高血压患者血清同型半胱氨酸水平变化及临床意义

目的探讨高血压患者血清同型半胱氨酸(Hcy)水平变化及临床意义。方法对82例原发性高血压患者(轻度高血压患者组22例,中度高血压患者组34例,重度高血压患者组26例)及对照组30例健康体检者血清Hcy水平进行检测,并进行比较与分析。结果重、中、轻度高血压患者组患者血清Hcy水平均显著高于对照组,差异均有统计学意义(P<0.05);重、中度高血压患者组患者血清Hcy水平均显著高于轻度高血压组,差异亦均具有统计学意义(P<0.05);重度高血压患者组患者血清Hcy水平均显著高于中度高血压组,差异亦均具有统计学意义(P<0.05)。结论及早检测高血压患者血清Hcy水平,对高血压病情严重程度的评价及治疗方案的选择具有重要的临床意义。     

同型半胱氨酸与颈动脉狭窄支架置入术后再狭窄程度的相关性

目的:探讨血浆同型半胱氨酸与缺血性脑血管病患者颈动脉狭窄血管内支架成形术后再狭窄程度的相关性.方法:测定64例缺血性脑血管病患者颈动脉狭窄血管内支架成形术后患者血浆(Hcy)水平,并行数字减影全脑血管造影,根据颈部血管造影.结果:将患者分为正常组(12例),颈动脉轻度狭窄组(23例),颈动脉中度狭窄组(18例)和颈动脉重度狭窄组(11例),并进行对照分析.狭窄组患者血清Hcy水平均显著高于正常水平,颈动脉狭窄血管内支架成形术后重度狭窄组Hcy水平高于颈动脉中度狭窄组及颈动脉轻度狭窄组,颈动脉中度狭窄组明显高于颈动脉轻度狭窄组.结论:Hcy是血管炎症的标志物,Hcy水平与颈动脉狭窄患者血管内支架成形术后再狭窄程度呈正相关,在临床诊断及病情判断上具有价值.     

同型半胱氨酸水平与年龄因素在高血压合并焦虑状态中的作用探讨

目的 研究血清同型半胱氨酸(Hcy)水平及年龄因素在高血压患者合并焦虑状态之间的关系.方法 对164例近1周常规治疗血压仍不稳定的原发性高血压患者进行患者健康问卷抑郁量表(PHQ-9)和广泛性焦虑量表(GAD-7)抑郁焦虑状态测评,根据合并焦虑状态情况分为无焦虑组(28例)、轻中度焦虑组(81例)和重度焦虑组(55例).分析患者的GAD-7水平,同时检测患者Hcy、LDL-C、HDL-C、高敏C反应蛋白(hs-CRP)和纤维蛋白原(FIB),比较3组间的差别及与高血压合并焦虑状态程度的相关性.结果 无焦虑组、轻中度焦虑组、重度焦虑组的年龄分别为(58.1±2.4)、(58.2±2.0)、(60.6±2.3)岁,Hcy分别为(12.8±0.8)、(16.4±0.7)、(17.4±1.1) μmol/L,3组年龄及Hcy比较差异均有统计学意义(P＜0.05).相关分析显示GAD-7评分与PHQ-9评分相关,相关系数为0.581 (P ＜0.01)；GAD-7评分与Hcy及年龄相关；与其他检验指标未显示相关性.多元回归分析显示PHQ-9、Hcy及年龄是影响高血压合并焦虑状态评分的重要因素.结论 Hcy水平和年龄因素与高血压合并焦虑状态程度具有相关性.     

血浆纤维蛋白原及同型半胱氨酸的检测在妊娠期高血压疾病中的意义

目的 探讨血浆纤维蛋白原(fibrinogen,FIB)及同型半胱氨酸(homocysteine,Hcy)对妊娠期高血压疾病评价作用,以期注重防范.方法 选取妊娠期高血压疾病患者110例作为研究对象,包括子痫前期轻度55例,子痫前期重度55例,并选取同时期正常晚期妊娠55例和妊娠期高血压55例作为对照,均抽取静脉血观察在FIB、Hcy含量变化情况.对子痫组均予硫酸镁治疗,并以同时期先兆流产55例患者作为对照,观察治疗后第3、7、10天在血清FIB、Hcy含量变化情况,观察两者和妊娠其高血压疾病相关性.结果 妊娠期高血压疾病患者血浆Hcy、FIB含量越高,疾病越严重,差异有统计学意义(P<0>.05),经硫酸镁治疗后,子痫前期轻度组、子痫前期重度组血清Hcy、FIB含量逐渐降低,和先兆流产组比较差异有统计学意义(P<0.05).妊娠高血压疾病与Hcy、FIB呈正相关(r值分别为8.936、9.244,P<0.05).结论 密切监测Hcy、FIB水平对预防、诊疗和动态监测有重要参考价值.     

原发性高血压合并急性脑梗死患者血清同型半胱氨酸水平变化

目的探讨血清同型半胱氨酸水平与原发性高血压合并急性脑梗死的关系。方法选取急性脑梗死患者96例,其中单纯脑梗死患者42例（脑梗死组）,原发性高血压合并脑梗死患者54例（高血压脑梗死组）;选取同期就诊的单纯原发性高血压患者48例（高血压组）及健康体检患者40例（对照组）。观察所有研究对象的血清Hcy水平及脑梗死组、高血压脑梗死组患者脑梗死情况。结果中度高血压患者的血清Hcy水平较轻度高血压患者明显升高（P〈0．05）,而重度高血压患者血清Hcy水平较中度高血压患者明显升高（P〈0．05）;高血压组、脑梗死组、高血压脑梗死组患者血清Hcy水平均较对照组明显升高（P〈0．01）;高血压脑梗死组血清Hcy水平较高血压组、脑梗死组均明显升高（P〈0．05）;高血压脑梗死组患者大面积梗死、再发性梗死、多灶性梗死的发生率较脑梗死组明显增高（P〈0．05）。结论血清Hcy水平增高与原发性高血压合并脑梗死的发生存在一定的关系,且与患者脑梗死病变程度有关。常规检测患者血清Hcy水平对于原发性高血压合并急性脑梗死患者的预防、治疗、预后等具有萤要的临床价值。     

血清Lp-PLA2、Hcy、mALB、NAG、CysC联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值

目的 探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)、血清胱抑素-C(CysC)、尿微量白蛋白(mALB)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值。方法 前瞻性选取2019年3月至2020年9月我院收治的82例妊娠期高血压疾病的患者,根据孕妇病情程度分成妊娠期高血压组(n=27,血压≥140/90 mmHg,尿蛋白阴性)、轻度子痫前期组(n=26,血压≥140/90 mmHg,尿蛋白≥0.3 g/24h)和重度子痫前期组(n=29,血压≥160/100 mmHg,尿蛋白≥2.0 g/24h)。根据内生肌酐清除率(Ccr)水平将82例妊娠期高血压疾病患者分成肾功能异常组(Ccr80 ml/min)42例和肾功能正常组(Ccr≥80 ml/min)40例。统计各项指标水平与患者病情、肾功能的关系,用ROC曲线分析其联合检测的诊断价值。结果 重度子痫前期组血清Lp-PLA2、Hcy和CysC和尿mALB和NAG水平均比轻度子痫前期组和妊娠期高血压组高(P 0.05),轻度子痫前期组血清Lp-PLa2、Hcy和CysC和尿mALB和NAG水平比妊娠期高血压组高(P 0.05)。肾功能异常组血清Lp-PLA2、Hcy和CysC和尿mALB和NAG水平比肾功能正常组高(P 0.05)。ROC曲线分析显示,血清Lp-PLA2、Hcy、mALB、NAG、CysC联合检测在妊娠期高血压疾病早期肾脏损伤中的诊断价值AUC为0.928,灵敏度为92.86%(39/42),特异度为95.00%(38/40),准确度为93.90%(77/82)。结论 血清Lp-PLA2、Hcy、CysC、尿mALB、NAG水平随着妊娠期高血压疾病的病情严重程度有明显相关,联合检测对妊娠期高血压疾病早期肾脏损伤的诊断有较高价值。     

高血压肾脏损害患者血清脂联素、胱抑素C和同型半胱氨酸联合检测的临床意义

目的 探讨原发性高血压肾脏损害患者的血清脂联素(ADPN)、胱抑素C(CysC)和同型半胱氨酸(Hcy)联合检测的临床价值。方法 选择2019年1月至2020年8月在深圳市宝安区中心医院就诊的196例原发性高血压肾脏损害患者为观察组,据肾小球滤过率估计值(eGFR)将观察组分为肾功能轻度下降86例为A组,中度下降62例为B组,重度下降48例为C组;同期选择健康者100例为健康组、原发性高血压无肾病患者100例为对照组,分析比较各组患者血清的ADPN、CysC、Hcy和eGFR浓度水平,分析各组患者血清的ADPN、CysC和Hcy浓度水平跟GFR及ACR相关性,分析ADPN、CysC和Hcy联合检测在高血压早期肾损伤诊断中的效果。结果 观察组CysC和Hcy均高于健康组和对照组,对照组CysC和Hcy均高于健康组,观察组ADPN和eGFR均低于健康组和对照组,对照组ADPN和eGFR均低于健康组,差异均有统计学意义(P 0.05);C组的ACR、eGFR、CysC和Hcy均低于B组和A组,B组的ACR、eGFR、CysC和Hcy均低于A组,C组的ADPN高于B组和A组,B组的ADPN高于A组,差异均有统计学意义(P 0.05);观察组的CysC和Hcy均与eGFR呈显著负相关(R显著正相关(R ACR呈显著负相关(R于高血压肾脏损害的诊断AUC值分别为0.65、0.71、0.73及0.87,三者联合检测对于高血压肾脏损害的诊断效能较单独检测高。结论 血清ADPN、CysC和Hcy水平与高血压肾脏损害病情严重程度相关,ADPN、CysC和Hcy联合检测可作为高血压肾脏损害临床诊断及病情评估的无创生物学指标。     

血浆同型半胱氨酸与脑梗死及颈动脉硬化相关性的研究

目的探究血浆同型半胱氨酸与颈动脉硬化、脑梗死的相关性。方法随机选取并回顾性分析2011年6月至2012年1月于我院治疗脑梗死患者76例(研究组)及76例同期健康体检者(对照组)。对比两组患者同型半胱氨酸(Hcy)水平、颈动脉内膜-中层厚度(IMT)。结果研究组高同型半胱氨酸血症患者明显高于对照组差异存在统计学意义(P<0.05),研究组Hcy、叶酸水平明显高于对照组(P<0.05)。研究组76例患者中44例出现颈动脉硬化,按照IMT、PSV将研究组患者分为颈动脉梗死轻度组、中度组、重度组。各组Hcy、IMT存在相关性,中度组及重度组Hcy、IMT水平均显著高于轻度组,存在统计学意义(P<0.05),且两者亦存在统计学差异(P<0.05)。结论血浆Hcy水平与动脉膜粥样硬化有一定联系,在一定程度上可以提示脑梗死进展和治疗情况。同时对于动脉粥样硬化的早期干预具有指导作用。     

老年高血压患者同型半胱氨酸升高伴血脂异常分析

目的:研究老年高血压伴同型半胱氨酸(Hcy)患者的血脂情况,探讨Hcy对动脉粥样硬化的可能影响。方法:收集中心2013年2月至2014年2月间诊治的老年高血压患者80例为研究对象,根据Hcy数值分为H型高血压组和非H型高血压组,检测并比较两组患者的Hcy及血脂水平。结果 :H型高血压患者较多,为48例(60%),非H型高血压患者为32例(40%)。H型高血压组的低密度胆固醇水平明显高于非H型高血压组,而高密度胆固醇及载脂蛋白A明显低于非H型高血压组,差异均有统计学意义(P<0.05)。结论 :老年高血压患者较多伴有Hcy升高,同时预示其血脂异常,与动脉粥样硬化病变的发生可能相关。     

脑梗死与高同型半胱氨酸的相关性研究

目的分析脑梗死和高同型半胱氨酸(Hcy)之间的相关性。方法随机选取54例脑梗死患者作为观察组,同时选取同期健康体检人员54例作为对照组,测量两组研究对象Hcy浓度,以此研究脑梗死和Hcy之间的关系。结果观察组血清Hcy水平(22.54±7.01)μmol/L明显高于对照组(11.74±2.34)μmol/L,差异有统计学意义(P<0.05),轻度障碍患者血清Hcy水平明显低于中度及重度障碍患者,中度患者血清Hcy水平低于重度障碍患者,差异具有统计学意义(P<0.05)。结论 Hcy是脑梗死独立危险因素,脑梗死发作时Hcy水平明显升高,为临床脑梗死的预防和治疗提供了必要的参考价值。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.     

日舒安洗剂治疗皮肤病353例

目的：观察日舒安洗剂对湿疹、皮炎等皮肤病的疗效及对皮肤常见致病菌的抑菌效果。方法：针日舒安洗剂按：１０用温开水稀释后清洗或坐浴,ｂｉｄ,５￣１０ｍｉｎ／次,７￣１０ｄ为１个疗程。结果：有效率８３．３％,并对白色念珠菌,金黄色葡萄球菌,红色毛癣菌,淋球菌作体外抗菌试验,均有不同程度的抑菌作用,治疗中未见过敏或刺激现象。结论：在同类产品中,日舒安价格低廉,值得推广应用。