特发性身材矮小儿童成骨细胞的功能状况

目的通过检测特发性身材矮小(ISS)儿童血清骨碱性磷酸酶(BAP)及骨钙蛋白(OC)水平,探讨其成骨细胞的功能状况。方法ISS组36例及健康对照组儿童50例。ISS组分为青春期前组及青春期组。测各组儿童身高、体质量、体质量指数,采用CHN法评定左侧手、腕部骨化指标,计算骨龄。采用ELISA法测其血清BAP及OC水平。结果青春期前,ISS儿童血清BAP及OC水平为(79.90±25.96)U/Lvs(60.96±18.46)μg/L,健康对照组为(152.17±35.36)U/Lvs(76.16±28.03)μg/L;青春期,ISS儿童血清BAP及OC水平为(108.33±35.20)U/Lvs(63.82±24.81)μg/L,健康对照组为(156.30±35.29)U/Lvs(104.92±28.26)μg/L。青春期前及青春期ISS组血清BAP及OC水平均明显低于健康对照组,存在显著性差异(Pa<0.01)。结论ISS儿童以成骨细胞为中心环节的骨塑造和再造能力均较健康生长发育少年儿童差。     

关节液检查的临床意义

检查30例关节炎患者的关节液,结果示类风湿性关节炎患者关节液中白细胞数为330～72600/mm~3,粒细胞为9～97％,结合关节液的其它物理性质,对类风湿关节炎的诊断有一定参考价值。并观察到类风湿关节炎患者血清中IgG、IgA、IgM和关节液中IgG高于其它类型关节炎。     

Rheumatoid arthritis and membranoproliferative glomerulonephritis: an unusual case

SUMMARY: Renal involvement is not uncommon in rheumatoid arthritis (RA). Many RA patients have renal dysfunction either secondary to the drugs used to treat arthritis or because of the chronic inflammation. Renal pathologies have often included amyloidosis, drug-related renal disease and mesangial glomerulonephritis. However, membranoproliferative glomerulonephritis has only been rarely reported. We report a case of rheumatoid arthritis associated with membranoproliferative glomerulonephritis that rapidly progressed to end-stage renal disease.     

82例高血压患者16项人格特质测验

研究目的应用卡特尔16项人格特质测验探讨原发性高血压患者的人格特征。研究背景高血压病是危害人类健康的常见病之一，发病率逐年上升，但其病因至今尚未阐明，故有必要从心理、人格方面来探讨高血压的发病原因，以利于高血压病的防治。研究方法本文对82例均由2名以上内科医师确诊为原发性高血压、且现在高压仍保持在20／12．7kPa以上的患者进行卡特尔16项人格特质测验，并与78例人群对照分析。结果高血压患者在C－稳定性、E－峙强性、Q－紧张性以及在双重人格因素类型中的适应与焦虑方面与正常对照组有显著差异（P＜0．05）。结论心理－社会因素是促使高血压发生的重要因素，它对高血压病因的阐明有重要意义，同时也使我们越来越重视运用心理、行为疗法，如生物反馈、各种松驰疗法等去防治高血压。     

带血管蒂岛状筋膜瓣移植治疗晚期类风湿性髋关节炎

目的：阐明带血管蒂岛状筋膜瓣移植治疗晚期类风湿性髋关节炎的疗效。材料和方法：对４２例４８髋晚期类风湿性髋关节炎病人采用以旋股外侧血管降支为蒂的股前外侧筋膜瓣移植行患髋成形术。结果：术后随访４～１０．５年，平均４．５年，髋关节活动范围术前平均１６．５°，术后２２８．６°，按照Ｃｈａｒｎｌｅｙ和吴之康人工髋关节置换术后的疗效评定标准，优良２９髋、很好１３髋、好６髋，尚可、差、很差无。结论：患者年龄在１５～４０岁之间为合适的治疗年龄。与人工髋关节置换术相比，本方法对髋关节正常结构破坏小；一旦手术失败仍可选用其它治疗方法弥补；且并发症少、费用低、远期效果好。     

Dopamine transporter density is decreased in parkinsonian patients with a history of manganese exposure: What does it mean?

Manganese (Mn) exposure can cause parkinsonism. Pathological changes occur mostly in the pallidum and striatum. Two patients with a long history of occupational Mn exposure presented with Mn-induced parkinsonism. In one patient, magnetic resonance imaging (MRI) showed findings consistent with Mn exposure, and Mn concentration was increased in the blood and urine. However, this patient's clinical features were typical of idiopathic Parkinson disease (PD). Previous pathological and positron emission tomography studies indicate that striatal dopamine transporter density is normal in Mn-induced parkinsonism, whereas it is decreased in PD. Therefore, we performed [(123)I]-(1r)-2 beta-carboxymethoxy-3beta-(4-iodophenyl)tropane ([(123)I]-beta-CIT) single-photon emission computed tomography. Severe reduction of striatal beta-CIT binding was indicated, which is consistent with PD. We propose three interpretations: (1) the patients have PD, and Mn exposure is incidental; (2) Mn induces selective degeneration of presynaptic dopaminergic nerve terminals, thereby causing parkinsonism; or (3) Mn exposure acts as a risk of PD in these patients. Our results and careful review of previous studies indicate that the axiom that Mn causes parkinsonism by pallidal lesion may be over-simplified; Mn exposure and parkinsonism may be more complex than previously thought. Further studies are required to elucidate the relationship between Mn and various forms of parkinsonism.     

养阴清热、宣痹通络法治疗类风湿性关节炎的临床研究

目的 观察清络通痹颗粒治疗类风湿性关节炎阴虚络热证的临床疗效。方法 将118例患者随机分为清络通痹颗粒治疗组63例和雷公藤多甙片对照组55例，观察用药前后主要症状、体征和实验室检测指标的变化。结果 治疗组的临床治愈率为9．52％，临床治愈显效率为38．10％，总有效率为90．48％，疗效明显优于对照组的0％、20％、83．64％（P＜0．05）；治疗组的类风湿因子滴度、血沉、C反应蛋白、免疫球蛋白也明显降低，与对照组相比差异显著（P＜0．05或P＜0．01）。结论 清络通痹颗粒具有抗炎镇痛、调节免疫紊乱等作用，从而达到控制病情的治疗效果。     

Lipoprotein lipase in relation to inflammatory activity in rheumatoid arthritis

Objective. To evaluate the impact of chronic inflammation on lipoprotein lipase (LPL) levels and triglyceride metabolism in patients with rheumatoid arthritis (RA). Design. Plasma levels of LPL activity and mass before and after heparin were determined in post-menopausal women with active RA and in controls. The results were related to lipid levels and inflammatory variables. The LPL activity and mass together with triglyceride levels were also measured before and 6 h after an oral fat load. Setting. The study was performed on in- and out-patients at a University Rheumatology clinic. The controls came from the same reference area. Subjects. Altogether 17 consecutive post-menopausal female patients with RA and 16 age and sex matched controls were enrolled for the initial determination of LPL. Fifteen of the patients and 15 of the controls agreed to take part in the fat load. Of these, one patient and one control were excluded. Main outcome measures. LPL determination: basal levels and post-heparin levels of LPL activity and mass. Correlations between LPL and blood lipids (cholesterol, triglycerides), lipoprotein levels (high density lipoprotein, HDL; low density lipoprotein, LDL), erythrocyte sedimentation rate (ESR) acute phase proteins (orosomucoid, haptoglobin, fibrinogen mass) and cytokines (tumour necrosis factor α, TNF-α; interleukin 1β, IL-1β; and interleukin-6, IL-6). Fat tolerance test: LPL activity, mass and triglyceride levels before and 6 h after a per oral fat load. Results. Pre-heparin LPL mass (P<0.01) and activity (P<0.01) were significantly lower in the rheumatoid patients. Pre-heparin LPL mass showed no correlation to the lipid levels, but an inverse correlation to several inflammatory parameters; it was significant for orosomucoid (r_s=?0.63, P<0.05) and C-reactive protein (CRP) (r_s=?0.54, P<0.05) and close to significant for haptoglobin (r_s=?0.48, P=0.087) and IL-6 (r_s=?0.52, P=0.061). Six hours after a lipid load the LPL activity and mass were significantly lower in RA (P<0.05 and P<0.01, respectively) but the triglyceride level was not significantly different compared to controls. Conclusion. An inverse relationship exists between inflammatory status and pre-heparin LPL mass. Pre-heparin LPL mass reflects mainly the inactive monomeric fraction of LPL. This has been shown to hinder the uptake of remnant lipoprotein particles through competition with lipoprotein bound dimeric LPL for the LDL receptor-related protein (LRP receptor) on hepatocytes and macrophages in culture. A decrease of the level of monomeric LPL in plasma may thus be beneficial for remnant catabolism. The same mechanism may on the other hand increase macrophage uptake of lipids. This may not affect global lipid metabolism but may be important in driving the atherosclerotic process in the vessel wall.