2004年全国克山病病情监测汇总分析

目的掌握2004年全国克山病患病及发病趋势。方法根据《克山病监测》标准(WS/T78-1996)及《克山病诊断标准》(GB17021-1997)对监测点区居民进行普查,随访2003年在册的克山病病例,对克山病发病相关因素进行调查。结果18个监测点区潜在型、慢型克山病检出率分别为3.5%和0.7%,估计全国有491万￣600万克山病病例,其中慢型克山病患者65万￣117万。潜在型、慢型克山病发病率分别为1.8‰和0.1‰,估计新发潜在型13万～39万例,新检出慢型病例最高可达4.3万例。人均发硒0.365mg/kg。粮硒平均0.020mg/kg。结论克山病仍然是一个严重的地方性公共卫生问题,工作重点应放在克山病监测、患者管理和硒预防等方面。     

自发性气胸胸腔镜肺大疱切除术围术期系统护理体会

目的总结自发性气胸胸腔镜肺大疱切除术围术期系统护理的体会。方法对40例行胸腔镜肺大疱切除术的自发性气胸患者,围术期做好心理、疼痛及加强呼吸道、健康宣教等系统护理措施。结果 40例均成功完成胸腔镜手术。手术时间40～100 min,平均57.58 min。术后胸腔引流量100～400 m L,平均256mL。术后出现切口血清肿1例,皮下气肿1例,均经对症处理后治愈。未发生胸腔出血等其他并发症,均痊愈出院。出院时患者及家属对护理工作的总满意率为97.50%。术后随访6～12个月,其间无1例复发。结论对胸腔镜肺大疱切除术的自发性气胸患者,围手术期做好系统护理,可减少并发症发生风险和术后复发率,并利于提升手术效果和患者及家属对护理工作的满意率。     

老年收缩期高血压患者血浆同型半胱氨酸、NO、ET-1的变化及意义

目的探讨老年收缩期高血压（ISH）患者血浆同型半胱氨酸（Hcy）、NO、ET-1水平变化及其临床意义。方法选取单纯收缩期高血压患者30例（ISH组）、双期高血压患者30例（DH组）和老年健康查体正常者25例（对照组）,测定其血浆Hcy、NO、ET-1水平。结果 ISH组血浆Hcy、ET-1均高于DH组、对照组,NO低于DH组、对照组;Hcy与NO呈负相关（r=-0.529,P〈0.01）,与ET-1呈正相关（r=0.576,P〈0.01）。结论 Hcy可能通过影响患者血浆NO、ET-1水平变化促进老年ISH的发生、发展。     

经鼻空肠营养支持在重症急性胰腺炎治疗中的疗效观察

目的研究早期经鼻空肠营养支持对重症急性胰腺炎（SAP）的治疗作用。方法回顾性分析近年来洛阳市中心医院收治的48例重症急性胰腺炎患者的临床资料,其中应用全胃肠外营养治疗25例（TPN组）,应用肠内营养治疗23例（EN组）。观察两组治疗期间c-反应蛋白、血清白蛋白水平、疾病恢复及并发症出现情况,并进行统计学处理。结果治疗1周后,EN组和TPN组c一反应蛋白水平、ApacheU评分比较差异均有统计学意义。EN组和TPN组治疗第2天和第14天的血清白蛋白水平组内比较差异均有统计学意义,同时间点组间比较差异均无统计学意义。TPN组出现感染7例,腹泻6例,四肢血栓1例。EN组出现感染1例,腹泻1例。结论早期经鼻空肠营养支持对重症急性胰腺炎患者安全、可靠、有效,能改善SAP患者营养状况,促进病情恢复,减少并发症,疗效显著,无严重不艮反应。     

2005年黑龙江省尚志市克山病病情监测结果分析

根据《克山病监测》标准和“关于继续进行克山病监测及防治工作的通知”的要求,2005年地方病控制中心对黑龙江省历史克山病病区尚志市政新、富强村进行克山病病情调查,结果分析如下。     

硒和蛋白质对大鼠心肌蛋白质及DNA修复酶的影响

目的 研究低硒低蛋白引起的氧化应激对大鼠心肌蛋白质及DNA修复酶的影响.方法 60只健康雄性Wistar大鼠,按体重随机分为4组,每组15只:低硒低蛋白组(A)、常硒低蛋白组(B)、低硒常蛋白组(C)和常硒常蛋白组(D),饲养1年.处死后,采用2,4-二硝基苯肼(DNPH)比色法检测大鼠心肌蛋白质羰基的含量;提取心肌组...     

硒和蛋白质与大鼠心肌GPX1、GPX4表达及翻译

目的研究硒和蛋白质对大鼠心肌GPX1、GPX4表达及其翻译过程的影响。方法 60只雄性Wistar大鼠按硒与蛋白质两因素两水平的析因设计随机分为四组,饲养一年后处死,western blot方法检测心肌GPX1、GPX4和SBP2蛋白表达水平;RT-PCR方法扩增心肌GPX1、GPX4 mRNA上SECIS序列,SSCP法确定其基因型后进行碱基序列测定。结果低硒组心肌组织GPX1、GPX4含量低于常硒组（P〈0.001;P〈0.05）,SBP2含量高于常硒组（P〈0.05）;低蛋白组心肌组织GPX1含量低于常蛋白组（P〈0.001）,SBP2含量高于常蛋白组（P〈0.05）;硒与蛋白质在影响心肌GPX1表达方面有交互作用（P〈0.001）;GPX1、GPX4基因的SECIS碱基序列并未发生变异。结论在低硒低蛋白条件下,心肌GPX1和GPX4含量显著降低,而SBP2含量则增加;GPX1、GPX4基因的SECIS碱基序列并未发生变异。     

黄绿青霉素对低硒低蛋白大鼠心肌损伤的初步观察

目的 观察黄绿青霉素(CIT)对低硒低蛋白大鼠心肌损伤的特点.方法 40只4周龄Wistar大鼠,雌雄符半,体质量60～80 g,按2×2析因设计随机分为常硒常蛋白无毒素组、常硒常蛋白加毒素组、低硒低蛋白无毒素组和低硒低蛋白加毒素组(将低硒低蛋白合为一种因素考虑),每组10只.分别采用常硒常蛋白和低硒低蛋白饲料喂养大鼠至第10周后,加毒素组大鼠饲料中投予CIT(5 mg·kg-1·d-1)继续喂养至第16周.观察各组大鼠的毛色、摄食、体质量增长情况,计算心脏质量指数,观察心肌病理变化,检测血清硒、白蛋白水平、肌酸激酶(CK)和谷胱甘肽过氧化物酶(GSH-Px)活性以及心肌超氧化物歧化酶(SOD)活性.结果 硒、蛋白和CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK、GSH-Px活性和心肌SOD活性的影响不存在交互作用(F值分别为0.000、1.210、0.625、0.981、2.785、0.074、0.001,P均>0.05);硒、蛋白对大鼠血清硒、白蛋白水平、心脏质量指数和血清GSH-Px活性的主效应有统计学意义(F值分别为507.698、87.734、4.201、109.389,P均<0.05);CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK活性的主效应有统计学意义(F值分别为10.929、4.371、26.108、24.844、4.439,P均<0.05).低硒低蛋白两组的血清硒水平[(70.4±40.0)、(87.7 ±59.6)μg/L]低于常硒常蛋A两组[(446.1±74.8)、(502.1±39.2)μg/L,P均<0.05];低硒低蛋白两组的血清白蛋白水平[(34.36±1.28)、(33.38±2.48)g/L]低于常硒常蛋白两组[(40.69±1.30)、(38.71±2.15)g/L,P均<0.05];相同硒和蛋白水平下,加毒素组的心脏质量指数[(4.14±0.36)×10-3、(4.39 ±0.53)×10-3]高于无毒素组[(3.56±0.26)×10-3、(3.80±0.28)×10-3,P均<0.05];低硒低蛋白加毒素组的血清CK活性[(2.54 ±0.56)kU/L]低于低硒低蛋白无毒素组[(3.37±0.67)kU/L,P<0.05].低硒低蛋白两组的血清GSH-Px活性>(408.1±412.6)、(510.5 ±392.0)U/L[低于常硒常蛋白两组[(1667.8±102.2)、(1731.5±144.4)U/L,P均<0.05].电镜结果显示,常硒常蛋白加毒素组大鼠部分心肌细胞闰盘断裂,各带连接断裂,部分区域心肌细胞有溶解现象,有水肿表现;低硒低蛋白无毒素组大鼠心肌细胞膜结构改变不明显,核周围肌丝结构消失,可见大量絮状物质沉积;低硒低蛋白加毒素组大鼠心肌细胞肌节各带结构不很清晰,核旁线粒休嵴轻度疏松,偶见空泡变,大量弥漫性肌质网扩张.结论 CIT是诱导大鼠心肌细胞损伤的主要因素,低硒低蛋白加重病变,但独立致病作用较弱.

Abstract：

Objective To ohserve the rat myocardial damage induced by citreoviridin(CIT)in the status of combined selenium and protein deficiency.Methods According to 2×2 factorial design,forty 4-week-old healthy Wistar rats were randomly divided into four groups.i.e.combined selenium and protein adequate with no CIT and with some CIT groups(Se+Pro+CIT-.Se+Pro+CiT+),combined selenium and protein deficiency with no CIT and with some CIT groups(Se-Pro-CIT-,Se-Pro-CIT+).The numbers of male and female were fifty-fifty.Theserats were fed with combined selenium and protein adequate and combined selenium and protein deficiency fodder until the 16th week. Cardiac toxicity of CIT was evaluated by general state of health, heart weight index, myocardial pathological change, the levels of selenium and the activities of glutathion peroxidase (GSH-Px) and creatine kinase (CK) in serum, and the activity of superoxide dismutase(SOD) of myocardium. Results The interaction effects of combined selenium and protein deficiency and adequate CIT on body weight, serum levels of selenium and albumin, heart weight index, the activities of CK and GSH-Px in serum and SOD of myocardium were statistically not significant(F= 0.000, 1.210, 0.625, 0.981, 2.785, 0.074, 0.001, all P> 0.05). The main effects of combined selenium and protein on the levels of serum selenium and albumin, heart weight index and the activity of GSH-Px in serum were statistically significant(F = 507.698, 87.734, 4.201, 109.389, all P < 0.05). The main effects of CIT on body weight, the levels of serum selenium and albumin, heart weight index and the activity of CK in serum were statistically significant(F = 10.929, 4.371, 26.108, 24.844, 4.439, all P < 0.05). The mean levels of serum selenium of Se-Pro- groups [(70.4 ± 40.0), (87.7 ± 59.6 )μg/L] were lower than those of Se+Pro+ groups [(446.1 ± 74.8),(502.1 ± 39.2)μg/L, all P < 0.05]. The mean levels of serum albumin of Se-Pro- groups [(34.36 ± 1.28 ), (33.38 ±2.48)g/L] were lower than those of Se+Pro+ groups[(40.69 ± 1.30), (38.71 ± 2.15)g/L, all P < 0.05]. The mean levels of heart weight index of CIT+ groups[(4.14 ± 0.36) × 10-3, (4.39 ± 0.53) x 10-3] were higher than those of CIT-groups[(3.56 ± 0.26) x 10-3, (3.80 ± 0.28) x 10-3, all P < 0.05] respectively at the same levels of selenium and protein. The mean levels of CK in serum of Se-Pro-CIT+ group[(2.54 ± 0.56)kU/L] was lower than that of Se-Pro-CIT- group [(3.37 ± 0.67 )kU/L, P < 0.05]. The mean levels of activity of GSH-Px in serum of Se-Progroups[(408.1 ± 412.6), (510.5 ± 392.0)U/L] were lower than those of Se+Pro+ groups[(1667.8 ± 102.2),(1731.5 ± 144.4)U/L, all P < 0.05]. In Se+Pro+CIT+ group, there was part of intercalary disc of cardiac myocytes fragmented;the conjunctions between myoeytes were broken;in some region, cardiac myocytes became edematous,even dissolved. In Se-Pro-CIT- group, the change of cardiac myocytes membrane structures was not obvious;filament structure was disappeared around nucleus;deposition of mass floccule could be seen. In Se-Pro-CIT+ group,the structure of sarcomeres was not obvious;mitochondrial cristae was loosened;cavities in myocytes could be seen occasionally;there were lots of disseminated sareoplasmic reticulum extending. Conclusions .CIT is the main risk factor in inducing myocardial damage. The deficiency of combined selenium and protein can aggravate the damage,but its independent pathogenic effect is weak.     

急性冠脉综合征者缺血性J波的临床研究

目的 研究伴有缺血性J波急性冠脉综合征(ACS)者的临床情况,评价缺血性J波的临床价值.方法 回顾分析372例ACS患者的心电图及相关临床资料,根据心电图有无缺血性J波分为J波组、无J波组,比较两组临床情况、恶性心律失常发生率等.结果 J波组ST段抬高型心肌梗死(STEMI)的发生率明显高于无J波组,J波组恶性心律失常的发生率为25.8%,明显高于无J波组的4.2%,J波组终点事件的发生率明显高于无J波组,差异均有统计学意义(P＜0.05).结论 ACS伴有缺血性J 波患者临床情况差,预后不良.