口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对hs-CRP和ADA的影响

目的探讨口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对高敏C反应蛋白（hs-CRP）和腺苷脱氨酶（ADA）的影响。方法结核性胸膜炎患者135例,按照给药方法的不同分为观察组和对照组,观察组57例予以口服和胸腔注射糖皮质激素,对照组78例予以口服糖皮质激素。观察两组的疗效、症状和体征、胸膜的厚度、胸穿次数、胸腔积液中的hs-CRP和ADA水平。结果观察组的总有效率为87.72%,优于对照组的71.79%（P〈0.05）。观察组的胸水消失时间、发热消退时间、胸痛消退时间和盗汗消退时间均较对照组明显缩短,差异有统计学意义（P〈0.01）。观察组的胸穿〈3次的比例明显高于对照组（P〈0.01）,而胸膜增厚的比例明显低于对照组（P〈0.05）。两组治疗后胸水中hs-CRP和ADA水平均较治疗前明显降低,用药3d和用药后7d,观察组的胸水中hs-CRP和ADA水平较对照组降低更为明显,差异有统计学意义（P均〈0.05）。结论口服结合胸腔注射糖皮质激素治疗结核性胸膜炎具有较好的疗效,可显著降低胸腔局部的hs-CRP和ADA表达。     

结核性胸膜炎血清和胸水中IL-17的表达水平及其意义

目的:探讨结核性胸膜炎血清和胸水中IL-17的表达水平及其临床意义。方法:收集住院收治的初治结核性胸膜炎患者30例和非结核性胸膜炎患者20例,另选择健康体检人员20例为正常对照组。采用双抗体夹心ELISA测定血清及胸水中IL-17的含量。结果:结核性胸膜炎组血清中IL-17的含量高于正常对照组和非结核性胸膜炎组(P0.05),具有统计学意义。结核性胸膜炎组胸水中IL-17的含量高于非结核性胸膜炎组(P0.05)。结核性胸膜炎组和非结核性胸膜炎组的胸水与对应血清中的IL-8的含量具有统计学差异(P0.05)。结核性胸膜炎组患者在规则治疗1、3、7、14 d时,血清和胸水中IL-17的含量均逐渐下降,血清中IL-17的含量于治疗3 d时显著低于入院时水平(P0.05),胸水中IL-17的含量于治疗7 d时显著低于入院时水平(P0.05)。结论:IL-17参与了结核性胸膜炎的发病机制,可以作为早期诊断及观察治疗效果的分子学免疫指标。     

胸腔积液中肿瘤坏死因子和腺苷脱氨酶含量对结核性胸？…

目的;探讨肿瘤坏死因子和腺苷脱氨酶对结核性胸膜炎的诊断价值。方法：ＡＤＡ采用比色法,ＴＮＦ采用ＥＬＩＳＡ法对２７例恶性胸腔积液,５２例结核性胸腔积液进行了检测。结果：结核性胸腔积液ＡＤＡ和ＴＮＦ水平都明显高于恶性胸腔积液,差别具有显著性。结论：应用ＴＮＦ和ＡＤＡ可能有助于结核性胸膜炎的鉴别诊断。     

结核性胸膜炎的临床分析

目的 研究结核性胸膜炎的临床特点和治疗方法.方法 我院1997年～2008年住院治疗124例结核性胸膜炎患者,经综合性治疗进行回顾性分析.结果 124例结核性胸膜炎患者治疗后明显好转,随访62例均无复发.结论 结核性胸膜炎的治疗应该采取综合治疗为主.     

链霉素胸腔内注射治疗结核性胸膜炎伴胸腔积液8例

目的 在于探讨链霉素在胸膜腔内注射抑制胸水产生的作用.方法 明确诊断为结核性胸膜炎伴胸腔积液且在正规抗结核治疗下,引流胸腔积液后注射链霉素.结果 疗效明显,且无并发症发生.结论 胸膜腔内注射链霉素治疗结核性胸膜炎伴胸腔积液安全、疗效肯定.     

胸腔内注药治疗结核性胸膜炎研究进展

结核性胸膜炎是临床上常见的肺外结核病,是当肺部结核炎症累及胸膜时引起的胸膜炎症。结核性胸膜炎的发病与结核分枝杆菌感染及机体的免疫状态密切相关。常有少量至中等量积液,由于结核性胸膜炎渗液中的蛋白质较高,易引起胸膜粘连及肥厚。目前多采用抽胸腔积液联合抗结核化疗进行治疗,并口服糖皮质激素口服,但部分患者仍会出现胸液包裹和(或)胸膜肥厚、粘连,严重者甚至胸廓变形或形成结核性脓胸。近年来,人们通过胸穿抽液后向胸腔内注射药物的方法,辅助治疗结核性胸膜炎,在促进积液的吸收、预防胸膜肥厚或粘连、减少包裹形成等方面均取得了明显的疗效。     

结核性胸膜炎的诊断进展

结核性胸膜炎是我国渗出性胸腔积液的最常见原因,本文对结核性胸膜炎各项诊断指标及诊断方法作一综述。     

低强度氦氖激光对结核性胸液中淋巴细胞凋亡的影响

目的:探索氦氖激光可否促进结核性胸液消退及其细胞学机制。方法:采用原位末标记DNA技术观察结核性胸膜炎患者使用氦氖激光胸膜腔内和血管内联合照射后胸液中淋巴细胞凋亡的时相动力学改变。结果:1日1次低能量穴3mw雪氦氖激光血管内和3日1次抽液时胸膜腔内照射60min可明显缩短胸液淋巴细胞凋亡时间,治疗3日平均半数凋亡时间降至81.2h,与对照组的98.3h有明显差异穴P<0.05雪,照射6日降至73.1h,其后维持于低水平直至胸水完全消退。结论:低强度氦氖激光胸膜腔和血管内联合照射可显著促进胸液淋巴细胞凋亡,可能是其加快胸水消退的重要机制之一。     

利培酮治疗首发精神分裂症患者血清同型半胱氨酸、脂蛋白a、甲状腺激素水平的研究

目的探讨利培酮对精神分裂症患者血清同型半胱氨酸、脂蛋白a、甲状腺激素水平影响。方法选择首发精神分裂症患者50例,服用利培酮治疗前及8周后分别抽血检测血清同型半胱氨酸、脂蛋白a、甲状腺激素水平。结果治疗前FT3（3．30±0．60）ng／L、T4（9．25±2．25）mg／L;治疗后FT3（3．10±0．60）ng／L、T4（8．54±1．71）mg／L,结果均降低,差异有统计学意义（P〈O．05）。FT4、T3、TSH、同型半胱氨酸、脂蛋白a治疗前后差异无统计学意义（P〉0．05）。结论长期服用抗精神分裂症药物患者需监测甲状腺激素水平。     

Effects of dehydroepiandrosterone supplement on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus

The objective of this study was to evaluate the efficacy of low dose dehydroepiandrosterone (DHEA) on health-related quality of life (HRQOL) in glucocorticoid treated female patients with systemic lupus erythematosus (SLE). Forty one women ( ≥ 5 mg prednisolone/day) were included in a double-blind, randomized, placebo-controlled study for 6 months where DHEA was given at 30 mg/20 mg ( ≤ 45/ ≥ 46 years) daily, or placebo, followed by 6 months open DHEA treatment to all patients. HRQOL was assessed at baseline, 6 and 12 months, using four validated questionnaires and the patients' partners completed a questionnaire assessing mood and behaviour at 6 months. DHEA treatment increased serum levels of sulphated DHEA from subnormal to normal. The DHEA group improved in SF-36 “role emotional” and HSCL-56 total score (both p < 0.05). During open DHEA treatment, the former placebo group improved in SF-36 “mental health” (p < 0.05) with a tendency for improvement in HSCL-56 total score (p = 0.10). Both groups improved in McCoy's Sex Scale during active treatment (p < 0.05). DHEA replacement decreased high-density lipoprotein (HDL) cholesterol and increased insulin-like growth factor I (IGF-I) and haematocrit. There were no effects on bone density or disease activity and no serious adverse events. Side effects were mild. We conclude that low dose DHEA treatment improves HRQOL with regard to mental well-being and sexuality and can be offered to women with SLE where mental distress and/or impaired sexuality constitutes a problem.     

Effects of hyperoncotic albumin and parathyroid hormone infusion on jejunal electrolyte and water absorption in the rat

Preferential plasma volume expansion by infusion of hyperoncotic albumin solution dialyzed against distilled water (calcium-poor albumin) decreases sodium reabsorption in the dog proximal renal tubule during hydropenia. No such decrease is observed when infusing a calcium-rich hyperoncotic albumin solution. A possible role of parathyroid hormone (PTH) has been postulated. To investigate whether similar changes could be observed in intestinal electrolyte and water absorption, the effects of systemic hyperoncotic albumin infusion on jejunal transport of water, sodium, and calcium were studied in hydropenic rats by perfusing proximal jejunum in situ. It was further sought whether PTH could play a direct role in jejunal electrolyte and water transfer.Following infusion of calcium-poor, sodium-poor hyperoncotic albumin solution (group I), net jejunal absorption of water, sodium, and calcium decreased significantly when compared to control. Concurrently, lumen-to-mucosa (1-m) calcium flux, measured using 45 Ca, diminished significantly. Following infusion of calcium-rich, sodium-poor hyperoncotic albumin solution (group II), no changes in net or unidirectional fluxes were observed. After infusion of calcium-rich, sodium-rich hyperoncotic albumin solution (group III), net jejunal absorption of water and sodium, but not of calcium, were found significantly decreased when compared to control.Plasma ionized calcium increased 10 min after calcium-rich hyperoncotic albumin loading, but decreased significantly at that time when the calcium-poor hyperoncotic albumin solution was infused. However, 30 min after each of the calcium-rich and calcium-poor albumin infusion, plasma ionized calcium was increased in both groups of rats. Plasma immunoreactive PTH was unchanged 30 min after expansion with the calcium-rich solution but it increased significantly after expansion with the calcium-poor solution.Intravenous infusion of bovine PTH (group IV) resulted in a decrease of net jejunal water, sodium, and calcium flux. The decrease in net calcium transport was accompanied by a decrease in 1-m calcium flux. No such changes were observed when PTH was replaced by vehicle (group V).It is concluded that: (1) hyperoncotic albumin infusion induces jejunal water, sodium, and calcium flux changes dependent on the calcium and sodium content of the infused solution: calcium-poor, sodium-poor hyperoncotic albumin infusion leads to a decrease in net jejunal electrolyte and water absorption possibly via stimulation of PTH secretion; (2) sodium-poor hyperoncotic albumin infusion does not modify per se these fluxes in the hydropenic rat; (3) exogenous PTH infusion as well as endogenous stimulation of PTH secretion results in a comparable decrease of jejunal water, sodium, and calcium absorption.     

Effects of saline loading on jejunal absorption of calcium,sodium, and water,and on parathyroid hormone secretion in the rat

Summary To investigate whether intestinal calcium absorption parallels that of sodium following extracellular fluid volume expansion, the effects of saline loading on intestinal transport of calcium. sodium and water were studied in rats by perfusing jejunal loops in situ.After calcium-free saline infusion net calcium absorption was reversed similar to that of sodium and water and net secretion occurred. Concurrently, blood-to-lumen (b-l) calcium flux, measured using⁴⁵Ca, increased significantly (P<0.001). Following expansion with calcium-containing Ringer a similar reversal of net calcium, sodium and water flux was also observed. Again, the b-l calcium flux increased but to a significantly lesser extent (P<0.05). Plasma ionized calcium remained unchanged after calcium-rich Ringer loading, but decreased significantly (P<0.001) when calcium was omitted from the solution. Plasma immunoreactive parathyroid hormone was unchanged after expansion with the calcium containing solution but increased following calcium-free infusion.It is concluded that after extracellular fluid volume expansion: 1. net jejunal calcium absorption is decreased; 2. the decrease parallels that of sodium and water; 3. b-l calcium transport is enhanced to a greater degree by calcium-free Ringer infusion than by a calcium-rich solution. This difference could be the result of increased parathyroid hormone secretion.     

心理护理在糖尿病肾病患者透析中负性情绪的应用效果

目的：探究心理护理在糖尿病肾病患者透析中的负性情绪的应用效果。方法：选取本院从2014年5月至2015年5月的90例老年早期糖尿病肾病患者,将入组的患者按随机数表法随机分为两组,观察组和对照组,每组分别为45例,对照组实施持续质量改进模式,观察组实施持续质量改进模式联合心理护理,共进行2周。观察记录两组患者透析过程中不同时间段患者发生低血糖的例数;观察记录两组患者透析过程中不同时间点的血糖水平;观察记录两组患者护理前后负性情绪情况,负性情绪包括抑郁、焦虑情绪。结果：比较两组患者透析过程中不同时间段患者发生低血糖例数,观察组1、2、4 h的低血糖患者例数分别为5、9、7例,对照组1、2、4 h低血糖患者例数分别为12、21、13例,观察组在1、2、4 h时患者发生低血糖的例数明显少于对照组,差异具有统计学意义(P<0.05);比较两组患者透析过程中不同时间点患者血糖水平,观察组透析开始时、透析2 h时、透析结束时患者血糖水平分别为(6.68±3.23)、(2.35±1.23)、(5.95±3.43) mmol/L,对照组透析开始时、透析2 h时、透析结束时患者血糖水平分别为(6.67±3.21)、(1.98±1.25)、(3.85±2.09) mmol/L,透析开始前两组患者血糖水平差异不大,无统计学意义(P>0.05),透析2 h时两组患者血糖水平下降,对照组患者血糖水平低于观察组患者,差异明显,具有统计学意义(P<0.05),透析结束时两组患者血糖水平均提高,观察组患者血糖水平提高,与对照组差异明显,具有统计学意义(P<0.05);护理后观察组SDS、SAS评分分别降为(36.43±5.33)、(39.45±5.22)分,对照组SDS、SAS评分分别降为(54.52±6.11)、(56.45±5.53)分,心理护理后两组患者的SDS评分、SAS评分均降低,且观察组患者SDS评分、SAS评分均明显低于对照组患者,差异明显,具有统计学意义(P<0.05)。结论：心理护理在糖尿病肾病患者应用能够有效改善抑郁、焦虑负性情绪,促进患者健康恢复。     

多发性肌炎/皮肌炎患者外周血单个核细胞中糖皮质激素受体α、βmRNA表达与糖皮质激素疗效相关性的研究

目的探讨多发性肌炎/皮肌炎（PM/DM）患者外周血单个核细胞（PBMC）中糖皮质激素受体（GR）正常表位α和突变体表位β mRNA表达与PM/DM患者对糖皮质激素（GC）疗效的相关性。方法采用逆转录-聚合酶链反应（RT-PCR）方法对18例GC治疗敏感、10例GC治疗抵抗的PM/DM患者PBMC中GRα、β mRNA的表达水平进行了检测,同时采用放射免疫分析法测定血清中的皮质醇含量,并与20例正常对照进行比较。结果血清皮质醇含量在GC治疗敏感和抵抗的PM/DM患者及正常对照间差异均无统计学意义（均P〉0.05）。GC治疗敏感和抵抗的PM/DM患者PBMC中GRα mRNA的表达水平均显著低于正常对照（均P〈0.01）,且GC治疗抵抗的PM/DM患者显著低于GC治疗敏感的PM/DM患者（P〈0.05）。GC治疗敏感和抵抗的PM/DM患者PBMC中GRβ mRNA的表达均显著高于正常对照（均P〈0.05）,但在GC治疗敏感和抵抗的PM/DM患者间则差异无统计学意义（P〉0.05）。结论GRα mRNA表达水平降低可能与PM/DM患者对GC治疗抵抗相关,GRβ mRNA表达水平在PM/DM患者的GC治疗抵抗中无显著作用。     

Effects of peripheral neuropathy on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases

Introduction

Chronic obstructive pulmonary diseases (COPD) have some systemic effects including systemic inflammation, nutritional abnormalities, skeletal muscle dysfunction, and cardiovascular, skeletal and neurological disorders. Some studies have reported the presence of peripheral neuropathy (PNP) at an incidence of 28-94% in patients with COPD. Our study aimed to identify whether PNP affects exercise performance and quality of life in COPD patients.

Material and methods

Thirty mild-very severe patients with COPD (male/female = 29/1, mean age = 64 ±10 years) and 14 normal subjects (male/female = 11/5, mean age = 61 ±8 years) were included in the present study. All subjects underwent pulmonary function testing (PFT), cardiopulmonary exercise testing, electroneuromyography and short form 36 (SF-36).

Results

Peak oxygen uptake (PeakVO₂) was lower in COPD patients (1.15 ±0.53 l/min) than healthy subjects (2.02 ±0.46 l/min) (p = 0.0001). There was no PNP in healthy subjects while 16 (53%) of the COPD patients had PNP. Forced expiratory volume in 1 s (FEV₁) and PeakVO₂ were significantly different between patients with PNP and those without (p = 0.009, p = 0.03 respectively). Quality of life of patients with PNP was lower than that of patients without PNP (p < 0.05).

Conclusions

The present study demonstrates the exercise limitation in COPD patients with PNP. Thus, presence of PNP has a poor effect on exercise capacity and quality of life in patients with COPD. Furthermore, treatment modalities for PNP can be recommended to these patients in order to improve exercise capacity and quality of life.     

早中期结直肠癌患者情绪及生活质量的10周团体心理治疗

目的:探讨团体心理治疗对早中期结直肠癌患者情绪及生活质量的影响。方法:采用开放对照试验设计。选取北京大学肿瘤医院结直肠癌患者67名,依患者意愿分配入干预组(n=34)和对照组(n=33)。干预组除常规康复(如复查、康复咨询、中药康复、锻炼等)外,接受为期10周每周1次的团体心理治疗,而对照组仅进行常规康复。使用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量核心问卷(QLQ-C30)比较两组干预前后焦虑、抑郁、生活质量的差异。结果:10周末测评时,干预组脱落4人,对照组脱落3人。基线时,干预组SAS、SDS得分均高于对照组[(42.0±7.7)vs.(36.0±6.8),(44.4±11.5)vs.(38.7±9.0);均P﹤0.05],QLQ-C30各项得分差异无统计学意义(均P0.05)。10周干预后,干预组SAS、SDS、QLQ-C30疲乏症状得分均比干预前降低,整体生活质量得分较干预前提高(均P﹤0.05)。对两组患者(基线得分-干预后得分)的差值进行比较,发现干预组患者SAS、SDS、角色功能、疲乏症状得分的差值均高于对照组(均P﹤0.05)。结论:团体心理治疗有助于降低早中期结直肠癌患者焦虑及抑郁水平,提高生活质量,可作为辅助治疗方法应用于有需要的患者。     

头颈部面罩和胸部体罩固定对胸上段食管癌放疗剂量分布的影响

目的：研究头颈部面罩和胸部体罩固定在胸上段食管癌(EC)三维放疗计划系统(TPS)放疗应用中对剂量分布的影响。方法：回顾性分析128例胸上段EC患者临床资料,根据放疗时体位固定工具不同,将患者分为面罩组46例和体罩组82例,所有患者均取仰卧位并采用调强适形放射治疗进行干预,体位固定方法为面罩组以热塑头颈面罩固定,体罩组采用热塑体膜固定,比较两组摆位误差、剂量分布、危及器官受照剂量、近期疗效和不良反应等指标。结果：面罩组X轴、Y轴和Z轴摆位误差绝对值明显低于体罩组(P<0.05),面罩组射线均匀性指数明显低于体罩组,射线适形度指数明显高于体罩组(P<0.05),两组肿瘤靶区D_max、D_min和D_mean比较差异无统计学意义(P>0.05);面罩组双肺V₁₀、V₂₀、V₃₀以及脊髓D_mean均低于体罩组,差异有统计学意义(P<0.05);面罩组和体罩组患者客观缓解率分别为58.70%和54.88%,两组近期疗效比较...