肝细胞癌和其它慢性肝病HCV HBV感染比较分析

对１２８例有病理诊断依据的肝细胞场（ＨＣＣ）、４７例慢迁肝（ＣＰＨ）、１０５例慢活肝（ＣＡＨ）、４６例肝硬化（ＬＣ）．采用嵌套式ＰＣＲ技术检测其血标本中的丙型肝炎病毒（ＨＣｖ）ＲＮＡ和乙型肝炎病毒（ＨＢＶ）ＤＩＩＡ，对这两种病毒的血清学标志也进行了研究。结果：在ＨＣＣ组。ＨＣＶＲＮＡ１４．１％阳性，ＨＢＶＤＮＡ７ｉ．３％阳性。ＣＰＨ，ＣＡＨ，ＬＣ和ＨＣＣ的ＨＢＶ感染率均在９０％左右，而ＨＣＶ感染率则分别为８．５％、９．５％、１７．４％和１９．５％，显示ＨＣＶ感染率随肝病严重程度的增加而有增加的趋势；晚期肝病组的ＨＣＶ感染率（１９．０％）显著高于慢性肝炎组（９．２％，Ｐ＜０．０５）。提示ＨＣＶ感染后经过慢性肝炎、肝硬化发展为ＨＣＣ可能是一个逐渐演进的病理过程。ＨＣＶ，ＨＢＶ重叠感染率。ＨＣＣ组高于ＣＰＨ，ＣＡＨ，而与ＬＣ相近，显示ＨＣＶ重叠感染在原有ＨＢＶ感染的基础上促进病变向着迁延化、慢性化，进而向着肝硬化、ＨＣＣ方向发展。     

急性黄疸型肝炎284例血清学分析

应用ＥＬＩＳＡ法对２８４例急性黄疸型肝炎（急黄肝）患者的血清标本回顾性地检测了甲型肝炎病毒（ＨＡＶ）、乙型肝炎病毒（ＨＢＶ）、丙型肝炎病毒（ＨＣＶ）、丁型肝炎病毒（ＨＤＶ）及戊型肝炎病毒（ＨＥＶ）感染标志。结果，各种肝炎病毒单一感染占７９．６％，重叠感染占１８．７％（其中二重感染１７％，三重感染０．７％，四重感染１．０％）；各种肝炎病毒的检出率依次为：ＨＡＶ５８．８％＞ＨＢＶ３６．６％＞ＨＥＶ１１．３％＞ＨＣＶ１０．９％＞ＨＤＶ２．１％。提示，在我国ＨＡＶ和ＨＢＶ感染可能是急黄肝的最主要病因，单纯甲肝、单纯乙肝及甲乙混合感染可能是急黄肝的主要类型。     

原发性肝癌66例临床资料分析

探讨原发性肝癌（ＨＣＣ）的发病规律，对６６例ＨＣＣ临床资料进行全面分析，结果表明：ＨＣＣ的９２．４％存在肝硬化病变基础及进行性肝损害，８１．８％肝炎病毒标志物阳性，其中乙型肝炎病毒（ＨＢＶ）６８．２％，丙型肝炎病毒（ＨＣＶ）１９．７％，ＨＢＶ、ＨＣＶ双重感染１２．１％。甲胎蛋白（ＡＦＰ）、异常凝血酶原（ＰＴ），ＨＣＣ组与非ＨＣＣ组，ＡＦＰ分别为８１．８％（５４／６６）和６．２％（３３／５３４），Ｐ＜０．０１；ＰＴ分别为７８．７％（５２／６６）和３６．７％（１９６／５３４），Ｐ＜０．０１。超声可准确、反复动态观察ＨＣＣ的发展变化。对ＨＢＶ、ＨＣＶ阳性肝硬化者计划性进行超声、ＡＦＰ、ＰＴ观察有重要意义。     

庚型肝炎病毒合并／重叠其他肝炎病毒感染状况调查

了解庚型肝炎病毒合并／重叠其他肝炎病毒感染状况。方法；分别对４９７例不同病原的病毒性肝炎患者进行ＨＧＶ ＲＮＡ检测，对其中１８０例患者进行抗－ＨＧＶ检测。结果：１．ＨＧＶ在各型病毒性肝炎患者中总的合并／重叠感染率为７．８％．２；ＨＧＶ合并／重叠感染丙型肝炎病毒感染率为１８．９％，高于其他肝炎病毒的合并／重叠感染率．Ｐ〈０．０１。３．有输血史的病人ＨＧＶ ＲＮＡ阳性率高于无输血史的患者，Ｐ〈０．０１     

庚型肝炎病毒合并/重叠其他肝炎病毒感染状况调查

目的：了解庚型肝炎病毒（ＨＧＶ）合并／重叠其他肝炎病毒感染状况。方法：分别对４９７例不同病原的病毒性肝炎患者进行ＨＧＶＲＮＡ（ＲＴＰＣＲ）检测，对其中１８０例患者进行抗ＨＧＶ（ＥＬＩＳＡ）检测。结果：①ＨＧＶ在各型病毒性肝炎患者中总的合并／重叠感染率为７．８％（３９／４９７）。②ＨＧＶ合并／重叠感染丙型肝炎病毒感染率为１８．９％（１０／５３），高于其他肝炎病毒的合并／重叠感染率，Ｐ＜０．０１。③有输血史的病人ＨＧＶＲＮＡ阳性率（１６．０％，１２／７５）高于无输血史的患者（６．４％，２７／４２２），Ｐ＜０．０１。④合并／重叠ＨＧＶ感染组与非合并／重叠ＨＧＶ感染组比较，两组肝功能指标无统计学差异（Ｐ＞０．０５）。⑤抗ＨＧＶ的检出率为１２．８％（２３／１８０），但其中仅有２１．７％（５／２３）同时为ＨＧＶＲＮＡ阳性。结论：①输血是传播ＨＧＶ的主要途径之一，但ＨＧＶ也可经非输血途径传播。②ＨＧＶ致病性可能较弱。③抗ＨＧＶ阳性并不一定代表ＨＧＶ病毒复制。     

少年儿童肝炎72例血清抗—HCV检测及HCV、HBV重叠感染的临床意义

对７２例少年儿童各型肝炎进行丙型肝炎病毒抗体（抗—ＨＣＶ）和乙型肝炎病毒标志（ＨＢＶＭ）检测，发现抗—ＨＣＶ阳性率为４０．３％，ＨＢＶＭ阳性率为６１．１％，输血后肝炎抗—ＨＣＶ阳性率（６６．６％）高于非输血后肝炎者（３７．８％）。ＨＣＶ、ＨＢＶ重叠感染率分别为：ＡＨ５．８％，ＣＰＨ２７．２％、ＣＡＨ６８．７％，各组差异有高度显著性（Ｐ＜０．０１）。提示本地少年儿童肝炎仍以乙型肝炎为主，但ＨＣＶ感染不容忽视；输血是ＨＣＶ感染的主要途径；ＨＣＶ、ＨＢＶ重叠感染易使病情慢性化和重症化。     

386例乙肝患者合并其它肝炎病毒感染的初步观察

本组３８６例乙肝患者合并其它肝炎病毒感染的总感染率为３２．９０％。其中合并ＨＡＶ、ＨＣＶ、ＨＤＶ和ＨＥＶ感染的感染率分别为８．０３％、１７．０９％、６．９９％和０．７７％。可见ＨＢＶ合并ＨＣＶ感染率较高，值得重视。ＨＢＶ合并感染组治愈好转率（６７．７２％）较ＨＢＶ单纯阳性组（８２．２４％）低，而恶化死亡率（３２．２８％）较单纯阳性组（１７．７６％）高（Ｐ＜０．０５）。ＨＢＶ合并ＨＣＶ和ＨＤＶ感染的患者，其临床治愈好转率（６０．６１％和５５．５６％）低于ＨＢＶ合并ＨＡＶ和ＨＥＶ组（９０．３２％和１００％），而恶化死亡率（３９．３９％和４４．４４％）高于另外二组（９．６８％和０）（Ｐ＜０．０５）。以上结果说明，合并感染，特别是ＨＢＶ合并ＨＣＶ或ＨＤＶ感染，能够加重病情，延缓恢复，导致肝病加重，是患者预后不良的重要因素。     

122例肝病患者肝内HDV,HBV感染的研究

本文对１２２例各型肝病患者用ＡＢＣ法同时检测肝内ＨＤＶ及ＨＢＶ抗原。结果显示，ＨＢｓＡｇ和／或ＨＢｃＡｇ检出率为２７．８７％（３４例），其中ＨＢｃＡｇ为１３．２２％（１６例），ＨＢｓＡｇ为１８．１８％（２２例），两者无显著性差异（Ｐ＞０．０５）．ＨＤＡｇ检出率为４．９２％（６例），这６例丁型肝炎血中均检出ＨＢｓＡｇ和抗一ＨＢｃ，为慢性肝炎．在重肝、肝硬化和肝癌患者的肝内未检出ＨＤＡｇ．说明我国肝炎病毒感染仍以ＨＢＶ为主，ＨＤＶ感染率明显低于欧美，ＨＤＶ感染与ＨＢＶ感染关系密切，ＨＢＶ感染合并ＨＤＶ感染时易使病程慢性化。     

260例HBV感染者血清的抗－HCV检测

本文报告应用酶联免疫吸附试验（ＥＬＩＳＡ）法对百色地区２６０例乙型肝炎病毒（ＨＢＶ）感染者进行的丙型肝炎病毒抗体（抗－ＨＣＶ）检测，结果阳性率为２２．６９％（５９／２６０），其中男性为２３．１５％，女性为２１．０５％。表明百色地区ＨＣＶ的感染非常普遍。抗－ＨＣＶ的检出率与ＨＢＶ感染者的年龄、性别、职业无关（Ｐ＞０．０５）。在ＨＢＶ感染的各型肝炎中均检出抗－ＨＣＶ，其中原发性肝癌的检出率为６３．６４％，慢活肝为６０％，肝硬化为４６．１５％，急性肝炎为４５．４５％，慢迁肝为１６．１３％，无症状ＨＢＶ感染者为７．７９％，经统计学处理有高度显著性差异（ｘ２＝６９．８３，Ｐ＜０．００５）。说明ＨＢＶ和ＨＣＶ的重叠感染可促使肝病的恶变。     

用套式RT-PCR法检测肝细胞癌中丙型肝炎病毒基因型

目的　检测人肝细胞癌（ＨＣＣ）组织中丙型肝炎病毒（ＨＣＶ）基因型。方法　用ＲＴＰＣＲ法常规检测ＨＣＣ组织和部分患者血清ＨＣＶ,再以巢式ＲＴＰＣＲ法对ＨＣＶ阳性标本中５种ＨＣＶ基因型进行鉴别。对多数标本中ＨＢｓＡｇ和ＨＢＶＤＮＡ也进行了免疫组化和原位杂交检测。结果　ＨＣＣ组织中ＨＣＶ阳性率为５０％（３９／７８）,与ＨＢＶ者（６４．４％）差异无显著性意义（Ｐ＞０．０５）,两者重叠感染率３４％（２０／５９）。在１０例血清ＨＣＶ阴性ＨＣＣ患者中,３例ＨＣＣ冰冻组织检出ＨＣＶＲＮＡ。在ＨＣＣ组织中共检出３种ＨＣＶ基因型,其中２ａ、１ｂ、３ａ和混合型分别为１７例（４３．６％）、９例（２３．１％）、４例（１０．３％）和２例（５．１％）,各基因型间差异有极显著性意义（Ｐ＜０．０１）,但２ａ型与１ｂ型间差异无显著性（Ｐ＞０．０５）,２ａ型与ＨＢＶ的重叠感染明显较其他ＨＣＶ基因型者常见（Ｐ＜０．０５）。结论　２ａ型ＨＣＶ是ＨＣＣ组织中最常见的基因型并易与ＨＢＶ重叠感染率,ＨＣＣ患者血清ＨＣＶ检测不一定能准确反映ＨＣＣ组织中的ＨＣＶ感染率,其所示基因型也有所不同。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.