2001年 · 第114卷第12期

Objective To define the functional significance of IL-1 receptor antagonist (IL-1ra) gene polymorphism and to investigate, the production of IL-1ra by monocytes from individuals with different genotypes of IL-1. Methods The genotype of IL-1ra was detected by polymerase chain reaction (PCR). Peripheral monocytes obtained from patients with immunoglobin A nephropathy (IgAN), Henoch-Schonlein purpura nephritis (HSPN) and normal subjects were matched in sex and age between the IL1RN-2 allele carriers and non-carriers. The secretion of IL-1ra, IL-1α and IL-1β in the supernatant of GM-CSF (10 ng/ml) treated and untreated monocytes were measured by ELISA. Results The secretion of IL-1ra by monocytes stimulated with GM-CSF was significantly higher in the IL1RN-2 allele non-carriers than those of carriers both in IgAN (21.55±3.08 vs 13.85±2.24 ng/ml, P < 0.001) and HSPN (23.72±6.68 vs 12.67±2.24 ng/ml, P < 0.01) as well as in normal controls (20.29 ± 1.45 vs 10.51±2.3 ng/ml, P < 0.001). All showed no significant differences in monocyte secretion of IL-1α and IL-1β by GM-CSF stimulation between the IL1RN-2 allele carriers and non-carriers. Conclusions These results indicate that a functional correlation of the IL1RN-2 allele and IL-1ra production is present in patients with IgAN and HSPN. This gene polymorphism control of IL-1 ra production may contribute to the variety of clinical responses to inflammatory stimulation in individuals with different genotype of IL-1ra. Chin Med J 2001; 114(12):1313-1316

Objective To summarize microskin grafting in recent 15 years. Methods Microskin grafting was performed in 162 patients with extensive burn. The indications and forms of the grafting, mechanization in making microskin and outcome of wound recovered by micrografts were discussed. Results Extremely extensive third degree burns, common extensive third degree burns and extensive granulation wound were healed by different ways of microskin grafting. A new machine was used to mince micrografts with good clinical results. The homografts as covertures were exfoliated in either necrosis or desquamation. Scar formation was related to wound repair. Conclusions Microskin grafting has made progress in recent years. The orientation and even spread of micrografts are very important for good wound repair. The technique should be further improved. Chin J Surg 2001; 39: 708-710.

Objective To investigate the prevalence and features of active human cytomegalovirus (HCMV) infection in children with systemic lupus erythematosus (SLE) and evaluate the diagnostic value of the HCMV using antigenemia assay, serum polymerase chain reaction (PCR) and serology test. Methods Twenty-one SLE children undergoing immunosuppressive therapy were enrolled in this study. Immunofluorescence assay, PCR and serology tests were used to determine HCMV pp65 and p72 antigens in leukocytes, HCMV DNA in sera, and HCMV specific IgM and IgG antibodies, respectively. As a control group, twenty-one immunocompetent children with skeletal malformation were involved in this study. Statistical analysis was performed using Chi-square test or Fisher's exact test (Systat, USA), P values less than 0.05 were considered significant. Results Active HCMV infection was diagnosed in 28.6% (6/21) of SLE patients, with none in the control group; the difference between the two groups was significant (P = 0.027). Two out of 6 SLE patients developed active HCMV infection before immunosuppressive therapy and the remaining 4 patients developed SLE after immunosuppressive therapy. Among the 21 SLE children, HCMV pp65 antigenemia was detected in 5 patients, p72 antigenemia in 3 patients, serum HCMV DNA in 9 patients, serum HCMV-specific IgM in 2 patients, and IgG in 19 patients. The sensitivity and specificity for diagnosis of active HCMV infection were 83.3% and 100%, respectively for pp65 antigenemia; 50% and 100% for p72 antigenemia; 100%and 80% for serum PCR; 33.3% and 100% for HCMV IgM serology; 50% and 100% for HCMV IgG serology. Conclusions Compared with the control group, active HCMV infection is much more frequent in SLE children, and can occur before treatment with immunosuppressive agents, but most often occur after immunosuppressive therapy. In comparison with the other techniques used in this study, the pp65 antigenemia assay seems to be a better method for the early diagnosis and monitoring of active HCMV infection in children with SLE. Chin Med J 2001; 114(12):1309-1312

Objective To detect the patients with IgA nephropathy by glycobilolgy and immunological technique. Methods An helia aspera lectin-ELISA immunoassay was developed to discriminate the aberrantly glycosylated IgA in serum from normal IgA molecules by using HAA lectin, which reacts preferentially with the GaINAc of the terminal sugar chain, and AKP conjugated specific IgA antibody. Results The results given by A405 nm values from 156 controls, 22 patients with IgAN and 19 patients with uncertain IgAN were 0.22±0.10, 0.68±0.17 and 0.38± 0.15, respectively. The significance between the controls and the patients with IgAN was observed (P < 0.001). Conclusion This assay is sensitive, specific and valuable for the diagnosis of patients with IgA nephropathy. Chin J Lab Med 2001; 24: 288-289.

Objective To evaluate the efficacy of cyclosporin A (CSA) in the treatment of idiopathic membranous nephropathy (IMN), a prospective controlled clinical study was performed. Methods This study included a group of 30 IMN patients, among them 15 were treated with CSA and 15 with captopril (CAP). The diagnosis of IMN was made with exclusion of secondary forms of membranous nephropathy by extensive clinical and pathological studies. No patients received steroids or cytotoxic agents for six months prior to enrollment. In the CSA group, CSA was given at an initial dosage of 5 mg•kg-1 •d-1, gradually tailed off over the first three months and maintained at 2 mg•kg-1•d-1 for 12 months. In the CAP group, CAP was given at a dosage of 37.5 mg/day. Results In the first three months, 6 (6/15) complete remissions (CR) and 2 (2/15) partial remissions (PR) were observed in the CSA group while only 2 (2/15) PRs were observed in the CAP group. Before the end of the 15-months, 8 patients in the CSA group experienced CR and 4 patients experienced PR. One CR patient relapsed as the dosage of CSA was reduced, so 7 patients remained in CR at the end of the first 15-months. No additional CR or PR was observed in the CAP group during late follow-up. At the last visit (an average follow-up time of 44 months) in the CSA-group, another 2 CR patients had relapsed and 1 CR patient shifted to PR after stopping the CSA treatment, so 4 CR and 5 PR remained in the CSA group. In the CAP group, 3 spontaneous CRs occurred beyond 1.5 year's follow-up, with 3 CR and 2 PR at the last visit. No difference was found between the averages of the initial and the last serum creatinine levels in either group. No serious adverse effects were found during CSA treatment. Re-biopsy data of three patients responsive to CSA treatment showed that no pathological improvement of glomerular basement membrane was observed, even in cases at remission. Tubulointerstitial fibrosis was found in 1 relapsed CR patient, whose serum creatinine increased above the normal range, but not in the other 2 patients whose serum creatinine remained in the normal range. Conclusions CSA therapy at a dosage of 5 mg • kg-1 • d-1 is effective in inducing remission of nephrotic syndrome in adult IMN patients within three months, with a response rate of 80%. A relatively high rate of relapse (50%) was observed within 2 years after the withdrawal of CSA treatment. Chin Med J 2001; 114(12):1305-1308

Objective To construct a recombinant live attenuated Salmonella typhimurium vaccine strain expressing Helicobacter pylori urease subunit B (ureB). Methods ureB gene was amplified by PCR and cloned into a prokaryotic expression plasmid pTrc99a, and the identified recombinant plasmid was then used to transform an attenuated Salmonella typhimurium vaccine strain SL3261. The ureB expressed in the recombinant vaccine strain was analyzed by SDS-PAGE and optical density scanning. Two and 10 days after recombinant strain intragastric immmunization, the C57BL/6 mice were sacrificed, and the spleens and terminal ileums were cultured. Results The ureB gene could be amplified from the recombinant prokaryotic expression plasmid pTrc99A-ureB and the plasmids extracted from transformed SL3261 strain. SDS-PAGE and optical density scanning indicated that ureB was expressed in the recombinant vaccine strain SL3261 (pTrc99A-ureB) as a protein with 66 kD of molecular weight. Recombinant strain was found in both spleen an terminal ileum of each mouse two and ten days after intragastric immunization. Conclusions A recombinant liver attenuated Salmonella typhimurium vaccine strain expressing Helicobacter pylori ureB was constructed and identified, and this study will help to develop an oral recombinant live vaccine against Helicobacter pylori infection. Chin J Dig 2001; 21: 526-529.

Objective To study the effect of transforming growth factor-α (TGF-α) on early stage of embryo implantation. Methods Mouse blastocysts were cultured in vitro in medium containing various concentrations of TGF-α. Blastocyst implantation capacity was evaluated by calculating the percentage of embryos with attachment or outgrowth. Matrix metalloproteinases (MMPs) secretion of blastocysts was observed using gelatin zymography. Results There was no significant difference in the percentage of attachment between control and TGF-α treated groups, but the percentage of outgrowth of TGF-α treated groups was significantly higher than that of the control group after 24 h culturing. Gelatin zymography showed that blastocysts cultured in TGF-α treated groups started secreting MMPs earlier than those in the control group. Conclusion TGF-α is involved in regulating the mouse embryo implantation process by promoting blastocyst outgrowth and secreting matrix matalloproteinases. Chin Med J 2001; 114(12):1300-1304

Objective To summarize the experience in microsurgical treatment of multiple intracranial aneurysms. Method Eight patients with 17 aneurysms were analyzed retrospectively. Results Seven patients were followed up from 0.5 month to 10 years. According to Student's standard, the results in 5 patients were excellent and 2 good. One patients with bilateral PCom aneurysm died 1 week after operation. Conclusions Multiple intracranial aneurysms should be removed as soon as possible, especially bilateral ones. The best way is first to clip the bled aneurysm and then the contra lateral one by using coronal incision and bilateral pterional approach. The approach has the advantage of minimal invasion, good exposure, and less time-consuming. Chin J Surg 2001; 39: 667-668.

Objective The radiation sensitive gene rad 21 of Schizosaccharomyces pombe is involved in the repair of double-stranded breaks in DNA and is essential for mitotic growth. The hHR21sp gene is its human homologue. In an attempt to investigate the role of hHR21sp in DNA repair, we studied the effects of UV and γ-ray irradiation on hHR21sp gene expression in normal human peripheral blood cells, and non-iradiated peripheral and bone marrow cells from Fanconi anemia (FA) patients who have shown DNA repair deficiency. Methods Total steady state RNA was extracted from peripheral blood cells and bone marrow. RNA transcripts were quantified after RT-PCR and Southern blot, phosphoimmage and autoradiogram analysis. The results were compared with control groups. Results hHR21sp expression was significantly increased from 3 h to 9 h after UV irradiation in peripheral blood cells from normal subjects at doses of 40 - 80 j/m2 (P < 0.05). hHR21sp was also up-regulated by γ-ray irradiation at 6 h to 9 h at dose of 1 to 5 Gy (P < 0.01), which was more significant than the UV irradiation. In the non-irradiated FA patient group, hHR21sp expression was decreased in bone marrow hematopoietic cells (P < 0.05). After activation by PHA and IL-2, there was still a significant depression in expression by the FA patients peripheral blood cells compared with control groups (P < 0.05). Conclusion hHR21sp was up-regulated at doses and times irradiated at the range tested in normal peripheral blood cells, and is more affected by γ-ray irradiation than UV irradiation. FA patient bone marrow hematopoietic cells and peripheral blood mononuclear cells showed down-regulation of hHR21sp expression. The results imply that defects in DNA repair via hHR21sp expression may play an important role in the pathogenesis of FA syndrome. Chin Med J 2001; 114(12):1295-1299

Objective To determine whether low power density microwave radiation can induce irreversible changes in rabbit lens epithelial cells (LECs) and the mechanisms of the changes. Methods One eye of each rabbit was exposed to 5 mW/cm2 or 10 mW/cm2 power density microwaves for 3 hours, while the contralateral eye served as a control. Annexin V-propidium iodide (PI) two-color flow cytometry (FCM) was used to detect the early changes in rabbit lens epithelial cells after radiation. Results Lots of rabbit LECs were in the initial phase of apoptosis in the 5 mW/cm2 microwave radiation group. A large number of cells became secondary necrotic cells, and severe damage could be found in the group exposed to 10 mW/cm2 microwave radiation. Conclusion Low power densities of microwave radiation (5 mW/cm2 and 10 mW/cm2) can induce irreversible damage to rabbit LECs. This may be the non-thermal effect of microwave radiation. Chin Med J 2001; 114(12):1290-1294

Objective To evaluate the feasibility of contrast enhanced three-dimensional (3D) magnetic resonance angiography (MRA) in identifying the systemic blood supply in pulmonary sequestration. Methods Three patients who were suspected of pulmonary sequestration were examined by contrast enhanced 3D MRA. MR images were compared with surgical findings. Results Contrast enhanced 3D MRA clearly demonstrated systemic arteries from the descending thoracic aorta supplying the basilar segments of the lower lobe in each case. Pulmonary veins from these segments, which drained into the left atrium in two cases, were also detected. MRA images were consistent with those observed in surgery. Conclusion Contrast enhanced 3D MRA allows accurate diagnosis of pulmonary sequestration and may obviate the need for more invasive investigations. Chin Med J 2001; 114(12):1326-1328

Objective To evaluate the effectiveness of a community-based acquired immunologic deficiency syndrome (AIDS) educational intervention in young adults. Methods A quasi-experimental design was used. Two townships in Kunshan county, matched by socioeconomic characteristics, were randomly assigned to intervention or control group. Eight hundred young adults aged 18 - 30 were recruited from the two townships as study subjects. A 12-month comprehensive educational intervention on AIDS prevention was conducted in the intervention group through local family planning services. Results After intervention, subjects in intervention significantly improved their knowledge on AIDS and attitudes related to AIDS prevention. Reported rate of condom use during the last episode of sexual intercourse increased from 8.5% at baseline to 14.4% after intervention (χ2 = 4.66, P = 0.0308). No obvious change was observed among subjects in control group. Conclusion This study demonstrated the feasibility of integration of AIDS educational intervention into the existing family planning services. Integration of AIDS programs into family planning program should be considered as a realistic approach for AIDS control in China. Chin J Epidemiol 2001; 22: 326-329.

Objective To establish a rat model of chronic atrophic gastritis and explore the factors inducing atrophy. Methods In accordance with repeated orthogonal design of L8(27), 60% alcohol and 20 mmol/L sodium deoxycholate (served as factor A), 0.05%-0.1% ammonia water (factor B), 0.05% indomethacin (factor C) were given, alone or in combination, to rats in three experiments for 3 months, 6 months or 9 months respectively. Then the rats were dissected, and their pathologic changes of the gastric mucosa were assessed. Results Typical signs of chronic atrophic gastritis (CAG) were found in all rats which were treated with factor A, B, C alone or in combination for 6 or 9 months. No significant difference of pathologic changes of gastric mucosa was found between the rats treated for 6 months and those for 9 months. No obvious CAG signs were found in the rats treated with factor A, B, C for 3 months. Conclusion Sixty percent of alcohol, 20 mmol/L sodium deoxycholate, 0.05%-0.1% ammonia water and 0.05% indomethacin given to Sprague-Dawley rats for 6 months can successfully establish the animal model of CAG. Prolongation of the model-establishment time is not able to further facilitate the atrophy of gastric mucosa. Chin Med J 2001; 114(12):1323-1325

Objective To study the inhibitory effect of oxymatrine on hepatitis B virus (HBV) in vitro. Methods Microparticle enzyme immunoassay. bDNA signal amplification assay was used for determining secreted HBsAg/HBeAg in the culture medium, HBV DNA from core particles in the cytoplasm and MTT colorimetric assay was used to assay the oxymatrine cytotoxity. Results The inhibitory rates of HBsAg and HBeAg were 40.57% and 48.27% by oxymatrine at the concentration of 2000 μg/ml. At 100 - 2000 μg/ml, it can remarkably decrease the level of viral core associated-HBV DNA in the cytoplasm. No significant toxicity was shown in such concentrations. Conclusion Oxymatrine has a potential anti-HBV activity in vitro. Chin J Dig 2001; 21: 550-552.

Objective To understand the clinical significance of membrane receptors of interleukin-2 (CD25) in peripheral blood lymphocytes (PBL) of patients with gastric cancer. Methods CD25 percentages in PBL from 110 patients with gastric cancer and 100 normal individuals were examined by flow cytometry. Results were analyzed clinically and pathologically. Results Mean CD25% in PBL from normal individuals and patients with gastric cancer were 17.24±5.33 and 22.47 ± 6.82, respectively, and the difference was significant (P < 0.01). Abnormally elevated CD25% in PBL from patients with gastric cancer were correlated with tumor site, macropathology type, tumor size, differentiation degree and clinical stage. Conclusion Measuring CD25% in PBL from gastric cancer patients before surgery may provide a reference for diagnosis, immune treatment and judging prognosis. Chin Med J 2001; 114(12):1320-1322

Objective To evaluate the effect and feasibility of using estrogen cream for the prevention and treatment of recurrent urinary tract infection (UTI) in postmenopausal women. Methods Forty-five postmenopausal women with a history of recurrent UTI were divided into two groups (group premarin and group antibiotic). Participants were assigned to apply intravaginal premarin cream (group premarin, n = 30) or oral antibiotic (group antibiotic, n = 15) for 3 months respectively. Urine routine test, midstream urine and vaginal cultures, vaginal health score (VHS), vaginal cell maturation value (MV), endometrial thickness and blood estrogen level were obtained before and after the study. Results The incidence of UTI in the group premarin was significantly reduced as compared with that in the group antibiotic (2/27 vs 12/15, P < 0.001). In the group premarin Lactobacilli reappeared (from 0 to 59.3%) and MV (from 9.2 ± 6.8 to 74.6±14.1) and VHS (from 5.2 ±0.4 to 13.4±2.5) were improved after 3 months. There was no significant change in the group antibiotic. Conclusion It seems that intravaginal use of estrogen cream would effectively prevent and reduce the UTI in postmenopausal women. China J Obstet Gynecol 2001; 36: 531-533.

Objective To investigate the changes of β-adrenergic receptor (βAR) in peripheral lymphocytes and β2AR mRNA levels at different stages of bronchial asthma. Methods β2AR density and β2AR mRNA level in peripheral lymphocytes, cAMP and cGMP levels in blood plasma were estimated by radioligand binding assay, radioimmunoassay and RT-PCR. Results (1) Maximum bound volume (Bmax) and equilibrium dissociation constant (Kd) of β2AR of lymphocyte in asthma patients at remission stage were markedly higher than that in normal subjects, while cAMP levels in blood plasma showed no difference. Bmax of β2AR and cAMP levels in asthma patients at acute exacerbation stage were significantly lower than that in normal subjects, and Kds between these two groups were not much different. (2) Expression of β2ARmRNA in peripheral lymphocytes of asthmatics at remission stage was not significantly different compared with that in normals. Conclusions Amount and function of βAR and β2ARmRNA levels are related to asthmatic conditions. Changes of βAR and β2ARmRNA in asthma might rather be a pathological change accompanied by the course of the disease than a primary defect. Chin Med J 2001; 114(12):1317-1319