免疫因素在甲状旁腺功能减退症发病机制中的作用

甲状旁腺功能减退症(甲旁减)相对罕见,手术、遗传缺陷等多种因素可导致其发病。目前有研究提示免疫因素在甲状旁腺功能减退症发病中可能具有一定作用。体液免疫方面,随着抗甲状旁腺抗体在特发性甲旁减患者中的发现,自身免疫因素在甲旁减发病机制中的作用逐渐成为国际上的研究热点。目前研究主要集中在钙敏感受体抗体和NALP5(NACHT leucine-rich-repeat protein 5)自身抗体。由于抗体异质性、检测方法、抗体阳性判断标准等原因,不同研究中这两种自身抗体在甲旁减患者中的阳性检出率差异很大。关于细胞免疫机制在甲旁减发病的作用,目前研究甚少。     

慢性荨麻疹自身抗体的表达情况及意义分析

目的:对慢性荨麻疹自身抗体的表达情况及意义分析。方法:收集近期在本院治疗的慢性自身免疫性荨麻疹患者78例作为观察组,同时随机选择同期健康体检者78例作为对照,检测抗FcεRI抗体、抗甲状腺自身抗体(抗甲状腺过氧化物酶自身抗体与抗甲状腺球蛋白抗体)、抗幽门螺杆菌(HP)自身抗体、抗核抗体(ENA)、抗dsDNA抗体等自身抗体表达情况,并进行比较分析。结果:与对照组相比较,慢性荨麻疹患者FcεRI抗体、抗甲状腺抗体、HP抗体、抗dsDNA等自身抗体表达阳性率均明显升高,与对照组比较差异具有统计学意义,抗核抗体阳性率差异则不具有统计学意义。与对照组相比较,慢性荨麻疹患者FcεRI抗体、抗核抗体、抗dsDNA等自身抗体表达水平明显升高,比较差异具有统计学意义(P<0.05)。结论:慢性特发性荨麻疹的发病与其自身免疫背景有关,其血清内存在多种自身抗体异常表达,值得临床进一步研究应用。     

B淋巴细胞刺激因子对慢性特发性荨麻疹患者产生抗FcεRI抗体和抗IgE抗体的影响

目的:探讨慢性特发性荨麻疹患者血清B淋巴细胞刺激因子(Bly S)对抗Ig E抗体和抗FcεRI抗体的影响。方法:选取慢性特发性荨麻疹患者100例作为疾病组,选取同期体检健康者100例作为健康组。检测两组受试者血清Bly S、抗Ig E抗体及抗FcεRI抗体水平;分离培养疾病组患者外周血中的B淋巴细胞,分为两份保存,在其中一份培养液中加入有效水平的Bly S,检测抗Ig E抗体及抗FcεRI抗体水平,作为试验组,将另一份作为空白对照组。分析血清Bly S与抗Ig E抗体及抗FcεRI抗体之间的关系。结果:疾病组血清Bly S、抗Ig E抗体及抗FcεRI抗体水平明显高于健康组,差异具有统计学意义(P<0.05)。试验组培养液中抗Ig E抗体及抗FcεRI抗体水平明显高于对照组,差异具有统计学意义(P<0.05);试验组中抗Ig E抗体及抗FcεRI抗体水平与Bly S呈正相关(r=0.765、0.722,P<0.05)。结论:慢性特发性荨麻疹患者血清Bly S可刺激B淋巴细胞产生抗Ig E抗体和抗FcεRI抗体,这可能与慢性特发性荨麻疹的发病机制有关。     

强直性脊柱炎合并大动脉炎的临床特点

目的 　探讨强直性脊柱炎（ankylosing spondylitis，AS）合并大动脉炎（Takayasus arteritis，TA）患者的临床特点。 方法 　回顾性分析2000年6月至2011年7月北京协和医院确诊的AS合并TA患者的资料。使用改良的纽约标准作为AS的诊断标准，美国风湿病学会大动脉炎分类标准作为TA的诊断标准。所有患者均行抗核抗体、类风湿因子、抗中性粒细胞胞浆抗体、抗心磷脂抗体检查，排除结缔组织疾病或其他疾病。同时行红细胞沉降率 (erythrocyte sedimentation rate，ESR)、C反应蛋白、HLA-B27、心脏超声心动图、主动脉及其分支的血管造影或CT 血管造影和/或血管超声、骶髂关节X线和CT检查。 结果 　7例患者诊断为AS合并TA，其中男性4例，女性3例。就诊时年龄18⁵0岁，平均年龄（29.6±10.6）岁。5例患者HLA-B27阳性，2例阴性。所有患者ESR和C反应蛋白均升高，ESR平均84 mm/h。所有患者均先诊断AS，多年后又发现TA。诊断TA前，患者AS病史最短3年，最长29年，平均（13.9±11.6）年。发现TA的原因主要由于出现TA受累血管的症状或炎症所引起的发热。 结论 　AS合并TA并非随机现象，炎症因素可能在发病机制中起重要作用。     

原发性胆汁性肝硬化检测自身免疫性肝病相关自身抗体谱的临床意义

目的:分析原发性胆汁性肝硬化(PBC)患者中自身免疫性肝病相关自身抗体谱的情况及其相关的临床价值。方法:选择2009年1月-2013年12月收治的PBC患者61例(PBC组)、自身免疫性肝炎(AIH)50例患者(AIH组)和其他肝病52例患者(对照组),检测各组的血清抗线粒体抗体(AMA)(采用间接免疫荧光法)、血清自身免疫性肝病相关自身抗体谱(采用ELISA法),包括AMA-M2、抗GP210抗体、抗SP100抗体、抗SLA抗体、抗LC1抗体、抗LKM-1抗体。结果:在PBC组中AMA、AMA-M2、抗GP210抗体、抗SP100抗体、抗LC1抗体、抗SLA抗体及抗LKM-1抗体阳性率分别为91.8%(56/61)、86.9%(53/61)、36.1%(22/61)、24.6%(15/61)、1.6%(1/61)、0(0/61)、1.6%(1/61);在AIH组中分别为18.0%(9/50)、6.0%(3/50)、8.0%(4/50)、14.0%(7/50)、0(0/50)、6.0%(3/50)、4.0%(2/50);而在对照组中分别为5.8%(3/52)、1.9%(1/52)、5.8%(3/52)、11.5%(6/52)、0(0/52)、0(0/52)、0(0/52)。AMA、AMA-M2和抗GP210抗体在PBC组中阳性率较AIH组明显增高(P<0.01)。而抗SLA抗体在AIH组阳性率较PBC组明显增高(P<0.01)。结论:抗LC1抗体、抗SLA抗体和抗LKM-1抗体在PBC和AIH患者中的阳性率低,检测该3种抗体的意义不大;因此筛查抗GP210抗体和AMA对PBC的诊断具有重要的临床意义。     

肌力下降、呼吸衰竭、心力衰竭、抗线粒体抗体阳性——罕见炎性肌病的不典型表现

一例老年女性患者,慢性病程,临床表现为下肢进行性肌力下降、心力衰竭、二氧化碳潴留,伴眶周色素沉着、眉周毳毛增多及多种自身抗体阳性。经多学科讨论,以膈肌运动减低引起的限制性通气功能障碍为突破口,逐步梳理病因,结合临床表现、血液学与影像学特征以及股四头肌肌肉病理与免疫组化结果,最终诊断为抗线粒体抗体相关炎性肌病。通过纠正心力衰竭、间断无创呼吸机辅助通气及康复训练,患者临床症状及功能状态明显改善。该患者不具有抗线粒体抗体相关炎性肌病的典型表现,能快速明确病因并解决诊疗决策中的难题,再次体现了多学科协作在疑难病诊治中的重要作用。     

LPS诱导小鼠急性肺损伤TLR4及TNF-α表达

目的:研究脂多糖(LPS)诱导的小鼠急性肺损伤机制。方法:实验分为正常对照组、模型组及抗体组;正常对照组小鼠腹腔腔内注射等量0.9%Na Cl。模型组腹腔内注射LPS(4 mg/kg)。抗体组在造模前8~10 h,应用小鼠Toll样受体4/髓样分化蛋白2(TLR4/MD2)复合物抗体腹腔内注射50μg。各组均在造模5 h后留取血和肺组织,采用细菌内毒动态浊度法检测血浆LPS的含量,HE染色判定小鼠肺组织病理变化,RT-PCR测定小鼠肺组织TLR4基因表达,Western-blot测定TLR4蛋白表达;ELISA检测小鼠血清中TNF-α的水平。结果:和正常对照组比较,模型组及抗体组小鼠血浆内毒素含量显著升高(P<0.05),模型组小鼠肺组织HE染色呈ALI表现;和模型组比较,抗体组TLR4 m RNA、蛋白及TNF-α的表达明显下调(P<0.05)。结论:急性肺损伤机制可能与LPS和TLR4受体结合介导TNF-α信号途径相关。     

ANCA相关性疾病及血清学检测进展

抗中性粒细胞胞浆抗体(ANCA)是一组以人中性粒细胞及单核细胞胞浆成分为靶抗原的自身抗体,ANCA不仅是ANCA相关性系统性血管炎的血清学标志物,也在多种非血管炎疾病中起重要作用。ANCA靶抗原种类繁多,在不同疾病中阳性率分布不同,所累积的器官和程度也不同。因此,本文主要对近年来ANCA相关性疾病的临床意义及ANCA的血清学检测作一详细阐述。     

肝源性溃疡的发病机制与药物治疗

肝源性溃疡是指在肝硬化基础上出现的消化性溃疡,是肝硬化患者上消化道出血的常见原因,其发病率较单纯消化性溃疡者高。目前肝源性溃疡发病机制尚未完全明确,可能是门脉高压、肝功能不全等多种因素共同影响发展而成的。因存在肝硬化的基础,肝源性溃疡的治疗除抗溃疡治疗外,还需考虑原发病的治疗,治疗上存在一定的难度。本文结合国内外的研究结果,对肝源性溃疡的发病机制及药物治疗特点予以综述。     

妊娠期高血压患者抗磷脂抗体水平与妊娠结局的关系研究

目的:研究妊娠期高血压(HDCP)患者抗心磷脂抗体(ACA)及抗β_2-糖蛋白1(β_2-GP1)抗体水平与妊娠结局的关系,深入探讨抗磷脂抗体(APA)在HDCP发病中的作用,为临床预防及治疗HDCP提供新的理论依据。方法:选择在本院接受常规产检的妊娠期高血压疾病孕妇,采用酶联免疫吸附法(ELISA)检测孕妇ACA及抗β_2-GP1抗体水平,根据ELISA法检测结果分组,观察组A为仅ACA阳性孕妇,观察组B仅抗β_2-GP1抗体阳性孕妇,对照组为ACA及抗β_2-GP1抗体均阴性孕妇,每组均纳入30例。分析三组患者不良妊娠结局,以观察组A和观察组B为对象进行研究,分析APA水平与妊娠结局的相关性,分析不同抗磷脂抗体间相关性。结果:观察A组不良妊娠结局总发生率为46.67%,明显高于观察组A(36.66%)和对照组(10.00%),三组患者不良妊娠结局比较差异有统计学意义(P<0.05)。观察组A和观察组B两组患者ACA-IgM平均为(11.46±4.51)GPLU/mL、ACA-IgG平均为(9.42±3.51)MPLU/mL、抗β_2-GP1抗体平均为(104.63±21.83)U/mL。抗β_2-GPI抗体与围产儿死亡呈正相关(P<0.05),ACA-IgM、ACA-IgG和抗β_2-GP1抗体均与早产呈正相关(P<0.05),ACA-IgM与FGR呈正相关(P<0.05)。HDCP患者的ACA-IgG、ACA-IgM和抗β_2-GP1抗体三者两两间均呈正相关(P<0.05)。结论:HDCP患者ACA及抗β_2-GP1抗体与不良妊娠结局具有一定相关性,APA水平的检测对预测不良妊娠结局具有一定参考。     

浅析高速公路工程招投标中的最低评标价法

结合目前高速公路施工项目招投标活动的实际情况,阐述了最低评标价法的概念,归纳了其优点及存在问题,对完善最低评标价法提出几点策略,以期促进招标投标市场更加规范有序。     

Place-Making in Megaprojects in Melbourne

This article analyses state-led place-making practices in Melbourne. The two levels of government that influence planning in Melbourne make much of the city as ‘culturally vibrant’ and ‘creative’, and have incorporated creative city-inspired place-making principles into many layers of the planning system. An examination of the development of two mixed-use megaprojects in central Melbourne reveals however that ideals of culturally engaging public places, and indeed of creative landscapes for middle-class consumption, wither in the face of more basic imperatives for economic development. In these case studies the ‘creative city’, no matter how the idea is interpreted, has little traction either as a set of inclusive place-making principles or as a gentrification strategy. The article concludes that the creative city-inspired place-making objectives in the planning system at both state and local levels are ambiguous in their overall intents and completely unsupported by statutory controls. Such place-making objectives as are realised are the compromised results of the interplay of uncoordinated decisions, delivered at the pleasure of the developer.     

Pathogens in septage in Vietnam

Septage is widely acknowledged as a major source of infectious pathogens while disposal of septage, and the operation and maintenance of septic tanks, is not regulated in many developing countries. Twenty untreated septage and septage sludge samples were taken from Can Tho City, Vietnam to examine their pathogen content, and indicator micro-organisms. Escherichia coli and Enterococcus spp. were detected in all samples, regardless of sludge storage time. Phages were detected in 80% of samples. Salmonella spp. were detected in 70% of the untreated septage and 60% of septage sludge samples. Concentrations of phages and bacteria tested in septage sludge after many years of tank storage were much higher than the expected levels. Helminth ova were present in 95% of untreated septage samples with an average of 450 ova l^− 1, and were detected in all septage sludge samples with an average of 16,000 ova l^− 1. Twelve varieties of helminth ova were identified. More helminth ova varieties in higher concentrations were found in septage than those reported from stool samples. The varieties' frequency ranged from 10% to 50% and Ascaris lumbricoides predominated. Results show that pathogens and indicator micro-organisms, especially helminth ova, accumulate in sludge. Thus helminth ova should be considered when septage sludge is treated and used for agriculture. Proper health protection measures must be applied for people handling septage.     

新时期广东城市化的新特点

新时期广东城市化出现以下特点:知识源导向、城市由单体向群体化发展、产业集群推动、政府主导自上而下的集约化发展、城镇化向城市化转变、由重“数量”发展向重“质量”发展的转变。     

谈城市历史保护规划的误区

由于缺乏起码的历史文化知识,忽视历史文化遗产的保护,错误的决策导致了建设性的破坏,要加强城市保护的教育,培养合格人才。     

浅谈我国工程项目建设成本控制存在的问题

结合目前我国施工企业工程项目成本管理现状,对工程项目成本管理过程中存在的问题进行了较详细的分析,并提出了一些解决问题的办法,以做好项目成本控制工作,进而增强企业经济实力。     

浅谈建筑施工临时用电安全

针对由于建筑施工临时用电安全管理的不完善和不规范操作而导致大量工伤事故频频发生的问题,为消除用电安全隐患,对建筑施工临时用电安全管理进行了归纳和分析,并提出了整改意见,以确保现场人员及电气设备的安全运行。     

Perchlorate exposure in lactating women in an urban community in New Jersey

Perchlorate is most widely known as a solid oxidant for missile and rocket propulsion systems although it is also present as a trace contaminant in some fertilizers. It has been detected in drinking water, fruits, and vegetables throughout New Jersey and most of the United States. At sufficiently high doses, perchlorate interferes with the uptake of iodine into the thyroid and may interfere with the development of the skeletal system and the central nervous system of infants. Therefore, it is important to quantify perchlorate in breast milk to understand potential perchlorate exposure in infants. In this study we measured perchlorate in breast milk, urine, and drinking water collected from 106 lactating mothers from Central New Jersey. Each subject was asked to provide three sets of samples over a 3-month period. The average ± SD perchlorate level in drinking water, breast milk, and urine was 0.168 ± 0.132 ng/mL (n = 253), 6.80 ± 8.76 ng/mL (n = 276), and 3.19 ± 3.64 ng/mL (3.51 ± 6.79 μg/g creatinine) (n = 273), respectively. Urinary perchlorate levels were lower than reference range values for women of reproductive age (5.16 ± 11.33 μg/g creatinine, p = 0.03), likely because of perchlorate secretion in breast milk. Drinking water perchlorate levels were ≤ 1.05 ng/mL and were not positively correlated with either breast milk or urine perchlorate levels. These findings together suggest that drinking water was not the most important perchlorate exposure source for these women. Creatinine-adjusted urine perchlorate levels were strongly correlated with breast milk perchlorate levels (r = 0.626, p = < 0.0005). Breast milk perchlorate levels in this study are consistent with widespread perchlorate exposure in lactating women and thus infants. This suggests that breast milk may be a source of exposure to perchlorate in infants.     

安康市工程施工企业未来几年人才需求调查

为了不断提高工程类专业的办学质量,对安康市区主要施工企业或项目经理部未来几年人才需求状况进行了调查,同时提出相关建议,以期培养更多的该类专业人才,满足施工企业需求。