长期服抗癫痫药所致的周围神经传导速度变化

２４例长期服用抗癫痫药的病人测定右正中神经和胫神经的运动传导速度（ＭＣＶ）及感觉传导速度（ＳＣＶ）。结果除１例外均有异常。ＳＣＶ减慢较ＭＣＶ明显；ＳＣＶ正中神经异常率（８３％）较胫后神经（６８％）显著增高，但异常率与癫痫的发作类型，用药种类无明显关系。     

肝硬化门脉高压患者浆ANP—RIA水平与门脉血流动的关系

目的：探讨ＡＮＰ与肝硬化ＰＴＨ门脉血液动力学的相互关系。方法：对４８例肝硬化门脉高压病人,采用双功多普勒测定门、脾静脉血流量（ＰＶＢＦ＆ＳＶＢＦ）,同步采用放射免疫测定法检测血浆中ＡＮＰ的水平,并分析ＰＶＢＦ＆ＳＶＢＦ与ＡＮＰ的相关性。结果：肝硬化ＰＴＨ患者ＰＶＢＦ、ＳＶＢＦ均显著升高,代偿期显著升高的ＡＮＰ与门脉高血流量呈显著正相关。结论：门脉系统高血流动力学改变存在于肝硬化门脉高压发病的始终,     

当归对正常及肝硬化犬血浆胰高血糖素水平的影响

众所周知，胰高血糖素参与了肝硬化高动力循环和门脉高压的形成。我们以往的研究证实。中药当归对肝硬化门脉高压症有良好的预防及治疗作用。为探讨其作用机理，本文研究了当归对正常及胆道结扎肝硬化犬内脏血浆胰高血糖素水平的影响。结果表明，用药后两组动物血浆胰高血糖素水平均显著下降，且肝硬化组下腔静脉和门静脉内血浆胰高血糖素水平的变化与其门脉和门脉血流量的变化呈显著正相关。提示当归可能通过减少胰高血糖素的分泌和     

定量聚合酶链反应检测肝病患者血清中乙型肝炎病毒 …

目的 了解肝病患者血清乙型肝炎病毒（ＨＢＶ）ＤＮＡ的含量，以便观察临床抗病毒治疗效果及血清ＨＢＶ ＤＮＡ水平与病情及预后的关系。方法 应用荧光素标记的半巢式引物在扩增中能量转移的定量聚合酶 链反应（ＱＰＣＲ），对６３例肝功能异常的肝病患者血清进行ＨＢＶ ＤＮＡ含量测定，并与普通ＰＣＲ及酶联免疫吸附试验（ＥＬＩＳＡ）进行比较。结果 ＱＰＣＲ阳性率为８２。５４％，普通ＰＣＲ法为７１．４３％，ＥＬＩＳＡ     

单纯疱疹病毒Ⅱ型和人乳头瘤病毒的感染与人工流产术后不孕症的关系

目的探讨性传播病毒和不孕症的关系。方法应用聚合酶链反应（ＰＣＲ）对６０例人工流产术后不孕症妇女和３９例正常妇女进行了生殖道单纯疱疹病毒Ｉ型（ＨＳＶ２）和人乳头瘤病毒（ＨＰＶ）的检测。结果不孕组和对照组ＨＳＶ２的阳性检出率分别是８０．０％和２５．５％，两组间有极显著性差异（Ｐ＜００１）；ＨＰＶ的阳性率分别是５３３％和３３３％，两组间无显著性差异（Ｐ＜０．０５）；ＨＳＶ和ＨＰＶ在两组中的混合感染的阳性率分别是４３．３％（２６／６０）和２３．１％（９／３９），两者有显著性差异（Ｐ＜０．０５）。表明ＨＳＶ２或ＨＳＶ２和ＨＰＶ的混合感染与人工流产术后不孕症有显著的相关性，很可能是不孕的原因之一。两组９９份标志中，ＨＳＶ２和ＨＰＶ混合感染的阳性率为３５．３５％，统计学分析表明，ＨＳＶ２和ＨＰＶ感染与不孕有极显著的相关性χ＝１２．５，Ｐ＜０．０１。结论ＨＳＶ２和ＨＰＶ的感染和不孕症相关     

醛化鹅血球用于血凝抑制试验在肾综合征出血热病人血清分型中的应用

经戊二醛醛化的鹅血球做肾综合征出血热病毒（ＨＦＲＳＶ）的血凝抑制试验（ＨＩ），对ＨＦＲＳ病人血清进行分型，与新鲜鹅血球相比较，符合率为９８．４％；其醛化血球反复冰融后，血球完整不裂解；在４℃或－３０℃保存１年与ＨＦＲＳＶ的血凝素凝集效价未下降，适于制成试剂盒应用。     

二维富里叶变换方法在逐搏心电图频率分量变异性分析中的应用

晚电位是在体表心电信号中具有高频分量的微弱信号（１～２０ μ Ｖ），通常能在患有室性心动过速病人心电记录中观测到，这些信号的评估需要十分复杂的信号记录技术（对于单搏分析）或信号平均技术，然而，信号平均可能会掩盖风险信息，因此，发展了依赖于 １２８ 个连续心搏中的 ８０ｍ ｓ 数据段进行二维富里叶变换的单搏谱变异（ Ｓ Ｂ Ｓ Ｖ），这个方法描述了这些心电片段频率成份的逐搏变异特性，一个参数函数使得对晚电位的客观探测成为可能，并对下列病人进行研究和分析：３５ 例患有室性心动过速的心梗病人（１ 组）、５０ 例没有室性心动过速的心梗病人（２ 组）和 １０ 例健康志愿者。 Ｓ Ｂ Ｓ Ｖ 将 １ 组 ３５ 例病人中的 ２９ 人（８３％ ）鉴别成病理性的，这 ２９ 例病人中的１４ 人（４８％ ）仅根据显著性的 Ｗｅｎｃｋｅｂａｃｈ 类的传导方式（来鉴别的），在２ 组５０ 例病人中只有 ５ 人的 Ｓ Ｂ Ｓ Ｖ 显示出异常。在 ３ 组中，没有发现异常结果。因此，在心梗病人中检测晚电位的 Ｓ Ｂ Ｓ Ｖ 是一个很有希望的方法。 Ｓ Ｂ Ｓ Ｖ 不仅包含信号平均后频率分析结果，而且评估了可变的 Ｅ Ｃ Ｇ 分量。     

左肾静脉不全结扎对大鼠肾水通道蛋白1和水通道蛋白2mRNA表达的影响

目的：观察左肾静脉不全结扎大鼠肾ＡＱＰ１和ＡＱＰ２ｍＲＮＡ表达的变化,探讨肾静脉压增高引起肾小管重吸收减少的分子机制。方法：成年雄性Ｗｉｓｔａｒ大鼠随机分成左肾静脉不全结扎组（ＶＣＧ）和假手术组（ＳＯＧ）,用左肾脉不全结扎法复制精索静脉曲张,２月后进行Ｎｏｒｔｈｅｒｎｂｌｏｔ分析,结果与ＳＯＧ相比ＶＣＧ大鼠左肾ＡＱＰＩｍＲＮＡ表达强度明显减弱,ＡＱＰ２ｍＲＮＡ表达强度则无明显差异,睾丸组织无杂交信     

多梗塞痴呆和Alzheimer型痴呆认知功能与局部脑血流的关系

目的：探讨多梗塞痴呆和Ａｌｚｈｅｉｍｅｒ型痴呆患者神经心理功能与局部脑血流的关系。方法：对３３例多梗塞痴呆（ＭＩＤ）、２１例Ａｌｚｈｅｉｍｅｒ型痴呆（ＤＡＴ）病人和２４例健康对照组作了单光子发射计算机断层显像（ＳＰＥＣＴ）检查，采用相对定量法测定局部脑血流（ｒＣＢＦ）。并作神经心理学测验。结果：ＭＩＤ病人左额颞叶ｒＣＢＦ与言语智商（ＶＩＱ）相关显著；左额、右顶、丘脑ｒＣＢＦ与总智商（ＦＩＱ）明显相关；左颞、右顶叶ｒＣＢＦ与脑损伤指数（ＤＱ）相关明显。ＤＡＴ病人左颞、右额叶ｒＣＢＦ与ＶＩＱ，右顶枕叶ｒＣＢＦ与操作智商（ＰＩＱ），左额颞、右顶叶ｒＣＢＦ与ＤＱ相关明显。ＭＩＤ、ＤＡＴ病人左颞叶ｒＣＢＦ与记忆商数（ＭＱ）相关显著。结论：提示ＭＩＤ、ＤＡＴ病人智能减退与脑血流降低有关。     

抗戊型肝炎病毒IgG的检测

应用ＥＬＩＳＡ方法对１９９０年沈阳一起暴发流行的戊型肝炎病人及对照人群７９份血清进行了抗戊型肝炎病毒（ＨＥＶ）ＩｇＧ的检测。显性感染病人与非疫区正常对照人群抗－ＨＥＶＩｇＧ检出率分别为５５．３２％（２６／４７）和２０．００％（２／１０），两者存在显著性差异（ｘ２＝４．１２，Ｐ＜０．０５）。显性感染病人急性期，病后８个月血清抗－ＨＥＶＩｇＧ检出率分别为１００．００％（８／８）和谐４１．９４（１３／３１），前者明显高于后者（ｘ２＝６．８３，Ｐ＜０．０１）。８例病人急性期和病后４个月血清抗体平均滴度分别为０．６８４和０．２３４，抗体滴度下降２．９２３倍，存在显著性差异（Ｔ＝２．２３９，Ｐ＜０．０５）。显性感染病人和ＳＧＰＴ升高无症状人群急性期血清间抗－ＨＥＶＩｇＧ检出率、抗体平均摘度存在明显差异（Ｐ＜０．０５，Ｔ＞１．９６０，Ｐ＜０．０５）。     

肝硬化门脉高压症患者胃左静脉组织ET-1和NO的变化与静脉压的关系

目的探讨肝硬化门脉高压症患者胃左静脉组织中内皮素-1(ET-1)和一氧化氮(NO)比值的变化及其与胃左静脉压力的相关性。方法放射免疫法和硝酸酶还原法检测肝硬化门脉高压症患者及对照组患者胃左静脉组织中ET-1和NO含量,术中测定胃左静脉压力,比较两组ET-1/NO比值的变化,并对ET-1/NO比值与胃左静脉压力进行相关性分析。结果门脉高压症患者胃左静脉组织中ET-1/N0比值较对照组明显升高(P<0.05)。ET-1/N0比值与胃左静脉压力呈显著正相关关系(P<0.05)。结论肝硬化门脉高压症患者存在ET-1和NO失衡,ET-1产生相对过多,可能是门脉高压症形成和发展的重要原因之一。ET-1/N0比值与胃左静脉压力相关,可以用来间接反映门静脉压的高低,从而对预测曲张静脉破裂出血有一定的意义。     

Early graft hemodynamics in living related liver transplantation evaluated by Doppler ultrasonography

The aim of this study was to clarify the perioperative hemodynamics of liver grafts without vascular complications during and early after liver transplantation from living donors. This study was carried out in 4 child recipients (lateral segment left lobe grafts) and 6 adult recipients (right lobe grafts) of liver transplantation from living donors. The hemodynamics of the hepatic artery, portal vein, and hepatic vein of the grafts during and until 7 days after surgery were studied by Doppler ultrasonography. The maximum flow velocity of the hepatic artery, mean portal blood flow velocity, and pulsatility index (PI) of the hepatic artery increased in all 10 grafts with no vascular complication after vascular anastomosis. After surgery, the mean portal blood flow velocity showed a peak 3 days after surgery and reached a nadir 7 days after surgery in both the lateral segment left lobe grafts in children and the right lobe grafts in adults, but it was significantly higher in the right lobe grafts in adults (mean +/- SD 31.0 +/- 6.3 vs. 22.4 +/- 0.9 cm/sec). Also, as the hepatic artery blood flow velocity increased the portal blood flow velocity decreased, the hepatic blood flow during liver regeneration was suggested to be controlled by both the artery and portal vein. The range of PI of the hepatic artery was 0.60-1.86. The mean hepatic venous blood flow was stable throughout the observation period (30.4 +/- 8.8 cm/sec). Although the hepatic venous flow waves changed widely from pulsed waves to a flat flow, its changes did not suggest a vascular complication. Evaluation of changes by Doppler ultrasonography in the hemodynamics of the liver grafts without vascular complications during and early after liver transplantation from living donors is considered to be useful for accurate monitoring of the hemodynamics during liver regeneration and early detection of abnormalities.     

Safety,efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis

Background/Aims

Portal-vein thrombosis (PVT) develops in 10-25% of cirrhotic patients and may aggravate portal hypertension. There are few data regarding the effects of anticoagulation on nonmalignant PVT in liver cirrhosis. The aim of this study was to elucidate the safety, efficacy, and predictors of response to anticoagulation therapy in cirrhotic patients.

Methods

Patients with liver cirrhosis and nonmalignant PVT were identified by a hospital electronic medical record system (called BESTCARE). Patients with malignant PVT, Budd-Chiari syndrome, underlying primary hematologic disorders, or preexisting extrahepatic thrombosis were excluded from the analysis. Patients were divided into two groups (treatment and nontreatment), and propensity score matching analysis was performed to identify control patients. The sizes of the thrombus and spleen were evaluated using multidetector computed tomography.

Results

Twenty-eight patients were enrolled in this study between 2003 and 2014: 14 patients who received warfarin for nonmalignant PVT and 14 patients who received no anticoagulation. After 112 days of treatment, 11 patients exhibited significantly higher response rates (complete in 6 and partial in 5) compared to the control patients, with decreases in thrombus size of >30%. Compared to nonresponders, the 11 responders were older, and had a thinner spleen and fewer episodes of previous endoscopic variceal ligations, whereas pretreatment liver function and changes in prothrombin time after anticoagulation did not differ significantly between the two groups. Two patients died after warfarin therapy, but the causes of death were not related to anticoagulation.

Conclusions

Warfarin can be safely administered to cirrhotic patients with nonmalignant PVT. The presence of preexisting portal hypertension is a predictor of nonresponse to anticoagulation.     

能谱CT基物质分离技术在肝硬化与正常肝脏血流定量研究中的应用

目的:探讨能谱CT基物质分离技术在Child-Pugh A级肝硬化与正常肝脏血流动力学定量研究中的应用价值。方法:收集临床确诊肝硬化Child-Pugh A级并行上腹部增强CT检查患者30例作为肝硬化组,同时收集肝脏及门静脉增强CT检查无异常患者30例作为正常肝脏组。两组均采用能谱CT扫描并重建70 keV单能量图像、碘基物质分离图像,在70 keV、碘基图像上分别测量动脉期（AP）和门静脉期（PV）肝脏五叶（肝尾状叶、肝左外叶、肝左内叶、肝右前叶、肝右后叶）CT值和碘浓度（IC）,计算动脉期碘分数(AIF)和门静脉期碘含量（PVIC）。采用独立样本t检验比较两组能谱参数,并运用ROC曲线分析各参数诊断效能。结果:肝硬化组动脉期CT值和碘浓度与正常肝脏组无统计学差异（P>0.05）,而门静脉期CT值和碘浓度显著低于正常肝脏组（P<0.05）。肝硬化组肝脏AIF稍高于正常肝脏组（P>0.05）,而肝脏PVIC均显著低于正常肝脏组（P<0.05）。以门静脉期肝脏平均碘浓度21.47 mg/mL为阈值评价肝硬化与正常肝脏血流时,ROC曲线下面积（AUC）为0.790,敏感度为77.8%,特异度为83.3%,显著高于肝脏CT值和PVIC。结论:能谱CT基物质分离技术可以用来评价肝硬化与正常肝脏血流动力学的改变和差异,为肝硬化的早期诊断提供更多依据。     

The contrast-enhanced Doppler ultrasound with perfluorocarbon exposed sonicated albumin does not improve the diagnosis of renal artery stenosis compared with angiography

There are no studies investigating the effect of the contrast infusion on the sensitivity and specificity of the main Doppler criteria of renal artery stenosis (RAS). Our aim was to evaluate the accuracy of these Doppler criteria prior to and following the intravenous administration of perfluorocarbon exposed sonicated albumin (PESDA) in patients suspected of having RAS. Thirty consecutive hypertensive patients (13 males, mean age of 57 ± 10 years) suspected of having RAS by clinical clues, were submitted to ultrasonography (US) of renal arteries before and after enhancement using continuous infusion of PESDA. All patients underwent angiography, and haemodynamically significant RAS was considered when ≥50%. At angiography, it was detected RAS ≥50% in 18 patients, 5 with bilateral stenosis. After contrast, the examination time was slightly reduced by approximately 20%. In non-enhanced US the sensitivity was better when based on resistance index (82.9%) while the specificity was better when based on renal aortic ratio (89.2%). The predictive positive value was stable for all indexes (74.0%–88.0%) while negative predictive value was low (44%–51%). The specificity and positive predictive value based on renal aortic ratio increased after PESDA injection respectively, from 89 to 97.3% and from 88 to 95%. In hypertensives suspected to have RAS the sensitivity and specificity of Duplex US is dependent of the criterion evaluated. Enhancement with continuous infusion of PESDA improves only the specificity based on renal aortic ratio but do not modify the sensitivity of any index.     

Doppler measurement of cardiac output across prosthetic mitral valves

Summary In 46 patients with a normal functioning mitral valve prosthesis (15 St. Jude, 19 Medtronic Hall, 12 Hancock) cardiac output was measured by pulsed Doppler echocardiography across the valve prosthesis. Simultaneously cardiac output was determined by thermodilution or pulsed Doppler echocardiography in the left ventricular outflow tract (2.8 l/min–9.5 l/min). The prosthetic valve area was calculated using the pressure half-time method. Cardiac output was calculated by multiplying time-velocity integrals with the mitral valve area. Cardiac output measurements across the mitral prosthesis correlated significantly with thermodilution (r=0.96, SEE=0.400 l/min) and pulsed Doppler echocardiography flow measurements in the left ventricular outflow tract (r=0.82, SEE=0.679 l/min). The mean percent error of the Doppler transmitral flow measurement was 10.8%. Doppler transmitral flow underestimated cardiac output values of more than 6.5 l/min in 6 of 7 patients. Cardiac output measurements across Hancock (SEE=0.473 l/min) and St. Jude prostheses (SEE=0.538 l/min) were more accurate than across Medtronic Hall prostheses (SEE=0.847 l/ min).Cardiac output can be calculated by pulsed Doppler echocardiography across normal functioning mitral prostheses. Due to the different flow dynamics the accuracy of cardiac output measurement depends on the prosthetic valve type. Reliable measurements of cardiac output can be performed across Hancock and St. Jude prostheses only. This method is limited in volume flow measurements across Medtronic Hall prostheses.     

小凹蛋白与内皮型一氧化氮合成酶在人肝硬化组织中的表达及意义

目的检测人肝硬化组织中小凹蛋白(caveolin-1)、内皮型一氧化氮合成酶(eNOS)的细胞定位及蛋白表达水平的变化,探讨caveolin-1的表达对eNOS的影响。方法免疫组织化学染色检测30例肝硬化患者活检后肝组织和30例肝外伤、肝血管瘤患者正常肝组织中caveolin-1和eNOS的细胞定位。Western印迹检测caveolin-1和eNOS的蛋白表达水平变化。结果caveolin-1和eNOS均主要分布于肝窦内皮细胞中,caveolin-1在肝硬化组和对照组表达阳性率有差异,分别为87%和40%(P<0.05)。eNOS在肝硬化组和对照组表达阳性率有差异,分别为33%和66%(P<0.05)。caveolin-1在肝硬化组织中表达较正常肝组织中明显增强。eNOS在肝硬化组织中呈低水平表达,较正常肝组织中表达明显减少。结论肝硬化肝窦内皮细胞的损伤降低了eNOS的表达。caveolin-1的过表达促进eNOS-caveolin-1复合物的形成,加剧了门静脉高压症的发生。     

Penicillar arterioles of red pulp in residual spleen after subtotal splenectomy due to splenomegaly in cirrhotic patients: a comparative study

Background: Following splenomegaly due to portal hypertension, pathologic characteristics include passive congestion and lymphoplasia. High venous pressure and hemodynamics can result in vascular proliferation and lymphoplasia, and promote splenic microcirculation and functional changes. The aim of this study was to determine the changes in penicillar arterioles (PAs) of red pulp in residual splenic tissue after subtotal splenectomy due to splenomegaly in cirrhotic patients to provide anatomic and physiologic evidence for reserved splenic surgery. Methods: Thirteen patients with splenomegaly due to portal hypertension, who were treated surgically, comprised the splenomegaly group. After 8 years, we obtained another specimen by puncture biopsy from the residual spleen group. We designated patients with splenic trauma as the control group. The morphology of PAs under light microscopy was facilitated by EVG staining and immunohistochemistry for CD34. Semi-thin sections were HE-stained. The ultrastructure of PA endothelial cells was observed under electron microscopy. Results: In the residual spleen group, diffuse distribution, tenuous elastic intima in the arterial wall, and continuity in PA of red pulp were seen under light microscopy. A significantly lower density and average cross-sectional area of PAs were observed in the residual spleen group compared with the splenomegaly and control groups (P < 0.01). A uniform mitochondrial matrix and a decreased number of ruptured cristae in PA endothelial cells were observed under electron microscopy. While there were some beneficial changes (splenic artery flow volume, portal venous diameter, and portal venous flow volume), the platelet and leucocyte counts were markedly increased in residual spleen. Conclusion: Subtotal splenectomy can eliminate the factors which precipitate splenomegaly (portal hypertension), improve the reconstruction of splenic capillaries, correct hypersplenism, and restore normal splenic function.     

小凹蛋白与内皮型一氧化氮合成酶在人肝硬化组织中的表达及意义

目的 检测人肝硬化组织中小凹蛋白(caveolin-1)、内皮型一氧化氮合成酶(eNOS)的细胞定位及蛋白表达水平的变化,探讨caveolin-1的表达对eNOS的影响.方法 免疫组织化学染色检测30例肝硬化患者活检后肝组织和30例肝外伤、肝血管瘤患者正常肝组织中caveolin-1和eNOS的细胞定位.Western印迹检测caveolin-1和eNOS的蛋白表达水平变化.结果 caveolin-1和eNOS均主要分布于肝窦内皮细胞中,caveolin-1在肝硬化组和对照组表达阳性率有差异,分别为87%和40%(P＜0.05).eNOS在肝硬化组和对照组表达阳性率有差异,分别为33%和66%(P＜0.05).caveolin-1在肝硬化组织中表达较正常肝组织中明显增强.eNOS在肝硬化组织中呈低水平表达,较正常肝组织中表达明显减少.结论 肝硬化肝窦内皮细胞的损伤降低了eNOS的表达.caveolin-1的过表达促进eNOS-caveolin-1复合物的形成,加剧了门静脉高压症的发生.