慢性肝病患者门诊随访情况调查

随机选取我院2010年8月至2011年5月246例门诊慢性肝病患者,调查患者中以病毒性肝炎及肝硬化患者为主（74．0％,182例）,其他肝病患者较少.病毒性肝炎及肝硬化患者失访率较低（40．1％,73／182）．低于其他肝病失访率（Х^2=12．382,P〈0．05）.失访者中,病毒性肝炎及肝硬化患者与其他肝病患者相比性别差异无统计学意义（Х^2=10．137,P〉0．05）,不同年龄（Х^2=31．783．P〈0.05）.学历（Х^2=32．803,P〈0．05）比较,差异均有统计学意义。在失访原因中对病情的不重视（44例,38．3％）及医生沟通欠佳（21例,18．3％）为主要原因。加强对于慢性肝病患者对疾病认识非常重要。     

丙型病毒性肝炎患者补体对免疫沉淀的抑制作用研究

目的 了解丙型肝炎患者补体对免疫沉淀抑制作用（IIPC）在丙型肝炎的发病中的作用。方法 采用辣根过氧化物酶（PO）作为抗原，通过比色法对185例病毒性肝炎患者血清IIPC进行了研究，并同时对补体成分C3、C4进行检测。结果 与正常对照者比较，丙型肝炎所致的慢性活动性肝炎、慢性迁延性肝炎、重症肝炎、肝硬化IIPC均降低（P〈0．01，0．05），而与急性肝炎组、病毒携带者无差别（P〉0．05），急性肝炎组、慢性迁延性肝炎、慢性活动性肝炎、肝硬化、重症肝炎IIPC低下的发生率分别为39．0％、65．2％、51．0％、34．8％、73．3％。结论 丙型肝炎所致的不同肝病中IIPC均有所降低，并与其严重程度有关。     

赣南地区肝硬化人群的病因调查与分析

目的探讨赣南地区肝硬化的病因分布情况,为预防与治疗提供参考。方法对赣南地区876例肝硬化患者临床资料进行回顾性分析,分析引起肝硬化的病因,并比较不同年龄、性别的病因分布。结果 876例肝硬化患者病因构成主要为病毒性肝炎后肝硬化（50.5%）,其次分别为酒精性肝硬化（22.4%）、酒精合并肝炎所致肝硬化（12.0%）、原发性胆汁性肝硬化（5.9%）、血吸虫性肝硬化（5.5%）、隐源性肝硬化（3.8%）;〈30岁患者以隐源性肝硬化为主,而其他患者的主要病因均为病毒性肝炎后肝硬化;男性与女性患者均以病毒性肝炎为主要病因,但男性酒精性肝硬化所占比例显著高于女性（P〈0.05）,女性原发性胆汁性肝硬化所占比例高于男性（P〈0.05）。结论赣南地区肝硬化病因仍然以病毒性肝炎为主,但其他病因所致肝硬化所占比例不断上升,而不同性别、年龄间肝硬化病因存在差异。     

自身抗体检测对自身免疫性肝病的临床意义

目的：探讨自身抗体检测对自身免疫性肝病诊断及鉴别的意义。方法：将696例受试对象分为3组：（1）AILD组：其中AIH患者41例,PBC患者142例;（2）病毒性肝炎组：乙型肝炎患者184例,乙型肝炎合并肝硬化患者81例,丙型肝炎患者160例,丙型肝炎合并肝硬化患者32例;（3）正常对照组56例。用间接免疫荧光法检测血清中ANA、AMA、ASMA和ANCA;用免疫印迹法检测AMA—M2型、SLA/LP、LKM-1和LC-1。结果：自身免疫性肝病组中ANA总阳性率为88．5％,高于其他各组（P〈0．01）;AIH组ASMA阳性率为17．1％,高于其他各组（P〈0．05）;PBC组AMA及AMA—M2亚型阳性率分别为84．5％和82．4％,明显高于其他各组（P〈0．05）;病毒性肝炎组中丙肝肝硬化患者ANA阳性率较高,为40．6％。结论：ANA,AMA及其亚型、ASMA等自身抗体检测是诊断自身免疫性肝病的重要指标,对各种类型的慢性肝病常规进行自身抗体检测有助于发现和鉴别AILD。     

纤维连接蛋白检测在肝病中的临床意义

目的探讨纤维连接蛋白（FN）在肝病中的意义。方法采用免疫比浊法检测220例各种肝病患者血清FN水平，并与其他肝功能指标进行比较。结果急性肝炎与轻／中度慢性肝炎之间差异无显著性（P〉0．05）；急性肝炎与重度慢性肝炎、肝硬化、慢性重型肝炎之间差异有显著性（P〈0．05、P〈0．001、P〈0．001）；与血清白蛋白（ALB）、前白蛋白（PRE—A）、凝血酶原活动度（PTA）呈正相关（P〈0．001）。结论血清FN水平在一定程度上能反映肝脏损伤的程度，检测血清FN对估计重度慢性肝炎、肝硬化、慢性重型肝炎患者病情、预后、转归均有一定意义。     

北京市大兴区乙肝后肝硬化死亡状况分析

目的 了解人群乙肝后肝硬化死亡的规律，以及与慢性乙肝的关系，找出肝硬化防治的重点人群。方法 查阅1995-2002年死亡证明书，回顾性调查直接死因为肝硬化患者的性别、年龄、病程等相关信息。结果 查阅18763份死亡证明书，共167例死于肝硬化，其中男性肝硬化死亡率高于女性（x^2=83．505，P=0．00）；患肝硬化后男性死亡年龄早于女性（t=3．535，P=0．000）；肝硬化死亡有慢性乙肝病史者占19．84％，患病平均病程为13．09年，不同性别差异无显著性t=-1．616，P=0．109）。结论 男性为肝硬化的高发人群，也是防治的重点人群；预防慢性乙肝是防治肝硬化的根本措施。     

110例慢性肝衰竭患者的病因构成及预后影响因素分析

目的：分析慢性肝衰竭的病因构成及影响预后的因素。方法回顾性分析110例慢性肝衰竭患者的临床资料,分析患者的病因构成情况;并根据预后将患者分为存活组61例及死亡组49例,分析可能影响预后的相关因素。结果110例慢性肝衰竭的患者中,HBV 感染占69．09％（76／110）,HCV 感染占8．18％（9／110）,酒精性肝病占14．54％（16／110）,自身免疫性肝炎占2．7％（3／110）,其他原因占5．4％（6／110）。死亡组年龄≥50岁、肝硬化以及有肝性脑病、肝肾综合征、消化道出血、原发性腹膜炎及腹水患者的比率明显高于存活组（P＜0．05）。结论病毒性肝炎、酒精性肝病史是罹患慢性肝衰竭的主要病因,年龄≥50岁、有肝硬化基础、合并肝性脑病、肝肾综合征、消化道出血、原发性腹膜炎及腹水可能影响患者的预后。     

慢性肝炎病人胆结石的发生率及其临床特点分析

目的探讨慢性肝炎病人胆囊结石的发生率、影响因素及临床特点。方法采用B超检查观察慢肝病人胆囊结石发生率、性别差异和年龄等特点。结果胆囊结石发生率慢肝组为18．28％（62／339），对照组为5．07％（61／1203），两组有极显著差异（P〈0．001）；胆结石发生率性别比较：慢肝组男性16．85％（45／267），女性23．61％（17／62），性别间差异无显著性（P〉O．05），对照组男性2．25％（9／368），女性6．23％（52／835），性别间差异有显著性（P〈O．01）；胆结石发生率按年龄20～，40～，60～分组比较：慢肝组分别为16．81％，19．26％，25．93％，组间差异无显著性（P〉0．05），对照组分别为1．54％，4．90％，11．87％，组间差异有显著性（P〈0．001）。结论慢肝病人因伴有反复、持续的胆道损害、胆囊功能障碍、胆汁理化性质改变等因素，致使胆结石的发生率增高，胆结石发生的性别间差异小，年龄趋于年轻化。     

我校1434例教职工B超体检结果分析

目的：探讨高校教职工的健康状况及患病特点。方法：对新疆医科大学1434例35岁以上教职工行空腹B超各脏器（肝脏、胆囊、脾脏、胰腺、肾脏）检查，并分析了检出疾病的顺位和年龄分布。结果：1434例职工共检出患者822例（57．32％），其中慢性胆囊炎及胆石症279例（19．46％），脂肪肝237例（16．53％），非寄生虫性肝囊肿117例（8．16％），肾囊肿73例（5．09％），胆囊息肉39例（2．72％），肝内血管瘤31例（2．16％），慢性肝病22例（1．53％），肾积水20例（1．39％），肝包虫3例（0．21％），肾肿瘤1例（0．07％）；女性慢性胆囊炎及胆石症检出率明显高于男性（X^2=5．32，P〈0．05），男性脂肪肝检出率明显高于女性（X^2=18．37，P，〈0．05），女性肾囊肿检出率明显高于男性（X^2=11．53，P〈0．05）；B超检查检出病例总数、非寄生虫性肝囊肿、肾囊肿、肾积水均随年龄增长而增多（X^2值分别为21．51、124．54、73．06、12．80，P均〈0.05）。结论：高校教职工所患疾病多为不良习惯所致的慢性疾病。指导教职工控制疾病的危险因索，纠正不良生活方式，开展健康科普教育，提高自我保健意识，是今后保健工作的重点。     

佛山市顺德区成人非酒精性脂肪性肝病的现状研究

目的调查佛山市顺德区成人非酒精性脂肪性肝病的现状。方法收集佛山市顺德区陈村医院普通体检者1673名相关临床资料,包括身高、体重、腰围、血压、肝功能、血脂、血糖及肝脏、胆囊和脾脏超声检查等,进行统计学分析,探讨佛山市顺德区成人非酒精性脂肪肝性肝病的现状和疾病谱以及相关危险因素。结果1673名普通体检者中检出非酒精性脂肪性肝病患者258例,检出率为15．4％,其中男性患病率为17．5％。女性患病率为12．4％,男性患病率明显高于女性;非酒精性脂肪性肝病高发年龄段为40～〈60岁;非酒精性脂肪性肝病发病相关因素包括体重指数、高脂血症、性别、年龄、肝功能异常、空腹血糖代谢紊乱、高血压,其中,以体重指数≥25kg/㎡相对风险度最高（OR=9．942,95％CI4．802～20．576）,其次为高脂血症（OR=2．062,95％CI1．285～3．311）及男性（OR=1．810,95％CI1．150～2．811）。结论佛山市顺德区成人非酒精性脂肪性肝病患病率较高,与国内发达城市相差不大,在40～〈60岁人群及男性中较高发,肥胖、高脂血症为非酒精性脂肪性肝病的易患因素;应积极开展关于非酒精性脂肪性肝病防治的健康教育,引起人们对非酒精性脂肪性肝病的重视,加强自我保健意识。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.