丁苯酞联合舍曲林对缺血性脑卒中后抑郁及细胞因子的影响

目的探讨丁苯酞软胶囊联合舍曲林对缺血性脑卒中后抑郁(IPSD)及细胞因子的影响。方法 IPSD患者80例随机分为丁苯酞组、对照组各40例,均给予缺血性脑卒中基础治疗、心理治疗及口服舍曲林抗抑郁治疗,丁苯酞组在此基础上应用丁苯酞软胶囊,疗程12 w,评价丁苯酞联合舍曲林对IPSD患者抑郁症状、神经功能缺损程度及对白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α的影响。结果连续治疗4、8、12 w时两组汉密尔顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NIHSS)评分显著降低(P<0.01),且丁苯酞组显著低于对照组(P<0.05);治疗4 w时两组神经功能损伤改善程度无统计学差异(P>0.05),治疗8、12 w时丁苯酞组效果显著优于对照组(P<0.05);连续治疗4、8、12 w时两组IL-6、TNF-α含量均显著下降(P<0.01),且丁苯酞组下降程度明显高于对照组(P<0.05)。结论丁苯酞软胶囊联合舍曲林可明显改善IPSD患者的抑郁程度、神经功能缺损及降低IL-6、TNF-α水平。     

丁苯酞软胶囊治疗缺血性脑卒中患者的疗效及对侧支循环血流及神经功能的影响

目的探讨丁苯酞软胶囊治疗缺血性脑卒中患者的疗效及对侧支循环血流及神经功能的影响。方法选取2014年9月至2016年8月在本院诊治的缺血性脑卒中患者68例,随机分为对照组与观察组,每组34例。对照组患者使用阿托伐他汀钙联合阿司匹林肠溶片治疗,观察组患者在对照组治疗的基础上加用丁苯酞软胶囊治疗。比较两组患者的临床疗效、血脂水平、侧支循环血流情况、神经功能以及不良反应发生情况。结果观察组患者的临床疗效显著优于对照组,治疗总有效率(94.12%)显著高于对照组(76.47%),差异具有统计学意义(P0.05)。治疗30 d后,两组患者的总胆固醇、三酰甘油水平均明显降低(P0.05);观察组患者的大脑前动脉血流、后动脉血流速度及NIHSS评分均小于对照组(P0.05)。治疗过程中,两组患者不良反应发生率比较差异无统计学意义(P0.05)。结论在阿托伐他汀钙联合阿司匹林治疗的基础上,加用丁苯酞软胶囊治疗缺血性脑卒中患者,可显著提高临床治疗效果,改善患者侧支循环状况,但不会增加患者的不良反应,有利于患者的康复。     

丁苯酞注射液对急性脑梗死合并颅内动脉狭窄患者颅内动脉血流动力学、氧化应激及血清Hcy和CysC水平的影响

目的探讨丁苯酞注射液对急性脑梗死合并颅内动脉狭窄患者颅内动脉血流动力学、氧化应激损伤及血清同型半胱氨酸(Hcy)和胱抑素(Cys)C水平的影响。方法急性脑梗死合并颅内动脉狭窄患者78例随机分为观察组与对照组。对照组给予常规治疗,观察组在对照组基础上结合丁苯酞注射液治疗。两组疗程均为2 w。比较两组治疗前后Barthel指数(BI)和美国国立卫生研究院脑卒中量表(NIHSS)评分、颅内动脉血流动力学、氧化应激损伤、血清Hcy和CysC水平变化及随访3个月改良Rankin量表评分。结果两组治疗后BI较治疗前明显增加而NIHSS评分较治疗前明显降低(P0.05);观察组治疗后BI明显高于对照组而NIHSS评分明显低于对照组(P0.05)。两组治疗后颅内动脉峰流速(Vp)和平均流速(Vm)较治疗前明显增加而脉动指数(PI)较治疗前明显降低(P0.05);观察组治疗后颅内动脉Vp和Vm明显高于对照组而PI明显低于对照组(P0.05)。两组治疗后血清超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)水平较治疗前明显增加而丙二醛(MDA)水平较治疗前明显降低(P0.05);观察组治疗后血清SOD和GSH-Px水平明显高于对照组而MDA水平明显低于对照组(P0.05)。两组治疗后血清Hcy和CysC水平较治疗前明显降低(P0.05);观察组治疗后血清Hcy和CysC水平明显低于对照组(P0.05)。观察组改良Rankin量表评分明显低于对照组(P0.05)。结论丁苯酞注射液对急性脑梗死合并颅内动脉狭窄患者效果明显,可改善患者颅内血流动力学,可减轻氧化应激损伤及降低血清Hcy和CysC水平。     

rt-PA动脉溶栓结合丁苯酞治疗急性脑梗死的有效性及安全性

目的探讨重组组织型纤溶酶原激活剂(t-PA)动脉溶栓结合丁苯酞治疗急性脑梗死的有效性及安全性。方法选择脑卒中患者104例,分为两组,各52例,观察组采用rt-PA动脉溶栓联合丁苯酞,对照组单纯使用丁苯酞,随访90 d,比较两组治疗前后脑卒中量表(NIHSS)评分和生活活动能力量表(ADL)评分,并统计两组治疗安全性与临床效果。结果两组NIHSS评分均低于治疗前(P<0.05),治疗后30、90 d,观察组NIHSS评分显著低于于对照组(P<0.05),两组ADL评分均高于治疗前(P<0.05),治疗后30、90 d,观察组ADL评分显著高于对照组(P<0.05),观察组发生再发脑出血和再发脑梗死的比例均低于对照组(P<0.05),观察组痊愈率高于对照组(P<0.05),恶变或死亡比例低于对照组(P<0.05)。结论 rt-PA动脉溶栓结合丁苯酞治疗急性脑梗死能有效改善患者神经功能和生活能力,且早期溶栓治疗后,能减少再发出血和再发梗死比例,提高临床效果,值得临床推广。     

丁苯酞软胶囊联合高压氧对老年急性脑梗死患者转化生长因子β1、尿酸水平及生活质量的影响

目的探讨丁苯酞软胶囊联合高压氧治疗对老年急性脑梗死(ACI)患者血清转化生长因子(TGF)-β1、血尿酸(UA)水平及生活质量的影响。方法 96例老年ACI患者根据治疗方案不同分为3组各32例,对照组给予常规抗血小板聚集、控制血压血糖、降脂、改善机体微循环、脑细胞活化剂等方案治疗;丁苯酞组给予常规治疗方案+丁苯酞软胶囊治疗;联合组给予常规治疗方案+丁苯酞软胶囊+高压氧治疗。对比3组治疗效果及治疗2、4 w后血清促血管生成素(Ang)-2、TGF-β1、UA、血管内皮生长因子(VEGF)水平变化,并采用美国国立卫生研究院脑卒中量表(NHISS)、日常生活活动能力(ADL)量表评估3组治疗前后神经功能及生活质量变化。结果治疗前3组ADL评分、NHISS评分及血清VEGF、Ang-2、TGF-β1、UA水平比较差异无统计学意义(P0.05);治疗4 w后,3组神经功能缺损程度及生活质量均较治疗前明显改善(P0.05),且联合组治疗2、4 w后ADL评分显著高于对照组、丁苯酞组(P0.05),NHISS评分显著小于对照组、丁苯酞组(P0.05);治疗4 w后,联合组总有效(96.88%)显著高于对照组(75.00%)和丁苯酞组(62.50%)(P0.05);治疗4 w后,3组血清TGF-β1、UA水平均较治疗前明显改善(P0.05),且联合组治疗2、4 w后TGF-β1、UA水平显著优于对照组、丁苯酞组(P0.05);3组血清VEGF、Ang-2水平均于治疗2 w后达到高峰,并于治疗4 w后下降,且联合组治疗2、4 w后血清VEGF、Ang-2水平显著高于对照组、丁苯酞组(P0.05)。结论老年ACI患者采用丁苯酞软胶囊联合高压氧治疗能显著改善神经功能,调节VEGF、Ang-2水平,改善血清TGF-β1、UA水平,提高生活质量,疗效显著。     

依达拉奉联合丁苯酞治疗急性缺血性脑卒中的疗效及安全性

目的:探讨依达拉奉联合丁苯酞治疗急性缺血性脑卒中(AIS)的疗效以及安全性。方法:选择在我院接受治疗的AIS患者100例,采用随机数表法均分为丁苯酞组和联合治疗组(依达拉奉联合丁苯酞治疗)。两组患者均接受常规治疗,治疗5周,比较两组患者治疗前后血清炎症因子水平、miR-222表达及神经功能缺损的变化,以及治疗后的疗效、并发症情况。结果:与治疗前比较,两组治疗后超敏C反应蛋白(hsCRP)、肿瘤坏死因子α(TNF-α)和白介素8(IL-8)水平均明显下降,miR-222表达均明显增加,神经功能缺损评分均明显下降(P均=0.001);且与丁苯酞组比较,联合治疗组hsCRP[(13.12±2.56)mg/L比(10.02±3.02)mg/L]、TNF-α[(16.12±4.18)μmol/L比(13.78±3.24)μmol/L]和IL-8[(19.45±5.98)μmol/L比(15.12±3.29)μmol/L]水平显著下降,miR-222[(1.21±0.34)×10-3比(1.89±0.41)×10-3]表达显著增加,神经功能缺损评分[(19.12±4.02)分比(13.45±3.17)分]显著下降(P均<0.01)。联合治疗组总有效率明显高于常规治疗组(96.00%比70.00%,P=0.001)。两组均未出现明显不良反应。结论:依达拉奉联合丁苯酞治疗急性缺血性脑卒中患者疗效显著,能够有效降低炎性因子,改善神经功能,安全性好。     

丁苯酞氯化钠注射液对进展性脑卒中患者微栓子清除机制的影响

目的讨论丁苯酞氯化钠注射液对进展性脑卒中患者微栓子清除机制的影响。方法采取单中心随机对照前瞻性研究,110例进展性脑卒中患者作为研究对象,采用随机数字表法将入组患者分为丁苯酞组(60例)和对照组(50例)。丁苯酞组给予基础治疗+丁苯酞注射液治疗,对照组给予基础治疗。观察丁苯酞对进展性脑卒中患者微栓子清除机制的影响,比较各组间患者治疗前后脑灌注水平,微栓子阳性率,微栓子个数,血清组织型纤溶酶原激活剂(tPA),纤溶酶原激活剂(PAI)表达水平及丁苯酞对进展性脑卒中的疗效及安全性。结果治疗后,丁苯酞组微栓子数量明显低于对照组(P0.05);治疗后,两组tPA均显著上升,且以丁苯酞组上升更为明显,两组PAI均显著下降,且以丁苯酞组下降更为明显,组间差异存在统计学意义(P0.05);治疗后,两组CBF和CBV水平明显提升,但丁苯酞组水平提升更加明显,组间差异存在统计学意义(P0.05);丁苯酞组生存率明显高于对照组,脑卒中再发率明显低于对照组(P0.05);治疗14 d中丁苯酞组不良反应发生率明显低于对照组(P0.05)。结论丁苯酞氯化钠注射液对进展性脑卒中患者微栓子清除机制为溶栓机制降解和血流动力学洗脱,同时其可有效提升患者的生存率,且安全性较好。     

穴位贴敷联合丁苯酞治疗缺血性脑卒中恢复期的临床观察

目的分析穴位贴敷联合丁苯酞治疗缺血性脑卒中恢复期的临床效果。方法选择2019年1月至2021年1月期间于我院接受治疗的140例缺血性脑卒中恢复期患者作为本次研究主体,根据随机数表法将所有患者分为两组,对照组(70例)仅使用丁苯酞治疗,观察组(70例)则在上述基础上加用穴位贴敷治疗,对两种治疗方案的临床效果进行分析。结果观察组神经功能缺损恢复程度高于对照组,差异有统计学意义(P0.05);观察组治疗效果高于对照组,差异有统计学意义(P0.05)。结论采取穴位贴敷联合丁苯酞治疗缺血性脑卒中恢复期患者的临床疗效确切,能促使患者神经功能有效恢复,值得应用。     

丁苯酞对缺血性脑卒中老年患者的疗效及其血清高迁移率族蛋白B1、白细胞介素-18和-23的影响

目的观察丁苯酞对缺血性脑卒中老年患者的疗效及其血清高迁移率族蛋白(HMG)B1、白细胞介素(IL)-18和-23的影响。方法缺血性脑卒中的老年患者150例随机分为对照组(75例)应用常规治疗,研究组(75例)在常规治疗基础上加用丁苯酞。应用酶联免疫吸附实验检测两组治疗前、后血清HMG B1、IL-18和IL-23的表达。结果治疗2 w后,研究组美国国立卫生研究院脑卒中量表(NIHSS)评分明显低于对照组,总有效率明显高于对照组;两组治疗后血清HMGB1、IL-18和IL-23的含量均下降,但是研究组下降值明显高于对照组(均P<0.05)。结论缺血性脑卒中患者在常规治疗基础上加用丁苯酞临床疗效明显,丁苯酞可有效下调血清中HMGB1、IL-18和IL-23的表达,阻止脑卒中促进因子的活化。     

脉血康胶囊联合丁苯酞治疗老年缺血性脑卒中的疗效及对血清BDNF、Hcy、LPa、Fg的影响

目的研究脉血康胶囊联合丁苯酞治疗老年缺血性脑卒中的疗效,观察对血清脑源性神经营养因子(BDNF)、血同型半胱氨酸(Hcy)、血浆溶血磷脂酸(LPa)、纤维蛋白原(Fg)的影响。方法选择2012年1月—2017年6月在我院进行治疗的缺血性脑卒中病人136例,按照治疗方法分为观察组和对照组。对照组使用丁苯酞治疗,观察组在对照组基础上联合脉血康胶囊治疗,观察两组治疗后的临床疗效,对比血液流变学及BDNF、Hcy、LPa、Fg水平的变化。结果治疗后,观察组总有效率为97.06%,明显高于对照组的73.53%(P0.05);观察组病人BDNF水平显著高于对照组,且观察组Hcy、LPa水平及美国国立卫生研究院卒中量表(NIHSS)评分较对照组明显降低,两组差异具有统计学意义(P0.05);治疗后观察组病人纤维蛋白原、血浆黏度、血小板聚集值均显著低于对照组(P0.05);治疗后观察组病人后遗症发生率均明显低于对照组(P0.05)。结论丁苯酞可显著改善缺血性脑卒中病人的精神状态,并促进认知神经恢复,结合脉血康胶囊治疗可改善脑卒中病人生活质量,提高缺血性脑卒中病人的生活质量及心理功能健康指数。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.