未治疗原发性高血压患者脉搏波速度与血浆同型半胱氨酸水平相关性分析

目的 研究未经治疗的原发性高血压患者各动脉节段脉搏波速度（PWV）变化及其相关因素.方法 选取未经治疗的原发性高血压患者97例,健康对照组97例.采用Complior分析仪测定颈-股动脉脉搏波传导速度（CF-PWV）、颈-桡动脉脉搏波传导速度（CR-PWV）和颈-踝动脉脉搏波传导速度（CA-PWV）.采用全自动生化分析仪检测血糖、血脂、尿酸、同型半胱氨酸、高敏C反应蛋白等血液生化指标.结果 与对照组比较,未治疗的原发性高血压患者CF-PWV、CR-PWV和CA-PWV、血压、心率、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、尿酸和同型半胱氨酸均显著增加（P＜0.05或P＜0.01）.高密度脂蛋白胆固醇、肌酐和高敏C反应蛋白无明显变化.多因素逐步回归分析显示,CF-PWV的独立相关因素是高血压（β=0.333,P＜0.01）、脉压差（β=0.269,P＜0.01）和同型半胱氨酸（β=0.124,P＜0.05）.CR-PWV的独立相关因素是高血压（β=0.376,P＜0.01）、心率（β=0.148,P＜0.05）和同型半胱氨酸（β=0.135,P＜0.05）.CA-PWV的独立相关因素是高血压（β=0.556,P＜0.01）、体质量指数（β=-0.163,P＜0.01）和同型半胱氨酸（β =0.145,P＜0.05）.结论 未治疗原发性高血压患者各动脉节段PWV增加,血浆同型半胱氨酸水平是其独立相关因素之一.     

冠状动脉粥样硬化性心脏病患者冠状动脉病变SYNTAX评分与高敏C反应蛋白、基质金属蛋白酶-9的关系

目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病,CHD)患者冠状动脉病变SYNTAX评分与高敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)的关系.方法 选择经冠状动脉造影证实的冠心病患者76例和同期住院的非冠心病患者32例(对照组),通过Logistic回归分析确定冠心病的危险因素,依据SYNTAX评分结果分为低分组30例、中分组28例和高分组18例,比较SYNTAX评分与血清hs-CRP、MMP-9的关系.结果 低密度脂蛋白胆固醇、hs-CRP、MMP-9、吸烟史及糖尿病史是冠心病患者的独立危险因素;冠心病患者低分组、中分组、高分组之间,随着SYNTAX评分的增加血清hs-CRP、MMP-9水平增加,线性相关分析结果显示,血清hs-CRP、MMP-9与SYNTAX评分呈正相关(r=0.519、0.586,P＜0.01).结论 SYNTAX评分是预测冠心病患者病变程度较理想的指标,该评分越高血清炎症因子hs-CRP、MMP-9表达水平越高,患者冠状动脉病变越严重.     

急性冠状动脉综合征患者基质金属蛋白酶9基因多态性

目的 探讨基质金属蛋白酶9基因C1562T多态性与中国南方汉族人群冠心病的关系.方法 对经冠状动脉造影证实的急性冠状动脉综合征患者150例(急性冠状动脉综合征组)、稳定型心绞痛患者110例(稳定型心绞痛组)和同期冠状动脉造影阴性、排除冠心病诊断的患者70例(对照组)进行研究,采用酶联免疫吸附试验测定血浆基质金属蛋白酶9水平,采用聚合酶链反应-限制片长多态性技术分析基质金属蛋白酶9基因中C1562T基因多态性,比较各组的基因型和等位基因频率.结果 急性冠状动脉综合征组血浆基质金属蛋白酶9水平明显高于稳定型心绞痛组(P＜0.05)和对照组(P＜0.01),而稳定型心绞痛组与对照组比较,差异无统计学意义(P＞0.05).急性冠状动脉综合征组基质金属蛋白酶9基因CT、CT TT基因型频率以及T等位基因频率均高于对照组和稳定型心绞痛组(P＜0.05或0.01),稳定型心绞痛组与对照组各基因型和等位基因频率分布差异无统计学意义(P＞0.05).C1562T位点CT/TT基因型患者血浆基质金属蛋白酶9水平显著高于CC基因型患者(P＜0.01).结论 基质金属蛋白酶9基因C1562T多态性可能与中国南方汉族人群急性冠状动脉综合征有关,1562T等位基因是动脉粥样硬化斑块不稳定性的易感基因.     

血清明胶酶与绝经后女性代谢综合征的关系

目的 通过测定绝经后女性代谢综合征（MS）患者血清明胶酶[基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶-9（MMP-9）]水平的变化,探讨明胶酶与绝经后女性代谢综合征的关系.方法 选择2010年4月至2011年4月我院体检科、心内科及内分泌科患者,分为绝经后健康女性对照组27例及绝经后代谢综合征女性患者28例,采用酶联免疫的方法测定血清中MMP-2及MMP-9水平,用胶乳增强免疫比浊法测定血清高敏C反应蛋白（hs-CRP）水平,对两组结果进行比较分析.结果 绝经后女性代谢综合征患者血清MMP-9水平显著高于绝经后女性非代谢综合征者水平,两组比较差异有统计学意义（P＜0.01）;而两组MMP-2水平比较差异无统计学意义（P＞0.05）.结论 绝经后女性代谢综合征患者血清中可见明显高水平的MMP-9,其可能参与了动脉血管粥样硬化的早期病理生理进程.     

HS-CRP、MMP-9、LVEF与急性冠脉冠脉综合征心脏事件相关性研究

目的：探讨急性冠脉综合征患者高敏C-反应蛋白、血浆基质金属蛋白酶-9、左室射分数与心脏事件的相关性。方法：选取2013.6-2014.12于我院心内科住院治疗的128例急性冠脉综合征患者，记录所有研究对象的一般临床资料，包括性别、年龄、吸烟史、高血压病史、糖尿病病史等，分别测定入院24小时内和同期40例门诊体检者的高敏C-反应蛋白、血浆基质金属蛋白酶-9水平，分别行心脏彩超检查，测定其左室射血分数；随访1年，记录急性冠脉综合征患者出院后心脏事件数，回顾性比较心脏事件阳性组和阴性组的高敏C-反应蛋白、血浆基质金属蛋白酶-9水平和左室射血分数。结果：心脏事件阳性组高敏C-反应蛋白、血浆基质金属蛋白酶-9和左室射血分数均数分别为15.3±5.0mg/L、112.5±60.1 ng/ml和39.2%，阴性组分别为7.0±2.0mg/L、95.3±40.3 ng/ml和45.7%，阳性组高敏C-反应蛋白明显高于阴性组，左室射血分数明显低于阴性组，均具有统计学意义，阳性组基质金属蛋白酶-9水平有高于阴性组的趋势，但无统计学意义。结论：高水平高敏C-反应蛋白与低左室射血分数与急性冠脉综合征患者再发心脏事件有关，基质金属蛋白酶-9水平与再发心脏事件无明显关系。     

早期应用辛伐他汀对急性冠状动脉综合征血清基质金属蛋白酶及其抑制因子和高敏C-反应蛋白水平的影响

目的:研究早期应用辛伐他汀对急性冠状动脉综合征患者稳定斑块、减少炎症反应的作用.方法:采用随机、对照方法,将137例急性冠状动脉综合征患者分为他汀治疗组(辛伐他汀20 mg/d,n=69)和他汀对照组(n=68);于发病12～48小时和治疗8周后分别测定血清基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制因子-1(TIMP-1)、MMP-9/TIMP-1、高敏C-反应蛋白(hs-CRP)水平.另设健康对照组(n=60)与之对照.结果:①治疗前他汀治疗组和他汀对照组的血清MMP-1、MMP-9、MMP-9/TIMP-1、TIMP-1、hs-CRP水平均较健康对照组明显增高(P＜0.01～0.001),与血脂水平不相关.②他汀治疗组经辛伐他汀治疗8周后血清MMP-1、MMP-9、MMP-9/TIMP-1、hs-CRP水平较治疗前均明显降低(P＜0.001),他汀对照组除血清hs-CRP水平降低外(P＜0.05),其他各项指标均无变化.结论:早期应用他汀治疗,可减少急性冠状动脉综合征患者的冠状动脉粥样斑块基质成分的降解和炎症反应,具有稳定斑块作用.     

老年高血压和糖尿病患者动脉僵硬度的影响因素分析

目的 评价老年高血压和(或)糖尿病患者动脉僵硬度及其影响因素. 方法 320例老年患者分为4组:对照组、糖尿病组、高血压组、高血压并存糖尿病组(联合患病组).收集年龄、体质指数、性别、吸烟、血压、脉压及平均动脉压,测定血清空腹血糖、血脂、糖化血红蛋白、超敏C反应蛋白等;并应用COLIN-VP1000动脉硬化测定仪测量入选者踝臂脉搏波传导速度(baPWV)以评价对动脉硬化的影响. 结果 联合患病组、糖尿病组、高血压组、对照组baPWV值分别为(2165.9±479.9)cm/s、(2158.6±386.9)cm/s、(1881.2±383.8)cm/s和(1667.2±279.3)cm/s,联合患病组、高血压组及糖尿病组的baPWV水平与对照组比较,差异均有统计学意义(F=8.473,P＜0.05),联合患病组与糖尿病组的baPWV值比较,差异无统计学意义,高血压组与糖尿病组及联合患病组的baPWV值比较,差异有统计学意义(均P＜0.05).联合患病组脉压、超敏C反应蛋白最高,与对照组比较,差异有统计学意义(均P＜0.05).多元线性回归分析结果显示,血清空腹血糖、平均动脉压、脉压、超敏C反应蛋白、低密度脂蛋白胆固醇与baPWV水平呈正相关(均P＜0.05). 结论 糖尿病、高血压是老年人动脉僵硬度增高的影响因素,而高血糖对老年人动脉僵硬度的影响可能起了更重要的作用.血糖、平均动脉压、脉压、超每C反应蛋白、低密度脂蛋白胆固醇均是影响动脉僵硬度的独立危险因素.     

冠心病患者血清氧化低密度脂蛋白受体和基质金属蛋白酶-9水平变化及其临床意义

目的:观察冠心病患者血中凝集素样氧化低密度脂蛋白受体-1(LOX-1)、基质金属蛋白酶-9(MMP-9)水平变化及其相关性.方法:采用酶联免疫吸附法测定20例急性冠状动脉综合征患者(ACS组)、20例稳定型心绞痛患者(SA组)、20例非冠心病患者(对照组)血清LOX-1、MMP-9水平的变化.结果:①ACS组患者血清LOX-1、MMP-9水平高于SA组(均P＜0.05)及对照组(均P＜0.01);SA组患者血清LOX-1、MMP-9水平高于对照组(均P＜0.05);ACS患者治疗2周后LOX-1、MMP-9较治疗前显著下降(P＜0.01);②LOX-1、MMP-9的ROC曲线下面积分分别为0.786、0.716,且差异有统计学意义.结论:ACS患者血清LOX-1、MMP-9水平显著升高,二者可作为斑块不稳定的判断指标.     

替罗非班对急性冠状动脉综合征患者介入术后炎症因子的影响

目的观察替罗非班对急性冠状动脉综合征（acute coronary syndrome，ACS）患者经皮冠状动脉介入术（percutaneous coronary intervention，PCI）治疗后血清炎症因子的影响。方法初次确诊为ACS85例，对照组41例，未应用替罗非班；替罗非班组44例，用替罗非班治疗，测定其可溶性CD40配体、高敏C反应蛋白、基质金属蛋白酶-9水平。结果替罗非班试验组血清可溶性CD抗原40配体、高敏C反应蛋白、基质金属蛋白酶-9水平显著低于对照组，差异有统计学意义（P〈0．05）。结论ACS患者PCI术后应用替罗非班可明显降低血清炎症因子的水平。     

2型糖尿病合并冠心病患者血小板表面CD62P和CD40L的表达水平

目的 探讨2型糖尿病合并冠心病患者血小板表面CD62P和CD40L的表达水平及其和血清高敏C反应蛋白的关系.方法 选择单纯冠心病患者34例、单纯2型糖尿病患者33例、2型糖尿病合并冠心病患者30例及对照者30例,采用流式细胞术分别检测血小板表面CD62P和CD40L的表达水平,并与血清高敏C反应蛋白作相关分析.结果 2型糖尿病合并冠心病组血小板CD62P、CD40L和高敏C反应蛋白水平较对照组、单纯冠心病组及单纯2型糖尿病组显著升高(P<0.01),血小板CD62P和CD40L与血清高敏C反应蛋白水平呈正相关(r分别为0.343和0.495,P均<0.05).结论 2型糖尿病合并冠心病患者的血小板表面CD62P和CD40L表达水平明显升高,并与血清高敏C反应蛋白明显正相关.血小板表面CD62P和CD40L的表达水平可能是预示糖尿病患者合并冠状动脉粥样硬化的重要指标.     

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.