拉米夫定阻断乙型肝炎病毒宫内传播的临床探讨

【目的】研究拉米夫定对HBsAg阳性孕妇的乙肝病毒 (HBV)宫内阻断作用。【方法】拉米夫定组 43例 ,孕 2 8周起口服拉米夫定 ,每天 10 0mg至产后 30d。对照组 5 2例 ,未予用药。两组孕妇均于孕 2 8周、分娩前 ,其新生儿于生后 2 4h内免疫接种前抽静脉血检测HBsAg、HBeAg及HBV的定量。【结果】拉米夫定组孕妇HBV的DNA水平显著下降 (P <0 0 5 ) ,其新生儿宫内感染率 (16 3% )明显低于对照组 (32 7% ) ,P <0 0 5。两组孕妇及其新生儿未发现有不良反应。【结论】携带HBV孕妇产前服用拉米夫定可有效减少HBV宫内感染发生率。     

孕妇乙型肝炎病毒感染与胎儿宫内感染的关系

目的探讨孕妇血清中乙型肝炎病毒血清学标志物(HBVM)和DNA(HBV DNA)与胎儿宫内乙型肝炎病毒感染的关系。方法应用电化学发光和荧光定量聚合酶链反应(FQ-PCR)对65例乙肝表面抗原(HBsAg)阳性孕妇的母血及产后婴儿外周血的乙型肝炎血清学标志物和DNA进行检测。结果65例HBsAg阳性孕妇血清中HBeAg和HBV DNA的检出率分别为32.2%、46.2%;所生婴儿外周血中HBsAg、HBeAg和HBV DNA的检出率分别为16.9%、23.1%、4.6%。HBeAg和HBV-DNA阳性孕妇所生婴儿外周血HBsAg检出率分别为38.1%和36.7%,显著高于HBeAg和HBV-DNA阴性者的4.5%和0(<0.01)。婴儿外周血中HBsAg阳性率随孕妇HBV DNA含量增加而增加。结论孕妇血清中HBeAg和HBV DNA阳性是胎儿宫内感染HBV的高危因素,胎儿宫内感染率随母血中HBV DNA含量增加而增加。     

产妇血清HBV DNA含量对乳汁和新生儿血清HBV DNA浓度的影响

 【目的】 探讨乙型肝炎病毒携带产妇血清HBV DNA含量对乳汁和新生儿血清中HBV DNA含量的影响,以指导孕期处理和母乳喂养。【方法】 选择乙型肝炎病毒携带产妇145例,采用荧光定量聚合酶链反应(FQ-PCR)技术对产妇血清,母乳和新生儿血清HBV DNA进行检测,并将产妇血清HBV DNA浓度分3级,分析产妇血清不同HBV DNA浓度级对乳汁及新生儿血清HBV DNA浓度的影响。【结果】 血清HBV DNA < 500 copies/mL的产妇74例,乳汁中检出HBV DNA阳性为零,新生儿血清HBV DNA阳性1例;血清HBV DNA浓度为500 ~ 1.0 × 106 copies/mL产妇30例,乳汁中检出HBV DNA阳性为3例,新生儿血清HBV DNA阳性1例;血清HBV DNA浓度为≥1.0 × 106 copies /mL产妇41例,乳汁中检出HBV DNA阳性为36例,阳性率为87.8%,新生儿血清HBV DNA阳性仅3例。【结论】 产妇血清中HBV DNA≥1.0 × 106 copies/mL时, 乳汁中HBV DNA阳性率大幅度增加, 而当产妇血清HBV DNA浓度小于1.0 × 106 copies/mL, 乳汁中HBV DNA检出率极低?产妇血清HBV DNA浓度对宫内感染影响不大。     

乙肝病毒携带孕妇血清和乳汁中HBV—DNA定量检测研究

目的探讨HBV携带孕妇血清HBV标志物与血清、乳汁中HBV—DNA含量之间的关系,评价母乳喂养的安全性。方法利用EUSA筛查乙肝五项至少一项阳性的孕妇血清HBV—M．将其分为HBeAg阳性组和HBeAg阴性组共180例。同时应用荧光定量PCR对其血清和乳汁中的HBV—DNA进行检测。结果HBeAg阳性组孕妇的血清和乳汁HBV—DNA阳性率为97．7％（88,90）和62．2％（74／90）,HBV—DNA平均载量的对数量为7．32±1．83和4．02±1．21。HBeAg阴性组孕妇的血清和乳汁HBV—DNA阳性率为55．5％（50／90）和13．3％（13／90）,HBV—DNA平均载量的对数量为5．62±0．93和3．32±0．51。孕妇血清中HBeAg阳性组其乳汁和血清中HBV—DNA阳性率及病毒载量与HBeAg阴性组差异有统计学意义（P〈0．05）。结论HBV携带孕妇的血清中HBV—DNA载量越高,其乳汁HBV—DNA含量越高;二者高度相关（r=0．932,P〈0．01）。血清HBV载量高的孕妇最好不要进行母乳喂养。     

孕妇血、脐血、乳汁的乙型肝炎病毒DNA水平及其相关性

【目的】探讨乙型肝炎病毒 (HBV)母婴垂直传播的规律 ,为预防和阻断HBV的母婴传播提供依据。【方法】对 6 8例HBsAg阳性孕产妇以荧光定量PCR方法检测其静脉血、脐血、乳汁HBVDNA含量并分析其相关性。【结果】孕妇血与脐血HBVDNA的含量相关系数为 0 34 46 (P =0 0 0 8) ,孕妇血与乳汁HBVDNA的含量的相关系数为 0 144 9(P =0 2 6 1)。【结论】孕妇血HBVDNA水平与脐血HBVDNA水平呈正相关 ,降低孕妇血HBVDNA水平 ,有利于控制HBV宫内感染 ;对HBsAg阳性产妇应检测乳汁HBVDNA ,以便指导母乳喂养。     

不同血清学模式乙肝患者的血清病毒水平及其临床意义

目的 :探讨乙肝患者的不同血清学模式与血清乙肝病毒核酸 ( HBV DNA)含量关系及其临床意义。方法 :采用 EL ISA和定量 PCR方法检测 78例乙肝患者的血清乙肝病毒标志物 ( HBVM)和 HBV DNA含量 ,并将 HBVDNA含量和患者肝功能中的主要指标进行相关性分析。结果 :78例乙肝患者的 HBV DNA阳性率为 83 .3 % ( 65 / 78) ,65例阳性患者的血清 HBV DNA含量平均为 5 .78± 1.12 (对数值 ) ;慢性乙型肝炎和活动性乙型肝炎肝硬变患者的血清 HBV DNA含量显著高于急性乙型肝炎患者 ( P<0 .0 1) ;HBe Ag或 HBs Ag阳性组的 HBV DNA含量均显著高于HBe Ag或 HBs Ag阴性组 ( P<0 .0 1或 P<0 .0 5 ) ;在出现 HBe Ab血清转换组中 ,HBV DNA阳性率高达 77.8%～ 78.6% ;血清 HBV DNA含量与血清谷丙转氨酶 ( AL T)水平无相关性 ( r=0 .0 2 5 ,P>0 .0 5 ) ,但与血清总胆红素水平呈正相关 ( r=0 .3 0 3 ,P<0 .0 5 )。结论 :HBV慢性持续感染可能与病毒复制活跃及病毒变异等因素有关 ;慢性乙肝患者在出现 HBe Ab血清转换时 ,并不表示病毒复制停止 ,而只是病毒复制水平降低 ;乙肝患者的肝损害与 HBV复制有一定关系     

孕妇HBV携带与胎儿HBV宫内感染的关系

目的:探讨孕妇乙型肝炎病毒(HBV)携带状况与胎儿HBV宫内感染的关系。方法:2 0 0 3年7月至2 0 0 4年6月在我院产检时检出HBs Ag阳性的孕妇共76例,嘱再次抽血检测乙型肝炎血清标志物(两对半)及HBV- DNA定量,待孕妇分娩时收集其胎儿脐带血检测乙型肝炎血清标志物(两对半)及HBV- DNA定量,将孕妇血清与胎儿脐带血的结果进行比较。结果:孕妇血清HBV- DNA阳性组4 0例,其胎儿HBV宫内感染15例,感染率为37.5 % ;HBV-DNA阴性组36例,其胎儿HBV宫内感染6例,感染率为16 .7% ,两组比较,差异有显著性(P<0 .0 1)。孕妇血清单HBs Ag阳性组4 4例,其胎儿HBV宫内感染6例,感染率13.6 % ;HBs Ag、HBe Ag双阳性组32例,其胎儿HBV宫内感染15例,感染率4 6 .9% ,两组比较,差异有显著性(P<0 .0 1)。结论:孕妇HBs Ag、HBe Ag双阳性和(或) HBV- DNA阳性是胎儿HBV宫内感染的高危因素     

乙型肝炎与肝炎后肝硬化血清HBVM和HBV DNA测定分析

目的：探讨乙型肝炎与肝炎后肝硬化患者中血清乙型肝炎标志物HBVM与HBV DNA的阳性表现及其对临床诊断及治疗的意义。方法：对我院收治的214例有乙型肝炎及肝炎后肝硬化患者同时进行HBVM与HBV DNA检测,对HBVM用ELISA方法进行定性分析。结果：HBV DNA定性检测结果表明,急慢性肝炎患者中HBV DNA阳性率与肝炎后肝硬化患者血清中HBV DNA阳性率比较有显著性差异（P〈0.01）;乙型肝炎和肝炎后肝硬化患者HBsAg、HBeAg,抗HBc阳性患者中,HBV DNA阳性率为94.16%,HBsAg、抗HBe、抗HBc阳性患者中HBV DNA阳性率为61.64%,两者比较有显著性差异（P〈0.01）。其中,3例HBV DNA阳性,但HBVM全阴性,7例抗HBsAb、抗HBe、抗HBc阳性,1例HBV DNA呈阳性。肝功能检测提示患者有肝细胞损伤。结论：HBVM的检测不能作为HBV感染及HBV活动的唯一指标;HBV DNA能准确地反映HBV感染及HBV活动的情况。     

先天性异常和优生学

050870乙型肝炎表面抗原与乙型肝炎e抗原阴性孕妇乙型肝炎病毒宫内感染的研究/归巧娣…∥中华妇产科杂志.—2005,40(2).—99～102探讨应用套式PCR方法检测乙型肝炎表面抗原(HBsAg)及乙型肝炎e抗原(HBeAg)阴性孕妇乙型肝炎病毒(HBV)宫内感染的状况。方法:选择HBsAg与HBeAg阴性,其他HBV血清标志物阳性孕妇及其新生儿24例作为病例组,同期HBV血清标志物全部阴性孕妇及其新生儿16例作为对照组。采用套式PCR方法检测两组孕妇及其新生儿的血清及外周血单个核细胞(PBMC)中HBV DNA。结果:(1)病例组24例孕妇中,血清HBV DNA阳性8例,…     

围生期乙型肝炎病毒母婴传播阻断方法的临床研究——附54例病例分析

目的探讨阻断乙型肝炎病毒(HBV)母婴传播的方法及效果。方法调查乙型肝炎病毒表面抗原(HB-sAg)阳性孕妇的新生儿HBV感染率;将HBsAg阳性孕妇分为HBeAg/HBV DNA阳性组与HBeAg/HBV DNA阴性组,阳性组与阴性组分别随机分成两组,A组采用主动免疫法,新生儿用乙肝疫苗24h内、1、6月注射乙肝疫苗,B组新生儿乙肝疫苗+高效价乙型肝炎免疫球蛋白(HBIg)。用ELISA法检测母亲的血清及新生儿血清乙型肝炎病毒标志物(HBVM),PCR法检测HBV-DNA,随访1年检测小儿HBVM。结果HBeAg/HBVDNA阳性组孕妇新生儿HBV感染率高于HBeAg/HBVDNA阴性者(P=0.000)。HBeAg/HBVDNA阳性组孕妇的A组阻断率高于B组阻断率(P=0.024);阴性者的A组阻断率与B组阻断率无明显差异(P=0.910)。结论两种方法均能起到阻断作用,但主动+被动免疫能增强阻断作用。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.