慢性肺源性心脏病PTFv1改变的临床意义

目的探讨慢性肺源性心脏病PTFv1改变的临床意义.方法比较慢性肺源性心脏病PlFv1≤-0.04mm·s36例(观察组)和PTFv1正常36例(对照组)的LAD、LVEDD、E/A、LVEF值及治疗前后心律失常发生率.结果与对照组比较,观察组LAD、LVEDD显著增大(P＜0.01),E/A、LVEF显著降低(P＜0.01).治疗前两组心律失常发生率差异无显著性意义(P＞0.05),治疗后观察组心律失常消失者较对照组少,两组差异有显著性意义(P＜0.01).结论PTFv1≤-0.04mm·s提示慢性肺源性心脏病合并左心功能受损,PTFv1对慢性肺源性心脏病的治疗和随访具有重要指导意义.     

慢性肺源性心脏病Ptfv1改变的临床意义

目的探讨慢性肺源性心脏病Ptfv1改变的临床意义.方法比较Ptfv1≤-0.04mm·s的慢性肺源性心脏病患者30例(观察组)和同期Ptfv1正常的慢性肺源性心脏病患者30例(对照组)的LAD、LVEDd、E/A、LVEF值及治疗前后心律失常发生率.结果与对照组比较,观察组LAD、LVEDd值增高,E/A、LVEF值降低.治疗前两组心律失常发生率差异无显著性意义(P＞0.05),治疗后观察组心律失常消失者较对照组少,两组差异有显著性意义(P＜0.01).结论Ptfv1≤-0.04mm·s提示慢性肺源性心脏病合并左心室舒张功能受损,Ptfv1对慢性肺源性心脏病的治疗和随访有着重要指导意义.     

原发性高血压PTFV1改变的临床意义

目的探讨原发性高血压患者PTFv1改变的临床意义。方法比较PTFv1≤-0.04mm·s的原发性高血压患者50例(观察组)和同期PTFv1正常的原发性高血压患者50例(对照组)的LAD、LVEDd、IVST、PWT、E/A、LVEF值及心律失常情况。结果与对照组比较,观察组LAD、LVEDd、IVST、PWT值增高,E/A值降低,心律失常发生率增高,差异均有非常显著性意义(P<0.01)。结论PTFv1≤-0.04mm·s提示原发性高血压合并左心室舒张功能障碍和较高的心律失常发生率。     

比索洛尔治疗老年慢性阻塞性肺病急性加重并肺心病患者的疗效及对心功能、hs-CRP、NT-proBNP水平的影响

目的探讨比索洛尔治疗老年慢性阻塞性肺病急性加重(AECOPD)并肺源性心脏病的疗效及对心功能、高敏C反应蛋白(hsCRP)、氨基末端脑钠肽前体(NT-pro BNP)水平的影响。方法选择120例AECOPD并肺源性心脏病患者,分为观察组与对照组各60例,其中对照组给予常规治疗,观察组在常规治疗的基础上给予比索洛尔治疗,比较两组患者治疗有效率、治疗前后hs-CRP、NT-pro BNP水平及心功能指标。结果观察组治疗后有效率明显高于对照组(P<0.05);观察组治疗后左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左心房内径(LAD)各指标较对照组改善明显(P<0.05);观察组治疗后hs-CRP、NT-pro BNP水平改善较对照组明显(P<0.05)。结论比索洛尔治疗AECOPD并肺源性心脏病的疗效显著,可显著改善心功能,降低hs-CRP、NT-pro BNP水平。     

Ptfv1对冠心病并发早期左心功能不全的评价

目的:分析心电图Pv_1终末电势(terminal force,Ptfv_1)评价冠心病早期心功能不全的诊断价值。方法:测定受检者心电图和心脏彩色多普勒;受检者冠心病组(120例)分成左室射血分数(LVEF)≥50％组(n=60),LVEF<50％组(n=60),另设正常对照组(n=60);对各组Ptfv_1进行分析.结累:以Ptfv_1≤-0.02 mm·s为异常标准,120例冠心病患者中Ptfv_1异常者96例,占80％。以Ptfv_1 ≤-0.04mm·s为异常标准,Ptfv_1异常者60例,占50％。冠心病患者中LVEF≥50％组与LVEF<50％组比较,分别以Ptfv_1≤-0.02 mm·s或≤-0.04 mm·s为异常标准,两组Ptfv_1异常均有非常显著差异(P<0.01)。结论:用Ptfv_1≤-0.02mm·s评价冠心病合并早期左心功能不全,其敏感性,特异性及真阳性率较高,且可观察心功能的动态变化,适合基层医院,有较高的临床实用价值。     

慢性阻塞性肺疾病患者左心功能变化的研究

目的 通过超声心动图对慢性阻塞性肺疾病急性加重期(AECOPD)患者的左心功能进行评价,探讨COPD患者左心功能的变化.方法 回顾性分析79例AECOPD患者的超声心动图结果,30例健康体检者作为对照组.根据有无慢性肺源性心脏病和呼吸衰竭将AECOPD患者分别分为肺源性心脏病组和非肺源性心脏病组,呼吸衰竭组和非呼吸衰竭组,分别比较各组超声心动图反映左心功能各项指标的差异及其与肺功能的关系.结果 ①肺源性心脏病组与非肺源性心脏病组年龄及性别比例差异无统计学意义;呼吸衰竭组与非呼吸衰竭组年龄及性别比例差异无统计学意义.②肺源性心脏病组左心室舒张末期内径[LVEDD(42.70±4.21) mm]和左心室舒张末期容积[LVEDV(85.18±19.05)ml]均小于对照组[LVEDD(46.27±5.03) mm;LVEDV(102.83±26.62) ml]和非肺源性心脏病组[LVEDD(45.04±4.42) mm;LVEDV(96.87±20,32) ml],P值均＜0.05;非肺源性心脏病组与对照组[LVEDD(46.27±5.03) mm;LVEDV(102.83±26.62) mm]比较差异无统计学意义.③肺源性心脏病组和非肺源性心脏病组二尖瓣口舒张早期血流速度二尖瓣1舒张晚期血流速度(E/A)均较对照组减小,肺源性心脏病组E/A小于非肺源性心脏病组,肺源性心脏病组、非肺源性心脏病组、对照组E/A分别为0.79±0.29,0.93±0.20,1.34±0.21,P值均＜0.05.④呼吸衰竭组(0.87±0.20)和非呼吸衰竭组(0.82±0.31)E/A均较对照组(1.34±0.21)减小,P值均＜0.05;呼吸衰竭组与非呼吸衰竭组比较差异无统计学意义.⑤AECOPD患者右心室内径(RVID)与LVEDD 、LVEDV和E/A均呈负相关,r值分别为-0.244、-0.221、-0.245,P值均＜0.05.⑥AECOPD患者第1秒呼气容积占预计值百分比与LVEDD和LVEDV均呈正相关,与右室流出道(RVOT)和RVID均呈负相关,r值分别为0.337、0.281、-0.276、-0.243,P值均＜0.05.⑦AECOPD患者残气量/肺总量与RVOT和RVID均呈负相关,r值分别为-0.5、-0.375,P值均＜0.05.结论 COPD患者存在左心室舒张功能受损.慢性肺源性心脏病患者左心室腔减小,左心舒张功能受损.随着肺功能损害严重程度的增加,左心室腔逐渐减小,右心室腔逐渐增大.     

风湿性心脏病患者发生心房颤动的临床因素分析

目的了解风湿性心脏病并发心房颤动(简称房颤)与临床相关因素的关系。方法将162例风湿性心脏病患者分为房颤组(n=87)和窦性心律(简称窦律)组(n=75),统计年龄、性别,换瓣前行心脏超声检查。测量两组患者左房内径(LAD)、右房内径(RAD)、右室内径(RVD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果与窦律组比较,房颤组年龄大,LAD、RAD、RVD增大,而LVEDD变小,LVEF降低(P<0.01)。单和多因素回归均显示LAD与房颤发生呈正相关(P<0.01),而LVEDD和LVEF与房颤呈负相关(P<0.01)。结论风湿性心脏病并发房颤主要与心脏结构发生的改变和血流动力学变化有关。     

心脉隆注射液治疗慢性阻塞性肺疾病急性加重期合并慢性肺源性心脏病的疗效观察

目的观察心脉隆注射液治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并慢性肺源性心脏病的临床疗效。方法选取2018年1月—2019年12月于九江市第一人民医院住院治疗的AECOPD合并肺源性心脏病病人共81例,随机分为心脉隆组(41例)与对照组(40例)。对照组病人给予常规治疗,心脉隆组在常规治疗的基础上加用心脉隆注射液治疗,比较两组病人治疗前后尿量、右室内径、肺动脉压(PAP)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)及治疗后6 min步行距离(6MWD)。结果两组治疗后尿量均较治疗前增加(P<0.05),且心脉隆组尿量较对照组明显增加(P<0.05);治疗后,两组右室内径均较治疗前明显缩小(P<0.05),NT-proBNP、PAP均较治疗前明显降低(P<0.05),LVEF均较治疗前明显升高(P<0.05),且心脉隆组右室内径小于对照组(P<0.05),NT-proBNP、PAP低于对照组(P<0.05),LVEF高于对照组(P<0.05);治疗后,心脉隆组6MWD大于对照组(P<0.05)。结论在常规治疗基础上加用心脉隆注射液治疗AECOPD合并肺源性心脏病,可减轻病人右心负荷,改善心功能,提高6MWD。     

稳心颗粒治疗慢性肺源性心脏病的疗效观察

目的 观察稳心颗粒治疗肺源性心脏病的疗效.方法 选择116例慢性肺源性心脏病患者,随机分为治疗组60例和对照组56例.对照组给予抗感染、通畅呼吸道、纠正缺氧、控制心力衰竭及平喘等治疗;治疗组在对照组治疗的基础上加用稳心颗粒1袋、3次/d冲服;两组均连接治疗1个月.观察两组患者治疗前后的心功能、心律失常、自觉症状的变化及药物不良反应等.结果 治疗1个月后,治疗组的总有效率显著高于对照组(P＜0.05),治疗组未发生严重的药物不良反应.结论 稳心颗粒治疗慢性肺源性心脏病安全有效.     

比索洛尔联合卡托普利对中老年原发性高血压患者血压及心功能的影响研究

目的探究比索洛尔联合卡托普利对中老年原发性高血压患者血压及心功能的影响。方法选取南阳市第二人民医院2013—2014年收治的中老年原发性高血压患者100例,随机分为对照组与观察组,每组50例。对照组患者给予氯沙坦联合卡托普利口服治疗,观察组患者给予比索洛尔联合卡托普利口服治疗。14 d为1个疗程,两组患者均治疗3个疗程。比较两组患者治疗前后舒张压(DBP)、收缩压(SBP)及心功能指标〔包括左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、心排血量(CO)、左房室瓣舒张早期血流频谱E峰/舒张晚期血流频谱A峰(E/A比值)〕,治疗期间不良反应发生情况。结果治疗前两组患者SBP、DBP比较,差异无统计学意义(P>0.05);治疗后观察组患者SBP、DBP均低于对照组(P<0.05)。治疗前两组患者LAD、LVEDD、LVEF、CO、E/A比值比较,差异无统计学意义(P>0.05);治疗后观察组患者LAD、LVEDD小于对照组,E/A比值高于对照组(P<0.05);治疗后两组患者LVEF、CO比较,差异无统计学意义(P>0.05)。观察组患者不良反应发生率为6.0%,对照组患者不良反应发生率为10.0%,差异无统计学意义(P>0.05)。结论比索洛尔联合卡托普利能有效降低中老年原发性高血压患者的血压,改善心功能,且不良反应较小。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。