健康风险评估系统对血脂检测的对比研究

 目的 探讨健康风险评估(health risk appraisal,HRA)系统对体检人群血脂水平的检测应用价值。 方法 选取来我院体检中心健康体检的235人作为研究对象,对其进行统一问卷调查、血生化检查,行HRA系统检测,按照HRA系统描述可将检测人群分为血脂未见异常组及血脂水平变化组。 结果 (1) HRA描述的血脂水平变化组相对应的血脂生化指标三酰甘油(TG)与低密度脂蛋白胆固醇(LDL-C)水平均高于血脂未见异常组,且差异有统计学意义(P<0.05)。(2)不同HRA分组,血脂水平变化组的高三酰甘油血症(高TG)、高胆固醇血症(高TC)、高低密度脂蛋白胆固醇血症(高LDL-C)、低高密度脂蛋白胆固醇血症(低HDL-C)患病率均明显高于血脂正常组,两组的高三酰甘油血症(高TG)、高低密度脂蛋白胆固醇血症(高LDL-C)的患病率比较差异有统计学意义(P<0.05)。(3)HRA系统对血脂高三酰甘油血症(高TG)的敏感性达75.44%,对高低密度脂蛋白胆固醇血症(高LDL-C)的敏感性达74.80%。 结论 HRA系统可作为健康人群血脂功能异常早期风险筛查的工具。
     

中链脂肪酸与脂代谢

过去临床一直强调：降低每日膳食总能量、总脂肪、胆固醇、饱和脂肪及反式脂肪酸摄入量是降低血三酰甘油、胆固醇,以及预防动脉粥样硬化的有效措施之一。但近年来研究发现,膳食中脂肪酸的种类和组成同样起重要作用。中链脂肪酸（ medium-chain fatty acids, MCFAs）为含有8～12个碳原子的饱和脂肪酸,常见为辛酸（C8∶0）和癸酸（C10∶0）,自然界主要来源于母乳、牛奶及其制品、棕榈仁油和椰子油等。 MCFAs和甘油通过酯化作用形成中链三酰甘油（medium-chain triglycerides,MCT）,MCT中辛酸和癸酸的比例多在50∶50～80∶20范围,与长链三酰甘油（ long-chain triglycerides , LCT ）相比,它进入体内后可快速代谢氧化提供能量,且不易在组织器官储存,因而能减少脂肪组织的富集。20世纪50年代,MCT应用于临床治疗包括胰腺功能不全、脂质吸收障碍、淋巴运输系统障碍及长链脂肪酸（long-chain fatty acids, LCFAs）氧化缺陷的患者［1］。目前,MCT已经作为营养支持的重要组成之一,应用于胆囊纤维化、高脂血症、癫症、腹泻和脂肪吸收不良等相关性疾病的治疗。越来越多的研究显示,MCT可改善机体代谢紊乱或症状,对脂代谢具有重要的调节作用,具有防治高脂血症及心血管疾病发生的作用,笔者就MCFAs对脂代谢的影响及其机制的研究进展作一介绍。     

武警某执勤部队膳食铁与血脂水平的相关性研究

 目的 研究武警某执勤部队战士膳食铁与血脂间的关系,为进一步提供合理膳食结构、保持机体血脂代谢平衡提供理论基础。方法 115名战士作为调查对象,采用3 d称重法对其食堂伙食供应情况连续调查,计算其食物总铁元素、动物来源的血红素铁及植物来源的非血红素铁摄入量;取空腹静脉血,全自动生化分析仪检测血浆总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、高密度脂蛋白胆固醇(HDL cholesterol,HDL-C)和低密度脂蛋白胆固醇(LDL cholesterol,LDL-C),采用多元回归分析食物总铁元素、动物性食物来源的血红蛋白铁,以及植物性食物来源的非血红蛋白铁摄入量与血脂之间关联;单因素方差分析不同区间食物总铁元素、动物来源的血红蛋白铁,以及植物来源的非血红蛋白铁等不同铁摄入量其血脂异常发病率的差异。结果 每日膳食中总铁、动物性食物来源的血红蛋白铁以及植物性食物来源的非血红蛋白铁摄入量的平均值分别为47.1、26.5、19.9 mg,食物总铁和动物源性铁含量与血浆总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)呈正相关(P＜0.05)。随着不同区间食物总铁和动物源性铁摄入量中位数的增加,血脂异常的发病率逐渐增加。结论 动物源性膳食铁可显著影响血脂水平。     

胆红素对大鼠实验性高脂血症的防治作用

 目的 研究胆红素对大鼠实验性高脂血症的防治作用.方法 将Wister大鼠随机分为对照组、模型组、预防组、治疗组.对照组每日灌胃一般饮用水10 ml/kg,其余各组每日灌胃脂肪乳10 ml/kg,连续灌胃4周.预防组于灌胃脂肪乳第1天开始静脉注射胆红素钠注射液5 ml/kg,两周后治疗组开始静脉注射胆红素钠注射液5 ml/kg,对照组、模型组注射等容积氯化钠注射液.预防组连续注射胆红素钠注射液5周,治疗组注射胆红素钠注射液3周.末次给药后24 h,眼眶取血制备血清,测定血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C).结果 预防组TC、TG、LDL-C均明显低于模型组(P<0.01),预防组TC、TG、LDL-C低于治疗组(P<0.05).结论 胆红素对大鼠实验性高脂血症 TC、TG、LDL-C不但有明显的治疗作用,而且有预防作用,是治疗高脂血症有效的新方法.     

ET技术早期评价高脂血症患者颈动脉弹性的临床研究

目的:应用血管回声跟踪(ET)技术早期评价高脂血症分型组患者颈动脉弹性功能.材料和方法:筛选高脂血症患者42例,按血脂异常(类型)分为高胆固醇血症组(16例)、高三酰甘油血症组(13例)和混合型高脂血症组(13例),同期随机选取正常对照组30例,采用ET技术测量颈总动脉弹性参数,并分析各参数与血胆固醇、三酰甘油含量及病程之间的关系.结果:①高脂血症组β、EP、PWVβ和AI较正常对照组明显增高(P<0.05);AC较正常对照组降低(P<0.05).②混合型高脂血症组与高胆固醇组血症和高三酰甘油血症组相比,β、EP、PWVβ和AI增高(P<0.05),AC降低(P<0.05);而与高胆固醇血症组、高三酰甘油血症相比,各参数差异无统计学意义(P>0.05).③血胆固醇、三酰甘油水平及高脂血症的病程与β、EP、AI和PWVβ呈显著正相关,与AC存在负相关.结论:应用ET技术可准确评价高脂血症患者颈动脉弹性功能发生的早期改变.     

运输机空勤人员生活方式及血脂水平与体重指数相关性观察

目的：观察运输机空勤人员吸烟等生活习惯及血脂水平对体重指数的影响。方法：选择运输机空勤人员158例,查阅年度健康体检报告记录血脂水平,并计算体重指数;通过问卷调查和座谈了解日常生活方式。根据中国成年人体重指数标准分为正常组44例、超重组94例和肥胖组20例,观察吸烟、饮酒、体育锻炼等生活方式及血脂水平对体重指数影响。结果：正常组吸烟率、饮酒率、高三酰甘油血症率、高胆固醇血症率,均显著或非常显著低于肥胖组（P〈0.05,P〈0.01）,规律锻炼率显著高于肥胖组（P〈0.05）;正常组饮酒率、高三酰甘油血症率、高胆固醇血症率,均显著低于超重组（P〈0.05）;超重组高三酰甘油血症率、高胆固醇血症率显著低于肥胖组（P〈0.05）。结论：应加强对运输机空勤人员的健康宣教,改变饮酒等不良生活习惯,维持正常体重,以减少心血管病的发生。     

有氧运动和膳食脂肪对ApoE基因缺陷小鼠已经形成的动脉粥样硬化斑块的作用

为了研究有氧运动和低脂膳食对ApoE基因缺陷小鼠中已经形成的动脉粥样硬化斑块的作用,将动物分为低脂膳食运动与不运动和高脂膳食运动与不运动4组,进行10周中等强度的跑台运动.结果表明不论低脂膳食或高脂膳食,10周的有氧运动使ApoE基因缺陷小鼠的TC、TG、LDL-C和ApoB水平显著降低(P＜0.05),使低脂膳食喂饲的ApoE基因缺陷小鼠HDL-C和ApoAI水平增加(P＜0.05);与低脂膳食相比,高脂膳食增加运动和非运动时ApoE基因缺陷小鼠血浆TG、TC、LDL-C和ApoB的水平(P＜0.05);中等强度的跑台运动和低脂膳食均可延缓ApoE基因缺陷小鼠主动脉窦处已经形成的动脉粥样硬化斑块的进一步发展;有氧运动结合低脂膳食组中ApoE基因缺陷小鼠的动脉粥样硬化斑块面积进展低于单独的运动组和低脂膳食组.研究提示有氧运动或低脂膳食均有利于控制动脉粥样硬化斑块的进一步发展,有氧运动和低脂膳食两种因素结合的作用大于单独的有氧运动或低脂膳食的作用.     

脑梗塞血脂载脂蛋白测定及其临床意义

测定62例脑梗塞与50例健康对照者血清胆固醇（TC）、三酰甘油（TG）,载脂蛋白AI（ApoAI）,脂蛋白B100（ApoB100）,结果表明脑梗塞患者血TG,ApoB100水平明显高于对照组（P＜0．01）,ApoAI,ApoAI／ApoB100水平明显低于对照组（P＜0．01）,TC水平与对照组无显著差异（P＜0．05）,,提示脑梗塞组存在显著的腊代谢紊乱,TG,ApoB100升高和ApoAI,ApoAI／ApoB100下降是脑梗塞发生的重要危险因素。     

飞行员高三酰甘油应答诱导胰岛素抵抗现象

目的 探讨脂肪负荷餐后高三酸甘油应答诱导胰岛素抵抗及其与动脉粥样硬化的关系。方法 50名飞行员分为试验组和对照组(各25名)。试验组食脂肪负荷餐.分别于空腹,餐后3、8h采血;对照组不食脂肪负荷餐,采血时间同试验组。测定3个时间点血浆三酰甘油、血糖和胰岛素水平,计算胰岛素敏感指数。结果 试验组富含三酰甘油的脂蛋白清除延迟发生率4/25。4名富含三酰甘油脂蛋白清除延迟者餐后3h胰岛素敏感指数低于试验组餐后3h均值。试验组在餐后3h高三酰甘油应答的同时胰岛素敏感指数降低,与两组空腹及对照组3h相比差异有显著性意义。结论 高三酰甘油应答或富含三酰甘油脂蛋白清除延迟诱导胰岛素抵抗可能是产生这一现象的直接原因。     

血尿酸及血脂与帕金森病患病风险关系研究

目的探讨血尿酸(BUA)及血脂与帕金森病患病风险的关系。方法选取自2014年1月至2018年6月秦皇岛市第一医院收治的帕金森病患者132例为观察组,另选取同期于我院进行体检的健康人员100例作为健康组。记录并比较两组研究对象的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、BUA水平,以及载脂蛋白A、载脂蛋白B、脂蛋白a水平,并应用多因素Logistic回归分析来分析BUA、血脂水平与帕金森病患病风险的关系。结果观察组患者的TC、TG、LDL-C、HDL-C、BUA水平,以及载脂蛋白A、载脂蛋白B、脂蛋白a水平均明显低于健康组,组间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,TC、LDL-C、HDL-C、BUA、载脂蛋白A及脂蛋白a与帕金森病发病有关(P<0.05),TG、载脂蛋白B水平与帕金森病发病无关(P>0.05)。结论 TC、LDL-C、HDL-C、BUA、载脂蛋白A及脂蛋白a均是帕金森病发病的保护因素。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。