尿毒症患者血浆氧化修饰低密度脂蛋白一氧化氮内皮素的测定及相关性分析

目的：探讨尿毒症患者并发心血管疾病与氧化修饰低密度脂蛋白（ox—LDL）、一氧化氮（NO）、内皮素（ET）的关系。方法：测定46例正常对照及48例尿毒症患者（其中21例无心血管疾病，27例有并发心血管疾病）的ox—LDL、NO、ET及TC、TG、HDL—C、LDL—C的含量。结果：尿毒症患者组血浆ox—LDL和ET水平明显高于正常对照组，尿毒症患者组NO水平明显低于正常对照组。有心血管病变的尿毒症患者血浆OX—LDL和ET水平明显高于无心血管病变尿毒症患者组，而血浆NO水平明显低于无心血管病变尿毒症患者组。在有心血管病变的尿毒症患者中，ox—LDL水平与ET水平呈正相关，ox—LDL与NO水平呈负性相关。尿毒症患者TC、TG、LDL—C水平与正常对照组比较明显升高。（P〈0．01），HDL—C水平明显降低（P〈0．01）。结论：尿毒症患者中oX—LDL和ET升高，同时NO降低，三者协同作用，进一步导致血管内皮细胞损伤，促进了心血管疾病的发生和发展。     

C反应蛋白及脂联素与2型糖尿病大血管病变的相关性研究

目的：分析2型糖尿病（DM）合并大血管病变与血清超敏C反应蛋白（hs—CRP）及脂联素水平的相关性。方法：将2型糖尿病患者79例，按照有无大血管病变分为伴大血管病变组（A组）40例，无大血管病变组（B组）39例；另选择健康者40例作为正常对照组（C组）。均检测血清hs-CRP、脂联素及空腹血糖（FBG）、空腹胰岛素（FINS）、血脂等指标。结果：A组血清hs-CRP高于B、C组（P〈0．05，P〈0．01），B组明显高于C组（P〈0．01），A组脂联素水平明显低于B、C组（P〈0．01），B组明显低于C组（P〈0．01）。相关分析提示，血清hs-CRP与脂联素有相关性（P〈0．01）。结论：hs-CRP和脂联素对预测DM患者发生大血管病变具有重要意义。     

支气管肺泡灌洗加局部抗生素治疗支气管扩张伴感染的疗效

目的 研究支气管肺泡灌洗联合局部抗生素治疗支气管扩张并发感染的有效性。方法采用前瞻式病例对照研究,临床入选124例支气管扩张并发感染患者,按照入院先后顺序编号,根据随机数字方法分成2组,每组62例,分别为对照组（常规治疗）和研究组（支气管肺泡灌洗联合局部抗生素治疗）,治疗后比较两组患者的相关临床指标。结果研究组的住院天数和住院总费用均较对照组明显减少（P〈0．05）。两组患者治疗后的PaO2、SaO2及PaO2／FiO2均较治疗前明显改善（P〈0．05）,但治疗后研究组的这些指标较对照组改善更显著（P〈0．05）。研究组总有效率为100％,高于对照组的85．48％（P〈0．05）。结论支气管肺泡灌洗联合局部抗牛素治疗支气管扩张并发臆染不仅能铭昂著根高临床效巢．而日节省医疗咨源．     

髋关节假体置换术后早期血中游离脂肪及血小板激活状态检测的临床意义

目的研究髋关节假体置换术后早期血小板激活与骨髓脂肪入侵的关系及其在脂肪栓塞综合征（FES）早期诊断和危险性预测中的价值。方法将26例髋关节假体置换术患者作为研究组，24例软组织手术患者作为对照组。采用血凝块冰冻切片、油红“O”染色镜检及流式细胞法CD62P测定，在术前及术后24h内对两组患者进行动态检测。结果研究组术后早期血中游离脂肪阳性率和CD62P测定值均高于对照组（P〈0．05或P〈0．01）；研究组术后早期两项指标均明显高于术前（P〈0．05或P〈0．01），对照组手术前后差异无统计学意义；研究组术后早期血中游离脂肪呈阳性者CD62P测定值高于阴性者（P〈0．05或P〈0．01）。结论髋关节假体置换术可引起骨髓脂肪入侵血液循环并导致血小板激活。血小板激活状态的流式细胞检测可以帮助FES的早期诊断及危险性预测。     

床旁血液灌流抢救急性重度有机磷中毒的疗效观察

目的：观察血液灌流抢救急性重度有机磷农药中毒的疗效。方法：将2005-08—2009-05收治的57例重度有机磷农药中毒患者随机分为对照组和治疗组,治疗组在常规内科治疗的基础上加用血液灌流（HP）,对照组单纯行常规内科治疗。观察对照两组病例的治愈率、阿托品总用量、昏迷时间、住院天数。结果：治疗组阿托品总用量减少（t=4．092,P〈0．01）,患者昏迷时间缩短（t=3．24,P〈0．01）,住院天数缩短（t=4．505,P〈0．01）,治愈率提高（X2=4．073,P〈0．05）。结论：对于重度有机磷农药中毒患者,除内科常规治疗外加用血液灌流。     

卵巢早衰患者外周血T淋巴细胞亚型分布与生殖激素变化的相关性分析

目的探讨卵巢功能早衰（POF）患者外周血CD4^＋、Th1／Th2分布及其与生殖激素变化的相关性。方法选取POF患者36例为研究组,31例正常人为对照组,应用流式细胞仪研究两组外周血CD4^＋,T淋巴细胞Th1／Th2分布,同时应用酶联免疫法测定两组性激素促卵泡生成素（FSH）、黄体生成素（LH）、雌激素（E2）、孕激素（P）、雄激素（D、泌乳素（PRL）水平,并对结果进行相关性分析。结果卵巢早衰组Th1细胞百分比（42．23±9．76）明显高于对照组（26．33±6．25）,P〈0．01;Th1／Th2细胞比值（1．15±0．12）明显高于对照组（0．57±0．08）,P〈0．01;FSH、LH水平均明显高于对照组,P〈0．05;E2、PRL水平均低于对照组,P〈0．05：对外周血T淋巴细胞亚群与雌激素水平进行相关性分析显示,血清E2降低,CD4、Th1／Th2与E2呈正相关。结论CD4^＋,Th1／Th2细胞分布调节失衡,可能与卵巢早衰的发生有关。     

高同型半胱氨酸血症对高海拔地区阿尔茨海默病影响的观察

目的：探讨高同型半胱氨酸（Hey）水平对高原地区阿尔茨海默病（AD）的影响以及干预治疗。方法：选取30例高海拔地区（西宁海拔2260m）AD患者,28例同龄同一地区健康老年人为对照组。测定血清Hcy、叶酸、维生素B12水平,并对AD患者进行了12周叶酸5mg及维生素B12 500μg干预治疗。主要疗效指标为神经量表MMSE、ADAS—cog和ADL。结果：AD患者血清Hcy水平高于对照组（P〈0．01）,血清叶酸水平低于对照组（P〈0．05）,VitB12在2组间变化不大。AD组有18例（60．0％）患者有高同型半胱氨酸血症,而对照组6例（21．0％）,P〈0．01。治疗12周后AD患者MMSE、ADAS—00g和ADL差别有统计学意义（P〈0．01和P〈0．05）,血清Hcy水平较治疗前明显下降（P〈0．01）。结论：高海拔AD患者血清Hcy水平明显增高,而高Hcy与高海拔AD患者饮食中叶酸摄入不足有密切关系。经干预治疗可降低AD患者血清Hcy水平,有效地改善AD患者认知功能、社会活动以及日常生活能力。     

曲美他嗪联合培哚普利治疗慢性充血性心力衰竭疗效观察

目的观察曲美他嗪（TMZ）联合培哚普利治疗慢性充血性心力衰竭（CHF）患者的临床疗效。方法72例CHF患者随机分为研究组和对照组，均给予内科常规抗心衰治疗。对照组加服培哚普利，初始剂量2mg，每日1次，逐渐加至靶剂量4mg，每日1次；研究组在对照组的基础上接受曲美他嗪20mg／次，3次/d。治疗12周。结果治疗12周，两组心功能较治疗前有明显改善，治疗组临床总有效率为93．4％，较对照组（80．6％）显著提高（P〈0．05）；超声心动图LVEF均较治疗前有明显改善（P〈0．01或P〈0．051．但治疗组较对照组改善更为显著（P〈0．05）。治疗组LVEDD、LVESD、LADD均较治疗前改善，差异有显著性（P〈0．01或P〈0．05），而对照组无改善；两组均未发现有明显的不良反应。结论TMZ联合培哚普利治疗CHF是一种安全有效的方法。     

高原扁桃体反复感染伴OSAHS患者血中CRP、TNF-a的相关性研究

目的：观察高原（2300m～3700m）扁桃体反复感染伴阻塞性睡眠呼吸暂停低通气综合征（OSABS）患者血中C-反应蛋白（CaP）、肿瘤细胞坏死因子-a（TNF—a）水平影响。方法：选择通过多导睡眠仪（PSC）确诊的30例OSAHS患者和29例正常对照组。用放射免疫法测定两组血清TNF-a水平，用散射比浊法测定两组血清CRP水平，进行对照分析。结果：OSAHS患者呼吸暂停-低通气指数（AHI）与CRP、TNF—a水平呈正相关（r=0．37，P〈0．01），与夜间最低SaO2呈负相关（r=-0．56，P〈0．001）。OSAHS患者CRP、TNF—a水平较对照组显著性增高（P〈0．001）。结论：OSAHS患者CRP、TNF—a血清水平增高与炎症、低氧血症的发生相关。     

肝硬化大鼠Kupffer细胞血小板活化因子合成水平及其受体表达

目的研究肝硬化时Kupffer细胞血小板活化因子（PAF）生成水平及其受体表达的变化及意义。方法建立CCl4诱导的肝硬化模型,分离、培养Kupffer细胞,快速^3H—PAF液闪检测Kupffer细胞及其培养上清液内PAF水平,免疫组织化学染色检测PAF在Kupffer细胞内的分布情况,受体饱和结合实验和RT-PCR分析Kupffer细胞PAF结合能力及PAF受体mRNA表达水平。结果肝硬化大鼠Kupffer细胞合成与释放PAF明显增加,分别为对照组的1．48倍（P〈0．01）和2倍（P〈0．01）。免疫组化显示Kupffer细胞胞浆内PAF呈阳性表达。肝硬化大鼠的Kupffer细胞PAF结合能力Bmax明显升高（P〈0．01）,而受体亲和力Kd与对照组比较无明显变化。RT-PCR显示PAF受体mRNA表达明显增加（P〈0．05）。结论Kupffer细胞是肝硬化时PAF生成的一个重要来源,通过增加PAF合成和释放并上调PAF受体表达,Kupffer细胞参与肝硬化门脉高压的形成。     

肝硬化失代偿期并发肠道真菌感染的回顾性研究

目的：总结和探讨肝硬化失代偿期合并肠道真菌感染的临床特点、病原菌种类、易感因素、防治及预后。方法：以2004-10～2009-08收治的肝硬化失代偿期患者为调查对象,设合并肠道真菌感染组（32例）和非真菌感染对照组（35例）。对资料进行单因素分析,感染危险因素采用非条件Logistic回归模型分析。结果：肝硬化失代偿期583例次,32例（5.4%）确诊为肠道真菌感染,包括21例经实验室粪便培养阳性证实,11例连续2次粪涂片发现菌丝,但无阳性实验室培养证据。共分离出了7种22株真菌。22例感染者在入院前2周使用了抗菌素。肠道真菌感染以腹胀和顽固性腹泻常见,以稽留热和弛张热型为主。27例肠道真菌感染者外周血白细胞升高。肠道真菌感染后多数患者病情加重,表现为Child-Pugh模型评分增加或死亡。经logistic回归分析,肝功能C级、抗生素使用时间、自发性腹膜炎、食管静脉曲张破裂出血是肠道真菌感染的密切危险因素。依据药物敏感试验抗真菌治疗被认为有效,但缺乏抗真菌药物可能造成肝肾功能进一步损害的评价。统计学分析显示,发生肠道真菌感染的失代偿期肝硬化患者8周内病死率为37.5%,明显高对照组（5.7%）。结论：肠道真菌感染是一种机会感染,伴随肝硬化失代偿期的病理生理改变和肠道微生态环境破坏,促使肠道对真菌的易感性增加。肠道真菌感染增加了肝硬化患者的病死率,防治有相当难度。结合临床症状提高警惕,及时有效的治疗肠道真菌感染是提高其生存率的手段。     

幽门螺杆菌感染与肝硬化患者血清胃泌素变化的关系

目的探讨幽门螺杆菌（Hp）感染与肝硬化患者血清胃泌素变化的关系。方法检测肝硬化患者及正常对照组血清胃泌素，用^14C-尿素呼气试验（^14C-UBT）检查有无Hp感染，对比分析肝硬化及正常对照组血清胃泌素变化，分析肝硬化Hp感染组与非Hp感染组血清胃泌素变化。结果肝硬化患者血清胃泌素水平较对照组明显升高（P〈0．001），不同分级肝功能血清胃泌素有差异，肝硬化Hp感染组与非Hp感染组血清胃泌素水平有显著差异（P〈0．01）。结论肝硬化血清胃泌素水平与肝功能受损程度有关，Hp感染也是重要的原因之一。     

重型肝炎和肝炎肝硬化合并感染的临床分析

 目的探讨重型肝炎和肝硬化患者合并感染情况及其相关因素.方法调查286例重型肝炎和肝硬化患者感染发生率、发生部位,对其相关因素和预后情况进行分析.结果感染发生率为47.20%,其中院内感染发生率为40.56%,感染部位以腹膜炎、肠道感染为主,分别占35.19%和22.22%,感染的发生与患者的年龄、抗生素的使用、侵袭性的操作、合并症及病情严重程度有关,并直接影响患者死亡率.结论重型肝炎和肝硬化患者免疫功能低下,易并发各种感染而直接影响预后,临床上应重点抓住其相关因素,减少感染发生,改善患者预后.     

慢性肝病患者发生肝性脑病的危险因素

 目的 探讨慢性肝病患者发生肝性脑病(hepatic encephalopathy, HE)的危险因素。方法 以2014—2019年医院收治的64例HE患者为研究对象。以HE患者首次明确诊断为肝炎或肝硬化的时间为研究起点,首次发作HE作为研究终点,通过单因素和多因素分析,探讨引发HE可能的独立危险因素。结果 单因素和多因素分析表明,年龄(OR:1.066,P<0.0001)、肝硬化(7.979,P<0.0001)、乙肝病毒(HBV)感染及治疗(5.838,P<0.0001)、脾脏肿大(2.722,P=0.003)、食管胃底静脉曲张(EGV, 1.986,P=0.024)和ALT水平高低(2.940,P<0.0001)是影响HE 发病的独立危险因素。肝病患者HE 1年、3年、5年、10年的发病率分别是14.06%、34.38%、42.19%和85.94%。结论 年龄、肝硬化、HBV感染及治疗、脾大、EGV和血清ALT水平是潜在预判肝病患者HE发作的临床指标。     

肝硬化Child-Pugh分级与LGV内径关系的MSCTA分析研究

目的探讨胃左静脉(LGV)和门静脉(PV)内径与肝硬化Child-Pugh分级间的关系。资料与方法应用16层螺旋CT对100例肝硬化患者和200名正常对照者行上腹部增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)和容积重组(VR)对PV和LGV进行血管重建,测量LGV和PV主干的直径并进行统计学分析。结果总体肝硬化组LGV和PV管径与正常对照组比较明显增粗(P<0.05)。Child-A级和B级组PV最大内径较正常对照组和Child-C级组显著增粗(P<0.05)。Child-C级组和正常对照组、Child-A级和B级组PV最大内径比较差异无统计学意义(P>0.05)。正常对照组、肝硬化无腹腔积液组、肝硬化有腹腔积液组LGV内径逐渐增粗且差异具有统计学意义(P<0.05)。结论多层螺旋CT血管成像(MSCTA)可以清晰显示LGV和PV整体解剖结构,并能准确测量其内径,LGV和PV内径与肝硬化程度存在一定关系,但影响LGV和PV内径因素较多,不能单纯依靠管径大小评价肝硬化程度。     

Sonography of the caudate vein: value in diagnosing Budd-Chiari syndrome

OBJECTIVE: The aim of this study was to evaluate the usefulness of sonography in measuring the caudate vein and lobe when diagnosing Budd-Chiari syndrome. MATERIALS AND METHODS: Our study included a group of 16 patients with Budd-Chiari syndrome. We compared this patient group with a control group of 40 patients with cirrhosis and 66 healthy subjects without liver disease. On sonography, we measured the diameter of the caudate lobe and the presence and diameter of the caudate vein. These measurements were then compared for both groups. RESULTS: In half of the patients with Budd-Chiari syndrome, sonography showed a visible caudate vein (3-21 mm; mean, 7.3 mm; median, 4.6 mm). However, in the control group, spontaneous visualization was seen in only eight (7.5%) of 106 subjects, none of whom had cirrhosis. The caudate lobe was larger in patients with cirrhosis than in healthy subjects. Likewise, in patients with Budd-Chiari syndrome, the caudate lobe was larger than that in patients with cirrhosis. CONCLUSION: When sonography reveals a caudate vein equal to or larger than 3 mm in diameter in the appropriate clinical setting, one should strongly suspect Budd-Chiari syndrome.     

肝硬化患者幽门螺杆菌感染与血氨的关系

 目的探讨肝硬化患者幽门螺杆菌(Helicobacter pylori,Hp)感染与血氨的关系.方法选择68例Hp阳性的乙型肝炎后肝硬化患者为阳性组,34例Hp阴性的乙型肝炎后肝硬化患者为阴性组,40例Hp阴性的健康检查者为对照组.分别检测各组的空腹血氨.阳性组病例治疗1周,停药4周后复查Hp,根治Hp后复查血氨.将阳性组病例分为大、中和少量感染组,根据肝功能Child分级进行分组,比较各组血氨水平.结果阳性组血氨浓度显著高于阴性组(P＜0.01);阴性组血氨浓度亦显著高于对照组(P＜0.01);Hp根治后血氨浓度显著下降(P＜0.01);大量感染组血氨浓度显著高于少量感染组(P＜0.05);阳性组中不同肝功能分级组血氨浓度之间有显著差异(P＜0.05),而阴性组中不同肝功能分级组血氨浓度之间无显著差异(P＞0.05).结论Hp感染与肝硬化的血氨浓度升高密切相关,易并发肝性脑病,根治Hp可使血氨水平显著降低,有利于防治肝性脑病.     

Right posterior hepatic notch sign: a simple diagnostic MR finding of cirrhosis

PURPOSE: To determine the frequency of occurrence of the right posterior hepatic notch sign at MR imaging in patients with cirrhosis, and to assess its diagnostic capability of this sign as a simple diagnostic MR finding of cirrhosis. MATERIALS AND METHODS: This study population included 330 patients with pathologically proved cirrhosis (N = 202) or without clinical evidence of chronic liver diseases (N = 128, control group). MR images were qualitatively evaluated for the presence of the right posterior hepatic notch sign. This sign was considered present if there was a sharp notch in the right posterior surface of the liver. The presence of the expanded gallbladder fossa sign was also evaluated during the same reading session. RESULTS: The right posterior hepatic notch sign was observed in 145 of the 202 patients in the cirrhosis group, while this sign was seen in only two of the 128 patients in the control group (P < 0.0001). The sensitivity, specificity, and accuracy of this sign for the MR diagnosis of cirrhosis were 72%, 98%, and 82%, respectively. When the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered for the MR diagnosis of cirrhosis, the sensitivity and accuracy increased to 86% and 89%, respectively. CONCLUSION: The right posterior hepatic notch sign can be used as a simple and highly specific sign of cirrhosis, if present. The diagnostic performance can be improved when the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered.     

Local tumor control of intermediate and advanced stage hepatocellular carcinoma after local ablative treatment with image-guided interstitial high-dose-rate brachytherapy: A subgroup analysis of 286 HCC nodules

PURPOSEImage-guided interstitial high-dose-rate brachytherapy (iBT) has been demonstrated to offer high local tumor control rates (LTC) of >90% after local ablation of intermediate and advanced hepatocellular carcinoma (HCC; BCLC B and C). The purpose of this study was to show the efficacy of iBT stratified by subgroups and to identify clinical characteristics associated with superior local tumor control (LTC) based on a highly heterogenous patient populationMETHODS AND MATERIALSA cumulative number of 286 HCC nodules in 107 patients were retrospectively analyzed. Clinical and imaging follow-ups were conducted every 3 months after treatment. Analyzed clinical factors were: etiology, presence of liver cirrhosis, radiographic features, lesion size, pretreatment, administered dose, presence of portal hypertension, portal vein thrombosis, and level of alpha-fetoprotein (AFP).RESULTSLTC rate was 88.8% for a median follow-up of 14.3 months (range 3–81 months; 95% CI: 85–92%). Median minimal enclosing tumor dose (D100) was 16.1 Gy (range 7.1–30.3 Gy; reference dose 15 Gy). Subgroup analysis showed significant fewer local recurrences for alcoholic liver disease (ALD)-related HCCs compared to those related to other causes of liver cirrhosis (nonalcoholic fatty liver disease, virus-related liver cirrhosis and other causes) (p = 0.015). LTC was significantly lower after prior surgical resection (p = 0.046). No significant variance was observed for the applied D100 in each group or for all other clinical factors tested.CONCLUSIONSIBT achieves high LTC rates across treated subgroups. However, further studies should particularly address the possible impact of underlying etiology on local recurrence with emphasis on a possible higher radiosensitivity of ALD-related HCCs.     

Signal changes in liver and spleen after Endorem administration in patients with and without liver cirrhosis

The goal of this study was to compare the effect of Endorem on the signal intensity of the spleen in patients with normal liver tissue and in patients with liver cirrhosis. Thirty patients with normal liver tissue and 47 with liver cirrhosis were examined before and after i. v. Endorem administration. The patients were examined with a 1.5-T magnet system (Magnetom Vision) using a semiflexible cp-array coil. Three different pulse sequences were used: a T1-weighted gradient-echo sequence, a T2-weighted fast spin-echo sequence with spectral fat suppression, and a T2^*-weighted gradient-echo sequence. The signal-to-noise ratios (SNRs) of two areas of the liver and spleen were determined. The mean SNRs of the liver and spleen in patients with and without liver cirrhosis were compared. For assessment of statistical significance, the t-test at a level of P < 0.05 was applied. After i. v. administration of Endorem, no differences were seen with the T1-weighted gradient-echo sequence for the liver and spleen and, with the T2-weighted fast spin-echo sequence, no differences were found for the spleen. Significant differences between both groups were seen for the liver with the T2-weighted fast spin-echo sequence. The SNR in the noncirrhotic liver group was 57.4 % lower than the SNR in the cirrhotic liver group. With the T2^*-weighted gradient-echo sequence, the SNRs of the liver and spleen in the noncirrhotic liver group, compared with the cirrhotic liver group, were 126.8 % and 45.6 % less, respectively. The effect of Endorem on the liver in patients with Child C-stage liver cirrhosis was 32.1 % less than in patients with Child B-stage liver cirrhosis. Likewise, the Endorem effect on the spleen was 27.1 % less in patients with Child C-stage compared with Child B-stage liver cirrhosis. Hepatic and splenic uptake of Endorem is significantly decreased in patients with liver cirrhosis. Received: 3 February 1999; Revision received: 21 October 1999; Accepted: 27 October 1999