脾切除治疗慢性特发性血小板减少性紫癜13例临床分析

目的:分析脾切除治疗慢性特发性血小板减少性紫癜(CITP)的疗效。方法:对13例CITP患者在皮质激素治疗效果不佳或有皮质激素治疗禁忌、不能耐受等情况下采用脾切除治疗。结果:13例患者接受脾切除治疗6个月后的总有效率92%,1年后总有效率85%,3年总有效率77%。结论:慢性特发性血小板减少性紫癜患者在不能或不愿意继续使用糖皮质激素治疗时,采用脾切除治疗是一种切实可行的方法。     

归脾汤治疗慢性特发性血小板减少性紫癜30例分析

目的分析归脾汤治疗慢性特发性血小板减少性紫癜(chronic idiopathic thrombocytopenic purpura,CITP)的临床疗效。方法60例CITP患者,30例采用归脾汤治疗,其余30例患者纳入对照组。治疗后随访3~6个月,参照疗效评定标准评定疗效。结果中位随访期为5个月。两组患者近期治疗有效率分别为86.6%(中药组)和73.3%(西药组),P0.05,中药组治疗效果较对照组好。结论归脾汤治疗慢性特发性血小板减少性紫癜可明显提高疗效,值得临床深入研究。     

脾切除治疗慢性特发性血小板减少性紫癜

目的观察脾切除治疗慢性特发性血小板减少性紫癜（CITP）患者的疗效。方法对26例CITP患者在皮质激素治疗效果不佳、有皮质激素治疗禁忌、不能耐受皮质激素治疗或其他自身原因拒绝接受皮质激素治疗的情况下采用脾切除治疗。结果26例患者接受脾切除治疗半年后的总有效率88％,1年总有效率81％,3年总有效率70％。结论慢性CITP病人不愿意或不能继续使用糖皮质激素治疗时,采用脾切除治疗是值得推荐的一种方法。     

脾切除治疗特发性血小板减少性紫癜疗效分析

目的寻求特发性血小板减少性紫癜有效的、副作用少的治疗方法。方法对内科治疗疗效欠佳的16例患者行脾切除治疗。结果显效10例,良好3例,有效率81.3%。结论脾切除治疗特发性血小板减少性紫癜疗效好,副作用少。     

脾切除难治性特发性血小板减少型紫癜的临床分析

目的通过分析脾切除对难治性特发性血小板减少性紫癜病例,统计脾切除对难治性特发性血小板减少性紫癜（ITP）的治疗效果及影响因素,寻找术前如何预测判定脾切除的疗效的方法,并分析术后效果差、再用药物治疗的效果。探索难治性特发性血小板减少性紫癜有效的、副作用少的治疗方法。方法对1996年5月-2011年3月在山西医科大学第二附属医院行脾切除术治疗难治性特发性血小板减少型紫癜的62例（其中1例附加副脾摘除术）的年龄、性别、术前有无出血、术前对激素的反应、脾脏是否肿大、术后血小板峰值与脾切除疗效进行统计学分析。结果全部62例中,显效34例,良效13例,进步10例,无效5例,有效率（显效＋良效）为75.8%。性别和脾脏是否肿大与脾切除术疗效无统计学意义,有无出血症状、年龄、术后血小板峰值、骨髓巨核细胞数具有统计学意义,术前对激素的反应、术前血小板计数具有临床用应价值。结论术前对激素的反应、术前血小板计数可作为脾切除术的疗效预测指标。     

脾切除治疗成人特发性血小板减少性紫癜的临床观察

目的:研究脾切除对成人内科治疗无效的特发性血小板减少性紫癜(ITP)的治疗效果。方法:对1990～2000年内科治疗无效的51例成人特发性血小板减少性紫癜患者进行脾切除手术。全组患者术后随访0.5～9年,平均46月。结果:术后血小板1周内恢复正常(≥100×10~9/L)者45例,占88.2％;术后2个月随访,总有效率90.2％。对41例患者进行中远期(0.5～9年)随访,总有效率为80.5％,4例复发,复发率9.75％。结论:术后血小板回升较早和回升幅度较高者预后较好。糖皮质激素治疗的效果不影响脾切除疗效。术前PAIgG检测值对预测脾切除疗效无相关性。选择性脾切除术对内科治疗无效的慢性ITP患者是一种安全和有效的治疗方法。     

霉酚酸酯治疗脾切除无效的特发性血小板减少性紫癜

目的 探讨霉酚酸酯(mycophenol memofeil,MMF)治疗脾切除无效的特发性血小板减少性紫癜(chronic idiopathic thrombocytopenic purpura,CITP)的疗效及不良反应.方法 MMF每日口服1.5-2.0g,至少12周;无效者12周后停药.结果 10患者中6例(60%)有效,3例(30%)完全缓解(CR),2例(20%)部分缓解(PR),1例(10%)轻微缓解(MR).2例出现轻度腹泻.结论 MMF治疗脾切除无效的CITP是安全、有效的.     

不同病因患者脾切除前后血液流变学指标的变化

对９０例不同疾病（外伤性脾破裂３０例、肝硬变脾亢３０例、特发性血小板减少性紫癜３０例）脾切除前后血液流变学指标的变化进行了比较,发现术前肝硬变脾亢和特发性血小板减少性紫癜患者全血粘度和血小板聚集功能明显低于对照组（Ｐ＜０．０５～０．０１）,提示多种因素可导致和加重术前出血症状。术后近期３组脾切除患者和对照组患者血液流变学指标均有升高,是术后高凝期,应予重视。术后远期３组脾切除患者全血粘度仍为高值,血小板聚集功能增强,但导致的原因并不相同。对增高明显者,为防止脾切除后血栓和栓塞形成,应采取针对性的预防和治疗措施。     

干扰素联合长春新碱、泼尼松治疗慢性难治性特发性血小板减少性紫癜

特发性血小板减少性紫癜 (ITP)是指因免疫异常所致的获得性血小板减少症 ,为临床上常见的一种出血性疾病 ,糖皮质激素被认为是治疗ITP的首选药物 ,约有 1/3患者可获得长期疗效 ,10 %～ 30 %的慢性特发性血小板减少性紫癜治疗十分棘手。 1999年 1月— 2 0 0 3年 1月我们采用干扰素与长春新碱、泼尼松治疗慢性难治性特发性血小板减少性紫癜 2 4例 ,现报告如下。1　资料与方法1.1.　一般资料　本组 2 4例慢性难治性特发性血小板减少性紫癜 (CITP)均符合 1986年 12月首届中华血液学会血栓与止血学术会议诊断标准。其中男 3例 ,女 2 1例 ;年…     

小儿慢性特发性血小板减少性紫癜 血小板结合抗体的检测及临床意义

本文对26例小儿慢性特发性血小板减少性紫癜(CITP)进行了血小板结合抗体(PAIgG)检测和观察。以探求PAIgG对小儿CITP的诊断、治疗和预后的关系。     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.