免疫学检验联合检测在类风湿关节炎诊断中的临床价值

目的:探讨免疫学检验联合检测在类风湿关节炎临床诊断中的价值。方法:选择2019年3月—2020年3月收治的非类风湿关节炎患者37例设为A组,选择同期收治的类风湿关节炎患者37例设为B组,两组均开展免疫学检验联合检测,总结分析两组临床检验结果。结果:B组患者的类风湿因子(RF)、抗角蛋白抗体(AKA)以及抗环瓜氨酸多肽抗体(抗CCP)阳性检出率均高于A组,差异有统计学意义(P<0.05);B组的IgG水平明显高于A组,补体C3与补体C4低于A组,两组比较差异均有统计学意义(P<0.05)。结论:免疫学检验联合检测用于类风湿关节炎的临床诊断,可有效提高类风湿关节炎疾病诊断的准确性。     

尖吻蝮蛇血凝酶对腹部手术切口止血作用的有效性和安全性

目的评价尖吻蝮蛇血凝酶在腹部手术切口的止血作用及对凝血功能的影响及其安全性.方法随机、盲法、平行对照的多中心研究.180例外利腹部择期中等手术患者分为高剂量组(A),低剂量组(B)和安慰剂组(C)三组,各60例.A组予尖吻蝮蛇血凝酶3U,B组予2U,C组给予0.8%右旋糖苷,术前15 min静脉注射.观察腹部手术切口出血的止血时间、出血量、单位面积出血量及机体凝血功能和安全性.结果A,B,C三组的平均止血时间分别为(37.5±21.4),(37.5±19.),(59.7±25.1)s,切口出血量分别为(1.83±1.32),(1.86±1.03),(3.47±1.55)g,单位面积出血量分别为(0.030±0.017),(0.033±0.014),(0.077±0.033)g·cm-2.A和B组3方面结果相似(P＞0.05);B组3方面的结果均明显少于C组(P＜0.01),A和B组的止血效果明显优于C组.三组凝血指标和全血黏度结果相似.无不良事件.结论尖吻蝮蛇血凝酶对腹部切口毛细血管出血有较好的止血作用和安全性,疗效不随药物剂量增加而增加.     

异甘草酸镁及泮托拉唑钠联合生长抑素治疗重症急性胰腺炎的效果观察

目的 探讨异甘草酸镁、泮托拉唑钠、生长抑素联合治疗重症急性胰腺炎(SAP)的疗效及安全性.方法 收集SAP患者123例,随机分为A组、B组、C组,A组给予异甘草酸镁注射液治疗.B组给予泮托拉唑钠、生长抑素联合治疗.C组给予异甘草酸镁、泮托拉唑钠、生长抑素联合治疗.比较3组治疗前后的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症指标及尿素氮、谷丙转氨酶、氧合指数等脏器功能指标变化情况及腹痛缓解时间、胃肠道功能恢复时间及撤离呼吸机时间.结果 治疗后,A组CRP、TNF-α、IL-6水平分别为(36.5±4.6) mg/L、(28.6±6.5)pg/L、(125.8±30.1) pg/L,B组为(34.7±5.1) mg/L、(29.0±6.2) pg/L、(123.4±28.7) pg/L,C组为(19.4±5.0)mg/L、(22.4±5.7)pg/L、(91.4±20.3)pg/L,3组CRP、TNF-α、IL-6水平均较治疗前明显降低(P＜0.05),而C组降低程度最明显(P＜0.05).A组腹痛缓解时间、胃肠道功能恢复时间、撤离呼吸机时间分别为(3.2±0.5)d、(3.2±0.9)d、(4.2±0.8)d,B组为(3.3±0.6)d、(3.1±0.8)d、(4.1±0.7)d,C组为(1.7±0.6)d、(2.4±0.6)d、(2.8±0.6)d,C组腹痛缓解时间、胃肠道功能恢复时间、撤离呼吸机时间均显著低于A、B组(P＜ 0.05).治疗后,A组氧合指数、尿素氮、谷丙转氨酶水平分别为(310.8±51.3)mmHg(1 mmHg=0.133 kPa)、(8.6±2.4) mmol/L、(48.5± 10.1) U/L,B组为(315.9 ±54.0)mmHg、(8.4±2.6)mmol/L、(49.6±9.8)U/L,C组为(463.7±92.0) mmHg、(6.1±1.4) mmol/L、(29.2±8.4)U/L,3组氧合指数均较治疗前明显升高(P＜0.05),尿素氮、谷丙转氨酶水平较治疗前明显降低;治疗后,C组氧合指数较A组、B组明显升高(P＜0.05).C组的总有效率(90.2％)明显高于A组(68.3％)、B组(68.3％)(P＜ 0.05).结论 异甘草酸镁、泮托拉唑钠、生长抑素联合治疗SAP能明显改善患者的炎症反应,改善其体征及临床症状,保护脏器功能,提高临床疗效,值得临床推广应用.     

类风湿关节炎合并肺间质病变与类风湿因子、抗环瓜氨酸肽抗体、涎液化糖链抗原 -6相关性

目的探讨类风湿因子( RF)抗环瓜氨酸肽( CCP)抗体，涎液化糖链抗原 -6(KL-6)在类风湿关节炎( RA)合并肺间质病变( ILD)病人中的表达及与疾病的相关，性。方法回顾性研究 2018年 5月至 2021年 5月大同市第五人民医院收治的 125例 RA病人，根据病人病情分为单纯 RA组及 RA合并 ILD组，按照年龄、性别随机分层选择 60例健康体检者为对照组。收集一般资料，比较三组研究对象的年龄、性别、 C-反应蛋白( CRP)、红细胞沉降率( ESR)、疾病活动性评分( DAS28)、免疫球蛋白 A(IgA)、免疫球蛋白 G(IgG)、免疫球蛋白 M(IgM)、用力肺活量( FVC)、第一秒用力呼吸末容积( FEV1)、第一秒用力呼吸末容积与用力肺活量比值( FEV1/FVC)等指标；采用酶联免疫吸附法检测血清中 RF、抗 CCp、KL6表达水平， Pearson法分析 RF、抗 CCp、KL6与相关指标表达的相关性，采用多重线性回归分析 RA合并 ILD病人 RF、抗 CCp、KL6表达水平的影响因素。利用受试者工作特征( ROC)曲线评价血清 RF、抗 CCp、KL6水平对 RA合并 ILD病人的诊断价值。结果 RA合并 ILD组与单纯 RA组病人血清中 RF［( 572.25±118.54)、(312.66±58.23)IU/mL)］、抗 CCp［( 255.44±74.56)、(152.36±50.28)IU/mL］、 KL6［( 619.12± 205.68)、(363.70±51.87)U/mL］表达水平均高于健康对照组［( 85.51±9.49)IU/mL，(63.83±11.85)IU/mL，(317.25±48.87)U/mL］，且 RA合并 ILD组高于单纯 RA组( P<0.05)； RA合并 ILD病人血清中 RF、抗 CCp表达呈正相关( r=0.45，P<0.05)，RF与 KL6表达呈正相关( r=0.44，P<0.05)，抗 CCp、KL6表达呈正相关( r=0.42，P<0.05)； RA合并 ILD病人血清中 RF、抗 CCp、KL6表达与 CRP、 ESR、DAS28、CRP、ESR、DAS28表达均呈正相关，与 FVC、FEV1表达均呈负相关( P<0.05)。三者联合检测 RA合并 ILD病人的 AUC 95%CI为 0.99(0.96，1.00)灵敏度和特异度分别为 97.96%、96.05%。结论在 RA合并 ILD病人血清中 RF、抗 CCp、KL6表达水平明显升高，且联合检测三，者对诊断 RA合并 ILD病人具有重要意义。     

3种高血压药物治疗方案的最小成本分析

目的:评价3种高血压药物治疗方案的经济学效果。方法:对69例患者分别采用的以依那普利(A组)、氯沙坦(B组)、非洛地平(C组)为主要降压药的治疗方案进行最小成本分析。结果:3组临床疗效无显著性差异(P>0.05),A组的总成本为(922.07±649.06)元,降压总成本为(487.54±173.13)元;B组总成本为(1981.99±791.83)元,降压总成本为(1056.30±375.70)元;C组总成本为(1054.09±445.75)元,降压总成本为(706.23±219.63)元。结论:从药物经济学角度看,A方案为较佳选择。     

阿托伐他汀钙联合非诺贝特治疗混合型高脂血症合并高尿酸血症的临床观察

目的 探讨阿托伐他汀钙联合非诺贝特治疗高脂血症合并高尿酸血症的疗效及安全性。方法 选择混合型高脂血症伴高尿酸血症患者182例,按照随机数字表法分为A组60例,B组61例和C组61例。A组患者每次给予阿托伐他汀钙10 mg·d-1,口服;B组患者每次给予非诺贝特200 mg·d-1,口服;C组患者每次给予阿托伐他汀钙10 mg·d-1加非诺贝特200 mg·d-1,口服。比较血清总胆固醇(TC)、低密度脂蛋白(LDL-C)、甘油三酯(TG)、高密度脂蛋白(HDL-C)和血尿酸(BUA)的变化及用药过程中的不良反应。结果 治疗8周后, 3组患者的TG[A、B、C组分别为(2.95±0.35)、(1.54±0.29)、(1.64±0.35) mmol·L-1]、TC[A、B、C组分别为(4.68±0.53)、(5.20±0.64)、(4.20±0.42) mmol·L-1]、LDL-C[A、B、C组分别为(2.95±0.35)、(1.54±0.29)、(1.64±0.35) mmol·L-1]均较治疗前TG[A、B、C组分别为(3.52±0.40)、(3.48±0.45)、(3.66±0.38) mmol·L-1];TC[A、B、C组分别为(6.55±0.89)、(6.31±0.67)、(6.33±0.73) mmol·L-1]; LDL-C[A、B、C组分别为(3.35±0.52)、(3.23±0.46)、(3.31±0.44) mmol·L-1]降低,HDL-C[A、B、C组分别为(1.39±0.35)、(1.49±0.29)、(1.52±0.33) mmol·L-1]较治疗前[A、B、C组分别为(1.35±0.37)、(1.32±0.30)、(1.28±0.36) mmol·L-1]上升,总体差异有统计学意义(P＜0.05)。治疗后B组和C组患者血清TG均低于A组(P＜0.05),且B组、C组的血清HDL-C均高于A组(P＜0.05)。A组和C组患者血清TC和LDL-C均低于B组(P＜0.05)治疗后B组和C组患者BUA水平[分别为(298.5±39.9)、(282.7±45.6) μmol·L-1]显著低于A组(391.3±55.2 μmol·L-1)(P＜0.05)。3组患者不良反应的发生率(A、B、C组分别为13.33%、6.56%、11.48%)差异无统计学意义(P＞0.05)。结论 阿托伐他汀钙联合非诺贝特能有效降低高脂血症合并高尿酸血症患者血清TG、TC、LDL-C和BUA的水平,同时升高HDL-C的水平,且不良反应发生率低,值得临床推广。     

不同剂量巴曲亭对术中出渗血量及机体出凝血功能影响的研究

目的:研究不同剂量巴曲事用以减少术中出渗血量及对机体出凝血功能的影响。方法:60例ASA Ⅰ-Ⅱ级行择期全子宫切除术的病人,随机分为对照组(A组)、巴曲亭2KU组(B组)及巴曲亭4KU(C组)三组,切皮前5分钟分别予以生理盐水、巴曲亭2KU、巴曲亭4KU。分别于切皮前和术毕采血检测血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)及血常规检查,并测定术中出血量。结果:A组病人术毕Hb、RBC、PLT、Hct水平较给药前显著下降,PT、APTT有所延长,Fbg变化不明显。B、C组术毕FIB值较给药前显著下降,其他指标变化不大。组间比较,B、C组术毕Hb、RBC、PLT、Hct水平较A组显著升高,B、C组间无显著性差异。B、C组术毕FIB值较A组显著下降,两组间无显著性差异,三组间PT及APTT变化不明显。术中出血量A组为268.8±46.6ml,B组为183.4±37.3ml,C组为192.5±52.7ml。B、C组术中出血量较A组显著下降,B、C组间无明显差异。结论:术前应用巴曲亭2～4KU可显著改善病人的凝血功能,减少术中出血量。     

透明角膜小切口白内障超声乳化术后角膜散光的变化

目的评价角膜地形图引导的透明角膜小切口超声乳化白内障吸除折叠式人工晶体植入术后角膜散光的变化。方法将119例(130只眼)白内障患者分为A、B、C三组,A组为对照组,B组为循规性散光组,C组为逆规性散光组;A、B两组行上方透明角膜切口,C组行颞侧透明角膜切口,行超声乳化白内障吸除折叠式人工晶体植入,比较术后角膜散光的变化情况。结果A、B、C三组术后90d平均手术性角膜散光度分别为(0.64±0.65)D、(0.75±0.58)D和(0.69±0.55)D,两两比较无显著性差异(P>0.05);平均角膜散光度A组较术前增加0.07D,B、C两组较术前减少0.34、0.37D,与A组比较有显著性差异(P<0.05)。结论以透明小切口行超声乳化白内障吸出折叠式人工晶体植入术,术后角膜散光度小,角膜地形图可准确反映角膜曲率变化,对指导术前角膜切口位置的选择及评价白内障术后角膜散光的变化具有重要的临床意义。     

经伤椎单双侧置钉与不置钉治疗胸腰段骨折的疗效比较

目的比较后路短节段经伤椎单双侧置钉与不置钉治疗胸腰段椎体骨折的临床疗效。方法采用回顾性分析的方法,自 2017年 1—12月,安徽医科大学附属六安医院采用后路短节段椎弓根钉内固定术治疗胸腰段单一椎体骨折病人 98例。根据伤椎置钉多少分为三组:跨伤椎置钉组( A组) 32例,单侧伤椎置钉组( B组) 28例,双侧伤椎置钉组( C组) 38例,随访时间范围为 12~20个月,平均 16.2个月,对三组病人的术中、术后及末次随访相关指标进行比较。结果三组病人的手术时间［A组(88.00±11.75)min,B组( 87.63±11.85)min,C组( 89.97±11.28)min,F＝0.405］、术中出血量［A组( 107.81±16.09)mL,B组(111.72±20.02)mL,C组( 113.43±19.18)mL,F＝0.825］、术后疼痛视觉模拟评分( VAS)［A组( 3.19±0.93)分, B组( 3.36±0.83)分, C组(3.34±0.77)分, F＝0.383］、术后第 3天的伤椎前缘高度比［A组(96.07±2.23)%,B组(96.79±2.90)%,C组( 96.75±3.76)%,F＝0.545］及矢状位 Cobb角［A组( 5.07±1.95)°,B组( 4.40±1.34)°,C组( 4.29±1.66)°,F＝2.060］比较均差异无统计学意义( P＞0.05)。末次随访时, B、C组病人的伤椎前缘高度比［A组( 92.79±1.97)%,B组( 94.12±2.00)%,C组( 95.00±1.70)%,F＝12.079］、矢状位 Cobb角［A组( 7.77±1.87)°,B组( 6.47±1.54)°,C组( 6.38±1.58)°,F＝7.046］、伤椎复位丢失情况［高度丢失: A组( 3.01±1.18)%,B组( 2.26±0.87)%,C组( 1.83±0.60)%,F＝15.175;角度丢失: A组(2.68±1.06)°,B组( 2.07±0.85)°,C组(2.11±0.86)°,F＝4.349］与A组病人相比差异有统计学意义( P＜0.05),B组与 C组病人相比差异无统计学意义( P＞0.05)。结论经伤椎置钉与传统的跨伤椎置钉相比在治疗胸腰段椎体骨折上能更有效的降低后期复位椎体高度的丢失和减少迟发型后凸畸形的发生;单侧置钉与双侧置钉疗效相似。     

rhFGF与rhEGF分期使用修复深Ⅱ度烧伤创面的临床观察

目的:观察分期使用重组牛碱性成纤维细胞生长因子(rhFGF)与重组人表皮细胞生长因子(rhEGF)治疗深Ⅱ度烧伤创面愈合的临床疗效。方法:随机选择同一患者4处深度相同、部位相应的创面进行自身对照,4处创面分别标记为A、B、C、D,20例深Ⅱ度烧伤患者共80个创面,相应归为A、B、C、D组:A组创面采用rhEGF治疗,B组创面采用rhFGF治疗,C组创面先使用rhFGF,10d后使用rhEGF治疗,D组创面为0.9%氯化钠对照组。观察创面完全愈合所需要的时间、创面愈合质量,以及全身和局部反应。结果:A组的平均愈合时间为(18.20±1.67)d,B组为(19.15±2.01)d,C组为(16.45±1.57)d,D组为(23.65±2.41)d。A、B、C组的平均愈合时间较D组短,C组的平均愈合时间较A、B组短,差异均具有统计学意义(P<0.05);A组与B组相比,愈合时间无显著性差异(P>0.05)。A、B、C组的平均愈合质量比D组好。各组治疗期间未见明显的全身或局部不良反应。结论:分期使用rhFGF和rhEGF能有效促进深Ⅱ度烧伤创面的愈合和修复,缩短愈合时间。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.