血浆是引起血沉增快的主要因素

目的：阐明血沉增快的原因是血浆还是红细胞。方法：收集72例血沉异常的抗凝血标本,同时收集血型相对应的72例血沉正常标本,组成血型相同的血沉异常和正常标本72对,每对互换血浆后重新测定血沉,与原始血沉结果比较,并通过多元线性回归分析血沉与血浆蛋白及血脂浓度的关系。结果：血沉异常标本的红细胞加入血沉正常标本的血浆后,72例（100%）血沉均减慢,其中30例血沉下降90%以上,35例下降70%-90%,7例小于70%。血沉正常标本的红细胞加入血沉异常标本的血浆后,67例（93%）血沉加快,其中58例（81%）变为异常（18例血沉加快10倍以上,40例加快5-10倍）。球蛋白、白蛋白和纤维蛋白原与血沉具有线性关系,球蛋白（r=0.420,P〈0.001）和纤维蛋白原（r=0.673,P〈0.001）与血沉呈正相关,而白蛋白（r=-0.558,P〈0.001）与血沉呈负相关。结论：血沉增快主要与血浆因素相关,红细胞对于血沉的影响作用很小。     

益生菌联合早期肠内营养治疗重症急性胰腺炎临床疗效的Meta分析

目的系统性评价益生菌联合早期肠内营养对重症急性胰腺炎(sever acute pancreatitis,SAP)的临床疗效。方法计算机检索中国知网、万方数据库、维普期刊数据库、PubMed、Embase和The Cochrane Library,收集关于益生菌联合早期肠内营养治疗SAP的临床随机对照试验(randomized controlled trials,RCTs),按照纳入和排除标准筛选文献、提取资料,并对全部纳入的文献进行质量评价,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果与对照组相比,研究组能够显著降低SAP患者的感染率(OR=0.23,95% CI:0.15~0.35,P<0.001)、病亡率(OR=0.21,95% CI:0.07~0.61,P=0.004)、血淀粉酶(WMD=-49.73,95% CI:-73.91~-25.55,P<0.001)、白细胞数量(WMD=-3.79,95% CI:-4.56~-3.02,P<0.001)、CRP含量(WMD=-33.59,95% CI:-48.31~-18.88,P<0.001),缩短腹痛消失时间(WMD=-12.83,95% CI:-14.73~-10.92,P<0.001)以及住院时间(WMD=-8.66,95% CI:-11.58~-5.75,P<0.001),增加患者血浆中白蛋白(WMD=5.84,95% CI:5.12~6.56,P<0.001)的含量。结论益生菌联合早期肠内营养能够显著降低SAP患者的感染率、病亡率、血淀粉酶、白细胞数量、CRP含量,缩短腹痛消失时间以及住院时间,并且还能增加患者血浆中白蛋白的含量。     

紫癜性肾炎临床表现与肾脏损伤相关性分析

目的:分析紫癜性肾炎患者的临床及病理资料,探讨两者之间相关性,并利用临床指标评估肾脏损伤的程度。方法:收集哈尔滨医科大学附属第一医院肾内科肾活检及临床确诊为紫癜性肾炎的101例住院病人。分别比较年龄、病程、紫癜出现的次数、血压、蛋白尿、尿红细胞数、血肌酐、血浆白蛋白及纤维蛋白原与肾脏损伤程度之间的关系。结果:紫癜性肾炎肾脏损伤程度与病程(P0.0001)、血压(P0.0001)、蛋白尿(P0.0001)、血肌酐(P0.0001)、纤维蛋白原(P=0.0189)呈正相关;与血浆白蛋白(P0.0001)呈负相关;与年龄(P=0.6515)、紫癜出现的次数(P=0.912)、血尿(P=0.0781)没有统计学差异。结论:紫癜性肾炎的临床表现及化验指标,如紫癜的病程、紫癜出现的次数、血压、蛋白尿、血肌酐、血浆白蛋白及纤维蛋白原等与肾脏损伤的严重程度密切相关,通过对临床表现及化验指标的评价分析可以对肾脏损伤程度作出初步评估,对肾活检患者的选择、治疗方案的确定及判断预后均有一定的指导意义。     

葛根素对肺心病大鼠血液流变学和肺动脉压的影响

目的:观察葛根素对肺心病大鼠血液流变学和肺动脉压的影响。方法:40只SD大鼠随机分为4组(n=10):对照组,模型组,葛根素低剂量(300 mg/kg ip)和高剂量组(600 mg/kg ip),参考薛氏常压低氧方法建立肺心病大鼠模型,常压低氧4周后测定大鼠血浆粘度,全血粘度,红细胞容积,纤维蛋白原和红细胞聚集指数等血液流变学指标和平均肺动脉压。结果:葛根素能显著降低肺心病大鼠血浆粘度,全血粘度,红细胞容积,纤维蛋白原(P<0.05),对红细胞聚集指数无显著性作用(P>0.05),显著降低模型组降低肺动脉压(P<0.05)。结论:葛根素对肺心病大鼠有治疗效果,为临床治疗肺心病提供实验依据。     

退变腰椎间盘中IL-17表达的变化及其意义

目的:研究退变的椎间盘组织中IL-17表达的变化及其与椎间盘退变严重程度之间的关系。方法:收集退变椎间盘标本23例,正常椎间盘标本12例,通过免疫组织化学染色、免疫荧光染色、实时-定量PCR(RT-PCR)和酶联免疫吸附实验(ELISA)从细胞、蛋白和基因水平检测椎间盘组织中IL-17和孤独受体(retinoid-related orphan receptor,RORγt)的表达。结果:免疫组化染色显示退变椎间盘组织中IL-17阳性细胞比例较对照组明显增高,有统计学差异(P<0.05);免疫荧光染色显示退变椎间盘组织中Th17细胞含量明显增多(P<0.05);退变的椎间盘组织中IL-17和RORγt m RNA的相对表达量较对照组增加,有统计学差异(P<0.001),且两者之间呈显著正相关(r=0.6919,P<0.001);退变的椎间盘组织中IL-17的含量较对照组明显增加(P<0.01),且与椎间盘退变的严重程度呈正显著相关(r=0.4714,P<0.01)。结论:IL-17含量增加参与了腰椎间盘退变的病理过程,并且可能对椎间盘退变起促进作用。     

14-3-3θ蛋白在鼻咽癌中的表达和临床意义

目的:探讨14-3-3θ蛋白在鼻咽癌中的表达和临床意义。方法:在72例人鼻咽癌和正常鼻咽组织中利用免疫组织化学染色法检测14-3-3θ蛋白的表达情况,并分析其表达与鼻咽癌临床病理学特征之间的关系。结果:在72例鼻咽癌和正常鼻咽组织中,14-3-3θ蛋白表达的阳性率分别为69.4%和15.2%。统计学分析表明,14-3-3θ蛋白的表达与鼻咽癌临床分级(P=0.045)、淋巴结转移(P0.001)、肿瘤复发(P=0.041)具有显著相关性,而与鼻咽癌患者的年龄(P=0.444)、性别(P=0.795)、组织类型(P=0.468)等均无关。Spearman相关性统计分析发现,14-3-3θ蛋白高表达与鼻咽癌高临床分级(r=-0.256,P=0.030)、淋巴结转移阳性(r=0.506,P0.001)、肿瘤复发(r=0.106,P=0.033)呈正相关,而与鼻咽癌患者的年龄、性别、组织类型等均无相关性(P0.05)。结论:在鼻咽癌组织中,癌基因14-3-3θ在鼻咽癌组织中表达增加,并且与疾病临床分级、转移复发等密切相关。     

类风湿关节炎患者血脂水平与疾病活动度的相关性研究

目的:观察类风湿关节炎(RA)患者血脂的变化,以及血脂水平与疾病活动度之间的相关性。方法:对71例RA患者和77例正常对照的血脂水平进行回顾性分析,并对RA患者的血脂水平与其疾病活动度进行相关性分析。结果:RA患者的血清总胆固醇(TC)、甘油三酯(TG)水平均高于正常对照组(P0.01),高密度脂蛋白(HDL)水平降低(P0.01)。DAS28评分与TC(r=0.49,P0.01)、TG(r=0.38,P0.01)和LDL(r=0.55,P0.01)呈正相关,与HDL呈负相关(r=-0.57,P0.01),血沉与TC(r=0.26,P=0.03)、TG(r=0.28,P=0.02)呈正相关,C反应蛋白与TC(r=0.65,P0.01)、TG(r=0.30,P=0.01)和LDL(r=0.39,P0.01)均呈正相关。结论:RA患者存在血脂水平异常,且与疾病活动度相关。对血脂进行干预可能改善RA患者的长期预后。     

人类免疫缺陷病毒1型同性恋感染者与健康人群Th17/Treg平衡状况的比较研究

通过探讨人类免疫缺陷病毒1型(HIV-1)同性恋感染者外周血中辅助性T细胞17(Th17)与CD4+CD25hiFoxp3+调节性T细胞(Treg)比例及Th17/Treg平衡状态与疾病进展的关系,初步阐明Th17/Treg失衡在HIV发病机制中的作用和意义。选取54例未经抗病毒治疗的HIV感染者,另有32名健康志愿者作为正常对照。分离外周血单核细胞后,利用流式细胞技术检测Th17和Treg水平。结果表明,在HIV感染者外周血中Th17比例明显低于正常对照组(0.68±0.35vs1.42±0.86,P<0.001),Treg比例明显高于正常对照(6.15±2.12vs4.50±0.76,P<0.001),导致HIV感染者中Th17/Treg比例较正常对照显著降低(0.12±0.07vs0.31±0.17,P<0.001)。研究还发现,Th17/CD4比例与CD4+T细胞计数正相关(r=0.371,P<0.05),与病毒载量不相关;Treg/CD4比例与CD4+T细胞计数负相关,与病毒载量正相关(r=-0.402,P<0.05;r=0.447,P<0.001)。此外,Th17/Treg比例与CD4+T细胞计数正相关,与病毒载量负相关(r=0.525,P<0.001;r=-0.318,P<0.05)。结果提示,HIV感染中存在Th17/Treg失衡现象,与疾病进程密切相关,可能在HIV进展中具有重要作用。     

Gelsolin蛋白在类风湿性关节炎和系统性红斑狼疮的临床诊断及疾病活动度评价中的意义

目的:分析gelsolin蛋白对类风湿性关节炎(rheumatoid arthritis,RA)和系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床诊断及疾病活动度评价的意义。方法:采集RA 30名和SLE 47名及健康人群50名的临床资料及血清标本,定量Western Blot法检测血清gelsolin水平。分析gelsolin蛋白与RA和SLE患者临床表现及疾病活动度的相关性。结果:RA、SLE和正常对照组之间性别、年龄、血红蛋白、血小板、血红细胞、血白细胞之间没有显著差异;RA患者出现CRP、转氨酶、RF、CCP异常的阳性率明显高于SLE患者(P0.05);而SLE患者出现白蛋白、尿蛋白、尿红细胞、尿素氮、ANA、肌酐异常增高的几率高于RA患者(P0.05)。gelsolin蛋白在SLE和RA血清中的含量均显著低于正常人(P0.05),且RA患者含量更低(P0.05)。gelsolin蛋白滴度与RA的疾病活动度无明显相关性(r=0.089,P=0.652),而与SLE的疾病活动度呈显著负相关(r=0.646,P0.05)。gelsolin蛋白正常组RA患者的转氨酶升高、CRP、RF、CCP阳性率均显著高于SLE患者(P0.05)。gelsolin蛋白降低组SLE患者的白蛋白、尿蛋白、尿红细胞、尿素氮、ANA、肌酐阳性率显著高于RA患者(P0.05)。结论:gelsolin蛋白滴度检测可作为RA和SLE临床辅助诊断手段,其滴度变化可作为SLE疾病活动度进展的预判指标。     

新生溶血病患儿红细胞上致敏抗体对Rh 血型检测的影响

目的:探讨新生溶血病患儿红细胞致敏抗体对其Rh血型鉴定的影响。方法:采用抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)五种方法对近三年来我院收集的163例新生溶血病患儿红细胞进行Rh血型检测,对五种检测结果不一致的患儿红细胞进行0.2 M 2-巯基乙醇抗体放散,比较放散后五种方法检测结果并验证其准确性。结果:29例直接抗体试验阳性患儿的五种Rh血型检测结果不一致,经0.2 M 2-巯基乙醇抗体放散后检测结果均一致。Rh血型准确性验证表明,红细胞放散测定的Rh血型完全符合临床现象。结论:患儿红细胞的致敏抗体达一定数量后,会影响抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)对Rh血型鉴定,0.2M 2-巯基乙醇抗体放散法是一种正确鉴定新生儿Rh血型的简单可行的方法。     

On the origin of the Hirudinea and the demise of the Oligochaeta

The phylogenetic relationships of the Clitellata were investigated with a data set of published and new complete 18S rRNA gene sequences of 51 species representing 41 families. Sequences were aligned on the basis of a secondary structure model and analysed with maximum parsimony and maximum likelihood. In contrast to the latter method, parsimony did not recover the monophyly of Clitellata. However, a close scrutiny of the data suggested a spurious attraction between some polychaetes and clitellates. As a rule, molecular trees are closely aligned with morphology-based phylogenies. Acanthobdellida and Euhirudinea were reconciled in their traditional Hirudinea clade and were included in the Oligochaeta with the Branchiobdellida via the Lumbriculidae as a possible link between the two assemblages. While the 18S gene yielded a meaningful historical signal for determining relationships within clitellates, the exact position of Hirudinea and Branchiobdellida within oligochaetes remained unresolved. The lack of phylogenetic signal is interpreted as evidence for a rapid radiation of these taxa. The placement of Clitellata within the Polychaeta remained unresolved. The biological reality of polytomies within annelids is suggested and supports the hypothesis of an extremely ancient radiation of polychaetes and emergence of clitellates.     

On the ontogeny of the haptor and the evolution of the Monogenea

Data on the ontogeny of the posterior haptor of monogeneans were obtained from more than 150 publications and summarised. These data were plotted into diagrams showing evolutionary capacity levels based on the theory of a progressive evolution of marginal hooks, anchors and other attachment components of the posterior haptor in the Monogenea (Malmberg, 1986). 5 + 5 unhinged marginal hooks are assumed to be the most primitive monogenean haptoral condition. Thus the diagrams were founded on a 5 + 5 unhinged marginal hook evolutionary capacity level, and the evolutionary capacity levels of anchors and other haptoral attachement components were arranged according to haptoral ontogenetical sequences. In the final plotting diagram data on hosts, type of spermatozoa, oncomiracidial ciliation, sensilla pattern and protonephridial systems were also included. In this way a number of correlations were revealed. Thus, for example, the number of 5 + 5 marginal hooks correlates with the most primitive monogenean type of spermatozoon and with few sensillae, many ciliated cells and a simple protonephridial system in the oncomiracidium. On the basis of the reviewed data it is concluded that the ancient monogeneans with 5 + 5 unhinged marginal hooks were divided into two main lines, one retaining unhinged marginal hooks and the other evolving hinged marginal hooks. Both main lines have recent representatives at different marginal hook evolutionary capacity levels, i.e. monogeneans retaining a haptor with only marginal hooks. For the main line with hinged marginal hooks the name Articulon-choinea n. subclass is proposed. Members with 8 + 8 hinged marginal hooks only are here called Proanchorea n. superord. Monogeneans with unhinged marginal hooks only are here called Ananchorea n. superord. and three new families are erected for its recent members: Anonchohapteridae n. fam., Acolpentronidae n. fam. and Anacanthoridae n. fam. (with 7 + 7, 8 + 8 and 9 + 9 unhinged marginal hooks, respectively). Except for the families of Articulonchoinea (e.g. Acanthocotylidae, Gyrodactylidae, Tetraonchoididae) Bychowsky's (1957) division of the Monogenea into the Oligonchoinea and Polyonchoinea fits the proposed scheme, i.e. monogeneans with unhinged marginal hooks form one old group, the Oligonchoinea, which have 5 + 5 unhinged marginal hooks, and the other group form the Polyonchoinea, which (with the exception of the Hexabothriidae) has a greater number (7 + 7, 8 + 8 or 9 + 9) of unhinged marginal hooks. It is proposed that both these names, Oligonchoinea (sensu mihi) and Polyonchoinea (sensu mihi), will be retained on one side and Articulonchoinea placed on the other side, which reflects the early monogenean evolution. Except for the members of Ananchorea [Polyonchoinea], all members of the Oligonchoinea and Polyonchoinea have anchors, which imply that they are further evolved, i.e. have passed the 5 + 5 marginal hook evolutionary capacity level (Malmberg, 1986). There are two main types of anchors in the Monogenea: haptoral anchors, with anlages appearing in the haptor, and peduncular anchors, with anlages in the peduncle. There are two types of haptoral anchors: peripheral haptoral anchors, ontogenetically the oldest, and central haptoral anchors. Peduncular anchors, in turn, are ontogenetically younger than peripheral haptoral anchors. There may be two pairs of peduncular anchors: medial peduncular anchors, ontogentically the oldest, and lateral peduncular anchors. Only peduncular (not haptoral) anchors have anchor bars. Monogeneans with haptoral anchors are here called Mediohaptanchorea n. superord. and Laterohaptanchorea n. superord. or haptanchoreans. All oligonchoineans and the oldest polyonchoineans are haptanchoreans. Certain members of Calceostomatidae [Polyonchoinea] are the only monogeneans with both (peripheral) haptoral and peduncular anchors (one pair). These monogeneans are here called Mixanchorea n. superord. Polyonchoineans with peduncular anchors and unhinged marginal hooks are here called the Pedunculanchorea n. superord. The most primitive pedunculanchoreans have only one pair of peduncular anchors with an anchor bar, while the most advanced have both medial and lateral peduncular anchors; each pair having an anchor bar. Certain families of the Articulonchoinea, the Anchorea n. superord., also have peduncular anchors (parallel evolution): only one family, the Sundanonchidae n. fam., has both medial and lateral peduncular anchors, each anchor pair with an anchor bar. Evolutionary lines from different monogenean evolutionary capacity levels are discussed and a new system of classification for the Monogenea is proposed.In agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. EditorIn agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. Editor