不同治疗方案对多发性骨髓瘤患者骨病的影响

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

不同治疗方案对多发性骨髓瘤患者骨病的影响

Objective To explore the difference of effects of two regimens (bortezomib and dexamethasone, BD; and thalidomide and dexamethasone, TD) on bone disease in multiple myeloma(MM).Methods Forty patients with newly diagnosed and refractory or relapsed MM were treated with BD or TD regimens from Dec 2006 to Sep 2008. Bone pain score and X-ray examination were carried out before and after therapy. Serum levels of DKK-1, sRANKL, OPG and TRACP-5b were measured by ELISA before and 3 months after therapy. Results Serum TRACP-5b concentration was significantly decreased in patients received TD regimen (5.94 U/L before therapy vs 4.84 U/L 3 months after therapy ,P ＜ 0.05), and so did for serum DKK-1 concentration in patients responded to BD regimen (35.11 μg/L before vs 32.03 μg/L 3 months after therapy,P ＜0.05) ;for serum concentration of sRANKL in patients responded to BD regimen (1.05 pmol/L before vs 0.67 pmol/L 3 months after therapy, P ＜ 0. 05); and for serum concentration of TRACP-5b in responders to BD regimen (5.57 U/L before therapy vs 4.90 U/L 3 months after therapy ,P ＜0.05). Conclusion Bortezomib lowers levels of serum DKK-1 and RANKL in responders, thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption. Thalidomide decreases bone resorption regardless of treatmant response.     

强直性脊柱炎患者血清Dickkopf-1、抗酒石酸酸性磷酸酶5b的意义

目的：通过测定强直性脊柱炎（AS）患者血清Dickkopf-1（DKK-1）、抗酒石酸酸性磷酸酶5b（TRACP-5b）的水平,分析AS各项临床指标与DKK-1、TRACP-5b的相关性,探讨AS骨结构损伤的特点。方法记录30例AS患者的年龄、性别、病程、HLA-B27及治疗前后晨僵、脊柱痛、枕壁距、指地距、血沉（ESR）、C反应蛋白（CRP）、Bath AS疾病活动指数（BASDAI）、骶髂关节CT分级,以酶联免疫吸附法（ELISA）测定研究对象血清DKK-1、TRACP-5b的水平,对比AS患者与健康对照组血清DKK-1、TRACP-5b水平的差异,并分析其与AS各项临床指标的相关性。结果1.AS患者的血清DKK-1、TRACP-5b水平分别为819.65±204.56 pg/mL、3.9393±1.3354 U/L,均低于健康对照组（1591.50±335.92 pg/mL、8.6379±1.9148 U/L）,差异有统计学意义（P＜0.05）;2.早期AS患者血清DKK-1、TRACP-5b水平分别为1186.00±493.70 pg/mL、5.9150±2.9282 U/L,均高于中晚期AS患者（636.60±181.04 pg/mL、2.9614±1.3772 U/L）,但差异无统计学意义（P＞0.05）;3.AS患者血清DKK-1、TRACP-5b均与患者骶髂关节CT分级呈负相关（P＜0.05）,与其他临床指标均不相关;4.AS患者血清DKK-1、TRACP-5b呈正相关（P＜0.0001）。结论DKK-1、TRACP-5b在AS骨结构损伤发生中可能起了一定的作用。     

Anti-virus efficacy of cyclosporine in renal transplant recipients with hepatitis C virus-RNA positive

BACKGROUND:The selection of immunosuppressants and anti-hepatitis C virus drug is currently the focus for the hepatitis C virus-positive patients after receiving renal transplantation. OBJECTIVE:To investigate the anti-virus replication effect of cyclosporine in hepatitis C virus-RNA positive renal transplant recipients in addition to its anti-rejection effect. METHODS:Eleven hepatitis C virus-RNA positive renal transplant recipients were enrol ed and treated with cyclosporine, prednisone and mizoribine. Hepatitis C virus-RNA level, hemoglobin, liver functions and renal functions were evaluated before treatment and at 6 and 12 months after treatment. RESULTS AND CONCLUSION:The median of hepatitis C virus-RNA in 11 patients before treatment, and at 6 and 12 months after treatment were 1.22×107 copies/mL,1.11×104 copies/mL and 4.19×106 copies/mL respectively. At 6 months after treatment,8 cases of hepatitis C virus-RNA were negative (hepatitis C virus-RNA<500 copies/mL), and the total response of hepatitis C virus-RNA was 73%, and the sustained virological response was 55%(6/11) at the final fol ow-up. There was no significant difference of alanine transaminase, serum creatinine and serum uric acid levels before and after treatment (P>0.05), and the hemoglobin level was increased after treatment. During the fol ow-up, acute rejection only occurred in one patient and was control ed within 3 days after methylprednisolone pulse therapy. Cyclosporine-based treatment would be a better choice for renal transplant recipients combined with hepatitis C virus infection for both the anti-virus replication and anti-rejection effect.     

血液稀释疗法改善高脂血症患者血脂血粘度观察

Background:Hemodilution therapy changes cellular ultrastructure and decreased serum concentration of various constitutes of patients with hyperlipemia through self-blood transfusion under ultraviolet radiation and infusion of oxgen. Objective:To investigate influence of hemodilution on hyperlipemia. Design:Level of Blood lipid before and after hemodilution was measured in 48 patients with hyperlipemia. Unit:Out-patient department, 251th Hospital of China People's Liberation Army. Subject:48 patients with hyperlipemia during 1999-2000,36 male,12 female(mean age:50.4± 5.9).Diagnostic creteria was as followed:(1)serum lipoprotein[(s)]≥ 300mg/L or (2)TG>=3.6mmol/L or (3)cholesterol≥ 6.28mmol/L.Patients with liver or renal disease were excluded from the study.     

阿托伐他汀对老年脑梗死伴高血脂患者颈动脉粥样硬化斑块的影响

Objective To investigate the effect of atorvastatin on arteriosclerosis plaque of carotid artery in elder patients with cerebral infarction and hypercholesterolemia. Methods With self-comparsion of before and after treatment,50 subjects with arteriosclerosis plaque of carotid artery were given atorvastatin 10 mg,qn for 12 months. After treatment 6 and 12 months, arteriosclerosis plaque of carotid artery、 intima-media thickness and peak index were measured in all patients. Results After 6 and 12 months adminstration of atorvastatin, TC、TG、LDL-C were all reduced (P<0.05), and HDL-C was elevated (P<0.01) in all patients.The initial diameter of carotid was significantly enlarged in 12 months (P<0.01). The size of plaque decreased (P<0.01) in 12 months after atorvastatin therapy than before(P<0.01). Conclusion The effect of atorvastatin is certain and it can stabilize the plaque of carotid artery.     

阿托伐他汀对老年脑梗死伴高血脂患者颈动脉粥样硬化斑块的影响

Objective To investigate the effect of atorvastatin on arteriosclerosis plaque of carotid artery in elder patients with cerebral infarction and hypercholesterolemia. Methods With self-comparsion of before and after treatment,50 subjects with arteriosclerosis plaque of carotid artery were given atorvastatin 10 mg,qn for 12 months. After treatment 6 and 12 months, arteriosclerosis plaque of carotid artery、 intima-media thickness and peak index were measured in all patients. Results After 6 and 12 months adminstration of atorvastatin, TC、TG、LDL-C were all reduced (P<0.05), and HDL-C was elevated (P<0.01) in all patients.The initial diameter of carotid was significantly enlarged in 12 months (P<0.01). The size of plaque decreased (P<0.01) in 12 months after atorvastatin therapy than before(P<0.01). Conclusion The effect of atorvastatin is certain and it can stabilize the plaque of carotid artery.     

Improvement of hyperlipemia by hemodilution therapy

Background:Hemodilution therapy changes cellular ultrastructure and decreased serum concentration of various constitutes of patients with hyperlipemia through self－ blood transfusion under ultraviolet radiation and infusion of oxgen. Objective:To investigate influence of hemodilution on hyperlipemia. Design:Level of Blood lipid before and after hemodilution was measured in 48 patients with hyperlipemia. Unit:Out－ patient department, 251th Hospital of China People's Liberation Army. Subje…     

The influence of modified electrocomulsive therapy on serum interleukin—6 in schizophrenic patients

AIM：To explore the influence of modified electroconvulsive therapy on serum interleukin-6 in schizophrenic patients.METHOD:Testing change of serum IL-6 in 60 cases treated with MECT and 60 control cases treated with clozapine therapy by ELISA method. RESULTS:Serum IL-6 level before treatment of both groups was positive related to SAPS; serum IL-6 level wasn′t related to BPRS total score, factor score and SANS total fractions. IL-6 level of clozapine therapy group decrease apparently after treatment, and IL-6 level was apparently positive related to anxious depressed factor of BPRS; but there was no apparent difference in IL-6 level of MECT group between before and after treatment.CONCLUSION:To schizophrenic patients, clozapine can take effects of immune inhibit through inhibiting serum IL-6; MECT may have different mechanism.     

身心综合疗法对2型糖尿病患者心理健康和生活质量及血糖的影响研究

Objective To investigate the impact of Psychotherapy and exercise therapy to Type 2 Diabetes Mellitus in life,psychology and blood glucose.Methods Adopt RCT (randomized controlled trial),60 patients in control group and 90 patients in intervention group,drug and alimentation were given to control group.Based on the drug and alimentation,Psychotherapy and exercise therapy were given to intervention group.observe variation in fasting blood glucose,blood glucose 2 h after meal,urine glucose during 24 h,glycosylated hemoglobin,mental state and life quality both intervention and control group after 8 weeks.Results Blood glucose 2h after meal and glycosylated hemoglobin were (7.54±1.19) mmol/L and (6.69±0.96)% in intervention group,tetal effective ratio was 98%;(7.62±0.80) mmol/L and (7.15±0.82)% in control group,total effective ratio is 76%.the outcomes of two groups were statistical significant (P＜0.05 ).The discrepancy in mental health factor and life quality dimension before and after the therapy inside the intervention group were also statistically significant.Conclusions Psychotherapy and exercise therapy can not only improve the level of mental healthy and life quality of Type 2 Diabetes MeUitus patients,but also control the blood glucose efficiently.     

双膦酸盐联合传统化疗对多发性骨髓瘤骨代谢指标的影响

目的 探讨尿Ⅰ型胶原氨基末端肽(uNTX)、血清骨特异性碱性磷酸酶(sBAP)水平在多发性骨髓瘤(MM)骨病中的临床意义,并了解双膦酸盐对MM溶骨性骨病的治疗作用.方法 53例MM患者(初治33例、复发难治10例、平台期10例)分为两组:氯膦酸盐联合化疗组(简称治疗组)33例,单纯化疗组(简称对照组)20例.应用酶联免疫吸附试验(ELISA法)检测uNTX浓度,应用化学发光法检测sBAP浓度.结果 ①治疗组和对照组治疗前uNTX水平分别为(173.74±14.55)μg/L和(129.79±12.13)μg/L,差异无统计学意义(P＞0.05).治疗6个月后,治疗组为(85.71±8.23)μg/L,明显低于对照组[(121.59±12.43)μg/L](P＜0.05).同时治疗组中治疗前与治疗后3个月(P=0.045)、治疗后6个月(P＜0.01)相比,差异均有统计学意义.②治疗组和对照组治疗前血清sBAP水平分别为(4.78±0.55)μg/L和(8.42±1.32)μg/L,差异无统计学意义(P＞0.05);治疗6个月后,治疗组为(16.01±0.52)μg,/L,明显高于对照组[(9.62±1.29)μg/L](P＜0.01).同时治疗组中治疗前与治疗后3个月相比,差异无统计学意义(P＞0.05);治疗前与治疗后6个月相比,差异有统计学意义(P＜0.01).结论 骨代谢标志物uNTX、sBAP是临床了解MM患者溶骨性骨病的早期敏感指标.同时,双膦酸盐可以减轻MM患者骨质的降解代谢,促进其合成代谢,对MM溶骨性骨病有一定的治疗价值.     

硼替佐米联合双膦酸盐对多发性骨髓瘤骨代谢指标的影响及意义

本研究旨在探讨双膦酸盐联合不同化疗方案对多发性骨髓瘤患者骨代谢指标血清Dickkopf-1（DKK-1）、核因子NF—κB配体受体激活蛋白（RANKL）的影响，证实硼替佐米联合双膦酸盐对溶骨性骨病的治疗作用。43例初治及难治复发患者分为2组，硼替佐米联合唑来膦酸治疗组23例（A组），传统化疗联合唑来膦酸治疗组（B组）20例。应用酶联免疫吸附试验（ELISA法）检测DKK-1和RANKL浓度。结果表明，A组治疗前、后血清DKK-1中位水平分别为43．2和30．4μg/L（P〈0．05），而B组治疗前、后血清DKK-1中位水平分别为45．6和40．9μg/L（P〈0．05）。A组与B组相比，治疗前DKK-1浓度差异无统计学意义（P〉0．05），治疗后A组DKK-1浓度明显低于B组（P〈0．05）。A组治疗前、后血清RANKL中位水平分别为0．83pmmoL／L和0．45pmmol／L，差异有统计学意义（P〈0．05）；而B组治疗前、后血清RANKL中位水平分别为0．79pmmol／L和0．65pmmol／L，差异有统计学意义（P〈0．05）。A组与B组相比，治疗前DKK-1浓度差异无统计学意义（P〉0．05），治疗后DKK-1浓度明显低于B组（P〈0．05）。结论：硼替佐米联合双膦酸盐明显减低MM患者血清DKK-1、RANKL水平，对MM溶骨性骨病有-定的治疗价值。     

不同方案治疗多发性骨髓瘤患者血管内皮细胞功能的变化

目的探讨初治多发性骨髓瘤(multiple myeloma,MM)患者不同方案治疗前、后内皮细胞功能的变化及其意义。方法 76例MM患者随机分成两组,36例MM患者采用长春地辛加表阿霉素加地塞米松(VAD)方案治疗,40例MM患者采用沙利度胺联合VAD(T-VAD)方案治疗,应用双抗体夹心酶联免疫法(ELISA)测定MM患者治疗前及2周期治疗后血浆内皮素1(ET-1)、凝血酶调节蛋白(TM)、组织因子(TF)、血管性血友病因子(vWF)水平以及应用发色底物法检测其血浆抗凝血酶(AT)、组织型纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制物1(PAI-1)的活性水平。结果两组不同方案治疗后MM患者血浆ET-1、TM、t-PA、PAI-1水平均较治疗前明显升高;治疗后血浆TF、AT水平有明显下降;治疗前、后比较差异有统计学意义(t=2.061~3.674,P0.05或0.01);VAD方案治疗前、后血浆vWF水平变化不明显,差异无统计学意义(t=1.873,P0.05);T-VAD组治疗后血浆vWF水平比治疗前明显升高,差异有统计学意义(t=2.648,P0.05)。治疗后血浆ET-1、TM、TF、vWF、PAI-1水平T-VAD组比VAD组变化更明显,分别为(20.25±6.38)ng/L vs(14.12±5.16)ng/L(P0.01);(39.56±9.53)μg/L vs(33.91±9.42)μg/L(P0.05);(12.25±7.36)ng/L vs(15.85±5.28)ng/L(P0.05);(157.76±35.78)%vs(138.79±45.25)%(P0.05);(1.02±0.34)U/L vs(0.88±0.29)U/L(P0.05)。结论不同方案治疗MM患者均可导致内皮细胞损伤及纤溶异常,T-VAD治疗方案影响更显著;内皮细胞损伤及纤溶异常可能是MM患者治疗过程中易于发生血栓的主要原因。     

类风湿关节炎患者血清DKK-1，CCL21水平与体液免疫指标的相关性研究

目的　探讨类风湿关节炎（ rheumatoid arthritis ,RA）患者血清 Dickkopf-1（DKK-1）,趋化因子（ chemokine, CCL）21水平与体液免疫指标的相关性。方法　选择 2018年 3月～ 2020年 6月邯郸市中心医院免疫科收治的 120例 RA患者（ RA组）和 117例体检志愿者（对照组）,根据 28个关节疾病活动度（ disease activity score 28,DAS28）评分将 RA组分为低度组（ 2.6～ 3.2分,38例）、中度组（ 3.3～ 5.1分,50例）和重度组（＞ 5.1分,32例）。检测血清 DKK-1,CCL21,免疫球蛋白 A（immunoglobulin A, IgA）、免疫球蛋白 G（IgG）、免疫球蛋白 M（IgM）、免疫球蛋白 E（IgE）、补体 C3和补体 C4水平。分析 DKK-1,CCL21与 IgG,IgA,IgM,IgE,补体 C3,补体 C4之间相关性。结果　RA组血清 DKK-1（72.14±15.26 pg/ml）,CCL21（285.16±32.16 pg/ml）,IgG（16.35±4.56 g/L）,IgA（3.65±0.52 g/L）和 IgM（1.95±0.42 g/L）水平高于对照组（ 43.26±7.46 pg/ml,170.06±20.41pg/ml,10.35±1.65g/L,2.02±0.24g/ L,1.42±0.39g/L）,差异均有统计学意义（ t=10.061～ 32.803,均 P＜ 0.05）,补体 C3（1.05±0.16 g/L）和补体 C4（0.15±0.07 g/L）水平低于对照组（ 1.39±0.25g/L,0.36±0.11g/L）,差异均有统计学意义（ t=12.502,17.579,均 P＜ 0.05）。重度组血清 DKK-19（83.26±3.09 pg/ml）,CCL21（310.06±6.45 pg/ml）,IgG(19.84±0.68 g/L）,IgA（4.14±0.03 g/ L）和 IgM（2.28±0.06 g/L）水平高于中度组（ 74.90±6.59 pg/ml,289.75±12.54 pg/ml,17.40±2.11 g/L,3.71±0.26 g/ L,2.03±0.16 g/L）和轻度组（59.15±2.34 pg/ml, 258.15±4.06 pg/ml, 12.03±0.21 g/L, 3.16±0.02 g/L, 1.57±0.03 g/L）,差异均有统计学意义（ t=6.322～ 162.999, 均 P＜ 0.05）;补体 C3和补体 C4水平低于中度组 (1.18±0.02 g/L vs 1.07±0.05 g/L,0.20±0.01 g/L vs 0.16±0.04 g/L)和轻度组 (0.91±0.02 g/L,0.09±0.01 g/L), 差异均有统计学意义（t= 5.536～ 45.847,均 P＜ 0.05）。中度组血清 DKK-1,CCL21,IgG,IgA和 IgM水平高于轻度组（ t=12.993～ 17.468,均 P＜ 0.05）;补体 C3和补体 C4水平低于轻度组（ t=18.607,10.527,均 P＜ 0.05）,差异均有统计学意义。 RA患者血清 DKK-1和 CCL21水平与 IgG,IgA和 IgM呈正相关（ r=0.742～ 0.805,均 P＜ 0.05）,与补体 C3和补体 C4水平呈负相关（ r= -0.736～ -0.744,均 P＜ 0.05）,各组之间的 IgE差异均无统计学意义 (F=0.869,P＞ 0.05),DKK-1和 CCL21与 IgE也无相关性 (r=0.168,0.203,均 P＞ 0.05)。结论　RA患者血清 DKK-1和 CCL21水平升高与 RA疾病活动程度以及 IgG,IgA和 IgM增高与补体 C3和 C4消耗有关。     

人工虎骨对原发性骨质疏松症患者骨钙素和抗酒石酸酸性磷酸酶5b的影响

目的观察人工虎骨对原发性骨质疏松症患者骨代谢生化标志物骨钙素(BGP)和抗酒石酸酸性磷酸酶5 b(TRACP 5b)水平的影响。方法入选原发性骨质疏松症患者86例,性别均为女性,绝经1年以上,年龄(60.5±3.6)岁。口服人工虎骨粉胶囊,3次/d,每次3粒,共3个月。治疗前后分别测定患者血清BGP水平(放射免疫法)和TRACP5b水平(酶联免疫吸附法)。结果治疗后血清BGP明显增高[(8.31±2.41)]μg/L vs(5.81±1.93)μg/L,P<0.05],血清TRACP 5b明显降低[(2.49±0.81)]u/L vs(4.26±0.86)u/L,P<0.05]。结论人工虎骨可以通过增加原发性骨质疏松症患者的骨形成,减少骨吸收而发挥其治疗作用。     

胰岛素对急性ST段抬高型心肌梗死伴应激性高血糖患者近期预后的影响

目的 探讨胰岛素治疗对急性ST段抬高型心肌梗死(ASTEMI)伴应激性高血糖患者近期预后的影响.方法 将128例ASTEMI伴应激性高血糖患者随机分为治疗组和对照组各64例,均给予抗凝、抗血小板、他汀类、β受体阻滞剂、硝酸酯类药物和血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)治疗,治疗组在此基础上给予50 U胰岛素(选用诺和灵R)加入50 ml生理盐水中静脉泵入.分别在治疗前和治疗后第7天抽取静脉血,测定空腹血糖、超敏C反应蛋白(hs-CRP),并比较两组的近期预后情况.结果 治疗组治疗后空腹血糖较治疗前显著下降[(5.4±0.8)、(11.6±2.3)mmol/L,t =13.97,P＜0.01],而对照组无明显变化[(10.7±2.1)、(11.2±2.7) mmol/L,t =1.79,P＞0.05].两组患者的hs-CRP均较治疗前显著下降[治疗组(6.2±1.5)、(12.8±2.4) mg/L,t=14.26;对照组(8.7±1.8)、(13.1±2.6)mg/L,t=10.97,P均＜0.01].两组治疗后空腹血糖、hs-CRP比较,差异均有统计学意义(t值分别为-9.78、-0.37,P均＜0.01).随访3个月,治疗组患者主要不良心脏事件发生率低于对照组[ 12.50％ (8/64)与34.38％ (22/64),X2=5.02,P＜0.05].结论 胰岛素治疗能改善ASTEMI伴应激性高血糖患者的近期预后.     

复方甘草酸苷联合葛根素对非酒精性脂肪性肝病患者血清瘦素及胰岛素抵抗指数的影响

目的 探讨复方甘草酸苷联合葛根素对非酒精性脂肪性肝病（NAFLD）患者血清瘦素水平及胰岛素抵抗指数的影响.方法 将120例NAFLD患者应用计算机随机分为4组,基础治疗组、复方甘草酸苷组、葛根素组、联合治疗组各30例.基础治疗组采用基础护肝疗法,给予维生素、肝泰乐、多种氨基酸等治疗;复方甘草酸苷组应用复方甘草酸苷60ml入液静脉滴注;葛根素组应用葛根素注射液400mg入液静脉滴注;联合治疗组给予复方甘草酸苷60ml及葛根素400 mg静脉滴注.4组患者疗程均为4周.检测治疗4周前后患者血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆固醇、甘油三酯、瘦素、空腹血糖及胰岛素,并计算胰岛素抵抗指数,应用德国西门子双源CT仪行肝脏CT检查.结果 基础治疗组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为（83.08±15.68）、（43.32±11.72） U/L,（52.12±15.62）、（36.08 ±7.28） U/L,（6.20±1.30）、（5.60±0.70）mmol/L,（2.70±0.50）、（2.10±0.40） mmol/L,（14.63±3.26）、（7.61±2.46） μg/L,7.9±1.8、7.0±1.2,组内比较差异均有统计学意义（t值分别为12.828、4.244、16.648、21.442、3.341、16.152,P均＜0.01）;复方甘草酸苷组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为（83.06±14.38）、（43.28±11.06） U/L,（51.68±15.48）、（37.28±7.22） U/L,（6.30±1.50）、（5.70±0.80） mmol/L,（2.60±0.40）、（2.20±0.50） mmol/L,（15.13±3.87）、（7.89 ±2.26） μg/L,（7.8±2.2）、（7.1±1.6）,组内比较差异均有统计学意义（t值分别为8.893、4.225、16.520、24.708、6.353、21.137,P均＜0.01）;葛根素组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为（82.68±14.36）、（44.26±9.68） U/L,（50.06±15.23）、（36.86±6.88） U/L,（6.20±1.60）、（5.60±0.70） mmol/L,（2.70±0.52）、（2.26±0.48） mmol/L,（15.68±3.26）、（6.89±2.18）μ∥L,7.7±2.8、7.0±1.8,组内比较差异均有统计学意义（t值分别为7.087、8.138、18.159、7.244、7.470、32.283,P均＜0.01）;联合治疗组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为（84.62±14.88）、（22.28±9.38） U/L,（49.12±16.56）、（28.48±9.06） U/L,（5.70±1.60）、（5.00±0.60） mmol/L,（2.78±0.50）、（1.70 ±0.40） mmol/L,（14.78±3.68）、（4.63±2.36） μg/L,7.6±2.1、6.2±1.6,组内比较差异均有统计学意义（t值分别为14.255、11.272、8.371、9.941、8.102、37.626,P均＜0.01）.4组治疗前各指标比较差异均无统计学意义（P均＞0.05）,治疗后联合治疗组低于其他3组（P均＜0.05）,基础治疗组、复方甘草酸苷组、葛根素组之间比较差异均无统计学意义（P均＞0.05）.结论 复方甘草酸苷联合葛根素治疗NAFLD通过降低患者血清瘦素水平、改善胰岛素抵抗,增加肝细胞对胰岛素的敏感性,从而调节血脂代谢,达到治疗NAFLD的目的.     

Early detection of skeletal muscle injury by assay of creatine kinase MM isoforms in serum after acute exercise

We could detect skeletal muscle injury early after an acute exercise bout by measuring creatine kinase (CK, EC 2.7.3.2) MM isoforms in serum. Eleven men performed 120 alternating-arm, eccentric (muscle lengthening) biceps contractions with the intensity of each contraction being 110% of maximal concentric strength--a form of exercise previously shown to cause significant increases of CK in serum at 24 h and muscle soreness 48 h after exercise. Total CK and CK-MM isoform activities in serum were determined before and at 0.5, 0.75, 1, 1.5, 2, and 6 h after exercise. Using thin-film agarose gels and a rapid isoelectric focusing technique, we separated the MM isoforms into MM3 (skeletal muscle form), MM2, and MM1 (in vivo conversion forms). The isoforms reflected the MM form released into the serum from tissue as well as the conversion of one form to another. There were no significant increases in total CK from before to 6 h after exercise: 75 (SD 36) vs 91 (SD 33) U/L. However, CK MM3 in serum increased significantly (P less than 0.01) within 2 h after exercise from 22 (SD 6)% to 28 (SD 6)%. The MM3 to MM1 ratio also increased significantly (P less than 0.05) during this time, from 0.6 (SD 0.3) to 0.9 (SD 0.4). Thus, quantification of CK MM isoforms permitted very early detection of skeletal muscle enzyme release.     

氯沙坦对原发性高血压伴高尿酸血症患者血清超敏C反应蛋白和尿酸浓度的影响

目的 探讨氯沙坦对原发性高血压伴高尿酸血症（HUA）患者血清超敏C反应蛋白（hsCRP）和尿酸（UA）的影响及其安全性.方法 将80例高血压伴HUA患者随机分为氯沙坦组（40例）和硝苯地平组（40例）,每组分别给予氯沙坦50 mg/d、硝苯地平控释片30 mg/d口服,连续治疗6个月,检测用药前、后血清hs-CRP、UA、肝肾功能、血肌酸磷酸激酶（CK）浓度及血压的变化.结果 与治疗前比较,治疗6个月后氯沙坦组与硝苯地平组的收缩压（SBP）、舒张压（DBP）均显著降低[氯沙坦组收缩压由（158.5±13.2） mmHg降至（136.7±9.4） mmHg,t=3.50,P＜ 0.01;舒张压由（95.6±8.4） mmHg降至（83.3±6.4） mmHg,t=3.49,P＜ 0.01;硝苯地平组收缩压：（157.7 ±13.9） mmHg降至（134.6±8.2）mmHg,t=3.53,P＜ 0.01;舒张压：（96.1 ±8.9）mmHg降至（81.2 ±6.8）mmHg,t=3.56,P＜ 0.01],但组间比较差异无统计学意义.氯沙坦组的血清hs-CRP、UA浓度较用药前明显下降,差异均有统计学意义[氯沙坦组hs-CRP：（5.68±1.53） mg/L降至（3.52±0.57） mg/L,t=3.82,P＜ 0.01;UA：（502 ±45）μmol/L降至（450 ±38） μmol/L,t=3.48,P＜0.01];而硝苯地平组血清hs-CRP、UA浓度较用药前无明显变化[血清hs-CRP：（5.61±1.64） mg/L降至（5.33±1.48） mg/L,t=1.34,P＞ 0.05;UA：（499 ±43）μmol/L降至（489 ±42） μmol/L,t=0.68,P＞ 0.05].氯沙坦组患者服药前后肝肾功能、CK的变化均无显著差异,未发生严重不良事件.结论 氯沙坦能降低原发性高血压伴HUA患者的血清hs-CRP、UA浓度,治疗期间无严重不良反应,安全性良好.