抗氧化低密度脂蛋白抗体的检测及临床意义

目的探讨血清抗氧化低密度脂蛋白(ox-LDL)抗体的检测方法,并观察分析血清抗ox-LDL抗体水平对冠状动脉粥样硬化斑块稳定性的评估价值.方法用酶联免疫吸附法(ELISA法)检测100例冠心病患者[17例急性心肌梗死(AMI),41例不稳定型心绞痛(UAP),42例稳定型心绞痛(SAP)]及31例正常健康对照者(对照组)血清抗ox-LDL抗体水平;并对100例患者进行了1年随访.结果血清抗ox-LDL抗体水平在AMI组(1.39±0.68)和UAP组(1.35±0.62)明显高于对照组(0.81±0.31,P<0.01)和SAP组(0.94±0.36,P<0.01);随访1年后,有22例患者发生心脏事件.血清抗ox-LDL抗体水平在发病组(1.67±0.69)明显高于病变稳定组(1.03±0.44,P<0.01).Logistic回归分析结果血清抗ox-LDL抗体水平与患者预后关系密切(P<0.01).结论血清抗ox-LDL抗体水平与冠心病患者预后密切相关,可以作为冠状动脉粥样硬化斑块易损性的评估指标.     

抗氧化低密度脂蛋白抗体的检测桨临床意义

目的 :探讨血清抗氧化低密度脂蛋白 (ox LDL)抗体的检测方法 ,并观察分析血清抗ox LDL抗体水平对冠状动脉粥样硬化斑块稳定性的评估价值。方法 :用酶联免疫吸附法 (ELISA法 )检测 10 0例冠心病患者 [17例急性心肌梗死 (AMI) ,41例不稳定型心绞痛 (UAP) ,42例稳定型心绞痛 (SAP) ]及 31例正常健康对照者 (对照组 )血清抗ox LDL抗体水平 ;并对 10 0例患者进行了 1年随访。结果 :血清抗ox LDL抗体水平在AMI组 (1.39± 0 .6 8)和UAP组 (1.35± 0 .6 2 )明显高于对照组 (0 .81± 0 .31,P <0 .0 1)和SAP组 (0 .94± 0 .36 ,P <0 .0 1) ;随访 1年后 ,有 2 2例患者发生心脏事件。血清抗ox LDL抗体水平在发病组 (1.6 7± 0 .6 9)明显高于病变稳定组(1.0 3± 0 .44 ,P <0 .0 1)。Logistic回归分析结果 :血清抗ox LDL抗体水平与患者预后关系密切 (P <0 .0 1)。结论 :血清抗ox LDL抗体水平与冠心病患者预后密切相关 ,可以作为冠状动脉粥样硬化斑块易损性的评估指标     

高密度脂蛋白胆固醇水平对冠心病患者介入治疗术后不良心血管事件的影响

目的探讨高密度脂蛋白胆固醇(HDL-C)水平对冠心病患者介入治疗术后不良心血管事件的影响。方法选择开封市第二人民医院心内科2013年2月—2014年2月收治的行介入治疗的冠心病患者113例,按照介入治疗前HDL-C水平分为低水平组(HDL-C1.32 mmol/L)57例和高水平组(HDL-C≥1.32 mmol/L)56例,均随访观察12个月,记录两组患者术后不良心血管事件发生情况。结果两组患者均获得完全随访,随访率为100.0%。随访期间低水平组患者不良心血管事件发生率为31.6%,高于高水平组的16.1%(χ2=6.115,P=0.023)。结论 HDL-C水平较高的冠心病患者介入治疗术后不良心血管事件发生率较低。     

血浆瘦素水平与冠心病患者冠状动脉病变程度及预后的相关性分析

目的观察接受冠状动脉造影患者的血浆瘦素水平,探讨评价其与冠心病、冠状动脉病变程度及患者临床预后的关系。方法入选住院接受冠状动脉造影的患者116例,男性79例,女性37例,年龄33～82岁,平均(62±11)岁,测定空腹血糖、C反应蛋白、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、纤维蛋白原及血肌酐水平,并立即测定瘦素水平。在冠状动脉造影术后1.5年,对冠心病患者进行门诊或电话随访。所有患者均签署知情同意书。分析瘦素水平与冠心病患者临床预后的关系。结果 116例患者的瘦素水平三分位统计分析后分为低水平组39例(1.032～2.060μg/L)、中水平组39例(2.061～5.299μg/L)、高水平组38例(5.300～40.706μg/L)。相关分析显示冠状动脉病变Gensini积分与血浆瘦素水平呈显著正相关(r=0.23,P=0.012)。80例冠心病患者完成了平均2年的随访,在低、中、高水平瘦素组中,主要不良心脏事件的发生率分别为10.0%、45.8%、65.4%,差异有统计学意义(均为P<0.01),并且这种升高的趋势同样具有统计学意义(P<0.01)。结论瘦素水平与冠心病患者冠状动脉病变程度及不良心脏事件的发生相关。     

不同剂量氟伐他汀对急性冠状动脉综合征患者血管内皮功能及炎症因子的影响

目的探讨较大剂量与常规剂量氟伐他汀相比,对急性冠脉综合征(ACS)患者是否有进一步的改善血管内皮功能和抗炎的作用。方法收集本院ACS患者120例,常规治疗基础上随机给予氟伐他汀40mg(40mg组)或氟伐他汀80 mg(80 mg组),每晚睡前服用。治疗4周,测定治疗前后患者血清NO、Hs-CRP、IL-6、HSP60的水平,随访临床事件发生情况。结果两组患者治疗4周后血清NO水平均有所升高[40 mg组:(56.68±12.01)μmol/L比(74.49±12.38)μmol/L,P<0.05;80mg组:(51.29±14.67)μmol/L比(82.57±12.17)μmol/L,P<0.01],且80 mg组患者血清NO水平升高更明显(P<0.05)。两组患者血清Hs-CRP、IL-6、HSP60水平均有所下降[40mg组分别为:(14.79±12.68)mg/L比(6.17±4.68)mg/L,(47.96±37.54)ng/L比(36.21±20.06)ng/L,(6.36±1.24)μg/L比(3.14±1.09)μg/L,P<0.05;80 mg组分别为:(14.48±12.32)mg/L比(4.31±3.56)mg/L,(50.35±40.17)ng/L比(31.24±15.49)ng/L,(6.25±1.16)μg/L比(1.25±0.98)μg/L,P<0.01],且80mg组下降更明显(均为P<0.05)。临床事件的随访观察显示,40 mg组共有10例(16.67%)患者发生心血管事件,80 mg组仅有4例(6.67%)发生心血管事件,发生率两组间差异有统计学意义(P<0.05)。结论氟伐他汀可升高ACS患者血清NO水平,降低Hs-CRP、IL-6及HSP60水平,其改善血管内皮功能和抗炎作用在短期内呈剂量依赖性。较大剂量氟伐他汀早期强化治疗可以明显减少ACS患者近期心血管事件的发生率,且安全性良好。     

伴颈动脉粥样硬化短暂性脑缺血发作患者血浆组织因子变化的意义

目的探讨短暂性脑缺血发作(TIA)患者颈动脉病变与血浆组织因子(TF)水平的关系及临床意义。方法选择TIA患者58例,根据彩色多普勒超声将不稳定性斑块的22例为A组,稳定性斑块的19例为B组,无斑块的17例为C组,用ELISA法测定3组患者血浆TF水平。53例完成3年随访,根据TF水平分为高水平组22例,低水平组31例,比较2组患者3年时脑卒中风险。结果 A组血浆TF水平明显高于B组和C组(P<0.05,P<0.01),B组血浆TF水平明显高于C组(P<0.05);血浆TF水平与管腔狭窄率呈正相关(r=0.356,P<0.05);高水平组脑梗死发生率和反复TIA发作比例明显高于低水平组(P<0.05,P<0.01)。结论伴颈动脉粥样硬化斑块的TIA患者血浆TF水平增高可预测脑梗死的发生,其可作为TIA患者预后评价指标。     

高敏C-反应蛋白与冠脉病变程度及支架植入术后心血管事件的关系

目的探讨血清高敏C-反应蛋白(hs-CRP)水平与冠心病患者病变程度及冠脉支架植入后心血管事件的关系。方法选择139例冠状动脉支架植入的冠心病患者,其中稳定型心绞痛组44例,急性冠脉综合征组95例,术前测定血清hs-CRP水平并按hs-CRP水平分为两组,A组(hs-CRP<3.0 mg/L)55例,B组(hs-CRP≥3.0 mg/L)84例,比较分析患者冠脉病变程度及术后1年内的心血管事件。结果急性冠脉综合征组术前血清hs-CRP水平较稳定型心绞痛组明显升高(P<0.01);B组患者病变程度较A组严重(P<0.01),术后1年内的心血管事件发生率显著高于A组(P<0.01)。结论血清hs-CRP水平与冠脉病变程度相关,且是冠脉病变支架植入术后1年内预后的预测指标,提示冠脉病变程度及术后1年内心血管事件发生率与血管壁的炎症反应相关。     

冠心病患者ET-1水平变化及与预后关系的分析

目的 探讨冠心病患者血清内皮素-1(ET-1)水平变化及与预后的关系.方法 随机选取2005年7月至2006年11月在南华大学附属第二医院住院确诊的冠心病(CHD)患者120例(试验组)及健康体检者31名(对照组).CHD患者中,稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)各30例.所有入选对象于入院后24 h内采血样本,健康体检者于体检当时采血样本,分离、冷藏血清,用ELISA方法测定ET-1浓度.随访研究对象,了解CHD患者近期急性心血管事件发生率.结果 ①STEMI组、NSTEMI组、UAP组和SAP组血清ET-1水平分别为(28.67±4.09)ng/L、(16.69±1.68)ng/L、(14.33±2.39)ng/L、(6.04±1.01)ng/L,均较正常对照组血清ET-1水平(3.35±1.02)ng/L显著升高(P＜0.01);STEMI组分别与NSTEMI组、UAP组、SAP组比较血清ET-1水平,SAP组分别与NSTEMI组、UAP组比较血清ET-1水平,差异均有统计学意义(P＜0.01),但是,UAP组和NSTEMI两组组间比较血清ET-1水平差异无统计学意义(P＞0.05).②实验对象血清ET-1高水平组(22.53%)较低水平组(8.66%)近期心血管急性事件发生率增高.结论 血清ET-1水平高低可反映冠心病患者病情严重性和近期急性心血管事件发生的可能性.     

氧化低密度脂蛋白及其自身抗体与冠心病的相关性

目的探讨氧化低密度脂蛋白(ox-LDL)及其自身抗体(ox-LDLAb)与冠心病(CHD)的相关关系,并绘制受试者工作特征曲线(ROC),评价其临床诊断意义。方法分别提取血浆和血清,用酶联免疫吸附(ELISA)方法测定血浆ox-LDL及血清ox-LDLAb浓度。结果冠心病患者ox-LDL、ox-LDLAb明显高于对照组(P<0.01),且急性心梗组(AMI)、不稳定心绞痛组(UAP)高于稳定心绞痛组(SAP)(P<0.05)。ox-LDL与ox-LDLAb)负相关。ROC曲线下面积ox-LDL为(0.805±0.039),0x-LD-LAb为(0.747±0.041),对急性冠脉综合征(ACS)有一定的鉴别力。结论血ox-LDL、ox-LDLAb水平的高低与冠心病严重程度呈正相关,可作为预测ACS和识别斑块不稳定的一项血清学指标。     

罗红霉素治疗冠心病的疗效观察

目的:探讨罗红霉素在冠心病治疗中的作用。方法:选择符合冠心病诊断标准的60例血肺炎衣原体抗体IgG阳性患者,采用随机方法均分为罗红霉索治疗组及对照组,1个月后治疗组复查血肺炎衣原体抗体IgG,随访1年。结果:罗红霉素治疗组,3例出现心血管事件,发生率10％,对照组10例出现心血管事件,发生率33.3％,罗红霉素治疗组心血管事件发生率明显低于对照组(P<0.05),两组治疗前,治疗组治疗前、后肺炎衣原体抗体IgG滴度比较差异无显著性。结论:罗红霉素能减少冠心病心血管事件发生率。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.