2003年 · 第116卷第04期

Purpose To review the efficacy and safety of pegylated interferons (peginterferons) in the treatment of chronic hepatitis C. Data sources An English language literature search (MEDLINE 1988 - 2001) was performed and a total of 19 original articles related to the issue were selected. Data extraction After careful review of the selected papers, the meaningful results and conclusions were extracted using scientific criteria. The papers reviewed pertained mainly to the efficacy and safety profiles of peginterferons in the treatment of chronic hepatitis C. Results Peginterferon can effectively prolong the half-life of interferon and can be effectively administered conveniently as a once-a-week dose. The antiviral effect using peginterferon was enhanced compared with that of standard interferon, but the frequency and severity of adverse events were typical of those associated with interferon-a. Conclusions Based on its efficacy, safety and convenient dosing, peginterferon is more favorable than standard interferon in the treatment of chronic hepatitis C. Chin Med J 2003; 116(4):495-498

Objective To review and summarize literature regarding stimulatory and inhibitory signaling pathways from different types of Fc gamma receptors (FcγRs). Data source Articles were obtained from Medline from January 1991 to April 2002. Study selection Over 100 English language papers and reviews published over the last 11 years were selected. Results and Conclusions Stimulatory Fcγ receptors include FcγRI, FcγRIIA, FcγRIIC, and FcγRIII A. They transduce signals through the immunoreceptor tyrosine-based activation motif (ITAM) in subunits or in the cytoplasmic domain. Inhibitory Fcγ receptors, such as FcyRIIB, are single chain receptors, transducing signals through an immunoreceptor tyrosine-based inhibitory motif (ITIM) in cytoplasmic domains. Stimulatory signals include protein phosphorylation, increase in intracellular free calcium, the production of 1 ,4, 5-triphosphate inositol (IP3) and diacylglycerol (DAG) mainly through the Src-family kinases, phosphoinositide 3-kinase (PI3-K) and phospholipase C (PLC). Inhibitory signaling has been implicated in the repression of the above activities as well as inhibition of B cell responses through Src homology 2-containing inositol phosphatase (SHIP). Chin Med J 2003; 116(4): 487-494

Objective To summarize the results of general survey, primary structure analysis and related functional studies of abnormal hemoglobins (Hbs) found in Hunan Province. Data sources International Hb journals, Chinese biochemical and biomedical journals and other articles relevant to hematology. Study selection All Hb variants found in Hunan and identified by primary structure analysis during 1980 - 1991 were included. Data extraction Data concerning 11 types of Hb variants found in 3 districts and 7 counties in Hunan Province were briefly documented. Their frequencies of occurrence were calculated and their distributions among Han, Yao, Tujia and Dong ethnic groups were listed. Results Thirty-six cases with abnormal Hb were identified out of 7412 individuals screened in Hunan. 11 different types of Hb variants were recognized by primary structure analysis in 19 propositi along with their family members, including 5 α-chain variants, 4 β-chain variants, 1 5-chain variant and 1 5-β chain fusion variant. Oxygen equilibrium characteristics, reaction dynamics, the rate of globin chain synthesis (RGCS), morphology observation by electron microscopy and DNA analysis were all used in the functional studies of hemoglobinopathies. Conclusions The average incidence of abnormal Hbs in Hunan is 0.486%. In Jianghua County, whose inhabitants are mostly of the Yao ethnic group, the incidence is significantly higher (1.09%). Hb Jianghua [β120(GH3) Lys→lle] and Hb Shuangfeng (SF)[α27( B8) Glu→Lys] were two new variants first reported in international literature; whereas Hb Lille [α74 (EF3) Asp → Ala], HbA2 Flatbush [δ22(B4) Ala→Glu] and Hb Lepore-Boston [δ87(F3)-β116(G18)] were the first three instances to be found in China. Hb SF displayed an oxygen affinity 1.5-fold higher than that of HbA at pH 7.4 and 25℃ with its oxygen equilibrium curve shifted to the left. Reticulocytes of Hb SF heterozygote showed unbalanced RGCS, quite similar to that found in β-thalassemia minor. Erythrocytes of Hb SF heterozygote were changed to spherocytes and began to lyse after incubation with sodium salicylate or sulfadiazine (pH 7. 4, 37℃) for 2 - 4 h. These findings explained the sudden attack of hemolytic anemia provoked by two drugs in Hb SF propositus. The genotype of a patient with Hb Q-H disease is identified as -,- / -, αQ by DNA restriction mapping. Chin Med J 2003; 116(4): 483-486

Objective To performance susceptibility testing of antifungal agents. Due to the increasing number of resistant strains, susceptibility testing of antifungal agents is gaining importance. Methods We compared the results of standard macrotube dilution reference method with two different microdilution methods, as well as the disc diffusion method in order to test the susceptibility of 150 Candida strains to fluconazole. Results Overall correlation between microdilution and macrodilution methods was 86%. It was 91%between the Minimal Inhibitory Concentrations obtained from macrodilution and disc diffusion zone diameters. Conclusion The disc diffusion test was evaluated as a low-cost, reproducible, and efficient way of assessing the in vitro susceptibility of Candida strains to fluconazole. Chin Med J 2003; 116(4): 633-636

Objective To investigate the effects of salvianolic acids on human umbilical vein endothelial cells (HUVEC) against damage induced by cholestane-3β-5α-6β-triol (chol-triol). Methods The viability of HUVEC was measured by MTT method. The apoptosis of HUVEC induced by chol-triol was detected by flow cytometry and TUNEL assay. The production of malondialdehyd (MDA) in HUVEC was tested by thiobarbaturic acid (TBA) assay. Results The viability of HUVEC treated with chol-triol 100 μmol/L decreased by 39. 8% while salvianolic acids 100 μg/ml increased by 27.9%. The apoptotic rate of HUVEC measured by PI staining increased from 6% -8% to 17% - 20% after chol-triol treatment for 12 h. Salvianolic acids 100 μg/ml reduced the apoptotic rate to 10% - 14% after treatment HUVEC for 1 h prior to chol-triol treatment. In another experiment, chol-triol increased the number of TUNEL-positive cells 5 times, but salvianolic acids 10 μg/ml and 100 μg/ml reduced the number of TUNEL-positive cells by 36. 9% and 61.2%, respectively. The production of MDA in HUVEC increased by 120.7% after chol-triol treatment for 12 h. Salvianolic acids 10 μg/ml and 100 μg/ml also decreased the concentration of MDA by 28. 7% and 39.8%, respectively. Conclusion Salvianolic acids has protective effect on endothelial cells against damage induced by chol-triol. Chin Med J 2003; 116(4): 630-632

Objective To examine whether lipopolysaccharide (LPS)-induced apoptosis correlates with TNF-α release by type Ⅱ alveolar epithelial cells (AEC Ⅱ), whether TNF-α knockout (TNF KO) abrogates the induction of apoptosis by LPS and whether TNF-α is sufficient to induce apoptosis in this cell type. Methods AEC Ⅱ were isolated from wild type mice and TNF KO mice. Cells were stimulated with LPS or recombinant murine TNF-α for 24 h. TNF-α in culture supernatant was determined by ELISA following LPS stimulation. Apoptosis was determined by the terminal deoxynucleotidyl transferase end-labeling (TUNEL) assay after treatment with either LPS or TNF-α. Results LPS induced apoptosis in wild type AEC Ⅱ in a concentration-dependent manner. LPS-induced AEC Ⅱ apoptosis was accompanied by an 11-fold increase (from 0. 073 ± 0.065 ng/ml in control to 0.94 ± 0.14 ng/ml in 50 μg/ml of LPS, P < 0.01) in TNF-α release. However, increasing concentrations (5 or 25 ng/ml) of recombinant murine TNF-α failed to induce AEC Ⅱ apoptosis. In addition, apoptosis did occur in AEC Ⅱ isolated from TNF KO mice following LPS stimulation. Conclusions This study confirms that LPS induces TNF-α release and apoptosis in murine AEC Ⅱin vitro. Exogenous TNF-α failed to induce AEC Ⅱ apoptosis, and apoptosis occurred following LPS stimulation in cells lacking the ability to produce TNF-α. Taken together, these results suggest that LPS-induced AEC Ⅱ apoptosis occurs by a TNF-α-independent mechanism. Chin Med J 2003; 116(4): 625-629

Objective To test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer. Methods The subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of [(T-B)/(NT-B)] was calculated as radioactivity of mass to that of opposite corresponding tissue, and [ (T-B)/(NT-B)]≥1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects. Results Using Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92. 9% and 90. 6% respectively, the positive predictive value 89. 7%, the negative predictive value 93.5%, and the accuracy 91. 7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88. 6% and 85% respectively. Conclusions It is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer. Chin Med J 2003; 116(4): 620-624

Objective To evaluate a devascularization technique for hypervascular tumors of the head and neck by direct intratumoral puncture. Methods Six cases of hypervascular tumor of the head and neck were reviewed, focusing on findings from digital subtraction angiography and preoperative direct intratumoral embolization and their effects after the operation. Results Total devascularization by complete embolization was achieved in 2 cases: 1 nasopharyngeal angiofibroma and 1 spongiform tumor, both of which were completely excised endoscopically with blood loss of 60 ml. Incomplete devascularization through 80% - 90%embolization was achieved in the other 4 cases: 1 paraganglioma was totally removed with 800 ml of blood loss, 1 hemangioblastoma was not completely excised with 400 ml of blood loss and 2 nasopharyngeal angiofibromas involving the intracranial region were partially eliminated with a total blood loss of 1600 ml. Conclusion The new technique of preoperative embolization of hypervascular tumors of the head and neck by direct intratumoral puncture, which can decrease blood loss during the accompanying tumor resection and increase the possibility of complete tumor removal, is feasible, convenient, safe, and effective. Chin Med J 2003; 116(4):616-619

Objective To evaluate the clinical value of various kinds of interventional techniques in the treatment of Budd-Chiari syndrome (BCS). Methods Multiple techniques such as recanalization of the inferior vena cava (IVC) under the guidance of marker and multi-angled fluoroscopy, recanalization of the hepatic vein with a transjugular approach, PTA, Z-expandable metallic stent (Z-EMS) implantation and modified TIPSS were used to treat 103 patients with BCS. Results Of 103 patients with BCS, 59 patients with obstruction of IVC were treated using recanalization of IVC. Seventeen patients with hepatic vein obstruction had their hepatic veins recanalized. The rest of the patients were given other methods of interventional treatment. Of all the subjects, 101 successfully underwent their procedures, with a success rate of 98. 06%; and only 2 failed to recanalization of the IVC. Fifty-three patients were treated using PTA for the first time, with a success rate of 100%. In the 48 patients undergoing Z-EMS implantation for the first time, the success rate was 95.8%. Five patients were treated with modified TIPSS. After these interventional treatments, the success rate was 100%. Two patients died 16 h and 72 h respectively after operation because of DIC and severe hemoptysis. Seventy-two patients were followed up for 1 - 94 months (with a mean of 42.3 months). The mean follow-up of a BCS patient treated with PTA was 52. 1 months, resulting in a primary patent rate of 59.4% and a restenosis rate of 40. 6%. The mean follow-up of BCS treated with stenting was 33. 5 months, with a primary patent rate of 87. 5% and a restenosis rate of 12. 5%. Eight patients died 7-64 months after the interventional procedure. Conclusion Recanalization of IVC or the hepatic vein transjugularly, PTA, Z-EMS implantation and modified TIPSS can be regarded as safe and effective micro-invasive methods in the treatment of BCS. Chin Med J 2003; 116(4): 609-615

Objective To discuss the roles of serum interleukin-18 (IL-18), interleukin-10 (IL-10) and soluble interleukin-2R (sIL-2R) in the pathogenesis of chronic hepatitis C and to observe the effects of interferon (IFN) on the above- mentioned serum cytokines. Methods The levels of above- mentioned cytokines were detected in 10 healthy individuals, 24 asymptomatic hepatitis virus C (HCV) carriers and 27 patients with chronic hepatitis C (before and after IFN treatment) using enzyme linked immunosorbent assay (ELISA). Results The levels of the cytokines in patients with chronic hepatitis C are higher than in healthy people (P < 0.05) and in asymptomatic HCV carriers(P < 0.05). The values of the cytokines show a significant positive correlation to ALT (P < 0.05). Levels of tested cytokines decreased observably after IFN treatment (P < 0.05). The grades of the serum levels for sIL-2R and IL-10 before IFN treatment (from high to low) were categorized accordingly: non-response group > partial- response group > complete- response group (P < 0.05). Conclusions The tested cytokines co-participate in the pathogenesis of chronic hepatitis C, and can be used to evaluate the effect of IFN on the immune state of organisms. Furthermore, sIL-2R and IL-10 are important for predicting the anti-viral efficacy of IFN. Chin Med J 2003; 116(4): 605-608

Objective To report 21 cases of postinfectious encephatitis according to ICD-NA, postinfectious/parainfectious encephalitis is an independent disease. Methods Using the uniform criteria provided by The Council of State and Territorial Epidemiologists ( CSTE) and Centers for Disease Control and Prevention (CDC), we diagnosed postinfectious encephalitis among patients admitted to The First Hospital of Harbin Medical University and analyzed the characteristics of these cases. Results All the patients had histories of preceding infection, and most of them suffered from mental and conscious disorders. Adrenocortical hormone was effective. Conclusions Postinfectious encephalitis is an independent disease. According to this article, about 10% patients with encephalitis admitted to our hospital are postinfectious. Chin Med J 2003; 116(4): 602-604

Objective To investigate injury to epidermal melanocyte by Q-switched Alexandrite laser. Methods Multiple biopsies were performed on 5 patients with nevus of Ota from before irradiation to 1 year after irradiation. Fourteen specimens were obtained for light microscopy, and 17 for transmission electron microscopy. Results Melanosomes in epidermal melanocytes were both smaller in size and fewer in number than those in dermal melanocytes. Immediately after irradiation, focal extracellular vacuoles of the basal layer could be observed under light microscopy. Most epidermal melanocytes underwent mild or moderate injury in the form of vacuolated melanosomes, swollen mitochondria, dilation of endoplasmic reticulum, and expansion of extracellular space, retaining intact cell membranes. Normal structures were restored 5 months to 1 year after irradiation, with no depigmentation or hyperpigmentation as seen by light microscopy. Conclusion Injury of melanosomes in epidermal melanocytes is reversible. Chin Med J 2003; 116(4): 597-601

Objective To evaluate the efficacy of interferon (IFN) alpha-2b and lamivudine therapy in children with chronic hepatitis B virus (HBV) infection. Method Ten children who developed chronic hepatitis B infection received IFN alpha-2b 10 million international units (IU)/m2 body surface area, subcutaneously three times a week for six months. IFN + lamivudine therapy began to be used in the cases who were unresponsive to IFN treatment. Results Among 27 HBsAg (+) subjects in this study, interferon treatment was given to 11 subjects who developed chronic hepatitis. One case was excluded from the study due to detection of Herpes type 1 encephalitis. At the end of six months of follow-up, complete response was obtained in three (30%) patients and partial response in four (40%) patients, whereas no response was detected in three (30%) patients. Fifty percent of the cases experienced serological response, 70% biochemical response, and all (100%) had histological response. In three cases started concomitant IFN + lamivudine therapy, HBV-DNA became negative at the second month of treatment. Conclusions IFN-alpha and lamivudine can be used for the treatment of chronic hepatitis B infection in children. Chin Med J 2003; 116(4): 593-596