目的 探讨克罗恩病(CD)患者血清中期因子(MK)、正五聚蛋白3(PTX3)水平与活动度指标和辅助性T细胞(Th17)/调节性T细胞(Treg)比值的相关性.方法 选择2019年4月至2021年3月上海中医药大学附属曙光医院收治的CD患者92例,根据简化克罗恩病疾病活动指数(CDAI)分为缓解期组24例,轻度活动组36例,中重度活动组32例,选择同期体检的健康志愿者90例作为对照组.分析CD患者血清MK、PTX3水平与疾病活动度指标和Th17/Treg比值的相关性.结果 研究组血清MK、PTX3、C反应蛋白(CRP)、红细胞沉降率(ESR)及Th17、Th17/Treg、白细胞介素(IL)-10、IL-17、IL-23均显著高于对照组,Treg显著低于对照组(P<0.05).中重度活动组血清MK、PTX3、CRP、ESR及Th17、Th17/Treg、IL-10、IL-17、IL-23显著高于轻度活动组、缓解期组(P<0.05),Treg显著低于轻度活动组、缓解期组(P<0.05);轻度活动组血清MK、PTX3、CRP、ESR及Th17、Th17/Treg、IL-10、IL-17、IL-23显著高于缓解期组,Treg显著低于缓解期组(P<0.05).CD患者血清MK与PTX3、CRP、ESR、简化CDAI、Th17/Treg呈正相关,PTX3与MK、CRP、ESR、简化CDAI、Th17/Treg呈正相关(P<0.05).结论 CD患者血清PTX3、MK水平异常升高,其水平与CD疾病活动度及Th17、Treg细胞失衡有关,检测两者水平可为临床CD诊治及病情评估提供参考.

目的 探讨乙型肝炎病毒(hepatitis B virus,HBV)基因型与S蛋白变异的关联,为分析病毒基因型在疾病预后转归中的作用提供理论基础.方法 选择上海中医药大学附属曙光医院东院2019年1月至2019年10月门诊或住院的HBeAg阴性慢性乙型肝炎患者99例,其中,B基因型50例,C基因型49例.基因测序法用于S蛋白基因序列分析,分类变量间差异分析采用χ2检验与连续校准.非正态分布数据采用非参数秩和检验.结果 HBeAg阴性慢性乙型肝炎组C基因型的S蛋白变异率高于B基因型为87.76％(43/49)比66.00％(33/50),(χ2=6.567,P=0.010),且变异差异位点似乎为随机分布,主要亲水区(major hydrophilic region,MHR)与MHR外的变异率,C基因型均高于B基因型为38.78％(19/49)比18.00％(9/50),(χ2=5.266,P=0.022);85.71％(42/49)比56.00％(28/50),(χ2=10.550,P=0.001).两基因型MHR的"a"决定簇[32.65％(16/49)比12.00％(6/50),(χ2=6.107,P=0.013)]以及MHR外的细胞毒T淋巴细胞+辅助性T淋巴细胞(CTL+Th)免疫表位[69.39％(34/49)比40.00％(20/50),(χ2=8.620,P=0.003)]与非免疫表位[53.06％(24/49)比30.00％(15/50),(χ2=5.424,P=0.020)]差异均有统计学意义.结论 HBeAg阴性慢性乙型肝炎患者C基因型较B基因型更容易产生HBV S蛋白变异.

目的 探讨HBeAg阴性慢性乙型肝炎患者乙型肝炎病毒(HBV)主要亲水区(MHR)外变异特征及临床意义.方法 选择本院2019年3月至2019年12月门诊或住院的慢性乙型肝炎患者154例,分为非活动性HBsAg携带状态组(n=55)与HBeAg阴性慢性乙型肝炎组(n=99).使用基因测序法进行MHR外与MHR区基因序列分析,并分析比较两组变异率及变异位点差异.结果 非活动性HBsAg携带组MHR外变异率为45.45％,HBeAg阴性慢性乙型肝炎组变异率明显提高至70.71％,两组具有统计学意义(P＜0.05),MHR外变异主要集中于细胞毒T淋巴细胞+辅助性T淋巴细胞(CTL+Th)免疫表位区,变异率HBeAg阴性慢性乙型肝炎组显著高于非活动性HBsAg携带组,差异具有统计学意义P＜0.05),而非免疫表位区变异率HBeAg阴性慢性乙型肝炎组虽高于非活动性HBsAg携带组,但差异无统计学意义.此外,MHR以及MHR区域内"a"决定簇变异率两组之间差异也无统计学意义.结论 MHR外以及MHR外CTL+Th免疫表位区变异为HBeAg阴性慢性乙型肝炎危险因素,可增加发生HBeAg阴性慢性乙型肝炎的风险.

糖尿病肾病是一种严重的糖尿病并发症[1],患者一旦出现典型症状便表示病情已处于不可逆状态,常规治疗仅能延缓患者的肾功能恶化速度,患者仍会不可避免的病情恶化,从而导致尿毒症的出现,威胁患者生命[2].因此,尽早确诊对于糖尿病患者的治疗有着重要的意义.相关研究指出,糖尿病肾病患者的肾功能指标检验对于患者的诊断和治疗有着重要的价值[3].本研究抽取2019—2020年在我院经病理诊断确诊为糖尿病肾病的40例患者进行临床研究,对肾功能指标检验在糖尿病肾病中的价值进行验证分析,现报告如下.

目的 探讨慢性乙型肝炎(CHB)患者、肝硬化患者乙型肝炎病毒(HBV)S蛋白变异的差异及其临床意义.方法 选取CHB患者114例,其中慢性HBV携带者41例(慢性HBV携带组)、非活动性乙型肝炎表面抗原(HBsAg)携带者38例(非活动性HBsAg携带组)、肝硬化组35例(肝硬化组).采用测序法检测所有对象的HBV S蛋白基因序列.结果 慢性HBV携带组、非活动性HBsAg携带组与肝硬化组之间年龄和HBV DNA载量差异均有统计学意义(P<0.01),性别及HBV基因型差异均无统计学意义(P>0.05).肝硬化组HBV S蛋白总体变异率明显高于非活动性HBsAg携带组和慢性HBV携带组(P<0.05、P<0.01).慢性HBV携带组、非活动性HBsAg携带组与肝硬化组S蛋白的主要亲水区(MHR)外变异率及细胞毒T淋巴细胞(CTL)+辅助性T淋巴细胞(Th)免疫表位区变异率依次升高(P<0.01).3组之间S蛋白的MHR及位于MHR内的"a"决定簇、LOOP1和LOOP2的变异率差异均无统计学意义(P>0.05),MHR外的非免疫表位区变异率差异亦无统计学意义(P>0.05).慢性HBV携带组中有1例患者同时出现MHR外Th免疫表位区、CTL免疫表位区和非免疫表位区3个位点变异,1例患者出现MHR与MHR外Th免疫表位区2个位点变异,其他患者均为单点变异,且MHR外CTL+Th免疫表位区与非免疫表位区变异率相当,呈随机分布.非活动性HBsAg携带组有5例(13.15％)患者出现2个位点以上的变异,肝硬化组有9例(25.71％)患者出现2个位点以上的变异,且2个组的变异位点集中于MHR外CTL+Th免疫表位区.结论 HBV S蛋白MHR外,尤其是MHR外CTL+Th免疫表位区变异不仅与HBeAg阴性血清学状态相关,也与肝硬化相关.

Objective To analysis the frequency and mutational patterns of HBV(hepatitis B virus) S protein in the different phases of chronic hepatitis B patients, exploring the clinical implication of these mutations in CHB. Methods The difference of S protein mutation rates and mutation site among each groups were analyzed by cases-comparison. 112 cases of chronic hepatitis B patients in Shanghai Shu-guang hospital were enrolled in this study; they were divided into four groups, immune-tolerance group [IT, 36 cases, male 20 cases,female 16 cases,age 28.00 (25.00,30.75)years], immune-clearance group [IC, 28 cases, male 17 cases,female 11 cases,age 29.00 (25.25,31.75) years], low-replication group [LR, 25 cases, male 17 cases,female 8 cases,age 39.00 (35.00,45.50) years], reactivation group [RE, 23 cases, male 15 cases,female 8 cases, age 43.00 (36.00, 48.00) years]. DNA sequencing was used to detection HBV S protein gene mutation. Difference between categorical variables were analyzed using Chi-square test, Non-parametric test (kruskal-wallis H and Mann-Whitney U) was used for non-normal distribution data. Results Naturally occurring MHR (major hydrophilic region) variants was 16.67％ (6/36 cases) in IT group, preferentially within"a"determinant in the first loop, compared with IC (21.43％,6/28 cases), LR (20.00％,5/25 cases) and RE (34.78％,8/23 cases), there was no statistics Significance (χ2=2.814, P=0.421), while variant frequencies outside the MHR were 11.11％ (4/36 cases) and 14.29％ (4/28 cases) in IT and IC group, viral diversity gradually increased during LR phase with 24.00％(6/25 cases) of mutation frequency, and peak at RE phase (52.17％, 12/23 cases) with a statistics significance (χ2=15.041, P=0.002). Conclusion Amino acid substitutions is not only the consequence of the pressure of host immunity, it may be a probably cause of disease reactivation.

目的:探讨祛风利湿合剂治疗亚急性湿疹的临床疗效及作用机制.方法:60例亚急性湿疹患者随机分为观察组和对照组各30例.观察组给予祛风利湿合剂,每日两次,每次30 mL;对照组给予咪唑斯汀缓释片,每晚1次,每次10 mg;两组患者均治疗4周.比较两组患者治疗前后的视觉模拟评分(visual analogue scale,VAS)、瘙痒时间占夜间睡眠的百分比(the percent of itching time,PIT)、湿疹面积及严重度指数评分(eczema area and severity index,EASI)和血清中趋化因子(thymusand activation-regulated chemokine,TARC)水平.结果:观察组和对照组的有效率分别为83.3％ (25/30)、63.3％(19/30),两组有效率比较,差异无统计学意义(P＞0.05);临床愈显率分别为53.3％ (16/30)、20.0％ (6/30),观察组优于对照组(p＜0.01).两组患者治疗后VAS、PIT、EASI、血清TARC水平均低于治疗前(P＜0.01);观察组治疗后PIT、EASI、血清TARC水平低于对照组治疗后(P＜0.01).结论:祛风利湿合剂治疗亚急性湿疹疗效显著,可显著降低VAS、PIT、EASI,其机制可能与调节血清TARC表达水平有关.

目的 针对解脲支原体(ureaplasma urealytieum,UU)、沙眼衣原体(ehlamydia trachomatis,CT)、淋病奈瑟菌(neisseria agonorrhoeae,NG)检测的传统法与现有市售PCR试剂盒相比较评估二者临床应用价值方法 应用常规方法(用液体培养法检测解脲脲原体,用胶体金法检测沙眼衣原体,培养/镜检法检测淋病奈瑟氏菌)与PCR法检测392例女性生殖泌尿道标本,分别计算阳性率、灵敏性和特异性,使用McNemar检验两种方法的差异.结果 以PCR为参比方法,传统方法的UU与CT灵敏性与特异性分别为66.36％,100％与63.27％,100％,两种方法比较均具有统计学意义(x2=108.00,P＜0.01,kappa =0.579与x2=16.06,P＜0.05,kappa=0.756),传统方法NG的灵敏性与特异性为67.85％与99.35％,两种方法相比无统计学意义(x2=2.08,P＞0.05,kappa=0.747).结论 尽管在UU、CT检测的灵敏性上,PCR方法优于传统培养方法,但两者联合检测可提高检出率,尤其对于NG的检测.因此PCR法目前无法完全取代传统培养法.

Objective To investigate the relations of methylenetetrahydrofolate reductase(MTHFR) gene C677T polymorphism with hyperhomocysteinemia(HHcy) and acute coronary syndrome(ACS). Methods A total of 81 patients with ACS,including 51 cases of normal homocysteine(Hcy) and 30 cases of HHcy,and 98 healthy subjects(healthy control group) were enrolled. The relations of MTHFR gene C677T polymorphism with HHcy and ACS susceptibility were analyzed. Results The distribution of genotypes in ACS group and healthy control group was in conformity with the principle of Hardy-Weinberg equilibrium. Compared to healthy control group,the odds ratios(OR) [95% confidence interval(CI)] for ACS of MTHFR gene C677T TT to CC,TT to CT+CC and T to C were 2.60(1.12-6.03),2.02(1.06-3.86) and 1.66(1.09-2.53),respectively. Furthermore,the OR (95%CI)for HHcy of MTHFR gene C677T TT to CT+CC was 2.74(1.08-7.00). Conclusions MTHFR gene C677T TT genotype is a risk factor for HHcy and may increase the risk of ACS.

Objective:To explore the diagnosis value of serum creatine kinase (CK-MB),high-sensitivity C-reactive protein (hs-CRP),interleukin-35 (IL-35) and troponin Ⅰ (cTnⅠ) in viral myocarditis.Methods:The research subjects were 63 cases of patients with viral myocarditis who diagnosed and accepted treatment in our hospital between January 2012 to January 2015,as the experimental group;while 60 cases of healthy people in our hospital as the same period as a control group.Compared the levels of serum CK-MB,hs-CRP,IL-35,and cTnⅠ in two groups.Results:The positive rates of CK-MB,hs-CRP,cTnⅠ in experimental group were significantly higher than control group,the differences were statistically significant(P＜0.05);The levels of serum CK-MB,hs-CRP,L-35 and cTnⅠ test results were significantly higher than the control group,the differences were statistically significant (P＜0.05);The sensitivity and specificity of cTnⅠ were highest,and the specificity of hs-CRP was higher than CK-MB,but the sensitivity was lower.Conclusion:Serum hs-CRP,CK-MB,cTnⅠ and IL-35 can be used as an important indicator of the diagnosis of viral myocarditis.

Objective To analysis the risk factors for elevated ALT level in patients with Non-alcoholic fatty liver diseases (NAFLD).Method Fifty-six (male 25,female 31) NAFLD patients with elevated ALT and 153 NAFLD patients (male 64,female 89) with normal ALT and 160 (male 80,female 80) health subjects were selected.ALT was detected by rate assay,total cholesterol (TC),triglycerides (TG),low-density lipoprotein cholesterols (LDL-C),high-density cholesterol (HDL-C) and uric acid (UA) were detected by enzymatic method.Free fatty acid (FFA) was detected by immunoturbidimetry assay.Spearman correlation was used to analysis the relation between ALT and TC,TG,LDL-C,HDL-C,UA and FFA.Logistic regression was used to analyses the risk factor for elevated ALT level.Results TC,TG,LDL-C,UA and FFA levels were significantly higher in NAFLD group (including normal ALT group and elevated ALT group) than those in health group no matter male and female,HDL-C was significantly lower in these two groups when compared to control group,but binary logistic regression and spearman analysis showed that only UA and FFA were the risk factors for elevated ALT level and significantly positively correlated with ALT level,abnormal UA and FFA for male were associated with 3.96-fold(95CI％ =1.40～ 11.22,P=0.010) and 3.27-fold (95 ％ CI =1.14 ～ 9.40,P =0.028) of increased risk of elevated ALT level respectinely,correlation coefficient were 0.40(P=0.000),0.29(P=0.006),Meanwhile Exp(B) of elevated ALT level for female with abnormal UA,FFA were 4.49 (95CI％=1.79～11.28,P=0.001) and 3.17 (95CI％ =1.25～8.04,P=0.015),correlation coefficient were 0.34 (P =0.000),0.27 (P =0.003).Conclusion Elevated ALT level was not associated with dyslipidemias,but related to UA and FFA.They can be used as candidate markers for predicting severity of liver damage.

目的 建立有助于头皮白屑风辨证分型的客观化检测指标,并探讨头皮白屑风病因病机.方法 根据中医辨证分型将白屑风患者分为血热风燥型(26例)与肠胃湿热型(51例),15例正常人群作为对照组.马拉色菌采用巢式聚合酶链反应(PCR)方法进行检测;皮脂含量采用油脂检测仪检测;红斑采用红斑评分标准进行评分.结果 肠胃湿热组皮脂含量为50.55±19.00,高于血热风燥组(20.08±7.96)与正常组(19.40±11.34),差异具有统计学意义(P＜0.01);肠胃湿热组球形、限制型马拉色菌感染率分别为68.63％、94.12％、高于血热风燥组(34.62％、61.54％)与正常组(33.33％、60.00％),差异同样具有统计学意义.结论 皮脂与马拉色菌检测可以作为头皮白屑风辨证分型的辅助检测指标.

Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that plays a critical role in the folate and homocysteine metabolism.MTHFR mutation leads to decreased 5-methylenetetrahydrofolate synthesis.Consequently, it influences the conversion of homocysteine to methionine causing homocysteine accumulation.Homocysteine has been considered as an independent risk factor for a variety of diseases such as cardiovascular diseases , neurological and psychiatric disorders as well as cancers .The study on the correlation between methylenetetrahydrofolate reductase gene polymorphisms and diseases and the discovery of its clinical value is getting more and more attention.

目的 比较乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)与乙肝病毒DNA (HBV-DNA)对干扰素治疗HBeAg阳性慢性乙型肝炎48周HBeAg血清学转换的临床预测价值.方法 252例接受干扰素治疗的HBeAg阳性慢性乙型肝炎患者为研究对象,分为HBeAg血清学转换组(83例)与未转换组(169例).利用受试者工作特征(ROC)曲线计算灵敏度、特异度、阳性预测值(PPV)与阴性预测值(NPV).结果 12周与24周HBeAg分别以90 S/CO与25 S/CO为临界值时,其预测治疗48周HBeAg血清学转换的灵敏度、特异度、PPV,NPV分别为0.852,0.639,0.680,0.828与0.899,0.663,0.763,0.845,24周的HBV-DNA载量与较基线下降幅度也具有较高灵敏度与特异度.结论 HBeAg血清定量值为干扰素治疗慢性乙型肝炎血清学转换最佳预测指标,此外,治疗24周HBV-DNA载量与较基线下降幅度也具有一定预测价值.

ObjectiveTo investigate effects ofEuphorbiae ebracteolatae Radixon the proliferation and apoptosis in human papillomavirus (HPV)-18-infected HeLa cells.MethodsThe alcohol extract ofEuphorbiae ebracteolatae Radixwas prepared. Cell proliferation was determined using the MTT assay, and apoptotic cells was determined using the Hoechst 33258 staining.ResultsHPV-18-infected HeLa cells were treated with 10, 20 μg/mlof the alcohol extract ofEuphorbiae ebracteolatae Radixfor 12 h, the cell proliferation inhibition rate were significantly increased compared to the control group (16.36% ± 5.06%, 18.59% ± 5.99%; allP<0.01);HPV-18-infected HeLa cells were treated with 0.625, 1.25, 2.5, 5, 10, 20 μg/ml of the alcohol extract ofEuphorbiae ebracteolatae Radixfor 72 h, the cell proliferation inhibition rate were significantly increased compared to the control group (13.82% ± 3.66%, 30.24% ± 6.58%, 43.29% ± 4.29%, 53.32% ± 1.41%, 54.24% ± 1.97%, 50.68% ±1.74%;allP<0.01). The Hoechst 33258 staining showed that HPV-18-infected HeLa cells were treated with 10 μg/ml of the alcohol extract ofEuphorbiae ebracteolatae Radixfor 24 h, the apoptotic cells were found.ConclusionEuphorbiae ebracteolatae Radixcould inhibit the proliferation and induce apoptosis in HPV-18-infected HeLa cells.

目的 探讨全血标本冷藏保存1周对血清乙肝病毒DNA(HBV DNA)复检结果的影响.方法 采集乙肝患者外周全血150例,及时2～8℃保存,分别于采血后第1天和第7天用实时荧光定量PCR法(FQ-PCR)检测血清HBV DNA水平.结果 150例全血标本第1天、第7天时血清HBV DNA载量分别为:5.50±1.46、5.64±1.53,结果呈小幅升高趋势,但两组差异无统计学意义(P＞0.05);以第1天结果为基准,第7天时结果偏倚绝对值为(4.26±0.03)％,其中15例偏倚大于±7.5％.结论 以分析中质量控制为前提,全血标本冷藏保存l周对血清HBV DNA复测结果的影响符合ISO 15189室内质控要求,能满足临床追加检测或复查申请;操作误差和FQ-PCR方法学的不足仍是造成复测较大偏差的最主要原因.

探讨耐亚胺培南铜绿假单胞菌的耐药性及其产超广谱β-内酰胺酶基因型.收集2011年7月至2013年12月上海市中医药大学附属曙光医院临床分离的铜绿假单胞菌共1 125株,筛选亚胺培南耐药株,常规纸片法检测其耐药性,并用E-test检测金属β-内酰胺酶(MBL),采用PCR法检测耐药基因型.结果显示,1 125株铜绿假单胞菌中耐亚胺培南铜绿假单胞菌共计617株,占54.8％;亚胺培南敏感铜绿假单胞菌共计508株,占45.2％.617株亚胺培南耐药铜绿假单胞菌100％为多重耐药,而亚胺培南敏感铜绿假单胞菌的多重耐药率仅为13.78％,明显较前者低(X2=871.15,P＜0.05);亚胺培南耐药的铜绿假单胞菌中MBL表型阳性共126株,阳性率为15.4％,94株(74.60％)表现为VIM-2阳性,10株(7.94％)表现为IMP-1阳性,1株检出OXA-10,且该例菌株同时表达VIM-2.临床分离的耐亚胺培南的铜绿假单胞菌多为多重耐药,其产MBL的主要基因型是VIM-2.

Objective To investigate the direct effect of"Antiphlogistic No.1" on the degranultion of RBL-2H3 mast cells stimulated by anti-DNP IgE and DNP-BSA complex.Methods The effect of "Antiphlogistic No.1" on stabilization of RBL-2H3 cell membrane was assessed by degranultion inhibition rate.β-hexosaminidase and IL-4 released from RBL-2H3 cells were detected by PNAG colorimetric assay and ELISA.Results β-hexosaminidase and cytokine IL-4 production releases from RBL-2H3 cells was reduced after they had been treated with "Antiphlogistic No.1".The inhibition rate of β-hexosaminidase release was 42.47％ at the concentration of 8 μg/ml (P＜0.01) and dose dependently increased to 52.40％,68.26％ and 72.15％ respectively when drug concentration up to 80 μg/ml,800 μg/ml,8000 μg/ml,while inhibition rate of IL-4 generation were 13.87％,23.27％,31.95％,39.99％ (P＜0.01)."Antiphlogistic No.1" maximum inhibition rate of β-hexosaminidase release is 84.48％ of dexamethason maximum inhibition rate while "Antiphlogistic No.l" maximum inhibition rate of IL-4 is close to dexamethason maximum inhibition rate.Conclusion "Antiphlogistic No.1" could stabilize the cellular membrane of RBL-2H3 and provide protection against Ⅰ type allergic response.

Objective To study the diagnostic value of neutrophil VCS parameters in bacterial infection.Methods Whole blood cell analysis by Backman Coulter LH750 automatic blood cell analyzer and microscopic examination were performed in 142 patients with bacterial infections,67 healthy subjects and 50 patients with virus infection.Total white blood cell count(WBC),neutrophil granulocyte percentage(NE%),neutrophil VCS parameters,including mean neutrophil volume(MNV),mean neutrophil conductivity(MNC),mean neutrophil scatter(MNS),neutrophil volume distribution width(NDW) were taken for statistical analysis.Results In bacterial infection group,MNV was significantly higher than that of normal group(P<0.01),MNS was significantly lower than that of healthy controls(P<0.01),and NDW was significantly higher than that in the control group(P<0.01).In certain bacterial infection patients,even though the total number of leukocytes or percentage of neutrophils were normal,MNV and NDW still showed abnormality.When MNV≥145,the specificity was 82.1% and the sensitivity was 81.2%,significantly higher than that of WBC and NE%.No significant difference in VCS parameters(P>0.05) was found between virus infection group and healthy group.Conclusions Neutrophil VCS parameters could be used as new criteria for diagnosis of bacterial infection.

目的 通过对Beckman Coulter LH750血细胞分析仪所提示的异常细胞报警信息与手工镜检的对比,评价其在实际工作中的作用.方法 采集静脉全血2 mL,检测448例有异常细胞报警提示的样本及400例无异常提示的样本,并同步进行手工镜检白细胞分类.结果 仪器对异常细胞报警提示功能的诊断特异性为75.8%,灵敏度为98.5%,阳性预测值为75%,阴性预测值为98.5%.结论 该仪器具有较高的灵敏度及特异性,能较好地大批量检测临床样本.但在实际工作中对其异常提示应加以分析并制定合理的复检规则,最终以手工镜检分类为准.