目的 分析早、中期肝细胞癌（HCC）切除术后早期（≤2年）复发的危险因素并探讨术前系统免疫炎症指数（SII）对早、中期HCC术后早期复发的预测价值。方法 回顾性研究2017年10月—2020年10月于我院接受肝癌根治性切除术的238例早中期HCC患者,收集基线资料,通过1∶1倾向性评分匹配（PSM）均衡组间协变量获取早期复发组及未复发组各69例;单因素和多因素Logistic回归分析影响术后早期HCC复发的相关因素,构建列线图模型,临床决策曲线（DCA）评估列线图预测模型在临床的应用效果;受试者操作特征（ROC）曲线评价预测效能,根据最高约登指数确定截断点。结果 单因素及多因素Logistic回归分析结果均提示微血管侵犯（MVI）及术前系统免疫炎症指数（SII）高水平是术后早期复发的独立危险因素;列线图模型有较好的预测效能;ROC曲线计算出SII最佳临界值为696.85×10⁹／L。结论 术前高水平SII可能对预测HCC患者术后早期复发具有潜在价值。

严重烧伤后患者免疫功能的失调,易导致创面感染、全身炎症反应综合征、脓毒症、感染性休克等并发症,增加患者病死率。免疫细胞功能适度的活化将有助于烧伤患者抵御外界病原体的侵袭、促进创面的愈合,但功能过度激活或者功能低下,则会引发一系列严重的后果。本文旨在归纳严重烧伤后中性粒细胞、单核/巨噬细胞、肥大细胞、NK细胞及T淋巴细胞等免疫细胞的功能变化与炎症反应之间的关系,为完善烧伤患者诊疗、减少并发症、改善预后提供新的思路。

The imbalance of immune function in severely burned patients can easily lead to wound infection,systemic inflammatory response syndrome,sepsis,septic shock and other complications,which increase the mortality of patients. Moderate activation of immune cell function will help burned patients to resist the invasion of external pathogens and promote wound healing,but excessive activation or low function can lead to a series of serious consequences. The purpose of this paper is to summarize the relationship between the functional changes of immune cells such as neutrophils,monocytes/macrophages,mast cells,NK cells,T lymphocytes and inflammatory reaction after severe burns,and to provide new ideas for improving the diagnosis and treatment of burned patients,reducing complications and improving the prognosis.

目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 探索两种常用免疫学指标—结核菌素试验(purified protein derivative skin test, PPD皮试)与结核分枝杆菌γ-干扰素释放试验(tuberculosis-interferon gamma release assay,TB-IGRA)对结核病的辅助诊断价值。方法 收集2017年1月—2021年1月于我中心门诊部就诊的疑似结核病患者资料,共171例,所有病例均行PPD皮试和外周血TB-IGRA。将病例分为结核病组(TB组)和非结核病组(非TB组)。TB组共98例,非TB组共73例。比较两组病例PPD皮试、TB-IGRA对结核病诊断的准确度、敏感度、特异度。结果 TB-IGRA对结核病诊断的准确度、敏感度和特异度分别为94.2%、93.9%和90.4%,PPD皮试对结核病诊断的准确度、敏感度和特异度分别为77.2%、84.7%和76.7%。TB-IGRA的准确度和特异度与PPD皮试比较差异有统计学意义(分别为χ²=20.034,P<0.05和χ²=5.176,P<0.05);TB-IGRA的敏感度高于PPD皮试,但两者比较差异无统计学意义(χ²=0.948,P>0.05)。2组间TB-IGRA结果、PPD皮试结果比较差异均具有统计学意义(分别为χ²=132.77,P<0.01和χ²=47.963 5,P<0.01)。结论 TB-IGRA和PPD皮试均具有良好的结核病辅助诊断价值;TB-IGRA的引进大大提高了诊断试验的准确度和特异度,但仍需要进一步探索其诊断标准以更好地为临床使用。

Objective To explore the auxiliary diagnosis value of two commonly used immunological indicators for tuberculosis, purified protein derivative skin test (PPD test) and tuberculosis-interferon gamma release assay (TB-IGRA). Methods A total of 171 cases of suspected tuberculosis patients who were treated in the outpatient department of our center from January 2017 to January 2021 were collected. All cases underwent PPD test and peripheral blood TB-IGRA. The cases were divided into tuberculosis groups (TB group) and non-tuberculosis group (non-TB group). There were 98 cases in the TB group and 73 cases in the non-TB group. The accuracy, sensitivity, and specificity of PPD test and TB-IGRA for tuberculosis diagnosis were compared between the two groups. Results The accuracy, sensitivity, and specificity of TB-IGRA for tuberculosis diagnosis were 94.2%, 93.9% and 90.4% respectively, which of PPD test for tuberculosis diagnosis were 77.2%, 84.7% and 76.7% respectively. The accuracy and specificity of TB-IGRA were statistically different from those of PPD test (χ²=20.034,P<0.05 and χ²=5.176,P<0.05, respectively). The sensitivity of TB-IGRA was higher than that of PPD test, but the difference was not statistically significant (χ²=0.948,P>0.05). The differences of TB-IGRA and PPD test results between the two groups were statistically significant (χ²=132.77,P<0.01 and χ²=47.9635,P<0.01). Conclusion Both TB-IGRA and PPD test had good auxiliary diagnostic value for tuberculosis; the introduction of TB-IGRA had greatly improved the accuracy and specificity of the diagnostic test, but it is still necessary to further explore its diagnostic criteria to better serve the clinical use.

目的 使用金标免疫层析法检测儿童腹泻粪便标本,将其轮状病毒的结果进行分析汇总。方法 选取本院2020年1月—2021年1月收治的86例儿童腹泻者,根据金标免疫层析法的检测方式,将检测结果为阳性者的轮状病毒粪便标本进行回顾性分析。将86例阳性者的轮状病毒粪便标本送往我市疾控中心,采用逆转录-聚合酶链式反应(RT-PCR)进行检测,分析对比检测情况。结果 86例儿童腹泻感染经金标免疫检测为阳性者80例,阳性率为93.02%,同时将86例粪便标本送往本市疾控中心采用RT-PCR检测验证70例阳性,轮状病毒阳性率为81.39%,两种检测方法相比,金标免疫检测结果其准确度更高;80例阳性者中,1岁以下的婴幼儿为31例,占38.75%,较为多见,其次为1岁、2岁的儿童,各占23.75%、25.00%。季节性以秋季和冬季为轮状病毒的高发期,11-12月份36例,占45.00%,1-2月、9-10月18例、16例,占22.50%、20.00%;男女性别比中2组阳性率比较,经统计学分析无明显差异性(χ²=2.500,P＞0.05)。结论 轮状病毒多以5岁以下的婴幼儿为主,秋冬季节较为常见,采取金标免疫层析法的检测方式,来检测儿童的粪便标本,其操作简单,可快速准确地检测出轮状病毒,且该方法具有一定的临床诊断价值,值得推广应用。

目的 探讨华南地区自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)临床特点,提高对该病的认识。方法 回顾性总结2010年1月—2020年1月期间收治的居住在华南地区AIH-PBC OS患者37 例,对患者的临床表现、血清学、影像学和病理学特点,伴发肝外自身免疫性疾病等情况进行分析。结果 37例AIH-PBC OS以女性(94.6%)为主,平均发病年龄(48.3±10.3)岁,确诊年龄(50.4±9.2)岁,病程(2.7±2.5)年。83.8%患者存在临床症状,以乏力纳差,身目黄染、尿黄及瘙痒最为常见。在所有患者中,诊断为慢性肝炎为45.9%,代偿性肝硬化为18.9%,失代偿性肝硬化为35.1%,合并肝外自身免疫性疾病占35.1%,以自身免疫性甲状腺疾病和干燥综合征最常见。血清谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、碱性磷酸酶、总胆红素、总胆固醇、低密度脂蛋白胆固醇水平均升高,失代偿肝硬化期患者血红蛋白和白蛋白下降(P<0.05)。近一半患者血清免疫球蛋白G、免疫球蛋白M和免疫球蛋白A水平升高,失代偿肝硬化期患者免疫球蛋白G升高最为明显(P<0.05)。自身抗体包括抗核抗体阳性率、抗线粒体抗体和(或)抗线粒体抗体M2型抗体阳性率、抗平滑肌抗体阳性率、抗核点蛋白抗体阳性率、抗核包膜蛋白抗体阳性率分别为92%、67.6%、10.8%、11.1%、13.8%。病理学提示AIH-PBC OS患者可见汇管区淋巴细胞和浆细胞浸润,肝小叶界面炎,并伴有不同程度小胆管病变,70.2%同时伴有AIH-PBC特征。肝脏影像学显示在所有患者中,29.7%存在肝硬化,18.9%存在门静脉高压,62.2%存在脾大,18.9%存在腹腔积液。结论 AIH-PBC OS同时具有AIH及PBC疾病的临床特点,病情较复杂、发病较隐蔽;同时伴有血脂代谢障碍,且容易并发肝外自身免疫性疾病。

目的 探讨丙酸睾酮注射液联合乌司他丁对脓毒症患者免疫失衡的调节作用。方法 选取我院2019年10月—2020年1月收治的88例脓毒症患者,随机分成观察组和对照组各44例,对照组采用乌司他丁配合常规治疗,观察组在此基础上联合丙酸睾酮注射液对患者治疗,比较治疗1周2组临床疗效差异,观察治疗前及治疗1周,2组炎症因子水平[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-1β(IL-1β)]、睾酮(T)、白蛋白(Alb)水平及疾病危重程度(APACHEⅡ评分)、器官衰竭程度(SOFA评分)变化,分析治疗1周内2组患者药物不良反应发生情况差异。结果 治疗1周,观察组总有效率高于对照组(P＜0.05);2组患者IL-6、IL-1β水平及APACHEⅡ、SOFA评分均降低,且观察组较对照组更低(P＜0.05);2组患者IL-10、T、Alb水平均升高,且观察组较对照组更高(P＜0.05);2组药物不良反应总发生率比较无统计学意义(P>0.05)。结论 丙酸睾酮注射液联合乌司他丁治疗脓毒症可取得良好临床疗效,可有效改善病情及预后,对患者免疫失衡调节有积极意义。

Objective To investigate the regulatory effect of testosterone propionate injection combined with ulinastatin on immune imbalance in patients with sepsis.Methods A total of 88 patients with sepsis treated in our hospital from October 2019 to January 2020 were randomly divided into observation group and control group,with 44 cases each.The control group was treated with ulinastatin combined with routine treatment,while the observation group was treated with testosterone propionate injection additionally.The clinical efficacy difference between the two groups were compared after treating 1 week.The levels of inflammatory factors [interleukin-6 (IL-6),interleukin-10 (IL-10),interleukin-1 β (IL-1β)],testosterone (T),albumin (Alb),the severity of disease (APACHE II score) and the degree of organ failure (SOFA score) in the two groups were observed before and 1 week after treatment.The differences of adverse drug reactions between the two groups within 1 week of treatment were analyzed.Results The total effective rate of the observation group was higher than that of the control group (P＜0.05).IL-6 and IL-1β levels and APACHE II and SOFA scores decreased after treatment,while those of the observation group were lower than the control group (P＜0.05).The levels of IL-10,T and Alb in the two groups were increased,while those in the observation group were higher than the control group (P ＜ 0.05); the total incidence of adverse drug reactions in the two groups was not statistically significant (P>0.05).Conclusions Testosterone propionate injection combined with ulinastatin had good clinical efficacy in the treatment of sepsis,effectively improved the condition and prognosis,and had positive significance in the regulation of immune imbalance.

目的 观察免疫球蛋白联合甲泼尼龙疗法对自身免疫性脑炎患者T淋巴细胞亚群、免疫球蛋白、白介素-6(IL-6)和CXC趋化因子13(CXC13)水平影响。方法 选取2017年1月—2020年3月本院收治的60例自身免疫性脑炎患者,采用随机数字表法分为观察组30例与对照组30例。对照组给予甲泼尼龙疗法,观察组在对照组结合免疫球蛋白治疗。两组均以4周后评价。比较两组疗效,治疗前后T淋巴细胞亚群、免疫球蛋白、IL-6、CXC13及简易智能精神状态检查量表(MMSE)变化。结果 观察组总有效率(83.33%)高于对照组(60.00%)(P<0.05)。观察组治疗后CD⁺₃、CD⁺₄和CD⁺₄/CD⁺₈高于对照组(P<0.05)。观察组治疗后血清IgA、IgG和IgM水平低于对照组(P<0.05)。观察组治疗后血清IL-6和CXC13水平低于对照组(P<0.05)。观察组治疗后MMSE评分高于对照组(P<0.05)。结论 免疫球蛋白联合甲泼尼龙疗法对自身免疫性脑炎患者疗效良好,且可增强机体细胞和体液免疫功能,降低IL-6和CXC13水平。

Objective To observe the effect of immunoglobulin combined with methylprednisolone on T lymphocyte subsets, immunoglobulin, interleukin-6 (IL-6) and CXC chemokine 13 (CXC13) in patients with autoimmune encephalitis. Methods 60 patients with autoimmune encephalitis admitted to our hospital from January 2017 to March 2020 were divided into 30 cases of observation group and 30 cases of control group. The control group was treated with methylprednisolone, and observation group was treated with immunoglobulin compared with the control group. The course of treatment in both groups was 4 weeks. The effects of the two groups were compared. The changes of T lymphocyte subsets, immunoglobulin, IL-6, CXC13 and MMSE before and after treatment were compared. Results Total effective rate (83.33%) of the observation group was higher than that of control group (60.00%) (P<0.05). After treatment, in the observation group, CD⁺₃, CD⁺₄ and CD⁺₄/CD⁺₈ were higher than that of control group (P<0.05); levels of serum IgA, IgG and IgM were lower than that of control group (P<0.05); serum levels of IL-6 and CXC13 were lower than that of control group (P<0.05); MMSE score was higher than that of control group (P<0.05). Conclusion Immunoglobulin combined with methylprednisolone is effective in the treatment of autoimmune encephalitis. It may enhance the cellular and humoral immune function, and reduce the levels of IL-6 and CXC13.

目的 通过对43种融合基因在儿童白血病中的结果分析,探讨融合基因阳性的儿童急性B淋巴细胞白血病(acute B-lymphoblastic leukemia,B-ALL)的免疫表型特征。方法 应用实时荧光探针PCR法对2016年10月—2018年12月在深圳市儿童医院就诊的初发或复发B-ALL患儿进行融合基因检测,采用多参数流式细胞术(flow cytometry,FCM)对B-ALL患者进行免疫表型检测。结果 120例B-ALL患儿融合基因筛选总阳性率为37.5%(45/127),包括TEL/AML1 27例、E2 A/PBX1 7例、BCR/ABL1 6例、MLL 4例、TLS/ERG 1例;不同年龄段白血病融合基因阳性率差异有统计学意义(P<0.01),性别分布差异无统计学意义(P>0.05)。各融合基因阳性组CD19阳性率为100%,TEL/AML1阳性表达患者普通-B-ALL表型占比最高(77.8%),干/祖细胞抗原CD34的阳性率为81.5%;E2 A/PBX1阳性表达患者以前-B-ALL表型为主,不表达已知的T系及髓系抗原;各融合基因阳性组及阴性组患儿髓系抗原阳性率比较差异有统计学意义(P<0.01),以BCR/ABL1基因表达组阳性率最高(100%)。结论 5种融合基因在患者年龄构成及免疫表型中具有一定的分布特点;B-ALL特征性免疫表型的改变可用于融合基因表达的预测,提高融合基因结果判读的准确率。

Objective To investigate the immunophenotype features of children with acute B-lymphoblastic leukemia(B-ALL) combined with fusion gene expressing after to analyze the results of the 43 fusion genes. Methods Real-time fluorescent probe PCR assay was used for the detection of fusion genes in 120 cases of children from Shenzhen Children's Hospital with B-ALL newly or recurrently diagnosed from Oct 2016 to Dec 2018. Multi-parameter flow cytometry(FCM) was used for the detection of the immunophenotype in children with B-ALL. Results Of all the 120 cases, the fusion genes were detected at positive rate of 37.5%(45/120), included TEL/AML1 27 cases, E2 A/PBX1 7 cases, BCR/ABL1 6 cases, MLL 4 cases, TLS/ERG 1 cases. The positive rate of leukemia fusion gene had statistically difference among fusion genes positive groups based on age(P<0.01). There was no statistically difference in the gender distribution(P>0.05). The expressing of CD19 was at positive rate of 100% in all of the groups. The rate of the common-B-ALL was the highest B-ALL subtype in the TEL/AML1 positive groups(77.8%). The stem /progenitor associated antigen CD34 was at positive rate of 81.5%. The pre-B-ALL was the main subtype in the E2 A/PBX1 group, which was no expression of the known T-ALL associated antigen MyAg antigen. There was statistically difference in the positive rate of MyAg expression among all of the groups(P<0.01), with the highest rate in the BCR/ABL1 group(100%). Conclusion There were certain distribution features in age composition and immunophenotype of children with B-ALL carrying five kinds of common fusion genes. The characteristic changes of the immunophenotype of B-ALL may be used to predict the expression of fusion genes and improve the accuracy of fusion genes by the supplementary role of immunophenotype analysis.

目的 探讨腹腔镜手术与传统开腹手术对右半结肠癌患者免疫功能指标及临床疗效的影响。方法 选取80例右半结肠癌患者,随机分成两组,各40例分别行腹腔镜手术及传统开腹手术,分别比较两组患者手术前后免疫功能指标及相关临床疗效的差异。结果 腹腔镜组及开腹组术后免疫指标CD3⁺、CD4⁺、CD8⁺均出现不同程度下降,但腹腔镜组免疫指标CD3⁺、CD4⁺均优于开腹组(P＜0.05);腹腔镜组术中出血量、术后胃肠排气功能恢复时间、住院时间均优于开腹组(P＜0.05);两组手术时间及淋巴结清扫个数方面无显著差异(P＞0.05)。结论 腹腔镜手术治疗右半结肠癌不仅对患者免疫功能损害较低,还较开腹术具有术中出血量少、术后恢复快等优点,值得临床推广。