肿瘤坏死因子-α、白细胞介素-1 β、-6水平与充血性心力衰竭关系的临床研究

目的探讨肿瘤坏死因子α(TNFα)、白细胞介素1β(IL1β)、白细胞介素6(IL6)与充血性心力衰竭(CHF)的关系。方法采用放射免疫分析法(RIA)测定三组入选者血清TNFα、IL1β、IL6的含量,CHF心功能Ⅰ、Ⅱ级组(30例),CHF心功能Ⅲ、Ⅳ级组(30例),对照组(28例)。结果心功能Ⅲ、Ⅳ级组患者血清TNFα、IL1β、IL6含量显著高于对照组(P<0.01)和心功能Ⅰ、Ⅱ级组(P<0.05),心功能Ⅰ、Ⅱ级组显著高于对照组(P<0.01);TNFα与IL1β、IL6呈显著正相关(r1=0.763,r2=0.684均P<0.01)。结论TNFα、IL1β、IL6水平与CHF发生发展密切有关。     

细胞因子在急性心肌梗塞中的作用

为探讨细胞因子在急性心肌梗塞（AMI）中的作用，测定了28例AMI患者血清肿瘤坏死因子α（TNFα）和白细胞介素1β（IL－β）水平，并选择13例不稳定型心绞痛（UA）患者和15例健康人作为对照。结果表明：AMI组血清TNFα水平明显高于UA组及正常组（P＜0．01），UA组血清TNFα水平明显高于正常组（P＜0．01）；血清IL－1β水平在严重的AMI患者（心功能KillipⅢ、Ⅳ级）明显高于正常组（P＜0．01）。提示血清TNFα和IL-1β水平与心肌缺血的严重程度有关。     

老年慢性心力衰竭患者血尿酸和炎性因子水平变化及相关性分析

目的探讨老年慢性心力衰竭(CHF)患者血尿酸水平以及高敏C反应蛋白(hs CRP)、白细胞介素6(IL-6)、TNF-α等炎性因子水平的变化,并对其进行相关性分析。方法选择CHF患者65例(CHF组),根据心功能分级(NYHA),Ⅱ级15例,Ⅲ级32例,Ⅳ级18例;另选心功能正常的老年人45例(对照组)。所有入选者采用日本产OLYMPUS.AU5400全自动生化仪测定血尿酸、hs-CRP及血肌酐水平,采用放射免疫法测定lL-6、TNF-α水平,采用彩色多普勒超声测定左心室舒张末内径、左心房内径、LVEF、左心室二尖瓣舒张早期血流峰值和舒张晚期血流峰值比值。结果与对照组比较,CHF组心功能Ⅲ、Ⅳ级患者血尿酸、TNF-α、IL-6、hs CRP水平明显升高(P<0.01),并随心功能分级加重而增加。血尿酸水平与TNF-α、hs-CRP、IL-6等炎性因子呈正相关(r=0.74,r=0.60,r=0.68,P<0.01),而与LVEF呈负相关(r=-0.73,P<0.01)。结论老年CHF患者血尿酸水平显著升高,并与循环中的炎性因子密切相关,是CHF患者心功能恶化的重要预测指标。     

慢性心力衰竭患者炎性细胞因子的变化及作用

目的探讨致炎细胞因子白细胞介素1(IL-1)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)和抗炎细胞因子白细胞介素10(IL-10)在慢性心力衰竭发生发展中的变化及作用。方法入选心力衰竭患者150例和健康对照50名,采用酶联免疫吸附法检测血清IL-1、IL-6、IL-10、TNF-α和IFN-γ的水平。结果心力衰竭组患者血清IL-1、IL-6、IL-10、TNF-α和IFN-γ的水平显著高于对照组(P<0.05或P<0.01),且随着纽约心功能分级(NYHA)的增加而升高,并与左心室射血分数(LVEF)呈负相关(r=-0.586、-0.454、-0.521、-0.514、-0.502,均为P<0.01),与左心室舒张末容积(LVEDV)呈正相关(r=0.603、0.45、0.542、0.519、0.438,均为P<0.01);IL-1、IL-6、TNF-α、IFN-γ总和与IL-10的比值:NYHAⅢ级和Ⅳ级患者高于对照组(P<0.05或P<0.01),NYHAⅣ级患者高于Ⅲ级和Ⅱ级患者(P<0.05),NYHAⅢ级患者高于Ⅱ级患者(P<0.05),但NYHAⅡ级患者与对照组间差异无统计学意义(P>0.05);冠心病心力衰竭和扩张型心肌病心力衰竭患者的IL-1、IL-6、IL-10、TNF-α和IFN-γ水平比较,差异无统计学意义(P>0.05)。结论心力衰竭患者致炎细胞因子和抗炎细胞因子均增高,但抗炎因子增加相对不足,炎症反应随着心力衰竭程度加重而加重,与心功能状态有相关性,与病因无显著相关性,细胞因子在心力衰竭的发生发展中起着重要的作用。     

维吾尔族男性冠心病心力衰竭与血清尿酸的相关性

目的：探讨维吾尔族男性冠心病患者心力衰竭与血清尿酸浓度的相关性。方法：218例维吾尔组男性冠心病患者,按左室射血分数（LVEF）分三组,LVEF≥50％组（对照组,72例）、40％〈LVEF〈50％组（71例）、LvEF≤40％组（75例）,比较三组血清尿酸浓度的变化;所有患者心功能再参照NYHA分级分为Ⅰ级组（37例）、Ⅱ级组（80例）、Ⅲ级组（67例）、Ⅳ级组（34例）,比较四组血清尿酸浓度的变化;按冠脉粥样斑块的稳定型再分为急性冠脉综合征（ACS,101例）组和稳定型心绞痛（SAP,117例）组,比较血清尿酸浓度的变化及血尿酸和LVEF的相关性。结果：LVEF≥50％组、40％〈LVEF〈50％组、LVEF≤40％组三组血清尿酸浓度依次增高．各组间差异均有显著性（P〈0．05）,血尿酸与LVEF呈负相关（r=-0．408,P〈0．01）。按NYHA分级分组,心功能Ⅳ级组血尿酸高于其余三组．心功能Ⅲ级组血尿酸高于心功能Ⅰ、Ⅱ级组,差异均有显著性（P均〈0．05）,心功能Ⅱ级组与心功Ⅰ级组血尿酸差异无显著性（P=0．62）;ACS组血清尿酸浓度明显高于SAP组（P〈0．01）。Pearson相关分析显示SUA与LVEF呈负相关（r=-0．408,P〈0．01）。结论：血清尿酸增高与心力衰竭严重程度密切相关,是心功能恶化的预测因子,也是心血管急性事件的预测因子。     

男性慢性心力衰竭患者血清脂联素水平改变及其临床意义

目的测定男性慢性心力衰竭（CHF）患者血清脂联素（APN）、高敏C-反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）、白介素-6（IL-6）的变化,分析APN水平与炎性反应递质及心力衰竭严重程度的关系。方法选取2010年3月—2011年6月我院住院的CHF患者82例,健康对照组41例,CHF组按NYHA分级分为Ⅱ、Ⅲ、Ⅳ级。应用放射免疫法检测血清APN,酶联免疫吸附法检测TNF-α,IL-6和hs-CRP水平。结果 CHF组患者血浆APN及hs-CRP、TNF-α、IL-6水平均明显高于健康对照组（P〈0.01）,且均随着NYHA分级程度的加重而显著增加（P〈0.05）;APN水平与hs-CRP水平呈负相关（r=-0.32,P〈0.05）,与TNF-α水平呈负相关（r=-0.49,P〈0.01）、与IL-6水平呈负相关（r=-0.61,P〈0.01）,与心脏指数（CI）呈正相关（r=0.41,P〈0.05）。CHF组Ⅲ、Ⅳ级患者随心功能的快速改善,APN水平显著减少（P〈0.01）,TNF-α为APN水平的独立影响因素。结论男性患者随着心力衰竭严重程度的增加,血清APN水平显著增高,并且与血清炎性递质呈显著负相关。随心功能的快速改善,APN水平显著降低。血清APN水平是预测心力衰竭严重程度的有价值的指标。     

同型半胱氨酸及脑钠肽水平与慢性心力衰竭严重程度的相关性分析

目的 分析慢性心力衰竭（CHF）患者血清同型半胱氨酸（Hcy）和脑钠肽（BNP）水平变化和与严重程度的相关性。 方法 连续纳入2016年2月~2017年2月期间在天津市第三中心医院分院心内科住院的慢性心力衰竭患者（CHF）,共79例。对照组入选同期住院无心衰的冠心病患者60例;CHF组按照NYHA心功能分级法分Ⅱ级（n=35）、Ⅲ级（n=22）、Ⅳ级（n=22）3个亚组,各组分别测量Hcy、BNP水平,及左室射血分数（LVEF）相关指标。分别比较CHF组和对照组及CHF各心衰亚组间Hcy、BNP水平的差异,及Hcy和BNP的相关性。 结果 CHF组血清Hcy、BNP水平明显高于对照组,差异有统计学意义（P<0.05）;并且随着心功能分级的增加,血清Hcy、BNP水平亦明显增高（P<0.05）; Hcy和BNP呈正相关（r=0.22,P=0.048）,差异有统计学意义。 结论 血清Hcy水平变化可一定程度上反映心力衰竭的严重程度。     

慢性心力衰竭患者血清尿酸水平及临床意义的探讨

目的 探讨心力衰竭患者血清尿酸（UA）水平变化及临床意义。方法对我院收治的心力衰竭患者95例进行血清尿酸水平测定．根据心功能状况（按NYHA分级）将患者分成3组：心功能Ⅱ级为A组20例，心功能Ⅲ级为B组27例，心功能Ⅳ级为C组48例，并与健康对照组23例对比。结果 心力衰竭组血清尿酸浓度明显高于健康对照组（P〈0.01）且心力衰竭越严重．级别越高．血清尿酸水平越高：心功能Ⅳ级与Ⅱ级，Ⅲ级与Ⅱ级和Ⅲ级与Ⅳ级相比UA浓度筹异有统计学意义（P〈0.01）；而不同病因冠心病，风湿性心脏病，扩张型心肌病，高血压性心脏病引起的心衰血清尿酸水平比较差异无统计学意义（P〉0.05）．心衰时血清尿酸水平在性别间差异无统计学意义（P〉0．05）。结论血清尿酸浓度是反映心衰病情严重程度的指标之一，故对心衰患者测定血清尿酸浓度对疗效的观察，和病情的评估有重要意义。     

心力衰竭患者氧化低密度脂蛋白和细胞因子的变化及其相关性

目的:深讨氧化应激和细胞炎性因子在心衰(CHF)发病机制中的作用。方法:随机选择108例NYHA心功能分级Ⅱ～Ⅳ级的CHF患者,并选择40例健康体健者作对照,测定血清ox-LDL和血浆肿瘤坏死因子-a;白介素-6(IL-6)的浓度,分析其与心衰严重程度的关系,ox-LDL与肿瘤坏死因子(TNF-a)和IL-6的相关性。结果:不同心功能级别患者ox-LDL与TNF-a水平均明显高于对照组(P<0.05或P<0.01),且其水平随着心衰加重而进行性升高;心功能Ⅲ级和Ⅳ级组IL-6水平明显高于对照组(P<0.01);ox-LDL与NYHA分级呈显著正相关(r=0.638,P<0.01),与TNF-a和IL-6呈正相关(r值分别为0.357、0.264,P值分别<0.01、<0.05)。结论:CHF患者血中氧化低密度脂蛋白和细胞因子的水平、心衰严重程度密切相关,可作为判断心衰严重程度的指标之一。     

急性心肌梗死患者的血清尿酸水平与其心功能的相关性分析

目的探讨急性心肌梗死患者的血清尿酸水平与其心功能的相关性,为判断患者病情提供参考。方法选取2018年7月至2020年6月我院收治的急性心肌梗死患者63例作为研究对象,采用美国纽约心脏病学会心功能分级标准(NYHA)[4]对患者进行心功能分级,按照心功能分级将患者分为心功能Ⅱ级组(20例)、心功能Ⅲ级组(22例)、心功能Ⅳ级组(21例)。检测比较三组患者的血清尿酸、N端前脑钠肽(NT-proBNP)及心肌肌钙蛋白T(TnT)水平;对患者的血清尿酸水平与其NT-proBNP、TnT水平的关系进行Pearson相关性分析。结果不同心功能分级患者的血清尿酸、NT-proBNP及TnT水平均随着患者心功能分级的增高而增高,心功能Ⅱ级、Ⅲ级、Ⅳ级组患者的水平比较差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,急性心肌梗死患者的血清尿酸水平与其NT-proBNP、TnT水平均呈正相关(r=0.823,P<0.05;r=0.922,P<0.05)。结论急性心肌梗死患者的血清尿酸水平与其心功能呈正相关,血清尿酸水平可作为判断患者病情的一个重要指标。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.