青岛港中老年人群血浆同型半胱氨酸分布特点及危险因素分析

目的:了解青岛港中老年人群血浆总同型半胱氨酸在不同性别、年龄组的分布特点,分析血浆总同型半胱氨酸与相关危险因素的关系。方法:于2000-03以山东青岛港年龄40岁以上中老年职工3940名为研究对象。根据心脑血管疾病危险因素进行问卷调查:①调查表:一般情况(被调查者的年龄、性别、职业及婚姻等情况)、既往病史(冠心病史、脑卒中史等)、个人史(如吸烟史、饮酒史)及家族史等。②体格检查:包括身高、体质量、血压的测量,心肺查体。③心电图检查。④血液学检查(包括血糖、血脂分析、血浆总同型半胱氨酸、血肌酐等)。高血浆总同型半胱氨酸血症诊断标准:按照整个体检人群75%的总同型半胱氨酸水平作为分组标准,即17μmol/L为分界点。高于此分界点为高总同型半胱氨酸血症。对总同型半胱氨酸的分布特点及传统心脑血管疾病危险因素进行统计学分析。结果:调查纳入3940名,男2937名,女1003名;平均年龄(53±9)岁。3940名入选者血浆总同型半胱氨酸分布范围为2.53～115.77μmol/L。①血浆总同型半胱氨酸的几何均数:男性为14.98μmol/L,女性为11.33μmol/L,男性高于女性(P<0.001)。②各年龄组男性总同型半胱氨酸水平均高于女性(各组P<0.05);年龄>60岁组血浆同型半胱氨酸水平男、女均高于年龄<60岁组(P<0.05)。③Logistic回归分析:男性、年龄、收缩压、体质量指数、肌酐清除率和心脑血管疾病史是血浆总同型半胱氨酸升高的危险因素。结论:①青岛港中老年人群血浆总同型半胱氨酸水平存在年龄、性别差异。②血浆总同型半胱氨酸的主要危险因素包括男性、年龄、收缩压、体质量指数、肌酐清除率和心脑血管疾病史。     

中青年脑梗死与高同型半胱氨酸血症的关系

背景：高同型半胱氨酸血症是冠心病的一个新的独立危险因素，但与脑血管疾病的关系尚有争议，空腹血浆总同型半胱氨酸水平难以完全揭示高同型半胱氨酸血症对脑梗死的影响。目的：探索高同型半胱氨酸血症及叶酸、维生素B12等营养因素和中青年脑梗死的关系，以及蛋氨酸负荷试验对于发现隐匿性高同型半胱氨酸血症的作用。设计：病例-对照实验。Spearman相关分析。对象：选择2000／2003解放军海军总医院神经内科发病2d内收住入院的脑梗死患者85例。男63例。女22例；年龄29-55岁，平均（48．74&;#177;5．05）岁。腔隙性脑梗死48例，动脉血栓性脑梗死37例。同期选择本科医务工作者及本院体检健康志愿者44名作为正常对照组，男30名，女14名，年龄29-55岁。平均（47．75&;#177;6．71）岁。方法：住院第1天空腹抽取静脉血6mL，取2mL测定空腹血浆总同型半胱氨酸水平利用高效液相色谱法，空腹采血后即刻口服蛋氨酸0．1g／kg，4h后再次取血检测血浆总同型半胱氨酸水平；取其余4mL空腹抽取的静脉血检测血清叶酸、维生素B12采用化学发光法。主要观察指标：①脑梗死组与对照组空腹及负荷后血浆总同型半胱氨酸水平。②脑梗死组与对照组高同型半胱氨酸血症发生率[以高于正常对照组空腹或／和负荷后4h血浆总同型半胱氨酸水平95％参考范围的上限作为诊断高同型半胱氨酸血症的标准，即空腹，男性〉17．26μmol/L，女性〉14．17μmol／L；负荷后，男性〉44．57μmol/L，女性〉40．02μmol/L]。③脑梗死组与对照组血清叶酸、维生素B12水平。④血浆总同型半胱氨酸水平与相关危险因素的单因素分析。结果：85例脑梗死患者，44例正常对照组均进入结果分析。①脑梗死组与对照组空腹及负荷后血浆总同型半胱氨酸水平：脑梗死组空腹及负荷后显著高于对照组[（22．49&;#177;9．80），（13．08&;#177;2．33）μmol／L；（48．07&;#177;11．20），（37．23&;#177;3．48）μmol／L，（t=8．409，8．187，P〈0．01）]。②脑梗死组与对照组高同型半胱氨酸血症发生率：脑梗死组显著高于对照组[68％（58／85），（9％，4／44），X^2=40．628，P〈0．01]，其中空腹血浆总同型半胱氨酸水平高于正常35例（41％，35／85），负荷后血浆总同型半胱氨酸水平高于正常23例（27％，23／85）。③脑梗死组与对照组血清叶酸、维生素B12水平：脑梗死组显著低于对照组[（5.73&;#177;2.52），（7．14＋2．20）μg/L；（473．47&;#177;190．19），（576．70&;#177;212．05）ng／L，（t=3．151，2．809，P〈0．01）]。④血浆总同型半胱氨酸水平与相关危险因素的单因素分析：空腹及负荷后血浆总同型半胱氨酸水平与性别、叶酸及维生素B12均具有显著性相关（r=0．306-0．488，P〈0．01），而与其他危险因素及神经功能缺损评分无相关性（r=0．021-0．173，P〉0．05），仅空腹血浆总同型半胱氨酸水平与空腹血糖水平呈显著正相关（r=0．186，P〈0．05）。结论：高同型半胱氨酸血症是中青年脑梗死的一个独立的危险因素，而蛋氨酸负荷试验是发现隐匿性高同型半胱氨酸血症必要手段，叶酸与维生素B12缺乏是引起高同型半胱氨酸血症间接导致脑梗死的重要营养因素。     

同型半胱氨酸两种不同类型标本测定结果比较

目的研究以不同类型标本测定同型半胱氨酸结果的差异及与临床符合情况。方法将研究对象分成两组，心脑血管疾病组50例，对照组50例。分别采血分离血浆与血清，以血浆和血清标本分别进行同型半胱氨酸测定。结果心脑血管组的血清和血浆测定结果（以；±5d表示）分别为（29．52±10．54）μmol／L和（18．64±9．04）μmol／L。对照组的血清和血浆测定结果分别为（16．28±4．36）μmol／L和（9．53±4．83）μmol／L。结论·测定同型半胱氨酸时，最好以血浆标本测定，其结果更符合临床实际。     

复发性脑梗死患者血浆同型半胱氨酸水平及相关因素分析

目的 探讨复发性脑梗死患者血浆同型半胱氨酸水平特点,并对其相关因素进行分析。方法测定45例复发性脑梗死（RCI）、84例初发性脑梗死（FCI）患者的血浆同型半胱氨酸、三酰甘油、胆固醇、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）水平并进行分析。结果RCI组的同型半胱氨酸为17．70±7．57μmol／L．FCI组同型半胱氯酸为14．28±4．92μmol／L,差异有统计学意义（P〈0．05）;RCI组高同型半胱氨酸发生率（55．5％）高于FCI组（36．9％）,差异有统计学意义（P〈0．05）。高同型半胱氨酸与脑梗死复发相对危险度（OR）值为2．34,高血压、糖尿病、冠心病与脑梗死复发密切相关,OR值分别为3．64、2．34和2．58。结论除高血压、糖尿病、冠心病是脑梗死复发的传统危险因素外,高同型半胱氨酸是脑梗死复发的又一新的危险因素。     

腔隙性脑梗死患者血浆同型半胱氨酸指标检测及其结果分析

目的 探讨腔隙性脑梗死患者血浆同型半胱氨酸指标变化及其临床意义,并分析血浆同型半胱氨酸水平与年龄关系.方法 用日立7600-020全自动生化分析仪,采用速率法测定117 例腔隙性脑梗死患者血浆同型半胱氨酸指标,并测定98名健康对照者血浆同型半胱氨酸进行对比分析.结果 腔隙脑梗死患者组血浆同型半胱氨酸水平（18.43±4.80μmol/L）显著高于健康对照组（11.66±3.40μmol/L）,P〈0.01.健康组显示血浆同型半胱氨酸水平随年龄增长而增高.结论 腔隙性脑梗死患者血浆同型半胱氨酸水平比健康者显著升高,在排除年龄和性别因素后,患者组血浆同型半胱氨酸水平仍显著高于对照组.可视为腔隙脑梗死的独立危险因素.     

青岛港人群高尿酸血症患病率与心血管病危险因素的关系

目的：调查青岛港人群中血尿酸分布特点，分析其与心血管病危险因素的关联。方法：调查于2000—04／12完成。选择18-54岁青岛港职工11926名，从中整群抽样8640名进行了尿酸测定，均自愿参加调查。调查内容包括问卷、体格检查、实验室检查和特殊检查。通过问卷收集一般资料、个人疾病史、饮食和生活习惯和家族史等。测量职工的血压、身高及体质量。抽取空腹12h以上的静脉血，测定生化指标，血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿酸均用酶法测定，肌酐用苦味酸法测定。尿酸与心血管病的传统危险因素为血压、超重和肥胖、血糖、血脂。高尿酸血症为男性尿酸≥416μmol／L，女性尿酸≥357μmol／L。 结果：纳入青岛港职工8640名，全部进入结果分析，无脱落；①青岛港职工尿酸水平及高尿酸血症分布：男性尿酸水平明显高于女性[（320．0&;#177;66．1），（250．6&;#177;56．3）μmol／L]。男性总高尿酸血症患病率明显高于女性[7．3％，3．3％（χ^2=46．2，P〈0．01）]。②血浆尿酸与传统心血管病危险因素的相关性：除了男性年龄、血糖水平与尿酸水平无显著相关外，其他各因素均与尿酸有显著相关性（r=-0．128-0．286，P〈0．01）。③不同尿酸水平职工的心血管病危险因素水平比较：根据高尿酸血症评估标准，将全部职工按性别分别分为正常尿酸组和高尿酸血症组。除男性年龄、女性高密度脂蛋白胆固醇和心率外，两组间其他各危险因素水平比较．差异均有显著性意义（P〈0．05—0．01）。④不同尿酸水平职工的高血压、糖尿病、血脂异常等患病率比较：无论男女，高尿酸血症组的高血糖（空腹血糖受损＋糖尿病）、高血压、血脂异常和超重（包括肥胖）患病率均显著高于正常尿酸组（在20．33—249．30，P〈0．01）。（5）不同尿酸水平职工危险因素的个体聚集情况：无论男女2个及2个以上的危险因素的聚集比率在高尿酸血症组显著高于正常尿酸组[男：62．0％，29．2％；女：44．9％，13．2％（χ^27．75-164．20，P〈0．05-0．01）]。 结论：青岛港职工中高尿酸血症患病率较高，血尿酸水平与传统心血管病危险因素紧密相关，提示尿酸可以作为中国人心血管病危险因素的标志物。     

高血压病及其血管病变患者血浆同型半胱氨酸检测的临床价值

目的探讨高血压病及其血管并发症患者血浆同型半胱氨酸（Hcy）检测的临床意义。方法选取105例高血压病作为研究对象，其中单纯高血压病患者33例合并冠心病患者28例，合并糖病患者23例，合并脑梗死患者21例，另抽取同期健康体检者30名作为对照组，采用循环酶法检测Hcy水平。结果高血压病患者血浆Hcy水平（16．72±3．70μmol／L）高于对照组（10．91±2．31μmol／L），差异具有统计学意义（P〈0．05）；同时高血压病合并冠心病、糖尿病及脑梗死患者血浆Hcy水平（20．81±4.26μmol,／L，21．15±4．85μmol／L，23．35±5．39μmol／L）与对照组比较均明显升高（P〈0．05）。结论高血压病患者Hcy水平增高可能在高血压病及其血管病变的发生发展中起着一定的作用，是心脑血管疾病的独立危险因素。     

影响冠心病病人同型半胱氨酸水平的主要非遗传因素分析

目的 分析影响冠心病人血浆同型半胱氨酸水平的主要非遗传因素.方法 164例住院冠心病患者,测定血浆同型半胱氨酸水平并分析其与全血叶酸、血浆维生素B12、血清雌二醇浓度以及冠心病传统危险因素之间的关系.结果 血浆同型半胱氨酸水平与叶酸、维生素B12水平呈负相关,男性血浆同型半胱氨酸浓度高于女性[（20.74±13.42）×10-6mol/L比（15.56±8.16） ×10-6mol/L,P〈0.05],吸烟者高于不吸烟者[（22.29±15.18）×10-6mol/L比（17.21±9.54） ×10-6mol/L,P〈0.05].结论 叶酸、维生素B12、性别和吸烟是影响冠心病患者血浆同型半胱氨酸水平的主要非遗传因素.     

盐酸氟桂利嗪对同型半胱氨酸诱导人脐静脉内皮细胞株黏附分子表达的干预

目的：观察盐酸氟桂利嗪对同型半胱氨酸诱导的人脐静脉内皮细胞株黏附分子表达的影响。 方法：实验于2005-02／08在西京医院神经内科实验室完成。人脐静脉内皮株细胞培养，取第4—7代指数生长期细胞，接种到96孔板，24h细胞贴壁后换液，加入药物处理，随机分为正常对照组、同型半胱氨酸组及盐酸氟桂利嗪组3组，正常对照组，仅予空白RPMI-1640培养基培养24h；同型半胱氨酸组，分别加入终浓度为100μmol／L、200μmol／L、500μmol／L．1000μmol/L的同型半胱氨酸培养24h；盐酸氟桂利嗪组：加入终浓度为10μmmol／L盐酸氟桂利嗪及终浓度分别为100μmol／L、200μmol／L、500μmol／L、1000μmol／L的同型半胱氨酸，培养24h。以上每组各种浓度共8孔。用ELISA法检测各组不同培养条件下可溶性细胞间黏附分子1和可溶性血管细胞黏附因子1的吸光度值（波长490nm）。 结果：同型半胱氨酸组中随着培养液同型半胱氨酸浓度的增加可溶性细胞间黏附分子1的吸光度值从（0．143&;#177;0.013）增至（0．175&;#177;0．006），与对照组相比差异有显著性意义（P〈0．01）；可溶性血管黏附分子1从（0．112&;#177;0．008）增至（0．147&;#177;0．014）．与对照组相比差异有显著性意义（P〈0．01）；10μmmol／L的盐酸氟桂利嗪＋100μmol／L同型半胱氨酸组与相同浓度的同型半胱氨酸组相比吸光度值也减少．差异无显著性意义（P〉0．05）；10μmmol／L的盐酸氟桂利嗪＋200μmol／L、500μmol／L、1000μmol／L同型半胱氨酸组的吸光度均低于相同浓度的同型半胱氨酸组．差异有显著性意义（P〈0．01）；表明盐酸氟桂利嗪明显抑制同型半胱氨酸所诱导的可溶性细胞间黏附分子1和可溶性血管细胞黏附因子1的表达。 结论：盐酸氟桂利嗪能够减少同型半胱氨酸引起的人脐静脉内皮细胞株黏附分子的上调，可能对细胞具有保护作用。     

体检人群同型半胱氨酸检测分析

目的了解长沙地区体检人群体内血清同型半胱氨（Hey）浓度水平和特点,分析讨论旨在引起对Hcy常规检测的重视。方法基于小分子捕获技术（SMT）的S-腺苷同型半胱氨酸的方法。结果341例人群血清Hcy浓度（μmol／L）43．25±19．23,71．26（243／341）的结果高于正常值5～15μmol／L水平,男性血清Hey浓度（μmol／L）48．97±20．52,女性Hcy浓度（μmoL／L）26．03±11．35,不同性别血清Hcy浓度差异有统计学意义（P〈0．05）,随年龄的增加血清Hey浓度增加明显,差异有统计学意义（P〈0．05）。结论同型半胱氨酸是一个反映身体健康状况十分重要的指标,应像对待血压、血脂、血糖一样把它作为常规的预防筛选检测指标项目用于临床。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Activity of amikacin and ampicillin in succession and in combination

One strain each of Escherichia coli and Streptococcus faecalis were exposed to amikacin and ampicillin in combination as well as in succession. Exposure to ampicillin for 1 hr followed by amikacin for 3 or 4 hr had the greatest antibacterial activity when the antibiotics were applied in succession. The least effective exposures for both organisms were 1 hr to amikacin followed by 3 or 4 hr to ampicillin. Exposure to the antibiotics in combination each at 1 MIC had the overall greatest antibacterial activity. Simultaneous exposure to the antibiotic combination does not necessarily mean simultaneous activity of both ampicillin and amikacin on the E. coli. The cell wall autolytic activities produced by ampicillin are triggered within 10 min after physical contact with the bacteria. In contrast, amikacin requires at least 30 min after physical contact to manifest its activity on the ribosome. Although physical exposure to both antibiotics in the combination is simultaneous, the specific activity of each is in fact sequential, with ampicillin acting first. This explains the synergistic effect of the combination. It appears, therefore, that the synergistic or antagonistic affect of a drug combination is determined by the sequence and timing of the antibacterial manifestations of its components.     

Sites of in vivo extraction and interconversion of testosterone and androstenedione in dogs

The interconversion and extraction of testosterone and androstenedione across and within different tissues or areas have been studied by the constant infusion technique. The results were calculated using the (3)H/(14)C ratios and radioactive concentrations of testosterone and androstenedione obtained from afferent and efferent blood and tissues at equilibrium. In each tissue studied, the interconversion between testosterone and androstenedione inside the tissue was significantly higher than the corresponding interconversion across the tissue. The pulmonary contribution to the total interconversion between testosterone and androstenedione was far more important than that of any of the other tissues studied. The hepatic metabolic clearance rates of testosterone and androstenedione were not different from their metabolic clearance rates in the mesenteric area. The extraction of each of these compounds, although not negligible, was lower in the kidney and the femoral bed compared with the extraction in the liver and the mesenteric area. Finally, with the possible exception of the liver, testosterone and androstenedione were more completely metabolized when they originated from the cells than from afferent blood.The evaluation of these different tissue transfer constants provides more precise information concerning the relative importance of different sites in the metabolism of these interconverting hormones.     

Role of oxidants and antioxidants in atherosclerosis: results of in vitro and in vivo investigations

Both in vitro and in vivo studies have shown that oxidants are central in the development of atherosclerosis. Consequently, additional studies evaluated the protective effects of various natural and synthetic antioxidants, alone and in combination, with most studies focusing on alpha-tocopherol (vitamin E). Here, we summarize the role of oxidants in the pathomechanism of atherosclerosis. We also discuss epidemiological studies and others focused on the protective effect of vitamin E against atherosclerosis. Other antioxidants are also considered if they were included in studies involving vitamin E. The protective effect of antioxidants on atherosclerotic pathomechanisms has been confirmed in vitro, but only in some animal studies. Various epidemiological and observational studies have produced conflicting results on the protective effect of antioxidants. Most studies of primary or secondary prevention failed to show a protective effect. These conflicting results are biased by a number of factors, including differences between the study groups. Therefore, we describe these studies in detail.     

纤维支气管镜在儿童咯血诊断与治疗中的应用

目的 评价纤维支气管镜术在儿童咯血病因诊断及治疗中的价值以及安全性.方法 应用用日本产Olympus BF 3c-40纤维支气管镜(最小外径3.6 mm)给58名咯血原因不明的患者行纤维支气管镜检查,并予镜下局部止血治疗.判断出血部位、观察病变情况和出血的原因、临床表现、其他辅助检查、治疗及转归等进行综合分析.结果 引起咯血的主要疾病为气管支气管、肺部的炎症24例(41.3%)、支气管内膜结核12例(20.7%)、支气管异物8例(13.7%)、特发性肺含铁血黄素沉着症7例(12.1%)、支气管扩张4例(6.9%)、心肺血管发育异常1例,原因不明2例.诊断阳性率为96.5%.镜下发现有活动性出血18例,镜下局部止血治疗后显效者10例,有效者8例,有效率为100%.术中并发短暂低氧血症(SaO2＜85%,＜20 s)15例,加大吸氧流量后均改善;术后发热3例均为低热,24 h后热退.结论 纤维支气管镜检查可明确出血部位及原因并可进行局部治疗,且安全的有效.     

Pharmacokinetics and tolerance of flunitrazepam in neonates and in infants.

OBJECTIVE: To study the pharmacokinetics of flunitrazepam (used for sedation in neonates and infants), to determine the influence of both gestational and postnatal age on the pharmacokinetic parameters, and to analyze the relationship between the hemodynamic parameters and flunitrazepam plasma concentration. METHODS: Flunitrazepam was infused for 20 minutes as a single dose (0.2 mg x kg(-1)) and as multiple doses (0.1 mg x kg(-1)). Six to eight 1-mL blood samples were collected per patient. Flunitrazepam plasma concentration was measured by gas chromatography-mass spectrometry. RESULTS: Thirty-one patients (25 neonates and six infants) were included in the study. Only three of them received multiple doses. After the single dose (n = 28), half-life was 22.6 +/- 7.3 hours, clearance was 0.15 +/- 0.14 L x kg x h(-1), and volume of distribution was 4.6 +/- 4.1 L x kg(-1) (mean +/- SD). Plasma clearance and volume of distribution significantly increased with postnatal age (P < .05), but no pharmacokinetic parameter varied significantly with gestational age. Diastolic blood pressure significantly decreased with increasing flunitrazepam plasma concentrations (P < .05). CONCLUSION: Postnatal age but not gestational age influenced flunitrazepam pharmacokinetic parameters in neonates and infants. Diastolic blood pressure was inversely correlated to flunitrazepam plasma concentration.