哮喘患者痰液中亚硝酸盐/硝酸盐含量的变化及其意义

目的　探讨痰液中一氧化氮（ Ｎ Ｏ） 代谢终产物———亚硝酸盐／ 硝酸盐（ Ｎ Ｏ２／ Ｎ Ｏ３） 测定在哮喘临床中的应用价值。方法　应用 Ｇｒｉｅｓｓ 重氮法测定４５ 例不同时期、不同程度哮喘患者及１５ 例慢性支气管炎（ 慢支） 合并肺心病急性发作期患者痰液、血清 Ｎ Ｏ２／ Ｎ Ｏ３ 含量，同步测定哮喘患者痰液中嗜酸细胞阳离子蛋白（ Ｅ Ｃ Ｐ） 水平及肺通气功能。结果　哮喘轻、中、重度发作期患者痰液 Ｎ Ｏ２／ Ｎ Ｏ３ 中位数浓度（ 分别为１３１ μｍｏｌ／ Ｌ、１３６ μｍｏｌ／ Ｌ） 与缓解期组（８５ μｍｏｌ／ Ｌ） 及正常对照组（６３ μｍｏｌ／ Ｌ） 比较，差异有显著性（ Ｐ＜ ００５） ；发作期组与缓解期组比较差异有显著性（ Ｐ＜ ０ ．０５） ；慢支合并肺心病急性发作期患者痰液 Ｎ Ｏ２／ Ｎ Ｏ３ 水平（３３ μｍｏｌ／ Ｌ） 与各哮喘组及正常对照组比较，差异有显著性（ Ｐ＜ ００５） 。缓解期及发作期哮喘患者痰液 Ｎ Ｏ２／ Ｎ Ｏ３ 与一秒钟用力呼气容积占预计值百分比（ Ｆ Ｅ Ｖ１ 占预计值％ ）间呈显著负相关（ｒ 分别＝ － ０５８７ 、－ ０４８５ ， Ｐ 均＜ ００５） ；而痰液 Ｎ Ｏ２／ Ｎ Ｏ３ 与 Ｅ Ｃ Ｐ 间呈     

乙型肝炎及原发性肝癌患者sIL-2R的变化

目的探讨ｓＩＬ２Ｒ水平与乙型肝炎病情的关系及其在原发性肝癌早期诊断中的价值．方法以ＥＬＩＳＡ法动态检测１１３例乙型肝炎及６例原发性肝癌患者ｓＩＬ２Ｒ水平，另选３１例健康体检者作对照组．结果以ｑ检验、ｔ检验进行统计学处理（微机处理，ＰＯＭＳ２００版）．结果各型乙型肝炎ｓＩＬ２Ｒ水平均显著高于正常对照（ＮＣ）组（Ｐ＜００１），其顺序依次为：ＨＣＣ＞ＣＳＨ＞ＣＨ（ＩＩ）＞ＬＣ＞ＣＨ（ＩＩ）＞ＡＨ＞ＣＨ（Ｉ）＞ＮＣ．ＨＣＣ组ｓＩＬ２Ｒ均值达正常值的２倍以上，且与ＣＨ（Ｉ），ＣＨ（Ｉ），ＡＨ间存在显著性差异（Ｐ＜００１，＜００５及＜００５）；ＣＨ（ＩＩ）组显著高于ＣＨ（Ｉ）组（Ｐ＜００１）．ＨＢｅＡｇ阳性组及ＨＢＶＤＮＡ阳性组ｓＩＬ２Ｒ水平显著高于阴性组．结论ｓＩＬ２Ｒ是监测乙型肝炎病情、ＨＢＶ复制及诊断早期原发性肝癌的一项敏感标志．     

自由基在实验性胃癌及癌前病变发生中的作用

目的探讨自由基在胃癌及其癌前病变发生中的作用．方法将１００只Ｗｉｓｔａｒ大鼠分为２组，实验组（７０只），给予１００ｍｇ／Ｌ甲基硝基亚硝基胍（ＭＮＮＧ）水溶液自由饮用３０ｗｋ，对照组（３０只）饮用自来水．选５个时相点，动态观察ＭＮＮＧ诱发实验性胃癌及其癌前病变过程中大鼠体内丙二醛（ＭＤＡ）、脂质过氧化物（ＬＰＯ）、谷胱甘肽过氧化物酶（ＧＳＨＰＸ）及超氧化物歧化酶（ＳＯＤ）等的变化情况．结果在实验组，ＭＤＡ平均含量在５２ｗｋ非常显著地大于０ｗｋ（Ｐ＜００１），并显著地大于１６ｗｋ以前（Ｐ＜００５）．胃癌组织ＭＤＡ含量显著高于胃癌癌前病变组织（Ｐ＜００５）．癌组织ＬＰＯ的含量显著高于癌前病变组织（Ｐ＜００５）．实验组，总ＳＯＤ和ＣｕＺｎＳＯＤ活性在５２ｗｋ明显低于１６ｗｋ之前（分别为Ｐ＜００５和Ｐ＜００１）．癌组织ＣｕＺｎＳＯＤ含量非常显著地小于正常胃粘膜（Ｐ＜００１），亦明显低于胃粘膜异型增生和肠上皮化生（Ｐ＜００５）．在３０ｗｋ和５２ｗｋＧＳＨＰＸ活性显著低于１６ｗｋ以前．结论自由基在实验性胃癌及其癌前病变发生中具有一定作用，自由基清除剂可能对胃癌的综合防治具有积极意义     

血脂康对高脂饮食家兔血管内皮细胞功能的保护作用

目的探讨血脂康对高胆固醇饮食家兔血管内皮细胞功能的保护作用。方法健康纯种新西兰白兔３０只，随机分层分组法分为对照组（普通饲料），高脂组（普通饲料＋１５％胆固醇），治疗组（普通饲料＋１５％胆固醇＋血脂康０８ｇ·ｋｇ－１·ｄ－１），在实验不同阶段，观察各组家兔血清脂质、一氧化氮及血浆内皮素、前列环素、血栓素含量及血管内皮细胞病理形态学改变。结果实验前各组血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、血浆内皮素（ＥＴ）１、血清一氧化氮（ＮＯ）、血浆血栓素（ＴＸ）Ｂ２及６酮前列腺素（ＰＧ）Ｆ１α等无明显差异。实验１２周，高脂组、血脂康治疗组血清ＴＣ、ＴＧ、ＬＤＬＣ及血浆ＥＴ１、ＴＸＢ２及ＴＸＢ２／６酮ＰＧＦ１α比值明显高于对照组，但治疗组明显低于高脂组（Ｐ值均＜０．０５）；血浆ＮＯ低于对照组（Ｐ＜０．０５），但治疗组高于高脂组（Ｐ＜０．０５）。病理结果显示：血脂康治疗组主动脉、冠状动脉粥样硬化病变及血管内皮细胞损伤明显轻于高脂组。结论血脂康具有明显的调整脂质代谢及保护血管内皮细胞功能的作用。     

增龄对小鼠心肌氧自由基浓度,超氧化物歧化酶活性及丙二醛…

以心肌氧自由基浓度，超氧化物歧化酶活性、丙二醛含量为指标，观察了增龄对心肌自由基反应的影响，结果表明：（１）心肌ＯＦＲ浓度随增龄上升，至１３、１７月龄时达到显著水平（Ｐ＜０．０５）；（２）心肌ＳＯＤ活性随增龄下降，至１３、１７月龄时达到显著水平（Ｐ＜０．０５）；（３）心肌ＭＤＡ含量随增龄而增加，至１３、１７月龄时增加显著（Ｐ＜０．０５，Ｏ＜０．０１）；（４）老年小鼠（１７月龄）心肌ＳＯＤ活性与ＯＦ     

老年慢性阻塞性肺疾病患者骨密度测定及影响因素分析

目的探讨老年慢性阻塞性肺疾病（ＣＯＰＤ）患者骨质疏松的发生及有关影响因素。方法应用双能量Ｘ线吸光测定法测定ＣＯＰＤ组３９例患者及对照组１９例全身及局部的骨矿物含量,同时测定营养状态、血清钙、磷、碱性磷酸酶和肺功能。结果ＣＯＰＤ组体重、体重／理想体重％、上臂围、三头肌皮皱厚度、臂肌围、第２、３、４腰椎（Ｌ２～４）及左股骨Ｗａｒｄ＇ｓ区骨密度水平均显著低于对照组（Ｐ＜０．０５）。ＣＯＰＤ组Ｌ２～４和左股骨Ｗａｒｄ＇ｓ区骨质疏松发生率显著高于对照组（Ｐ＜０．０５）。Ｌ２～４和左股骨Ｗａｒｄ＇ｓ区骨密度均与体重、体重／理想体重％、上臂围、三头肌皮皱厚度、臂肌围呈显著正相关（Ｐ＜０．０５）。左股骨Ｗａｒｄ＇ｓ区骨密度与用力肺活量（ＦＶＣ％）、一秒钟用力呼气量（ＦＥＶ１％）及一秒率（ＦＥＶ１／ＦＶＣ％）均呈显著正相关（Ｐ＜０．０５）。结论老年ＣＯＰＤ组骨质疏松发生率高于同年龄对照组。营养状态、肺功能指标为影响ＣＯＰＤ患者骨密度的相关因素。     

冠心病患者纤溶活性、血小板功能及内皮素在运动前后的变化及其临床意义

目的研究冠心病患者在运动前后纤溶活性、血小板活化状态及血管内皮功能的变化。方法根据冠状动脉造影结果，选择冠心病患者（ＣＨＤ组）３７例，分为单支及多支病变组；另选健康人２７例为对照组（Ｃ组）。采用次极量运动试验观察上述部分指标在运动前后的变化。结果（１）运动前，组织型纤溶酶原激活剂（ｔＰＡ）、纤溶酶原激活剂抑制因子１（ＰＡＩ１）活性、血浆５羟色胺（５ＨＴ）水平及血小板５ＨＴ２Ａ受体密度，ＣＨＤ组均高于Ｃ组（Ｐ＜０．０５）；血浆内皮素（ＥＴ）１浓度两组差异无显著性（Ｐ＞０．０５）。（２）运动后，ＣＨＤ组ｔＰＡ活性下降（Ｐ＜０．０５），ＰＡＩ１活性上升（Ｐ＜０．０２５）；血浆５ＨＴ水平及血小板５ＨＴ２Ａ受体密度增加（Ｐ＜０．０５）；血浆ＥＴ１浓度上升，与Ｃ组比较差异有显著性（Ｐ＜０．０５）。上述各指标的增高，多支病变组较单支病变组明显（Ｐ＜０．０１～０．００５）。（３）运动前仅ＰＡＩ１活性与心肌缺血面积呈正相关（ｒ＝０．４５２，Ｐ＜０．００５）。结论冠心病患者纤溶活性下降，血小板激活，血管内皮受损，使冠心病患者易发生冠状动脉痉挛及血栓形成。次极量运动使之进一步加重而易诱发冠心病事件。     

肝炎后肝硬变肝损害与细胞免疫功能(英文)

目的研究肝炎后肝硬变（ＰＨＣ）患者的细胞免疫状态及其与肝功能损害的关系．方法５１例ＰＨＣ患者，包括ＣｈｉｌｄＰｕｐｈＡ级２０例、Ｂ例１８例、Ｃ级１３例和２２例健康对照者，外周血经用ＦｉｃｏｌＨｙｐａｑｕｅ梯度离心分离单个核细胞后，采用３ＨＴｄＲ掺入技术测定了淋巴细胞转化，ＩＬ２和ＮＫ细胞活性．结果在ＰＨＣ患者淋巴细胞转化指数（ＳＩ）、ＩＬ２活性（ＳＩ）和ＮＫ细胞活性（％）较对照组均明显降低（１８１±１３０ＶＳ３４９±２１７，Ｐ＜００１；８１±６０ＶＳ１３６±５８，Ｐ＜００１；４０３±２１７ＶＳ６１３±２０５，Ｐ＜００１）．免疫功能缺陷与ＣｈｉｌｄＰｕｐｈ分级有关，Ｃ级明显低于Ａ、Ｂ级（Ｐ＜００１），Ｂ级低于Ａ级（Ｐ＜００５）．结论ＰＨＣ患者存在细胞免疫功能缺陷，且与肝损害程度有关．     

消化系恶性肿瘤患者血清与腹水中细胞因子活性变化

目的研究消化系恶性肿瘤（ＤＭＴ）患者血清与腹水中内源性ＩＬ２,ＩＬ６,ＩＬ８,ＴＮＦα和ＩＦＮγ的生物学活性．方法应用ＥＬＩＳＡ法检测了１５例ＤＭＴ患者（肝癌１１例,胆总管癌１例,胰腺癌１例,胃癌１例,直肠癌１例）血清与腹水中５种细胞因子活性,并与６例肝硬变（ＬＣ）患者和８例正常成人进行了比较分析．结果ＤＭＴ患者血清ＩＬ２,ＩＬ６的生物学活性显著低于ＬＣ（Ｐ＜００５）;腹水中ＩＬ２,ＩＬ８活性显著低于ＬＣ组（Ｐ＜００１）,而ＩＬ６和ＩＦＮγ活性则高于ＬＣ组（Ｐ＜００１,００５）．ＤＭＴ患者血清中ＩＬ６,ＩＬ８活性明显高于正常成人组（Ｐ＜００５）;ＩＬ２,ＩＦＮγ则低于正常成人组,但缺乏显著性．肝癌血清和腹水中ＩＬ２活性显著高于非肝癌组（Ｐ＜００５）;而ＩＬ６活性则相对降低（Ｐ＜００５）．结论恶性肿瘤患者血清中ＩＬ２和ＩＦＮγ活性低于正常人,是ＤＭＴ患者抗肿瘤免疫功能缺陷的标志．ＩＬ６对于预测ＤＭＴ患者的预后具有重要的意义     

冠心病患者血浆降钙素基因相关肽水平的临床观察

选择符合ＷＨＯ诊断标准的急性心肌梗死（ＡＭＩ）２０例，心绞痛（ＡＰ）３０例，应用放射免疫分析法动态观察血浆降钙素基因相关肽（ＣＧＲＰ）含量变化，并与３０例正常人作对照。结果显示：对照组血浆ＣＧＲＰ含量为５１．３３±３７．１０ｎｇ／Ｌ，ＡＭＩ组发病第１天血浆ＣＧＲＰ含量为３５．７４±１０．４２ｎｇ／Ｌ，显著低于对照组（Ｐ＜０．０１），发病第３天开始升高（４４．０４±１２．４１ｎｇ／Ｌ），第７天趋于正常（５１．２４±１３．１０ｎｇ／Ｌ），与对照组比较无显著差异（Ｐ＞０．０５）。ＡＰ组在心绞痛发作期血浆ＣＧＲＰ含量为２３．１０±１７．１０ｎｇ／Ｌ，显著低于对照组（Ｐ＜０．００１），经治疗２ｗ症状缓解后复查血浆ＣＧＲＰ含量升高至３０．５５±２９．５８ｎｇ／Ｌ（Ｐ＜０．０５）。提示循环血中ＣＧＲＰ含量不足是ＡＭＩ、ＡＰ发病的重要因素之一。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.