支气管哮喘患者缓解期肺功能和气道反应性测定

目的　测定哮喘患者缓解期的肺功能和气道反应性 ,探讨其临床意义。方法　对 34例缓解期哮喘患者作肺功能测定和支气管激发试验 ,比较肺功能正常和异常组气道反应性。FEV1 /FVC比值≥ 70 %为肺功能正常 ;5 0 %及 2 5 %用力肺活量时呼气流速 (V50 、V2 5)实测值 /预计值 <70 %为小气道功能异常。PD2 0 FEV1 <1 2. 8μmol为支气管激发试验阳性 ,即气道反应性增高。 结果　 34例缓解期哮喘患者中肺功能异常 2 6例 (76 . 5 %) ,正常 8例 (2 3. 5 %) ;支气管激发试验阳性 2 3例(6 7. 7%) ,阴性 1 1例 (32 . 3%)。肺功能异常组与肺功能正常组激发试验阳性率比较有显著性差异(P <0 . 0 1 )。结论　缓解期哮喘患者多数存在小气道功能异常和气道高反应性 ,提示缓解期气道炎症仍持续存在 ,需长期维持治疗 ;定期复查肺功能有助于指导缓解期治疗。     

白三烯拮抗剂联合吸入糖皮质激素治疗慢性中度持续支气管哮喘的疗效

目的 观察白三烯拮抗剂联合吸入糖皮质激素对慢性中度持续支气管哮喘患者的临床疗效、对肺功能(FEV1)、晨晚间PEF值、气道反应性(PC20FEV1)和治疗有效率等的影响,评价其在哮喘治疗中的作用和地位.方法 162例患者随机分为观察组和对照组,观察组:丙酸倍氯米松气雾剂(必可酮)吸入250 μg,3次/d,加孟鲁司特(顺尔宁)10 mg,口服,1次/d;对照组:丙酸倍氯米松(必可酮)吸入250μg,3次/d.两组患者均可根据病情需要吸入沙丁胺醇气雾剂(万托林).疗程均为4周.两组治疗前后测定肺功能(FEV1),晨晚间PEF值,气道反应性(PC20FEV1),同时记录日间哮喘症状评分、夜间憋喘次数、每周吸入沙丁胺醇气雾剂次数剂量等,治疗结束后作出临床症状评价及疗效判断.结果 两组治疗后日间哮喘症状评分、夜间憋喘次数、每周吸入沙丁胺醇气雾剂次数剂量较治疗前均有显著减少(P＜0.05),两组治疗后肺功能(FEV1)、晨晚间PEF值、气道反应性(PC20FEV1)较治疗前均显著改善(P＜0.05),但观察组与对照组上述指标治疗后组间比较差异有显著性(P＜0.05).结论 白三烯拮抗剂联合吸入糖皮质激素治疗慢性中度持续支气管哮喘患者,能显著减轻哮喘气道阻塞和气道高反应性,减少哮喘发作次数、改善哮喘症状、减少吸入沙丁胺醇气雾剂次数剂量,值得临床推广应用.     

必可酮吸入治疗咳嗽变异型哮喘的肺功能评价

目的评价吸入必可酮气雾剂(BDP)对咳嗽变异型哮喘(CVA)的疗效.方法 40例CVA患者予BDP吸入治疗3个月,治疗前后测定肺功能用力肺活量(FVC)、一秒钟用力呼气容积(FEV1.0)、呼气峰流速(PEF)、最大呼气中段流量(FEF25～75%)、50%肺活量最大呼气流量(FEF50%)、25%肺活量最大呼气流量(FEF75%)、气道阻力Raw和比气道传导率sGaw,并与对照组比较.结果 CVA患者FVC、FEV1.0、PEF接近于正常人,而FEF25～75%、FEF50%、FEF75%、sGaw明显低于正常(P<0.01),Raw高于正常(P<0.01).治疗后FEF25～75%、FEF50%、FEF75%、sGaw显著增高(P<0.01),Raw明显降低(P<0.01).结论 CVA患者存在小气道功能障碍,BDP吸入治疗疗效肯定,可改善肺功能.     

射干麻黄汤对哮喘患者气道高反应性的影响

目的观察射干麻黄汤对寒哮患者气道高反应性的影响。方法 51例轻、中度寒哮患者随机分为两组。对照组给予沙丁胺醇气雾剂,治疗组在对照组的基础上加用射干麻黄汤中药配方颗粒冲服,两组均治疗12周,分别于治疗前和治疗后进行哮喘控制测试评分(ACT评分)、最大呼气峰流速(PEF)、肺通气功能及支气管激发或舒张试验检测,并进行疗效判定。结果治疗组疗效优于对照组(P0.05),两组FEV1、FEV1%预计值、PEF均较治疗前显著改善(P0.05),而治疗组气道高反应性(支气管激发或舒张实验阳性率)及PEF变异率均较对照组下降(P0.05),ACT评分较对照组明显改善(P0.05)。结论射干麻黄汤能改善哮喘患者的症状及气道高反应性。     

支气管哮喘患者治疗前后气道反应性分析

目的探讨研究支气管哮喘患者在治疗前、治疗后的气道反应性。方法选择2009年9月-2012年11月云浮市新兴县人民医院收治的轻度支气管哮喘患者50例和中度支气管哮喘50例为研究对象,对患者均给予临床治疗,治疗方案为氟替卡松/沙美特罗吸入,其中轻度哮喘患者剂量为50/100mg,每日2次;中度哮喘患者剂量为50/250mg。观察治疗前、治疗后2个月、3个月两组患者的气道反应性。结果轻度哮喘和中度哮喘患者在治疗2个月后,其症状积分、第一秒钟用力呼气量占预计值百分比(FEV1%)和最大呼吸流量占预计值百分比(PEF%)均有明显改善,差异有统计学意义(P<0.05);两组患者在治疗3个月与治疗2个月的症状积分、FEV1%及PEF%比较差异无统计学意义(P>0.05)。结论支气管哮喘患者在治疗2个月内会有明显的气道反应性改变,但是在3个月后会维持在一定水平,需要医生引起重视,调整药物治疗方案。     

动态肺量测定在支气管哮喘中的应用

目的探讨动态肺量测定技术在支气管哮喘中的应用.方法建立动态肺量测定技术,对20例支气管哮喘患者每天清晨、下午和入睡前连续14 d动态监测气道功能、症状和情绪.结果白天标准肺功能检查结果正常的支气管哮喘患者,第一秒用力呼气量(FEV1)和最大呼气峰流量(PEF)在夜间和凌晨可出现明显下降.肺功能指标与支气管哮喘症状的相关分析发现,只有7例患者(35%)支气管哮喘症状与FEV1和PEF存在相关关系.4例患者(20%)肺功能基本正常,但有很多症状,症状与FEV1和PEF无相关关系,但与负面情绪相关.另外2例患者(10%)肺功能损害严重,但几乎没有症状.结论动态肺量测定技术能客观反映支气管哮喘患者气道功能的昼夜自然变化,因此可以更准确地反映支气管哮喘的严重程度.动态肺量测定技术结合症状和情绪的同步监测,可以帮助识别出特殊症状感觉类型的支气管哮喘患者.     

特布他林/普米克令舒联合治疗成人支气管哮喘疗效观察

目的 观察特布他林/普米克令舒治疗支气管哮喘的疗效和安全性.方法 50例确诊为中、重度哮喘患者予以普米克令舒160 μg,2次/d,特布他林0.5 mg,2吸/次,3次/d,若症状控制不良可按需使用,共用12周.观察吸入前与吸入后4周、12周的临床症状变化、药物反应及肺功能相关指标[FEV1(第一秒用力呼气容积),FEV1%(FEV1占预计值百分比),PEF(最大呼气峰流速值),PEF%(PEF占预计值百分比)].结果 通过治疗可显著改善临床症状、肺通气功能;并降低气道高反应性(AHR).治疗前后差异有统计学意义(P<0.05),提示联合吸入糖皮质激素(ICS)及β2受体激动剂(LABA)治疗能很好地改善肺功能,吸入治疗时间越长,疗效越好.结论 使用特布他林/普米克令舒吸入剂对中、重度哮喘患者能够完全控制症状、改善肺功能,具有良好的依从性和轻微的不良反应.     

吸烟与非吸烟哮喘患者诱导痰的比较

目的观察吸烟轻度支气管哮喘患者诱导痰中炎症细胞的变化以了解吸烟对轻度支气管哮喘患者气道炎症及气道反应性的影响。方法随机抽取23例吸烟的轻度支气管哮喘患者定为吸烟组（A组）及随机抽取23例非吸烟的轻度支气管哮喘患者定为非吸烟组（B组），两组治疗前进行肺功能测定、气道反应性试验及诱导痰细胞分数计数。结果两组呼气峰流量（PEF）、第一秒用力呼气容积占预计值百分比（FEV1％）及气道反应性差异无统计学意义（P〉0．05）；A组患者诱导痰中中性粒细胞高于B组（P〈0．01），且经相关分析显示诱导痰中的中性粒细胞数量与PEF及FEV1（％）呈负相关（P〈0．01），而与气道反应性呈正相关（P〈0．01）。结论吸烟哮喘患者气道中的中性粒细胞比非吸烟哮喘患者气道中的中性粒细胞增多，且与PEF及FEV1（％）呈负相关，而与气道反应性呈正相关。     

舒利迭治疗支气管哮喘60例疗效观察

目的:观察舒利迭治疗支气管哮喘的疗效。方法:60例确诊为支气管哮喘的患者予吸入舒利迭100-200μg/次,每日2次,共用8周。观察吸入前后临床症状变化、肺功能及药物反应。结果:支气管哮喘患者经舒利迭吸入治疗哮喘症状明显改善,治疗后患者第一秒用力呼气容积(FEV1)、用力呼气峰流速(PEF)显著提高。仅5例(占8.3%)患者出现轻微不良反应。结论:吸入舒利迭治疗支气管哮喘有较好的临床疗效,不良反应少。     

咳嗽变异性哮喘的临床诊断分析

目的认识咳嗽变异性哮喘(CVA)的临床特点,提高其诊断率。方法对门诊原因不明的长期慢性咳嗽患者行常规肺功能检测,对第1秒钟用力呼气容积(FEV1)实测值预计值<70%患者行支气管舒张试验,FEV1实测值预计值≥70%患者行支气管激发试验。结果157例患者支气管舒张试验阳性13例,支气管激发试验阳性38例。结合临床特点及对支气管扩张剂和激素的治疗效果确诊48例为CVA。结论咳嗽变异性哮喘以慢性咳嗽或胸闷为主要表现,大多数具有气道高反应性,行支气管激发或舒张试验测定是诊断的有力依据,结合对支气管扩张剂和激素的治疗效果可确诊     

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.