丹参川芎嗪注射液治疗放射性肺损伤的疗效及其机制研究

目的观察丹参川芎嗪注射液对于胸部放疗后患者肺损伤发生率及血浆TGF-β1、TNF-α的影响。方法 112例患者分为两组,治疗组(丹参川芎嗪注射液+放疗)58例,对照组(放疗)54例,观察两组治疗前后血浆TGF-β1、TNF-α的变化以及治疗后放射性肺损伤的发生率。结果治疗前两组血浆TGF-β1、TNF-α含量比较无明显差异;治疗后治疗组较对照组明显降低,差异有统计学意义(P0.05)。治疗组放射性肺损伤的发生率较对照组减少。结论丹参川芎嗪注射液可减少放疗后患者血浆TGF-β1、TNF-α的升高幅度,预防急性放射性肺炎和放射性肺纤维化有一定的疗效,具有较好的安全性。     

血必净治疗对急性胰腺炎患者血浆炎性反应细胞因子的影响

目的:观察血必净注射液治疗对急性胰腺炎患者血浆CRP和炎性反应细胞因子水平的影响。方法:将42例急性胰腺炎患者随机分为试验组(21例)和对照组(21例)两组,对照组患者给予常规药物治疗,试验组在对照组的基础上加用血必净注射液治疗,总疗程2周。分别在治疗前和治疗后检测两组患者血浆中CRP、TNF-α、IL-6、IL-1β和TGF-β浓度,并比较两组患者肝肾功能相关指标的变化。结果:治疗前两组患者hs-CRP、TNF-α、IL-6、IL-1β和TGF-β水平差异均无统计学意义(P>0.05);治疗后,试验组患者hs-CRP、TNF-α和IL-6水平较治疗前显著降低(P<0.05),而TGF-β水平则较治疗前显著增高(P<0.05);治疗后,试验组患者TNF-α、IL-6水平的降低和TGF-β水平的增高较对照组更为显著(P<0.05);治疗后,试验组患者肝、肾功能有效改善。结论:血必净有效抑制促炎细胞因子的释放,上调抑炎细胞因子TGF-β表达量,纠正炎性反应细胞因子网络的失衡,对急性胰腺炎具有良好的治疗作用。     

芪参益肺汤对接受放疗的肺癌患者细胞因子的影响

目的探讨芪参益肺汤对接受放疗的肺癌患者细胞因子的影响和对放射性肺炎的防治作用。方法将95例接受放疗的肺癌患者按数字随机表法分为2组,每组55例,两组均给予肺癌三维适型放疗,治疗组同时给予中药芪参益肺汤口服。比较两组放射性肺炎症状严重程度和血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子β1(TGF-β1)水平。结果治疗组症状严重程度显著低于对照组(P0.05);血清IL-6、TNF-α、TGF-β1水平均低于对照组(P0.01),差异均有统计学意义。结论芪参益肺汤可有效保护肺功能,降低肺损伤,有临床应用价值。     

乙酰半胱氨酸泡腾片对放射性肺炎患者体液因子表达的影响*

目的 研究乙酰半胱氨酸泡腾片对肺癌患者放疗后发生放射性肺炎时体液因子表达的影响。方法 选取2016年5月—2017年7月河北北方学院附属第一医院收治的放疗后发生放射性肺炎并需继续放疗的肺癌患者80例。采用简单随机化方法分为观察组和对照组,每组40例。对照组给予单纯放射治疗,观察组在对照组基础上给予乙酰半胱氨酸泡腾片口服治疗。观察两组患者的治疗有效率,应用药物前后C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、转化生长因子-β（TGF-β）、表面活性物质结合蛋白（SP-A、SP-D）和谷胱甘肽（GSH）的表达情况。结果 治疗后,观察组治疗有效率85.00%,高于对照组（65.00%）（P?<0.05）;观察组患者CRP、TNF-α、IL-6、IL-8和IL-10水平均低于对照组（P?<0.05）;观察组患者SP-A、SP-D和GSH水平高于对照组（P?<0.05）。结论 乙酰半胱氨酸泡腾片可提高放射性肺炎临床治疗总有效率,降低炎症因子表达,提高SP-A、SP-D及GSH水平,值得临床推广。     

N-乙酰半胱氨酸雾化吸入对特发性肺纤维化患者 TGF-β1、IL-6、VEGF表达的影响

目的：探讨N-乙酰半胱氨酸对特发性肺纤维化的临床疗效,并分析其对患者肺泡灌洗液中 TGF-β1、IL-6、VEGF表达水平的影响。方法：收集我院2016年3月-2019年3月70例特发性肺纤维化患者,分析N-乙酰半胱氨酸对患者肺功能、纤维化指标以及肺泡中 TGF-β1、IL-6、VEGF的表达水平;结果：两组FVC、FEV1/FVC、DLCO以及血氧饱和度治疗后两组均有明显改善(P＜0.05)。观察组治疗前后PCIII差值为36.18±5.86ng/ml,明显高于对照组的15.64±3.63ng/ml,其余指标CIV、PICP、LN观察组差值均明显高于对照组(P＜0.05);TGF-β1、IL-6、VEGF观察组治疗前后TGF-β1、IL-6、VEGF治疗前后的差值显著高于对照组(P＜0.05);肺功能指标中,除FEV1外其余指标与TGF-β1均有明显的负相关性(r＜-0.5,P＜0.05),而纤维化指标中PCIII、CIV、PICP与TGF-β1均有明显的正相关性(r＞0.5,P＜0.05);IL-6与FEV1、LN无明显相关性;除FEV1及CIV外,其余肺功能与VEGF均表现出明显的负相关性(r＜-0.5,P＜0.05),与纤维化指标表现性出显著正相关性(r＞0.5,P＜0.05)。结论：N-乙酰半胱氨酸雾化吸入能够有效改善IPF患者的肺功能,并通过干预TGF-β1、IL-6、VEGF的表达水平改善患者的肺纤维化程度,值得临床推广应用。     

甲型H1N1流感合并肺炎患者外周血中细胞因子、C反应蛋白、T淋巴细胞计数的动态分析

目的探讨合并肺炎的甲型H1N1流感患者血浆中相关细胞因子、C反应蛋白(CRP)及T淋巴细胞计数在病程中的变化特征,为临床早期诊断与治疗提供参考。方法检测16例合并肺炎的住院甲型H1N1流感患者血浆中相关细胞因子[γ干扰素(IFN-γ),白细胞介素6(IL-6),白细胞介素8(IL-8),肿瘤坏死因子-α(TNF-α),转化生长因子-β1(TGF-β1)]水平、CRP及T淋巴细胞计数的变化。根据患者入院时血气分析中动脉血氧分压(PaO2)水平,分为重症组(PaO2<60 mm Hg)9例与轻症组(PaO2≥60 mm Hg)7例;另设健康对照组8例。结果治疗前后(发病第7天、14天采血样),各组IFN-γ,IL-6,IL-8,TNF-α等水平变化无统计学意义(P>0.05),各组间差异亦无统计学意义(P>0.05)。治疗前重症组TGF-β1水平较轻症组明显增加,差异有统计学意义(P<0.05),治疗后重症组TGF-β1仍维持较高水平,与治疗前相比差异无统计学意义(P>0.05),部分病例在恢复期(体温正常,气短减轻,血氧正常)发现肺纤维化征象。CRP水平的升高与低淋巴细胞血症在重症组和轻症组均常见,但重症组治疗...     

N-乙酰半胱氨酸联合噻托溴铵对慢性阻塞性肺疾病稳定期患者呼吸功能的影响

目的研究N-乙酰半胱氨酸联合噻托溴铵对慢性阻塞性肺疾病(COPD)稳定期患者呼吸功能的影响。方法将2018年5月至2019年5月该院收治的COPD患者80例依据随机数表法分为对照组和观察组,每组40例。所有患者均进行基础治疗,对照组加用噻托溴铵治疗,观察组在对照组基础上联用N-乙酰半胱氨酸治疗。研究两组患者治疗前后肺功能与血清炎性因子变化。结果治疗前,两组肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白介素-8 (IL-8)水平、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒率(FEV1/FVC)相比,差异无统计学意义(P0.05);治疗后,两组肺功能均有所改善,炎症因子水平均显著降低,与对照组相比,观察组CRP、TNF-α、IL-8水平均较低,FVC、FEV1/FVC、FEV1水平均较高,差异具有统计学意义(P0.05)。结论 N-乙酰半胱氨酸联合噻托溴铵治疗COPD稳定期可显著改善呼吸功能,降低炎症因子水平,具有较高临床推荐价值。     

N-乙酰半胱氨酸对稳定期慢性阻塞性肺疾病患者炎症反应及肺功能的影响

目的探讨N-乙酰半胱氨酸(NAC)对稳定期慢性阻塞性肺疾病(COPD)患者炎症反应及肺功能的影响。方法选择2017年9月—2019年1月我院收治的稳定期COPD患者118例,按随机数字表法分为两组,每组59例。对照组予以家庭肺康复指导,并口服阿奇霉素片;观察组在对照组基础上给予N-乙酰半胱氨酸治疗。比较两组治疗前后的血清炎症因子CRP、IL-8、TNF-α、GRO-α及肺功能水平,并对比两组不良反应发生率。结果两组治疗前CRP、IL-8、TNF-α、GRO-α、FEV_1、FEV_1/FVC水平相比,差异无统计学意义(P>0.05);观察组治疗后各炎症因子水平低于对照组,肺功能指标优于对照组,差异有统计学意义(P<0.001);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 N-乙酰半胱氨酸治疗稳定期COPD患者能够有效缓解其炎症反应状态,利于改善肺功能,且具有较高安全性。     

防纤汤对放射性肺炎大鼠的影响及作用机制

目的 研究防纤汤对放射性肺炎大鼠肺部组织病理、肺表面活性物质结合蛋白和炎症因子的影响,探讨防纤汤治疗放射性肺炎的疗效和作用机制。 方法 将90只SPF级雄性SD大鼠随机分空白组、模型组和3个治疗组(低剂量组、中剂量组和高剂量组),利用6 mV X射线对治疗组、模型组大鼠全胸照射,总剂量20 Gy,进行放射性肺炎大鼠造模处理,治疗组予灌胃防纤汤,模型组及空白组予灌胃等量生理盐水。照射后第1天灌胃用药直至照射后6周,照射后第2、4、8周每组随机取6只大鼠取材,在HE染色光镜下观察肺组织病理形态学变化,免疫组化法检测白细胞介素-3(IL-3)、白细胞介素-6(IL-6)、白细胞介素-7(IL-7)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)、C 反应蛋白(CRP)、肺表面活性物质结合蛋白(SP-A、SP-D)水平,并作相关性分析。 结果 与模型组相比,治疗组大鼠肺组织充血及水肿较轻或无,炎症细胞浸润性少或无,间质内存在较少或无胶原纤维增生。与空白组比较,模型组、治疗组IL-3、IL-6、IL-7、TNF-α、TGF-β、CRP水平均明显升高(中剂量治疗4周,P值分别为0.012、0.033、0.027、0.018、0.024、0.009),SP-A、SP-D水平均明显降低(中剂量治疗4周,P值分别为0.004、0.005);与模型组比较,治疗组IL-3、IL-6、IL-7、TNF-α、TGF-β、CRP水平均明显降低(P<0.05),SP-A、SP-D水平均明显升高(P<0.05)。相关性结果分析发现,IL-6与SP-A、SP-D呈强负相关性,IL-3、IL-7与SP-A、SP-D呈负相关性,TNF-α、TGF-β与SP-A、SP-D呈弱正相关性。不同剂量的治疗组对大鼠肺组织病理和所检测的体液因子的影响具有剂量相关性。 结论 防纤汤改善放射性肺损伤炎性程度的疗效明确。SP-A、SP-D的变化与IL-3、IL-6、IL-7、TNF-α、TGF-β具有相关性,推测防纤汤的作用机制是通过上调SP-A、SP-D水平,抑制炎症因子IL-3、IL-6、IL-7的释放。     

谷氨酰胺对急性肺损伤患者的保护作用与机制研究

目的:探讨谷氨酰胺对急性肺损伤患者外周血单核细胞表面Toll样受体(TLR4)、肿瘤坏死因子(TNF-α)、白细胞介素-1β(IL-1β)的影响。方法:80例急性肺损伤患者随机分为观察组和对照组,每组各40例。对照组实施常规治疗及护理,观察组在此基础上给予谷氨酰胺注射治疗。检测两组不同时间点血浆中TLR4、TNF-α和IL-1β的水平。结果:治疗7 d和14 d后,观察组血浆TLR4、TNF-α和IL-1β水平均低于对照组,两组比较差异具有统计学意义(P<0.05)。结论:谷氨酰胺能够降低急性肺损伤患者体内TLR4、TNF-α及IL-1β水平,对急性肺损伤患者具有一定程度的保护作用,并同时缓解促炎性细胞因子介导的多器官组织损害。     

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.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.