In this study we report on the clinical and autoimmune characteristics of severe and critical novel coronavirus pneumonia caused by severe acute respiratory syndrome‒associated coronavirus 2 (SARS‐CoV‐2). The clinical, autoimmune, and laboratory characteristics of 21 patients who had laboratory‐confirmed severe and critical cases of coronavirus disease 2019 (COVID‐19) from the intensive care unit of the Huangshi Central Hospital, Hubei Province, China, were investigated. A total of 21 patients (13 men and 8 women), including 8 (38.1%) severe cases and 13 (61.9%) critical cases, were enrolled. Cough (90.5%) and fever (81.0%) were the dominant symptoms, and most patients (76.2%) had at least one coexisting disorder on admission. The most common characteristics on chest computed tomography were ground‐glass opacity (100%) and bilateral patchy shadowing (76.2%). The most common findings on laboratory measurement were lymphocytopenia (85.7%) and elevated levels of C‐reactive protein (94.7%) and interleukin‐6 (89.5%). The prevalence of anti‒52 kDa SSA/Ro antibody, anti‒60 kDa SSA/Ro antibody, and antinuclear antibody was 20%, 25%, and 50%, respectively. We also retrospectively analyzed the clinical and laboratory data from 21 severe and critical cases of COVID‐19. Autoimmune phenomena exist in COVID‐19 subjects, and the present results provide the rationale for a strategy of preventing immune dysfunction and optimal immunosuppressive therapy.

ABSTRACT Asymptomatic SARS-CoV-2-infected individuals are thought to play major roles in virus transmission. This study aimed to analyze the characteristics of asymptomatic carriers with COVID-19 to control the spread of the virus. We retrospectively investigated the clinical characteristics of 648 consecutive subjects who were enrolled in the study and were divided into asymptomatic carriers, mild cases, ordinary cases, severe or critical cases, and evaluated their impact on disease severity by means of Spearman correlation and multiple regression analyses. Receiver operating characteristic curve analysis was conducted to determine the optimum cutoff levels of laboratory findings for diagnostic predictors of asymptomatic carriers of COVID-19. In our study, a total of 648 subjects on admission with a mean age of 45.61 y including 345 males and 303 females were enrolled in our study. The leukocyte, lymphocyte, eosinophil, platelet, C-reactive protein, interleukin-6, CD3+, CD4+, and CD8 + T lymphocyte levels, and the erythrocyte sedimentation rate differed significantly among the groups (all p ≤ 0.05). Disease severity was negatively associated with the CD3+ (r = −0.340; p < 0.001), CD4+ (r = −0.290; p = 0.001) and CD8+ (r = −0.322; p < 0.001) T lymphocyte levels. The significant diagnostic predictors of asymptomatic carriers of COVID-19 included the blood cell, cytokine, and T lymphocyte subset levels. Inflammation and immune response may play important roles in disease progression. Hence, the laboratory parameters identified should be considered in clinical practice, which provide new insights into the identification of asymptomatic individuals and the prevention of virus transmission.

Coronavirus Disease 2019 (COVID-19) pandemic has rapidly spread across the globe while little multi-center research about the epidemiological characteristics of cluster transmission is conducted. To provide a more comprehensive description of the epidemiological characteristics of cluster transmission and the virulence of SARS-CoV-2 carried by asymptomatic carriers, we studied the epidemiological characteristics of 70 clusters. 70 clusters including 311 consecutive subjects from January 20, 2020, to March 10, 2020, were enrolled. Of 70 clusters, 5 were infected by asymptomatic or presymptomatic carriers. We gathered and analyzed information about their demographic, epidemiological, clinical, diagnostic classification, and cluster characteristics. Among the 66 asymptomatic carriers in Jiangsu Province, 49 asymptomatic were observed in 311 subjects distributed in 70 clusters. We demonstrated that there is a significance between the severity of cases infected by asymptomatic carriers and cases infected by symptomatic patients (P=0.033) and the former usually presented with milder symptoms. A significant difference was shown regarding the level distribution of age (P=0.006) and the frequency distribution of gender (P=0.014) and disease severity of COVID-19 (P=0.008) among the seven groups classified by the relationship with the index cases. The average age of infected medical staff was the youngest and the majority of infected medical are females while the infected patients were generally oldest and usually accompanied by severest symptoms. We concluded that asymptomatic carriers are mainly screened out of clusters and the patients infected by asymptomatic carriers present with milder symptoms than those infected by symptomatic patients, which indicated that the SARS-CoV-2 shares decreased virulence among asymptomatic carriers. Effective measures should be taken to prevent transmission in hospitals to protect doctors, nurses, and patients.

Critically ill patients with coronavirus disease 2019 (COVID-19) have a high case fatality rate. Hence, controlling the disease progression of severely ill COVID-19 patients to avoid the development of severe-to-critical COVID-19 is the most important target of COVID-19 treatment. The latest autopsy results of COVID-19 patients have shown the presence of viscous secretions in the airways. However, no studies are available that specifically describe and analyze the sputum characteristics and the effects of various sputum drainage methods on the prognosis of COVID-19 patients. In our study, we found that elderly COVID-19 patients were more susceptible to progression to critical illness (P = .024) and were likely to have accompanying lymphopenia (P = .035) or increased neutrophil counts (P = .019). We observed that there was a higher proportion of patients with Grade 3 sticky sputum in the critically ill group than in the noncritically ill group (P = .026), suggesting that changes in sputum characteristics may be one of the early warning signs of critical COVID-19. In addition, we found that the application rates of large doses of ambroxol (P = .043) and prone-position drainage (P = .037) were relatively high in COVID-19 patients with good prognoses, suggesting that the early application of large doses of expectorant drugs and prone-position drainage in COVID-19 patients may avoid progression to critical illness and improve the prognosis.

目的 探究吉非替尼联合TP(紫杉醇+顺铂)对晚期非小细胞肺癌患者血清炎性因子及体液免疫功能的影响.方法 选取2018年8月～12月我院收治的80例晚期非小细胞肺癌患者,随机分为对照组和观察组.对照组患者采用TP方案治疗,观察组采用吉非替尼联合TP方案治疗,3周为一个治疗周期,共进行4个周期治疗.比较两组治疗前后血清炎性因子变化情况及体液免疫功能改变.结果 治疗前两组患者血清中IL-1、IL-6、TNF-α表达水平比较,差异无统计学意义(P＞0.05),治疗后两组患者血清中IL-1、IL-6、TNF-α表达水平均降低,且观察组IL-1、IL-6、TNF-α水平显著低于对照组,两组之间比较差异具有统计学意义(P＜0.05).治疗前两组患者血清中IgG、IgM、IgA表达水平比较,差异无统计学意义(P＞0.05),治疗后两组患者血清中IgG、IgM、IgA表达水平均降低,且观察组IgG、IgM、IgA水平显著高于对照组,两组之间比较差异具有统计学意义(P＜0.05).结论 吉非替尼联合TP可降低晚期肺癌患者的血清炎性因子水平,提高患者免疫功能,值得临床上进一步推广使用.

目的 研究乙肝肝硬化与乙肝肝硬化合并糖尿病患者肠道菌群结构是否存在差异性.方法 收集9例乙肝肝硬化和6例乙肝肝硬化合并糖尿病患者粪便标本,提取粪便DNA,进行PCR扩增(上游引物:5'CCATCTCATCCCTGCGTGTCTCCGACTCAGACACGACTCCTACGGGAGGCAGCAG-3',下游引物:5'CCTATCCCCTGTGTGCCTTGGCAGTCTCAGACGAGCTGACGACARCCATG-3')并对产物进行纯化,利用Roche454高通量测序平台对两组患者的粪便菌群16SrDNA的V3-V6区域进行测序及生物信息学分析.结果 乙肝肝硬化及乙肝肝硬化合并糖尿病两组间的多样性参数(OTU数、chaol指数、simpson指数、shannon指数)均无统计学差异.后者肠道中的变形菌门明显多于前者(P＜0.05),拟杆菌门与厚壁菌门的比例无明显差异;纲的水平上,γ-变形菌纲在后者明显较多(P＜0.05),其余纲水平未见差异;目的水平上,后者伯克氏菌目较前者明显增多(P＜0.05),而脱硫弧菌目明显减少(P＜0.05),其余无统计学差异;科的水平上,韦荣球菌科、产碱菌科在后者的肠道菌群中的比例明显增多(P＜0.05),而链球菌科、梭菌科在前者肠道中占优势(P＜0.05),其余的在科水平中无统计学差异;属的水平上,Parabacteroides、Roseburia、韦荣氏球菌属、萨特氏菌属在后者的肠道菌群中的比例较多(P＜0.05),而Faecalibacterium、链球菌属在前者肠道中更占优势(P＜0.05),其余未见明显差异.结论 乙肝肝硬化与乙肝肝硬化合并糖尿病患者的肠道菌群结构具有相似性但又存在各自的特异性,某些菌群的差异有可能成为治疗乙肝肝硬化合并糖尿病的新靶点.

1儿童肝癌概况1975年以来，虽然儿童肿瘤的发病率呈缓慢增加趋势，但肿瘤在儿童和青少年中仍相对罕见。儿童或青少年肝癌患者应前往具备经验丰富的肿瘤多学科专家团队的正规医疗机构进行治疗，专家团队包括初级护理师、小儿外科医生、放射肿瘤科医生、儿童血液病专家、康复专家、儿童护理专家、社会护工以及精神病专家，以保证患者接受正规治疗、支持护理和康复训练，继而改善患者生存和生活质量。

AIM To determine the level of serum thymidine kinase 1 (TK1) in patients with hepatocellular carcinoma (HCC) and analyze its clinical significance in the diagnosis and prognosis of HCC.METHODS Using Western blot with enhanced chemiluminescence detection,we determined the serum level of TK1 in 77 patients with hepatocellular carcinoma (HCC group),41 patients with cirrhosis (cirrhosis group) and 47 healthy controls (control group).Patients with HCC were followed for 2 years.We defined all-cause mortality as the endpoint event.Measurement data which met the non-normal distribution are described using median and analyzed using non-parametric Kruskal-Wallis test.ROC curve analysis was used to evaluate the diagnostic efficacy of TK1 to identify HCC.Kaplan-Meier method was used to perform survival analysis,and log-rank method was used to test the difference between groups.RESULTS Serum TK1 was significantly higher in patients with HCC [1.85 (range,0.94-3.755) pmol/L] than in patients with cirrhosis [0.90 (range,0.56-3.13)pmol/L] and in control people [0.72 (0.49-1.07)pmol/L] (P ＜ 0.05),although there was no significant difference between the cirrhosis group and control group.The area under the ROC curve of serum TK1 for the diagnosis of HCC was 0.739 (P ＜ 0.05).With a cut-off value of 1.105 pmol/L,serum TK1 had a sensitivity of 0.714 and a specificity of 0.693.The level of serum TK1 is positively correlated with age,aspartate transaminase (AST),Child-Pugh grade,BCLC stage,vascular invasion,tumor size and tumor number (P ＜ 0.05).Serum TK1 level in patients with BCLC stage C/D HCC was higher than that in patients with BCLC stage A/B HCC (P ＜ 0.05).CONCLUSION Serum TK1 is elevated in patients with HCC and can be used as a serological marker for the diagnosis of HCC.Serum level of TK1 is positively correlated with age,AST,Child-Pugh grade,BCLC stage,vascular invasion,tumor size and tumor number.Serum level of TK1 is higher in patients with advanced-stage HCC,suggesting that it may be associated with prognosis.

目的 探讨重组人白介素-1 l(recombinant human interleukin-11,rhIL-11)及重组人血小板生成素(recombinant human thrombopoietin,rhTPO)在治疗肝硬化脾功能亢进所致血小板减少的临床疗效及差异.方法 选取肝硬化脾功能亢进所致血小板减少(PLT≤75×109/L)的患者66例分为两组,一组接受皮下注射rhIL-11 3 mg/次,qd;另一组接受皮下注射rhTPO 15000 μg/次,qd;观察及比较两组治疗效果.结果 rhIL-11和rhTPO两个治疗组入组例数分别为42例和24例,rhIL-11和rhTPO治疗后血小板数值均较治疗前增高(P＜0.05),rhIL-11和rhTPO两组平均升高幅度分别为5.95×109/L±12.31×109/L、45.92×109/L±37.47×109/L;rhIL-11治疗的第10天血小板较治疗前明显改善(P＜0.05),而rhTPO治疗的第7天血小板数值就较治疗前明显升高(P＜0.05);两组均在治疗开始的第3天血小板计数开始升高,在第10天达到最大值,rhIL-11组第3、5、7、10天的血小板相比治疗前分别增长了4％、18％、21％、50％,相比治疗前,rhTPO组第3、5、7、10天的血小板分别增长了39％、84％、145％、267％;对于重度血小板减少患者,rhIL-11治疗前后血小板差异无统计学意义;在重度血小板减少患者中,rhTPO治疗后血小板数值较治疗前升高,差异具有统计学意义(P＜0.05);rhIL-11与rhTPO治疗肝硬化血小板减少症的有效率分别为75％和100％,且二者之间有效率差异具有统计学意义(P＜0.05);rhIL-11治疗后血红蛋白低于治疗前(P＜0.05),治疗前后rhTPO对血红蛋白无影响;rhIL-11和rhTPO对治疗前后的白细胞、肝功能及凝血无影响;rhTPO不良反应发生率低于rhIL-11(P＜0.05).结论 rhIL-11与rhTPO均能短期显著升高肝硬化脾功能亢进患者血小板水平,相比rhIL-11,rhTPO提升血小板时间更快,对于重度血小板减少疗效更好,不良反应发生率更低.

肝细胞癌（hepatocellular carcinoma,HCC）因发病隐匿、预后极差而严重影响患者生存期,是常见的恶性肿瘤之一.研究发现β肾上腺素能受体信号通路与多种肿瘤的发生和发展密切相关,尤其以β2肾上腺素能受体（β2-adrenergic receptor,β2-AR）信号通路为主参与的肿瘤细胞的分化、增殖和凋亡,参与肿瘤的血管生成、肿瘤的生长和转移.本综述拟探讨β2-AR信号通路在HCC发生与发展的调控机制,为进一步开展HCC相关的发病机制、诊断、治疗方面的研究提供新思路和方法.

10.3969/j.issn.2095-4344.2013.25.014

目的了解哈尔滨市区脂肪肝在健康体检人群中的患病情况,探索常见危险因素与脂肪肝的相关性,为脂肪肝的综合防治提供参考依据。方法通过收集哈尔滨市大健康体检中心体检人群的相应资料,选取具有代表性的企事业单位及普通个体检查群体,资料信息包括一般检查项目和临床检验项目,整理后运用统计学方法进行分析。结果在2 436例被调查者中有1 231例患有不同程度的脂肪肝,其总人群患病率达到了50.53%,其中男性711例,患病率为61.35%,女性520例,患病率为40.72%;男性显著高于女性（P＜0.05）。脂肪肝患病率随年龄增长迅速增加,男性人群中以50～59岁年龄组患病率最高（68.21%）,以中、重度脂肪肝患病为主;女性人群中以40～49岁年龄组患病率最高（50.40%）,而后随年龄增长患病率逐渐下降。与健康人群组相比,脂肪肝组人群肥胖、高尿酸血症、血脂异常、骨密度减低等疾病的患病率明显较高。结论哈尔滨市城市居民中脂肪肝的患病率较高,男性高于女性;脂肪肝的患病情况与年龄具有一定的相关性;肥胖、高尿酸血症、糖尿病和血脂代谢异常等可能是脂肪肝患病的主要危险因素。

Objective To study the regulation of D-ribose on blood glucose,lipids and insulin in C57BL / 6 mice fed a high-fat diet,and to explore the effect of D-ribose on impaired glucose tolerance and insulin resistance.Methods Thirty-six C57BL / 6 mice were assigned to four groups,namely normal control,high-fat control,low doses of D-ribose + high-fat diet(high-fat +2.5% ribose) and high dose of D-ribose + high-fat diet group(high-fat +5% ribose).After 11 weeks,oral glucose tolerance test(OGTT) was performed and glucose area under the curve(AUC) was calculated.Experimental period lasted 12 weeks.The detection of blood biochemical parameters and insulin were conducted after the mice were killed.Results Levels of fasting glucose were lower in the mice fed the high-fat diet+ 5%D-ribose than in the mice fed the high-fat diet(P0.05).The fasting serum insulin concentrations and HOMA-IR were signi?cantly lower in the high-fat diet+ 2.5% D-ribose and high-fat diet+ 5% D-ribose groups than in high-fat control group(P0.01).The levels of serum cholesterol(CHO) and high-density lipoprotein cholesterol(HDL-C) showed no significant difference among the three groups fed the high-fat diets(P0.05).Serum triglyceride(TG),low density lipoprotein cholesterol(LDL-C) and free fatty acids(FFA) levels were lower in the high-fat diet+ 5% D-ribose groups than in the high-fat control group(P0.05).Conclusion These results suggest that d-ribose exerts a preventive effect on impaired glucose tolerance or insulin resistance induced by the high fat diet.[ACTA NUTRIMENTA SINICA,2013,35(2):142-145]

Objective The incidence rate of age-related cataract( ARC) is very high in the elderly population in China,and therefore the prevention and delay of cataract are becoming a focus of attention. The propose of this investigation was to determine the contents of free fatty acids in ARC patients and healthy controls,explore the relation between fatty acids and cataract progression,and provide some new ideas to prevent and delay the development of cataract. Methods We collected serum samples from 50 ARC patients( the cataract group) and 50 healthy persons( the control group),and detected the levels of various fatty acids in the serum using gas chromatography-mass spectrometry( GC / MS). Results Totally,16 fatty acids were detected. The levels of arachidonic acid( C20: 4n-6),docosahexaenoic acid( C22: 6n-3),tetracosanoic acid( C24: 0),and docosapentaenoic acid( C22: 5n-6) were significantly lower in the cataract than in the control group( P 0. 05),and so were the levels of n-3 and n-6 unsaturated fatty acids,total fatty acids,total unsaturated fatty acids,total polyunsaturated fatty acids and essential fatty acids( P 0. 05). Conclusion The fatty acid profiles change significantly in cataract patients,and the serum fatty acid levels are generally lower in cataract patients than in healthy persons. The lack of fatty acids may be associated with the progression of cataract.

目的 了解哈尔滨市体检人群高尿酸血症的患病情况,并对其分布特征进行描述.方法 收集哈尔滨市大健康体检中心2436人的体检资料,包括一般检查项目和临床检验项目,整理后运用t检验和x2检验进行分析.结果 所调查的人群中,男性平均血尿酸水平为(369.05±83.07) μmol/L,女性为(277.11±67.50) μmol/L,男性高尿酸血症患病率为26.83％,女性为11.12％,男性显著高于女性(x2=98.07,P＜0.05).结论 体检人群中高尿酸血症患病率较高,男性高于女性.男性高尿酸血症患病以青壮年为主,30～39岁年龄组患病率最高,为33.07％；女性患病情况有随年龄增长而逐渐升高的趋势.

OBJECTIVE:To investigate the influencing factors of efficacy of plasma perfusion in patients with severe jaundice.METHODS:The clinical data of 78 patients with severe jaundice due to different causes receiving HB-H-6 resin plasma perfusion therapy admitted to Tianjin Third Central Hospital from October 2006 to July 2010 were retrospectively analyzed. Patients were divided into improved group (n = 51) and ineffective group (n = 27) according to outcomes. The effecting factors of prognosis, including age, sex, hospital stay days, number of perfusion therapy received, Child-Pugh scores before perfusion, total bilirubin (TBil) levels before perfusion, and mean TBil rebound rate were studied by univariate and multivariate logistic regression analysis.RESULTS:All 78 patients received (3.31 ± 1.36) times of HB-H-6 resin plasma perfusion treatment. Child-Pugh score before perfusion, TBil (μmol/L) before perfusion and mean TBil rebound rate in improved group were significantly lower than those in ineffective group [Child-Pugh score before perfusion: 8.06 ± 1.01 vs. 9.44 ± 1.19; TBil before perfusion: 384.29 ± 170.41 vs. 504.93 ± 206.88; mean TBil rebound rate: -(7.35 ± 20.76)% vs. (37.32 ± 23.22)%]. They were also significantly different in gender between two groups (improved group: 30 males, 21 females; ineffective group: 24 males, 3 females, P < 0.05 or P < 0.01). Gender and mean TBil bounce rate were defined as independent significant factors influencing the clinical results by multivariate logistic regression analysis. Regression coefficient β were 5.35 and -2.82 for gender and mean TBil bounce rate respectively [χ (2) = 64.42, P = 0.000]. Receive operating characteristic curve (ROC curve) analysis showed that the area under the curve (AUC) was 0.90 (0.82, 0.97), and mean TBil bounce rate higher than 29.5% indicated poor prognosis. No obvious side effects were observed after plasma perfusion.CONCLUSIONS:Gender and mean TBil bounce rate were independent risk factors in treatment of severe jaundice with HB-H-6 resin plasma perfusion. Mean TBil bounce rate higher than 29.5% indicated a poor prognosis.