Volume 90  ·   Issue 04  ·  2010

percutaneous nephrolithotomy (PCNL), as one of the surgical methods for the treatment of kidney stones, has the advantages of less trauma, quicker recovery and higher rate of stone removal compared with traditional open surgery. It has been more and more accepted and applied by urologists, and has become the most commonly used surgical method for the treatment of kidney stones.

General practice is a new type of medical discipline, which takes people as the center, maintains and promotes health as the goal, and provides continuous, comprehensive and convenient basic health services to individuals, families and communities. In the past 40 years, general practice has made long-term development in the world, and general practitioners have become the main force of community health service and rural health service. General practice medical service and specialty medical service perform their respective duties and develop in coordination, and gradually become an international recognized ideal model of primary health care service. 60% to 70% of the total physicians in advanced countries in the world are general practitioners.

Objective To compare the efficacy of minimally invasive percutaneous nephrolithotomy (PCNL),ureteroscopes supple of lens of lithotrity(URSf),ureter forcedly of lens of lithotrity (URSnf),laparoscopic ureterolithotomy and retroperitoneal laparoscopic ureterolithotomy and to explore the best methods and indications for treating the complex upper urinary tract calculi.Methods The distribution of cases was as follows:URSnf(n=869),URSf(n=56),MPCNL(n=57),laparoscopic ureterolithotomy (n=9)and retroperitoneal laparoscopic ureterolithotomy(n=80).Results A Successful outcome was obtained in URSnf(n=856),URSf(n=51),MPCNL(n=46),Iaparoscopie ureterolithotomy(n=9) and retroperitoneal laparoscopic ureterolithotomy (n=75).And the Success rate was 98.50%,91.07%,80.70%,100%and 93.75% respectively.Five cases (0.47%) failed and there were not severe complication in all surgery groups.Conclusion If a good indication of each approach is mastered,5 minimally invasive are relatively safe and highly effective for most patients with complex upper urinary tract calculi.

Objective To determine the hemodynamic status,fluid-electrolyte changes and complications associated with irrigation time in percutaneons nephrolithotripsy.Methods A total of 68 renal calculi patients (31 males and 37 females) were recruited.The lateral recumbent percutaneous nephrolithotripsy was operated with Ho laser under ultrasonic guidance.0.9% NaCl was used as perfusion fluid.The following items were recorded:mean arterial blood pressure(MAP),heart rate,central venous pressure (CVP),hemoglobin,sodium,potassium and chloride;perfusion time during operation;peri-operative and post-operative complications.Results (1) Peri-operative and post-operative conditions:the average operative time was 83.1±22.21 minutes.Two cases stopped because of bleeding after puncture and the tube of stoma war placed for stone clearance of the second time.There was more bleeding in 11 patients,but the operations were continued with blood transfusion and close monitoring.Two operations ceased because of a premonition of congestive heart failure.Nine patients needed post-operative blood transfusion and 18 had a post-operative fever.One patient bled in and around the tube and had a peri-renal infection a week later. (2) Changes of observation parameters:there was no significant difference in CVP,heart rate,hemoglobin,sodium,potassium and chloride(P>0.05).The post-perfusion value of MAP increased(P<0.05) especially in the cases of more bleeding and long time of irrigation.Peri-operative and post-operative injection of furosemide could reduce the CVP value.The average irrigation time in the fever group was longer than the non-fever group(P<0.05) and the CVP value of the fever group was higher than the non-fever group (P<0.05).Conclusion Low pressure and short time of perfusion are safe in clinical practice.Congestive heart failure after the perfusion and the occurrence of post-operative infections are difficult to avoid when there are a long time of irrigation and more bleeding during operation.

Objective To evaluate the correlation between stone culture and SIRS,ascertain the clinical implication of stone culture in PCNL. Methods Clinical data of 66 patients who underwent PCNL in our department were analyzed retrospectively.Eight risk factors including stone culture+drug sensitivity,urine culture+drug sensitivity,age,gender,prophylactic antibiotics,stone volume,operative time and the number of tract. Multiple statistics methods were used for analysis to evaluate the impact of SIRS,and compare the difference between stone culture and urine culture.Results Univariate analysis and Multivariate logistic regression model showed that positive stone culture was the risk factor of SIRS (P<0.05).Positive stone culture was found in 48.48% patients,which was higher than that of urine culture (30.30%).Fourteen patients(66.67%) of 21 postoperative SIRS patients were prescribed antibiotics according to the stone culture rosult. And all of them recovered unevently without developing septic shock or MODS.Conclusions Positive stone culture is the important risk factor of post-PCNL SIRS.Stone culture is better than urine culture in directing postoperative antibiotics prescribsion and should be routinely used.

Objective To study the clinical diagnosis and treatment of sarcomatoid renal cell carcinom, and to analyze the connection of prognosis with therapy. Methods 10 cases with sarcomatoid renal cell carcinom from 1997-2007 in our hospital were analyzed,and the related literatures were reviewed. Results All patients were performed with operation, and pathologically diagnosed as sarcomatoid renal cell carcinoma. Cases with metastasis were performed with chemical therapy , biological therapy or radiotherapy after operation. Clinical stage (TNM) of 10 cases is T1N0M0 1 case, T2N0M0 3 cases,T3N0M0 lcase, T4N0M0 lease,T2N0M1 3 cases,T4N0M1 lease. 60% (6/10) of patients were diagnosed with metastasis or diffusion. In these 6 cases, 4 cases were diagnosed with pulmonary metastasis, 1 with brain metastasis, and 1 with osseous metastasis, and 1 with inferior vena cava tumor thrombus. The average life span of all 10 cases was 17 months, and cases with advanced stage was 8 monthes. Otherwise, the average survival time of cases with earlier stage was 30 monthes, and it was 21 monthes from diagonosis to metastasis. Conclusion Sarcomatoid renal cell carcinom is a special type of renal cell carcinom with features of high malignant and rapid progress. It is clinical rare and with bad prognosis. Operation is the first choice for the therapy, the effect of radiaotherapy or chemical therapy is not obviously. The lung is main position for metastasis. Early diagnosis and treatment are effective to prolong the life span of patients, and the new therapy may be more important.

Objective To observe the influence of the plasma thromboxane B2(TXB2) , 6-keto-PGFla, CD62P and PAC-1 and Thrombus in patients with primary thrombocytosis ( ET). To observe the effect of sodium ozagrel to prevent and treat thrombosis in patients with ET. Methods The subjects including 48 patients with ET. All patients were measured the plasma TXB2, 6-keto-PGF1α, CD62P and PAC-1 before and after treatment with or without sodium ozagrel. Results The plasma levels of CD62P, PAC-1, TXB2, 6-keto-PGF1α and TXA2/PGI2 in the patients with ET were significantly higher than the normal people ( P < 0.01 ) . The levels of CD62P, PAC-1, TXB2, TXB2/6-keto-PGF1α in patients with treatment of sodium ozagrel were higher than patients without treatment of sodium ozagrel ( P < 0. 01 ) . The plasma levels of CD62P, PAC-1 and TXA2/PG12 in patients with treatment of sodium ozagrel and that in normal people had no significant distinction ( P < 0. 01 ). All the index of conventional therapy group were higher than normal people(P<0. 01 ) but had no significant distinction with the patients before conventional treating. The incidence of thrombus in patients treated with sodium ozagrel was lower than patients treated without sodium ozagrel(P < 0.05). Conclusion With the treatment of sodium ozagrel in patients with ET, the CD62P, PAC-1, TXB2 and TXA2/PGI2 of plasma could be decreased. And the incidence of thrombus was decreased.

Objective To compare the clinical traits in comorbidity between depression and neurological disorder with depressive disorder and explore the characteristic of the outpatients with neurological disorder comobidity in depression. Methods According to Diagnosis and Statistic Manual for Mental Disorder-IV (DSM-IV) criteria, outpatients were diagnosed as depressive disorder at Departments of Neurology and Psychology. We used HAMD-17 scale to evaluate the patient's severity. Results There was no statistical difference in severity of depression in two groups. But the clinical traits showed significant differences between two outpatient groups: the outpatients with neurological disorder comobidity in depression were elder, had more somatic disorders and a higher retard symptom factor score while the other are relative younger, have less physical disorders and higher the core symptom factor score on the other hand. Conclusion The patients of comobidity between depression and neurological disorders have unique clinical traits. Thus it will be helpful to improve the identification of diagnosis and choose an appropriate treatment if we know the differences well.

Objective To investigate the clinical significance of positive sputum culture for filamentous fungi. Methods The medical data of 140 patients positive for filamentous fungi in sputum culture at Peking Union Medical College Hospital were reviewed retrospectively. Based on the diagnostic criteria by European Organization for Research and Treatment of Cancer/Mycoses Study Group, invasive pulmonary fungal infection (IPFI) was diagnosed. The clinical characteristics of cases with and without IPFI were analyzed respectively. Results Among all 140 cases positive for filamentous fungi in sputum culture, only 22 cases could be diagnosed as IPFI. Two of 22 IPFI cases were confirmed by post-operative pathology, I case was confirmed by positive blood culture for filamentous fungi and the remaining 19 cases were diagnosed clinically according to the nature of hosts, characteristics of pulmonary infections and microbiological evidence (positive sputum culture for filamentous fungi, 2-5 times for each case). Most of etiological fungi in IPFI patients belonged to Aspergillus. And the identity of isolated fungal strain was mostly one strain for each patient In IPFI group, patients who had been treated with broad-spectrum antibiotics ( 100% ) , steroids ( 13, 59. 1 % ) or immunosuppressant ( 7, 31.8%) or who had pulmonary X-ray imaging changes( 100% ) , primary diseases (21, 95. 5% ), hypoalbuminemia (18, 81. 8% ) or hemoptysis (10, 45. 5% ), were significantly more than those in non-IPFI group ( 66. 9% , 34. 7% , 18. 6% , 79.7% , 72.0%, 45.8% and 4.2% respectively; P < 0.05 for each item) . In IPFI group, itraconazole, amphotericin B and/or voriconazole were administrated, 8 patients (36.4%) were cured and 14 patients (63.6%) passed away. In non-IPFI group, the patients were treated with antibiotics, fluconazole, anti-tuberculosis, steroids or combined with immunosuppressant, chemotherapy or bronchoalveolar lavage; 96 cases (81.4%) were cured or showed improvement, and 22 cases (18.6%) died or gave up further treatment.Conclusions The clinical significance of positive sputum culture for filamentous fungi are associated with the times of positive culture, the number and species of isolated fungal strains. Meanwhile it is important to determine whether there is IPFI according to the nature and clinical characteristics of patients.

：Objective To investigatethe expression of non-classical major histocompatibility complex( MHC)-I molecule, humanleucocyte antigen ( HLA ) G, including membrane-bound HLA-G (mHLA-G), intracellular HLA-G(iHLA-G) and soluble HLA-G (sHLA-G), in peripheral blood of surviving kidneytransplantation recipients and understand the relevance between HLA-G and the function oftransplanted organ, as well as the onset of acute rejection. Methods A longitudinal studywas performed on 175 kidney transplantation recipients. Three groups were involved in thisstudy, including acute rejection group (n = 36), function stable group (n = 139) andhealthy control group (n = 30). The expression of mHLA-G1 and iHLA-G1 in the T lymphocytesof peripheral blood was detected by flow cytometry analysis and the sHLA-G5 level detectedby ELISA. Results The average rate of CD4~+ mHLA-Gl~+ , CD8~+ mHLA-Gl~+ , CD4~+ iHLA-Gl~+, CD8~+ iHLA-Gl~+ in T lymphocytes of healthy control group was 0. 43% ±0. 19% , 1. 23%±0.41% , 27% ± 13% and 36% ± 14% respectively. That of acute rejection group was 0. 57%± 0. 34% , 1. 31% ± 0. 56% , 26% ± 8% and 37% ± 17% ; that of function stable groupwas 0. 61% ± 0.43% , 1. 39% ±0.47% , 26% ±9% and 37% ± 17% respectively. There was nosignificant difference among the three groups (all P >0. 05). The average of sHLA-G5levels in plasma of control group was (25±14) ng/ml, acute rejection group (24 ± 15)ng/ml (pre-operative) and (34±21) ng/ml (postoperative) , function stable group (25 ±11)ng/ml (pre-operative) and (56 ±32) ng/ml (post-operative). There was no significantdifference among the three groups ( pre-operative, P > 0. 05 ) . The average of sHLA-G5levels in plasma of function stable group was higher than that of acute rejection group(postoperative, P < 0. 05) . Conclusion There is a subset of CD4~+ HLA-G1~+ and CD8~+HLA-G1~+ T lymphocytes with low percentage in peripheral blood of those surviving kidneytransplantation recipients. The expressions of mHLA-G1 and iHLA-G1 have no relevance withthe onset of acute rejection. sHLA-G5 is correlated with acute rejection in peripheralblood of surviving transplantation recipients.

Objective To investigate the association of Killer cell immunoglobin-like receptor (KIR) gene and KIRs' ligand (HLA-C) gene polymorphisms with type 1 diabetes(T1DM).Methods Using polymerase chain reaction-sequence specific primer (PCR-SSP) to detect KIR and HLA-C genotype in 180 T1DM patients and 199 healthy controls from Hunan Han population.Results (1) The frequencies of KIR 2DL1 (98.9% vs 92.0%,OR=7.78,P=0.002),3DLl (94.3% vs 86.4%,OR=2.67.P=0.009)and 2DS4(83.9% vs 70.9%,OR=2.14,P=0.003) were significantly higher in T1DM patients than those in the controls.(2) There were no differences in the frequencies of HLA-C1 and HLA-C2 between the patients and the controls,but the frequency of HLAC1+/C2+(3.9% vs 9.6%,OR=0.38,P=0.03) was significantly lower in the T1DM patients.(3) The combination KIR2DL1-/HLA-C2-(0.6% vs 6.0%,OR=0.087,P=0.003) and KIR 2DS1-/HLA-C2-(53.3% vs 64.8%,OR=0.62,P=0.023) was significantly lower in the T1DM patients.Conclusion The KIR gene polymorphism and KIR/HLA-C gene compatibility are associated with T1DM.

：Objective To explore therelationship between plasma adipocyte fatty acid-binding protein(A-FABP),adiponectin (APN)levels and A-FABP/APN ratio with femoral intima-media thickness (FA-IMT)andendothelium-dependent vasodilation in patients with newly diagnosed type 2 diabetesmellitus (T2DM).Methods Plasma A-FABP and APN in 133 patients with newly diagnosed T2DMwere measured by enzyme-linked immunosorbent assays.FA-IMT,endothelium-dependent andindependent vasodilation of brachial artery was measured by high-resolution vascularultrasound.Upper quartile of FA-IMT was regarded as a criterion of elevated FA-IMT,defined as early atherosclerosis (AS). The patients were subdivided into low FA-IMT group( FA-IMT <0. 60 mm, n =34), middle FA-IMT group (0. 60 mm≤FA-IMT <0. 73 mm,n = 33),high FA-IMT group (0. 73 mm ≤ FA-IMT < 0. 80 mm, n = 33) and early AS group ( FA-IMT≥0. 80 mm, n = 33 ). ResultsPlasma A-FABP/APN ratio was higher in early AS group than in low IMT control group[A-FABP/APN × 1000, 3.9(2. 8～6. 1 ) vs 2. 9( 1.8～5.7), P <0. 05]. FA-IMTcorrelated positively with plasma A-FABP/APN ratio (r =0. 216, P =0. 006) and negativelywith APN (r = -0. 179,P=0. 020). After adjusted for age, gender and BMI, FA-IMT stillcorrelated positively with plasma A-FABP/APN ratio (r =0.217, P =0.007) and negativelywith APN (r = -0.172, P =0.026).Endothelium-depondent vasodilation correlated negativelywith plasma A-FABP/APN ratio ( r = - 0. 166,P =0. 028). After adjusted for age, gender andBMI, endothelium-dependent vasodilation still correlated negatively with plasma A-FABP/APNratio (r =-0. 153, P =0. 042). Conclusion Plasma A-FABP/APN ratio is closely associatedwith FA-IMT and endothelium-dependent vasodilation. Plasma A-FABP/APN ratio may be abetter clinical marker of AS and endothelial dysfunction than A-FABP or APN alone inpatients with newly diagnosed T2DM.

：Objective To investigatethe methods of manganese enhanced magnetic resonance imaging in 7. 0 T magnetic field fortracing corticospinal tract in rat brain in vivo. Methods 0. 4 μl volume of 1 mol/L aqueoussolution of MnCl_2 was injected into the primary motor cortex of 9 SD rats understereotaxis. MRI studies were performed for tracing corticospinal tract and other coherentnerve tracts before injection and 24 hours, 48 hours, 72 hours, 7 days after injectionrespectively using 7. 0T Micro-MRI. Results Corticospinal tract was visualized perfectlyfrom primary motor cortex, thalamus, cerebral peduncle to pons at different time pointsafter Mn~(2+) administration, and the best contrast was achieved after 24-48 h. At thesame time, a small quantity of Mn~(2+) reached the opposite somatosensory cortex throughthe corpus callosum. Conclusion Manganese enhanced MRI visualizes perfectly the transportof Mn~(2+) through axoplasmic flow in corticospinal tracts. This method may be used toinvestigate the change of corticospinal tract and the functional connectivity between twosides of hemisphere in rat brain.

Objective To explore the mechanism of gensenoside Rh2 in reversing the resistance of lung adenocarcinoma cells to cisplatin. Methods In the Rh2, DDP and DDP + Rh2 group A549DDP cells were treated with Rh2, cisplatin, cisplatin + Rh2 respectively for 48 hours. In the control group the A549DDP cells were not treated with any kind of drugs. The state of mitochondrial permeability transition pore (PTP) was evaluated by ultraviolate spectrofluorometer. Concentration of calcium in cells, membrane potential of mitochondrion and apoptosis cells were determined by flow cytometry. The expression of cyt-c and Caspase-3 was estimated by Western blots . Cellular shapes were observed by fluorencent microscopy. Results The concentrations of calcium were similar among the former three groups, but was obviously increased in the Rh2 + DDP group (t= 22. 47, P < 0. 01). A540 of mitochondrion among the former three groups were not different , but decreased significantly in the Rh2 + DDP group (t = 8. 21, P < 0. 01 ). The membrane potentials of mitochondrion showed no difference in the former groups, that was remarkably lower in the Rh2 + DDP group than in the control group (x~2 =46.01 ,P <0. 01). There was little expression of cty-c and Caspase-3 in the former groups , but high expression of those in the Rh2 + DDP group. Fluorenscence was distributed equably on the cells nucleus in the former groups. In the Rh2 + DDP group many cell nucleus shrank or were distorted. The apoptosis rate of the cells was 6. 32% ,7. 24% ,7. 41% and 21.96% in the four groups respectively. Which in Rh2 + DDP group was higher than that in the control group (t = 10. 92, P < 0.05). Conclusions The effect of gensenoside Rh2 reversing resistance of lung adenocarcinoma A549DDP cells to cisplatin can be performed by apoptotic mitochondria pathway.

：Objective To compare thecardioprotective effect of self-assembling peptide (RAD16-Ⅱ )and thermosensitive hydrogel DPHP ( Dex-PCL-HEMA/PNIPAAm) and investigate theoptimal property of hydrogel for the treatment of myocardial infarction ( MI). Methods MImodel was induced by left anterior descending ( LAD) coronary artery ligation in SD rats.The animals were randomized into three groups to receive RAD16-Ⅱ hydrogel ( n = 15 ) , DPHP hydrogel ( n = 15 ) or PBS ( phosphatebuffered saline; control group n = 15) ; sham-operated rats (n = 10) , a suture was tiedloosely around left coronary artery without ligating it At Day 20 post-MI, left ventriclefunction was evaluated by echocardiography and cardiac catheter. Masson's trichrome wasused for histological examination; anti-α-smooth muscle antigen (α-SMA)was applied to label the neovasculature formation in infarct area. Results The ratsreceiving DPHP hydrogel showed a significantly smaller left ventricle end diastolicdiameter ( LVEDd) and higher levels of left ventricle fraction shortening (LVFS) and leftventricle end systolic pressure (LVESP) than the rats in RAD16-Ⅱ group [LVEDd (7.9 ±0. 9)mm vs (8. 9 ±0. 8)mm] ; [LVFS (25.4 ±5.1)%vs (21.9 ±2. 9)% ; LVESP (114. 0 ±7. 6) mm Hg vs (99. 1 ±9.6) mm Hg; P <0. 05].Histological examination showed uncompleted degraded hydrogel in infarct area of DPHPgroup but not in RAD16-Ⅱ group. The animals receivingDPHP hydrogel demonstrated significantly a smaller infarct size, a higher infarct wallthickness and a lower vessel density in infarct than the animals receiving RAD16-Ⅱ hydrogel (P<0. 05). Conclusion DPHP hydrogel implantationfurther inhibits the post-MI ventricle remodeling than RAD16-Ⅱhydrogel implantation. The mechanism is notcorrelated with the vascular density in infarct area.

Acute respiratory distress syndrome (ARDS) is an acute hypoxic respiratory insufficiency or failure caused by diffuse interstitial and alveolar edema caused by damage of pulmonary capillary endothelial cells and alveolar epithelial cells in the course of non-cardiac diseases such as severe infection, shock, trauma and burn. The pathophysiological features are decreased lung volume, decreased lung compliance, severe ventilation and/or blood flow imbalance. The clinical manifestations are progressive hypoxemia and respiratory distress, and the lung imaging manifestations are heterogeneous exudative lesions.

Genetic variation can affect lung function in children and adults, and may eventually lead to the occurrence of chronic obstructive pulmonary disease (COPD), and this effect is more obvious in high-risk groups. Animal experiments have proved that matrix metalloproteinase 12 (MMPl2) plays a key role in smoking-induced emphysema. However, the mechanism of MMP12 in the pathogenesis of human emphysema is still unclear. To investigate the relationship between single nucleotide polymorphism (SNP) of MMP12 and lung function, Dr. Hunninghake and others from the United States analyzed seven cohort studies, and the results were published on the website of the New England Journal of Medicine (www.nejm.org) on December 16, 2009.

Case 1: A 30-year-old male was diagnosed with myelodysplastic syndrome with blastosis type Ⅱ. He underwent sibling haploid hematopoietic stem cell transplantation (HSST) in our hospital in August 2008. The patient was treated with conventional maryland + cyclophosphamide + anti-human T lymphocyte immunoglobulin (BuCy + ATG) pretreatment regimen ~ ([1]), cyclosporine, mycophenolate mofetil and short-course methotrexate (MTX) to prevent graft versus host disease (GVHD). The blood cells were successfully transplanted by transfusion of mononuclear cells 7.5×108/kg. The patient developed rash, diarrhea and hematochezia at +24 days. The patient was diagnosed with acute GVHD of grade IV. The patient was given methylprednisolone 1 mg · kg ~ (-1) · d ~ (-1) and then added to 5 mg · kg ~ (-1) · d ~ (-1), prolekorf and anti-CD25 monoclonal antibody. After treatment, the rash, bloody stool disappeared, diarrhea improved, and the amount of hormone was gradually reduced. Anti-CD25 monoclonal antibody was applied 5 times.

A 53-year-old female was admitted to the hospital in November 2007 due to "progressive asthenia and anorexia for more than 2 years and low fever for 2 weeks". The patient developed asthenia and anorexia without obvious triggers 2 years before admission, and the symptoms gradually worsened. She came to our hospital for medical treatment 15 months before admission. At that time, she had no fever, no yellowing staining of skin and sclera, positive liver palm and spider nevus, no palpable swelling of superficial lymph nodes, no positive signs in cardiopulmonary examination, and no other abnormalities in the abdomen except liver and splenomegaly (3 and 4 fingers under costa, respectively). B-ultrasound examination revealed cirrhosis of liver and splenomegaly.

Ureteral calculus is a common disease in urology. In recent 25 years, many new minimally invasive techniques and therapeutic methods have been continuously applied to the treatment of ureteral calculus. Although the choice of minimally invasive therapeutic methods has been increased, sometimes many problems have arisen due to the failure to choose the therapeutic methods reasonably. This paper emphasizes the indications of various minimally invasive therapeutic methods, and thus condenses the new concept of ureteral three-segment quadrature method, and tries to guide the choice of minimally invasive therapeutic methods for ureteral calculus, and further improves the understanding of the importance of clinical choice.

1. Summary of microRNAs 1. Discovery and types of microRNAs: MicroRNAs, referred to as miRNAs for short, are a kind of non-coding small molecule single stranded RNAs widely existing in vertebrates, fruit flies, nematodes and plants. The length of microRNAs is about 22 nucleotides in eukaryotes, and can degrade the target mRNA or inhibit its translation through specific base pairing with the target mRNA, thus regulating the expression of genes after transcription. At present, the length of multiple miRNAs found in different species is generally about 22 nucleotides, of which miRNAs with a length of 21-23 nucleotides account for about 84% ~ ([1]).

Human tissue kallikrein (HK) is a group of secretory serine hydrolases, encoded by kallikrein (KLK) gene. It has 15 family members, and is the largest known family of human serine proteases. HK is mainly expressed in steroid-producing or hormone-dependent tissues such as prostate, breast, ovary and testis ~ ([1]). It can be divided into two categories: tissue kallikrein and plasma kallikrein. The two kallikreins have significant differences in relative molecular mass, substrate specificity, immunological characteristics, gene structure and type of kallikrein released ~ ([2]).

A 33-year-old male was admitted to the hospital on December 18, 2007 because of repeated dizziness, fatigue, palpitation and shortness of breath after activity for more than 2 years. In March 2005, the patient suffered from fatigue without obvious trigger, pale complexion, palpitation and shortness of breath after activity. The blood routine in the local hospital showed that white blood cells were 10.6×10~9/L, hemoglobin 49 g/L, platelets 243×10~9/L, reticulocytes 3.4%; Peripheral blood classification lymphocytes 90%; Bone marrow image: hyperplasia was obviously active, granulocyte: 55.5%, erythroid: 12.5%, considering the cause of lymphocytosis to be investigated, fatigue aggravated in August 2005, blood image: white blood cells 5.1×10~9/L, hemoglobin 38 g/L, platelets 280×10~9/L, reticulocytes 0.58%, bone marrow image: hyperplasia was obviously active, granulocyte 61.5%, erythroid 1.5%, erythroid significantly decreased; The presence of "pure red aplastic anemia" is considered;