连续性肾脏替代疗法在重症急性肾功能衰竭治疗中的应用

目的 回顾分析连续性肾脏替代疗法（ＣＲＲＴ）在重症急性肾功能衰竭（ＡＲＦ）治疗中的应用和影响预后的因素。方法 １９８６年５月至１９９９年１月用ＣＲＲＴ治疗重症ＡＲＦ患者１０１例，回顾性分析了患者临床特点、ＣＲＲＴ方法和预后。结果 １０１例患者中６０例（５９．４％）度过疾病的急性期（存活组），４１例（４０．６％）在急性期死亡（死亡组），对两组患者的临床统计学资料、肾功能衰竭的特点、疾病严重程度（ＡＰ  

Clinical applications of B-type natriuretic peptide (BNP) testing.

Many claims have been made in recent years regarding the utility of plasma B-type natriuretic peptide (BNP) concentration measurements in the diagnosis, risk stratification and monitoring of patients with heart failure. This paper summarizes the current evidence and provides guidance for practising clinicians. Overall, plasma BNP testing appears to be of most value in the diagnostic arena, where it is likely to improve the performance of non-specialist physicians in diagnosing heart failure. In clinical practice, BNP testing is best used as a 'rule out' test for suspected cases of new heart failure in breathless patients presenting to either the outpatient or emergency care settings; it is not a replacement for echocardiography and full cardiological assessment, which will be required for patients with an elevated BNP concentration. Although work is ongoing in establishing the 'normal' values of BNP, heart failure appears to be highly unlikely below a plasma concentration of 100 pg/ml. However, as BNP levels rise with age and are affected by gender, comorbidity and drug therapy, the plasma BNP measurement should not be used in isolation from the clinical context.  

肌钙蛋白T检测对不稳定性心绞痛患者的预后判断

目的本研究旨在评价血清肌钙蛋白Ｔ（ｃＴｎＴ）定量测定对不稳定性心绞痛患者的预后判断价值。方法对６０例不稳定性心绞痛患者（ＵＡＰ）、１８例稳定心绞痛患者及２０例健康人分别进行血清ｃＴｎＴ、肌酸激酶（ＣＫ）和其同工酶（ＣＫ－ＭＢ）的测定，并观察住院期间的心性事件发生率。结果６０例ＵＡＰ患者中３２例（５３％）ｃＴｎＴ≥０．３μｇ／Ｌ，明显高于余２８例（分别为０．７５±０．２４μｇ／Ｌ和０．１２±０．０４μｇ／Ｌ，Ｐ＜０．００１），但ＣＫ、ＣＫ－ＭＢ差异并无显著性。不稳定心绞痛患者中ｃＴｎＴ升高组３０天内其发生急性心肌梗塞、心脏性猝死、顽固性心绞痛的发生率明显高于ｃＴｎＴ正常值（４３．８％比７．１％，Ｐ＜０．０１）；对上述心脏事件，定量ｃＴｎＴ检测的敏感性为８７．５％，阴性预期值达９２．９％，准确性为６６．７％。结论ｃＴｎＴ是反映心肌细胞损伤的灵敏性、特异性均较好的生化指标；ｃＴｎＴ升高对判断不稳定心绞痛患者预后有较好的预测价值。  

Chemokines in pathology and medicine

About 50 human chemokines and nearly 20 receptors have been identified and characterized in little more than a decade since the discovery of interleukin 8 (IL-8), the first chemotactic cytokine. Research in this field has dramatically changed our understanding of leucocyte traffic in inflammation and immunity. This paper has been written for scientists and practitioners in the field of medicine. It reviews in concise and intelligible form information that I consider useful for understanding the role of chemokines in human pathophysiology. The main areas covered are: (i) the basics of chemokine structures, mode of action, activities and selectivity; (ii) newer aspects of the broad involvement of chemokines in the regulation of immune defence and the housekeeping of the immune system; (iii) the role of chemokines in pathology as illustrated by animal models and studies of human diseases; and (iv) novel therapeutic approaches for a variety of inflammatory conditions, which are based on modulation of chemokine activity.  

脑钠素与急性心肌梗死预后关系的临床研究

目的 探讨血浆脑钠素(BNP)浓度与急性心肌梗死(AMI)预后的关系。方法血样在心肌梗死急性期由110例AMI患获得，经在住院期间及经平均12个月的随访，观察心血管事件发生组与未发生组患的血浆BNP浓度差异。结果AMI后血浆BNP浓度呈显升高，发生心血管事件的患血浆BNP浓度明显高于未发生；急性期血浆BNP与心血管事件发生相关。结论AMI急性期血浆BNP浓度显升高，提示心血管事件发生率高；BNP可作为AMI后心血管事件的预测因子。  

Identification of novel FLT-3 Asp835 mutations in adult acute myeloid leukaemia

Genomic DNA from 97 cases of adult de novo acute myeloid leukaemia (AML) was screened using polymerase chain reaction (PCR) and conformation-sensitive gel electrophoresis (CSGE) for FLT3 exon 20 mutations. Initial sequencing of four cases, representing the spectrum of CSGE abnormalities, revealed changes affecting codon Asp835 in three cases and also an intron 20 A to G change. In order to identify all possible Asp835 alterations, as well as the frequency of the intronic change nucleotide 2541 + 57 A-->G, the patient PCR products were digested with EcoRV and NlaIII respectively. Seven cases (7.2%) possessed a mutation affecting Asp835; these were identified, following DNA sequencing, as Asp835Tyr (n = 5), Asp835His (n = 1) and Asp835del (n = 1). Alterations affecting Asp835 were not found in 80 normal control DNA samples. In contrast, the nucleotide 2541 + 57 A-->G change was shown to be a polymorphism, with an allelic frequency of 0.24 for the G and 0.76 for the A allele. This study reports, for the first time, point mutations in the human FLT3 gene that, because of their homology with other class III receptor tyrosine kinase mutations, probably result in constitutive activation of the receptor.  

Expression and prognostic significance of survivin in de novo acute myeloid leukaemia

Survivin is an inhibitor of apoptosis (programmed cell death) overexpressed in various human cancers, but undetectable in normal differentiated tissues. A potential distribution and prognostic significance of survivin in patients with de novo acute myeloid leukaemia (AML) was investigated. By immunofluorescence of bone marrow specimens and peripheral blood mononuclear cells, survivin was detected in 75 out of 125 interpretable AML cases (60%), with reactivity in 50-90% of AML cells. Survivin expression correlated with a lower white blood cell count (WBC) (P = 0.008 by the Mann-Whitney test) and was associated, in the 55 cases of FAB M0/M1/M2, with leukaemic granulocytic maturation (one out of five M/L0, 11 out of 22 M/L1 and 23 out of 28M/L2; P = 0.007 by the Fisher test). In 69 patients treated with the Acute Leukaemia French Association (ALFA) 9000 protocol, survivin expression was significantly associated with a lower WBC (P = 0.03 by the Mann-Whitney test) and favourable/intermediate cytogenetics (P= 0.03 by the Fisher test). There was no significant difference in complete remission rate or overall survival between survivin-positive and survivin-negative AML patients (P = 0.15 by the log-rank test). However, survivin expression became an independent negative prognostic factor for survival when adjusted with the Cox model for established prognostic factors in AML (cytogenetics, age and WBC) or for the ALFA 9000 treatment arm (RR = 2.8 and P = 0.026, by the likelihood-ratio test). These data suggest that survivin expression may be considered as a new unfavourable prognostic factor of de novo AML and suggest a role for apoptosis inhibition in influencing disease outcome.  

糖尿病合并脑卒中病情及转归的探讨

目的　探讨糖尿病合并脑卒中病情及转归与血糖水平的关系。方法　对糖尿病合并脑卒中及非糖尿病脑卒中的发病年龄进行比较，根据入院时血糖水平将１２２ 例分为３ 组，观察其与病情及转归的关系。结果　糖尿病合并脑卒中与非糖尿病脑卒中病人５０ 岁以后发病者有明显差别，且并发脑梗死较非糖尿病多见。入院时血糖＜ １６－７ｍ ｍｏｌ／Ｌ者，脑卒中多属轻、中型，而血糖≥１６－７ｍ ｍｏｌ／Ｌ者，重症者多，病死率高。结论　糖尿病合并脑卒中临床症状的轻重及病情转归与入院时血糖水平的高低有关，若血糖≥１６－７ｍｍｏｌ／Ｌ提示脑组织损害范围较广，病情严重，易诱发酮症酸中毒或高渗性昏迷；而且是急性期预后不良的指标之一，所以，控制好血糖是预防及治疗的关键  

内皮功能不全与冠心病

内皮细胞通过产生和释放血管反应性调解历子如内皮衍生舒张因子（EDRF）和一氧化氮（NO）,在维持心血管系统稳态中起中心作用。内皮功能不全可能通过下列途径在冠心病尤其是动脉粥样硬化和血栓早期形成和发展阶段的病理生理机制中起关键作用：（1）导致冠状动脉血管张力调节机能受损；（2）加速冠状动脉知管壁重塑过程；（3）促进血小板活化和聚集；（4）促进单核细胞和中性粒细胞活化和粘附。内皮功能不全和许多冠心病危险因素如血脂异常、高血压、吸烟、糖尿病、肥胖、年龄、性别等密切相关，同时与冠心病的许多临床类型如心绞痛、急性心肌梗死（AMI）、急性冠状动脉综合`症心衰甚至心律失学相关联，内皮功能不全还与冠心病的药物治疗、介入性治疗和预后有关。因此测定冠状动脉内皮血管反应性可以为有冠心病危险或已患有冠心病的患者提供可作为诊断、治疗和预后工具的关键信息。本综述总结了内皮功能不全和冠心病之间存在密切关系证据。并尽力揭示内皮功能不全对冠心病的作用及其机制。相信，随着对内皮功能不全发生机制的深入了解，可能产生新的预防和治疗策略，从而降低冠心病的发病率和死亡率。