma in mice, which may be mediated by up-regulated PEDF-activated p38/Bax/caspase apoptosis pathway.

目的 确定自制免疫刺激复合物(ISCOMATRIX)作为HCA587蛋白疫苗佐剂的有效剂量,并探讨其与CpG联合作为HCA587蛋白疫苗佐剂的免疫效力和肿瘤治疗效果.方法 应用透析法将Quil A、胆固醇和磷脂制备成ISCOMATRIX,经磷钨酸负染并采用透射电子显微镜观察自制ISCOMATRIX的结构.建立小鼠免疫模型,将联合CpG的HCA587蛋白疫苗与不同剂量的自制ISCOMATRIX佐剂混合,经尾根部皮下免疫小鼠;采用酶联免疫斑点试验(ELISpot)检测产生IFN-γ 的脾细胞频数,采用酶联免疫吸附法(ELISA)检测血清HCA587特异性抗体水平.在小鼠右侧胁腹部皮下接种B16-HCA587肿瘤细胞建立荷瘤小鼠模型,按照处理方式不同将小鼠分为HCA587蛋白疫苗治疗组(接种100μL包含CpG与最佳剂量的自制ISCOMATRIX的HCA587蛋白疫苗)与PBS对照组(注射100 μL的无菌PBS),使用游标卡尺测量肿瘤大小.结果 自制ISCOMATRIX佐剂呈典型的蜂窝状结构,直径20～30 nm,大小均一.12、36 μg(QuilA浓度分别为0.012％、0.036％)的自制ISCOMATRIX组小鼠脾细胞分泌IFN-γ 的频数与商品化ISCOMATRIX阳性对照组比较,差异无统计学意义(均P＞0.05),且显著高于 CpG+36 μg ISCOM 对照组与 PBS 组(均 P＜0.000 1);5 μg 与 18μg自制 ISCOMATRIX 组小鼠分泌 IFN-γ 的脾细胞频数,高于CpG+36 μg ISCOM对照组与PBS组(均P＜0.000 1),但低于商品化ISCOM组(P=0.004).12、18与36 μg自制ISCOMATRIX组的血清HCA587抗体水平与商品化ISCOM阳性对照组比较,差异无统计学意义(均P＞0.05);与PBS组相比,12μg自制ISCOMATRIX组1 × 104倍稀释血清的抗体滴度显著升高(P=0.006 2).与PBS对照组相比,HCA587蛋白疫苗治疗组肿瘤生长速度减缓,且第35天测量时肿瘤大小显著较小(P=0.018 1).结论 以12μg自制ISCOMATRIX作为佐剂联合CpG制备的HCA587蛋白疫苗能诱导有效的免疫应答,并抑制荷瘤小鼠的肿瘤的生长,具有一定的肿瘤治疗作用.

目的 探讨系统性红斑狼疮(Systemic lupus erythematosus,SLE)初诊患者入院血压与系统性红斑狼疮活动指数(Systematic lupus erythematosus disease activity index,SLEDAI)评分、血清补体C3、C4的相关性,并评估引发SLE患者高血压的危险因素.方法 2017年9月至2019年9月我院收治的95例SLE初诊患者,根据血压高低分为SLE血压升高组33例,SLE血压正常组62例,另选取同期100例健康体检者为对照组.采用医用臂式电子血压计测量3组入院血压;采用速率散射比浊法测定血清补体C3、C4;采用SLEDAI-2000评分评估SLE疾病活动程度;采用Pearson相关性分析法分析血压与实验指标的相关性,Logistic回归分析模型分析疾病危险因素.结果 SLE初诊患者入院血压高于健康体检者.SLE血压升高组SLEDAI-2000评分显著高于SLE血压正常组.SLE初诊患者收缩压、舒张压与SLEDAI-2000评分呈正向相关关系(r=0.490,P<0.05;r=0.408,P<0.05),舒张压与血清补体C3、C4呈正向相关关系(r=0.223,P<0.05;r=0.285,P<0.05).Logistic回归分析显示SLEDAI-2000评分和血清补体C3是导致SLE患者高血压的危险因素(P<0.05).结论 SLE初诊患者SLEDAI-2000评分与血压呈正向相关关系,舒张压与血清补体C3、C4呈正向相关关系.SLEDAI评分及血清补体C3是导致SLE患者高血压的危险因素.

目的 研究维生素B12、叶酸在南昌地区萎缩性舌炎患者血清中的表达水平及其与萎缩性舌炎的关系,为萎缩性舌炎治疗提供参考.方法 选取南昌大学附属口腔医院黏膜科 2019 年 11 月至 2021 年 2 月诊治的萎缩性舌炎患者 72 例为病例组,另选取来院行口腔体检的同年龄段正常人 170 例为对照组,采用化学发光法测定血清维生素B12 和叶酸,同时收集病例组和对照组血细胞分析中MCV(红细胞平均体积)、HGB(血红蛋白)、RBC(红细胞数)三项指标进行分析.结果 病例组MCV显著高于对照组(P＜0.05),RBC和HGB显著低于对照组(P＜0.05),三种指标差异有显著性.病例组维生素B12 水平较对照组低,叶酸水平较对照组高,均有统计学差异(P＜0.05).口服维生素B12 两周后疼痛指数及病损面积较初诊时显著降低,有统计学差异(P＜0.05).病例组维生素B12 与叶酸呈负相关(P＜0.05),对照组维生素B12 与叶酸无相关性(P＞0.05).结论 萎缩性舌炎患者维生素B12 水平降低,叶酸水平升高,且维生素B12 与叶酸水平呈负相关关系.维生素B12 可以改善萎缩性舌炎患者的临床症状.

The present study examined potential association between the daily intake and serum levels of copper (Cu), selenium (Se), and zinc (Zn) and the risk of osteoarthritis (OA) and rheumatoid arthritis (RA) using data from the National Health and Nutrition Examination Survey (NHANES). Daily intake and serum concentrations of Cu, Zn, and Se in 4200 adults from the 2011-2016 NHANES were examined and divided into normal, OA patients, and RA patients. The level of serum Cu was higher in OA and RA than in non-arthritis, while the levels of serum Se and Zn were no different in the three groups. Serum Se and Zn, but not Cu, concentrations were highly correlated with daily intake. Cu, Se, and Zn intake was independently associated with increased risk of OA, but not with RA. And there was a trend for higher odds of OA among participants in the higher Cu, Se, and Zn intake. Future large longitudinal studies are warranted to confirm these findings.

目的 探讨类风湿性关节炎(RA)患者血脂与炎症指标的关系.方法 选择RA患者(RA组)132例和健康体检者(对照组)127例,比较2组血脂指标水平[包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(NHDL-C)、低密度脂蛋白胆固醇(LDL-C)、TC/HDL-C比值、LDL-C/HDL-C比值];同时按炎症指标C反应蛋白(CRP)水平将132例RA患者分为CRP异常组与CRP正常组,比较2组血脂指标水平.采用Spearman相关检验分析RA患者CRP值、疾病活动度(DAS28-CRP评分)与血脂的相关性.结果 RA组血清TC、HDL-C、NHDL-C水平均明显低于对照组(P<0.05);CRP异常组血清TC、HDL-C水平明显低于CRP正常组(P<0.05),LDL-C/HDL-C比值明显高于CRP正常组(P<0.05).血清TC、HDL-C、NHDL-C水平与CRP值呈显著负相关(r=-0.300、P<0.001,r=-0.423、P<0.001,r=-0.207、P=0.017),血清TC、TG、HDL-C、NHDL-C水平与DAS28-CRP评分呈显著负相关(r=-0.254、P=0.003,r=-0.204、P=0.019,r=-0.179、P=0.040,r=-0.207、P=0.017).结论 炎症导致类风湿性关节炎患者血脂水平下降.相比于常规的血脂水平监测,CRP可能是评估类风湿性关节炎患者心血管疾病风险的更好选择.

Abstract Background HCA587/MAGE-C2 is a cancer-testis (CT) antigen, which is expressed in immunoprivileged germ-line regions and many kinds of tumor tissues. In the present study, we developed a novel recombinant HCA587 protein vaccine with Freund’s adjuvants and CpG as adjuvant. The objective is to survey its ability inducing antigen specific immune response and antitumor activity in mice model. Methods The levels of cellular and humoral immune responses induced by different regimens were compared by IFN-γ ELISpot and Ab ELISA, as well as by intracellular cytokine staining (ICS) analysis in different vaccination strategies. The tumor volume was measured and the survival curve was evaluated by log-rank test. Results After the comparison of different strategies, HCA587 protein with CFA and 50µg CpG elicited strongest specific IFN-γ-secreting splenocytes and anti-HCA587 antibody. And this vaccine combination induced highest IFN-γ+CD4+ T cells by ICS analysis. When the B16-HCA587 tumor-bearing mice were inoculated with the HCA587 protein vaccine combined with CFA and CpG, the tumor growth was retarded significantly with no change of survival time. Conclusion Our data indicates that HCA587 protein formulated with CFA and 50µg CpG elicits potent cellular and humoral immune responses and partial antitumor effect in mice model. This provides new experimental data for the preclinical research of HCA587 protein vaccine.

目的 明确不同分型及预后分层的骨髓增生异常综合征(Myelodysplastic Syndrome,MDS)患者WT1基因水平的表达及疗效的关系.方法 采用实时荧光定量PCR方法检测MDS患者的WT1基因表达水平,分析不同MDS类型与预后分层之间WT1表达水平,同时分析其与疗效关系.结果 MDS-SLD及MLD组WT1表达水平较低,与对照组无显著差异(P>0.05),而MDS-EB-1及EB-2组WT1表达水平较对照组及SLD及MLD组显著升高(P<0.05).按IPSS-R积分系统进行预后分层,极低危组、低危组与中危组的WT1表达水平与对照组相比差异无统计学意义(P>0.05),而高危组及极高危组的MDS患者WT1表达水平显著高于其它组(P<0.05).MDS-EB患者治疗后,WT1表达水平显著下降.结论 WT1基因表达水平与MDS患者的疾病进展相关,其水平的变化在患者的疗效与预后的评估具有参考意义.

Aims The purpose of this study is to elucidate the correlation between thyroid hormone, glycosylated hemoglobin (HbA1c), vitamin D and type 2 diabetes mellitus (T2DM) with Hashimoto’s thyroiditis (HT), and to seek the independent predictors affecting disease development. Methods The study included 44 T2DM with HT, 94 T2DM, and 112 healthy subjects. We investigated some laboratory factors like thyroid hormone and compared the levels. Independent predictors determination by logistic univariate regression analysis were analyzed. The diagnostic value of thyroid-stimulating hormone (TSH) and threshold concentration were determined by ROC curve. Results In T2DM with HT group, levels of PTH, HbA1c were lower and levels of TSH were significantly higher, when compared with T2DM group. But there was no significant difference in vitamin D between these two groups. In both logistic univariate regression analysis and multiple logistic regression analysis, TSH, HbA1c were independent predictors for T2DM with HT. Based on the ROC curve, the best cut-off value of the TSH was 4 mIU/L (sensitivity 72.7%, specificity 94.6%, AUC = 0.832) for predicting T2DM with HT in T2DM patients. Conclusions TSH has increased risk for T2DM evolving into T2DM complicated with HT, so it is important to monitor the concentrations of TSH in patients with T2DM. Although vitamin D was not the independent predictor in T2DM with HT development, effect of vitamin D deficiency on the progress of diabetes and its complications should be taken into consideration.

目的 本研究基于生物信息学分析,探寻肝细胞癌(hepatocellular carcinoma,HCC)发生发展的枢纽基因,为HCC患者的预后提供潜在的生物标志物.方法 从GEO数据库下载两个肝细胞癌芯片数据(GSE14520和GSE46408),通过GEO2R筛选HCC组织和正常肝组织之间的差异表达基因(DEGs).利用STRING数据库构建DEGs的蛋白质互作(PPI)网络,并用Cytoscape软件的CytoHubba插件计算PPI中各基因的连接度,筛选出枢纽基因.通过利用ONCOMINE、GEPIA2、cBioPortal、GeneMANIA、DAVID6.8和TIMER数据库对筛选出的枢纽基因进行转录、翻译、生存情况和肿瘤免疫浸润相关性等方面的验证,并分析其是否具有作为HCC预后生物标志物的潜力.结果 筛选出3个枢纽基因(CCNB1、ASPM和AUR-KA),且均在HCC中高表达.生存分析表明这3个基因均与HCC患者的总体生存率和无病生存率显著相关.肿瘤免疫浸润分析结果进一步提示CCNB1、ASPM和AURKA可能是HCC潜在的预后标志物.结论 CCNB1、ASPM和AURKA可能是HCC发生发展的枢纽基因,具有成为HCC预后标志物的潜力.

目的 探讨血清铜蓝蛋白(CER)、透明质酸(HA)和游离三碘甲腺原氨酸(FT3)评估慢性乙型肝炎(CHB)患者肝纤维化程度的临床应用价值.方法 以南昌大学第二附属医院2014年7月-2018年1月确诊的136例CHB患者、44例乙型肝炎后肝硬化患者、20例HBsAg阳性原发性肝癌患者为研究对象,随机选取同期50例健康体检者为对照组.采用免疫散射比浊法检测患者血清CER,化学发光法检测HA和FT3,采用单因素方差分析或秩和检验比较各受试组与对照组的血清CER、HA、FT3及其他相关指标水平,对CER、HA、FT3与肝纤维化诊断模型进行相关性分析,并采用受试者特征曲线(ROC)分析结果.结果 重度CHB组、失代偿期肝硬化组CER水平低于对照组,差异有统计学意义(P<0.05);重度CHB组、肝硬化组HA水平高于对照组,差异有统计学意义(P<0.05);肝硬化组、HCC组FT3水平低于对照组,差异有统计学意义(P<0.05).Pearson相关性分析显示,CER与肝纤维化诊断模型(r=–0.202,P=0.004)和基于4因子的肝纤维化指标(r=–0.200,P=0.006)呈负相关,HA与二者呈正相关(r=0.491,P<0.001;r=0.514,P<0.001),FT3与二者呈负相关(r=-0.246,P=0.001;r=–0.361,P<0.000).FT3、HA和CER诊断肝硬化的AUC分别为0.831、0.826和0.668,联合诊断的诊断效能从高到低依次为CER+HA+FT3、HA+FT3、CER+HA和CER+FT3.结论 CHB患者血清CER、HA、FT3水平与其肝脏纤维化程度具有相关性,对诊断慢性乙型肝炎后肝硬化有重要的参考价值.

目的:探讨柔红霉素对人B细胞淋巴瘤OCI-LY7细胞凋亡的影响及其机制,阐明柔红霉素在弥漫大B细胞淋巴瘤中的耐药机制.方法:将体外培养的OCLLY7细胞分为0、0.1、1.0和10.0 mg·L-1柔红霉素组.采用MTT法检测各组OCI-LY7细胞存活率,流式细胞术检测各组OCI-LY7细胞凋亡率,Western blotting法检测各组OCI-LY7细胞中凋亡相关蛋白Bax、cleaved caspase-3和survivin表达水平.后续实验分为对照组、柔红霉素组、柔红霉素+空载体组和柔红霉素+s urvivin组,按照上述方法检测survivin过表达后各组OCI-LY7细胞存活率、凋亡率和细胞中凋亡相关蛋白表达水平.结果:与0 mg·L-1组比较,处理48 h后0.1、1.0和10.0 mg·L-1柔红霉素组OCI-LY7细胞存活率和细胞中survivin蛋白表达水平逐渐降低(P＜0.05),而细胞凋亡率和细胞中cleaved caspase-3及Bax蛋白表达水平逐渐升高(P＜0.05).与对照组比较,柔红霉素组OCI-LY7细胞存活率和细胞中survivin蛋白表达水平明显降低(P＜0.05),而细胞凋亡率和细胞中cleaved caspase-3及Bax蛋白表达水平明显升高(P＜0.05);与柔红霉素组比较,柔红霉素+survivin组OCI-LY7细胞存活率和细胞中survivin蛋白表达水平明显升高(P＜0.05),而细胞凋亡率和细胞中cleaved caspase-3及Bax蛋白表达水平明显降低(P＜0.05).结论:柔红霉素可诱导OCI-LY7细胞凋亡,其作用机制可能与下调survivin蛋白表达有关.

目的 探讨汉族人群人类白细胞抗原B27(HLA-B27)基因亚型在强直性脊柱炎(AS)的表达及亚型分析,评价其检测在临床上的应用价值.方法 选取2016年1～12月南昌大学第二附属医院门诊及住院AS患者74例,其中,类风湿关节炎(RA)65例,腰椎盘间盘突出(LIDH)51例,脊柱结核(ST)50例,骨关节炎(OA)53例.选取40例作为健康对照,应用BD FACS Calibur流式细胞仪检测细胞HLA-B27抗原;聚合酶链反应-直接测序分型(PCR-SBT)技术对HLA-B27基因亚型进行分型.结果 AS患者HLA-B27阳性率高于RA、LIDH和ST疾病及健康对照组(P<0.007);30～<40岁年龄组男性人群HLA-B27阳性率高于女性人群(P<0.05);AS患者HLA-B27基因亚型以B2704为主.结论 南昌汉族人群中AS患者HLA-B27基因亚型以B2704、B2705为主,且B2704是AS的发病易感基因亚型.

目的 类风湿关节炎(RA)是继发性骨质疏松的常见原因,本研究旨在通过分析比较RA患者血清类风湿因子(RF)、抗环瓜氨酸多肽抗体(anti-CCP)、C-反应蛋白(CRP)、血细胞沉降率(ESR)及骨代谢六项指标水平,探讨RA患者骨质疏松的危险因素.方法 133例RA患者根据双能X线检测的骨密度(BMD)结果分为骨质疏松组、骨量减低组和骨量正常组,检测各组受试者RF、anti-CCP、CRP、ESR及骨代谢六项等指标,分析比较各组受试者各指标水平差异,并比较各组患者糖皮质激素用药情况,多元logistic回归分析上述指标与RA患者骨质疏松的关系.结果 ①RA患者血清RF、anti-CCP、CRP及ESR水平相较于正常人群显著升高;②骨质疏松和骨量减低组CRP、ESR及骨碱性磷酸酶(BALP)、β胶原特殊序列(β-CTx)两项骨代谢指标水平较RA骨量正常组显著升高,且OP组糖皮质激素使用率明显高于骨量正常组,差异有统计学意义;③患者年龄、病程、疾病活动度及使用糖皮质激素是RA患者发生骨质疏松的独立危险因素OR(95％CI)分别为1.116(1.013-1.230)、1.775(1.191-2.645)、4.356(1.741-10.898)和9.448(1.040-85.802).结论 RA患者血清自身抗体、炎症指标及骨代谢指标水平存在不同程度异常,患者年龄、病程、疾病活动度及糖皮质激素使用情况可作为判断RA患者骨质疏松风险的参考指标,有助于指导临床对RA患者疾病发展和病程进行监测,并进行及时的合理治疗.

Objective To evaluate the role of serum immunoglobulin light chains in monitoring and predicting prognosis of chronic kidney disease .Methods Totally 1512 chronic kidney patients (CKD) were assigned into 3 groups, chronic renal insufficiency group (Group CRI, n＝743), chronic renal failure group (Group CKF, n＝155), and ne-phritic syndrome group (Group NS, n＝614).Meanwhile, 73 cases of urinary tract infection group (Group UTI) and 50 healthy participants for physical examination (Group Control) were also selected.Immune scatter turbidity was applied to detect the levels of urinary free light chains and serum light chains .Results The levels of serum free κand λlight chains in Group NS was significantly lower than those in Group CKD and CKF (P＜0.01).The levels of urine free κand λlight chains in Group CRI, CKF, NS and UTI were significantly higher than those in Group Control (P＜0.01).Compared with Group UTI (0) and Control (0), the proportions of the patients with urinary κand λfree light chains double positive were significantly higher in Group CRI (51.9%), CKF (65.6%) and NS (67.9%) (P＜0.05).And they were also significantly higher in Group NC and CKF than that in Group CRI (P＜0.05).Conclusion Detection of the level of uri-nary free light chains has a profound impact in the aspect of diagnosing chronic kidney disease , evaluating patient′s condi-tion and the degree of renal corpuscle and tubular injuries.

Objective:To explore combined detection of mad2 with anti-nuclear mitotic spindle apparatus antibody(MSA)and anti-centromere antibody(ACA)and their clinical value for the diagnosis of small cell lung cancer(SCLC).Methods:One hundred and twen-ty SCLC patients,110 non-small cell lung cancer(NSCLC)patients,and 115 pulmonary nodule(PN)patients were enrolled in this study. The expression of mad2 was analyzed by qt-PCR.MSA and ACA were detected by indirect immunofluorescence(IIF)staining.Results:mad2 was overexpressed in SCLC and NSCLC samples(P<0.05).There were significant differences between the results obtained for SCLC and NSCLC samples by qt-PCR(P<0.05).AUC in ROC curve for mad2 expression was 0.799 with an intermediate diagnostic value. In the correlative analysis,the odds ratio of MSA and ACA was 6.94 and 5.60,respectively.In the correlation analysis,Kappa value of mad2 with MSA was 0.49,and Kappa value of mad2 with ACA was 0.42.In the parallel analysis,the sensitivity and specificity was 83.31% and 79.34%,respectively,while the Youden Index was 0.62.Moreover,in the serial analysis,the sensitivity and specificity was 65.32% and 93.35%,respectively,and the Youden Index was 0.59.Conclusions:In comparison with the NSCLC and PN samples,mad2 was overexpressed in SCLC samples.Therefore,mad2 ought to play a critical role in the pathology of SCLC.The combined expression of mad2 with MSA and ACA may contribute to enhancing the sensitivity and specificity of detection;this expression may allow early diag-nosis and clinical diagnosis of SLCC and may be a promising treatment for SCLC.

Objective To evaluate the role of anti-neutrophil cytoplasmic antibody(ANCA) determination for systemic vasculitis. Methods Indirect immunofluorescence(IIF) was performed to determine serum ANCA in 13 866 patients,and enzyme-linked immunosorbent assay(ELISA) was used to determine anti-myeloperoxidase (MPO) antibody and anti-protease 3(PR3) antibody. Results Among the 13 866 patients,there were 318 positive cases of ANCA,with the positive rate of 2.29%. There were 135(2.07%) males and 183(2.50%) females,and there was no statistical significance between the 2 groups(χ2=2.650,P>0.05). The difference of the ANCA positive rate with different ages had statistical significance(χ2=28.978,P<0.01). The positive rate of ANCA between males and females in different age groups had statistical significance(χ2=54.550,P<0.01;χ2=17.800, P<0.01). The p-ANCA and c-ANCA and target antigen distribution had statistical significance(χ2=86.524, P<0.01).Conclusions ANCA is potential in the diagnosis and treatment of vasculitis and autoimmune diseases, especially for ANCA-associated systemic vasculitis.

目的 探讨自身免疫性肝病(AILD)合并血管炎患者检测血清抗中性粒细胞胞质抗体(AN-CA)、IgG4的临床意义.方法 选取AILD合并血管炎患者67例,AILD未合并血管炎患者170例、非AILD患者132例及健康体检者43例,采用间接免疫荧光法(IIF)检测ANCA和速率散射比浊法检测IgG4,并对结果进行统计分析.结果 原发硬化性胆管炎(PSC)合并血管炎患者ANCA阳性率最高为68.97％,与非AILD、健康对照组差异均具有统计学意义(P<0.01);PSC合并血管炎IgG4水平最高为(131.17±123.66)mg/dL,与AILD未合并血管炎组、非AILD组、健康对照组比较,差异均具有统计学意义(P<0.01);PSC合并血管炎IgG4水平AUC=0.845,P<0.01,95％置信区间为0.737～0.952,曲线下面积最大,诊断价值最高.结论 ANCA、IgG4检测对于AILD合并血管炎患者的血清学诊断及鉴别诊断具有重要的临床意义,其中对PSC合并血管炎鉴别诊断意义最显著.

Objective To investigate the clinical diagnostic value of serum procalcitonin(PCT),D-dimer (DD),C-reactive protein(CRP)in acute-on-chronic liver failure(ACLF). Methods 124 ACLF patients, 63 chronic hepatitis B patients,32 chronic hepatitis C patients,24 chronic hepatitis E patients and 60 healthy controls from the second affiliated hospital of Nanchang University were enrolled in this study.PCT was detected by a sandwish immunodetection method. D-dimer was detected by Latex Turbidimetry. CRP was detected by rate nephenometry. The detection results were used for analyzing the clinical diagnostic value of ACLF with infection. Results(1)The level of PCT,DD and CRP in ACLF group were significantly higher than non-ACLF group and healthy controls(P<0.05).The levels of PCT,DD and CRP in the infection group were significantly higher than non-infection group(P<0.05).(2)The positive rates of PCT,DD and CRP in the infection group were 93.24%, 78.38%,89.19%,which were significantly higher than the non-infection group and healthy controls respectively (P < 0.05).(3)The sensitivity(93.24%)and specificity(90.00%)of PCT were the highest among all indexes. (4)The area under the ROC curve of PCT,DD,CRP were 0.892,0.715,0.755,respectively.PCT had the highest diagnostic value. Conclusion The levels of serum PCT,DD and CRP have a significant clinical value for the early diagnosis of ACLF with infection.