肝移植治疗原发性胆汁性肝硬化的近期疗效

目的 分析肝移植治疗原发性胆汁性肝硬化(PBC)的近期疗效.方法 2001年10月～2006年2月,接受肝移植手术的PBC患者共17例,平均年龄(49.6±6.6)岁.回顾患者住院期间及随访期的资料,根据Mayo公式计算患者保守治疗的1 a预计生存率.观察患者术后临床特征、复发和生存情况,分析死亡原因;计算移植后患者实际生存率,并与1 a预计生存率比较.结果 本组患者平均随访时间(28.8±15.7)月; 移植后患者症状迅速缓解、肝功能改善.移植后0.5、1、2 a的实际生存率分别为100%、100%、83.3%.生存分析显示,本组患者1 a实际生存率显著高于保守治疗的1 a预计生存率(77%)(P=0.006); 17例中仅1例患者移植15个月后,经肝活检证实PBC复发,移植18个月后因继发胆管炎、感染性休克死亡.结论 肝移植可提高终末期PBC患者的生活质量,延长其生存时间.     

异基因造血干细胞移植治疗bcr/abl融合基因阳性急性白血病的临床疗效观察

目的:观察异基因造血干细胞移植治疗bcr/abl融合基因阳性急性白血病的临床疗效。方法:对MICM分型确诊的18例bcr/abl融合基因阳性急性白血病患者,采用化疗或加用酪氨酸激酶抑制剂达完全缓解后行异基因造血干细胞移植术。结果:18例行异基因造血干细胞移植术后,均获得造血及免疫功能重建。9例无病存活;1例复发,经治疗后再次达完全缓解;8例死亡,其中因复发死亡3例,移植相关死亡5例。2a无病生存率为(31.6±14.0)%,2a总生存率为(48.0±13.9)%;中位无病生存时间(9.0±3.1)个月,中位总生存时间(18.0±8.0)个月。结论:异基因造血干细胞移植是目前治愈bcr/abl融合基因阳性急性白血病的惟一有效手段,联合酪氨酸激酶抑制剂能有效提高长期生存率。     

肝癌肝移植术后肿瘤复发患者生存的危险因素分析

目的分析肝癌肝移植术后肿瘤复发患者生存的危险因素。方法回顾性分析99例肝癌接受肝移植术后肿瘤复发或转移患者的生存预后及影响因素。所有患者移植术前均合并乙型肝炎病毒感染。生存分析包括移植术后总体生存（OS）和带瘤生存（SWT）分析。结果本组患者随访时间3.9~71.5个月,平均19.8个月。1、2及3年OS为68.8%、39.1%及34.4%。1、2及3年SWT为53.0%、28.6%及26.8%。影响OS和SWT的独立的危险因素包括移植术前非手术治疗（〉2次）（=3.23,〈0.01）、移植术后肿瘤多发复发或转移（=2.457,〈0.05）、移植肝内肿瘤复发（=3.52,〈0.01）和索拉非尼治疗（=0.31,〈0.01）。结论术前合并乙型肝炎的肝癌肝移植术后患者、肿瘤多发复发或转移及肝内肿瘤复发是影响预后的危险因素。手术切除或局部抗肿瘤治疗联合索拉非尼治疗能够有效改善肝癌肝移植术后肿瘤复发患者的生存情况。     

自体造血干细胞移植治疗淋巴瘤44例分析

目的：评价自体造血干细胞移植(AHSCT)治疗淋巴瘤的临床疗效。 方法：回顾分析我院干细胞移植中心44例行AHSCT的淋巴瘤患者的临床资料。44例被诊断为淋巴瘤的患者在经过数个疗程的放化疗后达到完全缓解或部分缓解后在我院行自体干细胞移植后,随访治疗。 结果：44例AHSCT治疗淋巴瘤患者中,有1例死于动员化疗后并发的真菌感染,其余43例均获得造血重建,中位随访时间为17(1～53)个月。43例移植成功患者中,存活32例(74％),死亡11例。11例死亡患者中9例(21％)复发后经过一段时间的姑息治疗后死亡,1例患者死于移植相关并发症,1例死于非移植相关并发症。患者截止随访时间时的总生存率(0S)和无病生存率(DFS)均为是72％。平均生存时间为3.7（?0.6）年,3年生存率为68%,估计5年生存率为51%。AHSCT后维持治疗者未见复发。 结论：自体造血干细胞移植治疗淋巴瘤具有技术条件成熟,适应症广泛,治疗效果显著的特点,是淋巴瘤治疗方案中的重要的重要组成部分。     

自体外周血造血干细胞移植术治疗淋巴瘤44例疗效分析

目的：评价自体造血干细胞移植（autologous hematopoietic stem cell transplantation,AHSCT）治疗淋巴瘤的临床疗效。方法：回顾分析我院干细胞移植中心44例行AHSCT的淋巴瘤患者临床资料。44例被诊断为淋巴瘤的患者在经过数个疗程的放化疗后达到完全缓解或部分缓解后在我院行自体干细胞移植后,随访治疗。结果：44例AHSCT治疗淋巴瘤患者中,有1例死于动员化疗后并发的真菌感染,其余43例均获得造血重建,中位随访时间为17个月（1～53个月）。43例移植成功患者中,存活32例（74％）,死亡11例。11例死亡患者中9例（21％）复发后经过一段时间的姑息治疗后死亡,1例患者死于移植相关并发症,1例死于非移植相关并发症。患者截止随访时间时的总生存率和无病生存率均为72％。平均生存时间为（3.7±0.6）年,3年生存率为68%,估计5年生存率为51%。AHSCT后维持治疗者未见复发。结论：AHSCT治疗淋巴瘤具有技术条件成熟、适应证广泛、治疗效果显著的特点,是淋巴瘤治疗方案中的重要组成部分。     

激活骨髓自体移植治疗急性早幼粒细胞白血病

目的　探讨激活骨髓 (ABM)自体移植作为急性早幼粒细胞白血病 (APL)缓解后巩固强化治疗的意义。方法　 31例病人 ,第一次完全缓解 (CR1) 2 7例、CR2 3例、第二次复发部分缓解 (PR) 1例 ;移植预处理方案 :2 7例接受MACC(马法兰、阿糖胞苷、环磷酰胺、环己亚硝脲 )方案 ,5例用TBI +CY(全身放疗 +环磷酰胺 )方案 ;荧光原位杂交测定PML/RARα融合基因 ;用Kaplan Meier生存曲线评估移植后无病生存率 ,COX回归模型分析性别、PML/RARα阳性、移植前状态 (CR1与CR2和PR)、初治时白细胞 (WBC)和血小板 (PBC)值对无病生存的影响。结果　CR1病人移植后无一例复发 ,移植后无病生存期 3～ 113个月、中位无病生存期 4 6个月 ,5年无病生存率为 10 0 % ;CR2病人 1例于移植后 19个月复发 ,另 2例分别无病生存为 7与 4 8个月 ;PR患者在移植后获CR 8个月复发。移植后全部病人均获得造血重建 ,无一例死于移植相关并发症。多因素分析长生存与移植前状态相关 (P <0 .0 5 ) ,而与性别、PML/RARα阳性、初诊时WBC和PBC数无关 ;诱导缓解后PML/RARα阳性与初诊时WBC和PBC数相关。结论　激活骨髓自体移植治疗CR后的APL病人能降低复发率和提高无病生存率、尤是CR1后的APL病人。     

肝癌术后复发转移再切除治疗28例疗效分析

目的评价再手术在肝癌复发治疗中的地位.方法回顾性分析我院28例肝癌术后复发转移再手术治疗的随访资料.结果本组28例复发肝癌行再切除手术34例次,无手术死亡.再切除术后1、3、5年生存率分别为78.6%(22/28)、35.7(10/28)、21.4%(6/28),中位生存时间26个月.第1次手术后1、3、5年生存率分别为96.4%(27/28)、78.6%(22/28)、46.4%(13/28),中位生存时间56个月.1例患者术后生存长达45年.结论肝癌术后应加强监测,早期发现病灶.手术再切除是肝癌术后复发的首选治疗方法,可明显延长患者术后生存时间.     

肝移植术后中远期并发症及其转归

目的探讨肝移植术后中远期并发症及其转归。方法收集69例(3例为再次肝移植)肝移植患者的临床及随访资料。分析生存率和术后死亡原因,观察中远期并发症发生率及其转归。结果 69例患者术后总1、3和5年累计生存率分别为94.0%、76.6%及73.3%,其中良性疾病者分别为96.7%、89.9%及89.9%,恶性疾病者分别为91.9%、65.1%及59.2%。良、恶性组间累计生存率差异有统计学意义(<0.05)。术后死亡22例中有17例死于肿瘤复发。中远期主要并发症有慢性排斥反应、迟发性急性排斥反应、胆道并发症、门静脉血栓、精神并发症、乙型肝炎复发及肿瘤复发等。结论肿瘤复发、急慢性排斥反应和胆道并发症是影响肝移植术后长期存活的主要原因。严格掌握肝移植的指征,早期发现并积极治疗各种并发症可改善预后。     

自体造血干细胞移植治疗26例儿童晚期、复发难治性淋巴瘤的临床研究

目的评价自体外周造血干细胞移植治疗晚期、复发难治性淋巴瘤患儿的长期生存率、复发率,并分析影响患儿长期存活率的相关危险因素。方法纳入我院2009年1月至2016年11月确诊的晚期、复发难治性淋巴瘤患儿共26例,采用BEAM方案预处理后行自体造血干细胞移植。采用Kaplan-Meier生存曲线和log-rank检验分析影响患儿总生存率和无事件生存率的因素。结果入组26例患者,男性17例,女性9例,男女比1.88︰1,中位年龄10（4～16）岁,霍奇金淋巴瘤8例,非霍奇金淋巴瘤18例。移植前分期为:Ⅱ期1例,Ⅲ期19例,Ⅳ期6例。移植前完全缓解（CR）18例,部分缓解（PR）8例。中位随访时间45.8（8～89.3）月,随访期间总生存率94.4%,无事件生存率87.8%。移植后3例患儿复发（随访期间复发率11.5%）,1例复发后合并噬血细胞综合征死亡,2例复发后联用化疗及局部放疗后再次获得CR,长期使用白细胞介素-2（IL-2）维持治疗。生存分析显示移植前部分缓解是影响患儿无事件生存率的危险因素（P=0.002）。结论自体外周造血干细胞移植治疗儿童晚期、复发难治性淋巴瘤的长期生存率较高,移植前疾病部分缓解为影响患儿无事件生存率的危险因素。     

原发性肝癌行同种异体原位肝移植治疗的疗效评价

目的 总结肝癌患者肝移植术后的疗效,探讨肝癌患者肝移植的适应证。方法收集我院2000年8月至2003年12月进行的43例肝癌肝移植患者的资料,对手术后的生存期进行分析,并进行随访。结果最长随访时间3年零9个月,全组死亡18例,仍存活25例,其中7例带瘤生存。死亡的病例中,死于肿瘤复发12例,围手术期死亡3例,分别死于腹腔感染(1例)、出血(1例)及急性肾功能衰竭(1例),其他原因死亡(3例)。以寿命表法计算,1年生存率为85．5％,2年生存率为65．5％,3年生存率为43．0％。结论肝移植为晚期肝癌的治疗提供了一种新的手段,部分患者可获得较长期的无瘤生存。无肝外转移的晚期肝癌可作为目前肝移植的适应证。     

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.     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.