流行性出血热患者血浆内毒素含量测定及其与临床相关性…

本文用鲎试剂－合成基质偶氮显色法对９０例流行性出血热（ＥＨＦ）病人进行血浆内毒素定量检测。９０例病人共检测了２３８份血浆标本，同时检测３０例健康人血浆作为正常对照。血浆内毒素的正常值为５０ｎｇ／Ｌ。８８例病人血浆内毒素升高（大于５０ｎｇ／Ｌ）。病人血浆内毒素越高，临床症头及体征越重。在ＥＨＦ各期内毒素含量不同。在低血压期和少尿期内毒素浓度升高具有显著意义；发热期和多尿期内毒素轻度升高，恢复期内毒素     

肝脏病患者血浆内毒素定量检测分析

本文采用鲎变形细胞溶解物（LAL）改良基质显色法对91例肝脏病患者和20例健康对照血浆内毒素进行定量检测。结果，急性肝炎血浆内毒素水平为65．36±30．41ng／L；重症肝炎为161．88±112．88ng／L；慢性活动性肝炎为92．25±56．18ng／L；肝硬化为76．03±46．09ng／L。与正常对照组（5．25±2．90ng／L）相比均显著增高，P＜0．001。各种肝病内毒素阳性率（≥50mg／L）分别为70％、100％、75％、89％．其中重症肝炎内毒素水平明显高于其他肝病组．P＜0．01。表明肝脏病患者大多伴有明显的内毒素血症，血浆内毒素的检出率及浓度与疾病的严重程度及预后有关。     

78例病毒性肝炎血浆内毒素检测的临床分析

本文采用鲎试验对78例病毒性肝炎和20例健康人血浆内毒素定量检测，结果急性肝炎为70．14±30．40ng／L；慢性肝炎为105．03±66．03ng／L；重症肝炎119．07±66.44ng／L；原发性肝癌为139±35．59ng／L；对照组5．25±2．90ng／L．4组肝炎与对照组相比均有显著差异（P＜0．01）。78例肝炎患者ALT和血清脸红素（SB），重症肝炎和肝癌组血浆内毒素水平与ALT、SB增高一致．ALT分别为174．89±99.60u／L和134．30±63.75u／L；SB分别为145．36±51．95mmol／L和102．53±50．54mmol／L，其他两组与内毒素关系不大。表明肝炎患者血浆内毒素水平均有不同程度增高，对判断病情和预后有一定意义。     

肝硬变和原发性肝癌患者血浆胃动素水平的测定

目的：测定肝硬变及原发性肝癌患者血浆MTL水平，并初步探讨其变化的意义。方法；肝硬变患者43例；原发性肝癌36例，其中伴肝硬变32例；慢性胃炎32例；消化性溃疡35例；正常对照组40例。血浆MTI。用放射免疫法测定。结果：血浆MTL。慢性胃炎［（336．55±68．12）ng／L］、消化性溃疡[（356．24±83．74）ng／L］与正常对照组［（327．65±71．37）ng／L]比较均差异不显著（P＞0．05）；肝硬化［（540．68±166．72）ng／L］，原发性肝癌［（501．56±156．44）ng／L]血浆MTL含量显著升高，与正常对照组比较差异非常显著（P＜0．01）。结论：测定血浆MTL对肝硬变和原发性肝癌的诊断具有一定的临床意义。     

血浆内皮素与降钙基因相关肽测定在肾移植中的意义

本文选择了21例肾移植患者采用放射免疫分析法检测其血浆中ET与CGRP在肾移植手术前后的水平，以探讨血浆ET与CGRP在肾移植手术前后变化及意义。结果显示肾移植前尿毒症患者血浆ET含量显著升高（134．31±29．499／L），与正常组比较（44．71±11．84）差异显著（P＜0．05）。肾移植术后ET水平明显下降（12．66±31．44ng／L）与术前比较有显著性差异（P<0．05）；CGRP在移植后（73．28±40．7ng／L）明显高于移植前（40．77±19．52ng／L），差异显著（P<0．05）。结果表明ET含量在肾脏病患者血中增高与CGRP含量减少两种因素共同加速了患者肾功能的恶化．随着肾移植术后ET浓度下降与CGRP浓度升高患者高血血症状得以改善，尿量增多，肾功能衰竭得以缓解。本组资料发生术后排斥反应的5例患者中血浆ET与CGRP含量在手术前后无明显变化（P＞0．05）．提示ET与CGRP在肾移植患者血浆中的变化对于判断手术预后及排斥反应的发生具有重要意义．     

孕中期羊膜腔穿刺时母体血浆而非羊水中的可溶性fms样酪氨酸激酶-1升高是先兆子痫的危险因素

目的：本研究旨在确定血浆及羊水中可溶性fms样酪氨酸激酶-1（sFlt-1）浓度升高是否为先兆子痫的高危因素。研究设计：采用病例对照研究，比较先兆子痫及正常孕妇在孕中期母体血浆及羊水中sFlt-1的浓度。研究对象为32例先兆子痫孕妇（包括18例重度先兆子痫孕妇）和128例相匹配且妊娠结局正常的孕妇。排除标准包括：异常胎儿核型或有严重畸形、多胎、慢性高血压、糖尿病或肾病等。用特异免疫法测定sFlt-1浓度，采用非参数检验统计数据。结果：①先兆子痫孕妇的血浆sFlt-1浓度显著高于对照孕妇【中位数（极差）：730ng／L（60～3375ng／L）vs441ng／L（58—1959ng／L），P〈0．05】，而羊水中sFh-1浓度不存在差异【中位数（极差）：10504ng／L（5253—38023ng／L）vs10236ng／L（4326～87684ng／L），P=0．65】；②重度先兆子痫孕妇血浆sFlt-1中位浓度高于轻度先兆子痫者，但无统计学意义[中位数（极差）：762ng／L（261—3309ng／L）vs 334ng／L（60—3375ng／L）P=0．07]，而两者羊水中sFlt-1的浓度无显著性差异，P=0．45；     

肝硬化腹水并发白发性细菌性腹膜炎病人血浆和腹水尿激酶型纤溶酶原激活物及其受体水平的分析

目的检测肝硬化腹水并发自发性细菌性腹膜炎（SBP）病人血浆和腹水中尿激酶型纤溶酶原激活物（uPA）及其受体（uPAR）的含量变化,分析肝硬化并发自发性细菌性腹膜炎病人血浆和腹水uPA和uPAR水平的变化及其uPA／uPAR比值与其病情转归的关系。方法应用酶联免疫吸附试验（ELISA）检测肝硬化并发SBP病人血浆和腹水23例及正常人30例血浆中尿激酶型纤溶酶原激活物（uPA）及其受体（uPAR）。结果①SBP病人血浆uPA和uPAR含量水平分别为（0．63±0．29）μg/L、（0．47±0．35）μg／L,均明显高于正常对照组（O．05±0．01）μg／L、（0．08±0．009）μ／L,二者相比,有显著差异（P〈0．01）;②SBP病人腹水uPA和uPAR含量分别为（0．68±0．35）μg／L、（0．54±0．42）μg/L,均明显高于其血浆组,有显著差异（P〈0．05）;③SBP病人血浆uPA／uPAR比值分别为（1．93±1．26）μg/L、（1．91±1．33）μg／L均明显高于对照组（0．63±0．07）μg／L,有非常显著差异（P〈0．01）;但其血浆和腹水之间uPA／uPAR比值相比较差异没有统计学意义（P〉0．05）。结论肝硬化腹水SBP病人腹水中uPA及其受体uPAR含量水平高于其血浆中的水平,血浆和腹水uPA／uPAR比值在评估肝硬化病人的病情转归方面有很高的临床价值。     

过敏性紫癜患儿血浆TFPI水平变化的研究

目的：探讨儿童过敏性紫癜（AP）血浆组织因子途径抑制物（TFPI）的含量及其在病程不同时期的变化趋势。方法：选择AP患儿23例设为AP组,正常健康儿童23名设为正常对照组,分别检测其血浆TFPI含量并进行比较;将AP组病例给予基础治疗,于治疗前、治疗后14 d检测其血浆TFPI含量并进行分析比较。结果：①AP组血浆TFPI含量（59.639±24.568）ng/ml比正常对照组血浆TFPI含量（88.761±12.214）ng/ml明显降低,差异有统计学意义（P=0.000〈0.01）;②AP组治疗后14 d血浆TFPI含量（71.209±23.055）ng/ml较治疗前（59.639±24.568）ng/ml升高,差异有统计学意义（P=0.000〈0.01）;显示随着时间延长,血浆TFPI呈升高趋势。结论：AP儿童血浆TFPI水平较正常儿童降低,随着病程延长呈上升趋势。     

急性白血病病人凝血酶-抗凝血酶复合物、血管性血友病因子、D二聚体的检测及其临床意义

目的观察急性白血病病人凝血酶-抗凝血酶复合物（thrombin antithrombin complex,TAT）、血管性血友病因子（von willebrand factor,vWF）、D二聚体（D-dimer,D-D）含量的变化并分析其特点。方法应用ELISA方法检测50例急性白血病病人和30例正常人血浆TAT、vWF、D-D的含量动态变化。结果急性白血病病人初诊时血浆TAT（52.76±17.42 ng/ml）、vWF（197.93%±32.07%）、D-D（542.75±377.14 ng/ml）比正常对照组TAT（2.75±0.77 ng/ml）,vWF（67.28%±18.65%）,D-D（41.96±6.57 ng/ml）含量明显升高（P〈0.01）;急性早幼粒细胞白血病病人血浆TAT、vWF、DD含量均高于其他类型急性白血病病人（P〈0.01）,经维甲酸治疗7 d后下降,21 d后可达正常。结论急性白血病病人血管内皮受损、体内存在凝血与纤溶功能异常,应根据不同机制采取防治措施以防止出血。     

妊娠期高血压疾病患者血浆中神经肽Y和内皮素的含量变化及其意义

【目的】观察妊娠期高血压疾病患者血浆缩血管活性物质神经肽Y（NPY）和内皮素（ET）含量的变化并探讨其在妊娠期高血压疾病发病中的l临床意义。【方法】应用放射免疫法对43例妊娠期高血压疾病患者（高血压组）、36例正常妊娠妇女（对照组）和19例正常非孕妇女（正常组）血浆中NPY及ET含量进行了检测。【结果】（1）与非孕正常组妇女相比，正常妊娠妇女血浆中NPY和ET的含量虽有所上升，但没有显著差异（P〉0．05）。（2）高血压组患者血浆中NPY的含量显著高于妊娠组晚孕妇女（P〈0．01），并随妊娠期高血压疾病的病情加重而上升，与其平均动脉压呈显著正相关（P〈0．05）。与NPY含量变化一样，高血压组妇女血浆ET含量（96．05±13．57ng／L）与正常晚期妊娠妇女（36．48±6．17ng／L）相比有显著的上升（P〈0．01），并且与妊娠期高血压疾病的严重程度成显著正相关关系（P〈0．01）。[结论]妊娠期高血压疾病患者缩血管活性物质异常升高可能在妊娠期高血压疾病的发病机制中起重要作用。     

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.