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关键词： 皮肌炎   间质性肺炎   疾病活动度   CALLY指数  

摘要： 背景:C反应蛋白–白蛋白–淋巴细胞(CALLY)指数在具有免疫过程的疾病中显示出良好的前景。然而,有关其在皮肌炎中的应用的研究还很有限。这项回顾性研究旨在评估CALLY对皮肌炎患者的间质性肺病和疾病活动度的预测价值。方法:我们收集了105位皮肌炎患者(45位患有间质性肺炎,60位无间质性肺炎)和102名健康对照者的临床数据。从电子医疗记录中提取临床特征,采用二元逻辑回归和ROC曲线分析CALLY、临床特征和疾病活动度之间的相关性。结果:皮肌炎患者的CALLY水平明显低于对照组(P Background: The C-reactive protein-albumin-lymphocyte (CALLY) index has demonstrated potential in assessing diseases with immunological processes. However, investigations into its applicability in dermatomyositis (DM) remain limited. This retrospective study aims to assess the predictive value of the CALLY index for interstitial lung disease and disease activity in patients with dermatomyositis. Methods: Data from 105 patients with DM (45 with interstitial lung disease [ILD], 60 without ILD) and 102 healthy controls were collected. Relevant clinical characteristics were extracted from medical records. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to examine correlations among CALLY, clinical characteristics, and disease activity. Results: Patients with DM demonstrated significantly lower CALLY values compared to controls (P < 0.001). Within the DM cohort, patients with ILD exhibited significantly lower CALLY values than those without ILD (P <0.05). CALLY showed a negative correlation with the global Visual Analogue Scale (VAS) score (r = −0.305, P = 0.002). ROC analysis determined the optimal CALLY cutoff value for predicting non-ILD in DM patients to be 8.41 (sensitivity 91.1%, specificity 40%, area under the ROC curve = 0.620). CALLY (P = 0.005) was identified as an independent predictor of DM without concurrent ILD. Conclusions: The CALLY index demonstrated a significant association with the absence of interstitial lung disease and reduced disease activity in patients with DM, indicating its potential utility in the assessment and monitoring of dermatomyositis.

关键词： amniocentesis   bulging membranes   cervical insufficiency   CRP   emergency cerclage   IL-6   physical examination-indicated cerclage   twin pregnancy  

摘要： Objectives: To assess the usefulness of first amniotic sac Interleukin-6 (IL-6) to rule out intra-amniotic inflammation (IAI), as well as maternal blood c-reactive protein (CRP), to select patients with a twin pregnancy who may benefit from an emergency cerclage. Materials and Methods: Retrospective, descriptive study among all patients with a twin pregnancy and mid-trimester bulging membranes admitted to a tertiary Hospital from January 2012 to September 2023. According to the Hospital’s Protocol, all patients received a vaginal and abdominal ultrasound, a maternal blood test, and an amniocentesis of the first sac to rule out IAI, defined by IL-6 ≥ 2.6 ng/dL. Results: A total of 28 patients with a twin pregnancy and mid-trimester bulging membranes were included. Among them, 18 patients (64.28%) had IL-6 levels ≥ 2.6 ng/dL. Cerclage was placed in 10 patients with IL-6 < 2.6 ng/dL. Perinatal mortality in pregnancies with IL-6 ≥ 2.6 ng/dL was 77.22%. The gestational age at delivery of patients with IL-6 < 2.6 ng/dL was 34 ± 3 weeks, compared to 23 ± 4 weeks when IL-6 was ≥2.6 ng/dL (p < 0.001). The latency to delivery with IL-6 < 2.6 ng/dL was 88.1 ±31.56 days, compared to 13.11 ± 20.43 days when IL-6 was ≥2.6 ng/dL (p < 0.001). Significant differences were found in maternal blood CRP levels in both study groups (no IAI 4.32 ± 3.67 vs. IAI 13.32 ± 15.07, p < 0.05). The area under the curve with an ROC curve was 0.799 (IC 95% 0.596–0.929), with a cut-off of 3.9 mg/L (S 94.4%, % E 62.5%). The gestational age at delivery with CRP < 3.9 mg/L was 33 ± 5 weeks, while in cases with CRP ≥ 3.9 mg/L, it was 24 ± 5 weeks (p < 0.001). The latency days to delivery were 86.5 ± 44.88 and 21.95 ± 30.97 days (p < 0.01), respectively. A positive correlation between the IL-6 values of both amniotic sacs was obtained, along with the Spearman coefficient correlation rank (rho = 0.835, p < 0.001). Conclusions: Compared to those with IAI, patients with a twin pregnancy and mid-trimester bul

关键词： 慢性阻塞性肺疾病急性加重期   肺部感染   细胞因子   肺功能  

摘要： 目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)并发肺部感染患者的临床特征。方法 比较130例AECOPD并发肺部感染患者(感染组)和130例无肺部感染的慢性阻塞性肺疾病患者(非感染组)的临床资料、血清细胞因子水平和肺功能。根据感染严重程度将感染组患者分为轻度感染组(41例)、中度感染组(51例)和重度感染组(38例),比较三组患者血清细胞因子水平和肺功能。结果 感染组使用呼吸机、合并糖尿病、长时间卧床患者比例以及血清IL-6、IL-8、TNF-α水平均高于非感染组(P<0.05),感染组第1秒用力呼气容积(FEV_(1))、每分钟最大通气量(MVV)和最大呼气中期流速(MMF)低于非感染组(P<0.05)。随着感染严重程度的增加,血清IL-6、IL-8和TNF-α水平升高,FEV_(1)、MVV和MMF降低(P<0.05)。结论 AECOPD并发肺部感染患者使用呼吸机、合并糖尿病和长时间卧床比较更高,且患者肺部感染越严重,血清细胞因子水平越高,肺功能越差。

关键词： 创伤性脑损伤   围术期   T淋巴细胞亚群   颅内感染   预后  

摘要： 目的:观察创伤性脑损伤患者围术期CD3^(+)、CD4^(+)及CD8^(+)T淋巴细胞亚群变化趋势,及对颅内感染预后的预测价值。方法:收集在我院接受手术治疗的开放性颅脑损伤患者72例,分别于术前(t_(0))、术后1d(t_(1))、术后7d(t_(2))检测其外周血中CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞亚群比例以及CD4^(+)/CD8^(+)比值,将患者按照昏迷程度分成轻中型组(44例)和重型组(28例),按照是否继发颅内感染分为感染组(11例)和未感染组(61例),按照1个月后结局分为预后良好组(46例)和预后不良组(26例),比较两组T淋巴细胞亚群变化趋势差异,并采用受试者工作特征曲线(ROC)分析各指标的临床价值。结果:患者整体CD4^(+)细胞比例及CD4^(+)/CD8^(+)随时间变化均呈先升高后降低趋势,其中重型组患者CD4^(+)/CD8^(+)升高趋势较轻中型组低(P<0.05);未感染组患者CD3^(+)细胞水平先升高后下降、CD8^(+)无显著变化,而感染组CD3^(+)、CD8^(+)细胞水平先降低后升高;预后良好组患者CD8^(+)细胞水平先升高后降低,而预后不良组先降低后升高。ROC曲线分析结果显示,t_(1)时的CD3^(+)、CD4^(+)及CD8^(+),t_(2)时的CD4^(+)、CD4^(+)/CD8^(+)对于患者颅内感染的预测价值较高,t_(0)时的CD4^(+)/CD8^(+)、t_(1)时的CD4^(+)、t_(2)时的CD4^(+)及CD4^(+)/CD8^(+)对于患者的预后预测价值较高。结论:创伤性脑损伤患者围术期T淋巴细胞亚群整体呈先下降后升高趋势,且对患者继发颅内感染及预后具有一定预测意义。

关键词： 肺炎支原体肺炎   微小核糖核酸-509-5p   微小核糖核酸-222-3p   T淋巴细胞亚群   相关性  

摘要： 目的 探究肺炎支原体肺炎患儿血清微小核糖核酸-509-5p(miR-509-5p)和微小核糖核酸-222-3p(miR-222-3p)表达水平与T淋巴细胞亚群的相关性。方法 取本院2023年2月至2024年2月收治的肺炎支原体肺炎患儿82例即为肺炎组,据其病情严重程度,分为轻度组(n=52)和重度组(n=30)。同期选择在本院体检健康的儿童82例为对照组。采用实时荧光定量PCR(qRT-PCR)对miR-509-5p和miR-222-3p水平进行检测。采用流式细胞术检测T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平。Pearson相关性分析肺炎支原体肺炎患儿血清miR-509-5p和miR-222-3p表达水平与T淋巴细胞亚群的关系。分析血清miR-509-5p和miR-222-3p水平在诊断重度肺炎支原体肺炎患儿的价值。结果 肺炎组血清中miR-509-5p水平显著低于对照组(t=10.964,P<0.001),miR-222-3p水平显著高于对照组(t=12.832,P<0.001)。与对照组相比,肺炎组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著降低(t=9.496、19.744、12.610、5.787,P<0.001)。Pearson相关性分析显示肺炎支原体肺炎患儿血清miR-509-5p水平与CD3^(+)(r_(P)=0.525,P<0.05)、CD4^(+)(r_(P)=0.623,P<0.05)、CD8^(+)(r_(P)=0.663,P<0.05)、CD4^(+)/CD8^(+)(r_(P)=0.741,P<0.05)水平呈正相关关系,miR-222-3p与CD3^(+)(r_(P)=-0.535,P<0.05)、CD4^(+)(r_(P)=-0.662,P<0.05)、CD8^(+)(r_(P)=-0.684,P<0.05)、CD4^(+)/CD8^(+)(r_(P)=-0.691,P<0.05)水平呈负相关关系。与轻度组相比,重度组患者血清中miR-509-5p水平显著降低(t=5.046,P<0.001),miR-222-3p水平显著升高(t=4.372,P<0.001)。ROC曲线结果显示,与miR-509-5p和miR-222-3p单独诊断相比,两者联合检测对重度肺炎支原体肺炎患儿诊断的AUC显著升高(ZmiR-509-5p~miR-509-5p+miR-222-3p=1.958,P=0.040;ZmiR-222-3p~miR-509-5p+miR-222-3p=1.878,P=0.042)。结论 肺炎支原体肺炎患儿血清miR-509-5p低表达,miR-222-3p高表达,二者与T淋巴细胞亚群有关,miR-509-5p和miR-222-3p检测对重度肺炎支原体肺炎患儿有一定的诊断价值。

关键词： 类风湿性关节炎   感染   病原菌分布   耐药   红细胞沉降率   肝素结合蛋白   肿瘤坏死因子-α  

摘要： 目的探讨老年类风湿性关节炎(RA)合并感染的病原菌及红细胞沉降率(ESR)、肝素结合蛋白(HBP)、肿瘤坏死因子-α(TNF-α)联合的诊断价值,为临床的诊疗提供指导。方法随机选取2020年10月—2023年10月中国人民解放军海军第九七一医院和青岛大学附属医院收治的82例老年RA合并感染患者为感染组,91例老年RA未合并感染患者为未感染组;统计感染患者感染部位、检出病原菌及其药敏结果,比较两组患者外周血ESR、HBP、TNF-α水平,采用受试者工作特征(ROC)曲线分析三指标对老年RA患者合并感染的诊断价值。结果老年RA合并感染部位主要为呼吸系统(34.15%)及泌尿系统(23.17%)。82例老年RA合并感染患者共培养出98株病原菌,主要为大肠埃希菌、金黄色葡萄球菌。大肠埃希菌对氨苄西林、头孢唑林、哌拉西林耐药严重,金黄色葡萄球菌对青霉素耐药严重。感染组ESR(35.92±9.87)mm/h、HBP(50.41±16.21)ng/ml、TNF-α(80.05±26.67)ng/L高于未感染组(P<0.05)。ESR、HBP、TNF-α联合诊断老年RA患者合并感染的曲线下面积(AUC)值为0.948,敏感度为91.46%,特异度为97.80%。结论老年RA合并感染患者以呼吸系统、泌尿系统感染为主,病原菌主要为大肠埃希菌、金黄色葡萄球菌,各病原菌耐药性有一定差异,ESR、HBP、TNF-α水平升高,三者联合诊断感染的价值较高。

关键词： ABH   2-(   S   )-amino-5-boronohexanic acid   ADMA   asymmetric dimethylarginine   Arg1   Arginase 1   Arg2   Arginase 2   CAD   coronary artery disease   CVD   cardiovascular disease   EC   endothelial cell   eNOS   endothelial nitric oxide synthase   GABR   global   l   -arginine bioavailability ratio   HSC   hepatic stellate cell   IL   interleukin   iNOS   inducible nitric oxide synthase   I/R   ischemia-reperfusion   ISPF   isonitrosopropiophenone   K   m   Michaelis constant   MAPK   mitogen-activated protein kinase   MDSC   myeloid-derived suppressor cell   MI   myocardial infarction   MS   mass spectrometry   NO   nitric oxide   nor-NOHA   N   ω   -hydroxy-nor-arginine   NOS   nitric oxide synthase   RBC   red blood cell   PMN   polymorphonuclear neutrophil   SCD   sickle cell disease   SLC25A29   solute carrier family 25 member 29   STAT   signal transducer and activator of transcription   T2DM   type 2 diabetes mellitus   TCR   T cell receptor   V   max   maximum reaction rate  

摘要： The enzyme arginase catalyzes the hydrolysis of L-arginine into L-ornithine and urea. The 2 existing isoforms Arg1 and Arg2 exhibit different cellular localizations and metabolic functions. Arginase activity is crucial for nitrogen detoxification in the urea cycle, synthesis of polyamines, and control of L-arginine bioavailability and nitric oxide (NO) production. Despite significant progress in the understanding of the biochemistry and function of arginases, several open questions remain. Recent studies have revealed that the regulation and function of Arg1 and Arg2 are cell type–specific, species-specific, and profoundly different in mice and humans. The main differences are in the distribution and function of Arg1 and Arg2 in immune and erythroid cells. Contrary to what was previously thought, Arg1 activity appears to be only partially related to vascular NO signaling under homeostatic conditions in the vascular wall, but its expression is increased under disease conditions and may be targeted by treatment with arginase inhibitors. Arg2 appears to be mainly a catabolic enzyme involved in the synthesis of L-ornithine, polyamine, and L-proline but may play a putative role in blood pressure control, at least in mice. The immunosuppressive role of arginase-mediated arginine depletion is a promising target for cancer treatment. This review critically revises and discusses the biochemistry, pharmacology, and in vivo function of arginases, focusing on the insights gained from the analysis of cell-specific Arg1 and Arg2 knockout mice and human studies using arginase inhibitors or pegylated recombinant arginase. Significance Statement: Further basic and translational research is needed to deepen our understanding of the regulation of Arg1 and Arg2 in different cell types in consideration of their localization, species-specificity, and multiple biochemical and physiological roles. This will lead to better pharmacological strategies to target arginase activity in liver, car

关键词： 食管癌   新辅助化疗   信迪利单抗   临床疗效   T淋巴细胞  

摘要： 目的分析实施术前新辅助化疗联合免疫疗法对接受胸腔镜手术的食管癌患者的影响。方法根据相关标准纳入浚县人民医院2022年9月13日至2024年5月28日间收治的120例食管癌胸腔镜手术患者,根据患者术前接受的治疗方案分为对照组和研究组,其中64例对照组患者实施新辅助化疗,56例研究组患者实施新辅助化疗联合免疫治疗,两组患者均治疗2个疗程后评估临床疗效,同时对比患者治疗前后肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)和鳞状细胞癌抗原(SCC-Ag),以及T淋巴细胞亚群CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞和CD8^(+)T淋巴细胞的水平差异,对比两组患者治疗期间化疗不良反应的发生率差异。结果研究组患者的客观缓解率(48.21%)以及疾病控制率(92.86%)均明显高于对照组(29.69%,79.69%),差异均有统计学意义(P<0.05)。治疗前,两组患者肿瘤标志物CEA、SCC-Ag和CYFRA21-1的表达水平比较,差异无统计学意义(P>0.05);治疗后两组患者CEA、SCC-Ag和CYFRA21-1表达水平均低于治疗前,且研究组低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者各T淋巴细胞亚群分布水平比较,差异无统计学意义(P>0.05)。治疗后,两组患者CD3^(+)和CD4^(+)水平均低于治疗前,但研究组高于对照组,差异均有统计学意义(P<0.05);治疗后,对照组CD8^(+)水平低于治疗前,研究组CD8^(+)水平高于治疗前,且研究组CD8^(+)T水平高于对照组,差异有统计学意义(P<0.05)。在两组患者治疗期间,两组患者出现最高和最低的不良反应均分别为“血液和淋巴系统异常”和“甲状腺功能异常”,其中研究组患者“血液和淋巴系统异常”的发生率为23.21%,显著低于对照组(45.31%),差异具有统计学意义(P<0.05);其余不良反应发生率对比差异无统计学意义(P>0.05)。结论在接受胸腔镜手术的食管癌患者术前开展新辅助化疗联合免疫疗法临床效果较好,不仅有助于控制疾病进展,还有助于缓解化疗对患者免疫水平的不利影响,应用安全性较好。

关键词： 红细胞增多症,真性   原发性血小板增多症   TET2突变基因   细胞因子  

摘要： 目的探讨TET甲基胞嘧啶双加氧酶2(TET2)基因突变对JAK2^(V617F)+骨髓增殖性肿瘤(MPN)患者发生继发性骨髓纤维化(SMF)的影响。方法回顾性收集天津医科大学第二医院血液科完成二代测序检测的JAK2^(V617F)突变的MPN患者,选取TET2基因突变的JAK2^(V617F)+MPN患者为突变组,年龄、性别相匹配的TET2基因未突变的JAK2^(V617F)+MPN患者为未突变组,随访至2022年11月11日,比较两组患者死亡率和SMF的差异。用二代测序技术检测血液系统肿瘤性疾病的325个突变基因,以确定两组突变基因的差异;酶联免疫吸附试验(ELISA)检测并比较2组患者骨髓上清转化生长因子(TGF)-β1、白细胞介素(IL)-17、干扰素(IFN)-γ等细胞因子水平的差异。采用多因素Cox回归模型分析JAK2^(V617F)+MPN患者发生SMF的影响因素。结果共纳入96例患者,突变组32例,男16例,女16例,年龄[M(Q1,Q3)]为61(53,70)岁;非突变组64例,男32例,女32例,年龄58(51,68)岁。共随访61(43,116)个月,突变组死亡率[15.6%(5/32)比1.6%(1/64),P=0.007]和SMF的比例[43.8%(14/32)比14.1%(9/64),P=0.001]均高于非突变组。突变组FAT1[25.0%(8/32)比7.8%(5/64),P=0.028]、U2AF1[15.6%(5/32)比0,P=0.003]、KMT2D[15.6%(5/32)比3.1%(2/64),P=0.039]基因突变的比例均高于非突变组。突变组TGF-β1[13837(8298,17509)比7915(3586,10545)ng/L,P=0.016]、IL-17[7.4(6.3,7.5)比6.1(5.9,7.1)ng/L,P=0.007]、IFN-γ[8.5(8.1,9.1)比8.0(7.5,8.3)ng/L,P=0.007]水平均高于非突变组。多因素Cox回归模型分析结果显示:TET2突变(HR=8.483,95%CI:1.278~56.330)是JAK2^(V617F)+MPN患者发生SMF的危险因素。结论TET2突变是影响JAK2^(V617F)+MPN患者发生SMF的危险因素。