目的 探讨慢性HBV感染者和肝细胞癌患者细胞毒性T淋巴细胞相关抗原-4(cytotoxic T lymphocyte associated antigen-4,CTLA-4)和T细胞免疫球蛋白及黏蛋白分子-3(T cell immunoglobulin and mucin domain-3,TIM-3)的基因多态性分布,以及二者的联合作用.方法 通过病例对照研究方法,提取439例慢性HBV感染者(无症状携带者48例,慢性肝炎154例,肝硬化134例和肝癌103例)和220例健康对照者的基因组DNA,限制性片段长度多态性聚合酶链反应(PCR-RFLP)技术检测所有患者DNA的CTLA-4+49 A/G和TIM-3-1516 G/T基因型分布频率,采用χ2检验分析基因型频率、等位基因频率在HBV感染组与对照组的分布情况以及在肝癌组与非肝癌组的分布情况.结果 HBV感染组的CTLA-4+49含A基因型(GA+AA)频率高于对照组(P<0.001,OR=1.924).HBV感染组的TIM-3-1516含T基因型(GT+TT)频率高于对照组(P=0.002,OR=2.263).CTLA-4+49 GG/TIM-3-1516 GG基因型组合在HBV感染组中的分布频率低于对照组(P<0.001,OR=0.242).非肝癌组(无症状携带者、慢性肝炎和肝硬化患者)的CTLA-4+49 GA和AA基因型频率高于肝癌组(分别为P<0.001,OR=2.433和P=0.003,OR=2.798).非肝癌组的TIM-3-1516 GG基因型频率高于肝癌组(P=0.042,OR=1.725).CTLA-4+49 GA/TIM-3-1516 GG和CTLA-4+49 AA/TIM-3-1516 GG基因型组合在非肝癌组的分布频率高于肝癌组(分别为P=0.001,OR=3.728和P=0.003,OR=4.032).结论 CTLA-4+49含A基因型和TIM-3-1516含T基因型可能是慢性HBV感染的危险因素,基因型组合增加了慢性HBV感染的发病风险.CTLA-4+49 GG基因型和TIM-3-1516 GT+TT基因型可能与HCC发生相关,基因型组合也增加了HCC发生的风险.CTLA-4和TIM-3基因多态性可能各自并联合地增加慢性HBV感染和肝细胞癌的风险.

7月28日,是世界肝炎日.之所以定于7月28日,是为了纪念乙型肝炎病毒发现者、诺贝尔奖得主巴鲁克·布隆伯格诞辰. 乙型肝炎病毒感染是一个全球性的公共卫生问题,对全球人群的健康产生了巨大影响.在不干预的情况下,慢性乙型肝炎(简称慢乙肝)可逐渐发展为肝硬化、肝细胞癌,甚至肝衰竭,严重威胁患者的生命.

目的 探讨慢性HBV感染者PD-1和CTLA-43′UTR的基因多态性分布,以及二者之间的交互作用.方法 通过病例对照研究方法,PCR-RFLP技术检测慢性HBV感染者433例,健康对照者208例,PD-1 rs10204525和CTLA-4 rs3087243的基因型分布频率,采用χ2检验分析HBV感染组与健康对照组的基因型频率、等位基因频率、基因间的交互作用、与疾病严重程度的关系.结果 PD-1 rs10204525:与GG基因型相比,慢性HBV感染组的AA基因型频率明显高于健康对照组(P=0.019,OR=2.231,95％CI=1.127～4.418),A等位基因频率明显高于健康对照组(P=0.033,OR=1.334,95％CI=1.024～1.739).CTLA-4 rs3087243:与AA基因型相比,慢性HBV感染组的GG基因型频率明显高于健康对照组(P=0.016,OR=2.196,95％CI=1.145～4.214),G等位基因频率明显高于健康对照组(P=0.040,OR=1.320,95％CI=1.012～1.723).PD-1和CTLA-4的基因型交互后,在HBV感染组和健康对照组中的差异、与疾病严重程度、与肝癌的关系均有统计学意义.结论 PD-1 rs10204525的A A基因型和A等位基因可能是慢性HBV感染的危险因素,CTLA-4 rs3087243的GG基因型和G等位基因可能是慢性HBV感染的危险因素.联合基因型可增加慢性HBV感染的危险因素.CTLA-4 rs3087243的GG基因型和G等位基因可能与HCC感染相关.

目的 探讨体素内不相干运动成像(IVIM)定量参数与直肠癌分期及分化程度的关系.方法 选取2015年3月至2019年2月西安交通大学第二附属医院收治的95例直肠癌患者,所有患者均行MRI检查,测定IVIM纯扩散系数(D)、灌注相关假扩散系数(D*)、灌注分数(f).MRI检查后2周内予以根治性手术.根据术中探查结果与术后病理报告确定患者TNM分期、分化程度、脉管神经侵犯情况.比较不同TNM分期、分化程度、脉管神经侵犯情况患者的D、D*、f值.结果 Ⅰ、Ⅱ期患者与Ⅲ、Ⅳ期患者的D、D*、f值的差异无统计学意义(P＞0.05).不同分化程度患者D *、f的差异无统计学意义(P＞0.05).高分化患者的D值显著高于中分化与低分化患者,中分化患者显著高于低分化患者(P＜0.05).脉管神经侵犯患者与未侵犯患者的D*、f的差异无统计学意义(P＞0.05).脉管神经侵犯患者的D显著低于未侵犯患者(P＜0.05).结论 IVIM-DWI参数可无创评估直肠癌恶性程度,分化程度低、发生脉管神经侵犯的D值相对更低,对直肠癌恶性程度的评估价值较高.

Objective To investigate the efficacy and safety of abdominal indwelling catheterization for the patients with large-volume ascites.Methods A total of 84 patients with liver cirrhosis complicated with large-volume ascites admitted in the first affiliated hospital of Xi'an Jiaotong University from January 2015 to December 2015 were retrospectively analyzed.Patients were divided into two groups,one was the puncture group and another was the catheterization group.The efficacy and safety were evaluated.Results Forty-four patients were enrolled in catheterization group,whereas forty patients were enrolled in puncture group.Symptoms associated with ascites had been eased and patients' qualities of life had been improved in 2 weeks in each group.The tube fell out rate was 27.3％ for patients in catheterization group.There was no operation related complications such as death,bleeding and intestinal perforation occurred.Either Child B stage or Child C stage,the dynamic changes of liver function and renal function in catheterization group were comparable to those in puncture group.No adverse event such as catheterization-related or puncture-related infection was observed.Conclusion Abdominal catheterization is effective and safe in management of large amount of ascites complicated with cirrhosis,however,the high rate of tube-fell-out should be paid more attention.