310例慢性肾小球肾炎患者辨证规律研究

目的：通过对慢性肾小球肾炎患者（CKD2～3期）的中医证候分型、临床症状、中药疗效以及临床指标间相关性研究,探讨本病的中医证型分布特点,为进一步探索中药临床研究提供依据。方法：回顾性收集2008年～2011年入住我院肾病科的慢性肾小球肾炎患者的病史资料、中医临床症状、相关临床指标,运用统计分析方法研究慢性肾小球肾炎的中医辨证分型规律以及治疗方法。结果：（1）慢性肾小球肾炎的中医证型中以气阴两虚型、肝肾阴虚型常见;（2）脾肾阳虚型蛋白尿水平最高,差异具有统计学意义（P〈0.05）;（3）脾肾阳虚型中药治疗有效率最低（66.7%）。结论：慢性肾小球肾炎的中医证候以气阴两虚最为常见,脾肾阳虚型蛋白尿水平最高,治疗有效率最低。     

成人特发性膜性肾病遗传易感性与中医证型的关联性研究

目的:探讨特发性膜性肾病(IMN)的足细胞裂隙隔膜相关蛋白基因NPHS1、NPHS2与中医辨证分型的关联。方法:收集原发性肾病综合征患者200例,其中实验组(IMN)38例,对照组(非IMN)162例,两组病人外周血淋巴细胞中获得基因组DNA进行序列分析、测定,分析NPHS1基因G349A位点、NPHS2基因G686A,C695T位点的多态性及其与中医证型关联。结果:(1)两组年龄分布差异有统计学意义(P<0.05);(2)两组NPHS1基因G349A位点基因型频率分布差异有统计学意义(P<0.05)。实验组纯合突变AA基因型频率明显高于对照组;杂合突变GA基因型频率明显低于对照组;(3)两组NPHS2基因G686A,C695T位点未发现多态性改变;(4)两组中医证型本虚证中气(阳)虚证、阴虚证差异有统计学意义(P<0.05);两组标实证中湿热证和血瘀证差异有统计学意义(P<0.05)。(5)未发现候选基因多态性与中医辨证分型的明显相关性。结论:在PNS患者中IMN患者年龄偏大。NPHS1基因G349A位点基因型AA与IMN发病有相关性。IMN中医证型气(阳)虚证、血瘀证明显多于非IMN患者,阴虚证、湿热证明显少于非IMN患者。未发现候选基因多态性与中医辨证分型的明显相关性。     

The medical management of acute coronary syndromes and potential roles for new antithrombotic agents

Antithrombic therapy is recommended to prevent ischemic complications in patients with high-risk non-ST-segment elevation acute coronary syndromes, including patients with unstable angina/non-ST-segment elevation myocardial infarction and patients with ST-segment elevation myocardial infarction undergoing fibrinolysis with fibrin-specific agents. Ischemic benefit from these agents must be balanced against an increased risk of bleeding, which may itself carry adverse long-term consequences. Recent trials suggest that the low-molecular-weight heparin enoxaparin may be superior to unfractionated heparin for preventing ischemic complications, although it also may be associated with an increase in bleeding risk. In two other contemporary trials, the Factor Xa inhibitor fondaparinux improved mortality and morbidity in patients with unstable angina/non-ST-segment elevation myocardial infarction and in patients with ST-segment elevation myocardial infarction undergoing fibrinolytic reperfusion, without increasing bleeding risk. These data underscore the promise of new antithrombotic agents to improve outcomes in acute coronary syndrome (ACS) patients being medically managed.     

肺癌的副肿瘤性神经综合征20例分析

目的 探讨肺癌的副肿瘤性神经综合征（PNS）的临床特点以防止肺癌诊断的延误。方法 对我院1991-01-2002-01住院的20例经病理和细胞学确诊肺癌并PNS患的临床资料进行回顾性分析。结果 肺癌并PNS发生率为2.2%(20/919)，其中LambertEaton肌无力综合征8例，感觉运动性神经病5例，脑脊髓炎3例，感觉性神经病1例，癌的关系不熟悉或重视不够是延误诊断的主要原因。对有PNS应进一步检查以减少肺癌的误（漏）诊率。     

霍奇金淋巴瘤并噬血细胞综合征1例报告

目的报告1例合并噬血细胞综合征的霍奇金淋巴瘤病例。方法以持续高热起病的1例初治霍奇金淋巴瘤,抗感染治疗效果不佳,予ABVD(表柔比星、博来霉素、长春瑞滨、达卡巴嗪)方案化疗后体温一度控制,后又出现高热,伴进行性全血细胞减少及肝功能恶化,完善相关检查后诊断明确为合并噬血细胞综合征,加予肾上腺糖皮质激素。结果患者噬血得到有效控制,相关指标均恢复正常。结论霍奇金淋巴瘤合并噬血细胞综合征十分少见且预后不佳,其最佳治疗方案有待于进一步探索。     

肾综合征出血热合并多器官功能衰竭460例临床分析

目的:探讨肾综合征出血热合并多器官功能衰竭的发生机制、衰竭器官发生频率和临床分期及预后的相互关系。方法:回顾性分析我院近4年来460例肾综合征出血热合并多器官功能衰竭患者的临床资料。结果:460例患者中重型患者114例,危重型患者116例,死亡85例,病死率为18.5%。各个临床分期中发生器官衰竭数比例各不相同,在疾病的进展至低血压休克期和少尿期,出现多个脏器序贯衰竭的比例逐渐增加;病死率随着器官衰竭数的增加而呈正相关;发病年龄、发病后入院时间、有无血液透析或血液净化等因素与治愈率、死亡率显著相关。结论:保护易衰竭器官,及时防治休克、DIC、大出血、肾衰、水电解质紊乱和继发感染,避免或减少MODS的发生是治疗肾综合症出血热合并多器官衰竭的关键;为了提高肾综合征出血热的治愈率,应严格遵循"早发现、早休息、早治疗"的治疗原则,同时早期进行抗病毒治疗和使用免疫调节剂。     

Down-regulation of TET2 in CD3+ and CD34+ cells of myelodysplastic syndromes and enhances CD34+ cells proliferation

Aims and background: To investigate the expressions of TET2 mRNA in bone marrow CD3⁺ and CD34⁺ cells of the patients with myelodysplastic syndromes (MDS) and to study the effect of silencing TET2 by small interfering RNA (siRNA) on the biological characteristics of CD34⁺ cells. Methods: CD3⁺ and CD34⁺ cells were sorted by magnetic activated cell-sorting system from bone marrow of MDS patients and controls. The mRNA expressions of TET2 in bone marrow CD3⁺ and CD34⁺ cells of 28 MDS patients and 20 controls were detected by qPCR. The silencing effect of RNA interference (RNAi) on TET2 expression in CD34⁺ bone marrow cells of normal control was identified by qPCR and Western blot analysis. The cell cycle kinetics and cell apoptosis were then detected by flow cytometry. Results: The expression of TET2 mRNA in CD3⁺ and CD34⁺ cells was down-regulated in MDS compared with that in controls [(0.16±0.11) vs. (1.05±0.32) (P<0.001); (0.58±0.26) vs. (1.25±0.94) (P<0.005)]. The siRNA targeting TET2 suppressed the expression of TET2 in normal CD34⁺ cells. Meanwhile, the proliferation activity was significantly enhanced [G0/G1: (87.82±8.25)% vs. (92.65±7.06)% and (93.60±5.54)%, P<0.05; S: (11.50±8.31)% vs. (6.92±7.04)% and (5.95±5.53)%, P<0.05] and the apoptosis rate was declined [(21.28±9.73)% vs. (26.17±9.88)% and (26.20±9.78)%] in the cells which transfected with TET2 siRNA as compared to those in the cells transfected with scrambled siRNA and control cells. Conclusions: The TET2 expression of in CD3⁺ and CD34⁺ cells of MDS patients was decreased. Suppression of TET2 expression renders the CD34⁺ cells harboring more aggressive phenotype. This preliminary finding suggests that CD34⁺ cells lowering expression of TET2 may play an oncogenic role on myeloid tumor and CD3⁺ T cells of MDS patients may be derived from the malignant clone.     

左心室收缩功能对急性冠状动脉综合征患者经皮冠状动脉介入治疗临床转归的影响

目的探讨左心室射血分数减低的急性冠状动脉综合征患者进行经皮冠状动脉介入(PCI)治疗后的临床转归。方法110例急性冠状动脉综合征患者分为左心室射血分数正常(NEF)组和射血分数减低(DEF)组。NEF组共61例患者,男47例,女14例;DEF组共49例患者,男42例,女7例。记录PCI术后患者的重要心血管事件(包括心源性死亡、再次非致命性心肌梗死、再次心绞痛和心功能不全)。结果经过6～54个月随访发现,同NEF组相比,DEF组中术前急性广泛前壁心肌梗死多见,左心室收缩和舒张末期内径较大,高密度脂蛋白(HDL)胆固醇较低,差异有统计学意义。但二组间重要心血管事件发生率差异无统计学意义。结论对于左心室收缩功能减低的急性冠状动脉综合征患者经PCI和积极药物治疗后,近中期临床预后接近左心室收缩功能正常的患者。