心房颤动复律后联用缬沙坦与胺碘酮的疗效

目的观察口服胺碘酮和缬沙坦在心房颤动复律后维持窦性心律的疗效。方法持续性心房颤动患者98例,成功转复窦性心律后随机分为两组:胺碘酮组48例和胺碘酮联用缬沙坦组(联用组)50例。随访2年,观察两组维持窦性心律及左心房内径。结果胺碘酮组和联用组维持窦性心律的有效率分别为68．8％和86．0％,联用组左心房内径明显缩小,两组差异有统计学意义。结论胺碘酮联用缬沙坦可降低心房颤动复发率,更有效地维持心房颤动转复后的窦性心律。     

胺碘酮联用缬沙坦治疗阵发性房颤46例临床观察

目的观察口服胺碘酮联合应用血管紧张素Ⅱ受体拮抗剂(ARB)缬沙坦在阵发性心房颤动复律后维持窦性心律的疗效。方法将91例阵发性房颤患者随机分为胺碘酮组(Ⅰ组,n=45)与胺碘酮加缬沙坦组(Ⅱ组,n=46),疗效观察18个月。结果治疗6个月后窦性心律维持有统计学意义(P0.05),治疗12个月后两组左心房内径有统计学意义(P0.05)。结论胺碘酮与缬沙坦联合治疗阵发性房颤,维持窦性心律的疗效优于单用胺碘酮,并能延缓左心房扩大。     

缬沙坦联合胺碘酮治疗心房颤动的临床观察

目的：观察口服胺碘酮联合血管紧张素Ⅱ受体拮抗剂（ARB）缬沙坦治疗心房颤动的疗效,及对左心房功能的影响。方法：入选78例持续性心房颤动患者,随机分为两组,单纯口服胺碘酮（1组）36例,口服胺碘酮＋缬沙坦（11组）42例,疗程观察24个月。结果：共75例完成治疗．随访24个月,两组患者治疗12-24个月后左心房内径Ⅰ组显著高于Ⅱ组（P〈0．05）;治疗后Ⅱ组窦性心律维持12～24个月的均明显高于Ⅰ组（P〈0．05）。结论：口服胺碘酮联合缬沙坦可逆转左心房扩大,比单用胺碘酮能更有效地转复房颤,维持实性心律。     

胺碘酮联合氯沙坦预防心房颤动复律后复发

目的观察胺碘酮联合氯沙坦治疗阵发性和持续性心房颤动复律后维持窦性心律的疗效。方法80例具有转复窦性心律指征的阵发性和持续性心房颤动患者随机分为两组,单用胺碘酮治疗组（n=40）和胺碘酮＋氯沙坦治疗组（n=40）,12个月后停用胺碘酮,共随访18个月,观察药物对两组患者窦性心律的维持率及心房重构的影响。结果随访第12月和18月,窦性心律维持率在单用胺碘酮治疗组分别为45．9％和35．1％,在胺碘酮＋氯沙坦治疗组分别为79．5％和56．0％;胺碘酮＋氯沙坦组显著高于胺碘酮组（P均〈0．05）。胺碘酮＋氯沙坦组转变为永久性心房颤动患者（8例）显著低于单用胺碘酮治疗组（13例）,（P〈0．05）。左心房直径在单用胺碘酮组治疗前后有显著变化[治疗前（37．7±6．2）mm,治疗18月后时39．2±6．5mm）（P〈0．05）],而胺碘酮＋氯沙坦组无显著改变[治疗前（38．1±5．8）mm,治疗18月后（38．4±6．1）mm]。结论胺碘酮联合氯沙坦能提高心房颤动复律后维持窦性心律的疗效和防止心房结构重构。     

坎地沙坦酯联合比索洛尔及胺碘酮对高血压病合并持续性房颤的疗效

目的观察坎地沙坦酯联合比索洛尔及胺碘酮治疗高血压病合并持续性心房颤动的临床疗效。方法 96例高血压病合并持续性心房颤动患者随机分为常规治疗组和坎地沙坦组,每组48例,常规治疗组给予胺碘酮及比索洛尔治疗,坎地沙坦组在此基础上加用坎地沙坦酯,随访6、12个月后比较两组患者窦性心律维持率、左心房内径缩小等指标。结果随访6个月,坎地沙坦组窦性心律维持率为91.3,常规治疗组窦性心律维持率为83.3;随访12个月,坎地沙坦组窦性心律维持率为85.4,常规治疗组窦性心律维持率为75.0,两组同期窦性心律维持率差异有统计学意义（P均〈0.05）。两组患者12个月后左心房内径均缩小,各组治疗前后左房内径差异有统计学意义（P〈0.05）,坎地沙坦组左房内径缩小更明显,治疗后两组左房内径差异有统计学意义（P〈0.05）。结论坎地沙坦酯联合比索洛尔及胺碘酮能有效提高高血压病合并持续性心房颤动患者窦性心律维持率及缩小左房内径。     

小剂量胺碘酮与培哚普利联合治疗阵发性心房颤动的临床疗效

目的:评价小剂量胺碘酮与培哚普利联合治疗阵发性心房颤动(房颤)的临床疗效.方法:将108例阵发性房颤随机分为胺碘酮组(I组,n=53)和胺碘酮 培哚普利组(Ⅱ组,n=55),治疗随访时间为2年,研究终点为房颤发作.计算两组治疗后3、6、9、12、18和24个月的窦性心律维持率和治疗前、治疗后6、12、18个月的左心房内径.结果:两组治疗前和治疗后6、12个月间左心房内径无差别,18个月后有显著性差异(P＜0.05);治疗后第3、6、9个月,I组窦性心律的维持率低于Ⅱ组,但无显著性差异,而治疗12个月后,两组间有显著性差异(P＜0.05～0.025),治疗结束时I组的窦性心律维持率为61.22%,Ⅱ组为82.35%.结论:胺碘酮与培哚普利联合治疗阵发性房颤维持窦性心律的疗效优于单用胺碘酮,并能延缓左心房的扩大.     

福辛普利联合胺碘酮治疗阵发性心房颤动的疗效分析

128例阵发性房颤患者随机分为治疗组和对照组,治疗组采用福辛普利联合胺碘酮治疗,对照组单用胺碘酮治疗.随访时间1 a,研究终点为房颤发作,观察两组窦性心律的维持率及治疗前后左心房内经.结果 治疗12个月,治疗组左心房内径显著小于对照组,窦性心律维持率显著高于对照组,两组比较差异有统计学意义（P＜0.05）.认为福辛普利联合胺碘酮治疗阵发性心房颤动的疗效优于单用胺碘酮.     

厄贝沙坦联合胺碘酮治疗阵发性心房纤颤86例临床观察

目的探讨厄贝沙坦联合胺碘酮治疗阵发性心房颤动的临床疗效。方法将86例阵发性心房颤动的患者分为治疗组和对照组,均给予胺碘酮治疗,治疗组加用厄贝沙坦,疗程均为1年。比较两组治疗后第3、6、12个月的窦性心律维持率和治疗后第6、12个月的左心房内径。结果治疗后第3、6个月治疗组窦性心律的维持率分别为87％和80％,高于对照组的84％和71％,两组间比较差异无统计学意义（P〉0．05）,而治疗后12个月后,治疗组的窦性心律维持率为77％,对照组为58％,两组间比较差异有统计学意义（P〈0．05）。治疗组治疗前、治疗后第6个月和第12个月的左心房内径分别为（39．8±1．4）mm、（38．3±1．9）mm、（37．5±1．6）mm;对照组为（38．7±1．7）mm、（38．7±1．7）mm、（39．8±1．5）mm,两组治疗12个月后左心房内径比较差异有统计学意义（P〈0．05）。结论厄贝沙坦联合胺碘酮治疗阵发性心房颤动,预防心房颤动复发的疗效显著优于单用胺碘酮,并有延缓左心房扩大的作用。     

厄贝沙坦联合胺碘酮对阵发性房颤复律后维持窦性心律的效果

目的：观察厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的临床效果及其对左心房内径的影响。方法：选择阵发性心房颤动患者89例,分为胺碘酮治疗组（44例,单纯服用胺碘酮）,联合治疗组（45例,服用胺碘酮及厄贝沙坦）,随访12个月,观察两组患者治疗前后窦性心律维持率,左房内径的变化,并进行比较分析。结果：治疗12个月后,与胺碘酮组比较,联合治疗组窦性心律维持率明显提高（64.3%比81.4%）,左房内径明显减小[（40.12±10.6）mm比（34.10±10.11）mm],P均〈0.05。结论：厄贝沙坦联合胺碘酮对阵发性心房颤动复律后维持窦性心律的作用明显优于单用胺碘酮,且明显抑制左房扩大,无明显不良反应。     

血管紧张素Ⅱ受体拮抗剂、胺碘酮联用对预防心房颤动的影响

目的观察厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律的作用及对左心房功能的影响。方法98例持续性心房颤动(持续超过7d)患者,药物或电复律后随机分为两组,Ⅰ组50例给予胺碘酮0.2g,1次/d;Ⅱ组48例给予厄贝沙坦150mg,1次/d,胺碘酮0.2g,1次/d;两组均连服6个月。分别于治疗后第1周、2周、1个月、2个月、4个月及6个月复查心电图或动态心电图,观察心房颤动复发情况;复律后次日及6个月后做超声心动图(UCG)检查,观察左心房功能变化。结果共87例完成治疗。随访6个月,心房颤动复发Ⅰ组为34.9%(15/43),Ⅱ组为13.6%(6/44),两组比较差异有统计学意义(P<0.05),Ⅱ组复律后次日及治疗6个月后,超声测量左心房内径由(42±12)mm缩小为(34±11)mm,治疗前与治疗6个月后比较差异有统计学意义(P<0.01),而Ⅰ组上述指标比较差异无统计学意义(P>0.05)。结论厄贝沙坦联用胺碘酮在持续性心房颤动转复后维持窦性心律,较单用胺碘酮更有效,长期服用厄贝沙坦可逆转左心房扩大,降低左心房压,有利于消除心房颤动复发的基础。     

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。