水飞蓟宾磷脂复合物对慢性乙型肝炎患者血清细胞因子及肝纤维化指标的影响

Objective To observe the influence of silybin capsules (SC) on hepatic fibrosis indexes and cytokines in patients with chronic hepatitis B(CHB). Methods Eighty-three patients with chronic hepatitis B were randomly divided into control group(n =42) and observation group(n = 41) acording to visiting order. The control group received general protective and supportive treatment with polarized solution, energy misture, potassium mag-nessium aspartape, hypoxanthine riboside, salvia miltiorrhiza and so on. Patients in observation group were added SC 105mg, three times per day. Serum precollagen type Ⅲ( PC Ⅲ), Ⅳ-typo collagen (CⅣ), hyaluronate (HA), laminin (LN) and transforming growth factor-beta (TGF-β), tumor necrosis factor alapha(TNF-α), interleukin 6 (IL-6) levels were measured by specific-RIA and ELISA methods before and after the treatment. Results After treatment, serum TGF-β[(174.4±49.7) μg/L], TNF-α[(89.5±25.8) μg/L], IL-6 [(232.6±61.7) μg/L], HA [(180.24±53.78) μg/L], PC Ⅲ[(171.33±48.65) μg/L], LN [ ( 168.06±38.57) μg/L] and CⅣ [(153.46±36.52) μg/L] levels in observation group were obviously decreased than those in control group. Conclusion Silybin capsules influences the levels of cytokines in patients with CHB and has anti-fibrosis effect on liver tissue.     

甲状腺疾病患者血清可溶性细胞间黏附分子-1测定的临床意义

Objective To explore the contents and clinical significance of soluble intracellular adhesion molecule-1 ( sICAM-1 ) in patients with single goitre,Graves'and Hashimoto disease. Methods The contents of sICAM-1 in 100 cases of simple goiter group, Graves disease (GD) group 250 cases, Hashimot group 50 cases and 100 normal control were examined by sICAM-1 Radioimmunoassay(RIA) method,and the results were analyzed. Results There were no significant difference of sICAM-1 contents between ( 170.43 ± 34. 23 ) μg/L in normal control group and ( 182.48 ± 40.05) μg/L in simple goiter group( t = 1. 104, P ＞ 0. 05 ); The contents of slCAM-1 in GD group and HT group [( 279.93 ± 86.69) μg/L、 (250.36 ± 81.56) μg/L] were higher than the control group( t = 2.310,2. 210, all P ＜0. 05) ;The sICAM-1 contents in 3 species.methods after treatment [( 178.95 ±59.78) μg/L, ( 185.65 ±53.25)μg/L, (259.41 ± 71.46) μg/L)] were significantly lower than before treatment [(316.53 ± 66.13) μg/L, (277.79±64.30)μg/L,(285.71 ±72.14)μg/L](t=2.312,2.278,2.328,all P ＜0.05);After the Graves'patients were treated and their thyroid function were normal,their serum sICAM-1 levels( 251.92 ± 77.75 )μg/L were lower than that( 329.34 ± 90.47 ) μg/L in relapse Graves'group( t= 2.412 ,P ＜ 0. 05). Conclusion sICAM-1 RIA can be used as a parameter in diagnosing autoimmune thyroid diseases and in evaluating effects of therapy,stopping medicine or the relapse of Graves' disease.     

缬沙坦治疗早期糖尿病肾病82例临床观察

Objective To explore influence of valsartan on MAU of patients with DN at early stage.Methods 163 patients with DN at early stage were randomly divided into experimental group and control group.Two groups were given routine therapy, and experimental group were added the therapy of valsartan.Period of treatment was 24 weeks, and compared the UAER, Cr, BUN of two groups.Results After treatment of 24 weeks, UAER, Cr, BUN of experimental groups was (142.4 ± 15.6) μg/min, ( 68.7 ±9.4) μmol/L, (3.5 ± 1.2 ) mmol/L, compared with (195.8±23.7)(μg/min,(93.8 ± 13.6) μmol/L, (6.3 ±1.5) mmol/L before treatment, had significant difference (t = 13.675,11.287,2.469,all P<0.05).Compared with( 199.6 ±24.7)μg/min,(87.7 ±11.3)μmol/L、(6.2 ± 1.3)mmol/L of control group after treatment, declined more significantly (t = 13.246,10.312,2.518,all P<0.05).There was no serious complications occurred in two groups.Conclusion Valsartan used in patients with DN at early stage,can significantly improve the function of kidney and enhance clinical effect,decline the side reaction.     

噻托溴铵治疗稳定期慢性阻塞性肺疾病的疗效观察

Objective To explore the clinical effect of inhaling tiotropium in treatment of patients with stable chronic obstructive pulmonary disease.Methods The clinical data of 240 patients with stable chronic obstructive pulmonary disease were retrospectively analyzed,and they were divided into two groups,the group treated with tiotropium and the group treated with ipratropium bromide(n = 120 in each group).The lung function was detected 2 weeks before and after the treatment, and the clinical symptoms were observed.Results FVC, FEV1, FEV1/FVC, and FEV1/predictive value of the tiotropium group were(3.64 ±0.58) L, (2.53 ±0.25) L, (62.40 ±9.42)% ,(58.24 ± 4.83)% respectively,much higher than(3.14 ±0.36)L,( 1.91 ±0.23)L,(56.50 ±7.36)%,(50.41 ±5.54)% of the ipratropium bromide group(t =2.037,1.875,2.616,2.945,all P<0.05) ,and the clinical symptoms were better changed in tiotropium group than in ipratropium bromide group (H = 5.990, P < 0.05 ).Conclusion Tiotropium could effectively improve lung function and clinical symptoms in patients with stable COPD.     

慢性阻塞性肺疾病患者血清同型半胱氨酸分析

Objective To investgate the change of the serum homocysteine in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD), and to explore the possible cause of the change. Methods Patients with AECOPD (n =208 ) were collected in respiratory department of Beijing Claoyang hospital from March 2007 to September 2010, healthy people in medical clinic of Beijing Chaoyang hospital ( n = 60) were enrolled as control group. We observed the changes of the serum homocysteine in this AECOPD group and control group.Results The serum homocysteine in patients with AECOPD was (19.20 ± 7.11 )μmol/L and the positive rate was 53.85% (112/208); meanwhile the serum homocysteine of control group was (7.67 ±4.33) μ mol/L, with a positive rate of 5.0% (3/60). There was a significant difference between the two groups ( P ＜ 0.01 ). Conclusion There is an increase in the serum homocysteine in patients with AECOPD, which may be caused by the blood hypercoagulable state and prothrombotic state of AECOPD patients.     

慢性阻塞性肺疾病患者血清同型半胱氨酸分析

Objective To investgate the change of the serum homocysteine in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD), and to explore the possible cause of the change. Methods Patients with AECOPD (n =208 ) were collected in respiratory department of Beijing Claoyang hospital from March 2007 to September 2010, healthy people in medical clinic of Beijing Chaoyang hospital ( n = 60) were enrolled as control group. We observed the changes of the serum homocysteine in this AECOPD group and control group.Results The serum homocysteine in patients with AECOPD was (19.20 ± 7.11 )μmol/L and the positive rate was 53.85% (112/208); meanwhile the serum homocysteine of control group was (7.67 ±4.33) μ mol/L, with a positive rate of 5.0% (3/60). There was a significant difference between the two groups ( P ＜ 0.01 ). Conclusion There is an increase in the serum homocysteine in patients with AECOPD, which may be caused by the blood hypercoagulable state and prothrombotic state of AECOPD patients.     

The dynamic changes of serum tumor necrosis factor-α and the clinical significance in acute lung injury rats caused by mechanical trauma

Objective To determine the dynamic changes and mechanism of tumor necrosis factor-α(TNF-α) in serum in acute lung injury(ALI) induced by mechanical trauma in mechanical trauma rat model. Methods Totally 40 male Wistar rats were randomly divided into sham group and trauma group, sham-acute lung injury group and acute lung injury group. Noble-Collip drum was used to establish mechanical trauma rat model. Intraperitoneal injection of TNF-α established acute lung injury model. All rats after modeling of abdominal aortic blood sampling time points were killed and the serum levels of TNF-α were asasyed by ELISA. Results Serum TNF-α levels (334. 78 ±± 28) ng/L in the trauma group were significantly higher than those in the sham group( 177 ±10 ) ng/L (P ＜0. 01 ). The pathological results showed that both in trauma group and acute lung injury group lung infection were very obvious, while it was basically normal in both sham group and sham-acute lung injury group. Conclusions Serum TNF-αt levels of mechanical trauma may be associated with acute lung injury after mechanical trauma. Therefore, dynamic observation of the change of serum TNF-α after mechanical trauma will help the assessment and prognosis of the disease, it has important clinical significance.     

The dynamic changes of serum tumor necrosis factor-α and the clinical significance in acute lung injury rats caused by mechanical trauma

Objective To determine the dynamic changes and mechanism of tumor necrosis factor-α(TNF-α) in serum in acute lung injury(ALI) induced by mechanical trauma in mechanical trauma rat model. Methods Totally 40 male Wistar rats were randomly divided into sham group and trauma group, sham-acute lung injury group and acute lung injury group. Noble-Collip drum was used to establish mechanical trauma rat model. Intraperitoneal injection of TNF-α established acute lung injury model. All rats after modeling of abdominal aortic blood sampling time points were killed and the serum levels of TNF-α were asasyed by ELISA. Results Serum TNF-α levels (334. 78 ±± 28) ng/L in the trauma group were significantly higher than those in the sham group( 177 ±10 ) ng/L (P ＜0. 01 ). The pathological results showed that both in trauma group and acute lung injury group lung infection were very obvious, while it was basically normal in both sham group and sham-acute lung injury group. Conclusions Serum TNF-αt levels of mechanical trauma may be associated with acute lung injury after mechanical trauma. Therefore, dynamic observation of the change of serum TNF-α after mechanical trauma will help the assessment and prognosis of the disease, it has important clinical significance.     

脑心通对急性冠脉综合征患者血脂及超敏C反应蛋白的影响

Objective To investigate the effects of atorvastatin combined with Naoxintong capsules on serum lipid level and hish sensitivity C-reactive protein(hs-CRP)in patients with acute coronary syndrome(ACS).Methods 82 ACS patients were randomly divided into observation group(10 mg/d of atorvastatin and 4 capsules 3 times of Naoxintong daily,n=41) and control group(20 mg/d of simvastatin daily,n=41).The levels of serum lipid and hs-CRP were detected before and after treatment.Results 8 weeks after treatment,the levels of serum hpid[TC (4.21±0.87)mmol/L,TG(1.99±0.48)mmol/L,LDL-C(2.71±0.83) mmol/L] and serum hs-CRP(5.63±1.38)mg/L in observation group were significantly lower than those in control group[TC(4.89±0.91)mmol/L,TG (2.58±0.52)mmol/L,LDL-C(3.28±0.89)mmol/L],and serum level HDL-C(1.89±0.47)mmol/L was higher than that in control group(1.63±0.45)mmol/L(t=2.55-4.36,P<0.01～0.05).Conclusion Adjuvant therapy of Naoxintong could promote the levels of serum lipid and hs-CRP in patients with ACS.and offer a better therapeutic effect in these patients.     

脑心通对急性冠脉综合征患者血脂及超敏C反应蛋白的影响

Objective To investigate the effects of atorvastatin combined with Naoxintong capsules on serum lipid level and hish sensitivity C-reactive protein(hs-CRP)in patients with acute coronary syndrome(ACS).Methods 82 ACS patients were randomly divided into observation group(10 mg/d of atorvastatin and 4 capsules 3 times of Naoxintong daily,n=41) and control group(20 mg/d of simvastatin daily,n=41).The levels of serum lipid and hs-CRP were detected before and after treatment.Results 8 weeks after treatment,the levels of serum hpid[TC (4.21±0.87)mmol/L,TG(1.99±0.48)mmol/L,LDL-C(2.71±0.83) mmol/L] and serum hs-CRP(5.63±1.38)mg/L in observation group were significantly lower than those in control group[TC(4.89±0.91)mmol/L,TG (2.58±0.52)mmol/L,LDL-C(3.28±0.89)mmol/L],and serum level HDL-C(1.89±0.47)mmol/L was higher than that in control group(1.63±0.45)mmol/L(t=2.55-4.36,P<0.01～0.05).Conclusion Adjuvant therapy of Naoxintong could promote the levels of serum lipid and hs-CRP in patients with ACS.and offer a better therapeutic effect in these patients.     

类风湿关节炎合并肺间质纤维化的临床特征研究

目的 对类风湿关节炎合并肺间质纤维化患者的临床特征进行分析,为今后的临床诊治工作提供可靠的参考依据.方法 选取2010年1月-2013年3月我院收治的类风湿性关节炎患者102例,按照是否合并肺间质纤维化分成合并组和单纯组,而后对这两组的临床观察指标进行对比分析.结果 合并组患者的男性所占比例、吸烟者比例、患者年龄、发病年龄、抗环瓜氨酸抗体、类风湿因子、C反应蛋白水平以及骨破坏发生率均较单纯组高.结论 类风湿关节炎患者合并肺间质纤维化可能与诸多临床指标均存在较大的相关性,临床应给予关注,采取有效措施进行预防和治疗.     

胸腺肽治疗重症肺炎合并脓毒血症的疗效研究

目的探讨胸腺肽治疗重症肺炎合并脓毒血症的疗效。方法收集2013年12月~2015年10月期间我院收治的重症肺炎合并脓毒血症患者共82例,随机分为观察组和对照组,每组41例,对照组给予常规治疗;观察组在给予常规治疗的基础上皮下注射胸腺肽治疗,两组患者均连续治疗5d。比较两组临床疗效、机械通气时间及ICU住院时间、IL-6、TNF-α、CD4~+、CD8~+、CD4~+/CD8~+。结果观察组临床治疗显效率(95.12%)明显高于对照组(80.48%),机械通气时间及ICU住院时间均少于对照组,差异有统计学意义(P0.05)。治疗后观察组和对照组IL-6、TNF-α、CD8~+水平与治疗前比较均出现明显降低,CD4~+、CD4~+/CD8~+与治疗前比较均出现明显升高,观察组IL-6、TNF-α、CD8~+水平低于对照组,CD4~+、CD4~+/CD8~+高于对照组,两组差异有统计学意义(P0.05)。结论胸腺肽治疗重症肺炎合并脓毒血症临床疗效较好,可使患者的临床症状得到明显改善,免疫功能明显提高,可作为一种治疗重症肺炎合并脓毒血症有效的方法在临床推广应用。     

输尿管镜联合尿道切开镜治疗9例尿道狭窄

目的探讨输尿管镜联合尿道切开镜治疗尿道狭窄的疗效。方法骶管麻醉下用F8/9.8输尿管镜检查尿道狭窄情况,直视下将导丝通过狭窄段尿道置入膀胱。如尿道狭窄段无小孔通道,可从膀胱造瘘管内注入美蓝液,再用力按压膀胱,同时观察闭锁远端有无蓝色液体渗出。改尿道切开镜循导丝的后尿道于12点处切割狭窄环,前尿道于6点方向切开,边切割边推进尿道镜,直至24F尿道内切开镜进入膀胱。术后常规留置F18～F22三腔气囊导尿管4～6周,运用抗生素治疗,拔管后定期行尿道扩张1～3月。结果本组患者手术均一次切开成功。本组手术时间35～83 min,平均46 min。术后住院5～8 d。留置导尿管拔出后l周内排尿通畅,19～21F尿道扩张器通过顺利。无尿失禁、尿外渗、继发性出血,尿道热等发生。结论输尿管镜直视下留置安全导丝,再行尿道切开镜治疗尿道狭窄可有效减少尿道穿孔或假道的发生,是一种并发症少、创伤小、住院时间短、恢复比较快的手术方法。     

洁尔阴治疗尖锐湿疣48例

本文就洁尔阴治疗本院门诊的尖锐湿疣患者48例总结分析如下：回资料与方法l．l临床资料近5年本院JI诊收治的尖锐湿疣86例,其中阴道发病48例（558％）;诊断依据：患者本人或性伙伴有不洁性生活史,肉眼检查阴道粘膜有大小不等的、淡红色赘生物,质较脆,易出血,形状有乳头状、菜花状、疣状。1．2治疗方法患者取卧位,自行将洁尔阴原液10～20ml用阴道冲洗器注入阴道深部,抬高臀部防止药液流出,保持约10分钟,然后起立,让药液流出,每天1～2次,1周为1个疗程。2结果用药2个疗程,治愈35例（729％）;部分病灶消失43例（89．6％）;无效5…     

髓系恶性肿瘤伴骨髓纤维化患者的预后研究

目的评估骨髓纤维化、骨髓增生异常综合征相关预后系统对我国急性髓系白血病(AML)、骨髓增生异常综合征(MDS)伴骨髓纤维化的预后效力,探讨AML/MDS伴骨髓纤维化预后因素。方法回顾性分析134例AML及MDS伴骨髓纤维化患者病例资料,采用PMF-IPSS、DIPSS、IPSS-Chinese、DIPSS-Chinese、MYSEC-PM、 MDS-IPSS、IPSS-R、WPSS对其进行预后分组及评估,并分析预后因素。结果 PMF-IPSS、DIPSS、IPSS-Chinese、DIPSS-Chinese、MYSEC-PM、 MDS-IPSS、IPSS-R、WPSS均不能对AML/MDS伴骨髓纤维化患者进行准确预后,在MDS-IPSS、WPSS基础上增加骨髓纤维化分级可改善其预后效力。有脾肿大(P=0.015)、有输血依赖(P=0.008)、纤维化分级≥2级(P<0.001)、CRP>5.0 mg/L(P=0.032)是AML/MDS伴骨髓纤维化的不良预后因素。结论目前缺乏AML/MDS伴骨髓纤维化的预后系统,脾肿大、输血依赖、纤维化分级及CRP与其预后相关,或许可为预后评估及治疗提供新的选择。     

新斯的明复合罗哌卡因术后硬膜外镇痛的临床效果

目的 探讨新斯的明复合罗哌卡因患者自控硬膜外镇痛(PCEA)效果.方法 60例择期行胆囊切除术的患者随机分为4组,每组15例.PCEA均用罗哌卡因178 mg,用生理盐水稀释到100 ml.A组加新斯的明2 mg,B组加新斯的明3 mg,C组加吗啡4 mg,D组加新斯的明2 mg和吗啡2 mg.记录术后6、12、24和48 h的VAS评分、循环变化及胃肠功能恢复时间.结果 A组术后48 h内各记录时点的VAS评分均比B、C、D 3组高.4组术后血压和心率变化与术前比较均无显著性差别;C组术后瘙痒的发生率(26.7%)明显高于其他3组.结论 罗哌卡因178 mg PCEA加新斯的明2 mg和吗啡2 mg的镇痛效应与单加吗啡4 mg相当,而副作用明显减轻.     

肺结核合并呼吸衰竭患者机械通气治疗的护理

目的对机械通气治疗肺结核合并呼吸衰竭患者的护理方法和效果进行分析和研究,探讨其优势和不足,总结经验,以更好的指导临床护理的进行。方法随机选择我院近3年采用机械通气治疗的70名肺结核合并呼吸衰竭患者,有针对性的对患者进行密切的护理,观察病情和护理效果,并加以总结。结果对机械通气治疗肺结核合并呼吸衰竭患者进行适当护理后,患者得到较好恢复,病情有所缓解,成功脱离呼吸机,同时有效减少其他并发症状的出现,具有较好的护理效果。结论适当的护理,能够使采用机械通气治疗的肺结核合并呼吸衰竭患者较快恢复,摆脱呼吸器帮助,病情得到有效缓解,有效率较高,同时,能有效减少并发症发生率,具有较高的临床使用价值和推广价值。     

射频消融房室结折近性心动过速55例临床分析

目的:房室结折返性心动过速(AVNRT)拟行射频消融(RFCA)治疗的患者,在术中密切注意各种操作细节,可降低Ⅲ度房室传导阻滞(AVB)的发生率,提高RFCA成功率.方法:选择自2000年6月至2006年1月共55例AVNRT拟行RFCA的患者,常规放置CS电极、HRA电极、HIS电极、RV电极,行心内电生理检查(EPS),确诊为AVNRT.消融导管经股静脉送至右房,采用影像与心内电图相结合确定靶点,在希氏束和冠状静脉窦口之间进行仔细标测,寻找小A大V,确定靶点图的标准为A/V为小于0.5,无H波,于窦性心律下行射频消融,功率为20 W-30 W,在放电过程中,严密监测,如有AV间期延长、快速交界心律(＞150 bpm)、消融电极向上移位等立即停止放电,重新标测;成功标志为:放电15秒内出现交界性心律,在该部位继续放电,直至交界性心律消失.消融的终点为:静滴异丙肾上腺素不能诱发原有的心动过速,无AH跳跃,无心房回波,消融成功.结果:55例AVNRTK患者均为慢径消融,成功率100%,无1例复发,其中2例在术中出现一过性I度AVB,立即停止放电,观察1-3 min均恢复正常房室传导,而另1例在术中出现Ⅲ度AVB,立即停止放电,但始终未恢复正常房室传导,成为永久性ⅢAVB.结论:在AVNRT的RFCA中,应严密监测,可降低Ⅲ度AVB发生率,提高RFCA成功率.