辛伐他汀对急性冠状动脉综合征患者高敏C-反应蛋白的影响

目的探讨调脂对急性冠状动脉综合征(ACS)患者冠脉病变炎症的影响。方法采用随机、单盲、对照方法将125例ACS患者分为辛伐他汀治疗组(n=63)非辛伐他汀治疗组(n=62),另选健康对照组(n=60),测定治疗前、治疗后8周血浆高敏C-反应蛋白(hs-CRP)水平的变化。结果ACS患者的hs-CRP水平明显增高,经辛伐他汀治疗8周后其血浆hs-CRP水平明显下降,非他汀治疗组各项指标无明显变化。结论他汀调脂可阻滞ACS患者冠脉病变的炎症反应。     

急性冠脉综合征时血浆白介素6、P选择素和血清C反应蛋白的变化及氟伐他汀对其影响

目的观察急性冠脉综合征(ACS)患者血清C反应蛋白(CRP)水平、血浆白介素6(IL-6)和P选择素(GMP-140)的浓度,然后观察氟伐他汀对其影响,以探讨CRP水平与ACS的关系、氟伐他汀对炎症的抑制作用及其机制.方法将206例ACS患者随机分为氟伐他汀组(105例,氟伐他汀80 mg,连服3 d)和普通治疗组(101例).检测治疗前后血清CRP 水平、血浆IL-6、GMP-140的浓度和血脂浓度.结果 ACS时,血清的CRP 水平、IL-6和GMP-140的浓度明显高于正常人(P<0.05).且AMI患者的CRP、IL-6、GMP-140较UAP组增高明显(P<0.05).在治疗前,氟伐他汀组和普通治疗组间的上述指标无明显差异.但氟伐他汀治疗后,CRP、IL-6、GMP-140明显下降(分别为1.89比0.53 mg·dl-1,0.19比0.05 ng·ml-1,49.52比16.73 mmol·L-1,均P<0.05).普通治疗组则无改变.ACS的血脂水平治疗前后无统计学差异(P>0.05).结论 ACS时,血清CRP、血浆IL-6和GMP-140浓度升高,氟伐他汀治疗可以明显降低这些炎性介质的水平.     

辛伐他汀调脂干预治疗急性冠脉综合征病人血浆CRP及NO水平的影响

目的探讨辛伐他汀对急性冠状动脉综合征(ACS)病人血浆C-反应蛋白(CRP)及血脂干预的作用。方法符合ACS诊断标准的病人73例,随机分成辛伐他汀组(治疗组)和常规组(对照组),分别在治疗前和治疗28d后,清晨空腹抽静脉血5mL,应用速率散射免疫比浊法测定血浆CRP,同时测定血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、一氧化氮(NO)等水平。结果治疗组CRP,LDL,TC,TG较对照组明显下降(P<0.05或P<0.01),而NO水平明显升高(P<0.01)。结论辛伐他汀调脂干预治疗,能够降低ACS应激反应,减轻冠状动脉粥样硬化的炎症反应和脂质过氧化损伤,改善冠状动脉内皮细胞功能。     

瑞舒伐他汀对急性冠脉综合征患者血清脂联素和高敏C反应蛋白的影响

目的探讨瑞舒伐他汀对急性冠脉综合征（ACS）患者血清脂联素（APN）、高敏C反应蛋白（hs—CRP）的影响。方法42例ACS患者,在常规治疗基础上加服瑞舒伐他汀10mg,睡前服用,1次／d。另选取年龄、性别等相匹配33例正常体检者为NC组。治疗时间12周。检测治疗前后2组研究对象血脂、APN、hs—CRP等因素的变化。结果治疗前ACS组的血清APN明显低于NC组（P〈0．05）,而血清hs—CRP明显高于NC组（P〈0．05）;瑞舒伐他汀治疗后血清APN明显升高,hs—CRP水平显著下降（P〈0．05）。结论瑞舒伐他汀可明显升高血清APN水平,明显降低ACS患者hs—CRP水平,从而可能改善ACS患者的炎症状态。     

急性冠脉综合征患者血清脂联素与C反应蛋白关系的研究

目的 探讨急性冠脉综合征(ACS)患者血清脂联素与C反应蛋白(CRP)的关系.方法 临床及冠状动脉造影明确诊断的急性冠脉综合征患者50例,稳定型心绞痛(SAP)组21例和对照组15例,分别检测其血清脂联素、CRP水平,并进行比较.结果 血清脂联素水平ACS组明显低于SAP组和对照组(P<0.01),CRP水平ACS组与SAP组和对照组比较有显著差异(P<0.01),而SAP组和对照组之间差异均无统计学意义.ACS患者血清脂联素水平随动脉粥样硬化程度的加重呈进行性下降.血清脂联素水平与冠状动脉的狭窄程度、CRP水平呈负相关.结论 ACS患者血清脂联素水平降低,其与CRP之间的相互关系可能促进了动脉粥样硬化的发展.     

急性冠脉综合征早期辛伐他汀治疗对血脂和炎症反应标记物的影响

目的　观察急性冠脉综合征 (ACS)早期辛伐他汀治疗对血脂和炎症反应标记物的影响及差异 ,探讨他汀类药物在ACS早期治疗中的作用。　方法　ACS住院患者 12 3例 ,入院后测定血浆甘油三酯 (TG)、总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、白细胞介素 6 (IL 6 )和C反应蛋白 (CRP)水平 ,然后随机分为辛伐他汀治疗组和非辛伐他汀治疗组。出院时重复测定上述指标。同期测定 15例慢性稳定性心绞痛 (CAP)患者和 15名健康者作对照比较。　结果　 1 ACS患者血浆TC、LDL C、IL 6、CRP显著高于健康者 (P <0 0 1) ,血浆LDL C、IL 6显著高于CAP患者 (P <0 0 1)。 2 出院与入院时比较 ,辛伐他汀组和非辛伐他汀组血浆IL 6、CRP显著降低 (P <0 0 1) ,出院时辛伐他汀组血浆IL 6、CRP也显著低于非辛伐他汀组 (P <0 0 1)。 3 据入院时血浆IL 6、CRP水平 ,把ACS患者分别分为IL 6、CRP高值组和低值组 ,出院与入院时比较 ,高值组和低值组血浆IL 6、CRP均显著降低 (P<0 0 1,P<0 0 1) ,但只有高值组 ,出院时辛伐他汀治疗者血浆IL 6、CRP显著低于非辛伐他汀治疗者 (P <0 0 1,P <0 0 5 )。　结论　ACS患者早期辛伐他汀治疗有明显抗炎症作用。     

急性冠状动脉综合征早期阿托伐他汀治疗对CRP及NO的影响

目的观察阿托伐他汀早期治疗急性冠状动脉综合征(ACS)对 C-反应蛋白(CRP)及一氧化氮(NO)的影响,探讨阿托伐他汀治疗 ACS 的作用机制。方法 60例 ACS 患者随机分为常规治疗组(n=30)及阿托伐他汀组(n=30)。常规治疗组应用阿斯匹林、肝素、硝酸酯类、血管紧张素转化酶抑制剂(ACEI)及β-受体阻滞剂等,不使用其他调脂、抗氧化药物、非类固醇类消炎镇痛药物;阿托伐他汀组在常规治疗基础上加用阿托伐他汀20 mg/d,疗程4周。测定治疗前后 CRP、NO 及血脂,如总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白(TC、TG、LDL-C、HDL-C)水平并与健康对照组(n=30)比较。结果 ACS 患者 CRP 升高,NO 降低,TC、TG、LDL-C 升高,经治疗后 CRP 均有下降,NO 均明显升高,阿托伐他汀组与常规治疗组比较,变化更明显(P<0.001),且其 CRP、NO 变化幅度与其降脂幅度无明显相关性;ACS 患者治疗后 TC、TG、LDL-C 下降,阿托伐他汀组分别下降了15%、6%、16.4%,HDL-C 升高达5.0%;阿托伐他汀组有2例出现胃肠道反应,未见严重不良反应。结论阿托伐他汀早期治疗 ACS 通过降低 CRP 水平,提高 NO 水平而起到稳定斑块、抑制炎症,改善内皮功能等作用,是有效、安全的治疗手段。     

阿托伐他汀对急性冠脉综合征患者血脂及C反应蛋白的影响

目的:探索阿托伐他汀对急性冠脉综合征(ACS)患者高脂血症及C反应蛋白(CRP)的作用。方法:82例 ACS患者随机分为阿托伐他汀组和常规治疗组,分别在入院时、1周后及接受高脂餐负荷实验后检测CRP和血脂水平。结果:阿托伐他汀治疗组患者治疗后CRP及总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)水平显著降低 (P<0．01),餐后血浆TG、CRP较对照组显著降低(P<0．001,<0．01)。结论:短期阿托伐他汀治疗可有效降低 ACS患者血清中CRP、TG、LDL-C水平。     

瑞舒伐他汀对急性冠脉综合征患者血浆TF及TFPI的影响

目的:观察瑞舒伐他汀对急性冠脉综合征(ACS)患者血浆组织因子(TF)、组织因子途径抑制物(TFPI)及血脂水平的影响。方法:选择2015-2017年60例ACS患者,其中急性心肌梗死(AMI)30例(AMI组),不稳定型心绞痛(UAP)患者30例(UAP组)。另选取正常对照组20例。将60例ACS患者随机分为瑞舒伐他汀组(32例)以及普通治疗组(28例)。用酶联免疫吸附法测定患者入院时及治疗2周后血浆TF、TFPI及血脂水平。结果:(1)AMI组、UAP组血浆TF、TFPI及低密度脂蛋白胆固醇(LDL-C)水平均明显高于对照组(均P0.05),AMI组与UAP组组间差异无统计学意义。(2)治疗2周后,瑞舒伐他汀组血浆TF与血清LDL-C水平较治疗前明显降低(均P0.01),TFPI水平较治疗前明显升高(P0.05);普通治疗组治疗2周后上述指标与治疗前比较均无显著性差异。(3)瑞舒伐他汀组治疗2周后TF、TFPI水平的变化与血脂水平的变化均无相关性。结论:ACS患者血浆TF与TFPI水平明显升高。瑞舒伐他汀通过降低TF,升高TFPI水平,抑制血栓形成,且这种作用与调脂作用无关。     

大剂量阿托伐他汀对急性冠脉综合征患者冠脉支架置入治疗后炎症因子和血脂的影响

目的探讨大剂量阿托伐他汀治疗对急性冠脉综合征(ACS)冠脉介入(PCI)治疗后患者的调脂疗效及炎症因子的影响。方法 88例成功进行PCI治疗的ACS患者,随机分为A组46例和B组42例。在常规治疗基础上,A组加用阿托伐他汀40 mg/d,B组加用阿托伐他汀20 mg/d。分别随访和检测两组患者在治疗后4、12和24周的血脂、血浆MMP-9、hs-CRP水平及药物不良反应。结果治疗后A组血脂和炎症因子水平的改善情况均优于B组(P<0.05),治疗后12、24周LDL-C达标(≤1.86 mmol/L)率A组高于B组(P均<0.05),两组均无严重的药物不良反应发生。结论大剂量阿托伐他汀对PCI治疗后的ACS患者抗炎和调脂疗效更优,且无严重的不良反应。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.