低剂量螺旋CT在矽肺诊断中的应用

目的探讨低剂量螺旋CT在矽肺诊断中的应用价值。资料与方法 60例矽肺患者分别采用螺旋CT常规剂量(130mA)、低剂量(20mA)进行扫描,比较两种扫描条件下矽肺阴影大小、密集度及矽肺分期情况。结果 20mA与130mA螺旋CT扫描均显示≥20mm阴影16例,大阴影5例,小阴影39例。130mA扫描1级密集度35例,2级密集度10例,3级密集度15例;20mA扫描1级密集度33例,2级密集度12例,3级密集度15例。20mA与130mA螺旋CT扫描均显示矽肺Ⅰ期26例,Ⅱ期12例,Ⅲ期22例,两者在显示矽肺阴影大小、密集度以及矽肺分期方面差异均无统计学意义(P>0.05)。结论 20mA低剂量与130mA常规剂量螺旋CT扫描在显示矽肺阴影大小、密集度以及矽肺分期方面无显著差异,20mA低剂量螺旋CT扫描可作为矽肺筛查的手段之一在临床应用。     

高脂饮食对自发性高血压大鼠中心动脉弹性的影响及鱼油的干预作用

目的观察高饱和脂肪酸及富含鱼油(n-3多不饱和脂肪酸)饮食对自发性高血压大鼠(SHR)大动脉弹性的影响。方法选择8周龄雄性SHR 30只,适应性喂养至14周龄后,按体重随机分为3组,每组10只,分别给予普通饲料、高脂饲料、高脂加鱼油饲料,持续喂养至36周龄,共干预22周。同龄对照大鼠(WKY)30只同前分组。干预后测定血压、体重、血浆游离脂肪酸谱、生化指标,喂养结束后,应用组织多普勒超声法测定中心动脉脉搏波传导速度(APWV),应用组织化学和免疫组织化学法测定中心动脉管壁的病理改变和基质金属蛋白酶9(MMP-9)的表达水平。结果 SHR高脂饮食组血压较普食组和高脂加鱼油组升高(160.5±5.5 mm Hg比153.1±1.0mm Hg、155.1±6.7 mm Hg,P0.01);HE染色显示高脂饮食组动脉管壁中膜横截面积(MCSA)较普食组增加(35500±8536μm2比28348±3956μm2,P0.05),高脂加鱼油组胸主动脉MCSA较高脂饮食组减小(16865±7235μm2,P0.05)。WKY大鼠MCSA无明显变化。SHR大鼠高脂饮食组主动脉弹力纤维占中膜面积百分比较普食组减少(21.1%±2.3%比30.7%±2.3%,P0.05),高脂加鱼油组较高脂饮食组升高(34.5%±4.1%,P0.05)。SHR大鼠高脂饮食组中心动脉APWV较普食组增加,而高脂加鱼油组APWV较高脂饮食组减小(P0.05)。SHR大鼠高脂饮食组的主动脉壁中MMP-9表达较普食组、高脂加鱼油组升高。结论高饱和脂肪酸饮食具有刺激SHR大鼠大动脉血管壁增厚、上调MMP-9在动脉壁表达及增加动脉僵硬度的作用,而富含n-3多不饱和脂肪酸的饮食可能通过逆转这一作用发挥预防及控制血压的作用。     

不同同步放化疗方案治疗中晚期子宫颈癌临床分析

目的比较中晚期子宫颈癌采用单药顺铂、多西紫杉醇联合顺铂同步放化疗与单纯放疗的疗效与毒性反应。方法回顾性分析98例ⅡB~ⅢA期子宫颈癌患者的临床病理资料。根据治疗方法分为A组(放疗联合顺铂同步放化疗组)、B组:(放疗联合多西紫杉醇加顺铂同步放化疗组)和C组(单纯放疗组)。观察三组的疗效与毒性反应。结果 A、B、C组治疗有效率分别为86.5%(32/37)、90.2%(37/41)、65.0%(13/20),三组比较,差异有统计学意义(P=0.037)。A、B、C组发生Ⅲ~Ⅳ度白细胞降低比例分别为51.4%(19/37)、63.4%(26/41)和25.0%(5/20)(P=0.019),Ⅲ~Ⅳ度恶心呕吐发生率分别为32.4%(12/37)、48.8%(20/41)和10.0%(2/20)(P=0.011)。结论同步放化疗用于治疗中晚期子宫颈癌疗效确切,两种化疗方案的疗效及毒性反应无明显差异。     

坐骨神经痛中西医治疗进展

对中西医治疗坐骨神经痛的方法进行系统总结,力图探索最佳的治疗方案,为临床治疗提供参考.     

慢性心力衰竭患者血浆IL-22水平的检测及意义

目的探讨慢性心力衰竭（CHF）患者外周血血浆IL-22的水平及意义。方法采用酶联免疫吸附法（ELISA）检测56例CHF患者（CHF组）和17例正常对照者（对照组）外周血血浆IL-22,TNF-α及IL-10的水平。结果 CHF患者外周血血浆IL-22水平显著高于对照组,且其水平在缺血性心脏病者与非缺血性心脏病者间差异无统计学意义,但心功能NYHA分级Ⅲ-Ⅳ级者水平明显高于NYHA分级Ⅰ-Ⅱ级者。IL-22水平与TNF-水平呈正相关,而与IL-10水平显著负相关。结论 CHF患者外周血外周血IL-22的水平增加,且与心功能有一定关系。IL-22可能参与了心力衰竭的发生发展。     

肝素及低分子肝素对脑血管病患者血中妊娠相关血浆蛋白A浓度的影响

目的 探讨临床脑血管疾病治疗中应用的肝素和低分子肝素对血清学标志物PAPP.A浓度的影响,为进一步准确评价PAPP-A的临床意义提供依据.方法 选取山东大学齐鲁医院2009年11月至2010年5月收入院的40例脑血管病患者,分别采集药物注射前后的血标本.按照治疗方法及肝素和低分子肝素的用药情况分成4组:A组,10例皮下注射低分子肝素抗凝患者,注射前、治疗第1天、第2天和第7天注射后3 h以及末次注射后24 h分别抽取静脉血.B组,10例未用低分子肝素抗凝患者,入院时、入院第1天、第2天和第7天抽取静脉血.C组,10名肝素抗凝支架治疗患者,造影前、注射肝素前、注射肝素后第3、5、15、40和100分钟从动脉鞘管抽取动脉血.D组,10例未用肝素抗凝造影患者,造影前和造影完成后分别从动脉鞘管抽取动脉血.用ELISA方法检测各组标本中PAPP-A浓度,分析不同处理组组间差异及组内各时间点间的差异.结果 A组患者PAPP-A 浓度呈时间依赖性,随着给药天数的增加逐渐从注射前的12.36(9.90～14.32)mIU/L升高至第7天21.80(23.50～19.73)mIU/L,差异有统计学意义(M=38.72,P<0.01).C组患者静脉注射肝素后PAPP-A浓度5 min内由12.86(9.67～14.05)mIU/L升高至51.56(44.20～66.00)mIU/L,差异有统计学意义(M=46.06,P<0.01).皮下注射低分子肝素1周后A组PAPP-A的浓度为21.80(23.50～19.73)mIU/L,高于B组的11.81(9.21～12.89)mIU/L,差异有统计学意义(U<0.001,P<0.01).C组静脉注射肝素15 min时PAPP-A的浓度为43.70(37.70～54.30)mIU/L,高于D组造影后的14.18(11.25～15.86)mIU/L,差异有统计学意义(U<0.001,P<0.01).皮下注射低分子肝素后血中PAPP-A的峰值比静脉注射肝素的峰值低,A组与C组分别为21.80(23.50～19.73)、51.56(44.20～66.00)mIU/L,差异有统计学意义(U=0.999,P<0.01).结论 脑血管疾病临床治疗中应用肝素和低分子肝素会导致血中PAPP-A浓度的升高,选用PAPP-A作为评价指标时应考虑药物的影响.

Abstract：

Objecfive To investigate the effects of treatment for cerebrovascular disorder patients with heparin and low molecular weight heparin(LMWH) on serum PAPP-A concentrations and provide the basis for evaluating the clinical significance of PAPP-A in the following study.Methods Forty cases with cerebrovascular disease from Qilu Hospital from November 2009 to May 2010 were collected in this study.Blood samples were taken before and after drug administration.All cases were divided into four groups according to situation of medication.Group A consisted of 10 patients who received subcutaneous LMWH anticoagulation therapy, and blood samples were collected before LMWH injection, three hours after subcutaneous LMWH anticoagulation therapy in the first day, the second day and the seventh day and 24 hours after the last injection. Group B consisted of 10 patients who did not receive LMWH therapy, and blood samples were collected immediately after admission, the first day, the second day and the seventh day after admission. Group C consisted of 10 patients with percutaneous carotid intervention who received intravenous heparin at the beginning of stenting, and blood samples were collected from the arterial sheath just before angiography and heparin administration, and at 3, 5, 15, 40 and 100 min after heparin administration. Group D consisted of 10 patients who received carotid angiography but LMWH-free therapy,and blood samples were collected from the arterial sheath just before and after angiography. Serum PAPP-A concentrations were analyzed by ELISA to evaluate the differences of intra-groups and differences at different time points of inter-groups. Results In group A, PAPP-A concentrations were time dependent and elevated gradually from 12. 36 (9. 90-14. 32) mIU/L before LMWH injection to 21.80 (23.50-19.73) mIU/L at the seventh day after injection (M=38. 72, P < 0.01 ). In group C, there was a rapid increase of PAPP-A concentration from 12. 86 ( 9. 67-14. 05 ) mIU/L to 51.56 ( 44. 20-66. 00 ) mIU/L within 5 min after intravenous heparin injection (M=46. 06, P <0. 01 ). The PAPP-A concentration of one week after LMWH administration in group A was 21.80 (23.50-19.73) mIU/L, significantly higher than that in group B [11.81 (9. 21-12. 89) mIU/L] (U<0. O01, P<0.01). The PAPP-A concentration at 15 min after heparin administration in group C was 43.70 (37.70-54. 30) mIU/L, significantly higher than that after angiography in group D [14. 18 (11.25-15. 86) mIU/L] ( U<0. 001, P <0. 01 ). The peak level of blood PAPP-A after subcutaneous LMWH injection was significantly lower than that after intravenous heparin injection. The concentrations in group A and C were 21.80 ( 23.50-19. 73 ) and 51.56 (44. 20-66. 00) mIU/L respectively, and had a significant difference ( U=0. 999, P < 0. 01 ) . Conclusions Both intravenous heparin and subcutaneous LMWH administration induce an increase in serum PAPP-A concentration. The effect of drug should be considered when PAPP-A is selected as an evaluation indicator.