支原体肺炎合并胸腔积液、肺不张27 例临床分析

目的:探讨肺炎支原体肺炎合并胸腔积液、肺不张的诊断和治疗问题。方法:回顾性分析27例MPP合并胸腔积液、肺不张患儿的临床特征、诊治过程的临床资料,并结合文献进行讨论。结果:在27例MPP患儿中,肺CT表现为胸腔积液17例,肺不张10例;24例治愈,1例胸膜肥厚粘连,2例遗留闭塞性细支气管炎。结论:对MPP合并胸腔积液、肺不张患儿应早诊断,早治疗,除应用大环内酯类药物外,应联合应用头孢菌素,激素及丙种球蛋白,疗效肯定。     

支原体肺炎合并胸腔积液、肺不张27例临床分析

目的：探讨肺炎支原体肺炎合并胸腔积液、肺不张的诊断和治疗问题。方法：回顾性分析27例MPP合并胸腔积液、肺不张患儿的临床特征、诊治过程的临床资料,并结合文献进行讨论。结果i在27例MPP患儿中,肺CT表现为胸腔积液17例,肺不张10例;24例治愈,1例胸膜肥厚粘连,2例遗留闭塞性细支气管炎。结论：对MPP合并胸腔积液、肺不张患儿应早诊断,早治疗,除应用大环内酯类药物外,应联合应用头孢菌素,激素及丙种球蛋白,疗效肯定。     

难治性肺炎支原体肺炎患儿血清炎性细胞因子变化的临床意义及其危险因素分析

目的:探讨难治性肺炎支原体肺炎(RMPP)患儿血清炎性细胞因子变化的临床意义及其危险因素。方法:将我院从2016年1月～2020年1月收治的72例RMPP患儿纳入研究,记作RMPP组。另取我院同期收治的普通肺炎支原体肺炎(MPP)患儿70例作为对照组。检测所有患儿的血清炎性细胞因子水平,并进行对比。此外,对比两组患儿各项基线资料,并以多因素Logistic回归分析RMPP发生的危险因素。另外,比较两组患儿的影像学特征。结果:RMPP组患儿血清白细胞介素-6(IL-6)以及白细胞介素-10(IL-10)水平均高于对照组(P0.05);而两组肿瘤坏死因子-α(TNF-α)水平对比差异不明显(P0.05)。RMPP组年龄、发热持续时间、发热峰值、住院时间以及发热伴随症状人数占比均高于对照组(P0.05)。经多因素Logistic回归分析发现:发热持续时间、发热峰值、住院时间以及发热伴随症状均是RMPP患儿发病的危险因素(OR=2.773、2.344、1.058、2.515,均P0.05)。RMPP组大叶性肺炎、胸腔积液人数占比均高于对照组,而支气管肺炎人数占比低于对照组(P0.05)。结论:RMPP患儿血清IL-6以及IL-10水平均存在明显高表达,且发热持续时间、发热峰值、住院时间以及发热伴随症状均是RMPP发病的危险因素,临床工作中需要予以重视。     

阿奇霉素联合痰热清治疗小儿肺炎支原体肺炎疗效观察

目的:探讨阿奇霉素联合痰热清治疗小儿肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)的临床疗效.方法:124例MPP患儿随机分为对照组(56例)与治疗组(68例),其中对照组给予阿奇霉素序贯治疗,治疗组则在此基础上另外给予痰热清治疗.采用双抗体夹心ELISA法、免疫比浊法分别检测治疗前后所有MPP患儿血清CRP、IL-6与TNF-α含量.同时观察比较两组临床疗效、症状体征及不良反应情况.结果:①经治疗所有患儿血清CRP、IL-6与TNF-α浓度均明显下降(P<0.01),治疗组与对照组间差异无统计学意义(P0.05).②治疗组总有效率为97.06%,显著高于对照组83.93%的总有效率(P<0.05).③治疗组退热时间,咳嗽和肺啰音消失时间均显著短于对照组(P<0.05).④治疗组不良反应发生率明显低于对照组,差异具有统计学意义(P<0.05).结论:痰热清联合阿奇霉素序贯疗法治疗小儿MPP安全有效,值得进一步推广.     

肺炎支原体肺炎合并喘息患儿血清25（OH）D3水平与肺功能的相关性及其影响因素分析

摘要 目的：探讨肺炎支原体肺炎（MPP）患儿合并喘息的影响因素,分析血清25-羟维生素D3[25(OH)D-3]水平与MPP合并喘息患儿肺功能的关系。方法：选择2017年1月至2020年1月我院收治的90例MPP患儿,根据是否合并喘息将其分为MPP合并喘息组（39例）和MPP未合并喘息组（51例）。检测血清25(OH)D-3水平以及肺功能[最大呼气流速（PEF）、PEF占预计值百分比(PEF% pred)、第一秒用力呼吸容积（FEV₁）、用力肺活量（FVC）、FEV₁/FVC比值、FEV₁占预计值百分比（FEV1%pred）],Pearson相关性分析25(OH)D-3与MPP合并喘息患儿肺功能的关系,单因素及多因素Logistic回归分析影响MPP合并喘息的危险因素。结果：MPP合并喘息组血清25(OH)D-3水平、PEF、PEF% pred、FEV₁/FVC比值、FEV1%pred低于MPP未合并喘息组（P＜0.05）,Pearson相关性分析显示,MPP合并喘息组患儿血清25(OH)D-3水平与PEF、PEF% pred、FEV₁/FVC比值、FEV₁%pred均呈正相关（r=0.519、0.612、0.571、0.593,P＜0.05）。单因素分析显示,MPP合并喘息组年龄低于MPP未合并喘息组（P＜0.05）,病程长于MPP未合并喘息组（P＜0.05）,肺部啰音比例、嗜酸性粒细胞计数、MP-IgM抗体滴度高于MPP未合并喘息组（P＜0.05）。多因素Logistic回归分析结果显示低龄、肺部啰音、嗜酸性粒细胞计数增高、MP-IgM抗体滴度增加、25(OH)D-3减少是MPP合并喘息的危险因素（P＜0.05）。结论：MPP合并喘息患儿25(OH)D-3水平较低,低龄、肺部啰音、嗜酸性粒细胞计数增高、MP-IgM抗体滴度增加、25(OH)D-3缺乏为MPP合并喘息的危险因素,25(OH)D-3缺乏与MPP合并喘息患儿肺功能下降有关。     

肺炎支原体肺炎患儿血清免疫球蛋白变化及其临床意义

目的 探讨肺炎支原体肺炎(MPP)患儿血清免疫球蛋白变化的临床意义.方法 随机抽取2010年6月~2012年6月在我院儿科就诊的50例肺炎支原体肺炎患儿和50例普通肺炎患儿,分为支原体感染组(MPP 组)和非支原体感染组(nMPP组),同时选取同期在我院体检的健康儿童50例作为对照组,分别对3组儿童的血清免疫球蛋白水平进行检测,比较其差异.同时根据症状轻重对支原体感染组患儿的血清免疫球蛋白水平进行比较.结果 MPP组和nMPP组血清免疫球蛋白IgA、IgM、IgG水平均高于对照组;MPP组IgM、IgG水平均高于nMPP组;重症组IgA、IgM、IgG水平均高于轻症组,以上差异均有统计学意义(均P<0.05).结论 体液免疫紊乱在MPP中发挥了重要作用,免疫球蛋白水平的检测为MPP的诊断和发病程度的判断提供一定的临床依据.     

肺炎支原体肺炎患儿血清SP-D、Gal-3、CCL5水平与炎症因子和预后不良的关系研究

摘要 目的：探讨肺炎支原体肺炎（MPP）患儿血清表面活性蛋白D（SP-D）、半乳糖凝集素-3（Gal-3）、C-C基序趋化因子配体5（CCL5）水平与炎症因子和预后不良的关系。方法：选取2020年1月～2021年1月我院收治的165例MPP患儿为MPP组,另选取54例健康儿童为对照组。采用ELISA法检测血清SP-D、Gal-3、CCL5、白细胞介素-6（IL-6）、IL-8水平,放射免疫法检测血清肿瘤坏死因子-α（TNF-α）水平。采用Pearson/Spearman相关系数分析MPP患儿血清SP-D、Gal-3、CCL5水平与IL-6、IL-8、TNF-α水平的相关性。通过多因素Logistic回归分析MPP患儿预后不良的影响因素。采用接受者操作特征（ROC）曲线分析血清SP-D、Gal-3、CCL5水平对MPP患儿预后不良的预测价值。结果：与对照组比较,MPP组患儿的血清SP-D、Gal-3、CCL5以及IL-6、IL-8、TNF-α水平升高（P＜0.05）。MPP患儿的血清SP-D、Gal-3、CCL5水平与IL-6、IL-8、TNF-α水平均呈正相关（P＜0.05）。血清SP-D、Gal-3、CCL5、IL-6、TNF-α水平较高、病变类型为大片状阴影、热程较长是MPP患儿预后不良的危险因素（P＜0.05）。血清SP-D、Gal-3、CCL5三项联合预测MPP患儿预后不良的曲线下面积（AUC）为0.926,明显大于三项指标单独预测的0.842、0.794、0.771。结论：MPP患儿血清SP-D、Gal-3、CCL5水平升高,与炎症因子和预后不良密切相关,可作为MPP患儿预后不良的预测指标。     

孟鲁司特钠对哮喘患儿T淋巴细胞亚群CD4~+和CD8~+水平的影响

目的:探讨孟鲁司特钠联合抗生素对哮喘患儿T淋巴细胞亚群CD4+和CD8+水平的影响。方法:选取我院收治的哮喘患儿50例,并将其随机分为两组,每组各25例。对照组予常规抗生素治疗,实验组在此基础上加用孟鲁司特钠治疗。观察和比较两组患儿的临床疗效、一年内复发率,以及CD4+、CD8+和CD4+/CD8+比值的变化情况。结果:两组哮鸣音、咳嗽及喘憋持续时间均获得改善,实验组优于对照组,差异有统计学意义(P0.05)。与同组治疗1天后比较,两组患儿治疗5、10天后的CD4+、CD8+以及CD4+/CD8+比值均明显升高;与同组治疗5天后比较,两组患儿治疗10天后CD4+、CD8+以及CD4+/CD8+比值均明显升高;实验组患儿治疗5天、10天后的CD4+、CD8+以及CD4+/CD8+比值均明显高于对照组,差异均有统计学意义(P0.05)。两组治疗后CD4+、CD8+以及CD4+/CD8+比值变化呈显著差异(P0.05)。实验组1年复发率显著低于对照组,差异有统计学意义(P0.05)。结论:孟鲁司特钠可能通过影响哮喘患儿CD4+、CD8+及CD4+/CD8+水平,改善患儿的临床症状,缩短其住院时间,值得临床推广应用。     

铁代谢水平及淋巴细胞水平变化对口腔溃疡患者病情发生发展的影响

为了探讨口腔溃疡患者铁代谢水平及淋巴细胞水平变化对病情发生发展的影响,本研究选择2016年3月至2017年3月期间在我院口腔科确诊的复发性口腔溃疡患者200例作为研究对象(观察组),选择同期体检的100名健康志愿者作为对照组。通过采用比色法检测受试者的血清铁水平,采用电化学发光法检测受试者铁蛋白水平,使用流式细胞仪检测受试者的T淋巴细胞亚群(CD3~+, CD4~+和CD8~+)水平,采用多因素Logistic回归分析复发性口腔溃疡的危险因素。本研究发现观察组的血清铁和铁蛋白水平均显著低于对照组(p0.05),观察组的CD3~+、CD4~+和CD8~+水平均显著低于对照组,观察组的CD4~+/CD8~+比值显著低于对照组(p0.05),铁蛋白、血清铁、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+为复发性口腔溃疡的独立危险因素(p0.05),其中铁蛋白和血清铁的OR值高于其他参数,其次为CD4~+。研究获得初步结论认为,复发性口腔溃疡患者的铁蛋白、血清铁、T淋巴细胞亚群(CD3~+, CD4~+, CD8~+)和CD4~+/CD8~+比值显著低于健康体检者,且上述指标均是复发性口腔溃疡的独立危险因素。     

重组人血管内皮抑制素联合胸腺肽对肺癌合并恶性胸腔积液患者血清炎症因子和免疫功能的影响

目的:研究重组人血管内皮抑制素联合胸腺肽对肺癌合并恶性胸腔积液患者血清炎症因子和免疫功能的影响。方法:选择2015年1月～2017年12月我院收治的60例肺癌合并恶性胸腔积液患者,并将其随机分成两组。对照组将60 mg重组人血管内皮抑制素经引流管缓慢注入患者的胸腔内,观察组联合将300 mg胸腺肽经引流管缓慢注入患者的胸腔内。治疗8周后,对比两组的治疗有效率,治疗前后的血清白介素-6、肿瘤坏死因子-α以及白介素-23水平、每分钟最大通气量(Maximum ventilation per minute,MVV)、1秒钟用力呼气量占用力肺活量比值(forced expiratory volume in one second to forced vital capacity ratio,FEV1/FVC)、CD8~+、CD4~+及CD4~+/CD8`+的改变情况。结果:治疗后,观察组的有效率为86.67%,明显高于对照组(P0.05)。两组治疗后的MVV和FEV1/FVC均较治疗前明显升高(P0.05),且观察组MVV和FEV1/FVC均明显高于对照组(P0.05)。两组治疗后的血清白介素-6、肿瘤坏死因子-α以及白介素-23水平均较治疗前明显降低(P0.05),且观察组以上指标均显著低于对照组(P0.05)。观察组治疗后的CD4~+/CD8~+以及CD4+均明显高于对照组(P0.05),CD8~+明显低于对照组(P0.05)。结论:重组人血管内皮抑制素联合胸腺肽可以改善减轻肺癌合并恶性胸腔积液患者的免疫功能,减轻机体的炎症状态,改善肺功能,提高治疗效果。     

胎盘多肽对子宫肌瘤患者T 淋巴细胞亚群、NK细胞及炎症因子水平的影响

目的:探讨胎盘多肽对子宫肿瘤切除术后患者血清炎症因子变化和免疫功能的影响。方法:收集我院收治的子宫肿瘤切除术后患者57例,根据就诊先后顺序不同分为对照组和实验组,实验组采用胎盘多肽治疗,对照组采用常规治疗。检测两组患者CD3~+、CD4~+、CD8~+、NK细胞、CRP及IL-6水平,并比较两组的临床效果。结果:治疗后,两组患者血清CRP及IL-6水平均低于治疗前,且实验组明显低于对照组,差异具有统计学意义(P0.05)。治疗后,两组患者CD3~+、CD4~+、CD4~+/CD8~+、NK细胞均高于治疗前,而CD8~+低于治疗前,差异具有统计学意义(P0.05);实验组患者治疗后CD3~+、CD4~+、CD4~+/CD8~+、NK细胞显著高于对照组,而CD8~+低于对照组,差异具有统计学意义(P0.05)。与对照组相比,实验组患者的首次排气和排便时间明显较短,差异具有统计学意义(P0.05)。结论:胎盘多肽能够明显改善子宫肌瘤切除患者的免疫功能,降低炎症反应,有助于患者术后康复。     

The acute-phase proteins serum amyloid A and C reactive protein in transudates and exudates

The distinction between exudates and transudates is very important in the patient management. Here we evaluate whether the acute-phase protein serum amyloid A (SAA), in comparison with C reactive protein (CRP) and total protein (TP), can be useful in this discrimination. CRP, SAA, and TP were determined in 36 exudate samples (27 pleural and 9 ascitic) and in 12 transudates (9 pleural and 3 ascitic). CRP, SAA, and TP were measured. SAA present in the exudate corresponded to 10% of the amount found in serum, that is, the exudate/serum ratio (E/S) was 0.10 +/- 0.13. For comparison, the exudate/serum ratio for CRP and TP was 0.39 +/- 0.37 and 0.68 +/- 0.15, respectively. There was a strong positive correlation between serum and exudate SAA concentration (r = 0.764; p < 0.0001). The concentration of SAA in transudates was low and did not overlap with that found in exudates (0.02-0.21 versus 0.8-360.5 g/mL). SAA in pleural and ascitic exudates results mainly from leakage of the serum protein via the inflamed membrane. A comparison of the E/S ratio of SAA and CRP points SAA as a very good marker in discriminating between exudates and transudates.     

脓毒症患儿血清SAA、PCT、CRP水平与预后的关系及其诊断价值分析

摘要 目的：探讨脓毒症患儿血清淀粉样蛋白A（SAA）、降钙素原（PCT）、C反应蛋白（CRP）与预后的关系,并分析三者对脓毒症的诊断价值。方法：纳入我院于2016年8月～2020年6月期间收治的脓毒症患儿60例开展回顾性研究,作为脓毒症组,选取同期于我院进行体检的健康儿童40例作为对照组,比较两组血清SAA、PCT、CRP水平。根据脓毒症患儿1个月内的生存、死亡情况,分成生存组（n=42）、死亡组（n=18）,比较两组临床资料及血清SAA、PCT、CRP水平,经COX回归模型分析脓毒症患儿死亡的危险因素。绘制受试者工作特征（ROC）曲线分析血清SAA、PCT、CRP对脓毒症的诊断价值。结果：脓毒症组血清SAA、PCT、CRP水平显著高于对照组（P＜0.05）。死亡组器官障碍数量＞2个、脓毒性休克患儿占比分别为55.56%、44.44%,显著高于生存组的19.05%、9.52%（P＜0.05）;死亡组入院后1 h内使用抗菌治疗患儿占比为38.89%,显著低于生存组的69.05%（P＜0.05）;死亡组血清SAA、PCT、CRP水平高于生存组（P＜0.05）。COX多因素分析结果显示,器官障碍数量＞2、脓毒性休克及血清SAA、PCT、CRP水平升高是脓毒症患儿死亡的危险因素（P＜0.05）,而入院后1 h内使用抗菌治疗是脓毒症患儿死亡风险的保护性因素（P＜0.05）。血清SAA、PCT、CRP单独及三者联合诊断脓毒症的曲线下面积（AUC）分别为0.808、0.780、0.761、0.912。结论：脓毒症患儿血清SAA、PCT、CRP明显升高,三者升高均为脓毒症患儿死亡的危险因素,且对脓毒症具有一定诊断价值。     

The association of leptin and C-reactive protein with the cardiovascular risk factors and metabolic syndrome score in Taiwanese adults

ABSTRACT: BACKGROUND: Serum C-reactive protein (CRP) and leptin levels have been independently associated with the cardiovascular risk factors. The aim of the present study was to determine if their serum levels were associated with cardiovascular risk factors or metabolic syndrome as well as their correlation in the Taiwanese population. METHODS: This retrospective study included 999 subjects (> 18 y), who underwent a physical examination in Chang-Gung Memorial Hospital-Linkou and Chiayi in Taiwan. The associations between CRP and/or leptin levels and cardiovascular risk factors and metabolic syndrome were determined using independent two sample t-tests to detect gender differences and chi-square tests to evaluate differences in frequencies. To compare the means of the variables measured among the four groups (high and low leptin and high and low CRP), analysis of variance (ANOVA) was used. RESULTS: Both CRP and leptin levels were independently associated with several cardiovascular risk factors, including diabetes, hypercholesterolemia and metabolic syndrome in both men and women (P < 0.05). In addition, a positive correlation between leptin and CRP levels was observed in both genders. Both high-CRP and high-leptin were associated with high blood glucose, waist circumference and serum triglyceride. Whereas increased metabolic syndrome incidence was observed in males with elevated leptin regardless of CRP levels, females with elevated CRP or leptin had increased incidence of metabolic syndrome. CONCLUSION: Both leptin and CRP levels were associated with cardiovascular risk factors as well as metabolic syndrome score in both men and women although gender-specific differences were observed. Thus, CRP and leptin may represent useful biomarkers for predicting the onset of cardiovascular disease or metabolic syndrome in Taiwanese adults. Trial registration IRB/CGMH 100-3514B.     

Metabolic predictors of inflammation, adhesion, and coagulability in healthy younger-aged adults

Elevated levels of inflammatory biomarkers are associated with the pathophysiology of cardiovascular diseases and are predictors of cardiovascular events. The objective of this study was to determine the unique contributions of metabolic factors as predictors of inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)), adhesion (soluble intercellular adhesion molecule-1 (sICAM-1)), and coagulation (D-dimer) in healthy younger-aged adults. Participants were 83 women and 92 men (mean age 30.04 years, s.d. +/- 4.8, range 22-39) of normal weight to moderate obese weight (mean BMI 24.4 kg/m(2), s.d. +/- 3.35, range 17-32). The primary data analytical approaches included Pearson correlation and multiple linear regression. Circulating levels of CRP, IL-6, sICAM-1, and D-dimer were determined in plasma. Higher levels of CRP were independently associated with higher BMI, a greater waist-to-hip ratio, female gender, and higher triglycerides (P < 0.001). Higher IL-6 levels were independently associated with a greater waist-to-hip ratio (P < 0.01). Higher levels of sICAM-1 were independently associated with higher BMI, higher triglycerides, and lower insulin resistance (P < 0.001). Higher D-dimer levels were independently associated with higher BMI and being female (P < 0.001). Having a higher BMI was most consistently associated with elevated biomarkers of inflammation, adhesion, and coagulation in this sample of healthy younger-aged adults, although female gender, insulin resistance, and lipid levels were also related to the biomarkers. The findings provide insight into the adverse cardiovascular risk associated with elevated body weight in younger adults.     

Patients with Cushing's syndrome have increased intimal media thickness at different vascular levels: comparison with a population matched for similar cardiovascular risk factors.

Cushing's syndrome (CS) is associated with high cardiovascular risk. The aim of this study was to analyze intimal media thickness (IMT) in patients with CS and compare them with subjects matched for similar conventional and independent cardiovascular risk factors. Twenty eight patients with CS (mean age: 40.7 +/- 2.5 y) and 28 subjects (mean age: 41.1 +/- 14 y) matched for sex, age, smoking habit, body mass index, blood pressure levels, glucose and lipid metabolism were evaluated. IMT was measured at right and left common carotid (CC), carotid bulb (BC), aorta (Ao) and femoral (F) levels by B-echo-Doppler ultrasonography. Although parameters of cardiovascular risk factors did not differ statistically between patients and controls, IMT was significantly increased (right and left CC-IMT, p < 0.05; right and left BC-IMT, p < 0.01, Ao-IMT p < 0.05) and wall plaques were more common (14.2 % VS. 7.1 %) in patients. In CS patients, CC-IMT and F-IMT correlated positively and significantly with fasting glucose (right CC-IMT: r (2) = 0.37, p = 0.05; left CC-IMT: r (2) = 0.43, p = 0.02; right F-IMT: r (2) = 0.57; p < 0.01; left F-IMT: r (2) = 0.47, p = 0.01) and HOMA index (left CC-IMT: r (2) = 0.64, p < 0.01 and left F-IMT: r (2) = 0.48, p < 0.05). The CS patients' waist-to-hip ratio (WHR) was evaluated and correlated positively and significantly with CC-IMT (right: r (2) = 0.53, p = 0.01 and left: r (2) = 0.44, p = 0.05). No correlation was found between IMT and cortisol levels, however. In conclusion, patients with CS have more severe atherosclerotic damage than a population matched for similar cardiovascular risk factors. Multiple events related to long-term cortisol effects on metabolism and at vascular and endothelial sites may increase the risk of cardiovascular damage in patients with CS.     

TAA 致慢性肝病内毒素血症大鼠清道夫受体、CD14 表达变化*

目的:观察清道夫受体(SR)和脂多糖受体CD14在TAA介导的慢性肝病内毒素血症大鼠肝组织中的表达。方法:通过大鼠持续灌胃给小剂量(12mg/kg.d)TAA建立大鼠肝损伤内毒素血症模型,HE染色光镜观察肝脏病理变化;改良赖氏法检测大鼠血清ALT、AST;改良过氯酸法测定血清内毒素含量;酶联免疫法检测大鼠血清CD4+和CD8+;免疫组化染色方法观察大鼠肝组织清道夫受体和CD14的表达。结果:TAA诱导后,大鼠肝脏出现片状坏死并可见灶性炎症;血浆ALT、AST及内毒素水平显著升高(P<0.05或P<0.01);血清CD4+、CD8+T细胞明显降低(P<0.01);肝组织CD14表达上调,清道夫受体表达下调,和正常大鼠相比,差异显著(P<0.05)。结论:肝组织SR表达下降和CD14表达增强可能是TAA介导慢性肝病内毒素血症的重要机制。     

急性B淋巴细胞白血病儿童化疗后微小残留病灶免疫表型改变的分析

目的:分析儿童急性B淋巴细胞白血病(B-cell acute lymphoblastic leukemia,B-ALL)化疗过程中首次微小残留病灶(minimal residual disease,MRD)免疫表型的变化规律及特点,为临床诊断及后续微小残留病的监测提供依据。方法:回顾性分析我院2013年1月至2018年4月收治的393例B-ALL患儿的免疫分型结果及诱导化疗第15天首次MRD数据。结果:(1)在393例白血病中,B-ALL相关特征性免疫表型的出现频率为:CD19+/CD10+/34+64.4%;CD19+/CD10+/34部分表达,15.5%;CD19+/CD34+/CD20+,58.5%;CD19+/CD10+/CD13+,13.2%;CD19+/CD10+/CD33+,5.9%;CD19+/CD10+/CD117+,0.7%;CD19+/CD10+/CD123+,50.1%;CD19+/CD10-/34±,5.9%;CD19+/CD10-/CD20-,2.5%;CD34bright,12.2%;(2)共有285例首次MRD检测结果呈阳性,有181例(63.5%)MRD检测结果至少有1个抗原荧光强度发生改变,其中出现一个抗原强度变化的为83例(29.1%),2个抗原荧光强度变化的为57例(20.0%),3个抗原荧光强度变化为31例(10.9%),4个及4个以上抗原荧光强度变化为10例(3.5%)。抗原荧光强度变化频率最高的依次为CD45、CD34、CD20;(3)共有7例患儿复发,复发时行免疫分型检测,其中4例与初发时有抗原荧光强度变化。结论:(1)儿童B-ALL远高于其他白血病类型,且具有独特的相关特征性免疫表型。初发B-ALL免疫分型结果不仅可完善白血病MICM分型,更是化疗后MRD监测的线索及客观依据;(2)在儿童B-ALL化疗过程中,免疫表型极有可能会发生变化,在后续的微小残留病灶检测过程中应注意对变化抗原的判断和追踪。     

血清和胸水中CA125在结核性和癌性胸水中的表达及临床意义

目的:探讨血清和胸水中CA125在结核性和癌性胸水中的表达及鉴别诊断意义。方法:抽选我院确诊的结核性胸水病人85例(结核组)和癌性胸水病人71例(癌症组),检测两组患者血清和胸水中CA125表达,并以胸水/血清中CA125比值10(p-CA125/s-CA12510)为临界值,观察其对癌性胸水的鉴别特异度、灵敏度及准确性。结果:癌症组胸水中CA125表达及p-CA125/s-CA125比值均显著高于结核组(P0.05);但血清中两组CA125表达比较差异无显著性(P0.05);两组胸水中,以35U/ml为临界值,两组患者阳性率92.9%(79/85)、100%(71/71)比较差异无显著性(X2=7.0718,P=0.0078)。癌症组中p-CA125/sCA125比值10的比率(84.5%VS 17.6%)明显高于结核组(X2=66.6244,P=0.0000);并以其为诊断癌性胸水的临界值,鉴别诊断特异度、灵敏度及准确性分别为82.3%、84.5%、83.3%。结论:血清和胸水中CA125表达对于鉴别结核性或者是癌性胸水的临床意义不大,但是p-CA125/s-CA125比值对于鉴别结核性和癌性胸水具有一定临床价值。     

IL-6，IL-8 的检测在鉴别良恶性胸水中的诊断价值分析

目的:分析检测血清、胸水中白细胞介素6(IL-6)、白细胞介素8(IL-8)水平对良恶性胸水的鉴别诊断价值。方法:采用酶联免疫吸附试验(ELISA)检测32例良性胸水患者和40例恶性胸水患者血清及胸水中IL-6、IL-8水平,以及30例健康体检者血清中IL-6、IL-8水平。结果:良性胸水组及恶性胸水组血清IL-6、IL-8水平均显著高于正常对照组,差异具有统计学意义(P<0.05);与恶性胸水组比较,良性胸水组胸水及血清中IL-6、IL-8水平升高更为显著(P<0.05),良性胸水组IL-6、IL-8的胸水/血清比值也显著高于恶性胸水组,差异具有统计学意义(P<0.05)。结论:胸水及血清中IL-6、IL-8的检测对良、恶性胸水患者具有鉴别诊断意义。