急性心理应激对不同特质焦虑大学生免疫功能的影响

目的探讨急性心理应激对不同特质焦虑大学生免疫功能的影响.方法用状态-特质焦虑问卷(STAI)对120名大学生自愿者进行测试,筛选出高、低焦虑组各22名,再对高、低焦虑组随机分为应激组和对照组;应激后用放射免疫法测定其血清白介素-2、白介素-6和皮质醇的含量.结果高、低焦虑组大学生血清中皮质醇浓度应激组[分别为(203.69±29.60)μg/L,(244.57±53.96)μg/L]高于对照组[分别为(164.60±49.77)μg/L,(131.71±56.85)μg/L](P＜0.05,P＜0.01).高焦虑组大学生血清中白介素-2、白介素-6浓度应激组[分别为(1.35±0.29)μg/L,(154.95±32.23)ng/L]低于对照组[分别为(2.65±0.82)μg/L,(204.33±58.57)μg/L](P＜0.01,P＜0.05);低焦虑组大学生血清中白介素-2的浓度应激组(1.83±0.53)μg/L低于对照组(2.81±1.23)μg/L(P＜0.05).结论急性心理应激对高焦虑组个体血清白介素-2、白介素-6浓度变化的影响较低焦虑个体大,特质焦虑人格是影响急性心理应激导致免疫功能改变的因素之一.     

肾上腺皮质激素反应在心肌缺血预适应保护中的作用

目的:探讨肾上腺皮质激素反应在心肌缺血预适应保护中的作用。方法:30只家兔随机分为5组,缺血预适应组(IPC),缺血再灌注组(IR),依托咪酯组(Etom),甲基强的松龙组(MP)和对照组(control),以心肌梗死面积/缺血面积,血清肌酸激酶(CK)活性,肌钙蛋白I(cTnI)浓度为检测指标,同时检测血清皮质醇动态变化。结果:IPC组、Etom组、IR组、MP组心肌梗死面积/缺血面积分别为5.9%±2.8%,11.3%±3.6%,26.8%±4.5%,18.2%±3.7%,CK活性增高值分别为(255±89)U/L,(314±160)U/L,(855±371)U/L,(768±404)U/L,cTnI增高值分别为(3.6±0.6)μg/L,(5.9±2.0)μg/L,(8.1±3.6)μg/L,(6.1±2.3)μg/L。各指标组间比较均有统计学意义(P<0.01)。Etom组皮质醇反应明显钝化。结论:钝化皮质醇反应可明显削弱IPC的保护作用,甲基强的松龙有一定程度心肌保护作用,提示IPC保护作用中可能有应激反应成分参与。     

氟西汀对慢性应激大鼠血清皮质醇、肿瘤坏死因子-α、胃黏膜细胞间黏附分子-1表达的影响

目的 研究氟西汀对慢性应激大鼠血清皮质醇、肿瘤坏死因子-α(TNF-α)含量、胃黏膜细胞间黏附分子-1(ICAM-1)表达的影响.方法 将青年雄性Wistar大鼠24只随机分为对照组、应激组、氟西汀组各8只.应激组和氟西汀组大鼠每笼1只喂养,实验第1-21天,接受各种不同的应激.氟西汀组大鼠每天给予氟西汀水溶液灌胃.对照组大鼠群养不给任何刺激.实验第22天杀死所有大鼠,检测血清皮质醇、TNF-α浓度;用免疫组化法检测胃黏膜蛋白ICAM-1表达,进行图像分析,测定光密度平均值.结果 应激组大鼠与对照组比较,血清皮质醇含量[(77.12±9.76)μg/ml,(44.96±6.25)μg/ml,t=7.85,P<0.01]、TNF-α含量[(69.66±6.68)pg/ml,(39.21±3.57)pg/ml,t=11.37,P<0.01]、胃黏膜ICAM-1表达的光密度平均值[(53.87±6.84),(30.26±3.68),t=8.59,P<0.01]有明显增高;与应激组比较,氟西汀组大鼠血清皮质醇含量[(58.82±6.56)μg/ml,t=4.40,P<0.01]、TNF-α含量[(50.18±3.23)pg/ml,t=7.43.P<0.01]、胃黏膜ICAM-1表达的光密度平均值(36.61±4.39,t=6.00,P<0.01)明显下降.结论 慢性应激可引起大鼠血清皮质醇、TNF-α含量增高,胃黏膜ICAM-1过表达,而氟西汀可以部分的逆转这些改变.     

肺癌患者化疗前后血清CYFRA21-1、NSE和CA125水平的变化及意义

目的分析肺癌患者化疗前后血清角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)和糖类抗原125(CA125)水平的变化及意义。方法选取2013年2月至2015年6月保定市第三中心医院收治的84例肺癌患者为肺癌组,同时选择同期进行体检的84例健康者作为对照组,检测肺癌组化疗前后和对照组血清CYFRA21-1、NSE和CA125水平,并与对照组比较。结果肺癌组化疗前血清CYFRA21-1、NSE及CA125水平均明显高于对照组[(12.69±3.57)μg/L比(1.62±0.48)μg/L,(22.53±6.84)μg/L比(7.31±2.49)μg/L,(34.91±10.16)U/mL比(17.29±3.46)U/mL](P<0.01);肺癌组患者化疗后血清CYFRA21-1、NSE及CA125水平明显低于化疗前[(7.42±2.25)μg/L比(12.69±3.57)μg/L,(12.49±3.12)μg/L比(22.53±6.84)μg/L,(22.88±4.18)U/mL比(34.91±10.16)U/mL](P<0.01)。结论 CYFRA21-1、NSE、CA125水平的变化对肺癌化疗提供可靠的实验室观察指标,在预测患者化疗效果上有临床参考价值。     

急性心理应激对不同特质焦虑大学生TNF-α和IL-6的影响

目的探讨急性心理应激对不同特质焦虑大学生免疫功能的影响.方法用特质焦虑问卷(TAI)对236名大学生自愿者进行测试,筛选出高、低焦虑组各28名,再将每组随机分为试验组和对照组;用放射免疫法测定血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的含量.结果应激后,血清中TNF-α、IL-6均升高[(1.85±0.32)ng/ml],TNF-α[(1.85±0.33)ng/ml]的变化差异有显著性(t=2.28,P＜0.05);低焦虑组大学生TNF-α和IL-6浓度的变化与总体上相似(tTNF-α=2.98,P＜0.05,tIL-6=0.77,P＞0.05);高焦虑组大学生TNF-α的浓度高于对照组,IL-6浓度则有下降的趋势,但差异均无显著性(tTNF-α=0.63,tIL-6=0.47,P＞0.05).结论急性心理应激可导致大学生血清TNF-α、IL-6浓度升高,提示急性心理应激可以引起机体自然免疫功能的增强;心理应激引起低焦虑特质个体自然免疫增强的现象较明显,而对高特质焦虑个体的作用不明显.     

老年患者术后认知功能障碍与血清S100β及神经元特异性烯醇化酶的关系

目的 探讨血清S100β和神经元特异性烯醇化酶(NSE)与老年人发生术后认知功能障碍(POCD)的关系.方法 使用中文版成人智力量表(WAIS)和韦氏记忆量表(WMS)对560例行择期手术的老年患者进行术前1天和术后1周的神经、精神功能测试,对439例未发生术后认知功能障碍的老年人(对照组)和121例POCD患者进行麻醉前和手术结束及术后6h、24h血清S100β和NSE的含量检测.结果 麻醉前POCD患者血清S100β和NSE的含量与对照组无明显差异(P>0.05);术毕两组患者血清S100β和NSE的含量为最高[分别为(0.68±0.32)μg/L,(1.28±0.51)μg/L,P<0.05;(13.51±6.23)μg/L,(22.08±10.11)μg/L,P<0.05];术后24h对照组患者血清S100β和NSE的含量已恢复至麻醉前水平[分别为(0.50±0.11)μg/L,(10.90±2.93)μg/L],而POCD患者血清S100β和NSE的含量仍维持较高水平[分别为(0.98±0.27)μg/L,(16.44±6.83)μg/L],两组比较差异有显著性(P<0.05).POCD组血清S100β和NSE与认知障碍各项指标呈相关性(r=0.367～0.786,P<0.05).结论 血清S100β和NSE的含量与老年患者POCD发生存在关联性.     

慢性肾功能不全患者血清黏附分子和高敏C反应蛋白水平变化的临床意义

目的 探讨慢性肾功能不全患者血清可溶性细胞间黏附分子-1(sICAM-1)、血管细胞黏附分子-1(sVCAM-1)、高敏C反应蛋白(hsCRP)水平的变化及其临床意义.方法 慢性肾功能不全患者44例(CRF组),正常对照组36例,采用酶联免疫吸附法(ELISA)检测循环血清中sICAM-1、sVCAM-1及hsCRP水平.结果 CRF组循环血清中sICAM-1、sVCAM-1及hsCRP水平[分别为(299.3±43.0)μg/L,(1295.3±213.0)μg/L,(11.7±2.5)mg/L]较正常对照组[分别为(114.4±16.9)μg/L,(353.4±98.5)μg/L,(5.3±1.4)mg/L]明显升高(P＜0.01).结论 慢性肾功能不全患者循环血清中sICAM-1、SVCAM-1及hsCRP水平升高,提示在其疾病进展过程中存在血管炎症改变.     

2型糖尿病患者外周血激素水平与高敏C反应蛋白的关系

目的研究2型糖尿病(T2DM)外周血激素水平与高敏C反应蛋白(hs-CRP)的关系。方法选取2014年1月至2015年6月唐山市第三医院收治的T2DM患者共80例作为T2DM组,同时选取同期体检健康志愿者共80例作为健康对照组。测定其血激素[血皮质醇、促肾上腺皮质激素(ACTH)、24 h尿游离皮质醇(UFC)]及hs-CRP水平。比较T2DM组和健康对照组、不同体型T2DM患者的血激素及hs-CRP水平,并进行血激素水平与hs-CRP的相关性。结果 T2DM组的血皮质醇、ACTH、UFC和hs-CRP水平显著高于健康对照组[(316±48)μg/L比(148±57)μg/L,(393±80)pg/L比(173±55)pg/L,(80±13)μg比(41±9)μg,(3.8±0.8)mg/L比(1.1±0.3)mg/L,P<0.01]。T2DM组腹型肥胖患者的血皮质醇、ACTH、UFC和hs-CRP水平显著高于非腹型肥胖患者[(343±53)μg/L比(256±49)μg/L,(411±82)pg/L比(356±61)pg/L,(82±15)μg比(76±10)μg,(4.3±1.8)mg/L比(2.9±0.4)mg/L,P<0.05]。Pearson相关分析结果显示,血皮质醇、ACTH、UFC与hs-CRP无相关性(r=0.197,0.148,0.116,均P>0.05)。结论 T2DM患者血激素水平与炎症反应无关,但hs-CRP可作为判断T2DM发生发展和评估预后的重要指标。     

大肠癌围手术期血清IAP和sE-cad水平的动态观察

目的 探讨大肠癌患者围手术期血清免疫抑制酸性蛋白(IAP)和可溶性上皮型钙黏附蛋白(soluble epithelial cadherin,sE-cad)水平的变化及其临床意义.方法 分别用单向免疫扩散法和ELISA法测定60例大肠癌患者手术前后血清IAP和sE-cad水平的改变,并与健康对照组比较分析.结果 大肠癌组治疗前较对照组血清IAP和sE-cad均增高[(673.3±77.3)μg/mL vs (508.3±69.5)μg/mL,(88.3±11.7)μg/L vs(8.33±0.77)μg/L],与对照组比较差异有显著性(P<0.01);且与淋巴结转移和肿瘤临床TNM分期有明显相关性.行根治性手术组(33例)术后血清IAP和sE-cad均显著降低[(530.7±50.2)μg/mL vs(667.7±47.5)μg/mL,(6.96±0.34)μg/L vs (144.2±37.1)μg/L](P<0.01);而姑息性手术组(27例)血清IAP和sE-cad则无显著变化[(659.8±58.9)μg/mL vs (676.1±50.7)μg/mL;(153.2±20.5)μg/L vs (149.8±31.7)μg/L](P>0.05).大肠癌患者血清IAP和SE-cad的变化与肿瘤的浸润转移和病程有关.结论 动态检测大肠癌患者血清IAP和SE-cad的变化,有助于估计患者的治疗效果和预后.     

腹腔镜下纤维胆管镜取石术在胆总管结石取石中的疗效

目的探讨腹腔镜下纤维胆管镜取石术在胆总管结石取石中的临床疗效。方法将2012年7月至2015年7月张家口市第二医院收治的胆总管结石患者120例按照随机数字表法分为腹腔镜组和对照组,各60例。对照组行开腹胆总管切开取石术,腹腔镜组采用腹腔镜下纤维胆管取石术。比较两组患者手术时间、术中出血量、住院时间、术后肛门排气时间、肠道功能恢复时间及手术并发症发生情况,分别于手术前1 d及术后1、3、5 d采用放射免疫法检测患者血清皮质醇、C肽、游离三碘甲状腺原氨酸(FT3)水平。结果腹腔镜组术中出血量少于对照组(54±8)m L比(108±14)m L],住院时间显著短于对照组[(4.7±0.8)d比(11.7±2.3)d](P<0.01);腹腔镜组肛门排气时间、肠道功能恢复时间显著短于对照组[(56.3±6.8)min比(18.2±2.9)min,(32.7±2.8)h比(10.9±0.7)h](P<0.05)。腹腔镜组切口感染、胆瘘、胆管感染发生率均显著低于对照组[0%比13.3%(8/60),5.0%(3/60)比20.0%(12/60),3.3%(2/60)比15.0%(9/60),P<0.05]。两组患者术后1、3、5 d血清皮质醇、C肽均较治疗前升高[腹腔镜组:(158±24)、(160±23)、(156±20)μg/L比(144±21)μg/L,(1.31±0.31)、(1.42±0.30)、(1.42±0.23)mmol/L比(0.81±0.22)mmol/L;对照组:(208±26)、(236±27)、(226±24)μg/L比(139±18)μg/L,(1.82±0.41)、(2.21±0.52)、(2.11±0.41)mmol/L比(0.90±0.23)mmol/L],呈先上升后降低的趋势,至术后3 d达峰值,对照组波动幅度较大。两组患者术后1,3,5 d FT3均较治疗前降低[腹腔镜组:(5.31±0.42)、(5.72±0.54)、(5.83±0.54)pmol/L比(6.24±0.52)pmol/L;对照组(3.71±0.21)、(3.52±0.21)、(3.92±0.31)pmol/L比(5.91±0.43)pmol/L],呈先降低后上升的趋势,至术后3 d达最低值,对照组波动幅度较大(P<0.05)。两组在组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。结论腹腔镜下纤维胆管镜取石治疗胆总管结石创伤小、安全性高,且对患者的应激反较轻,有利于患者术后恢复,值得临床推广应用。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…