132例老年冠心病患者C-反应蛋白检测在诊断中的意义

目的探讨老年冠心病患者C-反应蛋白检验在诊断中的意义。方法对132例老年CHD患者进行了CRP含量检测。结果老年CHD组中稳定型心绞痛（UA）、不稳定型心绞痛、AMI患者CRP含量分别为（258．3±22．8）mg／L、（314．1±29．6）mg／L、（227．1±23．5）mg／L,正常对照组为（3．56±1．28）mg／L。老年CHD组CRP浓度比对照组明显升高（P〈0．05）。其中不稳定型心绞痛患者CRP水平比UA患者显著增高（P〈0．05）,而UA患者与AMI患者比较亦显著增高（P〈0．05）。本研究结果表明,老年CHD患者CRP浓度较对照组显著增高（P〈0．05）;而不稳定型心绞痛患者CRP浓度较稳定型心绞痛患者显著增高（P〈0．05）。结论可见老年冠心病与炎症有密切的联系。因此,动态检查血中CRP的含量不但有利于协助诊断老年冠心病,并且有助于老年不稳定型心绞痛与急性心肌梗死的鉴别。     

心脑舒通胶囊治疗冠心病心绞痛150例临床分析

目的探讨心脑舒通胶囊对冠心病心绞痛的疗效。方法将150例冠心病心绞痛患者随机分成两组。对照组采取常规疗法,治疗组在常规治疗的基础上加心脑舒通治疗。观察用药前后心绞痛的发作情况、硝酸甘油日消耗量、心电图变化、血脂及血液流变学指标。结果治疗组在减少硝酸甘油用量、缓解心绞痛发作及改善心电图方面优于对照组（P〈0．01）,另治疗组治疗前后血液流变学指标有明显改善（P〈0．05）。结论心脑舒通胶囊可用于治疗冠心病心绞痛。     

格列吡嗪控释片对2型糖尿病患者血管内皮功能的影响

目的　探讨格列吡嗪控释片对2型糖尿病患者血管内皮功能的影响。方法　76例2型糖尿病者,经2周洗脱期后,随机分为两组。一组4 0例应用格列吡嗪控释片;另一组36例应用格列本脲。根据达到目标血糖调整药物剂量,单药未能达标者加用阿卡波糖,治疗期12周。每位患者均采用高分辨率超声显像法,分别于治疗前后各进行一次右肱动脉血管内皮功能检测。结果　格列本脲组治疗前后肱动脉内径基础值、反应性充血及含服硝酸甘油后肱动脉内径变化,均无显著性差异[(3. 70±0 . 5 7)mm对(3 .72±0 . 5 9)mm ,(5 . 4 6±0 .82 ) %对(5 .70±0 .84 ) % ,(2 0 . 5±5 . 0 ) %对(2 0 . 1±5 . 1) % ,P >0 .0 5 ]。格列吡嗪控释片组治疗前后肱动脉内径基础值、含服硝酸甘油后肱动脉内径的变化,也无显著性差异[(3 .72±0 . 6 2 )mm对(3 .73±0 . 6 3)mm ,(19. 8±5. 5 ) %对(19. 9±5 . 8) % ,P >0 . 0 5 ];但反应性充血引起肱动脉内径变化,治疗前后具有非常显著性差异[(5. 6 7±0 .79) %对(9. 4 6±3 .81) % ,P <0 . 0 1]。结论　格列吡嗪控释片可能改善2型糖尿病者的血管内皮功能。     

原发性醛固酮增多症患者与左心室肥厚

目的探讨原发性醛固酮增多症（原醛）及其主要亚型：腺瘤型和增生型的左室肥厚情况。方法入选确诊原醛患者250例。其中142例行分侧肾上腺静脉取血，分为原醛腺瘤组68例，原醛增生组74例，选取同期年龄、性别、24小时平均血压相匹配的原发性高血压（EH）患者246例作为对照，所有入选者记录一般临床资料和生化指标，并行超声心动图检查。结果1）左室舒张末期内径原醛组[（49．6&#177;4．3）mm]高于EH组[（48．3&#177;4．2）mm，P〈0．053，原醛组左室后壁厚度[原醛组（10．5&#177;2．2）mm vs EH组（9．9&#177;1．1）mm]、左室质量（LVM）[原醛组（232．2&#177;75．1）g vs EH组（207．5&#177;46．6）g]、左室质量指数（LVMI）[原醛组（131．9&#177;37．4）g／m^2 vs EH组（118．3&#177;23．7）g／m^2]显著高于EH组（P均〈0．01）。2）在原醛组中LVMI与收缩压及立位血浆醛固酮独立相关。3）1级高血压中原醛组的LVMI高于EH组，但差异无统计学意义（P〉0．05）；2级、3级高血压中，原醛组的LVMI高于EH组（P〈0．05或P〈0．01）。4）左室后壁厚度[原醛组（10．8&#177;3．0）gVSEH组（10．3&#177;1．3）g，P〈0．053；、LVM[原醛组（249．5&#177;81．7）g vs EH组（219．4&#177;67．7）g，P〈0．01]、LVMI[原醛组（139．9&#177;41．0）g／m^2 vs EH组（125．1&#177;32．9），P〈0．01]原醛腺瘤组显著高于原醛增生组。5）左室肥厚在EH组、原醛腺瘤组和增生组的构成比分别为42．7％，63．2％和43．2％，3组之间差异有统计学意义（P=0．009）。结论原醛患者左室肥厚的发病率高于EH患者，其中以原醛腺瘤组更为严重。     

蜂胶对白喉杆菌的抑菌试验

目的探讨河南蜂胶对白喉杆菌的抑菌效果。方法采用琼脂平板扩散法，以白喉杆菌为实验菌种，设置不同pH平板实验组和不同的蜂胶浓度组，每组3次重复，每张滤纸片（直径6ram）加样7μl，记录24h的抑菌效果。结果河南蜂胶在pH5．5、6．0、6．5、7．0、7．5、8．0和8．5不同条件下对白喉杆菌的抑菌环直径（mm）分别为：14．50&#177;0．50、10．83&#177;0．76、10．66&#177;0．29、10．42&#177;1．38、9．92&#177;0．14、9．83&#177;0．29和9．92&#177;0．14。蜂胶浓度从15．50％倍比稀释至0．50％时对白喉杆菌的抑菌环直径（mm）依次为：12．50&#177;1．00、11．50&#177;0．87、11．33&#177;0．76、9．67&#177;0．29、9．17&#177;0．58和7．75&#177;0．25，≤0．25%浓度组和空白对照组均无抑菌环。结论随pH增高，河南蜂胶对白喉杆菌的抑菌活性减弱。随着蜂胶浓度降低，对白喉杆菌的抑菌活力减弱，最低抑菌浓度为0．50％。     

高分辨率超声在检测糖尿病患者早期血管内皮功能中的应用

目的评价高分辨率超声在检测初发糖尿病患者的动脉内-中膜厚度(IMT)和血管内皮功能中的应用价值。方法测定22例老年初发糖尿病患者、142例非老年初发糖尿病患者及同期20例老年健康者和20例非老年健康者的颈动脉、髂动脉、股动脉的内-中膜厚度,肱动脉反应性充血前后及舌下含服硝酸甘油前后内径的变化,并进行统计学分析。结果老年糖尿病组反应性充血时肱动脉内径变化率为(10．03±6．39)％,较老年对照组(15．87±4．79)％下降,两组比较差异有统计学意义(P<0．05);老年糖尿病组各段动脉IMT测值较老年对照组增厚(P<0．05);非老年糖尿病组反应性充血时肱动脉内径变化率为(13．38±5．94)％,较非老年对照组(16．91±5．97)％下降,两组比较差异有统计学意义(P<0．05);硝酸甘油介导的肱动脉内径变化百分率各组间比较,差异无统计学意义(P>0．05)。结论高分辨率超声检查可及早发现糖尿病患者血管内皮功能受损情况,对于糖尿病大血管并发症的早期发现及治疗效果的评价具有应用价值。     

曲美他嗪对稳定型心绞痛血管内皮功能的影响

目的 :探讨曲美他嗪对稳定型心绞痛血管内皮功能的影响。方法 :稳定型心绞痛 6 0例 ,随机分为 2组 ,对照组常规服用硝酸酯类、钙离子拮抗剂、β受体阻滞剂、血小板抑制剂 ;曲美他嗪组在服用以上药物的基础上加用曲美他嗪 （2 0 m g） ,每日 3次 ,服 4周。采用高分辨超声技术检测肱动脉舒张功能 ;测定两组基础状态和治疗后的血浆一氧化氮 （NO）、内皮素 - 1（ET- 1）水平。结果 :1反应性充血引起肱动脉内径变化 ,曲美他嗪组显著增强 （P<0 .0 1）。两组含服硝酸甘油后的血管舒张反应无显著差异 （P>0 .0 5 ）。 2治疗后 ,曲美他嗪组与对照组比较 NO显著升高 ,ET- 1水平下降 ,有非常显著性差异 （P<0 .0 1）。结论 :曲美他嗪对稳定型心绞痛血管内皮功能具有保护作用。     

中老年高尿酸血症对血管内皮功能的影响

目的探讨中老年高尿酸血症对血管内皮功能的影响。方法对100例48-68岁经健康体检无心血管疾病或痛风者(其中50名血尿酸正常对照者,50例高尿酸血症者),应用高分辨率超声显像法检测其肱动脉血管内皮依赖性舒张功能。结果两组的肱动脉内径基础值[分别为(3．8±0．6)mm 和(3．8±0．7)mm]及含服硝酸甘油后肱动脉内径变化百分率[分别为(19±5)％和(19±6)％],差异均无统计学意义,高尿酸血症组反应性充血后肱动脉内径变化的百分率[(12±4)％]较正常对照组[(17±5)％]显著降低(P<0．01)。结论中老年高尿酸血症患者存在血管内皮功能障碍。     

应用动态血糖监测系统评价双相门冬氨酸胰岛素30对老年2型糖尿病患者的疗效

目的应用动态血糖系统（CGMS）观察老年人2型糖尿病（T2DM）患者中性鱼精蛋白锌胰岛素NPH与双相门冬氨酸胰岛素30（BI-Asp30）治疗的疗效和安全性。方法T2DM患者22例，分别接受BIAsp30和NPH治疗12w，治疗结束即时进行72h CGMS观察。结果12w时BI-Asp30组糖化血红蛋白（HbAlC）显著低于NPH组（7．46&#177;0．94％vs 7．90&#177;0．93）。CGMS检查显示，BIAsp30组早餐后（9．3&#177;2．4mmol／L vs 10．3&#177;2．5mmol／L）和晚餐后2h血糖（PG）（9．1&#177;2．2mmol／L vs 10．1&#177;3．1mmol／L）降低更明显，血糖≥10mmol／L时间百分比明显降低（14．5&#177;10．1 vs 20．8&#177;11．4），凌晨3点PG不过低（5．2&#177;0．8mmol／L vs 4．1&#177;1．0mmol／L）。BIAsp30组夜间低血糖发生率（1例次）显著少于NPH组（3例次），夜间血糖≤3．0mmo／L时间百分比亦明显减少（1．93&#177;1．37 vs 5．03&#177;1．33）。结论BIAsp30治疗更接近生理胰岛素分泌模式，能更好地控制餐后PG，减少低血糖发生。     

坎地沙坦加氢氯噻嗪对轻中度高血压的疗效和安全性

目的评价坎地沙坦加氢氯噻嗪（复方坎地沙坦酯片）对原发性高血压的降压疗效和安全性。方法对原发性高血压患者经过2周清洗期后，进入坎地沙坦酯片8mg单药治疗期，对4周后血压未达标者（达标血压为〈140／90mmHg），以随机、双盲双模拟、平行对照、多中心试验方法，分别服复方坎地沙坦酯片（坎地沙坦酯16．0mg／氢氯噻嗪12．5mg）或坎地沙坦酯片16mg单药治疗8周。结果经过2周清洗期，共有392例进入单药治疗期，坎地沙坦酯8mg单药治疗（n=353）2周后，血压下降值（10．2&#177;0．6）／（6．5&#177;5．7）mmHg；4周的下降值为（10．8&#177;10．9）／（6．6&#177;6．1）mmHg，4周血压达标率为15．3％（54／353例），组内比较，差异有非常显著意义（P〈0．01）。在以后8周随机双盲对照期，复方坎地沙坦酯组（134例）与坎地沙坦酯单药组（142例）4周时的血压分别下降为（9．3&#177;11．7）／（8．7&#177;6．2）和（5．4&#177;10．8）／（5．4&#177;6．1）mmHg；8周时为（11．1&#177;11．2）／（10．7&#177;6．6）和（7．8&#177;11．1）／（7．8&#177;6．3）mmHg（组内及组间比较P〈O．01）。随机期4周时联合治疗组血压达标率分别为64．9％（87／134），单药组为39．4％（56／142），8周时分别为79．9％（107／134）和51．4％（73／142）（组间比较P〈0．01）。不良反应事件，在单药治疗期为6．2％（22／353），复方坎地沙坦组为2．9％（4／134），坎地沙坦酯组2．8％（4／142），组间比较差异无统计学意义（P〉0．05）。结论复方坎地沙坦酯片较之单用坎地沙坦对原发性高血压患者有较好的降压效果和耐受性。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.