糖尿病患者人危险病毒因素的变化及其临床意义

观察糖尿病患者人巨细胞病毒(HCMV)、柯萨奇B组病毒(CVB)和胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADAb)及空腹血糖水平(FPG)的变化,分析其临床意义,选取我院2012年10月到2014年10月期间,收治的糖尿病患者共130例。根据糖尿病患者的病情将患者分为1型糖尿病患者(T1DM)和2型糖尿病患者(T2DM),每组各65例,1型糖尿病患者(T1DM)为A组,2型糖尿病患者(T2DM)为B组,另外再选取65例健康人作对照C组,对各组人员的胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADAb)及空腹血糖水平(FPG)、人巨细胞病毒Ig M抗体(HCMV-Ig M)、人巨细胞病毒Ig G抗体(HCMV-Ig G)、柯萨奇B组病毒Ig M抗体(CVB-Ig M)水平进行检测,并探究其临床意义。比较ICA、GADAb、抗HCMV-Ig M、抗HCMV-Ig G、抗CVB-Ig M,A组的阳性率分别为32.3%、72.3%、43.1%、58.5%、26.2%,B组的阳性率分别为3.2%、41.5%、7.7%、24.6%、3.1%,C组人员的阳性率为3.1%、21.5%、3.1%、3.1%、0%,A、B两组分别与C组比较,B组的抗HCMV-Ig G和ICA抗体的检测阳性率与C组有明显的差异(p0.05)。FPG水平比较,A、B、C三组具有明显的差异(p0.05)。检测人巨细胞病毒(HCMV)、柯萨奇B组病毒(CVB)和胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADAb)及空腹血糖水平(FPG)水平,对糖尿病患者的临床诊断具有重要的意义。     

人类巨细胞病毒感染与急性冠脉综合症患者血清炎症介质的相关性研究

目的:分析人类巨细胞病毒(HCMV)感染与急性冠脉综合症(ACS)患者炎症介质的相关性,探讨HCMV感染在ACS发生、发展过程中的作用。方法:选取我院2017年5月~2019年5月收治的冠心病患者118例,根据病情将其分为ACS组(n=81)和稳定型心绞痛(SAP)组(n=37),另选取同时期在我院进行健康检查的健康志愿者40例作为对照组。检测所有受试者血清特异性HCMV-Ig G、HCMV-Ig M,比较所有受试者血清sP-选择素(sP-selectin)、肿瘤坏死因子-α(TNF-α)及超敏C-反应蛋白(hs-CRP)水平。分析ACS组患者血清sP-selectin、TNF-α、hs-CRP水平与HCMV-Ig M抗体滴度的相关性。结果:ACS组、SAP组的HCMV-Ig G阳性率分别为81.48%、78.38%,均明显高于对照组的45.00%,差异有统计学意义(P<0.05)。ACS组的HCMV-Ig M阳性率为40.74%,明显高于SAP组的10.81%和对照组的5.00%,差异有统计学意义(P<0.05)。ACS组患者血清sP-selectin、TNF-α及hs-CRP水平均明显高于SAP组和对照组,差异有统计学意义(P<0.05)。ACS组HCMV-Ig M阳性患者血清sP-selectin、TNF-α及hs-CRP水平均明显高于HCMV-Ig M阴性患者,差异有统计学意义(P<0.05)。ACS组患者血清sP-selectin、TNF-α、hs-CRP水平与HCMV-Ig M抗体滴度均呈正相关(P<0.05)。结论:慢性HCMV感染可能在动脉粥样硬化的发生及发展中起着重要作用,而急性HCMV感染可能通过上调机体sP-selectin、TNF-α、hs-CRP等炎症因子水平,进一步促进ACS的发生发展。     

儿童特发性血小板减少性紫癜与人巨细胞病毒感染的关系

目的:探讨特发性血小板减少性紫癜的治疗转归与巨细胞病毒感染的关系。为临床合理有效地治疗ITP提供部分参考。方法:用ELISA法和流式细胞仪分别检测患儿血清HCMV抗体及外周血淋巴细胞亚群。选取2005.1-2006.12在本院儿科就诊的68例新发ITP患儿,将其按有无HCMV感染分为HCMV感染组和非感染组,比较二者的免疫状态,近期(两周)疗效,远期(六月)疾病转归之间的关系。结果:68例ITP患儿中HCMV感染30例,非HCMV感染ITP存在T淋巴细胞亚群的异常,即CD4+细胞减低,CD8+细胞升高。HCMV感染患儿T淋巴细胞总数亦降低,CD4+细胞下降明显。近期疗效无明显差异,远期转归相比较有统计学意义。结论:HCMV感染诱发的细胞免疫异常是儿童ITP发病及病程迁延的重要因素。应同时进行抗病毒和免疫治疗。     

血液病患者的巨细胞病毒感染

用间接酶联免疫吸附实验(ELISA)对新近诊断的179例血液病患者血清巨细胞病毒(HCMV)IgM和IgA抗体进行了检测。阳性率分别为11,17％11,73％,明显高于对照人群(4,76％和3,97％),提示血液病患者由于免疫功能下降,易于发生HCMV活动性感染。     

HCMV-DNA定量检测和HCMV-IgG抗体AI检测在儿童HCMV感染诊断中的临床价值

摘要 目的：探讨人巨细胞病毒（HCMV）-DNA定量检测和HCMV-免疫球蛋白G（IgG）抗体亲和力指数（AI）检测在儿童HCMV感染诊断中的临床价值。方法：收集高度疑似HCMV活动性感染患儿血清样本103例作为研究组,健康体检儿童血清样本94例作为对照组。分析HCMV-DNA定量检测结果和HCMV-IgG抗体AI检测结果,并比较不同年龄、不同性别患儿HCMV-DNA阳性结果检出率和低HCMV-IgG抗体AI检出情况。结果：研究组血清HCMV-DNA阳性率为33.01%（34/103）,对照组血清HCMV-DNA均为阴性,研究组血清HCMV-DNA阳性率明显高于对照组,差异有统计学意义（P<0.05）。研究组血清低HCMV-IgG抗体AI检出率为13.59%（14/103）,对照组未检出低HCMV-IgG抗体AI,研究组血清低HCMV-IgG抗体AI检出率高于对照组,差异有统计学意义（P<0.05）。研究组不同性别之间患儿血清的HCMV-DNA阳性率、低HCMV-IgG抗体AI检测结果均无统计学差异（P>0.05）。研究组年龄1～5岁患儿血清HCMV-DNA阳性率明显低于年龄1 d～<6个月和年龄6个月～<1岁患儿（P<0.05）。三个年龄段患儿的血清低HCMV-IgG抗体AI检测结果均无统计学差异（P>0.05）。结论：1岁以下儿童更易受到HCMV感染,HCMV-DNA定量检测和HCMV-IgG抗体AI检测结果可以为临床早期诊断和治疗HCMV感染提供有效依据。     

肿瘤患者化疗后人巨细胞病毒活动性感染检测

探讨肿瘤患者化疗后人巨细胞病毒感染检测方法的应用价值。使用免疫组化法、酶联免疫吸附试验检测IgG/M抗体,以及实时荧光定量(FQ-PCR)检测HCMV DNA。47份全血标本中抗原阳性率为48.9%,平均抗原阳性细胞数7.9±8.1(1-65)/5×104WBC,HCMV DNA阳性率19.1%(10/47),HCMV DNA含量均值为6.320×105copies,白细胞HCMV-DNA阳性率51%(25/47),HCMV DNA含量均值为3.830×107 copies,HCMV pp65抗原阳性率为48.9%(23/47),IgG抗体均阳性,IgM抗体阳性率为23.4%(12/47),以PP65抗原阳性为对照,IgM抗体检测的敏感率仅为49.3%。在连续动态检测HCMV多种指标时,结合DNA及抗原动态检测具有更高临床应用价值。     

孕妇尿液人巨细胞病毒DNA筛查及血液HCMV抗体测定的对照研究

目的对于孕妇尿液进行HCMV—DNA筛查,减少和有效地避免胎儿及新生儿的HCMV感染。HCMV．DNA筛查同时进行HCMV抗体检测,明确诊断HCMV感染的灵敏、准确方法。方法应用荧光定量PCR（FQ．PCR）方法进行尿液HCMV-DNA测定。血液HCMV IgM、IgG抗体检测应用酶联免疫（ELISA）方法。结果筛查6568例孕妇尿HCMV．DNA,阳性273例,阳性率为4．2％。孕妇在12—20周者,阳性率为10．3％;孕妇在21～30周者,阳性率为33．3％;孕妇在31～39周者,阳性率为56．4％。在273例尿液HCMV—DNA阳性者中,56例同时进行血液HCMV IgM、IgG抗体检测,Igi抗体阳性者2例,IgG抗体阳性者22例。结论在孕妇HCMV感染的筛查与诊断中FQ．PCR是灵敏准确的方法。孕妇中HCMV—DNA筛查是保证母婴健康,提高人口素质的保障。     

类风湿性关节炎患者EBV感染情况分析

目的:检测类风湿性关节炎患者血清EBV(Epstein-Barr virus)衣壳抗原IgA抗体(VCA-IgA),分析EBV感染与类风湿性关节炎的相关性.方法:用酶联免疫吸附试验(ELISA)检测92例确诊为类风湿性关节炎患者和80例体检健康者血清VCA-IgA抗体,分析两组人群EBV VCA-IgA阳性率.结果:类风湿性关节炎患者VCA-IgA抗体阳性率为9.8％(9/92);健康对照组阳性率为2.4％ (2/85)(x2=4.038,P＜0.05).结论:类风湿性关节炎患者血清EBV VCA-IgA抗体检出率明显高于健康对照组,提示部分类风湿性关节炎患者发病与EBV感染有关.     

湛江地区小儿肺炎支原体感染调查分析

目的:探讨湛江地区小儿肺炎支原体(MP)感染情况.方法:采用日本富士瑞必欧株式会社肺炎支原体抗体检测试剂(SERODI-A-MYCOII),对2005年1月至2008年12月在本院就诊的肺炎患儿进行血清MP抗体检测,对不同年度、不同季节、不同年龄及性别MP肺炎的发病情况进行统计.结果:受检人数2825例,MP抗体阳性率为40.2%.阳性率的多少与不同的年龄段、不同性别有明显区别.0～1岁婴儿期MP感染率为9.5%;1～3岁组幼儿MP感染率为40.4%;4～6岁学龄前期MP感染发病率为45.4%;7～14学龄期MP感染率为48.3%.0～1岁组MP阳性率明显低于其他年龄组,差异有统计学意义(x2=110.5523,P＜0.01).男、女性肺炎患儿阳性率分别为36%、49.4%,两者比较差异有统计学意义(x2=44.9891,P＜0.01).一年四季均可发病.结论:MP肺炎的发病与年龄、性别、季节和年度有密切关系.     

重症肌无力患者抗乙酰胆碱受体抗体的测定及意义

用ELISA法对56例重症肌无力(MG)患者治疗前后的血清乙酰胆碱受体(AchR)抗体进行了检测。检测结果为MG患者治疗前后的血清AchR抗体阳性率46.4%。而且发病年龄越大,患者体内AchR抗体阳性率越高。患者患病时间越长体内AchR抗体含量降低。伴发胸腺瘤的患者AchR抗体阳性率明显高于胸腺正常者,全身型MG患者AchR抗体检测阳性率高于眼肌型患者。     

正常顺产儿与早产儿人巨细胞病毒和风疹病毒脐带血清抗体检测分析

通过间接酶联免疫法检测178份新生儿(正常顺产儿为114例,早产儿64例)脐带血血清中人巨细胞病毒(human cytomegalovirus,HCMV)和风疹病毒(rubella virus,RV)IgG和IgM抗体,并分析所测结果与临床表现的相关性。结果表明,178例新生儿脐带血血清中HCMV-IgG阳性标本为168例(94.38%),HCMV-IgM阳性标本为1例(0.56%);RV-IgG阳性标本为119例(66.85%);RV-IgM阳性标本为1例(0.56%)。其中,正常顺产儿脐带血中HCMV-IgM和RV-IgM阳性率均为0.87%(1/114),HCMV-IgG阳性率为94.73%(108/114),RV-IgG阳性率为61.40%(70/114),HCMV和RV IgG两者均阳性者为55.26%(63/114);早产儿HCMV-IgM和RV-IgM均为阴性(0/64),HCMV-IgG阳性率为93.75%(60/64),RV-IgG阳性率为76.56%(49/64),HCMV和RV IgG两者均阳性者为70.31%(45/64)。早产儿与正常顺产儿比较,早产儿的RV-IgG阳性率和HCMV和RV-IgG两者均阳性者均高于正常顺产儿,且差异有统计学意义(P<0.05)。可见,HCMV感染率较高,至今仍无有效的HCMV疫苗,应加大疫苗研发力度。所查新生儿RV-IgG阳性率为66.48%,提示中国33%以上的育龄期妇女有在孕早期暴露感染的机率,国家有必要加大该种疫苗的接种力度。     

新生儿高胆红素血症与先天性巨细胞病毒感染的相关性研究

目的:探讨新生儿高胆红素血症与巨细胞病毒(HCMV)感染的相关性及临床意义。方法:对170例疑为高胆红素血症新生儿血清标本分别检测HCMV的IgG和IgM及血清总胆红素(TBIL)。排除高胆红素血症新生儿血清标本100例为正常对照。结果:高胆红素血症患者血清HCMV-IgG、IgM阳性率高于正常对照组,两者比较有统计学意义。结论:巨细胞病毒感染与新生儿高胆红素血症相关性大,是引起高胆红素血症的主要病原之一。     

Preparation of P52 recombinant antigenic protein from human cytomegalovirus (HCMV)

Analysis of published reports helped us single out the most potent antigens among HCMV proteins: phosphoproteins pp150(UL32) and p52(UL44). Theoretical computer analysis of p52 epitopes showed the main antigenic determinants not cross-reacting with antigens of other viruses. Virus-containing (strain AD169) material was obtained and genome DNA was isolated. Amplification of a site of gene UL44 coding for unique determinants detected a PCR fragment of required electrophoretic mobility. The fragment was cloned in vector pLBE. The specificity of cloning was confirmed by restriction analysis of theoretical sites. Nucleotide sequence of cloned fragment of UL44 gene was studied by Maxam-Gilbert's method. Cloning in expressing bacterial vectors helped obtain HCMV recombinant protein p52 in the pure form and fused with beta-galactosidase. Enzyme immunoassay with HCMV-positive and negative donor sera and ABBOTT HCMV sera showed that recombinant p52 increased the sensitivity and specificity of a previously obtained recombinant pp150 as an antigen to HCMV-IgG and HCMV-IgM. The sensitivity and specificity is 100% with 98-99% reliability.     

Impact of Human Cytomegalovirus Infection and its Immune Response on Survival of Patients with Ovarian Cancer

Human cytomegalovirus (HCMV) has been detected in various types of tumors. We studied the prevalence of HCMV in ovarian cancer and its relation to clinical outcome. Paraffin-embedded tissues obtained prospectively from 45 patients with ovarian cancer and 30 patients with benign ovarian cystadenoma were analyzed for expression of HCMV immediate-early protein (IE) and HCMV tegument protein (pp65) by immunohistochemistry. Plasma was analyzed for HCMV serology. HCMV-IgG levels were higher in patients with ovarian cancer or benign cystadenoma than in age-matched controls (P?=?.002, P?<?.0001, respectively). HCMV IgM was detected in 12% of ovarian cancer patients and 3% of patients with benign tumors but was absent in controls. In patients with ovarian cancer, higher IgG levels were associated with better outcomes (P?=?.04). Extensive HCMV-IE protein expression was detected in 75% of ovarian cancers and 26% of benign tumors; pp65 was detected in 67% of ovarian cancers and 14% of benign tumors. A higher grade of HCMV infection was associated with higher stage of disease. Extensive HCMV-pp65 expression was associated with shorter median overall survival than focal expression (39 versus 42.5?months, P?=?.03). At study closure, 58% of ovarian cancer patients with focal pp65 expression were alive versus 27% of patients with extensive pp65 expression (P?=?.03). Thus, HCMV proteins are detected at different levels in ovarian tumors and benign cystadenomas. Ovarian cancer patients with focal HCMV-pp65 expression in their tumors and high IgG levels against HCMV lived longer, highlighting a need for in-depth studies of the oncomodulatory role of HCMV in ovarian cancer.     

先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布的比较

目的:比较先兆早产、胎膜早破、妊娠期糖尿病及正常妊娠女性阴道菌群分布情况。方法:选择2016年6月至2018年6月在苏州大学附属第二医院妇产科住院的妊娠女性806例,其中先兆早产组206例,胎膜早破组234例,妊娠期糖尿病组156例,正常妊娠组210例。记录四组女性异常阴道菌群检出率及异常阴道菌群分布情况。结果:四组女性的年龄、孕周比较无统计学差异(P>0.05)。先兆早产组、胎膜早破组异常阴道菌群检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),而妊娠期糖尿病组、正常妊娠组异常阴道菌群检出率比较无统计学差异(P>0.05)。先兆早产组、妊娠期糖尿病组白色假丝酵母菌检出率高于胎膜早破组、正常妊娠组(P<0.05),先兆早产组、胎膜早破组阴道加德纳菌检出率高于妊娠期糖尿病组、正常妊娠组(P<0.05),先兆早产组无乳链球菌检出率高于胎膜早破组、妊娠期糖尿病组、正常妊娠组(P<0.05),胎膜早破组大肠埃希菌检出率高于先兆早产组、妊娠期糖尿病组、正常妊娠组(P<0.05)。结论:妊娠女性阴道感染以白色假丝酵母菌、大肠埃希菌、无乳链球菌、阴道加德纳菌为主,且先兆早产、胎膜早破女性阴道致病菌感染率较高,妊娠期糖尿病女性阴道白色假丝酵母菌的感染率较高。     

Type 1 diabetes in pre-school children - long-term metabolic control, associated autoimmunity and complications

Diabet. Med. 29, 1291-1296 (2012) ABSTRACT: Aims To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6?years of age. Methods Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6?years (study group) and 220 patients at older than 6?years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared. Results The mean follow-up period was more than 8?years. For the study group, mean HbA(1c) levels ranged from 64?mmol/mol to 66?mmol/mol (8.0-8.2%) until age 10?years, and then rose to 73?mmol/mol (8.8%). The HbA(1c) levels were higher in the study than in the comparison group for comparable ages (P?=?0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P?=?0.03). Kaplan-Meier diagnosis rates of celiac disease, 10?years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank?=?0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy. Conclusions Children diagnosed with Type 1 diabetes before the age of 6?years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6?years. For children diagnosed with Type 1 diabetes aged under 6?years, good metabolic control was achievable until age 10?years, after which it deteriorated. Higher HbA(1c) levels observed in children diagnosed before the age of 6?years were associated with longer duration of disease.     

Effect of insulin on the adipose tissue of patients with diabetes mellitus]

A study was made of insulin sensitivity of the adipose tissue biopsied in 11 healthy women, and in 10 women with normal weight suffering from newly-detected diabetes mellitus. In difference from healthy persons in the adipose tissue of patients suffering from diabetes, insulin in a concentration of 50 mu/ml failed to enhance the oxidation of glucose to CO2, and in a concentration of 50 and 100 mu/ml failed to enhance the glycogen synthesis from glucose. Reduction of the sensitivity of different ways of glucose metabolism in the adipose tissue to insulin in patients suffering from diabetes mellitus pointed to the possibility of disturbance of insulin interaction with the cell membrane in this disease.     

Role of glycaemic control in development of microalbuminuria in patients with insulin dependent diabetes.

OBJECTIVE--To ascertain which factors determine the progression from very low rates of albumin excretion to persistent microalbuminuria in patients with insulin dependent diabetes mellitus. DESIGN--A 10 year prospective study of a cohort of diabetic patients. SETTING--Outpatient department of the Portsmouth District Hospitals. SUBJECTS--97 patients with insulin dependent diabetes mellitus who were initially free of microalbuminuria and hypertension. MAIN OUTCOME MEASURE--Urinary albumin: creatinine ratio. RESULTS--Eight of the 97 patients had developed microalbuminuria (urinary albumin:creatinine ratio > 3 mg/mmol in three consecutive early morning samples) by the 10 year follow up. The group who developed microalbuminuria had higher baseline log10 plasma glucose concentrations (mean (SD), 1.210 (0.122) v 0.984 (0.196) mmol/l, P < 0.001) and glycated haemoglobin concentrations (1.112% (0.069%) v 0.997% (0.076%), P < 0.001) and a younger age at onset of diabetes (10.0 (5.5) v 15.6 (7.8) years, P < 0.05). There was no difference in baseline duration of diabetes, smoking, sex, insulin dose, body mass index, serum creatinine concentration, or systolic, diastolic, or mean arterial blood pressure between the two groups. Multiple linear regression analysis showed that urinary albumin:creatinine ratio at 10 years was influenced by initial albumin:creatinine ratio (P = 0.006), initial glycated haemoglobin concentration (P = 0.002), and duration of diabetes (P = 0.045). Genotype for angiotensin converting enzyme was not related to the development of microalbuminuria nor, in a larger group of patients, the presence of any degree of diabetic nephropathy. CONCLUSION--In patients with insulin dependent diabetes mellitus the progression of minimal albuminuria and the development of microalbuminuria is determined primarily by poor long term glycaemic control. There is a weaker relation with longer duration of disease and younger age at onset of diabetes, but blood pressure does not seem to be implicated. Gene polymorphism for angiotensin converting enzyme is not linked to the development of microalbuminuria or established diabetic nephropathy.     

The Asp298 allele of endothelial nitric oxide synthase is a risk factor for myocardial infarction among patients with type 2 diabetes mellitus

Background

To establish an efficient prophylaxis of coronary artery disease reliable risk stratification is crucial, especially in the high risk population of patients suffering from diabetes mellitus. This prospective study determined the predictive value of coronary calcifications for future cardiovascular events in asymptomatic patients with diabetes mellitus.

Methods

We included 716 patients suffering from diabetes mellitus (430 men, 286 women, age 55.2 ± 15.2 years) in this study. On study entry all patients were asymptomatic and had no history of coronary artery disease. In addition, all patients showed no signs of coronary artery disease in ECG, stress ECG or echocardiography. Coronary calcifications were determined with the Imatron C 150 XP electron beam computed tomograph. For quantification of coronary calcifications we calculated the Agatston score. After a mean observation period of 8.1 ± 1.1 years patients were contacted and the event rate of cardiac death (CD) and myocardial infarction (MI) was determined.

Results

During the observation period 40 patients suffered from MI, 36 patients died from acute CD. The initial Agatston score in patients that suffered from MI or died from CD (475 ± 208) was significantly higher compared to those without cardiac events (236 ± 199, p < 0.01). An Agatston score above 400 was associated with a significantly higher annualised event rate for cardiovascular events (5.6% versus 0.7%, p < 0.01). No cardiac events were observed in patients with exclusion of coronary calcifications. Compared to the Framingham risk score and the UKPDS score the Agatston score showed a significantly higher diagnostic accuracy in the prediction of MI with an area under the ROC curve of 0.77 versus 0.68, and 0.71, respectively, p < 0.01.

Conclusion

By determination of coronary calcifications patients at risk for future MI and CD could be identified within an asymptomatic high risk group of patients suffering from diabetes mellitus. On the other hand future events could be excluded in patients without coronary calcifications.