冠心病妇女绝经后雌激素替代治疗对趋化因子受体CXCR2的影响

目的：探讨经雌激素替代治疗后的绝经后冠心病妇女外周血单核细胞趋化因子受体CXCR2的变化。方法：选22例已绝经的冠心病妇女为观察组,20例绝经后健康妇女作为对照组,两组受试又随机分为干预组和安慰剂组,干预组口服结合型雌二醇（倍美力）,每日0．625mg,连续3个月,安慰剂组口服安慰剂（维生素C）,观察对象均分别于用药前及用药3个月末抽血测血清雌二醇（E2）水平,外周血单核细胞趋化因子受体CXCR2蛋白表达水平。结果：（1）治疗前冠心病组血清E2,CXCR2蛋白水平显低于正常对照组（P＜0．01）;（2）经过雌激素干预治疗3个月后,绝经后妇女血清E2水平均显上升（P＜0．01）,外周血单核细胞趋化因子受体CXCR2水平均显下降（P＜0．01）,且冠心病组较对照组变化更明显;（3）血清E2水平与CXCR2水平变化呈显负相关（r=-0.46).结论：雌激素替代治疗后的绝经后妇女外周血单核细胞趋化因子受体CXCR2下调,且有冠心病变化更明显,提示与雌激素的心脏保护作用有关。     

雌激素替代疗法对绝经后妇女血清血管紧张素转化酶及血脂代谢的影响

目的:探讨雌激素替代疗法(ERT)对绝经后妇女血清血管紧张素转化酶(ACE)含量及血脂代谢的影响.方法:测定45例健康绝经后妇女应用ERT(治疗组)前及应用ERT14wk后血清ACE、雌二醇(E2)及血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]含量,并与45例健康绝经后妇女应用安慰剂(对照组)进行对照.结果:对照组应用安慰剂前后,ACE及血脂各项含量无变化;治疗组应用ERT后,ACE含量明显降低且与E2呈负相关,血清TC,LDL-C及Lp(a)含量降低,HDL-C含量升高,TG无变化.结论:绝经后妇女补充雌激素,可通过降低血清ACE水平及改善血脂代谢共同发挥对心血管系统的保护作用.     

雌激素替代治疗对绝经后特发性流出道室性心律失常的影响

目的:探讨性激素水平与绝经后女性特发性室性心律失常(IOTVA)的关系,并观察雌激素替代治疗对其影响.方法:检测绝经后女性正常组和IOTVA患者组血清性激素水平及室性心律失常数目;观察IOTVA组给予雌激素替代治疗后的效果.结果:IOTVA组雌激素水平较正常绝经后女性相比显著降低(8.4±3.4 vs 36.9±12....     

早期雌激素替代疗法对去卵巢家兔动脉粥样硬化的影响

目的探讨早期雌激素替代疗法对去卵巢家兔动脉粥样硬化病变的影响。方法36只雌性新西兰大白兔随机分成假手术组（A组）、对照组（B组）和雌激素组（C组）,每组12只,各组均进食含1.5%胆固醇的高脂饲料。A组不去卵巢,B组和C组均去卵巢,A组、B组均给予安慰剂,C组给予小剂量雌激素（戊酸雌二醇2?mg/周）,饲养12周后均切开股动脉后取血,并取全长的主动脉。分别检测血液学指标,光镜下观察组织病理。取主动脉根部5?mm?标本进行切片(横切面):HE染色,观察横切面动脉硬化病变的内膜/中膜厚度比值;苦味酸天狼星红染色,观察斑块内胶原纤维的含量,免疫组化法半定量观察横切面斑块内巨噬细胞的阳性率。其余部分从胸主动脉起始部到腹主动脉分叉处纵行剖开,油红O染色,分析纵剖面斑块面积及占主动脉的面积比。结果无论是横切面HE染色的内膜/中膜厚度比,还是纵剖面油红O染色的动脉粥样硬化斑块面积及占主动脉的面积之比,A、C组都明显小于B组（P＜0.05）,C组斑块内巨噬细胞的阳性率明显低于B组（P＜0.05）,但C组斑块内胶原纤维的含量多于B组（P＜0.05）。结论早期雌激素替代治疗可改善血脂代谢,减少斑块内巨噬细胞的数量,增加斑块内胶原纤维的含量,稳定斑块,可能是通过这些作用抑制了动脉粥样硬化斑块的进展。     

胆囊疾病与冠状动脉粥样硬化性心脏病的相关性及危险因素分析

目的 分析胆囊疾病(GBD)与冠状动脉粥样硬化性心脏病(CAD)的关系及相关危险因素.方法 回顾性分析经冠状动脉造影明确的CAD患者(CAD组,n=712)和冠状动脉无狭窄的疑似CAD者(对照组,n=571)的临床资料,比较两组GBD的患病率,采用Logistic回归分析体质量指数(BMI)、腰围、高血脂及糖尿病与GBD的相关性.结果 CAD组中GBD的患病率显著高于对照组(37.5％和25.6％,P＜0.01).单因素和多因素Logistic回归分析均显示,男性GBD与CAD具有显著相关性(OR=1.32,95％ CI:1.17 ～1.49,P＜0.01),女性CAD与GBD无显著相关性.BMI、高血压史、高血脂史和糖尿病史是与GBD相关的危险因素.结论 男性GBD与CAD具有显著相关性.     

穴位埋线对颈椎病疗效的影响

目的：探讨穴位埋线、中医汤药和按摩对颈椎病的治疗作用。方法将120例颈椎病患者随机分为穴位埋线组（40例）、中医汤药组（40例）和按摩组（40例）。穴位埋线组通过对颈项部相关穴位埋线进行治疗;中医汤药组以葛根汤加减进行治疗;按摩组是以舒经活血、理筋整复进行治疗。观察颈椎病症状消失时间的长短、愈后在一定时间内有无复发。结果穴位埋线组痊愈率为90％,中医汤药组痊愈率为85％,按摩组痊愈率为75％。穴位埋线组优于中医汤药组和按摩组,并缩短患者的治疗时间、减少患者复发的次数、医疗费用。结论穴位埋线组可以显著改善颈椎病,促进颈椎病的康复。     

乳腺癌患者新辅助化疗对雌激素受体表达的影响

目的探讨新辅助化疗对同一乳腺癌患者雌激素受体(ER)表达的影响,以及ER表达改变后对内分泌治疗效果的影响。方法选择109例可手术的乳腺癌患者,分析术前空芯针穿刺活检标本及术后大体标本癌组织中ER变化。结果 109例中3例患者发生肿瘤重度化疗反应致病理医生判断ER表达困难;3例患者新辅助化疗后达到病理完全缓解,免疫组化无法测定ER,该6例不参与评价。新辅助化疗前、后ER表达的阳性率分别为48.5%(50/103)和51.5%(53/103)。化疗前50例阳性患者中,13例化疗后转为阴性;相反,53例化疗前阴性患者中,16例转为阳性,化疗前、后ER表达的构成比发生了明显变化(P<0.01)。50例化疗前ER表达阳性患者中,轻-中度治疗反应占80.0%(40/50),中-重度治疗反应占20.0%(10/50);53例表达阴性患者中,轻-中度治疗反应占58.5%(31/53),中-重度治疗反应占41.5%(22/53),二者比较差异有统计学意义(P<0.05)。13例ER阳性化疗后转为阴性患者中,轻-中度治疗反应占53.8%(7/13),中-重度治疗反应占46.2%(6/13);16例ER阴性化疗后转为阳性患者中,轻-中度治疗反应占62.5%(10/16),中-重度治疗反应占37.5%(6/16),二者比较,差异无统计学意义(P>0.05)。结论对于临床病例在化疗后出现的ER表达改变,不能作为后继内分泌治疗或化疗的惟一选择依据。     

Postmenopausal vaginal bleeding during estrogen therapy

Opinions on whether dilatation and curettage is justified in the case of vaginal bleeding in postmenopausal women taking estrogens are presented. Postmenopausal bleeding induced by estrogens usually stops after cessation of treatment, while bleeding due to endometrial cancer usually recurs or continues after cessation of estrogen therapy. Since endometrial cancer may become "silent" after initial bleeding, dilatation and curettage is indicated in all cases of postmenopausal vaginal bleeding, irregardless of estrogen therapy.     

Prolonged estrogen therapy in postmenopausal women

The therapeutic use of estrogens for more than 25 years made it possible to examine evidence of their safety and effectiveness in a study of 292 postmenopausal women who had undergone prolonged estrogen therapy. Diethylstilbestrol and conjugated equine estrogens have been used most frequently since 1945. The study showed that only 5% of patients necessitated discontinuation from severe side effects; the latter of the 2 compounds was tolerated without side effects among almost all patients. Hot flashes were completely relieved in 93 of 94 patients. Prolonged estrogen therapy was the treatment for postmenopausal osteoporosis in 119 patients, 103 of whom had suffered collapse of vertabrae. Either complete or significant relief from pain occurred in 90%. A group of 27 women showed evidence that estrogen is a prophylactic against postmenopausal osterporosis. Justification for the fear that mammary and cervical carcinoma may result from this therapy is absent. When combined with periodic pelvic and vaginal cytological examinations, prolonged cyclic oral estrogen therapy is safe and effective treatment for postmenopausal women with disabling symptoms or osteoporosis.     

雌激素在视网膜疾病中作用的研究进展

雌激素是一类有广泛生物活性的类固醇化合物,它不仅对女性生殖系统有重要影响,对视网膜也有保护作用。雌激素减少可导致视网膜疾病的风险增加。本文就雌激素在视网膜疾病中的作用机制,以及雌激素在视网膜疾病相关领域的研究进展作一综述。     

甲硝唑治疗牙周疾患的疗效观察

目的：探讨甲硝唑治疗牙周病的临床效果。方法：实验组服用甲硝唑，200mg/次，每日3—4次，对照级用乙酰螺旋霉素300mg／次，每日4次，7天为一疗程，同时配以牙齿洁治术。结果：实验组有效113例（占93．39％），对照组有效107例（占88．42％）。结论：甲硝唑治疗牙周病的临床效果明显优于乙酰螺旋霉素。     

Letter: Hyperlipemia during estrogen therapy

The effects of weight loss and reduction of carbohydrates and saturated-fat intake in cases 2 and 3, the decline in lipid levels from the extremely high levels in all 4 cases, when estrogen therapy was discontinued, to levels still abnormal emphasizes the importance of the estrogens in producing these massive elevations of serum cholesterol and triglyceride levels. It is rare to see patients with simple hyperlipidemias who have triglyceride levels in the 4000-5000 range. Also, such excellent declines have not been observed on dietary modification alone. Patients 1 and 4 did not receive dietary modification but had similar declines in lipid levels on cessation of estrogen therapy. It is concluded that, in these patients, the marked lipid elevations can be attributed to the estrogen therapy, superimposed on a pre-existing lipid abnormality.     

Cancer of endometrium and prolonged estrogen therapy

A causal link between prolonged estrogen (E) therapy and endometrial cancer is argued for in this report of a case who was treated with large amounts of estrogenic substances almost continuously for an 8-year period. In 1919 a 25-year-old woman was admitted with asthma of 1-year duration. Asthma onset had been very severe, requiring administration of epinephrine hydrochloride every few hours and frequent hospital observation. In 1928, the patient was amenorrheic for 8 months; in 1936, she experienced amenorrhea for 4 months. In 1937 (patient now 45 years old), the relationship between amenorrhea and increased severity of asthma was suspected. At this time, the patient also complained of hot flashes and sweats. Treatment with estrogenic substances was begun in 1937 and continued through 1945. 3 unusual features were noted during therapy: 1) persistence of hot flashes; 2) persistence of high urine titers of follicle stimulating hormone (FSH) despite adequate E doses; and 3) absence of bleeding when E was temporarily withdrawn. By 1945, endometrial cancer had been identified by vaginal smear and verified by biopsy. Because of the previous absence of respose of FSH to prolonged E therapy, Es were omitted for 4 weeks, and after this period the vaginal smear showed complete absence of intrinsic estrogenic stimulation, and the urine titer of FSH was high. E given for 10 days caused moderate pituitary inhibition. Determination of 17-keto-steroids made before and after therapy was abnormally low. Except for the state of chronic illness and the continuous administration of asthma medication (chronic alarm reaction?), there is no explanation of carcinoma grade 2.     

腹腔镜手术治疗胆囊疾病术中意外诊断胆囊癌及处理方法

目的探讨腹腔镜下胆囊手术治疗意外发现胆囊癌的诊断及处理方法。方法回顾性分析1999.5-2011.6间15例患者腹腔镜胆囊切除术发现意外胆囊癌的临床资料。结果 15例意外胆囊癌患者中,Ⅰ期2例,Ⅱ期9例,Ⅲ期3例,Ⅳ期1例。15例患者中1例失访,14例患者获得随访,术后1年内死亡4例,3年内死亡7例,4例随访至今仍存活,分别存活16、28、33和43个月。结论重视胆囊癌的高危人群或可疑病例,尽早采取手术治疗,在术中发现可疑为胆囊癌者,需冰冻切片检查,应将开腹胆囊癌根治术为其治疗选择的术式。     

PTGD治疗急性胆囊炎的临床疗效观察

目的:探讨B超引导下经皮经肝胆囊穿刺引流术(PTGD)治疗急性胆囊炎的临床方法和临床疗效。方法:将我院2009年1月～2011年5月收治的120例急性胆囊炎患者分为观察组和对照组,对照组用传统的胆囊切除术治疗,观察组采用PTGD治疗,比较两组患者的临床疗效。结果:观察组的治愈率、抗生素的使用时间、并发症的发生率、死亡率及住院时间分别为95.0%、(4.1±1.9)d、0.0、0.0、(18.2±3.2)d,对照组分别为90.0%、(6.4±2.1)d、20.0%、10.0%、(23.7±4.6)d,两组治愈率比较无统计学意义(P>0.05),但观察组抗生素使用时间、住院时间显著短于对照组(P<0.05),并发症发生率及死亡率明显低于对照组(P<0.05)。结论:PTGD治疗急性胆囊炎疗效确切,可明显降低并发症和死亡率,且创伤小,值得临床推广。     

辣椒对人体空腹胆囊容积和试餐引起的胆囊收缩的影响

使用超声成像仪研究辣椒对健康成人空腹胆囊容积和试餐引起的胆囊收缩的影响。结果表明，吞服１０％的辣椒煎液１０ｍｌ，１ｈ可见胆囊收缩，胆囊容积明显减小，而不明显影响试餐引起的胆囊收缩。     

雌孕激素序贯疗法预防宫腔镜下子宫纵隔电切术后宫腔粘连的价值探讨

目的:观察宫腔镜下子宫纵隔电切术的疗效,评价术后应用雌孕激素序贯疗法预防宫腔粘连的价值.方法:选取子宫纵隔患者60例,随机分为对照组和观察组,各30例.2组患者均行腹腔镜监视下宫腔镜子宫纵隔电切术,对照组术后放置宫内节育器(金属圆环);观察组放置宫内节育器(金属圆环),并采用雌孕激素序贯人工周期疗法.所有患者于术后3个月行宫腔镜复查,比较2组宫腔粘连情况;继续随访至术后1年,比较2组患者妊娠及月经情况.结果:所有患者均顺利完成手术,无明显并发症发生.2组患者术后3个月宫腔粘连率差异无统计学意义(P>0.05);2组术后1年经期紊乱、经量增多及妊娠率差异亦均无统计学意义(P>0.05).结论:宫腔镜下子宫纵隔电切术安全有效,能有效提高患者妊娠率,但术后应用雌孕激素序贯疗法预防宫腔粘连未见明显价值.